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Extra Hepatic Biliary Atresia Associated with Choledochal Cyst: A Diagnostic Dilemma in Neonatal Obstructive Jaundice
Shalini Sinha,Yogesh Kumar Sarin
Journal of Neonatal Surgery , 2013,
Abstract: The presentation of extra hepatic biliary-atresia (EHBA) as well as choledochal cyst (CDC) in the neonate may be similar. Since the surgical management and prognosis are entirely different, it is important to differentiate between the two entities. We present a case with co-existing EHBA and CDC which led to a diagnostic dilemma.
Outcome of Jejuno-Ileal Atresia Associated with Intraoperative Finding of Volvulus of Small Bowel
Shalini Sinha,Yogesh Kumar Sarin
Journal of Neonatal Surgery , 2012,
Abstract: Aim: To compare the outcome of patients with jeuno-ileal atresia (JIA) associated with the intraoperative finding of volvulus of small bowel (group A) with that of JIA without volvulus (group B). Materials and Methods: It is a retrospective observational study conducted at one of the two units of Pediatric Surgery, in a tertiary care public hospital of India, from January 2001 to December 2010. Hospital records were retrieved and analyzed. During this time period, 65 patients with JIA were operated of which 40 (61.5%) had ileal atresia (IA) and 25 (38.5%) had jejunal atresia (JA). Eleven (16.9%) patients had associated intraoperative finding of volvulus of small bowel (Group A) and were studied and compared with group B- not associated with intraoperative findings of volvulus of small bowel (n=54). The demography, clinical features, operative findings, associated anomalies, anastomotic leakage, and outcome were compared. Results: Group A comprising of 6 boys and 5 girls, had 8 IA and 3 JA; one case each of Type 3b and Type 4 JIA was seen. Associated anomalies included meconium ileus (n=2), Down’s syndrome (n=1) and malrotation (n=1). Anastomotic leak rate was 75% for IA and 66.7% for JA. The mortality was 91% in Group A, 100% for IA and 67% for JA. Group B comprising of 37 boys and 17 girls, had 32 IA and 22 JA; 2 cases of Type 4 and 1 case of Type 3b JIA was seen. Associated anomalies were malrotation (n=2), meconium ileus (n=1), exomphalos (n=1), gastroschisis (n=1) and ileal duplication cyst (n=1). The anastomotic leak rate for JA was 8/21 (38.1%) and IA was 3/28 (10.7%); persistent obstruction was seen in 3/21(14.3%) JA and 1/28 (3.6%) IA patients. In group B, overall mortality rate was 8/22 (36.4%) for JA and 9/32 (28%) for IA. The morbidity and mortality was significantly higher in group A when compared to group B. Conclusions: JIA associated with volvulus (without malrotation) is a sinister entity with a dismal outcome in our experience.
Prenatally Diagnosed Retroperitoneal Fetus-In-Fetu with Ipsilateral Testicular Atrophy: A Case Report
Shalini Sinha,Yogesh Kumar Sarin,Nita Khurana
Journal of Neonatal Surgery , 2012,
Abstract: We report a case of prenatally diagnosed Fetus-in-fetu (FIF) residing in the left retro-peritoneum in a 2-week-old neonate which was also associated with ipsilateral testicular atrophy. A comparison of features differentiating FIF from a retroperitoneal teratoma, and various theories of origin of FIF are described. The causal relationship of ipsilateral atrophic testis with FIF in this case is also discussed.
Yogesh Kumar Sarin,Akshay Sharma,Shalini Sinha,Vidyanand Pramod Deshpande
Journal of Neonatal Surgery , 2012,
Abstract: Aim: To describe the management and outcome of patients with duodenal webs, managed over a period of 12 years in our unit.Methods: It is a retrospective case series of 18 patients with congenital duodenal webs, managed in our unit, between 1999 and 2011. The medical record of these patients was retrieved and analyzed for demographic details, clinical presentation, associated anomalies, and outcome. Results: The median age of presentation was 8 days (range 1 day to 1.5 years). Antenatal diagnosis was made in only 2 (11.1%) patients. The commonest presentation was bilious vomiting. Associated anomalies were present in 8/18 patients, common being malrotation of gut. Down’s syndrome was seen in 2 patients and congenital heart disease in 1 patient. One patient had double duodenal webs. There was a delay in presentation of more than 5 days of life in 11/18 (61%) patients. Three patients who presented beyond neonatal age group had fenestrated duodenal membranes causing partial obstruction. In addition, the diagnosis was missed in patients operated for malrotation elsewhere (n=2), imperforate anus (n=2) and esophageal atresia with tracheo-esophageal fistula (n=1). A lateral duodenotomy with excision of the obstructive membrane was done in all patients. A trans-anastomotic tube (TAT) for enteral feeding was used in 8 patients The mortality rate was 4/18 (22%); the main causes being sepsis, prematurity, very low birth weight and associated congenital anomalies. The mean hospital stay for the 14 survivors was 18 days. Total parental nutrition (TPN) was not given to any patient.Conclusions: Congenital duodenal webs are different as the diagnosis is often missed especially in case of perforated webs. Outcome depends upon the time of presentation and associated anomalies. The use of TAT feeding for nutritional support is an easy alternative to TPN.
Neonatal Sacrococcygeal Teratoma: Our Experience with 10 Cases
Shalini Sinha,Yogesh Kumar Sarin,Vidyanand P Deshpande
Journal of Neonatal Surgery , 2013,
Abstract: Aim: To analyse the outcome of neonatal sacrococcygeal teratomas (SCT) in our setup. Materials and Methods: Hospital records of 10 neonates, who were operated for SCT during 14 years time period, were retrieved and analysed. Letters were sent to 6 parents/ caretakers of children who were lost to follow up; none of them responded. Results: Seven girls and 3 boys with a mean age of 9 days (range 1- 30 days) underwent excision of SCT in the neonatal period. Antenatal pickup rates were poor (2/10). Two patients presented with tumor rupture. Though all had an obvious mass at birth, only half of them presented on day 1 of life. The remaining 5 patients came late at a mean age of 11 days. Half of the SCTs were 10 cm or larger in size. One patient was misdiagnosed as meningomyelocoele. All underwent complete excision with coccygectomy by posterior approach in prone position. There were only 2 patients who could be classified as Altman Type II, the rest were all Altman Type I. Histopathology (HPE) revealed mature cystic teratoma (n=8), grade 1 immature teratoma (n=1) and grade 3 immature teratoma (n=1). There was no mortality; and complications were seen in 3/10 patients (1 neurogenic bladder, 1 major wound infection with ventriculitis and 1 minor wound infection). The mean follow up was 25 months (range 1 month to 6 years) in 4 patients with no recurrence. Conclusions: Neonatal SCTs are usually benign with a good outcome after complete surgical excision with a low complication rate. Although long term follow up has been advocated, the follow up was poor in this series.
Use of the Mitrofanoff principle in urinary tract reconstruction: Experience with 122 children
Sinha Shalini,Sen Sudipta,Chacko Jacob,Karl Sampath
Journal of Indian Association of Pediatric Surgeons , 2006,
Abstract: Purpose: Use of the Mitrofanoff principle is a valuable adjunct to many reconstructive urological procedures in the pediatric age group requiring clean intermittent catheterization (CIC) especially if the urethra is not easily catheterizable. We present our experience with 122 children and analyze the results of this operation. Materials and Methods: 133 Mitrofanoff channels (100 appendicular, 31 ureteric and 2 Monti) were constructed in 122 children (93 boys and 29 girls) of mean age 6.3 years over the period from 1997 to 2005. The procedure was part of the reconstructive procedure in patients of neurogenic bladder (n=44), exstrophy-epispadias (n=40), posterior Urethral valve (n=30), and other diseases (n=8). Additional procedures included augmentation cystoplasty (n=90) and bladder neck procedure (n=46). Results: Mean follow-up was 2.6 years in 109 patients. Overall results were satisfactory. Major complication rates with the Mitrofanoff conduit using appendicular and ureteric channels were 7.4 % in and 25.8%, respectively, most of the ureteric channels due to non-use, there being alternate channels for catheterization. Only six (4.5%) children required re-operation for significant problems with the Mitrofanoff conduit: revision of stoma due to stenosis or kinking (n=4) and closure of stoma due to troublesome leak (n=2). Children and parents were satisfied with the results of the operation and the majority was compliant with regular CIC. All children were socially well accepted and those above 6 years of age were attending regular school. Conclusions: The Mitrofanoff procedure is a feasible and acceptable option, with a low complication rate, for use as part of complex urinary reconstruction in a developing country. Patient education, family motivation, and cost reduction are important factors for success.
Hybrid Mutual Authentication Protocol for 802.16j against Rogue Station and DoS Attack
Computer Science , 2013,
Abstract: WiMAX is a promising technology that provides high data throughput with low delays for various user types and modes of operation. These advantages make WiMAX applicable both for infrastructure purposes and end-client usage. Since WiMAX is presented as a network framework and a last-mile technology, it is believed to be capable of handling a wide range of usage scenarios. For example, while the end users have an opportunity to use WiMAX as the primary connection medium for acquiring services such as on-demand video streaming, VoIP connections and mobile bank transactions, the service providers may use it for data relaying purposes among access points. To meet the technical requirements of these various scenarios, majority of the WiMAX research has been conducted on physical and MAC layers; however little has been invested in a comprehensive and efficient security solution, which has resulted in a wide range of security weaknesses and reactive solutions. Many security problems remain to be addressed in different modes and for different user types even in the final security standard of WiMAX, PKMv2. Mobile multi-hop relay (MMR) WiMAX networks have attracted lots of interest in wireless communication industry because of its scalable coverage, improved data rate and relatively low cost. Even with the additional security functionalities security of MMR WiMAX network is the main challenge because messages have to be transmitted through one or more relay stations, which makes it more difficult to ensure the authenticity of messages and entities involved in the transmission. In this thesis, we present a hybrid security solution to overcome the security problem of rogue station (BS/RS) attack and denial of service attack (DoS) in MMR WiMAX.
Nanostructures: Enhancing Potential Applications in Biomedicals  [PDF]
Shalini Singh
Journal of Biomaterials and Nanobiotechnology (JBNB) , 2013, DOI: 10.4236/jbnb.2013.41002
Abstract: Nanotechnology is defined as the study and application of 1 - 100 nm sized structures. Nanomaterials have opened avenues for the industries and scientific endeavors. These recognized for unique size, dependant physical and chemical properties (optical, magnetic, catalytic, thermodynamic, electrochemical) [1]. Most significant properties of nanoparticles is their carbon strength. It is said to be so tough that recently with a nano-sized particles i.e. carbon nanotube—a bullet proof T-shirt/vests was manufactured. Nanotechnology were firstly proposed/initiated by Nobel Prize winner Richard Feynman in 1959 [2]. This science is credited to have applications ranging from electronics, biomedicals, food, fuel cells to biosensors and even fabrics. Though every field of science progressing but still faces some lacunae and that result in development of a new technology. The thriving biomedical techniques for disorders like cancers etc. is still in developmental stage where researchers and doctors are working hard for concrete therapeutic results from such nano-techniques. On Cancers, the harmful side effects of its treatment like chemotherapy can’t be left aside which is result of one of its drug delivery methods that don’t pinpoint their intended target cells accurately rather affects whole area. Researchers in universities like Harvard and MIT have been able to attach special RNA strands, measuring about 10nm in diameter, to nanoparticles and fill the nanoparticles with a chemotherapy drug. The RNA strands get attracted to cancer cells. When the nanoparticle encounters a cancer cell it adheres to it and releases the drug into the cancer cell. This directed method of drug delivery has great potential for treating cancer patients while producing less side harmful effects than those produced by conventional chemotherapy [3]. This paper provides valuable information to the researchers, knowledge experts and policy makers regarding the application of nanotechnology and its values in science and technology. Biomedical is one of the major issues which were catered by nanotechnology.
Proteome Analysis of the Plasma Membrane of Mycobacterium tuberculosis
Sudhir Sinha,Shalini Arora,K. Kosalai,Abdelkader Namane,Alex S. Pym,Stewart T. Cole
Comparative and Functional Genomics , 2002, DOI: 10.1002/cfg.211
Abstract: The plasma membrane of Mycobacterium tuberculosis is likely to contain proteins that could serve as novel drug targets, diagnostic probes or even components of a vaccine against tuberculosis. With this in mind, we have undertaken proteome analysis of the membrane of M. tuberculosis H37Rv. Isolated membrane vesicles were extracted with either a detergent (Triton X114) or an alkaline buffer (carbonate) following two of the protocols recommended for membrane protein enrichment. Proteins were resolved by 2D-GE using immobilized pH gradient (IPG) strips, and identified by peptide mass mapping utilizing the M. tuberculosis genome database. The two extraction procedures yielded patterns with minimal overlap. Only two proteins, both HSPs, showed a common presence. MALDI–MS analysis of 61 spots led to the identification of 32 proteins, 17 of which were new to the M. tuberculosis proteome database. We classified 19 of the identified proteins as ‘membrane-associated’; 14 of these were further classified as ‘membrane-bound’, three of which were lipoproteins. The remaining proteins included four heat-shock proteins and several enzymes involved in energy or lipid metabolism. Extraction with Triton X114 was found to be more effective than carbonate for detecting ‘putative’ M. tuberculosis membrane proteins. The protocol was also found to be suitable for comparing BCG and M. tuberculosis membranes, identifying ESAT-6 as being expressed selectively in M. tuberculosis. While this study demonstrates for the first time some of the membrane proteins of M. tuberculosis, it also underscores the problems associated with proteomic analysis of a complex membrane such as that of a mycobacterium.
Molecular Docking Studies of Myricetin and Its Analogues against Human PDK-1 Kinase as Candidate Drugs for Cancer  [PDF]
Shalini Singh, Pradeep Srivastava
Computational Molecular Bioscience (CMB) , 2015, DOI: 10.4236/cmb.2015.52004
Abstract: Phosphoinositide-dependent protein kinase-1 (PDK1), the class of serine threonine kinase, is a master regulator of the AGC family of kinases. It is a main component of the PI3K pathway. As it is reported that this pathway is most commonly, and this pathway is the most commonly deregulated among many cancers. So designing a selective inhibitor of PDK1 may have the efficacy as an anticancer agent. Herein, we describe our work focused on the structure based on screening of 95% similar analogues of Myricetin deposited in PubChem database as earlier studies have been suggested that myricetin acts as an anti cancer agent. Further molecular docking as well as the in silico ADMET studies are incorporated on these compounds to evaluate the binding and pharmacokinetic properties of these compounds. Due to low oral bioavailability, clinical use of myricetin is limited. Therefore this study is an attempt towards screening of structurally similar better compounds as compare with myricetin which can act as better inhibitor against PDK-1.
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