Assessment of Quality of Life among Children with Bronchial Asthma and their Caregivers at the National Hospital Abuja; Nigeria

Background: The global disease burden associated with bronchial asthma has continued to increase particularly among children. Asthma-related quality of life is a health related assessment of disease impact on patient and care givers.Aim: To determine the perceived quality of life (QOL) among children with bronchial asthma and their caregivers as well as the related factors.Subjects and methods: This was a prospective study of children diagnosed with bronchial asthma and the caregivers attending the Respiratory Clinic of the National hospital Abuja; Nigeria. Using the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) information from the various domains was obtained. The PAQLQ 23 questions assessed the child physical domain (5); emotional (8) and social behaviors (10); and the PACQLQ 13 questions assessed the caregivers' activity limitation domain (4) and emotional function (9).Mean QOL scores from each domain and overall scores were calculated based on a seven-point scale. A QOL score of 7 was reported as best with no impairment; score one as least and severest impairment; score 4 as mid point in the range from 2-6 of moderate degree impairment. Other information on the demographic biodata and clinical information from child and caregivers was also obtained.Results: Forty-three children and 43 caregivers each were enrolled; from August to December 2014. Patients were aged 7-15years; 25(58.1%) males; 18(41.9%) females; while caregiver's were males 23(53.5%); females 20(46.5%); age range 21- 48years. 25(58.1%) caregivers were of middle- lower socio-economic status; 20(46.5%) children had persistent asthma; 22(51.2%) well controlled; 21(48.8%) partly controlled. Medication use were; none; 17 (39.5%); long acting beta2 agonist/ inhaled corticosteroids (LABA/ ICS); 13(30.2%); antihistamine; 8 (18.6%); leukotriene receptor antagonist (LTRA);5(11.6%). Overall mean QOL was 4.89(4.54- 5.24;95% CI) for the children and 4.6 (3.91- 4.82; 95% CI) for caregivers; correlation (R) 0.438 p=0.003. Multiple regression showed that females gender had significant impairment in mean QOL scores in the activity domain (p= 0.022); and those with poor control and severe asthma also had significant impairment in mean QOL (p 0.05).Conclusion: Asthma impacted QOL of both the asthmatic children and caregivers with female gender in the activity domain; severe and not well controlled disease as independent predictors of quality of life

Laparoscopic sleeve excision of lesser curvature gastrointestinal autonomic nerve tumour.

Gastrointestinal autonomic nerve tumors (GANT) are uncommon stromal tumors of the intestinal tract. Their histological appearance is similar to that of other gastrointestinal stromal tumors. We report probably the first laparoscopic excision of this rare tumor from our geographical region and compare our findings with the available case reports in the medical literature. A 38 year old male patient undergoing a routine health check was diagnosed with an exophytic growth on the lesser curvature of stomach on computerized tomography and underwent an initial endoscopic biopsy which was inconclusive. He underwent a laparoscopic sleeve excision of the GANT on the lesser curvature. Radical surgical resection of gastrointestinal autonomic nerve tumors seems to be the only available curative approach and survival seems possible even in large tumors.

Review of Childhood Measles Admissions at the National Hospital, Abuja

Background: The global disease burden from measles as a vaccine preventable disease remains high despite decades of interventions by various organs and agencies. Objectives: To determine the prevalence and outcome of childhood cases of measles admitted into the children's emergency ward of the National hospital and highlight the possible contributing factors. Design: Retrospective. Subjects : A total number of 43 children with measles presenting at the National Hospital Abuja; seen over a 40 months period; January 2002 and April 2005. Methods: Cases-folders of patients seen at the Emergency Paediatric Unit (EPU) of the National Hospital Abuja during the period under review with the clinical diagnosis of measles were reviewed. Results: The children were aged between seven to 12months; with 25 (58.1) age 24 months and below. Twenty three (53.5) of the subjects had received prior measles vaccination. History of contact with cases of acute measles was present in 26 (60.5). Associated protein energy malnutrition (PEM) was found in 30 (69.8) with 28 (65.1) parents of these children being of lower social economic classes (III; IV etV). Recorded complications included gastroenteritis; bronchopneumonia; laryngo-tracheo-bronchitis as part of croup syndrome; tuberculosis; and otitis media. Three fatalities (7.0) were record in this review; all in association with bronchopneumonia. Conclusion : Measles with its complications still present as a fatal illness even among vaccinated children

Prevalence of acquired MDR-TB and HIV co-infection.

BACKGROUND: Mounting prevalence of primary and acquired multidrug-resistant tuberculosis in India is a sorry reminder of all round failure in our fight against tuberculosis and also of the necessity for new effective strategies. OBJECTIVES: (1) To assess the prevalence and pattern of drug resistant pulmonary tuberculosis among treated patients or on those on treatment without adequate response and (2) to evaluate HIV seropositivity among MDR-TB patients. METHODS: Pulmonary TB patients, who had at least six months of unsuccessful anti-tuberculous treatment were selected for the study. Their sputum specimens were examined for M. tuberculosis culture and drug sensitivity pattern and serological examinations for HIV infection were carried out. RESULTS: Sputum specimens of 618 patients' (61.8%) of a total of 1000 examined had shown culturable M. tuberculosis. Four hundred ninty-five patients (49.5%) were found to expectorate tubercle bacilli resistant to one or more anti TB drugs. MDR-TB was detected in 339 patients (33.9%). HIV seropositivity among MDR-TB was 4.42%. Significantly, 245 patients (24.5%) had tubercle bacilli resistant to one or more reserve drugs too (ethionamide, kanamycin and/or ofloxacin). CONCLUSIONS: Prevalence of MDR-TB was high in the study population. It is essentially an acquired condition. Its association with HIV disease was at present on the lower side, an observation contrary to published western literature. Higher rates of resistance for reserve drugs (ethionamide, kanamycin and/or ofloxacin) in patients who never had these drugs in their earlier treatment schedules suggest the possibility of emerging spontaneous drug resistant mutants.