Medical quiz on endocrinology

MEDICAL QUI

Paediatrics pain management

Pain is one of the most common symptoms experienced the world over. It has always received the needed attention and care in the adult but not until recently among children. Several erroneous beliefs contributed to the inadequate attention among children such as assumption that children did not experience pain to the extent that adults do, because of the immaturenervous system, or that children would not remember the pain. A paediatrician is expected to be knowledgeable about pediatric painmanagement principles, provide a calm environment for painful procedures, use appropriate assessment tools and techniques, anticipatepainful experiences, use a multimodal approach (pharmacologic, cognitive,behavioral, and physical) to pain management, use a multidisciplinaryapproach when possible and involve families in creating solutions for their child’s pain. Studies have shown that the most common reason for unrelieved pain is failure to routinely assess pain and provide pain relief. The theories, pathways, transmission, regulations, classifications, assessment scales and the treatment of paediatric pain and practical issues that arise from the use of pharmacologic analgesic in the children were also reviewed and highlighted

Childhood pneumonia at the University of Ilorin Teaching Hospital, Ilorin Nigeria

Background/Objectives: Pneumonia is a leading cause of morbidity and mortality in children and thus this study was designed to document the sociodemographic, clinical features as well as the bacterial agents  responsible for pneumonia in children seen at University of Ilorin Teaching Hospital.Methodology: A descriptive cross -sectional study of children aged one month to 14 years with features of pneumonia admitted between July 1st 2010 and June 31st, 2011 was carried out. Sociodemograpic data, clinical features, complications and outcome were obtained. Chest radiographs and blood samples for culture of bacterial organism and full bloodcounts were obtained in all children.Results: Pneumonia accounted for 13.3% (167 out of 1254) of the all admissions during this period. The male: female ratio was 1.5:1, and 101(60.5%) of the children were infants. Bronchopneumonia was identified in 147(88%) children, lobar pneumonia in 15 (9%) while 5(3%) had a combination of both. Cough, fever, difficulty in breathing, tachypnoea andchest wall recessions were recognised as clinical features in the study population. Bacteraemia was present in 46(27%)children and Staphylococcus aureus was the most common organism cultured from the blood of children with pneumonia present in 11 (23.9%) out of the 46 (100.0%) isolates. Heart failure was associated complication present in 52 of the 60 children with one or more complications accounting for over 30% of all patients. Eleven out of the 15 children with lobar pneumonia hadpneumonia-related complications which was significantly higher compared to 46 of 157 children with bronchopneumonia, p=0.003. The case fatality was 6.6%. Eight (72.7%) of the children that died were infants while the remaining three (27.3%) were aged between 12 and 60 months. The mean duration of hospitalization among those who survived of 6.5 ±5.0 days was significantly lower than the corresponding value of 10.2 ±12.3 days in those that died, p= 0.042. Conclusion: Pneumonia-related mortality and morbidity is high in under-five children, with the infant age group most affected. Bronchopneumonia is the most prevalent ALRI diagnosis but lobar pneumonia is associated with a higher mortality

Unusual occurrence of congenital hypothyroidism in a set of same sex triplets: challenges of diagnosis in a resource poor setting

Congenital hypothyroidism is the most common endocrinological disorder in children. Genetic and intrauterine factors have been implicated in its aetiology. The aim of this study was to describe an unusual occurrence of congenital hypothyroidism in a set of same sex triplets and challenges associated with the diagnosis. This is a review of a set of female triplets delivered at 34 weeks gestational age and noticed to have reduced activity, hypotonia and poor suck. On testing for thyroid hormones the patients were found to be hypothyroid. However this diagnosis was delayed until the 6th week of life as a result of difficulties in running the test. The subjects of the study were placed on thyroxine supplementation and have been doing well. Congenital hypothyroidism can occur in multiple order pregnancies and clinicians should have a high index of suspicion for its occurrence.Keywords: Congenital hypothyroidism; Triplets; Diagnosi

Massive subgaleal haematoma in a 5 year old child – A case report

Subgaleal haematoma (SH) is a collection of blood between the bony skull and the loose connective tissue. It is almost a diagnosis confined to the neonatal age group with very few occurring beyond the age. Presentation could be sudden or chronic as deterioration in the cardio pulmonary status,shock, skin changes, airway obstruction and neurological sequealae.While assisted delivery with birth trauma are recognized causal factorsin the neonate, trauma to the head and blood related disorders have been reported to be major causes in older children and adults. Usually, the Small SH resolves spontaneously while the massive ones require active management; often with neuro surgical intervention. It also needs identifying the cause so as to treat and prevent a recurrence. We present a case of massive SH in a 5 year old mentally subnormal child with seizure disorder with a favourable outcome

Reference values of haematological parameters of healthy adults in the north central zone of Nigeria

Background: Haematological parameters differ from one population to another due to several factors. To determine the clinical implication of the blood parameters of an individual in the state of health or disease, we need to have the knowledge of the normal reference range for that locality.Objectives: To determine the reference values of haematological parameters of apparently healthy adults in Ilorin.Design: A descriptive cross sectional study.Setting: Ilorin, North Central zone of NigeriaSubjects: Nine hundred and ten (443 males and 467 females) randomly selected normal, HIV negative individuals aged 18-65 yearsResults: The red blood cell count, Haemoglobin concentration, PCV and MCHC were significantly higher among males than females while the platelet count, total WBC count and absolute neutrophil count were significantly higher in females than in males. There was however no significant gender difference in the values of MCV, MCH and absolute lymphocyte count. The normal reference values obtained in this study were notably different from those that are used currently in the hospital.Conclusion: The normal reference value obtained in this study was notable different from those that are currently used in the hospital. These findings will have clinical implications regarding the adjustment of our current reference values and definitely add value to the management of patients in this part of the country

Home interventions, ethnicity and socio-economic status of children with febrile convulsions in Ilorin, North-Central Nigeria

Background: During most occurrences of febrile convulsions in children, certain home interventions are instituted. These interventions may either be helpful or harmful. Aims and Objectives: To determine the variation of home interventions with ethnicity and socio-economic class (SEC) and the outcome of febrile convulsions following such interventions. Methodology: The home interventions carried out on children that presented with febrile convulsion(s) were prospectively studied over a period of one year (January – December 2004). Information on the age, gender, ethnicity, nature of pre-hospital interventions and parental socioeconomic status were obtained and analyzed. Results: A total of 167 children were recruited. One hundred and one (60.5 %) applied home intervention such as pouring of water on the child in 61 (60.4%), insertion of spoon in mouth in 53 (52.5%), balm application on 13 (12.9%), rubbing of onion on the face in 10 (9.9%), application of cow’s urine concoction in 11 (10.9%), use of scarification in 6 (5.9%), and use of palm oil concoction in 5 (5.0%). All eleven children that were given cow’s urine concoctions were of Yoruba ethnic stock, while the five children that had palm kernel oil concoction were of Igbo ethnic stock. Conclusion: Pre-hospital intervention is common among children with febrile convulsions. Ethnicity and socio-economic class are strongly associated with the nature of the intervention. Keywords: Home intervention; Febrile Convulsion; Ethnicit

Assessment of complementary feeding practices among care givers in Ilorin, Kwara State.

Background: Appropriate feeding practices are of fundamental importance for the survival, growth and development of any child. Objectives: The aim of this study was to assess feeding practices of mothers in Ilorin, Kwara State. Methodology: A total of 210 nursing mothers and caregivers for children aged 6 to 36 months were studied. Data collection was with a structured questionnaire and data was analyzed using SPSS version 14.0. Results: Thirty eight (18%) of the mothers interviewed practiced exclusive breast feeding. Ninety (42.8%) of the respondents introduced complementary diets between 4-6 months while 24 (11.4%) introduced it before 4 months. Reasons for the introduction included “inadequacy of breast milk alone” 102(48.6%), “lack of sufficient breast milk” 24(11.4%) and “advice from health workers” 37(17.4%). Rice was the first complementary food introduced in 72(34.3%). The use of feeding bottles was reported in 67(31.9%). Conclusion: The rate of EBF practice was low, there was early introduction of inadequately nutritious complementary feeds and use of feeding bottles was also found to be common. We recommend the need for continuous education on appropriate feeding practices for children by health workers to mothers and caregiver. Key words: complementary feeding ; practices; caregive