Unusual Metastatic Patterns of Wilms Tumor: A Case Series.

Wilms tumor (WT) is the most common renal malignancy of childhood. The common metastatic sites are the lungs, liver, and lymph nodes, with brain and bone metastases occurring rarely. Metastatic disease can be present at initial diagnosis or may occur with relapse or disease progression. The majority of relapses in WT occur within the first two years post-treatment. Late relapses are rare. This article describes four cases of WT, each demonstrating an unusual site or timing of metastases. Case 1 presented primarily with jaw metastases, Case 2 presented with bone (vertebrae) and spinal metastases manifesting as paraplegia, at relapse one year after completion of treatment, Case 3 presented with isolated liver metastases four years after treatment completion, and Case 4 presented with brain metastases after six weeks of treatment abandonment. This case series demonstrates the varied pattern of metastases of WT and highlights the need for a high index of suspicion for WT among patients who present with unusual sites of tumor or for metastasis in those who present with neurologic symptoms during or after treatment.

Admissions and mortality over a 5-year period in a limited-resource neonatal unit in Ghana.

OBJECTIVE: To review admissions and deaths at the neonatal intensive care unit (NICU) of the Korle Bu Teaching Hospital (KBTH), Ghana from 2011 to 2015, for the purposes of documentation of outcomes and identification of areas for improvement. DESIGN: A retrospective descriptive study of NICU Admissions & Discharges from 2011 to 2015. All data in the NICU Admissions & Discharge books were transferred into a spreadsheet and analysed. SETTING: The NICU of KBTH provides secondary and tertiary care for premature and critically ill term babies in the southern half of Ghana. RESULTS: Over the 5-year period, 9213 babies were admitted to the NICU. Admission weights ranged from 300 to 6700g with median of 2400g. Overall mortality rate was 19.2%. Mortality rates were progressively and significantly higher in babies with lower admission weights and earlier gestations. CONCLUSIONS: We report a high NICU mortality rate of 19.2%, compared to the worldwide range of 3.1% to 29%. This wide range of outcomes is attributable to differences in the severity of illness of patients and to the organisation of resources devoted to obstetric and neonatal care. To substantially improve perinatal and neonatal outcomes, there is a need for wider coverage and better quality of health care; and to consider rationing of care. Complex interventions are necessary to improve outcomes, not just an increase in the allocation of particular resources. FUNDING: None declared.

Admissions and mortality over a 5-year period in a limited-resource neonatal unit in Ghana

Objective: To review admissions and deaths at the neonatal intensive care unit (NICU) of the Korle Bu Teaching Hospital (KBTH), Ghana from 2011 to 2015, for the purposes of documentation of outcomes and identification of areas for improvement.Design: A retrospective descriptive study of NICU Admissions & Discharges from 2011 to 2015. All data in the NICU Admissions & Discharge books were transferred into a spreadsheet and analysed. Setting ­ The NICU of KBTH provides secondary and tertiary care for premature and critically ill term babies in the southern half of Ghana. Results: Over the 5-year period, 9213 babies were admitted to the NICU. Admission weights ranged from 300 to 6700g with median of 2400g. Overall mortality rate was 19.2%. Mortality rates were progressively and significantly higher in babies with lower admission weights and earlier gestations. Conclusions: We report a high NICU mortality rate of 19.2%, compared to the worldwide range of 3.1% to 29%. This wide range of outcomes is attributable to differences in the severity of illness of patients and to the organisation of resources devoted to obstetric and neonatal care. To substantially improve perinatal and neonatal outcomes, there is a need for wider coverage and better quality of health care; and to consider rationing of care. Complex interventions are necessary to improve outcomes, not just an increase in the allocation of particular resources

Audit of antenatal steroid use in mothers of preterms admitted to a neonatal intensive care unit in Ghana.

BACKGROUND: Antenatal corticosteroids (ACS) are established as an effective method of reducing preterm morbidity and mortality. At the Korle Bu Teaching Hospital (KBTH), a tertiary referral centre in Ghana, it is recommended that a course of ACS should be given to mothers before delivery between 24 weeks to 34 weeks gestation. OBJECTIVES: The study was performed primarily to determine the level of adherence to guidelines on administration of ACS. METHODS: All babies with gestational ages up to 34 weeks admitted to the neonatal unit (NICU) during the period of the study were eligible for inclusion. RESULTS: There were 214 eligible admissions during the study period, of which 93 babies (43%) were studied due to poor access to medical records. Dexamethasone was the only steroid used, and mothers of 65 (70%) of the 93 babies received at least one dose; 17 (18%) received only one dose, 35 (38%) - 2 doses, 9 (10%) - 3 doses, and 4 (4%) - 4 doses. CONCLUSIONS: This study has shown a low uptake of antenatal corticosteroids, similar to other low-income and middle-income countries. To improve preterm survival and morbidity, there is an urgent need to increase the use of corticosteroids before preterm deliveries in Ghana and other low-income and middle-income countries. FUNDING: Not indicated.