Acute extradural haematomas in children: A single neurosurgery unit's 12-year experience

BACKGROUND

Acute extradural haematomas (AEDHs) occur infrequently in children. This study was undertaken to review our experience with management and outcomes of this condition in children treated in the Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital.

METHOD

A retrospective review of medical records of all children (age less than or equal to (≤) 12 years) with a diagnosis of AEDH admitted from January 2003 to December 2014 was performed. Records were analyzed for demographics, mechanisms of injury, clinical presentation, neuroradiology findings, management and outcomes at discharge.

RESULTS

A total of 150 children with AEDHs were admitted during this period. The mean age was 6.6 ± 3.8 years with a peak incidence in the 7-9 year age group. There were 84 (56%) males, (M: F= 1.3:1). Sixty AEDHs resulted from road traffic crashes (40%). On admission 104 (69.3%) children were Glasgow coma scale (GCS) 13-15, 26 (17.3%) GCS 9-12 and 20 (13.4%) GCS 3-8. Haemoglobin was less than (<) 8 g/dl in 56% of infants (p < 0.001). Skull fractures were identified in 78% of cases. Surgical management was undertaken in 83% of children and the mean hospital stay was 6.9 ± 6.1 days. Four children (2.7%) died during in-hospital stay period. One hundred and forty one (94%) children had a favourable Glasgow outcome scale (GOS) at discharge.

CONCLUSION

AEDHs in children carry a good prognosis, but can be potentially fatal. A vigilant approach is required when assessing these children, as early diagnosis and treatment yields gratifying results.

Palatability and efficacy of rodent baits for eradicating house mice (Mus musculus) from Gough Island, Tristan da Cunha

Context Introduced house mice (Mus musculus) are a serious predator of seabird chicks at Gough Island, resulting in declining populations of several threatened species. This has prompted the preparation of plans to eradicate mice from Gough and other islands. However, relatively little is known about the palatability and efficacy of rodent baits for house mice, as most studies have focussed on rats (Rattus spp.). Aims The study’s aim was to test the palatability of non-toxic forms of two commercially available rodent pellet bait formulations (Pestoff® 20R and Final®) and a new pellet bait formulated specifically for mouse control (Pestoff® 20M) to house mice on Gough Island. We also tested the efficacy of toxic Pestoff 20R and Final pellets containing 20 and 25 ppm of the anticoagulant toxin brodifacoum. Methods Five trials with 50 mice housed in individual cages and kept at ambient temperature and light cycles, were undertaken during the year. Palatability of bait pellets was measured over five days and compared with a non-toxic control food (standard ‘rodent pellets’ sourced from a pet food supplier). Toxic bait trials were run for 25 days with bait administered at 1, 2 and 10 g for a 24-h period and at 20 g per day for 72 h. Key results All three baits were highly palatable; however, mice showed the greatest preference for Pestoff 20M and 20R, consuming a larger mass of bait. Estimated oral LD50 values of brodifacoum for Gough mice were 0.44 mg kg–1 and the average time to death following exposure was 5.5 days (range 0–16 days). Two mice (~1% of those tested) survived after apparently ingesting doses of brodifacoum estimated to be 5 and 10 times the oral LD50 values, potentially indicating a lower susceptibility to brodifacoum in some individuals, although subsequent exposure at higher doses resulted in mortality. Conclusions The results of this study confirmed that house mice on Gough Island find bait pellets highly palatable and that brodifacoum is an effective toxin with LD50 values and time to death within the same range (0.4 to 0.52 mg kg–1 and 5.2 days) as other studies, indicating no major difference in the susceptibility of Gough mice to this poison. Implications We recommend that bait manufacturers produce formulations designed to be attractive to mice and consider the use of higher concentrations of brodifacoum to increase the likelihood of all mice obtaining a toxic dose when small quantities of bait are consumed, although higher toxin concentrations must be balanced against the increased risks to non-target species. Eradication operations targeting mice should undertake more than one bait drop to ensure any individuals surviving the initial drop have access to sufficient toxic bait to cause mortality upon second or subsequent exposure.

Spread of an emerging Mycobacterium tuberculosis drug-resistant strain in the western Cape of South Africa

BACKGROUND

South Africa has a high burden of drug-resistant tuberculosis (TB).

METHODS

Routine drug susceptibility testing was performed prospectively over a 2-year period on Mycobacterium tuberculosis isolates in two health districts of the Western Province, South Africa. A cluster of drug-resistant strains that shared a rare mutation in katG315 was found in 64 of the 450 cases identified as having been infected with drug-resistant TB. Isolates belonging to this cluster were phenotypically and genotypically characterised. Epidemiological and clinical characteristics were used to identify mechanisms leading to the acquisition and spread of this drug-resistant strain.

RESULTS

An outbreak of an emerging non-Beijing drug-resistant strain infecting 64 pulmonary tuberculosis (PTB) cases was identified. This previously undetected genotype (now designated DRF150) is characterised by five IS6110 insertions, specific spoligotypes and high levels of resistance to the first-line TB medications isoniazid, streptomycin and rifampicin. In 45% of the cases it is also resistant to ethambutol and pyrazinamide. Key factors leading to the development and spread of this drug-resistant genotype were inappropriate chemotherapy, poor adherence to treatment and prolonged periods of infectiousness due to delays in susceptibility testing.

CONCLUSIONS

Molecular markers allowed early identification of an emerging non-Beijing drug-resistant strain.

Characterization of bluetongue virus ribonucleic acid

An improved purification procedure yielded bluetongue virus free from any single-stranded ribonucleic acid (RNA) component. Double-stranded RNA obtained from purified virus or isolated from infected cells was fractionated into 5 components by means of sucrose gradient sedimentation analysis, and into 10 components by electrophoresis on polyacrylamide gels. The size of these components vary from 0.5 x 10(6) to 2.8 x 10(6) daltons, with a total molecular weight estimate of about 1.5 x 10(7) for the viral nucleic acid. The denaturation of the genome and separation of the resulting fragments are also discussed.