Role of Ommaya Reservoir in Pediatric Hydrocephalus: Experience in Bangladesh Medical College Hospital from 2019-2021.

The goal of this study was to analyze the efficacy of the Ommaya reservoir within all the different types of hydrocephalus in pediatric patients. At the same time, it's safe for repeated aspirations or long-term retention of the reservoir in the body. This retrospective, cross-sectional study was performed from January 2019 to December 2021, 33 consecutive cases of reservoir implantation were taken into the study irrespective of the etiology of hydrocephalus in the Neurosurgery Department of Bangladesh Medical College Hospital, Dhaka, Bangladesh. These were mostly placed along with endoscopic third ventriculostomy and some were placed as an intermediary procedure to combat shunt complications in emaciated infants. Cerebrospinal fluid (CSF) aspiration was done in case of failed endoscopic third ventriculostomy and the frequency of aspiration depended upon the production of cerebrospinal fluid. Acetazolamide was routinely administered in each patient to reduce the frequency of aspiration. Most of the patients required ventriculo-peritoneal (VP) shunt while they had sufficient body weight and few required no surgery. The average age at presentation was 76.88 days. All the neonates and infants had less weight in terms of their age. 42.4% of babies needed aspiration 2 times per week. Among all cases, 9.1% developed reservoir complications. Complications were not related to the number and volume of aspiration or duration of the reservoir in the body. Two (2) patients died after one year of reservoir implantation due to unknown etiology. Out of the 31 survivors, 3 patients did not need any further aspiration and 19 patients needed a ventriculo-peritoneal shunt, but the reservoir was kept in situ for a future emergency. The rest of them is waiting for a definitive shunt procedure. Other findings include low socioeconomic group was more prone to low birth weight and they carried the burden of congenital hydrocephalus and meningomyelocele. Most affected babies had their prenatal period in arsenic-affected areas in Bangladesh. Overall folic acid supplementation was started after the formation of the neural tube irrespective of socioeconomic status. Ommaya reservoir placement along with endoscopic third ventriculostomy plays a vital role in delaying shunt in endoscopic third ventriculostomy failure. It is a 'time buying' procedure until the baby has sufficient weight for successful shunt surgery. It has been found very effective intermediary intervention for managing shunt infection and it also helps revive a channel in shunt obstruction.

Bilateral Lateral Rectus Recession in Duane Retraction Syndrome Type II: A Case Report.

A two year presented to the clinic with abnormal head posture and right-sided face turn since birth. On examination, he showed a large right face turn of 40° while concentrating on a near target. His ocular motility assessment showed a -4 limitation of adduction in the left eye with 40 prism diopters (PD) exotropia and grade 1 globe retraction of the left eye. He was diagnosed with type II Duane retraction syndrome (DRS) in the left eye and planned for lateral rectus recession of both eyes. Postoperatively, the patient was orthotropic at distance and near in primary gaze with resolved face turn and improvement of limitation of adduction to -2, but some limitation of abduction -1 in the left eye was observed. Herein, we discuss the clinical features, etiologies, tailored evaluation, and management for type II DRS patient.

Acquired Brown Syndrome After a Fist Punch: A Case Report.

A 15-year-old male presented with double vision in the left and upward gaze following a hit in the right orbital region. The orthoptic assessment revealed -2 limitation of elevation in the adduction position of the right eye and right hypotropia of 20 prism diopter (PD) in the left gaze and right hypotropia of 10 PD in the upward gaze. He was diagnosed with traumatic Brown syndrome and planned for superior oblique lengthening surgery for the right eye. Two months postoperatively, the patient has a normal extra-ocular motor function with the elimination of diplopia and significant improvement of elevation of the right eye in the adduction position. Herein, we discuss the clinical features, etiologies, tailored evaluation, and management for the patient with traumatic Brown syndrome.

Knowledge, Attitude, and Practice Among Parents of Strabismic Children in Saudi Arabia: A Cross-Sectional Study.

Background Strabismus is a reversible condition that must be identified and treated during the critical period of childhood. Thus, this study aims to evaluate the degree of knowledge, attitude, and practice among parents of strabismic children in Riyadh, Saudi Arabia. Method To this end, a cross-sectional study was conducted from August 2021 to November 2021 with a sample size of 424 parents of children with strabismus seeking ophthalmologic consultants in private and governmental ophthalmology clinics in Riyadh, Saudi Arabia. A self-administered questionnaire was used to collect the data. The questionnaire contains knowledge-related questions about strabismus, beliefs-related questions, questions addressing the barriers parents face regarding strabismus in a child, and sources of information about cross-eye and its management. Data were analysed using the SPSS database version 21 (IBM Corp., Armonk, NY, USA). P-values <0.5 was used for clinical significance. Result We found that most parents know there is a relationship between strabismus and refractive errors (69%) and cross eye can be corrected (55%). Moreover, strabismus causes psychosocial difficulties (55%), low self-esteem, and low school performance. Parents of strabismic children believed that their love for their children is not affected due to crossed eyes (53%) and that strabismic children should not be taken to traditional healers (59%). Barriers faced during the management of strabismus are parents' negligence (76%), fear of surgery (34%), and high cost (29%). Doctors are the most used and preferred source of information among parents of strabismic children. Conclusion This study identifies gaps in knowledge, wrong beliefs in society, and the barriers faced by parents of strabismic children. Thus, raising awareness of the importance of detecting and treating strabismus early, avoiding psychosocial complications, and improving children's quality of life.

Glomerular disease and acute kidney injury in Sudan: Demographics, histological diagnosis and outcome.

BACKGROUND: Acute kidney injury (AKI) is a relatively common clinical condition, associated with high rates of mortality. Although there is extensive literature on the nature and consequence of AKI in the developed world, much less is known in the developing world and more specifically in sub-Saharan Africa (SSA). OBJECTIVES: To describe the demographics, histological diagnosis and clinical course of patients presenting with AKI to a single centre in Sudan. METHODS: Retrospective data were collected on 100 consecutive patients with AKI and an active urinary sediment, who underwent diagnostic native percutaneous renal biopsy. RESULTS: The mean (standard deviation) age of those biopsied was 33.6 (14.1) years of age, with a preponderance (58%) of females. The most common clinical indications for biopsy were AKI associated with haematuria and proteinuria (72%), AKI and proteinuria (22.5%) or AKI and haematuria (5%). The frequencies of the most common primary glomerulonephritides (GN) were focal segmental GN (15%) and mesangiocapillary GN (8%). Lupus nephritis was the most frequent secondary GN associated with AKI (31%) and the most common overall histological diagnosis. Peak creatinine, but not oliguria, at presentation predicted likelihood of remaining dialysis-dependent. Age at presentation but not baseline renal function by estimated glomerular filtration rate (eGFR), was associated with the likelihood of having residual chronic kidney disease following an episode of AKI. CONCLUSIONS: The data suggested differences in the pattern of intrinsic renal/glomerular disease leading to AKI to those published and mainly derived from the developed world and patients in SSA.

Diagnosis of typhoid fever by Dot enzyme immunoassay in an endemic region.

OBJECTIVE: To compare the results of Dot Enzyme Immunoassay (EIA) and concomitantly performed blood culture for the diagnosis of typhoid fever. METHODS: The results of Dot Enzyme Immunoassay (EIA) of patients who also had blood cultures/bone marrow culture performed at the same time were analyzed. The period of study spans between April 1997-September 1997. RESULTS: A total of 1760 Dot Enzyme Immunoassays were performed from April 1997 to September 1997. Of these, only 128 (7.2%) cases had concomitantly performed blood/bone marrow cultures. Therefore, the study was narrowed down to these 128 cases. Sixty-nine cases were culture positive for S. typhi. Of these culture proven cases, IgM antibodies by Dot EIA were positive only in 49 (71%) cases while 20 (28.9%) of culture proven cases remained negative for IgM antibodies. CONCLUSION: Taking blood/bone marrow culture as gold standard, the sensitivity of Dot EIA was found to be 71% while specificity was found to be 43%. The predictive value of the positive test was found to be 59.7% and that of a negative test was found to be 56.5%.