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Laparoscopic repair of Morgagni hernia has been described in adults and children. In the published reports, the crux of the repair consists of suturing the posterior part of the diaphragmatic defect to the undersurface of the sternum or the posterior rectus sheath. The tissue on the undersurface of the sternum is variable is in its nature and may be inadequate for suturing, hence compromising the strength of the repair. A technique that circumvents this problem and offers a strong anatomical repair is described. A Morgagni hernia was diagnosed in a 2-year-old girl with trisomy 21, who presented with recurrent chest infections. She underwent laparoscopic repair of the hernia using three ports. The tissue on the undersurface of the sternum was inadequate for a conventional repair. The procedure was modified as follows: a small transverse incision was made over the lower end of the sternum. Three nonabsorbable mattress sutures were inserted through the sternum, the anterior edge of the diaphragmatic defect, and back through the sternum and tied with extracorporeal knots. The child was discharged home on the second postoperative day. At 6-month follow up, the child was asymptomatic, and had been infection free. A chest radiograph was normal. This is a simple, novel, noninvasive method, which offers a secure anatomical repair and it is not dependent on the adequacy of the tissue on the undersurface of the sternum.

Juvenile dermatomyositis classically manifests as necrotising vasculitis in multiple organs. It mainly involves the vessels of skin and muscle and is associated with subcutaneous deposits of calcium. Ureteric involvement in dermatomyositis is extremely rare. The authors present a case of a 14-year-old girl with juvenile dermatomyositis with intramural ureteric calcification mimicking pelviureteric junction (PUJ) obstruction.

Background: The World Health Organization recommends direct observation of treatment (DOT) to support patients with tuberculosis (TB) and to ensure treatment completion. As per national programme guidelines in India, a DOT provider can be anyone who is acceptable and accessible to the patient and accountable to the health system, except a family member. This poses challenges among children with TB who may be more comfortable receiving medicines from their parents or family members than from unfamiliar DOT providers. We conducted a non-inferiority trial to assess the effect of family DOT on treatment success rates among children with newly diagnosed TB registered for treatment during June–September 2012. Methods: We randomly assigned all districts (n = 30) in Gujarat to the intervention (n = 15) or usual-practice group (n = 15). Adult family members in the intervention districts were given the choice to become their child’s DOT provider. DOT was provided by a non-family member in the usual-practice districts. Using routinely collected clinic-based TB treatment cards, we compared treatment success rates (cured and treatment completed) between the two groups and the non-inferiority limit was kept at 5%. Results: Of 624 children with newly diagnosed TB, 359 (58%) were from intervention districts and 265 (42%) were from usual-practice districts. The two groups were similar with respect to baseline characteristics including age, sex, type of TB, and initial body weight. The treatment success rates were 344 (95.8%) and 247 (93.2%) (p = 0.11) among the intervention and usual-practice groups respectively. Conclusion: DOT provided by a family member is not inferior to DOT provided by a non-family member among new TB cases in children and can attain international targets for treatment success. Trial Registration: Clinical Trials Registry–India, National Institute of Medical Statistics (Indian Council of Medical Research) [ABSTRACT FROM AUTHOR]

Background: India accounts for one-fifth of the global TB incidence. While the exact burden of childhood TB is not known, TB remains one of the leading causes of childhood mortality in India. Bacteriological confirmation of TB in children is challenging due to difficulty in obtaining quality specimens, in the absence of which diagnosis is largely based on clinical judgement. While testing multiple specimens can potentially contribute to higher proportion of laboratory confirmed paediatric TB cases, lack of high sensitivity tests adds to the diagnostic challenge. We describe here our experiences in piloting upfront Xpert MTB/RIF testing, for diagnosis of TB in paediatric population in respiratory and extra pulmonary specimens, as recently recommended by WHO. Method: Xpert MTB/RIF testing was offered to all paediatric (0–14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities in the project areas covering 4 cities of India. Results: Under this pilot project, 8,370 paediatric presumptive TB & presumptive DR-TB cases were tested between April and–November 2014. Overall, 9,149 specimens were tested, of which 4,445 (48.6%) were non-sputum specimens. Xpert MTB/RIF gave 9,083 (99.2%, CI 99.0–99.4) valid results. Of the 8,143 presumptive TB cases enrolled, 517 (6.3%, CI 5.8–6.9) were bacteriologically confirmed. TB detection rates were two fold higher with Xpert MTB/RIF as compared to smear microscopy. Further, a total of 60 rifampicin resistant TB cases were detected, of which 38 were detected among 512 presumptive TB cases while 22 were detected amongst 227 presumptive DR-TB cases tested under the project. Conclusion: Xpert MTB/RIF with advantages of quick turnaround testing-time, high proportion of interpretable results and feasibility of rapid rollout, substantially improved the diagnosis of bacteriologically confirmed TB in children, while simultaneously detecting rifampicin resistance. [ABSTRACT FROM AUTHOR]

Priapism is a rare condition in childhood. The majority of reported cases are boys with sickle cell disease, in whom nonoperative management may be successful when patients present early. We report a 14-year-old boy with sickle cell disease who presented with priapism of 72-h duration and was successfully treated by bilateral saphenocorporal shunts. [ABSTRACT FROM AUTHOR]