Childhood acute glomerulonephritis in Ibadan Nigeria

Background: Acute glomerulonephritis (AGN) is an important cause of mortality and morbidity in children in developing countries while its  incidence has declined in the developed world. This study was to document its present impact in our setting.Aim: To evaluate the sociodemographic features and clinical outcomes in children hospitalized for AGN in the Paediatric Nephrology Unit of the University College Hospital, Ibadan.Subjects and Methods: This was a descriptive analytical study of children aged 2 to 14 years admitted with AGN between 2007 and 2019. Their sociodemographic data, clinical features, complications and outcome were analysed.Results: AGN accounted for 116 (8.9%) of new renal cases admitted over the period. Seventy-four (63.8%) were male, mean age (SD) was 8.2 (3.3) years and peak age incidence between 5 and 9 years. Average annual hospital incidence rose from 4-5 new cases to 8-9 new cases/annum with an upsurge to 17 cases in 2019. Highest yearly monthly incidence was between June and December. Forty -five out of 50 (90%) evaluated subjects were in the middle/ low socioeconomic classes. Stage 2 hypertension occurred in 30/50 (60%) with hypertensive crises in 24%. RPGN occurred in 6/50 (12%) of cases accounting for 5 of the 8 dialysed patients and 4 of the 5 deaths. The case fatality rate was 4.3%.Conclusion: The study showed a progressive increase in the hospital incidence of AGN.RPGN was a major risk factor for death in children with AGN and therefore requires a high index of suspicion and an appropriate early intervention. Key words: Childhood, Acute Glomerulonephritis (AGN), Postinfectious AGN, Rapidly progressive glomerulonephritis (RPGN), Hypertensive crises,  Outcome&nbsp

A case report of suspected angioedema in a child after administration of mebendazole, cotrimoxazole and leaf extracts

Adverse drug reactions in children are an important public health problem. Children are at a higher risk of developing adverse drug reactions as they seldom express their own drug therapy experiences. Factors that have been implicated include polypharmacy especially with anti-infective and nonsteroidal anti-inflammatory drugs; also concomitant use of traditional medicines which is prevalent in some cultures. Cutaneous drug allergy is a common manifestation of adverse drug reactions.Keywords: Angioedema, Mebendazole, Co-trimoxazole, Leaf extract

Major urogenital malformations in Nigerian children

Background:There is scanty data on the pattern of childhoodurogenital malformations in many resource-poorcountries, including Nigeria.Objective:To describe the pattern of occurrence of majorurogenital malformations in children presenting in atertiary health care centre in sub Saharan Africa.Design:Retrospective case review.Patients:All children with major urogenital malformationspresented at the Department of Paediatrics of theUniversity College Hospital, Ibadan, a large tertiaryhealth care institution in South West Nigeria. In theperiod from July 1985 to December 1995.Main results:A total number of 125 cases of major urogenitalmalformations were seen during the study period.The commonest of these malformations were posterior urethral valves (40.0%), hypospedias(18.4%), ambiguous external genitalia (12.8%) andectopia vesicae (11.2%).Prenatal diagnosis was rare and most patientspresented late. Mortality during first admission was14.4% (18/125), mostly accounted for by cases ofposterior urethral valves.Conclusion: Posterior urethral valves accounted for the majority of major urogenital malformations seen in the setting studied. The high mortality probably reflected the severity of the lesions and late presentation of patients (which was related to the rarity of prenatal diagnosis). Increased awareness of these lesions among physicians practising in developing countries and greater use of ultrasonography in the third trimester of pregnancy may improve the prognosis by early detection and management

Influence of disease remission on renal dimensions in childhood nephrotic syndrome in Ibadan, South West Nigeria

Background: The hallmark of Nephrotic syndrome is massive proteinuria, with associated enlarged kidneys. However the association between remission status and size of the kidneys in patients with nephrotic syndrome is not known. This study is aimed at determining the dimensions of the kidneys of children with nephrotic syndrome and to compare kidney dimensions in patients with nephrotic syndrome who were in remission compared with the dimensions in patients who were not in remission.Subjects and Methods: This is a case-control study, where fiftythree children with diagnosis of Nephrotic syndrome and fiftyseven age matched healthy controls were analysed. The kidneys of both cases and controls were scanned using the B- mode ultrasound and the kidneys Bipolar, anteroposterior and transverse dimensions and volume were determined.Results: The mean renal longitudinal, anteroposterior, transverse dimensions and volume were higher in cases compared to the controls, bilaterally (p <0.001). The mean difference in values of the measured parameters between the cases in remission and those yet to attain remission was not significant. The bipolar dimension of the left kidney showed positive correlation with duration of disease (r= 0.290, p=0.035). The study was also able to demonstrate high incidence of nephromegaly, in 52.8%, 62.3% and 67.9% respectively for the right kidney, left kidney and combined.Conclusion: Despite a comparative global enlargement in the kidney dimensions in children with nephrotic syndrome compared with controls and the general population, the remission status does not seem to be a significant factor.Keywords: Nephrotic syndrome, renal dimensions, ultrasonography, nephromegaly, paediatric

Renal Doppler Indices in Children with Nephrotic Syndrome: Findings from a Tertiary Hospital in Nigeria

Summary: The resistive and pulsatility indices are known tools for assessing renal function in kidney diseases, especially in proteinuric conditions like Paediatric Nephrotic syndrome (NS) which is a glomerular disease. However, there is a limited knowledge in the use of Doppler Resistive and pulsatility indices in the management of this disease condition. This was a case control study involving 53 cases and 57 controls. The Doppler parameters, resistive index (RI) and pulsatility index (PI) of the renal interlobar arteries were determined for the upper, middle, and lower poles bilaterally for both controls and cases. The mean RI on the right and left were 0.59 ± 0.06 and 0.58 ± 0.06 respectively for the NS cases whereas for the controls it was 0.61 ± 0.05 and 0.60 ± 0.04 on the right and left respectively. The mean PI on the right and left measured 0.96 ± 0.16 and 0.94 ± 0.15 respectively for the NS cases while that for the control cases measured 0.98 ± 0.13.and 0.95 ± 0.12 on the right and left respectively. Although, the interlobar arteries mean RIs were generally less than that for the controls, but only the left middle pole showed statistically significant mean difference (p= 0.004). There was also statistically significant mean difference (p= 0.048) between the cases and controls in the left middle pole PI. However, no correlation was found when the renal RI and PI are compared with the serum albumin and creatinine. Although there was no statistical significance between the mean RI and PI of the NS cases and controls, except in the left middle pole RI, it is recommended that Doppler ultrasound should still be part of management of Nephrotic syndrome patients especially those who have developed end stage renal disease in order to monitor their renal function.Keywords: Paediatric, Nephrotic Syndrome, Renal, Resistive Index, Pulsatility Inde

Epidemiology of complications of male circumcision in Ibadan, Nigeria

BACKGROUND: The number of infants managed for neonatal circumcision injuries in our unit has been on the increase over the past 16 years. In our search for the sources and reasons for these injuries, we were unable to identify any previous studies of circumcision injuries from our environment. We therefore decided to carry out this study in order to shed some light on this growing problem. METHODS: The patients were made up of 370 consecutive consented children attending our infant welfare clinic for immunization over a period of 3 months. Information on their demographic data, their age at circumcision, where, why and who circumcised them was obtained from their mothers. They were clinically examined for the presence and type of complications of circumcision. RESULTS: Our circumcision rate was 87%. Neonatal circumcision had been performed in 270 (83.9%) of the children. Two hundred and fifty nine (80.7%) were performed in hospitals. The operation was done by nurses in 180 (55.9%), doctors in 113 (35.1%) and by the traditional circumcisionist in 29 (9%) of the children. Complications of circumcision occurred in 65 [20.2%] of the children. Of those who sustained these complications, 35 (53.8%) had redundant foreskin, 16 (24.6%) sustained excessive loss of foreskin, 11 (16.9%) had skin bridges, 2 (3.1%) sustained amputation of the glans penis and 1 (1.5%) had a buried penis. One of the two children who had amputation of the glans also had severe hemorrhage and was transfused. Even though the complications tended to be more likely with nurses than with doctors or traditional circumcisionists, this did not reach statistical significance (p = 0.051). CONCLUSION: We have a very high rate of complications of circumcision of 20.2%. We suggest that training workshops should be organized to adequately retrain all practitioners of circumcision on the safe methods available

Factors affecting practices and attitude of nursing mothers towards exclusive breastfeeding of their infants 0-12 months in Ihioma Orlu Local Government Area of Imo State

Background: Inappropriate infant feeding practices has long been observed in our society and it is one of the global problems responsible for about one-third of the cases of malnutrition worldwide. Objective: This study assessed the factors affecting practice and attitude of nursing mothers towards exclusive breastfeeding of their infants (0-12 months) in Ihioma Orlu Local Government Area Imo State. Methodology: A total of 331 Nursing mothers paired with their children 0 – 12 months were randomly selected using open ballot selection, from households in Ihioma Orlu L.G.A, Imo State. A structured questionnaire was administered to the Nursing mothers to obtain information relevant to the study. Data obtained were analyzed using descriptive statistics and Chi square analysis to determine the relationship between variables at significant level p=0.05 using Statistical Package for Social Sciences version 22. Result: Result shows that 49.5% of Nursing mothers aged 30-39years, 72.2% were married, 56.5% had higher institution, 47.4% were civil servant, 20.8% trader, 42.3% earned a monthly income of ₦10,000-₦30,000, 35.3% of mothers initiate breastfeeding within one hour after delivery, 56.5% discard Colostrum, 59.2% practice exclusive breastfeeding, with 55.5% breastfed exclusively for a duration of first six months of birth, 32.6% fed the children on only breast milk, 25.1% on complementary food, 16.0% on only infant formula, 66.5% introduce other foods other than breast milk to the child at 6 months after delivery, 73 (22.1%) were delivered through cesarean section, 60 (18.1%) of the children were born with low birth weight (Less than 2.5kg). There is significant relationship between exclusive breastfeeding and age of children (X2=11.164; P=0.001), age of mothers (X2=11.755; P=0.019), initiation of breastfeeding after delivery(X2=38.570; P<0.001), birth weight (X2=12.569; P=0.028) and type of food fed to the child(X2=57.539: P<0.001). Conclusion: This study depicted high prevalence of inappropriate infant feeding practices among mothers, were initiation of breast feeding, type of food fed to the child, age of mother and child are the observed factors affecting practice of exclusive breastfeeding among mothers in the study area

Collodion baby: A report of 4 cases

Introduction: The term collodion baby refers to a clinical entity noted in newborns who are enmeshed by a translucent, cornified substance like sheets of uniform texture so called (collodion membrane) which gives the whole body surface a varnished appearance. Although, some other diseases and conditions may lead to collodion membrane formation, inalmost all the cases the cause is an autosomal recessive ichthyosiform disease.Case Presentation: The first three cases are all from a consanguineouslymarried couple of Fulani decent. The abnormal appearances of the babies’ skin were all noticed at birth. Parents are first cousins. The last case is a female born at GA of 40wks through emergency caesarian section dueto poor progress of labor. She was admitted into the Newborn with abnormal skin. These series are crucial so as to enable the pediatrician have a high index of suspicion of its existence and to be equipped with the skills to tackle the numerous complications that follow the disease.They contribute to mortality and morbidity among children in Nigeria and the exact etiology is unknown. However genetic and environmental factors among others are commonly implicated. This report is thus aimed at presenting these abnormalities which are rather rare and to highlight thatearly intervention improves the outcome in patients with these conditions.Conclusion: Early recognition of this clinical entity and early institution of appropriate therapy can definitely reduce morbidity and mortality in neonates.Key Words: Collodion Baby, Neonates, Genetic Disorde

PROPOSED MULTI-SPECIALIST HOSPITAL IN PORT HARCOURT, NIGERIA: TOWARDS INTEGRATING BIOPHILIC DESIGN FOR WELLBEING.

In response to the evolution and modification of human needs and priorities, the built environment has evolved over time from simple unplanned dwellings to more complex organized ones, and it has now been made obvious that man’s basic need for shelter involves more than just a roof over his head - it has become a foundation for his health and overall well-being, even more so in hospital environments and healthcare facilities. Therefore, the need for intentional design of healthcare facilities that can cater to the wellbeing needs of people, passively, while performing its mainstream healthcare functions has arisen, especially in Southern Nigeria where the black soot menace has plagued the air. One of the ways to achieving this is by integrating nature into the environment and this approach is Biophilic Design which uses nature in the space, nature of the space and natural analogues to improve wellbeing. The aim of this research is to investigate the impact of biophilic design principles on human health and wellbeing with a view to applying same to the design of a multi-specialist hospital in Port-Harcourt, Rivers State, Nigeria. This study employed both quantitative and qualitative research methods which include a questionnaire-based survey in 4 selected hospitals in Nigeria and case studies of 6 selected hospitals to identify biophilic design strategies and the extent of their application, as well as users’ perception of the impact on their wellbeing. Findings show that most hospitals in Nigeria are designed with minimal biophilic features and therefore only moderately impacts on the wellbeing of their users. This study has developed an architectural design of a multi-specialist hospital that employs biophilic design strategies to improve wellbeing of the users

Is the Art of Renal Biopsy on the Decline in Nigeria?

Background: Renal biopsy remains the means by which definitive parenchymal kidney disease diagnoses are made. With the renal biopsy, the activity, progression and prognosis of renal parenchymal diseases can be studied with objectivity. We investigated the trend of renal histopathology request in a tertiary hospital in Nigeria over 31 years.Objective: To determine the trend of renal biopsy requests in one of the biggest tertiary hospitals in Nigeria over a 31-year period (1981- 2011).Methods: We retrospectively analysed all the renal biopsies submitted to the Department of Pathology, University College Hospital (UCH) Ibadan, South-West Nigeria over a 30 year period (1981-2011). Trend of requests of all the biopsies submitted from the Surgery, Paediatrics and Medicine departments was analysed using a test for linear  trend. Gender and age groups trends were also studied.Results: A significant reduction in the rates of renal biopsy request over the 31-year period (p=0.001) was noted which is attributed to diminution in requests from the Medicine and Paediatrics Departments (p<0.001), while the rates of requests from Surgery Department remain fairly uniform over this period (p=0.05). Decrease in biopsy requests significantly cuts across the ages in both genders. Conclusion: Lack of adequately trained manpower, poor health insurance scheme and lack of facilities may be contributory in renal biopsy requests decline. Adequate efforts should be made towards reviving this important investigative modality in Nigerian tertiary hospitals.Keywords: Kidney, Biopsy, Histology, Trend test, UCH Ibadan