Oxidative stress markers and disease severity among children with sickle cell anaemia

Background: Sickle cell anaemia has been associated with oxidative stress. Total Antioxidant Capacity (TAC), Total Oxidant Status (TOS) and Oxidative Stress Index (OSI) are cumulative markers of oxidative stress. Objective: To evaluate the serum levels of oxidative stress markers in children with sickle cell anaemia (SCA) and determine the relationship between these markers and disease severity. Method: One hundred and fifty-six children, comprising 78 with SCA, aged 1 - 15 years and 78 age- and sex-matched Haemoglobin AA controls were studied. Serum TOS, OSI, and TAC were determined using ELISA kits. The severity of the SCA was determined using clinical and laboratory parameters. Result: Children with SCA had lower mean serum TAC (0.83±0.31UAE) than controls (1.19±0.24UAE) with p< 0.001) but positive correlation with TOS (r = 0.3, p = 0.008) and OSI (r = 0.6, p < 0.001). Conclusion: Children with SCA had lower TAC but higher TOS and OSI than matched controls. Oxidative stress markers had a significant relationship with SCD severity

Sickle cell disease clinical phenotypes in children from South-Western, Nigeria.

BACKGROUND: The clinical phenotypes of children with sickle cell disease (SCD) are poorly described in many sub-Saharan countries including Nigeria. OBJECTIVES: The objective was to highlight various clinical phenotypes of SCD in children and investigate the influence of sociodemographic indices on the development of SCD complications. METHODS: We carried out a cross-sectional study of 240 pediatric patients attending the sickle cell clinic and the emergency room in a teaching hospital in South-Western Nigeria over a 12-month period. The clinical phenotypes and severity of the disease were documented, and the influence of sociodemographic variables was investigated. RESULTS: The five leading clinical phenotypes in our patients were significant pain episodes, that is, vaso-occlusive crisis in 159 (66.3%); anemic crisis in 62 (25.8%); severe bacterial infections, 57 (23.8%); acute chest syndrome (ACS), 27 (11.3%) and stroke, 7 (2.9%). Forty-two (33.1%) had a previous history of dactylitis (hand-foot syndrome). Other clinical phenotypes such as avascular necrosis of the femur, 4 (1.7%); nephropathy, 2 (0.8%); priapism, gallstone and chronic leg ulcer, one (0.4%) each, were not commonly seen. More children with a history of asthma had ACS. Furthermore, high steady-state white blood cell count was associated with severe disease. CONCLUSION: The clinical phenotypes of SCD in children from South-Western Nigeria are highly variable with the disease manifesting very early and about 10% having significant complications. Sociodemographic characteristics appear to have little influence on the development of SCD complications among our patients, but age and low-socioeconomic class are associated with anemic crisis.

Current sickle cell disease management practices in Nigeria.

BACKGROUND: Although Nigeria has the highest burden of sickle cell disease (SCD) worldwide, there is still variable and poor utilisation of standard-of-care practices for SCD patients in the country. METHODS: This was a questionnaire survey of doctors in some dedicated SCD clinics in Nigeria in order to document the facilities available and common management practices. RESULTS: There were responses from 18 clinics based in 11 institutions. The number of patients being followed in each centre ranged from 15 to approximately 11 000. All clinics provided malaria prophylaxis and folic acid routinely to their patients. Only eight clinics prescribe penicillin prophylaxis. Eight prescribe hydroxyurea to patients who can afford it when indicated. All of the centres except three have electronic cell counters, but all had access to haemoglobin electrophoresis. Three had high-performance liquid chromatography machines installed but none was being routinely used. One institution had a functioning molecular biology laboratory. There is no official newborn screening programme in the country. All had access to microbiology and chemistry laboratories. Nine institutions had CT, six had MRI and three had transcranial Doppler facilities. CONCLUSION: The care available for SCD in Nigeria is still suboptimal and there is an urgent need for concerted effort to tackle the problem, but to make a significant impact on the burden of the disease would require more focus at the primary care level. Some steps to achieving this are outlined.

Perception of personal risk of acquiring human immunodeficiency viral infection/acquired immune deficiency syndrome among people attending outpatient clinics in a teaching hospital of Nigeria.

The Human Immunodeficiency Virus (HIV) pandemic is on the increase with the highest burden in sub-Saharan Africa. This descriptive cross-sectional study was carried out in 2008 to assess the knowledge, self-perception of risk of contracting HIV infection and risky sexual practices among patients attending some out-patient clinics at the University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria. The knowledge on the modes of transmission and methods of prevention of HIV was high. Although, 53.0% of the study participants perceived themselves not to be at risk of contracting HIV infection, 80.6% were engaged in risky sexual practices within a year preceding the study. Significantly more participants with multiple sexual partners, past and present history of Sexually Transmitted Infections (STI) perceived themselves not to be at risk (P= 0.001, 0.008 and 0.001 respectively). Effective strategies must therefore be developed, to enhance risk-perception since poor risk-perception is known to mitigate behavioral change.

Asymptomatic bacteriuria in Nigerian children with sickle cell anemia.

Urinary tract infections (UTI) in children with sickle cell anemia (SCA) may result in long term renal dysfunction. The prevalence, potential risk factors, and clinical significance of asymptomatic bacteriuria (ASB) were investigated in 196 Nigerian children with SCA in stable state. These children had clinical evaluation and assessment of their mid-stream urine (MSU) for pyuria, culture, and sensitivity tests; urinalysis for proteinuria, and estimated glomerular filtration rate (eGFR), hematocrit, serum creatinine and uric acid estimation. Children with confirmed ASB were compared with those without ASB. Those with confirmed ASB were monitored for 6 months for persistence of significant growth, development of symptomatic UTI, and evaluation of renal functions. The prevalence of probable and confirmed ASB in this cohort of SCA children were 12.2% and 6.6%, respectively. Confirmed ASB was more prevalent among older (P = 0.046) and female (P = 0.003) SCA children, particularly those with pyuria (odd Ratio, OR = 5.4, 95% confidence interval, CI = 2.7-11.0, P < 0.001) and proteinuria (OR = 1.4, 95% CI = 3.9-8.7, P = 0.006). Previous symptomatic UTI was not associated with ASB. Also, the mean eGFR, serum creatinine, and uric acid were not different in the group with ASB and those without ASB (P > 0.05). At the end of 6 month follow-up, two (15.4%) of the 13 children with ASB had persistence of significant growth, but none develop symptomatic UTI. Also, none of the two with persistent ASB had hypertension or deranged renal function. ASB is a significant problem in older age female SCA children, although renal functions were not different among those with and without ASB. A large scale randomized placebo-controlled trial of conventional treatment for ASB in SCA is advocated to define its long-term clinical significance.

Datura stramonium poisoning in children.

Although substance abuse is fairly common among adolescents, poisoning from Datura stramonium (a broadleaf annual erect herb with spine-covered seed capsule) is uncommon in children and has not been reported in our locality. We present the case of two children admitted at the Children Emergency Room of a teaching hospital following ingestion of extract of Datura stramonium. They developed neurotoxicity (confusion, agitation, mydriasis, and hallucination) and were managed symptomatically with good outcome. A high index of suspicion and early management of poison in children is imperative if a favorable outcome is expected. Early presentation and the presence of an eyewitness contributed to the very good outcome in these index cases. In this report, we discussed the symptomatology and management of Datura toxicity in children.

Effects of lime juice on malaria parasite clearance.

One hundred and twenty children with acute uncomplicated malaria who were managed at the children's outpatient department of the Wesley Guild Hospital, Ilesa (a unit of Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Osun state, Nigeria) were recruited into the study to determine the effects of lime juice on malaria parasite clearance. These children were randomized into treatment with World Health Organization recommended antimalarials (artemisinin combination therapy, ACT) either alone or with lime juice. Nine of them were lost to follow-up, four were in the group that were managed with ACT and lime, and five in the group that were managed on ACT alone. The average (SD) time to achieve >75% reduction in parasite load was significantly lower in patients on ACT and lime; 30.5 ± 2.4 h against 38.6 ± 3.3 h for those on ACT alone (p < 0.001). Also, while a significantly higher proportion of children on antimalarial drugs and lime juice achieved complete parasite clearance by 72 h of therapy (p = 0.007), ten (18.2%) patients without lime had early treatment failure (p = 0.003). There were no side effects with the use of lime juice. It may therefore be inferred, from this preliminary work, that lime juice when used with the appropriate antimalarial may enhance malaria parasite clearance especially in those with uncomplicated malaria.

Childhood injuries in Ilesa, South-Western Nigeria: causes, pattern, and outcome.

BACKGROUND: In Sub-Saharan Africa, infections and undernutrition are the leading causes of childhood death; however injuries are now contributing significantly to childhood morbidity and mortality. OBJECTIVE: To determine the aetiology, morbidity and mortality associated with injuries in children in South-Western Nigeria. METHODS: This was an observational cross-sectional study of consecutive childhood injury attendances and admissions into the hospital's Children Emergency Room (CHER) over a one-year period. Socio-demographic data as well as the data on the cause, site, and possible risks of injury; parts of the body affected and eventual outcome of the patients were documented. RESULTS: Injury accounted for 382 (10.6%) of the 3,604 attendances, 142 (11.9%) of 1193 admissions and 11 (20.4%) of 54 deaths in CHER. Their ages ranged from six weeks to 15 years, with a mean (SD) of 6.7 (3.9) years, and a male:female ratio of 1.6:1. Road traffic accidents, 130 (34.0%), were the most common cause, followed by falls 119 (31.2%), cuts 44 (11.5%), bits 26 (6.8%), and burns 24 (6.3%). Injuries occurred mostly at home 154 (40.1%), on the road 142 (37.4%), and at school 59 (15.2%). Lack of supervision and/or poor anticipation of potential dangers were the leading risks associated with childhood injuries. CONCLUSION: Injuries contribute significantly to childhood deaths in South-Western Nigeria. A well-orchestrated public enlightenment programme to improve home, school, and road supervision of children as well as concerted efforts to make these places safer could help ameliorate the situation.

Prevalence of overweight and obesity among children in Ile-ife, south-western Nigeria.

BACKGROUND: Childhood obesity is a potential health problem in Nigeria because of our changing patterns of lifestyle. It is associated with significant health, medical and psychological consequences for children and adolescents. OBJECTIVE: To determine the nutritional status of Nigerian children aged six to eighteen years using anthropometry. METHODS: The study which was a school-based cross-sectional survey employed a multi-staged random sampling method. Four secondary and four primary schools (two private and two public) were selected to ensure adequate representation of the focus age group of six to 18 years and social classes. Ninety students were selected from each school. Overall, 360 subjects were selected from primary and secondary schools respectively giving a total of 720 school children. Each subject had a questionnaire complete followed by the measurement of height and weight. Nutritional status was determined using the International Obesity Task Force criteria. RESULTS: Two (0.3%) of the 720 students studied were obese both being females. Twenty (2.8%) subjects were overweight of which 17 (85.0%) were females and three (15.0%) males. Females had a higher prevalence of overweight when compared with males. There was a higher proportion of overweight students in the higher social classes when compared with the lower social classes (p=0.03). Five hundred and sixty (77.8%) were underweight with a BMI less than 18.50. CONCLUSION: Obesity and overweight are rather uncommom problems among children in Ile-Ife a semi urban south-western Nigeria town. However, overweight is more common in children from high social classes and among adolescents, the girls tend to have higher BMI than the boys. Underweight is prevalent among these children.