ABSTRACT CD4 T-cell percentages, viral load and thymic function measured as T-cell receptor rearr... more ABSTRACT CD4 T-cell percentages, viral load and thymic function measured as T-cell receptor rearrangement excision circle (TREC) levels were determined every 2-3 months in six treated HIV-infected children for 4 years. All children experienced a marked increase in CD4 cell count after therapy, accompanied by a concomitantly marked increase in TREC levels. In children, the decrease in viral load caused by antiviral therapy leads to an increase in CD4 T cells, mainly because of a recovery in the thymic production of new T cells.
Introduction: Discharge against medical advice (DAMA) is a worldwide problem with negative health... more Introduction: Discharge against medical advice (DAMA) is a worldwide problem with negative health and socioeconomic effects. Factors that have been implicated as causes or contributing to DAMA include financial constraints, lack of health insurance, deteriorating clinical condition of the patient, and problematic doctor-patient relationships. Aims: determine the incidence and profiles ofDAMA on the medical wards, so as to allows for evidence-based interventions to reduce this problem to a minimum. Materials and Methods: This was a case-control study carried out on the medical wards of Federal Medical Center, Ido-Ekiti, South-West Nigeria. The medical records of all patients admitted to the male and female medical wards between January 2008 and April 2011 were reviewed. After being identified through the admission/discharge log, patients who were DAMA and a similar number of patients with regular discharge had their case notes retrieved. Information extracted included bio-data, diagnosis, duration of hospital stay, and reason for discharge. Results: One hundred and thirty-eight patients representing 7.2% were DAMA during the study period. Ninety five cases had complete medical records, and full analysis was carried out on these and 94 other cases with regular discharge as control. The mean age of the DAMA cases was 50.8 ± 18.3 years, with 58 (61.1%) of these patients being male; while the mean age of the control group was 54.1 ± 16.5, of which 54 (57.4%) were male. The mean duration of admission for patients with DAMA was 10.4 ± 9.2 days as against 11.9 ± 10 in the control group, a difference that is not statistically significant. The associations between type of discharge, sex, and duration of admission are shown through odds ratios of 0.883 and 0.833 respectively. Financial problems (48%), lack of clinical improvement (28.8%) and leaving to seek alternative/complimentary medical care (23.1%) were the factors found to be responsible for DAMA in the study. Conclusion: The incidence of discharge against medicine is high in this study. There is a need for all stakeholders to evaluate factors responsible for DAMA, with the aim of reducing this trend.
Cardiovascular autonomic dysfunction (CAD) has been documented as part of neurological complicati... more Cardiovascular autonomic dysfunction (CAD) has been documented as part of neurological complications in sickle cell anaemia (SCA). There is little information on CAD from sub-Saharan Africa with 25-40% prevalence rate of sickle cell trait. This study therefore assessed cardiovascular autonomic reflex function in a group of Nigerians with SCA. Forty SCA and 44 controls (Hemoglobin AA) were studied. They were assessed using 6 non-invasive cardiovascular autonomic reflex (CAR) tests. Parasympathetic functions were assessed with heart rate variability (HRV) to deep breathing, Valsalva maneuver and lying-to-standing test while sympathetic blood pressure regulation was assessed by systolic and diastolic blood pressure responses to lying-to-standing position and isotonic handgrip test. Mean haemoglobin (Hb) concentration of SCA patients and controls were 8.4 +/- 2.4 g/dl and 13.1 +/- 0.9 g/dl, respectively. Baseline heart rate was significantly faster in the SCA patients (84 +/- 12 beats/minute) than in controls (76 +/- 11 beats/minute) [P < 0.05]. Eleven SCA compared to 2 controls had abnormal responses to deep breathing test (P = 0.003); 15 SCA and 6 controls had impaired Valsalva ratio (P = 0.01); 8 SCA and 4 controls had abnormal responses lying-to-standing test (P = 0.2). Although, more SCA patients compared to controls had abnormal responses to sympathetic mediated blood pressure tests the difference was insignificant (P > 0.05). Overall 21 (53%) SCA patients compared to 4 control subjects (9%) fulfilled the criteria for cardiovascular autonomic neuropathy (presence of e"3 CAR tests) with p < 0.05. CAN occur in Nigerians with SCA with relative preservation of the sympathetic blood pressure reflex control compared to parasympathetic heart rate regulation. Increase baseline heart rate associated with SCA in the presence of chronic anaemia could result in myocardial hypertrophy and dilatation. This is likely to be predispose sicklers to hypoxia-related arrhythmia.
Background: Sickle Cell Disease (SCD) is a common autosomal recessive disorder worldwide that mos... more Background: Sickle Cell Disease (SCD) is a common autosomal recessive disorder worldwide that mostly affects Africans. Hyperuricemia, a common biochemical finding, occurs in up to 41% of SCD patients. Although hyperuricaemia is the most important risk factor for gout, thelatter is uncommonly reported in SCD.Objective: To determine the frequency and factors associated with hyperuricaemia and gout among patients with Sickle Cell Disease  (SCD).Design: This was a cross sectional study.Methods: The study involved 104 SCD patients and 104 haemoglobin AA (HbAA) controls. The diagnosis of gout was based on the  demonstration of monosodium urate crystals in the synovial fluid of symptomatic individuals. Hyperuricaemia was found in 28 (26.9%) and 2 (1.9%) of SCD and control participants respectively (p<0.001). The median (range) Serum Uric Acid (SUA) was higher among patients (330 μmol/L [146 to 702 μmol/]) than in controls (232 μmol/L [143 to 440 μmol/L]), (p<0.01). Six (5.8%) cases of gout were found among the patients and none among the controls (p=0.029). The pattern of articular involvement was monoarticular in 2 (33.3%), oligoarticular in 3 (50%) and polyarticular in 1 (16.7%). One (16.7%) patient had subcutaneous tophi. Factors associated with gout in SCD were age, hyperuricaemia, more than two SCD crises in the past year and more than two hospital admissions in the past year.Conclusion: Gout as is hyperuricaemia, is more frequent in persons with SCD than in the general population. It is mostly oligoarticular and older patients with multiple attacks of painful joint swelling as well as frequent hospital admissions may be at higher risk of gout
Saudi Journal of Kidney Diseases and Transplantation, 2018
Kidney transplantation is the gold standard for end-stage renal disease. All over the world there... more Kidney transplantation is the gold standard for end-stage renal disease. All over the world there are several challenges preventing sufficient organ donation to meet the growing needs of patients on the waiting list. One major challenge which is common to most countries is the shortage of organs from willing living donors. Many countries, especially, the developed countries, have devised several models of expanding their donor pools to meet the growing needs of patients on the waiting list. Nigeria, a developing country has very low kidney transplantation rate even though some progress have been made in making the procedure feasible in about a dozen hospitals in Nigeria. One very major challenge has been the shortage of donor organ supply. This paper intends to proffer suggestions on how to expand the organ donor pool in Nigeria.
While data from the latter part of the twentieth century consistently showed that immigrants to h... more While data from the latter part of the twentieth century consistently showed that immigrants to high-income countries faced higher cardio-metabolic risk than their counterparts in low- and middle-income countries, urbanization and associated lifestyle changes may be changing these patterns, even for conditions considered to be advanced manifestations of cardio-metabolic disease (e.g., chronic kidney disease [CKD]). Using cross-sectional data from the Center for cArdiometabolic Risk Reduction in South Asia (CARRS, n = 5294) and Mediators of Atherosclerosis in South Asians Living in America (MASALA, n = 748) studies, we investigated whether prevalence of CKD is similar among Indians living in Indian and U.S. cities. We compared crude, age-, waist-to-height ratio-, and diabetes- adjusted CKD prevalence difference. Among participants identified to have CKD, we compared management of risk factors for its progression. Overall age-adjusted prevalence of CKD was similar in MASALA (14.0% [95...
ABSTRACT CD4 T-cell percentages, viral load and thymic function measured as T-cell receptor rearr... more ABSTRACT CD4 T-cell percentages, viral load and thymic function measured as T-cell receptor rearrangement excision circle (TREC) levels were determined every 2-3 months in six treated HIV-infected children for 4 years. All children experienced a marked increase in CD4 cell count after therapy, accompanied by a concomitantly marked increase in TREC levels. In children, the decrease in viral load caused by antiviral therapy leads to an increase in CD4 T cells, mainly because of a recovery in the thymic production of new T cells.
Introduction: Discharge against medical advice (DAMA) is a worldwide problem with negative health... more Introduction: Discharge against medical advice (DAMA) is a worldwide problem with negative health and socioeconomic effects. Factors that have been implicated as causes or contributing to DAMA include financial constraints, lack of health insurance, deteriorating clinical condition of the patient, and problematic doctor-patient relationships. Aims: determine the incidence and profiles ofDAMA on the medical wards, so as to allows for evidence-based interventions to reduce this problem to a minimum. Materials and Methods: This was a case-control study carried out on the medical wards of Federal Medical Center, Ido-Ekiti, South-West Nigeria. The medical records of all patients admitted to the male and female medical wards between January 2008 and April 2011 were reviewed. After being identified through the admission/discharge log, patients who were DAMA and a similar number of patients with regular discharge had their case notes retrieved. Information extracted included bio-data, diagnosis, duration of hospital stay, and reason for discharge. Results: One hundred and thirty-eight patients representing 7.2% were DAMA during the study period. Ninety five cases had complete medical records, and full analysis was carried out on these and 94 other cases with regular discharge as control. The mean age of the DAMA cases was 50.8 ± 18.3 years, with 58 (61.1%) of these patients being male; while the mean age of the control group was 54.1 ± 16.5, of which 54 (57.4%) were male. The mean duration of admission for patients with DAMA was 10.4 ± 9.2 days as against 11.9 ± 10 in the control group, a difference that is not statistically significant. The associations between type of discharge, sex, and duration of admission are shown through odds ratios of 0.883 and 0.833 respectively. Financial problems (48%), lack of clinical improvement (28.8%) and leaving to seek alternative/complimentary medical care (23.1%) were the factors found to be responsible for DAMA in the study. Conclusion: The incidence of discharge against medicine is high in this study. There is a need for all stakeholders to evaluate factors responsible for DAMA, with the aim of reducing this trend.
Cardiovascular autonomic dysfunction (CAD) has been documented as part of neurological complicati... more Cardiovascular autonomic dysfunction (CAD) has been documented as part of neurological complications in sickle cell anaemia (SCA). There is little information on CAD from sub-Saharan Africa with 25-40% prevalence rate of sickle cell trait. This study therefore assessed cardiovascular autonomic reflex function in a group of Nigerians with SCA. Forty SCA and 44 controls (Hemoglobin AA) were studied. They were assessed using 6 non-invasive cardiovascular autonomic reflex (CAR) tests. Parasympathetic functions were assessed with heart rate variability (HRV) to deep breathing, Valsalva maneuver and lying-to-standing test while sympathetic blood pressure regulation was assessed by systolic and diastolic blood pressure responses to lying-to-standing position and isotonic handgrip test. Mean haemoglobin (Hb) concentration of SCA patients and controls were 8.4 +/- 2.4 g/dl and 13.1 +/- 0.9 g/dl, respectively. Baseline heart rate was significantly faster in the SCA patients (84 +/- 12 beats/minute) than in controls (76 +/- 11 beats/minute) [P < 0.05]. Eleven SCA compared to 2 controls had abnormal responses to deep breathing test (P = 0.003); 15 SCA and 6 controls had impaired Valsalva ratio (P = 0.01); 8 SCA and 4 controls had abnormal responses lying-to-standing test (P = 0.2). Although, more SCA patients compared to controls had abnormal responses to sympathetic mediated blood pressure tests the difference was insignificant (P > 0.05). Overall 21 (53%) SCA patients compared to 4 control subjects (9%) fulfilled the criteria for cardiovascular autonomic neuropathy (presence of e"3 CAR tests) with p < 0.05. CAN occur in Nigerians with SCA with relative preservation of the sympathetic blood pressure reflex control compared to parasympathetic heart rate regulation. Increase baseline heart rate associated with SCA in the presence of chronic anaemia could result in myocardial hypertrophy and dilatation. This is likely to be predispose sicklers to hypoxia-related arrhythmia.
Background: Sickle Cell Disease (SCD) is a common autosomal recessive disorder worldwide that mos... more Background: Sickle Cell Disease (SCD) is a common autosomal recessive disorder worldwide that mostly affects Africans. Hyperuricemia, a common biochemical finding, occurs in up to 41% of SCD patients. Although hyperuricaemia is the most important risk factor for gout, thelatter is uncommonly reported in SCD.Objective: To determine the frequency and factors associated with hyperuricaemia and gout among patients with Sickle Cell Disease  (SCD).Design: This was a cross sectional study.Methods: The study involved 104 SCD patients and 104 haemoglobin AA (HbAA) controls. The diagnosis of gout was based on the  demonstration of monosodium urate crystals in the synovial fluid of symptomatic individuals. Hyperuricaemia was found in 28 (26.9%) and 2 (1.9%) of SCD and control participants respectively (p<0.001). The median (range) Serum Uric Acid (SUA) was higher among patients (330 μmol/L [146 to 702 μmol/]) than in controls (232 μmol/L [143 to 440 μmol/L]), (p<0.01). Six (5.8%) cases of gout were found among the patients and none among the controls (p=0.029). The pattern of articular involvement was monoarticular in 2 (33.3%), oligoarticular in 3 (50%) and polyarticular in 1 (16.7%). One (16.7%) patient had subcutaneous tophi. Factors associated with gout in SCD were age, hyperuricaemia, more than two SCD crises in the past year and more than two hospital admissions in the past year.Conclusion: Gout as is hyperuricaemia, is more frequent in persons with SCD than in the general population. It is mostly oligoarticular and older patients with multiple attacks of painful joint swelling as well as frequent hospital admissions may be at higher risk of gout
Saudi Journal of Kidney Diseases and Transplantation, 2018
Kidney transplantation is the gold standard for end-stage renal disease. All over the world there... more Kidney transplantation is the gold standard for end-stage renal disease. All over the world there are several challenges preventing sufficient organ donation to meet the growing needs of patients on the waiting list. One major challenge which is common to most countries is the shortage of organs from willing living donors. Many countries, especially, the developed countries, have devised several models of expanding their donor pools to meet the growing needs of patients on the waiting list. Nigeria, a developing country has very low kidney transplantation rate even though some progress have been made in making the procedure feasible in about a dozen hospitals in Nigeria. One very major challenge has been the shortage of donor organ supply. This paper intends to proffer suggestions on how to expand the organ donor pool in Nigeria.
While data from the latter part of the twentieth century consistently showed that immigrants to h... more While data from the latter part of the twentieth century consistently showed that immigrants to high-income countries faced higher cardio-metabolic risk than their counterparts in low- and middle-income countries, urbanization and associated lifestyle changes may be changing these patterns, even for conditions considered to be advanced manifestations of cardio-metabolic disease (e.g., chronic kidney disease [CKD]). Using cross-sectional data from the Center for cArdiometabolic Risk Reduction in South Asia (CARRS, n = 5294) and Mediators of Atherosclerosis in South Asians Living in America (MASALA, n = 748) studies, we investigated whether prevalence of CKD is similar among Indians living in Indian and U.S. cities. We compared crude, age-, waist-to-height ratio-, and diabetes- adjusted CKD prevalence difference. Among participants identified to have CKD, we compared management of risk factors for its progression. Overall age-adjusted prevalence of CKD was similar in MASALA (14.0% [95...
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