Relationship between rickets and incomplete distal renal tubular acidosis in children

<p>Abstract</p> <p>Background</p> <p>In the Sub Saharan Africa Rickets has now been established to be due primarily to calcium deficiency and sometimes in combination with vitamin D deficiency. The main thrust of management is calcium supplementation with or without vitamin D. An observation was made that some children with nutritional rickets do not respond to this management modality. The recently reported high prevalence of Incomplete Distal Renal Tubular Acidosis (idRTA) in adults with osteoporosis as brought to fore the possibility of this being a possible cause of calcium wastage and therefore the poor response in these group of children with rickets.</p> <p>Aim</p> <p>To determine the prevalence of idRTA amongst a cohort of subjects with rickets</p> <p>To show a relationship between rickets and incomplete distal renal acidosis</p> <p>To determine the response of children with rickets and idRTA to addition of Shohl's solution to therapy</p> <p>Methodology</p> <p>Two separate cohorts of children with rickets performed the ammonium chloride loading test to detect those with incomplete renal tubular acidosis. Following identification for idRTA, Shohl's solution was added to therapy of calcium and vitamin D supplementation and their response compared to those without idRTA on calcium and vitamin D supplementation solely.</p> <p>Results</p> <p>50 children with rickets aged from two to six years of age and composed of 29 females and 21males were investigated. Incomplete renal tubular acidosis was found in 38% of them. Prevalence of idRTA was highest amongst those aged 3-6 years of age. Those with idRTA had worse limb deformities, biochemical and radiological parameters than those who hadn't. Rate of response on those with idRTA treated with Shohl's solution was at par with those without idRTA.</p> <p>Conclusion</p> <p>Incomplete idRTA exist amongst children with rickets and should be looked out for in severe rickets and older children. Treatment of idRTA will lead to optimal response and healing of rickets.</p

Doppler ultrasound features of ophthalmic artery in diabetic retinopathy in a Nigerian Teaching Hospital

Background: Diabetes mellitus is a metabolic disease characterized by elevated blood glucose level due to impaired insulin secretion, insulin action or both with diabetic retinopathy being the most common microangiopathic complication. A comparative, cross- sectional study aimed at evaluating Doppler blood flow indices in the ophthalmic artery in diabetic retinopathy and non-retinopathy patients when compared to normal controls in a Nigerian tertiary hospital.Methods: Data were collected over 7 months (April 2017-October 2017) in Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria. Sixty-five diabetic retinopathy patients, 65 diabetic patients without retinopathy and 65 non-diabetic controls had their ophthalmic artery Doppler indices assessed for comparison.Results: The end diastolic velocity (EDV) of the ophthalmic arteries in the diabetic patients were significantly lower than those of control group (EDV=5.84±2.59 cm/s, p<0.001 bilaterally). In diabetic patients with retinopathy, the end diastolic velocity of the ophthalmic arteries was significantly lower than those of diabetic patients without retinopathy (EDV=5.84±2.59 cm/s right eye, EDV=5.75±2.39 left eye, p<0.001 bilaterally). The resistivity index (RI) of the ophthalmic arteries was significantly higher in both diabetic patients with retinopathy and those without retinopathy compared to control group (RI=0.92±0.07 right eye, p=0.044 right eye, p<0.001 left eye) with resistivity index of diabetic retinopathy respondents significantly higher than the diabetic patients with no retinopathy.Conclusions: The study showed that Doppler is a useful screening parameter in identifying eyes at risk of developing sight threatening proliferative disease in diabetic patients. Significant differences exist in ophthalmic artery Doppler flow indices of diabetics with retinopathy compared to the healthy controls.

Cardiovascular Risk Factor Burden and Association With CKD in Ghana and Nigeria

INTRODUCTION: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD); however, the burden of cardiovascular risk factors in patients with CKD in Africa is not well characterized. We determined the prevalence of selected cardiovascular risk factors, and association with CKD in the Human Heredity for Health in Africa Kidney Disease Research Network study. METHODS: We recruited patients with and without CKD in Ghana and Nigeria. CKD was defined as estimated glomerular filtration rate of 50 years, and body mass index (BMI) <18.5 kg/m 2 were independently associated with CKD. The association of diabetes and smoking with CKD was modified by other risk factors. CONCLUSION: Cardiovascular risk factors are prevalent in middle-aged adult patients with CKD in Ghana and Nigeria, with higher proportions in Ghana than in Nigeria. Hypertension, elevated cholesterol, and underweight were independently associated with CKD

Rationale and Design of the Diet, CKD, and Apolipoprotein L1 Study in Low-Income and Middle-Income Countries

IntroductionDiet, chronic kidney disease (CKD), and Apolipoprotein L1 (APOL1) (DCA) Study is examining the role of dietary factors in CKD progression and APOL1 nephropathy. We describe enrollment and retention efforts and highlight facilitators and barriers to enrollment and operational challenges, as well as accommodations made in the study protocol.MethodsThe DCA study is enrolling participants in 7 centers in West Africa. Participants who consented were invited to complete dietary recalls and 24-hour urine collections in year 1. We conducted focus groups and semistructured interviews among study personnel to identify facilitators and barriers to enrollment as well as retention and operational challenges in the execution of the study protocol. We analyzed emerging themes using content analyses.ResultsA total of 712 participants were enrolled in 18 months with 1256 24-hour urine and 1260 dietary recalls. Barriers to enrollment were the following: (i) a lack of understanding of research, (ii) the burden of research visits, and (iii) incorporating cultural and traditional nuances when designing research protocols. Factors facilitating enrollment were the following: (i) designing convenient research visits, (ii) building rapport and increased communication between the research team and participants, and (iii) cultural sensitivity - adapting research protocols for the populations involved. Offering home visits, providing free dietary counseling, reducing the volume of study blood collection, and reducing the frequency of visits were some changes made in the study protocol that increased participant satisfaction.ConclusionAdopting a participant-centered approach with accommodations in the protocol for cultural adaptability and incorporating participant feedback is vital for carrying out research in low-income and middle-income regions

Enabling the genomic revolution in Africa

H3Africa is developing capacity for health-related genomics research in Afric

Research capacity. Enabling the genomic revolution in Africa.

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