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Byline: Nutan, Vinod. Verma, Swati. Singh, Vinit. Thakur Introduction Post-operative distress is common among paediatric patients. The cause can be multifactorial such as thirst, hunger, pain, post-operative vomiting and emergence [...]

Atypical neurofibromatous neoplasm with uncertain biologic potential presenting as a paratesticular scrotal mass in a neonate with congenital giant melanocytic nevus is rare. Only one such case of neonatal scrotal neurofibroma has been reported earlier. We report an additional case and its management. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of duodenal perforation (DP) in children is often delayed. This worsens the clinical condition and complicates simple closure.Objectives: To explore the advantages of using T-tube in surgeries for DP in children.Patients and Methods: A retrospective study was conducted on all patients of DP managed in the Department of Paediatric surgery at a tertiary centre from January 2016 to December 2020. Clinical, operative and post-operative data were collected. Patients, with closure over a T-tube to ensure tension-free healing, were critically analysed.Results: A total of nine DP patients with ages ranging from 2 years to 9 years were managed. Five (55.6%) patients had blunt abdominal trauma; a 2-year-old male had perforation following accidental ingestion of lollypop-stick while a 3-year-old male had DP during endoscopic evaluation (iatrogenic) of bleeding duodenal ulcers; cause could not be found in other 2 (22.2%) patients. Of the five patients with blunt abdominal trauma, 4 (80%) had large perforation with oedematous bowel, necessitating repair over T-tube. Both patients with unknown causes had uneventful outcomes following primary repair with Graham's patch. Patients with lollypop-stick ingestion and iatrogenic perforation did well with repair over T-tube. The only trauma patient with primary repair leaked but subsequently had successful repair over a T-tube. One patient with complete transection of the third part of the duodenum and pancreatic injury who had repair over T-tube died due to secondary haemorrhage on the 10th post-operative day.Conclusion: Closure over a T-tube in DP, presenting late with oedematous bowel, ensures low pressure at the perforation site, forms a controlled fistula and promotes healing, thereby lessening post-operative complications. [ABSTRACT FROM AUTHOR]

Postoperative posterior reversible encephalopathy syndrome has seldom been reported in the pediatric age group. We describe this syndrome in a child of hereditary spherocytosis who underwent splenectomy for hypersplenism. [ABSTRACT FROM AUTHOR]

As we all are aware of from the recent headlines, hackers routinely steal intellectual property, privileged information, financial data, social security numbers, email addresses - which they sell on the black market for obscene profits and not the last but least costly ransomware attack. In 2020, more than 550 security breaches were reported to the U.S. Privacy Rights Clearinghouse, and 1.1 billion individual records were compromised or stolen since 2005 [1]. Regardless of their industry vertical or scale most organizations are vulnerable to cyber attacks, and yet continue to gamble with their reputations because they aren't taking cyber security seriously. It's just a matter of time before they join the countless other firms who've suffered embarrassing and costly privacy & security breaches due to weak process or lack of visibility. Because cyber threats and vulnerabilities constantly evolve; many organizations may not be as effective at managing the associated risk as they might be in managing risk in other areas of the business. Cyber threats are on the rise and growing exponentially in complexity; at the same time, the economy is forcing organizations to drive down their operational costs while still maintaining an aggressive, productive and agile business model. [ABSTRACT FROM AUTHOR]

Background: Large wounds following surgery for neural tube defects are difficult to close; physical wound characteristics such as position and dimension would serve as a guide for their surgical closure. Aim: To study how wound dimension determines the choice between primary and rhomboid flap closure of skin defects following surgery for neural tube defects. Materials And Methods: A retrospective study was carried out on cases of neural tube defects operated in the department of paediatric surgery at a tertiary center for 3 years from January 2015 to December 2017. Data regarding clinical features, location, wound dimensions following surgery, any bony deformity, method of closure used, distance of wound from anus, and postoperative complications were collected and analyzed. Results: A total of 114 cases were operated during this period; 86/114 had primary closure, whereas 28/114 needed rhomboid flap for tension-free cover. Primarily closed wounds had a biphasic distribution of (long axis)/(short axis) ratio (with values either >1.65 or <0.63), whereas those covered by rhomboid flaps had a mean ratio of 1.25 (range, 0.71-1.45). All six cases with bony deformity needed rhomboid flaps. Although all lipomeningomyelocele defects could be primarily closed, all rachischisis needed flap cover. Infected lesions had a mean wound distance of 5.3 cm from posterior anal margin. Conclusion: Defect's position, its size and shape, and any bony deformity determine the choice of closure of postoperative wound. The versatile, safe, and universal rhomboid flap is an aesthetic solution to the large skin defects in patients of neural tube defects. [ABSTRACT FROM AUTHOR]

Background: With increasing survival of patients suffering from necrotizing enterocolitis (NEC) colonic strictures, as its late sequelae, is increasingly being seen and most of these patients present with chronic constipation. Case Series: Five patients of acquired colonic stricture presenting with abdominal distension and constipation are being reported here. All five patients varied in clinical features, age at presentation and surgical management. Three of them had abdominal distension and constipation with poor nutritional status. Primary resection with anastomosis could be done in only one while stoma was made initially in other patients. One patient presented with sealed perforation and fistula between jejunum and colon. All, except one patient, had stricture at splenic flexure. Histopathology of colon reported normal ganglion cells in all patients. Conclusion: All survivors of necrotizing enterocolitis, should be followed for the development of colonic stricture; It should be kept as important differential diagnoses of chronic constipation in children. [ABSTRACT FROM AUTHOR]

Post-operative intussusception is a recognised cause of intestinal obstruction in child especially during post-operative period. The diagnosis of post-operative intussusception may be difficult due to inconsistent clinical manifestation. It should be considered in any patient who develops abdominal distension, pain, and vomiting after partial return of gastrointestinal function especially after Ladd's procedure. [ABSTRACT FROM AUTHOR]

Endotracheal tube block due to various mechanical causes such as mucous, blood clot, denture, and ampoules have been reported. A patient of achalasia cardia with chronic passive aspiration pneumonitis developed mucoid mass in the respiratory passage which dislodged during the surgical procedure. The episode occurred almost an hour after induction of anesthesia and the dislodged mucoid mass blocked the lumen of endotracheal tube, leading to hypoxia and impending cardiac arrest. However, the patient was salvaged by replacing the tube. [ABSTRACT FROM AUTHOR]