Pediatric Group Research Articles

Pediatric Canalicular Lacerations: Epidemiology and Surgical Outcomes.

The aim of this study was to report the epidemiology and surgical outcomes of canalicular lacerations in the pediatric age group. All pediatric patients who underwent repair of canalicular lacerations of any cause were included in this study. Age, sex, mechanism of trauma, and type of stent used were recorded. The study group consisted of 47 patients with a median age of 6.4 years (22mo-17y). Thirty of the patients were male (63.8%). The lower canaliculus was affected in 76.6% (n=36), the upper canaliculus in 40.4% (n=19), and both canaliculi in 17% (n=8). The most common cause of canalicular laceration was sharp objects (n=33, 70.2%). Canalicular laceration most commonly affects boys and especially involves the lower canaliculus. There was no difference in functional success between monocanalicular and bicanalicular stents. Prevention of canalicular lacerations should be the main focus.

Overview of the Etiology, Pathology, and Prognosis of Giant Cell Hepatitis.

Giant cell hepatitis is an important diagnostic consideration in early childhood, especially for patients who present with jaundice. Different diseases may play a role in their etiology. In this study, we presented pediatric patients in our center diagnosed with giant cell hepatitis. Liver biopsies performed in our hospital between January 2010 and December 2023 were retrospectively evaluated, and biopsies with histological giant cell formation were included in the study. Demographic, clinical, and histopathological characteristics of the patients were obtained from the medical records. Our study included 31 cases of giant cell hepatitis. Twenty-four (90.3%) of the patients were male, and the median age was 4 months (range, 1-148 mo). The most common clinical findings were jaundice (93.5%). Among the 31 patients, idiopathic giant cell hepatitis was observed in 13 cases (41.9%), and etiology was elucidated in 18 patients. The most common diagnoses in these patients were progressive familial intrahepatic cholestasis, biliary atresia, and autoimmune hepatitis (22.6%, 19.4%, and 9.7%, respectively). The most common accompanying histopathologic findings were canalicular cholestasis (87.1%), lobular cholestasis (54.8%), and pericellular fibrosis (35.5%). Liver transplant was required in 10 patients (32.3%). Nine patients (29%) died from various reasons. Although follow-up of 13 patients (41.9%) are ongoing, 9 patients (29%) are no longer being followed. Few studies in the pediatric age group on giant cell hepatitis have been conducted in the literature. Similar to our series, etiology could not be specified in most of the patients in these reports. Additional research is needed to improve our understanding of the disease process, uncover any other potential causes, and create specific treatment options.

Review of Ocular and Non-Ocular causes of Headache in Adult and Pediatric Patients; A multicenter study

Purpose: To determine ocular and non-ocular causes of headache in adult and pediatric patients in three tertiary care hospital of Multan, Pakistan Study Design: Cross-sectional study. Place and Duration of Study: This multi-centre study was conducted in Combined Military Hospital, Multan, Pakistan and The Children’s Hospital and The Institute of Child Health, Multan, Pakistan from February 2023 to September 2023. Methods: The non-probability convenience sampling technique was used. The data collection and diagnosis were done by a consultant ophthalmologist. The statistical analysis of this study was conducted using SPSS version 23. Results: The study comprised of a total of 600 patients. The mean age of the adult patients was 27.16±14.39 years ranging between 16to 80 years and the mean age of pediatric patients was 10.1±2.40 years. The patients were divided into four groups based on the etiology of headache that were ocular, non-ocular, combined ocular causes and ocular and non-ocular causes combined. The most common ocular cause was myopia in 43(14.3%) adults and 47 (15.8%) pediatric patients. However, the most common non-ocular cause was migraine in 72(24.0%) adult patients and frontal sinusitis in 43 (14.3%) pediatric patients. Conclusion: Refractive errors were the most common ocular etiology of headache in ophthalmology patients predominately myopia in the adult and pediatric population. Migraine was the most common non-ocular etiology in adult population whereas frontal sinusitis was most common in the pediatric age group.

Langerhans cell histiocytosis of the orbit: pediatric case series

ObjectiveTo describe the clinical, imaging characteristics, and treatment of pediatric orbital Langerhans cell histiocytosis (LCH). DesignRetrospective case series. ParticipantsChildren with orbital LCH. MethodsChildren with orbital LCH who presented to 4 different centres over the past 10 years. Demographic details, presenting features, imaging, histopathology, immunohistochemistry, and management outcomes were analyzed. ResultsSixteen patients were reviewed. The mean age of presentation was 6.56 ± 4.38 years (range, 1−18 years). Eyelid swelling was the most common presenting feature (13, 81%), followed by proptosis (1, 5%), eyebrow swelling (1,5%), and temple swelling (1, 5%). Imaging revealed superior orbital lesions with osteolytic defects of the orbital roof in 13 (72.2%) patients. Frontal and zygomatic bones were the most commonly affected. All the orbital lesions were extraconal. All patients in the study were diagnosed with LCH from orbital tissue biopsy. Three patients also demonstrated extra-orbital involvement. Two patients (12.5%) had intraoperative steroid injection with curettage, and 1 patient (6.25%) underwent curettage only. The remainder of the patients (n = 13, 81.25%) received systemic steroids and chemotherapy after undergoing biopsy. All patients had complete remission of disease without any signs of recurrence, except for 1 case of refractory LCH. ConclusionsLCH is a rare disorder of the orbit and should be considered in the differential diagnosis for osteolytic lesions involving the superior orbit among the pediatric age group. Histopathologic confirmation is mandatory. Although optimal treatment remains controversial, complete removal of unifocal orbital LCH is recommended and may be achieved through excision and curettage.

Radiological perspective on earthquake trauma: differences in children and adults.

February 2023 saw major earthquakes in Pazarcık and Elbistan, causing significant devastation in Turkey. Patients were transferred to hospitals in neighboring provinces, with multiple traumas-especially fractures and organ injuries-forming the main reasons for hospital admissions. This study aimed to examine earthquake-related injuries in pediatric and adult populations to understand differences. This study analyzed 1,220 adults and 590 pediatric patients with radiological imaging out of 8,704 earthquake trauma cases. Radiological images were assessed independently by two radiologists. Statistical analysis using SPSS examined relationships between variables such as age group and injury type. Results showed 40% of adults and 64% of children had normal radiological findings. Cerebral and extremity traumas were most common in pediatrics, while adults showed more extremity, thoracic, and spinal traumas. Significant differences between adult and pediatric groups were observed in cranial fractures, thoracic and lumbar vertebral fractures, hemopneumothorax, lung contusions, rib fractures, femur and talocalcaneal fractures, and compartment syndrome (p<0.001). Earthquake-related injuries may vary between children and adults. Due to children's more flexible anatomical structure, it is believed that earthquake-related injuries occur less frequently in children. In this study, head traumas were more common in children compared to adults. The rate of cranial fractures was significantly higher in children, with a higher incidence of epidural hematoma compared to adults. Spinal traumas were more frequent in adults than in children, attributed to children's greater flexibility reducing the risk of entrapment under rubble. Pediatric thoracic compliance being significantly higher than in adults often resulted in milder chest traumas. However, compartment syndrome was more common in children, with a lower rate of accompanying bone fractures compared to adults. No significant difference was observed between children and adults in maxillofacial, abdominal, and pelvic traumas. These findings provide insights for future disaster healthcare planning and management.

Primary Central Nervous System Burkitt's Lymphoma in a Pediatric Patient: A Case Report and Literature Review.

The objective of this research is to examine the therapy and outlook of pediatric primary central nervous system Burkitt lymphomas. This study involves a retrospective analysis of the clinical data of a child with primary central nervous system Burkitt lymphoma who underwent treatment in our department. In addition, pertinent literature was reviewed to provide a comprehensive understanding of the topic. The patient was admitted to the neurosurgery department with symptoms of headache and vomiting. Brain magnetic resonance imaging (MRI) revealed multiple lesions in the right frontal and temporal lobes, dorsal thalamus, and posterior medulla oblongata. Most of the tumor mass was surgically removed from the right ventricle and diagnosed as Burkitt lymphoma. Abnormal lymph nodes were not found outside of the central nervous system. The patient achieved complete remission (CR) after receiving 6 cycles of treatment (R-AA-BB-CC-AA-BB-CC) based on the regimen of the Southern Pediatric Non-Hodgkin Lymphoma Treatment Collaboration Group 2017. As of November 23, 2023, the patient remained alive with no evidence of recurrence. Primary central nervous system Burkitt lymphoma is rare in children, and there is no universally accepted treatment protocol. However, the regimen outlined by the South China Children's Cancer Group-Non-Hodgkin Lymphoma in 2017 (SCCCG-NHL-2017) can serve as a useful reference for treating pediatric non-Hodgkin lymphoma.

Pediatric Weight Management Group Classes: Improving Productivity and Patient Retention in Outpatient Hospital Settings

Pediatric Weight Management Group Classes: Improving Productivity and Patient Retention in Outpatient Hospital Settings

Assessment of anxiety in parents of children undergoing tonsillectomy under general anaesthesia: A cross-sectional study.

Surgery in the pediatric age group entails a significant amount of anxiety for parents. Due to anxiety, parents are unable to take care of their children, which could affect the child's well-being and contributes to poor outcomes. The primary objective of this study is to determine the frequency of preoperative anxiety in parents before the surgery of their children. It is a cross-sectional descriptive study that included either parent of 147 children of American Society of Anaesthesiology (ASA) I & II, aged 1-12 years undergoing tonsillectomy over the period of 1 year. Each parent's demographic data were recorded and requested to answer a proforma containing the Amsterdam Preoperative Anxiety Information Scale (APAIS) for assessing anxiety on a 5-point Likert scale. Median interquartile range (IQR), and frequency (%) were used to report the normal, skewed, and categorical variables. APAIS anxiety and information scores were compared by using either the Mann-Whitney U-test or the Kruskal-Wallis test. Furthermore, anxiety scores were grouped (present/absent) with a cut-off score of 11 for the presence of anxiety, and multivariate logistic regression was performed to explore the relationship between potential risk factors and the parent's anxiety. Overall, anxiety was present in 59 (40.1%) respondents with 20 (33.9%) being fathers and 39 (66.1%) mothers. The median (IQR) for APAIS anxiety and information score were 9 ± 5 and 5 ± 2, respectively. Higher median anxiety scores were observed statistically significant in children under 5 years old, mother respondents, mothers aged 35 or younger, fathers under 40, and mothers with graduate or higher education (p < 0.05). Father respondents (AOR = 0.3, 95% CI = 0.1-0.8, p = 0.01), and mother's education less than graduation (AOR = 0.2, 95% CI = 0.1-0.6, p = 0.006) were also found to be statistically significant predictors. There is a significant prevalence of anxiety in parents of children who underwent surgery under general anaesthesia, and mothers have showed significantly higher anxiety levels than fathers.

Observational Study of Rotavirus Related Gastrointestinal Tract Infection in Pediatric Age Group in Kut City Hospitals

In this study, the prevalence and impact of rotavirus infections on pediatric patients under six years old were investigated. Rotaviruses emerged as a predominant cause of severe diarrheal illness in newborns and young children globally. A comprehensive observational study in Al Kut city from May to September 2022 included 99 cases, revealing a 46.5 % positive rate for rotavirus. Statistical analysis indicated a significant association between rotavirus infection and increased frequency of diarrhea episodes (P=0.004) and severe dehydration (P=0.001). Moreover, rotavirus-positive cases were more likely to require intravenous fluid therapy (P=0.02). These findings underscore the substantial burden of rotavirus on both the healthcare system and society, emphasizing its role as a major contributor to infant gastroenteritis, often leading to severe complications and hospitalization

Diabetic Ketoacidosis Complications in Pediatrics: A Narrative Review

Introduction: Around the world type I diabetes mellitus (T1D) is becoming more prevalent among pediatrics. The most common cause of mortality in children is diabetic ketoacidosis (DKA). It affects up to one-third of people with T1D. The most common complication of pediatric diabetic ketoacidosis is cerebral edema; however, it is not the only adverse effect of DKA that necessitates continuous observation. Methods: This study was conducted as a narrative review obtaining all applicable data on complications of diabetic ketoacidosis (DKA) in the pediatrics age group. Conclusion: This review of literature discusses the effects of DKA on different body systems including neurological, coagulopathy, pulmonary, gastrointestinal, infectious, and renal effects. Aim: To educate families and healthcare professionals about the significance of strict glycemic control and early identification of DKA in order to prevent the onset of those consequences, we examine each of those multisystem impacts in children

Patients' readiness for digital communication and demand for transferring medical services to a remote format

Objective: to assess the readiness of patients for online communication with a medical professional and the demand for medical care in a remote format. Material and methods. 507 patients were interviewed using a questionnaire developed by the author. The questionnaire allows you to obtain data on the respondent's experience in using online communications with a doctor, the respondent's readiness for "digital" visits, the impact of Internet resources on the patient's trust in the recommendations of the attending physician. Results. 30.6±2.1 % of patients use online communications when interacting with their doctor, 40.5%±2.2% would like to have this opportunity. There was a difference in readiness for digital communications between groups of respondents interested in pediatric specialists (parents of children attending children's clinics) and groups of Central District Hospital patients and patients of urban hospitals (p&lt;0.001). The influence of age on patients' readiness for online communication has been confirmed. The most in demand in the remote format were referral services (for tests, hospitalization), especially in the parent group. The study of patients' behavior in relation to the search for a "second opinion" on the Internet showed that most of the respondents are currently not inclined to double-check their doctor's appointments, and the absolute majority of respondents (82.8±1.7%) trust their treating real doctor, and not Internet advice. Conclusion. The results of the study indicate the readiness of the population to introduce digital communications and transfer part of medical care to the digital field, the most in demand were services for registration of referrals to hospitalization, to narrow specialists, tests, prescriptions for medicines that the patient receives on a regular basis.

Prevalence of schistosomiasis and its association with anemia in Ethiopia, 2024: a systematic review and meta‑analysis

BackgroundSchistosomiasis is a neglected tropical disease that affects over 250 million people, predominantly in impoverished communities, including those in Ethiopia. However, there is currently no available national data regarding its prevalence in Ethiopia or its potential association with anemia.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-2020) guideline was followed in our study. A comprehensive search strategy was conducted using international databases (PUB Med, Embase, Scopus, and Science Direct) and websites (Google Scholar and Google) from their date of inception to April 22, 2024. The quality of the retrieved studies was assessed using an adapted version of the Newcastle–Ottawa Scale. Publication bias and statistical heterogeneity were statistically assessed. A random effects model was applied, and all analysis was performed with STATA 17 statistical software.ResultThe prevalence of schistosomiasis was assessed in twelve studies with 5747 participants. S. mansoni was studied in 11 research papers, while S. hematobium was assessed in one study. Using a random effect model due to high heterogeneity (I2 = 98.46%; P < 0.001), the overall pooled prevalence of schistosomiasis in Ethiopia was 22% (95% CI: 14.3, 29.6). The prevalence of schistosomiasis was about two and a half times higher in rural settings (23%) (95% CI: 15, 31) than in urban areas (10%) (95% CI: 3, 17). The burden of schistosomiasis was 23% between 2020 and 2024, compared to 16% from 2015–2019, with a higher prevalence among pediatric age groups (22%) versus 14% in mixed pediatric and adult age groups. The magnitude of schistosomiasis for good and very good-quality papers was 22% and 17%, respectively. In all the subgroup analyses, there was considerable statistically significant heterogeneity. No study was found to evaluate the association of schistosomiasis with anemia.ConclusionThe study reveals Ethiopia's higher schistosomiasis prevalence. Rural areas have a high burden of schistosomiasis. No eligible study was found to evaluate the association of schistosomiasis with anemia. Therefore, prevention and control measures should focus on rural settings.Trial registrationThe registration number at PROSPERO is CRD42024538522.

Translation, adaptation and initial validation of the Oldenburg Burnout Inventory (OLBI) in Río de la Plata health personnel

The study addresses the translation, cross-cultural adaptation and initial validation of the Oldenburg Burnout Inventory (OLBI) questionnaire into Spanish, particularly for the context of health personnel. The OLBI, based on the Job Demands - Resources Model, evaluates burnout and job disengagement. After a rigorous methodological process, two versions of the questionnaire were carried out, followed by a pilot test and cognitive interviews. Comprehension problems were identified in a question related to work disconnection. Adjustments were made to the final version, which was validated with a multiprofessional pediatric palliative care group. The results showed adequate reliability for the Exhaustion scale and acceptable for the Disconnection scale. The importance of considering the particularities of the work context in adapting the instrument was highlighted. Although limitations, such as sample size, are acknowledged, it is suggested that the OLBI – UY version is promising and can be used in future studies for a more comprehensive psychometric analysis. This study represents an original contribution by addressing the adaptation of a relevant instrument for measuring burnout in Spanish-speaking health personnel in the Río de la Plata.

Barriers to Type 1 Diabetes Adherence in Adolescents.

Background: Adolescence is a particularly crucial period of physical, emotional, and social development and adaptation, rendering these formative years rather challenging for individuals with chronic conditions like type 1 diabetes (T1D). Despite rapid improvement in diabetes therapies, adolescents with T1D are characterized by poorer adherence to treatment regimens compared with other pediatric age groups. Insufficient adherence is strongly related to low diabetes control, increasing morbidity, and risk for premature mortality. This study aimed to provide a comprehensive overview of adolescents' most common barriers to T1D adherence, stressing the need for a deep and comprehensive understanding of these barriers. The complexity of these barriers is underscored by the diverse factors contributing to poor T1D adherence in adolescents. Methods: A narrative review was conducted, surveying four databases (PubMed, Scopus, EMBASE, and Web of Science) for full-text articles in the English language published up to June 2024. All studies related to barriers to T1D adherence in adolescents were considered. The literature was selected using selection and exclusion criteria and extracted and organized using Mendeley. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. This review revealed that adolescents face numerous obstacles to T1D adherence related to psychological factors, flux in family dynamics, perceived social pressures, therapy-related factors, transitioning responsibility, risk-taking behaviors, and pubertal changes. Conclusions: Navigating the adaptations to the different aspects of T1D, from treatment to complications and adolescents' personal growth, effectively requires a thorough understanding of the barriers of a treatment regimen that patients at this critical age face.

Prosthesis applications and challenges in children with earthquake-related amputations

BackgroundAmputations are among the most important traumatic injuries caused by earthquakes. However, data on amputee children and prosthesis application is quite limited in the literature. The aim of the study is to evaluate the injury-related data, stump problems, prosthesis application, difficulties and complications experienced with prosthesis during follow-up of children with 2023 Kahramanmaraş earthquake-related limb loss. Patients and methodsSociodemographic and injury-related data, pre-amputation and post-amputation interventions, prosthesis application, current prosthetic problems, and revision surgeries of the amputee children were recorded. ResultsMedian age of patients (n = 102) admitted to our center was 13.0 years. 67.6 % of patients had one or more concomitant injuries. Median time and number of amputations were 4 (0–57) days and 1 (1–4), respectively. Of the total 120 amputations, 67.5 % (n = 81) were lower extremity amputations. Most common amputation levels were transtibial (29.1 %, n = 35), transfemoral (22.5 %, n = 27), and transhumeral (15.8 %, n = 19). Most amputees (56.8 %) underwent revision surgery after initial amputation. Median duration of time from amputation to prosthesis application was 184 (28–314) days. For 25 prostheses, a socket revision was required. Six patients had surgical revision of the stumps to allow prosthetic fit and mobility (due to bone overgrowth, soft tissue failure, heterotopic ossification). ConclusionLimited healthcare facilities, surgeries performed under emergency conditions, accompanying multiple traumas, inadequate follow-up conditions, and additional difficulties arising from the pediatric patient group lead to difficulties in the care of pediatric amputee patients. Our results will guide the care of this vulnerable patient population in the event of a similar unfortunate disaster.

Pidotimod – Current Role and Evidence

ABSTRACT Recurrent respiratory infections (RRIs) are common in the pediatric age group and in patients with chronic respiratory disorders, leading to frequent hospitalization and poorer quality of life. Studies have shown that an immature immune system in childhood can predispose to RRIs, leading to adult life. Immunomodulators are drugs which modulate the immune system of the host to increase resistance against various infections. They interact with specific receptors and cellular components of innate and adaptive response to modulate the immune response. Pidotimod (PDT) is one such immunomodulator which has shown emerging evidence in the past 2 decades, to reduce the recurrence of lower respiratory tract infections and help in faster recovery from the same. This review highlights the evidence behind the potential role of PDT in the prevention and management of RRIs.

Filum terminale infected epidermoid cysts in pediatric age group; A case series

BackgroundEpidermoid cysts are rare and account for only 1 % of primary spinal tumors. It's due to inclusion of ectodermal tissue during the third and fourth weeks of gestation. Infected epidermoid cysts are exceedingly rare with very few reports in literature. The clinical presentations include radicular symptoms, motor weakness, sphincteric disturbance, and repeated chemical meningitis. Surgery of this kind of tumor remained a challenge and of a considerable recurrence rate. MethodsThis is a retrospective study reviewing the records of six children who were treated for filum terminale infected epidermoid cysts. All patients underwent microsurgery, and the surgical outcomes were studied through a follow up period of at least 24 months. ResultsAll children had a low back dermal sinus with purulent discharge. One child was a recurrent presentation after the previous two surgeries for evacuation of pus collection, and the other five children were operated for the first time. All the six children had an associated neurological deficit; one child presented with active central nervous system infection, and one child had a history of meningitis and admission to hospital prior to our surgery. Regular follow up revealed no recurrence in any of the six patients. The five patients, who presented with motor weakness, showed significant improvement of the motor power with regular post-operative physical therapy. ConclusionEpidermoid cysts are rare benign lesions that may lead to significant morbidity when infected. The aim of microsurgical excision is to remove the cyst content and its capsule without inducing or increasing neurological deficit by the aid of intraoperative neuromonitoring and microsurgery techniques.

Postoperative seizure outcomes and antiseizure medication utilization based on histopathological diagnosis: A retrospective cohort study

ObjectiveAnalyze the association between histopathology, seizure outcomes, and drug load of antiseizure medications (ASMs) 5–8 years after epilepsy surgery to inform preoperative decision-making and consultation. MethodsIn this retrospective, non-interventional, single-center study, patients who visited the epilepsy clinic at West China Hospital, Sichuan University from Jan 1, 2015 to Dec 31, 2020 were assessed. Patients with postoperative histopathology after epilepsy resection were included and categorized into 13 etiological groups. The primary outcomes were achieving Engel class 1 at 1, 2, 3, 5, and 8 years postoperative. Secondary outcomes included the use of ASMs and comparison of postoperative seizure outcomes between adults and children. Univariate and multivariable analyses were conducted to explore the association between clinical characteristics such as histopathology and seizure outcomes. ResultsA total of 315 patients were include. Patients with embryonic dysplastic neuroepithelial tumor (DNT) achieved the best seizure outcomes (84.6 % Engel class 1). DNT (odds ratio, OR=0.103, 95 %CI=0.012–0.899), cavernous hemangiomas (OR=0.140, 95 %CI=0.024–0.819) and meningioma (OR=0.137, 95 %CI=0.021–0.910) were independently associated with a higher probability of seizure-free outcome. The results of epileptic seizures in adult and pediatric groups with different pathologies were significantly different, and the preoperative and postoperative ASM dosages were also different among adult patients with various etiologies. Additionally, multivariate analysis showed that early age at onset (adjusted hazard ratio (HR) = 1.754, 95 % CI=1.049–2.934, P=0.032), late surgical age (HR=0.569, 95 %CI=0.339–0.954, P=0.032), and longer duration from seizure onset to surgery (HR=1.735, 95 % CI=1.028–2.928, P=0.039) were independent predictors of unfavorable outcomes in epileptic seizures. Conclusionswe demonstrated that the seizure outcomes of focal epilepsy have high pathological specificity, with histopathological diagnosis serving as a crucial and independent determinant of seizure outcome. Surgical assessment should be contemplated for all patients with presumed refractory focal epilepsy, irrespective of their age.

Factors influencing secondary overtriage in trauma patients undergoing interhospital transfer: A 10-year multi-center study in Hong Kong

BackgroundWith the development of regionalised trauma networks, interhospital transfer of trauma patients is an inevitable component of the trauma system. However, unnecessary transfer is a common phenomenon, and it is not without risk and cost. A better understanding of secondary overtriage would enable emergency physicians to make better decisions about trauma transfers and allow guidelines to be developed to support this decision making. This study aimed to describe the pattern of secondary overtriage in Hong Kong and identify its associated factors. MethodsThis was a retrospective review of 10-years of prospectively collected multi-center data from two trauma registries in the New Territories of Hong Kong (2013−2022). The primary outcome is secondary overtriage, which was defined as early discharge alive within 48 h, Injury Severity Score (ISS) <15, and no surgical operation done. Patient characteristics, physiology, anatomy and investigation variables were compared against secondary overtriage using univariate and multivariable analyses. ResultsDuring the study period, 3852 patients underwent interhospital transfer from a non-trauma center to a trauma center, and 809 (21 %) of the transfers were considered secondary overtriage. The secondary overtriage rate was higher in pediatric age groups at 34.8 % (97/279). Logistic regression analysis showed secondary overtriage to be associated with blunt trauma and an Abbreviated Injury Scale (AIS) score of <3 for head or neck, thorax, abdomen and extremities. ConclusionInterhospital transfer is an essential component of the trauma system. However, over one-fifth of the transfers were considered unnecessary in Hong Kong, and this could be considered to be an inefficient use of resources as well as cause inconvenience to patients and their families. We have identified related factors including blunt trauma, AIS <3 scores for head or neck, thorax, abdomen and extremities, and opportunities to establish and improve on transfer protocols. Further research should be aimed to safely reduce interhospital transfers in the future to improve the efficiency of the Hong Kong trauma system.

Primary Anterior Sagittal Anorectoplasty Shift from Staged to Single-stage Procedure for Low Anorectal Malformations in Female Children: Our Initial Experience in Single Centre.

Anorectal malformation (ARM) is a common congenital anomaly found in the paediatric age group. Previously, the repair of the vestibular fistula (VF) was performed as three-stage procedure with initial colostomy followed by a definite procedure and, lastly, colostomy closure. At present, a single-stage procedure is preferred, especially in lower anomalies owing to the convenient and time-saving approach. The clinical profile and outcome of ASARP for treatment of ARM in females (vestibular anus and perineal fistula). A retrospective analytical study was conducted at Government Medical College, Jammu. A total of 60 patients were included in the study. Most of the patients were in the age group of 1-5 years (30%), followed by 6 months-1 year age group (25%). Forty-five (75%) females had VF while 15 (25%) had perineal fistula. Intraoperative complication was vaginal tear seen in 6 (10%) patients followed by rectal tear seen in 3 (5%) patients. Early post-operative complications were seen in 9 (15%) patients. Wound infection was the most common complication seen in 5 (8.3%) patients, wound dehiscence in 3 (5%) patients and retraction of rectum in 1 (1.6%) patient. Late post-operative complications were seen in 24 (40%) patients. Perineal excoriation was the most common complication seen in 6 (10%) patients, constipation seen in 5 (8.3%) patients, anal stenosis in 4 (6.6%) patients and mucosal prolapse in 4 (6.6%) patients. The single-staged ASARP procedure resulted in satisfactory outcomes. It is an excellent procedure for females with VF and perineal fistula. Appropriate selection, preparation of patient, optimal correction with minimal sphincter damage and needful post-operative care of wound give excellent cosmetic and functional outcomes in terms of continence. It also decreases the burden on treating the surgeon, family and psychological stress on the patients and parents.