Abdelmoneim E M. Kheir

RETRACTED ARTICLE: Infantile colic, facts and fiction

Infantile colic is one of the major challenges of parenthood. It is one of the common reasons parents seek medical advice during their child’s first 3 months of life. It is defined as paroxysms of crying lasting more than 3 hours a day, occurring more than 3 days in any week for 3 weeks in a healthy baby aged 2 weeks to 4 months. Colic is a poorly understood phenomenon affecting up to 30% of babies, underlying organic causes of excessive crying account for less than 5%. Laboratory tests and radiological examinations are unnecessary if the infant is gaining weight normally and has a normal physical examination. Treatment is limited and drug treatment has no role in management. Probiotics are now emerging as promising agents in the treatment of infantile colic. Alternative medicine (Herbal tea, fennel, glucose and massage therapy) have not proved to be consistently helpful and some might even be dangerous. In conclusion infantile colic is a common cause of maternal distress and family disturbance, the cornerstone of management remains reassurance of parents regarding the benign and self-limiting nature of the illness. There is a critical need for more evidence based treatment protocols.

Xerophthalmia in a Traditional Quran Boarding School in Sudan

Purpose: To determine the prevalence of xerophthalmia at a traditional boarding school where children do not receive a diet adequate in vitamin A. Materials and Methods: A cross-sectional survey of 406 males residing in a Quranic traditional school was conducted using the World Health Organization xerophthalmia checklist. The association between the prevalence of night blindness and proportion of students staying at the school for 6 consecutive months and those eating solely at the school was investigated. The difference in age between children with night blindness and those without was investigated. Statistical significance was indicated by P<0.05. Results: The prevalence of night blindness, conjunctival xerosis and Bitots spots was 24%, 12.5% and 1%, respectively. None of the boys had corneal ulceration, corneal scars and corneal xerosis. No significant association was observed between the differences in mean age and development of night blindness (P=0.657). There was a significant association between the duration of stay (cut-off of 6 months continuously) at the institute and the development of night blindness (P=0.023). There was no statistical significance between regularly eating at the maseed and outside the “maseed” and the development of night blindness (P=0.75). Conclusion: Children residing at a traditional school are vulnerable to developing xerophthalmia where the diet is inadequate in vitamin A. Institutional caregivers should be made aware of the importance of providing a balanced diet rich in vitamin A. Institutional caregivers should also be educated on the signs and symptoms of vitamin A deficiency for early detection of xerophthalmia.

Brain tuberculoma, an unusual cause of stroke in a child with trisomy 21: a case report

BackgroundTuberculosis remains a public health problem in developing countries and is associated with lethal central nervous system complications. Intracranial tuberculomas occur in 13% of children with neurotuberculosis. Patients with trisomy 21 have an increased risk for stroke, which usually stems from cardiovascular defects.Case presentationWe report a case of a 12-year-old Sudanese boy with trisomy 21 who was presented to our hospital with focal convulsions and right-sided weakness. The results of neuroimaging and histopathological examinations were consistent with cerebral tuberculoma. The patient had a good initial response to antituberculosis drugs and steroids. To the best of our knowledge, this is the first case report of multiple brain tuberculomas described in a child with trisomy 21.ConclusionsPatients with trisomy 21 have an increased risk for stroke. Our patient had an exceptional case of stroke caused by tuberculoma. The present case emphasizes the need to consider tuberculomas in the differential diagnosis of children with neurological symptoms living in areas of high tuberculosis incidence.

Life-Threatening Haemolysis Induced By Henna in a Sudanese Child with Glucose-6-Phosphate Dehydrogenase Deficiency

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathy in humans affecting about 400 million people worldwide (1,2). It is an X-linked recessive inborn error of metabolism which can result in haemolysis on exposure to a number of triggers, such as some infections, and certain medicines and foods. The Mediterranean mutation is the most common variant of the enzyme deficiency and is often associated with favism (3). Severe haemolytic episodes may result after contact with oxidants (4). Henna, obtained from the crushed leaves of Lawsonia alba, has been used for centuries to dye the skin, hair and nails in many countries in south-east Asia and the Middle East (5). The application of henna has resulted in life-threatening episodes of haemolytic anaemia in individuals with a genetic deficiency in G6PD activity (6,7). We report on a 6-year-old boy, previously undiagnosed with G6PD deficiency, who developed life-threatening haemolysis after application of henna to his skin. This is the first report of henna-induced haemolytic anaemia in Sudan. Written informed consent was obtained from the father of the child for publication of this case report and any accompanying images. A 6-year-old boy was brought by his parents to Soba University Hospital on 26 March 2015 with a two-day history of shortness of breath, headache and yellow discolouration of the sclera. There had been a change in his urine colour which was tea-like. This child was previously very well, however, his mother reported that henna had been applied to his hands and feet as part of a kindergarten graduation ceremony 3 days prior to admission. Similar symptoms had developed at the age of 2 years when henna was applied to his skin on the occasion of his circumcision but they did not seek any medical advice at the time. Apart from this, his past history was uneventful. There was no past history of blood transfusion or drug ingestion and no family history of a similar condition. Physical examination revealed an extremely pale child with henna applied to his hands and feet (Figures 1 and 2). He was irritable with slight jaundice. His pulse rate was 125 beats/min., respiratory rate 30 breaths/min., temperature 37.3°C, oxygen saturation 99% in room air and blood pressure normal (100/70 mmHg). Clinical examination also revealed gallop rhythm and a short systolic murmur (haemic) on the left sternal border. All these symptoms and signs were suggestive of an acute haemolytic process. Laboratory investigations showed haemoglobin of 4 g/dL, haematocrit of 13.1%, reticulocyte count of 5.1%, white cell count of 18.2 × 109/L and platelet count of 359 2 × 109/L Peripheral smear showed mild hypochromia with anisocytosis and nucleated red blood cells. Blood film for malaria was negative and direct Coomb test was negative. Urine microscopy showed few pus cells, no red blood cells and bilirubin (++). A urine test for haemoglobin was not done as it was not available in our laboratory. Liver function test revealed a total serum bilirubin of 51.3 Umol/L and direct bilirubin of 5.13 Umol/L; the rest of the liver function tests were normal. Renal function tests showed no derangement with serum urea of 12.5 mmol/L, creatinine 44.21 Umol/L sodium 136 mmol/L and potassium of 4.2 mmol/L. A presumptive diagnosis of acute haemolysis due to G6PD deficiency was made and the child received 1 blood transfusion and folic acid after which he recovered fully. Six weeks later a blood sample was sent abroad to Jordan for G6PD assay by kinetic determination. It showed a low level of G6PD of 3.1 U/g (normal range 4.50–13.50 U/g), confirming his G6PD deficiency. The child was discharged home in good health after having been counselled regarding the condition and given a list of drugs and food items to avoid including nitrofurantoin, nalidixic acid, sulfamethoxazole and fava beans.

Multicystic nephroma masquerading as hydatid cyst: a diagnostic challenge

BackgroundMulticystic nephroma is an uncommon, non-familial renal neoplasm that is usually benign. About 200 cases of this lesion have been described in the literature.Case presentationWe report on a Sudanese child who presented at the age of two and a half years with an abdominal mass, clinical and radiological features favored the diagnosis of hydatid cyst which is endemic in this African tropical country, and the diagnosis of multicystic nephroma was only possible after histopathological examination.ConclusionMulticystic nephroma is a rare benign tumour with an excellent prognosis. Clinical and radiological differentiation of multicystic nephroma from hydatid cyst is difficult. Thus, histopathological examination of the surgical specimens seems to be the only feasible method of making the correct diagnosis.

Self-reported, House-Officer's Competency and Knowledge

This study was conducted to assess the competency of fresh medical graduates in dealing with common emergency conditions. Graduates who received structured training in Emergency Medicine (EM) as part of their medical school curriculum (stratified group) were compared to those who did not (pooled group). Curricula of medical schools were reviewed. Structured questionnaire was used to collect data which included self-reported competencies and demographics among the medical graduates. The study population were 162 freshly graduated doctors, among them 35 received structured training in EM. Lack of competency in clinical skills ranged from 2.9% - 40% and 11.4% - 53% among stratified and pooled groups respectively. We found a statistically significant difference in skills related to assessment of acutely ill patient, use of ABCDE approach, valve mask ventilation, dysphagia screening, management of diabetic emergencies, and management of convulsions. A relatively higher level of competency was reported in those who received structured training in emergency medicine. Incorporation of emergency medicine in the curricula might improve the competency of junior doctors.