Cyclosporine -induced Kaposi Sarcoma; a Case Report of an Adolescent Male with Steroid-resistant Nephrotic Syndrome

Although there are many reported cases of immunosuppressive-induced Kaposi sarcoma in renal transplant patients on immunosuppressive therapy, a similar report of Kaposi sarcoma among steroid-resistant nephrotic syndrome (SRNS) patients on immunosuppressive therapy is rare.This is a report of a 12-year-old Nigerian adolescent male with SRNS who developed cutaneous Kaposi sarcoma following a prolong use of cyclosporine A. This case should serve as a reminder for the possibility of malignancy development, especially Kaposi sarcoma, when SRNS patients receive cyclosporine as a steroid-sparing immunosuppressive therapy.Keywords: Steroid resistant nephrotic syndrome; cyclosporine A; Immunosuppression; Kaposi Sarcoma

Exposure to benzene, toluene, ethylbenzene, and xylene (BTEX) at Nigeria's petrol stations: a review of current status, challenges and future directions

Introduction: In Nigeria, because of increasing population, urbanization, industrialization, and auto-mobilization, petrol is the most everyday non-edible commodity, and it is the leading petroleum product traded at the proliferating Nigeria's petrol stations (NPSs). However, because of inadequate occupational health and safety (OHS) regulatory measures, working at NPSs exposes petrol station workers (PSWs) to a large amount of hazardous benzene, toluene, ethylbenzene, and xylene (BTEX) compounds. Methods: Studies on BTEX exposures among Nigerian PSWs are scarce. Thus, constraints in quantifying the health risks of BTEX limit stakeholders' ability to design practical risk assessment and risk control strategies. This paper reviews studies on the OHS of Nigerian PSWs at the NPSs. Results: Although knowledge, attitude, and practices on OHS in NPSs vary from one Nigeria's study setting to another, generally, safety practices, awareness about hazards and personal protective equipment (PPE), and the use of PPE among PSWs fell below expectations. Additionally, air quality at NPSs was poor, with a high content of BTEX and levels of carbon monoxide, hydrogen sulfide, particulate matter, and formaldehyde higher than the World Health Organization guideline limits. Discussion: Currently, regulatory bodies' effectiveness and accountability in safeguarding OHS at NPSs leave much to be desired. Understanding the OHS of NPSs would inform future initiatives, policies, and regulations that would promote the health and safety of workers at NPSs. However, further studies need to be conducted to describe the vulnerability of PSWs and other Nigerians who are occupationally exposed to BTEX pollution. More importantly, controlling air pollution from hazardous air pollutants like BTEX is an essential component of OHS and integral to attaining the Sustainable Development Goals (SDG) 3, 7, and 11

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

The survival of a child with severe volume depletion at the emergency department depends on the competency of the first responder to recognize and promptly treat hypovolemic shock. Although the basic principles on fluid and electrolytes therapy have been investigated for decades, the topic remains a challenge, as consensus on clinical management protocol is difficult to reach, and more adverse events are reported from fluid administration than for any other drug. While the old principles proposed by Holliday and Segar, and Finberg have stood the test of time, recent systematic reviews and meta-analyses have highlighted the risk of hyponatraemia, and hyponatraemic encephalopathy in some children treated with hypotonic fluids. In the midst of conflicting literature on fluid and electrolytes therapy, it would appear that isotonic fluids are best suitable for the correction of hypotonic, isonatraemic, and hypernatraemic dehydration. Although oral rehydration therapy is adequate to correct mild to moderate isonatraemic dehydration, parenteral fluid therapy is safer for the child with severe dehydration and those with changes in serum sodium. The article reviews the pathophysiology of water and sodium metabolism and, it uses the clinical case examples to illustrate the bed-side approach to the management of three different types of dehydration using a pre-mixed isotonic fluid solution (with 20 or 40 mmol/L of potassium chloride added depending on the absence or presence of hypokalemia, respectively). When 3% sodium chloride is unavailable to treat hyponatraemic encephalopathy, 0.9% sodium chloride becomes inevitable, albeit, a closer monitoring of serum sodium is required. The importance of a keen and regular clinical and laboratory monitoring of a child being rehydrated is emphasized. The article would be valuable to clinicians in less-developed countries, who must use pre-mixed fluids, and who often cannot get some suitable rehydrating solutions

Short-Term Outcomes of Pediatric Renal Transplantation in Nigeria; A Single-Center Experience: Pediatric renal transplantation in Nigeria

Background and Aim: Renal transplantation (RT) is the preferred treatment modality for children with end-stage kidney disease (ESKD). Unfortunately, RT remains inaccessible for children with ESKD in resource-constrained countries. This case-series describes a short-term follow-up of RT in three children in the Zenith Medical and Kidney Centre (ZMKC), Abuja, Nigeria.  Methods: The immediate allograft function (IAF), allograft functions and recipients’ survival at 6-24 months of follow-up of three pediatric ESKD patients from January 2018 to January 2020 were described. Allograft functions were assessed using serum creatinine and Doppler ultrasound scan. RT involved the use of basiliximab and thymoglobulin for induction therapy and oral prednisolone, tacrolimus and mycophenolate mofetil for maintenance immunosuppressive therapy.  Results: Recipients including two males and one female were 9-17 years (mean age: 12 years). Primary steroid-resistant focal segmental glomerulosclerosis nephrotic syndrome, congenital posterior urethral stricture and lupus nephritis were the causes of ESKD in recipients seen over 24 months, 6 months, and 6 months, respectively. The female recipient had lupus nephritis. The IAF was excellent in all the cases. All the three children are alive with good allograft functions at the end of their respective follow-up period.  Conclusion: This case-series showed that a successful pediatric RT program is feasible in a resource-constrained setting like Nigeria

Healthful School Environment in Primary Schools: A Cross-Sectional Study of Gwagwalada Area Council, Federal Capital Territory, Nigeria

Background: Children spend long hours of the daytime in schools where they are exposed to the various components of the school environment which may affect their health status. There is, therefore, a need to constantly evaluate the status of the school environment. This study sought to assess the school environment in primary schools in Gwagwalada Area Council in the Nigerian Federal Capital. Materials and Methods: A descriptive cross-sectional study was carried out among 146 public and private primary schools using the school environment component of the school health programme evaluation scale. The key variables in the evaluation scale included the methods of sewage and refuse disposals, infrastructural features of the classrooms, sitting comfort for pupils and teachers, health hazards and safety measures in the schools, healthful living in the schools as well as evidence of maintenance of the school environment. Results: A borehole was the source of water supply in 76(52.1%) schools. Of the 118(80.8%) schools with water closet toilets, 103(97.3%) were private while 15(37.5%) were public schools. In 127(87%) schools, the refuse disposal method was open dumping/ burning. Ventilation was adequate in 38(95%) public and 55(51.9%) private schools (p< 0.001). School fence was present in 102 (69.9%) schools. Overall, only 6 (5.7%) out of  the 106 private schools scored up to the acceptable minimum score of 57; no public school attained such a score (Fischer’s exact 2.361, p-value =  0.124). Conclusion: The environments of primary schools in Gwagwalada Area Council, lack the basic requirement to make them healthful. A mechanism should be put in place to ensure compliance with a standard environment