Baller Gerold Syndrome (BGS) is a rare autosomal recessive disorder that is apparent at birth. The disorder is characterized by distinctive malformations of the skull and facial area and bones of the forearms and hands. We are reporting a new case of BGS in a 10-month-old female child born of an epileptic mother who was on sodium valproate during the initial months of pregnancy. The baby was born with premature closure of the metopic suture, unilateral radial aplasia with limb malformation and other congenital anomalies that conformed with the description of BGS. The parents and other family members were unaffected, karyotyping was normal and there was no history of consanguinity. Fetal valproate exposure has been previously reported as the cause of this fetal malformation syndrome, which is generally inherited as an autosomal recessive trait. The peculiar pregnancy history and the supporting literature on the effects of valproic acid on the fetus exposed in utero to it with numerous case reports in the literature referring to BGS as a result of fetal exposure to valproate made us conclude that this is indeed a case of BGS secondary to valproate-induced teratogenesis.

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Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major health care problems worldwide even in Pediatric population. The etiology of CKD in children with ESRD is varied. Most of them are started on peritoneal dialysis or hemodialysis before being considered for renal transplantation.The aims and objective of this study was to analyzed the patient group, methodology, results and outcomes of hemodialysis catheter insertion and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion for children with ESRD. The etiology of ESRD in children with CKD is also reviewed.Methods: All children with ESRD who underwent CAPD catheter and haemodialysis catheter insertion over a period of 5 years were included in the study. CAPD catheters were inserted by open and laparoscopic assisted methods. The procedures were done without image guidance due to logistical constraints in a limited resource scenario. Analysis of all relevant case records, operative notes and postoperative events were done.Results: A total of 40 patients who underwent CAPD and hemodialysis catheter insertions were analysed. The primary cases (no previous insertion of dialysis catheter) included 29 and secondary cases (history of previous insertion of dialysis catheter) were 7. Re-insertions (of the same type of dialysis catheter) were 2 in each group. No significant complications occurred in either group.Conclusions: Dialysis catheters for ESRD in Paediatric population can be inserted safely even without image guidance and with very few complications.

Introduction: Undescended testis is a common surgical problem in children which needs to be treated by one and a half year of age. When testis is non palpable, it could be either absent, and when present intra-abdominal or inguinal. Methodology: A hospital based retrospective study was conducted in department of paediatric surgery, Thiruvananthapuram. Study population consisted of children treated with nonpalpable undescended testis from January 2016 to June 2021. Results: Mean age of intervention was 43.7 months (range 7 to 153 months). Incidence of absent testis was 30.97%. in 156 children who had ipsilateral undescended testis, 92 had intra-abdominal testis and 43 had inguinal testis. Presence of nubbin of testis in ipsilateral scrotum and contralateral testicular hypertrophy were suggestive of absent ipsilateral testis (p <0.001). Testis is absent in 11.3% only when ipsilateral hemi scrotum is under developed. Conclusion: Proportion of absent testis is 30.97% in children with unilateral undescended testis. Presence of nubbin of testis in ipsilateral scrotum and contralateral testicular hypertrophy are predictive of ipsilateral testicular absence. Keywords: Undescended testis, atrophic testis, Contralateral hypertrophy.

Background: Secondhand Smoke (SHS) exposure is known to be associated with various cardiovascular and respiratory problems but its effect on pulmonary function remains unexplored. This study was done to evaluate the effect of Secondhand Smoke (SHS) exposure on lung function among non-smoking population.Methods: This cross-sectional study was conducted in Bahour, Pondicherry from 2017-2018.  350 participants, age 40 year and older, with no respiratory symptoms or prior lung diseases were included in this study. Both self-reported history and measurement of urinary cotinine level were used to evaluate the smoking status. Spirometry data, including FVC and FEV1 were used to assess lung function. Diverse variables between groups were compared using T- test and Chi-square test. Analysis of covariance (ANCOVA) adjusted for age, height, alcohol consumption, and level of exercise was used to see any statistical differences in lung function parameters between non-SHS exposed and SHS-exposed groups.Results: Among 350 non-smokers, 120 were SHS-exposed. The urinary cotinine levels clearly distinguished SHS exposure, and the mean urinary cotinine levels were 7±0.3 and 11±0.4 in non-SHS exposed group vs SHS-exposed group, respectively. However, both groups had no significant difference in lung function and was found normal.Conclusions: SHS exposure urinary cotinine is a valuable marker.

Background: Acute appendicitis is a common surgical problem, with complicated appendicitis having significant post operative complications, which contribute significantly to cost of medical care. Methodology: A hospital based retrospective study was conducted in department of paediatric surgery, Thiruvananthapuram. Study population consisted of children treated with complicated appendicitis from January 2016 to June 2021. Results: The study had 30.4% surgical site soft tissue infection (SSI). There was 13.48% incidence of major complication, with laparoscopic and open appendicectomies having similar incidence even though not statistically significant. SSI was more common with appendicular abscess and post ileal appendix. Post operative intra-abdominal abscess is more common with open appendicectomy, generalised peritonitis, post ileal appendix and base/proximal perforation of appendix. Post operative adhesive intestinal obstruction was more common with laparoscopic appendicectomy, appendicular abscess and base/proximal perforation of appendix. Total hospital stay correlates significantly with duration of symptoms on presentation with mean hospital stay of 7.72 days. Conclusion: Complicated appendicitis have high incidence of post operative complications, 30.4% SSI and 13.48% serious complications like intra-abdominal collection and adhesive intestinal obstruction. Keywords: Appendicitis, Complication, Surgical site infection, Children.

Background: Asthma is a chronic inflammatory disorder of the airways causing bronchial hyper-responsiveness that is characterized by variable and recurring symptoms and airflow obstruction. Asthma is characterized by multiple biomarkers measurable in biological fluids. To become useful, these biomarkers need to be quantifiable by reliable systems, reproducible in the clinical setting, easy to obtain and cost-effective. bjective: The current study aimed to assess the relation between clinical symptoms, functional parameters and biomarkers of airway inflammation. Materials and Methods: This prospective, observational and single-center study carried out in the outpatient and inpatient department of Thoracic medicine, Tirunelveli Medical College Hospital, Tamil Nadu, India from June-2017 to June-2018 was aimed to assess the relation between clinical symptoms, functional parameters and biomarkers of airway inflammation in all stable asthmatic patients of 18–60 years of age. The severity of asthma was assessed according to the GINA criteria, based on clinical symptoms and pulmonary function test. Blood samples were collected for absolute eosinophil count and induced sputum samples for eosinophil count. Data was entered in Microsoft Excel and statistical analysis was performed by t-test. p<0.05 was considered statistically significant.

Introduction: Foreign Body Aspiration (FBA) is a common and serious paediatric emergency condition. A Suspected Foreign Body Aspiration (SFBA) is based on Clinical History (CH), Physical Findings (PF), and Chest Radiograph (RAD/CXR). The predictive accuracy of these factors as indicators of FBA and to perform Rigid Bronchoscopy (RB) based on these factors has been debated. Aim: To evaluate the sensitivity, specificity, positive predictive value and negative predictive value of clinical history, physical findings and radiology in SFBA. Materials and Methods: A retrospective analysis was conducted on paediatric patients with suspicion of foreign body aspiration, admitted in the Department of Paediatric Surgery at Government Medical College, Thiruvananthapuram, Kerala, India, between January 2006 and December 2020. Factors in CH, PF, and RAD were subjected to univariate and multivariate analysis to evaluate the predictive accuracy of these factors as indicators for bronchoscopy. Sensitivity, specificity, positive and NPV were calculated for the clinico-radiological indicators in predicting FBA. The association between evidence of FBA and clinico-radiological indicators was evaluated by Pearson Chi-square test; and p-values <0.05 were considered to be statistically significant. Results: A total of 458 children (263 males and 195 females) were admitted with SFBA having mean age of 29.49±24.92 months, 389 had confirmed FBA, and 69 had no FBA. The age group of 1-2 years was found to be a statistically significant factor for FBA (p-value=0.03). Foreign Body aspiration Witnessing Event (FBEW) (p-value <0.0001, sensitivity=91%, specificity=31%), choking spell (p-value <0.0001, sensitivity=95%, specificity=25%), acute cough (p-value <0.0001, sensitivity=87%, specificity=46%), tachypnea (p-value <0.0167, sensitivity=89%, specificity=20%), decreased breath sound (p-value <0.0001, sensitivity=92%, specificity=35%), abnormal CXR (p-value <0.0001, sensitivity=94%, specificity=37%) and hyperinflation (p-value <0.0001, sensitivity=95%, specificity=31%) were found to be independent statistically significant factors in FBA. Multivariate analysis showed a PPV of 97% when the aspiration event was witnessed along with abnormal physical and radiological findings. Conclusion: It was observed that assessment of clinico-radiological parameters is valuable in predicting FBA. The indications of RB in SFBA can be safely based on these clinico-radiological parameters.