Congenital diaphragmatic hernia in a 2-month old infant: a case report

Congenital diaphragmatic hernia (CDH) in young infants is easily misdiagnosed as bronchopneumonia yet survival of such patients lies in prompt diagnosis and surgical treatment. The report aimed to increase awareness among Paediatricians and Paediatric Surgeons of the need for high index of suspicion for this condition to allow for early diagnosis and management. A two-month old infant presented with a five-week history of cough of sudden onset and a week history of difficulty in breathing. He had been managed in several hospitals for bronchopneumonia. Examination findings showed features of respiratory distress, widespread coarse crepitations and bowel sounds in the lung fields. Chest radiograph showed `loops of bowel in the mediastinum. He had surgical reduction and repair of the hernia, made excellent recovery post-op and was discharged home. CDH is an uncommon anomaly but a high index of suspicion will allow early diagnosis and treatment with favourable outcome when picked early

Exstrophy Anomalies: Preliminary Review of 18 Cases in Maiduguri; North-Eastern Nigeria

Background: Exstrophy anomalies; although rare; pose a tremendous challenge to both surgeons and surrogates. Management is intricate and experience with large members is restricted to a few centres worldwide. This report is a review of 18 cases of these anomalies managed in University of Maiduguri Teaching Hospital (UMTH) over 8 years; highlighting the intricacies of management; and contributes to the existing data bank on this subject matter in our environment. Materials and Methods: We reviewed the records of all cases of anomalies that were managed in the index hospital from December 2002 to December 2010. Results: Eighteen cases were studied. The youngest was a 2-day-old neonate and the oldest was 6 years at repair; with a median age of 4 months. There were 7 boys and 9 girls with bladder exstrophy; and the remaining two were girls with cloacal exstrophy; giving a male-female ratio of 7:11 for the exstrophy anomalies. Eight patients (33.5) had associated congenital anomalies; 16.7 had undescended testes (UDT); anorectal malformation (ARM) and patent processus vaginalis (PPV); and duplicate bladder occurred in 5.6 of the patients. All but one patient had bilateral posterior iliac osteotomy at bladder closure. Out of the 17 patients that had osteotomy; 76.5 had satisfactory bladder closure (no complication); 5.9 had superficial wound dehiscence; 11.8 had bladder neck dehiscence and 5.9 had complete disruption. The lone patient that did not undergo osteotomy had complete bladder dehiscence. Postoperative immobilization was done for 3 weeks for 16 cases; one was discontinued after 1 week because of complication. The longest follow-up was for 2 years and the shortest for 2 weeks. Four patients (22.2) did not turn up for follow-up. Conclusion: Exstrophy anomalies although rare remain a major challenge in paediatric surgery. Iliac osteotomy; among other technical considerations; remains a cornerstone for successful bladder closure

Significance of pyuria in the diagnosis of urinary tract infection in children with sickle cell anaemia in Maiduguri, Nigeria

Urinary tract infection (UTI) is a significant cause of morbidity and mortality in children; especially in those with sickle cell disease; who are at higher risk of infections. It will be useful to have a simple test which can be used in resource limited health facilities as a means of screening such children for UTI with the view to instituting prompt treatment. This study is carried out to determine the usefulness of significant pyuria in detecting UTI in febrile children with sickle cell anaemia (SCA). Two hundred and fifty febrile children with sickle cell anaemia that attended State Specialist Hospital and University of Maiduguri Teaching Hospital (UMTH) were prospectively studied with their consent. Urine sample was collected using standard procedure; examined for pus cells and was cultured at the Microbiology laboratory of UMTH. The study showed UTI prevalence of 26. Significant pyuria was found to have sensitivity of 55.4; specificity of 77.8; the efficacy of the test was 72.0and the test has low positive predictive value of 46.8in detecting bacteriuria in SCA patients. The significant pyuria observed in this study support its usefulness in the diagnosis of UTI among children with SCA especially in communities having limited facilities or personnel for carrying out urine culture

Antibacterial and phytochemical screening of the ethanolic leaf extract of azadirachta indica (neem) (meliaceae).

Azadirachta indica is a very useful traditional medicinal plant in the sub-continent and each part of the tree has some medicinal properties. The plant is native to Asia, but has now naturalized in West Africa and is widely cultivated in Nigeria as an ornamental as well as medicinal plant. This study aimed at screening the active components and the antibacterial effects of the ethanolic leaf extract of Azadirachta indica. Fresh leaves of the plant were collected, dried, homogenized and extracted using 95% Ethanol. The extract was used for the phytochemical screening and bacterial susceptibility testing using cup-plate method.The result obtained from this study showed the presence of tannins, saponins, flavonoids, alkaloids, glycosides, reducing sugars and terpenes in the ethanolic leaf extract. The antibacterial effect produced by the extract was dose-dependent at the tested doses (6.25 mg, 12.5 mg, 25 mg, 50 mg and 100 mg) on Escherichia coli (E. coli), Staphylococcus aureus (S. aureus) and Salmonella typhi (S. typhi). The minimum inhibitory concentration (MIC) for E. coli, S. aureus and S. typhi were 2.39 mg, 3.31 mg and 4.79 mg respectively. The effect produced by the ethanolic leaf extract at 100mg (18 mm) was statistically significantly higher than that of 1.5 mg ciprofloxacin (14 mm) on S. typhi (p<0.05). Azadirachta indica ethanolic leaf extract contains pharmacologically active constituents that may be responsible for its activity against S. aureus, E. coli and S. typhi. Therefore, the use of Neem plant in our community for treating diverse medical ailments especially infectious diseases is highly justified.