Medical quiz on endocrinology

MEDICAL QUI

Transient neonatal diabetes or neonatal hyperglycaemia: A case report

Transient neonatal diabetes and neonatal hyperglycaemia both present in the neonatal period with features of hyperglycaemia, dehydration and weight loss. Differentiating these conditions clinically is difficult. We describe the case of a 13 day old female whom we managed recently who could have had either condition. Hyperglycaemia is not as commonly documented as would be expected for the frequency of neonatal disease and when it does occur, it will worsen neonatal morbidity and mortality. Blood glucose levels in babies ondextrose infusion should be monitored regularly in order to help individualiseglucose requirements

Ventilatory support of the newborn

Respiratory disorders are a frequent cause of admission in the newborn. Respiratory diseases have unique physiologic, anatomic and clinical characteristics during this period necessitating special management. Knowledge of the pathophysiology of pulmonary diseases and their differential impact on the lungs of differing stages of maturity is essential to the safe and efficacious applications of special techniques of treatment. Principles of respiratory management include establishment of the airway, ensuring oxygenation, assisted ventilation, assessing adequacy of ventilation, correction of metabolic abnormalities and alleviation of cause of distress. The goal of treatment is safe and effective assistance to oxygen delivery and carbon dioxide removal from the tissues. Inspired oxygen should be administered in a controlled manner to provide adequate but not excessive blood oxygen tension levels. Mechanical ventilation may be required to treat metabolic abnormalities. There is the need for continuous monitoring and re- evaluation. This article is intended to present an overview of the embryology of the respiratory system, pulmonary physiology in the newborn, the principles of oxygen therapy and mechanical ventilation. It also discusses the complications that can follow. Key words: Ventilatory support, oxygen delivery, newbor

Prevalence and determinants of pre-term deliveries in the University of Ilorin Teaching Hospital, Ilorin, Nigeria

In Nigeria, over 900,000 children under the age of five years die every year. Early neonatal death is responsible for a little over 20% of these deaths. Prematurity remains a significant cause of these early neonatal deaths. In some series, it is reported to be responsible for 60–70% of these deaths. This study aimed to determine the prevalence and determinants of pre-term deliveries at the University of Ilorin Teaching Hospital, Ilorin. This was a prospective cohort study conducted over a 9-month period at the University of Ilorin Teaching Hospital. Records of deliveries and data on maternal socio-biological and antenatal variables were collected during this period in order to determine the prevalence and determinants of pre-term deliveries. Out of the 2,489 deliveries that took place over a 9-month period, there were 293 pre-terms, giving a pre-term delivery rate of 120 per 1,000 deliveries. Of the total deliveries, 1,522 singleton deliveries that satisfied inclusion criteria were recruited; 185 of them were pre-term deliveries giving a case:control ratio of 1:7. Significant determinants of pre-term delivery identified were previous pre-term delivery (P=0.001; OR=3.55; 95% CI=1.71–7.30), antepartum hemorrhage (P=0.000; OR=8.95; 95%CI=4.06–19.78), premature rupture of the membranes (P=0.000; OR=6.48; 95%CI=4.33–9.67), maternal urinary tract infection (P=0.006; OR=5.89; 95%CI=1.16–27.57), pregnancy induced hypertension (P=0.007; OR=3.23; 95%CI=2.09–4.99), type of labor (P=0.000; OR=6.44; 95%CI=4.42–9.38) and booking status (P=0.000; OR=4.67; 95%CI=3.33–6.56). The prevalence of pre-term delivery was 120 per 1,000 live births. Factors significantly associated with pre-term delivery were low socio-economic class, previous pre-term delivery, antepartum hemorrhage, premature rupture of fetal membranes, urinary tract infection, pregnancy induced hypertension, induced labor, and booking elsewhere outside the teaching hospital

Knowledge and Practices of PMTCT among Health Care Providers in Private Hospital in Ilorin, Nigeria

Introduction: In the developed countries where mother to child transmission of the virus is still high preventing MTCT is essential and starts during the antepartum period where diagnosis can be made andantiretrovirals and other prevention strategies can be instituted. A  significant proportion of Maternity care and delivery services are rendered by private hospitals. Adequate knowledge by health care providers ofantiretroviral use and other PMTCT strategies will be required to ensure control of vertical transmission of the virus.Objective: To assess the knowledge and practice of PMTCT among health care providers in private health facilities in Ilorin, Nigeria.Method: This is a review of health care providers in private health facilities Ilorin, Nigeria, between December2011 and November2012. Information on biodata, general knowledge on HIV and PMTCT and practices done to prevent vertical transmission were collected with use of questionnaires and were analyzed using SPSS statistical software version 17.Result: 265 questionnaires were applied but 223 were complete and analyzed. Their age range was 20-62years; mean age was 32.45+7.0SDyrs and Mean working experience was 5.89+5.17SD yrs. Nurses constituted the greater percentage 64.1% of the health care providers. Knowledge that vertical transmission could be prevented was good (95.5%), however 15.2% felt HIV could be transmitted through sharing of spoon or eating together. Only 20% had training in PMTCT and 17% worked in health facilities where ARV was administered to HIV positive pregnant women. A larger number 72% referred the HIV positive women to other centres for antenatal care and delivery. Antiretroviral drugs administered to the mothers were, 42.1% administered single drug ARV therapy, 21.1% gave 2 ARV drugs which is not in any standard protocol while only 5.3%  administered 3 ARV drugs. Prophylactic ARV administration to the babies also revealed deficiencies.Conclusion: Knowledge and practice of PMTCT among health care providers in private sectors was poor. There were no clear cut guidelines for  antiretroviral drug administration for mothers and babies. Training and retraining on PMTCT should be encouraged.Keywords: Knowledge, Practice, health care provider, PMTC

Unusual occurrence of congenital hypothyroidism in a set of same sex triplets: challenges of diagnosis in a resource poor setting

Congenital hypothyroidism is the most common endocrinological disorder in children. Genetic and intrauterine factors have been implicated in its aetiology. The aim of this study was to describe an unusual occurrence of congenital hypothyroidism in a set of same sex triplets and challenges associated with the diagnosis. This is a review of a set of female triplets delivered at 34 weeks gestational age and noticed to have reduced activity, hypotonia and poor suck. On testing for thyroid hormones the patients were found to be hypothyroid. However this diagnosis was delayed until the 6th week of life as a result of difficulties in running the test. The subjects of the study were placed on thyroxine supplementation and have been doing well. Congenital hypothyroidism can occur in multiple order pregnancies and clinicians should have a high index of suspicion for its occurrence.Keywords: Congenital hypothyroidism; Triplets; Diagnosi

Brucellosis as an Emerging Threat in Developing Economies:Lessons from Nigeria

Nigeria is the most populous country in Africa, has a large proportion of the world's poor livestock keepers, and is a hotspot for neglected zoonoses. A review of the 127 accessible publications on brucellosis in Nigeria reveals only scant and fragmented evidence on its spatial and temporal distribution in different epidemiological contexts. The few bacteriological studies conducted demonstrate the existence of Brucella abortus in cattle and sheep, but evidence for B. melitensis in small ruminants is dated and unclear. The bulk of the evidence consists of seroprevalence studies, but test standardization and validation are not always adequately described, and misinterpretations exist with regard to sensitivity and/or specificity and ability to identify the infecting Brucella species. Despite this, early studies suggest that although brucellosis was endemic in extensive nomadic systems, seroprevalence was low, and brucellosis was not perceived as a real burden; recent studies, however, may reflect a changing trend. Concerning human brucellosis, no studies have identified the Brucella species and most reports provide only serological evidence of contact with Brucella in the classical risk groups; some suggest brucellosis misdiagnoses as malaria or other febrile conditions. The investigation of a severe outbreak that occurred in the late 1970s describes the emergence of animal and human disease caused by the settling of previously nomadic populations during the Sahelian drought. There appears to be an increasing risk of re-emergence of brucellosis in sub-Saharan Africa, as a result of the co-existence of pastoralist movements and the increase of intensive management resulting from growing urbanization and food demand. Highly contagious zoonoses like brucellosis pose a threat with far-reaching social and political consequences

Priapism Clinical Presentation and Complications: Review of 12 Cases

In the West African, Priapism is a well recognized complication of sickle cell disease (SCD). Several lessons have been learnt over the years in the sub region, but it is doubtful if these have affected the outlook of priapism in the region. Records of patients with priapism seen in the emergency room between January 2006 and December 2007 were retrieved and analyzed. Twelve patients were identified with a mean age was 25.17 years. All the patients had sickle cell haemoglobinopathy with mean duration of onset to presentation of 175 hours. Carvenosal aspiration and irrigation with normal saline solution of adrenalin solution was sufficient to induce penile tumescence in 75% of patients and one of the patients had El Ghorab carvenoglanular shunt. Half of the patients had resultant impotence. A growing population of adult sickle cell disease patient will continue to present with cases of priapism.Keywords: Priapism, Presentation, Complications, Sickle cell diseaseThe Tropical Journal of Health Sciences Vol 19 No 1 (January 2012

Prevalence Of Early Onset Sepsis In Relation To Exclusive Breast Feeding Among Newborns In Ilorin

Neonatal Septicaemia (NNS) remains an important cause of morbidity and mortality in Nigeria. This prospective cross- sectional study was carried out to determine the relationship between exclusive breastfeeding and incidence and outcome of neonatal sepsis in population of Nigerian newborns. Subjects were babies either with clinical features of septicaemia or risk factors for sepsis. Study was over a 1-year period. The breastfeeding status of the babies was ascertained and a single venous sample of 2ml of blood was taken from a peripheral vein, following skin preparation for culture. One hundred and ninety three babies were recruited; of these 65 (33.6 percent) had culture proven septicaemia out of which 36(55.4 percent) babies were exclusively breastfed (EB) and 29 (44.6 percent) were not. In those <72hours of life, fatality was 5.3 percent in the (EB) compared to 34.6 percent in the non-exclusively breastfed (NEB) babies (p<0.0001, OR=9.5). Beyond 72 hours, fatality in the EB group was 15.8 percent and for the NEB 39.4 percent {p=0.024, OR=3.4}. Stratifying by blood culture result, (EB) babies had fatality rate of 13.9 percent while the NEB a fatality of 37.9 percent in the blood culture positive group. (P=0.026; OR=3.7) exclusive breastfeeding was associated with significantly lower prevalence of early onset sepsis and reduced neonatal mortality in study population.Keywords: Neonate, Sepsis and Breast feedingThe Tropical Journal of Health Sciences Vol 19 No 1 (January 201

Neuro-Opthalmic Manifestations in a Patient With Hodgkin Disease: A Case Report

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