Browsing by Author "Pranay Panigrahi"

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Five-year experience of anorectal malformation with oesophageal atresia in tertiary care hospital
(Wolters Kluwer Medknow Publications, 2020) Sarita Chowdhary; Pranay Panigrahi; Rakesh Kumar
Aim: We had done this study for TEF with Anorectal malformation and TEF with no Anorectal malformation in terms of age, sex, surgical outcomes and mortality. Materials and Methods: This was a retrospective review of cases with clinical data (from April 2012 to April 2017). The participants of this study were 236 patients who had been diagnosed and managed for ARM. Among these patients, 25 patients associated with EA were selected as the subject patient group. Results: The incidence of tracheoesophageal fistula with ARM was 11.1%. The study has more male preponderance. All cases are of Type c except two cases of Type a. According to the classifications of ARMs, there were two cases with rectourethral fistula and eight cases with rectoperineal fistula and covered anus in the males. In females, there was a varied distribution of seven cases. There was one case (4%) presenting as a part of the Vertebral anorectal malformation cardiac tracheoesophageal renal and limb anomalies (VACTERL) association, which is the representative example of a complex anomaly. Most of the cases died due to cardiac problem and pneumonitis (due to delayed presentation). Conclusion: The study concludes the experience of EA (±fistulae) with ARM, their distribution, incidence and outcome of the tertiary care centre. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.
Modified laparoscopic excision of choledochal cyst: Technique and early results
(Wolters Kluwer Medknow Publications, 2021) Vaibhav Pandey; Vivek Srivastava; Pranay Panigrahi; Rakesh Kumar; Shiv Prasad Sharma
Background: Choledochal cyst is a common congenital anomaly requiring surgical treatment. Nowadays, laparoscopic excision is the preferred approach. We studied a modification in the classical laparoscopic approach to facilitate the dissection of a cyst. Materials and Methods: A prospective comparative study was done on 42 Type I choledochal cyst children. One group was operated by classical laparoscopic technique, while the other group was operated by modification of classical technique by deliberately opening the cyst wall and dividing the cyst into two hemi-cups, followed by dissection and excision. The intraoperative and postoperative parameters were assessed in both the groups. Results: The age, gender ratio, clinical presentation, and cyst diameter were comparable in both the groups. There was a significantly higher success rate (95.7% vs. 73.7%, P = 0.042) and lesser time for cyst excision (96.43 ± 12.15 vs. 120.91 ± 17.38 min P < 0.001) in the modified technique when compared to the classical technique. Further in three patients, it was possible to convert the classical procedure to a modified technique and complete the cyst excision. The postoperative outcomes were similar in both the groups. Conclusion: The modified laparoscopic excision shortens the operative time with higher success rate and comparable short-term morbidity vis-a-vis classical laparoscopic technique. © 2021 Journal of Indian Association of Pediatric Surgeons.
Novel approach for the dissection of upper pouch during primary repair of esophageal atresia with tracheoesophageal fistula: Technique and results
(W.B. Saunders, 2020) Vaibhav Pandey; Pranay Panigrahi; Rakesh Kumar; Arj Deo Upadhyayay; Shiv P Sharma
Background: We describe a technical modification to approach for dissection of proximal pouch in patients undergoing the primary repair of congenital Esophageal atresia with tracheoesophageal fistula (EA-TEF). Methods: A prospective comparative study was performed from January 2016 to December, 2019 including the patients who were undergoing primary repair of EA-TEF (Type C). The patients were divided into Group A (upper pouch dissection by classical approach) and Group B (technical modification). The two groups were compared for operative outcome and complications. Modified OSATS score was used to rate the performance of operators in two groups and were compared. Results: Total of 70 patients were included. In Group B, the mean operating time was less compared to Group A. The incidence of tracheal injury was also less when compared to previous data (p = 0.042). Mean OSATS score for flow of operation and overall performance was better in Group B (p = 0.002, p = 0.005). The OSATS score was also better for fifth and seventh case in Group B, proving its faster learning by trainee fellows. Conclusion: The technical modification decreases chances of tracheal injury and shortens the learning curve for upper pouch dissection. Level of evidence: Level III. © 2019 Elsevier Inc.
Role of urinary transforming growth factor beta-b1 and monocyte chemotactic protein-1 as prognostic biomarkers in posterior urethral valve
(Wolters Kluwer Medknow Publications, 2020) Pranay Panigrahi; Sarita Chowdhary; Shyamendra Pratap Sharma; Rakesh Kumar; Neeraj Agarwal; Shiv Prasad Sharma
Background: Posterior Urethral Valves (PUV) are the most common cause of congenital LUT obstruction in males. Biomarkers of glomerular or tubular injury may be of particular value in predicting the need for surgical intervention or in tracing progression of chronic kidney disease. Measurement of biomarker in urine is relatively easy. Aim: To evaluate the changes in values of urinary Transforming Growth Factor Beta 1(TGF-B1) and Monocyte Chemotactic Protein (MCP-1) before and after valve ablation and its prognostic value in Posterior urethral valve. Material and Method: This prospective study was conducted from September 2016 to August 2018. The study group included 20 consecutive male babies with the diagnosis of PUV treated and followed up versus equal numbers of age matched control without any renal or urinary tract disease. Pre-operative urine samples were collected in Operative room. Cystoscopy and valve ablation was done. Follow up was done clinically by urinary stream and radiologically with VCUG. Follow-up was planned at 1 month, 3 months and 6 months following cystoscopic valve ablation. All collected urine samples were centrifuged at 10,000 rpm for 20 minutes. Supernatant was collected and two divided aliquots were stored at -200c to be thawed on the day of assay. Optical density of each well was recorded at 450 nm and 540 nm A p-value of <0.05 was considered to be statistically significant. Result and Discussion: Out of 20 cases of PUV, 14 (70%) cases were 1st born males of their family. The median age at the time of valve ablation in PUV cases was 2.5 (1.20-3.87) years.. Most common symptoms are fever and UTI. The preoperative median serum creatinine level was 1.65 mg/dl(1.22-2.42) pre-ablation, and fall significantly after ablation. Median eGFR level (calculated) was 25.635 (16.38-35.40) and after 6 months was 71.490 (45.44-96.93). Preoperative median MCP1 in PUV cases was 147.2 (82.8-512.5) and significant difference was also found in 1st, 3rd and 6th months after surgery (p<0.001, p=0.004 and p=0.002).Preoperative median TGF-B1 level was 197.8 pg/ml (79.9-386.4). There was no statistically significant change in TGF-B1 level at preoperative to 1 month and preop to 3 months after surgery but at 6 months after surgery the median TGF-B1 level significantly decreased as compared with preoperative TGF-B1 level. Conclusion: TGF β1 and MCP1 can be considered as prognostic urinary biomarkers in patients of PUV and can be used to specify and counsel patient's attendant regarding possibility of ESRD and need for further intervention. © 2020 Journal of Indian Association of Pediatric Surgeons.
To determine the genotyping of Fc-gamma receptor FCGR2A polymorphism as genetic susceptibility to neonatal sepsis: A study from a tertiary center of North India
(Wolters Kluwer Medknow Publications, 2022) Sarita Chowdhary; Kanika Sharma; Ashish Ashish; Abhay Kumar Yadav; Pranay Panigrahi; Akas Mishra; Deepak Kumar; Royana Singh
Background: Neonatal sepsis term is an infection of newborns <28 days of age. It is a common cause of death in developing countries. The receptor-gamma receptor FCGR2A has been shown to be associated with neonatal sepsis. It is an activating receptor found in many cell types such as monocytes, neutrophils, macrophages, platelets, and others. The receptor has a polymorphism (single-nucleotide polymorphism rs1801274) in its gene (FCGR2A) that encodes either a histidine (H) or arginine (R) at amino acid position 131. There are many studies showing the impact of these FCGR2A polymorphisms on sepsis. Our study aims to determine the prevalence of Fc-gamma receptor FCGR2A (rs1801274) polymorphism in neonatal sepsis and control in Eastern UP populations. Patients and Methods: We conducted a cross-sectional descriptive study of 590 patients (310 healthy individuals and 280 sepsis patients) to determine polymorphisms in the CD32A coding region in neonates. All individuals were genotyped for a variant at position 131 of the FcγRIIA gene. Discussion: In our study, the prevalence of FcγRIIa polymorphism is more in neonates with sepsis than in noninfected neonates. It was observed that the heterozygous allele (AG) were significantly increased in septic neonates when compared to the normal. Conclusion: Our data indicate that FcγRIIA genotyping can be used as a marker of genetic susceptibility to sepsis. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Urinary flow rates in anterior hypospadias: Before and after repair and its clinical implication
(Wolters Kluwer Medknow Publications, 2023) Shyamendra Sharma; Sarita Chowdhary; Rakesh Kumar; Manoj Yadav; Pranay Panigrahi
Context: Hypospadias is a common urological anomaly which could be surgically corrected with good cosmetic results. Aims: We aimed to detect changes in urinary flow parameters both before and after tubularised incised plate urethroplasty (TIPU) using uroflowmetry. Settings and Design: Data collected were clinically implemented hypothesising the probability of urethrocutaneous fistula following stricture with Qmax variation. Materials and Methods: This study is a prospective analysis done from December 2017 to October 2019. A total of 104 cases of anterior hypospadias were included in the study. A single surgical unit did TIPU. Pre-operative and post-operative uroflowmetry was done, and Qmax was recorded at 3 months, 6 months and 1 year after surgery. Mean Qmax was calculated for all intervals. A significant decrease in Qmax of a child (<2 standard deviation) was ascertained. Urethral calibration was done in those cases with a significant decrease of Qmax and analysed statistically. Results: The mean age was 6.97 ± 2.41 years. Out of 104 children, 73 (70.2%) and 31 (29.8%) had distal and mid-shaft hypospadias, respectively. The pre-operative mean Qmax of the population was 6.20 ± 0.42 ml/s. Arithmetic mean Qmax at 3 months, 6 months and 1 year was 8.53 ± 0.42, 11.18 ± 0.47 and 13.71 ± 0.44 ml/s, respectively. On comparing the pre-operative with post-operative mean Qmax, a significant increase was found postoperatively (P < 0.0001). Twenty-four patients had significantly decreased Qmax value after 6 months. In these patients, follow-up urethral dilation was done with significant improvement. Conclusion: The changes in maximum flow rate (Qmax) are suitable for use in routine follow-up. A significant decrease in Qmax over time indicates the onset of urethral stricture. These cases are to be intervened before venturing to redo urethroplasty. © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
Urinary KIM-1 and CA 19-9: Biomarkers for Guiding Treatment Decisions after Pyeloplasty
(Tehran University of Medical Sciences, 2025) Sunil Kumar Singh Gaur; K. Sharma; Sarita Chowdhary; Shiv Prasad Sharma; Pranay Panigrahi
Introduction Urinary biomarkers KIM-1 and CA 19-9 are being evaluated as diagnostic indicators for congenital obstructive hydronephrosis in pediatric patients. This study focuses on the quantification of these biomarkers pre-and post-surgery, correlating their levels with ultrasonographic findings and histopathological assessments to refine diagnostic accuracy and therapeutic approaches. Biomarker analysis aids in identifying candidates for surgical intervention and addresses the challenge of persistent obstruction following pyeloplasty, facilitating timely, targeted treatments to safeguard renal function. Methods This two-year prospective analysis examined urinary KIM-1 and CA 19-9 concentrations in 40 pediatric patients diagnosed with UPJO. The study cohort included individuals below 16 years of age, provided follow-up consent was obtained. A total of three cases were excluded due to either loss to follow-up or the necessity for repeat surgical intervention. Urine specimens were collected at baseline (pre-operative) and at 1, 3, and 6 months’ post-operative intervals, with biomarker quantification conducted using ELISA kits. Diagnostic evaluation included ultrasonography and nuclear imaging modalities. Statistical analyses were performed, and significance was established at P-value<0.05. Results The study included 37 cases of UPJO requiring pyeloplasty, alongside healthy controls. Among the cases, 51.3% were children aged 1–5 years, with a male predominance of 81.08%. Post-operative outcomes demonstrated a statistically significant reduction in the antero-posterior diameter (APD). Urinary biomarkers KIM-1 and CA 19-9 exhibited a notable post-operative decline, with KIM-1 showing a more substantial decrease. The sensitivity and specificity of CA 19-9 marginally exceeded those of KIM-1. Conclusions Urinary biomarkers KIM-1 and CA 19-9 effectively monitor pyeloplasty outcomes in children with congenital obstructive hydronephrosis, providing a cost-effective, child-friendly alternative to renal scans, ensuring timely interventions, safeguarding kidney function, and reassuring families. © 2025 Urology Research Center (URC), Tehran University of Medical Sciences.