Congenital Diseases of Esophagus

Esophageal atresia (EA) presents some of the greatest technical hurdles that pediatric has to face. Postnatally, the classical clinical presentation of an infant with EA is an abnormally mucousy infant who is drooling excessive amount of saliva. Diagnosis confirmed when an orogastric tube cannot be passed through the mouth into the stomach. Examination should assess the as cardiac, anal limb. The purpose of the surgery is to divide the trachea esophageal fistula (TEF) and to restore esophageal continuity blind-ending upper esophageal. Achalasia is an uncommon disorder of esophagus dysmotility. Patients typically present with a history of progressively worsening dysphagia that begins with solid foods. The initial diagnosis test in child with dysphasia is usually a contrast esophagogram. Classic findings include a dilated, dysmotile esophagus and a bird’s beak deformity at the gastroesophageal junction. The main treatments of achalasia are esophageal myotomy, balloon dilation or botulism toxin. Esophageal diverticula are often first suspected on Chest X ray(CXR) due to presenting symptoms. These lesions can cause wheezing, dyspnea, hemoptysis and recurrent pneumonia due to airway compression and dysphasia due to esophagus compression. These duplications should be further investigated by CT scan or Magnetic resonance imaging (MRI). The preferred method of treatment is thoracoscopy or thoracotomy

Emergency Abdominal Surgery in Infants and Children

The term acute abdomen refers to sudden severe abdominal pain with unclear etiology that is less than 24 h in duration. In children, acute abdominal pain presents a diagnostic dilemma. Although many cases of acute abdominal pain are benign, some of them need rapid diagnosis and treatment to minimize morbidity. The present chapter provides an overview of abdominal surgical emergencies in children and discusses the most common disorders that cause surgical acute abdomen

Comparison of Combination of Sclerotherapy and Tiersch's Procedure with Perineal Rectopexy with Mesh in Children

Introduction: Perineal rectopexy is a method for surgical treatment of rectal prolapse in children, but its accomplished using different techniques. We investigated the combination therapy of Tiersch's operation and sclerotherapy and compared its outcome with mesh rectopexy with talc. Materials and Methods: A total of 80 children with rectal prolapse were selected and divided in two groups. In the control group rectopexy was performed by perineal mesh rectopexy with talc. In the case group, injection of 30% saline and, Tiersch’s operation were performed. The parameters used to compare the success of interventions were improvement of incontinence and constipation and a low rate of recurrence. Result: Our results showed that the rate of improvement in constipation and incontinency was not significantly different in the two groups. The recurrence rate was 1.6 % in both groups in one year of follow up. Fifteen patients (37.5%) in the control group had severe anxiety and pain during the extraction of mesh. The length of hospitalization was 6.2± 0.94 in the controls and 0.86± 0.63 days in case group. Conclusion: Our study suggests the combination perineal therapy (T+S) as an alternative approach for children who have limitations regarding talc rectopexy or the high hospital charges related to this approach

The effect of splenic hilum ligation on the injured spleen and its function in rat model

Background: The aim of this study was to compare the outcome of splenic hilum ligation (SHL) and splenectomy in spleen trauma in rat model. Methods: This interventional study was performed on 38 rats with spleen injuries. Rats were randomly divided into SHL and splenectomy groups. After 7 days of surgery, IgG, IgA, IgM, and IgE were measured. At this time, blood smear was prepared to evaluate Howell-Jolly bodies, target cells, schistocyte, poikilocyte, and anisocyte. Three months after the surgery, the spleen viability was evaluated by relaparotomy. Results: After 7 days, white blood count was significantly lower in SHL group as compared to control group (P = 0.024). All variables in peripheral blood smear were significantly lower in SHL group as compared to control group, except Howell-Jolly bodies (P = 0.461). In the SHL group, all spleens were viable in second operations. Conclusions: SHL can be used safely in the management of traumatic splenic injuries in rats

Evaluation of cumulative radiation dose in neonates in neonatal surgery ward of Alzahra Hospital of Isfahan

Introduction: The purpose of this study, is evaluation of the average of cumulative radiation exposure in admitted neonates in neonatal surgery ward.Materials and methods: Participants were all neonates consecutively admitted to the neonatal surgery unit of the study hospital for surgery and need one type of radiological study during hospitalization. Thermo luminescent dosimeters (TLD GR200) were used for evaluating absorbed dose of radiation on the body. For controlling of confounding variables, 130 admitted neonates who need no radiation were selected as control group.Results: In this study, we evaluated 169 neonates.The most x -ray examination was on ribcage (338 cases). Total amount of bowel and backbone x-ray examinations were 117 and 11 respectively. Total amount of contrast enema, meal and swallow was 8, 9 and 5 respectively. The cumulative absorbed dose in 19 patients was more than 10 mSv. There was a significant differences between control group with other x ray examination groups (p=0.001). The mean of accumulated received dose for patients during admission period was 3.13±5.12 mSv.Conclusion: The average of accumulated received dose for neonates was about 3.13 mSv. Although this dose is less than annual limit dose, but it is inacceptable in comparison with other medical centers

Lessons from an IV drug abuser : reform the blood safety surveillance measures.

An IV drug abuser donated his blood to check his HIV status for free. He concealed his past drug abuse, but appropriately chose the Confidential Unit Exclusion (CUE) option. Since the screening for transfusion transmissible infections tested negative, he tried to donate blood for a second time following a consultation session. This time, he declared his past drug behavior and was permanently rejected from further blood donation. Apart from the factors on the donor side, the health interview, donor notification, and post-CUE consultation procedures should also be sufficient for making such donors feel safe about stating their past history of risky behaviors

Ischiorectal Block with Bupivacaine for Post Hemorrhoidectomy Pain

Background: Hemorrhoid is one of the most common surgical diseases occurring in the anorectal region. In this study, we evaluated the effect of ischiorectal fossa block on alleviating post hemorrhoidectomy pain. Methods: In this study, 90 patients suffering from hemorrhoids were evaluated. They were randomly divided into 3 groups. The first group had no block, the second group an ischiorectal block with placebo (normal saline), and the third group a preemptive ischiorectal block with bupivacaine. Postoperative variables such as pain intensity, pethidine consumption, nausea, and vomiting were compared between the groups. Results: The postoperative pain score in group 1 was 8.5 ± 1.3 and 8.1 ± 0.9 (P = NS) in group 2. The post operative analgesic demand was 3.1 ± 1.5 and 3.3 ± 1.8 hours in groups 1 and 2, respectively (P = NS). The post operative pain score and analgesic demand were 4.2 ± 2.1 and 9.3 ± 2.7 hours, respectively, in group 3 (P < 0.0001). Conclusions: Preemptive ischiorectal block reduces the posthemorrhoidectomy pain and opioid demand. © The Korean Pain Society, 2012

The COVID-19 vaccination acceptance/hesitancy rate and its determinants among healthcare workers of 91 Countries: A multicenter cross-sectional study.

The aim of this study was to investigate the COVID-19 vaccination acceptance rate and its determinants among healthcare workers in a multicenter study. This was a cross-sectional multi-center survey conducted from February 5 to April 29, 2021. The questionnaire consisted of 26 items in 6 subscales. The English version of the questionnaire was translated into seven languages and distributed through Google Forms using snowball sampling; a colleague in each country was responsible for the forward and backward translation, and also the distribution of the questionnaire. A forward stepwise logistic regression was utilized to explore the variables and questionnaire factors tied to the intention to COVID-19 vaccination. 4630 participants from 91 countries completed the questionnaire. According to the United Nations Development Program 2020, 43.6 % of participants were from low Human Development Index (HDI) regions, 48.3 % high and very high, and 8.1 % from medium. The overall vaccination hesitancy rate was 37 %. Three out of six factors of the questionnaire were significantly related to intention to the vaccination. While 'Perceived benefits of the COVID-19 vaccination' (OR: 3.82, p-value<0.001) and 'Prosocial norms' (OR: 5.18, p-value<0.001) were associated with vaccination acceptance, 'The vaccine safety/cost concerns' with OR: 3.52, p-value<0.001 was tied to vaccination hesitancy. Medical doctors and pharmacists were more willing to take the vaccine in comparison to others. Importantly, HDI with OR: 12.28, 95 % CI: 6.10-24.72 was a strong positive determinant of COVID-19 vaccination acceptance. This study highlighted the vaccination hesitancy rate of 37 % in our sample among HCWs. Increasing awareness regarding vaccination benefits, confronting the misinformation, and strengthening the prosocial norms would be the primary domains for maximizing the vaccination coverage. The study also showed that the HDI is strongly associated with the vaccination acceptance/hesitancy, in a way that those living in low HDI contexts are more hesitant to receive the vaccine