Deliberate self-harm resulting in gastric outlet obstruction; a case report

No Abstract. Nigerian Medical Practitioner Vol. 49(3) 2006: 56-5

Femoral hernias in children at the Olabisi Onabanjo University teaching Hospital, Sagamu, Nigeria

Objective: To ascertain the diagnostic accuracy and outcome of surgical treatment in Nigerian children referred for paediatric surgical opinion at the Olabisi Onabanjo University Teaching Hospital, Sagamu, South-west Nigeria. Design: A retrospective review of our practice experience over a 15-year period; between January, 1989 and December, 2003. Setting: The Olabisi Onabanjo University Teaching Hospital (OOUTH), serves as a referral centre for other government and private hospitals in and around the Ogun State, South-west Nigeria. The OOUTH, though a tertiary medical centre also receives patients who present directly at the General Out-Patient Clinics and the Emergency Units of the hospital. The catchment population is estimated at 7.5 million. Subjects: The medical records of all patients under 14 years of age with a final diagnosis of femoral hernia who presented between January, 1989 and December, 2003 were reviewed. Methods: The age, sex, mode of presentation, findings at surgery, procedure performed, immediate post-operative and 12 months follow-up details were recorded. Results: Seven of 1,213 (0.58%) patients with groin hernias within the study period had femoral hernias; four (57%) were girls and three (43%) were boys. Age range was 3 to 9 years. The mode of presentation in all the children was recurrent lump in the groin. Five patients (71%) had right sided lump while the lump was on the left side in two of the patients. The duration of symptoms ranged from two years to eight years. The provisional diagnosis by the referring general practitioners and paediatricians were incorrect in all seven patients. Five patients (71%) were correctly diagnosed preoperatively by the attending surgeon while two were thought to be inguinal hernias. Conclusion: The diagnosis of femoral hernia remains a challenging problem in childhood because of its rarity and similar clinical presentation as inguinal hernia. East African Medical Journal Vol.81(9) 2004: 447-44

Kawasaki Disease in A Nigerian Child- a case report

We report a three year old child who appeared to have a drug-induced muco-cutaneous hypersensitivity reaction during treatment for a febrile illness, but eventually manifested all the diagnostic criteria for Kawasaki Disease (KD) while on admission. Although an initial diagnosis of Steven-Johnson's Syndrome was made, the emerging clinical features, presence of thrombocytosis, low plasma proteins and high ESR, prompted a change of diagnosis to Kawasaki Disease. She received bed rest and steroid therapy due to the absence of Intravenous ImmunoglobulinGand our reluctance to use aspirin. Although she did not manifest any echocardiographic cardiac features while on admission, a verbal autopsy report of her sudden death two days after discharge against medical advice, suggested possible cardiac involvement. In view of the high mortality risk asscociated with non-institution or delay of definitive treatment, it is important to add KD to the list of differential diagnoses in febrile children with muco-cutaneous lesions. Key words; Atypical measles, Kawasaki Disease, Nigeria, Verbal Autops

Clinical Profiles of Newborns with Malaria Parasitaemia in Sagamu

Congenital malaria parasitaemia, a consequence of transmission of parasites from mother to foetus during pregnancy or delivery, is not uncommon amongst newborns in malaria endemic areas. Its clinical significance is often unclear however, as some researchers report an absence of symptoms in the majority of cases, whilst others report features that are indistinguishable from those of neonatal sepsis. This article describes our observations of a cohort of parasitaemic neonates during a prospective study of congenital malaria in Olabisi Onabanjo University Teaching Hospital, Sagamu. To describe the clinical profiles of newborns with congenital malaria parasitaemia. Screening of a consecutive sample of live newborns (aged 0-3 days) delivered at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, for malaria parasitaemia by microscopic examination of stained blood films. Data analysis was done with Epi-info version 6 software, and level of significance set at 0.05), and mortality rate amongst symptomatic parasitaemic babies (1/3) was correspondingly higher than that of their asymptomatic counterparts (1/18). Despite the high prevalence of congenitalmalaria parasitaemia in newborns in this study, majority of the subjects were asymptomatic, and the incidence of clinical manifestations of illness was low. Long term follow up studies with a larger population of newborns are required to determine the clinical and public health significance of congenital malaria parasitaemia in endemic areas.Key words: neonates, congenital, malaria, Nigeri

Diagnosing congenital malaria in a high-transmission setting: clinical relevance and usefulness of P. falciparum HRP2-based testing

Congenital malaria diagnosis is challenging due to frequently observed low parasite density infections, while their clinical relevance during early infancy is not well characterized. In Nanoro health district (Burkina Faso), we determined the prevalence of congenital malaria by real-time quantitative PCR and we assessed the performance of rapid diagnosis test (RDT) and light microscopy (LM) to detect Plasmodium falciparum infections in cord-blood samples. In addition, we examined the usefulness of P. falciparum Histidine Rich Protein2 (PfHRP2) as surrogate biomarker of infection and explored association between congenital malaria and clinical outcomes. A prevalence of congenital malaria by qPCR of 4% (16/400) was found, which increased to 10% among newborns from mothers infected at delivery. RDT and LM showed poor performances indicating limited utility for congenital malaria screening in cord blood. Because PfHRP2 detection in cord blood could be affected by transplacental passage of parasite antigens, PfHRP2 might not be used as a surrogate biomarker of congenital malaria infections. There was no evidence of a significant clinical impact of congenital malaria on infant's health from birth to 59 days of life. Case control studies including long-term follow up may provide additional understanding on the relevance of neonatal malaria infection