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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.

PURPOSEThis study aims to compare the imaging findings of carotid body tumors on contrast-enhanced computed tomography (CT) with the intraoperative Shamblin grade and to evolve an imaging-based scoring system that can accurately predict the Shamblin grade.METHODSPreoperative contrast-enhanced CT scans of 40 patients who underwent surgical excision of carotid body tumors in our institution between 2004 and 2017 were retrospectively reviewed. The angle of contact with the internal carotid artery (ICA), tumor volume, presence of peritumoral tuft of veins, loss of tumor adventitia interface and distance from the skull base were assessed and compared with the intraoperative Shamblin grades of the tumor. Ordinal logistic regression was used to determine which parameters could be predictors of the Shamblin grades. Receiver operator characteristic (ROC) curves were used to score the tumor volumes.RESULTSAmong the 42 tumors evaluated, 6 (14.3%) were surgically classified as Shamblin I, 15 (35.7%) as Shamblin II, and 21 (50%) as Shamblin III tumors. Pairwise comparison between the three Shamblin groups showed a statistically significant difference for angle of contact with ICA, maximum tumor dimension, presence of peritumoral tuft of veins and loss of tumor adventitia interface (p = 0.001, p = 0.001, p = 0.038 and p = 0.003, respectively). However, tumor volumes and distance from skull base were not significantly different between the Shamblin groups (p = 0.136 and p = 0.682). A scoring system, including four of the above mentioned parameters (angle of contact with ICA, tumor volume, presence of peritumoral tuft of veins, and loss of tumor adventitia interface) was developed with a maximum score of 8 and a minimum of 2. A statistically significant difference was found between the final scores among the three Shamblin groups (p < 0.001). Using ROC curves, a final score of ≥6 was found to separate Shamblin grade III tumors from grade I and II tumors (sensitivity, 95.24%; specificity, 71.43%). All patients with documented intraoperative estimated blood loss of >1000 mL had Shamblin grade III tumors. Postoperative complications like stroke, ICA thrombosis and lower cranial nerve palsies were seen only with Shamblin grade II and III tumors.CONCLUSIONThe simple scoring system we have proposed correlates well with the Shamblin grade and helps in identifying patients who have a higher risk of developing complications.

Introduction: Vibrio cholerae (V. cholerae) infection (O1, O139, and non-O1/non-O139) in children can occur in the form of gastroenteritis and bacteraemia. Aim: To describe and compare the clinical characteristics, laboratory profile and outcome of children with gastroenteritis due to V. cholerae O1, O139 and V. cholerae non-O1/non-O139 and to present a case series describing the clinical and laboratory profile and outcome of children with V. cholerae non-O1/non-O139 bacteraemia. Materials and Methods: A retrospective study was conducted on the medical records of children under 15 years of age in whom V. cholerae was identified in stool culture or blood culture. The children who presented from January 2010 to November 2018 in Christian Medical College and Hospital, Vellore, India were included. The following details were noted: symptoms and signs (including vital signs and state of dehydration) at presentation, co-morbidities, anthropometry, complete blood counts, serum electrolytes, creatinine, reports of stool culture, blood culture and antibiotic susceptibility, details of treatment given (including hospital admission, IV fluids and antibiotics) and outcome. The group-wise comparison for continuous variables was done using Independent t-test. The categorical data among the groups were compared using the chi-square test. Results: Among the 8990 stool cultures and 1,23,005 blood cultures done in children during the study period for various reasons, V. cholerae had grown in stool culture of 105 children and blood culture of six children. Children with V. cholerae O1 were more tachypnoeic/acidotic (44.8% vs. 10.0%; p

Objective Motor impairments related to hand function are common symptoms in patients with movement disorders, such as Parkinson’s disease (PD) and focal hand dystonia (FHD). However, hand dysfunction has not been quantitatively assessed as a clinical tool for screening patient groups from healthy controls (HCs). The aim of our study was 1) to quantitatively assess hand dysfunction in patients with PD and FHD and its usefulness as a screening tool 2) to grade disease severity in PD and FHD based on hand dysfunction. Methods The current case-control study included HCs (n = 50) and patients with known history of PD (n = 25) or FHD (n = 16). Hand function was assessed by a precision grip task while participants lifted objects of 1.3 N and 1.7 N under dry skin conditions, followed by very wet skin conditions (VWSCs). Receiver operating characteristic and summative scoring analyses were performed. Results In PD, the combination of loading phase duration and lifting phase duration at quantitative cutoffs of 0.36 and 0.74 seconds identified 21/25 patients as diseased and 49/50 subjects as HCs with 1.7 N under VWSCs. In PD, 5/21 was graded as “mild” and 16/21 as “moderate cases.” In FHD, slip force at a cutoff of 1.2 N identified 13/16 patients as diseased and 41/50 subjects as HC with 1.7 N under VWSCs, but disease severity could not be graded. Conclusion Our results demonstrate the use of precision grip task as an important clinical tool in assessment of hand dysfunction in movement disorder patients. Use of quantitative cutoffs may improve diagnostic accuracy and serve as a valuable adjunct to existing clinical assessment methods.

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]

Socioeconomic status (SES) scales measure poverty, wealth and economic inequality in a population to guide appropriate economic and public health policies. Measurement of poverty and comparison of material deprivation across nations is a challenge. This study compared four SES scales which have been used locally and internationally and evaluated them against childhood stunting, used as an indicator of chronic deprivation, in urban southern India.A door-to-door survey collected information on socio-demographic indicators such as education, occupation, assets, income and living conditions in a semi-urban slum area in Vellore, Tamil Nadu in southern India. A total of 7925 households were categorized by four SES scales-Kuppuswamy scale, Below Poverty Line scale (BPL), the modified Kuppuswamy scale, and the multidimensional poverty index (MDPI) and the level of agreement compared between scales. Logistic regression was used to test the association of SES scales with stunting.The Kuppuswamy, BPL, MDPI and modified Kuppuswamy scales classified 7.1%, 1%, 5.5%, and 55.3% of families as low SES respectively, indicating conservative estimation of low SES by the BPL and MDPI scales in comparison with the modified Kuppuswamy scale, which had the highest sensitivity (89%). Children from low SES classified by all scales had higher odds of stunting, but the level of agreement between scales was very poor ranging from 1%-15%.There is great non-uniformity between existing SES scales and cautious interpretation of SES scales is needed in the context of social, cultural, and economic realities.

The novel and fused thiabenzene-1-methyl-1-oxide analogs (5a-e) were synthesized by the reaction of Dimethylsulfoxoniummethylide (DIMSOY) and 4-alkoxy-2H-chromene-carboxaldehydes with cyclic Michel acceptors and having a leaving group at β-position. The compounds thus prepared were characterized by mass analysis, 1H and 13C NMR techniques and screened for their antibacterial activity by in vitro and in silico studies. The antibacterial activity of all the purified analogs (5a-e) were determined for Methicillin-resistant Staphylococcus aureus (MRSA) by disk diffusion technique. Molecular docking studies for these compounds (5a-e) were performed against Tyrosyl-tRNA synthetase inhibitor using AutoDock. Also discussed the Density functional theory (DFT) computational studies for these compounds (5a-e). Infectious diseases caused by MDRB (multidrug resistant bacteria) are an important problem to be addressed globally. They have been among the leading causes of death, disability, growing challenges to health security and human progress, especially in developing countries for centuries. The inspiring preliminary results of these fused thisbenzene-1-methyl-1-oxide analogs (5a-e), upon further modification will produce a best drug candidate having anti-MRSA activity. [ABSTRACT FROM AUTHOR]

Background: Common mental disorders (CMD) cause a range of health, social and economic burden, and disorders like depression and anxiety are more prevalent among women. Prevalence and factors contributing to increased vulnerability for CMDs have regional variation. Identification of factors contributing to the vulnerability is essential to both psychiatric epidemiology and in addressing mental health challenges in the community. Methods: This cross-sectional study aimed at understanding the burden of CMD and its association with social determinants of mental health. Women hailing from urban slum attending the outpatient family care facility for their medical problems constituted the sample. Data was collected using a clinical research form with variables such as sociodemographic profile, health profile, and psychosocial profile. The questionnaire had specific questions on indicators of poverty, certain stressors, and support system. Presence of CMD was assessed using Clinical Interview Schedule-Revised (CIS-R), a standard tool for CMD research in primary care settings. A cut off score of 12 and above was considered for detecting CMD. Research ethical principles were adhered to and data was analyzed using SPSS 21.0. Results: Among 172 women, 77 (44.8%) were diagnosed to have CMDs. Univariate analysis revealed a significant association between age, marital status, living arrangement, educational level, difficulty with buying food, presence of debt, chronic medical illness, husband's alcohol use, marital satisfaction, experiencing abuse, family support, religious participation, and a diagnosis of CMD. Multivariate analysis showed high burden with nuclear family arrangement, difficulty to buy food, experiencing abuse and, low burden with higher educational level, family support, and religious participation. Conclusion: Considering the high prevalence and the treatment gap of CMDs in primary setting, family-physician should be sensitized for detection and management of CMDs. Social interventions targeting poverty, women's education and empowerment, and support system are likely to decrease the burden of CMDs in this population. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare the imaging findings of carotid body tumors on contrast-enhanced computed tomography (CT) with the intraoperative Shamblin grade and to evolve an imaging-based scoring system that can accurately predict the Shamblin grade.Methods: Preoperative contrast-enhanced CT scans of 40 patients who underwent surgical excision of carotid body tumors in our institution between 2004 and 2017 were retrospectively reviewed. The angle of contact with the internal carotid artery (ICA), tumor volume, presence of peritumoral tuft of veins, loss of tumor adventitia interface and distance from the skull base were assessed and compared with the intraoperative Shamblin grades of the tumor. Ordinal logistic regression was used to determine which parameters could be predictors of the Shamblin grades. Receiver operator characteristic (ROC) curves were used to score the tumor volumes.Results: Among the 42 tumors evaluated, 6 (14.3%) were surgically classified as Shamblin I, 15 (35.7%) as Shamblin II, and 21 (50%) as Shamblin III tumors. Pairwise comparison between the three Shamblin groups showed a statistically significant difference for angle of contact with ICA, maximum tumor dimension, presence of peritumoral tuft of veins and loss of tumor adventitia interface (p = 0.001, p = 0.001, p = 0.038 and p = 0.003, respectively). However, tumor volumes and distance from skull base were not significantly different between the Shamblin groups (p = 0.136 and p = 0.682). A scoring system, including four of the above mentioned parameters (angle of contact with ICA, tumor volume, presence of peritumoral tuft of veins, and loss of tumor adventitia interface) was developed with a maximum score of 8 and a minimum of 2. A statistically significant difference was found between the final scores among the three Shamblin groups (p < 0.001). Using ROC curves, a final score of ≥6 was found to separate Shamblin grade III tumors from grade I and II tumors (sensitivity, 95.24%; specificity, 71.43%). All patients with documented intraoperative estimated blood loss of >1000 mL had Shamblin grade III tumors. Postoperative complications like stroke, ICA thrombosis and lower cranial nerve palsies were seen only with Shamblin grade II and III tumors.Conclusion: The simple scoring system we have proposed correlates well with the Shamblin grade and helps in identifying patients who have a higher risk of developing complications. [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.