Diabetes mellitus foot ulcer and associated factors among Type 2 diabetes patients in a Tertiary Institution in Southwest Nigeria.

Aim: This study aims to assess the proportion of diabetic foot ulcer (DMFU) and associated factors among patients with type 2 diabetes in a tertiary hospital in Southwest Nigeria. Methods: A pretested semi-structured interviewer-administered questionnaire adapted from the STEPwise Approach to Surveillance of Noncommunicable Disease Risk Factors of WHO.14 was used for data collection from a sample of 181 patients with type 2 diabetes mellitus. Sociodemographic, behavioral, clinical, and laboratory variables were collated from the participants. Chi-square test and logistic regression were used to identify the predictors of DMFU. Results: A total of 166 patients had their questionnaires completed. The mean age (standard deviation) of the respondents was 62.6 (14.3) years. The proportion of DMFU was 18.7%. More than two-third (71.1%) of our respondents had clinical symptoms suggestive of peripheral neuropathy while 34.3% of the patients seen in the study had evidence of peripheral vascular disease on duplex Doppler ultrasound. Male patients were about five times more likely to have DMFU than female patients (adjusted odds ratio [AOR] =5.27; 95% confidence interval [CI] = 1.001-27.841). Those with duration of diabetes ≥10 years were more likely to have DMFU than those with disease duration <10 years (AOR = 15.47; 95% CI = 1.201-199.314). Patients with fasting blood glucose (FBG) of ≥ 7.2 mmol/L were about four times more likely to have DMFU than those with FBG of <7.2 mmol/L (AOR = 4.19; 95% CI = 1.618-18.463). Conclusions: The proportion of DMFU was 18.7%, and the predictors identified included sex, duration of disease, and FBG level.

Résumé Objectif: Cette étude vise à évaluer la proportion de l'ulcère du pied diabétique (DMFU) et des facteurs associés chez les patients atteints de diabète de type 2 dans un hôpital tertiaire du sud-ouest du Nigéria. Méthodes: Un questionnaire prétesté à un intervieweur semi-structuré adapté à l'approche par étapes de la surveillance des facteurs de risque de maladie non transmissibles de l'OMS.14 a été utilisé pour la collecte de données à partir d'un échantillon de 181 patients atteints de 17 diabète de type 2. Les variables sociodémographiques, comportementales, cliniques et de laboratoire ont été rassemblées auprès des participants. Le test du chi et la régression logistique a été utilisé pour identifier les prédicteurs du DMFU. Résultats: Un total de 166 patients ont réussi leurs questionnaires. L'âge moyen (écart-type) des répondants était de 62,6 (14,3) ans. La proportion de DMFU était de 18,7%. Plus de deux tiers (71,1%) de nos répondants présentaient des symptômes cliniques suggérant une neuropathie périphérique tandis que 34,3% des patients observés dans l'étude avaient des signes de maladie vasculaire périphérique sur l'échographie Doppler duplex. Les patients masculins étaient environ cinq fois plus susceptibles d'avoir du DMFU que les patientes (rapport de cotes ajustée [AOR] = 5,27; intervalle de confiance à 95% [IC] = 1,001­27,841). Ceux qui ont une durée de diabète ≥ 10 ans étaient plus susceptibles d'avoir du DMFU que ceux souffrant de durée de la maladie <10 ans (AOR = 15,47; IC à 95% = 1,201­199,314). Les patients atteints de glycémie à jeun (FBG) ≥ 7,2 mmol / L étaient environ quatre fois plus susceptibles d'avoir du DMFU que ceux avec FBG de <7,2 mmol / L (AOR = 4,19; IC à 95% = 1,618­18,463). Conclusions: La proportion de DMFU était de 18,7% et les prédicteurs identifiés comprenaient le sexe, la durée de la maladie et le niveau de FBG. Mots-clés: Ulcère du pied, Nigéria, diabète sucré de type 2.

Kidney Transplantation in Sickle Cell Disease Patients: Case Series and Experience from a Nigerian Kidney Transplant Center.

Sickle cell nephropathy is one of the long-term complications of sickle cell disease (SCD). About a quarter of SCD patients who survive up to 40 years of age will require some form of renal replacement therapy in their lifetime. Organ transplantation in SCD patients poses great challenges, particularly in lower middle income countries (LMIC) like Nigeria. This report highlights the management of three SCD patients who successfully underwent renal transplantation. The patients were aged 39, 47, and 58 years, respectively, with similarly previous history of multiple blood transfusions, recurrent vaso-occlusive crises, and had all progressed to end-stage renal disease. Preoperative exchange blood transfusion and plasmapheresis were offered in one and two of the patients, respectively. One of them required preoperative vaccination against encapsulated organisms due to autosplenectomy. Antithymocyte globulin was used as induction therapy in two of these patients while basiliximab was used in the third. All patients are alive with good renal function 18, 24, and 48 months post transplantation, respectively. In conclusion, kidney transplantation can be safely carried out on SCD patients with a satisfactory outcome.

Obesity and CKD in Sub-Saharan Africa: A Narrative Review.

Obesity is a major public health problem in the developed world, where it has reached an epidemic status over the last few decades. In parallel with this, the prevalence of chronic kidney disease (CKD) has increased. Although obesity is a risk factor for hypertension and diabetes, it is also independently associated with the development and progression of CKD. Two-third of patients with CKD worldwide will be residents of developing countries by the year 2030. Risk factors for CKD are prevalent in the sub-Saharan Africa region; this review discusses the available data regarding the relationship between obesity and CKD. The prevalence of CKD appears to correlate with increasing adiposity in sub-Saharan Africa; however, limited data are currently available, and the analysis of this association is further complicated by a variety of parameters used to define obesity. (eg, body mass index vs waist circumference). Longer, large-scale studies are needed to inform the prevalence and kidney implications of obesity in sub-Saharan Africa.

Organ Donation Among Tiers of Health Workers: Expanding Resources to Optimize Organ Availability in a Developing Country.

UNLABELLED: The global increase in end organ failure but disproportional shortage of organ donation calls for attention. Expanding the organ pool by assessing and improving health workers' attitude at all levels of care may be a worthwhile initiative. METHODS: A questionnaire-based cross sectional study involving tertiary, secondary, and primary health institutions in Southwestern Nigeria was conducted. RESULTS: Age range was 18 to 62 (36.7 ± 9.2) years. Only 13.5%, 11.7%, and 11.2% from primary, secondary, and tertiary health centers, respectively, would definitely donate despite high level of awareness (>90%) at each level of care. Participants from primary health care are of low income (P < 0.05), and this cohort is less likely to be aware of organ donation (P < 0.05). At each level of care, permission by religion to donate organs influenced positive attitudes (willingness to donate, readiness to counsel families of potential donors, and signing of organ donation cards) toward organ donation. Good knowledge of organ donation only significantly influenced readiness to counsel donors (P < 0.05) and not willingness to donate (P > 0.05). At each level of health care, young health care workers (P < 0.05) and women (P > 0.05) would be willing to donate, whereas men show positive attitude in signing of organ donor cards (P < 0.05) and counseling of families of potential donors (P > 0.05). CONCLUSIONS: Knowledge and willingness to donate organs among health care levels were not different. Considering the potential advantage of community placement of other tiers of health care (primary and secondary) in Nigeria, integrating them would be strategically beneficial to organ donation.

Challenges of hemodialysis in a new renal care center: call for sustainability and improved outcome.

BACKGROUND: Nephrologists are faced with enormous challenges in the management of patients with end-stage renal disease, especially in sub-Saharan Africa, where hemodialysis is the most common modality of renal replacement therapy in the region. Therefore, we reviewed our 3 years of experience with hemodialysis services in a tertiary hospital located in a rural community of South West Nigeria. This was with a view to presenting the profile of hemodialysis patients and the challenges they face in sustaining hemodialysis. METHODS: We reviewed the case records and hemodialysis registers for 176 patients over the 3 years from November 2010 to December 2013. The data were analyzed using Statistical Package for the Social Sciences version 20 software. RESULTS: Of the 176 patients, 119 (66.9%) were males. The mean age of the patients was 44.87±17.21 years. Most were semiskilled or unskilled (111; 63.5%) and 29 (16.5%) were students. Twenty-six (14.8%) had acute kidney injury in the failure stage. Chronic glomerulonephritis, hypertensive nephropathy, and diabetic nephropathy accounted for 45.3%, 23.3%, and 12.1%, respectively, of patients with end-stage renal disease. Only 6.8% of patients could afford hemodialysis beyond 3 months. CONCLUSION: Sustainability of maintenance hemodialysis is poor in our environment. Efforts should be intensified to improve other modalities of renal replacement therapy, in particular kidney transplantation, which is cost-effective in the long-term. Also, preventive measures such as education for affected patients and the general population would assist in reducing the prevalence and progression to end-stage renal disease.