Category: Nevin Manimala

Spine (Phila Pa 1976). 2021 Aug 2. doi: 10.1097/BRS.0000000000004184. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective cohort study with chart review.

OBJECTIVE: To determine if there is a difference in reoperation rates for adjacent segment disease (operative ASD) in posterior cervical fusions (PCF) that stop at -C7 versus -T1/T2.

SUMMARY OF BACKGROUND DATA: There are surgical treatment challenges to the anatomical complexities of the cervicothoracic junction (CTJ). Current posterior cervical spine surgery is based on the belief that adjacent segment disease (ASD) occurs if fusions are stopped at C7 although there is varying evidence to support this assumption.

METHODS: Patients were followed until validated reoperations for ASD, membership termination, death, or 03/31/2020. Descriptive statistics and five-year crude incidence rates and 95% confidence intervals (CI) for operative ASD for PCF ending at -C7 or -T1/T2 were reported. Time-dependent crude and adjusted, multivariable Cox-Proportional Hazards models were used to evaluate operative ASD rates with adjustment for covariates or risk change estimates more than 10%.

RESULTS: We identified 875 patients with PCFs (beginning at C3 or C4 or C5 or C6) stopping at either -C7 (n = 470) or -T1/T2 (n = 405) with average follow-up time of 4.6 (±3.3) years and average time to operative ASD of 2.7 (±2.8) yrs. Crude overall incidence rates for stopping at -C7 (2.12% (1.02%-3.86%)) and -T1/T2 (2.48% (1.25%-4.40%)) were comparable with no statistical difference in risk (adjHR = 1.47, 95% CI = 0.61-3.53, P = 0.39). Additionally, we observed no differences in the probability of operative ASD in competing risk time-dependent models (Grey’s Test P = 0.448).

CONCLUSION: A large cohort of 875 patients with PCFs stopping at -C7 or -T1/T2 with an average follow-up of > 4 years found no statistical difference in reoperation rates for ASD (operative ASD).Level of Evidence: 3.

PMID:34341320 | DOI:10.1097/BRS.0000000000004184

Transl Psychiatry. 2021 Aug 2;11(1):416. doi: 10.1038/s41398-021-01536-y.

ABSTRACT

Depression is currently the leading cause of disability around the world. We conducted an epigenome-wide association study (EWAS) in a sample of 58 depression score-discordant monozygotic twin pairs, aiming to detect specific epigenetic variants potentially related to depression and further integrate with gene expression profile data. Association between the methylation level of each CpG site and depression score was tested by applying a linear mixed effect model. Weighted gene co-expression network analysis (WGCNA) was performed for gene expression data. The association of DNA methylation levels of 66 CpG sites with depression score reached the level of P < 1 × 10^-4. These top CpG sites were located at 34 genes, especially PTPRN2, HES5, GATA2, PRDM7, and KCNIP1. Many ontology enrichments were highlighted, including Notch signaling pathway, Huntington disease, p53 pathway by glucose deprivation, hedgehog signaling pathway, DNA binding, and nucleic acid metabolic process. We detected 19 differentially methylated regions (DMRs), some of which were located at GRIK2, DGKA, and NIPA2. While integrating with gene expression data, HELZ2, PTPRN2, GATA2, and ZNF624 were differentially expressed. In WGCNA, one specific module was positively correlated with depression score (r = 0.62, P = 0.002). Some common genes (including BMP2, PRDM7, KCNIP1, and GRIK2) and enrichment terms (including complement and coagulation cascades pathway, DNA binding, neuron fate specification, glial cell differentiation, and thyroid gland development) were both identified in methylation analysis and WGCNA. Our study identifies specific epigenetic variations which are significantly involved in regions, functional genes, biological function, and pathways that mediate depression disorder.

PMID:34341332 | DOI:10.1038/s41398-021-01536-y

Afr J Paediatr Surg. 2021 Oct-Dec;18(4):215-218. doi: 10.4103/ajps.AJPS_132_20.

ABSTRACT

BACKGROUND: This prospective comparative study aims to assess the efficacy of fibrin sealant to improve outcomes in paediatric patients operated for hypospadias.

MATERIALS AND METHODS: Forty consecutive patients with hypospadias were randomised into two groups of twenty patients each. The first group underwent hypospadias repair, technique depending on the type of hypospadias, whereas in the second group, fibrin sealant was used to reinforce the urethroplasty. Assessment was done with respect to the type of hypospadias, type of repair done, operative time, immediate post-operative complications (early ooze and skin flap-related complications), intermediate complications (urethra-cutaneous fistula) and delayed post-operative complications (penile torsion and poor cosmetic outcome) at follow-up. We also compared the overall improvement in outcome among the two groups.

RESULTS: First Group: The mean operative time was 1 h and 45 min. Complications were seen in nine patients: Early ooze (n = 2); skin flap-related complications (n = 3); fistula (n = 7); poor cosmetic outcome (n = 7) and penile torsion (n = 4). Second Group (Fibrin Sealant): The mean operative time was 1 h and 30 min. Post-operative complications were observed in five patients: Coronal fistula (n = 3) and poor cosmetic outcome (n = 3). On comparing, the differences in outcomes of ooze, skin flap-related complications and torsion were found to be statistically significant with P < 0.05. The differences in the urethra-cutaneous fistula and cosmetic appearance were not found to be statistically significant. The difference in overall improvement in complications was found to be statistically significant.

CONCLUSION: Fibrin sealant, when applied over the urethroplasty suture line as a waterproof cover, may help to improve the outcome in patients with hypospadias.

PMID:34341306 | DOI:10.4103/ajps.AJPS_132_20

Afr J Paediatr Surg. 2021 Oct-Dec;18(4):219-223. doi: 10.4103/ajps.AJPS_159_20.

ABSTRACT

BACKGROUND: Congenital heart defects (CHDs) are one of the most common associated anomalies in patients with an orofacial cleft (OFC). However, few studies have shown the association between cleft type and CHDs in our population. This study aimed to assess the prevalence of CHDs in a cohort of OFC patients at a tertiary health facility in Nigeria, as well as assess the risk of CHD by OFC type.

MATERIALS AND METHODS: This was a prospective study design. Patients with an OFC were consecutively enrolled at a single OFC treatment facility. All subjects were assessed by a paediatric cardiologist and had echocardiography done. They were categorised based on the presence of CHDs, as well as the OFC phenotypic type (cleft lip and/or alveolus, cleft lip and palate and cleft palate only). Statistical analysis was done using STATA version 14 (College Station, Texas), and significance was set at P < 0.05.

RESULTS: A total of 150 subjects enrolled in the study over a period of 2 years (2018-2020). The median age of subjects was 6 months (interquartile range: 2-24), and 54.7% were female. The prevalence of CHDs in the subjects reviewed was 30.7%. Based on the severity of CHDs, the majority presented with simple defects (95.6%). Overall, the most common presentation was patent foramen ovale (12.7%), followed by septal defects (8.0%). There was no significant association between cleft type and the odds of a CHD.

CONCLUSION: The study reports a relatively high prevalence of CHDs in patients with OFC; however, there was no association between the risk of CHD by cleft type. Although a majority of CHDs may pose a low operative risk, cardiac evaluation is recommended for all cases of OFC to aid the identification of potentially high-risk cases.

PMID:34341307 | DOI:10.4103/ajps.AJPS_159_20

Afr J Paediatr Surg. 2021 Oct-Dec;18(4):190-194. doi: 10.4103/ajps.AJPS_166_20.

ABSTRACT

INTRODUCTION: Intra-peritoneal collection (IPC) following laparoscopic appendectomy (LA) of complicated appendicitis in children is a serious complication. This is associated with a longer duration of hospital stay, more costs, and psychological upsets of both children and their parents. The aim of this study is to evaluate different factors that may affect the development of IPC following LA of complicated appendicitis.

PATIENTS AND METHODS: Seventy-five children were admitted with acute complicated appendicitis. All of them had LA between January 2016 and October 2020. The following variables were studied: patients’ demographics, clinical findings, laboratory and imaging studies and operative parameters. Patients were divided according to their post-operative course into two groups; Group (A): patients with IPC (n = 19), Group (B): patients without IPC (n = 56). Potential risk factors for the development of post-operative IPC were identified by univariate and multivariate logistic regression analysis.

RESULTS: Nineteen cases (25.3%), out of 75 patients, presented with post-operative collection. Forty-seven (62.7%) patients were males, the overall median age was 11 (inter-quartile range [IQR] 10-13). The most significant operative variable was the operative time, which was significantly longer in Group A, 78 min (IQR 75-88) versus 56 (50-66), P = 0.001. The following variables were associated with an elevated incidence of post-operative IPC; age, body mass index, total leucocytic count (TLC), duration of symptoms, pediatric appendicitis score, pre-operative morbidity, being on medications, operative time, suction and irrigation or suction only and drain duration. In the multivariate model, TLC (odds ratios [OR]: 1.358, P 0.006), symptoms duration (OR: 2.051, P 0.012), morbidity (OR: 2.064, P 0.041) and operative time (OR: 2.631, P 0.039) were statistically significant and confirmed as being predictors of IPC post-LA in complicated appendicitis.

CONCLUSION: Post-operative IPC is quite common after LA for complicated appendicitis. Increased TLC, prolonged symptoms duration, associated co-morbidity and operative time could be predictors of its occurrence. Improving general condition, surgical technique and reducing operative time help to reduce its incidence.

PMID:34341301 | DOI:10.4103/ajps.AJPS_166_20

Afr J Paediatr Surg. 2021 Oct-Dec;18(4):205-209. doi: 10.4103/ajps.AJPS_134_20.

ABSTRACT

BACKGROUND: A neck mass is any abnormal lesion in the neck that can be seen, palpated, or identified on imaging. It is one of the most common reasons for presentation to the surgical clinics.

AIM: the aim is to analyse the clinical presentation and treatment outcome in children who were diagnosed and managed for neck masses in a tertiary centre in Northwestern Nigeria.

MATERIALS AND METHODS: The records of patients managed for neck masses over 7 years between January 2013 and December 2019 were reviewed. Demographic and clinical data were retrieved and analysed using Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA).

RESULTS: A total of 99 cases were reviewed and there were 52 (52.5%) males and 47 (47.5%) females with male-to-female ratio of 1.1:1, and mean age ± standard deviation of 4.4 ± 3.9 years, the primary complaints of all the patients were neck swellings. The anterior triangle was the most common region involved in 86 (86.9%) patients. The majority of the neck masses were congenital, accounting for 71 (71.8%) patients. Ultrasound scanning was the most commonly requested radiological investigation done in 87 (87.8%) patients.

.: Thyroglossal duct cyst was the most common paediatric neck mass seen in 41 (41.4%) patients. The majority of the patients 68 (68.7%) had an excisional biopsy of the lesion. Surgical site infection was the most common complication noted in 7.1% of the study population.

CONCLUSION: Most of the neck masses were congenital and were managed surgically. Prompt diagnosis with appropriate treatment may result in a good outcome.

PMID:34341304 | DOI:10.4103/ajps.AJPS_134_20

Indian J Pathol Microbiol. 2021 Jul-Sep;64(3):524-527. doi: 10.4103/IJPM.IJPM_665_20.

ABSTRACT

BACKGROUND: The COVID-19 pandemic lockdown has forced university hospitals to forego traditional classes and embrace online teaching platforms as the sole modality of medical education. Herein, we describe our experience of shifting from the arena of a real to a virtual classroom during the lockdown phase. Materials and.

METHODS: The institutional subscription of G-suite was used for creating a virtual Google classroom. Google Calendar, Google Meet, and Google Forms were used for notification of schedules, conducting theory and practical classes, and conducting assessments, respectively. The learner-centric SNAPPS model was adapted for an interactive case-based learning (CBL) program using multimedia tools. Students’ perspective on online education was assessed based on their responses to a validated questionnaire.

RESULTS: The conduction of online classes, particularly the live practical classes and the CBL program got the maximum affirmative (up to 85%) responses. Students of the same batch also performed better in a test following the online CBL (77.03% vs 73.3%, P = 0.03, paired t-test statistically significant) compared to a test before it. However, access to laptops and poor Internet connectivity were significant causes of concern for nearly 40% of students.

CONCLUSION: The use of virtual classroom has proved to be an efficient method for continuing teaching of Pathology to MBBS students in times of lockdown when face-to-face conventional teaching was not possible. The experience indicated that in the future a judicious mixture of traditional and online classes may be a more effective educational design for teaching Pathology to MBBS students.

PMID:34341264 | DOI:10.4103/IJPM.IJPM_665_20

Afr J Paediatr Surg. 2021 Oct-Dec;18(4):182-186. doi: 10.4103/ajps.AJPS_102_20.

ABSTRACT

INTRODUCTION: Acute appendicitis is the most common surgical emergency with a lifetime incidence of 7%-8%. There are two operative modalities that are currently used for the management of this condition in the paediatric population. The objective of this cohort study was to review the outcome of the management of paediatric surgical patients presenting with acute appendicitis after either an open appendectomy (OA) or laparoscopic appendectomy (LA) was performed.

METHODS: This was a 2-year retrospective study conducted from 01 January 2016 until 31 December 2017 on paediatric surgical patients < 13 years of age undergoing appendectomies. Eighty-one (n = 81) files of patients were reviewed, and data analysis was performed on two comparative groups namely the OA group and LA group, with the aid of the SAS system with statistical significance based on P < 0.05.

RESULTS: During the study period, 81 children (male: female ratio of 2:1) underwent appendectomies. Nearly 38% (n = 31) of the cases had an OA, with 62% (n = 50) of the cases having an LA. Seven (14%) LA cases were converted to OA. Simple appendicitis accounted for 16% (n = 13) of the patients, with complicated appendicitis accounting for 79% (n = 64) and other pathologies accounting for 5% (n = 4). There were no post-operative complications in the cases of simple appendicitis. Six cases (15.38%) in the LA group versus two cases (5.26%) in the OA group developed intra-abdominal collections, which was statistically significant (P = 0.018). One (2.56%) patient in the LA group versus two patients (7.89%) in the OA group developed intestinal ileus (P = 0.09). Two patients (5.13%) in the LA group versus six patients (15.79%) in the OA group developed surgical-site infection, which was statistically significant (P = 0.013). The mean days of hospital stay was 4.51 days in the LA group versus 5.34 days in the OA group, which was statistically significant (P = 0.016). There were no re-admissions or re-operations in the simple appendicitis group. In the complicated appendicitis cases, five cases (12.82%) were re-admitted in the LA group compared to five cases (13.16%) in the OA group (P = 0.943). Two (5.13%) cases had a re-operation in the LA group compared to one case (2.63%) in the OA group (P = 0.360).

CONCLUSION: Considering that there was an increased incidence of complicated cases and operations being performed by trainees, LA appears feasible at a tertiary-level hospital in a developing country, as shown in this study. Therefore, cases of simple appendicitis can be performed laparoscopically; however with regard to complicated appendicitis, there is no superiority between the two operative modalities in this study, which is consistent with international literature. However, in this study, it can be postulated that the learning curve was a major contributory factor to the increased levels of complications, as all operations were performed by trainees. Therefore, we recommend implementation of adequate simulation practices in laparoscopy in the setting of a developing country to attain the laparoscopic expertise of our international counterparts in order to improve the standard of care.

PMID:34341299 | DOI:10.4103/ajps.AJPS_102_20

Indian J Pathol Microbiol. 2021 Jul-Sep;64(3):479-483. doi: 10.4103/IJPM.IJPM_612_20.

ABSTRACT

AIM: The present study evaluates the prognostic significance of perineural invasion (PNI) on 2-year, 5-year, and overall survival in patients undergoing gastrectomy and D2 lymphadenectomy due to locally advanced gastric cancer.

MATERIALS AND METHODS: Included in the study were 231 patients who underwent surgery between November 2006 and October 2018 due to stage 1B and over locally advanced gastric cancer, whose records were reviewed retrospectively.

STATISTICAL ANALYSIS: The variables in the presence or absence of PNI were compared between the two groups with a Chi-square test, a Fisher’s exact test, a likelihood ratio, and a Mann-Whitney U test. Overall survival data were evaluated with a Kaplan-Meier test. Prognostic factors were evaluated with a stepwise Cox regression analysis.

RESULTS: PNI was identified in 167 (72.3%) of the patients. The 2-year, 5-year, and overall survival rates at the end of the follow-up period were 85.9%, 70.3%, and 64.1% in those without PNI, and 52.7%, 38.3%, and 36.5% in those with PNI, respectively. In a multivariate analysis, PNI appeared to be a significant prognostic factor for 2-year survival (P = 0.04) but had no effect on 5-year and overall survival.

CONCLUSIONS: Survival was shorter in patients with PNI than in patients without PNI, and PNI had no effect on overall survival, although it was found to be of prognostic significance for 2-year survival.

PMID:34341257 | DOI:10.4103/IJPM.IJPM_612_20

Indian J Pathol Microbiol. 2021 Jul-Sep;64(3):484-489. doi: 10.4103/IJPM.IJPM_337_20.

ABSTRACT

BACKGROUND AND AIMS: An early correct diagnosis of celiac disease (CD) is fundamental to reversal of symptoms and prevention of complications in pediatric patients. Our aim was to evaluate the role of duodenal bulb biopsy by studying the degree of mucosal damage in the duodenal bulb (D1) and second part of the duodenum (D2) and correlating the findings with serum IgA anti-tTG levels.

SETTINGS AND DESIGN: Pediatric patients (age <18 years) with clinical suspicion of CD and positive IgA anti-tTG titers were consecutively enrolled over a period of one year. Demographic variables, anthropometry, clinical history, laboratory values and endoscopic findings were studied. Endoscopic biopsies obtained from D1 and D2 were evaluated and assigned histopathologic grades that were correlated with serology.

STATISTICAL ANALYSIS USED: Descriptive statistics were employed.

RESULTS: A total of 37 clinically suspected cases of pediatric CD were studied. The mean age was 6.7 years and the M:F ratio was 1:1.3. Thirty-two (32) children had varying degrees of growth impairment. Eight (8) children had only extra-intestinal symptoms. Thirty (30) children were anemic, hypoalbuminemia was seen in five (5) children while transaminitis was seen in two (2) children. IgA anti-tTG >300 U/ml was associated with Marsh-Oberhuber Grade 3 morphology at atleast one site.

CONCLUSIONS: Low positive serology values should be confirmed by histopathology. Biopsies should be taken even in the absence of endoscopic abnormality. Additional D1 biopsies placed in a separate container can increase the diagnostic yield.

PMID:34341258 | DOI:10.4103/IJPM.IJPM_337_20