Late presentation of dural tears:Two case reports and review of literature

BACKGROUND The late presentation of dural tears(LPDT)has a low incidence rate and hidden symptoms and is easily ignored in clinical practice.If the disease is not treated in time,a series of complications may occur,including low intracranial pressure headache,infection,pseudodural cyst formation,and sinus formation.Here,we describe two cases of LPDT.CASE SUMMARY Two patients had sudden fever 1 wk after lumbar surgery.Physical examination showed obvious tenderness in the operation area.The patients were confirmed as having LPDT by lumbar magnetic resonance imaging and surgical exploration.One case was caused by continuous negative pressure suction and malnutrition,and the other was caused by decreased dural ductility and low postoperative nutritional status.The first symptom of both patients was fever,with occasional headache.Both patients underwent secondary surgery to treat the LPDT.Dural defects were observed and dural sealants were used to seal the dural defects,then drainage tubes were retained for drainage.After the operation,the patients were treated with antibiotics and the patients’surgical incisions healed well,without fever or incision tenderness.Both recovered and were discharged 1 wk after the operation.CONCLUSION LPDT is a rare complication of spinal surgery or neurosurgery that has hidden symptoms and can easily be overlooked.Since it may cause a series of complic-ations,LPDT needs to be actively addressed in clinical practice.

Prune Belly Syndrome: A Ten-Year Single Tertiary Centre Experience in South-South, Nigeria

Background: Prune belly syndrome (PBS) is a congenital anomaly that consists of a triad of abdominal wall defect, bilateral cryptorchidism, and urinary tract dilation. The disease is of varying severity. This study aims to highlight the challenges and peculiarities in the management of PBS in a resource-poor setting. Materials and Methods: This is a ten-year retrospective study conducted at the University of Port Harcourt Teaching Hospital. Ethical approval for the study was sought and gotten from the hospital’s ethical committee. The information gotten included history, duration of symptoms, examination findings, age of the patient, category of disease, and intraoperative findings. The data from the folders were collected and evaluated. Frequencies, percentages, the mean and standard deviation were used to summarize the data as appropriate. Results: Fifteen patients were included in the study. The hospital incidence of PBS was 112/100,000, twelve males and three females. The age range was from 1 day to 15 years, mean age was 14 months ± 2.3 months. Most patients presented between 3 months and 2 years and 11 months. Twelve patients had category three PBS and five patients had associated anomalies. Eleven male patients died after 5 years of follow-up from progressive renal deterioration. The female patient fared better than the males. Conclusion: PBS is rare, most patients with the condition present late. The most common cause of mortality was progressive renal deterioration.

Pattern of Stroke Admissions, Radiodiagnostic Compliance, and Outcomes in the Intensive Care Unit of a Tertiary Hospital, South-South, Nigeria

Background: Stroke patients form an integral part of patients admitted into the intensive care unit (ICU);and may need airway maintenance, supplemental oxygen and even endotracheal intubation for mechanical ventilation. Method: In this retrospective study, the medical records and radiological investigations of the patients were assessed. Also, their socio-demographics, and clinical diagnosis and background co-morbidities were noted. The radiological diagnosis post CT was used to determine the type of stroke for those compliant;while clinical assessment alone was used to determine the diagnosis in those who did not do CT. They were also classified into 2 groups: those requiring mechanical ventilation (for ICU care) and those without the need for mechanical ventilation (for high dependency Unit (HDU) care). The eventual clinical outcome was noted. Result: A total of eighty-eight cases, 67% (n = 59) were males and 33% (n = 29) females. 89.8% (n = 79) had hypertension, 3.4% (n = 3) had diabetes while 6.8% (n = 6) had both hypertension and diabetes. Of the hypertensives, 36.7% (n = 29) had hemorrhagic stroke and 66.3% (n = 50) had ischaemic stroke. 53.3% (n = 46) patients had High dependency Unit (HDU care while 47.7% (n = 42) were mechanically ventilated. Of the number in HDU, 51.5% (n = 17) were haemorrhagic, while 52.7% (n = 29) were ischaemic. Clinical diagnosis of ischemic stroke was done in 55 (62.5%) and hemorrhagic stroke in 37.5% (n = 33). Of the lot, only 19.3% (n = 17) of them did CT and 80.7% (n = 71) did not have CT done. None did MRI. Late presentation (beyond 24 hrs) was a common feature for most of the patients, for whom immediate cardio-respiratory support became necessary. Overall mortality rate was 62.5% (n = 55). 39.1% (n = 18) of the HDU (46) patients died, while 88.1% (n = 37) of the ventilated (42) patients died. 56.6% (n = 26) were discharged from the HDU and 4.3% (n = 2) referred to another facility. Of the 42 patients on mechanical ventilation 88.1% (37) died, 9.5% (n = 4) discharged, and 2.4% (n = 1) referred to another health facility. Summary: Low neuroimaging compliance by Stroke patients in our environment and late presentation to hospital, impacts negatively on good outcome of the disease. This, coupled with the high cost of these facilities, makes their use unaffordable, suggesting a strong indication for comprehensive quality and affordable health care and health insurance in the country.

The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort

Background:A delay presentation for human immunodeficiency virus(HIV)patient’s care(that is late engagement to HIV care due to delayed HIV testing or delayed linkage for HIV care after the diagnosis of HIV positive)is a critical step in the series of HIV patient care continuum.In Ethiopia,delayed presentation(DP)for HIV care among vulnerable groups such as tuberculosis(Tb)/HIV co-infected patients has not been assessed.We aimed to assess the prevalence of and factors associated with DP(CD4<200 cells/μl at first visit)among Tb/HIV co-infected patients in southwest Ethiopia.Methods:A retrospective observational cohort study collated Tb/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012.The data analysis used logistic regression model at P value of≤0.05 in the final model.Results:The prevalence of DP among Tb/HIV co-infected patients was 59.9%.Tb/HIV co-infected patients who had a house with at least two rooms were less likely(AOR,0.5;95%CI:0.3–1.0)to present late than those having only single room.Tobacco non-users of Tb/HIV co-infected participants were also 50%less likely(AOR,0.5;95%CI:0.3–0.8)to present late for HIV care compared to tobacco users.The relative odds of DP among Tb/HIV co-infected patients with ambulatory(AOR,1.8;95%CI,1.0–3.1)and bedridden(AOR,8.3;95%CI,2.8–25.1)functional status was higher than with working status.Conclusions:Three out of five Tb/HIV co-infected patients presented late for HIV care.Higher proportions of DP were observed in bedridden patients,tobacco smokers,and those who had a single room residence.These findings have intervention implications and call for effective management strategies for Tb/HIV co-infection including early HIV diagnosis and early linkage to HIV care services.