Clinical Profile, Management, and Outcome of Posterior Urethral Valves in Children - Experience from a Tertiary Care Hospital.

Background: Posterior urethral valves (PUV) are the most common obstructive anomaly of the lower urinary tract in children. End-stage renal disease (ESRD) in 17% of the children is due to PUV. The present study helps know the spectrum of the disease, management options, and the outcome in these children. Methods: The present study is a descriptive type of study by review of medical records of all the children presented to the hospital from 2015 to 2019. Profile of PUV includes any abnormality in antenatal ultrasonography (USG), age at presentation, presenting complaints, general condition at the time of presentation, biochemical investigations like serum creatinine and electrolytes at admission, clinical progression during hospital stay and the type of intervention. Outcome variables studied were improvement in the stream and overall well-being of the child, renal function, recurrent urinary tract infections (UTIs). Follow-up period varied from 1 to 6 years. Results: A total of 73 patients were included in the study. The mean age of presentation was 3.4 years. The most common presenting complaints were poor urinary stream and dribbling of urine. Antenatal USG showed abnormality in 23 patients. Renal function was abnormal in 28 patients. Out of 73 patients, 51 underwent endoscopic ablation of valves, 19 underwent vesicostomy, and three patients underwent supravesical diversion. During the follow-up recurrent UTI was observed in 11 patients, 15 patients progressed to chronic kidney disease, and 15% of patients were hypertensive. Mortality in the present study was 4%. Conclusion: PUV includes a spectrum of diseases from mild form to lethal conditions. Early intervention by relieving obstruction may prevent or delay the ESRD; hence, timely intervention is necessary in these children.

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.

Complications and Management of Retained Double-J Stents in Children During the Coronavirus Disease-2019 Pandemic.

Background: Double-J (DJ) stents were commonly used for internal drainage after major reconstructive procedures or in cases of obstruction and ureteral injuries. They should be removed or changed within the stipulated time; otherwise, they can lead to various complications such as stent occlusion, migration, breakage, encrustation, stone formation at either end of the stent, and entanglement of the two stents if bilateral stenting was done. The present study focuses on the complications and the management due to delay in the removal of the DJ stents due to the coronavirus disease-2019 pandemic. Materials and Methods: This is a cross-sectional study over a period of 9 months. Children <12 years were included in the study. The patients' demographic data, indication for DJ stenting, time gap between DJ stenting and removal, complication with delay in DJ stent removal, and its management were recorded. Indwelling duration for >4 months was considered a delay in removal. All patients were followed up for 3 months. Results: A total of 10 patients were included in the study. Encrustation, proximal migration, distal migration, knotting of the stent, and entanglement of the bilateral stents in the bladder were observed. These complications were managed by various endourological procedures such as ureteroscopy, percutaneous nephroscopic, and cystoscopic removal. During follow-up, all patients were symptom-free. Conclusion: Prolonged indwelling stents can cause various complications. Endourological procedures are an essential armamentarium for a pediatric surgeon to manage these complications. Proper patient counseling regarding indwelling stents and maintaining stent registry and sending automatic messages and e-mails to patients may prevent these complications.

Sepsis Screening of Neonatal Abdominal Surgery and Its Outcomes.

Aim: The aim of this study was to evaluate the early indicators of sepsis (sepsis screening) and their statistical correlation with sepsis in neonatal abdominal surgery. Materials and Methods: A prospective observational study was performed on thirty consecutive neonate cases aged between 0 and 28 days with surgical abdomen at the Paediatric Surgery Department, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi. The study duration was 18 months. Septic screening was done in all neonates on day 0, 1, 3, 7, and 14 days of surgery with serum procalcitonin, C-reactive protein, total leukocyte count, immature/total neutrophil ratio, and microerythrocyte sedimentation rate. A septic screening-positive patient (three or more positive parameters out of five) was correlated with sepsis and analysis was done. Results: A total of 30 neonates of abdominal surgical cases were included consequently, out of which 56.7% (n = 17) were male and 43.3% (n = 13) were female. Maximum cases were of congenital diaphragmatic hernia 20% (n = 6) and then anorectal malformation 16.7% (n = 5). About 70% of neonates were sepsis screening positive. Fifty percentage of neonates were diagnosed to have sepsis on the clinical or laboratory findings, so sensitivity and specificity of sepsis screening were 93.33% and 40%, respectively. There was total 30% mortality in this study. Conclusion: Sepsis screening is an early marker of sepsis, which can be used to help in early detection of neonatal surgical sepsis and timely intervention that can lead to decrease mortality and morbidity in neonatal surgery.

Musculoskeletal and Esthetic Complications after Neonatal Thoracotomy: Revisited.

Aim: The aim is to study the complications of neonatal thoracotomy and its preventive measures. Methods: We retrospectively reviewed 53 neonates who underwent thoracotomy from January 2017 to December 2019 for a period of 3 years. Patient demographic data, primary disease for which they underwent thoracotomy, postoperative complications (immediate and delayed) during follow-up were documented. Results: During 3-year period, 53 neonates underwent thoracotomy for various surgical pathologies. The indications were esophageal atresia with tracheoesophageal fistula (n = 49), eventration of diaphragm (n = 3), congenital lobar emphysema of left upper lobe of lung (n = 1). Most of them were right posterolateral thoracotomies (n = 48, 90.56%) and left posterolateral thoracotomy was done in only 5 cases (9.43%). Associated anomalies were seen in 22 cases, such as cardiac (n = 19), renal (n = 4) and gastrointestinal (n = 5). Associated comorbidities seen in 14 cases; preterm (n = 4), low birth weight (n = 13), delayed presentation (n = 6). Early postoperative complications such as pneumonia (34%, n = 18) and wound infection (11.3%, n = 6) were noted. Delayed complications include musculoskeletal abnormalities (n = 19, 35.8%) and esthetic complications such as asymmetry of chest (5.6%). Conclusion: Neonatal thoracotomy is associated with complications such as pneumonia, wound infections, and musculoskeletal abnormalities such as asymmetry of chest and scoliosis. These can be prevented by adequate postoperative pain relief, muscle-sparing thoracotomies, avoiding tight closures, and nerve injuries. Long-term follow-up is required because these complications may manifest later on also. Early detection and institution of physiotherapy may help.

Delayed presentation of anorectal malformations in a tertiary care hospital in India.

AIM: To study delayed presentation of ARMs, management and its effect on surgical and functional complications. METHODS: It is a retrospective study from March 2015 to March 2020. All the patients satisfying the criteria of delayed ARMs, i.e., presenting 7 days after birth were included. Information regarding type of ARM, mode of presentation, time of presentation, associated anomalies, management strategy, postoperative complications and functional outcome was noted. Minimum follow-up period was 6 months. RESULTS: Out of 102 patients with ARM, 44 patients presented late. Among the 44 patients, 9 were males and 35 were females. Associated comorbidities observed are low birth weight (n = 9) and preterm (n = 13). Associated anomalies observed were cardiac (n = 18), renal (n = 8), other gastrointestinal (n = 5) and skeletal (n = 1). (1) Male: rectourethral fistula-2 (staged repair), anal stenosis-3 (anoplasty) and anocutaneous fistula-4 (anoplasty). (2) Female: vestibular fistula: 15 (6 primary definitive surgery + 9 staged repair), ectopic anus: 3 (staged repair), anal stenosis: 2 (anoplasty), urogenital sinus: 4 (staged repair), H-type ARM: 8 (staged repair) and persistent cloaca: 3 (staged repair). Primary repair was done in 15 patients (34%), and staged repair was done in 29 patients (65.9%). Anoplasty was done in 9 patients, ASARP (modified tsuchida's procedure) in 8 patients and PSARP in 27 patients. Postoperative complications observed were constipation (n = 21, 47.7%), fecal incontinence (n = 12, 27.27%) with perianal excoriation in 2 patients, anal stenosis (n = 3, 6.8%) and rectal mucosal prolapse (n = 2, 4.5%) CONCLUSION: Delayed presentation of ARMs is not uncommon and is more common in females. Management is almost similar to those who present early. Those who present with chronic constipation and megarectum require staged repair. Complications were more frequent with delayed presentation. Hence, every newborn should have careful examination of perineum and screened for ARM to avoid possible morbidity and mortality.

Spectrum of paediatric blunt abdominal trauma in a tertiary care hospital in India.

Aim: To study the profile of paediatric blunt abdominal trauma and to assess the correlation of grade of injury with the outcome. Materials and Methods: It is a prospective observational study from January 2015 to December 2020. Children below 12 years with blunt abdominal trauma were included. Patient demographic data, treatment given and the final outcome were recorded. All patients were followed up for a minimum of 6 months to maximum 5 years. Results: A total of 68 patients were included in the study. Fall from height was the most common mode of injury (62%) followed by road traffic accidents (35%) and the other causes included in the miscellaneous group (hit by animal and fall of heavy object on the abdomen; 3%). Most commonly injured organ was liver (n = 28, 41%) followed by spleen (n = 18, 26%) and kidney (n = 15, 22%). Other injuries were bowel perforations (jejunal [n = 4], ileal [n = 1] and large bowel [n = 1]; 9%), pancreaticoduodenal (n = 5, 7%), urinary bladder (n = 3, 4%), abdominal vascular injury (iliac vein-1, inferior vena cava-1;3%), adrenal haematoma (n = 2,3%) and common bile duct (CBD) injury (n = 1, 1%). More than one organ injury was seen in 13 cases (19%). Non-operative management was successful in 84% (n = 27) and laparotomy was done in 16% (n = 11). Most of the patients sustained Grade IV injury (n = 36, 53%) and majority of the patients (n = 60, 88%) had good outcome without any long-term complications. Conclusion: Profile of paediatric blunt abdominal trauma include solid organ injuries such as liver, spleen, kidney, pancreas, adrenal gland and others like bowel injury, CBD, urinary bladder and abdominal vascular injury. The grade of injury does not correlate with the outcome in a higher grade of injury and these children had good outcome.