Clinical Summary and Reasoning Format: Cognition Levels and Proposal of a Grading System.

The Clinical Summary and Reasoning Format (CSRF) was designed by the Faculties of Paediatrics of the National Postgraduate Medical College of Nigeria and the West African College of Physicians. The form is recommended for routine use in clinical practice as well as for training and examination purposes. The form has sections for documenting information derived from interacting with an index patient and sections for documenting sequential deductions on the way to various levels of diagnosis. The levels of cognition required to complete different sections of the Clinical Summary and Reasoning Format (CSRF) vary in complexity. The CSRF is potentially useful for assessing the quality of a clinician's clinical reasoning process. Such assessment will be enhanced by having a grading system for completed CSRF forms. In turn, grading contents of the form should reflect complexity of the levels of cognition required for the various sections. The present paper evaluated the sections of the CSRF with reference to the modified Bloom's Taxonomy of cognition and also proposed a grading scheme for assessing CSRF forms completed by trainees.

Le format de résumé clinique et de raisonnement (CSRF) était conçu par les Facultés de Pédiatrie du National Collège médical de troisième cycle du Nigeria et de l'Afrique de l'Ouest Collège des médecins. Le formulaire est recommandé pour la routine utilisation dans la pratique clinique ainsi que pour la formationet l'examen Fins. Le formulaire comporte des sections pour documenter les informations dérivé de l'interaction avec un patient index et des sections pour documenter les déductionsséquentiel les sur le chemin de diverses niveaux de diagnostic. Les niveaux de cognition requis pour compléter différentes sections du résumé clinique et du raisonnement Le format (CSRF) varie en complexité. Le CSRF est potentiellement utile pour évaluer la qualité d'un processus de raisonnement clinique du clinicien. Cette évaluation sera amélioré par la mise en placed'un système de classement pour le CSRF complété Formes. À son tour, le contenu de classement du formulaire doit refléter complexité des niveaux de cognition requis pour les différents sections.Le présent document a évalué les sections du CSRF avec référence à la taxonomie modifiée de bloom de la cognition et a également proposé un système de notation pour l'évaluation des formulaires CSRF complété par des stagiaires. Mots-clés: Cognition, Raisonnement clinique, Évaluation, Notation.

Clinical Summary and Reasoning Format: A Tool for Clinical Practice and Medical Training.

Patients' records are often bulky and unwieldy, necessitating the creation of summaries. A structured summary format adds the advantage of improved organization and easier retrieval of information. However, typical clinical summary formats do not document intermediate deductions linking symptomatology to diagnosis and to that extent fall short of tracking the cognition process of the clinician. The Clinical Summary and Reasoning Format of the Faculties of Paediatrics of the National Postgraduate Medical College of Nigeria and the West African College of Physicians was designed to track the clinical thought and reasoning processes of clinicians. It consists of two major sections. The first section is for documenting data from history, physical examination and early laboratory reports while the second section is for recording hierarchical deductions on the way to reaching various levels of diagnosis. Definitions and descriptions of the various components of the format are herein presented. The usefulness of the format for clinical practice, clinical training and assessment of trainees is discussed.

Les dossiers des patients sont souvent volumineux et peu maniables, ce qui nécessite la création de résumés. Un format de résumé structuré offre l'avantage d'une meilleure organisation et d'une récupération plus facile de l'information. Cependant, les formats de résumé clinique typiques ne documentent pas les déductions intermédiaires reliant la symptomatologie au diagnostic et, dans cette mesure, ne permettent pas de suivre le processus cognitif du clinicien. Le format de résumé clinique et de raisonnement des facultés de pédiatrie du National Postgraduate Medical College of Nigeria et du West African College of Physicians a été conçu pour suivre la pensée clinique et les processus de raisonnement des cliniciens. Il se compose de deux sections principales. La première section sert à documenter les données provenant de l'histoire, de l'examen physique et des premiers rapports de laboratoire, tandis que la seconde section sert à enregistrer les déductions hiérarchiques permettant d'atteindre les différents niveaux de diagnostic. Les définitions et les descriptions des différents composants du format sont présentées ici. L'utilité du format pour la pratique clinique, la formation clinique et l'évaluation des stagiaires est discutée. Mots clés: Cognition, Résumé clinique, Raisonnement clinique, Format, Diagnostic. Mots clés: Cognition, Résumé clinique, Raisonnement clinique, Format, Diagnostic.

Risk Factors of Skin Diseases among School Children in South Eastern Communities in Nigeria.

BACKGROUND: Skin disorders frequently seen among primary school children are common causes of morbidity. Determining the risk factors of skin diseases, will enhance a better understanding of skin health and prevent skin diseases in school children. AIM: To determine the common risk factors of skin diseases among primary school children in Umuahia South Local Government Area of Abia State. METHODS: A descriptive cross-sectional study carried out over a 4-month period among pupils of public and private primary schools. Diagnosis of skin diseases was based on clinical findings as well as laboratory investigations where indicated. A pre-tested, self-administered, close ended questionnaire was used to ascertain the risk factors of skin diseases. RESULTS: Eight hundred and forty-seven (847) and seven hundred and thirteen (713) subjects were recruited from public and private schools respectively. Fifty-six percent of the subjects were males. The mean age of the study participants was 8.74 ± 2.08 years. The overall prevalence of skin diseases was 40.2%. Using a multivariate logistic regression, gender, number of people per room, frequency of bathing per week and source of water were found to be significant risk factors for skin diseases. CONCLUSION: Socio-demographic factors and living conditions are significant risk factors of skin diseases. Standard hygienic practices by school children and their parents/ caregivers will help to reduce the high prevalence of skin diseases in our environment.

CONTEXTE: Les troubles cutanés fréquemment observés chez les enfants des écoles primaires sont des causes courantes de morbidité. Déterminer les facteurs de risque des maladies de la peau, permettra de mieux meilleure compréhension de la santé de la peau et de prévenir les maladies les enfants scolarisés. OBJECTIF: Déterminer les facteurs de risque communs des maladies cutanées chez les élèves de l'école primaire de la zone de Umuahia South Local Government Area of Abia State. MÉTHODES: Étude descriptive transversale menée pendant une période de 4 mois auprès d'élèves d'écoles primaires publiques et privées. Le diagnostic des maladies de la peau était fondé sur les cliniques ainsi que sur des examens de laboratoire, le cas échéant. Un questionnaire pré-testé, auto-administré et fermé a été utilisé pour déterminer les facteurs de risque des maladies de la peau a été utilisé pour déterminer les facteurs de risque des maladies de la peau. RÉSULTATS: Huit cent quarante-sept (847) et sept cent treize (713) personnes ont été recrutés respectivement dans des écoles publiques et privées respectivement. Cinquante-six pour cent des sujets étaient de sexe masculin. L'âge moyen des participants à l'étude était de 8,74 ± 2,08 ans. La prévalence globale des maladies de la peau était de 40,2 %. En utilisant une régression logistique multivariée, le sexe, le nombre de personnes par pièce, la fréquence des bains par semaine et la source d'eau se sont avérés être des facteurs de risque significatifs de maladies de la peau. CONCLUSION: Les facteurs sociodémographiques et les conditions de vie sont des facteurs de risque significatifs de maladies de la peau. Les pratiques hygiéniques normalisées des écoliers et de leurs parents ou parents/soignants contribueront à réduire la prévalence élevée des maladies de la peau dans notre environnement. MOTS CLÉS: Facteurs de risque, maladies de la peau, écoles, enfant.

Spectrum of skin disorders among primary school children in Umuahia, South-East Nigeria.

Background: Skin disorders among primary school children are common in many countries, with a variable spectrum. They can constitute major health problems, resulting in considerable discomfort, parental anxiety, and embarrassment to the child. Aim: To determine the prevalence and pattern of skin diseases among primary school children in the Umuahia South local government area. Subjects and Methods: This was a descriptive cross-sectional study carried out over a 4-month period from December 2016 to March 2017 among school children consecutively recruited from their various primary schools. Result: A total of 1560 children aged 5 to 15 years with a mean age of 8.74 ± 2.079 years were studied. The overall prevalence of skin diseases was 40.2%. The prevalence in public schools was 46.0%, whereas the prevalence in private schools was 33.2% (P < 0.001). Skin eruptions and itchy skin were the most common presentations, whereas tinea capitis, pityriasis versicolor, and scabies were the most common skin diseases noted among the school children. Conclusion: The prevalence of skin diseases in the population studied is high, especially in public schools. The most common manifestation of skin disease is rash, and the most common type of skin disease is tinea capitis. It is recommended that standard hygienic practices should be maintained by primary school children and their parents/caregivers to prevent skin diseases.

Screen viewing practices and caregivers' knowledge of the health-related effects in children and adolescents in a Nigerian Urban City.

Background: Globally, a dramatic increase in the use of television and digital media has been observed among children and adolescents in recent times. The possible health-related effects of frequent and prolonged screen media viewing on these children and adolescents have triggered many concerns among researchers. Aim: The study is aimed to determine the screen media viewing practices and caregivers' level of knowledge about the health-related effects of prolonged screen viewing time on their children. This was a descriptive cross-sectional study among caregiver/child and adolescent dyads on outpatient clinic visits. Subjects and Methods: Respondents (caregivers/children's pairs) were consecutively recruited, and data was obtained using an unambiguous pre-tested semi-structured questionnaire comprising four domains: socio demographic characteristics; screen media viewing characteristics, perception of the health related effects of prolonged viewing time, and measures to limit prolonged screen viewing time in children. Descriptive and inferential statistics were done using Statistical Package for Social Sciences (SPSS) version 22.0 at a level of statistical significance P < 0.05. Results: Of the 205 respondents studied, the majority (67.8%, fathers and 76.1%, mothers) had tertiary education. The daily mean time spent by children watching television/screen media was 2 (± 1.58) hours. Up to 89.3% of the caregivers established good standards for healthy screen-viewing in their homes. However, 52.7% of them had poor knowledge of the health-related problems of increased viewing time. Socio-economic class (P = 0.002) and knowledge level of the parents (P = 0.000) were significant predictors limiting children's screen-viewing time. Conclusion: Increasing screen media viewing is common among the children studied. The majority of the caregivers had poor knowledge of health-related effects of prolonged viewing time despite high educational attainment. There is a need to enlighten caregivers on the possible health effects of excess screen media viewing so as to enable them to institute stringent measures to limit the attendant health consequences on the children.

Umbilical cord serum zinc in neonates delivered at the university of Nigeria teaching hospital, Enugu: Variation with gestational age.

Background: Zinc is particularly involved in cellular growth, neurodevelopment, and immune function, which is critical for child survival. To reduce neonatal mortality in developing countries, cost-effective and evidence-based interventions that can enhance growth, development, and immunity, need to be considered. Determining the zinc levels of neonates and how it relates to both gestational age is therefore imperative. Subjects and Methods: A descriptive cross-sectional study was carried out at the University of Nigeria Teaching Hospital, aimed at determining the umbilical cord serum zinc levels among neonates and their relationship with their gestational age. Two hundred and seventy-five neonates of gestational ages 28 to 42 weeks were enrolled in the study. Serum zinc levels were determined using the flame atomic absorption spectrophotometer (AAS model no. FS 240 AA.USA, Agilent Technology Ltd.). Results: Among the 275 neonates, there were 27 (9.82%), 28 (10.18%), and 220 (80%) preterms, moderate-to-late preterms, and term neonates, respectively. The mean serum zinc level of all neonates was 87 ± 16.07 µg/dL and within the normal limit of serum zinc. Their mean serum zinc level increased with increasing gestational age (F = 90.424, P < 0.001). Very preterm and moderate-to-late preterm neonates had mean serum zinc levels of 65.13 µg/dL ± 6.15 and 69.85 µg/dL ± 9.63 µg/dL, respectively. Conclusion: This study revealed that though the overall mean serum zinc of neonates was normal, preterms (especially those of lower gestational ages) were zinc deficient. Routine zinc supplementation at birth should be considered in preterm neonates to reduce the untoward effects of zinc deficiency.

Clinical Summary and Reasoning Format: A Tool for Clinical Practice and Medical Training.

Patients' records are often bulky and unwieldy, necessitating the creation of summaries. A structured summary format adds the advantage of improved organization and easier retrieval of information. However, typical clinical summary formats do not document intermediate deductions linking symptomatology to diagnosis and to that extent fall short of tracking the cognition process of the clinician. The Clinical Summary and Reasoning Format of the Faculties of Paediatrics of the National Postgraduate Medical College of Nigeria and the West African College of Physicians was designed to track the clinical thought and reasoning processes of clinicians. It consists of two major sections. The first section is for documenting data from history, physical examination and early laboratory reports while the second section is for recording hierarchical deductions on the way to reaching various levels of diagnosis. Definitions and descriptions of the various components of the format are herein presented. The usefulness of the format for clinical practice, clinical training and assessment of trainees is discussed.

Les dossiers des patients sont souvent volumineux et peu maniables, ce qui nécessite la création de résumés. Un format de résumé structuré offre l'avantage d'une meilleure organisation et d'une récupération plus facile de l'information. Cependant, les formats de résumé clinique typiques ne documentent pas les déductions intermédiaires reliant la symptomatologie au diagnostic et, dans cette mesure, ne permettent pas de suivre le processus cognitif du clinicien. Le format de résumé clinique et de raisonnement des facultés de pédiatrie du National Postgraduate Medical College of Nigeria et du West African College of Physicians a été conçu pour suivre la pensée clinique et les processus de raisonnement des cliniciens. Il se compose de deux sections principales. La première section sert à documenter les données provenant de l'histoire, de l'examen physique et des premiers rapports de laboratoire, tandis que la seconde section sert à enregistrer les déductions hiérarchiques permettant d'atteindre les différents niveaux de diagnostic. Les définitions et les descriptions des différents composants du format sont présentées ici. L'utilité du format pour la pratique clinique, la formation clinique et l'évaluation des stagiaires est discutée. Mots clés: Cognition, Résumé clinique, Raisonnement clinique, Format, Diagnostic.

Prevalence and risk factors for helicobacter pylori infection among children in Owerri, Nigeria.

BACKGROUND: Helicobacter pylori (H. pylori) is a gram-negative ubiquitous bacterium affecting over half of the world's population. Most infections are acquired in early childhood with highest prevalence in Africa and Asia. Infected individuals develop antibodies against H. pylori which persist up to 6 months after eradication. Low socioeconomic status, poor sanitation, poor personal hygiene, and absence of potable household water supply are prevalent in our environment and also linked with increased frequency of the disease with attendant health consequences. AIMS: The aim of the study was to determine the seroprevalence of H. pylori infection and potential sociodemographic factors among children in Owerri. METHODS: One hundred and twenty children aged 6 months to 15 years were studied from March to June 2016. Sociodemographic data was documented in a pretested structured questionnaire while rapid test kit that detects antibody to H. pylori by chromatographic flow was used to identify subjects with infection. Data were analyzed using SPSS version 20.0 with level of statistical significance at P < 0.05. RESULTS: H. pylori infection prevalence was 20.0%, increased with age and highest in the 10-15 years age group (P = 0.001). Increasing age and low socioeconomic class (SEC) were found to be significant risk factors of H. pylori seropositivity among study subjects. CONCLUSION: Prevalence of H. pylori infection was high, increased with age and lower SEC as well as highest among children aged 10 years and older. Efforts should be made to exclude H. pylori infection in children with suspected symptoms considering the high burden of the disease in our setting.

Comparative study of nutritional status of children and adolescents with sickle cell anemia in Enugu, Southeast Nigeria.

BACKGROUND: Poor growth and nutritional status are common features of sickle cell anemia (SCA) in children. The rising trend of obesity in children in developing countries has been reported despite a huge burden of undernutrition in these settings. In SCA, overweight/obesity is being increasingly reported. AIMS: To evaluate the nutritional status and its determinants in children with SCA and to compare the same with hemoglobin AA (HbAA) controls of similar age, gender, and socioeconomic status. METHODS: The study was a cross-sectional analytical study involving 175 subjects and controls aged 1-18 years who met the inclusion criteria. Weight and height were measured and body mass index (BMI) was calculated. Z scores were computed for the anthropometric measurements using the World Health Organization (WHO) standard reference. Hemoglobin concentration was determined using HemoCue Hb201+ Analyzer. RESULTS: Subjects had significantly lower Z- scores for weight, height, and BMI compared with controls. Stunting, wasting, and overweight/obesity were observed in 10.9%, 24.6%, and 5.1% of subjects compared with 2.3%, 5.7%, and 9.7% respectively in controls. Wasting, stunting and overweight/obesity in SCA were significantly associated with age while overweight/obesity was significantly associated with upper social class (P = 0.001). CONCLUSIONS: Poor growth and nutritional status are still prevalent while overweight and obesity are emerging comorbidities among children with SCA in our environment. Regular nutritional assessment of children with SCA should be encouraged while those at risk of under/over-nutrition should receive adequate nutritional rehabilitation to prevent possible complications.

Prevalence and Pattern of Psychosocial Disorders among Caregivers of HIV-infected Children in Enugu, South-Eastern Nigeria.

BACKGROUND: Nigeria has the highest burden of paediatric HIV in the world. HIV infection may result in significant life stressors, on both the infected children and their caregivers. METHODS: This included a hospital-based cross-sectional and comparative study. Subjects and controls who met the inclusion criteria were enrolled consecutively. Their socio-demographic variables were obtained and GHQ-28 was used to assess their psychosocial status. RESULTS: A total of 154 caregivers of HIV-infected children (subjects) and 154 caregivers of HIV-negative children (controls) were enrolled into this study. In total, 42 (27.3%) and 112 (72.7%) of the subjects were males and females, respectively, compared with 37 (24.0%) and 117 (76.0%) of the controls, respectively. The prevalence of psychosocial disorders among the subjects and controls was 39 and 2.6%, respectively (p < 0.001; odds ratio: 23.936). The patterns of psychosocial disorders among the caregivers of HIV-infected children were somatic symptoms (85%), anxiety/insomnia (80%), social dysfunction (63.3%) and severe depression (48.3%). CONCLUSION: There is a high prevalence of psychosocial disorders among caregivers of HIV-infected children.

Evaluation of the School Environment of Public and Private Schools in Enugu to Ensure Child Health Promotion.

OBJECTIVES: Poor maintenance of school environment can cause or worsen illnesses among schoolchildren. The objective of this study was to assess the healthfulness of school environments of primary schools in Enugu East, Nigeria, and to compare the difference if any between public and private schools. STUDY DESIGN: This was a cross-sectional noninterventional study of the school environments in Enugu East, Nigeria. METHODS: Multistage sampling method was used to select the sample population. The participating schools were inspected and their head teachers were interviewed using a questionnaire. Scores were awarded using the School Health Program Evaluation scale. Results: Thirty-three schools were studied. The most common source of water for most schools was well. Eleven schools dump refuse openly. Three public schools only had functional toilets. All public schools were adequately ventilated and lit. One private school had a foodservice area. Ten schools did not have a play field, while three public schools had soaps for handwashing. The mean scores for public and private schools were 33.00 and 37.86, respectively. Three schools only attained the minimum score of 57 of a maximum of 66. CONCLUSION: The environment of primary schools in Enugu east, Nigeria, is unhealthy and unfriendly and currently cannot promote and protect the health of the schoolchildren.

Nocturnal enuresis in school-aged children with sickle-cell anemia: Any relationship with hyposthenuria?

BACKGROUND: Reports show that children with sickle-cell anemia (SCA) have a tendency for nocturnal enuresis when compared with their counterparts with normal hemoglobin. Although nocturnal enuresis in SCA has been attributed to several factors including tubular and even bladder dysfunction, its relationship with hyposthenuria has been questioned in some studies. AIM: The study aims to determine the relationship of hyposthenuria with nocturnal enuresis seen in school-aged children with SCA. SUBJECTS AND METHODS: A cross-sectional study of seventy school-aged children with SCA, who met the study criteria and seventy age- and gender-matched controls was conducted at the Sickle-cell Clinic, University of Nigeria Teaching Hospital in Enugu, Southeast Nigeria. The diagnosis of enuresis among the subjects and controls was based on the Diagnostic and Statistical Manual of Mental Disorders-IV criteria while urine specific gravity (USG) was determined on dipstick urinalysis. The frequencies of categorical variables were compared using Chi-square test or Fisher exact test as appropriate and the means of continuous variables with Student's t-test. The level of statistical significance was taken as P< 0.05. RESULTS: The prevalence of hyposthenuria was 4.5% and 8.3% among enuretic and nonenuretic subjects respectively, 6.7% and 10.9% among enuretic and nonenuretic controls and 4.5% and 6.7% among enuretic subjects and controls, respectively. The differences were not statistically significant. The mean ± standard deviation USG was significantly higher in the subjects than in the controls (1.02 ± 0.01 vs. 1.01 ± 0.01, P = 0.013) and enuretic subjects than enuretic controls (1.02 ± 0.01 vs. 1.01 ± 0.01, P = 0.007). The prevalence of nocturnal enuresis was significantly higher in male subjects compared to female subjects (odds ratio [OR] [95% confidence interval (95% CI)] =8.14 (2.12, 31.24), χ2 = 12.21, P< 0.001) and male controls (χ2 = 5.57, P = 0.018). Enuretic subjects had a significantly higher prevalence of parental history of childhood enuresis (OR [95% CI] =10.39 [2.45, 44.05], P< 0.002) than the enuretic controls. The relationship between the enuretic subjects and controls with respect to age of attainment of urinary control, family size, socioeconomic class, and sibling history of enuresis were not statistically significant. CONCLUSIONS: Nocturnal enuresis in children with SCA may not be related to hyposthenuria. However, male gender and parental history of childhood enuresis are significant risk factors.

Assessment of gross malnutrition among primary school children using body mass index as an assessment tool in abakaliki metropolis of Ebonyi State, South-East Nigeria.

BACKGROUND: Obesity and overweight are emerging major health problems in developing countries in the background of undernutrition. These have been linked to a substantial increase in mortality and morbidity. OBJECTIVES: This cross-sectional survey was aimed at determining the prevalence of underweight, overweight, and obesity using body mass index (BMI) in primary school pupils in Abakaliki metropolis of Ebonyi State, south-east Nigeria. METHOD: Eight hundred and four participants aged 6-12 years, from four public and four private primary schools had their weights and heights measured using standard methods. BMI value was calculated for each subject and compared with BMI for age and sex from World Health Organisation (WHO 2007) reference standard. Socioeconomic status was determined using method proposed by Oyedeji. RESULTS: Out of 804 subjects, 426 (53.0%) were from public schools, whereas 378 (47%) were from private schools (P ≤ 0.01). Four hundred and fifteen (51.6%) were males and 389 (48.4%) were female (P = 0.88). The prevalence of underweight, overweight, and obesity using BMI were 4.5% and 1.2%, 0% in public schools and 1.1%, 5.0%, and 3.0% in private schools, (P < 0.001). The socioeconomic class significantly affected the prevalence of underweight, overweight, and obesity as more subjects with overweight and obesity belonged to upper social class, whereas more underweight subjects belonged to lower social class. CONCLUSION: Overweight and obesity are emerging in a background of undernutrition, showing ''double burden'' of nutritional disorder.

Relationship between zinc levels and anthropometric indices among school-aged female children with sickle cell anemia in enugu, Nigeria.

BACKGROUND: Sickle cell anaemia is one of the most common inherited disorders globally. Some affected children have retardation of physical growth which is also seen in those with zinc deficiency. OBJECTIVE: To assess the relationship between zinc levels and anthropometric indices of SCA children. METHODS: A cross- sectional, case-control study on young females aged 6-18 years at the UNTH, Enugu. Relevant clinical data as well as 24 hour dietary recall were collected. Weights and heights were measured using standard protocols and BMI calculated. Serum zinc was determined using Atomic Absorption Spectrophotometer. Data was analyzed using SPSS version 15.0 while the level of statistical significance was set at P < 0.05. RESULTS: Eighty-one subjects with HbSS and 81 matched controls with HbAA were studied. Mean weights of 34.58 ± 12.76kg found in patients were significantly lower than 40.19 ± 13.37kg in controls. Also mean BMI of 16.27 ± 2.76kg/m2 in patients were significantly lower than 18.40 ± 2.96kg/m2 in controls (P = 0.01). Mean heights of patients were lower than that of the controls though not significantly so (P > 0.05). Mean serum zinc levels of 58.01 ± 10.58µg/d1 in patients were significantly lower than 68.37 ± 8.6µg/dl in controls (P = 0.01). Positive correlation was found between serum zinc and BMI of the studied children. Serum zinc has a significant relationship with weight, height and BMI. CONCLUSION: Reduced serum zinc in SCA children was associated with low anthropometric indices. Estimation of serum zinc is also recommended in SCA children with low anthropometric indices.

Primary hypertension among a population of Nigerian secondary school adolescents: Prevalence and correlation with anthropometric indices: A cross-sectional study.

AIM: To assess the prevalence of primary hypertension and its correlation with anthropometric indices among a population of Nigerian adolescents. MATERIALS AND METHODS: A cross-sectional study of secondary school adolescents aged 10-19 years in Enugu, Nigeria, using multi-staged sampling method. Anthropometry and blood pressures were measured using standardized instruments. Data analysis was with the Statistical Package for Social Sciences (SPSS) Version 20.0 (Chicago, IL, USA). RESULTS: A total of 2419 adolescents (mean age, 14.80 ± 2.07 years) were included in the study. Prevalence of hypertension was 10.7%. Systolic and diastolic hypertension were observed in 232 (9.6%) and 85 (3.5%) of the participants, respectively. Forty-two of the 137 obese (30.7%) compared to 158 among the 1777 (7.7%) with normal body mass index (BMI) (P < 0.001) had systolic hypertension. Waist circumference (r = 0.37) and BMI (r = 0.37) significantly and positively correlated with systolic hypertension. CONCLUSION: Obese and overweight adolescents had higher prevalence of primary hypertension than their counterparts with normal BMI.

Diagnostic delay in pediatric cancer in Enugu, Nigeria: a prospective study.

Childhood cancer is a leading cause of childhood mortality in developed countries though ranks lower than infections in developing countries. Most patients with malignancies present late to hospital with consequent adverse outcome. Early diagnosis, therefore, is an important requirement in pediatric oncology as delayed diagnosis is associated with poor prognosis and huge economic cost. The study aims to identify factors associated with delay in the diagnosis of childhood cancer at University of Nigeria Teaching Hospital, Enugu.Children aged 0-17 years with admitting diagnosis of cancer which was histologically confirmed were reviewed prospectively over a 3-year period. An interviewer structured questionnaire was administered to patients or parents/caregivers to obtain information on patients' biodata, their symptoms as well as visit to health professionals or alternative health care providers before presentation at this hospital.Ninety patients were confirmed to have cancer. Overall median lag time (LT) was 15.7 weeks. Major contributors to delay were parents and the type of cancer patients presented with. Acute lymphoblastic leukemia (ALL) had the shortest median LT of 4.2 weeks while Hodgkin's disease had the longest median LT of 53.6 weeks (p = 0.01, Mann-Whitney test, 2-tailed). The median parent's delay was 12.3 weeks and health system delay was 3.6 weeks showing a significant difference in the two categories of delay (p < 0.0001, Mann-Whitney test, 2-tailed). The median treatment delay was 5 days.Public awareness and health system reform is imperative in reducing the delay in diagnosis of childhood cancer in our environment.

Blood pressure values in healthy term newborns at a tertiary health facility in Enugu, Nigeria.

BACKGROUND: Blood pressure (BP) is a reflection of hemodynamic variables. It is an important vital sign and indicator of clinical stability. Accurate measurement of this physiological signal is essential for the optimal management of the ill infant. An increase in the awareness of hypertension among neonates has resulted to increased ability to diagnose neonates with the disease. OBJECTIVES: This study aimed to determine BP values in apparently healthy term newborns in the first 48 h of life and evaluate the factors affecting BP at birth. METHODS: Three hundred and ten healthy appropriate for gestational age term newborns were consecutively recruited. BP measurements were determined using the oscillometric technique with the neonate supine after an appropriate size cuff was applied on the right arm. The monitor (Dinamap 8100) is switched on while the cuff inflation and deflation is automatically done by the instrument with subsequent display of the BP values on the screen. BP measurements were taken at age 0-24 h and 25-48 h. Their weight was measured with infant's weighing scale, and data analyzed with SPSS version 15. RESULTS: The mean systolic BP (SBP), diastolic and mean arterial BP at 0-24 h were 63.3 ± 5.5 mmHg, 36.8 ± 5.3 mmHg and 46.4 ± 5.2 mmHg respectively. There was a positive correlation between birth weight and SBP at birth. No significant correlation was found between BP and gender, mode of delivery or maternal age. CONCLUSION: This study provides current normative BP values that can be used in neonatal Intensive Care Unit.

Progressive myelopathy, a consequence of intra-thecal chemotherapy: case report and review of the literature.

Intra-thecal chemotherapy is a recognized therapy for hematological malignancies such as acute lymphoblastic leukemia (ALL). Despite the advantage of these drugs in treating or preventing central nervous system disease, they are not without complications. The authors describe a 12-year-old girl with ALL, who developed progressive myelopathy following intra-thecal administration of cytosine arabinoside. Initial presentation was urine and fecal retention that progressed to paraplegia, and finally encephalopathy. magnetic resonance imaging of the neuroaxis showed T2-weighted foci of increased signal intensity within the substance of the cervical cord indicative of myelopathy. Physicians should be wary of this rare complication of intra-thecal chemotherapy.

An unusual presentation of non-Hodgkins lymphoma: a case report.

BACKGROUND: Breast lymphoma is an uncommon disease with poor clinical outcome. The rarity of the disease is related to relatively small amount of lymphoid tissues in the breast. The prognosis usually depends on the stage at presentation. OBJECTIVE: To highlight an uncommon presentation of Non-Hodgkin's Lymphoma. CONCLUSION: Non-Hodgkin's lymphoma can affect the breast. A high index of suspicion and prompt histological diagnosis are needed for effective management.

Asthma control and quality of life in school- age children in Enugu south east, Nigeria.

AIMS AND OBJECTIVES: This study set out to assess the quality-of-life of school-age children in relation to their level of asthma control. PATIENTS AND METHODS: A cross-sectional descriptive study of children with asthma using the Paediatric Asthma Quality of Life questionnaire (PAQLQ) and the Asthma Therapy Assessment Questionnaire (ATAQ) to respectively assess the health-related quality of life and the level of asthma control. RESULTS: Ninety children with mean age of 11.8(SD, 2.8; 95% CI, 11.2 to 12.4) years, were enrolled. Fifteen children (16.7%) were well-controlled, 17 (18.9%) were partly-controlled while 58 (64.4%) had uncontrolled asthma. The mean asthma control score for all participants was 3.2 (95% CI, 2.8 to 3.7). The mean quality-of-life score was 5.3 (SD, 1.2; 95% CI, 4.9 to 5.5). The lowest score was in the symptom domain: 5.1 (SD, 1.4; 95% CI, 4.9 to 5.5), and among the 14-17 year age group (4.5 SD, 1.5; MD=1.1; p=0.002). The emotional domain was the least affected 5.4 (SD, 1.3; 95% CI, 5.1 to 5.7). Children with well-controlled asthma had the best quality-of-life scores in symptom domains: 5.6 (SD, 1.3; 95% CI, MD=0.6, p=0.63). Quality of life scores were not significant in determining asthma control (MD=0.1, p=0.98). Age was noted as the strongest quality-of-life predictor (B=-0.2, p=0.002). CONCLUSIONS: QOL scores are better in children with well-controlled asthma. Adolescent age group marks a period of both poor asthma control and quality of life in children with asthma.