Outcome of intussusception among children in Kano

Intussusception is defined as the telescoping of a segment of the gastrointestinal tract within the lumen of the adjacent segment usually proximal to distal. It is a common cause of intestinal obstruction in children, rarely it can occur in adult. This condition is reported in both developed and developing countries, however there are few publications in Nigeria about the incidence, presentation and outcome of its management, most especially in children. This is a prospective study of pediatric patients managed in single center Kano over a period of 18months. The demographic data, clinical features, treatment and outcome of the management were evaluated and analyzed using SPSS version 23. Between June 2018 to December 2019, twenty-five children were managed with intussuception at Aminu Kano Teaching Hospital, there were 16 males and 9 females. The age of the patients ranges between 5 months to 6 years with most of patients in the ager range between 6 and 12 months. All of the 25 patients had exploratory laparotomy with manual reduction in 12 patients, while 13 patients had resection and anastomosis. Non-operative reduction using normal saline under ultrasound guidance was attempted for 2 patients, which was not successful. The length of hospital stay ranged between 4 days and 22 days. Few complications were observed which includes surgical site infection, wound dehiscence, postoperative ileus. One patient was re-operated for recurrent intussuception. Two patients died post operatively, while 23 patients were discharged home alive. Intussuception is still a common cause of intestinal obstruction in children in Kano. Late presentation was found to be associated with higher morbidity (complications).

Computed tomographic pattern of stroke among adult patients in north-eastern Nigeria

Stroke and its complications are major health problems in developing countries including Nigeria. It could be a major cause of death or disability especially when only clinical assessment is relied upon for diagnosis. Computed Tomography (CT) is a valuable tool for the diagnosis of stroke. CT pattern of stroke in the North Eastern Nigeria has not been fully described. This was a prospective descriptive study conducted at the Federal Teaching Hospital, Gombe, Nigeria from June 2016 to December 2016. One hundred and eleven patients who presented with clinical features of stroke and were referred to Radiology department for cranial CT were consecutively selected. Data were analysed using SPSS version 16.0 package. A p-value of ≤ 0.05 and confidence interval of 95% were adapted for statistical analysis. The variables were expressed as range, percentage and mean plus standard deviation. All comparison of variables was done applying kappa statistic and point-biserial correlation coefficient for the correlation analysis. There were 69 (62.2%) males and 42 (37.8%) females aged 18-90 years (mean ± SD of 57.49±13.47 years). Ninety-four (94) patients (84.7%) had ischaemic stroke, while the remaining 17 (15.3%) had haemorrhagic stroke. Lobar location was identified as the most common site of ischaemic stroke while thalamo-ganglionic area was the commonest location for haemorrhagic stroke. Age and hypertension were found to be the commonest risk factors associated with stroke. It is evident from this study that ischaemic stroke is the most prevalent stroke subtype. The middle cerebral artery territory was the commonest vascular territory involved in stroke while hypertension and age are common risk factors for both ischaemic and haemorrhagic stroke.

Right destroyed lung due to tuberculosis in a Nigerian child: Case report and review of the literature

Destroyed Lung Syndrome (DLS) is total lung destruction from recurrent and chronic infections especially Tuberculosis (TB). It is rare in children and associated with chronic morbidity. It presents with chronic cough, progressive difficulty in breathing, hemoptysis and progressive respiratory failure. The pathology of DLS includes lung fibrosis, collapse, tracheal and mediastinal shift. We report the case of a 9 years old girl referred after three courses of anti-TB treatment for suspected TB reinfection with worsening clinical and radiologic features. Investigations revealed a destroyed right lung. Genexpert was initially positive and subsequently along with TB culture was negative. She improved on antibiotics and chest physiotherapy. Destroyed lung though rare in children should be considered in those who despite TB treatment present with worsening clinical and radiologic features. Early diagnosis and multi- disciplinary approach will prevent irreversible lung damage.

Acute spinal cord infarction syndrome unusually mimicking Transverse myelitis: A case report

Anterior Spinal Cord Infarction (ASCI) syndrome typically results from ischemia that affects the anterior spinal artery territory characterized by history of sudden onset flaccid paraplegia or quadriplegia depending on the level of the lesion. We describe a 57-years-old woman with sudden onset flaccid weakness of the lower limbs and numbness of the feet of two days duration, preceded by a day history of fever and several episodes of vomiting. Examination initially revealed bilateral hypotonia, hyporeflexia and dense paraplegia, with preservation of dorsal column sensations (fine touch/2-point discrimination, position and vibration sensation). Twenty-four hours thereafter a repeat examination showed hyper-reflexia and extensor plantar response with spastic paraplegia. Thoracic spine Magnetic Resonance Imaging (MRI) revealed thinning of the spinal cord extending from T1 to T9 levels with associated widening of the thecal sac suggestive of anterior spinal cord infarction with no other signal changes seen within the substance.

Accidentally swallowed toothbrush in mentally healthy patient: A case report and review of literature

Most ingested foreign bodies are usually passed through the gastrointestinal tract. Ingested toothbrush however is almost never passed due to their long length, which doesn’t negotiate the C-loop of the duodenum. Early endoscopic removal is however recommended to reduce chances of morbidity and mortality. Surgical option is considered when there is failure of endoscopic retrieval or when complication such as duodenal perforation has set in. In this case we present a 40-years-old man who accidentally ingested toothbrush that was removed surgically through mini laparotomy and gastrostomy.

Medico-social factors associated with late presentation in women with cancer of the cervix in Northern Nigeria

Cancer of the cervix is the commonest gynecological cancer and the leading cause of cancer mortality among women in Africa.Certain social behaviors have been associated with an increased risk of high-risk Human Papillomavirus (HPV) infection, which is responsible for virtually all cases of Invasive Cervical Cancer (ICC). Retrospective review of the medico-social and histo-pathologic patterns of cases of cancer of the cervix at the Gynecology Oncology Unit, Aminu Kano Teaching Hospital, Kano between January 2006 to December 2010 was conducted. The socio-demographic, medical and histological data of each patient were extracted and analyzed. A total of 91 cases of cancer of the cervix were identified. The mean age of the respondents was 48 years (SD±10.2years), mean parity was 7 (SD±3.2) and mean age at first marriage was 15.2 years (SD±1.9years). Most of the patients had being married more than once in their lifetime. Majority of the women were unemployed and over half had no formal education. The commonest presenting complaint and complication respectively was vaginal bleeding (72.5%) and anaemia (45.1%). Most of the patient had advanced stages of the disease (86.8%). Only 18 out of the 91 had undergone HIV testing, with 28% testing positive to the virus. The commonest histologic type of cervical cancer (85.7%) was Squamous Cell Carcinoma (SCC). There were statistically significant associations between advanced disease and age, parity and number of lifetime marriages. Patients with cancer of the cervix seen at our institution are within the reproductive age group. They are mostly grandmultiparous, have no formal education and have more than one life time marriages. They usually present with late stage disease and of SCC histologically.

Effect of topical bupivacaine on post-tonsillectomy pain relief in children

Tonsillectomy is a common surgery performed in paediatric otorhinolaryngology and is usually accompanied by considerable postoperative pain. Earlier literature has shown the use of topical bupivacaine for post-tonsillectomy pain relief to be promising. This study was conducted to evaluate the efficacy of topical bupivacaine application on post-tonsillectomy pain relief. Fifty consenting patients scheduled for tonsillectomy that met the inclusion criteria were enrolled in the study and assigned into two groups of 25 patients each. Group B had their tonsillar fossa packed with 0.5% bupivacaine soaked gauze for 5 minutes while Group S had normal saline. Pain intensity was measured at 1, 2, 4, 12 and 24 hours postoperatively, using the Faces Pain Scale- Revised (FPS-R). Mean scores for groups B and S at 1, 2, 4, 8, 12, 24 hours were 1.96±1.17, 2.40±0.82, 2.8±1.0, 2.88±1.17, 3.08±0.99, and 3.04±1.02 and 3.36±1.38, 4.72±1.62, 3.92±1.35, 3.76±1.45, 4.00±1.41, 3.38±0.98 respectively. The difference was significant at 1 and 2 hours only (P≤0.05). Post-tonsillectomy pain was reduced in the first two hours by application of bupivacaine soaked gauze.

A case report of bilateral uveitis with meningococcal septicaemia resulting to blindness and adjustment disorder

To report the rare case of a patient with bilateral uveitis with meningococcal septicaemia from Neisseria meningitides, resulting to blindness and adjustment disorder. A 9-years-old boy presented to the Emergency paediatric unit of a hospital with complaints of fever, and neck stiffness of one week duration. There was associated sudden decreased vision, pain and photophobia of both eyes. Neck was stiff and retracted with positive Kernig’s and Brudzinski’s signs. Neisseria meningitidis was isolated from both the turbid CSF and the blood. Visual Acuity (VA) was Perception of Light (PL) and Counting Finger (CF) in right and left eyes (RE and LE) respectively, with 360 degrees posterior synechiae and pupillary membrane. Diagnosis of meningococcal septicaemia with bilateral uveitis was made. Patient was treated with IV ceftriaxone, sub-conjunctival dexamethasone, dexamethasone, atropine and moxifloxacin eye drops and other supporting medications. Although he showed improvement of VA to RE-6/36, LE- 6/24, he absconded from follow- up and later relapsed with subsequent blindness (VA of Perception of Light in Both eyes) and symptoms of adjustment disorder. Although ocular involvement is rare in meningococcal septicaemia, patients should always have detailed ophthalmological examination as prompt diagnosis and management could improve the visual outcome.

Tuberculous parotitis in an immuno-competent adult: A rare clinical entity

Majority of the cases of Tuberculosis (TB) occur in the pulmonary system, other extrapulmonary sites are rare, accounting for 15% of all TB cases. Among the extrapulmonary manifestations, TB parotitis is extremely rare, only few cases were reported in Africa despite the endemicity of the disease. We present a 23 years old man who developed a right infra-auricular swelling of three month duration, with no clinical or laboratory evidence of immunosuppression or TB in the lungs or other part of the body. High index of suspicion is required to diagnose this rare condition and the place of histological examination is imperative.

Reported healthcare workers knowledge and practices of hand hygiene in specialist hospitals of Kano, Northwest Nigeria

Compliance with recommended hand hygiene among healthcare providers is important in the prevention of morbidity and mortality associated with hospitalacquired infections including drug resistant microorganisms. This study aimed to determine the reported knowledge and hand hygiene practices among healthcare workers in Specialist Hospitals in Kano, Nigeria. Descriptive cross-sectional study design was used to study 302 healthcare workers in the specialist hospitals in Kano. Data was collected using semi-structured self-administered questionnaire and analyzed at univariate, bivariate and multivariate levels using IBM SPSS version 22. The age of the respondents ranged from 18 to 59 years with a mean of 31.4±9 years. Up to onethird (36.1%) of the respondents had poor knowledge despite the reported hand hygiene practice of 78%. Use of Alcohol Based Hand Rub and soap and water constituted 26.7% and 15.7% respectively. There was statistically significant association between working in MMSH, working in Pediatrics wards, CHEW cadre, and attendance of hand hygiene training in the last 3 years and having good knowledge of hand hygiene. Hand hygiene training was found to improve hand hygiene knowledge [AOR=1.58, 95% CI= (1.01-2.5)] and practice [AOR=1.12 95%CI= (0.64-1.99)]. Reported knowledge of hand hygiene was poor but the practices were encouraging and associated with formal training of healthcare workers on hand hygiene. Therefore, Hospital management should ensure regular hand hygiene training and re-training among healthcare workers.