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.

Pattern of presentation of paediatric endocrine disorders in a Nigerian tertiary institution: an 11-year survey.

OBJECTIVES: There is need to generate epidemiological data regarding paediatric endocrine disorders (PEDs) in sub-Saharan Africa, since little attention has been given endocrine disorders in children in this sub-region over the years. The aim of the study was to determine the sociodemographic characteristics of children with endocrine disorders in our paediatric endocrinology clinic, as well as the pattern of presentation of these disorders. METHODS: This study included paediatric patients who presented to the endocrine clinic over an 11-year period. Data of patients seen during the study period were retrieved from the case notes and were analyzed using SPSS version 23. RESULTS: A total of 188 patients were seen over the study period, with an almost equal male:female ratio. Five of the patients (2.7%) could not be classified into any gender because of genital ambiguity. The age of the patients at diagnosis ranged from 0 to 18 years of age with a median age of 9.03 (9.94) years. All the 14 subdivisions of paediatric endocrine disorders were documented among the patients, with thyroid disorders ranking highest among the PEDs seen. Type 1 diabetes mellitus, obesity and pubertal disorders were the most prevalent PEDs (in descending order), after thyroid disorders. Congenital hypothyroidism accounted for 14.3% of patients with thyroid disorders. CONCLUSIONS: Thyroid disorders, type 1 diabetes mellitus and obesity rank highest among the PEDs in our locality. There is the need to create awareness among healthcare workers and the general public regarding these disorders, in order to improve appropriate and timely presentation of patients to the clinic.

The effectiveness of locally-prepared peritoneal dialysate in the management of children with acute kidney injury in a south-east Nigerian tertiary hospital.

Background: Peritoneal dialysis (PD) is the preferred mode of renal replacement therapy (RRT) in children with acute kidney injury (AKI). The gold standard remains the use of commercially-prepared PD fluid. In resource-poor nations, its availability and affordability remain a challenge. Aim: This study aims to report the effectiveness of locally-prepared PD fluid in the management of AKI in a south-east Nigerian tertiary hospital. Subjects and Methods: This was a retrospective study conducted at the paediatric ward of the University of Nigeria Teaching hospital, Enugu. The case records of 36 children seen over three years, diagnosed with AKI and requiring PD were reviewed. The retrieved information comprised biodata, aetiology of AKI, indications for PD, pre-and post-dialysis estimated glomerular filtration rate (eGFR) and patient outcomes. Results: The children (20 males and 16 females) were aged 3 to 36 months with a mean age of 9.92 ± 6.29 months. The common aetiologies of AKI were septicemia (30.6%), hemolytic uremic syndrome (19.4%), and toxic nephropathy (16.7%). The frequent indications for PD were uremic encephalopathy (58.3%) and severe metabolic acidosis (38.8%). The pre-and post-dialysis mean urine flow rate was 0.16 + 0.13 and 2.77 + 0.56 ml/kg/hour respectively. The eGFR before PD, at discontinuation, and a week later was 6.06 + 2.87, 24.44 + 15.71 and 59.07 + 22.22 mls/min/1.73m2 respectively. Conclusion: PD with locally-prepared dialysate is safe, effective and a life-saving alternative in the management of AKI in children.

Serum folate levels in children on long-term anti-seizure medication in a Nigerian tertiary center-Implications for practice and public health.

BACKGROUND: Epilepsy is the most common childhood neurological disorder in Nigeria. Treatment of epilepsy is long-term and sometimes lifelong with anti-seizure medications. There are conflicting reports on the effect of anti-seizure medications on serum folate. There is therefore a need to determine the effect of a commonly used anti-seizure medication's on serum folate levels of children. This would provide an evidence-based consideration for folic acid supplementation in children on anti-seizure medication as has been suggested by some studies. STUDY OBJECTIVES: To determine whether serum folate levels were lower in children taking long-term carbamazepine or sodium valproate, compared to a control group. METHODS: Serum folic acid levels were measured from well-nourished children between the ages of 1-17 years on carbamazepine and sodium valproate monotherapy and their age/sex-matched controls, using spectrophotometry. RESULTS: The mean serum folate levels of patients on carbamazepine (43) and sodium valproate (22) were 0.032 mg/l ± 0.009 and 0.028 mg/l ± 0.008, respectively. The mean folate levels of the controls were 0.046 mg/l ± 0.03 (p = 0 001). No statistically significant difference was observed between the serum folate levels of children on the two anti-seizure medications, that is, carbamazepine and valproate. CONCLUSION: The children on treatment with carbamazepine and sodium valproate for more than 6 months had statistically significantly lower serum levels of folic acid compared to the standard reference range and controls. The serum folate levels of children on carbamazepine were not statistically different from those on sodium valproate.

Becker's nevus syndrome: a case report.

BACKGROUND: Becker's nevus syndrome is a syndrome characterized by the presence of a Becker's nevus with ipsilateral breast hypoplasia or hypoplastic defects of the muscle, skin, or skeleton. The nevus usually consists of a circumscribed, unilateral, irregularly shaped hyperpigmented macule, commonly occurring around the anterior upper trunk, with/without hypertrichosis and/or acneiform lesions. This rare syndrome has not been reported in our locality to the best of our knowledge. CASE PRESENTATION: We report the case of a 15-year-old Igbo female patient who presented to our pediatric endocrinology clinic, University of Nigeria Teaching Hospital, Enugu, with complaints of asymmetry of the breasts and hyperpigmented macules on the side. Based on her symptoms, diagnosis of Becker's nevus syndrome was made. The diagnosis of Becker's nevus syndrome is mostly clinical, based on the presence of a Becker's nevus with ipsilateral breast hypoplasia or hypoplastic defects of the muscle, skin, or skeleton. In our patient, there was a Becker's nevus with ipsilateral breast hypoplasia. This syndrome, belonging to the class of epidermal nevus syndromes, is very rare, and is usually benign. She was placed on spironolactone tablets 50 mg daily, which have been associated with an improvement in the size of the hypoplastic breast, and her fears were allayed. CONCLUSION: This syndrome has not been reported in our locality to the best of our knowledge and, therefore, has a propensity for misdiagnosis by clinicians because of its rarity. We therefore report this to create awareness among clinicians regarding this condition that is associated with much psychosocial trauma among patients, and that can be easily managed with oral spironolactone.

Reducing incidence of cervical cancer: knowledge and attitudes of caregivers in Nigerian city to human papilloma virus vaccination.

BACKGROUND: Despite the high prevalences of Human Papilloma Virus (HPV) infections and cervical cancer in Nigeria, utilization of the HPV vaccine as a highly effective preventive measure remains low. The aim of this study was to find out the awareness and attitudes of caregivers to HPV infections and the factors that determine acceptance of an HPV vaccine for their pre-adolescent girls. METHODS: This was a cross-sectional descriptive study of 508 caregivers of female children in Enugu Nigeria. A semi-structured questionnaire was used to collect information on knowledge of HPV, cervical cancer as well HPV vaccine and its acceptance for pre-adolescent female children. The data was analysed using descriptive statistics. RESULTS: Five hundred and eight (508) caregivers of female children were interviewed. Less than half, 221,(43.5%) of them knew about HPV, among these, 163 knew how HPV is transmitted. Only 12 (2.4%) of the caregivers know that an HPV infection is a major risk factor for cervical cancer. Among the 221 participants who knew the meaning of HPV, 132 (59.7%) were aware of an HPV vaccine. Only 26 (19.7%) of those aware of a vaccine agreed it can effectively prevent cervical cancer. Lack of awareness about the vaccine and accessibility were the major reasons given by parents on why the vaccine has not been received by their female children. CONCLUSION: Despite high levels of education, awareness of HPV, HPV vaccine and the risks for cervical cancer remains low among caregivers in Enugu, south-east, Nigeria. Awareness and accessibility were the major determinants of HPV vaccine uptake among the caregivers. There is a need for massive and sustained awareness creation to increase HPV vaccination uptake in Nigeria.

Stretched penile length of healthy term neonates: normative values among Igbo babies in southeastern Nigeria.

AIM: To determine the normative values of stretched penile length in apparently healthy term Igbo newborn males in South eastern Nigeria and its relationship with gestational age, birth weight and birth length. METHODS: Eight hundred and eleven apparently healthy term male neonates within the first 72 h of life were studied. Enrolled subjects were consecutively delivered babies of Igbo extraction from three hospitals. The stretched penile length was measured using Schonfeld method, and the smoothed centiles (3 rd to 97th percentile values) for stretched penile length by gestational age were determined. RESULTS: The mean stretched penile length of term newborns was 3.46 ± 0.44 cm. The lower and upper limits (±2.5 SD) were 2.36-4.56 cm. Stretched penile length correlated positively with birth length and birth weight (r = 0.343, p = 0.001; r = 0.229, p = 0.001). CONCLUSION: This study has created the first smoothed percentile values for stretched penile length by gestational age for Igbo babies.