Efficacy and safety of Mojeaga remedy in combination with conventional oral iron therapy for correcting anemia in obstetric population: A phase II randomized pilot clinical trial.

BACKGROUND: To our knowledge, there is no prior randomized trial on the efficacy of Mojeaga remedy (a special blend of Alchornea cordifolia, Pennisetum glaucum and Sorghum bicolor extracts) when co-administered with standard-of-care for correction of anemia in obstetrics practice. This study determined the efficacy, safety and tolerability of Mojeaga as adjunct to conventional oral iron therapy for correction of anemia in obstetric population. METHODS: A pilot open-label randomized clinical trial. Participants with confirmed diagnosis of anemia in three tertiary hospitals in Nigeria were studied. Eligible participants were randomized 1:1 to either Mojeaga syrups 50 mls (200mg/50mls) administered three times daily in conjunction with conventional iron therapy (Mojeaga group) for 2 weeks or conventional iron therapy alone without Mojeaga (standard-of-care group) for 2 weeks. Repeat hematocrit level were done 2 weeks post-initial therapy. Primary outcome measures were changes in hematocrit level and median hematocrit level at two weeks post therapy. Maternal adverse events and neonatal outcomes (birth anomalies, low birthweight, preterm rupture of membranes and preterm labor) were considered the safety outcome measures. Analysis was by intention-to-treat. RESULTS: Ninety five participants were enrolled and randomly assigned to the Mojeaga group (n = 48) or standard-of-care group (n = 47). The baseline socio-demographic and clinical characteristics of the study participants were similar. At two weeks follow-up the median rise in hematocrit values from baseline (10.00±7.00% vs 6.00±4.00%;p<0.001) and median hematocrit values (31.00±2.00% vs 27.00±3.00%;p<0.001) were significantly higher in the Mojeaga group. There were no treatment-related serious adverse events, congenital anomalies or deaths in the Mojeaga group and incidence of other neonatal outcomes were similar (p>0.05). CONCLUSION: Mojeaga represents a new adjuvants for standard-of-care option for patients with anemia. Mojeaga remedy is safe for treating anemia during pregnancy and puerperium without increasing the incidence of congenital anomalies, or adverse neonatal outcomes. CLINICAL TRIAL REGISTRATION: www.pactr.samrc.ac.za: PACTR201901852059636 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5822).

A 7-year review of medical admission profile for clinical diseases in an intensive care unit of a low-resource setting.

Objective: Various patients needing organ or systemic support and close monitoring are routinely managed in the intensive care unit. This includes patients that emanate from various sources, like the trauma unit, emergency department, inpatient wards, and post-anesthesia care unit. Admissions into the intensive care unit due to medical conditions have not been analyzed in our environment to determine the common indications and the outcome. We aimed to determine the pattern of medical admissions and outcomes in the intensive care unit. Method: A retrospective study of all patients admitted to the intensive care unit of Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria, from January 1, 2014 to December 31, 2020, with medical diagnosis was conducted. Data were retrieved from the intensive care unit admission and discharge registers and analyzed using the Statistical Package for Social Sciences (SPSS) Version 20 (IBM Corp., Chicago, Illinois, USA). Results: Eighty-nine medical patients were admitted, which accounted for 7.63% of the total intensive care unit admissions of 1167 patients during the period, with a preponderance of males (57.3%). The most common medical condition for intensive care unit admission (31.5%) was a cerebrovascular accident. The mean length of stay was found to be 5.13 ± 3.42 days. Mortality following medical intensive care unit admission was 56.18%, which contributed to about 11.4% of the total ICU mortality. Conclusion: When compared to all other reasons for admission to a general intensive care unit, medical conditions account for a small percentage. The most frequent illness was a cerebrovascular accident.

Hypertension in HAART-naϊve HIV Subjects in Southeast Nigeria: A single-Center Study.

Background: Hypertension is a major healthcare problem in Nigeria with a probable prevalence of 36.6%. Human immunodeficiency virus (HIV) infection is a global healthcare problem. The factors which influence hypertension in HIV subjects have not been completely identified. The study aimed to determine the prevalence of hypertension and the factors which might influence hypertension in HAART-naïve HIV subjects. Methodology: This was a cross-sectional study involving 393 treatment-naïve HIV subjects and 136 age and sex-matched HIV seronegative controls. Anthropometric and demographic data were obtained, blood pressure measurements and other relevant investigations were performed. Hypertension was defined here as systolic blood pressure (SBP) ≥ 140mmHg and diastolic blood pressure (DBP) ≥ 90mmHg. Hypertension was compared between the HIV subjects and the non-HIV control. The association of the variables with hypertension in HIV subjects were determined. Results: The mean age of the HIV subjects was 39±11 years. Females were 282(72.0%) and males 110(28.0%). The prevalence of hypertension was 23.7% in HIV subjects and 31.6% in the non-HIV control. The prevalence of hypertension was 17.2% in HIV subjects with high density lipoprotein cholesterol (HDL) <1.0mg/dl and this was significantly lower than the prevalence of hypertension of 27.1% in those whose serum HDL was ≥ 1.0mg/dl. There was no significant association between hypertension and 24-hour urine osmolality (24HUOsm) (p=0.094), body mass index (BMI) (p=0.572), 24-hour urine protein (24HUP) (p=0.606), serum total cholesterol (p=0.628), serum low density lipoprotein cholesterol (LDL) (p=0.116), triglyceride (TG) (p=0.925), Systolic blood pressure had a significant correlation with serum HDL, (r=0.114, p=0.024). Similarly, CD4 cell count correlated significantly with DBP (r=0.123, p=0.012. Serum HDL (p=0.0.024) and CD4 cell count (p=0.012) predicted hypertension in HIV subjects. Conclusion: The prevalence of hypertension of 23.7% in HIV subjects was high in this study. Low CD4 cell count and low serum HDL were predictors of hypertension in HIV subjects.

Vitamin D and Acute Respiratory Infections in Children.

Background: This study sought to evaluate the association between serum vitamin D levels and acute respiratory infection (ARI) in under-five children in Nnamdi Azikiwe University Teaching Hospital (NAUTH) in Nigeria. Methodology: This study was conducted in NAUTH, Nigeria, in 2017, in 250 children with ARI, classified into those with acute upper respiratory infection (AURI) and those with acute lower respiratory infection (ALRI). and 250 children without ARI, matched for age and gender. Sociodemographic data and serum vitamin D were obtained. The data were compared between the study and the control groups. The data were compared between those with AURI and those with ALRI. Results: The mean serum 25(OH)D of (52.2±25.6 ng/ml) in the study subjects was lower than the (57.0±23.9 ng/ml in the control group (t=2.20, p=0.03).The mean serum 25(OH)D levels in children with ALRI [39.8±23.8 ng/ml] was lower than in those with AURI [56.0±24.9ng/ml] (t= 14.83, p <0.001). In addition, the association between low levels of serum 25(OH)D and severity of ALRI was significant (x2 = 9.45, p = 0.002). Conclusion: In under-five children, serum vitamin D levels were low, and these low levels were associated more with ALRIs than AURIs in this study.

Biochemical changes in tuberculosis.

INTRODUCTION: tuberculosis (TB) remains a global health issue with high morbidity and mortality rates especially in the developing countries. It is a multi-organ disease and can influence biochemical changes. This study sought to determine the influence of tuberculosis and its drug treatment on serum biochemical parameters in patients in Nigeria. METHODS: it was a descriptive observational cohort study on 150 subjects whose blood samples were analyzed for serum albumin, serum sodium, and serum potassium. The subjects were grouped into 3: TB group= 50 new TB subjects not on treatment, F group= 50 TB subjects on treatment for 2/12 or more and C group= 50 non-TB control subjects. These biochemical variables were compared between the 3 groups. RESULTS: male/female ratio was 1: 1.5, mean age 37.1±0.92 years, and range 18-65 years. The differences in mean values of serum albumin, calcium and sodium between the three groups were significant (p<0.001), whereas that of serum potassium was not significant (p=0.056). Those patients with new case TB had a significantly lower serum sodium, serum albumin and serum calcium than the control group and those on treatment, p<0.001. There was significant positive correlation between serum albumin and serum calcium (r=0.0.420, p<0.001) as well as serum sodium (r=0.310, p<0.001) in the study population. Similarly, the correlation between serum calcium and serum sodium was positive and significant (r=0.200, p=0.014). In contrast, the correlation between serum potassium and serum albumin and that between serum potassium and serum calcium was not significant. CONCLUSION: tuberculosis with or without anti-tuberculous medications was associated with significant reduction in serum albumin, serum sodium and serum calcium in this study.

Minor Blunt Injury-induced Rhabdomyolysis from a Road Traffic Accident in Nigeria.

Rhabdomyolysis, though not a common complication of minor blunt trauma, may result in life-threatening acute kidney injury (AKI). Here is illustrated a case of a young male who sustained minor blunt injuries in a road traffic accident, which he overlooked and presented with features of severe AKI. The patient is a 24-year-old male, who presented with progressive weakness, difficulty in walking, and features of uremia, 14 days after he sustained minor blunt injuries and lacerations in a road traffic accident. Evaluation showed elevated serum creatine kinase, serum myoglobin, and severe azotemia. He was commenced on hemodialysis. He was also commenced on antibiotics, analgesic, and 5% dextrose/saline. He had three sessions of hemodialysis on alternate days. His condition improved remarkably after the first session of dialysis. He was discharged after 18 days on admission. Follow-up in the clinic showed a normal renal function. This case report shows rhabdomyolysis from minor blunt injuries sustained in a road traffic accident and complicated by severe AKI. The patient almost recovered full renal function with management.

Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria.

BACKGROUND AND OBJECTIVES: Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgerypatients in Nigeria. METHODOLOGY: This was a prospective study in patients booked for surgery in 2014. Biodata, medical his tory, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined. RESULTS: The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p< 0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05). CONCLUSION: The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnormally low percentage predicted FEV1 and FVC were associated with PPCs.