Prevalence of Kidney Dysfunction and Associated Risk Factors in a Southwestern City in Nigeria: A Cross-Sectional Study.

BACKGROUND: The burden of chronic kidney disease (CKD) is huge, especially in countries such as Nigeria where majority of patients succumb to the disease early due to inability to afford care. Early diagnosis through regular screening of at-risk population is pivotal to stemming the scourge of the disease. AIM: To determine the prevalence of kidney dysfunction and associated risk factors in a community screening program. METHODS: This cross-sectional study assessed kidney dysfunction and associated risk factors among adults in Ondo City, Nigeria. Information about socio-demographic characteristics and some risk factors for kidney dysfunction was sought. Blood pressure, weight and height were measured. Blood samples were collected for random blood glucose check and serum creatinine while urine sample was collected for urinalysis. Kidney dysfunction was defined by estimated glomerular filtration rate (eGFR) below 60mls/min/1.73m2. Prevalence of kidney dysfunction and associated factors were determined. P value<0.05 was taken as significant. RESULTS: There were 410 participants with a mean age of 58.96±13.78 years. Majority (75.1%) were female. One hundred and forty-seven (35.9%) participants had kidney dysfunction. Identified risk factors for kidney dysfunction were hypertension (72.7%), diabetes mellitus (18.0%), alcohol intake (13.2%), tobacco smoking (2%), analgesic use (82.7%), use of herbal preparations (81.7%), proteinuria (6.1%), overweight (27.8%), generalized obesity (28.5%), and central obesity (33.9%). Significant factors associated with kidney dysfunction were older age (p=<0.001), lower level of education (p=<0.001), and being hypertensive (p=0.019). On binary logistic regression, older age (AOR: 9.14; CI: 3.68-22.7; p=<0.001) was the only significant factor associated with kidney dysfunction. CONCLUSION: The prevalence of kidney dysfunction and that of associated risk factors were relatively high in the screened population. Regular assessment of kidney function should be done in those with higher risk of kidney dysfunction, especially older patients with hypertension.

CONTEXTE: Le fardeau de la maladie rénale chronique (MRC) est énorme, en particulier dans des pays tels que le Nigeria, où la majorité des patients succombent à la maladie tôt en raison de l'incapacité à se permettre des soins. Le diagnostic précoce par le dépistage régulier des populations à risque est crucial pour endiguer le fléau de la maladie. OBJECTIF: Déterminer la prévalence de la dysfonction rénale et des facteurs de risque associés dans le cadre d'un programme de dépistage communautaire. MÉTHODES: Cette étude transversale a évalué la dysfonction rénale et les facteurs de risque associés chez des adultes à Ondo City, au Nigéria. Des informations sur les caractéristiques sociodémographiques et certains facteurs de risque de dysfonction rénale ont été recueillies. La pression artérielle, le poids et la taille ont été mesurés. Un échantillon de sang a été prélevé pour vérifier la glycémie aléatoire et la créatinine sérique, tandis qu'un échantillon d'urine a été collecté pour une analyse d'urine. La dysfonction rénale a été définie par un taux de filtration glomérulaire estimé (TFGe) inférieur à 60 ml/min/1,73 m2. La prévalence de la dysfonction rénale et des facteurs associés a été déterminée. Une valeur de p<0,05 a été considérée comme significative. RÉSULTATS: Il y avait 410 participants avec un âge moyen de 58,96 ± 13,78 ans. La majorité (75,1 %) étaient des femmes. Cent quarante-sept (35,9 %) participants avaient une dysfonction rénale. Les facteurs de risque identifiés pour la dysfonction rénale étaient l'hypertension (72,7 %), le diabète sucré (18,0 %), la consommation d'alcool (13,2 %), le tabagisme (2 %), l'utilisation d'analgésiques (82,7 %), l'utilisation d'herbes médicinales (81,7 %), la protéinurie (6,1 %), le surpoids (27,8 %), l'obésité générale (28,5 %) et l'obésité centrale (33,9 %). Les facteurs significativement associés à la dysfonction rénale étaient l'âge plus avancé (p=<0,001), un niveau d'éducation plus bas (p=<0,001) et l'hypertension (p=0,019). Dans la régression logistique binaire, le seul facteur significatif associé à la dysfonction rénale était l'âge plus avancé (RA : 9,14 ; IC : 3,68-22,7 ; p=<0,001). CONCLUSION: La prévalence de la dysfonction rénale et des facteurs de risque associés était relativement élevée dans la population examinée. Une évaluation régulière de la fonction rénale devrait être réalisée chez ceux présentant un risque élevé de dysfonction rénale, en particulier chez les patients plus âgés souffrant d'hypertension. MOTS-CLÉS: Filtration glomérulaire réduite; Dysfonction rénale; Facteur de risque ; Dépistage communautaire.

Knowledge of the national health act among physicians in two tertiary hospitals in Southern Nigeria

Objective: Knowledge of provisions of the National Health Act among physicians and stakeholders is pivotal to its successful implementation. This study aimed to assess the knowledge of the National Health Act (NHA) among Physicians in two tertiary hospitals in Nigeria. Methods: This was a cross-sectional study conducted in two tertiary hospitals in Southern Nigeria. The consecutively recruited eligible respondents were assessed for knowledge of NHA using a 24-item self administered close-ended structured questionnaire. The total obtainable score was 26. Those with <13 points had poor knowledge, 13-21 points had good knowledge and >21 points had excellent knowledge. Data were analyzed using SPSS version 21 software. P-value of < 0.05 was taken as significant. Results: One hundred and ninety-five doctors with a male: female ratio of 1.9:1 participated in the study. The majority (91.8%) were ≤40 years and 129(66.2%) of the participants were ≤ 10 years post qualification. The frequency of correctly answered questions ranged between 7.7% - 89.2%. According to overall knowledge scores; 64.6% had poor knowledge; 35.4% had good knowledge and none had excellent scores. There was no statistically significant association between knowledge of NHA and gender, age, and number of years post qualification (p > 0.05). Conclusion: This study showed that only about a third of the participants had good knowledge of key provisions of the NHA. We strongly recommend that relevant sections of the Act should be incorporated into the medical curriculum both at the undergraduate and postgraduate levels.

Histopathology of Brugia pahangi and Plasmodium berghei ANKA co-infection in the Gerbil (Meriones unguiculatus).

Co-infection with multiple different parasites is a common phenomenon in both human and animals. Among parasites that frequently co-infect the same hosts, are the filarial worms and malaria parasites. Despite this, the mechanisms underlying the interactions between these parasites is still relatively unexplored with very few studies available on the resulting pathologies due to co-infection by filarial nematodes and malaria parasites. Hence, this study investigated the histopathological effect of Brugia pahangi and Plasmodium berghei ANKA (PbA) infections in gerbil host. Gerbils grouped into B. pahangi-infected, PbA-infected, B. pahangi and PbA-coinfected, and uninfected control, were necropsied at different time points of post PbA infections. Brugia pahangi infections in the gerbils were first initiated by subcutaneous inoculation of 50 infective larvae, while PbA infections were done by intraperitoneal injection of 106 parasitized red blood cells after 70 days patent period of B. pahangi. Organs such as the lungs, kidneys, spleen, heart and liver were harvested aseptically at the point of necropsy. There was significant hepatosplenomegaly observed in both PbA-infected only and coinfected gerbils. The spleen, liver and lungs were heavily pigmented. Both B. pahangi and PbA infections (mono and coinfections) resulted in pulmonary edema, while glomerulonephritis was associated with PbA infections. The presence of both parasites induced extramedullary hematopoiesis in the spleen and liver. These findings suggest that the pathologies associated with coinfected gerbils were synergistically induced by both B. pahangi and PbA infections.

Histopathology of Brugia pahangi and Plasmodium berghei ANKA co-infection in the Gerbil (Meriones unguiculatus)

@#Co-infection with multiple different parasites is a common phenomenon in both human and animals. Among parasites that frequently co-infect the same hosts, are the filarial worms and malaria parasites. Despite this, the mechanisms underlying the interactions between these parasites is still relatively unexplored with very few studies available on the resulting pathologies due to co-infection by filarial nematodes and malaria parasites. Hence, this study investigated the histopathological effect of Brugia pahangi and Plasmodium berghei ANKA (PbA) infections in gerbil host. Gerbils grouped into B. pahangi-infected, PbA-infected, B. pahangi and PbA-coinfected, and uninfected control, were necropsied at different time points of post PbA infections. Brugia pahangi infections in the gerbils were first initiated by subcutaneous inoculation of 50 infective larvae, while PbA infections were done by intraperitoneal injection of 106 parasitized red blood cells after 70 days patent period of B. pahangi. Organs such as the lungs, kidneys, spleen, heart and liver were harvested aseptically at the point of necropsy. There was significant hepatosplenomegaly observed in both PbA-infected only and coinfected gerbils. The spleen, liver and lungs were heavily pigmented. Both B. pahangi and PbA infections (mono and coinfections) resulted in pulmonary edema, while glomerulonephritis was associated with PbA infections. The presence of both parasites induced extramedullary hematopoiesis in the spleen and liver. These findings suggest that the pathologies associated with coinfected gerbils were synergistically induced by both B. pahangi and PbA infections.

Observation levels in acute psychiatric admissions.

It was our objective to compare the influence of patients' variables and circumstances of admission on the use of observation levels in acute psychiatric admissions in a British mental health unit. We performed a prospective case note survey of all acute psychiatric admissions during 28 consecutive days in June and July 1991 within a large teaching hospital and a traditional psychiatric hospital in Nottingham, England. We compared, the demographic characteristics of 88 consecutive admissions, admission procedures, clinical data, initial observation levels and changes in observation levels. As for the results, most patients were admitted outside of regular working hours (weekends or after 5 p.m.). Most patients were placed on intermediate (close) observation. The most important factor associated with the choice of observation level was the legal status of the patient (chi2 = 14.79, df = 2, p < 0.001, Fisher's exact test p < 0.0001). There were significantly fewer incidents (chi2 = 7.72, df= 2, p < 0.05, Fisher's exact test p < 0.01) on the highest (special) category of observation. The observation policy of the unit was not followed consistently. The number of factors contributing to the choice of observation levels reflects the complexity of the task facing the staff. Special observation is an effective method of managing acutely disturbed patients. The time of admission of most patients implies that more trained staff should be provided outside of regular hours. Clinical staff should be regularly trained in the use of observation procedures. It should be a regular topic in clinical audit.

Clinical associations of lymphopenia in elderly persons admitted to acute medical and psychiatric wards.

Lymphopenia is a common finding in old people admitted to medical and psychiatric wards. We describe a pilot study of the clinical associations, and prognostic significance of lymphopenia in elderly persons admitted to acute medical and psychiatric wards. Consecutive patients admitted to acute medical and psychiatric wards were prospectively selected according to initial peripheral lymphocyte count (PLC) into lymphopenic (PLC < 1.0 X 10(9)/litre, n = 41), and non-lymphopenic (PLC > 1.5 x 10(9)/litre, n = 23). Results of routine haematological and biochemical investigations were recorded, as well as drug history and medical diagnoses. Anthropometric measurements, assessment of functional ability (Barthel ADL Index), and cognitive function (Mini-Mental State Examination) were then performed by investigators blind to lymphocyte status. Patients were contacted between 3 and 6 months following recruitment into the study. Lymphopenia was associated with functional ability as measured by a lower Barthel score (p = 0.004), and cognitive impairment as measured by the Mini-Mental State Examination (p = 0.02). No association was found with medical diagnostic groupings, drugs known to cause lymphopenia, nutritional status, or survival. Lymphopenia may be a significant marker of vulnerability, and a larger study is required to elucidate the veracity and mechanisms of lymphopenia-associated debility.