Cholera outbreaks among children in sub-Saharan Africa.

PURPOSE OF REVIEW: We review current knowledge on the burden, impact and prevention of cholera among children who bear the brunt of cholera outbreaks in sub-Saharan Africa. RECENT FINDINGS: Several studies have shown that recent outbreaks of cholera among African children are related to minimal progress in basic sanitation and infrastructural development. Poor hygiene practices such as open defecation and indiscriminate disposal of feces are still common in many parts of Africa. SUMMARY: Cholera case fatality rates in sub-Saharan Africa remain unacceptably high. Children are disproportionately affected and bear the brunt of the disease. Controlling outbreaks of cholera among African children will require a synchronous implementation of the five levels of disease prevention.

Can Oral Zinc Supplementation Reduce Relapses in Childhood Steroid-Sensitive Nephrotic Syndrome? A Systematic Review.

Introduction: Frequent relapses and steroid dependence are common treatment challenges of steroid-sensitive nephrotic syndrome (SSNS) in children. Acute respiratory infection (ARI) is the most frequently reported trigger of relapse. Given the role of zinc supplementation in preventing ARI, some studies show that this targeted intervention may reduce relapses in childhood SSNS. Aim: This systematic review aimed to determine if oral zinc supplementation can significantly reduce relapses in this disease. Methods: We searched the PubMed and Google Scholar electronic databases for interventional and observational analytical studies without limiting their year or language of publication. We selected studies with primary data that met our inclusion criteria, screened their titles and abstracts, and removed duplicates. We used a preconceived structured form to extract data items from selected studies and conducted a quality assessment of randomized controlled trials (RCTs) and non-randomized studies with the Cochrane collaboration tool and the Newcastle Ottawa Scale, respectively. We qualitatively synthesized the extracted data to validate the review's objective. Results: Eight full-text articles were selected, comprising four RCTs and four observational analytical studies. Two of the RCTs had a high risk of bias in three parameters of the Cochrane collaboration tool, while three non-randomized studies had low methodological quality. A total of 621 pediatric patients with SSNS were investigated in the eight studies: six participants dropped out in one study. Three RCTs indicate that zinc supplementation may lead to sustained remission or reduction in relapse rate. Similarly, three observational analytical studies suggest a significant relationship between reduced serum zinc levels and disease severity. Conclusion: Despite the association of zinc deficiency with increased morbidity in SSNS and the reduction of relapse rates with zinc supplementation, there is no robust evidence to recommend its use as a therapeutic adjunct. We recommend more adequately-powered RCTs to strengthen the current evidence.

Vitamin D3 supplementation as an adjunct in the management of childhood infectious diarrhea: a systematic review.

BACKGROUND: Some studies have reported the possible role of vitamin D3 in ameliorating disease outcomes in childhood infectious diarrhea. However, findings about its effectiveness and the association of serum vitamin D levels with diarrhea risk appear inconsistent. We aimed to determine the efficacy of oral vitamin D3 as an adjunct in managing childhood infectious diarrhea and the relationship between vitamin D status and the disease. METHODS: We searched the PubMed and Google Scholar electronic databases for relevant articles without limiting their year of publication. We selected primary studies that met the review's inclusion criteria, screened their titles and abstracts, and removed duplicates. We extracted data items from selected studies using a structured data-extraction form. We conducted a quality assessment of randomized controlled trials (RCTs) and non-randomized studies with the Cochrane collaboration tool and the Newcastle Ottawa Scale, respectively. We assessed the strength of the relationship between serum vitamin D levels and diarrhea using the correlation model. We estimated the I2 and tau2 values to assess between-study heterogeneity. RESULTS: Nine full-text articles were selected, consisting of one RCT, three cross-sectional studies, two cohort studies, two longitudinal/prospective studies, and one case-control study. A total of 5,545 participants were evaluated in the nine studies. Six non-randomized studies provided weak evidence of the relationship between vitamin D levels and diarrhea risk as there was no correlation between the two variables. The only RCT failed to demonstrate any beneficial role of vitamin D3 in reducing the risk of recurrent diarrhea. The calculated I2 and tau2 values of 86.5% and 0.03, respectively suggested a high between-study heterogeneity which precluded a meta-analysis of study results. CONCLUSION: Oral vitamin D3 may not be an effective adjunct in managing childhood infectious diarrhea. Additionally, the relationship between vitamin D status and infectious diarrhea appears weak. We recommend more adequately-powered RCTs to determine the effectiveness of vitamin D3 as an adjunct therapy in infectious diarrhea.

Postnatal probiotic supplementation can prevent and optimize treatment of childhood asthma and atopic disorders: A systematic review of randomized controlled trials.

Background: Although several randomized controlled trials (RCTs) published over the past 5 years show that prenatal or postnatal probiotics may prevent or optimize the treatment of childhood asthma and atopic disorders, findings from the systematic reviews and meta-analyses of these studies appear inconsistent. More recent RCTs have focused on postnatal probiotics, and linked specific probiotic strains to better disease outcomes. Objective: This systematic review aimed to determine if postnatal probiotics are as effective as prenatal probiotics in preventing or treating childhood asthma and atopic disorders. Methods: We searched the PubMed, Medline, Google Scholar, and EMBASE databases for RCTs published within the past 5 years (from 2017 to 2022). We included only full-text RCTs on human subjects published in or translated into the English language. We retrieved relevant data items with a preconceived data-extraction form and assessed the methodological quality of the selected RCTs using the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials. We qualitatively synthesized the retrieved data to determine any significant differences in study endpoints of the probiotic and placebo groups. Results: A total of 1,320 participants (688 and 632 in the probiotic and placebo groups) from six RCTs were investigated. One RCT showed that early Lactobacillus rhamnosus GG (LGG) led to a reduction in the cumulative incidence rate of asthma. Another study demonstrated that mixed strains of Lactobacillus paracasei and Lactobacillus fermentum could support clinical improvement in children with asthma while one trial reported a significant reduction in the frequency of asthma exacerbations using a mixture of Ligilactobacillus salivarius and Bifidobacterium breve. Three trials showed that a combination of LGG and Bifidobacterium animalis subsp lactis, Lactobacillus rhamnosus alone, and a probiotic mixture of Lactobacillus LOCK strains improved clinical outcomes in children with atopic dermatitis and cow-milk protein allergy. Conclusions: Postnatal strain-specific probiotics (in single or mixed forms) are beneficial in preventing and treating atopic dermatitis and other allergies. Similarly, specific strains are more effective in preventing asthma or improving asthma outcomes. We recommend more interventional studies to establish the most useful probiotic strain in these allergic diseases.

Haemostatic profile of children with nephrotic syndrome attending University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria.

BACKGROUND: Haemostatic derangements are thought to be due to an imbalance between hepatic synthesis of pro-coagulants and urinary losses of anticoagulants. OBJECTIVES: This study evaluated the coagulation profile of Nigerian children with nephrotic syndrome and examined the relationship between coagulation variables, disease state and steroid responsiveness. METHODS: A cross- sectional hospital based study on evaluation of coagulation profile of children with nephrotic syndrome compared with their age- and gender- matched controls. RESULTS: The median fibrinogen level in subjects and controls was the same (2.9 g/L). Sixteen of 46 (35%) children with nephrotic syndrome had hyperfibrinogenaemia. The median fibrinogen level of children in remission was 2.3 g/L and differed significantly when compared with those of children in relapse (p = 0.001). The median APTT of children with nephrotic syndrome was 45.0 s and differed significantly compared with those of controls (42.0 s) (p value = 0.02). The median prothrombin time in children with and without nephrotic syndrome were 12.0 and 13.0 s respectively, (p = 0.004). About 90% of children with nephrotic syndrome had INR within reference range. Thrombocytosis was found in 15% of children with nephrotic syndrome. The median platelet count in children with new disease was 432 × 103cells/mm3 and differed significantly when compared with those of controls (p = 0.01). INR was significantly shorter in children with steroid resistant nephrotic syndrome (SRNS) (median 0.8 s; IQR 0.8 -0.9 s) compared with controls (median 1.0 s; IQR 1.0 -1.1 s) (p = 0.01). Steroid sensitivity was the strongest predictor of remission in children with nephrotic syndrome; steroid sensitive patients were 30 times more likely to be in remission than in relapse (OR 30.03; CI 2.01 - 448.04). CONCLUSION: This study shows that the haemostatic derangements in childhood nephrotic involve mostly fibrinogen, APTT, PT, INR and platelet counts. Antithrombin levels are largely unaffected. Variations in fibrinogen, APTT, PT and INR values may be due to the heterogeneous nature of the disease.

Efficacy of short-term induction therapy with low-dose testosterone as a diagnostic tool in the workup of delayed growth and puberty in boys.

PURPOSE: Constitutional delay of growth and puberty (CDGP) represents the most frequent cause of delayed puberty in males, sharing some clinical features with growth hormone deficiency (GHD) and isolated hypogonadotropic hypogonadism (IHH). Short-term induction therapy (SIT) has been approved for the induction of puberty in CDGP. We aim to investigate the efficacy of SIT with transcutaneous testosterone gel (TTG) or intramuscular testosterone therapy (IMTT) in a cohort of CDGP subjects, compared to clinical observation. Furthermore, we aim to evaluate the role of SIT as a diagnostic tool to differentiate CDGP from GHD and IHH subjects. METHODS: The retrospective study included 246 male subjects with delayed puberty. The study population was divided into three groups: TTG, IMTT, and control group (CNT). RESULTS: At 6 months observation, height velocity (HV) was significantly increased in both treated groups compared to CNT group, particularly higher in TTG than IMTT group. A significant testicular enlargement was revealed in both CNT and TTG group compared to IMTT group. Furthermore, LH value was significantly greater in TTG compared to IMTT group. IGF-1 values after SIT rose significantly in both treated groups compared to CNT group. Moreover, almost all GH provocative tests performed after SIT showed a normal GH response. CONCLUSION: SIT with TTG appears to be more effective to induce growth spurt, better tolerated and with a more physiological effect on pubertal induction compared to IMTT in CDGP population. Finally, TTG might be a useful tool in the diagnostic work up to discriminate CDGP from GHD or IHH.

Lettuce-avicularin treatment reverses insulin resistance through stimulation of glycolytic kinases and insulin signaling molecules.

OBJECTIVES: In order to recommend a more effective approach to manage insulin resistance, we monitored the activities of glycolytic kinases, insulin signaling molecules, and incretin hormones and identified the possible targets related to the insulin-sensitizing effects of combined pharmacological and dietary intervention involving avicularin and lettuce. MATERIALS AND METHODS: Insulin resistance was induced in rats with a fructose-rich diet and confirmed from baseline analysis of FBS (>250 mg/dl), insulin (>25 µIU/ml), and HOMA-IR (>10). For 12 weeks, the insulin-resistant rats were treated exclusively with 5000 mg/kg b.w avicularin (DAvi) or by dietary placement on lettuce (DLet) or a combination of both and compared with non-insulin resistant rats. RESULTS: Avicularin reversed alterations in HbA1c and insulin levels. DLet produced no significant effect on the incretins GLP 1 (P=0.909) and GIP (P=0.990), but DAvi slightly stimulated GLP 1 but not GIP. A strong positive correlation was found between improved ß-cell responsiveness and the insulin signaling molecules: Akt2 (r=0.7248), IRS 1 (r=0.5173), and PI3K (r=0.7892). Only the combined avicularin and lettuce reversed the Akt2 levels (P=0.728). The lettuce meal slightly stimulated PI3K but normalized IRS 1 while avicularin treatment slightly stimulated IRS 1 but restored the PI3K levels (P=0.815). The positive correlation between ß-cell responsiveness and hexokinase (r=0.5959), PFK (r=0.6222), and PK (r=0.6591) activities were statistically significant. Alterations in glycolytic kinases were reversed by DLet and in combination with avicularin. CONCLUSION: A combined pharmacological and dietary approach with avicularin and lettuce is required to effectively reverse insulin resistance.

Knowledge, practices and perceived barriers of physiotherapists involved in disaster management: a cross-sectional survey of Nigeria-based and trained physiotherapists.

BACKGROUND: Disasters represent substantial health risks to the human population. Proper interventions at all stages of disaster management (DM) are essential for human-related outcomes. The role of physiotherapy in DM should not be underestimated, but unfortunately information on the involvement of physiotherapists in DM is limited in sub-Saharan Africa. METHODS: One hundred and fifty Nigeria-based and trained physiotherapists were recruited to complete a questionnaire investigating the knowledge, practices and perceived barriers of the role of physiotherapists in DM. RESULTS: Physiotherapists had moderate knowledge of their role at every stage of DM. However, their involvement in specific DM-related activities during various stages of DM in the country was low. Major barriers to the involvement of physiotherapists in DM included a lack of established government policies on the integration of physiotherapists in DM (90.0%) and a lack of specialty clinical practice areas in DM (89.3%). For improved involvement of physiotherapists in DM in Nigeria, respondents recommended creating an awareness of the role of physiotherapists in DM (91.3%), providing continuous education programmes on DM (90.6%) and inclusion of DM in physiotherapy training programmes in Nigeria (90.0%). CONCLUSION: Physiotherapists perceived that they are not adequately involved in DM in Nigeria, despite their moderate knowledge of their role during DM.

Does plantar lipoatrophy affect dynamic balance in HIV infected persons?

BACKGROUND: Chronic inflammation in HIV infection and antiretroviral therapy have been shown to cause balance disorders due to neuromusculoskeletal damage, sensorimotor deficits, failure of foot mechanoreceptors and/or plantar lipoatrophy. However, despite evidence of plantar lipoatrophy in HIV patients, there is a dearth of information on how this relates to walking balance. This study sought to investigate how plantar fat thickness affects dynamic balance in HIV infected persons. RESEARCH QUESTION: Can plantar lipoatrophy significantly affect walking balance in HIV infected persons? METHODS: This is a cross sectional study of 367 persons (106 HIV seronegative control subjects, 211 HIV seropositive subjects on antiretroviral therapy (HIV_ART) and 50 HIV ART naïve subjects (HIV_NonART)). Plantar fat thickness (PFT) was measured using diagnostic ultrasound. Subjects were asked to walk at 5 self-selected speeds, from very slow to very fast on a level 15-meter walkway. Average number of steps and time taken to complete the study distance were obtained, used to calculate gait parameters and plot the velocity field diagram for gait analysis. RESULTS: Findings from this study showed significant reduction in plantar fat thickness, velocity of travel, stride frequency and a significant increase in stride and double support duration (p < 0.01) in HIV-seropositive individuals compared to healthy controls but none were observed between HIV_ART and NonART groups. CONCLUSION: HIV infection significantly affects dynamic balance and increases the risk of falls, fracture and mobility impairment in this patient population. SIGNIFICANCE: This study will help clinicians to recognize plantar lipoatrophy as a significant cause of gait pathology in HIV infected persons and thus, make targeted interventions to minimize deformity and impairment, promote functional independence and improve quality of life.

Comparison of Dental Caries and Oral Hygiene Status of Children in Suburban with those in Rural Population of Southwestern Nigeria

ABSTRACT Objective: To compare prevalence of dental caries, oral hygiene status and associated risk factors of children in suburban and rural communities in the Southwest region of Nigeria. Material and Methods: Secondary data was extracted from cross-sectional researches conducted in two study locations involving 8 to 12 year olds. Data retrieved included age, gender, family structure, socioeconomic status, oral hygiene and dental caries. Caries assessment was done using WHO Oral Health Survey methods. Oral hygiene data was collected using Simplified Oral Hygiene Index (OHI-S) by Greene and Vermillion. Statistical significance was established at p<0.05. Results: The prevalence of dental caries in Group A and Group B study participants were 13.4% and 22.2% respectively. Children from rural community had significant higher caries prevalence (p=0.00) and poorer oral hygiene (P=0.00) compare with their counterparts in the suburban community. There was a significant association between oral hygiene, age and dental caries in suburban participants (p=0.02) while among the rural participants there was significant association between gender and dental caries (p=0.04). Children with poor oral hygiene have increased odds of having dental caries compared to children with good oral hygiene in the two study communities. Conclusion: Dental caries was more prevalent among the rural dwellers than the sub-urban dwellers. There is a need to make oral health care services/products available, accessible and affordable for the rural community.

Effects of methanolic extract of Brassica juncea seeds on biochemical parameters and histological integrity of the heart and liver of albino rats / Efectos del extracto metanólico de las semillas de Brassica juncea sobre los parámetros bioquímicos y la integridad histológica del corazón y el hígado de ratas albinas

SUMMARY: Brassica juncea (Indian mustard) seeds are consumed in treatment of high blood pressure, headache and prevention of heart disease. The aim of the present study was to investigate the effects of methanol extract of Brassica juncea seeds [BJME] on the heart and liver of adult Albino Wistar rats. A total of 24 albino rats of both sexes were divided into 6 groups [I - VI] of 4 rats per group. Groups I to IV received graded doses of the methanol extract by oral gavage while groups V and VI (controls) received 2 ml/kg body weight of 3 % Tween 80 and water respectively via oral gavage once daily. Treatment lasted for four weeks and the serum levels of aspartate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP) were estimated. The animals were sacrificed and the heart and liver tissues were excised for further histological processing for light microscopy. There was significant increase in AST and ALT levels following BJME treatment when compared to the controls. ALP activity did not differ significantly among the treatment and control groups. Histopathological changes consistent with toxic injury were observed in the heart and liver tissues of BJME- treated rats. In conclusion, the results of this study show that sub-acute administration of methanol seed extract of Brassica juncea can exert cardiotoxic and hepatotoxic effects in rats.

RESUMEN: Las semillas de Brassica juncea (mostaza india) se consumen en el tratamiento de la hipertensión arterial, el dolor de cabeza y la prevención de enfermedades del corazón. El objetivo del presente estudio fue investigar los efectos del extracto de metanol de semillas de Brassica juncea [BJME] en el corazón y el hígado de ratas Albino Wistar adultas. Un total de 24 ratas albinas de ambos sexos se dividieron en 6 grupos [I - VI] de 4 ratas por grupo. Los grupos I a IV recibieron dosis del extracto de metanol por sonda oral progresivamente, mientras que los grupos V y VI (control) recibieron 2 ml / kg de peso corporal de 3 % de 80 y agua, respectivamente, por sonda oral una vez al día. El tratamiento duró cuatro semanas y se estimaronlos niveles séricos de aspartato transaminasa (AST), alanina transaminasa (ALT) y fosfatasa alcalina (ALP). Los animales se sacrificaron y fueron analizados los tejidos del corazón y el hígado, para un procesamiento histológico adicional con microscopía óptica. Hubo un aumento significativo en los niveles de AST y ALT después del tratamiento con BJME en comparación con los controles. La actividad de ALP no difirió significativamente entre los grupos de tratamiento y control. Se observaron cambios histopatológicos compatibles con lesiones tóxicas en los tejidos del corazón y el hígado de ratas tratadas con BJME. En conclusión, los resultados de este estudio muestran que la administración subaguda de extracto de semilla de metanol de Brassica juncea puede ejercer efectos cardiotóxicos y hepatotóxicos en ratas.

Chronic kidney disease in children and the role of epigenetics: Future therapeutic trajectories.

Global differences in the observed causes of chronic kidney disease (CKD) in children are well documented and are attributed to dissimilarities in clime, race, hereditary, and ancestry. Thus, familial clustering and disparities in CKD prevalence rates across ethnic and racial groups indicate that the progression of renal disease has a strong genetic component. Mammalian studies have demonstrated a feasible nexus between nutrition and non-genetic exposure (around the time of conception and in epigenetic changes) in the expression of major genes identified in renal organogenesis. The major consequence is a reduction in the number of nephrons, with subsequent predisposition to hypertension and CKD. Identifying these epigenetic changes is crucial (due to their potentially reversible nature), as they may serve as future therapeutic targets to prevent kidney fibrosis and CKD. Despite progress in the field of epigenetics in oncology, research in other subspecialties of medicine is largely experimental with few existing studies regarding the clinical implication of epigenetics in renal disease. Therapeutic trajectories for CKD in children based on the influence of epigenetics may eventually revolutionize the management of this disease. The aim of the current narrative review is to appraise the role of epigenetics in CKD, and highlight the potential future therapeutic pathways.

Acute caloric restriction improves glomerular filtration rate in patients with morbid obesity and type 2 diabetes.

AIM: The role of caloric restriction in the improvement of renal function following bariatric surgery is still unclear; with some evidence showing that calorie restriction can reduce proteinuria. However, data on the impact of caloric restriction on renal function are still lacking. METHODS: Renal function, as measured by glomerular filtration rate (GFR), was evaluated in 14 patients with type 2 diabetes mellitus, morbid obesity and stage 2 chronic kidney disease before and after a 7-day very low-calory diet (VLCD). RESULTS: After the VLCD, both GFR and overall glucose disposal (M value) significantly increased from 72.6 ± 3.8 mL/min/1.73 m(-2) BSA to 86.9 ± 6.1 mL/min/1.73 m(-2) BSA (P=0.026) and from 979 ± 107 µmol/min(1)/m(2) BSA to 1205 ± 94 µmol/min(1)/m(2) BSA (P=0.008), respectively. A significant correlation was observed between the increase in GFR and the rise in M value (r=0.625, P=0.017). CONCLUSION: Our observation of improved renal function following acute caloric restriction before weight loss became relevant suggesting that calory restriction per se is able to affect renal function.