Correlation between dipstick urinalysis and urine sediment microscopy in detecting haematuria among children with sickle cell anaemia in steady state in Ilorin, Nigeria

Introduction: Haematuria is one of the clinical manifestations of sickle cell nephropathy. Although dipstick urinalysis detects haemoglobin and by extension haematuria; it does not confirm haematuria. Urine sediment microscopy confirms haematuria and constitutes a non-invasive "renal biopsy". The need to correlate dipstick urinalysis and urine sediment microscopy findings becomes important because of the cheapness, quickness and simplicity of the former procedure. Methods: Dipstick urinalysis and urine sediment microscopy were carried (both on first contact and a month after) among consecutive steady state sickle cell anaemia children attending sickle cell clinic at the University of Ilorin Teaching Hospital between October 2004 and July 2005. Results: A total of 75 sickle cell anemia children aged between 1-17 years met the inclusion criteria. Haematuria was found in 12 children (16.0%) and persistent haematuria in 10 children 13.3%. Age and gender did not have significant relationship with haematuria both at first contact (p values 0.087 and 0.654 respectively) and at follow-up (p values 0.075 and 0.630 respectively). Eumorphic haematuria was confirmed in all the children with persistent haematuria with Pearson correlation +0.623 and significant p value of 0.000. Conclusion: The study has revealed a direct significant correlation for haematuria detected on dipstick urinalysis and at urine sediment microscopy. It may therefore be inferred that dipstick urinalysis is an easy and readily available tool for the screening of haematuria among children with sickle cell anaemia and should therefore be done routinely at the sickle cell clinics.Key words: Sickle cell nephropathy, children, haematuria, dipstick urinalysis, urine sediment microscop

Diuretics use in Paediatric practice with focus on Furosemide

Diuretics remain a common medication in Paediatric practice and possibly one of the most important drugs in Nephrology practice. Understanding their mechanism, appropriate rationale for use and prompt identification of side-effects allows for high efficacy and safety in their use. On the background of challenges in our center with regards to the use of frusemide, this review is specifically focused on addressing factors that may affect frusemide efficacy, possible cause of resistance and drug interactions that may occur following its use

Determinants of modality of management of acute kidney injury in children seen at a tertiary hospital in Nigeria

Background: The cost of taking care of children with acute kidney injury (AKI) is enormous and beyond the reach of many caregivers in  sub-Saharan Africa which are largely resource poor. It is therefore imperative to determine those who may benefit from conservative management which is comparatively cheaper to the renal replacement therapy (RRT).Objectives: To determine the clinical characteristics of children who were offered conservative and renal replacement therapy and evolve the most statistically significant eligibility criteria. Methods: A descriptive  crosssectional study of children presenting with AKI admitted into the Emergency Paediatric Unit (EPU) of the University of Ilorin Teaching Hospital (UITH) between January 2008 to December 2012 was carried out. Demographic, clinical, and laboratory data were collected. A serialblood chemistry and urine analysis were also obtained. A total of 22 cases of acute kidney injury were seen within the period. Fourteen were conservatively managed while eight underwent sessions of dialysis.Results: The age range for those who had conservative managementwas 4-17 years with a mean ±SD of 8.11±3.91 years while the corresponding value in those with renal replacement therapy was 1.5-16years with a mean ±SD of 9.68±5.54years. There was no statisticalsignificant difference in the highest serum potassium, urea andcreatinine. However, the lowest urine output was significantly differentamong the two groups (p< 0.05).Conclusion: Urine output could be used as an eligibility criterion todetermine children with AKI who will require renal replacement therapy or benefit from a trial of conservative management.  Keyword: Acute kidney injury; conservative management; dialysi

Anhidrotic ectodermal dysplasia: a case report in a Nigerian child and literature review

This report of Hereditary anhidrotic ectodermal dysplasia (HAED), a genetic disorder characterized by abnormalities of structures of ectodermal origin, was informed by its rarity, and its import for survival in a tropical environment. The five-year old male was first seen on account of inability to cut the front teeth, and a persistent offensive nasal discharge. He had heat intolerance and inability to perspire from early infancy. Pedigree evaluation revealed that both parents are Nigerians and unrelated, but the maternal front dentition was visibly defective. A 19-year old female sibling needed dentures at 10 years of age, while the father was one of two survivors out of 12 children, eight of whom were males. Findings included hypotrichosis; “saddle-nose” deformity and an offensive nasal discharge; the skin was thin, warm and dry; he had no incisors and canines, but had a single erupted premolar on either side and radiographic evidence of unerupted premolars was found. Genetic counseling and parental anticipatory guidance were offered, as was antimicrobial treatment for the co-morbid atrophic rhinitis. Dentures were deferred on the dentist's advice. This case report of HAED in a Nigerian was aimed at raising the local index of clinical suspicion by highlighting the reality of rarities, even with inadequate diagnostic support. The diagnostic parameters, literature review and the management strategies are discussed.Key words: Anhidrotic ectodermal dysplasia; hypotrichosis; oligodontia;Nigeri

Current trends in the management of acute kidney injury in children

Acute Kidney Injury (AKI) previously known as acute renal failure (ARF) is a common problem in the paediatric emergency wards with infections likesepsis and malaria being the commonest causes in Nigeria. It has been known by various nomenclatures with a lack of standardised definition. This has made comparison of data very difficult. In the last decade, attempts have been made to standardize the definition by developing a classification criterion termed “RIFLE”. This is in turn undergoing variousmodifications with the most recent classification system developed by the Kidney Disease: Improving Global Outcomes (KDIGO). Despite these interesting developments, the basis of these classifications which is the use of serum creatinine measurements is fraught with its own limitations.This has led to discovery of various urinary and serum biomarkers like the cystatin C and neutrophil gelatinase associated lipocalin (NGAL) which appear to have very promising advantages over the well known creatinine measurements. Management of AKI continues to be anticipatory with appropriate fluid therapy and adequate treatment of infections. The benefits of furosemide and dopamine in management are still a constant source of debate. Treatment of life threatening complications like hyperkalaemia and hypertension as well as maintaining the kidney through the period of non-function can lead to remarkable recovery of renal homeostatic function.Keywords: acute kidney injury, paediatrics, managemen

Acute Respiratory Infections in the Middle-Belt Region of Nigeria

Background: ARI continues to be a leeding cause of death among children globally beyond the year 2000. Close 12 million children under the age of 5years die each year in the developing countries, mainly from preventable causes and approximately 2.28 million (19%) were due to acute respiratory infections (ARI). It therefore became necessary to assess the present status of the disease in Nigeria to mastermind workable plans for reducing the mortality and morbidity burden.Methods: A designed pro-forma was used to collect and collate information from mothers or direct care givers of children at both hospital and community levels relating to family background, home setting, anthropometry, clinical presentation of ARI, previous medications, investigations, complications and outcomes of illness.Results: A total of 163 children were recruited for the study. One hundred and six had moderate and severe form of ARI while 57 had mild form. The in-patients accounted for 15.2% of all the admission within the study period.All children were under 12 years of age with male preponderance. Fast breathing, Tarchypnoea, Cough and Fever were the leading ways of presentations. The immunization coverage of study population by various antigens in the EPI were poor. Majority of the hospital children had pre-consultation antibiotics while none of the children from the rural community had pre-recruitment antibiotics. Streptococcus pneumoniae and Staphylococcus aureus were the leading organisms isolated with good sensitivity to Quinolones, Gentamycin and Cephalosporins. Heart failure was the leading complications. Mortality was 12.3% among the hospitalized patient and none among the community children.Conclusion: It was concluded that ARI is still a major cause of morbidity and mortality among children with opportunity for burden reduction.Keywords: Acute Respiratory Infection, present outlook, burde

Knowledge, attitude and perception of respondents in a rural Nigerian community concerning the passage of discoloured urine in childhood

Background: Discolouration of urine in children raises concern among the general populace and forms a reason for consultation of physicians and other health workers. Anecdotally, it seems there is an awareness of what constitute discoloured urine. However, there is no documented report of the knowledge, attitude and perception of people to it. Objective: To determine the knowledge, attitude and perception of discoloured urine in children by respondents in a rural community in Nigeria. Methodology: The study was carried out in Iponrin, in Ilorin East Local Government Area of Nigeria with the aid of pre-tested questionnaires, which sought information on issues related to knowledge, attitude and perception of discoloured urine in children. Results: There were a total of 109 respondents comprising 64 (59%) males and 45 (41%) females with a mean age of 30 ± 16 years. Most of the respondents 87 (82%) have seen children with discolouration of urine and 65 (65%) respondents claimed that such children received treatment from a health facility. Furthermore majority of the respondents 55 (57%) reported that none of these children they saw developed anuria, while 93 (87%) respondents felt such children would survive. Conclusion: The study showed that respondents in the study community had an understanding of when urine colour is normal or abnormal. They are also aware that it could be caused by diseases and would therefore require treatment in a health facility. However, they did not know that it could cause anuria in some cases. We therefore recommend further enlightenment on the complication that may follow passage of discoloured urine. Keywords: knowledge, attitude, perception, discoloured urine, children Sahel Medical Journal Vol. 8(1) 2005: 20-2

Surgeon-General of Nigeria: the history, the politics and the need.

In the beginning of the year (2014) , the Federal Government of Nigeria agreed in principle to establish the office of the Surgeon General of Nigeria(SGN). However, while it was welcomed by the community of doctors, the other health workers rose up against it alleging that it was another ploy by doctors to subjugate other members of the health  team. This write- up has examined the history of the office of Surgeon General, what gaps it aims to fill and gains it could bring to a nation with dismal health indices.Key words: Surgeon-General, Nigeria, history, politic

Preventive Nephrology - Proposed Options in Childhood Nephropathy

Three children with renal disorders managed at the University of Ilorin Teaching Hospital are reported as case studies to underscore the need for preventive nephrology . The first case illustrates the inevitability of rapidly progressive renal failure when remedial management desired in the early stages of the nephropathy is not offered or available. Subsequent efforts to help the child were inadequate, too late and foreclosed by extreme poverty of the family. The second case typifies the acute on chronic nephropathy complicated by hypertension and again, extreme poverty of the family. The prognoses in such cases are uniformly bad. The third case represents an important group with relapsing type of nephrotic syndrome, which is amenable to remedial management, and a fair chance of a good span of life. A long term follow-up and attention to possible trigger factors that might lead to relapse is called for. In the three cases, it was posited that primary, secondary or tertiary preventive strategies would have been useful or was useful. Nigerian Journal of Paediatrics 2001; 28:46. pp. 46-4

Global Trend In The Qualifications Of Medical Educators

Fellowship degree of the National Postgraduate Medical College of Nigeria (NPMCN) or its equivalents is the highest educational and professional qualification of clinical Medical Educators in Nigeria while PhD is the acceptable highest qualification for their basic medical sciences counterparts. This had been the status ante until year 2012 when the National Universities Commission of Nigeria (NUC) issued a letter directing all university teachers, including clinicians to acquire a PhD or MD degree as non-possession would deny them promotion to a professor status and would debar them from aspiring to the position of Vice-Chancellor of their Universities. This paper highlights the history, current status and the way forward in solving the Fellowship versus PhD/MD conundrum by studying the laws that set up the NPMC, as the highest academic and professional training institution for clinical teachers, as well as the guidelines (Benchmark Minimum Academic Standard, BMAS) set by the NUC. Solutions are offered towards solving this conundrum for better medical education in an environment devoid of academic superiority wrangling in Nigeria. Key words: Medical Educator, Qualifications, Nigeria, Globa