A Review of the Literature on Childhood Burkitt Lymphoma in Nigeria

Background: Burkitt Lymphoma is common childhood tumour in sub Saharan Africa but the lack of centralized database on childhood cancer in Nigeria has made it difficult having a nationwide picture of its occurrence in the country.Objectives: This study was aimed at pooling published data from across the country with the hope of providing an overview of the profile of the disease in Nigeria.Methods: literature search was carried out on Pub Med/MEDLINE and Cochrane databases for all articles published between January 1975 and July 2015 using search strings such as children; cancer; Burkitt's; epidemiology; prevalence; treatment and Nigeria. Based on specific criteria; 39 studies were included.Results: Burkitt Lymphoma was the most common childhood malignancy in most parts of the country accounting for 18.3- 65.0% of malignant tumours but a few centers observed Retinoblas-toma as the most common. There was a decline in the frequency of Burkitt lymphoma in Ibadan from 1960-2010 and in Lagos. Peak ages of occurrence ranged from 5- 10 years; more males and children from low socio-economic classes were affected. Different centers reported predominant involvement of either the jaw or the abdomen but there were slightly more centers with predominance of the jaw. Retrospective studies yielded an estimated survival of 15-23% while the Event Free Survival probabilities at two years was 43% and 48% for the Nigerian centers that participated in an international study.Conclusion: Burkitt Lymphoma is a common tumour in Nigeria. Establishment of Cancer registries for better data capture and funding for better treatment outcomes is recommended

Challenges of Malaria Diagnosis in Paediatric Patients at a Nigerian Hospital.

Aims: This study compares the performance of routine malaria diagnostic tests, and explores the challenges of malaria diagnosis in paediatric patients in an endemic setting in South West Nigeria. Study Design: Cross sectional study Place and Duration of the Study: The study was conducted at the children’s outpatient and emergency units of the University College Hospital, Ibadan, Nigeria. Patients seen between May and August, 2013 were enrolled in the study. Methodology: The records of all 532 children aged six months to12 years who received treatment for an acute febrile illness at the hospital during the study period were reviewed. The proportion of children classified as having malaria by clinical diagnosis, Rapid Diagnostic Test (RDT) and blood smear microscopy were compared. Factors associated with test positivity were explored using multivariate analysis. Results: By clinical diagnosis 45.2% of children were diagnosed as having malaria, 37.6% tested positive to malaria parasite on RDT and 19.3% had positive blood smears on microscopy. Logistic regression showed that with RDTs, younger children were less often found to be positive than older children [OR: 0.594 (0.401-0.879)]. A similar lower probability of positivity was found for younger children on microscopy [OR0.624 (0.391-0.996)]. Positive smears were however recorded 3.9 times more often for those who gave a history of fever compared to those who did not [OR: 3.882 (1.154- 13.057)]. Conclusion: The true malaria morbidity among these paediatric patients remains questionable due to the differences in the results produced by the different diagnostic methods. The clinical implication of RDT-positive but microscopy-negative samples may be grave if microscopy results are erroneous. Quality control systems and surveillance of routine malaria diagnostics are imperative to limit misdiagnosis of malaria in this endemic setting.

Epidemic management: a Caribbean university's response to the 2009 H1N1 outbreak / Manejo de las epidemias: una respuesta de la universidad del Caribe al brote de H1N1 de 2009

BACKGROUND: In June 2009, the World Health Organization (WHO) declared a global influenza pandemic (1). During the throes of the epidemic, the Caribbean region recorded 22 deaths and 350 hospitalizations. Jamaica reported most of the deaths in the region - 7, followed by Trinidad and Tobago -5 and Barbados - 3; the remaining 7 deaths occurred in other Caribbean countries (2). In June, Jamaica reported its first case (3) and some three months later, in September 2009, The University of the West Indies (UWI) Mona Campus experienced an outbreak of the 2009 H1N1 virus infection. As one of the three main Campuses of the leading tertiary institution in the English-speaking Caribbean (others being in Trinidad and Tobago and Barbados in addition to an 'Open Campus'which serves the non-Campus territories), the UWI Mona Campus serves some 15 000 students. These students originate mainly from the Caribbean; North American and African students also comprise the student population. The University Health Centre provides primary care services to a community of students, staff (3000) and their dependents, retirees, visiting staff and students.

Antecedentes: En junio de 2009, la Organización Mundial de la Salud (OMS) declaró una pandemia mundial de gripe (1). Durante la agonía de la epidemia, la región del Caribe registró 22 muertes y 350 hospitalizaciones. Jamaica reportó la mayor parte de las muertes en la región, 7, seguida de 5 en Trinidad y Tobago y 3 en Barbados; las restantes 7 muertes ocurrieron en otros países del Caribe (2). En junio, Jamaica reportó su primer caso (3) y unos tres meses más tarde, en septiembre de 2009, la Universidad de West Indies (UWI) Mona Campus experimentó un brote del virus H1N1 de 2009. Como uno de los tres campus principales de la principal institución terciaria en el Caribe de habla inglesa (los otros dos en Trinidad y Tobago por un lado, y Barbados por otro, además de un 'Campus abierto', que sirve a los territorios sin campus), el campus de Mona, en UWI, presta servicio a unos 15000 estudiantes. Estos proceden principalmente de la región del Caribe; Estudiantes norteamericanos y africanos comprenden también la población estudiantil. El Centro de Salud de la Universidad brinda servicios de atención primaria a la comunidad de estudiantes residentes, al personal (3000) y sus dependientes, jubilados, así como al personal y los estudiantes de visita.

Service uptake and performance of the prevention of mother-to-child transmission (PMTCT) programme in Ibadan, Nigeria

The Prevention of Mother to Child Transmission (PMTCT) programme in the University College Hospital (UCH); Ibadan has been in existence for more than five years and has scaled up to other sites. The study evaluated the service uptake and performance of the programme using national key indicators. Antenatal and delivery records of women enrolled between July 2002 and June 2007 were reviewed. A total of 51952 women attended first antenatal visits and received HIV pre-test counselling. Of these; 51614 (99.5) accepted HIV test and 49134 (95.2) returned for their results. Out of the tested patients; 2152 (4.2) were identified to be HIV positive. Partners of positive patients accepting HIV testing were 361(16.7) with 87 (18.6) testing positive. There were a total of 942 deliveries out of which 39.2of the mothers and 95.2of the babies respectively received ARV prophylaxis. In all; 85.8(788/918) of the mothers opted for formula as the method of infant feeding. Out of the 303 babies eligible for ELISA testing; 68.3reported for the test and 17(8.7) tested positive. There has been progress in the programme; reflected in the increase in the number of new clients accessing the PMTCT service. However; partner testing and follow up of mother-infant pairs remain formidable challenges that deserve special attention

Mortality in Patients Treated for Tuberculous Pericarditis in Sub-Saharan Africa

Objective: To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa. Design: Between 1 March 2004 and 31 October 2004; we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon; Nigeria; and South Africa; and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study; with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression; we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up. Results: We obtained the vital status of 174 (94) patients (median age 33; range 14-87 years). The overall mortality rate was 26. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40versus 17; P=0.001). Independent predictors of death during follow-up were: (1) a proven non-tuberculosis final diagnosis (hazard ratio [HR] 5.35; 95confidence interval 1.76 to 16.25); (2) the presence of clinical signs of HIV infection (HR 2.28; 1.14-4.56); (3) co-existent pulmonary tuberculosis (HR 2.33; 1.20-4.54); and (4) older age (HR 1.02; 1.01-1.05). There was also a trend towards an increase in death rate in patients with haemodynamic instability (HR 1.80; 0.90-3.58) and a decrease in those who underwent pericardiocentesis (HR 0.34; 0.10-1.19). Conclusion : A presumptive diagnosis of tuberculous pericarditis is associated with a high mortality in sub-Saharan Africans. Attention to rapid aetiological diagnosis of pericardial effusion and treatment of concomitant HIV infection may reduce the high mortality associated with the disease

"Minimal intervention management" for gastroschisis: a preliminary report / "Tratamiento de Intervención Mínima" para la Gastroquisis Un Informe Preliminar

The replacement of eviscerated bowel, without anaesthesia, has been performed safely in stable neonates with gastroschisis. This technique, termed [quot ]minimal intervention management[quot ], was used in three infants treated at the Newborn Special Care Nursery of the University Hospital of the West Indies. Two infants had excellent results but one had bowel perforation during the procedure, necessitating conversion to formal laparotomy under general anaesthesia. In selected patients, advantages of this technique include the ability to be guided by patient response during the procedure in order to avoid excessive intra-abdominal tension, the avoidance of anaesthesia and minimal cost. This technique is proposed for wider use in developing countries

El reemplazo del intestino eviscerado, sin anestesia, se ha realizado de manera segura en neonatos estables con gastroquisis. Esta técnica, denominada "tratamiento de intervención mínima", se usó en tres infantes tratados en la Guardería de Cuidados Especiales del Recién Nacido en el Hospital Universitario de West Indies. Los resultados fueron excelentes en dos de los infantes, pero el tercero tuvo una perforación intestinal durante el procedimiento, por lo cual se hizo necesaria la conversión a la laparotomía formal bajo anestesia general. En pacientes seleccionados, esta técnica incluye entre sus ventajas la posibilidad de ser guiada por la respuesta del paciente durante el procedimiento, para prevenir así una tensión intra-abdominal excesiva, evitar la anestesia, y asegurar un costo mínimo. Se propone que el uso de esta técnica se haga extensivo en los países en vías de desarrollo.

Oesophageal foreign bodies at the University Hospital of the West Indies / Cuerpos extraños esofágicos en el Hospital Universitario de West Indies

A retrospective study was conducted of 97 patients with oesophageal foreign bodies (EFB). The patients were admitted to assess characteristics of EFB, modes of presentation and radiological and endoscopic findings. The patients were from the University Hospital of the West Indies and most (42) were over the fourth decade of life. The commonest EFB were bones. A negative radiological finding was not a reliable means to select patients for endoscopy. Oesophagoscopy is a reliable method in the treatment of EFB impaction. There were no major complications or deaths

Se realizó un estudio retrospectivo a 97 pacientes con cuerpos extraños esofágicos (CEE). Los pacientes fueron ingresados para evaluar las características de los CEE, los modos de presentación, así como los hallazgos radiológicos y endoscópicos. Los pacientes provenían del Hospital Universitario de West Indies, y la mayoría (42%) sobrepasaba la cuarta década de vida. Los CEE más comunes eran huesos. Un hallazgo radiológico negativo no era un medio fiable para seleccionar los pacientes para endoscopia. La esofagoscopia es un método fiable en el tratamiento de impacción de CEE. No hubo complicaciones mayores ni muertes.

Newborn circumcision using the Plastibell device: an audit of practice

Circumcision of newborn male infants is widely practiced but controversial. Our experience gained circumcising 205 Jamaican neonates, using the Plastibell device is presented. Circumcisions, were requested by parents usually for hygienic reasons, and were brief outpatient procedures. Subcutaneous penile ring block with 1 lidocaine provided the most effective form of procedural analgesia. Bell separation usually occurred within 10 days of the procedure. Cosmetic results met with unanimous parental acceptance. Minor complications occurred in 2.4 of circumcisions. Physicians circumcising newborns must be readily accessible post procedure to address parental concerns and allay anxiety

Chronic relapsing pancreatitis in a child: use of the puestow procedure to achieve ductal drainage

A case of chronic relapsing pancreatitis presenting in an 8-year old African Jamaican girl is outlined. Aggressive supportive management failed to control pain and vomitting. The Puestow Procedure effectively aborted these symptoms. The use of the Puestow procedure should not be inordinately delayed in chronic relapsing pancreatitis if symptoms persist, since it may not only control pain but also halt declining pancreatic function.