The Iron Status of Children with and without Sickle Cell Disease at the University of Ilorin Teaching Hospital, Nigeria.

BACKGROUND: Children with sickle cell disease (SCD) are at potential risk of iron overload from chronic transfusion and probable iron deficiency due to accelerated growth. However, only few studies on the iron status of children with SCD in Nigeria are available. METHODOLOGY: A cross-sectional study compared the iron status of 109 children with sickle cell disease with 109 age and sex-matched haemoglobin AA controls at the University of Ilorin Teaching Hospital. Parameters assayed were serum iron, ferritin, transferrin, and haemoglobin (Hb) concentrations. Considering the appropriate reference values for age and sex, these parameters were used to classify the children into high, normal, or low iron status. RESULTS: The median (interquartile range) serum ferritin level of 180.00 (237.50)ng/ml for the SCD subjects was significantly higher than 70.00 (120.00)ng/ml observed among controls, but the mean Hb and median serum transferrin levels were significantly lower in the subjects compared with the corresponding values in the controls, each showing statistical significance (p<0.05). The median serum iron levels did not differ significantly between the SCD (112µg/dl) and non-SCD (128µg/dl), p=0.309. A high proportion of subjects had low HB status (96.3%) compared with controls (56.9%), p=0.001. A significantly higher proportion of subjects (78%) had high ferritin status compared with the controls (48.3%; p <0.001). Ten (9.1%) SCD children had low serum iron status compared to 28 (25.7%) HbAA controls, p=0.002. Thirty-four (31.2) subjects had low transferrin status which was significantly higher than the corresponding number of controls (8;7.3%; p<0.001). CONCLUSION: The children with SCD in the index study were iron-sufficient.

CONTEXTE: Les enfants atteints de la drépanocytose (SCD) sont potentiellement exposés à un excès de fer dû aux transfusions chroniques et à une éventuelle carence en fer due à la croissance accélérée. Cependant, seulement quelques études sur l'état du fer chez les enfants atteints de la SCD au Nigéria sont disponibles. MÉTHODE: Une étude transversale a comparé l'état du fer de 109 enfants atteints de la drépanocytose à celui de 109 témoins de même âge et de même sexe porteurs d'hémoglobine AA à l'hôpital universitaire d'Ilorin. Les paramètres analysés étaient les concentrations de fer sérique, de ferritine, de transferrine et d'hémoglobine (Hb). En utilisant les valeurs de référence appropriées pour l'âge et le sexe, ces paramètres ont été utilisés pour classer les enfants en fonction de leur statut en fer, à savoir élevé, normal ou faible. RÉSULTATS: Le niveau médian (plage interquartile) de ferritine sérique de 180,00 (237,50) ng/ml chez les sujets atteints de SCD était significativement plus élevé que les 70,00 (120,00) ng/ml observés chez les témoins, mais la concentration moyenne en Hb et le niveau médian de transferrine sérique étaient significativement plus bas chez les sujets par rapport aux valeurs correspondantes chez les témoins, chaque différence étant statistiquement significative (p<0,05). Les niveaux médians de fer sérique ne différaient pas de manière significative entre les sujets atteints de SCD (112 µg/dl) et les témoins non atteints de SCD (128 µg/dl), p=0,309. Une proportion élevée de sujets présentait un faible statut en Hb (96,3 %) par rapport aux témoins (56,9 %), p=0,001. Une proportion significativement plus élevée de sujets (78 %) avait un statut élevé en ferritine par rapport aux témoins (48,3 % ; p <0,001). Dix (9,1 %) enfants atteints de SCD avaient un faible statut en fer sérique par rapport à 28 (25,7%) témoins HbAA, p=0,002. Trente-quatre (31,2 %) des sujets avaient un faible statut en transferrine, ce qui était significativement plus élevé que le nombre correspondant de témoins (8 ; 7,3 % ; p<0,001). CONCLUSION: Les enfants atteints de la SCD dans cette étude étaient suffisamment approvisionnés en fer.

Predictors of Bacterial Co-Infection and Outcome in Children with Severe Malaria in Ilorin, Nigeria.

BACKGROUND: Severe malaria is a significant cause of morbidity and mortality in Nigeria and concomitant bacteraemia may potentially worsen clinical outcomes. (Duration of admission, Mortality, Fever clearance time and Coma recovery time). OBJECTIVES: This study aimed at identifying the proportion of children with severe malaria who had concomitant bacteraemia, the pathogens implicated and their drug sensitivity pattern, predictors of bacterial co-infection and its effect on treatment outcome. METHODS: This was a hospital-based cross-sectional study at the Emergency Paediatric Unit of the University of Ilorin Teaching Hospital, Nigeria. The subjects were children aged 6 months to 14 years with severe malaria and microscopy confirmed parasitemia at admission. All subjects had blood culture samples drawn at admission for identification of bacterial isolates. Relevant clinical and laboratory parameters were recorded on case proformas. RESULTS: A total of 944 children were admitted into the Emergency Paediatric Unit during the study period with 176 (18.6%) managed for severe malaria. Of the 176 children with severe malaria, 41 (23.3%) had concomitant bacteraemia. Gram positive bacteria were the most common (70.7%) isolates with Staphylococcus aureus being the most predominant (65.9%). The bacterial isolates were mostly sensitive to Ciprofloxacin. Children with concomitant bacteraemia had a longer duration of admission (p = 0.028) and longer fever clearance time (p=0.015). Increasing duration of coma before presentation was the single independent predictor of bacteraemia (p= 0.010). CONCLUSION: Severe malaria constituted a significant cause of admissions in UITH with approximately a fourth of the subjects having bacterial co-infection and this was associated with a worse prognosis (longer duration of admission and fever clearance time). Increased duration of coma prior to admission was the only predictor of the presence of bacteraemia in children with severe malaria. This highlights the importance of investigating for concomitant bacteraemia, especially in children presenting with coma.

CONTEXTE: Le paludisme grave est une cause importante de morbidité et mortalité au Nigéria et bactériémie concomitante peut potentiellement aggraver les résultats cliniques. (Durée de admission, mortalité, temps d'élimination de la fièvre et rétablissement dans le coma temps). OBJECTIFS: Cette étude visait à identifier la proportion de les enfants atteints de paludisme sévère qui ont eu une bactériémie concomitante, les agents pathogènes impliqués et leur schéma de sensibilité aux médicaments, prédicteurs de la co-infection bactérienne et de son effet sur le traitement résultat. MÉTHODES: Il s'agissait d'une étude transversale en milieu hospitalier l'Unité de pédiatrie d'urgence de l'Université d'Ilorin Hôpital universitaire, Nigéria. Les sujets étaient des enfants de 6 ans mois à 14 ans avec paludisme sévère et microscopie confirmée parasitémie à l'admission. Tous les sujets avaient des échantillons d'hémoculture prélevé à l'admission pour l'identification des isolats bactériens. Les paramètres cliniques et de laboratoire pertinents ont été enregistrés sur formulaires de cas. RÉSULTATS: Au total, 944 enfants ont été admis dans le Unité pédiatrique d'urgence pendant la période d'étude avec 176 (18,6%) pris en charge pour le paludisme grave. Sur les 176 enfants avec paludisme sévère, 41 (23,3%) avaient une bactériémie concomitante. Gramme les bactéries positives étaient les isolats les plus courants (70,7%) avec Staphylococcus aureus étant le plus prédominant (65,9%). Les isolats bactériens étaient pour la plupart sensibles à la ciprofloxacine. Les enfants atteints de bactériémie concomitante avaient une durée plus longue d'admission (p = 0,028) et un temps d'élimination de la fièvre plus long (p = 0,015). L'augmentation de la durée du coma avant la présentation était la seule prédicteur indépendant de bactériémie (p = 0,010). CONCLUSION: Le paludisme sévère constituait une cause importante des admissions à l'UITH avec environ un quart des sujets avoir une co-infection bactérienne et cela a été associé à une pronostic (durée d'admission plus longue et élimination de la fièvre temps). L'augmentation de la durée du coma avant l'admission était la seul prédicteur de la présence de bactériémie chez les enfants paludisme grave. Cela souligne l'importance d'enquêter sur en cas de bactériémie concomitante, en particulier chez les enfants présentant avec coma.

Assessment of Post-Treatment Health-Related Quality of Life among Patients with Pulmonary Tuberculosis in Ilorin, Nigeria.

BACKGROUND: A lot of attention has generally been given to the microbiology and treatment of pulmonary tuberculosis with relatively limited consideration on its impact on the physical, psychological and social domains of the individual especially after successful drug treatment. AIM AND OBJECTIVES: This study aimed at assessing the health-related quality of life (HRQoL) and related factors among individuals who had successfully completed treatment for pulmonary tuberculosis (PTB) in Ilorin. METHODS: This was a hospital based cross-sectional study at the pulmonary outpatient clinics of the University of Ilorin Teaching Hospital and Kwara State Specialist Hospital, Sobi, Ilorin. HRQoL assessment was conducted in 308 consenting patients who had been certified microbiologically cured for bacteriologically confirmed PTB in the preceding three years using the validated St. George's Respiratory Questionnaire (SGRQ). All subjects also had plain chest radiograph done for assessment of the presence and extent of lung parenchymal damage. RESULTS: The overall total median percentage HRQoL score was 18.5 (7.9-28.2) with the highest score in the activity component [33.7 (18.3-41.8)] and least scores in the impact component [10.0 (0.0-21.9)]. The independent predictors of impaired HRQoL were age > 40 years (p= 0.007), absence of formal education (p=0.004), mMRC score >1 (p= 0.002), PTB retreatment (p=<0.001) and radiographic scores >3 (p= <0.001). CONCLUSION: There is impaired HRQoL following treatment for PTB in Ilorin. Hence, there is a need to incorporate HRQOL assessment as an adjunct outcome measure after PTB treatment especially in those with the above identified risk factors.

Attention deficit hyperactivity disorder in Ilorin: screening with the conner's teachers' rating scale

Background: The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) or its risk in North Central Nigeria has not been adequately reported. The consequences of missing the disorder and its co-morbidities are usually costly to the society. Method: Using a multi-stage sampling technique, nine primary schools from where a total of 1,480 pupils were selected across the three local government areas within Ilorin metropolis (two public and one private school from each LGA) we selected. An ADHD assessment tool - the short version of Conner's Teacher Rating Scale was administered on the pupils through their respective class teachers after training the teachers on how to administer the tool. They were classified into Inattention ADHD and Hyperactive/impulsive ADHD. Results: Of the 1480 (741 males and 739 female) pupils recruited, public schools contributed 1033 (69.8%) pupils while 447(30.2%) were from the private schools. A prevalence of 15.8% was found for ADHD risk. Statistically significant differences were present in the male to the female distribution of the Inattention ADHD, Hyperactivity ADHD (each with p< 0.05) but not in the overall ADHD index(p> 0.05). The ADHD Index was higher in the public schools. Conclusion: Prevalence of primary pupils aged 6-12 years in Ilorin at risk of ADHD is 15.8%, no significant gender variation was found. It is hereby recommended that Pre-primary school entry screening for ADHD should be instituted considered to enhance early recognition and prompt intervention so as to save the country from bad childhood that develops into bad adulthood with its myriads of anti-social and behavioural consequences

Intelligence quotient of neurologically impaired children attending neurology clinic in a nigerian tertiary institution

Background: The need to identify the intellectual capability of neurologically impaired children dictates their educability which can be estimated through their intelligence quotient (IQ). Draw-a-man test for IQ estimation is available, easy and has been validated in Nigeria. Method: Through a prospective, cross-sectional study that lasted 12 months (January-December, 2011), children aged 4 years and above attending neurology clinic were recruited once they have no severe motor or sensory limitations affecting their upper limbs and can obey the instruction to draw a person. Anthropometry was carried out on them and they were comfortably seated to draw a person. The parents or caregivers were instructed not to make any suggestion or hint to them and no time limit was given. Their drawings were assessed using the 52 parameters of Ziler and interpreted accordingly. Ethical procedures were adhered to. The analysis was done using SPSS version 16 and an interactive calculation tool for chi-square tests of goodness of fit and independence. Results: Seventy-five (45 male, 30 female) children met the inclusion criteria. Their clinical conditions were Epilepsy 48 (64%), Cerebral Palsy 6 (8%), ADHD 5 (6.7%), Down Syndrome 4 (5.3%), Speech/Hearing impairment 3 (4.0%), Hypothyroidism 2 (2.7%) and 7 (9.3%) others. Their ages ranged from 4 years to 16 years (mean±SD = 9.7± 3.8 years). Their IQ distribution were Normal 4 (5.3%), Borderline 12 (16.0%), Mild Mental Retardation 16 (21.3%), Moderate Mental Retardation 19 (25.3%), Severe and Profound Mental Retardation 24 (32.0%) with no significant difference in relation to their birth order. Conclusions: Ninety-six per cent of the study population had IQ below normal. Epilepsy was the commonest condition seen in the Paediatric Neurology clinic and all categories of IQ are seen among children with epilepsy

Febrile Convulsion among Hospitalized Children Aged Six Months to Five Years and Its Association With Haemoglobin Electrophoretic Pattern.

BACKGROUND: Febrile convulsion and sickle cell disease are common in tropical countries and both are associated with significant morbidity and mortality. Worldwide, Nigeria has the highest prevalence of sickle cell disease. However, there is a dearth of knowledge on the haemoglobin electrophoresis in patients with febrile convulsions. METHODS: This was a hospital based, descriptive, cross-sectional study of the relationship between haemoglobin genotype and febrile convulsion at the University of Ilorin Teaching Hospital over a period of 12 months. A self-designed pretested questionnaire was administered on the subjects, and necessary examinations and investigations were conducted. RESULTS: Of a total of 1675 children admitted into the emergency paediatric unit during the study period, children aged 6 months-5 years that presented with febrile convulsions were 167(10%). Of this, 1,212 were aged 6 months-5 years. Thus, the age specific, hospital-based prevalence was 13.8%. The M:F was 1.1:1. Their Haemoglobin genotype distribution was AA 131(78.4%), AS 23(13.8%), AC 6(3.6%), SS 6(3.6%), and 1(0.6%) SC. The mean age of the sickle cell disease patients was higher at 46.0±13.5 months compared to 29.2±15.4 months in the non-sickle cell disease patients (p=0.005). The mean packed cell volume in subjects with sickle cell anaemia was 8.8±1.5%; the only case of haemoglobin SC had packed cell volume of 20%, while the non-sickle cell disease patients had a normal PCV. Malaria was present in 80.4% of them. CONCLUSION: Febrile convulsion remains a common cause of hospitalisation. It is uncommon in haemoglobin SS where severe anaemia is always an accompanying derangement. The packed cell volume is nearly normal in children with normal haemoglobin genotype.

Mortality pattern within twenty-four hours of emergency paediatric admission in a resource-poor nation health facility.

BACKGROUND: Mortality among emergency paediatric admissions within the first 24 hours is high in resource- poor nations. Measures to reduce the childhood mortality rate can only be effectively planned and implemented when the causes and magnitude of this problem are well defined. OBJECTIVE: To determine the mortality pattern among emergency paediatric admissions within the first 24 hours in a health facility in Nigeria. METHODS: The clinical state and progress of post-neonatal patients who presented alive and were admitted into the emergency paediatric room of the University of Ilorin Teaching Hospital, Ilorin, Nigeria were monitored over a period of six months. The monitoring included records of diagnosis and outcome of management. RESULTS: A total of 606 children were admitted during the period of study out of which 51(8.4%) died. Twenty-nine (57%) of the deaths occurred within the first 24 hours of admission comprising 15 (51.7%) males and 14 (48.3%) females giving M:F ratio of about of 1:1. Majority of the deaths were among patients who reported late to the hospital. Loss of consciousness was a strong risk factor for mortality within 24 hours of admission. The highest mortality within the first 24 hours of admission was recorded among patients with malaria (89.0%) followed by protein energy malnutrition. CONCLUSION: Majority of deaths among emergency paediatric admission occur within the first 24 hours of admission and are associated with clinical conditions such as malaria and protein-energy malnutrition for which sustained intervention strategies must be developed.

Mortality pattern within twenty-four hours of emergency paediatric admission in a resource-poor nation health facility

BACKGROUND: Mortality among emergency paediatric admissions within the first 24 hours is high in resource- poor nations. Measures to reduce the childhood mortality rate can only be effectively planned and implemented when the causes and magnitude of this problem are well defined. OBJECTIVE: To determine the mortality pattern among emergency paediatric admissions within the first 24 hours in a health facility in Nigeria. METHODS: The clinical state and progress of post-neonatal patients who presented alive and were admitted into the emergency paediatric room of the University of Ilorin Teaching Hospital; Ilorin; Nigeria were monitored over a period of six months. The monitoring included records of diagnosis and outcome of management. RESULTS: A total of 606 children were admitted during the period of study out of which 51(8.4) died. Twenty-nine (57) of the deaths occurred within the first 24 hours of admission comprising 15 (51.7) males and 14 (48.3) females giving M:F ratio of about of 1:1. Majority of the deaths were among patients who reported late to the hospital. Loss of consciousness was a strong risk factor for mortality within 24 hours of admission. The highest mortality within the first 24 hours of admission was recorded among patients with malaria (89.0) followed by protein energy malnutrition. CONCLUSION: Majority of deaths among emergency paediatric admission occur within the first 24 hours of admission and are associated with clinical conditions such as malaria and protein-energy malnutrition for which sustained intervention strategies must be developed

Poisoning due to yam flour consumption in five families in Ilorin, Central Nigeria.

BACKGROUND: Food poisoning is known to occur sporadically from time to time due to poor hygienic preparation. Its occurrence rarely assumes epidemic proportion. OBJECTIVE: To report the ccurrence of food poisoning due to yam flour consumption among five families and to create public awareness about the condition. CASE REPORT: Food poisoning due to yam flour consumption which occurred almost in quick succession between February and July 2005 among five family clusters in Ilorin is reported. They presented variedly with diarrhoea, vomiting, abdominal pain, convulsion and loss of consciousness. They all recovered within 48 hours of admission. Even though we could not carry out toxicological tests, yam flour consumption was highly implicated as the cause. Investigations indicated that the use of certain lethal preservatives for the processing of the yam flour might be responsible. CONCLUSION: Poisoning from consumption of yam flour should be a differential diagnosis of acute seizure disorder or the occurrence of vomiting, diarrhoea and abdominal pain in the tropics. We recommend education on proper processing of all food products in view of the public health implication of doing otherwise.

Knowledge, attitude and perception of adults on childhood hypertension in a rural community in Nigeria.

BACKGROUND: Childhood hypertension is less common and not readily recognised compared to adult hypertension. It is being missed because of lack of routine blood pressure measurements in some health facilities in the developing countries. This setback is likely to affect the knowledge, attitude and perception of parents and caregivers to the disease. OBJECTIVE: To assess the knowledge, attitude and perception of childhood hypertension by adult respondents in a rural community in Nigeria. METHOD: The study was carried out with the aid of pre-tested questionnaires, which sought information on wide ranging issues bothering on knowledge, attitude and perception of childhood hypertension. RESULTS: Fifty-four 54/62 (89%) knew that hypertension implied high blood pressure. Fifty-eight 58/61(95%) also indicated that hypertension is detected by measuring the blood pressure. However 37/60 (62%) respondents did not think that childhood hypertension exist, while 53/59 (90%) respondents were not aware of any child diagnosed with hypertension. All our 62 respondents claimed to have seen 9 children with hypertension compared to 81 adults some of whom were related to them. CONCLUSIONS: We conclude that there is still a low awareness about the existence of childhood hypertension by the rural populace. While this problem is not a priority health problem in the community, an increased awareness of it is crucial the successful management of any child that develops it. Periodic community survey for childhood hypertension and mandatory routine blood pressure measurement in all children presenting for consultation is suggested.

Role of hepatic enzymes in the biochemical assessment of the severity of sickle cell anemia.

BACKGROUND AND OBJECTIVES: Various clinical and hematological indices have been used to assess the severity of Sickle Cell Anemia (SCA), however biochemical indices are lacking. Hepatomegaly has been a frequent finding in SCA and its persistence has been associated with increased disease severity. The association between hepatic enzymes and disease severity in SCA is undefined. This study was therefore designed to look at the association between clinical severity and hepatic enzymes in SCA subjects with persistent hepatomegaly (that is, lasting more than six months) in order to determine a possible role for hepatic enzymes as a biochemical index of severity. MATERIALS AND METHODS: Serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (SAP) and gamma-glutamyl-transferase (GGT) were determined in two groups of SCA subjects and in hemoglobin genotype AA (HbAA) controls. SCA group comprised of 37 subjects with persistent hepatomegaly equal to or greater than 10 cm (below right coastal margin) while the second group comprised another 38 SCA subjects without palpable hepatomegaly. 40 individuals with hemoglobin genotype AA served as control for both groups. Clinical and hematological parameters of severity which included steady state haematocrit, number of transfusions per year, number of crises per year and percentage HbF level were determined and scored in a manner similar to the Glasgow coma scale. Results obtained were analyzed with the aid of statistical package on EPI-INFO version 6.02. RESULTS: There was a significant increase in serum ALT, ALP and GGT levels in SCA with persistent hepatomegaly over those without hepatomegaly (p < 0.05, p < 0.05 and p < 0.01 respectively). All the index scores and the final aggregate severity scores were also significantly higher in SCA subjects with persistent hepatomegaly. Only GGT demonstrated a fairly positive and significant correlation (r = 0.46, P < 0.05) with increased clinical severity among the hepatic enzymes. CONCLUSION: Elevated serum level of GGT in SCA during steady state is suggestive of increased disease severity.

The serum concentrations of zinc, copper and selenium in children with inflammatory bowel disease.

OBJECTIVE: To estimate the levels of trace elements in children with inflammatory bowel disease (IBD). DESIGN: Prospective cross sectional study. SETTING: Gastroentrology Unit, Great Ormond Street Children's Hospital, London, UK. SUBJECTS: Seventy four children with inflammatory bowel disease confirmed endoscopically and histologically (38 ulcerative colitis and 36 Crohn's disease) and 40 age matched controls had their serum zinc, copper and selenium assayed at presentation. MAIN OUTCOME MEASURE: Serum levels of zinc, copper and selenium in children with inflammatory bowel disease and age matched controls. RESULTS: Seventy four children with inflammatory bowel disease confirmed endoscopically and histologically (38 ulcerative colitis and 36 Crohn's disease) and 40 age matched controls had their serum zinc, copper and selenium assayed at presentation. The serum levels of selenium were significantly lower in cases of ulcerative colitis 0.63 +/- 0.25 mmol/L and Crohn's disease 0.69 +/- 0.25 mmol/L than in the controls 0.84 +/- 0.13 mmol/L (p < 0.01). The serum copper concentration was significantly higher in those with Crohn's disease 22.7 +/- 5.49 mmol/L than in those with ulcerative colitis 17.6 +/- 5.15 mmol/L and the controls 20.76 +/- 4.06 mmol/L (p < 0.01). Children with Crohn's disease had a lower serum zinc level 11.01 +/- 2.49 mmol/L compared to the control level of 13.6 +/- 1.63 mmol/L (p < 0.05), but the levels were not significantly different in the controls and ulcerative colitis (p > 0.10). Children with inflammatory bowel disease have abnormal levels of the trace elements which is more marked in those with Crohn's disease. CONCLUSION: Children with IBD in this study show abnormalities of the trace elements which is probably a result of inadequate intake, reduced absorption, increased intestinal loss due to impairment of the absorption as a result of the inflammatory process. The reduced free radical scavenging action of zinc and selenium as a result of their deficiency may contribute to the continued inflammatory process of IBD. The recommendation of the supplementation of these trace elements in IBD is further supported by the findings of this study in children.

Serum immunoglobulin and immunoglobulin G subclasses in children with allergic colitis.

Serum immunoglobulin and immunoglobulin G subclasses were measured in thirty children with histologically proven allergic colitis and twenty age matched controls. Serum immunoglobulin A (mean +/- sd) (0.45 +/- 0.25 vs 87 +/- 0.41 Gm/L), IgG2 (29.2 +/- 13.1 vs 49.5 +/- 12.8 mg/dL), and IgG4 (7.58 +/- 3.01 vs 11.2 +/- 2.59 mg/dL) were significantly lower in allergic colitis than in the controls respectively (p < 0.001). There was a significant elevation of serum IgE in those with allergic colitis (p < 0.01). The serum IgG1 and IgG3 levels were not significantly different in allergic colitis and the controls (p > 0.10). Immunoglobulin A, IgG2 and IgG4 subclasses were low in 43.3%, 75.0% and 55.0% of cases of allergic colitis respectively, compared to 5.0% of the controls with low IgG2 and IgG4 (p < 0.005). The IgG1 and IgG3 subclasses were normal and comparable in both groups. Children with food allergic colitis in this study have low levels of IgG A, IgG2 and IgG4 subclasses. IgA, IgG2 and IgG4 subclass deficiency probably have a role to play in the pathogenesis of allergic colitis an mucosal immune defense mechanism.

Non-infective colitis in infancy: evidence in favour of minor immunodeficiency in its pathogenesis.

Forty two infants below the age of 2 years presenting with chronic non-infective diarrhoea and shown to have histologically proved colitis were investigated over a five year period. Allergic colitis was the most common cause of colitis, accounting for 62% of the cases. Other colitides diagnosed included: non-specific colitis, autoimmune enterocolitis, and ulcerative colitis accounting for 10% each; severe combined immunodeficiency 7%, and Crohn's disease 3%. A positive family history and a personal history of atopy were obtained in 48% and 29% of the cases respectively. Serum immunoglobulin A, IgG2, and IgG4 were very low in over 50% of the entire cohort of infants with colitis; 66% of those with severe combined immunodeficiency, autoimmune enterocolitis, and ulcerative colitis (n = 11) had low CD3 and CD4 T lymphocytes with an accompanying increase in CD8 in two thirds of those with severe combined immunodeficiency. T lymphocytes were normal in those with allergic colitis. Thus infants with proved non-infective colitis as a group show a high prevalence of IgA, IgG2, and IgG4 deficiency. It is likely that this minor deficiency of mucosa associated immunoglobulin production has a role in the pathogenesis of the colitic process.

Non infective colitis in infancy: evidence in favour of minor immunodeficiency in its pathogenesis.

Forty two infants below the age of two years presenting with chronic non infective diarrhoea and shown to have histologically proven colitis were investigated over a five year period at this hospital. Allergic colitis was the most common cause of colitis accounting for sixty two percent of the cases. Other colitides diagnosed included: non specific colitis, autoimmune enterocolitis and ulcerative colitis accounting for 9.5% each, severe combined immunodeficiency 7.1% and Crohn's disease 2.8%. A positive family history and a personal history of atopy was obtained in 47.6% and 28.6% of the cases. Serum immunoglobulin A, IgG2 and IgG4 were very low in over 50% of the infants with colitis. Sixty six percent of those with severe combined immunodeficiency, autoimmune enterocolitis and ulcerative colitis (n = 11) had low CD3 and CD4 T lymphocytes with an accompanying elevated CD8 in 2/3 of those with severe combined immunodeficiency. T lymphocytes were normal in those with allergic colitis. We conclude that infants with proven non infective colitis show as a group a high prevalence of IgA, IgG2 and IgG4 deficiency. It is likely that this minor deficiency of mucosal associated immunoglobulin production have a role in the pathogenesis of the colitic process.

Childhood epilepsy in Ilorin, Nigeria.

Ninety eight children with epilepsy attending the Neurology clinic, University of Ilorin Teaching Hospital over a two year period were studied prospectively. Males were more affected than females in a ratio of 5:3. Generalised tonic-clonic seizures accounted for 62.2% of the cases, and partial seizures for 17.4%. Infantile spasms were seen exclusively in infants less than two years old and absence and generalised seizures in children more than three years of age. Skull radiography showed abnormal findings in 11.2%. Ectroencephalography showed typical findings in 43.9%. Hemiplegia was the most common neurological sequelae (30.3%). Other sequelae include hyperactivity, irrational behaviour, expressive aphasia, mental subnormality, deafness, and blindness in that order. Therapy with a single appropriate anticonvulsant was usually effective for seizure control except in some patients with focal seizures, infantile spasms, severely delayed developmental milestones and prolonged seizures. Poor drug compliance remains the major constraint to adequate seizure control, further compounded in this environment by nonavailability of drugs and unaffordable costs.

Serum zinc, selenium and copper concentration in children with allergic colitis.

Children with allergic colitis have low levels of zinc and selenium which is partly a reflection of their low albumin levels and/or increased utilization of zinc and selenium as antioxidants as a result of the inflammatory process.

Hepatic function tests in children with sickle cell anaemia during vaso occlusive crisis.

Thirty children with sickle cell anaemia had their serum alanine aminotransferase, alkaline phosphatase, total protein, albumin and bilirubin, assayed during vaso-occlusive crisis and at recovery. Alanine aminotransferase, alkaline phosphatase and bilirubin levels were significantly higher during crisis than at recovery, (p < 0.005) especially in the young patient. However, the total protein and albumin levels were not significantly different in crisis and at recovery. A transient hepatic functional derangement during vaso-occlusive crisis is a probable explanation for the reported changes.

Treatment of diarrhoea by proprietary-medicine vendors.

PIP: Although oral rehydration therapy (ORT) is an effective and inexpensive means of treating dehydration resulting from acute gastroenteritis, many parents in Nigeria usually first seek treatment from patent-medicine dealers for their children with diarrheal diseases. The authors investigated the treatment of diarrhea by 75 patent and proprietary medicine store vendors in Ilorin, capital of Kwara State. There are 417 registered patent and proprietary medicine stores in the city. Seven investigators visited the stores where they individually presented themselves as parents or guardians of a child with diarrhea. 33.3% of respondents selling the medicines at the stores were owners, while the rest were only employees. 30% of the employees were primary school students. The storekeepers and employees rarely asked questions about the diarrhea and did not ask to see the child with diarrhea to determine whether there were signs of dehydration. Unaware of the efficacy of ORT, respondents at all stores recommended drugs to treat diarrhea. Storekeepers also poorly understood the seriousness of the condition and the need to refer some cases to a medical center. The government needs to review the existing laws which regulate the establishment and functions of such proprietary medicine stores. Furthermore, courses for store vendors need to be updated, with vendor training supervised by a monitoring system.^ieng