Are Generative Pretrained Transformer 4 Responses to Developmental Dysplasia of the Hip Clinical Scenarios Universal? An International Review.

OBJECTIVE: There is increasing interest in applying artificial intelligence chatbots like generative pretrained transformer 4 (GPT-4) in the medical field. This study aimed to explore the universality of GPT-4 responses to simulated clinical scenarios of developmental dysplasia of the hip (DDH) across diverse global settings. METHODS: Seventeen international experts with more than 15 years of experience in pediatric orthopaedics were selected for the evaluation panel. Eight simulated DDH clinical scenarios were created, covering 4 key areas: (1) initial evaluation and diagnosis, (2) initial examination and treatment, (3) nursing care and follow-up, and (4) prognosis and rehabilitation planning. Each scenario was completed independently in a new GPT-4 session. Interrater reliability was assessed using Fleiss kappa, and the quality, relevance, and applicability of GPT-4 responses were analyzed using median scores and interquartile ranges. Following scoring, experts met in ZOOM sessions to generate Regional Consensus Assessment Scores, which were intended to represent a consistent regional assessment of the use of the GPT-4 in pediatric orthopaedic care. RESULTS: GPT-4's responses to the 8 clinical DDH scenarios received performance scores ranging from 44.3% to 98.9% of the 88-point maximum. The Fleiss kappa statistic of 0.113 ( P = 0.001) indicated low agreement among experts in their ratings. When assessing the responses' quality, relevance, and applicability, the median scores were 3, with interquartile ranges of 3 to 4, 3 to 4, and 2 to 3, respectively. Significant differences were noted in the prognosis and rehabilitation domain scores ( P < 0.05 for all). Regional consensus scores were 75 for Africa, 74 for Asia, 73 for India, 80 for Europe, and 65 for North America, with the Kruskal-Wallis test highlighting significant disparities between these regions ( P = 0.034). CONCLUSIONS: This study demonstrates the promise of GPT-4 in pediatric orthopaedic care, particularly in supporting preliminary DDH assessments and guiding treatment strategies for specialist care. However, effective integration of GPT-4 into clinical practice will require adaptation to specific regional health care contexts, highlighting the importance of a nuanced approach to health technology adaptation. LEVEL OF EVIDENCE: Level IV.

Epidemiology of Childhood Fractures in Cotonou: A Retrospective Observational Study.

BACKGROUND: Childhood fractures are frequent. The aim of this study was to evaluate their epidemiological and clinical peculiarities in our context. MATERIALS AND METHODS: This was a retrospective study that focused on the files of children with a fracture. They were aged 0-15 years and received between January 2011 and December 2015 at the Emergency Department of the National Teaching Hospital of Cotonou. RESULTS: Two hundred and eighty fractures were recorded in 257 children. The average age was 8.24 years (7 days-15 years). Older children (6-10 years) were the most affected with 33.8% of cases. The predominance was male (sex ratio = 2.3:1). The aetiologies were dominated by road traffic accidents (45.1%) followed by domestic accidents (42.7%). Fractures were predominant in the lower limbs (52.1%). The most affected segments were the leg (25.4%) and the femur (23.6%). The fracture was open in 13.9% of cases. CONCLUSION: Childhood fractures interest preferentially the older boys. Then, road traffic accidents are the most frequent circumstances of occurrence in our context. Measures to prevent the main causes of these fractures must be taken, in order to reduce their frequency and ensure the development of children.

Guided growth vs.Tibial osteotomy at early stage of Blount disease in squelletically immature patients.

BACKGROUND: There are no comparative study between guided growth and tibial osteotomy in early stage of Blount disease (BD) to our knowledge. The aim of this work was to compare the results of patients treated by these two techniques. METHOD: This was a retrospective, descriptive, and analytical study over a period of 5 years in including 17 children (24 Knees) with an early stage of infantile BD in two centers. Patient were classified in two groups: group 1(treated by guided growth), group 2 (treated by Tibial Osteotomy).Preoperative alignment analysis using the tibial femoral angle (HKA) and the proximal medial tibial mechanical angle (mMPTA) were compared with three measurements taken postoperatively in each of the groups. The mean variations of the angles were compared between the two groups. RESULTS: Socio-demographic characteristics were similar for the two groups. Median age at surgery was 6.5 ± 2.5 [3-9 years] in group 1 and 6.8 ± 2.9 years [3-9 years]. At a follow-up of 24 ± 3.5 months, the limb alignment was significantly corrected (1,03°/month) in group 1 (median HKA 144°-171°; p = 0,001; median MMPTA 78°-87°, p = 0,018), and in group 2 we observed at a follow-up of 23 ± 15 months a progressive loss (0,52°/month) of the correction obtained immediately postoperatively (median HKA 160°-176°(immediate post operative) to 165,5°; p = 0,31; median MMPTA = 78°-86° (immediate post operative) to 80,5°; p = 0,37).There was a statistically significant difference between the mean variation in HKA between the two groups (group 1 = 22,5; group 2 = 4,5, p = 0.00), as well as for MMPTA; (group 1 = 7; group 2 = 2,5, p = 0,023).The rate of correction was 78% in group 1 with no rebound at a median follow-up after removal of the material of 10 ± 2.4 months. Within group 2, the rate of correction was 10% with a recurrence rate of 60%. CONCLUSION: Guided growth appears to be the best treatment for early stage of BD in squelletically immature patients.

Laparoscopic treatment of varicocele within adolescents in two African countries.

Varicocele is often ignored by adolescents and their parents, in our context. The aim of the study is to present the indications and results of laparoscopic treatment in a population of adolescent students. SUBJECTS AND METHODS: It is a descriptive and analytical prospective study over a period of 9 months (January to September 2013), focussed on cases of varicocele Grade 3 found in adolescents during a screening, and who underwent surgical treatment by laparoscopy. The laparoscopic treatment was done as part of a training mission to paediatrics surgeons, through a European Non-governmental organisation in two university hospitals in Africa. Of 2724 adolescent students examined, 149 (5.47%) had a varicocele. The average age was 16.39 ± 2.05 years (12 and 19). The side was unilateral (79.19%) with 76.51% left or bilateral (20.81%) (P = 0.00). According to the classification of Dubin and Amelar, there were 58 (38.92%) cases of Grade 1, 66 (44.30%) were Grade 2 and 25 (16.78%) were Grade 3. RESULTS: The laparoscopic treatment was performed in 23 patients with varicocele Grade 3, by modified Palomo's technique, sectioning a segment of vessels between clips (15) between nodes (2) or after coagulation without clips and ligation (6). The hospital stay was 36 h. It has been observed one case of post-operative moderate vaginal hydrocele and 11 cases testicular hypertrophy. CONCLUSION: The laparoscopic treatment of varicocele in adolescents reduces post-operative morbidity related to conventional open surgery. This technique has been available in two poor African countries through partnership north-south.

[Tethered cord syndrome in children: about a case]. / Syndrome de la moelle attachée chez l'enfant: à propos d'un cas.

Tethered cord syndrome is a spectrum of neurological symptoms due to a constant or intermittent axial traction of the terminal cone of the spinal cord, fixed in abnormal caudal position. It is a rare congenital lesion whose symptoms can be observed only in adulthood. We report the case of a 10-year-old boy with tethered cord syndrome discovered due to bladder and anal incontinence and confirmed by lumbosacral magnetic resonance imaging. He underwent neurosurgical release of the terminal cone by posterior approach. Evolution was marked by improvement of sphincteric disorders. This case study has been followed by a literature review on this subject. This case study highlights the role of magnetic resonance imaging (MRI) in the diagnosis of this disorder.

[Littré's strangled umbilical hernia in children: a rare complication due to a common malformation of the small bowel]. / Hernie de Littré ombilicale étranglée chez l'enfant: complication rare d'une malformation fréquente de l'intestin grêle.

Meckel's diverticulum is the most common congenital anomaly of the small bowel. Although it is a common anomaly in the general population, its occurrence in a hernial sac, in particular at the umbilicus, is uncommon and it is known as Littré's hernia. We here report the case of a 6-month female infant, admitted with painful irreducible umbilical swelling. The diagnosis of strangled umbilical hernia was made. Meckel inflammatory diverticulum in the hernial sac was detected intraoperatively. The patient underwent wedge resection of the diverticulum followed by the closure of the intestinal gap using continuous suture and parietal repair. Clinical diagnosis of Littré's hernia is difficult and therapeutic approach varies depending on the medical team.

Paediatric urologic pathologies at the national teaching hospital in Cotonou: A etiological and therapeutic aspects.

BACKGROUND: Urological pathologies of children are dominated by congenital malformations of the kidneys and urinary tract. Their management is often surgical. The objective of this survey was to study etiological and therapeutic aspects of urological presentations in children. PATIENTS AND METHODS: Data for aetiology, treatment, and results in children hospitalized at the Paediatric Surgery service of National Teaching Hospital (CNHU) in Cotonou were retrospectively analyzed from January 1999 to December 2008. RESULTS: A total of 214 patients with complete data were evaluated. Urological pathologies represented 4.8% of the hospitalizations in paediatric surgery, with an incidence of 21 cases per year. The mean age was 4.9 ± 3.2 years (age 1 week to 14 years). The male to female ratio was 14:14. Cryptorchidism, hydrocele, nephroblastoma, the posterior urethral valves, ureteropelvic junction obstructions, post-circumcision haemorrhage and hypospadias were the most frequent pathologies. Congenital urological malformations represented 81.3%, followed neoplastic pathologies (7.9%), traumatic pathologies (6.1%) and others (4.7%). The disorders of male genitalia were more frequent and constituted 68.2% of the cases. The anomalies of the urinary tract were 30.8% and intersex disorders were 0.9%. The average age of the children urological pathologies at the time of consultation was 8.85 ± 4.6 years. The treatment was often surgical with a mortality of 2.8%.

Ultrasound diagnosis of varicocele in the adolescent: our experience from Benin.

BACKGROUND: The diagnosis of varicocèle is clinical. In order to improve diagnosis of varicocele, we compared the clinical with the ultrasound findings in schoolboys with the condition. This is because the conditions can affect testicular growth. PATIENTS AND METHODS: It was a cross-sectional, descriptive study of schoolboys aged from 10 to 19 years who had varicocele. Among 2724 boys examined, 149 had varicocele and only 81 had scrotal (18 with Doppler) and renal ultrasound examination. RESULTS: Among the 81 adolescents who were clinically diagnosed with varicocele and also with the aid of ultrasound scan, 25, 36 and 20 had grade 1, 2 and 3, respectively. Testicular hypotrophy (TH) was clinically noticed in 17 cases. At ultrasonography, varicocele was bilateral in 87.66% and unilateral in 12.34% (P = 0.01) with 32 adolescents (39.51%) showing TH compared with 20.99% being diagnosed with TH using clinical examination alone (P = 0.01). In 50 schoolboys (61.73%) with unilateral varicocele, a subclinical type was discovered at other side. Renal ultrasound revealed abnormalities in 4.93% of cases. Doppler ultrasound helped in finding varicoceles along the top edge of the testis (n = 15) and under tunica albuginea (n = 3). CONCLUSION: TH due to varicocele is better studied by ultrasound.

Paediatric urologic pathologies at the national teaching hospital in Cotonou: an etiological and therapeutic aspects

BACKGROUND: Urological pathologies of children are dominated by congenital malformations of the kidneys and urinary tract. Their management is often surgical. The objective of this survey was to study etiological and therapeutic aspects of urological presentations in children. PATIENTS AND METHODS: Data for aetiology, treatment, and results in children hospitalized at the Paediatric Surgery service of National Teaching Hospital (CNHU) in Cotonou were retrospectively analyzed from January 1999 to December 2008. RESULTS: A total of 214 patients with complete data were evaluated. Urological pathologies represented 4.8% of the hospitalizations in paediatric surgery, with an incidence of 21 cases per year. The mean age was 4.9 ± 3.2 years (age 1 week to 14 years). The male to female ratio was 14:14. Cryptorchidism, hydrocele, nephroblastoma, the posterior urethral valves, ureteropelvic junction obstructions, post-circumcision haemorrhage and hypospadias were the most frequent pathologies. Congenital urological malformations represented 81.3%, followed neoplastic pathologies (7.9%), traumatic pathologies (6.1%) and others (4.7%). The disorders of male genitalia were more frequent and constituted 68.2% of the cases. The anomalies of the urinary tract were 30.8% and intersex disorders were 0.9%. The average age of the children urological pathologies at the time of consultation was 8.85 ± 4.6 years. The treatment was often surgical with a mortality of 2.8%

[Labial fusion in the paediatric surgery department of Yopougon University hospital (Côte d'Ivoire): 108 cases]. / La coalescence des nymphes au service de chirurgie pédiatrique du CHU de Yopougon : à propos de 108 cas.

INTRODUCTION: Labial fusion is a benign genital disorder in girls. It may be either congenital or acquired, sometimes due to poor hygiene. Parental panic about this "absent vagina" contrasts with its simple, rapid, radical treatment. The study reports the result of simplified treatment. MATERIAL AND METHODS: This retrospective study covers cases from 1 January 1992 through 31 December 2006 and includes only the cases of young girls treated as outpatients. All patients underwent outpatient surgical treatment. They were placed in gynaecological position. After asepsis of the vulva, a curved Halsted mosquito forceps was inserted into the opening for partial adhesions or across the medial transparent membrane for complete fusion. The forceps were then opened gently until complete detachment occurred. Local anaesthesia with EMLA cream ensured the absence of pain; there was sometimes minimal bleeding. All patients had local antiseptic treatment afterwards. RESULTS: During this study period, 108 patients (including two sisters) with a mean age of 22 months were treated for labial fusion (101 cases of total fusion and 7 partial). Only seven were older than 5 years of age. Overall, 84 patients underwent this basic treatment of section and follow-up antisepsis; none had a recurrence. Twenty girls also received oestrogen cream, and 4 had the surgical section alone. DISCUSSION: This benign disorder is rare and generally isolated in our regions, unlike in Western countries where it is often associated with hormonal deficits. The principal approach has been either therapeutic abstention or oestrogen therapy, both currently recommended in developed countries. Oestrogen treatment is a long procedure (3 or 4 months), however, and follow-up is far from certain. In Africa, all genital disorders are considered serious. Early repair is desirable for that reason and to prevent urinary tract infections and traditional "treatment". Simple outpatient treatment by surgical section with local antiseptic treatment is effective. Vulvar hygiene is essential to prevent recurrence. CONCLUSION: This benign disorder can be treated by any physician, but the psychological impact of the site and the necessary speed suggest the choice of management in paediatric units.