Burn out among the paediatric surgeons of Pakistan.

This study was to assess the prevalence of Burnout syndrome among physicians, medical students and other healthcare professionals as they are considered more prone to it. It has been reported to be as high as >85% among surgeons, due to the sensitive and exhaustive nature of their job. The objective was to determine the prevalence of burnout among Paediatric surgeons (PS) of Pakistan. For this cross-sectional study, all PS working in Pakistan were included. In order to assess burnout, Maslach Burnout Inventory (MBI) was used. Burnout was found among 15% of the PS. In this group, it was also found that 17.5% of PS had high Emotional Exhaustion (EE), 12.5% had high Depersonalisation (DEP) and 30% had low Personal and Professional Achievement (PPA). Also 35% of PS were experiencing burnout in at least one domain. The significant protective factors we found in this group was having a non-doctor spouse for low EE (P=0.014), FCPS fellowship degree for low DEP (P=0.011), more than 2 post-graduation degrees for high PPA (P=0.008) and private practice for high PPA (P=0.020). We concluded that a large number of PS are facing burnout, and at the same time, a large proportion of them are at risk of moderate levels burnout from EE, DEP and PPA.

Evaluation of educational environment for postgraduate residents using Post Graduate Hospital Educational Environment Measure.

The objective of this study was to determine the level of educational environment among residents working in our hospital using Post graduate hospital educational environment measure (PHEEM). This cross-sectional study was conducted at services hospital, Lahore. All the Post-graduate residents (PGR's) working at Services hospital, Lahore were asked to fill a proforma having 2 parts: Bio-data and PHEEM. Out of 110 PGR's, 87 completed questionnaires, of which majority labelled education environment into level 3 (71%). Overall mean PHEEM score calculated was 90.49 ±15.44. Maximum score was found for teaching subscale followed by autonomy and social support subscale. Highest mean score was found for neurology (104) department and lowest for anaesthesia (72 ± 9.19). General surgery, internal medicine, paediatric medicine and gynaecology gave mean score of 90, 92, 93 and 89 respectively. There was non-significant difference in terms of PHEEM score when stratified for gender, year of residency and marital status.

Auto-Amputated Ovary Presenting as Abdominal Mass in an Infant.

Among female infants, a mass in the abdomen carries a large number of differential diagnoses. Arelatively uncommon condition is ovarian cyst, which may be encountered among such patients. Even more rare condition is auto-amputation of ovary. We herein, present a case of a female infant who presented as abdominal mass and turned out to be autoamputation of right ovary attached to mesentery of intestine. It was excised successfully and the patient is doing well at 3 years follow-up.

Comparison of single-dose nalbuphine versus tramadol for postoperative pain management in children: a randomized, controlled trial.

BACKGROUND: Acute postoperative pain control in children is an essential component of postoperative care, particularly in daycare procedures. Giving patients continuous narcotic analgesics can be risky; however, a single dose may be sufficient. METHODS: This study used a prospective, randomized controlled design and was conducted at the Pediatric Surgery Unit, Services Hospital, Lahore. In total, 150 patients who underwent inguinal herniotomy (age range: 1-12 years) were randomly assigned to two groups: group A (nalbuphine) and group B (tramadol). Patients were given a single dose of either nalbuphine (0.2 mg/kg) or tramadol (2 mg/kg) immediately after surgery and pain was measured at 0, 1, 2, 4, and 8 h. RESULTS: The demographic characteristics were similar between the two groups. The mean pain score was lower in group A than in group B at 0 and 1 h (P < 0.05). However, at 4 h and 8 h, the pain scores in group A were still lower, but not significantly. In all, 9 patients (12.0%) required rescue analgesics in group A compared to 16 patients (21.3%) in group B (P = 0.051). The mean time for requirement of rescue analgesics was 6.5 ± 0.5 h in group A and 5.3 ± 1.7 h in group B (P = 0.06). CONCLUSIONS: A single dose of nalbuphine is sufficient, and superior to tramadol, for postoperative pain management in children who have undergone daycare procedures.

Video Assisted Anal Fistula Treatment in a Child with Perianal Fistula.

Perianal fistula formation is a rare complication in children after rectal biopsy. Perianal fistula may become difficult to treat; therefore a lot of surgical options are present. One of these options is video assisted anal fistula treatment (VAAFT). We present a 6-year-old female who developed perianal fistula following rectal biopsy for which VAAFT was done successfully.

Duplication Cyst Presenting as Hydrocoele in a Child.

Enteric duplication cyst can occur anywhere in Gastrointestinal Tract (GIT), from oropharynx to rectum. Their presentation depends upon the portion of GIT involved. The most common site of GIT involved is small intestine, in 50% of cases. Small intestinal duplication cyst usually present with abdominal pain or mass and rarely as intussusception, volvulus or small bowel obstruction. It may also present very rarely as inguinal hernia of which only 2 cases have been reported yet. We report a 3 years child presenting as hydrocoele of the cord which turned to be duplication cyst which is very rare presentation.

Enteric duplication in children: A case series.

BACKGROUND: Enteric duplication (ED) cysts include a wide variety of cystic lesions, which can involve any part of the gastrointestinal tract (GIT). They can be referred to foregut, midgut, hindgut derived, depending upon the portion of GIT involved. The main purpose of this study was to document the variety of presentation, investigations, and treatment options employed. PATIENTS AND METHODS: This was a retrospective study at Paediatric Surgery Department of Services Hospital, Lahore from August, 2011 to August, 2013. The details of all the patients, including gender, and age, presenting complaint, abdominal examination findings, diagnostic modality, site, type, associated malformations, surgical option, and outcome were analysed. RESULTS: A total of eight patients with histopathological diagnosis of EDs managed were included in the study. Of these eight patients, six were males and two were females, with an average age of 2.4 years. The main diagnostic tool used was ultrasound in almost all patients. The most commonly involved site was ileum in 5 of 8 (62.5%) patients. Two cases had gastric involvement, while one patient had involvement of the descending colon. Six of eight were of tubular type (75%), while remaining 2 (25%) were of cystic type. Excision was possible in all these patients. CONCLUSION: ED can present with a wide spectrum of symptomatology. It can present as mass abdomen, intestinal obstruction or even can mimic as hydrocoele. High index of suspicion is therefore required. Ultimate aim of treatment is excision of cyst with preservation of vascularity of native gut.

Two cases of omental torsion mimicking acute appendicitis.

Acute appendicitis is often simulated by other entities like mesenteric adenitis, worm infestation, Meckel's diverticulitis, urinary tract infection and rarely omental torsion. We report two cases, a 6 year old boy and an 11 year old girl, who presented with symptoms and signs of acute appendicitis but upon exploration turned out to be omental torsion.

Cavernous haemangioma mimicking as clitoral hypertrophy.

Haemangioma is the most common benign neoplasm of infantile age. It is most commonly located in head and neck region, trunk and extremities but very rarely it can be located at clitoris. However, it is very important to differentiate clitoral haemangioma from enlargement of the clitoris secondary to androgen excess. Only four cases of clitoromegaly caused by cavernous haemangioma have been reported in the literature so far. Herein, we report our experience with a 10-year-old girl who presented with clitoromegaly and normal hormonal assay that turned out to be clitoral cavernous haemangioma after histopathological examination of the clitoral mass.

An epigastric heteropagus twin with ruptured giant omphalocele.

We present a case of heteropagus twins attached to the epigastric region. The neonate also had ruptured giant omphalocoele with most of gut and liver lying outside the abdominal cavity. Patient had uneventful surgery for separation of twins and repair of ruptured omphalocoele.

Transection of gut loop due to post-operative adhesions.

Transection of gut due to adhesive band is an unusual complication of adhesive bowel disease. A 2-year old female presented with signs and symptoms of intestinal obstruction. Eight months earlier she underwent laparotomy for excision of duplication cyst of ileum. Exploratory laparotomy performed during current admission showed complete transection of gut.

Child with a tail.

Spina Bifida occulta usually presents with some cutaneous stigmata e.g. hair patch, sinus, lipoma, hyperpigmented skin and very rarely a congenital tail. A congenital tail may and may not be associated with spina bifida occulta and tethered cord. A four month old male child presented with congenital tail which was associated with spinal dysraphism and caused tethering of the cord itself. The tail and tethering lesion were excised successfully.