Bone Mineral Density and Vitamin D Status in Nigerians: The Impact of HIV.

BACKGROUND: Both HIV infection and antiretroviral therapy (ART) may be associated with metabolic complications including bone loss. To further inform guidance on screening and treatment of bone disease, we evaluated the impact of HIV and ART on vitamin D (VD) levels and bone mineral density (BMD) among HIV-infected and uninfected Nigerians. METHODS: We carried out a cross-sectional study of HIV-infected participants and uninfected matched controls, who were recruited from a large clinical site in Jos, Nigeria. Calcaneal ultrasonography was used to assess BMD. VD levels were determined using electrochemiluminescence binding assay, with vitamin D deficiency (VDD) defined as <25 ng/ml. RESULTS: There were 241 participants (61 ART-experienced, 60 ART-naïve, and 120 HIV-uninfected), and the mean age was 39±10 years; 66% were female. VDD was present in 70.5% (95% CI:64.3­76.2%) of all participants; occurring in 70.0% of ART-experienced, 73.0% of ART-naïve and 69.0% of HIV-uninfected controls (p = 0.84). Overall, the prevalence of low BMD was 21.1% (95% CI: 16.1­26.8%); being present in 24.5% of ART-experienced, 26.6% of ART-naïve and 16.6% of HIV-uninfected controls (p = 0.22). Only female sex (OR 6.82; 95% CI:1.93­24.0, p <0.001) was significantly associated with low BMD in the HIV group. No HIV-specific factor including ART use and type was associated with low BMD. CONCLUSION: VDD and low BMD are both prevalent among HIV-infected and uninfected individuals in Nigeria. HIV, ART use, and VDD were not associated with low BMD.

CONTEXTE: L'infection par le VIH et la thérapie antirétrovirale (ART) peuvent être associées à des complications métaboliques, y compris la perte osseuse. Afin d'éclairer davantage les conseils sur le dépistage et le traitement des maladies osseuses, nous avons évalué l'impact du VIH et de la thérapie antirétrovirale sur les niveaux de vitamine D (VD) et la densité minérale osseuse (DMO) chez les Nigérians infectés et non infectés par le VIH. MÉTHODES: Nous avons mené une étude transversale auprès de participants infectés par le VIH et de témoins appariés non infectés, recrutés dans un grand centre clinique de Jos, au Nigeria. L'échographie calcanéenne a été utilisée pour évaluer la DMO. Les taux de vitamine D ont été déterminés à l'aide d'un test de liaison par électrochimiluminescence, la carence en vitamine D étant définie comme <25 ng/ml. RÉSULTATS: Il y avait 241 participants (61 ayant déjà reçu un traitement antirétroviral, 60 n'ayant jamais reçu de traitement antirétroviral et 120 non infectés par le VIH), et l'âge moyen était de 39±10 ans ; 66% étaient des femmes. La DMV était présente chez 70,5 % (IC 95 % : 64,3-76,2 %) de tous les participants ; elle était présente chez 70,0 % des personnes ayant déjà reçu un traitement antirétroviral, 73,0 % des personnes n'ayant jamais reçu de traitement antirétroviral et 69,0 % des témoins non infectés par le VIH (p = 0,84). Globalement, la prévalence d'une faible DMO était de 21,1 % (IC à 95 % : 16,1-26,8 %) ; elle était présente chez 24,5 % des personnes ayant déjà reçu un traitement antirétroviral, 26,6 % des personnes n'ayant jamais reçu de traitement antirétroviral et 16,6 % des témoins non infectés par le VIH (p = 0,22). Seul le sexe féminin (OR 6,82 ; 95% CI:1,93-24,0, p <0,001) était significativement associé à une faible DMO dans le groupe VIH. Aucun facteur spécifique au VIH, y compris l'utilisation et le type d'ART, n'a été associé à une faible DMO. CONCLUSION: La DMV et la faible DMO sont prévalentes chez les personnes infectées ou non par le VIH au Nigéria. Le VIH, l'utilisation d'un traitement antirétroviral et la DMV ne sont pas associés à une faible DMO. Mots-clés: Densité minérale osseuse, VIH, Ostéopénie, T-score, Vitamine D.

Knowledge, attitudes and practices towards Covid-19 among Nigerian healthcare workers during the Covid-19 pandemic: A single centre survey.

BACKGROUND: The COVID-19 pandemic has led to hundreds of thousands of deaths worldwide. AIMS: Being a novel viral disease, we sought to evaluate the knowledge and practice of doctors and nurses in a tertiary hospital regarding the disease. SUBJECTS AND METHODS: Using a self-administered questionnaire, respondents were asked questions on the cause, clinical features, and prevention of COVID-19. RESULTS: : We studied 409 respondents (238 doctors and 171 nurses) with a mean age of 34 ± 7 years and a median length of experience of five (IQR 2-9) years. The mean knowledge score was 9.6 ± 1.2 out of a maximum of 12 points with 337 (82.4%) respondents having good knowledge. The majority of respondents (62.8%) had not been trained on infection prevention and control since the outbreak of the pandemic. Only 95 (23.2%) had seen COVID-19 Standard Operating Procedures (SOP) displayed in the hospital. The use of the personal protective equipment (PPE) kit comprising the N-95 mask, face shield, gown, and shoes was seen by 194 (47.4%) respondents in recent times. A total of 397 (97.0%) respondents felt they were at an increased risk of contracting COVID-19 relative to the general populace. Measures taken to prevent COVID-19 included: wearing of face mask (68.7%), hand gloves (78.2%), frequent use of hand sanitizers (84.1%), frequent hand washing (84.8%), the daily wash of uniforms and ward coats (44.5%), daily cleaning of footwear (31.7%), and avoidance of taking home clothing and footwear worn in the hospital (54.2%). CONCLUSION: Despite having good knowledge of transmission and clinical features of SARS-CoV 2, the utilization of protective measures by HCW in this study is unsatisfactory.

Risk Factors for Chronic Kidney Disease in Newly Diagnosed Hypertensive Subjects in Southeast Nigeria.

BACKGROUND: The aim of this study was to determine the prevalence and associated risk factors for chronic kidney disease (CKD) in newly diagnosed hypertensive patients. MATERIALS AND METHODS: This was a cross-sectional analytical study involving consenting newly diagnosed hypertensive patients who presented at GOPD of Federal Medical Centre, Umuahia, within 0-3 months of diagnosis; and non-hypertensive controls. A semi-structured interviewer- administered questionnaire was used to record the socio-demographic, anthropometric, clinical and bio-chemical characteristics of the respondents. Data were analyzed and compared between the hypertensive group and the non-hypertensive control group. RESULTS: Two hundred and sixty participants took part in the study. However, only 240 completed the study (120 hypertensive, and 120 control participants). After follow-up for 3 months, 42 (35.0%) hypertensive patients had CKD compared to 11 (9.2%) of the non-hypertensive control group. The prevalence of CKD in the hypertensive participants was significantly higher (2=23.27, p<0.001). Multivariate regression analysis of CKD with variables in the hypertensive study group showed an association between CKD and sex (p=0.020), serum triglycerides (p=0.030) as well as serum uric acid (p=0.030). In the control group there was significant association between CKD and sex (p=0.020), serum total cholesterol (p=0.030) as well as serum uric acid (p=0.030). CONCLUSION: The prevalence of CKD among newly diagnosed hypertensives in southeast Nigeria was high. In this group, CKD had an association with sex, serum uric acid and serum triglyceride.

Blood pressure control and kidney damage in hypertension: Results of a three-center cross-sectional study in North Central Nigeria.

BACKGROUND: Hypertension is one of the commonest cause of chronic kidney disease (CKD) in Nigerians. We describe blood pressure (BP) control and kidney disease markers in patients with hypertension as part of measures to curb the burden of this chronic debilitating disease. METHODS: Patients with hypertension in the main tertiary hospitals in three states in north central Nigeria were evaluated for indicators of CKD, including proteinuria and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Patients had their early morning first void urine tested for proteinuria using Combi-10 test strips. eGFR was estimated using the MDRD equation. RESULTS: A total of 1063 subjects (63.1% females and 36.8% males) with a mean age of 55 ± 11 years were studied. Diabetes mellitus (DM) was present in 214 (20.6%) and 422 (39.7%) had optimal BP control. The median duration of hypertension was 6 years (range 1-44 years). Proteinuria occurred in 130 (12.2%), while 212 (19.9%) had reduced eGFR and 46 (4.3%) had proteinuria and reduced eGFR. The use of calcium channel blockers [adjusted odds ratio (AOR): 0.70, 95% Confidence Interval (CI) 0.50-0.99] and the use of more than two antihypertensive medications (AOR: 0.62, 95% CI 0.40-0.96) were associated with reduced odds of optimal BP control. Male sex (AOR: 1.75, 95% CI 1.14-2.70) and the use of renin-angiotensin-aldosterone system blocking medications (AOR: 2.07, 95% CI 1.18-3.64) were independently associated with proteinuria while DM (AOR: 1.69, 95% CI 1.06-2.55) and treatment with more than two medications (AOR: 1.86, 95% CI 1.09-3.17) were more likely to have reduced eGFR. CONCLUSION: A large proportion of hypertensive patients in north-central Nigeria have poorly controlled BP. Kidney damage is common among these patients.

MATERNAL AND NEONATAL OUTCOMES OF HISTOLOGICAL CHORIOAMNIONITIS.

BACKGROUND: Clinical Chorioamnionitis contributes to maternal and neonatal morbidity and mortality but the effect of histological chorioamnionitis is sparse in our environment. AIM: To determine the maternal and neonatal outcomes of histological chorioamnionitis amongst pregnant women and their babies. DESIGN OF THE STUDY: Cross sectional longitudinal study. SETTING: Jos University Teaching Hospital (JUTH), Jos, Nigeria. METHODOLOGY: Parturients were interviewed and examined as well as had their placenta examined histologically for chorioamnionitis. They and their babies were followed up for 6 weeks after delivery to monitor for any complications that may arise. RESULTS: A total of 148 parturients were enrolled from the labour ward of Jos University Teaching Hospital and of these 90 (60.8%) had histologic chorioamnionitis (HCA). As regards outcome, 9(10%) with histologic chorioamnionitis as well as 5(8.62%) of those without HCA had premature delivery. Low birth weight occurred in 12(13.33%) and 6(10.34 %) of those with HCA and without HCA respectively. In all, 1(1.47%) and 1(2.56%) of women with HCA and without HCA correspondingly had neonatal sepsis. Puerperal sepsis occurred in 2(2.94%) of those with HCA and 2(5.13%) of those without HCA. CONCLUSION: Our study has demonstrated that histological chorioamnionitis had no adverse maternal or neonatal effect. There is the need for more studies investigating the cause and the implication of histological chorioamnionitis.

Sexual behavior of medical students: A single institutional survey.

OBJECTIVE: We investigated the sexual practices of medical students as they are positioned to serve as peer educators in the fight against HIV/AIDS. METHODS: This was a cross sectional study, where self- administered questionnaires were distributed to consenting 4(th) to 6(th) year medical students in Jos, Nigeria with a view of elucidating information regarding sexual practices and condom utilization. Safe sex practice was defined as the use of condoms and being in a monogamous relationship. RESULTS: Of a total of 400 questionnaires distributed, 365 respondents (249 males and 116 females) had adequate data for analysis. A large proportion (62%) of our students have never had sex before and less than 30% of them are sexually active. Only 6.1% had multiple sexual partners and homosexuality was uncommon (1.9%). Condom utilization amongst the sexually active was high (65%) and similar among male and female students (71.3% vs. 51.9% respectively, p = 0.08). CONCLUSION: There exists safe sexual practice among medical students in our setting. This group could be recruited as peer educators in the war against HIV/AIDS.

Relationship between parental socio-economic status and casual blood pressure in coastal nigerian adolescents

BACKGROUND: Emerging data suggest that essential or primary hypertension occurs in the young. Parental socioeconomic status may play a role but the exact mechanisms still remain unclear. OBJECTIVE: This study was aimed at determining the relationship between parental socioeconomic status and casual blood pressure in adolescents. METHODS: One thousand and eight adolescents attending two secondary schools in Calabar; Nigeria were selected by stratified random sampling. Their blood pressure; weights and heights were taken using standard methods and sociodemographic data were obtained using a pretested semistructured questionnaire. RESULTS: Blood pressure was increased with age with males having higher values. The other major determinants of blood pressure were weight; height; body mass index; level of physical activity and parental socioeconomic status (p 0.05). Female adolescents with parents in the lower socioeconomic classes had significantly higher systolic and diastolic blood pressure (p 0.05). In contrast; parental socioeconomic status showed no significant relationship with systolic blood pressure and diastolic blood pressure in males (p 0.05).The prevalence of elevated blood pressure was higher in females than in males. CONCLUSION: Low parental socioeconomic status appear to be associated with higher casual blood pressure especially in female coastal Nigerian adolescents. Traditional determinants did not appear to play a significant role. Psychological stress arising from environmental and economic stressors may be responsible

Chronic kidney disease screening and renoprotection in type 2 diabetes.

BACKGROUND: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. METHODS: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. RESULTS: Urinalysis was done in 49.1% and serum creatinine in 50.3%. No patient had glomerular filtration rate estimated. Seventy nine (67.6%) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8%) of these patients BP control was optimal in 29.1%. CONCLUSION: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D.

Chronic Kidney Disease Screening and Renoprotection in Type 2 Diabetes

Background: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. Methods: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. Results: Urinalysis was done in 49.1and serum creatinine in 50.3. No patient had glomerular filtration rate estimated. Seventy nine (67.6) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8) of these patients BP control was optimal in 29.1. Conclusion: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D

Hepatitis B vaccination status and needle stick injuries among medical students in a Nigerian university.

BACKGROUND: Hepatits B virus (HBV) is the most common blood borne pathogen that poses an occupational risk to Health-care workers. The incidence of infection following needle stick injury has been reported to be high among medical students. Effective vaccines against HBV are available. The aim of this study was to determine the vaccination status and prevalence of needlestick injury among medical students in a tertiary institution in a developing country (Nigeria). METHOD: Information regarding hepatitis B status, history of needlestick injury and awareness of risk factors for HBV were obtained from clinical medical students using a self administered questionnaire. Three hundred and forty six students responded. RESULTS: Three hundred and five (88.7%) agreed that medical education exposes one to HBV infection and 315 (91.6%) were aware of the availability of vaccine against HBV. Only 42 (47.7%) were vaccinated against HBV. Majority (57.4%) gave lack of opportunity as reason for non immunization while 34.7% had never given it a thought. One hundred and sixty-six (48%) of the respondents admitted to a previous needlestick injury and only 17 (10.2%) of those who reported history of needlestick injury had post-exposure prophylaxis against HBV infection. CONCLUSION: HBV vaccination status is very low among medical students in Nigeria and the prevalence of needle stick injuries is high. Universities must not only provide HBV vaccination free of charge but also enforce its use by these students.

Primary hyperparathyroidism presenting with severe hypertension in a middle aged Nigerian--a case report.

OBJECTIVE: To draw attention to primary hyperparathyroidism as a cause of severe hypertension. RESULTS: A 47 year old Nigerian male presented with headache, occasional blurring of vision and dyspnoea on mild exertion of 2/12 duration. He had been troubled by painful osteoarthritis of the knees for 2 years for which he was taking NSAIDs. He was found to be severely hypertensive, BP 210/130mmHg and had bilateral knee crepitus. BP was resistant to control on Nifedipine R and Moduretic. Serum urea, creatinine, uric acid were normal but there was hyperacalcaemia and hyperchloraemia. Haematological indices, urinalysis, microscopy and culture of urine were normal. Parathyroid hormone level was raised. A parathyroid MIBI scan study showed an extensive area of significance towards the inferior pole of the right lobe of thyroid medially with a second area of very low significance medial to the left pole. These findings indicated the presence of a right inferior parathyroid adenoma. He had parathyroid surgery and a large adenoma in the right inferior gland and a smaller left inferior gland were removed and confirmed histologically. Corrected calcium and parathyroid hormone levels dropped to normal, and the BP was easily controlled with Lisinopril 5mg daily subsequently. He is not currently on antihypertensive medication two years post surgery. CONCLUSION: This case highlights the need for thorough investigation of cases of hypertension to exclude specifically secondary causes, which in some cases may be endocrine in origin and may easily be corrected.

Willingness of Nigerian healthcare workers to donate kidneys.

BACKGROUND: The attitude of healthcare workers (HCW) towards organ donation is cardinal to the successful implementation and sustainability of transplant programs. We present the outcome of a survey among HCW in a single tertiary institution in Nigeria regarding their willingness to be living-related kidney donors. METHODS: Self-administered questionnaires were randomly distributed to HCW evaluating their attitude towards living-related kidney donation. RESULTS: Of the 650 questionnaires distributed only 502 responded (clinical medical students 51%, physicians 31.7% and nurses 17.3%); 75.6% of respondents were willing to be living donors while 5.8% were against it, and 18.5% were undecided. Multivariate analysis identified willingness to receive, perceived risk associated with kidney donation, and attitude towards cadaveric donation as independent predictors of willingness of HCW to be living donors. CONCLUSION: Nigerian HCW have a positive attitude toward kidney donation.

Relation between Helicobacter pylori, inflammatory (neutrophil) activity, chronic gastritis, gastric atrophy and intestinal metaplasia.

BACKGROUND: To determine the relation of Helicobacter pylori infection with chronic inflammation, atrophy, activity level and intestinal metaplasia. PATIENTS AND METHODS: A cross-sectional study of 100 consecutive patients with dyspepsia. These patients were fasted for 12 hours and gastroscopic biopsy specimens were obtained from their gastric mucosae. The specimens were histologically evaluated for H. pylori, inflammatory activity, chronic inflammation, gastric atrophy and intestinal metaplasia. RESULTS: There were 50 (50%) females and 50 (50%) males. The average ages of women and men were 36.3 +/- 11.5 and 42.9 +/- 12.8 respectively. Helicobacter pylori was found in 79%. Neutrophil activity was observed in 83%. Inflammation was found in 95%, glandular atrophy in 38%, intestinal metaplasia in 28% of the cases. Incidental (early gastric) cancer was found in 3%, dysplasia in 2% and reactive gastropathy in 7% of the cases. A statistically significant relationship was found between Helicobacter pylori colonization intensity and the degrees ofneutrophil activity, chronic inflammation and intestinal metaplasia. CONCLUSION: We concluded that Helicobacter pylori infection results in neutrophil activation and chronic gastritis, and that it has a role in the development of intestinal metaplasia. The greater the intensity of Helicobacter pylori infection, the greater the degrees of neutrophil activation, chronic gastritis and intestinal metaplasia.

Hepatitis B Vaccination Status and Needle Stick Injuries among Medical Students in a Nigerian University

Background: Hepatits B virus (HBV) is the most common blood borne pathogen that poses an occupational risk to Health-care workers. The incidence of infection following needle stick injury has been reported to be high among medical students. Effective vaccines against HBV are available. The aim of this study was to determine the vaccination status and prevalence of needlestick injury among medical students in a tertiary institution in a developing country (Nigeria). Method: Information regarding hepatitis B status; history of needlestick injury and awareness of risk factors for HBV were obtained from clinical medical students using a self administered questionnaire. Three hundred and forty six students responded. Results: Three hundred and five (88.7) agreed that medical education exposes one to HBV infection and 315 (91.6) were aware of the availability of vaccine against HBV. Only 42 (47.7) were vaccinated against HBV. Majority (57.4) gave lack of opportunity as reason for non immunization while 34.7had never given it a thought. One hundred and sixty-six (48) of the respondents admitted to a previous needlestick injury and only 17 (10.2) of those who reported history of needlestick injury had post-exposure prophylaxis against HBV infection. Conclusion: HBV vaccination status is very low among medical students in Nigeria and the prevalence of needle stick injuries is high. Universities must not only provide HBV vaccination free of charge but also enforce its use by these students

Hepatitis B Vaccination Status and Needle Stick Injuries among Medical Students in a Nigerian University

Background: Hepatits B virus (HBV) is the most common blood borne pathogen that poses an occupational risk to Health-care workers. The incidence of infection following needle stick injury has been reported to be high among medical students. Effective vaccines against HBV are available. The aim of this study was to determine the vaccination status and prevalence of needlestick injury among medical students in a tertiary institution in a developing country (Nigeria). Method: Information regarding hepatitis B status; history of needlestick injury and awareness of risk factors for HBV were obtained from clinical medical students using a self administered questionnaire. Three hundred and forty six students responded. Results: Three hundred and five (88.7) agreed that medical education exposes one to HBV infection and 315 (91.6) were aware of the availability of vaccine against HBV. Only 42 (47.7) were vaccinated against HBV. Majority (57.4) gave lack of opportunity as reason for non immunization while 34.7had never given it a thought. One hundred and sixty-six (48) of the respondents admitted to a previous needlestick injury and only 17 (10.2) of those who reported history of needlestick injury had post-exposure prophylaxis against HBV infection. Conclusion: HBV vaccination status is very low among medical students in Nigeria and the prevalence of needle stick injuries is high. Universities must not only provide HBV vaccination free of charge but also enforce its use by these students

Pharmacological and Nonpharmacological Prevention of End-Stage Renal Disease

Slowing of the rate of deterioration in renal function in patients with chronic kidney disease (CKD) is feasible; but requires a combination of pharmacological and non pharmaco- logical interventions. Pharmacological interventions of proven efficacy are the following: a. Blood pressure control using angiotensin converting enzyme inhibitors and angioten- sin receptor blockers as the first line agents because these drugs have beneficial effects on glomerular haemodynamics and proteinuria in addition to their antihypertensive actions b. Strict blood glucose control in patients with diabetes mellitus c. Use of lipid-lowering agents (statins) d. Pharmacological control of hyperphosphataemia e. Prevention of anaemia with the use of erythropoietin and f. Pharmacological management of the underlying renal disease Non-pharmacological interventions are of equal importance and include maintenance of euvolaemia; prevention or prompt treatment of urinary tract obstruction and infection; hypercalcaemia and hypocalcaemia; and avoidance of nephroto- xins and smoking. The management of CKD is multifaceted and requires diligence and a team approach. Patients and their families should be active members of the team

Meigs' syndrome presenting as haemorrhagic pleural effusion.

BACKGROUND: The association of a benign ovarian tumor with ascites and hydrothorax that resolve after tumor resection, known as Meigs syndrome is a rare clinical entity. Rarer still is the haemorrhagic form of the syndrome OBJECTIVE: To describe a case of benign ovarian tumour associated with ascites and bloody pleural effusion. METHODS: A thirty-seven year old woman was referred for the further management of a pleural effusion. A detailed clinical evaluation was carried out, including pleural fluid cytology, chest CT scan and laparatomy. Treatment included antituberculous therapy and finally ovariectomy. RESULTS: The physical examination and a pelvic ultrasonographic scan revealed ascites in addition to a right sided ovarian mass. A chest CT-scan did not show any intrathoracic mass. Repeated pleural fluid cytology showed mesothelial cells but was negative for malignancy. An ovariectomy was performed and histological examination revealed a thecoma fibroma. The pleural effusion and ascites resolved spontaneously thus confirming the diagnosis of Meigs' syndrome. CONCLUSION: Meigs' syndrome should be considered in the differential diagnosis in female patients with hemorrhagic pleural effusion.

Inadequacy of dialysis, chronic inflammation and malnutrition in Nigerian patients on chronic hemodialysis.

PURPOSE: To identify the extent of underdialysis, chronic inflammation and malnutrition and their interrelationships in Nigerian hemodialysis patients. METHODS: In a prospective study including 10 adult patients, (6 men, 4 women) on hemodialysis in North Central Nigeria, malnutrition was assessed by body mass index (BMI), serum albumin and prealbumin, and bioimpedance (BIA) pre-and post dialysis, inflammation was evaluated by C-reactive protein (CRP) and adequacy of dialysis was judged by frequency of the hemodialysis sessions and Kt/V urea. RESULTS: Post-dialysis BMI was 21.3 (19.9, 24.3) kg/m2 (< 20 kg/m2 in 4 patients), serum albumin 31.5 (24.0, 32.0) g/L (< 30.0 g/L in 5), serum pre-albumin 25.2 (15.3, 31.1) mg/dL (< 18.0 mg/dL in 4), serum CRP 4.8 (1.2, 11.5) mg/dL (> 1.0 mg/dL in 8), phase angle 4.2 (3.7, 5.1) degrees (< 3 degrees in 3) and body fat deficit was diagnosed by BIA in 4 patients. Weekly frequency of dialysis was 3 times in 2 patients, twice in 1 and 1.2 in one patient receiving dialysis only twice weekly). By combined frequency of dialysis and Kt/V urea values, no patient received an adequate dose of dialysis and, indeed, all patients had overt symptoms of uremia. Low body weight, low serological and BIA nutrition indices, and high CRP levels occurred in the same patients. Patients on dialysis for > 1 year had worse nutrition indices than those on dialysis for < 1 year. CONCLUSIONS: Underdialysis was universal, while poor nutrition and chronic malnutrition were found in the majority of the small number of patients studied. These three adverse conditions, which were interlinked, may be common in Nigerian hemodialysis patients, because their underlying socioeconomic causes are widespread.

Prevalence of irritable bowel syndrome in a Nigerian student population.

Irritable bowel syndrome (IBS) is a widely recognized disorder accounting for up to 50% of referrals to gastroenterologists in the Western world. Existing literature had suggested that its prevalence is low among native Africans. The objective [corrected] is to document the prevalence of IBS in this environment. A cross-sectional study of clinical students at the Jos University Medical School and the School of Medical Laboratory Technology in Jos University were cohorted. Questionnaires based on the Rome II criteria were administered to 330 students (221 males and 109 females). Irritable bowel syndrome was present in 86 (26.1%) of the subjects, being present in 58 (26.4%) of the males and 28 (25.7%) of the females respectively (OR 0.97, 95% CI 0.57-1.63, p = 0.89). The mean age of subjects with IBS was 26.3 +/- 4.0 years and that of subjects without IBS was 26.5 +/- 3.8 years, p = 0.6. The majority (54.8%) of the subjects did not consider their symptoms as illness and therefore did not seek any form of care. More males sought medical care compared to females (19.6% vs. 3.6% respectively, p = 0.02). Depressive symptoms were present in 21 (24.4%) of subjects with IBS compared to 36 (14.8%) of those without (p = 0.06). Irritable bowel syndrome is a common disorder in the student population of a medical school in Northern Nigeria.

Arteriovenous fistula for patients on long term haemodialysis in jos, Nigeria.

BACKGROUND: The introduction of haemodialysis has prolonged the lives of patients with end-stage-renal disease (ESRD). To maintain them on long-term dialysis, vascular access procedures are required. OBJECTIVES: To describe the experience with arteriovenous fistula (AVF) from a developing country. METHODS: Eighty-two AVF were created in 74 patients on maintenance haemodialysis. They all had side-to-end AVF using prolene 7/0 monofilament suture for anastomoses. RESULTS: There were 55 males and 19 females with a male: female ratio of 2.9:1. The ages ranged from 18 to 70 years with a mean of 43.4 "12.1 years. Most of the AVF created were on the left upper limbs with the radio-cephalic and brachio-cephalic accounting for more than 70% . Eight patients developed thrombosis of the veins used for the AVF and one developed a pseudo aneurysm. CONCLUSIONS: Arteriovenous fistula makes long-term haemodialysis feasible. It can be created easily and has a low rate of complications.