Childhood Blindness and Visual Impairment in a Local Government Area in North-Central Nigeria: A Key Informant Survey.

Background: To use the Key Informant survey to estimate the magnitude and to identify the major causes of blindness and severe visual impairment in children of Nassarawa Eggon Local Government Area of Nasarawa State, Nigeria. Methodology: Twenty-eight trained Key Informants traced and referred children believed to be blind or visually impaired. Biodata record, history and eye examination were based on the operational definitions in the WHO/PBL coding instruction manual for childhood blindness. Data were entered and analyzed in the WHO/PBL Childhood Blindness Software (CBS) V 1.2.75 by an ophthalmologist and a statistician. Result: The Key Informants identified 51 children of which 50 (98%) were examined. Eight (16%) of the children examined were blind, another 8 (16%) had severe visual impairment, 16 (32%) were visually impaired, 7 (14%) had monocular blindness and 11 (22%) were normal. The estimated crude prevalence of childhood blindness was 0.01% and of moderate-severe visual impairment was 0.03%. The major causes of blindness and severe visual impairment were cataract, corneal opacity, and refractive errors. Ninety-four percent of the causes of blindness and moderate-severe visual impairment in children were avoidable. It was estimated that some 415 children in Nasarawa state are blind or have moderate to severe visual impairment. Conclusion: The estimated magnitude of blindness and visual impairment in Nassarawa Eggon LGA is 8 and 24 children respectively with a crude blindness prevalence of 0.01% (1 per 10,000). Cataract was the commonest cause of childhood blindness and severe visual impairment in Nassarawa Eggon local government area with 93.8% of the causes of blindness and visual impairment being avoidable.

Four evolutionary trajectories underlie genetic intratumoral variation in childhood cancer.

A major challenge to personalized oncology is that driver mutations vary among cancer cells inhabiting the same tumor. Whether this reflects principally disparate patterns of Darwinian evolution in different tumor regions has remained unexplored1-5. We mapped the prevalence of genetically distinct clones over 250 regions in 54 childhood cancers. This showed that primary tumors can simultaneously follow up to four evolutionary trajectories over different anatomic areas. The most common pattern consists of subclones with very few mutations confined to a single tumor region. The second most common is a stable coexistence, over vast areas, of clones characterized by changes in chromosome numbers. This is contrasted by a third, less frequent, pattern where a clone with driver mutations or structural chromosome rearrangements emerges through a clonal sweep to dominate an anatomical region. The fourth and rarest pattern is the local emergence of a myriad of clones with TP53 inactivation. Death from disease was limited to tumors exhibiting the two last, most dynamic patterns.

Safety profile of fast-track extubation in pediatric congenital heart disease surgery patients in a tertiary care hospital of a developing country: An observational prospective study.

BACKGROUND AND AIMS: Early extubation after cardiac operations is an important aspect of fast-track cardiac anesthesia. In order to reduce or eliminate the adverse effects of prolonged ventilation in pediatric congenital heart disease (CHD) surgical patients, the concept of early extubation has been analyzed at our tertiary care hospital. The current study was carried out to record the data to validate the importance and safety of fast-track extubation (FTE) with evidence. MATERIALS AND METHODS: A total of 71 patients, including male and female aged 6 months to 18 years belonging to risk adjustment for congenital heart surgery-1 category 1, 2, and 3 were included in this study. All patients were anesthetized with a standardized technique and surgery performed by the same surgeon. At the end of operation, the included patients were assessed for FTE and standard extubation criteria were used for decision making. RESULTS: Of the total 71 patients included in the study, 26 patients (36.62%) were extubated in the operating room, 29 (40.85%) were extubated within 6 h of arrival in cardiovascular intensive care unit and 16 (22.54%) were unable to get extubated within 6 h due to multiple reasons. Hence, overall success rate was 77.47%. The reasons for delayed extubation were significant bleeding in 5 (31.3%) cases, hemodynamic instability (low cardiac output syndrome) in 4 (25%) cases, respiratory complication in 2 (12.5%), bleeding plus hemodynamic instability in 2 (12.5) cases, hemodynamic instability, and respiratory complication in 2 (12.5%) cases and triad of hemodynamic instability, bleeding and respiratory complication in 1 (6.5%) case. There was no reintubation in the FTE cases. CONCLUSION: On the basis of the current study results, it is recommended to use FTE in pediatric CHD surgical patients safely with multidisciplinary approach.