Health‑Care Financing among Patients Admitted for Open‑Heart Surgery in Enugu

Background: Cardiovascular diseases have been noted to be expensive to manage and tend to cause significant morbidity and financial burden to affected individuals and households. Objective: This study aimed to determine the various sources of health financing among patients admitted to UNTH Ituku/Ozalla for open-heart surgery. Methodology: Twenty‑five patients admitted for cardiac surgery over a 6‑month period were selected for the study. A structured  questionnaire was administered to the patients or their caregivers. Data were analyzed using SPSS version 20. Results: There were 25 respondents who were admitted during the study period, this comprised 17 children and 8 adults. Amongthe respondents 24 (96%) paid out of pocket, 1 (4%) was by government tax. The major sources of funds were from personal savings 56% and goodwill from friend’s relations, faith-based organizations (4%), while 36% of the respondents borrowed money for the surgery. Three of the respondents had a form of health insurance, while 22 (88%) had no form of health insurance. The mean monthly income of the households was 86,320 (81,384.7) Naira and the mean monthly food expenditure was 33,200 (15934.76) Naira. About 72% (18) of the subjects knew about the National Health Insurance Scheme (NHIS), 4 (16%) knew about the Voluntary Health Insurance Scheme (VHIS), while 84% did not know about the VHIS. However, about 56% of the subjects were willing to enroll under the NHIS voluntary scheme. The cardiac surgery was catastrophic for 96% of the respondents. Conclusion: Cardiac surgery causes a significant financial burden to individuals and households. Individuals and households should be properly counselled on the benefits of health insurance. The government should increase funding for cardiovascular health and  strengthen the health insurance system. Keywords: Cardiac surgery, cardiovascular disease, health financin

Observed Causes of Severe Respiratory Distress among Children with Congenital Heart Disease

Background: Severe respiratory distress is a clinical feature commonly observed among children with congenital heart disease (CHD), butthe underlying cause is often misdiagnosed. Objectives: This study is aimed at determining the common causes of severe respiratory distress observed among children with CHD. Methods: This study was a retrospective study on children who had severe respiratory distress with underlying CHD seen between June 2017 and June 2018, and were consecutively recruited from two teaching hospitals. Results: Forty‑seven children aged 2 months to 15 years were admitted for severe respiratory distress secondary to CHD at our center between June 2017 and June 2018. The most common CHD was isolated ventricular septal defect (VSD), which made up 36.2%, followed by tetralogy of Fallot with 23.4%. Identifiable causes of respiratory distress in these children were restrictive airway disease (36.2%) as the most common cause, followed by pulmonary edema from congestive cardiac failure (27.7%). Among children with heart failure, 57.1%, 47.4%, 0%, and 50% of infants, children aged 1–5, 6–10, and above 10 years, respectively, were affected. Conclusion: Restrictive airway disease was noted as the most common cause of severe respiratory distress among children with CHD. Keywords: Children, congenital heart disease, restrictive airway disease, severe respiratory distres

Under-five malnutrition in a South-Eastern Nigeria metropolitan city

Background: Malnutrition (under and overnutrition) presents significant threats to child health. The co-existence of under and overnutrition in a population is increasingly being described in the literature . Objective: To identify the prevalence of malnutrition among under-five children in Enugu metropolis. Methods: A cross-sectional study of pre-primary school children conducted from January to May 2016. using stratified sampling technique. Caregiver-administered questionnaire was used to obtain relevant information. Weights and heights were measured using a standard weight scale and stadiometer/ length mat respectively. Wasting, stunting, overweight and obesity were determined based on the recommended WHO Growth Standard. Data analysis was done with SPSS version 20.0. The associations between nutritional status on one hand, and categorical variables such as age grouping, sex, socio-economic status, and maternal educationwere determined using chi square. . P-value < 0.05 were reported as statistically significant. Results: Eighteen (2.4%) and 26 (3.5%) subjects were wasted and stunted respectively. Eleven (1.5%) subjects were overweight while another 11(1.5%) subjects were obese. Risk factors for undernutrition were maternal education and low socioeconomic class while risk factor for overnutrition was upper socioeconomic class.. Conclusion: There is a low rate of malnutrition in the area of study. However, sustained efforts must continue to prevent further rise and possibly eliminate the scourge of malnutrition

Successful renal re-transplantation in the presence of pre-existing anti-DQ5 antibodies when there was zero mismatch at class I human leukocyte antigen A, B, & C: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hyperacute rejection may be prevented by avoiding the transplantation of kidneys into patients with pre-existing anti-donor Class I human leukocyte antigen antibodies. However, the role of anti-donor-Class II-human leukocyte antigen-DQ antibodies is not established. The question is ever more relevant as more sensitive cross-matching techniques detect many additional antibodies during the final crossmatch. We now report successful renal transplantation of a patient who had pre-existing antibodies against his donor's human leukocyte antigen-DQ5.</p> <p>Case presentation</p> <p>Our patient, a Caucasian man, was 34 years of age when he received his first deceased donor renal transplant. After 8 years, his first transplant failed from chronic allograft dysfunction and an earlier bout of Banff 1A cellular rejection. The second deceased donor kidney transplant was initially allocated to the patient due to a 0 out of 6 mismatch. The B cell crossmatch was mildly positive, while the T Cell crossmatch was negative. Subsequent assays showed that the patient had preformed antibodies for human leukocyte antigen DQ5 against his second donor. Despite having preformed antibodies against the donor, the patient continues to have excellent allograft function two years after his second renal transplant.</p> <p>Conclusion</p> <p>The presence of pre-existing antibodies against human leukocyte antigen DQ5 does not preclude transplantation. The relevance of having other antibodies against class II human leukocyte antigens prior to transplantation remains to be studied.</p

Localization and function of the renal calcium-sensing receptor

The ability to monitor changes in the ionic composition of the extracellular environment is a crucial feature that has evolved in all living organisms. The cloning and characterization of the extracellular calcium-sensing receptor (CaSR) from the mammalian parathyroid gland in the early 1990s provided the first description of a cellular, ion-sensing mechanism. This finding demonstrated how cells can detect small, physiological variations in free ionized calcium (Ca 2+) in the extracellular fluid and subsequently evoke an appropriate biological response by altering the secretion of parathyroid hormone (PTH) that acts on PTH receptors expressed in target tissues, including the kidney, intestine, and bone. Aberrant Ca 2+ sensing by the parathyroid glands, as a result of altered CaSR expression or function, is associated with impaired divalent cation homeostasis. CaSR activators that mimic the effects of Ca 2+ (calcimimetics) have been designed to treat hyperparathyroidism, and CaSR antagonists (calcilytics) are in development for the treatment of hypercalciuric disorders. The kidney expresses a CaSR that might directly contribute to the regulation of many aspects of renal function in a PTH-independent manner. This Review discusses the roles of the renal CaSR and the potential impact of pharmacological modulation of the CaSR on renal function

Proximate, Phytochemical and Antioxidant Mineral Compositions of Four Different Brands of Tea

The comparative studies of the proximate, phytochemical and antioxidant mineral compositions of four different brands of green tea were investigated. The four different brands, Tianshi®, Qualitea®, Slimfit®, and Xiang® were purchased from a supermarket in Ihiala Local Government Area of Anambra State, Nigeria. The samples were pulverized and stored in an airtight container prior to analysis. The proximate composition was analysed using AOAC method while phytochemical compositions of the green teas were investigated using standard methods. The result of the study indicated that the moisture content (15.80±0.01%) and protein content (1.05±0.00%) of Qualitea® was significantly higher (P&lt;0.05) compared to Slimfit and Xiang tea while the fibre content of Xiang tea (80.35±0.03%) was significantly higher (P&lt;0.05) than other tea studied. The phytochemical study showed the presence of flavonoids, tannins, alkaloids, saponins and cardiac glycosides in all the teas studied. However, Qualitea® contains the highest amount of phytochemicals when compared to the other brands of tea investigated. Data obtained from the antioxidant mineral study showed that the four brands of the tea are good sources of antioxidant minerals such as Fe, Zn, Cu, Mn and Se. It is therefore recommended that tea be included in our menu because of their nutritive and health benefits

Optimization of the Protein Nutritive Value of Wheat/Cassava Breadmix by Supplementing with Limiting Amino-Acids (L-Lysine & L-Methionine)

This study was carried out in line with the National policy on bread to incorporate 10% cassava flour into wheat flour for all bread baked in Nigeria. The objective of this study was to investigate if the addition of 10% cassava flour or more could be accommodated without compromising the nutritive value of bread. The effect of fortifying with limiting amino-acids was also investigated. This study employed a feeding trial and bioassay of tissues from albino rats of Wistar strain, to evaluate the effect of supplementing various levels of wheat/cassava bread mix feed, with 0.1% L-lysine and 0.1% L-methionine. Nine different diet regimens were used with four rats in each diet group. Cassava (100%) diet group was used as the control; and the diets fortified with 0.1% L-lysine and 0.1% Lmethionine used as secondary control. The parameters measured as 'markers' of nutritive value included: body weight changes, food conversion ratio (FCR) and net protein utilisation (NPU). The effects of dietary intake of the various wheat/cassava supplemented diets on haematological indices such as mean corpuscular haemoglobin concentration and biochemical indices such as cortisol, total protein and albumin in the plasma of fed rats were also determined. Results indicated that both 10% and 20% cassava input supported adequate nutritional and biochemical development of the fed rats, although fortification of the diets with 0.1% L-lysine and 0.1% L-methionine resulted in 10 – 20% improvement in all the nutritional indicators measured. Based on the results of this study, it was concluded that incorporation of 20% cassava flour into wheat bread supplemented with L-lysine and L-methionine is nutritionally better than, but haematologically and biochemically comparable to whole wheat bread in rats. Therefore, this findings lend support to the national policy on nutrient fortification and cassava incorporation into wheatbread for the general goal of improving food security in Nigeria.Keywords: Bread fortification, Weanling rat, L-methionine, L-Lysine, haematological indices, biochemical indicesNigerian Journal of Parasitology, Vol. 32 [2] September 2011, pp. 287-29

Effects of Four Different Food Additives on the Oxidative Stress Markers of Wistar Albino Rats

This work investigated the effects of food additives on the oxidative stress markers and liver marker enzymes. Food additives are products added to the basic food stuff with an aim of improving its flavor, aspect, texture, color, taste, and value. Thirty (30) Wistar rats were divided into five groups of six rats each. Group A received a daily dose of distillated water and normal rat pellet, Group B, C, D and E received 20 mg/kg body of Aspartame, Sodium Benzoate, Sodium nitrite and sodium sulfite respectively. The duration for exposure of these animals to food additives was 30 days and the groups were observed daily for general conditions. At the end of feeding the animals, blood samples were collected and analyzed. The result of the analysis showed that ALT significantly (p&lt;0.05) increased with sodium nitrite and sodium sulfite while ALP increased significantly (p&lt;0.05) with sodium sulphite. The oxidative stress biomarker, catalase showed a significant increase with sodium benzoate and sodium sulphite. The results revealed that the food additives are injurious to the animals. The toxicity of the food additives studied at 20 mg/kg are in the order of Sodium nitrite &gt; Sodium benzoate &gt; Sodium sulphite &gt; Aspartame

Pro-inflammatory Cytokine Response and Genetic Diversity in Merozoite Surface Protein 2 of Plasmodium falciparum Isolates from Nigeria

Background: Polymorphisms in Plasmodium falciparum merozoite surface protein-2 (msp-2) and associated parasite genetic diversity which varies between malaria-endemic regions remain a limitation in malaria vaccine development. Pro-inflammatory cytokines are important in immunity against malaria, understanding the influence of genetic diversity on cytokine response is important for effective vaccine design. Methods: P. falciparum isolates obtained from 300 Nigerians with uncomplicated falciparum malaria at Ijede General Hospital, Ijede (IJE), General Hospital Ajeromi, Ajeromi (AJE) and Saint Kizito Mission Hospital, Lekki, were genotyped by nested polymerase chain reaction of msp-2 block 3 while ELISA was used to determine the pro-inflammatory cytokine response to describe the genetic diversity of P. falciparum. Results: Eighteen alleles were observed for msp-2 loci. Of the 195 isolates, 61 (31.0%) had only FC27-type alleles, 38 (19.7%) had only 3D7-type alleles, and 49.3% had multiple parasite lines with both alleles. Band sizes were 275–625 bp for FC27 and 150–425 bp for 3D7. Four alleles were observed from LEK, 2 (375–425 bp) and 2 (275–325 bp) of FC27-and 3D7-types, respectively; 12 alleles from AJE, 9 (275–625 bp) and 3 (325–425 bp) of FC27-types and 3D7-types, respectively; while IJE had a total of 12 alleles, 9 (275–625 bp) and 3 (325–425 bp) of FC27-types and 3D7-types, respectively. Mean multiplicity of infection (MOI) was 1.54. Heterozygosity (HE) ranged from 0.77 to 0.87 and was highest for IJE (0.87). Cytokine response was higher among 0.05) but with neither parasite density nor infection type. Conclusion: P. falciparum genetic diversity is extensive in Nigeria, protection via pro-inflammatory cytokines have little or no interplay with infection multiplicity