Estimated Glomerular Filtration Rate and Risk of Survival in Acute Stroke

Objective: To assess the risk of survival in acute stroke using the MDRD equation derived estimated glomerular filtration rate.Design: A prospective observational cross-sectional study.Setting: Medical wards of a tertiary care hospital.Subjects: Eighty three acute stroke patients had GFR calculated within 48 hours of admission after basic data were captured.Outcome measures: Stroke outcome was defined as either discharged or still-in-care (survived) or all cause in-hospital death. GFR was estimated by the MDRD equation, stroke severity was assessed by the Canadian Neurological Scale (CNS). Data were compared between the GFR groups of < 60ml/min and . 60ml/min. Relative risks (RR) and odds ratios (OR) for stroke outcomes (survival and death) were estimated between the GFR groups and the homogeneity of the odds ratios among the different layers of stroke severity (CNS < 6.5 and . 6.5) was determined by Breslow-Day and Taronefs test. Matanel Hazensel and Cochranfs tests were used to determine conditional independence and the common odds ratio with stroke severity as a layering variable.Results: No significant differences were found between the age and sex distribution of the two GFR groups. Serum urea and creatinine and CNS were significantly different between the GFR groups (p<0.001, <0.001, <0.001). RR of survival and death for the GFR groups-less than 60ml/min and above or equal to 60ml/min were (0.425 and 1.204) and (2.360 and 0.830). The OR of survival for GFR below 60ml/min compared to GFRabove or equal to 60ml/min was 0.353. There was homogeneity across the two layers of stroke severity (CNS score less than 6.5 and above or equal to 6.5), p=0.612 and 0.612.Conclusion: Independent of stroke severity, GFR is a surrogate in the assessment of the risk of survival in acute strok

Prevalence of intestinal parasitic infections among HIV patients in Benin City, Nigeria

This study was carried out to determine the presence of intestinal parasites and their correlation with CD4+ T-cell counts and demographics among human immunodeficiency virus (HIV)-positive patients in Benin City, Nigeria. Stool specimens from 2,000 HIV-positive patients and 500 controls (HIV-negative individuals) were examined for ova, cysts, or parasites, using standard procedures. In addition, patient's blood samples were analyzed for CD4 counts by flow cytometry. An overall prevalence rate of 15.3% was observed among HIV-positive patients while 6.2% was noted among non-HIV subjects. HIV status was a significant (P<0.0001) risk factor for acquiring intestinal parasitic infections. Male gender, CD4 count <200cell/µl, and diarrhea were significantly associated with an increased prevalence of intestinal parasitic infections among HIV-positive patients. The level of education, occupation, and source of water among HIV patients significantly (P<0.0001) affected the prevalence of intestinal parasitic infections. Ascaris lumbricoides was the most predominant parasite in both HIV-positive patients and controls. A CD4 count <200 cells/µl was significantly associated with only Isospora belli and Cryptosporidium infections. The presence of pathogenic intestinal parasites such as A. lumbricoides, hookworm, Giardia intestinalis, Entamoeba histolytica, Trichuris trichiura, and Taenia species among HIV-infected persons should not be neglected. Cryptosporidium species and I. belli were the opportunistic parasites observed in this study. Routine screening for intestinal parasites in HIV-positive patients is advocated

Twenty-one-year-old male with congenital anomalies, obstructive uropathy and chronic renal failure: Is this a case of townes Brocks syndrome?

Townes – Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear anomalies/hearing loss, limb defects, anal, genitourinary, eye, spine anomalies, heart defects and sometimes mental retardation. This report presents the case of a 21-year-old secondary school leaver as a likely case of Townes-Brocks syndrome. He was born with congenital abnormalities consisting of fixed flexion deformities of hands, wrist and elbows, urethral meatal stenosis, scoliosis and aortic stenosis. He was diagnosed with obstructive uropathy at the age of 19 years and subsequently developed chronic renal failure. The report aims to highlight the need for early recognition of potentially preventable conditions, which, if left unattended to, can lead to unnecessary fatality. Nigerian Journal of Clinical Practice Vol. 10 (1) 2007: pp.91-9

Patient-related barriers to hypertension control in a Nigerian population

Chimezie Godswill Okwuonu,1 Nnamdi Ezekiel Ojimadu,2 Enajite Ibiene Okaka,3 Fatai Momodu Akemokwe41Nephrology Unit, Department of Internal Medicine, 2Department of Family Medicine, Federal Medical Center Umuahia, Abia State, 3Renal Unit, 4Neurology Unit, Department of Internal Medicine University of Benin Teaching Hospital, Benin City, NigeriaBackground: Hypertension control is a challenge globally. Barriers to optimal control exist at the patient, physician, and health system levels. Patient-related barriers in our environment are not clear. The aim of this study was to identify patient-related barriers to control of hypertension among adults with hypertension in a semiurban community in South-East Nigeria.Methods: This was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication.Results: A total of 252 participants were included in the survey, and comprised 143 males (56.7%) and 109 females (43.3%). The mean age of the participants was 56.6&plusmn;12.7 years, with a diagnosis of hypertension for a mean duration of 6.1&plusmn;3.3 years. Among these patients, 32.9% had controlled blood pressure, while 39.3% and 27.8%, respectively, had stage 1 and stage 2 hypertension according to the Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation of High Blood Pressure. Only 23.4% knew the consequences of poor blood pressure control and 64% were expecting a cure from treatment even when the cause of hypertension was not known. Furthermore, 68.7% showed low adherence to medication, the reported reasons for which included forgetfulness (61.2%), financial constraints (56.6%), high pill burden (22.5%), side effects of medication (17.3%), and low measured blood pressure (12.1%). Finally, knowledge and practice of the lifestyle modifications necessary for blood pressure control was inadequate among the participants.Conclusion: Poor knowledge regarding hypertension, unrealistic expectations of treatment, poor adherence with medication, unawareness of lifestyle modification, and failure to apply these were identified as patient-related barriers to blood pressure control in this study.Keywords: Blood pressure, medication adherence, knowledge of hypertension, proteinuria, diabetes mellitus, lifestyle modificatio

An audit of chronic kidney disease risk factors in type 2 diabetic patients in a tertiary hospital in Southern Nigeria

Background: Prevalence of diabetes mellitus (DM) is on the increase in Nigeria with diabetic nephropathy (DN) as one of the commonest causes of end stage renal disease among Nigerians. We determined the risk factors of chronic kidney disease (CKD) prevalent in type 2 diabetics.Methods: Type 2 diabetics attending the outpatient clinic of a tertiary health institution were recruited over a six week period and had their records reviewed.Results: A total of 144 type 2 diabetics were recruited. Fifty three (36.8%) were males while 91 (63.2%) were females. Mean age of all diabetics was 57.5± 11.5 years. The prevalence of obesity, metabolic syndrome, hypertension, dyslipidaemia, and poor glycaemic control were 38.8%, 70.8%, 67.4%, 64.6%, and 46.5% respectively. Central obesity, dyslipidaemia and metabolic syndrome were significantly more prevalent in female diabetics while hypertension and metabolic syndrome were more prevalent in elderly participants. Forty-four (30.6%) of the diabetics had CKD. Hypertension, dyslipidaemia and metabolic syndrome were more prevalent in diabetics with CKD, although only hypertension was significant.Conclusion: CKD risk factors were highly prevalent in type 2 diabetics in this study. Measures aimed at reducing these risks should be instituted to delay the onset and progression of CKD.Keywords: diabetes mellitus, chronic kidney disease, risk factor