Hematological Indices for Identifying Adverse Outcomes in Children Admitted to Pediatric ICUs.

BACKGROUND: The pediatric ICU (PICU) is a specialized area where critically sick children are managed. The mortality rates in PICUs are higher in developing countries as compared to developed nations. Many of these deaths could be prevented if very sick children were identified soon after they arrived at the health facility. Hematological indices like platelet lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) have been frequently used in adults as indicators of mortality. However, their use in the pediatric population is limited due to a lack of validated reference intervals. OBJECTIVE: The objective of the study is to assess the role of hematological indices in identifying adverse outcomes in terms of mortality in children admitted to the PICU. MATERIALS AND METHODS: It is a prospective, observational study done at a tertiary care hospital. All children aged one year to 12 years admitted to the PICU were enrolled in the study. A sample for complete blood count was taken within one hour of admission to the PICU. Children who had received blood products in the last two months, those on chronic medications (>two weeks) that can affect bone marrow cellularity, and known cases of hematological disorders such as megaloblastic anemia, hematological malignancies, immune thrombocytopenia, and aplastic anemia were excluded from the study. PLR, NLR, and platelets to mean platelet volume ratio (PLT/MPV) were determined and compared among the survivors and non-survivors. RESULTS:  Out of 275 enrolled patients, 119 (43.3%) patients expired during the study period. While PLR had high sensitivity and NLR had high specificity (85.71% and 92.31%, respectively) for predicting mortality, none of these parameters had a good area under the curve (AUC) in our study. PLT/MPV of ≥32 had a sensitivity of 39.5% and a specificity of 56.41% for predicting mortality. CONCLUSIONS: Hematological parameters have been used across the world to predict ICU mortality. PLR and NLR are simple hematological biomarkers, easy to calculate, and cost-effective, and ratios are better than individual parameters. More studies and stratified samples are required to evaluate the role of hematological markers in identifying the risk of mortality in children admitted to PICUs.

Primary intrathoracic synovial cell sarcoma requiring radical resection of the chest wall and diaphragm with reconstruction using titanium mesh.

Intrathoracic synovial cell sarcomas are extremely rare tumors with a high rate of recurrence after resection. We report one such case of synovial cell sarcoma arising from the chest wall, which was completely intrathoracic without an external component. The tumor was resected twice and in spite of adjuvant chemo-radiation the tumor recurred. Radical resection of the tumor with reconstruction of the chest wall and diaphragm using titanium mesh and polypropylene mesh respectively was done. A latissimus dorsi flap cover was provided. Titanium mesh is an excellent prosthesis of choice for reconstruction, as it provides stability and better cosmesis of the chest wall. Radical resection can be offered for suitable candidates, with very low morbidity and mortality. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01378-3.

Multiobjective Optimization of Heat-Treated Copper Tool Electrode on EMM Process Using Artificial Bee Colony (ABC) Algorithm.

Electrochemical micromachining (EMM) is a plausible method for manufacturing high accuracy and precision microscale components in a broad range of materials. EMM is commonly utilized to manufacture turbine blades for automobiles and aircrafts. In this present study, the EMM process was performed with a heat-treated copper tool electrode on aluminum 8011 alloy. The process parameters such as voltage, concentration of electrolyte, frequency, and duty factor were varied to analyze the effect of a heat-treated electrode on material removal rate (MRR), overcut, conicity, and circularity. It was observed that high MRR was obtained with lower overcut with an annealed electrode. The better conicity and circularity were obtained with a quenched electrode compared to other heat-treated and untreated tool electrodes. The artificial bee's colony (ABC) algorithm was used to identify the optimum parameters and, finally, the confirmation test was carried out to evaluate the error difference on the machining process. The optimum combination of input process parameters found using TOPSIS and ABC algorithm for the EMM process are voltage (14 V), electrolyte concentration (30 g/L), frequency (60 Hz), and duty cycle (33%) for the annealed tool electrode and voltage (14 V), electrolyte concentration (20 g/L), frequency (70 Hz), and duty cycle (33%) for the quenched tool electrode. It was confirmed that 95% of accurate response values were proven under the optimum parameter combination.

Adrenal Castleman's Disease: Case Report and Review of Literature.

Castleman's disease is a rare lymphoproliferative disorder of poorly understood etiology. It is most commonly located in the mediastinum. Castleman's disease mimicking adrenal neoplasm is a very rare differential diagnosis and unusual presentation. We report a rare suprarenal unicentric hyaline vascular variant of the disease in a 16-year-old boy with atypical symptoms mimicking an adrenal neoplasm.

Usefulness of narrow-band imaging in transurethral resection of bladder tumor: Early experience from a tertiary center in India.

BACKGROUND: The current standard for diagnosis and treatment of urinary bladder cancer is transurethral resection of bladder tumor (TURBT) using white light guidance. Narrow band imaging (NBI) has emerged as a promising method for identifying additional bladder lesions. Various studies have been published to evaluate its sensitivity in identifying new lesions and its impact on decreasing recurrences. In this study, we evaluated our early experience using NBI in TURBTs. AIMS AND OBJECTIVE: The aim of the study is to determine the accuracy of NBI in identifying additional malignant lesions during TURBT. MATERIALS AND METHODS: We retrospectively collected data for all patients who underwent either TURBT or repeat TURBT with white light and NBI from November 2016 to July 2017 at Cancer Institute (WIA). The number of additional lesions identified using NBI was evaluated along with its correlation with the final histopathology. RESULTS: Forty patients were analysed of which 20 underwent TURBT and 20 underwent repeat TURBT. Of these, 36 patients had complete resection of tumour. Additional lesions were detected in 6 patients (14%) by NBI of which 2 (33%) were malignant histology. The additional lesions detected were carcinoma in situ and no patient was upstaged. CONCLUSION: The inclusion of NBI to conventional white light TURBT increases the sensitivity for identifying additional lesions. The limitation of NBI is high false positivity and its availability. Long term follow up studies with larger subset of patients are required to evaluate its role in decreasing recurrences and justification in routine clinical practice.

Multiple adenoid basal cell carcinoma: An uncommon presentation.

Basal cell carcinoma (BCC) is the most common malignant skin tumor which occurs more frequently over the sun exposed parts of body. Its adenoid variant is a rare histological subtype. We report a case of multiple adenoid basal cell carcinomas at unusual sites in a middle-aged male patient.

Long-Term Functional and Oncological Outcomes Following Intersphincteric Resection for Low Rectal Cancers.

Surgery for low rectal cancer often involves a permanent stoma. Intersphincteric resection (ISR) with colo-anal anastomosis is a valuable sphincter sparing surgical procedure that avoids the need for permanent stoma in patients with low rectal cancer. The aim of this study was to analyze the long-term functional and oncological outcomes following ISR. This was a retrospective analysis of patients with low rectal cancer who underwent ISR with colo-anal anastomosis in our institution between 2007 and 2015. All patients had a diversion stoma. Bowel function outcomes were assessed prospectively using Wexner incontinence score, low anterior resection syndrome score (LARS), and the Cancer Institute Quality of Life (QoL) questionnaire. The histological reports were reviewed to assess the oncological adequacy of the surgery. Patterns of recurrence and survival were analyzed in this group of patients. Thirty-three patients who underwent an ISR were eligible for this study. Laparoscopic resection was performed in five patients. All the patients received neoadjuvant chemoradiation except the two who received short course radiation and one who did not receive any neoadjuvant treatment. The median distance from the anal verge to the distal edge of the tumor was 3 cm (range 1.5-5 cm). Distal resection margins and circumferential resection margins were negative in all the patients. The 30-day post-operative mortality rate was 3.03%. In 20 patients with a median follow-up of 48 months, the 3-year overall survival was 95%. One patient had recurrence in the para-aortic nodes. No patient had a local recurrence. Bowel function was assessed in 18 patients who had a minimum stoma free period of 1 year. After a median of 43 months following stoma closure, the median Wexner score was 3.56 (range 0-19), median LARS score was 4.78 (range 0-33), and the mean Cancer Institute QoL score was 151.56 ± 15.741. The QoL was average to very high with an overall acceptable quality of life. In this study, ISR was associated with acceptable long-term functional and oncological outcomes. It can be considered as a safe alternative to a permanent stoma in selected patients with low rectal cancer.