Hepatobiliary Findings in Nigerian Children with Sickle Cell Anaemia.

INTRODUCTION: Hepatobiliary abnormalities occur commonly in sickle cell anaemia and these have been extensively reported in the adult patients. However, complications have been sparsely reported in children especially in the sub-Saharan African continent. This study aimed to highlight the hepatobiliary complications in this group of children using clinical examination, laboratory testing and abdominal ultrasonography. The challenges in a resource limited country are also highlighted. SUBJECTS, MATERIALS AND METHODS: One hundred and thirty- four (134) children aged 1-18years with sickle cell anaemia in steady state were recruited into this crossectional study. Clinical history and physical examination obtained were documented. Relevant basic haematologic and biochemical indices (Full blood count, liver enzymes and viral markers for hepatitis B and C) and abdominal ultrasonographic parameters were documented for all the children. The relationship between the complications and possible risk factors (age, frequency of crisis and blood transfusions) were also documented. RESULT: Fifty-three (39.6%) of the children had hepatobiliary abnormalities. Chronic hepatitis B infection was the most prevalent complication (14.9%) seen followed by cholelithiasis (12.7%) and Hepatitis C infection (4.5%). Other complications identified were cholecystitis (3.0%), biliary sludge (1.5%), liver cirrhosis (0.7%). Age was significantly associated with viral hepatitis (p=0.003) and cholelithiasis (p=0.0007) and the conditions were more prevalent in the older age group. The hepatobilary complications were also more prevalent in the males. Frequent blood transfusions was significantly related to viral hepatitis (p=0.03). The use of hydroxyurea was not significantly related to any of the complications. CONCLUSION: Hepatobiliary abnormalities are prevalent in children with sickle cell anaemia. Clinical screening and the use of ultrasonography would aid early diagnosis and appropriate therapeutic intervention in this group of children.

INTRODUCTION: Les anomalies hépatobiliaires sont fréquentes dans la drépanocytose et ont été largement rapportées chez les patients adultes. Cependant, les complications ont été peu rapportées chez les enfants, en particulier sur le continent africain sub-saharien. Cette étude visait à mettre en évidence les complications hépatobiliaires dans ce groupe d'enfants en utilisant l'examen clinique, les tests de laboratoire et l'échographie abdominale. Les défis à relever dans un pays aux ressources limitées sont également soulignés. SUJETS, MATÉRIEL ET MÉTHODES: Cent trente-quatre (134) enfants âgés de 1 à 18 ans atteints de drépanocytose à l'état stable ont été recrutés dans cette étude transversale. L'histoire clinique et l'examen physique obtenus ont été documentés. Les indices hématologiques et biochimiques de base pertinents (numération globulaire, enzymes hépatiques et marqueurs viraux pour l'hépatite B et C) et les paramètres échographiques abdominaux ont été documentés pour tous les enfants. La relation entre les complications et les éventuels facteurs de risque (âge, fréquence des crises et des transfusions sanguines) a également été documentée. RÉSULTAT: Cinquante-trois (39,6 %) des enfants présentaient des anomalies hépatobiliaires. L'infection chronique par l'hépatite B était la complication la plus fréquente (14,9 %), suivie par la cholélithiase (12,7 %) et l'infection par l'hépatite C (4,5 %). Les autres complications identifiées étaient la cholécystite (3,0 %), les boues biliaires (1,5 %) et la cirrhose du foie (0,7 %). L'âge était significativement associé à l'hépatite virale (p=0,003) et à la cholélithiase (p=0,0007) et ces affections étaient plus fréquentes dans le groupe d'âge le plus élevé. Les complications hépatobiliaires étaient également plus fréquentes chez les hommes. Les transfusions sanguines fréquentes étaient significativement liées à l'hépatite virale (p=0,03). L'utilisation de l'hydroxyurée n'était pas significativement liée à aucune des complications. CONCLUSION: Les anomalies hépatobiliaires sont prévalentes chez lesenfants atteints de drépanocytose. Le dépistage clinique et l'utilisation de l'échographie permettraient un diagnostic précoce et une intervention thérapeutique appropriée chez ce groupe d'enfants. MOTS CLÉS: Hépatobiliaire, complications, enfants, drépanocytose, Nigeria.

Blood pressure to height ratio as a screening tool for prehypertension and hypertension in adolescents.

BACKGROUND: Current methods of detection of childhood hypertension are cumbersome and contribute to under-diagnosis hence, the need to generate simpler diagnostic tools. The blood pressure to height ratio has recently been proposed as a novel screening tool for prehypertension and hypertension in some populations. We evaluated its applicability in our environment. MATERIALS AND METHODS: The weights, heights, and blood pressure measurements of 2364 apparently healthy adolescents were determined. Sex-specific systolic and diastolic blood pressure to height ratios (SBPHR) and (DBPHR) were calculated, and their ability to detect prehypertension and hypertension was determined using receiver operating curves. Discriminatory ability was measured by the area under the curve (AUC) and optimal cutoff points along the curve were determined. P < 0.05 was considered statistically significant. RESULTS: The SBPHR and DBPHR were similar across all age groups and sexes. The AUC of SBPHR and DBPHR for diagnosing prehypertension and hypertension by sex was >0.95 for both diastolic and systolic hypertension in both sexes. It ranged between 0.803 and 0.922 for prehypertension and 0.954-0.978 for hypertension indicating higher accuracy for hypertension. Sensitivity was higher for systolic and diastolic hypertension (90-98%) compared with prehypertension (87-98%). Specificity was lower than sensitivity across all categories of hypertension and prehypertension (0.64-0.88%) though higher for hypertension (0.75-0.88) compared with prehypertension (0.64-0.75). CONCLUSION: BPHR is a useful screening tool for prehypertension and hypertension in black adolescents. Accuracy increased with higher degrees of hypertension.

Postural hypotension in type 1 diabetes: the influence of glycemic control and duration of illness.

BACKGROUND: Postural hypotension (PH) indicates the presence of cardiac autonomic neuropathy and in diabetes mellitus (DM) is associated with adverse outcome. Nonetheless, PH has been rarely characterized in young persons in Sub-saharan Africa where suboptimal care of DM is prevalent. AIMS: The aim of the study was to determine the prevalence of PH in young patients with type 1DM and its relationship with the duration of DM and glycemic control. SETTINGS AND DESIGN: It was a cross-sectional, case control study carried out in the pediatric out-patient clinic. MATERIALS AND METHODS: Each study participant had blood pressure (BP) measured in the supine and standing positions. Glycated hemoglobin (HbA1c) levels were determined and disease duration was documented. STATISTICAL ANALYSIS: The mean BP in the different positions was determined. The occurrence of PH, duration of disease and HbA1c levels was determined with logistic regression analysis. RESULTS: A total of 26 diabetic subjects and 26 age and sex matched controls were studied. 12 (46.2%) diabetic subjects had evidence of PH while none of the controls had PH. Diabetic subjects with PH had significantly longer duration of DM than those diabetics without PH (6.79 ± 4.81 vs. 2.83 ± 2.36, P = 0.023). The mean HbA1c level was similar in both groups of diabetic subjects (9.79 ± 2.07 vs. 9.17 ± 2.35). On logistic regression, age, duration of disease, HbA1c level and body mass index were not significant predictors of PH. CONCLUSION: PH is common in young persons with type 1 DM, with higher frequency in those with long standing disease.

Knowledge; Awareness; and Practice of the Use of Peak Flow Meters by Physicians in the Management of Asthma in Children

The peak flow meter (PFM) is a useful device in asthma monitoring and in determining the severity of symptoms. Against the background of reported under utilisation of PFMs in the management of asthma and prescription for home use; and the paucity of such data in developing countries; this study was carried out to assess the knowledge; awareness; and practice of physicians on the use of PFMs in the management of children with asthma. The work was a prospective cross-sectional study involving 67 doctors working in the paediatric departments of two government hospitals in Lagos State; Nigeria. The number of doctors varied as not all responded to all the questions. The figures therefore correspond with the number of doctors that responded to the particular issue/question addressed. The survey was conducted with a self-administered structure questionnaire. Information obtained included the availability of PFMs in consulting rooms; knowledge of their use; benefits; frequency of prescription; and constraints in prescribing PFMs for the home management of asthma. Only 13 (20.0) of the doctors (n=65) used the peak expiratory flow rate (PEFR) regularly in the diagnosis of asthma. The designation of the respondents and the years of experience in the management of asthma were significantly related to the frequency of prescription of the PFM (p=0.007; p=0.003 respectively).Non-availability was the highest constraint to PFM use (75.0); followed by the cost of the PFM (51.7). This study revealed that the physicians' knowledge about the PFM was suboptimal. The meters were rarely used in diagnosis nor prescribed for home management by physicians attending to asthmatic children at the two referral hospitals. The cost and availability of the PFM should be addressed by the hospital management

Prevalence and outcome of higher order multiple pregnancies in Lagos, Nigeria.

OBJECTIVE: To determine the prevalence and outcome of higher order multiple (HOM) pregnancies in Lagos, Nigeria. METHODS: The mode of delivery, gestational age, pregnancy and neonatal outcome of babies delivered from HOM pregnancies were reviewed retrospectively from the labor ward and theater registers, neonatal unit admission records and medical notes in a tertiary referral centre from April 2009 to March 2012. RESULTS: Twenty-two (15, 6 and 1 set of triplets, quadruplets and quintuplet, respectively) of 6521 pregnancies delivered during the period were HOM pregnancies giving a prevalence of 3.37/1000. All the 74 babies except 12 were delivered by cesarean section. There were 18 perinatal deaths giving a perinatal mortality rate of 243 per 1000. Overall mortality was significantly associated with no antenatal booking (21 versus 5, OR: 21.0, 95% CI: 2.1-72.3, p = 0.000), gestational age ≤30 weeks (21 versus 5, OR: 46.2, 95% CI: 11.2-189.9, p = 0.000) and birth weight <1000 g for live births (p = 0.000). Mode of delivery and number of fetuses >3 were however not significantly associated with mortality. CONCLUSION: Reduction of early preterm births by proper antenatal care and close feto-maternal monitoring of HOM pregnancies will significantly reduce the resultant immediate poor outcomes for these pregnancies and their newborns.

Congenital cystic adenomatoid malformation of the lung: a case report and diagnostic challenges in a typical African setting.

Congenital cystic adenomatoid malformation (CCAM) of the lung an entity which results from a harmatomatous proliferation of the bronchioles constitutes 25% of the all congenital lung anomalies. Majority of cases of CCAM usually present with respiratory distress from birth, while others may present with recurrent chest infections in childhood or in adulthood. Most reports on CCAM have been on caucasian children and the diagnosis of the condition appears to be challenging unless there is a high index of suspicion. This report describes the case of a child who presented in late infancy and was initially managed as a case of hydropneumothorax, however a Computed Tomography (CT) of the chest confirmed CCAM. The diagnostic challenges is also addressed.

Neonatal tetanus: the Massey Street Children's Hospital experience.

BACKGROUND: Neonatal tetanus (NNT), a major cause of neonatal deaths in the developing world appears to be on the downward trend in recent years. At the Massey Street Children's Hospital (MSCH), a foremost paediatric centre in Lagos an unpublished review revealed that NNT constituted 15-20% of the neonatal admissions in the period 2003-2005. OBJECTIVE: The aim of this study was to determine the current prevalence of the disease, describe the clinical characteristics of NNT cases seen at the hospital and proffer solutions that would contribute to the elimination of the disease. METHODS: This was a retrospective study. The clinical record of 66 patients with NNT admitted during a 2 year period (2006-2008) was reviewed. The clinical characteristic of the patients, co-morbidities/complications and mortality in the children was determined. The immunization status, facility used for Antenatal care and delivery by the mothers was also noted. RESULTS: NNT constituted 2.5% of neonatal admissions in the 2 year period. The mean age of the patients was 8.8 +/- 3.29 days. 36 (54.5%) of the patients died while 25 (37.9%) were discharged home. The overall case fatality rate (CFR) was 54.5%. Recurrent apnea was the commonest complication seen. 27 (40.9%) and 37 (56.1%) of the mothers had ANC and delivered at the TBA clinics respectively. Only 2 (3%) of the mothers attended government hospitals. CONCLUSION: Though there is a reduction in the number of cases of NNT over the years (15-20% prevalence to 2.5%) the CFR at the secondary health facility still remains unacceptably high. The preference of mothers for TBA clinics rather than government hospitals is a major concern which needs to be addressed.

Non-traumatic paraplegia in Nigerian children presenting at the University College Hospital, Ibadan.

A review of the presentation, management and outcome in all children presenting with non-traumatic paraplegia managed by the paediatric neurology team at the University College Hospital Ibadan, Nigeria from June 1989 to May 2004 is presented. Of the 110 patients, there were 54 males and 56 females giving a M:F ratio of 1:1. The mean age of the group was 5.3 (SD = 3.1) years, with a range from 9 months to 11 years. Infections and infectious processes caused the paraplegia in 102 (92.7%) of the cases with poliomyelitis and tuberculosis (TB) of the spine accounting for 88 (80%) of cases. The study period was divided into three 5 year periods. While poliomyelitis was the commonest cause of paraplegia (60%) in the first 5 years: TB spine was responsible for most cases (40%) in the last 5-year period of the study. There was a significant reduction in the total number of cases seen when the initial 5-year period was compared with the last (45 and 26 respectively, P = 0.001). Overall mortality among the 110 admitted patients was 7.2% being highest (50%) in malignant disorders and none was recorded in TB spine. Prognosis for eventual ability to walk was best in cases of TB spine where 37 of the 39 patients (95%) were ambulant by discharge after 60 days of anti-TB treatment. The 2 non-ambulant patients eventually walked within 3 months of discharge while on maintenance treatment for TB. Only 2 of the 51 non-ambulant patients obtained wheelchairs at discharge. The implications of inadequate facilities for investigation and treatment as well as the lack of financial and social support for the families of affected children are discussed.