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Zouari M, Ben Ameur H, Ben Saad N, Kraiem N, Rhaiem W, Mhiri R. Letter to the Editor: Acute Appendicitis in Infants: An Unusual Presentation. Surg Infect (Larchmt) 2023; 24:579-580. [PMID: 36946784 DOI: 10.1089/sur.2022.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Affiliation(s)
- Mohamed Zouari
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Hana Ben Ameur
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nesrine Ben Saad
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Najoua Kraiem
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Wiem Rhaiem
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Riadh Mhiri
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Zouari M, Ben Ameur H, Ben Saad N, Rhaiem W, Ben Ayed M, Mhiri R. Risk Factors for Failure of Nonoperative Management in Children With Ileocolic Intussusception. Pediatr Emerg Care 2023; 39:296-297. [PMID: 36598062 DOI: 10.1097/pec.0000000000002903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Zouari M, Ameur HB, Krichen E, Saad NB, Dhaou MB, Mhiri R. Risk factors for adverse outcomes following surgical repair of esophageal atresia. A retrospective cohort study. Dis Esophagus 2023; 36:doac070. [PMID: 36214334 DOI: 10.1093/dote/doac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/28/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Abstract
Esophageal atresia (EA) is a life-threatening congenital malformation of the esophagus. Despite considerable recent advances in perinatal resuscitation and neonatal care, EA remains an important cause of mortality and morbidity, especially in low-income countries. The aim of this study was to assess risk factors for adverse outcomes following surgical repair of EA at a single center in Tunisia. We performed a retrospective analysis using medical records of neonates with surgical management of EA at our institution from 1 January 2007 to 31 December 2021. In total, 88 neonates were included with a mortality rate of 25%. There were 29 girls and 59 boys. The diagnosis of EA was suspected prenatally in 19 patients. The most common associated anomalies were congenital heart diseases. Prematurity, low birth weight, outborn birth, age at admission >12 hours, congenital heart disease, postoperative sepsis, and anastomotic leak were risk factors for mortality following surgical repair of EA. Anastomotic tension was the only factor associated with short-term complications and the occurrence of short-term complications was predictive of mid-term complications. This study provides physicians and families with contemporary information regarding risk factors for adverse outcomes following surgical repair of EA. Thus, any effort to reduce these risk factors would be critical to improving patient outcomes and reducing cost. Future multi-institutional studies are needed to identify, investigate, and establish best practices and clinical care guidelines for neonates with EA.
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Affiliation(s)
- Mohamed Zouari
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Hana Ben Ameur
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Emna Krichen
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Nesrine Ben Saad
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Riadh Mhiri
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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Zouari M, Ben Ameur H, Ben Saad N, Kraiem N, Rhaiem W, Mhiri R. Cecal Volvulus: An Uncommon Diagnosis in a Child with Down's Syndrome. Arch Iran Med 2023; 26:117-118. [PMID: 37543932 PMCID: PMC10685901 DOI: 10.34172/aim.2023.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 08/08/2023]
Affiliation(s)
- Mohamed Zouari
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Hana Ben Ameur
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nesrine Ben Saad
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Najoua Kraiem
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Wiem Rhaiem
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Riadh Mhiri
- Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
- Research Laboratory “Developmental and Induced Diseases” (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Zouari M, Ben Ameur H, Ben Saad N, Rhaiem W, Ghariani O, Ben Hamad A, Mhiri R. Predictive Factors for Mortality in Pre-Term Neonates with Necrotizing Enterocolitis: A Retrospective Cohort Study. Surg Infect (Larchmt) 2023; 24:52-57. [PMID: 36525522 DOI: 10.1089/sur.2022.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Necrotizing enterocolitis (NEC) is a serious neonatal condition. Over the last three decades, there has been progress in neonatal intensive care with an increase in the incidence of pre-term births. This has led to an increase in the incidence of NEC. However, research studies regarding NEC outcomes in low-income countries are scarce. Our study aimed to assess predictive factors for mortality in patients with NEC in a single center in Tunisia. Patients and Methods: We conducted a retrospective data collection through a review of the patients' medical records. All neonates with a medical or surgical management of NEC between January 1, 2010 and March 31, 2022 were included. Results: A total of 102 neonates were included with the overall survival of 47%. Outcomes of the univariable analysis showed that patients in the deceased group had lower gestational age, lower five-minute Apgar score, lower birth weight, and lower platelet count than those in the survivor group. Multivariable logistic analyses demonstrated that gestational age <32 weeks (p = 0.024; odds ratio [OR], 2.5), five-minute Apgar score <8 (p = 0.017; OR, 3.621), birth weight <1,500 g (p = 0.001; OR, 4.136), platelet count <50,000/mm3 (p = 0.029; OR, 2.5), Bell's stage 3 (p = 0.035; OR, 2.496), and sepsis during hospitalization (p < 0.001; OR, 5.971) were associated with mortality in neonates with NEC. Conclusions: Our study showed that gestational age <32 weeks, five-minute Apgar score <8, very low birth weight, severe thrombocytopenia, Bell's stage 3, and sepsis during hospitalization were predictive factors for mortality in neonates with NEC. These factors would be useful to refine treatment modalities for better disease outcomes.
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Affiliation(s)
- Mohamed Zouari
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Hana Ben Ameur
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Nesrine Ben Saad
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Wiem Rhaiem
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Oussama Ghariani
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Neonatology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Amel Ben Hamad
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Neonatology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Riadh Mhiri
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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Affiliation(s)
- Mohamed Zouari
- Department of Pediatric Surgery Hedi-Chaker Hospital Sfax, Tunisia SfaxMedical School University of Sfax Sfax, Tunisia
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Zouari M, Ben Ameur H, Krichen E, Kraiem N, Ben Dhaou M, Mhiri R. Infected urachal cyst: an uncommon cause of severe sepsis in a neonate. World Jnl Ped Surgery 2022; 5:e000429. [DOI: 10.1136/wjps-2022-000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/26/2022] [Indexed: 11/03/2022] Open
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Zouari M, Ben Ameur H, Krichen E, Kraiem N, Ben Dhaou M, Mhiri R. Large defect size is associated with 30-day mortality following surgical repair of congenital diaphragmatic hernia. J Neonatal Surg 2022. [DOI: 10.47338/jns.v11.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Zouari M, Ben Ameur H, Krichen E, Kraiem N, Ben Dhaou M, Mhiri R. Time to Surgery Does Not Impact Outcome in Pediatric Appendicitis. Surg Infect (Larchmt) 2022; 23:558-563. [PMID: 35704046 DOI: 10.1089/sur.2022.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Despite the high prevalence of acute appendicitis in children and substantial resource utilization associated with this condition, no consensus has been reached on optimal timing for performing appendectomies. The aim of this study was to examine the association between time to appendectomy and outcomes and assess the feasibility of delayed appendectomy in children. Patients and Methods: We performed a retrospective analysis of all patients younger than 14 years of age undergoing an appendectomy for suspected appendicitis. We divided our patients into two groups based on whether their time to appendectomy was shorter or longer than eight hours: group A, early appendectomy and group B, delayed appendectomy. Then we compared the two study groups regarding demographic, clinical, and radiographic characteristics, peri-operative data, and outcomes. Results: During the eight-year study period, a total of 1,141 patients underwent appendectomies. After applying exclusion criteria, 852 children were included: 544 (63.8%) in group A and 308 (36.2%) in group B. There were no differences in the rate of complicated appendicitis at exploration, post-operative complications, length of post-operative hospital stay, and 30-day re-admission rate between the two study groups. Conclusions: Our study demonstrated that delaying appendectomy within 24 hours of presentation is safe and feasible for pediatric acute appendicitis. Therefore, patients presenting during nighttime hours could be initially treated conservatively with antibiotic agents. This allows the surgeon to delay surgery to the following day.
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Affiliation(s)
- Mohamed Zouari
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Hana Ben Ameur
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Emna Krichen
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Najoua Kraiem
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Riadh Mhiri
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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Bouzidi L, Triki M, Charfi S, Ameur HB, Dhaou MB, Bouaziz T, Boudawara T. Incidental Finding of Bilateral Ovarian Adrenal Rest Tumor in a Patient With Congenital Adrenal Hyperplasia: A Case Report and Brief Review. Pediatr Dev Pathol 2021; 24:137-141. [PMID: 33433255 DOI: 10.1177/1093526620980614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ovarian adrenal rest tumors (OART) are tumors that develop in females with congenital adrenal hyperplasia (CAH). In contrast to their counterpart in testicles, they are exceptional and few cases have been reported in the literature. In this report, we present clinicopathological findings of a female patient with CAH due to 21-hydroxylase deficiency who was incidentally diagnosed with OART with a review of the literature. The 14-year-old patient, who was raised as a boy, developed a virilizing syndrome with high testosterone levels that were attributed to non adherence to her replacement corticosteroid therapy. She consulted for sex reassignment surgery. Pelvic ultrasound was normal. She underwent hysterectomy and bilateral adnexectomy. No abnormalities were noticed during the operation. Grossly, both ovaries were variegated with well circumscribed and lobulated, brownish-yellow nodules. Histologically, the nodules were composed of nests of large polygonal cells with centrally located nuclei and prominent nucleoli. There was mild atypia and no crystals of Reinke. Thus, the findings of the histopathological examination were consistent with bilateral OART. Histological differential diagnosis of OART can be challenging particularly with leydig cell tumor, stromal luteoma and steroid cell tumors, not otherwise specified. OART must be considered in women with CAH and persistent virilizing symptoms despite negative imaging results.
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Affiliation(s)
- Lobna Bouzidi
- Department of Pathology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Meriam Triki
- Department of Pathology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Slim Charfi
- Department of Pathology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Hana Ben Ameur
- Department of Pediatric Surgery, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Department of Pediatric Surgery, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Touraya Bouaziz
- Department of Pediatrics, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Tahya Boudawara
- Department of Pathology, Habib Bourguiba University Hospital, Sfax, Tunisia
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