Impact of COVID-19 on renal replacement therapy: perspective from a Nigerian renal transplant centre.

Introduction: COVID-19 has had a huge impact on the health system and the world at large. Patients with kidney failure are a select group which have been affected significantly by the scourge of the disease. In the COVID-19 era, renal replacement therapy (RRT) in the form of dialysis and kidney transplantation required modifications in many centres in order to maintain high quality care and reduce infection rates among this susceptible group of patients. The objectives were to describe some of the challenges experienced in one of the leading renal care centres in Nigeria during the height of the COVID-19 pandemic and analyse the impact of practice changes on select outcomes. Methods: a retrospective cross-sectional review of haemodialysis activities and kidney transplantation among chronic kidney disease patients was done over a 15-month period ranging from April, 2019 to June, 2021. Data was extracted from the electronic media record (EMR) and analysed using SPSS version 22. Results: there was an initial significant drop in the number of haemodialysis sessions and kidney transplant surgeries by 16.7% and 66% respectively in the first 2 months of COVID-19 in our centre following the national lockdown. The mean monthly kidney transplant rate was 9±3.29 before the COVID-19 and the national lockdown, this figure reduced to 3.0±0.1 during the lockdown. Activities however normalized at 6 months following the initial lockdowns have remarkable exceeded pre-COVID numbers as at early 2021. Conclusion: after the initial drop in numbers of patients for haemodialysis and renal transplantation, there was an increase in numbers in the following months. It was instructive to put several steps in place in order to continue to offer high level RRT in the COVID-19 pandemic. RRT can safely be practiced in the COVID-19 pandemic.

Evaluation of dyslipidemia, lipid ratios, and atherogenic index as cardiovascular risk factors among semi-urban dwellers in Nigeria.

BACKGROUND AND OBJECTIVES: The increasing frequency of cardiovascular disease (CVD) rests on the presence of major cardiovascular risk factors including dyslipidemia. This dyslipidemia is also a target for the prevention and treatment of many cardiovascular diseases. Hence, identification of individuals at risk of CVD is needed for early identification and prevention. The study was carried out to evaluate dyslipidemia using the lipid ratios and indices instead of just the conventional lipid profile. METHODOLOGY: It was a cross-sectional study with 699 participants recruited from semi-urban communities in Nigeria. Anthropometric indices, blood pressure, and fasting lipid profiles were determined. Abnormalities in lipid indices and lipid ratios with atherogenic index were also determined. SPSS software version 17.0 were used for analysis, P< 0.05 was considered statistically significant. RESULTS: There were 699 participants with a mean age of 64.45 ± 15.53 years. Elevated total cholesterol, high low-density lipoprotein-cholesterol, elevated triglyceride, and low high-density lipoprotein were seen in 5.3%, 19.3%, 4.4%, and 76.3% of the participants, respectively. The Castelli's risk index-I (CRI-I) predicted the highest prevalence of predisposition to cardiovascular risk (47.8%) with females being at significantly higher risk (55.2% vs. 29.3%, P< 0.001). Atherogenic coefficient, CRI-II, CHOLIndex, atherogenic index of plasma (AIP) predicted a cardiovascular risk prevalence of 22.5%, 15.9%, 11.2%, and 11.0%, respectively, with no significant difference in between the sexes. CONCLUSIONS: Serum lipid ratios and AIP may be used in addition to lipid parameters in clinical practice to assess cardiovascular risks even when lipid profiles are apparently normal. AIP was more gender specific amidst the lipid ratios.

Patients' feelings about the presence of medical students in a New Teaching Hospital in Southwestern Nigeria.

BACKGROUND: This study aimed to evaluate how patients feel about the introduction of medical students into a former general hospital transformed to a teaching hospital in southwestern Nigeria and to also assess the extent to which they are willing to involve medical students in the management of their conditions. METHODS: In a descriptive cross-sectional study, a sample of 251 randomly selected patients were interviewed using a pretested questionnaire that assessed patients' demography, patients' acceptance of and reaction to the involvement of medical students in their clinical care including the specific procedures the patients would allow medical students to perform. RESULTS: Two hundred and fifty-one patients with mean age ± standard deviation of 37.33 ± 19.01 (age range = 16-120 years; M:F = 1:1.26) were recruited between January 01 and March 31, 2013. Most patients (86.5%) preferred to be treated in a teaching hospital and were comfortable with medical students as observers (83.7%) and serving as the doctors' assistant (83.3%) during common diagnostic procedures. Men were more willing to have invasive procedures such as insertion of urinary catheter (56.6% vs. 43.4%, P = 0.001). Acceptability of medical students (such as willingness of patients to have students read their medical notes) was significantly higher in nonsurgical specialties than in surgical specialties (77.5% vs. 22.5%, P< 0.001). Factors associated with a positive disposition include age> 40 years, male gender, and higher level of education as well as consultation in nonsurgical specialties (P = 0.001). DISCUSSION: Medical students are well received into this new teaching hospital setting. However, there is a need for more education of younger, less educated female patients of surgical subspecialties so that they can understand their importance as irreplaceable partners in the training of medical students.