Outcomes of Tunneled and Nontunneled Internal Jugular Catheters for Hemodialysis at Zenith Medical and Kidney Centre, Nigeria

Objectives: Tunneled and nontunneled jugular access routes are the most widely used routes for hemodialysis (HD) in developing countries.This study was a retrospective review of the utility, safety, and outcomes of both tunneled and nontunneled curved internal jugular catheteruse in patients with end‑stage renal disease (ESRD) in Zenith Medical and Kidney Centre, Abuja, Nigeria. Materials and Methods: This is a retrospective study of 100 ESRD patients on maintenance HD at the center between June 2019 and December 2019. All patients on maintenance dialysis with tunneled and nontunneled curved internal jugular catheter were observed for immediate and short‑term complications associated with the catheter. Results: Among the patients, 90 (90.0%) had tunneled dialysis catheters placement and dialyzed with it, while 10 (10%) patients had nontunneled dialysis catheters use. While 90 (90%) of the patients with the dialysis catheters developed no complications, ten (10%) patients had catheter‑related complications either during catheter insertion or while it was being used for dialysis. The most common in this study was reactionary hemorrhage which occurred in 5% of the patients evaluated. Ten (10%) of the patients with catheter placement required ultrasonic guidance. No death was recorded during catheter placement. Conclusion: Internal jugular tunneled and Non tunneled dialysis catheters (NTDCs) are safe with good outcomes among our ESRD patients. Keywords: Catheters, hemodialysis, Nigeria, outcome, tunneled and nontunneled dialysis catheters, Zenith Medica

Anatomical variations of the renal artery: a computerized tomographic angiogram study in living kidney donors at a Nigerian Kidney Transplant Center

Background: Understanding of the renal vascular anatomy is key to a safe and successful donor nephrectomy, which ultimately impacts on the renal graft function and survival in kidney transplant recipients. Objective: To report the various anatomical configurations of the renal artery identified in living kidney donors in a Nigerian kidney transplant institution . Materials and Methods: The computerized tomography angiograms of 100 consecutive living kidney donors were prospectively reviewed over an 18-month period. Anatomical variations of the renal arteries including accessory arteries and early divisions were noted. Duration of surgery and ischemic time were recorded intra-operatively. Data analysis was carried out using IBM SPSS version 20. Results: There were variations in renal artery configuration in 50 (50%) cases, 32% were accessory renal arteries while 18% were early branches of the renal artery. The classical bilateral solitary renal arteries were found in 50 (50%) of potential donors. There was statistically significant longer operating and ischemic time in donors with multiple renal arteries as compared with solitary arteries (p<0.05). Conclusion: There are a wide variety of renal artery configurations seen in potential kidney donors. The classical solitary renal artery remains the commonest and most favourable configuration for donor nephrectomy and transplantation

Unusual presentation of advanced prostate cancer in a black population of South-Western Nigeria

There are growing concerns on the varying pattern of advanced prostate cancer (PCa) presentation across the world. We report some of the unusual presentations of PCa at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, South-Western Nigeria. A review of all patients with histologically confirmed PCa who had unusual presentations between January 2014 and December 2015 was done. Unusual presentation was defined as an atypical feature in the absence of lower urinary tract symptoms (LUTS), with the diagnosis of PCa only suspected after abnormal digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) assay. Thirteen patients had an unusual presentation in OAUTHC during the study period. Five (38.5%) had left supraclavicular swellings while four (30.8%) had haematochyzia and tenesmus. Other unusual presentations include large bowel obstruction requiring emergency colostomy (2;15.4%) and a scalp mass (1;7.7%). All patients had appropriate treatment for stage of CaP and are being followed up in the out-patient clinic. The change in presentations of PCa may suggest the need for DRE and serum PSA assay among all middle-aged and elderly men presenting at health facilities. Large scale studies on PCa across different population groups may also help at identifying related clinical, demographic and epidemiological factors as well as possible validation of some of these unusual presentations

Constraints on the preservation of proxy data in carbonate archives – lessons from a marine limestone to marble transect, Latemar, Italy

This work evaluates an exceptionally complex natural laboratory, the Middle Triassic Latemar isolated platform in the northern Italian Dolomite Mountains and explores spatial and temporal gradients in processes and products related to contact metamorphism, dolomitization and dedolomitization of marine limestones. The relation between petrographic change and re-equilibration of geochemical proxy data is evaluated from the perspective of carbonate-archive research. Hydrothermal dolomitization of the limestone units is triggered by dykes and associated hydrothermal fluids radiating from the nearby Predazzo Intrusion. Detailed petrography, fluid inclusion analysis, δ13C and δ18O data and 87Sr/86Sr isotope ratios shed light on the extreme textural and geochemical complexity. Metamorphic and diagenetic patterns include: (i) peak-metamorphic and retrograde-metamorphic phases including three dolomite marbles, two dedolomite marbles, brucite, magnesium silicates and late-stage meteoric/vadose cement at the contact aureole; (ii) four spatially defined episodes of dolomitization, authigenic quartz, low magnesium calcite and late-stage meteoric cement at the Latemar isolated platform; and (iii) kilometre-scale gradients in δ13C values from the contact aureole towards the platform interior. Results shown here are relevant for two reasons: first, the spatial analysis of alteration products ranging from high-grade metamorphic overprint of marbles at temperatures of 700˚C in the contact aureole to moderately altered limestones in the platform interior at temperatures 20 km. Second, under rock-buffered conditions, and irrespective of metamorphic to diagenetic fluid-rock interactions, both marbles, and low-temperature hydrothermal dolomites have conservative marine δ13C and δ18O values. The fact that metamorphism and hydrothermal dolomitization of precursor limestones and early diagenetic dolostones did not per se reset environmental proxy data is of interest for those concerned with carbonate archive research in Earth’s deep time

Putting the “We” Into Well‐being: Using Collectivism‐Themed Measures of Well‐Being Attenuates Well‐being's Association With Individualism

Studies repeatedly have documented that societal well‐being is associated with individualism. Most of these studies, however, have conceptualized/measured well‐being as individual life satisfaction—a type of well‐being that originates in Western research traditions. Drawing from the latest research on interdependent happiness and on family well‐being, we posit that people across cultures pursue different types of well‐being, and test whether more collectivism‐themed types of well‐being that originate in Confucian traditions also are associated with individualism. Based on data collected from 2,036 participants across 12 countries, we find support for the association between individual life satisfaction and individualism at the societal level, but show that well‐being's association with individualism is attenuated when some collectivism‐themed measures of well‐being are considered. Our article advances knowledge on the flourishing of societies by suggesting that individualism may not always be strongly linked with societal well‐being. Implications for public policies are signaled

Challenges of residency training and early career doctors in Nigeria study (charting study): a protocol paper

Introduction: Early career doctors (ECDs) make up a significant proportion of the workforce of medical/dental practitioners in Nigeria. ECDs play pivotal roles in the Nigerian healthcare system. However, several factors affect ECDs in their career endeavours, ranging from poor remuneration to psychosocial problems (such as burn out, job dissatisfaction, etc.). While other countries have tried to investigate these factors and their impact, no national inquiry has been done yet in Nigeria. This demonstrates the critical need to conduct a nationally representativestudy exploring these factors, such as demographic, workplace and psychosocial factors, among ECDs in Nigeria. This article is a protocol paper for the challenges of residency training and early career doctors in Nigeria study; charting study to be conducted under the auspices of the Nigerian Association of Resident Doctors of Nigeria(NARD).Methods: The Charting Study would be a mixed study design, utilizing both qualitative and quantitative study designs and access data from structured questionnaire, focus group interview and secondary data available to the association.Conclusion: The outcome of this study will provide great insight into various issues affecting ECDs in Nigeria and make necessary recommendations.Keywords: Nigeria, early career doctors, junior doctors, physicians, dentists, workplace, psychosocial issue

Challenges of Residency Training and Early Career Doctors in Nigeria Phase II: Update on Objectives, Design, and Rationale of Study

Background: Early career doctors (ECDs) are a dynamic and highly mobile group of medical and dental practitioners who form a significant proportion of the health workforce in Nigeria. The challenges of residency training and ECDs in Nigeria CHARTING Phase I study explored limited challenges affecting ECDs under the broad themes of demography, workplace issues, and psychosocial issues. The CHARTING II was expanded to provide wider insight into the challenges of ECDs in Nigeria. Objective: This protocol aims to provide clear objectives including description of objectives, design, and rationale for the conduct of the proposed CHARTING II study which seeks to explore other components under the various themes of demographic, workplace, psychosocial issues affecting the ECDs in Nigeria, and which were not explored under CHARTING I.   Methodology: This shall be a mixed study design that will combine qualitative and quantitative methods, to investigate 27 subthemes among 2000 ECDs spread across 31 centers, accredited by the Nigerian Association of Resident Doctors. Participants shall be selected using the multistage sampling method. The primary data will be generated using structured proforma and validated questionnaires,while administrative sources would serve as a source of secondary data. Data will be entered and analyzed using appropriate statisticalsoftware. Conclusion: CHARTING II study would provide more robust data and insight into the problems encountered by ECDs in Nigeria. This would in turn build a platform for institutional engagement and advocacy in order to drive relevant policies to mitigate these challenges. Keywords: Early career doctors, Nigeria, residency, resident doctors, trainin

Irbesartan in Marfan syndrome (AIMS): a double-blind, placebo-controlled randomised trial

BACKGROUND: Irbesartan, a long acting selective angiotensin-1 receptor inhibitor, in Marfan syndrome might reduce aortic dilatation, which is associated with dissection and rupture. We aimed to determine the effects of irbesartan on the rate of aortic dilatation in children and adults with Marfan syndrome. METHODS: We did a placebo-controlled, double-blind randomised trial at 22 centres in the UK. Individuals aged 6-40 years with clinically confirmed Marfan syndrome were eligible for inclusion. Study participants were all given 75 mg open label irbesartan once daily, then randomly assigned to 150 mg of irbesartan (increased to 300 mg as tolerated) or matching placebo. Aortic diameter was measured by echocardiography at baseline and then annually. All images were analysed by a core laboratory blinded to treatment allocation. The primary endpoint was the rate of aortic root dilatation. This trial is registered with ISRCTN, number ISRCTN90011794. FINDINGS: Between March 14, 2012, and May 1, 2015, 192 participants were recruited and randomly assigned to irbesartan (n=104) or placebo (n=88), and all were followed for up to 5 years. Median age at recruitment was 18 years (IQR 12-28), 99 (52%) were female, mean blood pressure was 110/65 mm Hg (SDs 16 and 12), and 108 (56%) were taking β blockers. Mean baseline aortic root diameter was 34·4 mm in the irbesartan group (SD 5·8) and placebo group (5·5). The mean rate of aortic root dilatation was 0·53 mm per year (95% CI 0·39 to 0·67) in the irbesartan group compared with 0·74 mm per year (0·60 to 0·89) in the placebo group, with a difference in means of -0·22 mm per year (-0·41 to -0·02, p=0·030). The rate of change in aortic Z score was also reduced by irbesartan (difference in means -0·10 per year, 95% CI -0·19 to -0·01, p=0·035). Irbesartan was well tolerated with no observed differences in rates of serious adverse events. INTERPRETATION: Irbesartan is associated with a reduction in the rate of aortic dilatation in children and young adults with Marfan syndrome and could reduce the incidence of aortic complications