Insulin Regimens and Clinical Outcomes in a Type 1 Diabetes Cohort: The SEARCH for Diabetes in Youth study

OBJECTIVE To examine the patterns and associations of insulin regimens and change in regimens with clinical outcomes in a diverse population of children with recently diagnosed type 1 diabetes

Selecting short-statured children needing growth hormone testing: Derivation and validation of a clinical decision rule

<p>Abstract</p> <p>Background</p> <p>Numerous short-statured children are evaluated for growth hormone (GH) deficiency (GHD). In most patients, GH provocative tests are normal and are thus in retrospect unnecessary.</p> <p>Methods</p> <p>A retrospective cohort study was conducted to identify predictors of growth hormone (GH) deficiency (GHD) in children seen for short stature, and to construct a very sensitive and fairly specific predictive tool to avoid unnecessary GH provocative tests. GHD was defined by the presence of 2 GH concentration peaks < 10 ng/ml. Certain GHD was defined as GHD and viewing pituitary stalk interruption syndrome on magnetic resonance imaging. Independent predictors were identified with uni- and multi-variate analyses and then combined in a decision rule that was validated in another population.</p> <p>Results</p> <p>The initial study included 167 patients, 36 (22%) of whom had GHD, including 5 (3%) with certain GHD. Independent predictors of GHD were: growth rate < -1 DS (adjusted odds ratio: 3.2; 95% confidence interval [1.3–7.9]), IGF-I concentration < -2 DS (2.8 [1.1–7.3]) and BMI z-score ≥ 0 (2.8 [1.2–6.5]). A clinical decision rule suggesting that patients be tested only if they had a growth rate < -1 DS and a IGF-I concentration < -2 DS achieved 100% sensitivity [48–100] for certain GHD and 63% [47–79] for GHD, and a specificity of 68% [60–76]. Applying this rule to the validation population (n = 40, including 13 patients with certain GHD), the sensitivity for certain GHD was 92% [76–100] and the specificity 70% [53–88].</p> <p>Conclusion</p> <p>We have derived and performed an internal validation of a highly sensitive decision rule that could safely help to avoid more than 2/3 of the unnecessary GH tests. External validation of this rule is needed before any application.</p

Meningococcus serogroup C clonal complex ST-10217 outbreak in Zamfara State, Northern Nigeria.

After the successful roll out of MenAfriVac, Nigeria has experienced sequential meningitis outbreaks attributed to meningococcus serogroup C (NmC). Zamfara State in North-western Nigeria recently was at the epicentre of the largest NmC outbreak in the 21st Century with 7,140 suspected meningitis cases and 553 deaths reported between December 2016 and May 2017. The overall attack rate was 155 per 100,000 population and children 5-14 years accounted for 47% (3,369/7,140) of suspected cases. The case fatality rate (CFR) among children 5-9 years was 10%, double that reported among adults ≥ 30 years (5%). NmC and pneumococcus accounted for 94% (172/184) and 5% (9/184) of the laboratory-confirmed cases, respectively. The sequenced NmC belonged to the ST-10217 clonal complex (CC). All serotyped pneumococci were PCV10 serotypes. The emergence of NmC ST-10217 CC outbreaks threatens the public health gains made by MenAfriVac, which calls for an urgent strategic action against meningitis outbreaks

Physicochemical characteristics and green microalgae composition of selected rivers in Ogun State, Nigeria

The river system is the most complex of the freshwater bodies in the world and is prone to pollution especially from anthropogenic activities and the quality of water, as partially determined by physicochemical properties, is very crucial for primary productivity in the aquatic environment. This study determined the physicochemical characteristics and green microalgae of water collected from Majopa, Ogunpa and Uren rivers in Ogun State, Nigeria. Surface water samples were collected from three different rivers using direct collection method into the labelled bottles for physicochemical characteristics determination, culturing and ecological studies. Water samples for ecological studies were fixed in 4% unbuffered formalin while sample for culturing were not fixed but growth stimulated using Bold Basal Medium (BBM) and Blue- Green Medium (BG-11). The physicochemical parameters varied widely with the profile of water sample from Ogunpa River being the most favourable for widest diversity of green microalgae of all three. The pH of the water samples were slightly acidic ranging between 6.3 and 6.5 for the rivers, while the lower dissolved oxygen (2.61-3.01 mg/L) recorded pointed to a stressed environment which probably accounted for lower number of microalgae taxa observed, especially in Majopa River. The ecological studies showed the presence of ten taxa from the division Chlorophyta with nine taxa from Ogunpa River and Scenedesmus sp. being dominant genus across the rivers. The microalgae diversity of the river water was Ogunpa River˃Uren River˃Majopa River. BBM supported growth of the microalgae much better. The physicochemical properties portrayed Majopa and Ogunpa River water as unfit for drinking, while that of Uren River is relatively fit for drinking. It is highly recommended that the microalgae reported therein be further characterised for various possible economic benefits. Keywords: Growth, Microalgae, Nutrient, Ogun State, River, WaterDepth, Geothermal Energ

Malaria and HIV co-infection and their effect on haemoglobin levels from three healthcare institutions in Lagos, southwest Nigeria

Background: Malaria and human immunodeficiency virus (HIV) are two major infections with enormous public health consequence. Together, they are endemic in many developing countries with anaemia being the most frequent haematological consequence of the infections. Objective: To determine the prevalence of malaria and HIV co-infection as well as anaemia among selected patients from three health-care institutions in Lagos, Nigeria. Methods: A cross-sectional study of 1080 patients was carried out to determine the prevalence of malaria and HIV co-infection as well as anaemia. Blood sera from each of the patients were screened for malaria parasites, HIV-1 and HIV-2 using Giemsa stain, Cambridge Biotech Recombigen HIV-1/HIV-2 rapid device, respectively while haemoglobin estimation was performed using cyanmethemoglobin method. Results: Our data showed that the total number of malaria infected patients were significantly higher in HIV sero-positive patients 47.7% (31/65) when compared with their HIV sero-negative counterparts 25.8% (262/1015) P = 0.047. The result also revealed that 25.8% (8/31) of the patients co-infected with malaria and HIV had anaemia as compared to 11.1% (29/262) infected with malaria alone. Multivariable logistic regression analysis showed that patients with dual infection of malaria and HIV were twice likely to be anaemic than those infected with malaria alone [adjusted OR 2.4, 95% CI, 1.3 to 2.7,P = 0.014]. Conclusion: Our data indicated a higher prevalence of malaria in HIV infected patients and also revealed that patients coinfected with malaria and HIV were more likely to be anaemic