Pub Date : 2023-05-24DOI: 10.7196/sajch.2023.v17i2.1951
K Persad, L Nandlal, R Bhimma, T Naicker
Background. Africa has the highest rate of HIV infection, and HIV-associated nephropathy (HIVAN) is one of the most frequent kidneydiseases observed in children. HIVAN in children usually presents as a form of nephrotic syndrome, predominantly focal segmentalglomerulosclerosis (FSGS) on histopathology, that often leads to chronic kidney failure.Objective. This study determined the urinary concentrations of β-2-microglobulin (β2M) and cystatin C proteins in children with HIVANand primary FSGS.Methods. The study group comprised 34 children; 14 with HIVAN and 20 with primary FSGS. The control groups were 20 HIV-positiveand 20 HIV-negative children with no kidney disease. Urine samples collected from these 74 children were stored at -80°C. Bio-Plextechnology was used to analyse the urinary protein concentration of cystatin C and β2M.Results. A significant increase in urinary β2M levels was observed in the HIVAN group compared with the HIV-negative group(p=0.0240). No other statistically significant differences in urinary β2M concentrations were noted across the study groups. Urinarycystatin C levels were significantly increased in primary FSGS children compared with both HIV-negative (p=0.0041) and HIV-positivecontrols (p=0.0256). Urinary cystatin C displayed a significant increase in the primary FSGS compared with the HIVAN group (p=0.0150).No significant differences in urinary cystatin C levels were noted in the HIVAN group compared with the HIV-negative and HIV-positivecontrol groups.Conclusion. Urinary cystatin C has promising prognostic value to predict primary FSGS from HIVAN.
{"title":"The role of β-2-microglobulin and cystatin C as urinary biomarkers of focal segmental glomerulosclerosis in the setting of paediatric HIV infection","authors":"K Persad, L Nandlal, R Bhimma, T Naicker","doi":"10.7196/sajch.2023.v17i2.1951","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1951","url":null,"abstract":"Background. Africa has the highest rate of HIV infection, and HIV-associated nephropathy (HIVAN) is one of the most frequent kidneydiseases observed in children. HIVAN in children usually presents as a form of nephrotic syndrome, predominantly focal segmentalglomerulosclerosis (FSGS) on histopathology, that often leads to chronic kidney failure.Objective. This study determined the urinary concentrations of β-2-microglobulin (β2M) and cystatin C proteins in children with HIVANand primary FSGS.Methods. The study group comprised 34 children; 14 with HIVAN and 20 with primary FSGS. The control groups were 20 HIV-positiveand 20 HIV-negative children with no kidney disease. Urine samples collected from these 74 children were stored at -80°C. Bio-Plextechnology was used to analyse the urinary protein concentration of cystatin C and β2M.Results. A significant increase in urinary β2M levels was observed in the HIVAN group compared with the HIV-negative group(p=0.0240). No other statistically significant differences in urinary β2M concentrations were noted across the study groups. Urinarycystatin C levels were significantly increased in primary FSGS children compared with both HIV-negative (p=0.0041) and HIV-positivecontrols (p=0.0256). Urinary cystatin C displayed a significant increase in the primary FSGS compared with the HIVAN group (p=0.0150).No significant differences in urinary cystatin C levels were noted in the HIVAN group compared with the HIV-negative and HIV-positivecontrol groups.Conclusion. Urinary cystatin C has promising prognostic value to predict primary FSGS from HIVAN.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135140244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.7196/sajch.2023.v17i2.1945
D Reddy, A Coetzee, K Webb, M McCulloch, P Nourse
Background. Histopathological patterns of childhood primary nephrotic syndrome (PNS) and clinical response to steroids have beenassociated with certain race groups in parts of South Africa. However, there are no recent studies of childhood PNS in Cape Town.Objectives. To describe the demographics, histological subtypes and steroid response of patients with PNS who underwent kidney biopsiesat Red Cross War Memorial Children’s Hospital (RCWMCH) over a 10-year period.Methods. Details of patients with PNS who underwent kidney biopsies in the Paediatric Nephrology Department at RCWMCH between2006 and 2015 were retrospectively recorded.Results. A total of 103 patients were included in the study. Most patients were either of mixed race (42%) or black (36%), with a mean age of6.8 years and a male-to-female ratio of 1.19:1. The most identified histopathological subtype was mesangioproliferative glomerulonephritis(MesPGN; 60% (n/N=62/103)). Of the patients with focal segmental glomerulosclerosis (FSGS), MesPGN and minimal change disease(MCD) 45% (n/N=43/95) were steroid-resistant, and 54% (n/N=51/95) were steroid-sensitive. There was no significant associationbetween any race group and steroid response. Patients with FSGS were more likely to be black, while MCD was more common in mixed-race patients (p=0.04). There was no difference in the likelihood of being mixed race or black between patients with FSGS and MesPGN(p=0.472).Conclusion. MesPGN was the most common histopathological subtype found in our study. There was no significant association betweenrace and steroid response. Patients with FSGS were more likely to be black than mixed race when compared with MCD patients. Race wasnot otherwise significantly associated with any histopathological subtype
背景。在南非部分地区，儿童原发性肾病综合征(PNS)的组织病理学模式和对类固醇的临床反应与某些种族群体有关。然而，最近在开普敦没有关于儿童PNS的研究。描述在红十字战争纪念儿童医院(RCWMCH)接受肾活检的PNS患者10年期间的人口统计学、组织学亚型和类固醇反应。回顾性记录2006年至2015年期间在RCWMCH儿科肾内科接受肾活检的PNS患者的详细信息。研究共纳入103例患者。大多数患者为混血(42%)或黑人(36%)，平均年龄为6.8岁，男女比例为1.19:1。最常见的组织病理学亚型是系血管增殖性肾小球肾炎(MesPGN;60% (n / n = 62/103))。局灶节段性肾小球硬化(FSGS)、MesPGN和最小改变病(MCD)患者中，45% (n/ n =43/95)为类固醇耐药患者，54% (n/ n =51/95)为类固醇敏感患者。任何种族和类固醇反应之间没有明显的联系。FSGS患者多为黑人，而MCD患者多为混血儿(p=0.04)。FSGS患者与MesPGN患者混血或黑人的可能性无差异(p=0.472)。MesPGN是我们研究中发现的最常见的组织病理学亚型。在种族和类固醇反应之间没有明显的关联。与MCD患者相比，FSGS患者更有可能是黑人而不是混血儿。种族与任何组织病理学亚型均无显著相关性
{"title":"Primary nephrotic syndrome in children in Cape Town, South Africa","authors":"D Reddy, A Coetzee, K Webb, M McCulloch, P Nourse","doi":"10.7196/sajch.2023.v17i2.1945","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1945","url":null,"abstract":"Background. Histopathological patterns of childhood primary nephrotic syndrome (PNS) and clinical response to steroids have beenassociated with certain race groups in parts of South Africa. However, there are no recent studies of childhood PNS in Cape Town.Objectives. To describe the demographics, histological subtypes and steroid response of patients with PNS who underwent kidney biopsiesat Red Cross War Memorial Children’s Hospital (RCWMCH) over a 10-year period.Methods. Details of patients with PNS who underwent kidney biopsies in the Paediatric Nephrology Department at RCWMCH between2006 and 2015 were retrospectively recorded.Results. A total of 103 patients were included in the study. Most patients were either of mixed race (42%) or black (36%), with a mean age of6.8 years and a male-to-female ratio of 1.19:1. The most identified histopathological subtype was mesangioproliferative glomerulonephritis(MesPGN; 60% (n/N=62/103)). Of the patients with focal segmental glomerulosclerosis (FSGS), MesPGN and minimal change disease(MCD) 45% (n/N=43/95) were steroid-resistant, and 54% (n/N=51/95) were steroid-sensitive. There was no significant associationbetween any race group and steroid response. Patients with FSGS were more likely to be black, while MCD was more common in mixed-race patients (p=0.04). There was no difference in the likelihood of being mixed race or black between patients with FSGS and MesPGN(p=0.472).Conclusion. MesPGN was the most common histopathological subtype found in our study. There was no significant association betweenrace and steroid response. Patients with FSGS were more likely to be black than mixed race when compared with MCD patients. Race wasnot otherwise significantly associated with any histopathological subtype","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.7196/sajch.2023.v17i1.1929
C. van der Bijl, W. J. Steinberg, T. E. Kellerman, J. Botes, C. van Rooyen
Background. Doctor mothers are a high-risk group for early cessation of breastfeeding. Improving breastfeeding among doctor mothers would not only improve the wellbeing of their babies, but the experience might also enhance their advocacy for breastfeeding to patients.Objective. To describe the infant feeding intentions and behaviours of doctor mothers in Bloemfontein, South Africa, focusing onbreastfeeding and factors that impact the decision on feeding method.Methods. This was a descriptive study. The target population included female medical doctors with a biological child under the ageof 5 years, recruited via snowball sampling. Respondents completed an electronic questionnaire, answering questions regarding infantfeeding intentions and behaviours.Results. There were 104 respondents who provided information on 132 children. The median intended duration of exclusivebreastfeeding for the first-born child was 6 months and 6.5 months for the second-born, but the actual median duration for bothchildren was 3 months shorter. The intention to express breastmilk at work was 67.7% for Child 1 and 57.7% for Child 2; however,the actual outcome was less than half of the intention (32.0%). Most respondents (71.0%) indicated there was no dedicated area forexpressing breastmilk at their place of work.Conclusion. The intention to exclusively breastfeed was high (6 months), but the actual duration was 3 months shorter. The percentage of doctor mothers who eventually expressed breastmilk at work was less than half of those who intended to do so. Breastfeeding female doctors need more support in the postpartum period, especially when returning to work after maternity leave
{"title":"Breastfeeding intentions and behaviours of doctor mothers in Bloemfontein, South Africa","authors":"C. van der Bijl, W. J. Steinberg, T. E. Kellerman, J. Botes, C. van Rooyen","doi":"10.7196/sajch.2023.v17i1.1929","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1929","url":null,"abstract":"Background. Doctor mothers are a high-risk group for early cessation of breastfeeding. Improving breastfeeding among doctor mothers would not only improve the wellbeing of their babies, but the experience might also enhance their advocacy for breastfeeding to patients.Objective. To describe the infant feeding intentions and behaviours of doctor mothers in Bloemfontein, South Africa, focusing onbreastfeeding and factors that impact the decision on feeding method.Methods. This was a descriptive study. The target population included female medical doctors with a biological child under the ageof 5 years, recruited via snowball sampling. Respondents completed an electronic questionnaire, answering questions regarding infantfeeding intentions and behaviours.Results. There were 104 respondents who provided information on 132 children. The median intended duration of exclusivebreastfeeding for the first-born child was 6 months and 6.5 months for the second-born, but the actual median duration for bothchildren was 3 months shorter. The intention to express breastmilk at work was 67.7% for Child 1 and 57.7% for Child 2; however,the actual outcome was less than half of the intention (32.0%). Most respondents (71.0%) indicated there was no dedicated area forexpressing breastmilk at their place of work.Conclusion. The intention to exclusively breastfeed was high (6 months), but the actual duration was 3 months shorter. The percentage of doctor mothers who eventually expressed breastmilk at work was less than half of those who intended to do so. Breastfeeding female doctors need more support in the postpartum period, especially when returning to work after maternity leave","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49266976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.7196/sajch.2023.v17i1.xx
T. C. Gcaba, R. Singh, P. Jeena
Background. The routine use of empiric antibiotics in neonates born to mothers with prolonged rupture of membranes (PROM) iscontroversial.Objectives. To determine the incidence of probable and proven sepsis in such neonates and identify risk factors for sepsis and theiroutcomes.Methods. This was a retrospective chart review conducted at King Edward VIII Hospital over two years. Study participants included 200neonates and 181 mothers. Data were captured onto Microsoft Excel, collated and analysed using descriptive statistics and comparative data utilising the R Core Team’s R Statistical Computing Software, 2020.Results. Seven neonates (3.5%) had proven sepsis, 58 (29%) had probable sepsis, and 135 (67.5%) were without sepsis. Two (1.0%) neonates died and 188 (94.0%) received antibiotics. White cell count was normal in all cases without sepsis and abnormal in 65.5% and 28.6% of cases with probable and proven sepsis, respectively. A raised C-reactive protein was observed in only 22.4% and 14.3% of neonates with probable and proven sepsis, respectively. One hundred and sixty-seven (83.5%) mothers had no Group B Streptococcus (GBS) screening. Of those screened, three had GBS infection, but two did not receive antibiotics.Conclusions. The incidence of sepsis following PROM is low. Identifying neonates at risk is challenging, but the absence of clinical features and normal rapidly obtained supportive laboratory markers of sepsis provides reassurance that antibiotics could be temporarily withheld. Better GBS screening programmes and appropriate antibiotic responses for pregnant women should be implemented rigorously.
{"title":"The value of routine empiric antibiotic use in neonates born to mothers with prolonged rupture of membranes","authors":"T. C. Gcaba, R. Singh, P. Jeena","doi":"10.7196/sajch.2023.v17i1.xx","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.xx","url":null,"abstract":"Background. The routine use of empiric antibiotics in neonates born to mothers with prolonged rupture of membranes (PROM) iscontroversial.Objectives. To determine the incidence of probable and proven sepsis in such neonates and identify risk factors for sepsis and theiroutcomes.Methods. This was a retrospective chart review conducted at King Edward VIII Hospital over two years. Study participants included 200neonates and 181 mothers. Data were captured onto Microsoft Excel, collated and analysed using descriptive statistics and comparative data utilising the R Core Team’s R Statistical Computing Software, 2020.Results. Seven neonates (3.5%) had proven sepsis, 58 (29%) had probable sepsis, and 135 (67.5%) were without sepsis. Two (1.0%) neonates died and 188 (94.0%) received antibiotics. White cell count was normal in all cases without sepsis and abnormal in 65.5% and 28.6% of cases with probable and proven sepsis, respectively. A raised C-reactive protein was observed in only 22.4% and 14.3% of neonates with probable and proven sepsis, respectively. One hundred and sixty-seven (83.5%) mothers had no Group B Streptococcus (GBS) screening. Of those screened, three had GBS infection, but two did not receive antibiotics.Conclusions. The incidence of sepsis following PROM is low. Identifying neonates at risk is challenging, but the absence of clinical features and normal rapidly obtained supportive laboratory markers of sepsis provides reassurance that antibiotics could be temporarily withheld. Better GBS screening programmes and appropriate antibiotic responses for pregnant women should be implemented rigorously.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46743554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.7196/sajch.2023.v17i1.1779
D. Abdou, L. Selim, R. Coster, J. Smet, G. Nakhla, D. Mehaney
Background. Mitochondrial respiratory chain (RC) disorders are a growing group of disorders with a large variety of clinical presentations ranging from well-defined clinical syndromes to nonspecific manifestations, such as failure to thrive, exercise intolerance and seizures.Objective. To describe the clinical, biochemical, and histochemical spectrum of 38 Egyptian patients clinically suspected of havingmitochondrial RC disorders.Methods. A total of 38 patients (female, n=18 (47.4%); male, n=20 (52.6%)) clinically suspected of having mitochondrial diseases had been referred to the Inherited Metabolic Diseases Laboratory at Cairo University Children’s Hospital. Laboratory investigations and analyses included histochemical staining of cytochrome c oxidase and succinate dehydrogenase in muscle biopsies, as well as spectrophotometric assays of RC complexes in muscle homogenates.Results. Twenty-three patients (60.5%) were diagnosed with different RC enzyme deficiencies. Fifteen patients (65%) had complex Ideficiency and all of them also had lactic acidosis (mean (standard deviation)) plasma lactate concentration of 4 (1.65) mmol/L). Twopatients (9%) with marked complex IV deficiency both showed COX-negative ragged red fibers (RRFs) on histochemical staining.Combined complex I and complex II deficiency with scattered COX-stain deficiency and RRFs was diagnosed in 2 patients (5.25%), whilea further 2 patients (5.26%) had combined (complex I, II+III, complex IV) deficiencies. Isolated complex II deficiency was diagnosed in2 patients (5.26%) and 15 (39.5%) patients had normal RC enzyme activities.Conclusion. Biochemical assay of RC complexes is considered the cornerstone for diagnosis of RC complex mitochondrial disorders.These disorders are common among Egyptian paediatric patients.
{"title":"Clinical, biochemical, and histopathological diagnosis of Egyptian paediatric patients with suspected mitochondrial diseases: A hospital‑based study","authors":"D. Abdou, L. Selim, R. Coster, J. Smet, G. Nakhla, D. Mehaney","doi":"10.7196/sajch.2023.v17i1.1779","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1779","url":null,"abstract":"Background. Mitochondrial respiratory chain (RC) disorders are a growing group of disorders with a large variety of clinical presentations ranging from well-defined clinical syndromes to nonspecific manifestations, such as failure to thrive, exercise intolerance and seizures.Objective. To describe the clinical, biochemical, and histochemical spectrum of 38 Egyptian patients clinically suspected of havingmitochondrial RC disorders.Methods. A total of 38 patients (female, n=18 (47.4%); male, n=20 (52.6%)) clinically suspected of having mitochondrial diseases had been referred to the Inherited Metabolic Diseases Laboratory at Cairo University Children’s Hospital. Laboratory investigations and analyses included histochemical staining of cytochrome c oxidase and succinate dehydrogenase in muscle biopsies, as well as spectrophotometric assays of RC complexes in muscle homogenates.Results. Twenty-three patients (60.5%) were diagnosed with different RC enzyme deficiencies. Fifteen patients (65%) had complex Ideficiency and all of them also had lactic acidosis (mean (standard deviation)) plasma lactate concentration of 4 (1.65) mmol/L). Twopatients (9%) with marked complex IV deficiency both showed COX-negative ragged red fibers (RRFs) on histochemical staining.Combined complex I and complex II deficiency with scattered COX-stain deficiency and RRFs was diagnosed in 2 patients (5.25%), whilea further 2 patients (5.26%) had combined (complex I, II+III, complex IV) deficiencies. Isolated complex II deficiency was diagnosed in2 patients (5.26%) and 15 (39.5%) patients had normal RC enzyme activities.Conclusion. Biochemical assay of RC complexes is considered the cornerstone for diagnosis of RC complex mitochondrial disorders.These disorders are common among Egyptian paediatric patients.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46272392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-21DOI: 10.7196/sajch.2023.v17i1.1884
T. Mabelane, Cert. Allerg, M. C. Khaba, FC Path, E. Kiragu, MMed Paeds
Cow’s milk allergy (CMA) is one of the most common food allergies in the first years of life. CMA is classified as immunoglobulin E (IgE)or non-IgE-mediated reactions. IgE-mediated reactions are typically of immediate onset, with symptoms manifesting within 2 hours after ingestion. However, non-IgE-mediated reactions are delayed and mostly occur between 2 and 48 hours post exposure. This report describes a 17-year-old who presented with a long-standing history of pustular lesions immediately after cow’s milk ingestion. Allergy tests, which included skin-prick test (SPT); specific IgE to cow’s milk; cow’s milk IgE components; and Cellular antigen stimulation test (CAST) yielded insignificant results. However, an oral food challenge resulted in pustular lesions and abdominal pain within 30 and 120 minutes, respectively. A swab from a pustule cultured Staphylococcus aureus. CMA was confirmed and managed with dietary restriction. It is uncommon for non- IgE reactions to occur with immediate symptoms. S. aureus may be associated with atypical skin manifestation of CMA.
{"title":"An atypical presentation of non-IgE-mediated cow’s milk allergy associated with Staphylococcus aureus: A case study","authors":"T. Mabelane, Cert. Allerg, M. C. Khaba, FC Path, E. Kiragu, MMed Paeds","doi":"10.7196/sajch.2023.v17i1.1884","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1884","url":null,"abstract":"Cow’s milk allergy (CMA) is one of the most common food allergies in the first years of life. CMA is classified as immunoglobulin E (IgE)or non-IgE-mediated reactions. IgE-mediated reactions are typically of immediate onset, with symptoms manifesting within 2 hours after ingestion. However, non-IgE-mediated reactions are delayed and mostly occur between 2 and 48 hours post exposure. This report describes a 17-year-old who presented with a long-standing history of pustular lesions immediately after cow’s milk ingestion. Allergy tests, which included skin-prick test (SPT); specific IgE to cow’s milk; cow’s milk IgE components; and Cellular antigen stimulation test (CAST) yielded insignificant results. However, an oral food challenge resulted in pustular lesions and abdominal pain within 30 and 120 minutes, respectively. A swab from a pustule cultured Staphylococcus aureus. CMA was confirmed and managed with dietary restriction. It is uncommon for non- IgE reactions to occur with immediate symptoms. S. aureus may be associated with atypical skin manifestation of CMA.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46737143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-21DOI: 10.7196/sajch.2023.v17i1.1939
M. Selse, RT Saggers, E. Hentz, A. Elfvin, DE Ballot
Background. Necrotising enterocolitis (NEC) is an inflammatory disease almost exclusively affecting preterm infants. Previous research has presented a higher mortality rate in infants requiring surgical treatment compared with infants receiving medical treatment. However, the knowledge of mortality and morbidity of the disease in low- and middle-income countries is still limited.Objectives. To review infants with NEC admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH),determine a potential difference in mortality between medically and surgically treated infants, and to identify characteristics and factors associated with mortality among these infants.Methods. This retrospective study described infants with NEC born between 1 January 2016 and 31 December 2018 who were admittedto the neonatal unit. The characteristics and survival of these infants were compared using univariate and multivariate analyses.Results. During the study period, 5 061 infants were admitted to the neonatal unit, of which 218 infants were diagnosed with NEC.The period prevalence of NEC was 4.3% among all neonatal infants and 11.0% among very-low-birthweight (VLBW) infants. Mortalitywas significantly higher among surgically treated infants with NEC compared with medically treated infants (p=0.025, odds ratio 1.888(95% confidence interval 1.082 - 3.296)). Late-onset sepsis was significantly more common among VLBW infants with NEC (71.3%)compared with VLBW infants without NEC (27.1%). Among infants with late-onset sepsis, Gram-negative bacteria, multidrug-resistantbacteria and fungal sepsis was significantly more common in the group of infants with NEC.Conclusions. Infants with NEC treated surgically at CMJAH have an increased risk of dying compared with those receiving medicaltreatment, likely due to the severity of disease. Furthermore, this study emphasised the burden of sepsis among infants with NEC and may contribute to a better knowledge of NEC in South Africa.
{"title":"Outcome of infants with necrotising enterocolitis at Charlotte Maxeke Johannesburg Academic Hospital, South Africa","authors":"M. Selse, RT Saggers, E. Hentz, A. Elfvin, DE Ballot","doi":"10.7196/sajch.2023.v17i1.1939","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1939","url":null,"abstract":"Background. Necrotising enterocolitis (NEC) is an inflammatory disease almost exclusively affecting preterm infants. Previous research has presented a higher mortality rate in infants requiring surgical treatment compared with infants receiving medical treatment. However, the knowledge of mortality and morbidity of the disease in low- and middle-income countries is still limited.Objectives. To review infants with NEC admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH),determine a potential difference in mortality between medically and surgically treated infants, and to identify characteristics and factors associated with mortality among these infants.Methods. This retrospective study described infants with NEC born between 1 January 2016 and 31 December 2018 who were admittedto the neonatal unit. The characteristics and survival of these infants were compared using univariate and multivariate analyses.Results. During the study period, 5 061 infants were admitted to the neonatal unit, of which 218 infants were diagnosed with NEC.The period prevalence of NEC was 4.3% among all neonatal infants and 11.0% among very-low-birthweight (VLBW) infants. Mortalitywas significantly higher among surgically treated infants with NEC compared with medically treated infants (p=0.025, odds ratio 1.888(95% confidence interval 1.082 - 3.296)). Late-onset sepsis was significantly more common among VLBW infants with NEC (71.3%)compared with VLBW infants without NEC (27.1%). Among infants with late-onset sepsis, Gram-negative bacteria, multidrug-resistantbacteria and fungal sepsis was significantly more common in the group of infants with NEC.Conclusions. Infants with NEC treated surgically at CMJAH have an increased risk of dying compared with those receiving medicaltreatment, likely due to the severity of disease. Furthermore, this study emphasised the burden of sepsis among infants with NEC and may contribute to a better knowledge of NEC in South Africa.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41558132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-21DOI: 10.7196/sajch.2023.v17i1.1885
S. Mansoor, K. Petersen, UK Kala, P. Mosiane
Background. Crescentic glomerulonephritis (CGN) as a cause of progressive renal failure is rare. Crescent formation on kidney biopsyrepresents a response to injury of the glomerular capillary walls. There are limited published reports on paediatric CGN in Africa.Objectives. To describe the clinical presentation and outcome of children with CGN in Soweto, South Africa, over a 22-year period.Methods. A retrospective study was conducted at the Paediatric Renal Unit at Chris Hani Baragwanath Academic Hospital. Childrenyounger than 14 years with crescent formation in more than 50% of glomeruli on renal biopsy were included in the study. Kidney biopsy specimens were examined by light microscopy, immunofluorescence and electron microscopy. Demographic and clinical data were extracted from the patient files.Results. During the study period, 961 kidney biopsies were performed. Fourteen patients (1.5%) met inclusion criteria of crescents in>50% of glomeruli. Common clinical findings were oedema (n=13; 93%), microscopic haematuria (n=12; 86%), hypertension (n=11; 79%)and proteinuria (n=10; 71%). The median estimated glomerular filtration rate (eGFR) at presentation was 23.9 mL/min/1.73m2. Thirteen patients (93%) had immune-complex-mediated glomerulonephritis. The underlying cause was acute post-infectious glomerulonephritis in 9 patients (64%), membranoproliferative glomerulonephritis and IgA nephropathy in 2 patients each (14%) and global sclerosis in 1 patient (7%). Prolonged duration of symptoms resulted in a lower eGFR at follow-up. Treatment included peritoneal dialysis, methylprednisolone and cyclophosphamide. Seven (54%) patients had a normal eGFR at a median (range) follow-up of 36.7 (4.5 - 61.5) months. Six (46%) patients had progressed to chronic kidney disease stages 2 - 5. One patient was followed up for less than 3 months, and therefore was not included in the follow-up results.Conclusion. Poor outcomes were observed in patients who presented late. The clinical findings of haematuria, hypertension and acutekidney injury warrant early referral and kidney biopsy to determine management.
{"title":"Crescentic glomerulonephritis in children: A retrospective review of data from Chris Hani Baragwanath Academic Hospital","authors":"S. Mansoor, K. Petersen, UK Kala, P. Mosiane","doi":"10.7196/sajch.2023.v17i1.1885","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1885","url":null,"abstract":"Background. Crescentic glomerulonephritis (CGN) as a cause of progressive renal failure is rare. Crescent formation on kidney biopsyrepresents a response to injury of the glomerular capillary walls. There are limited published reports on paediatric CGN in Africa.Objectives. To describe the clinical presentation and outcome of children with CGN in Soweto, South Africa, over a 22-year period.Methods. A retrospective study was conducted at the Paediatric Renal Unit at Chris Hani Baragwanath Academic Hospital. Childrenyounger than 14 years with crescent formation in more than 50% of glomeruli on renal biopsy were included in the study. Kidney biopsy specimens were examined by light microscopy, immunofluorescence and electron microscopy. Demographic and clinical data were extracted from the patient files.Results. During the study period, 961 kidney biopsies were performed. Fourteen patients (1.5%) met inclusion criteria of crescents in>50% of glomeruli. Common clinical findings were oedema (n=13; 93%), microscopic haematuria (n=12; 86%), hypertension (n=11; 79%)and proteinuria (n=10; 71%). The median estimated glomerular filtration rate (eGFR) at presentation was 23.9 mL/min/1.73m2. Thirteen patients (93%) had immune-complex-mediated glomerulonephritis. The underlying cause was acute post-infectious glomerulonephritis in 9 patients (64%), membranoproliferative glomerulonephritis and IgA nephropathy in 2 patients each (14%) and global sclerosis in 1 patient (7%). Prolonged duration of symptoms resulted in a lower eGFR at follow-up. Treatment included peritoneal dialysis, methylprednisolone and cyclophosphamide. Seven (54%) patients had a normal eGFR at a median (range) follow-up of 36.7 (4.5 - 61.5) months. Six (46%) patients had progressed to chronic kidney disease stages 2 - 5. One patient was followed up for less than 3 months, and therefore was not included in the follow-up results.Conclusion. Poor outcomes were observed in patients who presented late. The clinical findings of haematuria, hypertension and acutekidney injury warrant early referral and kidney biopsy to determine management.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49513118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-21DOI: 10.7196/sajch.2023.v17i1.1942
K. Flack, M. Hauptfleisch, L. Scher
Background. Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder that is present in all populations andresults in muscle weakness owing to anterior horn cell degeneration. SMA is divided into three clinical subtypes and is an importantgenetic cause of morbidity and mortality but has not been well studied in sub-Saharan Africa.Objective. This study aims to describe the clinical features and genetic findings in black patients with SMA presenting to the Division ofPaediatric Neurology at Chris Hani Baragwanath Academic Hospital (CHBAH) over a 30-year period.Method. This study was a retrospective review of patient records. The study population was black paediatric neurology patients withclinical SMA, who attended CHBAH Neurology Clinic between 1988 and 2018. Patients were categorised into SMA type 1, 2 or 3 basedon their neurology assessment and clinical features were recorded.Results. The clinical findings in the study population (with SMA), i.e. hypotonia, areflexia and tongue fasciculations, were similar to those found in international studies. More than half of the patients (65.6%; n=86/131) had genetic tests, of which 84.8% were positive for SMA. This value was significantly higher than previously reported results from South Africa. At least 23.6% (n=31/131) had facial involvement.Conclusions. This study adds to the limited body of research on SMA in sub-Saharan Africa and highlights the lower frequency of ahomozygous deletion seen in the black South African population compared with the expected 95% worldwide.
{"title":"A review of spinal muscular atrophy in black South African paediatric patients","authors":"K. Flack, M. Hauptfleisch, L. Scher","doi":"10.7196/sajch.2023.v17i1.1942","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1942","url":null,"abstract":"Background. Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder that is present in all populations andresults in muscle weakness owing to anterior horn cell degeneration. SMA is divided into three clinical subtypes and is an importantgenetic cause of morbidity and mortality but has not been well studied in sub-Saharan Africa.Objective. This study aims to describe the clinical features and genetic findings in black patients with SMA presenting to the Division ofPaediatric Neurology at Chris Hani Baragwanath Academic Hospital (CHBAH) over a 30-year period.Method. This study was a retrospective review of patient records. The study population was black paediatric neurology patients withclinical SMA, who attended CHBAH Neurology Clinic between 1988 and 2018. Patients were categorised into SMA type 1, 2 or 3 basedon their neurology assessment and clinical features were recorded.Results. The clinical findings in the study population (with SMA), i.e. hypotonia, areflexia and tongue fasciculations, were similar to those found in international studies. More than half of the patients (65.6%; n=86/131) had genetic tests, of which 84.8% were positive for SMA. This value was significantly higher than previously reported results from South Africa. At least 23.6% (n=31/131) had facial involvement.Conclusions. This study adds to the limited body of research on SMA in sub-Saharan Africa and highlights the lower frequency of ahomozygous deletion seen in the black South African population compared with the expected 95% worldwide.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47366095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-16DOI: 10.7196/sajch.2023.v17i1.1958
AO Olajide-Ibiejugba, V. Nkosi, F. Rathogwa-Takalani, J. Shirinde, J. Wichmann, R. Green, K. Voyi
Proper asthma control can lessen the negative effects of asthma in adolescents, such that they can lead a normal and physically activelife. The study aimed to compare self-reported asthma control and actual test scores among adolescents in the inner provinces (Gauteng and North West) of South Africa. The asthma control test (ACT) questionnaire was administered to 123 of adolescents who had reported doctor-diagnosed asthma during the cross-sectional study. There was a statistically significant difference between self-reported asthma control and actual test scores among study participants (p=0.003). Out of the 90 study participants who claimed that their asthma was controlled, only 25 (27.78%) were correctly classified as ‘controlled’ according to the ACT. A high percentage (72.22%) of adolescents misclassified their asthma as ‘controlled’, whereas it was not. There is a lack of studies on asthma control in Africa.
{"title":"Asthma control among adolescents in the inner provinces of South Africa: Perception v. reality","authors":"AO Olajide-Ibiejugba, V. Nkosi, F. Rathogwa-Takalani, J. Shirinde, J. Wichmann, R. Green, K. Voyi","doi":"10.7196/sajch.2023.v17i1.1958","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1958","url":null,"abstract":"Proper asthma control can lessen the negative effects of asthma in adolescents, such that they can lead a normal and physically activelife. The study aimed to compare self-reported asthma control and actual test scores among adolescents in the inner provinces (Gauteng and North West) of South Africa. The asthma control test (ACT) questionnaire was administered to 123 of adolescents who had reported doctor-diagnosed asthma during the cross-sectional study. There was a statistically significant difference between self-reported asthma control and actual test scores among study participants (p=0.003). Out of the 90 study participants who claimed that their asthma was controlled, only 25 (27.78%) were correctly classified as ‘controlled’ according to the ACT. A high percentage (72.22%) of adolescents misclassified their asthma as ‘controlled’, whereas it was not. There is a lack of studies on asthma control in Africa.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41750546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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