The Clinical Utility of Kidney Cortical Thickness in assessing severity of CKD in Low Income Setting.

BACKGROUND: Renal Ultrasound Scan (RUS) is known to have an important role in assessing kidney function in healthy people and people with Chronic Kidney Disease (CKD) with the kidney length (KL) being the most commonly used measure. The Glomerular Filtration Rate (GFR) is the gold standard in kidney function assessment and its strength of correlation with a RUS measure is used in ascertaining the reliability of that RUS measure. OBJECTIVES: To compare the strength of correlations between the GFR and RUS measures like KL and cortical thickness (CT) in healthy people and people with CKD. METHODS: One hundred and forty study participants who had kidney ultrasound scan were studied. Creatinine based GFR was determined and linear correlation coefficients (r) were used to determine the relationship between the GFR and RUS measures. RESULTS: Seventy CKD cohorts with stage 2-4 disease and 70 healthy volunteers (each with 35 males and 35 females) took part. The total mean eGFR, KL and CT for the study participants were 70.5 ± 12.5ml/min, 10.0 ± 3.1cm, and 8.6 ± 2.7mm respectively. There was a progressive decline in eGFR and renal CT as CKD worsened down the stages. The mean eGFR, KL and CT of the CKD cohorts were 44.7 + 3.6 ml/min, 9.1 + 3.3 cm and 7.4 + 2.4 mm respectively. Among the CKD cohorts, the eGFR was highest in CGN and, the KL and CT were highest in obstructive uropathy. The GFR, was positively correlated with KL and CT, the strength of association being more with the CT. The mean age and GFR independently predicted the kidney cortical thickness. CONCLUSION: Kidney sizes were smaller in females, with aging and with declining kidney function. The CT being more positively correlated with GFR than the KL, is a more reliable RUS measure in assessing kidney function.

CONTEXTE: On sait que l'échographie rénale (ÉR) joue un rôle important dans l'évaluation de la fonction rénale chez les personnes en santé et chez les personnes atteintes d'insuffisance rénale chronique (IRC) avec la longueur des reins (KL) étant la mesure la plus couramment utilisée. Le débit de filtration glomérulaire (DFG) est l'étalon-or de l'évaluation de la fonction rénale et la force de sa corrélation avec une mesure RUS est utilisée pour déterminer la fiabilité de cette mesure RUS. OBJECTIFS: Comparer la force des corrélations entre le DFG et les mesures de l'ÉRU comme le KL et l'épaisseur corticale (EC) chez des personnes en bonne santé et des personnes atteintes d'IRC. MÉTHODES: Cent quarante participants à l'étude ayant subi une échographie rénale ont été étudiés. Le DFG basé sur la créatinine a été déterminé et des coefficients de corrélation linéaire (r) ont été utilisés pour déterminer la relation entre le DFG et les mesures de RUS. RÉSULTATS: Soixante-dix cohortes d'IRC avec une maladie de stade 2-4 et 70 volontaires sains (35 hommes et 35 femmes) ont participé à l'étude. Les moyennes totales du DFGe, du KL et du CT pour les participants à l'étude étaient respectivement de 70,5 ± 12,5 ml/min, 10,0 ± 3,1 cm et 8,6 ± 2,7 mm respectivement. On a constaté un déclin progressif du DFGe et du CT rénal au fur et à mesure de l'aggravation de l'IRC. Le DFGe moyen, le KL et le CT des cohortes d'IRC étaient de 44,7 + 3,6 ml/min, 9,1 + 3,3 cm et 7,4 + 2,4 mm respectivement. Parmi les cohortes d'IRC, le DFGeT était le plus élevé dans la NGC et le KL et le CT étaient les plus élevés dans l'uropathie obstructive.Le DFG était positivement corrélé avec le KL et le CT. La force de l'association étant plus importante avec le CT. L'âge moyen et le GFR prédisent indépendamment l'épaisseur corticale des reins. CONCLUSION: La taille des reins est plus petite chez les femmes, avec le vieillissement et le déclin de la fonction rénale. Le CT étant plus corrélée plus positivement avec le DFG que le KL, est une mesure plus fiable de l'EFR pour évaluer la fonction rénale. MOTS CLÉS: Taux de filtration glomérulaire, longueur du rein, épaisseur de la corticale.

Atomistic simulation reveals structural mechanisms underlying D614G spike glycoprotein-enhanced fitness in SARS-COV-2.

D614G spike glycoprotein (sgp) mutation in rapidly spreading severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) is associated with enhanced fitness and higher transmissibility in new cases of COVID-19 but the underlying mechanism is unknown. Here, using atomistic simulation, a plausible mechanism has been delineated. In G614 sgp but not wild type, increased D(G)614-T859 Cα-distance within 65 ns is interpreted as S1/S2 protomer dissociation. Overall, ACE2-binding, post-fusion core, open-state and sub-optimal antibody-binding conformations were preferentially sampled by the G614 mutant, but not wild type. Furthermore, in the wild type, only one of the three sgp chains has optimal communication route between residue 614 and the receptor-binding domain (RBD); whereas, two of the three chains communicated directly in G614 mutant. These data provide evidence that D614G sgp mutant is more available for receptor binding, cellular invasion and reduced antibody interaction; thus, providing framework for enhanced fitness and higher transmissibility in D614G SARS-COV-2 mutant.

LUNATE DISLOCATION: PRESENTATION OF TWO CASES OF A RARE CONDITION.

Lunate dislocation is a circumambient disruption of the lunate bone. It is an uncommon but devastating wrist injury that can have negative effect on lifestyle with significant morbidity. This injury can go unrecognized by physicians resulting in complications including but not limited to carpal tunnel syndrome and Kienbock's disease. We present two cases of type 4 lunate dislocation that presented within 24 hours of injury; one had fallen off a moving motorcycle while the other had been involved in a motor vehicle accident. The second developed carpal tunnel syndrome. Radiographs showed typical appearances. Both had Open Reduction with Internal Fixation (ORIF), recovered well, and had good function at the outpatient follow-up.

National trends in the treatment of diabetic nephropathy in the United States.

WHAT IS KNOWN AND OBJECTIVE: The prevalence of diabetic nephropathy continues to rise and it remains a strong predictor of morbidity and mortality in diabetic patients. Patients diagnosed with diabetic nephropathy are actively excluded from most trials involving diabetic medications and it is important to understand the prescription patterns in this subset of patients with diabetes. METHODS: Using the IMS Health's National Disease and Therapeutic Index, we analysed the medication prescription patterns for six classes of medications from 2010 to 2014 among patients, 35 years or older, with diabetic nephropathy. RESULTS: Annual office visits increased from 772 860 (95% confidence interval (CI), 755, 470-790, 249) in 2010 to 1 868 618 (95% CI, 1 834 422-1 902 814) in 2013 and declined to 830 596 (95% CI, 809 167-852 025) in 2014. Sulfonylureas and dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were the most frequently used of the four classes of diabetic medications included in this study. DPP-4 inhibitors use increased gradually and was used in 54% (95% CI 49-58) of treatment visits by the last quarter of 2014. Across these years, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEIs and ARBs) were prescribed in the majority of treatment visits with peaks above 90%. However, there were some periods when utilization of these antihypertensives was low. WHAT IS NEW AND CONCLUSIONS: Significant increases occurred in the uptake of new diabetic medications; DPP-4 inhibitors and SGLT-2 inhibitors and in the utilization of ACEIs and ARBs compared to the findings reported in other studies with increased complexity in the treatment of patients with diabetic nephropathy. Improved and continued used of these medications may be beneficial in improving patient outcomes.

Informed consent in otolaryngologic surgery: case scenario from a nigerian specialist hospital.

Informed consent is a foundational concept necessary for ethical conduct of clinical research and practice. It is a technical tool that shifts the autonomy to decide whether a medical procedure should be performed-from the doctor to the patient. However there is an ongoing discussion in bioethical circles on the level of comprehension of the informed consent process by the patients and research participants. We present this case vignette and the discussion afterwards to explore the question of to what extent a patient comprehends the information given to him/her before a surgical procedure is carried out. In other words, the question being asked here is how informed is informed consent in the context of oto-laryngological practice.

Therapeutic Effects of Exercise Training On Selected Cardio-Pulmonary Parameters and Body Composition of Nigerians with Chronic Heart Failure (A Preliminary Study).

BACKGROUND: The use of exercise training in the management of individuals with chronic heart failure has not been widely accepted by health care providers especially in Sub-Saharan Africa because of the possibility that the failing hearts may have a negative response to the increased workload and stress of exercise. OBJECTIVE: The study aimed to evaluate the effects of exercise training (ET) on selected cardio-respiratory and body composition variables of Nigerians with chronic heart failure (CHF). METHODS: Thirty two Nigerians with CHF (male - 17), aged 30 to 71 years, mean age 54.2 ± 1.9 years and New York Heart Association Functional Class (NYHA) II-III recruited from Cardiology Clinic of Lagos University Teaching Hospital Nigeria participated in the study. They were randomized into exercise (EG) and control groups (CG). Exercise group performed 12-weeks of aerobic and resistance training for 60 minutes, three sessions per week. Selected cardio-respiratory and body composition variables were measured pre and post intervention in both groups. Data was analyzed using SPSS-17 package. Level of significance was set at 0.05. RESULTS: There was no significant difference in the measured variables between the groups at baseline (p > 0.05). Significant improvement was seen in EG in all the measured variables except the systolic (p = 0.29) and diastolic blood pressure (p = 0.45). No adverse effect was observed during the exercise training. No significant improvement was observed in the control group (p > 0.05). CONCLUSION: Exercise training may improve cardiorespiratory and body composition variables in patients with chronic heart failure.

Comparison of the effects of tens and sodium salicylate iontophoresis in the management of osteoarthritis of the knee.

The aim of this study was to compare the effects of transcutaneous electrical nerve stimulation (TENS) and sodium salicylate Iontophoresis on pain and functional disability in patients with osteoarthritis of the knee. Twenty (20) subjects participated in this study. Their ages ranged from 40-65 years. They were assigned to either the TENS or Iontophoresis group. The application of TENS was done using an EV 904 unit made by. Electro-medical supplies, while Iontophoresis treatment was delivered using a Galvanic current machine by F.W. Read and Sons London. The subjects levels of pain and functional disability prior to commencement of treatment and after the 6 weeks of treatment was taken using the Visual Analogue Scale (VAS) and Disability Index Questionnaire for patients with osteoarthritis of the knee joint(s). Analysis of data obtained was done using the Mann-Whitney U test and level of significance was set at (P < 0.05). The statistical analysis of the result showed a statistically significant reduction in pain and functional disability in both groups (P < 0.05). Patients treated with Sodium salicylate iontophoresis had a more statistically significant reduction of pain and functional disability in comparison with TENS group (P < 0.05). It is hereby suggested that the use of sodium salicylate iontophoresis and TENS be included in treatment of osteoarthritis to enhance pain relief and functional activity.