ABSTRACT
@#Isolated progressive macrodactyly belongs to a heterogeneous group of congenital overgrowth syndromes, resulting in enlargement of all tissues localized to the terminal portions (fingers or toes) of a limb. The aim of this case report is to create further awareness among physicians on this rare clinical entity and present a short review of the literature. We present the case of a 10-year-old Nigerian girl with a history of progressive overgrowth of left thumb since birth. The patient‟s facies and body habitus were normal without hemihypertrophy. Anthropometric measurements of the child‟s hands, revealed an overgrowth of the left thumb compared with the right. The child had no café-au-lait spots or any other skin lesions. The radiograph of the hands revealed increase in size of both soft tissue and phalangeal bones (enlongated and broadened) of the left thumb. A diagnosis of isolated progressive left thumb macrodactyly was made and the patient was referred to the orthopaedic surgeon for surgical intervention. The child and her parents suffered psychological distress. Isolated progressive macrodactyly is very rare but it is cosmetically displeasing to the child, resulting in psychological distress.
ABSTRACT
Hypoglycaemia is a well recognized complication of falciparum malaria in children but its diagnosis may be overlooked because all the clinical features may be mimicked by severe malaria. To determine the prevalence of hypoglycaemia at the point of hospital admission of under-fives with falciparum malaria and identify its risk factors in patients seen in a Nigerian secondary-health-care institution. During a 12-month period and at the point of hospital admission, venous blood sample was collected into an appropriate sample bottle [fluoride-oxalate bottle] from 502 children who were below 5 years of age with positive falciparum malaria parasitaemia. The blood sample was analysed using the glucose-oxidase method. The duration of illness, degree of parasitaemia and time of last meal were noted for each child. Ninety two [18.3%] out of 502 children below five years old with falciparum malaria had hypoglycaemia [blood glucose below 2.6 mmol/L or 50 mg/dl] at the point of hospital admission. Twenty three percent [78 out of 339] of children below 36 months old were hypoglycaemic compared to 8.6% [14 out of 163] children aged 36 months and above; [p=0.01]. Prevalence of hypoglycaemia was higher in girls [20.7%] than boys [16.3%] [Odd ratio, OR = 0.75 [95% Confidence Interval, CI = 0.48-1.18]]. Forty [13.1%] out of 305 children whose time of last meal was 12 hours and below had hypoglycaemia compared to 52[26.4%] out of 197 whose time of last meal was greater than 12 hours; [p=0.02]. Hypoglycaemia at admission point was associated with a significant increase in mortality rate; [p=0.00]. The duration of illness and the degree of parasitaemia did not have significant difference with the prevalence of hypoglycaemia. In falciparum malaria, a greater interval [between 2 meals] than 12 hours in children below 36 months old predisposed them to hypoglycaemia. Routine monitoring of blood glucose at the admission point is suggested in malaria endemic region