Post-Hypospadias Repair Penile Score in Follow-Up Patients of Urethroplasty.

BACKGROUND: Hypospadias is described as the abnormal location of the urethral meatus upon the ventral surface of the penis with variable association with the abnormal development of the urethral spongiosum, ventral prepuce, and penile chordee. Numerous studies have utilized techniques like "Penile Perception Score (PPPS)," "Hypospadias Objective Scoring System (HOSE)," and "Hypospadias Objective Penile Evaluation Score (HOPE)" to evaluate the outcome after hypospadias repair, but there is a lack of evidence analyzing the utility of "Post-Hypospadias Repair Penile Score (PHRPS)." This study was carried out to assess PHRPS in children undergoing hypospadias repair. METHODOLOGY: A prospective cohort study was conducted at the department of pediatric surgery, uni-II, The Children's Hospital and University of Child Health Sciences, Lahore, Pakistan from November 2020 to December 2021. All male children aged up to 12 years and planning to undergo hypospadias repair during the study period were included. The PHRPS system was used to assess the outcomes of hypospadias repair. Qualitative data were represented as frequency and percentage, while mean and standard deviation (SD) were calculated for quantitative data. RESULTS: During this period, a total of 37 children were treated for hypospadias. The mean age of the patients at the time of repair was 8.2±3.6 years, ranging between 1.5 years and 12 years. Out of 37 patients, 14 (37.8%) had penoscrotal hypospadias, while 12 (32.4%) had distal penile hypospadias. In terms of acute post-surgery complications, edema was reported in 9 (24.3%), bleeding 1 (2.7%), and surgical site infection 1 (2.7), while all of these were successfully managed conservatively. Seven patients were lost to follow-up, so they were excluded from the final analysis. On the basis of PHRPS scoring, 17 (56.7%) patients had excellent outcomes, 2 (6.7%) had good outcomes, 8 (26.7%) had acceptable outcomes, and 3 (10.0%) had poor outcomes. CONCLUSION: The PHRPS is a new but simple objective tool, facilitating surgical audit and balanced evaluation of the outcomes of traditional and innovative procedures. The outcome of hypospadias repair was generally found to be good.

Contrast Enema: Solving Diagnostic Dilemmas in Neonates With Lower Intestinal Obstruction.

Background Anatomical abnormalities leading to bowel movement failure are the major cause of intestinal obstruction. This study was done to assess the diagnostic efficacy of contrast enema in neonates with lower intestinal obstruction. Methodology This prospective study was conducted in The Children's Hospital and University of Child Health Sciences, Lahore from February 2021 to July 2021. Patients presenting with constipation, abdominal distension, vomiting, and unable to pass meconium, evaluated clinically and by X-rays, were included in the study. Patients with lower intestinal obstruction (i.e., meconium ileus, Hirschsprung's disease, ileal atresia, meconium plug syndrome, and small left colon) were given contrast enema (gastrografin) after hydration. The radiologist was blinded by the clinical diagnosis or reference standard diagnosis, which was labeled prior to image interpretation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for major contrast enema diagnosis. Results During this period, a total of 34 patients were included in the study. The mean age of presentation was 72.0 ± 24 hours. There were 21 (61.8%) boys and 13 (38.2%) girls, representing a male to female ratio of 1.7:1. In four cases, our diagnosis on the basis of contrast enema was proven wrong. Sensitivity, specificity, PPV, and NPV of Hirschsprung's disease were found to be 93.3%, 50%, 87.5%, and 66.7%, while these were 84.6%, 66.7%, 91.7%, and 50.0%, respectively, for meconium ileus. Conclusion The diagnostic efficacy of contrast enema was found to be good in neonates with lower intestinal obstruction. The spectrum of intestinal obstruction among neonates shows diversity while contrast enema seems to play a major role in the identification and remodeling of the diagnostic plan in a major proportion of cases.

Sutured Versus Sutureless Enterostomies: An Alternative Technique in Critically Sick Neonates.

Background and objective Intestinal perforations and necrotizing enterocolitis (NEC) requiring the formation of temporary intestinal stoma are prevalent conditions worldwide. This prospective study aimed to address the following research question: does sutureless enterostomy lead to fewer complications compared to conventional enterostomy in critically sick surgical neonates who need a stoma? Methods We conducted a randomized control trial (TCTR20211011004) from October 2020 to October 2021. A total of 120 patients were randomized to the following two study groups: Group A: conventional sutured enterostomy; Group B: sutureless enterostomy, with 60 patients in each group. The operative time, complications, and mortality were compared between the two groups using the chi-squared test. Results The groups were comparable with respect to the mean age at presentation, gestational age, weight, and sex ratio. In Group A, the main operative diagnoses were NEC in 22 patients, pneumoperitoneum in 25, complicated meconium ileus in nine, bowel atresia in three, and midgut volvulus in one; while in Group B, 25 patients had NEC, 20 had pneumoperitoneum, eight had meconium ileus, two had bowel atresia, and five had midgut volvulus. The mean operative time (93.5 ± 28.71 minutes) was significantly longer in the conventional group compared to the sutureless group (52.08 ± 18.53 minutes). Oral feed was started significantly earlier in the sutureless stoma group. Mortality was 43.3% in Group A and 46.6% in Group B. Complication rate was significantly higher in sutured stoma group. Conclusion The management of critically sick neonates, especially those with NEC and intestinal perforation, still presents a surgical dilemma. Based on our findings, the sutureless enterostomy may reduce operative time and complications in critically sick neonates.

Empathy scores amongst undergraduate medical students and its correlation to their academic performance.

Introduction: Empathy is one of the soft skills required for building rapport and having meaningful patient-doctor interaction. Its effect on academic performance at the undergraduate level amongst Pakistani medical students is not known. This study was done to assess the relationship between empathy and gender, and the academic performance of undergraduate medical students of Azad Kashmir. Methods: This cross-sectional study was done in Poonch Medical College, Azad Kashmir, Pakistan, from May 2018 to May 2019. The sample size for this study consisted of 200 students, determined by Krejcie and Morgan sample size determination chart. Students who agreed to participate in the study were enrolled according to convenience sampling using google forms. The Interpersonal Reactivity Index (IRI) questionnaire was utilized as the data collection tool. Data were analyzed using SPSS version 25. The ethical review board approved the study. Comparisons between males and females at the IRI questions level, IRI domains level, and total IRI were made using the Mann-Whitney U test. The Spearman Rank Correlation test was used to assess the correlation between academic performance, IRI domains, and total IRI scores. A one-way ANOVA test was done to assess the relationship between academic performance and their study years. Results: A total of one hundred and fifty-one students (males 83, females 68, response rate 75.5%) participated in the study from the third to the final year of medical college. The mean empathy scores of males and females were 90.76 ± 8.39 and 91.72 ± 9.76 (p-value = 0.552). On the empathic concern scale, female students had significantly higher empathy scores (25.44 ± 3.49) than males (23.78 ± 3.88) (p-value=0.008). No significant correlation was found between the empathy scores and academic performance, using Spearman's correlation test (p>0.05). Conclusion: Females showed significantly higher empathy scores than males for two Interpersonal Reactivity Index items and empathic concern scale. Overall, male and female students had similar total empathy scores. The relationship between empathy and academic performance was non-significant.

Mesenteric Lipoma with Volvulus: A Rare Cause of Acute Abdomen in a Child.

Lipoma is benign tumor of mature fat cells and is reported to develop anywhere in the body, e.g. trunk and extremities; however, lipoma in the mesentery of gut is rare, particularly in children. Mesenteric lipomas may be asymptomatic or may present with acute abdomen by leading to volvulus of gut. We report a 6-year female with intestinal obstruction. Exploratory laparotomy revealed a large mesenteric lipoma in the mesentery of small bowel causing volvulus of ileum. Lipoma was excised and postoperative recovery remained uneventful both in the hospital and on subsequent follow up. We believe mesenteric lipoma should be considered as a cause of volvulus and in differential diagnosis of acute abdomen in children. Key Words:  Mesentery, Lipoma, Volvulus, Ileum, Intestinal obstruction.