Current trends in the management of acute kidney injury in children

Acute Kidney Injury (AKI) previously known as acute renal failure (ARF) is a common problem in the paediatric emergency wards with infections likesepsis and malaria being the commonest causes in Nigeria. It has been known by various nomenclatures with a lack of standardised definition. This has made comparison of data very difficult. In the last decade, attempts have been made to standardize the definition by developing a classification criterion termed “RIFLE”. This is in turn undergoing variousmodifications with the most recent classification system developed by the Kidney Disease: Improving Global Outcomes (KDIGO). Despite these interesting developments, the basis of these classifications which is the use of serum creatinine measurements is fraught with its own limitations.This has led to discovery of various urinary and serum biomarkers like the cystatin C and neutrophil gelatinase associated lipocalin (NGAL) which appear to have very promising advantages over the well known creatinine measurements. Management of AKI continues to be anticipatory with appropriate fluid therapy and adequate treatment of infections. The benefits of furosemide and dopamine in management are still a constant source of debate. Treatment of life threatening complications like hyperkalaemia and hypertension as well as maintaining the kidney through the period of non-function can lead to remarkable recovery of renal homeostatic function.Keywords: acute kidney injury, paediatrics, managemen

Challenges in the Management of Mucopolysaccharidosis Type II (Hunter’s Syndrome) in a Developing Country: a Case Report

BACKGROUND: Mucopolysaccharidosis type II (Hunter's syndrome) is an X-linked chromosomal storage disorder due to deficiency of the lysosomal enzyme iduronate-2-sulfatase with patients rarely living till adulthood. Failure to identify patients early could contribute to an increased morbidity as identified in this case report.CASE DETAILS: An eight year old patient with Hunter's syndrome identified five years after disease onset with severe cardiovascular complications exemplifies the challenges faced in resource-limited countries towards making diagnosis and treatment of rare conditions. Elevated urinary glycosaminoglycans levels or a strong clinical suspicion of Hunter's syndrome, as identified in the index case, is a prerequisite for enzyme activity testing. Urinary mucopolysaccharide(MPS) level was 69.6mg/mmol(normal range is 0.0 - 11.6mg/mmol), and the confirming MPS electrophoresis analysis showed elevated heparan sulphate in the urine sample. Enzyme activity testing, with absent or very low iduronate-2-sulfatase activity, is diagnostic. However, the scarce availability and high cost of these tests is another constraint in making a diagnosis.CONCLUSION: Identification and management of mucopolysaccharidosis type II pose a problem in resource-constrained countries due to late presentation, lack of facility for diagnosis and treatment, cost and expertise required for the management.KEYWORDS: Mucopolysaccharidosis, Hunter's syndrome, Mucopolysaccharid

Prevalence of snoring and symptoms of sleep disordered breathing among primary school pupils in Ilorin, Nigeria

Background/Aim: Snoring is the production of sound from the upper aero-digestive tract during sleep due to turbulent airflow This study is to determine the prevalence, pattern, night and daytime symptoms of snoring among nursery and primary school pupils in Ilorin, Nigeria due to its public health importance. Materials and methods: This cross sectional survey was carried out among nursery /primary school pupils in Ilorin, Kwara state between April and September, 2010. Ten schools were selected randomly from 100 schools sited within the 3LGAs of Ilorin municipality. Also private and public schools with different parental social economic status were selected. The pupils were selected from nursery 2 to primary 6 in each school using the class registers with the aid of a table of random numbers with 1500 children assessed. The parents/guardians were made to fill the questionnaires and same returned with visitations to the schools twice weekly and reminders sent via phone calls. Data were analyzed using EPIINFO 2002 version 2 software. Results: 1500 questionnaires were given out but 909 were completely filled and returned (response rate of 61%.). There were 598(65.8%) non snorers (NSn) and 311(34.2%) snorers (Sn) at different scales with 153 male snorers to 158 female snorers. The ages of the children ranges from 3 to 16 years (mean � SD, 8.3 � 4.8 years. The mean age for the Sn was 8.2 and 8.3 for NSn (range 3–6 years). No statistical difference in age, gender or socio-economic status between Sn and NSn. 598(65.8%) were non snorers (NSn) and 311(34.2%) were snorers (Sn) especially in the age groups 3–6 years, 121(38.9%) and above 6 years of age 101(32.7%) and below 3 years were 89(28%). Conclusion: Snoring is an important health problem among the pupils as a significant percentage snores and most of them are between third and sixth year of lif

Prevalence and Predictors of Tuberculosis Coinfection among HIV-Seropositive Patients Attending the Aminu Kano Teaching Hospital, Northern Nigeria

Background: The HIV/AIDS epidemic has been accompanied by a severe epidemic of tuberculosis (TB), although the prevalence of coinfection is largely unknown, especially in developing countries, including Nigeria. The aim of this study was to determine the prevalence and predictors of TB coinfection among HIV-seropositive Nigerians. Methods: The case files of HIV/AIDS patients attending Aminu Kano Teaching Hospital, Nigeria from January to December 2006 were reviewed. Results: A total of 1320 HIV/AIDS patients had complete records and were reviewed, among which 138 (10.5%) were coinfected with TB (95% CI, 8.9% to 12.2%). Pulmonary TB was diagnosed in 103 (74.6%) patients, among whom only 18 (17.5%) were sputum-positive. Fifty (36.2%) coinfected patients had some type of extrapulmonary TB (EPTB); 15 had both pulmonary TB and EPTB. Among the 35 patients with EPTB only, 20 (57.1%) had abdominal TB, 5 (14.3%) had TB adenitis, 5 (14.3%) had spinal TB, 3 (8.6%) were being monitored for tuberculous meningitis, and 1 (2.9%) each had renal TB and tuberculous adrenalitis. The highest prevalence of TB, 13.7% (n = 28), was seen among patients aged 41–50 years. TB coinfection was significantly associated with marital status, WHO clinical stage, and CD4 count. Marital status (OR, 2.1; 95% CI, 1.28–3.59; P = 0.04), WHO clinical stage at presentation (4.81; 1.42–8.34; P = 0.001), and baseline CD4 count (2.71; 1.51–6.21; P = 0.02) remained significant predictors after adjustment for confounding. Conclusions: The moderately high prevalence of TB among HIV-seropositive patients underscores the urgent need for strategies that lead to rapid identification and treatment of coinfection with active or latent TB

Comparison of QRS duration in African blacks and European caucasians

This study aimed to compare the QRS duration in a large population of healthy individuals living in Nigeria with a Caucasian population living in Scotland. The Nigerian population consisted of 782 males and 479 females with an age range of 20-87 years. The Caucasian population consisted of 859 males and 637 females with an age range from 18-82 years. For the Nigerian population, the overall QRS duration for males was 87.9 ± 9.4ms and for females, it was 83.4 ± 7.6ms. For the Caucasian population, the overall QRS duration in males was 93.7 + 9.8ms and in females was 86.1 + 7.7ms. In both populations, the mean QRS duration was higher in males than in females. There was a significantly longer QRS duration in Caucasian males and females compared to their Nigerian counterparts. However, the upper limits of normal QRS duration differed little between the two races

Women's employment and earned income in Northern Ireland

2nd of 4 reports on women's economic independenceAvailable from British Library Document Supply Centre-DSC:f99/2245 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo