Kawasaki disease: An unusual presentation in a 14-year old boy in Sokoto, north western Nigeria

Kawasaki disease (KD) is an acute systemic vasculitis that mostly affects children less than 5years. Occasionally, it may presents with renal  involvement of varying severity. In Nigeria and most of Africa, only a few cases of KD have been reported and these were among children withinthe typical age group. We report an unusual case of Kawasaki disease with renal manifestation in a 14 year old adolescent. Apart from the principalfeatures of KD comprising of high grade fever, non purulent conjunctivitis, polymorphous rash, right sided cervical lymphadenitis and symmetrical desquamative lesions of the digits of the hands and feet; our patient also had renal involvement. The renal manifestations included mild periorbitaledema, oliguria, hypertension (140/90mmHg), hematuria(++), proteinuria(++) and elevated serum urea and creatinine (8.3mmol/L and 1.9mg/dl respectively). He was managed with high dose aspirin at  80mg/kg/day. The dose was reduced (5mg/Kg/day) and subsequently stopped after serial echocardiography showed normal coronary arteries. Intravenous immune globuline (IVIG) could not be started due to nonavailability. Nevertheless, clinical signs resolved, renal function normalisedafter 6 weeks and echocardiographic picture did not deteriorate. Patient is currently on follow up at the paediatric cardiology clinic of UDUTH, Sokoto, Nigeria..Conclusion: Kawasaki disease can occur even in older children and renal manifestation may be self limiting. This report highlights the need for high index of suspicion in all cases.Key words: Kawasaki disease, renal involvement, Adolescent, Sokoto, North-western Nigeria

Evaluation of Antibiotic Prescription and Utilization amongst Hospitalized Children in a Tertiary Facility in Sokoto, North-Western Nigeria

Background: Antibiotics are the most widely utilized therapeutic agents. Inappropriate use causes increase cost and antibiotic resistance. The World Health Organization recommends assessment of antibiotics use to guide prescribing practices. Objective: To describe the pattern of antibiotic usage among paediatric inpatients aged > 1 month to 15 years in a tertiary hospital in Sokoto, Nigeria. Methods: Febrile children were recruited prospectively by systematic random sampling from January to October 2018. Socio-demographics, diagnosis, antibiotics administered were obtained from case notes. The WHO indicators of use of antibiotics were employed for evaluation. Data was analysed with SPSS version 23. Results: Out of 352 children, 318 (90.3%) received antibiotics; commonest being Ceftriaxone in 155/318 (48.7%), Cefuroxime in 74 (23.2%), and Metronidazole in 29 (9.1%). Average number of antibiotics per patient was 2.3±1.1 with treatment duration of 4.3±1.4days. Antibiotic consumption was 937.2 days of antibiotic therapy/1000 patient days (DOT/PD). Generic name was used in 92.3% while 100% of the drugs were on the essential medicine list. Frequent diagnoses were severe malaria 98/352 (27.8%), respiratory infections 39 (11.1%) and severe malnutrition in 38 (10.8%). Only 6 (1.7%) patients had microbiologic evidence of infection. Conclusion: Utilization of antibiotics is higher than recommended. There is need for improved diagnostic facilities to avoid antibiotic overuse and its consequences. Keywords: antibiotics, prescription, utilization, children, inpatients, DO

PREVALENCE AND CLINICAL FORMS OF MALARIA AMONG FEBRILE HIV-INFECTED CHILDREN SEEN AT USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL, SOKOTO, NIGERIA

Background: Malaria and HIV infections are major health problems facing the world today. Sub-Saharan Africa with 10 percent of world’s population harbors more than half the burden of the scourge. The present study determined the prevalence and clinical forms of malaria among febrile HIV-infected children aged 3months to 15years, seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. Materials and Methods: Cross-sectional study among febrile HIV-infected children and their control cohort were carried out between May and October 2016. The participants had the following investigations: malarial parasite, packed cell volume, random blood sugar, retroviral test.  Results: A total of 140 febrile HIV-infected children aged 3 months to 15 years and 140 febrile HIV-negative age- and gender-matched children were recruited; 100 of the HIV-infected children were on ART and cotrimoxazole. The prevalence of malaria among the febrile HIV-infected children was 71.4% (100/140) which was significantly lower than the prevalence of 94.3% (132/140) among the control group (χ2 27.72, p=0.001). Among the febrile HIV-infected children that had malaria, 54(54.0%) had uncomplicated malaria while 46(46.0%) had severe malaria. Of the 132 controls that had malaria, 48(36.4%) had uncomplicated malaria and 84(63.6%) had severe malaria (χ2 =7.184, p=0.007). Conclusion: Malaria is a problem in HIV-infected children. Since nearly half of the febrile HIV-infected children had severe form of malaria, it is recommended that health promotion, intermittent malaria prophylaxis, early diagnosis and prompt effective treatment should be instituted for HIV-infected children. This may prevent severe form of malaria and its attendant mortality

Uranium mobility in organic matter-rich sediments: A review of geological and geochemical processes

Uranium (U) is of enormous global importance because of its use in energy generation, albeit with potential environmental legacies. While naturally occurring U is widespread in the Earth's crust at concentrations of ~1 to 3 ppm, higher concentrations can be found, includingwithin organicmatter (OM)-rich sediments, leading to economic extraction opportunities. The primary determinants of U behaviour in ore systems are pH, Eh, U oxidation state (U(IV), U(VI)) and the abundance of CO3 2– ions. The concentration/availability and interrelationships among such determinants vary, and the solubility and mobility of ions (e.g. OH-, CO3 2–, PO4 3-, SiO4 4-, SO4 2-) that compete for U (primarily as U(VI)) will also influence the mobility of U. In addition, the presence of OM can influence U mobility and fate by the degree of OMsorption to mineral surfaces (e.g. Fe- and Si- oxides and hydroxides). Within solid-phase OM, microbes can influence U oxidation state and U stability through direct enzymatic reduction, biosorption, biomineralisation and bioaccumulation. The biogenic UO2 product is, however, reported to be readily susceptible to reoxidation and therefore more likely remobilised over longer time periods. Thus several areas of uncertainty remain with respect to factors contributing to U accumulation, stability and/or (re)mobilisation. To address these uncertainties, this paper reviews U dynamics at both geological and molecular scales. Here we identify U-OMbond values that are in agreement, relatively strong, independent from ionic strength and which may facilitate either U mobilisation or immobilisation, depending on environmental conditions. We also examine knowledge gaps in the literature, with U-OM solubility data generally lacking in comparison to data for U sorption and dissolution, and little information available on multi-component relationships, such as UOM-V (V as vanadate). Furthermore, the capability ofOMto influence the oxidation state of U at near surface conditions remains unclear, as it can be postulated that electron shuttling by OM may contribute to changes in U redox state otherwise mediated by bacteria. Geochemical modelling of the environmental mobility of U will require incorporation of data from multi-corporation studies, as well as from studies of U-OM microbial interactions, all of which are considered in this review

Pattern of Acquired Heart Diseases among Children Seen in Sokoto, North-Western Nigeria

Background: Acquired heart diseases (AHDs) are serious but largely preventable diseases. They are highly prevalent in developing countries where poverty, illiteracy, and poor socioeconomic conditions still pose a significant challenge. The prevalence and pattern of AHD among children have not been previously documented within the study area.Objectives: To determine the pattern and outcome of AHDs among children in Sokoto, North‑Western Nigeria.Subjects and Methods: A prospective study conducted at the Pediatric Department of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria from 1st July 2009 to 30th June 2014. Data from all the subjects with AHD were analyzed using Statistical Package for Social Sciences.Results: Of the 3810 children, 110 (2.9%) children were diagnosed with AHD over the study period. The mean age of the subjects was 10.4 ± 3.4 years with M: F ratio of 1.2:1. Rheumatic heart disease (RHD) was the most common AHD seen in 47 (42.7%) patients, followed by dilated cardiomyopathy/myocarditis in 36 (32.7%) and pericardial effusion in 12 (10.9%) patients. Endomyocardial fibrosis was seen in 7 (6.4%) patients while infective endocarditis and Kawasaki disease occurred in 6 (5.5%) and 2 (1.8%) patients respectively. Mortality rate was 17.3%. Commonly observed co‑morbidities included heart failure, bronchopneumonia, and pulmonary hypertension.Conclusion: The pattern of AHD is similar to other studies in developing countries, with RHD being the most prevalent. There is a need for increased emphasis on primary prevention to reduce the burden of these diseases in the study area.Keywords: Acquired Heart Disease, Children, Nigeria, Outcome, Pattern, Sokot