Clinical presentation and short-term outcomes of multisystemic inflammatory syndrome in children in Lagos, Nigeria during the COVID-19 pandemic: A case series.

Background: Multisystemic inflammatory syndrome in children (MIS-C) has increasingly been documented globally with the progression of the COVID-19 pandemic and a significant proportion of cases have been noted in children of Black descent. There has been a noticeable discrepancy in the presentation and outcomes of COVID-19 infection in sub-Saharan Africa compared to the rest of the world. We documented the demography, clinical features, laboratory and imaging findings, therapeutic management, and short-term outcomes of paediatric patients with MIS-C diagnosed during the COVID-19 pandemic in Lagos, Nigeria. Methods: We carried out a retrospective review of MIS-C cases seen in nine public and private hospitals in Lagos from July 10, 2020 to July 30, 2021. Data on clinical presentation, laboratory investigations, therapy as well as outcomes at 2 weeks, 6 weeks, 3 months and 6 months were analyzed. Findings: 28 children and adolescents with median age of 7·5 (IQR 2·3 - 9·4) years were diagnosed with MIS-C. MIS-C was suspected in 24 patients (85·7%) at initial clinical evaluation and mucocutaneous, gastrointestinal and cardiovascular manifestations were identified in 75·0%, 71·4% and 89·3% of patients respectively. Acute kidney injury and aseptic meningitis were noted in 32·1% and 17·9% of patients respectively. Cardiac manifestations at presentation included coronary dilatation and pericardial effusion in 46·4% each, ventricular dysfunction (32·1%), atrioventricular valve regurgitation (25·0%), prolonged QTc interval (40·0%) and first-degree atrioventricular block (16·0%). Therapy included aspirin in 89·3%, steroids in 75·0% and intravenous immunoglobulin (IVIG) infusion in 60·7%. All patients survived and were discharged after a mean of 11·14 (SD 5·65) days. Frequency of coronary dilatation had reduced from 46·4% to 7·1% by 3 months follow up and prolonged QTc interval persisted until the 6 week follow up in 4.5% of patients. Echocardiogram and electrocardiogram findings were normal in all patients assessed at 6 months follow up. Interpretation: MIS-C is an important diagnosis in children presenting with prolonged fever during the COVID-19 pandemic. Cardiovascular manifestations occurred in several children with MIS-C and improved by 6 months follow up. Early diagnosis and prompt institution of a combination of antiplatelet therapy, steroids and IVIG appear to be beneficial. Funding: None.

Quality of Referral Letters to the Paediatric Department of a Tertiary Hospital in Nigeria.

BACKGROUND: The referral letter is a flexible means of transmitting information about the care of patients from one healthcare worker to another. In developing regions of the world like Africa, where it may serve as the only means of transferring patient's information, the referral letter has infrequently been studied. OBJECTIVE: The study is to assess the quality of referral letters to the Paediatric department of a tertiary hospital in Nigeria. METHODS: Referral letters sent to the Olikoye Ransome-Kuti Emergency Center (ORKCEC) and the Paediatric Outpatient Clinics of the Lagos University Teaching (LUTH) between December 2012 and February 2013 were reviewed for content of information. Letter sent to the emergency center were compared with letter sent from sources within LUTH. RESULTS: A total of 356 letters were reviewed, with 196 (55.1%) letters sent to the Emergency center. The majority of the referral letters (262; 73.6%) were from hospitals other than LUTH-(inter-hospital). Patient's name (99.7%), name of referring hospital (93.3%) and presenting complaints (91.1%) were the most consistently filled. Information relating to adverse clinical warning (1.7%), request for feedback (4.2%) and urgency of referral (8.4%), were the least filled. Only in 28.4% of the letters were the results of any or all the investigations done included. More interhospital letters had information on findings on physical examination, treatment, urgency of referral and request for feed-back from the receiving specialists. Referral letters to the clinics were more likely than letters to emergency centre to contain information on presenting complaints, history of the presenting complaints, and findings on physical examination. CONCLUSION: Referral letters sent to the paediatric department of LUTH are poorly written with significant information about patient care frequently missing. Interhospital referral letters and letters sent to the clinics, though similarly low in quality, were more likely to contain information on physical findings and treatment received.

Paediatric acute kidney injury in a tertiary hospital in Nigeria: prevalence, causes and mortality rate.

BACKGROUND: The modest decline in child mortality in Africa raises the question whether the pattern of diseases associated with acute kidney injury (AKI) in children in Nigeria has changed. METHODS: A database of children, aged between one month and 16 years, with AKI (using modified pediatric RIFLE criteria) was reviewed. The cause of AKI was defined as the major underlying disease. The clinical and laboratory features of children with AKI who survived were compared to those who died. RESULTS: Of the 4 015 children admitted into Lagos University Teaching Hospital between July 2010 and July 2012, 70 episodes of AKI were recorded equalling 17.4 cases per 1000 children. The median age of the children with AKI was 4.8 (range 0.1-14.4) years and 68.6% were males. Acute kidney injury was present in 58 (82.9%) children at admission with 70% in 'failure' category. Primary kidney disease (38.6%), sepsis (25.7%) and malaria (11.4%) were the commonest causes. The primary kidney diseases were acute glomerulonephritis (11) and nephrotic syndrome (8). Nineteen (28.4%) children with AKI died. Need for dialysis [odds ratio: 10.04 (2.94-34.33)], white cell >15 000/mm(3) [odds ratio: 5.72 (1.65-19.89)] and platelet <100 000/mm(3) [odds ratio: 9.56 (2.63-34.77)] were associated with death. CONCLUSION: Acute kidney injury is common in children admitted to hospitals. The common causes remain primary kidney diseases, sepsis and malaria but the contribution of sepsis is rising while malaria and gastroenteritis are declining. Acute kidney injury-related mortality remains high.