Manish Pathak - Academia.edu (original) (raw)

Papers by Manish Pathak

Research paper thumbnail of Synthesis, Evaluation and Pharmacological action of Oxadiazole derivatives

Journal of Pharmacognosy and Phytochemistry

Impacted numerous drug discovery programs including-muscarinic antagonists, benzodiazepine recept... more Impacted numerous drug discovery programs including-muscarinic antagonists, benzodiazepine receptor partial agonists, Dopamine transporters, antirhinovirals, growth hormone secretagogues, 5-HT antagonists, antispasmodics. Heterocyclic compounds possess diverse biological properties that have led to intense study and research of these compounds. One of these compounds is Oxadiazole which has been found to exhibit various pharmacological activities. 1, 3, 4-oxadiazole having heterocyclic nucleus is a novel molecule which attract the chemist to search for a new therapeutic molecule. 1,3,4-oxadizole exhibited a wide range of biological activities which includes antibacterial, anti-tubercular, anticonvulsant, hypoglycemic, anti-allergic, enzyme inhibitor, vasodialatory, antifungal, cytotoxic, antiinflammatory, analgesic, hypolipidemic, anticancer, insecticidal, ulcerogenic activities etc. Out of the various derivative 2, 5-Disubstituted-1, 3, 4-oxadiazole is a widely exploited for various application. A large number of drugs used clinically have oxadiazole ring as a structural building block. The capacity of 1,3,4-oxadiazole nucleus to undergo variety of chemical reactions including electrophilic substitution, nucleophilic substitution, thermal and photochemical which make it medicinal backbone on which a number of potential molecules can be constructed. This review has basic information about 2, 5disubstituted-1, 3, 4-oxadiazole derivatives published in various journals for further development in the field. Oxadiazole derivatives are a class of heterocyclic compounds. The titled compounds were synthesized according to the procedures as given in the methodology. The reactions were monitored by TLC. The physical constants like melting point and solubility were determined for all the intermediates and final products. The compounds were further characterized by IR and 1H NMR and mass spectra. All the titled compounds were evaluated for their Anticonvulsant, Anti-inflammatory, Antibacterial, Antitubercular and Antioxidant activity.

Research paper thumbnail of Bronchial Carcinoid Tumour as a Rare Cause of Cushing’s Syndrome in Children: A Case Report and Review of Literature

Journal of Clinical Research in Pediatric Endocrinology

Cushing's syndrome (CS) is rare in childhood and adolescence. The most common paediatric cause of... more Cushing's syndrome (CS) is rare in childhood and adolescence. The most common paediatric cause of CS is exogenous administration of glucocorticoids; either topical, inhaled or oral corticosteroids. Endogenous causes can be classified into adrenocorticotropic hormone (ACTH) independent and ACTH dependent causes. Herein, we report our experience of managing a 12 year old girl who presented with features of CS and was found to have an ectopic, ACTH-secreting bronchial carcinoid tumour, which was resected surgically. Our patient was managed successfully by multidisciplinary approach and has recovered from hypertension and Cushing's habitus. The English language literature was searched from 2019 back, using PubMed, Google and Google Scholar. Keywords used for the search were; "Ectopic ACTH syndrome (EAS) in children", "bronchial carcinoid in children" and "Cushing's Syndrome in children". Children with bronchial carcinoid tumours causing EAS were identified. Case variables such as age, sex, type of carcinoid, investigations, surgery, recurrences and outcome were reviewed. Fourteen cases of paediatric bronchial carcinoid producing ACTH were found with a mean age of 15.8 years and female preponderance. Most of the patients had a right lung lesion and histological appearance was typical of carcinoid tumour. Bronchial carcinoid is extremely rare in children and only 4% are associated with CS. The postoperative treatment of CS is challenging with a high prevalence of hypertension, increased body mass index and visceral fat mass, impaired cognitive function and decreased quality of life. A careful follow up is indispensable for monitoring recurrence of carcinoid and complete remission of CS.

Research paper thumbnail of Commentary to “The use of urinary osmolality to evaluate postoperative renal function in children with ureteropelvic junction obstruction”

Journal of Pediatric Urology

Research paper thumbnail of Laboratory preparedness for SARS-CoV-2 testing in India: Harnessing a network of Virus Research & Diagnostic Laboratories

Indian Journal of Medical Research

Background & objectives: An outbreak of respiratory illness of unknown aetiology was reported fro... more Background & objectives: An outbreak of respiratory illness of unknown aetiology was reported from Hubei province of Wuhan, People's Republic of China, in December 2019. The outbreak was attributed to a novel coronavirus (CoV), named as severe acute respiratory syndrome (SARS)-CoV-2 and the disease as COVID-19. Within one month, cases were reported from 25 countries. In view of the novel viral strain with reported high morbidity, establishing early countrywide diagnosis to detect imported cases became critical. Here we describe the role of a countrywide network of VRDLs in early diagnosis of COVID-19. Methods: The Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV), Pune, established screening as well as confirmatory assays for SARS-CoV-2. A total of 13 VRDLs were provided with the E gene screening real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay. VRDLs were selected on the basis of their presence near an international airport/seaport

Research paper thumbnail of One-stage and two-stage laparoscopic assisted anorectoplasty (LAARP) for anorectal malformations (ARM)

Journal of Pediatric Endoscopic Surgery, 2021

Aim This study reviewed the literature on the technicalities and outcomes of one-and two-stage la... more Aim This study reviewed the literature on the technicalities and outcomes of one-and two-stage laparoscopic assisted anorectoplasty (LAARP) for anorectal malformation (ARM). Methods Systematic search of Medline/Pubmed, Embase and Web of Science database was performed using terms "two staged", "one staged", "anorectal malformation" and "laparoscopy". The search function was limited to human subjects and those less than 18 years of age. Two reviewers independently performed eligibility assessment and data extraction. Data were collected for type of malformation, surgical technique, post-operative complications and functional outcomes. Results The search between 2000-2020 identified 37 articles; and 10 articles met the eligibility criteria offering a sample size of 132 for this study. One-stage procedure was performed in n = 80, while two-stage procedure in n = 52. In one-stage procedure, recto-prostatic and recto-urethral bulbar fistula were the most common malformation approached, whereas in two-stage, these were recto-prostatic and recto-bladder neck fistula. Rectal prolapse was the most common post-operative complication in both one-stage and two-stage procedures. Functional assessment using the Krickenbeck classification was not possible for primary LAARP due to the inconsistent reporting. Conclusion One-stage LAARP is technically feasible but its generalizability still needs to be proven. With the available evidence, it is not possible to conclude on the functional outcome following one-stage LAARP.

Research paper thumbnail of Abstracts for IAPSCON 2018

Journal of Indian Association of Pediatric Surgeons, 2019

Research paper thumbnail of Development of a pulsed radio frequency ignited multicusp-free negative hydrogen ion source

Review of Scientific Instruments, 2020

A multicusp-free external antenna based radio frequency (RF) negative hydrogen (H−) ion source wa... more A multicusp-free external antenna based radio frequency (RF) negative hydrogen (H−) ion source was developed to produce 16 mA of H− ion current at −50 kVDC accelerating voltage operated with a pulse width of 2 ms at 2 Hz repetition rate. A pulsed RF igniter system is devised for generating the initial electron and ion pairs required to generate the main plasma in the pulsed mode. This pulsed RF igniter reliably starts ignition with a hydrogen gas flow rate in the range of 18–50 standard cubic centimeter per minute (SCCM). This system eliminates the need of igniter in continuous operation although it is operated in low power mode. This source operating at a low average power and without any moving parts can be expected to have a superior lifetime. This paper describes the development and operational characteristics of the pulsed RF ignited H− ion source.

Research paper thumbnail of Development of external RF antenna based cusp free high duty factor pulsed negative hydrogen ion source

SEVENTH INTERNATIONAL SYMPOSIUM ON NEGATIVE IONS, BEAMS AND SOURCES (NIBS 2020), 2021

An external RF antenna based cusp free negative hydrogen (H-) ion source has been designed and de... more An external RF antenna based cusp free negative hydrogen (H-) ion source has been designed and developed. This source operates at 10% duty factor and the key experimental results are reported in the paper. The extracted Hion beam current is 11 mA with 2 ms pulse duration and 50 Hz repetition rate at 50 keV beam energy. Operation of the Hion source at high duty factor results in temperature rise in components. This may lead to failure of electronic components, vacuum joints of the plasma or igniter chambers, or burn out the extraction electrodes. In order to keep the operating temperature within limits, a water cooling system was designed and incorporated for (i) the 2 MHz RF antenna operating at 90 A RMS at 7 kV AC, (ii) the extraction electrodes, operating at a maximum voltage of 15 kV DC, (iii) the plasma chamber (made of Aluminium Nitride, transparent to RF field with high thermal conductivity), and (iv) the Faraday cup for Hion current measurement. Forced air cooling was used for the 13.56 MHz RF-based pulsed igniter, plus on the various current-stabilizing electrode biasing networks and RF impedance matching networks.

Research paper thumbnail of Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Anaesthesia, 2021

SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...

Research paper thumbnail of Clinical, Serological, Whole Genome Sequence Analyses to Confirm SARS-CoV-2 Reinfection in Patients From Mumbai, India

Frontiers in Medicine, 2021

Background: SARS-CoV-2 infection may not provide long lasting post-infection immunity. While hund... more Background: SARS-CoV-2 infection may not provide long lasting post-infection immunity. While hundreds of reinfections have reported only a few have been confirmed. Whole genome sequencing (WGS) of the viral isolates from the different episodes is mandatory to establish reinfection.Methods: Nasopharyngeal (NP), oropharyngeal (OP) and whole blood (WB) samples were collected from paired samples of four individuals who were suspected of SARS-CoV-2 reinfection based on distinct clinical episodes and RT-PCR tests. Details from their case record files and investigations were documented. RNA was extracted from the NP and OP samples and subjected to WGS, and the nucleotide and amino acid sequences were subjected to genome and protein-based functional annotation analyses. Serial serology was performed for Anti-N IgG, Anti- S1 RBD IgG, and sVNT (surrogate virus neutralizing test).Findings: Three patients were more symptomatic with lower Ct values and longer duration of illness. Seroconversion ...

Research paper thumbnail of Arterio-Duodenal Fistula: A Rare Complication of Laparoscopic Choledochal Cyst Excision

Journal of Indian Association of Pediatric Surgeons, 2021

Choledochal cysts (CDC) are rare biliary tract anomalies characterized by congenital dilatation o... more Choledochal cysts (CDC) are rare biliary tract anomalies characterized by congenital dilatation of the extrahepatic and/or intrahepatic bile ducts. CDC excision with hepatico-enterostomy is the preferred surgery in modern era. Perioperative blood loss in a case of laparoscopic choledochal cyst excision (LCCE) is usually minimal and managed by conservative treatment such as blood transfusion and correction of coagulation factors. Massive hemorrhage in LCCE is rare and reported intraoperatively or within the first 3 postoperative days. Hereby, we present an unusual case of arterio-duodenal fistula, post LCCE presenting as delayed massive upper gastrointestinal bleeding in a male child and its successful endovascular management.

Research paper thumbnail of Single perineal opening with ‘H-type’ cecovesical fistula and blind-ending foreshortened distal colon: a new variant of persistent cloaca

BMJ Case Reports, 2021

Persistent cloaca is a rare and severe variety of anorectal malformation, which is more common in... more Persistent cloaca is a rare and severe variety of anorectal malformation, which is more common in females and includes a spectrum of abnormalities. The urinary tract, genital tract and rectum open into a common channel, which exteriorises as a single perineal opening. We are reporting a patient with a novel variation in the classical anatomy of the cloaca. The child has a short blind-ending colon with a cecovesical fistula associated with mullerian agenesis and lipomyelomeningocoele. The child is being managed in a stepwise approach and she has completed the anal reconstruction. Here, we discuss this novel variation in anatomy and challenges in its management.

Research paper thumbnail of Refractory congenital chylous ascites: Role of fibrin glue in its management

Journal of Indian Association of Pediatric Surgeons, 2020

Chylous ascites is the accumulation of triglyceride-rich lymph in the abdomen. Its occurrence dur... more Chylous ascites is the accumulation of triglyceride-rich lymph in the abdomen. Its occurrence during the infantile period is quite rare. Congenital chylous ascites (CCA) is one, which occurs in children <3 months of age, due to maldevelopment of the lymphatic system. There is no clearly defined treatment protocol for CCA; however, the use of medium-chain triglycerides (MCT)-based diet or total parenteral nutrition (TPN) with octreotide has been successful. Failure of conservative management, however, leads to surgical exploration to deal with those leaking lymphatics. In our case, we had initially given a trial of managing the child with MCT-based diet followed by a TPN along with octreotide. However, the failure of both leads us to operate the child during which we incorporated the use of fibrin glue over the leaking mesenteric lymphatic vesicles, which ultimately led to the resolution of the chylous ascites.

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

Journal of Pediatric Surgery, 2020

Purpose: To identify influence of different values of age and abnormal bowel length in HD patient... more Purpose: To 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. Methods: This 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. Results: Forty-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. Conclusion: Our 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.

Research paper thumbnail of Correspondence to “the usefulness of ultrasound examination in detecting testicular nubbin in Japanese boys with non-palpable testes”

Journal of Pediatric Urology, 2020

Research paper thumbnail of Laparoscopic Pyloromyotomy: A New Gold Standard for Infantile Hypertrophic Pyloric Stenosis

Research paper thumbnail of Duplex systems: Top-down or bottom-up approach?

Journal of Pediatric Urology, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Laparoscopic inguinal exploration for impalpable undescended testis: can we avoid the open inguinal exploration altogether?

Journal of Pediatric Endoscopic Surgery, 2019

Introduction Diagnostic laparoscopy is the gold standard for evaluating a child with impalpable u... more Introduction Diagnostic laparoscopy is the gold standard for evaluating a child with impalpable undescended testis (UDT). During the diagnostic laparoscopy, if the vas and vessels are seen coursing through the inguinal canal, the standard norm is to explore the inguinal canal via an inguinal crease incision. In this study, however, we explored the feasibility of laparoscopic inguinal exploration without any additional inguinal crease incision. Materials and methods The prospective study was done from 1.1.2019 to 30.6. 2019 to assess the feasibility of the laparoscopic inguinal exploration in cases of impalpable undescended testis, where testicular vessels are found to course into the inguinal canal during a diagnostic laparoscopy. The data including the descriptive characteristics, intraoperative findings, and surgical technique were collected and analysed. Results There were 17 cases of impalpable UDT operated in the Department of Pediatric Surgery from January 2019 to June 2019. Mean age of the patients was 8.5 years (1-16 years). Two patients had testicular vas and vessels coursing through the inguinal canal, both of which underwent laparoscopic inguinal exploration. In both of these cases, vas and vessels were found to end in testicular nubbin, at the level of the neck of the scrotum, which were excised laparoscopically, thus avoiding the open inguinal incision. Conclusion Laparoscopic inguinal exploration is a feasible and attractive alternative in cases of impalpable UDT where testicular vas and vessels are found to course through the inguinal ring.

Research paper thumbnail of Thoracic versus abdominal approach to correct diaphragmatic eventration in children

Journal of Pediatric Surgery, 2019

Background Plication of diaphragm (DP) for eventration (DE) can be done using thoracic or abdomin... more Background Plication of diaphragm (DP) for eventration (DE) can be done using thoracic or abdominal approaches. The purpose of our study was to compare outcomes between these approaches. Methods Retrospective records of children <16 years who underwent DP (single-centre, 2004-2018) were recorded and analysed. Data are reported as median (range). Results Eighty-nine cases were identified in thoracic (Congenital=5, Acquired=84) and 13 (Congenital=10, Acquired=3) in abdominal group aged 5.

Research paper thumbnail of Laparoscopic pyloromyotomy: learning curve journey and modification of the technique

Journal of Pediatric Endoscopic Surgery, 2019

Introduction Laparoscopic pyloromyotomy (LP) is becoming increasingly adopted in the management o... more Introduction Laparoscopic pyloromyotomy (LP) is becoming increasingly adopted in the management of patients with infantile hypertrophic pyloric stenosis (IHPS). We encountered few difficulties during the performance of laparoscopic pyloromyotomy initially so few modifications were done in the technique. We retrospectively analyzed and compared our patients who had undergone LP before the implementation of the modification with the patients operated after implementing the modifications. Materials and methods Retrospective analysis of the data of patients with IHPS operated in the Department of Pediatric Surgery; AIIMS Jodhpur from May 2016 to February 2019 was done. Medical records were reviewed for demographic data, physical findings, operative details, time to achieve full feeds, post-operative emesis, postoperative length of stay, complications, and follow-up. We compared our initial seven cases before the implementation of modification (cohort A) with the 11 cases after the implementation of these modifications (cohort B). Results The mean age and weight of the patients at the time of presentation was 44.2 days (range 30-120 days) and 3.25 kg (range 2-4.1 kg), respectively. The mean follow-up duration was 8 months. Both the cohorts were comparable in terms of mean age and weight at the time of presentation. The difference in duration of surgery, time to full feed and time to discharge was significant with a p value of < 0.0001, 0.0144 and 0.006, respectively. Conclusion LP is a safe, simple and easy to learn procedure that can reproduce the results of open Ramstedt pyloromyotomy.

Research paper thumbnail of Synthesis, Evaluation and Pharmacological action of Oxadiazole derivatives

Journal of Pharmacognosy and Phytochemistry

Impacted numerous drug discovery programs including-muscarinic antagonists, benzodiazepine recept... more Impacted numerous drug discovery programs including-muscarinic antagonists, benzodiazepine receptor partial agonists, Dopamine transporters, antirhinovirals, growth hormone secretagogues, 5-HT antagonists, antispasmodics. Heterocyclic compounds possess diverse biological properties that have led to intense study and research of these compounds. One of these compounds is Oxadiazole which has been found to exhibit various pharmacological activities. 1, 3, 4-oxadiazole having heterocyclic nucleus is a novel molecule which attract the chemist to search for a new therapeutic molecule. 1,3,4-oxadizole exhibited a wide range of biological activities which includes antibacterial, anti-tubercular, anticonvulsant, hypoglycemic, anti-allergic, enzyme inhibitor, vasodialatory, antifungal, cytotoxic, antiinflammatory, analgesic, hypolipidemic, anticancer, insecticidal, ulcerogenic activities etc. Out of the various derivative 2, 5-Disubstituted-1, 3, 4-oxadiazole is a widely exploited for various application. A large number of drugs used clinically have oxadiazole ring as a structural building block. The capacity of 1,3,4-oxadiazole nucleus to undergo variety of chemical reactions including electrophilic substitution, nucleophilic substitution, thermal and photochemical which make it medicinal backbone on which a number of potential molecules can be constructed. This review has basic information about 2, 5disubstituted-1, 3, 4-oxadiazole derivatives published in various journals for further development in the field. Oxadiazole derivatives are a class of heterocyclic compounds. The titled compounds were synthesized according to the procedures as given in the methodology. The reactions were monitored by TLC. The physical constants like melting point and solubility were determined for all the intermediates and final products. The compounds were further characterized by IR and 1H NMR and mass spectra. All the titled compounds were evaluated for their Anticonvulsant, Anti-inflammatory, Antibacterial, Antitubercular and Antioxidant activity.

Research paper thumbnail of Bronchial Carcinoid Tumour as a Rare Cause of Cushing’s Syndrome in Children: A Case Report and Review of Literature

Journal of Clinical Research in Pediatric Endocrinology

Cushing's syndrome (CS) is rare in childhood and adolescence. The most common paediatric cause of... more Cushing's syndrome (CS) is rare in childhood and adolescence. The most common paediatric cause of CS is exogenous administration of glucocorticoids; either topical, inhaled or oral corticosteroids. Endogenous causes can be classified into adrenocorticotropic hormone (ACTH) independent and ACTH dependent causes. Herein, we report our experience of managing a 12 year old girl who presented with features of CS and was found to have an ectopic, ACTH-secreting bronchial carcinoid tumour, which was resected surgically. Our patient was managed successfully by multidisciplinary approach and has recovered from hypertension and Cushing's habitus. The English language literature was searched from 2019 back, using PubMed, Google and Google Scholar. Keywords used for the search were; "Ectopic ACTH syndrome (EAS) in children", "bronchial carcinoid in children" and "Cushing's Syndrome in children". Children with bronchial carcinoid tumours causing EAS were identified. Case variables such as age, sex, type of carcinoid, investigations, surgery, recurrences and outcome were reviewed. Fourteen cases of paediatric bronchial carcinoid producing ACTH were found with a mean age of 15.8 years and female preponderance. Most of the patients had a right lung lesion and histological appearance was typical of carcinoid tumour. Bronchial carcinoid is extremely rare in children and only 4% are associated with CS. The postoperative treatment of CS is challenging with a high prevalence of hypertension, increased body mass index and visceral fat mass, impaired cognitive function and decreased quality of life. A careful follow up is indispensable for monitoring recurrence of carcinoid and complete remission of CS.

Research paper thumbnail of Commentary to “The use of urinary osmolality to evaluate postoperative renal function in children with ureteropelvic junction obstruction”

Journal of Pediatric Urology

Research paper thumbnail of Laboratory preparedness for SARS-CoV-2 testing in India: Harnessing a network of Virus Research & Diagnostic Laboratories

Indian Journal of Medical Research

Background & objectives: An outbreak of respiratory illness of unknown aetiology was reported fro... more Background & objectives: An outbreak of respiratory illness of unknown aetiology was reported from Hubei province of Wuhan, People's Republic of China, in December 2019. The outbreak was attributed to a novel coronavirus (CoV), named as severe acute respiratory syndrome (SARS)-CoV-2 and the disease as COVID-19. Within one month, cases were reported from 25 countries. In view of the novel viral strain with reported high morbidity, establishing early countrywide diagnosis to detect imported cases became critical. Here we describe the role of a countrywide network of VRDLs in early diagnosis of COVID-19. Methods: The Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV), Pune, established screening as well as confirmatory assays for SARS-CoV-2. A total of 13 VRDLs were provided with the E gene screening real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay. VRDLs were selected on the basis of their presence near an international airport/seaport

Research paper thumbnail of One-stage and two-stage laparoscopic assisted anorectoplasty (LAARP) for anorectal malformations (ARM)

Journal of Pediatric Endoscopic Surgery, 2021

Aim This study reviewed the literature on the technicalities and outcomes of one-and two-stage la... more Aim This study reviewed the literature on the technicalities and outcomes of one-and two-stage laparoscopic assisted anorectoplasty (LAARP) for anorectal malformation (ARM). Methods Systematic search of Medline/Pubmed, Embase and Web of Science database was performed using terms "two staged", "one staged", "anorectal malformation" and "laparoscopy". The search function was limited to human subjects and those less than 18 years of age. Two reviewers independently performed eligibility assessment and data extraction. Data were collected for type of malformation, surgical technique, post-operative complications and functional outcomes. Results The search between 2000-2020 identified 37 articles; and 10 articles met the eligibility criteria offering a sample size of 132 for this study. One-stage procedure was performed in n = 80, while two-stage procedure in n = 52. In one-stage procedure, recto-prostatic and recto-urethral bulbar fistula were the most common malformation approached, whereas in two-stage, these were recto-prostatic and recto-bladder neck fistula. Rectal prolapse was the most common post-operative complication in both one-stage and two-stage procedures. Functional assessment using the Krickenbeck classification was not possible for primary LAARP due to the inconsistent reporting. Conclusion One-stage LAARP is technically feasible but its generalizability still needs to be proven. With the available evidence, it is not possible to conclude on the functional outcome following one-stage LAARP.

Research paper thumbnail of Abstracts for IAPSCON 2018

Journal of Indian Association of Pediatric Surgeons, 2019

Research paper thumbnail of Development of a pulsed radio frequency ignited multicusp-free negative hydrogen ion source

Review of Scientific Instruments, 2020

A multicusp-free external antenna based radio frequency (RF) negative hydrogen (H−) ion source wa... more A multicusp-free external antenna based radio frequency (RF) negative hydrogen (H−) ion source was developed to produce 16 mA of H− ion current at −50 kVDC accelerating voltage operated with a pulse width of 2 ms at 2 Hz repetition rate. A pulsed RF igniter system is devised for generating the initial electron and ion pairs required to generate the main plasma in the pulsed mode. This pulsed RF igniter reliably starts ignition with a hydrogen gas flow rate in the range of 18–50 standard cubic centimeter per minute (SCCM). This system eliminates the need of igniter in continuous operation although it is operated in low power mode. This source operating at a low average power and without any moving parts can be expected to have a superior lifetime. This paper describes the development and operational characteristics of the pulsed RF ignited H− ion source.

Research paper thumbnail of Development of external RF antenna based cusp free high duty factor pulsed negative hydrogen ion source

SEVENTH INTERNATIONAL SYMPOSIUM ON NEGATIVE IONS, BEAMS AND SOURCES (NIBS 2020), 2021

An external RF antenna based cusp free negative hydrogen (H-) ion source has been designed and de... more An external RF antenna based cusp free negative hydrogen (H-) ion source has been designed and developed. This source operates at 10% duty factor and the key experimental results are reported in the paper. The extracted Hion beam current is 11 mA with 2 ms pulse duration and 50 Hz repetition rate at 50 keV beam energy. Operation of the Hion source at high duty factor results in temperature rise in components. This may lead to failure of electronic components, vacuum joints of the plasma or igniter chambers, or burn out the extraction electrodes. In order to keep the operating temperature within limits, a water cooling system was designed and incorporated for (i) the 2 MHz RF antenna operating at 90 A RMS at 7 kV AC, (ii) the extraction electrodes, operating at a maximum voltage of 15 kV DC, (iii) the plasma chamber (made of Aluminium Nitride, transparent to RF field with high thermal conductivity), and (iv) the Faraday cup for Hion current measurement. Forced air cooling was used for the 13.56 MHz RF-based pulsed igniter, plus on the various current-stabilizing electrode biasing networks and RF impedance matching networks.

Research paper thumbnail of Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Anaesthesia, 2021

SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...

Research paper thumbnail of Clinical, Serological, Whole Genome Sequence Analyses to Confirm SARS-CoV-2 Reinfection in Patients From Mumbai, India

Frontiers in Medicine, 2021

Background: SARS-CoV-2 infection may not provide long lasting post-infection immunity. While hund... more Background: SARS-CoV-2 infection may not provide long lasting post-infection immunity. While hundreds of reinfections have reported only a few have been confirmed. Whole genome sequencing (WGS) of the viral isolates from the different episodes is mandatory to establish reinfection.Methods: Nasopharyngeal (NP), oropharyngeal (OP) and whole blood (WB) samples were collected from paired samples of four individuals who were suspected of SARS-CoV-2 reinfection based on distinct clinical episodes and RT-PCR tests. Details from their case record files and investigations were documented. RNA was extracted from the NP and OP samples and subjected to WGS, and the nucleotide and amino acid sequences were subjected to genome and protein-based functional annotation analyses. Serial serology was performed for Anti-N IgG, Anti- S1 RBD IgG, and sVNT (surrogate virus neutralizing test).Findings: Three patients were more symptomatic with lower Ct values and longer duration of illness. Seroconversion ...

Research paper thumbnail of Arterio-Duodenal Fistula: A Rare Complication of Laparoscopic Choledochal Cyst Excision

Journal of Indian Association of Pediatric Surgeons, 2021

Choledochal cysts (CDC) are rare biliary tract anomalies characterized by congenital dilatation o... more Choledochal cysts (CDC) are rare biliary tract anomalies characterized by congenital dilatation of the extrahepatic and/or intrahepatic bile ducts. CDC excision with hepatico-enterostomy is the preferred surgery in modern era. Perioperative blood loss in a case of laparoscopic choledochal cyst excision (LCCE) is usually minimal and managed by conservative treatment such as blood transfusion and correction of coagulation factors. Massive hemorrhage in LCCE is rare and reported intraoperatively or within the first 3 postoperative days. Hereby, we present an unusual case of arterio-duodenal fistula, post LCCE presenting as delayed massive upper gastrointestinal bleeding in a male child and its successful endovascular management.

Research paper thumbnail of Single perineal opening with ‘H-type’ cecovesical fistula and blind-ending foreshortened distal colon: a new variant of persistent cloaca

BMJ Case Reports, 2021

Persistent cloaca is a rare and severe variety of anorectal malformation, which is more common in... more Persistent cloaca is a rare and severe variety of anorectal malformation, which is more common in females and includes a spectrum of abnormalities. The urinary tract, genital tract and rectum open into a common channel, which exteriorises as a single perineal opening. We are reporting a patient with a novel variation in the classical anatomy of the cloaca. The child has a short blind-ending colon with a cecovesical fistula associated with mullerian agenesis and lipomyelomeningocoele. The child is being managed in a stepwise approach and she has completed the anal reconstruction. Here, we discuss this novel variation in anatomy and challenges in its management.

Research paper thumbnail of Refractory congenital chylous ascites: Role of fibrin glue in its management

Journal of Indian Association of Pediatric Surgeons, 2020

Chylous ascites is the accumulation of triglyceride-rich lymph in the abdomen. Its occurrence dur... more Chylous ascites is the accumulation of triglyceride-rich lymph in the abdomen. Its occurrence during the infantile period is quite rare. Congenital chylous ascites (CCA) is one, which occurs in children <3 months of age, due to maldevelopment of the lymphatic system. There is no clearly defined treatment protocol for CCA; however, the use of medium-chain triglycerides (MCT)-based diet or total parenteral nutrition (TPN) with octreotide has been successful. Failure of conservative management, however, leads to surgical exploration to deal with those leaking lymphatics. In our case, we had initially given a trial of managing the child with MCT-based diet followed by a TPN along with octreotide. However, the failure of both leads us to operate the child during which we incorporated the use of fibrin glue over the leaking mesenteric lymphatic vesicles, which ultimately led to the resolution of the chylous ascites.

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

Journal of Pediatric Surgery, 2020

Purpose: To identify influence of different values of age and abnormal bowel length in HD patient... more Purpose: To 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. Methods: This 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. Results: Forty-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. Conclusion: Our 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.

Research paper thumbnail of Correspondence to “the usefulness of ultrasound examination in detecting testicular nubbin in Japanese boys with non-palpable testes”

Journal of Pediatric Urology, 2020

Research paper thumbnail of Laparoscopic Pyloromyotomy: A New Gold Standard for Infantile Hypertrophic Pyloric Stenosis

Research paper thumbnail of Duplex systems: Top-down or bottom-up approach?

Journal of Pediatric Urology, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Laparoscopic inguinal exploration for impalpable undescended testis: can we avoid the open inguinal exploration altogether?

Journal of Pediatric Endoscopic Surgery, 2019

Introduction Diagnostic laparoscopy is the gold standard for evaluating a child with impalpable u... more Introduction Diagnostic laparoscopy is the gold standard for evaluating a child with impalpable undescended testis (UDT). During the diagnostic laparoscopy, if the vas and vessels are seen coursing through the inguinal canal, the standard norm is to explore the inguinal canal via an inguinal crease incision. In this study, however, we explored the feasibility of laparoscopic inguinal exploration without any additional inguinal crease incision. Materials and methods The prospective study was done from 1.1.2019 to 30.6. 2019 to assess the feasibility of the laparoscopic inguinal exploration in cases of impalpable undescended testis, where testicular vessels are found to course into the inguinal canal during a diagnostic laparoscopy. The data including the descriptive characteristics, intraoperative findings, and surgical technique were collected and analysed. Results There were 17 cases of impalpable UDT operated in the Department of Pediatric Surgery from January 2019 to June 2019. Mean age of the patients was 8.5 years (1-16 years). Two patients had testicular vas and vessels coursing through the inguinal canal, both of which underwent laparoscopic inguinal exploration. In both of these cases, vas and vessels were found to end in testicular nubbin, at the level of the neck of the scrotum, which were excised laparoscopically, thus avoiding the open inguinal incision. Conclusion Laparoscopic inguinal exploration is a feasible and attractive alternative in cases of impalpable UDT where testicular vas and vessels are found to course through the inguinal ring.

Research paper thumbnail of Thoracic versus abdominal approach to correct diaphragmatic eventration in children

Journal of Pediatric Surgery, 2019

Background Plication of diaphragm (DP) for eventration (DE) can be done using thoracic or abdomin... more Background Plication of diaphragm (DP) for eventration (DE) can be done using thoracic or abdominal approaches. The purpose of our study was to compare outcomes between these approaches. Methods Retrospective records of children <16 years who underwent DP (single-centre, 2004-2018) were recorded and analysed. Data are reported as median (range). Results Eighty-nine cases were identified in thoracic (Congenital=5, Acquired=84) and 13 (Congenital=10, Acquired=3) in abdominal group aged 5.

Research paper thumbnail of Laparoscopic pyloromyotomy: learning curve journey and modification of the technique

Journal of Pediatric Endoscopic Surgery, 2019

Introduction Laparoscopic pyloromyotomy (LP) is becoming increasingly adopted in the management o... more Introduction Laparoscopic pyloromyotomy (LP) is becoming increasingly adopted in the management of patients with infantile hypertrophic pyloric stenosis (IHPS). We encountered few difficulties during the performance of laparoscopic pyloromyotomy initially so few modifications were done in the technique. We retrospectively analyzed and compared our patients who had undergone LP before the implementation of the modification with the patients operated after implementing the modifications. Materials and methods Retrospective analysis of the data of patients with IHPS operated in the Department of Pediatric Surgery; AIIMS Jodhpur from May 2016 to February 2019 was done. Medical records were reviewed for demographic data, physical findings, operative details, time to achieve full feeds, post-operative emesis, postoperative length of stay, complications, and follow-up. We compared our initial seven cases before the implementation of modification (cohort A) with the 11 cases after the implementation of these modifications (cohort B). Results The mean age and weight of the patients at the time of presentation was 44.2 days (range 30-120 days) and 3.25 kg (range 2-4.1 kg), respectively. The mean follow-up duration was 8 months. Both the cohorts were comparable in terms of mean age and weight at the time of presentation. The difference in duration of surgery, time to full feed and time to discharge was significant with a p value of < 0.0001, 0.0144 and 0.006, respectively. Conclusion LP is a safe, simple and easy to learn procedure that can reproduce the results of open Ramstedt pyloromyotomy.