Childhood vesiculobulous disorder (toxic epidermal necrolysis) in a resource constrained setting.

We report a case of childhood vesiculobulous disorder of the severity of Toxic Epidermal Necrolysis(TEN) in a 4 year ten month old female child resulting from caregiver prescribed medication. She is one of 4 children of a non consanguineous marriage with no family history of similar adverse drug reactions. She was initially managed in a private hospital before referral to our centre where we observed constraints of funds and crisis of confidence on the part of the parents. The need for enlightenment and counseling of care givers on cause of illness and advocacy for special funds for adverse drug events especially for indigent patients is hereby highlighted. Also the importance of optimization of available health care resources even in the midst of poor circumstances is emphasized.

Comparative outcome of overhead and total body phototherapy for treatment of severe neonatal jaundice in Nigeria.

Background: In Nigeria, neonatal jaundice is commonly treated by overhead phototherapy with neonates lying supine, often with effective exposure of less than one half of the body surface. Total body exposure in phototherapy has been in use for less than 2 years in Nigeria, but is available in only five neonatal centres.Aim: To compare the effectiveness of total body exposure (TBPE) with the conventional partial exposure (COPT) for treatment of hyperbilirubinaemia.Methods: Eleven datasets from 10 neonatal units across Nigeria were retrieved. They included neonates with severe hyperbilirubinaemia treated with TBPE using the Firefly® device (MTTS Asia) as a test group. The remainder of the patients, the controls, were treated with COPT. Any requirement for exchange blood transfusion (EBT) in either group was documented. Total serum bilirubin (TSB) >213.8 µmol/L (12.5 mg/dL) was treated as severe hyperbilirubinaemia. The efficiency of the intervention was determined according to the time taken for a severe case to be downgraded to mild at ≤213.8 µmol/L.Results: A total of 486 patients were studied, 343 controls and 143 cases. Mean (SD) postnatal age was 6 days (0.7) for cases and 5 (0.9) for controls, for gestational age (GA) in completed weeks was 36 (0.5) for cases and 37 (0.7) for controls and for birthweight was 2.7 kg (0.25) for cases and 2.7 (0.22) for controls. Mean (SD) pre-intervention TSB was 299.3 (35.7) µmol/L for cases and 327.3 (13.9) for controls. Severity downgrade day was Day 2 (0.4) for cases and Day 5 (1.1) for controls. Overall relative EBT rate was 6% for cases and 55% for controls (p= 0.0001), and early preterm relative EBT rate was 0% for cases and 68% for controls (p < 0.01).Conclusion: TBPE was quicker and safer for reduction of hyperbilirubinaemia and patients rarely required EBT. TBPE is recommended for rapid reduction of serum bilirubin levels and the reduction of treatment costs, morbidity and mortality in low- and middle-income countries.Abbreviations: EBT, exchange blood transfusion; TBPE, total body exposure technique; COPT, conventional partial exposure; TSB, total serum bilirubin; SB, serum bilirubin; NNJ, neonatal jaundice; SCNU, special care neonatal unit; LMIC, low- and middle-income countries; HIC, high-income countries; LED, light-emitting diode.

Outcome of hyperglycemic emergencies in a tertiary hospital, South East, Nigeria

Background: Hyperglycemic emergency (HE) is typically represented by diabetic ketoacidosis, (DKA) and hyperosmolar hyperglycemic state (HHS). It is a common cause of hospitalization due to diabetes mellitus (DM) and is associated with considerable mortality. In South East Nigeria, there is a paucity of studies on the treatment outcome of HE, hence the need for this study. Objective: The aim and objective of the study were to determine the outcome of treatment of adult persons living with diabetes managed for HE at Federal Medical Centre (FMC), Umuahia. Materials and Methods: This was a prospective study in which 110 consecutive adult patients managed for HE at FMC, Umuahia, were recruited. Data obtained included a total number of medical and diabetic admissions within the study period. For participants that met the inclusion criteria for the study, their bio­data, blood pressures, level of consciousness at presentation or while being treated, random plasma glucose, plasma electrolytes, urea, creatinine, and plasma 3­beta­hydroxybutyrate were noted and/or measured. Similarly, urine sample was collected from each participant for analysis (glucose, protein, and ketone). The outcome measures were patient's survival, hospitalization duration, and death. Analysis of data was done using SPSS 20.0 and the level of statistical significance was set at P < 0.05. Results: Of the 110 participants recruited, there were 46 (41.8%) males and 64 (58.2%) females. HE constituted 15.6% of the total medical admissions within the study period with a mortality of 10%. DKA and mixed form of HE were the predominant patterns in the study. While hospitalization duration was variable, no female participant was discharged against medical advice. Conclusion: The study showed that HE is a frequent acute complication of DM in this region ofNigeria and that HE typically presents as DKA and mixed form. Hospitalization for HE had a variable duration with a significant mortality

Perception and utilization of insecticide-treated mosquito net among caregivers of children in Abakaliki, Nigeria.

Background: Malaria contributes significantly to under-5 morbidity and mortality in Sub-Saharan African countries including Nigeria. The rollback malaria (RBM) initiative and millennium developmental goal 6 are the programs targeted at reduction in malaria burden. The target year here is 2015; it would be needful to determine the impact of these programs on lives of at-risk population. Objectives: To determine caregivers' perception and utilization of insecticide-treated mosquito net (ITN) for their children/wards under 5 years of age. Methods: It was a cross-sectional, descriptive, hospital-based study conducted at Federal Teaching Hospital, Abakaliki, between April 1, 2014, and October 31, 2014. A structured questionnaire was used to assess caregivers' perception and utilization of ITN. Relevant information collected from the respondents included awareness of what ITN is and its use, ownership, source and utilization of ITN, and frequency of antimalaria use for febrile episodes. Data were analyzed using Statistical Package for the Social Sciences (SPSS) Windows Program (SPSS Inc., Chicago, IL, USA) version 20.0 while the level of statistical significance was set at P < 0.05. Results: A total of 410 caregivers were interviewed; 362 (88.3%) were mothers. Three-hundred and eighty-four (93.7%) participants knew that ITN prevents mosquito bite that cause malaria infection, 81.2% (333/410) have at least one ITN in their homes, but only 215 (52.4%) use the ITN every night. Caregivers who used ITN regularly used antimalaria for their under-5 quarterly (34.9%) and rarely (33.9%). A significant relationship existed among socioeconomic class, knowledge of ITN, source of knowledge of ITN, frequency of anti-malaria use, and utilization of ITN. Conclusion: The study observed that awareness and ownership of ITN are high among study participants, but its utilization was suboptimal compared to RBM target for 2010 (80.0%). Health education and free distribution of ITNs should be further strengthened particularly among mothers of childbearing age and younger children.

RésuméArrière-plan: Le paludisme contribue de manière significative à sous-5 Taux de morbidité et de mortalité au Nigéria. Le programme Faire reculer le paludisme (RBM) et objectif de développement du millénaire 6 (OMD 6), ont été des programmes ciblés sur la lutte contre le paludisme fardeau. L'année cible 2015 est ici, il serait nécessaire de déterminer l'impact de ces programmes sur la vie des populations à risque. Objectif:évaluer les connaissances des intervenants en soins de santé et l'utilisation des MII pour leurs enfants/pupilles de <5 ans. Méthodes: Il s'agissait d'une étude basée sur l'hôpital descriptive effectuée dans FETHA entre avril et octobre 2014. Un questionnaire structuré a été utilisé pour évaluer les connaissances des intervenants en soins de santé et l'utilisation des MII. Critères utilisés comprenaient la conscience de ce que MII et son utilisation, la propriété, la source et l'utilisation des MII et de la fréquence de l'anti-malaria utiliser pour les épisodes fébriles. L'analyse a été effectuée à l'aide de SPSS version 20. Niveau de signification a été P < 0.05. Résultats: un total de 410 personnes soignantes ont été interviewés, 362 (88,3%) étaient des femmes. Trois cent quatre-vingt-quatre (93,7%) participants savaient qu'ITN empêche piqûre de moustique qui causent l'infection palustre, 81,2% (333/410) ont au moins une MII dans leurs foyers mais seulement 215 (52,4%) utilisent l'ITN chaque nuit. Les aidants naturels qui utilisaient régulièrement de MII utilisé contre la malaria pour leurs enfants de moins de cinq ans (34,9%) trimestriel et rarement (33,9%). Une relation significative existe entre la classe socio-économique, la connaissance de l'ITN, source de connaissance de l'ITN, la fréquence d'utilisation de lutte contre le paludisme et l'utilisation des MII. Conclusion: l'étude a observé que la sensibilisation et la propriété de l'ITN est élevée parmi les participants à l'étude, mais son utilisation est encore sous-optimale par rapport à faire reculer le paludisme Cible pour 2010 (80,0%). Mots clés: des moustiquaires imprégnées d'insecticide (MII), les connaissances, l'utilisation, le paludisme, les OMD, LA GESTION AXÉE SUR LES RÉSULTATS.

Diabetic ketoacidosis in a 9 month old child and the journey to 4 years.

We report a case of diabetes mellitus in a 9-month-old male, a product of a non-consanguinous marriage with no family history of diabetes mellitus. He presented initially with ketoacidosis in our emergency room and recovered from coma after 48 hours but was discharged after 14 days. He is now 4 years old and doing well and caregivers are coping even with the challenges of caring for a very young diabetic child. This article will help to build up the data bank for diabetes in infancy and childhood in our environment as well as highlight the challenges faced by both caregivers and physicians in the management of very young diabetics irrespective of socioeconomic status.