Relationship Between Serum Vitamin D Levels and Acute Pneumonia in Children Aged 1-59 Months in Nigeria.

INTRODUCTION: Acute pneumonia is a leading infectious cause of death among children under 5 years globally and in Nigeria. Despite various existing strategies and interventions, pneumonia mortality remains unacceptably high. Novel interventions like improving vitamin D status may be needed as optimal vitamin D status may facilitate the ability of immune cells to fight against infections like pneumonia. We investigated the relationship between serum vitamin D [25(OH)D] levels and acute pneumonia in children younger than 5 years in Nigeria. SUBJECTS AND METHODS: This cross-sectional study involved 135 children with pneumonia and 135 apparently healthy controls. Acute pneumonia was diagnosed using the revised World Health Organization criteria (2012) and chest radiological signs. Serum 25(OH)D concentrations were determined using a vitamin D ELISA kit. The mean serum 25(OH)D levels in both groups were compared and also determined odds ratio (OR) of pneumonia. RESULTS: The mean serum 25(OH)D level of children with pneumonia (52.14 ± 21.87 nmol/l) was significantly lower than that of controls (60.91 ± 32.65 nmol/l), p = 0.010. The proportion of children with low serum vitamin D levels (≤75.0 nmol/l) was significantly higher in the pneumonia group (n = 123, 91.1%) than the control group (n = 97, 71.9%), p < 0.001. After adjusting for confounders, serum 25(OH)D levels of greater than 75 nmol/l was associated with decreased odds of acute pneumonia (adjusted OR = 0.33, p = 0.007). CONCLUSION: A low vitamin D level was associated with increased risk of acute pneumonia. Lay summary. INTRODUCTION: Chest infection (pneumonia) is a leading cause of death in children younger than 5 years of age globally and also in Nigeria. Pneumonia death is still very high despite all the existing efforts at reducing it. New methods may still be needed to drastically reduce this problem. One of these new methods may include improving the vitamin D status of an individual because optimal vitamin D levels may help the body to fight against infections like pneumonia. We investigated the relationship between blood levels of vitamin D and pneumonia in children younger than 5 years. SUBJECTS AND METHODS: Vitamin D levels of 135 children with pneumonia were measured and compared with vitamin D levels of another 135 healthy children without pneumonia. We diagnosed pneumonia by using both revised World Health Organization criteria (2012) and chest X-rays signs. Blood levels of vitamin D were measured using a vitamin D ELISA kit. RESULTS: The average blood vitamin D level of children with pneumonia (52.14 ± 21.87 nmol/l) was low compared with that of children without pneumonia (60.91 ± 32.65 nmol/l), p = 0.010. The number of children with low blood vitamin D levels (≤75.0 nmol/l) was more in the pneumonia group (n = 123, 91.1%) than in children without pneumonia (n = 97, 71.9%), p < 0.001. After adjusting for other potential risk factors, blood level of vitamin D >75 nmol/l was associated with lower risk of having pneumonia, (adjusted OR = 0.33, p = 0.007). CONCLUSION: A low vitamin D level was associated with increased risk of acute pneumonia.

Sarcomatoid Renal Cell Carcinoma in an Adolescent with Sickle Cell Anaemia.

Malignancies have been reported to occur in people with sickle cell disease. Renal medullary carcinoma (RMC), also tagged seventh sickle cell nephropathy, is an aggressive cancer seen almost exclusively in people with sickle cell disease with more than 160 cases reported worldwide, but only few cases were reported in patients with sickle cell anaemia (HBSS) and from Nigeria. Sarcomatoid renal cell carcinoma is a renal tumour of any histologic variant containing foci of high-grade malignant spindle cells. We report an adolescent girl with sickle cell anaemia (HBSS) who presented with left renal tumour, histology of which confirmed a diagnosis of sarcomatoid renal cell carcinoma (sRCC). Surgical debulking and palliative care with chemotherapy were given, and she demised 10 months after. The rarity of the case and challenges of managing a cancer in the background of a chronic haematologic disorder are highlighted.

Ocular findings in children with severe clinical symptoms of homozygous sickle cell anaemia in Kaduna, Nigeria.

BACKGROUND: Sight-threatening retinopathy in Sickle Cell Disease is thought to be due mainly to vasoocclusion. Yet it is reportedly rarely found in children with Haemoglobin SS, (who most often suffer from vasoocclusion). However, earlier reports included patients with a wide range of clinical severity. AIM: To document ocular pathology in children with Haemoglobin SS with severe clinical disease. METHODS: Thirty-seven children with severe clinical disease (at least 3 vaso-occlusive episodes in one year) had detailed ocular examinations over a one-year period. RESULTS: No child (aged 3 to 13 years) had ocular symptoms. Visual acuity was abnormal in one child. Retinal pathology was found only in patients over 8 years. Neovascularization was observed in 3 eyes of 2 patients both of whom had higher than average irreversibly sickled cell counts and haemoglobin levels. Retinal and choroidal infarcts were found in 11 and 2 eyes respectively; sunburst lesions and salmon patch haemorrhages in 5 eyes each. Changes observed over the one-year period in the 32 survivors, were photocoagulation scars in one eye of a child who had undergone laser therapy and resolution of the salmon patch haemorrhages. CONCLUSION: Despite lack of visual symptoms, young children with haemoglobin SS with severe clinical symptoms can develop sight-threatening retinopathy. The possible role of autoinfarction in the causation of these lesions is discussed. Our study shows that routine yearly ophthalmological examinations are essential for children over 8 years.

Ocular findings in children with severe clinical symptoms of homozygous sickle cell anaemia in Kaduna; Nigeria

Background: Sight-threatening retinopathy in Sickle Cell Disease is thought to be due mainly to vasoocclusion. Yet it is reportedly rarely found in children with Haemoglobin SS; (who most often suffer from vasoocclusion). However; earlier reports included patients with a wide range of clinical severity. Aim: To document ocular pathology in children with Haemoglobin SS with severe clinical disease. Methods: Thirty-seven children with severe clinical disease (at least 3 vaso-occlusive episodes in one year) had detailed ocular examinations over a one-year period. Results: No child (aged 3 to 13 years) had ocular symptoms. Visual acuity was abnormal in one child. Retinal pathology was found only in patients over 8 years. Neovascularization was observed in 3 eyes of 2 patients both of whom had higher than average irreversibly sickled cell counts and haemoglobin levels. Retinal and choroidal infarcts were found in 11 and 2 eyes respectively; sunburst lesions and salmon patch haemorrhages in 5 eyes each. Changes observed over the one-year period in the 32 survivors; were photocoagulation scars in one eye of a child who had undergone laser therapy and resolution of the salmon patch haemorrhages. Conclusion: Despite lack of visual symptoms; young children with haemoglobin SS with severe clinical symptoms can develop sight-threatening retinopathy. The possible role of autoinfarction in the causation of these lesions is discussed. Our study shows that routine yearly ophthalmological examinations are essential for children over 8 years

Changing patterns in sensitivity of causative organisms of septicaemia in children: the need for quinolones.

A review of the pattern, and antibiotic sensitivities of blood culture isolates over a 3 year period in children presenting to the Paediatric Unit of Ahmadu Bello University Teaching Hospital, Kaduna is reported. Positive blood culture isolates were obtained in 26.9% of 1,982 children. The most prevalent isolates were Staphylococcus aureus (59.9%), Escherichia coli (16.9%) and Klebsiella (16.3%). There was a striking paucity of isolation of Salmonella typhi (1.3%) and Streptococcus. Sensitivity to commonly used drugs like ampicillin/cloxacillin, genticin, ceftazidime and chloramphenicol was low (8.0-50.0%), with a corresponding delayed fever resolution and prolonged hospital stay. 31.0-83.3% of the isolates were highly sensitive to pefloxacin, norfloxacin and ofloxacin, which were not generally recommended for use in paediatric patients. In two patients with no response to commonly used antibiotics, use of quinolones lysed their fever within 48 hours. This change of antibiotic sensitivity patterns calls for a thorough investigation into the potential role of these quinolones in paediatric chemotherapeutics either singly or in appropriate combinations with existing antibiotics.

Why healthcare workers give prelacteal feeds.

OBJECTIVE: Because prelacteal feeds can adversely affect breastfeeding, UNICEF/WHO discourage their use unless medically indicated. The study was carried out to determine the proportion of healthcare workers who routinely give prelacteal feeds, and their reasons for doing so; further, to determine whether any differences exist between medically and non-medically trained healthcare workers in their administration of prelacteal feeds. DESIGN: Survey. SETTING: Primary, secondary and tertiary health facilities in Kaduna township Nigeria. SUBJECTS: Of 1100 healthcare workers sampled, 747 (68%) responded. Of these 80% had received medical training, 20% had not. METHODS: Use of a pretested validated questionnaire. RESULTS: Large proportions of both medical and non-medically trained healthcare workers stated they routinely give prelacteal feeds (doctors, 68.2%; nurses, 70.2%; and non-medical, 73.6%). However their reasons for doing so differed significantly (P=0.00001). Nurses gave mainly for perceived breast milk insufficiency, doctors for prevention of dehydration, hypoglycaemia and neonatal jaundice and non-medical staff to prepare the gastrointestinal tract for digestion and to quench thirst. CONCLUSIONS: Most healthcare workers (medical and non-medical) routinely and unnecessarily give prelacteal feeds. Therefore training and retraining programmes in lactation management are necessary and must include non-medical staff. These programmes, while emphasizing the danger of giving prelacteal feeds, must deal with the misconceptions of each group. Deliberate efforts have to be made to incorporate clinical training in breastfeeding in curricula of Schools of Medicine and Nursing.

Variation in the pattern of bacterial infection in patients with sickle cell disease requiring admission.

In order to determine the prevalence and pattern of bacterial infections in children with sickle cell disease (SCD) admitted with acute illness, a prospective study of 304 sicklers aged 3 months to 15 years was carried out over 1 year in the emergency pediatric unit of ABU Teaching Hospital Kaduma. Initial blood and urine cultures were obtained in all cases and other cultures were performed as determined by the patients' clinical condition. Almost 60 per cent of the patients had positive bacterial cultures with gram negative organisms accounting for 55 per cent of them, but the single most predominant organism isolated was Staphylococcus aureus. Of note was the strikingly low isolation rate of Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitides. Possible reasons for this difference from the majority of reports from the western World are advanced and the implications discussed, especially as regards vaccination programmes in sickle cell disease and initial antibiotic treatment of those with acute illness.