Managing chronic renal insufficiency--intertwined roles of non-nephrologist and nephrologist

This article reviews reported evidence on the clinical aspects of chronic renal insufficiency, proffers the relative roles of nephrologist and nonnephroloist in the management of chronic renal insufficiency and highlights common errors in the management of patients with chronic renal insufficiency. A paradigm is proposed for management of individuals with progressive chronic renal insufficiency according to evidence of efficacy of options in intervention. Recognizing the interdependence of generalist/family physician and nephrologist, key issues surrounding the timing of referral for specialized renal care are examined. By preparing the patient for future uremia therapy well in advance of need, the stress of coping with a life-threatening crisis can be muted and selection of a specific modality (peritoneal dialysis, hemodialysis, renal transplantation) can be made with full thought, family support, and the time to effect the regimen. Common errors in handling patients with deteriorating renal function are examined with advice for their avoidance.     

Vaccine development for bacterial pathogens: Advances,challenges and prospects

The advent and use of antimicrobials have played a key role in treating potentially life-threatening infectious diseases, improving health, and saving the lives of millions of people worldwide. However, the emergence of multidrug resistant (MDR) pathogens has been a significant health challenge that has compromised the ability to prevent and treat a wide range of infectious diseases that were once treatable. Vaccines offer potential as a promising alternative to fight against antimicrobial resistance (AMR) infectious diseases. Vaccine technologies include reverse vaccinology, structural biology methods, nucleic acid (DNA and mRNA) vaccines, generalised modules for membrane antigens, bioconjugates/glycoconjugates, nanomaterials and several other emerging technological advances that are offering a potential breakthrough in the development of efficient vaccines against pathogens. This review covers the opportunities and advancements in vaccine discovery and development targeting bacterial pathogens. We reflect on the impact of the already-developed vaccines targeting bacterial pathogens and the potential of those currently under different stages of preclinical and clinical trials. More importantly, we critically and comprehensively analyse the challenges while highlighting the key indices for future vaccine prospects. Finally, the issues and concerns of AMR for low-income countries (sub-Saharan Africa) and the challenges with vaccine integration, discovery and development in this region are critically evaluated.     

Comparing posture induced intraocular pressure variations in normal subjects and glaucoma patients

AIM:To compare the posture-induced variations in intraocular pressure(IOP)between the primary open angle glaucoma(POAG)and non-glaucomatous eyes.METHODS:A case-controlled age matched study was conducted in 55 successive newly diagnosed POAG and 56 non-glaucomatous patients seen in glaucoma clinic and general outpatient eye clinic in the Alex Ekwueme University Teaching Hospital,Abakaliki.The IOPs of eligible correspondents were measured with Perkin’s hand-held tonometer in the sitting,supine flat and supine with pillow positions respectively.Measurement of IOP in each position was done after 15 min of assuming such posture.RESULTS:The IOP difference between the sitting and supine flat position was significantly higher in the POAG than non-glaucoma subjects(7.68±2.08 vs 4.03±0.13 mm Hg,P<0.001).The IOP difference between the sitting and supine with pillow positions was 2.61±1.49 mm Hg for POAG and 1.44±0.70 mm Hg in non-glaucoma(P<0.001),while difference between supine flat and supine with pillow positions was 5.07±2.24 mm Hg in POAG and 2.59±0.66 mm Hg in non-glaucomatous patients(P<0.001).CONCLUSION:Greater variations in posture induced IOP occurred in POAG patients than non-glaucomatous.The posture induced IOP variation is lowest in the sitting position and highest in the supine flat position.Evaluation of posture induced IOP changes may be an important tool in the management of glaucoma.     

Bioavailability of ciprofloxacin and fleroxacin: results of a preliminary investigation in healthy adult Nigerian male volunteers

The absolute bioavailability (BA) of ciprofloxacin and fleroxacin were evaluated in 19 adult Nigerian male volunteers. Subjects meeting the selection criteria were randomized to receive treatment either with fleroxacin (200 mg-i.v. and 200 mg oral dose) or ciprofloxacin (200 mg-i.v. and 250 mg oral dose). The i.v./oral or oral/i.v. switch was made after a one week washout period. Blood and urine samples were collected at pre-determined time intervals over a 72 h period for analysis of drug levels. Following intravenous administration the maximum serum concentration (Cmax) was 2.7+/-1.06mg/l for ciprofioxacin and 0.99+/-0.41 mg/l for fleroxacin; the area under the blood level curve (AUC) was 8.82+/-3.19 mg x h/l with ciprofloxacin and 8.52+/-3.83 mg x h/l with fleroxacin. Following oral administration the Cmax was 1.52+/-0.94 mg/l with ciprofloxacin and 0.57+/-0.08 mg/l with fleroxacin; the AUC was 9.87+/-4.10 and 7.55+/-1.42 mg x h/l, respectively. The absolute BA following oral administration was found to be 0.79+/-0.47 for ciprofloxacin and 1.01+/-0.78 for fleroxacin. When these BA results were corrected for renal clearance [Cl(r)] and elimination half-life (t1/2) the values were reduced to 0.37+/-0.17 and 0.31+/-0.18, respectively, for ciprofloxacin and 0.53+/-0.23 and 0.99+/-0.38, respectively, for fleroxacin. Only 38% with ciprofloxacin and 59% with fieroxacin, of the administered dose, was excreted unchanged following oral administration. More work, however, needs to be done on ciprofloxacin to support and/or confirm the above findings. Fleroxacin, on the one hand, exhibited a different trend from that observed in the literature with respect to Cmax and AUC where the values observed in this study were 3--4 fold lower than expected following identical doses, whilst on the other hand the observed BA profile in this study was consistent with literature trends.     

Electrocardiography is unreliable in detecting potentially lethal hyperkalaemia in haemodialysis patients.

BACKGROUND: It is speculated, but unconfirmed, that the usual electrocardiographic manifestations of hyperkalaemia are less frequent and less pronounced in persons with end-stage renal disease (ESRD) than in those with normal renal function. We studied 74 consecutively selected stable haemodialysis patients to determine the prevalence of electrocardiographic changes of hyperkalaemia in stable persons with ESRD receiving haemodialysis. METHODS: Pre-dialysis serum potassium concentration and other electrolytes were measured and simultaneous 12-lead electrocardiogram obtained. RESULTS: The 74 study subjects (45 men, 29 women) comprised 63 blacks (85%), four Hispanics (6%), four whites (6%), and three Asians (4%) of mean+/-standard deviation age 55.5+/-14.7 years. Mean pre-dialysis potassium concentration was 4.9+/-0.71 mEq/l (range 3.3-6.7). No study subject evinced arrhythmia or any of the typical electrocardiographic changes associated with hyperkalaemia. There was no significant difference in T wave amplitude (F statistic=2.1; P=0.11) or T wave to R wave ratio (F statistic=2; P=0.12) between quartiles of serum potassium concentration. Also, T wave amplitude was equivalent in patients with serum potassium concentration >5.5 mEq/l (7.1+/-4.1 mm) or < or =5.5 mEq/l (5.2+/-3.5 mm) (P=0.13). Linear regression analysis showed that the total serum calcium concentration had an inverse relation with T wave amplitude (P=0.03) after adjustment for other factors (a high total serum calcium concentration was associated with a low T wave amplitude). CONCLUSION: Haemodialysis patients with hyperkalaemia may not exhibit the usual electrocardiographic sequella of hyperkalaemia, possibly due in part to fluctuations in serum calcium concentration. Thus, the absence of electrocardiographic changes in hyperkalaemic haemodialysis patients should be interpreted with caution.     

Occupational stress among Nigerian construction trade artisans in the building construction sector: An intervention study

Background:Construction work can negatively affect artisans’ mental health in the form of stress. This research investigated the effect of cognitive behavioral intervention on occupational stress among Nigerian construction trade artisans in the building construction sector.Methods:In this randomized controlled study involving 3 waves of data collection, 140 construction trade artisans who presented with high occupational stress symptoms at the study onset were assigned randomly to either a treatment condition (n = 70) or to a waitlist control condition (n = 70). The study involved pre-treatment and post-treatment assessments and a 3-months follow-up. The artisans’ occupational stress questionnaire and artisans’ dysfunctional thoughts at work scale were the data collection instruments.Results:Results revealed a significant effect of group on artisans’ occupational stress and dysfunctional thoughts at work. Also, significant effects of time on artisans’ occupational stress and dysfunctional thoughts at work were recorded. Finally, group × time interaction effects on artisans’ occupational stress and dysfunctional thoughts at work were significant.Conclusion:Cognitive behavioral intervention effectively reduced occupational stress symptoms and dysfunctional thoughts at work among Nigerian construction trade artisans compared with a waitlist control condition.