Febrile Convulsion among Hospitalized Children Aged Six Months to Five Years and Its Association With Haemoglobin Electrophoretic Pattern

BACKGROUND: Febrile convulsion and sickle cell disease are common in tropical countries and both are associated with significant morbidity and mortality. Worldwide, Nigeria has the highest prevalence of sickle cell disease. However, there is a dearth of knowledge on the haemoglobin electrophoresis in patients with febrile convulsions.METHODS: This was a hospital based, descriptive, cross-sectional study of the relationship between haemoglobin genotype and febrile convulsion at the University of Ilorin Teaching Hospital over a period of 12 months. A self-designed pretested questionnaire was administered on the subjects, and necessary examinations and investigations were conducted.RESULTS: Of a total of 1675 children admitted into the emergency paediatric unit during the study period, children aged 6 months–5 years that presented with febrile convulsions were 167(10%) . Of this, 1,212 were aged 6 months-5 years. Thus, the age specific, hospital-based prevalence was 13.8%. The M:F was 1.1:1. Their Haemoglobin genotype distribution was AA 131(78.4%), AS 23(13.8%), AC 6(3.6%), SS 6(3.6%), and 1(0.6%) SC. The mean age of the sickle cell disease patients was higher at 46.0±13.5 months compared to 29.2±15.4 months in the non-sickle cell disease patients (p=0.005). The mean packed cell volume in subjects with sickle cell anaemia was 8.8±1.5%; the only case of haemoglobin SC had packed cell volume of 20%, while the non-sickle cell disease patients had a normal PCV. Malaria was present in 80.4% of them.CONCLUSION: Febrile convulsion remains a common cause of hospitalisation. It is uncommon in haemoglobin SS where severe anaemia is always an accompanying derangement. The packed cell volume is nearly normal in children with normal haemoglobin genotype.KEYWORDS: Febrile Convulsion, haemoglobin genotype, children, Malari

A re-appraisal of Warfarin control in the treatment of Deep Vein Thrombosis and / or Pulmonary Embolism

Background: Warfarin is commonly used for management of deep vein thrombosis (DVT) and pulmonary embolism (PE), controlling therapy by means of the International Normalized Ratio (INR). Objectives: To identify differences in INR results between patients with thromboembolic and haemorrhagic complications and controls. Methods: Two nested case-control studies from within a controlled trial of the duration of warfarin therapy (47 thrombotic and16 haemorrhagic complications). Results: Patients whose thromboembolism failed to resolve during treatment or recurred during or after treatment had non-significantly lower INR levels than matched controls (geometric mean 2.2 versus 2.3, p = 0.12). Patients with haemorrhage also had not statistically significant lower INR levels than their matched controls (2.1 versus 2.3, p = 0.22). The variability of INR levels was similar in both case groups and controls.The mean percentage of INR levels in the therapeutic range 2 3 was almost identical in thrombotic cases and controls (56.5% versus 56.1%). Compared to the haemorrhagic group, better control was achieved incontrols (61.5% versus 43.0%, p =0.01), but controls had slightly more INR values above the therapeutic range (12.1% versus 10.5%, p = 0.74) whilst haemorrhagic cases had more INR values below the therapeuticrange (46.6% versus 26.4%, p = 0.03). Conclusion: In this study, higher INR levels were not associated with haemorrhage suggesting that, forpatients being treated for DVT/PE, a modest increase in the target therapeutic range could be considered.Running head: Warfarin Control in treatment of DVT/PEKey words: Deep vein thrombosis; Haemorrhage; International normalized ratio; Pulmonary embolism; Thromboembolism; Warfarin.African Health Sciences 2009; 9(3): 179-18

5 year old girl with malignant lymphoblastic lymphoma: Challenges of managing haematological malignancies in a developing country

Background: Lymphoblastic lymphoma (LBL) is a neoplasm of lymphoblasts. The condition is predominantly lymph node–based disease arising from immature T cells in 85-90% of cases and immature B cells in the remainder. The lymphoma is aggressive, progresses rapidly, and often presenting as stage IV disease in more than 70% of patients. This disease makes up approximately 20% of childhood NHLObjective: To show case the management of childhood lymphoblastic lymphoma and the handicap faced by the oncologists and pathologists.Methods: A review of the index case was carried out at the paediatric department of Federal Medical Centre, Bida, Nigeria. This review took into cognisance patient’s demographic bio data, case history, general and physical examination, various investigations, methods of diagnosis and the type treatment. A comprehensive analysis and account of events before and after the commencement of chemotherapy were also reviewed.Results: This case identifies a 5 year old girl with aggressive malignant lymphoma; lymphoblastic type and the myriad of limitations faced by oncologists and pathologists in the management of haematological malignancies. Socio-cultural, financial (cost implications for the patient for both investigative and therapeutic interventions), inadequate resources and facilities were identified as some of the constraints leading to inadequate management and poor outcome in patients with this condition.Conclusion: Given the limitations associated with the management of cancers in this part of the world, efforts on the part of government and non-governmental agencies are necessary to strengthen and upgrade the existing facilities in various hospitals. The social welfare departments of tertiary hospitals should be adequately funded to meet the demand of thisgroup of patients