I grew up believing that is normal and beneficial to have a female child circumcised like a male child until, i saw a woman whose vaginal orifice is smaller than a pin head!
The circumcision of a female child has no benefit to the child and the community , it constitutes a lot of hazard and must stop in every part of the world where it is still being practised.
I have decided to play my part in the campaign to END Female genital mutilation by presenting in today's blog some of the world health organization assertions.
What is female genital Mutilation?
Female circumcision also known as female genital mutilation (FGM) is the total or partial cutting/removal of the external female genitalia or injury to the female genital organ for non-medical reason.
It alters the female genitalia(sexual organs), may disfigure it and cause a lot of untoward effects.
It is a criminal action, considered as violence towards women, a violation of women(human) right, and should not be allowed.
Types:
All of the types below are forms of Females genital mutilation and are written as explained by world Health Organization.
Type 1: Often referred to as clitoridectomy, this is the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).
Type 2: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva ).
Type 3: Often referred to as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris (clitoridectomy).
Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area. <script data-cfasync='false' type='text/javascript' src='//p246585.clksite.com/adServe/banners?tid=246585_470444_0'></script> Why do people do it?
In most societies, where FGM is practised, it is considered a cultural tradition, which is often used as an argument for its continuation.
In some societies, recent adoption of the practice is linked to copying the traditions of neighbouring groups. Sometimes it has started as part of a wider religious or traditional revival movement.
FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine or male.
FGM is often motivated by beliefs about what is considered acceptable sexual behaviour. It aims to ensure premarital virginity and marital fidelity. FGM is in many communities believed to reduce a woman's libido and therefore believed to help her resist extramarital sexual acts. When a vaginal opening is covered or narrowed (type 3), the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage extramarital sexual intercourse among women with this type of FGM.
Health implications
1.severe pain
2. Excessive bleeding (haemorrhage)
3. Genital tissue swelling
4. Fever
5. infections e.g., tetanus
6. Urinary problems
7. Wound healing problems
8. injury to surrounding genital tissue
9. Urinary problems (painful urination, urinary tract infections);
10. Vaginal problems (discharge, itching, bacterial vaginosis and other infections);
11. Menstrual problems (painful menstruations, difficulty in passing menstrual blood, etc.);
scar tissue and keloid;
12. Sexual problems (pain during intercourse, decreased satisfaction, etc.);
13. Increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean section, need to resuscitate the baby, etc.) and newborn deaths;
14. Need for later surgeries: for example, the FGM procedure that seals or narrows a vaginal opening (type 3) needs to be cut open later to allow for sexual intercourse and childbirth (deinfibulation). Sometimes genital tissue is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks;
15. Psychological problems (depression, anxiety, post-traumatic stress disorder, low self-esteem, etc.);
Benefits
IT HAS NO BENEFIT.
Eradicating Female genital mutilation is a challenge that we all must take part in, we must join hands with several organisations that are campaigning against it already.
Play your part , preach against it in your neighborhood, forward this piece to friends and family members.
A 10 /yr old girl presented in outpatient department with left flank pain of 2weeks duration, progressive abdominal mass of a week duration and weight loss of a week duration.
Notable on examination are evidences of weight loss and a tender, nodular mass on the right flank,
a) mention three diffential diagnosis for her condition.
B) the girl was noticed to be unable to use are lower limbs while being investigated and the Abdominal Ultrasonography showed the mass to originate from the left kidney, what is your most likely diagnosis at this point?
C) Discuss four investigations relevant to this diagnosis.
D) What are the risk factors to this condition?
E) Mention 5 prognostic factors in this condition.
F) What four complications may occur?
G) highlight the stages of this condition.
A four year old girl was referred to you from a peripheral hospital with history of Fever of ten days duration, vomiting and diarrhoea of week duration, he was said to have had reduced urine output for two days though urine color was Amber, there was also facial and pedal edema.
Examination revealed an acutely ill looking child, Febrile (temperature is 38.7centigrade) in mild respiratory distress, has pedal edema and facial puffiness, weight is 14kg.
Urine output is 0.3mls/kg/hr in the first 24hrs of admission
Serum creatinine is is 6mg/dl.
Potassium 5.4mmol/l.
Urea 20mg/dl.
a) What is your diagnosis?
b ) explain your initial fluid regimen to your nurses.
c) list ten causes of this condition.
d) Explain the pathophysiology of any three complications that may develop in this patient.
E) what is the place dopamine in the management of this patient?
F) Explain the term disequilibrum syndrome to your registrars.
1. A three -year old was brought to your specialist clinic with history to suggest severe mental retardation, special interest in water, and always laughing, he has had several episodes of seizure. Notable on examination include facial hypolasia,severe hypotonia and tremor. The following are likely to be true about this patient. a) This patient has a microdeletion on a paternity derived chromosome. b) This patient has paternal uniparental disomy. c) The prognosis is good. d) this patient speech is expected to be affected. e) The patient has Down syndrome. 2. A twenty-day old baby was rushed into the special care baby unit unconscious, he has being vomiting for three days, has not being thriving since birth, examination revealed a child who appeared small for age, with sunken eye balls. Random blood sugar was elevated with a value of 26mmol/l, urinalysis yielded ketonuria of + The following are correct about this patient. a). He has a chance of spontaneous cure. b). Abnormality of this type is mostly associated with mutation on chromosome 6p24. c. Permanent diabetes may result in up to 60 percent of patients with this condition d). Ketonuria is the hallmark of diagnosis e) soluble insulin is of choice in active phase. 3. A 6yr old boy presented in OPD with history of progressive generalised body swelling of a month duration, urine output has reduced, bedside urinalysis yielded 4+ of protein, serum albumin was 1.8mg/dl The following are likely to be correct of this patient and his condition. A) Most patient with steroid responsive type have repeated relapses B) A relapse is defined as proteinuria 3+ or 4+ for 3 consecutive days after initial remission. c)immunenoflorescence microscopy is typically negative D)children who continue to have proteinuria after 4 weeks of steroid therapy are considered steroid resistant. E) in congenital type , cure rate is hundred percent after transplantation. 4. Concerning Proteinuria A) Glomerular proteinuria should be suspected in any patient with a first morning urine protein : creatinine ratio >1.0. B) microalbuminuria in children has been found to be associated with obesity and to predict, with reasonable specificity, the development of diabetic nephropathy in type 1 dmicroalbuminuria in children has been found to be associated with obesity and to predict, with reasonable specificity, the development of diabetic nephropathy in type 2 diabetes mellitus. C. The dipstick may be falsely positive in patients with highly concentrated urine. d) orthostatic proteinuria occurs in less than 60% of patient with persistent proteinuria E)Nephrotic range if greater than 960mg/metre square/ day. 5. Anti neutrophilic cytoplasmic antibody associated vasculitis include the following : A). Kawasaki disease. B) henoch schonlein purpura. C.Takayasu disease. D) churg Strauss syndrome. E). Microscopic polyangitis.
I remember moving through the adult wards in medical school and the sight of the interns checking the blood sugar of their patients, from one bed to another without missing any ! Such is the place of diabetes in adult medicine, a very common condition among adults.
In children however, diabetes is not a very common occurrence such that doctors often miss the diagnosis when it occurs in children of resource poor countries. Diabetes in children may disguise as appendicitis, cerebral malaria,urinary tract infections, pneumonia or even typhoid enteritis.
A high index of suspicion is required for diagnosis of diabetes in children.One may need to routinely check the blood sugar of every child that present in the hospital for early diagnosis, treatment and prevention of complications of childhood diabetes.
I have made it a point of duty to bring this to the fore for this week because, it appears there is an increase in its occurrence amongst children seen in my facility in the last few years. This increase is such that in the last one year we have seen three cases, two of whom were initially managed as typhoid enteritis.
I hope to use this medium to educate us about this condition
What is Diabetes?
Diabetes simply means high blood sugar. It occurs when the sugar in the body (sugar is the end product of almost every thing we eat) is not available for energy generation and also not converted to the storage form, usually the insulin in such a person is not available or insufficient for this conversion, making lack of insulin or insufficient insulin the reason for this excess blood sugar.
Why do people have diabetes?
The reasons why people have diabetes is not entirely clear; however, some of the reasons may include:
Genetic abnormalities, infection, and diet.
Family history: children of diabetic parents should be routinely checked as they are often at higher risk.
Infections: some infections are capable of destroying pancreas, the insulin producing organ in the body, such infections include Mumps, tuberculosis, measles, other viral infections
Diet: western diet that predispose to Obesity may in turn predispose to a type of diabetes. Early exposure to "Canned" food with preservatives can trigger allergy/autoimmune reactions that may destroy insulin producing organ (this is hypothetical).
Here is a good news ; Human breastmilk is protective, it is cheap and unadulterated. Vitamins such as C, D and E vitamins are also protective.
Minerals like zinc ,selenium are also protective .
What are the signs of diabetes in children?
Weight loss: This though not universal and may be subtle is a very common sign, any unexplained weight loss in childhood must be investigated and the investigation panel must include blood sugar, please see your doctor or seek his or her opinion if your child is losing weight, you may even politely request for blood sugar check.
Frequent urination: if you notice that your child is urinating more frequently or too frequently please beckon on your doctor,. Some of these children may even start to bed wet newly.
Some children may start to drink water more often.
Some will eat more than before. !
Wounds on their body may not heal on time.
Some may have boil more often .
What to do if any of the above signs is seen?
See your doctor, preferably a paediatrician.,
the complications( stroke, blindness, kidney damage to mention a few) of diabetes are serious and may be life long, these complications are avoidable if diabetes is treated promptly.
To learn more..... Stay tuned.
Leave your questions, comments or suggestions in the comments box.
1) A mother presented with her 2 year old son who was left in care of her neighbour and was met watching television , he however has rash on the trunk, which was not there before leaving home.
Your registrar suspected physical Abuse and requested that you review before further plan.
Your examination shows widespread petechiae haemorrhage.
1. What four history will help you make diagnosis?
2. Mention Five of your differential diagnosis.
3. Mention three investigations that will help you make diagnosis.
4. The result of some of the investigations are as shown below:
WBC: 9000cells/ul.
PCV: 34 Percent
Platelet :52000cells/ul.
Bleeding time : 17minutes.
Prothrombin time: 12s.
Activated plasma thromboplastin time: 40s.
a) what is the most likely diagnosis?
b) Mention five causative agents.
C) mention four treatment modalities.
2. Your Houseofficer has seen a 4year old boy with history of abdominal distention of a year duration,notable findings on his examination include an abdominal mass extending from the right flank to the midline with smooth surface, he could get above and below the mass, the child weighs 20kg and has a length of 78cm.
1) Mention four likely diagnosis.
2. Mention two investigations that are of outmost relevance in making diagnosis.
3. The chest radiograph reveal multiple well circumscribed opacities on the lung fields.
a). What is your most likely diagnosis?
b). Mention four associations that may be expected.
c). What are the likely haematologic findings?
d). Mention five clinical features expected?
e. Mention four prognostic factors in this patient.
1. You have been managing a twelve year old boy since age seven month, when he presented with history of progressive abdominal distention , passage of large bulky stool and low weight of four kilograms, he developed inability to make smooth coordinated movements at age ten.
Parents have no such history.
The peripheral blood film of this boy revealed numerous Acanthocytes.
Which of the following conclusions is/are correct?
(a) The boy may have retinal degeneration.
(B) This condition is inherited as autosomal dominant.
(C) ricket is an early finding in this condition.
(d) Supplementation with vitamin E may cure this condition.
(e) This boy has hypobetalipoproteinaemia.
2. A 4 week old boy being managed by your resident doctors on outpatient basis for an extensive macular rash involving the scalp, face and the trunk,was noticed to have irregular heart rate, the maternal immunoglobin profile obtained during pregnancy showed elevated anti la antibodies.
Which of the following conclusions may be right?
(a) This rash typically last three to four months.
(b) majority of patients with this condition develop progressive cardiomyopathy.
(c) The cardiac arrythmias in this condition are permanent.
d) This rash is photosensitive.
(e) most feared complication of this condition is hepatitis.
3. expected findings in kwashiorkor include the following:
(a) increase cortisol and growth hormones level.
b) increase thyroid stimulating hormone level.
(c) high plasma ferritin level.
(d) blood transfusion is indicated for persistent lack of appetite.
(e) Apathy.
4. A 12yr old boy with recurrent passage of bloody urine since age four has now developed deafness, opthalmogical examination shows extrusion of the lens, you make the following conclusions :
a) anterior lenticonus is a pathognomonic feature of this condition.
b) This patient is at risk of nephrotic syndrome.
C) This condition can be inherited as autosomal dominant.
D) The deafness in this condition is acquired.
E) This condition occurs as a result of defect in Type one collagen.
5. A two year old girl whose mother is a vegan present with recurrent ulcer on the lips and tongue, you suspect the patient condition is due to :
a) lack of enough calorie intake.
b) vitamin B1 deficiency.
c) vitamin B5 deficiency.
d) vitamin C deficiency.
e) vitamin B12 deficiency.
Oral question:
A two year old boy who left the hospital against medical advice while on chemotherapy for retinoblastoma because the parent believed the eye swelling was due to spiritual attack, presented last night with several episodes of convulsions and loss of consciousness of about forty-five hours, the Glasgow coma score of three, absent cornea reflex and dilated and fixed pupils.
1) what is your diagnosis?
ii) list Five confounders in making this diagnosis.
iii) mention three other reflexes that are likely to be absent.
iv ) mention two investigations that will enable a definitive diagnosis.
v) describe apnea test?
It was another breastfeeding week on 1st to 7th August, 2017. This year's theme challenged us to work together to make breastfeeding sustainable. It requested the support of every man, woman, manager, policy maker, NURSE, doctor, health attendant, Husband and everybody.
Breastfeeding is a BIG task, it drains energy, you may have witnessed or heard about women fainting after breastfeeding; such is the energy it consumes and this shows that the level of support needed by a breastfeeding woman is unquantifiable/ enormous.
If you did not talk to someone last week about breastfeeding , you didn't do too well, you still have the chance to do that before it is too late or better still forward this piece of information to them.
Can we have Breastfeeding celerebrated every week just to lay emphasis on the importance of breastfeeding?
I need not bore us on why breastfeeding or breast milk is important, its rich contents and the protections it offers are superior.
What I want us to pay attention to is helping the breastfeeding women around us do it well, any form of encouragement done properly will be appreciated; a thumbs up, a pat, money, food, space, breastfeeding leave with pay , a space in your establishment for brastfeeding mothers to breastfeed are just some of the supports that will make the breastfeeding mother do it well.
If you look around well enough this task is often left for the aged women in the community who themselves need support, they pass down traditional practices (big kudos to them), some of these practices are very helpful. That they are willing to help always is commendable. However, we are now in an era when we know better and our knowledge should set us free, set our community free also.
My major concern today are the challenges and myths of breastfeeding.
I have been in a nursery bay where HOT water was prescribed, to help uterus contracts and breast milk flows. Right in the hospital, even in labour wards you see people including healthcare practitioners prescribe bland PAP etc as a form of galactogogue. These are based on traditions and psychology; they have little scientific basis.
The challenges of breastfeeding are numerous, I will mention a few:
1. Milk not flowing: this is common in the first 3 days after birth, it is a normal finding in most mothers and will soon flow, as a mother, you need to relax, eat well and drink a lot fluids, be happy, ensure you are not in any form of pain as this can cause delay in milk flow.
Please my fellow doctors, DO NOT PRESCRIBE HOT WATER FOR THESE WOMEN, doing so has no established basis ,tell me how much hot water can a woman who should be well hydrated drink? The breastfeeding mother should take about 3litres of water daily, normal (water at room temperature) will do. If the lack of milk flow extends beyond the 3rd day with all the above mentioned stuffs clearly addressed pleas see your doctor (pregnant woman doctor (Obstetrician) or babies doctor (Paediatrician)).
Palm wine is not a special fluid, if you are not interested don't drink, don't blame your inability to produce enough milk on lack of palm wine, a lot of people get unneccessarily worried because of this temporary problem to the extent that such worry inhibit their milk flow.
Pregnant women and breastfeeding mothers need GOOD FOOD,simple well prepared meal, No mandatory Pap .
The list below is a well illustrated 10 steps to
SUCCESSFUL BREAST-FEEDING Every facility providing maternity services and care for newborn infants should accomplish the following: 1 Have a written breast-feeding policy that is routinely communicated to all health care staff. iiTrain all health care staff in the skills necessary to implement this policy. iii Inform all pregnant women about the benefits and management of breast-feeding. iv Help mothers initiate breast-feeding within a half hour of birth. v Show mothers how to breast-feed and how to maintain lactation even if they should be separated from their infants. vi Give newborn infants no food or drink other than breast milk unless medically indicated., please babies do not need water while breastfeeding exclusively, herbal concoction is not needed, brestmilk is all in all in the right proportions. vii Practice rooming-in (allow mothers and infants to remain together) 24 hr a day. viii Encourage breast-feeding on demand. ix Give no artificial teats or pacifiers (also called dummies or soothers) to breast-feeding infants. x Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.
2. Pain while breastfeeding , this could be a normal finding initially but breast feeding should soon be itch free, free flowing , if the pain is disturbing lasting more than few hours after delivery, please prescribe pain killer for these women also encourage them to breastfeed more often during this period, yes the reasons for this pain may inlude
A) Breast engorgement..... Breast is overfilled, overstretched and painful, mother will need to Breastfeed more often to prevent this very painful challenge, give pain killer if one develops , other treatment modalities include warm compress, warm shower etc
B) Breast abscess.... Please never allow it get to this level, if this develops see a doctor fast. The woman will have pains, fever and may have chills.
C) Sores on the nipple(s)..this should not be, it is usually due to bad techniques of breastfeeding, the technique is about the most important thing , if the nipples have sores, the treatment is more breastfeeding to avoid engorgement and one can also express the milk and give through cup till the sores heal, the proper techniques must be emphasized. These techniques are usually taught during the antenatal vists and in the post natal ward after delivery (make it a point of duty to learn the proper technique, such that you can help yourself and people around you).
The technique is illustrated below properly.
Babies are designed to breastfeed and every mother is built to provide beast milk but the techniques must be right, everything must come together at the point baby attaches to the breast.
Get in a comfortable chair with great back support to feed your baby. Using a stool to rest your feet on will help with good posture and prevent you from straining your neck and shoulders.
Use your breastfeeding support pillow if you have one. (And if you don’t, use whatever kind of pillows you can find to help support you and the baby). A good breastfeeding pillow can make a huge difference in getting the baby in a proper position to latch on well.
Make sure your baby is tummy-to-tummy with you at all times.
Make sure you bring your baby to you, and do not try to lean onto the baby. Not only will this cause severe strain on your neck and shoulders, but it can affect the baby’s position.
Remember to keep your baby’s ear, shoulder, and hip in alignment, which will make swallowing easier.
The baby’s nose should be opposite the nipple.
You might need to hold your breast to help guide the nipple to your baby’s mouth. Grasp the breast on the sides, using either a “C” hold or “U” hold. Make sure you keep your fingers far from the nipple so you don’t affect how baby latches on.
Aim the nipple toward the baby’s upper lip/nose, not the middle of the mouth.You might need to rub the nipple across the top lip to get your baby to open his/her mouth.
The baby’s head should be tilted slightly back. You do not want his chin to his chest.
When he opens his mouth wide with the chin dropped and tongue down, he should latch on to the nipple. If he does not open wide, do not try to shove the nipple in and wiggle the mouth open. It is best to move back, tickle the lip again with the nipple and wait for a wide open mouth.
Try to get as much of the lower portion of the areola (the area around the nipple) in the baby’s mouth.
The baby’s chin should indent the lower portion of your breast.
Look to see if the baby’s bottom and top lip are flanged out like fish lips. If they are not, you may use your finger to pull the bottom one down and open up the top one more.
Positioning your baby to feed
There are many different positions that can work while breastfeeding. It is important to find one that is comfortable for both you and your baby. Make sure to utilize the tips in the above list to help ensure your position is correct.
Cross-Cradle Hold:
This position is often the most helpful for moms right after birth and until they get more confident in getting their baby latched on correctly. It feels awkward for many moms at first, but once they see how it allows them to use both their hands more effectively, moms get more comfortable with it.
You will use the arm on the opposite side you will be feeding from to hold and support your baby, while you use the hand on the side you are feeding from to support your breast.
Lay your baby next to you, tummy-to-tummy, with your opposite hand supporting the back of his head. You want to make sure you are holding at the neck, so you are just guiding the head. You will use the other hand (on the same side the baby is feeding from) to hold and navigate your breast and nipple. Once the baby is securely latched on, you can move your arms to the cradle hold.
Numerous other methods exist, check and learn.
3.Lastly for today, is a 3rd challenge
Breast leakage: innocuous, the milk overflows , stain wears and can be smelly, More hygiene needed, it resolves on its own.
The myth are numerous and challenges enormous the scope of today's blog can not exhaust them all. We shall revisit some other ones later .
Here I rest my case for this week, help mothers breastfeed, give the needed support.
Leave your comments , questions and suggestions in the box below.
Scary as it goes, convulsion or fits (seizure) is the commonest scary experience for mother to witness a child have, they chant all sorts of names. Jesus, Jehovah, doctor, Yepa, Oh! Ha! Just to mention a few.
I have witnessed them pee themselves but that is fine. What bothers me and affect these children more than the convulsion are the wrong interventions and the insults we inflict on them during this process.
This brings us to today's blog tittle.
"Care and Prevention of Febrile Convulsion in Children"
What is Febrile convulsion?
It is a convulsion (fit) or seizure in children when they are having fever, occurs usually in children between the age 6 months and 60 months (5yrs).
Convulsion may be characterized (but not restricted to) by abnormal movement of any part of the body usually jerking, pedaling, abnormal blinking of the eyes, upward rolling of the eyes, stiffening of the body, etc.
It is quite a common place in children.
Fever is defined as elevated body temperature, subjectively and rather unreliably checked by placing the back of the palm on the forehead in this part of the world.
The reliable method is by using a thermometer, a specimen is shown below.
Off mode
Default value when switched on.
Reading after measurement
Temperature greater than 37.5 Celsius measured from the armpit (there are other places one can check) is referred to as fever.
What are the causes?
The causes are mostly from infections, that may affect any part of the body except the brain. These include but not limited to :
Malaria
Catarrh and cough (flu, pneumonia)
Infection in the throat (tonsillitis and pharyngitis)
Infection in the passage for urine (urinary tract infections)
Infection in the ear (Otitis)
Like I said, infection anywhere in the body except the brain may be a cause . If the infection is in the brain, the outcome is worse and the associated fit is not called febrile convulsion.
What to do during a febrile illness to avoid febrile convulsion?
1. Have a thermometer to measure your children temperature. This can be done by anybody and everybody.A digital thermometer displays the temperature of the body on its screen.
Switch on the thermometer and simply put in the ampit for 2 minutes or till it alarms, Check the number displayed thereafter,If lesser than 37.5 Celcius, no problem, Values greater than 38 Celsius are particularly disturbing and requires care that may include
a) Complete exposure of the child
b) Fanning
c) Bathing with lukewarm water
d) Toweling with wet napkins (wet with warm water)
e) Administration of Paracetamol (only if the above methods fail and temperature is greater than 38 Celsius).
Paracetamol should not be used routinely in any child to prevent fever (it damages the liver and the kidney if used excessively).
Such child should at least be reviewed by a family physician or a paediatrician(babies doctor)
What to do during convulsion
Convulsion for one minute is like eternity to an helpless mother, so any form of intervention will do. Anything done to stop the convulsion is usually welcomed and appreciated though most of these interventions are needless and harmful as we shall soon see , the following are recommended steps of interventions
1. Remove all clothing and allow proper ventilation
2. Put to lie on the left side
3.Follow steps a to e of prevention written above
4. If available, insert a rectal diazepam. This is a gel that can be placed in the body through the anus and hastens abating the seizure
4. It is also Paramount to see a doctor (babies doctor)
May I quickly add that febrile convulsion usually does not leave a child damaged, There is no long term outcome. It is our wrong interventions during this period that damage these children.
What not to do.
1. Do not pee on the child. This is rather a common practice. Please, do not do it. The danger is the child run a greater risk of aspirating the urine(breathing in urine) and suffer lung infections and may even die from choking.
2. Do not give COW Urine,sounds funny or you say barbaric, people do it, and it is a very common practise.
The first problem here is cow urine, the second is that it is used alongside onion and garlic making a concoction that potentially lowers the blood sugar making the child to have more convulsions and subsequently suffer permanent brain damage.
3. Do not put their leg(s) in fire, Yes, people do it,in the last one month, I have seen a couple of cases.
The fact here is that fire can only worsen convulsion, It does not stop it,the child is then left with a damaged foot, prolonged hospital stay, more psychological effect the extent of which can not be quantified.
4. Do not insert spoon, or anything in their mouth while convulsing, you may remove their teeth , injure the mouth structures and the child may choke.
5. Don't give anything by mouth while a patient is convulsing or sleeping after convulsion, It is dangerous.
Most of the above interventions are instituted by Neighbours, grandparent, friends etc but not by the mother who is at the time of event practically " brain dead".
This is a case where doing nothing ( if u do not know what to do )is far better than doing useless stuff.
Please share this information , it will definitely help some poor children somewhere.
Leave your comments , suggestions , additions and questions in the comment box below.
1 . A 5yr old girl referred to you on account of Vaginal bleeding noticed following development of breast about 4month prior, she deny use of oestrogen containing creams, she has genus vagum and an irregular sharp edged rash on the the trunk , her pulse rate is fast and bounding.
The following conclusions are likely to be true of this condition
A). The average age of affectation in girls is 3yrs
B). In patients with associated cushing syndrome the ACTH level is low
C). Clinical hyperthyroidism is uncommon in this condition
D). Phosphaturia is the commonest extra glandular manifestation
E). A missense mutation occured in this patient.
2.Growth hormone is indicated in the following conditions
A) Turner syndrome
B)Prader Willis syndrome
C)End stage renal disease
D)Growth hormone deficiency
E) intra uterine growth restriction
3. The mother of a new born(1hr old) has called your attention to teeth in her baby's mouth , she knows this is unusual and wants an explanation, some of the valid points you told her include
A) This is an abnormal condition and the teeth as a rule must be extracted.
B) her child's condition is called neonatal teeth
C) cleft palate must be ruled out
D). Usually occur on the mandible
E) attachment of the teeth is deep rooted
4. A 6mo old boy seen at the out patient department with nasal discharge of few days to which the care giver procured decongestant from OTC, the attending resident noticed the heart rate to be 210bpm despite normal Temperature and respiratory rate , child is otherwise normal , you are invited to review and corroborate the above findings
A) This condition is likely not to need treatment.
B). This condition may rapidly progressed to heart failure
C) The over the counter decongestant may have a role in development of this condition
D)deep intranasal suctioning may reduce the heart rate
E) Digitization may be needed.
5.The result below was obtained from a 4yr old boy with Loss of consciousness.
Sodium ion:152mmol/l
Potassium ion : 3.8mmol/l
Random blood sugar,: 162mg%
BUN: 6mmol/l
Bicarbonate : 17mmol/l
Chloride ion :118mmol/l
The following conclusion is/are true
A) he has metabolic acidosis
B)plasma osmolality is 425Mosmol/l
C.) The anion gap is normal
D) Has renal tubular acidosis
E).May have diabetes insipidus
Use 7.5min for the questions.
Answer true for correct statement and false for incorrect statement
Incorrect answer attract 0.5 mark deduction.
Pass mark is 13/and above.
1. A 2 -day old girl noticed to have bled per rectum, the following may hold true of this patient
A). He may have vitamin k dependent bleeding.
B). He may have swallowed her mother's blood during delivery.
C.)bet-ke test may be important in making diagnosis
D).haemophilia is not a possible diagnosis since the baby is a girl
E). She has necrotizing enterocolitis
2. The following investigation result were obtained for the above child
i prothrobin time ( 20s)
ii plasma thromboplastin time (80s)
iii platelet counts (250000/ul)
iv cloting factors 5 and8 (normal)
Which of the following is /are true statement(s)
A).protein induced in vitamin K absence is a sensitive marker in this condition
B). The level of cloting factors 2,7,9, and 10 may be normal in this condition
C). The patient may have hemophilia A
D. There is impaired post translational decarboxylation of vitamin k dependent clothing factors.
E.Oral vitamin K may be used for prevention of this condition
3. A 4-week old boy has being vomiting, failing to thrive and he is severely dehydrated, the following are some of the differentials to consider
A.) Cystic fibrosis
B.) Galactosemia
(C).Neonatal diabetes
D). pyloric Stenosis
E). Sepsis
4. The above patient (3) was noticed to have cataract and jaundice on examination, blood culture done for the patient yielded Klebsiella sp.
The following are some of your conclusions
A).The boy most likely has Cystic fibrosis
B). Exclusion of glucose from the diet of this boy should be considered
C).The deficient enzyme may be Galactose-1-phosphate uridyl transferase.
D).Symptoms are due to accumulation of galactose in the blood
E.)This boy may suffer mental retardation.
5. The following conditions are commoner in females
A).Patent ductus arteriosus
B). Atrial septal defect
C).Ventricular Septal defect
D). Coaractation of aorta
(E).Pulmonary stenosis
I have chosen to speak out to the public through this medium having kept quiet for so long .
The last straw of events happened this weekend, another baby lost to a very preventable death, through needless hot formentation of the remnant of the baby's cord a means through which, though rare, an infection, a kind that sort of eat up the flesh around the cord occurs , This I must agree is rare occurrence but usually a fatal one.
Before I continue with my rant, may I be permitted to educate us on the universally acceptable means of caring for a newborn umbilical cord remnant.
What is an umbilical cord?
It is a thin rope of fleshy white gelatin that attach a baby to the placenta. It serves as a means of communication between the baby and the placenta (the mother).
It is a passage through which digested food from the mother, oxygen and other essentials of life are passed to the baby. Some of the baby's wastes are also passed through it to the mother for removal.
A baby is delivered of the mother only when the cord is severed after expulsion of the baby through whatever means Vaginal or abdomen (in case of caesarian cut).
The remnant of the severed cord is clamped (tied) as it contained blood vessels and will bleed out all the baby's blood if left unclamped (not tied). This remnant will naturally degenerate and drop off the baby, usually between day 4 and 7 though may rarely remain intact for longer time (maximum 28days), after which it is considered prolonged (Seek medical attention if it has not dropped after 2 weeks).
It usually will drop without leaving any appreciable wound, but may rarely leave an innocous fleshy outgrowth (Seek medical care if you see this).
Picture of a newborn showing the cord immediately after severance
Why is the need for special care of the cord?
The process that leads to eventual dropping of the cord produces dead tissue that is slightly foul smelling and must be cleansed off.
The dead tissue is a good medium for bacteria infection and other disease causing agents to grow and multiply so we must clean to prevent this. What are the ways by which we can care for the cord?
1. Normal baby bath twice daily (where necessary) with warm water containing one to two drops of savlon , towel dry after.
2. The remnant of the cord should not be tucked in to the diaper as it may be readily contaminated with baby's urine and stool.
3. The cord can be swabbed with methylated spirit (alcohol swab) 3 to 6 times daily at regular interval, triple dye or bacitracin, if available, may be applied daily.
4. WHO ( World Health Organisation ) recommends application of chlorhexidine gel (Available in health centres and some pharmacy shops) or savlon cleaning)
5. After the umbilical cord has dropped off, cleaning with methylated spirit should continue for one or two days after which no special care is needed.
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What is fobbiden?
1. Application of cow dung, yes I said cow poo, it is rather a common practice (though has reduced drastically) to see people apply this mess on their baby's cord. This is a dangerous practice as many of such children die of infection and/or tetanus.
2. Hot formentation... This is the cause of my early rant , it is a rampant practise in this part of the world and rather unfortunate as both the very educated and the uneducated are involved.
What is more disheartening is that this is like a tradition passing from one generation to the other.
We have to stand right and stop this right away( Say no to Cord formentation)
It is cruel as many of these children cry ceaselessly and helplessly while going through this torture
The baby is a well formed human , no internal wound of any sort that will be healed with your hot formentation, so stop it.
Picture of one of the scores of affected children
Another victim of our gruesome traditional practice
4.Application of mentholatum, Robb or Dustin powder is also very dangerous.
Anything other than the above mentioned methods of care can be potentially dangerous , ask from babies doctor before you do them.
Yes that you did it for your baby and you got away with it does not make it right.
I may have been hot formented but I (we) am(are) here to stop these barbaric practises .
A 12 year old boy presented in a peripheral hospital with history of abdominal pain, several episodes of vomiting and Loss of consciousness.
He was managed as a case of typhoid sepsis to no avail necessitating referral to you.
You obtained an history of recent weight loss and secondary enuresis that begins about a month prior presentation, he is also dyspnoic with fast deep breathing.
(a) What is Your likely assessment ?
b) Mention two bedside investigations that will help you clinch the diagnosis and your likely findings.
c) Mention 5 risk factors for this type of presentation.
c) Outline 5 principles of managent.
d)What 4 complications can occur acutely in this pateint and explain briefly the pathophysiology of any two.
A 15yr old girl presented in accident and emergency unit with two weeks history of fatigue, headache , joint and chest pain and great discomfort whenever she is expose to sunlight. You noticed that she also has macular rash on the face , pale and has pedal edema. a) .what is the most likely diagnosis ?
b) Mention two differentials.
c) State 5 of the criteria needed for making diagnosis.
d) Mention five relevant investigations.
e) mention Four drugs that can induce the above condition. f) mention three medications that may help in treatment of this condition. A 3 week old boy is brought to your clinic for evaluation , he has an episode of gross hematuria. , severe respiratory distress, mother volunteer an history of small volume liqour in pregnancy, he appears to have an abnormal facie, abdominal examination shows a mass palpable to both flanks. Amongst other abnormal result of investigations is a markedly deranged liver function test
A) What is the most likely diagnosis? B) list two differential diagnosis C) Mention four other investigations that may be relevant D) what two prominent associations are expected E.mention 5 complications that may arise F.what will be your treatment plan?
A 10yr old girl present in out patient department with history of pain in the ankles , and the wrists, the joints appear stiff on awakening in the morning.The involved joints are swollen , warm and tender.,
a. What is your diagnosis? b. Give two differential diagnosis C.list four investigations you will like to do. D.Give five classes of this condition according to the international league E. Mention three complications that may arise F. Mention four drugs that may be beneficial
What is Macrophages activation syndrome(MAS)? b. How is the diagnosis of MAS confirmed?
1. A 4yr old BOY with severe infectious mononucleosis was investigated for immune deficiency , the result shows deficiency in certain adhesive proteins on b and t lymphocytes. The following is true of this patient immune deficiency. a). It is an X linked reccesive condition b). Affected patient may develop acquired hypogamaglobinaemia c.) This is Duncan disease d.) Stem cell transplant offers no benefit e.) Prognosis is very poor. 2. A 5yr old boy rushed into CEW with history of repeated episodes of convulsion of an hour duration, he has had red urine that has being progressively reduce in quantity in the last 12hrs Examinations reveal an unconscious child , with periorbital fullness and severely elevated blood pressure. The following are true of this patient a). C3 hypo complementemia is an expected finding b) ricketsial is a known cause c) group B hemolytic streptococcus serotype 12 is a known cause d.). congestive heart failure is a feature e) lumpy bumpy deposit of immune complex is seen on light microscopy 3. The serology result of a 7yr old boy is as shown below : Anti HbC IgG positive Anti HbS positive The following are true of this patient a. He has an acute infection b. He is a chronic carrier of the infection C. He is highly infective at this stage d. He is safe throgh immunization against hepatitis b e. He is previously infected but has recovered. 4. Molluscum contagiosum a. A self limited condition b. Caused by Pox virus c. Curettage is the treatment of choice d. Infection is life long e. Coccidiomycosis is a differential 5. A 2 yr old boy was found with the container of red pills that belongs to his pregnant mother, he has swallowed some of the pills, if the toxic dose is exceeded the following will be True a) hematemesis within 6hrs of ingestion is expected b. This patient will benefits from administration of activated charcoal c. The boy will benefit from whole bowel irrigation d. penicillamine is the antidote for the ingested pill e) the antidote is preferably given subcutaneously.
7.5min time allowed 0.5 mark deducted as penalty for wrong options Score above 20 is excellent 15 to 20 good 10 to 15 is average
MCQ: Indicate True or False for ALL the options in the questions below.
1. A 28 day old boy with a birth weight of 4.5kg has been having recurrent hypoglycemia. He also has pits in the ear helix bilaterally. The parent request an audience with you to explain their child's condition. You mentioned that the child is at increased risk of having the following tumors
2. A 5yr old boy with chief complaint of excessive urination, voiding of large volume urine, failure to thrive, has normal blood sugar.
You make some of the following conclusions
(A) His condition can be caused by hypokalaemia
(B) Hypokalaemia may result from this condition
(C) Diabetes mellitus is a likely cause
(D) The likely deficient hormone has 9-amino acids
(E) C-peptide assay is neccesary for diagnosis
3. A 15year old girl with chief complaint of amenorrhea was observed to have a low posterior hairline, red green colour blindness and a height below two standard deviations from the mean.
The following hold true for this patient
(A) Parental age is a risk factor for this concondition (B) The lost chromosome is of paternal origin in most cases
(C) 99% of fetus with this condition end up in spontaneous abortion
D.This patient may have blood pressure that is higher in upper limbs that in the lower limbs
(E) lyphedema of the extremities is an expected finding
4. A newborn was noticed shortly after birth to have a an erythematous plaque on the left side of the face, the plaque persists on blanching, not tender though warm,an assesment of facial hemangioma is made.
The following hold true
(A) 50% of cases reach maximal involution by age of one
(B)This condition is commoner in boys than girls
(C)the lesion is more likely to get bigger in the next few days
(D)Occurrence is higher in preterms
(E)sodium bicarbonate is useful in the management of this patient.
(5) polydactyly
(A) bilateral involvement in 50% of cases
(B) Mostly pre axial
(C) repair is best at 3rd month of life
(D) may be tied off
(E) Seen in Ellis van creveld syndrome
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