The prevalence liver function and immunologic status of children with HIV and hepatitis Bvirus coinfection in Enugu, Nigeria

Background: Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection, predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication, hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu, determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts.Materials and Methods: A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients’ folders.Results: Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11- 15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6, P = 0.56). After the initiation of HAART, 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children ≥ 6 years was 230 cells/mm3 and 360 cells/mm3 respectively among the co-infected and nonco-infected, (P = 0.67). However, in children ≤ 5 years, it was 25% and 15 % respectively (P = 0.06).Conclusion: HBV co-infection among HIV infected children is common in our environment, and co-infection is associated with impaired immunity and probably liver enzyme derangement.Keywords: HIV infection, Children, HBV co-infection, Liver function, Immunologic statu

Bacterial Isolates of Surfaces in the Neonatal Intensive Care Unit of Enugu State University Teaching Hospital, Parklane, Enugu, and Their Antibiotic Susceptibility Patterns

Introduction: The duration of admission in the hospital, mortality rates, and care costs is increased in Neonatal Intensive Care Unit (NICUs) by nosocomial infections(NIs). There is a need for routine and regular environmental sampling in NICUs. Methodology: This was a cross-sectional study conducted in the NICU of Enugu State University Teaching Hospital. The researchers collected samples for culture from equipment and hospital surfaces in the unit. Susceptibility testing was done for isolates by the agar diffusion method using standard nutrient agar 1 discs. Results: We observed bacterial growth in 58 (54.7%) samples from the 106 samples collected. Staphylococcus aureus 35 (55.6%) was the most common isolate cultured, followed by Escherichia coli 14 (22.2%) and then coagulase-negative Staphylococcus13 (20.6%).  Among S. aureus isolates, 48.6% were methicillin-resistant S. aureus. Among the Gram-negative isolates, resistance was highest for ampicillin followed by meropenem. Conclusion: The most common isolates were S. aureus, coagulase-negative Staphylococcus, and E. coli. Health-care providers need improved hygiene standards to reduce the burden of NI. Keywords: Bacterial contamination, Neonatal Intensive Care Unit, Nigeria, susceptibility pattern

Ophthalmological Findings in Paediatric Non-Traumatic Coma in Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria

The ophthalmological examination is a vital aspect of the central nervous system examination in comatose children. Several authors have documented different findings with disparities in their recommendations about making ophthalmological examination a routine in the management of the unconscious child. This study sought to evaluate the relevance of routine ophthalmological examination in the management of unconscious children admitted into the paediatric emergency room of Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria. This was a prospective longitudinal study conducted from April 2018 to March 2019. Unconscious patients whose caregivers gave consent were recruited into the study. Traumatic causes of coma were excluded. Demographic features of the patients were obtained. The ophthalmologic examination and diagnoses were made by an ophthalmologist, while the emergency room pediatrician made clinical assessment and diagnoses. Sixteen unconscious children had ophthalmologic examinations done. The Glasgow coma scale scores ranged from 3 to 11, with a mean of 6.6±2.2. Thirteen (81.3%) of the children were classified as severe unconsciousness while the rest were moderate. The degree of unconsciousness was significantly associated with the outcome (?2 =16.0, P = 0.03). A total of six (37.5%) ophthalmologic diagnoses were made, which included cerebral malaria, degenerative myopia, orbital cellulitis, and exposure keratopathy. The presence of an abnormal ophthalmologic finding was not significantly associated with outcome (?2 =0.36, P = 0.55). Routine ophthalmologic examination may not be justified as a management protocol in unconscious children but may be considered in selected cases

Postpartum depression among mothers as seen in hospitals in Enugu, South-East Nigeria: an undocumented issue

Introduction: Postpartum depression is an uncommon and frequently undocumented issue that impacts negatively on maternal and child health. Methods: The study was carried out among mothers who attended postpartum clinics from two teaching hospitals and three private hospitals all in Enugu metropolis. The instrument employed for data collection was a structured self-administered questionnaire developed from the Edinburgh Postnatal depression Scale. The families were assigned socio-economic classes (SEC) using the recommended method (modified) by Oyedeji. The objectives of this study was therefore aimed to highlight the pattern and prevalence of post-natal depression among mothers in Enugu, south east Nigeria. Results: A total of 214 mothers attending postpartum clinics were recruited in this study. The prevalence of postpartum depression from this study is 22.9%. There are no significant association between socio-demographics of mother and depression, age (p= 0.556), educational level (p= 0.667), occupation (p=0.494), parity (p= 0.823) and mode of delivery (p= 0.760). Conclusion: This study has shown that the prevalence of postpartum depression in Enugu, south east Nigeria is 22.9% which is comparable to that obtained in African continents. We noted no significant associations between socio-demographics of mother, age, educational level, occupation, parity and mode of delivery and depression.Pan African Medical Journal 2016; 2

THE PREVALENCE LIVER FUNCTION AND IMMUNOLOGIC STATUS OF CHILDREN WITH HIV AND HEPATITIS B VIRUS COINFECTION IN ENUGU, NIGERIA

Background: Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection, predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication, hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu, determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts. Materials and Methods: A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients’ folders. Results: Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11- 15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6, P = 0.56). After the initiation of HAART, 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children ≥ 6 years was 230 cells/mm3 and 360 cells/mm3 respectively among the co-infected and nonco- infected, (P = 0.67). However, in children ≤ 5 years, it was 25% and 15 % respectively (P = 0.06). Conclusion: HBV co-infection among HIV infected children is common in our environment, and co-infection is associated with impaired immunity and probably liver enzyme derangement

Childhood poisoning: a 10-year experience in a tertiary hospital in Enugu State, Nigeria

Childhood Poisoning is a common cause of emergency room presentation, more so in underdeveloped countries where it contributes to a high incidence of hospitalization with variability in morbidity and mortality. This study retrospectively assessed the sociodemographic profiles, poisoning agents, clinical features and management of cases of childhood poisoning admitted at Enugu State University Teaching Hospital, Enugu. It was a 10-year retrospective study of all the cases of childhood poisoning admitted within the period of study at the Children’s Emergency Room of Enugu State University Teaching Hospital (ESUTH), Enugu. The prevalence of childhood poisoning in the study was 0.3%. Of all the subjects, 78.4% were ≤5 years and more than half were males and from lower socioeconomic classes. Accidental poisoning accounted for 70.3%; the predominant agents were kerosene and organophosphates. Palm oil was used by 67.6% of the participants as an intervention before presentation. Pneumonitis was the most common complication. Patients with peripheral oxygen saturation (SpO2) < 95% were 14 times more likely to have complications than those with SpO2 ≥ 95%. The duration of hospital stay was ≤3 in 59% of the cases and no mortality was recorded in this study.Childhood poisoning remains prevalent in our environment with kerosene being the commonest agent. Palm oil administration as a predominant pre-hospital intervention worsens outcomes. Duration of hospitalization depends on SpO2 at presentation, need for antibiotic therapy, and intention.

Relationship between Glycemic Levels and Treatment Outcome among Critically Ill Children admitted into Emergency Room in Enugu

Abstract Background Critically ill children are those in need of immediate attention on arrival to an emergency room. The importance of glycemic level measurement as well as maintaining the patency of the airway, effective breathing and circulation cannot be overemphasied. It has been highlighted that the peak hyperglycemia and hypoglycemia predict poor prognosis, longer lengths of hospital stay and higher mortality. The study aims to assess the relationship between glycemic level and treatment outcomes as well as length of hospital stay. Methods Analytical cross sectional method was used to study critically ill children aged ≥1 month to ≤10 years admitted into the Children Emergency Room of Enugu State University Teaching Hospital, Enugu. Their admission blood glucose was done. Interviewer administered questionnaire was used to collect information including sociodemographics, duration of hospitalization and outcome of treatment. Data was analysed using SPSS version 20. Chi square, logistic regressions and Kruskal Wallis tests were done as appropriate. Results A total of 300 patients were recruited. One hundred and seventeen (39%) had hyperglycemia, 62 (20.7%) patients had hypoglycaemia and 121 (40.3%) had euglycemia. Two hundred and fifty two (84%) were discharged while 48 (16%) died. There was significant association between glycemic levels and treatment outcome (p = < 0.001). Among the 48 who died, 12 (25.0%) had euglycemia, 21 (43.75%) had hypoglycaemia while 15 (31.25%) had hyperglycemia. On multivariate analysis, there was statistically significant association between hypoglycaemia and mortality (p = < 0.001). Unadjusted, those children with hypoglycaemia at presentation were about 4.7 times (UOR = 0.21, 95% Cl: 0.08–0.38) and adjusted, about 5 times (AOR = 0.20, 95% CI: 0.09–0.47) less likely to survive compared with those with euglycemia. Although not statistically significant, those with hyperglycemia were about 1.3 times less likely to survive compared with euglycemic children, adjusted and unadjusted (UOR = 0.75, 95% Cl: 0.33–1.68). Conclusion While both hypo- and hyperglycemia are associated with mortality, hypoglycaemia had a greater effect than hyperglycemia. Glycemic levels significantly affects treatment outcome

Use of probiotics in the management of acute watery diarrhoea in Nigerian children: How effective are S. Boulardii only preparations?

No Abstract

Distracted driving and cell phone use by Nigerian Road Users: A cross-sectional study

No Abstract

Negative Marking and the Student Physician–-A Descriptive Study of Nigerian Medical Schools

Background There is considerable debate about the two most commonly used scoring methods, namely, the formula scoring (popularly referred to as negative marking method in our environment) and number right scoring methods. Although the negative marking scoring system attempts to discourage students from guessing in order to increase test reliability and validity, there is the view that it is an excessive and unfair penalty that also increases anxiety. Feedback from students is part of the education process; thus, this study assessed the perception of medical students about negative marking method for multiple choice question (MCQ) examination formats and also the effect of gender and risk-taking behavior on scores obtained with this assessment method. Methods This was a prospective multicenter survey carried out among fifth year medical students in Enugu State University and the University of Nigeria. A structured questionnaire was administered to 175 medical students from the two schools, while a class test was administered to medical students from Enugu State University. Qualitative statistical methods including frequencies, percentages, and chi square were used to analyze categorical variables. Quantitative statistics using analysis of variance was used to analyze continuous variables. Results Inquiry into assessment format revealed that most of the respondents preferred MCQs (65.9%). One hundred and thirty students (74.3%) had an unfavorable perception of negative marking. Thirty-nine students (22.3%) agreed that negative marking reduces the tendency to guess and increases the validity of MCQs examination format in testing knowledge content of a subject compared to 108 (61.3%) who disagreed with this assertion (χ 2 = 23.0, df = 1, P = 0.000). The median score of the students who were not graded with negative marking was significantly higher than the score of the students graded with negative marking ( P = 0.001). There was no statistically significant difference in the risk-taking behavior between male and female students in their MCQ answering patterns with negative marking method ( P = 0.618). Conclusions In the assessment of students, it is more desirable to adopt fair penalties for discouraging guessing rather than excessive penalties for incorrect answers, which could intimidate students in negative marking schemes. There is no consensus on the penalty for an incorrect answer. Thus, there is a need for continued research into an effective and objective assessment tool that will ensure that the students’ final score in a test truly represents their level of knowledge