Post-operative fatal hypothermia in hydranencephaly with pre-operative hypothermia and a nerve palsy: a case report and review of the literature

A journal article on Post-operative fatal hypothermia in infants.Hydranencephaly is a rare condition characterised by complete or near complete absence of the cerebral hemispheres within relatively normal sized meninges and skull, the resulting cavity being filled with cerebrospinal fluid. It is considered to be an extreme form of porencephaly, a rare disorder characterised by a cyst or a cavity in the cerebral hemispheres. Some authors have referred to this disorder as schizencephaly

Sorghum value chain analysis in semi-arid Zimbabwe

The role of extension in strengthening relationships among stakeholders along agricultural commodity value chains remains an important discussion point especially with orphan crops in semi-arid areas. The study used a participatory framework to analyse the sorghum value chain in the Mid Zambezi Valley of Zimbabwe. A sample comprising of 380 small scale farmers, proportionately selected from five major sorghum producing wards, was used. Six agrodealers, 15 traders, 10 retailers, three wholesalers, and two processors were also sampled. Inaddition, focus group discussions, informant interviews, questionnaires and reviews of records were conducted. Input supply systems for sorghum are weakly developed and production is stalled by inappropriate innovations including seed and fertilizer application. Marketing and processing channels are limited due to erratic supply and low producer prices. Demand for sorghum inputs can be created by engaging extension agents in helping farmers with realising the benefits of using improved sorghum seed varieties and fertilizer in sorghum production. This will smoothen the flow of sorghum products along strategic value chain nodes.Keywords: Sorghum, small scale farmers, value chain, extension networks, marketing margins, agribusines

Effect of mixing cereal and legume straws on yield of grey oyster mushroom under controlled conditions

In Zimbabwe, yield of oyster mushroom ( Pleurotus ostreatus ) grown on sole substrates of maize or sorghum straw is low, <75% biological efficiency translating to less than a kilogramme of fresh mushroom per kg of dry substrate. This study aimed at determining the effect of mixing sorghum or maize straw with various proportions of bean straw, on the yield of grey oyster mushroom. Maize and sorghum straws were singly mixed with 0, 20, 40, 60, 80 and 100% bean straw, followed by a spawning rate of 5%. Eighteen days after incubation in a dark room, bags were hanged in a mushroom growing house with controlled temperatures (25-26oC). Mixing bean with maize straw had a significantly higher oyster mushroom yield (1, 229 g) than with sorghum straw (1,138 g); leading to biological efficiency of 83 and 74%, for maize straw and sorghum straw, respectively. Yield and biological efficiency decreased from 1,357 to 977 g plot-1 and 97 to 61%, respectively, when the proportion of bean straw was increased from 0-100%; while number of days to second and third harvest increased. There were significant interactions (P<0.05) for the number of pins, days to second and third harvest, between maize or sorghum straw with bean straw. Maize straw gave better performance with high percentages of bean straw than sorghum straw. Results showed that maize straw mixed with 20% bean straw produced better yield of grey oyster mushroom.Au Zimbabwe, le rendement de pleurotes ( Pleurotus ostreatus ) produites sur les substrats des pailles du ma\uefs ou du sorgho est faible, < 75% de l\u2019efficience biologique traduisant \ue0 moins d\u2019un kg des champignons frais par kg du poids sec du substrat. Cette \ue9tude visait \ue0 d\ue9terminerl\u2019effet du m\ue9lange des pailles du ma\uefs et du sorgho avec diverses proportions de la paille du haricot, sur le rendement du pleurote gris. Les pailles du ma\uefset du sorgho ont \ue9t\ue9 singuli\ue8rementm\ue9lang\ue9es avec 0, 20, 60, 80 et 100% de la paille du haricot, suivie par un taux de 5% de myc\ue9lium. Dix-huit jours apr\ue8s incubation dans une chambre noire, les sacs ont \ue9t\ue9 suspendus dans une chambre de croissance de champignon avec des temp\ue9ratures contr\uf4l\ue9es (25-26oC).Le m\ue9lange de la paille du haricot avec la paille du ma\uefs a eu un rendement significativement plus \ue9lev\ue9 du pleurote (1 229 g) qu\u2019avec la paille du sorgho (1 138 g)\ua0; entrainant une efficience biologique de 83 et 74%, pour la paille du ma\uefs et du sorgho, respectivement. Le rendement et l\u2019efficience biologique ont d\ue9cru du 1 357 \ue0 977 g plot-1 et 97 \ue0 61%,respectivement, quand la proportion de la paille du haricot a augment\ue9 de 0-100%\ua0; alors que le nombre de jours \ue0 la deuxi\ue8me et troisi\ue8me r\ue9colte a augment\ue9. Il y a eud\u2019interactions significatives (P<0.05) pour le nombre de broches, le nombre de jours \ue0 la deuxi\ue8me et troisi\ue8me r\ue9colte, entre la paille du ma\uefs etdu sorgho avec celle du haricot. La paille du ma\uefs a donn\ue9 de meilleures performances avec des pourcentages \ue9lev\ue9s de la paille du haricot que celle du sorgho. Les r\ue9sultats ont montr\ue9 que la paille du ma\uefs m\ue9lang\ue9e avec 20% de la paille du haricot ont produit de meilleur rendement du pleurote gris

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study.

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Neurological manifestation of phenytoin toxicity, resulting from drug interaction with chloramphenicol: a case report

Phenytoin toxicity masquerading as deterioration of neurological symptoms caused by interaction with chloramphenicol is a very rare but real risk. To the authors’ knowledge only one such case occurring in humans has been reported in the English literature. No case of clinical phenytoin toxicity occurring at less than double the serum phenytoin therapeutic levels, occurring as a result of chlorampenicol interaction has been documented, hence our report.A 17 year old man, whose frontal subdural empyema had been drained, had his seizures well controlled on phenytoin. Shortly after, he had a parasagital subdural empyema which was also drained. He was put on chloramphenicol. He improved tremendously until he then developed cerebellar symptoms. Phenytoin levels were noted to be almost twice the maximum therapeutic value. On stopping chloramphenicol, phenytoin levels normalized and symptoms resolved.Possibility of phenytoin toxicity should always be entertained in patients who are also taking chlorampenicol, presenting with new or worsening neurological symptoms

Neurosurgical injuries among small scale miners presenting to a tertiary hospital in Harare, Zimbabwe

Introduction: Small scale artisanal mining which is also called gold panning is rampant in gold rich areas in Zimbabwe. Objectives: This is a study of the nature and extent of neurosurgical injuries affecting miners and an evaluation of their financial means to access medical facilities. Design: This was a cross-sectional observational study carried out to study the neurosurgical injuries seen at Parirenyatwa Hospital.Materials and Methods: The setting was the Neurosurgical Unit at  Parirenyatwa hospital. The study period was January 2014 to December 2016. Data was collected at discharge onto a datasheet with subsequent computer analysis. Results: A total of 36 patients were seen during the study period following artisanal mining related neurosurgical injuries. Thirty-four (34) of them were male (94.4%) while two (2) were female (5.6%).The age range was 20-45 years

Brain aneurysm patients seen in Harare, Zimbabwe: cases review and review of literature 2012-2014

Objectives: The study aimed to look at the demographic information, size and location of intracranial aneurysms, treatment rendered and the outcomes in Zimbabwe.Design: Retrospective study.Setting: Parirenyatwa Group of Hospitals and Avenues Clinic, Harare, Zimbabwe.Subjects: Adult intracranial aneurysm patients.Interventions: Craniotomy and aneurysm clipping.Results: Seventeen patients were seen during the period of study. Twelve were female patients while five were male with a male to female ratio of 1:2. The age ranged from 25-73years, with the average age being 50 and median being 58 years. Fourteen patients were black Africans, two patients were Caucasian while one was Chinese. Ten of the seventeen (58.8%) had hypertension while two had a history of aneurysms in the family. Sixteen presented after rupture of the aneurysm while one was seen at diagnosis with an unruptured posterior communicating artery aneurysm. Most aneurysms were in the anterior communicating artery and the internal carotid artery territories (35% each). Nine of the seventeen patients did undergo craniotomy and clipping of the aneurysm. Three patients had intra-operative rupture of the aneurysm.Conclusion: There is need to improve patient and medical personnel education and so that more patience with this condition are seen and diagnosed in hospitals. This will also help to make surgery for brain aneurysm more acceptable in Zimbabwe

Serum S100B measurement as a diagnostic tool and prognosis predictor in head trauma in resource limited settings: insights from Harare, Zimbabwe

Introduction: Traumatic brain injury (TBI) as a major cause of global morbidity and mortality. CT scan and MRI are very useful tools in the evaluation of TBI yet in resource limited settings are mostly unavailable or expensive and are therefore not readily available for the evaluation of this condition. Serum S100B proteins levels were evaluated in this study as an additional tool for TBI diagnosis and the outcomes were observed.Materials and Methods: Using an ethically approved protocol, we recruited 90 consenting individuals: 50 TBI suspects (HIP), 20 healthy individuals (AHP) and 20 with non-neurological conditions (NNCP) from Parirenyatwa Hospital, Harare Zimbabwe. Serum S100B levels were determined by an ELISA kit. Questionnaires and clinical examination records were used to obtain participants’ demographic data.Results: Participants’ median age was 33.0 interquartile range (IQR): 28-43 years, with more males than females being recruited (p=0.001). The major cause of TBI in this study was motor vehicle crushes (78%). Median S100B levels were significantly higher in TBI suspects compared to AHP and NNCP. High levels of serum S100 were associated with a higher mortality. A CT scan result positive for neurological damage and severe head injury based on the Glasgow Coma Scale (GCS) was associated with high serum S100B levels (p=0.003 and p=0.002 respectively). A serum S100B above 350pg/ml with a median of 442pg/ml was uniformly fatal.Conclusion: Despite the small sample size, our study highlights the potential of S100B measurements in diagnosis and prognosis prediction for TBI cases in settings where CT scan is unavailable and or unaffordable

Effects of partnership change on microbicide gel adherence in a clinical trial (HPTN 035).

Use of HIV prevention methods may vary for women by types of sexual partners. In a microbicide safety and effectiveness trial (HPTN 035) differences in adherence to a microbicide study gel were compared between women with new versus ongoing partnerships over time. 1,757 women in the three HPTN 035 trial's arms completed the Follow-up Partner Status (FPS) questionnaire at their last study visit. Women married at baseline were asked if they had the same husband, new husband or new partner. Unmarried women were asked if they had changed partners or married. Self-reported gel adherence during the last sex act was compared at each quarterly visit between women with ongoing versus new partners. High gel adherence was compared with low gel adherence (85-100 vs. &lt;85 % of last vaginal sex acts reported with gel use, respectively) in multivariable models to assess associations with partner change. Overall 7 % of women (n = 123) reported a new partner and 41 % (51) of those reported a new husband. Median gel adherence was reported to be 100 % in women with ongoing partners and 75 % for women with new partners (p &lt; 0.001). In women reporting no gel use in their last sex act, only 12.5 % of the women with a new partner and none of those with an ongoing partner reported using condoms (p &lt; 0.001). Fewer women with new partners reported using both the gel and condom during the last sex act as compared to women with ongoing partners (median 50 vs. 71.4 %, p &lt; 0.001). After adjusting for age, site, education level, and sexual frequency, women with ongoing partners were more likely to report high gel adherence than those with new partners (AOR 2.5, 95 % CI 1.6, 3.9). This pattern persisted when gel use over time was compared between women with new versus ongoing partners. In the HPTN 035 trial, women with new partners had higher HIV incidence and reported less gel use and higher condom use. Specific counseling and support are needed to help women use potential HIV prevention methods, including microbicides, when they are changing partners