Diagnostic Role of Pediatric Appendicitis Score (PAS) in Appendicitis of Children

Appendicitis is one of the most common causes of acute abdominal pain in pediatrics and is the most common indication for emergency abdominal surgery in childhood. The diagnosis of pediatric appendicitis remains challenging. To evaluate the role of pediatric appendicitis score (PAS) in the diagnosis of appendicitis of children.Methods: In this study, 200 suspected appendicitis patients attended in four private hospitals in old Dhaka city over a period of about 34 months from January 2011 to May 2014 were selected as study subjects. Patient age, sex and each of the eight PAS components were collected. Children who had PAS less than six were discharged and contacted by telephone upto 1 month to verify final outcome. Rest of the children with PAS equal or more than 6 were underwent appendectomy.Results: Two hundred patients were assessed in this study. Out of them 67 (33.5%) children had appendicitis and 76 (38.0%) children had PAS equal or more than 6. In appendicitis children, maximum (85.3%) children were in age group 10- 16 years and 10 (14.7%) patients were in age group 5-9 years.Male (73.5%) were predominant than female (26.5%) in appendicitis children. Migration of pain, nausea and anorexia were in 43 (63.2%), 45 (66.2%) and 48 (70.6%) appendicitis children respectively. Fever, cough/percussion tenderness and tenderness in RLQ were in 37 (54.4%), 52 (76.5%) and 59 (86.8%) appendicitis children respectively. Leukocytosis andneutophilia were present in 42 (61.8%) and 46 (67.6%) appendicitis children respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy rate of PAS were 80.6%, 83.5%, 71.1%, 89.5% and 82.5% respectively.Conclusion: Paediatric Appendicitis Score is a good tool but not good enough for diagnosis of paediatirc appedicitis. It cannot be recommended for diagnosis of paediatric appendicitis because its negative appendicectomy rate as well as wrongly discharged rate is high.J. Paediatr. Surg. Bangladesh 6(1): 16-19, 2015 (Jan)

Residency Program A new era in postgraduate medical education in Bangladesh

not availableJ. Paediatr. Surg. Bangladesh 6(1): 1-2, 2015 (Jan)

Counselling of Parents, attendants, guardians in dealing of Paediatic Surgical Patients

not availableJ. Paediatr. Surg. Bangladesh 6(2): 32, 2015 (July)

Three Years Experience of Inguinal Hernia in Children in BSMMU

Objective: The aim of this study is to evaluate the management of inguinal hernias in children as a day case surgery in elective basis.Methods: From July 2011 to June 2014, 141 infants and children with inguinal hernias were seen, operated on, and followed up as outpatient procedure in the Department of Paediatric Surgery of Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh (BSMMU) Age, sex, side of hernia, presence of an associated hydrocele/ undescended testes/ VPshunt, occurrence of contralateral hernia, clinical aspects of these patients, type of surgery, mortality, and mobidity were studiedResults: The ages ranged from 2months to 14 years (mean age, 6.28 years) with a male-to female ratio of 3:1. There were 59.6% right, 34.8% left, and 5.7% bilateral hernias (all are indirect variety).The most common associated anomaly was hydrocele in 29(20.8%)patients, undescended testis in 9(6.5%) patients and in 4(2.8%) patients had ventriculoperitoneal shunt. The content of the hernial sac in 56(39.7%) patients were omentum and next were intestine in 30(21.3%) patients. Overall, there were 13 (9.2%) sliding hernias. Among them in five case of boys four (80%) patients contents were cecum and one (20%) patient was sigmoid colon. In case of girls, contents were ovaries in all eight patients. Contralateral groin exploration was not done of any patients at the initial hernia repair. There were recurrences in 2(1.4%) patients, 13(9%) patients developed wound infections, and 21(15%) patients had scrotal haematocele. There were no postoperative deaths. A contralateral hernia developed in three (2%) children within one year after the initial repair.Conclusions: Inguinal hernia is a common surgical condition in children. Elective surgery is associated with minimal morbidity. A routine contralateral groin exploration is not done at the initial hernia repairJ. Paediatr. Surg. Bangladesh 6(2): 34-38, 2015 (July)

Effectiveness of Dexamethasone compared with Prednisolone in Induction Therapy of Childhood Acute Lymphoblastic Leukemia

Background: Corticosteroids are an essential component of treatment for acute lymphoblastic leukemia (ALL). Prednisolone is the most commonly used steroid. There is increasing evidence that, even in equipotent dosage for glucocorticoid effect, dexamethasone has enhanced lymphoblast cytotoxicity and penetration of central nervous system compared with prednisolone.Objectives: To determine the effect of dexamethasone and prednisolone and to compare them in induction therapy of ALL in Children.Material & Methods: A total of 60 newly diagnosed cases of ALL confirmed by bone marrow study, children of either sex with age >1 year were included in this study. Variables studied were age, sex, presenting features, neutrophil count, blast cell count, platelet count, bone marrow status at diagnosis, on D15 & D29 of induction and side effects.Results: Mean age of the patients of group A was 6.28 years & that of group B was 7.2 years. Out of all patients of group A 19 (63.3%) were male and 11 (36.7%) were female. In group B 21 (70.0%) patients were male and rests 9 (30.3%) were female. No statistically significant difference was observed in both groups in terms of age, sex & presenting features. After induction significant difference was observed in liver & spleen size at day 7 and day 15. All patients of both groups had M3 marrow status at diagnosis. Overall, in group A 93.3% patients achieved M1 marrow status (fewer than 5% blasts) and 6.7% had M2 marrow status (5-25% blasts) at day 15 of induction. On the other side 66.7% patients of group B achieved M1 status and 33.3% M2 status at day 15. Statistically significant difference was observed between groups on day 15 in term of achieved marrow status (p<0.05). No statistically significant difference was observed between groups in term of infection in difference days of induction. On day 16 of induction maximum incidence of infection was observed in both groups.Conclusion: Dexamethasone may be an effective alternative option to prednisolone for the treatment of acute lymphoblastic leukemia in children.J. Paediatr. Surg. Bangladesh 6(1): 3-9, 2015 (Jan)

Outcome of Partial Splenectomy for Hypersplenism in Children with Thalassemia

Background: Total splenectomy, exposes children to the high risk of overwhelming postsplenectomy infections (OPSI). To avoid these adverse consequences, partial splenectomy has long been practiced for thalasseemia in children. It has been reported that the partial splenectomy keeps the child immunologically competent, hematologically stable with minimum blood transfusion and makes their life more comfortable in comparison to total splenectomy.Objectives: To compare the results of partial and total splenectomy.Methodology: This prospective interventional comperative study was done in the department of Pediatric Surgery, BSMMU from 2010 to 2012. Children who underwent partial splenectomy were considered as the case and who underwent total splenectomy as the control. Number of blood (RCC) transfusions (ml/ kg/year), Peripheral blood film (Hb%, WBC count, platelet count, Howell-Jolly body, serum bilirubin), volume of liver (ml), volume of spleen (ml), number of OPSI case, were compared between the case and control groups both pre and postoperatively.Results: Postsplenectomy blood transfusion requirement is comparatively more decreased in control group than case group. The inter group difference at 6 month is significant (p= 0.004). Peripheral blood pictures are improved in both groups. Post splenectomy hemoglobin level was increased in both groups but it was maintained at a more static fashion in control group than case group (P = 0.114). Howell-jolly body in the partial splenectomy group disappeared almost completely at month 6, while the same inclusion body in the total splenectomy group appeared in all the children (p= 0.001). There was no postsplenectomy infection in case group while two found in control group. After partial splenectomy the residual volume of the spleen was gradually increasing. The increase in volume of the liver was notably greater in the total splenectomy group than that in the partial splenectomy group (p< 0.05).Conclusion: Partial splenectomy in patients with ²-thalassemia is effective in controlling hemolysis, improving peripheral blood picture while preserving the residual splenic phagocytic and immune function.J. Paediatr. Surg. Bangladesh 6(2): 39-46, 2015 (July)

Combined MACE & Mitrofanoff Procedure for Total Neurogenic Feco-urinary Incontinence – A Case Report

Intractable fecal and urinary incontinence, often associated with myelomeningocele (MMC), usually prevents children from achieving physical and social independence. The Malone Antegrade Continence Enema (MACE) procedure, often performed in conjunction with a Mitrofanoff procedure to gain fecal & urinary continence, can help these patients to attain a better quality of life. In patients, who underwent the combined Mitrofanoff and MACE procedures simultaneously, the success rate is- 83% satisfactory for both bowel & urinary continence. With this procedure we report here, for the first time in Bangladesh, to the best of our knowledge, an association between two previously described techniques (the Mitrofanoff principle and MACE), that can solve the problem of dual incontinence in children with MMC. The case involved a 14 years old boy with total neurogenic feco-urinary incontinence following excision & repair of MMC at the age of 4 months. After the surgery, the boy is continent with normal renalfunction.J. Paediatr. Surg. Bangladesh 6(1): 28-31, 2015 (Jan)

Gastric Bezoar - A Rare Presentation in Infant

Gastric bezoar in neonate is a rare presentation. Because of rarity of phytobezoar and lactobezoar are not considered as the differential diagnosis of a lump and vomiting commonly. A 7 month female presented with left upper abdominal undifferentiated hard mobile lump and post prandial occasional vomiting. Diagnosis was non-conclusive with USG, contrast medium study of stomach and duodenum and contrast enhanced CT scan. After laparotomy and gastrostomy mass was removed and diagnosed as phytolactobezoar on macroscopic appearance.J. Paediatr. Surg. Bangladesh 6(1): 24-27, 2015 (Jan)

Constipation in Children

not availableJ. Paediatr. Surg. Bangladesh 6(1): 20-23, 2015 (Jan)

Gender Specific Psychological Distress in Cancer Patients with Underage Children

Background: Psychological distress has become an epidemic among cancer patients. Less is known about the pattern of anxiety and depression in cancer patients with minor children. Gender issue is also important in this regard. Psychological distress is an important predictor of quality of life in cancer patients. A majority of these disorders are eminently treatable.Materials and methods: A cross-sectional comparative study was done to compare anxiety and depression status between cancer patients having and not having minor children, attending at National Institute of Cancer Research Hospital, Oncology department in Dhaka Medical College Hospital and in Uttara Adhunik Medical College Hospital. The study was conducted for the time period from September, 2012 to June, 2013. In study group, having underage children, 123 cancer patients were included. Whereas in comparison group without having underage children, 116 patients were selected. Purposive sampling was applied. Cancer patients in both groups were selected randomly, each between the age from 20 to 60 years, corresponding to Karnofsky Performance Scale Score > 79. All The included cancer patients were married and did not have history of substance use or any prior psychiatric illness or co morbidities related to development of secondary psychiatric disorders. Distress among the patients were measured with the Hospital Anxiety and Depression Scale (Two sub scales – A – Anxiety subscale and D – Depression subscale).Result: In the study group, 60.2% respondents was male and 39.8% was female. And in comparison group male and female ratio was 42.2% and 57.8%. Mean age of the participants in study group was 36.97±4.37 and in comparison group was 42.98±11.74 years respectively. The mean duration since diagnosis was 12.85±13.11 months in study group and 11.53±6.72 months in comparison group. Majority of the respondents in study group were suffering from guynaecological cancer (25.2%) and gastro intestinal cancer (25.2%). Whereas majority cancer patients in comparison group were guynaecological cancer (31%) and haematolymphoid cancer (20.7) as well. Metastasis was present in 42.3% patients in study sample and 64.7% patients in comparison group. It was noticed that, both male and female in study group were found significantly more distressed than the comparison group (p < 0.001). In study group mean anxiety score in male (n=74) was 15.72±2.314 and in female (n=49) was 12.06±2.802, i.e. father with minor children were suffering from more anxiety than the mother (t = 7.878, p < 0.001). Mean depression score in male (study group) was 11.91±2.489, whereas in female it was 17.55±2.542, i.e. female cancer patients with minor children were found more depressed than male (t = 12.211; and p < 0.001). In comparison group, mean anxiety score among male (n=49) was 7.27±1.630 and in female (n=67) mean anxiety score was 8.84±1.592. Female were more anxious than male in comparison group (t = 5.196; p < 0.001). In this group, mean depression score in male was 9.671±1.651 and in female it was 8.58±2.161. Male without minor children were found more depressed than female in this group (t = 2.958; p = 0.004).But among all the cancer patients majority of female were found anxious (93.1%) i.e prevalence of anxiety was more in female. And majority of the male respondents (95.1%) were depressed; (odds ratio; depression in male: female = 3.120; CI at 95% level – from 1.176 to 8.276).Conclusion: Cancer father with minor children were more prone to development of higher anxiety. And anxiety was more prevalent in female among all the cancer patients with and without minor children.J. Paediatr. Surg. Bangladesh 6(1): 10-15, 2015 (Jan)