Biomedical subjects

C N Okoromah

Publications and source records attributed to C N Okoromah.

8 recordsLinked to original sources

PubMed2005

Neurofibromatosis with malignant transformation presenting as an emergency in a nigerian child: a case report.

Neurofibromatosis is a rare disease, and malignant transformation of this otherwise benign tumor is extremely rare in childhood. In this case report, attention is drawn to childhood neurofibromatosis presenting as a life-threatening triad of malignant transformation, visceral metastasis and upper airway obstruction leading to death in a 9-year-old female Nigerian child. This case report is purposed to draw attention to this condition, mostly reported in adults and to review literature on the disease.

Cell Transformation, Neoplastic↗

PubMed2004

Intramuscular arteether for treating severe malaria.

BACKGROUND: Quinine and artemisinin drugs are used in severe malaria, but quinine resistance is increasing. Arteether is a recently developed artemisinin derivative that is oil soluble, has a long elimination half life, and is more stable than other derivatives. OBJECTIVES: To compare intramuscular arteether with other antimalarial drugs to treat severe malaria. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (August 2004), CENTRAL (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to August 2004), EMBASE (1980 to August 2004), U.S. National Library of Medicine (NLM) Gateway (1953 to 1965), Web Science Citation (1981 to August 2004), LILACS (August 2004), Google search engine (August 2004), conference proceedings, and reference lists. We also contacted researchers, organizations, and pharmaceutical companies to help identify trials. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials of intramuscular arteether in adults and children with severe malaria. DATA COLLECTION AND ANALYSIS: We independently assessed the methodological quality of the trials and extracted data, and analysed data using Review Manager 4.2. MAIN RESULTS: Two small trials (n = 194) met the inclusion criteria. Both trials compared arteether with quinine in children with cerebral malaria and reported on similar outcomes. There was no statistically significant difference in the number of deaths (relative risk 0.75, 95% confidence interval 0.43 to 1.30; n = 194, 2 trials), neurological complications (relative risk 1.18, 95% confidence interval 0.31 to 4.46; n = 58, 1 trial), or other outcomes including time to regain consciousness, parasite clearance time, and fever clearance time. The meta-analyses lack statistical power to detect important differences. REVIEWERS' CONCLUSIONS: More trials with a larger number of participants are needed before a firm conclusion about the efficacy and safety of arteether can be reached.

Adult↗

PubMed2004

Diazepam for treating tetanus.

BACKGROUND: Clinical management of the muscle spasms and rigidity of tetanus poses a difficult therapeutic problem to physicians everywhere, especially in resource poor countries. There are wide variations in therapeutic regimens commonly used in clinical practice due to uncertainties about effectiveness of conventional drugs. Diazepam compared to other drugs (eg phenobarbitone and chlorpromazine) may have advantages because of combined anticonvulsant, muscle relaxant, sedative and anxiolytic effects. OBJECTIVES: To compare diazepam to other drugs in treating the muscle spasms and rigidity of tetanus in children and adults. SEARCH STRATEGY: We searched the Cochrane Neonatal Group trials register (October 2003), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2003), MEDLINE (1966 to October 2003), EMBASE (1980 to October 2003), LILACS (2003), CINAHL (October 2003), Science Citation Index, African Index Medicus, conference abstracts and reference lists of articles. We contacted researchers, experts and organizations working in the field and used personal communication. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials. DATA COLLECTION AND ANALYSIS: We independently identified eligible trials, assessed trial methodological quality and extracted data. MAIN RESULTS: Two studies met the inclusion criteria. Method of generation of allocation sequence, concealment of allocation and blinding were unclear in both studies. A total of 134 children were allocated to three treatment groups comprising diazepam alone, phenobarbitone and chlorpromazine, or phenobarbitone and chlorpromazine and diazepam.Meta-analysis of in-hospital deaths indicates that children treated with diazepam alone had a better chance of survival than those treated with combination of phenobarbitone and chlorpromazine (Relative Risk for death 0.36; 95% confidence interval 0.15 to 0.86; Risk Difference -0.22; 95% CI -0.38 to -0.06). Giving diazepam alone, or supplementing conventional anticonvulsants (phenobarbitone and chlorpromazine) with diazepam, was reported in one study to be associated with a statistically significantly milder clinical course and shorter duration of hospitalization. REVIEWER'S CONCLUSIONS: Although there is evidence that diazepam alone compared with combination of phenobarbitone and chlorpromazine is more effective in treating tetanus, the small size, methodological limitations and lack of data on drug safety from available trials preclude definite conclusions to support change in current clinical practice. The application of the present evidence should be moderated by local needs and circumstances, pending the availability of more evidence. We recommend a large multicenter, randomized controlled trial which compares diazepam alone with combinations of other drugs (excluding diazepam).

Anticonvulsants↗

PubMed2004

Profile of and control measures for paediatric discharges against medical advice.

BACKGROUND: Children are minors in health decision- making and discharges against medical advice (DAMA) may portend adverse health, social and psychological consequences . This study was aimed at ascertaining the prevalence rate and the determining clinical, sociodemographic factors as well as caregivers' perceptions associated with paediatric DAMA with the view of proferring possible control measures. DESIGN: Pre-tested administered questionnaires were used to collect relevant data prospectively (March 2000- March 2002) from consecutive patients undertaking DAMA. RESULTS: Prevalence rate of DAMA was 1.2%, comprising 202 of 16,440 discharges, of which 95 (47.0%) were neonates. Neonatal jaundice, gross congenital anomalies and severe birth asphyxia among neonates, and bronchopneumonia, gastroenteritis, malaria and malignancies among infant and older children,were the commonest diagnoses. Twenty (9.9%) cases were critically ill and 53(26.2%) were partially improved at discharge. Perceived improvement of illness, preference for outpatient care, financial constraints, high cost of hospital services, dissatisfaction and disagreements with care, were the commonest reasons for DAMA. CONCLUSION: DAMA is of multifactorial aetiology, involving clinically heterogeneous patients who may be critically ill or partially recovered. Socioeconomic, quality and cost of health care are implicated. This study recommends some control measures.

Caregivers↗

PubMed2004

Problems of management of burns injuries among children.

BACKGROUND: Contrary to our local experience, published data elsewhere show increased survival rates from major burns due to improvements in management. This study aimed at examining problems of burns management in children. DESIGN: Relevant data extracted from the records of 44 children included sociodemographic, clinical, management characteristics and outcomes. RESULTS: There were 86.0% thermal burns due to accidental, domiciliary events in 36 (81.8%. Mean (range) BSA was 35.9% +/- 4.0 (1%-95%), mostly 2nd degree burns in 34 (77.3%). Mean (range) duration of symptoms before presentation was 1.1 +/- 0.3 days (1-7 days). Following hospitalisation, involvement of key experts in acute burns care was either delayed or omitted. Intensive care monitoring and support including mechanical ventilation were unavailable for 11 (25.0%) cases with cardiorespiratory compromise. Septicaemia & pneumonias were associated with death in 9 (56.3%) of the 16 deaths. Klebsiella, pseudomonas and coliform organisms were isolated from most burns wound. Oral acetominophen and intramuscular dipyrone were the main analgesics used in 24 (54.6%) and 8 (18.2%) cases respectively. Anxiolytics were used in only 2 94.5%). Case fatality rate was 36.4%. Mortalities were 100% with BSA 50-100% (p=0. 000). CONCLUSION: Prevention and improvements in management of burns including early multidisciplinary care, critical care support, aggressive wound care and adequate pain control should be emphasised.

Adolescent↗

PubMed2004

Holt-Oram syndrome with hypoplastic left heart syndrome in an African child.

This report illustrates the rare association of Holt-Oram syndrome with hypoplastic left heart syndrome hitherto unreported in an African child. The above association is highlighted as this child and the only other case reported in a Caucasian were diagnosed post mortem. The need for early cardiovascular and genetic evaluation or simple detailed family history to aid counselling is also emphasised.

Abnormalities, Multiple↗

PubMed2004

Management of children with cerebral malaria in Lagos - a medical audit.

UNLABELLED: Cerebral malaria, one of the severe forms of malaria, carries a very high fatality rate even when managed in the best of centres. This underpins the need for a medical audit to review patient management steps or procedures to improve the standard of patient care of children with cerebral malaria in the Lagos University Teaching Hospital. METHODS: A retrospective audit of records of children with cerebral malaria who presented in the emergency room of the Lagos University Teaching Hospital in the last five years. Relevant clinical and patient management information of survivors were extracted from the records and analysed. RESULTS: The records show that critical information useful in the management of these children was lacking in 50 - 60% of the records reviewed. The appropriate anti-malarial drug (intravenous quinine) in adequate doses was used in 54(94.7% ) of cases. A total of 12 patients (21.1% ) still had either mannitol or dexamethasone given to them. Blood transfusion was ordered in 60% of the children despite severe anaemia being present in only 30% of them. CONCLUSION: This study highlights the sub-optimal level of knowledge and practice among doctors and the need for retraining of medical staff in maintaining proper records. The authors recommend the use of patient management guidelines.

Child, Preschool↗

PubMed2003

Clinical and management factors related to outcome in neonatal tetanus.

Although tetanus is a well-recognised, well-described, preventable and eradicable infection, it continues to ravage the lives of children in developing countries, especially among neonates. A cross-sectional review of cases of neonatal tetanus seen in LUTH was carried out retrospectively. Thirty-nine (39) cases were studied, comprising 26 (63.4%) males and 15 (36.6%) females, giving a male: female ratio of 1.6:1. Case fatality rate was 10.3%, thirty-five (89.7%) cases survived, of which nine (23.8%) survived with complications. Clinical factors that influence outcome were: a short interval between onset and presentation (p = 0.03), low tetanus score below 6.0 (p = 0.002), hyperpyrexia (p = 0.0001), heart failure (p = 0.035), cyanosis (p = 0.008) and crepitations (p = 0.003). Although several management factors were associated with mortality, these failed to meet statistical significance (p > 0.05). In this study, clinical factors, including presentation interval, were the principal determinants of outcome. The need for intensification and sustenance of preventive measures, early recognition and presentation, prompt treatment as well as improved care are emphasised. We recommend periodic audit of patient clinical data towards improving quality of care.

Cross-Sectional Studies↗