Cord Blood Thyroid Stimulating Hormone Values in Healthy Term Babies delivered at Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Northeastern Nigeria

BACKGROUND

Congenital hypothyroidism is one of the most common preventable causes of mental retardation and clinical manifestations are often subtle or absent at birth and hence the need for screening. Implementation of newborn screening requires local normative values.

OBJECTIVES

To determine the normative values of cord Thyroid Stimulating Hormone (TSH) among term babies in Bauchi, Northeast Nigeria and compare it with that from other centers in Nigeria.

METHODOLOGY

Cord blood samples from 200 term babies were analyzed for TSH by Fluorescence Immunoassay technique in this descriptive cross-sectional study. A cut-off of >20 µIU/ml was used for recall. The mean and range were determined and compared with those of previous local studies using t-test. Impact of some maternal and infant factors on TSH was also assessed.

RESULTS

The overall mean (SD) cord TSH was 3.74 (±1.99) µIU/ ml and the range was 0.73 to 15.22 µIU/ml (2.5th to 97.5th centile) and none had TSH > 20 µIU/ml and hence our recall rate was 0%. The mean cord TSH was comparable to that reported by a lone local multicenter study (p = 0.120) but significantly different from that of 3 other local studies (p < 0.001). There was also no significant difference between the means of different gender, birth weight groups, mode of delivery, socio-economic classes, maternal age and parity.

CONCLUSION

The Cord blood TSH level of most term newborn in Bauchi, similar to other Nigerian studies, is < 10 µIU/ml with a few but significant percentage recording cord TSH level > 10 µIU/ml. Gender, birth weight, mode of delivery, socio-economic class, maternal age and parity were not significantly related to cord TSH level. The mean blood TSH values from different studies across the country tend to vary based on the assay technique. We recommend a nationwide multicenter study with a much larger sample size, lower cutoff value for recall and a unified sample processing laboratory if national normative values are to be developed.

Factors Associated with SARS-CoV-2 Infection in Physician Trainees in New York City during the First COVID-19 Wave

Occupational and non-occupational risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in healthcare workers (HCWs), but studies evaluating risk factors for infection among physician trainees are lacking. We aimed to identify sociodemographic, occupational, and community risk factors among physician trainees during the first wave of coronavirus disease 2019 (COVID-19) in New York City. In this retrospective study of 328 trainees at the Mount Sinai Health System in New York City, we administered a survey to assess risk factors for SARS-CoV-2 infection between 1 February and 30 June 2020. SARS-CoV-2 infection was determined by self-reported and laboratory-confirmed IgG antibody and reverse transcriptase-polymerase chain reaction test results. We used Bayesian generalized linear mixed effect regression to examine associations between hypothesized risk factors and infection odds. The cumulative incidence of infection was 20.1%. Assignment to medical-surgical units (OR, 2.51; 95% CI, 1.18-5.34), and training in emergency medicine, critical care, and anesthesiology (OR, 2.93; 95% CI, 1.24-6.92) were independently associated with infection. Caring for unfamiliar patient populations was protective (OR, 0.16; 95% CI, 0.03-0.73). Community factors were not statistically significantly associated with infection after adjustment for occupational factors. Our findings may inform tailored infection prevention strategies for physician trainees responding to the COVID-19 pandemic.

Vitamin D and bone mineral status of newborn-maternal pair delivering at a tertiary hospital in Nigeria

Background

Vitamin D plays a vital role in the maintenance of bone health. The fetuses and exclusively breastfed neonates depend on maternal vitamin D store to meet their need. Widespread vitamin D deficiency among pregnant women have been reported with adverse fetal outcome. Nigeria lacks guideline on Vitamin D supplementation in pregnancy and infancy due to the paucity of data. We thus determined serum vitamin D of delivering mothers and their offsprings and other indicators of bone mineral health.

Aims

This study aimed to determine serum Vitamin D and other indicators of bone mineral health of delivering mothers and their offspring.

Material and Method

A cross-sectional study of delivering mothers and their newborns recruited consecutively until the minimal sample size was reached. Relevant information was obtained on a questionnaire. Maternal and cord serum vitamin D, calcium, albumin, phosphate, and alkaline phosphatase were determined. Data management was done using SPSS version 16.0.

Results

Of the 84 newborn-mother pairs studied, 17 (20.2%) of the mothers were Vitamin D deficient and 23 (27.4%) insufficient. Seven (8.3%) of the mothers were hypocalcaemic and 3 (3.6%) hypophosphataemic, while 19 (22.6%) had elevated alkaline phosphatase. Only 15 (17.9%) of the neonates were vitamin D insufficient and none of them was vitamin D deficient, hypocalcaemic, hypophosphataemic nor had elevated alkaline phosphatase. There was strong positive correlation between cord and maternal blood vitamin D level (r = 0.740, P = < 0.001).

Conclusion

Vitamin D deficiency and insufficiency is high among pregnant women in Maiduguri while insufficiency is common among the neonates. We recommend vitamin D supplementation to pregnant women and newborns in Maiduguri.

Surgical timing for mitral valve regurgitation

Advances in diagnostic and surgical techniques in the management of mitral regurgitation have resulted in improved survival rates and clinical outcomes. Echocardiography is a valuable noninvasive diagnostic tool in the determination of the timing of surgical correction of mitral regurgitation. Improved surgical techniques, the growing role of mitral valve repair, low operative mortality rates, and improved long-term survival rates are important considerations for earlier surgical intervention in symptomatic patients and in asymptomatic patients with echocardiographic criteria of left ventricular dilatation. Intraoperative transesophageal echocardiography is very useful in mitral valve repair and valve replacement with preservation of chordal structures.

Fatal Hemoptysis during Coronary Thrombolysis

Cerebral hemorrhage is the most dreaded complication of coronary thrombolysis. Significant bleeding has also been described from catheter-entry sites, the retroperitoneum, and the gastrointestinal and genitourinary tracts. However, hemoptysis induced by thrombolysis has rarely been described in the literature. We present a 66-year-old male who received front-loaded tissue plasminogen activator (tPA) for acute transmural anterior wall myocardial infarction and developed massive hemoptysis from preexisting cavitary lung disease. The patient died within 5 hours. We believe this is the first case report of fatal hemoptysis induced by coronary thrombolysis. A history of cavitary lung disease may be a risk factor for life-threatening hemoptysis in patients receiving thrombolytic therapy.

Gender differences and practice implications of risk factors for frequent hospitalization for heart failure in an urban center serving predominantly African-American patients

To identify the clinical correlates of recurrent heart failure hospitalization in a large urban hospital serving predominately African-American patients, and to provide further insight into modifiable risks for heart failure readmissions, a retrospective period prevalence review of the records of all adult patients admitted with a primary diagnosis of heart failure (International Classification of Diseases-9 code 428.0) between January and December 1995 was performed. The main outcome was the number of heart failure hospitalizations over 12 months. Twelve hundred patients were identified. Mean age was 64 +/- 16 years, 94% were black, 57% were women, and 40% were > or = 65 years old. Ninety-eight percent had a history of systemic hypertension and 55% had uncontrolled hypertension. Other comorbidities were left ventricular (LV) hypertrophy (64%), coronary artery disease (52%), and tobacco abuse (28%). Sixty-five percent of patients were on angiotensin-converting enzyme (ACE) inhibitors, 51% on calcium antagonists, and 8% on beta blockers. Most patients had suboptimal dosing of ACE inhibitors and there was inappropriate use of calcium antagonists in 56% of patients with moderate or severe systolic dysfunction. Diabetes mellitus and echocardiographic wall motion abnormality were independently associated with frequent admissions for women but not for men. Medication-related increase in heart failure hospitalization was seen for calcium antagonists in patients with severe LV dysfunction (odds ratio 2.24, 95% confidence intervals 1.0 to 5.03; p <0.03). Uncontrolled hypertension, underdosing of ACE inhibitors, and overuse of calcium antagonists in patients with significant LV dysfunction are potential targets for intervention.

Transient autonomic neuropathy in an adolescent with insulin dependent diabetes mellitus

A 15 year-old girl with insulin dependent diabetes mellitus of 11 years duration developed severe neuropathy involving the bladder and stomach. The bladder recovered after 2 months of intermittent catheterization. Metoclopramide relieved the gastric symptoms. Gastric emptying was normal after 2 further months of treatment. The neuropathy developed in spite of a mean HbA1c of 7.4% suggesting that factors in addition to glycemic control play a role in the development of the complications of insulin dependent diabetes mellitus.