Burden, clinical manifestation and outcome of severe malaria in children at a tertiary hospital in Northeast, Nigeria

Background: Severe malaria is a life-threatening medical emergency and requires prompt and effective treatment to prevent death. The presentation of severe malaria varies depending on such factors as country, age, immunity, socioeconomic factors, drug resistance and type of intervention measures used. The aim of this study is to document the burden and forms of severe malaria in children in this region. Objective of this study was to determine the prevalence, clinical manifestation and outcome of children with severe malaria in Federal Teaching Hospital, GombeMethods: Case notes of patients admitted to the emergency Paediatric Unit and paediatric medical ward of Federal Teaching Hospital, Gombe with severe malaria from January 2014 to December 2018 (5years) were reviewed.  Information sought included age, gender, use of ITN, parents’ education and occupation, criteria for diagnosis, treatment and outcome.Results: A total of 2,808 children were admitted during the period of study, out of these 237 (8.4%) had severe malaria. There were 140 (59.1%) male and 97 (40.9%) female with M: F of 1.4:1. Majority 129 (54.4%) of patients were aged more than 5 years. The most frequent modes of presentation were multiple convulsions 124 (52.3%), cerebral malaria 97 (40.9%) and severe anaemia 61 (25.7%). Some 45 (19.0%) of the subjects presented with multiple diagnostic criteria. Multiple convulsions, cerebral malaria and severe anaemia were significantly related to likelihood of mortality.Conclusions: The prevalence of severe malaria is high and multiple convulsions, cerebral malaria and severe anaemia are significantly associated with risk of mortality.

Nonsyndromic Aplasia Cutis Congenita: a Case Report.

Nonsyndromic aplasia cutis congenita is a condition in which babies are born with localized areas of missing skin. These areas resemble ulcers or open wounds, although they are sometimes already healed at birth. Lesions most commonly occur on the top of the head (skull vertex). In some cases, the bone and other tissues under the skin defect are also underdeveloped. If the baby is born by cesarean section, then the patient's attendants recognize the wound as an injury which might be performed by the surgeon at the time of cesarean section. We are reporting this type of a case whose father attempted to take legal procedure against the surgeon, but finally he understood that this was a congenital disease of his baby.

Effect of renal sympathetic denervation used in the treatment of resistant arterial hypertension on left ventricular hypertrophy and diastolic function

Background: Hypertension [HTN] results in structural and functional cardiac changes which increase cardiovascular morbidity and mortality. The effect of renal denervation [RD] on left ventricular hypertrophy [LVH] and left ventricular [LV] diastolic function is still unclear

Objective: This study investigated the effect of catheter-based renal sympathetic denervation on LVH and diastolic function in patients with resistant hypertension

Methods: We evaluated systolic and diastolic blood pressure [SBP and DBP, LV size, mass and diastolic function before and 6 months after RD in 68 patients with resistant hypertension by transthoracic echocardiography and Doppler

Results: SBP and DBP reduced 6 months after RD [-22 +/- 3 mmHg and -10 +/- 12mmHg; P<0.0001 respectively] LV mass index decreased similarly independent on BP response [-19.37 +/- 2.6 gm/m[2]: P<0.0001]. Diastolic parameters E/A ratio, E-wave deceleration time and intra-ventricular relaxation time improved similarly in all patients after 6 months [0.89 +/- 0.04; P=0.001, -24.85 +/- 8.93 ms; P=0.007 and -6.97 +/- 2.57 ms; P=0.012 respectively]

Conclusion: In patients with resistant hypertension and beside blood pressure lowering effect, renal denervation improves left ventricular hypertrophy and diastolic function. The relation of BP reduction effect and the improvement of cardiac hypertrophy and systolic function suggests a direct effect of sympathetic activity on LV remodeling and function which needs to be confirmed in larger prospective cohorts

Result of Simultaneous Correction of Alar Deformity with Primary Repair of Unilateral Cleft Lip.

Cleft lip and cleft palate has been a recognized congenital malformation from a very early stage in recorded history. The infant born with an orofacial deformity, which leads to develop an unwilling psychosocial problem among the parents and also among the relatives. Successful treatment of cleft is based on overcoming in tissue shortage and repositioning of the tissues in normal anatomical pattern so that it restores both appearance and function. Various modalities of theme, works, observations and involvement of multidisciplinary approaches were tried to achieve better cosmetic, aesthetic and functional aspect in management of cleft face. Poorly performed primary surgery carries a high risk of iatrogenic disturbances of subsequent orofacial growth. Delayed nasal repair in patient with cleft lip did not produce satisfactory aesthetic and functioning result. Aim & objective of the study is to achieve a cosmetically well-accepted face in respect to lip, philtrum and nose of both sides after cleft lip surgery and to reduce the incidence of secondary correction of deformed nose in a patient with cleft lip. In our study total 86 cases are studied according to preformed inclusion and exclusion criteria. Simultaneous correction of alar cartilage deformity at the time of primary repair of cleft lip may lessen the staged operative procedure and markedly reduce the economic burden to the family.

Left Atrial Myxoma in a Child: An Uncommon Presentation of a Rare Tumour in Early Age.

Myxomas are rare tumours but are the most common benign tumours of the heart. They can arise from any heart chamber. However, they arise more frequently from the left atrium. They have rarely been described as originating in early age. A case of left atrial myxoma successfully removed using cardiopulmonary bypass in a 8-year-old child is presented. Review of the literature emphasizes the rarity and clinically aggressive behavior of this tumor in this age group. The object of this case report is to present myxoma in children and to evaluate possible differences between young and adult patients.

Left Atrial Myxoma in a Child: An Uncommon Presentation of a Rare Tumour in Early Age.

Myxomas are rare tumours but are the most common benign tumours of the heart. They can arise from any heart chamber. However, they arise more frequently from the left atrium. They have rarely been described as originating in early age. A case of left atrial myxoma successfully removed using cardiopulmonary bypass in a 8-year-old child is presented. Review of the literature emphasizes the rarity and clinically aggressive behavior of this tumor in this age group. The object of this case report is to present myxoma in children and to evaluate possible differences between young and adult patients.

Socioeconomic and environmental factors affecting malaria infection in Fayoum Governorate, Egypt

Malaria as a disease has been identified in Egypt since ancient times. Remnant residual foci are still localized in two districts; Sinnuris and Faiyoum, Faiyoum Governorate. The work focused on socioeconomic and environmental factors affecting malaria infection. The results showed that malaria infection increase with the decrease of socioeconomic level of families, educational level of examined individuals and among unemployed or students. The infection increase among those lived in muddy or bad constructed house near the breeding places. The infection decreased significantly among who owned animal sheds and had large number of animals. The indoors use of 5% mala-thion did not affect the malaria infection

Malariometric parasitological survey in EI-Fayoum governorate, Egypt

Egypt represents the only focus in the Mediterranean region where Plasmodium falciparum transmission still occurs. A total number of 9065 individuals of different ages of both sexes were examined. 7236 [79.82%] individuals examined during [MBE] i.e. house-to-house visit; 1184 [13.06%] individuals examined by [PCD] i.e passive case detection; and 645 [7.12%] individuals represented [NOD]. The total number of positive cases was 52. Out of them, two only were P.vivax. But, the rest were P. falciparum, 32 cases [61.54%] were detected by MBE, 12 cases [23.08%] by PCD and 8 cases [15.38%] by NOD. The mean age of the total positive cases was 20.54 +/- 14.93 years. It was found that malaria infection didn't affected by sex. The parasite rate [PR] among was 0.57%, parasite formula was 96.15% for P. falciparum and 3.85% for P. vivax, species infection rate [SIR] was 0.55% for P. falciparum and 0.02% for P. vivax. Gametocytaemia was 74% of the total positive malaria cases. High parasite density [PD] was encountered among the younger age groups less than.five years

Prevalence and outcome of bacterial endocarditis in patients with implantable cardiac device infections

Cardiac device infection [CDI] is a devastating complication of permanent pacemaker [PPM] or implantable cardioverter-defibrillators [ICD]. The incidence and outcome of endocarditis among patients with CDI is not well defined. The aim of this study was to report our experience in the prevalence, clinical presentations, and management of bacterial endocarditis [BE] among patients with CDI in a tertiary care cardiac center over a 25-year period. A total of 2630 cardiac devices implanted in a cohort of 2367 patients over 25 years were studied. Of these, 117 [4.4%] patients presented with CDI. Clinical, bacteriologic and both transthoracic [TTE] and transoesophageal echocardiographic [TEE] assessment were done. Of the 117 patients with CDI [90 males, age range 18-82 yrs, mean = 63 +/- 6 yrs], 87 [74%] had redo procedures [battery replacement in 50, repositioning of leads in 12, device extrusion in 15 or evacuation of significant haematoma in 10 patients]. Of these 87 patients, 65 had -re-implants on the same day of explantation. In 30 patients [26%] no apparent cause of PI was identified. Of the 117 patietns with CDI, 30 patients [26% of CDI and 1.1% of total procedures] had device-related BE with vegetations having appeared in all patients by TEE [15 DDD, 9VVI, 3 CRT and 3 ICD]. The clinical presentations were prolonged fever in 25 patients [83%], significant pulmonary hypertension with thrombo-embolism in 3 patients [10%], severe sepsis and multi-organ failure in 2 patients [6%]. Twenty-eight patients [93%] had positive blood cultures [S aureus in 23 [77%] and enterococci in 5]. There were only 2 patients with negative blood cultures. Device lead vegetations were evident in 20 patients [>10 mm diameter in 13 patients]. Ten patients presented with only right heart valve vegetations. Of the 30 BE patients, 28 [93%] had PI while 2 patients had no apparent cause but frequent intravenous injections [one drug addict and one on regular haemodialysis]. Of the 20 patients with lead endocarditis, 15 had their leads removed surgically with re-implantation of either epicardial [6 patients] or endocardial leads [9 patients]. Fifteen patients had only medical treatment with proper antibiotics [5 patients with lead BE and all 10 patients with valvular BE]. Four patients [13%] died; all had their devices implanted on same day of explanation. Cardiac device redo procedures are major risk factors for CDI, especially with re-implantation on the same day. Device related BE carries a serious morbidity and mortality, yet surgical removal of the whole system in the management of choice. Blood stream bacteraemia is a potential risk factor in patients with cardiac devices and warrants prophylaxis against BE

Development of schistosomal school-based health education model for Yemeni school children

In this study, 152 students [90 males and 62 females] of primary [5[th] and 6[th] grades, 52 males and 30 females] and preparatory [1[st] and 2[nd] grades, 38 males and 32 females] schoolchildren of different age and sex group inhabited in two endemic villages with Schistosoma mansoni in Taiz Governorate were examination. The highest prevalence and intensity of S. mansoni were-among males at the age group from 10-<12years. A significant relationship was recorded between prevalence and intensity of infection and those who using pond water for human usage. The prevalence was significantly higher among children who received previous praziquantel treatment as well as those who didn't have TV, Radio and/or Video. The results were discussed on the light of certain variables

Proteinuria as a risk factor for stroke in type 2 diabetes mellitus

The study was designed to assess the relation between proteinuria and stroke in patients with type 2 diabetes mellitus. The study was conducted on two groups; Group I included 60 patients with type 2 DM with ischemic stroke, group II included 60 patients with type 2 DM without stroke. Both groups were matched by age, sex, body mass index and duration of diabetes. The study was performed at Al-Azhar University Hospitals from May 2005 to January 2006. The patients were evaluated clinically using Glasgow Coma Scale [GCS] for comatose patients and Canadian Neurological Scale [CNS] for conscious patients. Routine laboratory investigations as well as 24 hours urine protein were measured for both groups. CT scans were performed to all patients of group I within two days and after one week from the onset of stroke to determined site, depth and size of infarction. Systolic and diastolic blood pressures, prevalence of smoking and 24 hours proteinuria were significantly higher in group I than group II. On the other hand no significant changes were found on duration of DM, fasting and postprandial blood sugar, total cholesterol, LDL cholesterol, triglycerides, HbAlc, age and gender between two groups. In group I 38 patients were found to have proteinuria 38/60 [63%] versus 16 patients 16/60 [26.7%] had proteinuria in-group II, which was statistically significant. HDL-cholesterol only was significantly lower in-patients with proteinuria than those without proteinuria in-group I [p<0.01]. On the other hand no significant correlations were found between proteinuria and severity of strokes and CT findings. In multivariate logistic regression analysis, the ORs and 95% CLs for the variables identified as risk factors for stroke were as follow; SBP [OR 14.5, 95% CL 2.5-13.9], DBP [OR 13.1, 95% CL 2.4-15.9], proteinuria [OR 7.6, 95% CL 2.5-22.9], HDL cholesterol [OR 5.5,95% CL 2.1-23.5] and smoking [OR 4.89, 95% CL 1. 7-22.3]. Our results give evidence that proteinuria is an independent risk factor for ischemic stroke in patients with type 2 DM. Further support from additional prospective studies is recommended to confirm these findings

Pulmonary function tests in Parkinson's disease

The study was a cross-sectional and patient-control study. The study was performed at Al-Azhar university Hospitals from May 2005 to January 2006. The study was performed to document changes in respiratory pump and ventilatory function in idiopathic Parkinson's disease [PD] patients and its relationship with the main clinical presentation and the specific daily living activities [DLA] inthose patients. The study was conducted on 30 patients with PD and 10 healthy control volunteers. Patients were subjected to clinical evaluation by Unified Parkinson Disease Rating Scale [UPDRS] and respiratory pump function evaluation was done for patients and controls. Among patients group, 3 patients had normal pulmonary function [PF], 15 had obstructive PF pattern, 2 had restrictive PF pattern and 17 had upper airway obstruction. A significant disturbance in respiratory neuromuscular drive represent by the tracheal occlusion pressure after 100 m / sec from the start of quit inspiration [PO.l], decrease in respiratory muscle strength evaluated by maximum inspiratory pressure [PImax], marked respiratory muscle fatigue evaluated by [PO.l / PO.lmax]. A significant decrease in partial arterial oxygen pressure [PaO[2]] and increase in PaCO2 was found in patients group when compared to control group. Rigid / hypokinetic group patients 16/30 [53.3%] had significant [p<0.05] respiratory dysfunction rather than tremulous 14/30 [46.7%] group of patients. A significant negative correlation between the duration of disease, severity of illness, total daily living activity [DLA] and the severity of pulmonary dysfunction was found. Among the specific DLA, salivation and severe axial involvement was negatively correlated with maximum voluntary ventilation [MVV], PImax and PaO[2] Patients with Parkinsonis disease have impaired pulmonary function showing both obstructive and restrictive pattern, also abnormalities in mouth occlusion pressure and maximum inspiratory pressure were evident

RVoutflow tract pacing versus RV Apical pathophysiologic Effects and prognostic implications

Right ventricular apical pacing has been reported to be associated with adverse haemodynamic effects and alternative sites of pacing have been recommended. On the other hand RV septal pacing was claimed to be more physiological. The present work is intended to compare the classic right ventricular apical DDD pacing to RV outflow tract [RVOT] pacing in both normal and diseased hearts. We studied 30 patients [pts] with complete heart block [CHB]. Fourteen pts [Group I] had no underlying heart disease [8M and 6F with mean age 64.1 +/- 6.4, range 54-76 years] and 16 [Group II] had heart disease [10M, 6F, with mean age 67.5 +/- 8.9, range 58-86 years] including DCM in 12, 1HD in 3 and RHD in Ipt. Right ventricular apical pacing was conducted in 7pts from group I and 8pts from group II. RVA was conducted in 7pts of group I and 8pts of group II. Besides clinical evaluation, all pts were subjected to 2D echo before, and 6 months after pacing. Echo parameters studied included LVEDD, LVESD, EF% and CO with effects expressed in terms of% changes in various parameters. Compared to RVA pacing RVOT pacing in group I [pts with normal heart] induced insignificant% decrease in LVEDD [2.4 +/- 4.8vs 8.6 +/- 9.3, p value =0.146] or LVESD [4.6 +/- 7.8vs 8.3 +/- 6.0,p value =0.113] and insignificant increase in EF [2.4 +/- 4.6vs 0.42.6, p value =0.113] and CO [2.8 +/- 8.0vs 3.3 +/- 3.5, p value =0.08]. However in RVOT pacing in group II [pts with disease heart] induced significantly greater% decrease in LVEDD [3.0 +/- 2.8vs 1.2 +/- 2.3, p=0.005] in LVESD [3.7 +/- 0.9vs 2.5 +/- 2.3, p=0.000], and significantly greater% increase in EF [8.9 +/- 3.3vs I.7 +/- 1.2,p=0.001] and CO [5.8 +/- 9.6vs 10.7 +/- 18.3, p=0.04] in comparison to RVA pacing in group II In the presence of underlying cardiac dysfunction, DDD pacing by RVOT lead is hemodynamically more advantageous to classic RV apical pacing in terms of improving dimensions and enhancing systolic function. We recommend RVOT pacing in the presence of underlying HD to avoid the so called pacing-induced cardiomyopathy.

Effect of daily hemodialysis of uremic peripheral neuropathy

Objective and aim of the work: uremic syndrome is characterized by overall deterioration of biochemical and physiological functions in parallel with progression of renal failure. Uremic polyneuropathy represent a well- known complication of end-stage renal failure [ESRF] caused by major neurotoxins accumulating in uremia, such as urea, creatinine, uric acid, middle molecules and others. The study was performed to study the effect of daily hemodialysis on uremic polyneuropathy and improving the patients clinically and biochemically. The cases of this study were patients under regular hemodialysis in the Nephrology Unit, Medical Department, Al-Azhar University and Naser City Hospitals from October 2004 to Mayo 2005. Material and methods: the cases of this study were patients under regular hemodialysis in the Nephrology Unit, Medical Department, Al-Azhar University and Nasr City Hospitals. The patients classified into 2 groups: group 1 comprised 10 patients with ESRF under thrice-weekly hemodialysis for less than 3 years; group ii comprised 10 patiepts with ESRF under thrice-weekly hemodialysis for less than 3 years who shift to daily hemodialysis except Fridays for 6 months; and 10 healthy normal volunteers of matching age and sex were the control group. Complete clinical and laboratory instigation were performed with nerve conduction velocity [sensory] and distal latency [motor] for median, ulnar and common peroneal nerves. K [t/v] to assess the adequacy of hemodialysis. paraethesia showed significant differences after 6 months of daily dialysis [p < 0.001], while other neurological symptoms and signs showed no significant differences in both groups after 6 months of dialysis. Sensory and motor nerve conduction study was significantly impaired in the median, ulnar and common peroneal in both groups when compared to controls [p < 0.001]. Nerve conduction velocities [sensory] were significantly improved in three nerves after 6 months of daily dialysis [p < 0.01], on the other hand no significant improvement was noticed after 6 months of thrice-weekly dialysis. Distal motor latency [motor] showed no significant improvement in three nerves in both groups after 6 months of dialysis. K [t/v] value was not significantly improved after 6 months of daily dialysis [3.2 vs. 3.1, p = 0.521]. from our study we speculated that the protocol of daily hemodialysis is feasible in routine hospital practice being well tolerated by patients and having a low incidence of complications compared to the standard protocol. Further works are required to study the effect of daily home dialysis on the different clinical, biochemical and psychological aspects of dialysis patients as well as the economic aspects of the daily regimen hemodialysis

Sequential chemo-radiation versus radiation therapy in the treatment of stage III unresectable non-small cell lung cancer

This study included 49 patients with unresectable stageIII non-small cell lung cancer. All the patients received radical radiotherapy; it was preceded by Cisplatinum-based combination chemotherapy [Cisplatinum-Etoposid or Cisplatinum-Gemcitabene] in 25 cases [51%]. The chemotherapy induced a favourable objective partial response [>50% reduction] in only 5 cases [20%]. The median total dose of radiation therapy was 56 GY with 1.8 GY/fraction and 5 fractions/week, a median delay of 10 days was recorded in the overall period of radiotherapy. The median planned target area for radiation therapy was 210 cm2. the above mentoned parameters were comparable in both treatment arms. The majority of our cases did not suffer severe treatment related toxicity. An overall objective response was recorded in 30 cases [61%] with 2 cases [4%] in complete response. The median overall survival was 11 months, the 1 and 2-year overall survival rates were 52% and 26% respectively. The above mentioned treatment results were comparable in both treatment arms. this study did not show significant superiority of sequential chemoradiation therapy over radiation therapy in the treatment of stage III unresectable non-small cell lung cancer

Malaria status in Al - Hodeidah Governorate, Yemen: malariometric parasitic survrey and chloroquine resistance P. falciparum local strain

A cross sectional malariometric parasitic survey including 4000 Yemenis of various age/sex groups from 43 villages or harah in five selected districts representing Al-Hodeidah Governorate was done. Duplicate thin and thick blood smears were stained with Giemsa stain and examined. Out of 4000 examined slides, 646 were found to be malaria positive, 508 of them were detected through ACD, while 138 cases were detected by PCD. The overall parasite rate was 16.2%, a situation of prevalently mesoendemic condition. P. falciparum was the predominant species [96.7%], followed by P. vivax [1.7%] and the least prevalent was P. malariae [0.3%]. Yemen has been considered free of ovale malaria. The recorded indigenous case of P. ovale for the first time in Yemen should be taken into consideration for the existence of this particular Plasmodium species when surveying for malaria in future studies. The present study was the first document in Yemen to compare simultaneously the in vivo and in vitro response to chloroquine among 209 of P. falciparum field isolate patients that were satisfied all criteria of WHO for the implementation of the in vivo and in vitro tests and were obtained by PCD and ACD methods. Chloroquine resistance of local strain of P. falciparum was recorded in all studied districts [Zabid, Bajil, Azohrah, Azaidiah and Al- Hodeidah City]. RIII [high level of resistance] was recorded for the first time in Yemen and should be taken into consideration in the treatment of infected malaria patients

Peripheral neuropathy in patients with polyarteritis nodosa clinical and electrophysiological study

The aim of this study was to investigate the clinical and electrophysiological characteristics of peripheral neuropathy in patients with systemic polyarteritis nodosa. Thirteen patients with peripheral neuropathy and evidence of systemic vasculitis of polyarteritis nodosa type were included in this study. Eight patients presented with mononeuropathy multiplex. Three patients were presented with asymmetrical sensorimotor neuropathy. The remaining two patients presented with distal symmetrical polyneuropathy. Ulnar peroneal and sural nerves are the most common nerves affected in polyarteritis nodosa. The findings showed acute or subacute neuropathy. EMG and nerve conduction studies showed an evidence of axonal neuropathy with a significant reduction of the motor nerve action potential amplitudes

Disseminated tuberculosis with ocular tuberculoma and disseminated candidiasis in acquired immunodeficiency syndrome.

A 39 years man presented with painless progressive loss of vision and proptosis of left eye associated with constitutional symptoms. He was diagnosed to have acquired immunodeficiency syndrome (AIDS) with disseminated tuberculosis (TB) and invasive candidiasis. The proptosis was due to a retrobulbar mass. The uncommon occurrence of retrobulbar tuberculoma and invasive candidiasis is discussed and relevant literature is reviewed.