Acute Kidney Injury after First Dose of AstraZeneca COVID-19 Vaccine Managed in a Nigerian Hospital.

INTRODUCTION: The association of kidney disease and COVID-19 vaccination has been reported with minimal change disease being a common presentation. CASE REPORT: Index patient is a 54-year-old female who presented with a history of reduction in urine output within 3 weeks of receiving the Oxford-AztraZeneca COVID-19 vaccine. Her serum creatinine on admission was 1,057 µmol/L with a premorbid serum creatinine of 78 µmol/L. Her vital signs were stable. She was on antihypertensive and antidiabetic medications for hypertension and diabetes mellitus, respectively. Renal biopsy was precluded by her morbid obesity and she was commenced on oral prednisolone. She had 5 sessions of hemodialysis and her serum creatinine gradually reduced to 106 µmol/L, and she is being followed up on an outpatient basis. CONCLUSION: We report a case of a female patient with acute kidney injury following COVID-19 Oxford-AztraZeneca vaccination. Further studies are required to better understand the pathogenesis of the renal affectation post-vaccination.

INTRODUCTION: L'association de la maladie rénale et de la vaccination COVID-19 a été signalée, la maladie à changement minimal est une présentation courante. RAPPORT DE CAS: La patiente à l'étude est une femme de 54 ans qui a présenté des antécédents de réduction du débit urinaire dans les 3 semaines après avoir reçu le vaccin COVID-19 d'Oxford-AztraZeneca. Sa créatinine sérique à l'admission était de 1 057 µmol/L avec une créatinine sérique prémorbide de 78 µmol/L. Ses signes vitaux étaient stables. Elle prenait des médicaments antihypertenseurs et antidiabétiques pour l'hypertension et le diabète sucré, respectivement. Une biopsie rénale était impossible à cause de son obésité morbide et elle a été mise sous prednisolone par voie orale. Elle a subi 5 sessions d'hémodialyse et son taux de créatinine sérique a progressivement à 106 µmol/L, et elle est suivie en ambulatoire. CONCLUSION: Nous rapportons le cas d'une patiente souffrant d'une lésion rénale aiguë après la vaccination par le COVID-19 Oxford-AztraZeneca. D'autres études sont nécessaires pour mieux comprendre la pathogenèse de l'affectation rénale post-vaccination. Mots-clés: Vaccin COVID-19, Événement Indésirable, Lésion Rénale Aiguë.

Psychological distress and health-related quality of life among stable patients with bronchiectasis.

BACKGROUND: Bronchiectasis is characterized by chronic symptoms and impaired physical activity. Anxiety and depression usually complicate chronic illness. Thus, underdiagnosis of psychological distress in bronchiectasis may lead to increased morbidity and mortality. AIMS: The aim of this study is to evaluate the impact of physical illness on psychological distress and its association with health-related quality of life (HRQOL). SUBJECTS AND METHODS: This is a cross-sectional study of adults with bronchiectasis. Patients completed a study questionnaire, the hospital anxiety and depression scale and the World Health Organization quality of life brief (WHOQOL-BREF) questionnaire. Physical examination was conducted on all participants. RESULTS: 103 patients were recruited for this study: 54 males (52.4%) and 49 females (47.6%). The average age of the patients was 49.12 ± 14.37 years. The most common predisposing factor for bronchiectasis amongst the patients was previous pulmonary tuberculosis (51 patients, 49.5%). Chronic productive cough, which was reported by 98 of the subjects (95.15%), was the most common symptom. 89 subjects (86.41%) reported episodes of shortness of breath, 82 (79.61%) reported at least one episode of exacerbation, while 52 subjects (50.49%) were hospitalized for bronchiectasis in the previous 12 months. 23 subjects (22.3%) had anxiety and 32 (31.1%) had depression. Anxiety and depression were significantly associated with indicators of severe disease. The subjects recorded low HRQOL scores across all domains. Psychological distress displayed a significant negative association with all the quality-of-life domains except between anxiety and social interaction. CONCLUSION: Symptoms of depression and anxiety are common among patients with bronchiectasis and these symptoms have a negative impact on HRQOL.

Etiology and Clinical Evaluation of Patients with Bronchiectasis in a Tertiary Hospital in Nigeria.

BACKGROUND: Bronchiectasis is often considered an orphan disease in developed societies. This may not be the case with low-income countries. Currently there is a paucity of data on the pattern and presentation of this condition in Nigeria. OBJECTIVE: This study was undertaken to determine the frequency and pattern of presentation of bronchiectasis in a tertiary healthcare facility in Uyo, South-South, Nigeria. METHODS: We carried out a three-year prospective study of adult patients aged between 15-85 years diagnosed with bronchiectasis in the University of Uyo Teaching Hospital in Uyo, Nigeria between 2016 and 2019. RESULTS: Eighty-two patients were identified from the clinic register. Out of these, 76 were recruited into the study; made up of 44(57.9%) males and 32 (42.1%) females. The average age of the patients was 49.7 ± 14.1 years. Sixteen (21.1%) of the patients were HIV positive. Forty-four (57.9%) patients had previously been treated for pulmonary tuberculosis. Majority of the patients; 72 (94.7%) had chronic productive cough. Sixty-four (84.2%) had at least one episode of exacerbation within the last 12 months while 36(47.4%) had a severe exacerbation requiring hospitalisation. Hospitalisation was associated with several factors with the strongest contributor being the presence of respiratory distress on physical examination (OR 15.4 p= 0.002). CONCLUSION: Bronchiectasis is not an uncommon disease amongst our patients. A previous history of pulmonary tuberculosis is the commonest associated predisposing medical condition. There is a high rate of exacerbation among these patients with respiratory distress as the strongest predictor of hospitalisation.

CONTEXTE: La bronchectasie est souvent considérée comme une maladie orpheline dans les sociétés développées.Ce n'est peut-être pas le cas dans pays à faible revenu. Actuellement, il y a une pénurie de données sur les caractéristiques et la présentation de cette maladie au Nigeria. OBJECTIF: Cette étude a été entreprise pour déterminer la fréquence et le mode de présentation de la bronchectasie dans un établissement de soins tertiaires à Uyo, dans le sud-sud du Nigeria. MÉTHODES: Nous avons mené une étude prospective sur trois ans auprès de patients adultes âgés de 15 à 85 ans chez qui on a diagnostiqué une bronchectasie dans l'hôpital universitaire d'Uyo, à Uyo, entre 2016 et 2019. Uyo, au Nigeria, entre 2016 et 2019. RÉSULTATS: Quatre-vingt-deux patients ont été identifiés à partir du registre de la clinique registre. Parmi ceux-ci, 76 ont été recrutés dans l'étude ; composés de 44 (57,9 %) hommes et 32 (42,1 %) femmes. L'âge moyen des patients était de 49,7 ± 14,1 ans. Seize (21,1 %) des patients étaient séropositifs. Quarante-quatre (57,9 %) patients avaient déjà été traités pour une tuberculose pulmonaire.La majorité des patients ; 72 (94,7%) avaient une toux productive chronique. Soixante-quatre (84,2 %) ont eu au moins un épisode d'exacerbation au cours des 12 derniers mois, tandis que 36 (47,4 %) ont eu une exacerbation sévère nécessitant une hospitalisation. L'hospitalisation était associée à plusieurs facteurs, le facteur le plus important étant la présence d'une présence d'une détresse respiratoire à l'examen physique (OR 15.4 p= 0.002). CONCLUSION: La bronchectasie n'est pas une maladie rare parmi nos patients. Un antécédent de tuberculose pulmonaire est l'état médical prédisposant le plus fréquent.ll existe un taux élevé d'exacerbation chez ces patients, la détresse respiratoire étant le facteur prédictif le plus fort d'hospitalisation. MOTS CLÉS: Étiologie, Caractéristiques cliniques, Bronchiectasie, Exacerbation, Hospitalisation.

Protective role of Allium cepa Linn (onion) juice on maternal dexamethasone induced alterations in reproductive functions of female offspring of Wistar rats.

Maternal treatment with dexamethasone induces oxidative stress in the reproductive structures of offspring. Consumption of Allium cepa Linn improves antioxidant status. This study was designed to evaluate the protective role of Allium cepa Linn juice on maternal dexamethasone induced alterations in reproductive functions of the female offspring of Wistar rats. Twenty lactating dams (180-200 â€‹g) were randomly assigned into four groups (n â€‹= â€‹5) on the day of parturition and treated as follows during lactation for 21 days: Control (5 â€‹ml/kg BW distilled water); Dexamethasone (60 â€‹µg/kg BW); Allium cepa (5 â€‹ml/kg BW); Dexamethasone â€‹+ â€‹Allium cepa (60 â€‹µg/kg BW â€‹+ â€‹5 â€‹ml/kg BW). The female offspring were separated at birth. Days of vaginal opening and first oestrus cycle, length and frequency of estrous cycle as well as serum hormonal profiles were assessed as measure of reproductive functions. Ovarian superoxide dismutase (SOD) activity, catalase activity and malondialdehyde (MDA) level were measured as indices of oxidative stress. Oestrous cycle length, frequencies of diestrus as well as the Ovarian MDA were significantly increased (p â€‹< â€‹0.05) in dexamethasone (DEX) group relative to control group. Serum 17ß-oestradiol and corticosterone level in addition to SOD and catalase activities were significantly reduced (p â€‹< â€‹0.05) in DEX group relative to control. Co-administration of Dex with Allium cepa Linn juice reduced the oestrous length, frequency of diestrous as well as ovarian MDA. There was also a significant increase in serum 17ß-oestradiol, ovarian SOD and catalase activity. The results suggest that Allium cepa could protect against alterations in reproductive functions of offspring induced by maternal treatment with dexamethasone during lactation in Wistar rats. The flavonoid constituent of onion may also help in reducing oxidative stress in the offspring.

Comparability of serum creatinine-Based glomerular filtration rate equations in West African adult communities.

BACKGROUND: The clinical diagnosis of chronic kidney disease (CKD) is based on estimated glomerular filtration rate (GFR) using serum creatinine-based equations. Many formulas are used in estimating GFR. OBJECTIVES: We set out to determine the degree of agreement between the Cockcroft-Gault (CG), 4-variable Modification of diet in renal disease (MDRD). Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in our indigenous population. PATIENTS AND METHODS: Adult participants were recruited across all sectors of life, education, and occupation. Blood pressure, fasting blood glucose, lipid profile, urinalysis, serum creatinine, and anthropometry were measured. Estimated GFR (eGFR) was computed using CG, MDRD, and CKD-EPI equations with and without the race factor. The Lin's concordance index (rho_c) and Bland-Altman analysis were used to determine the degree of agreement between various pairs of creatinine-based eGFR equations [MDRD with the race factor (MDRDw)]; MDRD without the race factor (MDRD); CKD-EPI with race factor (CKD-EPIw); CKD-EPI without the race factor (CKD-EPI), and the CG equation. RESULTS: Two hundred and sixty-one adults, mean age 47.5 ± 9.9 years, 45.2% females participated in the study. Hypertension prevalence in the study population was 41.4 (95% CI 35.3-47.6%) while diabetes mellitus was 8.1% (95% CI 5.0-12.0%). The proportion of individuals with eGFRCKD-EPI less than 60 ml/min/1.73 m2 was 17.6 (95% CI 13.2-22.8%). All pairs of rho_c were lower than the threshold of 0.9 except for eGFRCKD-EPI versus eGFRCKD-EPw. CONCLUSION: There is significant discordance in the eGFR obtained from the various serum creatinine-based GFR equations in our population suggesting the need to validate these equations and determine the best equation for our general population.

Clinical Utility of Urinary ß2-Microglobulin in Detection of Early Nephropathy in African Diabetes Mellitus Patients.

Background. Studies have indicated that diabetic tubulopathy may occur earlier than glomerulopathy, therefore providing a potential avenue for earlier diagnosis of diabetic nephropathy. Urinary beta-2-microglobulin (ß2m) was investigated in this study as a potential biomarker in the detection of early nephropathy in type 2 diabetics. Methods. One hundred and two diabetic subjects and 103 controls that met the inclusion criteria had data (sociodemographic, medical history, physical examination, and laboratory) collected. Urinary ß2m levels and urinary albumin concentration (UAC) were determined. Results. Elevated urinary ß2m was more frequent among the diabetics (52%, 95% CI: 42.1-61.8%) than among the controls (32%, 95% CI: 22.9-41.2%). The frequency of microalbuminuria was higher in the diabetics (35.3%, 95% CI: 25.9-44.7%) than in the controls (15.5%, 95% CI: 8.4-22.6%). There was a positive correlation between urinary ß2m and UAC (rho = 0.38, p < 0.001). Multivariate analysis showed BMI (OR: 1.23, 95% CI: 1.05-1.45), eGFR (OR: 0.97, 95% CI: 0.94-0.99), and presence of microalbuminuria (OR: 3.94, 95% CI: 1.32-11.77) as independent predictors of elevated urinary beta-2-microglobulin among the diabetics. Conclusion. Urinary ß2m may be useful, either as a single test or as a component of a panel of tests, in the early detection of diabetic nephropathy.

Ectopic thoracic kidney and end-stage renal disease in a 38-year-old nigerian.

This patient is a 38-year-old housewife who presented with a one-month history of difficulty, in breathing, chest pain and bilateral leg swelling and had a blood pressure of 260/150 mmHg, features of malignant hypertension and hypertensive heart disease. Chest CT scan revealed a chest location of the left kidney. She also had elevated serum urea and creatinine and proteinuria (++). The right kidney was normally located with loss of corticomedullary differentiation. She is on maintenance haemodialysis and is being worked up for possible left nephrectomy.

Urban city transportation mode and respiratory health effect of air pollution: a cross-sectional study among transit and non-transit workers in Nigeria.

OBJECTIVES: To assess the respiratory health effect of city ambient air pollutants on transit and non-transit workers and compare such effects by transportation mode, occupational exposure and sociodemographic characteristics of participants. DESIGN: Cross-sectional, randomised survey. SETTING: A two primary healthcare centre survey in 2009/2010 in Uyo metropolis, South-South Nigeria. PARTICIPANTS: Of the 245 male participants recruited, 168 (50 taxi drivers, 60 motorcyclists and 58 civil servants) met the inclusion criteria. These include age 18-35 years, a male transit worker or civil servant who had worked within Uyo metropolis for at least a year prior to the study, and had no history of respiratory disorders/impairment or any other debilitating illness. MAIN OUTCOME MEASURE: The adjusted ORs for respiratory function impairment (force vital capacity (FVC) and/or FEV(1)<80% predicted or FEV(1)/FVC<70% predicted) using Global Initiative for Chronic Obstructive Lung Diseases (GOLD) and National Institute for Health and Clinical Excellence (NICE) criteria were calculated. In order to investigate specific occupation-dependent respiratory function impairment, a comparison was made between the ORs for respiratory impairment in the three occupations. Adjustments were made for some demographic variables such as age, BMI, area of residence, etc. RESULTS: Exposure to ambient air pollution by occupation and transportation mode was independently associated with respiratory functions impairment and incident respiratory symptoms among participants. Motorcyclists had the highest effect, with adjusted OR 3.10, 95% CI 0.402 to 16.207 for FVC<80% predicted and OR 1.71, 95% CI 0.61 to 4.76 for FEV(1)/FVC<70% predicted using GOLD and NICE criteria. In addition, uneducated, currently smoking transit workers who had worked for more than 1 year, with three trips per day and more than 1 h transit time per trip were significantly associated with higher odds for respiratory function impairment at p<0.001, respectively. CONCLUSIONS: Findings of this study lend weights to the existing literature on the adverse respiratory health effect of ambient air pollution on city transit workers globally. The role of other confounders acting synergistically to cause a more deleterious effect is obvious. In all, the effect depends on the mode and duration of exposure.