Transcranial Doppler and Magnetic Resonance in Tanzanian Children With Sickle Cell Disease

Background and Purpose: We determined prevalences of neurological complications, vascular abnormality, and infarction in Tanzanian children with sickle cell disease. // Methods: Children with sickle cell disease were consecutively enrolled for transcranial Doppler; those with slightly elevated (>150 cm/s), low (150 cm/s was associated with frequent painful crises and low hemoglobin level. Absent/low CBFv was associated with low hemoglobin level and history of unilateral weakness. In 49 out of 67 children with low/absent/elevated transcranial Doppler undergoing magnetic resonance imaging, 43% had infarction, whereas 24 out of 48 (50%) magnetic resonance angiographies were abnormal. One had hemorrhagic infarction; none had microbleeds. Posterior circulation infarcts occurred in 14%. Of 11 children with previous seizure undergoing magnetic resonance imaging, 10 (91%) had infarction (5 silent) compared with 11 out of 38 (29%) of the remainder ( P=0.003). Of 7 children with clinical stroke, 2 had recurrent stroke and 3 died; 4 out of 5 had absent CBFv. Of 193 without stroke, 1 died and 1 had a stroke; both had absent CBFv. // Conclusions: In one-third of Tanzanian children with sickle cell disease, CBFv is outside the normal range, associated with frequent painful crises and low hemoglobin level, but not hemolysis. Half have abnormal magnetic resonance angiography. African children with sickle cell disease should be evaluated with transcranial Doppler; those with low/absent/elevated CBFv should undergo magnetic resonance imaging/magnetic resonance angiography

Electrocardiographic and echocardiographic characteristics in HIV-1 and non-HIV-1 infected children at Muhimbili National Hospital, Dar es Salaam, Tanzania

Objective: The objective of the study was to describe the electrocardiographic and echocardiographic characteristics of HIV–1 infected children. aged 18 months to 7years.at Muhimbili National Hospital. Methods: A cross sectional comparative study was carried out between April 2001 and January 2002. All consecutive children aged between 18 months to 7 years admitted in the paediatric wards and those attending the out patient department between April 2001 and January2002 were enrolled for the study. Children who tested HIV-1 positive comprised the study group and those who tested HIV-1 negative formed the comparative group. Results: The study population consisted of 280 children, 160 males and 120 females. The overall prevalence of cardiovascular disorders was (83/280) 29.6%.The prevalence of cardiovascular disorders was significantly higher in HIV infected than non-HIV infected children,(46.2% versus 23.3%, p< 0.0001).The common cardiac disorders strongly associated with HIV infection were pericardial effusion, (26.9%) (p< 0.0002), Left ventricular dysfunction (LVD) 24.7% (p< 0.0004),Dilated cardiomyopathy (DCM) 24.4% (p< 0.0001), and sinus tarchycardia 20.5% (p< 0.0001). Endocarditis was not detected. Conclusion: Cardiac diseases are common in HIV infected children. ECG detectable sinus tachycardia prompts further investigation by Echocardiogram to detect the cardiac abnormalities in HIV-1 infected children. Tanzania Medical Journal Vol. 19 (1) 200