Behavioral Activation for Comorbid Depression in People With Noncommunicable Disease in India: Protocol for a Randomized Controlled Feasibility Trial

BACKGROUND

The increasing burden of depression and noncommunicable disease (NCD) is a global challenge, especially in low- and middle-income countries, considering the resource constraints and lack of trained human resources in these settings. Effective treatment of depression in people with NCDs has the potential to enhance both the mental and physical well-being of this population. It will also result in the effective use of the available health care resources. Brief psychological therapies, such as behavioral activation (BA), are effective for the treatment of depression. BA has not been adapted in the community health care services of India, and the feasibility of using BA as an intervention for depression in NCD and its effectiveness in these settings have not been systematically evaluated.

OBJECTIVE

Our objective is to adapt BA for the Indian NCD context and test the acceptability, feasibility, and implementation of the adapted BA intervention (BEACON intervention package [BIP]). Additionally, we aim to test the feasibility of a randomized controlled trial evaluation of BIP for the treatment of depression compared with enhanced usual care.

METHODS

Following well-established frameworks for intervention adaptation, we first adapted BA (to fit the linguistic, cultural, and resource context) for delivery in India. The intervention was also adapted for potential remote delivery by telephone. In a randomized controlled trial, we will be testing the acceptability, feasibility, and implementation of the adapted BA intervention (BIP). We shall also test if a randomized controlled feasibility trial can be delivered effectively and estimate important parameters (eg, recruitment and retention rates and completeness of follow-up) needed to design a future definitive trial.

RESULTS

Following the receipt of approval from all the relevant agencies, the development of the BIP was started on November 28, 2020, and completed on August 18, 2021, and the quantitative data collection was started on August 23, 2021, and completed on December 10, 2021. Process evaluation (qualitative data) collection is ongoing. Both the qualitative and quantitative data analyses are ongoing.

CONCLUSIONS

This study may offer insights that could help in closing the gap in the treatment of common mental illness, particularly in nations with limited resources, infrastructure, and systems such as India. To close this gap, BEACON tries to provide BA for depression in NCDs through qualified NCD (BA) counselors integrated within the state-run NCD clinics. The results of this study may aid in understanding whether BA as an intervention is acceptable for the population and how feasible it will be to deliver such interventions for depression in NCD in South Asian countries such as India. The BIP may also be used in the future by Indian community clinics as a brief intervention program.

TRIAL REGISTRATION

Clinical Trials Registry of India CTRI/2020/05/025048; https://tinyurl.com/mpt33jv5.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41127.

Outcome of a Simple Novel Technique to Reduce Soft Tissue Complications in Open Tendoachilles Injury: A Series of 20 Patients

Introduction

Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries.

Materials and methods

This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery.

Results

None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%).

Conclusion

This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.

Effect of Gamma-irradiation on the Physicochemical, Functional, and Antioxidant Properties of Unpigmented Brown Whole Rice Flour

Whole grain brown rice, being a rich source of fiber and other bioactive compounds like polyphenols is effective in reducing the risk of chronic diseases including cardiovascular diseases, hypercholesterolemia and Type II diabetes. The study was aimed to evaluate the effect of gamma irradiation on the physicochemical, functional and antioxidant properties of whole grain brown rice flour. The brown rice flour was conditioned to two different moisture contents of 10% and 12% and treated with gamma irradiation doses of 0 kGy (native or control), 2.5 kGy and 5 kGy. Moisture, protein, fat, ash and carbohydrate content of native flour was found as 10 g/100 g, 6.54 g/100 g, 1.54 g/100 g, 1.0 g/100 g, and 81.48 g/100 g, respectively. The hunter color 'L', 'a', and 'b' values of the native brown rice flour sample were found as 81.95, -0.97 and 17.36, respectively and were non-significantly (p ≥ 0.05) affected by gamma irradiation. Apparent amylose content was observed to decrease significantly (p ≤ 0.05) from 29.97 to 20.30 g/100 g with the increase in gamma irradiation dose and moisture content. The pasting properties such as peak viscosity, trough viscosity and final viscosity of all the flour samples decreased significantly (p ≤ 0.05) with the increase in irradiation dose. The functional properties such as water and oil absorption and emulsion capacities were increased while emulsion stability and foaming stability decreased upon irradiation. Irradiation led to an overall increase in the antioxidant activity of rice flours. In general, FTIR spectra revealed a decrease in the absorption intensities of the functional groups. Therefore, it can be concluded that gamma irradiation can be used as a tool to modify the physicochemical properties of rice flours as well as to improve their antioxidant properties.

Associations between posttraumatic stress symptoms and posttraumatic growth elements: A network analysis

OBJECTIVE

The COVID-19 pandemic is a collective trauma causing profound psychological distress and, in some cases, positive psychological changes. The present study ascertained the most influential symptoms and strong connections between posttraumatic stress (PTS) symptoms and posttraumatic growth (PTG) elements. It also examined the symptoms/elements that acted as a bridge between the two, to elucidate how PTS and PTG co-exist.

METHOD

The PTSD Checklist (PCL-5) and Posttraumatic Growth Inventory (PTGI) were used to assess PTS symptoms and PTG, respectively, in a sample of 509 adults from Kashmir, India.

RESULTS

The network analysis revealed negative trauma-related emotions as the most influential symptom in the PTS network, and the ability to do better things with life as the most influential element in the PTG network. Eight bridge symptoms/elements emerged between the PTS and PTG, namely intrusive thoughts, nightmares, more compassion for others, sleep disturbances, trauma-related amnesia, hypervigilance, willingness to express emotions, and counting on others more.

CONCLUSIONS

The study identified the most influential symptom in the PTS network and the bridge symptoms in the combined network of PTS symptoms and PTG elements in the context of the COVID-19 pandemic in the present sample. The bridge symptoms helped in understanding how PTS and PTG co-existed in adults exposed to disasters such as COVID-19. Identification of these symptoms can be highly significant for developing targeted interventions. These implications have been discussed further in the present study. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Bioactive characterization of ultrasonicated ginger (Zingiber officinale) and licorice (Glycyrrhiza Glabra) freeze dried extracts

Ginger (Zingiber officinale) and Licorice (Glycyrrhiza glabra L.) are one of the most popular spices having a wide range of bioactive compounds that have varied biological and pharmacological properties. The study was aimed to extract polyphenols from Himalayan medicinal herbs ginger and licorice in different solvents using ultra-sonication technique. The extraction efficiency (EE) was determined, and the extracts were characterized for physical properties (particle size, colour values), total phenolics, flavonoids, antioxidant properties, and structural and morphological features. Ultra-sonicated ginger in aqueous phase had the highest EE of polyphenols (15.27%) as compared to other solvents. Similar trend was observed in licorice with EE of 30.52 % in aqueous phase followed by ethanol: water (50: 50), and methanol: water (50:50) with 28.52% and 26.39%, respectively. The preliminary screening showed the presence of tannins, phenolics, flavonoids, saponins and carbohydrates, steroids and alkaloids in all the extracts. The phenolic and flavonoid content of dried ginger was found higher in ethanolic extracts compared to fresh ones as revealed by HPLC. Similarly, for licorice, the ethanolic fractions had the highest polyphenolic content. The representative samples of ginger (ethanol: water 75:25 and ethylacetate: water 75:25) and licorice (ethanol: water 70:30 and methanol: water 50:50) were studied for FESEM and particle size. The results showed the agglomerated extract micro-particles with a diameter of 0.5-10 µm and increased particle size (ginger: 547 and 766 nm), and (licorice: 450 and 566 nm). The findings could be beneficial for the advancement of ginger and licorice processing, for the comprehension of these herbs as a source of natural antioxidants in different food formulations.

Development of functional cakes rich in bioactive compounds extracted from saffron and tomatoes

Demand for health-promoting food products rich in bioactive compounds and fibers is increasing. The current study was aimed to evaluate the physicochemical, antioxidant and sensory characteristics of whole wheat flour cakes enriched with tomato powder (TP), crude lycopene (CL) and saffron extracts (SE). Physical characteristics such as loaf weight of cakes containing TP increased significantly (p < 0.05) while loaf volume decreased as compared to the control. The color of the crust and crumb of cakes enriched with TP and CL was dark red while cakes containing SE were bright and yellowish. Firmness of the fresh cake samples was found in the range of 7.25-14.53 N. Antioxidant properties were significantly (p < 0.05) improved after enrichment of cakes with TP, CL and SE. The storage period increased the water activity while antioxidant activity and concentration of total carotenoids was reduced. Thus, cakes enriched with TP, CL and SE could be successfully developed with improved antioxidant properties, without compromising the sensory quality of the product.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13197-021-05267-2.

Adaptation and psychometric validation of Hindi version of the Behavioural Emotion Regulation Questionnaire

BACKGROUND

The Behavioural Emotion Regulation Questionnaire (BERQ; Kraaij and Garnefski, 2019) is a recently developed tool which assesses behavioural strategies for emotion regulation.

AIM

The present study aimed at validating the factor structure and psychometric properties of the Hindi version of the BERQ (BERQ-H) in a sample of Indian population.

METHOD

A community sample of n = 358 individuals completed the Hindi version of the Behavioural Emotion Regulation Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, and the Kessler Psychological Distress Scale (K-10).

RESULTS

Exploratory factor analysis revealed that the original five factor structure of the BERQ was replicable. Confirmatory factor analysis favoured a modified five factor structure of the BERQ-H. The unidimensional and the second order factor models of the BERQ-H were not supported. The internal consistency reliability of the BERQ-H subscales was acceptable. Withdrawal, Actively approaching and Ignoring subscales showed inverse associations with depression, anxiety and psychological distress. Seeking distraction did not correlate significantly, whereas Seeking social support showed atypical associations with depression and psychological distress.

CONCLUSION

The BERQ-H is a reliable and valid measure of behavioural emotion regulation strategies. It is advisable to mainly interpret subscale scores on the BERQ-H instead of the overall score.

Molecular phylogeny, pathogenic variability and phytohormone production of Fusarium species associated with bakanae disease of rice in temperate agro-ecosystems

Bakanae is the emerging disease threating the rice cultivation globally. Yield reduction of 4-70% is recorded in different parts of the world. A total of 119 Fusarium isolates were collected from rice plants at different geographical locations and seeds of different rice cultivars. The isolates were evaluated for morphological, biochemical and pathogenic diversity. The amplification of TEF-1α gene was carried out for exploring the species spectrum associated with the cultivated and pre-released rice varieties. The production of gibberellin varied from 0.53 to 2.26 µg/25 ml, while as that of Indole acetic acid varied from 0.60 to 3.15 µg/25 ml among the Fusarium isolates. The phylogenetic analysis identified 5 different species of the genus Fusarium viz. Fusarium fujikuroi, F. proliferatum, F. equiseti, F.oxysporum and F. persicinum after nucleotide blasting in NCBI. Only two Fusarium spp. F. fujikuroi and F. proliferatum were found to be pathogenic under virulence assays of the isolates. The isolates showed a considerable variation in morphological and pathogenic characters. The isolates were divided into different groups based on morphology and pathogenicity tests. The isolates showed a considerable variation in morphology, phytohormone profile and virulence indicative of population diversity. Three species F. equiseti, F.oxysporum and F. persicinum which have not been reported as pathogens of rice in India were found to be associated with bakanae disease of rice, however their pathogenicity could not be established.

Pasting, rheology, antioxidant and texture profile of gluten free cookies with added seed gum hydrocolloids

The study was carried out with the aim of developing gluten free cookies using rice-chickpea composite flour. Guar and locust bean gum were added to formulations at two test concentrations (0.5 and 1.0%). To study the impact of these hydrocolloids, pasting and rheometry of dough formulations was carried out. The cookies produced were subjected to colour, spread ratio, hardness and antioxidant analysis. Protein (7.56 g/100g), fat (1.78 g/100g), ash (1.25 g/100g) and carbohydrate (80.41 g/100g) content of composite flour varied significantly (p ≤ 0.05) from both rice and chickpea. Higher viscosity, viscoelasticity and antioxidant profile was shown by dough formulations with added gums. Control cookies prepared without gums showed the L*, a* and b* values of 54.62, 3.81 and 35.97, respectively. With the addition of guar and locust bean gum, colour of the cookies became lighter. Spread ratio and hardness of cookies with added gums was higher.

Tomato powder and crude lycopene as a source of natural antioxidants in whole wheat flour cookies

The nutritional quality of bakery products keeps on degrading from the process of baking, packaging, transportation and storage. The present study was carried out to evaluate the effect of addition of tomato powder (2 & 4/100 g of flour) and crude lycopene (50 & 100 mg/100 g of flour), which have potent antioxidant activity, on the nutritional quality and shelf life of cookies prepared from whole wheat flour. Color values i.e., a* and b* of freshly prepared cookies containing tomato powder (TP) were found in the range of 5.40–6.21 and 33.20–33.40 respectively, and that of crude lycopene (CL) in the range of 5.18–5.24 and 32.50–34.90 respectively, higher than the control (4.53 and 32.50, respectively). Significant (p < 0.05) and non-significant (p > 0.05) increase was observed in the total phenolic content of dough containing TP (0.54–0.72 mg GAE/g) and CL (0.46–0.59 mg GAE/g), when compared to control (0.38 mg GAE/g). Antioxidant properties like, DPPH scavenging activity, reducing power and inhibition of lipid peroxidation (ILP), and total carotenoid content (TCC) of dough and cookies increased significantly (p < 0.05) upon incorporation of TP and CL. Sensory properties of enriched cookies were comparable with that of control. Color values (a* and b*), hardness, TCC, ILP and TPC were reduced significantly (p < 0.05) with storage.

Factor structure validation, psychometric evaluation and measurement invariance testing of the Brief Sensation Seeking Scale-Chinese (BSSS-C) in Indian adolescents

BACKGROUND

Self-report measures of sensation seeking though commonly used in research have not undergone factor structure or psychometric validation in Indian adolescents. The Brief Sensation Seeking Scale - Chinese (BSSS-C; Chen et al., 2013) is a less culture specific tool with excellent psychometric properties and presents a suitable option for use with Indian adolescents.

AIM

The present study aims to validate the factor structure, evaluate the psychometric properties, and examine the gender invariance of the BSSS-C in Indian adolescents.

METHODS

A community sample of adolescent, n = 2079, with mean age 17 years (SD = 1.71) completed the BSSS-C, the BIS/BAS, and the Adolescent Risky Behaviour scales.

RESULTS

The four factor structure of the BSSS-C exhibited good to excellent model fit, acceptable internal consistency reliability (α = 0.77) and, adequate construct as well as concurrent validity in Indian adolescents. Invariance testing revealed that the factor configuration and factor loadings of the BSSS-C were equivalent across the gender. Three of the four BSSS-C latent factors were amenable for mean comparisons across the gender.

CONCLUSION

BSSS-C is a reliable measure of the four dimensional model of sensation seeking in Indian adolescents. The gender differences in the BSSS-C factors are attributable to real differences in sensation seeking construct between male and female adolescents.

Development of functional cookies using saffron extract

Saffron extracts of two different concentrations were prepared and used as a source of natural antioxidants in whole wheat flour cookies. The effect on the color, texture and sensory properties of the product was also studied over a storage period of 9 months. Results revealed that spread ratio and hardness of cookies reduced non-significantly with the addition of saffron extract (SE). Color values 'L' and 'b' of cookies increased significantly from 50.7 to 53.9 and 36.5 to 47.0, respectively with the addition of SE while 'a' value decreased non-significantly (p > 0.05). DPPH radical scavenging activity, reducing power and inhibition of lipid peroxidation of dough and cookie samples containing SE were enhanced in comparison to control. The concentration of crocins, safranal and picrocrocin in DS50 and DS100 dough samples was found as 28.30, 48.30, 104.6 µg/g and 35.14, 62.38, 118.2 µg/g, respectively. Sensory scores of cookies containing SE were high as compared to control. All the quality parameters of cookies reduced during the storage period (0-9 months). However, the cookies with added SE revealed significantly higher quality attributes up to 6 months of storage without any significant loss in quality.

Effect of sonication and γ-irradiation on the properties of pea (Pisum sativum) and vetch (Vicia villosa) starches: A comparative study

In present study, the physicochemical, functional and pasting properties of starch obtained from commercially used pea were compared with vetch, an underutilized pulse variety. Starch from each cultivar was subjected to sonication (33kHz for 45min) and a dual treatment in which sonication was followed by irradiation (5kGy). Apparent amylose content of the starch from two varieties varied significantly (p>0.05) from 31.08-27.58g/100g. Sonication and dual treatment decreased the amylose content of starches. Syneresis varied more or less insignificantly (p<0.05) upon sonication. However, upon dual treatment, syneresis decreased significantly (p>0.05) from 47.82-35.22g/100g (pea) and 46.36-26.98g/100g (vetch) during the storage period of 120h. A combined effect of sonication and irradiation treatment significantly (p>0.05) changed the functional properties and pasting characteristics of starches. The samples that received the sonication treatment alone varied non-significantly from native pea and vetch starch in their physicochemical, functional and pasting properties.

Prospective memory in obsessive compulsive disorder

Studies on the nature and extent of prospective memory impairment in patients with obsessive-compulsive disorder are relatively scarce. The present study examined prospective memory in patients with obsessive-compulsive disorder in comparison to patients with schizophrenia and healthy controls. Prospective memory was assessed using Memory for Intentions Screening Test (MIST). Further, the participants were administered Delis-Kaplan Executive Function System Tower Test, Wisconsin Card Sorting Test, and Stroop Test for assessing their planning ability, mental flexibility and cognitive inhibition, respectively. Monitoring was assessed by frequency of clock checking. Results indicated that as compared to healthy controls, the patients with obsessive-compulsive disorder performed poorly on both time- and event-based prospective memory tasks, whereas, patients with schizophrenia performed poorly on time-based prospective memory task only. Further, both the patient groups had comparable performance across time- and event-based tasks. Results of error analysis indicated that patients with obsessive-compulsive disorder mainly committed no response and task substitution errors, whereas patients with schizophrenia committed no response errors. Except monitoring, none of the neurocognitive variables correlated with time or event-based prospective memory in any group. The findings are discussed in the light of their implications for retraining of prospective memory deficits in patients with obsessive-compulsive disorder and schizophrenia.

Meckel’s Diverticulum with Multiple Ileal Ulcers as a Source of Massive Gastrointestinal Haemorrhage in a Three Year Old Child

Meckel’s Diverticulum (MD) is a frequent congenital anomaly of small bowel often difficult to diagnose. It is usually asymptomatic and can present as bleeding, obstruction and inflammation. We report a case of MD in a 3 year old male child, diagnosed by 99mTc pertechnetate scan and confirmed on laparotomy. Excised specimen revealed a large MD with multiple ileal ulcers, as a source of massive bleeding per rectum. The clinical features and need for early diagnosis and treatment are discussed. DOI: http://dx.doi.org/10.3126/jnps.v33i3.7802   J. Nepal Paediatr. Soc. 2013;33(3):227-229

Congenital Descending Colonic Stenosis with Perforation of Transverse Colon in a Neonate: A Case Report

Colonic atresia and stenosis are rare causes of intestinal obstruction in the infant. Only 10 cases have been reported in Literature since 1966 and only one late-onset case has been reported in Literature until now. We describe the case of a 3 day old baby presenting with abdominal distension, failure to pass meconium and vomiting. X-ray of the abdomen showed dilated gut loops. Exploratory laparotomy was performed. At the junction of descending and sigmoid colon a stenosis was found, laparotomy also revealed a perforation of transverse colon. Transverse colostomy and a mucous fistula of sigmoid colon was performed after resecting stenosing segment and colon distal to perforation site upto stenosing site. Diagnosis was confirmed on histopathology. Colostomy was close after six weaks with uneventful recovery. Considering both the Literature and our case, congenital colonic stenosis should be considered one of the rare differential diagnoses in a neonate presenting as complete or partial intestinal obstruction. Key words: Colonic Stenosis; Perforation; Obstruction DOI: http://dx.doi.org/10.3126/jnps.v32i1.5446   J. Nepal Paediatr. Soc. Vol.32(1) 2012 73-75  

Pre-operative manometry of the blind rectal pouch to predict post-operative potential for continence in anorectal malformation

AIM

Despite technical advances in the surgical repair of anorectal malformation, many children suffer post-operative faecal incontinence. There are many ways to assess postoperative continence in these patients but there is no manometry-based method to assess and make predictions pre-operatively. In this pilot study an attempt was made to correlate the pre- and postoperative manometry and electromyography findings in order to use the pre-operative findings to predict the postoperative potential for continence.

METHODS

Ten patients aged 12 to 54 months were subjected to pre-posterior sagittal anorectoplasty manometry by introducing the balloon catheter probe through the distal colostomy into the blind rectal pouch. Electromyography activity in the striated muscle complex was also studied by placing electromyography needles in the midline in the anal dimple. A second study was repeated after posterior sagittal anorectoplasty (PSARP), the probe was introduced into the rectum via the neo-anus and the electromyography needles were placed on either side of the neo-anus. A third study was done, similar to the second study, after colostomy closure along with Kelly's scoring. Results of the three studies were compared.

RESULTS

Pre-posterior sagittal anorectoplasty rectal pouch pressures were in the range of 18.3-93.3 cm H2O and electromyographic activity was between 43.6 and 383.0 microv. Post-posterior sagittal anorectoplasty studies showed anal canal pressure in a similar range of 16.0-95.5 cm H2O and electromyographic activity between 57.0-340.7 microv. The post-colostomy closure anal canal pressures ranged from 22.7 to 99.1 cm H2O and electromyographic activity ranged from 65.7 to 335.7 microv. The Kelly's score ranged from 1-6.

CONCLUSION

Since, the pre-and postoperative manometry findings are quite similar and they correlate well with the surgical outcome, it may be possible to predict such an outcome before PSARP. Also, the pressure profiles and EMG activity in post-operative assessments suggest intact neural pathways despite blind pouch mobilisation.

Manometric evaluation of postoperative patients with anorectal anomalies

AIM

To evaluate the outcome of surgical treatment in patients with anorectal malformations and to correlate the clinical, manometric and electromyographic studies in assessment of postoperative continence in these patients.

METHODS

Forty-one patients operated on for anorectal malformations were evaluated retrospectively. These included 13 patients with low anomalies, 24 with high anomalies, and 4 with congenital pouch colon. Functional results after surgical correction were assessed on clinical basis using the Kelley's scoring system and by anorectal manometry. In addition, the electrical activity of contraction of the external sphincter muscle was studied using electromyography.

RESULTS

There was direct correlation between anal canal pressures and Kelley's score in patients with both high and low anomalies; Kelley's score of 6, 5, 4, 3 and less had pressures ranging between 60-75, 45-59, 30-44, 15-29 and less than 15 cm H2O, respectively. However, the electromyographic activity did not correlate well with Kelley's score.

CONCLUSIONS

Anorectal manometry correlates well with Kelley's scoring system and may be a more objective method of analyzing the results of surgery. Poor correlation between Kelley's score and electromyography may be a reflection of poor compliance with instructions to voluntarily contract the muscles of continence.

Sacrococcygeal teratoma with anorectal malformation

A 7-month-old child presented with imperforate anus, penoscrotal hypospadias and transposition, and a midline mucosa-lined perineal mass. At surgery the mass was found to be supplied by the median sacral artery. It was excised and the anorectal malformation was repaired by posterior sagittal anorectoplasty. Histologically the mass revealed well-differentiated colonic tissue. The final diagnosis was well-differentiated sacrococcygeal teratoma in association with anorectal malformation.

Optical pulse propagation in nonlinear photonic crystals

We present a formalism for optical pulse propagation in nonlinear photonic crystals of arbitrary dimensionality. Using a multiple-scale analysis, we derive the dynamical nonlinear Schrödinger equation obeyed by the envelope function modulating an underlying Bloch function. Effective coefficients appear in that equation characterizing the effects of Kerr nonlinearity, linear gain or loss, and material dispersion. They depend on how the underlying Bloch function "samples" these effects in the photonic crystal, and require for their calculation a specification of these effects throughout the photonic crystal, and the calculated bandstructure of the photonic crystals in the linear, nondispersive limit. We show that wave packets from different bands can experience significantly modified effective material properties.

Thoracoabdominal intestinal duplication with absent inferior vena cava

We report a rare case of thoracoabdominal intestinal duplication with absent inferior vena cava (IVC). The patient was initially explored with a mistaken diagnosis of diaphragmatic hernia on the basis of a chest radiograph and barium meal. However, a subsequent computed tomography scan revealed a mediastinal mass with an air-fluid level, a hugely dilated azygos vein, and an absent IVC. Thoracoabdominal exploration was required to excise the duplication cyst arising from the jejunum. We believe that this is the first report of this association.

Duplications of the alimentary tract in children

This study was conducted to assess the clinical, diagnostic and therapeutic approach in patients with alimentary tract duplication and review the relevant literature. A retrospective analysis of 28 patients of alimentary tract duplications treated between January 1990-December 1999 was carried out. There was a male preponderance (25:3); 71% of the patients were under 2 years of age. The presenting features were related to the anatomic location. Three patients were diagnosed antenatally. Real time ultrasonography and CT scan was undertaken for preoperative evaluation in the majority of patients. In selected cases a 99m-Tc-pertechnetate scan and barium meal follow through examination were also performed. Majority of duplications were in the jejunum and ileum. Twenty percent of our patients had thoracoabdominal duplication as compared to 2% reported in literature. Four patients required to be operated upon in the emergency for related complications. In the remaining patients complete excision of the cyst was done in 21 and only mucosectomy in 3 patients. Because these lesions are rare and can present with a wide range of clinical manifestations or may even be encountered intraoperatively, the appropriate surgical management requires the surgeon to be familiar with the anatomy and clinical characteristics of these lesions.

Retrospective analysis of surgical outcome, symptom changes, and hearing improvement following myringoplasty

This study examines the surgical and audiologic results of myringoplasty and what factors affect these outcomes. It also examines whether patients experience any improvement in their main symptoms following surgery. This was a retrospective analysis of case notes, patient questionnaires, and audiograms of all patients undergoing myringoplasty between 1990 and 1995 at Walsgrave Hospital, Coventry, UK. Overall success of myringoplasty for consultants was 81% and for trainees was 79%, with an overall success rate of 86% in children. Posterior and inferior perforations had a 90% success rate for repair, compared to only 67% of anterior perforations. There was a statistically significant reduction in air-bone gaps following myringoplasty, and the majority of patients felt that their ears were drier and had improved hearing. Myringoplasty is a successful procedure in the hands of consultants and trainees alike. The results are satisfactory enough to justify surgery purely for deafness and also in symptomatic children. There is a strong correlation between surgical success and resolution of symptoms and generally a satisfactory improvement in hearing.

Kikuchi's disease of the neck (histiocytic necrotizing lymphadenitis)

Histocytic necrotizing lymphadenitis (HNL), also known as Kikuchi's disease is a benign self limiting disease of unknown origin. It effects cervical lymph nodes, predominantly in young females. It is well described in the pathology literature, but little is written about this in the ENT literature, as few clinicians are probably aware of this condition. Five cases of cervical Kikuchi's disease are presented with a brief review of the literature.

An unusual foreign body in the larynx: a case report

Inhalation of a foreign body is a serious event. A small proportion of foreign bodies become impacted in the larynx, when urgent recognition is required to prevent disaster. The case of an 18-month-old baby with an impacted artificial finger nail in the larynx is described along with a brief review of the literature.

Tuberculous parotitis: a case report

Tuberculosis of the parotid gland is rare. It cannot be distinguished d form a parotid tumour by clinical examination alone, so surgical exploration has usually been required for diagnosis. We present a case with the same diagnostic dilemma.