An audit of a decade of acute peritoneal dialysis in children with acute kidney injury: A single-center experience.

Background: Acute peritoneal dialysis (PD) is the modality of choice to manage children with acute kidney injury (AKI). However, its use remains underutilized, despite the unquestionable advantages. Aims: This study, therefore, aimed to audit the complications, outcomes, and challenges encountered with PD as well as indications for PD and causes of AKI among under-5 children that had PD in a Nigerian tertiary hospital over a decade. . Patients and Methods: : A retrospective study of children with AKI, aged 0 to 5 years, managed with PD. In all the children, a PD catheter was inserted at the bedside by surgeons. PD was performed manually. Data were presented in descriptive statistics and a P value <0.05 was considered significant. Results: Twenty-nine (29) children had PD over a decade (January 2009 to December 2018). There were 12 males and 17 females aged 4-60 months (mean ± SD 18.8 ± 16.9). The PD yearly frequency was 2-7 times/year, mean of 2.9/year. The major identified indication for PD was difficulty of vascular access (86.2%) while the causes of AKI were sepsis 21 (43.8%); gastroenteritis 11 (22.9%); severe malaria 9 (18.8%); toxins/herbal medications 5 (10.4%); multiple congenital anomalies 2 (4.2%). Multiple causes of AKI occurred in some children. The major observed PD complications were catheter lockage 9 (37.5%); dialysate fluid retention 4 (16.7%); and peritonitis 4 (16.7%). The short-term outcome of the 29 children that had PD showed 20 (69%) discharged and 9 (31%) deaths over the period. The major challenge encountered was PD-related sepsis evidenced by the prevalence of peritonitis and catheter site infection. Conclusion: The predominant PD complications were catheter-related, mostly catheter blockage in a manually performed PD while the leading cause of AKI in our center was sepsis, affecting a large population of children requiring PD.

Transcranial Doppler Ultrasonography Imaging Studies in Children with Sickle Cell Anaemia in a Tertiary Hospital, Abuja, Nigeria.

BACKGROUND: Stroke risk in sickle cell anaemia (SCA) can be detected by abnormalities of cerebral blood flow velocities (CBFV), measurable by Transcranial Doppler Imaging (TCDI) ultrasonography. This has become an important strategy in the routine care of children with SCA globally. OBJECTIVES: To determine the pattern of CBFV and document the proportion of children with SCA at risk of stroke at National Hospital Abuja (NHA), Nigeria using TCDI. METHODS: This was a cross-sectional study of 130 children aged 2-16 years with SCA attending the haematology clinic at NHA. Systematic random sampling method was used in recruiting the participants and CBFV over the middle cerebral artery (MCA) were measured by TCDI technique. The criteria from the stroke prevention (STOP) trial in SCA used to stratify stroke risk, as modified for TCDI was employed to evaluate CBFV from the study. Thus, CBFV (stroke risk) were normal (standard) < 155cm/sec, conditional 155-179cm/sec and abnormal (high) >180cm/sec. RESULTS: There were 130 children with SCA, aged 7.7 ± 4.1 (mean age ± SD) years; and 59.2% were males. This study documented CBFV (stroke risk) as: normal 106 (81.5%), conditional 15 (11.5%) and abnormal (high) 9 (6.9%) in the MCA. The highest CBFV was recorded in the right MCA and ICA with 272cm/sec and 262cm/sec, respectively. There were significant interhemispheric differences between the CBFV on the right and left of PCA and ICA. CONCLUSION: This study documented that a significant proportion of children with SCA in Nigeria were at risk of stroke. Hence, the need for routine monitoring for stroke risk in children with SCA.

CONTEXTE: Le risque d'accident vasculaire cérébral dans la drépanocytose (SCA) peut être détecté par des anomalies des vitesses du flux sanguin cérébral (CBFV), mesurables par échographie transcrânienne d'imagerie Doppler (TCDI). Ceci est devenu une stratégie importante dans la prise en charge de routine des enfants atteints de SCA dans le monde. OBJECTIFS: Déterminer le modèle de CBFV et documenter la proportion d'enfants atteints de SCA à risque d'accident vasculaire cérébral à l'hôpital national d'Abuja (NHA), Nigéria en utilisant TCDI. cm / s. MÉTHODES: Il s'agissait d'une étude transversale de 130 enfants âgés de 2 à 16 ans atteints de SCA fréquentant la clinique d'hématologie de la NHA. La méthode d'échantillonnage aléatoire systématique a été utilisée pour recruter les participants et le CBFV sur l'artère cérébrale moyenne (ACM) a été mesuré par la technique TCDI. Les critères de l'essai de prévention des AVC (STOP) dans SCA utilisés pour stratifier le risque d'AVC, tels que modifiés pour le TCDI, ont été utilisés pour évaluer le CBFV de l'étude. Ainsi, les CBFV (risque d'accident vasculaire cérébral) étaient normaux (standard) <155 cm/s, conditionnels 155-179 cm / s et anormaux (élevés) e "180. RÉSULTATS: Il y avait 130 enfants avec SCA, âgés de 7,7 ± 4,1 (âge moyen ± ET) ans; et 59,2% étaient des hommes. Cette étude a documenté le CBFV (risque d'AVC) comme: normal 106 (81,5%), conditionnel 15 (11,5%) et anormal (élevé) 9 (6,9%) dans le MCA. Le CBFV le plus élevé a été enregistré dans le droit MCA et ICA avec 272 cm / sec et 262 cm / sec, respectivement. Il y avait des différences interhémisphériques significatives entre le CBFV à droite et à gauche du PCA et de l'ICA. CONCLUSION: Cette étude a documenté qu'une proportion significative d'enfants atteints de SCA au Nigéria étaient à risque d'accident vasculaire cérébral. D'où la nécessité d'une surveillance de routine du risque d'AVC chez les enfants atteints de SCA.

Randomized control trial of oral arginine therapy for children with sickle cell anemia hospitalized for pain in Nigeria.

Low arginine bioavailability is associated with vaso-occlusive painful crisis (VOC) severity in sickle cell anemia (SCA) and predicts need for pediatric hospitalization. Intravenous arginine therapy has opioid-sparing effects and was found to significantly decrease pain scores in children hospitalized with SCA-VOC in a phase-two randomized placebo-controlled trial (RCT). Efficacy of oral arginine is unknown. Our objective was to determine the safety and efficacy of oral arginine therapy in Nigerian children with SCA. A double-blind RCT of oral L-arginine-hydrochloride (100 mg/kg TID) was conducted in children with SCA-VOC, aged 5-17 years, hospitalized at two Nigerian sites. The primary outcome measure was analgesic usage, quantified by difference in the mean Analgesic Medication Quantification Scale (MQS). Secondary outcomes included daily pain scores, time-to-crisis-resolution and length-of-hospital-stay. An intention-to-treat analysis was performed. Sixty-eight children (age 5-17 years, mean 10.6 ± 0.4 years; 56% male), were randomized to receive L-arginine (35 patients) or placebo (33 patients). The mean total MQS for the arginine group was 73.4 (95% CI, 62.4-84.3) vs 120.0 (96.7-143.3) for placebo (P < .001). The mean rate of decline in worst pain scores was faster in the arginine arm vs placebo (1.50 [1.23-1.77] vs 1.09 [0.94-1.24] point/d, P = .009). Children receiving arginine had a shorter time-to-crisis-resolution (P = .02), shorter hospital-stay (P = .002) and experienced no serious adverse event. Pain control was more rapid, total analgesic requirement was significantly reduced, and most notably, time-to-crisis-resolution and length-of-hospital-stay were shorter in children with SCA-VOC receiving arginine vs placebo. Given the established safety and low cost, oral arginine is a promising adjuvant therapy for SCA-VOC management.

Should children know their HIV status? Prevalence, caregiver's perspectives and barriers to disclosure at the National Hospital Abuja, Nigeria.

BACKGROUND: Nigeria ranks second globally with a HIV/AIDS prevalence of 3.2%. HIV infected children are surviving to adolescence because of anti-retroviral therapy, but many do not know why they need to take these medicines. Disclosure is critical to long-term disease management, yet, if, how and when caregivers and or health professionals disclose to children is not well known in resource-limited settings. The barriers to disclosure remain largely undocumented. OBJECTIVES: To determine the prevalence and age of HIV disclosure to children in Abuja, Nigeria and identify caregivers perspectives as well as barriers to disclosure. METHODS: A cross-sectional study was done June-July 2016 using a structured questionnaire, convenience sampling and quantitative methods at the infectious disease clinics of National Hospital Abuja. A sample of 164 caregivers of HIV-positive children aged 5-16 years receiving antiretroviral therapy for at least 1 year were enrolled. RESULTS: Prevalence of full disclosure was 24.5%, partial disclosure 22.7%, with overall prevalence of 47.2%. Mean age at full disclosure was 11.87 years. Bivariate analysis showed significant difference between disclosure and child's level of education (χ2 for trend 26.710, P < 0.001), support for disclosure (χ2 4.399, P = 0.036) and if caregiver held the opinion that children should have disclosure done (Pearson's χ2 30.174, P < 0.001). However, on logistic regression, only the age of the child (P < 0.001, 95% CI 1.176-1.499) and the caregiver's opinion (P = < 0.001, 95% CI 4.914-2.542) remained significant. Various barriers to disclosure were identified. CONCLUSION: The prevalence of full disclosure is low and several barriers prevent early disclosure. Caregiver's and HCWs need empowerment with culturally appropriate skills and platforms to increase disclosure rates, which may help improve adherence.

Cerebral Venous Thromboses in a Child with Nephrotic Syndrome.

Nephrotic syndrome is associated with several complications among which are thrombo embolic phenomena. These are uncommon in children. This report describes an 8 year old male child with relapse of steroid resistant minimal change nephrotic syndrome who developed cerebral sagittal and transverse sinus thromboses. He presented with headaches, vomiting and photophobia; and developed VI cranial nerve palsy during the course of the illness. Diagnosis was made by Computed Tomographic Scan and Magnetic Resonance Angiography of the brain. He was treated with low molecular weight heparin initially and then, oral warfarin with close monitoring of the INR and anti-Factor Xa. He recovered without neurological deficits from the venous thromboses, and with marked improvements in his radiological features.

Paediatric dialysis services in Nigeria: availability, distribution and challenges.

BACKGROUND: Dialysis provides relief of complications of renal failure. However, the availability, distribution and challenges facing paediatric dialysis service (PDS) in Nigeria are presently unknown. METHODS: Questionnaires were mailed to federal government-funded tertiary hospitals in all 36 states in Nigeria including the Federal Capital Territory (FCT). The characteristics of hospitals providing PDS were compared to those not providing PDS. RESULTS: Thirty-four (34) tertiary hospitals in 31 States and the FCT participated in the study: 28 (82.4%), 22 (64.7%) and 12 (35.3%) had >1000 paediatric admissions per year, >50 paediatric beds and >10 paediatricians respectively. Sixteen (47.1%) provided at least one form of PDS; 2 (12.5%), 5 (31.3%) and 9 (56.3%) hospitals provided peritoneal dialysis (PD), haemodialysis (HD) and both forms, respectively. Centres providing PDS were more likely to be teaching hospitals (p value=0.000), had >10 paediatricians (p value=0.016) and provided dialysis to adults (p value=0.000). Lack of consumables, skilled manpower and high cost were common challenges identified. CONCLUSION: PDS is unavailable in about half of Nigeria. HD is the commonest modality available and most of the hospitals providing PDS are the large hospitals. Common challenges to PDS were lack of dialysis consumables, skilled manpower and high cost.

Malaria chemoprophylaxis in sickle cell disease.

BACKGROUND: Malaria is the most common precipitating cause of crises in sickle cell disease in malaria-endemic countries. Health professionals often recommend life-long malaria chemoprophylaxis for people with sickle cell disease living in these areas. It is therefore important we have good evidence of benefit. OBJECTIVES: To assess the effects of routine malaria chemoprophylaxis in people with sickle cell disease. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (January 2006), Cochrane Cystic Fibrosis and Genetic Disorders Group Specialized Register (July 2006), CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to January 2006), EMBASE (1974 to January 2006), LILACS (1982 to January 2006), and reference lists. We also contacted organizations and pharmaceutical companies. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials comparing chemoprophylaxis with any antimalarial drug given for a minimum of three months compared with a placebo or no intervention. DATA COLLECTION AND ANALYSIS: Two authors independently applied the inclusion criteria, assessed methodological quality, and extracted data. Dichotomous data were analysed using relative risks (RR) and presented with 95% confidence intervals (CI). MAIN RESULTS: Two trials with a total of 223 children with homozygous sickle cell disease met the inclusion criteria. A randomized controlled trial in Nigeria compared two different antimalarial drugs with a placebo, and reported that chemoprophylaxis reduced sickle cell crises (RR 0.17, 95% CI 0.04 to 0.83; 97 children), hospital admissions (RR 0.27, 95% CI 0.12 to 0.63; 97 participants), and blood transfusions (RR 0.16, 95% CI 0.05 to 0.56; 97 participants). A quasi-randomized controlled trial of 126 children in Uganda compared an antimalarial drug plus antibiotics with no antimalarial plus placebo. Chemoprophylaxis reduced the number of episodes of malaria and dactylitis, and increased mean haemoglobin values in this trial. AUTHORS' CONCLUSIONS: It is beneficial to give routine malaria chemoprophylaxis in sickle cell disease in areas where malaria is endemic.

The pattern of paediatric HIV/AIDS as seen at the National Hospital Abuja Nigeria.

BACKGROUND: Paediatric HIV/AIDS has become a significant cause of mortality and morbidity in our environment. OBJECTIVES: The objective of this paper is to determine the mode of transmission, clinical presentations and outcome of hospital admissions in children with Paediatric HIV/AIDS at the National Hospital Abuja Nigeria. METHODS: A retrospective study of children with Paediatric HIV/AIDS admitted into the hospital from January December 2000 was done. Screening for HIV infection was based on clinical criteria as recommended by WHO except in 3 children with previously diagnosed HIV seropositivity. One positive ELISA and one positive Western Blot assay diagnosed HIV seropositivity. RESULTS: Forty-three HIV positive children aged six weeks to nine years (mean 16.5 months, SD 26.32) were admitted into the Paediatric unit (exclusive of the newborn unit) of the hospital, accounting for 5.7% of all admissions into the unit. There were 35 infants (81.4%). There were 18 males and 25 females (male: female ratio 1:0.72). The presumed modes of transmission were mother to child transmission 40(93.02%), blood transfusion 2 (4.6%) and an unidentified route 1 (2.3%). All parents were in the reproductive age group and there were 6 discordant couples identified (mother HIV positive, father HIV negative). Common presenting symptoms were fever 16 (37.2.8%), diarrhoea 13 (30.2%), difficult/fast breathing 12 (27.9%) and vomiting 8 (18.6%), while clinical signs were crepitations in the lungs 27 (62.7%), pallor 22 (51.2%), oral thrush 20 (46.5%), hepatomegaly 18 (41.9%), and dehydration 16 (37.2%). Admitting diagnoses were pneumonia 26 (60.5%), septicaemia 4 (9.3%), diarrhoea with dehydration, intestinal obstruction and malnutrition 2 (4.7%) each. There were 14 deaths (mortality rate 32.6%); accounting for 28.57% of total deaths in the paediatric unit during the period. Thirteen (13) (92.8%) deaths occurred in children aged 2 years old and below. The greatest contributors to mortality were pneumonia 10 (71.4%) and septicaemia 2 (14.3%). Poor nutritional status was associated (p<0.05) with increased mortality. CONCLUSION: The findings indicate that paediatric HIVAIDS occurs predominantly by mother to child transmission and constitutes a significant cause of childhood morbidity and mortality at the National Hospital Abuja Nigeria. We recommend intensification of efforts to implement the existing prevention of mother to child transmission programme and further evaluation ofpneumonia in HIV positive children.

Phytomedicines (medicines derived from plants) for sickle cell disease.

BACKGROUND: Sickle cell disease (SCD) is a common recessively inherited disorder of haemoglobin affecting peoples originating from sub-Saharan Africa, the Middle East and Mediterranean basin, the Indian subcontinent, the Caribbean and South America. The homozygous state (SS) is associated with complications and a reduced life expectancy. Phytomedicines (medicine derived from plants in their original state) encompass much of what the populations most affected would encounter in terms of plant-remedies from traditional healers. There has been little in the way of systematic appraisal of their benefits. OBJECTIVES: To assess the benefits and risks of phytomedicines in people with SCD of all types, of any age, in any setting. SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders group specialised register of controlled trials of haemoglobinopathies, which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. We performed an additional search of the bibliographic database of Allied and Complementary Medicine (AMED). Date of most recent search of the trials register: September 2003. SELECTION CRITERIA: All randomised or quasi-randomised trials with participants of all ages with SCD, in all settings, comparing the administration of phytomedicines, by any mode to placebo or standard treatment, including blood transfusion and hydroxyurea. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality and extracted data from the study. MAIN RESULTS: Reports of two trials were found, of which only one, including 82 participants, was eligible for inclusion in this review. This Phase IIB (pivotal) study suggests that a phytomedicine, NIPRISAN, was effective in reducing episodes of SCD crisis associated with severe pain over a six-month period. NIPRISAN did not appear to affect the risk of severe complications or the level of anaemia. No serious adverse effects were reported. REVIEWERS' CONCLUSIONS: While NIPRISAN, as a phytomedicine, appeared to be safe and effective, over a six-month follow-up period of this study, in reducing crises associated with severe pain, further studies are required to assess its role in the management of people with sickle cell disease. The results of Phase III, multicentre trials are awaited.

Malaria chemoprophylaxis in sickle cell disease.

BACKGROUND: Malaria illness is associated with sickle cell crises. Health professionals often recommend life-long malaria chemoprophylaxis for people with sickle cell disease living in malaria endemic areas. It is therefore important we have good evidence of benefit. OBJECTIVES: To assess the effects of routine malaria chemoprophylaxis in people with sickle cell disease. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register (March 2003), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to March 2003), EMBASE (1988 to March 2003), and LILACS (2001, 39a Edition CD-ROM), and reference lists of articles. We contacted individual researchers working in sickle cell disease research to identify any unpublished trials. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials comparing chemoprophylaxis with any antimalarial drug given for a minimum of 3 months compared to placebo or no intervention. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied the inclusion criteria. MAIN RESULTS: One quasi-randomized controlled trial from Uganda gave antimalarial drugs and antibiotic prophylaxis together to 126 children with homozygous sickle cell disease. The authors reported the intervention group had fewer episodes of malaria, dactylitis, and higher mean haemoglobin values. REVIEWER'S CONCLUSIONS: There is very little direct evidence to support or refute giving routine chemoprophylaxis in sickle cell disease in areas where malaria is endemic.