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BackgroundEnumerating the relationship between cardiac structures, function and chamber sizes in children with sickle cell anemia would help in delineating some cardiovascular abnormalities which will aid the Pediatric cardiologist and the cardiac surgeons in a number of decision-making situations.ObjectivesThe objectives of this study are to assess the dimension of cardiac structures and left ventricular function in children with sickle cell anemia in steady state and controls using echocardiography.MethodsA cross-sectional prospective study that assessed cardiac structures and left ventricular function among fifty-one children with sickle cell anemia (HBSS) and compared with fifty children with HB AA type serving as controls.ResultsA significant high proportion of children with sickle cell anemia had abnormal Valvar dimension and left ventricular function above two standard deviations (2-SD) from the mean of the standard population compared to the control group, showing a statistically significant difference (χ2 = 10.42, p= 0.001). All the mean annular valves diameter, left ventricular internal dimension in systole and diastole, inter-sinus distance diameter and sinu-tubular junction diameter are higher in children with sickle cell anemia than controls and this is statistically significant. (p

Background: Double Inlet Left Ventricle (DILV) with transposition of the great vessels is rare in children with congenital heart disease. We present two cases seen at a paediatric echocardiography centre. Baby ND is a 28-day old female who presented with respiratory distress and cyanosis from the first day of life. Echocardiography showed a double inlet left ventricle and mal-posed great vessels. MB is a seven-month-old female who presented with breathlessness and cyanosis from the first day of life. Examination showed a soft pan-systolic murmur of grade 2 variety at the mid sternal boarder. ECG showed left ventricular dominance and abnormal T changes. Echocardiography revealed a double inlet left ventricle and mal-posed great vessels. Conclusion: Double inlet left ventricle and mal-posed great vessels is a rare complex cardiac anomaly of univentricular physiology. A high index of suspicion (especially if the new born presents with first day history of cyanosis and breathlessness) is necessary for quick referral and surgical intervention.

Introduction Patent ductus arteriosus (PDA) is a common acyanotic heart disease that presents with variable symptoms. Objectives This study is therefore aimed at determining the relationship between gender, age, and size of PDA and pulmonary hypertension. This study also seeks to determine the prevalence of elevated pulmonary artery systolic pressure in children with PDA. Patients and methods A descriptive study of children with patent ductus arteriosus was carried out from 2016 to 2020 in three institutions. The data were analysed with the IBM SPSS statistics for windows, version 20 (IBM Corp, Chicago) Result The mean ductal size was 3.78 (2.39) mm, with a minimum of 1.0 mm and a maximum size of 10.0 mm. The mean ductal size for males, 4.02 (2.53) mm was comparable with that of the females, 3.61 (2.28) mm (Student T-test = 0.8, 0.4). The mean pulmonary artery systolic pressure (PASP) of the patients was 43.36 (24.46) mmHg. Also the mean PASP was comparable among the males and the females, 48.37 (26.69) mmHg versus 39.63 (22.16) mmHg (Student T-test = 1.81, p = 0.07). There was no correlation between age and PASP (correlation coefficient = 0.009, p = 0.92). Sixty point two percent (60.2%) (62/103) of children with PDA had pulmonary hypertension. The proportion of males with pulmonary hypertension, 48.39% (30/62) was comparable with that of the females, 51.61% (32/62) (Chi2 = 2.05, p = 0.15) and females are 1.8 times more likely to have pulmonary hypertension as males (odds ratio 1.81, 95% CI 0.8–4.1). There was a positive correlation between ductal size and PASP (Pearson correlation coefficient = 0.26, p value = 0.007). Those with moderate and large sized duct tend to have moderate and severe pulmonary hypertension respectively and this is statistically significant. Chi2 = 17.85, p = 0.007 Conclusion The prevalence of pulmonary hypertension in children with PDA is 60.2%. Moderate and large size duct presents with moderate and severe pulmonary hypertension respectively. Females are 1.8 times more likely to have pulmonary hypertension than the males.

Background: Atrial septal defects are common congenital heart defects which could be discovered incidentally during cardiac screening of a child in heart failure. The aim of this study was to determine the predictors of heart failure in children with ostium secundum Atrial Septal Defects (os-sec ASD) and other associated structural lesions. Methods: Seventy-five children with os-sec ASD seen in two tertiary centres in Southern Nigeria were recruited prospectively. Details of age, gender, anthropometric parameters and echocardiographic findings were entered into a proforma. The sizes of the ASDs were categorized into 3 groups; small size= 0.05). There was however a significant association between the presence of heart failure and other structural defects co-existing with ASD (p = 0.038) and Large sized os-sec ASD of greater than 10mm (p = 0.0001) in those with isolated os-sec ASD. Conclusion: Children with ostium secundum Atrial septal defects could present with heart failure, which is more likely if the defect is >10mm or associated with other structural heart lesions.

OBJECTIVES The objective of this study is to document and compare plasma electrolytes of asphyxiated newborns of different degree within 48 hours of life. STUDY DISIGN A comparative cross-sectional study was conducted in the newborn special care unit at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Sodium, potassium, bicarbonate and ionized calcium levels were estimated in the plasma samples of neonates with perinatal asphyxia of different degree and healthy newborns (control group) within 48 hours of birth. MAIN OUTCOME MEASURES The plasma sodium, potassium, bicarbonate and ionized calcium levels were estimated in both, the study subjects and controls. RESULTS Mean plasma sodium level was significantly lower (134.93±5.24 mmol/l vs 141.90±3.36 mmol/l; P

Background & Objectives: Estimation of fetal maturity is common in obstetric practice especially when the women do not keep accurate menstrual records. An accurate establishment of expected date of delivery is fundamental to the management of both high risk and normal pregnancies. The objective of this study was to determine the placental diameter (PD), placental thickness (PT) and to establish a correlation between PD, PT and gestational age. Methods: This is an observational cross-sectional study that examines by means of ultrasonography the correlation between placental diameter and thickness with gestational age in Enugu, South East, Nigeria. Results: A total of 400 healthy subjects were recruited in 3rd trimester of pregnancy having fulfilled the inclusion criteria. PD and PT in this study did not correlate with parity. There is a linear increase of gestational age and placental thickness and diameter. These increases heighten between 38th week gestation and 40 weeks’ gestation. 205.0±1.4, 43.00±0.0 to 215.0±1.4, 46.00±2.8 respectively. Conclusion: Placental thickness and Placental diameter can be used to predict gestational age. It is therefore advised to use PT & PD in ultrasound obstetric assessment especially when Last menstrual period (LMP) is not clear. doi: https://doi.org/10.12669/pjms.36.5.1938 How to cite this:Njeze NR, Ogbochukwu JO, Chinawa JM. Correlation of ultrasound placental diameter & thickness with gestational age. Pak J Med Sci. 2020;36(5):1058-1062. doi: https://doi.org/10.12669/pjms.36.5.1938 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction: Atrial septal defect (ASD) is a common congenital heart disease in children that uncommonly presents with pulmonary hypertension. Much is not known about the exact predictor of PAH in children with ASD. Objectives: This study aimed to determine the predictors of pulmonary hypertension in children with ASD. Patients and Methods: This was a descriptive analysis of children with ASD carried out in three different institutions over a five-year period. Data entry and analysis were done using IBM Statistical Package for Social Sciences (SPSS) statistical software, version 25. Results: The majority of the participants, 52.2%, had pulmonary hypertension and 62.5% of them occurred as mild pulmonary hypertension. There was a very weak positive correlation between pulmonary hypertension and the size of atrial septal defect, increases in size of atrial septal defect correlate with increases in pulmonary hypertension and this was found not to be statistically significant (n = 67, r = 0.193, p = 0.118). There was a positive correlation between the size of atrial septal defect and the age of participants in months, increases in age correlate with increases in size of atrial septal defect and this was found to be statistically significant (n = 67, r = 0.357, p = 0.003). The highest proportion of respondents who had pulmonary hypertension, 64.7%, was seen among children less than 1 year old while the least proportion, 27.3%, was within 1–5 years, and the difference in proportions was found to be statistically significant (χ2 = 8.187, p = 0.017). Conclusion: Pulmonary hypertension in children with ASD occur usually in the mild form. Age is the only strong predictor of PAH in children with isolated ASD.&nbsp

Objectives: The main objective is to showcase the overall pattern and distribution of cardiac diseases diagnosed by echocardiography and to highlight the difficulties encountered in delivering a Pediatric Cardiology/Cardiac Service at University of Nigeria Teaching Hospital. Materials and Methods: There were 308 children seen from July 2011 to June 2016. Their echo reports and case notes were retrieved and analyzed using SPSS version 20 (Chicago). Results: Their age range was from 3 days to 18 years mean (6.5 ± 4.2 years). One hundred and seventy-five (57.0%) were male and 133 (43.0%) were female with male: female ratio of 1.3:1. Of these, 211 had structural heart disease with 154 being congenital heart disease (CHD) and 57 were acquired heart disease, giving the prevalence of 0.44% and 0.16%, respectively. Isolated ventricular septal defect was highest acyanotic CHD with 44.1%, while tetralogy of Fallot was highest with 14.3% in cyanotic group. Some rare anomalies were also seen; one case of left ventricular noncompaction syndrome, Eisenmenger's syndrome, and Ebstein's anomaly representing 0.6%, respectively. The outcome was satisfactory with 35.5% receiving surgery with 7.7% mortality. The cost of procedures and dearth of interventional equipment were some of the challenges encountered. Conclusion: Although there exists low prevalence of echo diagnosed cardiac disease, a good number of them could not get surgical intervention due to cost.

Background: Pregnancy losses (PLs) are usually a source of pain and psychological stress to the expectant couples. The association between ABO blood groups and some thrombogenic markers with PL among Nigerian women is mostly unknown. Aim: This study investigates the association between ABO blood group, deficiencies of protein C (PC), and protein S (PS) and PL. Patients and Methods: A cross‑sectional study involving 170 pregnant women grouped into two, those with or without a history of clinically‑ or ultrasonographically recognizable PL. ABO blood groups using the tile method, plasma concentrations of free protein S (fPS) antigen, protein C antigen (PCAg) by the enzyme‑linked immunosorbent assay‑based method, and PC activity (PCAc) by PROTAC method was determined.Results: There was no difference in mean values between the two groups for PCAg, PCAc, FPS, and blood group (P > 0.05). The chances of PL were; non‑O blood group (AOR 1.29; 95% CI 0.65‑‑2.54), deficient PCAg (AOR 1.75; 95% CI 0.87‑‑3.54), and deficient PCAc (AOR 1.05;95%CI 0.25‑‑4.13). There was a very poor correlation of miscarriage with FPS (rho 0.04), PCAg (rho 0.09), and PCAc (rho = 0.05).Conclusion: There was no significant association between PLs and ABO blood group phenotypes, PCAg, PCAc, fPS.Key words: Free protein S; Nigerian women; pregnancy loss; protein C antigen; thrombogenic markers.

The burdenofchildren with cardiovascular disease is on a rising trend. These rising trends are enhanced by the development of new technology in the diagnosis of cardiac lesions.This article is aimed at documenting the current trends in the occurrence of cardiac disease among children attending tertiary hospitals in Sothern Nigeria.This is a descriptive study which involved four hundred and thirty-nine (439) children who had cardiac disease confirmed with echocardiography from four health institutions, namely; Niger Delta University, Bayelsa, Nigeria; University of Nigeria Teaching Hospital, Enugu, Nigeria; Triple care hospital, Enugu, Nigeria and; Blessed children hospital, Enugu, Nigeria over a -five -year period from July 2016- July 2020.The prevalence of congenital heart disease was 83.6% and only 16.4% being acquired heart disease. Many of the children with congenital cardiac defects have associated features of Down syndrome (trisomy 21) and the frequency was related to the type of defect; 6.4% (28/439). These features of Down syndrome are seen mainly in children with AV canal defect 33.3% (14/42) and least in children with TOF 2.0% (1/51). Zero-point two nine percent (1/439) had dextro-cardia and 0.2% (1/340) had VACTERAL (ano-rectal malformation) association, 0.2 % (1/439) had cleft lip, 1.8% (8/439) had dysmorphism other than down syndrome. Five 62.5% (5/8) of such dysmorphic features were associated with VSD.The majority of the children with cardiac disease were from the middle class 63.6% followed by the higher class 21.9% and the least is from the lower class 14.5%. The prevalence values of heart disease were quite higher than that documented in previous studiesThe is a rising prevalence of congenital heart disease (83.6%) and acquired heart disease (16.4%) among children with cardiac disease in southern Nigeria. Extracardiac anomalies were also associated with these trends.

Background: Malnutrition poses a great burden to children in the tropics. However, this seems to be accentuated in children with congenital heart disease.Objectives: The present study is therefore aimed at determining the nutritional status of children with congenital heart disease and to compare them with those without congenital heart disease.Methods: This is a cross-sectional study, where congenital heart disease was diagnosed by means of echocardiograph. Anthro software was used to calculate Z scores for weight for age (WAZ), height for age (HAZ), and weight for height (WHZ). Body mass index (BMI) was calculated by the formula BMI = Weight (Kg)/height (M2).Results: The body mass index-for-age z-score (BAZ) and height/length-for-age z-score (HAZ) were calculated for both subjects and controls to determine their nutritional status. It was observed that 38.5% (112/291) of the subjects were wasted (BAZ < −2SD) compared to 6.25% (16/256) of the controls and the difference was statistically significant (χ2 = 81.2, p < 0.001). Stunting (height/length-for-age z-score < −2SD) was also observed in a greater proportion of subjects than controls as 37.8% (107/291) of subjects were stunted compared with 7.0% (18/256) of the controls (χ2 = 69.9, p < 0.001). The under-five subjects had more cases of malnutrition than the controls of same age group as illustrated in Table 6. Whereas 42.9% (96/224) of the under-five subjects were wasted, only 6.2% (12/192) of the controls were wasted. On the other hand, 4.2% (8/192) of the under-five controls were obese compared to 0.9% (2/224) of the subjects of similar age group.Conclusion: Children with congenital heart disease present with varying degrees of malnutrition that is worse compared with children without congenital heart disease. The impact of malnutrition is worse among children under the age of five. Wasting is more prevalent in children with cyanotic heart disease compared with those with acyanotic congenital heart disease. Overweight and obesity were notable features of malnutrition in children with congenital heart disease, but this is worse in children without congenital heart disease.

To determine the severity and prevalence of pulmonary hypertension and its relationship with age and body mass index (BMI) in healthy children.Observational study.University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, Lagos State University Teaching Hospital, Niger Delta University Teaching Hospital, Bayelsa and Blessed Children Hospital Enugu from January 2010 to December 2019.Four hundred and seventy (470) apparently healthy children aged 1 to 17 years underwent Doppler echocardiographic studies. Their tricuspid regurgitation velocity (TRV) was measured with continuous wave Doppler. Pulmonary artery systolic pressure (PASP) was estimated using the Bernoulli equation. Elevated PASP were determined at PASP ≥35/mmHg. Values were compared against age and BMI.The mean age was 7.9 ± 3.3 years. Four hundred and fifty-nine subjects (97.7%) had normal PASP while 11 (2.3%) had elevated PASP. Those with elevated PASP had a significantly higher mean TRV of 2.7 ± 0.22 cm/s (95% CI; 2.55-2.85) vs TRV of 1.56 ± 0.43cm/s (95% CI; 1.52-1.60) and higher mean PASP of 39.27±4.89 mmHg (95% CI; 35.99-42.56) vs 20.45 ± 5.34 mHg (95% CI; 19.96-20.94) (p=0.001). Though majority of the children had appropriate weight for ages, those with elevated PASP had a significantly greater weight than those with normal PASP (p0.001). There was a weak positive correlation of PASP with age (r=0.16) and BMI in normal weight (r=0.08). Obese children had a negative correlation value(r=-0.13). A weak negative correlation of PASP with BMI was seen in underweight (r=-0.17 and overweight (r=-0.73) children (p0.05).The mean pulmonary artery systolic pressure in the studied apparently healthy Nigerian children was 20.45± 5.34/ mmHg. The frequency of elevated PASP was 2.3%, commoner in children with higher BMI. Age and body mass index are not optimal predictors of PASP. Key Words: Pulmonary artery systolic pressure, Children, Pulmonary hypertension, Echocardiography.

Background Sickle cell anaemia (SCA) is characterized by attendant ischemia-reperfusion injury especially to the heart. Methods The aim of this work is to compare the right ventricular function of children with SCA in steady state (subjects) with those with haemoglobin AA genotype (controls), using echocardiography. It is a cross-sectional study, which echocardiographic measurements to assess right ventricular function among children with SCA and their controls. Results The mean trans annular plane systolic excursion (TAPSE) in subjects, 28.24 ± 5.23 (Z score: 0.258 ± 1.10) was higher than that in control, 25.82 ± 3.59 (Z score: - 0.263 ± 0.80), and the difference in mean was statistically significant, (t = 2.703, p = 0.008). Significantly higher proportion of subjects with sickle cell anaemia had right ventricular dysfunction (Abnormal TAPSE), 25 (50.0%) when compared with those in control, 11 (22.0%), {χ2 = 8.5, p = 0.0035}. A higher proportion of subjects with sickle cell anaemia (25.5%) had Pulmonary hypertension (RVP) when compared with control (2.0%) and the difference in proportions was found to be statistically significant, (χ2 = 11.668, p = 0.001). The prevalence of right ventricular diastolic dysfunction in subjects was 9.8% while control was 0%. Conclusion Children with sickle cell anaemia present with right ventricular dysfunction. Prevalence of right ventricular systolic and diastolic dysfunction were higher in subjects. More of the subjects in this study (25.5%) had pulmonary hypertension.

Adolescence is an important developmental period of childhood. Good health and adequate nutrition consisting major food constituents and trace elements like zinc are fundamental for optimal sexual maturation. To determine the relationship between zinc levels and pattern of breast and pubic hair development, as well as menarcheal age of female SCA children aged 6-18 years and their matched controls with hemoglobin genotype AA. Cross sectional, case-control study. Information on biodata, age at menarche, medical and drug history as well as 24-hour dietary recall was documented using interviewer administered questionnaire. Sexual maturation was assessed using Tanner staging and zinc levels determined using Atomic absorption spectrophotometer. Eighty-one subjects were compared with 81 controls. There was significant delay in the mean age of attainment of various Tanner stages of breast and pubic hair in the subjects. Mean age of 14.81 ± 1.07 years at menarche in subjects was significantly higher than 12.62 ± 1.18 years in controls (p = 0.001). Serum zinc of 58.01 ± 10.58 µg/dl in subjects was significantly lower than 68.37 ± 8.67 µg/dl in controls (p = 0.001). Serum zinc levels were found to have a significant positive relationship with stages of sexual maturation and mean age at menarche. Reduced serum zinc in children with SCA was associated with delayed sexual maturation.

Background Adolescents do present with somatization disorder which is often neglected by pediatricians. This could have serious consequences if not curbed early. Objectives This study is aimed at determining the pattern and types of Somatization disorder among adolescents attending secondary schools in south east Nigeria. Methods Somatization disorder was investigated among 485 adolescents from mixed schools using a stratified random sampling of adolescents from four secondary schools in southeast Nigeria. The Enugu somatization scale was used to evaluate for presence of somatization in the participants. Statistical analysis was with statistical package for social sciences (SPPS) version 19 (Chicago IL). Results A total of 485 adolescents aged 10–19 years were included in this study. The mean age of the respondents was 16.36 with standard deviation (SD) of 3.14 years. Two hundred and fifty-one (51.8%) had head features, 262 (54.0%) had body features, 303 (62.5%) had either head or body features while 210 (43.3%) had both head and body features. One hundred and thirty-four males (51.3%) compared to 117 females (52.2%) reported symptoms consistent with head symptoms (p = 0.038). One hundred and eleven males (42.5%) compared to 99 females (44.2) reported symptoms related to the head and body (p = 0.137) while 135 males (51.7%) compared to 127 females (56.7%) reported symptoms related to the body (p = 0.925). There were significant associations of age in categories with head, body, either head or body as well as both head and body features (all p value

Due to the enormous amount spent on histology of adenoid and tonsillar samples from children with adeno-tonsillectomy with no confirmed result of malignancy, it has become expedient to reconsider sending such tissues for histologyThe objective of this study was to determine the necessity of sending tissues of adenoid and tonsils for histology by means of ascertaining the prevalence of malignancy among children with adeno-tonsillectomy. This was a retrospective study done in three private hospitals that provide care for children in Enugu. Data was obtained from the medical records of 72 patients who had undergone tonsillectomy and/or adenoidectomy from September 2011 to May 2018. All the surgical cases done had their samples sent immediately for histology. A total of 72 adeno-tonsillar tissues were taken for histology of which all showed lymphoid hyperplasia with none showing any form of malignancy. Age group ranged from 6 months-18 years with 57 males and 15 females. Histology of the adeno-tonsillar tissue specimen was done among all the children with each costing 9000 Naira (26 US dollars). There were 3 tonsillectomies, 1 adenectomy and 68 adeno-tonsillectomies done. Indications for surgery were mainly upper airway obstruction for 69 cases and recurrent tonsillectomy for 3 cases. Histology revealed lymphoid hyperplasia for all cases. None of the patients in our study had histologic evidence of malignancy. Routine histopathologic examination in adeno-tonsillectomy specimens among children may be dispensable as it showed a negative cost-benefit ratio.

Introduction: Pyrexia of unknown origin (PUO) still remains a challenge in paediatric practice. Appropriate history, physical examination, and exhaustive investigations are crucial in managing cases of PUO. Case Presentation: UU, was a 1-year-old female, who was seen at our facility on 16 January 2020, with a 4-day history of fever. Fever was high grade and intermittent. Examination revealed pyrexia of 38°c and no other remarkable findings. Lassa fever virus serology, hepatitis B surface antigen, hepatitis C surface antigen, C-reactive protein, erythrocyte sedimentation rate, full blood count, blood culture (with Bactec), malarial parasite, Mantoux, and CXR were all requested. Results of all these investigations were negative. Echocardiography done showed a 0.23 cm² vegetation at the septal leaflet of the tricuspid valve. A diagnosis of infective endocarditis was made and intravenous vancomycin, ceftriaxone, and metronidazole were commenced. Weekly urinalysis and serum electrolyte urea and creatinine monitoring were documented. After a 3-week course of intravenous antibiotics, patient still had fever with temperature higher than 38°c. A diagnosis of PUO was made and a follow-up plan was to do a bone marrow aspiration to rule out leukaemia and serology to rule out connective tissue disease. Conclusion: In managing a child with PUO, detailed history, appropriate physical examination and exhaustive investigations should be done. This is crucial in that even if diagnosis is not reached, several causes of PUO could have been ruled out.

Background: The exact incidence of vascular injuries in Nigeria as a country especially south-east zone of Nigeria is unknown on account of under reporting and uncoordinated management of victims. Aim: To determine the pattern and outcome of common civilian vascular injuries managed in a teaching hospital in the south-east zone of Nigeria. Method: This is a retrospective study from January, 2007 to December, 2013. All case records of common civilian vascular injuries presenting at the accident center and those referred to the clinics as well as operation register and data banks of managing surgeons, were retrieved and analysed. Results: The age range of 12 - 75 years was rec-orded for the 26 patients. In this spectrum, age range of 21 - 30 years (19.2%) was the highest while the age range, 61 - 70 years (0%) was the lowest. One female (3.9%) and twenty five males (96.1%) were recorded, giving a female to male ratio of 1:25. In the upper extremity, brachial artery 6 (23.1%) was the most involved vessel while in the lower extremity, the most involved was the femoral artery 9 (34.6%). The patterns of presentation were isolated bleeding 10 (38%), arterivenous fistula 1 (3.5%) and pseudoaneurysm 8 (30%). 23 (88%) had good outcome. Conclusion: The incidence is about 4 cases per year. 23 (88%) had good outcome. The shortcoming of lattending physicians was because they were not conversant with hard and soft signs of vascular injuries with attendant limb loss and death of one of the victims. This short coming can be averted by training and retraining of doctors.

Background: Children with tetralogy of Fallot (TOF) present with various clinical and morphological attributes which aid in screening for primary, stage, or elective repair. Objectives: This study is aimed at determining the morphological and clinical indices that predict mode of repair among children with TOF in our locale. Materials and Methods: This was a retrospective echocardiographic review of children with TOF carried out in three different institutions over a 5-year period. Results: The mean age of presentation was 5.0 ± 5.3 years. The nutritional status revealed that 18.2% (8/44) were wasted, 25.0% had severe wasting, while 2.3% were obese. Stunting was observed in 4.5% of the patients and severe stunting in 29.5%. The mean pulmonary valve (PV) annulus of 43 of the patients assessed was 11.0 ± 5.5 mm (mean z-score: −2.03 ± 1.95). Five of them (11.6%) had values one standard deviation (1SD) below the mean of the standard population, 32.6% had values 2SD below the mean, and 27.9% had values 3SD below the mean. Of the 33 children whose right pulmonary artery (RPA) z-scores were assessed, 24.2%, 12.1%, and 12.1%, respectively, had RPA z-scores of 1SD, 2SD, and 3SD below the mean of the standard population, while 17.5% and 7.5% of 40 children whose left pulmonary arteries were assessed had z-scores of 1SD and 2SD below the standard mean, respectively. Right aortic arch and major aortopulmonary collateral arteries (MAPCAs) were seen in 8.1% and 30.5% of the children, respectively. 30.5% of the children with TOF had MAPCAs. Features of Down syndrome were observed in 4.8% (3/62) of the patients. Conclusion: A large proportion of patients present with various degrees of malnutrition with a significant low z-score for PV annulus and branch pulmonary artery diameters. The presence of right aortic arch and MAPCAs was observed in the patients. The increased rate of protein–energy malnutrition, small PV annulus, MAPCAs and presence of right aortic arch, etc., are screening tools that may assist the surgeon in selecting the various surgical options and timing in the approach of children with TOF in this locale.

Background: Suicidal right ventricle (SRV) is defined as a dynamic right ventricular outflow obstruction with a clinical hemodynamic significance. This is a rare and dangerous event in cardiology practice. Objectives: This systematic review is aimed at ascertaining different scenarios that can precipitate SRV in cardiology practice. Methods: Data for the systematic review was retrieved from Cochrane database, Google Scholar, PubMed review, Institute for Scientific Information “Web of Science,” and Medline. The search engine yielded 164 items on SRV. 148 articles were excluded thereafter because they did not meet the criteria for SRV with 16 articles left. The remaining 16 articles fulfilled the inclusion criteria and were further assessed for eligibility and 9 were excluded further, because they did not strictly fulfill the criteria for SRV. Finally, 7 research articles were included in the systematic review and quantitative synthesis. Results: Valvar pulmonary stenosis is the most common diagnosis warranting balloon pulmonary valvotomy (BPV). There is no gender predilection for SRV; 7 males and 6 females. The age range is 5–28 years with a mean of 19.8 ± 6.6 at 95 CI. The most common etiology of SRV was caused by a prior supra systemic right ventricle. In one study, 108 patients had balloon pulmonary valvuloplasty, but only 0.92% (1/108) of the patients who was >5 years developed SRV. Furthermore, out of six patients in another study who had BPV, only one (16.6%) had SRV. The commonest clinical presentation of SRV is cardiovascular collapse, the SRV was relieved in some cases by removing the offending agent (catheter) while some were treated with volume expanders and Beta-blockers. Conclusion: This review has shown that SRV is a rare abnormality in children and adults. It normally occurs during balloon valvotomy or surgical valvotomy.

Objectives: The study is aimed at determining that errors in assigning genotypes to intending couples do exist; and the impact of these errors on parents. Methods: The study was conducted at the children clinics in Enugu and Abakiliki, south east Nigeria. It is a cross-sectional retrospective study in which a review of the records of all the children attending 2 private clinics in Enugu and Abakaliki of Enugu and Ebonyi states respectively, over a 3-year period was done. Results: A total of 6006 children attended the children clinics over the study period. Twenty three (23) of them had sickle cell anaemia. Out of the 23 cases 10 (43.5%) were males and 13 (56.5%) were females. Male to female ratio was 1:1.3. The commonest features were abdominal and leg pains, involving 20 (87%) and 21 (91.3 %) respectively. Among the 23 parents that had their genotypes repeated, 9 males had different genotypes from what they had during courtship or before marriage. The genotypes of all the females that could recall their genotypes before marriage or during courtship were the same after a repeat test. Conclusions: There exist errors in assigning genotypes to parents which at the end made them have children with sickle cell anemia, unwittingly, with serious consequences bordering on strained relationship between the parents with the children bearing the brunt.

Objectives: The objectives of the study were to determine the prevalence and socio-economic determinants of autism among children attending primary and secondary schools in South East, Nigeria. Methods: This was a cross-sectional study that assessed the prevalence and socio-economic pattern of childhood autism among children attending primary and secondary schools in Enugu and Ebonyi states, South East Nigeria. The questionnaire was adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000). The study was carried out between June and October, 2014. The schools were selected by listing all the mixed schools in the urban and semi- urban areas by simple random sampling. Results: A total of 721 subjects completed the questionnaire. The age of respondents ranged between 3 and 18 years, with mean age of 12.71 and standard deviation of 3.03 years. Twenty one children fulfilled the criteria for autism giving a prevalence of 2.9%. There is a significant association between age in categories (fishers exact test, p = 0.013) and social class (p=0.033). Conclusion: The prevalence of autism was 2.9%; and the socio-economic characteristics of childhood autism in South East Nigeria are similar to those in other parts of the world. Keywords: Childhood autism; primary and secondary schools; Nigeria

Background: The heart with its intrinsic and indispensable function is a vital organ in the human body. Surgical management of diseases affecting it was initially thought to be incompatible with life. Surgeons who desired the respect of their colleagues were barred from operating on the heart, on the ground that human knowledge is very limited in that area. This notion was however changed in 1893 when laceration in the left ventricle was successfully repaired at Chicago Provident Hospital in USA. Three years later, the same feat was successfully reproduced several times in Frankfurt Germany. Also by 1938 in Boston Children Hospital, Massachusetts, USA, Robert Gross successfully interrupted a PDA in a 7-yearold child. This was followed by successful repair of coarctation of the aorta and the famous blue baby operation, all in 1944, thus unequivocally, proving that successful operation on the heart was tenable in the western world. On the contrary, in the early 1940s and 1950s, cardiac diseases requiring surgery for whole or part of their management were thought to be rare in Nigeria in particular and Africa in general. The establishment of cardiac registry at UCH, Ibadan in western Nigeria, in 1964 revealed all types of cardiac diseases including those requiring surgical intervention. Today, many cardiac diseases are treated by surgery in NCTCE, UNTH, Enugu and other centers in Nigeria. The western world is abandoning the perfected conventional open access cardiac surgery for minimal invasive cardiac surgery with comparable results vis-a-vis efficacy. Aim/Objective: To determine the scope of cardiac surgery at the National Cardiothoracic Center of Excellence and compare same with the continental and international standard. Materials and method: This is a retrospective study. From March, 2013 to February, 2016, (3 years) all case records of those that underwent cardiac operations at NCTCE were retrieved and analyzed using simple arithmetic method. Those who were diagnosed but could not be operated on, who either died or referred abroad due to the complexity of their cardiac diseases were excluded from the study. Results: During this period, spanning 3 years, a total of 209 cardiac operations were carried out, about 69.7 cases per year. The age range of the patients that were operated was 1 year to 72 years with a mean of 2.9. Of this number, 128 (61.2%) were males and 81 (38.8%) were females with a ratio of 1.6: 1. Also, open heart procedures constituted about 125 (59.6%), while closed heart procedures were 84 (40.4%). Out of 125 cases of open heart procedures, 79 (63.1%) were for acquired adult heart diseases while 46 (36.9%) were for congenital heart diseases. Mean hospitalization at the intensive care unit was 72 hours while the mean hospital stay was ten days. Mortality was about 25 (12.0%). Conclusion: From the results, NCTCE carried out significant number of cases during the period when compared to previous years. However, the youngest age group was 1 year old, suggesting that those below that age group were referred out. The mean hospital stay is relatively longer, suggesting that complications might have contributed.

Objective: To evaluate the relationship between the occurrence of priapism and important steady-state clinical and laboratory parameters in homozygous sickle cell disease (SCD). Subjects and Methods: Steady-state clinical and laboratory data were obtained from the medical records of 126 male patients seen in the clinic over a 7-year period. Estimated prevalence rates, correlation coefficients and independent t tests were calculated to assess the relationship between priapism and several important clinical and laboratory indices. Patient data on age, haemoglobin concentrations, the frequency of crises per annum, leucocyte counts, platelet counts, serum bilirubin and aspartate transaminase were evaluated. Results: The prevalence of priapism was determined to be 21.4%, and 22.2% of those affected had erectile dysfunction. There was a significant positive correlation between priapism and older age (p = 0.049) and lower leucocyte counts (p = 0.008). There was no significant relationship with other clinical or laboratory indices. Conclusion: About 1 in 4 of all homozygous older SCD patients had priapism, and an approximately similar ratio developed erectile dysfunction; they also had lower steady-state leucocyte counts. Other clinical and laboratory indicators of disease severity in SCD did not positively correlate with the occurrence of priapism, and this may imply an alternative pathogenetic mechanism.

Background. Attention deficit hyperactivity disorder (ADHD) is a neglected illness in a developing country.Objectives. The objectives of this study are to investigate the prevalence and pattern of ADHD among children in a Nigeria.Methods. A structured self-administered questionnaire was used to collect information from the parents of children (and older children) who attended children outpatients’ clinic during the study period. The DSM-IV-TR diagnostic criteria for attention deficit hyperactivity disorder were used.Results. Two hundred and seventy-three (273) out of 282 questionnaires were filled completely, giving a response rate of 96.8%. Nine (9) children fulfilled the stated criteria for ADHD giving a prevalence rate of 3.2%. There is no association between gender and ADHD (P=0.784).Conclusions. The prevalence of ADHD in our setting is 3.2%, which is similar to that obtained elsewhere in the world.

Background Medical students are exposed to stress and this can predispose them to psychological and behavioral consequences. Methods Psychosomatic disorders were investigated among 385 medical students from two teaching hospitals using a stratified random sampling. The Enugu somatization Scale (ESS) was used to evaluate for presence of somatization in the participants. Statistical analysis was done with the Statistical Package for Social Sciences (SPPS) version 19 (Chicago IL). Results A total of 385 medical students with a calculated mean age of 23.55 ± 3.33 years were recruited in this study. The prevalence of psychosomatic disorder was 55 (14.3%) with prevalence among males 33 (14.2%) and among females 22 (14.4%). Based on features, 44 (11.4%) had head features while 30 (7.8%) had body features of psychosomatic disorder respectively. Similar proportion of both males and females (about 14% each) had psychosomatic disorder. There was no statistically significant difference (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\chi^{2}$$\end{document}χ2 = 0.002, p = 0.966). Students aged 24 years and below had similar proportion of psychosomatic disorder 38 (14.3%) with those aged over 24 years 17 (14.2%). The difference was not statistically significant (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\chi^{2}$$\end{document}χ2 = 0.002, p = 0.964). Students from lower social class had lower proportion of psychosomatic disorder (10.6%) when compared to middle (17.2%) and upper (15.2%). The difference was equally not statistically significant (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\chi^{2}$$\end{document}χ2 = 1.759, p = 0.415). Male students had similar likelihood of psychosomatic disorder with females (OR 1.01, 95% CI 0.56−1.82). Those had belong to middle socio-economic class were about 1.2 times (AOR 1.15, 95% CI 0.54−2.45) and lower socio-economic class about 0.6 times (AOR 0.66, 95% CI 0.31−1.37) likely to have psychosomatic disorder than those from upper socio-economic class. Conclusions Psychosomatic disorders constitute an emerging mental health problem among medical students in Nigerian Universities. This can pose a major mental health problem if neglected. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0105-3) contains supplementary material, which is available to authorized users.

Background Psycho-active substance use among adolescents is a national and global problem and its attendant effects on adolescents cannot be overemphasized. The objectives of this study are to determine the prevalence and pattern of psychoactive substance use among adolescents; the substances involved and the extent of the problem in this locale. Methods This is a cross-sectional study that assesses the pattern of psychoactive substance use among secondary school adolescents in Enugu, south East, Nigeria. The study was carried out among adolescents attending six secondary boarding schools in Enugu metropolis of Enugu State of Nigeria. The WHO Student Drug Use Questionnaire was adapted for this study. Data were analyzed using the Statistical Package for Social Sciences program (SPSS), version 17. Chi-square and multivariate regression were used as a test of significance for qualitative variables. A p-value less than 0.05 were accepted as significant for each statistical test. Results Out of 900, a total of 896 respondents, comprising 400 and 82 boys (482) (53.8 %) and 400 and 14 girls (414) (46.2 %) completed the questionnaires. This gave a response rate of 99.6 %. The study revealed that the prevalence of current use for psychoactive substances ranges from 0.4 to 34.9 % while that for life use ranges from 0.8 to 63.5 %. The least being cannabis and the most being kola nuts. Kola nut is the most widely used psychoactive substance both for current use, past year use and the respondents’ life time use. It shows a lifetime prevalence of 63.5 % and a current use prevalence of 34.9 %. More than half of the users of each of the psychoactive substances take it occasionally, using them on 1–5 days in a month. On the other hand, almost one-quarter of the users of each of the substances take it on 20 or more days in a month. Conclusion The study revealed that the prevalence of current use for psychoactive substances ranges from 0.4 to 34.9 % while that for life use ranges from 0.8 to 63.5 %. The least being cannabis and the most being kola nuts. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0615-9) contains supplementary material, which is available to authorized users.

Introduction: Postpartum depression is an uncommon and frequently undocumented issue that impacts negatively on maternal and child health. Methods: The study was carried out among mothers who attended postpartum clinics from two teaching hospitals and three private hospitals all in Enugu metropolis. The instrument employed for data collection was a structured self-administered questionnaire developed from the Edinburgh Postnatal depression Scale. The families were assigned socio-economic classes (SEC) using the recommended method (modified) by Oyedeji. The objectives of this study was therefore aimed to highlight the pattern and prevalence of post-natal depression among mothers in Enugu, south east Nigeria. Results: A total of 214 mothers attending postpartum clinics were recruited in this study. The prevalence of postpartum depression from this study is 22.9%. There are no significant association between socio-demographics of mother and depression, age (p= 0.556), educational level (p= 0.667), occupation (p=0.494), parity (p= 0.823) and mode of delivery (p= 0.760). Conclusion: This study has shown that the prevalence of postpartum depression in Enugu, south east Nigeria is 22.9% which is comparable to that obtained in African continents. We noted no significant associations between socio-demographics of mother, age, educational level, occupation, parity and mode of delivery and depression. Pan African Medical Journal 2016; 23

Attention deficit/hyperactivity disorder (ADHD) is a neuropsychiatric disorder characterized with attention deficits, hyperactivity, or impulsiveness. The preva‐ lence of ADHD varies from country to country and from various cultural and geo‐ graphical zones. The pattern and distribution of ADHD also vary with gender and age. It has also been noted that some factors are associated with ADHD. For in‐ stance, some central nervous system anomalies had been associated with ADHD. Genetic and environmental risk factors have also been implicated. Some conduct and learning disorders have also been associated with ADHD. Of recent, some car‐ diac anomalies and behavioral disorders such as enuresis and encopresis have all been associated with children with ADHD. Conclusion: Attention deficit/hyperactivity disorder (ADHD), a neuropsychiatric disorder, varies in prevalence from one country to another with several associations.

Objectives: To determine the pulmonary function indices of children with sickle cell anemia (SCA) attending the pediatric sickle cell clinic at the University of Nigeria Teaching Hospital, Enugu, south-east Nigeria and to compare these indices with the results obtained from other regions. Methods: A case control study of lung function in children with SCA aged 6-20 years. The study was carried out in the University of Nigeria/University of Nigeria Teaching Hospital, Enugu State, Nigeria between October 2014 and January 2015. Measurements of the peak expiratory flow rate, forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) were evaluated. Results : A total of 80 subjects were recruited into the study, comprising 40 homozygous HbSS (hemoglobin SS) patients and an equal number of controls. Children with SCA had statistically lower values of FEV1 (1.6±0.52), FVC (1.76±0.95), and peak expiratory flow rate (PEFR) (309.00±82.64) when compared with normal hemoglobin genotype FEV1 (12.01±0.53), FVC (2.12±0.54), and PEFR (364.10±87.85). The mean FVC, FEV1/FVC, and PEFR were also higher in the male control group compared with the HbSS male group, but these differences were not statistically significant. Female controls had significantly larger FEV1, FVC, and PEFR values compared with the HbSS females. Conclusion : The lung function indices were significantly lower in children and adolescents with SCA compared with the matched controls with a hemoglobin genotype AA. Saudi Med J 2015; Vol. 36 (8): 928-934 doi: 10.15537/smj.2015.8.11525

Background: Renal impairment is routinely assessed using the estimated glomerular filtration rate (eGFR) and it may be helpful to obtain certain clinical or laboratory markers, which show relationship with glomerular filtration rate (GFR) in sickle cell disease (SCD). Aim : To assess the relationship between important clinical and laboratory parameters in SCD, and the eGFR. Patients and Methods: Steady state clinical and laboratory data were obtained from 228 homozygous SCD patients seen over a 7‑year period. The GFR was estimated using (isotope dilution mass spectrometry) traceable modification of diet in renal disease (MDRD) and Cockroft–Gault methods. The correlation coefficient and independent t‑test were done to assess the level of significance between the eGFR_MDRD and the known indicators of disease severity. Results: The serum alkaline phosphatase (ALP) and serum direct bilirubin levels both showed significant inverse relationship with eGFR_MDRD P = 0.012 and P = 0.24, respectively. The patients’ age, Hb, leukocyte count, platelet count, serum direct bilirubin and aspartate transaminase did not show a significant correlation. The eGFR_MDRD was more discriminatory revealing that 20.3% of the patients had suboptimal GFR. Proteinuria in steady state was observed in 20.3% of the patients. Conclusion: High serum direct bilirubin and ALP are associated with a deteriorating eGFR_MDRD. Other clinical and laboratory indicators of disease severity in SCD do not show the relationship with the GFR. MDRD_GFR estimation seemed to be a more appropriate method of estimating GFR in SCD. Key words : Cockroft–Gault, glomerular filtration rate, modification of diet in renal disease sickle cell

Introduction : The objective of this study was to determine the pattern, clinical profile and surgical intervention in children presenting with adenoids hypertrophy in a private hospital. Methods : The study was conducted at the general pediatric clinic of a private hospital in Enugu, south east Nigeria in collaboration with a missionary hospital with a visiting consultant ENT surgeon. Data collection was done with structured Questionnaire. This questionnaire design contains information on age, sex, address, social class among others. The diagnosis of adenoid hypertrophy was made based on clinical evaluation, confirmed by a lateral radiograph of the neck and postnasal sinuses. Results : A total of 2010 children attended the children outpatient clinic, of these, 26 had adenoid hypertrophy; giving a prevalence of 1.3% .Mean age of diagnosis is 32.6±17.9 months. Cough 19 (73.1%), catarrh 18(69.2%), history of allergy 15(57.7%), fever 13(50.0%), Snorring10 (38.4%), expiratory rhonchi 5(19.2%), and mouth breathing 4(15.4%) occurred mostly among children with adenoids hypertrophy. Ten children were referred for surgery and this was successful, others are being followed up and placed on steroids and bronchodilators. Conclusion : The prevalence of adenoid hypertrophy in this study is 1.3% with male predominance and majority coming from a low social class. Surgical outcome is excellent except one who had bleeding but was arrested subsequently.

We present a rare case of Dandy Walker Syndrome in a child who presents with complaints of frontal headache, neck pain, fever, progressive visual impairment and multiple generalized tonic clonic seizures, inability to stand and urinary incontinence. Given the clinical and neuro-imaging findings, the diagnosis of Dandy Walker Variant was made. Post surgical recovery (Ventriculo peritoneal shunt) was remarkable. Unfortunately he never regained sight. The purpose of presenting this case report is to highlight the distinctive manifestation of Dandy walker syndrome to enhance early diagnosis, prompt intervention and better outcome Keywords : Dandy Walker syndrome; congenital brain malformation; childhood blindness; hydrocephalus

Kawasaki disease (KD) is associated with coronary artery lesion, especially in the form of aneurysm and ectasia. The first case is 1-year, 9-month-old female; the second is a 13-month-old male, the third is a 14-month-old female, and the fourth is a 5-year, 6-month-old male who all satisfied the criteria of KD. Echocardiography done for all the series showed dilatation of the left anterior descending coronary artery measuring 2.15 mm with Z score of 2.53 and focal dilatation of left main coronary artery with maximum diameter of 2.9 mm with Z score of 2.44 for the first case, prominent left coronary artery measuring 2.19 mm with Z score of 1.28 with borderline dilatation of the circumflex coronary artery measuring 2 mm with a Z score of 2.13 for the second case, and left coronary dilatation measuring 3.5 mm with Z score of 3.61 and borderline left coronary artery dilatation measuring 3.5 mm with a Z score of 2.24, respectively, for the last two cases. We documented four cases of KD as much as we know, and all the four cases presented with coronary artery aneurism with a good response to chemotherapy.

Rhabdomyomas are rare tumors in children often associated with tuberous sclerosis. They are usually diagnosed during antenatal period or as an incidental finding. The first case is a 2.5-month-old child who was diagnosed to have rhabdomyomas at gestational age of 24 weeks. Electrocardiogram revealed left axis deviation and multiple premature atrial contractions. Echocardiography showed massive tumor occupying the right ventricular cavity. Tuberous sclerosis was seen on magnetic resonance imaging. He was commenced on everolimus with obvious regression of tumor. The second case is an 8-month-old male who was referred to us for cardiac evaluation. Echocardiography showed two masses of rhabdomyoma. He was also placed on everolimus but was lost to follow-up. Rhabdomyomas are rare tumors of the heart which respond well to chemotherapy.

BACKGROUND It is a documented fact that upper respiratory tract infection (URTI) is more of a viral illness. OBJECTIVES This study aims at documenting the prevalence of the use of unprescribed antibiotics in children aged

Background: Sickle cell anemia (SCA) is a genetic hematological disorder characterized by red blood cells that assume abnormal, rigid, and sickle shape. The musculoskeletal complications of SCA result from vessel occlusion, leading to tissue ischemia and infarction and progressive end organ damage. Aim: The aim of this study was to determine the pattern of musculoskeletal complications among children with SCA admitted at the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla. Subjects and Methods: This is a retrospective study of cases of musculoskeletal complications among SCA patients admitted in UNTH over a 58 month period. Data were analyzed using the SPSS version 20 and GraphPad Prism 5 softwares. Variables analyzed include musculoskeletal complications, age and gender distribution of subjects. Fisherfs exact was used to test for significant association of categorical variables while Mann Whitney U.test was used to compare the means. A P value of less than 0.05 was accepted as significant.Results: There were 300 registered patients in our sickle cell clinic. A total of 78 patients (52 males and 26 females) were admitted between January2007 and October 2012. The median age of the patients was 10 years (range: 9 months to 17 years). 25 of the 78 patients had musculoskeletal complications, giving a prevalence rate of 32.1%. The most common musculoskeletal complication was acute osteomyelitis, diagnosed in 10/78 (12.8%) of the patients. Conclusion: Acute osteomyelitis is the most common musculoskeletal complications in children with SCA attending UNTH Ituku Ozalla.Keywords: Children, Musculoskeletal complications, Sickle cell anemia

Objectives: This study aimed at determining the factors that influence the age at diagnosis of sickle cell anemia among children in Enugu, Nigeria. Methods: One hundred and fifty seven children with sickle cell anemia were recruited consecutively using a researcher administered questionnaire. Information obtained from patient’s mother included patient’s bio-data, social history, family history, age at confirmation of diagnosis and clinical information. Result: There was a wide variation of the age at diagnosis of sickle cell anemia ranging from 2 months to 14.7 years with a median age of 24 months. Only 10.4% were diagnosed before the age of six months and all were diagnosed after they have presented with symptoms and complications. The age of the mother and having an elder sibling with sickle cell anemia significantly affected the age at which the disease is diagnosed. Conclusion: There is a delay in the diagnosis of sickle cell anemia in Enugu with mother’s age and having an elder sibling with the disease influencing the age at diagnosis.

Cerebral malaria is a severe manifestation of a parasitic infection caused by Plasmodium falciparum. The sequelae of this disease such as blindness, deafness, loss of motor function could be emotionally traumatic and physically disabling. We, therefore, present this case of an 8-year-old boy who presented with high-grade intermittent fever associated with multiple convulsions and prolonged coma. He regained consciousness after 12 days of treatment with intravenous quinine but was found to have blindness, sensory-neural deafness and extrapyramidal sign. This extrapyramidal sign regressed following treatment with chlorpromazine. He also regained his sight and auditory function before he was discharged though not completely. This report is aimed at emphasizing these rare complications of cerebral malaria as well as reminding clinicians working in malaria endemic areas of the world on the need for early diagnosis and prompt treatment.

We present rare cases of three adverse drug events from artemeter-Lumefantrine(AL) ingestion. This is an antimalaria combination therapy used in the management of malaria. Adverse reaction is rarely reported when using this drug. We report these cases of our patients who developed urticaria and bullae. One had hypotension few hours after taking AL. We report these cases to show that though rare, adverse drug event can occur in AL. Conclusion : Artemesinin combination therapy though safe in children, is not without adverse reaction. Ke y Wo r d s : a r t eme t e r - Lumefantrine; Children; Adverse drug event.

Background: Complex congenital cardiac abnormalities are rare among children and contribute to mortality and morbidity. The prevalence and pattern of presentation vary from lace to place.Materials and Methods: The objective of this study was to determine the clinical profile and pattern of presentation of complex congenital cardiac malformations among children attending a tertiary hospital in Enugu State. A cross‑sectional retrospective study in which a review of the records of children who attended the children outpatient clinic of University of Nigeria Teaching Hospital (UNTH), Ituku‑Ozalla, Enugu State over a 5‑year period (January 2007‑June 2012) was undertaken.Results: Thirty one thousand seven hundred and ninety‑five (31,795) children attended the outpatient clinic of the hospital over the study period, of these, 65 had cardiac diseases, from which 16 were found to have congenital complex cardiac abnormalities of various types, giving a prevalence of 0.05%. Complex abnormalities seen in these children are Tricuspid atresia with various associations, cor triatriatum, single ventricle, and large ASD (atrio‑septal defect) with complete AVCD, cor triatriatum sinistrum with cardiomyopathy, DORV (double outlet right ventricle) with left sided aorta, hypoplastic tricuspid valve with a PDA (patent ductus artriosus), TOF (tetralogy of fallot), prolapse of aortic valve, and pulmonary regurgitation. One of these complex cardiac anomalies presented with Turner’s syndrome and another with VACTERAL association.Conclusions: The results of this study show that 0.05% of children who presented at cardiology clinic of a teaching hospital in Enugu State had congenital complex cardiac abnormalities and that the commonest forms seen were those with cor triatriatum and TOF.Keywords: Abnormalities, children, complex congenital cardiac, Enugu, presentationNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue 4

Vaginal discharge in children may result from a variety of causes. A long.standing intra.vaginal foreign body can pose both diagnostic and therapeutic challenges in children. Treatment failure may occur because of alteration of the normal vaginal flora. A 6.year.old girl, who lived with her parents, presented with a foul.smelling, blood.stained vaginal discharge as well as dysuria for 2 years. There was no history of sexual abuse. Initial evaluation that excluded gynecologic examination revealed lower abdominal tenderness. Vaginal swab and urine cultures yielded Staphylococcus aureus sensitive to ceftriaxone only. She was commenced on this antibiotic for 2 weeks, but the discharge persisted, necessitating referral to the gynecologist. Examination under anesthesia by the gynecologist revealed shreds of toilet tissue paper extracted from the vagina and slight excoriations on the wall of the vagina. Vaginal foreign body can present with diverse symptoms. It should be considered in any young female patient presenting with recurrent or persistent vaginal discharge. Keywords: Foreign body, Pediatric, Vaginal discharge

Background: Sickle cell anemia is associated with a hypercoagulable state that may lead to alterations in a coagulation profile. Measurements of coagulation factors are known to have some predictive value for clinical outcome.Objectives: To determine the coagulation profile of children with SCA in steady state and crisis and compare it with those with normal HbAA genotype.Materials and Methods: This is a prospective observational study involving 50 children with SCA in steady state, 50 in crises, and 50 with HbAA genotype, carried out from June to October 2009. All the values of coagulation profile were matched for age and sex.Results: The mean Prothrombin time (PT) (12.5 ± 1.2 secs), Activated partial thromboplastin time (aPTT) (41.6 ± 1.0 secs), and Thrombin time (TT) (12.3 ± 1.2 secs) of subjects with SCA in steady state as well as those during crises [PT (12.6 ± 1.8 secs), aPTT (45.6 ± 1.3 secs), TT (12.5 ± 1.7 secs)] were significantly prolonged compared to those of subjects with HbAA genotype. The mean bleeding time (BT) of 3.4 ± 1.0 mins was significantly shorter in children with SCA in steady state compared to those with HbAA genotype (3.7 ± 1.1 mins), (P < 0.038).Conclusion: Coagulation profile of patients with SCA is prolonged both in steady state and during crisis and when compared to those with HbAA genotype, though all values are within normal range.Key words: Children, coagulation profile, sickle cell anemia

Background: Abdominal colic is common in infants but generally harmless. The exact aetiology is unknown but it has been associated with vicious cycle of crying and swallowing of air by the infant. The excessive crying associated with it can result in a lot of distress for family members creating unnecessary panics. We sought to find the perception and management of abdominal colic by mothers in Enugu.Objective: Objective of this study is to determine the perception and ‘home management’ of abdominal colic in infants by mothers in Enugu, south-east Nigeria and the factors associated with them.Materials and Methods: A cross-sectional survey involving 177 mothers that presented with their infants at the pediatric outpatient clinic of the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu between June and November 2011. A pretested questionnaire was used after obtaining their consent.Results: A total of one hundred and seventy-seven mothers participated in this study. They were aged 20 to 60 years with mean age of 34 ± 7.3 years. Most of them (99.4%) believed that babies can have abdominal colic. While 41.3% attributed no problems to colic, the rest believed that it causes loose/greenish stools (12.4%), fever (16.4%) and vomiting (9.6%) etc. Most of the mothers (87.7%) do apply medications for colic which range from paracetamol (33.1%), Gbomoro (16.2%), teething powder (15.4%), salt water (13.2%), Buscopan (7.7%) and gripe water (4.6%).Conclusions: Mothers attribute symptoms of childhood illnesses to abdominal colic. This may have led to unnecessary and sometimes harmful management. There is need for health education of mothers and potential mothers.Key words: Abdominal colics, enugu, infants

Background : Patients with sickle cell anemia (SCA) are prone to recurrent pain crises related to red blood cell sickling and vaso.occlusion with subsequent tissue hypoxia. Alveolar hypoxia has been shown to be associated with entrapment of sickle cells in the pulmonary microcirculation which may propagate a cycle of further hypoxemia and sickling. Pulmonary complications are common in sickle cell disease (SCD) and may exacerbate microvascular occlusive phenomena. Thus, detecting hypoxemia is of particular importance in SCD. Objectives : This study was designed to determine the prevalence of hypoxemia among children with SCA and compare the oxygen saturation of those in crises with those in steady state. Materials and Methods : This is a prospective observational study involving 46 children with SCA in steady state, 42 with crises, and 42 with HbAA genotype carried out between August and December 2010. The study compared the oxygen saturation of sickle cell anaemic children in steady state and in crises with normal hemoglobin genotype using Nellcon pulse oximeter while the hemoglobin concentration was analyzed using automated Sysmex KX.21N model. Results : A total of 130 participants aged 6 months to 18 years were recruited. The overall prevalence of hypoxemia in this study was 13.8%. Hypoxemia was highest among SCA patients in the crisis state (23.8%) compared to 13% and 0% for those in the steady state and in those with normal hemoglobin genotype, respectively (ƒO2 = 6.425, P = 0.04). Hypoxemia was higher among those with hemoglobin less than 5 g/dl (30%) and least among those whose hemoglobin levels were 10 g/dl and above. Conclusions : Hypoxemia was significantly higher among children with SCA during Vaso-occlusion crises. We recommend that one should have a high index of suspicion and take prompt action in managing these individuals especially those with acute chest syndrome. Key words : Enugu, hypoxemia, oxygen saturation, sickle cell anemia

We present a rare and first case of Cor triatriatum sinistrum (CT) in a patient who presents with dyspnoea, easy fatigability, chest pain, murmurs and typical ECG and 2D-echo findings. The purpose of presenting this case report is to highlight the distinctive manifestation of Cor triatriatum sinistrum and to provide a concise report of this disease with the hope that such information will help identify patients earlier in the course of their disease. Surgical correction offers good and long term results for both classic and atypical types. In a resource poor country like ours, high index of suspicion, early diagnosis and timely referral are warranted so as to avert death.

Marfan syndrome (MS) is a disorder of the connective tissues characterized by various phenotypical and genetic manifestations. We present this case to show its rarity and to highlight the need of early diagnosis to avert the numerous complications that follow it. A 7-year-old male, who presented with an abnormal body physique that was noticed at age 2 months, poor vision that was noticed 5 years ago, recurrent chest pain that started 3 years ago, and recurrent easy tiredness that started 3 years ago. He developed poor vision 2 years later. Examination revealed an acutely ill-looking child with dyspnea, grade 4 apical positive surgical margins (PSM), grade 2 diastolic murmur (at the aortic area), multiple skeletal abnormalities with lens subluxation and iridodonesis. Diagnosis of MS was made and he was comanaged with ophthalmologists and orthopedic surgeons.

Toxoplasmosis is the most serious manifestation of infection, resulting from the vertical transmission of Toxoplasma gondii (T. gondii) transplacentally, from a parasitemic mother to her offspring. It could also be acquired. Case Presentation: E.B is a 17-month-old female baby who presented with recurrent fever x 16/12., chronic cough x 16/12, recurrent stooling x 15/12, recurrent ear discharge x 15/12, failure to gain weight x 15/12, and delayed developmental milestones. Examination revealed an acutely ill- or chronically ill-looking child in mild respiratory distress, afebrile (36.5°C), anicteric, acyanozed, moderately pale, well hydrated with generalized lymphadenopathy (axillary, inguinal, cervical), no digital clubbing, and no pedal fullness. Computed tomography (CT) scan revealed bilateral basal ganglia calcifications with a focal cystic area in the left basal ganglia; bilateral multifocal intracerebral hypodensities were noted from the frontal to the occipital lobes at different levels bilaterally, with calcifications limited to the basal ganglia. Serological test revealed the patient's serum to be positive for toxoplasma immunoglobulin G (IgG). Conclusion: Toxoplasmosis, though rare, can cause mortality and morbidity in children. Thus, a high index of suspicion is warranted in management.