Patterns of spinal cord malformation in cloacal exstrophy.

OBJECTIVE: The objective of this study was to assess the prevalence and spectrum of spinal dysraphism in a cohort of children with cloacal exstrophy (CEX) using MRI. METHODS: Children with CEX presenting between 1999 and 2019 with baseline spinal MRI were included. The images were reviewed in consensus to assess the type of dysraphism. The dysraphisms were initially reviewed and described based on their descriptive anatomy, and then classified according to anomalies of gastrulation, primary neurulation, or secondary neurulation. RESULTS: Thirty-four children were included. Thirty-three of these children had closed spinal dysraphism, and 1 had a normal spine. Of the 33 cases of closed spinal dysraphism, the conus and/or filum terminale were involved in all cases. The most common malformations were spinal lipoma (n = 20) and terminal myelocystocele (n = 11). The lipomas were heterogeneous: 4 dorsal, 9 transitional, 4 chaotic, and 3 terminal. A large subgroup (10/20, 50%) within the lipomas had an unusual morphology of noncontiguous double lipomas, the proximal fat related to the conus and the distal fat within the filum. These were difficult to characterize using existing classifications. In 2 cases, only a thickened filum was noted. The majority of these malformations were compatible with a disorder of secondary neurulation. CONCLUSIONS: Complex spinal dysraphisms are consistently associated with CEX. The unusual dysraphism patterns found in this group of patients highlight the limitations of current embryological classifications. Given the propensity for neurological deterioration in this group of patients, spinal MRI should be routinely performed. The type and distribution of malformations seen have implications for the wider understanding of the pathogenesis and classification of lumbosacral lipomas.

Pharmacists' perception of their role during COVID-19: a qualitative content analysis of posts on Facebook pharmacy groups in Jordan.

OBJECTIVE: This study aimed to evaluate the content available on Facebook pharmacy groups in Jordan regarding the perception of the pharmacists' role during the coronavirus pandemic in Jordan. METHODS: Researchers identified Facebook pharmacy groups through the search engine on the Facebook website. The main search keywords were pharmacy, pharmacist, pharmacists, and Jordan using both Arabic and English. Two researchers analyzed the posts and discussion threads on local pharmacy Facebook groups in a period between March 20th and April 3rd. A total of 184 posts and threads were identified for the purpose of the study. RESULTS: Identified threads and responses resulted in three overarching themes: pharmacists having a positive role during the pandemic, taking additional responsibilities and services, and having passive or negative roles. A positive role was seen in pharmacists acting as first-line healthcare providers, creating public's awareness regarding COVID-19, and being responsible for chronic medication refill during the pandemic. Taking additional responsibilities was summarized in home deliveries and involvement in industrial and corporate efforts to deal with the pandemic. A passive/negative role was seen mostly among hospital pharmacists not being proactive during the pandemic and by pharmacists trying to maximize profits during pandemic time. CONCLUSIONS: Pharmacists perceived their role as a positive role during the coronavirus pandemic. Not only they took responsibilities for their daily services during the crises, but they took additional responsibilities to assure patient safety and satisfaction.

Readmission within 30 days of discharge (ReAd): a quality-of-care indicator in paediatric surgery.

PURPOSE: Following a previously published 1 year audit of readmissions, this is a reaudit of our readmission rate (ReAd) in paediatric surgery, asking: is ReAd reproducible, can it be an indicator of quality of care in paediatric surgery, and can it be improved? METHOD: Prospectively collected Hospital Episode statistics were used to identify readmissions over 1 year. Patients were subdivided into emergency vs elective regarding the first admission and outcomes compared including with our previously published ReAd data. RESULTS: 2616 children (67% male) were admitted during 2016: 1398 (53%) elective and 1218 (47%) emergency admissions. The overall ReAd was 0.9%, comparable to and lower than our previously published rate of 2%. The commonest cause for readmission was appendicitis-related (22%). The emergency cohort ReAd was 1.5% (18/1218) compared to 0.4% (5/1398) in the elective cohort, 4× higher (p = 0.002). In the emergency cohort, the commonest causes for readmission were abdominal pain and perforated appendicitis. 80% of elective group readmissions were related to urological procedures. More of these required surgical intervention to treat (80% vs 22%) (p = 0.03). CONCLUSION: (1) ReAd is a reproducible and reducible quality-of-care indicator in paediatric surgery. (2) Emergency admission is a risk factor for readmission. (3) Appendicectomy was associated with the highest ReAd.

Foreign body ingestion in prisoners - the Belfast experience.

Deliberate ingestion of foreign bodies is common amongst prison inmates. The motives behind the ingestion are variable. As the only designated hospital in Northern Ireland treating acute surgical pathologies in the prison population, we reviewed our experience of foreign body ingestion between March 1998 and June 2007. Types of foreign objects, symptomatology, haematological analyses, radiological findings, operative intervention and complications were retrieved from case notes. A literature search was performed using Medline to correlate this clinical data with published evidence to produce therapeutic guidelines to assist the surgical multi-disciplinary team. Eleven prisoners presented with foreign body ingestion over the study period (M=8 and F=3, mean age: 28.1 years, range 21-48). Mean follow-up was 597 days (range 335-3325 days). Although the literature states that most foreign bodies usually pass spontaneously without the need for intervention, this study demonstrates a higher intervention rate of 36% within the Northern Irish prison population in comparison with other prisoners.