Fetus Papyraceous

Fetus papyraceous, the compressed remains of a dead twin retained in utero after its intrauterine death in the second trimester, is an uncommon finding. It is not usually associated with adverse physical effects on the mother or surviving twin. A case of fetus papyraceous which was discovered at UsmanuDanfodiyoUniversity teaching hospital, Sokoto, Nigeria during routine examination of the placenta and membranes after spontaneous vaginal delivery of a low birth weight, but otherwise healthy infant, to a primigravid mother is presented. No adverse effects on the mother were recorded. This is apparently the first reported case from Nigeria despite the high twinning rate in the country.Foetus papyrac\ue9, les restes comprim\ue9s d'un jumeau mort maintenu dans l'ut\ue9rus apr\ue8s sa mort intra-ut\ue9rine dans le deuxi\ue8me trimestre, est un r\ue9sultat rare. Il n'est pas habituellement associ\ue9 aux effets physiques d\ue9favorables sur la m\ue8re ou en jumeau survivant. Un cas du foetus papyrac\ue9 qui a \ue9t\ue9 d\ue9couvert \ue0 l'h\uf4pital d'enseignement de l\u2019Universit\ue9 d'Usmanu Danfodiyo, Sokoto, au Nig\ue9ria, pendant l'examen courant du placenta et les membranes apr\ue8s l'accouchement vaginal spontan\ue9e d'une naissance de bas poids, mais autrement un nourrisson en bonne sant\ue9, \ue0 une m\ue8re primigeste est pr\ue9sent\ue9. Aucun effet nuisible sur la m\ue8re n'a \ue9t\ue9 enregistr\ue9. C'est apparemment le premier cas rapport\ue9 du Nig\ue9ria en d\ue9pit du taux \ue9lev\ue9 de g\ue9mellit\ue9 dans le pays

Acute kidney injury in children

Acute kidney injury (AKI) (previously called acute renal failure) is characterized by a reversible increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. The incidence of AKI in children appears to be increasing, and the etiology of AKI over the past decades has shifted from primary renal disease to multifactorial causes, particularly in hospitalized children. Genetic factors may predispose some children to AKI. Renal injury can be divided into pre-renal failure, intrinsic renal disease including vascular insults, and obstructive uropathies. The pathophysiology of hypoxia/ischemia-induced AKI is not well understood, but significant progress in elucidating the cellular, biochemical and molecular events has been made over the past several years. The history, physical examination, and laboratory studies, including urinalysis and radiographic studies, can establish the likely cause(s) of AKI. Many interventions such as ‘renal-dose dopamine’ and diuretic therapy have been shown not to alter the course of AKI. The prognosis of AKI is highly dependent on the underlying etiology of the AKI. Children who have suffered AKI from any cause are at risk for late development of kidney disease several years after the initial insult. Therapeutic interventions in AKI have been largely disappointing, likely due to the complex nature of the pathophysiology of AKI, the fact that the serum creatinine concentration is an insensitive measure of kidney function, and because of co-morbid factors in treated patients. Improved understanding of the pathophysiology of AKI, early biomarkers of AKI, and better classification of AKI are needed for the development of successful therapeutic strategies for the treatment of AKI

Dialysis and pediatric acute kidney injury: choice of renal support modality

Dialytic intervention for infants and children with acute kidney injury (AKI) can take many forms. Whether patients are treated by intermittent hemodialysis, peritoneal dialysis or continuous renal replacement therapy depends on specific patient characteristics. Modality choice is also determined by a variety of factors, including provider preference, available institutional resources, dialytic goals and the specific advantages or disadvantages of each modality. Our approach to AKI has benefited from the derivation and generally accepted defining criteria put forth by the Acute Dialysis Quality Initiative (ADQI) group. These are known as the risk, injury, failure, loss, and end-stage renal disease (RIFLE) criteria. A modified pediatrics RIFLE (pRIFLE) criteria has recently been validated. Common defining criteria will allow comparative investigation into therapeutic benefits of different dialytic interventions. While this is an extremely important development in our approach to AKI, several fundamental questions remain. Of these, arguably, the most important are “When and what type of dialytic modality should be used in the treatment of pediatric AKI?” This review will provide an overview of the limited data with the aim of providing objective guidelines regarding modality choice for pediatric AKI. Comparisons in terms of cost, availability, safety and target group will be reviewed

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Treatment of Infections in Young Infants in Low- and Middle-Income Countries:A Systematic Review and Meta-analysis of Frontline Health Worker Diagnosis and Antibiotic Access

BACKGROUND: Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (<2 months) in low- and middle-income countries (LMICs). We aimed to address three questions regarding access to treatment for young infant infections in LMICs: (1) Can frontline health workers accurately diagnose possible bacterial infection (pBI)?; (2) How available and affordable are antibiotics?; (3) How often are antibiotics procured without a prescription? METHODS AND FINDINGS: We searched PubMed, Embase, WHO/Health Action International (HAI), databases, service provision assessments (SPAs), Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and grey literature with no date restriction until May 2014. Data were identified from 37 published studies, 46 HAI national surveys, and eight SPAs. For study question 1, meta-analysis showed that clinical sign-based algorithms predicted bacterial infection in young infants with high sensitivity (87%, 95% CI 82%-91%) and lower specificity (62%, 95% CI 48%-75%) (six studies, n = 14,254). Frontline health workers diagnosed pBI in young infants with an average sensitivity of 82% (95% CI 76%-88%) and specificity of 69% (95% CI 54%-83%) (eight studies, n = 11,857) compared to physicians. For question 2, first-line injectable agents (ampicillin, gentamicin, and penicillin) had low variable availability in first-level health facilities in Africa and South Asia. Oral amoxicillin and cotrimoxazole were widely available at low cost in most regions. For question 3, no studies on young infants were identified, however 25% of pediatric antibiotic purchases in LMICs were obtained without a prescription (11 studies, 95% CI 18%-34%), with lower rates among infants <1 year. Study limitations included potential selection bias and lack of neonatal-specific data. CONCLUSIONS: Trained frontline health workers may screen for pBI in young infants with relatively high sensitivity and lower specificity. Availability of first-line injectable antibiotics appears low in many health facilities in Africa and Asia. Improved data and advocacy are needed to increase the availability and appropriate utilization of antibiotics for young infant infections in LMICs. REVIEW REGISTRATION: PROSPERO International prospective register of systematic reviews (CRD42013004586). Please see later in the article for the Editors' Summary

Establishment of regional radiotherapy centres: a strategy for improving access to cancer treatment in Nigeria

No Abstract. Sahel Medical Journal Vol. 10 (2) 2007: pp. 38-4

Fetal outcome of labour with retained second twin in a tertiary health institution in Sokoto, North-Western Nigeria

Background: After the delivery of the leading twin, the second twin is at risk of distress from decreased placental perfusion due to premature separation of the placenta, birth trauma from intrauterine manipulations and increase in operative intervention due to mal-presentations. Aim: To evaluate the fetal outcome in cases of retained second twin in tertiary health institution in Sokoto, North-Westem Nigeria. Method: The case notes of patients who were managed for retained second twin at the Usmanu Dan-fodiyo University Teaching Hospital (UDUTH), Sokoto, from January 2005 to December 2009 were retrieved and analysed. The chi-square table was used to analyse some of the results. Results: During the study period, there were 163 twin births out of 10,221 total deliveries, giving a twining incidence of 16 per 1000 births. There were 33 cases where the second twin was retained, representing 3.2 per 1000 births or 1 in 5 twin deliveries. The peri-natal mortality of the second twin (515.2 per 1000 births) was significantly higher than the 151.5 per 1000 births observed for the first twin (p<0.01). The fetal case fatality rate in patients who presented 4hours after delivery of the first twin(61.5%) was significantly higher than that (14.3%) noted in those who presented within 4 hours of delivery (p<0.05). Mal-presentation and uterine atony accounted for (48.2%) and (39.4%) causes of retained twin respectively. Maternal morbidity was encountered in 60.6% of cases, and the commonest maternal complications were postpartum haemorrhage and uterine rupture. Conclusion: Twin pregnancy and delivery require care in institutions with facilities for intervention. Early referral of retained second twin to well-equipped hospitals is associated with better fetal outcome