Neurological sequelae in survivors of cerebral malaria

Introduction: Cerebral malaria is a common cause of neurological sequelae and death in childhood. Information on persistent neurological sequelae post hospital discharge and their predisposing factors are scarce. Methods: This is a prospective study describing persisting neurological impairments post discharge among children treated for cerebral malaria. In addition the study was designed to investigate the frequency of persistent neurologic deficits and the risk factors for their persistence in these patients. The case records of 160 patients treated for CM at the Paediatrics Department of University College Hospital, Ibadan from January 2004 to November 2006 were reviewed to recruit cases. Recruited survivors were then followed up for information concerning the presence and persistence of neurological sequelae. Results: A total of 160 children aged 9 months to 134 months were admitted and treated for CM during the study period. One hundred and thirty one (81.9%) survived while 29 (18.1%) died. The 131 survivors of cerebral malaria consisted of 64 boys and 67 girls. Neurological sequelae occurred in 13.7% of survivors of cerebral malaria at discharge and 4.6% at follow up. Six children with neurological deficits at discharge had persistence of deficits 6 months post-hospital discharge and one at 24 months. No associations were found between hypoglycemia, anemia, age, sex and multiplicity of convulsions, and persistence of neurologic sequelae. The persisting neurologic deficits among survivors at follow up were: memory impairment (1.5%), seizure disorders (0.8%), visual impairment (0.8%), speech impairment (0.8%), monoparesis (0.8%) and hyperactivity (0.8%) at follow up. The longest persisting sequelae lasted for at least 24 months. Conclusion: Neurologic deficits are not uncommon complications of CM. Neurologic sequelae may persist for as long as 24 months or more in survivors of childhood CM. There is no association between the risk factors for neurologic deficits and persistent neurologic sequelae.Key words: Cerebral malaria, neurological sequelae, children, Nigeri

Myasthenia gravis following chicken pox infection in a Nigerian primary school girl

We report a case of myasthenia gravis occurring post Chicken pox infection in a 9 year old Nigerian girl. The girl was growing and seeing normally until 2weeks after a chicken pox infection when she observed progressive drooping of both upper eye lids which worsens as the day progresses and has persisted for more than one year. There was good response to Neostigmine

Nigerian physicians' knowledge, attitude and practices regarding diabetes mellitus in the paediatric age group

Background: Despite the increasing prevalence of diabetes in the paediatric age group, information concerning Nigerian physicians' knowledge, attitude and practices with regard to diabetes care in children and adolescents is scarce.Objective: To assess the knowledge, attitude and practices of physicians working in Nigeria.Methods: The study examined several aspects of diabetes-related knowledge, attitude and practices of Nigerian physicians. A crosssectional survey was conducted among physicians in four towns in four different States in Nigeria, using a self-administered questionnaire to obtain data. Statistical analysis was performed using SPSS version 16.Results: A total of 288 medical practitioners from four towns in four different states in Nigeria filled the questionnaires. The distribution of participants was as follows: 25, 28, 85 and 150 from Benin (Edo State), Kano (Kano State), Ado-Ekiti (Ekiti State) and Gwagwalada (Federal Capital Territory), respectively. Questions answered correctly by more than half of the participants were: fasting plasma glucose diagnostic criterion for diabetes, 161(55.9%); best test for monitoring glycaemic control (72.9%); diabetic ketoacidosis (DKA) is an immediate complication (93.5%); insulin therapy is important in the control of childhood diabetes (86.5%); and diabetes is a dangerous disease (91.3%). Questions answered correctly by less than half of the participants were: the stronger hereditary nature of type 2 diabetes (39.6%) 10.1% and 2.8% knew that diabetes can present with fast breathing and abdominal pain respectively. Only 36.8% of the participants knew that children with diabetes should eat family diet. Concerning risk factors for diabetes, majority (82.6%) of the participant believe that eating too much sugar is a risk factor. Only 25.3% knew the correct method of storing insulin and 39.6% of participants stated that they do not know. This paucity of knowledge was more pronounced among physicians with less than ten years of medical practice experience after graduation from the medical school. Only a quarter (24.7%) of the respondents will allow an adolescent with diabetes to adjust his insulin dose.Conclusions: Knowledge gaps, ambivalent attitudes and suboptimal practices regarding diabetes mellitus in childhood and adolescence were found among Nigerian physicians, irrespective of duration of practice post-graduation from the medical school. Our results suggest that most physicians require additional education, focusing on DM in order to provide an acceptable level of care to children and adolescents with diabetes mellitus.Keywords: Knowledge, Attitude, Practices, Diabetes Mellitus, Children, Physicians, Nigeri

Primary congenital hypothyroidism complicated by persistent severe anaemia in early infancy: A case report with a literature review

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Osteogenesis Imperfecta – A Case Series and Review of Recent Advances in Management

Osteogenesis Imperfecta (OI) is an uncommon congenital abnormality of the connective tissues in which diagnosis and management pose significant challenges especially in Low and Middle-Income Countries. The objective of this report is to draw attention to this uncommon congenital anomaly. Two cases of OI were seen at birth and managed in Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. One of the babies died shortly after birth while the other baby was managed and discharged home. The discharged baby was on follow-up care in the clinic until the parents defaulted from further care. She eventually died at home after series of hospitalisations for recurrent respiratory tract infections. In conclusion, a high index of suspicion is required during prenatal care visit. When detected at birth, parents are to be educated on the multidisciplinary approach to management, challenges and possible outcome as there is yet no cure for this condition

Myasthenia gravis following chicken pox infection in a Nigerian primary school girl

We report a case of myasthenia gravis occurring post Chicken pox infection in a 9 year old Nigerian girl. The girl was growing and seeing normally until 2weeks after a chicken pox infection when she observed progressive drooping of both upper eye lids which worsens as the day progresses and has persisted for more than one year. There was good response to Neostigmine.</jats:p

Precocious puberty in a 24 month old Nigerian girl

Precocious puberty refers to the appearance of signs of puberty at an earlier age than is considered normal. It occurs ten times more commonly in girls than in boys. The overall incidence ranged from 1/5000 to 1/10,000 children. The cause is idiopathic in 90% of cases of female precocious puberty. We present BA a 24 month old female toddler who presented with one year history of progressive breast development and 6 month history of pubic hair growth. There was associated increasing weight, height and vaginal secretion. There was no similar occurrence in the family. Mother attained menarche at 14 years of age. Essential finding at presentation revealed a toddler who is heavy and tall for age with a weight of 17kg (>95th percentile for age and sex), height of 90.5cm (90th percentile for age and sex), Occipito frontal circumference of 49cm (normal). Her sexual maturity rating was Tanner stage 3 for breasts and stage 2 for pubic hair. An assessment of precocious puberty was made. Her investigation result showed an advanced bone age of 5 years; elevated serum gonadotrophins in the pubertal range; and essentially normal cranial CT. Abdomino pelvic USS showed an enlarged uterus for age, and a dominant right follicle with internal echo measuring 17.1mm X 15.2mm. Parents were counseled on the need for treatment to arrest the progression of precocious puberty but yet to respond because of financial constraint after 2 years of diagnosis. Female precocious puberty is ten times more common than male precocious puberty. The aetiology is idiopathic in 90% of cases and It is amenable to treatment. Integration of the investigation and treatment of childhood endocrine disorders into the National Health Insurance scheme will be a great panacea to the challenge of prompt management in developing countries