Heavy metal exposure and renal impairment: A systematic review of observational studies

Background: Environmental exposure to toxins has been strongly implicated in its multi-faceted etiology of chronic kidney disease, a serious public health problem affecting individuals, families, and communities. There is a need to synthesize available studies on the effect of heavy metal exposure on renal function, considering the rising global burden of kidney disease. The objective of this study is to determine the association between exposure to heavy metals and renal disease. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were used to conduct the review. A comprehensive independent search, title, abstract, and full-text screening of available literature on Google Scholar, PubMed, and OAREScience was done between March 2021 and May 2021. The criteria for study inclusion were full-text articles published in English language in the last 20 years (2001-2020), and observational primary human studies reporting the association between heavy metal exposure and renal disease. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the included studies. Results: A total of 552 studies were identified following the search from the different databases. A total of 13 studies were finally included in the review. Heavy metals implicated in the studies include cadmium, lead, mercury, and arsenic, with ten studies showing environmental exposure as the primary source. Ten (10) studies showed an association between heavy metal exposure and renal impairment (p<0.05) while only 3 studies reported no association. Conclusion: Environmental monitoring is needed to stem the tide of heavy metal exposure in view of the growing burden of chronic kidney disease.

Barriers to HIV Treatment Adherence: Findings from a Treatment Center in South-South, Nigeria.

Aims: Non-adherence to treatment represents a significant challenge to anti-retroviral treatment goals. This study aimed to identify and explore perceived barriers to adherence in non-adherent HIV patients attending the University of Port Harcourt Teaching Hospital. Study Design: This was a descriptive, cross-sectional study of HAART experienced patients who had less than 95% adherence to their HAART medication. Place and Duration of Study: The study was carried out between May and June 2011 at the Antiretroviral treatment center of the University of Port Harcourt Teaching Hospital in the Southern part of Nigeria Methodology: Data collection was via quantitative and qualitative methods. A structured interviewer administered questionnaire adapted from the Adult Antiretroviral Clinical Trials Group (AACTG) study was used to identify barriers to adherence. In addition, four focus group discussions (FGDs) were held with 27 purposively selected participants. Quantitative data was analyzed with SPSS version 18, while the FGDs were analyzed using thematic content analysis. Results: Ninety-six (96) patients, 39 (40.6%) males and 57 (59.4%) females with median age of 35.5 years participated in the study. Identified barriers to adherence included; being away from home during medication times 41 (42.7%), being busy with other things 35 (36.5%), forgetfulness 33 (34.4%), running out of pills 25 (26%), difficulty taking pills at specified times 25 (26.0%), the need to avoid side effects 16 (16.7%), and lack of a social support system 15 (15.6%). Barriers identified by the FGDs were fear of taking HIV drugs in front of others, sharing drugs with infected spouse, alcohol use, financial challenges, poor understanding about the effects of the drugs, forgetfulness, long clinic hours and poor attitude of health workers. Conclusion: Adherence counseling, use of reminder systems and treatment supporters are useful Public Health interventions for improving adherence and should be integrated into service delivery at this and other centers. In addition, better organization of the clinic, increasing staff strength and training will go a long way to address these barriers. Decentralization of HIV treatment centers to secondary and primary health facilities needs consideration.

Insecticide-treated bednet ownership and utilization in Rivers State, Nigeria before a state-wide net distribution campaign.

Background & objectives: Malaria presents a huge health and economic burden to families living in malaria endemic areas. The use of insecticide-treated nets (ITNs) is one of the global strategies in decreasing the malaria burden on vulnerable populations. The use of ITNs reduces clinical malaria by over 50% and all cause mortality in children by 15–30% when the overall population coverage is >70%. This study was aimed at establishing the level of household insecticide-treated bednet ownership and utilization in Rivers State, Nigeria before a statewide scale-up distribution campaign. Study design: A descriptive, cross-sectional study was carried out in the Rivers State in November 2008 among household heads or their proxies to serve as a pre-intervention baseline for the scale-up distribution of insecticide treated bednets in the state. The households were selected by a multi-staged sampling technique: first stage being the selection of Local Government Areas (LGAs) from Senatorial districts, second stage the selection of communities from LGAs and final stage the selection of households. Data were collected using a questionnaire adapted from the WHO/FMoH and analyzed using the Epi-Info version 6.04d statistical software package. Hypothesis tests were conducted to compare summary statistics at 95% significance level. Results: A total of 811 household heads or their proxies were interviewed. Their age ranged between 20 and 70 yr, with a mean of 47.96 ± 4.39 yr. The study showed that although 552 (68.1%) of the households owned bednets, only 245 (30.2%, 95% CI=27.1–33.5) of them owned long-lasting insecticidal nets (LLINs). Similarly, only 37.2% of those who owned ITNs slept under them the night preceding the survey. Conclusion: Household ITN ownership and utilization were low in the state. Incorporating behavour change communication package as part of the ITN distribution intervention is advocated to increase ITNs utilization in the state.

Serum lipids profile of untreated hypertensive patients in Port Harcourt, Nigeria

Background: Hypertension is the commonest non-communicable disease with variable prevalence rates in different parts of the world. Dyslipidaemia is associated with and predisposes to hypertension and hence increases the risk of cardiovascular disease. Aim: To determine the lipid profile in newly diagnosed hypertensive patients and compare them with age, sex and body mass index (BMI) of matched healthy non-hypertensive controls. Methods: A prospective descriptive study of newly diagnosed and treatment naive hypertensive patients. Healthy non-hypertensive adult Nigerians, who gave informed consent, consisting mainly of hospital staff and relatives of patients, matched for sex, age and BMI were recruited as controls. Results: A total of 89 patients, 42 females and 47 males and 87 healthy adults matched for age, sex, and body size were recruited as controls. Mean age of hypertensive subjects was 42.6±9.3 years and mean age for the control subjects was 41.5±4.5 years. The mean systolic blood pressure in the hypertensive subjects was 177.6±20.1 mmHg and mean diastolic blood pressure was 110.9 ±9.9 mmHg. The mean BMI in the hypertensive patients was 28.7±4.2 kg/m2, while the controls had mean BMI of 28.2±4.0 kg/m2 (P=0.5178). The mean total cholesterol (TCH) was 5.3±1.1 mmol/l in the study subjects and 4.7±0.95 mmol/l in the controls (P =0.0002). The mean low density lipoprotein cholesterol 250 in the study subjects was 4.3±1.1 mmol/l and 3.6±0.9 mmol/l in the control group (P=0.000054), while the mean triglyceride in the subjects was 1.3±0.3 mmol/l and 1.0±0.3 mmol/l in the controls (P=0.0000). Conclusion: Newly diagnosed hypertensives have significantly higher serum cholesterol levels than non-hypertensives of comparable age, sex and body size

A Three-Year Review of the Pattern of HIV Infection among Pregnant Women Attending Braithwaite Memorial Specialist Hospital; Port Harcourt; Nigeria

Background: The HIV prevalence rate in Rivers State was low at onset; but increased progressively; often exceeding the National average since 2001. However; there has been a reported decline in the prevalence in Nigeria and elsewhere with wide local and zonal differences. Aim: To assess the HIV sero-prevalence among pregnant women attending the antenatal clinic (ANC) at the Braithwaite Memorial Specialist Hospital Port Harcourt; Rivers State. Methods: Hospital records of all pregnant women who registered and attended the antenatal clinic from 2nd January 2005 to 31st December 2007 and were screened for HIV infection at the Haematology laboratory were retrieved and analysed using Epi-Info version 6.04d. Results: A total of 9;869 ANC attendees were screened for HIV infection at the Hospital. The prevalence rates were 4.8in 2005; 5.4in 2006 and 5.3in 2007. The pattern of infection showed that the highest prevalence rate of 5.6was found among the youngest age group (15- 24 years); clients with only primary education (8.5); and skilled workers (7.3) (p= 0.000). Conclusion: HIV infection is still in its epidemic phase in Rivers State unlike in other areas in the country where declines have set in. Caution is therefore required in extending the emerging declines in prevalence rates elsewhere to Rivers State; so that the existing political will and commitment in control efforts in the State are not weakened; if the State wishes to experience a sustained decline in prevalence rate in the foreseeable future

Social aspects of patients with pulmonary tuberculosis in Indonesia.

Tuberculosis (TB) patients have not only medical but also social problems related to their illness, which may influence their motivation for the completion of treatment. This study investigated the social aspects of patients with TB in an urban area of Jakarta, Indonesia. Most TB patients had poor nutritional status and lived in crowded environments. They faced joblessness and negative attitudes from their neighbors and relatives. A few of the patients were afraid that they would not find a partner; others said that their diseases impaired their marriages. We found that patients with a subnormal body mass index restricted their social contact with their family more than patients with a normal body mass index. In general, patients were supported by their families, both financially and socially. Our findings suggest that priority should be given to developing programs aimed at strengthening the family support of TB patients.