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Purpose Convulsive status epilepticus (CSE) is associated with a high morbidity and mortality. This study aimed to describe the clinical profile, aetiology, neuroimaging and EEG findings as well as outcome of children with CSE in Sub-Saharan Africa. Methods This was a retrospective analysis of electronic records of children with CSE admitted to the Paediatric Intensive Care Unit (PICU) over an 8-year period from January 2007 to December 2014. Results Seventy six patients were admitted to the PICU with CSE and 55(72%) had refractory status epilepticus. The median age at presentation was 15 months (IQR 6–37 months). The main aetiologies were meningoencephalitis and gastroenteritis in 33(43%) and 19(25%) patients respectively. The most frequently used antiepileptic drugs for CSE in PICU consisted of infusions of midazolam (96%) and thiopentone (22%). Neuroimaging findings were abnormal in 53(75%) patients with hypoxic changes in 17 patients. On multivariable regression, the predictors of poor outcome included the use of more than 3 antiepileptic drugs in PICU(RR-1.41(1.12–1.78), p=0.003), duration of mechanical ventilation for more than 3days (RR 1.98(1.22–3.20), p=0.005) and abnormal neuroimaging findings (RR 3.21(1.53–6.72), p=0.002). The mortality rate was 24%(n=18). Persistent seizures or a new neurological deficit occurred in 58%(n=44). The main cause of mortality was CSE related diffuse cortical and brainstem injury. Predominant neurological sequelae were cerebral palsy and persistent epilepsy. Conclusion The high burden of infection related CSE is associated with high morbidity and mortality rates in contrast to the rates in developed countries. This highlights the need for early recognition and treatment of underlying conditions.

Endometriosis refers to the presence of ectopic endometrial tissue outside the uterus, that may result in infertility or recurrent implantation failure.We aimed to document the number of histopathologically confirmed cases of endometriosis at the largest hospital in Africa during a three-year timeframe. Age, topographic site, pathological components, CD10 immunohistochemistry, metaplasia and associated neoplasms were documented.A retrospective, descriptive cross-sectional review of confirmed cases of endometriosis was conducted.Thirty-four (n = 34) patients were confirmed to have endometriosis within 43 topographic sites. More than one topographic site of involvement was documented in 5 patients. The age range was 24 to 58 years [median age 36.4 ± 8.03; mean 34.5 ± 8.03 yrs]. The most frequent diagnostic combination was the triad of endometrial glands, stroma and chronic haemorrhage as confirmed in 53% of the cases. The most frequent topographic site of involvement was the ovary (27.9%) followed by the fallopian tubes (16.7%), umbilical region (13.9%), and abdominal wall (11.6%). Endometriotic cyst was reported in 10 cases (29.4%) and the ovary was the most common site in which endometriotic cysts occurred (p .01). Endometrioma was only confirmed at the abdominal wall of one patient. CD10 immunochemistry was requested in 5 cases and confirmed the presence of endometrial stroma in all cases tested. Ciliated metaplasia was common (62%). Endometriosis was documented incidentally in context of two cases of neoplasia (pre-invasive and invasive).Endometriosis is diagnosed predominantly, but not exclusively, in women of child-bearing age. Ovarian involvement has a propensity to develop endometriotic cysts. CD10 immunohistochemistry has diagnostic value when endometrial stroma is limited or inconspicuous.

Background. The clinical presentation of type 1 diabetes in children can be acute or insidious, and symptoms may be subtle and frequently misinterpreted. Presentation with diabetic keto-acidosis (DKA) may be associated with significant morbidity and mortality in the paediatric population. This study set out to determine the characteristics of children presenting to the paediatric endocrine service at Inkosi Albert Luthuli Central Hospital (IALCH) with DKA at the time of diagnosis, and to determine the frequency of missed diagnoses in the previous month. Methods. A retrospective study was done at IALCH, the paediatric tertiary referral centre for KwaZulu-Natal, South Africa. The study sample included all children with an initial diagnosis of type 1 diabetes between January 2008 and June 2010. Children presenting with DKA were compared with those who presented without DKA. Results. During the period under review, 63 children presented with type 1 diabetes. Of these, 44 (69.8%) had DKA at the time of diagnosis. The median duration of symptoms preceding diagnosis in the DKA group was 2 weeks, versus 4 weeks in the non-DKA group ( p =0.002). There was no significant difference between the groups when ethnicity, gender and age at presentation were compared. Of 42 patients who presented to healthcare facilities in the month preceding diagnosis, 27 (64.3%) were misdiagnosed. Conclusion. Patients who presented with DKA had a shorter duration of symptoms than the non-DKA group. Ethnicity had no effect on characteristics at presentation. There was an unacceptable rate of missed diagnoses of type 1 diabetes in both the private and public sectors.