COVID-19 pandemic and lockdown: what has changed in common home accidents such as foreign bodies and corrosive injuries?

BACKGROUND: COVID-19 pandemic greatly affected our lives in all areas. Due to the social isolation policies implemented during this period, the majority of parents and all school-age children spent their lives at home. This study aims to investigate the effects of pandemic and isolation on home accidents treated in our center. METHODS: Foreign body ingestion (gastric foreign bodies: G.FB), foreign body aspiration (respiratory foreign bodies: R.FB), and corrosive substance (CS) ingestion cases admitted to our hospital between March 11, 2019, and March 10, 2021, were retrospectively analyzed. Demographic data, type and cause of home accidents, the time of the accident and the admission to the hospital, the location of the foreign body, and the follow-up data were recorded. The patients were divided into two groups: the pre-pandemic period (11 March 2019-10 March 2020) and the COVID pandemic period (11 March 2020-10 March 2021), and the data were evaluated between two groups as < 6 years old and 6-18 years old. RESULTS: During the 2 years, a total of 982 patients were admitted to our hospital for G.FB, R.FB, or CS. Four hundred and eighty-three of them (49.2%) were in the pre-pandemic period and 499 (50.8%) were in the pandemic period (p = 0.206). The mean age of the patients was 3.63 ± 3.32 years; 82.4% of the patients in the pre-pandemic group and 85.4% of the patients in the pandemic group were children < 6 years old. While the F/M ratio was 1/1.5 during the pre-pandemic period, it was 1/1.1 during the pandemic period. Of the cases, 73.3% were G.FB, 4.6% were R.FB, and 22.1% were CS. Almost half of the accidents occurred between the hours of 16 and 24. During the pandemic period, the accidents increased to occur between 0 and 8 am in children < 6 years old, and between 8 am and 4 pm in children 6-18 years old (p = 0.003). All of the home accidents in the 6-18 age group between 0 and 8 o'clock were girls (p < 0.0001). During the pandemic period, the frequency of button batteries and food products increased in G.FB. Also, the frequency of R.FB increased significantly (p = 0.006) and the most common R.FB was the food products. The frequency of CS increased in girls during the pandemic period, and CSs were brought to the hospital in a shorter time after the accident during the pandemic period (p = 0.007). CONCLUSIONS: It can be thought that the main reason why home accidents are common in the 0-6 age group is due to the developmental characteristics of the child rather than the longer time spent at home. The pandemic and isolation increase the frequency of foreign body aspirations and home accidents in girls.

Caudal Anesthesia for Pediatric Subumbilical Surgery, Less Load on the Postoperative Recovery Unit.

Introduction Caudal epidural anesthesia, when used as a sole method for surgical anesthesia, has favorable effects on the recovery duration and the time spent in the recovery unit. In this study we made a retrospective analysis of pediatric surgery operations under local, regional and general anesthesia. We aimed to find shorter postoperative recovery times with local and regional anesthesia. Materials and methods Data of the pediatric patients undergone subumbilical surgery during the two-year period in Pediatric Surgery clinic were collected. The patients' age, sex, surgery type, anesthesia and airway control routes, as well as duration of anesthesia, operation and recovery were obtained. Results Data of 937 patients were analyzed, of whom 811 (86.6%) were males. Caudal anesthesia was performed in 240 patients (25.6%) and the mean age of these patients was 3.83 ± 3.00 years. The patients with caudal and local anesthesia spent significantly less time in the postoperative recovery unit, compared with general anesthesia groups (P < 0.001). Conclusion Caudal anesthesia as a sole method for pediatric subumbilical surgery is a relatively safe method. Patients having operation under caudal anesthesia have faster discharge times from postoperative recovery units, compared with general anesthesia. This probably reduces recovery unit expenditures.

Primary abdominal wall hydatid cyst: a case report.

Hydatid disease is endemic in our country. A case of a 13-year-old girl with primary intermuscular hydatid cyst in the abdominal wall without other organ involvement is presented and discussed. At laparotomy, the entire endocyst, seen to push the peritoneum inwards, was totally extracted from the abdominal muscle planes without destroying the cyst wall. The postoperative course was uneventful. She is currently disease-free with a follow-up of two years. Hydatid cyst should be considered in endemic areas in patients presenting with a soft tissue mass in the abdominal wall.

The evaluation of the validity of Alvarado, Eskelinen, Lintula and Ohmann scoring systems in diagnosing acute appendicitis in children.

PURPOSE: To show whether Alvarado, Eskelinen, Lintula and Ohmann scoring systems have predictive values in diagnosing acute appendicitis in children. METHODS: Sixty patients with suspected acute appendicitis were prospectively evaluated. Alvarado, Eskelinen, Lintula and Ohmann scores were calculated separately for each patient at the time of admission. The specificity, sensitivity, positive and negative predictive values of the scores were calculated. The predictive value of the scores was evaluated with the receiver operating characteristic (ROC) curve and the consistency among the scores by Kappa test. RESULTS: Twenty of the patients were female (33.3 %). The mean age of the patients was 9.9 years (3-16 years). Forty two patients were operated and appendectomies were performed with the diagnosis of acute appendicitis. The area under the ROC curve showed that the scores had no predictive value in diagnosing acute appendicitis. Kappa test showed that agreement between the scores was not good. CONCLUSION: The sensitivity and specificity of the four scoring systems were not sufficient enough in diagnosing acute appendicitis in our patient group. We concluded that the most important factor affecting the decision for surgery in suspected acute appendicitis is the surgeon's experience combined with physical findings of repeated clinical examinations.

Intralesional bleomycin sclerotherapy in childhood lymphangioma.

This clinical trial was conducted to evaluate the efficacy of intralesional bleomycin sclerotherapy (IBS) in children with lymphangioma and to determine the incidence of complications in the treatment. Seventeen lymphangioma cases were treated with IBS from 2004 to 2012. Age, mode of presentation, locations and types of lesions, and results of treatment were studied. Lymphangioma was diagnosed by physical examination and imaging studies. Most of the lesions were located in the cervical region (n=8) and of macrocystic type (n=13). After the first injection, three patients were lost to follow-up. Good response was seen in 50% of the lesions, complete resolution in 35.7%, and poor response in 14.3%. No serious complications or side effects were observed after IBS. The average follow-up was 18.5 months. IBS is effective in the treatment of lymphangioma. Although no major adverse effects have been encountered, complications should be kept in mind and in the event of their occurrence be treated immediately.

Management of epididymal cysts in childhood.

BACKGROUND: A retrospective review was carried out to evaluate the clinical presentation of children with epididymal cysts (EC) and outcome of management at our institution. METHODS: There were 49 patients with EC in this series. The diagnosis of EC was made by physical examination and confirmed by ultrasound (US). RESULTS: The average age at presentation was 10.7 years (2 months-16 years). Scrotal mass (n: 22) and pain (n: 21) were the most frequent symptoms. Seven patients were lost to follow-up. The cysts were solitary in 32 patients and multiple in 10 patients. The mean value of cysts was 6.7 mm (2-20 mm). The cyst localisations were 22 in left, 16 in right, and bilateral in 4 patients. Complete involution of cysts was detected in 14 children. The average involution time was 11.2 months (1-37 months). In 20 cases, a decrease in cyst size was found. Cyst excision was performed in 8 patients with persistent scrotal pain or no cyst involution observed during follow-up. CONCLUSION: Conservative management of epididymal cysts is practical. However, surgical excision is recommended in patients with intractable scrotal pain or if the cyst size does not seem to involute.

Treatment of acute scrotum in children: 5 years' experience.

BACKGROUND: A retrospective review was carried out to determine the incidence of various causes and outcome of management in patients with acute scrotum. METHODS: Fifty children had a diagnosis of acute scrotum between 1st January 2007 and 15th May 2012. Age, mode of presentation, associated anomalies, and results of treatment were studied. Diagnosis of acute scrotum was confirmed by physical examination, Doppler ultrasound and biochemical investigations. RESULTS: Clinical presentation consisted of sudden swelling and pain in the inguinoscrotal region. The average age was 7.5 years (2 months-14 years). Causes of acute scrotum were orchitis/epididymo-orchitis (O /EO) in 22, strangulated inguinal hernia (SIH) in 16, testicular torsion (TT) in 11, and torsion of testicular appendage (TTA) in 1. Associated urological anomalies were found in 5 patients with O /EO. Medical treatment was applied to patients with O /EO, and surgical treatment was performed in patients with SIH, TT and TTA. CONCLUSION: In this series, O /EO was found to rank first as the cause of acute scrotum. Immediate surgical treatment in acute scrotum patients, except those with O /EO, is necessary. Associated urological anomalies should be investigated in patients with O /EO.

Torsion of an epididymal cyst: a case report and review of the literature.

Torsion of an epididymal cyst (EC) on its pedicle is an extremely rare condition that resembles acute testicular torsion. Herein, a boy with EC torsion managed surgically is presented and discussed in light of the relevant literature. The presented child is probably the fourth case of pediatric EC torsion, and to our knowledge, the first report of a child who was known to have EC and was followed conservatively until the occurrence of EC torsion.