Search

Objectives This study aims to evaluate whether stent removal through endoscopic retrograde cholangiopancreatography (ERCP) with balloon sweeps is necessary or whether stent removal by forward-viewing gastroscope without cholangiogram is sufficient.

Type II solar radio bursts are signatures of the coronal shocks and, therefore, particle acceleration events in the solar atmosphere and interplanetary space. Type II bursts can serve as a proxy to provide early warnings of incoming solar storm disturbances, such as geomagnetic storms and radiation storms, which may further lead to ionospheric effects. In this article, we report the first observation of 32 type II bursts by measuring various plasma parameters that occurred between May 2021 and December 2022 in solar cycle 25. We further evaluated their accompanying space weather events in terms of ionospheric total electron content (TEC) enhancement using the rate of TEC index (ROTI). In this study, we find that at heliocentric distance ∼1–2 R⊙, the shock and the Alfvén speeds are in the range 504–1282 and 368–826 km−1, respectively. The Alfvén Mach number is of the order of 1.2≤MA≤1.8 at the above-mentioned heliocentric distance. In addition, the measured magnetic field strength is consistent with the earlier reports and follows a single power law B(r)=6.07r-3.96G. Based on the current analysis, it is found that 19 out of 32 type II bursts are associated with immediate space weather events in terms of radio blackouts and polar cap absorption events, making them strong indications of space weather disruption. The ROTI enhancements, which indicate ionospheric irregularities, strongly correlate with GOES X-ray flares, which are associated with the type II radio bursts recorded. The diurnal variability in ROTI is proportional to the strength of the associated flare class, and the corresponding longitudinal variation is attributed to the difference in longitude. This article demonstrates that since type II bursts are connected to space weather hazards, understanding various physical parameters of type II bursts helps to predict and forecast the space weather.

Trichobezoar is a rare surgical condition that mostly occurs in the stomach and often causes a surgical emergency when left untreated. It is often predisposed by psychiatric conditions, mental retardation, previous gastric surgery, or abnormal anatomy. Trichobezoar progresses extremely slowly and is diagnosed through imaging such as a barium series, endoscopy, or computed tomography. Surgical removal is typically required. The patient in this case was a 12-year-old girl who presented with symptoms of abdominal pain, vomiting, nausea and constipation. She was found to be anaemic and underweight. Contrast-enhanced Computed Tomography (CECT) diagnosed acute intussusception and small bowel obstruction, which were treated by emergency laparotomy. During the operation, a large primary ileal trichobezoar was found in the distal part of the ileum with hair strands extending up to the transverse colon. The absence of masses elsewhere made the diagnosis even more peculiar, as primary intestinal trichobezoar is highly uncommon. Primary closure of the enterotomy was performed as it was viable, and the postoperative period was uneventful. A history of trichophagia was elicited, and a psychiatric assessment of the patient was conducted. Behavioural therapy was initiated for the trichophagia. In conclusion, trichobezoar is a rare surgical entity with modifiable predisposing factors that require a multidisciplinary management approach.

Introduction: Permanent pacemaker implantation (PPI) in neonates is challenging with respect to indications, device selection, implantation technique, and long-term outcomes. Complex anatomy, the need for long-term pacing with high rates, and a problematic postoperative period are the major problems. Methods: We prospectively followed up 22 newborns who underwent PPI below 28 days of life at our institute. Results: The median age at implantation was 2 days (interquartile range 1–9 days), and 9% were born preterm. The average heart rate before implantation was 46.4 ± 7.2 bpm. Maternal lupus antibodies were positive in 8 (36.4%) neonates, whereas 11 (50.0%) had associated congenital heart disease. Nineteen neonates underwent single chamber (VVI) and three underwent dual chamber (DDD) pacemaker implantation. Over a median follow-up of 46 months (range 2–123 months), the average ventricular pacing percentage was 87.5 ± 24.9%, with a stable pacing threshold. Seven children underwent pulse generator replacement due to battery depletion at a median age of 47 months. Pacing-induced ventricular dysfunction was seen in five children at a median age of 23.6 months, and two underwent upgradation to cardiac resynchronization therapy. Overall mortality was 13.6%, all due to tissue hypoperfusion and lactic acidosis in the postimplantation period. Conclusions: PPI in neonates has a favorable outcome with excellent lead survival. Overall mortality is 13.6%, which is predominantly in the postimplantation period and related to myocardial dysfunction.