ASSOCIATION BETWEEN FINGER CLUBBING AND CHRONIC LUNG DISEASE IN HIV INFECTED CHILDREN AT KENYATTA NATIONAL HOSPITAL.

BACKGROUND: Finger clubbing in HIV infected children is associated with pulmonary diseases. Respiratory diseases cause great morbidity and mortality in HIV infected children. OBJECTIVE: To determine association between finger clubbing and chronic lung diseases in HIV infected children and their clinical correlates (in terms of WHO clinical staging, CD4 counts/percentage, anti-retroviral therapy duration and pulmonary hypertension). DESIGN: Hospital based case control study. SETTING: The Kenyatta National Hospital (KNH) comprehensive care clinic (CCC) for HIV infected children and Paediatric General Wards. SUBJECTS: The study population comprised of HIV infected children and adolescents aged eighteen years and below. RESULTS: Chronic lung disease was more common among finger clubbed (55%) than non finger clubbed patients (16.7%). Finger clubbed patients had higher risk of hypoxemia (46.7%), pulmonary hypertension (46.7%) and advanced disease in WHO stage III/IV (91.7%) compared to non-finger clubbed patients. Finger clubbed patients had lower CD4 cells count and percentage (median 369 cells, 13%) compared to non-clubbed patients (median 861 cells, 28%). Duration of ART use was shorter in finger clubbed patients (median 5.5 months) compared to non-finger clubbed patients (median 40 months). CONCLUSION: Presence of finger clubbing in HIV infected children was associated with chronic lung disease, advanced WHO stage, lower CD4 counts/ percentage, shorter duration of ART use and higher likelihood of developing pulmonary hypertension.

An open randomized trial of artemether versus quinine in the treatment of cerebral malaria in African children.

We have compared the efficacy of artemether versus quinine as treatment for cerebral malaria in children in an open randomized clinical trial in Kenya. Children admitted to hospital with coma and Plasmodium falciparum parasitaemia were treated with either intramuscular artemether (3.2 mg/kg loading dose followed by 1.6 mg/kg daily) or intravenous quinine (20 mg/kg loading dose followed by 10 mg/kg every 8 h). Both drugs were well tolerated and no significant adverse effect was observed. Parasite clearance times (50% and 90%) were shorter in patients treated with artemether (median times [h], with interquartile ranges in brackets, were: 50%, 7.3 [4.2-12.4] vs. 15.5 [9-22]; 90%, 16.9 [13.2-25] vs. 28.5 [22-35]; P < 0.0001). The total mortality in 160 children with cerebral malaria was 16.25%, with no overall significant difference between the 2 treatment groups. In a subgroup of children with respiratory distress, mortality was higher in those treated with artemether (43.7% vs. 11.1%, P < 0.05). The frequency of neurological sequelae and clinical recovery times were similar in both treatment groups. We conclude that there would currently be no advantage in replacing quinine with artemether for the treatment of cerebral malaria in African children.