Investigation of natural and artificial radioactivity levels in travertines of the Cappadocia region in Turkey.

This study determined natural and artificial radionuclide concentrations to evaluate natural radioactivity and health risk levels of nine travertines in the Yaprakhisar and Balkayasi regions in Turkey. The samples coded B1-M, B2, B5, B7, B8, and B10 represent waste derived from the Yaprakhisar travertines, as well as samples T5-M, T12, and Z1 travertines derived from Balkayasi. The levels of natural and artificial radionuclide concentrations (232Th, 40K, and 137Cs) were measured using a high-purity germanium (HpGe) detector system. The travertine activity ranged from 2.09 to 12.07 Bq kg-1 for 232Th, 4.21 to 13.41 Bq kg-1 for 40K, and 0.42-3.26 Bq kg-1 for 137Cs. The results showed that the activity concentration values for 232Th, 40K, and 137Cs were coherent with the travertine analysis results in the UNSCEAR, 2000; 2008 publications. The values obtained were lower than the average values in the UNSEAR reports. The radiological hazard parameters calculated in this study were absorbed gamma dose rate (D), radium equivalent activity (Raeq), annual gonadal dose equivalent (AGDE), exposure dose (ER), total annual effective dose (AEDEtotal), excess lifetime cancer risk (ELCRtotal), gamma representative level (GRL), internal hazard index (Hin) and external hazard index (Hex).

Diagnostic Efficiency of Point-Of-Care Lung Ultrasonography in the Diagnosis of Adult Community-Acquired Pneumonia - A Single-Centre Study in Southeastern Nigeria.

BACKGROUND: Lung ultrasonography is an emerging tool in diagnosing community-acquired pneumonia (CAP) - a major cause of mortality worldwide. The objective of the study was to determine the diagnostic performance of point-of-care ultrasound (POCUS) of the lung compared to the chest radiograph in the diagnosis of CAP in adults. METHODS: Adults ≥ 18 years presenting at the general and medical outpatient clinics, medical and emergency wards with symptoms of suspected CAP were evaluated using a portable ultrasound device and single posteroanterior chest radiograph. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR-) with corresponding 95% confidence intervals were computed for the lung ultrasound (LUS) against the chest radiograph as the criterion standard. RESULTS: Out of the 65 patients eventually studied, 50 (76.9%) were diagnosed with pneumonia by chest radiograph. The sensitivity, specificity, PPV, NPV, LR+, LR- and DOR for the LUS against the chest radiograph, respectively, were 96% (95%CI, 86.3% - 99.5%), 93.3% (95%CI, 68.1% - 99.8%), 98.0% (95%CI, 87.8% - 99.7%), 87.5% (64.1% - 96.5%), 14.4 (95%CI, 2.2 - 95.7), 0.04 (95%CI, 0.01 - 0.17) and 336 (28.3 - 3985.0). The overall accuracy was 95.4% (95%CI, 87.1 - 99.0%). The median time to completion of the LUS was 13 minutes. CONCLUSION: Lung ultrasound at the point of care is a reasonably accurate tool for the diagnosis of CAP in adults presenting with typical features.

CONTEXTE: L'échographie pulmonaire est un outil émergent dans le diagnostic de la pneumonie communautaire (CAP) ­ une cause majeure de mortalité dans le monde entier. L'objectif de l'étude était de déterminer la performance diagnostique de l'échographie pulmonaire au point de soins (POCUS) par rapport à la radiographie thoracique dans le diagnostic de la CAP chez les adultes. MÉTHODES: Les adultes ≥ 18 ans se présentant aux cliniques générales et médicales, aux services médicaux et d'urgence avec des symptômes de CAP suspectée ont été évalués à l'aide d'un appareil d'échographie portable et d'une radiographie thoracique postéroantérieure unique. La sensibilité, la spécificité, les valeurs prédictives positive et négative (PPV et NPV), les rapports de vraisemblance positifs et négatifs (LR+ et LR-) avec les intervalles de confiance correspondants à 95 % ont été calculés pour l'échographie pulmonaire (LUS) par rapport à la radiographie thoracique comme norme de référence. RÉSULTATS: Sur les 65 patients étudiés, 50 (76,9 %) ont été diagnostiqués avec une pneumonie par adiographie thoracique. La sensibilité, la spécificité, la PPV, la NPV, les LR+, LR- et DOR pour la LUS par rapport à la radiographie thoracique étaient respectivement de 96 % (IC à 95%, 86,3% ­ 99,5%), 93,3% (IC à 95%, 68,1% ­ 99,8%), 98,0% (IC à 95%, 87,8% - 99,7%), 87,5% (64,1% - 96,5%), 14,4 (IC à 95%, 2,2 ­ 95,7), 0,04 (IC à 95 %, 0,01 ­ 0,17) et 336 (28,3 ­ 3985,0). La précision globale était de 95,4 % (IC à 95%, 87,1 ­ 99,0%). Le temps médian pour l'achèvement de la LUS était de 13 minutes. CONCLUSION: L'échographie pulmonaire au point de soins est un outil raisonnablement précis pour le diagnostic de la CAP chez les adultes présentant des caractéristiques typiques. MOTS-CLÉS: Échographie pulmonaire, Radiographie thoracique, Pneumonie communautaire, Précision diagnostique, Ressources limitées.

Pattern and Prevalence of Intestinal Helminthiasis among Human Immunodeficiency Virus-Infected Children at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State.

BACKGROUND: Children infected with the human immunodeficiency virus (HIV) may be more prone to helminthic infestation because they have depleted immunity, which increases their susceptibility to infection and infestations, even with minimally pathogenic organisms such as helminths. AIM: The prevalence and pattern of intestinal helminthiasis among children living with HIV attending the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu. PATIENTS AND METHODS: A cross-sectional study in which 70 HIV-infected children were consecutively recruited from the Pediatric HIV clinic and matched for age and sex with 70 children recruited from the children outpatient clinic (CHOP) of UNTH Ituku-Ozalla. Stool samples of study participants were collected and analyzed using the Kato-Katz method and subsequently examined under the microscope for helminths' eggs and larvae. The worm intensity was determined using the theoretical analytic sensitivity (TAS) of 24 eggs per gram (EPG) to obtain the number of eggs per gram of feces. The CD4+ count, which describes the severity of immunosuppression in HIV-positive children was determined using the PARTEC Cyflow counter for the CD4+ lymphocyte count, whereas HIV screening was performed using the rapid diagnostic tests for HIV (Determine, Statpack and Unigold). Data were analyzed using IBM SPSS. RESULTS: The prevalence of intestinal helminthiasis among HIV-infected and non-infected children was 27.1% and 12.9%, respectively (P = 0.038). HIV-positive children were more likely to have intestinal helminthiasis than HIV-negative children (odds ratio [OR] =2.525, 95% confidence interval [CI]: 1.052-6.063). Ascaris lumbricoides was the predominant helminthic species in both HIV-infected and non-infected groups; however, there was no statistical significance between intestinal helminthic species and HIV status (P = 0.655) but the severity of intestinal helminthiasis was significantly associated with decreasing CD4+ count (P = 0.028). The risk factors for intestinal helminthic infestation examined were similar in both HIV-positive and HIV-negative children (P > 0.05). CONCLUSION: There was a significantly higher prevalence of helminthic infestation among HIV-infected children compared to their HIV-negative counterparts. The severity of intestinal helminthiasis was significantly associated with decreasing CD4+ count.

Pulmonary Embolism: The Battle to Save Life in a Resource Poor Setting.

INRODUCTION: Pulmonary embolism (PE) is a cardiovascular emergency caused by occlusion of one or more pulmonary arteries by thrombi that originate from a deep venous thrombosis (subsequently called an embolus), typically in the large veins of the lower limb or pelvis. It is a common cause of preventable hospital death and a cause of mortality in obstetrics setting because it largely remains under diagnosed especially in a resource poor setting. CASE REPORT: Mrs OG, a 30-year-old primigravida, had a spontaneous delivery of a baby boy. A few hours after delivery, she had two episodes of syncope and was resuscitated with intra-venous fluids and blood transfusion. Further evaluation, with an abdominopelvic ultrasound scan, showed that she had supra-levator haematoma necessitating emergency exploratory laparotomy. During the induction of anaesthesia for the surgery, she had a cardiac arrest and was again resuscitated with cardiac compression and intravenous adrenaline. She was transferred to ICU on account of cardio-respiratory instability. On the 2nd day post operation, the chest physician reviewed and noted history of cough, haemoptysis and breathlessness of two days duration. She had an associated unilateral (right) leg swelling, with presence of cyanosis, tachypnoea and tachycardia with SPO2 fluctuating between 82-92% (while on oxygen with nasal prongs). The clinical probability of PE using Well's scoring system was high (11.5). In the absence of computerized tomography (CT) pulmonary angiography and ventilation perfusion (V/Q) scan, a Doppler ultrasound of both legs was done which showed dilation of the proximal one-third of the right femoral vein with meshwork of thrombi. She was subsequently commenced on Enoxaparin and intra-venous fluids and antibiotics. She also received supplementary oxygen. The Prothrombin time and International Normalized Ratio (INR) were monitored over the period. She slowly but progressively improved and was discharged home on oral warfarin. The index patient had cardiopulmonary arrest and expectedly, needed urgent intervention with embolectomy or thrombolytic therapy. In the absence of these, anticoagulation with vasopressor agents, supplementary oxygen and close monitoring was able to sustain the patient. SUMMARY: Pulmonary embolism is a killer condition with 10% of the patients dying within one hour of onset. Most times, mortality occurs in patients who were never diagnosed. The best prospect for reducing mortality in patients with PE lies in improving diagnosis.

INRODUCTION: L'embolie pulmonaire (EP) est une urgence cardiovasculaire causée par l'occlusion d'une ou plusieurs artères pulmonaires par des thrombus provenant d'une thrombose veineuse profonde (appelée par la suite embole), généralement dans les grosses veines du membre inférieur ou du bassin. Il s'agit d'une cause fréquente de décès hospitalier évitable et d'une cause de mortalité en obstétrique car elle reste largement sous-diagnostiquée, en particulier dans un contexte de ressources limitées. RAPPORT DE CAS: Mme OG, une primigeste de 30 ans, a accouché spontanément d'un petit garçon. Quelques heures après l'accouchement, elle a eu deux épisodes de syncope et a été réanimée avec des fluides intraveineux et une transfusion sanguine. Une évaluation plus poussée, avec une échographie abdomino-pelvienne, a montré qu'elle avait un hématome supra-levatorien nécessitant une laparotomie exploratoire d'urgence. Pendant l'induction de l'anesthésie pour la chirurgie, elle a fait un arrêt cardiaque et a été réanimée par compression cardiaque et adrénaline intraveineuse. Elle a été transférée aux soins intensifs en raison de son instabilité cardio-respiratoire. Le deuxième jour après l'opération, le médecin thoracique a examiné et noté une histoire de toux, d'hémoptysie et d'essoufflement depuis deux jours. Elle présentait un gonflement unilatéral (droit) de la jambe, une cyanose, une tachypnée et une tachycardie avec une SPO2 fluctuant entre 82 et 92 % (sous oxygène avec des pinces nasales). La probabilité clinique d'EP en utilisant le système de notation de Well était élevée (11,5). En l'absence d'angiographie pulmonaire par tomodensitométrie et de scintigraphie de ventilation et de perfusion (V/Q), une échographie Doppler des deux jambes a été réalisée et a montré une dilatation du tiers proximal de la veine fémorale droite avec un maillage de thrombus. Elle a ensuite été mise sous Enoxaparine, fluides intraveineux et antibiotiques. Elle a également reçu de l'oxygène supplémentaire. Le temps de prothrombine et le rapport international normalisé (INR) ont été surveillés pendant toute la période. Elle s'est lentement mais progressivement améliorée et a été renvoyée chez elle sous warfarine orale. Le patient de référence a fait un arrêt cardio-pulmonaire et, comme on pouvait s'y attendre, a dû subir une intervention urgente avec embolectomie ou thérapie thrombolytique. En l'absence d'une telle intervention, une anticoagulation avec des agents vasopresseurs, un supplément d'oxygène et une surveillance étroite ont permis de maintenir le patient en vie. RÉSUMÉ: L'embolie pulmonaire est une maladie mortelle, 10% des patients décèdent dans l'heure qui suit son apparition. La plupart du temps, la mortalité survient chez des patients qui n'ont jamais été diagnostiqués. La meilleure perspective pour réduire la mortalité chez les patients atteints d'EP réside dans l'amélioration du diagnostic. Mots clés: Embolie pulmonaire, milieu pauvre en ressources, diagnostic, prise en charge.

Screen viewing practices and caregivers' knowledge of the health-related effects in children and adolescents in a Nigerian Urban City.

Background: Globally, a dramatic increase in the use of television and digital media has been observed among children and adolescents in recent times. The possible health-related effects of frequent and prolonged screen media viewing on these children and adolescents have triggered many concerns among researchers. Aim: The study is aimed to determine the screen media viewing practices and caregivers' level of knowledge about the health-related effects of prolonged screen viewing time on their children. This was a descriptive cross-sectional study among caregiver/child and adolescent dyads on outpatient clinic visits. Subjects and Methods: Respondents (caregivers/children's pairs) were consecutively recruited, and data was obtained using an unambiguous pre-tested semi-structured questionnaire comprising four domains: socio demographic characteristics; screen media viewing characteristics, perception of the health related effects of prolonged viewing time, and measures to limit prolonged screen viewing time in children. Descriptive and inferential statistics were done using Statistical Package for Social Sciences (SPSS) version 22.0 at a level of statistical significance P < 0.05. Results: Of the 205 respondents studied, the majority (67.8%, fathers and 76.1%, mothers) had tertiary education. The daily mean time spent by children watching television/screen media was 2 (± 1.58) hours. Up to 89.3% of the caregivers established good standards for healthy screen-viewing in their homes. However, 52.7% of them had poor knowledge of the health-related problems of increased viewing time. Socio-economic class (P = 0.002) and knowledge level of the parents (P = 0.000) were significant predictors limiting children's screen-viewing time. Conclusion: Increasing screen media viewing is common among the children studied. The majority of the caregivers had poor knowledge of health-related effects of prolonged viewing time despite high educational attainment. There is a need to enlighten caregivers on the possible health effects of excess screen media viewing so as to enable them to institute stringent measures to limit the attendant health consequences on the children.

Prevalence and risk factors for helicobacter pylori infection among children in Owerri, Nigeria.

BACKGROUND: Helicobacter pylori (H. pylori) is a gram-negative ubiquitous bacterium affecting over half of the world's population. Most infections are acquired in early childhood with highest prevalence in Africa and Asia. Infected individuals develop antibodies against H. pylori which persist up to 6 months after eradication. Low socioeconomic status, poor sanitation, poor personal hygiene, and absence of potable household water supply are prevalent in our environment and also linked with increased frequency of the disease with attendant health consequences. AIMS: The aim of the study was to determine the seroprevalence of H. pylori infection and potential sociodemographic factors among children in Owerri. METHODS: One hundred and twenty children aged 6 months to 15 years were studied from March to June 2016. Sociodemographic data was documented in a pretested structured questionnaire while rapid test kit that detects antibody to H. pylori by chromatographic flow was used to identify subjects with infection. Data were analyzed using SPSS version 20.0 with level of statistical significance at P < 0.05. RESULTS: H. pylori infection prevalence was 20.0%, increased with age and highest in the 10-15 years age group (P = 0.001). Increasing age and low socioeconomic class (SEC) were found to be significant risk factors of H. pylori seropositivity among study subjects. CONCLUSION: Prevalence of H. pylori infection was high, increased with age and lower SEC as well as highest among children aged 10 years and older. Efforts should be made to exclude H. pylori infection in children with suspected symptoms considering the high burden of the disease in our setting.

Comparative study of nutritional status of children and adolescents with sickle cell anemia in Enugu, Southeast Nigeria.

BACKGROUND: Poor growth and nutritional status are common features of sickle cell anemia (SCA) in children. The rising trend of obesity in children in developing countries has been reported despite a huge burden of undernutrition in these settings. In SCA, overweight/obesity is being increasingly reported. AIMS: To evaluate the nutritional status and its determinants in children with SCA and to compare the same with hemoglobin AA (HbAA) controls of similar age, gender, and socioeconomic status. METHODS: The study was a cross-sectional analytical study involving 175 subjects and controls aged 1-18 years who met the inclusion criteria. Weight and height were measured and body mass index (BMI) was calculated. Z scores were computed for the anthropometric measurements using the World Health Organization (WHO) standard reference. Hemoglobin concentration was determined using HemoCue Hb201+ Analyzer. RESULTS: Subjects had significantly lower Z- scores for weight, height, and BMI compared with controls. Stunting, wasting, and overweight/obesity were observed in 10.9%, 24.6%, and 5.1% of subjects compared with 2.3%, 5.7%, and 9.7% respectively in controls. Wasting, stunting and overweight/obesity in SCA were significantly associated with age while overweight/obesity was significantly associated with upper social class (P = 0.001). CONCLUSIONS: Poor growth and nutritional status are still prevalent while overweight and obesity are emerging comorbidities among children with SCA in our environment. Regular nutritional assessment of children with SCA should be encouraged while those at risk of under/over-nutrition should receive adequate nutritional rehabilitation to prevent possible complications.

Relationship between zinc levels and anthropometric indices among school-aged female children with sickle cell anemia in enugu, Nigeria.

BACKGROUND: Sickle cell anaemia is one of the most common inherited disorders globally. Some affected children have retardation of physical growth which is also seen in those with zinc deficiency. OBJECTIVE: To assess the relationship between zinc levels and anthropometric indices of SCA children. METHODS: A cross- sectional, case-control study on young females aged 6-18 years at the UNTH, Enugu. Relevant clinical data as well as 24 hour dietary recall were collected. Weights and heights were measured using standard protocols and BMI calculated. Serum zinc was determined using Atomic Absorption Spectrophotometer. Data was analyzed using SPSS version 15.0 while the level of statistical significance was set at P < 0.05. RESULTS: Eighty-one subjects with HbSS and 81 matched controls with HbAA were studied. Mean weights of 34.58 ± 12.76kg found in patients were significantly lower than 40.19 ± 13.37kg in controls. Also mean BMI of 16.27 ± 2.76kg/m2 in patients were significantly lower than 18.40 ± 2.96kg/m2 in controls (P = 0.01). Mean heights of patients were lower than that of the controls though not significantly so (P > 0.05). Mean serum zinc levels of 58.01 ± 10.58µg/d1 in patients were significantly lower than 68.37 ± 8.6µg/dl in controls (P = 0.01). Positive correlation was found between serum zinc and BMI of the studied children. Serum zinc has a significant relationship with weight, height and BMI. CONCLUSION: Reduced serum zinc in SCA children was associated with low anthropometric indices. Estimation of serum zinc is also recommended in SCA children with low anthropometric indices.

Assessing medical students' perception of effective teaching and learning in Nigerian medical school.

BACKGROUND: Medical education is always in a state of dynamic equilibrium with continuous evolution of new techniques in teaching and learning. OBJECTIVES: Objective of this study is to determine medical students' perception on preferences of teaching and learning. PARTICIPANTS: A total of 207 medical students participated in the study. Most (73.9%) of them were males while the modal age group was 23-25 years. Majority (57.5%) of the students belong the middle socioeconomic class and 65.7% resided within the hostel. RESULTS: Majority of the students (48.8%) believe two hours is enough to per lecture. Among the five different teaching-learning methods investigated, use of multimedia methods was found to be most effective. There exist a statistically significant association was found only in gender with regular oral examinations (Χ2 = 4.5, df = 1, p = 0.03) and socioeconomic class with dictation of lecture notes (Χ2 = 17.9, df = 9, p = 0.03). CONCLUSION: The present day medical student will end up as a good clinician if modern techniques of teaching and communication skills of the lecturers are adopted.

Human rabies: still a neglected preventable disease in Nigeria.

BACKGROUND/OBJECTIVES: Adequate surveillance and monitoring of dog bite incidents are veritable tools in the determination of the epidemiology of human rabies infections. There is a paucity of data with regards to rabies in Nigeria. Hence, this study was aimed at describing the pattern and outcomes of dog bites and rabies infections among patients presenting to University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. SUBJECTS AND METHODS: This was a 10-year (January 1, 2004 to December 31, 2013) observational retrospective study. Case definition of rabies was based on ICD 10 criteria, while relevant clinical data were retrieved from individual folders of registered victims using a semi-structured questionnaire. Data were analyzed using SPSS version 17.0 while the level of statistical significance was set at P < 0.05. RESULTS: A total of 149 cases of dog bites were reported during the period under review, of which 6 (4.0%) had confirmed rabies. Ninety-six (64.4%) cases presented more than 24 h after the bites. Majority of the offending dogs were stray dogs 86 (57.7%), which attacked their victims unprovoked, in 54.6% of cases. Furthermore, most of the bites were from dogs with unknown history of rabies vaccination 72 (52.3%), while the case fatality rate was 100%. CONCLUSIONS: All the cases of rabies reported were as a result of bites from stray dogs with unknown history of rabies vaccinations, and the outcome was 100% fatality in all cases. Efforts should be made to create and strengthen awareness campaigns on control of rabies infections through responsible dog ownership including their regular vaccinations as well as provision and use of prompt postexposure prophylaxis in human cases of dog bites at all levels of health care.

Perception of child adoption among parents/care-givers of children attending pediatric outpatients' clinics in Enugu, South East, Nigeria.

BACKGROUND: There has been an increasing interest by couples in child adoption due to its acceptability in recent times in our locale. The enactment of the Child's Right Act in Nigeria has harmonized child adoption process across the nation. With the rising demand for babies from child care institutions by many Nigerian couples, there is need to ascertain their perception of child adoption. OBJECTIVES: To evaluate the perception of child adoption among parents/care-givers of children attending Pediatric Clinics in Enugu. MATERIALS AND METHODS: The parents and care-givers of children attending pediatrics out-patients clinics in Enugu, Enugu State, South East, Nigeria served as the respondents. Two hundred and fifty nine of them were selected by convenience sampling method after obtaining their informed written consent. The data were obtained using semi - structured questionnaire that was administered by an interviewer and subsequently analyzed using SPSS Version 15.0. RESULTS: Many caregivers (respondents) (94.2.7%) had heard of child adoption and 79.2% of them understood the actual meaning of the term child adoption. About 1.9% of them had adopted previously. Majority of the respondents (73.87%) prefers to adopt a child during its neonatal age with a slight preference for adoption of male babies. 15.1% and 8.9% of the respondents gave private hospitals and middle men, respectively, as sources of child adoption. Knowledge of the Government adoption laws and process was generally below average (49.2%) among the respondents. CONCLUSION: Continued advocacy and public enlightenment campaigns should be strengthened in order to harmonize adoption process in our setting.

Pattern and clinical profile of children with complex cardiac anomaly at University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.

BACKGROUND: Complex congenital cardiac abnormalities are rare among children and contribute to mortality and morbidity. The prevalence and pattern of presentation vary from place to place. MATERIALS AND METHODS: The objective of this study was to determine the clinical profile and pattern of presentation of complex congenital cardiac malformations among children attending a tertiary hospital in Enugu State. A cross-sectional retrospective study in which a review of the records of children who attended the children outpatient clinic of University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State over a 5-year period (January 2007-June 2012) was undertaken. RESULTS: Thirty one thousand seven hundred and ninety-five (31,795) children attended the outpatient clinic of the hospital over the study period, of these, 65 had cardiac diseases, from which 16 were found to have congenital complex cardiac abnormalities of various types, giving a prevalence of 0.05%. Complex abnormalities seen in these children are Tricuspid atresia with various associations, cor triatriatum, single ventricle, and large ASD (atrio-septal defect) with complete AVCD, cor triatriatum sinistrum with cardiomyopathy, DORV (double outlet right ventricle) with left sided aorta, hypoplastic tricuspid valve with a PDA (patent ductus artriosus), TOF (tetralogy of fallot), prolapse of aortic valve, and pulmonary regurgitation. One of these complex cardiac anomalies presented with Turner's syndrome and another with VACTERAL association. CONCLUSIONS: The results of this study show that 0.05% of children who presented at cardiology clinic of a teaching hospital in Enugu State had congenital complex cardiac abnormalities and that the commonest forms seen were those with cor triatriatum and TOF.

Mothers' perception and management of abdominal colic in infants in Enugu, Nigeria.

BACKGROUND: Abdominal colic is common in infants but generally harmless. The exact aetiology is unknown but it has been associated with vicious cycle of crying and swallowing of air by the infant. The excessive crying associated with it can result in a lot of distress for family members creating unnecessary panics. We sought to find the perception and management of abdominal colic by mothers in Enugu. OBJECTIVE: Objective of this study is to determine the perception and 'home management' of abdominal colic in infants by mothers in Enugu, south-east Nigeria and the factors associated with them. MATERIALS AND METHODS: A cross-sectional survey involving 177 mothers that presented with their infants at the pediatric outpatient clinic of the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu between June and November 2011. A pretested questionnaire was used after obtaining their consent. RESULTS: A total of one hundred and seventy-seven mothers participated in this study. They were aged 20 to 60 years with mean age of 34 ± 7.3 years. Most of them (99.4%) believed that babies can have abdominal colic. While 41.3% attributed no problems to colic, the rest believed that it causes loose/greenish stools (12.4%), fever (16.4%) and vomiting (9.6%) etc. Most of the mothers (87.7%) do apply medications for colic which range from paracetamol (33.1%), Gbomoro (16.2%), teething powder (15.4%), salt water (13.2%), Buscopan (7.7%) and gripe water (4.6%). CONCLUSIONS: Mothers attribute symptoms of childhood illnesses to abdominal colic. This may have led to unnecessary and sometimes harmful management. There is need for health education of mothers and potential mothers.

Weekend versus weekday hospital deaths: analysis of in-patient data in a Nigerian tertiary healthcare center.

AIM: This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. MATERIALS AND METHODS: This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95% confidence intervals. RESULTS: A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 ( P = 0.0461) and 1.41:1 ( P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 ( P = 0.7360). CONCLUSION: The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.

Profile of paediatric umbilical hernias managed at Federal Medical Centre Umuahia.

BACKGROUND: Umbilical hernias are common in children but many resolve spontaneously within the first five years of life. Most umbilical herniorrhaphies in our environment are due to symptomatic hernias which constitute a small percentage of all umbilical hernias. PATIENTS AND METHODS: A retrospective review of all pediatric patients with UH treated at Federal Medical Centre Umuahia, Abia State from February 2001 to February 2011. RESULTS: There were 22 patients but only 20 of the folders were found and analyzed. They were made up of 11 males and 9 females with a mean age of 6.19 +/- 0.83 years and median age of 6 years. Nine(7 males and 2 females) had acute incarcerations, nine (3 males and 6 females) had recurrent umbilical pains without incarceration and two (1 male and 1 female) had recurrent incarcerations. Age range for acute incarceration was 2-8 years (mean: 4.69 years, median: 4 years); recurrent umbilical pains was 4 months -15 years (mean: 7.7 years, median: 8 years) and for recurrent incarceration 2-10 years (mean: 6 years). All had standard umbilical hernia repairs except one whose parents declined surgery after reduction of acute incarceration. One patient with acute incarceration had gangrenous bowel with hernia sac abscess and was offered bowel resection with end-to-end anastomosis. On short-term follow-up, the symptoms resolved in all the patients following surgery. Five patients had six complications: 1 exuberant granulation tissue, 2 stitch reactions, 2 superficial wound dehiscence and one superficial wound infection. There were no mortalities and no recurrence on short-term follow-up. Only one patient (5%) registered under the National Health Insurance Scheme (NHIS). CONCLUSIONS: Active observation of all umbilical hernias at all ages will ensure early detection of complications and prompt treatment. Elective repair of umbilical hernias in patientsabove five years with fascia defect greater than 1.5cm is encouraged. Comprehensive NHIS will ensure early presentation and reduced complications.

Identification of Optimum Panel of Blood-based Biomarkers for Alzheimer's Disease Diagnosis Using Machine Learning.

With the increasing number of people living with Alzheimer's disease (AD), there is a need for low-cost and easy to use methods to detect AD early to facilitate access to appropriate care pathways. Neuroimaging biomarkers (such as those based on PET and MRI) and biochemical biomarkers (such as those based on CSF) are recommended by international guidelines to facilitate diagnosis. However, neuroimaging is expensive and may not be widely available and CSF testing is invasive. Bloodbased biomarkers offer the potential for the development of a low-cost and more time efficient tool to detect AD to complement CSF and neuroimaging as blood is much easier to obtain. Although no single blood biomarker is yet able to detect AD, combinations of biomarkers (also called panels) have shown good results. However, a large number of biomarkers are often needed to achieve a satisfactory detection performance. In addition, it is difficult to reproduce reported results within and across different study cohorts because of data overfitting and lack of access to the datasets used in the studies. In this study, our focus is to identify an optimum panel (in terms of the least number of blood biomarkers to meet the specified diagnostic performance of 80% sensitivity and specificity) based on a widely accessible data set, and to demonstrate a testing methodology that reinforces reproducibility of results. Realizing a panel with reduced number of markers will have significant impact on the complexity and cost of diagnosis and potential development of cost-effective point of care devices.

Rotavirus diarrhoea hospitalizations among children under 5 years of age in Nigeria, 2011-2016.

BACKGROUND: The high burden of rotavirus acute gastroenteritis (AGE) is well documented among children under 5 years of age, with the majority of mortality occurring in developing countries. Nigeria ranked second worldwide in the number of rotavirus deaths in 2013. As Nigeria plans to introduce rotavirus vaccine soon, a pre-vaccine documentation of rotavirus disease burden is necessary to determine vaccine impact. METHODS: Routine rotavirus surveillance was conducted during 2011-2016 in 3 sentinel sites in Nigeria using the standard WHO protocol. Children under 5 years of age hospitalized for acute gastroenteritis were enrolled and demographic, clinical and outcome data were collected. A stool sample was subsequently obtained and tested for human rotavirus antigen using the Enzyme-linked immunosorbent assay (ELISA). RESULTS: 2694 children with acute gastroenteritis were enrolled during January 2011 to December 2016; of these, 1242 (46%) tested positive for rotavirus. Among the rotavirus positive cases, 66% and 94% were younger than 12 months and 24 months respectively. Marked peaks in rotavirus positivity were seen in January of each year. Vomiting, and use of oral and intravenous fluids occurred more often in rotavirus positive cases as compared to rotavirus negative cases. CONCLUSION: The high prevalence of rotavirus disease highlights the need for urgent introduction of rotavirus vaccine in Nigeria. Additionally, this study provides pre-vaccine introduction disease-burden data that will serve as a baseline for rotavirus vaccine impact-assessment once vaccine has been introduced in the national immunization program.

The Burden and Outcome of Pediatric Renal Admissions at the Federal Teaching Hospital Abakaliki: A 3-year Review (2011-2013).

BACKGROUND: Renal diseases are important causes of morbidity and mortality in children worldwide particularly in the resource-poor countries of sub-Saharan Africa. Adequate data on these diseases in children in our setting are limited as a result of late/nonpresentation. AIM: The aim of the study is to review the pattern and outcome of pediatric renal admissions at the Federal Teaching Hospital (FETH) Abakaliki over a 3-year period. SUBJECTS AND METHODS: This was a retrospective observational review of all childhood renal admissions in FETH, Abakaliki, Ebonyi state between 2011 and 2013. Relevant clinical data extracted from the hospital records included patients' biodata, presenting symptom(s), examination finding (s), laboratory investigation results as well as treatment and outcome using a semi-structured questionnaire. Data collected were analyzed using SPSS software package version 16.0. The differences in proportions were tested for statistical significance using the Chi-square statistics. Statistical significance was based on P < 0.05. RESULTS: In the period under review, 1780 children were admitted, of which 4.4% (79/1780) had renal disorders. The mean age of the children was 8.37 (5.1) years. Nephrotic syndrome 32.9% (26/79) was the most common while on individual basis, meatal stenosis, acute kidney injury and end-stage renal disease, respectively, 1.3% (1/79) were the least renal disorders in the study population. The association between treatment mode and outcome of the treatment was statistically significant (P = 0.03), whereas other variables, such as age (P = 0.42), sex (P = 0.28), socioeconomic status (P = 0.33), and type of renal disease (P = 1.00) were not statistically significant. The case fatality rate was 3.8% (3/79). CONCLUSION: The prevalence of individual renal cases in the current study appears to be high. Nephrotic syndrome was the most common with the majority having favorable outcome. There is need to encourage early presentation as the outcome of some of these renal diseases is encouraging, especially when diagnosis and effective management are possible.

Accidental Childhood Poisoning in Enugu, South-East, Nigeria.

BACKGROUND: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time. AIM: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu. SUBJECTS AND METHODS: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted. RESULTS: Sixty-five cases of childhood poisoning were recorded during the 10-year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65). CONCLUSION: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications.

Seroprevalence and Correlates of Hepatitis C Virus Infection in Secondary School Children in Enugu, Nigeria.

BACKGROUND: Although children comprise a small fraction of the burden of hepatitis C virus (HCV) infections, which is a major global health challenge, a significant number of them develop chronic HCV infection and are at risk of its complications. AIM: The aim of the current study was to determine the prevalence and associated factors of HCV infection in school children in Enugu urban. SUBJECTS AND METHODS: This was a cross-sectional seroepidemiological study involving children aged 10-18 years selected using multistage systematic sampling in Enugu metropolis, Southeast Nigeria. The anti-HCV was tested using a 3(rd) generation enzyme-linked immunosorbent assay. Data were analyzed using SPSS Version 16.0 with the level of significance set at P < 0.05. RESULTS: Four hundred and twenty children were selected and screened comprising 210 (50.0%) males and females. The seroprevalence of anti-HCV was 4 (1.0%). Three (75%) out of the four positive cases for the anti-HCV were females while one was a male giving a male to female ratio of 0.3-1. Traditional scarifications/tattoos were the putative risk factors observed to be significantly associated with anti-HCV seropositivity. CONCLUSION: This study has demonstrated an anti-HCV seroprevalence of 1.0% among children aged 10-18 years in Enugu with traditional scarification as the predominant associated risk factor. Proper health education including school health education and promotion of behavioral change among the public on the practice of safe scarifications/tattoos should be encouraged in our setting.