Agrochemical use in Farming Practices and Risk Factors for Kidney Disease among Dwellers of Rural Farming Communities in South-West Nigeria.

BACKGROUND: The outlook of chronic kidney disease (CKD) in low-and-medium-income-countries is poor. Modern farming practices in Nigeria are becoming increasingly associated with the use of herbicides and pesticides. AIM: The study aimed to evaluate agrochemical use in farming practices and risk factors for kidney disease among dwellers of rural farming communities in South-West Nigeria. METHODS: This was a cross-sectional survey of adult dwellers of an agrarian rural farming community in South-West Nigeria. Participants provided information on demographics, lifestyles, knowledge, and awareness of risk factors for kidney disease, and the use of agrochemicals in farming practice. Anthropometric measurements and blood pressure values were obtained while blood and spot urine were collected for random blood glucose, serum creatinine, urinalysis, and albumin-creatinine ratio. RESULTS: A total of 572 rural dwellers were enrolled in the study, with a mean age of 49.9 ± 17.5 years while 39.3% were male and 88.9% engaged in active farming. The prevalence of traditional risk factors for kidney disease was hypertension (24.3%), Diabetes mellitus (2.8%), cigarette smoking (7.5%), alcohol intake (20.8%) and herbal consumption (57.1%). The use of pesticides/herbicides was reported in 69.9%, while 25.3% did not use protective gear during its use. Proteinuria, hematuria, and reduced eGFR were observed in 29.8%, 6.1%, and 33.9% of participants, respectively. CONCLUSION: This study showed a high prevalence of herbicides and pesticide use and traditional risk factors for kidney disease, in addition to the high prevalence of markers of kidney damage among the dwellers of rural farming settlements in South-West Nigeria.

Abnormalities of Kidney Function in Acute Malarial and non-Malarial Infections.

INTRODUCTION: The tropical environment is endemic with malaria and non-malarial infections which are responsible for the high morbidity and mortality in these low- and middle-income countries. In particular, acute malarial infection can cause significant multi-organ dysfunction, including kidney involvement. Early detection of kidney dysfunction will help to improve the quality of care and reduce associated morbidity and mortality. This study aimed at identifying the spectrum of kidney dysfunction in patients with acute malaria and non-malarial infections. METHODS: This was a prospective observational study in which participants with acute malarial infection, acute non-malarial infection, and apparently healthy individuals were enrolled. For acute malarial infection, participants with thick blood smear parasite density of ≥1000 parasite/µl and falciparum species on thin smear were enrolled. Demographic, clinical, and laboratory parameters were measured. The renal abnormalities examined were urea, creatinine and eGFR, albuminuria, electrolytes, and presence of acute kidney injury (AKI). RESULTS: The following electrolyte abnormalities were observed in participants with acute falciparum infection: hyponatraemia (10.7%), hypernatraemia (4.0%), hypokalaemia (8.0%), and hyperkalaemia (13.3%). The mean serum urea in participants with acute malaria was 33.8±8.8mmol/l while participants with non-malarial febrile illnesses and healthy controls had 34.7±9.0mmol/l and 26.8±7.6mmol/l, respectively. The mean serum creatinine among participants with acute falciparum infection was 1.0±0.3mg/dl compared to those of participants with non-malarial infections and healthy controls which were 1.1±0.4mg/dl and 0.8±0.3mg/dl, respectively. The difference in the observed mean serum creatinine among the 3 groups was statistically significant (p=0.023). The mean urinary sodium among participants with non-malarial infection was highest at 23.03mmol/l. There was transient albuminuria in 6.7% of participants with acute malarial infection which resolved after recovery from the infection. CONCLUSION: A relatively high frequency of serum electrolyte abnormalities, albuminuria and urine microscopic abnormalities were observed among subjects with acute malaria compared to those without malaria infection.

INTRODUCTION: L'environnement tropical est endémique d'infections paludéennes et non paludéennes qui sont responsables d'une morbidité et d'une mortalité élevées dans ces pays à revenu faible et moyen. En particulier, l'infection palustre aiguë peut provoquer un dysfonctionnement significatif de plusieurs organes, y compris une atteinte rénale. La détection précoce du dysfonctionnement rénal permettra d'améliorer la qualité des soins et de réduire la morbidité et la mortalité associées. Cette étude visait à identifier le spectre du dysfonctionnement rénal chez les patients atteints d'une infection palustre aiguë ou d'une infection non palustre. MÉTHODES: Il s'agit d'une étude prospective d'observation à laquelle ont participé des personnes souffrant d'une infection palustre aiguë, d'une infection non palustre aiguë et des personnes apparemment en bonne santé. Pour l'infection palustre aiguë, les participants présentant une densité de parasites sur frottis sanguin épais de ≥1000 parasites/µl et des espèces de falciparum sur frottis mince ont été enrôlés. Les paramètres démographiques, cliniques et de laboratoire ont été mesurés. Les anomalies rénales examinées étaient l'urée, la créatinine et le DFGe, l'albuminurie, les électrolytes et la présence de lésions rénales aiguës (IRA). RÉSULTATS: Les anomalies électrolytiques suivantes ont été observées chez les participants atteints d'une infection aiguë à falciparum : hyponatrémie (10,7 %), hypernatrémie (4,0 %), hypokaliémie (8,0 %) et hyperkaliémie (13,3 %). L'urée sérique moyenne chez les participants atteints de paludisme aigu était de 33,8±8,8mmol/l alors que les participants atteints de maladies fébriles non palustres et les témoins sains avaient 34,7±9,0mmol/l et 26,8±7,6mmol/l, respectivement. La créatinine sérique moyenne chez les participants atteints d'une infection aiguë à falciparum était de 1,0±0,3mg/dl par rapport à celle des participants atteints d'infections non palustres et des témoins sains qui étaient de 1,1±0,4mg/dl et 0,8±0,3mg/dl, respectivement. La différence dans la créatinine sérique moyenne observée entre les 3 groupes était statistiquement significative (p=0.023). Le sodium urinaire moyen parmi les participants atteints d'une infection non palustre était le plus élevé à 23,03 mmol/l. Une albuminurie transitoire a été observée chez 6,7 % des participants atteints d'une infection palustre aiguë, qui s'est résorbée après la guérison de l'infection. CONCLUSION: Une fréquence relativement élevée d'anomalies des électrolytes sériques, d'albuminurie et d'anomalies microscopiques de l'urine a été observée chez les sujets atteints de paludisme aigu par rapport à ceux qui n'étaient pas infectés par le paludisme. Mots-clés: Anomalies de la fonction rénale, infection aiguë par le paludisme à falciparum, infections non palustres.

Comparative analysis of fibroblast growth Factor-23 as a correlate of cardiovascular disease among individuals with chronic kidney disease, hypertensives, and healthy controls.

Background: Chronic kidney disease (CKD) is a global growing public health epidemic with attending morbidity and huge financial cost. Cardiovascular disease (CVD), a major complication of CKD, contributes to its excessive mortality rate. The aetio-pathogenesis of the excess burden of CVD in CKD is a feature yet to be unravelled. Fibroblast growth factor-23 (FGF-23) has been implicated as a risk factor for CVD among patients with CKD. However, most of these studies were predominantly among the Caucasian population. Aim: This study aims to determine the correlation between FGF-23 and CVD among Nigerians with CKD. Patients and Methods: A cross-sectional comparative study composed of three groups: participants with CKD, hypertensives without CKD, and healthy individuals, represented as group 1, 2, and 3, respectively. Information obtained included demographic data and occurrence of risk factors for CVD. Cardiovascular risks were assessed by echocardiography and all the participants had kidney function tests done with plasma FGF-23. Results: The study sample size consisted of 135 participants. The mean (SD) age for participants with CKD and controls were 50.2 (12.7), 54.3 (15.5), and 40.2 (14.1) years, respectively. The median [interquartile range (IQR)] of plasma FGF-23 for participants with CKD 210 (139-304) RU/ml, and controls 124 (86-170) RU/ml, and 71 (38 - 89) RU/ml P < 0.001. Most participants with CKD had left ventricular hypertrophy (LVH) (80.0%), compared to the controls; 28.9% and 6.7% P < 0.001. Similarly, majority of participants with CKD had elevated plasma FGF-23 with LVH (85.7%) compared to controls 55.6% and 11.5%, whereas for aortic valve calcification with elevated plasma FGF-23 among CKD and controls were 53.6% (P = 0.29), 37.0% (P = 0.03), and 19.2% (P = 0.06), respectively. Conclusion: Individuals with CKD had frequencies of elevated plasma FGF-23, LVH, and cardiac valve calcification, which are surrogates of cardiovascular events.

THE EARLY PHYSICIANS OF IBADAN MEDICAL SCHOOL: PROFESSOR ALEXANDER BROWN.

The paper chronicles the life and times of Professor Alexander Brown, the Foundation Professor and Head of the Department of Medicine at the University of Ibadan. The official opening of the University College Ibadan, Nigeria on 20 November 1957 as well as the graduation of the first set of clinical students in 1960 were glorious moments for Alexander Brown who laboured for 12years to witness these. He was also instrumental to the creation of the Department of Paediatrics (1962), Department of Radiology (1963) and the Medical Illustration unit of the hospital. Paediatrics and Radiology were initially units in the Department of Medicine. He played significant role in the development of postgraduate programmes in Cardiology, neuropsychiatry and nephrology units of the hospital and substantial role in the development of nursing education in the hospital. He was the brain behind the famous Ibarapa Community Health Project.

Integrative Care of the Older Persons in Nigeria: An Appraisal of the Geriatric Centre, University College Hospital, Ibadan.

BACKGROUND: Geriatric medicine is an emerging subspecialty in Nigeria. The interest in the care of older Nigerians followed the Madrid International Plan of Action on Ageing in April 2002. This led to an increase in research, publications and advocacy culminating in the establishment of the pioneer geriatric centre in Nigeria in 2012. Since then, there has been an increase in capacity building, manpower development and institutionalization of geriatric care in Nigeria. This is an account of the evolution of the Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan (UCH). METHODS: We undertook the review of the history, structure and key service elements in the Geriatric Centre, UCH from January 1, 2013, to December 31, 2020. RESULTS: The number of patients rose from 2,559 in the first year to 19,300 by the end of 2020. The initial four multidisciplinary units increased to 12 over the review period. Likewise, the in-patient admission increased between the first year (122 patients) and 2020 (141 patients). The overall mortality rate was 11.4% over the review period. Internship opportunities were provided to students including resident doctors, undergraduates (medical) and postgraduate students (Masters and PhD). Besides, 139 medical doctors have undergone the annual basic certificate training in geriatric medicine organised by the Centre. Also, 7 fellowship dissertations and 11 peer-reviewed papers have been published. CONCLUSION: The centre has demonstrated the possibility of caring for older patients in a low-resource setting. The employment of the multidisciplinary approach yielded a low mortality rate, higher attendance and manpower development.

CONTEXTE: La médecine gériatrique est une sous-spécialité émergente au Nigéria. L'intérêt pour les soins aux Nigérians âgés a suivi le Plan d'action international de Madrid sur le vieillissement en avril 2002. Cela a conduit à une augmentation de la recherche, des publications et du plaidoyer aboutissant à la création du centre gériatrique pionnier au Nigéria en 2012. Depuis lors, il y a eu Il y a eu une augmentation du renforcement des capacités, du développement de la main-d'œuvre et de l'institutionnalisation des soins gériatriques au Nigeria. Ceci est un compte rendu de l'évolution du Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan (UCH). MÉTHODES: Nous avons entrepris l'examen de l'historique, de la structure et des éléments de service clés du Centre gériatrique, UCH du 1er janvier 2013 au 31 décembre 2020. RÉSULTATS: Le nombre de patients est passé de 2 559 la première année à 19 300 fin 2020. Les quatre unités multidisciplinaires initiales sont passées à 12 au cours de la période d'examen. De même, l'hospitalisation a augmenté entre la première année (122 patients) et 2020 (141 patients). Le taux de mortalité global était de 11,4 % au cours de la période d'examen. Des opportunités de stages ont été offertes aux étudiants, notamment aux médecins résidents, aux étudiants de premier cycle (médecine) et aux étudiants de troisième cycle (maîtrise et doctorat). Par ailleurs, 139 médecins ont suivi la formation annuelle certifiante de base en médecine gériatrique organisée par le Centre. En outre, 7 thèses de bourses et 11 articles évalués par des pairs ont été publiés. CONCLUSION: Le centre a démontré la possibilité de prendre en charge des patients âgés dans un milieu à faibles ressources. L'emploi de l'approche multidisciplinaire a donné un faible taux de mortalité, une fréquentation plus élevée et un développement de la main-d'œuvre. Mots-clés: Soins intégratifs, personnes âgées, Centre gériatrique, Ibadan, Nigéria.

Prevalence and Correlates of Frailty Syndrome among Older Adults Attending Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan.

BACKGROUND: Frailty has emerged as an important clinical measurement among older adults because of its negative health outcomes. OBJECTIVE: This study measured the prevalence and factors associated with frailty among older adults aged 60 years and above at a Geriatric Centre in Nigeria. METHODS: In this descriptive cross-sectional study, 971 older adults were recruited consecutively. Data on sociodemographics characteristics and clinical parameters were obtained using an interviewer-administered questionnaire and physical examination performed. The Frailty syndrome and Frailty Index were assessed using the Fried Frailty Criteria (FFC) and Canadian Study of Health and Aging (CSHA) scale respectively. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05. RESULTS: The mean age of the participants was 71.3 (± 7.1) years with a female to male ratio of 2.4:1. Based on FFC scale, 498 older persons (51.3%) had frailty syndrome while only 148 (15.2%) were frail using the CSHA scale. The measure of agreement (Kappa statistics) was 0.22 (p<0001) indicating weak agreement between the two scales. Logistic regression analysis revealed increasing age (OR=1.948 [1.219-3.113]), multiple morbidities (OR= 1.584, [1.177-2.201]), depression (OR= 5.050, [2.501-9.442,]), imbalance or increased risk of fall (OR 1.623, [1.192-2.211,]), and inability to perform IADL (OR= 0.599 [0.535-0.670,]) to be the most significant determinants of frailty syndrome while obesity (OR=0.660, [0.449-0.971]), unusually appeared a deterrent. CONCLUSION: The prevalence of frailty syndrome was high among the older adults. Targeted and timely interventions on the modifiable factors may delay progression into frailty and the eventual negative health outcomes.

CONTEXTE: La fragilité a ete emerge comme un élément clinique important mesure chez les personnes âgées en raison de son état de santé négatif les résultats. OBJECTIF: Cette étude a mesuré la prévalence et les facteurs associée à la fragilité chez les personnes âgées de 60 ans et cidessus dans un centre gériatrique au Nigéria. MÉTHODES: Dans cette étude transversale descriptive, 971 des adultes plus âgés ont été recrutés consécutivement. Les données sur les caractéristiques sociodémographiques et les paramètres cliniques ont été obtenu à l'aide d'un questionnaire administré par l'enquêteur et un examen physique effectué. Le syndrome de fragilité et l'indice de fragilité ont été évalués à l'aide du Fried Frailty Critères (FFC) et étude canadienne sur la santé et le vieillissement (CSHA) respectivement. Bivarié et multivarié les analyses ont été réalisées à l'aide de SPSS version 21 à p <0,05. RÉSULTATS: L'âge moyen des participants était de 71,3 (± 7,1) ans avec un ratio femmes / hommes de 2,4: 1. Basé sur l'échelle FFC, 498 personnes âgées (51,3%) avaient un syndrome de fragilité alors que seulement 148 (15,2%) étaient fragiles selon l'échelle de la SCVS. La mesure d'accord (statistiques Kappa) était de 0,22 (p <0001) indiquant faible accord entre les deux échelles. Une analyse de régression logistique a révélé une augmentation de l'âge (OR = 1,948 [1,219-3,113]), morbidités multiples (OR = 1,584, [1.177-2.201]), dépression (OR = 5.050, [2.501-9.442,]), déséquilibre ou risque accru de chute (OR 1.623, [1.192-2.211,]), et l'incapacité d'effectuer une IADL (OR = 0,599 [0,535-0,670,]) pour être les déterminants les plus importants du syndrome de fragilité obésité (OR = 0,660, [0,449-0,971]), apparaissait inhabituellement dissuasif. CONCLUSION: La prévalence du syndrome de fragilité était élevée parmi les personnes âgées. Interventions ciblées et opportunes sur les facteurs modifiables peuvent retarder la progression vers la fragilité et les éventuels effets négatifs sur la santé. Mots clés: Syndrome de fragilité; Corrélats; Les adultes plus âgés; Gériatrie.

Impact of Impaired Kidney Function on Outcomes of Nigerians with COVID-9 Infection: Report of Two Cases from the University College Hospital, Ibadan.

COVID-19 infection predominantly affects the respiratory system; however, other systems and organs are also affected. The kidneys are among the organs commonly affected by SARS-CoV-2 and this has been reported to be a predictor of increased severity, need for intensive care (ICU), admission, and death. We presented two cases of COVID-19 that were associated with co-morbidities that include diabetes mellitus, systemic hypertension and impaired kidney function. The relationship of the multiple co-morbidities particularly the impaired kidney function with the outcomes of COVID-19 infection and the challenges of offering dialysis for patients with COVID-19 infection with kidney failure were discussed. The two cases presented also highlighted the state of preparedness for the management of COVID-19 and its various complications and co-morbidities, particularly kidney failure in a tertiary hospital in Nigeria at onset of the COVID-19 outbreak.

L'infection au COVID-19 affecte principalement les voies respiratoires système; cependant, d'autres systèmes et organes sont également affectés. Les reins font partie des organes les plus fréquemment touchés par SRAS-CoV-2 et cela a été rapporté comme étant un prédicteur de gravité accrue, besoin de soins intensifs (USI),l'admission, et la mort. Nous avons présenté deux cas de COVID-19 associés avec des comorbidités qui incluent le diabète sucré, systémique hypertension et le rénale affaibli. La relation des comorbidités multiples en particulier le rénale affaibli fonction des résultats de l'infection au COVID-19 et de la défis de l'offre de dialyse aux patients atteints de COVID-19 une infection avec insuffisance rénale a été discutée. Les deux cas présentés ont également mis en évidence l'état de préparation à la gestion du COVID-19 et de ses divers complications et comorbidités, en particulier insuffisance rénale dans un hôpital tertiaire au Nigéria au début du COVID-19 épidémie. Mots clés: lésion rénale aiguë, maladie rénale chronique, comorbidité, COVID-19.

Risk assessment and elemental quantification of anthropogenic activities in soil.

One of the significance parts of ecosystem is the soil, and it is often modified due to man activities. The objective of this work examined the extent of occurrence of elements in the soil and also to identify the soil contamination level via enrichment factor (EF) and contamination factor/pollution index. The enrichment value was computed using five elements (Ti, Mn, Zn, Cu, Cr) and iron (Fe) as reference element. Scandium (Sc) was not found at hospital dumpsite while arsenic (As) was not found at marketplace. Fe, Ca and K had high concentrations in all locations, ranging from 2651 to 4630 ppm, 2204.67 ppm - 3968.67 ppm and 3649.00 - 4773.67 ppm, respectively. The pollution index value is shown in this order: Ni > Fe > Cu > Cr > Zn > Mn > As an enrichment value in this order: Ni > Se > Cu > V > Zn > Cr > Zr > As > Mn > K > Ca > Rb > Ti > Sr, when Fe was used as a reference element. The overall risk index (RI) in all the locations in the soil was above the edge.

Exposure to Agrochemicals and Markers of Kidney Damage among Farmers in Rural Communities in Southwestern Nigeria.

BACKGROUND: Chronic kidney disease of unknown origin (CKDu) is assuming an epidemic proportion, especially in farming communities worldwide. We explored the relationship between CKD markers and agrochemical exposure among rural farmers in South Western Nigeria. METHODS: We studied selected farming communities in Southwestern Nigeria where the use of agrochemicals was widespread. A pre-tested questionnaire was administered to participants. Anthropometric data, information on use of agro-chemicals; urine and blood samples were obtained. Informed consent was obtained from participants. The study was approved by the Institutional Ethics committee and complied with 1975 Helsinki declaration, as revised in 2000. RESULTS: A total of 438 farmers made up of 202 males (46.1%) and 236 females (53.9%) were studied. The mean microalbuminuria was 30.2 ±11.7 mg/dl. Majority of the farmers had CKD stage 2(42.0%) and CKD stage 3 (37.7%). The type of farming engaged in had a positive, but not significant, correlation with eGFR (r=0.012, p=0.832). There was positive correlation between type of farming and GFR category (r=0.24, p=0.000). Frequency of use of hexachlorocyclohexane had a positive and significant correlation with eGFR (r=0.111, p=0.045). Annual crop farming had a correlation with UACR (r=0.149, p=0.024). CONCLUSION: Annual crop farming had a positive correlation with UACR, eGFR and GFR category. The prolonged use of agrochemicals on an annual basis can cause kidney damage.

Mortality Trends among Older Patients Admitted to the Geriatric Centre, University College Hospital, Ibadan, Nigeria, 2013-2017.

BACKGROUND: Attaining successful clinical outcomes in the management of hospitalised older patients in the overburdened healthcare services in Nigeria constitutes a major challenge against the backdrop of dearth of data on the predictors of mortality among them. OBJECTIVES: To describe the mortality trends and associated factors among older patients (>60 years) at the Geriatric Centre, University College Hospital, Ibadan between January 2013 and December 2017. METHODS: Hospital records of older patients admitted were analysed. Data extracted included socio-demographic, diagnoses, length of stay from date of admission to discharge or death. Results of vital signs, anthropometric measurements and laboratory tests carried out at admission were also obtained. RESULTS: The mean age of the 1,091 older patients admitted was 73.6±8.6 years. The overall crude proportion of in-hospital deaths was 9.0% (males=11.3% > females=7.2%, p=0.024) and it increased from 4.1% in 2013 to 12.1% in 2017. The overall unadjusted 30-day mortality rate per 1000 patient-days was 28.9 deaths (95% CI 23.5-35.3). The predictors of mortality were increased length of stay on admission OR=1.061 (95% CI 1.005-1.119), being retired OR=1.672 (95% CI 1.011-2.778), stroke OR=4.019 (95% CI 2.258- 7.138), heart failure OR=3.435 (95% CI 1.455-8.100), Sepsis OR=2.176 (95% CI 1.294-3.654), Anaemia OR=2.820 (95% CI 1.320-6.017), Dementia OR=3.701 (95% CI 1.433-9.549) and malignancies OR=2.658 (95% CI 1.181-5.979). CONCLUSION: There was a temporal increase in mortality among older patients. Similarly, staying longer on admission and chronic medical conditions with their complications were the most significant contributors to mortality.

Forensic mental health service implications of COVID-19 infection in Nigeria.

Forensic mental health services are fledgling in most African countries including Nigeria. The current formulation of such services in Nigeria is correctional psychiatry in addition to some hospital-based services. The COVID-19 pandemic presents significant challenges to the already fragile state of forensic mental health services within the country. Its impact includes limitation of access to and continuity of mental healthcare in prison as well as reduction in referrals from other services within the criminal justice system such as the police and the courts. Further tapering of previously less prominent aspects of forensic mental health service in the country such as the preparation of psychiatric court reports has also been observed. Forensic psychiatry training and research have equally been hampered by the pandemic. The lessons learnt from these challenges should offer practitioners and policy makers insight into strategic developmental objectives for the post-COVID era within services and training programmes.

Self-reported Sleep Disorder and Ambulatory Blood Pressure Phenotypes in Patients with or without Chronic Kidney Disease: Findings from Ibadan CRECKID Study.

BACKGROUND: Sleep disordered breathing has been closely linked to pathogenesis, poor control of hypertension, and progression of chronic kidney disease (CKD). Though hypertension and CKD are highly prevalent in Nigeria, the effects of sleep disorders on CKD and hypertension phenotypes have not been widely studied. This study investigated the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD. METHODS: Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP =140mmHg and/or DBP =90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2Equation and CKD was defined as eGFR<60ml/min/1.73m . RESULTS: A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; p<0.0001. CONCLUSION: This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.

Factors associated with sarcopenia among older patients attending a geriatric clinic in Nigeria.

CONTEXT: Aging is characterized by progressive and generalized loss of skeletal muscle mass and strength called sarcopenia which causes poor health and disability. There is paucity of data on this syndrome of public health importance among older Nigerians. AIM: This study determined the prevalence and factors associated with sarcopenia among persons aged 60 years and above at a geriatric center in Nigeria. MATERIALS AND METHODS: A cross-sectional study of 642 persons aged ≥60 years who attended the geriatric center between March and July 2014. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People criteria. Bivariate and multivariate analyses were carried out using SPSS 20. Alpha was set at 0.05. RESULTS: The mean age ± standard deviation of the respondents was 69.1 ± 7.2 years, and 378 (60.6%) were females. The point prevalence of sarcopenia was 5.4% which was significantly higher among the females compared with the males (7.1% vs. 2.8%) P = 0.02. Low muscle mass and low gait speed were found in 10.9% and 36.1%, respectively. Logistic regression analysis showed age (odds ratio [OR] =1.090; 95% confidence interval [CI] =1.034-1.149, P = 0.01), having no formal education (OR = 2.810; 95% CI = 1.043-7.573, P = 0.04), malnutrition (OR = 5.817; 95% CI = 1.471-23.434, P = 0.01), and female gender (OR = 3.068; 95% CI = 1.068-8.817, P = 0.04) to be the predictors of sarcopenia. CONCLUSION: Older people in this setting are at risk of developing sarcopenia, especially the females. Healthcare workers should address the social and health-related factors which could lead to sarcopenia.

Quantification of the Pyrrolizidine Alkaloid Jacobine in Crassocephalum crepidioides by Cation Exchange High-Performance Liquid Chromatography.

INTRODUCTION: Pyrrolizidine alkaloids (PAs) are secondary plant metabolites with considerable hepatoxic, tumorigenic and genotoxic potential. For separation, reversed phase chromatography is commonly used because of its excellent compatibility with detection by mass spectrometry. However, reversed phase chromatography has a low selectivity for PAs. OBJECTIVE: The objective of this work was to investigate the suitability of cation exchange chromatography for separation of PAs and to develop a rapid method for quantification of jacobine in Crassocephalum crepidioides that is suitable for analysis of huge sample numbers as required for mutant screening procedures. RESULTS: We demonstrate that cation exchange chromatography offers excellent selectivity for PAs allowing their separation from most other plant metabolites. Due to the high selectivity, plant extracts can be directly analysed after simple sample preparation. Detection with UV at 200 nm instead of mass spectrometry can be applied, which makes the method very simple and cost-effective. The recovery rate of the method exceeded 95%, the intra-day and inter-day standard deviations were below 7% and the limit of detection and quantification were 1 mg/kg and 3 mg/kg, respectively. CONCLUSION: The developed method is sufficiently sensitive for reproducible detection of jacobine in C. crepidioides. Simple sample preparation and rapid separation allows for quantification of jacobine in plant material in a high-throughput manner. Thus, the method is suitable for genetic screenings and may be applicable for other plant species, for instance Jacobaea maritima. In addition, our results show that C. crepidioides cannot be considered safe for human consumption. Copyright © 2017 John Wiley & Sons, Ltd.

Effect of genetic variants of bilirubin metabolism on the degree of hyperbilirubinemia in African-American newborns.

OBJECTIVE: The objective of our study was to measure the effect of genetic variants of these two enzymes, UGT1A1 and SLCO1B1, in the bilirubin metabolic pathway on the degree of hyperbilirubinemia in a cohort of African-American (AA) infants from our well-baby nursery. In addition, a second objective was to document the types and frequencies of genetic variations of these enzymes in our cohort. STUDY DESIGN: A prospective study of 180 AA infants from the Well Baby Nursery of an inner city community hospital, all of whose mothers were type O pos. Sixty infants were ABO-incompatible direct antiglobulin test (DAT) pos, 60 were ABO-incompatible DAT neg and 60 were type O+. Blood for carboxyhemoglobin (COHb) and variants of the enzymes uridine diphosphoglucuronosyltransferase 1A1 and hepatic solute carrier organic anion transporter 1B1 (SLCO1B1) was drawn at the time of the infants' initial bilirubin, and the infants' precise percentile on the Bhutani nomogram was calculated. RESULTS: Variants in the two enzymes studied were quite common. In total, 21.1% were positive for a Gilbert phenotype, whereas an additional 42.4% were heterozygous for the *28 or *37 variant of UGT1A1. In total, 67.2% were homozygous for the *60 variant of the phenobarbital responsive enhancer module. In total, 41.1% were homozygous for the *1b variant of SLCO1B1, whereas an additional 12.7% were positive for the *4 variant of this gene. In total, 20.6% of infants had variations in both genes. Using logistic regression when COHbc was assessed with each of the different variants, only COHbc (P<0.0001 to 0.0004) was significantly associated with the level of hyperbilirubinemia as defined by the Bhutani nomogram. CONCLUSION: Although we have found quite a large number of genetic variants of the UGT1A1 and SLCO1B1 genes in the AA population, it does not appear that they have a significant impact on the incidence of hyperbilirubinemia among this group of infants.

Morphometric study of lumbar vertebrae in adult South African subjects / Estudio morfométrico de las vértebras lumbares en sujetos adultos de Sudáfrica

Lumbar vertebral dimensions provide vital clinical information of immense diagnostic benefits to medical experts. The present study provides data for lumbar vertebral dimensions of a cohort of specimens of South African females and males. Measurements were obtained from lumbar vertebrae from the osteological collections in the Discipline of Clinical Anatomy, Nelson Mandela School of Medicine using a digital caliper. The antero-posterior body diameter (APD), interpedicular distance (IPD), midsagittal diameter (MSD) and pedicle length (PL) were measured while ratio of MSD to APD was calculated. Results showed gradual increase from L1 to L5 for mean APD and IPD, and a decrease for mean PL from L1 to L5. Mean MSD was observed to present a "U" curve pattern from L1 to L5, while MSD/APD ratio decreased from L2 downwards. We report that certain lumbar dimensions also showed significant correlation with age at distinct lumbar levels. The present data provides a baseline of lumbar vertebral morphology for the South African adult cohort and requires further investigations with larger cohort.

Las dimensiones lumbares vertebrales proporcionan información vital en la clínica para alcanzar un diagnóstico correcto. El presente estudio proporciona datos de las dimensiones vertebrales lumbares en una cohorte de hombres y mujeres de Sudáfrica. Las mediciones de las vértebras lumbares se obtuvieron de colecciones osteológicas correspondientes a la Cátedra de Anatomía Clínica, de la Escuela de Medicina Nelson Mandela. Se utilizó un calibrador digital. Se midieron el diámetro antero-posterior del cuerpo vertebral (DPA), la distancia interpedicular (DIP), el diámetro sagital mediano (DSM) y la longitud del pedículo (LP); y se calculó la relación de DSM con DPA. Los resultados mostraron un aumento gradual de L1 a L5 para la mediana de DPA y DIP, y una disminución de la media de LP de L1 a L5. La media de DSM presentó un patrón de curva en "U" de L1 a L5, mientras que el índice DSM / DPA disminuyó de L2 hacia inferior. Ciertas dimensiones lumbares también mostraron una correlación significativa con la edad en los distintos niveles lumbares. El presente estudio proporciona datos acerca de la morfología vertebral lumbar para una cohorte de adultos de Sudáfrica, y consideramos que se requieren de más investigaciones con una cohorte más amplia.

Comparison of antioxidant effects of kolaviron and vitamin C interventions on testicular structures following nevirapine administration in Sprague-Dawley rats / Comparación de los efectos antioxidantes en la intervención con kolaviron y vitamina C sobre las estructuras testiculares después de la administración de nevirapina en ratas Sprague-Dawley

Testicular toxicity has been implicated in highly active anti-retroviral therapy (HAART) treatment. Hence there is need to identify an effective antioxidant product that can alleviate testicular necrosis due to HAART administration. Forty eight adult male Sprague-Dawley rats were used in this study. The animals were divided into eight (8) groups: A-H (n= 6). Group A animals received normal saline as the control; Group B was given Nevirapine (Nv); Group C was given Kolaviron (Kv); Group D was given vitamin C; Group E was given Nv and Kv; Group F was given Nv and Vitamin C; Group G was given Nv for 56 d and Kv for 28 d serving as a withdrawal group; Group H was given corn oil. Nv, Kv and Vit. C were given at 1.54, 200 and 250 (mg·kg)/bw respectively while all administrations were through oral gavage. The body weights were taken every other day. Thereafter, they were anaesthetized with halothane. The testes were excised, weighed, fixed in Bouin's fluid and stained with H&E while the epididymes removed for semen fluid analyses. The results showed a significant (P<0.05) decrease in sperm motility in group E (Nevirapine + kolaviron) when compared with group F (Nevirapine + Vitamin C) while Sperm count was not significantly different (P>0.05) across the groups. The testicular histoarchitectural studies revealed indistinct spermatogonia, necrotic interstititial endocrine cells in the altered interstitial space, fragmented spermatids, atrophy of mature spermatocytes, degenerated germ cells, obliterated seminiferous tubules lumen, undifferentiated spermatogonia and cellular debris in the somniferous tubules lumen of nevirapine administered group but normal across the other groups. In the testis, there were no significant reduction in SOD, Catalase and GPx activities but a significant decrease in GST activity (P<0.001) when group E was compared with group F. In conclusion, vitamin C presents a better remediation in nevirapine induced spermiotoxicity compared to kolaviron in Sprague-Dawley rats.

La toxicidad testicular ha sido implicada en la terapia antirretroviral altamente activa (TARAA). Por lo tanto existe la necesidad de identificar un producto antioxidante eficaz que pueda aliviar la necrosis testicular en la administración de la TARAA. Cuarenta y ocho ratas macho Sprague-Dawley adultas fueron utilizadas. Los animales se dividieron en ocho (8) grupos: AH (n= 6). Grupo A, animales recibieron solución salina normal como el control; Grupo B, recibió Nevirapina (Nv); Grupo C, recibió Kolaviron (Kv); Grupo D, recibió vitamina C; Grupo E, recibió Nv y Kv; Grupo F, recibió Nv y vitamina C; Grupo G, recibió Nv durante 56 d y Kv por 28 d como un grupo de retirada; Grupo H, recibió aceite de maíz. Nv, Kv y Vit. C se administraron en dosis de 1, 54, 200 y 250 (mg · kg) de peso corporal respectivamente; todas las administraciones fueron por sonda oral. Los pesos corporales se tomaron cada dos días. A partir de ese momento los animales fueron anestesiados con halotano. Los testículos fueron extirpados, pesados y fijados en solución de Bouin y teñidos con H&E, mientras que el epidídimo se retiró para analizar el semen. Los resultados mostraron un descenso (p<0,05) en la motilidad de los espermatozoides en el grupo E (Nevirapina + Kolaviron) en comparación con el grupo F (Nevirapina + vitamina C), mientras que el recuento espermático no mostró diferencias significativas (P>0,05) entre los grupos. El estudio de la histoarquitectura testicular reveló espermatogonias indiferenciadas, con células intersticiales necróticas en el espacio intersticial y espermátidas fragmentadas. Además, en el grupo que recibió Nevirapina mostró espermatocitos maduros atrofiados, degeneración de células germinales, lumen de los túbulos seminíferos obliterados, espermatogonias indiferenciadas y restos celulares en el lumen de los tubulos seminíferos. En el resto de los grupos los resultados fueron normales. En el testículo hubo una reducción significativa en las actividades de la superóxido dismutasa, catalasa y glutatión peroxidasa, pero una disminución significativa en la actividad glutatión S-transferasa (P <0,001) al comparar los grupo E y F.

Carboxyhemoglobin levels as a predictor of risk for significant hyperbilirubinemia in African-American DAT(+) infants.

OBJECTIVES: To compare the degree of hemolysis in a group of direct antiglobulin test (DAT) positive (pos) African-American (AA) infants as measured by carboxyhemoglobin corrected (COHbc) for carbon monoxide in ambient air to a similar group of DAT negative (neg) ABO incompatible infants and a group without blood group incompatibility. To determine if COHbc is a better predictor of significant hyperbilirubinemia than DAT status. STUDY DESIGN: A prospective study of 180 AA infants from the Well-Baby Nursery of an inner city community hospital, all of whose mothers were type O pos. Infants (60) were ABO incompatible DAT pos, 60 were ABO incompatible DAT neg and 60 were type O(+). Blood for COHbc was drawn at the time of the infants' initial bilirubin and the infants' precise percentile on the Bhutani nomogram was calculated. RESULT: Mean COHbc of type O(+) infants was 0.76±0.21 and 0.78±0.24% for ABO incompatible DAT neg infants (P=0.63). Mean CoHbc for the ABO incompatible DAT pos infants was 1.03±0.41% (P<0.0001 compared with both type O and DAT neg infants). Optimal cutoff on the receiver operating characteristic curve for COHbc to determine the risk for being in the Bhutani curve high risk zone was COHbc >0.90% (area under the curve(AUC) 0.8113). This was similar to the AUC of the receiver operating characteristic curve using any titer strength of DAT pos as a cutoff (0.7960). CONCLUSION: Although not greatly superior to the titer strength of DAT pos, COHbc is useful in determining if the etiology of severe hyperbilirubinemia is a hemolytic process.

Ethical and legal issues in renal transplantation in Nigeria.

With the increasing number of patients being offered kidney transplantation by many centers in the developing world, it is not unexpected that there would be attendant ethical and legal issues even when the selection process for transplantation seems medically justified. Because of the inadequate infrastructure for hemodialysis and peritoneal dialysis, coupled with the challenges of logistics for maintenance dialysis, transplantation would seem to be the best option for patients with end-stage renal failure, even in developed economies where these can easily be tackled. The main issues here revolve around incentives for donors, organ trade and trafficking and the economics of eliminating the waiting list and the criminal activities of organ trans-plantation. In the developing world, with the current level of corruption and poverty, there is a need to redouble efforts to monitor transplant activities. Professional bodies should take the lead in this regard. Furthermore, there is a need for governments to engage in public consultation and community awareness concerning organ donation in living and deceased persons.

Comparative evaluation of biogas production from poultry droppings, cow dung and lemon grass.

The study explored the production of biogas from Lemon grass, Cow dung and Poultry droppings. The three substrates were pre-fermented according to standard methods. Six (6) kg of each pre-fermented substrate was mixed with water in ratio 1:1 v/v to form slurry and digested for 30days. A total of 0.125m(3), 0.191m(3) and 0.211m(3) of biogas were respectively produced from the Lemon grass, Cow dung and Poultry droppings with deviations of 0.00234m(3), 0.00289 m(3) and 0.00484 m(3) respectively. The cooking test carried out revealed that the scrubbed gas had higher cooking rates for water (0.12L/min, 0.085L/min and 0.079L/min for Lemon grass, Cow dung and Poultry droppings respectively) while the cooking rates for unscrubbed gas were 0.079L/min, 0.064L/min and 0.06L/min respectively. The pH of the medium fluctuated optimally between 6.5 and 7.8. The research demonstrated that Lemon grass produced less volume but better quality biogas compared to Cow dung and Poultry droppings.