Objective: To compare the outcome of rectal and surface electrode stimulation, when performed concomitantly with routine anal sphincter (AS) exercises and bio-feedback training, in children who have received corrective surgery to address Hirschsprung disease (HD). Methods: Sixty-seven patients (pediatric) who underwent corrective surgery due to HD were randomly assigned to Group A (rectal electrode, n=34) or Group B (surface electrode, n=33). The two groups were given the same protocols of AS and bio-feedback training. The Pediatric Quality of Life Inventory (PedsQL), Bowel Function Score (BFS), Pediatric Incontinence and Constipation Scoring System Scale (PICSS) were measured at baseline, post intervention and follow-up. Results: There were significant improvements in both groups over time across all outcomes. PedsQL increased (d=0.42–1.28, η²p up to 0.37), BFS improved notably (d=1.21, η²p=0.35), and PICSS decreased (d up to 1.15, η²p=0.33). The greatest gains occurred from baseline to follow-up, with smaller but significant changes from post-treatment to follow-up, indicating sustained effects. Conclusion Electrical stimulation with rectal electrodes, combined with AS exercises and bio-feedback training, is a major way of improving bowel functioning, continence and quality of life in Hirschsprung child. Such results highlight the promise of multimodal rehabilitation and should be supported by additional multicenter studies.

Background: Orthognathic surgery has become increasingly accurate with the integration of computerized technologies. This study aimed to evaluate the accuracy of custom-made plates in transferring the three-dimensional virtual plan to intraoperative maxillary repositioning. Methods: This study included 10 patients. A digital surgical simulation technique was used for preoperative planning. The surgical components— osteotomy/plates, locating guides, and customized titanium plates—were fabricated using computer-aided design and manufacturing techniques, replacing the need for a surgical splint. Postoperative outcomes were assessed using unaltered anatomical landmarks from the preoperative virtual plan. Absolute discrepancies in translational and rotational movements between the planned and actual postoperative positions were measured through superimposition analysis. This evaluation assessed the precision of custom-made plates in transferring the virtual surgical plan, identifying deviations in the cephalocaudal, mediolateral, and anteroposterior directions that could influence functional and esthetic outcomes. Results: No statistically significant differences were observed for any landmarks across the axial, coronal, and sagittal planes. The greatest variability was noted at the posterior nasal spine landmark in the axial plane (1.7 mm), compared with the coronal (0.9 mm) and sagittal (0.5 mm) planes. Conclusion Customized titanium plates effectively transferred the virtual surgical plan for maxillary repositioning without the need for an occlusal splint. However, potential posterior interference should be considered during surgical execution.

Background: Global longitudinal strain (GLS) is a valuable tool for assessing left ventricular (LV) systolic function, detecting subclinical dysfunction earlier than classic ejection fraction. Two-dimensional speckle-tracking echocar‑ diography (2D-STE) is widely used due to its accessibility and high temporal resolution, whereas feature-tracking cardiac magnetic resonance (FT-CMR) offers superior spatial resolution and reproducibility. In this study, we assess the relationships between longitudinal strain measurements obtained by 2D-STE and FT-CMR in patients with chronic ischemic heart disease (IHD). Methods: Fifty-five patients with IHD and left ventricular ejection fraction (LVEF) ≤ 49% underwent 2D-STE and FTCMR at least 3 months after an acute coronary event. Global and segmental longitudinal strain for all 17 myocardial segments was measured using both modalities. Pearson correlation and Bland–Altman analysis were used to assess correlation and agreement, respectively. Results: GLS showed a strong correlation between 2D-STE and FT-CMR (r = 0.793, P < 0.001), with a mean difference of 0.98% and limits of agreement from –3.2% to + 5.1%. Segmental strain demonstrated greater variability (r = 0.03 to 0.47), with the best agreement in mid and apical segments and greatest discrepancies at the basal level. Conclusions In patients with IHD and reduced LVEF, GLS obtained by FT-CMR and 2D-STE showed strong correla‑ tion and acceptable overall agreement. However, the relatively wide limits of agreement and variability in segmental strain, particularly in basal regions, indicate that the two methods are not fully interchangeable for individual assess‑ ment and follow-up. Both techniques reflect similar physiological trends but differ in absolute values, requiring cau‑ tion in regional strain interpretation.

Child abuse is a widespread global health crisis with longterm implications for children’s physical, psychological, and emotional well-being. Pediatric emergency departments (PEDs) are often the first point of contact for children experiencing abuse, presenting unique diagnostic challenges due to the diverse manifestations of maltreatment. In contrast to physical abuse that often leaves visible markers, nonphysical abuse (e.g., emotional neglect or psychological harm) frequently go undetected, exacerbating underreporting and delayed interventions. This article examines the prevalence, diagnostic challenges, and multidisciplinary strategies for addressing child maltreatment in PEDs. Cultural and systemic barriers, coupled with insufficient training and resource constraints, hinder the recognition of subtle signs of nonphysical abuse. Advances in diagnostic imaging, behavioral assessment tools, and laboratory investigations are discussed as critical components of comprehensive evaluations. Multidisciplinary teams play a pivotal role in addressing the complexity of abuse cases, combining medical, psychological, and legal expertise to provide holistic care while minimizing additional trauma. The integration of artificial intelligence into diagnostic workflows is explored as a transformative innovation, offering potential for early detection of abuse patterns and enhanced decision-making. However, the implementation of artificial intelligence requires careful consideration to ensure that it complements human expertise and aligns with ethical standards. There is a need for standardized protocols, targeted training programs, and supportive systems to empower healthcare professionals in recognizing and reporting all forms of child maltreatment. We propose more research to develop tools capable of detecting nonphysical abuse in PEDs. By combining technological advancements, multidisciplinary collaboration, and educational initiatives, PEDs can improve outcomes for vulnerable children and address the widespread issue of child maltreatment more effectively.

Background and Objectives: The timing of the reinstitution of warfarin after cesarean section (CS) delivery was not adequately addressed in the literature. This study aims to evaluate the risks of early versus late initiation of warfarin post-CS in patients with mechanical heart valves. Methods: This randomized, open-label cohort study included 114 pregnant women with mechanical heart valves planned to be delivered by CS at or after 28 weeks of gestation.Patients were randomly divided into two groups: Day-2-group, where warfarin was started on day 2, and Day-5-group, where warfarin was started on day 5 after CS. Maternal postoperative bleeding complications, mechanical valve thrombosis, need for blood transfusion or reoperation, and maternal mortality were identified. Results: Ten women (8.8%) had 11 bleeding complications, of whom 2 patients (20%) had intraperitoneal hemorrhage (none in Day-2-group and 2 in Day-5-group), 3 patients (30%) had subcutaneous hematoma (none in Day-2-group and 3 in Day-5-group), and 6 patients (60%) had sub-rectus hematoma (3 in Day-2-group and 3 in Day-5-group). No mechanical valve thrombosis, other thromboembolic events, or in-hospital maternal mortality were reported. Conclusion Despite the small number of events, the bleeding risk was lower in the group with early post-CS warfarin introduction than in the group with late warfarin introduction in patients with prosthetic heart valves.

Methods: This study included 36 patients with FHP with a mean age of 27±2.63 years. These patients were randomly assigned to the two following groups: experimental group A (n=19), which received CSEs and postural correctional exercises (PCEs), , and control group B (n=17), which received only the PCE program. Randomization was performed using the computer-generated block randomization method. Training was applied 3 times per week and lasted for 6 weeks. Data were collected before and after training using lateral view cervical X-ray and NDI. Results: Two-way mixed-design multivariate analysis of variance revealed significant improvements in mean cSVA and NDI values after training (p <0.05) in experimental group (A) compared with pre-training values, whereas no significant differences in these values were observed after training in the control group. In contrast, no significant difference in the mean Cobb angle values after training was observed between the groups. Conclusions Adding CSEs to PCEs is more effective than performing PCEs alone for managing FHP. The trial was registered in the ClinicalTrials. gov registry under the registration number NCT06160245.

Child abuse is a widespread global health crisis with longterm implications for children’s physical, psychological, and emotional well-being. Pediatric emergency departments (PEDs) are often the first point of contact for children experiencing abuse, presenting unique diagnostic challenges due to the diverse manifestations of maltreatment. In contrast to physical abuse that often leaves visible markers, nonphysical abuse (e.g., emotional neglect or psychological harm) frequently go undetected, exacerbating underreporting and delayed interventions. This article examines the prevalence, diagnostic challenges, and multidisciplinary strategies for addressing child maltreatment in PEDs. Cultural and systemic barriers, coupled with insufficient training and resource constraints, hinder the recognition of subtle signs of nonphysical abuse. Advances in diagnostic imaging, behavioral assessment tools, and laboratory investigations are discussed as critical components of comprehensive evaluations. Multidisciplinary teams play a pivotal role in addressing the complexity of abuse cases, combining medical, psychological, and legal expertise to provide holistic care while minimizing additional trauma. The integration of artificial intelligence into diagnostic workflows is explored as a transformative innovation, offering potential for early detection of abuse patterns and enhanced decision-making. However, the implementation of artificial intelligence requires careful consideration to ensure that it complements human expertise and aligns with ethical standards. There is a need for standardized protocols, targeted training programs, and supportive systems to empower healthcare professionals in recognizing and reporting all forms of child maltreatment. We propose more research to develop tools capable of detecting nonphysical abuse in PEDs. By combining technological advancements, multidisciplinary collaboration, and educational initiatives, PEDs can improve outcomes for vulnerable children and address the widespread issue of child maltreatment more effectively.

Background: This study compared the quality and duration of analgesia between the superior trunk (ST) and the clavipectoral fascial plane (CFP) blocks in conjunction with a selective supraclavicular nerve (SCN) block for clavicular surgeries. Methods: Fifty patients undergoing mid-third clavicular procedures were randomly assigned to the ST group (received an SCN block followed by blockage of the ST of the brachial plexus) and the CFP group (received an SCN block followed by the CFP block). The primary outcome was the time until the first rescue analgesia. Secondary outcomes included total nalbuphine dosage and numerical rating scale (NRS) scores within the first 24 hours, the onset of sensory block, as well as deltoid and biceps muscle function using the modified Bromage score (MBS), diaphragmatic excursion, along with satisfaction levels. Results: The ST group exhibited a more prolonged duration until the first request for rescue analgesia compared to the CFP group (18.76 ± 0.89 hours vs. 15.34 ± 1.38 hours), with a mean difference of 3.42 hours (95% confidence interval: 2.76 to 4.08, P < 0.001). The ST group consumed less nalbuphine and reported lower NRS scores at 6, 8, 12, 16, and 24 hours than the CFP group. Additionally, the ST group exhibited a lower MBS and diaphragmatic excursion than the CFP group. However, the differences in the onset of sensory block and satisfaction levels were not statistically significant. Conclusions The ST group demonstrated superior outcomes in pain control with less favorable outcomes concerning diaphragmatic excursion and upper limb motor function.