Delayed presentation of intussusception in children–a surgical audit

Background The preferred modality of treatment of intussusception is radiologic reduction; however, the situation is different in our setup, in which surgery is the only possible treatment modality to salvage patients. This study presents the management of patients of intussusception in our setup with delayed presentation, in which surgery becomes necessary to save life.Patients and methods This retrospective study included reviewing the records of all patients having intussusception. The patients were evaluated for their age of presentation, sex, duration of symptoms before presenting to the hospital, type of intussusception, complications of surgery, mortality, and follow-up.Results The study duration was 9 years and included 95 patients. The male-to-female ratio was approximately 2.5 : 1. The mean age at presentation was 3.24 ± 2.49 years. The mean duration of symptoms before presenting to the hospital was 6.08± 1.38 days. The presenting features were vomiting in 95 patients (100%), distension of theabdomen in 67 patients (70.5%), lump in the abdomen in 61 patients (64%), and bleeding per rectum in 10 patients (10.5%). Eighty-six patients (90.5%) had ileocolic or ileoileocolic intussusception. Resection was required in 75 patients (79%). The mortality rate in this study was 10.5%.Conclusion Despite the advances in the diagnosis and treatment of intussusception, a large number of children in the developing world still present very late. Hence, the treating surgeon must be ready to manage this entity effectively. Proper clinical evaluation, resuscitation, and treatment as per the condition of the patients yield good results.Keywords: bowel obstruction, children, delayed presentation, intussusceptions, surger

Conventional and unconventional surgical modalities for choledochal cyst: long-term follow-up

Background This study presents our experience of various modes of presentation, surgical methods applied (both conventional and unconventional), and their outcome on patients with choledochal cyst. Method This is a retrospective study in which files of all patients with choledochal cyst over a period of 10 years (1997–2007) were studied. Data collected from files included age, sex, modes of presentation, various surgical techniques, outcome, and follow-up. Results The total number of patients was 35. The most common mode of presentation was recurrent abdominal pain in 20 (57%) patients. It was followed by jaundice in 16 (45%) patients, fever, nausea, and vomiting in 10 (28.5%) patients, and other symptoms. Roux-en-Y hepaticojejunostomy was performed in 26 (74%) patients, hepaticoduodenostomy in five (14%) patients, external T-tube drainage in three (8%) patients, and cystoduodenostomy in two (5%) patients. Two patients expired in this series. The follow-up loss was 20%. Three patients who suffered from cholangitis were managed conservatively. No patient has shown cirrhosis and cholangiocarcinoma till now. Conclusion Choledochal cyst is an important entity in an Indian setup. The presentation has a wide spectrum; therefore, different types of surgical intervention would play a significant role in various situations.Keywords: choledochal cyst, follow-up of choledochal cyst, surgical technique

Nocardiosis in patients of chronic idiopathic thrombocytopenic purpura on steroids

We present two cases of chronic idiopathic thrombocytopenic purpura (ITP) on prolonged steroid therapy who developed subcutaneous and brain abscesses due to Nocardia asteroides. The special diagnostic and therapeutic challenges encountered in the patients because of severe thrombocytopenia are being highlighted

Short Communication Managing immunisation waste in a tertiary healthcare facility

ABSTRACT Immunisation protects children and adults against harmful infections before they come into contact with them in the community

A report of a rare congenital malformation in a Nepalese child with congenital pouch colon: a case report

Congenital pouch colon is one of rare congenital anomalies. We report a 3-day-old male child with congenital pouch colon who underwent a window colostomy but died because of overwhelming sepsis. Due to its rarity, many surgeons in our part of the world may not be aware of it, hence increasing the potential to its mismanagement. However, with simple keen observations, we can safely come to its diagnosis. The aim of this report is to bring attention to congenital pouch colon associated with anorectal malformation in our country, with a brief emphasis on an approach to its diagnosis and initial management

Bupropion and Naltrexone in Methamphetamine Use Disorder

BackgroundThe use of naltrexone plus bupropion to treat methamphetamine use disorder has not been well studied.MethodsWe conducted this multisite, double-blind, two-stage, placebo-controlled trial with the use of a sequential parallel comparison design to evaluate the efficacy and safety of extended-release injectable naltrexone (380 mg every 3 weeks) plus oral extended-release bupropion (450 mg per day) in adults with moderate or severe methamphetamine use disorder. In the first stage of the trial, participants were randomly assigned in a 0.26:0.74 ratio to receive naltrexone-bupropion or matching injectable and oral placebo for 6 weeks. Those in the placebo group who did not have a response in stage 1 underwent rerandomization in stage 2 and were assigned in a 1:1 ratio to receive naltrexone-bupropion or placebo for an additional 6 weeks. Urine samples were obtained from participants twice weekly. The primary outcome was a response, defined as at least three methamphetamine-negative urine samples out of four samples obtained at the end of stage 1 or stage 2, and the weighted average of the responses in the two stages is reported. The treatment effect was defined as the between-group difference in the overall weighted responses.ResultsA total of 403 participants were enrolled in stage 1, and 225 in stage 2. In the first stage, 18 of 109 participants (16.5%) in the naltrexone-bupropion group and 10 of 294 (3.4%) in the placebo group had a response. In the second stage, 13 of 114 (11.4%) in the naltrexone-bupropion group and 2 of 111 (1.8%) in the placebo group had a response. The weighted average response across the two stages was 13.6% with naltrexone-bupropion and 2.5% with placebo, for an overall treatment effect of 11.1 percentage points (Wald z-test statistic, 4.53; P<0.001). Adverse events with naltrexone-bupropion included gastrointestinal disorders, tremor, malaise, hyperhidrosis, and anorexia. Serious adverse events occurred in 8 of 223 participants (3.6%) who received naltrexone-bupropion during the trial.ConclusionsAmong adults with methamphetamine use disorder, the response over a period of 12 weeks among participants who received extended-release injectable naltrexone plus oral extended-release bupropion was low but was higher than that among participants who received placebo. (Funded by the National Institute on Drug Abuse and others; ADAPT-2 ClinicalTrials.gov number, NCT03078075.)

Prevalence of amyloid deposition in long standing rheumatoid arthritis in Iranian patients by abdominal subcutaneous fat biopsy and assessment of clinical and laboratory characteristics

BACKGROUND: The study was aimed at determining the prevalence of secondary amyloidosis in a group of Iranian patients with Rheumatoid Arthritis (RA), and the assessment of its correlation with the clinical and laboratory findings and data. METHOD: A total number of 220 patients (167 female and 53 male) with a minimum five-year history of RA were selected. Congo red staining method was used for staining the specimens obtained by abdominal subcutaneous fat biopsy (ASFB) method. All of the specimens were examined for apple-green birefringence under polarized light microscope. Clinical and laboratory characteristics of the patients were assessed. Chi-square test and unpaired student's t-test were run for intergroup comparisons. RESULTS: Amyloid deposition test yielded positive results in 15 out of the 220 cases (6.8%) examined by the ASFB technique. Thirteen patients were found to have minimal amyloid deposits. Of all the clinically significant cases, 8 (53%) presented with proteinuria, and 7 cases (46.6%) had severe constipation. CONCLUSION: The prevalence of fat amyloid deposits in Iranian patients with RA is low. In up to half of the study group the deposits were subclinical. Follow up studies are required to determine whether this subclinical amyloidosis can develop into full-blown clinically significant amyloidosis