Disorders of sex development: Challenges in a low-resource country.

AIM: We aimed to identify the challenges in the management of sexual development abnormalities in a low-resource country. METHODS: The study was retrospective from January 2000 to December 2017 based on patient records from two pediatric surgery departments. Epidemiological, clinical, paraclinical, treatment, and outcome data were studied. RESULTS: We collected data on 13 patients (average age = 7.95 years). The sex of rearing was as follows: three females (23%), 10 males (77%). Atypical genitalia other than hypospadias represented the reason for consultation in 92% of the cases. We could not find complete hormonal analyses; testosterone levels were studied in 69.23% of cases. We found the following disorders of sexual development (DSD): four patients with 46,XX karyotype (30.77%), eight patients with 46,XY karyotype (61.53%), and one patient with 46,XX/XY karyotype. Four patients had medical treatment only, four had surgical treatment only, and one patient had medical and surgical treatment. The medical treatment comprised topical administration of androgen. The surgical treatment consisted of feminizing genitoplasty for one patient and masculinizing genital surgeries for two patients. Six of the 13 patients were lost to follow-up. CONCLUSION: The socioeconomic difficulties of the population and the lack of access to basic diagnostic and paraclinical methods, coupled with the negative cultural representations of the pathology, constitute the challenges in the management of DSD in our practice.

[Extravasation injuries in newborns: our experience about 15 cases]. / Les accidents d'extravasation perfusionnelle chez le nouveau-né : une expérience de 15 cas.

Extravasation injuries are common complications that occur during infusion for diagnostic or therapeutic purposes by the peripheral or central venous catheters. In pediatric settings, iatrogenic extravasations are serious. When they are viewed late, they are sources of functional sequelae. The purpose of this study was to report our experience with the management of iatrogenic extravasations for therapeutic purposes. Between January 2010 and December 2012, fifteen newborns were supported for accidents of infusion of the upper and the lower limbs. The male was mostly affected. The mean age was 3.6days, with extremes of one and nine days. The average birth weight was 2900g. The range was 1200g and 3550g. Serum 10 % glucose and calcium chloride were implicated in all cases. The lesions were seen in the late stages III in six cases and IV in nine cases. The upper limbs were frequently affected. Nine lesions were in the upper limbs and six in the lower limbs. The dorsal surfaces, feet and hands were frequently affected in six and five cases, respectively. Two lesions were in the anterior aspect of the forearm and elbow. Elbows lesions were circular and realized a tourniquet effect. Treatment was conservative in eleven cases: five pro-inflammatory fatty dressings and six alcoholic dressings. The surgery was delayed in four cases. It combined excision-full thickness skin graft, excision-dressing-thin skin grafting, debridement and two-full thickness skin graft for retractable wrist scars. Two deaths were related to associate pathologies. One patient was lost for follow-up. Our results were satisfactory in functional, aesthetic and psychological aspects. Extravasation injuries are serious iatrogenic lesions. If the lesions are seen at an early stage in usual circumstances, in extreme exercise, they are seen late, sometimes at the stage of functional, psychological and cosmetic sequelae. The difficulty of the therapeutic management of these lesions requires prevention through the development of protocols and the permanent training of nursing staff for an efficient practice of infusion.

Epidemiological evaluation of onchocerciasis along Ogun River System, southwest Nigeria.

BACKGROUND & OBJECTIVE: Epidemiological studies were carried out to assess the prevalence and community microfilarial load (CMFL) of onchocerciasis after repeated annual treatment with ivermectin along Ogun river System, southwest Nigeria. METHOD: Skin snips were taken from consented participants in 11 selected communities along the River system. The microfilarial load of the community was estimated. RESULTS: The prevalence and CMFL varied significantly in the communities (p <0.05). The prevalence of onchocerciasis ranged from 19.1 to 45.6%, while the CMFL ranged from 0.11 to 1.03 microfilariae per skin snip. The CMFL recorded was <5 microfilariae per skin snip, i.e. recognized by WHO as threshold value in certifying the communities to be free of onchocerciasis as public health problem, thus, signifying the possibility of onchocerciasis elimination in the study area. CONCLUSION: Efforts should therefore be intensified to achieve improved ivermectin coverage and compliance in annual ivermectin treatment in order to completely eliminate onchocerciasis as a public health problem in the studied communities.

Challenge of pediatric oncology in Africa.

The care of children with malignant solid tumors in sub-Saharan Africa is compromised by resource deficiencies that range from inadequate healthcare budgets and a paucity of appropriately trained personnel, to scarce laboratory facilities and inconsistent drug supplies. Patients face difficulties accessing healthcare, affording investigational and treatment protocols, and attending follow-up. Children routinely present with advanced local and metastatic disease and many children cannot be offered any effective treatment. Additionally, multiple comorbidities, including malaria, tuberculosis, and HIV when added to acute on chronic malnutrition, compound treatment-related toxicities. Survival rates are poor. Pediatric surgical oncology is not yet regarded as a health care priority by governments struggling to achieve their millennium goals. The patterns of childhood solid malignant tumors in Africa are discussed, and the difficulties encountered in their management are highlighted. Three pediatric surgeons from different regions of Africa reflect on their experiences and review the available literature. The overall incidence of pediatric solid malignant tumor is difficult to estimate in Africa because of lack of vital hospital statistics and national cancer registries in most of countries. The reported incidences vary between 5% and 15.5% of all malignant tumors. Throughout the continent, patterns of malignant disease vary with an obvious increase in the prevalence of Burkitt lymphoma (BL) and Kaposi sarcoma in response-increased prevalence of HIV disease. In northern Africa, the most common malignant tumor is leukemia, followed by brain tumors and nephroblastoma or neuroblastoma. In sub-Saharan countries, BL is the commonest tumor followed by nephroblastoma, non-Hodgkin lymphoma, and rhabdomyosarcoma. The overall 5-years survival varied between 5% (in Côte d'Ivoire before 2001) to 34% in Egypt and up to 70% in South Africa. In many reports, the survival rate of patients is not mentioned but is clearly very low in many sub-Saharan Africa countries (Sudan, Nigeria). Late presentation was observed for many tumors like nephroblastoma in Nigeria, 72% were stages III and IV or BL stages III and IV were observed in 40% and 30%, respectively. Africa bears a great burden of childhood cancer. Cancer is now curable in developed countries as survival rates approach 80%, but in Africa, >80% of children still die without access to adequate treatment. Sharpening the needlepoint of surgical expertise will, of itself, not compensate for the major infrastructural deficiencies, but must proceed in tandem with resource development and allow heath planners to realize that pediatric surgical oncology is a cost-effective service that can uplift regional services.

Mycotoxins in food systems in Sub Saharan Africa: A review.

Mycotoxins, toxic secondary metabolites of fungi are now recognised as major cause of food intoxications in Sub Saharan Africa (SSA). Aflatoxins, the most important of the group have been implicated in acute aflatoxicoses, carcinogenicity, growth retardation, neonatal jaundice and immunological suppression in SSA. The hot and humid tropical climate provides ideal condition for growth of toxigenicAspergillus spp, making food contamination to be widespread in SSA, with maize and groundnuts being the most contaminated. The available data suggests that cassava products (the most important African food) are not prone to aflatoxin contamination. Recent data on ochratoxin A produced by species ofAspergillus on grains have indicated the necessity for it to be monitored in SSA. Fumonisins represent the most importantFusarium mycotoxins in SSA, and surveillance data indicate very high contamination rates of almost 100% in maize samples from West Africa. Limited information exists on the occurrence of trichothecenes, while the data currently available suggest that zearalenone contamination seems not to be a problem in SSA. The strategies under investigation to mitigate the mycotoxin problem in SSA include education of the people on the danger of consuming mouldy foods, pre and post harvest management strategies with emphasis on biological control, use of plant products to arrest fungal growth during storage, enterosorbent clay technology, and the search for traditional techniques that could reduce/detoxify mycotoxins during food processing.

The use of powder and essential oil of Cymbopogon citratus against mould deterioration and aflatoxin contamination of "egusi" melon seeds.

Experiments were carried out to determine the potential of using the powder and essential oil from dried ground leaves of Cymbopogon citratus (lemon grass) to control storage deterioration and aflatoxin contamination of melon seeds. Four mould species: Aspergillus flavus, A. niger, A. tamarii and Penicillium citrinum were inoculated in the form of conidia suspension (approx. 10(6) conidia per ml) unto shelled melon seeds. The powdered dry leaves and essential oil from lemon grass were mixed with the inoculated seeds at levels ranging from 1-10 g/100 g seeds and 0.1 to 1.0 ml/100 g seeds respectively. The ground leaves significantly reduced the extent of deterioration in melon seeds inoculated with different fungi compared to the untreated inoculated seeds. The essential oil at 0.1 and 0.25 ml/100 g seeds and ground leaves at 10 g/100 g seeds significantly reduced deterioration and aflatoxin production in shelled melon seeds inoculated with toxigenic A. flavus. At higher dosages (0.5 and 1.0 ml/100 g seeds), the essential oil completely prevented aflatoxin production. After 6 months in farmers' stores, unshelled melon seeds treated with 0.5 ml/ 100 g seeds of essential oil and 10 g/100 g seeds of powdered leaves of C. citratus had significantly lower proportion of visibly diseased seeds and Aspergillus spp. infestation levels and significantly higher seed germination compared to the untreated seeds. The oil content, free fatty acid and peroxide values in seeds protected with essential oil after 6 months did not significantly differ from the values in seeds before storage. The efficacy of the essential oil in preserving the quality of melon seeds in stores was statistically at par with that of fungicide (iprodione) treatment.

Natural occurrence of moulds and aflatoxin B1 in melon seeds from markets in Nigeria.

Shelled melon seeds (Colocynthis citrullus L.) were purchased from markets in randomly selected villages and towns in three states in each of the rain forest (Ogun, Oyo and Osun) and Northern guinea savanna (Kaduna, Niger and Bauchi) zones of Nigeria. The seed samples were analysed for incidence of visibly diseased seeds, moisture content, moulds and aflatoxin B1 contamination. The incidence of diseased seeds ranged from 6.4% to 50.4% in the forest, and 4.3% to 34.3% in the savanna, and the moisture content was 5.6% to 12.6% and 4.5% to 10.3%, respectively. Mould evaluation revealed that Aspergillus was the most frequent genus, followed by Penicillium, Botryodiplodia, Cladosporium and Rhizopus in decreasing sequential order. Aspergillus flavus had the highest individual count in melon seed from both zones. Aflatoxin B1 was detected at levels above 5 microg/kg in 32.2% of samples, while only 3.5% of the samples contained the toxin above the 20 microg/kg Nigerian tolerance level in food. The percentage of samples contaminated with aflatoxin B1 was statistically comparable for the pooled data of villages and towns. The median level of aflatoxin B1 was less than 5 microg/kg in the seed samples, while the mean aflatoxin B1 levels was 14.1 microg/kg in the forest and 13.0 microg/kg in the savanna samples.

Occurrence of aflatoxins and fumonisins in preharvest maize from south-western Nigeria.

A survey was conducted on the incidence of fungi, and the natural occurrence of aflatoxins and fumonisins in preharvest maize from fields in south-western Nigeria. Mycological examinations revealed the predominance of F. verticillioides (Zea mays) (syn. F. moniliforme), occurring in 89.3% of samples with a mean kernel infection of 49.4%, while Aspergillus flavus was isolated from 65% of samples having a mean kernel infection of 6.8%. Aflatoxin B1 was detected in 18.4% of samples with a mean of 22 micrograms kg-1, while aflatoxins B2, G1 and G2 were present in 7.8, 2.9 and 1% of the samples with mean levels of 10, 8 and 7 micrograms kg-1, respectively, in contaminated samples. Total aflatoxins ranged from 3 to 138 micrograms kg-1 in positive samples, with a mean of 28 micrograms kg-1. Fumonsin B1 was the predominant toxin detected in terms of frequency (78.6% of samples) and quantity (concentration range 70-1780 micrograms kg-1, mean = 495 micrograms kg-1). Fumonisin B2 was detected in 68 samples (66%) with a mean of 114 micrograms kg-1. Fifteen samples were contaminated with both aflatoxins and fumonisins.

Mycoflora and occurrence of aflatoxin B1 in dried yam chips from markets in Ogun and Oyo States, Nigeria.

Seventy-six samples of dried yam chips locally called elubo isu were purchased in 2000 from markets in Ogun and Oyo States of southwestern Nigeria. The samples were assessed for pH, moisture content, associated fungi and aflatoxin B1 contamination. The pH of samples ranged from 5.6 to 6.1,while the moisture contents varied from 6.8 to 14.5% in Ogun samples, and 7.1 to 13.6% in samples from Oyo. Aspergillus and Penicillium were the two prevalent genera of fungi, and the number of colony forming units per gram of these two genera in the yam chips studied exceeded the tolerance limit in foodstuffs. The other fungal genera isolated included Botryodiplodia, Cladosporium, Fusarium, Rhizopus, Mucor, Aureobasidium and Paecilomyces. The two most frequent fungal species were A. niger and A. flavus. Thin layer chromatographic analysis showed that 17 samples or 22% contained aflatoxin B1 beyond the detection limit (5 ppb), but only three samples or 4% had toxin level above 30 ppb, the tolerance level in food for human consumption. The mean concentration of aflatoxin B1 in positive samples was 27.1 ppb.

Evaluation of some fungi and bacteria for biocontrol of anthracnose disease of cowpea.

The efficacy of some fungal and bacterial isolates obtained from cowpea phylloplane in inhibiting the in vitro and in vivo growth of Colletotrichum lindemuthianum, causal agent of anthracnose of cowpea was investigated. Inhibition of growth of the pathogen with production of zones of inhibition was observed for Aspergillus flavus, A. ochraceus, Penicillium aurantiogriseum, Bacillus subtilis-BS21, B. subtilis-BS22 and B. subtilis-BS23. Inhibition of growth on contact was recorded for A. niger while Trichoderma viride-TH14 and T. viride-TH31hyperparasitized the pathogen. The two isolates of T. viride and all tested bacteria significantly reduced seedling infection from anthracnose infested seeds in pot experiments. Spray application of T. viride-TH31 on inoculated cowpea plants in the field effectively suppressed the incidence and severity of anthracnose disease, and significantly increased yield over the control. The antagonist was more effective when applied twice weekly than once in a week.

Fungal deterioration of melon seeds stored in jute sacks and polyethylene bags in Ago-Iwoye, southwestern Nigeria.

Laboratory studies were carried out in the Department of Biological Sciences, Ogun State University, Ago-Iwoye, southwestern Nigeria, to determine the extent of fungal deterioration of melon seeds stored in two types of storage bags viz; jute and polyethylene bags. Melon seeds of varieties Tc139 and V2 were stored in jute and polyethylene bags under ambient conditions using the 2 x 2 factorial design (variety vs type of bag) for 12 months. The moisture content (mc), incidence of visible mouldiness (ivm) and germinability of the stored seeds were determined monthly. The mc of Tc139 ranged from 6.1 to 6.7% in jute and 6.2 to 6.5% in polyethylene bags. The ivm which was initially 2.1% increased to 10.7% and 5.5% in jute and polyethylene bags respectively, after 12 months in storage. The germination percentage decreased from 96.3% to 28.7% and 45.3% in jute and polyethylene bags, respectively. The mc of V2 stored in jute and polyethylene bags varied from 5.9 to 6.4%, and 5.8 to 6.2%, respectively. The ivm increased from 1.8% before storage to 8.9% and 4.8% in jute and polyethylene bags, respectively, after 12 months. The percentage seed germination declined from 98.0% to 37.3% in jute and 48.7% in polyethylene bags after 12 months. Decreased incidence of field fungi namely: Alternaria,Botryodiplodia theobromae, Cladosporium, Fusarium and Macrophomina phaseolina was accompanied by simultaneous increase in storage fungi viz: Aspergillus, Penicillium, and Rhizopus with prolonged storage.

Fungi associated with post-harvest rot of black plum (Vitex doniana) in Nigeria.

The fungi associated with rot of Vitex doniana fruits (blackplum) were isolated and identified. Aspergillus niger, Botryodiplodia theobromae, Candida spp. Penicillium chrysogenum, Rhizopus stolonifer, Fusarium pallidoroseum F. oxysporum and Mucor mucedo were the primary rot causing fungi in contrast to Cladosporium herbarum and Mucor circinelloides which were just present as secondary colonizers. The rot fungi penetrated mainly through wounds and bruises on the surface of fruits. Mature green fruits were less susceptible to infection than half ripe and fully ripened red fruits. Optimum rot by pathogenic isolates occurred at 25-30 degrees C and relative humidity 72.5-100%. The results of investigation of influence of storage temperatures and relative humidity on the quality of uninoculated healthy fruits are presented and discussed.

Mycoflora and aflatoxin production in pigeon pea stored in jute sacks and iron bins.

The mycoflora, moisture content and aflatoxin contamination of pigeon pea (Cajanus cajan (L.) Millisp) stored in jute sacks and iron bins were determined at monthly intervals for a year. The predominant fungi on freshly harvested seeds were Alternaria spp., Botryodiplodia theobromae, Fusarium spp. and Phoma spp. These fungi gradually disappeared from stored seeds with time and by 5-6 months, most were not isolated. The fungi that succeeded the initially dominant ones were mainly members of the general Aspergillus, Penicillium and Rhizopus. Population of these fungi increased up to the end of one year storage. Higher incidence of mycoflora and Aspergillus flavus were recorded in jute-sack samples throughout the storage period. The moisture content of stored seeds was found to fluctuate with the prevailing weather conditions, being low during the dry season and slightly high during the wet season. The stored seeds were free of aflatoxins for 3 and 5 months in jute sacks and iron bins respectively. The level of aflatoxins detected in jute-sack storage system was considerably higher than that occurring in the iron bin system. Of 196 isolates of A. flavus screened, 48% were toxigenic in liquid culture (54% from jute sacks and 41% from iron bins).

[Rupture of the internal carotid artery following blunt cranio-cerebral trauma]. / Zerreissung der A. carotis interna nach stumpfem Schädel-Hirn-Trauma

Report on an 18-year-old patient who died 6 hours after a blunt cerebro-cranial trauma due to a hemorrhage from the intracranial extradural part of the internal carotid artery. Autopsy revealed multiple fractures of the cranial basis, hemorrhages due to brain contusion and hemorrhages of the pons as well as a rupture of the wall of the right internal carotid artery within the fractured carotid canal.