Pattern of Clinical and Laboratory Presentation of Cerebral Malaria among Children in Nigeria.

Introduction: Cerebral malaria (CM) is the most lethal form of severe malaria with high case fatality rates. Overtime, there is an inherent risk in changing pattern of presentation of CM which, if the diagnosis is missed due to these changing factors, may portend a poor outcome. Variations in the pattern of clinic-laboratory presentations also make generalization difficult. This study was, therefore, set out to report the pattern of clinical and laboratory presentation of CM. Methods: This was a cross-sectional study among children aged 6 months to 14 years admitted with a diagnosis of CM as defined by the World Health Organization criteria. A pretested pro forma was filled, and detailed neurological examination and laboratory (biochemical, microbiology, and hematology) investigations were done. P <5% was considered statistically significant. Results: Sixty-four children were recruited with a mean age of 34.9 ± 24.9 months and a male-to-female ratio of 1.9:1. There were 87.5% of under-five children. Fever (96.9%) was the major presenting feature closely followed by convulsions (92.2%). Convulsions were mainly generalized (94.9%) and multiple (76.5%). Profound coma (Blantyre coma score of 0) was present in 12.5% of cases, and the leading features on examination were fever (84.4%) and pallor (75.0%). Retinal vessel whitening (48.4%) was the most common funduscopic abnormality. Metabolic acidosis (47.9%), severe anemia (14.1%), hyperglycemia (17.2%), and hypoglycemia (7.8%) were seen among the children. Few (1.6%) had hyperparasitemia and bacteremia (3.2%). Conclusion: Early recognition of the clinical presentation and prompt management may improve the outcome of cerebral malaria.

Stretched penile length and total serum testosterone in term male neonates.

INTRODUCTION: the reference values of stretched penile length vary with different ethnic group. There is paucity of data on the reference range of total serum testosterone in neonates especially in Africa. This study therefore was to determine the normal stretched penile length, total serum testosterone levels in term male newborns and to correlate them with anthropometric parameters. METHODS: this was a prospective cross-sectional study. One hundred and twenty-four consecutive healthy term male neonates were recruited in the first 72 hours of postnatal life. The stretched penile length (SPL) was measured with a rigid metric ruler. Weight, length and occipitofrontal circumference were also measured. Total serum testosterone level was determined using Enzyme Linked Immunoassay. Data were analysed using the Statistical Package for Social Sciences for Windows version 20. RESULTS: a total of 124 term male neonates were recruited. The postnatal age of recruited neonates was one to 70 hours with a mean of 22.8 ± 17.6 hours and the mean of estimated gestation age was 38.5 ± 1.3 weeks. The range of stretched penile length was from 2.1 to 3.9 cm with a mean of 3.2 ± 0.4 cm and SPL less than 2.2 cm was considered as micropenis. The mean total serum testosterone level was 357.4 ± 241.7 ng/dl. The SPL had a positive correlation with the birth weight, length and total serum testosterone. The total serum testosterone and birth length were predictors of stretched penile length. CONCLUSION: among the studied population the mean stretched penile length was 3.2 cm and mean total serum testosterone was 357.4 ng/dL.

Estimations of total serum testosterone levels in Nigerian term neonates at birth using anogenital distance measurements.

Background In genital anomalies, measurement of total testosterone is required but is expensive and technically difficult to assay. Therefore, the measurement of anogenital distance, which is non-invasive and cheap, could be used to estimate total serum testosterone in neonates. The objective if this study is to determine the relationship between total serum testosterone and anogenital distance and estimate total serum testosterone levels in term neonates using measurements of anogenital distance. Methods This was a prospective cross-sectional study. Consecutive healthy term neonates were recruited in the first 72 h of postnatal life. Anogenital distance was measured with a digital vernier calliper. Total serum testosterone was determined using enzyme linked immunoassay. Results A total of 240 term neonates comprising 124 (51.7%) males and 116 (48.3%) females were studied. The overall mean anogenital distance was 19.7 (7.7) mm and 26.5 (3.7) mm for males which was more than twice 12.4 (2.3) mm for females (t = 35.3, p < 0.001, 95% confidence interval [CI], 13-14). The overall mean total serum testosterone level was 267.1 (204.8) ng/dL; and 357.4 (241.7) ng/dL in males which was more than twice of 170.6 (80.7) ng/dL for females (t = 7.9, p < 0.001, 95% CI, 144-221). There was positive correlation between total serum testosterone and anogenital distance (r = 0.425, p < 0.001). The correlation was stronger in males than in females. The linear regression equation was as follows: total serum testosterone (ng/dL) = 44.3 + 11.3*AGD (mm) with 95% CI, 8-14. Conclusions The known value of anogenital distance could be used to estimate total serum testosterone levels in term neonates.