SHORT TERM OUTCOME OF DIVERSION LOOP COLOSTOMY IN CHILDREN OF ANORECTAL MALFORMATION.

Purpose: Colostomy for patients with anorectal malformations decompresses an obstructed colon, avoids fecal contamination of the urinary tract, and protects a future perineal operation. The procedure is associated with several signicant complications. Objective: To study relation of various demographic factors, clinical features, complications and patient related factors with outcomes. Methods-All necessary data of these 50 patients were obtained from case sheets and attendants of patients admitted in SNCU, NICU and wards of department of paediatrics and surgery. All the details (demographic, patients related, surgery) of patient was lled in predesigned structured proforma. Results- More than half of babies were males (68%). The male to female ratio was 2.1:1. The mean weight at post-operative 7 days was 4.74±0.21 kgs which increased to 5.19±0.41 kgs at post-operative 1 month, 5.73±0.88 kgs at post-operative 2 months and 6.28±0.6 kgs at post op 3 months. There was signicant (p=0.001) increase in weight from post-operative 7 days to postoperative 1 month, 2 months and 3 months. Peri stomal skin excoriation was seen in 8% at post-operative 7 day, 14% at postoperative 1 month, 12% at 2 months and 4% at 3 months. Stomal prolapse was seen in 2% patients at post-operative 7 days and in 4% patients at 1 month & 2 months and became nil at 3 months post-operatively. There was signicant (p=0.001) difference in weight gain from 7 days to 3 months post-operative between groups of age <30 days (1.67±0.33 kgs) and ≥30 days (1.08±0.65 kgs). Conclusion- Minimal post-operative complications of diversion loop colostomy in children of anorectal malformation and hence we can conclude that loop colostomy is safe in patients with anorectal malformations. we recommend, a study with a large sample size and longer duration of follow up, needs to be done to have a more effective and rationale conclusion.

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Multicenter Study of 342 Anorectal Malformation Patients: Age, Gender, Krickenbeck Subtypes, and Associated Anomalies

European Journal of Pediatric Surgery ◽

10.1055/s-0039-1695789 ◽

2019 ◽

Vol 30 (05) ◽

pp. 447-451

Author(s):

Tahmina Banu ◽

Anwarul Karim ◽

Maryam Ghavami Adel ◽

Kokila Lakhoo ◽

Tasmiah Tahera Aziz ◽

...

Keyword(s):

Anorectal Malformations ◽

Associated Anomalies ◽

Gender Distribution ◽

Female Ratio ◽

Iranian Patient ◽

Relative Incidence ◽

Organ Systems ◽

Rectovesical Fistula ◽

Global Initiative ◽

Male To Female

Abstract Introduction Published studies based on Krickenbeck classification of anorectal malformations (ARMs) are still insufficient to assess the global as well as regional relative incidence of different ARM subtypes, gender distribution, and associated anomalies. The primary purpose of this study was to provide an estimate of those in Global Initiative for Children's Surgery (GICS) research group. Materials and Methods We collected ARM data prospectively for 1 year from four institutes of different geographic locations. A total of 342 patients were included in this study (195, 126, 11, and 10 from Bangladesh, Iran, Papua New Guinea, and Oxford, United Kingdom, respectively). Results Overall male to female ratio was 1:1. The most frequent ARM subtype was perineal fistula (23.7% = 81/342). About 48.5% (166/342) patients had at least one associated anomaly. Cardiac and genitourinary systems were the most commonly affected systems, 31.6% (108/342) and 18.4% (63/342), respectively. These organ-systems were followed by anomalies of vertebral/spinal (9.9% = 34/342), musculoskeletal (4.4% = 15/342), and gastrointestinal/abdominal (3.2% = 11/342) systems. Rectovesical fistula had the highest percentage (96.4% = 27/28) of associated anomalies. About 18.1% (62/342) patients had multiple anomalies. ARMs (both isolated and with associated anomalies) occurred equally in males and females. Comparison between patients from Bangladesh and Iran showed differences in relative incidence in ARM subtypes. In addition, Iranian patient group had higher percentage of associated anomalies compared with Bangladeshi (73 vs. 35.4%). Conclusion Our study provides important insights about ARM subtypes, gender distribution and associated anomalies based on Krickenbeck classification especially from Bangladesh and Iran.

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Birth Defects: A Hospital Based Study in Chittagong, Bangladesh

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v13i3.20994 ◽

2014 ◽

Vol 13 (3) ◽

pp. 5-10 ◽

Cited By ~ 1

Author(s):

Tahmina Banu ◽

Tanvir K Chowdhury ◽

Sahadeb Kumar Das ◽

Md Zonaid Chowdhury ◽

Md. Momtazul Hoque ◽

...

Keyword(s):

Birth Defects ◽

Hospital Admissions ◽

Anorectal Malformations ◽

Chi Square ◽

Female Ratio ◽

Birth Prevalence ◽

Medical College ◽

Common Causes ◽

Chi Square Test ◽

Male To Female

Introduction: Birth defects are one of the most common causes of disability in developed and developing countries. Birth defects are structural or functional anomalies, including metabolic disorders, which are present at the time of birth. Although the worldwide incidence of birth defects is estimated at 3-7%, the rate varies widely between countries. In this paper, we categorized the birth defects most commonly seen in Bangladesh and their outcome. We hope to use this information to guide the strategies used to manage these problems.Materials and Methods: This hospital based, descriptive study was done in the Department of Pediatric Surgery in Chittagong Medical College and Hospital from January 2008 to December 2012. Records of all patients with birth defects in our hospital and departmental database were reviewed. Types of birth defects, age, sex, surgery performed and outcome were analyzed in patients admitted during this period. Data were analyzed by SPSS 17. Statistical analysis was performed by the chi-square test and mean and percentage values were calculated. P<0.05 was considered to be statistically significant.Results: During this five year period, there were 5661 patients of birth defects admitted in this department. Of these, 5156 had a single congenital anomaly and 505 had multiple congenital anomalies. The male to female ratio was 2.1: 1. Birth defects comprised 44.61% of all Pediatric surgical admissions and 0.90% of total hospital admissions. The gastrointestinal system was the most common organ system involved, followed by the genitourinary system. Inguinal hernias were the most common gastrointestinal abnormality and hypospadias were the most common genitourinary case. A total of 3921 operations were performed for birth defects, representing 69.26% of total admission for birth defects. Most operations were done for gastrointestinal and genito-urinary defects. Inguinal herniotomy was the most commonly performed operation followed by laparotomy for various indications. There were 225 deaths for birth defects. While this is only 3.97% of all admissions for birth defects, this represents 51.49% of all (pediatric) deaths during the study period. The most common cause of death was anorectal malformations followed by gastroschisis.Conclusion: The study helps assess the burden of birth defects in the Bangladeshi society. There is a need for more extensive, nationwide screening studies to determine the birth prevalence, types and distribution of birth defects in Bangladesh.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i3.20994

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Pattern of anorectal malformation in a tertiary care hospital of Bihar

International Surgery Journal ◽

10.18203/2349-2902.isj20203249 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2647

Author(s):

Zaheer Hasan ◽

Vinit Kumar Thakur ◽

Ramdhani Yadav ◽

Digamber Chaubey

Keyword(s):

Anorectal Malformation ◽

Tertiary Care ◽

Medical Science ◽

Work Load ◽

Care Hospital ◽

Female Ratio ◽

Neonatal Intestinal Obstruction ◽

Male Preponderance ◽

Socioeconomic Strata ◽

Male To Female

Background: Anorectal malformation (ARM) is common cause of neonatal intestinal obstruction and is one of the most common neonatal surgical emergency encountered by paediatric surgeons. There is no published study about the prevalence of ARM cases within the referral zone of the hospital. This study was done to demonstrate the burden of Anorectal malformation and their surgical intervention as seen in Indira Gandhi Institute of medical science, Patna, Bihar.Methods: Data were retrospectively collected over a period of four years between January 2015 and December 2018. The data collected were demographic status of the patient, diagnosis, associated anomaly, duration of hospital stay and their surgical intervention.Results: There were 395 cases of anorectal malformation out of 93203 OPD patients (0.42%). Male to female ratio of 3.01:1. ARM also represented 25.3% of neonatal emergency surgical procedures. The majority of the patient had presented in the neonatal period (51.6%) with mean weight of 2.6 kg. The most common type of ARM found in male patient was rectourethral fistula n=215 (54.4%) in which 164 (76.2%) patients were with rectobulbar fistula and 51 (23.8%) patients had rectoprostatic fistula. Sixty nine (17.4%) female patients presented with perineal fistula.Conclusions: We found a clear male preponderance of anorectal malformation in our study. Patients affected were mostly from poor socioeconomic strata of the society. Present study confirms huge work load of anorectal malformation in this region. This will be helpful in future planning and effective management including financial constraints of the treatment for our poor patients.

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Short term outcome of retrograde tibiopedal access in management popliteal and infrapopliteal disease

International Surgery Journal ◽

10.18203/2349-2902.isj20185476 ◽

2018 ◽

Vol 6 (1) ◽

pp. 216

Author(s):

Baker Ghoneim ◽

Mahmoud Nasser ◽

Mohamed Ali

Keyword(s):

Limb Ischemia ◽

Target Lesion ◽

Primary Patency ◽

Short Term ◽

Puncture Site ◽

Perioperative Mortality ◽

Term Outcome ◽

Female Ratio ◽

Antegrade Approach ◽

Male To Female

Background: Aim was to evaluate the safety and efficacy of retrograde tibiopedal access after failed antegrade recanalization in patients with femero-popliteal and infrapopliteal occlusions.Methods: This is a retrospective study including patients presenting with critical limb ischemia due to femero-popliteal and infrapopliteal occlusions for whom retrograde transpedal/tibial access was used after failure of antegrade approach at the vascular surgery unit in Kasr Al Aini hospitals in the period from June 2015 to June 2017.Results: The study included 18 patients with a mean age of 64 years and male to female ratio 2.6:1. All patients presented with CLI (Rutherford category 4-6), all lesions were Trans Atlantic Society Consensus (TASC) II D, and Technical success was accomplished in 17 cases (94.4 %). In one case, failure to cross the target lesion via both antegrade and retrograde accesses occurred and the patient was immediately converted to an open surgery (popliteal tibial bypass). Complications included 2 puncture site hematoma that were managed conservatively; no AVF. There was no perioperative mortality. Primary patency was 81.25 % at 6 month.Conclusions: retrograde tibiopedal access is safe and effective technique after failed antegrade recanalization in patients with popliteal and infrapopliteal occlusions.

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Sex differences in the case-fatality rates for COVID-19—A comparison of the age-related differences and consistency over seven countries

PLoS ONE ◽

10.1371/journal.pone.0250523 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250523

Author(s):

Manfred S. Green ◽

Dorit Nitzan ◽

Naama Schwartz ◽

Yaron Niv ◽

Victoria Peer

Keyword(s):

Sex Differences ◽

Age Groups ◽

Case Fatality ◽

Age Group ◽

Related Factors ◽

Female Ratio ◽

Age Related ◽

Incidence And Mortality ◽

Meta Regression ◽

Male To Female

Background Early in the COVID-19 pandemic, it was noted that males seemed to have higher case-fatality rates than females. We examined the magnitude and consistency of the sex differences in age-specific case-fatality rates (CFRs) in seven countries. Methods Data on the cases and deaths from COVID-19, by sex and age group, were extracted from the national official agencies from Denmark, England, Israel, Italy, Spain, Canada and Mexico. Age-specific CFRs were computed for males and females separately. The ratio of the male to female CFRs were computed and meta-analytic methods were used to obtained pooled estimates of the male to female ratio of the CFRs over the seven countries, for all age-groups. Meta-regression and sensitivity analysis were conducted to evaluate the age and country contribution to differences. Results The CFRs were consistently higher in males at all ages. The pooled M:F CFR ratios were 1.71, 1.88, 2.11, 2.11, 1.84, 1.78 and 1.49, for ages 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, 80+ respectively. In meta-regression, age group and country were associated with the heterogeneity in the CFR ratios. Conclusions The sex differences in the age-specific CFRs are intriguing. Sex differences in the incidence and mortality have been found in many infectious diseases. For COVID-19, factors such as sex differences in the prevalence of underlying diseases may play a part in the CFR differences. However, the consistently greater case-fatality rates in males at all ages suggests that sex-related factors impact on the natural history of the disease. This could provide important clues as to the mechanisms underlying the severity of COVID-19 in some patients.

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PRIMARY PROCEDURE FOR ANORECTAL MALFORMATIONS IN CHILDREN; A SINGLE CENTER EXPERIENCE

Journal of Medical Sciences ◽

10.52764/jms.21.29.1.06 ◽

2021 ◽

Vol 29 (01) ◽

pp. 21-25

Author(s):

Tariq Waheed ◽

Sajjad Ali ◽

Muhammad Uzair ◽

Inayat ur Rehman

Keyword(s):

Hospital Stay ◽

Anorectal Malformation ◽

Wound Dehiscence ◽

Anorectal Malformations ◽

Good Alternative ◽

Anal Stenosis ◽

Paediatric Surgery ◽

Female Ratio ◽

Single Center Experience ◽

Primary Procedure

Tariq Waheed , Sajjad Ali , Muhammad Uzair ,Inayat Ur Rehman Objective: To share our experience with outcome of primary procedure for anorectal malformation (ARM) in children. METHODOLOGY: Retrospective study included 40 patients from both sexes operated between January 2018 and January 2019 for high and intermediate ARM in the department of paediatric surgery Khyber teaching hospital Peshawar. Patients with common cloaca and associated life threatening anomalies were excluded. Demographic and clinical data was tabulated and analyzed. Cost of the procedure was recorded in Pakistani Rupees and hospital stay in days. Continence was evaluated by Kelly’s score and parents’ satisfaction graded by Likert scale. RESULTS: Male to female ratio was 1.6:1. Mean hospital stay was 5.91±1.01 days and mean cost of 22950 ± 3234 PKR. Wound dehiscence was recorded in 3 (7.5%), 2 (5.0%) patients developed surgical site infection and 11 (35.48%) patients had perianal excoriation. Adhesive obstruction and mucosal prolapse were seen in 1 (2.5%) patient each while anal stenosis in 2(5.0%) Patients. After 6 months 28 (70%) patients had formed stools while 12 (30%) had loose stools. Stool frequency was 0-1 time/day in majority i.e. 20 (50 %) patients. Continence was fair in 24 (60%) patients. Parents of 20 (50%) patients were very satisfied, 17(42.5%) satisfied only. Continence for age and sex revealed insignificant P values of 0.213 and 0.07 respectively. CONCLUSION: Primary procedure for anorectal malformations may be a good alternative to traditional three stage procedure in selected patients with intermediate and high variety of ARM. KEY WORDS: Anorectal malformation (MeSH); Abdominoperineal pull through (Non-MeSH); Kelly’s score (Non-MeSH).

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Direct cost of treatment in patients with acute ST-elevation myocardial infarction in Vietnam

MedPharmRes ◽

10.32895/ump.mpr.3.3.2 ◽

2019 ◽

Vol 3 (3) ◽

pp. 7-11

Author(s):

Sy Van Hoang ◽

Tuan Thanh Tran ◽

Kha Minh Nguyen

Keyword(s):

Myocardial Infarction ◽

Direct Cost ◽

Treatment Cost ◽

Financial Burden ◽

Intervention Group ◽

St Elevation Myocardial Infarction ◽

Related Factors ◽

Female Ratio ◽

Conservative Group ◽

St Elevation

Background: Acute myocardial infarction has become a serious financial burden for patients, healthcare system, and society. It is therefore necessary to assess treatment cost of myocardial infarction that had been conducted in many countries in the world and still not fully analysed in Vietnam. Thus, we sought to describe acute ST-elevation myocardial infarction treatment cost and analyse related factors to acute ST-elevation myocardial infarction treatment cost. Methods and Materials: A retrospective cross-sectional study. Patients who was diagnosed by ST-elevation myocardial infarction at Cho Ray Hospital from June 2018 to February 2019, satisfied inclusion and exclusion criteria. Results: We collected 130 patients with acute ST-elevation myocardial infarction with male: female ratio of 3:1, at average age of mean ± Standard deviation (SD) = 62.9 ± 12.6. The length of stay in hospital was mean ± SD = 7.1 ± 3.3 days and the median direct cost of MI was 68,902,500 VND (interquartile range (IQR): 5,737,200 – 104,266,000 VND). The average total cost of acute ST-elevation myocardial infarction in the percutaneous coronary intervention group was more than 16 times as the conservative group. The treatment strategies and hospital complications were major factors that affected treatment cost. Conclusion: The median direct cost of acute ST-elevation myocardial infarction was accounted for 68,902,500 VND. Complications directly affected costs.

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Disparities between IgG4-related kidney disease and extrarenal IgG4-related disease in a case–control study based on 450 patients

Scientific Reports ◽

10.1038/s41598-021-89844-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Qiaozhu Zeng ◽

Jingyuan Gao ◽

Xinyu Zhang ◽

Aichun Liu ◽

Zhenfan Wang ◽

...

Keyword(s):

Kidney Disease ◽

Clinical Laboratory ◽

Imaging Finding ◽

Age At Onset ◽

Female Ratio ◽

Related Disease ◽

Igg4 Related Disease ◽

Peking University ◽

Chinese Cohort ◽

Male To Female

AbstractWe aimed to compare the demographic, clinical and laboratory characteristics between IgG4-related kidney disease (IgG4-RKD+) and extrarenal IgG4-related disease (IgG4-RKD−) in a large Chinese cohort, as well as describing the radiological and pathological features of IgG4-RKD+. We retrospectively analyzed the medical records of 470 IgG4-related disease (IgG4-RD) patients at Peking University People’s Hospital from January 2004 to January 2020. The demographic, clinical, laboratory, radiological and pathological characteristics between IgG4-RKD+ and IgG4-RKD− were compared. Twenty IgG4-RD patients who had definite etiology of renal impairment including diabetes, hypertension and etc. were excluded. Among the remained 450 IgG4-RD patients, 53 were diagnosed with IgG4-RKD+ . IgG4-RKD+ patients had older age at onset and at diagnosis. Male to female ratio of IgG4-RKD+ patients is significantly higher. In the IgG4-RKD+ group, the most commonly involved organs were salivary gland, lymph nodes and pancreas. It was found that renal function was impaired in approximately 40% of IgG4-RKD+ patients. The most common imaging finding is multiple, often bilateral, hypodense lesions. Male sex, more than three organs involved, and low serum C3 level were risk factors for IgG4-RKD+ in IgG4-RD patients. These findings indicate potential differences in pathogenesis of these two phenotypes.

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P129 The utility of routine operative swab culture in uncomplicated peri-anal abscesses

BJS Open ◽

10.1093/bjsopen/zrab032.128 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Apoorva Khajuria ◽

Tuba Rahim ◽

Mariam Baig ◽

Kai Leong ◽

Apoorva Khajuria

Keyword(s):

Inflammatory Bowel Disease ◽

Perianal Abscess ◽

Female Ratio ◽

Incision And Drainage ◽

Common Presentation ◽

History Of ◽

Inflammatory Bowel ◽

Operative Findings ◽

The Cost ◽

Male To Female

Abstract Introduction Despite perianal abscess being a common presentation, certain aspects of its management remain controversial, especially the routine use of intra-operative swab cultures. Methods A retrospective review of patients that underwent incision and drainage procedures for a perianal abscess over a six-month period was undertaken. Results Over 6 months, 50 patients were identified. The male to female ratio was 3:1 and median ASA score was 1. Only 6/50 patients presented with recurrent abscess and 1 patient had history of inflammatory bowel disease. On the basis of operative findings, 39 patients (78%) had uncomplicated abscess (not associated with cellulitis, sinus or fistula); swab cultures were performed in 26 (67%) of these patients. All patients were discharged on the same day; microbiology reports did not impact the treatment and no patients were followed up in clinic post-operatively or presented with recurrence. The number of unnecessary microbiology swabs undertaken in this cohort equates to approximately 52 unnecessary swabs a year. The cost of one swab is £10.10p, which means £520 could potentially be saved annually. Conclusion Routine intra-operative swab cultures do not impact management decisions, add to unnecessary costs and therefore should not be undertaken in uncomplicated or first presentation of peri-anal abscesses.

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High rates of gastroesophageal cancers in patients with dyspepsia undergoing upper gastrointestinal endoscopy in Uganda

Endoscopy International Open ◽

10.1055/a-1480-7231 ◽

2021 ◽

Vol 09 (07) ◽

pp. E997-E1000

Author(s):

Ronald Mbiine ◽

Cephas Nakanwagi ◽

Olivia Kituuka

Keyword(s):

Positive Association ◽

Referral Hospital ◽

Outcome Variable ◽

Mulago Hospital ◽

Upper Gastrointestinal Endoscopy ◽

Female Ratio ◽

Mulago National Referral Hospital ◽

Male To Female ◽

Upper Gastrointestinal ◽

National Referral Hospital

Abstract Background and study aims Dyspepsia is the most common presenting symptom in the gastrointestinal clinic of Mulago National Referral hospital. The etiology is essentially not fully described in our patient population. This study was therefore conducted to establish the causes of dyspepsia based on endoscopic diagnosis among patients with dyspepsia seeking care at the National Referral hospital of Uganda. Patients and methods This retrospective study conducted in the endoscopy unit of Mulago hospital reviewed 356 patient endoscopy reports spanning January 2018 to July 2020 with a focus on those with a referral indication of dyspepsia. Age and sex were the independent variables of interest while the endoscopy findings as reported by the endoscopist were the outcome variable of interest. Results Of the 356 endoscopy reports reviewed, 159 met the inclusion criterion of dyspepsia as the indication. Participant mean age was 47.7 years (± 16.53) with the majority (25.79 %) in the fifth decade while the male to female ratio was 1. The majority of patients had organic dyspepsia (90.57 %) while the commonest finding was gastritis 69 (43.4 %). Gastroesophageal cancers represented (18) 11.32 % of all findings. There was a positive association between age > 50 years with gastroesophageal cancers (7.639) as well as age < 50 years and functional dyspepsia (2.794); however, all these were not statistically significant (P = 0.006 and (P = 0.095, respectively). Conclusions Organic/structural dyspepsia comprises over 90 % of investigated dyspepsia with 11 % comprising cancer among patients seeking endoscopy at the National Referral Hospital of Uganda.

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