Undescended testes: perspective from a developing country

Objective: This report details the findings at operation and challenges of managing undescended testes (UDT) in southeastern Nigeria.Methods: Prospective evaluation of children managed for undescended testis from January 2013 to November 2015 in Enugu, southeastern Nigeria.Results: There were 54 patients with total of 69 undescended testes (39 unilateral, 15 bilateral) involving the left side in 39 and the right side in 30 cases. The median age at operation was 5 years (Range 1 – 15 years). Three (4.35%) testes were localized at suprascrotal position, 12 (17.4%) were emergent, 33 (47.8%) canalicular, 18 (26.1%) abdominal, and 3 (4.35%) were vanishing. The volume of the localized testes ranged from 0.7mls to 8.5mls (mean 2.0mls). Epididymal anomaly was noticed in 31 (47%) with the commonest anomaly being head non-fusion. Age at operation was an independent predictor of testicular volume (OR 4.91). Single stage scrotal repositioning was achieved in 28/37 (75.7%) of cases and was not dependent on age (p=0.58). Testes localized distal to the internal ring are more likely to be mobilized to the scrotum at initial orchidopexy than those located in intraabdominal position (44/48 vs 4/18; p<0.05).Conclusion: Most of the patients with UDT in our setting had surgery at a later age than recommended. The age at operation correlated with the size of the testis but did not affect the location of the testis, and the success with one-stage scrotal repositioning. Long-term follow up and evaluation is imperative.Keywords: Undescended testes; anomalies; morphology; Challenges; Developing Countr

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26 of infants (580/2,265; range, 0�100; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received �1 antimicrobial agent (92, antibacterial; 19, antifungal; 4, antiviral). The most common reasons for antibiotic therapy were �rule-out� sepsis (32) and �culture-negative� sepsis (16) with ampicillin (40), gentamicin (35), amikacin (19), vancomycin (15), and meropenem (9) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26), amikacin (20), and meropenem (16) were the most prescribed agents. Length of therapy for culture-positive and �culture-negative� infections was 12 days (median; IQR, 8�14) and 7 days (median; IQR, 5�10), respectively. Mortality was 6 (42, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Funding: Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship © 2021 The Author

Colostomy for large bowel anomalies in children: A case controlled study

AbstractBackgroundIn children, colostomy may be required as a crucial part of treatment of some congenital anomalies of the large bowel. The procedure is associated with significant complications. This study reviews the morbidity and mortality of colostomy formation and closure for large bowel anomalies over a 10-year period in southeast Nigeria.MethodsEvaluation of 182 colostomies and 146 colostomy closures performed in children at the University of Nigeria Teaching Hospital Enugu from January 1995 to December 2004.ResultsHirschsprung's disease (106) and anorectal malformation (76) were the large bowel anomalies requiring colostomy. Of these, 133 (73.1%) were boys, while 49 (26.9%) were girls and their age ranged from 3days to 15years (mean 2.8years). For anorectal malformation, the mean age at colostomy formation was 15.5days (range 3–75days), while in Hirschsprung's disease the mean age was 4.6years (range 8days–15years). Ninety-two children (50.5%) had defunctioning colostomy and 90 (49.5%) had loop colostomy, with 177 (97.3%) of these sited in the transverse colon, while the remaining 5 (2.7%) were sited in the sigmoid colon. There were 123 complications that developed in 79 (43.4%) children. Skin excoriation (40 cases) and prolapse (37 cases) were the commonest complications. Other complications included wound infection (20 cases), superficial wound dehiscence (9 cases), stoma stenosis (5 cases), stoma retraction (5 cases), stoma bleeding (3 cases) and 2 cases each of stoma necrosis and burst abdomen. The complications were not dependent on the primary indication but prolapse occurred more frequently in children with Hirschsprung's disease who had colostomy after 5years of age (P<0.001). Loop colostomy had higher complication rate than defunctioning colostomy (P<0.001). Colostomy revision was required in 15 patients. Death directly related to colostomy formation occurred in 3 (1.6%) patients from severe infection. Complications following colostomy closure (20 cases) occurred in 17 children and include wound infection (11 cases), stitch granuloma (5 cases), and 2 cases each of small bowel obstruction and incisional hernia. These were not related to the duration of the colostomy.ConclusionsA significant number of colostomies for large bowel anomalies are constructed late in our setting. This is largely due to delayed presentation in Hirschsprung's disease and may be associated with increased morbidity. Loop colostomy is associated with higher rate of complication and as much as possible should be performed less often

Right paratesticular abscess mimicking neonatal testicular torsion and caused by Proteus mirabilis

AbstractThe clinical presentation of neonatal paratesticular abscess may closely resemble that of, neonatal testicular torsion and the use of scrotal ultrasonography to differentiate the two has low, sensitivity. We propose early operative treatment of suspected neonatal testicular torsion to salvage, the testicle in cases of paratesticular abscesses. This is a report of the successful transinguinal, drainage of a right neonatal paratesticular abscess preoperatively diagnosed as testicular torsion and, caused by Proteus mirabilis. The testicle was salvaged

Spontaneous perforation of the bile duct in infants: a case report

Spontaneous perforation of the bile duct is a rare disease in children. To date, less than a hundred cases have been reported in English literature. A number of techniques have been applied to achieve preoperative diagnosis yet most cases are diagnosed at operation. A 3-month-old girl presented with fever, vomiting, progressive abdominal distension, jaundice and diarrhoea. Abdominal ultrasonography showed localized collection of fluid that displaced the small bowel to the right side of the abdomen. The fluid was found to be bilious on paracentesis. At laparotomy, biliary pseudocyst was found but the site of perforation was no longer identifiable. Excision of the containing wall and external drainage was carried out. 9 months after operation the child is well. A high index of suspicion should improve diagnosis and ensure early intervention