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Author(s): Rakesh Kumar [1,2]; Madhuri Evangeline Sadanala [2]; Santosh Nagasubramanian [2]; Anjana Joel [3]; Arun Joseph Philip George [2]; S Mahasampath Gowri [4]; Partho Mukherjee [2]; Ashish Singh [3]; Rajiv [...], Introduction: Chemotherapy, postchemotherapy retroperitoneal lymph node dissection (pcRPLND), and metastasectomy remain the standard of care for the management of advanced nonseminomatous germ cell tumor (NSGCT). Methods: We retrospectively studied 73 patients who had pcRPLND at a single tertiary-care center (2003-2022). Surgical and clinicopathological features and oncological outcomes are presented. Results: The mean age was 28.27 years (15-48). Three-fourths had Stage III disease at diagnosis. International Germ Cell Cancer Collaborative Group risk stratification was 54.54 and 21.21 in intermediate risk, and poor risk, respectively. Sixty-two patients had Standard, 7 had Salvage and 4 underwent Desperation pcRPLND. Eleven patients (15.06) required adjunctive procedures. Thirteen patients (17.8) had ≥ class 3 Clavien-Dindo complications and postoperative mortality occurred in 5 (6.8) patients. The histopathologies (HPE) of the pcRPLNDs were necrosis, teratoma, and viable tumor in 39.7, 45.2, and 15.1, respectively. Seven patients underwent metastasectomy. An 85 size reduction in the size of RPLN predicted necrosis. There was 71.4 concordance between pcRPLND and metastasectomy HPEs. The median follow-up was 26.72 months (inter-quartile range - 13.25-47.84). The 2-year recurrence-free survival (RFS) rate was 93 (95 confidence interval [CI]-83-97) and the overall survival (OS) rate was 90 (95 CI-80-95). This is the largest series of pcRPLND for NSGCT in India to our knowledge. Conclusion: Although most of the cohort belonged to stage III, an RFS and OS rate of >90 at 2 years was achieved. We believe that successful management of postchemotherapy residual masses in NSGCT is contingent on the availability of multidisciplinary expertise and is therefore best done at tertiary-care referral centers.

Background: Parenting style may be an important and modifiable contributor to behavioral difficulties in very preterm children. Objectives: This study assessed the relationship between parenting styles and the behavior of very preterm and term preschool children. Study Design: This was a cross-sectional comparative study. Methods: The Parenting Styles and Dimensions Questionnaire and the Strengths and Difficulties Questionnaire were administered to 30 parents of very preterm children and 30-term children. Results: Children of permissive parents were more likely to demonstrate problems with behavior compared to children of authoritative parents (95% confidence interval [CI], odds ratio [OR]: 37.4 [3.6–392.6]) in the Chi-square analysis adjusted for socioeconomic status. Children of permissive parents exhibited higher rates of emotional problems (95% CI, OR: 5.2 [1.2–22.3]), hyperactivity (95% CI, OR: 7.05 [1.6–31.6]), and decreased prosocial behavior (95% CI, OR: 6.5 [1.5–28.2]. Conclusion: Permissive parenting was found to be associated with behavioral difficulties. This reiterates the role of parent education in teaching functional strategies for handling children's behavior. [ABSTRACT FROM AUTHOR]

Introduction: Rhabdomyolysis (RM) is a condition where there is injury to striated muscle fibers causing release of myoglobin, creatine phosphokinase (CPK), and other intracellular contents into the circulation. High myoglobin levels cause acute kidney injury (AKI). Trauma is the most common cause of RM and development of complications related to the degree of myoglobin released. Currently, the degree of RM is assessed and treatment is instituted based on serum CPK. As myoglobin is the direct cause of AKI, we set out to determine if serum myoglobin is a more reliable predictor than CPK for the development of AKI in traumatic RM. Methodology: A prospective observational study of 90 patients was admitted to the surgical Intensive Care Unit/high dependency unit of a tertiary hospital with traumatic RM whose serum CPK >5000 U/L. Along with standard treatment including intravascular volume optimization and hemodynamic stabilization, they were treated with "crush protocol." Daily/twice a day, serum CPK and myoglobin were estimated. Categorical data are expressed as frequency and percentage, and the continuous variables are presented as mean (standard deviation) or median (interquartile range) based on normality. Other statistical analyses were done using the Chi-square test, independent t-test, and rank sum test based on normality. Results: Fourteen out of 90 patients developed AKI and one patient required renal replacement therapy. CPK value of >12,000 U/l was identified to have 64% sensitivity and 56% specificity for developing AKI whereas serum myoglobin value of >5000 ng/ml was identified to have 78% sensitivity and 77% specificity for developing AKI. Conclusion: Following traumatic RM, in patients on "crush protocol," serum myoglobin is a more sensitive and specific test than serum CPK, for predicting AKI. [ABSTRACT FROM AUTHOR]

Dear Editor, Cerebral visual impairment (CVI) is defined as a disorder of vision related to brain injury or dysfunction not attributable to ocular or anterior visual pathway disorder.[[1]] It has been reported to be one of the commonest causes of childhood visual impairment.[[2]] A retrospective study (Institutional Review Board no 12602, dated 29.1.2020) was carried out in children who visited our clinic over 15 months in a tertiary care hospital who were diagnosed as having profound visual impairment due to CVI. The results of this study indicate that vision stimulation strategies administered with good compliance, spectacles prescribed for hypoaccommodation, and healthy optic disc were associated with better visual outcomes. [Extracted from the article]

Objective: To compare perioperative and oncological outcomes between stapler and manual closure in patients undergoing total laryngectomy for advanced endolaryngeal squamous cell carcinoma., Methods: Patients with advanced endolaryngeal tumours operated between July 2017 and July 2023 were retrospectively dichotomised into stapler closure and manual closure cohorts and compared., Results: Seventy-one patients with a median age of 57 years were included in our study. The median surgical duration was 270 minutes for the manual closure cohort and 245 minutes for the stapler closure cohort. The pharyngo-cutaneous salivary fistula rate was 6 per cent less in the stapler closure cohort. The estimated mean survival was not significantly different 54.5 months (95 per cent, confidence interval 46.3-62.71) in the manual closure cohort versus 28.12 months (95 per cent, confidence interval 23.6-32.63) in the stapler closure cohort ( p = 0.79)., Conclusion: Stapler closure can be used in endolaryngeal tumours, and it reduces operating time, thus facilitating efficient utilisation of operation time with non-inferior oncological outcomes as compared to traditional manual closure.