Risk Factors of Metabolic Syndrome among Normal Weight Adolescents in Lagos, Nigeria.

BACKGROUND: In the last few decades, the global disease epidemiology shift has resulted in the preponderance of noncommunicable diseases such as Metabolic Syndrome (MetS). Globally, an increasing prevalence is reported among children and adolescents in whom the condition was once rare. There is a dearth of data in Nigeria on MetS, especially among normal-weight adolescents. OBJECTIVE: To determine the prevalence and risk factors of MetS among normal-weight adolescents attending secondary schools at Mushin Local Government, Lagos. METHODS: This descriptive cross-sectional study recruited adolescents using a multi-stage sampling technique. Self-administered questionnaires were used to obtain data on socio-demographic characteristics, physical activity, medical, family and dietary history. Waist circumference (WC), was measured from the midpoint between the lowest rib and the top of the iliac crest to determine central obesity, Body mass index was calculated as weight (in kilograms) divided by height (in meters2), and the World Health Organization (WHO) growth charts were used to determine their BMI percentiles. An appropriately sized bladder cuff of a sphygmomanometer was used in obtaining the blood pressure. RESULTS: A total of 259 normal-weight adolescents were recruited. The mean ± SD of participants was 13.6 ± 2.3 years. The prevalence of MetS among participants was 2.7%. The most common cardiometabolic risk factors were central obesity and elevated blood pressure in 7.7% and 7.3% of participants. Physical activity was significantly associated with a lower prevalence of MetS. A family history of hypertension and diabetes in first-degree relatives was significantly associated with MetS. CONCLUSION: Metabolic syndrome was documented among apparently healthy normal-weight adolescent. A family history of hypertension or diabetes and physical inactivity were significantly associated with metabolic syndrome in study participants.

CONTEXTE: Au cours des dernières décennies, le changement épidémiologique mondial des maladies a entraîné la prépondérance des maladies non transmissibles telles que le syndrome métabolique (MetS). À l'échelle mondiale, une prévalence croissante est signalée chez les enfants et les adolescents chez qui cette maladie était autrefois rare. Il y a une pénurie de données au Nigeria sur le MetS, en particulier chez les adolescents de poids normal. OBJECTIF: Déterminer la prévalence et les facteurs de risque du MetS chez les adolescents de poids normal fréquentant les écoles secondaires du gouvernement local de Mushin, à Lagos. METHODES: Cette étude transversale descriptive a recruté des adolescents à l'aide d'une technique d'échantillonnage à plusieurs degrés. Des questionnaires auto-administrés ont été utilisés pour obtenir des données sur les caractéristiques sociodémographiques, l'activité physique, les antécédents médicaux, familiaux et alimentaires. Le tour de taille (WC) a été mesuré à partir du point médian entre la côte la plus basse et le haut de la crête iliaque pour déterminer l'obésité centrale. L'indice de masse corporelle a été calculé comme le poids (en kilogrammes) divisé par la taille (en mètres2), et l'indice mondial de santé Les courbes de croissance des organisations (OMS) ont été utilisées pour déterminer leurs centiles d'IMC. Un brassard vésical de taille appropriée d'un sphygmomanomètre a été utilisé pour obtenir la tension artérielle. RESULTATS: Au total, 259 adolescents de poids normal ont été recrutés. La moyenne ± écart-type des participants était de 13,6 ± 2,3 ans. La prévalence du MetS parmi les participants était de 2,7 %. Les facteurs de risque cardiométaboliques les plus courants étaient l'obésité centrale et l'hypertension artérielle chez 7,7 % et 7,3 % des participants. L'activité physique était significativement associée à une prévalence plus faible du MetS. Des antécédents familiaux d'hypertension et de diabète chez des parents au premier degré étaient significativement associés au MetS. CONCLUSION: Un syndrome métabolique a été documenté chez des adolescents de poids normal apparemment en bonne santé. Des antécédents familiaux d'hypertension ou de diabète et l'inactivité physique étaient significativement associés au syndrome métabolique chez les participants à l'étude. MOTS CLES: Syndrome métabolique ; Adolescents ; Poids normal; facteurs de risque cardiométaboliques.

Sexual Maturation of Female Adolescent Patients with Sickle Cell Anaemia in Lagos, Nigeria.

BACKGROUND: Sickle cell anaemia (SCA) has been shown to have adverse effects on growth and sexual development. Recent Nigerian studies have reported a declining trend in the age of sexual maturation and menarche in haemoglobin AA (HbAA) individuals. OBJECTIVE: To evaluate the sexual maturation of female patients with SCA aged 10 to 19 years seen at Lagos University Teaching Hospital Idi-Araba, Lagos and Sickle Cell Foundation. METHODS: It was a cross-sectional study involving 140 girls with SCA (subjects) and an equal number of girls with HbAA (controls) who were matched for age and socio-economic class over a fivemonth period. The evaluation involved anthropometry, calculation of BMI and determination of breast and pubic hair development using Tanner staging. RESULTS: The mean BMI for the subjects was 17.2±2.39 kg/m2and 20.2±3.09 kg/m2 for the controls (p < 0.001). The mean age at onset of breast development (B2) was 13 ± 0.39 years in the subjects and 10.5 ± 0.51 years in the controls (p < 0.001). The corresponding mean age for pubic hair development (PH2) was also higher at 13.8 ± 0.59 years for the girls with SCA and 10.4 ± 0.51 years for the controls (p <0.001), while menarche was achieved in the subjects at 14.7 ± 1.68 years and in the controls at 12.3 ± 1.33 years (p < 0.001). Upper socioeconomic class was associated with earlier menarche and faster transition from pre-pubertal stage to pubertal stage of sexual maturation in the controls but was not observed in the SCA subjects. CONCLUSION: Sexual maturity in patients with SCA lagged behind those of the HbAA controls.

CONTEXTE: Il a été démontré que la drépanocytose (ACS) a un effet néfaste sur la croissance et le développement sexuel. Des études nigérianes récentes ont rapporté une tendance à la baisse de l'âge de maturation sexuelle et de la ménarche chez les individus hémoglobine AA (HbAA). OBJECTIF: Évaluer la maturation sexuelle de patientes atteintes d'ACS âgées de 10 à 19 ans vues à l'hôpital universitaire de Lagos IdiAraba, Lagos et à la Fondation drépanocytaire. MÉTHODOLOGIE: Il s'agissait d'une étude transversale portant sur 140 filles atteintes d'ACS (sujets) et un nombre égal de filles atteintes d'AAb (témoins) qui ont été appariées pour l'âge et la classe socio-économique sur une période de cinq mois. L'évaluation comprenait des mesures anthropométriques, le calcul de l'IMC et la détermination du développement des poils mammaires et pubiens à l'aide de la stadification Tanner. RÉSULTATS: L'IMC moyen pour les sujets était de 17,2±2,39 kg/m2 et de 20,2±3,09 kg/m2 pour les témoins (p<0,001). L'âge moyen au début du développement mammaire (B2) était de 13±0,39 ans chez les sujets et de 10,5±0,51 ans chez les témoins (p<0,001). L'âge moyen correspondant pour le développement des poils pubiens (PH2) était également plus élevé à 13,8±0,59 ans pour les filles atteintes d'ACS et à 10,4±0,51 ans pour les témoins (p<0,001) tandis que la ménarche a été atteinte chez les sujets à 14,7±1,68 ans et chez les témoins à 12,3±1,33 ans (p <0,001). La classe socio-économique supérieure a été associée à une ménarche plus précoce et à une transition plus rapide du stade prépubertaire au stade pubertaire de maturation sexuelle chez les témoins, mais n'a pas été observée chez les sujets SCA. CONCLUSION: La maturité sexuelle chez les patients atteints d'ACS était inférieure à celle des témoins de l'HbAA. MOTS CLÉS: Hémoglobine SS, Maturité sexuelle, Ménarche.

Cord Blood Thyroid Stimulating Hormone Values in Healthy Term Babies delivered at Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Northeastern Nigeria.

BACKGROUND: Congenital hypothyroidism is one of the most common preventable causes of mental retardation and clinical manifestations are often subtle or absent at birth and hence the need for screening. Implementation of newborn screening requires local normative values. OBJECTIVES: To determine the normative values of cord Thyroid Stimulating Hormone (TSH) among term babies in Bauchi, Northeast Nigeria and compare it with that from other centers in Nigeria. METHODOLOGY: Cord blood samples from 200 term babies were analyzed for TSH by Fluorescence Immunoassay technique in this descriptive cross-sectional study. A cut-off of >20 µIU/ml was used for recall. The mean and range were determined and compared with those of previous local studies using t-test. Impact of some maternal and infant factors on TSH was also assessed. RESULTS: The overall mean (SD) cord TSH was 3.74 (±1.99) µIU/ ml and the range was 0.73 to 15.22 µIU/ml (2.5th to 97.5th centile) and none had TSH > 20 µIU/ml and hence our recall rate was 0%. The mean cord TSH was comparable to that reported by a lone local multicenter study (p = 0.120) but significantly different from that of 3 other local studies (p < 0.001). There was also no significant difference between the means of different gender, birth weight groups, mode of delivery, socio-economic classes, maternal age and parity. CONCLUSION: The Cord blood TSH level of most term newborn in Bauchi, similar to other Nigerian studies, is < 10 µIU/ml with a few but significant percentage recording cord TSH level > 10 µIU/ml. Gender, birth weight, mode of delivery, socio-economic class, maternal age and parity were not significantly related to cord TSH level. The mean blood TSH values from different studies across the country tend to vary based on the assay technique. We recommend a nationwide multicenter study with a much larger sample size, lower cutoff value for recall and a unified sample processing laboratory if national normative values are to be developed.

BACKGROUND: L'hypothyroïdie congénitale est l'une des causes évitables les plus courantes de retard mental et les manifestations cliniques sont souvent subtiles ou absentes à la naissance, d'où la nécessité d'un dépistage. La mise en œuvre du dépistage néonatal nécessite des valeurs normatives locales. OBJECTIFS: Déterminer les valeurs normatives de l'hormone stimulatrice de la thyroïde (TSH) du cordon chez les bébés nés à terme à Bauchi, Nord-Est du Nigeria et les comparer à celles d'autres centres du Nigeria. MÉTHODOLOGIE: Des échantillons de sang ombilical de 200 bébés nés à terme ont été analysés pour la TSH par la technique d' étude descriptive transversale. Un seuil de >20 µUI/ml a été utilisé pour le rappel. La moyenne et l'intervalle ont été déterminés et comparés avec ceux des études locales précédentes en utilisant le test t. L'impact de certains facteurs maternels myet infantiles sur la TSH a également été évalué. RÉSULTATS: La moyenne globale (SD) de la TSH du cordon était de 3,74 (±1,99) µIU/ml et l'intervalle était de 0,73 à 15,22 µIU/ml (2,5 à 97,5 centiles) aucun n'avait une TSH > 20 µIU/ml et donc notre taux de rappel était de 0%. La moyenne de TSH au cordon était comparable à celle rapportée par une seule étude multicentrique locale unique (p = 0,120) mais significativement différente de celle de 3 autres études locales (p < 0,001). Il n'y avait pas non plus de différence significative entre les moyennes des différents sexes, groupes de poids de naissance, mode d'accouchement, classes socio d'accouchement, les classes socio-économiques, l'âge maternel et la parité. CONCLUSION: Le niveau de TSH dans le sang de cordon de la plupart des nouveau-nés à termede la plupart des nouveau-nés à terme à Bauchi, comme dans d'autres études nigérianes, est < 10 µUI/ml mais significatif, enregistrant un niveau de TSH du cordon > 10 µIU/ml. Le sexe, le poids à la naissance, le mode d'accouchement, la classe socio-économique maternelle et la parité n'étaient pas significativement liés au taux de TSH au cordon. Le site valeurs moyennes de la TSH sanguine provenant de différentes études dans le pays ont tendance à varier en fonction de la technique de dosage. Nous recommandons une étude nationale multicentrique avec une taille d'échantillon beaucoup plus grande, une valeur seuil pour le rappel et un laboratoire de traitement des échantillons unifié si des valeurs normatives nationales doivent être développées. Mots clés: Sang de cordon, Hormone de stimulation thyroïdienne, Bébés à terme.

Vitamin D and bone mineral status of newborn-maternal pair delivering at a tertiary hospital in Nigeria.

BACKGROUND: Vitamin D plays a vital role in the maintenance of bone health. The fetuses and exclusively breastfed neonates depend on maternal vitamin D store to meet their need. Widespread vitamin D deficiency among pregnant women have been reported with adverse fetal outcome. Nigeria lacks guideline on Vitamin D supplementation in pregnancy and infancy due to the paucity of data. We thus determined serum vitamin D of delivering mothers and their offsprings and other indicators of bone mineral health. AIMS: This study aimed to determine serum Vitamin D and other indicators of bone mineral health of delivering mothers and their offspring. MATERIAL AND METHOD: A cross-sectional study of delivering mothers and their newborns recruited consecutively until the minimal sample size was reached. Relevant information was obtained on a questionnaire. Maternal and cord serum vitamin D, calcium, albumin, phosphate, and alkaline phosphatase were determined. Data management was done using SPSS version 16.0. RESULTS: Of the 84 newborn-mother pairs studied, 17 (20.2%) of the mothers were Vitamin D deficient and 23 (27.4%) insufficient. Seven (8.3%) of the mothers were hypocalcaemic and 3 (3.6%) hypophosphataemic, while 19 (22.6%) had elevated alkaline phosphatase. Only 15 (17.9%) of the neonates were vitamin D insufficient and none of them was vitamin D deficient, hypocalcaemic, hypophosphataemic nor had elevated alkaline phosphatase. There was strong positive correlation between cord and maternal blood vitamin D level (r = 0.740, P = < 0.001). CONCLUSION: Vitamin D deficiency and insufficiency is high among pregnant women in Maiduguri while insufficiency is common among the neonates. We recommend vitamin D supplementation to pregnant women and newborns in Maiduguri.

Comparative evaluation of carotid intima media thickness in paediatric type 1 diabetic children and healthy children in Ibadan and Lagos, Nigeria

Patients with type 1 diabetes are at greater risk of cardiovascular disease and atherosclerosis. Carotid in-tima­media thickness (CIMT) measured by ultrasound is a marker of atherosclerosis and can predict future cardiovascular events.The aim of this study was to measure the CIMT in paediatric type 1 diabetes patients in Ibadan and Lagos and compare results with the CIMT of non-diabetic healthy control children. Carotid ultrasound was performed and CIMT measured in 70 subjects (35 diabetic patients and 35 non-diabetic controls matched for age and sex). Mean age was 12.8±3.2 years. A slightly higher, but non-significant mean CIMT was seen in diabetic cases: mean values in type 1 diabetes patients were 0.475±0.068 and 0.476±0.069 (right and left respectively) while in controls, mean values were 0.467±0.064 and 0.468±0.054 (p=0.618 and 0.575 respectively). The CIMT in both groups correlated positively with age and body mass index (BMI). Significantly higher mean CIMT values were seen in males with type 1 diabetes on both sides. However, there was no significant correlation between CIMT and duration of illness, insulin dosage, or blood pressure. CIMT is a safe and convenient measurement, which may be helpful in predicting an increased risk of future cardiovascular disease in children with type 1 diabetes

Blood pressure to height ratio as a screening tool for prehypertension and hypertension in adolescents.

BACKGROUND: Current methods of detection of childhood hypertension are cumbersome and contribute to under-diagnosis hence, the need to generate simpler diagnostic tools. The blood pressure to height ratio has recently been proposed as a novel screening tool for prehypertension and hypertension in some populations. We evaluated its applicability in our environment. MATERIALS AND METHODS: The weights, heights, and blood pressure measurements of 2364 apparently healthy adolescents were determined. Sex-specific systolic and diastolic blood pressure to height ratios (SBPHR) and (DBPHR) were calculated, and their ability to detect prehypertension and hypertension was determined using receiver operating curves. Discriminatory ability was measured by the area under the curve (AUC) and optimal cutoff points along the curve were determined. P < 0.05 was considered statistically significant. RESULTS: The SBPHR and DBPHR were similar across all age groups and sexes. The AUC of SBPHR and DBPHR for diagnosing prehypertension and hypertension by sex was >0.95 for both diastolic and systolic hypertension in both sexes. It ranged between 0.803 and 0.922 for prehypertension and 0.954-0.978 for hypertension indicating higher accuracy for hypertension. Sensitivity was higher for systolic and diastolic hypertension (90-98%) compared with prehypertension (87-98%). Specificity was lower than sensitivity across all categories of hypertension and prehypertension (0.64-0.88%) though higher for hypertension (0.75-0.88) compared with prehypertension (0.64-0.75). CONCLUSION: BPHR is a useful screening tool for prehypertension and hypertension in black adolescents. Accuracy increased with higher degrees of hypertension.

Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

"BACKGROUND: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. EVIDENCE: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. PROCESS: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. RESULTS: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. CONCLUSION: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required."

Neonatal Diabetic Ketoacidosis in a Nigerian Infant: A Case Report.

Neonatal diabetic ketoacidosis is a rare condition that may occur in the first few weeks of life as a complication of neonatal diabetes mellitus. The prominent clinical features are hyperglycaemia and dehydration. It could also mimick an infection. The danger of inappropriate diagnosis is increased morbidity and mortality. To prevent this, we advocate routine testing of blood glucose levels in neonates and infants who present at the emergency rooms. We report a case of neonatal diabetic ketoacidosis in a female who presented at our facility.

Prevalence of prediabetes in secondary school students in Port Harcourt, Nigeria

This study aimed to assess the prevalence of prediabetes using impaired fasting glucose (IFG) in secondary school students aged 10 to 19 years in Port Harcourt; Nigeria; and to determine associated risk factors. Fasting blood glucose (FBG); blood pressure (BP); and body mass index (BMI) was measured. All students who had a FBG of 5.6 - 6.9mmol/l were asked to undergo an oral glucose tolerance test (OGTT). A total of 880 students were studied. The prevalence of IFG using the International Society for Paediatric and Adolescent Diabetes (ISPAD) criteria was 17% and prevalence was comparatively higher in subjects who were obese; had systolic prehypertension or diastolic hypertension; as well as a family history of diabetes. There was; however; no statistical association between the BMI percentile categories; BP category; sex and age category; or family history of diabetes and occurrence of IFG. The prevalence of IFG was 4% using the World Health Organization (WHO) criteria. Only one child had diabetes. Sixty-six (42%) students who had IFG had an OGTT; of which 10(15%) had IGT. We conclude that prediabetes is common in this population; and screening should be considered; at least in those with obesity or a family history in diabetes

Hypoglycaemia in Children Aged 1 Month to 10 Years Admitted to the Children's Emergency Centre of Lagos University Teaching Hospital; Nigeria

Background. Hypoglycaemia occurs in many disease states common in the tropics; and may also complicate treatment of malaria. It may contribute significantly to morbidity and mortality. Objectives. To determine the prevalence of and clinical conditions associated with hypoglycaemia. Methods. A total of 430 patients aged 1 month to 10 years were recruited consecutively from the Children's Emergency Centre of Lagos University Teaching Hospital. Clinical and demographic data were entered into a predesigned study proforma. Blood glucose was determined in the laboratory using the glucose oxidase method. Hypoglycaemia was defined as plasma glucose 2.5 mmol/L. Results. The median age of the study subjects was 24 months; with a range of 1.5 - 120 months. A total of 248 patients (57.6) were 24 months old. The mean (standard deviation) blood glucose of all the study subjects was 5.19 (2.05) mmol/L (median 4.9 mmol/L). Twenty-four patients (5.6) were hypoglycaemic. The predominant disease conditions in which hypoglycaemia occurred were severe malaria; multisystemic infections; marasmus; malignancies and gastroenteritis. Mortality was higher in hypoglycaemic patients than in those without hypoglycaemia (33.3 v. 5.4; p0.01). Conclusion. Hypoglycaemia complicates many common childhood illnesses seen in the emergency room and is associated with significant mortality. Hypoglycaemia should be suspected in severely ill children with severe malaria; multisystemic infections; marasmus; malignancies and gastroenteritis

The effect of home visits on the quality of life of children and adolescents with type 1 diabetes mellitus.

OBJECTIVE: The aim of the study was to analyze the impact of home and school visits and to strengthen the knowledge on diabetes education on the quality of care and life of children and adolescents with diabetes. METHODOLOGY AND RESULTS: This was a descriptive cross-sectional study of all children and adolescents (n = 16, seven males and nine females), attending a pediatric diabetes center (mean age: 11.25 yr ± 4.82, range: 5-17 yr), mean duration of diabetes being 4.6 ± 3.9 yr, range 0.5-8.4 yr. Ten patients were visited by the medical social worker at home and school, their knowledge ondiabetes education was strengthened, and intervention effect was evaluated 4 months later. Positive effects observed were that clinic visits became regular, there was notification by school of clinical status, a reduction in number of hypoglycemic episodes at school, increased acquisition of glucometers, and daily and regular (100%) self home blood glucose (BG) monitoring. The mean center HbA1c was reduced from 12.86 ± 2.5% to 9.41 ± 1.56%, the change from previsit was 3.45%. The mean center morning BG dropped from 181.60 ± 71.96 to 127.54 ± 27.54 mg/dL reflecting change from previsit BG of 54.19 mg/dL. However, these visitations had little effect on checking of BG at school. CONCLUSION: This study stressed the importance of home and school visits and diabetes education on the quality of care and life of the children and adolescents with diabetes in our region.

Relationship between vitamin D levels and outcome of pneumonia in children.

BACKGROUND: Pneumonia, a common childhood infection in Nigerian children with a number of debilitating complications such as empyema thoracis, has been linked to vitamin D deficiency due to its ability to modulate the T lymphocyte of the immune system . OBJECTIVE: To determine the relationship between vitamin D and outcome of pneumonia in children. METHODS: This was a case-control study involving 24 children, admitted for pneumonia as subjects and 10 children without pneumonia as controls. Pre-formatted questionnaire was utilized to obtain background information, anthropometric measurements were made to determine nutritional status and estimation of 25- hydroxy cholecalciferol (25OHD) done for all those studied. RESULTS: The mean (SD) serum 25OHD concentration was 104 (59) nmol/L and 130 (107) nmol/L for subjects and controls respectively. Amongst the subjects 15 (54%) had serum 25OHD less than 70 nmol/L and 11 (46%) serum 25OHD greater than 70 nmol/L. Hypocalcaemia was present in 15 (54%) of the subjects. Further analysis of hypocalcaemia with regards to the concentration of serum 25OHD showed that 2 (13%) had levels below 40 nmol/L, 10 (67%) had levels below 70 nmol/L and 3 (20%) above 70 nmol/L. Hypocalcaemia was more frequent among subjects with 25OHD below 70nmol/L compared with those above 70nmol/L, (p =0.01). Empyema thoracis and death occurred amongst the two subjects with 25OHD between 27.5 and 40 nmol/L. Anaemia was more frequent among subjects with 25OHD below 70 nmol/L compared with those above 70 nmol/L (p = 0.03). CONCLUSION: The study showed that Vitamin D insufficiency, and not solely its deficiency, may have an important role to play in the immune and haemopoetic system. It may therefore affect the response of a child to infections especially pneumonia.

Relationship between Vitamin D Levels and Outcome of Pneumonia in Children

BACKGROUND: Pneumonia; a common childhood infection in Nigerian children with a number of debilitating complications such as empyema thoracis; has been linked to vitamin D deficiency due to its ability to modulate the T lymphocyte of the immune system . OBJECTIVE: To determine the relationship between vitamin D and outcome of pneumonia in children. METHODS: This was a case-control study involving 24 children; admitted for pneumonia as subjects and 10 children without pneumonia as controls. Pre-formatted questionnaire was utilized to obtain background information; anthropometric measurements were made to determine nutritional status and estimation of 25- hydroxy cholecalciferol (25OHD) done for all those studied. RESULTS: The mean (SD) serum 25OHD concentration was 104 (59) nmol/L and 130 (107) nmol/L for subjects and controls respectively. Amongst the subjects 15 (54) had serum 25OHD less than 70nmol/L and 11 (46) serum 25OHD greater than70nmol/L. Hypocalcaemia was present in 15 (54) of the subjects. Further analysis of hypocalcaemia with regards to the concentration of serum 25OHD showed that 2 (13) had levels below 40nmol/L; 10 (67) had levels below 70nmol/L and 3 (20) above 70nmol/L. Hypocalcaemia was more frequent among subjects with 25OHD below 70nmol/L compared with those above70nmol/L; (p = 0.01). Empyema thoracis and death occurred amongst the two subjects with 25OHD between 27.5 and 40nmol/ L. Anaemia was more frequent among subjects with 25OHD below 70nmol/L compared with those above70nmol/L (p = 0.03). CONCLUSION: The study showed that Vitamin D insufficiency; and not solely its deficiency; may have an important role to play in the immune and haemopoetic system. It may therefore affect the response of a child to infections especially pneumonia

Zinc supplementation in children with acute diarrhoea.

BACKGROUND: In Nigeria, diarrhoeal disease is second only to malaria as a cause of death the under 5 age group. This study was aimed at assessing the benefit or otherwise of zinc supplement in acute diarrhoea. SUBJECTS AND METHODS: This was a multi-centred randomized double blind controlled study. Children with acute diarrhoea aged between 6 and 24 months were randomized into zinc supplemented and placebo groups. Plasma zinc levels were analyzed at enrollment and at the end of the study. The children were reviewed for the next three months from the time of enrollment. RESULTS: The mean plasma zinc levels at baseline and at the end of the study were 0.06 +/- 0.04 and 0.067 +/- 0.03 ppm in the zinc supplemented group and 0.11 +/- 0.02 and 0.05 +/- 0.03 ppm in the control group. The differences were not statistically significant. The zinc supplemented group had an average weight gain of 1.1 kg as against 0.73 kg (p = 0.00) for the control group in the study period. No adverse effect was reported on account of zinc supplementation. CONCLUSION: Zinc supplementation is beneficial in acute diarrhoea as observed in this study.

Prevalence of overweight and obesity in Eti-Osa LGA, Lagos, Nigeria.

In many of the urban centres of the developing countries, a change in lifestyle due to increased affluence has been observed. It has been shown that change in lifestyle is an important factor in the global epidemic of overweight and obesity. The aim of this study was to assess the influence of lifestyle and socioeconomic class on the prevalence of overweight and obesity amongst adolescents from rural and urban centres in Lagos, Nigeria. This is a cross-sectional prospective survey carried out on a sample of 1504 randomly selected adolescents, aged between 10 and 19 years, from six public secondary schools located in urban and rural areas of the Eti-Osa local government area of Lagos State, Nigeria. A self-designed completed questionnaire was used to determine the participants' socio-demographic characteristics. Anthropometric measurements were taken to calculate their body mass index (BMI). The overall prevalence rates of overweight and obesity in the urban and rural areas, respectively, were 3.7% and 0.4%, and 3.0% and 0.0%. Socioeconomic class did not significantly affect the BMI values. Overweight is an evolving problem, while obesity is seemingly not a problem yet in adolescent school-aged children in Lagos State, Nigeria.

Acute asthma in a children's emergency room: a clinical audit and management guideline proposal.

BACKGROUND: Adequate asthma control in children includes optimal medical management of acute exacerbations of the disorder. Asthma guidelines provide critical information and serve as quick reference decision-support material for clinicians. AIM: This clinical audit aimed at evaluating emergency management of acute asthma as well as proposing for use a management protocol, with the view of improving quality of care. METHOD: This is a retrospective audit of the management of acute asthma over 18 months (October 2000-April 2002) Relevant data related to diagnostic and therapeutic procedures in thirty asthmatics were extracted and examined. RESULTS: There were 20 males and 10 females (M:F ratio 2:1). Mean age (range) was 5.9 years (10 months-12.5 years) and mean (range) duration of symptoms prior to presentation was 1.9 days (2 hours-8 days). Trigger factors, current medications, clinical and functional indices of severity of acute asthma were not documented in 73.3%, 93.3% and 96.7% cases respectively. Diagnostic labels used in 28 (93.3%) did not reflect the acute nature or severity of the acute episode. Although nebulized salbutamol and oral corticosteroids were used for 80.0% of cases, aminophylline was frequently prescribed in addition. Discharge medications and instructions, including follow up in the respiratory clinic were not given in 21 (70.0%) and 28 (93.3%) cases respectively. CONCLUSION: This audit noted that the overall management of acute asthma in the emergency room and the documentation of crucial information vital in the acute and long-term care of asthmatics were inadequate. We propose and recommend for use in the Children's Emergency Room, acute asthma management guideline and protocol-based asthma paper records as well as computerization of patient records.

Surgical timing for mitral valve regurgitation.

Advances in diagnostic and surgical techniques in the management of mitral regurgitation have resulted in improved survival rates and clinical outcomes. Echocardiography is a valuable noninvasive diagnostic tool in the determination of the timing of surgical correction of mitral regurgitation. Improved surgical techniques, the growing role of mitral valve repair, low operative mortality rates, and improved long-term survival rates are important considerations for earlier surgical intervention in symptomatic patients and in asymptomatic patients with echocardiographic criteria of left ventricular dilatation. Intraoperative transesophageal echocardiography is very useful in mitral valve repair and valve replacement with preservation of chordal structures.

Gender differences and practice implications of risk factors for frequent hospitalization for heart failure in an urban center serving predominantly African-American patients.

To identify the clinical correlates of recurrent heart failure hospitalization in a large urban hospital serving predominately African-American patients, and to provide further insight into modifiable risks for heart failure readmissions, a retrospective period prevalence review of the records of all adult patients admitted with a primary diagnosis of heart failure (International Classification of Diseases-9 code 428.0) between January and December 1995 was performed. The main outcome was the number of heart failure hospitalizations over 12 months. Twelve hundred patients were identified. Mean age was 64 +/- 16 years, 94% were black, 57% were women, and 40% were > or = 65 years old. Ninety-eight percent had a history of systemic hypertension and 55% had uncontrolled hypertension. Other comorbidities were left ventricular (LV) hypertrophy (64%), coronary artery disease (52%), and tobacco abuse (28%). Sixty-five percent of patients were on angiotensin-converting enzyme (ACE) inhibitors, 51% on calcium antagonists, and 8% on beta blockers. Most patients had suboptimal dosing of ACE inhibitors and there was inappropriate use of calcium antagonists in 56% of patients with moderate or severe systolic dysfunction. Diabetes mellitus and echocardiographic wall motion abnormality were independently associated with frequent admissions for women but not for men. Medication-related increase in heart failure hospitalization was seen for calcium antagonists in patients with severe LV dysfunction (odds ratio 2.24, 95% confidence intervals 1.0 to 5.03; p <0.03). Uncontrolled hypertension, underdosing of ACE inhibitors, and overuse of calcium antagonists in patients with significant LV dysfunction are potential targets for intervention.

Fatal Hemoptysis during Coronary Thrombolysis.

Cerebral hemorrhage is the most dreaded complication of coronary thrombolysis. Significant bleeding has also been described from catheter-entry sites, the retroperitoneum, and the gastrointestinal and genitourinary tracts. However, hemoptysis induced by thrombolysis has rarely been described in the literature. We present a 66-year-old male who received front-loaded tissue plasminogen activator (tPA) for acute transmural anterior wall myocardial infarction and developed massive hemoptysis from preexisting cavitary lung disease. The patient died within 5 hours. We believe this is the first case report of fatal hemoptysis induced by coronary thrombolysis. A history of cavitary lung disease may be a risk factor for life-threatening hemoptysis in patients receiving thrombolytic therapy.

Transient autonomic neuropathy in an adolescent with insulin dependent diabetes mellitus.

A 15 year-old girl with insulin dependent diabetes mellitus of 11 years duration developed severe neuropathy involving the bladder and stomach. The bladder recovered after 2 months of intermittent catheterization. Metoclopramide relieved the gastric symptoms. Gastric emptying was normal after 2 further months of treatment. The neuropathy developed in spite of a mean HbA1c of 7.4% suggesting that factors in addition to glycemic control play a role in the development of the complications of insulin dependent diabetes mellitus.