Problem In Pediatric Patients Research Articles

Emotional and behavioral problems in pediatric patients with migraine and tension-type headache

ObjectiveThis study aimed to investigate the associations between psychopathological characteristics of children and adolescents with primary headache, as measured by the Strengths and Difficulties Questionnaire (SDQ), and treatment outcomes. MethodsA cohort study was conducted on 124 pediatric patients with primary headache. At the first consultation, the SDQ was completed by the parents. The analysis of treatment efficacy was conducted on 90 patients with a follow-up period of at least one year. Treatment responders were defined as those who showed 50% reduction in the headache frequency. First, an analysis of the SDQ total scores and five subscales, among the migraine and tension-type headache groups, was conducted for 124 participants. Second, the association between the SDQ scores and treatment outcomes in the groups with periods of improvement of less than three months and three months or more were analyzed in 90 patients. ResultsMigraine patients displayed more difficulties than strengths in terms of the total score (p = .004) and in the emotional symptoms subscale (p = .012) compared with tension-type headache patients. Migraine patients who required more than three months to show improvement displayed more peer problems (p = .020), while tension-type headache patients who required more than three months to show improvement displayed fewer conduct problems (p = .007). ConclusionEvaluation of patient characteristics using the SDQ at first consultation can predict the treatment outcome. Moreover, it can help provide appropriate initial treatment and improve outcome of primary headache in children.

Study of the association between generic and disease-specific quality of life and behavior problems in pediatric patients with chronic kidney disease stage 3 or higher and the quality of life and mental health of their primary caregivers.

Chronic kidney disease (CKD) can affect quality of life and mental health of patients and their primary caregivers (PCs) in different disease stages. This prospective, cross-sectional, descriptive, comparative, and analytical study of patients with stage 3-5 CKD, aged 8-18 years, assesses the association between patients' general and disease-specific health-related quality of life (HRQOL) and behavioral problems and their PCs' QoL and mental health status. PedsQL 4.0, PedsQL ESRD, CBCL, and YSR questionnaires were used to evaluate 80 patients while their PCs were assessed by SF-36 and MINI questionnaires. The study participants were divided into three groups: G1: stage 3-4 CKD, G2: peritoneal dialysis and hemodialysis, and G3: kidney transplantation. Lower indexes in PedsQL 4.0 and PedsQL ESRD were demonstrated in G2 patients. No deviant internalizing and/or externalizing conducts were shown by the CBCL questionnaire while the YSR questionnaire demonstrated significant differences in all domains with higher scores in G2 patients without reaching clinical range for individual syndromes. G3 PCs presented the lowest SF-36 scores and the highest occurrence of psychiatric diagnoses, according to MINI, when compared to other PCs. Parallelism was found between scores of PedsQL 4.0 and PedsQL ESRD with tendency to higher scores in the PC's view compared to the patient's view. CKD affects HRQOL of patients and their PCs, as well as patients' behavior problems and their PCs' mental health. PCs' perceptions of patients' QOL and behavioral problems may be related to their mental health status and QOL self-perceptions.

Management of Functional Constipation in Pediatrics Based on Nurse Educational Intervention

Back ground: Constipation is a prevalent problem in pediatric patients and one of the ten most common pathological conditions visited by general pediatricians (1). It accounts for up to 25 percent of referrals to a pediatric gastroenterologist. Therefore, this study was done to evaluate the effects of a nurse-based education program on reducing the symptoms of chronic functional constipation in children (2). Methods: This clinical trial study was conducted on 95 children (48 control and 47 intervention group), aged 3 to 14 years old, and selected randomly out of the patients referred to Imam Reza Clinic affiliated to Shiraz University of Medical Sciences in 2014. The control group only received the usual treatment prescribed by the physician; however, the intervention group received a comprehensive nursing program. Then, having completed Rome III Criteria Form immediately after the intervention for one month, two months, and three months, we collected the required data. The significance level in this study was 0.05. Results: The mean age of the samples was 78.30±32.52 months in the intervention group and 74.60±32.26 months in the control group. Also, the average weight of children in the intervention group was 23302.17±12034.96 grams and in the control group 21376.09±9351.80 grams. 18% of the samples from the intervention group and 22% of the control group were males. With a follow-up of 3 months, the percentage of changes in the intervention group in items 1 (two or fewer defecation in the toilet per week) and 4 (history of painful or hard bowel movement) was 48.9% and 74.5%, respectively, and in the control group 22.9% and 52.1%, respectively. Therefore, positive changes in the intervention group were better than the control group. The difference between these two variables was statistically significant (p-value 0.05), despite changes in the percentage of items in different periods of 1, 2, and 3 months. Conclusion: The findings of this study indicate that nursing education programs have a desirable effect on the reduction of some symptoms of chronic functional constipation based on Rome III criteria in children aged 3-14 years.

Application of the international classification of functioning in the rehabilitation examination of children of the palliative non-oncology group

Annotation. Rehabilitation of children who need palliative non-oncology care is a complex and multi-vector task. WHO defines palliative pediatric care as a complex of active care for the physical and mental state of the child, its cognitive abilities, as well as support for the patient's family. To provide comprehensive palliative care that is child- and family-centered, it is possible to use the International Classification of Functioning to examine and build a rehabilitation system.
 The purpose of the study: to analyze the application of the international classification of functioning in the process of rehabilitation examination of children who need palliative care.
 Research methods: empirical methods (comparison, description, measurement), theoretical method (axiomatic), general logical methods (analysis, synthesis, generalization). The study was conducted on the basis of the Rivne Educational and Rehabilitation Center «Special Child» 47 (100%) children took part in the study.
 Research results. The International Classification of Functioning-Children, Adolescents (ICF-DP) was used to define a set of tools for rehabilitation assessment of pediatric patients. Taking into account the psychometric criteria of the assessment scales, the following were selected for the examination of the Structure and function of the body component: s 710 – brain structure – disease history and systematized diagnoses according to ICD-10; Pain sensation (b 280) – 5-point scale of verbal assessments, visual-analog scale of pain intensity (10 points), FLACC scale; Joint mobility functions (b 710) – goniometry; Muscle tone functions (b 735) – Modified Ashforth spasticity scale; to analyze the problem Sleep functions (b 134) allowed a survey of parents; observing the control of voluntary motor functions (b 760) contributed to the study of the state of the problem.
 Examination of the domains of the Activity and Participation component was provided by the PEDI Pediatric Disability Questionnaire, parent questionnaire, observation of pediatric patients: communication (d 310-340), Schooling (d 820), recreation, leisure (d 920) – PEDI Pediatric Disability Questionnaire (assessment social functions); d 550 nutrition – PEDI pediatric disability questionnaire (self-care); moving from place to place (d 460) – Classification of the system of general motor functions GMFCS; use of precise movements of the hand and hand (d 440) – MACS fine motor development level (levels), «Box and cubes» test; maintaining body position (d 415) – observation. Through survey and observation, the Environmental Factors component examined the presence of facilitating or barrier factors. In the aspect of personal factors, the patient's age, gender, and motivation for physical therapy classes were analyzed. Structure and function disorders were found in 43% of the overall assessment, activity and participation limitations covered 39%, and environmental factors – 18%. A review of limitations and impairments confirms that the greatest problem in pediatric patients requiring palliative care is in the Activity and Participation component (182 points). Therefore, the use of the International Classification of Functioning – Children, Adolescents contributes to the selection of tools for assessing the functioning of children in need of palliative care, and ensures the control of the effectiveness of rehabilitation.
 Conclusions. Evaluation of pediatric patients who belong to the non-oncology palliative group is a complex, multifaceted task, since complex disorders and pathological conditions prompt the search for evaluation resources that would allow monitoring the effectiveness of the rehabilitation process. The International Classification of Functioning, which is represented by the Basic Set «Childhood Cerebral Palsy» provides those domains that fully reveal the needs of a child with a disability in all areas of life – Structures and functions of the body, Activity and Participation, Environmental factors. The international classification of functioning must be used to assess the pathological condition of a pediatric patient, since it is the multifaceted examination that will ensure the formation of a multifaceted rehabilitation program.

Evaluation of the use of chlorpromazine for agitation in pediatric patients.

IntroductionChlorpromazine is a first-generation antipsychotic used for behavioral problems in pediatric patients. However, other therapies may demonstrate both improved outcomes and fewer side effects. Within our institution, chlorpromazine has been the standard medication used for treatment of pediatric agitation. The study objective was to evaluate the appropriateness of chlorpromazine use (including efficacy, appropriate dosing, drug interactions, and tolerability) to optimize the treatment of pediatric agitation.MethodsData regarding drug interactions, patient behavior, dosing, and side effects was collected for each patient administered chlorpromazine from January 2019 through June 2019. Data were analyzed using descriptive statistics assessing the incidence of drug-drug interactions (DDIs), incidences of inefficacy, inappropriate dosing, and side effects.ResultsA total of 70 patients and 130 administrations of oral or intramuscular chlorpromazine were evaluated. Of these administrations, 49 (38%) resulted in a DDI. Eighteen (14%) administrations were ineffective for managing symptoms of agitation. Eleven (8%) administrations were dosed inappropriately, and 46 (35%) administrations resulted in side effects possibly caused by chlorpromazine.DiscussionResults from this study demonstrate opportunities for improvement in patient care due to instances of drug interactions, inefficacy, inappropriate dosing, and side effects with the use of chlorpromazine.

Evidence-based Standardization of Constipation Management in the Emergency Department: A Quality Improvement Study.

This prospective QI project involved a multidisciplinary team at a large urban pediatric tertiary care center. The study team constructed a key driver diagram and identified interventions, such as creating a standardized evaluation and management algorithm for constipation, using free open-access medical education platforms, incorporating the electronic medical record interface, and expanding educational conferences to include standardized approach and discharge instructions for patients with constipation across all acuity levels. The primary measure of AXR utilization was tracked overtime on a statistical process control chart to evaluate the impact of interventions. The percentage of visits for constipation that included an AXR decreased from a baseline of 49.6%-37.1%, a 25% reduction. Length-of-stay, return visits within 7 days, and inpatient admissions remained unchanged by the interventions. QI methodology successfully decreased AXR utilization in the evaluation of constipation across a broad spectrum of acuity levels. Further interventions may help to decrease the length of stay and further decrease AXR utilization.

Is Testicular Torsion a Real Problem in Pediatric Patients With Cryptorchidism?

Purpose: To present management and outcomes of patients with cryptorchidism suffering from testicular torsion.Methods: This is a retrospective review of pediatric patients with torsion of undescended testes, who were treated between 2009 and 2019. We recorded: the age, symptoms, duration of torsion, results of physical examination, surgery findings, and additional treatment. Additionally, an extensive online literature search, from 2015–2020, was performed to identify other similar case series.Results: We identified 9 boys with torsion of the undescended gonad, which represented 4.7% of all 192 boys with testicular torsion. The mean age of boys with torsion of undescended testis was 8.7 years. The mean duration of symptoms in our study group was long and it was up to 28.5 h. All patients had inguinal canal exploration. In eight cases, testicular necrosis and primary orchidectomy was performed. Furthermore, 45 cases were identified in the literature and reviewed.Conclusion: According to clinical experience and available studies, torsion of male undescended gonads is a comparatively rare condition. Nevertheless, diagnosis is still delayed and connected with inevitable orchidectomy.

Evaluation of QTc Interval Effects of Antipsychotic Medications for Intensive Care Unit Delirium in Pediatric Patients.

Intensive care unit delirium is an increasingly recognized problem in pediatric patients. Controversy exists regarding the safety and efficacy of antipsychotic medications for this indication. The objective of this study was to determine the incidence of and risk factors for QTc interval prolongation in pediatric patients treated with antipsychotics for ICU delirium. Retrospective chart review of pediatric patients admitted to the pediatric ICU or pediatric cardiac ICU and diagnosed with ICU delirium between October 1, 2014, and October 31, 2015. Patients were included if they received at least 1 dose of an antipsychotic for the treatment of delirium after a positive screen using the Cornell Assessment of Pediatric Delirium scoring tool. For the 26 patients included, the median change in QTc interval on treatment was -4 msecs. Two patients (8%) had QTc interval prolongation while on antipsychotic therapy. No risk factors were identified in these 2 patients that put them at increased risk for QTc interval prolongation. The incidence of QTc interval prolongation in pediatric patients who were treated with antipsychotics for ICU delirium was low. There is need for future research to determine which pediatric patients are at risk for QTc interval prolongation when antipsychotic medications are used for the treatment of ICU delirium.

Mesiodense; a common dental problems in pediatric patient. A case report

A mesiodense is a most common supernumerary tooth which is one of the most significant dental anomalies at the primary and early mixed dentition stages. The reported prevalence of mesiodense in general population ranges between 0.15% to 1.9% and more frequently found in the permanent dentition but rarely found in primary dentition. Mesiodense are primarily responsible for eruption disturbances or delay of the maxillary anterior permanent teeth emergence. Therefore the dentists and parents are great concern about malocclusion and esthetic problems which is caused by mesiodense. Early detection, diagnosis and treatment of mesiodense is important to prevent further complications in permanent dentition. A case of mesiodense of 8 years old child in upper anterior region in mixed dentition and their management have been discussed.
 Update Dent. Coll. j: 2020; 10 (2): 26-28

An approach of clinical pharmacist pertaining to solve drug related problems in pediatric patients

Background: The objectives of the study were to assess the outcomes of clinical pharmacist intervention in solving drug related problems in pediatric patients and to identify the drug related problems in accordance with the causes observed.Methods: It was a prospective observational study done over a period of six months (October 2019 to March 2020) at Apollo children’s hospital in Chennai.Results: Total of 480 subjects were enrolled into the study, out of which 248 were male children and 232 were female children. The patients were divided into 4 age groups. In this study 60.41% pediatric patients were prescribed with less than 5 drugs 290 (60.41%). Drug related problems which were identified during the study was classified according to Pharmaceutical Care Network Europe (PCNE) and drug-related problem (DRP) classification (v9.00). The most frequent DRP was drug choice problem 37 (33.33%). The total number of caused drug related problems was 73 and same number of interventions was given by clinical pharmacist. The most frequent cause of drug related problems was identified as dose selection 31 (42.46%). Outcomes of interventions revealed that 70 (95.89%) problems were solved overall.Conclusions: In this study, clinical pharmacist’s level of involvement has shown interesting results. Moreover, they play an essential role in improving patient safety and outcome, reducing cost and providing quality of care for ill patients.

Gastrointestinal, nutritional, endocrine, and microbiota conditions in autism spectrum disorder.

Gastrointestinal, nutritional, metabolic, endocrine, and microbiota medical problems in pediatric patients diagnosed with autism spectrum disorder (ASD) are some of the coexisting medical conditions in ASD diagnosis. Their prevalence reaches more than 91 % for gastrointestinal problems, up to 89 % for nutritional and metabolic disorders, more than 50 % for thyroid dysfunction, and up to 100 % for microbiota-related conditions. There is an urgency for medical practice to be updated and to include the assessment, testing, diagnosis, and treatment of these coexisting medical conditions in ASD diagnosis in the pediatric, adolescent, and adult population. A strict management of such conditions results in positive changes in the quality of life and symptoms based on which ASD is diagnosed many times. It should be based on high-quality scientific evidence with an adequate medical care and control.

Comparison of intranasal midazolam versus intranasal ketamine for preoperative anesthetic sedation in pediatric patients

Introduction: During induction of anesthesia anxiety of children may be reduced more effectively by sedative medication than parental presence. Keeping in view, the necessity of reducing preoperative anxiety and postoperative psychological problem in pediatric patients, this study was conducted to compare the efficacy and safety of intranasal midazolam versus intranasal ketamine for preanesthetic sedation in pediatric patients. Methods: Ninety patients scheduled for the surgery lasting between 30 min and 120 min under general anesthesia were randomly divided into two groups: Group A patients received intranasal midazolam 0.2 mg/kg as premedication (5 mg/mL ampoule), whereas Group B patients received intranasal ketamine 5 mg/kg as premedication (50 mg/mL vial). The primary outcome measures were the comparison of degree of sedation of intranasal midazolam versus intranasal ketamine for preanesthetic sedation in pediatric patients by accessing parental separation, acceptance of face mask, venipuncture score, and postoperative sedation, whereas the secondary outcome measures were the comparison of side effects. The comparison of quantitative and qualitative variables between the groups was done using the unpaired student's “t”-test and Chi-square test or Fisher's exact test, respectively. Results: The percentage of patients in the ketamine group with parental separation score more than 2 was significantly higher as compared to the midazolam group. Acceptance of face mask, response to venipuncture, postoperative sedation, and postoperative side effects were comparable between the two groups. Both groups have minimal side effects. Conclusions: Both midazolam and ketamine nasally are an effective pediatric premedication for sedation with minimal side effects. Parental separation was better in the ketamine group as compared to the midazolam group.

Trauma-Informed Care in Pediatrics: A Developmental Perspective in Twelve Cases with Narratives.

The dose-response relationship of adverse childhood experiences (ACEs) with chronic morbidities is recognized as prevalent. However, screening for ACEs and implementing trauma-informed care (TIC) have yet to become a standard of care in pediatrics. To document impactful developmental experiences of implementing TIC and universal screening of ACEs in the pediatric setting, elucidate the relationship between ACEs and their common presentation of developmental and behavioral health problems in pediatric patients, and propose feasible system changes to promote evidence-based professional expertise. During pediatric residency training, I implemented routine universal screening of pediatric patients using ACE questionnaires. Research-based trauma-informed practices, such as patient-centered communication regarding adverse health outcomes associated with prevalent ACEs, were used. Clinical vignettes describe 12 cases. Most patients and their families were receptive to counsel on recognizing, preventing, and mitigating the effects of toxic stress resulting from ACEs. Behavior in a patient, and sometimes a parent, was addressed from a developmentally sensitive lens of TIC, and appropriate therapeutic interventions were discussed. Addressing ACEs opened crucial conversations with some patients, which promoted efficacious, developmentally sensitive care. Implementing TIC in the pediatric setting, especially in training, is not only feasible but also vital to adequately understand the patient population. Equipped with clinical knowledge and experience in addressing ACEs, practitioners will more readily empower patients and their families to improve health outcomes. When pediatric practitioners discover, intervene, and address the adverse effects of ACEs, their care becomes more efficacious and evidence based.

DOZ047.91: Bronchoscopic treatment of recurrent tracheoesophageal fistula: is it an effective option?

Abstract Purpose Despite technical and surgical improvements, treatment of recurrent tracheoesophageal fistula (rTEF) still remains a challenging problem in pediatric patients. Bronchoscopic closure of rTEF using different agents is described with different success rates in the literature. This study aimed to report results of patients with rTEF treated with chemocauterization using trichloroacetic acid (TCA) and with laser cauterization (LC) followed by fibrin glue (FG) application. Methods Nine patients with rTEF were included in the study from 2014 to 2018. Four patients underwent fistula closure with LC followed by FG application, while another four patients had chemocauterization with TCA. In one case both agents were used. Patients were checked for the success of the treatment by bronchoscopy. All patients had the diagnosis of rTEF. Seven patients had EA with distal TEF and the remaining two patients had H-type TEF as primary pathologies. FG application was performed by LC followed by injection of FG into the fistula. Application of the TCA was made by a TCA-soaked sponge for 30 seconds and 3 times each trial. Results Nine children of the age range 4 months to 5 years (mean 1.5 year) were treated endoscopically. Follow-up ranged between 3 months and 5 years (mean 28 months). Among the nine patients only in one patient with only laser coagulation with FG application the treatment was successful. In the remaining eight patients all attempts failed. All these patients underwent open surgical closure of the fistula. There were no acute or late complications related to either endoscopic method. Conclusion The results of this study suggest that endoscopic occlusion of recurrent TEF has a low success rate. Surgical closure is still a standard method with a high success rate. Even though endoscopic options are less invasive, they prolong the period of aspiration and may cause increased pulmonary problems.

Is antibiotic lock therapy effective for the implantable longterm catheter-related bloodstream infections in children?

Tural Kara T, Özdemir H, Erat T, Yahşi A, Aysev AD, Taçyıldız N, Ünal E, İleri T, İnce E, Haskoloğlu Ş, Çiftçi E, İnce E. Is antibiotic lock therapy effective for the implantable long-term catheter-related bloodstream infections in children? Turk J Pediatr 2019; 61: 895-904. Catheter-related bloodstream infections (CRBSIs) are an important problem in pediatric patients with central venous catheters. This study aimed to determine the incidence of CRBSIs, responsible pathogens and outcomes of antibiotic lock treatment (ALT) in pediatric patients. Between January 2010 and November 2015 all hospitalized pediatric hematology, oncology and immunology patients diagnosed with CRBSIs were retrospectively analyzed. Seventy-eight CRBSI episodes were detected in 60 pediatric patients. The incidence of CRBSIs was 4.20/1000 catheter days. The most frequently detected pathogen was methicillin-resistant coagulase-negative Staphylococcus. Pseudomonas aeruginosa, Klebsiella spp., and Escherichia coli were other commonly isolated microorganisms. ALT was administered in 42 patients. The success rate of ALT was 81% (34/42). Catheter was removed without ALT in 36 episodes. Common reasons for catheter removal were sepsis and causative microorganisms which had high probability of biofilm formation. CRBSIs are an important cause of morbidity and mortality in pediatric patients. ALT is safe and effective. It is possible to obtain satisfactory results when ALT is used with intravenous systemic antibiotics for CRBSIs, though in some cases catheter removal is necessary. ALT helps to prevent unnecessary catheter removal in pediatric patients.

Evaluating protective and therapeutic effects of alpha-lipoic acid on cisplatin-induced ototoxicity

Cisplatin, a small platinum-containing molecule, is a widely used, highly effective anticancer drug. However, severe side effects have been found in cancer patients treated with cisplatin, including nephrotoxicity, neurotoxicity, and ototoxicity. These cisplatin-induced side effects can have a major impact on patient quality of life, including social development problems in pediatric patients that develop hearing loss. Previous studies have suggested that the major cause of cisplatin-induced ototoxicity is abnormal accumulation of reactive oxygen species (ROS) and oxidative stress. Alpha-lipoic acid (ALA), one of the most effective antioxidants, is known to be involved in the cellular antioxidant system and may have a protective effect on cisplatin-induced ototoxicity. However, the therapeutic effect of ALA on damaged hearing function and its detailed mechanism of action are not fully understood. This study focused on determining whether ALA has a potential as a protective and/or therapeutic agent for cisplatin-induced ototoxicity. Histological and physiological analyses were performed using cisplatin-treated mouse cochlea and HEI-OC1 culture cells in pre- and post-treatment with ALA in vitro and in vivo. We found that ALA contributes to protecting mitochondrial function by preventing ROS accumulation and inhibiting apoptotic cell death. Importantly, post-treatment with ALA consistently showed an almost equal restorative effect to pretreatment, in vitro and in vivo, supporting the possible use of ALA as a therapeutic agent for cisplatin-induced ototoxicity. This study is the first report on a strong therapeutic potential of ALA to rescue ototoxic hearing loss caused by cisplatin, and our data provide key evidence that ALA may act as a reducing agent for glutathione disulfide to increase glutathione levels on behalf of glutathione reductase. This result was consistent in both cultured cells and the mouse model, which improves the clinical value of ALA for therapy of cisplatin-induced ototoxicity.

Pharmacy quality improvement project to enhance the medication management process in pediatric patients.

Improvement in the quality of the medication management process is a crucial component of twenty-first-century medicine. To improve the quality of medication management process within pediatric specialty through designing a quality improvement project for the pharmaceutical care services in a children' hospital to solve the drug-related problems during drug prescribing, administration, and monitoring. A total of 900 medical files were evaluated (100 file/month) from the pediatric medical ward to detect any medication errors during prescribing, administration, or monitoring of the drugs. Three pharmacy quality indicators were designed to detect any medication errors during prescribing, administration, or monitoring of the drugs, then a collective datasheet was designed to record any defect in the system during drug management process within the hospital. A quality improvement project was designed using many quality improvement techniques to decrease the rates of medication errors in each drug handling stage. Brainstorming, fishbone chart, questionnaire, and voting were the main quality tools used to detect the causes of medication errors problem in pediatric patients. Certain actions were implemented which included educational program, implementation of clinical pharmacy, intravenous admixture, and drug information services. The quality improvement interventions succeeded in decreasing the rates of medication errors in each stage. These interventions succeeded in decreasing the rates of medication errors in prescribing, administration, and monitoring stages from 47, 60, and 56% respectively to ≤ 15% within 9months. Pharmacists can have a key role in improving the health-care system's quality in developing countries' health-care systems.

Current methods of patellar instability imaging in children. Selection of the best treatment approach

Background. Patellar instability is a common problem in pediatric patients. Up to 2%–3% of all knee injuries are associated with acute patellar dislocation. According to the data in the literature, patients aged 10–17 years are at the highest risk of patellar dislocation and subsequent instability. These patients must be evaluated according to the proposed algorithm to select the optimal treatment method.
 Aim. To diagnose patellar instability in children and subsequently select the optimal treatment method based on acquired data.
 Materials and methods. The study is based on data acquired through the examination and treatment of 147 patients at the 9th Department of Pediatric Traumatology and Orthopedics. Great emphasis was put on computed tomography (CT) data, its essential parameters, which require the most thorough analysis, and assessment methods. These parameters include patellar tilt, dysplasia of the distal metaepiphysis of the femur, the tibial tubercle–trochlear groove index, and the rotational relation of the femur and tibia.
 Results. A novel algorithm for patient examination using CT is proposed. Data obtained by multislice CT (MSCT) had a significant influence on the selection of the surgical method for treating patients with patellar instability.
 Conclusion. The examination of patients with patellar instability using MSCT in adherence to the proposed diagnostic algorithm allows the selection of the optimal treatment method, which will increase the likelihood of rapid recovery of patients and their return to the level of activity similar to that before injury.

DBS in pediatric patients: institutional experience.

DBS is initially used for treatment of essential tremor and Parkinson's disease in adults. In 1996, a child with severe life-threatening dystonia was offered DBS to the internal globus pallidus (GPi) with lasting efficacy at 20years. Since that time, increasing number of children benefited from DBS. We retrospectively evaluated our database of patients who underwent DBS from 2011 to 2017. All patients ≤ 17years of age at the time of implantation of DBS were included in this series. Subjective Benefit Rating Scale (SBRS), Hoehn Yahr Scale (HYS), Fahn Marsden Rating Scale (FMRS), Clinical Global Impressions Scales (CGI), and Yale Global Tic Severity Scale (YGT) were used to evaluate clinical outcome. Between May 2014 and October 2017, 11 children underwent DBS procedure in our institution. Six of them were female and five of them were male. Mean age at surgery was 11.8 ± 4.06years (range 5-17years). In our series, four patients had primary dystonia (PDY) (36.3%), three patients had secondary dystonia (SDY) (27.2%), two patients had JP (18.1%), and two patients had Tourette Syndrome (TS) (18.1%). Two JP patients underwent bilateral STN DBS while the other nine patients underwent bilateral GPi DBS. SBRS scores were 1.75 ± 0.5 for patients with PDY, 3 ± 0 for patients with JP, 2.5 ± 0.7 for patients with TS, and 2 ± 1 for patients with SDY. Mean FMRS reduction rate was 40.5 for patients with dystonia. Significant improvement was also defined in patients with TS and JP after DBS. None of the patients experienced any intracerebral hemorrhage or other serious adverse neurological effect related to the DBS. Wound complications occurred in two patients. There are many literatures that support DBS as a treatment option for pediatric patients with medically refractory neurological disorders. DBS has replaced ablative procedures as a treatment of choice not only for adult patients, but also for pediatric patients. Wound-related complications still remain the most common problem in pediatric patients. Development of smaller and more flexible hardware will improve quality of children's life and minimize wound-related complications in the future.

A Clinical Study and Management of Inguino-scrotal Swellings In Children

Aims and Objectives: To know the most common surgical problems in pediatric patients presented with inguino-scrotal swellings and management done routinely.
 Methodology: This study was carried out in the department of general surgery, Sharadaben hospital and pediatric surgery of VS hospital, Ahmedabad. The cases were studied for a period of about one year (January, 2017 to Dec, 2017) and all children below 12 years of age, presenting to us with inguinoscrotal swellings were included in this study. The information was analysed in terms of age, diagnosis, procedure carried out and outcome.
 Results: Amongst the 150 children under the age of 12 years, 143 patients were males and 7 were females. Among these 150, 52 cases were of hydrocoele, 70 cases of hernia (of which 63 were males and 7 were females), 25 cases of undescended testis and 3 cases of epididymo orchitis were documented. All cases underwent simple herniotomy for hernia and hydrocoele, orchidopexy for undescended testis. The length of hospital stay ranged from 2-4 days with mean of 2.46 days. 11 children in the study were documented to have short term complications, all of which were recognised in the hospital and managed with good results.
 Conclusion: Hernia and Hydrocoele in children are often congenital and diagnosed clinically (history and examination). Indirect inguinal hernia are more common than other groin hernias. Open herniotomy is the operation of choice for inguinal hernia in children.