Abnormal Lower Extremity Hemodynamics at Doppler US in Children with Sickle Cell Anemia

Background Children with sickle cell anemia (SCA) are predisposed to developing leg ulcers in early adolescence; however, the underlying physiologic mechanisms are not well understood, which hinders the development of prophylactic antiulcer interventions. Purpose To determine if occlusive arterial disease or abnormal hemodynamics exist in the lower limb peripheral arteries of children with SCA. Materials and Methods This was a prospective cross-sectional study conducted between July 2020 and May 2021. Two groups of participants were enrolled: children with SCA and healthy controls. Each child had their anthropometric measurements taken, followed by B-mode, color Doppler, and spectral Doppler US evaluation of the distal anterior and posterior tibial arteries. Ankle-brachial index evaluation was also performed. Hemodynamic values were compared between children with SCA and healthy controls, with statistical significance set at the P < .05 level. Results Forty-five children with SCA (mean age, 9.5 years ± 3.7 [SD]; 26 boys) and 45 healthy controls (mean age, 9.3 years ± 3.8; 25 boys) were evaluated. Children with SCA had higher peak systolic velocities, end-diastolic velocities, and blood volume flow in their distal anterior and posterior tibial arteries compared with the healthy participants (P < .001 across all 12 measurements). Children with SCA also had lower resistive index and pulsatility index values compared with healthy controls in at least one of the anterior and posterior tibial arteries bilaterally. Monophasic spectral patterns were exclusively observed in participants with SCA. The ankle-brachial index values for the participants with SCA (mean, 1.09 ± 0.08) and healthy participants (mean, 1.06 ± 0.02) were within normal range. Conclusion Abnormal peripheral hemodynamic characteristics were found in the lower limbs of children with sickle cell anemia. No evidence of occlusive peripheral artery disease was present. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Paltiel in this issue.

Lymphoepithelial cyst of the pancreas. A case report

We present the case of a 63 year-old male who presented with a cystic lesion of the distal pancreas. Excision and histology showed this to be a lymphoepithelial cyst. Cystic lesions of the pancreas represent a diagnostic challenge, especially when pseudocyst secondary to pancreatitis is excluded. These lesions can be broadly classified into benign, pre-malignant and malignant. Widely used imaging modalities such as CT and MRI are not able to categorically differentiate between these. More invasive procedures such as endoscopic US and FNA again do not give a cast-iron diagnosis. Our patient had a symptomatic cystic lesion in his pancreas which was excised after cross-specialty discussion. We advocate that this is the ideal way to treat patients with cystic lesions of the pancreas, with each case considered on its own merits as all current diagnostic investigations have their limitations.

HIV prevalence among prison inmates in a central prison in southern Malawi, 2005

A cross-sectional study of 164 prison inmates (142 men [86.6%] and 22 women [13.4%]) in Malawi estimated a HIV prevalence rate of 36.6%; 29.9% among men and 50% among women. Three (2.1%) men reported having sex with men, and none reported intravenous drug use.

Awareness and knowledge of glaucoma among workers in a Nigerian tertiary health care institution

Purpose:

The aim of this study reports the level of awareness and knowledge of glaucoma among selected health care personnel at a health institution in southwestern Nigeria.

Materials and Methods:

Health personnel at the Federal Medical Centre, Owo, Nigeria, a tertiary health care institution were stratified into a clinical and an administrative directorate. One-hundred twenty participants were selected from each directorate by a random sampling technique. A structured questionnaire was used to collect sociodemographic data and data on the level of knowledge and awareness of glaucoma. Statistical analyses included the independent t-test and Pearson's chi-square test for categorical variables. Statistical significance was indicated by P < 0.05.

Results:

From the target population of 240 participants, 216 (98 males; 118 females) completed the questionnaire. The mean age of the participants was 35.07 ± 07 years. A total of 148 (68.6%) participants had heard of glaucoma comprising all participants from the clinical directorate and 28 participants from the administrative directorate. There was no statistically significant difference between the clinical and administrative directorates about the knowledge of the aspect of vision that is first affected by glaucoma, the painless nature of glaucoma among most Africans and the irreversible nature of glaucoma-related blindness (P > 0.05, all comparisons).

Conclusion:

There is the need to update the knowledge base of these workers if they are to be useful in propagating information of the irreversible blindness that could arise from delay in glaucoma diagnosis and treatment.

Angiomyolipoma presenting as renal abscesses: a consideration for further evaluation of renal abscess

AIMS AND OBJECTIVES

This is to describe an usual presentation of renal angiomyolipoma as renal abscess

CASE REPORT

This is a case report of a 51 year old man with clinical and radiological features suggestive of renal abscess. The patient had exploratory laparatomy and a simple nephrectomy for a non functioning kidney which was more like a bag of pus. The histological report however revealed renal abscess coexisting with angiomyolipoma supporting previous reports that renal abscess may be a harbinger of other renal pathologies.

CONCLUSION

Abscesses are usually managed by drainage and the dictum of 'wherever there is pus let it out' holds generally but this does not always suffice in renal abscesses because renal abscesses are often found in the background of other diseases which may be of more clinical importance.

African traditional medication and keloid formation in herpes zoster ophthalmicus

Keloid scar complicating herpes zoster ophthalmicus (HZO) has not been much reported among Africans despite the African population having dark skin. We report on a middle-aged Nigerian with HZO who developed keloid scar following use of traditional herbs to the herpetic rashes. A 52-year-old immune-competent Nigerian male presented with a 2-week history of vesicular rashes involving the left side of the forehead down to the tip of the nose. He initially presented to an African traditional healer who had advised application of various herbs to the lesion. When he presented to the eye clinic, he was treated for the associated uveitis with significant improvement. The cicatricial skin change gradually became raised with clinical appearance of keloid at 1 year of follow-up. Cicatricial skin changes in HZO are not unusual, but keloid formation among Africans has not been much described. Late presentation, use of traditional herbs some of which have corrosive effect and secondary bacterial infection are the possible factors that may encourage such abnormal wound healing. The myth associated with HZO in the local African setting as well as the fact that African traditional healers are still widely accepted among most African communities may play a role in increasing the risk of keloid formation among our population following HZO infection.

Outcome of trabeculectomy with 5-fluorouracil using releasable suture technique in a Nigerian Tertiary Hospital

BACKGROUND

Trabeculectomy has undergone a series of modifications in recent times most of which are aimed at improving the efficacy of the procedure while reducing complications. The use of releasable sutures is one of such modifications.

OBJECTIVE

To assess the efficacy and complications associated with the use of releasable sutures and 5-Fluorouracil(5-FU) in trabeculectomy among indigenous African patients with primary open angle glaucoma.

METHODS

This was a chart review of 22 eyes of 17 patients diagnosed with primary open angle glaucoma. All the eyes included in the review had trabeculectomy with 5-Fluorouracil using releasable suture technique with postoperative clinic follow- up visit for a minimum period of 72 weeks. Information sought included patient's demographics, preoperative antiglaucoma medications, pre- and post- operative intraocular pressure, and associated complications.

RESULTS

There were 17(13 M, 4 F) patients with 22 eye surgeries. Their mean age was 49.8 ± 9.3 years. The mean preoperative intraocular pressure was 27.7 ± 5.9 mmHg. The intraocular pressure on the first post-operative day was 10.6 ± 11.1 mmHg. The mean pressure before the removal of the releasable suture was 14.1 ± 10.8 mmHg and after removal was 6.0 ± 7.2 mmHg, (p > 0.0001). The mean intraocular pressure at 72 weeks of follow up was 16.9 ±5.6 mmHg. A qualified success rate of 81.8% was achieved in terms of intraocular pressure control. There were two eyes complicated by blebitis and an eye complicated by malignant glaucoma.

CONCLUSION

The use of releasable suture in trabeculectomy helped in maintaining the intraocular pressure at a lower level in the early postoperative period and in reducing postoperative shallowing of the anterior chamber. The procedure appears to be associated with some sight- threatening complications such as endophthalmitis.

Parathyroid carcinoma. Mini-series of patients successfully treated with minimally invasive surgery using intra-operative PTH assays, and literature review

Parathyroid cancer is a rare cause of primary hyperparathyroidism, with a surgeon anecdotally expected to see a single case in his/her entire career. In our unit, however, we have treated three patients recently. The accepted optimal treatment of parathyroid cancer is radical resection at the initial surgery, but a low index of suspicion means that most parathyroid cancers are not identified pre- or intra-operatively. This results in the majority of patients having inadequate surgery. All three patients were treated by minimally invasive surgery, with radical en bloc resection based on intra-operative suspicion of malignancy. Pre-operative imaging guides the neck exploration, and intra-operative PTH assays confirm excision of the source of excess PTH. All patients have remained well with no recurrence to date. We review the literature on parathyroid cancer, and suggest features that point to a parathyroid tumour being malignant.

Visual impairment from age-related cataract among an indigenous African population

AIM

To determine the magnitude of visual impairment (VI) resulting from lens opacity/cataract among a rural population in southwestern Nigeria.

METHOD

A population-based cross-sectional survey using a multistage sampling method to select subjects >or=50 years. Participants with pinhole visual acuity of <or=6/18 in their better eye, exclusively from lens opacity/cataract, were further examined by an ophthalmologist. Their level of VI was categorised using the International Classification of Disease tenth revision and lens opacity was graded using the World Health Organization's cataract grading system.

RESULTS

From the enumerated population of 1200 subjects, 1031 subjects were examined. The prevalence of VI from cataract/lens opacity in the population studied was 11.9% (95% CI: 10.1-14.0) with a cataract blindness prevalence of 2.0% (95% CI: 1.3-3.0). The odds for VI increased with increasing age and female patients had 1.6 times the odds for cataract blindness than did male patients. Mixed cataract was the most prevalent of the visually disabling cataract. (3.9% (95% CI: 2.8-5.2)), whereas posterior subcapsular cataract was the least prevalent (2.5% (95% CI: 1.7-3.7)).

CONCLUSION

VI from cataract remains a public health problem in the Akinyele district of Nigeria. The need for a comprehensive cataract surgical service using the VISION 2020 model is necessary in the district if the burden from the backlog of visually disabling cataract is to be reduced.

Visual outcome of cataract surgery in University College Hospital, Ibadan Nigeria

BACKGROUND

Cataract is a leading cause of avoidable blindness, while cataract surgery is the commonest major surgical procedure worldwide.

OBJECTIVE

To evaluate the visual outcome and causes of poor vision in patients who had cataract extraction at a major hospital in Nigeria.

METHODS

A retrospective study of the case notes of patients who had cataract extraction in the Eye Clinic of University College Hospital, Ibadan between July and Dec. 2004 was done. The visual outcome was analyzed using the WHO categorization of visual outcome and those with poor visual outcome evaluated for the cause of such poor outcome.

RESULTS

Forty-seven (40.2%) of the eyes had good outcome before refraction and the number increased to 80 (67.8%) after correcting for postoperative refractive error. The highest single cause of poor visual outcome was uncorrected refractive error, 32 (47%) eyes. Other causes included posterior capsule opacification 7 (18.4%) eyes, preexisting ocular co-morbidity such as glaucoma, optic atrophy and maculopathy 6 (15.9%) eyes.

CONCLUSIONS

This review showed that uncorrected refractive error and posterior capsular opacification were the major causes of poor visual outcome after cataract surgery. Preoperative biometry for all patients, meticulous intra operative cortical clean up, adoption of the cataract surgery outcome tally sheet and better patient selection will help improve the outcome of our cataract surgeries.

Combined central retinal artery and vein occlusion complicating orbital cellulitis

Orbital Cellulitis is a dreaded ophthalmologic disease. It may destroy vision and the eye and may even become life threatening. Often visual loss is the result of exposure and subsequent destruction of ocular tissue commonly the cornea and the uvea. We report a case of combined central retinal artery and vein occlusion complicating orbital cellulitis in a 35 year old patient who was 37 weeks pregnant resulting in loss of vision in the affected eye. There have been few case reports of this type of complication of orbital cellulitis.

Reproductive strategy of Oreochromis niloticus (Pisces: Cichlidae) in Opa reservoir, Ile-Ife, Nigeria

The fish family Cichlidae has a large diversity and dominates African freshwater bodies, with over 200 species reported in inland waters. Sampling for the fish Oreochromis niloticus (Linnaeus) in Opa reservoir, Nigeria, started in October 1997 and extended until February 2000. The fishing methods employed for collecting the 1 430 specimens were cast netting and gillnetting. Egg diameter varied between 2.12 mm and 2.69 mm with a mean of 2.47+/-0.02. Female gonadosomatic index was 1.34+/-0.01 (0.12-4.06, n= 637). The male gonadosomatic index was 0.39+/-0.02 (0.03-1.67, n=789). In Opa reservoir, O. niloticus bred throughout the study period. The species was a maternal mouth brooder with the female fish carrying eggs and fry in the buccal cavities. The sex ratio of O. niloticus was approximately 1:1 in the reservoir. The fecundity of the species was between 73 eggs and 1 810 eggs per female with a mean fecundity of 815 eggs.

Leprosy in Nkhotakota District Hospital

OBJECTIVE

To study the profile of leprosy cases at Nkhotakota District Hospital in Central Region of Malawi.

DESIGN

Retrospective cross-sectional study of all registered cases of leprosy from records over a nine year period (January 1992 to April 2001)

SETTING

Nkhotakota District Hospital-Central Region of Malawi.

RESULTS

In total 526 cases of leprosy were identified from the records. The prevalence rates gradually increased from 0.998 per 10,000 cases in 1992 to 3.39 cases per 10,000 in 1995. There was however a gradual decline of prevalence rates from 1997/1998 that had 3.17 cases per 10,000 to 1.3 cases per 10,000 in 2001. 1996 registered 2.34 cases per 10,000. Fifty seven cases (10.8%) were found with children of the age of 14 or below and 469 (89.2%) cases were of adults. Paucibacillary leprosy presented with more cases than multibacillary leprosy (p < 0.0000001). There were 80 (15.2%) cases of multibacillary leprosy compared to 446 (84.8%) cases of paucibacillary leprosy. In addition more males were affected by multibacillary leprosy than females (p < 0.0001) and females were more affected by paucibacillary leprosy (p < 0.01) than males.

CONCLUSION

The results show that paucibacillary leprosy though minor in Malawi can become endemic as paucibacillary leprosy is a reflection of leprosy contacts in the population. We therefore recommend continued epidemiological surveys of leprosy. Training in leprosy detection should be encouraged so that this disease can be totally eradicated in Malawi.

Evaluation of syndromic management of sexually transmitted infections in Blantyre, Malawi

Sixty-five consecutive patients presenting to the sexually transmitted infections (STI) clinic, Queen Elizabeth Central Hospital (QECH), Blantyre were interviewed and six health centres were visited to assess the quality of syndromic management of STIs and also to evaluate the success of partner treatment of index cases. The results showed that more females (55%) than males (45%) presented and 69% of interviewed patients were between 17 - 25 years. Age range was between 17 and 56 years and median age was 27. Married people predominated at 69% while singles were only 20%. 66%, 20% and 14% were index case, sexual partners and repeat cases respectively while 33% of the attendees had had an STI within the previous 3 months. Approximately 95% of patients had formal education and 97% had religious affiliations. When compared to previously criteria, the result of this survey showed that information dissemination, health education and counselling of patients with STIs were poor with only 29% being adequately managed. We also observed that only 20% of partners were treated in this study. Health centers lacked the necessary equipment, personnel and supplies to adequately provide syndromic management services. Furthermore, record keeping in these centres was poor.

Epidemiology and mortality of burns at the Queen Elizabeth Central Hospital Blantyre, Malawi

OBJECTIVES

To determine the most common causes, population most at risk and the pattern of mortality of burn injuries at the Queen Elizabeth Central Hospital, Blantyre, Malawi.

DESIGN

Retrospective cross sectional study.

SETTING

Burns Unit, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi.

SUBJECTS

One thousand eight hundred and twenty five case files of burn patients admitted to the QECH, Blantyre, between January 1994 and December 1999, involving 941 male and 884 female patients among whom 145 were epileptic.

MAIN OUTCOME MEASURE

Aetiology of burns and the population most at risk at the QECH, Blantyre.

RESULTS

More males (52%) than females (48%) suffered from burns during the six year study period. Children below age five (55%) were most at risk while 89% were below 30 years of age. Hot water (38%) was the most common cause of burns, but among epileptic patients, it was open fire (83%). While 71% of all inpatients had superficial burns (less than 10% TBSA) 22% had deep burns requiring grafting. Almost all the patients (98%) had multiple antibiotic therapy combined with topical application of silver sulfadiazine. Overall mortality was 12% but among the epileptic patients it was 16%.

CONCLUSION

Children under five years of age were the major victims of burn injuries in this study. There is, therefore, need to mount effective awareness campaigns in order to target the root causes of burns in children.

Antibiotic resistance in bacteria - an emerging public health problem

The discovery and eventual introduction of anti-microbial agents to clinical medicine was one of the greatest medical triumphs of the twentieth century that revolutionized the treatment of bacterial diseases. However, the gradual emergence of populations of antibiotic-resistant bacteria resulting from use, misuse and outright abuse of antibiotics has today become a major public health problem of global proportions. This review paper examines the origins and molecular epidemiology of resistance genes, global picture of antibacterial resistance, factors that favour its spread, strategies for its control, problems of control and the consequences of failure to contain antibiotic resistance in bacteria.

Bacteriology of burns at the Queen Elizabeth Central Hospital, Blantyre, Malawi

A retrospective study to determine the bacterial profile and antibiotic susceptibility pattern of burn isolates at the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi was undertaken. While a total of 1825 burn patients were admitted to the hospital over a 6-year period (January 1994 to December 1999) only 317 (17.4%) specimens selected from as many patients were processed. One hundred and seventy (170/53.6%) specimens yielded single while the rest (147/46.4%) had multiple isolates giving a total of 535 bacterial isolates. Of this number, 236 (44.1%) were Gram-negatives and 299 (55.9%), Gram-positives. Among the Gram-negatives, Pseudomonas aeruginosa, Proteus mirabilis, Coliforms/Escherichia coli and Klebsiella pneumoniae were the most common accounting for 94.1% while in the Gram-positive group, staphylococcal and streptococcal spp. predominated (100%). However, the three most common isolates were Staphylococcus aureus (37.6%), P. aeruginosa (22.4%) and beta-haemolytic streptococci (13.6%). While S. aureus and beta-haemolytic streptococci were most susceptible to penicillin (33.3 and 64.4% susceptibility, respectively), gentamycin appeared most effective against P. aeruginosa (53.3%). A general broad-spectrum resistance to panels of antibiotics used in the study was however observed among the bacterial isolates. From these results, S. aureus, P. aeruginosa, streptococcal spp., P. mirabilis, Coliforms and K. pneumoniae representing 96.4% of all isolates were the most common in the Burns Unit.

The prevalence of HIV infection among burn patients in a burns unit in Malawi and its influence on outcome

In a 1 year study, 342 patients admitted to the Burns Unit at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi underwent a voluntary HIV test. Forty (11.7%) tested HIV positive: of those aged above 15 years, 31% (34 out of 112) were HIV positive, whilst 3% (6 of 231) aged under 15 were HIV positive of whom the majority were in those aged under 5 years (5 of 125, 4%). Patients who were HIV positive had an increased risk of death (P=0.04) which was mainly due to sepsis, but those HIV patients, who did not develop infection or recovered from an episode of sepsis, had similar hospital stay, need for skin grafting and graft take as nonHIV patients. There was no difference in pathogens cultured from wound swabs taken from HIV positive and negative patients. HIV positive patients had significantly lower CD4 counts as compared to HIV negative patients (mean 383mm3 (S.D. 320) and 937mm3 (S.D. 497), respectively). However, low CD4 counts were also found in the HIV negative patients (mean 901, range 131-1964) and 24% had CD4 <500/mm3. Both HIV status and the total body surface area (TBSA) burned were independent predictors of CD4 count. TBSA was an independent risk factor for death (odds ratio 1.3; 95% CI 1.1, 1.4). In patients with TBSA burns of over 30%, mortality approached 100% irrespective of HIV status, but in patients with burns of 11-20% TBSA and who were HIV positive have a mortality of 25% compared to 12% in HIV negative patients; for 21-30% TBSA burns mortality was 100% compared to 50% for HIV positive and HIV negative patients, respectively.

Specialisation patterns of medical graduates, University of Malawi College of Medicine, Blantyre

OBJECTIVE

To describe specialization patterns of medical graduates of the University of Malawi College of Medicine.

DESIGN

Cross sectional study.

SUBJECTS

Medical graduates of the University of Malawi College of Medicine.

SETTING

University of Malawi College of Medicine.

MAIN OUTCOME MEASURES

Speciality choices, sources of funding for training, employer at time of graduate studies and country where specialist training obtained.

RESULTS

Between 1991 and 2000, 60 (35.5%) of the 169 graduates of the College of Medicine of the University of Malawi have obtained or are in specialist training, 38/60 (63.3%) with training institutions either in the United States or the United Kingdom, 10 (16.7%) had gone to South Africa, 8% Kenya, 5% to the Republic of China (Taiwan) and 3.3% to Uganda. Other countries are; Uganda, Australia and Finland. The preferred specialties were; Public Health 17 (28.8%), Internal Medicine 12 (20%) and Paediatrics 10 (16.7%). Most of the funding was provided by agencies/institutions in the USA and UK. At the time of their training fellowship, 33 (55%) of the candidates were employed by the College of Medicine, 24 (40%) by the public service and the rest, three (5%) by other institutions.

CONCLUSIONS

Most Malawian medical graduates are obtaining their specialty training overseas funded mostly by institutions/agencies in the UK and USA. There is need to explore ways on how training could be provided regionally. Malawi and her neighbours must develop post graduate speciality training locally and regionally.

Buruli ulcer in Malawi - a first report

One hundred and sixty-one specimens swabbed from as many patients with chronic wounds/ulcers over a period of eight months yielded 3 acid-alcohol fast bacilli (AFB) organisms that slowly grew only at 32°C on Lowenstein-Jensen(LJ) medium producing creamy-yellow colonies between 39 and 45 days post-incubation. Mycobacterial organisms harvested from culture were strongly positive when subjected to both catalase spot test and catalase heat stability test indicating the presence of Mycobacterium ulcerans, the aetiological agent of Buruli ulcer.

Effect of promethazine on the metabolism of chloroquine

Co-administration of promethazine hydrochloride and chloroquine phosphate resulted in increased blood levels of chloroquine and its metabolites. However, there is no statistical difference between the means obtained for the initial rate of excretion and the total drug excreted within three hours.

Feline calicivirus subunit vaccine--a prototype

A vaccine was prepared from a subunit component, antigenically similar to the whole feline calicivirus (FCV) particles. Despite the limited number of animals available for this study we were able to demonstrate that the vaccine protected cats when challenged with a virulent strain of the virus while the non-vaccinates kept as controls developed clinical and histopathological symptoms of the calicivirus disease.

High-pressure liquid chromatographic analysis of sennosides A and B purgative drugs

Procedures are described for the analysis of the main anthraquinone glycosides of senna powder, senna fruit tablets, and sennoside tablets by high-pressure liquid chromatography (HPLC). In one HPLC analysis, TLC was used to separate the glycosides prior to elution on a strong anion-exchange column with 0.1 M ammonium nitrate solution (pH 9.0) as the mobile phase. In another HPLC analysis, separation was effected using a weak anion-exchange column with 0.1 M ammonium nitrate solution (pH 5.7A) as the mobile phase.

Ion-pair partition chromatography analysis of anthraquinone glycosides of senna and pharmaceutical preparations of senna

Ion-pair partition has been combined with HPLC for the rapid detection and separation of the major anthraquinone glycosides of senns, sennosides A and B. A Corasil C18 column (5 microns) with methyl alcohol (30 percent in water) containing 0.005 M tetrabutylammonium phosphate, pH 7.5, as mobile phase was used. In the application to the assay of drugs, sennosides A and/or B constituents of the crude senna drug, Senokot syrup, Senokot tablets, and Pursennid tablets have been estimated in the presence of other constituents of the crude drug and pharmaceutical preparations. The results obtained are compared with colorimetric assay results.