Pediatric cystic nephroma: clinical and molecular genetic characteristics

Cystic nephroma (CN) is a rare renal tumor occurring in children which belongs to a group of neoplasms linked with the inherited DICER1 syndrome. Given the rarity of CNs, it is important to describe clinical, radiological, and molecular genetic characteristics of these tumors in children and adolescents as well as to analyze treatment outcomes. We present our experience in managing 8 patients with histologically verified CN who received treatment and consultations at the D. Rogachev NMRCPHOI over a period of 9 years (2012–2020). The study was approved by the Independent Ethics Committee and the Scientific Council of the D. Rogachev NMRCPHOI. The patients’ parents gave their consent to the use of their child’s data, including photographs, for research purposes and in publications. We performed a retrospective analysis of clinical presentation, radiological findings, the extent of treatment given to patients, treatment outcomes, and the results of molecular genetic testing. The study included patients aged between 8.6 and 197 months at diagnosis (the median age was 14.2 months). The analysis of initial complaints revealed that six patients (75%) had an increased abdominal girth and a palpable mass in the abdomen, one patient (12.5%) presented with arterial hypertension, and another patient (12.5%) had a mass detected by a routine abdominal ultrasound examination. On contrast-enhanced computed tomography scans, CNs appeared as multicystic masses with thin, contrast-enhancing septa; the CN volume ranged from 59.7 to 1293.1 cm3 (the median volume was 626.3 cm3 ). In all cases, the diagnosis of CN was verified histologically. Surgical treatment included nephrectomy (n = 6) or partial resection of the affected kidney (n = 2) with the removal of the tumor. Some patients (n = 5) included in our analysis received pre-operative chemotherapy at the discretion of their treating physicians. Molecular genetic testing was carried out for 7 children: 4 out of 7 patients (57.1%) were found to have somatic and germline mutations in the DICER1 gene. Carriers of pathogenic DICER1 variant were identified in the family of 1 patient. The median duration of follow-up was 17.6 months (range: 1.7 to 58.9 months). Currently, all patients are alive, no relapses have occurred. Cystic renal neoplasms detected by radiological investigations should be reviewed at the reference centers for pediatric oncological diseases and included CN in the differential diagnosis. Initial surgery is the first line of treatment for cystic nephroma. The final diagnosis is made on the basis of a histological examination of tumor tissue. All patients with confirmed CN should be referred for genetic counseling and molecular genetic testing for germline mutations in the DICER1 gene and should receive surveillance recommendations for the early detection of other metachronous DICER1-associated tumors.

The impact of height on the spread of spinal anesthesia and stress response in parturients undergoing caesarean section: a prospective observational study

Background The spread of spinal anesthesia was influenced by many factors, and the effect of body height on spinal anesthesia is still arguable. This study aimed to explore the impact of height on the spread of spinal anesthesia and the stress response in parturients. Methods A total of ninety-seven parturients were allocated into two groups according to their height: the shorter group (body height was shorter than 158 cm) and taller group (body height was taller than 165 cm). Spinal anesthesia was performed with the same amount of 12 mg plain ropivacaine in mothers of different heights. The primary outcome of the study was the success or failure of the spinal anesthesia. The secondary outcomes of the study were stress response, time to T6 sensory level, the incidence of hypotension, the satisfaction of abdominal muscle relaxation and patient VAS scores. Results The rate of successful spinal anesthesia in the shorter group was significantly higher than that in the taller group (p = 0.02). The increase of maternal cortisol level in the shorter group was lower than that in the taller group at skin closure (p = 0.001). The incidence of hypotension (p = 0.013), time to T6 sensory block (p = 0.005), the quality of abdominal muscle relaxation (p < 0.001), and VAS values in stretching abdominal muscles and uterine exteriorization (p < 0.001) in the shorter group were significantly different from those in the taller group. Multivariate analysis showed that vertebral column length (p < 0.001), abdominal girth (p = 0.022), amniotic fluid index (p = 0.022) were significantly associated with successful spinal anesthesia. Conclusions It’s difficult to use a single factor to predict the spread of spinal anesthesia. Patient’s vertebral column length, amniotic fluid index and abdominal girth were the high determinant factors for predicting the spread of spinal anesthesia. Trials registration ChiCTR-ROC-17012030 (Chictr.org.cn), registered on 18/07/2017.

342 Effects of Maternal Nutrient Restriction During Late Gestation on Primiparous Dam Performance and Fetal Growth

To determine the effects of late gestational nutrient restriction (NR) on heifer performance, fetal growth, and calving difficulty, single-sired fall-calving Hereford-SimAngus heifers (BW: 451 ± 28 [SD] kg; BCS: 5.4 ± 0.7) bred to a single sire were allocated by fetal sex and expected calving date to either 100% (control; CON; n = 12) or 70% (n = 13) of NASEM net energy and metabolizable protein requirements for maintenance, pregnancy, and growth. Beginning on d 160 of gestation, heifers were individually fed chopped sorghum sudan hay (1.74 Mcal ME, 6.66% CP, 72.0% NDF; DM basis) and based on individual intakes, supplemented to meet targeted nutritional planes. Dam BW, BCS, and backfat (BF) were determined pre-treatment, every 21 d (BW) or 42 d (BCS and BF) during treatments, and post-calving. At birth, calf BW and size (length, heart girth, abdominal girth, flank girth, cannon circumference, cannon length, shoulder height, and ribeye area) were measured. Data were analyzed with treatment, treatment initiation date, and calf sex (when P &lt; 0.25) as fixed effects. Dam BW tended to be less (P = 0.09) and BCS was less (P = 0.04) at d 202 of gestation for NR dams. Dam BW, BCS, and BF were less (P ≤ 0.01) in NR dams for the remainder of gestation. Post-calving, NR dams weighed 64 kg less (P ≤ 0.01) than CON, with a BCS of 3.6 ± 0.1. Nutrient restriction did not affect (P ≥ 0.27) calf gestation length, BW, or size. Calf BW as % post-calving dam BW tended to be greater (P = 0.09) for NR calves. Fetal presentation was normal for all CON births, while 23.1% of NR dams had fetal malpresentation (P = 0.12). In the current study, NR dam BW and BCS were sacrificed during late gestation without altering fetal growth trajectory.

Correlation of skin epidural distance and posterior epidural space depth with age, weight, height, BMI, abdominal girth and position of the patient: A prospective randomised study

Lumbar epidural block is a commonly used procedure for providing anaesthesia, post-operative analgesia in all groups of patients irrespective of age, sex, weight and height of the patients. The knowledge of posterior space is important in view of the fact that this is the space where drugs for epidural anaesthesia/ analgesia are used. The knowledge of variability of this space with physical parameters of the patient, help us in reducing the incidence of total spinal anaesthesia.Two hundred adult patients in the age group of 20-60 years requiring subarachnoid block were chosen for the study. Using 22G Quincke spinal needle, epidural space was identified and skin epidural distance was measured. Proceeding the spinal needle further, causes needle to lie in subarachnoid space. The skin subarachnoid distance was measured. The difference between skin-subarachnoid distance and skin epidural distance denoted the posterior epidural space width. Its correlation with physical parameters was studied.Mean skin epidural distance was 4.30 ±0.57 in lateral position and 4.05 ± 0.57 in sitting position, the difference being statistically significant. (P= 0.002). There was positive correlation between skin epidural distance with weight, BMI and abdominal girth of the patient. Mean posterior epidural space depth was 0.468+14 cm in lateral position and 0.459+0.14 cm in sitting position, the difference being statistically insignificant. There was a positive correlation between posterior epidural space depth and height of the patient.The skin epidural distance varies with weight, BMI, abdominal girth and position of the patient. The posterior epidural space depth varies with the height of the patients.

Case Report on Post Operative Case of Exploratory Laparotomy for Ruptured Ectopic Pregnancy with Septicemia

Introduction: Extra uterine pregnancy is a first-trimester pregnancy problem that affects 1.3–2.4 percent of all pregnancies. The key signs of the ectopic pregnancy are abdominal discomfort and vaginal bleeding along with Sharp, dull, or cramping pains may be experienced around 50% of the women who are suffering from ectopic pregnancy. The neglected ectopic pregnancy may results in the fallopian tube can burst, internal abdominal bleeding, shock, and serious blood loss and later complication is septicemia. As a health care professional it’s very important to manage certain complication with medical and surgical management. Main Symptoms and/or Important Clinical Findings: A 20 years old female with post operative case of Exploratory Laparotomy admitted in A.V.B.R.H. on 14/02/2021.with chief complaints of the after undergone certain investigation she has diagnosed as Exploratory Laparotomy with septicemia as post-op complication. The Main Diagnoses, Therapeutic Interventions, and Outcomes: A 20 years old female with post-operative Exploratory Laparotomy for Ruptured Ectopic Pregnancy operated case with septicemia, with chief complaints of acute abdominal pain, and vaginal bleeding the doctors manage her initially with I.V. fluids, antibiotics, Zonac suppository and adequate nursing management. Nursing Perspectives: The nursing interventions initiated for managing present case are fluid replacement therapy, monitoring vital sign per hourly, monitoring the CBC reports and other investigations like USG abdomen, blood glucose levels. Maintained TPR Chart, I/O Charting, abdominal girth charting. Conclusion: In the Present case the patient of A 20 year old female with post operative exploratory laparotomy for ruptured ectopic pregnancy with septicemia it has been managed with the therapeutic and surgical treatment ,right now the patient condition then patient has discharged on dated 22/2/21.

24 Effects of Spring versus Fall Calving on Fetal Growth, Vigor at Birth, and Neonatal Circulating Metabolites in Beef Calves

To determine the effect of season on perinatal nutrient availability, assessed through fetal growth, calf vigor, and neonatal circulating metabolites, multiparous and primiparous dams (age: 4.7 ± 2.4 yr; BCS: 5.3 ± 0.6) from 4 spring (2014–2017; n = 202) and 4 fall (2015, 2017–2019; n = 177) calving experiments were observed during parturition. Time to stand (spring: 67; fall: 104) was determined as minutes from birth to standing for 5 sec. After birth, calf BW and size (spring: 99; fall: 169; length, heart girth, abdominal girth, and cannon circumference) were recorded. Jugular blood samples were obtained from 63 spring and 89 fall calves at 0 (pre-suckling), 6, 12, 24, and 48 h postnatally. Data were analyzed either with the fixed effect of season (single point) or the fixed effects of season, hour, and their interaction with hour as a repeated effect (over time); calf sex was included when P &lt; 0.25. Experiment was a random effect. Fall-born calves tended to have lighter (P = 0.09) BW and faster (P = 0.05) time to stand than spring-born calves. Season did not affect (P ≥ 0.18) other calf size measures. The season x hour interaction (P ≤ 0.07) affected circulating glucose, non-esterified fatty acids (NEFA), triglycerides, urea nitrogen, globulin, and total protein. Spring-born calves had greater (P ≤ 0.009) 0 h glucose, 0 and 6 h NEFA, and 0, 6, 12, and 48 h triglycerides than fall-born calves. Fall-born calves had greater (P = 0.03) total protein at 24 h and tended to have greater (P ≤ 0.10) total protein and urea nitrogen at 48 h and globulin at 24 h. Season affected albumin, which was greater (P = 0.003) in fall-born calves. These data suggest that calving season influences perinatal nutrient availability, which may impact the transition to postnatal life.

Peritoneal inclusion cyst in a patient with glycogen storage disease type Ib and Crohn’s like disease

Background Glycogen storage disease type Ib (GSD Ib) due to biallelic mutations in SLC37A4 is often associated with inflammatory bowel disease. Peritoneal inclusion cysts (PICs) are variable sized, fluid-filled, mesothelial-lined cysts that usually occur in premenopausal woman. Risk factors for the development of PICS comprise prior abdominal surgeries and inflammatory diseases. Results We herein report on a female patient with GSD Ib and Crohn’s like disease who underwent recurrent abdominal surgery due to suspected intraabdominal abscesses. At the age of 36, abdominal pain and an increase in the abdominal girth was observed. MRI revealed a large PIC. Due to multiple previous complications conservative management was chosen, and the cyst remained stable in size during a 1-year follow-up. Conclusions PIC should be included in the differential diagnosis of abdominal cystic masses especially in premenopausal women with either IBD or previous abdominal surgery. Radiologist, gynecologist, and gastroenterologist should be aware of this rare condition to prevent inappropriate and aggressive treatments.

A prediction model using machine-learning algorithm for assessing intrathecal hyperbaric bupivacaine dose during cesarean section

Background The intrathecal hyperbaric bupivacaine dosage for cesarean section is difficult to predetermine. This study aimed to develop a decision-support model using a machine-learning algorithm for assessing intrathecal hyperbaric bupivacaine dose based on physical variables during cesarean section. Methods Term parturients presenting for elective cesarean section under spinal anaesthesia were enrolled. Spinal anesthesia was performed at the L3/4 interspace with 0.5% hyperbaric bupivacaine at dosages determined by the anesthesiologist. A spinal spread level between T4-T6 was considered the appropriate block level. We used a machine-learning algorithm to identify relevant parameters. The dataset was split into derivation (80%) and validation (20%) cohorts. A decision-support model was developed for obtaining the regression equation between optimized intrathecal 0.5% hyperbaric bupivacaine volume and physical variables. Results A total of 684 parturients were included, of whom 516 (75.44%) and 168 (24.56%) had block levels between T4 and T6, and less than T6 or higher than T4, respectively. The appropriate block level rate was 75.44%, with the mean bupivacaine volume [1.965, 95%CI (1.945,1.984)]ml. In lasso regression, based on the principle of predicting a reasonable dose of intrathecal bupivacaine with fewer physical variables, the model is “Y=0.5922+ 0.055117* X1-0.017599*X2” (Y: bupivacaine volume; X1: vertebral column length; X2: abdominal girth), with λ 0.055, MSE 0.0087, and R2 0.807. Conclusions After applying a machine-learning algorithm, we developed a decision model with R2 0.8070 and MSE due to error 0.0087 using abdominal girth and vertebral column length for predicting the optimized intrathecal 0.5% hyperbaric bupivacaine dosage during term cesarean sections.

The Effect of Mahish Mutra Ghanvati in Udar-jatodakawastha- A Case Study

Ayurveda emphasizes that all the diseases are the result of weak state of Agni. Improper functioning of Agni leads to various metabolic disorders. Ascites describes the condition of pathologic fluid collection within the abdominal cavity .According to Ayurveda Udar-Jatodakawastha can be corelated with ascites as the sign and symptoms are same. Mandagni,Ajirna and malavrudhi are the reasons behind udar-jatodakawastha. In this article a case study of Udar-Jatodakawastha in which Mahishmutra Ghanvati has been given over a period of 14 days resulted in the reduction of the abdominal girth, decreases in weight without any treatment emergent adverse effect and reduction of all symptoms. Mahishmutra Ghanvati causes deepan, pachan, srotorodhanashnam and virechan(Malavishodhana).

A Paediatric Case Study Report of Cholera in an Endemic Area of Cebu Province of Philippines

ZD, 2 years old male child from Cebu city Philippines with chief complaint of loose watery stools was admitted by his mother to a tertiary hospital. Five days prior to the admission, onset of the disease with three episodes (approximately 100 ml each) of non-foul smelling loose watery (yellow) stools was observed with moderately severe dehydration. However, it was observed that the patient was playful and with a good appetite. He was given 1 pack per day Vivalyte rehydration solution hence, the episode reduced to one time. One night prior to admission, an increase in bowel movement frequency was noted. The stool colour changed to yellowish to greenish with mucus. The patient turned anorexic and weak with sunken eyeballs. In the morning of the admission, the patient had another 2 episodes of the stools with formed particles. Patient also had 3 episodes of non-projectile vomiting (approximately 30 ml/ episode) irrelevant to the food intake timings. At the Emergency Room, the patient was treated with IV Fluids of Normal Saline Solution (60 cc/ kg/ day); CBC showed thrombocytosis with neutrophilic predominance, serum electrolytes revealed hyponatremia and hypokalaemia. Stool Culture was done. Medications started were Zinc Sulphate at 20 mg per day and Oral rehydration solution. The patient was referred to an infectious specialist care with a primary impression or consideration of Cholera thus Erythromycin was started at 50 mg/kg/day (3 doses/ day). Since the patient was under developed or did not match with the normal developmental milestones like no teething, open anterior fontanel, and deviation in the weight height ratio had developed as significant deviation in head circumference, chest circumference and abdominal girth due to the infused fluid volume overload. There might be chances of making wrong clinical diagnosis like viral diarrhoea complicated to give rise meningitis by primary care givers in absence of a confirmed laboratory results, an immediate initiation of an empirical treatment with fluid resuscitation and antibiotics undertaken, hence, the patient was referred to the care of a specialist of the infectious diseases for further evaluation and treatment. At ward, the patient was observed awakened, irritable, without respiratory distress and tachycardia, with moderate dehydration and a positive fluid balance of 210 ml. Stool exam results showed 55-65 WBC per high power field. Intra Venous (IV) Fluid to correct the imbalance of electrolytes and medications were continued. Following days, the patient had 4 episodes of loose watery stools amounting to 100 - 200 ml per episode with passage of Ascaris. Patient was slightly irritable, with still sunken eyeballs, otherwise with good turgor, mobility and strong pulses. IV Hydration was continued. Albendazole (400 mg/ tab) single dose was given. Electrolyte imbalance was already corrected. However, the stool culture was positive for Vibrio cholerae. On the fifth hospital day, the patient got normal for all the symptoms and signs. Erythromycin was prescribed for 3 days at the rate of 50 mg/ kg/ day (3 doses/ day). Further, Zinc Sulphate tablets (20 mg/ tab) twice a day was also prescribed and then the Patient was discharged. In absence of teething, Doxycycline as the drug of choice for the Cholera treatment might have been prescribed for a fast recovery. However, doxycycline is contraindicated in children less than 8 years of age due to the risk of yellow tooth discolouration and dental enamel hypoplasia. Generally, V. cholerae often becomes drug-resistant against multiple antibiotics through its enzymatic functions (HGT) that modify antibiotics chemically. Hence changing the antibiotic regimen remains the best strategy to get the best prognosis if the previously administered antibiotic doesn’t work properly. Another, before discharging, the condition of the patient might also have confirmed as normal through the required laboratory exams even if the patient was tolerating orally well. Moreover, the patient might have been referred to a paediatrician or called for an early follow up to reassess him and prescribe probiotics and other growth regulatory supplements for complete well-being of the patient.