HIV Sero-Prevalence among Infants Attending Immunization Centers in Calabar Metropolis, Cross River State, Southern, Nigeria

Introduction: Pediatric Human Immunodeficiency Virus (HIV) infection accounts for over 2.3% of all pediatric infections. Many HIV-infected infants are not identified until they develop symptoms and present with illness at health facilities. However, the six weeks immunization visit provides an opportunity for HIV-infected mothers and their exposed infants to be identified before symptoms occur. This study was therefore conducted to determine the HIV status of infants attending immunization clinics in Calabar with a view to enrolling them into treatment. Subjects and Method: This cross sectional descriptive study was conducted in two Local Government Areas of Calabar consisting 22 selected immunization centers. Using the multistage sampling method, 330 infants were screened. Ethical clearance was obtained from the supervising Ministry of Health. Rapid test was conducted, reactive specimens had Deoxyribonucleic Acid Polymerase Chain Reaction (DNA PCR) done using Dried Blood Spots (DBS). Results: A total of 330 infants aged 6 to 14 weeks were recruited, 173 (52.4%) were males while 157(47.6%) were females giving male to female ratio of 1.1:1. Mean age of the infants was 9.20 ± 3.1 weeks. Twenty four (24) tested positive for HIV antibodies, after HIV DNA PCR test, 14(4.2%) infants were infected. Antenatal care registration (ANC) and maternal ANC HIV status were statistically significant P=0.03 and P= 0.02 respectively. Conclusion: HIV exposed and infected infants are still been missed and only diagnosed later in life. Therefore, maternal HIV status determination and early diagnosis at immunization centers is recommended to bridge the Prevention of Mother To child Transmission (PMTCT) gap

Locked–in Syndrome in a Nigerian male with Multiple Sclerosis: a case report and literature review

Background: Locked-in syndrome is an extremely difficult neurologic condition to recognize, especially by the non-specialists. A case of locked-in syndrome in a 41–year old Niger Deltan Nigerian with relapsing  remitting form of multiple sclerosis (MS) is presented, including a detailed literature review. Patient and Case Report: The patient was in a state of spastic quadriplegia, motionless and aphasic  (mute), with the preservation of consciousness and the ability to open and blink the eyes and move them  vertically. Two episodes of the disease, varying in duration, have been described. The diagnosis of MS was made from the history and the typical clinical presentation: history of relapsing and remitting signs and clinical evidence of multi-focal involvement of the central nervous system. Conclusion: Patient died at the age of 45 years, from pulmonary complications. This article may enhance easy recognition and management of the syndrome by all clinician

Locked–in Syndrome in a Nigerian male with Multiple Sclerosis: a case report and literature review

Background: Locked-in syndrome is an extremely difficult neurologic condition to recognize, especially by the non-specialists. A case of locked-in syndrome in a 41–year old Niger Deltan Nigerian with relapsing remitting form of multiple sclerosis (MS) is presented, including a detailed literature review. Patient and Case Report:The patient was in a state of spastic quadriplegia, motionless and aphasic (mute), with the preservation of consciousness and the ability to open and blink the eyes and move them vertically. Two episodes of the disease, varying in duration, have been described. The diagnosis of MS was made from the history and the typical clinical presentation: history of relapsing and remitting signs and clinical evidence of multi-focal involvement of the central nervous system. Conclusion:Patient died at the age of 45 years, from pulmonary complications. This article may enhance easy recognition and management of the syndrome by all clinicians

Folic acid and brain function in childhood

Folic acid supplementation does not only prevent neural tube defects in the foetus but is an essential ingredient in the growth and development of the cerebral cortex. This micronutrient promotes the thickness of the cerebral cortex; the extent of the thickness being directly proportional to the intelligent quotient, neurocognitive and psychological output of the child. Children with thin cortices are prone to poor cognitive performance, autism and psychiatric disorders such as depression. Folic acid supplementation in the first three months of pregnancy largely protects against neural tube defects; studies have shown that children whose mothers take folic acid supplement throughout pregnancy exhibit relatively higher levels of emotional intelligence. Nevertheless, in spite of long-standing recommendations that women of child-bearing age take folic acid to protect against neural impairment, a large proportion do not comply; less than half of the world’s population lives in countries that require folic acid fortification of grain products. A large portion of pregnant women in poor world countries do not attend antenatal care hence have no access to prescription of essential haematinic/folic acid. It is recommended that all women who are either planning or capable of pregnancy take a daily supplements containing 0.4 - 0.8 mg (400-800 μg) of folic acid. Fortified foods like some breads, juices, and cereals contain adequate folic acid; others are leafy green vegetables, like spinach, broccoli, and lettuce beans, peas, and lentils. Fruits like lemons, bananas, and melons are also rich sources of folate. There is need for more advocacy regarding antenatal care of pregnant mothers with emphasis on folate supplementation before and throughout pregnancy, to boost the intellectual and psychological capacity of children into adulthood

Autonomic manifestations of epilepsy

Abstract: An epileptic fit does not only manifest as bizarre motor activity but can destabilize autonomic functions. Abnormal electrical discharge originating from the cerebral cortex can spreads to involve the autonomic system thus creating a dysfunction of the sympathetic and the parasympathetic which modulate the cardiorespiratory, digestive, genitourinary systems. The autonomic phenomenon can be encountered in simple partial, complex partial, generalised tonic-clonic, absence and generalized tonic seizures. Both the motor and the autonomic components may manifest simultaneously; at times the autonomic symptoms may precede or outlast the motor components. Autonomic features affecting the cardiopulmonary function may be life-threatening and contributes to 8-17% of deaths in individuals with epilepsy. Hypoventilation, apnoea, atrial fibrillation, sinus arrhythmias, atrial and ventricular premature depolarisations, bundle branch block and asystole are known to manifest in the peri-ictal and also in interictal phases of epilepsy. Poor control, and polytherapy in the management of patients, render some epileptics more vulnerable toexcessive excitability of the autonomic nervous system. The aim of this communication, therefore, is to alert and remind healthcare givers on the autonomic phenomena of epileptic fits some of which may result in sudden unexpected death. Clinician should always take a holistic approach in the evaluation of epilepsy patients and watch out especially for cardiorespiratory variability during and in-between attacks.Key Words: Epilepsy, Autonomic dysfunction

Aetiology and comorbidities of cerebral palsy in a developing country

Background: Cerebral palsy (CP) is a common disabling condition of movement and posture causing activity limitation arising from a static injury to the developing brain. Common risk factors for cerebral palsy in Africa include severe birth asphyxia, kernicterus and neonatal infections. This study is aimed at determining the aetiology and comorbidities associated with cerebral palsy in our environment.Methods: All children with CP presenting to the Paediatric Neurology clinic of the University of Calabar Teaching Hospital whose parent gave consent were recruited into the study. The biodata of the children and that of the parent’s/ care givers were obtained. A detailed pregnancy and delivery history, neonatal history, seizures during first three years of life and developmental mile stones was documented.Results: Seventy children with CP were recruited into the study of which 46 (65.7%) were males and 24 (34.3%) females. Majority of the children were from low social class and products of home, church or TBA’S delivery where supervision is poor. Severe birth asphyxia and CNS infections are the commonest identified risk factors. Spastic quadriplegic CP is the dominant type of CP followed by spastic hemiplegia. There is a significant statistical relationship between the aetiology and the type of CP. Epilepsy (60%) speech defect (42.9%) and microcephaly (40%) are the predominant comorbidities seen in the study. Cortical atrophy and ventricular dilatation are predominant CT findings in contrast to periventricular leukomalecia seen in developed countries.Conclusions: Majority of the patients with CP in this study are from low social class and were delivered in places with poor obstetrics care. Improved perinatal care through an adequate social support system may reduce the burden of the disease

The impact of an enlightenment program on community perception towards children with epilepsy

Background: Epilepsy is associated with social stigma and discrimination which is often harmful and devastating. Lack of knowledge and misconception is responsible for these negative attitudes. Public awareness and education are known to improve perception towards epileptics.Methods: A sensitization workshop among community leaders on epilepsy was carried out in a rural community in Cross River State, Nigeria. A pretest questionnaire was administered to participants based on items related to knowledge and perception towards epileptics. The respondents were offered a 2-hour workshop on the causes, types, cure and myths about epilepsy. The same questionnaire was again applied after the workshop. The responses before and after intervention were compared using the McNemar test statistic, with a significance level at p<0.05.Results: Seventy-two respondents participated in the study comprising of 42 (58.3%) males and 30 (41.7%) females. Twenty-eight (38.9%) had primary education and the same number had tertiary education. There was a positive correlation between level of education and performances in the perception towards various domains of epilepsy. Statistical significant differences were found in perceptions regarding cure, mode of contracting epilepsy and potentials of epileptics. However, no statistical difference in perception after the intervention regarding marriage to epileptics.Conclusions: Respondents with higher level of education demonstrated significantly better awareness and attitude towards epileptics compared to those with lower levels the intervention package produced a significant improvement in most domains of perception about epilepsy. Public enlightenment is effective in reducing social stigma and discrimination. It should be encouraged to curtail the negative attitude and perception towards epileptics

Socio - demographic characteristics of HIV patients diagnosed at immunization centres in Calabar, South – south, Calabar, Nigeria

Introduction: The World Health Organization (WHO) estimated that 3.2 million children were living with Human Immunodeficiency Virus (HIV) at the end of 2013, mostly in sub- Saharan Africa. Socio- economic and demographic factors do not only affect viral transmission but also the success of preventive strategies and treatment.Objective: To determine the socio -demographic characteristics of mothers, and the relationship between maternal and HIV status of their infants attending immunization clinics in Calabar.Methods: Using multistage sampling method, 330 subjects were enrolled and screened from 63 immunization centres. The sociodemographic characteristic ofeach infant’s mother was documented. The results of Rapid test for mothers and Dried Blood Spots (DBS) results for infants were compared.Results: Of the 330 subjects recruited, 173 (52.4%) were males while 157(47.6%) were females. Mean age of the infants was 9.20 ± 3.1 weeks. Twenty four mothers and infants tested positive for HIV antibodies. After confirmatory tests using HIV Deoxyribosenucleic acid (DNA PCR), 14(58.3%) out of 24 antibody seropositive infants were infected. The transmission rate after confirmation was 58.3%.Conclusion: Parental education, social class and low maternal Antiretroviral drug (ARV) use were responsible for transmission. It is therefore recommended that health education on ARV use during antenatal period and HIV status of mother baby pair be done at immunization centres. HIV positive mothers and babies should be promptly referred for therapy.Keywords: Immunization, HIV, Infants, DNA PCR, PMTCT, AR

Malaria parasite positivity among febrile neonates

Background: Malaria, earlier considered rare in neonates, has been reported with increasing frequency in the last decade. Neonatal malaria diagnosis is challenging because the clinical features are non-specific, variable and also overlap with bacterial infection.Aim: To determine the prevalence of neonatal malaria and the associatedclinical features in newborn babies with fever.Patients and methods: One hundred and fifty neonates with fever admitted into the Newborn unit of the University of Calabar Teaching Hospital, over a six month period, were recruited consecutively. Symptoms and signs for each neonate were documented. Blood film for malaria parasites and investigation for sepsis workup were done before commencement of drugs.Results: One hundred and fifty babies were recruited. Most (85.3%) of the babies were aged .7 days. One hundred and thirty six (90.7%) of the mothers were booked for antenatal care (ANC). Most of the babies were from primiparous women (54.7%). Six babies (4%) had malaria  parasitaemia with four (2.7%) being congenital malaria and two (1.3%)acquired malaria. Plasmodium falciparum was the only species identified. All six with malaria were from the 136 booked mothers. Four of the affected six neonates also had septicaemia. The clinical features in babies with malaria only were, fever, fast breathing and jaundice while thosewith malaria and bacterial co-infection had, in addition, poor suck.Conclusion: Malaria infection and septicemia can coexist in some Nigerian newborns and since the clinical presentation of each of these condition are closely similar, it is recommend that malaria parasite investigation be included as part of the investigation in the newborns with fever. This approach can help to avoid a delay in applying the appropriate therapeuticinterventio

Neonatal seizures in Calabar: A revisit

Newborns admitted with convulsion in the University of Calabar Teaching Hospital, Calabar during the period 1st May 2004 to 30 April 2006 were studied prospectively. The aim was to determine the place of birth in relation to the cause of seizures, the current situation in terms of the aetiology, clinical spectrum and outcome. There were 55 neonates with convulsion representing 5% of admissions into the newborn unit during the period. Birth asphyxia, sepsis, and hypoglycaemia were important identifiable aetiological factors which operated either singly (45.5%) of cases) or in concert (54.5% of cases) in causing seizures. Hypocalcaemia and hyponatraemia contributed less. These results are similar to that of a previous study carried out in this centre ten years earlier . There was no statistical significant difference between home and hospital deliveries in relation to causes of seizures. Septicaemia was caused mainly by staphylococcus aureus, enterobactericae and unclassified coliforms. No neonatal meningitis was diagnosed. Surprisingly, there was a high prevalence of generalized seizures (76.4%). The mortality of 34.0% was related to onset of the seizures within 4 days of life but not the place of birth.The causes of neonatal seizures in our environment are mostly preventable. There is need to provide modern facilities for investigating newborn seizures, training and retraining of Traditional Birth Attendants, health education of expectant mothers