Early Endoscopic Decompression in Treatment of Pediatric Ureterocles Presenting to a Single Institution and Requirement of Secondary Procedures in these Patients

The basic goals of treatment of ureterocele are preservation of renal function, relieving obstruction, preventing and managing reflux, and maintaining continence. Our study was mainly focussed on the role of early endoscopic decompression in these patients and need for a secondary procedure.The study was conducted as prospective study starting from January 2015 to December 2018, at the Division of Pediatric Surgery of the Sheri Kashmir Institute of Medical Sciences (SKIMS) , India. Children were either diagnosed prenatally as having ureterocele or postnatally mostly presenting as urinary tract infections . All the children with diagnosis of ureterocele at ultrasonography were included, if treated by endoscopic access. Both intravesical and extravesicalureteroceles were included.Twelve patients presented with ureterocele over a 3 year period. There were 8 girls and 4 boys. 2 patients were diagnosed prenatally and 10 in postnatal period. Average age of the patients at the time of decomporssion was 16 months. 9 patients in the study group had unilateral single system ureteroceles. 2 patients had bilateral ureterocele with one patient among them having bifid system on right side. One patient had unilateral ureterocele with a bifid system. UTI was the most common presentation .Two patients in our study required a definitive surgery (16.66%) after initial decompression. Rest of the 10 patients were strictly followed up did not require a definitive surgery. Among these 10 patients one patient had bilateral ureterocele and underwent endoscopic decompression only. 9 patients had single system unilateral ureterocele and decompression sufficed in them as a definitive treatment. Among these 9 patients two had mild degree of VUR which resolved with conservative treatment. Patients who have achieved toilet training were observed for bladder dysfunction and had none till date and are still on follow-up.We recommend edoscopic decompression as a definitive treatment in unilateral single system ureteroceles ,however a close follow-up is recommended

Posterior reversible encephalopathy syndrome after augmentation cystoplasty in a child with neurogenic bladder

Posterior reversible encephalopathy syndrome (PRES) or leukoencephalopathy syndrome was introduced into clinical practice in 1996 by Hinchey et al., to describe unique syndrome, clinically expressed during hypertensive and uremic encephalopathy, eclampsia, and immunosuppressive therapy. Hyperperfusion with resultant disruption of the blood–brain barrier results in vasogenic edema, but not infarction, most commonly in the parieto-occipital regions. The severity of this clinical symptom varies. For example, the visual disturbance can manifest as blurred vision, homonymous hemianopsia, or even cortical blindness.Patients may be mildly confused or agitated but can become comatose.Other symptoms less commonly seen include nausea, vomiting, seizures, and brainstem deficits.Chronic kidney disease (CKD) and acute kidney injury are both commonly present in patients with PRES. We are presenting a rare case of neurogenic bladder who developed PRES after augmentation cystoplasty due to underlying CKD

Assessment of Predictors of Mortality in Neonatal Intestinal Obstruction

Background: Neonatal intestinal obstruction (NIO) continues to be a life-threatening condition with high mortality rates especially in developing countries. Highly skilled specialized care and facilities are required for survival. This study was conducted to assess various factors responsible for outcome in such neonates, so that extra attention is paid to the ones at high risk, with the idea to bring down the mortality rates in neonates admitted with intestinal obstruction. Materials and Methods: This study was a prospective observational study conducted on all neonates admitted with features of intestinal obstruction in our hospital from February 2014 to August 2016. The patients were followed up for a minimum of 1 month. Data was collected on prescribed proforma and analyzed for age, sex, prematurity, birth weight, clinical features, duration of symptoms, diagnosis, lab investigations, surgical procedure performed, complications etc. using the Statistical Package for Social Sciences (SPSS). Results: There were 120 neonates with intestinal obstruction, of which 92 neonates survived and 28 died. The mortality rate was 23.33%. There were 74 males and 46 females. The mean gestational age was 38.2±1.77 wks with a range between 32 to 41 wks. The mean age at presentation was 5.58 days with a range between 5 hrs to 26 days. The mean weight at presentation was 2510g. Mean duration of symptoms was 3.40 days. Gross congenital anomaly was seen in 22 neonates. Sepsis on admission was noted in 51 patients out of whom 23 died. Twenty-two patients presented with perforation peritonitis, of which 14 expired. Fifty-four neonates experienced significant in-hospital delay in surgery. The mean duration of stay in the hospital was 8.40 days. Overall, 92 neonates were discharged from the hospital. Conclusion: Neonatal intestinal obstruction is still associated with high mortality. After analyzing various factors we conclude, that increased age at presentation, delay in seeking treatment after the onset of symptoms, CRP/ blood culture positive sepsis on arrival, thrombocytopenia, acute kidney injury (raised urea and creatinine), acidosis and coagulopathy on admission, bowel perforation with peritonitis and the need for continued mechanical ventilation after surgery were the statistically significant risk factors for mortality in neonates with NIO in our series. However, sex, mode of delivery, gestational age, weight at presentation, hypothermia on arrival, associated gross congenital anomalies, delay in surgery after admission (in-hospital delay) and duration of stay in hospital were found to be statistically insignificant risk factors for mortality in our series

Experience of establishing and coordinating a nationwide network for bidirectional intussusception surveillance in India: lessons for multisite research studies

Objectives To document and share the process of establishing the nationally representative multisite surveillance network for intussusception in India, coordination, data management and lessons learnt from the implementation.Design This study combined both retrospective and prospective surveillance approaches.Setting 19 tertiary care institutions were selected in India considering the geographic representation and public and private mixParticipants All children under-2 years of age with intussusceptionPrimary and secondary outcome measures The experience of site selection, regulatory approvals, data collection, quality assurance and network coordination were documented.Results The site selection process involved systematic and objective four steps including shortlisting of potential institutions, information seeking and telephonic interaction, site visits and site selection using objective criteria. Out of over 400 hospitals screened across India, 40 potential institutions were shortlisted and information was sought by questionnaire and interaction with investigators. Out of these, 25 institutes were visited and 19 sites were finally selected to participate in the study. The multistep selection process allowed filtering and identification of sites with adequate capacity and motivated investigators. The retrospective surveillance documented 1588 cases (range: 14–652 cases/site) and prospective surveillance recruited 621 cases (range: 5–191 cases/site). The multilayer quality assurance measures monitored and ensured protocol adherence, complete record retrieval and data completeness. The key challenges experienced included time taken for obtaining regulatory and ethical approvals, which delayed completion of the study. Ten sites continued with another multisite vaccine safety surveillance study.Conclusion The experience and results of this systematic and objective site selection method in India are promising. The systematic multistep site selection and data quality assurance methods presented here are feasible and practical. The lessons from the establishment and coordination of this surveillance network can be useful in planning, selecting the sites and conducting multisite and surveillance studies in India and developing countries

Association of meteorological parameters with intussusception in children aged under 2 years: results from a multisite bidirectional surveillance over 7 years in India

Objectives The study aimed to document the association between intussusception in Indian children and meteorological parameters and examine regional variations.Design A bidirectional (retrospective and prospective) surveillance between July 2010 and September 2017.Setting At 20 hospitals in India, retrospective case record review during July 2010 and March 2016 and prospective surveillance during April 2016 and September 2017 were performed.Participants 2161 children aged 2–24 months with first intussusception episode were included.Interventions The monthly mean meteorological parameters (temperature, sunshine, rainfall, humidity and wind speed) for the study sites were collected.Methods The association between monthly intussusception cases and meteorological parameters was examined at pooled, regional and site levels using Pearson (r) and Spearman’s rank-order (ρ) correlation, factorial analysis of variance, and Poisson regression or negative binomial regression analyses.Results The intussusception cases were highest in summer and lowest in autumn seasons. Pearson correlation analysis showed that temperature (r=0.056; p<0.05), wind speed (r=0.134; p<0.01) and humidity (r=0.075; p<0.01) were associated with monthly intussusception cases. Spearman’s rank-order correlation analysis found that temperature (ρ=0.049; p<0.05), wind speed (ρ=0.096; p<0.01) and sunshine (ρ=0.051; p<0.05) were associated with monthly intussusception cases. Poisson regression analysis resulted that monthly intussusception case was associated with rising temperature (North region, p<0.01 and East region, p<0.05), sunshine (North region, p<0.01), humidity (East region, p<0.01) and wind speed (East region, p<0.01). Factorial analysis of variance revealed a significant seasonal difference in intussusception cases for pooled level (p<0.05), 2–6 months age group (p<0.05) and North region (p<0.01). Significant differences in intussusception cases between summer and autumn seasons were observed for pooled (p<0.01), children aged 2–6 months (p<0.05) and 7–12 months (p<0.05).Conclusions Significant correlations between intussusception cases and temperature, humidity, and wind speed were observed at pooled and regional level in India. A peak in summer months was noted, which may be used for prediction, early detection and referral for appropriate management of intussusception