Correlation between Albuminuria and Ankle Brachial Index among Nigerians with Chronic Kidney Disease

Background: Peripheral arterial disease (PAD), the most common manifestation of atherosclerosis and chronic kidney disease (CKD), has been described as an independent risk factor for its development. The combination of CKD and PAD multiplies the risk of cardiovascular disease. Ankle-brachial pressure index (ABPI) is a good marker of atherosclerosis and is useful for the diagnosis of PAD. The study aimed to determine the prevalence, pattern and predictors of PAD in patients with CKD. Materials and Methods: This was a cross-sectional study of patients with CKD with age and gender-matched controls. Medical history relating to CKD and PAD was obtained using a pre-tested questionnaire. The ABPI was measured using handheld Doppler ultrasound equipment. Blood samples were drawn for serum creatinine and spot urine for Urinary Albumin Creatinine Ratio (UACR). Results: One hundred and thirty-two subjects participated in the study, 66 cases and 66 controls. The mean ages were 47.5±15.9 years in cases and 41.6±11.6 years in controls. The mean ABPI (0.9±0.2 vs 1.0±0.1, p-0.01), eGFR (62.8±28.2 vs 98±23.1ml/min/1.73m2 , p-0.01) were lower in the cases compared to the controls while UACR was higher in the cases (3.1±1.1 vs 1.2±0.1, p-0.01. The prevalence of PAD was 36 (54.5%) and 15 (22.7%) among cases and controls, respectively (p < 0.01) while low eGFR OR, 3.9 (1.86-10.41), elevated Systolic blood pressure (SBP) OR, 1.83 (1.40-5.78) and UACR (t-3.663, p-0.023) were associated with PAD in CKD. Conclusion: This study demonstrated that high prevalence of PAD among individuals with CKD while low eGFR, elevated SBP and microalbuminuria were clinical correlates of PAD in CKD

SARS-CoV-2 sequencing collaboration in west Africa shows best practices.

Correspondence - No abstract available

Public Health Surveillance for Adverse Events Following COVID-19 Vaccination in Africa

Local, national, and international health agencies have advocated multi-pronged public health strategies to limit infections and prevent deaths. The availability of safe and effective vaccines is critical in the control of a pandemic. Several adverse events have been reported globally following reception of different vaccines, with limited or no data from Africa. This cross-sectional epidemiological study investigated adverse events following COVID-19 vaccination in Africans from April–June, 2021 using a structured online questionnaire. Out of 1200 participants recruited, a total of 80.8% (n = 969) respondents from 35 countries, including 22 African countries and 13 countries where Africans live in the diaspora, reported adverse events. Over half of the vaccinees were male (53.0%) and frontline healthcare workers (55.7%), respectively. A total of 15.6% (n = 151) reported previous exposure to SARS-CoV-2, while about one-fourth, 24.8% (n = 240), reported different underlying health conditions prior to vaccination. Fatal cases were 5.1% (n = 49), while other significant heterogenous events were reported in three categories: very common, common, and uncommon, with the latter including enlarged lymph nodes 2.4% (n = 23), menstrual disorder 0.5% (n = 5), and increased libido 0.2% (n = 2). The study provided useful data for concerned authorities and institutions to prepare plans that will address issues related to COVID-19 vaccines

Prevalence of hypertension among antiretroviral therapy naïve patients in Lagos, Nigeria

Abstract Background The gains from successful antiretroviral therapy (ART) roll-out could be compromised by the increasing burden of non-communicable diseases, particularly cardiovascular diseases among people living with HIV (PLWH). Hypertension remains a significant contributor to cardiovascular diseases. This study aims to determine the prevalence and determinants of hypertension among ART-naïve PLWH in a large ART clinic in Lagos, Nigeria. Materials and methods This study uses data collected from adult ART-naïve PLWH enrolled at an ART clinic over ten years. Participants aged 18 years and older, not pregnant, and not accessing care for post-exposure prophylaxis were included in the study. Hypertension was defined as systolic and diastolic blood pressure greater than or equal to 140 mmHg and 90 mmHg, respectively. Logistic regressions were used to investigate the factors associated with hypertension. Results Among the 10 426 participants included in the study, the majority were females (66%) and aged 25—49 years (84%). The crude prevalence of hypertension was 16.8% (95%CI 16.4 – 17.2) while the age and sex standardised prevalence rate was 21.9% (95%CI 20.7 – 23.2), with males (25.8%, 95%CI 23.5 – 28.0) having a higher burden compared with females (18.3%, 95%CI 17.0 – 19.6). Increasing age, male gender, overweight or obesity, co-morbid diabetes mellitus or renal disease, and CD4 count ≥ 201 cells/μL were significantly associated with prevalent hypertension. Conclusion There was a substantial burden of hypertension among ART-naïve PLWH, which was associated with the traditional risk factors of the condition. This highlights the need to integrate screening and care of hypertension into routine HIV management for optimal care of PLWH. Graphical Abstrac

Enzyme Responsive Vaginal Microbicide Gels Containing Maraviroc and Tenofovir Microspheres Designed for Acid Phosphatase-Triggered Release for Pre-Exposure Prophylaxis of HIV-1: A Comparative Analysis of a Bigel and Thermosensitive Gel

The challenges encountered with conventional microbicide gels has necessitated the quest for alternative options. This study aimed to formulate and evaluate a bigel and thermosensitive gel, designed to combat the challenges of leakage and short-residence time in the vagina. Ionic-gelation technique was used to formulate maraviroc and tenofovir microspheres. The microspheres were incorporated into a thermosensitive gel and bigel, then evaluated. Enzyme degradation assay was used to assess the effect of the acid phosphatase enzyme on the release profile of maraviroc and tenofovir microspheres. HIV efficacy and cytotoxicity of the microspheres were assessed using HIV-1-BaL virus strain and HeLa cell lines, respectively. Maraviroc and tenofovir release kinetics followed zero-order and Higuchi model kinetics. However, under the influence of the enzyme, maraviroc release was governed by first-order model, while tenofovir followed a super case II transport-mechanism. The altered mode of release and drug transport mechanism suggests a triggered release. The assay of the microspheres suspension on the HeLa cells did not show signs of cytotoxicity. The thermosensitive gel and bigel elicited a progressive decline in HIV infectivity, until at concentrations of 1 μg/mL and 0.1 μg/mL, respectively. The candidate vaginal gels have the potential for a triggered release by the acid phosphatase enzyme present in the seminal fluid, thus, serving as a strategic point to prevent HIV transmission

Assessment of Perceived Health and Environmental Problems of Household Energy Consumption among Ilese Ijebu Residents Southwestern Nigeria

The study was carried out among Ilese-Ijebu residents southwestern Nigeria, to assess their perceived health and environmental problems associated with different sources of household energy use for cooking, then their perception and acceptability of adopting other alternative source of energy (biogas). A focused group discussion and self-structured questionnaire administration methodologies were adopted to elicit information on their current energy sources and adoption for alternative energy source (biogas). The researchers randomly selected twenty five (25) households to include the total sample size of one hundred (100) and organized an interactive session on the subject matter, during which three prepared forms were given out to the participants to filled their demographics characteristics, sources of energy for household cooking with associated health and environmental problems and perception and acceptability of biogas, descriptive statistics and likert scale technique were used to analyze the results obtained. The results of the analysis showed that, the respondents do make use of more than one source of energy for cooking, kerosene stoves (95), firewood (63), charcoal stove(32), while lesser people made use of liquefied gas (12) and electricity (5). Average numbers of respondents 50-60 are aware of associated health and environmental problems with firewood and charcoal, but not ready to use electricity and liquefied gas because of bills and fire hazards when the energy sources is  not properly handled. However, the likert scale results of the positive score of 227 and the negative score of 598 on the acceptability of use of biogas for domestic cooking indicating that, presently, the residents are not ready to adopt the biogas as the alternative energy. Therefore, there is need to organize massive awareness campaign, health education talks among the residents on the effect of air pollution associated with household energy sources and consumption, health and financial benefits of adopting other alternative clean energy source

Outcomes of tunneled internal jugular venous catheters for chronic haemodialysis at the University College Hospital, Ibadan, Nigeria

Introduction: vascular access is an important aspect of haemodialysis treatments and determinant of patient outcomes. Arteriovenous (AV) fistula has been described as the preferred haemodialysis vascular access for patients on chronic dialysis. There continues to be a challenge with the creation of AV fistula, due to shortage of vascular surgeons skilled in the AV fistula creation particularly in source limited setting. We described the outcomes of the tunneled internal jugular venous catheters amongst our patients at the University College Hospital (UCH) Ibadan. Methods: a retrospective study of patients on maintenance haemodialysis at the UCH, Ibadan, we reviewed the records of all patients on chronic dialysis over a period of 5 years. Information obtained include demographics, types and aetiology of renal failure, types of vascular access, observed complications and outcomes. Results: a total number of 147 catheters were inserted during the period under review, 94 were in males while 53 were females. The age range was 18-85 years while the mean age was 46.3 ± 17.2 years. The range and mean duration for Tunneled Dialysis Catheter (TDC) carriage were (30 - 1,440) and 220±185 days respectively. The observed immediate complications of TDCs were failed first attempt 7(4.7%), reactionary haemorrhage 5(3.4%), arrhythmia 3(2.0%), haemothorax 2(1.4%) while death during catheter placement was recorded in 2(1.4%) cases. Catheter related infection was the commonest long-term complications and occurred in 15 cases (10.1%), while being diabetic increased the risk of developing catheter related complications. One tenth of our patients with End Stage Renal Disease on TDC had kidney transplantation while catheter related mortality was 16.3%. Conclusion: internal jugular tunneled dialysis catheters despite its shortcomings, has been a safe procedure with good outcomes among our patients on maintenance haemodialysis

Predictors and outcome of acute kidney injury after non-cardiac paediatric surgery

Abstract Background It is necessary to define the problem of acute kidney injury (AKI) after non-cardiac surgery in order to design interventions to prevent AKI. The study aimed to evaluate the occurrence, determinants and outcome of AKI among children undergoing general (non-cardiac) surgery. Methods This was a prospective cohort study of patients aged ≤ 15 years who had general surgery over 18 months period at a tertiary hospital in Nigeria. AKI was evaluated at 6 and 24 h and within 7 days of surgery. Data were analysed using SPSS version 21. Results A total of 93 patients were studied with age ranging from 3 days to 15 years (median = 4 years). AKI occurred within 24 h of surgery in 32 (34.4%) and cumulatively over 7 days in 33 (35.5%). Patients who had sepsis were nearly four times as likely as others to develop perioperative AKI (OR = 3.52, 95% CI 1.21, 10.20, p = 0.021). Crude mortality rate was 12.1% (4/33); no mortality was recorded among those without AKI, p = 0.014. Conclusion Perioperative AKI occurred in 35.5% of children who underwent general (non-cardiac) surgery. Patients who had sepsis were four times more likely than others to develop AKI. Mortality was documented only in patients who had AKI

Low level SARS-CoV-2 RNA detected in plasma samples from a cohort of Nigerians: Implications for blood transfusion.

The present global pandemic triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has lingered for over a year in its devastating effects. Diagnosis of coronavirus disease 2019 (COVID-19) is currently established with a polymerase chain reaction (PCR) test by means of oropharyngeal-, nasopharyngeal-, anal-swabs, sputum and blood plasma. However, oral and nasal swabs are more commonly used. This study, therefore, assessed sensitivity and specificity of plasma as a diagnostic in comparison with a combination of oral and nasal swab samples, and the implications for blood transfusion. Oropharyngeal (OP) and nasopharyngeal (NP) swab samples were obtained from 125 individuals suspected to have COVID-19 and stored in viral transport medium (VTM) tubes. Ten millilitres of blood samples in EDTA were also obtained by venepuncture and spun to obtain plasma. Viral RNA was obtained from both swabs and plasma by manual extraction with Qiagen QIAamp viral RNA Mini Kit. Detection was done using a real time fluorescent RT-qPCR BGI kit, on a QuantStudio 3 real-time PCR instrument. Average age of study participants was 41 years, with 74 (59.2%) being male. Out of the 125 individuals tested for COVID-19, 75 (60%) were positive by OP/NP swab. However, only 6 (4.8%) had a positive plasma result for COVID-19 with median Ct value of 32.4. Sensitivity and specificity of RT-PCR SARS-CoV-2 test using plasma was 8% and 100% respectively. There was no false positive recorded, but 69 (55.2%) false negatives were obtained by plasma. SARS-CoV-2 viral RNA was detected, albeit low (4.8%) in plasma. Plasma is likely not a suitable biological sample to diagnose acute SARS-CoV-2 infection. The implication of transfusing blood in this era of COVID-19 needs further investigations

Monitoring of Lassa virus infection in suspected and confirmed cases in Ondo State, Nigeria

Introduction: Lassa virus (LASV), the causative agent of Lassa fever (LF), an endemic acute viral haemorrhagic illness in Nigeria, is transmitted by direct contact with the rodent, contaminated food or household items. Person-to-person transmission also occurs and sexual transmission has been reported. Thus, this study investigated the presence of LASV in body fluids of suspected and confirmed cases. Methods: this was a cross-sectional study between March 2018 and April 2019 involving 112 consenting suspected and post ribavirin confirmed cases attending the Lassa fever treatment center in Ondo State. Whole blood was collected from 57 suspected and 29 confirmed cases. Other samples from confirmed cases were 5 each of High Vaginal Swab (HVS) and seminal fluid; 12 breast milk and 4 urine. All samples were analyzed using reverse transcription-PCR (RT-PCR) targeting the S-gene of LASV. Results: analysis of whole blood by RT-PCR showed that 1/57 (1.8%) suspected and 1/29 (3.4%) confirmed post ribavirin treated cases were positive. While LASV was detected in 2/5 (40%) post ribavirin treated seminal fluids and 1/11 (8.3%) breast milk. However, LASV was not detected in any of the HVS and urine samples. Conclusion: the detection of LASV in seminal fluid and breast milk of discharged post ribavirin treated cases suggests its persistence in these fluids of recovering Nigerians. The role of postnatal and sexual transmissions in the perennial outbreak of LF needs to be further evaluated