RESUMEN
Background: Multisystemic inflammatory syndrome in children (MIS-C) has increasingly been documented globally with the progression of the COVID-19 pandemic and a significant proportion of cases have been noted in children of Black descent. There has been a noticeable discrepancy in the presentation and outcomes of COVID-19 infection in sub-Saharan Africa compared to the rest of the world. We documented the demography, clinical features, laboratory and imaging findings, therapeutic management, and short-term outcomes of paediatric patients with MIS-C diagnosed during the COVID-19 pandemic in Lagos, Nigeria. Methods: We carried out a retrospective review of MIS-C cases seen in nine public and private hospitals in Lagos from July 10, 2020 to July 30, 2021. Data on clinical presentation, laboratory investigations, therapy as well as outcomes at 2 weeks, 6 weeks, 3 months and 6 months were analyzed. Findings: 28 children and adolescents with median age of 7·5 (IQR 2·3 - 9·4) years were diagnosed with MIS-C. MIS-C was suspected in 24 patients (85·7%) at initial clinical evaluation and mucocutaneous, gastrointestinal and cardiovascular manifestations were identified in 75·0%, 71·4% and 89·3% of patients respectively. Acute kidney injury and aseptic meningitis were noted in 32·1% and 17·9% of patients respectively. Cardiac manifestations at presentation included coronary dilatation and pericardial effusion in 46·4% each, ventricular dysfunction (32·1%), atrioventricular valve regurgitation (25·0%), prolonged QTc interval (40·0%) and first-degree atrioventricular block (16·0%). Therapy included aspirin in 89·3%, steroids in 75·0% and intravenous immunoglobulin (IVIG) infusion in 60·7%. All patients survived and were discharged after a mean of 11·14 (SD 5·65) days. Frequency of coronary dilatation had reduced from 46·4% to 7·1% by 3 months follow up and prolonged QTc interval persisted until the 6 week follow up in 4.5% of patients. Echocardiogram and electrocardiogram findings were normal in all patients assessed at 6 months follow up. Interpretation: MIS-C is an important diagnosis in children presenting with prolonged fever during the COVID-19 pandemic. Cardiovascular manifestations occurred in several children with MIS-C and improved by 6 months follow up. Early diagnosis and prompt institution of a combination of antiplatelet therapy, steroids and IVIG appear to be beneficial. Funding: None.
RESUMEN
We aim to evaluate the effect of Moringa leaf (ML) and seed (MS) inclusive diets on critical biomarkers [acetylcholinesterase (AChE), monoamine oxidase (MAO), angiotensin-I converting enzyme (ACE), adenosine deiminase (ADA) and arginase activities, and thiobarbituric acid reactive species (TBARS) level] associated with erectile dysfunction (ED) in the penile tissue of diabetic male rats treated with/without Acarbose (ACA). About 60 mg/kg BW streptozotocin (STZ)-induced diabetic rats were fed with ML and MS inclusive diets and cotreated with ACA for 14 days. The result indicated that AChE, MAO, ADA, ACE, and arginase activities, as well as TBARS level were (p < .05) restored in the diabetic rats fed with ML/MS inclusive diets treated with/without ACA compared to the untreated diabetic rats. In conclusion, the combination therapy of ML/MS inclusive diets plus ACA could be explored toward the management of diabetic-induced ED. PRACTICAL APPLICATIONS: We discovered in this study, treatments of diabetic rats with ACA and co-fed with 2% and 4% of Moringa leaf and seed inclusive diets for 14 days, could be of great benefit toward the management of ED caused by diabetes, as evidenced by the expression of some ED-related biomarkers in the penile tissue of diabetes male rats, compared to that of ACA treated alone. Thus, it seems reasonable to explore the effect of food-drug interaction on the large-scale clinical trial to manage diabetes complications, such as the potential effect of Moringa leaf and seed inclusive diets co-administered with ACA for the holistic management of diabetes-induced erectile dysfunction (ED).