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...

Introduction. Visceral artery aneurysms are uncommon. Among them, splenic artery is the most common (46–60%). Most splenic artery aneurysms are asymptomatic and diagnosed incidentally, but its rupture, potentially fatal, occurs in up to 8% of cases. Presentation of Case. A female patient, 64 years old, diagnosed with a giant aneurysm of the splenic artery (approximately 6.5 cm in diameter) was successfully submitted to endovascular treatment by stent graft implantation. Discussion. Symptomatic aneurysms and those larger than 2 cm represent some of the main indications for intervention. The treatment may be by laparotomy, laparoscopy, or endovascular techniques. Among the various endovascular methods discussed in this paper, there is stent graft implantation, a method still few reported in the literature. Conclusion. Although some authors still consider the endovascular approach as an exception to the treatment of SAA, in major specialized centers these techniques have been consolidated as the preferred choice, reserving the surgical approach in cases where this cannot be used. For being a less aggressive approach, it offers an opportunity of treatment to patients considered “high risk” for surgical treatment by laparotomy/laparoscopy.

Purpose: Conservative management has been largely used for renal trauma. Although this approach is safe and highly recommended, it can hide a pre-existing unknown condition, such as tumors or urinary malformations. A high index of suspicion is needed for early recognition of these conditions. We present four cases treated at the Pediatric Oncology Institute -Federal University of São Paulo, which have been initially treated conservatively for renal trauma. Materials and Methods:We reviewed all 218 renal cases of renal tumors treated at our institution in a 22-year period, searching for associated trauma events. Results: Four cases of renal tumors were initially treated conservatively for blunt renal trauma of low energy mechanism. Patients' ages ranged from 7 to 12 years old. Two patients had no previous symptoms, one patient had hematuria and another had an abdominal mass. Computerized Axial Tomography (CT) of the abdomen revealed disparate magnitude of the renal bleeding to the low energy mechanism of trauma. All patients underwent surgical treatment. Kidney specimens showed Wilms tumor in three cases and renal carcinoma in one. Conclusions:The association between renal tumors and trauma should be suspected when renal trauma hemorrhage on abdominal CT scan does not match the low energy mechanism of blunt abdominal trauma. The key for a successful diagnosis of renal tumor or congenital malformations is the high index of suspicion for these conditions.

Background:Thyroid gland malignancies are rare in pediatric patients (0.7% of tumors); only 1.8% are observed in patients aged &lt;20 years, with a higher prevalence recorded in women and adolescents. Risk factors include genetic syndromes, MEN disorders, autoimmune diseases, and exposure to ionizing radiation. Radiotherapy is also associated with an increased risk of secondary thyroid cancer. This study describes the clinical features and surgical outcomes of primary and secondary thyroid tumors in pediatric patients.MethodsInstitutional data were collected from eight international surgical oncology centers for pediatric patients with thyroid cancer between 2000 and 2020. Statistical analyses were performed using the GraphPad Prism software.ResultsAmong 255 total cases of thyroid cancer, only 13 (5.1%) were secondary tumors. Primary thyroid malignancies were more likely to be multifocal in origin (odds ratio [OR] 1.993, 95% confidence interval [CI].7466–5.132, p = 0.2323), have bilateral glandular location (OR 2.847, 95% CI.6835–12.68, p = 0.2648), and be metastatic at first diagnosis (OR 1.259, 95% CI.3267–5.696, p &gt; 0.999). Secondary tumors showed a higher incidence of disease relapse (OR 1.556, 95% CI.4579-5.57, p = 0.4525) and surgical complications (OR 2.042, 95% CI 0.7917–5.221, p = 0.1614), including hypoparathyroidism and recurrent laryngeal nerve injury. The overall survival (OS) was 99% at 1 year and 97% after 10 years. No EFS differences were evident between the primary and secondary tumors (chi-square 0.7307, p = 0.39026).ConclusionsThis multicenter study demonstrated excellent survival in pediatric thyroid malignancies. Secondary tumors exhibited greater disease relapse (15.8 vs. 10.5%) and a higher incidence of surgical complications (36.8 vs. 22.2%).

Resumo: O estudo teve como objetivo descrever a experiência da Educação Permanente em Saúde vivenciada pelos profissionais de saúde de um serviço pré-hospitalar móvel de urgência. Estudo descritivo, de natureza qualitativa, desenvolvido com 36 profissionais do SAMU-192 de Juazeiro-BA. Os dados foram obtidos mediante entrevista semi-estruturada, e analisados por meio da análise de conteúdo. O núcleo de educação do serviço não se encontra implantado e a sobrecarga de trabalho foi apontada como um desafio para a consolidação. Conclui-se que estratégias educativas são componentes essenciais para o fortalecimento e melhoria do componente pré hospitalar móvel de atenção às urgências.Descritores: Educação em Saúde, Socorro de Urgência, Educação ContinuadaStanding in health education: experience of health professionals of pre-hospital care serviceAbstract: The study aimed to analyze the experience of Continuing Education in Health experienced by health care professionals in assisting the pre-hospital mobile emergency in the municipality of Juazeiro-BA. Descriptive and Quantitative research, developed with 36 professional working in the SAMU-192 to Juazeiro-BA. Data were obtained through interviews using a semi-structured, between September and October 2010, and analyzed using content analysis. For most respondents, the term Continuing Education in Health has an ongoing process of meaning within the required service in terms of individual growth and not as a process of collective change. Conclude that the found a profile of professionals interested and willing to achieving the Education Center in the SAMU emergency Juazeiro-BA, which is not deployed.Descriptors: Health Education, Emergency Relief, Education ContinuingEducación permanente para la salud: experiencia de los profesionales de atención móvil de emergenciaResumen: Analizar la experiencia de Educación Continua en Salud experimentado por profesionales de la salud en la asistencia de emergencia pre-hospitalaria móvil en el municipio de Juazeiro-BA. Métodos: La investigación cualitativa, de tipo exploratorio y descriptivo, desarrollado con 36 profesionales que trabajan en el SAMU-192 a Juazeiro-BA. Los datos se obtuvieron a través de entrevistas semi-estructurada, entre septiembre y octubre de 2010, y se analizaron mediante análisis de contenido. Resultados: Para la mayoría de los encuestados, el término Educación Continua en Salud cuenta con un proceso continuo de significado dentro del servicio requerido en términos de crecimiento individual y no como un proceso de cambio colectivo. Conclusión: Se encontró un perfil de los profesionales interesados y dispuestos a lograr el Centro de Educación en la emergencia SAMU Juazeiro-BA, que no se ha implementado.Descriptores: Educación en Salud, Socorro de Urgencia, Educación Continua