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Background As the COVID-19 pandemic completes one year, it is prudent to reflect back upon the challenges faced and the management strategies employed to tackle this overwhelming healthcare crisis. We undertook this study to validate our institutional protocols which were formulated to cater to the change in volume and pattern of neurosurgical cases during the raging pandemic. Methods All admitted patients scheduled to undergo major neurosurgical intervention during the lockdown period (15 March 2020 to 15 September 2020) were included in the study. The data involving surgery outcomes, disease pattern, anaesthesia techniques, patient demographics as well as COVID-19 status was analysed and compared with similar retrospective data of neurosurgical patients operated during the same time period in the previous year (15 March 2019 to 15 September 2019). Results Barring significant increase in surgery for stroke (P = 0.008) and hydrocephalus (P <0.001), the overall case load of neurosurgery during the study period in 2020 was 42.75% of that in 2019 (P <0.001); and the same was attributable to a significant reduction in elective spine surgeries (P < 0.001). However no significant difference was observed in the overall incidence of emergency and essential surgeries undertaken during the two time periods (P = 0.482). There was an increased incidence in the use of monitored anaesthesia care (MAC) techniques during emergency and essential neurosurgical procedures by the anaesthesia team in 2020 (P < 0.001). COVID-19 patients had overall poor outcomes (P = 0.003), with significant increase in mortality amongst those subjected to general anaesthesia vis-a-vis MAC (p = 0.014). Conclusions Despite a significant decrease in neurosurgical workload during the COVID-19 lockdown period in 2020, the volume of emergency and essential surgeries did not change much compared to the previous year. Surgery in COVID-19 patients is best avoided, unless critical, as the outcome in these patients is not favourable. The employment of monitored anaesthesia care techniques like awake craniotomy, and regional anaesthesia; facilitate a better outcome in the COVID-19 era.

Bubble Continuous Positive Airway Pressure is safe, efficacious and easy to use in preterm neonates with mild to moderate respiratory distress.

HIV positive children who have low CD4 count, poor school attendance, and performance are at a higher risk of being detected with EBD. Screening with PPSC to identify EBD in HIV positive children attending HIV clinic in a hospital setting could help in early diagnosis and management.

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In a randomized controlled design, 100 healthy, term neonates in the first week of life, undergoing heel prick for routine screening were randomized to receive a heel prick in either the drowsy/sleeping state or the awake (but not fussy or crying) state. 48 babies in sleeping or drowsy states and 47 in the awake states were analyzed. Infants in the drowsy/sleeping states scored significantly lower on the Neonatal Infant Pain Score (NIPS) (median score 5) at 30 seconds post stimulus compared with infants in higher states of alertness (median score 6). They also had a shorter total duration of cry (29.17 sec ± 8.95 vs 32.67 sec ± 9.82). However, there was no difference in the NIPS score between the two groups at 45 seconds post stimulus. We concluded that babies in the drowsy/sleeping states of alertness at the time of a painful stimulus appear to show a less intense behavioral response to pain as compared to those in the awake state.

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Surgery was performed under general anaesthesia under cortisol cover. The patient was positioned supine with legs abducted, catheterised, prepped, and draped. Stay sutures were placed on the labia majora to keep them abducted and on the glans clitoris to keep it in traction. The incision was marked, being circumcoronal and extending posteriorly on either side of the urethral plate region up to the introitus. About 1:200,000 adrenaline was infiltrated under the clitoral skin and urethral plate area. The clitoris was degloved till its root (Figure 1). Two vertical incisions were made over the degloved clitoral shaft ventrally, incising the Bucks fascia and tunica albuginea in this region. The corpora cavernosa were dissected and ligated at the clitoral base and excised preserving the neurovascular structures to the glans clitoris running dorsally on the clitoral shaft. The clitoris was shortened by folding the redundant clitoral tissue and anchoring the glans clitoris to soft tissues below the symphysis pubis. The redundant clitoral skin was split dorsally in the midline and transposed down both sides to form the clitoral hood and labia minora (Figure 2). The postoperative recovery was uneventful. The patient now has normal appearing genitalia and sensate clitoris. Figure 3 is a sketch showing the operative plan. DISCUSSIONEnlargement of the clitoris can be found in CAH and other virilising states. Clitoral enlargement is frequent in CAH and the decision to undergo reduction is an individualised one.1 While minor degrees of clitoral enlargement can be left alone, marked enlargement can cause confusion as to gender, embarrassment and a