Main Presenting Signs Research Articles

Chest Wall Hydatid Disease: Surgical management and risk Factors for Recurrence and Mortality

Background Hydatidosis of the thoracic wall differs from other hydatid localizations in its pathophysiology, diagnostic, and therapeutic management. It is a little-studied entity. The objectives of our work were to describe its surgical management and to analyze the factors that may influence recurrence and mortality. Methods A retrospective, descriptive, longitudinal, and multicenter study on four university hospital surgical centers of Tunis, from January 1995 to December 2022 including operated hydatid cysts of the thoracic wall. Overall survival (OS) and cumulative recurrence rates were calculated. Univariate and multivariable Cox regression analyses were performed to identify recurrence and mortality risk factors. Results Forty-nine patients were included. The mean age was 41 ± 17 years [8-76]. The main presenting sign was thoracic parietal swelling (n=22). Chest ultrasound and CT scan showed multivesicular formation in 17 and 33 cases, respectively. Muscle involvement was in the intercostal (n=4), paravertebral (n=13), and pectoralis major (n=3) muscles. Bone involvement was vertebral (n=11), costal (n=12), costo-vertebral (n=21) and sternal (n=2). A posterolateral thoracotomy was performed (n=20). Surgical excision at various levels of the chest wall with spinal stabilization (n=15) was performed. Sixty-three percent of the patients received antiparasitic medical treatment. Recurrence occurred in 37% of cases. Four patients died from hydatidosis-related complications. Factors could be independently associated with recurrence such as male gender, and vertebral involvement. The presence of a visceral hydatid cyst located at a distance from the parietal lesion at the time of diagnosis and the occurrence of postoperative infectious complications could increase mortality. Conclusions Chest wall hydatidosis represents a rare medical condition where surgery remains the preferred treatment modality. However, it carries a substantial burden of morbidity and mortality, influenced by various factors. Further large-scale studies are necessary to gain a deeper understanding of these factors and to optimize management strategies accordingly.

Profil épidémiologique et histologique des tumeurs du système nerveux central à Dakar

INTRODUCTION : Les tumeurs du système nerveux central sont rares. Elles sont responsables d’une mortalité et d’une morbidité importantes. Les types histologiques varient selon l’âge. L’objectif de cette étude était de déterminer le profil épidémiologique et histologique des tumeurs du système nerveux central au Centre Hospitalier National Dalal Jamm. MATERIELS ET METHODES : Nous avons mené une étude rétrospective descriptive concernant les patients pris en charge dans le service d’Oncologie-Radiothérapie du Centre Hospitalier National Dalal Jamm de Novembre 2018 à Octobre 2021. L’âge, le sexe, les principaux signes révélateurs, la tumeur d’origine pour les lésions secondaires, la topographie des tumeurs, et les types histologiques ont été étudiés. RESULTATS : Nous avons colligé 82 cas de tumeurs du système nerveux central. L’âge médian des patients était de 43 ans avec des extrêmes de huit et 73 ans. Soixante-treize virgule deux pour cent des cas trouvés étaient des femmes. Les enfants représentaient 8,5% de la population étudiée. Les signes cliniques les plus fréquents au diagnostic étaient les céphalées (68,3%,), la baisse de l’acuité visuelle (28%) et les nausées/vomissements (24,4%). Il s’agissait de 72% de tumeurs secondaires dont la majorité était d’origine mammaire (58,6%) et pulmonaire (5,2%). Les tumeurs primitives étaient dominées par le glioblastome (39,1%). CONCLUSION : Les tumeurs du système nerveux central sont rares au Sénégal et généralement observées chez l’adulte. Elles sont majoritairement secondaires d’un cancer du sein et le glioblastome est la tumeur primitive la plus fréquente.

218. A 5-Year Retrospective Study of Actinomyces Odontolyticus Bacteraemia

BackgroundActinomyces species are Gram positive anaerobic, non-sporulating, non-acid fast, non-motile, irregularly staining bacterium. It is associated with a wide range of infections including; dental caries, abscesses, intraabdominal and bloodstream infections. A. odontolyticus normally a commensal organism found in the mouth, was first isolated from dental caries in 1958. The incidence of Actinomyces odontolyticus bacteremia is less common.MethodsWe are reporting 15 cases of isolated A. odontolyticus blood stream infection at HMC, State of Qatar from 1/1/2016 to 1/11/2020. We aim to describe their clinical characteristic, risk factors and treatment outcome.ResultsOur patients with bacteraemia fall into one of two groups. The first group consists of paediatric patients with unremarkable co-morbidities. The second group includes older adults, often with co-morbidities that pre-dispose to infection, such as diabetes mellitus or hypertension. Fever was the main presenting sign and symptom in 12 patients (80%). Nine of the patients were females (60%). 13 patients (86%) received antibiotics. Maximum duration of antibiotics was 60 days and minimum duration was three days. The infectious disease team was consulted for six patients (40%). One patient died while the other 14 recovered uneventfully with a case fatality rate of 6.6%. Reported cases of Actinomyces odontolyticus bacteraemia in Hamad Medical Corporation between 1/1/2016 to 1/11/2020 Minimal inhibitory concentrations (MICs) of selected antibiotics against A. odontolyticus, including interpretations and breakpoints, as reported by the AMRHAI reference unit, PHE Colindale ConclusionClinicians of all specialties need to be aware of the rising number of reports of Actinomyces species bacteraemia due to widespread availability of molecular identification techniques, including MALTI-TOF. 3 Furthermore, more studies are needed to determine guidelines for treating these resilient microbesDisclosures All Authors: No reported disclosures

Guide to common skin disorders in donkeys

Background: Although they are a minority equine species in the UK, donkeys are both much loved companion animals and conversely frequently neglected and suffer poor welfare. Skin disease is a common complaint and often presents at an advanced state due to a number of factors, including inadequate owner knowledge, infrequent checking and grooming, and a lack of concern for the welfare of the affected donkey, alongside donkey‐specific factors, such as a difference in hair coat from horses.Aim of the article: This article covers the main presenting signs that veterinary surgeons see in donkeys with skin disease, and offers guidance on diagnosis and treatment options.

Laryngeal Trauma

Introduction Laryngeal trauma can be an immediately life-threatening entity. Failure to recognize such injuries and delay in securing the airway may have fatal results. Early diagnosis and accurate evaluation with proper treatment is vital. Materials and Methods Fifteen patients with laryngotracheal injuries were analyzed prospectively. The outcome was assessed both in terms of voice and airway, on short term and long term basis. Result Commonest cause of injury was suicidal followed by road traffic accidents and strangulation. The main presenting symptoms and signs were stridor, hoarseness, haemoptysis and odynophagia. Five patients suffered penetrating trauma and ten patient sustained blunt trauma. Sites of laryngeal injury included; hyoid bone fracture, mixed soft tissue and cartilaginous injuries, thyrohyoid membrane and cricothyroid membrane injuries. Eleven patients presented within 24 hours of the injury. Outcome (airway and voice) was good in ten patients whereas it was poor in three patients. Poor results were seen in patients who had delayed surgical intervention. Conclusion Early surgical intervention is recommended for traumatic laryngeal injuries to ensure a good outcome; which further depends upon patient’s condition, injury and treatment-specific factors.

Risk factor analysis for “diagnosis not reached” results from bovine samples submitted to British veterinary laboratories in 2013–2017

Routine diagnostic data from laboratories are an important source of information for passive animal health surveillance. In Great Britain, the Veterinary Investigation Diagnosis Analysis (VIDA) database includes records of diagnostic submissions made to a nationwide network of 28 veterinary post-mortem facilities (VPFs). Data on “diagnosis not reached” (DNR), i.e. where submissions do not lead to a confirmed diagnosis, are analysed quarterly to look for unexpectedly high incidences of DNRs which could indicate the presence of a new or emerging disease in British livestock populations. The objective of the present study was to provide a better understanding about the reasons of DNR occurrence and to inform improvements of the coverage and reporting of this kind of surveillance data.A subset of the VIDA database comprising diagnostic submissions from cattle received from 2013 to 2017 (122,444 records) was analysed. A mixed-effects multivariable logistic regression model, accounting for clustering by farm and county, was used to investigate associations between potential predictors and DNR. The variables included in the model were: VPF identity, animal sex, age, production purpose, main presenting sign of the animal from which the sample was obtained, and sample submission type.The variable that showed the strongest association with DNR was the main presenting sign of the animal, followed by submission type, VPF identity, animal age, sex, and production purpose, in that order. Submissions from animals with abortion as the main clinical sign had the highest odds ratio (OR 21.6, 95 % confidence interval [CI] 19.6–23.9, with mastitis taken as the baseline). Submissions where neither carcasses (i.e. a whole dead animal provided for post-mortem examination) nor foetuses (i.e. an unborn dead animal) were provided had approximately 12 times the odds of being DNR, compared to submissions of a carcass (OR 11.6, 95 % CI 10.7–12.5). In addition, submission type and main presenting sign can be considered as important confounders in the association between the other predictors and DNR.This study has helped characterise DNR occurrence and suggests some possible improvements that could be made to the passive surveillance system investigated, such as encouraging greater carcase submission, accounting for identified issues when interpreting increased occurrence of DNR and further investigating reduced submissions or greater DNR occurrence in some geographical regions.

Clinico-Pathological Study of Adenovirus Associated with Respiratory Infections in Children

Background:Adenovirus is associated with respiratory tract infections in children worldwide. However, there is insufficient data about adenovirus infections in Egyptian children and the genotypes present in this infection.Objective:The aim of the present study was to investigate the prevalence of adenovirus and its genotypes in respiratory tract infection in children by real-time Polymerase Chain Reaction (PCR).Methods:The study was a cross-sectional study that included 100 children complaining of respiratory tract infections signs and symptoms. Laboratory investigation for adenovirus included real-time polymerase chain reaction and genotypes detection by Multiplex Polymerase Chain Reaction (PCR).Results:Adenovirus was detected by PCR for fiber gene in 11% with genotype 3 in 6 samples (54.5%) and genotype 7 in 5 samples (45.5%) positive for adenovirus by Multiplex PCR. The main presenting symptoms and signs in children with adenovirus detected by PCR were cough, fever, wheezing, and croups (90.9%, 81.1%, 63.6%, and 63.6%, respectively). The diagnosis in children with adenovirus was pneumonia in 72.7% and bronchitis in 27.7%. There were statistically insignificant differences in demographic, clinical, and hematological parameters between children with adenovirus and children negative to adenovirus by PCR.Conclusion:The clinical characteristics of respiratory infections with adenovirus vary upon the age of the patients and the immune status. Therefore, there is a requirement for an extensive study of adenovirus in respiratory infections in children with different ages and immune status.

Risk factors and surgical management of sigmoid volvulus among patients attending Al-Karama Teaching Hospital of Iraq

Background: Sigmoid volvulus is defined as torsion of the sigmoid colon around its mesenteric axis, which leads to acute large intestine obstruction, which, if left untreated, often results in life-threatening complications, such as bowel ischemia, gangrene and perforation. The aim of this study was to analyse sigmoid colon volvulus when its presented as a surgical emergency.Methods: This was a prospective study of 25 patients presented with the features of strangulated sigmoid colon volvulus to Al-Karama Teaching Hospital (surgical casualty) from March 2014 to March 2018. Eighteen patients (72%) were males and seven patients (28%) were females. The age of the patients ranged from 20-70 years. The main risk factor was chronic constipation, laxative dependency and high fiber diet. The main presenting symptoms and signs were absolute constipation, generalized abdominal distension, tenderness, tachycardia and fever. The patients were investigated by plain abdominal X-ray and haematological investigations.Results: Among the 25 patients, 13 had distended gangrenous sigmoid colon volvulus, 9 out of the remaining 12 patients were discovered to have distended non-gangrenous sigmoid colon volvulus of the rest 3 patients, 2 were found to have Ileo-sigmoid knotting and the last patient had a perforated gangrenous sigmoid colon volvulus. Four patients developed postoperative complications and one patient died.Conclusions: Volvulus of the sigmoid colon is more predominant in males. Middle age individuals seem to be the most affected group by sigmoid colon volvulus. Majority of patients with sigmoid colon volvulus have history of chronic constipation, laxative dependency and high fiber diet.

Acute Cerebellitis in Children: A Many-Faceted Disease.

Acute cerebellitis is a rare inflammatory condition. It may have a benign, self-limiting course or present as a fulminant disease resulting in severe cerebellar damage or even sudden death. We present the clinical, laboratory, and radiologic data in 9 children diagnosed with acute cerebellitis, who were identified by database search in our pediatric medical center from January 2000 to November 2014. The main presenting symptom was headache, and the main presenting sign was ataxia. Bilateral diffuse hemispheric involvement was the most common imaging finding at presentation. Mycoplasma pneumoniae was the most common infectious pathogen found. Treatment included steroids in all cases, antibiotics in 4, and intravenous immunoglobulins in 6. Six patients had a full recovery, and 3 had residual neurologic complications. Magnetic resonance imaging (MRI) is the modality of choice for diagnosis. The course of acute cerebellitis varies from a commonly benign and self-limiting disease to an occasionally fulminant disease, resulting in severe cerebellar damage or sudden death.

Computed tomography features of gastrointestinal linitis plastica: spectrum of findings in early and delayed phase imaging.

To analyze the features of gastrointestinal linitis plastica obtained by computed tomography (CT). We conducted a single-center, retrospective analysis of 45 cases of gastrointestinal tract linitis plastica collected over a 10-year period. "Linitis plastica" was defined based on histological characteristics. Primary and secondary linitis plastica were included. Two readers independently assessed the radiological findings (i.e., number of lesions, mass, wall thickening, and enhancement). The patient cohort comprised 23 men and 22 women with an average age of 63.2years. The main presenting signs and symptoms were impaired general health and ascites (22/45 patients, 48.8%). The stomach was the affected organ in 68.3% of the cases, while the rectum was affected in 11.7% of the cases. Primary linitis was found in 73.3% of the cases, and solitary lesions were found in 77.8% of the cases. The most common CT finding was wall thickening (91.7%) with a complete disappearance of folds and enhancement of the entire wall at 2min. Four lesions (6.6%) were described as masses, and only one (1.7%) was described as a wall atrophy. Linitis plastica can affect the entire digestive system. Its potentially secondary nature necessitates a systematic search for a primary tumor. An appropriate CT protocol is required to detect the specific radiological features of this fibrous cancer. CT can help confirm the diagnosis of linitis plastica, rule out differential diagnoses, and indicate the need for deep biopsies where possible.

Evaluation of Neurotoxicity in Lithium Treated Patients Admitted to Poison Control Center-Ain Shams University Hospitals during the Years (2011-2014)

Lithium has been the first line drug in treating bipolar disorder. It has a low therapeutic index and toxic levels are frequently seen in clinical practice. Chronic lithium intoxication due to progressive accumulation of lithium was found to be more common. Symptoms are primarily neurologic; mental status is often altered and can progress to coma. The aim of the study is to evaluate the neurotoxicity among lithium intoxicated patients and its association with serum lithium levels through a cross sectional hospital based study over four years in the Poison Control Center, Ain Shams University Hospitals (PCC-ASUH). Factors affecting the outcome of lithium intoxicated patients were deduced. Subjects and methods: Lithium intoxicated patients presented to the PCC-ASUH during the period from January 2011 to January 2015 were prospectively evaluated. For every patient we recorded the duration of lithium intake, comorbidities and concomitant use of medications. Clinical manifestations, serum lithium level, renal function (serum urea and creatinine) and serum electrolytes (sodium and potassium) in addition to the treatment characteristics were also recorded. Patients were divided according to their outcome into two groups: (Survivors and Non survivors). Results: Twenty five lithium intoxicated patients were enrolled in our study; the mean duration of lithium therapy was similar in both groups (more than 12 years). The main clinical presenting sign of lithium intoxicated patients was coma with its different grades. Glasgow Coma Score (GCS) was significantly lower among non survivors. Relevant history of diabetes mellitus and hypertension was found in 15 patients and 13 patients respectively. Non psychotropic medications (including angiotensin converting enzyme inhibitors and diuretics) that interact with lithium clearance were more prevalent among non survivors. Neuroleptics were used by 22 patients and this was of no significant difference between survivors and non survivors. There was no significant difference between serum lithium levels in survivors and non survivors. Rehydration therapy with intravenous fluids was significantly more prevalent among the survivors. While no significant difference was found between both groups as regards the use of hemodialysis. Conclusion: The serious morbidity suffered by lithium intoxicated patients might be reduced by careful monitoring and awareness of factors that might predict their outcomes including altered conscious level or drug interactions (diuretics or angiotensin converting enzyme inhibitors). Clinicians should seriously maintain a high level of suspicion in treating patients maintained on lithium noting that serum lithium levels do not accurately predict toxicity and they should not solely rely on it.

Treating retinoblastoma in the first year of life in a national tertiary paediatric hospital in Mexico

Retinoblastoma is the most common primary ocular malignancy in childhood, but little has been documented on the clinical and biological differences in children diagnosed before one year of age. We observed patients in this age group and followed them for up to 19years. This retrospective, descriptive, observational study reviewed the medical records of Mexican patients, who were diagnosed with retinoblastoma before one year of age at a national paediatric hospital from 1995 to 2014. The variables analysed were age at diagnosis, weight, presenting signs, the time from first symptoms to diagnosis, family history, laterality, ocular rescue and survival rate. The 108 patients had a mean age of 7.65months and 15.7% had a family history of retinoblastoma. The majority (55.5%) had bilateral retinoblastoma, the most common presenting sign was leukocoria (86.1%), and the most common stage of diagnosis was Group V (84.1%). More than half were underweight for their age. The overall survival rate was 92% and the disease-free survival rate was 84%. Retinoblastoma is a malignancy that can be present at birth, especially if it is a bilateral hereditary form of the disease. Leukocoria was the main presenting sign. Early diagnosis dramatically improved the prognosis for ocular rescue.

Clinical Outcomes of 48 Pet Ferrets with Adrenal Disease

Medical records of 48 pet ferrets that underwent adrenalectomy were retrospectively reviewed to investigate the frequency and clinical outcomes of adrenal diseases in pet ferrets. These diseases were most commonly diagnosed in ferrets aged 3 to 5 years and in neutered females (58.3%). Adrenal disease occurred most frequently in the left adrenal gland (72.9%), followed by involvement of both adrenal glands (16.7%) and the right adrenal gland (10.4%). The mean sizes (length * thickness) of the adrenal glands as determined by ultrasonography were 8.96 * 5.08 mm and 12.91 * 8.26 mm for the left and right adrenal glands, respectively. In the ferrets with adrenal disease, alopecia (82.2%) was the main presenting clinical signs in both sexes, and vulvar swelling was seen in 32.1% of the females with adrenal disease. The common incidental findings included renal cysts (29.2%) and splenomegaly (25.0%). Histological findings showed pheochromocytoma, adenoma, and hyperplasia in 44.7%, 14.9%, and 12.8% of cases, respectively. The survival rates at 1- and 2- years after surgery were 87.5% and 74.0%, respectively. Alopecia and vulvar swelling improved within an average of 3.4 months and 12 days after surgery.

Ophthalmological manifestations in patients with Leigh syndrome

BackgroundTo describe the ophthalmological manifestations in patients with childhood onset Leigh syndrome (LS) and investigate the correlation between genotypes and phenotypes in patients with LS.MethodsChildhood onset LS was clinically and...

Epidemiology of hydatid disease in Qatar: a hospital based study from 2000 to 2013

ObjectivesTo describe the epidemiological and clinical profile, treatment and outcome for hydatid diseases among the patients admitted to Hamad General Hospital. MethodsThis retrospective study was carried out on patients admitted to Hamad General Hospital between 1st January 2000 and 31st December 2013. Descriptive statistics including range and percentage were used in analyzing the patient characteristics and laboratory parameters. ResultsHydatid disease was confirmed in 32 patients. The mean age of them was (35.59±13.00) years (range: 11-67 years) and 90.6% (29/32) of them were non-Qataris with male predominance. The main presenting symptom was abdominal pain 71.9% (23/32) followed by fever 45.9% (15/32). The main presenting sign was hepatomegaly 62.5% (20/32). Single organ involvement was found in 87.5% (28/32) and the common site involved was the liver 81.3% (26/32) followed by the lung 15.6% (5/32). The diagnosis was established by abdominal ultrasound and/or abdominal CT and confirmed by serology in all patients. The diagnosis was confirmed by histology in 90.6% (29/32) patients. All patients received albendazole, and 90.6% (29/32) patients had surgical intervention. Duration of albendazole therapy was (53.9±51.5) d. All patients were cured. ConclusionsHydatid disease is uncommon in Qatar. It occurs mainly among non-Qataris from endemic areas and affects the liver mostly. Surgical intervention and albendazole administration are highly effective.

Chronological variations of children poisoning causes in zahedan, South of iran.

Background:Poisoning is a common pediatric emergency among children and adolescents in the Emergency Department of Zahedan University of Medical Sciences hospital.Objectives:The aim of this study was comparing the characteristics and variations of pediatric poisoning between two retrospective studies (1998 and 2008). We hypothesized that the epidemiology of pediatric patients admitted for poisoning is related to variations of environmental agents and drug usage.Patients and Methods:Records of 170 patients from 1998 and 147 from 2008 with acute poisoning were retrospectively evaluated and compared.Results:Poisoning mostly occurred in children younger than five years old via oral route (72.94%-87%) and by single exposure (94.12%-96.6%). It was also noted that 86.8%-90% of cases were accidentally poisoned. Drugs were the most common poisoning agents in both studies (52.94% and 37.41%, respectively) and analgesics-antipyretics were the most common poisoning drugs. Drug poisoning was more common among children under five years old in both the studies. Neurological signs including lethargy and coma were the main presenting signs. About 80%-95% of cases were referred to the hospital within three hours of poisoning and supportive-symptomatic therapy was provided to them; charcoal/naloxone was administered for most of the patients (26.2% in 2008 and 21% in 1998). Mortality rate due to drug poisoning was 3-4 cases in both studies; but, non-drug poisoning mortality rate was higher.Conclusions:Preventable accidental poisoning is a significant cause of morbidity in children in developing countries. The study provided information on evolving trends and the need for increasing awareness about potential toxins as well as appropriate storage of toxins in the house to reduce the occurrence of accidental poisoning.

Otitis Media with Effusion in Children: A Follow up Study in West Baghdad, Iraq

Objective: To study the clinical, audiological and radiological characteristics as well as treatment outcome of children less than 12 years old suffered from Otitis Media with Effusion (OME) from West Baghdad, Iraq. Materials and Methods: This is a follow up study performed upon 180 child under 12 years old, diagnosed having OME by clinical, audiological and radiological means, they were treated in Al-Ramadi and Al-Fallujah General Hospitals drained from West Baghdad and Al-Anbar Governorate, during the period from May 2010 to July 2012. The data obtained from the parents, clinical examination and investigations like Pure Tone Audiometry (PTA), tympanometry and lateral soft tissue x-ray of the neck had been done. The treatment outcome studied after follow up for six months. Results: There were 54.4% boys and 45.6% girls. The main presenting symptom was hearing impairment (brought by family) (47.2%) and the main presenting sign was retraction of tympanic membrane (91.7%), the mean amount of hearing loss by PTA was 22.6 ± 5.5 dB. In 92.2% of patients tympanometry was type B. The size of the adenoid measured by Adenoid\Nasopharyngeal ratio was located mainly on Grade 3+ (43.3%). All the patients were given medical treatment, 61.1% of them responded. Patients that failed to response to medical treatment underwent different modalities of surgical means represented mainly by myringotomy and adenotonsillectomy. Conclusion: There was significant correlation between the size of adenoid and the type of tympanogram and hearing threshold. The treatment was mainly medical, while surgical means if indicated they were myringotomy accompanied mainly with adenotonsillectomy.

An unexpected diagnosis in children with male phenotype and bilateral nonpalpable gonad: congenital adrenal hyperplasia with female genotype

Female pseudohermaphroditism is the most frequent form of ambiguous genitalia in children with congenital adrenal hyperplasia (CAH). However, a small group of children with complete urethral development in contrast to 46XX karyotype can be encountered. We aimed to define the characteristics of patients with 46XX CAH but having fully developed male external genitalia. The records of 11 children with CAH and 46XX karyotype but having male phenotype, encountered from 1990 to 2012 were reviewed retrospectively. The age, presenting signs and symptoms, diagnostic studies, surgical procedures, early results and outcome were noted. All patients were evaluated by gender assignment team and the decision of the family was also taken into consideration during gender assignment. Eleven children (mean age 3.64±3years) (range 5days-10years) were enrolled. The main presenting signs were nonpalpable gonads (n=7), hyperpigmentation (n=2), jaundice (n=1) and electrolyte imbalance (n=1). All patients had bilateral nonpalpable gonads and male phenotype with mean phallus length of 4.5±1.7cm. Urethral meatus is located at normal position (n=6) or hypospadiac (n=5). Labioscrotal fusion was complete in all cases and they were classified as4th (n=3) or5th (n=8)degree of virilization according to Prader's classification. All children had CAH and 46XX genotype. Pelvic ultrasound (n=8) and genitocystogram (n=9) were used, and genitocystoscopy was performed (n=6). Male gender was assigned in most (n=10) and female gender in one. Corrective surgery could be performed in 10 patients. The surgical procedures were hysterectomy+bilateral salphingo-oophorectomy+vaginectomy (n=9), chordee release (n=3) and then second-stage (n=2) or one-stage urethra repair (n=1), and pure one-stage urethra repair (n=1). One case underwent surrenalectomy before the diagnosis of CAH. Mastectomy (n=1) and fistula repair (n=3) were additional operations. Only one child could be undergone feminizing genitoplasty and another was lost to follow-up. Unfortunately, most of the children underwent surgery in adverse to genotype because of constituted sexual identity. Children with male phenotype and bilateral nonpalpable gonads should undergo promptly biochemical analyses for CAH and early chromosomal analysis.

Complex and Compound Odontomas

This study aimed to analyze and discuss the demographic, clinical, and surgical aspects of 53 surgically treated odontomas and to review the literature. A retrospective review was performed on all cases of treated odontomas in our center. A review of the recent literature about demographic aspects of odontomas was performed. A total of 53 odontomas with a mean age of 35 years were surgically treated during the study period: 32 complex odontomas, 20 compound odontomas, and 1 immature odontoma. Compound odontomas occurred more often at the mandible with a predilection for the anterior region, whereas complex odontomas showed up more often in the posterior regions of the mandible. Odontomas most commonly occurred in patients in the second decade of life. The main presenting sign was the eruption failure of permanent teeth (44 cases), whereas 1 patient referred pain as the presenting symptom. Odontomas are hamartomas not rarely encountered by oral and maxillofacial surgeons. Odontomas usually determine delayed eruption; thus, in case of any dentition anomaly or jaw deformation in children and adolescents, it is very important to investigate the presence of possible odontomas with radiographs.

Prevalence of uncomplicated malaria in a paediatrics outpatient department of a tertiary health institution in Sokoto, Nigeria

Background: Malaria remains one of the major tropical health challenges in the world today. It accounts for more than 80% of estimated 1.5 – 3 million deaths of children annually especially those aged 5 years and below. There is paucity of data on the prevalence of uncomplicated malaria in children in Sokoto.Objectives: To determine the prevalence of uncomplicated malaria in children aged 0 – 15 years. Methods: The health registers and outpatient cards of children aged 0 – 15 years that presented to the Paediatrics Outpatient Department/Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between 1st June 2007 and 31st May 2009 were studied retrospectively. Information of the patients with regards to their age, gender, presenting features, date of presentation at the clinic, and diagnosis of malaria (clinical and parasitological) were extracted from the registers and case records and analyzed.Results: During the study period, a total of 15,909 children aged 0 – 15 years were seen in our clinic. Of this number, 7,224 had clinical and parasitological diagnosis of uncomplicated malaria giving a prevalence rate of 45.4%.those aged 5 years and below were 5,782 (49.6%) while the remaining 1,442 (34.0%) were aged above 5 years. Males were 4,068 (56.3%) while the females were 3,156 (43.7%) with M: F ratio of 1.3:1. The main presenting symptoms were fever (100%), reduced appetite (80.5%), reduced activity (75%) and chills (74%). The main presenting signs were pyrexia (84.5%), splenomegaly (38%) and hepatomegaly (14%). Malaria was the leading cause of paediatrics outpatient clinicattendance followed by acute respiratory infection and diarrhoeal disease. Though malaria occurred throughout the year, majority of the cases were seen during the raining and early dry reasons.Conclusion: Malaria is partly meso-endemic and hyper endemic in the studied area and children aged 5-years and below are the most susceptible. It is therefore, recommended that more efforts should beput in place towards malaria control and prevention particularly in this age group.