Salicylate poisoning in children: report of three cases

K Maitland, CO Musumba, AO Pamba, PA Sasi, M English
2004 East African Medical Journal  
Objective: To highlight the pattern of patients with transitional cell carcinoma of the urinary bladder with regards to age, sex, ethnic origin and histopathological classification. Design: A ten year retrospective study. Setting: Kenyatta National Hospital, Nairobi, Kenya. Subjects: Fifty two patients who presented at Kenyatta National Hospital over the ten year period with histologically proven transitional cell carcinoma of the urinary bladder. There were 41 males and 11 females aged 27 to
more » ... emales aged 27 to 84 years. The mean age was 57 years. Results: The peak incidence was in the 60-69 years age group. The male to female ratio was 4:1. The regional (provincial) distribution revealed Central and Eastern had 77%, Rift valley had 6%, Nairobi, North Eastern, Western and Coast provinces had 2% each. In the ethnic distribution; Kikuyus, Kambas and Merus were 77% while others were 17.3%. Transitional cell carcinoma was found in 67% of the patients, 60% had advanced disease. Twenty nine percent were smokers while 25% consumed alcohol. The main occupation was farming in 65%. The most Common clinical presentations were haematuria 98% and lower abdominal pains in 71%. A total of 99,028 patients were admitted to the surgical wards,transitional cell carcinoma patients represented only 0.6%. Conclusion: Transitional cell carcinoma is a rare disease. At Kenyatta National Hospital it only represented 0.6% of all surgical admissions during the study period. It accounted for 67% of all bladder tumours an increase in incidence compared to previous studies. It is common in males more than females, with a peak in the seventh decade. Majority of the patients were from central Kenya. Alcohol, smoking and farming were the most important risk factors. Haematuria was the most important presenting clinical feature. Poor record keeping may have contributed to the low number of patients enrolled into the study. There is need for a thorough prospective study to find out the actual prevalence of bladder tumours. ABSTRACT Background: Kaposi's sarcoma (KS) is associated epidemiologically with HIV infection and a number of countries have reported a dramatic increase in the incidence of KS with the advent of AIDS. Although AIDS is prevalent in Kenya, no studies on the impact of AIDS on the pattern of KS has been carried out. Objective: To determine any changes in the pattern of KS that might have occurred since the advent of AIDS in the country. Design: Retrospective descriptive study. Setting: Kenyatta National Hospital (KNH). Method: Pathology records of cases of KS diagnosed at KNH from 1968 to 1997 were analysed with respect to relative frequency, age, sex and site distribution; and trend. The period was divided into the pre and post AIDS era from 1983, which is the time the first AIDS patient was reported in the country. Result: A total of 1108 cases of KS consisting of 911 males and 197 females were recorded. The relative frequency of KS ranged between 2% to 5% of the total malignancies. There was a gradual decline in the male to female ratio from about 10:1 in the sixties to about 2:1 in 1997. There was no dramatic difference in the age distribution in the preand post AIDS era, although a large number of cases were recorded as adults without age specification in the post AlDS era. Site distribution was characteristic of the disease with most of the cases having the lesions occurring in the lower limbs and involving the skin. Conclusion: Although these findings do not demonstrate a dramatic alteration in the pattern of KS in the post AIDS era there were indications that such changes may have been obscured by under-reporting. The fall in the male:female ratio is a strong indication of a rise in KS among female patients. A further study is necessary to elucidate the true impact of AIDS on the pattern of KS in the country. ABSTRACT Objectives: To quantify missed opportunities for immunisation, document reasons for their occurrence and evaluate the extent of inappropriately given vaccine doses. Design: A cross sectional study of children under two years of age attending health facilities. Setting: Six health facilities predominantly serving the slums of Nairobi. Methodology: Information on vaccination was extracted from child immunisation cards as well as from mothers or guardians of children. Results: Effective immunisation coverage for Bacille-Callmette Guerin (BCG) was 91%. Coverage for the birth dose, first, second, and third doses of oral polio vaccine (OPV0, OPVI, OPV2, and OPV3) was 44%, 83%, 79% and 75% respectively. Effective coverage for first, second and third doses of diphtheria-pertusis-tetanus (DPTI, DPT2 and DPT3) vaccine was 88%, 87% and 85% respectively. Measles coverage was 80%. Immunisation coverage for all antigens except OPV0 and OPV3 would have been increased to over 90% had missed immunisation opportunities and inappropriately administered vaccination been avoided. There would have been an 11% increase in OPV3 coverage to 86%. Increases in coverage for OPVI and OPV2 would have been 16% and 18% respectively. Coverage would have increased by 10% for diphtheria pertusistetanus (DPT) doses DPTI and DPT2, and 7% for DPT3. Measles immunisation coverage would have increased by 19% had missed immunisation opportunities and inappropriately administered vaccinations been avoided. The overall missed opportunities rate was 3%. The proportions of missed opportunities were higher for the OPV series than DPT series. Conclusion: Missed immunisation opportunities among clinic attendees in Nairobi occur and routine supervision should be strengthened in these health facilities in order to minimise such missed opportunities and inappropriately administered vaccines. ABSTRACT Objective: The present investigation has been designed to study the incidence of the rectus stern muscle in German human cadavers dissected in the Kingdom of Saudi Arabia, trying to find a postulation for the development of such muscle when present. Design: Gross dissection of 130 cadavers, of both sexes, was performed throughout a period of 10 years. Setting: Intervention: Investigation of the origin and insertion of the rectus sterni and measurements of its length and width. Results: Two adult cadavers, one of each sex, had shown well-developed bilateral rectus stern muscles. All muscles identified were parasternal in position, being superficial to the medial portion of the pectoralis major muscle. Minor morphological differences were observed among the four muscle masses concerning their length, breadth, origin and insertion. Conclusion: The current study has determined the incidence of the rectus sterni muscle, in German cadavers to be 1.54% per bodies examined compared to 4% in cadavers from Saudis. Such a frequency is compared to that reported in different geographic populations. The rectus sterni muscle is innervated by the anterior cutaneous branches of the intercostal nerves. The description of the rectus sterni muscle and its incidence determined in the present study, might be of a great help for clinicians radiographing or tackling the pectoral region. ABSTRACT Objective: To evaluate the comparative efficacy of 400 mg albendazole (Smith Kline Beecham) as a single dose and three brands of mebendazole (Janssen, Unibios and East African Pharmaceuticals) at doses of 100 mg twice a day for three consecutive days in the treatment of single or mixed infections with Ascaris lumbricoides and or Trichuris trichiura in four treatment groups of school children. Design: Randomized trial. Setting: Wondo-Genet, southern Ethiopia. Subjects: School children, aged six to nineteen years. Results: The percentage cure rate and egg reduction rate obtained with albendazole and mebendazole from the three brands were not significantly different in the treatment of ascariasis. However, significant differences were found among the percentage cure rates and egg reduction rates of the four treatment groups in the treatment of trichuriasis. Comparatively, high cure rate (89.8%) and egg reduction rate (99.1%) were observed in vermox (Janssen) treated group followed by Unibios (India) treated group (53.3% and 96.53% cure and egg reduction rates, respectively), whereas low cure rate (17.1%) and egg reduction rate (69.8%) were seen in the albendazole treated group. Conclusion: The results of this study suggest that in areas of single or mixed infections with Trichuris trichiura and/or Ascaris lumbricoides are common public health problems and where laboratory facilities are not available to make parasite identification, mebendazole (particularly vermox, a product of Janssen laboratory) would be the drug of choice to treat trichuriasis and ascariasis. However, either mebendazole from the different brands or albendazole is effective in the treatment of ascariasis in areas where trichuriasis is not prevalent. ABSTRACT Background: Advanced age and parity constitute two major factors in the outcome of pregnancy and labour management both in the developed and developing countries. Objective: To examine pregnancy outcomes in women aged 40 years and above with the view of proffering solution to some of the problems encountered. Design: A case control retrospective study. Setting: Obafemi Awolowo University Teaching Hospital, lle-lfe, Nigeria from 1st January, 1995 to 31st December, 1999. Subjects: Three hundred and three women who delivered at 40 years of age or above. The control group comprised of 303 women who delivered between 20 and 29 years during the five years period. Main outcome measures: Gestational age at delivery, birth weight, mode and type of delivery, pregnancy and birth outcome. Results: This showed a significant increase in prematurity, low birth weight, medical complications, operative deliveries (Caesarean section, vacuum and forceps), birth asphyxia and perinatal deaths all at P<0.05. Conclusion: There is a poor pregnancy outcome at fourty years and above. Patients need to be counselled for care in a specialised centre. ABSTRACT Objective: To ascertain the pattern and frequency of malignant tumours of female genital tract in North Eastern Nigeria. Design: A retrospective analysis of surgical biopsy materials. Setting: University of Maiduguri Teaching Hospital, the only teaching hospital in the North Eastern region of Nigeria. Subjects: Three hundred and eighty-two cases of female genital malignancies histologically confirmed between January 1st 1991 and December 31st 2000. Results: The age range of patients whose specimens were received during the ten year period was three to eighty years. Mean age of presentation was 44.2 years, (SD + 13). Cancer of the uterine cervix was the most common (70.5%), followed by ovarian cancer (16.3%), then cancer involving the uterus (8.5%). There was a steep rise in reported cases within the period of study especially for cancer of the cervix. Ovarian tumours were the most common tumours in the teenage group. Conclusion: The high incidence of cancer of the uterine cervix and the early mean age of presentation of all malignancies underlies the importance of screening programmes and awareness campaign in our community. The study also provides the basis for further analysis of female genital malignancies. ABSTRACT Objective: To compare the growth and illness pattern of infants who were exclusively breast fed for six months with those of infants commenced on complementary feeding before the age of six months and ascertain reasons for the early introduction of complementary feeding. Design: A comparative prospective study. Setting: Urban Comprehensive Health Centre (UCHC), Obafemi Awolowo University Teaching Hospitals Complex, lle-lfe. Subjects: Three hundred and fifty-two mothers and their normal birth weight babies, weighing 2.500kg or more, and aged less than 14 days were serially recruited into the study. Main outcome measures: Mean/median monthly weights in the first six months of life, history/outpatient presentation for illnesses. Results: Of the 352 mother-infant pairs recruited into the study, 345 (98%) were successfully followed up for the first six months of life. At six months, 264 (76.5%) were exclusively breast-fed, 45 (13.1%) were started on complementary feeding, between the ages of four and six months while 36 (10.4%) commenced complementary feeding before the age of four months. Infants who were exclusively breast-fed for six months had median weights above the 50th percentiles of the WHO/NCHS reference that is currently used in the national "road to health" (growth monitoring) cards. Furthermore, the mean weight of these babies at age six months was above those of babies who started complementary foods before six months. They also reported fewer symptoms and had fewer illness episodes (0.l episodes per child) compared to those who started complementary feeding before six months. Infants who commenced complementary feeding before four months reported more symptoms and had more illness episodes (1.4 episodes per child) compared to those that commenced complementary feeding between four and six months (1.2 episodes per child). Common symptoms/illnesses seen or reported during the study among the groups were fever, diarrhoea and cough. Reasons given for early introduction of complementary foods include insufficient breast milk, thirst and convenience. Conclusion: It is concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the infants studied. Early introduction of complementary foods did not provide any advantages in terms of weight gain in our environment, it was frequently associated with illness episodes and growth faltering. Many mothers however require support, encouragement and access to health care providers to breastfeed exclusively for the first six months of life. ABSTRACT Background: Low density lipoprotein cholesterol (LDL-C) concentrations form the basis for treatment guidelines established for hyperlipidaemic patients. LDL-C concentrations are commonly calculated using the Friedwald formula (FF) which has several limitations. Recently, direct methods for LDL-C estimation have been developed which are suitable for routine laboratories. Objective: To compare serum LDL-C concentrations determined by a direct assay and the Friedwald formula. Design: Cross-sectional study. Setting: Mater Hospital Laboratory, Nairobi, Kenya. Methods: The clinical performance of the two methods was evaluated by analysing 211 fresh plasma samples from fasting adult patients. The samples were divided into four groups-normolipidaemic; and Types IIa, IIb and IV hyperlipidaemias. Results: The Friedwald formula (FF) correlated best with the direct assay in the normolipidaemic samples (r = 0.879; y= 0.468 + 0.852x). Direct LDL-C values were significantly lower than the FF in the Type IIa hyperlipidaemia samples (paired differences 0.38 ± 0.62). There was only 65% agreement between the two methods in the borderline high LDL-C group of the National Cholesterol Education Program (NCEP) classification (LDL-C 3.36 -4.14mmol/L). Conclusion: There is lack of agreement between the FF and the Abbott direct LDL-C assay. If the two methods are used interchangeably, there may be confusion in the classification and control of lipid lowering medication for patients with hyperlipidaemia. SUMMARY To raise clinicians' awareness of chronic (therapeutic) salicylate poisoning as a common cause of admission in paediatric patients presenting to hospital with respiratory distress (a clinical manifestation of metabolic acidosis) and a history of 'over the counter' treatment with salicylate (Aspirin). We present two complex cases and provide a review of the literature on pathogenesis, clinical presentation and management of salicylate poisoning. A complete history of the illness, including questions on drug use, is vital in assessing the cause of metabolic acidosis in children. Due to the limited options available in managing such patients in many developing countries, emphasis should be placed on prevention of poisoning by educating the community and health care providers. 169
doi:10.4314/eamj.v81i3.9147 fatcat:hvz6x57k7bhrhgg2zui4exuepu