Congenital pulmonary airway malformation: A case report of a rare cause of neonatal respiratory distress and review of the literature.

Congenital pulmonary airway malformation (CPAM), formerly known as congenital cystic adenomatoid malformation (CCAM), is a rare developmental dysplastic lesion of the fetal tracheobronchial tree. CPAM is a rare cause of neonatal respiratory distress; however, its presence may span fetal to adult period. In two previous case-reports from Nigeria, CPAM was present in post-neonatal infants. We report the case of a neonate, who presented with increasing respiratory distress and an abnormal chest radiograph, initially assumed as pneumonic changes. A revised diagnosis of CPAM was made after a chest computed tomography (CT) scan. The neonate subsequently had a successful excision of the affected lobe with remarkable clinical improvement. The case highlights the need to utilize superior imaging studies such as CT when plain radiographs are inconclusive.

Decision-Delivery Interval and Perinatal Outcome in Emergency Caesarean Section:A University Teaching Hospital Experience.

BACKGROUND: The recommended time for decision-delivery-interval (DDI) in emergency caesarean section is 30 minutes, though this is rarely achieved in practice. Good perinatal outcome has been achieved with DDI up to 240 minutes. OBJECTIVES: To evaluate the average time it took to deliver the baby by emergency caesarean section after the decision had been taken and determine the effect on perinatal outcomes when this time exceeded 240 minutes. MATERIALS AND METHODS: This prospective observational study was undertaken in Lagos State University Teaching Hospital between January and May 2009. Data was collected from the case notes of the mothers and the neonates admitted to Special care baby unit(SBCU) using a proforma. The main outcome measures were DDI, 5-minute Apgar score, newborn admission to special care baby unit(SCBU) and perinatal outcome.Odds ratio (OR) with 95% Confidence interval (CI) for factors affecting DDI and perianatal outcomes in different DDI categories were calculated by logistic regression and multivariate analysis with p<0.05 considered statistically significant. All data were analyzed with SPSS17.0 statistical software. RESULTS: A total of 359 emergency caesarean sections were performed within the study period. None was done within the recommended 30-minute period. The average DDI was 401 + 315 min, with a range of 45-1393 min.Univariate analysis of factors affecting DDl showed that DDI >240 minutes was significantly more likely in urgent as opposed to crash surgery (OR 4.52[95% CI: 2.78-7.35]), in spinal as opposed to general anaesthesia(OR 2.16[95% CI: 1.40-3.30]) and in junior as opposed to senior surgeon (OR 2.52[95% CI: 1.64-3.89]). Concerning foetal out-comes, DDI> 240 minutes was associated with significantly higher incidence of low Apgar scores at 5-minutes(OR 2.09 [95%CI: 1.33-3.29]) and admission to SCBU(OR 1.66[95% CI: 1.07-2.57]) but did not significantly affect perinatal deaths(OR 1.01[ 95%CI: 0.51.2.01]). Multiple logistic regression analysis showed that DDI >240 minutes was significantly influenced by degree of urgency of the surgery (a OR 3.76[95%CI: 2.17-6.53], p=0.005) and rank of surgeon(aOR 0.55[95%CI: 0.48-1.34],p=0.017) but not by type of anaesthesia(a OR 0.80[95% CI: 0.48-1.34],p=0.397). Multiple logistic regression analysis of perinatal outcomes showed that DDI>240 minutes was significantly associated with 5-minute Apgar score (aOR 0.29[95%CI: 0.11-0.79],p=0.015) and admission into SCBU(aOR 2.59[95%CI: 1.01-6.63],p=0.048) but not with perinatal deaths (aOR 1.54[95%CI: 0.66-3.80],p=0.302). CONCLUSION: The average DDI in this study was 401 + 315mins. Whilst perinatal deaths were not significantly affected when the time exceeded 240 minutes, 5-minute Apgar scores and SCBU admissions were significantly higher. The 30-minute recommendation may remain the target if these outcomes are to be improved.

Serum iron status of under-five children with sickle cell anaemia in lagos, Nigeria.

Background. Iron status in patients with sickle cell anaemia is a matter of continuing investigation. Objective. This paper aims to determine the serum iron status of under-five, sickle cell anaemia patients. Methods. The study spanned from December 2009 to February 2010 at the Consultant Outpatient Clinics involving 97 HbSS subjects and 97 age- and sex-matched HbAA controls. Biochemical iron status was assayed in subjects and controls. Results. Age range of the children was seven months to five years, with a mean of 30.6 (±15.97) months. Irrespective of gender, mean serum iron values were higher in HbAA controls than their HbSS counterparts but the observed difference was not significant (P = 0.299 and 0.111, resp.). The mean total iron binding capacity values of males and females were also not significantly different for sickle cell anaemia subjects and controls (P > 0.05). Males and females with HbAA had significantly lower serum ferritin when compared with their HbSS counterparts. Irrespective of gender, mean transferrin saturation was lower in HbSS subjects but the difference was not statistically significant (P > 0.05). Conclusion. Children with sickle cell anaemia have higher serum ferritin than controls, implying relatively higher iron content in the reticuloendothelial cells.

Immunogenicity, safety and reactogenicity of the 10-valent pneumococcal non-typeable haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in Nigerian Infants: a randomised trial.

AIMS AND OBJECTIVES: The immunogenicity, reactogenicity and safety of the 10- valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) were evaluated in a cohort of Nigerian infants included in a study conducted in Mali and Nigeria (ClinicalTrials.gov identifier: NCT00678301). SUBJECTS AND METHODS: In this open, randomised, controlled study, 119 healthy infants received combined diphtheria-tetanus-whole-cell pertussis-hepatitis B/ Haemophilus influenzae type b vaccine (DTPw-HBV/Hib) and oral poliovirus vaccine (OPV) co-administered with PHiD-CV (PHiD-CV group) or without PHiD-CV (control group) at 6-10-14 weeks of age. Pneumococcal antibody responses and opsonophagocytic activity were measured and adverse events were recorded. RESULTS: One month post-dose 3, for each of the vaccine pneumococcal serotypes, e"90.1% of PHiD-CV recipients had an antibody concentration e"0.2 ug/mL compared to < 9 % (except for serotypes 14 [32.4%] and 19F [27.8%]) in the control group. For each of the vaccine pneumococcal serotypes, e"90.6% of infants in the PHiD-CV group had an OPA titre e"8, compared to % 18% (except for serotype 7F [60.0%]) in the control group. Anti-protein D antibody geometric mean antibody concentrations were 2949.7 EL.U/mL in the PHiD-CV group and 68.9 EL.U/mL in the control group. For each DTPw-HBV/Hib antigen antibody seroprotection/seropositivity rates were e"94.4%. Tolerability was generally comparable between the PHiD-CV and control vaccination groups. CONCLUSIONS: PHiD-CV co-administered with routine vaccines was immunogenic for all vaccine pneumococcal serotypes and protein D in Nigerian infants. Vaccine tolerability was generally comparable between the PHiD-CV and control groups. These results suggest PHiD-CV can be co-administered with other vaccines included in the National Programme on Immunisation.

Trauma at a Nigerian teaching hospital: pattern and docu-mentation of presentation.

BACKGROUND AND OBJECTIVES: This study is aimed at identifying the characteristics of injuries and determining the efficiency of documentation of patients' records in a tertiary hospital where there is no trauma registry. PATIENTS AND METHODS: A retrospective case record analysis was conducted of injured patients seen at the Accident and Emergency unit over a 12 month period from January to December 2003. RESULTS: A total of 1078 records of injured patients that attended the A&E were analysed. Their mean age was 31 years (range 3 months to 85 years). Laceration (n = 408) and fractures (n = 266) representing 62.5% of injuries were seen. Injuries to the lower limb occurred in 239 patients, multiple anatomical sites 224, head 224, upper limb 203, the neck 20, and the abdomen 11 patients. Trauma was due to road traffic accident in 977 patients, fall in 39, assault in 14 while burns and firearm injuries occurred in 5 and 7 patients respectively. The mean injury severity score (ISS) was 4. Severe injuries, ISS > 15 occurred in 54 patients with mean ISS of 21, and resulted from RTA in 92.6% of cases. Mortality from severe injuries occurred in 31.5% of cases while overall mortality was 2%. Most deaths were associated with multiple injuries (60.9%) and head injury (30.4%). Incomplete documentation of accident and injury data occurred frequently, from 2% of some data to 100% of others. CONCLUSIONS: Lacerations and fractures were the most common injuries. Mortality is due usually to head and multiple injuries. Research into appropriate strategies for prevention of injuries, especially RTA, is required but this must start with the establishment of institutional and regional trauma registries for complete documentation of relevant data.