This descriptive and comparative review examines the changing epidemiology, treatment, renal and patient outcome of childhood nephrotic syndrome (NS) in tropical Africa (TpAfr). In the 1960s to 1980s, corticosteroid-resistant non-minimal change disease (nMCD) including quartan malaria nephropathy (QMN) was the dominant renal histopathology type. The overall incidence of NS was 0.35-1.34% of hospital admissions. Median age at onset of NS ranged between 4.0 and 12.0 years while the mean (SD) age range was 5.8 (3.8) to 10.3 (4.8) years across studies. The male: female ratio was 1.6:1.0. The overall mean (SD) incidence of idiopathic minimal change disease (MCD) [21.6 (18.6%)] compared with idiopathic nMCD [59.1 (25.7%)] demonstrates significant dominance of the latter (p = 0.0001). Post-1989, the following mean (SD) incidences of histopathological types were: MCD 20.4 (17.7%), focal segmental glomerulosclerosis 39.0 (26.3%), membranoproliferative glomerulonephritis 25.4 (16.8%), proliferative glomerulonephritis 16.7 (27.0%) and membranous nephropathy 7.4 (4.5%). While the mean (SD) proportion of steroid resistance (SR) [73.5 (19.2%)] was significantly greater than the mean complete remission (CR) [26.5 (19.2%)] during 1960-1989 (p=0.005), mean (SD) SR [27.4 (25.3%)] was significantly lower than mean (SD) CR [66.1 (28.0%)] post-1989 (p < 0.001). Unlike QMN, hepatitis B virus, HIV infection, sickle cell disease and systemic lupus erythematosus are now increasingly being associated with NS in TpAfr. Mean (SD) renal survival post-1989 was 58.3 (37.0%) while all-cause mortality was 9.8%. Children with NS now survive better than before, reflecting improved access to healthcare and transition to a clinical pattern favouring idiopathic NS and increased sensitivity to corticosteroids.

BackgroundOcular emergencies can cause permanent vision loss if they are not recognized and treated promptly. This study was carried out to identify the factors responsible for poor visual outcome following emergency eye surgeries.MethodsA cross-sectional study was carried out on all patients who had surgical emergency eye procedures. Clinic and theatre records of all eligible patients were retrieved. Demographic characteristics, duration of symptoms, laterality, presenting visual acuity, documentary pictures, classfication of eye injury, duration of days before surgery, surgical procedures performed and six weeks post-operative visual acuity were obtained from the records. Data were analyzed using Statistical Package for Social Sciences, version 25.ResultsOne hundred and ninety-four patients had emergency eye surgical procedures constituting 16.3% of all ocular emergencies. There were 145(74.7%) males and 49 (25.3%) females with a male-to-female ratio of 3:1. The proportion of students, 48(67.6%), that presented within 24 hours of injury was the highest while the civil servants, 8(17.8%), had the lowest proportion. Corneo-scleral repair topped the list of surgeries and was the commonest, 106(54.6%), procedure carried out the same day of presentation. A 3rd of the patients, 28(34.1%), who presented within 24 hours had normal vision 6 weeks post-operatively while over 4/5th of the patients who presented after 24 hours were blind six weeks post-operatively.ConclusionThe prevalence of eye emergency surgical procedures was high with over 4/5th of these patients becoming blind six weeks post-operatively. Some of the factors responsible for poor visual outcome were delayed presentation, pre-operative visual acuity and delayed surgical intervention.

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Bone infarction involving the orbit in sickle cell disease is not common. Bilateral orbital infarction in a previously undiagnosed sickle cell hemoglobinopathy has not been previously reported. In this report, we present a case of an 11-year-old previously undiagnosed sickle cell disease Nigerian girl with severe acute bilateral orbital infarction and retinal detachment to highlight that hemoglobinopathy induced orbital infarction should be considered in African children with acute onset proptosis with or without previous history of sickle cell hemoglobinopathy.

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