Relationship of age, anthropometry and haemoglobin concentration with echocardiographic findings in Nigerian children with sickle cell anaemia

Background: Assessment of the structural and functional effects of sickle cell anaemia (SCA) on the heart can be done using echocardiography.There has been no agreement on which indicator of body size (weight, height, and body surface area (BSA)) or age in children should be used to relate to and correct echocardiographic measurements.Aim: To correlate the echocardiographic findings of children with SCA aged one to fifteen years in steady state with their age, anthropometryand haemoglobin concentration.Methods: A prospective study carried out at the Lagos University Teaching Hospital (LUTH), between May and October 2005. The subjects were 60 paediatric patients attending the LUTH SCA outpatient clinic and 60 age, sex and socioeconomic matched controls. Their height, weight, and echocardiographic parameters were measured and their BSA and haemoglobin level were determined.Results: The direct echocardiographic measurement (AO, LA, LVPW, EDD, ESD, IVS) and LVM each increased progressively with body weight, height, body surface area and age in both subjects and controls (r > 0.3, p < 0.001 in each case). Multivariate analysis showed that height correlated significantly with AO, ESD, EDD and LVPW in the subjects. All the parameters except age were significantly correlated with LVM both in univariate and multivariate analysis.Conclusion: Echocardiographic parameters in SCA patients are significantlycorrelated with anthropometric indices and age. Our data suggest best correlation with height in these subjects

Severe childhood malaria syndromes defined by plasma proteome profiles

BACKGROUND Cerebral malaria (CM) and severe malarial anemia (SMA) are the most serious life-threatening clinical syndromes of Plasmodium falciparum infection in childhood. Therefore it is important to understand the pathology underlying the development of CM and SMA, as opposed to uncomplicated malaria (UM). Different host responses to infection are likely to be reflected in plasma proteome-patterns that associate with clinical status and therefore provide indicators of the pathogenesis of these syndromes. METHODS AND FINDINGS Plasma and comprehensive clinical data for discovery and validation cohorts were obtained as part of a prospective case-control study of severe childhood malaria at the main tertiary hospital of the city of Ibadan, an urban and densely populated holoendemic malaria area in Nigeria. A total of 946 children participated in this study. Plasma was subjected to high-throughput proteomic profiling. Statistical pattern-recognition methods were used to find proteome-patterns that defined disease groups. Plasma proteome-patterns accurately distinguished children with CM and with SMA from those with UM, and from healthy or severely ill malaria-negative children. CONCLUSIONS We report that an accurate definition of the major childhood malaria syndromes can be achieved using plasma proteome-patterns. Our proteomic data can be exploited to understand the pathogenesis of the different childhood severe malaria syndromes

Case Report: Camptomelic Dysplasia in One of Twins

Camptomelic dysplasia, a very rare and lethal form of skeletal dysplasia is reported in one of a set of twins. He presented on the second day of life with short, deformed lower limbs and respiratory distress from birth and died on the fifth day of life. This report highlights the features of camptomelic dysplasia and draws attention to its occurrence in a Nigerian child. With advances in neonatal life support, there is need to proffer solutions to the problems that presently make the prognosis of camptomelic dysplasia, poor. Nigerian Journal of Paediatrics 2002; 29:122-124

Acquired ventricular septal defect: A rare sequel of blunt chest trauma in a 7‑year‑old boy

Ventricular septal defect (VSD) is the most common congenital cardiac lesion encountered worldwide. Only very rarely is it acquired, and causation through blunt injury in a child is extremely rare. A previously healthy 7‑year‑old boy suffered blunt chest trauma while at play. He presented 11 days later with features of acute congestive cardiac failure. Two‑dimensional echocardiographic examination revealed a mid‑muscular VSD. The connection between the defect and the trauma was not initially appreciated. Facilities for required urgent open‑heart surgery were not available. Cardiac failure was refractory to antifailure therapy. His clinical condition steadily worsened, and he succumbed after 20 days on admission. We conclude that a diagnosis of traumatic VSD, though rare, should be considered in any previously well child presenting in acute congestive cardiac failure following blunt trauma to the chest. Any such patient should undergo careful echocardiographic evaluation. There is an urgent need for facilities for open‑heart surgery to be more readily available and accessible in Nigeria.Key words: Acquired ventricular septal defect, traumatic ventricular septal defect, blunt chest injury, cardiac failure, echocardiograph

Palliation for transposition of great arteries

Background: At the University College Hospital Ibadan we have no facility for total surgical correction of transportation of the great arteries (TGA). This prospective study reviews the palliative procedures we have used in the management of TGA. Method: Patients with the diagnosis of TGA were evaluated for morphological type. The choice of palliative procedure was made in some of the patients with morphological type in mind. No fixed criteria were used for allocating patients to Blalock-Hanlon (B-H), atrial septectomy while pulmonary banding (PB) and Blalock-Taussig (B-T) shunt have definite indications. Results: Fourteen consecutive patients with TGA were palliated. The ages of these patients ranged between 3 to 11 months (6.8 ± 2.4 months), there were 8 males to 6 females (1.3:1). Six patients had B-H atrial septectomy and 2(33.3%) died within 48 hours, 4 patients had B-T shunt and there were no mortality, 4 patients had PB and 2 (50.0%) died within 72 hours. The overall operative mortality was 28.6%. All the 10 survivors had improvement of their clinical features and fall in packed cell volume during the period of follow-up, which lasted 5 to 13 months (mean 9.3 ± 1.2 months). All patients had delayed wound healing. Conclusion: Appropriate and timely palliative surgery has a place in patients with TGA as an interim care. Key Words: Palliative surgery, transposition, great arteries Nigerian Journal of Surgical Research Vol.5(1&2) 2003: 129-13

Patency of the Ductus Arteriosus in Newborns: Experience in a Special Care Baby Unit

A prospective cohort study of infants admitted into the Special Care Baby Unit, University College Hospital, Ibadan, has revealed a 24.5 per cent prevalence of patency of the ductus arteriosus (PDA) among 97 infants, who were admitted over a six-month period. The major factor predisposing to PDA was prematurity (p=0.014). A higher incidence of PDA (35 per cent) was found among the preterm infants, and of these preterm infants, the very low birth weight (VLBW) infants were found to be more highly susceptible to PDA (p = 0.028). The mean birth weight of the preterm infants who developed PDA in the study was 1447g, while that of those preterm infants without PDA was 1835g. There was no relationship between the sex of the infants and the development of PDA. A strong association was however, found between respiratory distress and PDA (

Coarctation of the Aorta: Experience at the University College Hospital, Ibadan

Between May 1977 and June 1998, 697 patients with congenital heart diseases were admitted to the cardiothoracic surgical unit (CTSU) at the University College Hospital, Ibadan. Eighteen (2.6 per cent) of the patients with 19 coarctations of the aorta (CoA) were retrospectively studied. The age range of all the patients with CoA was 18 days to 30 years (mean 7.2±8.2 years), but for the 15 patients who underwent surgery, it was one month to 30 years (mean 8.6±8.3 years). Three patients died preoperatively of congenital cardiac anomalies associated with infantile CoA. There were 16 thoracic and two abdominal CoA, while one patient had recurrent CoA. Resection and end-to-end anastomosis was performed in four patients, dacron tube interposition graft in three, and dacron patch graft in four patients. Other procedures were employed in five patients. Operative mortality was 25 per cent. Operative deaths occurred in two infants with isolated CoA, a neonate who had associated pulmonary hypertension and a 17-year old who had surgery for re-coarctation. Complications of surgery included post-operative haemorrhage in two patients, intra-operative hemorrhage in one and hoarseness of the voice in four patients. Paradoxical hypertension occurred in three patients, graft occlusion and wound dehiscence occurred together in one patient and two patients had chylothorax. It is concluded that CoA is a surgically correctable congenital anomaly which is probably less frequently diagnosed locally.Nigerian Journal of Paediatrics 2002;29:27-33