Twin births in the university of Portharcourt teaching hospital Portharcourt:a 6 year review

Objective:To provide information on twin births and associated factors in Port barcourt South South Nigeria.Methods:Data on twin deliveries from 1st January 2003 to 31st December 2008 were collected and analysed.This included the maternal age and parity,gestation age,Apqar scores,sex and birth weight of twins.Results:A total of 11042 deliveries occurred over the study period with 333 being twins giving a twin rate of 1∶33.Male twins constituted 48% of twin births with male to female ratio of 1∶1.08.The mean age and parity of mothers were 29.6 years and 2.5 respectively.Presentation of the cephalic/cephalic for the first and second twins was the most common(63.4%).Severe birth asphyxia(first minute Apgar score 1-3)occurred in 3.9% of twins.Male-male twin pair occurred in 28.5% of twins,male-female in 39% while female-female occurred in 32.5%.The Caesarian section rate was 48%.Conclusion:The twining rate in this study is high.In this locality,there is a need for early ultrasound scanning of pregnant women particularly those of parities 1 to 3 and those aged 25-34 years in whom highest rates of twinning occurred to detect twinning when present and refer them to sufficiently equipped centres for adequate antenatal and perinatal care.

Refractory Oedema of Nephrotic Syndrome in a Resource Poor Setting: A Case Presentation

Background: Oedema, a constant feature of childhood nephrotic syndrome can be severe, enough to cause respiratory embarrassment. It can also be refractory to diuretic monotherapy. In such cases, combination of salt poor albumin (SPA) infusion and diuretics has remained the best treatment option. However, the cost of SPA has made it practically unavailable in resource-poor settings. It becomes a therapeutic dilemma when nephrotic syndrome patients of financially-constrained caregivers present with refractory anasarca in a resource-poor settings. Case review: We present a seven-year-old boy with relapsed steroid sensitive nephrotic syndrome who presented to Abia State University Teaching Hospital Aba, in respiratory distress with anasarca and a weight of 58 kilograms. SPA could not be accessed due to financial constraints. A decision to use fresh whole blood in the place of SPA, in combination with frusemide, achieved a lifesaving diuresis and regression of the anasarca. Conclusion: Whole blood is a good alternative for the treatment of refractory oedema in children with nephrotic syndrome in resource poor settings.

Evaluation of utilization of antenatal services by mothers of babies with severe birth asphyxia

Objective:To evaluate the utilization of antenatal services by mothers of babies delivered with severe birth asphyxia at the University of Port Harcourt Teaching Hospital(UPTH) Port Harcourt,Nigeria.Methods: A case control study of the utilization of antenatal services by 97 mothers of newborns with severe birth asphyxia delivered at UPTH from 1st February to 31st October 2009 compared with mothers of newborns with normal Apgar scores was done.Relevant pregnancy,birth,family and social history was obtained by personal interviews and referral to case notes.Results: Significantly more of the mothers of babies with normal Apgar score booked early(4 months or less) and had up to 8 or more antenatal visits prior to delivery than mothers of asphyxiated babies 86(88.6%) vs 68(70.2%),P=0.002;93(95.7%) vs 68(70.2%),P=0.001 respectively.Significantly more subjects 56(57.7%) than the controls 45(46.4%) were primiparous,P= 0.04.Also,significantly more subjects 19(19.5%) suffered delay prior to intervention in labour than the controls 5(5.1%),P=0.004.Conclusion: Primiparity,delayed booking,inadequate antenatal visits and late intervention in labour have been identified as significant contributors to severe birth asphyxia.

Tuberculosis of the Spine (L5, S1) Secondary to Scrofuloderma with Viral Warts in a 15-Year-Old Male

We report this case of a 15-year-old male who presented to the children outpatient clinic (CHOP) of Abia State University Teaching Hospital (ABSUTH), Aba on the 5th of November 2015. He had tuberculosis (TB) of the skin (scrofuloderma) which was not diagnosed and had received treatment other than anti-TB medication. He now presented 9 years after with multiple body discharging sinuses, cicatricial skin lesions, tuberculosis of the spine (L5, S1) with contracture of the Achilles Tendon and genital warts. Subsequent treatment with full anti-TB drugs led to resolution of his illness. A higher index of suspicion is required for early diagnosis of extrapulmonary TB. Prompt and adequate treatment with anti-TB medication ensures cure in such cases. Appropriate control program is also known to improve the outcome and reduce sequelae.

A Rare Classical Presentation of Bardet-Biedl Syndrome in a Three-Year-Old Male from South East Nigeria: A Case Report

Bardet-Biedl Syndrome (BBS) is a rare autosomal recessive ciliopathy characterized by obesity, post-axial polydactyly, renal abnormalities, mental retardation, pigmentary retinopathy and hypogenitalism. Diagnosis is rare in early childhood, and only few of the features are present at that age. This is because the disease is slow evolving. However, it is possible to find majority of the component of this syndrome in very young children. A 3-year old very obese male presented with clinical features of sepsis and congestive cardiac failure. He is a product of non-consanguineous marriage with unremarkable family history. Both parents are of the Ibo tribe in Nigeria. Polydactyly was noticed at birth. There was delay in some aspects of his developmental milestone. Examination revealed mild hypertelorism and retrognathia, polydactyly of both feet with syndactyly of the big and second toes. Other findings were short broad hands, mottled pigments on the retina, moderate mental retardation, hypogenitalism, nephrotic syndrome, renal tubulopathy, hyperglycaemia and hypopigmented skin lesions. A case of BBS with all the primary features and some secondary manifestations in a very young child is hereby reported. A high index of suspicion for BBS should be shown in any young child with at least one of the features of this syndrome. This will enhance earlier diagnosis and improve disease outcome.

Lymphoma in Two Siblings: A Plausible Case of Familial Lymphoma?

We repot two cases of lymphoma manifesting in siblings, one is Hodgkin’s lymphoma (HL) and the other is Non-Hodgkin’s lymphoma (NHL) in a nuclear family. Each presented a year apart. The patients were well and alive as at the time of this report and did not show any signs of the disease. There was no history of tuberculosis (TB) or contact with any one with TB. Other common lymphadenopathy associated conditions were excluded and histology of excised lymph nodes was confirmatory of the lymphomas. We were constrained by facilities on the demonstration of Ebstein Barr Viruses (EBV) or genetic associations. This is the first plausible case of reported familial lymphoma in Nigeria.