Evaluation of Myocardial Injury Using Serum Cardiac Troponin-I in Asphyxiated Neonates at Enugu State University Teaching Hospital, Enugu, South-East Nigeria.

BACKGROUND: The burden of perinatal asphyxia remains high in our environment and when asphyxia is severe, vital organs are affected, with resultant multiorgan hypoxic-iscahemic injury to the heart, the brain, adrenals and other organs. STUDY AIM: To evaluate for myocardial injury in asphyxiated term neonates with hypoxic ischaemic encephalopathy using serum cardiac troponin-I (cTnI). METHODS: The study was a hospital-based descriptive cross-sectional study involving sixty term asphyxiated neonates and sixty gestational age-and sex-matched controls. The subjects were term neonates with five-minute Apgar score ≤ 6 and HIE while the controls were healthy term neonates with five-minute Apgar score > 6. Five-minute Apgar score was utilized to classify asphyxia into mild, moderate and severe asphyxia. The degree of encephalopathy was determined by modified Sarnat and Sarnat criteria. The serum cTnI was measured in subjects and controls at 12-24 hours of life using Enzyme-linked immunosorbent assay technique. The serum bilirubin levels were also measured in participants to exclude hyperbilirubinemia. RESULTS: The median serum cTnI levels was significantly higher in the subjects (0.56ng/mL; 0.25-0.94ng/mL) than in the controls (0.50ng/mL; 0.00-0.67ng/mL), respectively; p=0.001. Similarly, the median serum cTnI level in HIE stage II (0.56ng/mL; 0.38-0.72ng/mL) or III (0.56ng/ml; 0.50-0.94ng/mL) was also significantly higher than the median value in HIE stage I (0.38ng/mL;0.25-0.72ng/mL) or in controls (0.50ng/mL; 0.00-0.67ng/mL); p<0.001. There was significant positive correlation between serum cTnI levels and severity of HIE in asphyxiated neonates (rs = 0.505, p < 0.001). CONCLUSION: serum cTnI levels were elevated in severely asphyxiated neonates with HIE. The concentration of serum cTnI demonstrated significant positive correlation with HIE severity. Hence, the presence of HIE in asphyxiated neonates should prompt an evaluation for myocardial injury using serum cTnI. Any derangement noted should warrant instituting cardiovascular support in order to improve outcome and reduce asphyxia-related mortality.

Correlation between Lipid Profile and Left Ventricular Geometry and Function in Children with Chronic Kidney Disease.

BACKGROUND: Dyslipidaemia in children with chronic kidney disease is a risk factor for cardiovascular disease especially left ventricular hypertrophy. There have been conflicting reports on the association between serum lipid levels and left ventricular structure and function in children with chronic kidney disease. OBJECTIVES: This study is aimed to determine the correlation between lipid profile and left ventricular geometry and function in children with chronic kidney disease. The study first established lipid profile levels in children with chronic kidney disease (CKD) and compared them with those with normal renal and cardiac function. This was a cross-sectional comparative study carried out among children with CKD and age and sex-matched children without any renal or cardiac pathology as controls. RESULTS: The age range of the study population was 6-17 years with a mean of 12.33 ± 4.24 years, with no statistical difference between groups (t = 0.000, P = 1.000). Though lipid profile levels were higher in subjects with chronic kidney injury than controls, only TG (Triglycerides) was significantly higher in the subjects (1.9 ± 0.4mmol/l) when compared with controls (1.4 ± 0.2mmol/l). P =0.001. There was a positive correlation observed between serum very low-density lipoprotein (VLDL) and left ventricular mass index (LVMI), left ventricular posterior wall diameter (LVPWd), and left ventricular mass (LVM) in subjects r = 0.413, 0.409, 0.414 respectively. The TG/HDL ratio of subjects (1.4±0.4) was higher than controls (1.1 ± 0.1) and this was statistically significant (t = -2.6; p = 0.011). Furthermore, the NON-HDL/TC of subjects (0.8 ±0.1) was higher than that of controls (0.7±0.1) and this was statistically significant (t = -4.0; p <0.001). Finally, the NON-HDL/HDL of subjects (4.0 ± 1.4) was higher than that of controls (2.7 ± 0.5) and this was statistically significant (t -4.0; p<0.001). CONCLUSION: Serum triglycerides are the only lipoprotein that was noted to be significantly higher in children with chronic kidney disease when compared with controls. VLDL is the only lipoprotein with a significant correlation with left ventricular dimension, and hypertrophy. Children with CKD have higher TG/HDL, Non-HDL/ TC, and Non-HDL/HDL ratios than their normal counterparts.

BACKGROUND: La dyslipidémie chez les enfants atteints d'insuffisance rénale chronique est un facteur de risque de maladie cardiovasculaire, en particulier d'hypertrophie ventriculaire gauche. Il y a eu des rapports contradictoires sur l'association entre les taux de lipides sériques et la structure et la fonction ventriculaires gauches chez les enfants atteints d'insuffisance rénale chronique. OBJECTIFS: Cette étude vise à déterminer la corrélation entre le profil lipidique et la géométrie et la fonction ventriculaires gauches chez les enfants atteints d'insuffisance rénale chronique. L'étude a d'abord établi les niveaux de profil lipidique chez les enfants atteints d'insuffisance rénale chronique (IRC) et les a comparés à ceux ayant une fonction rénale et cardiaque normale. Il s'agissait d'une étude comparative transversale réalisée auprès d'enfants atteints d'IRC et d'enfants appariés selon l'âge et le sexe sans aucune pathologie rénale ou cardiaque comme témoins. RÉSULTATS: La tranche d'âge de la population étudiée était de 6 à 17 ans avec une moyenne de 12,33 ± 4,24 ans, sans différence statistique entre les groupes (t = 0,000, P = 1,000). Bien que les taux de profil lipidique étaient plus élevés chez les sujets atteints d'insuffisance rénale chronique que chez les témoins, seule la TG (triglycérides) était significativement plus élevée chez les sujets (1,9±0,4 mmol / l) par rapport aux témoins (1,4±0,2 mmol / l). P=0,001. Une corrélation positive a été observée entre les lipoprotéines sériques de très basse densité (VLDL) et l'indice de masse ventriculaire gauche (LVMI), le diamètre de la paroi postérieure ventriculaire gauche (LVPWd) et la masse ventriculaire gauche (LVM) chez les sujets r = 0,413, 0,409, 0,414 respectivement.Le rapport TG/HDL des sujets (1,4±0,4) était supérieur à celui des témoins (1,1±0,1) et cela était statistiquement significatif (t = -2,6 ; p = 0,011). De plus, la LAT/CT non HDL des sujets (0,8±0,1) était supérieure à celle des témoins (0,7±0,1) et cela était statistiquement significatif (t = -4,0; p <0,001). Enfin, le NON-HDL/ HDL des sujets (4,0±1,4) était supérieur à celui des témoins (2,7±0,5) et cela était statistiquement significatif (t -4,0 ; p <0,001). CONCLUSION: Les triglycérides sériques sont les seules lipoprotéines qui ont été notées pour être significativement plus élevées chez les enfants atteints d'insuffisance rénale chronique par rapport aux témoins. La VLDL est la seule lipoprotéine présentant une corrélation significative avec la dimension ventriculaire gauche et l'hypertrophie. Les enfants atteints d'IRC ont des rapports TG/HDL, Non-HDL/TC et Non-HDL/ HDL plus élevés que leurs homologues normaux. Mots-clés: Triglycérides sériques; Géométrie ventriculaire gauche; Fonction ventriculaire gauche, enfants; Profil lipidique.

Left Ventricular Function and Geometry of Children with Chronic Kidney Disease (CKD) in a Resource-Poor Setting of Africa.

BACKGROUND: Chronic Kidney Disease (CKD) is a multisystemic clinical condition characterized by an irreversible deterioration of renal function that invariably progresses to end-stage renal disease (ESRD). Cardiovascular affectation portends morbidity and mortality in chronic kidney disease. OBJECTIVE: The aim of the study was to compare the prevalence of changes in function, and geometry of the left ventricle in children with CKD and their controls. METHODOLOGY: This was a descriptive cross-sectional study. Children aged 6 to 17 years with features suggestive of CKD along with age and sex-matched apparently healthy controls seen at the University of Nigeria Teaching Hospital, Enugu were enrolled consecutively. Blood samples werecollected for baseline investigations and e-GFR, followed by trans-thoracic two-dimensional echocardiography to assess the left ventricular function and geometry. Data was analysed using the statistical package for social sciences (SPSS) version 17.0. Simple frequencies and proportions, Student's t-test and chi-square were applied appropriately. P value at <0.05 was significant. RESULTS: Out of 9,419 children aged 6-17 years seen within the study period in the hospital, 24 met the criteria for CKD. The incidence rate was 5 cases per million child population per year. Mean age was 12.33 ± 4.24 years, with a male to female ratio of 2:1. Left ventricular hypertrophy (LVH), eccentric LVH and Left ventricular dilatation (LVD) were seen in 50.0%, 33.3% and 41.7% of subjects respectively. Left ventricular diastolic dysfunction and left ventricular systolic dysfunction occurred in 37.5% and 8.3% subjects, respectively. CONCLUSION: Prevalence of left ventricular geometry and function abnormalities was high in subjects. Intervention measures are advocated.

CONTEXTE: La maladie rénale chronique (MRC) est un état clinique multisystémique caractérisé par une détérioration irréversible de la fonction rénale qui évolue invariablement vers l'insuffisance rénale terminale (IRT). L'atteinte cardiovasculaire est un facteur de morbidité et de mortalité dans la maladie rénale chronique. OBJECTIF: Le but de l'étude était de comparer la prévalence des changements de la fonction et de la géométrie du ventricule gauche chez les enfants atteints d'IRC et chez les témoins. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive transversale. Des enfants âgés de 6 à 17 ans présentant des caractéristiques suggérant une IRC, ainsi que des témoins apparemment sains, appariés par l'âge et le sexe, vus au University of Nigeria Teaching Hospital, Enugu, ont été inscrits consécutivement. Des échantillons de sang ont été prélevés pour les examens de base et l'e-GFR, suivis d'une échocardiographie trans-thoracique bidimensionnelle pour évaluer la fonction et la géométrie du ventricule gauche. Les données ont été analysées à l'aide du progiciel statistique pour les sciences sociales (SPSS) version 17.0. Les fréquences et proportions simples, le test t de Student et le chi-carré ont été appliqués de manière appropriée. La valeur P à <0,05 était significative. RÉSULTAT: Sur les 9 419 enfants âgés de 6 à 17 ans vus à l'hôpital pendant la période d'étude, 24 répondaient aux critères de l'IRC. Le taux d'incidence était de 5 cas par million d'enfants par an. L'âge moyen était de 12,33 ± 4,24 ans, avec un rapport hommes/femmes de 2:1. Une hypertrophie ventriculaire gauche (HVG), une HVG excentrique et une dilatation ventriculaire gauche (DVG) ont été observées chez 50,0 %, 33,3 % et 41,7 % des sujets respectivement. Une dysfonction diastolique du ventricule gauche et une dysfonction systolique du ventricule gauche ont été observées chez 37,5 % et 8,3 % des sujets, respectivement. CONCLUSION: La prévalence des anomalies de géométrie et de fonction du ventricule gauche était élevée chez les sujets. Des mesures d'intervention sont préconisées. Mots clés: Fonction ventriculaire gauche, Géométrie ventriculaire gauche, Maladie rénale chronique, Enfants.

Community-Acquired acute kidney injury in critically Ill children as seen in the emergency unit of a tertiary hospital in Enugu, Southeast Nigeria.

BACKGROUND: Acute kidney injury (AKI) has been shown to be common in critically ill patients with associated very poor outcome. There is paucity of data regarding its epidemiology, particularly in developing countries. This study aims to assess the presence of AKI among critically ill children to determine its prevalence, outcome, and outcome determinants in children suffering from AKI. PATIENTS AND METHODS: This is a cross-sectional observational study of critically ill children admitted to the children emergency unit of University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu. Critically ill children suffering from AKI were identified and classified using the pediatric RIFLE criteria. RESULT: A total of 300 children were studied. One hundred and eighty (60%) were males. The prevalence of AKI in the study population was 56%. Factors associated with AKI included age <5 years (OR = 3.618; 95% CI = 2.100-6.235; P < 0.001), inability to drink (OR = 2.866; 95% CI = 1.723-4.766; P < 0.001), tachycardia (OR = 2.111; 95% CI = 1.071-4.163; P = 0.031), unconsciousness (OR = 3.128, 95% CI = 1.303-7.511; P = 0.011), and hypotension (OR = 2.619; 95% CI = 1.008-6.804; P = 0.048). The odds of death increased with increasing severity of AKI among those who had pRIFLE-F, who were 24 times more likely to die than those with no AKI (OR = 24.38; 95% CI = 5.702-104.194; P = 0.001). CONCLUSION: The prevalence of AKI in the study population was unacceptably high. The risk factors to its occurrence can be determined from epidemiologic and clinical data, and therefore, clinicians attending to critically ill patients should identify those with AKI for early intervention to reduce the expected poor outcomes associated with its occurrence.