Management of severe aortic valve stenosis in the neonate

Aortic valve stenosis (AS) causing obstruction to the left ventricular outfl ow, and hence reduction of the cardiac output, remains a therapeutic challenge for paediatric cardiologists and cardiothoracic surgeons. Infants that present at birth may have very dysplastic valves with severe or critical AS and are typically the most diffi cult to treat. This article therefore focuses on the managementof severe AS in the neonate. This article also revises the embryology of the semi-lunar valves, as the morphology of the aortic valve often dictates the treatment pathway

Disclosure of Paediatric HIV Status to Infected Children and Significant Others: Impact and Psychosocial outcomes

There is limited data on disclosure of Paediatric HIV to significant others in the social network of children which may impact on their care. This study determined the prevalence of disclosure of Paediatric HIV to infected children and others as well as their impact on the children. It took place at the Paediatric Infectious Disease Clinic of the University College Hospital, Ibadan. Caregivers of HIV positive school aged children were interviewed using a semi-structured questionnaire and the Parent version of the Strength and Difficulties Questionnaire. Data was analysed using IBM SPSS Statistics version 20.0. A total of 200 children were studied with a male: female ratio of 1.3:1 and ages ranging from 6-17 years. Disclosure of HIV status had been done to 54 (27%) of the 200 children. Disclosure was not associated with a significant difference in psychological functioning or adherence to ART. Disclosure had been made to extended family members in 128 (64%) of the 200 patients, to the children’s siblings in 33 (21.4 %) of the 154 who had siblings, to the family spiritual leaders in 28 (14%) of the 200 families and to the children’s teachers in 3 (1.5%) of 197 cases in school. In response to disclosure, all the siblings, teachers and spiritual leaders encouraged the families and expressed willingness to support but this was so for only 108 (84.4%) of the 128 extended family members. Major forms of support given were financial, medication reminder, emotional support and prayers. Negative outcomes included stigmatization and HIV related parental separation. There is need for health workers to promote disclosure to significant others and provide support for families who get abandoned by relations following disclosure

Ocular manifestations of children with sickle cell disease in Ibadan, Nigeria

Background: Children with sickle cell disease can present with ocular complaints. Regular eye examination can detect sight threatening conditions amenable to treatment. The aim of the study was to describe ocular manifestation of children with sickle cell disease attending the Pediatric Outpatient Department of the University College Hospital Ibadan.Methodology: Children 15 year and below diagnosed with sickle cell disease at the Pediatric Outpatient of the University College Hospital were examined in detail by the Ophthalmologist to document ocular findings.Results: One hundred and five (105) patients were examined. Mean age was 3.22 ± 2.49 years with a male to female ratio of 1.2: 1. Ninety children (85.7%) had Hemoglobin SS while HB SC had 15(14.3%). The commonest ocular finding was retinal vascular tortuosity in 15(14.3%). Other important findings were central retinal artery occlusion in 2 (1.9%) patients; black sunbursts pigmentation 2(1.9%); chorioretinal atrophy 3(2.8%), salmon patch retina hemorrhage 1(0.95%); retina holes1(0.95%) and retina coloboma1(0.95%). The only anterior segment finding was jaundice in all the patients. No conjunctiva vascular abnormalities were found.Conclusion: Retinal vascular tortuosity is the commonest ocular manifestation of children with sickle cell disease in Ibadan. Central retinal artery occlusion, a devastating condition is an emerging manifestation. Regular eye examination for sickle cell retinopathy in children less than 15 years of age is not recommended

Situation Analysis Of The Existing Infant Feeding Pattern At The commencement Of The Prevention Of Mother To Child Transmission (PMTCT) of HIV Programme In Ibadan

To evaluate breastfeeding and weaning practices associated socio-demographic factors and knowledge aboutmother- to- child transmission ofHIVamongmothers in Ibadan. A cross sectional survey was conducted among 513 mothers of children aged 6- 24 months, attending infant welfare clinics. Data collection was by a structured questionnaire, which was supplemented by focus group discussions to further explore some of the issues covered in the survey. Breast-feeding rate was 99.4%, the duration of which ranged from 1-22 months with a median of 14 months among those who had stopped breastfeeding. Only 145 (28.3%) mothers breastfed their babies exclusively for six months and 259(50.8%) initiated breastfeeding within one hour of birth; both were associated with at least secondary level of education. The main obstacle to exclusive breastfeeding was the belief that water is required to quench thirst in babies. Expression of breast milk was not favoured by majority of the mothers (68%) most of whom felt that the milk would get contaminated. Wet nursing was rarely practiced (0.4%). Most of the mothers, 436 (85%) were aware that HIV could be transmitted through breast milk but the attitude towards amotherwho did not breast feedwas negative in 96.8%of respondents.Adherence to recommended infant feeding options for HIV-exposed infants are likely to be faced with challenges in a culture where breastfeeding is the norm and exclusive breastfeeding rate is low. There is need for counseling and health education on prevention ofmother- to- child transmission of HIV.Keywords: Exclusive breastfeeding, situation analysis, infant feeding patterns, Ibada

Early deaths and other challenges to childhood cancer survival in Ibadan, Nigeria

Study to determine the frequency of early deaths and the associated risk factors in children suffering from cancer at the University College Hospital, Ibadan

Retrospective Reports of Childhood Trauma in Adults with ADHD

Although studies have documented higher prevalence of abuse in children with ADHD, no studies have investigated childhood reports of abuse in individuals identified withADHDin adulthood. Method: FortyADHDwomen, 17ADHD males, 17 female controls, and 40 male controls complete the Childhood Trauma Questionnaire and other measures of psychosocial functioning. Results: Emotional abuse and neglect are more common among men and women with ADHD as compared to controls. Sexual abuse and physical neglect are more commonly reported by females with ADHD. Although childhood abuse is significantly correlated with depression and anxiety in adulthood, having ADHD is a better predictor of poorer psychosocial functioning in adulthood. Conclusion: Clinicians are alerted that patients with ADHD symptoms have a high probability of childhood abuse

Maternal obesity is associated with the formation of small dense LDL and hypoadiponectinemia in the third trimester

Context: Maternal obesity is associated with high plasma triglyceride, poor vascular function, and an increased risk for pregnancy complications. In normal-weight pregnant women, higher triglyceride is associated with increased small, dense low-density lipoprotein (LDL). Hypothesis: In obese pregnancy, increased plasma triglyceride concentrations result in triglyceride enrichment of very low-density lipoprotein-1 particles and formation of small dense LDL via lipoprotein lipase. Design: Women (n = 55) of body mass index of 18–46 kg/m2 were sampled longitudinally at 12, 26, and 35 weeks' gestation and 4 months postnatally. Setting: Women were recruited at hospital antenatal appointments, and study visits were in a clinical research suite. Outcome Measures: Plasma concentrations of lipids, triglyceride-rich lipoproteins, lipoprotein lipase mass, estradiol, steroid hormone binding globulin, insulin, glucose, leptin, and adiponectin were determined. Results: Obese women commenced pregnancy with higher plasma triglyceride, reached the same maximum, and then returned to higher postnatal levels than normal-weight women. Estradiol response to pregnancy (trimester 1–3 incremental area under the curve) was positively associated with plasma triglyceride response (r2 adjusted 25%, P < .001). In the third trimester, the proportion of small, dense LDL was 2-fold higher in obese women than normal-weight women [mean (SD) 40.7 (18.8) vs 21.9 (10.9)%, P = .014], and 35% of obese, 14% of overweight, and none of the normal-weight women displayed an atherogenic LDL subfraction phenotype. The small, dense LDL mass response to pregnancy was inversely associated with adiponectin response (17%, P = .013). Conclusions: Maternal obesity is associated with an atherogenic LDL subfraction phenotype and may provide a mechanistic link to poor vascular function and adverse pregnancy outcome

Preeclampsia is associated with compromized maternal synthesis of long chain polyunsaturated fatty acids leading to offspring deficiency

Obesity and excessive lipolysis are implicated in preeclampsia (PE). Intrauterine growth restriction is associated with low maternal body mass index and decreased lipolysis. Our aim was to assess how maternal and offspring fatty acid metabolism is altered in mothers in the third trimester of pregnancy with PE (n=62) or intrauterine growth restriction (n=23) compared with healthy pregnancies (n=164). Markers of lipid metabolism and erythrocyte fatty acid concentrations were measured. Maternal adipose tissue fatty acid composition and mRNA expression of adipose tissue fatty acid–metabolizing enzymes and placental fatty acid transporters were compared. Mothers with PE had higher plasma triglyceride (21%, P<0.001) and nonesterified fatty acid (50%, P<0.001) concentrations than controls. Concentrations of major n−6 and n−3 long-chain polyunsaturated fatty acids in erythrocytes were 23% to 60% lower (all P<0.005) in PE and intrauterine growth restriction mothers and offspring compared with controls. Subcutaneous adipose tissue Δ−5 and Δ−6 desaturase and very long-chain fatty acid elongase mRNA expression was lower in PE than controls (respectively, mean [SD] control 3.38 [2.96] versus PE 1.83 [1.91], P=0.030; 3.33 [2.25] versus 1.03 [0.96], P<0.001; 0.40 [0.81] versus 0.00 [0.00], P=0.038 expression relative to control gene [square root]). Low maternal and fetal long-chain polyunsaturated fatty acid concentrations in PE may be the result of decreased maternal synthesis