scholarly journals Magnetic Resonance Imaging Findings in Childhood Epilepsy at a Tertiary Hospital in Kenya

2021 ◽  
Vol 12 ◽  
Author(s):  
Pauline Samia ◽  
Nicholas Odero ◽  
Maureen Njoroge ◽  
Shem Ochieng ◽  
Jacqueline Mavuti ◽  
...  
Keyword(s):  
Hippocampal Sclerosis ◽  
Periventricular Leukomalacia ◽  
Epileptiform Activity ◽  
Tertiary Hospital ◽  
Sub Saharan Africa ◽  
University Hospital ◽  
Childhood Epilepsy ◽  
Imaging Findings ◽  
Categorical Data Analysis ◽  
Mri Findings

Background: Neuroimaging is important for determining etiology and guiding care in early childhood epilepsy. However, access to appropriate imaging in sub-Saharan Africa is modest, and as a consequence, etiological descriptions of childhood epilepsy in the region have been limited. We sought to describe MRI findings in children with epilepsy presenting to a tertiary hospital in Nairobi, Kenya, over a 6-year period of routine care.Materials and Methods: We undertook a retrospective review of MRI findings of children aged between 0 and 18 years with a diagnosis of epilepsy presenting to the pediatric neurology department of Aga Khan University Hospital in Nairobi, Kenya, between January 2014 and July 2020. Over this period, the hospital had 1.5T MRI machines (GE1.5T Signa Excite and GE 1.5T Signa Explorer) and a 3T MRI machine (Philips 3T Ingenia). MRI images were independently reviewed by two study radiologists, and the findings were summarized and categorized into a study database. Related clinical and electroencephalographic (EEG) details were extracted from patient records. Categorical data analysis methods were applied to investigate for relationships between clinically relevant neuroimaging findings and key clinical and EEG observations.Results: Over the study period, 288 children with a confirmed diagnosis of epilepsy had an MRI. They were of median age of 6 [interquartile range (IQR) 2–11] years. Ninety-five (33%) children had abnormal findings on imaging. The most common findings were encephalomalacia related to chronic infarcts (n = 18: 6.3%), cerebral atrophy (n = 11: 3.8%), disorders of neuronal migration (n = 11: 3.8%), periventricular leukomalacia (n = 9: 3.1%), and hippocampal sclerosis (n = 8: 2.8%). Findings related to infectious etiology were only observed in four children. Clinical comorbidity and inter-ictal epileptiform activity on EEG were independently associated with abnormal findings on imaging.Conclusion: Up to a third of the children who underwent an MRI had a positive yield for abnormal findings. Imaging findings related to infectious etiologies were little observed in our cohort, in contradistinction to etiology studies in similar settings. At the time of the study, comorbidity and inter-ictal epileptiform activity on EEG were associated with abnormal findings on imaging and should be considered in informing prioritization for imaging in childhood epilepsy in this setting.

scholarly journals Molecular characterization of multidrug-resistant Klebsiella pneumoniae and Escherichia coli harbouring extended spectrum beta-lactamases and carbapenemases genes at a tertiary hospital, Kenya

2017 ◽  
Vol 32 (4) ◽  
Author(s):  
Daniel Maina ◽  
Gunturu Revathi ◽  
Andrew C. Whitelaw
Keyword(s):  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Tertiary Hospital ◽  
Multidrug Resistant ◽  
Sub Saharan Africa ◽  
University Hospital ◽  
Beta Lactamases ◽  
Extended Spectrum ◽  
Extended Spectrum Beta Lactamases ◽  
Sub Saharan

Background. Multidrug-resistant (MDR) Gram negative rods are increasingly being reported in sub-Saharan Africa. Molecular investigations play an important role, alongside other measures, in controlling nosocomial infections attributed to these organisms. This study aimed to determine the common extended spectrum beta-lactamases (ESBL) and carbapenemases genes, and clonal relationship in MDR Klebsiella pneumoniae and Escherichia coli. Methods. Fifty-four MDR isolates collected at the Aga Khan University hospital, Nairobi in the month of August 2012 formed the study. These were picked after an increase in the number of resistant strains during the said period was experienced. Results. blaCTXM was present in 41 (74%) of the isolates, while blaSHV was detected in 18 (33%) and blaTEM in 13 (24%) of the isolates. Nine (16.7%) of the isolates harboured all three ESBL genes and 8 (14.8%) harboured two. Eight of the isolates (all E. coli) had none of the ESBL genes tested. Two isolates harboured carbapenemases genotypes: one had blaNDM-1 and the other blaSPM. Sequencing matched CTXM-15 and TEM-1 genes in all the isolates harbouring blaCXTM and blaTEM respectively. However, there was diversity in blaSHV with SHV-11 and SHV-12 genes predominant. The isolates were non-clonal. Conclusions. The isolates mostly harboured blaCTX-M-15 while only a few had carbapenemases genes. Lack of clonality suggests these were the stable circulating strains at the time of the study.

scholarly journals Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization

2010 ◽  
Vol 68 (6) ◽  
pp. 898-902 ◽  
Author(s):  
Andrea Garcia de Almeida ◽  
Magda Lahorgue Nunes ◽  
André Luis Fernandes Palmini ◽  
Jaderson Costa da Costa
Keyword(s):  
Refractory Epilepsy ◽  
Epileptiform Activity ◽  
University Hospital ◽  
Seizure Type ◽  
Mri Findings ◽  
Unexpected Death ◽  
Cross Sectional ◽  
Epileptiform Discharges ◽  
Significant Difference ◽  
Lesion Localization

OBJECTIVE: The aim of this study was to verify incidence and characteristics of sudden unexpected death in patients (SUDEP) with refractory epilepsy and its relation to previous surgery and lesion localization. METHOD: A cross sectional study was carried out in a cohort of 550 patients with refractory epilepsy followed up by the Epilepsy Surgery Program of the University Hospital of PUCRS, Porto Alegre, Brazil, between January, 1992 and July, 2002. Patients were allocated in two groups (operated and non operated). Seizure type, distribution of interictal spikes and MRI findings were correlated with the SUDEP outcome. RESULTS: The estimated incidence of probable SUDEP amounted to 29:1000 individuals. Probable SUDEP occurred in 1.2% of the 166 patients of the non operated group and in 3.7% of the 384 patients who were operated (OR=3.02, 95% CI 0.69-13.16) (p=0.11). Comparing patients who died to patients alive in the operated group a significant difference was observed concerning the following variables: SUDEP patients had a predominance of generalized seizures (p=0.002), extratemporal lesion on MRI (p<0.001) and epileptiform activity over extratemporal regions (p=0.001). CONCLUSION: In surgically treated patients with refractory epilepsy, an extratemporal location of the lesion and of the epileptiform discharges significantly correlated to SUDEP. Thus it is possible that in those patients; the underlying disease may play a role in the pathogenesis of SUDEP.

scholarly journals Postoperative opioids and risk of respiratory depression – A cross-sectional evaluation of routines for administration and monitoring in a tertiary hospital

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Karoline Kolås Andersen ◽  
Gunnvald Kvarstein
Keyword(s):  
Respiratory Depression ◽  
Patient Monitoring ◽  
Current Practice ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Post Anesthesia Care Unit ◽  
Cross Sectional ◽  
Routes Of Administration ◽  
Surgical Ward ◽  
Cross Sectional Design

AbstractObjectivesOpioids are the most potent analgesics in the treatment of postoperative pain. Respiratory depression is, however, a serious side effect. The aims of this study were to evaluate current practice and routines for post-operative administration of opioids in a Norwegian university hospital and to evaluate whether the clinical safeguards adequately protected patients’ safety regarding risk of respiratory depression.MethodsThe study had a retrospective cross-sectional design and included 200 patients, treated with opioids postoperatively. The patients were treated in a post-anesthesia care unit (PACU) before transferal to a surgical ward. Relevant data such as opioid dosages, routes of administration, sedation and respiratory function, routines for patient monitoring, and numbers of patients with opioid induced respiratory depression was collected.ResultsTwo patients (1%) developed respiratory depression that needed naloxone to reverse the effect, and 32 patients (16%) had a respiratory rate (RR) <10/min, which may have been caused by opioids. In the PACU, the patient’s RR was evaluated on a routine base, but after transferal to a surgical ward RR documented in only 7% of the patients.ConclusionsThe lack of routines for patient monitoring, especially RR, represented a risk of not detecting opioid induced respiratory depression.

scholarly journals Prevalence, distribution and antimicrobial susceptibility pattern of bacterial isolates from a tertiary Hospital in Malawi

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pizga Kumwenda ◽  
Emmanuel C. Adukwu ◽  
Ebot S. Tabe ◽  
Victor. C. Ujor ◽  
Pocha S. Kamudumuli ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Bacterial Infections ◽  
Blood Stream ◽  
Tertiary Hospital ◽  
Sub Saharan Africa ◽  
Bacterial Isolates ◽  
Susceptibility Pattern ◽  
Management Options ◽  
Subsequent Increase ◽  
Antimicrobial Susceptibility Pattern

Abstract Background Bacterial infections are a significant cause of sickness and death in sub-Saharan Africa. This study aimed at establishing the prevalence, distribution and antimicrobial susceptibility pattern of major bacterial isolates from patients accessing medical care at a tertiary hospital in Malawi. Methods We retrospectively reviewed bacteria culture and antimicrobial susceptibility records for 4617 patients from 2002 to 2014 at Mzuzu Central Hospital (MCH). No inclusion and exclusion criteria were followed. Data was analysed using excel (Microsoft office, USA) and GraphPad prism 7 software programs. Results The most prevalent isolates were S. aureus (34.7%, n = 783), Klebsiella species (17.4%, n = 393) and Proteus species (11.4%, n = 256). Most microorganisms were isolated from adults (88.3%, n = 3889) and pus was the main source (69.3%, n = 1224). S. pneumoniae was predominantly isolated from cerebrospinal fluid (60.3%, n = 44) largely collected from children (88.2%, n = 64). Overall, most bacteria exhibited high resistance to all regularly used antimicrobials excluding ciprofloxacin. Conclusions Our report demonstrates an increase in bacterial infection burden in sites other than blood stream and subsequent increase in prevalence of antimicrobial resistance for all major isolates. Creating an epidemiological survey unit at MCH will be essential to help inform better treatment and management options for patients with bacterial infections.

scholarly journals Pyogenic and tuberculous discitis: magnetic resonance imaging findings for differential diagnosis

2013 ◽  
Vol 46 (3) ◽  
pp. 173-177 ◽  
Author(s):  
Cristiano Gonzaga de Souza ◽  
Emerson Leandro Gasparetto ◽  
Edson Marchiori ◽  
Paulo Roberto Valle Bahia
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Correct Diagnosis ◽  
Cord Compression ◽  
Intervertebral Discs ◽  
University Hospital ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Radiographic Findings ◽  
Vertebral Bodies

Spondylodiscitis represents 2%–4% of all bone infections cases. The correct diagnosis and appropriate treatment can prevent complications such as vertebral collapse and spinal cord compression, avoiding surgical procedures. The diagnosis is based on characteristic clinical and radiographic findings and confirmed by blood culture and biopsy of the disc or the vertebra. The present study was developed with Clementino Fraga Filho University Hospital patients with histopathologically and microbiologically confirmed diagnosis of spondylodiscitis, submitted to magnetic resonance imaging of the affected regions. In most cases, pyogenic spondylodiscitis affects the lumbar spine. The following findings are suggestive of the diagnosis: segmental involvement; ill-defined abscesses; early intervertebral disc involvement; homogeneous vertebral bodies and intervertebral discs involvement. Tuberculous spondylodiscitis affects preferentially the thoracic spine. Most suggestive signs include: presence of well-defined and thin-walled abscess; multisegmental, subligamentous involvement; heterogeneous involvement of vertebral bodies; and relative sparing of intervertebral discs. The present pictorial essay is aimed at showing the main magnetic resonance imaging findings of pyogenic and tuberculous discitis.

scholarly journals Multiple sclerosis in Kenya: Demographic and clinical characteristics of a registry cohort

2021 ◽  
Vol 7 (2) ◽  
pp. 205521732110227
Author(s):  
Imran Jamal ◽  
Jasmit Shah ◽  
Peter Mativo ◽  
Juzar Hooker ◽  
Mitchell Wallin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Symptom Onset ◽  
Clinical Characteristics ◽  
Age Of Onset ◽  
Sub Saharan Africa ◽  
University Hospital ◽  
Tertiary Referral Hospital ◽  
Female Ratio ◽  
Sub Saharan ◽  
Neuro Imaging

Background Multiple Sclerosis (MS) is the leading cause of non-traumatic neurological disability in young adults. There is limited literature regarding the burden of MS in sub-Saharan Africa (SSA). Objective To describe the demographic and clinical characteristics of patients with MS (PwMS) presenting to a tertiary referral hospital in Nairobi. Methods We conducted a retrospective descriptive study for PwMS presenting to Aga Khan University Hospital, Nairobi from 2008–2018. Results 99 cases met the diagnostic criteria for MS with a male to female ratio of 1:4. Majority (68.7%) of PwMS were indigenous Africans with a mean age of onset of 30.7 years. Mean duration from symptom onset to first neuro-imaging was 5.04 years. Only 33% of patients had sensory symptoms at onset whereas 54.5% had vitamin D deficiency/insufficiency. Majority (79.5%) had relapsing remitting MS (RRMS) and 56.6% were initiated on disease modifying therapy (DMT). Only 21.2% of patients on DMT were non-compliant. Patients with RRMS were more likely to be initiated on DMT at our hospital (p < 0.001). Conclusion Clinical characteristics of these patients largely resemble those of other SSA cohorts and African American patients. There was a delay between symptom onset and neuroimaging. There were also issues with DMT compliance.

Transperineal Ultrasonographic and Magnetic Resonance Imaging Findings of Vaginal Adenosis

2021 ◽  
Vol 17 ◽  
Author(s):  
Sebnem Karasu ◽  
Atilla Hikmet Cilengir ◽  
Irfan Ocal ◽  
Serpil Aydogmus
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Chronic Pelvic Pain ◽  
English Literature ◽  
Vaginal Wall ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Proven Case ◽  
Magnetic Resonance Imaging Mri

Background: Vaginal adenosis is a rare clinicopathological entity which refers to the presence of glandular endometrial tissue in the vaginal wall. Case report: A gravida 46-year-old woman was presented to the gynecology department with symptoms of chronic pelvic pain. Maternal Diethylstilbestrol (DES) usage has been proven effective in the development of vaginal adenosis. It can also be idiopathic. Its sonographic or magnetic resonance imaging (MRI) findings have not been described in English literature previously. Conclusion: Here, we report the clinical, transperineal ultrasonographic (US) and MRI findings of a pathologically proven case of vaginal adenosis.

scholarly journals Prevalence and Mortality of Cryptococcal Disease in Adults with Advanced HIV in an Urban Tertiary Hospital in Sierra Leone: A Prospective Study

2019 ◽  
Author(s):  
Sulaiman Lakoh ◽  
Hannah Rickman ◽  
Momodu Sesay ◽  
Sartie Kenneh ◽  
Rachael M. Burke ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
World Health ◽  
Categorical Variables ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Cryptococcal Disease

Abstract Background The global annual estimate for cryptococcal disease related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count <100/µl. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone. MethodsA cross-sectional study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm3 from January to April, 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with eight weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher’s exact test was used to compare categorical variables. Results A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm3 (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days). Eight participants had a positive blood CrAg, giving a prevalence of 4.7% (95% CI: 2.4-9.2%). Of those with a positive CrAg, CSF CrAg was positive in five (62.5%). Five (62.5%) CrAg-positive participants died within the first month, while the remaining three were alive and established on ART at eight weeks. ConclusionA substantial prevalence of cryptococcal antigenaemia and poor outcome of cryptococcal disease were demonstrated in our study. The high mortality suggests a need for the HIV programme to formulate and implement policies on screening and pre-emptive fluconazole therapy for all adults with advanced HIV in Sierra Leone, and advocate for affordable access to effective antifungal therapies.

scholarly journals Spectrum of childhood interstitial and diffuse lung diseases at a tertiary hospital in Egypt

2021 ◽  
pp. 00880-2020
Author(s):  
Salma G. Abdelhady ◽  
Eman M. Fouda ◽  
Malak A. Shaheen ◽  
Faten A. Ghazal ◽  
Ahmed M. Mostafa ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Lung Diseases ◽  
Demographic Data ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Systematic Evaluation ◽  
Pulmonary Hemosiderosis ◽  
Diffuse Lung Diseases ◽  
Diffuse Lung

BackgroundChildhood interstitial and diffuse lung diseases (chILD) encompass a broad spectrum of rare pulmonary disorders. In most developing middle eastern countries, chILD is still underdiagnosed. Objective: To describe and investigate patients diagnosed with chILD in a tertiary university hospital in Egypt.MethodsWe analyzed data of consecutive subjects (<18 years) referred for further evaluation at the Children's Hospital, Ain Shams University. Diagnosis of chILD was made in accordance with the chILD-EU criteria. The following information was obtained: demographic data, clinical characteristics, chest CT findings, laboratory studies, spirometry, BAL and histopathology findings.Results22 subjects were enrolled over 24 months. Median age at diagnosis was 7 years (range 3.5–14 years). The most common manifestations were dyspnea (100%), cough (90.9%), clubbing (95.5%) and tachypnea (90.9%). Systematic evaluation led to the following diagnoses: hypersensitivity pneumonitis (n=3), idiopathic interstitial pneumonias (n=4), chILD related to chronic granulomatous disease (n=3), chILD related to small airway disease (n=3), postinfectious chILD (n=2), Langerhans cell histiocytosis (n=2), Idiopathic pulmonary hemosiderosis (n=2), granulomatous lymphocytic interstitial lung disease (n=1), systemic sclerosis (n=1), familial interstitial lung disease (n=1). Among the subjects who completed the diagnostic evaluation (n=19), treatment was changed in 13 (68.4%) subjects.ConclusionSystematic evaluation and multidisciplinary peer review of chILD patients at our tertiary hospital led to changes in management in 68% of the patients. This study also highlights the need for an Egyptian chILD network with genetic testing, as well as the value of collaborating with international groups in improving health care for children with chILD.

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