Chronic kidney disease in type 2 diabetes mellitus patients: Comparison of KDIGO and KDOQI guidelines

Background: Chronic kidney disease (CKD), has become a public health concern as it has been reported to cause adverse outcomes such as kidney failure and premature death. This cross sectional study compared the Kidney Disease: Improving Global Outcomes (KDIGO) and Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines in assessing the prevalence of CKD in Type 2 diabetes Mellitus (T2DM) patients.Methods: We consecutively sampled a cross-section of 202 T2DM patients from the Ho municipality in the Volta region (Ghana). Structured pre-tested questionnaires were administered to obtain information on gender, age, body mass index (BMI), systolic and diastolic blood pressure, medication used, duration on medication, and duration of diabetes. Serum creatinine and urine protein were estimated using standard protocols and CKD was classified according to KDIGO and KDOQI guidelines.Results: The prevalence of CKD was 63.4% and 58.4% using the KDIGO and KDOQI guidelines respectively. The prevalence of mildly decreased renal function or worse (eGFR < 60/ml/min/1.73 m2) was 10.4% for KDIGO guideline and 7.9% for KDOQI guidelines with an excellent agreement between both definitions showing bias = -0.129, 95%CI = (-0.17 to -0.08) on Bland-Altman analysis. Participants older than 70 years were more likely to have CKD when KDIGO criteria was used (P = 0.018). The prevalence of albuminuria was 47.0% with 21.9% presenting with 1+ and 2+ grades.Conclusion: KDIGO guideline estimates higher prevalence of CKD than KDOQI guidelines in the same study population. KDIGO guideline might help in early detection and proper classification of CKD which will illicit stage-specific treatment.Keywords: Type 2 diabetes mellitus, Chronic kidney disease, Estimated glomerular filtration rate, Albuminuri

Thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus patients in Ghana: A comparative cross-sectional study

Introduction: Thyroid disorders and diabetes mellitus coexist and are prevalent endocrinopathies among adult population. Thyroid dysfunction contributes to metabolic imbalances, increase beta-cell apoptosis and glucose intolerance. There is paucity of data and contradicting findings on how thyroid dysfunction influence glycaemic control. Therefore, we evaluated thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus (T2DM) patients in Ghana. Methods: A comparative cross-sectional study was conducted among 192 T2DM patients from Effia Nkwanta Regional Hospital. Three consecutive monthly fasting plasma glucose (FBG) and glycated haemoglobin (HbA1c) were analysed and the results were classified as, moderate hyperglycaemia (MH) (FBG = 6.1–12.0 mmol/L, HbA1c \u3c 7%), severe hyperglycaemia (SH) (FBG ≥ 12.1 mmol/L, HbA1c \u3e 7%) and good glycaemic controls (GC) (FBG = 4.1–6.0 mmol/L, HbA1c \u3c 7%). Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4), body mass index (BMI) and other clinical parameters were measured. Data analysis was done using R language version 4.0.2 and p \u3c.05 was considered statistically significant. Results: There were no significant differences in age (years) between patients in the various glycaemic groups (p =.9053). The overall prevalence of thyroid disorders was 7.8% among T2DM patients. The prevalence of thyroid disorders was higher in patients with SH (11.7%) followed by those with MH (7.5%) and then those with GC (5.4%). Serum levels of TSH and FT3/FT4 ratio were significantly lower in T2DM patients with SH compared to those with MH and the GC (p \u3c.0001). However, FT4 was significantly higher in SH patients compared to the good glycaemic controls (p \u3c .01). The first tertiles of TSH [aOR = 10.51, 95% CI (4.04–17.36), p \u3c .0001] and FT3 [aOR = 2.77, 95% CI (1.11–6.92), p =.0290] were significantly and independently associated with increased odds of hyperglycaemia. Conclusion: The prevalence of thyroid dysfunction is high in T2DM and increases with hyperglycaemia. Reduced TSH and T3 may worsen glycaemic control. Periodic monitoring of thyroid function should be incorporated into management guidelines among T2DM patients in Ghana

Developing a modified low-density lipoprotein (M-LDL-C) Friedewald’s equation as a substitute for direct LDL-C measure in a Ghanaian population: a comparative study

Despite the availability of several homogenous LDL-C assays, calculated Friedewald\u27s LDL-C equation remains the widely used formula in clinical practice. Several novel formulas developed in different populations have been reported to outperform the Friedewald formula. This study validated the existing LDL-C formulas and derived a modified LDL-C formula specific to a Ghanaian population. In this comparative study, we recruited 1518 participants, derived a new modified Friedewald\u27s LDL-C (M-LDL-C) equation, evaluated LDL-C by Friedewald\u27s formula (F-LDL-C), Martin\u27s formula (N-LDL-C), Anandaraja\u27s formula (A-LDL-C), and compared them to direct measurement of LDL-C (D-LDL-C). The mean D-LDL-C (2.47±0.71 mmol/L) was significantly lower compared to F-LDL-C (2.76±1.05 mmol/L), N-LDL-C (2.74±1.04 mmol/L), A-LDL-C (2.99±1.02 mmol/L), and M-LDL-C (2.97±1.08 mmol/L) p \u3c 0.001. There was a significantly positive correlation between D-LDL-C and A-LDL-C (r=0.658, p\u3c0.0001), N-LDL-C (r=0.693, p\u3c0.0001), and M-LDL-C (r=0.693, p\u3c0.0001). M-LDL-c yielded a better diagnostic performance [(area under the curve (AUC)=0.81; sensitivity (SE) (60%) and specificity (SP) (88%)] followed by N-LDL-C [(AUC=0.81; SE (63%) and SP (85%)], F-LDL-C [(AUC=0.80; SE (63%) and SP (84%)], and A-LDL-C (AUC=0.77; SE (68%) and SP (78%)] using D-LDL-C as gold standard. Bland-Altman plots showed a definite agreement between means and differences of D-LDL-C and the calculated formulas with 95% of values lying within ±0.50 SD limits. The modified LDL-C (M-LDL-C) formula derived by this study yielded a better diagnostic accuracy compared to A-LDL-C and F-LDL-C equations and thus could serve as a substitute for D-LDL-C and F-LDL-C equations in the Ghanaian population

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Analysis of Temperature Drop Along the Radial Axis in Steady State Heat Transfer of Nuclear Fuel Element Using ANSYS APDL

Nuclear reactor core is usually made up of cylindrical fuel elements that contain fuel pellets, helium gas gap and cladding material. In this paper our goal was to analyze the temperature drop from the centerline of the fuel where the maximum temperature occurs, to the gas gap and then finally to the cladding surface. The geometrical, physical and thermal properties of the fuel element are known. The Nuclear fuel element used in this calculation was UO2, which is the standard fuel element for Light Water Reactors. We used two techniques to solve this problem. The First Technique was to try to obtain an exact solution of the steady state analysis using the classical heat conduction equation. The second approach was to use FEA which is inbuilt in ANSYS APDL, where the partial differential equation is automatically solved numerically using finite different method. The results were compared and the conclusion was that the addition of gas gap between the pellet and the cladding material further contributes to the increase in the centerline temperature. The bigger the thickness of the gap, the higher the centerline temperature, this is due to the fact that the thermal conductivity of helium gas is very low, hence it is not very good at carrying heat from one surface to another. This is partly the reason why the thickness of the gas gap is usually very small.

Comparative Assessment of Knowledge, Attitudes, and Practice of Breast Self-Examination among Female Secondary and Tertiary School Students in Ghana

Background. Breast cancer remains a serious public health problem globally. It is particularly increasing among adolescents and premenopausal women. Breast self-examination (BSE) is the most effective and feasible means of detecting breast cancer early in developing countries. This study aimed at evaluating and comparing knowledge of BSE among secondary and tertiary school students and at revealing their attitudes and practices about BSE. Method. This cross-sectional study was conducted among 1036 female secondary and tertiary school students of Kwame Nkrumah University of Science and Technology and Technology Senior High School. Data was obtained using a pretested questionnaire to access sociodemography, knowledge, attitudes, and practice of BSE among the students. Result. Most students were within the age of 15–24 years; 90.9% were aware of BSE. A high level of knowledge on BSE was found in 54.5% of the students. Knowledge was significantly higher in tertiary than secondary school students (p=0.002). 24.1% of the students thought BSE could be performed anytime; however only 8.1% of the students performed BSE monthly as recommended, whilst 41.8% had never practiced. Of these, more secondary students had never practiced BSE as compared to the tertiary students. 22.3% indicated they would wait for a change in a detected breast lump before seeking medical attention. 96.3% of the participants agree BSE is a good practice which must be encouraged. Conclusion. Teaching of BSE should be intensified beginning at the high school level, emphasizing practice and its benefits for early detection of breast cancer

Profiling immuno-metabolic mediators of vitamin B12 deficiency among metformin-treated type 2 diabetic patients in Ghana.

BackgroundThe association between prolong metformin usage and B12 deficiency has been documented. However, the prevalence estimates of metformin-induced vitamin B12 deficiency showed substantial disparity among studies due to varied study definitions of vitamin B12 deficiency. Metformin blocks the calcium dependent absorption of the vitamin B12-Intrinsic Factor complex at the terminal ileum. Lack of intrinsic factor due to the presence of auto-antibodies to parietal cells (IFA) could lead to vitamin B12 deficiency and subsequently cause peripheral neuropathy. We investigated the prevalence of vitamin B12 deficiency using more sensitive, combined markers of vitamin B12 status (4cB12) and the immuno-biochemical mediators of vitamin B12 deficiency.MethodsIn this observational study, 200 consecutive consenting metformin-treated T2DM patients, aged 35 and above, attending the diabetic clinic at KATH were recruited. Vitamin B12 deficiency was classified based on the Fedosov age-normalized wellness quotient. Anthropometric measurement was taken as well as blood samples for immunological and biochemical mediators. Peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Statistical analysis was performed using the R Language for Statistical Computing.ResultsUsing the combined indicator (4cB12), the prevalence of metformin induced vitamin B12 deficiency was 40.5% whilst the prevalence of MNSI-Q and MNSI-PE diabetic neuropathy was 32.5% and 6.5% respectively. Participants with vitamin B12 deficiency had significantly higher levels of IFA, GPA, TNF-α, TC, LDL and albumin compared to those with normal vitamin B12 levels (p ConclusionVitamin B12 deficiency and diabetic neuropathy are very high among metformin-treated T2DM patients and it is associated with increased GPA, IFA, TNF-α and cardiometabolic risk factors (higher LDL and TC and lower HDL). Upon verification of these findings in a prospective case-control study, it may be beneficial to include periodic measurement of Vitamin B12 using the more sensitive combined indicators (4cB 12) in the management of patients with T2DM treated with metformin in Ghana