Laparoscopic cholecystectomy in children: A systematic review and meta-analysis.

BACKGROUND: Laparoscopic cholecystectomy (LC) has become the procedure of choice for the removal of gallbladder within the paediatric population. The aim of this study was to perform a systematic review and meta-analysis of the literature spanning the last 20 years to understand the indications for and safety of LCs in children. METHODS: A comprehensive search of the published English language literature from January 2000 to June 2020 was done on PubMed, MEDLINE, and Google Scholar. RESULTS: In total, 76,524 LC cases were identified from 114 studies. 78.9% of the patients were female and average age was 12 years old. Associated haematological disorders were identified in 16% of cases. The commonest indication for LC was cholelithiasis (68.4% in 66 studies), followed by cholecystitis (59.2% in 53 studies). Median operating time was 77 min. Median hospital stay was 2 days. The overall postoperative complication rate was 3.4% Major complications included bile duct injury (0.4%) and intra- or post-operative bleeding (0.9%). The conversion rate to open procedure was 2%. When comparing post-operative outcomes between emergency and elective admissions, three papers lent themselves to meta-analysis demonstrating no significant difference (p = 0.42). There was no statistically significant difference in postoperative complication rate between "hot" and "cold" laparoscopic cholecystectomies (p = 0.6). CONCLUSION: This systematic review and meta-analysis is the largest collection of subjects on laparoscopic cholecystectomies in children. Laparoscopic cholecystectomy is a safe operation in children, with complication rates similar or comparable to the adult literature. Cholelithiasis, cholecystitis and biliary dyskinesia were the commonest indications for LC.

Comparison of laparoscopic cholecystectomy in children at paediatric centres and adult centres: a systematic review and meta-analysis.

INTRODUCTION: Paediatric laparoscopic cholecystectomy (LC) is performed by both paediatric and adult surgeons. The aim of this review was to compare outcomes at paediatric centres (PCs) and adult centres (ACs). METHODS: A literature search was conducted, in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, for papers published between January 2000 and December 2020. Statistical analysis was performed using Stata® version 16 (StataCorp, College Station, TX, US). RESULTS: A total of 92 studies involving 74,852 paediatric LCs met the inclusion criteria. Over half (59%) of the LCs were performed at ACs. No significant differences were noted in the male-to-female ratio, mean age or mean body mass index between PCs and ACs. The main indications were cholelithiasis (34.1% vs 34.4% respectively, p=0.83) and biliary dyskinesia (17.0% vs 23.5% respectively, p<0.01). There was no significant difference in the median inpatient stay (2.52 vs 2.44 days respectively, p=0.89). Bile duct injury was a major complication (0.80% vs 0.37% respectively, p<0.01). Reoperation rates (2.37% vs 0.74% respectively, p<0.01) and conversion to open surgery (1.97% vs 4.74% respectively, p<0.01) were also significantly different. Meta-analysis showed no significant difference in overall complications (p=0.92). CONCLUSIONS: The number of LCs performed, intraoperative cholangiography use and conversion rates were higher at ACs whereas bile duct injury and reoperation rates were higher at PCs. Despite a higher incidence of bile duct injury at PCs, the incidence at both PCs and ACs was <1%. In complex cases, a joint operation by both paediatric and adult surgeons might be a better approach to further improve outcomes. Overall, LC was found to be a safe operation with comparable outcomes at PCs and ACs.

Single dartos flap versus double dartos flap in hypospadias repair: A systematic review and meta-analysis with trial sequential analysis and fragility index.

INTRODUCTION: Hypospadias is a common congenital urogenital anomaly. Despite advancements in surgical techniques, still it presents challenges in management. An important aspect of hypospadias repair is the use of protective layers to cover neourethra. This review focuses on comparing the Single Dartos Flap (SDF) and Double Dartos Flap (DDF) techniques, used to cover the neourethra. These techniques differ in terms of the number of dartos layers used to cover the neourethra. METHODS: This systematic review, follows PRISMA guidelines, included six RCTs from PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science, and CINAHL. Patients with hypospadias repair with use of SDF or DDF were analyzed for outcome, Urethrocutaneous fistula, meatal stenosis, glans dehiscence, penile torsion and cosmetic outcomes. Statistical analysis was done using Review Manager, with TSA and FI ensuring result robustness. RESULTS: Six studies met inclusion criteria, and risk of bias assessment indicated low risk across all domains. Meta-analysis results favored DDF over SDF for reducing urethrocutaneous fistula (RR 0.37, 95% CI 0.20-0.68) but showed no significant difference in meatal stenosis and glans dehiscence. DDF also associated with lower risk of penile torsion (RR 0.05, 95% CI 0.01-0.35). CONCLUSION: The systematic review, based on randomized controlled trials (RCTs), provides evidence supporting the use of DDF over SDF in hypospadias repair, particularly in distal hypospadias using the TIP procedure. The article emphasizes the potential advantages of DDF in reducing UCF but further robust evidence is needed to confirm these results based on the findings of TSA and FI.

Post-urethroplasty complications in hypospadias repair: a systematic review and meta-analysis comparing polydioxanone and polyglactin sutures.

Background: Polyglactin (PG) and polydioxanone (PDS) sutures are extensively used based on the surgeon's preference. The development of post-reconstruction urethrocutaneous fistula (UCF) is variably attributed to the choice of suture material for urethroplasty. This meta-analysis compares complications of hypospadias repair using PG and PDS sutures. Methods: The systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors conducted thorough searches in databases including MEDLINE, EMBASE, CENTRAL, Scopus, Google Scholar, and clinical trial registries. Outcome measures included UCF, meatal stenosis, wound infection, urethral stricture, glans dehiscence, and overall complications. Quantitative analysis was used with fixed or random-effect models to find the pooled risk ratio and I2 heterogeneity. Results: The criteria for inclusion were met by five comparative studies with the inclusion of 1244 children altogether. Pooled analysis failed to show a statistically significant difference in the incidence of meatal stenosis, urethral stricture, wound infection, and total complications using PG and PDS sutures. However, it showed a reduction in the incidence of UCF with PDS suture hypospadias repairs (risk ratio=0.66, 95% CI 0.48 to 0.92). Conclusions: PDS sutures are associated with decreased incidence of UCF than PG after hypospadias repair. The incidence of meatal stenosis, urethral stricture, wound infection, and total complications was not affected by the type of suture material used for repair. Clinical implications: This meta-analysis suggests decreased incidence of UCF when PDS sutures are used for hypospadias repair which may impact the choice of suture material for repair. PROSPERO registration number: CRD42023409710.

Tubularized incised plate urethroplasty and grafted tubularized incised plate urethroplasty: systematic review, meta-analysis and trial sequential analysis.

Background: Hypospadias is one of the most common genital birth defects. There are around 300 various techniques available for the repair of hypospadias. This study aims to compare the reported outcomes of Tubularized incised plate urethroplasty (TIP) and Grafted TIP (GTIP) repair in children undergoing primary hypospadias repair. Methods: This meta-analysisadhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and we framed our research question using the population, intervention, control and outcomes format. We conducted comprehensive electronic searches across various databases, employing a Boolean search strategy with predefined search terms. Only randomized controlled trials (RCTs) were included for quantitative analysis. Results: Totally, 10 RCTs met our inclusion criteria for quantitative analysis. The results indicated that urethrocutaneous fistula, glans dehiscence, and stricture rates were comparable between the two groups. The incidence of meatal stenosis was found to be significantly lower in the GTIP group with a relative risk (RR) of 0.32 (95% confidence interval (CI) 0.15 to 0.67). Conclusion: The coucomes UCF, glans dehiscence, and stricture rates were comparable between the two groups. Notably, the incidence of meatal stenosis was found to be significantly lower in the grafted TIP group. In terms of operative time, our quantitative synthesis demonstrated that the TIP group had a shorter operative time than the GTIP group with significant heterogeneity.

Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years.

AIM: To review our practice of Meckel's Tc-99m pertechnetate scans over 18 years with regard to indications for the test, sensitivity and specificity in our particular referral patients' population. MATERIALS AND METHODS: This is a retrospective review of Meckel's scans performed in two paediatric tertiary care teaching hospitals from April 1993 to March 2011 and followed up till October 2011. The scan was performed according to published international guidelines. 183 patients were included in this study. We classified the patients into two groups: group 1, which included 77 patients (42 %) presenting with painless per rectum bleeding, and group 2, which included 106 patients (58 %) presenting with other non-specific symptoms (e.g. abdominal pain, possibly associated with nausea and/or vomiting, failure to thrive). Data were analysed using Chi square test, considering P value less than 0.05 as significant. The age of the patients ranged from 4 days to 16.5 years (median 3 years). RESULTS: 161 of the total 183 children on the study (88 %) had a negative Meckel's scan, and 22 children (12 %) had a positive scan. In the group with a positive Meckel's scan (22 children), all patients underwent surgical exploration and ectopic gastric mucosa was found in 17 cases (77 %, true positives). In the remaining 5 cases (23 %), there was no evidence of ectopic gastric mucosa (false positives). Within the group with a negative scan, 8 children (5 %) underwent surgery; only 1 child had a ectopic gastric mucosa detected following surgery (false negative). In other 52 children (32 %) of the group with a negative Meckel's scan, an endoscopy was done, which showed a normal result in 21 children and was abnormal in 31 children. Of the remaining 101 (63 %) children with a negative Meckel's scan, 74 children (46 %) improved without any further intervention. In 13 cases (8 %), other pathologies were identified. The sensitivity and specificity of the Meckel's scan for ectopic gastric mucosa were 94 and 97 %, respectively. The Meckel's scan was positive in 26 % of the patients of group 1 and in only 2 % patients of group 2. The difference between the two groups was highly significant [P < 0.0001 (Yates-corrected Chi square); odds ratio 18 (Woolf-logit method 95 % CI)]. CONCLUSION: The Meckel's scan retains a high diagnostic accuracy in children for detecting a Meckel's diverticulum with ectopic gastric mucosa within it, when performed according to the recommended guidelines. The test yields its highest positive result in children presenting with significant per rectum bleeding.

Qualitative Exploration Toward the Development of a Parent-Rated Scale for Insomnia in Children with Autism Spectrum Disorder.

Toward the development of a new parent-rating for insomnia, this multi-site qualitative study explored sleep problems and related impacts in children with autism spectrum disorder (ASD) and their families. To ensure content validity of the measure, we conducted six focus groups with caregivers (N = 25) of 24 children (age 3 to 18 years) with ASD. Based on parent report, all children had a history of mild or greater insomnia. The focus group transcripts were systematically coded to identify major themes. Verbatim comments from caretakers were used to generate 134 candidate items. Further review by the research team and an expert panel followed by individual cognitive interviews with 12 parents reduced the item bank to 40. The thematic analysis of focus group transcripts identified 7 categories: (1) Trouble falling asleep; (2) trouble staying asleep; (3) early morning waking; (4) bedtime routines; (5) parental strategies for bedtime management; (6) impact of sleep problems on the child; and (7) impact of sleep problems on the family. The Flesch Kincaid Grade Level of the 40-item version was 7.2 (seventh grade reading level). Insomnia in children with ASD shares features in common with insomnia in the general pediatric population. However, perhaps owing to autistic features such as insistence on sameness, sensory sensitivities, communication impairments, insomnia in children with ASD appears to have unique behavioral manifestations. Content validity and item clarity of the 40-item bank were supported by expert panel review and cognitive interviews with caregivers of children with ASD.

Methadone use in pregnancy: evidence of progression in the severity of addiction.

The number of opiate users is well documented; however, the severity of opiate use has received little attention. This retrospective study in a North of England hospital updates the progression in the severity of addiction in pregnancy. Patients treated were reviewed and the doses of prescribed methadone documented. Historical data were also used for comparison. The severity in addiction in pregnancy was assessed by the woman's drug usage expressed as the daily dose of prescribed methadone at the end of pregnancy. From 2001 to 2008 there was an increase in the mean dose of methadone prescribed at delivery from 28.2 ml/day in 2001 to 57.9 ml/day in 2008. Historically, the use was 27.3 ml/day in 1992-1996 and 32.4 ml/day in 1997-2003. No trend was noted in the number of pregnant users. In conclusion, we observed no recent increase in the number of methadone users presenting, but the severity of drug usage in pregnancy has increased.

Nonparasitic splenic cysts in children: Current status.

BACKGROUND: at present, the management of nonparasitic splenic (NPS) cysts in children is not well described in literature. The aim of this study was to evaluate the current status of NPS cysts in the world literature and develop some higher level of evidence in the management of this disease entity. In this study, we have also included our experience with NPS cysts. METHODS: a systematic study of NPS cysts published in the English literature, between the periods of 1989-2008, was performed. The data were analyzed with respect to the type of cysts, mode of presentation, patient's demography, management modalities and complications. Data were quoted as median and range. Categorical data were analyzed using Chi(2) tests. P value ≤ 0.05 was considered as significant. All children, who presented to us with NPS cysts during the last 20 years, were reviewed and followed up till December 2009. RESULTS: after critical review of 249 abstracts, 25 studies (retrospective 13, cases reports 11 and prospective study 1) were finally included in this project. This included a total of 166 patients. The types of cysts were congenital (82%), traumatic (15%) and hamartomatous (3%). Male to female ratio was one to one. Median age of presentation was 11 years. Abdominal pain was the main complaint in 46% cases. Forty seven percent of the cysts were diagnosed incidentally. History of trauma was present in 11% cases. 1% cases were operated on due to the rupture of the cysts. Open procedures were performed in 60% cases [11% (total splenectomy), 29% (partial splenectomy) and 20% (cystectomy)]. Laparoscopic procedures were performed in the rest 40% cases [2% (total splenectomy), 4% (partial splenectomy) and 34% (cystectomy/partial decapsulation/unroofing)]. Median follow up period was 24 months (range 3-96 months). Recurrences were seen in only 2% of open procedures as Opposed to 41% in laparoscopic procedures (P<0.0001). Looking at the laparoscopic procedures individually, all the recurrences were seen in patients who had had cystectomy/partial decapsulation/unroofing. We treated 7 children (4 males and 3 females), who had a median age of 11 years (range 1-14 years); two of whom presented with large cysts having a diameter of 25 cm and 15 cm, respectively. They underwent open partial splenectomy without recurrence. The other five children had small cysts having a diameter of <5cm and they were asymptomatic. Presently, the children with small cysts are being followed up conservatively, with no concerns so far. CONCLUSIONS: congenital cysts are the most common NPS cysts in children. About half of the cysts are diagnosed incidentally. For bigger cysts, either open or laparoscopic partial splenectomy is the procedure of choice. Laparoscopic-cystectomy/partial decapsulation/unroofing procedures have unacceptably higher recurrence rates and hence should not be recommended. Smaller cysts (< 5 cm diameter) can be treated conservatively with regular ultrasound follow up, but if they become symptomatic or progress in size, surgical intervention is indicated.

Quenching effect of oscillating potential on anisotropic resonant transmission through a phosphorene electrostatic barrier.

The anisotropy in resonant tunneling transport through an electrostatic barrier in monolayer black phosphorus either in presence or in absence of an oscillating potential is studied. Non-perturbative Floquet theory is applied to solve the time dependent problem and the results obtained are discussed thoroughly. The resonance spectra in field free transmission are Lorentzian in nature although the width of the resonance for the barrier along the zigzag (Г-Y) direction is too thinner than that for the armchair (Г-X) one. Resonant transmission is suppressed for both the cases by the application of oscillating potential that produces small oscillations in the transmission around the resonant energy particularly at low frequency range. Sharp asymmetric Fano resonances are noted in the transmission spectrum along the armchair direction while a distinct line shape resonance is noted for the zigzag direction at higher frequency of the oscillating potential. Even after the angular average, the conductance along the Г-X direction retains the characteristic Fano features that could be observed experimentally. The present results are supposed to suggest that the phosphorene electrostatic barrier could be used successfully as switching devices and nano detectors.

The need for Paediatric Emergency Laparotomy Audit (PELA) in the UK.

INTRODUCTION: The National Emergency Laparotomy Audit (NELA) has raised serious concerns about the processes of care and outcomes in adult emergency laparotomies in the UK. To date, no comparable data have been published for children. The aim of this study was to investigate the need for a similar audit in children. METHODS: Data were collected retrospectively following NELA guidelines. Results were analysed using QuickCalcs (GraphPad Software, La Jolla, CA, US). RESULTS: The study period spanned 7.5 years. A total of 161 patients were identified for inclusion in the audit. The median patient age was 2.8 years. Half (49%) of the cohort were deemed ASA (American Society of Anesthesiologists) grade ≥2. A history of previous abdominal surgery was noted in 37% of the patients. The median time from admission to operation was 15 hours. Over a third (39%) of the operations were performed out of hours. The most common indications for surgery comprised adhesive bowel obstruction (37%), intussusception (27%) and volvulus (9%).The median length of hospital stay was 8 days with the median postoperative stay being 6 days (NELA data 10.6 days). Half (51%) of the cases required intensive care following surgery. The 30-day mortality rate was 3.1%. The overall mortality rate was 4.3% (NELA data 16%). Patient care was led by a consultant surgeon in 100% of cases (NELA data 89%). CONCLUSIONS: This is the first study in children that provides baseline data about the standards of care and outcomes from a single centre paediatric emergency laparotomy audit. A larger study using data from multiple centres would be of great benefit.

trans-Dichloro-bis-(arylazoimidazole)palladium(II): synthesis, structure, photoisomerization, and DFT calculation.

Reaction between PdCl(2) and 1-alkyl-2-(arylazo)imidazole (RaaiR') or 1-alkyl-2-(naphthyl-alpha/beta-azo)imidazole (alpha/beta-NaiR') under reflux in ethanol has isolated complexes of compositions Pd(RaaiR')(2)Cl(2) (5, 6) and Pd(alpha/beta-NaiR')(2)Cl(2) (7, 8). The X-ray structure determination of one of the molecules, Pd(alpha-NaiBz)(2)Cl(2) (7c), has reported a trans-PdCl(2) configuration, and alpha-NaiBz acts as monodentate N(imidazole) donor ligand. The spectral (IR, UV-vis, (1)H NMR) data support the structure. UV light irradiation (light source: Perkin-Elmer LS 55 spectrofluorimeter, Xenon discharge lamp, lambda = 360-396 nm) in a MeCN solution of the complexes shows E-to-Z isomerization of the coordinated azoimidazole unit. The reverse transformation, Z-to-E, is very slow with visible light irradiation. Quantum yields (phi(E-->Z)) of E-to-Z isomerization are calculated, and phi is lower than that of the free ligand but comparable with those of Cd(II) and Hg(II) complexes of the same ligand. The Z-to-E isomerization is a thermally induced process. The activation energy (E(a)) of Z-to-E isomerization is calculated by controlled-temperature experimentation. cis-Pd(azoimidazole)Cl(2) complexes (azomidazole acts as N(imidazole) and N(azo) chelating ligand) do not respond upon light irradiation, which supports the idea that the presence of noncoordinated azo-N to make free azo (-N=N-) function is important to reveal photochromic activity. DFT calculation of Pd(alpha-NaiBz)(2)Cl(2) (7c) has suggested that the HOMO of the molecule is constituted of Pd (32%) and Cl (66%), and hence photo excitation may use the energy of Pd and Cl instead of that of the photofunctional -N=N-Ar motif; thus, the rate of photoisomerization and quantum yield decrease versus the free ligand values.

Left Antegrade Continent Enema (LACE): review of the literature.

PURPOSE: LACE is gradually becoming more established for the treatment of constipation. The purpose of this study was to review the current status of LACE procedure in paediatric practice. MATERIALS AND METHODS: A systematic database search was performed. Patients who underwent a LACE procedure between 2002 and May 2007 were reviewed retrospectively. The data was analysed with respect to indications for operation, operative techniques, outcome, and complications. The outcomes were compared with those of right-sided antegrade colonic enema (RACE) procedures, published in the same period. RESULTS: Nine studies describing 93 patients were identified. The underlying diagnoses were spina bifida (70 %), anorectal malformation (10 %), idiopathic constipation (10 %), Hirschsprung's disease (4 %) and other (6 %). The mean age at operation was 10 years. The various operative procedures used included retubularisation of the sigmoid colon (31 %), retubularisation of the splenic flexure (28 %), left Monti from the descending colon (15 %), and retubularisation of the ileum (3 %). Minimally invasive techniques were used in 23 % of cases. Mean volume of enema used was 414 ml. The mean transit time for enema was 31 minutes. Social continence was achieved in 94 % (complete in 72 %; partial in 22 %) cases. Stomal stenosis was seen in 14 % of cases, of which 9 % required revision of the stoma and 5 % responded to dilatation. Sixteen studies describing 583 patients were found for RACE. Indications for operation were similar to those for LACE. Open procedures were done in 86 % of cases, and laparoscopic assisted procedures in 14 % of cases. Mean age at operation was 10 years. Mean volume of enema used 618 ml. Median evacuation time was 53 minutes. Continence was achieved in 94 % of cases. Stomal stenosis occurred in 26 %. CONCLUSION: The results of LACE procedures are encouraging, especially in light of the lower amount of enema fluid required, the quicker enema transit time and fewer complications. Overall outcome (continence) is comparable to that of RACE.

Delayed diagnosis for undescended testes.

Delayed diagnosis of undescended testes is a major problem. A retrospective review of 298 testes units was performed to assess the age at referral, age at operation, complications and final outcome. The mean age at referral was 57 months. Only 24% of cases were operated below 2 years. A similar pattern of delayed orchidopexy has been reported by many other centres. As orchidopexy is recommended soon after 6-7 months of age, there is an urgent need for increased awareness of undescended testes and its consequences at all levels of child health care.

Modified prognostic criteria for oesophageal atresia and tracheo-oesophageal fistula.

AIM: With the advances in technology, the outcome of oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF) has significantly changed. The aim of this study was to review the outcome of OA and TOF with respect to the various known prognostic criteria and to find out if there is a need for a further modification of the prevailing prognostic classification. METHODS: The case notes of 57 newborns with OA/TOF treated between 1996 and 2004 were reviewed retrospectively. Patient demographics, associated anomalies and management were studied. The outcome was analysed with respect to different published prognostic criteria (Spitz, Waterston, Bremen and Montreal). RESULTS: The results in this series show identical results for Waterston class A and B as well as for the Bremen "without complications" groups. Furthermore, there was no statistically significant difference between Spitz type I (survival 100 %) and type II (survival 92.8 %) (Fisher's exact test [p = 0.259], Pearson's chi-square [p = 0.088] and Mann-Whitney test [p = 0.091]). There was, however, a significant variation (Fisher's exact test) after combining the results for Spitz type I & II and comparing them to type III (p = 0.006). On the basis of these results, a further modified prognostic criteria for infants with OA/TOF is proposed. Group A would include infants with either a single poor prognostic risk factor (i.e., weight below 1.5 kg or a major cardiac anomaly) or isolated TOF/OA. According to this study, the prognosis for such infants should be excellent (survival = 98 %). The alternate group (B) would include infants affected by both negative risk factors and TOF/OA; such infants have a poor prognosis (survival = 33 %). CONCLUSIONS: Survival for children with TOF/OA is not dependent on factors including birth weight, gestational age, pre/postoperative ventilation and a major cardiac anomaly taken independently. In the modified prognostic classification for OA/TOF, a low birth weight combined with cardiac malformations is associated with a poor prognosis. This alternate prognosticator offers benefits for appropriately advising parents of babies with such anomalies taking the current standards of care into consideration. It should also serve as a foundation stone for further prospective studies.

Pregnancy outcome in women who use opiates.

BACKGROUND: Opiate use in pregnancy is on the increase. There are a number of complications associated with this problem but current data from UK centres are sparse. DESIGN: A retrospective study. SETTING: A North of England Hospital. METHODS: Maternal and neonatal case records were studied and a standard data set completed. MAIN OUTCOME MEASURES: Maternal and neonatal outcomes were classified by the woman's drug usage at the end of pregnancy. RESULTS: One hundred and ten babies born to 108 women were studied and 41% had evidence of previous exposure to the hepatitis C virus. Women who took heroin in later pregnancy were significantly more likely than women who were stabilised on methadone to have a baby who needed morphine (40% versus 19%), had higher mean maximum neonatal abstinence scores (NAS) (5.8 versus 4.7) and stayed in the neonatal unit significantly longer (mean 17.2 days versus 11.8 days). There were two neonatal deaths and the overall rate of prematurity was 29%. CONCLUSIONS: The outcome for pregnancy in women who use opiates is complicated by high rates of prematurity and neonatal death. Women who used heroin in later pregnancy had babies who developed more severe NAS and needed a longer hospital stay than women who used only methadone.

The importance of social media for patients and families affected by congenital anomalies: A Facebook cross-sectional analysis and user survey.

BACKGROUND: We aimed to define characteristics and needs of Facebook users in relation to congenital anomalies. METHODS: Cross-sectional analysis of Facebook related to four congenital anomalies: anorectal malformation (ARM), congenital diaphragmatic hernia (CDH), congenital heart disease (CHD) and hypospadias/epispadias (HS/ES). A keyword search was performed to identify relevant Groups/Pages. An anonymous survey was posted to obtain quantitative/qualitative data on users and their healthcare needs. RESULTS: 54 Groups and 24 Pages were identified (ARM: 10 Groups; CDH: 9 Groups, 7 Pages; CHD: 32 Groups, 17 Pages; HS/ES: 3 Groups), with 16,191 Group members and 48,766 Page likes. 868/1103 (79%) of respondents were parents. Male:female ratio was 1:10.9. 65% of the users were 26-40years old. Common reasons for joining these Groups/Pages included: seeking support, education, making friends, and providing support to others. 932/1103 (84%) would like healthcare professionals (HCPs) to actively participate in their Group. 31% of the respondents felt that they did not receive enough support from their healthcare system. 97% of the respondents would like to join a Group linked to their primary hospital. CONCLUSIONS: Facebook Groups/Pages related to congenital anomalies are highly populated and active. There is a need for HCPs and policy makers to better understand and participate in social media to support families and improve patient care.

Thirty-days readmissions in pediatric surgery: The first U.K. experience.

INTRODUCTION: The aim of this study was to investigate readmissions within 30days of operation (ReAd) in the setting of a tertiary pediatric surgical practice in the UK. METHODS: Using Hospital Episode Statistics, cases that were readmitted within 30days of primary operation were identified retrospectively. Demographics including age, gender, preexisting comorbidities, diagnosis on primary admission and the treatment, length of stay, and diagnosis on readmission with treatment, including further surgical intervention, were collected from discharge summaries and hospital notes. Neonates were excluded from this study. Comorbidities, involving one or more systems, were also identified for each case of readmission. ReAds were classified into emergency and elective cohort depending on the nature of the primary operation. Outcomes were compared between these two groups. Data were quoted as median (range) unless indicated otherwise. Data were analyzed using SPSS software Desktop 22.0, using Mann-Whitney U and Chi-Squared tests, with a consideration that a P≤0.05 was significant. RESULTS: A total of 2378 procedures were performed during the study period. Elective cases, including day cases, accounted for 77% (n=1837) of all cases. The remaining 23% (n=541) were emergency cases. Total unplanned readmission rate within 30days (ReAd) was 2%. Further surgical procedures were required in 38%. Having excluded neonates, the most common primary procedure leading to readmission within 30days was appendicectomy (26%). Overall, the most common cause for readmission within 30days was postoperative infection (30%). The ReAd in emergency cohort was 3.5% in comparison to 1.5% in elective, which was significantly different (P value=0.007). CONCLUSION: Readmission within thirty days of primary procedure in pediatric surgery has little published data. An efficient discharge planning may play a vital role in preventing unwanted readmission. Elective operations had a significantly lower readmission rate than emergency operations. Having excluded neonates, appendicectomy was found to be the most common operation associated with readmission in the pediatric surgical practice. Although widely used as quality care indicator in adults, more studies are required to validate readmission rate as a quality of care indicator in pediatric surgery practice.

Thyroid Surgery in Children: Clinical Outcomes.

AIM: The aim of this study was to review the outcomes of thyroid surgery in children operated for both benign and malignant conditions. PATIENTS AND METHOD: Demography, clinical features, and surgical outcomes were noted retrospectively for operations performed during the last 23 years. Results were analyzed using Fisher exact test and Woolf (logit) method with p value < 0.05 considered as significant. RESULTS: In total, 61 children (43 girls and 18 boys) underwent thyroidectomy for benign (70%) and malignant (30%) conditions. Median follow-up period was 1.4 years. In the benign group, 84% children had Graves disease and 16% had other conditions. In this study, 42% children had total, 22% had near-total, 27% had subtotal, and 9% had type 2 hemithyroidectomy. In the malignant group, 50% had multiple endocrine neoplasia, 33% had papillary, 11% had follicular cancer, and 6% had B-cell lymphoma. Fifty percent children had prophylactic thyroidectomy, 44% had total thyroidectomy plus lymphadenectomy, and 6% had hemithyroidectomy. At the time of surgery, children with benign conditions were older than those with malignancy (median, 12 vs. 7.5 years). There were no incidents of postoperative bleeding or infection. Hypocalcemia was significantly more frequent in the malignant group (39 vs. 9%, p value = 0.01). The type of recurrent laryngeal nerve (RLN) injury was more serious in the benign group (one bilateral and one unilateral permanent injury) than in the malignant group (transient hoarseness in three). Overall rate of complications was higher for operations for malignancy (56 vs. 28%, p value = 0.07). In Graves disease, the subtotal thyroidectomies had a recurrence of 30% but no recurrence was seen following total or near-total thyroidectomy group (p value = 0.01). There was no recurrence in the malignant group. Children operated after 2000 were younger than those operated before 2000 (median age, 9 vs. 14 years). Malignant conditions were more common in children operated after 2000 in comparison to before 2000 (55 vs. 10%). CONCLUSION: Benign conditions are commonest indications for thyroid surgery in children but the incidence of surgery for malignant conditions is rising. Overall rate of complications, especially hypocalcemia, is higher after surgery for malignancy but all cases of permanent RLN injury were in benign group. Total or near total thyroidectomy prevents recurrence of thyrotoxicosis and is an operation of choice for Graves disease.