Normalization of Cardiac Structural dimension and Function to Body Surface Area in South East Nigeria Children.

BACKGROUND: Standardizing cardiac valve structures and function to body surface area will help the clinician and surgeons in decision-making. AIM: To evaluate the z-scores of the sizes of cardiac structures and function and to present them in Gaussian curves and reference values. MATERIALS AND METHODS: This was a cross-sectional study that involved 300 apparently healthy children. This study was performed among healthy children from birth to 18 years. Children with a normal echocardiogram, those with no chronic illness, no congenital heart defect, and no acquired heart defect were included in the study. RESULT: The majority fell within the normal limits, as shown in the Gaussian curves. For instance, 40 (13.3%) of atrioventricular (AV) valve diameters were +1 Z-score above the normal, and only 5 (1.7%) were +2 Z-score above the normal. About 9.3% (28/300) had below -2 Z-score below normal, while only 5% had -1 Z-score below normal. Similarly, the left ventricular function z-scores were also derived at -3 Z-scores to +3 Z-scores. The standard reference values were compared with the results obtained from our Z score values. There was no significant difference noted in the Z-scores. P values ranged from 0.07 to 0.84 for all the cardiac structures except for gender, where Z-scores of the mitral valve and left pulmonary artery varied significantly (P = 0.02). CONCLUSION: Reference values of cardiac structure and function were presented using Z scores, and we noted no significant difference when compared with the Western standard values except for the mitral valve and left pulmonary artery.

Echocardiographic Comparison of Left Ventricular Systolic Function and Aortic Blood Flow Velocimetry in Children with Ventricular Septal Defect.

BACKGROUND: The assessments of left ventricular (LV) longitudinal systolic dynamics in children with ventricular septal defect (VSD) have achieved a major milestone in the evaluation of LV systolic function. OBJECTIVES: This study aims to evaluate the LV function, LV mass (LVM), and the descending aorta blood flow in children with VSD compared to that obtained in age and sex-matched controls. RESULTS: The mean LVM of the control, 113.5 ± 123.9 was higher than that of those who had VSD, 75.8 ± 83.9, and the difference in mean was found to be statistically significant (Mann-Whitney U = 2.322, P = 0.022). The mean EF of the control, 67.9 ± 10.3 was comparable to that of those with VSD, 65.6 ± 13.9, (Student's t = 1.223, P = 0.223). Similarly, the mean descending aorta blood flow of control, 1.6 ± 2.2 was comparable to that of those with VSD, 3.9 ± 16.1, (Mann-Whitney U = 1.002, P = 0.321). There was a very weak positive correlation between LVM and descending aorta blood flow among the subjects (n = 85, r = 0.117, P = 0.425). There was a very weak negative correlation between LVM and descending aorta blood flow among control. (n = 85, r = -0.065, P = 0.609). CONCLUSION: The LVM among children with VSD is lower than controls but there is no difference between LV function in subjects and controls. There is a linear increase of LVM with descending aorta blood flow.

Health-related quality of life in children and adolescents with epilepsy in Enugu: Need for targeted intervention.

BACKGROUND: Epilepsy, a chronic brain disorder, predisposes children to low Health-Related Quality of Life (HRQOL). OBJECTIVE: This study aimed at assessing the HRQOL in Nigerian children with epilepsy and compare it with that in healthy children. METHODS: A cross-sectional study of 166 children with epilepsy (CWE), aged 5-18 years on anti-epileptic drugs (AEDs) for at least 6 months and 166 age and sex-matched apparently healthy children was conducted. A generic version of the Pediatric Quality of Life (Peds QoL version 4) scale was used to assess HRQOL. RESULTS: There were significant differences in Quality-of-Life mean scores in the domains of social functioning, psychosocial combination, and psychosocial plus physical activities between cases and controls. The school function scores of <50, indicating low QOL, were significantly more (Chi square = 35.37) (P = 0.0001) among the cases (32.5%) compared to the controls (6.3%). Similarly, low quality of life in the psychosocial combination were observed significantly (P_ = 0.042) more among the cases (12.7%) compared to the controls (6.3%). Low quality of life in emotional feeling domain were noted significantly (Chi square = 12.9) (P = 0.0002) more in subjects aged between 8 and 12 (20%). QOL scores of below 50 in the social function domain were observed significantly (Chi square = 6.49) (P = 0.039) more in subjects aged between 5 and 7 years (44.8%). There was significant gender difference in Quality-of-life index in school functioning domain in subjects. (Chi Square = 6.49) (P value = 0.039). Children in the upper social class scored higher in the social functioning domain, and social class was significantly associated with scores in the social domain of functioning. (F = 3.75 and P = 0.03). QOL scores below 50 in the emotional domain were significantly more among subjects aged 8-12 years/13-18 year, s and QOL scores of <50 in the school function domain were significantly more in subjects aged 5-7 years. (P = 0.0002) (P = 0.039), respectively. CONCLUSION: HRQOL is reduced in CWE in all domains of Peds QoL. Significant predictors of reduced HRQOL include age, gender, and socioeconomic class. Beyond seizure control, epilepsy management should be oriented towards ensuring the optimal health-related quality of life.

Comparison of plasma electrolytes of perinatally asphyxiated and normal term babies.

OBJECTIVES: The objective of this study is to document and compare plasma electrolytes of asphyxiated newborns of different degree within 48 hours of life. STUDY DISIGN: A comparative cross-sectional study was conducted in the newborn special care unit at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Sodium, potassium, bicarbonate and ionized calcium levels were estimated in the plasma samples of neonates with perinatal asphyxia of different degree and healthy newborns (control group) within 48 hours of birth. MAIN OUTCOME MEASURES: The plasma sodium, potassium, bicarbonate and ionized calcium levels were estimated in both, the study subjects and controls. RESULTS: Mean plasma sodium level was significantly lower (134.93±5.24 mmol/l vs 141.90±3.36 mmol/l; P < 0.05), mean plasma bicarbonate level was significantly lower (16.98±3.99 mmol/l vs 18.54±2.36 mmol/l; P < 0.05), and mean plasma ionized calcium level was significantly lower (1.10±0.14 mmol/l vs 1.25 0.11 mmol/l; P < 0.05) in subjects compared to controls while mean plasma potassium was significantly higher (5.07±0.93 mmol/l vs 4.65±0.51 mmol/l P < 0.05) in subjects compare to controls. CONCLUSION: The tendency to have hyponatremia, hyperkalemia, acidosis and hypocalcemia is very high among the study subjects which underscores the need for great vigilance in electrolyte monitoring when managing an asphyxiated baby.

Sonographic Biometry of Normal Kidney Dimensions among School-age Children in Nsukka, Southeast Nigeria.

BACKGROUND: Some kidney diseases are usually associated with changes in kidney size. OBJECTIVE: To determine sonographically the normal limits and percentile curves of the kidney dimensions according to age, gender and somatometric parameters among school-age children. METHODS: A prospective cross-sectional research design and convenience sampling method were utilized. Participants included 947 normal subjects (496 boys and 451 girls) aged 6-17 years old. The sonographic examination was performed on a Shenzhen DP-1100 machine with 3.5 MHz convex transducer. Longitudinal and transverse dimensions of the kidneys were obtained in coronal plane with the subject in the supine or left lateral decubitus position. RESULTS: The means of right and left kidney lengths in mm were 79.6 ± 8.1 and 81.6 ± 8.3, respectively while that of the right and left kidney widths in mm were 35.03 ± 3.6 and 35.09 ± 3.6, respectively. Dimensions of the kidneys were not statistically different in boys and girls (p > 0.05). There was a statistically significant difference between right and left kidney length (p < 0.05). Height correlated best with both kidney lengths. Thus the normal limits, prediction models and percentile curves of kidney lengths were established with respect to height. CONCLUSION: Sonographic determination of pathologic changes in the size of the kidneys necessitates knowing the normal ranges of its lengths especially with respect to height in school-age children.

Sonographic determination of spleen to left kidney ratio among Igbo school age children of south east Nigeria.

BACKGROUND: Clinical determination of mild splenomegaly is notoriously inaccurate. OBJECTIVES: To determine sonographically the spleen to left kidney ratio according to age and somatometric parameters among school age children in a tropical environment. METHODS: A cross sectional study and convenience sampling were done on 947 apparently healthy subjects (496 boys and 451 girls) aged 6-17 years at the University of Nigeria Medical Centre, Nsukka. The sonographic examination was performed on Shenzhen DP-1100 machine with 3.5 and 5 MHz convex transducers. Spleen and left kidney lengths were obtained using appropriate techniques. The weight and height of the subjects were obtained with the participants wearing light weight street clothes without shoes. RESULTS: Measurement of spleen and left kidney lengths were reliable within and between sonographers. The spleen and left kidney lengths were not statistically different in boys and girls (p > 0.05). The spleen to left kidney ratio according to age and somatometric parameters is constant at about 1.13 with 1.3 as the upper limit of normal in the studied population. CONCLUSION: Sonography can be used to detect mild splenomegaly if the spleen to left kidney ratio is greater than 1.3 in the absence of renal disease among school age children.

Prevalence and pattern of child abuse and associated factors in four secondary institutions in Enugu, Southeast Nigeria.

UNLABELLED: In our society, child abuse is most often not recognized. In addition, little attention is focused on child abuse due to the menace of severe acute malnutrition and infections, which are the major pediatric problems in our setting. There is need therefore for public awareness of the existence of the various forms of child abuse in the society. The objective of this study is to determine the prevalence, pattern, socioeconomic implication, and factors associated with child abuse among secondary school students attending four secondary schools in Enugu. This is a prospective study where cases of child abuse were investigated using a convenience sampling of students attending four secondary schools in Enugu. A total of 372 subjects participated in the study comprising 192 (51.6 %) females and 180 (48.4 %) males (χ (2) = 7.74, p = 0.38). Their median age was 15.0 (12-18) years. One hundred and sixty-six of 370 (44.8 %) made up of 85 (51.2 %) females and 81 (48.8 %) males reported that they had been hit repeatedly with an implement, showing no significant difference in the gender of respondents physically abused. Thirty-eight (10.2 %) respondents admitted that they have been forced or persuaded to have sexual experience against their wish as teenagers. A total of 58/346 (16.8 %) respondents admitted that they have been abused emotionally in one way or the other by either birth parents or other relatives who brought them up. CONCLUSIONS: Child abuse is a notable problem among secondary school students and adolescents, though this is highly underreported as seen in this study.

Sonographic biometry of spleen among school age children in Nsukka, Southeast, Nigeria.

BACKGROUND: Normative value of spleen size among school age children is important for objective assessment of the spleen. OBJECTIVES: This study was aimed at determining sonographically the normal limits of the spleen size according to age, sex, and somatometric parameters among school age children. METHODS: A cross sectional study was done on 947 apparently healthy subjects (496 boys and 451 girls) aged 6 - 17 years. The subjects were recruited from some primary and secondary schools within Nsukka metropolis and also from out patients in the study centre. A pilot study was done to determine the intra- and inter rater reliability of sonographic measurements of the spleen. The sonographic examination was performed on Shenzhen DP-1100 machine with 3.5 and 5 MHz convex transducers. Spleen sizes were obtained with the subject in a right lateral decubitus position. RESULTS: Measurement of spleen length was reliable while measurement of spleen width was less reliable within and between sonographers. Dimensions of the spleen were not statistically different in boys and girls (p > 0.05). Height correlated best with spleen dimensions. CONCLUSIONS: Normogram of the spleen size with respect to height is important in the determination of some pathology associated with changes in its size.

Behavioral problems of siblings of epileptic children in Enugu.

BACKGROUND AND OBJECTIVE: The existence of a psychosocial dysfunction in the siblings of children with chronic illness has been documented. There are very few reports on siblings of children with epilepsy. The aim of this study is to investigate to what extent the children's epilepsy has affected their healthy siblings in our own center. MATERIALS AND METHODS: Epileptic patients who consecutively referred to the Pediatric Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu, from October 1999 to September 2000 were recruited. Demographic data were obtained, with a questionnaire administered to the parents. Information on the behavior of the school-age siblings and control was obtained by the class teachers using Rutter's behavior scale (B2) for children (Teacher's Scale). RESULTS: One hundred and fifty-six children with epilepsy, of age four to fifteen years, 124 males and 32 females, with a Male: Female ratio of 4: 1, were recruited; and 156 school-age siblings of the epileptic children (index children) and 156 controls were studied. Prevalence of behavioral problems was 38.5 and 15.4%, respectively, among the index and control children ( P < 0.001). There was no significant sex difference in the two groups. There was a significant difference in the distribution of the types of behavior problems between the index and controls ( P < 0.05). The duration of epilepsy did not affect the prevalence of behavior problems ( P < 0.05), but seizure control had a significant effect on the prevalence of behavior problems ( P < 0.001). CONCLUSIONS: Siblings of children with epilepsy have more behavioral disturbances than controls. A strong association was found between poor seizure control and the prevalence of behavioral problems.