The Enormity of Chronic Kidney Disease in Nigeria: The Situation in a Teaching Hospital in South-East Nigeria

Background. The magnitude of the problem of chronic kidney disease (CKD) is enormous, and the prevalence keeps rising. To highlight the burden of CKD in developing countries, the authors looked at end-stage renal disease (ESRD) patients seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Method. ESRD patients seen from 01/05/1990 to 31/12/2003 were recruited. Records from A&E Department, medical-out-patients, wards and dialysis unit were used. Results. A total of 1001 male versus 537 female patients were reviewed. About 593 male versus 315 female patients had haemodialysis. The mean age was 42.55 ± 15.43 years and 86.5% were <60 years. Primary renal disease could not be determined in 51.6% while hypertension and glomerulonephritis accounted for −17.2% and 14.6%, respectively. Death from renal causes constituted 22.03% of medical deaths. Conclusion. The prognosis for CKD patients in Nigeria is abysmal. Only few patients had renal-replacement-therapy (RRT). The prohibitive cost precludes many patients. This underscores the need for preventive measures to reduce the impact of CKD in the society

Microbial contamination and preservative capacity of some brands of cosmetic creams

Purpose: Cosmetic and topical products need not be sterile but may contain low levels of microbial load during use. This study was conducted to determine and compare the level and type of microbial contaminants in commercial cosmetic products sold in the market and a laboratory prepared aqueous cream and their preservative capacities while in use. Methods: Ten brands of commercially available cosmetic creams and lotions were randomly purchased from the open markets in Benin City. Aqueous Cream was also prepared. Their bacterial and fungal loads as well as types were evaluated. Preservative capacity was evaluated by challenging the creams and lotions with washed and characterized isolates of Staph. aureus and viable counting was performed by the surface viable method. The prepared aqueous cream was similarly challenged with the test organism. Results: All the products were contaminated to varying degrees. Staphylococci and other gram-positive cocci were the most preponderant; gram-negative isolates were hardly found. Fungal contaminants consisted largely of Asp. fumigatus, Penicillium and Microsporium species. Challenge test (re-infection) with Staph. aureus revealed the commercial products as having low capacity for suppressing bacterial proliferation such as may be encountered during in – use contamination. Conclusion: Commercial cosmetic creams and lotions evaluated did not generally meet the standards for microbial limits as specified in official monographs. Such products can adversely affect health status of consumers as well as the stability profiles of the products. Key words: Commercial products; cosmetic creams; cosmetic lotions; microbial contamination Trop J Pharm Res, December 2003; 2(2): 229-23

Enzyme production and activities of lignocellulolytic fungi cultivated on agricultural residues

A total of 30 fungal fruiting bodies were collected from decaying plant materials (barks and litter) from the wild based on morphological variations. Nine of these fungi purified to monoaxenic cultures were included in the present study and also a type strain Ganoderma lucidum ATCC- 32471. These fungi were screened for lignocellulolytic activities, five of these organisms produced ligninolytic enzymes when exposed to two different concentrations of guaiacol (0.02% and 0.2%) on two different media (MEA and PDA). All ten fungal isolates screened for cellulolytic activity were positive for the production of the cellulase enzyme. The fungal isolates were characterised using morphological and molecular methods. Molecular characterization using ITS1 and ITS4 primers was able to identify these fungal isolates to degrees of accuracy ranging from 98% to 100%. The phylogenetic and lineage analysis showed that the species varied amongst phylum Basidiomycota, Ascomycota and early diverging fungal lineages Mucormycotina. Both monocultures and dual cultures of these 10 fungal species were cultivated for the purpose of spectrophotometrically quantifying and evaluating enzyme production on agricultural waste residues; corn cob, sugar cane bagasse and wheat straw. A pattern of antagonistic invasion interaction was identified to demonstrate increased enzyme production on dual cultures. Four of these fungal species, Trichoderma sp. KN10, Rhizopus microsporus KN2, Fomitopsis sp. KN1 and Coriolopsis sp. KN6 demonstrated tendencies of invasion and replacement in co-cultures. The fungi and their dual cultures showed varying levels of enzyme production. Analysis of mean showed dual culture interactions involving KN10 with values for MnP production approximately at 1.46U/ml compared to monoculture of 0.06U/ml. Further, dual laccase values approximately at 0.09U/ml compared to monocultures of 0.05U/ml. Overall the highest enzyme activity was observed using wheat straw. This study demonstrated and proved that agricultural waste residues can be used for lignocellulytic enzyme production and that antagonistic invasion by some fungi (in particular Trichoderma sp. KN10) in co-cultures can increase production of one or more of the three enzyme laccase, lignin peroxidase and manganese peroxidase.Environmental SciencesPh. D. (Environmental Science

Prevalence of CKD-MBD in pre-dialysis patients using biochemical markers in Enugu, South-East Nigeria

Background: As kidney function declines, there is a progressive deterioration in mineral homeostasis with disruption of normal serum and tissue concentration of phosphorus and calcium, and changes in circulating levels of hormones-parathyroid hormone (PTH), calcitriol (1,25(OH)2 D), and Fibroblast growth factor-23 (FGF-23).Objective: This study was aimed at determining the prevalence of markers of CKD-MBD in pre-dialysis patients.Methods: We evaluated consecutively 168 subjects made up of 85 CKD patients and 83 healthy controls, who were attending the renal clinics and medical outpatient of University of Nigeria Teaching Hospital,  Enugu. GFR was estimated and serum calcium, phosphorus, alkaline phosphatase, PTH, and 25(OH) D levels assayed.Results: The prevalence of various mineral bone disease abnormalities were 70% hyper-phosphatemia, 85% hyper-parathyroidism, and 100% low levels of 25 (OH) D among the patients. Estimated GFR  correlated negatively with both serum phosphorus, and PTH. Age of the patients ranged from18-76 years with a male to female ratio of 1.7:1. Chronic Glomerulonephritis (CGN), hypertension and diabetes mellitus caused CKD in 75% of the patients. There was no significant decrease in serum calcium levels of patients compared to controls. The patients did not have pathologically raised alkaline phosphatase, although their mean level was significantly higher than that of the control group.Conclusion: Low 25 (OH) D levels (insufficiency/deficiency), hyperparathyroidism, and hyper-phosphatemia were the obvious markers of CKD-MBD in our pre-dialysis patients. These should be evaluated at presentation in these patients.Key words: CKD-MBD, Predialysis, biochemical markers, Southeast Nigeria

Pattern of cancer deaths in the medical wards of a teaching hospital in South East Nigeria

Background: Cancers are emerging public health problems in developing countries like Nigeria. The epidemiological shift and aging population make cancers a challenge.Objective: We set out to describe the pattern of death due to cancer in our medical ward. The hospital is one of the premier hospitals covering the South East zone of Nigeria.Materials and Methods: We retrospectively reviewed the case notes and death certificates of all who died of cancer in our adult medical wards for 16 years (January 1995 to December 2010).Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL) version 17.0 was used.Results: Twenty seven thousand, five hundred and fourteen patients were admitted into the medical wards. Six thousand, two hundred and fifty died. Out of the 6250 deaths, cancers accounted for 7.6%. Male to Female ratio was 2.4:1. The mean age at death was 43.7 ± 17.4 years. The mean age at death in both sexes was similar (42.9 ± 17.5 for men and 45.7 ± 17.0 years for women), P = 0.109. Primary liver cell carcinoma was the most common cause of death among men (40.8%), while cancer of hematopoietic organ was the most common in women (48.7%). The overall fatality rate was 1.7% (477/27 514) of medical admissions. Younger and middle age groups were most commonly affected in both sexes. Conclusion: Since the most productive age groups were affected, governments in developing countries should as a matter of urgency put in place adequate cancer preventive and curative services.Keywords: Cancer, mortality, medical wards, South East NigeriaNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Analysis of Edible Mushroom Marketing in Three Villages in Central Cross River State, Nigeria

This study examined the marketing of edible mushroom in three villages (Alesi, Ekukunela and Ohon) in Central Cross River State, Nigeria. The marketing of edible mushroom in the state offers job opportunities for both skilled and unskilled rural population at farm gate and offers market employment opportunities for middlemen (wholesalers and retailers), enable talent utilization and stimulation of increase in edible mushroom production. The socio-economic characteristics of sellers, profit margin and marketing efficiency were the main focus. One hundred and twenty respondents were interviewed at three different markets in three selected villages in Central Cross River State, Nigeria, namely: Alesi, Ekukunela and Ochon. These markets were chosen because of the large number of edible mushroom sellers in them. However, the sellers were randomly selected. This study revealed that the marketing of edible mushroom in Central Cross River State was completely dominated by women and children, with monthly profit margin for Alesi, Ekukunela and Ochon markets as N60,000.00, N56,000.00 and N52,000.00 per annual respectively. This suggests that edible mushroom marketing business was lucrative. The concentration of sellers is low while entry is free. The markets are thus prefect competitive markets. The regression analysis, however, revealed that of all the marketing costs, transportation had the most significant impact on the returns of sellers in all the studied markets. It was therefore recommended that farmers should form Mushroom Grower and Marketing Cooperative to enable them obtain loans from banks. Banks should provide loans with low interest rate to both small and large – scales genuine mushroom farmers and marketers (not politicians, motor park boys or civil servant). Furthermore, extension agents should monitor beneficiaries of such loans to ensure that the farmers or marketers do not divert funds to buy motor-cycles, cars or marry more wives and also they should ensure regular repayment of loans by loan beneficiaries. The study also recommended that government should implement action –research type of programs that integrate institutional-technical and socio-economic aspect of mushroom farming and include post harvest and marketing aspects either through cooperatives or export processing zones. Finally, the study recommended that serious attention should be paid to improve the markets to perfect markets for optimal efficiency.KEY WORDS: Edible Mushroom, Nutrition, Improved Health, Marketing Efficienc

Prevalence of autonomic dysfunction among pre-dialysis chronic kidney disease patients in a tertiary hospital, South East Nigeria

Background: Autonomic dysfunction (AD) has been recognized as an important contributor to the poor outcome in chronic kidney disease (CKD) patients. Several studies have reported abnormalities in heart rate variability (HRV) among these patients. Objectives: To determine the prevalence of Autonomic Dysfunction (AD) in pre-dialysis Chronic Kidney Disease (CKD) patients in a tertiary hospital in South East Nigeria.Methods: A cross sectional study of eighty chronic kidney disease patients attending the renal unit out-patient in the University of Nigeria Teaching Hospital (UNTH) Enugu was carried out. Forty subjects, drawn randomly, who had no kidney disease served as control. Autonomic function was assessed with non – invasive cardiovascular tests including, measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing test, heart rate response to Vasalva manoeuvre and heart rate response to respiration. Results: With the battery of 5 tests used to assess AD, the frequency of autonomic dysfunction in pre-dialysis chronic kidney disease patients was 51.3% compared to 7.5% in the control group. Heart rate response to standing was the most sensitive test to detect AD in this group of subjects.  Conclusion: AD is a common problem among pre-dialysis CKD patients in Nigeria.  Keywords: Prevalence, autonomic dysfunction, pre-dialysis

High Prevalence and Low Awareness of Hypertension in a Market Population in Enugu, Nigeria

Background. A community-based study put the prevalence of hypertension in Nigeria at 32.8%. Market workers in Nigeria lead sedentary life style and often depend on salt-laden fast food while at work. Method. An unselected population of market workers were screened for hypertension and its risk factors by a pretested, structured questionnaire, clinical examination, and laboratory investigation. Hypertension was defined as BP ≥ 140 and/or ≥ 90 mmHg or being on drug therapy. Results. Forty-two percent of the screened population were hypertensive. Of this number, 70.6% did not know they were hypertensive before the screening. More males than females (P = .022) were hypertensive. Prevalence of hypertension increased with age from 5.4% in the age group <20 years to 80% in the age group ≥70 years. Conclusion. The prevalence of hypertension in market workers in this study was 42%, and the majority of them were unaware of their disease