Awareness of warning signs among suburban Nigerians at high risk for stroke is poor: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Although stroke is a leading cause of morbidity and mortality in Nigeria, there is no information on awareness of its warning signs. This study was designed to assess awareness of stroke warning signs in Nigerians at increased risk.</p> <p>Methods</p> <p>A hospital-based cross-sectional study conducted at Irrua Specialist Teaching Hospital, in southern Nigeria. Patients with a diagnosis of hypertension, diabetes or both were interviewed for the warning signs of stroke in the outpatient clinic by trained interviewers. The main outcome measure was ability to identify at least one stroke warning sign.</p> <p>Results</p> <p>There were 225 respondents with a mean age of 58.0 ± 11.7 years. Only 39.6% could identify at least one stroke warning sign while the commonest sign identified was sudden unilateral limb weakness (24.4%). On multivariate logistic regression analysis, male sex (β = 0.26, 95% CI = 0.14–0.39, p < 0.001) and 11 or more years of education (β = 0.16, 95% CI = 0.03–0.29, p = 0.02) emerged the independent predictors of ability to identify at least one warning sign.</p> <p>Conclusion</p> <p>Awareness of stroke warning signs is poor among Nigerians at increased risk for the disease. Efforts should be made to improve on the level of awareness through aggressive health education.</p

Mayer-Rokitansky-Kuster-Hauser Syndrome, Type 2 presenting with end stage kidney disease: a rare occurrence

Background: The association unilateral renal agenesis, renal malformation, kidney disease in residual kidney, uterine agenesis, vaginal atresia and skeletal malformations is a rare occurrence being reported in between 1 in 5000 to 1 in 20,000 live births. It is also known as Mayer-Rokitansky-Kuster- Hauser (MRKH) Syndrome and is as a result of Mullerian duct abnormalities. It is a rare case and is associated with anomalies of the urinary tract, ovaries, kidneys. cervix and vagina. While it has been recognized worldwide, it is rare and this is the first time it is being reported in this environment presenting this late with End Stage Kidney Disease necessitating hemodialysis. Method: The patient's history, physical examination findings and investigations were carefully evaluated. A diagnosis of End stage kidney disease thought to be as a result of the repeated Urinary Tract Infections and hypertension was made. The patient was re-evaluated in detail and the diagnosis of MRKH syndrome was made. Conclusion: There is need for clinicians to recognize the associations between primary amenorrhea, the presence of secondary sexual characteristics, recurrent Urinary Tract Infection, skeletal muscle abnormalities as a part of the MRKH syndrome. This is important so that close follow up will be dome early to prevent or delay the onset of end stage kidney failure, as well as to bring together a multi-specialist team to manage the medical, renal, psychological and gynecologic issues that are associated with the syndrome

Financial implications of anemia management in anaemic chronic kidney disease patients in South-South Nigeria.

Anaemia is a common occurrence in Chronic Kidney Disease (CKD) patients being almost universal in End Stage Renal Disease (ESRD) patients. Modern management of anaemia involve the use of Erythropoiesis Stimulating Agents (ESA’s) and parenteral iron. It is a highly effective therapy, but its use in our environment seems to be largely hampered by costs. While studies have shown that the costs are high, few or no studies have addressed the actual costs in Naira.Objectives- To assess the cost implications of anaemia management using ESA’s and parenteral iron and vitamins at the University ofBenin Teaching Hospital, a tertiary health care centre in South-South Nigeria.Methods-Costs of investigating a patient for anaemia were obtained from the revenue unit of the laboratory. Costs of purchase of erythropoietin and iron sucrose, syringes, needles, folic acid and other medications were obtained from the revenue unit of the pharmacy department of the University of Benin Teaching Hospital. These costs were evaluated using the standard prescription for EPO use in renal disease patients. The total costs were compared to the salary structure of the Edo state civil service, and the CONTISS salary structure of the Federal Government of Nigeria. The prevalent number of patients using EPO and Iron sucrose were also evaluated. Results- Average costs of Erythropoietin at 4000iu 2 times weekly and iron sucrose 200mg weekly and baseline investigations was approximately₦40,300 in the first week and ₦29,500 every subsequent week. This amounts to ₦128,800 in the first one month and ₦118,000 per month or ₦1,426,800 for the first year then ₦1,416,000 (one million four hundred and sixteen thousand naira) yearly. This may account for why only a few of our patients, 8(4.73%) are using EPO and parenteral iron at the point of this analysis.Conclusion- The cost of management of anaemia with erythropoietin is very expensive and out of reach for most Nigerians. This is most likely the reason why EPO use has not been widespread among our CKD patients. There is need for a review of pricing to enable more CKD patients to have access to EPO as only 23.08% of our CKD patients are currently on EPO management irregularly and only 4.73% of our patients are on Iron Sucrose and erythropoietin

Challenges of dialyzing a bleeding, anaemic Jehovah’s Witnesses patient without blood transfusion

Background: Hemodialysis is the prescribed treatment for uremia and is life-saving. Most centers, including the University of Benin Teaching&nbsp; Hospital require that patienthas minimum of hemoglobin 6.7g/dl (PCV 20%) before hemodialysis. Patient had been refused dialysis at 2 different centers.Aim: We present this Jehovah’s Witnesses patient that was bleeding postprostatectomy, with PCV 16% (Hb 5.3 mg/dl), in uraemic encephalopathy and hypotensive. Patient and all his relatives refused blood transfusion on account of being of the Jehovah’s Witnesses faith. Patient presented at Yeshua Medical center, with Urea 246mg/dl, Creatinine 13.1 mg/dl and blood pressure 80/50mmHg.Materials and Method: Relatives of patient were cautioned on the need for blood transfusion. They provided signed waivers in case of any outcome considering the very poor prognosis. Patient was dialyzed with Nikkisso DBB 05/06 without systemic heparinisation.Results: The patient improved significantly after first session of dialysis and had complete recovery after subsequent 2 sessions.Conclusion: Dialyzing anemic bleeding patients appearstobe feasible in those who refuse blood transfusion on account of religious inclination, so&nbsp; long as adequate safety procedures are followed. Key Words: Anemia, Bleeding, Dialysis, Blood Transfusion, Jehovah’s Witnes

Prevalence of elevated serum creatinine among treated hypertensives in South-South Nigeria.

Chronic Kidney Disease (CKD) is a major issue of public importance in Nigeria. Hypertensive nephrosclerosis is one of the major cause of CKD in Nigeria, being responsible for over half of our CKD patients. The objective of this study was to evaluate the level of creatinine in treated hypertensives in this environment which is a major marker of renal disease.Materials/ Methods: This is a retrospective study conducted at the University of Benin Teaching Hospital.Records of patients attending the hypertensiveclinic of the University of Benin Teaching Hospital were assessed and evaluated for socio-demographic data, blood pressure levels and serum creatinine levels.A cut off mark of 1.5mg/dl was used to evaluate elevated serum creatinine levels.Results: There were 826patients with a male/female ratio of 1:1.32. Males were 356 (43.1%) and females 470 (56.9%). Among these patients, 118 (14.3%) had a serum creatinine value of over 1.5mg/dl, signifying renal disease.Conclusion: A significant number of managed hypertensive patients, 118 (14.3%), have an elevated serum creatinine value when a cut-off point of 1.5mg/dl was used. The figures rose to 230(27.8%) with a serum creatinine value of over 1.4 mg/dl was used. This signifies kidney disease. The level of asymptomatic kidney disease is quite high in our population of treated hypertensive patients. This figure is likely to be higher when tests of microalbuminia and creatinine clearance are performed for this group of patients

Pitfalls in non-utilization of basic clinical methods in the detection of kidney disease: a case report

Background: Chronic kidney disease (CKD) is a devastating problem worldwide. Early detection and intervention usually lead to more favourable outcomes. However, CKD is sometimes under diagnosed except in its very late stages where little can be done. This is partly because a lot of interns and physicians do not apply basic clinical methods of history, physical examination and laboratory investigations to evaluate patients.Methods: A case report involving a 32 year old woman who presented to a health facility with complaints of abdominal pain and vomiting. A proper medical history was not taken, basic physical examinations were not done and baseline investigation were not carried out or interpreted properly.Results: This caused the patient to undergo needless laparotomy.Conclusion: There is need for medical doctors to acquaint themselves with knowledge of basic medical skills needed for detection of kidney disease. This will aid early detection and institution of appropriate measures.Keywords; Chronic kidney disease, misdiagnosis, basic clinical methods, early detectio

Factors associated with blood pressure control in predialysis chronic kidney disease patients: Short-term experience from a single center in Southern Nigeria

Background: Hypertension is a leading cause of kidney disease worldwide, and chronic kidney disease (CKD) is a known cause of secondary hypertension. Blood pressure (BP) control is a main‑stay in the management of CKD because it retards the progression of established CKD.Aim: To determine BP control and its associated factors in predialysis CKD patients in a tertiary hospital setting.Methodology: CKD patients who attended the renal outpatient clinic during the period from December 2013 to June 2014 were recruited into the study. Demographic and clinical information were obtained from their case records. The average of the three most recent clinic BPs was calculated for each patient. Good BP control was taken as an average BP of &lt;140/90 mmHg.Results: One hundred and three patients (53 males and 50 females) met inclusion criteria for the study. The mean age of the patients was 40.6 ± 17.4 years. Estimated glomerular filtration rate was &lt;60 ml/min in 49.5% of patients. Good BP control was seen in 57 (55.3%) patients. Poor BP control was associated with middle age, proteinuric CKD, and prescription of 3 or more BP medication. Conclusion: BP control in predialysis CKD patients still needs to be optimized. Special attention should be given to middle‑aged patients who have proteinuric CKD and those on multiple BP drugs without optimal BP control.Keywords: Blood pressure control, chronic kidney disease, predialysi

Cost Evaluation of Haemodialysis for End Stage Renal Disease Patients: Experience from Benin City, Nigeria

Background: Maintenance haemodialysis is a life sustaining mode of treatment of End Stage Renal Disease (ESRD) patients. However, the widespread and sustained application of this mode of treatment has been largely unsuccessful because of costs. Objectives: To assess the costs and use of haemodialysis in a Nigerian Teaching Hospital. Method: Cost of baseline investigation, admissions, medications and dialysis proper were assessed. This was compared to the total salaries of both the state and federal Government civil servants. Dialysis records for the patients, over the past 2 years, were evaluated to assess the frequency of dialysis per patient.Results: Average dialysis cost per month inclusive of procedures, investigations, medications and dialysis proper was about N292,950 for the 1st month for twice a week dialysis and N357,950 for the first month for 3 times a week dialysis. Annual cost was N1,889,450 for twice weekly dialysis and N2,760,450 for 3 times a week dialysis. This is in contrast to the average annual salary of state civil service workers which ranged from N216,000:00 to N1,965,612:00 and Federal Civil Service workers ranging from N777984:00 to N2553992:92 (CONTISS 9- CONTISS 15) .Conclusion: Maintenance haemodialysis as is currently practiced is extremely very expensive and is out of the financial reach of most Nigerians including employed ones. This is even more important as virtually all our ESRD patients are not working. There is need to review costs to enable our ESRD patients to dialyse adequately

Improving clinical diagnostic accuracy of Lassa fever - the use of WBCT-20

No Abstract. African Journal of Clinical and Experimental Microbiology Vol. 7(3) 2006: 189-19

Ethylene Diamine Tetra-Acetic Acid (EDTA) Induced Pseudothrombocytopenia, (A Case Report.)

Thrombocytopenia caused by E.D.T.A can cause misdiagnosis of patients’ illness and may lead to inappropriate treatment if the problem is not recognized. We present this case of a male patient with spuriously low platelet count caused by EDTA. It is a phenomenon that results in low platelet count recorded by auto-analysers on blood collected in EDTA bottles. This phenomenon occurs as a result of anti-bodies that cause platelet aggregation in blood anti-coagulated with EDTA. These are anti-bodies in the IgM or IgG class reacting with the antigenic binding site of the gp II b glycoprotein.Keywords: Pseudothrombocytopenia, EDTA, Ethylene Diamine tetra-acetic Aci