Search

Single-step Coulomb excitation of 46,48,49,50Ti is presented. A complete set of E 2 matrix elements for the quintuplet of states in 49Ti, centred on the 2 + core excitation, was measured for the first time. A total of nine E 2 matrix elements are reported, four of which were previously unknown. 22 49 Ti 27 shows a 20% quenching in electric quadrupole transition strength as compared to its semi-magic 22 50 Ti 28 neighbour. This 20% quenching, while empirically unprecedented, can be explained with a remarkably simple two-state mixing model, which is also consistent with other ground-state properties such as the magnetic dipole moment and electric quadrupole moment. A connection to nucleon transfer data and the quenching of single-particle strength is also demonstrated. The simplicity of the 49Ti-50Ti pair (i.e., approximate single- j 0 f 7 / 2 valence space and isolation of yrast states from non-yrast states) provides a unique opportunity to disentangle otherwise competing effects in the ground-state properties of atomic nuclei, the emergence of collectivity, and the role of proton-neutron interactions. [ABSTRACT FROM AUTHOR]

Purpose: Breast cancer is a significant global health issue, contributing to 15% of cancer-related deaths. Our laboratory has pioneered a novel approach, combining Ayurvedic principles with green nanotechnology, to develop a scientifically rigorous medical modality referred to as Nano-Ayurvedic Medicine, recently approved by the US Patents and Trademarks Office. Here in we report a new Nano-Ayurvedic medicine agent derived from gold nanoparticles encapsulated with phytochemicals from Ginkgo biloba plant (GB-AuNPs)., Methods: We have developed biocompatible gold nanoparticles using electron-rich phytochemicals from Ginkgo biloba as reducing agent cocktail. Ginkgo biloba phytochemical-encapsulated gold nanoparticles (GB-AuNPs) were fully characterized, and their anticancer activity, including immunomodulatory profiles, were evaluated against breast (MDAMB-231) cancer cell lines., Results: Characterization revealed spherical morphology for GB-AuNPs and possessed optimum in vitro stability through high zeta potential of -34 mV for optimum in vivo stability. The core size of GB-AuNPs of 19 nm allows for penetration into tumor cells through both EPR effects as well as through the receptor-mediated endocytosis. The Antitumor efficacy of this nano-ayurvedic medicine agent revealed strong antitumor effects of GB-AuNPs towards MDAMB-231. Our investigations reveal that GB-AuNPs enhance anti-tumor cytokines (IL-12, TNF-α, IFN-γ) and reduce pro-tumor cytokines (IL-10, IL-6), promoting the conversion of protumor M2 macrophages into M1-like macrophage antitumor phenotype. Cellular studies show that GB-AuNPs offer superior anti-tumor efficacy and a better safety profile against breast tumors compared to cisplatin., Conclusion: Our investigations have demonstrated that the nano-ayurvedic medicine agent, GB-AuNPs, treats cancers through an immunomodulatory mechanism facilitated by elevated levels of anti-tumor cytokines (TNF-α, IFN-γ and IL-12) with concomitant downregulation of pro-tumor cytokines expression (IL-6 and IL-10). The green nanotechnology approach for the development of nano-ayurvedic medicine agent (GB-AuNPs), as described in this paper, presents new and attractive opportunities for treating human cancers and other debilitating diseases and disorders., Competing Interests: The authors (s) report no conflicts of interest., (© 2024 Thipe et al.)

Background: The outlook of chronic kidney disease (CKD) in low-and-medium-income-countries is poor. Modern farming practices in Nigeria are becoming increasingly associated with the use of herbicides and pesticides., Aim: The study aimed to evaluate agrochemical use in farming practices and risk factors for kidney disease among dwellers of rural farming communities in South-West Nigeria., Methods: This was a cross-sectional survey of adult dwellers of an agrarian rural farming community in South-West Nigeria. Participants provided information on demographics, lifestyles, knowledge, and awareness of risk factors for kidney disease, and the use of agrochemicals in farming practice. Anthropometric measurements and blood pressure values were obtained while blood and spot urine were collected for random blood glucose, serum creatinine, urinalysis, and albumin-creatinine ratio., Results: A total of 572 rural dwellers were enrolled in the study, with a mean age of 49.9 ± 17.5 years while 39.3% were male and 88.9% engaged in active farming. The prevalence of traditional risk factors for kidney disease was hypertension (24.3%), Diabetes mellitus (2.8%), cigarette smoking (7.5%), alcohol intake (20.8%) and herbal consumption (57.1%). The use of pesticides/herbicides was reported in 69.9%, while 25.3% did not use protective gear during its use. Proteinuria, hematuria, and reduced eGFR were observed in 29.8%, 6.1%, and 33.9% of participants, respectively., Conclusion: This study showed a high prevalence of herbicides and pesticide use and traditional risk factors for kidney disease, in addition to the high prevalence of markers of kidney damage among the dwellers of rural farming settlements in South-West Nigeria., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

Eco-friendly interlocking concrete pavement block was developed using the admixture of bamboo leaf ash and metakaolin. This was done to develop an eco-friendly interlocking paving block for sustainable pavement construction. Bamboo leaf ash and metakaolin were added as a supplementary cementitious material. The supplementary cementitious material (bamboo leaf ash and metakaolin) were admixed and added at 0, 5, 10, 15, 20, 25 and 30 % replacement of cement. The workability of the fresh concrete (slump) at the varied percentage additions, and the mechanical properties of the concrete at 7, 14, 28, and 56 days of curing were assessed, including their microstructural characteristics. The outcome of the research showed that increasing the percentage of (bamboo leaf ash + metakaolin) reduces the workability of the concrete. With a 20 % addition of this cementitious material, the developed fresh concrete became unworkable. In addition, replacing up to 10 % of the concrete in the pavement with bamboo leaf ash and metakaolin increased the mechanical strength of the concrete by 28.7 %. At 30 % a percentage increase of 3.6 % was recorded. However, the strength at 5 % was still adequate for pavement construction with a 13.62 % increase in mechanical strength. The compressive strength at 5 % and 10 % addition of the supplementary cementitious material at maturity met the criteria for constructing a semi-rigid pavement, using IRC standards. The microstructural assessment showed that the number of pores in the mature concrete samples decreased at 10 % addition of bamboo leaf ash and metakaolin. The research data provides construction workers, researchers, and highway engineers with vital information regarding the viability of these sustainable materials for pavement improvement., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations., Methods: We conducted this scoping review to answer the question: "what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively., Results: Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively., Conclusion: Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined., (© 2023. The Author(s).)

The transfer model suggests that urea unfolds proteins mainly by increasing the solubility of the amide backbone, probably through urea-induced increase in hydrogen bonding. Other studies suggest that urea addition increases the magnitude of solvent-solute van der Waals interactions, which increases the solubility of nonpolar sidechains. More recent analyses hypothesize that urea has a similar effect in increasing the solubility of backbone and sidechain groups. In this work, we compare the effects of urea addition on the solvation of amides and alkyl groups. At first, we study the effects of urea addition upon solvent hydrogen bonding acidity and basicity through the perturbation in the fluorescence spectrum of probes 1-AN and 1-DMAN. Our results demonstrate that the solvent's hydrogen bonding properties are minimally affected by urea addition. Subsequently, we show that urea addition does not perturb the intra-molecular hydrogen bonding in salicylic acid significantly. Finally, we investigate how urea preferentially interacts with amide and alkyl groups moieties in water by comparing the effects of urea addition upon the solubility of acetaminophen and 4-tertbutylphenol. We show that urea affects amide and t-butyl solubility (lowers the transfer free energy of both amide (backbone) and alkyl (sidechain) groups) in a similar fashion. In other words, preferential interaction of urea with both moieties contributes to protein denaturation., (© 2022 Wiley-VCH GmbH.)

Introduction: The tropical environment is endemic with malaria and non-malarial infections which are responsible for the high morbidity and mortality in these low- and middle-income countries. In particular, acute malarial infection can cause significant multi-organ dysfunction, including kidney involvement. Early detection of kidney dysfunction will help to improve the quality of care and reduce associated morbidity and mortality. This study aimed at identifying the spectrum of kidney dysfunction in patients with acute malaria and non-malarial infections., Methods: This was a prospective observational study in which participants with acute malarial infection, acute non-malarial infection, and apparently healthy individuals were enrolled. For acute malarial infection, participants with thick blood smear parasite density of ≥1000 parasite/µl and falciparum species on thin smear were enrolled. Demographic, clinical, and laboratory parameters were measured. The renal abnormalities examined were urea, creatinine and eGFR, albuminuria, electrolytes, and presence of acute kidney injury (AKI)., Results: The following electrolyte abnormalities were observed in participants with acute falciparum infection: hyponatraemia (10.7%), hypernatraemia (4.0%), hypokalaemia (8.0%), and hyperkalaemia (13.3%). The mean serum urea in participants with acute malaria was 33.8±8.8mmol/l while participants with non-malarial febrile illnesses and healthy controls had 34.7±9.0mmol/l and 26.8±7.6mmol/l, respectively. The mean serum creatinine among participants with acute falciparum infection was 1.0±0.3mg/dl compared to those of participants with non-malarial infections and healthy controls which were 1.1±0.4mg/dl and 0.8±0.3mg/dl, respectively. The difference in the observed mean serum creatinine among the 3 groups was statistically significant (p=0.023). The mean urinary sodium among participants with non-malarial infection was highest at 23.03mmol/l. There was transient albuminuria in 6.7% of participants with acute malarial infection which resolved after recovery from the infection., Conclusion: A relatively high frequency of serum electrolyte abnormalities, albuminuria and urine microscopic abnormalities were observed among subjects with acute malaria compared to those without malaria infection., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2023 by West African Journal of Medicine.)

Deconstruction is an innovative and sustainable option for building end-of-life. It can turn the negative impacts of demolition, including diverting valuable resources from the congested landfill into beneficial use through reuse and recycling. However, the feasibility of deconstruction has placed a massive limitation on the implementation of deconstruction. This research carried out a systematic literature review of 35 academic and 3 non-academic pieces of literature to develop a construct-based deconstructability framework. This framework - built around technical, economic, legal, operational, schedule and social construct - describes the condition under which deconstruction is likely to work and drivers influencing deconstructability. A total of 44 drivers influencing deconstructability were established and ranked from which design and building technology, cost including expense and revenues from the resale, supply and demand of the recovered component and material, the schedule for the deconstruction were identified as most influential. However, every identified driver should be considered during the deconstructability assessment of a building.

Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD); however, the burden of cardiovascular risk factors in patients with CKD in Africa is not well characterized. We determined the prevalence of selected cardiovascular risk factors, and association with CKD in the Human Heredity for Health in Africa Kidney Disease Research Network study., Methods: We recruited patients with and without CKD in Ghana and Nigeria. CKD was defined as estimated glomerular filtration rate of <60 ml/min per 1.73 m 2 and/or albuminuria as albumin-to-creatinine ratio <3.0 mg/mmol (<30 mg/g) for ≥3 months. We assessed self-reported (physician-diagnosis and/or use of medication) hypertension, diabetes, and elevated cholesterol; and self-reported smoking as cardiovascular risk factors. Association between the risk factors and CKD was determined by multivariate logistic regression., Results: We enrolled 8396 participants (cases with CKD, 3956), with 56% females. The mean age (45.5 ± 15.1 years) did not differ between patients and control group. The prevalence of hypertension (59%), diabetes (20%), and elevated cholesterol (9.9%), was higher in CKD patients than in the control participants ( P  < 0.001). Prevalence of risk factors was higher in Ghana than in Nigeria. Hypertension (adjusted odds ratio [aOR] = 1.69 [1.43-2.01, P  < 0.001]), elevated cholesterol (aOR = 2.0 [1.39-2.86, P  < 0.001]), age >50 years, and body mass index (BMI) <18.5 kg/m 2 were independently associated with CKD. The association of diabetes and smoking with CKD was modified by other risk factors., Conclusion: Cardiovascular risk factors are prevalent in middle-aged adult patients with CKD in Ghana and Nigeria, with higher proportions in Ghana than in Nigeria. Hypertension, elevated cholesterol, and underweight were independently associated with CKD., (© 2022 Published by Elsevier Inc. on behalf of the International Society of Nephrology.)

The paper chronicles the life and times of Professor Alexander Brown, the Foundation Professor and Head of the Department of Medicine at the University of Ibadan. The official opening of the University College Ibadan, Nigeria on 20 November 1957 as well as the graduation of the first set of clinical students in 1960 were glorious moments for Alexander Brown who laboured for 12years to witness these. He was also instrumental to the creation of the Department of Paediatrics (1962), Department of Radiology (1963) and the Medical Illustration unit of the hospital. Paediatrics and Radiology were initially units in the Department of Medicine. He played significant role in the development of postgraduate programmes in Cardiology, neuropsychiatry and nephrology units of the hospital and substantial role in the development of nursing education in the hospital. He was the brain behind the famous Ibarapa Community Health Project., (© Association of Resident Doctors, UCH, Ibadan.)

Background: Chronic kidney disease (CKD) is a global growing public health epidemic with attending morbidity and huge financial cost. Cardiovascular disease (CVD), a major complication of CKD, contributes to its excessive mortality rate. The aetio-pathogenesis of the excess burden of CVD in CKD is a feature yet to be unravelled. Fibroblast growth factor-23 (FGF-23) has been implicated as a risk factor for CVD among patients with CKD. However, most of these studies were predominantly among the Caucasian population., Aim: This study aims to determine the correlation between FGF-23 and CVD among Nigerians with CKD., Patients and Methods: A cross-sectional comparative study composed of three groups: participants with CKD, hypertensives without CKD, and healthy individuals, represented as group 1, 2, and 3, respectively. Information obtained included demographic data and occurrence of risk factors for CVD. Cardiovascular risks were assessed by echocardiography and all the participants had kidney function tests done with plasma FGF-23., Results: The study sample size consisted of 135 participants. The mean (SD) age for participants with CKD and controls were 50.2 (12.7), 54.3 (15.5), and 40.2 (14.1) years, respectively. The median [interquartile range (IQR)] of plasma FGF-23 for participants with CKD 210 (139-304) RU/ml, and controls 124 (86-170) RU/ml, and 71 (38 - 89) RU/ml P < 0.001. Most participants with CKD had left ventricular hypertrophy (LVH) (80.0%), compared to the controls; 28.9% and 6.7% P < 0.001. Similarly, majority of participants with CKD had elevated plasma FGF-23 with LVH (85.7%) compared to controls 55.6% and 11.5%, whereas for aortic valve calcification with elevated plasma FGF-23 among CKD and controls were 53.6% (P = 0.29), 37.0% (P = 0.03), and 19.2% (P = 0.06), respectively., Conclusion: Individuals with CKD had frequencies of elevated plasma FGF-23, LVH, and cardiac valve calcification, which are surrogates of cardiovascular events., Competing Interests: None

One of the significance parts of ecosystem is the soil, and it is often modified due to man activities. The objective of this work examined the extent of occurrence of elements in the soil and also to identify the soil contamination level via enrichment factor (EF) and contamination factor/pollution index. The enrichment value was computed using five elements (Ti, Mn, Zn, Cu, Cr) and iron (Fe) as reference element. Scandium (Sc) was not found at hospital dumpsite while arsenic (As) was not found at marketplace. Fe, Ca and K had high concentrations in all locations, ranging from 2651 to 4630 ppm, 2204.67 ppm - 3968.67 ppm and 3649.00 - 4773.67 ppm, respectively. The pollution index value is shown in this order: Ni > Fe > Cu > Cr > Zn > Mn > As an enrichment value in this order: Ni > Se > Cu > V > Zn > Cr > Zr > As > Mn > K > Ca > Rb > Ti > Sr, when Fe was used as a reference element. The overall risk index (RI) in all the locations in the soil was above the edge., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature.)

Background: Geriatric medicine is an emerging subspecialty in Nigeria. The interest in the care of older Nigerians followed the Madrid International Plan of Action on Ageing in April 2002. This led to an increase in research, publications and advocacy culminating in the establishment of the pioneer geriatric centre in Nigeria in 2012. Since then, there has been an increase in capacity building, manpower development and institutionalization of geriatric care in Nigeria. This is an account of the evolution of the Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan (UCH)., Methods: We undertook the review of the history, structure and key service elements in the Geriatric Centre, UCH from January 1, 2013, to December 31, 2020., Results: The number of patients rose from 2,559 in the first year to 19,300 by the end of 2020. The initial four multidisciplinary units increased to 12 over the review period. Likewise, the in-patient admission increased between the first year (122 patients) and 2020 (141 patients). The overall mortality rate was 11.4% over the review period. Internship opportunities were provided to students including resident doctors, undergraduates (medical) and postgraduate students (Masters and PhD). Besides, 139 medical doctors have undergone the annual basic certificate training in geriatric medicine organised by the Centre. Also, 7 fellowship dissertations and 11 peer-reviewed papers have been published., Conclusion: The centre has demonstrated the possibility of caring for older patients in a low-resource setting. The employment of the multidisciplinary approach yielded a low mortality rate, higher attendance and manpower development., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2021 by West African Journal of Medicine.)

Variants in the Apolipoprotein L1 ( APOL1 ) gene (G1-rs60910145, rs73885319, G2-rs71785313) are common in Africans and in individuals of recent African ancestry and are associated with an increased risk of non-diabetic chronic kidney disease (CKD) and in particular of HIV associated nephropathy (HIVAN). In light of the significantly increased risk of HIVAN in carriers of two APOL1 risk alleles, a role in HIV infectivity has been postulated in the mechanism of APOL1 associated kidney disease. Herein, we aim to explore the association between HIV viremia and APOL1 genotype. In addition, we investigated interaction between BK and JC viruria, CKD and HIV viremia. A total of 199 persons living with HIV/AIDS (comprising 82 CKD cases and 117 controls) from among the participants in the ongoing Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network case control study have been recruited. The two APOL1 renal risk alleles (RRA) genotypes were associated with a higher risk of CKD (OR 12.6, 95% CI 3.89-40.8, p < 0.0001). Even a single APOL1 RRA was associated with CKD risk (OR 4.42, 95% CI 1.49-13.15, p = 0.007). The 2 APOL1 RRA genotypes were associated with an increased probability of having HIV viremia (OR 2.37 95% CI 1.0-5.63, p = 0.05). HIV viremia was associated with increased CKD risk (OR 7.45, 95% CI 1.66-33.35, P = 0.009) and with a significant reduction of JC virus urine shedding (OR 0.35, 95% CI 0.12-0.98, p = 0.046). In contrast to prior studies, JC viruria was not associated with CKD but was restricted in patients with HIV viremia, regardless of CKD status. These findings suggest a role of APOL1 variants in HIV infectivity and emphasize that JC viruria can serve as biomarker for innate immune system activation., Competing Interests: KS – Inventor on patent USTPO 77864 entitled: Methods and Kits for Determining Predisposition to Kidney Disease. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Kruzel-Davila, Sankofi, Kubi Amos-Abanyie, Ghansah, Nyarko, Agyemang, Awandare, Szwarcwort-Cohen, Reiner-Benaim, Hijazi, Ulasi, Raji, Boima, Osafo, May Adabayeri, Matekole, Olanrewaju, Ajayi, Mamven, Antwi, Ademola, Plange-Rhule, Arogundade, Akyaw, Winkler, Salako, Ojo, Skorecki and Adu.)

Background: Acute respiratory failure, a major cause of death in COVID-19, is managed with high-flow oxygen therapy via invasive mechanical ventilation. In resource-limited settings like Nigeria, the shortage of ventilators and oxygen supply makes this option challenging. Evidence-based non-invasive alternatives to mechanical ventilation such as the use of continuous positive airway pressure (CPAP) devices exist, but there have been concerns that non-invasive ventilation may expose healthcare workers to infection from aerosolized dispersion of SARS-CoV-2. We propose to evaluate the feasibility, adaptability and acceptability of a CPAP/O 2 helmet solution for non-invasive ventilation among patients with COVID-19 and health workers in eight COVID-19 treatment and isolation centers in Nigeria., Methods: The study will occur in 4 stages: (1) convene a Steering Committee of key stakeholders and recruit implementation sites; (2) use the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework to guide a needs assessment of treatment centers' capacity to use high-flow oxygen therapy to treat COVID-19 patients and utilize the findings to develop an implementation strategy for the use of a CPAP/O 2 helmet solution; (3) build infrastructure to support training and data monitoring processes and to develop implementation protocols to evaluate the adaptability of the strategy for the use of the CPAP/O 2 helmet; and (4) train health workers, distribute a CPAP/O 2 helmet solution for non-invasive ventilation, pilot test the implementation strategy, and assess feasibility of its use and acceptability that includes monitoring altered risk of SARS-CoV-2 infection among healthcare workers., Discussion: The CPAP/O 2 helmet solution for non-invasive ventilation in Nigeria can serve as a scalable model for resource-poor countries, and beyond the COVID-19 pandemic, has the potential to be deployed for the treatment of pneumonia and other respiratory diseases., Trial Registration: NCT04929691. Registered June 18, 2021-retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04929691., (© 2021. The Author(s).)

Background: Childhood nephrotic syndrome, if left untreated, leads to progressive kidney disease or death. We quantified the prevalence of steroid-sensitive nephrotic syndrome, steroid-resistant nephrotic syndrome, and histological types as the epidemiology of nephrotic syndrome in Africa remains unknown, yet impacts outcomes., Methods: We searched MEDLINE, Embase, African Journals Online, and WHO Global Health Library for articles in any language reporting on childhood nephrotic syndrome in Africa from January 1, 1946 to July 1, 2020. Primary outcomes included steroid response, biopsy defined minimal change disease, and focal segmental glomerulosclerosis (FSGS) by both pooled and individual proportions across regions and overall., Findings: There were 81 papers from 17 countries included. Majority of 8131 children were steroid-sensitive (64% [95% CI: 63-66%]) and the remaining were steroid-resistant (34% [95% CI: 33-35%]). Of children biopsied, pathological findings were 38% [95% CI: 36-40%] minimal change, 24% [95% CI: 22-25%] FSGS, and 38% [95% CI: 36-40%] secondary causes of nephrotic syndrome., Interpretation: Few African countries reported on the prevalence of childhood nephrotic syndrome. Steroid-sensitive disease is more common than steroid-resistant disease although prevalence of steroid-resistant nephrotic syndrome is higher than reported globally. Pathology findings suggest minimal change and secondary causes are common. Scarcity of data in Africa prevents appropriate healthcare resource allocation to diagnose and treat this treatable childhood kidney disease to prevent poor health outcomes., Funding: Funding was provided by the Canadian Institute for Health Research (CIHR) and the National Institute of Health (NIH) for the H3 Africa Kidney Disease Research Network. This research was undertaken, in part, from the Canada Research Chairs program., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Time of medication delivery from the onset of illness is one factor that determines disease outcomes. In this study, we aimed to reduce the average time from admission to the first dose of antibiotic by at least 30% and increase the percentage of neonates receiving the first antibiotic dose within 1 hour of neonatal intensive care unit arrival to 50% over 12 months in asymptomatic neonates 34 weeks and older estimated gestational age with exposure to maternal chorioamnionitis as a sample population., Method: This study involved 135 infants 34 weeks and older gestational age exposed to chorioamnionitis. We documented the demographic characteristics of mothers and infants. We monitored time to the administration of the first dose of antibiotics through multiple plan-do-study-act cycles. We identified barriers to timely antibiotic administration and targeted them with multipronged interventions in plan-do-study-act cycles. Process measures were displayed monthly using X-bar/S control charts and P charts. We applied established rules for detecting a special cause., Results: We reduced the meantime to the first dose of antibiotics from 130 to 78 minutes (40% reduction). The percentage of infants who received the first antibiotic dose within 60 minutes rose from 5.8% to 36.3% during the study period. Special cause improvement was seen in all process measures. The most significant improvement seen was in the time to obtain a blood culture and the interval between intravenous access placement and antibiotic delivery., Conclusion: Multipronged interventions can help improve timely medication delivery to neonates in the neonatal intensive care unit in this example of infants exposed to chorioamnionitis., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.)

COVID-19 infection predominantly affects the respiratory system; however, other systems and organs are also affected. The kidneys are among the organs commonly affected by SARS-CoV-2 and this has been reported to be a predictor of increased severity, need for intensive care (ICU), admission, and death. We presented two cases of COVID-19 that were associated with co-morbidities that include diabetes mellitus, systemic hypertension and impaired kidney function. The relationship of the multiple co-morbidities particularly the impaired kidney function with the outcomes of COVID-19 infection and the challenges of offering dialysis for patients with COVID-19 infection with kidney failure were discussed. The two cases presented also highlighted the state of preparedness for the management of COVID-19 and its various complications and co-morbidities, particularly kidney failure in a tertiary hospital in Nigeria at onset of the COVID-19 outbreak., Competing Interests: The Authors declare that no competing interest exists

Background: Frailty has emerged as an important clinical measurement among older adults because of its negative health outcomes., Objective: This study measured the prevalence and factors associated with frailty among older adults aged 60 years and above at a Geriatric Centre in Nigeria., Methods: In this descriptive cross-sectional study, 971 older adults were recruited consecutively. Data on sociodemographics characteristics and clinical parameters were obtained using an interviewer-administered questionnaire and physical examination performed. The Frailty syndrome and Frailty Index were assessed using the Fried Frailty Criteria (FFC) and Canadian Study of Health and Aging (CSHA) scale respectively. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05., Results: The mean age of the participants was 71.3 (± 7.1) years with a female to male ratio of 2.4:1. Based on FFC scale, 498 older persons (51.3%) had frailty syndrome while only 148 (15.2%) were frail using the CSHA scale. The measure of agreement (Kappa statistics) was 0.22 (p<0001) indicating weak agreement between the two scales. Logistic regression analysis revealed increasing age (OR=1.948 [1.219-3.113]), multiple morbidities (OR= 1.584, [1.177-2.201]), depression (OR= 5.050, [2.501-9.442,]), imbalance or increased risk of fall (OR 1.623, [1.192-2.211,]), and inability to perform IADL (OR= 0.599 [0.535-0.670,]) to be the most significant determinants of frailty syndrome while obesity (OR=0.660, [0.449-0.971]), unusually appeared a deterrent., Conclusion: The prevalence of frailty syndrome was high among the older adults. Targeted and timely interventions on the modifiable factors may delay progression into frailty and the eventual negative health outcomes., Competing Interests: The Authors declare that no competing interest exists

Background: Chronic kidney disease of unknown origin (CKDu) is assuming an epidemic proportion, especially in farming communities worldwide. We explored the relationship between CKD markers and agrochemical exposure among rural farmers in South Western Nigeria., Methods: We studied selected farming communities in Southwestern Nigeria where the use of agrochemicals was widespread. A pre-tested questionnaire was administered to participants. Anthropometric data, information on use of agro-chemicals; urine and blood samples were obtained. Informed consent was obtained from participants. The study was approved by the Institutional Ethics committee and complied with 1975 Helsinki declaration, as revised in 2000., Results: A total of 438 farmers made up of 202 males (46.1%) and 236 females (53.9%) were studied. The mean microalbuminuria was 30.2 ±11.7 mg/dl. Majority of the farmers had CKD stage 2(42.0%) and CKD stage 3 (37.7%). The type of farming engaged in had a positive, but not significant, correlation with eGFR (r=0.012, p=0.832). There was positive correlation between type of farming and GFR category (r=0.24, p=0.000). Frequency of use of hexachlorocyclohexane had a positive and significant correlation with eGFR (r=0.111, p=0.045). Annual crop farming had a correlation with UACR (r=0.149, p=0.024)., Conclusion: Annual crop farming had a positive correlation with UACR, eGFR and GFR category. The prolonged use of agrochemicals on an annual basis can cause kidney damage.

Forensic mental health services are fledgling in most African countries including Nigeria. The current formulation of such services in Nigeria is correctional psychiatry in addition to some hospital-based services. The COVID-19 pandemic presents significant challenges to the already fragile state of forensic mental health services within the country. Its impact includes limitation of access to and continuity of mental healthcare in prison as well as reduction in referrals from other services within the criminal justice system such as the police and the courts. Further tapering of previously less prominent aspects of forensic mental health service in the country such as the preparation of psychiatric court reports has also been observed. Forensic psychiatry training and research have equally been hampered by the pandemic. The lessons learnt from these challenges should offer practitioners and policy makers insight into strategic developmental objectives for the post-COVID era within services and training programmes., Competing Interests: The authors have no competing interests to declare., (© 2020 The Authors.)

Background: Attaining successful clinical outcomes in the management of hospitalised older patients in the overburdened healthcare services in Nigeria constitutes a major challenge against the backdrop of dearth of data on the predictors of mortality among them., Objectives: To describe the mortality trends and associated factors among older patients (>60 years) at the Geriatric Centre, University College Hospital, Ibadan between January 2013 and December 2017., Methods: Hospital records of older patients admitted were analysed. Data extracted included socio-demographic, diagnoses, length of stay from date of admission to discharge or death. Results of vital signs, anthropometric measurements and laboratory tests carried out at admission were also obtained., Results: The mean age of the 1,091 older patients admitted was 73.6±8.6 years. The overall crude proportion of in-hospital deaths was 9.0% (males=11.3% > females=7.2%, p=0.024) and it increased from 4.1% in 2013 to 12.1% in 2017. The overall unadjusted 30-day mortality rate per 1000 patient-days was 28.9 deaths (95% CI 23.5-35.3). The predictors of mortality were increased length of stay on admission OR=1.061 (95% CI 1.005-1.119), being retired OR=1.672 (95% CI 1.011-2.778), stroke OR=4.019 (95% CI 2.258- 7.138), heart failure OR=3.435 (95% CI 1.455-8.100), Sepsis OR=2.176 (95% CI 1.294-3.654), Anaemia OR=2.820 (95% CI 1.320-6.017), Dementia OR=3.701 (95% CI 1.433-9.549) and malignancies OR=2.658 (95% CI 1.181-5.979)., Conclusion: There was a temporal increase in mortality among older patients. Similarly, staying longer on admission and chronic medical conditions with their complications were the most significant contributors to mortality.

Introduction: Peritoneal dialysis is a form of renal replacement therapy that is both effective and relatively affordable. Peritoneal dialysis (PD) was first used in Nigeria as a treatment option for renal failure. Its use was first reported in Nigeria in 1969 and became more widespread in the 80s and 90s. Haemodialysis, which is capital intensive to set up and requires infrastructures and facilities such as electricity, intense water consumption and buildings, seems to have upstaged peritoneal dialysis both in demand and supply., Methods: This cross-sectional study is a convenient survey of nephrologists, renal technicians and nurses in Nigeria. We used a structured, self-administered questionnaire on a cross-section of members and associate members attending a national nephrology association meeting., Results: There were 68(54.4%) doctors, 43(27.2%) nurses, and 14(11.2%) renal technicians, all from medical institutions with renal treatment programs who participated in the study. The most common problems encountered with PD use are financial constraints (51.7%), inadequate fluid supply (50%), frequent line blockage (22.4%) and frequent infections (17.2%). Reasons attributed to the stoppage of PD in the centres included lack of PD fluids (50.8%), unavailability of PD catheters (22.8%), lack of expert personnel to train (15.8%)., Conclusion: Main challenges to peritoneal dialysis use in Nigeria include limited experience and training and availability and cost of consumables. Effort to overcome the factors militating against its use should be positively pursued so that peritoneal dialysis will be re-integrated into the mainstream of renal replacement therapy once more., Competing Interests: The authors declare no competing interests., (© Samuel Ajayi et al.)