Portal hypertension evolving from sickled hepatopathy: Could hepatic venous Doppler ultrasound be beneficial in its evaluation?

PURPOSE: Sickle cell intrahepatic cholestasis involves sickling within hepatic sinusoids leading to vascular stasis and localized hypoxia resulting in ballooning of the hepatocytes causing a direct back pressure effect with resultant intracanalicular cholestasis. Vascular stasis may ultimately lead to portal hypertension. We proposed to document findings suggestive of portal hypertension evolving from hepatopathy in steady-state sickle cell disease (SCD) patients using hepatic venous Doppler ultrasound. METHODS: This is a prospective case series of 6 SCD subjects in steady-state (median age, 30 years; range, 19-43), comprising of 3 males and 3 females, who underwent a routine Doppler ultrasound evaluation of their hepatic veins and were discovered to have an abnormal biphasic waveform pattern. Venous blood was obtained from all subjects to evaluate for P-selectin, homocysteine, foetal haemoglobin, haematocrit levels, white cell and platelet counts. Doppler ultrasound was also carried out on all subjects to evaluate for the hepatic waveform, right renal artery RI and PI along with the hepatic artery velocities. RESULTS: All the 6 subjects had reduced haematocrit (median value of 21.5%; range, 18-25%) and some degree of renal dysfunction (plasma cystatin-C ranged from 1.6 to 12.2 mg/L). Elevated white cell count, hyperhomocysteinemia, reduced SpO2(<94.0%) and reduced estimated GFR (eGFR < 90 ml/min) was also noted in 4 subjects (66.7%). Similarly, 4 subjects (66.7%) had elevated RI in the right kidneys while 3 subjects (50.0%) had elevated PI in the right kidney. CONCLUSION: Doppler ultrasound Hepatic vein waveform analysis may be a useful examination in the evaluation of patients with SCD as it may elicit feature of portal hypertension. Further studies are suggested to confirm this in a larger population of SCD patients using the gold standard.

A multicentre study evaluating the risk and prevalence of diabetic retinopathy in children and young people with type 1 diabetes mellitus.

INTRODUCTION: There is currently limited data published on the prognostic factors and prevalence of diabetic eye disease in children and young people (CYP) with Type 1 diabetes mellitus (T1DM), yet diabetic retinopathy remains one of the commonest causes of blindness in young adults. The aim of this study was to determine the risk and prevalence of diabetic retinopathy (DR) and to evaluate the risk factors associated with diabetic retinopathy in CYP with T1DM. METHODS: All CYP with Type 1 diabetes between 12 and 18 years of age, registered with the regional diabetic retinopathy screening programme were evaluated from 2012 to 2013 in four diabetes units within the north west region of the United Kingdom. Patients who had evidence of diabetic retinopathy were reviewed to identify risk factors for presence or absence of diabetic retinopathy. RESULTS: 237 patients between the ages 12-18 years were included in the. The prevalence of diabetic retinopathy was 11%. Out of 27 patients with evidence of diabetic retinopathy, 44% were reported as background changes and 56% had pre-proliferative DR. Significant risk factors for diabetic retinopathy disease in the population using univariate analyses were duration of diabetes, puberty, age at diagnosis and mean HbA1c in the preceding 12 months. Multivariate logistic regression analysis found age of diagnosis (p = 0.04) and mean HbA1c as significant independent risk factors for presence of diabetic retinopathy (p = 0.02). CONCLUSIONS: The prevalence of diabetic retinopathy in this paediatric population was 11%. Early age at diagnosis and poor metabolic control are independent risk factors for diabetic retinopathy.

Relationship between Renal Doppler Indices and Biochemical indices of Renal Function in Type 2 Diabetes Mellitus.

OBJECTIVES: Diabetic nephropathy is a common complication of diabetes mellitus due to microangiopathy leading to end stage renal disease. This study determined the relationship between renal resistivity index and pulsatility index with biochemical indices of renal function in patients with type 2 diabetes mellitus methods: This study involved 80 adults with type 2 diabetes mellitus. Urinary albumin excretion rate (UAER) and serum creatinine levels were measured, and the estimated glomerular filtration rate (eGFR) was calculated. Right renal resistivity index (RI) and pulsatility index (PI) values were determined. RESULTS: Mean renal resistivity index was 0.72±0.06 while the pulsatility index was 1.36 ± 0.24. Resistivity index was positively correlated with albuminuria (r = 0.426; p <0.001) and serum creatinine (r = 0.458; p <0.001), but negatively correlated with eGFR (r = -0.399; p <0.001). There was positive correlation between pulsatility index and albuminuria (r = 0.341; p = 0.002), and serum creatinine (r = 0.478; p = <0.001); and negative correlation between PI and eGFR (r = - 0.359; p = 0.001). CONCLUSIONS: Renal resistivity index and pulsatility index may provide valuable non-invasive estimate of predicting the presence and severity of renal dysfunction in patients with type 2 diabetes.

Variations of renal vascular anatomy in a nigerian population: A computerized tomography studys.

BACKGROUND: A broad spectrum of renal vascular variations has been reported by anatomists and radiologists. The prevalence of these variations is extremely divergent in different populations. Therefore, radiologists and surgeons in different climes must be knowledgeable about the type and prevalence of the variants in their area of practice to avoid diagnostic pitfalls and for optimization of surgical techniques. OBJECTIVE: The objective of this study is to describe the types and prevalence of renal vascular variations among patients undergoing contrast-enhanced computerized tomography (CECT) of the abdomen in a Nigerian population, as well as provide a concise review of literature on the embryological basis and clinical significance of the identified variations. MATERIALS AND METHODS: This study was a retrospective review of 200 CECT of the abdomen to identify variations of arterial (accessory, early branching, and precaval) and venous (multiple, retroaortic, and circumaortic) anatomy of the kidneys. RESULTS: We studied 200 patients, 102 (51%) females and 98 (49%) males. Age range is 18-90 years (mean = 53.08 ± 17.01). Prevalence of any renal vascular variations was 50%, arterial variations were 37%, and venous variations were 13%. Variations were significantly more common in males, P = 0.000075. The most common arterial variant was the accessory renal artery (23%) seen in 10% (right) and 13.0% (left); early branching was seen in 4.0% (right) and 0.5% (left) as well as precaval right renal artery seen in 4.5%. Venous variants were late confluence 3.0% (right) and 2.5% (left); multiple veins was seen in 2.5% (right) and 2.5% (left) as well as retroaortic left renal vein seen in 2.0%. The inferior polar accessory artery was the most prevalent accessory artery. Early arterial bifurcation was significantly more common on the right (P = 0.016) while other vascular variants showed no statistically significant association with laterality. CONCLUSION: Variation of renal vascular anatomy is a frequent finding among Nigerians. Radiologists and surgeons must be aware of these variants for optimization of surgical techniques.

Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest Nigeria.

PURPOSE: To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography. MATERIALS AND METHODS: 60 adult subjects with suspected obstructive uropathy and 60 asymptomatic apparently healthy controls with normal renal ultrasound features were evaluated. B-mode sonography of the kidneys and spectral Doppler examination of the renal interlobar arteries of all the participants were performed. The mean resistive indices (mRI) of both interlobar arteries were obtained and compared to that of the controls. The mRI of bilaterally obstructed kidneys were also compared with the mRI of unilaterally obstructed kidneys. RESULTS: The mRI of the right and left kidneys of subjects were 0.72±0.04 and 0.69±0.06 while those of the controls were 0.64±0.04 and 0.63±0.03 respectively. The mRI for the grades of caliectasis increased from grade I (0.72±0.03) to grade II (0.73±0.03) and grade III (0.73±0.02) but fell within the most severe levels of obstruction (0.69±0.07). There was no statistically significant relationship between the grades of caliectasis and unilateral or bilateral obstruction for both kidneys. The results show a sensitivity and specificity of 86.7% and 90% respectively when mRI≥0.7 was used to determine presence of obstruction. CONCLUSION: Renal duplex sonography is highly sensitive and specific for diagnosis of obstructive uropathy. Increased resistive index of the obstructed kidney may be a useful diagnostic tool in situations where intravenous urography cannot be done or is contraindicated.

Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest Nigeria

To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography.

Penile size in healthy Nigerian newborns: country-based reference values and international comparisons.

AIM: To establish normal reference values for penile size in Nigerian newborn boys and to compare those values with standards from other populations. METHODS: A total number of 261 healthy newborn boys delivered at gestational ages of 28 weeks or more were enrolled in the study. Penile lengths and widths were measured within 72 h of birth. RESULTS: The mean (±SD) penile length in the 261 Nigerian males studied was 3.4 ± 0.48 cm, while the mean mid-shaft diameter was 1.2 ± 0.14 cm. Compared with data from other populations, Nigerian newborn boys had similar penile sizes to those reported for US Caucasian boys (mean 3.4 cm), but significantly greater penile sizes than those reported for boys from China and Hong Kong (mean 3.0 and 3.1 cm, respectively; both p < 0.001). There was a slight, but significant, difference in size between Nigerian and Malaysian boys, with Malaysian boys having greater penile sizes (mean 3.5 cm; p < 0.05). CONCLUSION: A Nigerian newborn with a penile length of <2.39 cm can be considered to have a micropenis.

Paediatric endocrine disorders at the university college hospital, ibadan: 2002 - 2009.

BACKGROUND: Until recently, most published research focus more on infectious diseases and malnutrition giving the impression that endocrine disorders are uncommon. Reports on endocrine disorders in children in developing countries are few compared to developed countries reflecting the different level of prevalence in the different geographical locations and or level of awareness and availability of facilities for proper diagnosis. OBJECTIVE: This study aims at defining the burden of paediatric endocrine disorders in Ibadan. SUBJECTS/METHODS: A review of records of children who presented at University College Hospital, Ibadan with paediatric endocrine disorders from 2002 to 2009 was carried out. RESULTS: During the eight-year period, a total of 110 children presented with various endocrine disorders but only 94 had complete data for this study. There were 47(50%) males and 37(39.4%) females, and in 10(10.6%) of them, had genital ambiguity at presentation. Patients' ages ranged from 2 weeks to 15 years with a median of 3 years. Many (35%) patients were malnourished with weight less than 80% of the expected weight for age and only 9% were overweight. Yearly distribution of cases showed a steady increase in number of cases from 2005. Rickets and metabolic disorders constituted 56.4% of patients; Diabetes mellitus was diagnosed in 12.8%, adrenal disoders in 10.6%, pubertal disorders in 5.3% and growth disorders in 4.3% of the patients. Thyroid disorders were present in 6.4%, obesity in 3.2% while the least common disorder was Diabetes insipidus (1%). About 58% of the children had parents in the low socioeconomic status and the management of the cases were severely hampered by lack of funds. About 60.6% of these patients were lost to follow up, during the period. CONCLUSIONS: Paediatric endocrine disorders are associated with a high incidence of malnutrition. Most patients presented with rickets which is a preventable condition.

The validity of ultrasonography in the diagnosis of zygomaticomaxillary complex fractures.

The aims of this study were to determine the sensitivity, specificity, positive and negative predictive values of ultrasonography in detecting zygomaticomaxillary complex fractures, and to highlight factors that may affect the validity of ultrasonography in the diagnosis of zygomaticomaxillary complex fracture. Twenty-one patients with suspected fractures of the zygomaticomaxillary complex presenting at the authors' hospital were included in this prospective study. All the patients had plain radiographic and computed tomography (CT) investigations. All underwent ultrasonographic examination of the affected region using an ultrasound machine with a 7.5 MHz probe. The different radiologists were not aware of the results of the other two investigations. Statistical significance was inferred at P<0.05. The validity of ultrasonography varied with fracture sites with a sensitivity of 100% for zygomatic arch fractures, 90% for infraorbital margin fractures and 25% for frontozygomatic suture separation. Specificity was 100% for the three types of fracture. There was no statistically significant difference in the ability of CT scan and ultrasonography to diagnose fractures from various zygomaticomaxillary complex fracture sites (P=0.47). Ultrasonography has proved to be a valid tool for the diagnosis of zygomatic arch and displaced infraorbital margin fractures.

Audit of management of gallbladder cancer in a Nigerian tertiary health facility.

BACKGROUND: Gallbladder cancer is a rare malignancy with a variable incidence worldwide. It ranks number eight among all gastrointestinal cancer seen in Nigeria. It is associated with high mortality and morbidity because it is usually diagnosed very late. Adequate surgical resection is the only modality with hope of cure. This requires advanced surgical skills which is quite rare in most developing countries like Nigeria. In this current work, we audit the management and outcome of gallbladder cancer in our hospital, highlighting peculiarity associated with our setting. PATIENTS AND METHOD: Consecutive patients managed as cases of gallbladder cancer at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between January 1990 and December 2010 were studied retrospectively. Patient demographics, disease and treatment-related variables, and outcomes were analyzed by SPSS version 16.0. RESULTS: Thirty-one cases of gallbladder cancer were diagnosed over the 21-year period, and this accounts for about 0.3% of all cancer cases seen in our hospital. The median age of this patient cohort was 58 years (range 28 to 79 years). Seventeen (54.8%) patients were age below 60 while 14 (45.2%) were age 60 and above. Twenty-seven patients (87.1%) were female and four (12.9%) were male, with a male to female ratio approximately 1:7. Over 80% of the patients presented with a triad of upper abdominal pain, weight loss, and jaundice. Majority (67.7%) of the patients were diagnosed intraoperatively. Only four patients underwent complete resection as they had radical cholecystectomy including regional lymph node dissection and wedge resection of the gallbladder fossa of the liver. The stages of the resected patients were T3 in three patients and T2 in one. Overall 1- and 5-year survival rates for our entire patient cohort were 32% and 10%, respectively. CONCLUSION: In conclusion, this study showed that preoperative diagnosis of gallbladder cancer could be challenging in our environment. A triad of upper abdominal pain, jaundice, and weight loss with judicious use of available radiological modality will increase the chances of making the preoperative diagnosis of the cancer. It also showed that good outcome can be obtained when radical surgery is offered to these few patients within the limitation of resources in few patients with resectable tumor.

The comparison of intelligence quotients of atopic and nonatopic children in ibadan, Nigeria.

BACKGROUND: Atopy-related illnesses such as atopic dermatitis and asthma are chronic illnesses, and children suffering from such illnesses are subjected to frequent absenteeism from school. Studies have shown that the performance of children with asthma was comparable to their healthy counterparts despite their absenteeism at school, in contrast to findings in other chronic illnesses like epilepsy. AIM: In the present study, we investigated the association between atopy and intelligence quotient (IQ) scores in a group of Nigerian children in Ibadan, a city in southwestern Nigeria. MATERIALS AND METHODS: This is a cross-sectional study of children in an urban elementary school. Questionnaires to ascertain the presence of atopy-associated conditions such as hay fever, atopic dermatitis, asthma, allergic rhinitis, and allergic conjunctivitis were administered to the parents of 128 pupils in the 3(rd) to 6(th) grades of elementary school. Based on the responses to the questionnaire, pupils were categorized as being atopic and nonatopic. All the pupils underwent the Standard Progressive Matrices IQ test. The IQ scores were then compared among these two groups of children. RESULTS: Out of the children studied, 26.6% were found to have atopy and after adjusting for factors such as age and sex, the IQ scores in this atopic group were not found to be statistically different from the scores in the nonatopic group (r = 2.122872, P = 0.009). CONCLUSION: IQ scores were not statistically significantly different for children with and without atopy. Thus, the presence of atopy does not appear to be associated with low IQ scores and hence, may not be related to poor school performance.

Neglected massive intracerebral abscess: an unusual cause of bilateral visual loss.

BACKGROUND: Bilateral visual loss following chronically raised intracranial pressure is not uncommon especially in developing countries. However, this calls for concern when the cause of the raised intracranial pressure is neglected pyogenic cerebral abscess. CASE SUMMARY: A sixteen year old male student presented to our unit with eight months history of recurrent headache associated with early morning vomiting. He developed bilateral visual loss a month prior to presentation. He had sought treatment at several herbal homes and orthodox hospitals before presentation. His cranial computed tomographic scan (CT) showed a massive peripheral contrast enhancing lesion in the frontal lobes with gross midline shift and other evidence of mass effect. He subsequently had craniotomy and excision of the mass. Intraoperative and laboratory findings confirmed the lesions to be abscess. He had ciprofloxacin and metronidazole for four weeks. He had uneventful postoperative period though his visual loss has persisted. He is being followed up in the clinic. CONCLUSION: This patient illustrates that untreated frontal lobe abscess could cause bilateral visual loss from chronically elevated intracranial pressure (ICP). Even though this should be rare in contemporary neurosurgical practice, ignorance and poverty which are rife in developing countries will be important contributory factors. Physicians working in developing countries should be aware of the symptomatology of cerebral abscess and raised ICP. They should encourage patients to do cranial CT when the features are suggestive of space occupying lesions.

Recent advances in childhood diabetes mellitus.

Diabetes mellitus (DM) is a syndrome characterized by disturbed metabolism of carbohydrate, protein, and fat. It is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin. It presents with very different medical and psychosocial issues in children. Epidemiological studies indicate that there is gradual but steady increase in the incidence of both type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in both developed and developing countries. The manifestations, therapy goals, clinical course, susceptibility to complications of diabetes differ among childhood cases. T1DM accounts for the majority of cases of diabetes in children. Diabetic ketoacidosis may be the initial presentation of T1DM in many children particularly in Africa probably due to low level of awareness. The focus of this review on T1DM is to provide an overview of the major advances in the aetiology, pathogenesis, and clinical management of newly diagnosed children and their subsequent management with the aim of ensuring optimal growth and development as well as preventing acute and chronic complications. The advances in insulin therapy and regimens and the presentation and management of diabetic ketoacidosis are discussed. The prospects for the cure of the disease are also highlighted in this review.

Multiple pituitary hormone deficiency caused by pit-I mutation and the challenges of management in a developing country.

BACKGROUND: In most developing countries, childhood endocrine disorders are not as common as infections but they do occur. Multiple pituitary hormone deficiency (MPHD) is a known cause of familial short stature. This is very rarely diagnosed in Nigerian children. We describe the challenges of diagnosis and management of childhood endocrine conditions in a developing economy using a ten year old Nigerian girl with MPHD as an illustration. METHODS: Patient had auxological data suggestive of short stature. In order to make a definitive diagnosis, pituitary function tests were carried out in the United Kingdom. RESULTS: Biochemical tests revealed growth hormone (GH) deficiency, Thyroid Stimulating Hormone (TSH) deficiency, decreased prolactin (PRL) level, normal cortisol and gonadotrophins. Her DNA analysis identified PIT-1 mutation in exon-6. She was placed on recombinant GH and thyroxine with evidence of catch up in height. CONCLUSIONS: There were challenges to management such as, inadequate facility for diagnosis, huge cost of treatment and little awareness about childhood endocrine conditions amongst health workers in a developing economy.

Mothers knowledge on the cause, prevention and symptoms of malaria in a university staff clinic in an urban setting in Southwestern Nigeria.

This prospective study was carried out at Jaja Clinic, University of Ibadan, Nigeria. The study documented the knowledge of mothers of children about the cause, prevention and symptoms of malaria. These were mothers of children between ages 1 month to 12 years that presented with fever at the clinic for the first time during the current illness. Data was collected with structured questionnaires administered to the mothers of the enrolled children. The children were clinically examined by clinicians and blood films for malaria parasites were taken and examined in the laboratory using Giemsa stain. The haematocrit level of each child was also determined. 60.4% of the children were 1 month-5 years (mean age 33.0 +/- 15.2 months) while 39.6% of them were over 5-12 years (mean 8.1 +/- 2.1 years). Most of the mothers (58.3%) had above secondary school education. Blood films for malaria parasites were positive in 76% of the children that presented with fever. 74.2% of the mothers knew mosquito bite as the cause of malaria while 13.2% of them were ignorant of the cause of malaria. The main protective measures practiced by the mothers against mosquito bites were netted windows (86.2%), use of aerosol insecticides (76.1%), and mosquito coil (17.0%). Most mothers were not knowledgeable about the use of insecticide treated nets (ITN) which is the most recently introduced protective measure against mosquito bite. Ninety percent of the mothers knew fever as the major symptom of malaria. The degree of parasitaemia affected the PCV level. The greater the parasite count, the lower the PCV level.

Normal pelvic dimensions of Nigerian women in Ile Ife by computed tomographic pelvimetry.

OBJECTIVE: This study was undertaken to determine the baseline pelvic parameters as assessed by computed tomographic (CT) pelvimetry in Nigerian women and to compare the pelvic parameters with those derived from other studies. DESIGN: The study was carried out in pregnant women at 36 weeks and above referred for routine CT-pelvimetry. SUBJECT: A total of 100 pregnant women at 36 weeks and above referred to the Radiology Department were prospectively recruited for this study, they included women with breech presentation after 36 weeks gestation and women who either had previous lower segment caesarean section for reasons other than confirmed or suspected cephalopelvic disproportion (CPD). The subjects' ages ranged from 24-45 years. RESULTS: The mean anteroposterior and transverse inlet pelvic diameters were 11.6 cm +/-SD 0.9 and 12.0 +/-SD 0.8 cm respectively. The range of anteroposterior and transverse diameters of the inlet were 8.4 cm-14.0 cm and 10-13.8 cm respectively. The mean outlet diameter was 11.5 cm +/-SD 1.2 cm. The mean bispinous diameter of the pelvis was 10.6 cm +/-SD 0.9 cm. There was significant positive correlation between anteroposterior diameter inlet and outlet as well as the bispinous diameters (1st, 4th - 6th pairs) p<0.001. CONCLUSION: here are significant variations in pelvic parameters of Nigerian women when compared with values from other countries of the world. These significant variations are anthropometric in origin.

Calcium and phosphate levels in Nigerian children with malaria.

Calcium and phosphate levels were investigated in 39 children with malaria (six severe and 33 uncomplicated) and in 39 healthy children. Hypocalcaemia (calcium <2.13 mmol/L, adjusted for albumin level) was detected in 23.1% of malaria cases and in 5.1% of controls, and hypophosphataemia (<1 mmol/L) in 38.5% of cases and in 15.4% of controls. Mean (SD) calcium levels in cases [2.26 (0/15)] were similar to those in controls [2.24 (0.12)]. In Nigerian children, hypocalcaemia and hypophosphataemia are associated with malaria.

A five-year review of childhood mortality at the University College Hospital, Ibadan.

INTRODUCTION: The present study sought to provide a comprehensive description of causes of mortality in a local Nigerian children population as a measure of their health status. METHODS AND PATIENTS: A retrospective study of the pattern of mortality among 12,522 children admitted into all the six wards of the department of Paediatrics, University College Hospital, Ibadan during a five-year period (January 1996 - December 2000) was done. RESULTS: There were 1,185 deaths with an overall mortality rate of 9.5 per cent. There was no significant change in childhood mortality rate over the five years reviewed. Of the 1185 deaths, 48.8 % occurred within 24 hours and neonatal deaths accounted for 50.8 % of the total number of deaths. The leading causes of death were neonatal tetanus, Prematurity/low birth weight, neonatal septicaemia, severe birth asphyxia, meningitis, severe malaria, pneumonia, septicaemia, severe malnutrition, and measles. Deaths from sickle cell anaemia were found only among children above 5 years of age. CONCLUSIONS: Majority of deaths occurred in neonates and were preventable.

Genetic diversity of the msp-1 locus and symptomatic malaria in south-west Nigeria.

Genetic characteristics of Plasmodium falciparum may play a role in the clinical severity of malaria infection. We have studied the association between diversity at the merozoite surface protein-1 (msp-1) locus and the severity of disease in childhood malaria in Ibadan, south-west Nigeria. Two hundred and twenty-three children (median age of 34.5 months) presenting with malaria were enrolled into the study. They comprised 53 children with asymptomatic malaria (ASM), 101 with acute uncomplicated malaria (UM) and 69 with severe malaria (SM). Genotyping of the msp-1 locus was by polymerase chain reaction. The distribution of msp-1 alleles was significantly different between the three groups. Asymptomatic malaria samples had a higher median number of alleles than the other two groups. The type of msp-1 allele detected was significantly associated with the clinical category of malaria. The absence of K1 alleles was associated with a three-fold increase risk of UM and a four-fold increased risk of SM when compared with asymptomatic malaria. The absence of MAD20 alleles was associated with a five-fold increase risk of UM and an eight-fold increase of SM. We have found an association between the msp-1 locus of P. falciparum and clinical severity of malaria in a sample of Nigerian children. Our findings show that the presence of the K1 and MAD20 alleles was significantly associated with ASM and consequently a reduced risk of developing the symptomatic disease.