Diagnosing renal failure due to diethylene glycol in children in a resource-constrained setting.

BACKGROUND: In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource-constrained countries, this study investigated whether AKI associated with DEG could be identified by other means. METHODS: This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children with AKI over a 6-month period were reviewed. RESULTS: Sixty (50.4%) of 119 children ingested "My pikin" teething syrup. Compared to children who had not ingested it, they were significantly (p < 0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management. CONCLUSIONS: Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.

Management of AIDS-associated Kaposi's sarcoma in Nigerian children: a case series and review of literature.

INTRODUCTION: There is a paucity of published studies on the management and outcome of AIDS-associated Kaposi's sarcoma (AAKS) in African children. In this study, we reviewed the management and literature of AAKS in Nigerian children. PATIENTS AND METHODS: A prospective review of children aged 1 to 14 years and adolescents aged 15 to 18 years who presented with AAKS. Following clinical evaluation and resuscitation, patients were treated with highly active antiretroviral therapy (HAART). Stable patients were further treated with chemotherapy consisting of vincristine, doxorubicin, and bleomycin. Patients were monitored until death or loss to follow-up. RESULTS: There were 9 patients: 6 children and 3 adolescents. Three children had vertical transmission of HIV infection. Kaposi's sarcoma was the AIDS-defining disease in 5 patients. One patient was on HAART at the time of diagnosis. There were multiple skin lesions in all patients, and cervical lymph nodes and oropharynx were frequently affected. The CD4 counts at the time of AAKS diagnosis ranged 78 to 601 cells/ uL, mean of 317. Five patients had best palliative care. Three had anticancer chemotherapy, of which 2 were alive 4 years after diagnosis. Three patients died at the initial hospitalization 2 to 6 weeks after diagnosis. CONCLUSION: Children and adolescents with AAKS presented with generalized skin lesions and lymphadenopathy, which facilitated the diagnosis. The majority of the patients presented with advanced disease that was rapidly fatal. However, patients with good immunity may have a prolonged control of symptoms if treated with HAART and appropriate anticancer chemotherapy.

Seroprevalence of hepatitis A virus infection among schoolchildren and adolescents in Kaduna, Nigeria.

BACKGROUND: Hepatitis A is an infectious viral disease, caused by hepatitis A virus (HAV), endemic in many developing countries. A recent review of the global prevalence of HAV infection and susceptibility by the WHO had few data on the seroprevalence of HAV in Nigeria. This study was designed to determine the seroprevalence of HAV among schoolchildren and adolescents in Kaduna State and to identify factors associated with seropositivity. METHODS: Questionnaires were administered to 403 participants aged 2-19 years, and blood samples were collected during April-July 2009 and screened for anti-HAV IgG using an anti-HAV IgG enzyme immunoassay kit. χ(2) and Fisher's exact tests were used to identify variables associated with the presence of anti-HAV IgG. RESULTS: The mean ± SD age of the study population was 11.7 ± 3.2 years. Of the 403 serum samples, 29 were positive for HAV, giving an overall seroprevalence of 7.2% (95% CI 4.9-10.2%) among the study population. Seropositivity with respect to age ranged from 4.6% (10/218; 95% CI 2.2-8.3%) in the 11-15 years age group to 30% (3/10; 95% CI 6.7-65.3%) in the ≤5 years age group. Anti-HAV seropositivity was associated with sewage disposal methods and parents' educational level (p < 0.05). CONCLUSION: This study shows that the majority of the study population lacked natural immunity (anti-HAV IgG). This low HAV exposure may be attributed to improvements in sanitary conditions and socioeconomic status. Further research involving an older population in different parts of the country is required to determine the current epidemiological pattern of HAV.