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Background: Identifying impaired quality of life is a recognized component of asthma management with no published data in Nigerian children with asthma. The aim of this study was to describe the health-related quality of life of school-aged children with and without asthma seen at the Asthma Clinic of the University of Nigeria Teaching Hospital, Enugu. Methods: Cross-sectional hospital -based study of children aged 7- 17 years (with and without asthma) attending the Paediatric Asthma and General Children Outpatient Clinic of the University of Nigeria Teaching Hospital (UNTH) from parts of the south – east region of Nigeria were consecutively enrolled. Quality of life (QOL) scores were obtained using the Paediatric Quality of Life inventory (PedsQLTM) questionnaire which measures the core dimensions of health: physical functioning, emotional functioning, social functioning and school functioning. Results: There were a total of 180 study participants: (90 with asthma and 90 without asthma). Overall quality of life scores for children with asthma was worse than in those without asthma; 75.5, SD19.3 and 82.7, SD14.5 respectively (MD 7.1, CI = 2.3 to 2.3, p=0.01). Physical function domain was significantly more affected in asthmatics than nonasthmatics; 73.4, SD 23.2 vs. 84.4, SD17.3 respectively (MD 11.1, CI = 5.0 to 17.1, p=0.002). The psychosocial health summary scores in children with and without asthma were 77.6 SD 18.1 vs.81.1 SD15.1 (MD 3.5, CI= -1.4 to 8.4, p= 0.24), with the highest scores obtained in the social functioning domain for both asthma and nonasthma patients; 82.7, SD 20.3 and 87.6, SD 15.7(MD 4.9, p = 0.08) respectively. In both the overall and specific QOL domains, boys had higher scores than girls, irrespective of age or socioeconomic status with an inverse relationship between increasing age and QOL scores (r= -0.2, p=0.07). Conclusions: Children with asthma showed worse QOL and significant impairment in their physical functioning, more noticeable among the female study population. Information obtained from our QOL study forms a basis for a more informed management plan with regards to which age groups are more affected and the specific domains of health in children with asthma that need to be given closer attention to reduce asthma morbidity. The study emphasizes the need for QOL integration in asthma management for a more holistic approach to outcome evaluation of treatment rather than the physical outcomes.

Background: Acute exacerbation is a major cause of morbidity in asthmatic children. It can occur even in well controlled asthma. Aim: To determine the prevalence and pattern of acute exacerbation of asthma in children seen at the emergency room of the University of Nigeria Teaching Hospital (UNTH), Enugu.Materials and methods: This was a descriptive, cross sectional study in which consecutive children with acute exacerbation of asthma presenting to the Children Emergency Room (CHER) of UNTH, Enugu were recruited. Information from the history and examination were documented with a structured questionnaire completed by the attending doctor. Severity of their exacerbation was determined using the Global Initiative for Asthma (GINA) guidelines. The children were treated using the written management protocol used in CHER, UNTH, Enugu which was adapted from GINA guidelines. Results: There were a total of 114 presentations (episodes) of acute exacerbation asthma by 104 children within the study period with eight children having multiple episodes. This represented 6.5% of the overall number of emergency cases seen during the period. Nearly an equal number (ratio; 1: 1.04) of males and females were enrolled with the mean age of 7.9 ± 4.7 years. More children with asthma exacerbations were admitted during the rainy season months of May and June, while the dry season months of December and January recorded lower number of episodes. Most (86.0%) cases were mild to moderate exacerbations and 16 (15.3%) were severe.Three of the 22 (13.6%) children on controller medications were among the 16 that had severe exacerbation. No death was recorded during the period. Conclusion: The prevalence of asthma exacerbation is relatively high in our tropical environment and the pattern is similar to those of the developed countries in terms of age and sex distribution, however, the peak period of presentation differ in our environment.

Introduction: Malaria still remains a major cause of morbidity and mortality in children despite concerted efforts to reverse this. Chemoprophylaxis involves the use of anti malarial drugs to prevent malaria infection in humans. However the increasing resistance of plasmodium to medications has limited the effectiveness of chemoprophylactic regimens used in the past. This study will explore the perception of caregivers about these practices and determine the proportion of caregivers who treat their children for malaria without meeting standard criteria. Methodology: This cross-sectional descriptive study, was carried out over a 3-month period, from March 2017 to June 2017. Structured questionnaires accompanied by informed consent forms were sent to parents of selected pupils through their children. The first section of the questionnaire was about socio-demographic features of participants while the second section, collected information on outcome variables which assessed respondents’ level of practice of chemoprophylaxis. Results: A total of 318 (77.2%) caregivers give antimalarial prophylaxis to their children. Mothers without tertiary education (χ = 12.90, P = 0.00) and those f r o m middle and lower socioeconomic classes (χ =15.76, P = 0.00) were significantly more likely to administer malaria chemoprophylaxis to their children. Conclusion: The misconception on malarial chemotherapy could portend treatment failure if not controlled. Extensive public enlightenment programs on the guidelines for use of anti-malarial will go a long way in ensuring rational use of anti-malarial drugs in the fight against malaria particularly in high burden areas such as Nigeria.

The Paediatric Association of Nigeria first published management guideline for community-acquired pneumonia in 2015 and covered available evidence at that time. This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline. The guideline is developed to assist clinicians in the care of children with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among children in the clinical course of CAP. The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians to make timely diagnosis and institute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated. The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.

Chronic sinusitis is an inflammatory lesion that involves the paranasal sinuses with symptoms and signs that are beyond 12 weeks in duration. It commonly presents with nasal stuffiness, mouth breathing, purulent nasal discharge, post natal drip, snoring, cough, headache, facial fullness, hyposmia, sore throat and halitosis. Features of ocular and cerebral complications may be present at diagnosis but are uncommon and can thus result in misdiagnosis. A 15 year old male presented with sudden onset ptosis and other symptoms that initially suggested an intracranial SOL or a Cavernous sinus thrombosis. A CT scan of the head and neck structures identified chronic sinusitis as the only likely pathology. We present this case to highlight an unusual ocular complication of chronic sinusitis.

The study examines the impact of crime on sustainable tourism development in the southern senatorial district of Cross River State, Nigeria, focusing on kidnapping, armed robbery, and drug abuse/trafficking in relation to the Calabar Carnival. Employing a survey design, data from 384 respondents were collected through questionnaires and interviews. Simple linear regression analysis indicates a significant association between kidnapping, armed robbery, drug abuse/trafficking, and sustainable tourism, particularly the Calabar Carnival. Recommendations include prioritizing local community involvement in tourism management to address security concerns, enhancing security personnel training in tourism education and modern policing techniques, and allocating increased funding for alternative means of subsistence for indigenous populations. These measures aim to mitigate negative impacts, encourage tourism, and foster sustainability in the region.

Russia’s invasion of Ukraine in 2022 triggered a conflict that has transformed international relations through drastic impacts on policymaking, energy politics, and alliances. Such impacts have produced severe multi-dimensional consequences for African countries that have yet to be sufficiently interrogated in the literature. In response to this gap, this paper examined the security implications of the conflict for African countries to offer a comprehensive analysis that considers the intersection of the conflict with contemporary economic, human, social, and political issues confronting Africa. In discourse using a qualitative approach and rooted in a theoretical perspective drawn from the Copenhagen School, the paper underlined the security implications as evident in the areas of food security and governance, buttressing that the proxy conflicts and power struggles associated with this war have exacerbated existing challenges related to food availability and interfered with the consolidation of democracy in Africa. The paper concluded that the war’s multi-dimensional impact potentially compounds political instability vectors. It generates dynamics capable of eroding social cohesion and fomenting social unrest in Africa, meriting its designation as an issue of great concern to African policymakers.

The study examined the level of Protected Area Management Practices in the Nigerian National Park Service. Primary data were collected through interviews and Focus Group Discussion. Secondary data involved a reconnaissance survey of the park for two months to assess the situation on ground in the study area. Data obtained were analyzed using descriptive statistics as well as chi-square. Results of the study revealed that management strategies adopted in the operations of the park were inadequate for effective park management. Adequate funding and provision of modern patrol equipment were considered necessary for effective management of the park.

The development of digital technology and intense competition have forced owners of small firms (MSMEs) to adapt technological developments to compete with competitors quickly. This study examines the effect of digitalization and competitive advantage on market sustainability and performance. This study used a qualitative method by distributing questionnaires to 166 MSMEs owners in Indonesia. The finding of this research indicate that digitalization and competitive advantage affect sustainability and market performance. This study's results suggest to MSMEs owners that technological proficiency is crucial for companies to survive in an uncertain environment.

Adaeze C Ayuk, Vivian O Onukwuli, Ijeoma N Obumneme-Anyim, Joy N Eze, Uzoamaka C Akubuilo, Ngozi R Mbanefo, Kenechukwu K Iloh, Osita U Ezenwosu, Israel O Odetunde, Henrietta U Okafor, Ifeoma J Emodi, Tagbo Oguonu College of Medicine University of Nigeria, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, NigeriaCorrespondence: Adaeze C AyukCollege of Medicine University of Nigeria, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, NigeriaEmail adaeze.ayuk@unn.edu.ngIntroduction: When a child reaches a certain age, he or she moves over to the adult physician. For this to maximally benefit the child, there has to be a process of equipping the child with skills required for taking on more responsibilities. Transitioning involves a process in which the adolescent with chronic illness is prepared ahead of time to enable them to eventually transfer to adult care with good outcomes. In high-income countries with well-organized health financing, the transitioning process begins as early as 12 years. In Africa, this process is not as organized and most hospitals would write a referral letter once the child turns 18 and transfer to adult clinic. In four of our chronic disease clinics (asthma, HIV, sickle cell anaemia and chronic kidney diseases) patients up to 24 years old are still attending the paediatric clinics. Understanding transition readiness among African adolescents remains a gap. Our findings will form a basis for informed practices for adolescent clinics in African countries.Methods: This was a descriptive cross-sectional study of pre-transition readiness in adolescents and young adults with chronic illnesses attending four outpatient specialist clinics in a tertiary hospital in Enugu Nigeria. This was done using the validated STARx Questionnaire. Total scores were computed and scores nearer the upper limit of 90 were acceptable, while mean subdomain scores of 4 and above were considered as optimal level of transition readiness. Demographic and clinical data were also collected. Acceptability to move on to adult-oriented care was documented using binary response (yes/no). Cross tabulations were done, and likelihood ratios obtained for predictors of acceptability of transition. Significant value was set at p-value of ≤ 0.05.Results: A total of 142 adolescents and young adults aged 12 to 24 years were studied. There were 38.0% (54), 24.6% (35), 22.5% (32) and 14.8% (21) from HIV, sickle cell anaemia, asthma and nephrology clinics, respectively. Their mean age was 15.6 years ± 2.4, and 48.6% (69) were male. The mean total transition readiness score was 56± 14 and this was not nearer the higher spectrum of total scores obtainable. Highest mean scores (3.7) occurred in the knowledge subdomain while least mean score (2) was noted in the use of medication reminders. The males had highest scores in the knowledge subdomain while the females were better informed about medication adherence and were more inquisitive about their chronic illness. Only about 37% (53) of the adolescents and young adults welcomed the idea of moving on to adult-care clinics. Children who had less frequent emergency hospital visits and better treatment outcome accepted the idea of transfer to adult care. Irrespective of the age all participants had suboptimal subdomain scores. High scores did not influence the participants’ choice to embrace transfer to adult care.Conclusion: There is suboptimal transition readiness irrespective of the age. The older age groups were less willing to transfer to adult care. Better disease knowledge and better communication skills did not positively influence acceptability of transfer to adult care.Keywords: adolescent, African, chronic, readiness, transition, transfer

Samuel N Uwaezuoke,1 Adaeze C Ayuk,1 Ikenna K Ndu,2 Chizoma I Eneh,2 Ngozi R Mbanefo,1 Osita U Ezenwosu1 1Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria; 2Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria Abstract: This narrative review aims to highlight the current paradigm on pain management in sickle cell vaso-occlusive crisis. It specifically examines the pathophysiologic mechanisms of sickle cell pain as well as the pharmacologic and nonpharmacologic methods of pain management. Recurrent painful episodes constitute the major morbidity in sickle cell disease (SCD). While adolescents and young adults experience mostly acute episodic nociceptive pain, it is now recognized that a significant number of adult patients develop chronic neuropathic and centralized pain. In fact, current evidence points to an age-dependent increase in the frequency of SCD patients with chronic pain.Management of disease-related pain should be based on its pathophysiologic mechanisms instead of using recommendations from other non-SCD pain syndromes. Pain management in vaso-occlusive crisis is complex and requires multiple interventions such as pharmacologic, nonpharmacologic, and preventive therapeutic interventions. Pharmacologic treatment involves the use of non-opioid and opioid analgesics, and adjuvants – either singly or in combination – depending on the severity of pain. The basic approach is to treat SCD pain symptomatically with escalating doses of non-opioid and opioid analgesics. Given the moderate-to-severe nature of the pain usually experienced in this form of SCD crisis, opioids form the bedrock of pharmacologic treatment. Multimodal analgesia and structured, individualized analgesic regimen appear more effective in achieving better treatment outcomes. Although the current evidence is still limited on the supportive role of cognitive behavioral therapy in pain management, this nonpharmacologic approach is reportedly effective, but needs further exploration as a possible adjunct in analgesia. Keywords: sickle cell pain, nociceptive pain, non-opioids, opioids, multimodal analgesia, cognitive behavioral therapy

Before 2022, the primary mode for monkeypox virus (MPXV) transmission was known to be zoonotic, and only limited human-to-human transmission was documented (2,2). Human MPXV infections resulting in mpox disease [...]

Samuel N Uwaezuoke,1 Joy N Eze,1 Adaeze C Ayuk,1 Ikenna K Ndu2 1Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla Enugu, Nigeria; 2Department of Paediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria Abstract: Besides their fundamental role in transfusion medicine, ABO and other histo-blood group antigens are associated with the pathogenesis of some human diseases such as malignancy and thrombosis. Reports also show a possible relationship with the risk of asthma and other forms of respiratory atopy. This paper aims to critically review the current evidence linking ABO histo-blood group with the risk of respiratory atopy in children and adults. A literature search was conducted with PubMed to gather baseline data about this relationship. The search extended to studies published within the past 45 years. First, the molecular mechanism underpinning the role of ABO antigenic system in human diseases comprises a fascinating relationship with von Willebrand factor and several pro-inflammatory and adhesion molecules. Second, specific blood group types vary with asthma phenotypes; severe asthma is associated with B phenotype, while mild and moderate asthma is associated with O and A phenotypes. Third, O phenotype has been linked to allergic rhinitis but only in males. Furthermore, asthma risk is related to O/Lewis negative/secretor phenotypes, while a significant relationship has also been established with B phenotype but not with A and O phenotypes. However, one study failed to establish a significant relationship with any of the ABO blood group antigens. In conclusion, there is no unanimity on the specific histo-blood groups linked to respiratory atopy risk, although asthma phenotypes are associated with specific blood groups. Despite the prospect that this relationship holds for the use of blood-group typing in evaluating respiratory atopy risk in children, more evidence-based studies are still required for its validation. Keywords: blood-group phenotypes, asthma phenotypes, B phenotype, von Willebrand factor, asthma risk, blood-group typing

Samuel N Uwaezuoke, Adaeze C Ayuk, Joy N Eze Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria Abstract: Severe asthma or therapy-resistant asthma in children is a heterogeneous disease that affects all age-groups. Given its heterogeneity, precision in diagnosis and treatment has become imperative, in order to achieve better outcomes. If one is thus able to identify specific patient phenotypes and endotypes using the appropriate biomarkers, it will assist in providing the patient with more personalized and appropriate treatment. However, there appears to be a huge diagnostic gap in severe asthma, as there is no single test yet that accurately determines disease phenotype. In this paper, we review the published literature on some of these biomarkers and their possible role in bridging this diagnostic gap. We also highlight the cellular and molecular mechanisms involved in severe asthma, in order to show the basis for the novel biomarkers. Some markers useful for monitoring therapy and assessing airway remodeling in the disease are also discussed. A review of the literature was conducted with PubMed to gather baseline data on the subject. The literature search extended to articles published within the last 40 years. Although biomarkers specific to different severe asthma phenotypes have been identified, progress in their utility remains slow, because of several disease mechanisms, the variation of biomarkers at different levels of inflammation, changes in relying on one test over time (eg, from sputum eosinophilia to blood eosinophilia), and the degree of invasive tests required to collect biomarkers, which limits their applicability in clinical settings. In conclusion, several biomarkers remain useful in recognizing various asthma phenotypes. However, due to disease heterogeneity, identification and utilization of ideal and defined biomarkers in severe asthma are still inconclusive. The development of novel serum/sputum-based biomarker panels with enhanced sensitivity and specificity may lead to prompt diagnosis of the disease in the future. Keywords: therapy-resistant asthma, heterogeneous respiratory disorder, phenotypes, diagnostic markers

Samuel N Uwaezuoke,1 Adaeze C Ayuk2 1Pediatric Nephrology Firm, 2Pediatric Pulmonology Firm, Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria Abstract: This article aimed to review the current prognostic and diagnostic tools used for community-acquired pneumonia (CAP) and highlight those potentially applicable in children with CAP. Several scoring systems have been developed to predict CAP mortality risk and serve as guides for admission into the intensive care unit. Over the years, clinicians have adopted these tools for improving site-of-care decisions because of high mortality rates in the extremes of age. The major scoring systems designed for geriatric patients include the Pneumonia Severity Index and the confusion, uremia, respiratory rate, blood pressure, age >65 years (CURB-65) rule, as well as better predictors of intensive care unit admission, such as the systolic blood pressure, multilobar chest radiography involvement, albumin level, respiratory rate, tachycardia, confusion, oxygenation and arterial pH (SMART-COP) score, the Infectious Diseases Society of America/American Thoracic Society guidelines, the criteria developed by España et al as well as the systolic blood pressure, oxygenation, age and respiratory rate (SOAR) criteria. Only the modified predisposition, insult, response and organ dysfunction (PIRO) score has so far been applied to children with CAP. Because none of the tools is without its limitations, there has been a paradigm shift to incorporate biomarkers because they are reliable diagnostic tools and good predictors of disease severity and outcome, irrespective of age group. Despite the initial preponderance of reports on their utility in geriatric CAP, much progress has now been made in demonstrating their usefulness in pediatric CAP. Keywords: community-acquired pneumonia, children, scoring systems, biomarkers

Noodle can be made from tapioca, but the protein content was very limited. The purpose of this study was to increase protein content of tapioca wet noodle with addition of 0-50% white jack bean flour and to evaluate the physical, chemical and organoleptic properties. This study was preceded by a reduction HCN content. After HCN content fulfilled SNI standards, white jack bean was then made into flour. In this study, wet noodle was made with the ratio of tapioca: white jack bean flour 100:0; 90:10; 80:20; 70:30; 60:40; and 50:50 respectively. Physical characteristics of noodle was investigated in this study were cooking loss, expansion ratio, tensile strength, and elongation. Organoleptic characteristics were studied by preference and difference test. Noodle product which was preferred by panelists was analyzed for the nutritional content. The results showed that soaking jack bean in 2% sodium bicarbonate solution for 40 hours with pulping in the first 10 hours and continued with soaking water 3 times 10 hours can reduce HCN content by 87.08%. The cooking loss and force of tensile strength were increased while expansion ratio and elongation decreased with higher proportions of white jack bean flour used. Wet mie made of ratio tapioca: white jack bean flour 80:20 got the preferences by panelists, and was able to increase protein content 9.51 fold with protein content 7.15% db. Keywords: Wet noodle, white jack bean, tapioca, protein ABSTRAK Mie dapat dibuat dari tapioka, namun kandungan protein mie tapioka sangat rendah. Tujuan dari penelitian ini adalah untuk meningkatkan kandungan protein mie basah dari tapioka dengan penambahan tepung koro pedang putih 0-50% dan evaluasi sifat fisik, kimia, dan organoleptik produk mie basah tersebut. Penelitian ini didahului dengan pengurangan kadar HCN koro pedang putih dan pembuatan tepung koro pedang putih. Pembuatan mie basah dari tapioka dilakukan dengan variasi rasio campuran tapioka: tepung koro pedang putih 100:0; 90:10; 80:20; 70:30; 60:40; dan 50:50. Karakteristik fisik mie yang diteliti meliputi kehilangan padatan akibat pemasakan, rasio pengembangan, tensile strength, dan elongasi. Karakteristik organoleptik mie yang diteliti meliputi uji kesukaan dan pembedaan. Mie yang disukai panelis selanjutnya dianalisis kandungan gizinya. Hasil penelitian menunjukkan bahwa perendaman koro pedang putih dalam larutan natrium bikarbonat 2% selama 40 jam dengan pengupasan pada jam ke-10 pertama dan dilanjutkan dengan penggantian air rendaman setiap 10 jam dapat mengurangi kadar HCN sebesar 87,08%. Pada mie yang dihasilkan, makin banyak penambahan tepung koro pedang putih, kehilangan padatan akibat pemasakan (cooking loss) dan gaya pada tensile strength meningkat, sedangkan rasio pengembangan dan elongasi menurun. Produk mie basah yang dibuat dengan rasio tapioka: tepung koro pedang putih sebanyak 80:20 masih disukai panelis, dan mampu meningkatkan kandungan protein sebesar 9,51 kali sehingga kandungan protein mie yang dihasilkan sebanyak 7,15% db. Kata kunci: Mie basah, koro pedang putih, tapioka, protein

Background. Subcutaneous fat necrosis (SFN) is a rare, temporary, self-limited pathology affecting adipose tissue of full-term or postmature neonates. It is a rare entity especially in Nigeria and usually occurs in the first weeks following a complicated delivery. Because it is not very common, diagnosis is easily missed. It may resolve spontaneously without sequelae but patients need to be followed up because of development of late complications especially hypercalcemia. We report a case of SFN of the newborn noted within one week of birth and highlight the need for proper prompt diagnosis and the need for follow-up to assess possible complications.