Assessment of some cardiovascular risk factors in predialysis chronic kidney disease patients in Southern Nigeria

Background:

Cardiovascular risk factors are responsible for cardiovascular disease and rapid progression of chronic kidney disease (CKD) to end-stage renal disease. Prompt evaluation, modification, and treatment of these factors in predialysis patients will reduce morbidity and mortality. This study assessed some cardiovascular risk factors in predialysis CKD patients in a tertiary hospital in Southern Nigeria.

Patients and Methods:

This was a case–control study that involved 76 consecutive predialysis CKD patients and 38 age-and sex-matched controls without CKD over 1 year period. Both groups were assessed for cardiovascular risk factors, and comparisons were made. A P value of <0.05 was taken as significant.

Results:

The mean ages of the CKD versus control group were 48.00 ± 15.28 versus 45.34 ± 15.35 years. The male:female ratio was 1.7:1 for both groups. The common etiologies of CKD in this study were hypertension 30 (39.5%), diabetes mellitus 23 (30.3%), and chronic glomerulonephritis 19 (25%). There were 38 (50%) in CKD stage 3, 31 (40.8%) in CKD stage 4, and 7 (9.2%) in CKD stage 5. The common cardiovascular risk factors found in the CKD versus control were hypertension (96.1% vs. 42.1%), anemia (96.1% vs. 23.7%), left ventricular hypertrophy (77.6% vs. 23.7%), dyslipidemia (67.1% vs. 39.5%), hypocalcemia (60.1% vs. 18.5%), hyperphosphatemia (63.2% vs. 0%), and hyperuricemia (57.9% vs. 15.8%). These risk factors were significantly higher in CKD group. Hyperphosphatemia and hypoalbuminemia significantly increased across CKD stages 3–5. Anemia was significantly more common in males whereas dyslipidemia was more common in female CKD patients.

Conclusion:

Cardiovascular risk factors were highly prevalent in predialysis CKD subjects even in early stages. Hypoalbuminemia and hyperphosphatemia significantly increased across the CKD stages 3–5 whereas anemia and dyslipidemia showed significant gender differences. Cardiovascular risk factors should be treated early in predialysis CKD patients.     

A cross-sectional study of the knowledge and attitude of medical laboratory personnel regarding continuing professional development

Background:

Continuing professional development (CPD) in Medical Laboratory Scientists (MLS) is aimed at equipping laboratory professionals with the necessary skills to enhance practice. The laboratory scientists are usually the first contact between the patient and health care system in aspects of diagnosis and monitory of diseases. As such, it becomes imperative to assess the knowledge of laboratory personnel regarding CPD.

Materials and Methods:

Self-administered questionnaires were distributed to 200 laboratory personnel''s attending the maiden CPD workshop organized by the Association of MLS in Jos the Plateau state capital.

Results:

One hundred and thirty-five (82 males and 53 females) of the 200 administered questionnaires were returned. Only 32 of them (23.7%) attended CPD program in the last 1 year with 10 (7.5%) engaging in online CPD. Five (3.7%) of the respondents had the privilege to attend an international CPD. Majority (95.2%) of the respondents identified CPD as an essential component of professional career development. Lack of sponsorship was identified as a major setback in CPD efficiency by 93.8% of respondents. About 58 (46.4%) noted that poor attendance in CPD workshops was due to unavailability of policy guideline for CPD. One hundred and twenty (95.2%) of respondents had an aim of improving their skills after attending CPD workshops.

Conclusion:

The overall attitude of Nigerian MLS toward attending CPD workshop is poor; however, the knowledge regarding the importance of CPD is adequate. There exists a gap between sponsorship for CPD by various institutions and MLS.     

Clinicopathological features of gastric carcinoma in Ibadan,Nigeria, 2000-2011

Aim:

The most recent study on the clinicopathological features of gastric carcinoma from the University College Hospital (UCH), Ibadan, was done in 2000. The aim of this study is to update the knowledge on the clinicopathological features of gastric carcinoma diagnosed in the Pathology Department of the UCH Ibadan between 2000 and 2011.

Materials and Methods:

This was a 12-year retrospective review of clinical and demographic data and the histopathological features of gastric cancers diagnosed at the Pathology Department of the UCH. The chi square test, Fisher''s exact test, and the t-independent test were used as applicable in the statistical analyses.

Results:

A total of 117 cases of gastric carcinoma were histologically diagnosed at the Pathology Department of UCH, Ibadan in this period giving a relative ratio frequency of 1.38% for all cancers. It represented 18.4% of all gastrointestinal tract malignancies diagnosed in the same period. There was a male preponderance with male:female ratio of 1.72:1; the middle-aged and elderly made up about 76.1% of cases. The disease was clinically and histologically advanced in 92.8% of cases. Gastric tumours were predominantly antral/ pyloric in 80% of cases and exophytic in 62.3% of cases. The intestinal histotype constituted 47.0% cases although a rise in the diffuse histological type was observed.

Conclusion:

There is a decline in the relative ratio frequency of gastric carcinoma in Ibadan; and a fall in the rate of the intestinal type of gastric carcinoma relative to the diffuse type when compared to previous studies from our centre.     

The effect of hospital infection control policy on the prevalence of surgical site infection in a tertiary hospital in South-South Nigeria

Background:

Surgical site infections (SSIs) are a significant cause of morbidity, emotional stress and financial cost to the affected patients and health care institutions; and infection control policy has been shown to reduce the burden of SSIs in several health care institutions. This study assessed the effects of the implementation of the policy on the prevalence of SSI in the University of Port Harcourt Teaching Hospital, Nigeria.

Patients and Methods:

A review of the records of all Caesarean sections carried out in the hospital, before and 2 years after the implementation of the infection control policy was conducted. Data collected include the number and characteristics of the patients that had Caesarean section in the hospital during the period and those that developed SSI while on admission.

Results:

The proportion of patients with SSI decreased from 13.33% to 10.34%, 2 years after the implementation of the policy (P-value = 0.18). The implementation of the policy did not also result in any statistically significant change in the nature of the wound infection (P-value = 0.230), in the schedule of the operations (P-value = 0.93) and in the other predisposing factors of the infections (P-value = 0.72); except for the significant decrease in the infection rate among the un-booked patients (P-value = 0.032).

Conclusion:

The implementation of the policy led to a small decrease in SSI, due to the non-implementation of some important aspects of the WHO policy. The introduction of surveillance activities, continuous practice reinforcing communications and environmental sanitation are recommended to further decrease the prevalence of SSI in the hospital.     

Burden and pattern of micro vascular complications in type 2 diabetes in a tertiary health institution in Nigeria

Introduction

Diabetes mellitus (DM) afflicts at least 5 million people in Nigeria, with more than 80% having type 2 diabetes mellitus (T2DM). Microvascular complications increase both morbidity and mortality inpatients with T2DM. The aims of this study were to report the burden of various microvascular complications in T2DM and to identify various factors associated with these complications in patients with T2DM attending the diabetes outpatients'' clinic.

Methods

Ninety (90) patients with T2DM who have attended diabetes clinic for at least 3 months were recruited for this study. Detailed history, physical examination and biochemical analysis was done in each of the patients. All patients underwent a detailed standard evaluation to detect diabetic retinopathy (fundoscopy), neuropathy (10g monofilament and/or diabetes neuropathy scores), and nephropathy (microalbuminuria, macroalbuminuria, serum creatinine and estimated glomerular filtration rate).

Results

There was high prevalence of microvascular complications among patients with T2DM. Almost half of patients with T2DM had some form of microvascular complications; diabetic neuropathy being the commonest (69.6%),followed by nephropathy (54.5%) and retinopathy (48.9%). The factors associated with developing these complications were increasing age, duration of diabetes, hypertension and dyslipidaemia for nephropathy and neuropathy.

Conclusion

There is a high burden of microvascular complications in patients with type 2 diabetes. Age, male gender, hypertension, glycaemic control, BMI and duration of diabetes, and glycaemic control were factors associated with microvasular complications.     

Pneumonia in Nigeria: The way forward

Pneumonia is the leading cause of child deaths in Nigeria. Interventions to combat pneumonia are known and globally available, but not yet deployed effectively in Nigeria. While the under‐five pneumonia deaths dropped globally by 51% during the Millennium Development Goals (MDG) years (2000 to 2015), the rate declined by a mere 8% in Nigeria. In this commentary, we focus on three factors that may have stalled Nigeria's progress on pneumonia control. First, a chronically weak health system failed to deliver the needed services at scale. Second, strong coordination of a multipronged and well‐funded push against pneumonia was absent. Third, sound and timely data on pneumonia intervention coverage were lacking, thus blunting the accountability mechanisms that could have driven quick, targeted action. In response, the Federal Ministry of Health recently developed a National Pneumonia Control Strategy with the support of the “Every Breath Counts Coalition” (EBCC). This strategy, a first of its kind, articulates a common vision for reducing pneumonia‐led morbidity and mortality and provides a unified approach to respond comprehensively to pneumonia within and outside the health sector. Strong political will and sustainable financing are now needed to effectively implement this strategy and accelerate progress on pneumonia control. This will contribute hugely to achieving the government's health goals, the Sustainable Development Goal (SDG) 3.2 and the Global Action Plan on Pneumonia and Diarrhoea (GAPPD) targets.     

Impact of social support on participation after stroke in Nigeria

Background: Participation which entails involvement in life situations and represents a higher level of functioning can be severely restricted after a stroke. This study investigated the impact of social support on participation of stroke survivors in Nigeria.

Methods: Ninety-six community-residing stroke survivors were recruited from physiotherapy outpatient departments of two tertiary care hospitals in Northern Nigeria. Socio-demographic, clinical, participation (London Handicap Scale), and social support (Multidimensional Scale of Perceived Social Support) data were obtained. The impact of social support on global and domain-specific participation was examined using bivariate analyses and multiple regression analyses.

Results: Mean (SD) age of the stroke survivors was 56.6 (12.0) years. Social support was a significant (β = 0.41, p < 0.0001) and independent determinant of the economic self-sufficiency domain of participation (p < 0.0001) in a regression model that accounted for 27% of the variance in the domain (R² = 0.27). Social support, however, had no independent effect on overall participation and the other participation domains namely mobility, physical independence, occupation, social integration, and orientation.

Conclusion: The impact of social support was significant only in the economic self-sufficiency domain of participation with higher availability of social support related to better economic self-sufficiency. This finding provides additional information on the importance of social support post-stroke.