An Audit of Perineal Trauma and Vertical Transmisson Of HIV.

Restrictive episiotomy is recommended for the prevention of vertical transmission of HIV. The study compared the frequency of episiotomy use and the occurrence of perineal tears; and related factors in HIV positive and HIV negative women and to assess their effect on Mother-to-child transmission (MTCT) of HIV. A total of 110 HIV positive and 134 HIV negative parturients were enrolled in the study. The incidence of episiotomy was more in the HIV negative group (p=0.0000) while that of perineal tear was not affected by HIV status (p=0.17). The rate of episiotomy was significantly affected by primigravidity in HIV negative subjects (OR= 0.032, 95% CI 0.0072-0.13). The rate of perineal tear was significantly affected by primigravidity in HIV positive subjects (OR=8.55, 95% CI 1.91-38.7) and multigravidity in HIV negative subjects (OR= 0.030, 95% CI 0.133-0.71). Gestational age and mean birth weight had no effect on the rate of episiotomy (p value =0.57 and 0.30) and perineal tear (p value= 0.79 and 0.061). There was no mother-to-child HIV transmission. Episiotomies should be given when needed irrespective of HIV status because of the risk of consequent perineal tear and with HAART the risk of MTCT from perineal trauma is minimal.

Malnutrition in acutely ill children at the paediatric emergency unit in a tertiary hospital in Nigeria.

BACKGROUND: In many developing countries, malnutrition remains an important cause of morbidity and mortality particularly in under-five children. The factors responsible for malnutrition could be immediate, underlying or basic, acting either alone or together. It has been shown that children who are malnourished have poorer outcomes from other illnesses than well-nourished children. It is important therefore to periodically describe the extent and pattern of childhood malnutrition so that effective preventive measures can be put in place. OBJECTIVE: To describe the prevalence and pattern of malnutrition in children presenting with acute illnesses at the Jos University Teaching Hospital. PATIENTS AND METHODS: A cross-sectional descriptive study in children aged 6 to 59 months seen at the paediatric emergency unit from April to October 2012. The subjects were recruited consecutively. Each child had both clinical assessment and appropriate laboratory evaluations done alongside anthropometric measurements. The nutritional/dietary and socio-demographic histories were also obtained. RESULTS: Of the 379 children, 224 (59.1%) were males and 155 (40.9%) females. The median age was 17 months, range (6-57). Wasting (WFH z-scores ≤-3 to <-1SD) was evident in one hundred children, giving an overall prevalence of 26.9%. Severe wasting (WFH z-score <-3), was present in 22 (5.9%) children indicating the prevalence of marasmus, whereas only two children (0.53%) had oedematous malnutrition (kwashiorkor). Stunting or chronic malnutrition, (HFA z-scores ≤-3 to <-1SD) was present in 67 children (18.0%). Seventeen (4.6%) were severely stunted (HFA z-score <-3). CONCLUSIONS: Wasting was the most common form of malnutrition in the study.

Pelvi-Ureteric Junction Obstruction at Red Cross Children's Hospital, Cape Town: a Six Year Review.

INTRODUCTION: Congenital abnormalities of the kidney and urinary tract (CAKUT) are significant causes of end stage renal disease (ESRD) in children. Some of these abnormalities, when identified early, are amenable to treatment. In developing countries, very few published reports exist concerning the pattern and scope of CAKUT in childhood. METHODS: This is a retrospective review of all patients with confirmed Pelvi-Ureteric Junction (PUJ) obstruction who were diagnosed antenatally with hydronephrosis between Jan 2002 and Dec 2007 at the Red Cross Children's Hospital, Cape Town. The clinical course of every patient was reviewed for a twelve-month period after confirmation of the diagnosis. RESULTS: One hundred patients, 80 males and 20 females, were included in the analysis. Thirty-two children (32%) had bilateral PUJ obstruction while the rest had unilateral involvement of the left (40%) or right (28%) kidney; overall, 132 kidneys were affected. mild, moderate and severe pelvic dilatation was present in 44.7%, 36.4% and 18.9% of affected kidneys respectively. One child required nephrostomy during the first day of life while eighteen children were treated by pyeloplasty. Urinary tract infection was confirmed in eleven children. At 12 months of follow-up, 83 affected kidneys (62.9%) demonstrated spontaneous resolution of PUJ obstruction while 14 (18.5%) kidneys improved after surgical intervention. Spontaneous resolution occurred more often in kidneys with mild to moderate pelvic dilatation. CONCLUSION: Spontaneous resolution of the PUJ obstruction occurred in a substantial proportion of children by twelve months of follow-up and complete resolution is more likely in mild to moderate dilatation.

Discrepancy between predicted and measured GFR in hospitalized Nigerian children.

Current clinical guidelines for the management of chronic kidney disease recommend the use of prediction equations for determination of glomerular filtration rate (GFR). Our aim was to determine the accuracy of the Schwartz and the modified Counahan-Barratt equations in predicting GFR in hospitalized Nigerian children. We compared GFR as estimated by the Schwartz and the Counahan-Barratt equations against endogenous creatinine clearance (Ccr) in 90 hospitalized Nigerian children of varying renal function. The bias (i.e. the mean difference) in GFR estimation by the Schwartz and the modified Counahan-Barratt equations in relation to Ccr were 16.7 and 21.5, respectively. The predicted GFR values correlated poorly with the measured Ccr (-0.19 and -0.18 for Schwartz and Counahan-Barratt equations respectively). The positive predictive value of the Schwartz and Counahan-Barratt equations to detect GFR <60 ml/min were 9.8% and 11.9% respectively. These equations do not provide reliable estimates of the GFR when compared to Ccr in Nigerian sick children and hence can not replace Ccr in clinical practice. Further studies are needed to develop reliable alternatives for Ccr in these children.