Background: The survival and outcome of neonates with anorectal malformations (ARM) have much improved in the developed countries due to optimal perioperative and postoperative care but in developing countries, sepsis, low birth weight, delayed presentation, and lack of intensive care for neonates are still important in affecting the outcome. This study was carried out to evaluate factors of poor outcome (mortality) in neonates with ARM. Method: This is a prospective analytical study. A total of 44 consecutive neonates with Anorectal malformations (ARM) presenting to the Department of Pediatric Surgery, The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad, were included. Variables studied included age at presentation, gender, birth weight, type of malformation, sepsis at presentation, type of surgery performed, postoperative complications, and their relationship to the outcome. The statistical analysis was performed using SPSS version 21. Results: A total of 44 neonates with ARM were included in the study. In the study population, 56.8 % (25) were males and 43.2% (19) were females. The mean age at presentation was 2.1 ± 0.5 days. The mean birth weight was 2.5 ± 0.6 kg. Overall mortality was 29.5% (13) with 13.63% (6) patients died pre-operatively. The most common cause of death in postoperative patients was sepsis (40%). There was a statistically significant relationship between low birth weight (P= <0.01) and sepsis at presentation (P=0.001) with mortality. No statistically significant association was found when the outcome was compared with age at presentation (P=0.21) and postoperative complications (P=0.16). Conclusion: In developing countries, the lack of resources, lack of trained midwives/LHVs, intensive care are contributing factors to sepsis and delayed presentation, and ultimately mortality. Good antenatal care, awareness of the midwives/Lady Health Visitors to refer such patients in time, and provision of adequate intensive care can improve the outcome of surgery in ARMs.
Objective: The objective of this study is to determine diagnostic accuracy of ultrasonography for diagnosis of Intussusception in children taking surgical findings as gold standard. Study Design: Cross sectional study Place and Duration of Study: The department of Pediatricsurgery,Children Hospital and Institute of Child Health, Lahore and PIMS Children Hospital,Islamabad during the time period from June 2019 to May 2021. Methodology: 170 children fulfilling inclusion criteria were taken. After taking informed consent from parents or attendants of the children a detailed history was taken regarding their age, gender and address. All patients with symptoms and signs such as vomiting, abdominal pain and/or distension, rectal bleeding, pallor or lethargy were admitted. They were examined and investigated through ultrasound. The final diagnosis of Intussusception was confirmed on surgery by expert consultant with experience more than 5 years after postgraduation. Ultrasonographic images taken at the time of diagnosis were obtained. Results: The mean age of children was 3.56±3.29 years with 105(61.8%)male children and 65(38.2%)females.The Ultrasound results showed positive result in 97 (57.1%) children and negative in 73 (42.9%) children.The Surgical findings showed positive results in 107 (62.9%) and negative in 63 (37.1%) children.The sensitivity, specificity, Negative Predictive Value (NPV), and Positive Predictive Value (PPV) for ultrasound keeping surgical findings in diagnosis of intussusception were 85.05%, 90.48%, 93.81%, and 78.08% respectively, whereas, the overall diagnostic accuracy was 87.06%. Conclusion: It is concluded that ultrasonography for diagnosis of Intussusception in children is very useful diagnostic modality. USG can help us for prompt and timely diagnosis and early surgical intervention can be done to minimize morbidity related to delayed diagnosis. Keywords:Intussusception, Abdominal surgery, Imaging, Ultrasound, Accuracy
Objective: The aim of this study is to determine the effectiveness of muscle sparing axillary skin incision (MISASCI) among patients of late paediatric empyema thoracic were undergone decortication. Study Design: A prospective study Place and Duration: The study was conducted at Children Hospital and Institute of Child Health Lahore and Women and Children Hospital Rajjar, Charsada during the period from December 2020 to May 2021. Methods: Total 50 children of both genders were presented in this study. Patients were aged 1 month-12 years. Patients’ detailed demographics age, sex and weight were calculated after taking informed written consent from authorities. Patients had late paediatric empyema thoracic were enrolled. MSASCI was used for decortication among all cases. Effectiveness of incision was calculated post-operatively in terms of visibility and size of scar, intraoperative exposure and access to the lobes. Complete data was analyzed by SPSS 23.0 version. Results: There were 30 (60%) male and 20 (40%) females with mean age 7.14±7.44 years. Mean body weight of the children was 16.58±9.74 kg. We found pyopneumothorax in 20 (40%), followed by encysted empyema in 12 (24%), multiloculated empyema in 9 (18%), bilateral Empyema thorax in 5 (10%),and diaphragmatic hernia in 4 (8%). Adequate exposure was seen among 49 (98%) cases. Chest tube was removed within 5.87±4.54 days. Good lung expansion was found in 47 (94%) cases. Air leak was found among 6 (12%) cases. Frequency of scars was very low only among 4 (8%) cases. Conclusion: We concluded in this study that MSASCI was effective for decortication among patients of late paediatric empyema thoracic in terms of post-operative good lung expansion, adequate exposure with minimum numbers of scars and less complications i.e air leak in all cases. Keywords: MSASCI, Paediatric Empyema Thoracic, Decortication, Complications
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