Awareness of Medical Research among the Resident Doctors in a Tertiary Care Hospital in India.

Aim: The aim of this study was to study the awareness of medical research (MR) among resident doctors in a tertiary care hospital. Materials and Methods: This is a descriptive and cross-sectional study conducted for 30 days among the residents of paraclinical, surgical, and nonsurgical specialties, based on a customized self-prepared questionnaire. Convenience sampling was done. Undergraduates, interns, and faculty members were excluded from the study. Scoring was given from 1 to 10 based on their responses to the ten knowledge-based questions in the questionnaire. Data regarding the publication of research articles if any, obstacles in conducting research, and suggestions to improve the research awareness were recorded. Descriptive analysis of the data was done. Based on the scoring, they were divided into three groups: below average if the score is <5, average if the score is 5-7, and above average if the score is 8-10. Results: A total of 364 resident doctors were included in the study. They were divided into three groups which include paraclinical (n = 56, 15%), surgical (n = 132, 36%), and nonsurgical branches (n = 176, 48%). Scores for the three levels, i.e., below average, average, and above average were 0, 39% (n = 140), and 61% (n = 224), respectively. Forty-eight percent of participants had a publication. Obstacles for conducting the research included lack of time (55%), lack of interest (29%), lack of guidance (35%), and lack of material and teaching (45%). The majority (n = 300, 82%) suggested that conducting more interactive sessions or teaching programs may help in improving the awareness on research. Conclusions: Most of the resident doctors had a fair knowledge of MR but its application into practice was limited. Including research as a part of the medical curriculum, conducting educational programs or conferences oriented on research may improve the awareness about research.

Perioperative Course of COVID-19 in Pediatric Patients Undergoing Emergency Surgeries.

Objective: Adults with COVID-19 infection undergoing surgery have an increased risk of complications and mortality. However, literature mentioning the perioperative course and outcome of children with COVID-19 infection undergoing emergency surgery is still lacking. Therefore, we planned this study to observe the need for postoperative ventilation, oxygen requirements, and postoperative mortality in pediatric patients with COVID-19 infection scheduled for emergency surgery. Methods: After ethical committee approval, all the COVID-19-infected pediatric patients who underwent an emergency surgery from April 2020 to May 2021 were included. Data collected included details of COVID-19 disease, American Society of Anesthesiology (ASA) grading, comorbidities, perioperative details such as tachycardia or bradycardia, any oxygen desaturation (SpO2<90), need for postoperative oxygen therapy, postoperative ventilation, and recovery/death. Results: A total of 22 COVID-19-infected pediatric patients underwent emergency surgery in the study period. Fourteen (63.6%) were asymptomatic at the time of admission. Nineteen patients (86.4%) belonged to ASA grade IE and three (13.6%) patients belonged to ASA grade III E. Three patients (13.6%) had comorbidities. Only one patient had hypotension and tachycardia intraoperatively. The same patient needed postoperative ventilation and succumbed. Conclusion: Our study shows that pediatric surgical patients with COVID-19 infection do not exhibit an increased need for oxygen or postoperative ventilation, postoperative pulmonary complications, or high mortality unless there is associated comorbidity.

Anorectal Malformations in Male Monozygotic Twins and Review of Literature.

Anorectal malformations (ARMs) are one of the common congenital gastrointestinal malformations with a prevalence of 0.2-0.6/1000 live births. There are only a few reported cases of familial ARMs in literature suggesting different patterns of inheritance. Among them, isolated ARMs in monozygotic twins are quite rare with significant male preponderance. Most of these ARMs are either of intermediate or low anomaly type. We reported two pairs of male monozygotic isolated ARMs from a tertiary care hospital in India and reviewed the literature in details adding to the total of nine pairs of twins till date.

Influence of Parental Awareness Drive on Preoperative Fasting Compliance in Pediatric Day Care Surgery.

Context: Optimum preoperative fasting is imperative for the prevention of aspiration in pediatric patients. The current guidelines advocate 2-4-6 rule for the same. However, direct supervision is lacking in large volume centers. Aims: Thus, we aimed to determine the fasting compliance of children preoperatively and to ascertain whether parents understood the significance and purpose of optimum fasting. Materials and Methods: Design - A prospective questionnaire-based study regarding preoperative fasting was performed in pediatric patients aged 1-10 years scheduled for "day care surgery" or "same day admission surgery" over 12 weeks. Thereafter, parental awareness drive was carried out, and a re-audit was performed with a questionnaire in the next cohort of patients. Results: The number of patients in the pre and postcounseling groups were 98 and 99. Thirteen percent of the patients were optimally fasted for solids initially. Re-audit confirmed compliance increased to 46%. Patients fasting adequately (2-3 h) for clear fluids increased from 22.4% to 51.5% postcounseling. The number for optimally breast-fed children increased postaudit (23.1%-39.1%). Consequent to the drive, parental awareness increased and 49.5% parents knew that only plain water was permitted during fasting. Number of parents considering preoperative fasting important increased from 39.8% to 79.7%. Initially, 27.6% of the parents did not know the reason for fasting, which reduced to 3% postaudit. Conclusion: Parents are misinformed and ignorant about optimum preoperative fasting. Adequate education and awareness to improve their knowledge was associated with increased compliance for optimal fasting.

An Analysis of Safety and Efficacy of Day-care Surgery in Children in a Tertiary Care Hospital in India.

BACKGROUND: Advances in surgery and anesthesia have paved the way for the establishment of day-care surgery (DCS). Observations that children achieve better convalescence in the home environment along with significant economic advantages have led to this paradigm shift in clinical practice. AIMS AND OBJECTIVES: This study is aimed to evaluate the feasibility of performing various surgical procedures on day-care basis and assess parental satisfaction with DCS in children. MATERIALS AND METHODS: In this prospective observational study, all children >3 months of age undergoing various elective surgical procedures as day-care cases in our institution were enrolled. Types of operations, complications, including any unplanned admissions and parental satisfaction, were recorded. RESULTS: Between December 2015 and December 2018, a total of 654 day-care surgeries were performed in our institution by pediatric surgeons. The mean age was 5.5 years with M: F 5.5:1. Thirty different surgical procedures were successfully performed as DCS, the common procedures being inguinal herniotomy (31.5%), and orchidopexy (14.3%). Unplanned admissions were recorded in 2.29% (15/654) patients (scrotal edema-5, postoperative pain-8, and a long recovery from anesthesia-2). No major complications occurred; two minor complications during follow-up were superficial wound infection and drug reaction. Overall parental satisfaction was very high (100%)-preoperative prolonged fasting period and long waiting time in the preoperative room of afternoon shift patients (7.95% and 8.3%) were the reasons for their discontent. CONCLUSIONS: DCS in children is safe and effective with high parental satisfaction. It can substantially reduce the waiting list for several surgical procedures in children.

An Analysis of the Comparative Efficacy Between a Third-Generation and a Second-Generation Supraglottic Airway Device in Patients Undergoing Laparoscopic Cholecystectomy.

Background and objective Supraglottic airway devices are extensively used nowadays to secure the airway and minimize postoperative airway-related complications. This study aimed to evaluate whether the Baska® mask (BM) provides higher seal pressure and a better first-time insertion compared to the laryngeal mask airway (LMA) ProSeal™ (LMA-P) in adult laparoscopic cholecystectomy. Methodology This prospective, randomized, single-blinded interventional study was performed after obtaining ethical approval from the Institutional Ethics Committee at the Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Sixty adult patients of both genders scheduled for laparoscopic cholecystectomy under general anesthesia were divided into two groups, with 30 patients in each group. Our study observed the number of insertion attempts, time of insertion, oropharyngeal seal pressure (OSP), number of patients requiring manipulation for proper placement of supraglottic airway devices, and ease of insertion. Results There were no significant differences in terms of insertion attempts, ease of insertion, and laryngopharyngeal morbidity between the groups. The mean OSP at five minutes was 31.55 ±2.23 cm H2O, and that at 30 minutes was 35.86 ±3.70 cm H20 in the BM group, while in the LMA-P group, it was 24.17 ±3.74 cm H20 and 25.97 ±3.79 cm H20 respectively (p<0.001). In our study, the trend of OSP continued to increase in the BM group more than in the LMA-P group during surgery. Conclusion The BM provided better OSP than the LMA-P, which was observed throughout the surgery.

Opsoclonus-myoclonus Syndrome with Neuroblastoma in Children and their Anaesthetic Management.

Opsoclonus-myoclonus syndrome (OMS) or the dancing eye syndrome, is a rare inflammatory neurological disorder often with paraneoplastic aetiology. It has an incidence of 1 in 1000,000 population worldwide. Opsoclonus-myoclonus syndrome is associated with 2-3% of patients having neuroblastoma. The authors present 5 cases of OMS in children who had neuroblastoma and underwent surgical resection. The median age was 26 (14-36) months. Male: female ratio was 1:1.5. All the patients had moderate to severe symptoms. Duration of symptoms at presentation varied from 3 days to one and half years. The possibility of OMS should be considered in all children presenting with probable neurological symptoms. Pharmacological therapy combined with surgery results in a good outcome. Balanced anaesthesia with the most commonly used drugs can be safely administered in the patients with opsoclonus-myoclonus syndrome. Key Words: Opsoclonus, Myoclonus, Neuroblastoma, Child, Anaesthesia.

Omphalocele major with absent lower limb.

A newborn delivered by Caesarian section presented with an absent anterior abdominal wall and visible bowel loops and liver. The defect was covered by a thin membrane. The patient had associated absent left lower limb and right foot fusion defect. The patient was haemodynamically stable; general condition was average. No genito-urinary abnormality was detected. The anal opening was present normally, and the patient passed meconium immediately after birth. A diagnosis of omphalocele major with amelia was made. The patient was initially managed by topical application of povidone-iodine for eschar formation and epithelisation of the sac. The patient was discharged after 1 week with advice for regular follow-up.

Intraoral teratoma in a newborn presenting as severe respiratory distress.

A new born female presented to us immediately after birth with mass protruding from the mouth, with severe respiratory distress and was immediately intubated. Antenatal ultrasonography did not reveal any abnormality. On examination, a non-pulsatile, multilobulated, 4 cm×5 cm sized mass of variable consistency was seen originating from the palate with no other associated congenital anomaly. CT showed a large heterogeneous mass arising from the hard palate with few hyperdense calcific areas with no intracranial extension. Mass was excised completely. Histopathological examination showed features of mature teratoma.

A rare case of isolated complete diphallia and review of the literature.

A 3-year-old boy presented with complaints of abnormal genitalia. On examination, there was penile duplication with two completely separate phalluses, unequal in size, one with hypospadias and the other with meatus at the tip of the glans. Voiding cystourethrography revealed a normal sized single bladder but two urethras with no associated vesicoureteral reflux.

Infantile hypertrophic pyloric stenosis in twins.

Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical cause of vomiting, which requires surgery in infant. There is the complete or partial obstruction of pylorus due to hypertrophy of circular muscle of the pylorus leading gastric outlet obstruction. The occurrence of IHPS in dizygotic twins is rarer and the theory of genetic origin alone does not explain it. Recent literature points to the association of bottle feeding in singletons to be a major aetiological factor for this condition. Here, we present a rare case of dizygotic twins who were bottle-fed and were affected with IHPS. We review the literature and focus on the question of whether this condition in twins supports a genetic or environmental origin of IHPS.