Medication Adherence and Direct Treatment Cost among Diabetes Patients Attending a Tertiary Healthcare Facility in Ogbomosho, Nigeria

Background: Diabetes mellitus (DM) is now prevalent in many countries in sub-Saharan Africa, with associated health and socioeconomic consequences. Adherence to antidiabetic medications has been shown to improve glycaemic control, which subsequently improves both the short- and longterm prognosis of the disease. The main objective of this study was to assess the level of adherence to antidiabetic drugs among outpatients in a teaching hospital in southwestern Nigeria.Methods: A cross-sectional study was carried out using the eight-item Morisky Medication Adherence Scale (MMAS-8) among diabetic patients attending the medical outpatients’ diabetes clinic of Ladoke Akintola University Teaching Hospital, in Ogbomosho, Oyo State in southwestern Nigeria, during a three-month period (October to December 2013).Results: A total of 129 patients participated in the study with a male-to-female ratio of 1:1.5. Seventy-eight (60.5%) patients had systemic hypertension as a comorbid condition while the remaining were being managed for diabetes mellitus alone. Only 6 (4.7%) of the patients had type 1 DM while the remaining 123 (95.3%) were diagnosed with type 2 DM. Metformin was the most prescribed oral hypoglycaemic agent (n = 111, 58.7%) followed by glibenclamide (n = 49, 25.9%). Medication adherence was classified as good, medium, and poor for 52 (40.6%), 42 (32.8%), and 34 (26.6%) patients, respectively. Medication costs accounted for 72.3% of the total direct cost of DM in this study, followed by the cost of laboratory investigations (17.6%).Conclusion: Adherence of diabetes patients in the study sample to their medications was satisfactory. There is a need for the integration of generic medicines into routine care as a way of further reducing the burden of healthcare expenditure on the patients

Body Mass Index and severity of lumbar degenerative disc disease in adult patients using Oswestry Disability Index: any correlation?

Background: More than 90% of people will experience an episode of debilitating Low Back Pain (LBP) at some point in their lifetime. Lumbar Degenerative Disc Disease (LDDD) is the commonest cause of LBP globally in individuals aged 40 years and above. Body Mass Index (BMI) may be directly related to LDDD pathogenesis, progression, severity of symptom manifestation, and response to treatment.Objectives: The aim of this study was to determine the relationships between BMI and symptoms severity of LDDD in adult patients using Oswestry Disability Index (ODI); to determine the relationship between BMI and the clinical severity of LDDDs, and to determine the relationship between BMI and ODI in these patients.Methodology: All adult patients with signs and symptoms of LDDD presenting at clinic or emergency room were consecutively recruited and studied in two government tertiary hospitals in the North West and South West of Nigeria. The weight, height, symptomatology and ODI preformats were assessed for each patient. The information was analysed using Statistical Package for Social Sciences (SPSS) version 24.0. The statistical significance was set at P< 0.05. The chi-square tests were used to determine the relationships of BMI with the severity of symptoms and ODI in the studied patients.Results: The study involved 344 patients with male to female ratio of 1:1.6 and mean age of 59.8 years. The patients with normal range of BMI and elevated BMI accounted for 32% (110 patients) and 68% (234 patients) respectively. The study showed 73% of the participants with severe forms of disability while 27% of them had mild to moderate disability. The durations of symptoms varied from 1 to 15 years with the mean symptoms duration of 5.63 years. All the patients presented with varied and multiple symptoms. Altered sensation (paraesthesia) was found in 99.4% of them. The involved levels of lumbar spine on radiographs were L5/S1 (40.4%), T12/L1 (18.6%), L4/L5 (21.3%), L1/L2 (11.2%), L2/L3 (3.3%), L3/L4 (2.7%) and T12/L1 to L5/S1 (2.5%). There was a significant relationship between clinical symptoms and patients BMI on Chi-Square Tests (p < 0.05). The BMI also showed a significant relationship with ODI (p value = 0.001) while in symptoms and ODI (p value < 0.05).Conclusions: This study showed that there was a statistically significant (P < 0.05) relationship between BMI and clinical severity of LDDD including severity of Oswestry ODI with worsened symptoms among individuals with elevated BMI when compared to those with normal range of BMI.Keywords: Body Mass Index, Lumbar Degenerative Disc Disease, Clinical severit

Politics and Politicking: The Organizational Perspective

The totality of our community, society, the whole world and even the entire universe is an organization. Organizing involves developing a structure of roles for effective performance and it requires a network of decision and communication for coordinating efforts towards group and enterprise goals. For effectiveness an organizational structure must be understood and principles and policies must be put into practice through the structural organizational politics. Power and politics are interrelated and interwoven with the fabric of an organization. Politics, power and politicizing are necessary, unavoidable and inevitable. The paper therefore examined the features of organizational structure, sources of power, leadership styles, features and tactics of organizational politics. The paper equally examined the mistakes in organizational setting and way out. It was then concluded that effective managers need to be fully aware of the existence of political tactics, have the required wisdom, knowledge, skill and should learn how best to manage the organizational politics for the efficacy of the organizational setting. DOI: 10.5901/mjss.2014.v5n20p105

Genetics of Childhood Steroid Sensitive Nephrotic Syndrome: An Update

Advances in genome science in the last 20 years have led to the discovery of over 50 single gene causes and genetic risk loci for steroid resistant nephrotic syndrome (SRNS). Despite these advances, the genetic architecture of childhood steroid sensitive nephrotic syndrome (SSNS) remains poorly understood due in large part to the varying clinical course of SSNS over time. Recent exome and genome wide association studies from well-defined cohorts of children with SSNS identified variants in multiple MHC class II molecules such as HLA-DQA1 and HLA-DQB1 as risk factors for SSNS, thus stressing the central role of adaptive immunity in the pathogenesis of SSNS. However, evidence suggests that unknown second hit risk loci outside of the MHC locus and environmental factors also make significant contributions to disease. In this review, we examine what is currently known about the genetics of SSNS, the implications of recent findings on our understanding of pathogenesis of SSNS, and how we can utilize these results and findings from future studies to improve the management of children with nephrotic syndrome

Mutations in the Gene That Encodes the F-Actin Binding Protein Anillin Cause FSGS

FSGS is characterized by segmental scarring of the glomerulus and is a leading cause of kidney failure. Identification of genes causing FSGS has improved our understanding of disease mechanisms and points to defects in the glomerular epithelial cell, the podocyte, as a major factor in disease pathogenesis. Using a combination of genome-wide linkage studies and whole-exonne sequencing in a kindred with familial FSGS, we identified a missense mutation R431C in anillin (ANLN), an F-actin binding cell cycle gene, as a cause of FSGS. We screened 250 additional families with FSGS and found another variant, G618C, that segregates with disease in a second family with FSGS. We demonstrate upregulation of anillin in podocytes in kidney biopsy specimens from individuals with FSGS and kidney samples from a murine model of HIV-1 associated nephropathy. Overexpression of R431C mutant ANLN in immortalized human podocytes results in enhanced podocyte motility. The mutant anillin displays reduced binding to the slit diaphragm associated scaffold protein CD2AP. Knockdown of the ANLN gene in zebrafish morphants caused a loss of glomerular filtration barrier integrity, podocyte foot process effacement, and an edematous phenotype. Collectively, these findings suggest that anillin is important in maintaining the integrity of the podocyte actin cytoskeleton

Common Risk Variants in AHI1 Are Associated With Childhood Steroid Sensitive Nephrotic Syndrome

Introduction: Steroid-sensitive nephrotic syndrome (SSNS) is the most common form of kidney disease in children worldwide. Genome-wide association studies (GWAS) have demonstrated the association of SSNS with genetic variation at HLA-DQ/DR and have identified several non-HLA loci that aid in further understanding of disease pathophysiology. We sought to identify additional genetic loci associated with SSNS in children of Sri Lankan and European ancestry. Methods: We conducted a GWAS in a cohort of Sri Lankan individuals comprising 420 pediatric patients with SSNS and 2339 genetic ancestry matched controls obtained from the UK Biobank. We then performed a transethnic meta-analysis with a previously reported European cohort of 422 pediatric patients and 5642 controls. Results: Our GWAS confirmed the previously reported association of SSNS with HLA-DR/DQ (rs9271602, P = 1.12 × 10−27, odds ratio [OR] = 2.75). Transethnic meta-analysis replicated these findings and identified a novel association at AHI1 (rs2746432, P = 2.79 × 10−8, OR = 1.37), which was also replicated in an independent South Asian cohort. AHI1 is implicated in ciliary protein transport and immune dysregulation, with rare variation in this gene contributing to Joubert syndrome type 3. Conclusions: Common variation in AHI1 confers risk of the development of SSNS in both Sri Lankan and European populations. The association with common variation in AHI1 further supports the role of immune dysregulation in the pathogenesis of SSNS and demonstrates that variation across the allele frequency spectrum in a gene can contribute to disparate monogenic and polygenic diseases

Genetic risk variants for childhood nephrotic syndrome and corticosteroid response

IntroductionThe etiology of most cases of nephrotic syndrome (NS) remains unknown, therefore patients are phenotypically categorized based on response to corticosteroid therapy as steroid sensitive NS (SSNS), or steroid resistant NS (SRNS). Genetic risk factors have been identified for SSNS from unbiased genome-wide association studies (GWAS), however it is unclear if these loci are disease risk loci in other forms of NS such as SRNS. Additionally, it remains unknown if these risk loci are associated with response to therapy. Thus, we investigated the association between SSNS risk loci and therapy response in a large, multi-race cohort of children along the entire spectrum of childhood-onset NS.MethodsWe enrolled 1,000 patients with childhood-onset NS comprised of SSNS and SRNS. Genotyping was done using TaqMan and Direct Sanger Sequencing for 9 previously reported childhood SSNS risk loci. We compared the allele frequencies (AF) and variant burden between NS vs. controls and SRNS vs. SSNS.ResultsAll 9 risk loci were associated with NS compared with healthy controls (p = 3.5 × 10−3–<2.2 × 10−16). Variant burden greater than 7 was associated with risk of SRNS (OR 7.4, 95% CI 4.6–12.0, p = 8.2 × 10−16).ConclusionOur study showed that genetic risk loci for childhood SSNS are associated with pattern of therapy response, may help predict disease outcome, and set the stage for individualized treatment of NS