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Background: Malaria remains one of the leading health problems of the developing world, and acute kidney injury (AKI) is a well-recognized complication of severe malaria in adults; but the clinical importance of AKI in paediatric severe malaria is not well documented. Knowledge of the prevalence and factors associated with AKI among children with severe malaria is among the key strategies, which can help to reduce the burden of AKI among this vulnerable group. Methodology. A hospital-based prospective cross-sectional descriptive and analytic study of children with severe malaria was carried out at Kiryandongo General Hospital. The study involved 350 children with severe malaria attending the study site from August to October 2021. Questionnaires were administered to caretakers to obtain sociodemographic characteristics. Medical data were obtained through physical examination followed by laboratory tests. Blood samples were tested for creatinine and blood smear for malaria. Data were analyzed using binary logistic regression (bivariate and multivariate) to assess for the factors associated with AKI. A p value < 0.05 was considered statistically significant. Results: The mean age of children with severe malaria was 7.0 ± 3.8 years, and 54.3% of them were male. Of the 350 children enrolled, 167 had AKI, giving an overall AKI prevalence of 47.7% (95% CI: 42.5-53.0). The factors that were significantly associated with AKI among children with severe malaria included caretaker with no formal education (aOR = 21.0, 95% CI: 1.68-261.18, p = 0.018), caretaker with primary education level (aOR = 4.5, 95% CI: 1.41-14.12, p = 0.011), age of child < 5 years (aOR = 1.8, 95% CI: 1.07-2.88, p = 0.025), history of receiving NSAIDs (aOR = 5.6, 95% CI: 2.34-13.22, p < 0.001), moderate anemia (aOR = 3.1, 95% CI: 1.39-6.94, p = 0.006), and severe anemia (aOR = 3.8, 95% CI: 1.66-8.55, p = 0.002). Conclusion: The prevalence of AKI was high among children with severe malaria in Kiryandongo General Hospital. Acute kidney injury among children with severe malaria was associated with low level of education of caretakers, age of children less than 5 years, history of receiving NSAIDs, and anemia. The management of severe malaria should include screening for AKI especially in children under five years of age, anemic, and those who have received NSAIDs.
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Sickle cell disease (SCD) is an umbrella term for a group of life-long debilitating autosomal recessive disorders that are caused by a single-point mutation (GluâVal) that results in polymerization of hemoglobin (Hb) and reversible sickle-shape deformation of erythrocytes. This leads to increased hemolysis of erythrocytes and microvascular occlusion, ischemia-reperfusion injury, and tissue infarction, ultimately causing multisystem end-organ complications. Sickle cell anemia (HbSS) is the most common and most severe genotype of SCD, followed by HbSC, HbSß 0thalassemia, HbSß+thalassemia, and rare and benign genotypes. Clinical manifestations of SCD occur early in life, are variable, and are modified by several genetic and environmental factors. Nearly 500 children with SCD continue to die prematurely every day, due to delayed diagnosis and/or lack of access to comprehensive care in sub-Saharan Africa (SSA), a trend that needs to be urgently reversed. Despite proven efficacy in developed countries, newborn screening programs are not universal in SSA. This calls for a consolidated effort to make this possible, through the use of rapid, accurate, and cheap point-of-care test kits which require minimal training. For almost two decades, hydroxyurea (hydroxycarbamide), a century-old drug, was the only disease-modifying therapy approved by the U.S. Food and Drug Administration. Recently, the list expanded to L-glutamine, crizanlizumab, and voxelotor, with several promising novel therapies in the pipeline. Despite its several limitations, hematopoietic stem cell transplant (HSCT) remains the only curative intervention for SCD. Meanwhile, recent advances in gene therapy trials offer a glimpse of hope for the near future, although its use maybe limited to developed countries for several decades.
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Background: In low resource settings in sub-Saharan Africa healthcare workers (HCW) have a high risk of contracting hepatitis B infection. Vaccination of HCWs is to protect them from acquisition of hepatitis B from patients. Objective: To evaluate the hepatitis B virus (HBV) serological and vaccination status of HCWs in the Butembo Antenna in the Eastern Democratic Republic of Congo (DR Congo) and to investigate the factors influencing hepatitis screening and vaccination. Methods: A cross-sectional study using a structured questionnaire was carried out from 1st to 30th April 2021 among consenting HCWs in Butembo (≥18 years of age). Data was analysed using SPSS version 23. Results: Of 373 participants, 178 (47.7%) had already been screened for HBV. Screening was more likely for HCWs in a rural or publicly owned facility (P<0.05). A total of 25 (6.7%) HCWs were fully vaccinated against HBV; the factors associated with full vaccination were: prior screening for HBV (odds ratio: 9.03 (2.51-38.61), P<0.0001), prior knowledge of the value of post-exposure prophylaxis (odds ratio 12.9 (2.89-80.44), P=0.0004), prior knowledge of hepatitis B vaccine benefits (adjusted odds ratio: 4.54 (1.66-13.05), P=0.002) and prior exposure to hepatitis B infection (adjusted odds ratio: 2.61 (1.08-6.39), P=0.039). Conclusion: Screening and vaccination rates of HCWs for HBV are extremely low, and not high enough to prevent the spread of this serious illness and its complications. There is a dire need to increase vaccination rates among HCWs in Eastern DR Congo. The DRC government should issue vaccination against HBV as a recommendation at the national level.
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INTRODUCTION AND IMPORTANCE: Kerosene and rodenticides are used in many households in developing countries. This case report aims to discuss the progression and management of a patient with intentional kerosene and rodenticide poisoning. To our knowledge, this is the first documented case of blended kerosene-rodenticide poisoning in medical literature. CASE PRESENTATION: This report describes a 23-year-old man who survived after intramuscular self-injection of 5 ml of kerosene mixed with a rodenticide into his left upper limb, with intent to commit suicide. He was admitted to our hospital following a convulsion and brief loss of consciousness. Compartment syndrome developed within 24 h of admission, necessitating urgent fasciotomy, repeated surgical debridement, limb elevation, wound cleaning and dressing, in addition to intravenous fluids, antibiotics, and close observation. Blood transfusion, phytomenadione (vitamin K1), tetanus toxoid, and analgesics were recommended. The patient also received physiotherapy, and was treated for depression. The limb healed completely, with contractures at the left wrist joint. CLINICAL DISCUSSION: Injected kerosene and rodenticide may result in compartment syndrome and variable local and systemic complications which require multifaceted care and a prolonged follow-up period. CONCLUSION: Seemingly minor injuries at presentation may quickly progress into considerable complications such as compartment syndrome. It is imperative that physicians comprehensively investigate patients with poisoning for multiorgan dysfunction. Anticipation of local and systemic complications of injected poisons and timely medical and surgical intervention is life-saving.
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Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.
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Sclerema neonatorum (SN) is a rare form of panniculitides with an obscure incidence, aetiology, and pathogenesis. This condition is peculiar to preterm neonates, especially those with comorbidities such as sepsis, congenital anomalies, congenital heart disease, and gastrointestinal and respiratory diseases. Usually, it presents within the first seven days of life, but may develop a few weeks later. Typically, SN manifests with diffuse hardening of the skin and subcutaneous tissues that subsequently bind to the underlying muscle and bone, often beginning in the buttocks, thighs, or trunk, and progressing to other body parts, but sparing the soles, palms, and genitalia. Diagnosis is based on clinical characteristics. It has been associated with a high mortality, despite aggressive use of various treatment modalities such as antibiotics, steroids, fresh blood transfusion, exchange blood transfusion, and intravenous immunoglobins. This is a report of a macrosomic term neonate who presented with typical clinical and histopathological features of SN.