Global Sex Disparity Of Covid-19: A Descriptive Review Of Sex Hormones And Consideration For The Potential Therapeutic Use Of Hormone Replacement Therapy In Older Adults

The 2019-2020 SARS-related coronavirus-2 (SARS-CoV-2) pandemic has brought unprecedented challenges to healthcare sectors around the world. As of November 2020, there have been over 64 million confirmed cases and approaching 2 million deaths globally. Despite the large number of positive cases, there are very limited established standards of care and therapeutic options available. To date, there is still no Food and Drug Administration (FDA) approved vaccine for COVID-19, although there are several options in various clinical trial stages. Herein, we have performed a global review evaluating the roles of age and sex on COVID-19 hospitalizations, ICU admissions, deaths in hospitals, and deaths in nursing homes. We have identified a trend in which elderly and male patients are significantly affected by adverse outcomes. There is evidence suggesting that sex hormone levels can influence immune system function against SARS-CoV-2 infection, thus reducing the adverse effects of COVID-19. Since older adults have lower levels of these sex hormones, we therefore speculate, within rational scientific context, that sex steroids, such as estrogen and progesterone, needs further consideration for use as alternative therapeutic option for treating COVID-19 elderly patients. To our knowledge, this is the first comprehensive article evaluating the significance of sex hormones in COVID-19 outcomes in older adults

Home dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference

Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to healthcare, health system policies, provider bias or preferences, cultural beliefs, individual lifestyle concerns, potential care-partner time, and financial burdens. In May 2021, KDIGO (Kidney Disease: Improving Global Outcomes) convened a controversies conference on home dialysis, focusing on how modality choice and distribution are determined and strategies to expand home-dialysis use. Participants recognized that expanding use of home dialysis within a given health system requires alignment of policy, fiscal resources, organizational structure, provider incentives, and accountability. Clinical outcomes across all dialysis modalities are largely similar, but for specific clinical measures, one modality may have advantages over another. Therefore, choice among available modalities is preference-sensitive, with consideration of quality of life, life goals, clinical characteristics, family or care-partner support, and living environment. Ideally, individuals, their care-partners, and their healthcare teams will employ shared decision-making in assessing initial and subsequent kidney failure treatment options. To meet this goal, iterative, high-quality education and support for healthcare professionals, patients, and care-partners are priorities. Everyone who faces dialysis should have access to home therapy. Facilitating universal access to home dialysis and expanding utilization requires alignment of policy considerations and resources at the dialysis-center level, with clear leadership from informed and motivated clinical teams

The prevalence of acute kidney injury in women with hypertensive disorders of pregnancy in Africa: a systematic review and meta-analysis

Background: Hypertensive disorder of pregnancy (HDP) is a leading and preventable cause of pregnancy-related acute kidney injury globally. This systematic review and meta-analysis determined the prevalence of AKI in cases of HDP in Africa. Methods: A systematic search of PubMed and African Journals Online (AJOL) was undertaken to identify articles with relevant data published between 1991 and 2022. The pooled prevalence of AKI in women with HDP was determined using meta-analytic techniques. Results: Eighteen eligible articles were included in the systematic review and meta-analysis. The studies included reported on 8 703 pregnant women with HDP with a median age of 27.7 years. Most of the studies were crosssectional and had medium or poor methodological quality. The overall prevalence of AKI was 6.0% (95% CI 3.4–9.3%, I2 = 96.7%; p-value for heterogeneity <0.001). There was no difference in AKI prevalence by African subregion. There was a higher prevalence of AKI in the post-RIFLE era compared to the pre-RIFLE era [7.1% (4.3–10.5%) versus 1.6% (0.5–3.2%); p < 0.001]. The pooled AKI prevalence was higher in the studies that used established AKI consensus criteria than those where criteria were not used [19.6% (10.7–30.3%) versus 4.8 (2.4–8.0%); p = 0.001]. Conclusion: The pooled prevalence of AKI in HDP in Africa was 6.0%. Using consensus AKI definition criteria improves the sensitivity of AKI detection in HDP. The early involvement of nephrologists, as part of a multidisciplinary team taking care of women with HDP, may enhance early AKI detection and reduce the likelihood of renal complications

Productivity and Unemployment in Nigeria

Productivity and employment are issues that are central to the social and economic life of every country. The extant literature refers to productivity and unemployment as constituting a vicious circle that explains the endemic nature of poverty in developing countries. And it has been argued that continuous improvement in productivity is the surest way to breaking this vicious circle. Growth in productivity provides a significant basis for adequate supply of goods and services thereby improving the welfare of the people and enhancing social progress. As pointed out by Dernburg (1985:63), "Without it there would be no growth in per capita income, and inflation control would be all the more difficult". In fact, the observation has been made that continuous enhancement of productivity has been very central to the brilliant performance of the Asian Tigers and Japan in recent years (Simbeye, 1992; World Bank 1993). Recent developments in the world economy have also shown that countries with high productivity are not only central to the determination of global balance of powers (e.g Japan and Germany), but also serve as centres of stimulus, where world resources (including labour) are redirected to, as opposed to countries with low or declining productivity. Recent studies, for example, Rensburg and Nande (1999) and Roberts and Tybout (1997) have also shown that high productivity increases competitiveness in terms of penetrating the world market. Thus, a country with high productivity is often characterized by a very high capacity utilization (optimal use of resources), high standard of living, low rate of unemployment and social progress. Unemployment, on the other hand, has been categorized as one of the serious impediments to social progress. Apart from representing a colossal waste of a country's manpower resources, it generates welfare loss in terms of lower output thereby leading to lower income and well-being (Akinboyo, 1987; and Raheem, 1993). Unemployment is a very serious issue in Africa (Vandemoortele, 1991 and Rama, 1998) and particularly in Nigeria (Oladeji, 1994 and Umo, 1996). The need to avert the negative effects of unemployment has made the tackling of unemployment problems to feature very prominently in the development objectives of many developing countries. Incidentally, most of these countries' economies are also characterized by low productivity. Thus, it seems obvious to many policy makers that there must be a straight forward connection between productivity and employment/unemployment. However, the theoretical linkage between productivity and unemployment is yet to be settled in the literature. While some researchers posit that higher productivity may increase unemployment (e.g. Diachavbre, 1991; Krugman, 1994), some others argue that it could increase employment (e.g Yesufu, 1984; Akerele, 1994; CEC, 1993). In view of the unfolding reality coupled with the protracted debates this paper attempts to examine the linkage between productivity and unemployment. Specifically, it examines the dimensions of productivity and unemployment in Nigeria as well as the direction of causality between them. To this end, the rest of the paper is organized thus. Following this introduction is part II, which examines the conceptual and theoretical is sues. Part III discusses the profile of productivity and unemployment in Nigeria while the empirical link between them is examined in part IV. The final part contains the policy implications and conclusions

Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas

Abstract Background There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions. Methods Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. Results Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters). Conclusions High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation

Evaluation of serum magnesium differences in hypertensive crises and control patients: A randomly matched case‐control study

Although the role of magnesium in blood pressure has been well studied among hypertensive patients, no study has explored the role of magnesium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum magnesium levels between hypertensive crises patients and matched controls (age‐, sex‐, race‐, and diabetes‐matched) in a 1:1 random match. This study is a single‐center, retrospective, chart review, case‐control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive crises and have a documented magnesium level. The control group patients were required to be 18 years of age or older, have no diagnosis of hypertensive crises, and have a documented magnesium level. The primary outcome of the study was to compare the mean serum magnesium in patients with hypertensive crises versus patients without hypertensive crises. Three hundred and fifty‐eight patients were included in the study: 179 patients in both the case group and control group. The primary outcome results showed that serum magnesium concentration was not significantly different between the case group (1.89 ± 0.29 mg/dl) and control group (1.90 ± 0.31 mg/dl) (p = .787). This study found no significant difference in serum magnesium levels in patients with hypertensive crises compared to a random matched control group. Larger observational or experimental studies may be useful to evaluate the effect of magnesium on blood pressure in hypertensive crises