Anaemia and its predisposing factors in pre-dialysis chronic kidney disease patients in Jos, Nigeria

Background: Chronic Kidney Disease (CKD) is a rising global health problem. The association of CKD with anaemia, which causes are multifactorial, portends a poorer prognosis. When diagnosed and treated, CKD patients with anaemia experience improved cognitive function and quality of life. We determined the prevalence of anaemia and associated factors among pre-dialysis CKD patients in Jos.Methods: A cross-sectional study was carried out in the Jos University Teaching Hospital (JUTH) from September 2016 to May 2017 involving 55 CKD patients enrolled consecutively. History, physical examination and laboratory investigations (full blood count by automated haemato-analyser, reticulocyte count by manual supravital stain, serum creatinine by Jaffe reaction) were performed on all patients. The obtained data was analyzed using Epi Info verison 3.5.4 and p values <0.05 were considered statistically significant.Results: The mean age of the CKD study population was 47±13years. The mean values for haemoglobin (Hb) concentration, mean cell volume (MCV) and mean cell haemoglobin (MCH) were 11.89±3.01g/dl, 86.6±51.2fl and 27.87±8.89pg respectively. The mean white blood cell (WBC) and platelet counts were 6.22±2.42 X109/L and 283±137 X109/L respectively. The mean reticulocyte production index was 1.2±1.5%. The prevalence of anaemia among CKD patients was 54.5%. Factors associated with anaemia were aging, female gender, history of diabetes mellitus and declining eGFR.Conclusion: The prevalence of anaemia in pre-dialysis CKD patients in JUTH is high. It is recommended that CKD patients be evaluated routinely for the possible factors that may predispose or predict anaemia.Conflict of interest: NilKeywords: Chronic kidney disease, anaemi

Secondary hyperparathyroidism among Nigerians with chronic kidney disease

Backround: Secondary hyperparathyroidism (SHPT) is a manifestation of chronic kidney disease mineral bone disorder (CKD-MBD). SHPT is common in patients with chronic kidney disease (CKD) and is associated with significant morbidity and mortality.Methods: A cross- sectional descriptive study involving 230 patients with CKD. Results: The mean age of the study population was 44.17±15.24 years. The median intact parathyroid hormone and alkaline phosphatase levels were 96pg/ml (range 4-953pg/ml) and 88 iu/l (range 10-800 iu/l) respectively. The mean (with standard deviation) calcium, serum phosphate, calcium phosphate product and haemoglobin levels were 2.22±0.29mmol/l, 1.8±0.62mmol/l, 3.94±1.42mmol2/l2 and 9.90±1.87g/dl respectively. Majority of patients had advanced CKD with 70.3% of patients in stage G5. The prevalence rates of SHPT, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase and elevated calcium phosphate product were 55.2%, 34.8%, 66.1%, 42.2% and 25.2% respectively. Univariate analysis revealed that SHPT was associated with hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase, proteinuria, anaemia, hypertension, left ventricular hypertrophy and stage of kidney disease; being worse with advancing kidney disease. Independently associated with SHPT were hypocalcaemia (OR=4.84), hyperphosphataemia (OR=3.06), and elevated alkaline phosphatase (OR=2.04).Conclusion: The prevalence of SHPT in CKD is high, occurs early and is independently associated with hypocalcaemia, hyperphosphataemia and elevated alkaline phosphatase. The prevalence of SHPT also increases with worsening renal function.Keywords: Secondary hyperparathyroidism, chronic kidney disease, intact parathyroid hormone, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase

Control of risk factors for nephropathy among Nigerian outpatients with Type 2 diabetes mellitus

Background and Objectives: To determine the proportion of type 2 diabetic  outpatients with adequate control of risk factors for nephropathy in a Nigerian teaching hospital.Methods: Between April and July 2005, 160 type 2 diabetic outpatients were  assessed for control of average fasting blood glucose and blood pressure over 3 visits, and current use of ACE inhibitors. All patients were over 30 years of age and had been followed up for at least one year with at least 6 prior clinic visits.Results: We studied 58 male and 102 female subjects with a mean (±SD) age of 54±10 years. The majority (54.7%) had diabetes between 1 and 5 years, and 95% were on antidiabetic drugs, most commonly both a sulphonylurea and metformin (64.5%). 114 (71.2%) were being treated for hypertension. The mean fasting blood glucose (FBS) was 7.6±2.9mmol/L, and 73 (45.6%) had good glycaemic control  (mean FBS≤ 5.6mmol/L). A total of 51 (31.9%) had good blood pressure control (<140/90mmHg in non-hypertensives and <130/80mmHg in hypertensives), and 73 (45.6%) were currently receiving ACE inhibitors. Only five (3.1%) had the combination of good glycaemic control, good blood pressure control and received ACE inhibitors. Conversely, 23 (14.4%) had a combination of poor glycaemic control, poor blood pressure control, and were not receiving ACE inhibitors. Duration of diabetes (p<0.01), elevated creatinine (p<0.01), and elevated systolic blood  pressure (p<0.01) were independently associated with proteinuria.Conclusion: Despite the availability of measures to prevent the progression of diabetic nephropathy, control of risk factors was poor. Physicians and diabetic patients in Nigeria must work together to improve their management of risk factors for nephropathy.Key words: Diabetes mellitus, chronic kidney disease, renoprotectio

Hypertonicity: Pathophysiologic Concept and Experimental Studies

Disturbances in tonicity (effective osmolarity) are the major clinical disorders affecting cell volume. Cell shrinking secondary to hypertonicity causes severe clinical manifestations and even death. Quantitative management of hypertonic disorders is based on formulas computing the volume of hypotonic fluids required to correct a given level of hypertonicity. These formulas have limitations. The major limitation of the predictive formulas is that they represent closed system calculations and have been tested in anuric animals. Consequently, the formulas do not account for ongoing fluid losses during development or treatment of the hypertonic disorders. In addition, early comparisons of serum osmolality changes predicted by these formulas and observed in animals infused with hypertonic solutions clearly demonstrated that hypertonicity creates new intracellular solutes causing rises in serum osmolality higher than those predicted by the formulas. The mechanisms and types of intracellular solutes generated by hypertonicity and the effects of the solutes have been studied extensively in recent times. The solutes accumulated intracellularly in hypertonic states have potentially major adverse effects on the outcomes of treatment of these states. When hypertonicity was produced by the infusion of hypertonic sodium chloride solutions, the predicted and observed changes in serum sodium concentration were equal. This finding justifies the use of the predictive formulas in the management of hypernatremic states

Bacterio-Chemical Assessment of Hand-Dug Wells in New Haven, Enugu State Nigeria

The focus of the study was a bacterio-chemical analysis of hand-dug wells in New Haven, Enugu State Nigeria. Three wells, W1, W2, and W3 were randomly selected for the study. The method adopted for the selection of the wells was a simple random sampling. A total of 180 water samples from the wells were analyzed for metals and enteric bacteria. The enteric bacteria were identified using Gram reaction, lactose fermentation, indole, and catalase, oxidase, Voges-Proskauer procedures. The metal concentrations were determined by using atomic absorption spectrophotometer. The result of the study showed that the average concentrations of iron, zinc, calcium, magnesium, and lead were within the permitted limits stipulated by WHO and The Federal Republic of Nigeria. Bacteria identified were Escherichia coli (E. coli) and Salmonella. It was concluded that water from the wells in New Haven, Enugu State Nigeria should be treated before they can be used for drinking and other domestic uses

A Randomized Controlled Trial to Examine the Relationship Between Peer Mentoring for Physical Activity and Cardiometabolic Health

Background: Studies examining the effect of peer mentoring on physical activity levels have been conducted in mostly elderly and young populations, and the results have been inconsistent. This study examined the impact of one-on-one peer mentoring on physical activity and cardiometabolic parameters in urban adults. Methods: The study participants were 353 overweight or obese adults residing in Abuja, Nigeria. They were randomized into two groups, peer-mentored (n = 128) and a control (n = 225) group. All the participants received nutritional counseling and were invited to attend instructor-led physical activity sessions each week for six months. Differences in the frequency, duration, and intensity of physical activity and cardiometabolic parameters, including body fat, muscle mass and lipids, were evaluated within and between the groups with t and rank sum tests. Results: At the end of the study period, the average time spent on physical activity increased significantly by 14% (p = 0.006), and the average time spent on vigorous physical activity increased by 99% (p = 0.003) compared to baseline for participants in the peer-mentored group. For those in the control group, the average time spent on physical activity decreased significantly by 7% (p = 0.03), while the average time spent on vigorous physical activity increased by 30%, but this was not statistically significant (p = 0.34). In both groups, there were significant improvements in the total cholesterol, low- and high-density lipoproteins and triglycerides levels, at the end of the study period, compared to baseline. Conclusions: In these overweight or obese adults, we observed that peer mentoring was positively associated with increased physical activity. Peer mentoring also holds great promise for improving cardiometabolic health and promoting a healthy lifestyle in adults

Prevalence of irritable bowel syndrome: A community survey in an African population

Background : Irritable bowel syndrome (IBS) has been reported to be common in the West. Community surveys are lacking in the African setting. We determined the prevalence of IBS in a rural community setting in Nigeria. Method : Questionnaires were administered to consenting individuals. Subjects satisfying the Rome II criteria for IBS were invited for physical examination at a health center to identify the presence of "alarm factors." Results : One hundred forty (31.6%) of the 443 evaluated individuals fulfilled the Rome II criteria for IBS, with a male-to-female ratio of 1.37:1 (P= .11). The prevalence of IBS was highest (39.3%) in the third decade, followed by 25% in the fourth decade (P= .009). Ninety-six (67%) IBS individuals had the alternating pattern of diarrhea and constipation, whereas 28 (20%) and 19 (13%) had constipation and diarrhea subtypes, respectively. Conclusion : IBS as diagnosed by the Rome II criteria has a high prevalence in the African rural population, as obtained elsewhere.Contexte: Irritable Syndrome (IBS) a \ue9t\ue9 signal\ue9 \ue0 \ueatre commune \ue0 l\u2019Ouest. Enqu\ueates communautaires font d\ue9faut dans le contexte africain. Nous avons d\ue9termin\ue9 la pr\ue9valence de IBS dans un milieu rural. communaut\ue9 d\ue9fi nition dans le Nig\ue9ria. M\ue9thode: Questionnaires ont \ue9t\ue9 administr\ue9 aux personnes consentantes. Sujets de satisfaction de la Rome II crit\ue8res d\u2019IBS ont \ue9t\ue9 invit\ue9s pour l\u2019examen physique dans un centre de sant\ue9 \ue0 identifi er la pr\ue9sence de \u201c alarme les facteurs \u201d. R\ue9sultats: Un cent et quarante (31,6 %) des individus \ue9valu\ue9es 443 rempli le Rome Crit\ue8res II IBS avec un m\ue2le \ue0 ratio f\ue9minin de 1.37:1 (p = 0,11) .la pr\ue9valence IBS \ue9tait plus \ue9lev\ue9 dans la troisi\ue8me d\ue9cennie (39.3 %), suivie de 25 % dans le quatri\ue8me dix ans (p = 0.009). Quatre-vingt-seize (67 %) IBS personnes avaient le mod\ue8le d\u2019alternance de la diarrh\ue9e et constipation, alors que 28 (20 %) et 19 (13 %) avaient constipation et la diarrh\ue9e subtypes respectivement. Conclusion: IBS comme un diagnostic par les crit\ue8res de Rome II a une haute pr\ue9valence dans la population rurale africaine comme obtenu ailleurs

Adoption and impacts of agricultural technologies and sustainable natural resource management practices in fragile and conflict affected settings: A review and meta-analysis

Climate change and conflicts co-exist in many countries with significant welfare and socio-environmental implications. Different approaches are being promoted to adapt and build resilience to these fragilities including the adoption of sustainable farm practices that have the potential to increase agricultural productivity and maintain environmental sustainability. We undertake a systematic review and perform a meta-analysis to understand and synthesize the adoption and impacts of agricultural technologies and natural resource management practices with a special attention to fragile and conflict affected settings. We employ state of the art machine learning methods to enable process and selection of appropriate papers from a universe of over 78,000 papers from leading academic databases. We find that studies on adoption and impact of agricultural technologies and natural resource management practices are highly clustered around Ethiopia and Nigeria. We do not find any studies on Small Island States. We observe a wide array of characteristics that influence adoption of these technologies. Of the over 1400 estimates of determinants collected, majority predict input technologies while very few studies and estimates are found in relation to risk management and mechanisation technologies. Our meta-analysis shows an average effect size of 7 - 9% for the different technologies and practices. For the outcomes: land productivity, food security and household welfare, we obtain effect sizes of 6, 8 and 9% respectively. We do not observe much in terms of publication bias. Both climate and conflict vulnerability not only cause far more food insecurity, poverty, and degradation of the environment on their own but also reinforce each other through the climate change – conflict linkage. For these detrimental effects to be curtailed, utilisation of climate-smart agricultural technologies and natural resource management practices need to be encouraged. We thus lend credence to the development, dissemination and upscaling of these sustainable practices. We observe a lot of space for growth and adoption of these technologies

Fluid balance concepts in medicine: Principles and practice.

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance

Associations between red blood cell variants and malaria among children and adults from three areas of Uganda: a prospective cohort study.

BACKGROUND: Multiple red blood cell (RBC) variants appear to offer protection against the most severe forms of Plasmodium falciparum malaria. Associations between these variants and uncomplicated malaria are less clear. METHODS: Data from a longitudinal cohort study conducted in 3 sub-counties in Uganda was used to quantify associations between three red blood cell variants Hb [AA, AS, S (rs334)], alpha thalassaemia 3.7 kb deletion, and glucose-6-phosphate dehydrogenase deficiency A-(G6PD 202A genotype) and malaria incidence, parasite prevalence, parasite density (a measure of anti-parasite immunity) and body temperature adjusted for parasite density (a measure of anti-disease immunity). All analyses were adjusted for age, average household entomological inoculation rate, and study site. Results for all variants were compared to those for wild type genotypes. RESULTS: In children, HbAS was associated, compared to wild type, with a lower incidence of malaria (IRR = 0.78, 95% CI 0.66-0.92, p = 0.003), lower parasite density upon infection (PR = 0.66, 95% CI 0.51-0.85, p = 0.001), and lower body temperature for any given parasite density (- 0.13 ℃, 95% CI - 0.21, - 0.05, p = 0.002). In children, HbSS was associated with a lower incidence of malaria (IRR = 0.17, 95% CI 0.04-0.71, p = 0.02) and lower parasite density upon infection (PR = 0.31, 95% CI 0.18-0.54, p < 0.001). α-/αα thalassaemia, was associated with higher parasite prevalence in both children and adults (RR = 1.23, 95% CI 1.06-1.43, p = 0.008 and RR = 1.52, 95% CI 1.04-2.23, p = 0.03, respectively). G6PD deficiency was associated with lower body temperature for any given parasite density only among male hemizygote children (- 0.19 ℃, 95% CI - 0.31, - 0.06, p = 0.003). CONCLUSION: RBC variants were associated with non-severe malaria outcomes. Elucidation of the mechanisms by which they confer protection will improve understanding of genetic protection against malaria