Burns in pediatric population admitted in two tertiary care hospitals

Burns in Pediatric population accounts for almost 77% of total burn cases in developing countries including Pakistan. To calculate the frequency and causes of burns in pediatric population. Prospective cross sectional survey done in the emergency departments of pediatric units of Mayo Hospital Lahore and Pakistan Institute of Medical Sciences, Islamabad over 6 months from July to December 2012. Subjects and All new cases of burns presenting to the emergency departments of these hospital were included in the study while those who were previously admitted with burns and were undergoing some reconstructive surgery or treated for complications were excluded. A questionnaire was completed by the duty doctor while interviewing the parents or care givers. The frequency of all variables was measured in percentage. A total of 600 children were enrolled in the study. Their ages ranged from 0-12 years with 270[45%] constituting toddlers between the ages of 1-2 years. Gender showed female predominance in 372[62%] cases. Place of injury was home in 80% cases [480]. Mothers were illiterate in 60% cases [370]. Commonest causes of burns were scalds [43.6%], followed by flame burns [20.6%], electrical burns [15.3%], chemical burns [10.2%] and other causes [10.3%]. Single multipurpose room of poor socioeconomic homes and maternal ignorance about burn prevention were common contributing factors. Burns were more in toddlers and in female gender. Creating awareness in mothers can reduce the injury Manifold

Causes of childhood unintentional injuries in urban cities of Pakistan

Unintentional childhood injuries are the leading cause of death and disability worldwide and its incidence is higher in low to middle income countries. To determine the frequency of childhood unintentional injuries in pediatric units of two tertiary care hospitals. Prospective cross sectional study in pediatric surgical unit of Mayo Hospital, Lahore [01 July, 2012 to 30 September, 2012] and Children's Hospital, PIMS, Islamabad [01 October, 2012 to 31 December, 2012] July to December 2012. All children presenting with unintentional injuries to the pediatric surgical emergency of above two hospitals were included in study. Unintentional Injuries were [burns, RTAs, falls, piercing sharps etc.] are accidental injuries that occur without any planned intention of someone to harm children. Children who were previously treated for unintentional injuries, unexplained injuries, medico-legal cases were excluded from the study. An informed consent was taken [from the parents or care-givers] and the questionnaire was filled by the duty doctor through interview. The demographic data was taken. Age, Gender and maternal educational status were measured Frequency of all variables was measured and simple frequency was measured. The data was analyzed in SPSS 11 version. A total of 600 patients [300 from each selected hospital] were included in the study. The predominant cause of unintentional injury was burn [37.2%] followed by fall [21.5%] and pedestrian hit [16.1%]. Maximum unintentional injuries were noted in 6-10 years [45%] and minimum in 0-1 years [1%]. Male children were affected more [62%] as compared to females. Maternal education was low or nil in 40% cases with majority [46.6%] belonging to poor socioeconomic group. Home was the most frequent place of injury [58.7%]. This study showed that 37% of the unintentional injuries were due to burning and the most common place of injury was the home which may be reduced by creating awareness in public and especially by educating the mothers

Duplication cyst in a new born

Intestinal duplication is a rare congenital anomaly. Duplications found in proximity of small intestine are the most common enteric duplications encountered and majority of these occurs in the ileum. They may be either cystic or tubular and most of them are located in the mesentery of intestine. We are here presenting a case of a neonate who got delivered by lower segment caesarean section [LSCS] with a huge abdominal mass. At surgery there was huge small gut duplication at ileum

Factors affecting survival in patients with oesophageal atresia and tracheo-oesophageal fistula

To evaluate the various factors affecting survival in babies with oesophageal atresia and tracheo-oesophageal fistula. Descriptive study. The study was carried out at the Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad from March 2004 to March 2005. All neonates with oesophageal atresia [EA] and tracheo-oesophageal fistula [TEF] during the study period were included in the study. Patients having isolated EA were excluded. A total of 80 patients were included in the study. Patients were received from the emergency department, OPD and Neonatal ICU. Diagnosis was confirmed by passing a radio opaque orogastric tube. Investigations were done to look for other associations. After stabilisation, right thoracotomy was performed, fistula was ligated and divided. An attempt was made to do a primary oesophago-oesopahgostomy. Nasogastric feeding was started on 2nd post-operative day. A contrast oesophagogram was performed on the 7th postoperative day and having ruled out leak, oral feeding was started. Out of the total, 33 [41%] survived and 47 [58%] patients died. Out of 47 deaths 20 [25%] died before surgery and 27 [34%] died after surgery. Mean follow up period was 6 months. Sixteen [20%] patients had anastomotic leak, 24 [30%] had anastomotic stricture, and 64 [80%] patients had postoperative pneumonia. We conclude that proper antenatal check ups will detect the problem early, avoid home deliveries and hence improve survival. Pneumonitis and septicaemia significantly affect survival. Availability of ICU is one of the main determinants of survival. The likely cause of high mortality rate in pre-operative patients in our series is non-availability of NICU due to limited space in our setup

Surgical ligation of patent ductus arteriosus in a non-cardiac surgical centre

Surgery for Patent Ductus Arteriosus [PDA] is usually performed in specialized cardiac centres with either open surgery of percutaneous embolisation using different materials and devices. This involves high cost of treatment especially for those poor patients who have grown up to several years of age without seeking any treatment for their disease. The objective of this study is to evaluate the safety of surgery for PDA in a non cardiac paediatric surgical setup. A total of 89 patients of 8 months to 12 years [mean 3 years] age were operated over a period of 13 years [from 1993 to 2006]. Fifty-five cases were females and 34 were males. Investigations included x-ray chest, ECG and echocardiography. All patients with PDA were included in the study except those who had other associated cardiac anomaly and those who had a calcified ductus. The ductus was dissected out and ligated with non-absorbable suture [Silk No. 1 or 2]. The patients were discharged by the 5[th] postoperative day. In majority of the patients the recovery was smooth and uneventful. Eight patients had minor complications which were treated conservatively. There were 3 mortalities in this series; 2 patients were over 10 years of age and had calcified ductus. They died during surgery due to primary haemorrhage and 1 died after 24 hours in the intensive care unit. All patients were reviewed at 1 week, 1 month, 3 months and 1 year after surgery. In majority, the typical machinery murmur disappeared immediately or a soft systolic murmur persisted for up to 4 weeks and then disappeared. With proper patient selection, the procedure can safely be performed in a paediatric surgical setup with facilities for cardiac monitoring. The surgeon needs to receive some additional training in the cardiac institution for safe surgery on these children. This will significantly reduce the cost with minimal complications especially for those poor patients who cannot afford the modern procedures due to monitory constraints. Children older than 10 years are not suitable for open surgery because of calcification of the duct

Tubularized incised plate urethroplasty of hypospadias

To describe tubularized incised plate [TIP] urethroplasty, for the treatment of anterior hypospadias. Design: Descriptive study. Place and Duration of Study: This study was carried out in the Department of Pediatric Surgery, The Children hospital, Pakistan Institute of Medical Sciences Islamabad, from January 2003 to February 2004. Materials and There were 30 patients with anterior hypospadias. Children between 2-years to 12 years were included in the study. Tubularized incised plate urethroplasty [Snodgrass procedure] was performed in all the patients. Meatus was matured taking care not to close too much to avoid stenosis. Dressing was kept to prevent haematoma and oedema formation. Frequent irrigation of the stent was done to avoid blockage. Procedure was successful in 22 patients. Meatal stenosis was noted in three patients, two required dilatations only and in one patient meatotomy was performed. Three patients developed single urethrocutaneous fistula. One patient had complete breakdown. Tubularized incised plate urethroplasty was found to be a useful procedure for distal or anterior hypospadias with less complications. Special precautions like maturing the meatus to avoid stenosis and keeping the stent patent with frequent irrigation helps in minimizing fistula formation. The dressing technique prevented postoperative hematoma and edema of penile stuff