Dinesh K. Gupta

Cloning, sequencing, and expression of the hepatitis E virus (HEV) nonstructural open reading frame 1 (ORF1)†

Hepatitis E virus (HEV) causes enterically transmitted epidemic and sporadic viral hepatitis affecting millions of people in the developing world. Different geographical isolates of HEV show a high degree of homology at the nucleotide and amino acid levels. The ∼7.2 kb RNA genome has three open reading frames of which ORF1 is predicted to code for the viral nonstructural polyprotein. The expression, processing and properties of the nonstructural ORF1 polyprotein have not been reported so far. In this study, the complete HEV ORF1 was reconstructed from overlapping fragments amplified by polymerase chain reaction (PCR) of total RNA isolated from the bile fluid of a rhesus monkey experimentally infected with HEV isolate from an epidemic. The complete assembled ORF1 was sequenced using HEV specific primers. The ORF1 polyprotein was expressed in E. coli, in a cell free translation system and in HepG2 cells, and was characterized by western blotting and immunoprecipitation using acute phase patient serum as well as polyclonal antibodies raised against defined parts of the ORF1 polyprotein. The nonstructural polyprotein of HEV was expressed as a 186 kDa protein. No processing was observed into discrete units, either in‐vitro based on a kinetic analysis, or in HepG2 cells based on immunoprecipitation. J. Med. Virol. 60:275–283, 2000.

Use of fibrin glue in preventing urethrocutaneous fistula after hypospadias repair

UNLABELLEDnUrethrocutaneous fistula is one of the most common complications after hypospadias surgery. The incidence of fistula development has varied from 4% to 20% in larger series. We sought to investigate the role of fibrin glue (Tisseel manufactured by Baxter India Pvt Ltd, Chennai, India) to reduce the chances of fistula formation in cases in proximal penile hypospadias.nnnMETHODnA total of 120 patients with proximal penile hypospadias (patients having urethral meatus at posterior third of penile shaft and at penoscrotal junction) were included in the present study. Patients were randomly allocated into 2 groups of 60 each by using Strata 9 software random number table. In group A, fibrin glue was used as a sealant after hypospadias surgery, whereas in group B, no sealant was used. All the operations were performed by single surgeon using transverse preputial tubularized island flap urethroplasty.nnnRESULTnFistula formation occurred in 6 cases in group A (10%) and 19 cases in group B (32%) (P = .027). The fistulae observed in fibrin glue group A were single and small in size (<1 mm). Multiple (>or=2 fistulae) and larger fistulae (>2 mm) were observed in group B. Overall complication was significantly higher in group B (P = .006).nnnCONCLUSIONnFibrin glue in hypospadias repair does not eliminate fistula formation. However, it seems that it minimizes the incidence of fistula formation.

Single-stage repair for rectovestibular fistula without opening the fourchette

BACKGROUNDnAnorectal malformations are one of the most common congenital defects. This study is conducted to demonstrate new technique for treatment of rectovaginal fistula without disturbing the fourchette through posterior sagittal approach.nnnMETHODnAll the patients of rectovestibular fistula admitted after the neonatal age were treated with posterior sagittal anorectoplasty without opening the fourchette. The results were evaluated for cosmetic appearance and anal continence.nnnRESULTnA total of 40 patients were included in our study. All patients were more than 1 month old. Operative time ranges from 70 to 150 minutes. The cosmetic appearance was good. Anal continence was good in 72% cases and fair in 20% cases. Fifteen percent of patients had minimal constipation and 7.5% patients had mucosal prolapse.nnnCONCLUSIONnSingle-stage repair for vestibular anus through posterior sagittal anorectoplasty without opening fourchette has a good cosmetic appearance and good anal continence.

Duplication cyst of pyloroduodenal canal: a rare cause of neonatal gastric outlet obstruction: a case report

BackgroundA 21 day old male child presented with non bilious vomiting and abdominal mass.Case presentationThis case is reported because pyloroduodenal duplication cysts are an extremely rare congenital anomaly, whose clinical presentation often mimics those of hypertrophic pyloric stenosis. Ultrasound examination showed cystic mass at pyloric region and barium study was suggestive of extrinsic mass compressing the pyloric region. A laparotomy, a tense cystic mass was present at the pyloroduodenal junction (PDC) which was resected and end to end anastomosis was done. Patients followed an uneventful recovery and doing well.ConclusionThe clinical and radiological analysis can reveal configurational changes consistent with a large extrinsic mass rather than muscular hypertrophy and can lead to accurate preoperative diagnosis.

Sutureless skin closure with isoamyl 2-cyanoacrylate in pediatric day-care surgery

Importance of day-care surgery in pediatric age group is ever increasing and nowadays bulk of surgery is performed as a day-care procedure. Day-care procedure requires short intra-operative period and less postoperative complications. The introduction of tissue adhesive has been received enthusiastically since they may result in equivalent tensile strength-improved cosmetic appearance of the scar and lower infection rate when compared to sutures, staples and adhesive tape. We have used isoamyl 2-cyanoacrylate as a tissue adhesive for skin closure in day-care surgery. Novocryl is ideal for such procedure as it is a sterile, inert, non-toxic, biocompatible and bacteriostatic liquid topical skin adhesive containing isoamyl 2-cyanoacrylate formulation. We applied isoamyl 2-cyanoacrylate glue in 100 patients over skin cut margin after stitching subcutaneous tissue. Skin margin were held together by means of skin hook for 1–2xa0min. The cosmesis was better as there were no suture marks or lumpiness. There were no major complications in our study. Thus, isoamyl 2-cyanoacrylate can be considered as an alternative to skin suturing in the pediatric day-care surgery.

Double coin in esophagus at same location and same alignment — a rare occurrence: a case report

Coin is the most common foreign body swallowed by pediatric age group. The multiple coin swallowing is extremely rare and very few cases had been reported in English literature. Most of them were present at different site and had different alignment in the esophagus. The location of the coin (trachea vs. esophagus) is commonly determined by the alignment of the coin on radiographic studies. A 4-year-girl was presented to us with history of coin ingestions one day back without any respiratory distress. On radiological study there was suspicion of two coins on same location and alignment. The diagnosis was confirmed after removal. The both coin was removed successfully by esophagoscopy. Unexpected second foreign bodies in pediatric esophageal coin ingestions are rare and it is mandatory to do post operative radiography after removal to exclude duplex coin or tracheal coin. We are presenting this case because of its rarity, difficulty in diagnosis especially when proper history is not available.

Role of propranolol in ulcerated haemangioma of head and neck: a prospective comparative study

PurposeInfantile haemangiomas comprise the majority of vascular anomalies and are considered the predominant vascular tumour type 1. We performed this prospective study to evaluate the therapeutic response and propranolol tolerance in infants with ulcerated infantile haemangioma of head and neck region.MethodsSixty-four patients with ulcerated infantile haemangiomas (IHs) of head and neck region, without any prior treatment and with age older than 1 month, were included in the study, after informed consent was obtained, and were randomly divided into groups A and B. Group A patients were given oral propranolol at a dose of 2xa0mg/kg per day in three divided doses as outpatients. Group B patients were given oral ibuprofen at a dose of 10xa0mg/kg 8-hourly and paracetamol at dose of 16.2xa0mg/kg 8-hourly. Documentation of gender, age, haemangioma location, duration of ulceration and pain was measured on the second and fifth day after commencement of treatment in both groups using the Children’s Hospital of Eastern Ontario Pain Scale.ResultsThere was no difference in pain score between the two groups (P value 0.074). Mean duration of healing of ulceration in group A was 17.93u2009±u20092.22xa0days and in group B was 27.71u2009±u20092.33xa0days (P value <0.001). In group A, out of 28 patients, 8 (28.5xa0%) were complete responders, 16 (57.1xa0%) were partial responders and 4 (14.2xa0%) were non-responders.ConclusionPropranolol is a valuable therapeutic alternative for treatment of ulcerated haemangiomas and effectively reduces pain.

A child presented with bilateral congenital constriction ring in lower extremity: a case report

IntroductionThe congenital constriction ring of lower extremity is very uncommon and rare condition. The actual incidence in general population is not known. In English literature, very few cases are reported time to time as congenital constriction band syndrome associated with musculoskeletal disorder like congenital talipes equino varus. The lesion can involve skin only or goes to deeper structure up to bone, which can lead to gangrene of foot or auto amputation.Case presentationWe are presenting a case of bilateral congenital constriction ring in lower limb who presented at age of 4 year without any other associated congenital anomaly, simply managed by Z-plasty, which improves quality of life after physiotherapy.ConclusionCongenital constriction ring of lower limb is extremely rare condition in children. Early diagnosis and management is mandatory, either in single stage or by stage procedure, to prevent auto-amputation of limb and to improve quality of life on feet.

Role of color Doppler ultrasound in the diagnosis of nonpalpable testes

PurposeColor Doppler ultrasound has been used for the diagnosis of torsion of testes. The purpose of this study was to evaluate the sensitivity of this noninvasive tool in detecting impalpable testes. Patients and methodsTwenty-five children with nonpalpable testes were treated at the Department of Pediatric Surgery, Institute of Medical Science, Banaras, between 2007 and 2009. Color Doppler ultrasound was used for detecting the position, size, and vascularity of nonpalpable testes. These patients were subsequently revaluated by laparoscopy. ResultsOut of 25 cases, 15 cases were unilateral and 10 cases were bilateral (a total of 35 nonpalpable testes). The color Doppler ultrasound study successfully localized 30 of the 35 nonpalpable testes, which were confirmed by subsequent laparoscopic examination. The sensitivity of color Doppler in locating testes was 85.71% (95% confidence interval=0.64–0.97). ConclusionColor Doppler ultrasound is an effective noninvasive method for the initial diagnosis of impalpable testes and for planning its subsequent management.

Gastric teratoma presented as gastric outlet obstruction and melena; report of rare case

Gastric teratoma is a very rare tumor, accounting for less than 1xa0% of all teratomas in infants and children. Melena or upper gastrointestinal tract bleeding in newborns and infants is a rare event and is usually caused by a benign lesion. Gastric teratoma has been reported as a cause of gastrointestinal bleeding on a few occasions. As gastric teratomas generally present as a palpable abdominal mass, more aggressive solid masses of childhood must be excluded. We present intramural extension of gastric teratoma presented as symptom of gastric outlet obstruction and melena.