Esophageal lung associated with VACTERL anomaly: a case report

Esophageal lung is an extremely rare type of bronchopulmonary foregut malformation in which the main stem bronchus is anomalously connected to the esophagus instead of the trachea and is supplied by branches of pulmonary artery. Less than 25 cases have been reported so far in literature. We hereby report first case of esophageal lung associated with VACTREL anomaly. An 8-month-old female child with weight of 4.7 kg presented with recurrent lower respiratory infections. She was diagnosed to have esophageal lung on basis of clinical examination, chest X-ray f/b computed tomogram of chest and esophagobronchoscopy. There was a bifid vertebra at D9 level with scoliosis, an ectopic left kidney and dextrocardia with patent foramen ovale. Thus, this case was classified as having VACTREL association. Patient was successfully operated for excision of the hypoplastic lung via thoracotomy. She recovered well and gaining weight at 3 months f/u without any respiratory infection since surgery. High index of suspicion is necessary for the diagnosis of esophageal lung when common causes of recurrent respiratory infections are ruled out.

Trends in tobacco use in Nepal

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Tuberculous intestinal perforation in a case of Burkitt lymphoma on chemotherapy - A case report

Intestinal perforation induced by chemotherapy in a patient of Burkitt lymphoma is a known potential complication whichcarries high mortality. Perforation may also occur as a result of the transmural nature of the tumour. Patients on chemotherapyare prone to contract infectious diseases due to a compromised immune system. Pulmonary tuberculosis has been reported inthese patients, but abdominal tuberculosis has not. We report the case of a five year old boy on chemotherapy for Burkittlymphoma, and who developed a tuberculous jejunal perforation. The patient underwent drain insertion and stabilizationfollowed by exploratory laparotomy with resection of the pathological segment and closure of the duodenal stump at the fourthpart. Bowel continuity was re-established by gastrojejunostomy. Histopathologic examination of the resected segment revealedintestinal tuberculosis. Anti -tubercular therapy was started and continued for nine months. The last cycle of chemotherapy wasadministered 1 month after surgery. At 1 year of follow up the patient is asymptomatic and thriving well

An unusual presentation of rectal atresia with rectal duplication cyst in a neonate: A case report

A 10 days old male baby brought with abdominal distension and cystic swelling in the left buttock. Radiological investigationssuggested para-rectal abscess or rectal duplication cyst. Patient underwent transverse loop colostomy and later definitivesurgery by posterior sagittal approach. Intra-operative findings were suggestive of small atretic rectal segment with duplicationcyst of the rectum. To the best of our knowledge, neonatal rectal atresia with rectal duplication cyst has not been reported inEnglish literature

Kalman filter and variants for estimation in 2DOF serial flexible link and joint using fractional order PID controller

Robotic manipulators have been widely used in industries, mainly to move tools into different specific positions. Thus, it has become necessary to have accurate knowledge about the tool position using forward kinematics after accessing the angular locations of limbs. This paper presents a simulation study in which an encoder attached to the limbs gathers information about the angular positions. The measured angles are applied to the Kalman Filter (KF) and its variants for state estimation. This work focuses on the use of fractional order controllers with a Two Degree of Freedom Serial Flexible Links (2DSFL) and Two Degree of Freedom Serial Flexible Joint (2DSFJ) and undertakes simulations with noise and a square wave as input. The fractional order controllers fit better with the system properties than integer order controllers. The KF and its variants use an unknown and assumed process and measurement noise matrices to predict the actual data. An optimisation problem is proposed to achieve reasonable estimations with the updated covariance matrices.Web of Science1115art. no. 669

Forgotten DJ stents with calculi in a double moiety re-implant: A case report

Calculi occurring around double J (DJ) stents is a rare occurrence. Our case was of a 12-year-old female who was operated for ureteric re-implantation of both moieties in a case of left sided double moiety with Grade IV VUR. Two DJ stents were kept in situ and patient was lost to follow-up. The stents and resultant calculi came into notice when she came with abdominal pain and dysuria. They were removed by pyelolithotomy with suprapubic cystolithotomy

Minimal access surgery in children: An initial experience of 28 months

Background : This study reports our 28 months experience with minimal access surgery (MAS) in children. Materials and Methods : This was a review of all children who underwent MAS between December 2004 and March 2007 at the Departments of Paediatric Surgery, Seth Gordhandas Sunderdas Medical College (GSMC) and King Edward the VII Memorial (KEM) Hospital, India. Results and observations were tabulated and analysed, comparing with observations by various other authors regarding variety of indications such as, operative time, hospital stay, conversion rate, complications, safety, and feasibilty of MAS in neonates, in the appropriate operative groups. Results : A total of 199 procedures were performed in 193 children aged between 10 days and 12 years (average age: 5.7 years). One case of each, adrenal mass, retroperitoneoscopic nephrectomy, laparoscopic congenital diaphragmatic hernia (CDH) repair, and abdominoperineal pull-through for anorectal malformation, were converted to open surgeries due to technical difficulty. The overall conversion rate was 3%. Morbidity and mortality were very minimal and the procedures were well tolerated in majority of cases. Conclusion : We concluded that MAS procedures appear to be safe for a wide range of indications in neonates and children. Further development and expansion of its indications in neonatal and paediatric surgery requires further multi-institutional studies and larger cohort of patients, to compare with standards of open surgery

Evolution and Exploration of Azadirachta indica in Dentistry: An Update

Despite great achievements globally in oral health of populations, dental caries and periodontal diseases are the most important oral health burdens particularly among under-privileged groups in developed and developing countries. Nonetheless, oral cancer is the sixth most common cancer reported globally with an annual incidence of over 300,000 cases, of which 62% arise in developing countries. Apart from the traditional therapeutic modalities available so far that are usually synthetic drugs, researchers are presently discovering unexplored horizons of herbs for curing these ailments. One such beneficial herb is Azadirachta indica (Neem) that has been widely accepted throughout the world for its innumerable medicinal properties. The limitless benefits of neem has been documented in Indian traditional medicinal books like ‘Charak – Samhita’ & ‘Sushruta – Samhita’. Neem tree has been valued long back, since centuries by the Indian citizens for cleaning the teeth, skin diseases, consumption as a tonic & eradicating worms etc & many more. The present review discusses the in-vivo, in-vitro and animal studies utilizing the electronic databases Pubmed, Embase and Google Scholar till 31st December 2016 that highlights the medicinal properties of this wonder herb from oral health point of view suggesting its role as anti-gingivitis, anti-microbial, antiplaque, anticandidiasis, anti-periodontitis, effective endodontic irrigant, dental erosion therapy, anticaries & oral cancer therapy. Although the results are encouraging, but more scientific validation is required so that the incorporation of this ayurvedic herb into modern dentistry could be justified

Acute acalculous cholecystitis causing gall bladder perforation in children

We report two cases of children who presented with acute abdomen due to gall bladder perforation and biliary peritonitis. Cholecystectomy with peritoneal lavage proved curative