HIV-Associated Nephropathy among Children with Renal Disease in Port Harcourt, Nigeria.

INTRODUCTION: Human Immunodeficiency Virus (HIV) infects multiple tissues of the body, including the renal parenchyma, with HIV-associated Nephropathy (HIVAN) being the most common form of the HIV-related renal disease and an important cause of End Stage Renal Disease (ESRD) in HIV infected patients. There is paucity of studies on HIVAN among children with renal diseases, most studies on HIVAN focused on prevalence among HIV patients with vertical transmission being the commonest route. We undertook this study to determine the prevalence and impact of HIVAN among our renal patients and to highlight the new route of HIV transmission observed in these group of patients in Port Harcourt, Southern Nigeria. MATERIALS AND METHODS: The study was conducted among renal patients managed in the Paediatric department of the University of Port Harcourt Teaching Hospital from December 2016 to March 2019. The information on the HIVAN patients were stored and retrieved from the renal register where all cases of renal diseases were enrolled. The diagnosis of HIVAN was made based on presence of significant proteinuria (≥ 1+), with one or more of the following: abnormal microscopic examination of urinary sediments, rising serum creatinine, renal ultrasound finding of enlarged echogenic kidneys and histology finding of focal segmental glomerulosclerosis. The patient's sociodemographic data, clinical presentation, route of transmission of HIV, laboratory investigations, treatment, and clinical outcome were obtained and analysed using SPSS version 25.0. RESULTS: There were 112 cases of renal diseases seen during the study period of which 10 (8.9%) had HIVAN. The HIVAN patients were aged between 4-17years. Four (40%) of these HIVAN cases had CKD of which 2 (20%) had ESRD. The route of transmission of HIV was vertical (mother-to-child) in 8 patients and via sexual route in two older male patients aged 17years who were homosexuals. Mortality rate among the HIVAN patients was 30%, with 2 (20%) lost to follow up. CONCLUSION: There is a rising prevalence of HIVAN among paediatric patients with renal diseases in our environment, with homosexuality being a new route of HIV transmission observed in the older patients.

INTRODUCTION: Le virus de l'immunodéficience humaine (VIH) infecte plusieurs tissus du corps, y compris le parenchyme rénal, la néphropathie associée au VIH (VIHAN) étant la forme la plus courante d'insuffisance rénale liée au VIH et une cause importante de maladie rénale en phase terminale (IRT) chez les patients infectés par le VIH. Il y a peu d'études sur le VIHAN chez les enfants atteints de maladies rénales, la plupart des études sur le VIHAN se concentrant sur la prévalence chez les patients VIH avec transmission verticale étant la voie la plus courante. Nous avons entrepris cette étude pour déterminer la prévalence et l'impact du VIHAN chez nos patients rénaux et pour mettre en évidence la nouvelle voie de transmission du VIH observée dans ce groupe de patients à Port Harcourt, dans le sud du Nigeria. MATÉRIAUX ET MÉTHODES: L'étude a été menée auprès de patients rénaux pris en charge dans le service de pédiatrie de l'hôpital universitaire de l'Université de Port Harcourt de décembre 2016 à mars 2019. Les informations sur les patients VIHAN ont été stockées et extraites du registre rénal où tous les cas de maladies rénales ont été inscrits. Le diagnostic de VIHAN a été posé sur la base de la présence d'une protéinurie significative (≥ 1+), avec un ou plusieurs des éléments suivants: examen microscopique anormal des sédiments urinaires, augmentation de la créatinine sérique, détection par échographie rénale de reins échogènes hypertrophiés et observation histologique du segment focal glomérulosclérose. Les données sociodémographiques, la présentation clinique, la voie de transmission du VIH, les examens de laboratoire, le traitement et les résultats cliniques du patient ont été obtenus et analysés à l'aide de la version 25.0 de SPSS. RÉSULTATS: Il y a eu 112 cas de maladies rénales observés au cours de la période d'étude, dont 10 (8,9%) avaient HIVAN. Les patients HIVAN étaient âgés de 4 à 17 ans. Quatre (40%) de ces cas de VIHAN avaient une IRC dont 2 (20%) avaient une IRT. La voie de transmission du VIH était verticale (mère-enfant) chez 8 patients et par voie homosexuelle chez deux patients masculins âgés de 17 ans. Le taux de mortalité parmi les patients VIHAN était de 30%, avec 2 (20%) perdus de vue. CONCLUSION: Il y a une prévalence croissante du VIHAN chez les patients pédiatriques atteints de maladies rénales dans notre environnement, l'homosexualité étant une nouvelle voie de transmission du VIH observée chez les patients plus âgés. MOTS CLÉS: Néphropathie associée au VIH, prévalence, résultat, homosexualité.

Pattern of blood pressure and hypertension in adolescents in Port Harcourt, Nigeria.

BACKGROUND: The rate and prevalence of hypertension in children is increasing. Childhood hypertensionif untreated can lead to hypertension in adulthood with its consequent cardiovascular and renal complications. Early detection of paediatric hypertension may lead to improvement in cardiovascular health in adults. OBJECTIVE: This study aims to determine the blood pressure (BP) pattern and prevalence of hypertension in asymptomatic secondary school children and factors associated with hypertension in these adolescents. METHODS: A cross-sectional study of 820 adolescents selected from 12 secondary schools in Port Harcourt was conducted. BP was measured by the auscultatory method. The average of three readings was taken as the actual blood pressure. Hypertension was defined as systolic and/or diastolic blood pressures equal to or greater than the 95th percentile for age, sex and height. Data was analysed using SPSS version 17.0. RESULTS: Systolic and diastolic BP increased with age in all subjects. Male subjects had a higher systolic BP compared to females. Hypertension was seen in 26 (3.2%) subjects; 13 males and 13 females. The proportional prevalence was higher in the age group 15-17 years (3.9%); in those in social classes V (9.1%) and with family history of hypertension (3.6%), (p à 0.05 in all cases). It was however significantly higher in the obese subjects (p = 0.000). CONCLUSION: The prevalence of hypertension in adolescents in Port Harcourt is high and is strongly associated with obesity. We recommend blood pressure measurement as part of the school health programme in secondary schools.

Prevalence of microalbuminuria among secondary school children.

BACKGROUND: Microalbuminuria is an early sign of kidney and cardiovascular damage. Therefore, early detection in asymptomatic individuals may be helpful in preventing deterioration in renal function. METHODS: We carried out a cross-sectional study of 820 secondary school students aged 10 - 19 years from September to November 2008. The urine samples of 615 (75.0%) without overt proteinuria and haematuria were tested for microalbuminuria using the micral test strips. Values of greater than 20mg/L were considered positive. RESULTS: There were 299 (48.6%) males and 316 (51.4%) females, with a M:F ratio of 1:1.1. The prevalence of microalbuminuria as seen in 214 of the students was 33.2%. It was significantly higher in females (45.3%), obese subjects (35.4%), those with hypertension (70.6%), those with positive family history of hypertension (59.5%), and diabetes mellitus (46.4%). Microalbuminuria was found in 1 of the 2 subjects who had features of DM and in one subject with sickle cell anemia. CONCLUSION: The prevalence of microalbuminuria in Nigerian adolescents is high. We recommend routine screening for microalbuminuria in adolescents for early detection and prevention of renal damage.

Familial focal segmental glomerulosclerosis (FSGS) in a Nigerian family and exclusion of mutations in NPHS2,WT1 and APOL1.

BACKGROUND: Focal segmental glomerulosclerosis (FSGS) is a significant cause of end-stage renal disease. It is generally considered to be sporadic but familial cases have been reported in varied ethnic groups. Genetic mutations implicated in familial FSGS involving NPHS1, NPHS2, WTI and APOL1 have not been studied in African children living outside America. This is the first report of familial FSGS and genetic study from children living in Africa. CASE REPORT: We reported two siblings; a 4-year old male and a 15-year old female from a non-consanguineous family with renal biopsy-confirmed FSGS who presented with Nephrotic syndrome (NS). The male was steroid dependent NS and achieved long term remission after two courses of oral cyclophosphamide, while the elder sister is steroid resistant and has not achieved remission with cyclosporine. We performed mutational analysis on the family by sequencing both strands of all exons of NPHS2, WT1 and APOL1 using exon flanking primers. There was absence of common gene mutations in NPHS2, WT1 and APOL1 gene in any of the two children. CONCLUSION: We present for the first time mutational analysis of NPHS2, WT1 and APOL1 in a sibling with familial FSGS from Nigeria. There may be different and unidentified gene mutations responsible for FSGS in indigenous African children.

Microalbuminuria in children with human immunodeficiency virus (HIV) infection in Port Harcourt, Nigeria.

BACKGROUND: Microalbuminuria is an early manifestation of HIV associated nephropathy (HIVAN). This study was to determine the prevalence and risk factors for microalbuminuria in children with HIV infection in Port Harcourt, Nigeria. METHODS: Urine specimen of 50 children with HIV infection seen over a 4 months period (October 2007-February 2008) was assayed for albumin and creatinine to determine urinary albumin to creatinine ratio (ACR). Microalbuminuria was defined as urinary albumin to creatinine ratio (ACR) of greater than 2.5-25 mg/mmol. The glomerular filtration rate (GFR) was calculated using the Schwartz formula. RESULTS: There were 28 (56%) males and 22 (44%) females with a male to female ratio of 1.3:1. They aged 1 month to 18 years with a mean age of 4.07 +/- 3.61 years. Microalbuminuria occurred in 6 (12%) patients; 3 males and 3 females, mean age of 5.5 +/- 4.6 years. Five (83.3%) of the patients with microalbuminuria had clinical AIDS and CD4+ cell count less than 200 cells/microL. All the patients with microalbuminuria were not receiving highly active antiretroviral therapy (HAART) at the time of study. One (16.7%) patient had overt HIV-associated nephropathy (HIVAN) with ACR greater than 2.5 mg/mmol, elevated serum creatinine 400 micrommo/L, urea of 20 mmol/L and a GFR of 69 ml/min/1.73m2. CONCLUSION: The prevalence of microalbuminuria in Nigerian children with HIV infection is high, and it occurs mainly in older children with clinical AIDS who are not on HARRT.

Simple Vision Screening in Lower Primary School Children in Port Harcourt City

Background: Vision disorders are significant causes of morbidity worldwide and in children; can lead to life long visual impairment or blindness. Thus; the impact on a child's education and life if not detected and ameliorated on time; can constitute a huge socio-economic burden to the child; family and community. Aim: To determine the prevalence of reduced vision in lower primary school children in Port Harcourt city. Methods: A multi-staged sampling technique was used to select 1;234 lower primary school pupils from 12 schools in Port Harcourt for visual screening. Visual acuity (VA) measurements using Snelling's charts; and a basic eye examination using a pen torch was carried out in all the pupils. Vision was regarded as reduced if VA is 6/18; in which case a pinhole was presented to the affected eye and VA repeated; to check for presence of refractive error. Results: A total of 1;234 school children were screened; 73 pupils had reduced vision in one or both eyes giving a prevalence of 5.9. Refractive errors accounted for 72.6of cases of reduced vision. Gross external eye abnormalities accounted for 9.6of cases of reduced vision; with corneal opacity and nystagmus being the most commonly seen. Conclusion: Reduced vision is an important cause of visual disability in primary school pupils in Port Harcourt city; mostly due to correctable refractive errors. There is therefore a need for routine vision screening of all pupils; especially on commencement of school for early detection and treatment; to prevent life long visual disability

Pattern of endocrine diseases in children at the University of Port Harcourt Teaching Hospital

Background: Endocrine disorders (ED) vary greatly in their prevalence according to age and gender. Although most of these disorders are uncommon; they usually run a chronic course; contributing to long term morbidity and ultimately mortality if not recognized and treated early. Aim: To determine; the pattern of ED in children seen at the University of Port Harcourt Teaching Hospital (UPTH). Methods: We reviewed the case files of patients seen in the Paediatric Endocrinology clinic of the UPTH from July 2001 to July 2007.The information obtained were patients' characteristics; diagnosis; management and outcome. Diagnosis of each disorder was based on clinical features; relevant laboratory investigations and imaging studies. Results: Thirty patients were seen with various endocrine disorders. They comprised 13 (43.3) males and 17 (56.7) females with a M: F ratio of 1:1.3. Their ages ranged from 10 months to 16 years. Diabetes mellitus (DM) was the commonest disorder seen in 14 (46.7) patients. This was followed by disorders of puberty and thyroid gland in 12 (40) and 4 (13.3) patients respectively. Delayed puberty was the commonest disorder of puberty seen in 4(33.3) of the patients. This was followed by premature thelarche and gynaecomastia in 3(25) patients each. One female (8.3) had precocious puberty. The patients with diabetes had Type 1 DM and all except for one patient received insulin injection. There was delay in the diagnosis of congenital hypothyroidism and lack of drugs for the treatment of some pubertal disorders in our environment. Conclusion: This study shows that endocrine disorders do occur in children in our environment. A high index of suspicion is therefore required for early diagnosis. There is also need for provision of hormone therapy (HT) for children with pubertal disorders in Nigeria

Screening for congenital color vision deficiency in primary children in Port Harcourt City; teachers' knowledge and performance.

BACKGROUND: One hundred and thirty teachers were studied to evaluate their knowledge of congenital Color Vision Deficiency (CVD), and their ability to perform the Ishihara color vision test, so as to determine if they can provide color vision screening services for their pupils. METHODS: The teachers were randomly selected from 13 schools in Port Harcourt City (PHC) and given a six hours training workshop on vision disorders in children and congenital color vision screening. They were given a self administered pre and post test questionnaires before and after training respectively. Subsequently, they screened 1,300 of their school pupils for congenital vision deficiency using the Ishihara color vision chart; and their results compared to that of the research team. RESULTS: Female teachers constituted 84.6% and males 15.4% of the study population. Seventy three teachers (53.8%) were from public schools while 46.2% were from private schools. Prior to the training workshop, only 6.2% of teachers had heard of the Ishihara color vision chart and none of the teachers could identify or knew how to use the chart. However with training there was significant improvement in knowledge of CVD. Comparison of the teachers' performance of color vision screening using the Ishihara chart to that of the research team showed a sensitivity of 67.6% with a specificity of 99.1%. The prevalence of congenital color vision deficiency in the 1,300 primary school screened was 2.6%, with males having a significantly higher prevalence than females. CONCLUSION: The study thus concludes that congenital color vision deficiency is prevalent amongst primary school children in Port Harcourt City, and with training, teachers can effectively perform color vision screening, and as such modify their teaching methods to accommodate the child with color vision deficiency.

Development and validation of standardized clinical summary format.

BACKGROUND: The use of a structured guideline in medical education to reach a diagnosis provides accurate information which is relatively free from bias. The purpose of this paper is to assess the performance of medical students using unstructured and structured format in case summary. METHODS: One hundred and sixty- nine medical students in Part III MB; BS Programme in the University of Port Harcourt were studied. There were 83 students in Paediatics [SP] and 86 students in Obstetrics and Gynaecology [SOG] postings. The students had video recorded presentation of three clinical cases comprising of two paediatrics [PC1&PC2] and one surgical case [SC3]. The summary for the first case [PC1] was done using an unstructured format, while the second case [PC2] was done with both unstructured PC2a and structured PC2b format. The Surgical case [SC3] was done using only the structured format. The discrete pieces of important information in each case were quantified and scored by trained assessors. PC1and SC3 had a total of 16 points each while PC2 had a total of 24 points. RESULT: The pre-exposed SOG students scored significantly higher than none-exposed SPG students in PC1 and SC3; P<0.05. In PC2 75.1% students scored above 12 points using structured summary format compared to 38.5% students with unstructured format , P<0.05. The students had significantly higher score using structured format in SC3 than PC1. CONCLUSION: The use of structured summary format enabled better case summary than unstructured format, and it's transferable across different departments.

Screening for Congenital Color Vision Deficiency in Primary Children in Port Harcourt City; Teachers' knowledge and performance

Background: One hundred and thirty teachers were studied to evaluate their knowledge of congenital Color Vision Deficiency (CVD); and their ability to perform the Ishihara color vision test; so as to determine if they can provide color vision screening services for their pupils. Methods: The teachers were randomly selected from 13 schools in Port Harcourt City (PHC) and given a six hours training workshop on vision disorders in children and congenital color vision screening. They were given a self administered pre and post test questionnaires before and after training respectively. Subsequently; they screened 1;300 of their school pupils for congenital vision deficiency using the Ishihara color vision chart; and their results compared to that of the research team. Results: Female teachers constituted 84.6and males 15.4of the study population. Seventy three teachers (53.8) were from public schools while 46. 2were from private schools. Prior to the training workshop; only 6.2of teachers had heard of the Ishihara color vision chart and none of the teachers could identify or knew how to use the chart. However with training there was significant improvement in knowledge of CVD. Comparison of the teachers' performance of color vision screening using the Ishihara chart to that of the research team showed a sensitivity of 67.6with a specificity of 99.1. The prevalence of congenital color vision deficiency in the 1;300 primary school screened was 2.6; with males having a significantly higher prevalence than females. Conclusion: The study thus concludes that congenital color vision deficiency is prevalent amongst primary school children in Port Harcourt City; and with training; teachers can effectively perform color vision screening; and as such modify their teaching methods to accommodate the child with color vision deficiency

Double diabetes: an emerging disease in children and young adults

Background: Studies in most countries have shown an increasing incidence of diabetes mellitus in children and young adults. Double diabetes is a newly recognized problem in children with different diagnostic and therapeutic measures. Methods: A review of over 30 literature obtained from Google; PUBMED search and journal publications on ""double diabetes"" was done to determine the incidence; pathophysiology; pathogenesis; diagnostic criteria; treatment and prevention of double diabetes in children and young adults. Results: Most of the reports on double diabetes were from western countries and Asia. Type 1 diabetes resulting from antibodies to the insulin-producing pancreatic beta cell was more prevalent in children. However; with increasing obesity the incidence of type 2 diabetes resulting from insulin resistance was high in children and young adults. Most patients with double diabetes were established type 1 diabetics; who while on insulin and on hypercaloric diet developed obesity especially during puberty and hence associated type 2 diabetes. The incidence was more in black than in white children. They presented with some clinical and laboratory features of both types 1 and 2 diabetes. Some authors advocated treatment with both insulin and oral hypoglycaemic drugs mainly metformin to improve insulin sensitivity. Prevention of childhood obesity by encouraging physical activities and dietary control would prevent double diabetes. Conclusion: Double diabetes is increasing in children and young adults. A high index of suspicion is required in obese children with diabetes

Paediatric acute peritoneal dialysis in southern Nigeria.

BACKGROUND: Acute peritoneal dialysis (APD) is the preferred treatment for isolated failure of the kidney. The authors reviewed children with acute renal failure (ARF) who had APD in Port Harcourt, Nigeria. RESULTS: 221 patients, 147 boys and 74 girls (M: F, 1.99:1), mean (SD) age 5.4 (4.9) years had ARF. Dialysis was indicated in 112 cases. The main clinical indication being convulsion/uraemia 30 (26.8%) Only 27 patients (21 boys and 6 girls) had APD, giving an access rate of 24.1%. The commonest dialysis related complication was catheter malfunction 12 (44.4%). The mortality rate among the dialysed patients was 22.2%. Lack of dialysis and intractable hypertension significantly increased mortality (chi2 = 7.13, p<0.01) and (chi2 = 14.9, p<0.001) respectively. CONCLUSION: APD is effective in reducing mortality of children with ARF. However, there were low dialysis access rate and few complications.

Nocturnal enuresis among secondary school students in Port Harcourt, Nigeria

Background: Enuresis is a common problem in children. The impact upon the lives of children and their families is often underestimated. Aim: The study was to determine the prevalence; causes and effect of enuresis among students in Port Harcourt. Methods : A survey of junior and senior students from 2 secondary schools in Port Harcourt Local Government area was done using self-administered questionnaire. Results: A total of 491 students between the ages of 10-21years were studied. There were 248 (50.5) females and 243(49.5) males. Nocturnal enuresis (NE) was reported in 124(25.3) students; out of which 59(47.6) had primary NE. NE was significantly more in males than in females and in those from polygamous homes(c2=7.29; df = 1; p0.01 and c2 ) students. Non-organic causes of secondary NE include parental separation 12 (9.7); divorce 16 (12.9) and death in the family 4 (3.2). Enuresis affected 75 (60.5) of the students; as well as their parents. Fifty (40.3) students felt embarrassed about bedwetting and in 27 (21.8) students the parents were very angry and had to beat them. Treatment offered included prayers in 44 (35.6) and waking at night in 15 (12.1). Conclusion: Enuresis is a common problem among secondary students in Port Harcourt. Secondary nocturnal enuresis is more prevalent; and stressful to both the sufferer and the parents

Prevalence of sexual activity and outcome among female secondary school students in Port Harcourt, Nigeria.

Sexual activity among 534 Nigerian female secondary school students was studied using self-administered questionnaire. Prevalence of sexual intercourse was 25.7%. There was no significant difference between the junior (48.2%) and senior (51.8%) students (p > 0.05). Seventeen (12.4%) students had initiated sexual intercourse before 11 years. The frequency of sexual exposure was high, with 34.3% of the students having intercourse more than once in a week. Pregnancy rate among sexually active females was 27.0%, with 24.8% rate of induced abortion. Early sexual health education starting from primary school would be helpful in influencing the reproductive decisions and sexual behaviour of the students, including contraceptive acceptance and usage, to avoid teenage pregnancy. Education of parents is also recommended in order to overcome the cultural barriers that discourage parents from providing sex education to their children at home.