Ultrasound-guided procedures for postoperative pain management in pediatric patients undergoing abdominal surgeries: A systematic review.

Many ultrasound-guided procedures are available for administering analgesia via peripheral nerve blockade. This systematic review aims to compare different ultrasound-guided procedures to determine which procedure is better suited for pediatric abdominal surgeries. The objective is to understand the efficacy of ultrasound-guided procedures for postoperative pain management in children undergoing abdominal surgeries and to identify which procedure takes less time and is better suited for a particular surgery. A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for pediatric abdominal surgeries conducted with ultrasound-guided procedures for administering analgesia. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. We reviewed 13 articles with 910 patients included. Age groups varied from 6 months to 21 years. The most common block used was the transversus abdominis block (47.76%), and the most common surgery performed was hernia and hydrocele (52.10%). Quadratus lumborum block was used in 26.92%, erector spinae block in 8.97%, modified transversus abdominus block and rectus sheath block in 9.62%, and ilioinguinal block in 6.73% of the patients. No complications were reported in any of the studies. Transversus abdominus block is less effective in two of the studies. Each procedure for pediatric postoperative analgesia has specific advantages and limitations, highlighting the complexity of tailoring interventions. Our review focuses on the advancements in ultrasound-guided analgesia for lower abdominal surgeries in pediatric patients while also emphasizing the need for future randomized controlled trials (RCTs) to compare efficacy, standardize practices, and improve patient outcomes.

Scrotal migration of peritoneal end of ventriculoperitoneal shunt in an infant - A rare entity.

Ventriculoperitoneal shunt migration into the scrotum is a rare phenomenon that has been reported in nearly 35 patients in the literature till date. Genitalia-related complications of ventriculoperitoneal shunts in children like inguinoscrotal migration usually occur during 1st year of the shunt procedure due to factors like raised abdominal pressure and patency of process vaginalis. We report a case of scrotal migration of tip of ventriculoperitoneal shunt in a 2-month-old infant presenting to us with communicating hydrocephalus. In a patient with inguinoscrotal swelling and ventriculoperitoneal shunt, migration of shunt should be suspected. Prompt diagnosis and management of this condition is important due to various complications like shunt dysfunction and testicular lesions. Treatment of this condition is surgical closure of the patent processes vaginalis and shunt reposition.

Pediatric PseudoTumoral Hepatic Tuberculosis. A Great Mimicker!!

Pediatric liver masses are rare and difficult to treat. Common liver masses in children include hepatoblastoma, hemangiomas, liver abscesses, and hydatid disease. Isolated liver tuberculosis (TB) is rare in children and can have variable clinical presentations. We report a child with isolated liver TB masquerading as a liver tumor.

Internet Survey: Health Screening in Sports.

While cardiovascular screening protocols exist, they have been focused on teenaged and college aged athletes versus adult athletes. To assess community awareness of health screening as related to adult athletes, we have created an internet questionnaire (QN). The survey was posted through social media (e.g. Facebook, Reddit, Flotrack and Active), for 11 months, that queried sports history, medical history, and symptoms while playing sports. A total of 3,750 respondents (R) answered the questionnaire, 2,776 male and 974 female. Age range: 18-83 yrs, avg: 33.7±11.22 yrs, median: 31 yrs. Seventy four per cent of R (2,775/3,750) reported having at least one of the following symptoms while playing sports: dizziness, blacking/passing out, racing heartbeat, or chest pain, and 13.5% (505/3,750) of R reported two or more. 62.3% (1,730/2,775) did not recall having symptoms. This underreporting was a result of "no one asking" 49.5% (857/1,730); "not answering after being asked" 28.2% (488/1,730), and "not telling the truth" 22.2% (384/1,730). Of interest, 97.1% (3,642/3,750) want a screening QN; 95.8% (3,592/3,750) want pre-screening by an MD. Prior to sports, only 22.9% (857/3,750) were required to answer a QN vs 38.0% (1,424/3,750) had a physical exam (PE); 14.9% (560/3,750) of individuals had both PE and QN. We conclude that adult participants in sports commonly experience symptoms but do not report them. Nearly all respondents favor participating in a screening questionnaire that would assess for cardiovascular problems.