Circulating tumor DNA and radiological tumor volume identify patients at risk for relapse with resected, early-stage non-small-cell lung cancer.

BACKGROUND: Predicting relapse and overall survival (OS) in early-stage non-small-cell lung cancer (NSCLC) patients remains challenging. Therefore, we hypothesized that detection of circulating tumor DNA (ctDNA) can identify patients with increased risk of relapse and that integrating radiological tumor volume measurement along with ctDNA detectability improves prediction of outcome. PATIENTS AND METHODS: We analyzed 366 serial plasma samples from 85 patients who underwent surgical resections and assessed ctDNA using a next-generation sequencing liquid biopsy assay, and measured tumor volume using a computed tomography-based three-dimensional annotation. RESULTS: Our results showed that patients with detectable ctDNA at baseline or after treatment and patients who did not clear ctDNA after treatment had a significantly worse clinical outcome. Integrating radiological analysis allowed the stratification in risk groups prognostic of clinical outcome as confirmed in an independent cohort of 32 patients. CONCLUSIONS: Our findings suggest ctDNA and radiological monitoring could be valuable tools for guiding follow-up care and treatment decisions for early-stage NSCLC patients.

Detection of NRAS G12D and NRAS G13C mutant genes among apparently healthy and haematologic malignant individuals in Federal Capital Territory, Nigeria.

Rat Sarcoma gene mutations is an important aspect in the management of hematologic malignancies globally. Unfortunately, this is not the trend in West Africa, including Nigeria. This study was aimed at detecting NRAS G12D and NRAS G13C mutant genes among apparently healthy and haematologic malignant individuals, and to explore their association with some clinical and demographic factors as well as disease status and progression. A total of 200 cfDNAs, 100 each from haematologic malignant patients and blood donors, respectively, were analyzed for the presence of NRAS gene mutations in codons 12 and 13. These mutations were tested using multiplex allele-specific PCR (AS-PCR). The mutations were detected by selective amplification using mutation-specific synthetic oligonucleotides. NRAS G12D and NRAS G13C mutations were 20.0% and 10.0%, respectively. In 17.5% of the 100 haemapoietic cancer patients, NRAS G12D mutant genes were seen while 7.5% of NRAS G13C mutation was found. Both mutant genes were observed in five healthy blood donors each. This result confirms the existence of NRAS mutations in Nigerian haemapoietic cancer patients and the preponderance of G-A transitions over G-T transversions. Mutant NRAS genes were associated with the types and stages of cancer, highlighting probable connection between mutation and increased susceptibility as well as quick progression of hematologic malignancies in the population studied. The result also highlighted higher risk of susceptibility/progression associated with leukemia than other hematopoietic cancers. We recommend more studies on NRAS mutation specifically targeted at improved diagnosis and prognostic therapy. The role of RAS mutation should be explored in other aside blood cancers in the Nigerian population.

Prevalence of human T-cell lymphotropic virus and the socio-demographic and risk factors associated with the infection among post-natal clinics women in Zaria, Nigeria.

Introduction: Human T-cell lymphotropic virus has long been associated with Adult T-cell leukemia/lymphoma, HTLV-associated myelopathy/tropical spastic paraparesis, and hairy cell leukemia. Aim: The aim was to determine the prevalence of HTLV antibodies as well as the socio-demographic and risk factors associated with HTLV among women attending postnatal clinics in Zaria. Methodology: A total of 190 samples were collected within the months of January and June 2017 and qualitative determination of antibodies for HTLV in serum was performed by an antigen sandwich enzyme immunoassay method. Results: The study established an HTLV infection prevalence of 3.2% (6/190). Higher prevalence was observed among women from polygamous families [6.2% (4/64)], the self-employed [6.5% (4/62)], those in age group of 15-25 years [6.2% (5/72)] and women with only primary education [5.9% (2/32)] although the associations were not statistically significant. Similarly, there was no significant association between HTLV infection and history of family cancer (P = .629), intravenous drug use (P = .682), sharing of sharp objects (P = .596,) and history of X-ray exposure (P = .366), except for history of previous blood transfusion which shows significant association (P = .010). Conclusion: The study established a prevalence an HTLV of 3.2% that HTLV in Zaria therefore routinely screened is necessary.

Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review.

BACKGROUND: Annually, 2.6 million stillbirths occur worldwide, 98% in developing countries. It is crucial that we understand causes and contributing factors. METHODS: We conducted a systematic review of studies reporting factors associated with and cause(s) of stillbirth in low- and middle-income countries (2000-13). Narrative synthesis to compare similarities and differences between studies with similar outcome categories. MAIN RESULTS: A total of 142 studies with 2.1% from low-income settings were investigated; most report on stillbirths occurring at health facility level. Definition of stillbirth varied; 10.6% of studies (mainly upper middle-income countries) used a cut-off point of ≥22 weeks of gestation and 32.4% (mainly lower income countries) used ≥28 weeks of gestation. Factors reported to be associated with stillbirth include poverty and lack of education, maternal age (>35 or <20 years), parity (1, ≥5), lack of antenatal care, prematurity, low birthweight, and previous stillbirth. The most frequently reported cause of stillbirth was maternal factors (8-50%) including syphilis, positive HIV status with low CD4 count, malaria and diabetes. Congenital anomalies are reported to account for 2.1-33.3% of stillbirths, placental causes (7.4-42%), asphyxia and birth trauma (3.1-25%), umbilical problems (2.9-33.3%), and amniotic and uterine factors (6.5-10.7%). Seven different classification systems were identified but applied in only 22% of studies that could have used a classification system. A high percentage of stillbirths remain 'unclassified' (3.8-57.4%). CONCLUSION: To build capacity for perinatal death audit, clear guidelines and a suitable classification system to assign cause of death must be developed. Existing classification systems may need to be adapted. Better data and more data are urgently needed.

Seroprevalence of IgG antibodies to herpes simplex virus type-1 in Nigerian children.

BACKGROUND: Herpes simplex virus type-1 (HSV-1) can cause chronic ulcerative infection in immunosuppressed children leading to latency with subsequent reactivate in the conjunctiva resulting in scarring, thickening of the cornea and blindness. They are also common cause of fatal sporadic encephalitis in 70% of paediatric patients. This cross sectional study determined the prevalence of HSV-1 in children in Kaduna State, Nigeria. METHOD: A total of 377 blood samples were collected from children less than five years old attending some selected hospitals in Kaduna State and analyzed for HSV-1 IgG antibodies employing Enzyme immune assaytechnique by using commercially available ELISA Kits. RESULTS: Sero-prevalence rate of 57.8% (218/377) was obtained. The highest prevalence of HSV-1 infection was obtained in children in age group 49-60 months (85.2%) and lowest in children in age group 13-24 months (44.8%). Further analysis of the result of children less than one year old showed that children 9-16 weeks old were more susceptible to HSV-1 infection. HSV-1 infection was significantly associated with age (X2 = 37.92, df = 4, p = 0.001). Though a higher prevalence was obtained in female children (61.5%) than male children (54.5%), the difference observed in the prevalence was not statistically significant (X2 = 1.84, df = 1, P = 0.105). HSV-1 infection was significantly associated with children who were in school (X2 = 15.28, df = 1, P = 0.001) with a higher prevalence of 74.3%. CONCLUSION: Over half of the children sampled were protected from HSV-1 infection while 42.2% were susceptible to the infection and were at risk of developing severe HSV-1 manifestation which includes keratitis, encephalitis and Keratoconjunctivitis.

Optimal sites for agricultural and forest residues energy conversion plant using geographic information system.

The Federal Government of Nigeria (FGN) has committed to net-zero emission development pathways to respond to the Paris Agreement adopted in 2015. However, the country is in dire need of energy to support its developmental ambitions. Therefore, it is necessary to consider green energy technologies to support both socioeconomic development and to meet the FGN's emission reduction target. In view of this, the current work presents the optimal sites for bioenergy plants in a state in Nigeria using Geographic Information System (GIS). Key findings suggest that 62.03 PJ/yr and 4.12 PJ/yr of energy could be derived from crop residues and forest residues, respectively, to support the state's bioenergy development. The crop residues considered include plantain (stem), oil palm (shell and fibre), maize (stalks) and cassava (peel and stalks). Six criteria were used in selecting the optimal sites, and include biomass residue distribution, settlement, road accessibility, nearness to waterline, slope and aspect. These criteria were incorporated into the ArcGIS platform through the weighted overlay tool. Strategically, the analysis presents seven sites for biomass plants to sustainably meet part of the energy needs. The efforts of the current work which supports not less than three SDGs-SDG 7 (Clean and Affordable Energy), SDG 12 (Responsible Consumption and Production) and SDG 13 (Climate Action), will assist policymakers in Nigeria to make appropriate policies within the climate change space.

The prevalence of malarial parasitaemia among blood donors in Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria.

BACKGROUND: Blood serves as a vehicle for transmission of blood-borne pathogens and transfusion-associated malaria is a major concern in malaria endemic countries. The study was conducted to determine the prevalence of malaria parasite among blood donors in Zaria, Nigeria. METHODS: A total of 160 venous blood samples were screened for malaria parasites using Giemsa-stained thick and thin blood films between June and August 2011. The ABO phenotypes were classified using a haemaglutination standard test. RESULTS: Of the 160 samples examined, 47 (29.4%) were infected. Plasmodium falciparum was the commonest species of Plasmodium detected in the study (80.5%: 38/47). The infection was significantly (p<0.05) detected more in female donors (43.8%: 7/16) than male donors (27.7%: 40/144) and was not associated with age. However the peak parasitaemia showed a bimodal distribution with donors in both age groups 26-35 and 36-45 having the highest prevalence (31%), while age group 18-25 had the lowest (25.7%: 9/35). Donors with blood group AB had the predominant infection rate (37.5%: 3/8) while blood group O had the least (26%: 25/94). Malaria parasite was detected with the highest prevalence at low (+) density (57.5%: 27/47). CONCLUSION: The present study showed a considerable prevalence of asymptomatic malaria, hence some risk of malarial transmission by the blood donors. Therefore, careful screening for malaria parasite is recommended to ensure safe blood. Positive samples should be indicated on blood packs and curative antimalarial drugs followed by prophylactic drugs should be given to all recipients of parasitized blood. Commercial donors should be freely given mosquito treated bed nets and be encouraged to sleep under them.

Reconstruction of the chest wall after excision of a giant malignant peripheral nerve sheath tumor.

Primary chest wall tumors are uncommon and constitute 0.2-2% of all tumors. Metastatic tumors and tumors of local extension are more common. Malignant peripheral nerve sheath tumor (MPNST) of the chest wall is even rarer and its incidence on the chest wall not stated in the literature. The incidence in the general population is 0.0001% while the risk is approximately 4600 times higher in patients with type I neurofibromatosis and 3-13% of them will finally develop into MPNST, usually after latent periods of 10-20 years. Clinically, these tumors are aggressive, locally invasive, and highly metastatic. Excision of giant chest wall tumor leaves a defect that is reconstructed using musculocutaneous flaps with or without a mesh. We report the case of a 24-year-old man who presented at the surgical outpatient clinic with 7 months history of persistent left sided chest pain minimally relieved by analgesics, 5 months of cough and worsening dyspnoea, and 3 months history of anterior chest swelling on the left side of the manubrium. Following evaluation and investigations, the tumor was excised and the residual defect closed with methylmetacrylate sandwiched between two prolene meshes and overlaid with both pectoralis major muscles. The histology of the excised mass revealed MPNST He made an uneventful postoperative recovery, but died barely 3 months later from widespread pulmonary metastases. A review of the literature revealed that such tumors hardly ever reach such large-size as in our case.

Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity.

UNLABELLED: Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity. METHOD: Case note of a patient managed for traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity was used with a review of relevant literature. SUMMARY: A 49-year old civil engineer who presented with 2-year history of easy fatigability and palpitations as well as a 6-month history of hypertension and was initially managed as a case dilated cardiomyopathy to rule out incipient CCF secondary to hypertension, was evaluated and found to have chronic diaphragmatic hernia through the central tendon with evisceration of the stomach and coils of the small bowel into the pericardial cavity. Though there was history of motor vehicle crash preceding the development of the symptoms, but the long history of effort dyspnoea and palpitations added to enlarged cardiac silhouette on posterior anterior chest x-ray, a diagnostic challenge was posed which was resolved by thoracoabdominal CT scan. Patient had left sided posteriorlateral thoracotomy via 7h intercostal space followed with reduction of thq stomach and coils of small bowel after careful adhesiolysis and repair of the defect in double layers. CONCLUSION: High index of suspicion is very important in the diagnosis of diaphragmatic central tendon injury considering the rarity of the injury and diagnostic challenges it poses in chronic form. However, where the facilities are available, CT scan and 2-D echo will most of the time clinch the diagnosis; also is upper gastrointestinal series.

Diversity of rotavirus VP7 and VP4 genotypes in Northwestern Nigeria.

BACKGROUND: Nigeria has recently been ranked third among the 10 countries with the greatest number of rotavirus disease-associated deaths per year. Estimates attribute up to 33,000 deaths annually to rotavirus disease in Nigerian children <5 years old. Although the introduction of the new oral, live attenuated rotavirus vaccines may not occur for another 4-6 years in developing countries, background data on burden of disease, cost of rotavirus disease, and characterization of circulating strains is required to hasten this introduction to children who would clearly benefit from the intervention. METHODS: Between July 2002 and July 2004, fecal specimens were collected from 869 infants and young children <5 years of age presenting with diarrhea in Kaduna, Kebbi, Sokoto, and Zamfara states in northwestern Nigeria. In addition, 194 control specimens were also collected from children matched for age. Specimens were screened for the presence of rotavirus antigens. Rotavirus-positive specimens were further analyzed to determine electropherotype, subgroup specificity, and G and P genotypes. RESULTS: Rotavirus was detected in 18% of children with diarrhea and 7.2% of the age-matched case control subjects. The highest rotavirus burden was detected in children aged <6 months. The majority of the rotavirus-positive specimens revealed viruses of long electropherotypes, subgroup II specificity, and G1P[8] genotypes. Furthermore, more than a quarter of specimens (37%) displayed mixed G and P genotypes, and almost a third could not be genotyped. CONCLUSIONS: The high numbers of mixed rotavirus infections highlight the multitude of enteric pathogens to which children in African countries are exposed. Data on circulating rotavirus strains serve to inform African government officials to the serious health threat posed by rotavirus in their respective countries and to document the diversity of strains before vaccine introduction.

Persistent Hypertension Up to One Year Postpartum among Women with Hypertensive Disorders in Pregnancy in a Low-Resource Setting: A Prospective Cohort Study.

Background: Hypertensive disorders in pregnancy (HDPs) are associated with lifelong cardiovascular disease risk. Persistent postpartum hypertension in HDPs could suggest progression to chronic hypertension. This phenomenon has not been well examined in low- and middle-income countries (LIMCs), and most previous follow-ups typically last for maximally six weeks postpartum. We assessed the prevalence of persistent hypertension up to one year in women with HDPs in a low resource setting and determined associated risk factors. Methodology: A prospective cohort study of women conducted at eight tertiary health care facilities in seven states of Nigeria. Four hundred and ten women with any HDP were enrolled within 24 hours of delivery and followed up at intervals until one year postpartum. Descriptive statistics were performed to express the participants' characteristics. Univariable and multivariable logistic regressions were conducted to identify associated risk factors. Results: Of the 410 women enrolled, 278 were followed up to one year after delivery (follow-up rate 68%). Among women diagnosed with gestational hypertension and pre-eclampsia/eclampsia, 22.3% (95% CI; 8.3-36.3) and 62.1% (95% CI; 52.5-71.9), respectively, had persistent hypertension at six months and this remained similar at one year 22.3% (95% CI; 5.6-54.4) and 61.2% (95% CI; 40.6-77.8). Maternal age and body mass index were significant risk factors for persistent hypertension at one year [aORs = 1.07/year (95% CI; 1.02-1.13) and 1.06/kg/m2 (95% CI; 1.01-1.10)], respectively. Conclusion: This study showed a substantial prevalence of persistent hypertension beyond puerperium. Health systems in LMICs need to be organized to anticipate and maintain postpartum monitoring until blood pressure is normalized, or women referred or discharged to family physicians as appropriate. In particular, attention should be given to women who are obese, and or of higher maternal age.

Metabolic syndrome following hypertensive disorders in pregnancy in a low-resource setting: A cohort study.

OBJECTIVES: Hypertensive disorders in pregnancy (HDPs) are associated with risk of future metabolic syndrome. Despite the huge burden of HDPs in sub-Saharan Africa, this association has not been adequately studied in this population. STUDY DESIGN: This was a prospective cohort study on pregnant women recruited between August 2017 - April 2018 and followed up to one year after their deliveries and evaluated for presence of metabolic syndrome at delivery, nine weeks, six months and one year. MAIN OUTCOME MEASURES: Prevalence of metabolic syndrome RESULTS: A total of 488 pregnant women were included: 410 and 78 with HDPs and normotensive, respectively. None of the normotensive had metabolic syndrome until one year (1.7% = 1 out of 59 observations), while among those with HDPs were 17.4% (71 of 407), 8.7% (23 of 263), 4.7% (11 of 232) and 6.1% (17 of 278), at delivery, nine weeks, six months and one year postpartum, respectively. High BMI and blood pressure were the drivers of metabolic syndrome in this population. The incidence rate in HDPs versus normotensive at one year were, respectively, 57.5/1000 persons' year (95%CI; 35.8 - 92.6) and 16.9/1000 persons' years (95%CI; 2.4-118.3), with incidence rate ratio of 3.4/1000 person's years. Only parity significantly predicted the presence of metabolic syndrome at one year [(aOR= 3.26/delivery (95%CI; 1.21-8.79)]. CONCLUSION: HDPs were associated with a higher incidence of metabolic syndrome up to one year postpartum. Women with HDPs should be routinely screened for metabolic syndrome within the first year postpartum to reduce cardiometabolic risks.

An Assessment of Ovarian Cancer Histotypes Across the African Diaspora.

OBJECTIVE: Ovarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. METHODS: Patients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at p<0.05. RESULTS: Nigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7± 12.8 years) relative to USB (58.9 ± 15.0) and CBB (59.0± 13.0,p<0.001). Black women [CBB (25.2 ± 15.0), Nigerians (29.5 ± 15.1), and USB (33.9 ± 17.9)] were diagnosed with GCT younger than White women (35.4 ± 20.5, p=0.011). Black women [Nigerians (47.5 ± 15.9), USB (50.9 ± 18.3) and CBB (50.9 ± 18.3)] were also diagnosed with SCST younger than White women (55.6 ± 16.5, p<0.01). CONCLUSION: There is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation.

Genomic characterization of human rotavirus G8 strains from the African rotavirus network: relationship to animal rotaviruses.

Global rotavirus surveillance has led to the detection of many unusual human rotavirus (HRV) genotypes. During 1996-2004 surveillance within the African Rotavirus Network (ARN), six P[8],G8 and two P[6],G8 human rotavirus strains were identified. Gene fragments (RT-PCR amplicons) of all 11-gene segments of these G8 strains were sequenced in order to elucidate their genetic and evolutionary relationships. Phylogenetic and sequence analyses of each gene segment revealed high similarities (88-100% nt and 91-100% aa) for all segments except for gene 4 encoding VP4 proteins P[8] and P[6]. For most strains, almost all of the genes of the ARN strains other than neutralizing antigens are related to typical human strains of Wa genogroup. The VP7, NSP2, and NSP5 genes were closely related to cognate genes of animal strains (83-99% and 97-99% aa identity). This study suggests that the ARN G8 strains might have arisen through VP7 or VP4 gene reassortment events since most of the other gene segments resemble those of common human rotaviruses. However, VP7, NSP2 (likely), and NSP5 (likely) genes are derived potentially from animals consistent with a zoonotic introduction. Although these findings help elucidate rotavirus evolution, sequence studies of cognate animal rotavirus genes are needed to conclusively determine the specific origin of those genes relative to both human and animal rotavirus strains.

Role of astrovirus in intussusception in Nigerian infants.

Intussusception (IS) is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. Viral infections, mostly adenovirus, enteroviruses, human herpesvirus and Epstein-Barr virus are reported in 20-50% of childhood cases of IS. Between January and July 2004, six stool specimens collected from infants 0- to 8-months old diagnosed and admitted for IS were investigated for the presence of rotavirus, astrovirus and adenovirus antigens. Astrovirus antigen was detected in three of the six stool specimens by enzyme immune assay (EIA) and confirmed in two specimens by reverse transcription-polymerase chain reaction (RT-PCR). Rotavirus, non-enteric adenovirus and astrovirus were detected by EIA, as mixed infections in a single specimen. The rotavirus strain revealed a SGI+II, mixed G1G2G8P[6] genotype and had no visible electrophoretic profile. A larger study is needed to determine the extent of involvement of astroviruses in IS in infants and the virus should be included in studies investigating the aetiology of IS.

Isolated testicular metastasis from prostatic adenocarcinoma.

Metastatic carcinomas to the testes are rare with prostate adenocarcinoma being the most common. Reported cases of metastatic carcinoma to the testes are usually associated with metastasis to other sites. Metastasis to the testis alone without associated secondaries to other sites can occur and so far, few cases have been reported globally. Due to the rarity of such presentation and the need for proper evaluation of orchiectomy specimens for prostatic adenocarcinoma, we report a case of an 84-year-old with isolated metastasis to the left testes. This was discovered incidentally the following orchiectomy as a form of hormonal therapy for prostatic adenocarcinoma.

Résumé Metastatic carcinomas to the testes are rare with prostate adenocarcinoma being the most common. Reported cases of metastatic carcinoma to the testes are usually associated with metastasis to other sites. Metastasis to the testis alone without associated secondaries to other sites can occur and so far, few cases have been reported globally. Due to the rarity of such presentation and the need for proper evaluation of orchiectomy specimens for prostatic adenocarcinoma, we report a case of an 84-year-old with isolated metastasis to the left testes. This was discovered incidentally the following orchiectomy as a form of hormonal therapy for prostatic adenocarcinoma.

Epidemiology of rotavirus infection in north-western Nigeria.

Rotaviruses (RV) are associated with approximately 33 000 deaths in children <5 years of age annually in Nigeria. However, limited data exit on RV infection in north-western Nigeria. During July 2002 to July 2004, 1063 (869 diarrhoeic and 194 control) stool samples were collected from children <5 years of age presenting with diarrhoea in north-western Nigeria. The stools were analysed for RV antigen and further characterized by antigenic and genomic methods. RV was detected in 18% of children with diarrhoea and 7.2% of the age-matched case controls. The highest RV burden was detected in children <6-months-old. Long electropherotypes and VP6 subgroup I + II specificity predominated.

Rotavirus infection in four states in north-western Nigeria.

BACKGROUND: Rotaviruses are associated with approximately 611,000 deaths worldwide and with 33,000 deaths in Nigeria in children < 5 years of age annually However, limited data exit on rotavirus (RV) infection in North-western Nigeria. This study surveyed RV infection in four states in Northwestern Nigeria. METHODS: During July 2002 to July 2004, 1063 (869 diarrhoeic and 194 control) stool samples were collected from children <5 years of age presenting with diarrhoea in clinics/hospitals in Kaduna, Kebbi, Sokoto and Zamfara States. The stools were analysed for RV antigen and the RV positive stools were further characterized by antigenic and genomic methods. RESULTS: Rotavirus was detected in 18% of children with diarrhoea and in 7.2% of the age-matched case controls. Rotavirus antigen was detected more frequently in Kaduna state (p > 0.05). The highest RV burden was detected in children aged below six months. The infection occurred throughout the study period. The most common clinical features associated with RV were fever (71%), vomiting (64.1%) and a combination of fever and vomiting (48.2%). Vomiting was strongly associated with RV (p < 0.01). There was a statistically significant association between food type and rotavirus infection (p < 0.05), with the highest prevalence occurring amongst children exclusively breast-fed. The majority of the RV positive samples revealed long electropherotypes and VP6 subgroup I+II specificity. CONCLUSION: Rotavirus was shown to be an important cause of diarrhoea in children 0-5 years of age in Northwestern Nigeria. An effective vaccine would therefore need to be administered at birth for children in the study area since there is no effective way to completely eliminate rotavirus infection other than vaccination. There is also a need for additional studies in Nigeria to provide data required to hasten vaccine introduction.

Epidemiology of rotavirus and astrovirus infections in children in northwestern Nigeria.

BACKGROUND: Recent estimates attribute 527,000 deaths in children less than five years of age to rotavirus diarrhea annually, with 145,000 occurring in sub-Saharan Africa. Human astroviruses have been identified as one of the most frequent causes of infantile diarrhea, second in incidence only to rotavirus. This study was conducted to determine the prevalence of rotavirus and astrovirus and also to establish the circulating strains of rotavirus in a community in Nigeria where most diarrheic patients do not visit clinics or health care centers. METHODS: A total of 154 stool samples (134 diarrheic and 20 non-diarrheic) were collected from infants and young children less than 5 years of age from January-March 2002. Samples were obtained by house-to-house visit in randomly selected districts in Zaria, Northwestern Nigeria. The samples were screened for rotavirus and astrovirus antigens using commercially available Enzyme Linked Immunosorbent Assay (ELISA) kits. All positive group A rotavirus samples were further subjected to VP6 sub-group ELISA, Polyacrylamide gel electrophoresis (PAGE) to determine their RNA electropherotypes and Reverse transcription polymerase chain reaction (RT-PCR) to determine their VP7 and VP4 genotypes. RESULTS: Rotavirus and astrovirus antigens were detected in 9% (12) and 5% (7) of the 134 diarrheic stool samples respectively. No viral antigen was detected in the non-diarrheic stools. Rotavirus infection was more common in younger children than astrovirus infection. VP6 sub-group II specificity (58.3%), long RNA electropherotypes (41.6%), VP7 genotype G1 (33.3%) and VP4 genotype P [6] (33.3%) were the most common strains in circulation at that time in the community. Of significance is the fact that a large proportion of the rotavirus strains in circulation could not be assigned either a VP6 subgroup or RNA electrophoretic pattern probably as a result of low viral load. CONCLUSION: In this community-based study, rotavirus and astrovirus were significantly associated with diarrhea. However, the prevalence of rotavirus infection among children appears to be low while that of astrovirus falls in the range seen in hospital-based studies around the continent.

Dry Gangrene in Children with Typhoid Intestinal Perforation: A Report of Two Cases.

Intestinal perforation is a life-threatening complication of typhoid fever commonly seen in developing countries, but extraintestinal complications are infrequently reported. We report herein two cases of gangrene seen in children managed for typhoid intestinal perforation, highlighting the challenges faced in their management.