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Preview: Journal of Tropical Pediatrics - current issue

Journal of Tropical Pediatrics Current Issue

Published: Tue, 23 May 2017 00:00:00 GMT

Last Build Date: Sat, 27 May 2017 07:46:01 GMT


In this Issue 63/3


Transfer of the Sick Neonate: What Is Needed?


Globally, the under-5 mortality has reduced over the past two decades, but not sufficiently enough to reach the Millennium Development Goal (MDG) 4. The under-5 mortality was 91 per 1000 live births in 1990 and reduced to 43 per 1000 live births in 2015, the year defined to reach the MDG targets. The difference in the rates in high-income countries (7 deaths per 1000) was nearly 10-fold lower. Recently, the international community has set up the sustainable development goals, where the target is to reduce under-5 mortality to 25 per 1000 live births globally by 2030 [1].

Lipid Peroxidation and Altered Antioxidant Profiles with Pediatric HIV Infection and Antiretroviral Therapy in Addis Ababa, Ethiopia


HIV- and highly active antiretroviral therapy (HAART)-associated elevations in oxidative stress likely play a role in incomplete immune reconstitution, opportunistic infections and non-AIDS co-morbidities. We aimed to test the hypothesis that children living with HIV exhibit elevated markers of oxidative stress and reduced antioxidant profiles and that HAART-therapy will exacerbate these differences. HIV-positive HAART-naïve (n = 50) and HAART-treated (n = 50) and HIV-negative control (n = 50) participants, 3–15 years of age, were recruited from Black Lion Hospital in Ethiopia. Serum malondialdehyde (MDA) and bilirubin were higher and vitamin C and zinc were lower in HAART-naïve and HAART-treated compared with HIV-negative subjects and higher in HAART-treated compared with HAART-naïve subjects. Uric acid was higher in HAART-naïve compared with HAART-treated and HIV-negative subjects. Differences in MDA and several antioxidants were also observed across treatment regimens. Thus, children living with HIV exhibited systemic elevations in oxidative stress and reduction in antioxidants, which are exacerbated with HAART therapy.

Prevalence of Hypertension in Nigerian Children and Adolescents: A Systematic Review and Trend Analysis of Data from the Past Four Decades


Despite four decades of research, there is no systematic review and trend analysis on paediatric (pre)hypertension in Nigeria. This article reviewed data from cross-sectional studies on the subject. From the initial 9334 articles identified, 30 studies that met the inclusion criteria were systematically reviewed. Data from studies that defined hypertension as blood pressure (BP) greater than the 95th percentile for age, height and sex gave a prevalence of 8.2% [95% confidence interval (CI): 3.6–28.2%] for prehypertension and 5.1% (95% CI: 2.9–8.6%) for hypertension. For studies that defined hypertension as BP greater than 2 SD points from the mean of the population, the prevalence of hypertension was found to be 4.0% (95% CI: 2.8–5.7%). A significant negative trend (Z = −0.89; α < 0.01) with small magnitude (Q = −0.019; 95% CI: −0.070 to 0.028) was found for hypertension in the reviewed population. The prevalence of (pre)hypertension in Nigerian children and adolescents is moderate but has slightly declined over time.

Zika Virus: A Serious Global Health Threat


In February 2016, the World Health Organization declared Zika virus (ZIKV) infection a public health emergency of international concern, given the precipitous spread of the virus across the Americas. Unlike arboviruses such as Chikungunya and Dengue, which have also recently emerged in the western hemisphere, ZIKV was identified in communities where concurrent neurologic conditions such as microcephaly and Guillain-Barre (GB) syndrome were occurring at alarming rates. Thus, investigations to systematically evaluate the link between ZIKV, congenital malformations (including microcephaly) and GB syndrome remain a top priority.

Subcutaneous Basidiobolomycosis Resembling Fournier’s Gangrene


Basidiobolomycosis is an uncommon cutaneous zygomycete infection typically seen in immunocompetent individuals. Diagnosis can be made by biopsy and fungal culture of the lesion. Treatment with Potassium iodide and co-trimoxazole is simple and effective. Early and accurate diagnosis of basidiobolomycosis is essential to avoid dissemination and mortality. We present a case with basidiobolomycosis resembling Fournier’s gangrene.

Vitamin D Levels in Malnourished Children under 5 Years in a Tertiary Care Center at Muhimbili National Hospital, Dar es Salaam, Tanzania—A Cross-sectional Study


Objective: To evaluate vitamin D levels/deficiency among malnourished children <5 years admitted at a tertiary care center, the Muhimbili National Hospital, Dar es Salaam, Tanzania. Children with malnutrition may have co-existing vitamin D deficiency (VDD), which may be severe.Methods: Serum vitamin D and alkaline phosphatase were evaluated, and X-ray of the wrist was carried out on 134 children.Results: VDD was found in 41 of 134 children (30.6%). The mean vitamin D level was 74.8 nmol/l. The mean alkaline phosphatase level was 176.6 U/l. Sixty-four (48%) children were found to have severe stunting, of whom 20 (31.2%) were vitamin D deficient. Marasmic children had higher odds of VDD compared with other forms of malnutrition.Conclusion: The high prevalence of VDD in malnourished children underlines the need for active surveillance and aggressive management.

Malignancies in Children with Human Immunodeficiency Virus Infection – Our Experience at Chandigarh, North India


Background: With improved survival in children living with human immunodeficiency virus (HIV) infection (CLHIV), malignancies are being increasingly recognized.Patients and methods: Among the CLHIV registered at our institute from January 1994 to March 2015, children with malignancy were analysed in detail.Results: In total, 734 children affected by HIV were registered. Out of these, 11 children (9 boys, 2 girls) were diagnosed to have malignancy. Malignancy was the presenting feature of HIV infection in 4 children. High-grade non-Hodgkin lymphoma (NHL) was the most common malignancy noted in 9 of 11 (81%) children, whereas the remaining 2 children had Hodgkin’s lymphoma. Survival in our cohort was 80% among children in whom chemotherapy was initiated, and overall survival was 36% (4 of 11 children).Conclusion: NHL was the most common malignancy in CLHIV in our cohort. Low-conditioning chemotherapy protocols along with initiation of anti-retroviral therapy resulted in improved outcomes in CLHIV with malignancy.

Improved Neonatal Mortality at a District Hospital in Aweil, South Sudan


Neonatal deaths comprise a growing proportion of global under-five mortality. However, data from the highest-burden areas is sparse. This descriptive retrospective study analyses the outcomes of all infants exiting the Médecins sans Frontières-managed neonatal unit in Aweil Hospital, rural South Sudan from 2011 to 2014. A total of 4268 patients were treated over 4 years, with annual admissions increasing from 687 to 1494. Overall mortality was 13.5% (n = 576), declining from 18.7% to 11.1% (p for trend <0.001). Newborns weighing <2500 g were at significantly increased mortality risk compared with babies ≥2500 g (odds ratio = 2.27, 95% confidence interval = 1.9–2.71, p < 0.001). Leading causes of death included sepsis (49.7%), tetanus (15.8%), respiratory distress (12.8%) and asphyxia (9.2%). Tetanus had the highest case fatality rate (49.7%), followed by perinatal asphyxia (26.5%), respiratory distress (20.4%) and neonatal sepsis (10.5%). Despite increasing admissions, overall mortality declined, indicating that survival of these especially vulnerable infants can be improved even in a basic-level district hospital programme.

Comparison of Two Low-cost Methods of Cooling Neonates with Hypoxic Ischemic Encephalopathy


Background: Several low-cost methods are used in resource-limited settings to provide therapeutic hypothermia in asphyxiated neonates. There is inadequate data about their efficacy and safety. Methods: This is a retrospective study comparing two low-cost cooling methods—frozen gel packs (FGP) and phase changing material (PCM). Results: There were 23 babies in FGP and 45 babies in the PCM group. Induction time was significantly shorter with FGP than PCM (45 vs. 90 minutes; p-value < 0.001). Proportion of temperature readings outside the target range was significantly higher (9.8% vs. 3.8%; p-value < 0.001) and fluctuation of core body temperature was wider (standard deviation of target temperature 0.4 °C vs. 0.28 °C) in the FGP group, compared with PCM group.Conclusion: Both FGP and PCM are effective and safe, comparable with standard servo-controlled cooling equipment. PCM has the advantage of better maintenance of target temperature with less nursing input, when compared with FGP.

Epidemiological Features of Hand, Foot and Mouth Disease during the Period of 2008–14 in Wenzhou, China


This study aimed to analyze the epidemiological characteristics of hand, foot and mouth disease (HFMD) during 2008–14 in Wenzhou, China. The epidemiological data of HFMD retrieved from the Wenzhou Center for Disease Control and Prevention were retrospectively analyzed. HFMD infections with enterovirus 71 (EV71), Cox A16 or other pathogens were further verified by polymerase chain reaction (PCR) and real-time PCR. A total of 213 617 cases of HFMD were reported between 2008 and 2014 in Wenzhou. The average incidence was 384.31 of 100 000, and the fatality rate was 0.14‰. The incidence of HFMD peaked between April and July, and it occurred more frequently in males than in females. Approximately 92.68% of the HFMD patients were children aged <5 years. Nearly 80% of the cases were diagnosed within 2 days after onset. The major HFMD pathogen was EV71. This study suggested that appropriate comprehensive prevention and control measures should be taken to avoid the spread of HFMD.

Clinical Predictors of Multiple Organ Dysfunction Syndromes in Pediatric patients with Scrub Typhus


Scrub typhus can produce multiple organ dysfunction syndrome (MODS). Early recognition of the patients at risk of MODS would be helpful in providing timely management and reducing the mortality. In all, 449 children with scrub typhus were enrolled at three hospitals in Yunnan, China from January 2010 to January 2015. The patients’ clinical status of organ system dysfunction was evaluated on the day of discharge from hospital by using standard criteria. The patients were classified into MODS present (64 cases, 14.3%) or MODS absent (385 cases, 85.7%). Multivariate logistic regression analyses revealed that the prognostic factors for MODS included skin rash (odds ratio, OR = 3.3, p = 0.037), time interval form treatment to defervescence (OR = 1.2, p = 0.035), hemoglobin (OR = 0.54, p = 0.041), platelet counts (OR = 0.06, p < 0.001), aspartate-aminotransferase (OR = 4.7, p = 0.011) and total bilirubin (OR = 2.3, p = 0.013). By describing risk factors resulting in MODS in pediatric scrub typhus, our study provides clinicians with important information to improve the clinical monitoring and prognostication of MODS.

Review of Naturally Occurring Intussusception in Young Children in the WHO African Region prior to the Era of Rotavirus Vaccine Utilization in the Expanded Programme of Immunization


Rotavirus vaccines, Rotarix and RotaTeq, are increasingly being introduced in national immunization programmes in Africa to prevent severe dehydrating acute gastroenteritis. A low-level risk of intussusception has been associated with rotavirus vaccines. We reviewed published data on intussusception in children <2 years of age in Africa. PubMed electronic database search was used to retrieve papers published on intussusception. The search was further refined to identify surveillance reports and case series conducted from 1980 to 2014, with at least 25 cases. The initial search identified 34 studies, and the refined search yielded 16. Intussusception occurred naturally in infants 2–4 months and peaked around 5–8 months of age. Delayed presentation was common and required surgical intervention in 87% (1008 of 1158) of cases with a high CFR, 10–33.7%. In African children, intussusception has been reported infrequently at a young age when the first dose of rotavirus vaccine is administered.