Department Of Pediatric Surgery Research Articles

Investigation of the effect of video-based game application on acute pain in children under surgery

Aims: The aim of this study is to investigate whether video-based game application is effective on post-surgical acute pain in children. Methods: A randomized controlled trial was conducted between September 2022 and February 2023 in the department of pediatric surgery at a research and practice hospital affiliated with the university. Eighteen children aged 2-4 who were hospitalized after undergoing surgery due to illness and/or trauma, who did not have any problems grasping the upper extremity, and whose parents allowed them to participate in the study were included in the study. Children who had chronic pain complaints for more than 3 months, regardless of the pathology requiring surgery, and children who needed to be given painkillers in the postoperative period were excluded from the study. In our study, the Postoperative Pain Scale for preschool children was applied to all children after the effect of anesthesia wore off. Children in the game group were allowed to play video-based games for 30 minutes via a handheld game console called Nintendo Switch Lite. Pain assessment was performed three times before starting the game, at the 15th minute, and at the end of the 30th minute. Children in the control group were assessed for pain three times at 15-minute intervals within 30 minutes after the effect of anesthesia wore off without any intervention. The result was calculated by taking the average of 3 evaluations in both groups. Results: 18 children with an mean age of 3.05±0.89 years, 4 girls and 5 boys in the game group and 9 boys in the control group, were included in the study. The age and preoperative pain values were similar between the two groups (p>0.05). In the post-surgical pain evaluation, the pain mean of the play group was 1.72±0.89, while the pain mean of the control group was 4.03±1.25. A statistically significant difference was found in post-surgical pain values between the two groups (p=0.003). Conclusion: As a result of our study, it was determined that video-based game application had a positive effect on acute pain in children undergoing surgery.

A Comprehensive Analysis of Echinococcus granulosus Infections in Children and Adolescents: Results of a 7-Year Retrospective Study and Literature Review.

Cystic echinococcosis (CE) is a neglected tropical parasitic disease linked with significant social and economic burdens worldwide. The scientific community has minimal information on echinococcosis in Romanian people, and hospital medical records are the only sources that may be used to investigate its status. A 7-year retrospective clinical study on pediatric patients with CE from Southeast Romania was performed, and 39 children and adolescents were included, aged 2-15 years old. They were hospitalized with cystic echinococcosis in the Pediatric Department and Pediatric Surgery Department of Constanta County Clinical Emergency Hospital "St. Apostle Andrew" between 1 January 2017 and 1 October 2024. Twenty-nine (74.36%) pediatric patients came from rural zones, and 10 (25.64%) had urban residences. In total, 28 children (71.79%) had contact with four different animals (dogs, goats, pigs, and sheep); only four were from urban zones, and they had contact only with dogs. Data regarding the length of hospital stay, cyst location, and complications were collected and analyzed. According to the medical files, the diagnosis was established using imaging techniques and serological tests for CE. IgE and IgG reported appreciable variations in correlation with all parameters, and significant differences (p < 0.05) were recorded. IgE levels considerably increased in cases of no animal contact, pulmonary involvement, complications, surgical treatment, and multiple hospitalizations. Moderate IgE values were recorded in cases of urban residences, pig and sheep contact, and hepatic involvement. The IgG concentration considerably increased with sheep contact and moderately increased in cases of rural zones, hepatic involvement, complications, and surgical treatment. The results show that incidental discovery, symptoms, complications, multiple dissemination, pulmonary involvement, and dog and pig contact increase the hospitalization time. Extensive data analysis supports our results. Our findings highlight the complexity of managing E. granulosus infections in children and evidence the importance of a multidisciplinary approach, combining early diagnostic tools, tailored medical therapy, and careful surgical intervention when necessary.

Case Series of Transverse Testicular Ectopia in Children

ABSTRACT Introduction: Transverse testicular ectopia (TTE) is an uncommon urological abnormality in children where both the gonads migrate toward the same hemi-scrotum. Herein, we describe five cases of children with TTE and their management at a tertiary care center. Materials and Methods: Five cases with complaints of inguinal hernia and undescended testis were presented to the department of pediatric Surgery at a tertiary care center have been taken up for the study. The history, investigations, surgical findings, and procedures were reviewed retrospectively. Case Summary: Of the five cases, one presented with irreducible inguinal hernia, two presented with unilateral hernia with contralateral undescended testis, and two presented with bilateral undescended testes. Inguinal herniotomy and transseptal orchiopexy were performed in all 5 cases. Three of the five cases were associated with persistent Müllerian duct syndrome (PMDS). Conclusion: In children with unilateral cryptorchidism and a contralateral descendent testis with an associated hernia, TTE should be suspected and ultrasonographic evaluation must be done to diagnose this condition before surgery. Transseptal orchiopexy is highly recommended to manage these cases especially when vasa deferentia are fused. In the case of PMDS, it is preferred to preserve Müllerian remnants.

Frequency, Etiology and Risk Factors of Infant Burn Injuries

Background: Pediatric population in Pakistan is exposed to alarming consequences of burn injuries. Infants have a higher risk of fatality from burns than adolescents and adults. Merely few burn centers across the country are equipped with the resources and trained doctors/paramedical staff who can cater well to the neonatal and infant burn patients. We studied the frequency, etiology and risk factors of infant burn injuries to call attention and bring in public policy for its prevention and awareness among public. Methods: This was a cross-sectional study conducted in the Department of Pediatric Surgery and Pediatric Burn Unit, Mayo Hospital, Lahore, Pakistan from September 2023 to August 2024. All patients being admitted with burn injuries who were 12 months old or younger were included in the study. A structured questionnaire was filled by the duty doctor after interviewing the parents/guardians. Results: Total 2638 children presented with burns. Out of 867 admissions 75 were infants with male predominance. Mean age was 9.4+3.4 months ranging from 11 days to 12 months. 62 were scalds, 12 flame burns and one electric burn. Mothers were primary caretakers in 89% cases and 97% mothers were house wives. 71% lived in nuclear families. 64 out of 75 were kitchen accidents. All families faced major disruption in natural gas supply in their homes. Majority accidents occurred in winters and 62.6% in January and February alone. Conclusion: Infant burns can be prevented by close surveillance, keeping infants away from kitchen, support system for mothers at home and keeping stove and hot items on shelves away from reach. Provision of hot running water and infrastructure for adequate power and gas supply along with awareness/prevention campaigns by government bodies are needed to save vulnerable infants from this adversity.

Comparison of Platelet Rich Plasma Dressing with Conventional Saline Dressing on Spoke Wheel Injury Wounds in Pediatric Patients: A Randomized Controlled Trial

Objectives: To compare the outcome of topical Platelet Rich Plasma (PRP) dressing versus normal saline dressings on Wheel spoke injury (WSI) wounds in terms of duration of wound healing, wound infection, pain and need for hospital stay. Methods: It was a Randomized controlled trial conducted in Department of Pediatric Surgery KEMU/Mayo Hospital Lahore from September 2023 to August 2024. Children 12 years of age or younger presenting with WSI having an open wound which was allowed to heal by secondary intention were included in the study. Group A got normal saline soaked dressing daily and group B was given topical PRP dressing. The PRP rich gel layer obtained after centrifuging patients’ own blood sample was applied on wound. This was done once weekly for maximum 4 sessions. Variables like duration of wound healing, wound infection and pain along with other parameters were recorded. Results: Our sample consisted of total 69 patients 34 were Group A as control and 35 were Group B as cases. Mean age was 8.2 + 1.8 years with male predominance. Mean duration of healing was less for Group B having p value &lt;0.001. Group B cases had less wound infection rate and it was found to be statistically significant (p value 0.04 for gross signs of infection and 0.015 for bacterial growth on wound culture). There was significant reduction in post dressing pain in PRP group only after 3rd week of dressing (p 0.009). Conclusion: We conclude that topical PRP is a promising adjunct in treating WSI in addition to other injuries with tissue loss. It can serve as an economical treatment option for rapid healing of WSI patients especially in developing nations.

Prevalence and Incidence of Peutz-Jeghers Syndrome and Juvenile Polyposis Syndrome in Japan: A Nationwide Epidemiological Survey in 2022.

Peutz-Jeghers syndrome (PJS) and juvenile polyposis syndrome (JPS) are autosomal dominant diseases associated with high cancer risk. In Japan, knowledge about the prevalence and incidence of PJS and JPS is lacking despite being crucial for providing appropriate medical support. We aimed to determine the prevalence and incidence of these diseases. In 2022, a nationwide questionnaire survey was conducted to determine the number of patients with PJS or JPS by sex and the number of newly confirmed cases from 2019 to 2021. The target facilities included gastroenterology, pediatrics, and pediatric surgery departments, which were stratified into seven classes on the basis of the total number of beds. We randomly selected target facilities using different extraction rates in each class, resulting in 1748/2912 facilities (extraction rate: 60%) as the final sample. We calculated the estimated number of patients using the response and extraction rates. A total of 1077 facilities responded to the survey. The estimated numbers of patients with PJS and JPS were 701 (95% confidence interval [CI]: 581-820) and 188 (95% CI: 147-230), respectively. The 3-year period prevalences of PJS and JPS were 0.6/100000 and 0.15/100000, whereas the incidences in 2021 were 0.07/100000 and 0.02/100000, respectively. Male patients constituted 53.5% and 59.6% in the PJS and JPS groups, respectively. We determined the prevalence and incidence of PJS and JPS in Japan for the first time. Further research is needed to obtain more detailed information, including the clinical differences and outcomes in Japan.

Quality of Life, Perceived Stigma, and Challenges Faced by the Parents of Girls with Congenital Adrenal Hyperplasia.

To assess the quality of life (QoL), perceived stigma, and extent of anxiety and/or depression among parents of female children with congenital adrenal hyperplasia (CAH). Observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery and Endocrinology Clinics of National Institute of Child Health (NICH), Karachi, Pakistan, from June to December 2022. Parents of the female children diagnosed with CAH were enrolled. A validated parent self-report questionnaire, parent- focused items of the experiences and reactions questionnaire used for assessing disorders of sex development (DSD)-related experienced or anticipated stigma and the patient health questionnaire-4 (PHQ-4) were used to gather the information. The scores were calculated for each item and compared among mothers and fathers. Independent samples student t-test was used to find any significant differences between the mean scores. A value of p <0.05 was considered statistically significant. Out of the 98 parents, there were 74 (75.5%) mothers and 24 (24.5%) fathers. The score recorded in all three tools showed multiple challenges that had a negative impact on parents. In QoL assessment for experiences and reactions, scores between mothers and fathers were similar. In the PHQ-4 tool, the scores were significantly related to the female gender of the parents as anxiety and depression were more reported in mothers (p = 0.046). In parents of children >7 years of age, the differences in scores were statistically significant for the domains such as talking to others, and stigma. The parental QoL was affected resulting in limited social interactions with the feeling of being stigmatised. Many reported significant anxiety and/or depression. Parental anxiety, Congenital adrenal hyperplasia, Disorders of sex development, Gender assignment, Gender.

Relationship between Preoperative Aspartate Aminotransferase-To-Platelet Ratio Index (APRI) and Gamma Glutamyl Transpeptidase (GGT) With Early Postoperative Jaundice Clearance and Native Liver Survival in Biliary Atresia

Purpose: The purpose of this study was to observe the relationship between Preoperative Aspertate Aminotransferase to Platelet Ratio Index (APRI) and Gamma-Glut amyl Transpeptidase (GGT) with early postoperative jaundice clearance and native liver survival that were operated in this institution. This study will help to identify the children who are likely candidates for early liver transplantation. Methods: This Observational Longitudinal study was conducted in the Department of Paediatric Surgery, BSMMU with the study period of24 months. Total 25 patients of biliary atresia were included in this study. 3 patients were excluded for death in early post operative period. All the patients were categorized according to age at operation as Group A(&lt;60 days), Group B(61-90 days), Group C(&gt;90 days). Measurement of serum bilirubin, Gamma-glutamyl transpeptidase (GGT), Aspertate aminotransferase to platelet ratio index (APRI)was done in preoperative and postoperative period (at 14-day, 1 month, 3 month and 6 month). Results: Total 3 patients were in Group A, 11 in Group B, 8 in Group C. Mean age atoperation was 86.2(±18.8SD) days and range was 57days to 140 days. Total 10 (45.5%) patient was jaundice free at 3 months after extended KPE and they were also remained jaundice free at 6 months while 12 (54.5%) patients had persistent jaundice. Mean preoperative Gamma-Glutamyl Transpeptidase (GGT) in persistent jaundice group was1208.42 (±855.82 SD) U/L and at 6 month after operation it was 711.3(±446.4 SD) U/L while in Jaundice free group preoperative Gamma-Glutamyl Transpeptidase (GGT) value was 900.40(±582.81SD) U/L and 6 month after operation it was 213.1(±89.1SD), (P=0.003) which is statistically significant. Mean preoperative APRI in persistent jaundice was1.95 (±1.52SD) and at 6 month it was 1.22(±0.53SD) while in Jaundice free group preoperative value was 1.10(±0.54SD) and 6 month of operation it was 0.39(±0.14SD), (P=0.004) which is statistically significant. ...

A new clinical classification of congenital biliary dilatation - HUAXI CBD classification.

Current biliary dilatation (BD) classifications are complex and based on cases including secondary BD, leading to unclear distinctions. Notably, congenital and secondary BD differ in etiology, symptoms, and prognosis. To propose a more concise and more suitable classification of congenital biliary dilatation (CBD), and exploring the feasibility and effectiveness of this classification in diagnosis and treatment. Based on the preoperative imaging data of patients with CBD admitted to the Department of Pediatric Surgery of West China Hospital of Sichuan University, from January 2015 to December 2018, a new classification of CBD was accomplished according to the site of bile duct dilatation lesions, which was named HUAXI CBD classification. The CBD was classified into 4 types: type I (distal extra-hepatic bile duct dilatation), type II (distal extra-hepatic combined with right and left primary hepatic bile duct dilatation), type III (extra-hepatic combined with secondary and above hepatic bile duct dilatation), and type IV (intra-hepatic bile duct dilatation). Meanwhile, the feasibility and reliability of the HUAXI CBD classification were analyzed by analyzing the clinical treatment strategies, perioperative complications and long-term follow-up results of different subtypes. A total of 300 patients with CBD were included in this study. According to the HUAXI CBD classification method, 240 cases were type I, 48 cases were type II, 10 cases were type III, and 2 cases were type IV. After treatment, patients with type I had a normal hepatobiliary function after surgery and a good prognosis; patients with type II had good recovery of liver function in 37 cases (77.1%), but 11 cases (22.9%) had postoperative complications during follow-up; patients with type III and IV had high incidence of cholangitis (6/10, 2/2, respectively) and choledocholithiasis (5/10, 2/2, respectively) after surgery, especially those with diffuse intrahepatic dilatation having a poor prognosis, eventually developing cirrhosis and necessitating liver transplantation. The HUAXI CBD classification is consistent with treatment principles, concise and easy to remember, and more suitable for CBD clinical application.

Synergistic use of Unplanned Reoperation and Hospital Readmission rates for quality monitoring in pediatric surgical care.

Unplanned reoperation (URO) and unplanned hospital readmission (UHR) are key quality indicators used to assess healthcare quality improvement. The aim of this study was to describe, quantify, analyze and compare both indicators in a Pediatric Surgery Department. An observational study was conducted reviewing the medical records of pediatric patients who underwent unplanned reoperation and unplanned hospital readmission over a six-year period in a pediatric surgical unit. The incidence, indications, and causes of reoperations and readmissions were analyzed. A total of 6,376 surgeries were performed over a six-year period. During this time, there were 37 (0.58%) URO and 20 (0.31%) UHR. There were 23/2,437(0.94%) URO and 14/2,437(0.57%) UHR among emergency surgeries. In contrast, there were 14/3,939(0.35%) URO and 6/3,939(0.15%) UHR among elective surgeries (p < 0.05). Outpatient surgeries had 3/1,639 (0.18%) URO and 1/1,639 (0.06%) UHR compared to inpatient surgeries that had 11/2,300(0.47%) URO and 5/2,300 (0.21%) UHR respectively (p = ns). A total of 1,570 appendectomies were performed during the study period, with 8/1,570(0.5%) patients requiring either a URO or a UHR. The most frequent indication for both URO and UHR were intra-abdominal infections. The main cause of URO was a technical error during surgery (70%), while the main cause of UHR was an error in the medical treatment (35%). In our practice, URO are more frequent than UHR. Emergency surgeries have a higher risk of undergoing an URO or a UHR. Acute appendicitis is the most common diagnosis associated with the need for an URO or a UHR. The majority of unplanned reoperation cases are due to technical errors during surgery.

Establishment and validation of a nomogram for predicting postoperative intestinal adhesion in children with acute appendicitis

PurposeThis study aims to explore the value of multiple indicators in the evaluation of risk factors for intestinal adhesion (IA) after appendectomy in children with acute appendicitis (AA).MethodsA retrospective study was conducted on 608 patients who underwent appendectomy in the Department of Pediatric Surgery, Children’s Medical Center of Jilin Province from January 2017 to April 2023, with a one-year follow-up period to record the occurrence of IA after appendectomy. Univariate and multivariate analysis were used to screen the risk factors of postoperative IA, and a prediction model was established to predict postoperative IA.ResultsThere were 527 patients in the non-IA group and 81 patients in the IA group. Binary Logistic regression was used to determine the strength of correlation with postoperative intestinal adhesion. The risk factors identified were as follows: DS ≥ 43 h (OR = 3.903, 5points), CRP ≥ 65 mg/L (OR = 3.424, 4.5points), PCT ≥ 0.9 µg/L (OR = 8.683, 8points), Surgical duration ≥ 100 min (OR = 6.457, 7points), Appendiceal perforation (OR = 6.073, 6.5points), Postoperative exhaust time ≥ 55 h (OR = 14.483, 10points). After test, the nomogram drawn based on binary logistic regression can obtain good prediction efficiency. In the training set, the area under the curve was 0.960, the sensitivity was 0.898, and the specificity was 0.905. In the test set, the area under the curve was 0.957, the sensitivity was 0.864, and the specificity was 0.906.ConclusionPostoperative exhaust time ≥ 55 h has a high risk of IA after appendicitis surgery in children. Early recovery of intestinal peristalsis function is essential. This scoring model is a novel and promising method for predicting postoperative IA.

The register of surgeries in 1925. To the 100th anniversary of Saint-Petersburg State Pediatric Medical University

2025 will a year of the 100th anniversary of Saint Petersburg State Paediatric Medical University and a year of the 120th anniversary of the clinical hospital. The article presents a register of surgeries which were performed in 1925 in the surgical clinic of the University. The articles reviews nosological structure of surgical patients, surgical procedures and anesthesia techniques used one hundred years ago. In the article, one can also find brief historical biographical notes about surgeons who were at the origins of the department and clinic of pediatric surgery of Saint Petersburg State Medical University: N.E. Berg, V.N. Katin-Yartsev, M.A. Toporkova, V.D. Sokolov, V.L. Magsky, A.I. Savshinsky and many others. The role of outstanding orthopedic traumatologist Prof. Roman R. Vreden, who founded the department and headed the surgical clinic of the University (then the Institute of Maternal and Infant Health) from 1925 to 1934 is underlined separately. Dr. Nikolai E. Berg, one of the founders of paediatric surgery, worked at the clinic and subsequently at the department from 1905 to 1949, including the war years and the Leningrad siege. Little information has been found on functioning of the surgical clinic in 1905–1925. There is a lot of work ahead with archives so as to study the history of the clinic and department of paediatric surgery in Saint-Petersburg State Paediatric Medical University.

Factors contributing to parental stress in newborns requiring surgical care: a cross-sectional study.

To assess parental stress in newborns undergoing surgical care. A cross-sectional study was conducted in the Department of Pediatric Surgery at a tertiary center. The study included all parents of newborns requiring surgery, admitted between July 2023 and June 2024. The overall stress score among the study population was 3.3 ± 1. Approximately 90% of parents reported experiencing at least some level of stress (stress score ≥ 2), with the "parental role alteration" domain scoring the highest (3.9 ± 1.1). In the "surgical aspects" domain, 27% reported extreme stress and 22% reported high stress. Higher stress scores were found among parents of preterm infants (3.6 ± 0.9 vs. 3.1 ± 1.1, p = 0.04), infants with a birth order ≥ 2 (3.4 ± 1.1 vs. 3.1 ± 1, p = 0.04), and those from the Muslim community. Graduate parents (2.8 ± 0.9, p = 0.01) and parents of upper socioeconomic status (2.3 ± 0.7, p < 0.0001) were found to have lower stress scores. Parental stress is significant among surgical newborns, especially in parents of preterm babies, babies with severe medical conditions, and those with lower education and socioeconomic status. "Parental role alteration" was the most stressful aspect, highlighting the need for targeted support.

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

Congenital Anomalies of the Kidney and Urinary Tract in Patients with Hirschsprung Disease.

To determine the frequency and types of congenital anomalies of the kidney and urinary tract (CAKUT) in patients with Hirschsprung disease. An observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery, National Institute of Child Health, Karachi, Pakistan, from June to December 2022. All patients with biopsy-proven Hirschsprung disease were included. Ultrasound was done to find out the anatomical and structural anomalies of the kidney and urinary tract. Functional assessment was done by renal function tests and MAG3 radioisotope scan where indicated. Fisher's exact test was applied to find out the association. A p ≤0.05 was taken as significant. Out of a total of 83, 15 (18.0%) patients had CAKUT. The mean age of the study population was 5.5 ± 2.3 years. It included 61 (73.5%) males and 22 (26.5%) females. No significant association was found between the type of Hirschsprung disease and CAKUT (p = 0.7). The gender distribution between CAKUT patients was also insignificant (p = 0.7). Renal hypoplasia was the most common anomaly found in six patients followed by hydronephrosis due to pelvi-ureteric junction obstruction in four children. All of these children were asymptomatic. Five male patients had undescended testis. Nearly a fifth of the children with Hirschsprung disease had CAKUT of whom renal dysplasia was the most common anomaly. There was no gender predilection and patients were asymptomatic regarding the urinary system. A routine ultrasound abdomen is a good screening investigation for identifying CAKUT. Hirschsprung disease, Kidney and urinary tract, Congenital diseases of the urinary tract, Congenital anomalies.

Analysis of platelet transfusion efficacy during extracorporeal membrane oxygenation (ECMO) treatment in pediatric patients post-cardiac surgery-a retrospective cohort study.

Postoperative extracorporeal membrane oxygenation (ECMO) may be necessary for pediatric patients following cardiac surgery, with associated risks of thrombocytopenia and bleeding. Prophylactic platelet transfusions are utilized to mitigate these risks, but the effectiveness of platelet transfusion cannot be reliably predicted. The aim of this study was to investigate the effect of platelet transfusion during postoperative treatment with ECMO in children undergoing cardiac surgery and to explore the optimal transfusion thresholds to reduce the number of platelet transfusions in patients and reduce the risk of death. We included in our study patients from the Pediatric Cardiac Surgery Department at the First Affiliated Hospital of Tsinghua University who underwent cardiac surgery and received ECMO treatment from January 1, 2019, to December 31, 2023, and received platelets transfusion at least once during the ECMO therapy. The platelet counts were determined both before and 24 hours posttransfusion of the platelet product. The corrected count increment (CCI) was calculated for the effectiveness estimation of platelet transfusion. The research subjects were divided into 3 groups based on the platelet count before transfusion (pretransfusion platelet count ≤30×109/L was the low-threshold group, pretransfusion count 31-50×109/L was the medium-threshold group, and ≥51×109/L was the high-threshold group) and the effective rates of each group were calculated. A total of 11 patients received 47 platelet transfusions, an average of 4.27 ± 1.67 per patient. According to the 24-hour postinfusion platelet (Plt) corrected critical control increase index (24-hour CCI) ≥4500, the infusion was considered to be effective, and ineffective when the CCI was <4500. Out of these, 22 transfusions (46.8%) proved effective, whereas 25 (53.2%) were deemed ineffective. The effective transfusion rates across the 3 groups were 69.2%, 50%, and 27.7%, respectively. The efficacy of platelet transfusion may be higher if a low threshold of platelet transfusion is chosen during ECMO treatment, on the premise of ensuring life safety.

Clinicopathological Profile of Sacrococcygeal Teratomas: A Retrospective Observational Study from North India

Introduction: Sacrococcygeal Teratomas (SCTs) are the most common extragonadal germ cell tumours during the neonatal period. Although they are typically benign, these tumours carry a significant risk of malignant transformation if not treated promptly. Early diagnosis through clinical evaluation, laboratory tests, and radiological investigations, followed by surgical excision, is crucial in preventing malignancy and ensuring better outcomes. Aim: To comprehensively analyse SCTs by examining the demographic distribution, clinical features, radiological characteristics, and histopathological profiles of affected patients. Materials and Methods: This retrospective descriptive observational study was conducted in the Department of Paediatric Surgery of Pandit Bhagwat Dayal Sharma, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, from June 2018 to May 2022 involving 11 patients diagnosed with SCT. These patients underwent thorough clinical evaluations, laboratory investigations, and radiological assessments. All patients were treated using standard posterior surgical excision techniques. Postoperative follow-up included both short- and long-term monitoring, focusing on wound infections, recurrence, and metastasis. The data were analysed using Statistical Packages for Social Sciences (SPSS) software version 25.0. Continuous variables were presented as mean±Standard Deviation (SD) or median and range, depending on the distribution. Categorical variables were expressed as frequencies and percentages. Results: Out of 11 patients, there were nine females and two males. The median age at presentation was 18 days, ranging from one day to three years. The majority of tumours belonged to Altman type 1a7 (63.6%), while types 2 and 3 each constituted two cases (18.2%). Clinical presentation predominantly involved a lower back mass Since birth in 10 (90.9%) cases. Histopathological Examination (HPE) revealed mature teratomas in 9 (81.8%) cases, with immature teratoma and yolk sac tumour each accounting for 9.1% (1 case each). Notably, early presentations correlated with mature teratomas, whereas delayed presentations were associated with yolk sac tumours. One patient with a Type 3 lesion experienced recurrence and metastasis during the follow-up period. Conclusion: The SCTs are predominantly found in neonates, with a strong female predominance. Early detection generally results in a favourable outcome, while delayed diagnosis is associated with an increased risk of malignancy, recurrence, and poorer prognosis. Careful follow-up is essential, particularly for patients with higher-risk tumour types and later-stage presentations.

Distraction osteogenesis in the treatment of transverse malocclusions in children

Relevance. Malocclusions accounts for 37% to 89% of all maxillofacial conditions in children aged 3 to 18 across various regions of Russia. These malocclusions can present as isolated issues in a single plane or as combined anomalies across multiple planes. Jaw narrowing or underdevelopment is influenced by various endogenous and exogenous factors. The choice of treatment depends on the severity of the malocclusion. While literature indicates several effective methods for treating transverse malocclusions, some aspects remain insufficiently explored.Materials and methods. A statistical analysis was conducted on 271 patient records of individuals with transverse malocclusions who received treatment in the Department of Pediatric Maxillofacial Surgery at A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of the Russian Federation, between 2013 and 2023.Results. There was an almost equal distribution of patients by gender, with a noticeable increase in medical consultations from 2013 to 2023. The majority of surgically treated patients were between 15 and 17 years old. Isolated transverse malocclusions were significantly less common than cases combined with other pathologies, with mesial occlusion being the most frequent comorbidity.Conclusion. The findings demonstrate a significant need for surgical treatment in pediatric patients with transverse malocclusions through distraction osteogenesis. This underscores the importance of continually improving treatment methods for children, including enhancing diagnostics, refining treatment indications, optimizing distraction protocols, and adjusting treatment courses. These efforts aim to improve the quality of rehabilitation for children, ensuring better outcomes into adulthood and facilitating their social adaptation.

Assessing use of the WHO surgical safety checklist for pediatric surgery in Senegal: A nationwide survey

Introduction The World Health Organization (WHO) introduced the surgical safety checklist (SSC) to reduce postoperative morbidity and mortality; however, its use in low- and middle-income countries is still low. Methods We conducted a survey from January 2 to 22, 2024, in public hospitals’ pediatric surgery departments and units in Senegal to assess the use of the WHO SSC or an adapted version. Results The participation rate was 100% (23 hospitals), with 11 second-level hospitals (47.8%) and 10 (43.5%) having at least two pediatric surgeons. All hospitals had an anesthetist nurse, and 18 hospitals (78.3%) had at least two scrub nurses. For the surgical workload, 14 hospitals (60.9%) had five to 10 surgical interventions weekly. Eleven hospitals (47.8%) had training on use of the SSC, and 8 of the 23 hospitals (34.8%) used the SSC. The WHO SSC nonutilization was mainly due to a lack of training in nine hospitals (60%) and SSC unavailability in five hospitals (33.3%). Members of 22 hospitals (95.6%) were available for training on use of the SSC. Conclusion The WHO SSC is poorly used in pediatric operating rooms of public hospitals in Senegal. The main reasons for nonutilization are remediable.

Endoscopic injection vs anti-reflux surgery for moderate- and high-grade vesicoureteral reflux in children: a cost-effectiveness international study

Even if vesicoureteral reflux is a common condition in children, there are no guidelines about the best therapeutic approach. This study aims to compare the results of endoscopic injection and ureteral reimplantation in children with grade III, IV and V VUR. A multicenter retrospective study included children with grade III, IV and V VUR treated from 2003 to 2018 at three Departments of Pediatric Surgery. Patients were divided into Group A (endoscopic injections) and Group B (anti-reflux surgery), B1 (open, OUR), B2 (laparoscopic, LUR) and B3 (robot-assisted laparoscopic RALUR). Follow-up was at least 5 years. 400 patients were included, 232 (58%) in group A and 168 (42%) in group B. Mean age at surgery was 38.6 months [3.1–218.7]. Mean follow-up was 177.8 months [60–240]. Group A had shorter operative time than group B (P < 0.01); lower analgesic requirement (p < 0.05), shorter hospital stay (P < 0.05) and lower overall costs (p < 0.05), but higher postoperative PNPs (p < 0.01), lower success rate (p < 0.01) and higher redo-surgery percentage (p < 0.01). No differences in terms of postoperative complications, success rate and mean radiation exposure between the two groups. Endoscopy is associated with shorter operative time, shorter hospitalization and lower cost, also in case of multiple injections. Recurrence rate after surgery is lower meaning lower rate of re-hospitalization and radiation exposure for children.