Intracranial aneurysms clipping in Rwanda, can it be done? What are the challenges?

Background: Intracranial aneurysms are vascular abnormalities that cause outpouching of the arterial wall [1]. Although they are not uncommon, there is scanty information regarding intracranial aneurysms in Africa [2]. Intracranial aneurysms are often asymptomatic until they cause symptoms and signs resulting from mass compression and/ or spillage of blood products into the arachnoid space. Currently available diagnostic tools are computed tomography (CT) angiography, magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (IADSA) [1]. In our setting we continue to diagnose and achieve clipping of intracranial aneurysms amongst the currently available choices of managing intracranial aneurysms.Objectives: To establish the feasibility and reflect on the challenges of clipping intracranial aneurysms in our settings. To raise awareness among health professionals and the general population.Methods: This is a retrospective case series of 5 patients diagnosed with intracranial aneurysms at King Faisal Hospital and Kigali University Teaching Hospital from October 2014 to October 2015. Available diagnostic methods used are the computed tomography (CT) angiography and/ or magnetic resonance angiography (MRA). We have excluded cases that were diagnosed with intracranial aneurysm at autopsy.Results: Five patients met inclusion criteria for our study. We describe case by case, the choices of therapeutic measures, the challenges encountered during their management and their outcome.Conclusion: Despite the challenges, intracranial aneurysms are treatable in Rwanda with good outcome. However, there is still lack of awareness about this pathology

Management Challenges of Pediatric Infective Endocarditis at Tertiary Level in Rwanda

Background: Management of Infective Endocarditis (IE) has been of great challenge for many years. Rapid diagnosis; effective treatment; and prompt recognition of complications are essential to good patient outcome as this condition is associated with a high morbidity and mortality in both adults and pediatric patients. In limited resources settings; management of IE is still a challenge due to early inappropriate antibiotherapy and therefore difficulties in its diagnosis and treatment. Objectives: To elicit challenges in management of patients suspected of IE at tertiary level in Rwanda. Methods: We report four patients with IE. For these patients; Duke's criteria were considered in making the diagnosis. Results and Conclusion: IE has protean clinical symptoms and signs; and can be of challenging diagnosis. The patients reported constituted a clinical challenge in the diagnosis and management of IE but most of them had had favorable outcome. The main clinical challenge was the prolonged stay to peripheral settings with inappropriate antibiotherapy which made most of the blood cultures falsely negative. Echocardiography and serial blood cultures provide the key to diagnosis as per Dukes criteria. Being alert to this mentioned challenge is crucial. As the key investigations are not steadily available in most peripheral health facilities; we strongly recommend early referral to tertiary level for all cases of suspected IE before initiation of antibiotherapy