Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review.

BACKGROUND: Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations. METHODS: We conducted this scoping review to answer the question: "what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively. RESULTS: Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively. CONCLUSION: Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined.

Association of Genetic Polymorphisms of TGF-ß1, HMOX1, and APOL1 With CKD in Nigerian Patients With and Without HIV.

RATIONALE & OBJECTIVE: Recent studies in the human immunodeficiency virus (HIV)-infected population have suggested that there are genetic predispositions to the development of chronic kidney disease (CKD) in this context. We investigated the association of genetic polymorphisms of the genes encoding apolipoprotein L1 (APOL1), transforming growth factor ß1 (TGF-ß1; a profibrotic cytokine), and heme oxygenase 1 (HMOX1) with prevalent CKD among adults with and without HIV infection. STUDY DESIGN: Case-control study. SETTING & PARTICIPANTS: West African adults including 217 HIV-infected patients with CKD (HIV+/CKD+ group), 595 HIV-infected patients without CKD (HIV+/CKD- group), 269 with CKD and no HIV infection (HIV-/CKD+ group), and 114 with neither CKD nor HIV (HIV-/CKD- group). EXPOSURE: The genetic polymorphisms with reference single-nucleotide polymorphism (rs) identification numbers rs1800469 (TGF-ß1), rs1800470 (TGF-ß1), rs121918282 (TGF-ß1); rs60910145 (APOL1 G1 risk allele), rs73885319 (APOL1 G1 risk allele), rs71785313 (APOL1 G2 risk allele), and rs743811 (HMOX1); HIV. OUTCOME: CKD. ANALYTICAL APPROACH: Single-nucleotide polymorphism (SNP) genotyping of rs1800469 (TGF-ß1), rs1800470 (TGF-ß1), rs121918282 (TGF-ß1); rs60910145 (APOL1), rs73885319 (APOL1), rs71785313 (APOL1), and rs743811 (HMOX1) was performed. Hardy-Weinberg equilibrium was evaluated for all SNPs, and minor allele frequencies were reported. A case-control analysis was performed, and multivariable logistic regression was used to control for potential confounders. RESULTS: Minor allele frequencies for TGF-ß1 (rs1800469, rs1800470, and rs1800471), APOL1 (rs60910145, rs73885319, and rs71785313), and HMOX1 (rs743811) were 0.25, 0.46, 0.46, 0.44, 0.45, 0.17, and 0.14, respectively. Among HIV-positive individuals, only TGF-ß1 rs1800470 (GG vs AA), APOL1 (in the recessive model), and hypertension were associated with prevalent CKD (adjusted ORs of 0.44 [95% CI, 0.20-0.97], 2.54 [95% CI, 1.44-4.51], and 2.17 [95% CI, 1.35-3.48], respectively). No SNP polymorphisms were associated with prevalent CKD among HIV-negative individuals. LIMITATIONS: The lack of histopathology data for proper categorization of the type of HIV-related nephropathy. CONCLUSIONS: APOL1 polymorphisms were highly prevalent in this population and among adult patients infected with HIV and were associated with increased CKD risk. The TGF-ß1 (rs1800470) polymorphism was associated with reduced risk, and HMOX1 polymorphisms were unassociated with CKD.

Assessment of iron deficiency anaemia and its risk factors among adults with chronic kidney disease in a tertiary hospital in Nigeria.

INTRODUCTION: A substantial proportion of patients with chronic kidney disease (CKD) develop iron deficiency anaemia (IDA). Despite the association of IDA with adverse cardiovascular outcomes, it remains underdiagnosed and poorly managed. Up to 70% of patients with CKD are anaemic at the time of initiating dialysis, while the predictors of IDA in these patients in our setting are unknown. This study aimed to determine the prevalence and risk factors for IDA in patients with CKD. MATERIALS AND METHODS: This is a case-control study of 157 patients with CKD and 157 age and gender matched subjects without CKD. Information obtained from the participants were socio-demographic details, aetiology of CKD, medication history and features of IDA. All participants had serum ferritin, total iron binding capacity (TIBC), transferrin saturation (TSAT), highly sensitive C-reactive protein, serum creatinine and complete blood count determined. RESULTS: The median estimated glomerular rate (22.7 [3.4-59.5] vs. 110.2 [60.3-152.8] ml/min/1.73 m2, P < 0.01), the mean haemoglobin concentration (9.3 ± 2.6 vs. 11.4 ± 1.7 g/dl, P < 0.01), and TSAT (27.9% ± 6.4% vs. 34.8% ± 8.1%, P < 0.04) were significantly lower in patients with CKD. The mean age, serum ferritin and TIBC were similar in both groups. The prevalence of absolute (24.8% vs. 13.4%, P < 0.01) and relative (17.8% vs. 7.6%, P < 0.01) iron deficiencies were higher among individuals with CKD compared to the controls. Female gender (odd ratio [OR]:1.50, 95% confidence interval [CI]:1.0267-4.1163, P < 0.04) and severity of CKD (OR: 3.43, 95% CI: 1.5568-7.8324, P < 0.02) were independently associated with IDA. CONCLUSION: IDA is common among individuals with CKD while female gender and severity of CKD were factors that independently predicted IDA.

Specific Physical Training in Elite Male Team Handball.

Wagner, H, Gierlinger, M, Adzamija, N, Ajayi, S, Bacharach, DW, and von Duvillard, SP. Specific physical training in elite male team handball. J Strength Cond Res 31(11): 3083-3093, 2017-Specific physical training in elite team handball is essential for optimal player's performance; however, scientific knowledge is generally based on temporary training studies with subelite athletes. Therefore, the aim of the study was to analyze the effects of specific physical training in an elite male handball team over the entire season. Twelve players of a male handball team from the First Austrian Handball League conducted a 1-year specific physical training program in addition to their normal (team handball techniques and tactics) weekly training. Performance was measured with 5 general and 4 specific tests as well as game statistics during competition. Repeated measures analysis of variances and paired sample t-test were used to analyze differences in performance during training. We found a significant increase in oxygen uptake, offense time, defense time, fast break time, and jump height in the specific tests. Game performance statistics revealed a lower throwing percentage in the hosting team (59%) compared with the rival teams (63%). Our results indicated that specific endurance and agility are an acceptable modality in elite male team handball. However, performance in competition is strongly influenced by specific techniques and tactics. We recommend to strength and conditioning professionals that they tailor strength and power training, coordination and endurance as specific as possible, using free weights, agility exercises that include change in direction and jumps as well as short (10-15 seconds) high-intensity intervals.

Sonography for Complete Evaluation of Neonatal Intensive Care Unit Central Support Devices: A Pilot Study.

OBJECTIVES: Neonates in the neonatal intensive care unit often require considerable support with endotracheal tubes, umbilical arterial and venous catheters, and peripherally inserted central venous catheters. Support device evaluation with radiography exposes neonates to ionizing radiation. This study evaluated the effectiveness of sonographic localization for endotracheal tubes, umbilical arterial and venous catheters, and peripherally inserted central venous catheters. METHODS: This blinded prospective Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant study with informed consent compared sonography to radiography for endotracheal tube, umbilical arterial and venous catheter, and peripherally inserted central venous catheter localization. Participants were consecutively recruited NICU patients of any weight, gestation, and chronologic age who had an endotracheal tube, umbilical arterial catheter, umbilical venous catheter, or peripherally inserted central venous catheter placed or adjusted and had subsequent radiographic confirmation within 24 hours. Sonographic evaluation was obtained as soon as possible, without prior review of the radiograph, and results were compared. RESULTS: Thirty sonographic studies were performed in 25 patients (14 male and 11 female), for a total of 50 lines and tubes: 18 umbilical venous catheters, 12 umbilical arterial catheters, 11 peripherally inserted central venous catheters, and 9 endotracheal tubes. Forty-nine support devices (98%) were visualized with sonography, all concordant with radiography. Forty-four were correctly positioned, and 6 were malpositioned. Sonography identified the location of umbilical venous catheters in all 18 cases (100%), umbilical arterial catheters in all 12 (100%), peripherally inserted central venous catheters in 10 (91%), and endotracheal tubes in 9 (100%). CONCLUSIONS: The effectiveness of sonography was excellent for evaluation of umbilical arterial and venous catheters, endotracheal tubes, and peripherally inserted central venous catheters. These results support the goal of further point-of-care training and accreditation to use sonography as a primary modality for complete evaluation of NICU support devices.

eGFR and chronic kidney disease stages among newly diagnosed asymptomatic hypertensives and diabetics seen in a tertiary health center in Nigeria.

OBJECTIVES: Moderate to severe CKD, may be symptomless and therefore may be undetected if effort is not made to assess kidney function. The aim of this study was to determine the eGFR of asymptomatic newly diagnosed hypertensives and diabetics with a view to creating awareness for early screening, evaluation and intervention especially in resource-poor settings where kidney replacement therapy is prohibitive. DESIGN, SETTING, PARTICIPANTS: This is a retrospective study. Records of all hypertensive and diabetic patients referred to the medical clinic were included in the study for analysis. They were considered newly diagnosed if they were just being referred and were not on antihypertensive therapy or had been on therapy only in the last one month. The diagnosis of diabetes mellitus was made according to the guideline of the American Diabetes Association. We included in the analysis patients who had anthropometric measurements and serum creatinine from which we calculated the eGFR. MAIN OUTCOME MEASURES: Use of eGFR and CKD stage in asymptomatic newly diagnosed hypertensives and diabetics. RESULTS: Six hundred and twenty eight patients were included in the study. The mean age (SD) for men and women were 50.19 (12.41) and 48.63 (14.43) respectively. A total of 242 (38.5%) had stage CKD stages 3a, 3b and 4 with a predominance of females: 184 (29.6%) vs 58 (9.2%). There was an association between CKD stage, sex (chi2 = 135.56, P < .001) and age (chi2 = 30.83, P = .01). CONCLUSION: A substantial number of asymptomatic patients with hypertension and diabetes have CKD stages 3 and 4, associated with age and sex, but not with the BP stage. Without a proper evaluation, which includes determination of GFR, significant deterioration of kidney function may be missed and an appropriate intervention may not be instituted.

Development of sustainable interlocking concrete paving blocks using bamboo leaf ash and metakaolin.

Eco-friendly interlocking concrete pavement block was developed using the admixture of bamboo leaf ash and metakaolin. This was done to develop an eco-friendly interlocking paving block for sustainable pavement construction. Bamboo leaf ash and metakaolin were added as a supplementary cementitious material. The supplementary cementitious material (bamboo leaf ash and metakaolin) were admixed and added at 0, 5, 10, 15, 20, 25 and 30 % replacement of cement. The workability of the fresh concrete (slump) at the varied percentage additions, and the mechanical properties of the concrete at 7, 14, 28, and 56 days of curing were assessed, including their microstructural characteristics. The outcome of the research showed that increasing the percentage of (bamboo leaf ash + metakaolin) reduces the workability of the concrete. With a 20 % addition of this cementitious material, the developed fresh concrete became unworkable. In addition, replacing up to 10 % of the concrete in the pavement with bamboo leaf ash and metakaolin increased the mechanical strength of the concrete by 28.7 %. At 30 % a percentage increase of 3.6 % was recorded. However, the strength at 5 % was still adequate for pavement construction with a 13.62 % increase in mechanical strength. The compressive strength at 5 % and 10 % addition of the supplementary cementitious material at maturity met the criteria for constructing a semi-rigid pavement, using IRC standards. The microstructural assessment showed that the number of pores in the mature concrete samples decreased at 10 % addition of bamboo leaf ash and metakaolin. The research data provides construction workers, researchers, and highway engineers with vital information regarding the viability of these sustainable materials for pavement improvement.

Immuno-virologic outcomes and immuno-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in Nigeria.

BACKGROUND: Predictors of immuno-virologic outcomes and discordance and their associations with clinical, demographic, socio-economic and behavioral risk factors are not well described in Nigeria since HIV viral load testing is not routinely offered in public HIV treatment programs. METHODS: The HACART study was a multi-center observational clinic-based cohort study of 2585 adults who started HAART between April 2008 and February 2009. A total of 628 patients were randomly selected at 12 months for immuno-virologic analyses. RESULTS: Virologic suppression rate (<400 copies/ml) was 76.7%, immunologic recovery rate (CD4 change from baseline ≥50 cells/mm3) was 77.4% and immuno-virologic discordance rate was 33%. In multivariate logistic regression, virologic failure was associated with age <30 years (OR 1.79; 95% CI: 1.17-2.67, p=0.03), anemia (Hemoglobin < 10 g/dl) (OR 1.71; 95% CI: 1.22-2.61, p=0.03), poor adherence (OR 3.82; 95% CI: 2.17-5.97, p=0.001), and post-secondary education (OR 0.60; 95% CI: 0.30-0.86, p=0.02). Immunologic failure was associated with male gender (OR 1.46; 95% CI: 1.04-2.45, p=0.04), and age <30 years (OR 1.50; 95% CI: 1.11-2.39, p=0.03). Virologic failure with immunologic success (VL-/CD4+) was associated with anemia (OR 1.80; 95% CI: 1.13-2.88, p=0.03), poor adherence (OR 3.90; 95% CI: 1.92-8.24, p=0.001), and post-secondary education (OR 0.40; 95% CI: 0.22-0.68, p=0.005). CONCLUSIONS: Although favorable immuno-virologic outcomes could be achieved in this large ART program, immuno-virologic discordance was observed in a third of the patients. Focusing on intensified treatment preparation and adherence, young patients, males, persons with low educational status and most importantly baseline anemia assessment and management may help address predictors of poor immuno-virologic outcomes, and improve overall HIV program impact. Viral load testing in addition to the CD4 testing should be considered to identify, characterize and address negative immuno-virologic outcomes and discordance.

Pattern of prescription of anti-hypertensive medications in a tertiary health care facility in Abuja, Nigeria.

INTRODUCTION: Marked changes have been made in the pharmacotherapy of hypertension over the years. In sub-Saharan Africa, hypertension pharmacotherapy is often thought to include only thiazide diuretics, beta blockers and centrally acting medications and, it is unclear if and how often calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers are used. OBJECTIVE: To examine the anti-hypertensive prescription pattern in a tertiary health centre in Nigeria to determine how it conforms to current guidelines. METHOD: 590 newly diagnosed hypertensive patients presenting at the Cardiology Unit of University of Abuja Teaching Hospital over a three-year period were studied. RESULT: Calcium channel blockers were the most frequently prescribed anti-hypertensive medications (66.9% of all cases) and centrally acting medications were prescribed in only 5.01% of cases. Single-pill combination either alone or in combination with other antihypertensive medications were prescribed in 17.3% cases. Of these, calcium channel blocker-based combinations constituted the most frequently used multiple drug combinations. 94.6% of the patients required more than one medication for blood pressure control. CONCLUSION: Anti-hypertensive pharmacotherapy in Abuja, Nigeria, compares favorably with the current recommendations in the prescription pattern of anti-hypertensive medications.

Effect of various hallux valgus reconstruction on sesamoid location: a radiographic study.

BACKGROUND: The correction of sesamoid subluxation is an important component of hallux valgus reconstruction with some surgeons feeling that the sesamoids can be pulled back under the first metatarsal head when imbricating the medial capsule during surgery. The purpose of this study was to radiographically assess the effect of an osteotomy on sesamoid location relative to the second metatarsal. METHODS: This is a retrospective radiographic study review of 165 patients with hallux valgus treated with reconstructive osteotomies. Patients were included if they underwent a scarf or basilar osteotomy for hallux valgus but were excluded if they had inflammatory arthropathy or lesser metatarsal osteotomy. A modified McBride soft tissue procedure was performed in conjunction with the basilar and scarf osteotomies. Each patient's preoperative and postoperative radiographs were evaluated for hallux valgus angle, intermetatarsal 1-2 angle, tibial sesamoid classification, and lateral sesamoid location relative to the second metatarsal. RESULT: The greatest correction of both hallux valgus and intermetatrsal 1-2 angle was achieved in basilar osteotomies (20.6 degrees and 9.7 degrees, respectively), then scarf osteotomies (14.4 degrees and 8.7 degrees, respectively). Basilar and scarf osteotomies both corrected medial sesamoid subluxation relative to the first metatarsal head an average of 2-3 classification stages. All osteotomies had minimal lateral sesamoid location change relative to the second metatarsal. CONCLUSION: The majority of sesamoid correction correlated with the intermetatarsal 1-2 correction. The concept that medial capsular plication pulls the sesamoids beneath the first metatarsal (ie, changes the location of the sesamoids relative to the second metatarsal) was not supported by our results. LEVEL OF EVIDENCE: Level III, retrospective case series.

Public perceptions of vehicular traffic emissions on health risk in Lagos metropolis Nigeria: A critical survey.

The perception and behavior of the public is key in reducing Traffic-related air pollution health burdens which has become an increasingly alarming problem in many cities across the globe. The study assessed the perception of the public about vehicle traffic emissions and the health hazard associated with them in Lagos, Nigeria using structured questionnaires. Multivariate statistical analysis and structural equation modeling were performed to determine the factors that were associated with the participant's perception of traffic air pollution and the health risks it presents. The findings revealed the majority (78.9%) of the respondents were aware of the haze air pollution from vehicles and its adverse effects on health. The regression model showed a significant relationship between age, education status, employment status, road proximity, vehicle ownership and air pollution awareness (P < 0.05). However, the structural equation model SEM revealed that age, gender, marital status, education, employment status, and road proximity showed statistical significance (p < 0.05) and indicated a linear relationship to vehicular emissions perception. The findings suggest the need to increase public education for all ages and especially for roadside residents on the effects of prolonged exposure and long-term effects of transport-related air pollution and associated risk. The result is applicable in many developing cities, especially in Sub-Saharan Africa.

Cardiovascular Risk Factor Burden and Association With CKD in Ghana and Nigeria.

Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD); however, the burden of cardiovascular risk factors in patients with CKD in Africa is not well characterized. We determined the prevalence of selected cardiovascular risk factors, and association with CKD in the Human Heredity for Health in Africa Kidney Disease Research Network study. Methods: We recruited patients with and without CKD in Ghana and Nigeria. CKD was defined as estimated glomerular filtration rate of <60 ml/min per 1.73 m2 and/or albuminuria as albumin-to-creatinine ratio <3.0 mg/mmol (<30 mg/g) for ≥3 months. We assessed self-reported (physician-diagnosis and/or use of medication) hypertension, diabetes, and elevated cholesterol; and self-reported smoking as cardiovascular risk factors. Association between the risk factors and CKD was determined by multivariate logistic regression. Results: We enrolled 8396 participants (cases with CKD, 3956), with 56% females. The mean age (45.5 ± 15.1 years) did not differ between patients and control group. The prevalence of hypertension (59%), diabetes (20%), and elevated cholesterol (9.9%), was higher in CKD patients than in the control participants (P < 0.001). Prevalence of risk factors was higher in Ghana than in Nigeria. Hypertension (adjusted odds ratio [aOR] = 1.69 [1.43-2.01, P < 0.001]), elevated cholesterol (aOR = 2.0 [1.39-2.86, P < 0.001]), age >50 years, and body mass index (BMI) <18.5 kg/m2 were independently associated with CKD. The association of diabetes and smoking with CKD was modified by other risk factors. Conclusion: Cardiovascular risk factors are prevalent in middle-aged adult patients with CKD in Ghana and Nigeria, with higher proportions in Ghana than in Nigeria. Hypertension, elevated cholesterol, and underweight were independently associated with CKD.

Prevalence of metabolic syndrome among hypertensive patients in Abuja, Nigeria.

BACKGROUND: It is well known that factors like high blood pressure, hyperglycemia, dyslipidemia, obesity and hyperuricemia tend to cluster together giving rise to what is called metabolic syndrome. In spite of the high prevalence of hypertension in Nigeria, there is a dearth of data describing the prevalence of metabolic syndrome in Nigerian hypertensive patients. We therefore set out to look at the prevalence of metabolic syndrome in hypertensive patients presenting to the cardiology clinic of a tertiary institution in Abuja, Nigeria. METHODS: Metabolic syndrome was defined in patients according to the World Health Organisation's definition. RESULTS: Of the 362 patients studied, 56.9% were male and 43.1% were female. The mean age was 51.80 +/- 11.63 years, mean duration of hypertension was 8.90 +/- 3.95 years, mean body mass index was 29.36 +/- 6.12 kg/m2 and mean arterial blood pressure was 110.28 +/- 18.17 mm Hg. Overall, 13.0% of the study population had metabolic syndrome; 16.7% of females and 10.2% of males. CONCLUSION: The prevalence of metabolic syndrome among hypertensive patients in Abuja, Nigeria is comparable to rates observed in some general populations in Europe. This might imply the epidemiological transition in disease pattern already being experienced in many parts of sub-Saharan Africa.

Knowledge and practice of post-exposure prophylaxis (PEP) against HIV infection among health care providers in a tertiary hospital in Nigeria.

OBJECTIVE: To assess the knowledge and practice of post exposure prophylaxis (PEP) against HIV infection among health care providers in University of Abuja Teaching Hospital (UATH). METHODS: A cross-sectional survey conducted on 230 health care providers in UATH. RESULTS: Majority (97.0%) of the respondents have heard about PEP, but only a few (30.9%) of them could correctly identify the drugs used and duration of PEP. A third of respondents have had one form of accidental exposure or the other. HIV test was carried out in about two-thirds (64.8%) of the source patients. Thirteen (28.3%) of the source patients were HIV-positive. Of the 13 respondents that were exposed to HIV-positive patients, only 3 (23.1%) received PEP, and these three completed PEP, while majority, 10/13 (76.9%) did not receive PEP in spite of their exposure to HIV-positive sources. CONCLUSION: The study shows that the knowledge and practice of PEP among health care providers are very poor.

Blood Pressure Control and its Determinants among Patients with Chronic Kidney Disease in a Nigerian Tertiary Hospital: A Cross-Sectional Study.

Background: Hypertension is a common cardiovascular risk factor associated with adverse renal and cardiovascular outcomes in chronic kidney disease patients. Significant reduction in these adverse outcomes could be achieved through adequate blood pressure control in those with hypertension. This study aimed to determine the prevalence of poor blood pressure control and associated factors among chronic kidney disease patients with hypertension in a Nigerian tertiary hospital. Methodology: This was a cross-sectional study that determined the prevalence of poor blood pressure control and its associated factors among chronic kidney disease patients with hypertension. Poor blood pressure control was defined as blood pressure ≥ 140/90mmHg. Factors associated with blood pressure control were determined on multivariate analysis. P-value less than 0.05 was considered significant. Results: A total of 494 chronic kidney disease patients with hypertension were studied. The mean age of patients was 48.77+13.06 with a range of 17-95 years. There were 303 (61.3%) males and 191 (38.7%) females. A total of 44.5% of the patients had end-stage renal disease while all patients were on antihypertensive medications. The common causes of chronic kidney disease were hypertension (35%), diabetes mellitus (26.5%), and chronic glomerulonephritis (12.1%).Poor blood pressure control was found in 74.4% of chronic kidney disease patients. The predictors of poor blood pressure control were age (AOR: 0.65; CI: 0.45-0.94; p=0.02), use of multiple anti-hypertensives (AOR: 1.99; CI: 1.36-2.90; p=<0.001) and the presence of significant proteinuria (AOR: 1.47; CI: 1.02-2.14; p=0.04). Conclusion: The majority of patients with chronic kidney disease had poor blood pressure control. Those who were young had significant proteinuria, and those who used≥ 3 antihypertensive medications were more likely to have poor blood control. There is a need to optimize BP management in chronic kidney disease patients in order to reduce adverse outcomes.

Resistivity index in the diagnosis and assessment of loss of renal function in diabetic nephropathy.

OBJECTIVE: The aim of this study was to determine the haemodynamics of the intrarenal arteries from the relationship between resistivity index (RI) and kidney function, and to identify the predictors of high RI among patients with diabetic nephropathy (DN) and those with diabetes mellitus (DM) without DN. METHODS: This was a cross-sectional survey of 133 participants, comprising 40 subjects with DM without DN, 53 with DM with DN and 40 healthy controls. Information obtained was demographics, lifestyle, medical and medication histories, while anthropometric and blood pressure measurements were taken. Albuminuria and estimated glomerular filtration rate were determined and RI was measured using a Doppler ultrasound scan. RESULTS: The mean intrarenal artery RIs were higher among the patients with DM without DN (0.60 ± 0.04) and the group with DM with DN (0.61 ± 0.04) than in the controls (0.56 ± 0.04) (p = 0.02). Glycated haemoglobin (HbA1c) predicted high RI in the DM without DN group (OR 2.81; CI: 1.73-9.03) while hypertension (OR 3.60; CI: 1.06-12.22) predicted high RI in the DM with DN group. CONCLUSIONS: Elevated intrarenal artery RI was prevalent among patients with DM without DN and those with DM with DN, while elevated HbA1c level and hypertension predicted elevated RI in subjects with DM without DN and those with DM with DN.

Fibroblast Growth Factor 23 (FGF 23) and intact parathyroid hormone (iPTH) as markers of mineral bone disease among Nigerians with non-diabetic kidney disease.

Background: Excess cardiovascular burden in patients with chronic kidney disease (CKD) has been attributed to the occurrence of CKD-Mineral Bone Disease (CKD - MBD). This study aimed to determine the spectrum of CKD-MBD among Nigerians with CKD using Fibroblast Growth Factor 23 (FGF 23) and intact Parathyroid Hormone (iPTH). Methods: Cross sectional survey of 105 patients with non-diabetic CKD and 104 controls. Information obtained were demographics, aetiology of CKD, features of CKD-MBD. Serum iPTH and FGF 23 were assayed. Results: The mean ages were 48.7±15.3 vs 48.6±17.4 years while 54.7% and 45.2% were males for cases and controls, respectively. The mean plasma FGF 23 (392.8±35.3 vs 133.8±22.7 RU/mL and plasma iPTH (289±25.6 vs 118±10.8 ng/L, respectively. The frequency of elevated FGF 23 (45.7% vs 24.0%, p<0.01) and abnormal iPTH (53.3% vs 14.1%, p- 0.01) were higher in cases. The prevalence of MBD were (59.0% vs 14.4%, p<0.01) in cases and controls while dialysis status OR 2.94, 95% CI (1.2803-5.3645), and elevated FGF 23 OR, 1.87, 95% CI (1.1782-5.4291) were associated with CKD-MBD. Conclusion: The study demonstrated high prevalence of CKD-MBD among patients with non-diabetic CKD while FGF23 and iPTH were useful assays in the diagnosis of CKD-MBD among Nigerians with CKD.

Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes.

BACKGROUND: Chorioamnionitis is a risk factor for fetal and neonatal outcomes. Therefore, predicting histological chorioamnionitis (HCA) and neonatal outcomes using clinical parameters could be helpful in management and preventing morbidities. OBJECTIVE: To determine if parameters of clinical chorioamnionitis (CCA) would be associated with HCA and neonatal outcomes. STUDY DESIGN: In this cohort study using a retrospective design, we analyzed the performance of signs of CCA in predicting HCA, and neonatal outcomes. Data were extracted from the electronic health record for all neonates with documented CCA delivered at our institution from 2011 to 2016. We compared our findings based on the old ACOG definition of CCA and the new definition released in 2017 - maternal fever plus any of fetal tachycardia, maternal leukocytosis, and purulent vaginal discharge. Maternal tachycardia and uterine tenderness were removed from the new criteria. Neonatal laboratory samples on admission, 12 h and 24 h were used to define the three time points of neonatal suspected sepsis. RESULTS: There were 530 mothers-infant dyads with chorioamnionitis. Seventy-three were preterm, and 457 were term. Eighty-eight percent of the preterm mothers had CCA, and HCA was present in 62.5% of 72 preterm placentas. Preterm infants with placental HCA significantly had lower birth weight, gestational age, placental weight, and more infants with lower 5-minute Apgar scores, compared to those with no HCA. In preterm infants, maternal urinary tract infection was significantly associated with decreased odds for HCA (OR 0.22, CI 0.10 - 0.71). More preterm babies with suspected sepsis criteria at the 3 time points had HCA (all p ≤ .01). In the term cohort, 95.4% and 65.6% had CCA and HCA, respectively. In term infants (n = 457), maternal leukocytosis (p = .002) and prolonged rupture of membranes (PROM; p = 002) were associated with HCA. Suspected sepsis was associated with PROM (p = .04), HCA (p = .0001), and maternal leukocytosis (p ≤ .05) in at least 1 of the 3 time points. CONCLUSION: Though maternal leukocytosis was significantly associated with the presence of HCA in the term cohort, there were no CCA criteria that accurately predicted presence of HCA in either the preterm or the term infants.

Ionothermal synthesis of activated carbon from waste PET bottles as anode materials for lithium-ion batteries.

Waste polyethylene terephthalate (PET) bottles have become a significant post-consumer plastic waste with attendant environmental problems. Hence, ionothermal synthesis has been used to prepare activated carbon (AC) anode materials from waste PET for both high performance and sustainable lithium-ion batteries (LIB). Particularly, using choline chloride deep eutectic salts (CU-DES) does not require post-synthesis washing and thereby reduces the complexity of the process and produces materials with unique low-surface area, higher levels of graphitization/ordering, and high nitrogen doping in the obtained ACs. The results show that the AC produced using CU-DES (PET-CU-A-ITP2) gave good electrochemical performance. Even though the material possesses a low surface area (∼23 m2 g-1), it displays a gravimetric capacity (GC) of ∼460 mA h g-1 and a coulombic efficiency (CE) of ∼53% in the 1st cycle and very good cycling performance with a capacity retention of 98% from the 2nd to the 100th cycle. The superior electrochemical performance of the PET-CU-A-ITP2 anode was found to be due to its better graphitization/ordering and dense structure which results in higher capacity, formation of less solid electrolyte interphase, and higher CE. These results show that dense carbons can be exploited as high-performance anodes in LIBs. Also, this research presents both a pathway for waste PET management and a waste-energy approach that could offer cheaper and greener LIBs to meet the sustainable development goals.

Functional bioactive compounds in ginger, turmeric, and garlic.

Nutrition plays a very important role in the health promotion of individuals and brought about a global paradigm shift from pharmaceuticals to nutraceuticals. This is due to the high cost, non-availability, and side effects associated with the unregulated consumption of pharmaceuticals. Over the ages, nutraceuticals from food products were reported to contain bioactive compounds with great health and physiological benefits. This report reviews bioactive compounds in selected foods namely ginger (Zingiber officinale), turmeric (Curcuma longa), and garlic (Allium sativum) as potential natural therapeutics for ailments of cancer and heart-related diseases. Analytical profiles, functional activities, and characterization of these compounds were discussed with possible recommendations for the prospective treatment of diseases using these nutraceuticals.