Prevalence of chronic kidney disease among the hypertensive patients in Wajir county, Kenya

Background: Chronic kidney disease (CKD) is public health burden and rising rapidly in prevalence in developing countries especially in Sub-Saharan Africa. CKD increases with advancing age and comorbidities like hypertension, diabetes and obesity. However, there is no data on CKD the prevalence and risk factors associated among the hypertensive adult patients in Wajir county. This study aimed at estimating the prevalence and establishing risk factors associated with CKD among hypertensive patients in Wajir county and sought to recommend viable preventive measures. Methods: Analytical cross-sectional study design utilized, non-probability consecutive sampling was adopted to obtain sample size of 293 respondent attending medical outpatient clinic at Wajir county referral hospital between September to December 2023. The study utilised primary data that were collected using structured questionnaires and secondary data from the laboratory result. Results: Key findings revealed majority of hypertensive patients have CKD (45.40%), highlighting a critical health concern in the region. The study found most CKD cases were in early stages (stages 1 and 2), some had progressed to severe stages (stages 4 and 5). Regression analysis identified several demographic and clinical factors associated with CKD development, including age, gender, and education, and employment status, family history of CKD and difficulty in medication compliance. Conclusions: there is high prevalence of chronic kidney disease among hypertensive adults in Wajir county. With nearly half of hypertensive patients also suffering from CKD, there is an undeniable public health crisis at hand in Wajir county. Study recommended initiation of targeted screening programs.

Growth of probiotic bacteria in trypticase phytone yeast medium supplemented with crude polysaccharides from Ganoderma lucidum

Ganoderma lucidum is a fungus usually used in traditional Chinese medicine. The high value of G. lucidum is related to its polysaccharides content. Crude polysaccharides from G. lucidum (GLCP) were obtained using hot water extraction method. There is about 0.57 g of GLCP in 1 g crude of G. lucidum. The prebiotic potential of GLCP was tested against probiotic bacteria namely: Bifidobacterium longum BB536, Bifidobacterium pseudocatenulatum G4, Lactobacillus acidophilus and Lactobacillus casei Shirota. The prebiotic potentials were studied in 10 mL basal Trypticase Phytone Yeast (abbreviated as bTPY) medium (without glucose) supplemented with various concentrations of GLCP (abbreviated as bTPYglcp) (0.5%, 1.0%, 1.5% and 2.0%). bTPY medium supplemented with glucose (abbreviated as bTPYglu) and inulin (abbreviated bTPYinu) were used as comparison. Viable cell counts of the bacteria and the pH of the medium were determined during anaerobic incubation period of 0 h, 12 h, 24 h and 48 h at 37 °C. In the presence of carbohydrate source, cultures showed various degree of growth increment. With regards to the growth supporting property: bTPYglu, bTPYglu+glcp, bTPYglcp and bTPYinu were ranked first, second, third and fourth respectively. Interestingly, in bTPYglcp medium, bacterial growth increased with increasing GLCP concentrations when incubated until 24 h. B. longum BB536 was ranked first (10.53 log cfu/mL) in term of their growth in this medium. Growth of B.pseudocatenulatum G4 was ranked second with 10.40 log cfu/mL. This study shows that, GLCP could support the growth of the bacteria tested.

Hypoparathyroidism in adult patients with beta-thalassemia major

To evaluate the prevalence of hypoparathyroidism in adult transfusion-dependent patients with beta-thalassemia major in a teaching referral hospital in Oman. All adult [>13 years] patients with beta-thalassemia major seen at Royal Hospital in Oman between 2004 and 2006 were studied. Demographic, pharmaceutical, clinical and biochemical data were collected for all the subjects. Analyses were performed using both descriptive and univariate statistics. A total of 31 patients were included into the study with an overall mean age of 19 +/- 3 years ranging from 14 to 30 years. Just over half of the subjects were males [n=16; 52%]. All the patients were on hypertransfusion and combined chelation therapy with desferrioxamine 40-60 mg/kg 5 days per week and deferiprone 75 mg/kg/day. Three of the patients had low levels of parathyroid hormone [<1.6 pmol/l]. A further three patients had normal levels of parathyroid hormone [1.6 - 9.3 pmol/l] in the presence of low serum calcium levels [<2.1 mmol/l]. These patients [with normal hypoparathyroid hormone levels, but lower calcium levels] were also defined to have hypoparathyroidism bringing the total prevalence of hypoparathyroidism in this cohort of adult patients with Beta-thalassemia major to 19% [6 out of 31]. The patients with hypoparathyroidism had statistically significantly lower levels of parathyroid hormone [2.7 versus 5.3 pmol/l; p=0.031] and serum calcium [1.7 versus 2.3 pmol/l; p=0.004] compared to those without hypoparathyroidism. The prevalence of hypoparathyroidism in adult beta-thalassemia major patients at this referral center was significantly higher [19%] than those reported elsewhere [2.5 and 10.7%]

Hepatits A induced diabetes mellitus, acute renal failure and liver failure

A 12-year-old otherwise healthy boy presented with hyperacute hepatic failure [encephalopathy, occurred within seven days of disease onset; total and direct bilirubin of 94 umol/l and 73 umol/I respectively; aspartate aminotransferase [AST] of 8,367 u/l; alanine aminotransferase [ALT] of 11,164 u/I; prolonged prothrombin time 29.1 sec [INR 3.03] and activated partial thromboplastin time of 48.2 sec [ratiol.6]], non-oliguric acute renal failure [creatinine of 591 umol/L and blood urea nitrogen of 21.0 mmol/L], transient leukopenia, transient thrombocytopenia, with new onset diabetes mellitus [on admission the patient had blood glucose of 23.9 mmol/L]. On admission, this patient had reactive 1gM antibody for acute hepatitis A with non-reactive results for hepatitis B surface antigen, hepatitis B core antibodies, and hepatitis C antibodies, The acute renal failure and hepatitis resolved in 17 days and 30 days from admission, respectively; but the patient continues to have diabetes mellitus 6 months [time of follow up] after the hepatitis A infection while the leukopenia and thrombocytopenia resolved in 3 and 6 days from admission respectively. This case illustrates unusual presentation of acute hepatitis A infection induced with acute liver failure, non-oliguric acute renal failure, and, diabetes mellitus as sequele of this infection

Double pylorus: as a cause of upper gastrointestinal bleeding

Double pylorus is a rare abnormality, and it occurs most commonly secondary of chronic peptic ulcer disease. It is usually treated conservatively and anti - ulcer therapy. However, refractory cases may require surgery. The most common causes of upper gastrointestinal tract bleeding are peptic ulcer disease, esophageal varices, Mallory-Weiss syndrome, and tumors. Hemangiomas and bleeding from biliary tract contribute a few cases. For double pylorus which is already a rare condition to present with upper gastrointestinal bleeding is very unusual

Direct laryngoscopy: a prospective study

Prospective clinical analysis of direct laryngoscopic procedures performed in Mosul Teaching Hospital Iraq. Patients and 100 direct laryngoscopic procedures performed in the period from September 1996 to June 1997. There were 55 males and 45 females. The average age was 42.8 years. The most common surgical indications were hoarseness [77%] and tumor-like mass detected on indirect laryngoscopy [38%]. Laryngeal squamous cell carcinoma [SCC] was the most common final diagnosis in the malignant cases. Chronic nonspecific laryngitis was the most common benign diagnosis. The diagnostic accuracy of indirect mirror laryngoscopy compared to direct laryngoscopy was 61%. The diagnostic accuracy of direct laryngoscopic findings and histological diagnosis was 87%. Direct laryngoscopy was difficult in 3 patients, those with short and muscular neck structure. The incidence of major complications was at least 4%. Minor complications occurred in 7% of the patients. Laryngospasm was significantly higher in patients who underwent direct laryngoscopy along with other procedures than in those who underwent direct laryngoscopy alone. Conclusions: Direct laryngoscopy was performed most often indicated for chronic hoarseness and tumor-like masses detected on indirect laryngoscopy. Laryngeal SCC was the most common malignancy and chronic nonspecific laryngitis was the most common non-malignant finding. The incidence of major complications was 4%. Laryngospasm was significantly higher in patients who had undergone procedures in addition to direct laryngoscopy. It is felt that patients who undergo direct laryngoscopy are most safely managed as in patients for 24 hours

Induction of apoptosis in AK-5 cells by rotenone involves participation of caspases.

AK-5 tumour cells undergo apoptosis after treatment with rotenone an electron transport inhibitor and oligomycin which inhibits mitochondrial ATPases. Apoptotic process involves the induction of caspases 2 and 3, whereas caspase 1 does not seem to be participating in rotenone/oligomycin induced apoptosis. DEVD which is a specific inhibitor of caspase 3, inhibited apoptosis in AK-5 cells. We have also observed a significant lowering of intracellular pH in AK-5 cells which are induced into the apoptotic process by rotenone. These results suggest an important role for mitochondrial electron transport in the induction of apoptosis in AK-5 tumour cells.

Purification and characterisation of tumour necrosis factor-alpha with cytotoxic activity against AK-5 cells.

Tumour necrosis factor (TNF) has been purified from the sera of animals in which the rat histiocytoma AK-5, was rejected spontaneously. Purified TNF-alpha is cytotoxic to AK-5 cells in vitro and the cytotoxic activity of TNF is completely neutralized by anti TNF antiserum. The circulating TNF levels are high by day 10 after the tumour transplantation. Animals which do not regress the tumour have very low levels of TNF in serum. Production of TNF by tumour regressing animals is part of the host immune response to the AK-5 tumour. Also, spleenomegaly in the animals which reject the AK-5 tumour is observed.