Idiopathic basal ganglia calcification (Fahr’s disease) in a 9-year-old Nigerian child

Fahr’s disease is a rare neurodegenerative disorder characterized by deposition of calcium on the walls of blood vessels of the Basal ganglia and Dentate nuclei of the Cerebellum. Patient can present with diverse array of symptoms including but not limited to seizure, extrapyramidal symptoms and mental retardation. We report a case of a 9-year-old female child with history of recurrent seizure. Brain CT showed symmetrical calcification in the basal ganglia

Management of severe tetanus using magnesium sulfate – The experience in a tertiary health institution in Southern Nigeria

Tetanus is a vaccine-preventable disease caused by the neurotoxin of Clostridium tetani: A motile, Gram-positive, sporeforming obligate anaerobe commonly found in the soil, dust, and alimentary canals of various animals. It remains a public health challenge in the developing countries as the morbidity and mortality rates remain high unlike in the developed world where the incidence is markedly low and no longer contributory to significant mortality. We report two male adolescents admitted in the pediatric department of a tertiary medical center of Nigeria for severe tetanus following an open injury to the limbs. Due to poor response to initial management with the combination of chlorpromazine, phenobarbitone, and diazepam, the latter was replaced with continuous infusion of magnesium sulfate after a loading dose was administered. Both the patients recovered without any prevailing complications and were discharged after 26 and 50 days of hospitalization, respectively, after receiving tetanus toxoid and were subsequently followed up. Successful severe tetanus management without the use of sophisticated medical gadgets and expensive treatment in a resource-poor economy is achievable as demonstrated by our study with the use of magnesium sulfate infusion

Prune-Belly syndrome in 2 cases seen in a tertiary medical institution Southeast Nigeria – A case report

Prune-Belly syndrome is a rare congenital disorder, and in underdeveloped and developing countries, the outcome is not well known as only a few isolated cases have been reported. A review of 2 male neonates admitted and managed for Prune-Belly syndrome in the neonatal unit of the Pediatric Department of the Federal Teaching Hospital of Nigeria. This appears to be the very first of such cases to be seen at this hospital. Both babies were delivered outside this tertiary institution and eventually referred here for proper diagnosis and management. Two male neonates aged 2 and 3 days, respectively, were admitted in the same month with a common history of maternal febrile history, poor cry on delivery, and oligohydramnios in one of them. Clinical examination showed scaphoid, lax, and wrinkled abdomen with visible peristalsis and flank fullness, ballotable kidneys, distended bladder, well-formed phallus, small scrotum, and absent testes. There were also musculoskeletal abnormalities ranging from lower limb dysgenesis to clubbing of the feet. Prune-Belly syndrome presents with a spectrum of features which present an overwhelming challenge to both the parents and the managing physician, especially in most resource-poor countries

Proteinuria and haematuria in apparently healthy primary school children in Enugu, Nigeria

Background: Mass screening for proteinuria and haematuria is advocated, especially in resource-poor countries with non-existent health insurance policy, to enhance awareness of renal diseases. This screening increases the chance for early detection and treatment, which in turn reduces incidences of resultant kidney failures. Objective: To determine the prevalence of asymptomatic proteinuria and haematuria in apparently healthy primary school children in Enugu. Methodology: This was a cross-sectional descriptive survey involving apparently healthy primary school children in Enugu, aged 6 to 12 years, conducted from January 2018 and March 2018 through a pre-tested, caregiver administered questionnaire. Subjects were clinically examined, and samples of on-the-spot mid-stream urine collected from each participant for dipstick urinalysis. The data obtained were analyzed using the Software Package for Social Science (SPSS) version 22 for Windows Results: One thousandchildren comprising, 437 (44%) males and 563 (56%) females were selected with an age range of 6 to 12 years and a mean of 10.13 ± 1.81 years. A total of 190(19%) urinary abnormalities were noted existing as isolated proteinuria, isolated haematuria or as a combination of both. These urinary abnormalities were more in the females, higher among the early adolescents (9-12 years) with proteinuria predominating.Conclusion: Asymptomatic urinary abnormalities can easily be detected early in the course of renal disease development. A urine dipstick is an important tool in the screening program for everybody, including children of school age. It is important that screening programs be organized for these children at regular intervals and those with positive findings referred immediately for appropriate management. Keywords: Proteinuria, Haematuria, Primary school children, Prevalence. Running title: Proteinuria and haematuria in school-aged children in Enugu

The effectiveness of locally-prepared peritoneal dialysate in the management of children with acute kidney injury in a south-east Nigerian tertiary hospital

Background: Peritoneal dialysis (PD) is the preferred mode of renal replacement therapy (RRT) in children with acute kidney injury (AKI). The gold standard remains the use of commercially-prepared PD fluid. In resource-poor nations, its availability and affordability remain a challenge.Aim: This study aims to report the effectiveness of locally-prepared PD fluid in the management of AKI in a south-east Nigerian tertiary hospital.Subjects and Methods: This was a retrospective study conducted at the paediatric ward of the University of Nigeria Teaching hospital, Enugu. The case records of 36 children seen over three years, diagnosed with AKI and requiring PD were reviewed. The retrieved information comprised biodata, aetiology of AKI, indications for PD, pre-and post-dialysis estimated glomerular filtration rate (eGFR) and patient outcomes.Results: The children (20 males and 16 females) were aged 3 to 36 months with a mean age of 9.92 ± 6.29 months. The common aetiologies of AKI were septicemia (30.6%), hemolytic uremic syndrome (19.4%), and toxic nephropathy (16.7%). The frequent indications for PD were uremic encephalopathy (58.3%) and severe metabolic acidosis (38.8%). The pre-and post-dialysis mean urine flow rate was 0.16 + 0.13 and 2.77 + 0.56 ml/kg/hour respectively. The eGFR before PD, at discontinuation, and a week later was 6.06 + 2.87, 24.44 + 15.71 and 59.07 + 22.22 mls/min/1.73m2 respectively.Conclusion: PD with locally-prepared dialysate is safe, effective and a life-saving alternative in the management of AKI in childrenKeywords: Peritoneal dialysis; renal replacement therapy; acute kidney injury; children; dialysate; developing country

The Civilian Vascular Trauma in a Low‑Income Country: The Determinant Factors of Morbidity and Mortality

Background: Civilian vascular injury is relatively common in the West African subregion, but it is highly underreported. Aim/Objective: The aim of the study was to evaluate the patients managed for civilian vascular surgeries and to determine the factors causing morbidity and mortality in low‑income countries. Materials and Methods: This is a retrospective study spanning a period of 13 years (2007–2019) of civilian vascular injuries managed in a tertiary hospital in a low‑income country. We obtained data from our hospital record department. Data obtained and analyzed were demography, etiology, vessels affected, pattern of presentation, stratification, and treatment. Results: Within the envisaged period, 58 patients were affected in civilian vascular trauma with a mean of 4.5 cases per year. The male‑to‑female  ratio was 0.9:0.1. The age range of patients affected was from 0–10 to 71–80, with the age group of 21–30 years being the most affected. Male was more affected (87.9%). Motor vehicle crashes were the most common etiology agent (42.0%). The femoral artery was the most commonly injured vessel (31.3%). In the pattern of presentation, bleeding with shock was dominant (49.8%). Lateral tarsorrhaphy accounted for the major vascular  treatment interventions (30.2%). Conclusion: The outcome was very variable and depended on warm ischemic time, type and/or mechanism of injury, collateral blood supply at the site of injury, and comorbidity. Keywords: Amputation, civilian, injury, vascular, warm ischemic tim