Eight year review of hemodialysis: treated patients in a tertiary center in Southern Nigeria.

BACKGROUND: Hemodialysis (HD) is the readily available modality of renal replacement therapy in Nigeria today. The number of centers for HD continues to increase, but the majority is still located in the big cities and towns. METHODS: A retrospective descriptive study in which records of patients on HD from 2004 to 2011 were reviewed. Data in respect of patients' sex, age, occupation and etiology of kidney disease were collected. Data were analyzed using Statistical Package for the Social Sciences statistical software version 16 (SPSS Inc, Chicago IL). RESULTS: A total of 1278 new patients were admitted for HD over the period of review; 60.9% (778) were males and 39.1% (500) females. Mean age of male patients was significantly higher than that of the females (P < 0.01). Those under the age of 40 years constituted 45.4% (580) of the study population, whereas 43.8% (560) were unskilled workers. Nearly 81.1% had CKD while 18.9% (241) had acute kidney injury (AKI). The most common cause of CKD and AKI were chronic glomerulonephritis (CGN) and sepsis respectively. CONCLUSION: This review showed a preponderance of males in the dialyzed population with males significantly older than the female patients. Patients aged ≤ 40 years and unskilled workers formed a large proportion of the population of HD treated patients. CGN and sepsis were the most common causes of CKD and AKI respectively.

Renal sonographic parameters in human immunodeficiency virus - infected subjects and relationship to CD4 cell count.

Nephropathy in human immunodeficiency virus (HIV)-infected patient is common and constitutes a major cause of endstage kidney disease. CD4 cell count is a useful parameter in the assessment of the degree of immunosuppression among HIV-infected patients. Manifestations of renal disease are thought to be more profound when CD4 cell counts are low. Sonography is a safe and inexpensive method of evaluating renal disease, including renal sizes and degree of echogenicity. Ultrasound examination was carried out prospectively at the University of Benin Teaching Hospital on 120 HIV-infected patients comprising 45 males (37.5%) and 75 females (63.5%). Renal sizes and degree of echogenicity were assessed. Correlation with CD4 + cell counts of the patients was done. Mean CD4 cell count mean was 18.34 ± 142.18 cells/mm 3 with female patients having a significantly higher cell count compared with males. Seventy-four patients (63.8%) had a cell count of <200 cells/mm 3 . Renal sizes were normal in 85%, small in 7%, and large in 8% of patients. Fifty patients (41.7%) had increased renal echogenicity and 8 (6.7%) had severe increased echo-texture. CD4 cell count did not correlate with renal sizes and echotexture. Results of this study show that large kidneys and marked increase in renal echotexture were not common even in a population of patients where the majority had CD4 cell count < 200 cells/mm 3 . This study shows that increased renal sizes and degree of echogenicity alone are not useful predictors of renal involvement in HIV/AIDS.

A 6-Month Review of Medical Admissions in a Nigerian Teaching Hospital

Purpose: To provide an overview of morbidity and mortality in the medical wards of a teaching hospital and to generate discussions among staff members with a view to improving patient outcomes and data handling. Methods: A retrospective survey of admissions and mortalities in the medical wards of the University of Benin Teaching Hospital was undertaken from 1st January to 30th June 2006; using ward Record and Change books; and copies of death certificates. Morbidity data were assessed for two medical wards and mortalities for all medical admissions within the period under review were evaluated. Results: Health information was managed entirely manually. Data sources were quite often inaccessible or mutilated; and the utility of available data was limited by incomplete and incorrect documentation. No clinical coding of morbidities or mortalities was available. Human immunodeficiency virus (HIV) infection and its complications accounted for significantly more female than male admissions (26.1and 16.2respectively; p=0.005); and for more female than male deaths (34.6and 29.6respectively; p 0.0001). Most deaths occurred between midnight and the start of the working day; with a second peak during prime working hours. Conclusions: Less than optimal health information management was apparent in the health facility studied. Mortality among the patients was highest in HIV-infected patients than other diseases. Capacity building and appropriate infrastructural development is required to improve the management of vitally important health information

Memory and perceptuo-motor performance in Nigerians with chronic renal impairment.

BACKGROUND: With the increasing prevalence of chronic renal failure among the indigenous African population, coupled with the emphasis on improvement in the quality of life, there is a need for reports on the cognitive functioning and the effect of the disease on the cognitive performance of affected individuals. MATERIAL/METHODS: Sixty consecutive non-dialyzed Nigerian patients with clinical and biochemical evidence of chronic renal failure and sixty healthy age-, sex- and education level-matched controls (volunteers) were studied using an automated neuro-psychological test battery (FePsy) to assess their memory and perceptuo-motor skills. RESULTS: The chronic renal failure patients performed worse in both verbal and visual memory than controls (p<0.0001). The patients compared favorably with the controls on concentration ability (p>0.05), but their perceptuo-motor speed was retarded (p<0.001). The levels of creatinine (p<0.01) and urea (p<0.01) and the presence of hypertension (p<0.05), asterixis (p<0.05), exertional dyspnea (p<0.05), and vomiting (p<0.05) affected their memory performance, with creatinine level being the most potent variable (p=0.0015). CONCLUSIONS: The results of this study confirm the presence of cognitive impairments in Nigerians with chronic renal impairment and buttress the importance of its aggressive and prompt management.

Tetanus: an analysis of the prognosticating factors of cases seen in a tertiary hospital in a developing African country between 1990 and 2000.

This is an analysis of the effects of prognosticating factors on the outcome of a case series of 66 patients with tetanus, presenting between 1990 and 2000. The mortality rate was 26.2% with a fatality rate of 16.2% for those under 40 years of age. This increased to 75% for those patients above 70 years of age. The socioeconomic status, immunization status, the incubation period, and age of the patient together with the severity of the spasms, duration of hospital stay, type of treatment received and time of onset were found to affect the outcome of the patients.

Tetanus: an analysis of the prognosticating factors of cases admitted into the medical wards of a tertiary hospital in a developing African country between 1990 and 2000.

This is an analysis of the effects of prognosticating factors on the outcome of patients with tetanus who were seen in our hospital between 1990 and 2000. Tetanus remains a major public health hazard associated with high mortality. A total of 66 cases were analysed with a slight female preponderance. The mortality rate was 26.2% with an age-adjusted fatality rate of 16.2% for those under 40 years of age. This increased to 75% for those patients above 70 years of age. The most common portal of entry was lower limb, specifically the foot, and this was the case in 56%. The socio-economic status of the patients, the immunisation status, the incubation period, the age of the patient, the severity of the spasms, the duration of hospital stay, the type of treatment received and the onset time were found to affect the outcome of the patients. We recommend that health care providers should take every opportunity to review the vaccination status of their parents and provide tetanus vaccine when indicated, and recall when treating injured patients that many middle-aged and older adults are not adequately immunised against tetanus.