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Summary : Eighty-two (87 per cent) of the 94 cases of post-neonatal tetanus patients seen in the department of paediatrics, University College Hospital, Ibadan, over an 11-year period were aged five years and above. Per sistent occurrence of this preventable condition for which an effective vaccine is available indicates deficiencies in the health system of the country. Although, a case fatality rate of 12 per cent com pared favourably with those of centres employing more sophisticated treatment modalities, mor bidity was high with patients spending an average of 23 days (range 3 to 76 days) in hospital. Al though no reliable record of tetanus immunization was obtained in 37 of the patients, 34, 8 and 15 patients received doses of DPT immunization of 0, 1 – 2 and 3, respectively, during infancy. No patient had tetanus toxoid (TT) administered after infancy. The findings indicate that the current Expanded Programme on Immunisation (EPI) recommended by the WHO for developing coun tries, of which three doses of DPT are given during infancy with no provision for booster doses, is inadequate for tetanus prevention during childhood. It is suggested that a clause be added to the EPI schedule, advising two extra doses of TT between ages four to six years and 11 to 12 years (entry into primary school and secondary school, respectively) for all children. In order to ensure compli ance, these booster doses of TT could be made prerequisites for entry into these schools.

Background: Urinary tract infection (UTI) is a significant cause of morbidity in children and individuals with sickle cell anaemia (SCA) have been reported to be at increased risk. It will be useful to have a simple means of screening such children for UTI with a view to instituting prompt treatment. Objectives: The objective of the study was to evaluate the usefulness of the nitrite test in detecting UTI in febrile SCA children. Methods: This prospective study was carried out in the department of Paediatrics, University College Hospital, Ibadan. The study group consisted of 171 children aged one to 15 years with SCA presenting with fever (temperature e” 37.5°C). Midstream urine specimen was collected from each patient and subjected to nitrite test, microscopy, culture and sensitivity. Results: There was significant bacteriuria in 37 (21.6 percent) children. A positive test for nitrite was obtained in the urine of eight patients, seven of whom had bacteriuria. The nitrite test in detecting bacteriuria had a specificity of 99.2 percent, a sensitivity of 18.9 percent, a positive predictive value of 87.5 percent and a negative predictive value of 81.6 percent. A positive nitrite test was significantly associated with bacteriuria, while a negative test was also significantly associated with an absence of bacteriuria. Conclusion: The nitrite test is useful as a screening test for UTI in SCA children. However, in sick children, urine microscopy and culture should still be done in spite of a negative test screening such children for UTI with a view to instituting prompt treatment. This study was designed to evaluate the usefulness of the nitrite test in detecting UTI in febrile SCA children.

A retrospective study was carried out on the prevalence of protein-energy-malnu- trition (PEM) among children attending Adeoyo Maternity and Children's hospi- tal, Ibadan, over a period of 27 months. A significant number of all the patients attended the out-patient (OP) clinic per month during the wet season than during the dry season (P0.05) between the number of in-patients during the wet and dry seasons. There was however, a significant difference (P

Summary:The present autopsy study has revealed that infection, contributing to 47 percent of the deaths, was the leading cause of child hood mortality from early neonatal period through school age period, with the highest incidence of 40 percent in the pre-school age period. The six leading infections, in descending order of frequency included pneumonia, meningitis, tuber culosis, measles, malaria and neonatal tetanus. Other common causes of mortality in the series included asphyxia in 11.0 percent, congenital malformations in 10.4 percent and malignancies in 8.7 percent of the total deaths. While preventable conditions generally, including infections, birth asphyxia, malnutrition, birth injuries and accidents accounted for 66.4 percent of the deaths, neonatal problems of asphyxia, birth injury and low birthweight contributed to 18.0 percent of the mortality. On the basis of the present findings, it is suggested that in order to reduce childhood mortality to acceptably low levels, improvement in obstetric and perinatal services in our institution should be undertaken. Furthermore, health education to parents, immunizations and economic improvement of parental status, should he carried out to prevent infections, malnutrition and accidents.

Summary: In order to determine the relative frequencies of the different causes of severe anaemia among patients with sickle cell anaemia (SCA), 104 con secutive patients with SCA presenting over an eight-month period with severe anaemia (PCV 15 percent) were studied at the children's emergency ward, University College Hospital, Ibadan. They accounted for 8.2 percent of all admissions and 24.2 percent of those who had severe anaemia. Among the patients with SCA, hyperhaemolytic, acute splenic sequestration and aplastic crises constituted 49,20 and 12.5 percent of the anaemic crises, respectively. Ten patients (9.6 percent) showed mixed features and could not be definitely classified. The frequency rate of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency was similar between patients with hyperhaemolytic and those with other forms of anaemic crisis, a finding which suggests that G 6-PD deficiency neither aggravates nor ameliorates haemolysis in SCA. The mortality in the series was 8.7 percent. Six of the patients who died had hyperhaemolysis while the other three had acute splenic sequestration crisis. Five of these deaths occurred despite emergency blood transfusion.

Summary: The three types of severe anaemic crises recognised in sickle-cell anaemia (SCA) are aplastic, acute splenic sequestration and hyperhaemolytic. However, among 104 consecutive SCA cases admitted to the Children Emergency Ward of the University College Hospital, Ibadan with severe anaemic crises recently, were ten (9.6 percent) children who had mixed features and did not fall neatly into any of the three recognised categories. The distributions of the sex and admission haematocrits in these ten children with mixed' anaemic crises were similar to those of the 94 others with easily classified (pure) anaemic crises. However, using statistical test appropriate for the small numbers involved, Salmonella bacteraemia was significantly more common (5/10) among the patients with ‘mixed' anaemic crises than in those (5/94) with pure crises (P=0.0006). The relative risk of Salmonella bacteraemia in ‘mixed' crises was 9.4 times that among those with pure crises (95%CI=3.28-26.98). Although none of the “mixed cases died, compared with a mortality of 9.6 percent among the 'pure cases, the difference was not significant (P=0.42). Bacteraemia appears to be associated with mixed' indeterminate) anaemic crises in SCA. This finding suggests that such patients would benefit from appropriate antibiotic therapy.

Summary: Local tetanus following intramuscular injection into the gluteal muscle, in a ten-year old female patient is reported. The patient presented initially at a private clinic with fever and was treated for presumed malaria with intramuscular injection given into both gluteal regions. Later development consisted of stiffness of the left lower limb. Diagnosis of local tetanus was made, based on provocative spasms of the underlying left gluteal muscles. The diagnosis of tetanus became more obvious a few days later, when the spasms were spontaneous and generalized. During the recovery, the spasms became localized again to the left lower limb.

Hepatitis C virus ( HCV) treatment is rapidly changing but little is known about patients' attitudes and knowledge about HCV. This study used a cross-sectional survey to examine the relationship between HCV knowledge and attitudes towards HCV in patients with HCV mono-infection and HIV/ HCV co-infection. Subsequently, an education intervention was developed with an abridged version of the cross-sectional survey administered before and after the education session to assess changes in knowledge and attitudes. 292 people participated in the cross-sectional survey, and 87 people participated in the education intervention. In the cross-sectional survey, the mean knowledge score regarding HCV was low (<50% of the total possible score). Mono-infected and co-infected individuals shared similar knowledge deficits and attitudes towards HCV despite having distinct demographic differences. Attitudes endorsed by patients included the following: 57% feared the consequences of HCV on their life, 37% felt HCV was not fatal, 27% did not believe they needed HCV medication, 21% felt ashamed of having HCV and 16% felt HCV treatment was not important. Attitudes that reflected indifference and shame towards HCV were associated with lower knowledge scores ( HCV knowledge score of 15.1 vs. 17.5, P < 0.01 for indifference and 15.3 vs. 17.2 for shame, P = 0.02). The education intervention improved knowledge scores but did not modify the assessed attitudes. Intervention studies are needed to effectively change attitudes towards HCV infection and treatment. [ABSTRACT FROM AUTHOR]

Involving diverse populations in early-phase (phase I and II) cancer clinical trials is critical to informed therapeutic development. However, given the growing costs and complexities of early-phase trials, trial activation and enrollment barriers may be greatest for these studies at healthcare facilities that provide care to the most diverse patient groups, including those in historically underserved communities (e.g., safety-net healthcare systems). To promote diverse and equitable access to early-phase cancer clinical trials, we are implementing a novel program for the transfer of care to enhance access to early-phase cancer clinical trials. We will then perform a mixed-methods study to determine perceptions and impact of the program. Specifically, we will screen, recruit, and enroll diverse patients from an urban, integrated safety-net healthcare system to open and active early-phase clinical trials being conducted in a university-based cancer center. To evaluate this novel program, we will: (1) determine program impact and efficiency; and (2) determine stakeholder experience with and perceptions of the program. To achieve these goals, we will conduct preliminary cost analyses of the program. We will also conduct surveys and interviews with patients and caregivers to elucidate program impact, challenges, and areas for improvement. We hypothesize that broadening access to early-phase cancer trials conducted at experienced centers may improve equity and diversity. In turn, such efforts may enhance the efficiency and generalizability of cancer clinical research., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: The real-world data on the safety profile of ventricular tachycardia (VT) ablation among elderly patients is not well-established. This study aimed to evaluate the procedural outcomes among those aged 18-64 years versus those aged ≥65 years who underwent catheter ablation of VT., Method: Using the Nationwide Readmissions Database, our study included patients aged ≥18 years who underwent VT catheter ablation between 2017 and 2020. We divided the patients into non-elderly (18-64 years old) and elderly age groups (≥65 years old). We then analyzed the in-hospital procedural outcome and 30-day readmission between these two groups., Results: Our study included 2075 (49.1%) non-elderly patients and 2153 (50.9%) elderly patients who underwent VT ablation. Post-procedurally, elderly patients had significantly higher rates of prolonged index hospitalization (≥7 days; 35.5% vs. 29.3%, p  < .01), non-home discharge (13.4% vs. 6.0%, p  < .01), 30-day readmission (17.0% vs. 11.4%, p  < .01), and early mortality (5.5% vs. 2.4%, p  < .01). There was no significant difference in the procedural complications between two groups, namely vascular complications, hemopericardium/cardiac tamponade, cerebrovascular accident (CVA), major bleeding requiring blood transfusion, and systemic embolization. Through multivariable analysis, the elderly group was associated with higher odds of early mortality (OR: 7.50; CI 1.86-30.31, p  = .01), non-home discharge (OR: 2.41; CI: 1.93-3.00, p  < .01) and 30-day readmission (OR: 1.58; CI 1.32-1.89, p  < .01)., Conclusion: Elderly patients have worse in-hospital outcome, early mortality, non-home discharge, and 30-day readmission following catheter ablation for VT. There was no significant difference between elderly and non-elderly groups in the procedural complications., Competing Interests: Authors declare no conflict of interests for this article., (© 2024 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

Purpose: HIF2α is a key driver of kidney cancer. Using a belzutifan analogue (PT2399), we previously showed in tumorgrafts (TG) that ∼50% of clear cell renal cell carcinomas (ccRCC) are HIF2α dependent. However, prolonged treatment induced resistance mutations, which we also identified in humans. Here, we evaluated a tumor-directed, systemically delivered, siRNA drug (siHIF2) active against wild-type and resistant-mutant HIF2α., Experimental Design: Using our credentialed TG platform, we performed pharmacokinetic and pharmacodynamic analyses evaluating uptake, HIF2α silencing, target gene inactivation, and antitumor activity. Orthogonal RNA-sequencing studies of siHIF2 and PT2399 were pursued to define the HIF2 transcriptome. Analyses were extended to a TG line generated from a study biopsy of a siHIF2 phase I clinical trial (NCT04169711) participant and the corresponding patient, an extensively pretreated individual with rapidly progressive ccRCC and paraneoplastic polycythemia likely evidencing a HIF2 dependency., Results: siHIF2 was taken up by ccRCC TGs, effectively depleted HIF2α, deactivated orthogonally defined effector pathways (including Myc and novel E2F pathways), downregulated cell cycle genes, and inhibited tumor growth. Effects on the study subject TG mimicked those in the patient, where HIF2α was silenced in tumor biopsies, circulating erythropoietin was downregulated, polycythemia was suppressed, and a partial response was induced., Conclusions: To our knowledge, this is the first example of functional inactivation of an oncoprotein and tumor suppression with a systemic, tumor-directed, RNA-silencing drug. These studies provide a proof-of-principle of HIF2α inhibition by RNA-targeting drugs in ccRCC and establish a paradigm for tumor-directed RNA-based therapeutics in cancer., (©2022 American Association for Cancer Research.)

Recent advances in treatment have transformed the management of cancer. Despite these advances, cardiovascular disease remains a leading cause of death in cancer survivors. Cardio-oncology has recently evolved as a subspecialty to prevent, diagnose, and manage cardiovascular side effects of antineoplastic therapy. An emphasis on optimal management of comorbidities and close attention to drug interactions are important in cardio-oncologic care. With interdisciplinary collaboration among oncologists, cardiologists, and pharmacists, there is potential to prevent and reduce drug-related toxicities of treatments. The cytochrome P450 (CYP450) family of enzymes and the P-glycoprotein (P-g) transporter play a crucial role in drug metabolism and drug resistance. Here we discuss the role of CYP450 and P-g in drug interactions in the field of cardio-oncology, provide an overview of the cardiotoxicity of a spectrum of cancer agents, highlight the role of precision medicine, and encourage a multidisciplinary treatment approach for patients with cancer., (© 2021 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.)

Background: Patients with baseline thrombocytopenia can have increased mortality and morbidity, but are typically excluded from randomized clinical trials studying acute coronary syndromes (ACS). We sought to better define the effect thrombocytopenia on clinical outcomes in ACS patients., Methods: Patients identified from the NCDR Chest Pain registry at Mayo Clinic Arizona from Oct 2015 to Sep 2018 were retrospectively classified into two groups: TP (platelet <150 × 10 3 μL) and control (platelet ≥150 × 10 3 μL). The groups were analyzed for the clinical outcome (all-cause mortality, major adverse cardiac events (MACE), and bleeding events). The TP group was divided into moderate-severe thrombocytopenia (TP mod ; platelet 50-100 × 10 3 μL) and mild thrombocytopenia (TP mild ; platelet 100-150 × 10 3 μL) for further analysis. P-value <0.05 is considered significant., Results: Five hundred and thirty-six patients were identified, and 72 patients (13%) had thrombocytopenia. The median follow-up time was 1.1 years. The TP group was older (TP vs. control: mean age 73 ± 13 years vs. 70 ± 13 years; P = 0.026). In patients discharged on dual-antiplatelet therapy, the TP group had higher all-cause mortality (23% vs. 7.3%; P = 0.007) but not major bleeding events (11% vs. 5.0%; P = 0.123). Only all-cause mortality increased with the severity of thrombocytopenia (TP mod vs. TP mild vs. control: 33% vs. 24% vs. 7.3%; P = 0.007)., Conclusions: In patients with ACS, baseline thrombocytopenia is associated with increased all-cause mortality and all bleeding events without net MACE benefit. Further study is needed to identify the optimal antiplatelet strategy in this higher risk population., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: The heterodimeric transcription factor HIF-2 is arguably the most important driver of clear cell renal cell carcinoma (ccRCC). Although considered undruggable, structural analyses at the University of Texas Southwestern Medical Center (UTSW, Dallas, TX) identified a vulnerability in the α subunit, which heterodimerizes with HIF1β, ultimately leading to the development of PT2385, a first-in-class inhibitor. PT2385 was safe and active in a first-in-human phase I clinical trial of patients with extensively pretreated ccRCC at UTSW and elsewhere. There were no dose-limiting toxicities, and disease control ≥4 months was achieved in 42% of patients., Patients and Methods: We conducted a prospective companion substudy involving a subset of patients enrolled in the phase I clinical trial at UTSW ( n = 10), who were treated at the phase II dose or above, involving multiparametric MRI, blood draws, and serial biopsies for biochemical, whole exome, and RNA-sequencing studies., Results: PT2385 inhibited HIF-2 in nontumor tissues, as determined by a reduction in erythropoietin levels (a pharmacodynamic marker), in all but one patient, who had the lowest drug concentrations. PT2385 dissociated HIF-2 complexes in ccRCC metastases, and inhibited HIF-2 target gene expression. In contrast, HIF-1 complexes were unaffected. Prolonged PT2385 treatment resulted in the acquisition of resistance, and we identified a gatekeeper mutation (G323E) in HIF2α, which interferes with drug binding and precluded HIF-2 complex dissociation. In addition, we identified an acquired TP53 mutation elsewhere, suggesting a possible alternate mechanism of resistance., Conclusions: These findings demonstrate a core dependency on HIF-2 in metastatic ccRCC and establish PT2385 as a highly specific HIF-2 inhibitor in humans. New approaches will be required to target mutant HIF-2 beyond PT2385 or the closely related PT2977 (MK-6482)., (©2019 American Association for Cancer Research.)

Background: Febrile seizures are common among children and these are known to result from the diverse aetiological factors, known to cause fever in children., Objectives: To determine the prevalence of bacteraemia amongst children with febrile seizures at the children's emergency room of the University College Hospital, Ibadan, Nigeria., Methodos: This was a prospective study involving 147 children who were presented with febrile seizures over a period of 13 months at the University College Hospital Ibadan. They all had their blood cultures sample taken under aseptic conditions. Other investigations performed on them included a packed cell volume, full blood count and blood film for malaria parasite., Results: A total of 83 males and 64 females with febrile seizures were studied. Their ages ranged from 4 to 60 months with a mean age of 26.35 + 13.76 months. Bacteraemia was diagnosed in 32(21.8%) of the cases. The predominant organism isolated from the blood of these patients was Staphylococcus aureus ., Conclusion: Bacteraemia is a frequent finding in children with febrile seizures hence, it may be beneficial to carry out blood culture in such children on the suspicion of a probable bacterial infection.

Background: NAD(P)H:quinone oxidoreductase 1 (NQO1) is a two-electron oxidoreductase expressed in multiple tumour types. ARQ 761 is a β-lapachone (β-lap) analogue that exploits the unique elevation of NQO1 found in solid tumours to cause tumour-specific cell death., Methods: We performed a 3+3 dose escalation study of 3 schedules (weekly, every other week, 2/3 weeks) of ARQ 761 in patients with refractory advanced solid tumours. Tumour tissue was analysed for NQO1 expression. After 20 patients were analysed, enrolment was restricted to patients with NQO1-high tumours (H-score ≥ 200)., Results: A total of 42 patients were treated. Median number of prior lines of therapy was 4. Maximum tolerated dose was 390 mg/m 2 as a 2-h infusion every other week. Dose-limiting toxicity was anaemia. The most common treatment-related adverse events were anaemia (79%), fatigue (45%), hypoxia (33%), nausea (17%), and vomiting (17%). Transient grade 3 hypoxia, reflecting possible methemoglobinaemia, occurred in 26% of patients. Among 32 evaluable patients, best response was stable disease (n = 12); 6 patients had tumour shrinkage. There was a trend towards improved efficacy in NQO1-high tumours (P = 0.06)., Conclusions: ARQ 761 has modest single-agent activity, which appears associated with tumour NQO1 expression. Principal toxicities include anaemia and possible methemoglobinaemia.

Appointment-keeping behavior is an important requisite for HCV linkage and treatment initiation. In this study we examine what impact hepatitis C (HCV) knowledge and attitudes has on appointment-keeping behavior among a cohort of HCV and HCV/HIV patients. Knowledge scores and attitude scales, obtained from a cross-sectional survey, were correlated with proportion of appointments kept 1 year prior to taking the survey. Independent risk factors for missing appointments were examined by multiple regression analysis. 292 HCV patients completed the survey, and 149 (51%) were co-infected with HIV. HCV patients kept 67.5 ± 17.4% of their total appointments and a similar proportion (67 ± 38.2) of Liver Clinic appointments, but they attended a higher proportion (73 ± 24.4) of Primary Care Clinic appointments. However, certain health beliefs, psychiatric illness, and HIV co-infection were independently associated with lower levels of appointment-keeping behavior. HCV knowledge was not associated with appointment-keeping behavior. Health beliefs, psychiatric illness, and HIV co-infection are associated with missing appointments, but no link between knowledge and appointment keeping behavior is apparent. In order to increase engagement into HCV care, HCV care coordination programs need to focus on addressing health beliefs and providing resources to those at highest risk for missing appointments.

Background: Febrile seizures are commonly encountered in emergency paediatric practice. Initial pre-hospital intervention given by caregivers has been shown to impact outcome., Objectives: To describe the spectrum of pre-hospital interventions given for the treatment of childhood febrile seizures in Ibadan, Nigeria., Methods: All consecutive cases of febrile seizures seen at the emergency room of University College Hospital, Ibadan over a period of 13 months were the subjects of the study. Details of history of illness including the interventions given before presentation were recorded. All the children had lumbar puncture and examination of their cerebrospinal fluid (CSF). All were followed up till discharge and the outcome was recorded., Results: A total of 147 children, 83 males and 64 females with febrile seizures were studied. Harmful traditional practices were found to be common in the cohort studied. Fifty-nine (40.1%) of the children received at least one form of intervention believed to be capable of aborting the seizure during the attack at home. Herbal preparation was the most common form of pre-hospital treatment, given in 15 (10.2%) of the cases. Other forms of pre-hospital interventions given were application of substances to the eyes (6.1%), incisions on the body (2%) and burns inflicted on the feet and buttocks (1.4%). None of the children received rectal diazepam or buccal midazolam as home remedy for seizures. There was a statistically significant relationship between harmful cultural practices and the socio-economic class of the caregivers (P=0.008)., Conclusions: Pre-hospital treatment of childhood seizures in Ibadan comprises mainly harmful traditional practices. There is a need for appropriate health education to reduce the morbidity and mortality associated with febrile seizures in the locality.

Background: Sickle cell disease is a common genetic disorder in Nigeria., Objectives: To determine the steady state haematocrit, liver size and spleen size in children with sickle cell disease and the factors that influence them., Methods: This was a retrospective study of children with sickle cell disorders who attended the anaemia clinic of the Children's Outpatient Department, University College Hospital, Ibadan between the years 2000-2009. Relevant data extracted from their case notes included socio-demographic variables, haemoglobin phenotype, steady state haematocrit and liver and splenic sizes. Means were compared with t-test and correlation tested with Pearson correlation. Statistical significance was set at p < 0.05., Results: A total of 415 (Male: female ratio 1.1:1) children were studied and 385 (92.8%) and 30 (7.2%) of the children were of haemoglobin (Hb) SS and Hb SC phenotypes respectively. Their ages ranged from 0.5-17 years with a mean (SD) of 7.3 (4.4) years. Mean (SD) steady state haematocrit for children with HbSC was 28.3 (4.5) % and significantly higher than 24.1 (3.7) % in HbSS. Mean steady state haematocrit was also higher in children from higher than lower socio-economic classes. There was a negative correlation of haematocrit with age, with hepatomegaly and splenomegaly. Steady state hepatomegaly occurred more frequently in HbSS than in HbSC., Conclusion: Haemoglobin phenotype, age and socio-economic status have some modifying influences on the steady-state features of sickle cell disease in Nigerian children. In addition, increasing liver and spleen sizes seem to be related to a decreasing haematocrit.

A review of the presentation, management and outcome in all children presenting with non-traumatic paraplegia managed by the paediatric neurology team at the University College Hospital Ibadan, Nigeria from June 1989 to May 2004 is presented. Of the 110 patients, there were 54 males and 56 females giving a M:F ratio of 1:1. The mean age of the group was 5.3 (SD = 3.1) years, with a range from 9 months to 11 years. Infections and infectious processes caused the paraplegia in 102 (92.7%) of the cases with poliomyelitis and tuberculosis (TB) of the spine accounting for 88 (80%) of cases. The study period was divided into three 5 year periods. While poliomyelitis was the commonest cause of paraplegia (60%) in the first 5 years: TB spine was responsible for most cases (40%) in the last 5-year period of the study. There was a significant reduction in the total number of cases seen when the initial 5-year period was compared with the last (45 and 26 respectively, P = 0.001). Overall mortality among the 110 admitted patients was 7.2% being highest (50%) in malignant disorders and none was recorded in TB spine. Prognosis for eventual ability to walk was best in cases of TB spine where 37 of the 39 patients (95%) were ambulant by discharge after 60 days of anti-TB treatment. The 2 non-ambulant patients eventually walked within 3 months of discharge while on maintenance treatment for TB. Only 2 of the 51 non-ambulant patients obtained wheelchairs at discharge. The implications of inadequate facilities for investigation and treatment as well as the lack of financial and social support for the families of affected children are discussed.

We present the findings in 14 paediatrics patients with SCA who had CT examination at the University College Hospital Ibadan on account of stroke between 1993 and 2000. There were 8 female and 6 male with a mean age of 11.25 years and SD of 3.66. Cerebral infarction was the most common finding occurring in 57% of the patients while intracerebral bleed was seen in 21%. Two patients had a mixed lesion and atrophy was seen in one patient. Five patients (36%) had their lesion on the right hemisphere while eight (57%) had their lesions on the left side. The frontal and parietal lobes were mainly affected. Prompt CT screening of the brain in a child with sickle cell anaemia who presents with symptoms and signs suggestive of stroke can help identify the particular type of lesion and this may influence mode of therapy given as well as prognosis

We reviewed our records over a 15-year period to determine whether or not the impression that stroke complicating sickle cell disease was less common than reported in North America. Records of children aged 16 years and below with a diagnosis of stroke seen at the University College Hospital, Ibadan, Nigeria between 1988 and 2002 were examined. Thirty-nine such patients were identified but only 31 had detailed records available for study. Twenty-seven of these had sickle cell disease, 26 with haemoglobin genotype SS and 1 with Hb S+C. Sickle cell disease was therefore responsible for 87% of stroke seen in children at our centre. With an average clinic population of about 500 patients with sickle cell disease, the hospital frequency of stroke among these patients is estimated at 5.4%. The mean age of occurrence of the first stroke was 6.8 years ranging from 17 months to 11 years. Of the 7 patients who had CT scans of the brain done, 5 had evidence of cerebral infarction while 2 had intracerebral haemorrhage. While only 2 deaths occurred among the cases reviewed, morbidity was significant with only 6 patients achieving complete recovery. Recurrent stroke occurred after an average of 25.6 months in 8 of 13 patients who were followed up (61.5%). The incidence of stroke among African children with sickle cell disease appears to be not as high as reported in patients from North America.

Background: Tuberculosis still remains a major problem in the developing countries. The involvement of the spine is also of increasing importance, because of the resurgence of TB in association with AIDS. This paper is designed to evaluate the applicability of CT in the diagnosis and definition of tuberculosis of the spine in Ibadan., Method: A restrospective study of the Computed Tomographic examination of 22 cases of spinal tuberculosis (Pott's disease) over a four-year period at the Radiology Department of the University College Hospital, Ibadan., Results: There was a male prevalence in the study. The mean age of respondents was 41.2 years. Neurological symptoms and back pain were the most common presentations. The thoracic spine was mostly involved while the cervical spine was least involved. Most lesions 77.3 % were demonstrated in two contiguous vertebral bodies. The vertebral bodies were destroyed in all the patients while the posterior elements were involved in 59%. The other CT findings were paravertebral soft tissue shadow in 40.9%, narrowed irregular disc spaces in 27.3% and fusion of vertebral bodies in 13.6%. The frequent bony destruction was osteolytic in nature, and was present in 64% of patients., Conclusion: CT is an adequate modality for thorough imaging and diagnosis of Pott's disease especially in patients with non specific or ambiguous presentations. It offers a unique opportunity of demonstrating clearly the various component of the spine, it also defines the pattern and extent of the destructive process.

Background: Computed Tomography (CT) is an important tool for neuroimaging, it offers an opportunity to investigate structural lesions as a cause of seizures with little morbidity. This study is designed to evaluate it's applicability in children with epileptic seizures., Method: It is a descriptive study of the CT scans of the 103 consecutive children who were referred to the CT suite of the University College Hospital on account of seizure disorders over a 5 year period (1997--2001)., Results: Only 103 (4.6%) of the subjects who had cranial scans done in five years were children with seizures disorders. The CT scans were abnormal in 53 (51.5 %). Hydrocephalus was the most common finding in 14 (13.6%). Cerebral atrophy and infarct were reported in 10.6% and 8.7% respectively. The outlined cranial fractures found in 6.8% were all depressed. A high incidence (74.4%) of abnormal scans was reported in the children with partial seizures. Thirty-three (62.3%) of the abnormal scans were amenable to surgery. The presence of neurologic deficit increased the yield of abnormal CT features., Conclusion: CT scans are of extreme value in the screening and definitive evaluation of seizures in children. It is advocated for excluding treatable conditions and monitoring progression of the disorder.

Unlabelled: As part of a larger project on childhood urinary tract infection, antimicrobial sensitivity tests were carried out on the bacterial isolates from the urine of febrile children seen at the University College Hospital, Ibadan, Nigeria., Methodology: Midstream urine specimens were collected from 171 sickle cell anaemia children and from an equal number of haemoglobin-A controls and cultured by standard methods. Sensitivity to eleven antimicrobials was tested using the disc-diffusion technique of Stokes., Results: Significant bacteriuria was obtained from 37 children with sickle cell anemia and 27 controls. The isolates were Escherichia coli, Klebsiella species, Non-haemolytic streptococcus, beta-haemolytic Streptococcus, Salmonella, Proteus and Pseudomonas species. Sensitivity was highest to Pefloxacin to which over 94% of the organisms were sensitive followed by Ceftriaxone (over 85%) and ceftazidime (over 85%). Sensitivities to nalidixic acid and cefuroxime were between 67.6% and 74.1%. Most of the isolates were resistant to gentamicin, amoxycillin, cotrimoxazole and ampicillin. In general the sensitivity pattern in the sickle cell anaemia group was similar to the pattern in the control group., Conclusion: Aetiological agents of childhood UTI in this environment are resistant to most of the drugs commonly recommended for its treatment. Nalixidic acid and cefuroxime are recommended as first line drugs while awaiting results of sensitivity testing. Ceftriazone and ceftazidime should be reserved for cases of non-response to first line drugs and in severe cases. Pefloxacin should be considered potential drug of treatment particularly in multi-drug resistant infections.

In a review of 94 paediatric patients treated for post-neonatal tetanus over a period of 11 years at the University College Hospital, Ibadan, Nigeria, reliable data regarding the care received for wounds that eventually resulted in tetanus was available in 58 patients. Seventeen of these patients had orthodox medical care for their wounds before developing tetanus. While some of the patients had received antibiotics and/or tetanus toxoid, no patient received antitetanus serum despite the fact that most of them had no previous immunization against tetanus. All the 3 victims of road traffic accidents were given tetanus toxoid but none of the 6 patients with chronic suppurative otitis media had any form of tetanus prophylaxis. The findings highlight the adverse consequences of failure to adhere to basic guidelines for management of the tetanus-prone wound.

Hyperventilation exercise during electroencephalography precipitated a recurrence of right hemiplegia and aphasia in a patient with Hb SS disease. Although recovery of function started within hours of the event, full recovery has not occurred six months after. Hyperventilation provocative test during electroencephalography should be discouraged in patients with sickle cell anaemia.

The relationship of foetal haemoglobin (HbF) to several clinical and haematological parameters in 86 children aged 5 to 16 years who had sickle cell anaemia (SCA) has been examined. The mean HbF level was 6.8 +/- 3.6%. Higher HbF values were significantly associated with fewer blood transfusions, fewer hospital admissions and higher rate of hepatomegaly. A trend for children with higher HbF levels to have better physical development and a more normal haemogram was also noted though this was not statistically significant.

Lymphocyte subpopulations in human cord blood have been examined using monoclonal antibodies, visualized with immunogold. The proportions of T11, T4, T8, and B1 cells in cord blood are very similar to values in adult peripheral blood. Some evidence of lymphocyte immaturity in cord blood is suggested by the presence of 12% CALLA-positive cells and the sum of T4 and T8 cells significantly exceeding the number of T11 cells; however, there were no TdT-positive cells. The presence of CALLA-positive lymphocytes in normal cord blood should be borne in mind when investigating blood smears from neonates for congenital leukemia.

Splenic reticuloendothelial function, as determined by pitted red cell counts in 114 pediatric patients with sickle cell disease, was evaluated. Patients with homozygous sickle cell disease (HbSS) had a mean pit count of 11.8 +/- 7.0% and the count increased with age. Sickle cell hemoglobin C disease (HbSC) patients had a mean pit count of 4.9 +/- 9.1%, the count being unaffected by age. One patient with HbS-beta thalassemia had a count of 12%, while eight patients with HbS-beta + thalassemia had a mean count of 0.4 +/- 0.3%. There was one patient each with HbSS-alpha thalassemia, HbS-O Arab, and HbS-Lepore, and the pit counts were 4.9, 31.4, and 0.4%, respectively. In both HbSS and HbSC patients, the pit count was significantly lower in patients who had palpable spleens. The pit count may be used as a predictor of disease severity in the sickle cell disorders.