Background: Alpha-2 adenoreceptors as an adjuvant to local anesthetic during caudal analgesia in children prolongs the duration of analgesia. This study was designed to compare the analgesic efficacy and adverse effects of dexmedetomidine and clonidine when added to ropivacaine for caudal analgesia in children undergoing lower abdominal surgeries. Methods: In a prospective study, Seventy-eight children received block with either 0.2% ropivacaine 1.5 mg/kg (Group R; n = 26) or 0.2% ropivacaine 1.5 mg/kg + 1 mcg/kg clonidine (Group RC; n = 26) or 0.2% ropivacaine 1.5 mg/kg + dexmedetomidine 1 mcg/kg (Group RD; n = 26). Results: Duration of analgesia was 7.15 ± 1.00 h in Group R, 11.57 ± 1.27 h in Group R + C, and 14.73 ± 1.53 h in Group R + D (P < 0.0001). One patient in Group R + D had vomiting and 1 patient in Group R had urinary retention which was not statistically significant (P > 0.05). Conclusion: Addition of clonidine and dexmedetomidine to caudal ropivacaine significantly prolongs the duration of analgesia without adverse effects.

Background: Epidermodysplasia verruciformis (EV) is a rare genodermatosis with autosomal recessive inheritance linked to human papilloma virus 5 and 8. It presents with flesh-colored or hypopigmented macules and plaques on the face, neck, hands, and body. They are asymptomatic but cause great cosmetic concern to affected individuals. An immune deficient state renders patients more susceptible to it; although some have no demonstrable ill health. Diagnosis is mostly clinical; nevertheless, skin biopsy for histopathology may be performed in doubtful cases. Treatment is aimed at cosmetic removal with retinoids, Imiquimod, and keratolytics among others. The aim of this report is to document the clinical profile of patients with EV, and highlight the challenges faced in managing patients. Materials and Methods: The clinical records from January 2006 to December 2013 were reviewed. Demographic data, HIV status, and biopsy results were extracted and entered onto Microsoft Excel spreadsheet. The results were analyzed with SPSS version 18. Results: A total of 33, 326 patients were seen during the review period; 96 (0.3%) had a clinical diagnosis of EV with 45 (46.9%) males and 51 (53.1%) females. The mean age was 20.8 ± 13.4, with a range of 2–52 years. A quarter of the patients were tested for HIV and 12 (13%) were positive. Conclusions: This study documents the frequency of EV in our environment and provides a baseline for more studies. The results concur with its rare occurrence worldwide and fail to show the exact relationship between HIV infection and EV. The challenges to managing these patients are mostly due to financial constraints; hence, basic investigations and optimal treatment could not be done in many of the patients.

Background: Although the majority of birth injuries are minor and often unreported, occasionally birth injuries may be so severe as to be fatal or leave the child with a permanent disability or even death.Objective: This study aimed to document the patterns and predictive factors of birth injuries in neonates presenting at the emergency center of a tertiary hospital in South west, Nigeria. Patients And Methods: This was a cross-sectional study of neonates who presented at the Olikoye Ransome-Kuti Children Emergency Center of the Lagos University Teaching Hospital between October and December 2016. All neonates admitted for treatment at the center for any clinical condition were included in the study after initial review or resuscitation/treatment for their primary complaint, and consent was obtained from their caregivers. The babies were examined by at least a senior resident and any abnormality documented. Any underlining medical conditions such as asphyxia and neonatal sepsis were properly investigated and treated. Statistical analyses were performed by chi-square, student's t-test, using SPSS version 20.0. P ≤ 0.05 was considered statistically significant. Results: A total of 134 neonates were reviewed during the study period with majority, 84 (62.7%), being males. The mean age at presentation was 65.2 ± 89.2 h (median 24 h). Caput succedaneum (22.2%) and subconjunctival hemorrhage (22.2%) were the most frequent injuries observed, while cranial nerve injury the least. One patient had multiple injuries (cranial nerve injury with fractures humerus). Conclusions: Overall prevalence and pattern of birth injuries in neonates presenting at our emergency center was consistent with various studies from other centers. Parity of the mother, significant maternal medical history, duration of labor, mode of delivery, and skill of attending personnel at delivery were significant factors associated with birth injuries

Background and Objective: In the last several decades, there has been a shift from general anaesthesia to regional anaesthesia for caesarean section worldwide. This rise notwithstanding, it is pertinent to determine the factors associated with the wholesome application of spinal anaesthesia for caesarean section in Nigeria. Method: A snap-shot survey was conducted in some selected hospitals in Nigeria. The survey determined the sociodemographic characteristics of patients, indication for surgery, grade of anaesthesia provider, contraindication to spinal anaesthesia and any other factor that may be noticed in the selected hospital (lack of appropriate drugs, spinal needles, absence of relevant expertise etc). Result: A total of 99 patients were attended to in four of the selected six hospitals within the study period. Thirty six (36.4%) women were nulliparous and maternal factors (82.8%) were the leading indications for caesarean section. Consultant anaesthetists (23.2%) and Senior Registrars (35.4%) were the leading anaesthesia providers for the caesarean sections. Eighty five (85.9%) patients received spinal anaesthesia and 14 (14.1%) had general anaesthesia for the Caesarean section. Fetal indication for Caesarean section was associated with a 3-fold chance of using general anaesthesia for the surgery (p = 0.0138, RR = 3.6, 95%CI 1.44 – 9.1). Conclusion: Over 85% of Caesarean sections in some hospitals in Nigeria were conducted under spinal anaesthesia. Fetal indications for caesarean section provoked over a 3-fold increase in general anaesthesia for caesarean section. The use of general anaesthesia for caesarean delivery was due to fetal indications for surgery, antepartum haemorrhage and failed spinal anaesthesia.

Context: Congenital cataract is a priority of Vision 2020: the right to sight, the global initiative to reduce the world's burden of avoidable blindness because it is an important treatable cause of visual physically challenged in childhood worldwide. Prevention and treatment require information about etiology that is currently unavailable for many regions of the world. From an epidemiologic study, the causative factors of pediatric cataract can be identified. Aims: This study aims to determine causes of childhood cataracts and to identify the preventable factors in tribes of hilly areas of Western India. Settings and Design: The present study is a hospital-based retrospective study. Materials and Methods: A retrospective study was conducted after reviewing the details of 165 patients of pediatric cataract aged between 3 months and 15 years who underwent cataract surgery in our institute from April 2011 to March 2014. A team of ophthalmologists and pediatricians attached to the center examined all the patients preoperatively. The type of cataract was determined using slit lamp biomicroscopy or operating microscope. Results: Nontraumatic cataract was 72.1% and traumatic cataract was 27.9%. Nontraumatic cataract includes hereditary (10.1%), rubella (5.0%), secondary (16.8%), and idiopathic (68.1%). In nontraumatic cataract group, 66 patients had bilateral cataract and 53 had unilateral cataract. Traumatic cataract was the most common in the age group of 6–10 years and most common cause of trauma is thorn (23.9%) followed by stone (21.7%), crackers (17.4%), wood stick (13%), finger (4.3%), chemical injury (4.3%), needle (4.3%), wire (2.2%), and others (8.7%). Conclusions: About 5% of nontraumatic bilateral cataracts in hills of Western India are due to rubella. An awareness program for precaution during pregnancy and immunization against rubella is needed to prevent it. School children must be educated for factors causing traumatic cataract and need supervised play in outdoor.

Background: Retinoblastoma is the most common intraocular childhood malignancy. Its management is, however, not without challenges especially in a developing country like Nigeria. This study sought to present the clinical profile and treatment outcome of patients with retinoblastoma managed in a Nigerian tertiary eye care facility highlighting the challenges with a view to improving the management of the disease. Materials and Methods: A retrospective, single-institution, and institutional review board-approved review of all patients diagnosed with retinoblastoma between January 2012 and December 2015 was done. Data obtained from case files of patients include demographic characteristics, presenting complaint, laterality of disease, tumor stage using the International Intraocular Retinoblastoma Classification, treatment, and outcome. Information obtained from phone calls to the caregivers were also summarized. Results: The review included 54 eyes of 41 patients between the ages of 2 months and 5 years. The mean age at presentation was 24.4 ± 11.4 months. There were 18 males (43.9%). Duration of symptoms before presentation ranged from 2 weeks to 2 years. Tumor was bilateral in 13 (31.7%) patients. Leukocoria was the most common presenting complaint observed in 32 (59.2%) eyes. Groups D and E were the most common intraocular tumor stage documented in 16 (29.7%) and 15 (27.8%) eyes, respectively. Most patients (29, 70.7%) defaulted from treatment after the first or second presentation. Only 6 (21.4%) of 28 patients offered enucleation or modified exenteration either at presentation (Class E) or after chemoreduction (orbital disease) consented. Conclusion: Late presentation, high default rate, and noncompletion of treatment were the major challenges facing retinoblastoma management in this center.

Background: The magnitude of presbyopes with appropriate near vision correction is low globally and spectacles' correction remains cost-effective option for low- and middle-income countries. Objectives: The objective of this study was to determine presbyopia correction coverage (PCC), presbyopic met need and unmet need, willingness to pay for a pair of near vision spectacles, and barriers to usage of near vision spectacles among adults aged 40 years and above in a semiurban population of Southwest Nigeria. Materials and Methods: A cross-sectional, population-based study was carried out on 440 participants who were 40 years and above. Participants were selected using multistage sampling technique. Participants had refraction for both distance and near vision. Information on the use, barriers, and source of near vision spectacle was collected using interviewer-administered questionnaire. Data analysis was done using Statistical Package for Social Sciences software version 22 (IBM Corp., New York, USA). Results: A total of 440 participants were examined. Male to female ratio was 1:1.2 and the mean age of the participants was 51 ± 8 years. The PCC in the study was 27.3% with met need of 20.5% and unmet need of 54.5%. The major barriers to usage of near spectacles in this study were “not a priority” at 38.4% (95% confidence interval [CI] 32.3–44.5) and “not aware of the problem” at 34.7% (95% CI 28.7–40.7). Most of the participants (75.7%) were willing to pay at least 1000 naira (US$6) for a pair of near spectacles; hence, cost was not a significant barrier. Conclusion: The PCC in the area was low. Basic eye screening and refractive services should be incorporated into primary eye care for easy accessibility by the adult population in this area.

Background: Elderly hypertensive patients have been reported to be particularly at the risk of cognitive dysfunction because of several factors. The previous studies in both rats and humans suggest that some classes of antihypertensive drugs could ameliorate the cognitive decline in elderly hypertensive patients. Most of these studies were among Caucasians in the Western world. This study was aimed at evaluating the oxidative stress and cognitive function status of elderly hypertensive Nigerians on regular antihypertensive drugs. Methods: One hundred and eight elderly hypertensive Nigerians of both gender who were 60 years old and above, were controlled with different antihypertensive drugs, and were enrolled into the study. All had cognitive function status evaluation using the Mini-Mental State Examination (MMSE) score. Totally 98 of the elderly hypertensive patients also had their oxidative stress status evaluated by measurement of their serum antioxidant levels. 33 elderly normotensive Nigerians were used as controls. Results: The elderly hypertensives had a significantly higher mean MMSE cognitive score of 27.97 ± 1.70 compared to the elderly normotensives with score of 26.97 ± 2.44 (P = 0.001). The elderly hypertensive patients had significantly higher mean level of serum antioxidants – catalase, superoxide dismutase, reduced glutathione, and glutathione peroxidase, compared to the elderly normotensive individuals (P < 0.01). Patients on calcium channel blockers had higher mean serum antioxidants level than patients on other classes of antihypertensive drugs. Conclusion: The present study suggests that elderly hypertensive Nigerians who were controlled with regular antihypertensive drugs, had better cognitive function and lower oxidative stress status than their normotensive counterparts.

Context: Most cases of gut malrotation are diagnosed in the 1^st year of life, but in minority of cases, the patient becomes symptomatic only in adolescence or adulthood. Aims: The aim of this study was to remind physicians to include intestinal malrotation in the differential diagnosis of children who present with recurrent abdominal pain, especially when it is associated with vomiting and other gastrointestinal symptoms. Settings and Design: This was an audit of the older children with gut Malrotation who presented to the Lagos University Teaching Hospital (LUTH). Subjects and Methods: The clinical records of children above the age of 1 year who presented with recurrent abdominal pain and/or vomiting between January 2013 and October 2015 at the LUTH were reviewed. Clinical features, radiological findings, and operation findings were documented. Statistical Analysis: Data were analyzed using the SPSS version 21 (SPSS Statistics for Windows, version 21.0, IBM Corp., USA). Data were presented in frequency and percentages. Results: Five patients with gut malrotation were seen during the study period. The median age was 7.0 years (range: 15 months–10 years). The most common complaint was intermittent colicky abdominal pain and recurrent vomiting in 5 (100%). Preoperative diagnosis was possible in 3 patients, with the use of abdominal computerized tomography scan. Operative findings included obstructing bands of Ladd, volvulus with situs inversus. Symptoms were relieved satisfactorily with surgical intervention. Conclusions: There is a need for a high index of suspicion for intestinal malrotation in children who present with a prolonged history of recurrent abdominal pain and vomiting irrespective of the age. Imaging enables accurate diagnosis and most effective treatment is surgical.

Ganglion cyst although a common swelling observed near joints of hands and feet, it is extremely rare in the sternoclavicular joint. Diagnosis is usually based on clinical examination, radiological investigations, or fine-needle aspiration cytology (FNAC). We hereby report a case of an 8-year-old girl who presented to the surgical outpatient department with a nontender, nonerythematous swelling over the right sternoclavicular joint for 3 months. Ultrasonography revealed a cystic swelling measuring 0.4 cm × 0.3 cm × 0.3 cm. The diagnosis of ganglion cyst was finally confirmed on FNAC. The aspiration acted both as diagnostic and therapeutic modality thus avoiding surgery. The patient is under follow-up for the chance of recurrence.

Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infants, presenting with nonbilious projectile vomiting. The authors report a rare case of bilious vomiting in a neonate with intraoperatively diagnosed IHPS and no other gastrointestinal anomalies.