Demographic Pattern and Clinical Characteristics of Patients Undergoing Haemodialysis in a Tertiary Centre of a Developing Country: A Review of 280 Cases.

Background: Globally, renal replacement therapy especially haemodialysis remains pivotal in the effective care of patients with kidney diseases since its acceptance as a treatment modality. Despite being widely embraced as a therapeutic option, several factors still hamper its utilization. A clinical audit of this modality option will allow elucidation of haemodialysis practises and peculiarities. Methods: The charts and records of 280 patients with renal impairments dialyzed between March 1st 2019 and February 28th 2023 were evaluated in retrospect. Data on retrieved demographic and clinical information were analyzed using SPSS 25 and patients' short-term survival was determined using the Kaplan Meier survival analysis and log rank test. Results: Out of the 280 patients who had 1716 dialysis sessions, 184 (65.7%) were males. The mean age was 47.9 ± 17.5 years. The majority (80.7%) of the patients had chronic kidney disease (CKD), as 90.2% of the dialysis sessions were for CKD. There was a male preponderance (69.1%) in the population. Hypertension was the commonest cause of CKD (41.2%) while sepsis was the commonest cause of acute kidney injury (50%). The median number of dialysis session was 4.0. The mean pre-dialysis hematocrit was 24.4 ± 7.1% and the mean single pool Kt/V was 0.9 ± 0.02. The femoral vein was the most used vascular access (95.4%). The short-term survival was positively related to the dialysis frequency on Kaplan-Meier analysis. Conclusion: Haemodialytic therapy in patients with renal disease is still of huge impact on survival despite the numerous factors affecting its effective delivery, especially in low-income nations.

Malaria Parasitaemia and its Associated Factors among Febrile Children in a Tertiary Hospital in Southwest Nigeria.

BACKGROUND: Malaria is a parasitic disease of public health concern especially among children because of their vulnerability. Objective: The study sought to evaluate the prevalence and severity of malaria and to assess the factors associated with malaria parasitaemia among children. METHODS: This was a hospital-based cross-sectional observation study. We enrolled 303 children aged 6 to 59 months who presented with fever. A structured questionnaire was used to obtain the demographic characteristics, determinant factors and the use of malaria preventive measures. Microscopic examination of blood film for malaria parasite was done. Data were analysed using SPSS version 23.0. The Pearson's Chi-square was used to determine the association between selected socio-demographic variables, clinical characteristics of participants and presence of malaria parasitaemia. A p-value less than 0.05 was considered significant. RESULTS: The mean ± SD age was 24.36 ± 16.63 months, 183 (60.4%) were male. Two hundred and thirteen (70.3%) participants tested positive for Plasmodium falciparum. Severe malaria accounted for 21.1% of all malaria cases. Severe anaemia (37.8%) and cerebral malaria (24.4%) were the common complications observed. Malaria was significantly associated with increasing age (p = 0.007). Children who slept regularly under LLIN and those using insecticidal spray were more likely to be protected from developing malaria (p = 0.002, p = 0.001, respectively). The socioeconomic status, maternal education, family size and knowledge of LLIN were not associated with the development of malaria (p= 0.901, 0.136, 0.413, 0.166, respectively). CONCLUSION: The prevalence of malaria is high; there is a need to increase the coverage of IRS, together with LLINs to reduce the transmission and burden of malaria, particularly among the susceptible population.

CONTEXTE: Le paludisme est une maladie parasitaire de la santé publique inquiètent particulièrement les enfants en raison de leur vulnérabilité. OBJECTIF: L'étude visait à évaluer la prévalence et la gravité du paludisme et d'évaluer les facteurs associés à la parasitémie palustre chez les enfants. MÉTHODES: Il s'agissait d'une observation transversale en milieu hospitalier. Nous avons inscrit 303 enfants âgés de 6 à 59 mois qui ont présenté avec de la fièvre. Un questionnaire structuré a été utilisé pour obtenir les caractéristiques démographiques, les facteurs déterminants et l'utilisation du mesures préventives contre le paludisme. Un examen microscopique du film sanguin pour le parasite du paludisme a été fait. Les données ont été analysées à l'aide de la version 23.0 du SPSS. Le Chi-carré de Pearson a été utilisé pour déterminer l'association entre certaines variables sociodémographiques, caractéristiques cliniques des participants et présence de parasitémie palustre. Une valeur de p en moins que 0,05 a été jugé significatif. RÉSULTATS: La moyenne ±'âge du DT était de 24,36 ± 16,63 mois, 183(60,4 %) étaient des hommes. Deux cent treize (70,3 %) participants testé positif pour Plasmodium falciparum. Paludisme sévère comptabilisé pour 21,1 % de tous les cas de paludisme. Anémie sévère (37,8 %) et le paludisme cérébrale, (24,4 %) étaient les complications courantes observées. Paludisme était significativement associé à l'augmentation de l'âge (p = 0,007). Enfants qui dormaient régulièrement sous LLIN et ceux qui utilisaient un spray insecticide étaient plus susceptibles d'être protégés contre le développement du paludisme (p = 0,002,p = 0,001, respectivement). Le statut socio économique, l'éducation maternelle, la taille de la famille et la connaissance de LLIN n'étaient pas associées avec le développement du paludisme (p= 0,901, 0,136, 0,413, 0,166,respectivement). CONCLUSION: La prévalence du paludisme est élevée; il y a un besoin pour augmenter la couverture de l'IRS, ainsi que les LLIAN pour réduire le transmission et charge du paludisme, en particulier parmi les personnes population sensibles. Mots-clés: Paludisme, Plasmodium falciparum, enfants de moins de cinq ans.

Pattern of Self-care practices among type 2 diabetes patients in Southwest, Nigeria.

BACKGROUND: Self-care practices in individuals with diabetes are important skills required to effectively prevent, manage, and limit complications associated with diabetes since patients spend considerably less time with health care providers than spend alone to manage their diabetes condition. AIMS: The aim of the study was to assess self-cate practices and their determinants among patients with type 2 diabetes. Hence, this study aimed at assessing self-care practices and their determinants among patients with type 2 diabetes. MATERIALS AND METHODS: This cross-sectional, descriptive, multi-center study was conducted among 348 type 2 diabetes patients selected from six tertiary hospitals in Southwest Nigeria. Descriptive statistical analysis was employed for categorical and continuous variables and multivariable logistic regression assessed association between determinant factors and adherence to self-monitoring of blood glucose (SMBG). RESULTS: Of the study participants, 83.1%, 66.9%, 28.4%, and 27.9% adhered to prescribed medications, physical exercise, had meal plans incorporated into their diabetes management and SMBG, respectively. There was a statistically significant association between male gender, duration of diabetes, and previous episode of hypoglycemia with adherence to SMBG practices while lower educational level and use of insulin were associated with less likelihood of adherence to prescribed medications. CONCLUSION: The degree to which individuals with diabetes adhered to recommended self-care practice components were less than satisfactory especially SMBG, physical activity, and having meal plans.

Measurement of neurodevelopmental effects of prenatal alcohol exposure in Ukrainian preschool children.

Effects of prenatal alcohol exposure (PAE) are rarely measured in preschool children due to relative insensitivity of assessment methods at this age. To examine the potential of a nonverbal battery in early identification of cognitive problems in alcohol-exposed children, 291 prospectively identified Ukrainian children were evaluated using a test battery focusing on early executive functioning (EF) and visuospatial skills, areas of cognitive development particularly sensitive to PAE in older children. Tests included the Differential Ability Scales, 2nd Edition (DAS-2) and several NEPSY/NEPSY-II subtests, standardized in the United States. Others were adapted from commonly used non-standardized neuropsychological measures of EF (Preschool Spatial Span, Imitation Hand Game, A not B, Delayed Attention, Subject Ordered Pointing). Children in two sites in Ukraine, Rivne and Khmelnitsky, were tested at 3 ½-4 ½ years to identify effects of PAE. Although most children performed within the average range, Alcohol-Exposed preschoolers had lower scores on DAS-II Summary Scores as well as on specific subtests. To evaluate the effects of alcohol dose during the pre-pregnancy recognition period and during mid-gestation of pregnancy, generalized linear regression models were used controlling for demographic and individual variables. In addition to DAS-II variables, measures reflecting sustained attention, working memory and ability to shift cognitive set were impacted by alcohol dose. Early executive function appears to subsume these performance differences. In conclusion, findings indicate that the effects of PAE can be identified in the preschool period and reliably measured using tests assessing nonverbal and spatial skills supported by executive functioning.

Hypertension and its Clinical Correlates in a Rural Community in South Western Nigeria.

BACKGROUND: Hypertension is the commonest cardiovascular risk factor globally and is a cause of untold morbidity and mortality. However, its clinical correlates at the community level have not been well elucidated. METHODS: History taking, anthropometric measurements, electrocardiograms and laboratory investigations were done for all the study subjects. Ethical approval was obtained from the institution's ethical body. Analysis was done using SPSS version 20. Two hundred people were recruited for the study. The prevalence of hypertension in the community was 58.5% with 31(15.5%) being newly diagnosed. The Body Mass Index [BMI] (28.2±6vs 25.6±5.3; P=0.003),Waist-Hip ratio (0.9±0.08 vs 0.86±0.06; p= 0.001), total cholesterol (5.675±1.8 vs 4.6±1.7, P=0.000), triglycerides (1.19±0.85 vs 0.91±0.59; p=0.019), LDL cholesterol (3.38±1.6 vs 2.66±1.5; p=0.002), heart rate (82.4±15.8 vs 76.8±11.2; p=0.018) QRS duration (84.8±13.4 vs 80.5±11.2; p=0.040), and QTc (0.423±0.041 vs 0.402±0.035; p=0.001) were higher in those with hypertension. NYHA functional class was worse in hypertensives (p=0.041). Prevalence of left ventricular hypertrophy (LVH) in hypertensives ranged from 2.6 to 48.2%, depending on the criteria used. Systolic blood pressure, pulse pressures, HDL levels and hip circumferences were higher in those with electrocardiographic LVH. Systolic blood pressure (OR:1.045, P=0.006; CI: 1.013-1.079) and a normal BMI (OR: 0.159, p= 0.004; CI: 0.045-0.559) were the independent predictors of LVH in this study. CONCLUSION: The prevalence of hypertension is rising, even in rural populations, with accompanying LVH, higher QTc and florid cardiovascular risk factors. It is therefore imperative to tighten the reins of control of blood pressure and other cardiovascular risk factors before the cardiovascular morbidity and mortality explode in the rural communities.

CONTEXTE: L'hypertension est le facteur de risque cardiovasculaire le plus courant dans le monde et est une cause de morbidité et de mortalité indicibles. Cependant, ses corrélats cliniques au niveau communautaire n'ont pas été bien élucidés. MÉTHODES: Des antécédents, des mesures anthropométriques, des électrocardiogrammes et des examens de laboratoire ont été effectués pour tous les sujets de l'étude. L'approbation éthique a été obtenue de l'organe déontologique de l'institution. L'analyse a été effectuée à l'aide de la version 20 de SPSS. Deux cents personnes ont été recrutées pour l'étude. La prévalence de l'hypertension dans la communauté était de 58,5%, 31 (15,5%) nouvellement diagnostiqués. L'indice de masse corporelle [IMC] (28,2 ± 6 vs 25,6 ± 5,3; P = 0,003), le rapport taille-hanches (0,9 ± 0,08 vs 0,86 ± 0,06; p = 0,001), le cholestérol total (5,675 ± 1,8 vs 4,6 ± 1,7, P = 0,000), triglycérides (1,19 ± 0,85 vs 0,91 ± 0,59; p = 0,019), cholestérol LDL (3,38 ± 1,6 vs 2,66 ± 1,5; p = 0,002), fréquence cardiaque (82,4 ± 15,8 vs 76,8 ± 11,2; p = 0,018) Durée du QRS (84,8 ± 13,4 vs 80,5 ± 11,2; p = 0,040) et l'intervalle QTc (0,423 ± 0,041 vs 0,402 ± 0,035; p = 0,001) étaient plus élevés chez les personnes souffrant d'hypertension. La classe fonctionnelle NYHA était pire chez les hypertendus (p = 0,041). La prévalence de l'hypertrophie ventriculaire gauche (LVH) chez les hypertendus variait de 2,6 à 48,2%, selon la critères utilisés. La pression artérielle systolique, les pressions de pouls, les taux de HDL et la circonférence de la hanche étaient plus élevés chez les personnes atteintes de LVH électrocardiographique. La pression artérielle systolique (OR: 1,045, P = 0,006; IC: 1,013­1,079) et un IMC normal (OR: 0,159, p = 0,004; IC: 0,045­0,559) étaient les prédicteurs indépendants de l'HGV dans cette étude. CONCLUSION: La prévalence de l'hypertension est en hausse, même dans les populations rurales, accompagnée de LVH, d'un QTc plus élevé et de facteurs de risque cardiovasculaires florissants. Il est donc impératif de resserrer les rênes du contrôle de la pression artérielle et des autres facteurs de risque cardiovasculaire avant que la morbidité et la mortalité cardiovasculaires n'explosent dans les communautés rurales. Mots clés: Hypertension, hypertrophie ventriculaire gauche, indice de masse corporelle, HDL.

Risk of Obstructive Sleep Apnoea among Adults in a Rural Community in Southwest Nigeria.

BACKGROUND: Obstructive sleep apnoea (OSA) is a common medical condition which has long been recognized as a major contributor to morbidity and mortality in developed countries but that remains underdiagnosed, particularly in rural communities. This study aimed to assess the prevalence of adults who have a high risk of obstructive sleep apnoea in a sample of adults living in Ejigbo, a rural community in south western Nigeria. METHODS: This was a community-based cross-sectional descriptive study done to assess the prevalence of high risk of obstructive sleep apnoea in adult residents of the community using the STOP-BANG questionnaire. Data collected include socio-demographic characteristics, anthropometric measurements and blood pressure. A blood sample was also taken for lipid profile. Factors associated with a high risk of obstructive sleep apnoea were identified. RESULTS: The study involved 257 participants out of which 88 (34.2%) had a high risk of OSA. Risk of obstructive sleep apnoea was significantly associated with male sex (p<0.001), age (p<0.001), body mass index (BMI) (p=0.001), neck circumference (p<0.001), cigarette smoking (p=0.039) and low density lipoprotein (p=0.043). CONCLUSION: Obstructive sleep apnoea is relatively common in the study area. This calls for urgent preventive measures to stem the tide and mitigate the associated morbidity and mortality.

Predialysis nephrology care amongst Palestinian hemodialysis patients and its impact on initial vascular access type.

Referral time for end-stage renal disease (ESRD) patients to nephrologists and initial vascular access method are considered significant factors that impact health outcomes at the time of hemodialysis (HD) initiation. Native arteriovenous fistula (AVF) is strongly recommended as initial access. However, little is known about the referral rate among ESRD receiving HD in Palestine and its correlation with AVF creation. In Ramallah Hemodialysis Center, we investigated the pre-dialysis nephrology care and AVF usage in 156 patients. Type of access at HD initiation was temporary central venous catheter (CVC) in 114 (73%), tunneled hemodialysis catheter (TDC) in 21 (13%) and AVF in 21 (13%). Out of all participants, 120 (77%) were seen by nephrologist prior to dialysis. Of the participants who initiated dialysis with a CVC, 36 (31%) had not received prior nephrology care. All participants who initiated dialysis with functional AVF had received prior nephrology care. Patients who were not seen by a nephrologist prior to HD initiation had no chance at starting HD with AVF, whereas 17% of those who had nephrology care >12 months started with AVF. In conclusion, a relatively large percentage of Palestinian HD patients who were maintained on HD did not have any predialysis nephrology care. In addition, patients who received predialysis nephrology care were significantly more likely to start their HD through AVF whereas all those without predialysis nephrology care started through CVC. More in-depth national studies focusing on improving nephrology referral in ESRD patients are needed to increase AVF utilization.

Mobile Phone Use in the Management of Diabetes in Nigeria: A New Potential Weapon.

Diabetes Mellitus (DM) is one of the leading chronic diseases in low- and middle-income countries globally including Nigeria The morbidities and mortalities associated with diabetes especially in Nigeria, have remained unacceptably high compared to many other nations. It has become one of the leading causes of stroke, blindness, heart attack and end-stage kidney disease. Most deaths occur in those below 60 years of age, the productive segments of the population. Health situation in Nigeria is characterised by double burden of illness, grossly inadequate health spending, and inadequate healthcare personnel especially in the rural areas. Shortage of diabetes care specialist is one of the major barriers to diabetes care in Nigeria. Mobile phone has emerged as one of the potent strategies that can impact positively on diabetes care if properly harnessed. The ubiquitous access and the multitasking nature of mobile phones are great opportunities to improve diabetes prevention, patient care, encourage self-management, support healthy behavioural changes and an ideal way of providing patient-centred care at the frequency and intensity that patient desires. In addition, there is a potential for mobile phones to provide an effective way of giving support to patients in rural and remote areas where health care provider contact may be less accessible. Use of short message services (SMS) phone calls, video calls and the use of social media networking applications are some of the ways a mobile phone can be used in diabetes management.

Perceived barriers and attitudes toward arteriovenous fistula creation and use in hemodialysis patients in Palestine.

In the dialysis center in Ramallah, we investigated the attitudes and perceived barriers to having arteriovenous fistula (AVF) in 156 patients. The current method of HD access was AVF in 52% and central venous catheter in 47%. Perceived causes of no or delayed AVF were: patient's refusal of AVF in 54.5%, late referral to a surgical evaluation in 31.3% and too long to surgical appointments in 14.2%. Among those who refused AVF, reasons were: concern about the surgical procedure in 42.5%, poor understanding of disease/access in 23.3%, fear of needles in 15.1%, denial of disease or need for HD in 17.8%, and cosmetic reasons in 1.4%. Forty six percent of patients believed they received education about AVF prior to the creation of HD access, and 73.7% would recommend AVF as the method of access due to the lower risk of infection (96%), easier to care for (16%), easier showering (14%), and better-associated hygiene (3%). In conclusion, the majority would recommend an AVF as the mode of vascular access for HD. The most common barrier to having an AVF was patient's refusal to undergo AVF creation because of their concern about the surgical procedure. A systematic evaluation of the process that precedes the creation of AVF may allow for better utilization.

Gestational age and socioeconomic status as mediators for the impact of prenatal alcohol exposure on development at 6 months.

BACKGROUND: Of the many negative outcomes associated with gestational alcohol use, one that has received relatively little attention is preterm birth and its possible contribution to effects of prenatal alcohol exposure (PAE) on development. To examine the increased risk for premature delivery associated with PAE and the joint influence of preterm birth and alcohol on child outcomes, analysis was carried out in a longitudinal cohort recruited in Western Ukraine. METHODS: Alcohol-using women and low or nondrinking controls were identified prenatally for a clinical trial of multivitamins and minerals (MVM) in ameliorating effects of PAE. Women were interviewed to provide information about medical and social status and other drug use. At delivery, information was collected about infant (N = 686) status including gestational age (GA) in weeks. Finally, 441 infants were followed to 6 months of age and cognitive (Mental Developmental Index [MDI]) and motor development (Psychomotor Developmental Index [PDI]) (measured using the Bayley Scales of Infant Development, second Ed (BSID-II). RESULTS: Seven percent infants were born at <37 weeks GA. The odds ratio for preterm delivery for Alcohol Exposed versus Low/No Alcohol was 2.6 (95% Confidence Interval 1.37, 4.94) (p < .003); MVM supplements were associated with a lower rate of preterm delivery overall, but the relative proportion of preterm births did not vary by MVM supplement status between alcohol exposure groups. In mediation models of 6 month cognitive and motor development with reference to Barron and Kenney in 1986, GA significantly mediated alcohol effects (MDI: Z = -2.64, p < .008; PDI: Z = -2.35, p < .02) although PAE independently affected both outcomes (MDI: t = -5.6, p < .000; PDI: t = -3.19, p < .002). CONCLUSION: Results suggest that PAE is associated with higher rates of preterm birth and that alcohol's effect on development in infancy may be both direct and mediated by shortened length of gestation.

Comparison of microleakage between bulk-fill flowable and nanofilled resin-based composites.

AIM: The objective was to compare the marginal leakage (silver nitrate uptake) of nanohybrid resin-based composite (RBC) and two bulk-fill flowable RBCs with specific clinical protocols. METHODS: Four experimental groups of RBC were investigated including conventional composite Filtek™ Supreme in 2 mm increment (FS2), Filtek™ Supreme in 4 mm increment (FS4), Filtek™ Supreme Flowable (BFF), and SureFil® SDR® flow (SDR). Class II box preparation (4 × 4 × 3 mm) in extracted intact human molars was carried out and restored using the experimental groups, all according to the manufacturers' recommendations except FS4. Samples were aged by thermocycling (2,000 cycles). Microleakage was calculated by measuring dye penetration in sectioned teeth using a stereomicroscope. Level of significance was set at P < 0.05. RESULTS: BFF and FS2 exhibited the least dye penetration and microleakage measurement with no significant difference between the two groups, followed by SDR. FS4 showed the highest microleakage with significant difference in comparison with BFF and FS2. Gingival microleakage was found to be significantly higher than occlusal microleakage. CONCLUSION: The microleakage of the bulk-fill composites BFF and SDR are comparable with conventional composite FS2; however, it is more predictable to use FS2.

The influence of different convergence angles and resin cements on the retention of zirconia copings.

PURPOSE: This in vitro study aimed to determine the ability of three resin cements to retain zirconia copings under two clinically simulated conditions. MATERIALS AND METHODS: Extracted human molars (72) were collected, cleaned, and divided into two groups. All teeth were prepared with a 15° total convergence angle for group 1 and a 30° total convergence angle for group 2, a flat occlusal surface, and approximately 4-mm axial length. Each group was divided by surface area into three subgroups (n = 12). All zirconia copings were abraded with 50-µm Al(2)O(3), then cemented using Panavia F 2.0 (PAN-1) (PAN-2) Rely X Unicem (RXU-1) (RXU-2), and Clearfil SA (CSA-1) (CSA-2). After cementation, the copings were thermocycled for 5000 cycles between 5°C and 55°C with a 15-second dwell time. Then the copings were subjected to dislodgment force in a universal testing machine at 0.5 mm/min. The force of removal was recorded, and the dislodgement stress was calculated. A Kruskal-Wallis test (nonparametric ANOVA) was used to analyze the data (α= 0.05), and the nature of failure was also recorded. RESULTS: The mean (SD) coping removal stresses (MPa) were as follows: PAN-1: 6.0 (1.3), CSA-1: 4.8 (1.4), RXU-1: 5.5 (2.3), PAN-2: 2.8 (1.1), CSA-2: 3.0 (1.25), and RXU-2: 2.6 (1.2). The Kruskal-Wallis test was significant. Mann-Whitney pairwise comparisons of the subgroups were significant (p < 0.05) for the comparisons between subgroups of group 1 and group 2. Mode of failure was mixed, with cement remaining principally on the tooth for PAN. For CSA and RXU, mode of failure was mixed with cement remaining principally on the zirconia copings. CONCLUSIONS: Retention values of zirconia copings with three different resin cements were not significantly different. Retention of zirconia copings cemented on the teeth with adequate resistance and retention form was higher than that cemented on teeth lacking these forms. The cement remained mostly on the tooth with the adhesive resin cement with a dentin bonding system. The cement remained mostly on the coping with the self-adhesive resin cement.