Pain Management in Pediatric Burns: A Review of the Science behind It.

Pediatric burns are a significant medical issue that can have long-term effects on various aspects of a child's health and well-being. Pain management in pediatric burns is a crucial aspect of treatment to ensure the comfort and well-being of young patients. The causes and risk factors for pediatric burns vary depending on various factors, such as geographical location, socioeconomic status, and cultural practices. Assessing pain in pediatric patients, especially during burn injury treatment, poses several challenges. These challenges stem from various factors, including the age and developmental stage of the child, the nature of burn injuries, and the limitations of pain assessment tools. In pediatric pain management, various pain assessment tools and scales are used to evaluate and measure pain in children. These tools are designed to account for the unique challenges of assessing pain in pediatric patients, including their age, developmental stage, and ability to communicate effectively. Pain can have significant physical, emotional, and psychological consequences for pediatric patients. It can interfere with their ability to engage in daily activities, disrupt sleep patterns, and negatively affect their mood and behavior. Untreated pain can also lead to increased stress, anxiety, and fear, which can further exacerbate the pain experience. Acute pain, which is short-term and typically associated with injury or illness, can disrupt a child's ability to engage in physical activities and impede their overall recovery process. On the other hand, chronic pain, which persists for an extended period, can have long-lasting effects on physical functioning and quality of life in children. The psychological consequences of burns can persist long after the physical wounds have healed, leading to ongoing emotional distress and impaired functioning. Multimodal pain management, which involves the use of multiple interventions or medications targeting different aspects of the pain pathway, has gained recognition as an effective approach for managing pain in both children and adults. However, it is important to consider the specific needs and considerations of pediatric patients when developing evidence-based guidelines for multimodal pain management in this population. Over the years, there have been significant advances in pediatric pain research and technology, leading to a better understanding of pain mechanisms and the development of innovative approaches to assess and treat pain in children. Overall, pain management in pediatric burns requires a multidisciplinary approach that combines pharmacologic and nonpharmacologic interventions.

Comparison of Type I and Type III Collagen Concentration between Oreochromis mossambicus and Oreochromis niloticus in Relation to Skin Scaffolding.

Background and Objectives: Skin scaffolding can be done using allografts and autografts. As a biological allograft, the skin of Oreochromis niloticus (ON) has been used due to its high type I and III collagen content. Oreochromis mossambicus (OM) is also a member of the Oreochromis family, but not much is known regarding its collagen content. As such, this study aimed to assess and compare the collagen content of the two fish species. Materials and Methods: This is a crossover study comparing the skin collagen contents of the two fish. Young fish were chosen, as they tend to have higher collagen concentrations. The skin samples were sterilized in chlorhexidine and increasing glycerol solutions and analyzed histochemically with Sirius red picrate under polarized light microscopy. Results: 6 young ON and 4 OM specimens were used. Baseline type I collagen was higher for OM, but at maximum sterilization it was higher for ON, with no differences in between Type III collagen was higher for OM across all comparisons with the exception of the last stage of sterilization. Generally, collagen concentrations were higher in highly sterilized samples. Conclusions: OM skin harvested from young fish, with its greater collagen III content may be a better candidate for use as a biological skin scaffold in the treatment of burn wounds, compared to ON.

Peritoneal Dialysis Catheter Placement in Children: Initial Experience with a "2+1"-Port Laparoscopic-Assisted Technique.

The placement of a peritoneal dialysis catheter (PDC) is currently a common procedure in pediatric surgeon practice, and the search for the ultimate technique never stops. The purpose of this study is to evaluate our experience with the laparoscopic PDC placement approach, performing a "2+1" ("two plus one") technique, where the "+1" trocar is placed in an oblique manner, pointing toward the Douglas pouch when passing through the abdominal wall. This tunnel is further used to place and maintain the proper position of the PDC. MATERIALS AND METHODS: We assessed a cohort of five children who underwent laparoscopic-assisted PDC placement between 2018 and 2022. RESULTS: This procedure is a simple, relatively quick, and safe technique for PDC placement. Furthermore, in our experience, concomitant omentectomy is necessary to reduce the risk of catheter obstruction and migration due to omental wrapping. CONCLUSIONS: The laparoscopic approach allows for improved visualization and more accurate placement of a catheter inside the abdominal cavity. Concomitant omental excision is necessary to prevent PDC malfunction and migration.

Current Concepts in the Etiology and Pathogenesis of Pectus Excavatum in Humans-A Systematic Review.

Pectus excavatum (PE) is the most common deformity of the chest wall and is characterized by the posterior depression of the sternum and the lower costal cartilages. To date, the etiology of PE in humans remains enigmatic. Several etiologic hypotheses have been proposed over the past two centuries. However, most of them have been scientifically dismissed and now have only historic value. In this systematic review, we assess scientific publications of the past two centuries addressing the issue of the origin of PE in humans. We present and discuss the histologic, genetic, biomechanical, and experimental scientific achievements that contributed to the clarification of its etiology and pathogenesis. With no clear consensus over the exact mechanism, most recent studies agree that the primordial defect leading the deformation of the anterior chest wall in PE is related to the costal hyaline cartilage structure and function. Further studies on this subject must be carried out. Genetic studies seem to be the most promising way to understand the exact mechanism of PE's origin and pathogenesis.

Costal cartilage overgrowth does not induce pectus-like deformation in the chest wall of a rat model.

Overgrowth of the costal cartilages has been frequently reported to be an etiological factor of chest wall deformities in children. The present study aimed to investigate if induced overgrowth of the costal cartilages could lead to deformation of the chest wall in a rat model. An insulin-like growth factor 1 (IGF1) solution was directly injected under the perichondrium of the last three costal cartilages of 2-week-old rat pups. Two different concentrations, 50 µg/ml (E50) and 100 µg/ml (E100), were applied. This procedure was repeated once per week for 5 consecutive weeks. Subsequently, 14 days after the last injection, all animals were euthanized before the shape of the thoracic cage was assessed, and the diameter was measured. In addition, the last three costal cartilages were dissected before the samples were prepared and examined by light microscopy. Rats that received E100 exhibited larger sagittal and coronal rib cage diameters compared with those in the E50 and control groups. However, no deformation could be observed in the chest wall. Microscopic examinations revealed an anabolic pattern in the E100 group. The present findings suggested that locally administered IGF1 stimulated cell proliferation and tissue growth in coastal cartilages in a dose-dependent manner in vivo. However, this induced overgrowth of the costal cartilages did not result in the deformation of the chest wall.

Expression of ß1 adrenergic receptor in vascular anomalies in children.

OBJECTIVE: Controversial, heterogeneous, and inconsistent responses to beta-blockers have been reported in some cases of infantile proliferative hemangiomas. On the basis of these clinical observations, we aimed to examine the ß1 adrenergic receptor (ß1-AR) protein expression distribution among different types of pediatric vascular anomalies. METHODS: Immunohistochemistry (IHC) was performed for ß1-AR on 43 surgical specimens. RESULTS: We found positive ß1-AR IHC staining in all intramuscular hemangiomas, capillary-lymphatic, lymphatic, venous, and combined malformations, and Masson's tumor cases, as well as in 7 of 10 cases of proliferative infantile hemangiomas. CONCLUSIONS: Our research demonstrates, for the first time, the degree of heterogeneous expression of ß1-AR among pediatric vascular malformations. Our results support the need for ß1-AR assessment in pediatric vascular anomalies to select cases with a robust response to ß1-selective blockers. ß1-AR assessment may have a strong impact on therapeutic refinement for pediatric vascular anomalies by selecting cases with a stronger response to beta-blockers.

Combined Staged Surgery and Negative-Pressure Wound Therapy for Closure of a Giant Omphalocele.

The management of giant omphaloceles had always been a point of interest for the pediatric surgeons. Many surgical techniques were proposed, but none of them succeeded to become the standard procedure in closing the congenital abdominal defect. We present a case of giant omphalocele in which we used staged surgical closure combined with a prosthetic patch, with negative-pressure therapy and, finally, definitive surgical closure. Even though a major complication occurred during the treatment, we were able to close the defect without any prosthetic material left in place.

Upper Extremity Fractures in Children-Comparison between Worldwide, Romanian and Western Romanian Region Incidence.

(1) Background: Fractures represent a significant part of all pediatric injuries, with distal forearm fracture being the most common fracture type in children. (2) Methods: In this comparative, epidemiological study we collected fracture incidence data from the scientific literature and compared it to real-world data extracted from the Romanian national and regional hospital database. In order to collect information on the epidemiology of upper extremity fractures in children, we conducted a systematic literature review on Medline, via PubMed. Extracted incidence data were stratified by fracture location, age or age interval and gender. Nationwide and Western Region incidence values were calculated for different fracture locations of the upper extremity using data extracted from a centralized hospital database. Incidence values were calculated using the mid-2018 census data. The search was restricted to the pediatric population. (3) Results: Incidence values for upper arm fractures nationwide and for Western Region were 54.83/100,000 person-years and 64.79/100,000 person-years, respectively. Forearm fractures had an incidence of 139.77/100,000 person-years and 139.56/100,000 person-years, respectively. The overall incidence of upper extremity fractures nationwide and for the Romanian Western Region were 206.02/100,000 person-years and 220.14/100,000 person-years, respectively. (4) Conclusions: Incidence of upper extremity fractures in the pediatric population varies according to the analyzed data. The calculated incidence depends on the site of fractures, assessed population (worldwide, Romanian population or regional-Western part of Romania) or patients' age.

Rat Animal Model of Pectus Excavatum.

BACKGROUND: pectus excavatum (PE) is the most common congenital deformity of the thoracic wall. Lately, significant achievements have been made in finding new, less invasive treatment methods for PE. However, most of the experimental work was carried out without the help of an animal model. In this report we describe a method to create an animal model for PE in Sprague-Dawley rats. METHODS: We selected 15 Sprague-Dawley rat pups and divided them into two groups: 10 for the experimental group (EG) and 5 for the control group (CG). We surgically resected the last four pairs of costal cartilages in rats from the EG. The animals were assessed by CT-scan prior to surgery and weekly for four consecutive weeks. After four weeks, the animals were euthanized and the thoracic cage was dissected from the surrounding tissue. RESULTS: On the first postoperative CT, seven days after surgery, we observed a marked depression of the lower sternum in all animals from the EG. This deformity was present at every CT-scan after surgery and at the post-euthanasia assessment. CONCLUSIONS: By decreasing the structural strength of the lower costal cartilages, we produced a PE animal model in Sprague-Dawley rats.

Smartphone Use and Postural Balance in Healthy Young Adults.

Maintaining an upright posture while talking or texting on the phone is a frequent dual-task demand. Using a within-subjects design, the aim of the present study was to assess the impact of a smartphone conversation or message texting on standing plantar pressure and postural balance performance in healthy young adults. Thirty-five subjects (mean age 21.37 ± 1.11 years) were included in this study. Simultaneous foot plantar pressure and stabilometric analysis were performed using the PoData system, under three conditions: no phone (control), talking on a smartphone (talk) and texting and sending a text message via a smartphone (text). Stabilometric parameters (center of pressure (CoP) path length, 90% confidence area and maximum CoP speed) were significantly affected by the use of different smartphone functions (p < 0.0001). The CoP path length and maximum CoP speed were significantly higher under the talk and text conditions when compared to the control. CoP path length, 90% confidence area and maximum CoP speed were significantly increased in talk compared to text and control. Talking on the phone also influenced the weight distribution on the left foot first metatarsal head and heel as compared with message texting. Postural stability in healthy young adults was significantly affected by talking and texting on a smartphone. Talking on the phone proved to be more challenging.

The Value of Imagistics in Early Diagnosis of Tuberous Sclerosis.

Tuberous sclerosis complex is a multisystemic genetic disorder with high phenotypical variability. Its progress frequently brings along autism (61%), epilepsy, intellectual disability (45%), and neurocognitive impairment (Gipson and Johnston, 2017). We are considering the case of an infant suspected with tuberous sclerosis complex by imagistic investigation in the prenatal period. The pre- and postnatal ultrasound, fetal MRI, ophthalmoscopy, and dermatological and neurological examinations were used for diagnosis and follow-up. The seven major and minor criteria were regarded as sufficient for accurate diagnosis.

Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children.

Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.

Do different dental conditions influence the static plantar pressure and stabilometry in young adults?

BACKGROUND: Posture is influenced by many factors and dental occlusion seems to have its role on postural stabilization. Our rationale to perform the study was to find out if there are differences of static plantar pressure and stabilometric parameters depending on different dental conditions. METHODS: The observational study consisted in plantar pressure assessment and stabilometric analysis of 95 right-handed healthy volunteer subjects (mean age 22.94 ± 2.52 years) by using the PoData system. Each subject followed four measurements with open eyes: mandibular postural position, maximum intercuspation, biting on cotton rolls and maximum mouth opening. Plantar pressure was recorded on 1st and 5th metatarsal heads and heel, and was expressed as percentage of weight distribution on each foot. The recorded centre of pressure (CoP) parameters were: CoP path length, 90%confidence ellipse area and maximum CoP speed. Statistical analysis used repeated-measures ANOVA with Bonferroni posthoc analysis and Friedman test. RESULTS: Loading on the left 5th metatarsal head was significantly higher in maximum mouth opening condition when compared to maximum intercuspation and to biting on cotton rolls. The left heel loading was significantly lower in the maximum mouth opening in comparison to maximum intercuspation. The CoP path length and maximum CoP speed were significantly higher in maximum mouth opening compared to the other three conditions. Confidence ellipse area had significantly lower values in maximum intercuspation and in the biting on cotton rolls conditions compared to the mandibular postural position, and in maximum intercuspation compared to maximum mouth opening. CONCLUSION: In young adults with an optimum functional occlusion the static plantar pressure is influenced by the maximum mouth opening. An improved postural stability was recorded in maximum intercuspation (a condition used during swallowing) in comparison to mandibular postural position (a condition that allows relaxation of the masticatory muscles after functional moments).

The Financial Burden of Setting up a Pediatric Robotic Surgery Program.

Background and Objectives: Robotic surgery is currently at the forefront of both adult and pediatric treatment. The main limit in the wide adoption of this technology is the high cost of purchasing and running the robotic system. This report will focus on the costs assessment of running a robotic program in a pediatric surgery center in Romania. Materials and Methods: In 12 months we performed 40 robot-assisted procedures in children. We recorded and analyzed data regarding their age, gender, pathological condition and comorbidities, surgical procedure, time of surgery, complications, hospital stay and related costs, medication, robotic instruments and consumables, additional cost, and income per case received from the National Insurance Company (NIC). Results: Mean cost per case was €3260.63 (€1880.07 to €9851.78) and was influenced by type of the procedure, intraoperative incidents, postoperative complication, and non-scheduled reinterventions (p < 0.05). The direct costs for operating the surgical robot were relatively constant, regardless of the surgical procedure (mean €1579.81). The reimbursement from the NIC ranged from 5% to 56% (mean 16.9%) of the total cost per case. Conclusion: In Romania, a pediatric surgery robotic program is not cost-efficient and cannot operate relying solely onto the health insurance system.

Early Prediction of Sepsis Incidence in Critically Ill Patients Using Specific Genetic Polymorphisms.

Several diagnostic methods for the evaluation and monitoring were used to find out the pro-inflammatory status, as well as incidence of sepsis in critically ill patients. One such recent method is based on investigating the genetic polymorphisms and determining the molecular and genetic links between them, as well as other sepsis-associated pathophysiologies. Identification of genetic polymorphisms in critical patients with sepsis can become a revolutionary method for evaluating and monitoring these patients. Similarly, the complications, as well as the high costs associated with the management of patients with sepsis, can be significantly reduced by early initiation of intensive care.

Costal Cartilages Do Not Overgrow in Patients with Pectus Excavatum.

OBJECTIVE: The purpose of this study was to determine whether or not patients with pectus excavatum (PE) exhibit costal cartilage overgrowth compared to normal subjects. MATERIALS AND METHODS: The computed tomography acquisitions of 32 patients with PE and 35 normal controls were analyzed. On axial images the length of the 4th-7th costal cartilages was measured to calculate the Haller index. The ratio between the length of the cartilages and the median of the transverse and longitudinal thorax diameters were recorded to account for anatomical variability. The length of the cartilages was compared between the PE and control subjects using the independent-samples t test. For patients with asymmetric PE the length of the 4th-7th costal cartilages was compared between the rotated and nonrotated sides. RESULTS: The mean transverse and coronal thorax diameters were 233.29 ± 24.47 and 231.69 ± 22.47 mm for PE patients and 252.67 ± 37.25 and 238.64 ± 27.40 mm for controls, respectively, with no significant differences between the two groups (p = 0.816 and 0.145). The mean sagittal diameter (59.30 ± 14.21 mm) and Haller index (4.02 ± 1.34) in the PE group were significantly different from the controls (107.34 ± 19.59 and 2.2 ± 0.54 mm, respectively; p = 0.00). Actual and relative lengths of costal cartilages were similar in both PE subjects and controls for all 4 costal cartilages measured. In subjects with asymmetric PE, both relative and absolute costal cartilage lengths were similar on the rotated and nonrotated side. CONCLUSIONS: The length of the 4th, 5th, 6th and 7th costal cartilages was similar in PE patients and the control subjects. These was also similar between the rotated and nonrotated sides of the sternum in patients with asymmetric PE.