What is the appropriate aganglionic bowel length on contrast enema for attempting single stage transanal endorectal pull-through in Hirschsprung disease?

PurposeTo identify influence of different values of age and abnormal bowel length in HD patients selected for single stage TERPT which affects the technique of surgery.MethodsThis observational study was carried out for over 2.5 years. All children younger than 14 years old with clinical suspicion for HD, typical transitional zone (TZ) on contrast enema (CE) distal to splenic flexure, preoperative diagnosis approved by full thickness biopsy, no previous surgical history and no urgency were included. The distance between the anus and TZ was considered as aganglionic length on CE. Biopsy was taken from distal to proximal of resected bowel to reach circumferentially normal innervated bowel. Paired sample Student's t-test, Pearson correlation test, receiver operating characteristic (ROC) analysis were performed.ResultsForty-eight patients were enrolled in this study. Measured mean for aganglionic bowel length on CE and pathology were 33.5 ± 17.1 cm and 56.8 ± 33.5 cm, respectively (p < 0.01). Correlation coefficient (R) and coefficient of determination (R2) were 0.632 and 40%, respectively (p < 0.01). The difference between radiologic and pathologic measurements in females was higher than males (mean: 29.3 vs 21.9 cm) but was not statistically significant (p = 0.75). There was statistically significant difference between CE and pathologic results in the infants younger than 10 months (p = .004). Abnormal bowel length equal to 52 cm predicted requirement of laparoscopy assistance/laparotomy with 75% sensitivity and 85% specificity.ConclusionOur investigation showed it is safe to attempt for single stage TERPT when aganglionic length on CE is less than 52 cm and the child with HD is older than 10 months. Chance of requiring additional laparotomy or laparoscopy assistance is low in these patients.Type of studyStudy of diagnostic test.Level of evidenceLevel II.     

The anchoring of a Cu(ii)–salophen complex on magnetic mesoporous cellulose nanofibers: green synthesis and an investigation of its catalytic role in tetrazole reactions through a facile one-pot route

Today, most synthetic methods are aimed at carrying out reactions under more efficient conditions and the realization of the twelve principles of green chemistry. Due to the importance and widespread applications of tetrazoles in various industries, especially in the field of pharmaceutical chemistry, and the expansion of the use of nanocatalysts in the preparation of valuable chemical reaction products, we decided to use an (Fe₃O₄@NFC@NSalophCu)CO₂H nanocatalyst in this project. In this study, the synthesis of the nanocatalyst (Fe₃O₄@NFC@NSalophCu)CO₂H was explained in a step-by-step manner. Confirmation of the structure was obtained based on FT-IR, EDX, FE-SEM, TEM, XRD, VSM, DLS, TGA, H-NMR, and CHNO analyses. The catalyst was applied to the synthesis of 5-substituted-1H-tetrazole and 1-substituted-1H-tetrazole derivatives through multi-component reactions (MCRs), and the performance was assessed. With advances in science and technology and increasing environmental pollution, the use of reagents and methods that are less dangerous for the environment has received much attention. Therefore, following green chemistry principles, with the help of the (Fe₃O₄@NFC@NSalophCu)CO₂H salen complex as a nanocatalyst that is recyclable, cheap, safe, and available, the use of water as a green solvent, and reduced reaction times, the synthesis of tetrazoles can be achieved.

Due to the importance and widespread applications of tetrazoles, especially in pharmaceutical chemistry, and the expansion of the use of nanocatalysts in the preparation of valuable chemical reaction products, we decided to use a (Fe₃O₄@NFC@NSalophCu)CO₂H nanocatalyst.     

Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture

Background

Outpatient management is appropriate for chronic pilonidal sinuses. Even though there are different surgical treatments for pilonidal sinuses, the outcome may not be uniformly satisfactory. The aim of this paper was to examine the ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture.

Methods

We present our experience with outpatient management of asymptomatic chronic pilonidal disease. We prospectively studied patients presenting with pilonidal disease from Mar. 20, 2005, to Mar. 20, 2008. All were managed as outpatients. We reviewed presentation, treatment, healing, time off work and recurrences.

Results

In all, 150 patients (131 men and 19 women) with chronic pilonidal sinuses underwent ambulatory plain lateral excision and primary repair during the study period. The mean age of patients was 22.1 years. The mean duration of surgery was 18.4 minutes. No general complications occurred. Local complications consisted of 3 wound infections and 4 wound hematomas. No sinus recurrence occurred. The healing rate was fast in all patients.

Conclusion

Advantages of ambulatory plain lateral excision and primary repair include immediate treatment, minimal pain and a quick return to normal activities. This method is a simple and effective procedure in the treatment of uncomplicated pilonidal sinuses.     

Quality comparison of remote anesthetic consultation versus on-site consultation in children with sedation for a magnetic resonance imaging examination—A randomized controlled trial

Background

In the course of the corona pandemic, digital media has increasingly been used in many areas of medical practice to reduce personal contact. As it is of interest whether this can be practiced in the context of anesthesia consultations without loss of quality, we interviewed parents whose children received a cardiac or neuro magnetic resonance imaging (MRI) under sedation. Parents either received an on-site or a remote consultation conducted by an anesthesiologist. Both parents and anesthesiologist were asked to indicate their satisfaction with the respective consultation procedure in a questionnaire.

Aim

The aim of this study was to investigate if remote pre-anesthesia consultation, supported by an online video, for parents whose children are receiving MRI examinations under sedation can replace the commonly performed on-site consultation, without decreasing its quality.

Methods

In this randomized trial, a total of 200 patients were included, one half received pre-anesthesia consultation on-site and the other half was given a link to a video and pre-anesthesia consultation was conducted by phone. As a primary analysis, we compared the level of satisfaction for the general procedure, the quality of the pre-anesthesia consultation and the contact to the anesthesiologists (or parents). We further investigated the frequency of complications and the preference for a possible next informed consent.

Results

Both groups showed high levels of satisfaction. Some anesthesiologists and parents were less satisfied with the quality of on-site pre-anesthesia consultation than with the remote. In our patient cohort, there was no evidence for higher risk of complications when information was provided by telephone. Further, parents as well as anesthesiologists clearly favored the combined form of telephone information and online video. Overall, 61.2% of parents and 64% of anesthesiologists would choose this form of pre-anesthesia consultation for repeat anesthesia.

Conclusions

We did not observe that combined telephone and video decreased the quality of pre-anesthesia consultation. A remote version seems feasible for simple procedures such as sedation for MRI. Further research on this topic in other areas of anesthesia would be beneficial.     

A case of Oguchi's disease with diabetic retinopathy

A 50-year-old Iranian diabetic woman with night blindness was referred to our clinic. Complete ophthalmic examination including ophthalmoscopy after dark adaptation and paraclinic evaluations such as fluorescein angiography and electroretinography were performed. Retinal neovascularization and preretinal haemorrhages compatible with high-risk characteristic proliferative diabetic retinopathy were observed bilaterally. In addition, a golden-yellowish discoloration of posterior pole was noted in her both eyes. The diagnosis of Oguchi's disease was made when this discoloration disappeared after dark adaptation for 3 h. Electroretinograms also confirmed the diagnosis by showing a slow negative wave followed by a slow positive wave in the photopic condition and absent a- and b-waves in the scotopic state. We concluded that proliferative diabetic retinopathy might occur in a patient with Oguchi's disease. This report represents this association in an Iranian patient for the first time.     

Hepatitis B virus surface protein mutations clustered mainly in CTL immune epitopes in chronic carriers: results of an Iranian nationwide study

Mutations within the coding region of hepatitis B surface antigen (HBsAg) have been found naturally in chronic carriers. To characterize the mutations of HBsAg from Iranian chronic carriers who were vaccine and/or medication naive. The surface genes from 360 patients were amplified and directly sequenced. The distribution of amino acid substitutions was classified according to different immune epitopes of the surface protein. All isolates belonged to genotype D . 222 (61.6%) of 360 patients contained at least one amino acid substitution. 404 (74.5%) of 542 amino acid changes occurred in different immune epitopes of HBsAg, of which 112 (27.7%) in 32 residues of B‐cell epitopes (62 in the ‘a’ determinant); 111 (27.4%) in 32 residues of T helper; and 197 (48.7%) in 32 residues inside cytotoxic T lymphocyte (CTL) epitopes. One Th (186–197) and two CTL (28–51 and 206–215) epitopes were found to be hotspot motifs for the occurrence of 213 (52.7%) substitutions. 20 stop codons were identified in different epitopes. There was a significant association between amino acid substitutions and anti‐HBe seropositivity; however, the correlation between such changes with viral load and ALT levels was not significant. In chronic hepatitis B virus(HBV) carriers, positive selection in particular outside the ‘a’ determinant appeared to exert influence on the surface proteins. These changes could be immune escape mutations naturally occurring due to the host immune surveillance especially at the T‐cell level.