Background: Acute appendicitis (AA) is a common surgical condition among children. Assessing the prognosis stage of the disease evolution is particularly crucial, and is still challenging. Aim: To analyse the preoperative parameters of children with confirmed AA, and to determine the predictive factors of complicated appendicitis (CA). Methods: The data of 402 children younger than 16 years with a confirmed diagnosis of AA were retrospectively evaluated. Enrolled children were divided into two groups: group A (children with non-complicated AA (NCA), n=221) and group B (children with CA, n=181). Preoperative biological parameters were comparatively analysed between the two groups to determine predictive factors for CA. Results: White blood cell count (WBC), absolute neutrophil count (ANC), neutrophil percentage (NE%), neutrophil-to-lymphocyte ratio (NLR), platelet count (PLT), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width (RDW), systemic immune inflammatory index (SII), and C-reactive protein (CRP) were higher within group B than group A children (p=0.0001, p=0.0001, p=0.0001, p=0.0001, p=0.0001, p=0.0001, p=0.002, p=0.01, p=0.04, respectively). The best area under the curve (AUC) to predict CA was for CRP (0.83, p<0.0001), followed by SII (0.64, p<0.0001), PLR (0.63, p<0.0001), NLR (0.62, p<0.0001), WBC (0.61, p=0.0002), and ANC (0.60, p=0.0002). The best cut-off for CRP in predicting CA was 73 mg/L (sensitivity: 73.89%; specificity: 82.11%), 3610.3 for SII (sensitivity: 41.67%; specificity: 82.11%), 174.53 for PLR (sensitivity: 67.22%; specificity: 57.14%), 9.54 for NLR (sensitivity: 54.44%, specificity: 66.97%), 18.33×103 cells/μL for WBC (sensitivity: 46.11%, specificity: 76.36%), and 15.65×103 cells/μL for ANC (sensitivity: 42.22%, specificity: 78.54%). Conclusion: CRP level followed by SII, PLR, NLR, WBC and then ANC can be used in differentiating simple from CA in children. Keywords: Acute Appendicitis, Complicated Appendicitis, Risk Prediction, Biomarkers, Children.
Background: Gastroschisis is a rare congenital condition that is typically diagnosed antenatally in developed countries. However, in resource-limited settings, it remains a significant therapeutic challenge. Mortality rate in sub-Saharan Africa is alarmingly high, ranging from 69.8 to 95%, compared to 2%–8% in high-income countries. Objective: This study aimed to identify disparities in the diagnosis and management of gastroschisis between low- and high-income countries to propose strategies for improving global outcomes. Material and Methods: We conducted a retrospective, observational, two-centre study at the University Hospital Centres of Cocody (Abidjan, Ivory Coast) and Limoges (France). The study included 34 neonates from Cocody and 19 from Limoges, treated between January 2012 and June 2023. Results: In Cocody, only 8.8% of cases were diagnosed prenatally, all deliveries occurred in peripheral centres, and 70.6% of neonates were transferred within 24 hours. Bowel reintegration was performed in a single stage in 38.2% of cases and in a two-stage procedure in 41.2%. In contrast, all cases in Limoges were diagnosed antenatally, deliveries took place within the hospital, and bowel reintegration occurred within 60 minutes of birth—either in one stage (78.9%) or two stages (21.1%). Mortality by day 28 was 94.1% in the Cocody cohort compared to 10.5% in Limoges. Conclusion: The key factors contributing to high mortality in resource-limited settings include a low antenatal diagnosis rate, leading to a high proportion of deliveries in peripheral centres and delays in surgical intervention. Additionally, the lack of paediatric intensive care units may have further increased mortality in complex cases. Keywords: Gastroschisis, Prognosis, Developing countries, Abdominal wall defect
Background: Circumcision is a frequently performed paediatric surgical procedure, undertaken for both cultural and medical indications. While the conventional techniques may be associated with postoperative pain, bleeding and delayed healing, laser technology may reduce these morbidities, but paediatric data relating specifically to the Holmium:YAG laser remain limited. Objective: This study aimed to describe the early clinical outcomes of circumcision performed with the Holmium:YAG laser in children. Methods: A prospective, single-centre descriptive case series of 60 consecutive boys aged 2 to 11 years who underwent Holmium:YAG laser circumcision under general anaesthesia at a tertiary care surgical department between March 2023 and February 2025. Operative time, estimated intraoperative blood loss, postoperative pain, bleeding, infection, and scarring or fibrosis were recorded intraoperatively and at 6 hours, 24 hours, 1 week and 3 weeks. Data were summarised descriptively; no comparative or inferential analysis was undertaken. Results: All 60 procedures were completed with the laser without conversion, and follow-up was complete at every time point. Mean operative time was 15.02 ± 2.93 minutes (range 10.2–19.7). Estimated blood loss was less than 5 ml in 55 patients (91.7%) and 5–10 ml in 5 (8.3%); no patient required transfusion or an additional haemostatic procedure. The mean pain score at 6 hours was 2.65 ± 1.33 (range 1–5), and every child recorded a score of zero at 24 hours, 1 week and 3 weeks. Mild or moderate oozing was documented at 6 hours in 42 patients (70.0%), all of which settled spontaneously; no bleeding was recorded at 24 hours, 1 week or 3 weeks, and no infection occurred at any assessment. At 3 weeks, appearances at the incision line were graded as none or minimal in 17 patients (28.3%), moderate, defined as scarring producing a mild glanular tilt, in 27 (45.0%), and as fibrosis producing chordee in 16 (26.7%); no patient required intervention during the follow-up period. Conclusion: Holmium:YAG laser circumcision was feasible in this paediatric cohort and was associated with short operative times, low estimated blood loss, rapid resolution of pain and no infective complications over three weeks. Early oozing was common though self-limiting. Scarring exceeding the minimal grade was recorded in 43 of 60 children (71.7%) at three weeks, including appearances graded as glanular tilt or chordee, although none required intervention and three weeks is too early an interval to characterise the final cosmetic result. As a single-arm series without a comparator, this study cannot establish superiority over conventional or device-assisted techniques; comparative studies with longer follow-up are required. Keywords: Circumcision, Lasers, Solid-State, Paediatrics, Postoperative Complications; Treatment Outcome
Background: Botulinum neurotoxin has evolved from a feared cause of food-borne paralysis into a versatile therapeutic agent. In paediatric urology, onabotulinumtoxinA has become an important minimally invasive option for neurogenic detrusor overactivity and selected refractory lower urinary tract dysfunctions. Objective: This narrative review aims to trace the major historical and scientific milestones in the development of botulinum toxin, describe its mechanism of action and evolution as a urological therapy, and critically summarise current paediatric urological applications, injection techniques, limitations, adverse events, and emerging technologies. Methods: A narrative literature search was performed using PubMed/MEDLINE and reference lists of relevant reviews and landmark articles, with emphasis on the history of botulinum toxin, mechanism of action, detrusor-sphincter dyssynergia, neurogenic detrusor overactivity, paediatric neurogenic bladder, injection techniques, safety, treatment failure, neutralising antibodies, and novel delivery systems. Historical primary reports, pivotal clinical studies, paediatric trials, systematic reviews, and recent relevant publications available through August 2026 were prioritised. Results: The historical progression from Kerner's early clinical observations and van Ermengem's microbiological isolation to Scott's therapeutic use and subsequent urological applications is closely linked to advances in neurophysiology and drug delivery. Paediatric evidence supports meaningful improvements in continence and urodynamic parameters in appropriately selected patients; however, repeated procedures, urinary tract infection, transient retention, incomplete response in poorly compliant or fibrotic bladders, possible immunogenic failure, cost, and anaesthesia burden remain clinically relevant limitations. Conclusion: Emerging longer-acting formulations and non-invasive delivery systems are promising but remain investigational for paediatric urology. Keywords: Botulinum neurotoxin; History of medicine; Neurogenic bladder; Overactive bladder; Paediatric urology
Background: While planning for the post-treatment rehabilitation of edentulous dental arches, most of the information is derived from anatomical landmarks of the face. If no pre-extraction records are available, it becomes difficult to plan for rehabilitation of such cases. Aim: To evaluate whether the intercanthal and intercanine distances can be used as a reliable guide to determine proportions of maxillary anterior teeth during the prosthetic rehabilitation of edentulous dental arches. Materials and Methods: This observational study included 500 subjects aged between 18-52 years. The mesiodistal width of maxillary central incisors and intercanthal and intercanine distances were measured for all study subjects; their correlation was assessed using Karl Pearson’s correlation coefficient (r) test. Results: The findings of the present study showed a positive and statistically significant correlation between the mesiodistal width of the maxillary left central incisor and the intercanthal distance among the study subjects (r-value=0.093, p-value=0.037). No significant correlation was observed among the studied parameters in terms of gender among the included subjects. Conclusion: In the absence of pre-extraction records of the patients, the ratio between the mesiodistal width of the maxillary left central incisor and the intercanthal distance may be considered as a plausible source of information by the clinicians to determine the proportions of maxillary anterior teeth during the prosthetic rehabilitation of edentulous dental arches. Keywords: Rehabilitation, Intercanthal Distance, Intercanine Distance, Anatomical Landmarks, Correlational Study
