Hypoglycaemia in children: Review of the literature

Hypoglycaemia is a common metabolic condition in children. It often presents urgent and therapeutic challenges and it has been documented to affect many childhood conditions. Its clinical presentation is not classical and requires a high index of suspicion for an early diagnosis and prompt management. Undiagnosed or undertreated hypoglycaemia has been found to increase mortality in children when it is present. This review sought to review the subject of hypoglycaemia in children and calls for testing for it in all sick and admitted children

Haemolacria (bloody tears): A perplexing symptom: A report of two cases

We present two cases of a boy and a girl (both aged four years) who presented with bloody tears. (haemolacria). The boy initially presented with cough, catarrh and three episodes of epistaxis. Full blood count, coagulation profile, bleeding time, blood film picture and X-ray of the postnasal space were normal. He started shedding blood stained tears initially on crying, two weeks later without associated epistaxis. Subsequently the bloody tearing became spontaneous. He was given intramuscular vitamin K and high dose vitamin C. Other relevant investigations to determine the cause could not be done due to financial constraints, however the bloody tearing stopped after two months and has not recurred after being followed up for two years. The second patient, presented with redness of the eyes and yellowish mucoid discharge of six days, lowgrade fever of three days and spontaneous bloody tears from both eyes. There was associated orbital cellulitis and vomiting of nonbloody recently ingested feeds. Blood investigations were suggestive of sepsis and assays of measured clotting factors and coagulation profile were normal. She was managed with antibiotics and improved with resolution of haemolacria which has not recurred during a follow up period of six months.Keywords: Bloody tears, haemolacria, children

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

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Mauriac Syndrome in a Nigerian child with Type 1 Diabetes Mellitus: A Case Report

A 14-year-old boy with Type 1 Diabetes mellitus (diagnosed at eight years of age) presented with complaints of fever, weight loss, growth failure, pubertal delay, abdominal swelling and discomfort. He was on Premixed insulin (70/30) with inadequate follow-up and poor diabetic control. Examination revealed cachexia, generalised lymphadenopathy, a protuberant abdomen and hepatosplenomegaly. Anthropometry showed a bodyweight of 19.6kg, a height of 116cm and a BMI of 14.1kg/m2, all markedly below the 3rd centile. He had no secondary sexual characteristics: axillary hair stage 1, pubic hair stage 1, penile length of 4.9cm and prepubertal testicular volumes of 3mls bilaterally. At presentation, his random blood glucose was 400mg/dl, and glycosylated haemoglobin was 11.6%. Screening for tuberculosis, human immunodeficiency virus, hepatitis and lymphoproliferative disorders were negative. Other blood investigation findings included leucocytosis, erythrocyte sedimentation rate of 30mm/hr, normal liver function tests, normal serum electrolytes, urea and creatinine. His haemoglobin genotype was AS. Chest radiograph showed features of bronchopneumonia. A presumptive diagnosis of Mauriac Syndrome was made. With the optimisation of glycaemic control, he improved clinically with a weight gain of 5.7kg over four months and resolution of hepatosplenomegaly

Neonatal breast abscess: a rare complication of a physiological phenomenon - a report of two cases and review of literature

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Breastfeeding practices and determinants in infants from birth to six months in a district of Abidjan - Cote d’ivoire

Introduction: Exclusive breastfeeding (EBF) has the benefits of reduced rates of infectious morbidity and mortality. However, the EBF rate remains low worldwide including in Côte d'Ivoire despite efforts by health authorities.Objective: The study was carried out to describe the knowledge and practices of mothers concerning infant feeding especially with regards to breastfeeding from birth to six months and to identify factors influencing these practices.Methods: This was a descriptive and cross-sectional study conducted over a one-month period (1st to 31st August 2014)at a hospital in Abobo-Avocatier.Results: A total of 318 mothers and their infants were recruited. The median (range) age of the mothers was 27 (14-40)years. Over half (64.5%) had some form of formal education, 78.9% lived with a partner while 24.5% were unemployed. The HIV status was unknown in 29.6% of cases. The majority of infants (94%), were born at term through vaginal route (91.5%) and the median (range) age was 74 (2-180) days with a M:F ratio of 1.18. More than half of mothers received advice on breastfeeding (57.2%) mainly by a health care provider (83%). The overall breastfeeding, EBF, predominant breastfeeding and mixed feeding rates were 79.9%, 43.3%, 46.84% and 18.9% respectively. Initiation rate of breastfeeding within the first hour was 29%.The maternal age (p=0.007) and low birth weight of the infant (p=0.023) were significantly associated with EBF. Other factors associated with EBF include the mother’s occupation and being married.Conclusion: Despite the high overall rate of breastfeeding in the study, EBF rates and timely initiation of breastfeeding after birth need to be improved. Awareness campaigns need to be strengthened and interventions instituted to scale up optimal breastfeeding practices.Keywords: Infants, breastfeeding, determinants, birth, Cote d’Ivoire, six months