Background: The most frequent cause of paediatric acute abdomen is acute appendicitis. If acute appendicitis is not treated promptly, one third of cases progress to complicated appendicitis. Complicated appendicitis is associated with significant morbidity and its management protocol differs significantly from that of uncomplicated appendicitis. In this study, we assessed the relationship between serum sodium levels and complicated appendicitis. Methods: We conducted a prospective observational study from July to December 2020 at the Department of Neonatal and Paediatric Surgery, The Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, on a sample size of 140 patients who met inclusion and exclusion criteria. For this study, we divided the patients into two groups. Group 1 had uncomplicated appendicitis and Group 2 had complicated appendicitis. These findings were then compared to preoperative serum sodium (Na) levels. Results: The median serum sodium level in group 1 (uncomplicated appendicitis) was 137.81 mg/dl, while in group 2 it was 131.35 mg/dl (Complicated Appendicitis). The sensitivity and specificity of serum sodium levels at a cut-off point of less than 135 mg/dl were 84.80% and 89.40%, respectively. Conclusion: Hyponatremia is currently thought to be a new marker for differentiating between complicated and uncomplicated appendicitis. It is a low-cost, high-efficiency predictive marker for diagnosing and differentiating complicated appendicitis in children.
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.
Background: Labial synechiae is a fairly common gynaecological problem that occurs as a result of inflammation leading to fusion between the labia minora. Being in a developing country with limited resources and poor compliance of patients to prolonged treatments, we are faced with immense challenges in the management of these girls. Aims: We wanted to evaluate the efficacy and the cost-effectiveness of manual separation and topical antibiotics with perineal hygiene in the management of pre-pubertal girls with labial synechiae. Materials and Methods: Design: Prospective, non-randomised interventional study. Participant: Pre-pubertal girls presenting with the diagnosis of labial synechiae in the period from September 2015 to January 2018. Interventions: Manual separation followed by topical antibiotic ointment application for 1 week with local hygiene. Outcomes measure: Complete release of the synechiae and no recurrence up to 6 months. Results: Out of the total 55 patients, only 48 patients were included, their age ranged from 3 months to 7 years (mean 2.8 years). Almost half of our patients were asymptomatic, and other half had symptoms (urinary tract infection, dripping of urine and itching). Majority of our patients belong to low middle class status. We had 100% complete release of synechiae and no recurrence on 6 months follow-up. Conclusion: Manual separation followed by topical antibiotics is a cost-effective method of the treatment of labial synechiae with immediate response and low recurrence rate.
Objective: To compare the post-operative outcomes after skin closure with Vicryl as compared to Prolene in paediatric day case surgeries. Study Design: Comparative Cross-sectional Study Place and Duration of Study: Department of Paediatric Surgery, Children Hospital, Pakistan Institute of Medical Sciences, Islamabad for six months (1st November,2021 to 30th April,2022) Patients and Methods: A total of sixty patients under the age of 12 years, who presented for day-case surgeries were divided into two groups: Vicryl (group A) and Prolene (group B). A single surgical team performed all the surgeries. The incidence of outcomes, such as pain, hematoma, infection, suture breakage and keloid formation was recorded after the procedure. At the 30th post-operative day, the scar assessment scale was used to evaluate the wound's healing. Results: Comparitive Cross-sectional study was conducted on 60 patients who underwent surgeries, having 30 in each group. Age and scar score for both the groups were compared. There was no sigfnificant difference observed for age p = 0.628 and it was significant for scars p = 0.007. Incidence of pain and infection was not statistically significant p ≥ 0.05. No hematoma, keloids and suture breakage were observed in both the sutures. Success Rate of Vicryl was 76.7% and that of Prolene was 93.3%. Success was positively correlated with scar r = 0.685. Conclusion: In our paediatric samples, we analyzed and concluded that prolene suture was better as compared to vicryl in terms of pain and infection. Keywords: Absorbable sutures, Day-case surgeries, Non-absorbable sutures, Prolene, Vicryl.
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