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Empyema thoracis in children is a disease of significant morbidity and mortality. In most patients the disease process develops due to lung infection-pneumonia resulting in parapneumonic effusion in the pleural space which is subsequently complicated into empyema (pus in pleural fluid). A combined approach of antibiotics, intercostal chest tube drainage (ICD) and fibrinolytics in case of loculated empyema are usual recommended treatment in empyema. In this prospective observational study 36 paediatric patients having bacterial empyema, attending the paediatric surgery department of Institute of Medical Science and SUM hospital, Bhubaneswar-Odisha, were taken. VATS was performed as primary intervention in all the cases along with proper antibiotics and post operation ICD. All cases were followed up for 12 weeks with continuation of appropriate antibiotics for 3 to 4 weeks post discharge. The most common symptom noted in patients was fever (100%), cough (88.88%), chest pain (80.55%), and breathlessness (77.77%). Common organism isolated in empyema fluid were staphylococci (36.11%), Pneumococci (30.55%), H. Influenza (27.77%) and anaerobes (5.55%). As per staging of empyema, 19 patients had stage-1and 17 had stage-2 disease. The mean time for ICD removal in stage-1cases was 4.7days and for stage-2 was 6.8 days. The mean time of hospital stay for stage-1 diseases was 5.2days and for stage-2 was 7.1 days. No VATS-related complications or recurrence was found in follow up. Early intervention by VATS in empyema thoracis in children is highly effective in terms of quick drainage of pleural space, early removal of ICD, less duration of hospital stay, and without any post-operative or future complication and recurrence. So VATS as primary treatment in empyema of children is highly recommended.

SummaryBiocultural and indigenous approaches to conservation, such as the sacred forests of India, are increasingly being recognized and valued. At these sites, the ecological aspects as well as the local community management and cultural significance of the landscape contribute to conservation success. From 2012 to 2015, we investigated five sacred forests in western Odisha (India) that varied in size from 1 to 1000 ha. Through interviews with 81 residents, we explored the types of groves, their use and management approaches. We investigated levels of grove disturbance and plant use with botanical survey methods. Some groves experience pressures from annual pilgrimage visitors, and we documented the relative impacts of pilgrims and other activities using ethnographic methods. Community participation or management by the Forest Department alone has not been completely effective in conserving these sacred natural sites; however, collaborative work can contribute to successful conservation. Continued community involvement is key to future biodiversity conservation in the sacred groves.

Iliopsoas abscesses are rare in neonates. Clinical presentation of neonates with iliopsoas abscess often mimic other common neonatal illness. Typical clinical features as described in adults may not be observed in neonates. Such abscesses cause a diagnostic dilemma for the clinician, often resulting in a delay in clinical diagnosis and institution of specific treatment. We report a case of a 10-day old term male neonate from community who presented with high grade fever, abdominal distension, left lower limb swelling with limitation of movement and diagnosed to have left sided iliopsoas abscess on ultrasonography. The neonate undergone and extraperitoneal surgical drainage of the abscess along with a course systemic antimicrobial agent. The case is of clinical importance because it describes the presence of a localized abscess in an uncommon location and Methicillin resistant staphylococcus being the causative organism, which represents a rare and potentially life-threatening infection in neonates.

From September 2015 to January 2016, we studied the tree species diversity, biomass and biomass carbon stock of two different forests in Western Odisha: a wildlife sanctuary and a sacred forest. The wildlife sanctuary is entirely managed by the Forest Department, whereas the sacred forest is jointly managed by the local community and the Forest Department. Our results showed that the sacred forest had a greater species richness, density and diversity compared to the wildlife sanctuary. The density in different diameter classes showed that the sacred forest is regenerating with a good regeneration potential, but the wildlife sanctuary had a poor regeneration potential with lower numbers of saplings than adults. However, the biomass and carbon content of the wildlife sanctuary were higher than in the sacred forest. This may be due to the presence of a higher proportion of old trees in the wildlife sanctuary compared to the sacred forest. Biomass values can be used to emphasize the role of management in maintaining the carbon stock in forest ecosystems. Our results can be helpful in framing conservation strategies and action plans for forest patches in India and globally.

Clinical presentation of echinococcosis in paediatric population is varied and depends on the site of involvement. The present study was planned to analyse the clinical presentations and therapeutic options for management of echinococcosis in children admitted to a tertiary care hospital. Medical records of children with echinococcosis was reviewed retrospectively over a period of 3 year and 6 months. Demographic data, clinical presentation, management and outcome data were collected and analysed. During the study period, 14 children with hydatid disease were admitted to the hospital. The frequency was higher in male (71.4%) compared to females (28.6%). Liver was found to be the commonest site for hydatid cyst with 78% of all cases had hydatid cyst localised to liver. In half of all cases liver was the only site of involvement. Both liver and lung were involved in 21.4% cases and one patient (7.1%) had pelvic hydatid cyst in addition to liver involvement. Two patients (14.3%) had only pulmonary involvement and one (7.1%) patient had a hydatid cyst in common bile duct. Right upper abdominal pain was the most common presentation (78.5%) with cyst in liver. Cough, breathing difficulty, jaundice was observed in 28.5%, 21.4% and 7.1% of all patients respectively. All children were managed with a combination of surgical and medical therapy. Right upper abdominal pain and chronic cough were the common clinical presentation of hydatid cyst with hepatic and pulmonary involvement respectively. Presence of such chronic symptoms would raise the clinical suspicion of hydatid disease in endemic regions.

The objective of this study was to determine the structure and composition of the molluscan community in two different intertidal profiles of the Bhitarkanika mangrove ecosystem of Odisha. Investigations on four study stations revealed the occurrence of 37 molluscan species represented by 25 gastropods and 12 bivalves. The comparative assessment demonstrated that molluscan species assemblage and diversity varied in the two different intertidal profiles with significantly higher abundance (P-value = 2.912e-11) at the mid-intertidal zone than the high intertidal zone. The species accumulation curve also indicates higher species accumulation in the mid intertidal zone as compared to the high intertidal zone. The two different zones were also found to differ significantly in physico-chemical parameters. Taken together, the observations demonstrated that hydrological and soil environmental conditions such as salinity, temperature, pH, electron conductivity and soil biomass carbon may influence the dispersion and distribution of benthic molluscan faunal assemblages among different mangrove habitats. The results highlighted the need for long-term studies and perspective when evaluating conservation practices in mangrove ecosystems.

Background Recognizing that litterfall and decomposition are key ecosystem functions for ecosystem stability in a terrestrial ecosystem, litterfall and decomposition in four sacred forests were studied from western part of Odisha. The present study focuses on the detailed aspects of litter dynamics, decomposition and consequent release of nutrients to the forest floor. The results obtained in this study will be beneficial in understanding the ecosystem functioning associated with nutrient cycling, which helps in determining possible management strategies for optimization of ecosystem functioning and productivity of these sacred forests. Results Litterfall and standing litter showed a seasonal pattern with most of the litter accumulated during the dry seasons and lowest in the rainy season. However, no significant difference was observed between the litterfall patterns of the sacred forests. The annual turnover rate (KL) was found to be in the range of 3.59/yr to 4.22/yr in studied sacred forests. The litter decomposition study was performed by litter bag technique and almost 95% of mass loss was observed within a period of 6 months. Such fast decomposition leads to faster rate of nutrient release across the sites. The studied elements can be set in the following order as regards to their return to the topsoil during decomposition in the order of K (Potassium) > N (Nitrogen) > P (Phosphorus). The approximate amount of nutrient released to the forest soil is quantified in the range of 184.76 to 33.61kg/ha of NPK (Nitrogen, Phosphorus and Potassium) in different sacred forests.Conclusion Such nutrient release and dynamics in sacred forests, may contribute an effective nutrient flow to the topsoil as well as to the surrounding agricultural landscapes boosting agricultural productivity and sustainability. This signifies the role of sacred forests in rendering an important ecological service in terms of nutrient cycling.

From September 2015 to February 2016, we collected field data to study the tree species diversity, population structure and regeneration potential of five sacred forests of western Odisha, India, t...

Background: Our aim of study is to evaluate the reduction of ileo-colic intussusception by ultrasound guided saline enema in children. Methods: This is a retrospective study of 58 cases of pediatric ileo-colic intussusception from September 2012 to September 2015 in which USG guided hydro reduction was attempted. Results: The success rate was 94%. Three cases underwent surgery. No bowel perforation is seen. No aspiration is seen. Conclusion: USG guided hydro-reduction of intussusception is a safe and effective method for reduction of intussusceptions. It has no radiation risk and has very minimal complication and can be used as routine procedure.

Introduction: Gallstone disease is being increasingly diagnosed as a cause of pediatric pain abdomen, requiring cholecystectomy. Most cases are idiopathic, while uncommon etiologic associations nowadays include obesity and hemolytic anemias/hemoglobinopathies; prolonged disease and high fat diet are predisposing factors. Management aspect is similar to adults. Aim: This study aims to compare the profile, interventions, and outcomes of pediatric gallstone disease patients, having undergone cholecystectomy, between two surgeons working at separate centers in India. Materials and Methods: Case records of all pediatric patients (≤15 years' age) having undergone cholecystectomy at both the centers by the respective surgeons (AP = 43 and KA = 17; total = 60 cases), between August 2015 and November 2019, were examined. Data were tabulated and inferences were drawn. Results: Male patients outnumbered female patients in both the studies (AP – M: F = 24:19, KA – M: F = 12:5). Anemia/hypoproteinemia and obesity were prevalent among the operated children (AP = 6 and KA = 3). Biliary pancreatitis (AP = 2 and KA = 2)/choledocholithiasis (AP = 7 and KA = 3) was the uncommon presentation; common bile duct obstruction with cholangitis/sepsis was rarer still. Laparoscopic cholecystectomy was the commonly performed procedure (AP lap: open = 41:2 and KA lap: open = 10:7). Choledocholithiasis patients underwent prior endoscopic retrograde cholangio-pancreatography (AP = 7 and KA = 3). Most patients had cholesterol/mixed gallstones. Complications were minimal, comparable with adult procedures. Conclusion: Pediatric gallstone disease is understated in literature and underestimated in clinical practice. Early diagnosis and timely referral to a surgeon for appropriate treatment can help prevent complications and reduce time–work–loss to child/parent.

Sacred forests are being protected by means of cultural and religious beliefs by the local communities and act as people participatory conservation sites for several important medicinal plants. Sacred forests are one of the oldest forms of biodiversity conservation sites still effectively managed by local people and act as in-situ conservation sites. In this context, the present study was carried out in Andhari sacred forest of Jharsuguda district as to collect the information regarding the traditional ethno medicinal knowledge acquired by the local medical practitioners. Only few indigenous people have adequate knowledge regarding the medicinal plants and their uses. These traditional knowledge were rapidly degrading and if not documented will be lost forever. The present study reveals the presence of 91 plants species belonging to 46 families being used by the practitioners to treat various diseases like dysentery, diarrhea, indigestion, worm infection, wound healing, headache, stomach disorders, Rheumatic disorders, snake bite, poisonous bite, menstrual problem etc. This ethnomedicinal information further needs to be validated by clinical trials for their safe uses. The study also reported the existence of 8 RET (Rare, Endangered and Threatened) medicinally important species which makes this site a biological hotspot and needs further effective conservation efforts.

An 11-years-old girl with a polyp in the gallbladder is reported. Laparoscopic cholecystectomy was curative.