Imparting postoperative functionality and cosmesis is a major challenge in enucleated eyes. Orbital implants are used to replace the volume lost by enucleated eye and maintain cosmetic symmetry with the fellow eye.A variety ofnon-integrated, synthetic semi-integrated, integrated, Bio-integrated & Biogenic varieties have been tried employing different materials. The favoured hydroxyapatite (bio-integrated) implant, due to its rough surface needs to be wrapped in donor sclera or other wrapping materials (like polyglactin-910 mesh, polytetrafluoroethylene sheet, etc.) to allow muscle attachment and integration. Monofilament polypropylene mesh used in herniorrhaphy is a bio-integrable material with little rejection hitherto reported. A series of 7 eyes of 7 patients were implanted with hydroxyapatite balls of sizes ranging from 12 to 16 mm. Each of such implants were given polypropylene mesh wrappings using 7- 0 prolene sutures. 6 of such implants were performed in the primary setting while 1 implant was undertaken as a secondary surgery, 8 weeks following the primary procedure of globe excision. 5 of these surgeries were done under local anaesthesia of a peribulbar block while 2 of these surgeries were performed under general anaesthesia. Post operative evaluation was done after 1 day, 1 week, 1 month, 3 months and 6 months in each of these cases. 1 case was lost to follow-up after 3 months. Surgical evaluation was rated on basis of intra operative ease of implantation and muscle attachment, early and late post operative complications, implant mobility and cosmesis achieved. Early complications included peri-orbital surgical edema, discharge, watering and foreign body sensation persisting upto 2 weeks post-operatively. Implant motility as judged 6 months post operatively was satisfactory in all cases. Sulcus deformity was noted in 1 case. No case presented with implant migration or exposure.

A single hole or other small manufacturing defects in endotracheal tubes can go undetected by naked eye examination as reported in the past, but presence and failure to detect multiple holes in endotracheal tube is a very rare phenomenon. We report an unusual case of two undetected holes in the endotracheal tube leading to ventilation impairment in the ongoing surgery, managed successfully by the vigilant anaesthesia team. Only one such similar incidence of multiple holes in endotracheal tube is mentioned in the literature. Performing equipment check before initiating anaesthesia is a must, by every anaesthesiologist without which high chances of fatal accidents on table can occur due to its failure jeopardising patient’s safety.

HHV-6 constitutes a widely spread viral infection among young children population with a seroprevalence of > 80% in children > 2 years of age [1]. HHV-6 is an enveloped DNA virus belongs to the β-herpes virus family and, together with its closest homologue HHV-7, forms the roseoloviruses subfamily (2). A wide range of clinical manifestation of HHV-6 has been described which may vary with age and immune status of a child including acute febrile illness with or without rash, Roseola Infantum, febrile convulsion, meningo-encephalitis, hepatitis and mononucleosis-like illness, etc. Here we report the case of a 2 years old boy previously healthy who presented with fever, lethargy, decreased level of consciousness and with neck stiffness, diagnosed clinically with severe meningo-encephalitis and confirmed on brain MRI. Human Herpes Virus 6 was the etiology of his encephalitis, verified by his blood neuro-9 PCR.

Introduction: This study aims at determining characteristics of eye mutilating surgeries in children in the pediatric ophthalmology department at the Institute of African Tropical Ophthalmology located in Mali (West Africa). Patients and methods: this was a retrospective descriptive study on the case history of mutilating surgery children aged 0 to 16 in the pediatric ophthalmology department of IOTA (the only available pediatric ophthalmology center in the country) between January 1, 2014 and December 31, 2018 (5 years). Results: During the study period, 106 eyes of 105 children were operated on through mutilating surgeries out of a total of 1405 procedures, with a frequency of 7.55%. The average age was 4.02 years with extremes of 1 and 16. Indications for mutilating surgery were dominated by oculo-orbital tumors (including retinoblastoma) with 60.38% (n = 65). (Table I). Retinoblastoma alone accounted for 54.72%. General anesthesia was performed in 96.22% (n = 102) of the cases. Enucleation was the commonest with 64.15% (n = 68), evisceration accounted for 33.96% (n = 41) and exenteration 1.89%. Conclusion: Mutilating surgery represents a significant part in the pediatric environment. Its performance should be subject of informed decision from the doctor and the child’s legal representatives.

Low vision and blindness define the two levels of visual impairment. They are a real public health problem. World Health Organization (WHO) estimates that 15 million children under the age of 15 years are affected by this impediment. Africa and Asia are the most affected. The aim of our study was to determine the causes of visual impairment in children at the Institute of African Tropical Ophthalmology (IOTA) located in Bamako (Mali). Materials and methods: This was a retrospective descriptive study covering 05 years. Our study included all children diagnosed with visual impairment with a complete medical file from January, 1^st 2015 to December, 31^st 2019. WHO International Classification of Diseases (ICD-10) was used to define the level of visual impairment. Results: We collected 145 cases of children aged 0 to 15 years with bilateral visual impairment out of a total of 2,500 consultations during the study period. The frequency of visual impairment accounted for 5.8%. Children under 5 were predominant with 44.14%. The sex-ratio was 1.16. According to WHO classification, low vision (category I and II) represented 37.93% (n = 55); and blindness (grade III, IV, V) was 62.02%. The anatomical site of the lesions was dominated by corneal lesions with 26.9%. Conclusion: Childhood blindness and low vision still remain a public health problem in our countries. In our study, corneal damage related to malnutrition was the most common.

Hemoglobin O-Arab is a rare mutation in Hb, a genetic defect caused by the synthesis of hemoglobin which substitutes for normal hemoglobin A. only the homozygous state is symptomatic, the latter are tolerated but associated with other hemoglobinopathies, it gives a severe clinical form. We report a case of heterozygous O-Arab hemoglobinopathy in a 40 years-old patient of Moroccan origin followed in endocrinology for a test of HbA1c in the context of his type 2 diabetes. HbA1c is performed by HPLC on ADAMS Arkray, showed the presence of a variant detected in the area of ​​HbC. The electrophoretic study of Hb carried out on capillaries (Sebia) at alkaline pH, showed the presence of a variant of Hb in the heterozygous state migrating at the level of the A2 zone, identified as an Hb 0- Arab. In Morocco, Hb O-Arab is an extremely rare mutant of Hb. In the homozygous state, is associated with other hemoglobinopathies, it can present in severe clinical form, hence the importance of the laboratory in the detection of couples at risk in order to offer genetic advice.

Brain abscess constitutes a rare medical condition in the newborn period. This condition if present in the majority of cases is a complication of meningitis with high morbidity and mortality at short and long term. Many unusual bacterial pathogens were implicated in this condition like Proteus, Klebsiella, Citrobacter, Staphylococcus Aureus, MRSA, StaphylococcusEpidermidis and Enterococcus (1, 2, 3). In this article, we report a case of a 28 days old late preterm baby presented with a history of poor feeding and low grade fever, who was found to have Staphylococcus Epidermidis meningitis without any focal neurologic signs with a huge brain abscess of 10 cm without neither midline shift nor hydrocephalus. The baby received a full course of antibiotherapy for total 4 weeks post drainage of abscess and was discharged home after documentation of radiological clearance in a repeated MRI without any neurologic sequalae.

Accessory breast is a congenital atavism ‎condition. Accessory breast tissue may be arising anywhere along the mammary line because of the failure ‎of complete maturation during embryogenesis. The malignancy in accessory breast tissue is considered as ‎primary breast cancer. Axillary breast cancer is not well recognized site of primary breast cancer.‎‏ ‏ This case report for a 55 year-old premenopausal female who presented with axillary immobile mass in her left axilla that diagnosed after extensive investigations as stage II B, ER, PR positive and HER neu positive poorly differentiated ‎accessory breast adenocarcinoma.‎ The patient was staged as stage II B and we followed NCCN guidelines 2013 for breast cancer in management, so our patient was surgically treated, followed by postoperative adjuvant chemotherapy in the form of 4 cycles doxorubicin and cyclophosphamide followed by 4 cycles of paclitaxel and 17 cycles trastuzumab. Subsequently radiotherapy was given followed by hormone therapy. We followed up the patient for 6 years and she is doing well. Accessory breast cancer is a rare disease and misdiagnosis of these cases is very immense and lead to extensive unnecessary investigations. Physicians have to be aware about these cases. Management of accessory breast cancer is according to the same guidelines for management of breast cancer. Follow up data should extensively encourage determining the prognosis of accessory breast cancer in comparison to usual breast cancer.

McCune-Albright syndrome (MAS) is classically defined by the clinical triad of fibrous dysplasia of bone (FD), café-au-lait skin spots, and precocious puberty (PP). It is a rare disease with estimated prevalence between 1/100,000 and 1/1,000,000. FD can involve a single or multiple skeletal sites and presents with a limp and/or pain, and, occasionally, a pathologic fracture. Scoliosis is common and may be progressive. In addition to PP (vaginal bleeding or spotting and development of breast tissue in girls, testicular and penile enlargement and precocious sexual behavior in boys), other hyperfunctioning endocrinopathies may be involved including hyperthyroidism, growth hormone excess, Cushing syndrome, and renal phosphate wasting. Café-au-lait spots usually appear in the neonatal period, but it is most often PP or FD that brings the child to medical attention. Renal involvement is seen in approximately 50% of the patients with MAS. The disease results from somatic mutations of the GNAS gene, specifically mutations in the cAMP regulating protein, G_s alpha. The extent of the disease is determined by the proliferation, migration and survival of the cell in which the mutation spontaneously occurs during embryonic development. Diagnosis of MAS is usually established on clinical grounds. Plain radiographs are often sufficient to make the diagnosis of FD and biopsy of FD lesions can confirm the diagnosis. The evaluation of patients with MAS should be guided by knowledge of the spectrum of tissues that may be involved, with specific testing for each. Genetic testing is possible, but is not routinely available. Genetic counseling, however, should be offered. Differential diagnoses include neurofibromatosis, osteofibrous dysplasia, non-ossifying fibromas, idiopathic central precocious puberty, and ovarian neoplasm. Treatment is dictated by the tissues affected, and the extent to which they are affected. Generally, some form of surgical intervention is recommended. Bisphosphonates are frequently used in the treatment of FD. Strengthening exercises are recommended to help maintaining the musculature around the FD bone and minimize the risk for fracture. Treatment of all endocrinopathies is required. Malignancies associated with MAS are distinctly rare occurrences. Malignant transformation of FD lesions occurs in probably less than 1% of the cases of MAS.

Acute pancreatitis may have a great variety of etiologies, but the two main causes, responsible of 80% of acute pancreatitis, are alcohol and biliary lithiasis. The other causes more rare, are drugs, genetic, malformative, cells tumor, medication and metabolic (hyperlipidemia, hypercalcaemia) hypercalcaemia secondary to primary hyperparathyroidism (P-HPT). We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma. Initially the acute pancreatitis was treated conservatively. The patient subsequently underwent surgical resection of the parathyroid adenoma. The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known, although some mechanisms have been proposed. It is important to treat the provoking factor. Therefore, the cause of hypercalcemia should be identified early.

Social distancing measures are steps we can take to minimize social contact or interaction between individuals. Social distancing, also called “physical distancing,” means practice of ensuring a minimum distance of 6 feet between two people to ensure that one person cannot contract the infection from another person. That’s because this infection spread when people cough, sneeze, or touch surfaces on which the corona virus resides. This is reason why, it is the most effective “social vaccines” available to fight this pandemic and considered “one of the most powerful weapons" against COVID-19. The whole World will face social distancing strategies for "a very long time" until unless critical care capacity is increased substantially or its treatment or a corona virus vaccine is developed in near future to build up immunity and to bring an end to the COVID-19 pandemic.

This research reports on the prevalence of typhoid fever among patients attending General Sani Abatcha Specialist Hospital Damaturu, Nigeria. Typhoid fever caused by Salmonella is an endemic disease in the tropic and sub tropic and has become a major public health problem in developing countries of world with an estimated annual incidence of 540 per 100,000. The annual incidence of typhoid is estimated to be about 17 million cases worldwide. It is often in tropical countries including Nigeria where they constitute serious sources of morbidities and mortalities. Blood samples were collected from 150 patients for appropriate bacteriological analysis which includes, Serological test (WIDAL), Blood culture on XLD agar, and Biochemical tests such as; oxidase, catalase, TSI and SIM: 122(81.33%) were found to be infected and 28(18.67%) were not infected i.e. negative. The overall number of males examined are 77 and 64(42.67%) were found to be positive. And for the females 73 were examined with 58(36.67%) infected. The prevalence is higher in males and among age group 26-30, where 11 examined and 8 (72.73%) infected. The prevalence of typhoid fever is considerable and most are due to four serotypes. The results imply the need for policy to promote public hygiene and regularly saved individuals in contact with food items for public consumption.