scholarly journals Management of early appendicular lump in children - laparoscopic technique versus open surgery: a comparative study in low-middle income country perspective

2020 ◽  
Vol 3 (2) ◽  
pp. e000131
Author(s):  
Mohammad Zonaid Chowdhury ◽  
Md Abdullah Al Farooq ◽  
M A Mushfiqur Rahman ◽  
Tanvir Kabir Chowdhury
Keyword(s):  
Pediatric Population ◽  
Treatment Plan ◽  
Open Appendectomy ◽  
Laparoscopic Technique ◽  
Eligibility Criteria ◽  
Laboratory Findings ◽  
Middle Income ◽  
Medical College ◽  
Low Middle Income Countries ◽  
Surgery Department

BackgroundIn the pediatric population, appendectomy is one of the most common emergency operations. Laparoscopic appendectomy (LA) is an accepted way of dealing with suspected uncomplicated appendicitis in children. The role of laparoscopy in appendicular lump is more controversial and remains undefined and is not well practiced in low-middle income countries. The aim of this study was to determine a better surgical treatment plan for early appendicular lump in children.MethodsThis prospective observational study was performed in Pediatric Surgery Department of Chittagong Medical College and Hospital for a period of 1 year from April 2018 to March 2019. Sixty children with appendicular lump selected consecutively as per eligibility criteria underwent either LA or open appendectomy (OA), that is, 30 children per group. They were followed up until hospital discharge to observe outcomes.ResultsThere were no differences in terms of patient’s age, sex, clinical presentation and laboratory findings between the two groups. Postoperative pain severity was significantly less in the LA group than that in the OA group (p<0.01). The incidence of wound infection was significantly lower in the LA group than that in the OA group (6.7% in LA and 46.7% in OA; p<0.01). Children in the LA group had a shorter duration of hospital stay in comparison to the OA group [median (IQR) was 8 (5.75–11.25) days and 12 (7.75–18.00) days, respectively, in LA and OA groups; p=0.01].ConclusionThe study findings suggest that LA is feasible and should replace OA in cases of early appendicular lump in children.

scholarly journals Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Dzulfikar D. L. Hakim ◽  
Ahmad Faried ◽  
Adila Nurhadiya ◽  
Ericko H. Laymena ◽  
Muhammad Z. Arifin ◽  
...  
Keyword(s):  
Rare Case ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Pediatric Intensive Care ◽  
Toxin Production ◽  
Clostridium Tetani ◽  
Anesthetic Care ◽  
Middle Income ◽  
Depressed Skull Fracture ◽  
Low Middle Income Countries

Abstract Background Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low–middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group. Case presentation We report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw.” Perioperative management of this rare case is reported and discussed. Conclusion The pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.

scholarly journals Theatres without borders: a systematic review of the use of intraoperative telemedicine in low- and middle-income countries (LMICs)

2021 ◽  
pp. bmjinnov-2021-000837
Author(s):  
Hariharan Subbiah Ponniah ◽  
Viraj Shah ◽  
Arian Arjomandi Rad ◽  
Robert Vardanyan ◽  
George Miller ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Case Reports ◽  
Surgical Care ◽  
Cochrane Collaboration ◽  
Optimal Care ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

ObjectiveThis systematic review aims to provide a summary of the use of real-time telementoring, telesurgical consultation and telesurgery in surgical procedures in patients in low/middle-income countries (LMICs).DesignA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Collaboration published guidelines.Data sourcesEMBASE, MEDLINE, Cochrane, PubMed and Google Scholar were searched for original articles and case reports that discussed telementoring, telesurgery or telesurgical consultation in countries defined as low-income or middle-income (as per the World Banks’s 2021–2022 classifications) from inception to August 2021.Eligibility criteria for selecting studiesAll original articles and case reports were included if they reported the use of telemedicine, telesurgery or telesurgical consultation in procedures conducted on patients in LMICs.ResultsThere were 12 studies which discussed the use of telementoring in 55 patients in LMICs and included a variety of surgical specialities. There was one study that discussed the use of telesurgical consultation in 15 patients in LMICs and one study that discussed the use of telesurgery in one patient.ConclusionThe presence of intraoperative telemedicine in LMICs represents a principal move towards improving access to specialist surgical care for patients in resource-poor settings. Not only do several studies demonstrate that it facilitates training and educational opportunities, but it remains a relatively frugal and efficient method of doing so, through empowering local surgeons in LMICs towards offering optimal care while remaining in their respective communities.

scholarly journals APENDECTOMY;

2017 ◽  
Vol 24 (05) ◽  
pp. 690-696
Author(s):  
Abdullah Bin Saeed ◽  
Ahmad Raees ◽  
Shoukat Ali
Keyword(s):  
Standard Deviation ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
Safe Procedure ◽  
Laboratory Findings ◽  
Medical College ◽  
Operative Duration ◽  
Group A ◽  
Group B

Introduction: Appendicitis is one of the most common cause of an acuteabdomen in young adults. Open appendectomy (OA) has been the gold standard for thetreatment of acute appendicitis since its introduction by Charles McBurney in 1889.Laproscopicappendectomy (LA) was first performed by Semn in 1983.After its introduction laparoscopicappendectomy (LA) proved to be a feasible and safe procedure. Objective: To compare theoutcome of Open appendectomy and Laparoscopic appendectomy in terms of mean visualanalogue score of postoperative pain and mean operative duration in the treatment of acuteappendicitis. Study Design: Randomized clinical trial. Setting: Punjab Medical College andaffiliated Hospitals, Faisalabad. Duration: Study was carried out for one year from 01-01-2016to 31-12-2016. Subjects and Method: A total of 70 patients with Appendicitis were includedin the study. All patients were diagnosed clinically and confirmed with Laboratory findings. 35patients underwent open appendectomy and laparoscopic appendectomy was used in 35.Outcome in terms of pain and operating time was compared in both groups. Results: Meanage in group A was 27.74 years with a standard deviation of 12.040. Mean age of patients ingroup B was 29.26 years with a standard deviation of 12.650. Post-Operative pain using VisualAnalog Scale was 7.34±2.014 in group A and 3±1.94 in group B. Operative duration in groupA was 42.33±4.25(minutes) and group B had a duration of 34.48±3.5(minutes). Conclusion:Outcome of Laparoscopic appendectomy is better than open appendectomy in terms of painand operative duration in patients undergoing Appendectomy.

scholarly journals Knowledge of Alzheimer’s Disease Among Medical Students of a Medical College

2018 ◽  
Vol 56 (211) ◽  
pp. 666-669 ◽  
Author(s):  
Rachana Sharma ◽  
Subhash Chandra Sharma ◽  
Sudarshan N Pardhan ◽  
Pratikshya Chalise ◽  
Luna Paudel
Keyword(s):  
Medical Students ◽  
Cross Sectional Study ◽  
Health Concern ◽  
First Year ◽  
Cross Sectional ◽  
Middle Income ◽  
Medical College ◽  
Middle Income Countries ◽  
Medical Study ◽  
Low Middle Income Countries

Introduction:Dementia is a public health concern as the prevalence is increasing worldwide with significant increase being in low-middle income countries. However these countries appear to be less prepared in handling this rise in terms of diagnosis and management. Methods: This cross-sectional study was conducted in Kathmandu medical College, from June 2017 to July 2017. Purposive sampling was done and the medical students who were in their first and final year of study were included in the study after obtaining an informed consent. Results: Total 185 students were included in the study, 80 (43.24%) from first year and 105 (56.75%) from final year of medical study. The mean score of knowledge among the students was 17.44± 2.46; 15.32± 1.22 among first year and 19.06± 1.87 among the final year students. Majority of the students said they have heard about dementia however, only 3 (3.75%) of first year and 43 (41.9%) from final year students have either attended a class or CME on dementia Conclusion:The knowledge about dementia was found to be average among medical students but better among final year medical students in comparison to first year. The knowledge was found to be better statistically among those who had either attended a class or CME on dementia or had exposure through different medias. Keywords:alzheimer`s disease; dementia; knowledge; medical students.

scholarly journals Effectiveness and Acceptability of Telerehabilitation in Physical Therapy during COVID-19 in Children: Findings of a Systematic Review

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1101
Author(s):  
Asma Alonazi
Keyword(s):  
Systematic Review ◽  
Physical Therapy ◽  
Access To Health Care ◽  
Health Care Services ◽  
Health Condition ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Rehabilitation Professionals ◽  
Care Services ◽  
Low Middle Income Countries

The goal of this systematic review was to determine the efficacy and acceptability of telerehabilitation in physical therapy (PT) and parental acceptance during the COVID-19 pandemic in children. In 2021, an electronic search of academic articles was performed using databases such as Embase, PubMed and Scopus. One-hundred and one articles did not satisfy the eligibility criteria after deleting duplicates and reviewing abstracts, while 16 papers did not meet eligibility after reviewing complete texts. Hence, full texts for 13 articles were retrieved, which were incorporated in the review. All these studies were observational studies assessing the effectiveness and acceptability of telerehabilitation in PT required for diverse conditions in children during the COVID-19 pandemic. All included studies revealed a positive effect of telerehabilitation in PT during the COVID-19 pandemic in children with different conditions. Moreover, the included studies revealed that both rehabilitation professionals and parents or caregivers of children were satisfied with the telerehabilitation services provided remotely. Thus, telerehabilitation appears to be a suitable and convenient strategy to offer remote services to children in need but cannot visit in person due to COVID-19. The existing evidence shows that telerehabilitation can be considered effective for children who need PT for any health condition mainly during the pandemic. However, due to the dearth of studies in this area, exploring this topic is recommended mostly in low-middle-income countries with poor access to health care services and limited resources. 

scholarly journals COVID-19 IN CHILDREN AND ADOLESCENT: CHARACTERISTICS AND SPECIFICITIES IN IMMUNOCOMPETENT AND ONCOHEMATOLOGICAL PATIENTS

2022 ◽  
Vol 14 (1) ◽  
pp. e2022009
Author(s):  
Federico Mercolini ◽  
Simone Cesaro
Keyword(s):  
Risk Factors ◽  
Pediatric Population ◽  
Treatment Options ◽  
Attributable Mortality ◽  
Prevention Measures ◽  
Middle Income ◽  
Children And Adolescent ◽  
Middle Income Countries ◽  
Care Givers ◽  
Low Middle Income Countries

SARS-CoV-2 pandemic affected less children and adolescents, morbidity and mortality figures being inferior to that reported for adults. In this review we focused on the clinical course, risk factors for severe COVID-19, mortality, treatment options and prevention measures in the pediatric and adolescent setting with special attention to the pediatric oncohematological patients. In this subgroups of patients, SARS-CoV-2 infection was often asyntomatic but 47 to 68% of patients require hospitalization and 9-10% of those hospitalized needed intensive care with a COVID-19 attributable mortality of about 4%. The multisystem inflammatory syndrome associated to Coronavirus 2019 was less frequent than that reported in the non-oncohematological pediatric population. Noteworthy, the course of COVID-19 was more severe in low-middle income countries. The key measures to prevent SARS-CoV-2 infection are the reduction of patients exposure to the SARS-CoV-2 and vaccination, now available fore care givers and parents and for patients and siblings > 12 years old. The treatment of COVID-19 in pediatric patients was mainly based on supportive care with dexamethasone and heparin prophylaxis for severely ill patients. Other measures, such as convalescent plasma, remdesivir and monoclonal antibodies have been used in limited case or within experimental protocols. Further studies are needed on the risk factors and outcome of SARS-CoV-2 infection in the pediatric immunocompromised patients. 

scholarly journals Jejuno-jejunal Intussusception as an Unusual Cause of Acute Abdomen of a 26 Year Female - A Case Report

2019 ◽  
Vol 10 (2) ◽  
pp. 111-114
Author(s):  
Md Mustafizur Rahman ◽  
Sami Ahmad ◽  
Jawhar Lal Singha ◽  
Shoaeb Imtiaz Alam ◽  
Mansurul Islam ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pediatric Population ◽  
Lead Point ◽  
College Hospital ◽  
Medical College ◽  
Small Bowel Intussusception ◽  
Common Etiology ◽  
Fibroid Polyp ◽  
Upper Abdominal ◽  
Surgery Department

Intussusception is a relatively common etiology of abdominal pain in pediatric population. In adults, on the other hand, this entity is seen infrequently and a lead point can be recognized in a vast majority of cases. A 27 year old woman who was admitted in the Surgery Department of Shaheed Sohrawardy Medical College Hospital after experiencing severe upper abdominal pain associated with nausea, vomiting and fever. Later on the patient developed features of intestinal obstruction. Ultrasonography demonstrated small bowel intussusception. A jejunal intussusception 50 cm distal to the dudeno-jejunal junction was found during laparotomy. Resection and anasto mosis was performed as gut was not viable. A diagnosis of jejunal inflammatory fibroid polyp was made based on the histological findings which act as a lead point for jejunal intussusception. J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 111-114

scholarly journals Infected Open Depressed Skull Fracture Complicated with Tetanus Grade I in an Unimmunized Child: A Rare Case Report with Literature Review

2020 ◽  
Author(s):  
Dzulfikar Lukmanul ◽  
Ahmad Faried ◽  
Adila Nurhadiya ◽  
Ericko H. Laymena ◽  
Muhammad Z. Arifin ◽  
...  
Keyword(s):  
Rare Case ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Pediatric Intensive Care ◽  
Toxin Production ◽  
Clostridium Tetani ◽  
Middle Income ◽  
Depressed Skull Fracture ◽  
Anaesthetic Care ◽  
Low Middle Income Countries

Abstract Background: Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low-middle income countries, tetanus still occurs (mostly in adult) due to the lack of immunization related to religious tenets, cultural belief or inaccesibility to medical care. In addition, tetanus in pediatric population shows features which are quite distinct from the adult group. Case Description: We reported a 7 year old girl that presented to our institution with a history of falling 10 days prior the admission, with only skin laceration of her forehead. Since one day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed as unimmunized child with open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw”. Perioperative management of that rare case is reported and discussed. Conclusion: This case is so exceptional, since the infected open depressed skull fracture complicated with trismus in an unimmunized child occurrence in our center is extremely rare; the pediatric intensive care of such patients requires halting further toxin production, neutralisation of circulating toxin and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tents of anaesthetic care in such case had to well managed and planned prior the surgery.

Childhood Intussusception: Timely Management Leads to Decreased Surgical Risk

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
Dr. Sunil Kumar Mehra, Dr. Dinesh Kumar Barolia, Dr. Arun Kumar Gupta, Dr. Vinita Chaturv
Keyword(s):  
Operative Procedure ◽  
Delayed Diagnosis ◽  
Diagnostic Methods ◽  
Treatment Modalities ◽  
Surgical Morbidity ◽  
Surgical Risk ◽  
Medical College ◽  
Pneumatic Reduction ◽  
Surgery Department ◽  
Resection And Anastomosis

Intussusception is the most common cause of intestinal obstruction in infants and children in < 1yr of age (1). Intussusception cases usually reported late therefore operative procedure was inevitable and results in significant morbidity and mortality. By this study we emphasized on timely transfer of intussusception case to a pediatric surgical center so as to decrease surgical risk. The surgical morbidity was low in those who were admitted early or directly to our center.  Methods - We retrospectively reviewed cases of intussusception in children <15 years. Children were treated from October 2015 to December 2107 at pediatric surgery department of SMS medical college Jaipur Rajasthan. Age, sex, month of admission, symptom with duration, diagnostic methods, and treatment modalities were recorded and analyzed.  Results - We studied 300 patients with intussusception.272 (90%) were treated surgically. We recently started ultrasonography guided pneumatic reduction and 24(85.7%) out of 28 treated successfully by it. Out of the patients requiring surgery 202 (67.34%) patients were reduced by per-operative manual reduction and in 60(22%) patients resection and anastomosis with 10(3.6%) treated with resection and ileostomy. 25.34% cases have delayed diagnosis and lately  transferred from peripheral hospitals requiring resection and diversion. Conclusion - In conclusion, Intussusception cases usually reported late therefore high likelihood of surgical management. The patients who underwent resection have longer duration of hospital stay.

The Impact of Covid 19 on Pregnant Women and Child Health

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1367-1373
Author(s):  
Nikhil Sanjay Mujbaile ◽  
Smita Damke
Keyword(s):  
Social Issues ◽  
Middle Income ◽  
Web Based ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
The Social ◽  
Social Separation ◽  
The Impact ◽  
And Child Health ◽  
General Wellbeing

The Covid illness (COVID-19) pandemic has spread rapidly all through the world and has had a drawn-out impact. The Pandemic has done incredible damage to society and made genuine mental injury to numerous individuals. Mental emergencies frequently cause youngsters to deliver sentiments of relinquishment, despondency, insufficiency, and fatigue and even raise the danger of self-destruction. Youngsters with psychological instabilities are particularly powerless during the isolate and colonial removing period. Convenient and proper assurances are expected to forestall the event of mental and social issues. The rising advanced applications and wellbeing administrations, for example, telehealth, web-based media, versatile wellbeing, and far off intuitive online instruction can connect the social separation and backing mental and conduct wellbeing for youngsters. Because of the mental advancement qualities of youngsters, this investigation additionally outlines intercessions on the mental effect of the COVID-19 Pandemic. Further difficulties in Low Middle-Income Countries incorporate the failure to actualize successful general wellbeing estimates, for example, social separating, hand cleanliness, definitive distinguishing proof of contaminated individuals with self-disconnection and widespread utilization of covers The aberrant impacts of the Pandemic on youngster wellbeing are of extensive concern, including expanding neediness levels, upset tutoring, absence of admittance to the class taking care of plans, decreased admittance to wellbeing offices and breaks in inoculation and other kid wellbeing programs. Kept tutoring is critical for kids in Low Middle-Income Countries. Arrangement of safe situations is mainly testing in packed asset obliged schools. 

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