Background: Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Transesophageal Bronchoscopic Ultrasound-guided fine-needle aspiration (EUS-B-FNA) are established modalities for evaluation of mediastinal/hilar lymphadenopathy in adults. Limited literature is available on the utility of these modalities in the pediatric population. Herein, we perform a systematic review and meta-analysis on the yield and safety of EBUS-TBNA and EUS-B-FNA in children. Methods: We performed a systematic search of the PubMed and EMBASE databases to extract the studies reporting the utilization of EBUS-TBNA/EUS-B-FNA in children (<18 years of age). Pooled diagnostic yield and sampling adequacy (proportions with 95% confidence intervals) were calculated using the random-effects model. Details of any procedure-related complications were noted. Results: The search yielded 12 relevant studies (five case series and seven case reports on EBUS-TBNA/EUS-B-FNA, 173 patients). Data from five case series (164 patients) were summarized for the calculation of sampling adequacy and diagnostic yield. Safety outcomes were extracted from all publications. The pooled sampling adequacy and combined diagnostic yield of EBUS TBNA/EUS-B-FNA were 98% (95% CI, 92-100%) and 61% (95% CI, 43-77%) respectively. A procedure-related major complication was reported in 1 patient (1/173, Major complication rate 0.6%), and minor complications occurred in 6 patients (6/173, Minor complication rate 3.5%). Conclusions: EBUS-TBNA and EUS-B-FNA are safe modalities for evaluation of mediastinal lymphadenopathy in the pediatric population. EBUS-TBNA/EUS-B-FNA may be considered as the first-line diagnostic modalities for this indication as they have a good diagnostic yield and can avoid the need for invasive diagnostic procedures.

Aims: To determine the prevalence of depression and anxiety in Indian patients undergoing CABG surgery and their relationship to physical activity and quality of life. Methods: 121 patients undergoing CABG surgery between November 2017 and May 2019 were included. The Hospital Anxiety and Depression Scale (HADS) was employed for the assessment of depression and anxiety. Health-related quality of life was assessed using the SF-36 questionnaire. The short form of the International Physical Activity Questionnaire (IPAQ) was used for assessment of physical activity. Participants were categorized into high, moderate or low physical activity. Results: The overall prevalence (95% CI) of depression and anxiety was 70.5% (0.61-0.78) and 64.6% (0.55-0.73) respectively. When a cut-off score of 11 instead of 8 was used on the HADS [Borderline cases excluded (HADS score 8-10)], the prevalence of depression and anxiety was 31.3% (0.22-0.40) and 40.7% (0.31-0.50) respectively. Patients with low levels of physical activity had a higher prevalence of depression and anxiety (p < 0.05). Patients with depression demonstrated a worse quality of life compared to those without depression in all domains measured by the SF-36 questionnaire. Among patients with anxiety, quality of life was worse in four out of the eight domains measured by the SF-36 questionnaire. Conclusion: Indian patients undergoing CABG surgery have a high prevalence of depression and anxiety. Patients with depression and anxiety were found to have low physical activity and poor quality of life when compared to their counterpart. Keywords: CABG; depression; anxiety; quality of life; physical activity.

Background and aims: Oral mucositis (OM) is common and distressing toxicity in children on chemotherapy. There is limited number of safe and effective therapeutic options available for OM. Ketamine oral rinse has shown promising results in few studies in adults. This randomized, double-blind placebo-controlled trial aimed to test the efficacy of ketamine mouthwash in reducing chemotherapy-induced severe OM pain in children. Methods: Children aged 8-18 years with severe OM were randomized to a single dose of ketamine mouthwash (4 mg/ml solution; dose 1 mg/kg) or a placebo. A sample size of 44 patients was determined. Pain score (6-point faces scale) was noted at baseline and 15, 30, 45, 60, 120, 180, and 240 min. The outcome variables were a reduction in pain score, need for rescue medications, and adverse events. Results: The baseline characteristics were comparable in the two groups. The mean OM pain at 60 min decreased by 1.64 points (CI 1.13-2.14) in the ketamine group and 1.32 points (CI 0.76-1.87) in the placebo group (p=0.425), with a group difference of 0.32 points. Rescue pain medication (at 60 min) was required in 13.6% in the ketamine group and 18.2% in the placebo group (p=1.000). There were no significant adverse events observed. Conclusions: Among children on cancer chemotherapy with severe OM, ketamine mouthwash at a dose of 1 mg/kg did not significantly reduce OM pain. It did not decrease the need for rescue pain medications. Further research is warranted to test higher doses of ketamine for a clinically significant effect.