The decision to pursue non-operative management rather than splenic preservation or splenectomy depends on the individual merits of each case. There is an increasing trend towards splenic preservation, particularly in younger, stable patients.

The aim of this study is to introduce the port-less laparoscopic repair of pediatric inguinal hernia as a novel technique to minimize the operative time, umbilical scar, patient charge and hospital costs. Methods In this prospective study, all patients admitted for laparoscopic inguinal hernia repair, from July 2017 to August 2018, were included. 68 children (aged 1-104 months) were randomly allocated to two groups: standard group included 34 patients using single port for telescope access and port-less group included 34 patients using direct camera insertion through umbilical stab incision. All patients were followed up for 6 months. Chi square, independent samples t test and multiple linear regression analysis were used to analyse the data. p value less than 0.05 was used for all analysis. Results The mean length of the umbilical scar and operative time were significantly higher in Group 1 compared to the port-less group. There was no significant difference in the insufflated CO 2 , length of hospital stay and incidence of infection. In multiple linear regression analysis, after adjustment for confounding variable, there was a significant difference between the mean operative time (β = 11.19, p < 0.001) and the mean length of the umbilical scar (β = 1.52, p < 0.001) between portless and standard groups. The use of the port-less laparoscopic technique results in less cost to the hospital and the patients. Conclusions Applying the port-less laparoscopic technique for inguinal hernia repair in pediatrics produces the same results compared to the single-port technique, with fewer costs, operative time and postoperative scar.

Background: Appendicitis is the inflammation of the appendix. In spite of advances in the diagnosis and management of acute appendicitis, its morbidity is still significant. Despite widespread use of ultrasonography, computed tomography (CT) scan, and laparoscopy to diagnose appendicitis, the rate of misdiagnosis is not diminished accordingly. Methods: The current study aimed at determining the prevalence of primary misdiagnosis in pediatric patients presenting with appendicitis to Aliasghar Hospital, a tertiary referral center in Tehran, Iran from 2005 to 2015. Results: In the present study, the misdiagnosis rate of acute appendicitis was 7.4% in 10 years. Most causes of misdiagnosis were mesenteric adenitis, urinary tract infection, and gastroenteritis. Despite the availability of various diagnostic methods, the majority of patients with initial misdiagnosis were finally subjected to laparotomy for acute appendicitis. Ultrasound examination was useful in only 23% of the cases. Location of appendicitis in patients with initial misdiagnosis was retrocec in nine patients (53%), retroileum in five patients (29%), and pelvis in three patients (18%). Conclusions: Closer attention to signs and symptoms of acute appendicitis and higher clinical suspicion could reduce the rate of misdiagnosis and therefore minimize complications.

Context: Hemolytic uremic syndrome (HUS), being more prevalent in infants and children, is recognized by a triad of acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia. It is classified according to the underlying disorders, such as infection, systemic, metabolic disorder, or complement dysregulation. It has a high rate of morbidity and mortality. Many types of treatment, such as conservative management, plasma exchange, regular plasma infusion, and even a new expensive medication, "Ecluzimab", have been suggested. The aim of this systematic review is to estimate the incidence and prevalence of HUS (according to diarrhea positive or negative samples). In addition, the study will investigate the clinical presentation and the outcome of Iranian patients. Evidence Acquisition: The following data bases will be explored for articles published between years 1985 and 2016, PubMed, EM-BASE, OVID, SCOPUS, Web of Sciences, Google Scholar, Google, barakatkns.com, MagIran, SID, dociran, PDFiran, and ganj.irandoc. Besides, all online university databases will be searched for theses and abstracts of local or international congresses; a manual search will be performed to identify pertinent cross references. Systematic review or meta-analysis, longitudinal and cohort studies, crosssectional, case-control, and epidemiological studies will be included in this review. Relevant conference proceedings, theses or unpublished data will also be considered. The retrieved data should comprise of proportions, incidence, prevalence, geographical distribution, mortality and morbidity rates (i.e. dialysis and central nervous system involvement). A meta-analysis will be performed if 3 similar studies are found. If sufficient data is extracted, subgroup analysis will be performed for age, gender, acute kidney injury, dialysis, and death. Results: The results of the current study could have implications for health policies, practice, research, and medical education: The data could improve clinical and health care decisions, allow estimation of the number of patients that require new medication, and could direct future research design in this field.

Our objective was to compare the diagnostic accuracy of Alvarado and appendicitis inflammatory response (AIR) scoring systems among children suspected of acute appendicitis concerning their postoperative outcomes. During a two-year period, a prospective multicentric study was carried in the selected hospitals of Iran. All children who were admitted with the diagnosis of acute appendicitis were enrolled in the study. However, patients suffering from generalized peritonitis or those who had a history of abdominal surgery were excluded. Before decision-making, each patient’s score according to two appendicitis scoring systems was calculated. The clinical outcomes and diagnosis of patients were then compared to the results of each scoring system. For those patients who were a candidate for surgery, the final diagnosis of acute appendicitis was made by histopathology. Patients were divided into a high- and low-risk group according to scoring systems outcomes. Among the patients with a low score for appendicitis, the AIR scoring system had a sensitivity and specificity of 95% and 74%, respectively, which was more promising in comparison to that of the Alvarado system (90% and 70%, respectively). Regarding the patients at higher risk of acute appendicitis, none of the scoring systems provided reliable results since both systems showed sensitivity and specificity of less than 50%, which was not sufficient to distinguish patients who are a candidate for surgery. AIR and Alvarado scoring systems are not accurate models to predict the risk of acute appendicitis among children; however, the AIR system could be used as a reliable material to rule out the acute appendicitis diagnosis.