Chronic kidney disease screening and renoprotection in type 2 diabetes

Background: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. Methods: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. Results: Urinalysis was done in 49.1% and serum creatinine in 50.3%. No patient had glomerular filtration rate estimated. Seventy nine (67.6%) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8%) of these patients BP control was optimal in 29.1%. Conclusion: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D

Stable thrombus formation on irradiated microvascular endothelial cells under pulsatile flow: Pre-testing annexin V-thrombin conjugate for treatment of brain arteriovenous malformations

© 2018 Elsevier Ltd Background: Our goal is to develop a vascular targeting treatment for brain arteriovenous malformations (AVMs). Externalized phosphatidylserine has been established as a potential biomarker on the endothelium of irradiated AVM blood vessels. We hypothesize that phosphatidylserine could be selectively targeted after AVM radiosurgery with a ligand-directed vascular targeting agent to achieve localized thrombosis and rapid occlusion of pathological AVM vessels. Objective: The study aim was to establish an in vitro parallel-plate flow chamber to test the efficacy of a pro-thrombotic conjugate targeting phosphatidylserine. Methods: Conjugate was prepared by Lys-Lys cross-linking of thrombin with the phosphatidylserine-targeting ligand, annexin V. Cerebral microvascular endothelial cells were irradiated (5, 15, and 25 Gy) and after 1 or 3 days assembled in a parallel-plate flow chamber containing whole human blood and conjugate (1.25 or 2.5 μg/mL). Confocal microscopy was used to assess thrombus formation after flow via binding and aggregation of fluorescently-labelled platelets and fibrinogen. Results and conclusions: The annexin V-thrombin conjugate induced rapid thrombosis (fibrin deposition) on irradiated endothelial cells under shear stress in the parallel-plate flow device. Unconjugated, non-targeting thrombin did not induce fibrin deposition. A synergistic interaction between radiation and conjugate dose was observed. Thrombosis was greatest at the highest combined doses of radiation (25 Gy) and conjugate (2.5 μg/mL). The parallel-plate flow system provides a rapid method to pre-test pro-thrombotic vascular targeting agents. These findings validate the translation of the annexin V-thrombin conjugate to pre-clinical studies

Lipid Profile of Patients with Liver Cirrhosis in Jos, Nigeria

Background: Liver cirrhosis is a chronic inflammatory condition associated lipid abnormalities. There are no studies documenting lipid levels among patients with liver cirrhosis in northern Nigeria.Methodology: Seventy four consecutive patients with liver cirrhosis seen at the Jos University Teaching Hospital and 88 apparently healthy controls had lipid levels estimated in the fasting state.Results: The median serum triglyceride levels were similar in both patients and controls (2.6 mmol/L versus 2.6 mmol/L, ÷2 0.09, P=0.7). The median LDL were also similar being 2.3 mmol/L and 1.9 mmol/L respectively, ÷2 =2.75 p= 0.09. However, the median total cholesterol and HDL cholesterol levels were significantly higher in the controls compared to the 2 study subjects (4.2 mmol/L vs. 3.6 mmol/L; X = 10.1; P=0.0001, and 1.1 mmol/L vs. 0.9 mmol/L; ÷2 = 21.7l,

HIV Associated Deep Vein Thrombosis: Case Reports from Jos, Nigeria

Deep vein thrombosis (DVT) has been reported to be 2-10 times commoner in HIV infected patients than in the general population. We report two cases of extensive unilateral deep vein thrombosis involving the lower limb in HIV infected patients on highly active antiretroviral therapy (HAART). Doppler ultrasound in the two patients revealed evidence of venous thrombosis from the femoral vein down to the posterior tibial veins. None of the patients had a history of acquired risk factors for DVT. Both patients responded well to anti-coagulants. A high index of suspicion may therefore be required to make the diagnosis and institute adequate management for this condition which has potentially lifethreatening consequencesKey Words: Acquired immune deficiency syndrome, Human immunodeficiency viral infection, deep vein thrombosis

Hepatocellular carcinoma in Jos, Nigeria

Background: Hepatocellular carcinoma (HCC) is the most common abdominal malignancy, representing 80- 90% of primary liver malignancies around the world. There is a disturbing trend of increased incidence of HCC around the world. We therefore, determined the trend of HCC in Jos. Methods: A ten-year retrospective review was done of all cases of HCC which diagnoses were histologically confirmed as recorded in the Cancer Registry of Jos University Teaching Hospital. The patients\' clinical case notes (including surgical and radiological findings) were also reviewed. Results: A total of 71 cases of HCC (31.3% 0f 227 liver biopsies in the same period) were diagnosed within the 10-year period. There were 46 males and 25 females with a male/female ratio of 1.8:1. The age range of the patients was 23 years to 75 years, with a mean age of 45.4±13.1 years. Seventy two percent (72%) of them were between ages 21 years and 50 years. Only 28% were between 51 years and 80 years. The highest rate of 12(17.1%) was seen in the year 2004. Conclusion: The study showed that there was a high prevalence of HCC in Jos, and that HCC was more prevalent in the younger age group compared to what obtains in developed nations. Keywords: Liver, Hepatocellular carcinoma, age, sex, trend.Nigerian Journal of Medicine Vol. 17 (2) 2008: pp. 211-21

Health Seeking Behavior of Physicians at the Jos University Teaching Hospital

Background: Physicians who have the task of caring for the sick also need to be cared for when they take ill. Healthseeking habits of physicians have been found to be poor in most developed countries. Utilization of health services by physicians in developing countries is not known. We sought to describe the health seeking habits of physicians in Nigeria.Materials and Methods: A cross-sectional survey was carried out among physicians at the Jos University Teaching Hospital, a tertiary referral health facility in North-central Nigeria. A pre-tested questionnaire was administered to physicians to get information on their self-reported health seeking habits. Results: Self prescription was practiced by 98.6% of the physicians, with antimalarials being the most prescribed drugs (62.5%). Only 46.9% consulted another physician when they take ill, although 78.2% felt they needed a family physician. Many (23.8%) of respondents treated their family members when last sick. The major factors considered by the respondents in choosing the physician they consulted were the specialty of the physician consulted (42.2%); the physician being in the same unit with them (38.5%), and friendship (15.6%). Four (3.7%) of the respondents would not consider any particular factor for choosing a physician if they have to. Conclusion: This study showed that a large proportion of physicians self-medicate and a few have family physicians. Guidelines need to be instituted to regulate self-prescribing among physicians in Nigeria. The role of family physicians in primary care needs to be emphasized.Keywords: Family physicians, Health seeking behaviour, Self prescribing