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Obaid YY, Toubasi AA, Albustanji FH, Al-Qawasmeh AR. Perinatal risk factors for infantile hypertrophic pyloric stenosis: A systematic review and meta-analysis. J Pediatr Surg 2023; 58:458-466. [PMID: 36137827 DOI: 10.1016/j.jpedsurg.2022.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/15/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is one of the most common diseases that require surgical intervention amongst the paediatric population. Although the treatment and the diagnosis of pyloric stenosis are well established, the perinatal risk factors associated with it still need further investigation. METHODS We searched the following databases: Cochrane, Google Scholar, PubMed, and Scopus. Studies were included if they were case-control or cohort in design and studied the perinatal risk factors associated with IHPS. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS). RESULTS Twenty-one articles were included in this meta-analysis, including 18,104,753 participants. Our analysis showed a significant association between IHPS and male sex (RR=2.71, 95% CI:1.93-3.78), maternal smoking (RR=1.75, 95% CI: 1.54 - 2.00), bottle-feeding (RR=1.68, 95% CI: 1.42 - 1.98), being first born (RR=1.23, 95% CI:1.07-1.40), African ethnicity (RR=0.51, 95% CI: 0.35-0.75), and cesarean section (RR=1.57, 95% CI: 1.49-1.66). On the contrary, there was no significant association between IHPS and multiple gestations, preterm labour, being born in summer, and small for gestational age (SGA). CONCLUSION In conclusion, our analysis showed that male sex, bottle feeding, maternal smoking and African ethnicity were significantly associated with the risk of IHPS. However, most of the included articles were retrospective in design which necessitates conducting future prospective well-designed studies to further investigate the risk factors of IHPS.
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Affiliation(s)
- Yazan Y Obaid
- Faculty of Medicine, University of Jordan, Amman, Jordan, 11962.
| | - Ahmad A Toubasi
- Faculty of Medicine, University of Jordan, Amman, Jordan, 11962
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Environmental exposure in the etiology of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Pediatr Surg Int 2022; 38:951-961. [PMID: 35441884 DOI: 10.1007/s00383-022-05128-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the occupational and environmental factors in the etiology of infantile hypertrophic pyloric stenosis (IHPS). METHODS Protocol was drafted according to the PRISMA guidelines and registered on PROSPERO (CRD42020152460). A search for a combination of terms related to IHPS, fetus and neonates, and environmental exposure was performed for studies published between 2000 and 2020 in the EMBASE, Pubmed, and MEDLINE databases. RESULTS Overall, 2203 abstracts were identified and 829 were screened. The full text of the selected articles (N = 98) was assessed for eligibility. Fifteen studies were included in quantitative synthesis. IHPS risk was significantly lower in black and Hispanic mothers than in white mothers [OR 0.47 (95% CI 0.44-0.51, p < 0.001), OR 0.85 (95% CI 0.77-0.94, p = 0.002), respectively]. Lower maternal education level and maternal smoking were risk factor for IHPS. We further observed a non-significant association between maternal folic acid usage and IHPS risk. Data were insufficient to evaluate occupational exposure. CONCLUSION This review provides an understanding of the role of environmental exposures in IHPS etiology. Lower maternal educational level, maternal smoking, and white ethnicity are associated with a significantly increased risk of IHPS, while folic acid use seems non-significantly associated with IHPS risk. LEVEL OF EVIDENCE III.
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van den Bunder FAIM, Allema JH, Benninga MA, de Blaauw I, van de Brug T, den Dulk M, Hulscher JBF, Keyzer-Dekker CMG, Witvliet MJ, van Heurn ELW, Derikx JPM. The Dutch Incidence of Infantile Hypertrophic Pyloric Stenosis and the Influence of Seasons. Eur J Pediatr Surg 2021; 31:525-529. [PMID: 33171518 DOI: 10.1055/s-0040-1721055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Studies report contradicting results on the incidence of infantile hypertrophic pyloric stenosis (IHPS) and its association with seasons. We aim to assess the IHPS incidence in the Netherlands and to determine whether seasonal variation is present in a nationwide cohort. MATERIALS AND METHODS All infants with IHPS hospitalized in the Netherlands between 2007 and 2017 were included in this retrospective cohort study. Incidence rates per 1,000 livebirths (LB) were calculated using total number of LB during the matched month, season, or year, respectively. Seasonal variation based on month of birth and month of surgery was analyzed using linear mixed model and one-way ANOVA, respectively. RESULTS A total of 2,479 infants were included, of which the majority was male (75.9%). Median (interquartile range) age at surgery was 34 (18) days. The average IHPS incidence rate was 1.28 per 1,000 LB (variation: 1.09-1.47 per 1,000 LB). We did not find a conclusive trend over time in IHPS incidence. Differences in incidence between season of birth and season of surgery were not significant (p = 0.677 and p = 0.206, respectively). CONCLUSION We found an average IHPS incidence of 1.28 per 1,000 LB in the Netherlands. Our results showed no changing trend in incidence and no seasonal variation.
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Affiliation(s)
- Fenne A I M van den Bunder
- Department of Pediatric Surgery, University of Amsterdam and Vrije Universiteit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jan Hein Allema
- Department of Pediatric Surgery, Juliana Children's Hospital, HAGA Hospital, The Hague, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, University of Amsterdam and Vrije Universiteit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud University, Amalia Children's Hospital, Radboud UMC, Nijmegen, The Netherlands
| | - Tim van de Brug
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands
| | - Marcel den Dulk
- Department of Surgery, MUMC, Maastricht University, Maastricht, The Netherlands
| | - Jan B F Hulscher
- Department of Pediatric Surgery, University of Groningen, Beatrix Children's Hospital, UMC Groningen, Groningen, The Netherlands
| | - Claudia M G Keyzer-Dekker
- Department of Pediatric Surgery, Erasmus Medical Center, Erasmus University, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marieke J Witvliet
- Department of Pediatric Surgery, University of Utrecht, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Ernest L W van Heurn
- Department of Pediatric Surgery, University of Amsterdam and Vrije Universiteit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, University of Amsterdam and Vrije Universiteit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
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Infantile hypertrophic pyloric stenosis in Bosnia and Herzegovina: A retrospective cohort study from the largest tertiary care facility. Asian J Surg 2021; 45:1694-1697. [PMID: 34801371 DOI: 10.1016/j.asjsur.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/07/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is the most common condition requiring surgery in infancy, but the etiology of IHPS is still unclear. The study aimed to analyze the epidemiological and clinical features of the infants with IHPS in our setting and determine the yearly trends in IHPS incidence in the Sarajevo Canton between 2007 and 2016. METHODS We retrospectively analyzed epidemiologic, clinical, and operative data of all infants undergoing pyloromyotomy for IHPS over ten years in the largest tertiary care facility in Bosnia and Herzegovina. RESULTS Fifty-three IHPS patients were diagnosed, yielding an overall incidence of 1.17 per 1000 live births (1.25 and 1.09 cases in 2007-2011 and 2012-2016, respectively). IHPS was more prevalent among male infants (ratio 6.6:1, p < 0.001). The mean age at onset of symptoms was 39.6 days (range, 17-107 days). The estimated median time from symptoms onset to hospitalization was 11 days (range, 1-17 days). The mean age at diagnosis was significantly longer in premature infants compared with term infants (p = 0.003). Both first-born rank and bottle-feeding were significantly associated with IHPS (p = 0.001 and p = 0.04, respectively). No seasonal variation associated with IHPS was detected (p = 0.25). No evidence was found of differences in the incidence of IHPS related to maternal age (p = 0.24) and smoking (p = 0.59). CONCLUSION Our data indicate a declining trend and provide insights into the clinical characteristics of IHPS in Bosnia and Herzegovina. Most of the obtained results are in line with the published data and could improve the quality of local pediatric services.
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Protocol: A systematic review and meta-analysis of the role of fetal and infantile environmental exposure in etiopathogenesis of infantile hypertrophic pyloric stenosis. PLoS One 2021; 16:e0247003. [PMID: 33592043 PMCID: PMC7886114 DOI: 10.1371/journal.pone.0247003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 01/27/2021] [Indexed: 01/10/2023] Open
Abstract
Infantile hypertrophic pyloric stenosis (IHPS) is one of the hallmark pediatric surgical diseases. However, its etiology remains incompletely understood. By systematically reviewing the literature, we aim to clarify the effect of the effect of occupational and environmental factors and role of nitric oxide (NO) metabolism in the etiopathogenesis of IHPS. The systematic review is drafted with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE). Systematic literature search will be performed for the period 2000 (Jan) to 2020 (Dec) in the databases: MEDLINE, EMBASE, PubMed. The systematic search will cover the literature in English and Turkish language and will be limited to studies on human subjects. Four investigators will independently search the databases (MEDLINE, EMBASE, PubMed) according to the defined search strategy. The full-text of the selected articles will be screened independently by four reviewers, against the inclusion criteria. Descriptive data will be extracted from each study regarding: study details, methods, participants, outcomes and calculations of association for potential further statistical analysis. If meta-analysis could not be undertaken, systematic approach to analyzing the findings of included multiple studies will be described. Heterogeneity will be assessed by quantifying the inconsistency across studies using I2 statistic. Statistical analysis will be performed using Comprehensive Meta-Analysis Version 3.0 software. The p values lower than 0.05 will be considered statistically significant for all analyses.
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Synthesis, Characterization, and Anti-diabetic Activity of Some Novel Vanadium-Folate-Amino Acid Materials. Biomolecules 2020; 10:biom10050781. [PMID: 32443614 PMCID: PMC7277503 DOI: 10.3390/biom10050781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023] Open
Abstract
A new six intraperitoneal injections insulin-mimetic vanadyl(IV) compounds [(VO)(FA)(AAn)] (where n = 1–6: AA1 = isoleucine, AA2 = threonine, AA3 = proline, AA4 = phenylalanine, AA5 = lysine, and AA6 = glutamine) were synthesized by the chemical reactions between folic acid (FA), VOSO4, and amino acids (AAn) with equal molar ratio 1:1:1 in neutralized media. These complexes were characterized by elemental analysis and estimation of vanadyl(IV) metal ions. The thermal stability behavior of these complexes was studied by TG-DTG-DTA analyses. The structures of these complexes were elucidated by spectroscopic methods like infrared, electron spin resonance (ESR), and solid reflectance spectroscopes. The powder X-ray diffraction (XRD) study suggested the crystalline nature of the complexes. Magnetic moments and electronic spectra revealed the square-pyramid geometrical structure of the complexes. The conductivity results refereed that all synthesized vanadyl(IV) complexes were of a non-electrolyte behavior. The infrared spectra assignments of these complexes revealed that the FAH2 and AAn chelates act as a bidentate ligation. The chelation towards vanadyl (IV) ions existed via deprotonation of one of the carboxylic groups of FAH2 drug ligand, and so amino acids act as bidentate ligands via N-amino and O-carboxylate groups. Both scanning and transmission electron microscope (SEM and TEM) techniques were used to investigate the surface morphology. The main task of this research is the aim of designing a new insulin alternative antidiabetic drug agent. The antidiabetic efficiency of these complexes was evaluated in streptozotocin-induced diabetic male albino rats. Liver and kidney functions, insulin and blood glucose levels, lipid profile, and superoxide dismutase antioxidant (SOD) are verified identifiers for the efficiency of VO(IV)/FA/AAn system compounds as antidiabetic drug agents.
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General surgery of childhood in the UK: a general surgeon's perspective. J Pediatr Surg 2020; 55:213-217. [PMID: 31757504 DOI: 10.1016/j.jpedsurg.2019.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/26/2019] [Indexed: 11/21/2022]
Abstract
The future of general surgery of children as practiced in District General (DGHs) and Rural General Hospitals (RGHs) by adult general surgeons and urologists is uncertain. It is likely that this is because of a combination of the overall trend towards specialization, concerns about clinical risk; uncertainty within the profession about the behavior of the regulator and criminal justice system when considering cases of alleged incompetence; reduced and more targeted training time, curriculum changes, and perhaps a concern by other specialties regarding the ability of DGH and RGH surgeons to provide a safe service. The impact of this on regional pediatric surgical units (RPSUs) is however considerable. While transfer of some conditions such as infantile hypertrophic pyloric stenosis and intussusception is justifiable, transfer of others such as undescended testis and suspected torsion is not. Close communication between regional specialists and local generalists, preferably in the setting of a formal network, together with a change in the priorities of local medical and nonmedical managers and cooperation between competing Trusts is required. Strategies for dealing with the problem are available but require a change in management and National Health Service (NHS) ethos to enact effectively. Adherence to evidence-based best practice with the help of the "Getting It Right First Time (GIRFT)" initiative is vital and, together with targeted publicity and encouragement, the trend may not be irreversible. LEVEL OF EVIDENCE: Level V.
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Coakley BA, Reppucci M. Challenges in Interpreting Pyloric Stenosis Administrative Data. Hosp Pediatr 2019; 9:1012-1013. [PMID: 31748238 DOI: 10.1542/hpeds.2019-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Donda K, Asare-Afriyie B, Ayensu M, Sharma M, Amponsah JK, Bhatt P, Hesse MA, Dapaah-Siakwan F. Pyloric Stenosis: National Trends in the Incidence Rate and Resource Use in the United States From 2012 to 2016. Hosp Pediatr 2019; 9:923-932. [PMID: 31748239 DOI: 10.1542/hpeds.2019-0112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Infantile hypertrophic pyloric stenosis (IHPS) is the most common reason for abdominal surgery in infants; however, national-level data on incidence rate and resource use are lacking. We aimed to examine the national trends in hospitalizations for IHPS and resource use in its management in the United States from 2012 to 2016. METHODS We performed a retrospective serial cross-sectional study using data from the National Inpatient Sample, the largest health care database in the United States. We included infants aged ≤1 year assigned an International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, code for IHPS who underwent pyloromyotomy or pyloroplasty. We examined the temporal trends in the incidence rate (cases per 1000 live births) according to sex, insurance status, geographic region, and race. We examined resource use using length of stay (LOS) and hospital costs. Linear regression was used for trend analysis. RESULTS Between 2012 and 2016, there were 32 450 cases of IHPS and 20 808 149 live births (incidence rate of 1.56 per 1000). Characteristics of the study population were 82.7% male, 53% white, and 63.3% on Medicaid, and a majority were born in large (64%), urban teaching hospitals (90%). The incidence of IHPS varied with race, sex, socioeconomic status, and geographic region. In multivariable regression analysis, the incidence rate of IHPS decreased from 1.76 to 1.57 per 1000 (adjusted odds ratio 0.93; 95% confidence interval 0.92-0.93). The median cost of care was $6078.30, whereas the median LOS was 2 days, and these remained stable during the period. CONCLUSIONS The incidence rate of IHPS decreased significantly between 2012 and 2016, whereas LOS and hospital costs remained stable. The reasons for the decline in the IHPS incidence rate may be multifactorial.
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Affiliation(s)
- Keyur Donda
- Division of Neonatology, Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Barbara Asare-Afriyie
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Marian Ayensu
- Department of Medicine, The Trust Hospital, Accra, Ghana
| | - Mayank Sharma
- Batchelor Children's Research Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Parth Bhatt
- Department of Pediatrics, Health Sciences Center, Texas Tech University, Amarillo, Texas
| | | | - Fredrick Dapaah-Siakwan
- Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut
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