CD4+ T-Lymphocyte counts among under-5 children with protein-energy malnutrition as seen in Usmanu Danfodiyo University Teaching Hospital , Sokoto, Nigeria

Background: Proteinenergy malnutrition is a prevalent public health  problem in the developing countries. It affects body systems including cell-mediated immunity.Objectives: To determine the effect of PEM on CD4+ Tlymphocyte counts among under -5 children.Methods: This was a prospective cross-sectional study conducted among HIV-negative children aged 6 - 59 months with PEM and the HIV-negative well-nourished children between November 1st, 2010 and July 31st, 2011. The socio-demographic characteristics, weight and some haematologicalindices of the both groups were documented. The CD4+ Tlymphocyte count was determined using Partec cytoflow machine.Result: One-hundred children were recruited for each group over a 9 month period. The two study groups were comparable in age (p= 0.53) and sex (p= 0.65). The mean CD4+ T-lymphocyte count in children with PEM was1705.5±605.6 cells/µL as compared to 2314.3±491.1 cells/µL among the controls (p= 0.0001). A statistically significant difference was observed in the mean CD4+ T-lymphocyte count of the different types of PEM with the highest value observed among children with kwashiorkor (2097.7±712.9 cells/µL) and lowest value observed among those with marasmus  (1449.3±368.2 cells/µL). There were significant differences in the mean CD4+ Tlymphocyte count of the control (2314.3±491 cells/µL) when  compared to those of marasmus (1449±368 cells/µL) (p= 0.001), marasmic-kwashiorkor (1888±762 cells/µL) (p= 0.002), underweight (1559±452 cells/µL) (p= 0.001) and underweight-kwashiorkor (1534±402 cells/µL) (p= 0.001), but it was comparable with that of kwashiorkor group (2098±713 cells/µL) (p= 0.21). A statistically significant difference was observed in the mean CD4+ Tlymphocyte count of the different types of PEM with the highest value observed among children with kwashiorkor (2097.7±712.9 cells/µL) and lowest value observed among those with  marasmus (1449.3±368.2 cells/µL).Conclusion: The PEM has deleterious effects on the CD4+ Tlymphocytecounts among under-5 children with PEM with the lowest count observed among those presenting with marasmus.Key words: CD4+ T-Lymphocyte, Count, PEM, Under-5

Thyroid function profile in cord blood and postnatal changes at 24 and 72hours in healthy term Nigerian neonates

Background: Studying the acute postnatal changes of newborn thyroid  function is essential for determining the best timing of screening for  congenital hypothyroidism. There is paucity of literature on neonatal  thyroid function and particularly the postnatal changes in Nigeria.Objectives: To describe the profile of thyroid function in cord blood and the postnatal changes at 24hours and 72hours in healthy term neonates  delivered in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.Subjects and methods: This was a prospective, descriptive and cross sectional study conducted over a six month period (between July-December 2009). Forty seven consecutively delivered healthy term neonates had their serum T3, T4, TSH assayed at birth, 24 and 72hours using the Enzyme linked immunosorbent assay (ELISA) technique. Data obtained are presented as mean, median and standard deviation (SD). Paired- t- testwas used for statistical inference.Results: The mean (SD) of the serum hormone concentrations in cord blood, and venous blood at 24hours and 72hours, respectively were as follows: T3, 0.58 (0.56) nmol/l, 1.15 (0.77)nmol/l, 0.83 (0.74)nmol/l; T4, 91 (83.1)nmol/l, 121.5 (106.4)nmol/l, 104.2 (84.2) nmol/l; and TSH, 5.95 (5.81)mU/l, 8.61 (8.34)mU/l, 2.52 (2.61) mU/ l.. The mean serum T3, T4 and TSH at 24hours were higher than cord blood levels (p<0.001, 0.03, 0.05 respectively). The mean serum T3 and T4 at 72hours, were higherthan cord blood levels (p = 0.07, 0.44), whereas TSH at 72hours was significantly lower than cord blood levels; (p<0.001).Conclusions: There was a rise, above cord level, of T3, T4 and TSH at 24hours, and a decline at 72hours, the latter being most marked in TSH. It is recommended that serum TSH taken at or greater than 72hours of life may be utilized for screening for congenital hypothyroidism in term babies,using postnatal age appropriate reference ranges. Serum T3, T4 should then be assayed for confirmation in all neonates with a positive TSH screening.Key words: Thyroid profile, postnatal changes, Term, Healthy neonates

Serum Antioxidant Vitamins Levels in Children with Sickle Cell Anaemia in Sokoto, North Western Nigeria

Sickle cell anaemia is associated with elevated oxidative stress via increase generation of reactive oxygen species (ROS), and decline in antioxidant defences. Increased oxidative stress is thought to play a role in the development of sickle cell anaemic complications. In the current study, vitamins A, C, and E levels were estimated in 35 sickle cell anaemics attending the Paediatric medical clinic of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria and the results compared with those of apparently healthy non-sickle cell anaemic volunteers of comparable age and social status. Serum levels of vitamin A, C, and E were 31.06 ± 2.97 μg/dl, 0.27 ± 0.05 mg/dl, 0.20 ± 0.01 mg/dl and 69.51 ± 4.54 μg/dl, 0.77 ± 0.10 mg/dl and 0.49 ± 0.02 mg/dl in sickle cell anaemics and non- sickle cell anaemic subjects respectively. There was significantly (P<0.05) decreased levels of antioxidant vitamins in sickle cell anaemic subjects. Age and gender did not have significant (P>0.05) difference. The results suggest that sickle cell anaemics in the study area have low serum levels of antioxidant vitamins, an indication that the sickle cell anaemics are predisposed to increased oxidative onslaught.Keywords: Sickle cell anaemia, serum vitamins A, C, and E

Prevalence of HIV-infection among under-5 children with protein energy malnutrition presenting at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Background: HIV infection is a major health problem worldwide. It is  associated with Protein-Energy Malnutrition (PEM) among under-5 childrenwith attendant high morbidity and mortality.Objective: To determine the prevalence of HIV-infection among children presenting withvarious subtypes of PEM.Methodology: Children suffering from PEM aged below 5 years admitted into the Paediatric units of UDUTH, Sokoto between October 1st, 2010 and April 30th, 2011 were tested for HIV infection using ELISA tests and HIVDNAPCR. Nutritional status was determined using the modified Wellcome Classification and socioeconomic classification was by the scheme developed by Oyedeji,s. Data were analyzed using SPSS 17.0 statistical package. P-value . 0.05 was considered significant.Results: One-hundred under-5 children (64 males, 36 females) with PEM were studied. The mean (±SD) age was 19.8&#177 9.2 months and the majority were aged 12.0-23.9 months. Twentyseven of the 100 children withPEM had HIV-infection giving a prevalence rate of 27%: 59.3% in males and 40.7% in females. Among the HIV-infected children, the 24.0 . 35.9 months age group was the most affected (53.8%). Infected and non-infected children were comparable in terms of age (χ2=7.35, p=0.12) , gender (χ2=0.36, p=0.55) and socioeconomic (χ2=3.01, p=0.25). Themode of transmission was maternal to child transmission in all cases. The highest prevalence of HIV infection was found among marasmus subgroup (65%). Twenty-two (81.5%) of the 27 cases were discharged home, whilefive patients died giving a case fatality rate of 18.5%.Conclusion: HIV infection is common among under-5 children with PEM with no age, gender or socioeconomic predilection. The clinical type of PEM most often affected is marasmus.Key words: Protein-energy malnutrition, HIV-infection, Under-

PREVALENCE AND CLINICAL FORMS OF MALARIA AMONG FEBRILE HIV-INFECTED CHILDREN SEEN AT USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL, SOKOTO, NIGERIA

Background: Malaria and HIV infections are major health problems facing the world today. Sub-Saharan Africa with 10 percent of world’s population harbors more than half the burden of the scourge. The present study determined the prevalence and clinical forms of malaria among febrile HIV-infected children aged 3months to 15years, seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. Materials and Methods: Cross-sectional study among febrile HIV-infected children and their control cohort were carried out between May and October 2016. The participants had the following investigations: malarial parasite, packed cell volume, random blood sugar, retroviral test.  Results: A total of 140 febrile HIV-infected children aged 3 months to 15 years and 140 febrile HIV-negative age- and gender-matched children were recruited; 100 of the HIV-infected children were on ART and cotrimoxazole. The prevalence of malaria among the febrile HIV-infected children was 71.4% (100/140) which was significantly lower than the prevalence of 94.3% (132/140) among the control group (χ2 27.72, p=0.001). Among the febrile HIV-infected children that had malaria, 54(54.0%) had uncomplicated malaria while 46(46.0%) had severe malaria. Of the 132 controls that had malaria, 48(36.4%) had uncomplicated malaria and 84(63.6%) had severe malaria (χ2 =7.184, p=0.007). Conclusion: Malaria is a problem in HIV-infected children. Since nearly half of the febrile HIV-infected children had severe form of malaria, it is recommended that health promotion, intermittent malaria prophylaxis, early diagnosis and prompt effective treatment should be instituted for HIV-infected children. This may prevent severe form of malaria and its attendant mortality

Design and management of an orthopaedic bone bank in the Netherlands

The design and management of an orthopaedic bone bank is a complex process in which medical organisation and legislation intertwine. Neither in the Netherlands, nor in any other European country, there are official guidelines for the organisation and management of an orthopaedic bone bank. In the Netherlands, the recently modified ‘law of security and quality for using human materials’ (WVKL) dictates requirements for technical and organisational aspects for the use of human tissue and cells. The bone bank procedures include a thorough questionnaire for donor selection, extensive serological, bacteriological and histopathological examination, as well as standard procedures for registration, processing, preservation, storage and distribution of bone allografts. This article describes the organisation of an accredited bone bank and can be used as a proposition for an official guideline or can be useful as an example for other orthopaedic bone banks in Europe

Paediatrics hiv/aids: Clinical presentation and practical management Challenges in Sokoto, Nigeria

Background: Implications of continuing HIV/AIDS pandemic in Nigeria is very grave for children. Lack of financial resources means care of children with HIV/AIDS is exceedingly difficult to provide. We described the clinical pattern and highlight the problems in the management of HIV/AIDS in children seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a two-year period.Methods: This prospective study was carried out between 1st January 2001 and 31st December 2002. The clinical presentation of each patient satisfying the WHO diagnostic criteria for paediatrics HIV/AIDS,admitted consecutively into our Emergency Paediatrics Unit (EPU) was documented. Laboratory diagnosis was by Enzyme linked immunosorbent assay (ELISA) for HIV- I and HIV- II in affected children and their mothers while confirmatory test was by Western blot. Treatment of each patient wasindividualised.Results: A total of 41 children with HIV/AIDS were admitted into EPU over the study period. There were 22 males and 19 females with ratio of 1.2:1. Age ranged from 0.25 years to 14 years with mean (SD) of 1.5 (2.2) years. Forty - one (97.6%) patients were aged 5 years and below. Modes oftransmission were vertical in 40 (97.6%), while 1 (2.4%) was by homosexual abuse. The commonest clinical feature was weight loss in 41 (100%), followed by fever (>one month) 39 (95%), chronicdiarrhoea 39 (95%), recurrent cough 37 (90%) and oro-pharyngeal candidiasis 35 (85%) in that order. Thirty- six (87.8%) patients had protein – energy malnutrition (PEM), marasmus constituting 58%. Thirtytwo(78%) patients were in WHO clinical stage 3 while the remaining 9 (22%) patients were in stage 4. The main types of infections were oral candidiasis, pneumonia, malaria, septicaemia, urinary tractinfections, and tuberculosis. Case fatality rate was 91%. Highly active antiretroviral therapy (HAART) was not freely available to children during the period of our study.Conclusion: The mortality of these antiretroviral naive HIV/AIDS children was very high. It is anticipated that current availability of HAART to children free of charge would improve the outcome of HIV/AIDS in this group

Glomerular filtration rate in steady state children with sickle cell anaemia in Sokoto, North-Western Nigeria

 Background: Sickle cell anaemia (SCA) affects mostly people of African origin. It causes kidney problems termed Sickle cell nephropathy (SCN). Increased   glomerular filtration rate (GFR) has been documented as one of the functional abnormalities seen in young SCA patients.Objective: To estimate GFR in Nigerian children with SCA in steady state in Usmanu Danfodiyo University Teaching Hospital (UDUTH), SokotoMethodology: All patients were randomly selected in a systematic fashion by choosing alternate patients as they presented at the SCA Clinic if they met the inclusion criteria. The controls were apparently healthy social class-matched haemoglobin AA children. Subjects were admitted into the ward for 24 hours. Anthropometric, blood pressure measurements were obtained and urine samples collected over 24hours and 3mls of venous blood was taken for biochemical analysis.Results: There were 70 males and 50 females with M:F ratio 1.4:1. There were equal numbers of both SCA and control subjects. The obtained mean (SD) GFR was  127.9(38.5) ml/min/1.73m2 for the SCA group and 126.6(20.2) ml/min/1.73m2 for the control group, with t-value 0.23; degree of freedom, 118 and p-value of 0.824.Conclusion: The mean (SD) GFR of SCA children in steady state is within normal range.Keywords: Steady state,  SCA children, GFR, North western Nigeria

Pattern Of Childhood Tuberculosis In Sokoto, Northwestern Nigeria

Background: The incidence and mortality rate of tuberculosis (TB) has been on the decline until its recent resurgence worldwide, with Nigeria inclusive. Objectives: We, therefore, considered it worthwhile, for this area of the country, evaluating its prevalence/incidence. Furthermore, TB\'s main clinical features on presentation, variable forms, outcome and associated factors would be ascertained. Methodology: This was a 6-year retrospective study conducted in the Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital (between 1st December 1998 and 30th November 2004). All case files of children aged 3 months – 15 years of age with the diagnosis of any form of TB were retrieved from Medical Records Department. The data were analyzed in respect to age, gender, mode of presentation, history of BCG vaccination and evidence of its scar, main clinical findings, and results of investigations, complications, and outcome. Results: Ninety-nine (99) cases of TB were seen over the study period. Total patient on admission was 9,434, giving an overall prevalence rate of 1.1%, that is, about 1,100 per 100,000 populations. The male: female ratio encountered was 1.4: 1.0. Of the 99 cases, 45 (45.5%) were in age group 3months- 5years, 32 (32.3%) in >5years- 10years, and 22(22.2%) in >10 - 15.0 year-age-group. The main presenting features were cough, 55(55.5%), fever,53(53.5%) and weight loss 33(33.3%). The most predominant form of TB seen in this series was pulmonary involvement in 46(46.5%) of cases, followed next in rank by disseminated TB, 22(22.2%). The three commonest complications seen in this study were protein energy malnutrition (n= 21), severe anaemia (n=16) and pleural effusion (n=11). Majority of patients had short course anti-TB therapy with current drugs. The case-fatality rate identified was 10.1% (10/99). Fifty-three (53.5%) had complete course of the treatment and were normal thereafter, while 36 (36.5%) cases either signed against medical advice or defaulted from follow-up. Conclusion: Tuberculosis remains one of the major causes of mortality in Nigerian children, and it is, therefore, pertinent improving our socio-economic status, and diligently pursuing BCG vaccination of all children at stipulated periods. Sahel Medical Journal Vol. 11 (4) 2008: pp. 110-11