Reliability of bedside blood glucose estimating methods in detecting hypoglycaemia in the children’s emergency room

Background: Hypoglycaemia occurs in many disease states common in the tropics. Facilities and skilled manpower required for laboratory blood glucose measurement are not always available in health facilities in developing countries. Objective: The study was carried out to determine the validity of bedside methods of blood glucose measurement in detecting hypoglycaemia.Methods: Blood glucose was determined by two bedside methods (Accuchek Active® and Betachek Visual®) in 430 patients aged between one month and 10years and simultaneously sent for laboratory spectrophotometric analysis at a wavelength of 500nm using the hexose kinase method. Hypoglycaemia was defined as plasma glucose < 2.5mmol/L.Results: The prevalence of hypoglycaemia was 5.6%.There was a higher correlation (r =0.84, p< 0.05) between Accuchek Active® results and laboratory values than was obtained with Betachek Visual ® (r = 0.48, p=0.000).In detection of hypoglycaemia, both bedside glucose monitors were found to have a high specificity and high predictive values of a negative test (99.8% and 98.5% for Accuchek Active® and 89.4% and 97.8% for Betachek Visual® respectively) with moderate sensitivity (75.0% and 66.7% respectively). However, the Accuchek Active® monitor has a much higher predictive value of a positive test (94.1%) compared to the Betachek Visual® (27.1%).Conclusion: The bedside glucose monitors are valid bedside tools for detecting or ruling out hypoglycemia.Keywords: hypoglycaemia, children, bedside investigation, glucose estimation, blood glucose

Nigerian physicians' knowledge, attitude and practices regarding diabetes mellitus in the paediatric age group

Background: Despite the increasing prevalence of diabetes in the paediatric age group, information concerning Nigerian physicians' knowledge, attitude and practices with regard to diabetes care in children and adolescents is scarce.Objective: To assess the knowledge, attitude and practices of physicians working in Nigeria.Methods: The study examined several aspects of diabetes-related knowledge, attitude and practices of Nigerian physicians. A crosssectional survey was conducted among physicians in four towns in four different States in Nigeria, using a self-administered questionnaire to obtain data. Statistical analysis was performed using SPSS version 16.Results: A total of 288 medical practitioners from four towns in four different states in Nigeria filled the questionnaires. The distribution of participants was as follows: 25, 28, 85 and 150 from Benin (Edo State), Kano (Kano State), Ado-Ekiti (Ekiti State) and Gwagwalada (Federal Capital Territory), respectively. Questions answered correctly by more than half of the participants were: fasting plasma glucose diagnostic criterion for diabetes, 161(55.9%); best test for monitoring glycaemic control (72.9%); diabetic ketoacidosis (DKA) is an immediate complication (93.5%); insulin therapy is important in the control of childhood diabetes (86.5%); and diabetes is a dangerous disease (91.3%). Questions answered correctly by less than half of the participants were: the stronger hereditary nature of type 2 diabetes (39.6%) 10.1% and 2.8% knew that diabetes can present with fast breathing and abdominal pain respectively. Only 36.8% of the participants knew that children with diabetes should eat family diet. Concerning risk factors for diabetes, majority (82.6%) of the participant believe that eating too much sugar is a risk factor. Only 25.3% knew the correct method of storing insulin and 39.6% of participants stated that they do not know. This paucity of knowledge was more pronounced among physicians with less than ten years of medical practice experience after graduation from the medical school. Only a quarter (24.7%) of the respondents will allow an adolescent with diabetes to adjust his insulin dose.Conclusions: Knowledge gaps, ambivalent attitudes and suboptimal practices regarding diabetes mellitus in childhood and adolescence were found among Nigerian physicians, irrespective of duration of practice post-graduation from the medical school. Our results suggest that most physicians require additional education, focusing on DM in order to provide an acceptable level of care to children and adolescents with diabetes mellitus.Keywords: Knowledge, Attitude, Practices, Diabetes Mellitus, Children, Physicians, Nigeri

Primary congenital hypothyroidism complicated by persistent severe anaemia in early infancy: A case report with a literature review

No Abstract

Vitamin D Deficiency and Its Health Consequences in Africa

Africa is heterogeneous in latitude, geography, climate, food availability, religious and cultural practices, and skin pigmentation. It is expected, therefore, that prevalence of vitamin D deficiency varies widely, in line with influences on skin exposure to UVB sunshine. Furthermore, low calcium intakes and heavy burden of infectious disease common in many countries may increase vitamin D utilization and turnover. Studies of plasma 25OHD concentration indicate a spectrum from clinical deficiency to values at the high end of the physiological range; however, data are limited. Representative studies of status in different countries, using comparable analytical techniques, and of relationships between vitamin D status and risk of infectious and chronic diseases relevant to the African context are needed. Public health measures to secure vitamin D adequacy cannot encompass the whole continent and need to be developed locally

Neonatal Diabetic Ketoacidosis In A Nigerian Infant: A Case Report

Neonatal diabetic ketoacidosis is a rare condition that may occur in the first few weeks of life as a complication of neonatal diabetes mellitus. The prominent clinical features are hyperglycaemia and dehydration. It could also mimick an infection. The danger of inappropriate diagnosis is increased morbidity and mortality. To prevent this, we advocate routine testing of blood glucose levels in neonates and infants who present at the emergency rooms. We report a case of neonatal diabetic ketoacidosis in a female who presented at our facility.Keywords: Neonate Diabetes mellitus Ketoacidosis Dehydratio

Blood pressure to height ratio as a screening tool for prehypertension and hypertension in adolescents

Background: Current methods of detection of childhood hypertension are cumbersome and contribute to under‑diagnosis hence, the need to generate simpler diagnostic tools. The blood pressure to height ratio has recently been proposed as a novel screening tool for prehypertension and hypertension in some populations. We evaluated its applicability in our environment.Materials and Methods: The weights, heights, and blood pressure measurements of 2364 apparently healthy adolescents were determined. Sex‑specific systolic and diastolic blood pressure to height ratios (SBPHR) and (DBPHR) were calculated, and their ability to detect prehypertension and hypertension was determined using receiver operating curves. Discriminatory ability was measured by the area under the curve (AUC) and optimal cutoff points along the curve were determined. P < 0.05 was considered statistically significant.Results: The SBPHR and DBPHR were similar across all age groups and sexes. The AUC of SBPHR and DBPHR for diagnosing prehypertension and hypertension by sex was >0.95 for both diastolic and systolic hypertension in both sexes. It ranged between 0.803 and 0.922 for prehypertension and 0.954–0.978 for hypertension indicating higher accuracy for hypertension. Sensitivity was higher for systolic and diastolic hypertension (90–98%) compared with prehypertension (87–98%). Specificity was lower than sensitivity across all categories of hypertension and prehypertension (0.64–0.88%) though higher for hypertension (0.75–0.88) compared with prehypertension (0.64–0.75).Conclusion: BPHR is a useful screening tool for prehypertension and hypertension in black adolescents. Accuracy increased with higher degrees of hypertension.Keywords: Adolescents, blood pressure, height, hypertensio

Enhanced Lung Function and Prevention of Peroxidative Damage by Vitamin E Supplementation in Childhood Asthma

This study was designed to assess the effects of vitamin E supplementation on the lung function and lipid peroxidation status of asthmatic children. Fifteen asthmatics (ten male and five female) aged between 6 and 13years, all in a stable state, were recruited from the paediatric out-patient respiratory clinic of the Lagos University Teaching Hospital, Idi-Araba (LUTH). Three millilitres of blood was drawn from the antecubital vein of each of the 15 patients before vitamin supplementation for assessment of plasma lipid peroxidation products. Lung function tests were performed on each subject before vitamin supplementation. After all measurements have been made, each patient received vitamin E (Teva Pharmaceuticals, Tel-Aviv, Israel) supplementation at a dose of 100 I.U./day for 6 weeks. Thereafter, all previous measurements were repeated on each patient. Mean SBP after vitamin E supplementation reduced slightly (0.73%) from 97.0mmHg to 96.3mmHg. The DBP increased by (7.76%) from 58.0mmHg to 62.5mmHg. Pulse pressure reduced from 39mmHg to 33mmHg(15.39%). The MAP changed from 71.0mmHg to 73.07 mmHg (0.03%). These changes were not significant. However, after vitamin E supplementation the plasma MDA concentration was significantly reduced by 34.8% from 66.0+2.3 nmol/L to 43.0+2.9 nmol/L. FEV1 increased significantly from 1.24 ± 0.06 L to 1.39 ± 0.02 L after vitamin E supplementation. The PEFR and FVC increased slightly by 8.43% and 3.53% respectively. From the results, we therefore concluded that vitamin E supplementation may improve lung function and also supresses peroxidative damage in young asthmatics. KEY WORDS: Vitamin E, lung function, childhood asthma. Nigerian Journal of Health and Biomedical Sciences Vol.4(1) 2005: 57-6

Are We Meeting The Calorie Needs Of Hospitalized Children?

For the past four decades, nutrition has assumed its pride of place on the list of advances in surgery and general patient care. We prospectively reviewed the effect of hospitalisation on the nutritional status of 28 children admitted for various surgical and medical conditions at the Lagos University Teaching Hospital. Parameters studied were admission weights, calorie intake and weight lost or gained within the first one week of admission. The mean Daily Calorie Intake among the 16 children admitted for infective medical conditions was 68.8% of ideal while the corresponding figure for those who had major surgeries was only 27.0% of ideal. Although the 12 surgical patients had admission weights satisfactorily suitable for their ages, they lost a mean 11.8% of admission weights at the end of the first week of hospitalisation and surgery. The medical group had a modest weight gain of 2.6% within the same period. It was concluded that hosplitalisation is deleterious to the nutritional status of children in our institution and various modes of nutritional support are recommended for ameliorating this undesirable side effect of hospital admission in this group of patients. Nigerian Quarterly Journal of Hospital Medicine Vol. 9, No. 2 (June 1999) pp. 112-11

Zinc supplementation in children with acute diarrhoea

No Abstract