Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...

Introduction: Research has shown clear correlation between inflammatory conditions and a prothrombotic state. Cerebral vein thrombosis can be fatal and diagnosis is challenging as symptoms are unspecific. Objectives: The main objective of the study is to find the association between headache and inflammatory bowel diseases. Material and methods: This cross-sectional study was conducted in Foundation University Islamabad and Dow Medical College Karachi during 2021 to 2022. Data was collected from 20 patients presenting in OPD of the hospital. Patients with inflammatory bowel disease unclassified presented to emergency department with a 3-day history of nausea, vomiting, headache and sporadic abdominal pain along with intermittent bloody stools in recent weeks. Results: Data was collected from 20 patients. There were 8 males and 12 females with mean age of 45.67 years. No differences were found when comparing the distribution of data including IBD and migraine or severe headache. The prevalence of migraine or severe headache and 95% confidence intervals (CIs) and by selected characteristics were calculated. Conclusion: It is concluded that headache is frequent and disabling in IBD patients, highlighting the probable role of the brain gut axis in this co-occurrence of pathologies.

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Objective: To determine the mean Parental treatment satisfaction scores in a day care pediatric surgical procedure. Method: A cross-sectional study was conducted at the department of Pediatric Surgery, Liaquat National Hospital, Karachi between September 2019 to March 2020. All children of age 1-15 years of either gender admitted in Day Care Surgery for undergoing any of the pediatric surgical procedures (Hernia surgery, circumcision surgery or cysts surgery) were included. Data regarding age of child, gender, educational status of mother and father and parental age was obtained and was noted. The questionnaire covered the following areas: surgical staff and general treatment satisfaction, nursing staff and general information satisfaction; and Anesthetic staff satisfaction. The total parenteral treatment satisfaction scores were calculated. Results: Age range of children in this study was from 1 to 15 years with mean age of 7.7 ± 5.5 years, mean age of mother was 35.1 ± 7.5, mean age of father was 39.7 ± 6.9, mean duration of surgery was 45 ± 13 and mean duration of anesthesia was 47 ± 5 in minutes. The mean Parental treatment satisfaction scores in a day care pediatric surgical procedure was 6.67 + 0.7. Conclusion: The satisfaction level of the parents was fair enough considering the units where pediatric sedation was administered. When the physical conditions and the communication with patients and their relatives are improved and the procedure schedule is followed strictly, there will be further improvement in positive clinical results. Keywords: Pediatric surgery, Parental, satisfaction score, Sedation

Objective: To determine outcome of colostomy closure without prior conventional bowel preparation. A cross-sectional study was conducted at the department of pediatric surgery, Nishtar Hospital, Multan between May 2020 to February 2021. Results: Out of these 102 study cases, 66 (64.7%) were boys and 36 (35.3%) were girls while male to female ratio was 1.83:1. Mean age of our study cases was 6.19 ± 2.64 years (with minimum age was 2 years while maximum age was 12 years). Mean duration of surgery in our study cases was 105.88 ± 18.55 minutes (with minimum duration of the surgery was 65 minutes while maximum duration of the surgery was 145 minutes). Obesity was noted in 15 (14.7%) of our study cases. Anastomotic leakage was noted in 10 (9.8%), wound infection in 15 (14.7%) and prolonged hospital stay in 30 (29.4%) of our study cases. Conclusion: The results of this study indicate that colostomy closure without prior conventional bowel preparation is a safe, reliable and cost effective mode of treatment. It can be applied to children of different age groups without any significant side effects and it provides less pre-operative hospital stay which is beneficial not only for the parents but also for the hospital authorities. So our study results recommend the use of colostomy closure without prior conventional bowel preparation with desired outcomes. Keywords: Colostomy closure, wound infection, anastomotic leak.