Management of Choroid Plexus Papillomas

Introduction: Choroid plexus papillomas are rare neuroepithelial tumors found primarily in children. It represents less than 1% of all central nervous system tumors. Materials and methods: A retrospective study including 14 patients with choroid plexus papilloma tumors were performed at the Neurosurgery Department in Ait IDDIR Health Hospital Establishment between January 2010 and December 2017. In each case, diagnosis was made clinically and confirmed radiologically and histo-pathologically. All patients were operated. Results and discussion: The mean age was 26 years (ranged 3 months –48 years) .In our department, we grouped together 14 cases of choroid plexus papilloma tumors. For mortality we had one case who died during surgery, survival rate for 04 years is 100% .We had not recurrence during the study period.All patients had intracranial hypertension (HIC) without neurological deficit and benefited from brain CT, MRI and an Angiography. The location of the tumor was: Lateral ventricle, Fourth ventricle, Third ventricle. All patients underwent surgical excision with or without ventriculo-peritoneal shunt. Conclusion: Choroid plexus papillomas are rare neuroepithelial tumors, typically considered benign lesions, derived from the choroid plexus and appear like cauliflower.

Break events of the western North Pacific summer monsoon during 1979–2018

The monsoon break is a typical phenomenon representing the monsoon’s subseasonal variability, but its understanding is still limited for the western North Pacific (WNP) area. This study identified all break events of the WNP summer monsoon (WNPSM) from 1979 to 2018. The statistical analysis suggests that break events occur from late June to late October and peak at the end of August. The occurrence frequency of break events decreases as the duration increases, with 74% persisting 3–7 days and merely 26% lasting longer (8–15 days). During the break period, which is characterized by significant suppression of convection, there is an extensive anticyclonic anomaly in the lower troposphere, corresponding to a notable westward retreat of the monsoon trough and a southwestward shift of the subtropical high. Meanwhile, an anomalous cyclone and convergence in the upper troposphere are also conducive to inhibiting convection.The composite results indicate that both 10–25-day and 30–60-day oscillations contribute to the break, with their dry phases explaining 49.6% and 37.5% of the original suppression of convection, respectively. Around the break, the phase alternation of the 10–25-day oscillation causes convection fluctuation, while the 30–60-day oscillation maintains a stable dry phase that favors the establishment and maintenance of the break. A further case-by-case diagnosis suggests that 46 (51) out of the 61 break events occur in dry phases of the 10–25-day (30–60-day) oscillation, while only 10 (4) events occur in wet phases, indicating that the phase of the two oscillations significantly modulates the occurrence of the monsoon break.

Airport Malaria in Non-Endemic Areas: New Insights into Mosquito Vectors, Case Management and Major Challenges

Despite the implementation of preventive measures in airports and aircrafts, the risk of importing Plasmodium spp. infected mosquitoes is still present in malaria-free countries. Evidence suggests that mosquitoes have found a new alliance with the globalization of trade and climate change, leading to an upsurge of malaria parasite transmission around airports. The resulting locally acquired form of malaria is called Airport malaria. However, piecemeal information is available, regarding its epidemiological and entomological patterns, as well as the challenges in the diagnosis, treatment, and prevention. Understanding these issues is a critical step towards a better implementation of control strategies. To cross reference this information, we conducted a systematic review on 135 research articles published between 1969 (when the first cases of malaria in airports were reported) and 2020 (i.e., 51 years later). It appears that the risk of malaria transmission by local mosquito vectors in so called malaria-free countries is not zero; this risk is more likely to be fostered by infected vectors coming from endemic countries by air or by sea. Furthermore, there is ample evidence that airport malaria is increasing in these countries. From 2010 to 2020, the number of cases in Europe was 7.4 times higher than that recorded during the 2000–2009 decade. This increase may be associated with climate change, increased international trade, the decline of aircraft disinsection, as well as delays in case diagnosis and treatment. More critically, current interventions are weakened by biological and operational challenges, such as drug resistance in malaria parasites and vector resistance to insecticides, and logistic constraints. Therefore, there is a need to strengthen malaria prevention and treatment for people at risk of airport malaria, and implement a rigorous routine entomological and epidemiological surveillance in and around airports.

The effect of Corona virus disease 2019 on the care and prevention of Leprosy, the case of Boru Meda, Amhara region,Ethiopia, 2020

Introduction: Corona pandemic was unexpected challenges of the globe that results multi-dimension problem. When the state of emergency declared, and different resources are mobilized for the prevention of Corona pandemic some health facilities were committed for the isolation and treatment center for COVID-19. Meanwhile, other diseases including leprosy patients are unable to get care, and prevention due to inaccessibility of the health facilities. Methods:Aggregate secondary data from the Amhara regional health bureau and Boru Meda General Hospital were used. Result: From the regional data 76.36% and Boru Meda General Hospital 51.6% new leprosy patients to be diagnosed and to be treated were not come to the health institution due to Corona pandemic. Due to lockdown and repurposed of the health institution strictly to Corona pandemic, leprosy patients with neuropathic ulcer which can be treated and healed with antibiotics and routine nursing care were become complicated and needs amputation (increased by 300%). Conclusion: Still leprosy is one of the community health problems in Ethiopia, however one can considered leprosy as eliminated. Currently, children with age less than 15 were get leprosy with disability grade II. Recommendation: Community mobilization, capacity building, active case surveillance and early case diagnosis and treatment should be carried out

Management of The Posterior Cerebral Fossa Ependymomas

Background Posterior fossa brain ependymomas are one of the most devastating forms of human illnesses which are more common in children. Brainstem compression, herniation and death are the risks with tumours in this critical location. Patients and Methods: A retrospective study including 50 patients with posterior fossa ependymoma were performed at the Neurosurgery Department in Ait IDDIR University Hospital between the period of January 2005 and December 2015 . In each case, diagnosis was made clinically and confirmed radiologically and histo-pathologically.. All patients received the adjuvant treatment Results Out of 50 patients, 30 (60%) patients were males and 20 (40%) were females. The mean age was 24 years (ranged 5 months –47 years) ; we identified 29 (58%) children and 21 (42%) adults,. Ventriculo-peritoneal shunts were placed in all our patients, the total tumor excision was done to 35% and the partial tumor excision was done to 65% patients. The most common complications were as follows: Shunt malfunction : 4% , operative cavity hematoma 6%, CSF fistula 4%, deterioration of Cerebellar syndrome 6%, Cerebellar Mutism 2%, Mixed nerves palsy 4% and early post operative deaths 10%. Tumor architecture was classified as classic (Grade II) in 35 (70%) cases and anaplastic (Grade III) in 13(26%) cases. Adjuvant treatment regimens following resection included radiation therapy only (72%) for 36 patients including children above and adults and chemotherapy only (36%) for 9 children below 4 years and 9 recurrent tumors. During follow-up period, recurrence occurred in 27% 11patients out of 41patients .Five patients died (10%). Conclusion The surgical treatment of posterior fossa tumours still represents a challenge for neurosurgeons, Radical surgery with preservation of vital structures is the treatment of choice in patients with Posterior Cerebral Fossa ependymomas.Our experience shows the accepted results, complications and surgical outcome in relation to previous clinical studies.

Preparedness of pre-intern medical graduates of three universities in Sri Lanka to diagnose and manage anaphylaxis

Background Early recognition and the optimal management of anaphylaxis saves lives but studies from different countries have demonstrated gaps in knowledge and practices between healthcare workers. There is a paucity of such data from Sri Lanka. We assessed knowledge, perception and self-confidence in the diagnosis and management of anaphylaxis amongst pre-intern medical graduates who would soon become first-contact doctors attending emergencies. Methods This cross-sectional study included pre-interns who graduated with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees in 2019 from three Sri Lankan universities with differing undergraduate curricula. Using consecutive sampling data were collected within four months of the final-MBBS examinations with a self-administered questionnaire and the answers on case diagnosis and management were used as the basis of outcome scores. Results 385 participants responded (response rate: 91.5%). 16.4% correctly identified all anaphylaxis triggers. Only 7.3% correctly diagnosed all ten case scenarios and 34.5% all seven cases of anaphylaxis. 98.2 and 97.9% correctly identified 1:1000 adrenaline as the first-line treatment and the intramuscular route. 9.9% would preferentially but incorrectly use the intravenous route if access was available. Only 79.2 and 55.6% knew the correct adult and paediatric doses of adrenaline and 50% agreed that follow-up care was needed. The mean scores for case diagnosis and management of anaphylaxis were 7.7/10 ± 1.4 and 16.9/20 ± 1.9, respectively. Multiple linear regression indicated that the final MBBS results classification (class of degree or no class indicated) was a positive predictor of case diagnosis score [class vs no class: B = 0.662 (95% CI 0.347–0.978), p < 0.001] and being a graduate of University 2 [B = 1.568 (95% CI 1.182–1.953), p < 0.001] and passing with a class at final MBBS [B = 0.716 (95% CI 0.319–1.113), p < 0.001] were positive predictors of management score. Self confidence in diagnosing and managing anaphylaxis were rated as 79.7 and 62.1% and there was a positive correlation between knowledge and perception scores and self-confidence (case-diagnosis: rpb = 0.111, p = 0.03; management: rpb = 0.164, p = 0.001). Conclusions Knowledge, perception and self confidence in the diagnosis and management of anaphylaxis was sub optimal amongst pre-interns and we identified areas that need improvement. A higher MBBS qualification classification was a predictor for correct diagnosis and management and confidence in diagnosis and management positively correlated with knowledge and perception scores. Further and enhanced educational and training strategies are needed for this life threatening emergency condition.

Case Report: unilateral condylar hyperplasia

Case: This report describes a clinical case of unilateral condylar hyperplasia (CH) with unique, atypical morphology. An important feature of this report is the documentation of a series of clinical photographs of the patient, showing a gradual increase in facial asymmetry associated with the CH. The main symptom reported in this case was facial asymmetry. The main intraoral clinical features observed in the patient were contralateral crossbite and ipsilateral open bite associated with CH. Surgical reshaping of the condyle was the treatment plan for this case. Conclusions: The main take away point from this case is the importance of obtaining previous photographs of the patient at different ages during case diagnosis, which helps the clinician to determine the approximate time of commencement of CH. This case also highlights the imaging features of rarely observed atypical shape of the hyperplastic condyle.

The Peculiar Case Of Diplopia

A nineteen - year - old female presented with a history of binocular diplopia for one week. She had a history of headache, seizures, and memory loss. Magnetic Resonance Imaging (MRI) of brain revealed subependymal astrocytoma as the cause of her symptoms. Our pa tient was a probable case of tuberous sclerosis complex (TSC). Diplopia was the presenting sign in this case diagnosis.