Vulnerability towards Online Sexual Grooming among Malaysian Children

This study was conducted to examine the vulnerability of Malaysian children towards online sexual grooming by ascertaining the level of vulnerability and the relationships with social media profiles and demographical factors. To achieve the objectives of this study, a quantitative method using a cross-sectional research design with the aid of electronic questionnaire via Google Form was used to gather the data. A total of 205 Malaysian children from the age of 10 to 17 years old participated in this study with their parents’ consent. Based on the analyses of the items, it was found that each child was vulnerable towards sexual grooming at different levels. This study also found that the frequency of social media usage was directly correlated with online sexual grooming vulnerability (r = 0.14, p = 0.05) and age of the respondents (r = 0.20, p = 0.006). Children with more social media accounts were also found to be more vulnerable towards online sexual grooming compared to those with lower number of social media accounts (F (2, 191) = 7.30, p = 0.001). Findings also revealed that there was no significant difference on online sexual grooming vulnerability in terms of gender (t (191) = -0.39, p = 0.149). As a conclusion, this study provide in-depth exposure related to online sexual grooming vulnerability to public as well as the urgent need for proactive prevention efforts to curb child sexual related offenses

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The experience of performing concurrent elective circumcision during paediatric laparoscopic inguinal hernia repair

Aim: Circumcision is a common procedure with indications ranging from medical to non-medical reasons. Elective circumcision (EC) in this context refers to a circumcision done on a non-diseased penis as part of cultural or religious purposes, as recommended by the Islamic religion. The number of EC performed is high in the Muslim predominant countries like Malaysia. In Universiti Kebangsaan Malaysia Medical Centre (UKMMC), EC is frequently added as an additional procedure to laparoscopic inguinal hernia (LIH) repair. The purpose of this study is to obtain objective data on this practice. Methods: This is an observational, ambispective cohort study of about five years duration comparing two groups of patients, those who had both LIH repair and EC and those who only had LIH repair. Outcomes of interest were post-operative morbidity and rate of recovery. Results: 237 patients aged between one month and 12 years underwent LIH repair for patent processus vaginalis (PPV). Post-operative complications were higher in the combination surgery group (4%) compared to LIH repair group (3.3%). However, both peri-operative morbidity and recovery outcomes did not show overall significance in this study (p = 0.770). The addition of EC was not associated with increase in the rate of complication over the abdominal wound, prolonged duration of post-operative hospitalization, worsen post-operative pain score and delay in return to routine activity. Conclusion: Performance of EC during LIH repair is safe and did not cause any significant added morbidity and prolonged recover

Laparoscopic Assisted Orchidectomy Eases Future Insertion of Testicular Prosthesis in Paediatric Patients

High ligation orchidectomy in paediatric patients is performed for testicular tumours. This is carried out via open surgery at the inguinal or groin region. In these boys, elective insertion of testicular prostheses is carried out later to improve the external genitalia appearance. In most cases, insertion of testicular prosthesis or implant is carried out via the previous scar, to avoid prosthesis extrusion; however this is usually difficult due to scarring and may cause haematoma and possible infection. We report a novel technique of laparoscopic assisted orchidectomy in an adolescent boy with disorder of sexual development (DSD) whom was suspected of having bilateral gonadal (testicular) malignant change, he successfully underwent bilateral ligation of testicular vessels laparoscopically and removal of both testes via a midline scrotal raphe incision; hence avoiding bilateral groin incisions. With this method, future insertion of testicular prostheses can be carried out via virgin inguinal incisions.</jats:p