Role of Interstitial Cells of Cajal in Congenital Ureteropelvic Junction Obstruction.

BACKGROUND: Although congenital ureteropelvic junction (UPJ) obstruction is the most common cause of neonatal hydronephrosis, aetiopathogenesis is still inconclusive. Recently, the paucity of interstitial cells of Cajal (ICC) at the narrow adynamic part of UPJ has been implicated as a causative factor. MATERIALS AND METHODS: This prospective study was conducted between October 2019 and March 2022 to find out the density of ICC by the immunohistochemical method using CD117 (c-kit) antibody, in resected segments of UPJ in obstruction patients and in renal tumour patients as control. ICC/high power field (hpf) was also studied from the margins of the resected segment in the obstruction group. The pre-operative and post-operative sonographic and renal scintigraphic features were compared. RESULTS: The median age of patients in the study group (n = 25) was 36 months and in the control group was 39 months. The mean ICC/hpf at the stenotic part of UPJ in the study group was 3.56 ± 1.26 and in the control group was 12.56 ± 1.89 (P = 0.0001). ICC density from the proximal and distal margins of the resected segment was 11.12 ± 2.12 and 11.68 ± 1.62, respectively (P < 0.001). The post-operative antero-posterior diameter of the renal pelvis and differential renal function showed significant improvement in comparison to the pre-operative value (P = 0.0045 and 0.0005, respectively). CONCLUSIONS: The significant decrease in the density of ICC at the stenotic part of UPJ compared to controls suggests a pacemaker role of these cells in ureteral peristalsis and the aetiopathogenesis of UPJ obstruction. Histopathological analysis of ICC should not only be limited to the stenotic part of UPJ but also should focus on the anastomosed ends of the ureter, which reflects post-pyeloplasty outcome.

Management outcomes of mesenteric cysts in paediatric age group.

BACKGROUND: Mesenteric cysts are rare intra-abdominal masses and high index of suspicion is required to clinically suspect this pathology and make a definitive diagnosis. They are most commonly located in the ileal mesentery but can be located anywhere along the gastrointestinal tract mesentery and may extend into the retroperitoneum. The rarity of these anomalies and diversity of clinical picture pose challenges in the diagnosis and operative management. The objective of this study is to determine the demographic pattern, clinicopathological diagnosis and management outcome of mesenteric cysts in our hospital. MATERIALS AND METHODS: This retrospective study was conducted on children operated for mesenteric cysts from October 2013 to September 2020. Statistical analysis was performed using Open Epi Version 3.01. RESULTS: Out of 32 children with a diagnosis of mesenteric cyst, 78% were below 5 years of age. Small intestine was affected in 26 cases and large bowel mesentery was the site of origin in six cases. Complete excision of mesenteric cyst was possible in all cases. Bowel resection was required in ten cases (31%) to enable complete excision. Bowel resection was required more often in children operated on emergency than those with elective surgery, and is statistically significant (P = 0.04; confidence interval: 0.05-0.96, odds ratio: 0.23). An uncommon co-existence with ileal atresia and detection of rare chylolymphatic cyst in another infant were also remarkable findings. Histopathology proved the diagnosis in all cases. There was no mortality or recurrence during hospitalisation and follow-up, which ranged from 3 months to 3 years. CONCLUSIONS: Mesenteric cysts present with diverse clinical features and children below 5 years of age are most commonly affected. Complete surgical excision is the optimal treatment and may require bowel resection in significant number of cases, especially those operated during emergency. Histopathology is the gold standard for diagnosis.

Eastern India Collaboration on Multisystem Inflammatory Syndrome in Children (EICOMISC): A Multicenter Observational Study of 134 Cases.

Background: Few single center studies from resource-poor settings have reported about the epidemiology, clinical feature and outcome of multisystem inflammatory syndrome in children (MIS-C). However, larger data from multi-center studies on the same is lacking including from Indian setting. Methods: This retrospective collaborative study constituted of data collected on MIS-C from five tertiary care teaching hospitals from Eastern India. Children ≤ 15 years of age with MIS-C as per the WHO criteria were included. Primary outcome was mortality. Results: A total of 134 MIS-C cases were included (median age, 84 months; males constituted 66.7%). Fever was a universal finding. Rash was present in 40%, and conjunctivitis in 71% cases. Gastro-intestinal and respiratory symptoms were observed in 50.7% and 39.6% cases, respectively. Co-morbidity was present in 23.9% cases. Shock at admission was noted in 35%, and 27.38% required mechanical ventilation. Fifteen (11.2%) children died. The coronary abnormalities got normalized during follow-up in all except in one child. Initial choice of immunomodulation had no effect on the outcomes. Presence of underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were the factors significantly associated an increased mortality. Conclusions: MIS-C has myriad of manifestations. Underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were associated with an increased mortality. No difference in outcome was noted with either steroid or IVIg or both. Coronary artery abnormalities resolved in nearly all cases.

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.

Colocolic Intussusception in a Child with Pathologic Lead Point Along with Intestinal Malrotation-A Rare Case Report and Brief Review.

Intestinal obstruction in children is frequently caused by intussusception and intestinal malrotation and when these two conditions co-exist, it is called Waugh's syndrome. Intussusception cases in children are mostly ileocolic, whereas, the colocolic variety is a rare entity and very few cases have been reported in literature. In all the reported cases of Waugh's syndrome, the intussusceptions were ileocolic type except one case, where colocolic type was mentioned with lymphangoima as Pathological Lead Point (PLP). We report a seven-year-old child of colocolic intussusception with juvenile polyp being the PLP along with intestional malrotation. It is an extremely rare association which has not been reported previously.

Association of CD34+ and CD90+ Stem Cells of Cord Blood with Neonatal Factors: A Cross-sectional Study.

OBJECTIVE: To characterize the primitive stem cell content of cord blood with regard to neonatal parameters. METHODS: In this cross-sectional study, CD34+ and CD90+ cells content were enumerated by flow-cytometry method. Their associations with various neonatal parameters like birth weight, gender, gestational age and mode of delivery were analyzed by univariate analysis. Multivariable linear regression model was then developed to further explain the effect of neonatal factors on these primitive cell counts. RESULTS: From a total of 106 recruited subjects, gender of the neonate did not have any influence on the expression of these proteins (CD34 and CD90) of cord blood stem cells or progenitors. Multi variable linear regression analysis using CD34+ and CD90+ cell counts as dependent variables revealed that birth weight and the mode of delivery were significant predictors of these cell counts. CONCLUSIONS: The present study suggests that birth weight and mode of delivery of the neonates influences cord blood stem cell yield.

Using the Mercy Method for Weight Estimation in Indian Children.

This study was designed to compare the performance of a new weight estimation strategy (Mercy Method) with 12 existing weight estimation methods (APLS, Best Guess, Broselow, Leffler, Luscombe-Owens, Nelson, Shann, Theron, Traub-Johnson, Traub-Kichen) in children from India. Otherwise healthy children, 2 months to 16 years, were enrolled and weight, height, humeral length (HL), and mid-upper arm circumference (MUAC) were obtained by trained raters. Weight estimation was performed as described for each method. Predicted weights were regressed against actual weights and the slope, intercept, and Pearson correlation coefficient estimated. Agreement between estimated weight and actual weight was determined using Bland-Altman plots with log-transformation. Predictive performance of each method was assessed using mean error (ME), mean percentage error (MPE), and root mean square error (RMSE). Three hundred seventy-five children (7.5 ± 4.3 years, 22.1 ± 12.3 kg, 116.2 ± 26.3 cm) participated in this study. The Mercy Method (MM) offered the best correlation between actual and estimated weight when compared with the other methods (r (2) = .967 vs .517-.844). The MM also demonstrated the lowest ME, MPE, and RMSE. Finally, the MM estimated weight within 20% of actual for nearly all children (96%) as opposed to the other methods for which these values ranged from 14% to 63%. The MM performed extremely well in Indian children with performance characteristics comparable to those observed for US children in whom the method was developed. It appears that the MM can be used in Indian children without modification, extending the utility of this weight estimation strategy beyond Western populations.