Haemodialysis dose is independent of type of surgically-created vascular access

Background: In the United States, the use of polytetraflourotheylene (PTFE) graft compared with native arteriovenous fistula (AVF) for haemodialysis vascular access has been increasing despite a greater than two-fold higher incidence of thrombosis and infection associated with PTFE grafts. Methods: We studied 214 haemodialysis patients with not more than two revisions of their vascular access, to determine whether any relationship exists between the type of haemodialysis vascular access and dialysis dose assessed primarily by urea reduction ratio (per cent reduction in blood urea nitrogen concentration after a dialysis session). Serum albumin concentration was used as a secondary outcome measure of dialysis adequacy. Urea reduction ratio and predialysis serum albumin concentration were measured at onset of study and at 4-week intervals and mean values were calculated for each subject. Results: The 214 patients (118 males, 96 females) included 173 Blacks (81%), 26 Whites (15%), and 15 Hispanics (7%), of mean (±SD) age 55.6±15.5 years. Of these 214 subjects, 111 (52%) had a native AVF, while 103 (48%) had a PTFE graft. Both mean urea reduction ratio (native AVF=69±6.7% vs PTFE graft=70±7.3%; P=0.31), and mean serum albumin concentration (native AVF=4.02±0.39 g/dl vs PTFE graft=4±0.33 g/dl; P=0.59) were equivalent in both groups. Separate multiple logistic regression analyses with type of vascular access as one of the independent variables, found no significant relationship between type of vascular access and either a urea reduction ratio >65% (P=0.67), or a serum albumin concentration >4 g/dl (P=0.89), after adjustment for age of vascular access, access revision, location of access, dialyser urea clearance, length of dialysis treatment, body weight, and age. Conclusion: We conclude that PTFE grafts do not permit delivery of better dialysis than native AVF. The increasing use of PTFE grafts in the United States does not have any clinical justification.     

Cardiovascular disease in elderly hemodialysis patients

Cardiovascular disease (CD) is the most common cause of death in all dialysis patients. We studied 104 stable elderly (≥ 65 years) hemodialysis patients to determine the prevalence of cardiovascular disease as evidenced by congestive heart failure or symptomatic coronary artery disease, by race and by coincidence of diabetes and to assess the impact of cardiovascular morbidity on physical activity. CD was judged to be present if a patient had clinical and laboratory confirmed congestive heart failure or coronary artery disease. Physical activity assessed by a modified Karnofsky scale was compared in subjects with and without CD. We inventoried co-morbid conditions and compared the extent of co-morbidity in elderly patients with and without CD. We determined the effect of advancing age and increasing duration of ESRD on the prevalence of CD. Thirty-seven (36%) subjects had CD while 67 (64%) did not. There was no significant difference in mean age (+CD=72.6±5.3 years; ?CD=71.3±5.2 years, p<0.9), or gender distribution (+CD m/f=23/14; ?CD m/f=31/36, p<0.18) between the two groups. The presence of CD did not influence mean scores on the modified Karnofsky scale (+CD=64.8±12.8; ?CD=66.2±14, p<0.618). Thirteen (35%) of 37 patients with CD required assistance for routine daily activities while 27 (40%) of 67 patients without CD were similarly debilitated (p<0.879). While patients with CD had more clinically significant comorbid conditions than those without CD, the scores of each subset on the comorbidity indices (+CD=7.5±2.3; ?CD=6.4±3.6, p<0.09) were not statistically different. Advancing age or duration on maintenance hemodialysis did not alter the risk for CD. Whites (men 15 of 18, women 3 of 11) had a greater prevalence of CD than blacks (men 6 of 23, women 10 of 37) (p<0.05). We infer that symptomatic CD disease is common in geriatric maintenance hemodialysis patients, more prevalent in whites than blacks, and the rate for CD doesn't increase with advancing age or duration of ESRD in elderly hemodialysis patients.     

Evaluation of Blood Transfusions in Anemic Children in Effia Nkwanta Regional Hospital,Sekondi-Takoradi,Ghana

Blood transfusion is a common practice in sub-Saharan Africa as a way of correcting anemia in children with mild and severe sicknesses. This study evaluated this practice in a secondary health-care institution in Ghana. A retrospective study was done over a 3-year period from January 2010 to December 2012. Medical records of children admitted, successfully treated, and discharged from the hospital were collected and analyzed. Data were analyzed using Epi Info version 7. Transfusions were more among male children (89, 63.1%) than female children (52, 36.9%). The highest number of blood transfusions were carried out on children in the age range 0–1 year (66, 46.8%). The majority of the blood transfusions were done on children with hemoglobin concentration level of 5 g/dL and below. Children with malaria parasitemia (83, 58.9%) had more transfusions than children without malaria parasitemia (58, 41.1%). Fever alone (43, 30.5%) and fever with gastrointestinal symptoms (33, 23.4%) were the predominant symptoms among children who had blood transfusions. In conclusion, younger children received more transfusions than older children. Also, male children received more blood transfusions than female children. Malaria was observed as a major contributory factor to the requirement for blood transfusions among the children.     

Perception of Nigerian Consumers on the Culinary,Social, and Health Attributes of Pepper Soup

This study evaluated the perception of consumers on the culinary, social, and health attributes of pepper soup. A structured questionnaire was used to identified reasons for taking pepper soup, the preferred type of pepper soup, social environment for the consumption of pepper soup, beverage accompaniment preferred with pepper soup, and types of food preferred as accompaniment with pepper soup. It also evaluated the perception about the claimed health benefits of the constituents of pepper soup. The survey indicated that pepper soup was mostly a weekly and occasional diet taken by respondents for enjoyment (68.3%) and relaxation (55.8%). About 90.2, 85.9, 90.2, and 92% of the respondents preferred catfish, goat meat, chicken, and cow tail, respectively, as the flesh components in their pepper soup. The preferred color, texture, and flavor was either light or dark brown, viscous or light, and peppery and spicy. Hot and warm pepper soup was preferred by 97% and 65.8% of the respondents, respectively. The respondents (66.3 and 79%) preferred to take their pepper soup with beer and wine, while 75.9 and 90.7% of respondents that have preference for non-alcoholic beverage as accompaniment preferred carbonated beverages and juices or mineral water, respectively. The majority of respondents (60.5 ± 8.52%) disagreed significantly (p > 0.05) that pepper soup possessed most of the health benefits associated with herbs, spices, and other constituents of pepper soup, implying that pepper soup may not be consumed for its perceived medicinal value.     

Adolescent pregnancy and the risk of Plasmodium falciparum malaria and anaemia-a pilot study from Sekondi-Takoradi metropolis, Ghana

The problem of malaria in adolescence has been surpassed by the immense burden of malaria in children, most especially less than 5. A substantial amount of work done on malaria in pregnancy in endemic regions has not properly considered the adolescence. The present study therefore aimed at evaluating the prevalence of Plasmodium falciparum and anaemia infection in adolescent pregnant girls in the Sekondi-Takoradi metropolis, Ghana. The study was carried out at four hospitals in the Sekondi-Takoradi metropolis of the western region of Ghana from January 2010 to October 2010. Structured questionnaires were administered to the consenting pregnant women during their antenatal care visits. Information on education, age, gravidae, occupation and socio-demographic characteristics were recorded. Venous bloods were screened for malaria using RAPID response antibody kit and Geimsa staining while haemoglobin estimations were done by cyanmethemoglobin method. The results revealed that adolescent pregnant girls were more likely to have malaria infection than the adult pregnant women (34.6% verses 21.3%, adjusted OR 1.65, 95% CI, 1.03-2.65, P=0.039). In addition, adolescent pregnant girls had higher odds of anaemia than their adult pregnant women equivalent (43.9% versus 33.2%; adjusted OR 1.63, 95% CI, 1.01-2.62, P=0.046). Taken together, these data suggest that adolescent pregnant girls were more likely to have malaria and anaemia compared to their adult pregnant counterpart. Results from this study shows that proactive adolescent friendly policies and control programmes for malaria and anaemia are needed in this region in order to protect this vulnerable group of pregnant women.     

Determination of electrode to nerve fiber distance and nerve conduction velocity through spectral analysis of the extracellular action potentials recorded from earthworm giant fibers

Microneurography and the use of selective microelectrodes that can resolve single-unit nerve activity have become a tool to understand the coding within the nervous system and a clinical diagnostic tool to assess peripheral neural pathologies. Central to these techniques is the use of the differences in the shape of the extracellular action potential (AP) waveform to identify and discriminate units from one another. Theoretical modeling of the origins of these shape differences has shown that the position of the nerve fiber relative to the electrode and the conduction velocity of the unit contribute to these differences giving rise to the hypothesis that more information about the fiber and its relationship to the electrode could be extracted given further analysis of the AP waveform. This paper addresses this question by exploring the electrical coupling between the electrode and nerve fiber. Idealized models and the literature indicate that two parameters, the electrode-fiber distance and the unit conduction velocity, contribute to the amplitude of the extracellular AP detected by the electrode, which confounds the quantification of coupling using the spike amplitude alone. To resolve this, we develop a method that enables differential quantification of these two parameters using spectral analysis of the single-unit AP waveform and demonstrate that the two parameters could be effectively decoupled in an in vitro earthworm model. The method could open the way forward toward micro-scale in situ monitoring of the interaction of nerve fiber and neural interface.     

Coasting acts through downregulation of VEGF gene expression and protein secretion

Sir, We read with great interest the recent article of Garcia-Velascoet al. (2004) which reported that coasting acts through downregulationof vascular endothelial growth factor (VEGF) gene expressionand protein secretion. Although it is of great clinical valueto understand the mechanism(s) involved in coasting and howit reduces the incidence of ovarian     

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.