The prioritisation of paediatrics and palliative care in cancer control plans in Africa.

BACKGROUND: Given the burden of childhood cancer and palliative care need in Africa, this paper investigated the paediatric and palliative care elements in cancer control plans. METHODS: We conducted a comparative content analysis of accessible national cancer control plans in Africa, using a health systems perspective attentive to context, development, scope, and monitoring/evaluation. Burden estimates were derived from World Bank, World Health Organisation, and Worldwide Palliative Care Alliance. RESULTS: Eighteen national plans and one Africa-wide plan (10 English, 9 French) were accessible, representing 9 low-, 4 lower-middle-, and 5 upper-middle-income settings. Ten plans discussed cancer control in the context of noncommunicable diseases. Paediatric cancer was mentioned in 7 national plans, representing 5127 children, or 13% of the estimated continental burden for children aged 0-14 years. Palliative care needs were recognised in 11 national plans, representing 157 490 children, or 24% of the estimated Africa-wide burden for children aged 0-14 years; four plans specified paediatric palliative needs. Palliative care was itemised in four budgets. Sample indicators and equity measures were identified, including those highlighting contextual needs for treatment access and completion. CONCLUSIONS: Recognising explicit strategies and funding for paediatric and palliative services may guide prioritised cancer control efforts in resource-limited settings.

CUTANEOUS INVOLVEMENT OF HODGKIN LYMPHOMA IN A CHILD--CASE REPORT.

Specific cutaneous involvement in Hodgkin Lymphoma is rare and has not been reported in the younger paediatric age group. We report a case of a ten year old girl who presented with specific cutaneous involvement, confirmed using immunohistochemical stains. Treatment with combination chemotherapy resulted in rapid disappearance of the lesions and contrary to the generally poor prognosis associated with most other such reported cases in adults, she has clinically remained disease free two and a half years post treatment. Obtaining an accurate pathological diagnosis is essential to ensure appropriate treatment even in resource limited settings as illustrated by this case.

An unusually large spindle cell sarcoma of the tongue in a male child.

Reports of spindle cell sarcoma in the tongue are very rare, and seldom in the child. We report a five-year-old male patient who presented with a massive lesion on the right side of the tongue. This was surgically excised and histologically diagnosed as a Spindle cell Sarcoma. Results of bone marrow aspiration further revealed that about 16% of his bone marrow was infiltrated with abnormal pleomorphic vacuolated cells with bluish cytoplasm, consistent with rhabdomyosarcoma (RMS) cells. The child was treated with surgery and chemotherapy with good initial response, but then died after one year following a relapse.

Outcome of hospital admissions in HIV-infected children at the Korle Bu Teaching Hospital, Accra, Ghana.

BACKGROUND: The burden of paediatric HIV infection remains high in resource-poor settings. Information on morbidity leading to hospitalisation as well as outcome is limited. OBJECTIVE: The objective of this study was to determine the reasons for hospital admissions of HIV-infected paediatric patients to a tertiary teaching hospital and the outcome of these admissions. METHODS: Retrospective chart review of inpatient records of all HIV-infected children aged 0 to 13 years admitted to the paediatric unit at Korle-Bu Teaching Hospital from 30 June 2007 to 30 June 2008 was performed. Abstracted data included age, gender, weight, presenting conditions, diagnosis, duration of hospitalisation, antiretroviral treatment, and outcome. RESULTS: A total of 102 admissions occurred among 76 children. The mean age of the children was 4.5 ± 3.79 years and 42 (55%) were males. HIV diagnosis was made during hospitalisation in 23 (30%) of the 76 patients. Overall, 55 (64%) of the 76 patients had a weight for age less than second percentile and 67% were not on antiretroviral therapy at time of admission. Of the 102 admissions, the predominant diagnosis included pneumonia (40%), gastroenteritis (24%), pulmonary tuberculosis (22%), and/or malaria (19%). Death occurred in 12 of the 102 admissions. Age, gender, and admitting diagnosis were not associated with death. CONCLUSIONS: Failure to thrive and common prevalent infections were the predominant reasons for hospitalisation for paediatric HIV/AIDS patients in Accra. Hospitalisations with these conditions should prompt early HIV testing. Efforts should be intensified to prevent maternal to child transmission of HIV infection.

Melanotic neuroectodermal tumour of infancy (progonoma) treated by radical maxillary surgery.

Two cases of melanotic neuroectodermal tumour of infancy (MNTI), otherwise known as melanotic progonoma, both arising from the maxilla are presented here. The two infants both presented within three months of each other and though clinically Burkitt's lymphoma was stated as a possible diagnosis, the correct diagnosis was made on biopsy specimens. Radical surgery consisting of wide resection of the tumour with margins of healthy tissue via hemi-maxillectomy was performed in each case as an initial method of treatment. At follow up four months later, both infants appeared clinically well. One infant was then lost to follow up thereafter but the other was reviewed three years later, and apart from slight facial asymmetry, there was no evidence of tumour recurrence.

The earplug procedure.

In the measurement of hearing, a masking dilemma is a situation in which it is not possible to use masking to determine if the signal is crossing the head and activating the opposite cochlea. A nonmasking procedure, called the earplug procedure, was developed to rule out crossover for air-conducted signals in patients with a masking dilemma. In the procedure, an earplug is inserted in the suspect ear in an attempt to increase the loss in that ear. If the loss is increased significantly, then thresholds were obtained from the test ear and crossover is ruled out. If there was no significant threshold shift with the earplug, crossover is not ruled out and the uncertainty remains. Threshold shift criteria were developed for five test frequencies and for single test frequencies. The procedure correctly rules out crossover for a majority of unmaskable ears.