RESUMEN
Background Supracondylar fracture with total displacement is classified as Gartland type 3. The operative management for this type of fracture can be closed reduction with percutaneous pinning (CRPP) or open reduction with internal fixation (ORIF). This study aims to determine whether CRPP or ORIF led to smaller changes in Baumann's angle, the carrying angle, loss of motion, and complication when treating pediatric supracondylar fractures. Methodology In a retrospective cohort design, pediatric patients presenting with supracondylar fractures at a tertiary care hospital in Bahrain between March and October of 2021 were enrolled. The collected data included age, gender, nationality, mechanism of injury, neurovascular status, type of surgery performed, follow-up period, range of motion, complications, Baumann's angle, carrying angle, and loss of motion. The changes in Baumann's angle, carrying angle, and reduction sufficiency were compared to the literature using Flynn's criteria for supracondylar fractures. Results This study included the records of 60 patients with supracondylar fractures. In total, 28 patients underwent CRPP (group A), whereas 32 underwent ORIF (group B). A statistically significant difference (p = 0.037) between group A and group B was noted when combining the loss of carrying angle scores and the loss of motion scores to form the final Flynn score. In group A, 26 (92.8%) cases had satisfactory results; 75% of these cases were excellent or good. According to Flynn's criteria, all patients in group B were satisfactory; 93.75% of these cases were excellent or good. The loss of motion was significantly different between the two groups (p = 0.038). The mean loss of carrying angle was significantly different between the two groups, with 5.51 ± 3.03 degrees for group A and 4.23 ± 1.85 degrees for group B (p = 0.023). The study had only two cases with unsatisfactory ratings belonging to group A. Conclusions In pediatric patients presenting with type 3 supracondylar fractures, when compared to CRPP, ORIF was associated with less loss of motion, less loss of carrying angle, higher overall satisfactory results according to Flynn's criteria, and fewer complications.
RESUMEN
Background Urinary tract infections (UTI) are a commonly encountered infection in the pediatric age group. Knowledge of the causative pathogens and their antimicrobial resistance patterns in specific geographical locations is important to provide optimum care. The aim of this study is to describe the prevalence and the antimicrobial resistance patterns of the pathogens causing UTI in the pediatric age group in one tertiary inpatient Pediatric unit in Bahrain. Methods This is a retrospective cross-sectional study, conducted at King Hamad University Hospital (KHUH), Bahrain. The inclusion criteria consisted of patients ≤ 14 years of age admitted to the Pediatrics department at KHUH with bacteriologically proven UTI between the months of January 2018 and May 2021. Patients who were identified to have chronic urinary tract conditions or neurodevelopmental problems involving the urinary tract were excluded from the study. Electronic medical records were used to collect data regarding the isolated pathogens and sensitivity testing results. Results A total of 242 cases with positive culture were included. The most common bacteria causing UTI in this sample were successively Escherichia coli (68.60%), Klebsiella pneumoniae (10.30%), Proteus mirabilis (4.69%) and Pseudomonas aeruginosa (3.31%) (p<0.01). E. coli was most resistant to cefazolin (94%), followed by ampicillin (62.68%), whilst it was most sensitive to nitrofurantoin (98.96%) followed by amikacin (98.43%) (p<0.01). K. pneumoniae showed the highest rate of resistance to ampicillin (95.24%) followed by cefazolin (83.33%), meanwhile having the highest sensitivity rate to amikacin (95.24%), followed by ciprofloxacin (90.48%). P. mirabilis had the highest resistance to cefazolin (100%) followed by nitrofurantoin (87.50%), while having the highest sensitivity to piperacillin/tazobactam (100%). Conclusion E. coli is the most common cause of UTI in the pediatric population and it was found to be most sensitive to nitrofurantoin and amikacin whilst being relatively resistant to cefazolin and ampicillin. Similarities between our study and previous studies around the world were found when comparing the antibiotics resistance patterns. Nevertheless, it is our recommendation that empirical antibiotic selection should be tailored to the local data collected from the region.