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The purpose of the study was to investigate the incidence of pancreatic contour variations on multidetector CT (MDCT) for abdominal examinations. A retrospective analysis of 700 MDCT scans was performed in patients who underwent triple phase CT abdomen between October 2018 and January 2021. After excluding 176 patients, finally total of 524 patients were included in the study. For simplification, we classified the pancreatic contour variations as classified by Ross et al. and Omeri et al. Pancreatic head–neck variations was classified into Type I-anterior, Type II-posterior and Type III-horizontal variety. Pancreatic body–tail variation was divided into Type Ia-anterior projection; Ib-posterior projection and Type IIa-globular, IIb-lobulated, IIc-tapered, and IId-bifid pancreatic tail. The most common type of variation in the head was Type II (n = 112, 21.3%) followed by Type III (n = 37, 7%) and Type I (n = 21, 4%). The most common type of variation in the body of pancreas was Type Ia (n = 33, 6.2%) followed by Type Ib (n = 13, 2.4%). In the tail region of pancreas, the most common variation was Type IIb (n = 21, 4%) followed by Type IIa (n = 19, 3.6%). Pancreatic contour variations are not very uncommon in daily practice. Knowledge of these variations is important for surgeons, radiologists and avoids misjudgement of normal pancreatic tissue as tumor or lymph node especially on unenhanced or single phase MDCT.

Objective Knowledge about COVID-19 in children is limited due to the paucity of reported data. The pediatric age group comprises only less than 5% of total COVID-19 worldwide, therefore, large studies in this population are unlikely in the immediate future. Hence, we planned to synthesize the current data that will help in a better understanding of COVID-19 in children. Evidence acquisition Four different electronic databases (MEDLINE, EMBASE, Web of Science, and CENTRAL) were searched for articles related to COVID-19 in the pediatric population. We included studies reporting disease characteristics and outcomes of COVID-19 in patients aged less than 19 years. We performed a random-effect meta-analysis to provide pooled estimates of various disease characteristics. Results 27 studies (4857 patients) fulfilling the eligibility criteria were included in this systematic review, from a total of 883 records. About half of the patients had each of fever and cough, 11% (6–17%) had fast breathing, and 6–13% had gastrointestinal manifestations. Most of the patients had mild to moderate disease, and only 4% had a severe or critical illness. Leukopenia was the commonest reported laboratory abnormality. Conclusion Even among the symptomatic COVID-19 cases, severe manifestations are seen in very few children. Though fever and respiratory symptoms are most common, many children also have gastrointestinal manifestations.

Mesenteric tear in blunt trauma patients needs a high index of suspicion for radiological diagnosis especially when presenting with subtle and indirect radiological features. Our patient had both direct and indirect computed tomography signs of mesenteric injury which we hereby discuss along with their sensitivity and specificity.

Sir,We read the systematic review by Sharma et al. with great interest and would like to bring out few issues in methodology, data analysis, and interpretation [1]. In view of conflicting results f...

To synthesize the current evidence for the presence of SARS-CoV-2 RNA in the human milk of mothers with confirmed COVID-19 and its potential role in neonatal SARS-CoV-2 infection. Using terms related to novel coronavirus 2019 and human milk, a systematic search was performed in three electronic databases (PubMed, EMBASE, and Web of Science) for studies published between December 2019 and 15 October 2020. Published peer-reviewed studies reporting the results of RT-PCR for SARS-CoV-2 RNA in human milk in mothers with confirmed COVID-19 were included. Proportion meta-analysis of case series and prospective cohort studies was performed using STATA version 14.2 (StataCorp, College Station, TX) and pooled estimate (with 95% confidence interval) of overall incidence of SARS-CoV-2 transmission was calculated. We identified 936 records, of which 34 studies (24 case-reports, 10 cohort studies) were eligible for this systematic review. A total of 116 confirmed COVID-19 lactating women (88 in cohort and 28 in case-reports) underwent RT-PCR testing in human milk, and 10 (six in case reports) were detected to have SARS-CoV-2 RNA. The overall pooled proportion (from cohort studies) for SARS-CoV-2 RNA detection in human milk was 2.16% (95% CI: 0.0–8.81%, I2: 0%). Four studies (six patients) also reported the presence of SARS-CoV-2 specific antibodies (along with RT-PCR) in human milk. The limited low-quality evidence suggests that SARS-CoV-2 RNA is detected in human milk in an extremely low proportion, however, based on current evidence no conclusion can be drawn about its infectivity and impact on the infants. In concordance with World Health Organization recommendations, exclusive breastfeeding should be considered in all cases unless any other contraindication exists.

BackgroundThe majority of the children with SARS-CoV-2 infection present with respiratory symptoms, hence various chest imaging modalities have been used in the management. Knowledge about the radiological findings of coronavirus disease (COVID-19) in children is limited. Hence, we systematically synthesized the available data that will help in better management of COVID-19 in children.MethodsFour different electronic databases (MEDLINE, EMBASE, Web of Science and CENTRAL) were searched for articles reporting radiological findings in children with COVID-19. Studies reporting thoracic radiological findings of COVID-19 in patients aged ResultsA total of 1984 records were screened of which forty-six studies (923 patients) fulfilled the eligibility criteria and were included in this systematic review. A chest computed tomography (CT) scan was the most frequently used imaging modality. While one-third of the patients had normal scans, a significant proportion (19%) of clinically asymptomatic children had radiological abnormalities too. Unilateral lung involvement (55%) was frequent when compared with bilateral and ground-glass opacities were the most frequent (40%) definitive radiological findings. Other common radiological findings were non-specific patchy shadows (44%), consolidation (23%), halo sign (26%), pulmonary nodules and prominent bronchovascular marking. Interstitial infiltration being the most frequent lung ultrasound finding.ConclusionCT scan is the most frequently used imaging modality for COVID-19 in children and can detect pneumonia before the appearance of clinical symptoms. Undefined patchy shadows, grand-glass opacities and consolidation are commonly observed imaging findings in COVID-19 pneumonia.

Dear Editor,We read the article on possible effects of BCG vacaccine in COVID-19 management should be discouraged and restricted to research purpose only.2

Dear Editor,We read the recent systematic review by Gu et al. [1] on the efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia. This review is an updated version of the last...

We observed that 760 (92.1%) out of 825 healthy newborns at our institution had vitamin D deficiency (VDD) at birth. These observations highlight the importance of regular screening and supplementation of vitamin D in the early years of life.

To the Editor, Perinatal management during COVID-19 requires expertise and coordination among various teams (obstetrics, neonatology, anesthesia, infectious disease) therefore, explicit guidance du...

An 8-month-old partially immunised infant girl presented with a history of fever, loose stool and decreased responsiveness for the past 2 days. On examination, she was moderately dehydrated and had poor sensorium. However, the rest of the systemic examination was normal. The complete blood count

To the Editor,The trial by Cavallin et al. [1] showed that along with others, home delivery is an independent risk factor for the need of exchange transfusion in neonates. We appreciate and applaud...

We read the article by Khuwuthyakorn et al. [1] which compared the efficacy of oral ibuprofen and oral indomethacin in very low-birthweight (VLBW) infants. The conclusions drawn in this underpowere...

A 32-year-old man presented with a fairly large intramedullary mass lesion involving D5 to L1 segment of spinal cord. It was hyperintense on both T1Weighted (W) and T2W sequences, with signal suppression on fat-saturation images leading to the diagnosis of dermoid cyst (with extensive intramedullary occupancy of dorsolumbar cord) with multiple tiny fat deposits along proximal cervicodorsal cord. Keywords: Dermoid, Intramedullary, Spinal

The role of zinc supplementation during diarrhoeal episodes is undisputed. A recent Cochrane systematic review has shown that in children older than 6 months, zinc supplementation shortens the aver...

Dear Sir,The trial by Balachander et al. [1] showed that ibuprofen and paracetamol (PCM) are equally efficacious for ductal closure in preterm infants. We agree with the author’s conclusions but wo...

Gall bladder (GB) duplication is a rare anatomical malformation, which can be detected by preoperative imaging study. We present a case of duplex gall bladder in a 14-year-old boy who presented with abdominal pain. On ultrasound, he had right nephrolithiasis and duplex gall bladder. Duplex gall bladder was confirmed on MR cholangiopancreatography. There was a dilemma for surgical management of duplex gall bladder; however, he became asymptomatic after conservative treatment. Prophylactic surgery is not recommended for asymptomatic incidentally detected duplex gall bladder. Radiologists and paediatric surgeons should be sensitised about the exact anatomy of this entity.

We describe a case of bilateral persistent fetal vasculature (PFV) in a 3-month-old boy who presented with bilateral white pupillary reflex and a possible diagnosis of retinoblastoma. On ultrasonography, there was an echogenic band in the posterior segment of both eyes which connected the posterior surface of the lens capsule to the optic disc. Colour Doppler revealed the presence of vascularity in the band along its entire length. No calcification or mass lesion was seen. These findings are diagnostic of PFV. Most cases of PFV are unilateral and sporadic in nature and closely mimic retinoblastoma. Although rare, PFV should be considered in the differential diagnosis when examining a case of bilateral leukocoria. Paediatricians should be aware of this rare but serious entity.

A term, 3.8 kg boy, born through meconium-stained liquor (MSL) was referred to a tertiary care hospital on day 4 of life in view of respiratory distress since birth. At admission, despite intubation and 100% oxygen, he had preductal and postductal saturation of 94% and 83%, respectively. In view

We read with interest the article by Prashantha et al. regarding the safety of low-cost devices for therapeutic hypothermia (TH) in low- and middle-income countries (LMIC) such as India [1] and wis...

An 8-year-old developmentally normal boy was brought to emergency following a fall from a bicycle on the road. He could not remember how he fell and regained consciousness in about 5 min. He had an abrasion on the right forearm and cheek. On neurological examination, he was fully conscious and alert with an orientation to time, place and person. There was no neurological deficit at the time of presentation in the emergency ward. The child was kept under observation. Two hours later, he experienced one episode of generalised tonic–clonic seizure which lasted for 3 min. Seizures were managed as per standard protocol. CT scan of the brain was done (figure 1), which showed a homogeneously hypodense midline lesion with …