Profile and management of central nervous system malformations in a tertiary hospital

Background: Central Nervous System (CNS) malformations rank among the commonest malformations. These may be identified in utero or noticed immediately after birth. Most studies showed Myelomeningocoele, a Neural Tube Defect (NTD) to be the commonest. Severe defects have a significant impact on long term disability. While some are preventable, most are surgically managed. Objective: To study the profile and management of CNS malformation in a tertiary hospital. Method: we undertook a 3-year retrospective study of the profile and surgical management, including the postoperative complications among Neonates admitted into the Special Care Baby Unit (SCBU). Data on place of delivery, Gender, Gestational age, Mode of delivery, Prenatal Diagnosis (Ultrasound Scan), types of malformations, types of surgeries, and postoperative complications were retrieved. Result: We found 71 patients with CNS anomalies (31.8% of all congenital anomalies), in delivery 10 (14.1%), out delivery 46(64.8%). Male=43, females=28. Term gestation 66 (93%), preterm 3(4.2%), post-term 2(2.8%). Delivered by Vagina (SVD) in 65(91.6%), Caesarean section 4(5.6%), and undocumented in 4(5.6%). Prenatal diagnosis in only 3(4.2%). Myelomeningocoele was 35(49.3%), meningocoele was 9(12.7%), Hydrocephalus was 18(25.3%), anencephaly was 1(1.4%), occipital Encephalocoele was 6(8.5%), Sincipital Encephalocoele was 2(2.8%). Operated on 53(75%), LAMA/lost to follow was 13(18%), preoperative death was 5(7%). Excision and closure of Neural Tube Defect were 34(64.2%), VP Shunt was 13(24.5%), Excision and closure of occipital Encephalocoele were 5(9.4%) craniofacial excision and repair of Sincipital Encephalocoele was 1(1.9%). CSF leak in 4(28.6%), wound infection in 3(21.4%), shunt infection and obstruction in 2(14.3%) each. meningitis, hypertrophied scar, and pseudo meningocoele in 1(7.1%) each. Conclusion: The commonest CNS anomaly is a Myelomeningocoele a preventable condition, Sincipital Encephalocoele is not common in our environment. Concomitant treatment of hydrocephalus averts post excision CSF Leak

Prevalence and outcome of hypoglycemia in children attending emergency pediatric unit of a specialist hospital in Nigeria

Background: Hypoglycemia is a common metabolic problem encountered in pediatric emergency admissions. The absence of clinical symptoms does not preclude the presence of hypoglycemia as presentation may vary from asymptomatic to central nervous system and cardiopulmonary disturbances. If untreated, hypoglycemia can result in permanent neurological damage or even death. Objectives: The objective of the study is to determine the prevalence, associated factors and outcome of hypoglycemia in pediatric emergency admissions at Ahmad Sani Yariman Bakura Specialist Hospital, Gusau, Nigeria. Materials and Methods: The study was a prospective cross­sectional study involving children aged 1 month­13 years. Blood glucose was determined at admission using Accu­Chek® Active Blood Glucose Meter, and hypoglycemia was defined as blood glucose levels <2.8 mmol/L (<50 mg/dL). Age of the patients, sex, interval of last meal, presenting complaints diagnoses were recorded. Results: A total of 154 children were studied.Thirty (19.5%) were infants and 71 (46.1%) were under­fives. Eighty­seven (56.5%) were males with male to female ratio of 1.3:1.The prevalence of hypoglycemia was 22.1%. The predominant disease conditions the children with hypoglycemia presented with were severe malaria, acute diarrheal disease, and sepsis. The prevalence of hypoglycemia was significantly higher among children whose last meal was 8 h and above before presentation (42.9%). Children who presented with hypoglycemia were significantly more likely to die (odds ratio [OR] =13.3; 95% confidence interval [CI] =4.6­38.7). Among those with hypoglycemia, males were significantly more likely to die (OR = 4.2, 95% CI = 1.0­18.0). Hypoglycemia was significantly associated with mortality in children with severe malaria and pneumonia (P = 0.04 and 0.01, respectively). Conclusion: The prevalence of hypoglycemia is still high in our emergency admissions. It is associated with significant mortality especially among male children and those presenting with severe malaria and pneumonia. We recommend that hypoglycemia sought for and promptly treated in children presenting to emergency to reduce mortality

Neuropathie peripherique revelatrice d'un poems syndrome : a propos d'un cas

Nous rapportons un cas de POEMS syndrome revele par une neuropathie peripherique; chez une femme de 51 ans francaise; vivant en Cote D'ivoire. Cette etude est une contribution a l'etude de ce syndrome rare et mal connu en Afrique Noire particulierement. Notre observation est un cas typique de poems qui reunit tous les criteres cliniques; paracliniques; therapeutiques et evolutifs decrits dans la litterature. Tous les 5 signes cardiaux qui rentrent dans sa definition ont ete observes: Polyradiculoneuropathie ;Organomegalie ; Endocrinopathie; proteine Monoclonale et Signes cutanes. On a releve egalement la presence d'autres signes comme l'anasarque; l'HTAP; qui traduisaient la gravite du syndrome. L'EMG etait en faveur d'une PRN chronique; avec une baisse des vitesses de conduction motrice et sensitive et une participation axonale. Les radiographies osseuses montraient des lesions osteocondensantes; compatibles avec un plasmocytome. Les corticoides se sont reveles inefficaces et devant l'aggravation du tableau clinique la patiente a beneficie d'une autogreffe de cellules souches hematopoietiques. Le pronostic parait sombre. Cette observation pose les problemes du diagnostic et de la prise en charge du POEMS en Afrique

Etude epidemiologique; clinique; biologique et radiologique des infections opportunistes a localisation neuromeningee chez l'enfant VIH positif en milieu hospitalier : a propos de 6 cas observes au CHu de Yopougon

Nous avons effectue une etude retrospective portant sur 6 (six) dossiers de malades hospitalises pour infection opportuniste du SNC diagnostiquee dans le service de Pediatrie Medicale du CHU de Yopougon de juin 1995 a juin 2002.*Sur le plan epidemiologique; les enfants etaient ages de 3 a 15 ans. La tranche d'age la plus touchee etait celle comprise entre 10 et 15 ans (3/6 soit 50pour cent) et 2/6 soit 33pour cent de nos patients avaient moins de 5 ans.La transmission materno-foetale etait le mode de contamination le plus frequemment rencontre chez nos patients. L'association des signes majeurs et les signes mineurs de Bangui ont ete retrouves dans les antecedents de tous nos patients.* Sur le plan clinique; les signes cliniques de l'infection VIH etaient retrouves chez tous nos patients avec une predominance de la fievre au long cours; de l'amaigrissement et la candidose oropharyngee representes chez 83pour cent (5/6) de nos patients suivis des signes d'infection pulmonaire (4/6 soit 66pour cent) et des lymphadenopathies (2/6 soit 33pour cent).Les signes neuromeninges tels le coma; le deficit moteur; les convulsions etaient les signes les plus frequemment rencontres (3/6 soit 50pour cent de nos patients); suivis de la raideur de la nuque; la baisse de l'acuite visuelle et le syndrome d'hypertension intracranienne representes a 33pour cent.Les difficultes diagnostiques etaient liees a la non specificite des signes cliniques.* Sur le plan biologique; 5/6 soit 83pour cent de nos patients avaient comme type de virus le VIH1 (serotype predominant en Cote d'Ivoire) et 16 pour cent avaient le VIH1 et 2Chez 2/6 (33pour cent) de nos patients qui ont pu avoir un dosage des CD4 et de la charge virale; le deficit immunitaire etait severe (6pour cent et 10;4pour cent). Tandis que la charge virale etait elevee (1.075.217 copies/ml et 279.932 copies/ml). Ce deficit immunitaire severe a favorise l'apparition des infections opportunistes du SNC.*Sur le plan radiologique; les images tomodensitometriques revelaient des hypodensites chez la majorite de nos patients (4/6 soit 66pour cent) suivies de l'atrophie cortico-sous-corticale (3/6 soit 50pour cent de nos patients) et enfin des processus expansif (meningiome et tuberculome) chez 2/6 soit 33pour cent des patients. Les caracteres non specifiques de ces manifestations sont a l'origine des difficultes de diagnostic de ces infections opportunistes.* Sur le plan des etiologies; les differentes investigations ont permis de retenir trois groupes etiologiques: la toxoplasmose etait l'etiologie predominante (3/6 soit 50pour cent de nos patients); la tuberculose (3/6 soit 50pour cent des patients); suivies de la cryptococcose neuromeningee (1/6 soit 16pour cent des patients).*L'evolution chez tous nos patients a ete fatale a plus ou moins long terme