Acute hemiplegia: aetiology and outcome in Nigerian children.

INTRODUCTION: acute hemiplegia of childhood is a postnatally acquired nonspecific clinical response of the brain to various aetiological insults in a child who was neurologically normal at birth. This study aims at evaluating the aetiology and outcome of acute hemiplegia in children admitted into the University of Calabar Teaching Hospital (UCTH), Nigeria. METHODS: a 5-year retrospective review of all children admitted to the Neurology Unit of the Department of Paediatrics of UCTH with a diagnosis of acute hemiplegia. The demographic characteristics of the children and the clinical features were noted. Investigations including neuroimaging of the brain and haemoglobin genotype were documented. The outcomes of the patients were recorded as either dead, recovered with deficit or loss to follow up. Data obtained was analysed using the SPSS version 24. Simple tables were used to display the results in number and percentages. RESULTS: twenty-five children with diagnosis of hemiplegia were admitted. Associated clinical features were prolonged seizures (68%), speech defect (32%), cranial nerve deficit (36%) and loss of consciousness (12%). Viral encephalitis was the common aetiology in 11(44%) of the patients, followed by meningitis and sickle cell anaemia in 6(24%) patients each. Four(16%) of the patients recovered completely within the follow up period of three month, 19(76%) had varying degrees of weakness; 2(8%) died. Twelve (48%) were lost to follow-up. CONCLUSION: central nervous system infections and sickle cell disease as dominant aetiological factors of acute hemiplegia in Nigerian children. This calls for effective infection control and genetic counselling.

Non-accidental broom sticks injury as a cause of post-neonatal tetanus.

INTRODUCTION: Non accidental injury sustained following deliberate self-harm or inflicted by parents or caregivers for disciplinary, traditional and therapeutic measures have grave consequences including exposing the incompletely child to post neonatal tetanus. This contributes to the continuing high incidence of post neonatal tetanus in developing countries. METHODS: A 12 year retrospective review of all children admitted into the children's ward of the University of Calabar Teaching Hospital with diagnosis of post neonatal tetanus was carried out. The demographic characteristics of the children were documented. Immunization status, possible portal of entry and outcome status were also recorded. Data obtained was analysed using SPSS version 22. RESULTS: There was a male preponderance of 70.5% amongst the 44 children with post neonatal tetanus. Non-accidental injuries accounted for 20(45.5%). Broom stick injury sustained during corporal punishment was responsible for 60% of tetanus from the non-accidental injury group. Low socio economic class and Inadequate or no immunizations are major risk factors for tetanus infection. CONCLUSION: Non accidental injuries inflicted on children as disciplinary measures accounted for about half of children with post neonatal tetanus. Broom stick injury was a major contributory factor. Lack of immunization and low social class remains major risk factors for post neonatal tetanus. Post neonatal tetanus presents another reason for sustained campaign against physical abuse of children.

Hematological indices in febrile neonates with malaria parasitaemia in Calabar.

BACKGROUND: Normal hematological indices has been determined in Nigerian newborns and found to be lower compared to their Caucasian counterparts. This was attributed to genetic factors. Malaria is endemic in Nigeria and is one of the major causes of ill health and death. Anemia is an important manifestation of malaria. Resistance by malaria parasites to antimalarial drug exacerbates the situation by continuous hemolysis. AIM: To determine the hematological indices in febrile newborn with malaria parasitemia. MATERIALS AND METHODS: One-hundred fifty neonates (0-28 days) with fever admitted into the Newborn Unit of University of Calabar Teaching Hospital, over a 6 months period, were recruited consecutively. Blood film for malaria parasites and samples for full blood count were obtained and sent to the laboratory before commencement of the treatment. Data analysis was with SPSS version 14. RESULTS: One-hundred fifty babies were recruited into the study. Most (85.3%) of the babies were aged ≤7 days. Six babies (4%) had malaria parasitemia. Plasmodium falciparum was the only species identified. All the babies that had parasitemia were anemic (mean hemoglobin [Hb] concentration of 12.6 g/dl) even when parasite count was low (average of 30.6/µl) though this could not be attributed solely to malaria. None of these neonates was transfused. All the other hematological indices were within the normal range of healthy newborn population irrespective of parasitization. CONCLUSION: Neonatal malaria does occur in our environment. While it does not affect the white blood indices, it lowers neonatal Hb. It is recommended that Hb concentration be estimated in newborns with malaria to reduce infant morbidity and mortality in our environment.

Malariometric Indices among Nigerian Children in a Rural Setting.

Malaria contributes to high childhood morbidity and mortality in Nigeria. To determine its endemicity in a rural farming community in the south-south of Nigeria, the following malariometric indices, namely, malaria parasitaemia, spleen rates, and anaemia were evaluated in children aged 2-10 years. This was a descriptive cross-sectional survey among school-age children residing in a rubber plantation settlement. The children were selected from six primary schools using a multistaged stratified cluster sampling technique. They were all examined for pallor, enlarged spleen, or liver among other clinical parameters and had blood films for malaria parasites. Of the 461 children recruited, 329 (71.4%) had malaria parasites. The prevalence of malaria parasitaemia was slightly higher in the under fives than that of those ≥5 years, 76.2% and 70.3%, respectively. Splenic enlargement was present in 133 children (28.9%). The overall prevalence of anaemia was 35.7%. Anaemia was more common in the under-fives (48.8%) than in those ≥5 years (32.8%). The odds of anaemia in the under fives were significantly higher than the odds of those ≥5 years (OR = 1.95 [1.19-3.18]). Malaria is highly endemic in this farming community and calls for intensification of control interventions in the area with special attention to school-age children.

Locked-in Syndrome in a Nigerian male with Multiple Sclerosis: a case report and literature review.

BACKGROUND: Locked-in syndrome is an extremely difficult neurologic condition to recognize, especially by the non-specialists. A case of locked-in syndrome in a 41-year old Niger Deltan Nigerian with relapsing remitting form of multiple sclerosis (MS) is presented, including a detailed literature review. PATIENT AND CASE REPORT: The patient was in a state of spastic quadriplegia, motionless and aphasic (mute), with the preservation of consciousness and the ability to open and blink the eyes and move them vertically. Two episodes of the disease, varying in duration, have been described. The diagnosis of MS was made from the history and the typical clinical presentation: history of relapsing and remitting signs and clinical evidence of multi-focal involvement of the central nervous system. CONCLUSION: Patient died at the age of 45 years, from pulmonary complications. This article may enhance easy recognition and management of the syndrome by all clinicians.

Locked-in Syndrome in a Nigerian male with Multiple Sclerosis: a Case Report and Literature Review

Background : Locked-in syndrome is an extremely difficult neurologic condition to recognize; especially by the non-specialists. A case of locked-in syndrome in a 41-year old Niger Deltan Nigerian with relapsing remitting form of multiple sclerosis (MS) is presented; including a detailed literature review. Patient and Case Report The patient was in a state of spastic quadriplegia; motionless and aphasic (mute); with the preservation of consciousness and the ability to open and blink the eyes and move them vertically. Two episodes of the disease; varying in duration; have been described. The diagnosis of MS was made from the history and the typical clinical presentation: history of relapsing and remitting signs and clinical evidence of multi-focal involvement of the central nervous system. Conclusion Patient died at the age of 45 years; from pulmonary complications. This article may enhance easy recognition and management of the syndrome by all clinicians

Locked-in Syndrome in a Nigerian male with Multiple Sclerosis: a Case Report and Literature Review

Background : Locked-in syndrome is an extremely difficult neurologic condition to recognize; especially by the non-specialists. A case of locked-in syndrome in a 41-year old Niger Deltan Nigerian with relapsing remitting form of multiple sclerosis (MS) is presented; including a detailed literature review. Patient and Case Report The patient was in a state of spastic quadriplegia; motionless and aphasic (mute); with the preservation of consciousness and the ability to open and blink the eyes and move them vertically. Two episodes of the disease; varying in duration; have been described. The diagnosis of MS was made from the history and the typical clinical presentation: history of relapsing and remitting signs and clinical evidence of multi-focal involvement of the central nervous system. Conclusion Patient died at the age of 45 years; from pulmonary complications. This article may enhance easy recognition and management of the syndrome by all clinicians

Mother-infant colonization and neonatal sepsis in prelabor rupture of membranes.

OBJECTIVE: This study aims to determine the incidence of prelabor rupture of membranes (PROM) in a tertiary care institution, the bacterial pathogens involved in maternal and neonatal colonization, and the major bacterial pathogens of neonatal sepsis in PROM. METHODS: This prospective study was conducted over 2 years from March 1999 to February 2001 in Abha Maternity Hospital, Abha, Kingdom of Saudi Arabia. Consecutive admissions of infant-and-mother pairs with PROM constitute the subjects of this survey. Every mother had endocervical swab taken before delivery, and their infants had surface swabs and sepsis screening before starting antibiotic therapy. RESULTS: The incidence of PROM was 12.6 per 1000 live births. Premature delivery rate was 54.6% while, the overall prematurity rate was 7.2%. The major microorganisms involved in genital colonization of the mothers were coagulase negative Staphylococcus (CONS) (24%), Klebsiella pneumoniae (13%), Pseudomonas aeruginosa (11.3%) and Enterococcus species (11.3%). The infants were colonized largely with CONS (31%), Klebsiella pneumoniae (18%) and Escherichia coli (E.coli) (17%). Fourteen percent of the infants were infected but in only 6% was septicemia documented (Staphylococcus aureus, 3 cases and 1 case each with CONS, group B Streptococci (GBS) and E.coli). In contrast to Western experience, the incidence of GBS was uncommon in both mothers and infants. The bacterial pattern suggests vancomycin and cefotaxime or aminoglycoside combination as empirical antibiotic therapy for both infected infants and selected contaminated mothers with PROM. CONCLUSION: Generally, it appears wasteful to routinely admit, screen and empirically treat all infants born after PROM; only ill infants, febrile mothers, or either, with associated chorioamnionitis deserve antibiotic treatment.

Congenital malformation of the gastrointestinal tract in Aseer region, Saudi Arabia.

OBJECTIVE: The aim of this prospective study was to evaluate the prevalence and pattern of congenital malformations of the gastrointestinal tract among the Saudi newborn population in Aseer region, Kingdom of Saudi Arabia. METHODS: Every consecutive newborn admitted to the neonatal intensive care unit of Aseer Central Hospital, Kingdom of Saudi Arabia with features of gastrointestinal tract anomaly during the period January 1995 to December 2000 had relevant data obtained and entered into a program form. RESULTS: During the 6 year period, a total of 1386 Saudi infants were admitted into the neonatal intensive care unit of Aseer Central Hospital. Of these, 12.4% were confirmed to have congenital malformation of the gastrointestinal tract; male/female ratio of 1.7:1. The total number of live births by Saudi mothers in Aseer region during the period was 128,093, giving an incidence rate of 1.3 per 1000 live births. The 172 newborns presented with 174 anomalies of the gastrointestinal tract. The leading malformations were imperforate anus (78 cases or 44.8%), tracheosophageal fistula/atresia (42 cases or 24.1%) and intestinal atresia (37 cases or 21.3%). Other lesions included Hirschsprung's disease (14 cases or 8%) and stenosis (2 pyloric and one duodenal) (1.7%). Some patients had more than one defect within the tract (1%) and multisystemic defects (23%). The overall fatality rate was (12%), due largely to post-operative infection (75% of cases) and multiple anomalies (25% of cases). CONCLUSION: The prevalence of congenital defect of the gastrointestinal tract in Aseer region appears to be high. The incidence of associated multisystemic anomalies is also high. Fatality incidence is influenced by post-operative sepsis and associated multiple defects. A high incidence of consanguineous marriage in the region may be the underlying etiological factor hence genetic counseling may be helpful.