Renal dysfunction and 30-day mortality risk in patients with acute stroke

Background: Chronic kidney disease (CKD) and stroke constitute worldwide public health problems with rising incidence, prevalence and poor outcomes. While the link between renal dysfunction and myocardial infarction is well established, the link with stroke has been less well investigated. In this study, the prevalence and prognostic implication of renal dysfunction in patients admitted with acute stroke was assessed.Methods: This was a prospective observational study of 130 patients with first-ever stroke admitted within 7 days of stroke onset and followed up for 30 days. The study outcome measure was 30-day mortality. Stroke subtype was verified by a computerized tomography (CT) scan of the brain. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the 4-variable Modification of Diet in Renal Disease (MDRD) equation. Renal dysfunction was defined as eGFR < 60 mL/min/1.73 m2 and significant proteinuria was defined as urinary protein excretion ≥ 0.5 g in 24 hours. The Cox proportional hazards regression model was used to determine the relationship between GFR, proteinuria and 30-day mortality.Results: The majority of the patients studied (56%) were male and their mean age was 61.3 ± 13.9 years. Ischaemic stroke was the most common stroke subtype, accounting for 74% of all cases. Overall, 38% of patients had reduced eGFR < 60 mL/min/1.72 m2 while 35% had significant proteinuria. eGFR < 60 mL/min/1.73 m2 (hazard ratio, HR 3.59, 95% CI 1.03–13.26, p < 0.001) and proteinuria (HR 1.86, CI 1.00–8.14, p = 0.035) were independent predictors of mortality. Other independent predictors were age > 70 years, haemorrhagic stroke subtype, CNS score < 6.5 and random blood glucose > 7.8 mmol/L.Conclusions:Renal dysfunction is common among adult Nigerian patients with acute stroke. Both reduced eGFR and proteinuria were independent predictors of 30-day mortality in these patients

APOE E4 is associated with impaired self-declared cognition but not disease risk or age of onset in Nigerians with Parkinson's disease

The relationship between APOE polymorphisms and Parkinson's disease (PD) in black Africans has not been previously investigated. We evaluated the association between APOE polymorphic variability and self-declared cognition in 1100 Nigerians with PD and 1097 age-matched healthy controls. Cognition in PD was assessed using the single item cognition question (item 1.1) of the MDS-UPDRS. APOE genotype and allele frequencies did not differ between PD and controls (p > 0.05). No allelic or genotypic association was observed between APOE and age at onset of PD. In PD, APOE ε4/ε4 conferred a two-fold risk of cognitive impairment compared to one or no ε4 (HR: 2.09 (95% CI: 1.13-3.89; p = 0.02)), while APOE ε2 was associated with modest protection against cognitive impairment (HR: 0.41 (95% CI 0.19-0.99, p = 0.02)). Of 773 PD with motor phenotype and APOE characterized, tremor-dominant (TD) phenotype predominated significantly in ε2 carriers (87/135, 64.4%) compared to 22.2% in persons with postural instability/gait difficulty (PIGD) (30/135) and 13.3% in indeterminate (ID) (18/135, 13.3%) (p = 0.037). Although the frequency of the TD phenotype was highest in homozygous ε2 carriers (85.7%), the distribution of motor phenotypes across the six genotypes did not differ significantly (p = 0.18). Altogether, our findings support previous studies in other ethnicities, implying a role for APOE ε4 and ε2 as risk and protective factors, respectively, for cognitive impairment in PD

Patterns of Passage into protected areas: drivers and outcomes of Fulani immigration, settlement and integration into the Kachia Grazing Reserve, Northwest Nigeria

Abstract Increasing land use and associated competition for natural resources in the wake of high human and livestock population pressures have been major challenges confronting pastoralists of West Africa. This is especially true in Nigeria where Fulani make up 4% of the national population and prevailing national insecurity issues are impacting on pastoral livelihoods, including violent conflicts over land and ethnic, religious and political disparities. This study examined the dynamics of immigration within the Kachia Grazing Reserve (KGR), an exclusively Fulani pastoralist community in Kaduna State, northwest Nigeria, prompted by concerns from both the farming communities and the authorities about mounting pressure on existing limited resources, particularly in regard to availability of cattle grazing resources. Drawing from a household census conducted in 2011 and employing a range of qualitative methods (focus group discussions and key informant interviews), this study explored the drivers and consequences of immigration and subsequent integration within the KGR community. The study revealed two types of immigration: a steady trickle of pastoralists migrating to the reserve to settle and acquire land, secure from the stresses of competition from cultivators, and the sudden influx of internally displaced persons fleeing violent clashes in their areas of origin. Population pressure within the reserve has risen steadily over the past three decades, such that it is severely overgrazed (as evidenced by reports from the KGR community that the animals run short of pasture even during the wet season due to desertification and the spread of non-edible weeds). The newer immigrants, fleeing conflict, tended to arrive in the reserve with significantly larger herds than those kept by established residents. Pastoralists in the reserve have been forced back into the practice of seasonal transhumance in both wet and dry seasons to support their herds, with all the attendant risks of theft, clashes with cultivators and increased disease transmission

Влияние фосфатных связующих на физико-механические свойства периклазохромитовых огнеупоров

У данній статті наведено та порівняно фізико-механічні властивості периклазо-хромітових матеріалів в залежності від різних типів фосфатних зв’язуючих та введення різних домішок. Визначено, що найбільш раціональним є введення триполіфосфату натрію.In given clause are resulted and the physycal-mechanical properties periclase-cgromite of materials are compared depending on different of types phosphate binding and introduction of the various additives. Is determined, that most rational is the introduction treepolyphosphate sodume

Pattern and predictors of urine protein excretion among patients with type 2 diabetes attending a single tertiary hospital in Lagos, Nigeria

Testing for proteinuria is used to screen for diabetic nephropathy. However, significant proportion of diabetics has normal urine protein excretion despite impaired renal function. We aimed to determine the factors predicting increased urine protein excretion in patients with type 2 diabetes. This was a cross-sectional study of 358 type 2 diabetics attending the diabetes clinic of a teaching hospital in Lagos. Data regarding patients’ demographic characteristics, and disease history were retrieved. Clinical measurement and samples for determination of plasma creatinine, and urine protein/creatinine ratio were obtained. Comparison of means was by student’s t-test, while for percentages, Chi-square test was used. Relationship between glomerular filtration rate (GFR) and urine protein excretion was assessed using linear regression while factors associated with increased urine protein was determined excretion logistic regression analysis. Level of statistical significance was set at P <0.05. Mean age was 57.84 + 11.12 years and mean duration of diabetes was 8.63 + 7.53 years. Urine protein excretion was increased in 191 (53.4%) of the patients. Patients with increased urine protein excretion were more likely to be hypertensive, to be on an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker had a higher mean systolic blood pressure, and a lower mean GFR. Patients with a GFR <60 mL/min/1.73 m2 had a six-fold increased odds of having increased urine protein excretion, while patients on an inhibitor of the renin-angiotensin-aldosterone system had a 50% reduced odds of having increased urine protein excretion. Proteinuria and reduced GFR are common among sub-Saharan African patients with type 2 diabetes. GFR below 60 mL/min/1.73 m2 and not receiving an inhibitor of the renin-angiotensin-aldosterone system predict increased urine protein excretion in them

Effect of calcium channel blockers on gingival tissues in hypertensive patients in Lagos, Nigeria: A pilot study

Background: Long-term treatment of common chronic cardiac conditions such as hypertension with calcium channel blockers (CCBs) has long been associated with gingival hyperplasia. This oral side effect may affect esthetics and function, yet often overlooked and therefore underreported among Nigerians. Aim: This study aimed to determine the association of CCBs with gingival overgrowth (GO) in hypertensive patients. Methods: This was a hospital-based, case–control study conducted among 116 hypertensive patients (58 CCB and 58 non-CCB age-matched controls) attending the medical outpatient clinic of a tertiary health institution in Lagos, Nigeria. Data collection tools included interviewer-administered questionnaires and periodontal examination. Sociodemographic details, medical history, and periodontal indices (gingival index, plaque index, class of GO according to drug-induced GO [DIGO] Clinical Index) were recorded. Results: The mean age was 59.4 ± 12.6 years, females representing 50.9%. In the CCB group, 39 (67.2%) participants were on amlodipine and 19 (32.8%) were on nifedipine. The mean duration of CCB use was 55.6 ± 53 months. DIGO was higher in CCB (36.2%) than that in non-CCB participants (17.2%) (χ2 = 4.4, P = 0.036). The risk of GO was higher in CCB users (odds ratio [OR] 2.7, [95% confidence interval (CI)]: 1.1–6.5). Amlodipine users had higher DIGO (37.5%) than that of nifedipine users (21.1%) (OR 2.3, [95% CI]: 1.0–5.3). The predominant class of DIGO among the CCB users was Class 2 DIGO Clinical Index (90.5%). Conclusion: The study reveals that the risk of GO is nearly three times in CCB than that of non-CCB users and twice higher in amlodipine than nifedipine users in Nigeria

Prevalence of hypertension and blood pressure profile amongst urban-dwelling adults in Nigeria: a comparative analysis based on recent guideline recommendations

Abstract Background Hypertension is the major risk factor for cardiovascular diseases and prevalence rates are critical to understanding the burden and envisaging health service requirements and resource allocation. We aimed to provide an update of the current prevalence of hypertension and blood pressure profiles of adults in urban Nigeria. Methods Cross sectional population-based survey in Lagos, Nigeria. Participants were selected using stratified multistage sampling. Relevant sections of the World Health Organization STEPwise approach to chronic disease risk factor surveillance were utilized for data collection. Blood pressures were categorized based on both the current American College of Cardiology/American Heart Association (ACC/AHA) 2017 guidelines and the pre-existing Joint National Committee on Hypertension 7 (JNC7) (2003) categories. Results There were 5365 participants (51.8% female), age range of 16–92 years, and mean age ± SD 37.6 ± 13.1. The mean ± SD systolic and diastolic blood pressures were 126.8 ± 18.6 and 80.6 ± 13.2 respectively. There was significant correlation between both systolic and diastolic blood pressures and age (Pearson correlation 0.372 and 0.357 respectively and p = 0.000 in both instances). The prevalence of hypertension was 55.0% (3003) and 27.5% (1473) based on the ACC/AHA 2017 guideline and the JNC7 2003 guidelines respectively. Body mass index was positively correlated with systolic and diastolic BP (p = 0.000). Conclusions Over half of the adult population in this major Nigerian city are classified to have hypertension by the recent guideline. There is an urgent need to develop and implement strategies for primordial prevention of hypertension (and obesity) and to restructure our healthcare delivery systems to adequately cater for the current and emerging hypertensive population

Assessment of levels and health risk of Potentially Toxic Elements (PTEs) in selected sachet water packaged from groundwater resources in Ogun State, Nigeria

Background: Sachet water is a source of affordable drinking water for low-income socioeconomic class. However, contamination by potentially toxic elements (PTEs) could pose severe adverse health risk to consumers. Objective: The present study aimed at assessing the levels and health risk of PTEs in selected sachet water samples packaged from groundwater resources in Ogun State, Nigeria. Methods: A total of 140 bags of selected sachet water brands were purchased and analysed for eleven PTEs (some of which are rarely reported in Nigeria) using inductively coupled plasma - optical emission spectrophotometer. Recovery experiment was conducted to validate the performance of the used analytical instrument. Blank samples were also run to cancel the matrix effect of the analysing reagents, and to calculate the limit of detection. PTE data were evaluated for simple descriptive and inferential statistics using SPSS for Windows. Health risk assessment was conducted for hazard quotient (HQ), hazard index (HI) and cancer risk (CR). Results: Chromium (Cr) was the highest observed PTE in sachet water from Asero (707±1102 µg L−1), Isolu (363±374 µg L−1) and Makun-Shagamu (359±204 µg L−1) sites. The concentrations of Cr were higher than the permissible limit of the World Health Organization in 63% of the sachet water samples. Furthermore, the average contents of lead (Pb) and thallium (Tl) were observed at higher concentrations than the acceptable limits. The HQs exceeding the permissible threshold of 1.0 were observed for silver (Ag), aluminium (Al), arsenic (As), cadmium (Cd), Cr and Tl in 29% of the sachet water consumed by adults and children; indicating adverse health effects. The CRs of Cd and Cr at all the sampling locations, and As at few sites were higher than the acceptable limit of 1 × 10−4; suggesting possible development of cancer by the consumers. Conclusion: The high levels and health risk estimates of PTEs in the sachet water samples suggested unsafe for consumption. Periodic monitoring of PTEs in sachet water from the study area is recommended

Assessment of Water Quality Index and the Probable Human Health Implications of Consuming Packaged Groundwater from Abeokuta and Sagamu, Southwestern Nigeria

Background: Contamination of groundwater could result in serious and irreparable health problems for consumers. This study assessed the water quality and human health implications of metals in packaged groundwater from Abeokuta and Sagamu, southwestern Nigeria. Methods: One hundred and forty bags of the packaged groundwater were purchased and analyzed for physical and chemical parameters using standard procedures, while metals were determined using inductively coupled plasma optical emission spectrophotometry. Risk assessment of metals was estimated using hazard index (HI), hazard quotient (HQ), and cancer risk (CR). Water quality index (WQI) was also evaluated. Results: The observed physical and chemical parameters, except Mn and Fe, in the packaged groundwater samples were observed to be within the permissible limits of the World Health Organization. The WQI data indicated suitability for drinking purposes. The health risk data indicated high HQs > 1.0 for Ca (for adults and children at all the monitoring sites), Mn (children at all the sites, and adults at six sites), Mo (children at four sites, and adults at three sites), and Cu (children at three sites and adults at one site). Conclusion: The CRs of the packaged groundwater for Co and Ni at many sites revealed values > the acceptable limit of 1 × 10−4, indicating possible development of cancer by the consumers