Elective surgery cancellations in pediatric surgery: rate and reasons.

INTRODUCTION: Canceling pediatric elective surgery leads to multiple disturbances regarding the inefficient operating room (OR) management, the financial repercussions, and the psychological impact on the patient and his family. This study aims to identify the reasons for cancellations among the pediatric population in our setting and suggest some convenient solutions. METHODS: We carried out a prospective and descriptive study over 12 months in the pediatric surgery department of Fattouma Bourguiba University Hospital. RESULTS: One thousand four hundred twenty-six patients were scheduled for surgery at the pediatric surgery department, of whom 131 (9.2%) were canceled. Medical and anesthesia-related reasons accounted for 62.5% of all cancellations, followed by surgical reasons at 16%, organizational or administrative issues at 11.5%, and patient-related reasons at 10%. The most significant causes were upper respiratory tract infections (URTIs) in 36.6%, abnormal blood test results in 16%, and non-adherence to preoperative fasting in 9.2%. CONCLUSIONS: The rate of pediatric elective surgery cancellations at Fattouma Bourguiba University Hospital was higher than the accepted average rate (5%). Therefore, to prevent these cancellations as much as possible, efforts should be made to promote children's medical care, operation scheduling, and efficient institution resource utilization.

Post-traumatic lateral abdominal wall hernia: a case report.

Traumatic abdominal wall hernia (TAWH) also known as blunt abdominal TAWH is uncommon. The clinical diagnosis is difficult. The authors present a case report of posthigh-energy abdominal blunt trauma causing a TAWH. Case presentation: A 36-year-women, with unremarkable past medical history, was presented to the Emergency Department after a stuck in high-speed two automobiles. She was hemodynamic, respiratory, and neurologically stable. The BMI was 36 kg/m². The abdomen was not distended with an ecchymotic lesion on the right flank. The thoracic abdominal and pelvic computed tomography (CT) scan revealed a rupture in the lateral abdominal wall muscles with a TAWH in the location of the skin ecchymoses. There was no visceral lesion or intraperitoneal fluid. A conservative treatment was indicated. The follow-up was uneventful, with hematoma resorption and no cellulitis or abscess. The patient was discharged after 1 week. An abdominal repair will be planned using a mesh. Clinical discussion: TAWH is a rare entity. The best imaging modality for diagnosis is the CT scan allowing classification of the hernia and a screen for other injuries. The presence of an isolated TAWH must lower the threshold to closely monitor or to operatively explore, given the high rate of false-negative findings at imaging features. Conclusion: TAWH should be suspected behind any blunt abdominal trauma with high energy. CT scan and ultrasound were helpful for diagnosis and the only curative treatment is surgery to avoid complications.

A Child With Acute Hematogenous Osteomyelitis of the Distal Fibula and Infective Endocarditis.

Acute hematogenous osteomyelitis (AHO) commonly interests the pediatric population. It typically affects the metaphyses of long tubular bones. However, the fibula is rarely involved. Regarding the hematogenous inoculation, this infection may be associated with distant foci. Herein, we present the case of a 10-year-old girl who was initially diagnosed with atypical AHO of the distal fibula complicated by a subperiosteal abscess. Upon admission, the child showed a severe septic condition, including embolic infective endocarditis (IE), which was responsible for multiple cerebral, renal, and splenic loci. AHO was successfully resolved with appropriate intravenous antimicrobial treatment targeting Staphylococcus aureus, surgical drainage, and debridement. Due to the complexity of the lesions and the embolic nature, the IE was also managed operatively with a mechanical prosthesis. The distal fibula is a rare and challenging location for AHO. EI co-infection should always be sought and suspected because, in such instances, it will genuinely complicate diagnostic and therapeutic management.

Developing learning objectives in postgraduate medical education for family medicine (Tunisia).

Introduction-Aim: The third cycle of medical studies (TCMS) lasts 3 years for the specialty of family medicine (FM) in Tunisia. The members of the FM committee of the Faculty of Medicine of Monastir (FMM) aimed to detail the learning objectives (LO) of residents in FM. METHOD: We used the Delphi method in 2 rounds including a group of experts called FM Learning Objectives Writing Group (FMLOWG) at the FMM. The FMLOWG included 74 university hospital physicians and FM internship supervisors. These members actively participated in the 10 meetings held during the month of March 2022. Three points were discussed: the identification of LOs; the development of training titles and the proposal of the teaching methods to be adopted. The writing was subdivided into 5 domains of LO: transversal, public health, typical population and by system. RESULTS: We identified 1359 LOs for FM residency, for which 552 were LOs per system (40.5%). The learning included 618 training session titles. Residents will have an academic training day every 3 weeks during 9 months for each TCMS year. CONCLUSION: A detailed, MF-specific consensus has been developed by majority of medical specialties. It will be a learning base for learners, a reference for supervisors and TCMS teachers.