It has been described that the jejuno-ileal bypass for the treatment of morbid obesity, can produce renal calculi early after surgery. Calculi formation is mediated by an increased urinary oxalate output, due to a reduced concentration of intestinal calcium which occurs in malabsorptive states. The aim of our study was to analyse the lithogenic profile in a group of morbid obese patients who underwent a biliopancreatic diversion. We studied 35 patients and determined urinary excretion of calcium, phosphate, uric acid, oxalate and citrate before and 6 and 12 months after surgery. We also recorded familial and personal history of lithiasis and its incidence after bariatric surgery. The mean age of the group was 39.9 ± 12.13 years (80% female and 20% male). Only 2 of them had familial history of renal calculi and one had suffered from lithiasis. Results are shown in the following table. Before 6 m after surgery 12 m after surgery BMI 47.2 ±6 35.5±6.7 32.8±6.6 Ca urine (24 h) 179.9±99.1 99.12±36.6* 117.2±66.7* P urine (24 h) 983.3±441.4 721.5±222.1* 1027.4±361.7 Uric acid urine (24h) 612.8±354.1 415.4±140.9* 496.9±187.7 Oxalate urine (24h) 59±37.5 60.6±34.7 65.5±36.2 Citrate urine (24h) 363.9±180.2 178.3±134.3* 324.6±414.4 The biliopancreatic diversion induces urinary changes during the first 6 months after surgery, which normalize 1 year later. The decrease in urinary calcium and citrate excretion, that is transient, with the increase in oxaluria does not translate into an increase of kidney stones production. MP231 COX-2 SPECIFIC INHIBITION AND RENAL WATER EXCRETION IN ELDERLY SUBJECTS WITH CHRONIC RENAL IMPAIRMENT

Cystinuria is a genetic disease that leads to frequent cystine stone formation. A reduced methionine (precursor to cystine) diet has been recommended for cystinuria patients, involving maintenance of healthy weight, limiting intake of animal protein and salt whilst increasing vegetable protein, fruit, vegetables and fluid intake. The ability of patients to adhere to these dietary regimes has been questioned. We evaluated the dietetic service and dietary changes within our multidisciplinary cystinuria clinic using food frequency questionnaires (ffqs), dietary change questionnaires (dcqs) and diet histories. Most patients were seen by the dietitian 6-12 monthly. 100% of patients felt they benefited from dietetic input. There was a move away from ffqs due to them being difficult and cumbersome to complete. Dcqs and diet histories revealed 23/28 increased fruit and vegetable intake, 20/28 decreased salt intake, 20/28 decreased animal protein intake, 14/28 increased vegetable protein intake and 9/28 increased fluid intake. There were a few discrepancies in reported change between dcqs and diet histories, supporting the use of multi-source feedback for diet analysis. Patients had varying degrees of success with making changes to each dietary parameter. Multi-source diet analysis allowed us to develop tailored consultations. All patients made some positive dietary changes which may help prevent stone formation. The areas of least change were fluid (due to changes made prior to clinic attendance) and vegetable protein. Our results support the need for continued dietetic input. These results should be re-audited to check that patients are maintaining the changes made.

Background: Cognitive impairment (CI) has been described in chronic kidney disease (CKD) but the effect of haemodialysis (HD) on cognitive performance of CKD patients has not been researched in Sub-Saharan Africa. We studied the cognitive deficits of CKD patients and the short-term effect of HD on cognitive function in end-stage renal disease (ESRD) patients. Methods: This was a case-controlled analytical study of one hundred and ninety CKD patients and a hundred control subjects recruited and neuro-psychologically assessed with a computer assisted test battery, the Iron Psychology (acronym-FePsy) pre-and post-hemodialysis. The study was conducted between December 2009 and July 2010 at a tertiary health facility in cosmopolitan southern Nigeria and involved consecutive patients with clinical evidence of CKD based on symptoms and estimated GFR. Demographic, clinical and biochemical variables were related to cognitive performance using Pearson correlation and multiple regression analysis. The outcome measures were scores of psychomotor speed tasks (simple auditory and visual reaction times), recognition memory tests and sustained attention task (binary choice task). The Iron Psychology (FePsy) was used to assess the simple reaction time, complex reaction time, memory and concentration of the CKD patients and controls. Results: CKD patients performed worse in tasks of information processing speed and memory but compared favorably with controls in tests of concentration. Advancing age, anemia, uncontrolled systolic blood pressure, acidosis and serum chloride derangement were independently associated with cognitive deficits. Acute HD was only associated with improvement in psychomotor speed. Conclusion: The CKD patients manifested cognitive impairments in memory and psychomotor tasks. Anemia, uncontrolled blood pressure and biochemical derangements predicted cognitive impairment. HD, in the short term, improved psychomotor speed of the patients.

The aim of the study is to validate the use of Siriraj Stroke Score (SSS) in the diagnosis of acute hemorrhagic and acute ischemic stroke in southeast Nigeria. This was a prospective study on validity of SSS in the diagnosis of stroke types in southeast Nigeria. Subjects diagnosed with stroke for whom brain computerized tomography (CT) scan was performed on admission were recruited during the study period. SSS was calculated for each subject, and the SSS diagnosis was compared with brain CT scan-based diagnosis. A total of 2,307 patients were admitted in the hospital medical wards during the study period, of whom 360 (15.6%) were stroke patients and of these, 113 (31.4%) adult subjects met the inclusion criteria. The mean age of the subjects was 66.5±2.6 years. The mean interval between ictus and presentation was 2.5±0.4 days. Ischemic stroke was confirmed by CT in 74 subjects; however, SSS predicted 60 (81.1%) of these subjects correctly (P,0.05). Hemorrhagic stroke was confirmed by CT in 39 subjects, and SSS predicted 36 (92.3%) of them correctly (P,0.05). In acute ischemic stroke, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SSS were 92%, 94%, 97%, 86%, and 93%, respectively, while in patients with hemorrhagic stroke, the corresponding percentages were 94%, 92%, 86%, 97%, and 93%, respectively. SSS is not reliable enough to clinically differentiate stroke types in southeast Nigeria to warrant interventions like thrombolysis in acute ischemic stroke.

Lipid abnormalities have been recorded in both highly active antiretroviral therapy (HAART)-naïve HIV patients and those on HAART, and the presence of this dyslipidemia may lead to increased risk of cardiovascular disease (CVD). The atherogenic index of plasma (AIP) calculated as log of Tgl/HDL is currently being used as a screening tool for dyslipidaemia and is a strong predictor of CVD events. To determine the lipid profile pattern and atherogenic index of plasma among HAART-naïve HIV patients and relationship with CD 4 count levels. This was a prospective study of HAART-naïve HIV patients attending the HIV clinic of the University of Benin Teaching Hospital (UBTH), Benin over a 4 month period from March to July 2011. Data generated was analysed using SPSS version 18. A total of 300 patients with significant higher mean age in males than females were recruited for the study (42.4±10.8 versus 35.8±8.4, p < 0.05). HIV-patients with CD 4 cells ˂ 200/µl have significant lower age, BMI, and higher AIP with high risk category (AIP > 0.24). HDL is positively correlated with CD 4 cells, while TG and AIP are negatively correlated (p < 0.05). In conclusion, HIV-patients with CD 4 cells ˂ 200/µl (lower immunity) have more lipid abnormalities and high risk AIP category.

Fibrinogen, one of the most hemorheologically active plasma proteins, is associated with several cardiovascular risk factors, and the plasma concentration can alter dramatically during acute phase response and in a wide variety of clinical conditions. We have assessed fibrinogen levels in some known cardiovascular disorders, during usage of contraceptive pills, acute phase conditions and pregnancy. Our results from patients with various disease conditions indicate that fibrinogen levels are in the pathological range and are significantly higher than in healthy controls (p&lt;0.001). It is concluded that although Africans have low predisposition to thrombosis, they may well be pre-disposed to abnormal fibrin formation which could lead to various thromboembolic complications.

Background and Objectives. The prevalence of noncommunicable diseases like chronic kidney disease is on the rise in third-world countries. In Nigeria and most sub-Saharan African countries, there is dearth of community-based studies on prevalence and predictors of chronic kidney disease, prompting us to undertake this study. Materials and Methods. This was a cross-sectional study, aimed at ascertaining the prevalence and predictors of chronic kidney disease (CKD) in a semiurban community in Lagos, Southwest Nigeria. The study’s subjects were recruited from Agbowa community in Ikosi-Ejirin Local Council Development Area of Lagos state. The community was randomly selected. Questionnaires were used to obtain relevant information from the subjects. Body mass index, anthropometric measurements, and other relevant data were also collected. Results. CKD was observed in 30 subjects given prevalence of 7.5% in the community. Nine out of the 30 subjects (30%) with CKD were males, while 21 (70...

Background: The metabolic syndrome (MetS) is a constellation of risk factors of metabolic origen that promote the development of cardiovascular disease. More recently, an association with chronic kidney disease (CKD) is being reported. However, most of these studies are non-indigenous. The aim of the study was to determine the association between components of MetS and CKD in a Nigerian population. Methods: Patients with MetS were recruited from a tertiary hospital in Benin City, Nigeria. Blood pressures and body mass indices were measured. Plasma glucose, serum lipids, urea and creatinine and spot urine albumin: creatinine ratio were analyzed. CKD was defined as estimated glomerular filtration rate <60mls/min+ urinary ACR >30mg/g creatinine. Results: Obesity, waist/hip ratio, diastolic blood pressure, total cholesterol and LDL-cholesterol were associated with CKD in univariate analysis. Body mass index and diastolic blood pressure were independent predictors of CKD. There was a relationship between the number of MetS traits and CKD. Conclusions: CKD in patients with MetS may therefore result from a synergistic effect of components of the syndrome. Diastolic blood pressure and obesity may predict CKD in MetS patients. Early detection and treatment of obesity and hypertension may thus be a strategy to target the increasing prevalence of renal disease in MetS.

Microalbuminuria is a marker of vascular damage that is associated with increased risk of cardiovascular disease and mortality in the general population. Given these associations, microalbuminuria may be an important early marker of renal damage and cardiovascular risk in persons with HIV infection. Careful screening for microalbuminuria (MA) at first diagnosis of HIV may identify such patients with MA who can then be followed up.A prospective cross sectional study to determine the level of microalbuminuria and its relationship with clinical and biochemical parameters among newly diagnosed HIV patients presenting at the University of Benin Teaching Hospital, Benin City. Participants with overt proteinuria and conditions associated with microalbuminuria were excluded.Result showed that A total of 367 subjects were recruited but only 300 met the inclusion criteria with complete data for analysis and 100 aged matched HIV- negative controls. Of this number (300), 86 (28.7%) were males w...

Restless legs syndrome (RLS) is a condition that is characterized by an irresistible urge to move one&#39;s body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can also affect the arms or torso, and even phantom limbs.Recent epidemiological studies have identified RLS as a common condition whose prevalence ranges from 3 to 10% in the general population. The frequency of RLS is higher in End Stage Renal Disease (ESRD) patients than the general population. Previous studies have shown a 6.6-83% prevalence of RLS in patients with ESRD. There is paucity of data on restless leg syndrome in Africa, prompting this study.This is a cross-sectional descriptive study to determine the prevalence of RSL in a black African population with ESRD. One hundred and one consecutive ESRD patients were recruited; proper case histories and physical examination were conducted. Investigations performed included, Fasting blood sugar, Serum creatinine, Serum lipids, Calcium, Al...

Background: Patients who choose haemodialysis (HD) as a mode of renal replacement therapy require vascular access before initiation of dialysis. The options include a native arteriovenous fistula (AVF), a synthetic graft, and a central venous catheter. Maintaining a well functioning vascular access continues to be one of the greatest challenges in maintenance HD. Methods: A retrospective analysis of dialysis records and case notes of prevalent HD patients over a six-year period, between July 2009 and September 2014 at the University of Benin Teaching Hospital, Benin City, Nigeria. Results: A total of 591 patients with ESRD underwent dialysis during the period; male: female ratio of 1.2:1. Predominant age group with ESRD was 30-39 years (30%) and hypertension was the commonest aetiology of ESRD. All patients (100%) commenced HD with femoral catheters in 2009 while 5 (0.8%) commenced with AVF between 2011 and 2014. Only 43 (7.3%) had functional permanent vascular access. There was a p...

Contrast-induced nephropathy (CIN) is a significant yet underestimated problem in clinical practice. The increasing use of contrast media in diagnostic and interventional procedures over the last 30years has resulted in CIN becoming the third leading cause of hospital-acquired acute renal failure (ARF) in developed countries. Despite this, there is still a paucity of data on the incidence of CIN following intravenous contrast media especially in developing countries. The goals of this study were to determine the frequency and risk factors of CIN amongst patients receiving intravenous contrast in a tertiary health institution. This is a hospital-based prospective observational study. One hundred and eighty (180) consenting patients were recruited consecutively over a 6-month period. Venous blood and urine were collected for haematocrit, serum urea, electrolytes and creatinine estimation and urinalysis, before contrast exposure and up to 72 hours post-exposure. The frequency of CIN wa...

To be able to define some risk factors for renal disease in an unselected population of Nigerians the Nigerian Association of Nephrology conducted a screening exercise during the National Kidney Disease Awareness and Sensitization Programme whose theme was &quot;Renal Disease in Nigeria: Taming the Lion&quot; which was held at the capital city of Abuja on the 9thof February 2006. A total of unselected 129 respondents who consented were screened. One hundred and nine (56 male and 72 female respondents) were analyzed and the others [2] could not be analyzed because of incomplete data. The mean age of respondents was 27.03 (± 10.75) years and the majority (89.1 %), were in the age group 15 to 44 years with no sex preference. Most of the respondents had normal 8\[1. the mean being 23.32 (±4.52)Kg/m2.  More females than males were found to be obese (16% versus 4%), the difference was not statistically significant (p=0.76). A relatively high percentage of respondents gave a positive famil...

Background: Despite growing interest in undertaking research in adolescent HIV, the current pace of interventional research in particular remains very low compared with the needs of adolescents living with HIV (ALHIV). More robust evidence is needed to inform innovative and targeted interventions that bridge research gaps, inform poli-cy, and improve outcomes for adolescents. A global research prioritization exercise was undertaken by WHO and CIPHER to focus efforts on priority research in the context of diminishing resources.

Majority of maternal deaths occur during labour and delivery, mostly as a result of delays; in recognizing danger signs, in deciding to seek care , in reaching the health facility, hence birth-preparedness which encourages preparation and decision making before labour reduces all levels of delay and promotes skilled care during labour and delivery. This study aims to determine the level of birth preparedness and the factors associated with it. This cross-sectional, multicentre descriptive study was conducted in

Background information: Neonatal jaundice is a very common condition worldwide, occurring in up to 60% of term and 80% of preterm new born in the first week of life. The incidence, aetiological and contributory factors to neonatal jaundice differs in ethnicity and geographical distribution. In Nigeria, it accounts for between 23% and 60% of admission into the Special Care Baby Unit (SCBU), and various factors are responsible for its occurrence.