Sexual Maturation of Female Adolescent Patients with Sickle Cell Anaemia in Lagos, Nigeria

BACKGROUND

Sickle cell anaemia (SCA) has been shown to have adverse effects on growth and sexual development. Recent Nigerian studies have reported a declining trend in the age of sexual maturation and menarche in haemoglobin AA (HbAA) individuals.

OBJECTIVE

To evaluate the sexual maturation of female patients with SCA aged 10 to 19 years seen at Lagos University Teaching Hospital Idi-Araba, Lagos and Sickle Cell Foundation.

METHODS

It was a cross-sectional study involving 140 girls with SCA (subjects) and an equal number of girls with HbAA (controls) who were matched for age and socio-economic class over a fivemonth period. The evaluation involved anthropometry, calculation of BMI and determination of breast and pubic hair development using Tanner staging.

RESULTS

The mean BMI for the subjects was 17.2±2.39 kg/m2and 20.2±3.09 kg/m2 for the controls (p < 0.001). The mean age at onset of breast development (B2) was 13 ± 0.39 years in the subjects and 10.5 ± 0.51 years in the controls (p < 0.001). The corresponding mean age for pubic hair development (PH2) was also higher at 13.8 ± 0.59 years for the girls with SCA and 10.4 ± 0.51 years for the controls (p <0.001), while menarche was achieved in the subjects at 14.7 ± 1.68 years and in the controls at 12.3 ± 1.33 years (p < 0.001). Upper socioeconomic class was associated with earlier menarche and faster transition from pre-pubertal stage to pubertal stage of sexual maturation in the controls but was not observed in the SCA subjects.

CONCLUSION

Sexual maturity in patients with SCA lagged behind those of the HbAA controls.

A 5-year multidisciplinary care outcomes in children with wilms' tumour managed at a tertiary centre: A retrospective observational study

BACKGROUND

Over the last two decades, there has been significant improvement in the outcomes of children with Wilms' tumour (WT) in high income countries (HICs) with approximately 85% survival rate globally. This is partly attributable to a multi-disciplinary team approach to care and the evolution of more robust treatment measures. A previous review in our centre prior to multi-disciplinary team shows a survival rate of 31.48%, However, the survival rates from low- and middle-income countries are still low when compared to HICs due to delays in access to care at all levels, poor to non-existent health insurance coverage, limited workforce resources, weak health-care systems and infrastructure. The aim of this study is to determine the impact of a multi-disciplinary team approach on the treatment outcomes of children with WT.

METHODOLOGY

This is a 5-year retrospective review of all patients managed with WT at the Lagos University Teaching Hospital, Lagos, Nigeria. Information was extracted from the patients' case notes, operation notes and ward admission records. The data were analysed with SPSS 25, and P < 0.05 was considered to be statistically significant.

RESULTS

Forty patients were included in the study; male to female ratio was 1.6:1. The disease occurred in the right kidney in 23 patients (57.5%) and on the left in 17 patients (42.5%). The average duration of symptoms before presentation was 3.6 months (range 1-7 months), majority of patients presented with abdominal masses and were assessed as per unit protocol with abdominal Computerized tomography scan, chest X-ray and abdominal ultrasound scan to assign the patient International Society of Paediatric oncology regimen. The predominant stage at surgery was Stage III 26 (65%), while Stage IV was 9 (22.5%). Morbidity after chemotherapy was 10 (25%). Twenty-five patients (63%) completed chemotherapy while 15 patients (37%) started chemotherapy but defaulted midway. The 5-year survival rate was 75%. Increasing age and male sex were associated with reduced odds of mortality; however, this was not statistically significant. Increased duration of treatment, being treated with chemotherapy alone, as well as advanced tumour stage and histology were associated with increased odds of mortality, however, this was not statistically significant.

CONCLUSION

The development of an institutional WT treatment pathway involving a multidisciplinary team has resulted in improved outcomes. There is need for increased community awareness to improve the time to presentation.

Blood pressure, hematologic and biochemical changes following L-arginine supplementation in children with sickle cell anaemia already on hydroxyurea therapy

Hydroxyurea is an approved therapy in the management of children suffering from sickle cell disease (SCD). In adults co-administration of hydroxyurea and L-Arginine in adult sufferers of SCD had shown some benefits. This study examined the effect of co-administration of hydroxyurea (15-35mg/kg/day) and L-Arginine (500 mg/day) for 6 weeks on blood pressure, haematological parameters, liver and antioxidant enzymes levels. The levels of these parameters when the subjects were on hydroxyurea alone were taken as control values. Results showed that the combined therapy (HU + L-Arginine) decreased SBP, DBP, MAP and PP (p <0.01 in each case) but increased %HbF, Hb and PCV (p< o.001 in each case). It elevated CAT, SOD, GPX (p < 0.001 in each case) but depressed MDA, AST, ALT and ALP (p < 0.001 in each case). The study shows that L-Arginine used as an adjunct to hydroxyurea therapy may be beneficial to children suffering from sickle cell anaemia.

Pulmonary hypertension among 5 to 18 year old children with sickle cell anaemia in Nigeria

BACKGROUND

Pulmonary hypertension (PHT) is a significant cause of mortality in patients with sickle cell disease (SCD). Few studies on PHT in SCD have been carried out in children. This study aimed to estimate the prevalence of PHT in children with sickle cell anaemia (SCA) and determine its clinical and laboratory correlates.

METHODS

In this cross sectional study, evaluation involved obtaining bio-data, history and physical examination findings in 175 SCA subjects with haemoglobin genotype SS aged 5 to 18 years and 175 age and sex matched controls with haemoglobin genotype AA. PHT was determined using peak Tricuspid Regurgitant Velocity (TRV) obtained from echocardiography as a marker. Complete blood count (CBC), lactate dehydrogenase (LDH) assay, reticulocyte count, foetal haemoglobin (HbF) estimation as well as Human Immunodeficiency Virus (HIV) I and II, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) screening were done for patients with SCA.

RESULTS

The mean peak TRV of subjects with SCA and controls was 2.2 ± 0.4 m/s and 1.9 ± 0.3 m/s respectively and prevalence of PHT among children with SCA and controls was 22.9% and 2.3% respectively. PHT in SCA correlated negatively with body mass index, haematocrit and haemoglobin.

CONCLUSION

This study affirms that PHT prevalence is high in children with SCA in Nigeria. Cardiovascular examination for signs of PHT is recommended for children with SCA and if required, further echocardiographic assessment from as early as five years.

Prevalence of Skin Diseases in Children with Human Immunodeficiency Syndrome Infection in Paediatric HIV Clinic of A Tertiary Hospital in Nigeria

BACKGROUND

HIV infection/AIDS being a multi-systemic disease affects the skin at various stages in course of the illness. A knowledge of the common skin diseases associated with HIV infection can lead to early detection, appropriate staging and commencement of appropriate care in the infected patients.

OBJECTIVE

The study was to document the prevalence and pattern of skin diseases in children with HIV infection seen at the Paediatric department of a tertiary centre in Nigeria.

METHODS

HIV positive children attending the PEPFAR HIV clinic of Lagos University Teaching Hospital, Nigeria were examined for the presence of skin lesions. Anthropometric measurements were also obtained. Blood samples Were taken for CD4+ cell count, viral load and full blood count.

RESULTS

Two hundred and fourteen (214) patients were studied, consisting of 107 HIV infected children and 107 uninfected children as controls. Skin lesions were observed in 89 (83%) of the HIV infected patients, while only 72 uninfected controls had skin lesions. (p = 0.035). The predominant skin disease in the HIV infected children was Pruritic papular eruption (PPE) with a frequency of 25.9%, followed by fungal infections (24.6%). Herpes zoster was found only in HIV infected children (p = 0.041). There was a strong correlation between the degree of immunosuppression (as reflected by the value of age dependent CD4+ cell count/CD4+ percentage). and the prevalence of skin disease in the HIV infected patients. The presence of pruritic papular eruptions and Herpes zoster was associated with advanced immunosuppression.

CONCLUSION

Skin diseases are common in HIV infection in our environment. Early detection of HIV infection can be made in the presence of skin diseases like Pruritic papular eruption and Herpes zoster.

Immune Suppression and Oral Manifestations of HIV in a Group of Nigerian Children

BACKGROUND

Oral manifestations are common in HIV positive children and have been reported as possible predictors of HIV disease progression. This study assessed the prevalence of oral manifestations of HIV/AIDS and its association with immune suppression in a group of HIV positive Nigerian children.

STUDY DESIGN

One hundred and twelve HIV positive children were examined for oral manifestations of HIV. The manifestations were compared with CDC Immune suppression categories using age specific CD4 lymphocyte counts.

RESULTS

A total of 85 (76%) children had oral lesions. Oral candidiasis (65.2%) and parotid gland swelling (33%) were the most common lesions. Presence of oral lesions was significantly associated with declining immune status, p<0.05.

CONCLUSION

The presence of oral lesions was significantly associated with lower immune status.

Potential drug-drug interactions in HIV-infected children on antiretroviral therapy in Lagos, Nigeria

Background

Multi-therapy is common in HIV-infected children, and the risk for clinically significant drug interactions (CSDIs) is high. We investigated the prevalence of CSDIs between antiretroviral (ARV) and co-prescribed drugs for children attending a large HIV clinic in Lagos, Nigeria.

Methods

The case files of pediatric patients receiving treatment at the HIV clinic of the Lagos University Teaching Hospital (LUTH), Idi-Araba, between January 2005 and December 2010 were reviewed. The ARV and co-prescribed drug pairs were evaluated for potential interactions using the Liverpool HIV Pharmacology Group website. The potential interactions were rated as A (no known interaction), B (minor/no action needed), C (moderate/monitor therapy), D (major/therapy modification), and X (contraindicated/avoid combination).

Results

Of the 310 cases reviewed, 208 (67.1%) patients were at risk of CSDIs. Artemisinin-based combination therapy was prescribed for over one-half of the patients, accounting for 40% of the CSDIs. Excluding this drug class, the prevalence of CSDIs reduced from 67.1% to 18.7% in 58 patients. Most of the CSDIs (579; 97.2%) were moderately significant and frequently involved nevirapine and fluconazole (58; 9.7%), zidovudine and fluconazole (55; 9.2%), zidovudine and rifampicin (35; 5.9%), and nevirapine and prednisolone (31; 5.2%). Age (P=0.392), sex (P=0.783), and moderate (P=0.632) or severe (P=0.755) malnutrition were not associated with risk for CSDIs.

Conclusion

There is a tendency for CSDIs between ARV and co-prescribed drugs among the group of children evaluated in this study. Measures are necessary to prevent important drug interactions and to manage those that are unavoidable.

Haematological abnormalities associated with paediatric HIV/AIDS in Lagos

INTRODUCTION

In HIV-1-infected children, haematological disturbances include bone marrow abnormalities and peripheral cytopenias. All three major cell lineages can be depressed.

METHODS

A cross-sectional study of baseline haematological parameters was undertaken in 68 children with confirmed HIV infection. In all cases, a complete blood count was done and some had CD4+ counts and HIV RNA PCR. The CD4+ count was analysed by the Coulter manual latex particle monoclonal antibody method and HIV RNA PCR by Roche Amplicor Monitor, version 1.5.

RESULTS

Anaemia (< 100 g/L) was present in 77.9%, severe (< 60 g/L) in 5.9%, moderate (60-70 g/L) in 32.3% and mild (80-99 g/L) in 39.7%. The mean haemoglobin concentration decreased as disease progressed (p < 0.05); 6% had leucopenia, 17.5% had neutropenia and 2.5% (one case) had thrombocytopenia; also, the four (6%) subjects with leucopenia were in clinical stages B and C. Neutropenia, lymphocytopenia and thrombocytopenia were seen more in clinical stages B and C, though this relationship was not statistically significant.

CONCLUSION

Both the erythroid and other cells lines are affected by HIV/AIDS and other associated factors. Anaemia is the most common haematological abnormality. The severity of peripheral cytopenias is related to the disease burden.

Haemoglobin and ferritin concentrations in cord blood in a tertiary health centre in Nigeria

BACKGROUND

Haemoglobin(Hb) and serum ferritin (SF) concentrations of cord blood of babies born at term at the Lagos State University Teaching Hospital, Maternity Centre (Ayinke House), Ikeja in the South-Western part of Nigeria were determined to establish mean values for these substances in our locality.

OBJECTIVES

To establish the mean values for haemoglobin and serum ferritin concentrations of cord blood of babies born at term in our environment and to determine the prevalence of foetal anaemia and low iron store in cord blood in our locality.

METHODS

Haemoglobin and ferritin levels in cord blood of 142 newborns were determined. Two millilitres of blood was collected from the cord of each newborn into EDTA bottle for complete blood count analysis and another 2mls into a plain bottle for serum ferritin assay. Cut-off values for cord blood Hb and serum ferritin concentrations were 12.5g/dL and 60 microg/L respectively.

RESULTS

The mean Hb and ferritin values were 13.024 +/- 2.41 g/dL and 70.85 +/- 97.07 microg/dL respectively. The prevalence of foetal anaemia is 32.4 %. About 59.2% of full term newborns had low iron store. Birth weight was significantly associated with Hb concentration (p=0.039) and apga sscore (p=0.002).

CONCLUSION

The prevalence of foetal anaemia was 32.4%. More than half (59.2%) of the newborns had low cord blood serum ferritin.

Orofacial and dental injuries associated with seizures in paediatric patients in Lagos University Teaching Hospital

OBJECTIVE

To determine the prevalence and pattern of presentation of orofacial and dental injuries in children with seizures at the Children's Emergency Unit of the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria.

METHODS

This was a prospective study of children with febrile or non-febrile convulsion who presented at the Children's Emergency Unit of LUTH between July 2008 and August 2009. The age, gender, type of convulsion and the presence/absence of orofacial and other bodily injuries were recorded in a proforma. Mechanism, type and classification of injury were recorded for patients with orofacial injuries.

RESULTS

A total of 257 children (148 males and 109 females) with febrile/non-febrile convulsion were included in the analysis. The mean age (SD) of patients was 32.8 ± 40.5 months. There were 223 (86.8%) cases of febrile convulsion and 34 (13.3%) cases of non-febrile convulsion. Thirteen children sustained orofacial injuries giving a prevalence of 5.1%. There was no significant difference in the prevalence of orofacial injury between patients with febrile convulsion (4.5%) and those with non-febrile convulsion (8.8%) (P=0.282). The most common cause of orofacial injuries was forceful insertion of hard object into the mouth during convulsive episodes. Twelve (92.3%) patients sustained soft tissue injury, while one sustained both soft and hard tissue injuries. The most common site of injury was the lip.

CONCLUSIONS

Oro-facial and dental injuries may occur in children with seizures. It is therefore important that these injuries be looked for by the paediatrician and the dentist/oral and maxillofacial surgeons should be involved in managing these children.

Dental caries status of HIV infected children in Nigeria

BACKGROUND

HIV positive children may be prone to developing Dental Caries due to prolonged and frequent use of sucrose containing medications and poor feeding practices.

OBJECTIVE

To determine the caries status of primary and permanent dentition in HIV positive Nigerian children using dmft/DMFT indices.

METHODS

One hundred and twelve HIV positive children aged 4 months to 13 years attending two dedicated HIV outpatient clinics were examined for dental caries of primary and permanent dentition using the WHO criteria. Carious lesions were recorded using the dmft and DMFT indices in the primary and permanent dentition respectively.

RESULTS

Forty four [39.3%] of the 112 children examined had dental caries mainly in the primary dentition in 96.7% of the cases. Mean dmft was 1.15 +/- 1.88, mean DMFT was 0.17 +/- 0.57. Dental caries was not significantly associated with the immune status of HIV positive children; chi2 = 2.58, P = 0.275.

CONCLUSIONS

Dental caries experience in the primary dentition of these HIV positive children was greater than in the Nigerian paediatric population. Dental caries prevalence in these HIV positive children although lower than that seen in developed countries was however higher than in other reports of healthy Nigerian children. There was no significant association between dental caries and immune status of HIV positive children.

Prevalence of proteinuria among HIV-infected children attending a tertiary hospital in Lagos, Nigeria

Sub-Saharan Africa is the epicentre of the HIV pandemic but there are few reports of HIV-related kidney diseases in children in this region. This study aimed to determine the prevalence of proteinuria in HIV-infected children at the Lagos University Teaching Hospital. Proteinuria was determined using urine protein-creatinine ratio. CD4+ cell count was determined for all the HIV-infected children. The mean age of the HIV-infected children was 74.4 +/- 35.6 months with a male: female ratio of 3:2. Compared with 6% of the 50 controls 20.5% of the 88 HIV-infected children had proteinuria (p = 0.026). Of 20 children with advanced clinical stage 40% had proteinuria compared with 14.7% of 68 children with milder stage (p = 0.004). Similarly, proteinuria was commoner among those with severe immunosuppression (p = 0.014). HAART use was not associated with significant difference in proteinuria prevalence (p = 0.491). Proteinuria was frequent among HIV-infected children, especially among those with advanced disease.

Kidney function of HIV-infected children in Lagos, Nigeria: using Filler's serum cystatin C-based formula

Background

Limited data is available on kidney function in HIV-infected children in sub-Saharan Africa. In addition, malnutrition in these children further reduces the utility of diagnostic methods such as creatinine-based estimates of glomerular filtration rate. We determined the serum cystatin C level and estimated glomerular filtration rate of 60 antiretroviral-naïve, HIV-infected children and 60 apparently healthy age and sex matched children.

Methods

Serum cystatin C level was measured using enzyme-linked immunosorbent assay technique, while glomerular filtration rate was estimated using Filler's serum cystatin C formula. Student t test, Mann Whitney U test, Pearson chi square and Fisher's exact test were used, where appropriate, to test difference between groups.

Results

Compared to the controls, the HIV-infected group had significantly higher median (interquartile range) serum cystatin C levels {0.77 (0.29) mg/l versus 0.66 (0.20) mg/l; p = 0.025} and a higher proportion of children with serum cystatin C level >1 mg/l {10 (16.7%) versus one (1.7%); p = 0.004}. The HIV-infected children had a mean (± SD) eGFR of 96.8 (± 36.1) ml/min/1.73 m² compared with 110.5 (± 27.8) ml/min/1.73 m² in the controls (p = 0.021). After controlling for age, sex and body mass index, only the study group (HIV infected versus control) remained a significant predictor of serum cystatin C level (β = -0.216, p = 0.021). The proportion of HIV-infected children with eGFR <60 ml/min/1.73 m² was eight (13.3%) versus none (0%) in the control group (p = 0.006). However, the serum cystatin C level, eGFR and proportions of children with serum cystatin C level >1 mg/l and eGFR <60 ml/min/1.73 m² were not significantly different between the HIV-infected children with advanced disease and those with milder disease.

Conclusions

HIV-infected children in Nigeria have higher serum cystatin C level and lower eGFR compared to age and sex matched controls.

Anthropometric indices of infants born to HIV-1-infected mothers: a prospective cohort study in Lagos, Nigeria

Numerous studies have reported that HIV-infected pregnant women are at increased risk of delivery of low birth weight (LBW) infants, of preterm deliveries and of intrauterine growth restriction. The objective of the study was to determine the effect of maternal HIV infection on the anthropometric characteristics of the babies at birth. A prospective study was carried out at the Lagos University Teaching Hospital, Nigeria. There were three times more LBW babies in the HIV-positive group than in the uninfected mothers (odds ratio = 3.47, 95% confidence interval = 1.69, 7.27; chi(2) = 12.99, P = 0.0003).The maternal weight (t = 15.85; P = 0.0001), maternal body mass index (BMI) (t = 15.07; P = 0.0003), birth weight of infants (t = 27.17; P = 0.0001) and birth length (t = 31.20; P = 0.001) were significantly less in HIV-positive mothers than in controls. In conclusion, poor maternal bodyweight and low BMI are significant contributors to LBW in HIV-infected women. Nutritional counselling, dietary intake and weight monitoring during pregnancy should be emphasized to improve pregnancy outcome in HIV-infected women.

Severe idiosyncratic drug reaction (Lyells syndrome) after ingesting dihydroartemisinin

Lyells syndrome also called Toxic epidermal necrolysis is the extreme form of idiosyncratic drug reaction that is called Steven Johnsons Syndrome: The condition results in an extensive loss of the skin with mucous membrane involvement. Lyells syndrome has been induced by many agents. The commonest agent in the literature being sulphonamides. However, in our search of the medical literature there was no report of dihydroarthemisinin as a cause of Lyells syndrome. We report three patients seen at two tertiary health institutions with Lyells syndrome after treatment for malaria with dihydroarthemisinin. This resulted from administration of dihydroarthemisinin with chloroquine in two patients and dihydroarthemisinin with Amodiaquine in one patient. The first patient was a seven year old child who developed 90% cutaneous involvement and died from hemorrhagic shock. The second was a 28 old female that developed a 76% body surface involvement and died from septicemia. The third patient was a pregnant 37 year old woman that developed 52% body involvement and died from septic shock. In these patients the earliest symptoms were not recognized and there was considerable delay before referral. In view of the recent WHO recommendation ofArthemisinin Combination Treatment (ACT) for malaria, we expect more cases of Steven Johnson Syndrome and Lyells syndrome from ACT treatment. The aim of this report is to raise the awareness of clinicians to this potentially fatal complication.

Effect of antiretroviral therapy on asymptomatic malaria parasitaemia in HIV-1 infected children

OBJECTIVE

To investigate the effect of antiretroviral ARV) therapy on the level of asymptomatic malaria parasitaemia in HIV-1 infected children.

METHODS

Sixty-six HIV infected children had blood films prepared for malaria parasite identification and count. Mean parasite densities were compared across clinical stages and immunologic categories of disease and antiretroviral treatment status.

RESULTS

Forty-five (68%) were less than 6 years old and 50 (75.7%) had advanced HIV disease. Twenty seven (41%) were on antiretroviral therapy. The prevalence of ASMP in the treated and untreated group was 44.4% and 15.4% respectively (p<0.01). The mean parasite density in the ARV treatment group was also significantly higher than in the untreated group (p=0.0071).

CONCLUSIONS

ARV therapy seems to be associated with higher rates of ASMP and higher mean parasite counts.

Neurological complications of sickle cell anemia in Nigerian Africans--a case-control study

PURPOSE

To determine the neurological complications associated with sickle cell anaemia (SCA) in Nigerians and evaluate the relative frequencies.

METHODOLOGY

Six-hundred-thirteen patients with SCA attending outpatient clinics of Lagos University Teaching Hospital and 616 control subjects were evaluated using a uniform structured questionnaire to determine the occurrence of neurological complications. The relative frequencies of neurological abnormalities in patients and controls were compared.

RESULTS

Neurological abnormalities occurred in a significantly higher percentage of patients (76%) compared to controls (32.1%). Among children, these abnormalities included stroke, febrile seizures and headache. Among adolescents and adults, the abnormalities included paraplegia, epileptic seizures and localized sensory neuropathy. Headache occurred in a significantly higher percentage in children and adolescents compared to controls, but not in adults.

CONCLUSIONS

We conclude that SCA is associated with neurological complications: stroke and febrile seizures in children, epileptic seizures, paraplegia and localized sensory neuropathy in adolescents and adults, headache in children and adolescents. Detailed studies of each of these complications would be required to provide further insight into their significance.

Effect of antiretroviral therapy on asymptomatic malaria parasitaemia in HIV-1 infected children

OBJECTIVE

To investigate the effect of antiretroviral (ARV) therapy on the level of asymptomatic malaria parasitaemia in HIV-1 infected children.

METHODS

Sixty-six HIV infected children had blood films prepared for malaria parasite identification and count. Mean parasite densities were compared across clinical stages and immunologic categories of disease and antiretroviral treatment status.

RESULTS

Forty-five (68%) were less than 6 years old and 50 (75.7%) had advanced HIV disease. Twenty seven (41%) were on antiretroviral therapy. The prevalence of ASMP in the treated and untreated group was 44.4% and 15.4% respectively (p<0.01). The mean parasite density in the ARV treatment group was also significantly higher than in the untreated group (p=0.0071).

CONCLUSIONS

ARV therapy seems to be associated with higher rates of ASMP and higher mean parasite counts.

Maternal HIV infection and intrauterine growth: a prospective study in Lagos, Nigeria

BACKGROUND

Low birth weight (LBW) is the most important cause of perinatal mortality and morbidity worldwide and particularly so in developing countries. Maternal HIV (Human Immunodeficiency Virus) infection has been identified as one of the risk factors to the development of low birth weight babies.

OBJECTIVE

To evaluate the effect of maternal HIV infection on the birth weight of the newborn at tertiary hospital in West Africa.

METHODS

The anthropometry of all HIV seropositive women who delivered in LUTH as well as that of their babies was determined using standard methods. Controls consisted of HIV seronegative women and their babies matched for age and parity with the above subjects.

RESULTS

There were a total of 262 subjects of whom 132 (50.4%) were HIV seropositive and 130 (49.6%) were HIV seronegative controls. There were five times more low birth weight (LBW) infants in the HIV seropositive group than in the controls (OR 5.77, CI=2.19-16.80; p=0.000075). The mean maternal body mass index, BMI (p=0.0003), mean maternal weight (p=0.0004) and mean birth weight of newborns (p=0.0002) were significantly lower in the HIV seropositive group than in the controls. Maternal weight and gestational age were significantly associated with low birth weight (OR 15.3, CI=2.6-316.0; p=0.002) and (OR 3.78, CI=1.37-10.9; p=0.007) respectively.

CONCLUSION

Maternal HIV infection is strongly associated with low maternal BMI and low birth weight in their offspring.

Constraints and prospects in the management of pediatric HIV/AIDS

BACKGROUND

Pediatric HIV/AIDS is increasing in Nigeria through mother-to-child transmission. Lack of diagnostic facility and affordability of therapy are major constraints. These factors were examined in Lagos University Teaching Hospital (LUTH) between 1996 and 2002.

MATERIALS AND METHODS

Case records of pediatric HIV/AIDS patients were examined for age, sex, mode of diagnosis, associated illnesses, treatment outcome and socioeconomic and HIV status of the parents.

RESULTS

Out of 124 cases confirmed to have HIV/AIDS, 56.5% were aged <18 months and 89.5% had > or =4 clinical features at presentation. There was an increasing trend in the number of cases from 1996 to 2002. Diagnosis was by WHO clinical criteria as no polymerase chain reaction (PCR), was done and only 12.1% had CD4+ count done. The commonest associated illness was tuberculosis (25.8%). Only 20.2% were placed on antiretroviral drugs during the period. Mothers were significantly younger than fathers (P<0.05) and were more likely to be HIV positive. High rate of discharges against medical advice and default from follow-up occurred.

CONCLUSION

Pediatric HIV/AIDS is on the increase at LUTH, and mothers were more HIV infected than fathers. The prohibitive cost of drugs prevented most patients from receiving therapy.

Serum magnesium, phosphate and calcium in Nigerian children with sickle cell disease

BACKGROUND

Biochemical abnormalities have been associated with sickle cell disease. Studies on phosphorus and magnesium in sickle cell disease have been conflicting. There is paucity of information on the role of these ions in the pathogenesis and management of sickle cell disease. This study was set out to determine the serum levels of magnesium, phosphorus and calcium in Nigerian children with sickle cell disease.

STUDY DESIGN

A case-control study carried out on children with HbSS genotype (cases) and age-matched controls with HbAA. Serum magnesium, calcium, phosphorus and albumin were measured using colorimetric methods.

RESULTS

Eighty-six subjects and forty-five controls were studied. The mean serum magnesium was 0.99mmol/L (0.02) and 0.98mmol/L (0.02) in the cases and controls respectively. The difference was not significant. Mean serum calcium was significantly lower in the cases [2.1mmol/L (0.3)] compared with the controls [2.3mmol/ L (0.15)]; p<0.01. Serum phosphorus was significantly higher in the cases than in the controls [2.2mmol/L (0.7) versus (1.5mmol/L (0.6); p<0.001]. There was no statistical difference in the albumin binding of calcium in both groups. A positive correlation existed between serum phosphorus and magnesium and also between serum calcium and magnesium in the cases group but no correlation between these parameters and age was found.

CONCLUSION

Children with sickle cell anaemia in this study had normo-magnesaemia, hyperphosphataemia and hypocalcaemia. Further studies on changes in intracellular concentrations of these ions in children with sickle cell disease are required. Such findings could be useful in designing better management in individuals with this abnormality.

Clinical evaluation of extract of Cajanus cajan (Ciklavit) in sickle cell anaemia

The major pathology in sickle cell anaemia (SCA) is sickling of red cells due to the precipitation of reduced haemoglobin. We report our experience with extract of Cajanus cajan as a possible antisickling agent by determining changes, if any, in clinical and laboratory features of the disease in patients given the extract in a single-blind placebo-controlled study. One hundred patients with steady-state SCA were randomized into treatment and placebo arms. The extract/placebo were administered twice daily to the subjects. Weight, hepatosplenomegaly, blood levels of biliurubin, urea, creatinine, and packed cell volume (PCV) were monitored over a 6-month period. Recall episodes of pain 6 months before enrolment were compared with episodes of pains recorded during the treatment period. Twenty-six cases (55.3 per cent) had hepatomegaly on enrolment. This significantly reduced to 33.3 per cent at 6 months (p = 0.03); but increased in the placebo arm (p > 0.05). The total number of recall painful episodes in cases was 207 (mean 4.4 +/- 10.3 (SD), range 0-60) and fell to 191 (mean 4.2 +/- 4.4 (SD), range 0-16); p = 0.03. Episodes of pain increased from 109 in controls (mean 2.6 +/- 5.0 (SD), range 0-26) to 164 (mean 3.9 +/- 4.3 (SD), range 0-22); p = 0.01. Mean PCV in the cases showed no appreciable changes (p = 0.1) but there was a significant increase in the controls (p = 0.02). In conclusion, the extract may cause a reduction of painful crises and may ameliorate the adverse effects of sickle cell anaemia on the liver. The mechanism of action remains to be determined.

Changes in erythrocytes following supplementation with alpha-tocopherol in children suffering from sickle cell anaemia

INTRODUCTION

Low plasma vitamin E level in children with sickle cell anaemia has been related to elevated level of irreversibly sickled cells which has been implicated in the pathogenesis of painful crisis. In adult patients supplementation with alpha-tocopherol has been shown to reduce irreversibly sickled cell count. In-addition, vitamin E supplementation increases resting forearm blood flow and reduces forearm vascular resistance in adult sickle cell anaemia sufferers.

AIM

The aim of the study was to examine the effects of supplementation with alpha-tocopherol on arterial blood pressure, some haematological parameters and osmotic fragility in children suffering from sickle cell anaemia.

METHODOLOGY

The effects of supplementation with alpha-tocopherol (100 mg. per day for 6 weeks) on packed cell volume (PCV) haemoglobin concentration ([Hb]), mean corpuscular haemoglobin concentration (MCHC), per cent foetal haemoglobin (% HbF), per cent irreversibly sickled cells (%ISC), erythrocyte osmotic fragility and blood pressure have been assessed in ten (10) children suffering from sickle cell anaemia. Their ages ranged from 4.0 to 10.0 years.

RESULTS

Supplementation with alpha-tocopherol significantly increased packed cell volume (p<0.001), haemoglobin concentration (p<0.01) and per cent foetal haemoglobin (p<0.001), but significantly reduced mean corpuscular haemoglobin concentration (p<0.01) and per cent irreversibly sickled cells (p<0.001). alpha-Tocopherol also increased the resistance of the cells to lysis. Supplementation with alpha-tocopherol had little or no effect on arterial blood pressure.

CONCLUSION

This study shows that short-term supplementation with alpha-tocopherol may be beneficial to the paediatric sickle cell sufferer.

Blood pressure, hematologic and erythrocyte fragility changes in children suffering from sickle cell anemia following ascorbic acid supplementation

The effect of ascorbic acid supplementation (100 mg/day for 6 weeks) on blood pressure, packed cell volume, irreversibly sickled cells, per cent fetal hemoglobin, hemoglobin concentration, and erythrocyte osmotic fragility was assessed in children suffering from sickle cell anemia. Fifteen children whose ages ranged from 4 to 11 years (7.5 +/- 0.75 years) were studied. Ascorbic acid supplementation reduced systolic blood pressure by 10.9 +/- 3.4 mmHg (p < 0.01), diastolic blood pressure by 7.3 +/- 2.0 mmHg (p < 0.01) and mean arterial pressure by 9.4 +/- 2.6 mmHg (p < 0.01). It significantly increased packed cell volume (p < 0.001), hemoglobin concentration (p < 0.001) and per cent fetal hemoglobin (p < 0.001), but reduced per cent irreversibly sickled cells (p < 0.001). Ascorbic acid supplementation also abolished the long tail of the erythrocyte osmotic fragiligram and increased the resistance of the cells to lysis.