Central Diabetes insipidus in a Nigerian child : A case report

Background: Central diabetes insipidus (CDI) is rare in children. About 30 - 50% of cases are idiopathic. Early and accurate diagnosis are crucial for safe and effective treatment. This is the first report of Central diabetes insipidus in a child in Nigeria.Case report: We report a case of central diabetes insipidus in a female toddler who presented at the University of Port Harcourt Teaching Hospital with polydipsia and polyuria with a urine specific gravity of 1.000 and normal blood sugar. The diagnosis of CDI was confirmed by her inability toconcentrate urine after a water deprivation test followed by an increase in urine osmolality from 59mOsm/kg to 158mOsm/kg and serum osmolality from 286mOsm/kg to 321Osm/kg following intravenous administration of desmopressin. The patient responded well to oral desmopressin.Conclusion: Central diabetes insipidus occurs in Nigerian children and responds to oral desmopressin. We recommended high index of suspicion in children with polyuria and polydipsia.Key words: Central diabetes insipidus, polyuria, polydipsia, desmopressin, Nigerian chil

Factors associated with substance use among secondary school adolescents in Gwagwalada Area Council, Abuja, Nigeria

Background: Adolescents use substances for various reasons such as for pleasure, stress and anger management. Many factors have been reported to influence adolescent substance use. However, there is paucity of reports from this part of Nigeria.Aim/Objectives: To identify the socio-demographic factors associated with substance use among secondary school adolescents in Gwagwalada Area Council.Materials and methods: A cross-sectional, descriptive, questionnaire-based, study was carried out in secondary schools among adolescents aged 10 years to 18 years who met the inclusion criteria and after appropriate ethical approval had been obtained.Results: One thousand, one hundred and ninety-six student-filled questionnaires were analysed. The mean age of the students was 14.54 years ± SD 2.28. The students' religion, family structure, residence and type of school were associated with licit substance use while their religion, family structure and residence were associated with illicit substance use (P =<0.05). There was also statistically significant relationships between frequency in participation in religious activities and tobacco use (P = <0.01) and birth order and cocaine and hallucinogen use at P = 0.014 and P = 0.018, respectively.Conclusion and recommendation: Several factors were associated with adolescent substance use in this study. It is recommended that more in-depth studies be done to determine causality.Kewords: Factors, substance use, adolescent, Abuj

Knowledge about safe motherhood and HIV/AIDS among school pupils in a rural area in Tanzania

\ud The majority of adolescents in Africa experience pregnancy, childbirth and enter motherhood without adequate information about maternal health issues. Information about these issues could help them reduce their pregnancy related health risks. Existing studies have concentrated on adolescents' knowledge of other areas of reproductive health, but little is known about their awareness and knowledge of safe motherhood issues. We sought to bridge this gap by assessing the knowledge of school pupils regarding safe motherhood in Mtwara Region, Tanzania. We used qualitative and quantitative descriptive methods to assess school pupils' knowledge of safe motherhood and HIV/AIDS in pregnancy. An anonymous questionnaire was used to assess the knowledge of 135 pupils ranging in age from 9 to 17 years. The pupils were randomly selected from 3 primary schools. Underlying beliefs and attitudes were assessed through focus group interviews with 35 school children. Key informant interviews were conducted with six school teachers, two community leaders, and two health staffs. Knowledge about safe motherhood and other related aspects was generally low. While 67% of pupils could not mention the age at which a girl may be able to conceive, 80% reported it is safe for a girl to be married before she reaches 18 years. Strikingly, many school pupils believed that complications during pregnancy and childbirth are due to non-observance of traditions and taboos during pregnancy. Birth preparedness, important risk factors, danger signs, postpartum care and vertical transmission of HIV/AIDS and its prevention measures were almost unknown to the pupils. Poor knowledge of safe motherhood issues among school pupils in rural Tanzania is related to lack of effective and coordinated interventions to address reproductive health and motherhood. For long-term and sustained impact, school children must be provided with appropriate safe motherhood information as early as possible through innovative school-based interventions.\u

Chronic kidney disease in children: the global perspective

In contrast to the increasing availability of information pertaining to the care of children with chronic kidney disease (CKD) from large-scale observational and interventional studies, epidemiological information on the incidence and prevalence of pediatric CKD is currently limited, imprecise, and flawed by methodological differences between the various data sources. There are distinct geographic differences in the reported causes of CKD in children, in part due to environmental, racial, genetic, and cultural (consanguinity) differences. However, a substantial percentage of children develop CKD early in life, with congenital renal disorders such as obstructive uropathy and aplasia/hypoplasia/dysplasia being responsible for almost one half of all cases. The most favored end-stage renal disease (ESRD) treatment modality in children is renal transplantation, but a lack of health care resources and high patient mortality in the developing world limits the global provision of renal replacement therapy (RRT) and influences patient prevalence. Additional efforts to define the epidemiology of pediatric CKD worldwide are necessary if a better understanding of the full extent of the problem, areas for study, and the potential impact of intervention is desired

Acute kidney injury in children

Acute kidney injury (AKI) (previously called acute renal failure) is characterized by a reversible increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. The incidence of AKI in children appears to be increasing, and the etiology of AKI over the past decades has shifted from primary renal disease to multifactorial causes, particularly in hospitalized children. Genetic factors may predispose some children to AKI. Renal injury can be divided into pre-renal failure, intrinsic renal disease including vascular insults, and obstructive uropathies. The pathophysiology of hypoxia/ischemia-induced AKI is not well understood, but significant progress in elucidating the cellular, biochemical and molecular events has been made over the past several years. The history, physical examination, and laboratory studies, including urinalysis and radiographic studies, can establish the likely cause(s) of AKI. Many interventions such as ‘renal-dose dopamine’ and diuretic therapy have been shown not to alter the course of AKI. The prognosis of AKI is highly dependent on the underlying etiology of the AKI. Children who have suffered AKI from any cause are at risk for late development of kidney disease several years after the initial insult. Therapeutic interventions in AKI have been largely disappointing, likely due to the complex nature of the pathophysiology of AKI, the fact that the serum creatinine concentration is an insensitive measure of kidney function, and because of co-morbid factors in treated patients. Improved understanding of the pathophysiology of AKI, early biomarkers of AKI, and better classification of AKI are needed for the development of successful therapeutic strategies for the treatment of AKI

Epidemiology of chronic kidney disease in children

In the past 30 years there have been major improvements in the care of children with chronic kidney disease (CKD). However, most of the available epidemiological data stem from end-stage renal disease (ESRD) registries and information on the earlier stages of pediatric CKD is still limited. The median reported incidence of renal replacement therapy (RRT) in children aged 0–19 years across the world in 2008 was 9 per million of the age-related population (4–18 years). The prevalence of RRT in 2008 ranged from 18 to 100 per million of the age-related population. Congenital disorders, including congenital anomalies of the kidney and urinary tract (CAKUT) and hereditary nephropathies, are responsible for about two thirds of all cases of CKD in developed countries, while acquired causes predominate in developing countries. Children with congenital disorders experience a slower progression of CKD than those with glomerulonephritis, resulting in a lower proportion of CAKUT in the ESRD population compared with less advanced stages of CKD. Most children with ESRD start on dialysis and then receive a transplant. While the survival rate of children with ERSD has improved, it remains about 30 times lower than that of healthy peers. Children now mainly die of cardiovascular causes and infection rather than from renal failure

Enuresis: Review Article

No Abstract available Key words: Enuresis, epidemiology, aetiology, treatment Nigerian Journal of Clinical Practice Vol.6(2) 2003: 111-11

Naphthalene poisonging in Children: a report of two cases

No Abstract. Nigerian Journal of Paediatrics Vol. 33 (2) 2006: pp. 60-6

Double diabetes: an emerging disease in children and young adults

Background: Studies in most countries have shown an increasing incidence of diabetes mellitus in children and young adults. Double diabetes is a newly recognized problem in children with different diagnostic and therapeutic measures. Methods: A review of over 30 literature obtained from Google, PUBMED search and journal publications on “double diabetes” was done to determine the incidence, pathophysiology, pathogenesis, diagnostic criteria, treatment and prevention of double diabetes in children and young adults. Results: Most of the reports on double diabetes were from western countries and Asia. Type 1 diabetes resulting from antibodies to the insulin-producing pancreatic beta cell was more prevalent in children. However, with increasing obesity the incidence of type 2 diabetes resulting from insulin resistance was high in children and young adults. Most patients with double diabetes were established type 1 diabetics, who while on insulin and on hypercaloric diet developed obesity especially during puberty and hence associated type 2 diabetes. The incidence was more in black than in white children. They presented with some clinical and laboratory features of both types 1 and 2 diabetes. Some authors advocated treatment with both insulin and oral hypoglycaemic drugs mainly metformin to improve insulin sensitivity. Prevention of childhood obesity by encouraging physical activities and dietary control would prevent double diabetes. Conclusion: Double diabetes is increasing in children and young adults. A high index of suspicion is required in obese children with diabetes. Keywords: Double diabetes, Emerging problem, Children, Young adults Port Harcourt Medical Journal Vol. 1 (2) 2007: pp. 76-8

Development and Validation of Standardized Clinical Summary Format

Background: The use of a structured guideline in medical education to reach a diagnosis provides accurate information which is relatively free from bias. The purpose of this paper is to assess the performance of medical students using unstructured and structured format in case summary. Methods: One hundred and sixty- nine medical students in Part III MB; BS Programme in the University of Port Harcourt were studied. There were 83 students in Paediatrics [SP] and 86 students in Obstetrics and Gynaecology [SOG] postings. The students had video recorded presentation of three clinical cases comprising of two paediatrics [PC1&PC2] and one surgical case [SC3]. The summary for the first case [PC1] was done using an unstructured format, while the second case [PC2] was done with both unstructured PC2a and structured PC2b format. The Surgical case [SC3] was done using only the structured format. The discrete pieces of important information in each case were quantified and scored by trained assessors. PC1and SC3 had a total of 16 points each while PC2 had a total of 24 points. Result: The pre-exposed SOG students scored significantly higher than none-exposed SPG students in PC1 and SC3;