Browsing by Author "Ademola, A. D."

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A case report of suspected angioedema in a child after administration of mebendazole, cotrimoxazole and leaf extracts
(Association of Resident Doctors (ARD), UCH, Ibadan, 2016) Ashubu, O. F.; Ademola, A. D.; Asinobi, O. A.
Acute kidney injury among paediatric emergency room admissions in a tertiary hospital in South West Nigeria: a cohort study
(Oxford University Press, 2019) Ademola, A. D.; Asinobi, A. O.; Ekpe-Adewuyi, E.; Ayede, A. I.; Ajayi, S. O.; Raji, Y. R.; Salako, B. L.; James, M.; Zappitelli, M.; Samuel, S. M.
Background. Epidemiological data on paediatric acute kidney injury (AKI) in sub-Saharan Africa are limited and largely retrospective. We performed a prospective study of AKI among patients admitted through the emergency room. Methods. Children admitted to the post-neonatal emergency room of the University College Hospital, Ibadan, Nigeria between February 2016 and January 2017 were studied. AKI was defined by Kidney Disease: Improving Global Outcomes serum creatinine criteria. AKI ascertainment relied on serum creatinine measurements carried out in routine care by post admission Day 1. We compared in-hospital mortality by post-admission Day 7 for patients with and without AKI (no-AKI). Results. Of the 1344 children admitted to the emergency room, 331 were included in the study. AKI occurred in 112 patients (33.8%) with a median age of 3.1 years [interquartile range (IQR) 0.9–9.4] and was Stage 3 in 50.5% of the cases. The no-AKI group had a median age of 1.8 (IQR 0.7–5.8) years. The underlying diagnoses in patients with AKI were sepsis (33.0%), malaria (12.5%) and primary renal disorders (13.4%). Twenty-four of the patients with AKI underwent dialysis: haemodialysis in 20 and peritoneal dialysis in 4. By Day 7 of admission, 7 of 98 (7.1%) patients in the AKI group had died compared with 5 of 175 (2.9%) patients in the no-AKI group [odds ratio 2.6 (95% confidence interval 0.8–8.5)]. Outcome data were not available for 58 (17.5%) patients. Conclusions. AKI is common among paediatric emergency room admissions in a tertiary care hospital in sub-Saharan Africa. It is associated with high mortality risk that may be worse in settings without dialysis.
An Audit of the Use of Renal Function Tests among Paediatric Mortalities
(Sciencedomain International, 2016) Asinobi, A. O.; Ademola, A. D.; Ogunku, O. O.
Background: Acute kidney injury is a frequent and serious complication encountered in critically ill children and is an independent risk factor for mortality. Major causes of childhood mortality in our environment are conditions frequently complicated by kidney failure, yet kidney failure is conspicuously absent in many of the reports. The actual proportion of these critically ill children subjected to renal function tests is not known. In view of the low representation of kidney failure as a cause of mortality in our environment, we sought to know what proportion of critically ill/dying patients had renal functions tests done and to identify any cases of missed diagnosis. Methods: This was a descriptive study of the mortalities in the Department of Paediatrics, University College Hospital, Ibadan, between August 2004 and May 2006, particularly those due to kidney failure. Data from the departmental mortality database collected on a weekly basis were analyzed. Results: Out of 4,941 admissions, there were 542 mortalities (age 1day -13 years) giving a mortality rate of 11%. Low birth weight, malaria, severe perinatal asphyxia, meningitis and neonatal tetanus were the leading five causes of death. Over 80% of the mortalities were under-fives
Childhood nephrotic syndrome in tropical Africa: then and now
(Taylor and Francis, 2017) Olowu, W. A.; Ademola, A. D.; Ajite, A. B.; Saad, Y. M.
This descriptive and comparative review examines the changing epidemiology, treatment, renal and patient outcome of childhood nephrotic syndrome (NS) in tropical Africa (TpAfr). In the 1960s to 1980s, corticosteroid-resistant non-minimal change disease (nMCD) including quartan malaria nephropathy (QMN) was the dominant renal histopathology type. The overall incidence of NS was 0.35–1.34% of hospital admissions. Median age at onset of NS ranged between 4.0 and 12.0 years while the mean (SD) age range was 5.8 (3.8) to 10.3 (4.8) years across studies. The male: female ratio was 1.6:1.0. The overall mean (SD) incidence of idiopathic minimal change disease (MCD) [21.6 (18.6%)] compared with idiopathic nMCD [59.1 (25.7%)] demonstrates significant dominance of the latter (p = 0.0001). Post-1989, the following mean (SD) incidences of histopathological types were: MCD 20.4 (17.7%), focal segmental glomerulosclerosis 39.0 (26.3%), membranoproliferative glomerulonephritis 25.4 (16.8%), proliferative glomerulonephritis 16.7 (27.0%) and membranous nephropathy 7.4 (4.5%). While the mean (SD) proportion of steroid resistance (SR) [73.5 (19.2%)] was significantly greater than the mean complete remission (CR) [26.5 (19.2%)] during 1960-1989 (p=0.005), mean (SD) SR [27.4 (25.3%)] was significantly lower than mean (SD) CR [66.1 (28.0%)] post-1989 (p < 0.001). Unlike QMN, hepatitis B virus, HIV infection, sickle cell disease and systemic lupus erythematosus are now increasingly being associated with NS in TpAfr. Mean (SD) renal survival post-1989 was 58.3 (37.0%) while all-cause mortality was 9.8%. Children with NS now survive better than before, reflecting improved access to healthcare and transition to a clinical pattern favouring idiopathic NS and increased sensitivity to corticosteroids.
Congenital anomalies in Ibadan, Nigeria
(Spectrum Books. Publisher, Ibadan Nigeria, 2016) Ayede, A. I.; Adeleye, A. O.; Olusanya, A. A.; Ademola, A. D.; Olayemi, O.; Ogbole, G. I.; Akinmoladun, J. A.; Agunloye, A. M.; Akinrinoye, O. O.; Takure, A. O.; Oyewole, O. B.; Oluwatosin, O. M.; Omokhodion, S. I.
Background: There is a need for a multidisciplinary database that can be used as a potential source for developing a protocol and a guideline for a possible nationwide prospective surveillance of congenital anomalies in Nigeria. Methods: This five-year cross-sectional retrospective survey of data from January 2009 to December 2013 was done at the University College Hospital, Ibadan. Data were collected from the admission records on the wards in 8 specialty units with the most workable documented clinical records of congenital anomalies in their care using a predesigned proforma. Proportions of congenital anomalies were determined based on systemic classification of the anomalies and the descriptive terms used were according to the ICD_10-chapter XVIII_RCPCH extension. Result: The total number of patients with congenital anomalies whose records were obtained from the ward registers was 1311, there were 75 (5.7%) missing case notes while information was obtained on 1236 (94.3%) patients. There were a total of 1479 anomalies with multiple anomalies seen in 16.1% of the patients. The male/female ratio was 2:1 and multiple births as well as positive family history of birth defects were seen in about 2.4% and 2.2% of cases respectively. Prenatal diagnosis of the anomalies was documented in only 11 cases (0.9%). Only about one in five cases presented within the neonatal period, and defects of the abdominal wall as well as the cranial-facial-orbital regions were the most prevalent. Next were those in the cardiovascular, spinal column, anorectal and genital, as well as musculoskeletal systems. Conclusion: The size and pan-systemic profiles of the birth defects documented in this study calls for further action on this all-important cause of childhood mortality and significant life-long morbidity in our country.
Diagnosing renal failure due to diethylene glycol in children in a resource-constrained setting
(Springer International Publishing, 2012) "Akuse, R. M.; Anyiam, J.; Eke, F. U.; Ademola, A. D.; Fajolu, I. B.; Gbelee, H. O.; Ihejiahi, U.; Bugaje, M. A.; Anochie, I. C.; Asinobi, A. O.; Okafor, H. U.; Adeleke, S. I.; Audu, L. I.; Otuneye, A.; Disu, E.; Idris, H.; Aikhonbare, H.; Yakubu, A.; Ogala, W.; Ogunrinde, O.; Wammanda, R.; Orogade, A.; Eseigbe, E.; Umar, L.; Musa, H.; Onalo, R.; West, B.; Paul, N.; Lesi, F.; Ladapo, T.; Boyede, O.; Okeowo, R.; Mustapha, A.; Akinola, I.; Chima-Oduko, O.; Awobusuyi O.
Background In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource constrained countries, this study investigated whether AKI associated with DEG could be identified by other means. Methods: This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children withAKI over a 6-month period were reviewed. Results Sixty (50.4%) of 119 children ingested “My pikin” teething syrup. Compared to children who had not ingested it, they were significantly (p<0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management. Conclusions Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.
Enabling the genomic revolution in Africa: H3Africa is developing capacity for health-related genomics research in Africa
(American Association for the Advancement of Science, 2014) Rotimi, C.; Abayomi, A.; Abimiku, A.; Adabayeri, V. M.; Adebamowo, C.; Adebiyi, E.; Ademola, A. D.
Factors associated with medication nonadherence among hypertensives in Ghana and Nigeria
(Hindawi Publishing Corporation, 2015) Boima, V.; Ademola, A. D.; Odusola, A. O.; Agyekum, F.; Nwafor, C. E.; Cole, H.; Salako, B. L.; Ogedegbe, G.; Tayo, B. O.
Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication non-adherence (MNA); our study therefore aimed to determine factors associated withMNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (𝑛 = 120), Ghana; and University of Port Harcourt Teaching Hospital, (𝑛 = 73) Apapa General Hospital Lagos (𝑛 = 79) and University College Hospital Ibadan (𝑛 = 85), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (𝑟 = −0.208, 𝑃 < 0.001), concern about medications (𝑟 = −0.0347, 𝑃 = 0.002), and knowledge of hypertension (𝑟 = 0.14, 𝑃 = 0.006). MNA was associated with formal education (𝑃 = 0.001) and use of herbal preparation (𝑃 = 0.014). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (𝑃 = 0.032). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (𝑃 = 0.006). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation.
Genomic approaches to the burden of kidney disease in Sub-Saharan Africa: the Human Heredity and Health in Africa (H3Africa) kidney disease research network
(International Society of Nephrology., 2016) Osafo, C.; Raji, Y. R.; Olanrewaju, T.; Mamven, M.; Arogundade, F.; Ajayi, S.; Ulasi, I.; Salako, B.; Plange-Rhule, J.; Mengistu, Y.; Mc’Ligeyo, S. O.; Moturi, G.; Winkler, C. A.; Moxey-Mims, M. M.; Rasooly, R. S.; Kimmel, P.; Adu, D.; Ojo, A.; Parekh, R. S.; Ademola, A. D.
Haemodialysis for paediatric acute kidney injury in a low resource setting: experience from a tertiary hospital in South West Nigeria
(Oxford University Press, 2016) Asinobi, A. O.; Ademola, A. D.; Alao, M. A.
Background: Acute kidney injury (AKI) is an important cause of preventable mortality among children. Management of AKI may require renal replacement therapy (RRT) but access to RRT for children in low resource settings is limited. Our study explored the role of haemodialysis in the management of children with AKI in a low resource setting in terms of aetiology and outcomes. Methods: A review of patients managed in the Paediatric Nephrology Unit, University College Hospital Ibadan, South-West Nigeria, who underwent haemodialysis for AKI from January 2006 to December 2014. Results: Sixty-eight patients (55.9% males), aged 3–16 (mean ± standard deviation, 9.0 ± 3.4) years were studied. The causes of AKI were sepsis (22.1%), malaria (17.6%) and glomerulonephritis (17.6%), intravascular haemolysis—cause unknown (16.2%), G6PDH deficiency (7.4%), malignancy (8.8%) and haemoglobinopathy (5.9%). The number of sessions of haemodialysis ranged from 1 to 10 (mode = 2 sessions) over a period of 1–55 days. Mortality was 27.9% (n = 19) and was related to the aetiology of AKI (P = 0.000): no deaths among patients with intravascular haemolysis or malaria, six deaths among patients with sepsis (40%), six (50%) among the patients with glomerulonephritis, while all the patients with malignancies died. Conclusions: The outcome of haemodialysis for AKI in Nigeria is relatively good and is related to the underlying aetiology of AKI. In addition to peritoneal dialysis, intermittent haemodialysis may have a role in the management of paediatric AKI in low resource settings and should be supported.
Human heredity and Health (H3) in Africa kidney disease research network: a focus on methods in Sub-Saharan Africa
(American Society of Nephrology, 2015) Osafo, C.; Raji, Y. R.; Burke, D.; Bamidele, O. T.; Tiffin,N.; Moxey-Mims, M. M.; Rasooly, R. S.; Kimmel, P. L.; Ojo, A.; Adu, D.; Parekh, R. S.; Ademola, A. D.
CKD affects an estimated 14% of adults in sub-Saharan Africa, but very little research has been done on the cause, progression, and prevention of CKD there. As part of the Human Heredity and Health in Africa (H3Africa) Consortium, the H3Africa Kidney Disease Research Network was established to study prevalent forms of kidney disease in sub-Saharan Africa and increase the capacity for genetics and genomics research. The study is performing comprehensive phenotypic characterization and analyzing environmental and genetic factors from nine clinical centers in four African countries (Ghana, Nigeria, Ethiopia, and Kenya) over a 5-year period. Approximately 4000 participants with specified kidney disease diagnoses and 4000 control participants will be enrolled in the four African countries. In addition, approximately 50 families with hereditary glomerular disease will be enrolled. The study includes both pediatric and adult participants age <1 to 74 years across a broad spectrum of kidney diseases secondary to hypertension-attributed nephropathy, diabetes, HIV infection, sickle cell disease, biopsy-proven glomerular disease, and CKD of unknown origin. Clinical and demographic data with biospecimens are collected to assess clinical, biochemical, and genetic markers of kidney disease. As of March 2015, a total of 3499 patients and controls have been recruited and 1897 had complete entry data for analysis. Slightly more than half (50.2%) of the cohort is female. Initial quality control of clinical data collection and of biosample and DNA analysis is satisfactory, demonstrating that a clinical research infrastructure can be successfully established in Africa. This study will provide clinical, biochemical, and genotypic data that will greatly increase the understanding of CKD in sub-Saharan Africa.
Kidney disease in hepatitis B surface antigen-positive children: experience from a centre in south-west Nigeria and a review of the Nigerian literature
(Taylor and Francis, 2017) Asinobi, A. O.; Ademola, A. D.; Okolo, C. A.; Adepoju, A. A.; Samuel, S. M.; Hoy, W. E.
Background: Kidney disease is an important extra-hepatic manifestation of hepatitis B virus (HBV) infection. However, there is paucity of recent literature on kidney disease in children and adolescents with HBV infection from several parts of sub-Saharan Africa including Nigeria. Objective: To review the pattern of kidney disease in hepatitis B surface antigen (HBsAg)-positive children and adolescents seen at a tertiary hospital in south-west Nigeria. Methods: A retrospective study was undertaken of HBsAg-seropositive children with kidney disease managed at University College Hospital, Ibadan, from January 2004 to December 2015. Patients were identified from the paediatric nephrology unit admissions and the renal histology registers. Results: 24 children and adolescents were studied, 17 of whom were male (70.8%), and the median age was 10.0 years (range 3–15). Ten (41.7%) had nephrotic syndrome, five (20.8%) had non-nephrotic glomerulonephritis, five (20.8%) were in end-stage renal disease (ESRD), including a patient with posterior urethral valves, and four had acute kidney injury secondary to acute tubular necrosis. Renal histology was available for 10 patients: nine had nephrotic syndrome associated with minimal change disease in six, focal segmental glomerulosclerosis in two and one had membanoproliferative glomerulonephritis. The patient with non-nephrotic glomerulonephritis had diffuse global sclerosis. Conclusion: The pattern of kidney disease in HBV-positive children demonstrated a predominance of nephrotic syndrome, followed by non-nephrotic glomerulonephritis, ESRD and acute kidney injury. Better diagnostic facilities and treatment are required. Prevention of HBV infection by universal childhood immunisation is the ultimate goal.
Kidney disease in hospitalised HIV positive children in Ibadan, South West Nigeria
(College of Medicine, University of Ibadan, 2012) Ademola, A. D.; Asinobi, O. O.; Oladokun, R. E.; Ogunkunle, O. O; Okolo, C. A; Ogbole. G. E.
Background: There is a paucity of data on the clinicopathologic pattern of kidney disease in Human Immunodeficiency Virus (HIV) seropositive children from sub-Saharan Africa and non from South West Nigeria. Objective: To determine the clinical pattern and outcome of kidney disease among HIV positive children hospitalised at a tertiary hospital South West Nigeria Methodology: A retrospective study of all HIV positive children who were hospitalised and managed for kidney diseases over a period of 78 months at the University College Hospital Ibadan, South West Nigeria was reviewed. Patients were followed up over the duration of hospital admission. Results: Ten children (six males and four females) aged 4 -15(10.4±3.2) years were identified. Four presented in acute kidney injury, (AKI) three with nephrotic syndrome (NS) and two in chronic kidney failure (CKF). One patient had left renal artery stenosis. Renal biopsy performed in three children showed focal segmental glomerulosclerosis in two patients and membranous nephropathy in the third. Management included antiretroviral therapy, Angiotensin Converting Enzyme Inhibitors and acute haemodialysis. Mortality was 40%. Conclusion: AKI, NS and CKF were the predominant clinical patterns of kidney disease in hospitalised HIV positive children and the mortality is high
Nephrotic syndrome complicating cyanotic congenital heart disease: A report of two cases
(West African College of Physicians/ West African College of Surgeons., 2008) Ogunkunle, O. O.; Asinobi, A. O.; Omokhodion, S. I.; Ademola, A. D.
BACKGROUND: Renal complications are said to be common in cyanotic congenital heart disease (CCHD), but have not been documented frequently in Nigerian children. Nephrotic syndrome (NS) is an uncommon complication of CCHD. OBJECTIVES: To report two cases of NS complicating CCHD who presented within months of each other, in order to draw attention to the problem. METHODS: The details of the clinical presentation, course and outcome of two children with CCHD, presenting with features of NS within months of each other, were reviewed. The patients were fully assessed clinically and were further investigated with chest X-ray, ECG ad echocardiography. RESULTS: A 12-year old girl with Fallot’s tetralogy underwent a Blalock-Taussig shunt at the age of 2 years, but subsequently defaulted from follow-up. She reappeared 10 years later with features of NS. Echocardiography revealed impaired myocardial function. Despite initial clinical improvement following three plasma exchanges and Enalapril therapy, she suddenly died on the 15th day of admission. The second patient was a 7-year old boy with tricuspid atresia, diagnosed at the age of 10 months, and similarly defaulted, reappearing six years later with features of NS. Oedema regressed with similar treatment, but his renal function deteriorated. He was stable enough to be discharged after six weeks on admission. CONCLUSION: Proteinuria is likely to be more common in Nigerian children with CCHD than has been previously appreciated. Early intervention in patients with CCHD is desirable in order to prevent development of complications which worsen the prognosis. Patients with CCHD should be screened regularly for proteinuria in order to detect and address renal complications early.
Paediatric end-stage renal disease in a tertiary hospital in South West Nigeria
(Asian Pacific Society of Nephrology, 2014) Asinobi, A. O.; Ademola, A. D.; Ogunkunle, O. O.; Mott S. A.
Background: Children and adolescents with end-stage renal disease (ESRD) in sub-Saharan Africa may have the worst outcomes globally. Barriers to management include late presentation, poor socioeconomic conditions, absence of medical insurance, limited diagnostic facilities and non-availability of chronic renal replacement therapy (RRT). Our study was to determine the incidence, aetiology, management and outcomes of paediatric ESRD in a tertiary hospital in Nigeria. Methods: A retrospective case review of paediatric ESRD at the University College Hospital Ibadan, Nigeria, over 8 years, from January 2005 to December 2012. Results: 53 patients (56.6% male), median age 11 (inter quartile range 8.5-12) years were studied. Mean annual incidence of ESRD in Ibadan for children aged 14 years and below was 4 per million age related population (PMARP) while for those aged 5-14 years it was 6.0 PMARP. Glomerulonephritis was the cause in 41 (77.4%) patients amongst whom, 29 had chronic glomerulonephritis and 12 had nephrotic syndrome. Congenital anomalies of the kidneys and urinary tract (CAKUT) accounted for 11 (21.2%) cases, posterior urethral valves being the most common. Acute haemodialysis, acute peritoneal dialysis or a combination of these were performed in 33 (62.3%), 6 (11.3%) and 4 (7.5%) patients respectively. Median survival was 47 days and in-hospital mortality was 59%. Conclusions: Incidence of paediatric ESRD in Ibadan is higher than previous reports from sub-Saharan Africa. Glomerulonephritis, and then CAKUT are the most common causes. Mortality is high, primarily due to lack of resources. Preventive nephrology and chronic RRT programmes are urgently needed.
Paediatric peritoneal dialysis in a developing country: practice, challenges and opportunities
(African Paediatric Nephrology Association, 2019) Asinobi, A. O.; Ademola, A. D.; Akuse, R. M.
Background: The practice and challenges of peritoneal dialysis (PD) in a developing country may be uniquely different from what obtains in developed countries. Method: A review of the practice and challenges of PD in Nigeria as a case study and documentation of opportunities for improvement Review: There has been renewed interest in the provision of PD to children in acute kidney injury in Nigeria and this has led to adaptations such as use of nasogastric tubes as PD catheters and use of constituted PD fluid. The use of adaptations is lifesaving but complication rates may be higher than with the use of standard gadgets. Other challenges include limited availability and high cost of PD catheters and PD fluid. There are also challenges with the availability of expertise for the insertion of PD catheters and the PD procedure. Opportunities to advance paediatric PD include sustained efforts to provide PD with the use of adaptations, collection of data on outcomes of PD, advocacy for more support from government, non- governmental organisations and industry in the forms of insurance coverage, access to consumables and/or training in paediatric PD. Conclusion: Sustained provision of PD with adaptations, documentation of outcomes, and advocacy may lead to improvement in paediatric PD services.
Peritoneal dialysis in childhood acute kidney injury: experience in Southwest Nigeria
(International Society for Peritoneal Dialysis, 2012) Ademola, A. D.; Asinobi, A. O.; Ogunkunle, O. O.; Yusuf, B. N.; Ojo, O. E.
Background: The choices for renal replacement therapy (RRT) in childhood acute kidney injury (AKI) are lim¬ited in low-resource settings. Peritoneal dialysis (PD) appears to be the most practical modality for RRT in young children with AKI in such settings. Data from sub-Saharan Africa on the use of PD in childhood AKI are few. Methods: We performed a retrospective study of chil¬dren who underwent PD for AKI at a tertiary-care hospital in southwest Nigeria from February 2004 to March 2011 (85 months). Results: The study included 27 children (55.6% female). Mean age was 3.1 ± 2.6years, with the youngest being 7 days, and the oldest, 9 years. The causes of AKI were in¬travascular hemolysis (n = 11), septicemia (n = 8), acute glomerulonephritis (n = 3), gastroenteritis (n = 3), and hemolytic uremic syndrome (n = 2). Peritoneal dialysis was performed manually using percutaneous or adapted catheters. Duration of PD ranged from 6 hours to 12 days (mean: 5.0 ± 3.3 days). The main complications were peri¬tonitis (n = 10), pericatheter leakage (n = 9), and catheter outflow obstruction (n = 5). Of the 27 patients, 19 (70%) survived till discharge. Conclusions: In low-resource settings, PD can be suc¬cessfully performed for the management of childhood AKI. In our hospital, the use of adapted catheters may have contributed to the high complication rates. Peritoneal di¬alysis should be promoted for the management of childhood AKI in low-resource settings, and access to percutaneous or Tenckhoff catheters, dialysis fluid, and automated PD should be increased.
Plasma homocysteine and B vitamins levels in Nigerian children with nephrotic syndrome
(African Field Epidemiology Network (AFENET), 2014) Orimadegun, B. E.; Orimadegun, A. E.; Ademola, A. D.; Agbedana, E. O.
Introduction: Available data on plasma homocysteine level in patients with nephrotic syndrome (NS) are controversial with increased, decreased and unchanged values reported. Therefore, plasma homocysteine and serum B vitamins in Nigerian children with NS were assessed in this study Methods: Fasting blood samples were analysed for plasma homocysteine, serum folate and B vitamins in 42 children with NS and 42 age and sex-matched healthy controls in this case control study. Data were compared between NS and control using t test and Chi square. Relationships were tested with regression analysis with p set at 0.05. Results: Prevalence of hyperhomocysteinaemia, low folate and cyanocobalamin in NS was 57.1%, 14.3% and 9.5% respectively. The mean homocysteine level was significantly higher in NS than control (11.3±2.6μmol/L versus 5.5±2.3μmol/L). Also, NS had lower folate and cyanocobalamin than control: 9.1±3.9ng/mL versus 11.2±3.1ng/dL and 268.5±95.7pg/mL versus 316±117.2pg/mL respectively. Weak but significant correlation between homocysteine and serum albumin (r = 0.347), folate (r = -0.607) and vitamin B12 (r = -0.185) were found in the NS group. Significant relationship was also found between homocysteine and vitamin B12 (ß = -0.64, 95% CI = -1.20, -0.08) after controlling for folate and vitamin B6 levels. Conclusion: Clinically important hyperhomocysteinaemia and low B vitamins occur in Nigerian children with nephrotic syndrome. This data suggest that potential usefulness of folate and vitamin B supplementation for reducing high homocysteine levels in nephrotic syndrome need to be further investigated
Prevalence and determinants of depression among patients with hypertension: A cross‑sectional comparison study in Ghana and Nigeria
(Wolters Kluwer ‑ Medknow, 2020) Ademola, A. D.; Boima, V.; Odusola, A. O.; Agyekum, F.; Nwafor, C. E.; Salako, B. L.
Background: Despite evidence linking depression to poor blood pressure (BP) control and increased hypertension‑related morbidity and mortality, there is paucity of data about depression among patients with hypertension in sub‑Saharan Africa. We assessed factors associated with depression among patients with hypertension in Ghana and Nigeria. Subjects and Methods: Patients with hypertension were recruited from four hospitals: In Ghana, Korle Bu Teaching Hospital (n = 120), and in Nigeria, the University of Port Harcourt Teaching Hospital, the Lagos State General Hospital, and the University College Hospital Ibadan (n = 237). Demographic, socioeconomic, psychosocial, and clinical factors which predicted depression among the study cohort were assessed by logistic regression. Depression and beliefs about medications were assessed with the Patient Health Questionnaire (PHQ‑9) and the Beliefs about Medication Questionnaire, respectively. Depression was regarded as PHQ‑9 score >4. Results: The mean ages of the Ghanaian and Nigerian cohort were 57.0 ± 13.7 years (58.3% female) and 56.4 ± 12.9 years (57.0% female), respectively. Prevalence of depression was 41.7% and 26.6% among the Ghanaian and Nigerian cohorts, respectively. Significant predictors of depression in the Nigerian cohort were age in years [OR 0.97 (0.95–0.99)], concern about medications [OR 1.15 (1.03–1.30)], and poor BP control [OR 2.06 (1.09–3.88)]. Young age was the only independent predictor of depression in the Nigerian cohort. In the Ghanaian cohort, none of the factors significantly predicted depression. Conclusion: Prevalence of depression is high among patients with hypertension in Ghana and Nigeria. Screening and treatment of depression among patients with hypertension in Ghana and Nigeria may have important implications for improving outcomes.
Spectrum of behavioural abnormalities in children with nephrotic syndrome in South Western Nigeria
(JsciMed Central, 2015) Balogun, F.; Ademola, A. D.
Nephrotic syndrome is a chronic childhood disease characterized by relapses and children with this condition tend to have behavioural problems associated with the disease. These behavioural problems are usually not anticipated in most resource limited settings and can be frightening thereby making the children and the care givers to be distressed. Seven children with nephrotic syndrome who developed various behavioural abnormalities while on admission were discussed. There were four girls and three boys with age range seven to fourteen years. The abnormal behaviours noted were visual and auditory hallucinations, inappropriate speech and behaviour, attempted suicide, attention seeking behaviour and social withdrawal. Those behavioural abnormalities were related to prednisolone therapy in five of the children. Diagnosis made wore psychosis and delirium while treatment given included counselling, Risperidone, Halloperidol, Diazepam and reduction or withdrawal of Prednisolone. Abnormal behaviour was not anticipated in those children so the caregivers were takon unaware. This can be worse in infants or in mild cases. Most of the behavioural abnormalities were also associated with the use of prednisolone. There is an urgent need to design guidelines for the management of behavioural abnormalities in nephrotic syndrome especially steroid therapy in resource limited settings. Harmonisation of the skills of paediatric nephrologist and child psychiatrist is also important to obtain the best outcome.