Intussusception after Rotavirus Vaccine Introduction in India.

BACKGROUND: A three-dose, oral rotavirus vaccine (Rotavac) was introduced in the universal immunization program in India in 2016. A prelicensure trial involving 6799 infants was not large enough to detect a small increased risk of intussusception. Postmarketing surveillance data would be useful in assessing whether the risk of intussusception would be similar to the risk seen with different rotavirus vaccines used in other countries. METHODS: We conducted a multicenter, hospital-based, active surveillance study at 27 hospitals in India. Infants meeting the Brighton level 1 criteria of radiologic or surgical confirmation of intussusception were enrolled, and rotavirus vaccination was ascertained by means of vaccination records. The relative incidence (incidence during the risk window vs. all other times) of intussusception among infants 28 to 365 days of age within risk windows of 1 to 7 days, 8 to 21 days, and 1 to 21 days after vaccination was evaluated by means of a self-controlled case-series analysis. For a subgroup of patients, a matched case-control analysis was performed, with matching for age, sex, and location. RESULTS: From April 2016 through June 2019, a total of 970 infants with intussusception were enrolled, and 589 infants who were 28 to 365 days of age were included in the self-controlled case-series analysis. The relative incidence of intussusception after the first dose was 0.83 (95% confidence interval [CI], 0.00 to 3.00) in the 1-to-7-day risk window and 0.35 (95% CI, 0.00 to 1.09) in the 8-to-21-day risk window. Similar results were observed after the second dose (relative incidence, 0.86 [95% CI, 0.20 to 2.15] and 1.23 [95% CI, 0.60 to 2.10] in the respective risk windows) and after the third dose (relative incidence, 1.65 [95% CI, 0.82 to 2.64] and 1.08 [95% CI, 0.69 to 1.73], respectively). No increase in intussusception risk was found in the case-control analysis. CONCLUSIONS: The rotavirus vaccine produced in India that we evaluated was not associated with intussusception in Indian infants. (Funded by the Bill and Melinda Gates Foundation and others.).

Congenital pouch colon: A comparative study between two modalities of management.

BACKGROUND: Congenital pouch colon (CPC) is an unusual anomaly with an unique geographical distribution. The aim of this study was to find out the incidence of CPC among anorectal malformation (ARM) cases in our institute and to compare the outcome between conventional three-staged surgery versus two-staged management approach. MATERIALS AND METHODS: This study was conducted in the department of pediatric surgery over a period of 7 years from 1st April 2013 to 31st March 2020. RESULTS: Out of 754 cases of ARMs, 43 cases of CPC were detected. The incidence of pouch colon among patients with high ARMs was found to be 7.6% with a male predominance (M:F = 4.4:1). The anomaly was diagnosed in 72% of our patients preoperatively and Type IV variety was the most common intra-operative finding. The survival after initial hospitalisation was 82% and 88% in three-stage and two-stage surgical procedures, respectively. However, the final clinical outcome after the completion of all stages of surgery and follow-up was better in two-staged approach (54% vs. 47%). CONCLUSION: Although, CPC is a rare anomaly, the incidence in our institute is 7.6% among high ARM cases. As compared to conventional three-staged surgery, the two-staged management approach has the advantage of better survival and decreased morbidity.

Congenital absence of jejunum and ileum: A case report and literature review.

We report an extremely rare finding 'congenital absence of jejunum and ileum' during explorative laparotomy of a 16-day-old female neonate. The dilated duodenum was terminating blindly, and the next segment of intestine was a peanut-sized cecum followed by microcolon. On an extensive survey of literature this type of intestinal atresia is not reported in living babies.

Apple-Peel Intestinal Atresia Along with Isolated Jejunal Duplication Cyst in a Newborn - An Extremely Rare Case Report and Brief Review.

Apple-peel type of intestinal atresia and non-communicating jejunal duplication cyst are rare congenital malformations. The coexistence is not reported in English literature. A five-day-old female neonate having intestinal obstruction and was found to have both the anomalies during laparotomy and was successfully managed. Being an extremely uncommon association between two congenital anomalies of gastrointestinal tract and surgical emergencies, it is reported with review of relevant literature.

Pheochromocytoma in a Child without Hypertension: A Contribution to the "Rule of 10s".

Pheochromocytoma (PCC) is a neuroendocrine tumor originating from chromaffin tissue in adrenal medulla. Its diagnosis and treatment are well defined in adults, but experience in children is limited. Children constitute only 10% of reported cases, the average age at presentation being 11 years. The most common presentation is sustained hypertension, which is absent in only 10% of children. We managed a 14-month-old female child with PCC, but she was not hypertensive. We report two unusual features, in this case, an extremely young age at presentation and a childhood case of nonhypertensive PCC contributing for "rule of 10s."

Duplication cyst of the cecum: A case report.

Duplication of alimentary tract is one of the rare congenital anomalies. A case of duplication cyst of the cecum, presented in the 3rd month of life, as intestinal obstruction. Excision of the cyst along with cecum and appendix was done. The child had an uneventful postoperative recovery following ileoascending anastomosis.