Gender disparity in risk factors for chronic kidney disease in a rural community in Southern Nigeria

Background: The evidence for gender disparity in prevalence of CKD is conflicting; while some studies report male preponderance, others have report female preponderance or no difference. Reasons for gender disparities in CKD prevalence may be related to differences in the occurrence of risk factors across the gender, amongst other factors. This study was to determine gender disparities in the risk factors for CKD. Method: This study is based on data from a community based cross-sectional study carried out in Ogbona, a rural community in Southern Nigeria. The WHO STEPS for surveillance of chronic diseases risk factors and chronic disease-specific morbidity and mortality questionnaire was adapted for this study. Four hundred and seventy-six participants were selected from 142 housing units in the community using multi-stage cluster sampling. Clinical examinations and laboratory investigations including serum creatinine, and urinalysis were performed. Results: Majority of participants were females (66.2%). CKD was commoner in females compared to males (14.3% vs. 12.7%, P= 0.06). More females than males had high body fat percentages (65.7% vs. 40.9%, P=<0.0001), high waist-hip ratio (99.7% vs 73.3%, P=<0.0001) and central obesity (43.1% and 4.3% P=<0.0001). More males compared to females used alcohol (56% vs. 9.2%, P=<0.0001), were overweight (42.2% vs 28.9%, P=0.004), and had proteinuria (6.2% vs 2.5%, P=0.054). The odds of females having central obesity are 16.7 times the odds of males having central obesity; similarly, the odds of females having high BF are 2.7 times the odds of males having high BF. Females had 122-fold the odds of men having high WHR. The odds of drinking alcohol are 92% less compared to males. There were no statistically significant gender differences regarding hypertension, diabetes mellitus, and use of nephrotoxins (NSAIDS, skin lightening agents, herbal medications). No female smoked cigarettes. Conclusion: This study shows that there is no statistically significant gender difference as regards prevalence of CKD, however several risk factors of CKD show gender disparity. The odds for central obesity, high WHR, high body fat percentages are significantly greater in females; while smoking, alcohol use, and over weightness, are commoner in males. There were no statistically significant gender differences regarding hypertension, diabetes mellitus, and use of nephrotoxins (NSAIDS, skin lightening agents, herbal medications)

ESTIMATED GLOMERULAR FILTRATION RATE AND RISK OF SURVIVAL IN ACUTE STROKE.

OBJECTIVE: To assess the risk of survival in acute stroke using the MDRD equation derived estimated glomerular filtration rate. DESIGN: A prospective observational cross-sectional study. SETTING: Medical wards of a tertiary care hospital. SUBJECTS: Eighty three acute stroke patients had GFR calculated within 48 hours of admission after basic data were captured. OUTCOME MEASURES: Stroke outcome was defined as either discharged or still-in-care (survived) or all cause in-hospital death. GFR was estimated by the MDRD equation, stroke severity was assessed by the Canadian Neurological Scale (CNS). Data were compared between the GFR groups of < 60 ml/min and ≥ 60 ml/min. Relative risks (RR) and odds ratios (OR) for stroke outcomes (survival and death) were estimated between the GFR groups and the homogeneity of the odds ratios among the different layers of stroke severity (CNS < 6.5 and ≥ 6.5) was determined by Breslow-Day and Tarone's test. Matanel Hazensel and Cochran's tests were used to determine conditional independence and the common odds ratio with stroke severity as a layering variable. RESULTS: No significant differences were found between the age and sex distribution of the two GFR groups. Serum urea and creatinine and CNS were significantly different between the GFR groups (p < 0.001, < 0.001, < 0.001). RR of survival and death for the GFR groups-less than 60 ml/min and above or equal to 60 ml/min were (0.425 and 1.204) and (2.360 and 0.830). The OR of survival for GFR below 60 ml/min compared to GFR above or equal to 60 ml/min was 0.353. There was homogeneity across the two layers of stroke severity (CNS score less than 6.5 and above or equal to 6.5), p = 0.612 and 0.612. CONCLUSION: Independent of stroke severity, GFR is a surrogate in the assessment of the risk of survival in acute stroke.

Analgesic, anti-inflammatory and antipyretic effects of the ethanol extract of Acalypha wilkesiana leaves in rats.

The leaves of Acalypha wilkesiana are commonly used for the treatment of pain, fever and ulcer by traditional medical practitioners without any scientific data to evaluate the appropriateness of some of the practices. Therefore, this study was carried out to determine whether the ethanol extract of Acalypha wilkesiana has analgesic, anti-inflammatory and antipyretic as well as anti-ulcer effects. The hot plate latency assay and formalin- induced paw licking models were used to evaluate analgesic effects. Animals were divided into groups comprising of five rats each. There were control (administered saline) and reference (administered indomethacin) groups. Also there were three extract groups administered 25, 50 or 100 mg/Kg body weight of extracts. Ulcer was induced using absolute ethanol followed by pylorus ligation in all animals; inflammation was induced using carrageenan while pyrexia was induced by injecting brewer's yeast intramuscularly into the dorsal part of the abdominal cavities of the rats. Different sets of rats were used for the anti-ulcer, anti-inflammatory and antipyretic studies although animal grouping for extract administration were as in analgesic studies. The results show that the extract produced dose-dependent and significant (p<0.05) analgesic and anti-inflammatory activities. The extract also significantly protected against ethanol induced ulcer. Likewise, the extract significantly (p<0.05) reduced the pyretic states of the animals. This study has therefore further provides evidences that may support the ethnomedicinal uses of the ethanolic extracts of Acalypha wilkesiana leaves.