Niger J Clin Pract
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Hypothyroidism in children with nephrotic syndrome (NS) is often attributed to prolonged loss of thyroxine binding globulin and thyroid hormones alongside protein in the urine. It has been historically associated with steroid-resistant NS alone. However, recent evidence supports the fact that subclinical hypothyroidism (SCH) does occur even in children with steroid responsive NS. Complications such as weight gain, hypercholesterolemia, delayed growth, delayed puberty, and depression could result from hypothyroidism and be erroneously attributed to NS, or the effect of steroid used in treatment. Incidentally salt intake, the major form of dietary iodine is often restricted in children with NS, possibly exacerbating any underlying hypothyroid state. ⋯ Screening of children for SCH with NS especially steroid-resistant NS and frequent relapsing steroid sensitive NS for hypothyroidism before complications arise is pertinent to their holistic management. This becomes even more imperative in our environment as iodine deficiency hypothyroidism is still prevalent in some parts of the country.
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Congenital diaphragmatic hernia (CDH) is an anomaly with significant morbidity in neonates. It has been traditionally managed by an open approach with a recent trend toward a minimally invasive approach. ⋯ We recommend trimming the margin of the defect, use of prosthetic mesh overlay reinforcement for repairs under tension, and to prefer extra-corporeal knotting along with higher placement of trocar, temporary increase in CO2, maximal use of muscle relaxant, extra-corporeal corner hitch stitch to reduce the operating time, and recurrence after thoracoscopic CDH repair.
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A healthcare system must be responsive to the needs of its clients, and this entails elements such as dignity, confidentiality, autonomy, prompt attention, social support, basic amenities, and choice of provider. This is targeted toward improvement and maintenance of the quality of healthcare with consequent improvement in patient outcomes at a reduced cost. ⋯ As a direct result of the findings, the hospital designed an 18-month renewable strategic plan premised on five pillars: (i) human resources development; (ii) improvement of quality of service; (iii) expansion of services and infrastructure renewals; (iv) financial re-engineering and partnership; and (v) appropriate utilization of technology. Through this policy redirection and constant re-evaluation, our quality improvement journey continues to yield desired positive health system outcomes. We recommend collaborative quality improvement initiatives with strong internal political will that can harness both the institution's resources and independent experts on health system development.
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Renal angiomyolipoma is the commonest benign solid kidney neoplasm though rare in clinical practice. The advent of radiological imaging techniques, refinement in surgical approach and techniques and availability of mammalian target of rapamycin have improved the outcome in these cohort of patients. ⋯ The incidence of renal angiomyolipoma among solid renal masses is 4.9% in our environment. Open radical nephrectomy is still the preferred method of treatment with satisfactory outcome.
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Ameloblastoma is a benign epithelial odontogenic tumor with a tendency for recurrence. Some recurrent tumors could behave unpredictably with atypical microscopic changes. ⋯ There was a high recurrence rate of recurrent tumors of ameloblastoma demonstrated in the present study, with a malignant presentation in some cases.