Herniotomy to Treat Inguinal Hernia in Children: Analysis of Clinical Outcome of One Decade Experience

Objective: Evaluation of the clinical outcome of inguinal herniotomy in children at a single center. Study Design: Retrospective cross-sectional study. Place and Duration of Study: Department of surgery, Northern Area Armed Forces Hospital Hafer al Batin, Saudi Arabia, from July 10, 2011, to Oct. 10, 2021. Materials and Methods: A total of 256 patients admitted with inguinal hernia underwent inguinal herniotomy. All the patients were treated by single senior pediatric surgeon. The age ranged from 2 months to 13 years. The data was collected regarding age at operation, gender, location, investigations performed, operative procedure, and complications of the surgical intervention. The follow up was also done in the outpatient clinic for 12 months to assess the complications and outcome of the procedure. The data was analyzed by IBM SPSS version 26.0. The Fischer exact test was applied to evaluate the association of site of inguinal hernia with gender. The p value less than 0.05 was considered statistically significant. Results: One hundred and seventeen (46%) patients had right sided inguinal hernia, 124 (48%) had left sided and 15 (6%) were having bilateral inguinal hernia. There was no per-operative and post-operative complication. There was no testicular atrophy. There was no recurrence of inguinal hernia during follow up of 12 months after surgery. All the children had successful clinical outcome on follow up of 12 months period. Fischer exact test was applied to find the association of type of inguinal hernia with gender and the p value was 0.166 which is considered statistically nonsignificant. Conclusion: Early inguinal herniotomy on next available elective list is safe, effective and feasible procedure to treat children with inguinal hernia

Single Stage Laparoscopic Orchiopexy for Impalpable Low Abdominal Undescended Testis in Children- Analysis of Outcome

Objective: To evaluate clinical efficacy of single stage laparoscopic orchiopexy by modified Prentiss procedure for the treatment of impalpable undescended testis within 2.5 cm from deep ring in children. Study Design: This was a retrospective case series study design. Place and Duration of Study: Department of surgery, section of pediatric surgery. Northern Area Armed Forces Hospital Hafer Al Batin, Saudi Arabia, from June 15, 2011, to Sep 15, 2021. Materials and Methods: All the children admitted with diagnosis of impalpable undescended testis were treated by single stage laparoscopic orchiopexy by modified Prentiss technique during the study period from June 15, 2011, till Sep 15, 2021. The total number of patients was 22. The age of the patients ranged from 1 year to 7 years. Seventeen (77.26 %) children had unilateral (10 with left sided and 7 with right sided) impalpable undescended testis. Five (22.72%) children had bilateral impalpable undescended testis. All the patients were evaluated by ultrasound and MRI abdomen to confirm the abdominal location. The patients were operated by single stage laparoscopic orchiopexy using modified Prentiss technique by single senior pediatric surgeon after confirming the location of testis within 2.5 cm from deep inguinal ring. All the patients were followed up in outpatient clinic after 1 week, after 6 months and after 1 year. The operative time, degree of post- operative pain, per operative and post- operative complications and follow up results were analyzed to evaluate the clinical outcome in terms of testicular location in the scrotum and size. Results: A total of 22 children were treated successfully by single stage laparoscopic orchiopexy by modified Prentiss technique. The age ranged from one year to 7 years at the time of surgery. Ten (45.45%) patients had left sided non-palpable testis, 7 (31.81%) had right sided and 5 (22.72%) children were having bilateral non palpable testis. There was no per-operative complication. One patient (4.54%) had scrotal hematoma which resolved spontaneously. All the children had successful outcome in terms of testicular size and location within scrotum after surgery on follow up of more than one year. There was no case (0%) of testicular atrophy in this series. Thirteen (59%) patients had testis in lowest position of scrotum, eight (36.36%) patients had testis in the middle scrotum and one (4.54%) patient had testis in the neck of the scrotum. Conclusion: Single stage Laparoscopic orchiopexy by modified Prentiss procedure is feasible, safe and effective technique to treat children with impalpable low abdominal undescended testis in childre

Retinoblastoma tells the story of our health care system

Objective: To review cases of retinoblastoma. Setting: Department of Pathology Aga Khan University Hospital Karachi. Method: Twenty three specimens from cases of retinoblastoma received over a period of eight years were routinely processes and stained with haematoxylin and Eosin stain Other stains were used for tuberculosis and melanin. Immunochemistry was resorted to in undifferentiated tumors. Results: Over 60% cases of retinoblastoma were diagnosed after 5 years and nine cases showed involvement of opti-nerve. Conclusion: Late diagnosis of retinoblastoma effects the stage of the tumors and the prognisis

Frequency of primary solid malignant neoplasms in both sexes, as seen in our practice

Background: To determine the frequency of various histologic types of primary solid malignant neoplasms in males and females, in our practice, in a large series of surgical biopdies. Method: A retrospective study of 20,000 consecutive surgical biopsies in the section of Histopathology, Aga Khan University Hospital (AKU), Karachi, in 2004. Results: Squamous cell carcinoma of oral cavity was the commonest malignant neoplasm in males followed by diffuse Large B cell, Non-Hodgkin\u27s lymphoma and Prostatic adenocarcinoma. In females, infiltrating Ductal carcinoma of the breast was overwhelmingly the commonest malignant neoplasm followed by Squamous cell carcinoma of the oral cavity and esophagus. Conclusion: Out of 20,000 biopsies, there were 4616(23.08%) malignant neplasms. Carcinoma of oral cavity is very common in our population in both sexes

Bullying of medical students in Pakistan: a cross-sectional questionnaire survey.

Background: Several studies from other countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced not only by medical students, but also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country. Methodology/Principal Findings: We conducted a cross-sectional questionnaire survey on final year medical students in six medical colleges of Pakistan. The response rate was 63%. Fifty-two percent of respondents reported that they had faced bullying or harassment during their medical education, about 28% of them experiencing it once a month or even more frequently. The overwhelming form of bullying had been verbal abuse (57%), while consultants were the most frequent (46%) perpetrators. Students who were slightly older, males, those who reported that their medical college did not have a policy on bullying or harassment, and those who felt that adequate support was not in place at their medical college for bullied individuals, were significantly more likely to have experienced bullying. Conclusion: Bullying or harassment is faced by quite a large proportion of medical students in Pakistan. The most frequent perpetrators of this bullying are consultants. Adoption of a policy against bullying and harassment by medical colleges, and providing avenues of support for students who have been bullied may help reduce this phenomenon, as the presence of these two was associated with decreased likelihood of students reporting having being bullied

Surgical Repair of Mid-penile to Distal Hypospadias in Children; Report of 93 Cases

Objective: To present the single surgeon’s experience in surgical repair of mid-penile to distal hypospadias in a series of 93 cases. Methodology: This is a retrospective study of management of patients of mid penile to sub coronal hypospadias at a median age of 24 months between June 2011 to August 2021. All the children were followed up for 6 months. Eighty-three children were between the age of 1 to 4 years and 10 children were from the age of 5 to 8 years. All the patients underwent physical examination to confirm the diagnosis and to exclude associated anomalies. All the children having mid penile to sub coronal hypospadias were included. All children with glanular hypospadias were excluded from the study. The repair was done under general anesthesia while using tubularized incised plate (TIP) technique. At completion of surgery compression dressing with transparent Tagaderm was used for one week in all the patients. Results: All of 90 patients had excellent cosmetic and functional outcome. Only 3 patients developed fistula which needed surgical intervention. Conclusion: Surgical repair of mid penile to sub coronal hypospadias by tubularized incised plate (TIP) technique is safe and effective. Compression dressing with transparent Tegaderm prevents complications of hematoma formation and wound infection

The Outcome of Surgical Removal of Thyroglossal Cyst in Children; Experience of a Decade

Objective: To present postoperative outcome of surgical removal of thyroglossal cyst (TC) in children; single surgeon’s experience of a decade. Methodology:  This is a retrospective study of 10 children admitted at Northern Area Armed Forces Hospital, Hafer Al Batin, Saudi Arabia, with the diagnosis of TC between period of June 2011 to October 2021. All the patients were managed by single surgeon by surgical removal with an average follow up of 5 years. There were six males and six females. The diagnosis was confirmed on clinical examination and supported by ultrasound evaluation of upper neck midline swelling. Surgical excision was done by Sistrunk procedure under general anesthesia. The outcome of surgical treatment of thyroglossal cyst is evaluated post operatively during an average regular follow up of 5 years. Results: All the 10 children were operated by Sistrunk procedure during the period from June 2011 to October 2021 who were admitted with diagnosis of thyroglossal cyst. There were no associated anomalies. All the patients had excellent cosmetic outcome without any problem of wound infection. There is no recurrence of thyroglossal cyst in this series.  Conclusion: Sistrunk surgical procedure to treat thyroglossal cyst in children is safe, effective and feasible with good cosmetic results. It avoids recurrence of thyroglossal cyst and morbidity. We recommend Sistrunk operation as gold standard to treat children with TC. &nbsp