In this report, we describe a rare case of a Nigerian male infant who presented with resistance to thyroid hormone associated with hyperthyroidism, cholestatic jaundice, a huge goitre and failure to thrive (weight faltering). He had delayed developmental motor milestones and at the age of 7 months, he has developed craniosynostosis. The hyperthyroidism persisted despite treatment with beta-blocker for tachycardia and antithyroid medications. The challenges encountered in the management of the patient are discussed

Isolated progressive macrodactyly belongs to a heterogeneous group of congenital overgrowth syndromes, resulting in enlargement of all tissues localized to the terminal portions (fingers or toes) of a limb. The aim of this case report is to create further awareness among physicians on this rare clinical entity and present a short review of the literature. We present the case of a 10-year-old Nigerian girl with a history of progressive overgrowth of left thumb since birth. The patient‟s facies and body habitus were normal without hemihypertrophy. Anthropometric measurements of the child‟s hands, revealed an overgrowth of the left thumb compared with the right. The child had no café-au-lait spots or any other skin lesions. The radiograph of the hands revealed increase in size of both soft tissue and phalangeal bones (enlongated and broadened) of the left thumb. A diagnosis of isolated progressive left thumb macrodactyly was made and the patient was referred to the orthopaedic surgeon for surgical intervention. The child and her parents suffered psychological distress. Isolated progressive macrodactyly is very rare but it is cosmetically displeasing to the child, resulting in psychological distress.

Brachial artery aneurysm is rare but could be potentially both life-threatening and limb-threatening. It may lead to peripheral nerve injuries which cause disability and affect everyday function, both domestic and economic. We present a rare case of pre-menarcheal adolescent girl with Graves’ disease co-existing with radial neuropathy due to radial nerve compression by a giant brachial artery pseudoaneurysm. The patient was managed surgically with aneurysmal resection and saphenous vein graft interpositioning. Prompt diagnosis and institution of appropriate surgical repair to prevent adverse outcome was imperative.

Zinc deficiency impairs growth and development but epidemiological data for zinc nutrition status among preschool children living in rural areas of Nigeria is lacking. The aim of the present study was to assess the zinc status and anthropometric indices of children aged between 6 and 60 months, living in a rural community in Edo State, Nigeria. In this community-based cross-sectional study, five out of the nine political wards (quarters) in the community were randomly selected; all the households with children aged between 6 and 60 months were included the study. A total of 252 children were selected to participate after obtaining informed consent from their parents. Steps were taken to avoid exogenous zinc contamination of the blood samples which were collected in the mornings. The serum zinc levels of the subjects were determined, using flame atomic absorption spectrophotometry. The weights, heights, head and mid-upper arm circumferences of each child were measured, using standard procedures. Z- scores of anthropometric indices of height-for-age, weight-for-age and weight-for-height were computed to assess the nutritional status of the children. The mean age of the study population was 32.7±17.0 months. The prevalence rates of stunting, underweight and wasting among the children were 18.2%, 14.7% and 11.1%, respectively. The overall mean serum zinc concentration was 4.77±3.02μmol/L, with a range of 1.0 16.52μmol/L. Of the 252 children, 220 (87.3%) had mean serum zinc concentration below 7.65μmol/L, representing severe zinc deficiency. The highest mean serum zinc concentration was found among children aged 6 to 12 months and this was followed by a progressive decline in serum zinc concentration from the age of 13 months up to 48 months. Correlation between the serum zinc concentration of the children and their age and social class of the parents were as follows: age, r = 0.09, at p = 0.15; social class, r = 0.08; at p = 0.21. The children with wasting had the lowest mean serum zinc concentration compared with either the group with underweight or stunting. The zinc nutritional status of preschool-age children in this community clearly indicates a suboptimal zinc status at the time of this study. According to the IZiNCG criteria, this should be considered as a public health problem among preschool-age children in this community. To effectively address the issue, social mobilization, intensive education and awareness campaign, with all target groups and policy makers are urgently required. Public health measures aimed at improving their zinc nutritional status should also be considered.

The offspring of a mother with Graves’ disease is at increased risk of morbidity (both immediate as well as long term) and mortality. The aim of the study was to retrospectively assess the concentrations of the serum Thyroid Stimulating Hormone (TSH), Thyroxine (T4) and Triiodothyronine (T3) as well as the anthropometric measurements in the first 6 months of life among offspring of mothers with Graves’ disease. In this study, the case files of all infants born to mothers with Graves’ disease who were referred to the Paediatric Endocrinology Clinic, University of Benin Teaching Hospital (UBTH), Benin City were retrieved and audited. The thyroid function tests (TFT) results as well the anthropometric data obtained in the first 6 months of life for offspring of mothers with Graves’ disease were recorded. Of the 10 neonates born to mothers with Graves’ disease, the thyroid function was normal in eight (80.0%) and abnormal in two (20.0%). Of the two infants with abnormal thyroid function, one had Transient Hyperthyrotropinaemia (elevated TSH with normal fT4) and the other had Euthyroid Hyperthyroxinaemia (elevated fT4 with normal TSH and no clinical symptoms). No case of neonatal Graves’ disease was observed. In the first 6 months of life, there was no statistically significant difference in anthropometric measurements between offspring of mothers with Graves’ disease and their counterparts whose mothers did not have Graves’ disease. Conclusion: Majority of infants born to mothers with Graves’ disease had normal thyroid function but the two leading abnormality of thyroid function observed in the newborn were Transient Hyperthyrotropinaemia and Euthyroid Hyperthyroxinaemia. No statistically significant difference was observed in the anthropometric measurements of offspring of mothers with Graves’ disease and those of mothers without Graves’ disease

Season is known to influence human secondary sex ratio but information on this subject is lacking in Nigeria. The objective of this study was to determine the secondary sex ratio (SSR) during the wet and dry seasons in Nigeria. In this retrospective cohort study, the records of all deliveries at St Philomena Catholic Hospital (SPCH), Benin City, Edo State, Nigeria between 1st January, 2005 and 31st December, 2014 (10 years) were retrieved and analyzed. The births were recorded according to the year and month of delivery. Stillbirths and infants with ambiguous genitalia were excluded from the analyses. The total number of live-births during the 10-year period under review was 13,702 and this consisted of 7,007 males and 6,695 females, resulting in a secondary sex ratio of 104.6:100 (1.05:1). In general, the monthly distribution of births was bimodal with a greater peak in May and a lesser peak in October with the highest and lowest SSRs in the months of June and March, respectively. In the dry season, the proportion of male births was higher than the proportion of female births; p > 0.05. In contrast, in the wet season the proportion of male births was lower than the proportion of female births; p > 0.05. In addition, the SSR was higher in the dry season (1.04) compared with the wet season (0.99). In Edo State, Nigeria, the proportion of male births tended to be higher than the proportion of female births during the dry seasons.

Maternal Age of 35 years or more at first pregnancy and childbirth is considered advanced reproductive age and a high pregnancy risk associated with increased adverse maternal and perinatal outcomes. The industrialized and developing countries are replete with supporting scientific literatures but only a few data on nulliparous women in our setting hence our interest to appraise the correlates of advanced maternal age at first childbirth and obstetric performance in Nigerian women. The objectives were to determine the influence of advanced maternal age at first pregnancy on the obstetric and perinatal outcomes. To compare the obstetric performance of women advanced in maternal age at first delivery with their younger counterparts and to determine the trend of identifiable adverse outcomes with increasing maternal age at first delivery. This was a retrospective comparative study of 1684 nulliparous women that had their childbirth between 2009 and 2013 at a mission Hospital. Those aged 35 years and above were the study subjects while those aged 20 - 34 years the control. Relevant database was raised from the case files. The prevalence of elderly nullipara in this study was 1.6%. They were statistically significant different in primary level of education (OR = 4.1, P = 0.02), prenatal care lack (OR = 2.6, P = 0.02), caesarean section (OR = 2.5, P = 0.0006), incidental myomectomy (OR = 19.1, P < 0.0001), prolonged pregnancy (OR = 0.6, P = 0.04) and episiotomy at vaginal delivery (OR = 0.5, P = 0.01). They were also insignificantly worse in ante partum hemorrhage (APH), induction of labor, perineal tear, HIV infection, postpartum hemorrhage (PPH), preterm birth, Low birth weight (LBW), Intrauterine growth restriction (IUGR), stillbirth ,neonatal birth asphyxia and Perinatal mortality. Caesarean section rate, caesarean myomectomy, APH, induction of labor, stillbirth rate, LBW and Perinatal mortality each maintained a statistical significant linear tendency (P < 0.05) with maternal age. First pregnancy at advanced maternal age is fraught with increased maternal morbidity, perinatal morbidity and mortality. We proffer early education, marriage or and childbearing, quality prenatal care and skilled attendance at delivery for safe motherhood.

In this review article, the genetics of size at birth, prenatal metabolic programming and the endocrine and metabolic consequences of abnormal size at birth are discussed. In addition, the relevance of fetal origin of adult disease in developing countries and the public health implication as well as future perspectives are also discussed. Being born either small- or large-for-gestational age affects such children and adults in several ways. These include increased risk of type 2 diabetes mellitus, metabolic syndrome, oxidative stress, persistent reduction in growth, cardiovascular disease, osteoporosis and premature pubarche as well as adrenarche. Individuals with abnormal size at birth who experienced rapid growth in the first three years of life have the greatest risk for future metabolic abnormalities. The mechanisms involved in prenatal (fetal) metabolic programming in infants with abnormal size at birth are just beginning to be explored. Both the “thrifty genes” and the “thrifty phenotype” could result in adverse health consequences later in life on exposure to plentiful nutrition. The most important epigenetic reactions affecting genetic transcription are acetylation and methylation. However, the major challenge at this point in time is to link such alterations with modifications in gene expression and ultimately, with metabolic abnormalities encountered in adult life. Thus, developmental origins of health and disease (DOHaD) represent a relatively new frontier of research and with time, some of the discrepancies may be resolved.

Age at menarche varies with time of onset and the influence of social factors depends on the population under consideration. The objective of the present study was to determine the age at menarche among secondary school girls in Benin City, Nigeria and identify some of the social factors that might influence it. In this cross sectional study information on age at menarche was obtained from 1,640 menstruating secondary school girls (aged between 10 and 20 years) using the status quo method. Information sought in the structured questionnaire used included date of birth, date of menarche, educational attainment and occupation of parents, birth position, family size and State of origin. Data was analyzed using SPSS version 12.0. The mean age at menarche was 13.44±1.32 years (95% Confidence Interval, CI= 13.36-13.50). One out of every 15 (6.7%) girls below 12 years of age had attained menarche, indicating early menarche. There was statistically significant relationship between the mean menarcheal age and socioeconomic status (p< 0.001), birth position (p< 0.01) and family size (p< 0.01). The current mean age at menarche among secondary school girls in Benin City is 13.44±1.32 years and it is influenced by socioeconomic status, birth position and family size.

Although an undescended testes (UDT) is the most common developmental anomaly of the urogenital organ in males, they have often been regarded as mild malformation and as a consequence have been poorly reported despite its association with increased risk of infertility and testicular cancer in later life. In Nigeria, data on its prevalence is scarce. The objective of the study was to determine the prevalence rates of undescended testes at birth, 3 months and 6 months of age respectively. A prospective hospital-based cohort study was conducted to determine the prevalence rates of UDT at birth, 3 months and 6 months of age. The infants were examined at birth for UDT, using standardized technique. The infants who were identified at birth to have undescended testes were re-examined at the ages of 3 and 6 months respectively. To minimize inter-observer error, one physician examined all the infants. The gestational age, birth weight and birth position of each the neonates were recorded. The maternal age, parity, educational attainment and occupation of the parents were noted. The season in which each of the infants was born was recorded. At birth, 2.8% (39 of 1,394) of live-born male infants had undescended testes (UDT). This prevalence rate declined to 1.2% at the age of 3 months and 0.6% at the age of 6 months with an overall spontaneous testicular descent rate of 79.5% (31 of 39 cases). The prevalence rates were significantly elevated for low birth weight and preterm infants. The frequency of spontaneous descent of the testes was higher in both low birth weight and preterm infants compared to normal birth weight and full-term infants respectively. Comparing twin and non-twin infants, the prevalence of UDT was 3.8% (2 of 52) versus 2.8% (37 of 1,342); p>0.05. At birth, low birth weight and preterm infants had a significantly higher prevalence than their full-term as well as preterm counterparts with preterm infants having a greater tendency to achieve spontaneous descent of the testicles than full-term infants.