Relationship of age, anthropometry and haemoglobin concentration with echocardiographic findings in Nigerian children with sickle cell anaemia

Background: Assessment of the structural and functional effects of sickle cell anaemia (SCA) on the heart can be done using echocardiography.There has been no agreement on which indicator of body size (weight, height, and body surface area (BSA)) or age in children should be used to relate to and correct echocardiographic measurements.Aim: To correlate the echocardiographic findings of children with SCA aged one to fifteen years in steady state with their age, anthropometryand haemoglobin concentration.Methods: A prospective study carried out at the Lagos University Teaching Hospital (LUTH), between May and October 2005. The subjects were 60 paediatric patients attending the LUTH SCA outpatient clinic and 60 age, sex and socioeconomic matched controls. Their height, weight, and echocardiographic parameters were measured and their BSA and haemoglobin level were determined.Results: The direct echocardiographic measurement (AO, LA, LVPW, EDD, ESD, IVS) and LVM each increased progressively with body weight, height, body surface area and age in both subjects and controls (r > 0.3, p < 0.001 in each case). Multivariate analysis showed that height correlated significantly with AO, ESD, EDD and LVPW in the subjects. All the parameters except age were significantly correlated with LVM both in univariate and multivariate analysis.Conclusion: Echocardiographic parameters in SCA patients are significantlycorrelated with anthropometric indices and age. Our data suggest best correlation with height in these subjects

The influence of socioeconomic status on the hemoglobin level and anthropometry of sickle cell anemia patients in steady state at the Lagos University Teaching Hospital

Background: Sickle cell anemia (SCA) has multisystemic manifestations and is associated with severe morbidity and high mortality. It commonly affects growth leading to wasting and stunting.Aims and Objectives: This study aimed to determine the influence of socioeconomic status on the nutritional status using anthropometric measurements and steady-state hemoglobin, of children with homozygous SCA, aged 1 year to 10 years in steady state at the Lagos University Teaching Hospital.Materials and Methods: This is a cross-sectional study involving 100 children with SCA and 100 age-, sex-, and social class-matched controls that fulfilled the inclusion criteria. Social class was assessed using educational attainment and occupation of parents. Hemoglobin concentration was determined using the oxy-hemoglobin method.Results: This study demonstrated a significantly lower mean weight and weight-for-height in the SCA patients than those of controls (P < 0.001). By contrast, this study did not demonstrate any statistical significant difference in the mean height and mean body mass index of SCA patients and controls (P = 0.06) and (P = 0.12), respectively. The mean weight, height, and body mass indices of the subjects and controls were consistently below those of the NCHS standards. The magnitude of the difference from the NCHS standard was also more pronounced in the subjects, increased with advancing age and affected male subjects more than females. Progressive declines in the anthropometric attainment and hemoglobin concentration were observed from social class 1 to 4; this was statistically significant in controls (P = 0.00) but not in subjects (P > 0.1). However, SCA patients had significantly lower values than controls in each of the social classes.Conclusion: Poor socioeconomic status has an adverse effect on the nutritional status and hemoglobin of SCA patients

Childhood dilated cardiomyopathy in Jos, Nigeria

Objective: to study the pattern of childhood dilated cardiomyopathy in Jos University Teaching Hospital, Nigeria.Methodology: Paediatric echocardiography records (January 2000 to June 2002 2 and ½ years) were reviewed and cases of dilated cardiomyopathy (DCM) identified. Clinical, radiologic, electro- and echocardiographic data of identified cases were reviewed.Results: childhood DCM (6 cases) was the commonest acquired heart condition diagnosed in children under the age of 5 years. Four patients presented with recurrent episodes of congestive heart failure (CHF) while 2 presented during their first episode. DCM was initially considered in only 1 child. Another child suffered a cerebro-vascular accident (CVA) before the diagnosis was made.Conclusions: DCM should be considered early in young children with long-standing or recurrent CHF. A high index of suspicion, early diagnosis and appropriate management should reduce morbidity, prevent complications and prolong survival. Sahel Medical Journal Vol. 8(4) 2005: 100-10

Premarital screening for sickle cell haemoglobin: awareness and acceptability among some categories of Health Professionals and Medical Students at the Lagos University Teaching Hospital.

Urinary tract infection (UTI), a significant but preventable cause of morbidity in children, is an important risk factor for development of renal insufficiency. Having simple and reliable means of screening children facilitate its prompt treatment.To evaluate the use of dipstick test for leukocyte esterase (LE) and nitrite as screening tool in the diagnosis of UTI in children.This cross-sectional study was done in the department of Paediatrics, University of Port Harcourt Teaching Hospital (UPTH) from February to October 2005. Children 2 to 15 years with symptoms suggestive of UTI were studied. Midstream urine specimen was collected from each patient forLEtest, nitrite test and culture.Out of 139 children, 72(51.8 percent) males and 67(48.2 percent) females studied, 33(23.7 percent) had positive urine culture. The prevalence of UTI was significantly higher in females than in males (p=0.001). The LE dipstick test correctly identified 17 of the 33 patients with culture proven UTI, with 51.5 percent sensitivity and 79.2 percent specificity. The nitrite dipstick test showed 42.4 percent sensitivity and 93.3 percent specificity. The combination ofLEand nitrite correctly identified 24, giving 73 percent sensitivity and 75.5 percent specificity. The LE seemed to have a higher sensitivity as a screening tool in the diagnosis of UTI than nitrite, but the difference was not statistically significant (p=0.46). However, the combination of LE and nitrite provided a higher sensitivity than either of them with a statistically significant difference (p=0.04). Keywords: Sickle cell anaemia, premarital screening, Haemoglobin genotype

Cerebral Abscess in a 7yr old with uncorrected tetralogy of Fallot: Anaesthetic management

Patients with uncorrected Tetralogy of Fallot (TOF) tend to be poor candidates for anaesthesia but with a goodunderstanding of the pathophysiology of the disease and an individualized anaesthetic plan, they can undergo surgicalinterventions safely. We report a case of a 7 year old boy with uncorrected TOF with features of raised intracranialpressure (ICP) due to a cerebral abscess who successfully underwent an emergency craniotomy with drainage at ourinstitution.Keywords: Tetralogy of Fallot, cerebral abscess, anaesthesia, cyanotic, heart diseas

Cardiovascular disease risk factors amongst secondary school students in an urban community in Nigeria

No Abstrac

Transcatheter closure of secundum atrial septal defect in adults: report of our first experience in a developing country

B Adeola Animasahun,1 Yele Aluko,2 Adeyemi Johnson,3 Kofo Ogunyankin,3 Sunita Maheshwari41Department of Paediatrics and Child Health, Lagos State University College of Medicine, Lagos, Nigeria; 2Mid Carolina Cardiology, Charlotte, NC, USA; 3First Cardiology Consultants, Lagos, Nigeria; 4Narayana Hrudayalaya Institute of Cardiac Sciences, Bangalore, IndiaBackground: Since the first report on device closure of atrial septal defect (ASD) in 1976, the procedure has gained wide acceptance and has been used worldwide, including parts of Africa. The advantages when compared to surgical closure include a shorter procedure time and hospital stay and no scarring. This mode of treatment was not available in Nigeria prior to the cases reported here, requiring patients to travel abroad for the procedure.Methods: A cardiac catheterization laboratory became available in Lagos, Nigeria in 2009, and in December 2010 the laboratory collaborated with Lagos State University College of Medicine and Lagos State University Teaching Hospital to perform the device closure on two women (aged 34 and 62 years) with secundum ASD. To the best of our knowledge, these are the first times the procedure has been performed in Nigeria.Results: Both patients made successful recovery and are stable.Conclusion: Transcatheter closure of ASD is now safe and available in Nigeria.Keywords: atrial septal defect, transcatheter closure, Nigeri

Clinical profile of Nigerian children with sickle cell anaemia

Abstract This study aimed to document the cardiovascular features of children with sickle cell anaemia (SCA), in steady state at the Lagos University Teaching Hospital (LUTH) using clinical evaluation. A prospective and cross-sectional study involving 100 children with SCA and 100 age and sex matched controls aged one to fifteen years. Their cardiovascular statuses were evaluated by clinical examination. About 80% of the subject were diagnosed after one years of age, twenty two [36.7%] of the 60 sixty subjects had received at least one blood transfusion. The commonest signs in subjects were hepatomegaly, pallor and laterally displaced apex beat. They had significantly lower systolic blood pressure and diastolic blood pressure but higher respiratory rates and pulse rates compared to controls. (p< 0.01). Sickle cell anaemia is diagnosed late among Nigerian children. Blood transfusion is common among children with SCA, Increased Respiratory rate and heart rate but lower systolic and diastolic blood pressure. The commonest clinical signs were hepatomegaly, pallor and laterally displaced apex beat, due to chronic anaemic state