In vitro trypanocidal activity of dibutyltin dichloride and its fatty acid derivatives

Searching for new compounds against pathogenic trypanosomes has been substantially accelerated by the development of in vitro screening assays. In an attempt to explore the chemotherapeutic potential of organotin compounds and to broaden the search for newer trypanocides, fatty acid derivatives of dibutyltin dichloride were synthesized and their in vitro trypanocidal profiles studied on Trypanosoma brucei brucei, Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense. A 24-h time course experiment was conducted with various concentrations of the compounds using a 24-well microtiter plate technique. The compounds tested were trypanocidal in a dose-dependent fashion: inhibiting survival and growth, resulting in irreversible morphological deformation and the eventual death of the parasites. The minimum inhibitory concentrations of the tested diorganotins are at low micromolar ranges: from 0.15–0.75 M for T. b. brucei, T. b. gambiense and T. b. rhodesiense. These observations suggest that organotin has chemotherapeutic potential.     

Spontaneous ileal perforation complicating low anorectal malformation

Anorectal malformation is a common anomaly in neonates. Although colorectal perforations have been reported as a complication, ileal perforation is rarely encountered. This is a report of a 2-day-old boy presenting with a low anorectal malformation, complicated with ileal perforation, necessitating laparotomy and ileal repair. Anoplasty was done for the low anomaly. Early presentation and prompt treatment of anorectal malformations is important to prevent such potential life threatening complication.Key words: Ileal perforation, low anorectal anomaly, spontaneous     

Monitoring Severe Pre-Eclampsia and Eclampsia Treatment in Resource Poor Countries: Skilled Birth Attendant Perception of a New Treatment and Monitoring Chart (LIVKAN Chart)

The lack of easy to use protocols and monitoring charts in the management of pre-eclampsia/eclampsia contribute to substandard care of women in resource poor settings. A treatment monitoring tool (LIVKAN chart) has been developed to improve the quality of care for these women. Based on feedback from skilled birth attendants (SBAs), a two page document which provides a visual record of the treatment and monitoring of women with severe pre-eclampsia/eclampsia over a 24?h period was developed. It also contains detailed treatment guidelines as well as a summary of the woman??s treatment. A two page document on instructions for use of the chart was also developed. The chart design was evaluated by different level SBAs via a semi structured questionnaire. There was a 92% (109) response rate. About 30% (33) and 58% (63) of the respondents provided care to women in Primary Health Care and referral health care facilities respectively. Ninety eight percentage of respondents indicated that the chart would be of additional benefit in their care of women with pre-eclamptic/eclampsia. Seventy three percentage of respondents indicated that the chart would also be useful to lower health care facility SBAs. The design of the chart ensures that guidelines for managing/monitoring of patients are instantly available on a concise easy-to-use chart which confers added advantage over other chart designs. Having been evaluated by SBAs, acceptability and utilization in poor resource settings should be high. A study has been designed to evaluate the acceptability and effectiveness of this new monitoring chart in both BEOCs and CEOCs in two sub-Saharan African countries.     

Colostomy in the newborn: technical pitfalls

Colostomy is a commonly performed procedure in the neonatal period but the procedure is frequently underestimated. This report is aimed at raising awareness to technical errors made in performing the procedure. In a period of 4 years, 5 patients who had colostomy in the neonatal period developed problems, which were attributed to errors made in performing the procedure and have been retrospectively reviewed. In 3 patients, the sigmoid colon was erroneously used for transverse colostomy resulting in poor function. There was increased blood loss and increase in operation time from colostomy take down at subsequent definitive surgery in all 3. In one other patient, the ileum was mistaken for the transverse colon and opened, requiring closure; the closure leaked necessitating laparotomy, resection and anastomosis but death occurred from peritonitis. The fifth patient developed stoma necrosis due to ligation of the marginal artery and narrow fascial opening. Colostomy refashioning was necessary but death occurred from overwhelming infection. The colostomies were performed at a peripheral hospital and by unsupervised residents. Colostomy in the newborn can be associated with significant morbidity and mortality and great care is necessary to avoid these. Some technical points to avoid these errors are highlighted.     

Blunt abdominal trauma in children: epidemiology, management, and management problems in a developing country

Trauma is the leading cause of death in children in developed countries. In tropical Africa, it is only beginning to assume importance as infections and malnutrition are controlled. In developed countries, the availability of advanced imaging modalities has now reduced the necessity for laparotomy to less than 10% following blunt abdominal trauma (BAT) in children. This report reviews the epidemiology, management, and unnecessary laparotomies for pediatric BAT in a developing country in a retrospective review of 57 children aged 15 years or less at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria over 12 years. The average age was 9 years and the male-female ratio 3.8:1. Seventy-four percent (74%) of abdominal injuries in children were due to blunt trauma. The commonest causes of injury were road traffic accidents (RTA) (57%), 88% in pedestrians and 59% in children aged 5–9 years. Falls were the cause of trauma in 36%, 60% of them aged 10–15 years. Other causes of injury were sports in 5% and animals in 2%. Diagnosis was clinical, supported by diagnostic peritoneal lavage or paracentesis. Two patients had ultrasonography, and none had computed tomography. Fifty-three patients had a laparotomy, 2 died before surgery, 1 was managed nonoperatively, and in 1 surgery was declined. There were 34 splenic injuries, 20 treated by splenic preservation, splenectomy in 13, and non-operative in 1. Fourteen gastrointestinal injuries were treated in 12 patients. Of 9 hepatic injuries, 4 were minor and were left untreated, 3 were repaired, 1 was packed to arrest hemorhage, and a lacerated accesory liver was excised. Four injuries to the urinary tract (bladder contusion 2, bladder rupture 1, ruptured hydronephrotic kidney 1) were treated accordingly. There were 4 retroperitoneal hematomas associated with other intra-abdominal injuries and 2 pancreatic contusions. One lacerated gallbladder was treated by cholecystectomy and a ruptured left hemidiaphragm was repaired transperitoneally. In retrospect, 27 (51%) patients could have been managed by observation (splenic injury 20, liver injury 5, bladder contusion 2) using advanced imaging modalities. One patient developed an intra-abdominal abscess following splenorrhaphy. The average hospital stay was 17 days. Mortality was 8 (14.5%) from gastric perforation (3), liver injury (2), splenic injury (1), and 2 patients died before surgery. BAT in this population results predominantly from RTA in pedestrians. Laparotomy may be avoided in 51% of cases if advanced imaging modalities are readily available. Accepted: 28 October 1999     

Typhoid ileal perforation in children: a scourge in developing countries

Over a 10-year period, 64 children aged < or = 12 years were treated for typhoid perforation, accounting for 56% of all cases of typhoid perforation at our institution. The perforation rates in the age groups < 1, 1-4, 5-9 and 10-12 years were 4%, 1.7%, 12.4% and 29.3%, respectively, with an overall perforation rate of 10.3%. The main features were fever (93.4%) and abdominal pain and tenderness (93.4%). Thirteen children (20.3%) had associated haemorrhage, presenting as haematochezia. The incidence of perforations was 52% during the rainy season and 48% during the dry season, but the disease occurred throughout the year with a peak in October, the beginning of the dry season, which was also the time of peak occurrence of typhoid without perforation. An average of 14 h (range 5-30) was required for resuscitation. Ketamine was used for anaesthesia in most cases. Treatment was by segmental resection (67%), wedge excision (17%) and simple closure (6%). Morbidity was high (53%), and wound infection (53%) and chest infection (30%) were the most common complications. There were 25 deaths (39%), most the result of overwhelming sepsis. Late presentation at > 7 days was associated with high mortality (p < 0.05). Typhoid perforation continues to be a scourge in children in developing countries and, in addition to preventive measures such as improved sanitation and the provision of safe water supplies, public enlightenment is necessary to ensure early presentation and improved survival.