A Cross-Sectional Study of Resident Training in Robotic Surgery in India.

Background The widespread implementation of robotic surgery in the Indian subcontinent has received mixed reactions from residents and mentors alike. To date, however, no study has documented the perception of Indian surgical trainees on the effect of robotic surgery on surgical training. Therefore, we conducted a questionnaire-based study on Indian surgical residents to assess their views about robotic surgery and the effect, they believe, it might have on resident training. Materials and methods Questionnaires were distributed to 300 surgical residents from programs that do not have surgical robots. All other residents, faculty, medical students, and interns were excluded from the study. The responses were collected and analyzed using appropriate statistical methods. Results Overall, 210 surgical residents responded to the survey. A majority of them (57.72%) reported low levels of knowledge regarding robotic surgery. While 88.10% of the study participants reported that the use of robotic surgery will continue to rise in India, an equal proportion (88%) believed that procuring a robot in their program will impair their training in open and laparoscopic surgeries. Conclusions The introduction of robotic surgery into surgical residency programs is seen, by most residents, as a threat to training in traditional surgical methods. This calls for the effective incorporation of robotic training into residency training with equal distribution of resident training cases in programs across the country.

Association of digital media exposure and addiction with child development and behavior: A cross-sectional study.

BACKGROUND: Media exposure which was traditionally restricted only to television has now broadened to include various handheld devices and constant internet access. Although high quality educational and interactive screen time is beneficial, excessive addiction and early introduction of such media use has various deleterious consequences. AIM: To estimate the exposure of media among Indian children and its influence on early child development and behaviour. SETTINGS AND DESIGN: A tertiary care hospital based cross-sectional study. MATERIALS AND METHODS: We included 613 children between 18 months and 12 years who visited the paediatric out-patient department for a well or a sick visit. Their media exposure was extensively analysed along with Problematic Media Use Measure Short Form (PMUM-SF). They were screened for behaviour problems using the Child Behaviour Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ) accordingly. Those under five years were also subjected to a screening using Ages and Stages Questionnaire (ASQ3). RESULTS: The most common gadget used was television followed immediately by smartphones. The average daily screen time was 2.11 hours, Mean+SD=2.11+1.53, 95% CI 2.11+ 0.12, found in (40.1%) of the study population. The prevalence of screen addiction was 28.1%, majority being boys. Increased screen time and media addiction were significantly associated with concerns in communication, problem-solving and personal-social domains, as well as conduct, hyperactivity and pervasive developmental disorder (PDD) problems. CONCLUSION: We conclude that media exposure among children should be enquired as a routine. This helps to curtail unhealthy digital media practices at the earliest to ensure a digital safe environment for children.

Effectiveness of Bedside Clinical Screening Tools in Predicting Short-Term Neurodevelopmental Delay Among Very-Low-Birth-Weight Pre-terms: A Prospective Observational Study.

BACKGROUND: Pre-term births are associated with increased risk of various morbidities, especially neurological. Early detection and early intervention to prevent these morbidities will have immediate and long-term benefits to the individuals and society at large. However, the screening and assessment tools, including both clinical and radiological, are not uniformly available in resource-poor settings. The present study was carried out to evaluate the validity of the clinical screening tools for detecting neurodevelopmental delay among very-low-birth-weight (VLBW) pre-term babies. METHODS: This prospective observational study was undertaken in the child development unit of a tertiary care hospital from July 2015 to October 2017. All pre-term VLBW neonates admitted in level III Neonatal Intensive Care within the first 24 hours of life were included in the study. They were subjected to Hammersmith Neonatal Neurological Examination (HNNE) and magnetic resonance imaging (MRI) of brain at term-equivalent age. Subsequently, the same group was followed up with Amiel-Tison (AT) angles, Child Development Centre (CDC) grading for sitting developed at Trivandrum, Kerala, India, and Denver Development Screening Test (DDST-II gross motor) at eight months corrected age, and their outcomes were analyzed. RESULTS: 17.9% of the ex-preterm were abnormal as per HNNE evaluation at term-corrected age. At short-term follow-up screening, 13.8% were found to be abnormal based on AT angles, while 35.2% were found to be abnormal as per CDC grading and 30.4% were found to have risk for delay as per DDST-II (gross motor). A high level of sensitivity (93.6%) and positive predictive value (91.2%) was observed for HNNE at term equivalent with MRI brain assessment considered as gold standard. Among the follow-up screening tools, CDC grading for sitting, AT angles, and DDST-II had high sensitivity (>85%). CONCLUSION: The combination of HNNE along with radiological assessment at term-corrected age can be considered as appropriate for predicting long-term neurodevelopmental outcome in VLBW pre-term infants. During follow-up, simple tools like CDC grading for motor milestones, AT angles, and DDST-II may be utilized if facilities for standard assessment are not available as in resource-poor settings.

Specific Learning Disability Unmasked by Psychophysiological Insomnia.

Sleep is essential for good cognition and academic performance. Children with deficits in learning and cognition thus have various sleep disturbances. Learning disabilities in dyslexia are exaggerated with associated sleep problems which also impact the daily routine. Although it is essential to rule out organic etiologies in insomnia, it should also be borne in mind to probe the child's functional performance in school. Psychophysiological insomnia should be considered in perpetuating stressful conditions. Any scholastic difficulty in a child has to be seriously evaluated to estimate the underlying condition. We report a rare case of psychophysiological insomnia diagnosed in a child with specific learning disability. Awareness of the associated sleep difficulties in dyslexia helps in improved assessment and treatment of such children.

The Spectrum of Sleep Disorders Among Children: A Cross-sectional Study at a South Indian Tertiary Care Hospital.

Introduction Sleep problems during infancy and early childhood are fairly common and rarely recognized in pediatric practice. These are mostly related to the initiation and maintenance of night-time sleep. Understanding sleep patterns and disorders associated with sleep is challenging, especially in the pediatric age group. This study was done to estimate the magnitude of sleep disorders in children and to evaluate the associated risk factors. Methods This cross-sectional study was carried out among 450 children visiting the pediatric outpatient department of Sri Ramachandra Institute of Higher Education and Research, Chennai, India between November 2018 and June 2019. Children with chronic illnesses and a history of physical or mental trauma in the past six months were excluded. The Sleep Disturbance Scale for Children (SDSC) was used to gather information regarding sleep disorders. Results It was observed that a majority of the participants (72.2%) slept 9-11 hours per day. Among 46.2% of the participants, the time lag between bedtime and sleep time was less than 15 minutes. Overall, sleep problems were present in 34% of the participants. History of sleep problems in infancy, absence of siblings, and parental presence while sleeping emerged as statistically significant risk factors for childhood sleep disorders (p: <0.05). Conclusion We believe our study provides a basis for exploring the pattern and problems associated with sleep behavior among children. There is a need for setting up routine screening measures in pediatric outpatient departments to facilitate early detection of sleep disorders in order to avoid complications.

Primary Renal Angiosarcoma Mimicking Renal Cell Carcinoma: A Case Report.

Primary renal angiosarcoma is an exceedingly rare malignancy of the kidney. It usually presents in the elderly with metastatic disease and dismal prognosis. Treatment protocols are not standardized for this very rare renal malignancy. We report the case of a young man who was incidentally diagnosed with primary renal angiosarcoma. Preoperative imaging was suggestive of renal cell carcinoma; however, postoperative histopathological examination confirmed it to be an angiosarcoma. The patient was treated with surgical excision followed by adjuvant chemotherapy and is doing well at one-year follow-up.

Single Session Endoscopic Removal of Bilateral Ureteric Stents Retained for Three Decades: A Case Report.

Forgotten ureteric stents are a devastating complication, which may require a multistage approach necessitating repeated surgeries and may even require removal of the entire renal unit. We report a 59-year-old woman with heavily encrusted bilateral ureteric stents forgotten for 32 years. Successful single-stage endoscopic removal reduced the morbidity and healthcare-related costs. This case report represents the longest indwelling duration of forgotten ureteric stents reported in the literature.

Atypical Presentation of Renal Leiomyosarcoma: A Case Report.

Primary renal sarcomas are rare comprising from 0.8 to 2.7% of adult renal tumours. They cannot be distinguished clinically or radiologically from the more common renal cell carcinomas. Leiomyosarcoma is the most common histological subtype accounting for around 50-60% of renal sarcomas. Leiomyosarcomas arise from the renal capsule, renal vein or the renal pelvis. They present with nonspecific clinical symptoms and signs and usually have a dismal outcome. Rarely atypical presentations such as acute tumour rupture and hematuria are encountered. We report a 27-year-old woman who presented with malignant hypertension. The hypertension was controlled emergently with antihypertensive agents. In view of the young age, a thorough workup was conducted to identify the cause of hypertension. Imaging studies revealed a solid enhancing renal tumour compressing the renal vasculature. As the staging workup did not reveal any evidence of metastases, the patient underwent right-sided open radical nephrectomy after adequate control of hypertension. The histological examination uncovered the renal tumour to be a leiomyosarcoma. Postoperative period was uneventful and she was doing well on one year follow up. Surprisingly the blood pressure normalised postoperatively and the patient was weaned off of her antihypertensive medications. This case is presented to highlight the atypical acute presentation of primary renal leiomyosarcoma with relatively good prognosis. Timely diagnosis and meticulous surgical resection improved the prognosis of this aggressive renal malignancy.

Study of Knowledge, Attitude, and Practice of Organ Donation Among Medical Students in a Tertiary Care Centre in South India.

Introduction The deceased donor renal transplantation (DDRT) program in India has seen its ups and downs. The Indian state of Tamilnadu runs a successful DDRT program. Future doctors play an important role in continuing with this success and hence educating them on organ donation is of paramount importance. Methods We conducted a cross-sectional questionnaire-based study from June 2015 to December 2017 among 480 medical students to analyse their knowledge, attitude and practice regarding organ donation. The validated questionnaire sheets were distributed during lecture hours and completed sheets were analysed. Results Of the 480 participants, 425 completed the questionnaire which is a response rate of 88.5%. Knowledge scores were uniformly low among all four batches of students (p=0.001). The first and third-year students scored better in practice (p=0.001) and attitude (p=0.001) domains. Females outnumbered males by scoring high in all three domains. Conclusion The poor knowledge score among all the batches of medical students is alarming. This implies the need for urgent changes in the medical curriculum to better educate future doctors of the country. Durable changes in practice can be brought about by changing the attitude of medical students.

Synchronous Triple Malignancies in an Indian Albino: A Case Report.

Oculocutaneous albinism (OCA) is a heterogenous disorder of skin pigmentation characterized by hypopigmentation of the skin, hair, and eyes. The absence of melanin predisposes these individuals to ultraviolet rays induced malignancies. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in OCA have been rarely reported. Malignant melanoma (MM) of the skin is also very rarely reported. Synchronous BCC, SCC, and MM are exceedingly rare. We report one such case managed successfully with surgical treatment. All the three malignancies were localized cancers and hence the outcome was good. The importance of regular follow up and periodic self-examination in such predisposed individuals are highlighted.