Latex allergy guidelines for people with spina bifida

State of the Art in Pediatric Anesthesia: A Narrative Review about the Use of Preoperative Time

This review delves into the challenge of pediatric anesthesia, underscoring the necessity for tailored perioperative approaches due to children's distinctive anatomical and physiological characteristics. Because of the vulnerability of pediatric patients to critical incidents during anesthesia, provider skills are of primary importance. Yet, almost equal importance must be granted to the adoption of a careful preanesthetic mindset toward patients and their families that recognizes the interwoven relationship between children and parents. In this paper, the preoperative evaluation process is thoroughly examined, from the first interaction with the child to the operating day. This evaluation process includes a detailed exploration of the medical history of the patient, physical examination, optimization of preoperative therapy, and adherence to updated fasting management guidelines. This process extends to considering pharmacological or drug-free premedication, focusing on the importance of preanesthesia re-evaluation. Structural resources play a critical role in pediatric anesthesia; components of this role include emphasizing the creation of child-friendly environments and ensuring appropriate support facilities. The results of this paper support the need for standardized protocols and guidelines and encourage the centralization of practices to enhance clinical efficacy.

Myelomeningocele: the evolution of care over the last 50 years

PURPOSE

Myelomeningocele (MMC) is one of the representative anomalies in the field of pediatric neurosurgery. During the 50 years of ISPN history, MMC had a tremendous changes in its incidence, clinical management and outcome with advanced understanding of its pathogenesis. We reviewed the changes in MMC during the period.

METHODS

We reviewed the literature review and collected our experiences.

RESULTS

During the 50 years, major changes happened in many aspects of MMC including incidence, pathoembryogenesis, folate deficiency, prevention, prenatal diagnosis, mode of delivery, treatment policy with ethical considerations, clinical treatment including fetal surgery, latex allergy, retethering, management outcome, multidisciplinary team approach, and socioeconomic and family issues.

CONCLUSIONS

There was a great advance in the management and research of MMC during the 50 years. It is a monumental achievement of pediatric neurosurgeons and colleagues of the related fields.

Sexual and reproductive health education for patients with myelomeningocele

AIM

To evaluate the sexual and reproductive health education received by patients with myelomeningocele, the most severe form of spina bifida.

METHOD

A survey designed to assess the sexual and reproductive health education given by a healthcare provider to patients with myelomeningocele was offered to all English-speaking patients aged 12 years or older with a myelomeningocele clinic visit.

RESULTS

In total, 67 surveys were completed. Menstruation and menstrual management were discussed at a rate of 85% in females. Few patients had discussions with a provider about fertility (42%), sexuality (37%), risk of sexually transmitted infections (45%), or had a relationship with a reproductive healthcare provider (54%). Differences by sex were observed for contraceptive education. The rate of discussions increased with age. A total of 67% of female patients and 33% of male patients requested a referral to a reproductive healthcare provider.

INTERPRETATION

Sexual and reproductive health education is part of comprehensive care for all patients and those with disabilities should not be excluded. The lack of consistent education received by patients supports the need for increased attention to this topic. We encourage multidisciplinary myelomeningocele clinics to establish a process for delivering complete and patient-specific sexual and reproductive health education.

A Rare Case of Giant Occipital Encephalocele With Thoracic Myelomeningocele: An Anesthetic Conundrum

Encephalocele and myelomeningocele are congenital defects in the cranium and spine with herniation of contents into an extracranial and extraspinal sac, respectively. The occurrence of encephalocele and myelomeningocele in the same patient has rarely been described in the literature. The anesthetic management of such cases is associated with multiple challenges, which include difficulty in securing the airway, prone positioning, blood loss, electrolyte imbalance, hypothermia, cardiorespiratory disturbances, and perioperative care. The main aims are, to prevent hemodynamic fluctuations and excessive pressure on the sac to avoid premature rupture and manage a possible difficult airway due to the head and neck mass. We report such a rare case to highlight and share our experiences faced during perioperative management of a giant vascular occipital encephalocele with impending rupture and thoracic myelomeningocele requiring surgical excision and repair. Previous similar case reports were also reviewed, and potential perioperative complications were discussed.

Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21st century

Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.

Investigating the landscape and trajectory of spina bifida research in Asia: a bibliometric analysis

BACKGROUND

Spina bifida is a type of a neural tube defect which affects 243.14 per 100,000 babies in Asia. Research articles on spina bifida have increased in the recent years. However, no study has focused on the research trends in this field in Asia.

METHODS

A systematic review of literature on spina bifida in Asia was performed using the Scopus database from inception to 2020. All published studies on spina bifida conducted in or published by authors from Asia were included in our analysis. Bibliometric information was obtained from Scopus and bibliometrics diagrams were created using VOSviewer software.

RESULTS

A total of 652 articles were obtained in this study. The number of publications showed an upward trend starting 2000s. The country with the greatest number of publications was Japan while All India Institute of Medical Sciences was the most productive institution in spina bifida research in Asia. The current focus of this field in Asia was prevalence of spina bifida, prenatal diagnosis, folic acid supplementation, and complications of spina bifida. Future areas of research in spina bifida include the genetic basis of neural tube defects and the use of stem cell technology as therapies for spina bifida.

CONCLUSION

This is the first bibliometric analysis on spina bifida in Asia. It showed the trend and future areas of research on spina bifida in Asia. Despite the increase in scientific literature on spina bifida research, more research outputs and collaborations are needed especially in developing countries in Asia.

The global incidence and associated factors of surgical gloves perforation: A systematic review and meta-analysis

BACKGROUND

Surgeon's hands are exposed to a range of chemical and physical stressors that influence the integrity of gloves. Thus, glove perforation facilitates pathogen transmission through the holes. Numerous studies have shown that glove perforation is of great importance, but there is still no complete consensus.

OBJECTIVE

This study aimed to investigate the safety conditions of surgical gloves based on the incidence of glove perforation among surgical teams.

METHODS

A literature review was conducted by searching PubMed, Embase, Scopus, ISI, and ProQuest databases. The incidence of glove perforation was reviewed in eight categories. A total of 580 articles were found in the initial search.

RESULTS

109 articles containing 130 datasets were analyzed. The overall incidence of glove perforation was 14.44 %. Surgeons had the highest incidence of glove perforation (23.09 %). An increase in the duration of surgery increased the odds of perforation. It was found that 68.58% of the glove perforations were not identified by practitioners.

CONCLUSION

Despite major advances in the design of surgical gloves, the issue of safety and integrity of gloves has not improved. Due to the high incidence of surgical glove perforations, most of which had not been identified, it is imperative to consider strategies to minimize the incidence of perforation. The results of the present study can be used to integrate information related to the rate of perforation of surgical gloves in different surgeries.

The microbiological and physical properties of catheters for intermittent catheterization: a systematic review on the impact of reuse and cleaning

STUDY DESIGN

Systematic Review.

OBJECTIVES

To review systematically the clinical evidence of the effectiveness of various intermittent catheter cleaning methods that have been proposed as methods to prepare catheters for reuse.

METHODS

A keyword search in Medline, Excerpta Medica dataBASE, the Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials, was undertaken to identify all English, Russian and German language literature evaluating the effectiveness of various intermittent catheter cleaning methods. Studies selected for review included analytical experimental, prospective cohort and cross-sectional. Cleaning methods reviewed included heat-based sterilization, chemical cleaning solutions, mechanical abrasion, photocatalytic sterilization, and combined methods.

RESULTS

Overall, 12 studies were included. Heat-based sterilization and mechanical abrasion methods were either not effective or damaged the physical properties of catheters. Two studies reported evidence that their chemical cleaning methods (i.e., soaked catheters in a 70% alcohol solution for 5 min or combined approach detergent wash followed by soaking in Milton sterilizing fluid also known as the Milton method) both preserved the structural integrity of their catheters and were bactericidal.

CONCLUSIONS

Numerous cleaning methods resulted in the destruction of catheters. However, there are two reported cleaning methods, submersion for 5 min in 70% alcohol and the "Milton method", that eliminate bacterial colonization while leaving the physical properties of the catheters unchanged. While these cleaning methods are promising, each was published in just one study, therefore higher-powered / longitudinal studies confirming the safety and efficacy of these cleaning methods must be obtained before current clinical recommendations can be modified.