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Item Predictors and outcomes of acute kidney injury after non-cardiac paeditaric surgery.(2019) Lawal, T.A.; Raji, Y.R.; Ajayi, S.O.; Ademola, A.D.; Ademola, O.O.; Adigun, O.O.; Ogundoyin, O.O.; Olulana, D.I.; Asinobi, A.O.; Salako, B.L.Background: It is necessary to define the problem of acute kidney injury (AKI) after non-cardiac surgery in order to design interventions to prevent AKI. The study aimed to evaluate the occurrence, determinants and outcome of AKI among children undergoing general (non-cardiac) surgery. Methods: This was a prospective cohort study of patients aged ≤ 15 years who had general surgery over 18 months period at a tertiary hospital in Nigeria. AKI was evaluated at 6 and 24 h and within 7 days of surgery. Data were analysed using SPSS version 21. Results: A total of 93 patients were studied with age ranging from 3 days to 15 years (median = 4 years). AKI occurred within 24 h of surgery in 32 (34.4%) and cumulatively over 7 days in 33 (35.5%). Patients who had sepsis were nearly four times as likely as others to develop perioperative AKI (OR = 3.52, 95% CI 1.21, 10.20, p = 0.021). Crude mortality rate was 12.1% (4/33); no mortality was recorded among those without AKI, p = 0.014. Conclusion: Perioperative AKI occurred in 35.5% of children who underwent general (non-cardiac) surgery. Patients who had sepsis were four times more likely than others to develop AKI. Mortality was documented only in patients who had AKI.Item Self-reported sleep disorder and ambulatory blood pressure Phenotypes in patients with or without chronic kidney disease: findings from Ibadan CRECKID study.(2019) Ajayi, S.O.; Adeoye, A.M.; Raji, Y.R.; Tayo, B.; Salako, B.L.; Ogunniyi, A.; Ojo, A.; Cooper, R.ed the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD. METHODS: Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP ≥140mmHg and/or DBP ≥90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2 Equation and CKD was defined as eGFR 60ml/min?1.73m2 Results: A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; Conclusion: This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.Item Outcomes of tunneled internal jugular venous catheters for chronic haemodialysis at the University College Hospital, Ibadan, Nigeria.(2018) Raji, Y.R.; Ajayi, S.O.; Aminu O.; Abiola, B.; Efuntoye, O.; Salako, B.L.Introduction: vascular access is an important aspect of haemodialysis treatments and determinant of patient outcomes. Arteriovenous (AV) fistula has been described as the preferred haemodialysis vascular access for patients on chronic dialysis. There continues to be a challenge with the creation of AV fistula, due to shortage of vascular surgeons skilled in the AV fistula creation particularly in source limited setting. We described the outcomes of the tunneled internal jugular venous catheters amongst our patients at the University College Hospital (UCH) Ibadan. Methods: a retrospective study of patients on maintenance haemodialysis at the UCH, Ibadan, we reviewed the records of all patients on chronic dialysis over a period of 5 years. Information obtained include demographics, types and aetiology of renal failure, types of vascular access, observed complications and outcomes. Results: a total number of 147 catheters were inserted during the period under review, 94 were males while 53 were females. The age range was 18-85 years while the mean age was 46.3 ± 17.2 years. The range and mean duration for Tunneled Dialysis Catheter (TDC) carriage were (30 - 1,440) and 220±185 days respectively. The observed immediate complications of TDCs were failed first attempt 7(4.7%), reactionary haemorrhage 5(3.4%), arrhythmia 3(2.0%), haemothorax 2(1.4%) while death during catheter placement was recorded in 2(1.4%) cases. Catheter related infection was the commonest long-term complications and occurred in 15 cases (10.1%), while being diabetic increased the risk of developing catheter related complications. One tenth of our patients with End Stage Renal Disease on TDC had kidney transplantation while catheter related mortality was 16.3%. Conclusion: internal jugular tunneled dialysis catheters despite its shortcomings, has been a safe procedure with good outcomes among our patients on maintenance haemodialysis.Item Outcomes of tunneled internal jugular venous catheters for chronic haemodialysis at the University College Hospital, Ibadan, Nigeria(2018) Raji, Y.R.; Ajayi, S.O.; Aminu O.; Abiola, B.; Efuntoye, O.; Salako, B.L.Introduction: vascular access is an important aspect of haemodialysis treatments and determinant of patient outcomes. Arteriovenous (AV) fistula has been described as the preferred haemodialysis vascular access for patients on chronic dialysis. There continues to be a challenge with the creation of AV fistula, due to shortage of vascular surgeons skilled in the AV fistula creation particularly in source limited setting. We described the outcomes of the tunneled internal jugular venous catheters amongst our patients at the University College Hospital (UCH) Ibadan. Methods: a retrospective study of patients on maintenance haemodialysis at the UCH, Ibadan, we reviewed the records of all patients on chronic dialysis over a period of 5 years. Information obtained include demographics, types and aetiology of renal failure, types of vascular access, observed complications and outcomes. Results: a total number of 147 catheters were inserted during the period under review, 94 were males while 53 were females. The age range was 18-85 years while the mean age was 46.3 ± 17.2 years. The range and mean duration for Tunneled Dialysis Catheter (TDC) carriage were (30 - 1,440) and 220±185 days respectively. The observed immediate complications of TDCs were failed first attempt 7(4.7%), reactionary haemorrhage 5(3.4%), arrhythmia 3(2.0%), haemothorax 2(1.4%) while death during catheter placement was recorded in 2(1.4%) cases. Catheter related infection was the commonest long-term complications and occurred in 15 cases (10.1%), while being diabetic increased the risk of developing catheter related complications. One tenth of our patients with End Stage Renal Disease on TDC had kidney transplantation while catheter related mortality was 16.3%. Conclusion: internal jugular tunneled dialysis catheters despite its shortcomings, has been a safe procedure with good outcomes among our patients on maintenance haemodialysis.Item Ethical and legal issues in renal transplantation in developing countries.(2016) Ajayi, S.O.; Raji, Y.; Salako, B.L.With the increasing number of patients being offered kidney transplantation by many centers in the developing world, it is not unexpected that there would be attendant ethical and legal issues even when the selection process for transplantation seems medically justified. Because of the inadequate infrastructure for hemodialysis and peritoneal dialysis, coupled with the challenges of logistics for maintenance dialysis, transplantation would seem to be the best option for patients with end-stage renal failure, even in developed economies where these can easily be tackled. The main issues here revolve around incentives for donors, organ trade and trafficking and the economics of eliminating the waiting list and the criminal activities of organ trans-plantation. In the developing world, with the current level of corruption and poverty, there is a need to redouble efforts to monitor transplant activities. Professional bodies should take the lead in this regard. Furthermore, there is a need for governments to engage in public consultation and community awareness concerning organ donation in living and deceased persons.Item Unaffordability of renal replacement therapy in Nigeria.(2016) Ajayi, S.O.; Raji, Y.; Bello, T.; Jinadu, L.; Salako, B.L.With the increase in epidemic proportions of diabetes worldwide, the number of patients who will require renal replacement therapy (RRT) will be a great challenge to the health infrastructures of developing countries such as Nigeria. Because those mostly affected are in the economically productive age group, a vicious circle is established whereby those who keep the economy going are the same people affected. Secondary and tertiary care of chronic kidney disease involving RRT would exact disproportionate toll on the income of patients in the developing world where patients pay out of pocket for their own care. Whilst there is an increase in the number of facilities offering RRT, there is no commensurate sustainability of care either by the patients themselves or even by the government. The level of unemployment is increasing. Kidney transplantation is out of reach in addition to the cost of post-transplant care, which includes hospitalization and immunosuppressive medications. Most of the endstage kidney disease patients who enlisted in our dialysis program were unable to get or sustain adequate hemodialysis. The data also showed that more men were dialyzed at our facilities over the period under review and the age distribution has not changed much over the decade. From this dismal picture in the last decade emerges a series of questions as to why this is so and what must be done to increase access to RRT. Prudent fund management and cost containment, local manufacture of dialysis materials and nongovernmental sources of funding are means of driving down the cost of dialysis. In countries where drugs and equipment for health services are locally manufactured, such as India and other countries, the cost of health care is more affordable than in countries such as Nigeria where these are imported.Item Bronchial asthma: a risk factor for hypertension?(2000) Salako, B.L.; Ajayi, S.O.Several attempts have been made to improve primary prevention of essential hypertension and many of these have been directed at avoiding the well known risk factors. Both asthma and hypertension are spastic disorders of smooth muscle, also asthmatics and hypertensives have been found to be salt sensitive. There is a suspicion that the similarities between these two diseases may predispose the individuals with one disease to the other, as pulmonary hypertension has been described during exercise- induced bronchoconstriction. We therefore, studied the blood pressure pattern during and after acute severe asthma (ASA) along with the frequency of hypertension in stable asthmatic patients. Two groups of patients were studied. Group 1 consisted of 12 patients with ASA (2 males, 10 females) with a mean age of 30 ± 9,9.years. The mean blood pressure during attack of ASA (147±16.9/ 100±8.2 mmHg) was higher than the mean BP (132±8.3/82±7 mmHg) 2 weeks after discharge from hospital without treatment in all patients (P < 0.05). Group 2 included 134 asthmatic subjects in stable state (54 males, 80 females) with a mean age of 45 ± 15 years and a range of 15-90 years. The overall frequency of hypertension was 37% with a proportion of 39% in males and 35% in females. Hypertension was defined as systolic blood pressure of £ 140mmHg and or diastolic blood pressure of £ 90mmHg. There was no difference between the frequency of attack of ASA in hypertensives (5.7 ±5.6 per year) and nonhypertensives (5.5 ± 3.8 per year), P < 0.05. We concluded that transient elevation of blood pressure may occur during ASA. The frequency of hypertension among asthmatics is quite high and concurrent family history of hypertension and frequency of attack of ASA did not seem to determine the status of blood pressure. Patients with asthma should have regular blood pressure check during follow-up visits.Item Blood pressure changes in haemodialysis: the nigerian experience(1998) Salako, B.L.; Ajayi, S.O.; Kadiri, S.; Arije, A.; Osoba, O.A.The blood pressure changes in haemodialysis were assessed during 59 sessions in 21 patients. Blood pressure was measured with I he corresponding pulse before and subsequently hourly during dialysis, and the patients weights were measured before and after dialysis. The mean systolic blood pressure before dialysis was 170,22 + 29.64mmHg. This showed a statistically sig nificant decrease at l hour. being 167^31.79mmHg (P < 0.002 at 2 hours, being 164.83 + 40.26mmHgwith (P < 0.001). at 3 hours, being 166.84+ 36.94mm Hg (P< 0.001) intradialysis, and immediately after 4 hours of dialysis 166.28 ±35.70mmHg t P < 001). The mean diastolic blood pressure before dialysis of 109.90 + 20.SOmmHg also showed a significant decrease at 1 hour 106.07 + 22.84mmHg (P< 001) 2 hours 105.98+ 22.10mmHg (P < 0.001) and 3 hours intradialysis 107.81 + 25.39mmHg (P< 0.001). These findings suggest that blood pressure changes in haemodialysis are affected by drop in weight that invariably occurs in haemodialysis due to the accompanying process of ultrafiltrationItem Confusion and delirium in acute falciparum malaria infection(1996) Salako, B.L.; Ajayi, S.O.