Cord Blood Thyroid Stimulating Hormone Values in Healthy Term Babies delivered at Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Northeastern Nigeria.

BACKGROUND: Congenital hypothyroidism is one of the most common preventable causes of mental retardation and clinical manifestations are often subtle or absent at birth and hence the need for screening. Implementation of newborn screening requires local normative values. OBJECTIVES: To determine the normative values of cord Thyroid Stimulating Hormone (TSH) among term babies in Bauchi, Northeast Nigeria and compare it with that from other centers in Nigeria. METHODOLOGY: Cord blood samples from 200 term babies were analyzed for TSH by Fluorescence Immunoassay technique in this descriptive cross-sectional study. A cut-off of >20 µIU/ml was used for recall. The mean and range were determined and compared with those of previous local studies using t-test. Impact of some maternal and infant factors on TSH was also assessed. RESULTS: The overall mean (SD) cord TSH was 3.74 (±1.99) µIU/ ml and the range was 0.73 to 15.22 µIU/ml (2.5th to 97.5th centile) and none had TSH > 20 µIU/ml and hence our recall rate was 0%. The mean cord TSH was comparable to that reported by a lone local multicenter study (p = 0.120) but significantly different from that of 3 other local studies (p < 0.001). There was also no significant difference between the means of different gender, birth weight groups, mode of delivery, socio-economic classes, maternal age and parity. CONCLUSION: The Cord blood TSH level of most term newborn in Bauchi, similar to other Nigerian studies, is < 10 µIU/ml with a few but significant percentage recording cord TSH level > 10 µIU/ml. Gender, birth weight, mode of delivery, socio-economic class, maternal age and parity were not significantly related to cord TSH level. The mean blood TSH values from different studies across the country tend to vary based on the assay technique. We recommend a nationwide multicenter study with a much larger sample size, lower cutoff value for recall and a unified sample processing laboratory if national normative values are to be developed.

BACKGROUND: L'hypothyroïdie congénitale est l'une des causes évitables les plus courantes de retard mental et les manifestations cliniques sont souvent subtiles ou absentes à la naissance, d'où la nécessité d'un dépistage. La mise en œuvre du dépistage néonatal nécessite des valeurs normatives locales. OBJECTIFS: Déterminer les valeurs normatives de l'hormone stimulatrice de la thyroïde (TSH) du cordon chez les bébés nés à terme à Bauchi, Nord-Est du Nigeria et les comparer à celles d'autres centres du Nigeria. MÉTHODOLOGIE: Des échantillons de sang ombilical de 200 bébés nés à terme ont été analysés pour la TSH par la technique d' étude descriptive transversale. Un seuil de >20 µUI/ml a été utilisé pour le rappel. La moyenne et l'intervalle ont été déterminés et comparés avec ceux des études locales précédentes en utilisant le test t. L'impact de certains facteurs maternels myet infantiles sur la TSH a également été évalué. RÉSULTATS: La moyenne globale (SD) de la TSH du cordon était de 3,74 (±1,99) µIU/ml et l'intervalle était de 0,73 à 15,22 µIU/ml (2,5 à 97,5 centiles) aucun n'avait une TSH > 20 µIU/ml et donc notre taux de rappel était de 0%. La moyenne de TSH au cordon était comparable à celle rapportée par une seule étude multicentrique locale unique (p = 0,120) mais significativement différente de celle de 3 autres études locales (p < 0,001). Il n'y avait pas non plus de différence significative entre les moyennes des différents sexes, groupes de poids de naissance, mode d'accouchement, classes socio d'accouchement, les classes socio-économiques, l'âge maternel et la parité. CONCLUSION: Le niveau de TSH dans le sang de cordon de la plupart des nouveau-nés à termede la plupart des nouveau-nés à terme à Bauchi, comme dans d'autres études nigérianes, est < 10 µUI/ml mais significatif, enregistrant un niveau de TSH du cordon > 10 µIU/ml. Le sexe, le poids à la naissance, le mode d'accouchement, la classe socio-économique maternelle et la parité n'étaient pas significativement liés au taux de TSH au cordon. Le site valeurs moyennes de la TSH sanguine provenant de différentes études dans le pays ont tendance à varier en fonction de la technique de dosage. Nous recommandons une étude nationale multicentrique avec une taille d'échantillon beaucoup plus grande, une valeur seuil pour le rappel et un laboratoire de traitement des échantillons unifié si des valeurs normatives nationales doivent être développées. Mots clés: Sang de cordon, Hormone de stimulation thyroïdienne, Bébés à terme.

Evaluating Ultrasound Determined Thyroid Volume as a Predictor of Newborn Thyroid Hormone Function.

BACKGROUND AND OBJECTIVES: Congenital hypo-thyroidism is a cause of intellectual and developmental disabilities in the newborn. Early screening and prompt treatment can prevent the devastating outcomes of congenital hypothyroidism. The disease burden of congenital hypothyroidism in Nigeria is higher than in many parts of the world. Using ultrasound, the authors sought to determine the normal mean thyroid gland volume in newborns and establish the thyroid gland volume as a predictor of thyroid hormone function in the newborn. METHODS: This was a descriptive cross-sectional study. Healthy newborns had their length and weight measured, thyroid ultrasound scan performed, and a blood sample taken for thyroid-stimulating hormone values. RESULTS: The mean total thyroid volume was 0.51cm3 ± 0.25. The thyroid volume of the right lobe (mean volume= 0.27cm3 ± 0.13) was significantly larger than the volume of the left lobe (mean volume =0.24cm3 ± 0.12) (p<0.001). The thyroid-stimulating hormone (TSH) values ranged from 1.36µIU/ml to 35.03µIU/ml with a mean value of 7.73µIU/ml ± 7.04. There was no significant correlation between the thyroid volumes and the TSH of the newborns. CONCLUSION: This study determined the mean thyroid volume in newborns. There was no significant correlation between the thyroid volumes and the TSH values of the newborns implying that the thyroid gland volume is not a reliable predictor of thyroid hormone function. Newborn, Ultrasound.

PREVALENCE OF BACTERAEMIA AMONGST CHILDREN WITH FEBRILE SEIZURES AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN.

BACKGROUND: Febrile seizures are common among children and these are known to result from the diverse aetiological factors, known to cause fever in children. OBJECTIVES: To determine the prevalence of bacteraemia amongst children with febrile seizures at the children's emergency room of the University College Hospital, Ibadan, Nigeria. METHODOS: This was a prospective study involving 147 children who were presented with febrile seizures over a period of 13 months at the University College Hospital Ibadan. They all had their blood cultures sample taken under aseptic conditions. Other investigations performed on them included a packed cell volume, full blood count and blood film for malaria parasite. RESULTS: A total of 83 males and 64 females with febrile seizures were studied. Their ages ranged from 4 to 60 months with a mean age of 26.35 + 13.76 months. Bacteraemia was diagnosed in 32(21.8%) of the cases. The predominant organism isolated from the blood of these patients was Staphylococcus aureus. CONCLUSION: Bacteraemia is a frequent finding in children with febrile seizures hence, it may be beneficial to carry out blood culture in such children on the suspicion of a probable bacterial infection.

Charge syndrome in a Nigerian infant: a rare genetic disorder.

BACKGROUND: Charge syndrome is a rare genetic disorder that arises during early fetal development and affects multiple organ systems. Diagnosis is largely clinical. Mutation at the CHD7 gene located on Chromosome 8 has been identified in a great number of patients reviewed in different parts of the world. Survival depends on the intensity of the medical management as well as an early aggressive approach to the feeding adaptation in these children. CASE REPORT: We report a case of a 42 day old baby with clinical features in keeping with Charge syndrome. He was a product of a full-term uneventful pregnancy period delivered to non consanguineous apparently healthy parents. Two older siblings were normal. He developed respiratory distress shortly after birth. Multiple abnormalities were identified at birth which included genital, ear, eye and cardiovascular as well as skeletal abnormalities. Genetic testing was not carried out due to cost. Child was managed by a multidisciplinary team. Main problems were those of sepsis and feeding adaptation. He later succumbed to death after a month on admission. CONCLUSION: This is the first case of Charge syndrome reported in Nigeria. It is a rare, multisystemic condition with grave health implications and early diagnosis and appropriate management could reduce morbidity and prevent mortality. This report is to increase awareness of this rare condition and to promote better identification and intervention of similar presentation in future.

A typical presentations of hypothyroidism and associated problems in Ibadan, Nigeria.

BACKGROUND: Hypothyroidism can present atypically making its recognition difficult especially in resource limited settings. CASE PRESENTATION AND MANAGEMENT: Two children presented with atypical features of hypothyroidism with resultant delay in diagnosis. Patient I presented with persistent respiratory distress, facial swelling and recurrent syncopal attacks. Cardiovascular examination was normal except for pulmonary hypertension. He did not respond to conventional supportive therapy and hypothyroidism was discovered much later. Patient II was a seven month old male infant with abdominal swelling, bilateral pitting leg oedema, poor weight gain and delayed developmental milestones. Examination revealed ascites and pericardial effusion. He was being managed for protein energy malnutrition until he was found to have hypothyroidism and was successfully managed with L thyroxin. CONCLUSION: A typical presentations of hypothyroidism in resource limited settings can result in delay in diagnosis and treatment which can lead to unnecessary morbidity and mortality. High index of suspicion and expertise are therefore required.

Type 1 diabetes mellitus in a known sickle cell anaemia patient: a rare combination in Nigeria.

BACKGROUND: Sickle cell anaemia is a very common disease condition in Nigeria. Its co-existence with type 1 diabetes mellitus is however rare, with only a few cases having been reported in literature and only two children have been reported from Nigeria. The genetic basis for this has not been fully reviewed. This case represents one of the few documented of both type 1 diabetes mellitus (T1DM) and homozygous sickle cell disease co-existing in an individual. More research is necessary to identify the factors that influence this co-morbidity and its effects on disease progression and patient management. CASE REPORT: Q. O, a ten year old girl presented in October 2011 with 9 year history of recurrent bone pains, yellowness of the eyes and poor growth. She also had a short history of polyphagia, polydipsia and polyuria. Haemoglobin electrophoresis showed SS while a random plasma glucose done at least twice was greater than 200 mg/dl. There was no ketosis nor did she have any other adverse complications. She is currently being managed as a case of sickle cell haemoglobinopathy with T1DM. Her management has been hampered by severe financial constraints. CONCLUSION: This report seeks to increase the awareness of this rare co-existence in this environment, as well as to highlight the antecedent challenges in management.

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.

Complete genome sequences of two feline leukemia virus subgroup B isolates with novel recombination sites.

It is generally accepted that all primary isolates of feline leukemia virus (FeLV) contain a subgroup A virus (FeLV-A) that is essential for transmission. In contrast, FeLV-B is thought to arise de novo in the infected animal through RNA recombination events with endogenous FeLV transcripts, presumably through copackaging of RNA from endogenous FeLV and exogenous FeLV-A. Here, we report the complete genome sequences of two novel strains of FeLV-B (FeLV-2518 and FeLV-4314) that were isolated in the absence of FeLV-A. The env genes of these isolates have been characterized previously, and the 3' recombination sites have been identified. We describe herein the 5' recombination breakpoints of each virus. These breakpoints were found to be within the signal peptide of the env gene and the reverse transcriptase-coding region, respectively. This is the first report of a recombination site within the pol gene of an FeLV-B genome and the first genetic characterization of multiple independently arising FeLV-B isolates that have been identified without a functional FeLV-A ancestral virus.

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.

Pre-hospital management of febrile seizures in children seen at the university college hospital, ibadan, Nigeria.

BACKGROUND: Febrile seizures are commonly encountered in emergency paediatric practice. Initial pre-hospital intervention given by caregivers has been shown to impact outcome. OBJECTIVES: To describe the spectrum of pre-hospital interventions given for the treatment of childhood febrile seizures in Ibadan, Nigeria. METHODS: All consecutive cases of febrile seizures seen at the emergency room of University College Hospital, Ibadan over a period of 13 months were the subjects of the study. Details of history of illness including the interventions given before presentation were recorded. All the children had lumbar puncture and examination of their cerebrospinal fluid (CSF). All were followed up till discharge and the outcome was recorded. RESULTS: A total of 147 children, 83 males and 64 females with febrile seizures were studied. Harmful traditional practices were found to be common in the cohort studied. Fifty-nine (40.1%) of the children received at least one form of intervention believed to be capable of aborting the seizure during the attack at home. Herbal preparation was the most common form of pre-hospital treatment, given in 15 (10.2%) of the cases. Other forms of pre-hospital interventions given were application of substances to the eyes (6.1%), incisions on the body (2%) and burns inflicted on the feet and buttocks (1.4%). None of the children received rectal diazepam or buccal midazolam as home remedy for seizures. There was a statistically significant relationship between harmful cultural practices and the socio-economic class of the caregivers (P=0.008). CONCLUSIONS: Pre-hospital treatment of childhood seizures in Ibadan comprises mainly harmful traditional practices. There is a need for appropriate health education to reduce the morbidity and mortality associated with febrile seizures in the locality.

Are endogenous feline leukemia viruses really endogenous?

Full length endogenous feline leukemia virus (FeLV) proviruses exist within the genomes of many breeds of domestic cat raising the possibility that they may also exist in a transmissible exogenous form. Such viruses would share receptor usage with the recombinant FeLV-B subgroup, a viral subgroup that arises in vivo by recombination between exogenous subgroup A virus (FeLV-A) and endogenous FeLV. Accordingly, all isolates of FeLV-B made to date have contained a "helper" FeLV-A, consistent with their recombinatorial origin. In order to assess whether endogenous viruses are transmitted between cats, we examined primary isolates of FeLV for which the viral subgroup had been determined for the presence of a subgroup B virus that lacked an FeLV-A. Here we describe the identification of two primary field isolates of FeLV (2518 and 4314) that appeared to contain subgroup B virus only by classical interference assays, raising the possibility of between-host transmission of endogenous FeLV. Sequencing of the env gene and U3 region of the 3' long terminal repeat (LTR) confirmed that both viral genomes contained endogenous viral env genes. However the viral 3' LTRs appeared exogenous in origin with a putative 3' recombination breakpoint residing at the 3' end of the env gene. Further, the FeLV-2518 virions also co-packaged a truncated FeLV-A genome containing a defective env gene, termed FeLV-2518(A) whilst no helper subgroup A viral genome was detected in virions of FeLV-4314. The acquisition of an exogenous LTR by the endogenous FeLV in 4314 may have allowed a recombinant FeLV variant to outgrow an exogenous FeLV-A virus that was presumably present during first infection. Given time, a similar evolution may also occur within the 2518 isolate. The data suggest that endogenous FeLVs may be mobilised by acquisition of exogenous LTRs yielding novel viruses that type biologically as FeLV-B.

Gastrointestinal tuberculosis in renal transplant recipients: case report and review of the literature.

Mycobacterium tuberculosis is an important opportunistic pathogen following renal transplantation and is often associated with adverse outcomes. Gastrointestinal tuberculosis (GITB) is an infrequent manifestation of TB but a potentially lethal one. We present a case of a renal allograft recipient with GITB 18 months after transplant and review other published cases to identify the typical presenting symptoms, risk factors, and natural history. Treatment of GITB is also discussed.

Persistence and transmission of natural type I feline coronavirus infection.

To examine the mode of natural transmission and persistence of feline coronavirus (FCoV), FCoV strains shed by domestic cats were investigated over periods of up to 7 years. An RT-PCR that amplified part of the 3' end of the viral spike (S) gene was devised to distinguish FCoV types I and II. All but 1 of 28 strains of FCoV from 43 cats were type I. Nucleotide identities of the amplified 320 bp product from 49 type I FCoVs ranged from 79 to 100 %. The consensus partial S sequence of isolates recovered from persistently infected cats at time intervals spanning years was generally conserved. While most cats were infected with a single strain, a few may have been infected by more than one strain. Cats that were transiently infected and ceased shedding could be re-infected with either the same, or a different, strain. In most cases, whether a cat became persistently or transiently infected was independent of the virus strain. However, one strain was unusual in that it infected the majority of cats in the household simultaneously and was still being shed 18 months later. Factors that influence whether FCoV establishes lifelong infection in some cats and not others are determined mainly by the host response to infection.

Dynamics of viral and proviral loads of feline immunodeficiency virus within the feline central nervous system during the acute phase following intravenous infection.

Animal models of human immunodeficiency virus 1, such as feline immunodeficiency virus (FIV), provide the opportunities to dissect the mechanisms of early interactions of the virus with the central nervous system (CNS). The aims of the present study were to evaluate viral loads within CNS, cerebrospinal fluid (CSF), ocular fluid, and the plasma of cats in the first 23 weeks after intravenous inoculation with FIV(GL8). Proviral loads were also determined within peripheral blood mononuclear cells (PBMCs) and brain tissue. In this acute phase of infection, virus entered the brain in the majority of animals. Virus distribution was initially in a random fashion, with more diffuse brain involvement as infection progressed. Virus in the CSF was predictive of brain parenchymal infection. While the peak of virus production in blood coincided with proliferation within brain, more sustained production appeared to continue in brain tissue. In contrast, proviral loads in the brain decreased to undetectable levels in the presence of a strengthening PBMC load. A final observation in this study was that there was no direct correlation between viral loads in regions of brain or ocular tissue and the presence of histopathology.

Protection against oronasal challenge with virulent feline leukaemia virus lasts for at least 12 months following a primary course of immunisation with Leukocell 2 vaccine.

The duration of immunity provided by a feline leukemia virus (FeLV) vaccine, Leukocell 2, was determined. Kittens were vaccinated when 9 and 12 weeks of age and were challenged 12 months later with FeLV-A/Glasgow-1. An oronasal challenge protocol without corticosteroid enhancement was developed in order to induce a persistent viraemia in a high proportion of adult cats. Fourteen of 18 (80%) of the vaccinated cats challenged in this way remained non-viraemic while 9/15 (60%) of age-matched controls became persistently infected, a preventable fraction of 63%. This difference was statistically significant (P=0.038). For comparison, 10 of 12 (83%) 15-17-week-old kittens challenged in the same way became persistently infected, confirming the relative resistance of adult animals to FeLV. Tests for virus neutralising and anti-feline oncornavirus-associated cell membrane antigen (FOCMA) antibodies suggested that the former were more important than the latter in protection. Thus, Leukocell 2 protected a significant proportion of cats from FeLV challenge 1 year after primary vaccination as kittens.

Comparison of six in-house tests for the rapid diagnosis of feline immunodeficiency and feline leukaemia virus infections.

Six rapid tests for the diagnosis of feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) infections which have recently been introduced in Europe for use in small animal practice were compared. Eight hundred serum samples were tested and those reacting FIV-positive in at least one of the tests were confirmed by Western blot, and those reacting FeLV-positive were confirmed by virus isolation. The specificity and sensitivity of each test and the quality of the results produced were compared.

Feline leukemia virus DNA vaccine efficacy is enhanced by coadministration with interleukin-12 (IL-12) and IL-18 expression vectors.

The expectation that cell-mediated immunity is important in the control of feline leukemia virus (FeLV) infection led us to test a DNA vaccine administered alone or with cytokines that favored the development of a Th1 immune response. The vaccine consisted of two plasmids, one expressing the gag/pol genes and the other expressing the env gene of FeLV-A/Glasgow-1. The genetic adjuvants were plasmids encoding the feline cytokines interleukin-12 (IL-12), IL-18, or gamma interferon (IFN-gamma). Kittens were immunized by three intramuscular inoculations of the FeLV DNA vaccine alone or in combination with plasmids expressing IFN-gamma, IL-12, or both IL-12 and IL-18. Control kittens were inoculated with empty plasmid. Following immunization, anti-FeLV antibodies were not detected in any kitten. Three weeks after the final immunization, the kittens were challenged by the intraperitoneal inoculation of FeLV-A/Glasgow-1 and were then monitored for a further 15 weeks for the presence of virus in plasma and, at the end of the trial, for latent virus in bone marrow. The vaccine consisting of FeLV DNA with the IL-12 and IL-18 genes conferred significant immunity, protecting completely against transient and persistent viremia, and in five of six kittens protecting against latent infection. None of the other vaccines provided significant protection.

Use of a reverse-transcriptase polymerase chain reaction for monitoring the shedding of feline coronavirus by healthy cats.

The pattern of shedding of feline coronavirus (FCoV) was established in 155 naturally infected pet cats from 29 households over periods of up to five years. Viral RNA was detected in faeces by reverse-transcriptase PCR (RT-PCR), and plasma antiviral antibodies by immunofluorescence. The cats rarely shed FCoV in their saliva. Three patterns of FCoV shedding were observed. Eighteen of the cats shed virus continuously, so were persistent, and possibly lifelong, carriers; none of them developed feline infectious peritonitis. Fifty-six cats ceased shedding virus, although they were susceptible to reinfection, and 44 shed intermittently or were being continuously reinfected. Four of the cats were resistant to infection. Seventy-three per cent of the virus shedding episodes lasted up to three months and 95 per cent up to nine months. There was a correlation between shedding and antibody titre but the cats could remain seropositive for some time after they had ceased shedding virus. One-off testing for FCoV by RT-PCR is inappropriate. Identification of longterm carriers requires that a positive result be obtained by RT-PCR on faecal samples for at least eight consecutive months. A cat should be shown to be negative over five months, or to have become seronegative, to ensure that it has ceased shedding virus.