Inflammatory Myofibroblastic Tumour in Children: A Report of Two Cases and Review of Literature

ABSTRACT

Inflammatory myofibroblastic tumour in paediatric patients present with a diagnostic dilemma because of its clinical, radiological and histopathological features overlapping with other mesenchymal tumours common in this age. Because of its rarity, the exact features are still unclear. Here, we are reporting clinical, radiological and histopathological appearances of two such cases. In both cases, the exact diagnosis was confirmed only after immunohistochemistry. There is a need for further detailed study to exactly determine the natural course and prognosis of these tumours.

A rare diagnosis of Langerhans cell histiocytosis made on thyroid histology with coexisting papillary thyroid cancer and AVP deficiency

Summary

A 48-year-old Asian male, presented to the hospital for an elective total thyroidectomy in the context of 6.3 cm thyroid nodule. The fine needle aspiration cytology of the nodule confirmed papillary thyroid cancer (PTC) with some atypical histiocytes. He has a history of idiopathic arginine vasopressin deficiency (AVP-D) and has been taking oral DDAVP 100 µg daily, self-adjusting the dose based on thirst and polyuria. Additionally, he also has a history of recurrent spontaneous pneumothorax. His total thyroidectomy was aborted due to significant intraoperative bleeding, and his admission was further complicated by post-operative hyponatraemic seizure. Thyroid histology revealed the diagnosis of Langerhans cell histiocytosis (LCH), and further investigation with contrast CT demonstrated multi-organ involvement of the thyroid, lungs, and bones.

Learning points

Langerhans cell histiocytosis (LCH) is a condition that can affect one or more organ systems, including the pituitary, where it can present as AVP deficiency. Strict monitoring of fluid balance, as well as serial monitoring of serum sodium, is essential in all patients with AVP-D in the perioperative setting. Iatrogenic hyponatraemic seizure is an uncommon but serious complication of DDAVP treatment in hospitalised patients with AVP-D. DDAVP dosing must be carefully monitored. LCH with multisystem involvement is an important mimic for metastatic conditions, and histological diagnosis is essential to guide treatment and prognosis. Although LCH without bone marrow involvement is unlikely to increase the risk of bleeding, its effect on tissue integrity may make surgery more challenging. BRAF-V600E mutation is an important driver mutation and a potential therapeutic target in the treatment of LCH.

Hepatic transcriptome profiling of largemouth bass (Micropterus salmoides Lacépède) injected with Flavobacterium covae or lipopolysaccharide

Flavobacterium covae (columnaris) is the most detrimental bacterial disease affecting the largemouth bass (Micropterus salmoides Lacépède) aquaculture industry. In the current study, fish received an intraperitoneal injection of either 1× PBS (100 μL), LPS in PBS (100 μL, 10 μg/mL), or F. covae (100 μL, 2.85 × 1011 CFU/mL) to simulate immunological challenges. After 24 h post-injection, liver tissue from the control and treated groups were then collected for transcriptome analysis. Results of the Gene Ontology (GO) and KEGG pathway analyses for the F. covae and LPS-injected groups found differentially expressed genes (DEGs) enriched primarily in toll-like receptors (TLRs), cytokine-cytokine receptors, complement and coagulation cascades, and the PPAR signalling pathways. This suggests that the liver immune system is enhanced by these five combined pathways. Additionally, the DEGs TLR5, MYD88, and IL-1 were significantly upregulated in F. covae and LPS-injected fish compared to the controls, whereas IL-8 was downregulated. The upregulation of TLR5 was unexpected as F. covae lacks flagellin, the protein that binds to TLR5. Additionally, it is unknown whether the TLR5 is upregulated by LPS. Further research into the upregulation of TLR5 is warranted. These results provide insight into immune responses and associated pathways contributing to the immune system in the liver during columnaris infection and induced response to LPS in largemouth bass.

Gastric Teratoma in Children: A Report of Two Cases and Review of Literature

ABSTRACT

Gastric teratomas are very rare tumours. They present with upper abdomen distension which can easily be confused with other common conditions with mass per abdomen in the paediatric age group. Surgical excision is curative for gastric teratomas. The diagnosis is confirmed by radiological evaluation followed by histopathological analysis of excised specimen. We are reporting two such cases of gastric teratomas who presented with complaints of upper abdomen distension. They were evaluated with radiological imaging and successfully managed by surgical excision.

Advocating for Routine Post-natal Surveillance and Urgent Neonatal Inguinal Hernia Repair

ABSTRACT

Inguinal hernias are more common in preterm and neonates and incidence of incarceration are reported to be more in the first 6 months of life. Strangulation follows incarceration and various incarcerated and strangulated contents having been reported in the sac. The fistulation of the herniated content through the scrotal skin is quite rare with only a few reported cases. We present the case of entero-scrotal fistula in a neonate managed with staged repair along with a brief review of the literature. A 27-days-old, full-term male presented with faecal discharge from the right scrotum. He had no tell-tale signs of obstructed hernia. A faecal fistulous opening was located in the right hemi-scrotum. The terminal ileum was seen as the content with an antimesenteric perforation, divided ileostomy and scrotal debridement was done and later ileo-ascending anastomosis was performed electively. Neonatal hernias should be considered an urgency and we advocate early surgery. The resource-limited setting and poor post-natal surveillance may have added to the worries. In our case, swelling and fistulation occurred in a very brief period of 36 h. We managed the child with a diversion stoma followed by ileo-ascending anastomosis later.

Extracorporeal Testicular Ectopia through Femoral Region: A Rare Variant of Scrotoschisis

A 2-year-old male child presented to us with absent left testis in scrotum since birth. Parents noted a pinkish white globular mass in medial aspect of left thigh. At the time of presentation (2 years old) he had a 2 x 2 cm, firm, subcutaneous swelling located on the medial aspect of the left thigh. Ultrasonography was suggestive of left ectopic testis of size 1 x 1.2cm in the femoral region. Orchidopexy was done. In our case the term scrotoschisis will not be appropriate as testicular extrusion has occurred through femoral region and not the scrotum. This can be considered as extracorporeal testicular ectopia or bubonoschisis, respective to the location of the defect. We are reporting a case of extra corporeal testicular ectopia through the femoral region for the first time.

Giant Colpolithiasis in Urogenital Sinus Anomaly with Urethral Duplication: A Case Report and Review of Literature

ABSTRACT

Primary vaginal calculi are uncommon in children. Urethral duplication in females is seen to occur in association with complex congenital malformations. We report the case of perianal persistent urogenital sinus with a hypertrophied clitoris with phallic urethra, scrotum-like pouch, uterus didelphys with obstructed hemivagina, and giant colpolithiasis in 46XX female. A 16-year-old presented with pain abdomen and cyclic passage of blood clots per rectum. She had a tender lump in left iliac region, a phallus like protrusion and a ruggous sac below it. Vaginal opening was absent. Computed tomography showed two uterine horns with a separate cervix and distended non-communicating hemivaginas with a large calcified oval mass in the left hemivagina. On exploration, calculus was extracted from the left hemivagina. The large calculus found in the left hemivagina appears to be the cause of all presenting symptoms. It obstructed the left hemivagina, filling the left uterine horn with menstrual blood causing its gradual enlargement and secondary infection. The early diagnosis and prompt referral of such an anomaly can only be ensured in institutional deliveries. For a significant proportion of newborns in the developing world, the ability to afford or even be referred to institutes which deal with such cases is a luxurious affair. We hope to bridge bridging the knowledge, attitude and practice gap that exists in our health-care system with this report.

Congenital Urethrocutaneous Fistula

ABSTRACT

Male congenital urethrocutaneous fistula is an extremely rare anomaly that is commonly associated with chordee or anorectal malformations. It is characterised by an abnormal urethral opening on the ventral aspect of the penis with well-formed distal urethra and meatus at the tip of the glans. The treatment is individualised according to the site of the fistula, associated anomalies and condition of the distal urethra. The principles of hypospadias surgery should be strictly followed.

Temperature dependent structural properties of Mn1.90M0.10O3(M = Cr and Fe)

The polycrystalline samples of Mn1.90Cr0.10O3(MCO) and Mn1.90Fe0.10O3(MFO) have been investigated for their temperature dependent magnetic and structural properties. The Cr and Fe substitutions have significant effect on the magnetic and structural properties of Mn2O3. Like pristine Mn2O3, the Cr and Fe substituted samples MCO and MFO also exhibit two antiferromagnetic transitions; one at ∼77 K, ∼80 K, respectively and another at ∼40 K. Our room temperature synchrotron x-ray powder diffraction (SXRD) results confirm that both the MCO and MFO samples crystallize in cubic symmetry. The temperature dependent SXRD results demonstrate the cubic to orthorhombic structural transition for the studied samples. The pristine Mn2O3shows cubic to orthorhombic transition around 310 K, whereas this structural transition shifted towards lower temperature side with these substitutions i.e. around 240 K for MCO and 260 K for MFO. Interestingly, the centrosymmetricPcabto non-centrosymmetricPca21change in symmetry is also resolved at the ferroelectric ordering temperature for MCO.

Comparison between in-plane and out-of-plane techniques for ultrasound guided cannulation of the left brachiocephalic vein in pediatric population: A randomised controlled trial

BACKGROUND AND AIMS

Brachiocephalic vein is a novel site for central venous cannulation in infants. It becomes useful in patients where the internal jugular vein lumen is small (e.g., volume deficient patient), patients with a history of multiple cannulations, and in whom subclavian puncture is contraindicated.

METHODS

In this randomized double-blinded study, 100 patients, aged between 0 and 1 year scheduled for elective central venous cannulation were recruited. The patients were allocated into two groups (50 patients in each). Group I patients had ultrasound (US) guided cannulation of the left brachiocephalic vein (BCV) by inserting a needle in-plane to the US probe from lateral to the medial direction, whereas Group II patients underwent cannulation of the BCV via an out-of-plane approach.

RESULTS

The first-attempt success rate was significantly higher in Group I (74%) than in Group II (36%) (p < 0.001). The total success rate was higher in group I (98%) than in group II (88%) however the difference was statistically insignificant (p > 0.05). The mean BCV cannulation time was significantly shorter in group I (35.46 ± 25.10) than in group II (65.24 ± 40.26) (p < 0.001). The rate of unsuccessful BCV cannulation (12%) and hematoma development (12%) was significantly higher in group II than in group I (2%).

CONCLUSION

Compared to the out-of-plane approach of left BCV cannulation, US-guided in-plane cannulation of the left BCV increased the first-attempt success rate, decreased the number of puncture attempts, and decreased the time required for cannulation.

Paediatric laparoscopic inguinal hernia repair: Level of disconnection of peritoneal cuff - An observational study

Introduction

Inguinal hernia is a common surgical condition in children. Conventionally, the open approach for inguinal hernia repair has been considered the gold standard. However, in the past two decades, laparoscopic inguinal hernia repair has gained popularity among paediatric surgeons as an alternative to the open approach. Apart from good cosmesis and shorter stay at hospital, laparoscopy offers clear-cut advantages of visualising contralateral site and simultaneous repair if it is patent. Many techniques for laparoscopic inguinal hernia repair have been proposed. In this retrospective observational study, we are comparing outcomes between proximal and distal disconnection of hernia sac.

Materials and Methods

Ninety-five patients with inguinal hernia were studied in two groups. Group A included 50 patients in which hernia sac was disconnected from the peritoneal cuff proximal to deep inguinal ring (DIR). Group B included 45 patients in which hernia sac was disconnected distal to DIR. Various sociodemographic parameters and intraoperative findings were compared. Outcomes were analysed in terms of post-operative pain, duration of stay at the hospital and recurrences.

Results

In group A, there were 46 males and four females with mean age of 4.01 years with standard deviation (SD) of 2.96. Group B included 37 males and eight females with mean age of 5.09 years with SD of 3.56. Excess post-operative pain was observed in 33 patients in Group A with proximal disconnection of hernia sac whereas it was seen in only three patients in Group B with distal disconnection of sac. The P was 0.001 which was highly significant. The duration of stay in the hospital was more in Group A (2.36 ± 1.22 days) as compared to Group B (1.8 ± 0.66 days) with a P of 0.0076 which was significant. Hernia recurrence was seen in four out of 50 patients in Group A (8%) as compared to no recurrence in Group B. However, the difference was not significant.

Conclusion

The disconnection of hernia sac distal to DIR is associated with less post-operative pain and shorter duration of hospital stay. There is less recurrence seen in distal disconnection of hernia sac as compared to proximal disconnection; however, to achieve the level of significance, a large cohort study is required.

Neonatal Sigmoid Colon Perforation in Low Anorectal Malformation

Anorectal malformations (ARMs) are common congenital anomalies in neonates. Colonic perforation is very rare in ARMs. Delay in diagnosis of neonate with ARM results in colonic perforations and life-threatening morbidity. Colonic perforation due to ARM may not be completely avoided; however, early diagnosis and management are essential in assuring better outcomes.

Giant choledochal cyst in infant: A rare case report

The cystic dilatation of the common bile duct (CBD) is a rare pathology in an infant. It is the second-most common surgical cause of cholestatic jaundice in infants after biliary atresia. A 4-month-old female child was admitted to our department with complaints of abdominal distension. The physical examination revealed the presence of a huge palpable mass involving the right hypochondrium up to the right iliac fossa and umbilical region. Ultrasound abdomen revealed a large intra-abdominal cyst but unable to comment on the organ of origin of the cyst due to its huge size. Multidetector computed tomography of the abdomen was suggestive of possible origin of the cyst from CBD extending from porta hepatis to pelvis. At laparotomy, there was a huge choledochal cyst extending from porta hepatis to pelvis. The choledochal cyst was excised, followed by Roux-en-Y hepaticojejunostomy.

Comparative study of the short-range structure of α-V2O5, α-TeO2 and xV2O5-(100 - x)TeO2 glasses using X-ray diffraction, Rietveld analysis and reverse Monte Carlo simulations

Vanadium-tellurite glasses, tetragonal TeO₂ and orthorhombic V₂O₅ crystalline samples were characterized for their atomic structure properties by synchrotron X-ray diffraction, pair distribution function analysis, reverse Monte Carlo simulations (RMC) and Rietveld analysis. The pair correlation function, G(r), of V₂O₅ shows the first peak at 1.61 Å. G(r) of TeO₂ shows three peaks at 1.57, 2.13 and 2.88 Å due to Te-O linkages of three different lengths, whereas the Te-Te atomic pair correlation shows a peak at 3.85 Å. The average coordination number of V with O in crystalline V₂O₅ is 4.39 while that of Te with O in crystalline TeO₂ is 3.71. G(r) of the vanadium tellurite glass shows the first peak at 1.90 Å due to overlapping Te-O and V-O atomic pair correlations. The RMC analysis on diffraction data of glasses found that the V-O coordination number is in the range 5.27-5.59 and the Te-O coordination number is 5.39-5.67. However, it is found that these coordination numbers cannot be clearly defined due to short-range disorder.

Perceived stigma among diabetic patients and their caregivers: a review

AIMS

Considerable number of studies in the existing literature indicate the existence of stigma related to many diseases, disabilities, and disorders, but less attention has been given to diabetes-related stigma. This narrative review of literature aims to explore the existence of stigma surrounding type 1 diabetes mellitus (T1DM).

METHODS

Literature were searched using search engines, Google Scholar, PubMed, and Scopus electronic databases published from year 2000 to 2020. Both qualitative and quantitative studies focusing on the stigma associated with T1DM were included. A total of 21 articles met the inclusion criteria. Thematic analysis of collected research material was done.

RESULTS

Results provided substantial evidence that stigma associated with T1DM was experienced by T1DM patients and their caregivers at some point in their lives and it had affected their lives in different domains such as difficulty finding a spouse, discrimination at employment opportunities, educational institutions, management of disease, being misjudged as a druggie, poor quality of life of the patient and caregiver, depressive symptoms among parents of patients, constant worrying of their child's disease management, and so on.

CONCLUSION

Stigma related to T1DM is experienced by individuals suffering from it, and it is widespread. It not only affects the sufferers but their loved ones also. To reduce and cope-up with stigma, there is a need to increase public education and awareness at a mass level. Further research and awareness will serve to build our understanding of the experience of diabetes-related stigma.

Angiomatoid Fibrous Histiocytoma with EWSR1 Rearrangement in an Unusual Location

Introduction/Objective

Angiomatoid fibrous histiocytoma (AFH) is a rare mesenchymal neoplasm most often arising in the superficial extremities of children and young adults. AFH can mimic clinical, histologic, and radiologic presentation of several different tumors, therefore diagnosis can be quite challenging.

Methods/Case Report

We report the case of a 32-year-old woman with no significant medical history who presented with three days of right upper quadrant pain. Radiologic studies showed a 2.3 centimeter right lower lobe soft tissue nodule abutting the right lower lobe bronchus.

Results (if a Case Study enter NA)

Subsequent lobectomy with mediastinal lymph node dissection was performed. Histopathologic examination of the right middle and lower lobes revealed a fibrohistiocytic appearing neoplasm with bland nuclear features and brisk associated lymphoplasmacytic and histiocytic infiltrate. Given the suspicion for AFH, fluorescent in situ hybridization for EWSR1 and FUS were performed at an outside facility with detection of EWSR1 gene rearrangement supporting the diagnosis of AFH.

Conclusion

AFH is a rare soft tissue neoplasm that is often indolent but intermediate in potential given the rare possibility of metastasis. While most common in superficial extremities, increasing unusual anatomic sites are being reported. Histologically, the tumor can show a spectrum of morphologic patterns including nodules to sheets of often monomorphic bland, spindle or ovoid cells in an inflammatory background and with associated fibrous pseudocapsule. Three characteristic chromosomal translocations have been identified: EWSR1-CREB1, EWSR1-ATF1 and FUS- ATF1. Treatment is wide surgical excision or radiotherapy if unresectable. The differential diagnosis can be broad with a spectrum from reactive, benign lesions to malignant neoplasms, including a variety of sarcomas.

Colonic Agenesis with Anorectal Malformation - Rarest Variant of Congenital Short Colon

We report a case of colonic agenesis with anorectal malformation in a newborn girl. The patient also presented with congenital heart disease. We are presenting the clinical features, intraoperative findings, and treatment plan.

The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates

Background

Distal femoral non-unions are challenging, and frequently associated with short distal fragments, poor bone stock, and with issues from previous implants.

Materials and methods

A retrospective study of 31 patients admitted with distal femoral non-unions treated using anatomical lateral locking plates. Non-union scores were used. The Knee Society and Neer's scores were used for the comparison of results. The mean follow-up was 39.5 months (from 24 months to 60 months).

Results

Stable union was accomplished in all. There was a significant improvement in the average Neer's score (24 preoperative to 82 post-operatively at final follow-up), the Part 1 Knee Society score from an average of 46 preoperatively to 84 post-operatively, and Part 2 Knee Society score from 36 preoperatively to 80 post-operatively.

Conclusion

Optimal stability, good compression at the non-union site (either by lag screws or a compression device or both), maintaining the axial alignment strictly, freshening of bone ends, using an adequate amount of cortico-cancellous bone graft, respecting the biology along with the correct choice of the implant (including the size) are essential to achieve union at the fracture site.

Clinical significance

Paying attention to the basic principles of management, good contact, stability and maintaining biology is essential in the treatment of non-union.

How to cite this article

Mukhopadhaya J, Ranjan R, Sinha AK, et al. The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates. Strategies Trauma Limb Reconstr 2022;17(3):137-143.

Internal fat prolapse from ischiorectal fossa masquerading as currarino syndrome

Pelvic magnetic resonance imaging (MRI) is the latest addition to already existing tools for evaluation of anorectal malformation (ARM). It provides detailed information about pelvic floor musculature as well as position of rectal pouch. However, lack of knowledge about normal pelvic floor anatomy can lead to misinterpretation of pelvic MRI which can create confusion and change in approach for surgery. A 14-month-old male child with diagnosis of ARM was evaluated with pelvic MRI. There was finding of abnormal protrusion of fat through the ischiorectal fossa which was misinterpreted as Currarino syndrome which created confusion immediately before posterior sagittal anorectoplasty. Pelvic MRI is highly informative while evaluating a case of ARM. However, a detailed knowledge of pelvic floor anatomy is mandatory to avoid wrong interpretation and misdiagnosis.

Chlorpyrifos and dichlorvos in combined exposure reveals antagonistic interaction to the freshwater fish Mrigal, Cirrhinus mrigala

Toxicity imposed by organophosphate pesticides to the freshwater cultivable fish species mrigal (Cirrhinus mrigala) was assessed under laboratory conditions. Healthy juveniles were exposed to chlorpyrifos, dichlorvos, and their equitoxic mixture in geometric series. Median lethal concentrations of chlorpyrifos were found to be 0.906 (0.689-1.179), 0.527 (0.433-0.633), 0.435 (0.366-0.517) and 0.380 (0.319-0.450) mg/L and dichlorvos were found to be 38.432 (33.625-47.866), 22.477 (19.047-26.646), 12.442 (9.619-14.196) and 11.367 (9.496-13.536) mg/L after 24 h, 48 h, 72 h and 96 h of exposure respectively. Surprisingly, the joint toxicity of these organophosphates in the binary mixture was less than additive during most of the exposure periods. Behavioral changes exhibited by individual as well as mixture pesticide treatments were loss of schooling behavior, aggregating at corners of the test chamber, elevated opercular beatings, surplus mucus secretion, slight color changes and sudden and rapid body movements before death. Loss of fish equilibrium was noticed only in chlorpyrifos treated fish, whereas sluggish behavior was noticed only in mixture pesticide treatment. Such behavioral studies can be applied as a non-invasive bio-monitoring tool for water quality assessment for fish growth and development. Despite the same mode of action of both pesticides, the antagonistic action in the binary mixture is an interesting outcome of this research that requires further investigation for a lucid understanding of the joint toxicity mechanism of such pesticides.

Identification and Classification of Depressed Mental State for End-User over Social Media

In researching social network data and depression, it is often necessary to manually label depressed and non-depressed users, which is time-consuming and labor-intensive. The aim of this study is that it explores the relationship between social network data and depression. It can also contribute to detecting and identifying depression. Through collecting and analyzing college students' microblog social data, a preliminary screening algorithm for college students' suspected depression microblogs based on depression keywords, and semantic expansion is researched; a comprehensive lexical grammar was proposed. This research provided has a preliminary screening method based on depression keywords and semantic expansion for college students' suspected depression microblogs, with a screening accuracy. This method forms a depression keyword table by constructing the basic keyword table and the semantic expansion based on the word embedding learning model Word2Vec. Finally, the word table is used to calculate the semantic similarity of the tested microblogs and then identify whether it is a suspected depression microblog. The experimental results on the microblog dataset of college students show that the comprehensive lexical method is better than the SDS questionnaire segmentation method and the expert lexical method in terms of screening accuracy; the comprehensive lexical approach can quickly and automatically screen out a tiny proportion of suspected doubts from a large number of college students' microblogs. Depression Weibo can reduce the workload of experts' annotation, improve annotation efficiency, and provide a suitable data processing basis for the subsequent accurate identification (classification problem) of patients with depression.

Different dietary combinations of high/low starch and fat with or without bile acid supplementation on growth, liver histopathology, gene expression and fatty acid composition of largemouth bass, Micropterus salmoides

High dietary levels of fat and/or starch can lower the growth and cause extensive liver inflammation that is linked to mortalities in largemouth bass, Micropterus salmoides. However, bile acids (BA) may mitigate these adverse effects. In a 2 × 2 × 2 factorial feeding trial, M. salmoides juveniles were fed different combinations of dietary high (HF), low fat (LF), high (HS) or low starch (LS) levels with or without BA supplementations at 1% for 8 weeks. A total of 8 isonitrogenous diets were formulated to include, HF/LS, HF/HS, LF/HS, LF/LS, HF/LS-BA, HF/HS-BA, LF/HS-BA and LF/LS-BA. Survival, growth performance, feeding efficiency, whole-body proximate composition, muscle/liver fatty acid composition, hepatic expression of growth regulator (GH/IGF1 axis), lipid metabolism (fatty acid synthase 'FASN' and cholesterol 7 alpha-hydroxylase 'CYP7A1') and antioxidant capacity (superoxide dismutase 'SOD') genes as well as liver histopathology were assessed. Results showed that among diets without BA, there was no significant effect on growth or feeding efficiency, but when BA was included this led to more variable effects including significantly higher weight gain in the LF/HS-BA group compared to all others fed BA. The HF, HS or their combination led to extensive hepatic inflammation, but BA appeared to partially mitigate this in the LF/HS group (i.e. LF/HS-BA). No abnormal liver histopathology was observed in the LF/LS and LF/LS-BA treatments. Muscle 22:6n-3 was significantly higher in the HF/LS and HF/HS-BA groups compared to those fed the HF/HS or LF/LS diets. Dietary fat had a significant effect on the moisture, crude lipid, and caloric content of M. salmoides. Hepatic expression of IGF-I and CYP7A1 were differentially modulated under different treatments. Overall, these results show that BA can alleviate some liver inflammation caused by high dietary starch; however the LF/LS diets led to a better balance between growth performance and liver health.

Modulations of blood biochemical parameters of golden mahseer, Tor putitora following exposures to single and mixed organophosphate

Increasing pesticide application is a serious threat to human health and biodiversity. In nature, pesticides prevail in mixtures; therefore the joint effects of pesticides should be taken into consideration due to their priority in toxicity research when aiming at realistic evaluations. In this study, individual and mixture toxicity of the commonly used organophosphate insecticides- chlorpyrifos and dichlorvos was explored. Healthy and clinically active juveniles of golden mahseer (Tor putitora) were exposed to sub-lethal doses (10% of the 96 h-LC₅₀) of the chlorpyrifos, dichlorvos, and their mixture. Blood sampling was conducted after 24 h and 96 h of exposure, followed by a 1 week recovery period. Among the examined biochemical parameters; blood glucose in dichlorvos treatment; alanine aminotransferase and alkaline phosphatase in chlorpyrifos and dichlorvos treatments; and aspartate aminotransferase and urea in mixture pesticide treatments were elevated. In contrast, blood albumin and triglycerides were diminished in mixture pesticide treatments. Vital organs like kidney and liver of the tested animals were compromised to different magnitudes in different pesticide treatments. Kidney was found to be more sensitive than liver in terms of pesticide toxicity during this short exposure experiment. This study revealed that most of the biomarkers were mainly affected at a later exposure phase (after 96 h) and steadily recovered during the depuration period.

Effects of bioprocessed soybean meal and nucleotide supplementation on growth, physiology and histomorphology in largemouth bass, Micropterus salmoides, juveniles

In this 8-week feeding trial, the effects of nucleotide (N) supplementation (at 0.05%) were compared in diets with conventional soybean meal (CSBM or CSBM + N) versus bioprocessed SBM (BSBM or BSMB + N) on largemouth bass, Micropterus salmoides, juveniles. A total of five isonitrogenous and isolipidic diets were formulated, with the control diet being fishmeal-based. Growth, feeding efficiency, proximate composition, hepatic expression of genes involved in lipid metabolism and growth as well as liver/intestinal histopathology were assessed. Results showed that growth was significantly higher in fish fed the control diet, but there was no significant effect of SBM type or nucleotide supplementation on growth, feeding efficiency, or proximate composition. Hepatic expression of growth hormone (GH), insulin-like growth factor I (IGFI), superoxide dismutase (SOD), fatty acid synthase (FASN) and cholesterol 7 alpha-hydroxylase (CYP7A1) were unaffected by the diets. Tumor necrosis factor alpha (TNF-α) and transforming growth factor beta (TGF-β) were significantly downregulated and upregulated, respectively, in the SBM-based treatments compared with the control. The intestinal villi were significantly shorter and wider in fish fed the CSBM diet compared to the other treatments. The villi height and width were similar between the control and those fed the BSMB + N diet. It may be possible that the unaffected growth by nucleotides were due to an insufficient dose and/or undisrupted nucleotide synthesis due to being cultured under good conditions. Meanwhile, the unaffected growth in the SBM treatment could indicate a tolerance of M. salmoides to plant proteins and associated antinutritional factors. Nevertheless, BSBM and/or nucleotides appeared to mitigate some adverse effects of dietary SBM to the intestinal histomorphology in M. salmoides.

Currarino syndrome or Hirschsprung disease: how to prevent diagnostic dilemma in chronic constipation

Background

Currarino syndrome is a rare congenital malformation having autosomal dominant inheritance. It comprises of anorectal malformation, presacral mass, and sacral vertebral defect occurring in variable proportion. The most common presentation is chronic constipation which is usually due to compression of rectum by anterior sacral mass. If clinical examination is not properly done and digital rectal examination is excluded from the examination, it can be misdiagnosed as other common cause of constipation like Hirschsprung disease.

Case presentation

We are reporting one such case of one-and-half-year-old female child with chronic constipation which was initially managed as Hirschsprung disease, but later on, after a repeat clinical examination with digital rectal examination, it was evaluated on the line of Currarino syndrome. The diagnosis was confirmed by contrast-enhanced computed tomography of abdomen with 3 dimensional reconstruction. It was then managed by posterior sagittal approach with excision of mass and anorectoplasty.

Conclusion

A proper protocol for clinical evaluation of patient with constipation prevents diagnostic dilemma between surgical causes of constipation in pediatric age group. Digital rectal examination must be included in the protocol for evaluation of chronic constipation. In pediatric age group, clinical workup should be done with keeping in mind the rare diagnosis of Currarino syndrome along with common cause of constipation like Hirschsprung disease.

Pseudotail with closed neural tube defect and neurogenic bladder masquerading as posterior urethral valve: a case report

Background

Pseudotail with occult spinal dysraphism with neurological deficit is a rare phenomenon. Ignoring pseudotail as sign of occult spinal dysraphism may lead to catastrophe in diagnosis and further management.

Case presentation

We are reporting a case of a 30-month-old male child who presented with a tail-like structure at lower back and dribbling of urine since birth. On initial evaluation at some other hospital, he was misdiagnosed as posterior urethral valve and underwent fulguration of valve. However, dribbling of urine persisted after initial procedure. On evaluation at our center, he was found to have pseudotail with occult spinal dysraphism and neurogenic bladder.

Conclusion

Pseudotail with occult spinal dysraphism with neurological deficit is a rare phenomenon. Neurogenic bladder in such case can be misdiagnosed as posterior urethral valve. So, neurogenic bladder with pseudotail should be evaluated cautiously to avoid misdiagnosis and mismanagement.

Joint toxicity assessment reveals synergistic effect of chlorpyrifos and dichlorvos to common carp (Cyprinus carpio)

Common carp (Cyprinus carpio) is an important aquaculture species. However, their production and health is sometimes threatened by pesticides. In common carp, extensive studies have been done for exposures of single pesticides, but effects of mixtures such as those of the commonly used chlorpyrifos and dichlorvos, are still unknown for this species. In the first phase of this work, an acute lethal exposure experiment was conducted to estimate 24 h to 96 h lethal concentrations (LC_10-90) of chlorpyrifos, dichlorvos and their mixture. Compared to dichlorvos, chlorpyrifos was found to be highly toxic to the tested species. Joint toxicity assessment of these pesticides in binary mixtures was dominated by synergism. In the second experimental phase, common carp were exposed to sub-lethal concentrations (LD-10% and HD-50% 96 h-LC₅₀) of individual pesticides and their mixture. General fish behaviors, buccal movements and feeding attempts by fish were recorded after 1 h, 24 h, 48 h, 72 h and 96 h whereas aerobic metabolism of fish was recorded for 0-24 h, 24-48 h 48-72 h and 72-96 h of exposure. All pesticide treatments elevated buccal movements and oxygen uptake in a dose dependent manner. Feeding depression was also observed by pesticide exposure. The augmented deleterious effect of these pesticides in a mixture suggests that joint toxicity assessment is critical to develop more realistic water quality standards and monitoring guidelines.

Coping strategies in response to different levels of elevated water hardness in channel catfish (Ictalurus punctatus): Insight into ion-regulatory and histopathological modulations

Water hardness above the optimal level can incite toxic effects in fish, which are often species specific. Hence, we aimed at obtaining insights on the potential effects of elevated water hardness as well as coping strategies in channel catfish (Ictalurus punctatus). First, a toxicity assay was performed where the 96 h-LC₅₀ was calculated as 4939 mg/L CaCO₃. Thereafter, to gain knowledge on the underlying adaptive strategies to high water hardness, fish were exposed to seven hardness levels (150, 600, 1000, 1500, 2000, 3000 and 4000 mg/L CaCO₃ at pH 8.15) for 15 days. Results showed that branchial activities of Ca²⁺-ATPase and Na⁺/K^+-ATPase, which facilitate Ca²⁺ uptake, reduced starting respectively from 1000 mg/L and 1500 mg/L CaCO₃. Nevertheless, Ca²⁺ burden in plasma and tissue (gills, liver and intestine) remained elevated. Hardness exposure also disturbed cations (Na⁺, K⁺, Mg²⁺) and minerals (iron and phosphorus) homeostasis in a tissue-specific and dose-dependent manner. Both hemoglobin content and hematocrit dropped significantly at 3000-4000 mg/L CaCO₃, with a parallel decline in iron content in plasma and gills. Muscle water content rose dramatically at 4000 mg/L CaCO₃, indicating an osmo-regulation disruption. Higher hardness of 3000-4000 mg/L CaCO₃ also incited a series of histopathological modifications in gills, liver and intestine; most likely due to excess Ca²⁺ accumulation. Overall, these data suggest that channel catfish can adapt to a wide range of elevated hardness by modulating Ca²⁺ regulatory pathways and histomorphological alterations, however, 1500 mg/L CaCO₃ and above can impair the performance of this species.

Conversion of Spent Coffee and Donuts by Black Soldier Fly (Hermetia illucens) Larvae into Potential Resources for Animal and Plant Farming

Nutritionally unbalanced organic waste can be converted into potential resources for animal and plant farming by culturing black soldier fly (Hermetia illucens) larvae (BSFL) and prepupae (BSFP). BSFL and BSFP are rich sources of protein and lipids, while the leftover excrement called "frass" can be used as an organic fertilizer. Using readily available resources, BSFL were cultured on spent coffee, donut dough or an equal blend for 35 days. Survival, productivity, daily pupation and biochemical composition of BSFL and BSFP were measured along with the nitrogen-phosphorus-potassium values of the frass. Survival was highest in the blend compared (81%) to spent coffee (45%) or dough (24%); however, BSFL and BSFP were significantly longer and heavier from dough. Stage and food significantly influenced the protein, lipid and glycogen content of the BSFL and BSFP, which tended to be higher in the latter. While fatty acids were often significantly higher in BSFL fed spent coffee, the amino acid composition of BSFL was generally higher in dough. Frass from the blend had significantly highest nitrogen content, while potassium and phosphorus were significantly higher and lower from spent coffee, respectively. Although coffee and donut dough were suboptimal substrates for BSFL, a blend of these produced BSFL and frass that were nutritionally comparable to soybean meal and many organic fertilizers, respectively.

Mixed toxicity of chlorpyrifos and dichlorvos show antagonistic effects in the endangered fish species golden mahseer (Tor putitora)

Golden mahseer (Tor putitora) is an economically important but endangered fish species in many countries. Increasing pesticide application can possess a threat to this species but their sensitivity to pesticides, typically chlorpyrifos and dichlorvos, is unknown. We determined 96 h-LC₅₀ of chlorpyrifos and dichlorvos to be 0.753 mg/L and 12.964 mg/L, respectively, indicating higher toxicity of chlorpyrifos than dichlorvos. Despite the same mode of action, their joint effect was antagonistic, with an additive index value of - 0.58 at 96 h-LC₅₀. Moreover, to get insights in the temporal sub-lethal effects, fish were exposed to 10% and 50% of the 96 h-LC₅₀ values of the respective pesticides. Aerobic metabolism, opercular movements, and feeding behavior were examined for sub-lethal end-points following 24 h, 48 h, 72 h and 96 h exposure. Both chlorpyrifos and dichlorvos in single exposures induced a significant drop in oxygen consumption rate; while it was significantly elevated in the mixed pesticide exposure. Accelerated opercular movements were observed in all pesticide treatment groups but were more persistent in chlorpyrifos treatments. Reduced feeding attempts were more pronounced in chlorpyrifos and mixture treatments wherein feeding attempts dropped to zero. Overall, the acute toxicity data reported in the present study can be used to assess the maximum tolerance level of golden mahseer to chlorpyrifos and dichlorvos, and their mixture. Furthermore, the sub-lethal end point responses can be applied in monitoring the environmental risk posed by these waterborne pesticides either individually or in combination to the aquatic life.

Physio-biochemical, metabolic nitrogen excretion and ion-regulatory assessment in largemouth bass (Micropterus salmoides) following exposure to high environmental iron

Iron overload is a significant water quality issue in many parts of the world. Therefore, we evaluated the potential toxic effects of waterborne elevated iron on largemouth bass (Micropterus salmoides), a highly valued sport and aquaculture fish species. First, a 96 h-LC₅₀ toxicity assay was performed to understand the tolerance limit of this species to iron; and was determined to be 22.07 mg/L (as Fe³⁺). Thereafter, to get a better insight on the fish survival during long-term exposure to high environmental iron (HEI) (5.52 mg/L, 25% of the determined 96 h-LC₅₀ value), a suite of physio-biochemical, nitrogenous metabolic and ion-regulatory compensatory responses were examined at 7, 14, 21 and 28 days. Results showed that oxygen consumption dropped significantly at 21 and 28 days of HEI exposure. Ammonia excretion rate (J_amm) was significantly inhibited from day 14 and remained suppressed until the last exposure period. The transcript concentration of Rhesus glycoproteins Rhcg2 declined; likely diminishing ammonia efflux out of gills. These changes were also reflected by a parallel increment in plasma ammonia levels. Under HEI exposure, ion-balance was negatively affected, manifested by reduced plasma [Na⁺] and parallel inhibition in branchial Na⁺/K⁺-ATPase activity. Muscle water content was elevated in HEI-exposed fish, signifying an osmo-regulatory compromise. HEI exposure also increased iron burden in plasma and gills. The iron accumulation pattern in gills was significantly correlated with a suppression of J_amm, branchial Rhcg2 expression and Na⁺/K⁺-ATPase activity. There was also a decline in the glycogen, protein and lipid reserves in the hepatic tissue from 14 days, 28 days and 21 days, respectively. Overall, we conclude that sub-lethal chronic iron exposure can impair normal physio-biochemical and ion-regulatory functions in largemouth bass. Moreover, this data set can be applied in assessing the environmental risk posed by a waterborne iron overload on aquatic life.

Differential modulation of oxidative stress, antioxidant defense, histomorphology, ion-regulation and growth marker gene expression in goldfish (Carassius auratus) following exposure to different dose of virgin microplastics

Goldfish (Carassius auratus) juveniles were exposed to virgin polyvinyl chloride microplastics (PVC-MPs) in triplicate at 0, 0.1 or 0.5 mg/L for four days. Afterwards, the histopathology of the gills, liver and intestines were examined, along with various antioxidant enzymes and indicators of oxidative damage (malondialdehyde (MDA) and hydrogen peroxide (H₂O₂)), in the brain, liver and gills. In addition, we also studied the expression of hepatic insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein 1 (IGFBP-1) and growth hormone (GH) receptor, while cortisol receptor (CR) and cytochrome P450 1A (CYP1A) gene expression were assayed in both the liver and gills. Histological analysis revealed PVC-MPs in the intestines at 0.1 and 0.5 mg/L, along with substantially shorter villi. The gills appeared undamaged by PVC-MPs exposure and had limited or no effect to antioxidant activity, Na⁺/K⁺-ATPase and H⁺-ATPase activity or plasma ion levels, but there was a prominent upsurge of the detoxification enzymes glutatione S-transferase (GST) activity and CYP1A expression. Livers showed inflammation and some occurrences of hemorrhaging and necrosis at 0.5 mg/L. While the brain showed some evidence of oxidative damage, the liver was the most susceptible to oxidative damage, based on increased MDA, H₂O₂ and various antioxidant enzymes. Hepatic expression of IGFBP-1 and GH receptor were significantly downregulated at 0.5 mg/L while CR was upregulated. Results indicate that exposure to environmentally relevant PVC-MP can cause oxidative damage in the brain and liver, adverse histomorphological changes to the intestine and liver and alter the gene expression in goldfish.

Ultrasound guided rhomboid intercostal block: A pilot study to assess its analgesic efficacy in paediatric patients undergoing video-assisted thoracoscopy surgery

Background and Aims

Ultrasound guided rhomboid intercostal plane block (RIB) is a relatively new regional anaesthesia technique that has shown to provide dermatomal coverage from T2-9 on the whole anterior and posterior hemithorax. It has proved effective in providing preemptive analgesia in various surgeries like mastectomy and thoracotomy. The aim of the study was to study the efficacy of RIB in paediatric patients: 7 to 12 years undergoing thoracoscopic surgeries in terms of analgesic requirement, pain scores and adverse effects.

Methods

In this randomised, prospective double-blind study, 40 American Society of Anesthesiologists I/II patients, of the age group 7-12 years scheduled for Video-assisted thoracoscopy (VATS) surgery were recruited. The patients were allocated to one of the two groups: group R: general anaesthesia + RIB (RIB group) and group F: general anaesthesia (FENT group). Perioperative opioid consumption and postoperative pain scores were recorded. Adverse effects like respiratory depression and nausea were also noted.

Results

Patients in group R required less intraoperative fentanyl dose (1.45 ± 0.65 vs 2.90 ± 0.45) (P < 0.05). Postoperative opioid consumption was also less in this group R (2.90 ± 0.91 vs 5.56 ± 1.08) (P < 0.05). Less number of patients experienced nausea (2 vs 6) and respiratory depression (2 vs 7) in group R.

Conclusion

Ultrasound guided RIB reduces perioperative opioid consumption in patients undergoing VATS surgery with lesser postoperative pain scores.

Structural correlations in the enhancement of ferroelectric property of Sr doped BaTiO3

The effect of Sr doping in BaTiO3(BTO) with nominal compositions Ba0.80Sr0.20TiO3(BSTO) have been explored on its structural, lattice vibration, dielectric, ferroelectric and electrocaloric properties. The temperature dependent dielectric results elucidate the enhancement in dielectric constant and exhibit three frequency independent transitions around 335, 250 and 185 K, which are related to different structural transitions. All these transitions occur at lower temperature as compared with pristine BTO, however; remnant electric polarization (Pr) of BSTO is much higher than in BTO. The value ofPris ∼5μC cm-2at room temperature and the maximumPr∼ 8μC cm-2is observed at tetragonal to orthorhombic and orthorhombic to rhombohedral transitions. The electro-caloric effect shows the maximum adiabatic change in temperature ΔT∼ 0.24 K at cubic to tetragonal transition. The temperature dependent synchrotron x-ray diffraction and Raman results show correlations betweenPr, crystal structure and lattice vibrations. Our results demonstrate the enhancement in ferroelectric properties of BTO with Sr doping. The origin of the enhancement in ferroelectric property is also discussed in correlations with the appearance of superlattice peak around room temperature due to TiO6octahedral distortion. These enhanced properties would be useful to design lead free high quality ferroelectric and piezoelectric materials.

Direct hybridization gap from intersite and onsite electronic interactions in CeAg2Ge2

Electronic and crystal structure studies are presented to describe the role of intersite and onsite interactions for antiferromagnetic ordering in CeAg2Ge2. The crystal structure showed a prominent magnetovolume effect with anomalous negative thermal expansion at low temperature as a consequence of itinerant electron magnetism. The direct hybridization gap with a V-shaped band observed in the angle resolved photoemission data at room temperature, indicates that spin polarized quasiparticle states exist in the gapped region. Valence band broadening and enhanced localization effects at low temperature indicate strong hybridization of the valence orbitals of Ce atoms with the near neighbor Ge atoms. We find that the intersite interaction between the Ce atoms at high temperature stabilizes the onsite interaction at low temperature that leads to the spin density wave type antiferromagnetism in CeAg2Ge2.

Image Guided Sclerotherapy of Masseteric Venous Malformations

Objective:

To describe results of image guided sclerotherapy of venous malformations (VM) localized in the masseter muscle.

Methods:

Retrospective review of prospectively maintained data was done to include consecutive cases treated over 5-year period, with minimum 6 months follow-up. Sclerotherapy was done using ultrasound (US) guided needle puncture(s) of the lesions percutaneously, and 3% polidocanol foam injected under image guidance.

Results:

Seventeen cases (10 male, 7 female) with mean age 15.6 years (range 6-28 years) were identified. Clinical presentation was with facial asymmetry, becoming pronounced on jaw clenching, and three cases had mild local pain. On US, the lesions appeared as partially compressible masses with anechoic spaces, showing color filling on releasing probe pressure. Fourteen had phleboliths. Eight patients had undergone magnetic resonance imaging, lesions appearing as oval, homogenous, lobulated, T2 hyperintense masses, with heterogeneous contrast enhancement. Number of sclerotherapy sessions were—single in four cases, two in eight cases and three in five cases, for total of 35 sessions (average 2.05 session per patient). The mean dose of drug injected per session was 1.85 mL and total mean dose per patient was 2.79 mL. Post-procedure vomiting occurred in one patient while all had local swelling and mild pain, lasting between 3 to 7 days. No facial nerve palsy or sloughing/ulceration/skin necrosis was noted. On US follow-up (6-26 months, mean 15.9 months), 12 patients had small echogenic masses without any vascularity, and five had small anechoic areas <25%. All patients had complete resolution of swelling and pain.

Conclusions:

For VMs localized to the masseter muscle, image guided sclerotherapy is highly effective and safe, and recommended as first line treatment.

Self-knotting of distal end of nasogastric tube-Not an uncommon possibility

IMPORTANCE

A nasogastric tube is used commonly to decompress the stomach and provide enteral feeding in surgical and medical practice. Sometimes this safe and innocent-looking tube may lead to unexpected complications. We focus here on the possibility of spontaneous 'lariat loop' knotting of the nasogastric tube when some resistance is felt on tube retrieval and describe a method of safe tube removal.

CASE PRESENTATION

We present a case of self-knotting of a nasogastric tube that was placed to decompress the stomach during the postoperative period after surgical repair of anorectal malformation in a 4-month-old boy.

CONCLUSION

Self-knotting of the distal end of nasogastric tube is an unusual complication with catastrophic sequelae if not addressed properly. If any resistance is felt during nasogastric tube retrieval, self-knotting of the tube must be suspected.