14 research outputs found
The prevalence and Predictors of generalised obesity in a rural farming community in the Niger Delta Region of Nigeria
Background: Obesity, an independent risk factor for cardiovascular diseases has become a global epidemic even in the developing nations of the world. Epidemiologic transition with rapid urbanisation is important variable implicated in the rising prevalence of obesity. The prevalence of this major risk factor for cardiovascular disorders like hypertension, heart failure, coronary artery disease etc has not been richly studied in the rural setting of the Nigerian Niger Delta regiondespite the increasing urbanisation taking place in same region. The aim of this research therefore is to determine the prevalence and predictors of obesity in a rural farming community of the Niger Delta region of NigeriaMethods: A cross sectional study involving 388 subjects aged 15 years and above. Demographic social and relevant medical information and social information were obtained using a questionnaire administered by face-to-face interview. Anthropometric (height, weight, waist circumference, Waist-Hip-Ratio) and blood pressure measurements were done. Blood samples were taken for fasting blood sugar.Results: The overall mean age of the study subjects was 40.88±16.52. The mean age for males was 40.66±17.23 and that for females was 40.98±16.17. The male to female ratio was 1:2.1. The prevalence of generalised obesity in this study was 3.4% .The females had a higher prevalence than the males (p= 0.02). The prevalence of obesity found to be highest in the 50 to 59 years age group. Pearson and Spearman’ rho correlation analysis of BMI with other parameters revealed that educational status, waist circumference, and hypertension had significant association while logistic regression confirmed these variables as well as physical inactivity as predictors of obesity.Conclusion: The prevalence of obesity in this rural community is 3.4% and educational status, waist circumference and hypertension are important predictors.Keywords: Prevalence, Predictors, generalised obesity, rural, Niger Delt
Pattern of cardiovascular disease admissions in the medical wards of the University of Port Harcourt Teaching Hospital: a retrospective review
Background: Cardiovascular disease as a leading contributor to global disease burden has shown an increase in its prevalence since the 19th century and was responsible for the global mortality of 17.5 million individuals in the year 2005. This has been linked to increasing urbanization and westernization of life style particularly in the sub-Saharan Africa. Hence, a study on the pattern and trend of cardiovascular disease admission in Port Harcourt an urban and a cosmopolitan city in Nigeria becomes important as such knowledge will influence Health care policy making and budgeting. This study is aimed at determining the frequency and the pattern of cardiovascular disease admissions in University of Port Harcourt Teaching Hospital.Method: A retrospective study of adult patients with diagnosis of cardiovascular disorders admitted into the medical wards of UPTH between January 2013 and December 2014 was carried out using the ward admission and discharge register.Results: A total of 1989 patients were admitted into the medical ward over the period of this study. Patients with cardiovascular disorders were 629 constituting 31.6% of the total admission. 346(55.01%) of the study population were females with males constituting 44.99%. The ages ranged between 20 and 94 years with a mean of 56.04 for males and 55.12 for females. The pattern of CVD observed in this study were heart failure (43.1%), cerebrovascular accident (CVA) (24.3%), diabetes and its complications (15.6%), uncontrolled hypertension (14.8%), acute MI (1.6%), symptomatic bradycardia ( 0.3%), acute pericarditis (0.2%) and ventricular tachycardia (0.2%). The death rate was found to be 12.2%.Conclusion: Heart failure and cerebrovascular accident are major causes of cardiovascular admissions in the medical wards of University of Port Teaching Hospital. Early detection, appropriate management as well as patient education will go a long way to reduce the morbidity and mortality caused by this rising trend.Keywords: Cardiovascular disease, pattern, medical admissions, UPT
Chemotaxonomic Significance and Environmental Implications of the Phytochemical Constituents of four Mussaenda L. (Rubiaceae) taxa in Nigeria
This work investigated the phytoconstituents of some Mussaenda taxa (Rubiaceae) collected from Nsukka (Derived Savanna) and Uyo (Tropical Rainforest) ecological zones of Nigeria to establish their contribution as possible taxonomic and environmental monitoring markers. Fresh leaf samples used in this study were collected from plants of the same age, air-dried, and made into powder for further use. Histochemical and phytochemical tests were carried out by following the standard procedures. Results of the comparative phytochemical screening revealed the presence of flavonoids, alkaloids, glycosides, phenols, hydrogen cyanide, reducing sugars, soluble carbohydrates, saponins, steroids, terpenoids, and tannins in varying proportions. Results of the phytochemical constitute analysis revealed the presence of the cystoliths from the M. elegans (MEL) and M. erythrophylla (MER) which were absent in Mussaenda “ Doña Aurora” (MDA) and Mussaenda “Doña Luz”(MDL). Further, the presence of the Raphides was unique to MEL while Gum and mucilage were reported only in MDA. Quantitatively, MEL had the highest value of terpenoids (650.88 mg/100g) while MDA had the highest values of phenols (899.27 mg/100g), alkaloids (311.01 mg/100g), reducing sugars (967.35 mg/100g), steroids (2.89 mg/100g), soluble carbohydrates (27.68 mg/100g) and tannins (393.16 mg/100g), and MDL was richest in glucosides (339.64 mg/100g), flavonoids (69.34 mg/100g) and hydrogen cyanides (1.34 mg/100g). The cluster analysis based on obtained phytochemical data revealed three (3) distinct clusters with MEL in cluster 1; MDA and MDL in cluster 2 while cluster 3 had MER. The evolutionary closeness of the two infraspecific and exotic species (MDA and MDL) were confirmed and their taxonomic relationship with the indigenous infrageneric taxa (MEL and MER) was established. The results also highlight the opportunity of employing plant metabolomics in ecological studies and environmental monitoring. 
Development of a Water Treatment Plant for Heavy Metal Adsorption
Advantages of adsorption method for the removal of heavy metals from drinking water are abundant in literature. However, there is little information on the practical application of this knowledge at domestic level. Middle and high income earners can afford more expensive heavy metal treatment technologies. Low income earners, however, are often exposed to heavy metal contaminated water. This study, therefore, demonstrates how a cheaply fabricated water treatment plant (WTP) can be used with discarded automotive tire (DAT) to remove metals from drinking water. Drinking water samples from borehole and river sources which were slightly acidic and contained metals such as chromium, aluminum, manganese, calcium, zinc and copper was placed in the WTP. Crushed DAT was added to the water and stirred at a rate of 110 revolutions per minute for ten minutes at room temperature. Results show that the use of DAT in the WTP improved pH by 8-9% while TDS improved by 41-27% in ground and surface water samples respectively. Also, copper, chromium, aluminum, and manganese improved by as much as 46%, 5.5%, 50% and 25% respectively in some water samples. The paper concludes by recommending that other adsorptive materials can be tested for use in the WTP
Post-acute COVID-19 neuropsychiatric symptoms are not associated with ongoing nervous system injury
A proportion of patients infected with severe acute respiratory syndrome coronavirus 2 experience a range of neuropsychiatric symptoms months after infection, including cognitive deficits, depression and anxiety. The mechanisms underpinning such symptoms remain elusive. Recent research has demonstrated that nervous system injury can occur during COVID-19. Whether ongoing neural injury in the months after COVID-19 accounts for the ongoing or emergent neuropsychiatric symptoms is unclear. Within a large prospective cohort study of adult survivors who were hospitalized for severe acute respiratory syndrome coronavirus 2 infection, we analysed plasma markers of nervous system injury and astrocytic activation, measured 6 months post-infection: neurofilament light, glial fibrillary acidic protein and total tau protein. We assessed whether these markers were associated with the severity of the acute COVID-19 illness and with post-acute neuropsychiatric symptoms (as measured by the Patient Health Questionnaire for depression, the General Anxiety Disorder assessment for anxiety, the Montreal Cognitive Assessment for objective cognitive deficit and the cognitive items of the Patient Symptom Questionnaire for subjective cognitive deficit) at 6 months and 1 year post-hospital discharge from COVID-19. No robust associations were found between markers of nervous system injury and severity of acute COVID-19 (except for an association of small effect size between duration of admission and neurofilament light) nor with post-acute neuropsychiatric symptoms. These results suggest that ongoing neuropsychiatric symptoms are not due to ongoing neural injury
Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study
Background:
Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea.
Methods:
CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2–7 months after hospital discharge and a later time point 10–14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107).
Findings:
2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4–6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5–8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (–19%; 95% CI –20 to –16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18–39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27–41% of this effect.
Interpretation:
Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition.
Funding:
UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council
Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study
Introduction:
The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.
Methods:
In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.
Findings:
Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.
Interpretation:
After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.
Funding:
UK Research and Innovation and National Institute for Health Research
SARS-CoV-2-specific nasal IgA wanes 9 months after hospitalisation with COVID-19 and is not induced by subsequent vaccination
BACKGROUND: Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced. METHODS: In this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia. IgA and IgG responses to NP and S of ancestral SARS-CoV-2, Delta and Omicron (BA.1) variants were measured by electrochemiluminescence and compared with plasma neutralisation data. FINDINGS: Strong and consistent nasal anti-NP and anti-S IgA responses were demonstrated, which remained elevated for nine months (p < 0.0001). Nasal and plasma anti-S IgG remained elevated for at least 12 months (p < 0.0001) with plasma neutralising titres that were raised against all variants compared to controls (p < 0.0001). Of 323 with complete data, 307 were vaccinated between 6 and 12 months; coinciding with rises in nasal and plasma IgA and IgG anti-S titres for all SARS-CoV-2 variants, although the change in nasal IgA was minimal (1.46-fold change after 10 months, p = 0.011) and the median remained below the positive threshold determined by pre-pandemic controls. Samples 12 months after admission showed no association between nasal IgA and plasma IgG anti-S responses (R = 0.05, p = 0.18), indicating that nasal IgA responses are distinct from those in plasma and minimally boosted by vaccination. INTERPRETATION: The decline in nasal IgA responses 9 months after infection and minimal impact of subsequent vaccination may explain the lack of long-lasting nasal defence against reinfection and the limited effects of vaccination on transmission. These findings highlight the need to develop vaccines that enhance nasal immunity. FUNDING: This study has been supported by ISARIC4C and PHOSP-COVID consortia. ISARIC4C is supported by grants from the National Institute for Health and Care Research and the Medical Research Council. Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research. The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute of Health and Care Research. The funders were not involved in the study design, interpretation of data or the writing of this manuscript
Accelarated immune ageing is associated with COVID-19 disease severity
Background
The striking increase in COVID-19 severity in older adults provides a clear example of immunesenescence, the age-related remodelling of the immune system. To better characterise the association between convalescent immunesenescence and acute disease severity, we determined the immune phenotype of COVID-19 survivors and non-infected controls.
Results
We performed detailed immune phenotyping of peripheral blood mononuclear cells isolated from 103 COVID-19 survivors 3–5 months post recovery who were classified as having had severe (n = 56; age 53.12 ± 11.30 years), moderate (n = 32; age 52.28 ± 11.43 years) or mild (n = 15; age 49.67 ± 7.30 years) disease and compared with age and sex-matched healthy adults (n = 59; age 50.49 ± 10.68 years). We assessed a broad range of immune cell phenotypes to generate a composite score, IMM-AGE, to determine the degree of immune senescence. We found increased immunesenescence features in severe COVID-19 survivors compared to controls including: a reduced frequency and number of naïve CD4 and CD8 T cells (p < 0.0001); increased frequency of EMRA CD4 (p < 0.003) and CD8 T cells (p < 0.001); a higher frequency (p < 0.0001) and absolute numbers (p < 0.001) of CD28−ve CD57+ve senescent CD4 and CD8 T cells; higher frequency (p < 0.003) and absolute numbers (p < 0.02) of PD-1 expressing exhausted CD8 T cells; a two-fold increase in Th17 polarisation (p < 0.0001); higher frequency of memory B cells (p < 0.001) and increased frequency (p < 0.0001) and numbers (p < 0.001) of CD57+ve senescent NK cells. As a result, the IMM-AGE score was significantly higher in severe COVID-19 survivors than in controls (p < 0.001). Few differences were seen for those with moderate disease and none for mild disease. Regression analysis revealed the only pre-existing variable influencing the IMM-AGE score was South Asian ethnicity (
= 0.174, p = 0.043), with a major influence being disease severity (
= 0.188, p = 0.01).
Conclusions
Our analyses reveal a state of enhanced immune ageing in survivors of severe COVID-19 and suggest this could be related to SARS-Cov-2 infection. Our data support the rationale for trials of anti-immune ageing interventions for improving clinical outcomes in these patients with severe disease
Whole-genome sequencing reveals host factors underlying critical COVID-19
Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease