AN UNUSUAL MASS OF THE CHEST WALL IN A 7 YEARS OLD CHILD: AN ASKIN'S TUMOUR

Askin’s tumour is a primitive neuroectodermal tumour developing from the soft tissues of the chest wall. It is commonly misdiagnosed due to features similar to other round blue cell tumours. The approach for its diagnosis and treatment is complex and requires a multidisciplinary team. The recommended treatment is chemotherapy and surgical excision mainly. The prognosis is dependent on many factors. We managed a child of Askin’s tumour using modalities such as neoadjuvant chemotherapy and surgical excision and found a good response.Key words: Chest wall mass, Askin’s tumour, Ewing sarcom

A Comparative Study of Operation Theatre Disinfection by Fumigation Using Different Compounds

A comparative study of operation theatre disinfection by fumigation using different compounds.Background and Objective: Objective of this study was i) to evaluate the efficacy of formalin and quaternary ammonium compounds (QUAT). ii) To compare the efficacy of both agents/techniques for operation theatre disinfection.Study Design: This was an interventional, Case control study. This study was conducted at Children Hospital & Institute of Child Health Sciences, general operation theatre.Material and Method: A total of 200 samples were collected out of which 80 samples ( plates as well swabs) were collected before and after formalin fumigation and 120 samples prior and after spray fogging using QUAT based compound. The samples were cultured on blood and Mac-Conkey agar. Identification and isolation was performed in microbiology department according to bacteriological standards.Results: During fumigation by formaldehyde 34.3% samples (n = 32) were pre positive while 21.9% samples were post positive on different surfaces. On the other side 47.9% samples (n = 48) were pre positive while only 18.7% samples were post positive on different surfaces. Average bacterial count of air reduced from 744 (21 cfu/m3) to 329 (9 cfu/m3) after formalin vapor and 858 (25 cfu/m3) reduced to 492 (14 cfu/m3) after fogging.Conclusion: This study proves that fogging by less toxic compounds takes less time and has fewer disadvantages if we use automatic equipment having fine particle siz

Surgical Outcome of Corrosive Induced Antropyloric strictures

Introduction: Corrosive induced upper gastrointestinal tract injuries in pediatric patients, is not easy to treat. Interestingly only few reports are available in English literature highlighting the management and surgical outcome of corrosive induced antropyloric strictures. The aim of this study was to determine the presenting features, management and outcome of patients treated at our institute with corrosive induced antropyloric strictures.Methods: This retrospective descriptive study was conducted at Paediatric Surgery Department of Children Hospital & Institute of Child Health, Lahore. Medical records of patients admitted for corrosive-induced gastric out let obstruction from January 2013 to December 2018 were included. The demographic, preoperative assessment, investigations, surgical procedure and follow up details were noted in a proforma. Results were analyzed by descriptive statistics using SPSS version 20. The quantitative variables were presented as mean ± SD. Qualitative variables were presented as frequency and percentages.Results: A total of 62 patients were included in this study. The mean age at presentation was 4.9 ±3.9 years. Of these 67.7% were male and the mean weight of children at the time of surgery was 12.6 ± 5.0 kilo grams. Bathroom cleaner was ingested by 77.4%. Vomiting was seen 100% cases while abdominal pain and weight loss was seen in 38.7 %, and 80.6% respectively. We preformed Heinke-mikulicz pyloroplasty in 59(95.2%) patients, Billroth II in 1(1.6%) and gastrojejunostomy in 2(3.2) cases. Postoperatively 40 children remained well during early post- op period while leak and respiratory issue were seen in 11.9% and 13.6% patients respectively. The mean hospital stay was 27.9±11.5 days. Two patients died after surgery and the rest were discharged. Mean fallow up 15.2±70 months. Of 60 discharged children 37 (62.7%) had no issue while 4 (6.8%) had leakage from previous jejunostomy site leak other 19 patients were lost to follow up.Conclusion:We conclude that surgical treatment for Antropyloric strictures due to corrosive injuries is an acceptable option with minimal complications. However, we emphasize on the preventive measure, child-proof containers and legislations to be taken by authorities and social welfare societie

Molecular markers-based DNA fingerprinting coupled with morphological diversity analysis for prediction of heterotic grouping in sunflower (Helianthus annuus L.)

Cultivated sunflower holds a very narrow genetic base and the efficient utilization of available genetic diversity is very important for a successful breeding program. In the present study, 109 sunflower genotypes were assessed for diversity paneling through a combined approach of morphological and molecular markers analysis. Morphological parameters including days to flower initiation, days to flower completion, plant height, stem curvature, number of leaves per plant, leaf area, head diameter, hundred seed weight, and seed yield per plant were studied. Simple sequence repeats (40 DNA markers) were deployed for diversity profiling. Data were analyzed by both univariate and multivariate statistics. SD and coefficient of variation confirm the presence of significant amounts of genetic variation for all the morphological parameters. Cluster Analysis and Principal Component Analysis further confirm the presence of distinct grouping patterns in the studied material. Cluster analysis of both morphological and molecular analysis revealed that restorer lines tend to group separately from A, B, and open-pollinated lines. Further grouping, at the sub-cluster level, revealed six distinct sub-clusters in each of the two major clusters. In total, 12 genotypes, 6 CMS lines (CMS-HAP-12, CMS-HAP-54, CMS-HAP-56, CMS-HAP-99, CMS-HAP-111, and CMS-HAP-112) and 6 restorer lines (RHP-38, RHP-41, RHP-53, RHP-68, RHP-69, and RHP-71) could be used as potential parents for hybrid development. As genotypes of similar genetic backgrounds tend to group closer, it is deduced that one genotype with the highest seed yield per plant could be used for further hybrid breeding programs in sunflowers

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Multiple singing magnet ingestion leading to pressure necrosis of the small bowel

Multiple Magnet ingestion may cause a number of sinister complications. We report a case of multiple singing magnets ingestion by a 2-year-old girl resulting in intestinal obstruction and pressure necrosis of the small bowel. A bunch of seven magnets present in the small bowel was removed operatively

Our experience with unusual gastrointestinal tract duplications in infants

Background: Classical duplications may present along any part of gastrointestinal tract (GIT) from mouth to anus. Atypical or unusual rare varieties of GIT duplications may also occur, but with different anatomical features. Materials and Methods: We reviewed our 5-year record (February 2008-January 2013) to describe clinical profile of unusual GIT duplications in neonates and small infants. Results: Three patients with atypical variety of GIT duplications were managed in our department during this tenure. Two were females and one male. Age was ranged between 11 days and 2 months. All patients presented with massive abdominal distension causing respiratory embarrassment in two of them. In all patients, the pre-operative differential diagnoses also included GIT duplication cysts. Computerized tomography (CT) scan showed single huge cyst in one and multiple cysts in two patients. In one patient the CT scan also depicted a thoracic cyst in relation to posterior mediastinum. At operation, one patient had colonic tubular duplication cyst along with another isolated duplication cyst, the second case had a tubular duplication cyst of ileum with its segmental dilatation, and in the third case two isolated duplications were found. Duplication cysts were excised along with mucosal stripping in one patient, cyst excision and intestinal resection and anastomosis in one patient, and only cysts excision in one. All patients did well post-operatively. Conclusion: We presented unusual GIT duplications. These duplications are managed on similar lines as classical duplications with good prognosis when dealt early