ABSTRACT
The estimation of the glomerular ?ltration rate (GFR), whose formulas are usually based on serum creatinine, is a fundamental data in clinical nephrology. The concept of “reference” or usual values adopted by health professionals is essential because of the paucity of research on the usual values of GFR in black Africa. The Modi?cation of Diet in Renal disease (MDRD) and Chronik Kidney disease-Epidemiology collaboration (CKDEpi) equations were determined in non-African populations. Usual values speci?c to the black African population by the evaluation of the formulas of Cockroft and Gault (CG), MDRD and CKD-Epi must be rigorous and are the subject of this study. The GFR was determined using the CG, MDRD and CKD-Epi formulas in a sample of 233 presumed healthy Senegalese adults (118 men, 115 women). SPSS and Excel 2016 software were used for statistical analysis. A value of P<0.05 was considered statistically signi?cant. The determination of the GFR by the Cockcroft method overestimates the CKD values by 10.24 (9.82 - 14.53) with p=0.001 and that of the MDRD by 7.47 (5.91 - 9.03) the CKD values with p=0.001. For a GFR measurement uncertainty of +/- 10%, the CG and CKD formulas cannot be superimposed with a low correlation coef?cient r = 0.52 and a coef?cient of determination R² = 0.28; whereas those of MDRD and CKD-Epi are on the other hand superimposable with r = 0.79 and R² = 0.63. Thus, the CKD-Epi formula should be preferred for determining the usual value of GFR in a healthy person.
ABSTRACT
Objective: Malaria remains a complex and overwhelming health problem affecting vulnerable groups such as pregnant women and their infants in Ghana. Malaria during pregnancy does not only pose a threat to the mother but can cause serious structural damages to the placenta and subsequently affect the pregnancy outcome. The aim of the study was to investigate the impact of Plasmodium parasites on the placenta and perinatal outcome of women delivering at Korle Bu Teaching Hospital. A better understanding of the impact of malaria parasites on the placenta morphology and prenatal outcome is crucial for better management of pregnant women and their babies. Methods: The study involved testing blood collected from postpartum placentas and examining the placental tissue for Plasmodium parasites, after which they were classified as study group (Plasmodium positive) or control (Plasmodium negative). The patients in the study group with similar gestational and maternal age were matched with patients from the control group. The morphological characteristics of the placenta and the perinatal outcome of the two patient groups were compared using an unpaired t-test. Results: Sixteen (16, 13.6%) out of 118 women tested positive for Plasmodium parasites on the maternal side of the placenta by both rapid diagnostic test and microscopy and /or tested positive for malarial parasite during pregnancy, whiles the rest (102, 86.4%) had no history of malaria in the index pregnancy and tested negative. The mean placenta weight was significantly reduced in the study group (difference: -102.0g; 95% Confidence Interval [CI]: 424.4g, 486.6g) who delivered during early term (p=0.02). Patients in the study group, who delivered during late term, had a significantly reduced mean placenta diameter (difference: -2.5cm; 95% CI: 20.0cm, 21.4cm) (p=0.003) and delivered infants with lower mean birth weight (difference: - 0.693kg; 95 CI: 3.268kg, 3.475kg) (p<0.001). Conclusion: Malaria during pregnancy does not only pose a threat to the mother but to the fetus and our results add evidence that malaria parasites cause alterations to certain morphological characteristics of the placenta which subsequently affect the birth weight as the pregnancy progresses to late term