Anemia is a major cause of morbidity and mortality among patients with sickle cell anemia. In this study, 108 episodes of severe anemia were prospectively evaluated in 108 patients with hemoglobin SS disease attending the pediatric sickle cell clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Young children between the ages of 2 and 4 years were found to be at the greatest risk of developing anemic crises (severe anemia). There was a gradual but progressive decline in the incidence of severe anemia in the age range 8-16 years old. Upper respiratory tract infections are the most commonly associated infections in patients with severe anemia. Others included malaria, septicemia, urinary tract infection, acute chest syndrome, and osteomyelitis. Their role in precipitating episodes of severe anemia among the patients studied could not be fully evaluated. Pallor, jaundice, and fever were the most commonly encountered symptoms in patients with severe anemia on admission. About half of the parents/guardians failed to notice severe anemia among the patients studied, perhaps due to the dark color of the African skin. Caregivers need to be educated on how to recognize anemia among patients with sickle cell anemia when they develop febrile episodes. Am. J. Hematol. 72:185-191, 2003.
Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has continued to disrupt medical care among patients with sickle cell anemia (SCA). The city lockdowns and restrictions to minimize virus transmission in countries have created gaps in the optimal management of children with SCA. Aim: The aim of this study was to access the clinical experience in the use of mobile health telemedicine for the care of children with SCA. Methods: At the start of national lockdown, text messages were sent to parents of children with SCA who are attending a tertiary hospital in Nigeria. The message included advice to call consultants in the pediatric hemato-oncology unit whenever their wards were sick or due for a routine clinic visit. Information obtained include date of call or text message, complaints, intervention prescribed, and feedback from the parents. Results: There were 115 calls and 43 texts from the parents from April through July 2020. The proportion of calls increased from 16.5% to 33.9%, while texts increased from 23.3% to 30.2% over the months. Responses were significant (P = 0.047). Respiratory symptoms (40%) were the most common complaints. The most frequent interventions were counseling (59%) and drug prescriptions (31%) with the resolution of most symptoms by day 7 (P < 0.001). Parents (60.8%) preferred phone interactions across the months (P < 0.05). No confirmed case of SARS-CoV-2 was recorded. Conclusion: Mobile health telemedicine is a beneficial tool in the maintenance of care and possibly prevention of SARS-CoV-2 infection among children with SCA in a resource-limited region. Efforts should be made by stakeholders to institute and promulgate telemedicine during this pandemic.
Background: Microalbuminuria and serum creatinine are markers of acute kidney injury. Birth asphyxia is responsible for 50% of all newborn deaths and acute non-oliguric kidney injury is one of such complications. This study was undertaken to determine the efficacy of serum creatinine and microalbuminuria for the detection of early renal lesion in severely asphyxiated babies in Calabar, Nigeria. Materials and Method: This prospective cross-sectional investigational study was undertaken among severely asphyxiated babies admitted into the newborn units of the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Standard method for blood collection and determination of urea, electrolytes were used. Micral-test strips were used on samples negative only for albumin after using urine dipstick. Color comparison was done with the standardized color scale on test strip container after 5 minutes. Results: Fifty term newborn babies were enrolled, their serum electrolytes, creatinine and creatinine clearance were essentially normal. Six (12%) babies had positive microalbuminuria, while 44(88%) had negative microalbuminuria with specificity and negative predictive values of 100% and 88% respectively. Conclusion: Microalbuminuria was not useful for early detection of acute renal failure in babies with severe birth asphyxia, but further studies are recommended.
Background: Low serum calcium (hypocalcemia) occurs in sickle cell anaemic (SCA) children. Concomitant presence of prolonged corrected QT (QTc) interval on electrocardiogram can ascertain hypocalcemia, especially during vaso-occlusive painful crises (VOC). Aim: The aim of the study was to determine the relationship between hypocalcemia and VOC. Methods: It was a prospective cohort study of 38 SCA children aged 4–17 years during VOC and when the same children were in steady state. Information regarding bone pain and clinical examination were obtained, following which electrocardiography was done during both clinical states. Blood was drawn for total calcium and serum albumin estimation. Results: The mean (standard deviation [SD]) of total calcium was significantly lower during VOC (1.90 [0.19] mmol/l) than during follow-up steady state (2.24 [0.22] mmol/l), P < 0.001. The mean rank of QTc interval was significantly higher during VOC (19.93) than in follow-up steady state (14.50), P < 0.001. Total calcium negatively correlated with QTc intervals during VOC (r s [36] = −0.36, P = 0.029) and follow-up steady state (r s[36] = −0.49, P = 0.002), while QTc interval was highly predictive of hypocalcemia (area under the curve [AUC] = 0.82, P < 0.001). Similarly, total calcium was highly predictive of VOC (AUC = 0.89, P < 0.001) at cutoff point of 2.13 mmol/l with 89.5% sensitivity and 81.6% specificity. Hypocalcemia was significantly observed during VOC than follow-up steady state (89.5% vs. 21.1%, P < 0.001) with odds ratio of 21.28 (95% confidence interval: 0.012–0.189; P < 0.001). Conclusion: Total calcium <2.13 mmol/l is associated with VOC. Regular total calcium tests should be done. SCA children may benefit from routine oral calcium to reduce frequency of VOC.
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