Evaluation of Inter-atrial Septal Defect Diameter and Left Ventricular Systolic Function in Children with Ostium Secundum Atrial Septal Defect in Enugu, Nigeria.

BACKGROUND: Children with ostium secundum atrial septal defect (OS ASD) usually present with varying degrees of ventricular dysfunction. OBJECTIVES: This study aimed to evaluate the left ventricular systolic function of children with OS ASD compared with control. METHODS: This was a cross-sectional study involving 113 children with OS ASD and 113 age- and sex- matched controls. Their age ranged from 1 month to 16 years. There were 49 males and 64 females in each group. Left ventricular systolic function of children with isolated OS ASD were compared with that of controls using echocardiography. Subjects and controls who fulfilled the inclusion criteria were consecutively recruited in the study. The data elicited from the study were analyzed with the IBM SPSS version 20 (IBM Corp, Chicago). RESULTS: The mean left ventricular mass (LV mass) of the control, 93.9±113.6 gm was significantly higher than that of subjects with OS ASD, 39.4±74.3 gm, (Mann Whitney U= 4.266, p< 0.001). Similarly, the mean left ventricular internal diameter in diastole (LVIDd) of the control,25.8±11.7 mm was significantly higher than that of participants with OS ASD, 19.9±7.1 mm (Mann Whitney U=4.522, p<0.001). The mean interventricular septal diameter in systole (IVSs) of the control, 7.2±3.5 mm was higher than that of participants with OS ASD, 5.0±1.9 mm and the mean difference was found to be statistically significant, (Student t=5.738, p<0.001). The mean left ventricular internal diameter in systole (LVIDs) of the control, 16.2±7.6 mm was significantly higher than that of participants with OS ASD, 12.9±5.8 mm, (Student t= 3.660, p< 0.001). There was no significant correlation between the size of interatrial septal defect of children with OS ASD and left ventricular systolic function and age :(Corr. Coef. 0.065, p= 0.492) ; EF( Corr. Coef. 0.121,p=0.202), FS (Corr. Coef. 0.139, p=0.143). CONCLUSION: Children with OS ASD had lower left ventricular mass compared with those with control. Females seem to have higher function than males.

CONTEXTE: Les enfants atteints de communication interauriculaire type ostium secundum (CIASOS) présentent généralement des degrés variables de dysfonction ventriculaire. OBJECTIFS: Cette étude visait à évaluer la fonction systolique ventriculaire gauche des enfants atteints de CIASOS par rapport à des témoins. MÉTHODES: Il s'agissait d'une étude transversale portant sur 113 enfants atteints de CIASOS et 113 témoins appariés selon l'âge et le sexe. Leur âge variait de 1 mois à 16 ans. Il y avait 49 garçons et 64 filles dans chaque groupe. La fonction systolique ventriculaire gauche des enfants présentant un CIASOS isolé a été comparée à celle des témoins à l'aide de l'échocardiographie. Les sujets et les témoins qui remplissaient les critères d'inclusion ont été recrutés consécutivement dans l'étude. Les données recueillies ont été analysées avec la version 20 d'IBM SPSS (IBM Corp, Chicago). RÉSULTATS: La masse moyenne du ventricule gauche (VG) du groupe témoin, 93,9±113,6 g, était significativement plus élevée que celle des sujets atteints d'OS ASD, 39,4±74,3 g (Mann-Whitney U = 4,266, p < 0,001). De même, le diamètre interne moyen du ventricule gauche en diastole (LVIDd) du groupe témoin, 25,8±11,7 mm, était significativement plus élevé que celui des participants atteints d'OS ASD, 19,9±7,1 mm (Mann-Whitney U = 4,522, p < 0,001). Le diamètre moyen du septum interventriculaire en systole (IVSs) du groupe témoin, 7,2±3,5 mm, était plus élevé que celui des participants atteints d'OS ASD, 5,0±1,9 mm, et la différence moyenne était statistiquement significative (Student t = 5,738, p < 0,001). Le diamètre interne moyen du ventricule gauche en systole (LVIDs) du groupe témoin, 16,2±7,6 mm, était significativement plus élevé que celui des participants atteints d'OS ASD, 12,9±5,8 mm (Student t = 3,660, p < 0,001). Il n'y avait pas de corrélation significative entre la taille du défaut septal interauriculaire chez les enfants atteints d'OS ASD et la fonction systolique du ventricule gauche et l'âge : (Coef. Corr. 0,065, p = 0,492) ; FE (Coef. Corr. 0,121, p = 0,202), FS (Coef. Corr. 0,139, p = 0,143). CONCLUSION: Les enfants atteints de CIASOS avaient une masse ventriculaire gauche plus faible que ceux du groupe témoin. Les filles semblent avoir une fonction plus élevée que les garçons. MOTS-CLÉS: Fonction ventriculaire gauche; Communication interauriculaire type ostium secundum (CIASOS); Malformation septale interauriculaire; Enfants; Échocardiographie.

Pattern and Prevalence of Intestinal Helminthiasis among Human Immunodeficiency Virus-Infected Children at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State.

BACKGROUND: Children infected with the human immunodeficiency virus (HIV) may be more prone to helminthic infestation because they have depleted immunity, which increases their susceptibility to infection and infestations, even with minimally pathogenic organisms such as helminths. AIM: The prevalence and pattern of intestinal helminthiasis among children living with HIV attending the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu. PATIENTS AND METHODS: A cross-sectional study in which 70 HIV-infected children were consecutively recruited from the Pediatric HIV clinic and matched for age and sex with 70 children recruited from the children outpatient clinic (CHOP) of UNTH Ituku-Ozalla. Stool samples of study participants were collected and analyzed using the Kato-Katz method and subsequently examined under the microscope for helminths' eggs and larvae. The worm intensity was determined using the theoretical analytic sensitivity (TAS) of 24 eggs per gram (EPG) to obtain the number of eggs per gram of feces. The CD4+ count, which describes the severity of immunosuppression in HIV-positive children was determined using the PARTEC Cyflow counter for the CD4+ lymphocyte count, whereas HIV screening was performed using the rapid diagnostic tests for HIV (Determine, Statpack and Unigold). Data were analyzed using IBM SPSS. RESULTS: The prevalence of intestinal helminthiasis among HIV-infected and non-infected children was 27.1% and 12.9%, respectively (P = 0.038). HIV-positive children were more likely to have intestinal helminthiasis than HIV-negative children (odds ratio [OR] =2.525, 95% confidence interval [CI]: 1.052-6.063). Ascaris lumbricoides was the predominant helminthic species in both HIV-infected and non-infected groups; however, there was no statistical significance between intestinal helminthic species and HIV status (P = 0.655) but the severity of intestinal helminthiasis was significantly associated with decreasing CD4+ count (P = 0.028). The risk factors for intestinal helminthic infestation examined were similar in both HIV-positive and HIV-negative children (P > 0.05). CONCLUSION: There was a significantly higher prevalence of helminthic infestation among HIV-infected children compared to their HIV-negative counterparts. The severity of intestinal helminthiasis was significantly associated with decreasing CD4+ count.

Normalization of Cardiac Structural dimension and Function to Body Surface Area in South East Nigeria Children.

BACKGROUND: Standardizing cardiac valve structures and function to body surface area will help the clinician and surgeons in decision-making. AIM: To evaluate the z-scores of the sizes of cardiac structures and function and to present them in Gaussian curves and reference values. MATERIALS AND METHODS: This was a cross-sectional study that involved 300 apparently healthy children. This study was performed among healthy children from birth to 18 years. Children with a normal echocardiogram, those with no chronic illness, no congenital heart defect, and no acquired heart defect were included in the study. RESULT: The majority fell within the normal limits, as shown in the Gaussian curves. For instance, 40 (13.3%) of atrioventricular (AV) valve diameters were +1 Z-score above the normal, and only 5 (1.7%) were +2 Z-score above the normal. About 9.3% (28/300) had below -2 Z-score below normal, while only 5% had -1 Z-score below normal. Similarly, the left ventricular function z-scores were also derived at -3 Z-scores to +3 Z-scores. The standard reference values were compared with the results obtained from our Z score values. There was no significant difference noted in the Z-scores. P values ranged from 0.07 to 0.84 for all the cardiac structures except for gender, where Z-scores of the mitral valve and left pulmonary artery varied significantly (P = 0.02). CONCLUSION: Reference values of cardiac structure and function were presented using Z scores, and we noted no significant difference when compared with the Western standard values except for the mitral valve and left pulmonary artery.

Echocardiographic Comparison of Left Ventricular Systolic Function and Aortic Blood Flow Velocimetry in Children with Ventricular Septal Defect.

BACKGROUND: The assessments of left ventricular (LV) longitudinal systolic dynamics in children with ventricular septal defect (VSD) have achieved a major milestone in the evaluation of LV systolic function. OBJECTIVES: This study aims to evaluate the LV function, LV mass (LVM), and the descending aorta blood flow in children with VSD compared to that obtained in age and sex-matched controls. RESULTS: The mean LVM of the control, 113.5 ± 123.9 was higher than that of those who had VSD, 75.8 ± 83.9, and the difference in mean was found to be statistically significant (Mann-Whitney U = 2.322, P = 0.022). The mean EF of the control, 67.9 ± 10.3 was comparable to that of those with VSD, 65.6 ± 13.9, (Student's t = 1.223, P = 0.223). Similarly, the mean descending aorta blood flow of control, 1.6 ± 2.2 was comparable to that of those with VSD, 3.9 ± 16.1, (Mann-Whitney U = 1.002, P = 0.321). There was a very weak positive correlation between LVM and descending aorta blood flow among the subjects (n = 85, r = 0.117, P = 0.425). There was a very weak negative correlation between LVM and descending aorta blood flow among control. (n = 85, r = -0.065, P = 0.609). CONCLUSION: The LVM among children with VSD is lower than controls but there is no difference between LV function in subjects and controls. There is a linear increase of LVM with descending aorta blood flow.

Eisenmenger Syndrome: A Revisit of a Hidden but Catastrophic Disease.

BACKGROUND: Eisenmenger syndrome (ES) is a rare condition seen in children with congenital heart disease (CHD). It is characterized by raised pulmonary vascular resistance (PVR) arising from a shunt reversal with the presence of desaturated blood in the systemic circulation. Proper timing and early intervention in children with congenital heart disease have made the syndrome a rare occurrence. However, this cannot be said in developing countries where facilities for the diagnosis and management of children with congenital heart disease are not optimal. OBJECTIVES: The aim of this narrative review is to highlight the importance of early diagnosis and to review the new techniques in the evaluation of children with ES. It also highlights in a snapshot the state of management of ES in a developing country. METHODS: A search for published data on ES was done through several search engines such as Pubmed, google scholar citation, systematic reviews, and meta-analysis. This involves research done over the past 30 years. Keywords such as Eisenmenger'syndrome, 'congenital heart defect', 'Pulmonary hypertension', 'catherterization', 'echocardiography', and children' were used. RESULTS: This review shows the new technique in the diagnosis, aetio-pathogenesis, management and treatment of children with ES in-depth descriptive analysis and new advances in the management of children with ES. CONCLUSION: Eisenmenger syndrome is a preventable disease that can be curbed by early diagnosis and treatment of children with congenital heart disease, especially in the developing world.

CONTEXTE: Le syndrome d'Eisenmenger (SE) est une affection rare observée chez les enfants atteints de cardiopathie congénitale. Il se caractérise par une augmentation de la résistance vasculaire pulmonaire (RVP) due à l'inversion d'un shunt et à la présence de sang désaturé dans la circulation systémique. Le syndrome est devenu rare chez les enfants atteints de cardiopathie congénitale grâce à un choix judicieux du moment et à une intervention précoce. Toutefois, il n'en va pas de même dans les pays en développement où les moyens de diagnostic et de prise en charge des enfants atteints de cardiopathies congénitales ne sont pas optimaux. OBJECTIFS: L'objectif de cette revue narrative est de souligner l'importance d'un diagnostic précoce et de passer en revue les nouvelles techniques d'évaluation des enfants atteints de SE. Elle met également en lumière, sous forme d'un instantané, l'état de la prise en charge de l'ES dans un pays en développement. MÉTHODES: Une recherche de données publiées sur l'ES a été effectuée à l'aide de plusieurs moteurs de recherche tels que Pubmed, google scholar citation, revues systématiques et méta-analyses. Il s'agit de recherches effectuées au cours des 30 dernières années. Des mots clés tels que "syndrome d'Eisenmenger", "malformation cardiaque congénitale", "hypertension pulmonaire", "cathétérisme", "échocardiographie" et "enfants" ont été utilisés. RÉSULTATS: Cette revue présente les nouvelles techniques de diagnostic, d'étio-pathogénie, de prise en charge et de traitement des enfants atteints de SE, ainsi qu'une analyse descriptive approfondie et les nouvelles avancées dans la prise en charge des enfants atteints de SE. CONCLUSION: Le syndrome d'Eisenmenger est une maladie évitable qui peut être enrayée par un diagnostic et un traitement précoces des enfants atteints de cardiopathies congénitales, en particulier dans les pays en développement. Mots-clés: Syndrome d'Eisenmenger; Enfants; Cardiopathie congénitale; Hhypertension pulmonaire; Prise en charge.

Correlation between Lipid Profile and Left Ventricular Geometry and Function in Children with Chronic Kidney Disease.

BACKGROUND: Dyslipidaemia in children with chronic kidney disease is a risk factor for cardiovascular disease especially left ventricular hypertrophy. There have been conflicting reports on the association between serum lipid levels and left ventricular structure and function in children with chronic kidney disease. OBJECTIVES: This study is aimed to determine the correlation between lipid profile and left ventricular geometry and function in children with chronic kidney disease. The study first established lipid profile levels in children with chronic kidney disease (CKD) and compared them with those with normal renal and cardiac function. This was a cross-sectional comparative study carried out among children with CKD and age and sex-matched children without any renal or cardiac pathology as controls. RESULTS: The age range of the study population was 6-17 years with a mean of 12.33 ± 4.24 years, with no statistical difference between groups (t = 0.000, P = 1.000). Though lipid profile levels were higher in subjects with chronic kidney injury than controls, only TG (Triglycerides) was significantly higher in the subjects (1.9 ± 0.4mmol/l) when compared with controls (1.4 ± 0.2mmol/l). P =0.001. There was a positive correlation observed between serum very low-density lipoprotein (VLDL) and left ventricular mass index (LVMI), left ventricular posterior wall diameter (LVPWd), and left ventricular mass (LVM) in subjects r = 0.413, 0.409, 0.414 respectively. The TG/HDL ratio of subjects (1.4±0.4) was higher than controls (1.1 ± 0.1) and this was statistically significant (t = -2.6; p = 0.011). Furthermore, the NON-HDL/TC of subjects (0.8 ±0.1) was higher than that of controls (0.7±0.1) and this was statistically significant (t = -4.0; p <0.001). Finally, the NON-HDL/HDL of subjects (4.0 ± 1.4) was higher than that of controls (2.7 ± 0.5) and this was statistically significant (t -4.0; p<0.001). CONCLUSION: Serum triglycerides are the only lipoprotein that was noted to be significantly higher in children with chronic kidney disease when compared with controls. VLDL is the only lipoprotein with a significant correlation with left ventricular dimension, and hypertrophy. Children with CKD have higher TG/HDL, Non-HDL/ TC, and Non-HDL/HDL ratios than their normal counterparts.

BACKGROUND: La dyslipidémie chez les enfants atteints d'insuffisance rénale chronique est un facteur de risque de maladie cardiovasculaire, en particulier d'hypertrophie ventriculaire gauche. Il y a eu des rapports contradictoires sur l'association entre les taux de lipides sériques et la structure et la fonction ventriculaires gauches chez les enfants atteints d'insuffisance rénale chronique. OBJECTIFS: Cette étude vise à déterminer la corrélation entre le profil lipidique et la géométrie et la fonction ventriculaires gauches chez les enfants atteints d'insuffisance rénale chronique. L'étude a d'abord établi les niveaux de profil lipidique chez les enfants atteints d'insuffisance rénale chronique (IRC) et les a comparés à ceux ayant une fonction rénale et cardiaque normale. Il s'agissait d'une étude comparative transversale réalisée auprès d'enfants atteints d'IRC et d'enfants appariés selon l'âge et le sexe sans aucune pathologie rénale ou cardiaque comme témoins. RÉSULTATS: La tranche d'âge de la population étudiée était de 6 à 17 ans avec une moyenne de 12,33 ± 4,24 ans, sans différence statistique entre les groupes (t = 0,000, P = 1,000). Bien que les taux de profil lipidique étaient plus élevés chez les sujets atteints d'insuffisance rénale chronique que chez les témoins, seule la TG (triglycérides) était significativement plus élevée chez les sujets (1,9±0,4 mmol / l) par rapport aux témoins (1,4±0,2 mmol / l). P=0,001. Une corrélation positive a été observée entre les lipoprotéines sériques de très basse densité (VLDL) et l'indice de masse ventriculaire gauche (LVMI), le diamètre de la paroi postérieure ventriculaire gauche (LVPWd) et la masse ventriculaire gauche (LVM) chez les sujets r = 0,413, 0,409, 0,414 respectivement.Le rapport TG/HDL des sujets (1,4±0,4) était supérieur à celui des témoins (1,1±0,1) et cela était statistiquement significatif (t = -2,6 ; p = 0,011). De plus, la LAT/CT non HDL des sujets (0,8±0,1) était supérieure à celle des témoins (0,7±0,1) et cela était statistiquement significatif (t = -4,0; p <0,001). Enfin, le NON-HDL/ HDL des sujets (4,0±1,4) était supérieur à celui des témoins (2,7±0,5) et cela était statistiquement significatif (t -4,0 ; p <0,001). CONCLUSION: Les triglycérides sériques sont les seules lipoprotéines qui ont été notées pour être significativement plus élevées chez les enfants atteints d'insuffisance rénale chronique par rapport aux témoins. La VLDL est la seule lipoprotéine présentant une corrélation significative avec la dimension ventriculaire gauche et l'hypertrophie. Les enfants atteints d'IRC ont des rapports TG/HDL, Non-HDL/TC et Non-HDL/ HDL plus élevés que leurs homologues normaux. Mots-clés: Triglycérides sériques; Géométrie ventriculaire gauche; Fonction ventriculaire gauche, enfants; Profil lipidique.

Pattern and predictors of internet addiction among secondary school adolescents in Enugu, Nigeria.

Background: Internet addiction has negative effects on adolescents. These range from psychological and social impediments to school absenteeism. Aim: To ascertain the pattern of Internet addiction and the factors that predict Internet addiction among secondary school adolescents in southeast Nigeria. Subjects and Methods: This was a cross-sectional study that involved 796 secondary school adolescents drawn from six secondary schools in Enugu, Nigeria. The data were analyzed using IBM Statistical Package for Social Sciences (SPSS) software. Results: The highest proportion of the respondents (36.3%) had a moderate level of Internet addiction, while the least proportion (2.1%) had severe dependence on the Internet. Adolescents who were less than 15 years of age have 1.1 odds of having Internet addiction when compared to those who were 20 years and above (AOR = 1.1; 95% CI: 0.4-2.8). The respondents who were of the low socioeconomic class were 1.2 times more likely to have Internet addiction when compared with those in the high socioeconomic class (AOR = 1.2; 95% CI: 0.9-1.7). About 20.1% of adolescents were always depressed when they are not using the Internet, while 16.3% of adolescents who were addicted to the Internet developed insomnia. Conclusion: There is a rising prevalence of Internet addiction among secondary school adolescents. Younger adolescents tend to be more addicted to the Internet than their older counterparts. A small number of them had severe Internet addiction. A subpopulation of adolescents who were addicted to the Internet presents with depression and sleep disorders.

Pre-operative 2-D transthoracic echocardiographic diagnosis with intra-operative findings of children with structural heart diseases: A comparative analysis.

Background: Structural heart disease is a major cause of morbidity and mortality in children. Echocardiography is accepted as the first line cost-effective diagnostic modality for pre-operative assessment of children with structural heart diseases. Two-dimensional transthoracic echocardiography (2-D TTE) may be the only diagnostic tool in a resource-poor environment where further investigations may be very expensive and not readily available. Aim: The aim of the study is to determine the degree of accuracy of pre-operative 2-D echocardiographic diagnosis with eventual surgical (intra-operative) findings among children with structural heart diseases with a view to audit the echocardiographic diagnoses and final surgical diagnoses among the patients in the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, a tertiary cardiothoracic center in Enugu, South-east Nigeria. Patients and Methods: 2-D TEE (GE Model) diagnosis of all the children that had cardiac surgery at University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla Enugu over a 3-year period was studied. All the patients had at least two echocardiographic sessions and results were recorded in a proforma. Surgical findings were obtained from post-operative surgical notes. Intra-operative findings were compared with 2-D TTE findings. Data were analyzed using SPSS version 20. The degree of accuracy was expressed as percentages. The relationship between the sensitivity of 2-D TTE and intra-operative findings as ascertained using sensitivities and positive predictive values. Results: There were 55 pediatric cardiac operations performed within the period under review. There were 22 males and 23 females, the age range was from 8 months to 17 years. Fifty-two (94.5%) were due to congenital heart diseases, whereas three (5.5%) were due to acquired heart diseases. Echocardiographic findings were the same as surgical findings in all isolated PDAs (100%), Isolated ASDs (100%), Mitral valve regurgitation three (100%), but missed out PDA as an associated finding in a case of sub-aortic VSD (7.7%) and an ASD in a case of TOF (5.9%), congenital absence of tricuspid valve was also missed as a component of complex cardiac anomaly one (1.1%). These omissions however did not change the surgical approach and outcome. Pre-operative echocardiographic diagnoses and eventual surgical diagnoses were largely concordant. The sensitivity of 2-D TTE and intra-operative findings is 94.5%, positive predictive value is 94.5%, and the false negative rate is 5.5%. Conclusion: Echocardiography is a veritable diagnostic tool in the pre-operative evaluation of children with structural heart diseases. Continuous training and re-training are key in skill development and capacity building in resource-poor countries.

Pulmonary Hypertension in Children with Ventricular Septal Defects.

BACKGROUND: Ventricular septal defect (VSD) is a common congenital heart disease which could be complicated with pulmonary hypertension (PH). OBJECTIVES: This study sought to establish the relationship between severity of PH and size of VSD and age. METHODS: This is a descriptive study where one hundred and fiftyone children aged 3 months to 18 years with echocardiographically confirmed VSD were studied. Pulmonary hypertension (PH) was determined using the tricuspid regurgitation jet velocity with a cutoff of systolic pulmonary arterial pressure (sPAP) at >25mmHg. Severity of pulmonary hypertension was classified into mild (25-50mg Hg); moderate, (51-60mm Hg) and severe ≥ 60mm Hg. Data were analysed using the SPSS version 25. RESULTS: Majority 52.9% had mild PH while 17.6% had severe PH. Mild PH (χ2=15.513, p=0.004) was found among 66.7% of those with small-sized VSD, 42% of those with moderate-sized VSD and 57.1% of those with large-sized VSD. There was a weak positive correlation between PH and size of VSD (n=132, r=0.320, p<0.001). For one-unit increase in age (in months), PH was noted to decrease by 0.030 (B= -0.030, 95%CI: -0.090- 0.030) and for a unit increase in size (mm) of VSD, PH increased by 1.681 units (B=1.681, 95%CI: 0.798- 2.563). CONCLUSION: There was a linear increase in pulmonary hypertension with increase in the size of ventricular-septal defect and decrease in the age of children with VSD. Age and VSD size were significant predictors of PH severity in children with VSD. All sizes of VSD are associated with pulmonary hypertension. A unit increase in age (in months), caused a decrease of PH by 0.030units and a unit increase in size (mm) of VSD resulted in an increased PH by 1.681 units.

CONTEXTE: La communication interventriculaire (CIP) est une cardiopathie congénitale courante qui peut se compliquer d'hypertension pulmonaire (HP). OBJECTIFS: Cette étude visait à établir la relation entre la sévérité de l'HTP et la taille de la communication interventriculaire et l'âge. MÉTHODES: Il s'agit d'une étude descriptive dans laquelle cent cinquante et un enfants âgés de 3 mois à 18 ans avec une VSD confirmée par échocardiographie ont été étudiés. L'hypertension pulmonaire (HP) a été déterminée en utilisant la vitesse du jet de régurgitation tricuspide avec un seuil de pression artérielle pulmonaire systolique (PAPS) à >25mmHg. La gravité de l'hypertension pulmonaire a été classée en légère (25-50mg Hg) ; modérée, (51-60mm Hg) et sévère ≥60mm Hg. Les données ont été analysées à l'aide du SPSS version 25. RÉSULTATS: La majorité 52,9% avait un PH léger tandis que 17,6% avaient un PH sévère. Un PH léger (χ2=15,513, p=0,004) a été trouvé chez 66,7% de ceux qui avaient une VSD de petite taille, 42% de ceux qui avaient une VSD de taille modérée et 57,1% de ceux qui avaient une VSD de grande taille. Il y avait une faible corrélation positive entre le PH et la taille de la VSD (n=132, r=0,320, p<0,001). Pour une augmentation d'une unité de l'âge (en mois), le PH a diminué de 0,030 (B= -0,030, 95%CI : -0,090- 0,030) et pour une augmentation d'une unité de la taille (mm) de la VSD, le PH a augmenté de 1,681 unités (B=1,681, 95%CI : 0,798- 2,563). CONCLUSION: Il y avait une augmentation linéaire de l'hypertension pulmonaire avec l'augmentation de la taille du défaut ventriculaireseptal et l'augmentation de l'âge des enfants avec VSD. L'âge et la taille de l'anomalie ventriculaire-septale étaient des prédicteurs significatifs de la gravité de l'hypertension pulmonaire chez les enfants atteints d'une anomalie ventriculaire-septale. Toutes les tailles de VSD sont associées à l'hypertension pulmonaire. Une augmentation unitaire de l'âge (en mois) a entraîné une diminution de l'HTP de 0,030 unité et une augmentation unitaire de la taille (mm) de la CIA a entraîné une augmentation de l'HTP de 1,681 unité. MOTS CLÉS: hypertension pulmonaire ; VSD ; taille ; âge.

The impact of body mass index on left ventricular mass index, right ventricular function, and cardiac dimension of children with sickle cell anemia in Enugu City.

BACKGROUND: Body mass index is a major determinant of cardiac annular valvar dimension and left ventricular mass index in children with sickle cell anemia. OBJECTIVES: The study is aimed at ascertaining the impact of Body Mass Index on Left ventricular mass index, right ventricular function and cardiac dimension of children with sickle cell anemia. METHODS: A case control study in which echocardiographic measurement of cardiac function and structures were ascertained among children with sickle cell anemia compared with hemoglobin AA genotype. RESULTS: There were 51 subjects and 50 controls. The subjects comprised 54.9% males and controls, 52.0% male. There was a strong positive correlation between BMI and most cardiac structure diameters among children with normal hemoglobin genotype (Pearson's correlation coefficient value, P < 0.001) There was also statistically significant positive correlation between BMI and LV mass among the subjects (n = 50, r = 0.5, P < 0.001). There was significant positive correlation between BMI and TAPSE in both subjects and controls as well as between BMI and RVSP among the subjects, but not the controls (p < 0.001). There was no significant difference in the number with left ventricular hypertrophy (LVH) based on their nutritional status (n = 51, χ^2 = 7.03, P = 0.32). The BMI correlated negatively with left ventricular mass index (LVMI) among the subjects, but the correlation was not statistically significant (r = -0.1, P = 0.53). CONCLUSION: There was significant positive correlation between BMI and TAPSE in both subjects and controls as well as between BMI and RVSP among the subjects, but not the controls. Body mass index correlated negatively with left ventricular mass index (LVMI) among the subjects.

Health-related quality of life in children and adolescents with epilepsy in Enugu: Need for targeted intervention.

BACKGROUND: Epilepsy, a chronic brain disorder, predisposes children to low Health-Related Quality of Life (HRQOL). OBJECTIVE: This study aimed at assessing the HRQOL in Nigerian children with epilepsy and compare it with that in healthy children. METHODS: A cross-sectional study of 166 children with epilepsy (CWE), aged 5-18 years on anti-epileptic drugs (AEDs) for at least 6 months and 166 age and sex-matched apparently healthy children was conducted. A generic version of the Pediatric Quality of Life (Peds QoL version 4) scale was used to assess HRQOL. RESULTS: There were significant differences in Quality-of-Life mean scores in the domains of social functioning, psychosocial combination, and psychosocial plus physical activities between cases and controls. The school function scores of <50, indicating low QOL, were significantly more (Chi square = 35.37) (P = 0.0001) among the cases (32.5%) compared to the controls (6.3%). Similarly, low quality of life in the psychosocial combination were observed significantly (P_ = 0.042) more among the cases (12.7%) compared to the controls (6.3%). Low quality of life in emotional feeling domain were noted significantly (Chi square = 12.9) (P = 0.0002) more in subjects aged between 8 and 12 (20%). QOL scores of below 50 in the social function domain were observed significantly (Chi square = 6.49) (P = 0.039) more in subjects aged between 5 and 7 years (44.8%). There was significant gender difference in Quality-of-life index in school functioning domain in subjects. (Chi Square = 6.49) (P value = 0.039). Children in the upper social class scored higher in the social functioning domain, and social class was significantly associated with scores in the social domain of functioning. (F = 3.75 and P = 0.03). QOL scores below 50 in the emotional domain were significantly more among subjects aged 8-12 years/13-18 year, s and QOL scores of <50 in the school function domain were significantly more in subjects aged 5-7 years. (P = 0.0002) (P = 0.039), respectively. CONCLUSION: HRQOL is reduced in CWE in all domains of Peds QoL. Significant predictors of reduced HRQOL include age, gender, and socioeconomic class. Beyond seizure control, epilepsy management should be oriented towards ensuring the optimal health-related quality of life.

Caring for Children with Congenital Heart Diseases:Economic Burden of Pre-Surgical Management on Nigerian Families.

BACKGROUND AND OBJECTIVES: Managing children with Congenital Heart Disease (CHD) attracts enormous cost especially in resource-poor settings like Nigeria. This study sought to determine the healthcare costs of pre-surgical management of CHD and describe its catastrophic effects on households. METHODS: Using a semi-structured interviewer-administered questionnaire, caregivers of children with CHD were interviewed. Family income, type of CHD, co-morbidity, healthcare payment mechanism and healthcare cost were explored over 3 months prior to the study. Healthcare costs were then averaged to obtain monthly estimates. Catastrophic health expenditure (CHE) was defined as healthcare spending above 10% family monthly income. Factors associated with increased healthcare spending in CHD management were explored using the Kruskal Wallis test of significance. RESULTS: Of the 108 parents interviewed, 81.0% paid for healthcare using out-of-pocket payment mechanism. The median direct monthly medical and non-medical costs were N==3,625 (range: N==200 - N==59,350) [$10.07; range:$0.56-$164.86] and N==420 (range: N==150 -N ==11,000) [$1.17; range $0.42-$30.56] respectively. Hospitalisation and transportation accounted for majority of the direct medical and non-medical costs, respectively. About 36.1% of families suffered financial catastrophe. Catastrophic overshoot and mean positive overshoot were 5.6% and 30.8% above the 10% income threshold, respectively. The healthcare spending was significantly higher in families of children with CHD complicated with heart failure (p=0.001) and pulmonary hypertension (p=0.038) and those who suffered financial catastrophe (p=0.001). Health insurance did not significantly reduce healthcare spending among the insured(p=0.630). CONCLUSION: The economic burden of pre-surgical management of children with CHD is high in Nigeria. Appropriate interventions governmental and non-governmental organisations are needed to cushion the burden of healthcare costs on affected families.

Complex congenital heart diseases among children presenting for cardiac surgery in a tertiary health facility in Enugu; South-East Nigeria. A rising trend.

BACKGROUND: Complex cardiac anomalies are a set of associated heart structural anomalies requiring some adaptive mechanism to maintain life. OBJECTIVES: This is to determine pattern and prevalence of common complex cardiac anomalies among children presenting for cardiac surgery in Enugu. METHODOLOGY: The children that present for cardiac surgery in our center over a six-month period were admitted and rescreened using a standardized echocardiographic method, information on biodata, oxygen saturation and 2D echo diagnosis were recorded in a proforma. RESULTS: A hundred and one (101) children with different structural heart diseases presented for cardiac surgery, 53 females and 48 males, 99 (98%) had congenital heart defects (49 cyanotic and 50 acyanotic). Complex cardiac anomalies were noted among 49 and 50 were non-complex, 6 (12.2%) acyanotic, and 43 (87.8%) cyanotic complex P < 0.01. This was noted among 21 females and 28 males. Children less than 3 years had 31 cases (63.3%) of the complex heart diseases while children between 5 years to 18 years had 14 (28.6%). The top three complex congenital heart disease were complex Tetralogy of Fallot which was found among 26 (53%) subjects. Tricuspid atresia and Truncus arteriosus were found in 3 children with congenial heart disease each, Shone complex was found in a child, Hypoplastic left heart syndrome was also noted in a child. CONCLUSION: The incidence of complex congenital heart diseases among prospective Paediatric cardiac surgery patients is high. Efforts should be made to improve access to preventive cardiology in order to curb these diseases.

Comparison of plasma electrolytes of perinatally asphyxiated and normal term babies.

OBJECTIVES: The objective of this study is to document and compare plasma electrolytes of asphyxiated newborns of different degree within 48 hours of life. STUDY DISIGN: A comparative cross-sectional study was conducted in the newborn special care unit at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Sodium, potassium, bicarbonate and ionized calcium levels were estimated in the plasma samples of neonates with perinatal asphyxia of different degree and healthy newborns (control group) within 48 hours of birth. MAIN OUTCOME MEASURES: The plasma sodium, potassium, bicarbonate and ionized calcium levels were estimated in both, the study subjects and controls. RESULTS: Mean plasma sodium level was significantly lower (134.93±5.24 mmol/l vs 141.90±3.36 mmol/l; P < 0.05), mean plasma bicarbonate level was significantly lower (16.98±3.99 mmol/l vs 18.54±2.36 mmol/l; P < 0.05), and mean plasma ionized calcium level was significantly lower (1.10±0.14 mmol/l vs 1.25 0.11 mmol/l; P < 0.05) in subjects compared to controls while mean plasma potassium was significantly higher (5.07±0.93 mmol/l vs 4.65±0.51 mmol/l P < 0.05) in subjects compare to controls. CONCLUSION: The tendency to have hyponatremia, hyperkalemia, acidosis and hypocalcemia is very high among the study subjects which underscores the need for great vigilance in electrolyte monitoring when managing an asphyxiated baby.

Evaluation of the School Environment of Public and Private Schools in Enugu to Ensure Child Health Promotion.

OBJECTIVES: Poor maintenance of school environment can cause or worsen illnesses among schoolchildren. The objective of this study was to assess the healthfulness of school environments of primary schools in Enugu East, Nigeria, and to compare the difference if any between public and private schools. STUDY DESIGN: This was a cross-sectional noninterventional study of the school environments in Enugu East, Nigeria. METHODS: Multistage sampling method was used to select the sample population. The participating schools were inspected and their head teachers were interviewed using a questionnaire. Scores were awarded using the School Health Program Evaluation scale. Results: Thirty-three schools were studied. The most common source of water for most schools was well. Eleven schools dump refuse openly. Three public schools only had functional toilets. All public schools were adequately ventilated and lit. One private school had a foodservice area. Ten schools did not have a play field, while three public schools had soaps for handwashing. The mean scores for public and private schools were 33.00 and 37.86, respectively. Three schools only attained the minimum score of 57 of a maximum of 66. CONCLUSION: The environment of primary schools in Enugu east, Nigeria, is unhealthy and unfriendly and currently cannot promote and protect the health of the schoolchildren.

Somatization disorder among adolescents in southeast Nigeria: a neglected issue.

BACKGROUND: Adolescents do present with somatization disorder which is often neglected by pediatricians. This could have serious consequences if not curbed early. OBJECTIVES: This study is aimed at determining the pattern and types of Somatization disorder among adolescents attending secondary schools in south east Nigeria. METHODS: Somatization disorder was investigated among 485 adolescents from mixed schools using a stratified random sampling of adolescents from four secondary schools in southeast Nigeria. The Enugu somatization scale was used to evaluate for presence of somatization in the participants. Statistical analysis was with statistical package for social sciences (SPPS) version 19 (Chicago IL). RESULTS: A total of 485 adolescents aged 10-19 years were included in this study. The mean age of the respondents was 16.36 with standard deviation (SD) of 3.14 years. Two hundred and fifty-one (51.8%) had head features, 262 (54.0%) had body features, 303 (62.5%) had either head or body features while 210 (43.3%) had both head and body features. One hundred and thirty-four males (51.3%) compared to 117 females (52.2%) reported symptoms consistent with head symptoms (p = 0.038). One hundred and eleven males (42.5%) compared to 99 females (44.2) reported symptoms related to the head and body (p = 0.137) while 135 males (51.7%) compared to 127 females (56.7%) reported symptoms related to the body (p = 0.925). There were significant associations of age in categories with head, body, either head or body as well as both head and body features (all p value <0.001). CONCLUSIONS: Psychosomatic problems do exist and may be on the rise among adolescents.

Community-Acquired acute kidney injury in critically Ill children as seen in the emergency unit of a tertiary hospital in Enugu, Southeast Nigeria.

BACKGROUND: Acute kidney injury (AKI) has been shown to be common in critically ill patients with associated very poor outcome. There is paucity of data regarding its epidemiology, particularly in developing countries. This study aims to assess the presence of AKI among critically ill children to determine its prevalence, outcome, and outcome determinants in children suffering from AKI. PATIENTS AND METHODS: This is a cross-sectional observational study of critically ill children admitted to the children emergency unit of University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu. Critically ill children suffering from AKI were identified and classified using the pediatric RIFLE criteria. RESULT: A total of 300 children were studied. One hundred and eighty (60%) were males. The prevalence of AKI in the study population was 56%. Factors associated with AKI included age <5 years (OR = 3.618; 95% CI = 2.100-6.235; P < 0.001), inability to drink (OR = 2.866; 95% CI = 1.723-4.766; P < 0.001), tachycardia (OR = 2.111; 95% CI = 1.071-4.163; P = 0.031), unconsciousness (OR = 3.128, 95% CI = 1.303-7.511; P = 0.011), and hypotension (OR = 2.619; 95% CI = 1.008-6.804; P = 0.048). The odds of death increased with increasing severity of AKI among those who had pRIFLE-F, who were 24 times more likely to die than those with no AKI (OR = 24.38; 95% CI = 5.702-104.194; P = 0.001). CONCLUSION: The prevalence of AKI in the study population was unacceptably high. The risk factors to its occurrence can be determined from epidemiologic and clinical data, and therefore, clinicians attending to critically ill patients should identify those with AKI for early intervention to reduce the expected poor outcomes associated with its occurrence.

Psychosomatic problems among medical students: a myth or reality?

BACKGROUND: Medical students are exposed to stress and this can predispose them to psychological and behavioral consequences. METHODS: Psychosomatic disorders were investigated among 385 medical students from two teaching hospitals using a stratified random sampling. The Enugu somatization Scale (ESS) was used to evaluate for presence of somatization in the participants. Statistical analysis was done with the Statistical Package for Social Sciences (SPPS) version 19 (Chicago IL). RESULTS: A total of 385 medical students with a calculated mean age of 23.55 ± 3.33 years were recruited in this study. The prevalence of psychosomatic disorder was 55 (14.3%) with prevalence among males 33 (14.2%) and among females 22 (14.4%). Based on features, 44 (11.4%) had head features while 30 (7.8%) had body features of psychosomatic disorder respectively. Similar proportion of both males and females (about 14% each) had psychosomatic disorder. There was no statistically significant difference ([Formula: see text] = 0.002, p = 0.966). Students aged 24 years and below had similar proportion of psychosomatic disorder 38 (14.3%) with those aged over 24 years 17 (14.2%). The difference was not statistically significant ([Formula: see text] = 0.002, p = 0.964). Students from lower social class had lower proportion of psychosomatic disorder (10.6%) when compared to middle (17.2%) and upper (15.2%). The difference was equally not statistically significant ([Formula: see text] = 1.759, p = 0.415). Male students had similar likelihood of psychosomatic disorder with females (OR 1.01, 95% CI 0.56-1.82). Those had belong to middle socio-economic class were about 1.2 times (AOR 1.15, 95% CI 0.54-2.45) and lower socio-economic class about 0.6 times (AOR 0.66, 95% CI 0.31-1.37) likely to have psychosomatic disorder than those from upper socio-economic class. CONCLUSIONS: Psychosomatic disorders constitute an emerging mental health problem among medical students in Nigerian Universities. This can pose a major mental health problem if neglected.

Testicular volume of healthy term neonates: Determination of normative values among Igbo babies in South-Eastern Nigeria.

BACKGROUND: Testicular volume (TV) in neonates has some predictive values of clinical importance. Establishing the normal values of TV among term newborn males of every population is important as differences exist among different populations. Much is not known on TV among Igbo newborns. AIM: The aim of this study was to determine the normative values of TV in apparently healthy term Igbo newborn males in Enugu, South-Eastern Nigeria and its relationship with gestational age (GA), birth weight (BW), and birth length (BL). SUBJECTS AND METHODS: This was a hospital-based, cross-sectional and descriptive study. Eight hundred and eleven apparently healthy term Igbo male neonates within the first 3 days of life were studied. The TV was measured with Prader Orchidometer (ZKL-135-H), ESP Model. Smoothed centiles (3-97th percentile values) for TV by GA were determined. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 (Chicago). P < 0.05 were regarded as statistically significant. RESULTS: The mean TV was 1.74 ± 0.62 ml ranging from 1 to 3 ml. The TV increased with increasing GA (P = 0.00). Pearson's correlation test between TV and birth length (r = 0.301, P = 0.001), as well as with BW (r = 0.247, P = 0.001) were significant. A linear regression demonstrated correlation between TV and birth length (P = 0.0001, r2 = 0.091). CONCLUSION: The mean TV among male Igbo newborn is 1.74 ± 0.62 ml. Also, the first smoothed percentile values for TV by GA for Nigerian Igbo babies is created.

Cerebral Malaria Complicated by Blindness, Deafness and Extrapyramidal Tract Manifestation.

Cerebral malaria is a severe manifestation of a parasitic infection caused by Plasmodium falciparum. The sequelae of this disease such as blindness, deafness, loss of motor function could be emotionally traumatic and physically disabling. We, therefore, present this case of an 8-year-old boy who presented with high-grade intermittent fever associated with multiple convulsions and prolonged coma. He regained consciousness after 12 days of treatment with intravenous quinine but was found to have blindness, sensory-neural deafness and extrapyramidal sign. This extrapyramidal sign regressed following treatment with chlorpromazine. He also regained his sight and auditory function before he was discharged though not completely. This report is aimed at emphasizing these rare complications of cerebral malaria as well as reminding clinicians working in malaria endemic areas of the world on the need for early diagnosis and prompt treatment.