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Exposure to communicative gestures, through their parents' use of gestures, is associated with infants' language development. However, the mechanisms supporting this link are not fully understood. In adults, sensorimotor brain activity occurs while processing communicative stimuli, including both spoken language and gestures. Using electroencephalogram (EEG) mu rhythm desynchronization (mu ERD), a marker of sensorimotor activity, we examined whether experimental manipulation of infants' exposure to gestures would affect language development, and specifically whether such an effect would be mediated by changes in sensorimotor brain activity. Mu ERD was measured in 10- to 12-month-old infants (

Introduction: Containment of the further spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and reducing fatality due to coronavirus disease 19 (COVID-19) represent a pressing challenge to global health services. Here, we present a management blueprint for both the containment of SARS-CoV-2 and treatment of COVID-19 through a comprehensive approach. Methodology: A cohort of 130 consecutive patients identified as positive for SARS-CoV-2 by testing of nasal swab by polymerase chain reaction were managed at a peripheral city of Bangladesh between 1 April and 31 May, 2020. Based on their clinical status, 64 of them were initially selected for isolation (Isolation Group) and 66 recommended for hospitalization (Hospital Group) as per the direction of the “Central COVID-19 Control” Center. Both groups of patients were allocated to receive standard of care management and oxygen inhalation, and intensive care unit management as and when necessary. Based on the conditions of the COVID-19 patients, there was an active system of patients being transferred from the “Isolation Group” to “Hospital Group” and vice versa. Results: Twelve patients of the “Isolation Group” were transferred to the hospital, as they exhibited symptoms of deterioration. Four patients of the “Hospital Group” died during the observation period of two months in the intensive care unit. However, there has been no fatality among the patients of the “Isolation Group”. Conclusions: The concept of “Isolation” and “Hospital Management” with the participation of the community seems to be an effective management strategy for COVID-19 in developing countries.

Beta activity is thought to play a critical role in sensorimotor processes. However, little is known about how activity in this frequency band develops. Here, we investigated the developmental trajectory of sensorimotor beta activity from infancy to adulthood. We recorded electroencephalography (EEG) from adults, 12-month-olds, and 9-month-olds while they observed and executed grasping movements. We analysed ‘beta burst’ activity using a novel method that combines time-frequency decomposition and principal component analysis (PCA). We then examined the changes in burst rate and waveform motifs along the selected principal components. Our results reveal systematic changes in beta activity during action execution across development. We found a decrease in beta burst rate during movement execution in all age groups, with the greatest decrease observed in adults. Additionally, we identified four principal components that defined waveform motifs that systematically changed throughout the trial. We found that bursts with waveform shapes closer to the median waveform were not rate-modulated, whereas those with waveform shapes further from the median were differentially rate-modulated. Interestingly, the decrease in the rate of certain burst motifs occurred earlier during movement and was more lateralized in adults than in infants, suggesting that the rate modulation of specific types of beta bursts becomes increasingly refined with age.

Multilevel inverters (MLIs) have been proposed for the purpose of increase power level and to improve the power factor and total harmonic distortion (THD) in comparison with conventional two-level inverters. This technological advancement helps to achieve high performance and low cost, transformer less multi-level inverters which may commonly exploited in grid tied Photovoltaic (PV) generating systems. The application areas of MLIs are residential use in uninterruptible power supplies (UPSs); All these applications require increased reliability in terms of lower switching losses, increased power factor, and low total harmonic distortion (THD) for ensuring robust and smooth operation. Selection of control strategy for MLIs is one of the important aspects while designing of MLI. SPWM (Sinusoidal pulse width modulation) technique has been selected and same is used in the proposed transformer less switch capacitor based MLIs. SPWM which is based on comparing the modulating and carrier signal for generating the switching pulses, is the fundamental switching and control strategy generally used in MLI control. The PWM method used to control the switching sequences of inverters is directly responsible for controlling the output waveforms of current and voltage, while defining the efficiency of the inverter by managing the switching losses and THD ratios. This paper proposes high efficient nine level, eleven level, thirteen level & fifteen level switched capacitor-based inverter. Further total harmonic distortion for each level has been calculated using MATLAB simulation and the value observed for the same is compared for each level of MLI.

Despite substantial evidence indicating a close link between action production and perception in early child development, less is known about how action experience shapes the processes of perceiving and anticipating others' actions. Here, we developed a novel approach to capture functional connectivity specific to certain brain areas to investigate how action experience changes the networks involved in action perception and anticipation. Nine- and-12-month-old infants observed familiar (grasping) and novel (tool-use) actions while their brain activity was measured using EEG. Infants' motor competence of both actions was assessed. A link between action experience and connectivity patterns was found, particularly during the anticipation period. During action anticipation, greater motor competence in grasping predicted greater functional connectivity between visual (occipital alpha) and motor (central alpha) regions relative to global levels of whole-brain EEG connectivity. Furthermore, visual and motor regions tended to be more coordinated in response to familiar versus novel actions and for older than younger participants. Critically, these effects were not found in the control networks (frontal-central; frontal-occipital; parietal-central; parietal-occipital), suggesting a unique role of visual-motor networks on the link between motor skills and action encoding. HIGHLIGHTS: Infants' motor development predicted functional connectivity patterns during action anticipation. Faster graspers, and older infants, showed a stronger ratio of visual-motor neural coherence. Overall whole-brain connectivity was modulated by age and familiarity with the actions. Measuring inter-site relative to whole-brain connectivity can capture specific brain-behavior links. Measures of phase-based connectivity over time are sensitive to anticipatory action.

Aim: To compare single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for the pediatric inguinal herniotomy. Materials and Methods: The present study was conducted on 100 patients of elective inguinal herniotomy from January 2019 to April 2020 and compared on the basis of single dose preoperative antibiotic versus five days antibiotic course. All the patients were evaluated on the 3rd, 7th and 28th post-operative period and instructions were given to the guardians about wound care and to attend for early follow up if any signs & symptoms of wound infection appear. Results: 50% of the patients were treated with prophylactic single dose antibiotic, i.e. inj. Ceftriaxone (30 mg/kg/dose) at the time of induction only and rest 50% were treated with inj. Ceftriaxone(30mg/kg/dose) at the time of induction as well as postoperatively at night followed by four days of oral antibiotic with Syr/Tablet. Cephalexin (25mg/kg/day) three times daily for another 4 days. Surgical Site Infection (SSI) in Group-B (4.0%) was higher than that of Group-A (2.0%) on day 3 but it was not significant (p=0.40). There was no significant difference in health status of the patients of the two groups when compared on post-operative day 7 and day 28 (p=0.99, p=0.99 respectively). Conclusion: Implementation of single dose antibiotic prophylaxis regimes tailored to the prevalent organisms in the institution can result in enormous savings, as the study shows significant reduction in hospital stay with no significant increase in incidence of SSI. Keywords: Pediatric, Inguinal hernia, Surgical site infection, Prophylaxis, Antibiotic

Objective: At present, duration and methods of radiographic follow-up after pediatric pyeloplasty are not well defined. We prospectively studied pediatric age group patients to assess outcome for cases of pyeloplasty on the basis of ultrasonography and DTPA scan. Materials and Methods : We assessed all cases of PUJ obstruction in age group 0-18 years, who got admitted in LLR hospital, Kanpur and underwent pyeloplasty. Patients were excluded if cause of pyeloplasty was acquired. Preoperatively patients underwent clinical evaluation with history and examination followed by radiological investigations including Renal USG & DTPA scan. All patients were followed up postoperatively at 3, 6, 9 & 12 months. In USG, renal parenchyma thickness, antero-posterior diameter of renal pelvis was assessed. In DTPA scan, differential renal function was assessed. Data of USG and DTPA scan were statistically compared. Result: 32 patients who underwent pyeloplasty at a median age of 4.2 years were studied. Follow-up was done for 1 year. On the basis of our study, DTPA scan is better than renal USG to assess functional outcome after pyeloplasty in pediatric age group up to 6 months during follow-up. But results are comparable for follow-up during 9 & 12 months postoperatively. The results of our study show that in the first 6 months, renal USG is not as much informative as DTPA scan to assess functional outcome after pyeloplasty but after 6 months, renal USG is equally effective as DTPA scan. Conclusion: Our study concludes that for poor resource countries, renal USG can be used to assess functional outcome after pyeloplasty in pediatric age group for post-operative follow-up, instead of costly & scarcely available investigation like Renal DTPA scan. Keywords: DTPA, PUJ obstruction, Pyeloplasty.

Self-inserted foreign bodies in the lower urinary tract are rare among children. The treatment of foreign bodies in the urethra is determined by their type, size, location, shape, and mobility. : We describe here a 10-year-old boy who had self inserted a needle into his urethra. Initial attempts to remove the needle from the urethra by inserting a cystoscope failed. The patient presented to our institution with bleeding per urethra with feeding tube insitu per urethra. As already attempted for urethroscopic removal, direct removal of needle done under general aneathesia done.: Per Rectal examination plays an important role and gives adequate information and timely management of the child leads to uneventful hospital stay Psychiatric evaluation is mandatory to detect an underlying mental disorder.

Background Biliary calculus disease (BCD) is one of the most prevalent diseases and poses a significant burden to the health care system in adults. The prevalence of BCD in children and adolescents is about 0.1% and 0.6%, respectively. Although many factors have been attributed to BCD in children, exact etiopathogenesis is not clear. BCD has been extensively studied in adults, but not much literature is available in children. The current review was undertaken to study BCD in children focusing on the objectives like predisposing factors, various modes of presentation, and management outcome of BCD in children in the northern part of India. Results Out of 42 children, two children had a history of ceftriaxone therapy. Two underwent ileal resection. The mean reticulocyte count was 1.79%. None had G6PD deficiency or abnormal osmotic fragility test. Clinical presentation was right upper quadrant pain (n = 42, 100%), calculous cholecystitis (n = 8, 19.0%), and jaundice (n = 3, 7.14%). The majority (n = 26, 61.92%) were overweight. Only 16.6% (n = 7) children had normal body mass index (BMI), and 9.3% (n = 4) were obese. The mean BMI was 26.3 kg/m2. 85.5% of children frequently consume junk foods. The majority of calculi were GB calculi accounting for 92.8% (n = 39) whereas 7.1% (n = 3) children had CBD calculi. Thirty-five were managed by laparoscopic cholecystectomy, three were managed by non-operative management, and one was managed by open cholecystectomy; among the three cases of CBD calculi, two were managed by endoscopic retrograde cholangiopancreatography (ERCP), stenting, and CBD exploration and one was managed by ERCP sphincterotomy. Conclusion Diet and overweight both appear to be important risk factors for pediatric BCD. Drug-induced calculi can be safely observed.

Contains fulltext : 247904.pdf (Publisher’s version ) (Open Access) Behavioral evidence shows that experience with an action shapes action perception. Neural mirroring has been suggested as a mechanism underlying this behavioral phenomenon. Suppression of electroencephalogram (EEG) power in the mu frequency band, an index of motor activation, typically reflects neural mirroring. However, contradictory findings exist regarding the association between mu suppression and motor familiarity in infant EEG studies. In this study, we investigated the neural underpinnings reflecting the role of familiarity in action perception. We measured neural processing of familiar (grasp) and novel (tool-use) actions in 9- and 12-month-old infants. Specifically, we measured infants' distinct motor/visual activity and explored functional connectivity associated with these processes. Mu suppression was stronger for grasping than for tool use, whereas significant mu and occipital alpha (indexing visual activity) suppression were evident for both actions. Interestingly, selective motor–visual functional connectivity was found during observation of familiar action, a pattern not observed for novel action. Thus, the neural correlates of perception of familiar actions may be best understood in terms of a functional neural network rather than isolated regional activity. Our findings provide novel insights on analytic approaches for identifying motor-specific neural activity while also considering neural networks involved in observing motorically familiar versus unfamiliar actions. 20 p.

The action observation network (AON) is a network of brain regions involved in the execution and observation of a given action. The AON has been investigated in humans using mostly electroencephalogram (EEG) and functional magnetic resonance imaging (fMRI), but shared neural correlates of action observation and action execution are still unclear due to lack of ecologically valid neuroimaging measures. In this study, we used concurrent EEG and functional Near Infrared Spectroscopy (fNIRS) to examine the AON during a live-action observation and execution paradigm. We developed structured sparse multiset canonical correlation analysis (ssmCCA) to perform EEG-fNIRS data fusion. MCCA is a generalization of CCA to more than two sets of variables and is commonly used in medical multimodal data fusion. However, mCCA suffers from multi-collinearity, high dimensionality, unimodal feature selection, and loss of spatial information in interpreting the results. A limited number of participants (small sample size) is another problem in mCCA, which leads to overfitted models. Here, we adopted graph-guided (structured) fused least absolute shrinkage and selection operator (LASSO) penalty to mCCA to conduct feature selection, incorporating structural information amongst the variables (i.e., brain regions). Benefitting from concurrent recordings of brain hemodynamic and electrophysiological responses, the proposed ssmCCA finds linear transforms of each modality such that the correlation between their projections is maximized. Our analysis of 21 right-handed participants indicated that the left inferior parietal region was active during both action execution and action observation. Our findings provide new insights into the neural correlates of AON which are more fine-tuned than the results from each individual EEG or fNIRS analysis and validate the use of ssmCCA to fuse EEG and fNIRS datasets.

Introduction: Sacrococcygeal teratoma (SCT) represent the most common benign and malignant germ cell tumors (GCT) in newborns and infants developing from primordial germ cells of the human embryo. Most of them are benign, however those presenting later in life and having major intra-pelvic component have greater malignant potential. Early and complete excision of the SCT has been the mainstay of successful management. The aim of this study is to describe the patient's details, management done, histopathology of the tumor, recurrence and the over all outcome of patients with SCT. Materials and Methods: Patients with histological diagnosis of sacrococcygeal teratoma during the period of January 2014 and October 2016 were included in this retrospective observational study. Data was collected regarding age, gender, mode of presentation, associated anomalies, Altman’s classification, investigations, treatment modality, tumor histology according to type of tumour with margin of resection, and outcome of management. All the diagnosed cases of SCT presenting during the above duration were included for study. Results: Twenty eight patients were included in the study. Out of them 75% were females and 25% were males. 32.14% presented during neonatal period. 78.57% presented with external mass. The tumour was completely resected by sacral approach in 22 patients and by combined abdominosacral approach in 06 patients. Recurrence was detected in one patients (3.57%); with Altman types 1 mature teratoma. Patients were followed for a duration ranged between 1 months and 3 years. Conclusion: Early diagnosis and early complete enblock excision of the tumor with the coccyx was mainstay of treatment with good prognosis. Late presentation and the presence of malignant changes are associated with poor prognosis. Intraoperative spillage of the tumor should be avoided. Overall survival of SCT is high. Keywords: Sacrococcygeal tumors, Germ cell tumor, Immature tissue.

The last decade has seen increased availability of mobile electroencephalography (EEG). These mobile systems enable researchers to conduct data collection “in-context,” reducing participant burden and potentially increasing diversity and representation of research samples. Our research team completed in-home data collection from more than 400 12-month-old infants from low-income backgrounds using a mobile EEG system. In this manuscript, we provide methodological and analytic guidance for collecting high-quality, mobile EEG in infants. Specifically, we offer insights and recommendations for equipment selection, data collection, and data analysis, highlighting important considerations for selecting a mobile EEG system. Examples include the size of the recording equipment, electrode type, reference types, and available montages. We also highlight important recommendations surrounding preparing a non-standardized recording environment for EEG collection, obtaining informed consent from parents, instructions for parents during capping and recording, stimuli and task design, training researchers, and monitoring data as it comes in. Additionally, we provide access to the analysis code and demonstrate the robustness of the data from a recent study using this approach, in which 20 artifact-free epochs achieve good internal consistency reliability. Finally, we provide recommendations and publicly available resources for future studies aiming to collect mobile EEG.

The aim is to study the complications of neonatal thoracotomy and its preventive measures.We retrospectively reviewed 53 neonates who underwent thoracotomy from January 2017 to December 2019 for a period of 3 years. Patient demographic data, primary disease for which they underwent thoracotomy, postoperative complications (immediate and delayed) during follow-up were documented.During 3-year period, 53 neonates underwent thoracotomy for various surgical pathologies. The indications were esophageal atresia with tracheoesophageal fistula (Neonatal thoracotomy is associated with complications such as pneumonia, wound infections, and musculoskeletal abnormalities such as asymmetry of chest and scoliosis. These can be prevented by adequate postoperative pain relief, muscle-sparing thoracotomies, avoiding tight closures, and nerve injuries. Long-term follow-up is required because these complications may manifest later on also. Early detection and institution of physiotherapy may help.

Contains fulltext : 227183.pdf (Publisher’s version ) (Closed access) Early in life, greater exposure to diverse people can change the tendency to prefer one's own social group. For instance, infants from racially diverse environments show less preference for their own-race (ingroup) over other-race (outgroup) faces than infants from racially homogeneous environments. Yet how social environment changes ingroup versus outgroup demarcation in infancy is unclear. A commonly held assumption is that early emerging ingroup preference is based on an affective process: feeling more comfortable with familiar ingroup than unfamiliar outgroup members. However, other processes may also underlie ingroup preference: Infants may attend more to ingroup than outgroup members and/or mirror the actions of ingroup over outgroup individuals. By aggregating 7- to 12-month-old infants' electroencephalography (EEG) activity across three studies, we disambiguate these different processes in the EEG oscillations of preverbal infants according to social environment. White infants from more racially diverse neighborhoods exhibited greater frontal theta oscillation (an index of top-down attention) and more mu rhythm desynchronization (an index of motor system activation and potentially neural mirroring) to racial outgroup individuals than White infants from less racially diverse neighborhoods. Neighborhood racial demographics did not relate to White infants’ frontal alpha asymmetry (a measure of approach-withdrawal motivation) toward racial outgroup individuals. Racial minority infants showed no effects of neighborhood racial demographics in their neural responses to racial outgroup individuals. These results indicate that neural mechanisms that may underlie social bias and prejudices are related to neighborhood racial demographics in the first year of life. 10 p.

Anorectal malformations (ARMs) are one of the common congenital gastrointestinal malformations with a prevalence of 0.2-0.6/1000 live births. There are only a few reported cases of familial ARMs in literature suggesting different patterns of inheritance. Among them, isolated ARMs in monozygotic twins are quite rare with significant male preponderance. Most of these ARMs are either of intermediate or low anomaly type. We reported two pairs of male monozygotic isolated ARMs from a tertiary care hospital in India and reviewed the literature in details adding to the total of nine pairs of twins till date.

EEG measures such as power and connectivity have been widely used to investigate the neuronal underpinnings of ADHD. Traditionally, the fixed band analysis, in which a single frequency band is applied to all the subjects, has been used to estimate these EEG measures. However, there are important interindividual differences in the predominant frequency of alpha-band oscillations. In this study, we present an individualized estimate of EEG in the alpha band and compared the results with traditional fixed band analysis. We also examined the EEG profile separately in lower and upper alpha bands. We further examined the association between EEG measures and ADHD symptoms. Eyes closed resting EEG was collected from 21 adolescents with clinically elevated levels of ADHD and 21 age and gender matched control subjects. Spectral power and connectivity were computed in lower and upper alpha bands. Results revealed a dissociation between upper and lower alpha band power and connectivity in ADHD. The ADHD group showed reduced power and connectivity in the lower alpha band and an elevation of upper alpha power compared to the Control group. EEG power in the lower alpha band was negatively associated with ADHD severity. Our results, however, did not provide conclusive evidence for IAF as an overall greater measure of EEG compared to the traditional fixed band method.

Contains fulltext : 236033.pdf (Publisher’s version ) (Open Access) From infancy, neural processes for perceiving others' actions and producing one's own actions overlap (neural mirroring). Adults and children show enhanced mirroring in social interactions. Yet, whether social context affects mirroring in infancy, a time when processing others' actions is crucial for action learning, remains unclear. We examined whether turn-taking, an early form of social interaction, enhanced 9-month-olds' neural mirroring. We recorded electroencephalography while 9-month-olds were grasping (execution) and observing live grasps (observation). In this design, half of the infants observed and acted in alternation (turn-taking condition), whereas the other half observed several times in a row before acting (blocked condition). Replicating previous findings, infants showed significant 6- to 9-Hz mu suppression (indicating motor activation) during execution and observation (n = 24). In addition, a condition (turn-taking or blocked) by time (action start or end) interaction indicated that infants engaged in turn-taking (n = 9), but not in the blocked context (n = 15), showed more mirroring when observing the action start compared with the action end. Exploratory analyses further suggest that (a) there is higher visual–motor functional connectivity in turn-taking toward the action's end, (b) mirroring relates to later visual-motor connectivity, and (c) visual attention as indexed by occipital alpha is enhanced in turn-taking compared with the blocked context. Together, this suggests that the neural processing of others' actions is modulated by the social context in infancy and that turn-taking may be particularly effective in engaging infants’ action perception system. 21 p.

Introduction: This study was designed to evaluate the importance of proper detailed history and examination of the patient as well as to determine the prevalence of unrecognized hypothyroidism among the paediatric patients with constipation attending the outpatient paediatric units in our hospital. Material and Methods: A retrospective review of medical records of paediatric patients ordered for thyroid function tests between July 2014 and June 2015 was performed. Total of 2210 paediatric patients were included in the study. A complete review of the medical records of these patients were performed which included indications for ordering thyroid tests, medical history, drug history, radiologic evaluation, other laboratory tests and subspeciality consultation.The samples were analyzed in the hormone unit of the Clinical Biochemistry Laboratory by a fully automated analyzer (Cobas e411, Roche). Data analysis was done using SPSS statistical software. Clinical diagnosis was made according to the paediatric reference ranges used in our clinical laboratory. Results: Out of all patients, 149 had history of constipation and 11 patients out of 149 had abnormal thyroid function. Repeat measurements after three months showed normal results for nine, while only two patients had results suggestive of hypothyroidism. Conclusion: Functional constipation is a condition which is to be diagnosed only by history or clinical examination. Thyroid profile where necessary is to be done after proper examination, to reduce the burden of cost to laboratory and society as well as exposing the pediatric patient to trauma. J Nepal Paediatr Soc 2016;36(2):143-146

A major challenge for electroencephalograph (EEG) studies on pediatric populations is that large amounts of data are lost due to artifacts (e.g., movement and blinks). Independent component analysis (ICA) can separate artifactual and neural activity, allowing researchers to remove such artifactual activity and retain a greater percentage of EEG data for analyses. However, manual identification of artifactual components is time-consuming and requires subjective judgment. Automated algorithms, like ADJUST and ICLabel, have been validated on adults, but to our knowledge, no such algorithms have been optimized for pediatric data. Therefore, in an attempt to automate artifact selection for pediatric data collected with geodesic nets, we modified ADJUST's algorithm. Our "adjusted-ADJUST" algorithm was compared to the "original-ADJUST" algorithm and ICLabel in adults, children, and infants on three different performance measures: respective classification agreement with expert coders, the number of trials retained following artifact removal, and the reliability of the EEG signal after preprocessing with each algorithm. Overall, the adjusted-ADJUST algorithm performed better than the original-ADJUST algorithm and no ICA correction with adult and pediatric data. Moreover, in some measures, it performed better than ICLabel for pediatric data. These results indicate that optimizing existing algorithms improves artifact classification and retains more trials, potentially facilitating EEG studies with pediatric populations. Adjusted-ADJUST is freely available under the terms of the GNU General Public License at: https://github.com/ChildDevLab/MADE-EEG-preprocessing-pipeline/tree/master/adjusted_adjust_scripts.

Exposure to early psychosocial deprivation as a result of institutional care disrupts typical brain development. The Bucharest Early Intervention Project (BEIP) is the first longitudinal study to investigate the neurodevelopment of institutionalized infants randomized to a foster care (FCG) intervention versus care as usual (CAUG). Here, we present findings from a follow-up assessment of brain electrical activity as indexed by resting EEG at age 16 years. In addition, we examined the effects of disruption of foster care placement, (e.g. the number of moves among foster care placements), on brain electrical activity. Resting-state EEG was collected from 48 CAUG, 46 FCG and 48 never institutionalized (NIG) control participants. Absolute (µV(2)) and relative (proportion) power were computed from eyes closed, resting EEG data for theta, alpha, and beta frequency bands. The CAUG displayed higher relative theta and lower relative alpha power compared to the FCG at age 16 years. The FCG showed brain activity comparable to the NIG. The results further showed that disruptions following the original foster care placement had an adverse effect on brain electrical activity. Within the foster care group, there were no effects of age of placement on EEG power. Placement of children who have experienced early institutional rearing into stable foster care settings ensures long-term improvement in brain functioning.

BACKGROUND: Child maltreatment, trauma symptoms, and alpha electroencephalography (EEG) asymmetry have been linked to problem behaviors and alcohol use disorders. OBJECTIVE: The goal of this pilot study was to clarify the role of alpha EEG asymmetry in the relation of maltreatment and problem behaviors. It was hypothesized that adolescents with more maltreatment, trauma symptoms, and right alpha EEG asymmetry would have more problem behaviors and alcohol use. It was also hypothesized that alpha EEG asymmetry would moderate the association between maltreatment/trauma symptoms and problem behaviors. PARTICIPANTS AND SETTING: Participants were 52 adolescents aged 12–14 years. Resting-state alpha EEG asymmetry was measured in this home-based study as a potential moderator in the association of child maltreatment and trauma symptoms to problem behaviors including alcohol use. RESULTS: Child maltreatment reports and trauma symptoms were significantly associated with problem behaviors (β = .259, p = .037 and β = .594, p < .001, respectively). Trauma symptoms were associated with alcohol-use (Incidence Rate Ratio = 1.048, p = .032). Right alpha EEG EEG asymmetry moderated the positive association of trauma symptoms and problem behaviors (β = - .383, p = .024). However, this was not the case for left alpha EEG asymmetry. CONCLUSIONS: Neural correlates associated with individuals’ affective-behavioral profiles may play a role in the susceptibility for problem behaviors among adolescents exposed to higher levels of childhood trauma. This could be useful in developing targeted assessments and interventions to prevent or treat these problems in adolescents.

Mu desynchronization is the attenuation of EEG power in the alpha frequency range recorded over central scalp locations thought to reflect motor cortex activation. Mu desynchronization during observation of an action is believed to reflect mirroring system activation in humans. However, this notion has recently been questioned because, among other reasons, the potential contamination of mu rhythm and occipital alpha activity induced by attention processes following presentation of visual stimuli in observation conditions. This study examined the validity of mu desynchronization as a measure of mirroring system activation in infants and further investigated the pattern of functional connectivity between the central and occipital regions during execution and observation of movement. EEG was recorded while 46 9-month-old infants executed grasping actions and observed an experimenter grasping. Current source density (CSD) was applied to EEG data and, time-frequency and connectivity analyses were performed in CSD transformed data. Mu desynchronization was evident over central regions during both execution and observation of movements. Independent alpha desynchronization over occipital region was also present in both conditions. The connectivity analyses revealed that central-occipital areas were functionally more connected compared to other areas of the brain during observation of movements. Collectively, the results demonstrate the validity of mu desynchronization as an index of infant mirroring system activity and support the proposal of a functional connection between distinct mirroring and attention processes during observation of action.

Behavioral inhibition (BI) is an early temperamental precursor of anxiety disorders, characterized by withdrawal from novel situations. Some but not all young children with BI go on to display anxiety disorders. Neural correlates, such as frontal alpha asymmetry or event-related negativity (ERN), could moderate the relations between early BI and later anxiety. The goal of this longitudinal study was to test frontal alpha asymmetry as a potential moderator of the relation between BI and later anxiety, and of the relation between BI and the social-effect ERN. 100 children were assessed for BI at ages 2 and 3, and we collected EEG during resting state and the social Flanker task at age 12. Frontal alpha asymmetry did not correlate with BI or anxiety, nor did it moderate the relation between early BI and later anxiety. However, frontal alpha asymmetry did moderate the relation between BI and the social-effect ERN. This suggests that, in adolescents who previously manifested BI, a pattern of resting EEG associated with avoidance predicts hypersensitivity to errors in a social context.

Objective This report describes a rare case of type IIA2 sagittal urethral duplication. Summary background data The presentation, investigation, and management of this rare anomaly are briefly discussed.Methods A 3½-year-old boy presented with urinary obstruction and recurrent urinary tract infection due to a stenosed dorsal urethra and segmental stenosis of the dominant ventral urethra. The child also had left-sided vesicoureteric reflux. Staged surgical management consisted of an initial vesicostomy followed by serial dilatation of the ventral urethral stricture, left ureteric reimplantation, and a 2-cm long distal urethrourethrostomy between the dorsal urethra, opening at the tip of the penis, and the ventral urethra, which had a hypospadic opening at the base of the glans.Results The functional and cosmetic outcomes were satisfactory.Conclusion The management needs to be individualizedas best suited for the patient.Keywords: urethra, urethral duplication, urethral stricture

Urinary bladder haemangiomas are rare benign mesenchymal tumors. They usually present with macroscopic haematuria. We report an unusual case of a 6 month old female child; she presented with a bleeding interlabial mass which turned out to be prolapsed urinary bladder haemangioma.

Aim: The aim of this study is to assess the pattern and mode of thoracoabdominal trauma and anatomical organ involvement, type of management employed, and overall outcomes in the pediatric population. Materials and Methods: A retrospective study conducted at a tertiary hospital over a period of 38 months with a total of 198 pediatric patients

Background: Mirror therapy (MT) is an increasingly employed method aimed at reducing phantom pain and other negative sensations following loss of a limb or damage to sensorimotor systems. However, the brain processes associated with the perception of limb ownership, a key correlate of MT, are unknown. Objective: To examine whether transient perceptions of limb ownership together with associated neural activity can be elucidated using a purpose-developed mirror reflection task combined with electrophysiological (EEG) measures and cuttingedge analyses. Methods: Brain activity was measured online using EEG in 20 healthy controls while they produced opening-closing movements of one hand in control conditions or while viewing the mirror reflection of the movements. The key experimental condition required participants to make a foot pedal response whenever a change in perception of ownership (of a mirrorreflected limb) occurred (Mirror condition). Control conditions and a strict epoching regime were employed using standard subtractive logic to isolate the perception of limb ownership (which was further verified by self-reports). Results: Data from 15 participants were suitable for complete analysis; the remaining reported no experience of ownership. Significant spectral power increases were found in central-parietal regions in association with perceptions of ownership, with the most prominent effect specific to the alpha frequency band (8–13 Hz) measured at the right parietal area. Source localization analyses further identified brain networks associated with the mirror reflection condition in the alpha frequency (parietal lobe) and the beta frequency (middle temporal areas). These were distinct from localized networks associated with the foot pedal response. Conclusion: Transient perceptions of ownership can be captured experimentally, and are associated with localized sites of neural activation. This is an initial step toward eventual development of therapeutic targets for interventions including brain computer interfaces (BCIs) aimed at ameliorating the negative effects associated with impaired or missing limbs.

The objective of this study is to use anorectal manometry for functional assessment of early postoperative results after corrective surgery for anorectal malformations (ARMs) in children and compare manometric observations with age-matched controls. Parents were counseled and management strategies were planned according to the manometric assessments.From August 2005 to September 2009, 32 patients who underwent surgery for ARM were assessed postoperatively with anorectal manometry using a water-perfused anorectal motility catheter to record anal canal length or high-pressure zone, resting pressure of anal canal (RP), and rectoanal inhibitory reflex (RAIR). These patients were divided in 2 groups (infants,1 year; children,1 year) according to the age at the time of performance of anorectal manometry that was done at 6 months or later following stoma closure or anoplasty.Out of these 32 patients, high anomaly was present in 13, whereas 19 had low type of defect. Manometric anal canal length of the children with high and low ARM was 2.10 ± .44 and 2.25 ± .53 cm, respectively, which was significantly shorter than that of their age-matched controls(P.05). In patients with high ARM, RP in infants (17 ± 7.7 mm of Hg) and children (21 ± 9.4 mm of Hg) was lower than that of controls (RP in infants = 42.43 ± 8.19 mm of Hg, RP in children = 43.43 ± 8.79 mm of Hg, P.001). In patients with low ARM, RP in infants (34 ± 8.6 mm of Hg, P = .002) and children (26 ± 9.9 mm of Hg, P = .001) was lower than that in controls. Presence of RAIR was demonstrated in 5 (38.4%) of 13 patients with high ARM and in 11 (57.9%) of 19 cases with low ARM. Parental counseling was done after this early evaluation, and management strategies like bowel management program and biofeedback training were planned according to the results of the tests.Our anorectal manometric results suggest that patients with ARM had short anal canal with lower RP and impaired RAIR, which could affect the ultimate functional outcome in these patients. Thus, postoperative anorectal manometric evaluation of the patients with ARM can give more realistic information about future continence and might help in planning future treatment strategies like bowel management program or biofeedback training.

Background/Aims: Preferential production of immunoregulatory cytokines may play an important role in the pathogenesis of chronic hepatitis B. Patients with chronic hepatitis B infection were evaluated to determine whether serum interleukin-10 (IL-10) levels were changed and whether the degree of these changes in serum levels correlated with HBV DNA levels, histologic activity index (HAI) or serum aminotransferase levels (ALT). Methodology: 15 patients diagnosed of chronic hepatitis B (wild type) with raised ALT, 15 inactive HBsAg carriers, 15 healthy people with resolved acute hepatitis B, and 15 healthy controls without any hepatitis marker positivity were included in the study. Serum IL-10 levels were measured. The associations between liver pathology, HBV DNA and ALT levels were assessed. Result: IL-10 is elevated more in chronic hepatitis B with positive HBeAg and raised ALT in comparison to asymptomatic carrier, resolved acute hepatitis B and control. Conclusions: IL-10 production is increased in chronic hepatitis B patients with HBeAg positivity and raised ALT as compared to other groups (p < 0.01). No correlation between HBV DNA, HAI or ALT could be established through this study. However, as IL-10 is increased in chronic hepatitis B infection with HBeAg positivity, the HBe antigen may be responsible for the raised IL-10 levels.

A 23-day-old male baby with a history of perinatal hypoxia presented with refusal of feeds and abdominal distension. The child had a right-sided cystic upper abdominal mass and features of neonatal septicemia. Abdominal ultrasound (US) and contrast-enhanced CT scan showed bilateral adrenal abscesses. Laparotomy with drainage of the abscesses successfully treated the condition. The literature on the subject is reviewed.

Introduction ‘Hepatology’, as an independent discipline of medical science, has recently been established in Bangladesh. The aim of this study was to formulate the distribution of pattern of liver diseases in this country. Materials and methods In this retrospective study, data regarding patients of liver diseases from the seven different administrative divisions of Bangladesh between January 2012 and 2013 were compiled. Results The study included 59,227 patients (age ranged 15-95 years). Majority of the patients were males (67.9%). Although all patients appeared at the department of hepatology, 13.2% were diagnosed with liver diseases, but a vast majority of patients (77.35%) were suffering from nonulcer dyspepsia or irritable bowel syndrome. Patients with liver diseases were mostly suffering from chronic liver diseases (CLDs) (37 -69%). Complication of CLD, like hepatic encephalopathy, was less frequent in regions with better healthcare system. Nonviral infections, like liver abscess and biliary ascarisis, were not uncommon. Acute hepatitis was another very common entity and contributed to approximately 20% cases. Conclusion This study provides insight about heterogeneous distribution pattern of liver diseases in different regions of Bangladesh. How to cite this article: Rahman S, Ahmed MF, Alam MJ, Debnath CR, Hoque MI, Hussain MM, Shamsul Kabir AKM, Karim MF, Khondokar FA, Mahtab MA, Masud MG, Mollick MKU, Moben AL, Noor-E-Alam SM, Podder PK, Raha AK, Rahim MA, Rashid MHO, Zaki KMJ, Akbar SMF. Distribution of Liver Disease in Bangladesh: A Cross-country Study. Euroasian J Hepato-Gastroenterol 2014;4(1):25-30.

Aim: This study was aimed at identifying factors which may affect the gap length in cases of esophageal atresia with tracheoesophageal fistula (EA-TEF) and whether gap length plays any role in determining the outcome. Materials and Methods: All consecutive cases of EA-TEF were included and different patient parameters were recorded. Plain radiographs with a nasogastric tube in the upper esophagus were taken. Patients were grouped into T1-T2; T2-T3; T3-T4; and T4 depending on the thoracic vertebral level of the arrest of the tube. During surgery, the gap length between the pouches was measured using a Vernier caliper and the patients were grouped into A, B, and C (gap length >2.1 cm; >1-≤2 cm and ≤1 cm). The operative gap groups were compared with the radiography groups and the other recorded parameters. Results: Total numbers of cases were 69. Birth weight was found to be significantly lower in Group A (mean = 2.14 kg) as compared to Group B (mean = 2.38 kg) and Group C patients (mean = 2.49 kg) (P = 0.016). The radiographic groups compared favorably with the intraoperative gap length groups (P < 0.001). The need for postoperative ventilation (70.83% in Group A vs. 36.84% in Group C, P = 0.032) and mortality (62.5%, 26.9% and 15.8% in Group A, B, and C, respectively, P = 0.003) co-related significantly with the gap length. Conclusion: Birth weight had a direct reciprocal relationship with the gap length. Radiographic assessment correlated with intraoperative gap length. Higher gap length was associated with increased need for postoperative ventilation and poor outcome.

Sir,Anastomotic stricture following complex esophageal and urethral anastomosis is often a distressing problem. Transanastomotic stenting and postoperative dilatation appears to be a useful adjunct in the management of this problem. Combined antegrade and retrograde dilatation is a very useful technique for difficult strictures.

Introduction Isolated splenic abscesses (SAs) are rare in children. We report a single-center experience with emphasis on their diagnosis, etiology, treatment, and outcome. Methods This is a retrospective review. Results Eighteen children (age, 3-16 years; male-female ratio, 5:1) were managed over a period of 8 years in a tertiary-care institution. Presenting symptoms included fever, abdominal pain, and anorexia. Splenomegaly was present in 12 (67%), leukocytosis in 9 (50%), and thrombocytosis in 12 (67%) patients. Associated diseases were thalassemia (1), tuberculosis (1), and typhoid fever (9). Solitary and multiple SAs were seen in equal numbers. Blood culture grew Salmonella paratyphi A in 1 case. Splenic aspirate culture was positive in 3 (Escherichia coli [1], S paratyphi A [1], Acinetobacter [1]). Widal serology was positive in 9 (50%) patients. Management consisted of intravenous broad-spectrum antibiotic therapy in all patients, together with percutaneous aspiration in 10 (56%) cases where the abscess size was greater than 3 cm. All patients responded, and complete resolution was observed. Conclusion Isolated SA in children responds favorably to conservative treatment with intravenous broad-spectrum antibiotics and percutaneous drainage without the need for splenectomy.

We reviewed the clinicopathological features, diagnosis, and surgical treatment of ectopic ureters (EU) in children in order to evaluate the anatomy, renal function, outcome, and the existence of any racial or regional difference in this abnormality. The records of 27 consecutive patients with 33 EU managed over a period of 7 years were analyzed. There were 25 female and two male patients. Their age ranged from 1 to 13 years, with an average of 4.5 years. The presenting features included history of continuous dribbling of urine with otherwise normal voiding in toilet-trained female patients, incontinence of urine, urinary tract infection, abdominal pain, and renal failure. The diagnostic work-up included ultrasonography (US) in all 27 patients, intravenous pyelography (IVP) in 23, micturating cystourethrogram (MCU) in 19, nuclear imaging (NI) in 16, and computed tomogram (CT) in five patients. All patients underwent examination under anesthesia (EUA) and cystourethrovaginoscopy immediately before the operation. Single-system ectopic ureter (SSEU) was present in 19 patients with 25 ureters (six bilateral), and duplex with ectopic ureter was present in eight cases. The left side was involved in 14 cases, the right side in seven, and the anomaly was bilateral in six cases. Abnormalities noted in the imaging studies were USG 23/27, IVP 23/23, MCU 11/19, NI 13/16, and CT 5/5 cases. EUA and cystourethrovaginocsopy helped in localization of the ectopic site and evaluation of the bladder. The surgical treatment included nephroureterectomy (NUT) for non-functioning kidney in 7 patients, heminephroureterectomy (HNUT) for non functioning upper pole of duplex kidney with EU in 6 patients, ureteric reimplantation (UTR) in 13 patients (19 ureters, 6 bilateral), and ureteropyelostomy (UTP) in one patient. In the follow-up period ranging from 1 to 5 years, 20 patients achieved continence; however, six cases with bilateral SSEU and one case of unilateral SSEU, who also had a patulous bladder neck, continued to dribble urine. SSEU was more common than duplex with ectopic ureter. A large number of functioning renal units associated with SSEU deserved preservation. The success of surgical treatment in terms of achievement of continence was high and depended on the integrity of the bladder neck.

Purpose The aim of this study was to perform a detailed histopathologic examination of the terminal colonic pouch and the colovesical fistula (CVF) excised during surgical management of male patients with the more severe forms (types I/II) of congenital pouch colon (CPC) associated with anorectal agenesis. Methods From January 2005 to December 2006, 25 male patients with types I/II CPC underwent abdominal exploration with dissection of the terminal portion of the colonic pouch and associated CVF till the bladder, division-ligation of the fistula, and excision of the colonic pouch. In 6 of the 25 patients, a complete dissection of the fistula to the bladder was possible, and in them, the terminal portion of the colonic pouch and the CVF were subjected to detailed histopathologic examination. The 6 patients included 3 newborns in whom this surgery was performed as a primary procedure, and 3 patients aged 3 months, 15 months, and 2 years, respectively, in whom a window colostomy of the pouch had earlier been performed. After due processing, multiple sections from the specimens were stained using the routine H&E method and examined under the microscope under different magnifications. Results In 4 specimens, the epithelial lining of the CVF consisted of transitional stratified epithelium with underlying anal/urethral glands. In 2 specimens, obtained from patients 15 months and 2 years old, respectively, the lining was of nonkeratinizing, stratified squamous epithelium. Other findings included aganglionosis in the muscle layers (n = 2), submucosal and subserosal fibrosis (n = 1), and thickening of muscle layers in the fistulous portion, suggestive of the presence of an internal sphincter (n = 2). Conclusions The CVF in patients with types I/II CPC shows histologic features of the normal anorectal canal.

Bilateral eventration of the diaphragm associated with malrotation of gut and unilateral renal agenesis is a very rare entity. The authors treated a seven mth old male child who presented to them with respiratory distress and gastrointestinal problem. The child was anemic and was in type II respiratory failure. His X-ray chest showed bilateral eventration of diaphragm and ultrasonography abdomen was consistent with left renal agenesis which was confirmed by radionuclide scan. Bilateral plication of the diaphragm done with correction of malrotation which was diagnosed peroperatively. The association of these three anomalies are rare and to be kept in mind whenever treating a patient with bilateral eventration of the diaphragm.

A 7-months-old male child presented with severe lower gastrointestinal bleeding. His radionuclide scan showed ectopic gastric mucosa in Meckel's diverticulum as well as in distal ileum. On exploration a 5 cm indurated bleeding ulcer found in ileum but no ulcer in Meckel's diverticulum or adjacent ileum. Histopathological examination of the specimen confirmed the diagnosis of ectopic gastric mucosa in ileum causing bleeding ulcer. Resection of the segment with end-to-end anastomosis cured the child. Such a synchronous lesion with Meckel's diverticulum has the potential to be missed, unless careful evaluation is done.