Browsing by Author "Vaibhav Pandey"

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A Clinicopathological Study to Assess the Role of Intralesional Sclerotherapy Following Propranolol Treatment in Infantile Hemangioma
(Scientific Scholar LLC, 2021) Rakesh Kumar; Preeti Tiwari; Vaibhav Pandey; Amrita Ghosh Kar; Narendra Tiwary; Shiv Prasad Sharma
As propranolol has emerged as first-line therapy for problematic infantile hemangioma, the number of non-responders and partial responders to propranolol therapy is also increasing. Aims: The study was conducted to evaluate the response of intralesional bleomycin, triamcinolone, and a combination of both as second line of treatment for the residual hemangioma following propranolol therapy Settings and Design: A prospective comparative study was conducted in patients who were either non-responders or partial responders to previous propranolol treatment. Materials and Methods: The patients randomly received injection bleomycin, injection triamcinolone, and combination of both bleomycin and triamcinolone. The response to treatment was recorded clinically by using photographs. The pathological response was assessed by calculating pre-treatment and post-treatment microvessel density in biopsy of lesion from the non-cosmetic sites using immunohistochemistry. Statistical Analysis Used: χ2 test was used to test the association between the variables. The utility of microvessel diameter (MVD) in terms of clinical response to the therapy was predicted by using receiver operating characteristic (ROC) curve. Results: Out of the 134 patients, 42 received bleomycin and 44 received triamcinolone and were treated with a combination of both. The overall clinical response was better in the combination group compared with the bleomycin group (P = 0.018) and triamcinolone group (P = 0.0005), respectively, after 6 months of follow-up. There was no difference in clinical response between the triamcinolone and bleomycin groups. Change in MVD correlated with the clinical response. Conclusion: The combination of bleomycin and triamcinolone is effective and safe for the treatment of residual hemangioma. © 2022 Journal of Cutaneous and Aesthetic Surgery.
Acetylcholinesterase histochemistry: A very useful technique in the diagnosis of Hirschsprung’s disease
(EL-MED-Pub, 2022) Brijesh K. Tripathi; Amrita Ghosh; Vaibhav Pandey; Ajay N. Gangopadhyay; Sarita Chawdhary; Shiv P. Sharma
Hirschsprung’s disease (HD) is a common congenital paediatric disorder. The gold standard for its diagnosis is the demonstration of the absence of ganglion cells on H&E stained sections from a spastic segment of the bowel, still at times; conclusive diagnosis of HD is difficult. This study was done to assess the accuracy of rapid Hematoxylin & Eosin (H&E) staining and AChE histochemistry in combination for the diagnosis of HD, especially in frozen section specimens. Samples from 36 clinically suspected HD cases were evaluated for the presence or absence of ganglion cells on H&E staining on both fresh-frozen and paraffin-embedded sections, whereas AChE staining was done on frozen sections only. Of the 36 cases of frozen section specimens from the spastic region of the colon, GCs were absent in 28 cases on H&E staining while positive staining patterns on AChE histochemistry were observed in 29 cases. Formalin-fixed paraffin-embedded sections showed the absence of GC on H&E staining in 28 cases. The sensitivity and specificity of frozen sections with rapid H&E were 77.78% and 81.82% while the sensitivity and specificity of AChE histochemistry were 80.56% and 81.82% respectively in the diagnosis of HD. Application of AChE histochemistry as an ancillary technique on frozen sections specimens of HD in combination with rapid H&E staining is very useful for definitive diagnosis of HD. © 2022 Tripathi BK et al.
Active Telephonic Follow-up During COVID-19 Lockdown: Initial Experience
(Springer, 2020) Vaibhav Pandey; Vivek Srivastava; Mohammed Imran; Akash Mishra
[No abstract available]
Adenomatous Hyperplasia of Palatal Minor Salivary Gland and Angiolipoma of the Floor of Mouth: The First Documented Case Report in a Neonate
(Springer, 2022) Rathindra Nath Bera; Vaibhav Pandey; Preeti Tiwari
Adenomatous hyperplasia of the salivary glands usually affects the parotid gland. Within the oral cavity, palate is the most common site. However, this lesion occurs in adults and till date no case has been documented in neonates. Angiolipomas are a variant of congenital lipomas which undergoes vascular proliferation. Angiolipomas of the oral cavity have not been documented till date among neonates. We herein report the first case of combined angiolipoma of the floor of the mouth with adenomatous proliferation of the minor salivary glands in a neonate. The case was managed through surgical excision, and the follow-up was uneventful. Histopathology confirmed the diagnosis. © 2021, The Association of Oral and Maxillofacial Surgeons of India.
Adverse Drug Reactions Following Propranolol in Infantile Hemangioma
(Springer, 2021) Vaibhav Pandey; Preeti Tiwari; Mohammed Imran; Akash Mishra; Deepak Kumar; S.P. Sharma
Objectives: To assess the adverse effects of propranolol therapy in infantile hemangioma. Methods: An ambispective study was conducted from August 2011 to December 2019. In retrospective arm all children managed for infantile hemangioma with propranolol were included and case records were assessed for adverse reactions. In prospective arm the adverse reactions were identified on the basis of predefined criteria. Results: A total of 514 patients (358 retrospective records) were included. A majority, 378 (73.5%) patients had an excellent response, 75 (14.5%) had partial response and 61 (11.8 %) had no response. A total of 82 (15.9%) patients experienced at least one adverse effect. Diarrhea with weight loss (27, 32.9%) and irritability with decreased sleep (21, 25.6%) were the most common adverse effects. The adverse effects in 22 (4.2%) cases lead to the discontinuation of propranolol. Younger age, low body weight and early onset were risk factors for development of severe adverse reactions. Conclusion: Young children with low body weight were at higher risk for adverse effects of propranolol. © 2021, Indian Academy of Pediatrics.
Aetiopathogenesis in Lower Limb Oedema
(Springer Nature, 2022) Vaibhav Pandey; Mohammad Imran
Edema of lower limb is a common clinical presentation of local and systemic disorders. The word “edema” is derived from the Greek word “oidēma, " where oidein means “to swell.” The swelling of the lower limbs may result from an increase in the amount of any of the tissue components, i.e., muscle, fat, blood, etc. From a clinical point of view, all the conditions which result in excessive accumulation of fluid in the lower limbs lead to edema. The etiology of edema of lower limb varies, and it is important to assess whether the swelling is congenital or acquired, acute or chronic, symmetric or asymmetric and is localized or part of generalized edema [1]. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.
An unusual case of renal fungal mass masquerading as renal cell carcinoma
(Wolters Kluwer Medknow Publications, 2020) Vaibhav Pandey; Munesh Kumar Gupta
[No abstract available]
Anorectal malformations
(Medknow Publications, 2014) Ajay Narayan Gangopadhyay; Vaibhav Pandey
Anorectal malformations (ARMs) are among the more frequent congenital anomalies encountered in paediatric surgery, with an estimated incidence ranging between 1 in 2000 and 1 in 5000 live births. Antenatal diagnosis of an isolated ARM is rare. Most cases are diagnosed in the early neonatal period. There is a wide spectrum of presentation ranging from low anomalies with perineal fistula having simple management to high anomalies with complex management. Advances in the imaging techniques with improvement in knowledge of the embryology, anatomy and physiology of ARM cases have refined diagnosis and initial management. There has been marked improvement in survival of such patient over the last century. The management of ARM has moved forward from classical procedures to PSARP to minimal invasive procedures. But still the fecal and urinary incontinence can occur even with an excellent anatomic repair, mainly due to associated problems. There has been a paradigm shift in approach to these patients which involves holistic approach to the syndrome of Anorectal malformations with a long term goal of achievement of complete fecal and urinary continence with excellent quality of life.
Assessment and comparison of fecal continence in children following primary posterior sagittal anorectoplasty and abdominoperineal pull through for anorectal anomaly using clinical scoring and MRI
(W.B. Saunders, 2016) A.N. Gangopadhyay; Vaibhav Pandey; D.K. Gupta; S.P. Sharma; Vijayendar Kumar; Ashish Verma
Introduction We aimed to compare and contrast these main surgical procedures for ARM in terms of structural outcome through pelvic MRI & functional outcome through Kelly's scoring. Material and method A prospective study was conducted from August 2011 to July 2013 including all the cases of ARM managed in single stage (operated by one surgeon, first author) since 1995 that came for follow up at age of 3 years or more. Patients were divided in three groups: Group 8.A, PSARP (60 patients); Group B, Abdomino-PSARP (40 patients); and Group C, APPT (40 patients). The functional assessment of anal continence was carried out at the age of 3 years or more using Kelly's method. Structural assessment was done by 1.5-T Magnetic Resonance Imaging (MRI). Results In 24 patients with rectobulbar fistula, 71.5% of Group A patients had good continence. In 50 patients with rectoprostatic fistula, 73.7% of Group A, 70% of group B and only 36% of Group C had good outcomes. Better development of each muscle was associated with better outcomes in terms of anal continence (P = 0.001). Conclusion There is better outcome with PSARP and Abdomino-PSARP in patients with rectobulbar and rectoprostatic fistula. MRI is a valuable modality for postoperative structural analysis of patients with ARM and is also useful for predicting the long term functional outcome of these cases. © 2016 Elsevier Inc. All rights reserved.
Assessment of Short-Term Outcomes in Children with Chronic Kidney Disease: Cohort Study
(Springer, 2025) Ram Babu; Lalit Kumar; Ankur Singh; Vaibhav Pandey; Shefali Agarwal; Anil Kumar; Rajniti Prasad; Abhishek Abinay; Shivender Singh
[No abstract available]
Bleomycin-triamcinolone sclerotherapy in the management of propranolol resistant infantile hemangioma of the maxillofacial region: A single arm prospective evaluation of clinical outcome and Doppler ultrasound parameters
(Elsevier Masson s.r.l., 2023) Preeti Tiwari; Rathindra Nath Bera; Vaibhav Pandey
Introduction: Propranolol has emerged as a first line agent in the management of hemangiomas. With increased use of propranolol, studies have also focused on relapses following propranolol therapy. Our current study evaluates the role of bleomycin triamcinolone sclerotherapy for the management of propranolol resistant Infantile Hemangioma (IH). We also evaluated the role color Doppler USG for response assessment of sclerotherapy. Methods: Patients with Propranolol resistant (Non- responders/ Partial responders) IHs were included in the study. Patients received intralesional bleomycin at a dose of 0.5 IU/kg followed by intralesional injection of triamcinolone at a dose of 2mg/kg body weight. Clinically patients were grouped into excellent, partial and non responders. Doppler parameters; Resistivity index (RI), Pulsatility index(PI) and Peak systolic velocity (PSV) were used to evaluate the response to sclerotherapy. These parameters were evaluated prior to sclerotherapy and 3 months following completion of therapy. The clinical responses of the patients were compared with the change in Doppler parameters before and after treatment. Results: A total of 115 participants were considered for analysis; 60.86% had excellent response, 32.17% had partial response and 6.95% had poor response. There was a significant change in terms of RI, PI and PSV in patients who were either excellent or partial responders. Poor responders did not have a significant change in Doppler parameters. Conclusion: Combined bleomycin- triamcinolone sclerotherapy is an effective therapy for the management of propranolol resistant IHs. Doppler parameters RI, PI and PSV are reliable indicators of response in the management of IH. © 2022 Elsevier Masson SAS
Cloacal Exstrophy with Normal Penis and Urethra - A Rare Variant
(Wolters Kluwer Medknow Publications, 2024) Ruchira Nandan; Bhanumurthy Kaushik Marripati; Ajit Kumar Vidhyarthy; Vaibhav Pandey
Classically, cloacal exstrophy presents with omphalocele, bladder exstrophy, imperforate anus, and spinal defects. We report a rare variant of cloacal exstrophy in a 6-day-old male with an intact lower abdominal wall, normal penis, and urethra. Only two such cases have been reported in the literature. © 2024 Copyright:
Coexisting Congenital Subglosso-palatal Membrane and Tongue Dermoid in a Neonate
(Springer, 2018) Preeti Tiwari; Vaibhav Pandey; Jayanto Tapadar
Background: Neonatal respiratory distress due to coexisting subglosso-palatal membrane and tongue dermoid has not been reported yet. Case characteristics: A newborn with respiratory distress having a membrane in the oral cavity. Excision of membrane revealed a tongue mass with cleft palate, obstructing the nasopharynx completely. Elective ventilation was followed by excision of mass. Outcome: The child was cured with uneventful course at follow-up of six months. Message: Co-existing congenital anomalies causing airway obstruction may be missed in presence of subglosso-palatal membrane. © 2018, Indian Academy of Pediatrics.
Color Doppler Ultrasound Indices as Predictors of Propranolol Response in Infantile Hemangioma: A Prospective Study
(Springer, 2024) Vaibhav Pandey; Rathindra Nath Bera; Amit Nandan Dhar Diwedi; Om Prakash Singh; Preeti Tiwari
Objective: To evaluate the utility of color Doppler ultrasonography in assessing infantile hemangioma response to treatment with oral propranolol. Method: A prospective study was conducted between January, 2016 and December, 2022, wherein children with symptomatic (ulceration, bleeding, pain and scarring) infantile hemangioma were given oral propranol (2 mg/kg per day in three divided doses) as outpatient therapy. The clinical response was assessed three months post-initiation of treatment (intermediate clinical response) and three months post-completion of treatment (final clinical response, FCR). The primary outcome measurement was a clinical and radiological response (resistivity index (RI), pulsatility index (PI) and peak systolic velocity) to treatment. The secondary outcomes assessed were the complications related to treatment. Result: Out of 601 patients who were started on propranolol, 99 developed severe adverse effects and were excluded from analysis. At FCR assessment, out of 502 participants, 64.3% (n = 323) showed excellent response, 17.7% (n = 89) showed partial, and 17.9% (n = 90) were non-responders. A significant increase in RI and PI values was noted in all children following propranolol treatment for six months. An increase > 7.5% in RI could identify responders with 92% sensitivity, 91% specificity and area under the curve (AUC) of 0.963. An increase of > 11.5% in PI could identify responders with 86% sensitivity, 91% specificity and AUC of 0.896. Patients initially showing no response but later becoming excellent responders had significantly higher RI and PI values. Conclusion: Color Doppler ultrasonography is a valuable tool in predicting the treatment outcome of infantile hemangioma using propranolol. © Indian Academy of Pediatrics 2024.
Congenital Segmental Dilatation of Ascending Colon with Distal Microcolon: A Diagnostic Dilemma
(Wolters Kluwer Medknow Publications, 2023) Ruchira Nandan; Vaibhav Pandey; Greeshma Suresh; Rajat Kumar Singh; Seth Kachhap
A 5‑day‑old male presented with bilious vomiting, a grossly distended abdomen, and passage of a small amount of stool. The anal opening was at a normal position. X‑ray abdomen showed a large bowel loop with a single air‑fluid level occupying more than half of the abdominal width. On laparotomy, the ascending colon was dilated to form a pouch‑like structure, and the ileum and appendix were opening into it. Colon distal to pouch was present as microcolon. Histopathology of the dilated segment was suggestive of congenital segmental dilatation (CSD). In CSD, the distal bowel is of normal caliber. This is a rare case of CSD of ascending colon with distal microcolon. © 2023 Journal of Indian Association of Pediatric Surgeons.
Controversy of Single versus Staged Management of Anorectal Malformations
(Springer India, 2017) Ajay Narayan Gangopadhyay; Vaibhav Pandey
Anorectal malformations’ (ARMs) management has taken strides over the past few decades. The advent of Posterior sagittal anorectoplasty (PSARP) and its acceptance by most people across the globe as standard procedure has given way to a debate of single vs. three-staged repair. After initial hesitancy and lot of skepticism, single-staged repair has very well established its role because of its advantages over the staged procedure. There is enough evidence which suggests that single-staged repair has got equally good outcome as that of staged repair (if not better). Further, one-staged repair offers advantages of lesser morbidity, lesser cost, and lesser burden to the family. The initially thought disadvantages of higher chances of injuries, wound infection and stress to neonates have been countered by growing evidences. The authors agree that staged procedure will continue to stay around for few specific indications like perforation peritonitis, extreme prematurity and special anatomical entities. Further, it can have more important role with advent of laparoscopy and better health infrastructure in future. But with new developments in imaging, scopes and neonatal care, single-staged repair is a feasible and safe modality for treatment of these anomalies. © 2017, Dr. K C Chaudhuri Foundation.
Conveyor Belt Entrapment Trauma in Children: An Unreported Menace
(Springer, 2020) Preeti Tiwari; Vaibhav Pandey; Badri P. Das; Anutosh K. Singh; Rakesh Kumar
A retrospective study was conducted including all the children who sustained motorized machine belt entrapment injuries. Six children included in study had mean (SD) Glosgow coma scale and pediatric trauma score of 5.7 (3.54) and 3.2 (1.21), respectively. Overall mortality and paraplegia rate were 33.3% each. Awareness and legislation both are important to curb this menace. © 2020, Indian Academy of Pediatrics.
Decortication through muscle-sparing axillary skin crease incision (MSASCI) in late paediatric empyema thoracic
(Springer India, 2015) Vaibhav Pandey; Ajay Narayan Gangopadhyay; Dinesh Kumar Gupta; Shiv Prasad Sharma; Vijayendar Kumar
Introduction: Video-assisted thoracoscopic surgery (VATS) is a less invasive and preferred modality for early stages of empyema (American Thoracic Society, Am Rev Respir Dis 85:935–6, 1962). Still, in the late organising phase, thoracotomy and decortication is the treatment of choice (American Thoracic Society, Am Rev Respir Dis 85:935–6, 1962). We aimed to evaluate the results of decortications through muscle-sparing axillary skin crease incision (MSASCI) in paediatric empyema thoracic. Methods: A prospective study was conducted between July 2011 and June 2013 including 28 patients of empyema thoracic in late organising phase. Decortication was performed through MSASCI in all cases. Utility of incision was assessed in terms of intra-operative exposure, access to all the lobes, size and visibility of scar. Result: Adequate exposure was possible in all cases. Complete excision of thickened parietal pleura with stripping of visceral peel was possible in all the cases with the release of entrapped lung. A chest tube was removed after a mean of 6.67 ± 4.62 days (5–14 days). Three patients had air leak. There were no other complications. All children had good lung expansion on chest radiography at 4 weeks. Scar was hardly visible in normal position in follow up. Conclusion: Muscle-sparing axillary skin crease incision is a good alternative to classical thoracotomy for decortication in paediatric age group for patients with organised empyema. © 2015, Indian Association of Cardiovascular-Thoracic Surgeons.
Distal duodenal web with malrotation: An unusual finding
(SAGE Publications Ltd, 2024) Greeshma Suresh; Vaibhav Pandey; Ruchira Nandan; Seth Kachhap
The most common site of the congenital duodenal web is the second part. Web distal to the second part of the duodenum is rare. It mimics the windsock deformity. Diagnosis may be missed if accompanying malrotation is present. We hereby report two cases of distal duodenal webs associated with malrotation and challenges in their diagnosis and management. © The Author(s) 2023.
Does Early Treatment of Paediatric Orbital Fracture Offer Any Advantage in Terms of Post-Operative Clinical Outcomes
(Springer, 2022) Rathindra Nath Bera; Preeti Tiwari; Vaibhav Pandey
Background: Trapdoor fractures commonly occur in children below 6 years of age. The high resiliency of bone, pneumatisation of sinuses and other factors lead to entrapment of muscle and/or soft tissue which undergoes ischaemic changes leading to residual diplopia. The timing of intervention in children ranges from 24 h to greater than 2 weeks. Early surgical intervention is particularly indicated in cases of Oculocardiac reflex. Methods: A Prisma guided systematic review of literature was conducted with no filters on language till September 2020. Studies on paediatric orbital fractures with data on timing of intervention and clinical outcomes were considered eligible for the review. The Oxford Level Of Evidence was used to assess the strength of individual studies. Results: A total of 19 studies (18 English, 1 French) were selected; except for one study all were retrospective series. The timing of intervention ranged from 24 h to more than 1 month. Most of the studies agreed that orbital fractures in children should receive early intervention preferably within 2 weeks. In case of white-eyed blowout fracture, oculocardiac reflex and trapdoor fractures with muscle entrapment surgical intervention should be carried out within 24–48 h. Discussion: Children presenting with facial injuries should be thoroughly examined for signs of muscle entrapment, diplopia, nausea, vomiting and bradycardia. If present these should receive early intervention. In cases with no signs of oculocardiac reflex and muscle entrapment a treatment within 2 weeks is recommended. If diplopia is mild or resolving with minimal hypoglobus and enophthalmos a wait and watch policy should be carried out. © 2021, The Association of Oral and Maxillofacial Surgeons of India.