Experience with anorectal malformations in Ile-Ife, Nigeria

The study was carried out to determine the characteristics and outcome of management of anorectal malformations (ARM) in Nigerian children at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife, Nigeria, between January 1986 and December 2002. Eighty-six children with ARM were studied, 48 males and 38 females. Only 12 (13.9%) presented to the hospital within 24 h of birth. Twenty-four (27.9%) patients had one or more associated congenital anomalies, with oesophageal atresia with tracheo-oesophageal fistula being the most common associated malformation. A low variety was identified in 26 (30.2%) cases, while 60 (69.8%) had intermediate or high lesions. Twenty-two patients with the low type of anomaly were offered primary anoplasty in the neonatal period, whereas 59 patients with intermediate or high malformations were offered a preliminary colostomy. A definitive pull-through procedure was ultimately performed in 27 of these 59 cases. Twenty-six patients (30.2%) died. Infection and severe associated malformations were responsible for most (65%) of the deaths. Early results of definitive surgery among survivors were generally good after a mean follow-up period of 13 months. Late presentation, inadequate facilities for neonatal intensive care, and paucity of specialist supportive personnel appear to have negatively influenced the outcome of treatment in our environment. Increasing awareness and availability of medical facilities and specialists are needed.     

Burkitt's lymphoma presenting as obstructive jaundice

A 12-year-old boy presented with a 5-month history of yellowness of the eyes, progressive painless abdominal swelling and weight loss. Physical examination revealed a grossly wasted child with marked jaundice and non-tender hepatomegaly. Liver function tests and abdominal ultrasound suggested obstructive liver disease. Tissue biopsy at laparotomy showed histological findings consistent with Burkitt's lymphoma. He was commenced on cytotoxic chemotherapy and, after two courses, the jaundice disappeared and he remained well. Although ante-mortem presentation of Burkitt's lymphoma as hepatic disease is rare, this condition should be included in the differential diagnosis of a child with obstructive jaundice.     

Microfilaria in hydrocele fluid cytology

Filariasis, a parasitic infection endemic in parts of India, Myanmar, islands of the South Pacific, West and East Africa and Saudi Arabia can be diagnosed from various types of cytopathological specimens. This case documents the detection of filarial infection from hydrocele fluid cytology in a 30-year-old Myanmar migrant worker in Malaysia.     

Helicobacter pylori infection, iron absorption, and gastric acid secretion in Bangladeshi children

BACKGROUND: Nonheme-iron absorption requires an acidic milieu. Reduced gastric acid output as a consequence of Helicobacter pylori infection could be an important limiting factor for iron absorption. OBJECTIVE: We measured gastric acid output and iron absorption from a non-water-soluble iron compound (ferrous fumarate) and a water-soluble iron compound (ferrous sulfate) in children with and without H. pylori infection. DESIGN: Gastric acid output was quantified before (basal acid output, or BAO) and after pentagastrin stimulation (stimulated acid output, or SAO) in 2-5-y-old children with iron deficiency anemia who were (n = 13) or were not (n = 12) infected with H. pylori. Iron absorption was measured by using a double-stable-isotope technique. H. pylori-infected children were studied before and after eradication therapy. RESULTS: BAO and SAO were significantly lower in the H. pylori-infected children (0.2 +/- 0.2 and 1.6 +/- 0.9 mmol/h, respectively) than in the uninfected children (0.9 +/- 0.7 and 3.1 +/- 0.9 mmol/h, respectively; P = 0.01 and P < 0.005). BAO and SAO improved to 0.8 +/- 1.3 and 3.3 +/- 2.4 mmol/h, respectively, after therapy. Iron absorption from ferrous sulfate was significantly greater than that from ferrous fumarate both before (geometric : 19.7% compared with 5.3%; P < 0.0001) and after (22.5% compared with 6.4%; P < 0.0001) treatment in H. pylori-infected children. Corresponding values for uninfected children were 15.6% and 5.4%, respectively (P < 0.001; n = 12). CONCLUSIONS: Iron absorption from ferrous fumarate was significantly lower than that from ferrous sulfate in both H. pylori-infected and uninfected Bangladeshi children. Treatment of H. pylori infection improved gastric acid output but did not significantly influence iron absorption. The efficacy of ferrous fumarate in iron fortification programs to prevent iron deficiency in young children should be evaluated.     

Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre

OBJECTIVE: To review our experience of percutaneous nephrolithotomy (PCNL) in children before school age, and determine its efficacy and safety in this age group. PATIENTS AND METHODS: The records of children aged < or = 5 years undergoing PCNL were reviewed. Variables assessed included stone number, size, location and type. The PCNL puncture site and number were also recorded. We reviewed stone clearance with PCNL, ancillary procedures used, complication rates and follow-up status of the children. RESULTS: There were 30 renal units in 29 children (median age 3.8 years, range 1.4-5). Because of poor growth the mean (SD) body weight of the children was only 12.2 (2.8) kg, which is near the 50th percentile for children of mean age 3.5 years. The median (range) stone burden was 2.35 (1.3-6) cm; 60% of the patients had single stones while 28% had more than five. There were five staghorn stones. All PCNL was primary and with one puncture, using a 17 F angled nephroscope; stones were fragmented using a pneumatic lithoclast. After PCNL stones were completely cleared in 60% of the renal units, which increased to 100% after combining it with extracorporeal shockwave lithotripsy. The median (range) follow-up was 24.9 (4-51) months; the overall complication rate was 6%. In the long follow-up hypertension was not detected in any child and isotopic renograms in 17 kidneys detected no new scarring or loss of renal function. CONCLUSION: PCNL is a safe and effective for treating renal stones in very young children.     

Perception and beliefs about mental illness among adults in Karfi village,northern Nigeria

Background  

This study was designed to examine the knowledge, attitude and beliefs about causes, manifestations and treatment of mental illness among adults in a rural community in northern Nigeria.     

Quality of life and survival prediction in terminal cancer patients: a multicenter study

BACKGROUND: It remains unclear whether health-related quality of life (HRQoL) measurements from patients and staff can be combined with medical data to predict survival in patients with terminal cancer. METHODS: The correlations between survival and potential health-related quality-of-life (HRQoL) prognostic variables were explored in 2 independent cohorts of patients with terminal cancer (248 patients in Cohort 1 and 756 patients in Cohort 2) after adjusting for clinical and demographics variables using Cox regression models. RESULTS: At the onset of the terminal phase (Cohort 1), the hazards of dying increased by 28% in the presence of dyspnea and by 68% in the presence of nausea/emesis; however, the most important predictors of worse survival were the presence of liver metastases (hazard ratio [HR], 2.5; 95% confidence interval [95% CI], 1.8-3.8), lung tumor (HR, 2.4; 95% CI, 1.7-3.4), and tumor burden (HR, 2.0; 95% CI, 1.4-2.7). In contrast, for patients who were seen in later stages of their terminal disease (Cohort 2), dyspnea (HR, 1.5; 95% CI, 1.1-1.9) and the coexistence of weakness with a diagnosis of digestive tumors (HR, 5.2; 95% CI, 1.2-21.8), breast tumors (HR, 3.1; 95% CI, 1.6-6.2), and genitourinary tumors (HR, 3.5; 95% CI, 1.6-7.8) were more predictive of survival than the type of tumor primary. Emotional functioning along with anxiety, spiritual distress, and lack of insight were not associated consistently with survival in both cohorts. CONCLUSIONS: Health care professionals should focus on physical HRQoL indicators, such as nausea and emesis, dyspnea, and weakness, to gather prognostic clues in patients with terminal cancer. These symptoms may reflect consequences of cancer cachexia and the progress of patients toward this terminal syndrome. Psychosocial distress did not appear to be associated consistently with survival; however, future studies should clarify further the prognostic significance of "positive attitudes", such as hope and optimism, in patients with advanced cancer.