Prospects of telemedicine during and post COVID-19: highlighting the environmental health implications

The outbreak of the coronavirus disease 2019 (COVID-19) in late 2019 had severe implications on the normal course of events across the globe. The imposition of lockdown, quarantine, and isolation measures by most countries to curtail the spread of the coronavirus led to the rapid development of information, communication, and technological (ICT) solutions to minimize the effect of the lockdown, and as an alternative to normal day-to-day physical interactions. Telemedicine involves the delivery of health care services by qualified health professionals using ICT for the exchange of valid information where distance is a critical factor, thus enhancing access to health care services. The use of ICT as a tool to improve access to health care services and for tackling the raging pandemic was one of the options embraced and considered by many countries. Indeed, there are indications that the use of telemedicine as a complementary option to current traditional medical practice will continue in the post-COVID period. The shift to telemedicine has severe health and environmental health implications and should be done with caution. Poor management of generated electronic waste was found to be responsible for environmental pollution and health hazards affecting major organs of the human body. Countries, especially those in the developing world, lack infrastructure for effective implementation of policies required to appropriately manage electronic waste. Therefore, it is highly imperative that adequate measures are put in place to mitigate the potential hazardous effects of the shift to telemedicine

Type 2 diabetes mellitus risk assessment among doctors in Ondo state

IntroductionDiabetes Mellitus (DM) has become a disease of public health importance in Nigeria. Early identification of DM risk is important in the reduction of this disease burden. This study assessed ten-year risk of developing type 2 DM among some medical doctors in Ondo State. MethodsThis was a cross-sectional study that assessed ten-year risk of developing type 2 DM among some doctors using the Finland Diabetic Risk Score form. Known diabetics were excluded from the study. Body mass index (BMI), waist circumference (WC), blood pressure and total DM risk score were determined for each participant.Results One hundred and ninety-two doctors participated in the study with a male: female ratio of 1.3:1. Majority (92.2%) were below 55 years, 22 (11.5%) were obese, 32(16.7%) had central obesity, 46(24%) reported physical inactivity, 49(25.5%) had family history of DM, 141(73.4%) do not take fruits and vegetables regularly. Forty-three (22.4%) were found to have elevated blood pressure while 6(3.1%) had elevated blood glucose. Fifty-seven (29.7%) of the participants had increased ten-year DM risk. Significant predictors of increase DM risk were age ≥ 45 years (AOR:9.08; CI 3.13-26.33; p = <0.001 ) ; BMI ≥25kg/m2 (AOR:11.41; CI:4.14-31.45; p = <0.001) ; family history of DM (AOR:9.93; CI:3.25-30.39; p = <0.001) ; abdominal obesity (AOR:6.66; CI:2.08-21.29; p= < 0.001); and infrequent dietary intake of fruits and vegetable(AOR:3.11;CI:1.03:9.37: p = 0.04) ConclusionThere was increased 10-year DM risk in about 30% of the participants. Lifestyle modification such as physical activity and regular consumption of fruits and vegetables should be encouraged among doctors

Sleep quality and associated factors among patients with chronic kidney disease in Nigeria: a cross-sectional study

Objective: Poor sleep quality adversely affects the overall well-being and outcomes of patients with chronic kidney disease (CKD). However, it has not been well studied in Africans with CKD. We determined the prevalence of poor sleep quality and associated factors among patients with CKD. Design: This was a cross-sectional study that involved patients with CKD . Settings: The study was carried out in the outpatient clinic of nine hospitals in Nigeria. Methods: Sleep quality, depressive and anxiety symptoms and quality of life (QoL) were assessed among 307 patients with CKD using Pittsburgh Sleep Quality Index Questionnaire, Hospital Anxiety Depression Scale Questionnaire and 12-item Short Form Health Survey Quality of Life Questionnaire, respectively. The prevalence of poor sleep quality and associated factors were determined. A p<0.05 was considered as statistically significant. Results: The mean age of the study participants was 51.40±15.17 years. The male:female ratio was 1.5:1 One hundred and twenty-one (39.4%) of the patients were on maintenance haemodialysis (MHD). The prevalence of poor sleep quality, anxiety symptoms and depressive symptoms among the patients was 50.2%, 37.8% and 17.6%, respectively. The prevalence of poor sleep quality in the CKD stages 3, 4, 5 and 5D was 38.1%, 42.6%, 52.2% and 58.7%, respectively. The prevalence of poor sleep quality was significantly higher in MHD patients compared with predialysis CKD (59.5% vs 43.6%; p=0.008). Factors associated with poor sleep quality were CKD stage (p=0.035), anaemia (p=0.003), pruritus (p=0.045), anxiety symptoms (p≤0.001), depressive symptoms (p≤0.001) and reduced QoL (p≤0.001). On multivariate analysis, factors associated with poor sleep were anxiety (AOR 2.19; 95% CI 1.27 to 3.79; p=0.005), anaemia (AOR 5.49; 95% CI 1.43 to 21.00;p=0.013) and reduced physical component of QoL (AOR 4.11; 95% CI 1.61 to 10.47; p=0.003). Conclusion: Poor sleep quality is common among patients with CKD especially in the advanced stage. The significant factors associated with poor sleep quality were QoL, anaemia and anxiety symptoms. These factors should be adequately managed to improve the overall outcomes of patients with CKD

Perceptions of the COVID-19 vaccine and willingness to receive vaccination among health workers in Nigeria

Objectives The study aimed to examine health workers’ perceptions of the coronavirus disease 2019 vaccine in Nigeria and their willingness to receive the vaccine when it becomes available. Methods This multi-center cross-sectional study used non-probability convenience sampling to enroll 1,470 hospital workers aged 18 and above from 4 specialized hospitals. A structured and validated self-administered questionnaire was used for data collection. Data entry and analysis were conducted using IBM SPSS ver. 22.0. Results The mean age of respondents was 40±6 years. Only 53.5% of the health workers had positive perceptions of the COVID-19 vaccine, and only slightly more than half (55.5%) were willing to receive vaccination. Predictors of willingness to receive the COVID-19 vaccine included having a positive perception of the vaccine (adjusted odds ratio [AOR], 4.55; 95% confidence interval [CI], 3.50−5.69), perceiving a risk of contracting COVID-19 (AOR, 1.50; 95% CI, 1.25–3.98), having received tertiary education (AOR, 3.50; 95% CI, 1.40−6.86), and being a clinical health worker (AOR, 1.25; 95% CI, 1.01−1.68). Conclusion Perceptions of the COVID-19 vaccine and willingness to receive the vaccine were sub-optimal among this group. Educational interventions to improve health workers' perceptions and attitudes toward the COVID-19 vaccine are needed

Urinary tract infections and antibiotic sensitivity pattern of uropathogens in a tertiary hospital in South West, Nigeria

Background: Urinary tract infection (UTI) is one of the factors implicated in morbidity among patients. Early diagnosis and treatment of UTI could be pivotal in overall treatment outcome. Aims: The aim of this study was to determine the prevalence of UTI, identify common isolates in UTI cases, and their in vitro sensitivity and resistance patterns to common antibiotics. Materials and Methods: This was a retrospective descriptive study of 181 patients with microbiological indications for UTI conducted between April 2014 and September 2015. Results: Out of 181 patients aged 20–86 years with a mean age of 51.43 ± 17.2 years, 79 (43.6%) had positive bacterial growth for uropathogens. Most common predisposing factors were urethral catheterization (32.5%), diabetes mellitus (23.7%), and urinary tract obstruction (18.7%). UTI was found to be more predominant among females (55.7%). The common isolates were Escherichia coli 30 (37.9%), Klebsiella pneumoniae 27 (34.2%), Pseudomonas aeruginosa 10 (12.7%), Proteus mirabilis 8 (10.1%), Enterococcus faecalis 3 (3.8%), Acinetobacter baumannii 1 (1.3%). The isolates were sensitive to nitrofurantoin and ciprofloxacin and ofloxacin while they were highly resistant to cotrimoxazole and tetracycline. Conclusions: UTI is common among patients affecting 43.6% of the participants in this study with E. coli being the most common uropathogen. ciprofloxacin, ofloxacin, and nitrofurantoin could therefore be recommended as the first line of drugs to clinicians for empirical treatment while awaiting sensitivity results. To prevent the emergence of resistant strains, rational use of drugs is encouraged

Task Sharing and Task Shifting (TSTS) in the Management of Africans with Hypertension: A Call For Action-Possibilities and Its Challenges

Hypertension is a leading cause of mortality globally and one of the most common risk factors for cardiovascular disease. Diagnosis, awareness, and optimal treatment rates are suboptimal, especially in low- and middle-income countries, with attendant high health consequences and grave socioeconomic impact. There is an enormous gap between disease burden and physician-patient ratios that needs to be bridged. Task sharing and task shifting (TSTS) provide a viable temporary solution. However, sociocultural, demographic, and economic factors influence the effective uptake of such interventions. This review discusses the dynamics of TSTS in the African context looking at challenges, feasibility, and approach to adopt it in the management of hypertension in Africa

Assessment of iron status in predialysis chronic kidney disease patients in a Nigerian Tertiary Hospital

Anemia in chronic kidney disease (CKD) is associated with poor overall outcome if not promptly managed with erythropoietin when indicated. This study assessed iron status and associated factors in predialysis CKD patients in Southern Nigeria. This was a cross-sectional study that assessed and compared iron status in 100 predialysis CKD patients and 90 healthy controls. Mean age of the CKD patients was 49.39 ± 14.84 years. Iron deficiency was present in 14% of CKD patients compared to 3% of the controls (P = 0.021). Among CKD patients with ID, 11 (85.7%) had functional iron deficiency while three (14.3%) had absolute iron deficiency. Serum ferritin was significantly higher in the predialysis CKD patients (P = 0.001). There was no significant gender difference in iron indices among the CKD patients. Functional iron deficiency was present in 11 (11%) of the CKD patients compared to none among the control group (P = 0.003). There was no significant association between iron deficiency and age, gender, etiology, and stage of CKD. Functional iron deficiency was the predominant form of iron deficiency in our predialysis CKD patients, and there was no significant association with age, gender, stage, or etiology of CKD

Protein energy wasting in pre-dialysis chronic kidney disease patients in Benin City, Nigeria: A cross-sectional study.

IntroductionProtein energy wasting (PEW) is common among chronic kidney disease (CKD) patients, especially those with advanced stage. It worsens frailty, sarcopenia and debility in CKD patients. Despite the importance of PEW, it is not routinely assessed during management of CKD patients in Nigeria. The prevalence of PEW and its associated factors were determined in pre-dialysis CKD patients.MethodsThis was a cross-sectional study that involved 250 pre-dialysis CKD patients and 125 age- and sex- matched healthy controls. Body mass index (BMI), subjective global assessment (SGA) scores and serum albumin levels were used in PEW assessment. The factors associated with PEW were identified. P-value of ResultsThe mean age of CKD and control group were 52.3±16.0 years and 50.5±16.0 years, respectively. The prevalence of low BMI, hypoalbuminaemia and malnutrition defined by SGA in pre-dialysis CKD patients were 42.4%, 62.0% and 74.8%, respectively. The overall prevalence of PEW among the pre-dialysis CKD patients was 33.3%. On multiple logistic regression, the factors associated with PEW in CKD were being middle aged (adjusted odds ratio: 12.50; confidence interval: 3.42-45.00; p ConclusionPEW is common in pre-dialysis CKD patients and it was associated with middle age, depression and advanced CKD. Early intervention aimed at addressing depression in early stages of CKD may prevent PEW and improve overall outcome in CKD patients

Seek and You Shall Find—Retrieval of a Retained Fractured Intravenous Cannula by Z-Plasty Incision: A Case Report

Peripheral venous cannulation is a common invasive procedure. Fracture of an intravenous cannula is rare and an under-reported complication of peripheral venous cannulation. Embolization of the intravenous fragment into the central venous system is potentially fatal. Urgent surgical retrieval, which is performed through a transverse or longitudinal incision, is the treatment of choice. We herein present the use of Z-plasty incision for the retrieval of a retained fractured peripheral intravenous cannula in a 61-year-old Nigerian man on hemodialysis for chronic kidney disease. The major benefits of this innovation are facilitation of access for exploration and prevention of joint contracture

Pattern of medications causing adverse drug reactions and the predisposing risk factors among medical in-patients in clinical practice: A prospective study

Background: Pharmacological interventions sometimes carry inherent significant risks which include adverse drug reactions (ADRs), drug interactions (DIs) and other consequences of inappropriate medication use. An adverse drug reaction (ADR) is defined in this study as a response to a drug which is noxious and unintended that occurs at doses normally used in man for therapeutic purposes. Despite the extensive study and attention given to ADRs, they still represent a clinically significant problem and burden with high incidence and prevalence. Aim: The main aim of this study was to evaluate and highlight the pattern of medications most frequently involved in ADRs and the predisposing risk factors among adult medical in-patients in clinical practice setting with the goal of preventing them and improving their treatment outcome. Methods: The patients admitted into the adult medical wards of a Nigerian University Teaching Hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven (507) patients were evaluated during the study, out of which 269 (53.1%) of them were males and 238 (46.9%) were females. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). The drugs most frequently involved in ADRs were insulin in 14 (27.5%) patients, Non-steroidal Anti-inflammatory drugs in 10 (19.6%) patients, antihypertensives in 8 (15.7%) patients, antimalarials in 5 (9.8%) patients, herbal medications in 4 (7.8%) patients and antibacterials in 3 (5.9%) patients. Furthermore, four (4) fatal ADRs were observed during the study; in which herbal medications caused two (2) deaths, sulfadoxine/pyrimethamine combination (maloxine®) caused one (1) death, and Iron dextran caused one (1) death. The most frequently affected body systems by ADRs were the central nervous system and the gastrointestinal system corresponding to the Antidiabetic drug-insulin use causing neuroglycopenic symptoms and Non-steroidal Anti-inflammatory drugs (NSAIDs) use causing NSAID-induced gastroenteritis/GIT bleeding, respectively. The elderly age group (≥ 65 years), presence of polypharmacy (taking more than 5 different pharmacologically active medications by a particular patient at the same time) and the presence of multiple comorbidities in a particular patient are clinically proven and significant risk factors found to be associated with and predisposed adult medical in-patients to ADRs in this study. Conclusion: The negative health burden and consequences of ADRs with the predisposing risk factors were significantly high among these adult medical in-patients. In this study, ADRs increase patients morbidity, mortality and length (duration) of hospitalization. Insulin and NSAIDs caused the highest number of ADRs which indicate that adequate caution, proper care and continuous monitoring must be implemented during the course of treating patients with these drugs in order to optimize their clinical efficacy and prevent the occurrence of ADRs in them