Hello everyone, I'm Cecilia Jigena and I'm, I'm Gdy, and we are research fellows at Cincinnati Children's Hospital. And along with Stay Current, we are sharing knowledge to improve child health around the globe. So, welcome back everyone to another episode of the HPS podcast. Today we have the September issue and for that we have Doctor Wit Holcom. The editor in chief of the Journal of Pediatric Surgery and the one who helped us choose the articles for today. I'm, uh, Red Holcomb. So for today, we have 4 articles. First, we are going to talk about actorsar quantum and how to differentiate it from pectus carinatum. Then we are going to talk about. About the repair of CD8 of patients that are on ECMO and when it is better to repair that we are going to talk about ER protocols for colorectal surgery and last we have uh a letter to the editor about physician suicide and how important it is to care about mental health in doctors. As always, we attach the papers in the description below, so, uh, click the links and read with us. OK, so the first paper for today is pectus or quantum, a pectus unlike any other, and this is a retrospective study done in France, and their aim was to better describe the pectus or quantum, and we talked to the first author of this paper. Hi, so I'm Sahab Delaville. I'm a resident at the Lyon Children's Hospital in France. So they review all the charts from the patients with pectussar quatum. They had 34 patients with a mean age of 10 years. The main diagnosis for them was done clinically, but 16 patients, meaning 47%, require an X-ray or. CT scan. pectus arcuatum is a bony deformity caused by a premature obliteration of the sternal sutures. So you have a patient with a thoracic deformation, which is a short sternum bent on itself. And I think that the picture, and I believe it's figure 3, is really good, the picture on the right, and you can see is how it's contrasted with a typical pectus carotum patient. And again, he was Doctor Holcomb, the editor in chief, who helped us choose these articles. What they found important is that 35% of the cases had a malformation associated like Noonan syndrome, scoliosis, or cardopathy, and we also found that 25% of our patients had a keletal malformation in their family, so, and for the treatment of this, if they want to do some treatment, the brace doesn't work. And it has to be with a surgery that includes an astronomy. So, if you have diagnosed a pectus archaeom, you have to think about associated malformation, so you need to look for a cardiac malformation with an ultrasound, and you need to see if the patient has a scoliosis. And here's what Doctor Holcomb had to say. It's not very commonly seen. But you need to recognize the patient that has this particular problem. Should we move to the second paper? Yeah, the second paper is the timing of congenital diaphragmatic hernia repair on extracorporeal membrane oxygenation impact surgical bleeding risk. This is a paper coming from Boston's, and we talked to the first author, Doctor Jason Smitters. I'm Jason Smithers. I'm a, a surgeon down at All Children's Hospital with uh Johns Hopkins in Florida. I spent the first, uh, almost 20 years at Boston Children's, and it, it was with the, the group in Boston that we, that we wrote this paper. So in this paper, they wanted to see what is the optimal timing for surgical repair in these patients. They did a retrospective review of 146 infants who underwent CDH repair uh while on ECMA support from 1995 to 2021. And they separated the patients in two groups, early repair and delayed repair. Their definition of early repair was during the 1st 48 hours after eggmocanulation, and then delayed repair was anything after that time. And that was Doctor Holcomb. He's the editor in chief and Journal of Pediatric Surgery. And the editor of the month to help us pick these articles to highlight. For reasons that might not be totally clear, that the earlier you do it, the, the less the bleeding risk was. I think it was in the ballpark of 1% if you operate in less than 24 hours. At 48 hours, it was 5 or 6%. And then after it jumped up to maybe 15%. And that was Doctor Smiters. He's the first author of this paper, and we can say that duration of ECMA support was shorter in the early repair group, but survival was not statistically different between the two groups. I think it is important to be switching into early repair, especially when they're on ECMO, cause knowing that we can repair them at the beginning of the ECMO run, that will decrease the surgical bleeding, I think it's beneficial cause usually before we only repair them after ECMO, yeah. And also, like they stated in their paper, there are some limitations for the study. First of all, it's retrospective and it's a single center uh patient population, and they mentioned that their center uh historically preferred early CDH repair for patients on ECMO. So the patients who had delayed repair in this paper may have clinical differences from early repair patients, so that might be the reason they got delayed repair. And I believe, as I mentioned earlier, that the pendulum has shifted in some people's minds towards an early repair, but I'm sure there's still a lot of pediatric surgeons who perform a delayed repair, and some even perform repair after the patient gets on ECMO, and that is. They won't repair the patient while on ECMO, and if, if the patient gets off ECMO, then they'll do the repair. If you only repair off ECMO, there's uh, there's a certain amount who died. Because they never came off ECMO. So, I think one of the keys is to grow, get the lung growth after you do the repair, and do it in such a way that the contralateral lung grows the most and not the ipsilateral lung. OK, so time for the 3rd paper. Meta-analysis of enhanced recovery after surgery or ERAS protocols for the perioperative management of pediatric colorectal surgery. And this paper comes from China, and they wanted to investigate the effects and safety of the ERAS protocols for pediatric colorectal surgery. Uh, these authors, uh, looked at several databases PubMed, M-Base, Cochrane Library, and so they found 10 studies involving 1300 patients. And comparing them, they found that ERAS protocols significantly reduce the intraoperative fluids needed by the patients and the postoperative opiate use. Also, what they found is that the first oral intake and the time for complete nutrition was less in those patients that were having ERRAS protocol versus those who weren't. Major finding was that there was a beneficial role for using these ERIS protocols in terms of accelerating rehabilitation, shortening the length of hospitalization. Uh, and this is just another paper affirming the benefits of ERIS protocols. Yeah, and clearly it's something that we see often, that having protocols improve patients' outcomes, whether it is an ERAS protocols or other type of protocols. The fact that everyone knows what to expect and how to proceed makes things better for the patients. In this last article, we discussed physician suicides, secondary to physicians stress, which has unfortunately become more common these days. At Global Custom, we are dedicated to disseminate comprehensive knowledge and we recognize the urgency of addressing this issue by engaging in meaningful discussions to explore potential solutions. Well, the last one is a letter to editor about physician suicide, a personal story and call to action. By Doctor Angie Yellen. She's an OBGYN at Johns Hopkins, and, and she is talking about her husband, which we lost to suicide two years ago, and she is. Calling all of us to action, physician suicide is a critical and deeply concerning issue within the medical community, which characterized by the tragically high rate of suicide among doctors compared to the general population. So I think this is a very important topic because every surgeon is going to have adversity in his or her practice. We're all gonna have patients and. Do everything to the best of your abilities, and yet there's not a good result, and I think it's important that we all know that there are support systems available to help those difficult situations. And fortunately we've been talking about these matters lately more and more. We know that various factors contribute to this alarming situation, including the high levels of stress, emotional and physical burnout, demanding work schedules. And the pressure to maintain a successful career. And there is a stigma which is associated with mental health issues within the medical profession, often discourages physicians from seeking help, which leads to untreated depression, anxiety, and other mental health disorders. I just think that the letter is, is a good reminder that there are support systems available for all of us when we have adversity and and conflicts that we just don't know how to get through, and we see people who are the kindest to their patients cannot show the same kindness to themselves, and unfortunately we lose them to these battles, and I wish we would. Speak more, make them feel comfortable and understood and let them know that everyone's struggling in their own way, that's. Doesn't mean that they're not brave enough. That doesn't mean they're not strong enough. This topic is not discussed openly nearly as much as it should be. It's, it's discussed more and more now versus 10 years ago, but it, it still should be discussed more openly. The important thing to put in words here is. Let's make mental health an issue to talk about and to be a thing that everyone can come forward so that we try to avoid people feeling ashamed or not in the need to seek for help. OK, so that was everything for today. We have really interesting papers. The first one was about pectus arquatum and how can we diagnose it, especially clinically looking at a short bended sternum. And how the treatment is based on erronomy, then we talk about the best time to operate a CDH patient who is on ECMO, knowing that it is better to operate them early on ECMO than late because of the surgical bleeding that is less. After that we talk about the ERAS protocols for colorectal surgery and how. This improve patients' outcomes, reducing the hospital length and the complications and opioid use and last we talk about the importance about mental health to make every pediatric surgeon and physician actually aware of this so we can help everyone who is in need out there. Thank you for listening to this episode. Please check the link in the description. below to read each paper and please follow State Cart MD on social media. Give us a rating and subscribe to the YouTube channel. And don't forget to download the Stay Current app on the App Store or Play Store for tons of content. I'm Cecilia Ganel and I'm E Goddy, and we are research fellows at Cincinnati Children's Hospital, and along with State Current, we are sharing knowledge to improve child health around the globe.
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