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Item Association between Perfluoroalkyl substance exposure and renal function in children with CKD enrolled in H3Africa kidney disease research network.(2019) Sood, S.; Ojo, A.O.; Adu, D.; Kannan, K.; Ghassabian, A.; Koshy, T.; Vento, S.M.; Pehrson, L.J.; Gilbert, J.F.; Arogundade, F.A.; Ademola, A.D.; Salako, B.O.; Raji, Y.; Osafo, C.; Antwi, S.; Trachtman, H.; Trasande, L.Item Urinary transforming growth Factor-Beta 1 (uTGF-β1) and prevalent CKD risk in HIVpositive patients in West Africa(2019) Ekrikpo, U.E.; Okuku, C.N.; Ajayi, S.O.; Ayodele, O.E.; Bello, A.K.; Wonkam, A.; Dandara, C.; Kengne, A.P.; Okpechi, I.Introduction: This study investigated the association of urinary transforming growth factor-b1 (uTGF-b1) with prevalent chronic kidney disease (CKD) in the HIV-infected population. Methods: HIV-positive patients without CKD (HIVþCKD, n ¼ 194) and 114 with CKD (HIV CKD) who did not have hypertension, diabetes mellitus, or hepatitis B or C, had their urinary protein-creatinine ratio (uPCR), serum transforming growth factor (TGF)–b1, and uTGF-b1 measured. uTGF-b1-creatinine ratios (uTGF-b1Cr) were calculated. Spearman correlation was used to determine the association between uTGF-b1Cr and various attributes, and the Cuzick trend test was used to assess the presence of a linear trend in median uTGF-b1Cr levels across the stages of CKD. Multivariable robust linear regression models were used to assess independent association with variability in uTGF-b1Cr and estimated glomerular filtration rate (eGFR) levels. Results: The age of the participants was 38.3 0.3 years with 73.4% women. The median uTGF-b1Cr was higher among HIV CKD (4.85 ng/mmol [25th–75th percentile 1.96–12.35] vs. 2.95 [1.02–5.84]; P ¼ 0.001]). There was significant correlation between uTGF-b1Cr and age (P ¼ 0.02), eGFR (P ¼ 0.001), and uPCR (P < 0.001) in the HIV CKD group. Among the HIV CKD patients, there was gradual reduction in the median level of uTGF-b1Cr with CKD severity (P ¼ 0.04). HIV CKD patients had significantly higher levels of uTGF-b1Cr after controlling for potential confounders. Using eGFR as dependent variable, proteinuria explained the changes associated with uTGF-b1Cr levels. Conclusion: HIV CKD patients express higher levels of uTGF-b1 especially in the early stages of CKD apparently related to proteinuria levels.Item May measurement month 2017: screening for hypertension in Nigeria, Sub-Saharan Africa.(2019) Ogah, O.S.; Arije, A.; Xia, X.; Beaney, T.; Adebiyi, A.A.; Sani, M.U.; Ojji, D.B.; Sogade, T.T.; Izezuo, S.; Chukwuonye, I,I.; Akinwusi, P.; Mbakwem, A.C.; Daniel, F.A.; Omotoso, A.B.; Poulter, N.R.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 Acute kidney injury among patients undergoing major surgery in a tertiary hospital in Nigeria .(2018) Raji, Y.R.; Ajayi, S.O.; Ademola, A.F.; Lawal, T.A.; Ayandipo, O.O.; Adigun, T.A.Background. Acute kidney injury (AKI) is an underreported but major cause of morbidity and mortality among patients undergoing major surgical interventions in sub-Saharan Africa (SSA). Whereas AKI is often seen following major cardiac surgery in high-income countries, a similar spectrum of surgical diseases and interventions is not seen in developing countries. The impacts on surgical outcomes have also not been well characterized in SSA. This study aimed at identifying risk factors, incidence and determinants and short-term outcomes of AKI among patients undergoing major surgery. Methods. This was a cohort study of adult patients undergoing major surgery at the University College Hospital, Ibadan, Nigeria. Data obtained were sociodemographic details, risk factors for AKI, details of surgery, anaesthesia and intraoperative events and short-term outcomes. Blood samples were obtained for pre-operative (pre-op) full blood count, serum electrolytes, blood urea and creatinine (SCr). Post-operatively (Post-op) SCr was determined at 24 h, Day 7 post-op and weekly until each patient was discharged. Results. A total of 219 subjects who had major surgery (86.3% elective) were enrolled. The median age of the patients was 46 (range 18–73) years and 72.6% were females. The surgeries performed were mostly simple mastectomies (37.4%), exploratory laparotomies (22.8%) and total thyroidectomies (16.4%). The incidences of AKI were 18.7% at 24 h and 17.4% at Day 7 post-op, while cumulative AKI incidence was 22.5% at 1-week post-op. Pre-op elevated SCr [odds ratio (OR) 3.86], sepsis (OR 2.69), anaemia (OR 2.91) and duration of surgery >120 min (OR 1.75) were independently associated with AKI. In patient mortality was 20.4% in individuals with AKI and 5.3% in those without AKI (P < 0.01) Conclusion. Peri-operative risk factors for AKI are common among patients undergoing major surgery in SSA hospitals. The cumulative incidence of AKI was high and independently associated with pre-op sepsis, anaemia, pre-existing kidney dysfunction and duration of surgery >120 minItem Increased urinary sodium excretion is associated with systolic blood pressure in first degree relatives of hypertensive patients in Ibadan, Southwestern Nigeria.(2018) Ajayi, S.O.; Adebiyi, A.; Kadiri, S.Introduction: Understanding the risk factors of hypertension has led to a better understanding of the pathogenesis, prevention and reduction in morbidity of hypertension. It is well known that offsprings of hypertensive parents have an increased risk of developing hypertension. It is therefore necessary to explore the physiological differences between normotensive patients with and without a positive family history of hypertension with respect to their urinary excretion of sodium. Methods: This study was carried out at the University College Hospital, Ibadan Nigeria, to determine if normotensive patients with a positive family history of hypertension are different with respect to their urinary excretion of electrolytes and blood pressure. It examined the relationship between 24-hour urinary excretion of sodium, chloride and potassium, urea and creatinine and blood pressure in subjects with and without family history of hypertension. It was a case-control study of sixty-two subjects: normotensive patients’ first degree relatives of primary hypertensive patients and normotensive patients without positive family history. Results: The mean (SD) systolic blood pressures for subjects with and without family history of hypertension were significantly different: 120.0(22.25) and 105.0(17.50) respectively, (p=0.001). The mean arterial blood pressures were significantly different: 86.4(10.2) mmHg and 80.1(8.1) mmHg respectively (p=0.010). The mean (SD) 24-hour urinary excretion of sodium for normotensive patients with and without positive family history of hypertension were 180.5 (45.50) mEq/L, and 156.0(36.25) mEq/L respectively. Systolic blood pressure and 24-hour urinary excretion of sodium was also higher in normotensive subjects with a positive family history of hypertension. Conclusion: Systolic blood pressure and twenty-four hour urinary excretion of sodium were higher in normotensive subjects with a positive family history of hypertension than in those without a family history of hypertension.Item A case report on Lassa fever and hearing loss: a rare occurrence and review of the literature.(2017) Daniel, A.; |Raji, Y.R.; |Ijitola, J.O.; Bello, T.O.; Jinadu, O.Y.; Ajayi, S.O.; Olaleye, O.D.; Salako, B.L; Lasisi, O.A.Lassa fever is highly endemic in Nigeria and other West African countries, it is a disease associated with high case fatality and chronic sequelae in those that survived. Lack of effective vaccine has made the disease difficult to control and it prevention depends on eradications of the multmammate rats and universal precautions by all when a case is identified. We report a case of a 51 years old health worker who had a severe form of Lassa fever complicated by sensorineural deafness at the University College Hospital, Ibadan, South West Nigeria.