Glans Diameter and Meatus Localization Are the Sole Predictors of Primary Distal Hypospadias Surgery Complications: A Multivariate Analysis of Single Surgeon Series.

INTRODUCTION: Tubularized incised plate urethroplasty (TIPU) surgery is among the most successful techniques for distal hypospadias. Our objective was the investigation of complication rates and their predictors. METHODS: Between 2010 and 2021, 150 patients with distal hypospadias were operated on consecutively by a single surgeon using the TIPU technique. The primary outcome was the complication rates including fistula, meatal stenosis, and glans dehiscence. Secondary outcomes were predictor factors of complications. RESULTS: The average glans diameter was 13.9 ± 0.10 mm and 57.0% of the patients had a glans diameter greater than 14 mm. Single-layer and double-layer urethroplasty were used in 55.3% (n = 83) and 44.7% (n = 67) of patients, respectively. Overall complication rate was 23.3% (n = 35), which included fistula (3.3%, n = 5), glans dehiscence (12.7%, n = 19), and meatal stenosis (8.6%, n = 13). Glandular meatus localization (OR = 58.8, p = 0.001) and smaller glans diameter (OR = 0.39, p = 0.001) were significant predictors in the multivariate analysis of overall complications. For fistula complications, only short operation time (OR = 0.83, p = 0.03) was found as a significant predictor. Glans width (<14 mm) was the only significant predictor of both glans dehiscence (OR = 3.4, p = 0.03) and stenosis (OR = 5.67, p = 0.013) complication. CONCLUSION: TIPU technique for distal hypospadias has notable success and acceptable complication rates. Dartos augmented single-layer urethral closure seems adequate for complication prevention. Preoperative assessment of the glans width and meatus site is advised to predict complication rates.

Child Abuse as an Example of Coexistence of Emotional and Physical Trauma Among Children: An Academic Overview With Altmetric Perspective.

INTRODUCTION: Child abuse combines emotional, physical, sexual, and neglect aspects of violence, thus diversifying the trauma for a child. Publications about child abuse had been discussed in academia for long years and evaluated by bibliometric analysis, frequently. This study aims to evaluate the most discussed/disseminated scientific publications about child abuse in electronic media such as social media accounts, blogs, podcasts, and media news sites using a new analysis method called altmetric analysis. METHODS: The data were obtained from the Altmetric Explorer database using the phrase "child abuse," in 2021. After being ranked by altmetric attention score (AAS), descriptive statistics for all publications as well as detailed analyses for the first-100 publications were performed. Variables evaluated were AAS, dimensions-badge value, distribution of web sources, demographic/geographic-breakdown type distributions, main subject categories, and mesh terms. Kruskal Wallis test was used for AAS and dimensions-badge value comparisons while Spearman correlations and regression analysis were also performed. Analyses were performed by SPSS 23.0 (IBM SPSS, Inc., Chicago, IL, USA) and p<0.05 was considered statistically significant. RESULTS: Publications about child abuse were shared extensively on social media, mostly on Twitter. In terms of the main subject, sexual abuse was the trending topic, followed by physical abuse and maltreatment. Psychology, studies in human society, health sciences, and law/legal issues were the four main science categories about the subject. The United States was the major disseminator of publications while Child Abuse and Neglect was the most productive journal. There was a weak but significant (p<0.05) positive correlation between AAS and dimensions-badge values. CONCLUSION: Child abuse is a multidimensional subject in social media. As the number of publications increases, the possibility of articles to be shared on different social media platforms also increases. The majority of the top-100 publications are the ones emphasizing the importance of child abuse in terms of the prevalence, individual/social burden, and negative consequences.

How does circumcision performed under regional anesthesia affect sleep, feeding, and maternal attachment in babies aged 0-4 months?

BACKGROUND: There is no consensus whether circumcision performed in the first months of life has negative effects on feeding, sleep, and maternal attachment in babies. This prospective study aimed to investigate this relation in the first months of life. This study is the first to investigate the effects of circumcision on feeding, sleep, and maternal attachment simultaneously. METHODS: The study group consisted of 75 families with their babies aged 0-4 months. Surgical circumcision procedure under regional anesthesia was applied to all patients. The questionnaires were used to evaluate the babies' feeding and sleeping habits, and the Maternal Attachment Inventory (MAI) was used to assess mother-baby attachment level. All assessments were performed before and one month after the circumcision. RESULTS: The mean age of the patients when circumcision was performed was 75 (74.52 ± 37.03) (3-120) days. The mean ages of mothers were 32 (32.51 ± 4.05) years. There was no statistically significant change in the sleep habits and feeding status of babies before and after circumcision. The mean maternal attachment value before circumcision was 101 (98.89 ± 6.77) points, while it was 103 (101.36 ± 4.21) points after circumcision. This result indicates that the maternal attachment score increased significantly after circumcision (p < 0.001). CONCLUSIONS: The circumcision performed under regional anesthesia between 0 and 4 months did not have any negative effect on sleep, feeding, and maternal attachment in babies.

The Controversy of Surgical Intervention for Anal Canal Duplication in Children.

OBJECTIVE: Since the first definition of anal canal little has been discovered about the etiology of this rare condition. We present four asymptomatic cases of anal canal duplication with diverse clinical and surgical findings. METHODS: A retrospective chart review was performed on four infants presenting with asymptomatic anal canal duplication, born between 2014 and 2016. Clinical characteristics and pathologic findings of patients either by radiological imaging or pathology were evaluated. The primary outcome measure was the complications. RESULTS: All patients were followed-up with physical examination and ultrasound for a mean of 3.5±1.0 years, lastly seen at the beginning of 2018. The female to male ratio was 3:1. Duplicate anal canal length varied between 12-20mm, and two of the four patients had a presacral cystic mass confirmed as a tail gut cyst following surgery. At follow-up, none of the patients had developed symptoms related to anal canal duplication, regardless of whether they had surgical intervention. CONCLUSION: Though surgical management is the preferred treatment for anal canal duplication, it seems that patients who do not undergo surgery might remain free of symptoms, suggesting that surgical intervention may be unnecessary.

A novel and simple machine learning algorithm for preoperative diagnosis of acute appendicitis in children.

INTRODUCTION: There is a tendency toward nonoperative management of appendicitis resulting in an increasing need for preoperative diagnosis and classification. For medical purposes, simple conceptual decision-making models that can learn are widely used. Decision trees are reliable and effective techniques which provide high classification accuracy. We tested if we could detect appendicitis and differentiate uncomplicated from complicated cases using machine learning algorithms. MATERIALS AND METHODS: We analyzed all cases admitted between 2010 and 2016 that fell into the following categories: healthy controls (Group 1); sham controls (Group 2); sham disease (Group 3), and acute abdomen (Group 4). The latter group was further divided into four groups: false laparotomy; uncomplicated appendicitis; complicated appendicitis without abscess, and complicated appendicitis with abscess. Patients with comorbidities and whose complete blood count and/or pathology results were lacking were excluded. Data were collected for demographics, preoperative blood analysis, and postoperative diagnosis. Various machine learning algorithms were applied to detect appendicitis patients. RESULTS: There were 7244 patients with a mean age of 6.84 ± 5.31 years, of whom 82.3% (5960/7244) were male. Most algorithms tested, especially linear methods, provided similar performance measures. We preferred the decision tree model due to its easier interpretability. With this algorithm, we detected appendicitis patients with 93.97% area under the curve (AUC), 94.69% accuracy, 93.55% sensitivity, and 96.55% specificity, and uncomplicated appendicitis with 79.47% AUC, 70.83% accuracy, 66.81% sensitivity, and 81.88% specificity. CONCLUSIONS: Machine learning is a novel approach to prevent unnecessary operations and decrease the burden of appendicitis both for patients and health systems. LEVELS OF EVIDENCE: III.

Long-term outcomes in pediatric appendiceal carcinoids: Turkey experience.

The tendency of non-operative management of appendicitis let us explore the natural history of appendiceal carcinoids, compare them with appendicitis patients, and determine the possibility of deciding the extent of the surgery and post-operative follow-up on behalf of the intraoperative findings. A retrospective review was performed of patients with appendicitis between 2009 and 2017. Of 2781 patients, 10 (0.36%) were diagnosed with appendiceal carcinoids. Sixty percent were female with an average age of 13.10 ± 1.73. The mean tumor size was 0.97 ± 0.34 cm with 70% located at the tip. Majority had an insular pattern (n = 9), six had subserosal fat tissue invasion, one had extension to mesoappendix, one had vascular invasion, and two had lymphatic invasion. The average mitotic index was 3.20 ± 1.40/50HPF, and Ki 67 activity was 3 ± 1.7%. The mean follow-up period was 66.40 ± 25.92 months. Patients were further evaluated with ultrasonography (n = 10), CT (n = 3), and MRI (n = 10). Serum markers including chromogranin (n = 9), NSE (n = 6), and 5-HIAA (n = 6) were normal. None required further treatment and had any symptoms of carcinoid syndromes or recurrences post-operatively.Conclusion: Other than appendectomy, no additional surgery or follow-up is required in appendiceal carcinoids less than 1.5 cm in size, regardless of the lymphoid or vascular invasion. What is Known: • The treatment of patients with a 1-2-cm tumor is not clear in both the pediatric and adult populations, and additional resection is needed. • Patients are monitored post-operatively with radiological and/or biochemical testing. What is New: • Appendectomy is curative for tumors less than 2 cm. • No additional surgery or follow-up is required in appendiceal carcinoids less than 1.5 cm in size regardless of the lymphoid or vascular invasion.

Intestinal rotation anomalies in childhood: review of 22 years' experience.

PURPOSE: We review our experience of treating intestinal rotation anomalies in infants and children in the 22-year period between 1978 and 2000. METHODS: The type of operation performed, postoperative complications, and mortality were compared in three age groups. Group 1 consisted of neonates <1 month old, Group 2 consisted of infants aged <1 year old, and Group 3 consisted of children aged >1 year old. RESULTS: There were 101 infants and children, with a female : male ratio of 2 : 1. Of the 101 patients, 72 (71%) were neonates, with a mean age of 11.8 days (range 1-28 days); 20 (19.8%) were under the age of 1 year, with a mean age of 6.7 months (range 1-12 months); and 9 (8.9%) were >1 year of age, with a mean age of 6 years (range 1-9 years). Eighty-five (84%) patients underwent emergency procedures. Ladd's operation was performed in all patients, with various additional procedures. The most frequent postoperative complications were adhesive intestinal obstruction, stoma necrosis, evisceration, and short bowel syndrome. The mortality rate was 36% in Group 1, 20% in Group 2, and 0% in Group 3. CONCLUSIONS: In this series surgery was usually performed as an emergency procedure, with higher morbidity and mortality in newborns than in older infants and children.