Changes in Selected Renal Function Parameters of Newly Admitted COVID-19 Patients from One Infectious Diseases Center in Ibadan, Nigeria: Indication for Immunopathology.

COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) enters the host cells through attachment to the Angiotensin Converting Enzyme-2 receptors (ACE-2) on the host cells. ACE-2 is known to affect renal functions, vasoconstriction and fluid homeostasis. Thus, the impact of SARS-CoV-2 infection on renal functional parameters is worth investigating. Plasma obtained from whole blood samples collected from newly diagnosed COVID-19 patients were analysed for albumin, urea, creatinine, Na, K, Cl and HCO3 using auto analysers. All newly diagnosed patients were immediately admitted for managed at the Infectious Disease Center, Olodo in Ibadan the capital of Oyo State, South Western Nigeria. The results obtained were evaluated to determine the frequency of derangements in the renal parameters of patients with the COVID-19 disease. It was observed that 57.1%, 37.8%, 32.7%, 28.1%, 18.7%, 17.8% and 3.4% of newly diagnosed COVID-19 patients had values of Cl, creatinine, albumin, Na, K, HCO3 and urea respectively outside the reference ranges. While 43.3%, 4.7%, 2.5%, 2.5%, 2.0%, 1.7% and 1.0% of COVID-19 patients had values of Cl, creatinine, Na, K, albumin, Urea and HCO3 respectively above the reference ranges. Of all admitted patients, 33.1%, 30.7%, 25.6%, 16.8%, 16.3%, 13.8% and 1.7% had creatinine, albumin, Na, HCO3, K, Cl and urea values respectively below reference ranges. The changes in renal function parameters of newly diagnosed COVID-19 patients portend that renal failure is imminent in poorly managed COVID-19 patients and this has immunopathology implications during SAR-COV-2 infection.

Sars-Cov-2 Infection Screening Using Two Serological Testing Methods.

The challenges associated with adequate deployment of nucleic acid amplification tests (NAATs) in developing countries underscores the important role of simple but sensitive and specific serological testing kits in COVID-19 diagnosis. Presently, there are a number of point-of-care tests for Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) screening. However, the reliability of these test kits is poorly documented and hence, needs to be ascertained. This study was therefore designed to determine the sensitivity and specificity of two serological test kits for COVID-19 screening with the view to providing necessary information on the suitability of their deployment as routine test kits for SARS-CoV-2 in Nigeria. Forty-seven (47) asymptomatic adults who had been tested for SARS-CoV-2 with the real-time reverse-transcriptase polymerase-chain reaction (RT-PCR) were enrolled into this study. Blood samples were obtained for qualitative determination of serum IgM and IgG antibodies to the S-antigen of SARS-CoV-2 using a commercially available IgM and IgG Rapid Diagnostic Test (RDT) and enzyme linked immunosorbent assay (ELISA). The association between the test kits (ELISA and RDT) and PCR in diagnosing COVID-19 was determined using the Fisher's Exact test at P<0.05. The sensitivity and specificity of the test kits were determined using ROC while the Positive Predictive Value (PPV), Negative Predictive Value (NPV), Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR), Diagnostic Odds Ratio (DOR) and accuracy were calculated as appropriate. Twenty-eight (59.6%) of the study participants had positive PCR result. ELISA and RDT identified 20 (42.6%) and 13 (27.7%) participants respectively as having anti- SARS COV-2 specific antibodies. ELISA had a better sensitivity performance, NPV, PLR, DOR and accuracy than the RDT while the RDT had a better specificity performance than ELISA. The proportion of participants with anti-SARS-CoV-2 IgM antibody identified using ELISA was significantly higher compared with RDT. In contrast, the proportion of participants with positive anti- SARS COV-2 IgG antibody identified using RDT was significantly higher compared with ELISA. ELISA has a better sensitivity for detecting anti-SARS-CoV-2 Spike-protein specific antibodies than the RDT. However, combination of RDT and ELISA for the detection of anti-SARS-COV-2 antibodies might be useful for population COVID-19 screening.

Older persons' perceptions about advanced directives and end of life issues in a geriatric care setting in Southwestern Nigeria.

INTRODUCTION: Advanced directives enable the planning of care and support services independent of the older person's ability to make the decision. There is a paucity of information regarding the views and preferences regarding advanced directives and other end of life issues among older persons in low and middle-income countries such as Nigeria. The study aimed to explore the knowledge, attitude and belief of older persons regarding decision making surrounding end of life and advance directives. METHODS: Data were collected through focus group discussions at a monthly social gathering of outpatients in a geriatric center in Oyo State, Nigeria. Discussions were audiotaped, transcribed and analyzed manually using a thematic approach. RESULTS: Respondents' knowledge about the end of life care and advanced directives as prescribed in high income settings were sparse and did not include choices about treatment options or any medical directives. The predominant perceptions among the participants bordered mainly on the arrangements for place of death, burial and property sharing. Participants listed in order of preference the major decision makers in the advanced directive process mainly, the oldest male child, religious leaders and legal practitioners. CONCLUSION: Our findings imply the need for improving knowledge and awareness about the benefits of advanced directives among older persons with a focus on opportunities for their active participation.