South African Journal of Child Health - Volume 5, Issue 4, 2011
Volume 5, Issue 4, 2011
Author D.F. WittenbergSource: South African Journal of Child Health 5 (2011)More Less
Increasingly, regulatory authorities require that specialist qualifications in clinical medicine should include a verifiable research component. Whereas university postgraduate degrees were generally awarded after training that included participation in research, the Colleges of Medicine relied on professional competency examinations as a measure of a candidate's suitability for specialist registration.
Source: South African Journal of Child Health 5, pp 107 –111 (2011)More Less
Background. Tissue factor pathway inhibitor (TFPI) is an endogenous protease inhibitor that regulates the initiation of the extrinsic coagulation pathway by producing factor Xa-mediated feedback inhibition of the tissue factor/factor VIIa (TF/VIIA) catalytic complex.
Objectives. To evaluate plasma TFPI levels in paediatric patients with nephrotic syndrome (NS) and its correlation with disease activity.
Subjects and methods. Fifteen nephrotic patients in relapse (proteinuria >40 mg/m2/h, hypo-albuminaemia and oedema) before initiating steroid therapy (group I) and another 15 nephrotic patients in remission after withdrawal of steroid therapy (group II) were compared with 15 age- and sex-matched healthy children (group III). Besides clinical evaluation and routine laboratory investigations of NS, tissue factor pathway inhibitor levels in plasma were measured by enzyme-linked immunosorbent assay (ELISA).
Results. The plasma TFPI level was higher in nephrotic patients during relapse (group I) and during remission (group II) (mean 102.53 (standard deviation (SD) 14.23) and 82.93 (SD 3.83) ng/ml, respectively) compared with that in the control group (62.40 (SD 7.53) ng/ml) (p<0.0001). In children with NS the plasma TFPI level was higher during relapse (group I) compared with the level in remission (group II) (p<0.0001). There was a negative correlation between the plasma TFPI level and total protein and serum albumin, and a positive correlation between the plasma TFPI level and the urinary protein/creatinine ratio (p<0.05).
Conclusion. NS was associated with increased level of plasma TFPI in comparison with the control group, and the increase was more apparent in patients with active disease.
Source: South African Journal of Child Health 5, pp 112 –116 (2011)More Less
Objectives. Exclusive breastfeeding for the first 6 months of life is still rare among nursing mothers. This study aimed to identify the factors influencing breastfeeding practices among mothers in Anambra State, Nigeria.
Methods. A prospective cohort study was conducted in three comprehensive health centres of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Anambra State, between September 2006 and June 2007. The breastfeeding practices of 228 nursing mothers were assessed at enrolment when attending the maternal and child welfare clinics for BCG immunisation, and at follow-up visits at 6, 10, 14, 20 and 24 weeks. In addition, four focus group discussion sessions (one in each centre) were held, involving a total of 35 nursing mothers.
Results. Most mothers 190 (83.3%) were aged between 20 and 34 years. The majority (208, 91.2%) had good or very good knowledge of breastfeeding. The main source of breastfeeding education was government health facilities (80.85%), but only 110 mothers (48.2%) initiated breastfeeding immediately (<1 hour) after delivery. The exclusive breastfeeding (EBF) rate fell from 143 (62.7%) at birth to 85 (37.3%) at 24 weeks. EBF was significantly associated with older maternal age, higher parity, delivery at a government facility, a positive family attitude towards EBF, and breastfeeding education from a government health facility (p<0.05). Focus group discussion showed that mothers believed that adequate nutrition and physical, financial and emotional support to them would increase EBF practice.
Conclusion. The rate of EBF was low among the mothers, and the factors identified that may influence its practice have important implications for breastfeeding intervention programmes. Activities to promote EBF should be focused on specific groups of women and locations in which it is poorly practised. In addition, support to the mothers is necessary.
Source: South African Journal of Child Health 5, pp 117 –119 (2011)More Less
Background. Tetanus is a preventable disease that can be eradicated by immunisation and improved obstetric practice.
Aim. To study the trend and outcome of tetanus admissions among children in the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.
Method. All cases of tetanus admitted into the children's ward of the UNTH over a 10-year period from July 1998 to June 2008 were analysed from the admission records.
Result. A total of 9 361 patient admissions were reviewed. Sixty-three (0.67%) of these patients had tetanus. Forty-one (65%) were neonates. Eighteen (28.6%) of the 63 patients with tetanus died, with mortality from neonatal tetanus (31.7%) not different from post-neonatal cases (22.7%) (p=0.45). Peaks of neonatal tetanus incidence were observed when immunisation of pregnant women was rejected by religious sects.
Conclusion. From this study, hospitalisation for tetanus over the period in review was generally low. There was no definite trend and mortality was unacceptably high. Indeed, there was no change in the mortality pattern from tetanus during the period under review.
Recommendations. There is a need to strengthen immunisation against tetanus during antenatal care and by giving booster doses beyond infancy.
Source: South African Journal of Child Health 5, pp 120 –122 (2011)More Less
Congenital diaphragmatic hernia (CDH) is a congenital malformation of the diaphragm that allows the abdominal organs to push into the chest cavity. We report the case of a 15-month-old patient who presented with a non-resolving opacity on a chest radiograph despite extensive antibiotic treatment. A large anterior mediastinal mass was seen on the chest radiograph with effacement of the right cardiac border and accompanying diminution of the liver shadow, suggesting intrathoracic herniation of abdominal contents. A computed tomography (CT) scan confirmed the presence of abdominal contents in the right hemithorax. Congenital diaphragmatic hernias can cause uncertainty in diagnosis and difficulty in subsequent treatment. Non-resolving chest opacities warrant further investigation by cross-sectional imaging such as a CT scan.
Pericarditis as initial clinical manifestation of systemic lupus erythematosus in a girl : case reportSource: South African Journal of Child Health 5, pp 123 –125 (2011)More Less
The most common diagnostic features of systemic lupus erythematosus (SLE) include mucocutaneous lesions, nephritis, arthritis and haematological disorder. Serositis in the form of pericarditis is an uncommon first-line clinical manifestation. We report on an 11-year-old Nigerian girl who presented recurrently with pericarditis as the initial clinical manifestation of SLE. Other diagnostic clinical features, namely malar rash and polyarthritis, evolved sequentially over time. Diagnostic laboratory features were lymphopenic leukopenia, a positive lupus erythematosus cell preparation and positive lupus anticoagulant tests. She responded well to non-steroidal anti-inflammatory and immunosuppressive therapy. Unexplained pericarditis in any child should warrant immediate screening for SLE.
Source: South African Journal of Child Health 5, pp 126 –127 (2011)More Less
Chest radiographs remain the imaging modality of choice for diagnosing diseases such as tuberculosis (TB) in children in developing countries. Despite chest radiographs not being sensitive or specific enough to detect lymphadenopathy in children with suspected pulmonary TB, there are specific radiographic findings that are unequivocal.