scholarly journals 786 Retrospective analysis of paediatric ENT surgery outcomes during the COVID pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Huang ◽  
E Bhargava ◽  
M Walsh ◽  
D Pennell ◽  
H Attya ◽  
...  
Keyword(s):  
Universal Screening ◽  
Surgical Complication ◽  
Paediatric Population ◽  
Medical Complications ◽  
High Morbidity ◽  
Paediatric Surgery ◽  
Infection Rates ◽  
Ent Surgery ◽  
Surgery Outcomes ◽  
Lower Morbidity

Abstract Introduction Studies show high morbidity/mortality for adults with peri-operative SARS-CoV-2 infection, leading to recommendations curtailing elective operations during the height of the pandemic. Our understanding of the risks associated with paediatric surgery is more limited, with preliminary data suggesting lower morbidity/mortality than in adults. A < 1% incidence of COVID-19 in paediatric patients undergoing preoperative universal screening is reported, and even in those testing positive, morbidity and mortality seem to be low. As waiting lists swell and the detriment associated with delaying surgery mounts, it is imperative to accurately quantify the risks of surgery in the paediatric population. Method Retrospective review of all paediatric ENT operations performed at the Evelina Children’s Hospital at the height of lockdown, from March to May 2020. Results 61 procedures were performed on 56 patients. 50% had a pre-operative SARS-CoV-2 nasopharyngeal swabs. All cases involved a change in anesthetic practice; 2 cases involved a change in surgical practice. We noted 2 medical complications and 1 surgical complication. All patients are currently extant. No staff or patients subsequently developed COVID. Conclusions Our perioperative infection rates and mortality/morbidity figures concord with figures published elsewhere in literature. We are cautiously optimistic regarding risks associated with paediatric ENT surgery.

scholarly journals Caudal tramadol bupivacaine combination for postoperative pain releif in subumbilical paediatric surgery

2014 ◽  
Vol 23 (2) ◽  
pp. 42-46
Author(s):  
Md Shafiqul Islam ◽  
Md Tajul Islam ◽  
Dilip Kumar Bhowmick ◽  
Moinul Hossain ◽  
AKM Akhtaruzzaman ◽  
...  
Keyword(s):  
Postoperative Nausea And Vomiting ◽  
Paediatric Population ◽  
Paediatric Surgery ◽  
Physical Status ◽  
Anaesthetic Agents ◽  
Group I ◽  
Caudal Analgesia ◽  
Group Ii ◽  
To Receive ◽  
Control Study

Background Regional anaesthesia in children provides the advantage of reduced requirements of other anaesthetic agents and of excellent analgesia introduction. Rational use of adjuvant with local anaesthetic in caudal route for prolonged optimal analgesia in paediatric population. Objectives To evaluate the quality and duration of postoperative analgesia in children undergoing subumbilical surgeries with caudally administered mixture of tramadol and bupivacaine. Methods Sixty children of ASA physical status I & II scheduled for elective subumbilical surgery were included in this prospective case-control study. Children were randomly assigned to receive caudal analgesia with plain bupivacaine (Group-I) and a mixture of tramadol-bupivacaine (Group-II) respectively. Blood pressure, heart rate, oxygen saturation and duration of analgesia were recorded postoperatively. Results Study revealed that mean duration of caudal analgesia in Group-I and Group-II were 245.67 ± 6.94 and 612.05 ± 16.49 minutes respectively which was significantly longer (P<0.001) in Group-II. Mean number of postoperative analgesics were 2.97±0.50 and 1.78±0.50 in Group-I and Group-II which was statistically highly significant (P=0.000). Postoperative nausea and vomiting was significantly high in Group-II (P=0.019). Conclusion Combination of tramadol with bupivacaine results in prolonged analgesia when administered in caudal route. In addition, tramadol is more useful in young children considering less respiratory depression than other opioids. DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18172 Journal of BSA, 2009; 23(2): 42-46

scholarly journals Getting It Right First Time: the national survey of surgical site infection rates in NHS trusts in England

2019 ◽  
Vol 101 (7) ◽  
pp. 463-471
Author(s):  
JLC Wong ◽  
CWY Ho ◽  
G Scott ◽  
JT Machin ◽  
TWR Briggs ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
National Survey ◽  
Financial Burden ◽  
Surgical Site Infections ◽  
Paediatric Surgery ◽  
Site Infection ◽  
Infection Rates ◽  
Infection Surveillance ◽  
Surgical Units ◽  
First Time

Introduction Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. Methods A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. Results Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. Conclusion The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.

scholarly journals Laparoscopic Watson Fundoplication Is Effective and Durable in Children with Gastrooesophageal Reflux

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Matthew G. Dunckley ◽  
Kapil M. Rajwani ◽  
Anies A. Mahomed
Keyword(s):  
Neurological Impairment ◽  
Paediatric Population ◽  
Reoperation Rate ◽  
Antireflux Procedure ◽  
Partial Fundoplication ◽  
Paediatric Surgery ◽  
Mechanical Complications ◽  
Anterior Fundoplication ◽  
Gastrooesophageal Reflux ◽  
Risk Of Aspiration

Gastroesophageal reflux (GOR) affects 2–8% of children over 3 years of age and is associated with significant morbidity. The disorder is particularly critical in neurologically impaired children, who have a high risk of aspiration. Traditionally, the surgical antireflux procedure of choice has been Nissen’s operation. However, this technique has a significant incidence of mechanical complications and has a reoperation rate of approximately 7%, leading to the development of alternative approaches. Watson’s technique of partial anterior fundoplication has been shown to achieve long-lasting reflux control in adults with few mechanical complications, but there is limited data in the paediatric population. We present here short- and long-term outcomes of laparoscopic Watson fundoplication in a series of 76 children and infants, 34% of whom had a degree of neurological impairment including severe cerebral palsy and hypoxic brain injury. The overall complication rate was 27.6%, of which only 1 was classified as major. To date, we have not recorded any incidences of perforation and no revisions. In our experience, Watson’s laparoscopic partial fundoplication can be performed with minimal complications and with durable results, not least in neurologically compromised children, making it a viable alternative to the Nissen procedure in paediatric surgery.

scholarly journals Morbidity Pattern and its Determinants among Tribal People in Kerala

2017 ◽  
Vol 16 (2) ◽  
pp. 39
Author(s):  
T D Simon
Keyword(s):  
The Other ◽  
High Morbidity ◽  
Consumption Expenditure ◽  
Per Capita ◽  
The Government ◽  
Lifestyle Diseases ◽  
Lower Morbidity ◽  
Per Capita Consumption ◽  
Social Sectors ◽  
Critical Reason

While Kerala has been hailed for its development in social sectors, the available data show the remarkable finding that Kerala’s morbidity is the highest in India. Literature reveals two major streams of argument for this, one questioning the comparability of the reported rates of morbidity and the other admitting that the higher rates of morbidity actually represent the situation.  The present study analyses the pattern of morbidity in Kerala, tries to analyse the morbidity pattern and finds out the reasons for highest morbidity in highest Monthly Per Capita Consumption Expenditure (MPCE) group and lower morbidity in ST households. The paper argues that the prevalence of lifestyle diseases among highest MPCE group is one critical reason for the high morbidity rates in Kerala. It also proposes urgent interventions on behalf of the government that can effectively counter the high rates of infectious diseases among ST households.

scholarly journals Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy

2021 ◽  
Vol 11 ◽  
Author(s):  
Taohui Ouyang ◽  
Na Zhang ◽  
Shenhao Xie ◽  
Bin Tang ◽  
Junjun Li ◽  
...  
Keyword(s):  
Endoscopic Surgery ◽  
Pituitary Adenomas ◽  
Internal Carotid ◽  
Surgical Complication ◽  
Tumor Resection ◽  
Incomplete Resection ◽  
Csf Leakage ◽  
Transsphenoidal Endoscopic Surgery ◽  
Aggressive Tumor ◽  
Surgery Outcomes

Surgery for pituitary adenomas (PAs) with cavernous sinus (CS) invasion in Knosp grade 4 is a great challenge and whether to adopt a conservative or aggressive surgical strategy is controversial. The aim of this study is to provide the outcomes and complications of an aggressive resection strategy for Knosp grade 4 PAs with transsphenoidal endoscopic surgery. Outcomes and complications were retrospectively analyzed in 102 patients with Knosp grade 4 PAs. Among them, primary PAs were seen in 60 patients and recurrent PAs were seen in 42 cases. Gross total resection (GTR) of the entire tumor was achieved in 72 cases (70.6%), subtotal tumor resection (STR) in 18 cases (17.6%), and partial tumor resection (PTR) in 12 cases (11.8%). Additionally, GTR of the tumor within the CS was achieved in 82 patients (80.4%), STR in 17 patients (16.7%), and PTR in 3 patients (2.9%). Statistical analyses showed that both recurrent tumors and firm consistency tumors were adverse factors for complete resection (P&lt;0.05). Patients with GTR of the entire tumor were more likely to have favorable endocrine and visual outcomes than those with incomplete resection (P&lt;0.05). Overall, the most common surgical complication was new cranial nerve palsy (n=7, 6.8%). The incidence of internal carotid artery (ICA) injury and postoperative cerebrospinal fluid (CSF) leakage was 2.0% (n=2) and 5.9% (n=6), respectively. Six patients (5.9%) experienced tumor recurrence postoperatively. For experienced neuroendoscopists, an aggressive tumor resection strategy via transsphenoidal endoscopic surgery may be an effective and safe option for Knosp grade 4 PAs.

scholarly journals Enteric Fever Complicated by Intestinal Perforation in Children: A Persistent Health Problem Requiring Surgical Management

2020 ◽  
Vol 36 (5) ◽  
Author(s):  
Muhammad Azhar ◽  
Naima Zamir ◽  
Mishraz Shaikh ◽  
Inayat Ullah
Keyword(s):  
Surgical Management ◽  
Health Problem ◽  
Intestinal Perforation ◽  
Surgical Procedure ◽  
Enteric Fever ◽  
Primary Repair ◽  
High Morbidity ◽  
Paediatric Surgery ◽  
Duration Of Symptoms ◽  
Enteric Perforation

Objective: To evaluate clinical presentation and surgical outcome in children with enteric perforation. Methods: A descriptive retrospective study was conducted in Department of Paediatric Surgery at National Institute of Child Health, Karachi from August 2016 and September 2019, in children 12 years of age and under with diagnosis of enteric perforation. Data about age, gender, duration of illness, hemodynamic status and baseline investigation on admission was reviewed. Details about patients operated early and those who required prolong resuscitation and were operated after 24 hours of admission, need for tube laparostomy, operative findings, type of surgical procedure performed and post-operative outcome were reviewed. Data was analyzed using SPSS version 22. Results: Ninety-seven patients, 60(61.85%) males and 37(38.14%) females were managed during the study period with age ranged from 3-12 years (mean 7.82, ± 2.94 years).and duration of symptoms ranged from 7-30 days (mean 15.56, ± 9.39days). High grade fever and abdominal pain were seen in all patients (100%). Pneumoperitoneum was noted in 71(73.19%) cases on X-ray abdomen. Fifty-one (52.57%) children were anemic and required blood transfusion before surgery. Seventy-one (73.19) patients were optimized and operated within 24 hours while 28(28.86%) cases required more resuscitation so tube laparostomy was done initially and operated after 24 hours. Seventy nine (81.44%) cases had single perforation, 14(14.43%) cases had multiple and four had sealed perforation. Primary repair of perforation was done in 37(38.14%) cases, while ileostomy in 65(76.01%) cases. Postoperatively wound infection was seen in 71(73.19%) cases, intra-abdominal collections in 31(31.95%) and burst abdomen in nine (9.27%) cases. Overall mortality was 12.37%. Till date in 47 patients (72.30%) reversal of stoma has been done. Conclusions: Enteric perforation in children presents usually with hemodynamic instability and sepsis due to prolong period of illness. Therefore, regardless of surgical procedure performed it is associated with high morbidity and mortality. doi: https://doi.org/10.12669/pjms.36.5.2270 How to cite this:Azhar M, Zamir N, Shaikh M, Inayat ullah4. Enteric Fever Complicated by Intestinal Perforation in Children: A Persistent Health Problem Requiring Surgical Management. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2270 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Molecular epidemiology of paediatric bloodstream infections caused by Gram-negative bacteria in Oxfordshire, UK

2021 ◽  
Author(s):  
Samuel Lipworth ◽  
Karina-Doris Vihta ◽  
Timothy Davies ◽  
Sarah Wright ◽  
Merline Tabirao ◽  
...  
Keyword(s):  
Population Structure ◽  
Bloodstream Infection ◽  
Treatment Guidelines ◽  
Bloodstream Infections ◽  
Paediatric Population ◽  
Control Measures ◽  
High Morbidity ◽  
Gram Negative ◽  
E Coli ◽  
Klebsiella Spp

Background: Gram-negative organisms are common causes of bloodstream infection during the neonatal period and early childhood with high morbidity and mortality as well as increasing concern about associated antimicrobial resistance. Whilst several large sequencing studies have permitted detailed analysis of the population structure of these isolates in adults, equivalent data is lacking in the paediatric population. Methods: We performed an epidemiological and sequencing based analysis of Gram-negative bloodstream infections in children under the age of 18 between 2008 and 2018 in Oxfordshire, UK. Findings: 327 isolates (of which 296 were successfully sequenced) from 287 patients were included in the study. The burden of infection in the paediatric population lies predominantly in neonates. Most infections were caused by E. coli/Klebsiella spp. and Enterobacter hormaechei. There was no evidence of an increasing incidence of E. coli bloodstream infections and for Klebsiella spp. there was some evidence that the incidence decreased slightly. Similarly the proportion of resistant isolates did not change over time, though we did identify some evidence of sub-breakpoint increases in gentamicin resistance. The population structure of E. coli isolates causing bloodstream infection in neonates and children mirrors that seen in adults. In most cases there was no evidence of transmission between patients/point source acquisition and whole genome sequencing was able to refute a previously suspected outbreak. Conclusion: Our findings support continued use of current empirical treatment guidelines and likely highlight the success of infection control measures in this population. Our data suggest that O-antigen targeted vaccines may have a role in reducing the incidence of neonatal sepsis, potentially by vaccination of pregnant women. Clinical trials to further investigate this possibility are warranted.

Surgical and Medical Costs for Fibromyalgia Patients Undergoing Total Knee Arthroplasty

2019 ◽  
Vol 32 (11) ◽  
pp. 1069-1074
Author(s):  
Tara Moore ◽  
Nipun Sodhi ◽  
Wayne B. Cohen-Levy ◽  
Joseph Ehiorobo ◽  
Angad Kalsi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Surgical Complication ◽  
Medical Complications ◽  
Readmission Rates ◽  
Surgical Costs ◽  
Episodes Of Care ◽  
Comorbidity Index ◽  
Total Knee ◽  
Financial Losses

AbstractThe potential added costs of managing fibromyalgia patients after total knee arthroplasty (TKA) have not been assessed. Therefore, the purpose of this study was to perform a cost analysis of fibromyalgia versus nonfibromyalgia patients who underwent TKA. Specifically, we evaluated the following episodes of care: (1) readmission rates, (2) total costs, (3) total reimbursements, and (4) net losses for surgical and medical complications. Patients who underwent TKAs between 2005 and 2014 from the Medicare Standard Analytical Files of the PearlDiver supercomputer were propensity score matched by patients with and without fibromyalgia in a 1:1 ratio based on age, sex, and the Charlson Comorbidity Index, yielding a total of 305,510 patients distributed equally between the cohorts for analysis. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were calculated. Mean costs, total costs, and total reimbursements were assessed as along with total net losses, which were defined as total costs minus total reimbursements. Fibromyalgia patients had similar 90-day readmission rates compared with nonfibromyalgia patients (OR: 1.03; 95% CI: 1.00–1.06; p = 0.06) but incurred lower readmission costs (US$2,318,384,295 vs. US$2,534,482,404; p < 0.001). Although fibromyalgia patients had higher total reimbursements for medical complications ($27,758,057 vs. US$18,780,610; p < 0.001), the increased management costs (US$106,049,870 vs. US$66,080,469; p < 0.001) led to greater net losses (US$78,291,813 vs. US$47,299,859; p < 0.001). Similarly, although fibromyalgia patients had higher total reimbursements for surgical complications (US$94,192,334 vs. US$73,969,026; p < 0.001), the increased surgical costs (US$382,122,613 vs. US$306,359,910; p < 0.001) led to greater net losses (US$287,930,279 vs. US$232,390,884; p < 0.001). This study highlights some of the potential financial discrepancies of managing patients with fibromyalgia. Our findings suggest medical and surgical complication costs to be greater than reimbursement, resulting in overall net financial losses. These findings need to be considered in the light of health care reform and cost structuring.

scholarly journals Molecular pathogenesis of craniopharyngioma: switching from a surgical approach to a biological one

2010 ◽  
Vol 28 (4) ◽  
pp. E1 ◽  
Author(s):  
Benedetta Ludovica Pettorini ◽  
Paolo Frassanito ◽  
Massimo Caldarelli ◽  
Gianpiero Tamburrini ◽  
Luca Massimi ◽  
...  
Keyword(s):  
Molecular Mechanisms ◽  
Benign Tumor ◽  
Recurrence Risk ◽  
High Morbidity ◽  
Therapeutic Implications ◽  
Best Management ◽  
Detailed Explanation ◽  
Neoplastic Process ◽  
Definition Of ◽  
Lower Morbidity

Craniopharyngioma has long been considered a benign tumor because of its pathological aspect. This primordial view of craniopharyngioma fit with the primitive treatment attempts based on blind resection of the tumor each time it recurred. The limits of this management strategy were proven early by the high morbidity related to the resection and recurrence risk despite radical lesion removal. Nowadays, craniopharyngioma must be considered a complex molecular disease, and a detailed explanation of the mechanisms underlying its aggressive biological and clinical behavior, despite some benign pathological features, would be the first step toward defining the best management of craniopharyngioma. Indeed, advances in the knowledge of the molecular mechanisms at the base of craniopharyngioma oncogenesis will lead to comprehension of the critical checkpoints involved in neoplastic transformation. The final research target will be the definition of new biological agents able to reverse the neoplastic process by acting on these critical checkpoints. This biological approach will lead to a refined therapy combining higher efficacy and safety with lower morbidity. In this paper the authors reveal state-of-the-art comprehension of the molecular biology of craniopharyngioma and the consequent therapeutic implications.

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