Paediatric Anatomical Models in Radiotherapy Applications.

Anatomical models have key applications in radiotherapy, notably to help understand the relationship between radiation dose and risk of developing side effects. This review analyses whether age-specific computational phantoms, developed from healthy subjects and paediatric cancer patient data, are adequate to model a paediatric population. The phantoms used in the study were International Commission on Radiological Protection (ICRP), 4D extended cardiac torso (XCAT) and Radiotherapy Paediatric Atlas (RT-PAL), which were also compared to literature data. Organ volume data for 19 organs was collected for all phantoms and literature. ICRP was treated as the reference for comparison, and percentage difference (P.D) for the other phantoms were calculated relative to ICRP. Overall comparisons were made for each age category (1, 5, 10, 15) and each organ. Statistical analysis was performed using Microsoft Excel (version 16.59). The smallest P.D to ICRP was for Literature (-17.4%), closely followed by XCAT (26.6%). The largest was for RT-PAL (88.1%). The rectum had the largest average P.D (1,049.2%) and the large bowel had the smallest (2.0%). The P.D was 122.6% at age 1 but this decreased to 43.5% by age 15. Linear regression analysis showed a correlation between organ volume and age to be the strongest for ICRP (R2 = 0.943) and weakest for XCAT (R2 = 0.676). The phantoms are similar enough to ICRP for potential use in modelling paediatric populations. ICRP and XCAT could be used to model a healthy population, whereas RT-PAL could be used for a population undergoing/after radiotherapy.

Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice.

INTRODUCTION: Environmental sustainability (ES) in healthcare is an important current challenge in the wider context of reducing the environmental impacts of human activity. Identifying key routes to making clinical radiology and radiotherapy (CRR) practice more environmentally sustainable will provide a framework for delivering greener clinical services. This study sought to explore and integrate current evidence regarding ES in CRR departments, to provide a comprehensive guide for greener practice, education, and research. METHODS: A systematic literature search and review of studies of diverse evidence including qualitative, quantitative, and mixed methods approach was completed across six databases. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess the included studies. A result-based convergent data synthesis approach was employed to integrate the study findings. RESULTS: A total of 162 articles were identified. After applying a predefined exclusion criterion, fourteen articles were eligible. Three themes emerged as potentially important areas of CRR practice that contribute to environmental footprint: energy consumption and data storage practices; usage of clinical consumables and waste management practices; and CRR activities related to staff and patient travel. CONCLUSIONS: Key components of CRR practice that influence environmental impact were identified, which could serve as a framework for exploring greener practice interventions. Widening the scope of research, education and awareness is imperative to providing a holistic appreciation of the environmental burden of healthcare. IMPLICATIONS FOR PRACTICE: Encouraging eco-friendly travelling options, leveraging artificial Intelligence (AI) and CRR specific policies to optimise utilisation of resources such as energy and radiopharmaceuticals are recommended for a greener practice.

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.

Drug utilization and blood pressure control in a population where antihypertensives are given free: effect of policy change.

OBJECTIVES: To assess the current utilization pattern of antihypertensive drugs and blood pressure (BP) control among treated hypertensives where there is a change in payment policy for antihypertensive drugs and to compare with a previous study when drugs were given free in the same setting. METHODS: A cross sectional study of hypertensive subjects being followed-up in the medical clinic of International Institute for Tropical Agriculture. RESULTS: One hundred and sixteen consecutive hypertensive subjects aged 50.9+/-8.6 years were studied. Eighty two (70.7%) of the subjects were fully controlled on the treatment, while 15 (12.9%) were not controlled at all. Systolic BP alone was controlled in 14 (12.1%) while in 5 (4.3%) subjects the Diastolic BP alone was controlled. Systolic BP was 133.4+/-14.0 (106-186) mmHg, while diastolic was 83.5+/-9.1 (59-110) mmHg. Salt use correlated with and was predictive of BP control, r = 0.336 and r2 = 3.383, p=0.001. Frequency of drug use: Diuretics 79.8%, calcium channel blockers (CCB) 51.8%, alpha-methyldopa 21.9%, angiotensin converting enzyme inhibitors 17.5%, beta-blockers 15.8%, vasodilator 1.8%, and prazosin 0.9%. CONCLUSION: In this study, twice as many patients as in the previous study had fully controlled blood pressure in spite of the new policy of co-payment. Health education and patient counselling along with availability of free drug could have contributed to improve adherence to antihypertensive drugs. Physicians managing hypertensive patients should pay attention not only to adequate dosing and appropriate combination of drugs but also to health education and patient counselling.

Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients

BACKGROUND:The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV-related oral lesions in paediatric Nigerian patients on HAART with those not on HAART.MATERIALS AND METHODS: All patients aged 15 years and below attending the Infectious Disease Clinic of Aminu Kano Teaching Hospital with a diagnosis of HIV were consecutively examined in a cross-sectional study over a 2-year period. Information was obtained by history, physical examinations, HIV testing, and enumeration of CD+ T cells. The results are presented. A P-value of <0.05 was considered significant.RESULTS:A total of 105 children comprising 63 males and 42 female who met the inclusion criteria participated in the study, mean age in months was 53.3±42.2, with a mean of 3.4±2.2 for male and 2.8±1.8 for female respectively. Oral lesions occurred in 61.9% of the children Overall, 22 (21.0%) had at least one oral lesion, 43 (41.0%) had multiple lesion. The most common lesion was oral candidiasis (79.1%). The angular cheilitis (43.8%) variant was most frequent. The mean CD4 counts were 1138 cells/mm(3), 913 cells/mm(3) and 629 cells/mm(3) for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA: F=0.185, df=2, 80, 82, P=0.831. Patients on HAART comprised about 61.9% and these were found to have reduced risk for development of such oral lesions as angular cheilitis (OR=0.76; 95% CI=0.56-1.02; P=0.03), pseudomembranous candidiasis (OR=0.71; 95% CI=0.54-0.94; P=0.024) and HIV-gingivitis (OR=0.59; 95% CI=0.46-0.75; P=0.001). HAART had some beneficial but insignificant effect on development of HIV-periodonttitis (OR=0.60; 95% CI=0.51-0.70; P=0.09). The chances of occurrence of other oral lesions were not significantly reduced by HAART (Kaposi sarcoma, OR=1.24; 95% CI=0.31-5.01; P=0.47, erythematous candidiasis, OR=1.13; 95% CI=0.62-2.06).CONCLUSION: HIV-related Oral lesions are frequently seen in HIV-infected Nigerian children. Paediatric patients receiving HAART had significantly lower prevalence of oral lesions, particularly oral candidiasis and HIV-gingivitis

Subclinical hypothyroidism in childhood obesity and its correlation with lipoproteins.

BACKGROUND/OBJECTIVE: There is an ongoing debate regarding the influence of subclinical hypothyroidism on body mass index. The objectives of the study were (i) to determine whether levels of thyroid stimulating hormone (TSH) are elevated in obese children, (ii) to compare the serum levels of triiodothyronine (T3) and thyroxine (T4) in obese with non-obese and (iii) to examine the association of subclinical hypothyroidism with lipoproteins and body mass index. METHODS: Fifty six obese children/adolescent girls aged 10.5 +/- 4.3 years, BMI 31.2 +/- 2.2 kg/m2 and apparently healthy children aged 11.2 +/- 5.2 years, BMI 21.0 +/- 2.1 kg/m2 were evaluated. Serum T3, T4 and TSH were measured using ELECSYS 1010 autoanalyzer while serum triglyceride, total cholesterol, LDL cholesterol, HDL cholesterol and glucose were measured using enzyme catalyzed colorimetric techniques. RESULTS: Subclinical hypothyroidism was observed in 10.7% of obese subjects. Significantly increase levels of T3 (p < 0.02), TSH (p < 0.01) and all lipoprotein fractions (p < 0.001) except HDL cholesterol which was lower (p < 0.001) were observed in obese than control subjects. TSH and triglyceride correlated positively with body mass index. CONCLUSION: Subclinical hypothyroidism was present in 10.7% of obese children. TSH and triglyceride correlated positively with body mass index in childhood/adolescent obesity. There is need for this group ofsubjects to be evaluated for thyroid hormones so that those requiring therapy can be diagnosed and treated.

Childhood diabetes mellitus in Kano, North West, Nigeria.

BACKGROUND: There is paucity of literature on childhood diabetes mellitus from developing countries and especially North west Nigeria and this has made it pertinent for documentation of the features of the disease in a major regional referral centre. The study was designed to describe the clinical presentation and outcome of childhood diabetes mellitus. METHODOLOGY: Retrospective review of hospital records of paediatric patients managed for diabetes at Aminu Kano Teaching Hospital, Kano. Nigeria between January 1999 and December 2006. The age, sex, presenting features, complications, laboratory features and outcome of the patients were retrieved from the hospital records: RESULTS: During the years under review eleven out of 3,585 admissions were managed for Type 1 diabetes mellitus giving a prevalence rate of 3.1/1000. Male to female ratio was 1:0.6. The mean age at presentation was 10 +/- 4.5 years most of the patients (72.7%) belonged to the lower socio-economic classes IV and V. The duration of symptoms ranged from 6 58 days with a mean of 24 +/- 22.8 days. The patients presented with urinary tract infections (36.4%), malaria (27.3%) and recurrent boils (18.2%). Three (27.3%) of the patients had polyuria and polydypsia while only one (91%) patient had polyphagia and weight loss. The mean random blood glucose on admission was 28.5 +/- 7.9 mmo/L (16.9 39.2mmo/L). Four patient presented with diabetic Keloacidosis. Two patients (18.2%) were discharged against medical advice while 1 (9.1%) patient died. CONCLUSION: Childhood Diabetes Mellitus, remains relatively uncommon in Nigeria.

Effect of instructions about the method of urine collection and storage on the isolation rate of urinary bacteria in children

A study of 65 children (29males and 36females) and aged between four weeks and 15years with significant bacteriuria was undertaking over a six month period to determine the effects of instruction received about the methods of urine collection and storage on the prevalence of urinary tract infection. The commonest clinical presentation was fever (64.6). Only 22(35.4) of the patients had specific symptoms suggestive of urinary tract infections. The instructions about urine collection were given to 48(73.8) care givers. This instruction was given by the attending doctors (84). Despite the explanation; 15(23.1) of the patients collected the urine samples wrongly and 44(67.7) stored the samples for longer than one hour. Significant bacteriuria was more prevalent in 74.2of patients who submitted their urine samples more than one hour after collection. Communication skill is important and should be emphasized in the trainings of health workers in procedure on the patients

Childhood diabetes mellitus in Kano, North West, Nigeria

There is paucity of literature on childhood diabetes mellitus from developing countries and especially North west Nigeria and this has made it pertinent for documentation of the features of the disease in a major regional referral centre. The study was designed to describe the clinical presentation and outcome of childhood diabetes mellitus. Retrospective review of hospital records of paediatric patients managed for diabetes at Aminu Kano Teaching Hospital; Kano. Nigeria between January 1999 and December 2006. The age; sex; presenting features; complications; laboratory features and outcome of the patients were retrieved from the hospital records. During the years under review eleven out of 3;585 admissions were managed for Type 1 diabetes mellitus giving a prevalence rate of 3.1/1000. Male to female ratio was 1:0.6. The mean age at presentation was 10 4.5years most of the patients (72.7) belonged to the lower socio-economic classes IV and V. The duration of symptoms ranged from 6 58days with a mean of 24 22.8days. The patients presentedwith urinary tract infections (36.4); malaria (27.3) and recurrent boils (18.2). Three (27.3) of the patients had polyuria and polydypsia while only one (91) patient had polyphagia and weight loss. The mean random blood glucose on admission was 28.5 7.9mmo/L (16.9 39.2mmo/L) Four patient presented with diabetic Keloacidosis. Two patients (18.2) were discharged against medical advice while 1(9.1) patient died. Childhood Diabetes Mellitus; remains relatively uncommon in Nigeria

Urinary tract infection in children with nephrotic syndrome in Kano, Nigeria.

BACKGROUND: Nephrotic syndrome is a common childhood renal disorder; the prevalence of Urinary tract infection (UTI) in these patients is high. The increased prevalence of UTI are due to immunoglobulin loss, defective T cell function, presence of ascites and relative malnutrition. OBJECTIVE: The study is to evaluate the prevalence of UTI , its etiological agents, antibiotics, sensitivity pattern and the outcome in children with nephrotic syndrome. METHODS: A prospective study of all patients with diagnosis of nephrotic syndrome from January 2003 to December 2006. Urine specimen were routinely obtained by clean catch method following careful preparation urethral orifices. The specimens were processed immediately. Five millimeters (5 ml) loopful of the sample were inoculated on a blood agar and CLED agar plates. Identification of the organism to species level was by using stokes disc diffusion technique. RESULTS: Forty two patients were studied. The mean age and SEM for males was 8.2 + 0.5 years and females with 7.9 + 0.8 years. The age range was two to fifteen years UTI was caused predominantly by Staphylococcus aureus in 67.9%, Klebsiella species (17.9%) and Pseudomonas (14.2%). There was high in vitro resistance of these organisms to nalidixic acid and ampicillin but sensitive to cefotaxime, ceftriazone and ciprofloxacin. CONCLUSION: It is recommend that UTI should be sought for in patients with nephrotic syndrome and treatment should be prompt and appropriate.

Cerebral palsy in Kano, Nigeria--a review.

BACKGROUND: Cerebral palsy is the most common form of chronic motor disability that starts in childhood. The aim of this study is to determine the magnitude of cerebral palsy in Kano and environs as well as to highlight the types, aetiologic factors and associated co-morbidities. METHOD: The medical records of 356 patients who attended the paediatric neurology clinic between January 1998 and December 2005 were examined and all those with diagnosis of cerebral palsy were studied. The relevant data extracted and analysed included age at first presentation, sex, physiologic form of cerebral palsy and co-morbidities. RESULTS: Of all the paediatric neurology cases, there were 151 (42.4%) cases of cerebral palsy. There were 95 males (62.9%) and 56 females (37.1%) giving a male female ratio of 1:7:1. The age range was 6 months 12 years. The difference between the two sexes was not statistically significant (P > 0.05) Birth asphyxia was the leading cause of cerebral palsy (45.7%), followed by neonatal jaundice (12.6%), seizure disorder (11.9%), meningitis (7.3%), prematurity (3.3%), encephalitis (2.6%), genetic disorder (1.3%), trauma (1.3%) and craniosynostosis ( 0.62%). In 20 (13.2%) cases, the aetiology was unknown. The physiologic forms of cerebral palsy observed included spastic (41.7%), mixed (29.8%), hypotonic (21.9%) and dyskinetic (6.6%). The most prevalent comorbid conditions included: speech impairment (15.2%), mental retardation (13.2%), auditory impairment (11.9%), strabismus (11.3%), seizure disorder (11%) and microcephaly (7.3%). CONCLUSION: It is suggested that general improvement in perinatal health services will reduce the burden of the disease in Kano and environs.

HIV exposed infants: a preliminary report of the Aminu Kano Teaching Hospital experience.

UNLABELLED: To determine the Sociodemographic characteristics, infant feeding choices and outcome of HIV exposed neonates attending the paediatric infectious disease clinic (IDC) of Aminu Kano Teaching Hospital Kano. PATIENTS AND METHODS: The records of all HIV exposed babies were reviewed. One hundred and ninety HIV exposed babies were seen between October 2003-December 2005. Of these 121 were part of the PMTCT programme while 69 were not. A total of 179(94.2%) babies were delivered at term while 11(5.8%) were delivered prematurely, with M: F ratio of 1.2:1. RESULTS: A substantial number of mothers in the non PMTCT group were diagnosed antenataly or even prior to conception yet they did not avail themselves of the interventions in the PMTCT programme. Reasons given were ignorance, inaccessibility to PMTCT centres and fear of stigmatisation. Breast milk substitute, was the leading choice of mothers in the PMTCT group while breast milk and mixed feeding was practised more in the non-PMTCT group. CONCLUSION: PMTCT remains the best way of preventing paediatric HIV infection and infant feeding counselling should be family oriented. Provision of free infant formula, PCR machines to enable early diagnosis, waiving of fees, and home visits would greatly improve infant follow up.

An appraisal of current management of childhood urinary tract infections among private medical practitioners.

BACKGROUND: Private medical practitioners manage substantial number of children with urinary tract infection in Nigeria. It is important to evaluate the management of urinary tract infection (UTI), because of complications that may arise form improper treatment. METHODS: This study was conducted during the 10th Annual General and Scientific Conference of Guild of Medical Directors in Kano. Study populations were private medical practitioners. The research tools were self administered questionnaires containing questions to illicit knowledge, attitude and treatment regarding childhood UTI. RESULTS: One hundred and twenty respondents returned their questionnaire. There were 98 (81.7%) males and 22 (18.2%) females. Twenty one (17.5%) had postgraduate qualification. Majority (87.5%) respondents preferred early morning and mid-stream urine for patients. Escherichia coli, Staphylococcus aureus and Proteus mirabilis were the commonest listed isolates. The knowledge of predisposing factors and complications following UTI was fair. Twenty-six percent would give chemoprophylaxis for repeat infections in females while only 7% would refer such patients to specialist. Reasons that warranted referral varied from inability to pay fees to the occurrence of complications in the course of therapy. Twenty-nine percent would use multiple therapy (antibiotics) because of the need to ensure adequate antimicrobial coverage, effective therapy and prevention of resistance and cost effectiveness. Ampicillin, Cotrimazole and Tetracycline featured as first line antibiotics among the respondents. CONCLUSION: Some practices are clearly at variance with recommendations. Continue medical education is recommended for bridging the gap between current practices, this will enhance patient's care.

Awareness and knowledge of mother-to-child transmission of HIV among mothers attending the pediatric HIV clinic, Kano, Nigeria.

BACKGROUND: Nigeria accounts for about 10% of all HIV/AIDS cases in the world. Globally women constitute 48% of adults infected with HIV; in Nigeria, they constitute 57%. There is an increase in the number of children infected with HIV in recent years as the number of HIV-positive women has increased. However, more than 90% of HIV infections in children aged less than 15 years are due to mother-to-child transmission of HIV. OBJECTIVE: To evaluate the awareness and knowledge of mother-to-child transmission of HIV, HIV/AIDS and the methods to prevent mother-to-child transmission of HIV. METHODS: This is a descriptive study. The study was carried out at the pediatric HIV clinic of Aminu Kano Teaching Hospital from 1 st July 2006 to 30 th December 2006. Mothers included in the study were mothers in first contact with HIV facilities, which was at our center, before any form of counseling. The instrument used was a questionnaire designed to assess awareness of the mothers about HIV/AIDS, evaluate their knowledge of possible routes of transmission and measures to prevent vertical transmission. The questionnaire was then pre-tested for comprehensibility, appropriateness of language, sensitivity of questions and average duration of administration. RESULTS: A total of 164 mothers brought their children for treatment to the pediatric HIV clinic. The level of awareness about HIV/AIDS among mothers was very high (100%), and the main sources of information were radio (48.8%) and television (37.8%). Ninety-one percent of mothers were aware of mother-to-child transmission of HIV. Transplacental route (41%) was the commonly identified route of transmission. The level of knowledge and perceptions of mother-to-child transmission of HIV is inadequate. CONCLUSION: There is a need to scale up education about mother-to-child transmission of HIV in our health facilities.

Spontaneous pre-labour rupture of membranes at term: immediate versus delayed induction of labour.

BACKGROUND: Spontaneous pre-labour rupture of membranes (SPROM) at term is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality, particularly because it is associated with a latency period from membrane rupture to delivery. OBJECTIVE: To compare the outcome of labour in women who had immediate induction of labour, with those who had delayed induction following SPROM at term. METHODS: A prospective case control study of 200 women who had either immediate induction of labour with intravaginal misoprostol tablets, or delayed induction with intravenous oxytocin infusion after an expectant period of 12 hours, at Aminu Kano Teaching Hospital, Kano, Nigeria. The outcome of labour was compared in the two groups using the Z test and Chi square test, while, p-value of less than 0.05 was taken as significant. The odds ratio (OR) and 95% confidence interval were also determined where appropriate. RESULTS: Immediate induction of labour with intravaginal misoprotol resulted in lower rates of caesarean section and operative vaginal delivery, with a higher rate of spontaneous vaginal delivery. The duration of latent phase of labour and hospital stay before delivery was statistically significantly shorter in the immediate induction group. Neonatal and maternal morbidity were insignificant and comparable between the two groups. CONCLUSION: Immediate induction of labour with intravaginal misoprotol resulted in significantly lower rates of intervention without compromising fetomaternal outcome. We recommend the immediate induction of labour with proper use of intravaginal misoprotol in women with SPROM at term.

Urinary tract infection in children with nephrotic syndrome in Kano, Nigeria

Background: Nephrotic syndrome is a common childhood renal disorder; the prevalence of Urinary tract infection (UTI) in these patients is high. The increased prevalence of UTI are due to immunoglobulin loss; defective T cell function; presence of ascites and relative malnutrition. Objective: The study is to evaluate the prevalence of UTI ; its etiological agents; antibiotics; sensitivity pattern and the outcome in children with nephrotic syndrome. Methods: A prospective study of all patients with diagnosis of nephrotic syndrome from January 2003 to December 2006. Urine specimen were routinely obtained by clean catch method following careful preparation urethral orifices. The specimens were processed immediately. Five millimeters (5mml) loopful of the sample were inoculated on a blood agar and CLED agar plates. Identification of the organism to species level was by using stokes disc diffusion technique. Results : Forty two patients were studied. The mean age and SEM for males was 8.2 + 0.5 years and females with 7.9 + 0.8years. The age range was two to fifteen years UTI was caused predominantly by Staphylococcus aureus in 67.9; Klebsiella species (17.9) and Pseudomonas (14.2). There was high invitro resistance of these organisms to nalidixic acid and ampicillin but sensitive to cefotaxime; ceftriazone and ciprofloxacin. Conclusion: It is recommend that UTI should be sought for in patients with nephrotic syndrome and treatment should be prompt and appropriate