Resistance to Thyroid Hormone associated with Hyperthyroidism, Cholestatic Jaundice, Goitre and failure to thrive (Weight Faltering): Case report and review of the literature

@#In this report, we describe a rare case of a Nigerian male infant who presented with resistance to thyroid hormone associated with hyperthyroidism, cholestatic jaundice, a huge goitre and failure to thrive (weight faltering). He had delayed developmental motor milestones and at the age of 7 months, he has developed craniosynostosis. The hyperthyroidism persisted despite treatment with beta-blocker for tachycardia and antithyroid medications. The challenges encountered in the management of the patient are discussed

Co-Existence of Graves’ Disease, Brachial Artery Pseudoaneurysm and Radial Neuropathy in an adolescent girl

@#Brachial artery aneurysm is rare but could be potentially both life-threatening and limb-threatening. It may lead to peripheral nerve injuries which cause disability and affect everyday function, both domestic and economic. We present a rare case of pre-menarcheal adolescent girl with Graves’ disease co-existing with radial neuropathy due to radial nerve compression by a giant brachial artery pseudoaneurysm. The patient was managed surgically with aneurysmal resection and saphenous vein graft interpositioning. Prompt diagnosis and institution of appropriate surgical repair to prevent adverse outcome was imperative.

Isolated Progressive Congenital Left Thumb Macrodactyly : Case Report and Literature Review

@#Isolated progressive macrodactyly belongs to a heterogeneous group of congenital overgrowth syndromes, resulting in enlargement of all tissues localized to the terminal portions (fingers or toes) of a limb. The aim of this case report is to create further awareness among physicians on this rare clinical entity and present a short review of the literature. We present the case of a 10-year-old Nigerian girl with a history of progressive overgrowth of left thumb since birth. The patient‟s facies and body habitus were normal without hemihypertrophy. Anthropometric measurements of the child‟s hands, revealed an overgrowth of the left thumb compared with the right. The child had no café-au-lait spots or any other skin lesions. The radiograph of the hands revealed increase in size of both soft tissue and phalangeal bones (enlongated and broadened) of the left thumb. A diagnosis of isolated progressive left thumb macrodactyly was made and the patient was referred to the orthopaedic surgeon for surgical intervention. The child and her parents suffered psychological distress. Isolated progressive macrodactyly is very rare but it is cosmetically displeasing to the child, resulting in psychological distress.

Offspring of Mothers with graves’ disease followed-up for the first six months of life: A retrospective study from a Nigerian Teaching Hospital

@#The offspring of a mother with Graves’ disease is at increased risk of morbidity (both immediate as well as long term) and mortality. The aim of the study was to retrospectively assess the concentrations of the serum Thyroid Stimulating Hormone (TSH), Thyroxine (T4) and Triiodothyronine (T3) as well as the anthropometric measurements in the first 6 months of life among offspring of mothers with Graves’ disease. In this study, the case files of all infants born to mothers with Graves’ disease who were referred to the Paediatric Endocrinology Clinic, University of Benin Teaching Hospital (UBTH), Benin City were retrieved and audited. The thyroid function tests (TFT) results as well the anthropometric data obtained in the first 6 months of life for offspring of mothers with Graves’ disease were recorded. Of the 10 neonates born to mothers with Graves’ disease, the thyroid function was normal in eight (80.0%) and abnormal in two (20.0%). Of the two infants with abnormal thyroid function, one had Transient Hyperthyrotropinaemia (elevated TSH with normal fT4) and the other had Euthyroid Hyperthyroxinaemia (elevated fT4 with normal TSH and no clinical symptoms). No case of neonatal Graves’ disease was observed. In the first 6 months of life, there was no statistically significant difference in anthropometric measurements between offspring of mothers with Graves’ disease and their counterparts whose mothers did not have Graves’ disease. Conclusion: Majority of infants born to mothers with Graves’ disease had normal thyroid function but the two leading abnormality of thyroid function observed in the newborn were Transient Hyperthyrotropinaemia and Euthyroid Hyperthyroxinaemia. No statistically significant difference was observed in the anthropometric measurements of offspring of mothers with Graves’ disease and those of mothers without Graves’ disease

Zinc Nutritional Status and anthropometriciIndices of Preschool children living in a rural community in Edo State, Nigeria

@#Zinc deficiency impairs growth and development but epidemiological data for zinc nutrition status among preschool children living in rural areas of Nigeria is lacking. The aim of the present study was to assess the zinc status and anthropometric indices of children aged between 6 and 60 months, living in a rural community in Edo State, Nigeria. In this community-based cross-sectional study, five out of the nine political wards (quarters) in the community were randomly selected; all the households with children aged between 6 and 60 months were included the study. A total of 252 children were selected to participate after obtaining informed consent from their parents. Steps were taken to avoid exogenous zinc contamination of the blood samples which were collected in the mornings. The serum zinc levels of the subjects were determined, using flame atomic absorption spectrophotometry. The weights, heights, head and mid-upper arm circumferences of each child were measured, using standard procedures. Z- scores of anthropometric indices of height-for-age, weight-for-age and weight-for-height were computed to assess the nutritional status of the children. The mean age of the study population was 32.7±17.0 months. The prevalence rates of stunting, underweight and wasting among the children were 18.2%, 14.7% and 11.1%, respectively. The overall mean serum zinc concentration was 4.77±3.02μmol/L, with a range of 1.0 16.52μmol/L. Of the 252 children, 220 (87.3%) had mean serum zinc concentration below 7.65μmol/L, representing severe zinc deficiency. The highest mean serum zinc concentration was found among children aged 6 to 12 months and this was followed by a progressive decline in serum zinc concentration from the age of 13 months up to 48 months. Correlation between the serum zinc concentration of the children and their age and social class of the parents were as follows: age, r = 0.09, at p = 0.15; social class, r = 0.08; at p = 0.21. The children with wasting had the lowest mean serum zinc concentration compared with either the group with underweight or stunting. The zinc nutritional status of preschool-age children in this community clearly indicates a suboptimal zinc status at the time of this study. According to the IZiNCG criteria, this should be considered as a public health problem among preschool-age children in this community. To effectively address the issue, social mobilization, intensive education and awareness campaign, with all target groups and policy makers are urgently required. Public health measures aimed at improving their zinc nutritional status should also be considered.

Prevalence of hypoglycemia among patients presenting with cholestasis of infancy in a Nigerian teaching hospital

This study assesses the prevalence of hypoglycemia among patients presenting at the University of Benin Teaching Hospital, Benin City, Nigeria with cholestasis of infancy. During a period of five years, forty patients aged between 15 days and 12 months who presented with cholestasis of infancy, were admitted and screened for hypoglycemia, using Accutrend glucometer. For patients with low blood glucose values, blood samples were further analyzed, using the standard glucose-oxidase method. Of the 2,835 patients admitted over a five-year period, 40 [1.4%] had cholestasis of infancy, giving an incidence of 14 cases per 1000 admissions, with a sex ratio of 2.1: 1 in favour of males. Nine [22.5%] of the 40 infants with cholestasis had at least one blood glucose concentration less than 2.6 mmol/L [hypoglycemia]. Of the nine hypoglycemic infants, three [33.3%] had one blood glucose concentration less than 1.6 mmol/L [severe hypoglycemia]. Seven [77.8%] of the nine hypoglycemic infants were diagnosed in the first 36 hours of admission. Lethargy and poor feeding were observed in three infants with severe hypoglycemia and three of them died. Six [66.7%] of the hypoglycemic infants were below 3 months of age. Hypoglycemia was observed among patients with cholestasis of infancy and the prevalence was higher among infants below 3 months of age

Point-of-admission hypoglycaemia among under-five Nigerian children with Plasmodium falciparum Malaria: prevalence and risk factors

Hypoglycaemia is a well recognized complication of falciparum malaria in children but its diagnosis may be overlooked because all the clinical features may be mimicked by severe malaria. To determine the prevalence of hypoglycaemia at the point of hospital admission of under-fives with falciparum malaria and identify its risk factors in patients seen in a Nigerian secondary-health-care institution. During a 12-month period and at the point of hospital admission, venous blood sample was collected into an appropriate sample bottle [fluoride-oxalate bottle] from 502 children who were below 5 years of age with positive falciparum malaria parasitaemia. The blood sample was analysed using the glucose-oxidase method. The duration of illness, degree of parasitaemia and time of last meal were noted for each child. Ninety two [18.3%] out of 502 children below five years old with falciparum malaria had hypoglycaemia [blood glucose below 2.6 mmol/L or 50 mg/dl] at the point of hospital admission. Twenty three percent [78 out of 339] of children below 36 months old were hypoglycaemic compared to 8.6% [14 out of 163] children aged 36 months and above; [p=0.01]. Prevalence of hypoglycaemia was higher in girls [20.7%] than boys [16.3%] [Odd ratio, OR = 0.75 [95% Confidence Interval, CI = 0.48-1.18]]. Forty [13.1%] out of 305 children whose time of last meal was 12 hours and below had hypoglycaemia compared to 52[26.4%] out of 197 whose time of last meal was greater than 12 hours; [p=0.02]. Hypoglycaemia at admission point was associated with a significant increase in mortality rate; [p=0.00]. The duration of illness and the degree of parasitaemia did not have significant difference with the prevalence of hypoglycaemia. In falciparum malaria, a greater interval [between 2 meals] than 12 hours in children below 36 months old predisposed them to hypoglycaemia. Routine monitoring of blood glucose at the admission point is suggested in malaria endemic region

Pediatric discharge against medical advice: experience from a Nigerian secondary healthcare institution

Often, discharge of children against medical advice has a negative effect on the well-being of the patient. To determine the prevalence of discharge against medical advice [DAMA] among hospitalized children and examine the reasons given by parents/guardians for such discharges. A retrospective 2-year medical records audit of children aged one day to 15 years discharged against medical advice was carried out in a pediatric unit of a secondary health-care facility. The overall prevalence of DAMA was 6.3% while the prevalence among neonates was 7.5%, p>0.05. Sixty-two [56.4%] of all cases were less than 12 months old with neonates accounting for 40 [64.5%] of the 62. The prevalence of DAMA was 2.8 times higher in male neonates compared to female neonates. Thirty two [9.9%] of 322 male neonates compared to 8 [3.7%] of female neonates were DAMA; Odd ratio, OR=2.8; 95% Confidence Interval, CI= 1.26, 6.20]. Majority [65.4%] of the signatories to the discharge documents were the child's fathers. In only 5.5% of cases were the child's mothers the signatories. Rate of re-admission was 13.6%. The commonest reason for DAMA in both neonates and older children was financial constraints. Parental disagreement with planned treatment and/or investigations ranked second in the case of neonates. DAMA is a common social pediatric health problem, especially among infants and has multifactorial etiology. Socioeconomic factors, parental misjudgment of improvement and disagreement with treatment plan were found to have a significant bearing to its occurrence