Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...

Background Neonatal gastric perforation (NGP) is a rare, serious, and life-threatening condition which needs early recognition with prompt intervention for better prognosis. Its etiology is not yet well established, but multiple speculations have been put forth for its etiopathogenesis. Few most considered are traumatic, spontaneous, or secondary to inflammatory process like necrotizing enterocolitis. This study describes the etiological and prognostic factors for patients with NGP in our experience at a single center. Results A total of 46 neonates were included. Male gender predominated with M:F being 1.7:1. Most (n=36) neonates presented within 10 days of life whereas 8 neonates presented within 15 days. At presentation, gas under diaphragm was the most common radiologic finding in 25 (54.3%) neonates. On exploratory laparotomy, it was found that greater curvature was involved in maximum number of cases (n=27), followed by lesser curvature and anterior and posterior walls of the stomach. Most of perforations were within 1–5 cm in size. Gastrorrhaphy was done in all cases, and in two cases, feeding jejunostomy was done along with repair for feeding purpose. Finally, spontaneous NGP was diagnosed in 30 (60.8%), and NEC patches on other parts of the intestine were seen in 11 patients. Postoperatively, 28 neonates developed complications in the form of sepsis (n=13), wound infection (n=10), and burst abdomen (n=5). Regarding clinical outcome, 27 (58.7%) were discharged from the hospital whereas 19 (39.3%) patients died. Conclusion Our results show that spontaneous NGP is most commonly associated with NEC in our population, usually affecting the greater curvature. We observed a high mortality rate; however, good ICU care may improve the survival.

Congenital segmental dilatation (CSD) of the intestine is a rare developmental anomaly characterized by sharply demarcated dilatation of a gastrointestinal segment and may present with intestinal obstruction. We report three cases of CSD of the intestine in neonates with varied presentation. First patient was mistaken as pneumoperitoneum on abdominal radiograph, which led to initial abdominal drain placement. The 2nd patient was a case of anorectal malformation associated with congenital pouch colon (CPC) and CSD of ileum; and the third case presented as neonatal intestinal obstruction and found to have CSD of ileum. All the patients were successfully managed in our department.

Breast cancer has become a rapidly prevailing disease among women all over the world. In term of mortality, it is considered to be the second leading cause of death. Death risk can be reduced by early stage detection, followed by a suitable treatment procedure. Contemporary literature shows that mammographic imaging is widely used for premature discovery of breast cancer. In this paper, we propose an efficient Computer Aided Diagnostic (CAD) system for the detection of breast cancer using mammography images. The CAD system extracts largely discriminating features on the global level for representation of target categories in two sets: all 20 extracted features and top 7 ranked features among them. Texture characteristics using cooccurrence matrices are calculated via the single offset vector. Multilayer perceptron neural network with optimized architecture is fed with individual feature sets and results are produced. Data division corresponds as 60%, 20%, and 20% is used for training, cross-validation, and test purposes, respectively. Robust results are achieved and presented after rotating the data up to five times, which shows higher than 99% accuracy for both target categories, and hence outperform the existing solutions.

Duplication cysts of small bowel seldom present in newborns and usually represent the development of complications. In utero complications may lead to mesenteric vascular accidents and thus resulting in intestinal atresias. We report three neonates with duplication cyst of small bowel causing localized intestinal volvulus, leading to small bowel intestinal atresia/stenosis. The neonates underwent excision of the duplication cyst and resection anastomosis of the small bowel. Post-operative recovery was uneventful in all three of them.

Congenital hernia of umbilical cord is a less frequent entity in newborns and occasionally associated with other maladies. Herein, we report three cases of hernia of umbilical cord. First case was associated with in-utero evisceration of entire small bowel through the presumably ruptured hernia of umbilical cord and other two cases had associated patent vitellointestinal duct (PVID). All of the cases were managed successfully.

Background: In hypospadias surgery, despite continued refinement of various surgical procedures, there is no completely satisfactory technique in terms of complications and cosmesis. In recent literature, urethral mobilization and advancement (UMA) is gaining popularity in the management of distal penile hypospadias with no or very low complication rate as compared to all other techniques. The aim of this study is to share our results by using UMA in the management of anterior hypospadias with or without chordae. Results: A total of 60 patients of anterior hypospadias having the mean age 57.15 ± 38.73 months were included. The mean length of hospital stay was 2.83 ± 1.33 days. The only peroperative complication was urethral injury during urethral mobilization seen in one patient. The most common postoperative complication was hematoma seen in five (8.3%) cases. Two patients (3.3%) had retraction of urethra. One patient had wound infection. Stenosis was labeled in four (6.6%). At 3 months follow-up, 93.3% patients had slit-like meatus and good urinary stream. Conclusion: We found that UMA technique had good functional as well as excellent cosmetic outcome, so the technique can be adopted for anterior hypospadias correction.

Background: Generally, the healthcare workers have a stressful job and it includes both physical and mental stress. We conducted this study to determine the burnout among postgraduate residents (PGR’s). Methods: This cross-sectional study was conducted at The Children’s Hospital and The Institute of Child’s Health, Lahore over a period of 3 months. A total of 113 PGR’s participated in this study. Burnout was measured using Copenhagen Burnout Inventory (CBI). Questionnaire was filled by participants on paper. Results were analyzed through SPSS–26. Results: In this study, most of the participants (n=70) were females. Mean age of the participants was 28.6±2.035 years. More than 50% participants suffer from moderate to severe burnout. Nine percent of participants had high personal and client related burnout. The highest mean score was for personal burnout scale. When burnout scores were categorized according to demographic details, personal burnout was significantly higher among those who considered that they are burnout (p=0.000) and work burnout was significantly higher among those who travelled to the workplace by their cars (p=0.025). Burnout was higher among females, those who have long duration to travel from their homes to the hospital and whose parents were doctors; however, the difference was not significant. The scale showed a good overall internal reliability (Cronbach’s alpha=0.697). Conclusion: This study showed a high rate of burnout among PGR’s that needs to be addressed and adequate measures should be taken to reduce it.