Diagnostic Evaluation of Tuberculosis: Existing Challenges and Merits of Recent Advances

Tuberculosis remains a major global public health problem despite the modest infectious disease control efforts. Timely and accurate diagnosis is pivotal to the reduction in tuberculosis related morbidity and mortality. In addition, drug resistant form of tuberculosis is a serious threat to the efforts at tuberculosis control and eradication. Hence; there is the need for efficient methods of Mycobacterium tuberculosis infection diagnosis and treatment. There are major advances in the laboratory diagnostic methods for detection of Mycobacterium tuberculosis which seeks to complement or replace the existing conventional methods in a view to reduction in under-diagnosis and improved infectious disease management. Chest computer tomographies, Cephid GeneXpert, Line probe are some of the Mycobacterium tuberculosis diagnostic advances while chest x-ray, sputum microscopy/culture represent some of the conventional methods of evaluation of both Mycobacterium tuberculosis infection and its multi-resistant strain. Intriguingly, the conventional tuberculosis diagnostics though time consuming and inefficient, its use still predominates in high disease burden settings. Meanwhile, the slow transition to use of advanced tuberculosis diagnostic methods seems to have an economic undertone. The seemingly lack of cutting edge advanced Mycobacterium tuberculosis diagnostics in high disease burden countries is attributable to their suboptimal health financing model and over reliance on the donor organizations thereby retarding progress in tuberculosis eradication

A roadmap for kidney care in Africa: An analysis of International Society of Nephrology–Global Kidney Health Atlas Africa data describing current gaps and opportunities

Delivery of kidney care in Africa is significantly constrained by various factors. In this review, we used International Society of Nephrology–Global Kidney Health Atlas (ISN–GKHA) data for Africa to address sub-regional differences in care delivery in the continent with focus on infrastructure, workforce, and the economic aspects of kidney care. Forty two African countries participated in the survey conducted in 2018. North Africa had the highest proportions of nephrologists [12.53 per million population (pmp)], nephrology trainees (2.19 pmp) and haemodialysis (HD) centres (8.58 pmp); whereas southern Africa had the highest proportions of peritoneal dialysis (PD) centres (0.89 pmp) and kidney transplant (KT) centres (0.29 pmp); West Africa had the greatest nephrology workforce shortages. The annual median costs of HD (US$22,731 [interquartile range (IQR): US$1,560–43,902]) and PD (US$34,165 [US$34,165–34,165]) were highest in Central Africa and only Algeria, Egypt and South Africa reported zero co-payment for all modalities of kidney replacement therapy in the public sector. Policies on chronic kidney disease and non-communicable diseases were scarcely available across all African sub-regions. The ISN–GKHA African data highlight a stark difference in kidney care measures between North and sub-Saharan Africa and also suggest the need for a more cohesive approach to policy formulations that support and protect patients with kidney disease in the continent, especially from the excessive costs associated with care. Using the World Health Organization (WHO) Global Action Plan for noncommunicable diseases, this paper proposes an African roadmap for optimal kidney care

Knowledge, attitude and practice of venous thromboembolism prophylaxis among medical practitioners in a teaching hospital setting

Background: Venous thromboembolism (VTE) is a common and potentially fatal clinical condition that is both preventable and treatable. The risk factors for the disease cut across patients and general population which underscores the need for prophylactic measures, early identification and prompt treatment. We aimed to assess the knowledge, attitude and practice of prophylaxis in venous  thromboembolism among medical doctors in Usmanu Danfodiyo University Teaching Hospital, Sokoto, North-West Nigeria.Methodology: The knowledge, attitude and practice of VTE prophylaxis among medical doctors was assessed using a validated self-administered questionnaire. The questionnaire consisted of two sections and a total of thirteen questions enquiring on knowledge and attitude/practice of VTE management.Results: A response rate of 80.5% was obtained following the administration of 200 questionnaires in this survey between July and December 2015. The majority of respondents were males (81.4%) and junior residents (41.6%) with a mean VTE prophylaxis knowledge score of 4.56±1.545. Importance of VTE prophylaxis in clinical practice received an overwhelming concordance among respondents (93.8%). However, about 55.9% admitted to ever prescribing VTE prophylaxis with 8.7% doing it routinely. Low molecular weight heparin was the most frequently used agent for VTE prophylaxis among respondents (40.4%), and there was paucity of knowledge on VTE prevalence in clinical practice among the respondents.Conclusion: Majority of the practitioners were knowledgeable about VTE and agreed that prophylactic measures are pivotal in preventing and/or reducing morbidity and mortality from the disease. Practice of VTE prophylaxis was suboptimal among the respondents, and the contributory factors included paucity of clear cut guidelines and inadequate knowledge of the disease magnitude. These underscore the need for guidelines towards VTE prophylaxis.Keywords: Pulmonary embolism, risk factors, health knowledge, preventivemeasure

Clinical pattern and outcome of acute kidney injury patients from a Tertiary Health Institution in Northwestern Nigeria

Background: Acute kidney injury (AKI) is a common cause of hospitalization associated with high mortality, especially in developing countries. Despite better understanding of the pathophysiology, mortality from AKI remains source of concern worldwide. AKI varies between countries and even within the same environment due to diverse diagnostic criteria. Studies from developing nations have alluded to the high incidence of AKI from preventable and potentially reversible causes affecting predominantly children and young adults. The growing concern as to whether the pattern and outcome have changed in recent times prompted this study. Materials and Methods: All the patients that met RIFLE criteria for the diagnosis of AKI were audited with specific reference to clinical pattern and outcome in Northwestern Nigeria. Results: A total of 318 patients (198 males and 120 females) that met RIFLE criteria for AKI were seen with age range and mean of 20–80 years and 42.0 ± 12.0 years, respectively. Severe gastroenteritis, septicemia, obstetric complications, and toxic nephropathies were leading causes of AKI. Main clinical features in order of magnitude were oliguria, fever, body swelling, unusual weakness, and vomiting. Sixty-eight percent had hemodialysis while 32% were managed conservatively. Overall, mortality was 26.4%, and conservative management was associated with higher mortality than those that had hemodialysis. Factors associated with high mortality were late presentation, severe anemia, and sepsis. Conclusion: AKI is common in our setting and causes are largely preventable and treatable. Identification and prompt correction of reversible causes and timely referral of severe cases to nephrologists are of immense importance

Frequency and specificity of red blood cell alloantibodies among blood transfusion recipients in Specialist Hospital, Sokoto

Background: Blood transfusion usually results in production of alloantibody against one or more foreign red blood cell antigens which may complicate subsequent transfusions. The probability of alloimmunization depends on number and frequency of transfusion, antigen immunogenicity, recipient immune response and ethnicity. Studies have demonstrated varied frequency of alloimmunization after multiple blood transfusions. The paucity of information on the foregoing in our environment prompted this study.Methods: A cross-sectional descriptive survey of the frequency and specificity of alloantibodies among transfused patients. Using their clinical records and blood transfusion history, data were analyzed with reference to sex, date of birth, history of transfusion, surgery and pregnancy.Results: A total of 150 transfused participants, in Specialist Hospitals, Sokoto were studied. Overall alloantibody positivity was 17.3% with females accounting for 96% and males 4%. The three most frequent alloantibodies were anti-K (34.62%), anti-E (23.08%) and anti- C (15.39%). Most common clinically significant alloantibody identified in men and women were anti-K and anti-E, respectively. The most common causes of alloimmunization for men and women were surgery and pregnancy related blood transfusion respectively.Conclusions: Alloimmunization against RBC antigens among blood transfused patients is common. Most common alloantibodies identified were anti-K and anti-E in females and anti-K in male and female respectively. The testing of blood donors for red cell antigens and antibody screening of recipients will be rewarding.Keywords: Transfusion, RBC, Alloantibody, Sokot

Characteristics, predictors and prospects of lung function among male cigarette smokers in Sokoto Metropolis, North-West Nigeria

Background: Cigarette smoking is a major risk factor for airflow limitation in addition to its other multi-systemic deleterious effects. Peak expiratory flow (PEF) measurement offers an opportunity to assess ventilatory function abnormalities in cigarette smokers.Objective: The objective of this study is to determine ventilatory function using peak expiratory flow rate among adult male cigarette smokers in comparison with matched predicted value.Methodology: This is a cross-sectional study among 150 current cigarette smokers aged 18-60years that were consecutively sampled in Sokoto metropolis. Peak expiratory flow was measured using Mini Wright’s Peak Flow Meter and adapted questionnaire was used to record all measurements and relevant data. Comparison was made between the measured and predicted peak expiratory flow rate.Result: A total of 150 male subjects who were predominantly below the age of 40years (76%) with mean age of 34.27±8.91years participated in this study. The mean pack-years and cigarette smoking index were 8.71±8.92 and 163.98±192.62, respectively. While the mean age of cigarette smoking commencement was 16.90±4.17years (9-36years).The mean measured PEF was 405.63±76.5 with the age group mean consistently decreasing with advancing age. Similarly, the difference between measured PEF and predicted PEF was significant and the magnitude of difference increased with advancing age. There was a negative correlation between PEF and pack-years smoked.Conclusion: Cigarette smoking is associated with decline in ventilatory function. The intensity of cigarette smoking and advancing age were the main predictors that determine the airflow status among cigarette smokers.Keywords: Determinants, pack-years, tobacco use, ventilatory functio

Benzoic Acid Based Beverages: Health Implications

Soft drinks nowadays are becoming an important part of the modern diet consumed in many communities worldwide and are available in the market virtually in the same form almost anywhere around the globe. Additives such as antioxidants and preservatives are usually added to soft drinks to increase their shelf life. Several acids such as benzoic and ascorbic acid are used in beverages to prevent oxidation and degradation of matrix.  Literature documented that combination of these preservatives in soft drinks results in benzene formation. Moreover, benzene has long been reported to inflict many public health problems. This review elucidated different health consequences such as hematological, neurological, reproductive and carcinogenic effects of exposure to benzene. Liver and kidney derangements were also reported from different epidemiological and experimental studies. Therefore, we suggest that combination of ascorbic acid and benzoic acid in beverages should be avoided by small scale and industrial manufactures. A closer monitoring of these preservatives in beverages by regulatory agencies is highly needed

Prevalence and risk factors associated with intradialysis mortality among renal failure patients in a tertiary hospital in a developing nation

Background: Hemodialysis is associated with potential risk of intradialysis death as a complication. We set out to determine some predialysis factors associated with intradialysis death in hemodialysis patients. Materials and Methods: We retrospectively reviewed the records of 457 patients who had hemodialysis at our facility over a 5-year period. Demographic and clinical data of patients who died during dialysis were compared with a control group made of the survivors of hemodialysis. Data was analyzed using SPSS IBM version 20. Numerical data were reported as mean ± SD. Comparison of means of continuous variables was done using student t-test. Chi square was used for comparing proportions. Multivariate logistic regression was done to determine the independent determinants of intradialysis mortality. P value < 0.05 was considered significant. Results: Of the 457 patients who had hemodialysis, 20 (4.4%) died while on hemodialysis during the review period. They were aged 47.35 ± 21.16 years (range, 16-85 years). The deceased were more likely to be elderly (P = 0.003), have pre dialysis hypotension (P < 0.004), depressed level of consciousness (P < 0.0001), predialysis pulmonary edema, and hospital admission (P = 0.047). Multivariate regression analysis identified low Glasgow coma scale (coma) as an independent risk factor for intradialysis death (P < 0.017). Conclusion: Intradialysis mortality risk is increased in a setting of elderly patients, impaired level of consciousness, pulmonary edema, and predialysis hypotension

Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review

Abstract Background Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations. Methods We conducted this scoping review to answer the question: “what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?” Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively. Results Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Conclusion Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined