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Background: Cardiometabolic disorders (CMDs) are the leading cause of morbidity and mortality globally. For decades, heart disease, stroke, diabetes mellitus (DM) and chronic kidney disease (CKD) have remained leading causes of death for both men and women in the US. Identification of preventable risk factors is needed to help ameliorate the burden of CMDs. While exposure to toxic heavy metals may contribute to the risk of CMDs, the results of studies examining their association have been inconsistent. Objective: To evaluate the association between blood levels of toxic heavy metals - cadmium, lead and mercury - and coronary heart disease (CHD), stroke, CKD, DM, metabolic syndrome (MetS), dyslipidemia, hypertension, and central obesity in a representative sample of US adults. Methods: We analyzed data from 36,862 adults aged 20 to 80 years in the US National Health and Nutrition Examination Survey (NHANES) 1999 to 2018 cycles. We dichotomized the levels of each metal using the median levels of the individuals without the outcomes, as the cut point. Results: A total of 816 adults had CHD, 1,251 had stroke, 653 had CKD, 6,341 had DM, 6,692 had IR, 18,251 had MetS, 3,597 had dyslipidemia, 20,024 had hypertension and 20,388 had central obesity. In models adjusted for sociodemographic factors and underlying medical diagnoses, we found that cadmium levels were positively associated with CHD [odds ratio: 1.28 (95% confidence interval: 1.06 - 1.55)], stroke [1.21 (1.03 - 1.41)], CKD [1.62 (1.51 - 1.74)] and dyslipidemia [1.17 (1.08 - 1.28)]; and inversely associated with DM [0.65 (0.60 - 0.70)], MetS [0.77 (0.72 - 0.82)] and central obesity [0.72 (0.68 - 0.76)]. In similarly adjusted models, lead levels were positively associated with CKD [1.90 (1.77 - 2.04)] and dyslipidemia [1.18 (1.08 - 1.12)]; and inversely associated with DM [0.51 (0.48 - 0.55)] and central obesity [0.72 (0.68 - 0.76)]. Mercury was positively associated with stroke [1.27 (1.12 - 1.45)], CKD [2.38 (2.23 - 2.54)], MetS [1.14 (1.08 - 1.21)], dyslipidemia [1.09 (1.01 - 1.17)], hypertension [1.19 (1.13 - 1.25)] and central obesity [1.10 (1.04 - 1.15)]. Conclusion: The results of this large cross-sectional analyses support the findings that cadmium, lead and mercury are significantly associated with several CMDs.

Hypertension is one of the commonest cause of chronic kidney disease (CKD) in Nigerians. We describe blood pressure (BP) control and kidney disease markers in patients with hypertension as part of measures to curb the burden of this chronic debilitating disease.Patients with hypertension in the main tertiary hospitals in three states in north central Nigeria were evaluated for indicators of CKD, including proteinuria and estimated glomerular filtration rate (eGFR)60 ml/min/1.73 mA total of 1063 subjects (63.1% females and 36.8% males) with a mean age of 55 ± 11 years were studied. Diabetes mellitus (DM) was present in 214 (20.6%) and 422 (39.7%) had optimal BP control. The median duration of hypertension was 6 years (range 1-44 years). Proteinuria occurred in 130 (12.2%), while 212 (19.9%) had reduced eGFR and 46 (4.3%) had proteinuria and reduced eGFR. The use of calcium channel blockers [adjusted odds ratio (AOR): 0.70, 95% Confidence Interval (CI) 0.50-0.99] and the use of more than two antihypertensive medications (AOR: 0.62, 95% CI 0.40-0.96) were associated with reduced odds of optimal BP control. Male sex (AOR: 1.75, 95% CI 1.14-2.70) and the use of renin-angiotensin-aldosterone system blocking medications (AOR: 2.07, 95% CI 1.18-3.64) were independently associated with proteinuria while DM (AOR: 1.69, 95% CI 1.06-2.55) and treatment with more than two medications (AOR: 1.86, 95% CI 1.09-3.17) were more likely to have reduced eGFR.A large proportion of hypertensive patients in north-central Nigeria have poorly controlled BP. Kidney damage is common among these patients.

In hyperglycemia, hypertonicity results from solute (glucose) gain and loss of water in excess of sodium plus potassium through osmotic diuresis. Patients with stage 5 chronic kidney disease (CKD) and hyperglycemia have minimal or no osmotic diuresis; patients with preserved renal function and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) have often large osmotic diuresis. Hypertonicity from glucose gain is reversed with normalization of serum glucose ([Glu]); hypertonicity due to osmotic diuresis requires infusion of hypotonic solutions. Prediction of the serum sodium after [Glu] normalization (the corrected [Na]) estimates the part of hypertonicity caused by osmotic diuresis. Theoretical methods calculating the corrected [Na] and clinical reports allowing its calculation were reviewed. Corrected [Na] was computed separately in reports of DKA, HHS and hyperglycemia in CKD stage 5. The theoretical prediction of [Na] increase by 1.6 mmol/L per 5.6 mmol/L decrease in [Glu] in most clinical settings, except in extreme hyperglycemia or profound hypervolemia, was supported by studies of hyperglycemia in CKD stage 5 treated only with insulin. Mean corrected [Na] was 139.0 mmol/L in 772 hyperglycemic episodes in CKD stage 5 patients. In patients with preserved renal function, mean corrected [Na] was within the eunatremic range (141.1 mmol/L) in 7,812 DKA cases, and in the range of severe hypernatremia (160.8 mmol/L) in 755 cases of HHS. However, in DKA corrected [Na] was in the hypernatremic range in several reports and rose during treatment with adverse neurological consequences in other reports. The corrected [Na], computed as [Na] increase by 1.6 mmol/L per 5.6 mmol/L decrease in [Glu], provides a reasonable estimate of the degree of hypertonicity due to losses of hypotonic fluids through osmotic diuresis at presentation of DKH or HHS and should guide the tonicity of replacement solutions. However, the corrected [Na] may change during treatment because of ongoing fluid losses and should be monitored during treatment.

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance.

Background: Chronic kidney disease (CKD) is one of the important complications of human immunodeficiency virus (HIV) infection. The prevalence of CKD in HIV-infected Nigerians at presentation is currently unknown. Materials and Methods: This was a comparative study of 400 antiretroviral drug naïve HIV-infected patients attending the HIV clinic of a teaching hospital in North Central Nigeria and 140 apparently healthy individuals. CKD was defined as estimated glomerular filtration rate (eGFR)

Backround: Secondary hyperparathyroidism (SHPT) is a manifestation of chronic kidney disease mineral bone disorder (CKD-MBD). SHPT is common in patients with chronic kidney disease (CKD) and is associated with significant morbidity and mortality. Methods: A cross- sectional descriptive study involving 230 patients with CKD. Results: The mean age of the study population was 44.17±15.24 years. The median intact parathyroid hormone and alkaline phosphatase levels were 96pg/ml (range 4-953pg/ml) and 88 iu/l (range 10-800 iu/l) respectively. The mean (with standard deviation) calcium, serum phosphate, calcium phosphate product and haemoglobin levels were 2.22±0.29mmol/l, 1.8±0.62mmol/l, 3.94±1.42mmol2/l2 and 9.90±1.87g/dl respectively. Majority of patients had advanced CKD with 70.3% of patients in stage G5. The prevalence rates of SHPT, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase and elevated calcium phosphate product were 55.2%, 34.8%, 66.1%, 42.2% and 25.2% respectively. Univariate analysis revealed that SHPT was associated with hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase, proteinuria, anaemia, hypertension, left ventricular hypertrophy and stage of kidney disease; being worse with advancing kidney disease. Independently associated with SHPT were hypocalcaemia (OR=4.84), hyperphosphataemia (OR=3.06), and elevated alkaline phosphatase (OR=2.04). Conclusion: The prevalence of SHPT in CKD is high, occurs early and is independently associated with hypocalcaemia, hyperphosphataemia and elevated alkaline phosphatase. The prevalence of SHPT also increases with worsening renal function. Keywords: Secondary hyperparathyroidism, chronic kidney disease, intact parathyroid hormone, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase.

Objectives Effective antiretroviral therapy has prolonged the survival of patients with HIV. Accordingly, studies of the consequences of ageing are increasingly important. We determined the prevalence of early menopause (EM) and its associated factors in a cohort of HIV-infected and HIV-negative controls in Jos, Nigeria. Methods HIV-infected women accessing care in an ambulatory setting and their negative counterparts from the general population were included. Menopause was defined as having gone one year since the last menstrual period. EM was defined as the onset of menopause at ≤45 years of age. Baseline characteristics were compared and logistic regression analyses were used to determine factors independently associated with EM. Results Out of a total of 253 women included, 58 attained menopause early, giving an EM prevalence of 22.9% (95% confidence interval [CI] 17.9–28.6%). Women with EM were younger (P

Objective To describe the prevalence of female sexual dysfunction (FSD) and its determinants among women with HIV infection enrolled for care and treatment in an ambulatory care setting. Methods A questionnaire-based cross-sectional survey was conducted among women attending the HIV clinic of Jos University Teaching Hospital, Nigeria, between March 2013 and February 2014. The self-administered Female Sexual Function Index (FSFI) was used to assess FSD; a score of less than 26.55 indicated FSD. Pearson coefficient was used to assess interdomain correlation, and multiple linear regression was used to identify factors associated with FSD. Results Among 370 participants, 330 (89.2%, 95% confidence interval [CI] 85.6%-92.2%) had FSD. The overall median FSFI score was 19.2 (interquartile range [IQR] 6.4-23.9). The arousal domain had the lowest subscore (median 2.7, IQR 0.0-3.6). The highest interdomain correlations were between lubrication and orgasm (r=0.87), arousal and lubrication (r=0.84), and arousal and orgasm (r=0.81) domains. Satisfactory health (β=3.34, 95% CI 1.16-5.52) and history of alcohol use (β=2.38, 95% CI 0.28-4.47) were independently associated with FSD. Conclusion FSD was prevalent among women with HIV infection. Care providers need to routinely address FSD as part of a comprehensive care package in the study setting.

Background: Hemodialysis (HD) is the main form of renal replacement therapy available in Nigeria. However, this is still largely unaffordable by individuals with resultant poor outcomes. Methods: This was a retrospective study of all patients with renal failure who had dialysis in the renal unit of Dalhatu Araf Specialist Hospital over the past 2 years. Information retrieved included sex, age, cause of renal failure, human immunodeficiency virus status, hepatitis B surface antigen status, antibodies to hepatitis C virus status, number of sessions, total duration on dialysis (in weeks), use of erythropoietin (EPO), common problems encountered on the dialysis machine, and the outcome of the patient. Results: A total of 68 patients (50% males) were enrolled in the study. The mean age was 41 ± 15 years (17–75), and mean weight in kilograms was 64.3 ± 10.9 (42–87). Acute kidney injury was seen in 18 (26.5%), while 50 (73.5%) had end-stage renal disease (ESRD). Chronic glomerulonephritis was the leading cause of ESRD (46%) with autosomal dominant polycystic kidney disease being the least (2%). The mean packed cell volume at the start of dialysis was 25.7% ± 5.9%. Tunneled necklines were in 11 (16.8%) and femoral catheters were in 48 (70.6%). The median total number of sessions was 4.0 (1–136), while the median duration on dialysis was 1 week (1–48) with both sexes having the same duration on dialysis (P = 0.44). The average frequency of dialysis among those with ESRD was twice weekly. Only 15 (30.0%) of those with ESRD continued dialysis after 3 months. The median survival time for females was 5 weeks while that for the males was 20 weeks (P = 0.108). EPO use was in 12 (17.7%) being 4000 IU once weekly. Cramps complicated the first sessions of dialysis in 27 (39.7%) patients. Conclusion: The survival of patients on HD in our environment is poor due largely to poor affordability despite its availability.

After signing of the Same-Sex Marriage (Prohibition) Act 2013 in Nigeria, media reports portray widespread societal intolerance toward the lesbian, gay, and bisexual population. This study was conducted to assess the attitudes of university undergraduates in Lagos state, Nigeria, toward provision of healthcare services for men who have sex with men (MSM), because the 2014 same-sex marriage prohibition law stipulates a jail sentence for organizations providing services to MSM.A cross-sectional descriptive study was conducted by using self-administered questionnaires to collect information, including homophobic attitudes and views on access to healthcare, from 4000 undergraduates in 10 randomly selected faculties in two universities. During analysis, inter-university and inter-faculty comparison was carried out between medical and nonmedical students.Outright denial of healthcare services to MSM was supported by 37.6% of the 3537 undergraduates who responded, whereas denial of HIV prevention services was supported by 32.5%. However, compared with 38.7% and 34.1% of undergraduates from other faculties, 23.7% and 18.2% of medical students agreed that healthcare providers should not provide services to MSM and that MSM should not have access to HIV prevention services, respectively (P = 0.000). Although a significant proportion of the medical students supported the statement that doctors and other healthcare workers should be compelled to give priority to other groups before MSM (29.4% of medical vs. 47.2% of students from other faculties), a statistically significant difference was observed between the two groups of students. The homophobic statement with the highest support was that doctors and healthcare workers should be compelled to report MSM who come to access treatment (48.1% of medical vs. 57.4% of students from other faculties).A very high proportion of the undergraduate students had a negative attitude toward provision of healthcare services to MSM in Nigeria; the medical students were, however, less homophobic than their nonmedical counterparts. If attitudes translate to a lack of healthcare service provision to MSM, with the high burden of HIV among MSM in Nigeria, it is unlikely that the country will achieve the UNAIDS 90-90-90 target of 90% of the population knowing their HIV status, 90% of people living with HIV receiving sustained antiretroviral medication, and 90% of those receiving antiretroviral medication having viral suppression by 2020.

Background: Since the discovery of the Upper Gastrointestinal (UGI) fiber optic endoscope machine in 1868 and following the discovery of Helicobacter pylori (H- Pylori) infection and its association with most gastroduodenal diseases in 1983 by Robin Warren and Barry Marshal, Our knowledge of diagnosis and treatment of most UGI diseases has significantly improved. Aim: The study aimed to establish the presence of H. pylori as a risk factor for common UGI disease as confirmed by UGI endoscopy and the pattern of findings in UGI endoscopy. Methodology: This study is a descriptive cross-sectional study that was carried out at the Endoscopy Unit of Jos University Teaching Hospital. A total of 260 patients referred for UGI endoscopy from August 2013 to April 2014 were recruited and investigated for H. pylori from the biopsy specimens taken during UGI endoscopy. The diagnosis of H. pylori was made by histology. Result: A total of 260 patients were studied, 159 (61.2%) males and 101 (38.8%) females. H. pylori were present in 169 (65%) and absent in 91 (35%). More females had H. pylori compared to males (67.3% and 63.5%). The common endoscopic findings were present in the stomach. Gastritis 57 (21.9%) was the most common abnormality seen in the stomach, while gastroesophageal reflux disease was the most commonly seen in the esophagus and duodenal ulcer in the duodenum. Conclusion: There is a positive correlation between H. pylori infection with endoscopic abnormalities seen among patients.

Background: Although erectile dysfunction (ED) is common, little is known about the impact of ED on the quality of life (QoL) among African men. Materials and Methods: We used the International Index of Erectile Function (IIEF) to evaluate ED and the WONCA charts to assess QoL among employees of a university. Results: A total of 508 men with a mean age of 43 ± 10 years were studied. IIEF5 scores of

Restrictive episiotomy is recommended for the prevention of vertical transmission of HIV. The study compared the frequency of episiotomy use and the occurrence of perineal tears; and related factors in HIV positive and HIV negative women and to assess their effect on Mother-to-child transmission (MTCT) of HIV. A total of 110 HIV positive and 134 HIV negative parturients were enrolled in the study. The incidence of episiotomy was more in the HIV negative group (p=0.0000) while that of perineal tear was not affected by HIV status (p=0.17). The rate of episiotomy was significantly affected by primigravidity in HIV negative subjects (OR= 0.032, 95% CI 0.0072-0.13). The rate of perineal tear was significantly affected by primigravidity in HIV positive subjects (OR=8.55, 95% CI 1.91-38.7) and multigravidity in HIV negative subjects (OR= 0.030, 95% CI 0.133-0.71). Gestational age and mean birth weight had no effect on the rate of episiotomy (p value =0.57 and 0.30) and perineal tear (p value= 0.79 and 0.061). There was no mother-to-child HIV transmission. Episiotomies should be given when needed irrespective of HIV status because of the risk of consequent perineal tear and with HAART the risk of MTCT from perineal trauma is minimal.Keywords: HIV positive; perineal trauma; episiotomy; perineal tear; MTCT

Osmotic diuresis results from urine loss of large amounts of solutes distributed either in total body water or in the extracellular compartment. Replacement solutions should reflect the volume and monovalent cation (sodium and potassium) content of the fluid lost. Whereas the volume of the solutions used to replace losses that occurred prior to the diagnosis of osmotic diuresis is guided by the clinical picture, the composition of these solutions is predicated on serum sodium concentration and urinary sodium and potassium concentrations at presentation. Water loss is relatively greater than the loss of sodium plus potassium leading to hypernatremia which is seen routinely when the solute responsible for osmotic diuresis (e.g., urea) is distributed in body water. Solutes distributed in the extracellular compartment (e.g., glucose or mannitol) cause, in addition to osmotic diuresis, fluid transfer from the intracellular into the extracellular compartment with concomitant dilution of serum sodium. Serum sodium concentration corrected to euglycemia should be substituted for actual serum sodium concentration when calculating the composition of the replacement solutions in hyperglycemic patients. While the patient is monitored during treatment, the calculation of the volume and composition of the replacement solutions for losses of water, sodium and potassium from ongoing osmotic diuresis should be based directly on measurements of urine volume and urine sodium and potassium concentrations and not by means of any predictive formulas. Monitoring of clinical status, serum sodium, potassium, glucose, other relevant laboratory values, urine volume, and urine sodium and potassium concentrations during treatment of severe osmotic diuresis is of critical importance.

Chronic kidney disease (CKD) is an increasingly prevalent problem worldwide. Treatment of end-stage kidney disease is beyond the reach of an average Nigerian. The prevention and early detection are imperative to reducing its burden.The aim of this study was to determine the prevalence of CKD and some of its risk factors among adults in a representative semi-urban Nigerian population.A cross-sectional study involving 400 randomly selected adults. Participants were assessed using the WHO stepwise approach. Urinary protein-creatinine ratio (PCR) and estimated glomerular filtration rate (GFR) from serum creatinine, among other parameters, were analysed. A PCR ≥200 mg/g was regarded as significant proteinuria while GFR60 ml/min/1.73 m2 was regarded as reduced GFR. Participants with abnormal PCR and/or reduced GFR were re-evaluated after 3 months to document persistence of these abnormalities. CKD was defined as persistent significant proteinuria and/or reduced GFR for more than 3 months.Data were complete for 328 participants. Persistent significant proteinuria was found in 5.8% while persistently reduced GFR was obtained in 4.6% of participants. Overall, the prevalence of CKD was 7.8%. The prevalence of some established CKD risk factors was old age, 36.3%; hypertension, 36.9%; diabetes mellitus, 7.9%; and family history of kidney disease, 6.4%. The predictors of CKD included old age (adjusted odds ratio = 3.2; confidence interval: 1.10-8.92; P= 0.02), hypertension: 3.5 (1.93-11.90; P= 0.001), family history of kidney disease; 4.5 (3.91-10.23; P= 0.01), generalised obesity 1.3 (1.20-6.21; P= 0.001) and central obesity 3.8 (1.13-12.68; P= 0.003).The prevalence of CKD and some of its risk factors were high. Effective control of the modifiable risk factors identified will assist in reducing the burden of CKD.

We compared the prevalence of menopause symptoms between women living with HIV to their HIV-negative peers and determined predictors of severe menopause symptoms in Jos, Nigeria. This descriptive cross-sectional study included 714 women aged 40–80 years. We compared prevalence and severity of menopause symptoms using the menopause rating scale (MRS). Logistic regression analysis was used to determine the predictors of severe symptoms. Six-hundred and seven (85.0%) were HIV-positive, with a mean duration of infection of 5.6 ± 2.7 years. The mean age of the cohort was 46 ± 5 years. The most prevalent menopause symptoms were hot flushes (67.2%), joint and muscle discomfort (66.2%), physical/mental exhaustion (65.3%), heart discomfort (60.4%), and anxiety (56.4%). The median MRS score was higher for HIV-positive compared to HIV-negative women (p = 0.01). Factors associated with severe menopause symptoms included HIV-positive status (aOR: 3.01, 95% CI: 1.20–7.54) and history of cigarette smoking (aOR: 4.18, 95% CI: 1.31–13.26). Being married (aOR: 0.49, 95% CI: 0.32–0.77), premenopausal (aOR: 0.60, 95% CI: 0.39–0.94), and self-reporting good quality of life (aOR: 0.62. 95% CI: 0.39–0.98) were protective against severe menopause symptoms. We found HIV infection, cigarette smoking, quality of life, and stage of the menopause transition to be associated with severe menopause symptoms. As HIV-positive populations are aging, additional attention should be given to the reproductive health of these women.

Chorioamnionitis is an important risk factor for vertical transmission of HIV/AIDS. We compared the prevalence and correlates of histologic chorioamnionitis (HCA) in HIV-positive and HIV-negative pregnant women. HIV-positive and -negative parturients were interviewed, examined and had their placentas examined histologically for chorioamnionitis. Data regarding HIV were also retrieved from their hospital records. A total of 298 parturients (150 HIV positive and 148 HIV negative) were enrolled. The two groups were similar in socio-demographic and obstetric parameters except for age. The prevalence of HCA was 57.1% in HIV-positive women and 61.6% in HIV-negative women ( p = 0.43). HCA staging was associated with the number of intrapartum vaginal examinations in HIV-positive subjects and nulliparity in HIV-negative subjects. The number of intrapartum vaginal examinations and coitus in the week prior to delivery significantly affected the grade of HCA in HIV-negative subjects. The prevalence of HCA in both HIV-positive and HIV-negative is high. Most variables did not affect the occurrence of HCA in both groups studied except number of intrapartum examinations, coitus in the preceding one week and nulliparity, which were related to severity of the disease.

Background: There is an increasing occurrence of non-communicable diseases worldwide. Among them, breast and cervical cancers are notable among females. These diseases often present late with adverse outcomes. Only early detection offered by screening of disease offers the hope of cure. Hence, we undertook a breast and cervical cancer screening education and exercise among female workers of a university community. Methods and Methods: This was part of a non-communicable disease survey among members of the university community. Structured questionnaires were administered on participants after a talk. Screening was carried out using the Papanicolau test for cervical cancer and clinical breast examination for breast cancer. Results: A total of 210 participants were screened. 42 (10.8%) and 23 (10.8%) had family history of breast cancer and previous breast lump, respectively. Only one participant (0.48%) had a breast lump. Abnormal Pap smear result was present in 59 (30.1%) (Inflammation [59.32%], high grade squamous intraepithelial lesion (HSIL) [10.17%], low grade squamous intraepithelial lesion (LSIL) [6.78%], atypical squamous cell of undetermined significance (ASCUS) [10.17%], Atypical squamous cells- cannot exclude HSIL’ (ASC-H) [11.86%] and atypical glandular cells of undetermined significance (AGUS) [1.69%]). Conclusion: The uptake of screening was low, the yield for cervical anomalies was also low, but a reasonable proportion of the participants had risk factors for breast and cervical cancers and so would benefit from further screening over time.

Three patients developed acute respiratory failure during treatment of diabetic ketoacidosis (DKA) diagnosed by the combination of hyperglycemia, anion gap metabolic acidosis, and presence of ketone bodies in serum. All three required tracheal intubation and mechanical ventilation. Table 1 shows pertinent laboratory values at admission and immediately before tracheal intubation. Serum anion gap was computed as [Na]S − ([Cl]S + [TCO2]S), where [Na]S, [Cl]S, and [TCO2]S are, respectively, the serum sodium, chloride, and total carbon dioxide concentrations. Serum tonicity in mOsm/l was calculated as 2 × [Na]S + [Glu]S, where [Glu]S is serum glucose concentration in mmol/l. ### Patient 1 A 12-year-old girl with no previous history of diabetes was admitted with DKA, symptomatic hypovolemia, and lethargy. On admission, her serum potassium concentration was in the normal range (Table 1), and her serum phosphate was 6.1 mg/dl. Initial treatment consisted of infusion of insulin and large volumes of saline. After 4 hours, she experienced cardio-respiratory arrest. Electrocardiogram showed ventricular fibrillation. Laboratory values obtained just before the arrest revealed profound hypokalemia and hypercapnia (Table 1). She recovered after electromechanical resuscitation, intubation, and infusion of large amounts of potassium chloride. However, she developed acute kidney injury, which improved without the need for dialysis and required prolonged tracheal intubation (1 week). ### Patient 2 A 14-year-old boy with no history of diabetes was admitted with DKA, coma, seizures, and profound hypotension. Computed tomography did not reveal any brain pathology. Admission laboratory values showed extreme hyperglycemia with hypertonicity and hypokalemia (Table 1). The boy received intravenous insulin plus large volumes of saline containing potassium chloride. After 3 hours, his hypotension had improved, but his serum glucose level was 1,794 mg/dl, serum sodium was 148 mEq/l, serum tonicity was 391.7 mOsm/l, serum chloride …

Disturbances in tonicity (effective osmolarity) are the major clinical disorders affecting cell volume. Cell shrinking secondary to hypertonicity causes severe clinical manifestations and even death. Quantitative management of hypertonic disorders is based on formulas computing the volume of hypotonic fluids required to correct a given level of hypertonicity. These formulas have limitations. The major limitation of the predictive formulas is that they represent closed system calculations and have been tested in anuric animals. Consequently, the formulas do not account for ongoing fluid losses during development or treatment of the hypertonic disorders. In addition, early comparisons of serum osmolality changes predicted by these formulas and observed in animals infused with hypertonic solutions clearly demonstrated that hypertonicity creates new intracellular solutes causing rises in serum osmolality higher than those predicted by the formulas. The mechanisms and types of intracellular solutes generated by hypertonicity and the effects of the solutes have been studied extensively in recent times. The solutes accumulated intracellularly in hypertonic states have potentially major adverse effects on the outcomes of treatment of these states. When hypertonicity was produced by the infusion of hypertonic sodium chloride solutions, the predicted and observed changes in serum sodium concentration were equal. This finding justifies the use of the predictive formulas in the management of hypernatremic states.

Hypertonicity causes severe clinical manifestations and is associated with mortality and severe short-term and long-term neurological sequelae. The main clinical syndromes of hypertonicity are hypernatremia and hyperglycemia. Hypernatremia results from relative excess of body sodium over body water. Loss of water in excess of intake, gain of sodium salts in excess of losses or a combination of the two are the main mechanisms of hypernatremia. Hypernatremia can be hypervolemic, euvolemic or hypovolemic. The management of hypernatremia addresses both a quantitative replacement of water and, if present, sodium deficit, and correction of the underlying pathophysiologic process that led to hypernatremia. Hypertonicity in hyperglycemia has two components, solute gain secondary to glucose accumulation in the extracellular compartment and water loss through hyperglycemic osmotic diuresis in excess of the losses of sodium and potassium. Differentiating between these two components of hypertonicity has major therapeutic implications because the first component will be reversed simply by normalization of serum glucose concentration while the second component will require hypotonic fluid replacement. An estimate of the magnitude of the relative water deficit secondary to osmotic diuresis is obtained by the corrected sodium concentration, which represents a calculated value of the serum sodium concentration that would result from reduction of the serum glucose concentration to a normal level.

Objective: To evaluate the CD4 cell count of human immunodeficiency virus (HIV)-positive pregnant ethnic Nigerian women and compare it with that of HIV-negative pregnant ethnic Nigerian women and to determine the relationship between CD4 cell count and the packed red blood cell volume (PCV) of HIV-seropositive and HIV-seronegative pregnant women. Materials/Methods: The study population included 130 ethnic Nigerian women between the ages of 17 and 40 years who came to the Antenatal and Prevention of Mother-to-Child Transmission (PMTCT) units of Jos University Teaching Hospital, in Jos, Nigeria. Relevant information such as age, occupation, tribal affiliation, gestational age, and prescribed drugs currently taken were obtained using a structured questionnaire. A selective technique was used to enroll pregnant women who tested positive for HIV infection and negative for malaria parasitemia, syphilis, and hepatitis B virus, along with healthy pregnant women with no history of these diseases. CD4 cell counts were determined using a Cyflow machine and packed red blood cell volume (PCV) obtained using a microhematocrit centrifuge. The Student t-distribution t-test was used to analyze data. Results: The highest prevalence of HIV infection was found in the group aged 26 to 30 years; the lowest prevalence was found in the group aged 36 to 40 years. The mean (SD) CD4 cell counts of HIVseropositive and seronegative women were 323.7 (170.7) and 578.3 (167.4), respectively (P < .001). Comparison of the CD4 cell count of HIV-positive and HIV-negative pregnant women with the PCV values from specimens from those women demonstrated a correlation coefficient r of 0.37 (P < .001) for the former group and an r of 0.37 (P < .82) for the latter. In HIV-seropositive and HIV-seronegative pregnant women with gestational age of less than 13 weeks, the mean (SD) CD4 cell counts were 610.X (170.3) (P < .001) and 302.0 (49.0) (P < .001) for the former and latter groups, respectively. The mean CD4 cell counts of the HIV-positive and HIV-negative pregnant women enrolled in our study with gestational age of 13 to 25 weeks and 26 to 38 weeks were 596 (146) (P < .001), 304 (170) (P < .001), 534 (189) (P < .001), and 254 (191) (P

Background: To determine the level of awareness and knowledge of HIV postexposure prophylaxis (HIV PEP) and determinants of adequate knowledge among Family Physicians in Nigeria. Materials and Methods: This was a cross‑sectional questionnaire‑based survey conducted among 175 Family Physicians at two national conferences. Results: Majority (97.7%) of the respondents was aware of the concept of HIV PEP and 99.4% believed it was effective in preventing HIV transmission. Over two third of our respondents had been exposed to NSI; however, less than 25% of those exposed received PEP. There was high level of knowledge of the various high‑risk body fluids as well as types of high‑risk exposures. 93.9% of our respondents knew that HIV PEP should commence within 1 h of exposure, 83.3% knew the correct duration of HIV PEP, but only 57.0% knew the ideal PEP regimen for high‑risk exposures. The total mean score for our respondents was 17.8±2.9 with 79.4% having an adequate score. Being a junior doctor and male sex were associated with adequate knowledge. Conclusion: This study shows that despite high levels of awareness and knowledge of HIV PEP, access to its use among family physicians in Nigeria is still sub‑optimal.Keywords: Family physicians, HIV PEP, NigeriaNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 2012

The integrity of the renal concentrating mechanism is maintained by the anatomical and functional arrangements of the renal transport mechanisms for solute (sodium, potassium, urea, etc) and water and by the function of the regulatory hormone for renal concentration, vasopressin. The discovery of aquaporins (water channels) in the cell membranes of the renal tubular epithelial cells has elucidated the mechanisms of renal actions of vasopressin. Loss of the concentrating mechanism results in uncontrolled polyuria with low urine osmolality and, if the patient is unable to consume (appropriately) large volumes of water, hypernatremia with dire neurological consequences. Loss of concentrating mechanism can be the consequence of defective secretion of vasopressin from the posterior pituitary gland (congenital or acquired central diabetes insipidus) or poor response of the target organ to vasopressin (congenital or nephrogenic diabetes insipidus). The differentiation between the three major states producing polyuria with low urine osmolality (central diabetes insipidus, nephrogenic diabetes insipidus and primary polydipsia) is done by a standardized water deprivation test. Proper diagnosis is essential for the management, which differs between these three conditions.Keywords: Central diabetes insipidus, hypernatremia, hypertonicity, nephrogenic diabetes insipidus, urine concentration, vasopressinNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 2012

Hospitalization rate is high in patients on chronic hemodialysis (HD). We investigated whether initiation of HD changes the rate and length of hospitalization. We analyzed hospitalizations in HD patients in one hospital over 15 years. We compared annual rate and length of hospitalizations, both presented as mean (95% confidence interval [CI]) between the pre-HD and HD period. Three hundred ninety-two patients, 98% men, 59% diabetic, and 66.3 ± 11.2 years old at the onset of HD, had 1016 hospitalizations in the pre-HD period (60.0 ± 42.9 months) and 1627 hospitalizations in the HD period (32.5 ± 25.9 months). Higher values were found in the HD than the pre-HD period for rate, (pre-HD 0.557 [95% CI 0.473-0.611], HD 2.198 [95% CI 1.997-2.399] admissions/[patient-year], P

The purpose of this study was to determine whether number of hospital admissions per patient per year (n/[pt-yr]) and hospital days per patient per year (d/[pt-yr]) differ between elderly and younger patients on chronic hemodialysis (HD). In a retrospective cohort analysis of incident HD patients in one dialysis unit over 15 years, we compared 166 HD patients older than 70 years (77.1 ± 4.7 yrs) at the onset of HD (group A) and 216 patients younger than 70 years both at onset (57.1 ± 7.6 yrs) and at the end of the HD period (group B). Eighty (48.2%) of group A and 141 (65.3%) patients of group B had diabetes mellitus. No differences were noted in the overall hospitalization rate, presented as mean, {95% Confidence interval} (group A 2.40 {2.04–2.75}, group B 2.03 {1.89–2.16} n[pt-yr]) and days/[pt-year] (group A 33.6 {25.3–41.8}, group B 24.1 {18.9–29.23}). Group A had higher number of hospitalization days (P = 0.012) for surgery or trauma and higher rate (P = 0.045) and days (P = 0.041) of hospitalization for miscellaneous causes, primarily pulmonary disease, or malignancy. Among diabetic patients, group A had only a greater number of hospital days for cardiac disease (P = 0.050). Among patients without diabetes, group A had a higher number for hospital days for surgery or trauma (P = 0.027). All other univariate comparisons were not significant. Multiple linear regression identified comorbidity, quantified by the Charlson index, Caucasian race and poor compliance with the HD schedule as predictors of admission rate and days per year for vascular access issues and comorbidity, poor compliance, and advanced age at onset of HD as predictors of admission for causes other than vascular access related. Hospitalizations, which affect quality of life, differ little between elderly and younger patients on HD. Therefore, hospitalizations do not constitute an argument for restricting access to HD to elderly patients.

Mortality from various causes is higher in patients on chronic hemodialysis (HD) than in the general population. There is evidence suggesting that some of the deaths in HD patients are preventable. To identify potentially preventable causes of death, we analyzed deaths that occurred in HD patients during hospitalization over a period of 15 years. We performed a retrospective cohort analysis of 410 patients on HD for at least 6 months between 1995 and 2009 (included), who had all their hospitalizations in the same hospital. The patients were classified into 3 groups: Those who died during hospitalization (group A, n=120), those who died away from the hospital (group B, n=135), and those who were alive at the end of the observation period (group C, n=155). Continuous variables were compared between groups by the Kruskall-Wallis statistic. Logistic regression was used to identify predictors of dying during the observation period and predictors of death in the hospital. For the whole HD group of 410 patients, only 9 (2.2%) were women. 59% of the patients had diabetes mellitus. Age at the onset of HD was 65.8 ± 11.5 years and the duration of HD was 34.4 ± 27.9 months. Group A patients had a higher annual rate and duration of hospitalization and a higher Charlson comorbidity index than either of the other 2 groups, and, in comparison with patients in group C, were older at the end of observation and had a shorter duration of HD. Cardiac disease (19.2%), vascular access complications (18.3%), peripheral vascular disease (16.7%), infections (15.8%), trauma (11.7%), central nervous system disease (7.5%), respiratory failure (4.2%), malignancy (3.3%), and gastrointestinal disease (3.3%) were the causes of the last hospitalization in group A. Compared with the patients who died during hospitalization without discontinuing HD, group A patients who discontinued HD had a longer duration of their last hospitalization (52.7 ± 77.7 vs. 14.3 ± 23.8 days, P

Background: Various preventive strategies have been employed to curb the spread of HIV infection as there is presently no cure. Abstinence, avoidance of multiple sexual partners, condom use, voluntary counselling and testing (VCT) and treatment of HIV-infected individuals form the cornerstone of HIV prevention. This study assessed the acceptability of VCT among medical students in a single institution in Nigeria Methodology: Self-administered questionnaires were distributed to clinical medical students of the University of Jos in a cross-sectional study. Results: Out of a total of 368 students surveyed, 178 (50.7%) have had VCT. There was no significant difference between the proportion of males and females who had had VCT previously (48.9% of males and 56.3% of females; χ2 = 1.65, OR = 0.76 95% CI: 0.46-1.20; p = 0.19). The majority of the respondents (83.1%) would want to have VCT. Fear of a positive test result was the main reason given by those who would be unwilling to be tested. Gender had no effect on the willingness of the subjects to have VCT as 81.8% of males and 87.1% of females were predisposed to it (χ2 = 1.95; OR = 0.63, 95% CI: 0.31-1.26). VCT acceptability was similar among sexually active and inactive respondents (80.2% and 80.2% respectively; χ2 = 0.018, p = 0.99). Conclusion: Awareness of VCT services and acceptability of VCT among medical students is high. These students can be role models for the optimization of VCT services.

Estimation of the glomerular filtration rate (GFR) is required in the assessment of patients with chronic kidney disease (CKD) in order to provide information regarding the functional status of the kidneys. Current guidelines advocate the use of prediction equations, such as the Cockcroft-Gault (CG) formula and the Modification of Diet in Renal Disease (MDRD) study-derived equations, over clearance of endogenous creatinine (Ccr) in achieving this aim. We were interested in knowing the accuracy of these equations in predicting the GFR in adult Nigerians with CKD.We conducted a review of records of patients who were evaluated for CKD at the Nephrology Clinic of the Jos University Teaching Hospital between 2001 and 2003. We compared the CG and MDRD equations against the Ccr in predicting the GFR in 130 patients (88 males and 42 females) with CKD.The means +/- standard deviation (SD) for the measured and predicted GFR by the CG and MDRD equations were similar (17.6 +/- 25.8 ml/min, 19.9 +/- 24.0 ml/min and 21.5 +/- 28.2 ml/min, respectively; analysis of variance [ANOVA], F = 0.68, P = 0.5). The mean difference between CG and Ccr was -2.2 +/- 14.8 ml/min, with discordance at Ccr values25 ml/min. The mean difference between MDRD and Ccr was -3.9 +/- 18.1 ml/min, with discordance at Ccr values40 ml/min.The CG and MDRD equations provide reliable alternatives to measured Ccr in the estimation of the GFR in Nigerian patients with CKD.

Background: Cognitive dysfunction is a common source of morbidity and mortality, usually observed in late stages of diabetes complications. Dementia is one of the commonest and most disabling late life mental disorders. The fact that data are scanty in the tropic cannot be overemphasized. There is a need to describe the association of cognitive dysfunction among our diabetics and its attendant risks such as duration of DM, age of patient, presence of hypertension and glycaemic control. Methods: a sample size of 180 patients was obtained with 120 diabetic subjects and 60 non-diabetics as controls. The mini-mental state examination (MMSE) was used to grade the severity of cognitive states. Result: twenty-six (21.7%) of the diabetic subjects had cognitive dysfunction with a score of less than twenty-four based on the mini-mental state examination (MMSE) while 6 (10.0%) of the controls had dementia. Conclusion: This study clearly shows that in a clinic setting, diabetes is associated with a greater trend toward impairments of cognitive function than in the non-diabetic population.

The state of hydration affects the outcomes of chronic dialysis. Bioelectrical impedance analysis (BIA) provides estimates of body water (V), extracellular volume (ECFV), and fat-free mass (FFM) that allow characterization of hydration. We compared single-frequency BIA measurements before and after 14 hemodialysis sessions in 10 Nigerian patients (6 men, 4 women; 44+/-7 years old) with clinical evaluation (weight removed during dialysis, presence of edema) and with estimates of body water obtained by the Watson, Chertow, and Chumlea anthropometric formulas. Predialysis and postdialysis values of body water did not differ between BIA and anthropometric estimates. However, only the BIA estimate of the change in body water during dialysis (-0.8+/-2.9 L) did not differ from the corresponding change in body weight (-1.3+/-3.0 kg), while anthropometric estimates of the change in body water were significantly lower, approximately one-third of the change in weight. Bioelectrical impedance analysis correctly detected the intradialytic change in body water content (the ratio V/Weight) in 79% of the cases, while anthropometric formula estimates of the same change were erroneous in each case. Compared with patients with clinical postdialysis euvolemia (n=7), those with postdialysis edema (n=5) had higher values of postdialysis BIA ratios V/FFM (0.77+/-0.01 vs. 0.72+/-0.03, p

Purpose To identify the extent of underdialysis, chronic inflammation and malnutrition and their interrelationships in Nigerian hemodialysis patients. Methods In a prospective study including 10 adult patients, (6 men, 4 women) on hemodialysis in North Central Nigeria, malnutrition was assessed by body mass index (BMI), serum albumin and prealbumin, and bioimpedance (BIA) pre-and post dialysis, inflammation was evaluated by C-reactive protein (CRP) and adequacy of dialysis was judged by frequency of the hemodialysis sessions and Kt/V urea. Results Post-dialysis BMI was 21.3 (19.9, 24.3) kg/m2 (< 20 kg/m2 in 4 patients), serum albumin 31.5 (24.0, 32.0) g/L (< 30.0 g/L in 5), serum pre-albumin 25.2 (15.3, 31.1) mg/dL (< 18.0 mg/dL in 4), serum CRP 4.8 (1.2, 11.5) mg/dL (> 1.0 mg/dL in 8), phase angle 4.2 (3.7, 5.1)° (< 3° in 3) and body fat deficit was diagnosed by BIA in 4 patients. Weekly frequency of dialysis was 3 times in 2 patients, twice in 1 and ≤1 time in 7. Single-pool Kt/V urea was 0.81 (0.68, 0.95, 1.2 in one patient receiving dialysis only twice weekly). By combined frequency of dialysis and Kt/V urea values, no patient received an adequate dose of dialysis and, indeed, all patients had overt symptoms of uremia. Low body weight, low serological and BIA nutrition indices, and high CRP levels occurred in the same patients. Patients on dialysis for > 1 year had worse nutrition indices than those on dialysis for < 1 year. Conclusions Underdialysis was universal, while poor nutrition and chronic malnutrition were found in the majority of the small number of patients studied. These three adverse conditions, which were interlinked, may be common in Nigerian hemodialysis patients, because their underlying socioeconomic causes are widespread. (Int J Artif Organs 2006; 29: 1067–73)

Multi-organ involvement by opportunistic infections and neoplasms is the major cause of morbidity and mortality in people living with HIV/AIDS. We determined the spectrum/frequency of hepatic histopathological lesions in a prospective study of postmortem liver biopsies from 100 patients (50 females and 50 males, age range 18-55 years) who died from HIV/AIDS in Jos university teaching hospital, Nigeria. The majority of the patients, 65 (65%), had clinical tuberculosis. Granulomatous hepatitis, chronic hepatitis, non-specific reactive hepatitis (NSRH) and steatosis were the commonest hepatic histopathologic lesions occurring in 34, 20,15 and 12% of patients, respectively. Seven (7%) had normal histological features. This study shows that the liver is affected in HIV/AIDS as reported elsewhere in the world. Therefore, liver biopsy in HIV patients may be helpful in the management of these patients.

Ulcerative colitis is rarely associated with immunoglobulin A nephropathy (IgAN). The development of IgA nephropathy complicates further the clinical course of patients with ulcerative colitis. A 72-year old man with a 30-year history of ulcerative colitis requiring colectomy and modest renal insufficiency secondary to complications of nephrolithiasis and renal artery stenosis developed glomerular hematuria, proteinuria and progressive renal failure. Percutaneous kidney biopsy revealed IgAN with extensive glomerular and interstitial sclerotic changes. After resection of a chronically infected ileo-rectal pouch, renal function improved, while hematuria and proteinuria gradually disappeared without specific treatment of the IgAN. The manifestations of IgAN complicating ulcerative colitis can be improved with effective treatment of the bowel disease even when there are extensive sclerotic changes in the kidneys.

Current clinical guidelines for the management of chronic kidney disease recommend the use of prediction equations for determination of glomerular filtration rate (GFR). Our aim was to determine the accuracy of the Schwartz and the modified Counahan-Barratt equations in predicting GFR in hospitalized Nigerian children. We compared GFR as estimated by the Schwartz and the Counahan-Barratt equations against endogenous creatinine clearance (Ccr) in 90 hospitalized Nigerian children of varying renal function. The bias (i.e. the mean difference) in GFR estimation by the Schwartz and the modified Counahan-Barratt equations in relation to Ccr were 16.7 and 21.5, respectively. The predicted GFR values correlated poorly with the measured Ccr (-0.19 and -0.18 for Schwartz and Counahan-Barratt equations respectively). The positive predictive value of the Schwartz and Counahan-Barratt equations to detect GFR

To identify differences that may affect morbidity and mortality of type 2 diabetic patients reaching ESRD between countries with different socioeconomic conditions.Comparison of clinical and laboratory features between 21 Nigerian (N) and 57 American patients (A) reaching ESRD over a 30 month period.Differences were noted in age at ESRD (N, 55.5+/-9.8; A, 64.5+/-9.6 years), duration of diabetes (N, 5.2+/-2.8, A: 14.9+/-4.9 years), body mass index (N, 24.5+/-4.1; A; 27.6+/-6.3 kg/m2), prevalence of left ventricular hypertrophy (N; 14%; A, 89%) and ischemic heart disease (N, 26%; A, 67%), blood pressure (N, [166.2+/-26.7]/[98.6+/-16.5] mmHg; A, [146.8+/-23.6]/[72.5+/-13.3] mmHg), creatinine clearance (N, 6.1+/-3.6; A, 14.8+/-3.5 ml/min), urine protein excretion (N, 1.2+/-0.7; A, 6.1+/-4.9 g/24-h), hematocrit (N, 28.0+/-6.0; A, 35.0+/-5.0%), serum glucose (N, 5.6+/-1.6; A, 10.5+/-5.5 mmol/l), and serum cholesterol (N, 5.32+/-2.57; A, 4.19+/-1.16 mmol/l) (all at Por = 0.05). Differences were also found in the number of antihypertensive medications (N 1.4+/-0.6; A 2.4+/-1.2 per patient), and use of medications for diabetes (N 29%, A 79%), statins (N zero, A 61 %) and erythropoietin (N zero, A 39%). 72% of the A, but none of the N patients had a functional dialysis access prior to ESRD.Between A and N patients reaching ESRD, there are differences in clinical features and laboratory values that may affect morbidity, mortality and impact on the health care resources. These differences indicate areas where further studies that could assist in the planning for ESRD care in both Nigeria and USA are required.

In developed countries, malnutrition is common in patients with chronic renal failure (CRF) and has adverse effects on patient morbidity and mortality. The prevalence of malnutrition before the initiation of dialysis is poorly characterized in CRF patients in developing countries. We studied the prevalence of malnutrition among Nigerians with CRF before commencement of dialysis. Body mass index (BMI) and serum protein levels were measured in 74 dialysis naive Nigerians with CRF and 48 controls. Patients with nephrotic syndrome, steroid use and failure of organs other than the kidneys were excluded. The mean BMI was significantly lower in the patients compared to the controls (22.4 +/- 14.9 kg/M2 Vs. 25.2 +/- 2.7 kg/M2; p = 0.0001). Low BMI (less than 20 Kg/M2) was present in 16 (21.6%) of the patients compared with one of the controls. The mean serum total protein and albumin were also significantly lower in the patients compared to controls (61.9 +/- 14.4 g/L Vs. 73.8 +/- 6.8 g/L; p < 0.0001, and 31.5 +/- 9.3 g/L Vs. 39.6 +/- 4.4 g/L; p < 0.0001 respectively). Protein malnutrition (serum albumin < 29 g/L) was present in 32 (43.2%) of patients with CRF and one (2.1%) of the control subjects. Malnutrition is common in Nigerian CRF patients before the commencement of dialysis. In these patients, emphasis should be placed on prevention and/or correction of malnutrition because of its documented adverse effects on the outcomes of maintenance dialysis.

Despite the growing body of evidence on the interaction between HIV and malaria in sub-Saharan Africa, there is a dearth of data on clinical malaria in HIV-infected patients in Nigeria. We determined the burden of clinical malaria in HIVinfected adult Nigerians and further investigated the association between their immunological status and the rates of clinical malaria. Ninety seven antiretroviral treatment-naïve HIV-infected adults were enrolled in a cross-sectional study from August to December, 2009. The participants had a complete clinical evaluation, thick and thin blood films for malaria parasites and CD4 cell count quantification. Clinical malaria was defined as having fever (temperature ≥ 37.5oC or history of fever within 48 hours) and a malaria parasite density above the median value obtained for subjects with co-existing fever and parasitaemia. Clinical malaria was diagnosed in 10 out of 97 patients (10.3%). Lower CD4 cell counts were associated with increasing rates of clinical malaria which was 0% at CD4 cell count of ≥ 500, 2.6% at 200-499 and 30% at

Background The contribution of obesity to obstructive sleep apnea (OSA) is poorly described in Nigeria. We aimed to compare OSA risk between obese and nonobese adults in urban Nigeria. Materials and Methods An analytic cross-sectional study was conducted. Participants were interviewed using the World Health Organization Non-Communicable Disease questionnaire. OSA risk assessment was performed using the STOP-BANG questionnaire. A total score of ≥3 on the STOP-BANG questionnaire indicated OSA risk, whereas a score ≥5 indicated high OSA risk. Obesity was defined as body mass index (BMI) >30 kg/m2. Relationship between obesity and OSA was tested using chi-square and logistic regression models used to control for confounding factors. Results There were 744 respondents, with a mean age of 44 (standard deviation 10) years. A total of 206 [27.7%, 95% confidence interval (CI) 24.46–30.9] respondents were obese (BMI ≥30 kg/m2). A total of 307 (41.3%, 95% CI 37.7–44.9) respondents scored ≥3 on the STOP-BANG questionnaire, whereas 37 (4.9%, 95% CI 3.6–6.7) scored ≥5. More number of obese than nonobese [57.8% (119/206) versus 34.9% (188/538)] respondents met the criteria for OSA risk (P < 0.001). Similarly, more obese persons [10.3% (21/206)] met the criteria for high-risk OSA compared to the nonobese [3% (16/538)]; P < 0.001. In logistic regression models adjusted for cigarette smoking and alcohol consumption, the odds for OSA risk was 15.76 (95% CI 7.44–33.9) in persons with BMI >35 kg/m2 compared to those with a BMI range of 18.5–24.99. Conclusion Obesity and OSA may be more prevalent in Nigeria than previously predicted. Obesity independently increased OSA risk in this population.

Human immunodeficiency virus (HIV) and malaria co-infection has become an important public health problem in sub-Saharan Africa. Data on HIV and malaria interaction in Nigerian adults is scanty. We determined the prevalence of malaria parasitaemia in HIV-infected adults and further investigated the role of immune status in the HIV/malaria association.This was a cross-sectional study involving 100 newly-diagnosed HIV-infected adults and 100 age and sex-matched HIV negative controls. Malaria parasitaemia was diagnosed by blood film microscopy using Giemsa staining technique and was defined as the presence of malaria parasites irrespective of species or parasite density. HIV infection was confirmed by western blot assay and CD4 T-lymphocyte count of the HIV-infected patients was quantified by flow cytometry.The prevalence of malaria parasitaemia was higher in HIV-infected adults (24%) than in the controls (9%) (chi2 = 8.17, p = 0.04). Participants residing in rural areas had higher prevalence of malaria parasitaemia than urban dwellers both for HIV-infected patients (34.1% Vs. 16.1%, chi2 = 4.3, p = 0.04) and controls (18.4%, Vs. 6.5%, chi2 = 3.4, p = 0.04). HIV-infected male patients tended to have malaria parasitemia more than their female counterparts (33.3% Vs. 17.2%, chi2 = 3.4, p = 0.06). Among HIV-infected patients, the prevalence of malaria parasitaemia progressively increased at lower CD4 cell counts, 10.3% for CD4 cell count of = 500, 17.5% for 200-499 and 45.2% for200 cells/microL (chi2 = 11.5, p = 0.003).HIV is likely to fuel malaria infection in tropical countries where both diseases are endemic. Malaria control practices should be further intensified in HIV-infected populations.

PURPOSE The purposes of this study were to analyze changes in the frequency of different categories of surgical procedures after initiation of chronic hemodialysis (HD) and to identify the types of procedures associated with in-hospital postoperative mortality. METHODS This was a retrospective analysis of surgical procedures performed in an incident HD population of 392 patients followed in the dialysis unit of one hospital over 15 years. Among these patients, 384 were men and 258 had diabetes mellitus. At the start of HD, age of the patients was 66.3 ± 11.2 years and Charlson index 5.35 ± 2.41. Rates of procedures per patient year (n/[pt-yr]), reported as mean (95% Confidence Interval [CI]), were compared by nonparametric methods. RESULTS In the whole HD population, the overall rate of procedures increased in the HD period (pre-HD 0.125 [95% CI 0.101-0.149] n/[pt-yr]; HD 0.928 [95% CI 0.795-1.061] n/[pt-yr]; p

Background: The use of urethral catheter is common in medical practice with up to 25% of hospitalized adults having an indwelling Foley catheter at some point during hospital stay. Its use however, is not without complications. We sought to find out the knowledge and practice patterns of physicians regarding urethral catheterization. Methodology: Self-administered questionnaires aimed at elucidating knowledge of the indications of urethral catheterization and precautionary measures effective against catheter-associated urinary tract infection (CAUTI) were distributed to physicians in a teaching hospital. Results: The majority of respondents correctly identified hemodynamic instability necessitating fluid administration (94.9%), lower urinary tract obstruction (92.1%), and assisting the healing of perineal wounds (84.3%) as appropriate indications for urethral catheter use. Incontinence (89.1%), preoperative use (88.3%), and epidural anesthesia (66.9%) were also identified as indications for catheterization. Early catheter removal (94.9%), use of condom catheter (91%), use of antibiotic coated Foley catheter (79.6%), intermittent catheterization (76.2%) and the use of automated reminders (67.6%) were correctly identified as measures that can prevent CAUTI by the majority of the respondents. Routine change of catheter was identified as an effective measure by 84% of the respondents. Conclusion: Physicians in a teaching hospital in Jos, Nigeria have adequate knowledge of indications for urethral catheter use and effective measures aimed at preventing CAUTI. More surgeons identified epidural anesthesia as an appropriate indication for urethral catheter use when compared to those of the medical specialties. Key Words Foley Catheter, Indications, Physicians, Urethral catheterization

Background: The introduction of highly active antiretroviral therapy (HAART) has significantly reduced the morbidity and mortality associated with HIV/AIDS. This benefit that HAART confers can only be maximized if patients present early. This study was embarked upon to describe the characteristics of patients presenting late at a teaching hospital in north central Nigeria. Methodology: This was a cross sectional study of patients who presented late with HIV/AIDS admitted into the medical wards of the Jos University Teaching Hospital over a one year period. Late presentation was defined as patients presenting in CDC class B or C Results: 56.7% of patients who were admitted with HIV /AIDS presented late with the majority (79%) being in CDC class C. The median CD4+ cell count was 88 cells/mm3 with a range of 12 -552 cells/mm3. Reasons for late presentation included fear of stigma 35 (46.7%), financial constraints 23 (30.7%), faith in herbal / spiritual healing 8 (10.7%) and not believing in HIV treatment 5 (6.7%). No one came to hospital in late stage because of distance from hospital. Similarly HCT services were not accessed early because of fear of stigma 37 (50.7 %), not wanting to know about status 29 (39.2 %), absence of symptoms 51(68%) and seeing partner as faithful 28 (38.9%). Tuberculosis was the commonest reason for hospitalization Conclusions: Stigma was the major reason for delayed HIV testing and late presentation.. Public education and enlightenment on the need for routine HCT and early presentation for care and treatment is advocated.Key Words HIV/AIDS, Late presentation, Stigma, Tuberculosis

Background: The 1994 International Conference on Population and Development in Cairo, Egypt drew attention to comprehensive reproductive health for women. The central role of reproduction in the lives of women in many parts of the world is now recognized. We sought to determine the prevalence of gynaecologic morbidity in a cohort of HIV-positive women with a view to determining the effect of HAART on their frequency of occurrence. Methodology: This was a cross-sectional study conducted in the ambulatory care HIV treatment clinic at the Jos University Teaching Hospital. A total of 369 HIV-positive women aged between 15 to 64 years were recruited. Demographic data, history of reproductive organ conditions and use of HAART were obtained. Pelvic examination was carried and Pap smears were obtained for cytology and interpreted using the Bethesda terminology. Results are presented as frequencies and means/median values using appropriate tests of comparison. Results: The mean age for those on HAART was 34±7 and 33±7 years for the HAART-naive group (p = 0.08). Median duration on HAART use was 12 (IQR: 1-41) months. The frequencies of the following self-reported symptoms were significantly higher in the HAART naïve group compared to the HAART experienced group: abnormal vaginal discharge (21.6% vs 9.6%), vaginal itching (39.4% vs 16.7%), abnormal menstruation (36.9% vs 18.4%) and post coital bleeding (5.1% vs 1.8%). On examination, the HAART naïve patients also had higher frequencies of purulent vaginal discharge, cervical erosion, cervical excitation tenderness, contact bleeding, cervical polyp and squamous intraepithelial lesions. Conclusion: This study revealed a higher prevalence of gynaecologic morbidity in HIVpositive women who are HAART-naïve compared with those on HAART. Treating HIV-infection therefore has additional sex-specific benefits for women in terms of reproductive health morbidity.Key Words HIV, HAART, Reproductive-organ, Nigeria

Background : Chronic hepatitis B virus (HBV) infection affects 350 million persons worldwide with its attendant consequences of liver cirrhosis and liver cancer. The degree of liver damage in asymptomatic hepatitis B surface antigen positive native Africans is unknown. We report hepatic histological findings in apparently healthy Nigerians infected with HBV. Methods : This was a retrospective study of apparently healthy Nigerians (61 males and 30 females) chronically infected with HBV aged 33±10 years who had liver biopsies done at the Jos University Teaching Hospital. Results : A lanine transferase (ALT) was elevated in 36.5% and serum albumin was low in 9.9% of the subjects respectively. Fifty nine subjects (64.8%) had evidence of chronic hepatitis, with 29 (49.2%) having histologic activity index (HAI) > 7. Normal histology was present in 27 (29.6%) subjects, three (4.6%) had frank cirrhosis and two (2.3%) had hepatocellular carcinoma with one on the background of cirrhosis. Similar proportions of subjects with 2 normal and elevated ALT levels (50% vs. 51% respectively) had HAI scores > 7; X = 0.1, p =0.92. Conclusion : Our study shows that the vast majority of incidentally detected asymptomatic individuals infected with HBV have significant liver disease. Policies aimed at screening, evaluation, treatment and prevention is mandatory in our communities.

Background : Liver cirrhosis is a chronic inflammatory condition associated lipid abnormalities. There are no studies documenting lipid levels among patients with liver cirrhosis in northern Nigeria. Methodology : Seventy four consecutive patients with liver cirrhosis seen at the Jos University Teaching Hospital and 88 apparently healthy controls had lipid levels estimated in the fasting state. Results : The median serum triglyceride levels were similar in both patients and controls (2.6 mmol/L versus 2.6 mmol/L, ÷2 0.09, P=0.7). The median LDL were also similar being 2.3 mmol/L and 1.9 mmol/L respectively, ÷2 =2.75 p= 0.09. However, the median total cholesterol and HDL cholesterol levels were significantly higher in the controls compared to the 2 study subjects (4.2 mmol/L vs. 3.6 mmol/L; X = 10.1; P=0.0001, and 1.1 mmol/L vs. 0.9 mmol/L; ÷2 = 21.7l, P Conclusion : Lipid abnormalities exist in patients with liver cirrhosis. HDL-C levels are significantly reduced in these subjects. Patients with liver cirrhosis thus, should be routinely screened for such abnormalities.

Background : Childhood kidney diseases remain important causes of significant morbidity and mortality in Nigeria. This is characterized by late presentation, missed diagnosis in certain cases and failure to offer renal replacement therapy to many renal failure patients who required it. Methodology : This was a retrospective study of children managed at the Jos University Teaching Hospital Jos, Nigeria, over a three- year period. Results : Acute glomerulonephritis (AGN) was the commonest renal disease (37.7%). Other conditions included chronic renal failure (20.3%), nephrotic syndrome (16%), urinary tract infection (11.6%), nephroblastoma (7.2%), hemolytic uremic syndrome (5.3%) and polycystic kidney disease (1.5%). The commonest complication of AGN was hypertensive encephalopathy. Chronic glomerulonephritis was the commonest cause of CRF (50%). Conclusions : AGN is the most common childhood renal disease in Jos, Nigeria. Improved socioeconomic and environmental conditions are needed in Nigeria to reduce the incidence of preventable renal diseases.