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Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Michael Abel Alao ◽  
Adebola Emmanuel Orimadegun ◽  
Olayinka Rasheed Ibrahim ◽  
Abayomi O. Oyenuga ◽  
Adanze Onyenonachi Asinobi ◽  
...  

Abstract Background Evidence exists as to the criticality of the first 24 h in the management of cerebral malaria. The morbidity and the mortality rate (35%) with the current intravenous monotherapy for the initial treatment of cerebral malaria are unacceptably high. Combination therapy and a shorter course of effective medication have been shown to improve outcomes in human participants in the treatment of other diseases. This study outlines a protocol to conduct a triple blinded parallel randomized controlled trial on cerebral malaria using dual intravenous medications compared to the current standard of monotherapy. Methods This is a parallel multi-site randomized controlled superiority triple blinded trial consisting of intravenous artesunate plus quinine and a control arm of intravenous artesunate only. Eligible and assenting children aged 6 months to 17 years will be recruited from 4 tertiary hospitals by random selection from the list of tertiary hospitals in Nigeria. Participants will be randomized and assigned in parallel into two arms using random numbers generated from GraphPad Prism (version 9) by a clinical pharmacologist who has no link with the investigators, the patients, or the statistician. The primary measurable outcome is survival at 12, 24, and 48 h post-randomization. A composite secondary outcome consists of the number of children that regained consciousness, parasitaemia and defervescence at 12 and 24 h post-randomization and haematological and inflammatory markers at 24 and 48 h post-randomization. Adverse events both solicited and unsolicited are recorded all through the study post-randomization. The study is approved by the State Research Ethics Review Committee. Data analysis will be performed in GraphPad Prism version 9. Discussion The outcome of this analysis will give insight into the efficacy and safety of dual intravenous antimalaria in the treatment of cerebral malaria among Nigerian children compared with the standard of care. The safety profile of this intervention will also be highlighted. This may help inform physicians on the optimal treatment for cerebral malaria to improve outcomes and reduce recrudescence and treatment failure. Trial registration Pan Africa Clinical Trial Registry PACTR202102893629864. 23/02/2021.


2021 ◽  
Vol 48 (2) ◽  
pp. 99-101
Author(s):  
E. Udo ◽  
I. Precious Oloyede ◽  
E.U. Bassey ◽  
O. Udoh

Histiocytoses are a rare group of proliferative disorders with very similar clinical and histological pictures. We present a case report of two variants seen in an eight-month-old female and five-month-old male in a tertiary hospital in southern Nigeria. They both presented with painless neck swellings and fever, leucocytosis, neutrophilia and lymphopenia. Initial histologic examinations of the cervical lymph nodes biopsy posed a diagnostic conundrum. However, Immuno-histochemical analysis done on both sample showed CD1a, positive S100 in keeping with Langerhans cell histiocytosis in the former. While, that of the latter showed strongly positive CD68, positive S-100 in 30% cells in keeping with Sinus histiocytosis with massive lymphadenopathy (SLMH) in the latter. Clinicians should have a high index of suspicion for histiocytosis in children presenting with generalised lymphadenopathy. Also, apart from the routine histology, immunohistochemistry analysis is recommended for all cases


2021 ◽  
Vol 15 (07) ◽  
pp. 953-961
Author(s):  
Bankole Peter Kuti ◽  
Hammed Hassan Adetola ◽  
Oyeku Akibu Oyelami

Introduction: Micronutrients are essential minerals and vitamins needed for optimal health. There are however conflicting reports about the roles of micronutrients in severity and outcomes of childhood pneumonia. This study aims to determine the socio-demographic and serum micronutrients – Zinc (Zn), Selenium (Se), Vitamins (Vit) A, C and E status of Nigerian children with or without pneumonia and relate these to pneumonia severity and outcome. Methodology: Children aged two months to 14 years with severe and non-severe pneumonia were recruited with age and sex-matched controls over 12 month period in a Nigerian tertiary health centre. Relevant history and serum micronutrients were compared in the two groups and related to pneumonia severity and length of hospitalisation (LOH). Results: One hundred and forty-four children (72 for each group) were recruited with median (IQR) age 1.6 (0.6 – 4.0) years and fifty-six (38.8%) had severe pneumonia. Pneumonia incidence was associated with undernutrition, inappropriate immunisation and Zn deficiency (p < 0.05). Hypovitaminosis A [60.8(22.2)µg/dl vs. 89.5(34.7)µg/dl; p < 0.001], low serum Zn [71.6(32.5)µg/dl vs. 92.6(24.6)µg/dl; p=0.019] and indoor air pollution (IAP) were associated with pneumonia severity. However, only IAP (OR = 4.529; 95%CI 1.187–17.284; p=0.027) and Zn deficiency (OR=6.144; 95%CI 1.157–32.617; p=0.033) independently predicted severe pneumonia. No significant correlation between serum micronutrients and LOH. Conclusions: Exposure to IAP and low serum micronutrients particularly Zn and Vit A were associated with pneumonia incidence and severity in Nigerian children. Routine micronutrient supplementation may assist to reduce the burden of childhood pneumonia in developing countries.


2021 ◽  
pp. 0192513X2110307
Author(s):  
Bayode I. Popoola ◽  
Funmi Togonu-Bickersteth ◽  
Joshua Aransiola ◽  
Akinjide Akintomide ◽  
Opeyemi Ekundayo

The article investigated educational challenges of Nigerian children raised in an unusual family context, the skipped generation households (SGHs). Specifically, it determined the proportion of school-age children in SGHs enrolled in schools and investigated children’s perception of the effect of SGHs on their education. The study adopted a descriptive survey design. Data were collected from 2144 indexed children from the three major ethnic groups in Nigeria. The results showed that 88.2% of children in SGHs were enrolled in schools, and that significant regional variations existed in school attendance by the children. Specific educational challenges of the children in SGHs included having to do assignment alone, not getting enough time to study, difficulty in paying school fees, and late coming to school. The article brought to the fore the need for government to improve the welfare of children raised in SGHs in order to mitigate the educational challenges confronting them.


Hemoglobin ◽  
2021 ◽  
pp. 1-6
Author(s):  
Maxwell U. Anah ◽  
Anthony C. Nlemadim ◽  
Chigozie I. Uzomba ◽  
Egorp O. Ineji ◽  
Friday A. Odey

Author(s):  
Tom D Thacher ◽  
Christopher T Sempos ◽  
Ramon A Durazo-Arvizu ◽  
Philip R Fischer ◽  
Craig F Munns ◽  
...  

Abstract Context Nutritional rickets results from the interaction of low vitamin D status and limited calcium intake. Serum alkaline phosphatase (AP) activity is a biomarker of impaired mineralization in rickets. Objective To assess the performance of serum AP activity in identifying nutritional rickets in calcium-deprived Nigerian children. Design, setting, and participants We reanalyzed data from a case-control study of children with active rickets and matched control subjects without rickets, using a multivariate logistic regression to assess the odds of rickets associated with AP activity, adjusting for age, sex, and weight for age z-score. Results A total of 122 children with rickets and 119 controls were included. Rachitic children had a mean (±SD) age of 54±29 months, and 55 (45.1%) were male. Cases and controls had low dietary calcium intakes (216±87 and 214±96 mg/day, respectively). Serum AP activity levels in cases and controls were 812±415 and 245±78 U/L, respectively (P&lt;0.001). AP was negatively associated with 25-hydroxyvitamin D values (r=-0.34; P&lt;0.001). In the adjusted model, the odds ratio (95% confidence interval) for rickets was 6.7 (4.1-12.2) for each 100 U/L increase in AP. The area under the receiver operating characteristic curve was 0.978. AP &gt;350 U/L identified nutritional rickets in Nigerian children with sensitivity 0.93, specificity 0.92, positive likelihood ratio 11.3, and negative likelihood ratio 0.07. Conclusions An AP &gt;350 U/L effectively discriminated between Nigerian children with and without nutritional rickets. AP is a low-cost biochemical test that could be used to screen for nutritional rickets, but cut-off values require validation in other populations, and laboratory values need to be standardized for widespread population studies.


2021 ◽  
Vol 22 (2) ◽  
pp. 170-178
Author(s):  
K.S. Akinwande ◽  
G.O. Arinola

Background: Intestinal helminth infection is associated with altered immune responses and compromised vaccine efficacy in infected children. Altered immune response due to Ascaris lumbricoides infection may compromise efficacy of oral poliovirus vaccination in children. There is no information on humoral immune response during oral poliovirus (OP) vaccination of A. lumbricoides–infected Nigerian children. The objective of this study is to determine the serum levels of cytokines (tumour necrosis factor–alpha TNF-α,  interferongamma IFN–γ, interleukins -4, -6, -8, -10) and poliovirus-specific IgA (PV-IgA) antibody in children infected with A. lumbricoides compared with helminth-negative children (control) before and after oral poliovirus vaccination. Methodology: Twenty-three A. lumbricoides-infected children between ages 5-15 years (13 males and 10 females) and 23 age (4-15 years) and sex-matched helminth-negative children who met selection criteria were enrolled into the study after ethical approval and informed consent. Their stool samples were examined for helminth ova using concentration technique. Sera were collected before and 3 weeks after OP vaccinations, and serum concentrations of IFN–γ, TNF–α, IL-4, -6, -8, -10, and poliovirus-specific IgA concentrations were determined by enzyme-linked immunosorbent assay. The level of statistical significance was set at α0.05. Results: Pre-vaccination serum levels of IFN–γ, IL–4, IL-6 and IL-8 were significantly higher in A. lumbricoides–infected children compared with pre-vaccination levels in helminth-negative children. Postvaccination serum levels of IFN–γ, IL–4 and IL-8 were  significantly higher in A. lumbricoides–infected children compared with post-vaccination serum levels in helminth-negative children. In the A. lumbricoides-infected children, pre-vaccination serum levels of IL-6 and IL-8 were significantly higher compared with post vaccination levels while pre-vaccination serum levels of IFN–γ, IL–4 and IL-8 were significantly higher in helminth-negative children compared with the post-vaccination levels. There was no significant reduction in post-vaccination median serum level of PV-IgA  compared with level before vaccination in A. lumbricoides-infected children. Also, there was no significant increase in post-vaccination median serum level of PV-IgA compared with level before vaccination in helminth-negative children. Conclusion: Oral polio vaccine administration caused decrease expression of inflammatory cytokines (IL-6 and IL-8) in A. lumbricoides-infected school children, and A. lumbricoides infection may reduce PV-IgA production following OP vaccination. Keywords: Ascaris lumbricoides infection, cytokines, children, poliovirus vaccination


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