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.

Assessment of overweight and obesity among Nigerian children and adolescents using triceps skin-fold thickness and body mass index.

The prevalence of obesity is increasing in children and adolescents even in resource-poor countries. The study aimed to determine the prevalence of obesity in a group of Nigerian school children using triceps skin-fold thickness (SFT) and body mass index (BMI). The subjects were 1235 randomly selected primary and secondary Lagos school children aged 5-18 years, triceps SFT was measured with Harpenden® calipers and BMI calculated from weight and height. Using BMI, overweight and obesity were defined as values of 85th to 94th percentile for age and sex and ≥95th percentile, respectively. Using triceps SFT, obesity was defined as SFT > 85th percentile of the NHANES III study. Fifty-seven subjects (15 boys and 42 girls) had SFT > 85th percentile with a higher prevalence in girls than boys (6.4% vs. 2.6%, P = 0.001). The prevalence of BMI-defined overweight and obesity were also higher among girls (11.9% vs. 5.7%, P < 0.001 and 4.7% vs. 2.2%, P = 0.02, respectively). Females of upper socioeconomic class were more likely to be overweight (16.2% vs. 6.6%, P < 0.0001), obese (6.3% vs. 2.8%, P = 0.03) or have elevated SFT (8.2% vs. 4.2%, P = 0.03) than those of low socioeconomic status. Forty-seven of 57 subjects (82.5%) with elevated SFT also had high BMI. The prevalence of obesity is low in the study population but the much higher prevalence of overweight suggests that steps should be taken to control fatness before the figures worsen. In more than 80% of subjects, elevated SFT co-existed with elevated BMI.

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.

Relationship between vitamin D levels and outcome of pneumonia in children.

BACKGROUND: Pneumonia, a common childhood infection in Nigerian children with a number of debilitating complications such as empyema thoracis, has been linked to vitamin D deficiency due to its ability to modulate the T lymphocyte of the immune system . OBJECTIVE: To determine the relationship between vitamin D and outcome of pneumonia in children. METHODS: This was a case-control study involving 24 children, admitted for pneumonia as subjects and 10 children without pneumonia as controls. Pre-formatted questionnaire was utilized to obtain background information, anthropometric measurements were made to determine nutritional status and estimation of 25- hydroxy cholecalciferol (25OHD) done for all those studied. RESULTS: The mean (SD) serum 25OHD concentration was 104 (59) nmol/L and 130 (107) nmol/L for subjects and controls respectively. Amongst the subjects 15 (54%) had serum 25OHD less than 70 nmol/L and 11 (46%) serum 25OHD greater than 70 nmol/L. Hypocalcaemia was present in 15 (54%) of the subjects. Further analysis of hypocalcaemia with regards to the concentration of serum 25OHD showed that 2 (13%) had levels below 40 nmol/L, 10 (67%) had levels below 70 nmol/L and 3 (20%) above 70 nmol/L. Hypocalcaemia was more frequent among subjects with 25OHD below 70nmol/L compared with those above 70nmol/L, (p =0.01). Empyema thoracis and death occurred amongst the two subjects with 25OHD between 27.5 and 40 nmol/L. Anaemia was more frequent among subjects with 25OHD below 70 nmol/L compared with those above 70 nmol/L (p = 0.03). CONCLUSION: The study showed that Vitamin D insufficiency, and not solely its deficiency, may have an important role to play in the immune and haemopoetic system. It may therefore affect the response of a child to infections especially pneumonia.

Relationship between Vitamin D Levels and Outcome of Pneumonia in Children

BACKGROUND: Pneumonia; a common childhood infection in Nigerian children with a number of debilitating complications such as empyema thoracis; has been linked to vitamin D deficiency due to its ability to modulate the T lymphocyte of the immune system . OBJECTIVE: To determine the relationship between vitamin D and outcome of pneumonia in children. METHODS: This was a case-control study involving 24 children; admitted for pneumonia as subjects and 10 children without pneumonia as controls. Pre-formatted questionnaire was utilized to obtain background information; anthropometric measurements were made to determine nutritional status and estimation of 25- hydroxy cholecalciferol (25OHD) done for all those studied. RESULTS: The mean (SD) serum 25OHD concentration was 104 (59) nmol/L and 130 (107) nmol/L for subjects and controls respectively. Amongst the subjects 15 (54) had serum 25OHD less than 70nmol/L and 11 (46) serum 25OHD greater than70nmol/L. Hypocalcaemia was present in 15 (54) of the subjects. Further analysis of hypocalcaemia with regards to the concentration of serum 25OHD showed that 2 (13) had levels below 40nmol/L; 10 (67) had levels below 70nmol/L and 3 (20) above 70nmol/L. Hypocalcaemia was more frequent among subjects with 25OHD below 70nmol/L compared with those above70nmol/L; (p = 0.01). Empyema thoracis and death occurred amongst the two subjects with 25OHD between 27.5 and 40nmol/ L. Anaemia was more frequent among subjects with 25OHD below 70nmol/L compared with those above70nmol/L (p = 0.03). CONCLUSION: The study showed that Vitamin D insufficiency; and not solely its deficiency; may have an important role to play in the immune and haemopoetic system. It may therefore affect the response of a child to infections especially pneumonia

Costs and performance of early hearing detection programmes in Lagos, Nigeria.

In line with global progress towards early detection of permanent congenital and early-onset hearing loss (PCEHL), the costs and performance of hospital-based and community-based infant hearing screening models were evaluated in Lagos, Nigeria. The protocol consisted of two-stage screening with transient-evoked otoacoustic emissions and automated auditory brainstem response followed by diagnostic evaluation for all infants referred after the second-stage screening. The main outcome measures were referral rates at screening, cost per baby screened, cost per case detected and yield for PCEHL. First-stage referrals were 32.2% for universal and 31.7% for targeted screening in the hospital, compared with 14.3% and 15.2%, respectively for the community-based programme. Second-stage referrals ranged from 3.3% under hospital-based universal screening to 4.9% under community-based targeted screening. The highest yields of 27.4 and 22.5 per 1000 were recorded under community-based targeted and universal screening, respectively. Screening cost per child was lowest (US$7.62) under community-based universal screening and highest (US$73.24) under hospital-based targeted screening. Similarly, cost per child detected with PCEHL was lowest (US$602.49) for community-based universal screening and highest (US$4631.33) for hospital-based targeted screening. Community-based universal screening of infants during routine immunisation clinics appears to be the most cost-effective model for early detection of PCEHL in low-income countries.

Blood chemistry, hematology and tryptophan level in cerebral malaria children.

BACKGROUND: Cerebral malaria is a deadly complication of P. falciparum infection, yet its pathogenesis remains incompletely understood. OBJECTIVE: The blood chemistry, hematology, protein and tryptophan levels in the cerebrospinal fluid (CSF) of cerebral malaria children were investigated. METHODS: Fifteen children (2.44 +/- 0.25 yr) diagnosed with cerebral malaria were used for this study. The control subjects consist of healthy and malaria-free children (2.50 +/- 0.16 yr). Two ml of blood were collected from each child between 0830 h and 0930 h. Blood chemistry and hematological parameters were analyzed using 2 ml each of Synchron CX5 auto-analyzer. The cerebrospinal fluid (CSF) was collected from the children using the lumbar puncture method, by inserting a sterile needle between the 4th and 5th lumbar vertebrae collected into sterile tubes. The CSF tryptophan, plasma and CSF protein concentrations and CSF protein concentration were determined. RESULTS: There were no significant (p > 0.01) differences in the plasma protein, glucose and CSF glucose levels of the cerebral malaria children as compared with the control. The packed cell volume (PCV) of the cerebral malaria children hemoglobin (Hb) levels were significantly (p < 0.01) lower as compared to control, but were significantly higher in CSF tryptophan and erythrocyte sedimentation rate (ESR) of cerebral malaria children were observed. Results of the study showed that cerebral malaria affected the CSF protein level, ESR, Hb and PCV, but do not affect plasma protein, glucose and CSF glucose concentrations. CONCLUSION: Data of the present study indicate that CSF protein, tryptophan, ESR, Hb and PCV could be used as possible markers in the diagnosis of cerebral malaria.

Zinc supplementation in children with acute diarrhoea.

BACKGROUND: In Nigeria, diarrhoeal disease is second only to malaria as a cause of death the under 5 age group. This study was aimed at assessing the benefit or otherwise of zinc supplement in acute diarrhoea. SUBJECTS AND METHODS: This was a multi-centred randomized double blind controlled study. Children with acute diarrhoea aged between 6 and 24 months were randomized into zinc supplemented and placebo groups. Plasma zinc levels were analyzed at enrollment and at the end of the study. The children were reviewed for the next three months from the time of enrollment. RESULTS: The mean plasma zinc levels at baseline and at the end of the study were 0.06 +/- 0.04 and 0.067 +/- 0.03 ppm in the zinc supplemented group and 0.11 +/- 0.02 and 0.05 +/- 0.03 ppm in the control group. The differences were not statistically significant. The zinc supplemented group had an average weight gain of 1.1 kg as against 0.73 kg (p = 0.00) for the control group in the study period. No adverse effect was reported on account of zinc supplementation. CONCLUSION: Zinc supplementation is beneficial in acute diarrhoea as observed in this study.

Prevalence of iron deficiency in children 6-24 months in Lagos.

BACKGROUND: Iron deficiency is the commonest cause of nutritional anaemia in children worldwide particularly in developing countries. Infants and toddlers are prone to developing iron deficiency anaemia (IDA). This study was carried out to determine the prevalence of IDA and some factors associated with it in this group of children. STUDY DESIGN: Haemoglobin concentration and mean corpuscular volume (MCV) estimations carried out in 282 apparently well children aged 6-24 months. Estimations of serum iron (SI), total iron binding capacity (TIBC), serum ferritin (SF) and transferrin saturation (TS) were also determined in children with anaemia (Hb concentration < 11.0 g/dl). Information on current diet was also obtained using a diet record. RESULTS: Two hundred and twenty three (79.1%) children had anaemia. The mean Hb concentrations of all the age groups were less than 11.0 g/dl. Forty (14.9%) children had IDA (defined as aneamia plus 2 or more of the following--MCV < 70fl, Ts < 10% or SF < 10 microg/dL). The mean age of children with IDA (8.96 +/- 2.54 months) was statistically lower than for those without the condition 10.94 +/- 4.55 months (p = 0.016). Inclusion of vegetables and animal protein less than three times a week in the diet were both significantly associated with IDA. CONCLUSION: The prevalence of IDA in this study is high especially before the age of 12 months and an average weekly intake less than 3 times a week or iron rich foods like animal protein and vegetables was significantly associated with IDA. Emphasis should be on the inclusion of iron rich foods in the diet following exclusive breastfeeding to reduce the prevalence of IDA in these children.

Acute asthma in a children's emergency room: a clinical audit and management guideline proposal.

BACKGROUND: Adequate asthma control in children includes optimal medical management of acute exacerbations of the disorder. Asthma guidelines provide critical information and serve as quick reference decision-support material for clinicians. AIM: This clinical audit aimed at evaluating emergency management of acute asthma as well as proposing for use a management protocol, with the view of improving quality of care. METHOD: This is a retrospective audit of the management of acute asthma over 18 months (October 2000-April 2002) Relevant data related to diagnostic and therapeutic procedures in thirty asthmatics were extracted and examined. RESULTS: There were 20 males and 10 females (M:F ratio 2:1). Mean age (range) was 5.9 years (10 months-12.5 years) and mean (range) duration of symptoms prior to presentation was 1.9 days (2 hours-8 days). Trigger factors, current medications, clinical and functional indices of severity of acute asthma were not documented in 73.3%, 93.3% and 96.7% cases respectively. Diagnostic labels used in 28 (93.3%) did not reflect the acute nature or severity of the acute episode. Although nebulized salbutamol and oral corticosteroids were used for 80.0% of cases, aminophylline was frequently prescribed in addition. Discharge medications and instructions, including follow up in the respiratory clinic were not given in 21 (70.0%) and 28 (93.3%) cases respectively. CONCLUSION: This audit noted that the overall management of acute asthma in the emergency room and the documentation of crucial information vital in the acute and long-term care of asthmatics were inadequate. We propose and recommend for use in the Children's Emergency Room, acute asthma management guideline and protocol-based asthma paper records as well as computerization of patient records.

Ultrasonographic measurements of the hepatobiliary axis of children with sickle cell anaemia in steady state

Sickle cell anaemia is associated with structural manifestations in the hepatobiliary axis but these manifestations have not been sufficiently examined in Nigerian or African children. This study wasconducted to evaluate the results of ultrasono-graphic measurements of the hepatobiliary axis of children with sickle cell anaemia in a Nigerian teaching hospital. One hundred and twenty children with Hb SS in steady state aged between 12 months and 15 years and sixty children with Hb AA matched by age and sex (as controls) were consecutively recruited from April through November 2002. Past and present medical histories were obtained and physical examination and abdominal ultrasonography were performed. The mean liver span; the common hepatic duct and common bile duct diameters; the longitudinal and transverse dimensions (but not the wall thickness) of the gallbladder were significantly higher in test subjects than controls (p 0.05). Multiple regression showed that age correlated significantly with all the studied ultrasound scan (USS) measurements (p 0.05). Recurrent episodes of abdominal pain correlated with gallbladder wall thickness (p

Anthropometric measurements in the detection of low birth weight infants in Lagos.

The present study was undertaken to determine the anthropometric risk indicators in the detection of infants with low birth weight. A total of 788 consecutive, singleton, live born infants had anthropometric measurements determined within 24 hours of life using standard methods. There were 389 (49.37%) males and 399 (50.63%) females; 136 (17.56%) of the infants were of low birth weight (LBW). Birthweight was significantly correlated with occipitofrontal circumference (OFC; r = 0.66), length (r = 0.86), mid-arm circumference (MAC; r = 0.88) and maximum thigh circumference (MTC; r = 0.95) (p < 0.001). Furthermore, OFC of 33.6 cm and 32.3 cm, length of 47.7 cm and 45.5 cm, MAC of 9.6 cm and 9.1 cm, and MTC values of 15.5 cm and 14.9 cm were the corresponding cut-off values with the best combination of sensitivity, specificity and predictive values (p < 0.001) for identifying infants with birth weights of < 2500 g and < 2000 g respectively. The use of these risk indicators would help to identify newborns for close supervision and care, as well as prevent mortality and postnatal developmental retardation.

Infantile achalasia in Down's Syndrome

A 3-year old girl with clinical features of Down's syndrome presented with persistent vomiting of undigested food and recurrent cough. Although her karyotype was not carried out; radiographs of the pelvis and hands revealed characteristic features of Down's syndrome. An investigative barium swallow to diagnose the cause of the vomiting showed achalasia which is a rare association with Down's syndrome