Prevalence of hematological abnormalities and malnutrition in HIV-infected under five children in Enugu

Background: Hematological abnormalities such as anemia, neutropenia, and thrombocytopenia occur in children infected by the human  immunodeficiency virus (HIV). These abnormalities are due to myelosuppression caused by the HIV and contribute to the morbidity and mortality of HIV.infected children. Malnutrition is prominent in HIV-infectedchildren due to associated conditions such as oropharyngeal candidiasis, diarrhea, and cytokine production which resultin poor intake, nutrient loss, and increased metabolic rate, respectively.Objectives: To determine the prevalence of hematological abnormalities (using the World Health Organization (WHO) case definitions) and malnutrition in HIV-infected children receiving care at the University of Nigeria Teaching Hospital, Enugu.Materials and Methods: The hematological and anthropometric indices of HIV.infected children between 18 and 59 months were assessed. Their hemoglobin level, neutrophil, and platelet counts were the hematological profiles evaluated using the WHO case definitions in HIV clinical staging. The weight-for-height z-score index was used to assess the nutritional status of subjects using the WHO reference ranges. The t-test, Chi-square, and Pearson correlation coefficient were used for statistical analysis.Results: There were 67 HIV positive children: 34 males and 33 females, aged 18-59 months. The mean hematological levels of subjects were hemoglobin (Hb) 10.4 ± 1.2 g/dl, neutrophil count 3,031 ± 1,039 cells/mm3, platelets count 294 ± 78 ~ 109/L. Two children (3.0%) had anemia (hemoglobin < 8 gm/dl) and were severely immunosuppressed,on highly active antiretroviral therapy treatment and had advanced HIV disease (clinical stage 3). Children who were malnourished were 15 (22.4%).Conclusion: Hematological abnormalities and malnutrition occur in HIV positive children.Key words: Haematological, malnutrition, anaemia, childre

Chronic kidney disease in children as seen in a tertiary hospital in Enugu, South-East, Nigeria

Background: The prevalence of chronic kidney disease (CKD) in children has been reported to be rising locally and globally. There is a dearth of data and inadequate facilities for the management of CKD in children in most of the developing countries like Nigeria.Objectives: The objective of this study is to ascertain the prevalence of CKD among children seen at University of Nigeria Teaching Hospital (UNTH), Enugu, South‑East Nigeria and also to determine the stage of CKD at presentation, possible etiology, treatment options offered and the outcome.Materials and Methods: A retrospective review of pediatric ward admissions in UNTH over a 5 year period (July, 2007 to June, 2012) was done. Information, including the age at presentation, symptoms, level of renal function, management and outcome, were obtained from the medical case notes.Results: There were 3002 pediatric admissions within the period of review, of which 98 (3.3%) had CKD, giving incidence of 3.0 new cases per million‑child population per year and the prevalence of 14.9 per million children population. Majority (54.1%) of those with CKD were over 10 years of age. Edema, oliguria and hypertension were the most frequent clinical features. The most common etiology was glomerular disease (63.6%) and 44.9% presented in CKD stage 4 and 5. Renal replacement therapy (RRT) was offered to 25 (25.5%) of the patients; 6 (24%) of whom had hemodialysis and 3 (12%) had acute peritoneal dialysis while 16 (64%) were managed conservatively. None of the patients had chronic or adequate dialysis. The overall outcome showed that 8 (8.2%) died while on admission, 15 (15.3%) left against medical advice (discharge against medical advice) because of financial constraints and could not access the therapy, 25 (25.5%) were discharged on conservative management and lost to follow‑up while another 50 (51.0%) were discharged and still on follow‑up.Conclusion: CKD in children poses myriad of challenges in management in our setting with late presentation of patients and limited resources being prominent. The majority of patients could not access and sustain RRT and the outcome continues to be daunting.Key words: Children, chronic kidney disease, Enugu, Nigeria, prevalenc

Renal Replacement Therapy in Children in the Developing World: Challenges and Outcome in a Tertiary Hospital in Southeast Nigeria

A 5-year observational, retrospective study was conducted to evaluate the indications, the availability, the accessibility, the sustainability, and the outcome of children managed for acute kidney injury (AKI) and end stage kidney disease (ESKD) who required renal replacement therapy RRT in Enugu, southeast Nigeria. A total of 64 patients aged 5 months to 16 years required RRT, of which only 25 underwent RRT, giving an RRT accessibility rate of 39.1%. Eleven (44%) patients required chronic dialysis program/ renal transplant, of which only 1 (9.1%) accessed and sustained chronic hemodialysis, giving a dialysis acceptance rate of 9.1%. Fifty (78%) of the patients belonged to the low socioeconomic class. Thirty-three (51.5%) could not access RRT because of financial constraints and discharge against medical advice (DAMA); 6 (9.4%) died on admission while sourcing for funds to access the therapy; 5 (7.8%) died while on RRT; 9 (14.1%) improved and were discharged for follow-up; 1 (1.6%) improved and was discharged to be on chronic dialysis program while awaiting renal transplantation outside the country/clinic follow-up, while the remaining 10 (15.6%) were unable to sustain chronic dialysis program or access renal transplantation and were lost to follow-up. We conclude that RRT remains unaffordable within the subregion

Management of severe tetanus using magnesium sulfate – The experience in a tertiary health institution in Southern Nigeria

Tetanus is a vaccine-preventable disease caused by the neurotoxin of Clostridium tetani: A motile, Gram-positive, sporeforming obligate anaerobe commonly found in the soil, dust, and alimentary canals of various animals. It remains a public health challenge in the developing countries as the morbidity and mortality rates remain high unlike in the developed world where the incidence is markedly low and no longer contributory to significant mortality. We report two male adolescents admitted in the pediatric department of a tertiary medical center of Nigeria for severe tetanus following an open injury to the limbs. Due to poor response to initial management with the combination of chlorpromazine, phenobarbitone, and diazepam, the latter was replaced with continuous infusion of magnesium sulfate after a loading dose was administered. Both the patients recovered without any prevailing complications and were discharged after 26 and 50 days of hospitalization, respectively, after receiving tetanus toxoid and were subsequently followed up. Successful severe tetanus management without the use of sophisticated medical gadgets and expensive treatment in a resource-poor economy is achievable as demonstrated by our study with the use of magnesium sulfate infusion

Survey of Treponemal Infections in Free-Ranging and Captive Macaques, 1999-2012.

Survey results showed treponemal infection among pet macaques in Southeast Asia, a region with a high prevalence of human yaws. This finding, along with studies showing treponemal infection in nonhuman primates in Africa, should encourage a One Health approach to yaws eradication and surveillance activities, possibly including monitoring of nonhuman primates in yaws-endemic regions

Specialty-care access for community health clinic patients: processes and barriers

Mabel C Ezeonwu School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA Introduction: Community health clinics/centers (CHCs) comprise the US’s core health-safety net and provide primary care to anyone who walks through their doors. However, access to specialty care for CHC patients is a big challenge.Materials and methods: In this descriptive qualitative study, semistructured interviews of 37 referral coordinators of CHCs were used to describe their perspectives on processes and barriers to patients’ access to specialty care. Analysis of data was done using content analysis.Results: The process of coordinating care referrals for CHC patients is complex and begins with a provider’s order for consultation and ends when the referring provider receives the specialist’s note. Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic–hospital affiliations, and poor communication between primary and specialty providers constitute critical barriers to specialty-care access for patients.Conclusion: Understanding the complexities of specialty-care coordination processes and access helps determine the need for comprehensive and uninterrupted access to quality health care for vulnerable populations. Guaranteed access to primary care at CHCs has not translated into improved access to specialty care. It is critical that effective policies be pursued to address the barriers and minimize interruptions in care, and to ensure continuity of care for all patients needing specialty care. Keywords: community health clinics and centers, access to healthcare, barriers to health care access, specialty-care referral process, care coordination, safety-net, undeserved populations, health care system, vulnerable populations, affordable comprehensive health insuranc

A Quick Glance at Paediatrics

Description based upon print version of record.9.5 NephroblastomaThis book represents a much-needed paediatric reference book, especially with regards to developing countries. It will be of interest and use to all professional stakeholders in paediatrics and child health, including paediatricians, general practitioners, family medicine specialists, paediatric teachers and lecturers, and medical students. It covers a wide range of topics including clinical paediatrics, preventive and social paediatrics, infectious diseases, non-communicable diseases, child health, clinical history taking, systemic physical examination and clinical reasoning. It also consider.Intro; Table of Contents; Foreword; Preface; Acknowledgement; Chief Editor; Contributors; Section 1: Introductory Paediatrics; 1.1 History Taking; 1.2 Physical Examination; 1.2.1 General Examination; 1.2.2 Examination of the digestive system; 1.2.3 Physical examination-Respiratory system; 1.2.4 Physical examination-Cardiovascular system; 1.2.5 Physical examination-Urogenital system; 1.2.6 Examination of the central nervous system; 1.2.7 Physical examination-Musculoskeletal sy; 1.3 Clinical reasoning; Section 2: Infectious diseases; 2.1 Malaria; 2.2 Polio/Poliomyelitis; 2.3 Viral Hepatitis2.4 Pertussis2.5 Diphtheria; 2.6 Tetanus; 2.7 Haemophilus Influenzae Infections; 2.8 Pneumococcal Infections; 2.9 Rotavirus Disease; 2.10 Measles; 2.11 Yellow Fever; 2.12 HIV/AIDS; 2.13 Cholera; 2.14 Typhoid Fever; 2.15 Mumps; 2.16 Rubella; 2.17 Influenza; 2.18 Varicella; Section 3: Gastro-enterology; 3.1 Gastroenteritis; 3.2 Malnutrition; 3.3 Liver/Gall Bladder Diseases; 3.4 Peptic Ulcer Disease; 3.5 Intussusception; 3.6 Abdominal pain in children; 3.7 Paralytic Ileus; 3.8 Constipation; 3.9 Malabsorption; 3.10 Gastroesophageal Reflux; Section 4: Cardiology4.1 Foetal and Neonatal circulation4.2 Pulmonary Hypertension; 4.3 Congenital Heart Diseases-Cyanotic; 4.4 Congenital Heart Disease-Acyanotic; 4.5 Infective Endocarditis; 4.6 Myocarditis; 4.7 Pericarditis; 4.8 Rheumatic Heart Disease; 4.9 Cardiac Failure; 4.10 Shock; 4.11 Cardiomyopathy; Section 5: Neurology; 5.1 Coma (The Unconscious Child); 5.2 Seizure Disorders (Epilepsies); 5.3 Neural Tube Defects; 5.4 Hydrocephalus; 5.5 Cerebral Palsy; 5.6 Acute Bacterial Meningitis; 5.7 Encephalitis; 5.8 Lesions of the upper and lower motor neurons; 5.9 Cerebellar disorders; Section 6: Respirology6.1 Upper respiratory tract infection6.2 Croup; 6.3 Foreign body aspiration; 6.4 Childhood asthma; 6.5 Rhinitis; 6.6 Lower respiratory tract infection; 6.7 Pneumonia; 6.8 Pleurisy, Pleural effusion and Empyema; 6.9 Bronchiolitis; 6.10 Pneumothorax; 6.11 Tuberculosis in children; Section 7: Nephrology; 7.1 Acute glomerulonephritis (AGN); 7.2 Nephrotic syndrome; 7.3 Acute kidney injury; 7.4 Chronic kidney disease (CKD); 7.5 Urinary tract infection/Pyelonephritis; 7.6 Renal tubular acidosis (RTA); 7.7 Posterior urethral valve; 7.8 Haemolytic uraemic syndrome (HUS); 7.9 Hypertension7.10 Water and electrolytes7.11 HIV-Associated Nephropathy (HIVAN); 7.12 Nephroprevention; Section 8: Dermatology; 8.1 Eczema/Atopic Dermatitis; 8.2 Impetigo; 8.3 Ecthyma; 8.4 Hair follicle infections; 8.5 Erysipelas and Cellulitis; 8.6 Erythema Multiforme I; 8.7 Erythema Multiforme II (Epidermal Necrolysis); 8.8 Superficial Mycosis I; 8.9 Superficial Mycosis II; 8.10 Ichthyosis; 8.11 Seborrhoeic Dermatitis; 8.12 Transient skin disorders of the newborn; Section 9: Oncology; 9.1 Benign and malignant tumours; 9.2 Burkitt Lymphoma; 9.3 Hodgkin's Lymphoma (HL); 9.4 Non-Hodgkin's Lymphoma1 online resource (795 p.

Simulation of Solutions to Excessive Vibration Problems of Pedestrian Footbridges

Footbriges are often prone to vibrations induced by pedestrian loading. They are long and slender and their weight is moderate. One of the classical and famous examples is the transverse vibrations encountered on the millennium bridge in London. Horizontal vibration problems have received considerable attention due to millennium bridge vibration problem, but potential problems relating to vertical vibrations are more common. Vibrations from pedestrian loads are mostly limited to vibration frequencies below 5Hz. Most pedestrian bridges have several vibration modes below the above mentioned frequency. Increasing the stiffness could be a remedy to this vibration problem. And for a slender structure, increasing the stiffness often implies a corresponding increas in mass of the structure, whereby the desired effect is notachieved. Instead damping is often used to reduce the excessive vibration problem of footbridges by attaching additional dampers to the structre. London Millennium bridge was modelled inthis thesis in order to show the effect of tuned mass damper. There was a substantial reduction of the displacement of the bridge when tuned mass dampers were added to the bridge model.+46(0)736740895 or +46(0)76223595

Using a Food Bank as a Platform for Educating Communities during the COVID-19 Pandemic.

PURPOSE: To describe a partnership between a public university and a regional foodbank aimed to promote health in food insecure communities, and to support nursing students\u27 learning experiences in community health. DESIGN: A single setting case study. METHODS: A comprehensive health needs assessment conducted through a windshield survey and key informant interviews was used to identify the community\u27s priorities. FINDINGS: Nursing interventions were tailored to the community\u27s needs by creating healthy recipes and providing education on food safety, lower back injury prevention, and chronic disease prevention and 15 management. CONCLUSION: During pandemics, nursing program partnerships with food banks could play pivotal roles in community health promotion. CLINICAL EVIDENCE: Food banks can serve as clinical platforms for nursing education and community wellness activities

Urinary findings in HIV positive children by dipstick screening test in Enugu

Background: Human immunodeficiency virus (HIV) affects the kidney. Urine screening for abnormalities can detect early renal parenchymal diseases.Objectives: To determine the prevalence of abnormal urinary findingsin HIV positive children in University of Nigeria Teaching Hospital,(UNTH), Enugu.Method: Urinary screening was carried out in 159 HIV positive childrenin UNTH over a period of 4-months, to detect presence of abnormalitiessuch as glycosuria, proteinuria, haematuria, as well as the presenceof nitrite and leucocyte esterase, abnormal urine pH and specificgravity (SG).Results: Eighty males and 79 females were screened. Five (5), 4, and a child had proteinuria, SG of > 1.015 and alkaline urine, giving aprevalence rate of 3.1%, 2.5% and 0.6% respectively. Neither of thesubjects had glycosuria, haematuria nor tested positive to nitrite andleucocyte esterase. Subjects with proteinuria were older (5-14 years),had longer duration of HIV diagnosis, longer duration of treatmentwith HAART, and a lower CD4 cell count (p=0.01). Sixty percent ofthose with proteinuria had severe immunosuppression, with 4 out ofthe 5 of them with urine SG more than 1.015. The children with urineSG more than 1.015 were among the older age group (5-14 years), onHAART, had non-advanced HIV disease as well as low CD4 cell count (p= <0.0001).Conclusion: Urinary abnormalities occur among HIV infected children.Longer duration of HIV diagnosis, older age and low CD4 cell count,are probable factors associated with proteinuria.We recommend routineurinary examination for HIV positive children