Introduction: Despite the known benefits of newborn follow-up clinics, attendance has historically been difficult. Infants with reported follow-up difficulty have a greater incidence of severe sensorimotor and cogniti...Introduction: Despite the known benefits of newborn follow-up clinics, attendance has historically been difficult. Infants with reported follow-up difficulty have a greater incidence of severe sensorimotor and cognitive deficits and poorer access to early intervention programs. Our objective was to determine the parent-reported reasons for loss-to-follow up in patients hospitalised at the neonatology unit of Laquintinie Hospital. Methodology: We carried out a cross-sectional study through phone interviews with parents/caregivers of patients hospitalised at Laquintinie over a 2-year period from 1st January 2021 to 31st December 2022. A non-standardised structured interview guide was used for data collection. Loss-to-follow up referred to absence to at least one visit as recorded in the neonatal follow-up chart. All necessary administrative and ethical considerations were duly respected. Results: Most neonates were born through vaginal delivery (n = 313, 69.45%). The neonates were admitted at a median gestational age of 33 weeks (Q1-Q3;32 - 35) and the median duration of hospitalisation was 12 days (Q1 - Q3;8 - 18). A total of 23 neonates had died at the time of interview giving a mortality rate of 5.1%. The three most reported reasons for loss-to-follow-up was lack of money (n = 310, 68.13%), assumption that follow-up had ended (n = 37, 8.13%), and newborn that died (n = 23, 5.1%). Conclusion: This study highlights the significant impact of financial constraints and absence of a robust follow-up system on poor uptake of neonatal follow-up post-discharge in resource limited settings like Cameroon. Our results serve as advocacy for national health insurance especially in neonates.展开更多
BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with si...BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.展开更多
AIM:To review the management of cataract in children in a tertiary hospital in a developing country,and to highlight the challenges therein.· METHODS:The hospital records of children aged 15 years or less that ha...AIM:To review the management of cataract in children in a tertiary hospital in a developing country,and to highlight the challenges therein.· METHODS:The hospital records of children aged 15 years or less that had cataract surgery at University of Nigeria Teaching Hospital,Enugu from 2005 to 2008 were reviewed retrospectively.Information was obtained on bio-data,pre-and post-operative visual acuity(VA),biometry,and type of surgery,use of intraocular lens(IOL) and presence of co-morbidity.SPSS was used for data entry and analysis.· RESULTS:The hospital records of 21 children(26 eyes) were analyzed.There were 12 males(57.1%) and 9 females(42.9%).Pre-operative VA could not be assessed in 11 eyes(42.3%),14 eyes(53.9%) had VA <3/60 and one eye(3.8%) had VA 6/60.Biometry was done in only 5 eyes(19.2%).All eyes had standard extracapsular cataract extraction without primary posterior capsulectomy;12 eyes(46.2%) had posterior chamber intraocular lens(PC-IOL) implant while 13 eyes(50.0%) had no IOL.After 12 weeks of follow up,vision assessment was available in only 15 eyes.With best correction,VA of 6/18 or better was achieved in only 5 eyes(33.3%).· CONCLUSION:Inadequate facilities and inadequate follow up after surgery are some of the challenges in managing paediatric cataract in the developing countries.If these challenges are not addressed,cataract will remain a major cause of childhood blindness and low vision in Africa for many years.There should be collaboration between Paediatric Ophthalmology Centres in industrialized and developing countries to enhance skill transfer.Governmental and International Non-governmental Organizations can go a long way to facilitate this exchange.展开更多
This is a report of our early experience in establishing a Paediatric surgical outreach program to Papua New Guinea (PNG) to build capacity and improve care. A Paediatric surgical outreach mission was initiated about ...This is a report of our early experience in establishing a Paediatric surgical outreach program to Papua New Guinea (PNG) to build capacity and improve care. A Paediatric surgical outreach mission was initiated about 4 years ago in collaboration with Singhealth and PNG along with the multidisciplinary team of health care professionals from Cardiology, Cardiothoracic Surgery, Orthopaedics, Urology, Plastics and Anaesthesia. On each mission trip of 4 - 7 days duration, Singhealth doctors supervise or perform surgeries for complex cases, conduct patient consultations and give lectures to impart knowledge and transfer skills to the local health care community in PNG. In addition, a 6 - 12 months training program in Singapore for PNG doctors has been started. For complex cases which cannot be managed in PNG, there is provision for transfer of patients to Singapore under KKROK fund for further treatment. So far 4 mission trips have been conducted in past 4 years for paediatric surgical unit in Port Moresby General Hospital of PNG focussing on teaching and training of local Paediatric surgeons. Based on evaluation of the Singhealth medical team, there is severe shortage of medical manpower, surgical skill and specialised expertise. Due to lack of intensive care facility, adequate medications and proper medical equipment in the hospital, there are many conditions being left untreated causing high morbidity and mortality among infants and neonates. Such humanitarian work inspires Singhealth towards its global health mission of promoting health equity in responding to the medical needs of PNG through training and leveraging on strength through partnership. In addition, our doctors gain invaluable learning from the exposure, hone their skill as they treat a diversity of cases and are innovative in their treatment options by working in an environment with limited resources.展开更多
Congenital heart disease(CHD)affects about 1%of live births.Among them,about 20%will undergo one or more surgical or percutaneous maneuvers on the right ventricle outflow tract or pulmonary valve.Transcatheter pulmona...Congenital heart disease(CHD)affects about 1%of live births.Among them,about 20%will undergo one or more surgical or percutaneous maneuvers on the right ventricle outflow tract or pulmonary valve.Transcatheter pulmonary valve implantation is a recently available less invasive alternative to surgery for treatment of right ventricular outflow tract dysfunction.Thus,residual dysfunction can be treated early and with a lower risk profile.This narrative review aimed to describe the state of the art of percutaneous pulmonary valve implantation.展开更多
Introduction: Females with sickle cell disease (SCD), despite having a delayed pubertal development, are subject to many worries relating to their abilities to conceive, their capacity to maintain a maternofetal-risk-...Introduction: Females with sickle cell disease (SCD), despite having a delayed pubertal development, are subject to many worries relating to their abilities to conceive, their capacity to maintain a maternofetal-risk-free pregnancy till term and give birth to healthy children without sickle cell disease. Knowing that unplanned pregnancies are more likely to increase maternofetal morbidity and mortality, we sought out to explore the pregnancy preferences in female patients with sickle cell disease to promote healthy conception and childbirth in this vulnerable population. Methodology: We conducted a cross-sectional study involving female patients of child-bearing age with sickle cell disease followed at Laquintinie Hospital Douala or who were members of a local sickle cell association. Pregnancy preferences were determined using the Desire to Avoid Pregnancy (DAP) scale. Factors associated with pregnancy preferences were determined using multivariable linear regression model. Threshold for significance was set at p Results: Seventy-seven patients were included with a mean age of 24.71 ± 5.53 years. Forty patients (51.95%) had one sexual partner and thirteen women (32.5%) used contraceptive methods. Most patients (46.0%) responded “Strongly Agree” or “Agree” to the statement “it would be a good thing for me if I became pregnant in the next 3 months”. The mean DAP score was 1.63 ± 0.91 [1.28 ± 0.82 in those who had a sexual partner and 1.99 ± 0.86 in those who had no sexual partner]. Factors that were positively associated with DAP score were students (b = 0.32, 95% CI [0.21, 0.95], p = 0.003), monthly income ≥ 100,000 FCFA (b = 0.24, 95% CI [0.07, 0.81], p = 0.022), and not having a sexual partner (b = 0.26, 95% CI [0.11, 0.85], p = 0.012). Conclusion: Most female patients with SCD have a low desire to avoid pregnancy. This is especially true for patients who are not students, have a partner and have a low monthly income.展开更多
Growth retardation is a significant complication observed in pediatric renal transplant recipients,originating from a multifactorial etiology.Factors contributing to growth impairment encompass pre-transplant conditio...Growth retardation is a significant complication observed in pediatric renal transplant recipients,originating from a multifactorial etiology.Factors contributing to growth impairment encompass pre-transplant conditions such as primary kidney disease,malnutrition,quality of care,growth deficits at the time of transplantation,dialysis adequacy,and the use of recombinant human growth hormone.Additionally,elements related to the renal transplant itself,such as living donors,corticosteroid usage,and graft functioning,further compound the challenge.Although renal transplantation is the preferred renal replacement therapy,its impact on achieving final height and normal growth in children remains uncertain.The consequences of growth delay extend beyond the physi-ological realm,negatively influencing the quality of life and social conditions of pediatric renal transplant recipients,and ultimately affecting their educational and employment outcomes.Despite advancements in graft survival rates,growth retardation remains a formidable clinical concern among children undergoing renal transplantation.Major risk factors for delayed final adult height include young age at transplantation,pre-existing short stature,and the use of specific immunosuppressive drugs,particularly steroids.Effective management of growth retardation necessitates early intervention,commencing even before transplantation.Strategies involving the administration of recombinant growth hormone both pre-and post-transplant,along with protocols aimed at minimizing steroid usage,are important for achieving catch-up growth.This review provides a comprehensive outline of the multifaceted nature of growth retardation in pediatric renal transplant recipients,emphasizing the importance of early and targeted interventions to mitigate its impact on the long-term well-being of these children from birth to adolescence.INTRODUCTION Children with chronic kidney disease(CKD)endure frequent hospitalizations and ongoing treatment,which significantly affect their quality of life.One of the most noticeable effects of CKD in children is poor growth,with stunted height being a common sign of chronic malnutrition.Growth assessment involves regularly measuring weight and height/length and comparing these against z-score charts,along with other anthropometric indicators like head circumference and mid-upper arm circumference.Data from the North American Pediatric Renal Trials and Collaborative Studies(NAPRTCS)registry shows that over 35%of children enrolled had stunted growth at the time of admission,with growth impairment being more severe in younger children(58%in those aged under 1 year,compared to 22%in those aged over 12 years).Additionally,the same data revealed that growth impairment worsens as the severity of the disease increases.Although recent advances in science have enabled better outcomes for children with CKD,in resource-limited settings,numerous children are still deprived of achieving optimal growth owing to the disease and its related factors.Stunting is a key indicator of chronic growth impairment in children.A study by Wong et al[1]in the United States Renal Data System found that each SD decrease in height among children with stage V CKD is linked to a 14%increase in the risk of death[1].Similarly,research by Furth et al[2]using data from the NAPRTCS indicated that children with a height standard deviation score(SDS)of-2.5 face a relative hazard of death of 2.07.Stunting also correlates with increased hospitalizations.A study in the United States followed 1112 pediatric patients with end-stage renal disease from 1990 to 1995.It showed that children with severe or moderate growth failure had higher hospitalization rates compared to those with normal growth.Specifically,the relative risk for hospitalization was 1.14(95%CI:1.1-1.2)for those with moderate growth failure and 1.24(95%CI:1.2-1.3)for those with severe growth failure,even after adjusting for age,sex,race,cause,and duration of end-stage renal disease,and treatment type[2](dialysis or transplant).The growth of a child significantly affects his/her psychological and overall well-being as an adult.Short children are often embarrassed by peers,and it has been observed that height influences employment status,with unemployment being more prevalent among stunted individuals.Further,marital opportunities can be fewer among stunted individuals[3].Hence,all measures to achieve adequate growth should be attempted in children with CKD,regardless of whether they undergo transplantation.展开更多
Vertebral involvement in particular is common in sickle cell patients. We report 3 cases of “fish vertebra” fractures in sickle cell patients aged 16, 18, and 24 years old respectively at Laquintinie Hospital, Doual...Vertebral involvement in particular is common in sickle cell patients. We report 3 cases of “fish vertebra” fractures in sickle cell patients aged 16, 18, and 24 years old respectively at Laquintinie Hospital, Douala. When the vertebral fractures were diagnosed, the 3 patients had back pain and kyphosis deformities of the dorsal spine. Treatment with an infusion of biphosphonates (zoledronic acid at a dose of 0.5 mg·per·kg) was offered to all three patients. Two out of three patients received treatment with biphosphonates with a successful outcome. Profound vitamin D deficiency is associated with increased bone remodeling and a history of fractures. In sickle cell anemia, vertebral fractures may also result from bone fragility, which is often overlooked as aseptic osteonecrosis and osteomyelitis, which are very often suspected.展开更多
During the past few decades, scientific evidence has been accumulated concerning the possible adverse effects of the exposure to environmental chemicals on the well-being of wildlife and human populations. One large a...During the past few decades, scientific evidence has been accumulated concerning the possible adverse effects of the exposure to environmental chemicals on the well-being of wildlife and human populations. One large and growing group of such compounds of anthropogenic or natural origin is referred to as endocrine-disrupting chemicals （EDCs）, due to their deleterious action on the endocrine system. This concern was first focused on the control of reproductive function particularly in males, but has later been expanded to include all possible endocrine functions. The present review describes the underlying physiology behind the cascade of developmental events that occur during sexual differentiation of males and the specific role of androgen in the masculinization process and proper organogenesis of the external male genitalia. The impact of the genetic background, environmental exposures and lifestyle factors in the etiology of hypospadias, cryptorchidism and testicular cancer are reviewed and the possible role of EDCs in the development of these reproductive disorders is discussed critically. Finally, the possible direct and programming effects of exposures in utero to widely use therapeutic compounds, environmental estrogens and other chemicals on the incidence of reproductive abnormalities and poor semen quality in humans are also highlighted.展开更多
Constipation in children is a major health issue around the world,with a global prevalence of 9.5%.They present to clinicians with a myriad of clinical signs.The Rome IV symptom-based criteria are used to diagnose fun...Constipation in children is a major health issue around the world,with a global prevalence of 9.5%.They present to clinicians with a myriad of clinical signs.The Rome IV symptom-based criteria are used to diagnose functional constipation.Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children.There are various risk factors identified globally,including centrally connected factors such as child abuse,emotional and behavioral issues,and psychological stress.Constipation is also precipitated by a low-fiber diet,physical inactivity,and an altered intestinal microbiome.The main pathophysiological mechanism is stool withholding,while altered rectal function,anal sphincter,pelvic floor,and colonic dysfunction also play important roles.Clinical evaluation is critical in making a diagnosis,and most investigations are only required in refractory patients.In the treatment of childhood constipation,both nonpharmacological(education and demystification,dietary changes,toilet training,behavioral interventions,biofeedback,and pelvic floor physiotherapy),and pharmacological(osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone)interventions are used.For children with refractory constipation,transanal irrigation,botulinum toxin,neuromodulation,and surgical treatments are reserved.While frequent use of probiotics is still in the experimental stage,healthy dietary habits,living a healthy lifestyle and limiting exposure to stressful events,are all beneficial preventive measures.展开更多
AIMTo evaluate the prevalence, risk factors and outcome of acute kidney injury （AKI） in very low birth weight （VLBW） infants. METHODSIn this retrospective study of VLBW infants, we analyzed the prevalence of AKI, ...AIMTo evaluate the prevalence, risk factors and outcome of acute kidney injury （AKI） in very low birth weight （VLBW） infants. METHODSIn this retrospective study of VLBW infants, we analyzed the prevalence of AKI, as defined by changes in serum creatinine and urine output, associated risk factors and outcomes.RESULTSA total of 293 VLBW infants （mean gestational age 28.7 wk） were included, of whom 109 weighed less than 1000 g at birth. The overall prevalence of AKI was 11.6% （22% in infants with a birth weight under 1000 g and 5.4% those heavier）. A total of 19 （55%） affected infants died, with a mortality rate of 58% in infant less than 1000 g and 50% in those heavier. After adjusting for confounding variables, only necrotizing enterocolitis （NEC） remained associated with AKI, with odds ratio of 4.9 （95%CI： 1.9-18.6）. Blood pressure and glomerular filtration rate （GFR） were not different between affected infants and the others upon discharge from hospital. A normal GFR was documented in all affected infants at one year of age.CONCLUSION Using Kidney Disease Improving Global Outcomes defnition of AKI, it occurred in over 10% of VLBW infants, more commonly in infants with lower birth weight. NEC was an independent associated risk factor. Renal function, as defined by GFR, was normal in all surviving affected infants 10 to 12 mo later.展开更多
Thyroid hemiagenesis is a rare form of thyroid dysgenesis of which some familial cases have been reported, including one associated with a heterozygous mutation in the Pax8 gene. However, the physiopathology remains n...Thyroid hemiagenesis is a rare form of thyroid dysgenesis of which some familial cases have been reported, including one associated with a heterozygous mutation in the Pax8 gene. However, the physiopathology remains not well known. The objectives of this study were 1) to describe the clinical features, 2) to look for familial clustering, and 3) to search for Pax8 mutations in a relatively large cohort of affected patients. A family history of thyroid dysgenesis was found in nine patients (40% ), whose affected relatives had ectopic thyroid (n = 4), athyreosis (n = 1), thyroid hemiagenesis (n = 2), or thyroglossal duct cysts (n = 2). Screening for Pax8 mutations identified abnormal migration profiles by SSCP analysis in 3 patients, but direct sequencing did not show coding region mutations in any of the 22 patients. In conclusion, this study provides the first evidence that thyroid hemiagenesis can occur as a familial disorder associated with any form of thyroid dysgenesis. This finding supports both a common underlying mechanism to the various abnormalities in thyroid development and a role for genetic factors; however, our results from Pax8 analysis suggest that this gene may not be a key factor.展开更多
BACKGROUND Staphylococcus caprae(S.caprae)is a human commensal bacterium which can be detected in the nose,nails,and skin.It can be responsible for heterogeneous infections such as bacteremia,endocarditis,pneumonia,ac...BACKGROUND Staphylococcus caprae(S.caprae)is a human commensal bacterium which can be detected in the nose,nails,and skin.It can be responsible for heterogeneous infections such as bacteremia,endocarditis,pneumonia,acute otitis externa,peritonitis,and urinary tract infections.Bone and joint infections due to S.caprae have also been reported,but most of them resulted from the infection of orthopedic devices,especially joint prostheses and internal osteosynthesis devices.Rare cases of primary osteoarticular infections caused by S.caprae have been described,including osteitis,arthritis,or spondylodiscitis.CASE SUMMARY We report an unusual case of subacute osteomyelitis in a toe phalanx caused by S.caprae in a 14.5-year-old girl.CONCLUSION Subacute S.caprae osteomyelitis is a little-known and probably underestimated community-acquired infectious disease.This microorganism’s pathogenicity should be seen as more than a classic nosocomial orthopedic device infection.展开更多
Aim: To determine the prevalence and risk factor of infectious spondylodiscitis in children in Benin. Patients and Method: A descriptive cross-sectional study over 5 years was conducted in rheumatology and paediatric ...Aim: To determine the prevalence and risk factor of infectious spondylodiscitis in children in Benin. Patients and Method: A descriptive cross-sectional study over 5 years was conducted in rheumatology and paediatric departments of National Hospital University Hubert Koutoukou Maga of Cotonou among children suffered from osteoarticular disorders. We selected patients with infectious spondylodyscitis. The data collected were analyzed using SPSS 20.0 software. Results: Among 179 children treated for osteo-articular disorders, 29 (16.2%) had infectious spondylodiscitis. There were 11 girls and 18 boys (sex ratio = 1.55). The main symptoms were dominated by low back pain (72.4). Fever was present in 58.6% of patients. Laboratory parameters of inflammation were higher than normal in all of the patients. Paraparesia was present in one case. L2-L3 disc was most affected (45.2% of cases). Mycobacterium tuberculosis was incriminated in 75,8%. Common places germs were dominated by negative baccillus germs (62.5%). The treatment was medical with a minimum duration of 3 months. All patients were immobilized with a lumbostat over a period of 3 months. Sicle cells disease, HIV, no BCG vaccination were the risk factors identified respectively in 9.4%, 11.3% and 16%. Conclusion: Diagnosis of spondylodiscitis in children is difficult in our country Keeping in mind unspecific subjective complaints and clinical findings. Early diagnosis uses magnetic resonance imaging which cost high and remains beyond the reach of our patients. Therefore, effective antibiotic therapy should be started promptly as soon as the diagnosis is suspected to avoid serious complications.展开更多
Type 1 Diabetes Mellitus remains one of the most complex chronic diseases in childhood. Although advances in knowledge and technology, as the use of insulin pumps or glucose sensors, have improved the quality of life ...Type 1 Diabetes Mellitus remains one of the most complex chronic diseases in childhood. Although advances in knowledge and technology, as the use of insulin pumps or glucose sensors, have improved the quality of life of patients, the onset of the disease, as well as long-term treatment and diet, are pitfalls for families and clinicians. It is important to bear in mind that acute, life-threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis, both in new diagnosis and in patients already on treatment, and may be hidden by other symptoms. Moreover, treatment with insulin and diet should always be tailored on lifestyle habits and age of the patient. Aim of this work is to briefly summarise and comment what are the worst insidious aspects of Diabetes and what are the best strategies to improve the management of the disease in childhood.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic impacted in a still undefined way pregnant women’s mental health.There are reports of mood and affect changes in the general population and the suggestion tha...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic impacted in a still undefined way pregnant women’s mental health.There are reports of mood and affect changes in the general population and the suggestion that similar changes occur also in the pregnant population.The greater vulnerability of women during the COVID-19 restriction period may translate into a greater risk for mental disorders in the gestational period.We hypothesised that pregnant women in the prepandemic period would have less psychopathology and more psychological support than pregnant women during the pandemic restriction period.AIM To compare pregnant women for anxiety,prenatal depression,psychopathology,and social support before and after the awareness of the pandemic.METHODSWe administered to women willing to participate in their 2nd-3rd trimesters of pregnancy theEdinburgh Postnatal Depression Scale(EPDS),the State-Trait Anxiety Inventory Form Y(STAI-Y),and the Symptom CheckList-90-Revised(SCL-90R);we further collected sociodemographicvariables and explored women’s social support.The comparison was cross-sectional.The firstsample was termed nonCOVID-19 because data were gathered before the COVID-19 outbreak(January 2020-February 2020)was declared,and the second sample termed COVID-19 becauseparticipants were already subjected to the COVID-19-related restrictive measures(January 2021-February 2021).Since normal distribution was not met(Shapiro-Wilk test applied),we appliednonparametric Mann-Whitney’s U-test to compare psychometric tests.Ethical standards were met.RESULTSThe nonCOVID-19 group reported higher support from partners only,while the COVID-19 groupreported multiple support(χ^(2)=9.7181;P=0.021);the nonCOVID-19 group scored higher than theCOVID-19 group only on state anxiety among psychometric scales[STAI-Y1,nonCOVID-19median=39(95%CI:39.19-51.10)vs COVID-19 median=32(95%CI:30.83-38.90);Mann-Whitney’sU=117.5,P=0.00596].Other measures did not differ meaningfully between the two groups.Scoreson the EPDS,the state and trait subscales of the STAI-Y,and most SCL-90R subscales intercorrelatedwith one another.The anxiety component of the EPDS,EPDS-3A,correlated poorlywith other measures,while it was the Global Symptom Index of the SCL-90-R that correlated moststrongly with most measures.Our results are at odds with most literature and do not confirmincreased depression and anxiety rates in pregnant women during the pandemic.CONCLUSIONThe ability of pregnant women to deal with novel generalised threats involves mobilization ofinner resources.Increasing sources of social support may have produced anxiolysis in the COVID-19 sample.展开更多
Nigeria has a very high number of sickle cell disease (SCD) population with addition of 150,000 babies born annually with the disease. Early infant diagnosis and good care make many of these babies survive to adulthoo...Nigeria has a very high number of sickle cell disease (SCD) population with addition of 150,000 babies born annually with the disease. Early infant diagnosis and good care make many of these babies survive to adulthood. Severe pain requiring moderately strong or very strong analgesics is a common presentation of patients with Sickle Cell Anaemia. Paediatricians find ready usefulness of Opioids which are very useful for the painful episodes among these patients. Therefore, the chances of abuse and addiction to these medications become very high and constitute additional burden on the deficient manpower in the health sector. Opioid Use Disorder among Sickle Cell Disease patients has subtle presentation, so a high index of suspicion is required to make both the diagnosis and referral to treatment centres. In this review, the epidemiology, pain pathophysiology, behavioural and pharmacologic therapy have been re-examined.展开更多
Background: Circumcision is the removal of the fore skin of the penis. It is one of the commonest operations performed worldwide. Meatal stenosis is an uncommon long-term complication of circumcision that can lead to ...Background: Circumcision is the removal of the fore skin of the penis. It is one of the commonest operations performed worldwide. Meatal stenosis is an uncommon long-term complication of circumcision that can lead to problems voiding. Aim: To identify the clinical presentations and management of meatal stenosis in Port Harcourt. Materials and Methods: This was a retrospective study of patients who presented with features of meatal stenosis between January 2012 and December 2021. The patients’ history, physical examination findings, investigations and treatment received were analysed. Results: A total of 52 patients with features of meatal stenosis were recruited for the study. The number of patients less than a year old, between a year and 5 years, between 6 and 10 years and greater than 11 years were 8, 12, 28 and 4 respectively. Only 8 patients presented within 6 months of onset of symptoms. The most common symptom was poor urine stream, followed by straining. Meatotomy was the most commonly performed procedure for meatal stenosis 24 (46.15%). The patients were followed up for at least 6 months. Six patients had recurrence after treatment of meatal stenosis. Three patients each had a recurrence following dilatation and meatotomy. No patient had recurrence after meatoplasty. Conclusion: Meatal stenosis is an uncommon complication post circumcision. Patients usually present late to the hospital in our study. Meatoplasty had the best outcome. After treatment of meatal stenosis patients should be followed up for 6 months.展开更多
Background: Prune belly syndrome (PBS) is a congenital anomaly that consists of a triad of abdominal wall defect, bilateral cryptorchidism, and urinary tract dilation. The disease is of varying severity. This study ai...Background: Prune belly syndrome (PBS) is a congenital anomaly that consists of a triad of abdominal wall defect, bilateral cryptorchidism, and urinary tract dilation. The disease is of varying severity. This study aims to highlight the challenges and peculiarities in the management of PBS in a resource-poor setting. Materials and Methods: This is a ten-year retrospective study conducted at the University of Port Harcourt Teaching Hospital. Ethical approval for the study was sought and gotten from the hospital’s ethical committee. The information gotten included history, duration of symptoms, examination findings, age of the patient, category of disease, and intraoperative findings. The data from the folders were collected and evaluated. Frequencies, percentages, the mean and standard deviation were used to summarize the data as appropriate. Results: Fifteen patients were included in the study. The hospital incidence of PBS was 112/100,000, twelve males and three females. The age range was from 1 day to 15 years, mean age was 14 months ± 2.3 months. Most patients presented between 3 months and 2 years and 11 months. Twelve patients had category three PBS and five patients had associated anomalies. Eleven male patients died after 5 years of follow-up from progressive renal deterioration. The female patient fared better than the males. Conclusion: PBS is rare, most patients with the condition present late. The most common cause of mortality was progressive renal deterioration.展开更多
Introduction: Musculoskeletal injuries are common in children but rarely severe. Their treatment varies according to the type of injury observed. The aim was to describe the epidemiological and therapeutic aspects of ...Introduction: Musculoskeletal injuries are common in children but rarely severe. Their treatment varies according to the type of injury observed. The aim was to describe the epidemiological and therapeutic aspects of severe musculoskeletal injuries in children during play. Patients and Methods: This was a retrospective descriptive study conducted in the Orthopaedic-Traumatology Department and the Paediatric Surgery Unit of the University Hospital of Bouaké between January 2018 and December 2020. It concerned patients less than 16 years of age hospitalised for more than 24 hours for a musculoskeletal trauma following a gambling accident. The variables studied were epidemiological and therapeutic. Results: A total of 53 patients were collected. The frequency was 2.9%. The mean age was 9 ± 3.99 years. There were 38 (71.7%) boys and 15 (28.3%) girls. The sex ratio was 2.5. The patients were attending school in 79.3% (n = 42). The circumstances of occurrence were dominated by falls during play accidents (n = 35;66%). Football was observed in 93.5% (n = 49). The thoracic limb (n = 35;66%) was the preferred site of these injuries. The injuries were closed (86.7%) with a predominance of forearm fractures (n = 22;41.6%). The average hospital stay was 2.8 ± 1.4 days. Most of the patients were treated orthopedically (n = 37;69.9%). The evolution was favourable without complications. Conclusion: Musculoskeletal injuries during play were infrequent (2.9%). The circumstances were dominated by falls during play. The injuries were mainly closed fractures, most of which were treated orthopedically.展开更多
文摘Introduction: Despite the known benefits of newborn follow-up clinics, attendance has historically been difficult. Infants with reported follow-up difficulty have a greater incidence of severe sensorimotor and cognitive deficits and poorer access to early intervention programs. Our objective was to determine the parent-reported reasons for loss-to-follow up in patients hospitalised at the neonatology unit of Laquintinie Hospital. Methodology: We carried out a cross-sectional study through phone interviews with parents/caregivers of patients hospitalised at Laquintinie over a 2-year period from 1st January 2021 to 31st December 2022. A non-standardised structured interview guide was used for data collection. Loss-to-follow up referred to absence to at least one visit as recorded in the neonatal follow-up chart. All necessary administrative and ethical considerations were duly respected. Results: Most neonates were born through vaginal delivery (n = 313, 69.45%). The neonates were admitted at a median gestational age of 33 weeks (Q1-Q3;32 - 35) and the median duration of hospitalisation was 12 days (Q1 - Q3;8 - 18). A total of 23 neonates had died at the time of interview giving a mortality rate of 5.1%. The three most reported reasons for loss-to-follow-up was lack of money (n = 310, 68.13%), assumption that follow-up had ended (n = 37, 8.13%), and newborn that died (n = 23, 5.1%). Conclusion: This study highlights the significant impact of financial constraints and absence of a robust follow-up system on poor uptake of neonatal follow-up post-discharge in resource limited settings like Cameroon. Our results serve as advocacy for national health insurance especially in neonates.
文摘BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.
文摘AIM:To review the management of cataract in children in a tertiary hospital in a developing country,and to highlight the challenges therein.· METHODS:The hospital records of children aged 15 years or less that had cataract surgery at University of Nigeria Teaching Hospital,Enugu from 2005 to 2008 were reviewed retrospectively.Information was obtained on bio-data,pre-and post-operative visual acuity(VA),biometry,and type of surgery,use of intraocular lens(IOL) and presence of co-morbidity.SPSS was used for data entry and analysis.· RESULTS:The hospital records of 21 children(26 eyes) were analyzed.There were 12 males(57.1%) and 9 females(42.9%).Pre-operative VA could not be assessed in 11 eyes(42.3%),14 eyes(53.9%) had VA <3/60 and one eye(3.8%) had VA 6/60.Biometry was done in only 5 eyes(19.2%).All eyes had standard extracapsular cataract extraction without primary posterior capsulectomy;12 eyes(46.2%) had posterior chamber intraocular lens(PC-IOL) implant while 13 eyes(50.0%) had no IOL.After 12 weeks of follow up,vision assessment was available in only 15 eyes.With best correction,VA of 6/18 or better was achieved in only 5 eyes(33.3%).· CONCLUSION:Inadequate facilities and inadequate follow up after surgery are some of the challenges in managing paediatric cataract in the developing countries.If these challenges are not addressed,cataract will remain a major cause of childhood blindness and low vision in Africa for many years.There should be collaboration between Paediatric Ophthalmology Centres in industrialized and developing countries to enhance skill transfer.Governmental and International Non-governmental Organizations can go a long way to facilitate this exchange.
文摘This is a report of our early experience in establishing a Paediatric surgical outreach program to Papua New Guinea (PNG) to build capacity and improve care. A Paediatric surgical outreach mission was initiated about 4 years ago in collaboration with Singhealth and PNG along with the multidisciplinary team of health care professionals from Cardiology, Cardiothoracic Surgery, Orthopaedics, Urology, Plastics and Anaesthesia. On each mission trip of 4 - 7 days duration, Singhealth doctors supervise or perform surgeries for complex cases, conduct patient consultations and give lectures to impart knowledge and transfer skills to the local health care community in PNG. In addition, a 6 - 12 months training program in Singapore for PNG doctors has been started. For complex cases which cannot be managed in PNG, there is provision for transfer of patients to Singapore under KKROK fund for further treatment. So far 4 mission trips have been conducted in past 4 years for paediatric surgical unit in Port Moresby General Hospital of PNG focussing on teaching and training of local Paediatric surgeons. Based on evaluation of the Singhealth medical team, there is severe shortage of medical manpower, surgical skill and specialised expertise. Due to lack of intensive care facility, adequate medications and proper medical equipment in the hospital, there are many conditions being left untreated causing high morbidity and mortality among infants and neonates. Such humanitarian work inspires Singhealth towards its global health mission of promoting health equity in responding to the medical needs of PNG through training and leveraging on strength through partnership. In addition, our doctors gain invaluable learning from the exposure, hone their skill as they treat a diversity of cases and are innovative in their treatment options by working in an environment with limited resources.
文摘Congenital heart disease(CHD)affects about 1%of live births.Among them,about 20%will undergo one or more surgical or percutaneous maneuvers on the right ventricle outflow tract or pulmonary valve.Transcatheter pulmonary valve implantation is a recently available less invasive alternative to surgery for treatment of right ventricular outflow tract dysfunction.Thus,residual dysfunction can be treated early and with a lower risk profile.This narrative review aimed to describe the state of the art of percutaneous pulmonary valve implantation.
文摘Introduction: Females with sickle cell disease (SCD), despite having a delayed pubertal development, are subject to many worries relating to their abilities to conceive, their capacity to maintain a maternofetal-risk-free pregnancy till term and give birth to healthy children without sickle cell disease. Knowing that unplanned pregnancies are more likely to increase maternofetal morbidity and mortality, we sought out to explore the pregnancy preferences in female patients with sickle cell disease to promote healthy conception and childbirth in this vulnerable population. Methodology: We conducted a cross-sectional study involving female patients of child-bearing age with sickle cell disease followed at Laquintinie Hospital Douala or who were members of a local sickle cell association. Pregnancy preferences were determined using the Desire to Avoid Pregnancy (DAP) scale. Factors associated with pregnancy preferences were determined using multivariable linear regression model. Threshold for significance was set at p Results: Seventy-seven patients were included with a mean age of 24.71 ± 5.53 years. Forty patients (51.95%) had one sexual partner and thirteen women (32.5%) used contraceptive methods. Most patients (46.0%) responded “Strongly Agree” or “Agree” to the statement “it would be a good thing for me if I became pregnant in the next 3 months”. The mean DAP score was 1.63 ± 0.91 [1.28 ± 0.82 in those who had a sexual partner and 1.99 ± 0.86 in those who had no sexual partner]. Factors that were positively associated with DAP score were students (b = 0.32, 95% CI [0.21, 0.95], p = 0.003), monthly income ≥ 100,000 FCFA (b = 0.24, 95% CI [0.07, 0.81], p = 0.022), and not having a sexual partner (b = 0.26, 95% CI [0.11, 0.85], p = 0.012). Conclusion: Most female patients with SCD have a low desire to avoid pregnancy. This is especially true for patients who are not students, have a partner and have a low monthly income.
文摘Growth retardation is a significant complication observed in pediatric renal transplant recipients,originating from a multifactorial etiology.Factors contributing to growth impairment encompass pre-transplant conditions such as primary kidney disease,malnutrition,quality of care,growth deficits at the time of transplantation,dialysis adequacy,and the use of recombinant human growth hormone.Additionally,elements related to the renal transplant itself,such as living donors,corticosteroid usage,and graft functioning,further compound the challenge.Although renal transplantation is the preferred renal replacement therapy,its impact on achieving final height and normal growth in children remains uncertain.The consequences of growth delay extend beyond the physi-ological realm,negatively influencing the quality of life and social conditions of pediatric renal transplant recipients,and ultimately affecting their educational and employment outcomes.Despite advancements in graft survival rates,growth retardation remains a formidable clinical concern among children undergoing renal transplantation.Major risk factors for delayed final adult height include young age at transplantation,pre-existing short stature,and the use of specific immunosuppressive drugs,particularly steroids.Effective management of growth retardation necessitates early intervention,commencing even before transplantation.Strategies involving the administration of recombinant growth hormone both pre-and post-transplant,along with protocols aimed at minimizing steroid usage,are important for achieving catch-up growth.This review provides a comprehensive outline of the multifaceted nature of growth retardation in pediatric renal transplant recipients,emphasizing the importance of early and targeted interventions to mitigate its impact on the long-term well-being of these children from birth to adolescence.INTRODUCTION Children with chronic kidney disease(CKD)endure frequent hospitalizations and ongoing treatment,which significantly affect their quality of life.One of the most noticeable effects of CKD in children is poor growth,with stunted height being a common sign of chronic malnutrition.Growth assessment involves regularly measuring weight and height/length and comparing these against z-score charts,along with other anthropometric indicators like head circumference and mid-upper arm circumference.Data from the North American Pediatric Renal Trials and Collaborative Studies(NAPRTCS)registry shows that over 35%of children enrolled had stunted growth at the time of admission,with growth impairment being more severe in younger children(58%in those aged under 1 year,compared to 22%in those aged over 12 years).Additionally,the same data revealed that growth impairment worsens as the severity of the disease increases.Although recent advances in science have enabled better outcomes for children with CKD,in resource-limited settings,numerous children are still deprived of achieving optimal growth owing to the disease and its related factors.Stunting is a key indicator of chronic growth impairment in children.A study by Wong et al[1]in the United States Renal Data System found that each SD decrease in height among children with stage V CKD is linked to a 14%increase in the risk of death[1].Similarly,research by Furth et al[2]using data from the NAPRTCS indicated that children with a height standard deviation score(SDS)of-2.5 face a relative hazard of death of 2.07.Stunting also correlates with increased hospitalizations.A study in the United States followed 1112 pediatric patients with end-stage renal disease from 1990 to 1995.It showed that children with severe or moderate growth failure had higher hospitalization rates compared to those with normal growth.Specifically,the relative risk for hospitalization was 1.14(95%CI:1.1-1.2)for those with moderate growth failure and 1.24(95%CI:1.2-1.3)for those with severe growth failure,even after adjusting for age,sex,race,cause,and duration of end-stage renal disease,and treatment type[2](dialysis or transplant).The growth of a child significantly affects his/her psychological and overall well-being as an adult.Short children are often embarrassed by peers,and it has been observed that height influences employment status,with unemployment being more prevalent among stunted individuals.Further,marital opportunities can be fewer among stunted individuals[3].Hence,all measures to achieve adequate growth should be attempted in children with CKD,regardless of whether they undergo transplantation.
文摘Vertebral involvement in particular is common in sickle cell patients. We report 3 cases of “fish vertebra” fractures in sickle cell patients aged 16, 18, and 24 years old respectively at Laquintinie Hospital, Douala. When the vertebral fractures were diagnosed, the 3 patients had back pain and kyphosis deformities of the dorsal spine. Treatment with an infusion of biphosphonates (zoledronic acid at a dose of 0.5 mg·per·kg) was offered to all three patients. Two out of three patients received treatment with biphosphonates with a successful outcome. Profound vitamin D deficiency is associated with increased bone remodeling and a history of fractures. In sickle cell anemia, vertebral fractures may also result from bone fragility, which is often overlooked as aseptic osteonecrosis and osteomyelitis, which are very often suspected.
文摘During the past few decades, scientific evidence has been accumulated concerning the possible adverse effects of the exposure to environmental chemicals on the well-being of wildlife and human populations. One large and growing group of such compounds of anthropogenic or natural origin is referred to as endocrine-disrupting chemicals （EDCs）, due to their deleterious action on the endocrine system. This concern was first focused on the control of reproductive function particularly in males, but has later been expanded to include all possible endocrine functions. The present review describes the underlying physiology behind the cascade of developmental events that occur during sexual differentiation of males and the specific role of androgen in the masculinization process and proper organogenesis of the external male genitalia. The impact of the genetic background, environmental exposures and lifestyle factors in the etiology of hypospadias, cryptorchidism and testicular cancer are reviewed and the possible role of EDCs in the development of these reproductive disorders is discussed critically. Finally, the possible direct and programming effects of exposures in utero to widely use therapeutic compounds, environmental estrogens and other chemicals on the incidence of reproductive abnormalities and poor semen quality in humans are also highlighted.
文摘Constipation in children is a major health issue around the world,with a global prevalence of 9.5%.They present to clinicians with a myriad of clinical signs.The Rome IV symptom-based criteria are used to diagnose functional constipation.Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children.There are various risk factors identified globally,including centrally connected factors such as child abuse,emotional and behavioral issues,and psychological stress.Constipation is also precipitated by a low-fiber diet,physical inactivity,and an altered intestinal microbiome.The main pathophysiological mechanism is stool withholding,while altered rectal function,anal sphincter,pelvic floor,and colonic dysfunction also play important roles.Clinical evaluation is critical in making a diagnosis,and most investigations are only required in refractory patients.In the treatment of childhood constipation,both nonpharmacological(education and demystification,dietary changes,toilet training,behavioral interventions,biofeedback,and pelvic floor physiotherapy),and pharmacological(osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone)interventions are used.For children with refractory constipation,transanal irrigation,botulinum toxin,neuromodulation,and surgical treatments are reserved.While frequent use of probiotics is still in the experimental stage,healthy dietary habits,living a healthy lifestyle and limiting exposure to stressful events,are all beneficial preventive measures.
文摘AIMTo evaluate the prevalence, risk factors and outcome of acute kidney injury （AKI） in very low birth weight （VLBW） infants. METHODSIn this retrospective study of VLBW infants, we analyzed the prevalence of AKI, as defined by changes in serum creatinine and urine output, associated risk factors and outcomes.RESULTSA total of 293 VLBW infants （mean gestational age 28.7 wk） were included, of whom 109 weighed less than 1000 g at birth. The overall prevalence of AKI was 11.6% （22% in infants with a birth weight under 1000 g and 5.4% those heavier）. A total of 19 （55%） affected infants died, with a mortality rate of 58% in infant less than 1000 g and 50% in those heavier. After adjusting for confounding variables, only necrotizing enterocolitis （NEC） remained associated with AKI, with odds ratio of 4.9 （95%CI： 1.9-18.6）. Blood pressure and glomerular filtration rate （GFR） were not different between affected infants and the others upon discharge from hospital. A normal GFR was documented in all affected infants at one year of age.CONCLUSION Using Kidney Disease Improving Global Outcomes defnition of AKI, it occurred in over 10% of VLBW infants, more commonly in infants with lower birth weight. NEC was an independent associated risk factor. Renal function, as defined by GFR, was normal in all surviving affected infants 10 to 12 mo later.
文摘Thyroid hemiagenesis is a rare form of thyroid dysgenesis of which some familial cases have been reported, including one associated with a heterozygous mutation in the Pax8 gene. However, the physiopathology remains not well known. The objectives of this study were 1) to describe the clinical features, 2) to look for familial clustering, and 3) to search for Pax8 mutations in a relatively large cohort of affected patients. A family history of thyroid dysgenesis was found in nine patients (40% ), whose affected relatives had ectopic thyroid (n = 4), athyreosis (n = 1), thyroid hemiagenesis (n = 2), or thyroglossal duct cysts (n = 2). Screening for Pax8 mutations identified abnormal migration profiles by SSCP analysis in 3 patients, but direct sequencing did not show coding region mutations in any of the 22 patients. In conclusion, this study provides the first evidence that thyroid hemiagenesis can occur as a familial disorder associated with any form of thyroid dysgenesis. This finding supports both a common underlying mechanism to the various abnormalities in thyroid development and a role for genetic factors; however, our results from Pax8 analysis suggest that this gene may not be a key factor.
文摘BACKGROUND Staphylococcus caprae(S.caprae)is a human commensal bacterium which can be detected in the nose,nails,and skin.It can be responsible for heterogeneous infections such as bacteremia,endocarditis,pneumonia,acute otitis externa,peritonitis,and urinary tract infections.Bone and joint infections due to S.caprae have also been reported,but most of them resulted from the infection of orthopedic devices,especially joint prostheses and internal osteosynthesis devices.Rare cases of primary osteoarticular infections caused by S.caprae have been described,including osteitis,arthritis,or spondylodiscitis.CASE SUMMARY We report an unusual case of subacute osteomyelitis in a toe phalanx caused by S.caprae in a 14.5-year-old girl.CONCLUSION Subacute S.caprae osteomyelitis is a little-known and probably underestimated community-acquired infectious disease.This microorganism’s pathogenicity should be seen as more than a classic nosocomial orthopedic device infection.
文摘Aim: To determine the prevalence and risk factor of infectious spondylodiscitis in children in Benin. Patients and Method: A descriptive cross-sectional study over 5 years was conducted in rheumatology and paediatric departments of National Hospital University Hubert Koutoukou Maga of Cotonou among children suffered from osteoarticular disorders. We selected patients with infectious spondylodyscitis. The data collected were analyzed using SPSS 20.0 software. Results: Among 179 children treated for osteo-articular disorders, 29 (16.2%) had infectious spondylodiscitis. There were 11 girls and 18 boys (sex ratio = 1.55). The main symptoms were dominated by low back pain (72.4). Fever was present in 58.6% of patients. Laboratory parameters of inflammation were higher than normal in all of the patients. Paraparesia was present in one case. L2-L3 disc was most affected (45.2% of cases). Mycobacterium tuberculosis was incriminated in 75,8%. Common places germs were dominated by negative baccillus germs (62.5%). The treatment was medical with a minimum duration of 3 months. All patients were immobilized with a lumbostat over a period of 3 months. Sicle cells disease, HIV, no BCG vaccination were the risk factors identified respectively in 9.4%, 11.3% and 16%. Conclusion: Diagnosis of spondylodiscitis in children is difficult in our country Keeping in mind unspecific subjective complaints and clinical findings. Early diagnosis uses magnetic resonance imaging which cost high and remains beyond the reach of our patients. Therefore, effective antibiotic therapy should be started promptly as soon as the diagnosis is suspected to avoid serious complications.
文摘Type 1 Diabetes Mellitus remains one of the most complex chronic diseases in childhood. Although advances in knowledge and technology, as the use of insulin pumps or glucose sensors, have improved the quality of life of patients, the onset of the disease, as well as long-term treatment and diet, are pitfalls for families and clinicians. It is important to bear in mind that acute, life-threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis, both in new diagnosis and in patients already on treatment, and may be hidden by other symptoms. Moreover, treatment with insulin and diet should always be tailored on lifestyle habits and age of the patient. Aim of this work is to briefly summarise and comment what are the worst insidious aspects of Diabetes and what are the best strategies to improve the management of the disease in childhood.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic impacted in a still undefined way pregnant women’s mental health.There are reports of mood and affect changes in the general population and the suggestion that similar changes occur also in the pregnant population.The greater vulnerability of women during the COVID-19 restriction period may translate into a greater risk for mental disorders in the gestational period.We hypothesised that pregnant women in the prepandemic period would have less psychopathology and more psychological support than pregnant women during the pandemic restriction period.AIM To compare pregnant women for anxiety,prenatal depression,psychopathology,and social support before and after the awareness of the pandemic.METHODSWe administered to women willing to participate in their 2nd-3rd trimesters of pregnancy theEdinburgh Postnatal Depression Scale(EPDS),the State-Trait Anxiety Inventory Form Y(STAI-Y),and the Symptom CheckList-90-Revised(SCL-90R);we further collected sociodemographicvariables and explored women’s social support.The comparison was cross-sectional.The firstsample was termed nonCOVID-19 because data were gathered before the COVID-19 outbreak(January 2020-February 2020)was declared,and the second sample termed COVID-19 becauseparticipants were already subjected to the COVID-19-related restrictive measures(January 2021-February 2021).Since normal distribution was not met(Shapiro-Wilk test applied),we appliednonparametric Mann-Whitney’s U-test to compare psychometric tests.Ethical standards were met.RESULTSThe nonCOVID-19 group reported higher support from partners only,while the COVID-19 groupreported multiple support(χ^(2)=9.7181;P=0.021);the nonCOVID-19 group scored higher than theCOVID-19 group only on state anxiety among psychometric scales[STAI-Y1,nonCOVID-19median=39(95%CI:39.19-51.10)vs COVID-19 median=32(95%CI:30.83-38.90);Mann-Whitney’sU=117.5,P=0.00596].Other measures did not differ meaningfully between the two groups.Scoreson the EPDS,the state and trait subscales of the STAI-Y,and most SCL-90R subscales intercorrelatedwith one another.The anxiety component of the EPDS,EPDS-3A,correlated poorlywith other measures,while it was the Global Symptom Index of the SCL-90-R that correlated moststrongly with most measures.Our results are at odds with most literature and do not confirmincreased depression and anxiety rates in pregnant women during the pandemic.CONCLUSIONThe ability of pregnant women to deal with novel generalised threats involves mobilization ofinner resources.Increasing sources of social support may have produced anxiolysis in the COVID-19 sample.
文摘Nigeria has a very high number of sickle cell disease (SCD) population with addition of 150,000 babies born annually with the disease. Early infant diagnosis and good care make many of these babies survive to adulthood. Severe pain requiring moderately strong or very strong analgesics is a common presentation of patients with Sickle Cell Anaemia. Paediatricians find ready usefulness of Opioids which are very useful for the painful episodes among these patients. Therefore, the chances of abuse and addiction to these medications become very high and constitute additional burden on the deficient manpower in the health sector. Opioid Use Disorder among Sickle Cell Disease patients has subtle presentation, so a high index of suspicion is required to make both the diagnosis and referral to treatment centres. In this review, the epidemiology, pain pathophysiology, behavioural and pharmacologic therapy have been re-examined.
文摘Background: Circumcision is the removal of the fore skin of the penis. It is one of the commonest operations performed worldwide. Meatal stenosis is an uncommon long-term complication of circumcision that can lead to problems voiding. Aim: To identify the clinical presentations and management of meatal stenosis in Port Harcourt. Materials and Methods: This was a retrospective study of patients who presented with features of meatal stenosis between January 2012 and December 2021. The patients’ history, physical examination findings, investigations and treatment received were analysed. Results: A total of 52 patients with features of meatal stenosis were recruited for the study. The number of patients less than a year old, between a year and 5 years, between 6 and 10 years and greater than 11 years were 8, 12, 28 and 4 respectively. Only 8 patients presented within 6 months of onset of symptoms. The most common symptom was poor urine stream, followed by straining. Meatotomy was the most commonly performed procedure for meatal stenosis 24 (46.15%). The patients were followed up for at least 6 months. Six patients had recurrence after treatment of meatal stenosis. Three patients each had a recurrence following dilatation and meatotomy. No patient had recurrence after meatoplasty. Conclusion: Meatal stenosis is an uncommon complication post circumcision. Patients usually present late to the hospital in our study. Meatoplasty had the best outcome. After treatment of meatal stenosis patients should be followed up for 6 months.
文摘Background: Prune belly syndrome (PBS) is a congenital anomaly that consists of a triad of abdominal wall defect, bilateral cryptorchidism, and urinary tract dilation. The disease is of varying severity. This study aims to highlight the challenges and peculiarities in the management of PBS in a resource-poor setting. Materials and Methods: This is a ten-year retrospective study conducted at the University of Port Harcourt Teaching Hospital. Ethical approval for the study was sought and gotten from the hospital’s ethical committee. The information gotten included history, duration of symptoms, examination findings, age of the patient, category of disease, and intraoperative findings. The data from the folders were collected and evaluated. Frequencies, percentages, the mean and standard deviation were used to summarize the data as appropriate. Results: Fifteen patients were included in the study. The hospital incidence of PBS was 112/100,000, twelve males and three females. The age range was from 1 day to 15 years, mean age was 14 months ± 2.3 months. Most patients presented between 3 months and 2 years and 11 months. Twelve patients had category three PBS and five patients had associated anomalies. Eleven male patients died after 5 years of follow-up from progressive renal deterioration. The female patient fared better than the males. Conclusion: PBS is rare, most patients with the condition present late. The most common cause of mortality was progressive renal deterioration.
文摘Introduction: Musculoskeletal injuries are common in children but rarely severe. Their treatment varies according to the type of injury observed. The aim was to describe the epidemiological and therapeutic aspects of severe musculoskeletal injuries in children during play. Patients and Methods: This was a retrospective descriptive study conducted in the Orthopaedic-Traumatology Department and the Paediatric Surgery Unit of the University Hospital of Bouaké between January 2018 and December 2020. It concerned patients less than 16 years of age hospitalised for more than 24 hours for a musculoskeletal trauma following a gambling accident. The variables studied were epidemiological and therapeutic. Results: A total of 53 patients were collected. The frequency was 2.9%. The mean age was 9 ± 3.99 years. There were 38 (71.7%) boys and 15 (28.3%) girls. The sex ratio was 2.5. The patients were attending school in 79.3% (n = 42). The circumstances of occurrence were dominated by falls during play accidents (n = 35;66%). Football was observed in 93.5% (n = 49). The thoracic limb (n = 35;66%) was the preferred site of these injuries. The injuries were closed (86.7%) with a predominance of forearm fractures (n = 22;41.6%). The average hospital stay was 2.8 ± 1.4 days. Most of the patients were treated orthopedically (n = 37;69.9%). The evolution was favourable without complications. Conclusion: Musculoskeletal injuries during play were infrequent (2.9%). The circumstances were dominated by falls during play. The injuries were mainly closed fractures, most of which were treated orthopedically.
