Gender Differences in Clinical Characteristics and Lifestyle Behaviours of Overweight and Obese Adolescents.

BACKGROUND: Energy intake and energy expenditure are different in boys and girls, especially during the adolescent period, a critical period for the development of obesity. However, gender-specific lifestyle behaviours that may influence the development of obesity among adolescent have not received sufficient attention. AIM: To determine gender differences in male and female overweight/ obese adolescents concerning their clinical parameters, dietary, sedentary and physical activity lifestyle behaviours. METHODS: From a total of 1036 secondary school students aged 10-17 years, BMI percentile for age and gender was used to identify overweight and obese individuals. These adolescents were then questioned on dietary, sedentary and physical activity lifestyle behaviours via a structured self-administered questionnaire. RESULTS: The overweight/obese adolescent identified were 92. Female adolescents were 1.5 times more than male adolescents. The male, overweight/ obese adolescents were significantly younger than their female counterparts (11.9 ± 1.0 years vs 13.2 ± 2.0 years p=0.0001). Female overweight/ obese adolescents were significantly heavier (67.1 ± 12.5 kg vs 59.6 ± 8.6 kg, p=0.003), with higher BMI (25.7 ± 3.7 kg/m2 vs 24.0 ± 2.3 kg/m2, p=0.012), and wider hip circumference (102.9 ± 9.0 cm vs 95.7 ± 6.7 cm, p=0.002). Regarding lifestyle behaviours, female overweight/ obese adolescents consumed more fast foods compared to their male counterparts (p=0.012). In contrast, significantly more male overweight/ obese adolescents were driven to and from school compared to female adolescents (p=0.028). CONCLUSION: Gender differences exist between overweight/obese female and male adolescents. The females were older, heavier and consumed fast foods more frequently. While their male counterparts were younger and tended to engage in less physical exertion. These factors should be considered when planning adolescents' weight loss and prevention interventions.

CONTEXTE: L'apport et la dépense énergétiques sont différents chez les garçons et les filles, en particulier pendant l'adolescence, une période critique pour le développement de l'obésité. Cependant, les comportements de style de vie spécifiques au sexe qui peuvent influencer le développement de l'obésité chez les adolescents n'ont pas fait l'objet d'une attention suffisante. OBJECTIF: Déterminer les différences entre les sexes chez les adolescents masculins et féminins en surpoids/obèses en ce qui concerne les paramètres cliniques, les habitudes alimentaires, la sédentarité et l'activité physique. MÉTHODES: Sur un total de 1 036 élèves du secondaire âgés de 10 à 17 ans, le percentile de l'IMC pour l'âge et le sexe a été utilisé pour identifier les personnes en surpoids et obèses. Ces adolescents ont ensuite été interrogés sur leurs habitudes alimentaires, leur sédentarité et leur activité physique au moyen d'un questionnaire structuré autoadministré. RÉSULTATS: 92 adolescents ont été identifiés comme étant ensurpoids ou obèses, les adolescentes étant 1,5 fois plus nombreuses que les adolescents. Les adolescents en surpoids/obèses étaient significativement plus jeunes que leurs homologues féminines (11,9 ±1,0 contre 13,2 ± 2,0 p =0,0001). Les adolescentes en surpoids/ obèses étaient significativement plus lourdes (67,1 ± 12,5 vs 59,6 ± 8,6, p=0,003), avec un IMC plus élevé (25,7 ± 3,7 vs 24,0 ± 2,3, p=0,012), et un tour de hanche plus large (102,9 ± 9,0 vs 95,7 ± 6,7, p=0,002). En ce qui concerne les habitudes de vie, les adolescentes en surpoids/obèses consommaient plus de fast-foods que leurs homologues masculins (p=0,012). En revanche, les adolescents en surpoids/obèses de sexe masculin étaient significativement plus nombreux à se rendre à l'école en voiture que les adolescentes (p=0,028). CONCLUSION: Il existe des différences entre les adolescents et les adolescentes obèses ou en surpoids. Les filles sont plus âgées, plus lourdes et consomment plus fréquemment des fast-foods. Leurs homologues masculins étaient plus jeunes et avaient tendance à faire moins d'efforts physiques. Ces facteurs devraient être pris en compte lors de la planification des interventions de prévention et de perte de poids chez les adolescents. Mots-clés: Différences entre les sexes, Comportements liés au mode de vie Surpoids, Obésité, Adolescents.

Clinical predictors of circulatory failure and coexisting morbidities in children seen in an emergency room in Southern Nigeria.

Background: Circulatory failure (shock) is a life-threatening emergency referring to a state of poor tissue perfusion and resultant anaerobic respiration at a cellular level. It is a common pathway for several severe pediatric morbidities. Aim: We evaluated the clinical predictors of shock and coexisting morbidities in acutely-ill children. Patients and Methods: This was a descriptive, cross-sectional study. Data were collected using a researcher-administered questionnaire eliciting demography, clinical features, diagnoses/differentials, and comorbidities. After binary analysis, multiple logistic regression identified variables that independently predict circulatory failure in the participants, using odds ratio (OR) and 95% confidence intervals (CI). Results: Five hundred and fifty-four children took part in the study. Their median age was 60 (IQR: 24-132) months, mean weight 16.3 ± 13.6 kg and mean height was 90.8 ± 33.2 cm; 53.7% of them were males while 46.3% were females. The incidence of shock was 14.3% among the participants on arrival at the emergency room. Febrile seizure (14.9%), dehydration (4.7%), pallor (3.1%), and coma (1.8%) were the clinical findings significantly associated with shock (P < 0.05). Leading underlying diagnoses and comorbidities associated with shock were severe malaria (85.4%) and severe sepsis (25.0%) (P ≤ 0.01). Also, seizure (OR = 0.07, 95% CI: 0.04-0.13; P ≤ 0.001) and severe sepsis (OR = 0.31, 95% CI: 0.15-0.65; P = 0.002) were independent predictors of circulatory failure. Conclusion: The presence of acute neurologic morbidities and severe infection predicts circulatory failure in the pediatric emergency setting. Early detection and prompt treatment will forestall shock-related complications in affected children.

Glomerular hyperfiltration in excess weight adolescents.

BACKGROUND: Childhood overweight/obesity burden is on the rise worldwide. Obesity affects virtually all organs. In the kidney, glomerular hyperfiltration that manifests as elevated glomerular filtration rate is a frequent manifestation in obesity. This adaptive renal manifestation to excess metabolic demand on the kidney, in children, has been studied mainly in the severely obese and is uncertain if it is present in less severe forms of excessive weight. In addition, glomerular hyperfiltration has been reported to be associated with high levels of the indicators of cardiometabolic risk, and these latter finding are solely from adult studies. OBJECTIVE: To ascertain if glomerular hyperfiltration occurs in overweight and less severely obese children and to determine any significant relevance of some indicators of cardiometabolic risk associated with hyperfiltration. SUBJECTS AND METHODS: This cross-sectional study involved 49 adolescents (28 overweight, 21 obese) and 49 normal weight adolescents. The participants were subjected to clinical examination, anthropometric measurement, laboratory investigation using standard techniques. Estimated glomerular filtration rates (eGFR) were calculated using the modified Schwartz equation. Hyperfiltration was defined as eGFR ≥140 ml/min/1.73 m2. RESULTS: Hyperfiltration was observed in 20 (40.8%) of the overweight/obese adolescents. The prevalence of hyperfiltration among the overweight and the obese adolescent was 24.5% and 16.3%, respectively. The mean estimated glomerular filtration rate of the overweight/obese adolescents was 141.0 ± 46.2 ml/min/1.73 m2, whereas that of the normal weight adolescents was 99.2 ± 17.1 ml/min/1.73 m2 (P = 0.0001). A higher prevalence of hypertension was observed among the overweight/obese adolescent with glomerular hyperfiltration. CONCLUSION: Glomerular hyperfiltration is not limited to morbidly obese children as the burden is also high in overweight and less severely obese adolescents.

Spectrum and outcome of neonatal emergencies seen in a free health-care program in South-Western Nigeria.

BACKGROUND: Neonatal emergencies contribute significantly to under-five morbidity and mortality in developing countries, partly due to poverty and limited access to quality healthcare in rural communities. AIMS: The aim is to evaluate the spectrum, outcome, case fatality rates (CFRs), and prognostic factors of neonatal emergencies seen in the two free health-care facilities in Ondo State. METHODS: This was a cross-sectional descriptive study of neonatal emergencies. Data were collected on eligible consecutive infants using a self-designed questionnaire. Neonatal emergencies were classified based on systemic involvement and underlying causes. Categorized data were expressed as percentages. Outcome and CFRs were presented pictorially. Inferential analysis was performed. The value of P < 0.05 was considered statistically significant. RESULTS: Altogether, 425 infants with neonatal emergencies were recruited, constituting 21.3% of the under-five medical emergencies managed during September 2014 to February 2015. The most frequent emergencies were neonatal sepsis (45.2%) and neurological emergencies, especially hypoxic ischemic encephalopathy (22.1%) and acute bilirubin encephalopathy (14.6%). Furthermore, 6.1% of the infants presented with disseminated intravascular coagulopathy. The outcome of the emergencies was as follows: 88.6% were discharged, 7.4% died, and 3.7% left against medical advice whereas 0.3% were referred for subspecialty services. The leading causes of death among the 32 mortalities in this survey were sepsis (39.5%), hypoxic ischemic encephalopathy (36.9%), and hypothermia (13.2%). Hypothermia, perinatal asphyxia, and hypoglycemia had the highest CFRs, 22.7%, 12.6%, and 11.8%, respectively. CONCLUSION: Neonatal encephalopathy and sepsis were the most common emergencies seen in the free health-care program. Furthermore, they accounted for a majority of the neonatal deaths. This should be taken into cognizance while designing local interventions for neonatal emergencies.

Bedside critical care training: A quasi-experimental study in the paediatric emergency department of a referral hospital in Nigeria.

Background: There is a need for critical care services outside intensive care units (ICUs), especially in emergency departments (EDs). However, there is a paucity of skilled manpower for ED critical care or emergency critical care (ECC) in resource-limited settings. Objectives: To evaluate the impact of bedside training on emergency critical care practices of clinical staff. Methods: This was a quasi-experimental study using a pretest - post-test design in a paediatric ED. The intervention was a six-week structured bedside training on bubble continuous positive airway pressure (CPAP) high-flow nasal cannula (HFNC) and mechanical ventilation. Participants' actual ECC practices pre and post training were evaluated, including their perceived proficiency on an uncalibrated 100 mm visual analogue scale (VAS). Descriptive and inferential analyses were done; p<0.05 was considered significant. Results: A total of 35 clinical staff participated in the training, comprising 9 (24.3%) paediatric registrars, 12 (32.5%) senior registrars, 10 (27.0%) nurses, 4 (10.8%) house officers and 2 (5.4%) paediatric consultants. The male:female ratio of the participants was 1:1.6, and their mean (SD) age was 33.24 (6.30 years. Participants' understanding of testing the CPAP circuit, connecting the patient and weaning significantly improved following training (p=0.004). Their capacity to select appropriate HFNC parameters improved (p=0.013). They performed more endotracheal intubations in the post-training period (p=0.001). Their pretest-post-test proficiency in mechanical ventilation increased on VAS (mean scores 45.26+31.99 v. 63.26+22.26; p=0.038). Also, there was a significant increase in their perceived proficiency in paediatric analgesia/sedation (30.83+29.86 v. 49.83+23.90; p=0.029). Conclusion: Short-term bedside critical care training enhanced the self-reported competency of paediatric ED staff. There is a need for on-the-job ECC training and retraining of clinical staff in our setting. Contribution of the study: Paediatric emergency department clinical staff desire hands-on critical care training in developing settings. Bedside training improves the knowledge and skills of nursing staff in non-invasive ventilation. Bedside training also builds the capacity of medical staff in invasive ventilation in the emergency department. Overall, short-term bedside training enhances the clinical knowledge and self-reported critical care practice of clinical staff in Children's Emergency Room.

Caregivers and Healthcare Workers' Willingness to Donate Kidney in Three Tertiary Institutions in Southern Nigeria.

BACKGROUND: Kidney transplantation (KT) is now the preferred renal replacement therapy in suitable patients with end-stage renal disease but organ availability is a major limiting factor. AIMS: To evaluate the willingness of caregivers (CGs) and healthcare workers (HWs) to donate a kidney and possible motivating factors in our setting. METHODS: This cross-sectional study was done at Mother and Child Hospital, Kidney Care Centre Ondo and Babcock University Teaching Hospital, all in Southern Nigeria. Participants' willingness to donate a kidney was assessed using Likert and Visual Analogue Scales (VAS). The data were analyzed using SPSS version 20.0. Student t test was used to compare weighted mean scores. Multivariate analysis done; P < .05 was taken as significant. RESULTS: A total of 563 CGs and HWs took part in the study. Sixty percent of them were aware of kidney donation (KD) but only 43.7% had a favorable attitude towards it, and these were predominantly HWs (63.4% vs 33.1%, P < .001). A quarter of the participants were adequately willing to donate a kidney; HWs were significantly more willing than CGs (45.4% vs 15.8%, P < .001). On VAS, the mean willingness score of HWs was higher than that of CGs (t = 7.13, P < .001). Factors strongly influencing the willingness of CGs to donate include their educational level (P = .028, OR = 4.86, 95% CI: 1.19-19.91) social class (P = .012, OR = 6.17 95% CI: 1.5-24.8) and having a relative with kidney disease (P = .019; OR = 3.07 95% CI: 1.25-12.00). Willingness correlated with awareness of KD among CGs (r = 0.534, P < .001). CONCLUSION: There is a low level of willingness alongside negative attitudes toward kidney donation among our participants.

Superior sagittal sinus thrombosis complicating typhoid Fever in a teenager.

Cerebral venous sinus (sinovenous) thrombosis (CSVT) is a rare life-threatening disorder in childhood that is often misdiagnosed. CSVT encompasses cavernous sinus thrombosis, lateral sinus thrombosis, and superior sagittal sinus thrombosis (SSST). We present an adolescent girl who was well until two weeks earlier when she had a throbbing frontal headache and fever with chills; she later had dyspnoea, jaundice, melena stool, multiple seizures, nuchal rigidity, and monoparesis of the right lower limb a day before admission. Urine test for Salmonella typhi Vi antigen was positive, and Widal reaction was significant. Serial cranial computerized tomography scans revealed an expanding hypodense lesion in the parafalcine region consistent with SSST or a parasagittal abscess. Inadvertent left parietal limited craniectomy confirmed SSST. She recovered completely with subsequent conservative management. Beyond neuropsychiatric complications of Typhoid fever, CSVT should be highly considered when focal neurologic deficits are present.

Evaluation of adolescent medicine sub-specialty training in Nigeria: trainees' perspectives

Objective: To evaluate the extent of coverage of curriculum contents pertinent to Adolescent Medicine; as well as the adequacy of facilities and professionals in Nigeria using residents' viewpoint. Design: A descriptive cross-sectional study. Setting: The Intensive Course in Paediatrics of the National Post-graduate Medical College of Nigeria at the University of Benin Teaching Hospital; Benin City Nigeria. Subjects: One hundred and three paediatric residents from training institutions in all zones of the country. Results: Altogether;68.0% and 32.0% of the participants were from Southern and Northern geopolitical zones respectively. Only 14% of them stated that a rotation in an AM unit is a part of training in their centres. None specified its duration. Coverage of AM topics; physical facilities and trainers were rated as inadequate by 77.0%; 82.8% and 70.8% of the respondents respectively. Residents from north were more likely to rate interview/ confidentiality in AM as covered (either partly or well) than their colleagues from the South; (p 0.01; OR= 5.3, 95% CI = 1.5-19.5). We found no difference between federal and state residents' perceived adequacy of AM training. Conclusion: AM in paediatric residency programme in Nigeria is still an unmet challenge. There is a need for a revision of the training curriculum to specify mandatory duration of clinical rotation in AM units