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A Akinsola

Publications and source records attributed to A Akinsola.

At least 19 recordsLinked to original sources
PubMed2006

Internal jugular and subclavian catheterisation: indications, problems and prospects in a Nigerian dialysis centre.

AIMS AND OBJECTIVES: To highlight the indications, problems and prospects of bedside non-surgically inserted jugular and subclavian dual lumen catheters. PATIENTS AND METHODS: Renal failure patients being managed in our centre with indications for central catheterisation were consecutively recruited at presentation. They had bedside non-surgical jugular and subclavian insertion of central catheters using modified Seldinger wire technique and the performance of the catheters monitored. RESULTS: Sixteen patients aged between 23 and 65 years had 32 central catheterizations during the 12-month period. The indications included its use as haemodialysis access in all catheterisations, additional indications were CVP monitoring in 5, and parenteral hyperalimentation in 1. Three catheterisations were in right subclavian vein, 4 in left internal jugular vein and 25 in right internal jugular vein. The duration of use ranged between 3 days and 11 weeks and blood flow rate used ranged between 250 and 350 mls/min. Nine (28.1%) catheterisations were complicated with exit site and systemic infection. Catheter blockage and accidental catheter removal were recorded in 3 patients each. Carotid artery puncture was recorded in 2 patients but haemostasis was maintained with direct digital compression. CONCLUSION: We conclude that percutaneous bedside internal jugular and subclavian (venous) catheterisation using dual lumen catheter is safe and devoid of major complications.

Adult↗
PubMed2005

An analysis of the effectiveness and benefits of peritoneal dialysis and haemodialysis using Nigerian made PD fluids.

Haemodialysis (HD) and peritoneal dialysis (PD) remains the cornerstone of management of patients with renal failure in developing countries as renal transplantation is just developing in most. Although both HD and PD are cost intensive, specific advantages and disadvantages have been identified with either of them. Comparative assessment of their effectiveness, benefits and cost will assist in providing a rational basis for preference of one or the other especially in third world countries where renal replacement therapy remains unaffordable and therefore relatively inaccessible to majority of patients. We therefore conducted this prospective randomised study to compare the effectiveness, benefits, cost and complications of acute or intermittent PD (IPD) and HD using locally manufactured PD fluids. Two groups of twenty patients with renal failure matched for age and clinical diagnosis were managed with IPD and HD and the effectiveness, costs and complications of both modalities compared. We found that both were comparably effective in the control of uraemia with significant reductions in the serum urea, creatinine and potassium from 29.2 +/- 7.2 mmol/L, 1693.7 +/- 580.5micromol/L and 4.8 +/- 1.2 mmol/L to 13.2 +/- 4.6 mmol/L, 796.0 +/- 458.0micromol/ L and 3.3 +/- 0.6 mmol/L respectively for IPD (P<0.05) and 34.4 +/- 9.0mmol/L, 1536.0 +/- 832.5 micromol/L and4.8 +/- 1.3 mmoV L to 14.6 +/- 7.5 mmol/L, 830.0 +/- 570.7 micromol/L and 3.9 +/- 0.8 mmol/L respectively for HD (P<0.05). In addition, there were significant improvements in serum bicarbonate in both groups. There was no significant difference in percentage reduction in serum urea, creatinine and serum potassium in both groups (P>0.05). However, HD managed patients required more blood transfusion (P<0.05). There were also comparably significant reductiohs in systolic, diastolic and mean arterial blood pressures in both groups (P<0.05). The costs of dialysis as well as the total cost of hospitalization were found to be significantly lower in patients managed with IPD (P<0.05). The commonest complication observed in patients managed with IPD was peritonitis while in patients managed with HD it was dialysis-induced hypotension. The clinical outcome was equally good in all the ARF patients as all of them recovered irrespective of the treatment modality; CRF patients did not fare as well with 37.5% mortality observed. We conclude that IPD and HD are effective renal replacement therapies with the former being significantly cheaper. IPD should be encouraged in our patients with ARF or acute exacerbation of chronic renal failure.

Acid-Base Equilibrium↗
PubMed2004

Patterns of presentation and mortality in tetanus: a 10-year retrospective review.

AIMS AND OBJECTIVES: To highlight the indications, problems and prospects of bedside non-surgically inserted jugular and subclavian dual luman catheters. PATIENTS AND METHODS: Renal failure patients being managed in our centre with indications for central catheterisation were consecutively recruited at presentation. They had bedside non-surgical jugular and subclavian insertion using modified seldinger wire technique and the performance of the Gatheters monitored. RESULTS: Sixteen patients aged between 23 and 65 years had 32 central catheterisations during the 12-month period. The indications included its use as haemodialysis access in all patients, additional indications were CVP monitoring in 5, and parenteral hyperalimentation in 1. Three catheterisations were in right subclavian vein, 4 in let internal jugular vein and 25 in right internal jugular vein. The duration of use ranged between 3 days and 11 weeks and blood flow rate used ranged between 50 and 350ml/min. Nine (28.1%) catheterisations were complicated with exit site and systemic infection. Catheter blockage and accidental catheter removal were recorded in 3 patients each. Carotid artery puncture was recorded in 2 patients but haemostasis was maintained with direct digital compression. CONCLUSION: We conclude that percutaneous bedside internal jugular and subclavian (venous) catheterisation using dual lumen catheter is safe and devoid of major complications. BACKGROUND: Tetanus, an ubiquitous disease still ravages our population despite the fact that it is totally preventable. The mortality had remained high with its attendant socio-economic implications as it affects mainly farmers in their prime of life. We conducted this retrospective review to be able to determine pattern of presentation, case fatality rate and factors influencing mortality with a view to mapping out control strategies. PATIENTS, MATERIALS AND METHODS: The case records of all managed patients aged 16 and above over a ten-year period (1992-2001) were retrieved and socio-demographic and clinical data as well as results of laboratory investigations were collated. Analysis was done using SPSS package. Chi-square analysis and student t-test were used for comparison of means as appropriate. P-values of <0. 05 was taken as significant. RESULTS: There were a total of 114 patients managed during the period, which comprised of 85 males and 29 females. The means age (+/- SD) was 35.96 (+/-17.76). Sixty six (57.89%) patients are either jobless or farmers. Majority of the patients had injuries in the lower limb 59.65% when compared with 20.18% that had theirs in the upper limb. 107 (93.86%) of the patients presented with trismus while only 82 (71.93%) had opsthotonus. Only 51 (44.73%) patients survived while 61 (53.5%) died. The mean age (+/- SD) of the survivors was 32.35 (+ 14.45) years while that of those that died was 39.4 (+/- 19.89) years (P = 0.036). Other factors that significantly influenced survival included severity of spasms (P = 0/003), tachycardia (P = 0.044), and degree of sedation (P <0.0001). No association was found between survival and incubation period, period of onset, site of injury and associated medical conditions. CONCLUSIONS: Tetanus is still associated with high mortality rate. Factors such as severity of spasma, age, sedation and tachycardia were found to significantly influence mortality. It is recommended that prophylactic life immunisation against tetanus be given to all Nigerians.

Adolescent↗
PubMed2004

Patterns of presentation and mortality in tetanus: a 10-year retrospective review.

BACKGROUND: Tetanus, an ubiquitous disease still ravages our population despite the fact that it is totally preventable. The mortality had remained high with its attendant socio-economic implications as it affects mainly farmers in their prime of life. We conducted this retrospective review to be able to determine pattern of presentation, case fatality rate and factors influencing mortality with a view to mapping out control strategies. PATIENTS, MATERIALS AND METHODS: The case records of all managed patients aged 16 and above over a ten-year period (1992-2001) were retrieved and socio-demographic and clinical data as well as results of laboratory investigations were collated. Analysis was done using SPSS package. Chi-square analysis and student t-test were used for comparison of means as appropriate. P-values of <0.05 were taken as significant. RESULTS: There were a total of 114 patients managed during the period, which comprised 85 males and 29 females. The mean age (+/- SD) was 35.96 years (+/- 17.76). Sixty-six (57.89% ) patients are either jobless or farmers. Majority of the patients had injuries in the lower limb (59.65% ) when compared with 20.18% that had theirs in the upper limb. 107 (93.86% ) of the patients presented with trismus while only 82 (71.93% ) had opsthotomus. Only 51 (44.73% ) patients survived while 61(53.5% ) died. The mean age (+/- SD) of the survivors was 32.35 (+ 14.45) years while that of those that died was 39.4 (+/- 19.89) years (P = 0.036). Other factors that significantly influenced survival included severity of spasms (P = 0.003), tachycardia (P = 0.044), and degree of sedation (P<0.0001). No association was found between survival and incubation period, period of onset, site of injury and associated medical conditions. CONCLUSIONS: Tetanus is still associated with high mortality rate. Factors such as severity of spasms, age, sedation and tachycardia were found to significantly influence mortality. It is recommended that prophylactic life immunisation against tetanus be given to all Nigerians.

Adolescent↗
PubMed2003

Attitudes toward kidney donation.

The Renal Unit of Obafemi Awolowo University Teaching Hospital Ile-Ife in Southwest Nigeria intends commencing a kidney transplantation program. This cross-sectional study aimed at examining the willingness of Nigerians to be living-related kidney donors. Three hundred and sixteen Nigerians (96 first-degree relatives of end-stage renal disease patients, 69 rural dwellers and 151 health workers) were interviewed regarding their willingness to donate kidneys using an interview schedule designed to elicit socio-demographic information, knowledge about kidney transplantation and attitude toward kidney donation. Sixty-two percent of health workers, 52.1% of the patients' relatives and 27.1% of rural dwellers expressed willingness to donate. Higher proportions of health workers and patients' relatives--compared with the rural dwellers--were willing to donate a kidney to their children, full-siblings and parents (P<0.05). The level of awareness about kidney transplantation was highest among health workers and least among rural dwellers (P<0.001). Altruism was the primary motivation for those willing to donate a kidney. The most important reason for refusal to donate was fear of adverse health consequences. Among the rural dwellers, never-married persons were more willing than the married to donate (P<0.05). Programs aimed at increasing awareness about the safety of kidney donation, reducing adverse beliefs about kidney donation, and encouraging altruistic tendencies will increase the availability of kidney donors.

Adolescent↗
PubMed2000

The haematological profile of Nigerians with chronic renal failure.

In an attempt to add to existing sparse literature on the haematological profile in chronic renal failure (CFR) in Nigeria, we have undertaken a comprehensive haematological sturdy of 39 patients (male 27, female 12) age range 11-56 yr., (mean 28.8 +/- 11.8) who had established pre-dialytic CFR. The mean haematocrit was 24.1 +/- 6.7% (range 12-40%). Severe anaemia was found in seven (18%), mild to moderate anaemia in 27 (69%) whilst five patients were not anaemic. Haematocrit correlated inversely with the degree of renal failure as assessed by serum creatinine (r = -0.35, P < 0.05). Red cell morphology was variable but the majority of patients showed a normocytic, normochromic blood film. The reticulocyte counts/indices were low. The mean total white cell count was generally within normal limits, ranging from (2 to 10.5 x 10(9)/l), with a mean of 5.3 +/- 2.1 x 10(9)/l and striking eosinophilia in 5 patients. Platelet count ranged between 82 and 350 x 10(9)/l (mean 156.5 +/- 65.7 x 10(9)/l) with only 3 patients having a relatively low count of < 100 x 10/l. Prolonged bleeding time (BT) > 9 minutes occurred in 13 (25.6%). There was no significant correlation between platelet count and bleeding time r = 0.21, P = 0.34. No significant correlation was observed between serum creatinine and bleeding time r = 0.09, P > 05. The bone marrow showed predominantly normocellular marrow but 7 patients had hypocellularity. Myeloid: Erythroid ratio ranged between 1:1 and 10:1, (mean 3:6:1) and correlated positively with serum creatinine values. (r = 0.37, P = 0.048). Bone marrow storage iron was absent in two and reduced in six patients. Severe anaemia is a common feature in Nigeria patients with CRF and it strongly associated with the severity of the renal failure. The low reticulocyte count and the tendency for erythroid hpoplasia to occur with increasing severity of renal failure would necessitate the use of erythropietin in our patients. The increased bleeding tendency in some of the patients calls for caution in surgical procedures in these patient.

Adolescent↗
PubMed2000

Creatinine clearance estimation from serum creatinine values: evaluation and comparison of five prediction formulae in Nigerian patients.

Predictability of creatinine clearance (CrCl) from serum creatinine would reduce the cost of renal care and obviate the need for 24-hours urine collection. Correlations have been established between serum creatinine (Scr) and 24-hour urinary creatinine clearance with derivation of various formulae. We have tested the applicability of these formulae in 34 Nigerian patients (22 males, 12 females) aged 18 to 58 years, (mean age 34.97 +/- 11.20 years) with established chronic renal failure (CRF) mean Scr level 742.26 +/- 388.15 mol/L. 32 age and sex matched healthy adults with serum creatinine values below 120 umol/l., served as controls. Serum creatinine and 24 hour CrCl levels were determined on two consecutive occasions. Creatinine clearance values were also derived from Scr using each of the established prediction formulae: Cockcrof and Gault [1] Gates [2] Hull et al [3]; Jelliffe [4]; and Mawer et al [5]. A relationship was sought between measured CrCl and the predicted values (derived) using the stated formulae. Regression equation were generated and correlation coefficient r, coefficient of determination r2, F-ration, prediction error, all defining the nature and strength of relationship were determined. We observed that good and statistically significant correlations exist between measured CrCl values and those predicated from the formulae (r ranging from 0.908 to 0.968 and r20.82 to 0.93 P = 0.000) and that a linear relationship exists in all cases. Cockcroft and Gault formula gave the highest coefficient of determination r2 = 0.94. It is concluded that the existing formulae are adequate for determining CrCl from Scr and should be frequently used in the long term follow-up of patients with Chronic Renal Failure (CRF) in our setting.

Adolescent↗
PubMed1992

The problem of follow-up of renal transplant patients in the tropics.

A 40-year-old male Nigerian with end-stage renal disease (ESRD) received a renal allograft from a live related donor, in the United Kingdom in 1986. Subsequently, in Nigeria, he developed recurrent episodes suggestive of chronic allograft rejection or allograft nephritis which necessitated hospitalisation in our establishment. He subsequently died during one such episode. The peculiar management problems and challenges posed by the patient during his recent admission in our clinical setting are discussed.

Adult↗
PubMed1991

Diabetes mellitus. I: Routine plain abdominal radiography.

The plain abdominal radiographs of 43 consecutive diabetic patients were studied. Disordered bowel motility which was unrelated to the severity of the diabetes mellitus occurred in 76.7% while artheriosclerosis occurred in 65%. Only 7% (3 patients) had pancreatic calcification; of these, one was a complication of urinary schistosomiasis (Schistosoma haematobium). All the patients with pancreatic calcification were above 45 years of age and had had diabetes mellitus for more than 7 years. This study shows that pancreatic calcification is uncommon among Nigerian diabetics, so plain abdominal radiography should be limited to patients who are above 45 years and who have had the illness for more than 7 years.

Adolescent↗
PubMed1991

Diabetes mellitus. II: Routine chest radiography.

Chest radiographs of 43 consecutive diabetic patients were evaluated with a view to determine their role as a routine investigation of patients with diabetes mellitus. 22 (51.2%) patients had normal chest radiographs. The remaining 21 patients had 61 abnormalities found in their chest radiographs. 26 (42.6%) of these were significant abnormalities while 35 (57.4%) were non-significant. Of the former, 42.3% were due to cardiomegaly while in the latter group, aortic unfolding was the main finding. Radiological abnormalities were more commonly observed in patients aged 40 years and over, than in those below, with a ratio of 3:1. Chest radiographs corroborated clinical diagnosis in 19 of the 21 cases in whom abnormalities were observed. This study shows that routine chest radiograph in diabetic patients is useful in those with clinical symptoms and in older diabetics above the age of 40 years.

Adolescent↗
PubMed1989

Enalapril and hydrochlorothiazide in hypertensive Africans.

The antihypertensive efficacy both of angiotensin converting enzyme (ACE) inhibitors and thiazide diuretics has been claimed to be influenced by plasma renin activity, which declines with age and is low in blacks. In a double-blind, placebo-controlled, double-dummy, randomized, parallel-group preliminary study, the antihypertensive efficacy and tolerability of the ACE inhibitor enalapril (20 mg day-1) and hydrochlorothiazide (50 mg day-1) were evaluated and compared for 4 weeks in 20 African patients with essential hypertension. The two groups had similar baseline clinical features and serum Na+ and K+ levels. Hydrochlorothiazide caused a significant and sustained fall in erect blood pressure with a reflex tachycardia. Enalapril exerted only a modest antihypertensive action, but significantly reduced erect heart rate. Direct comparison of hydrochlorothiazide- and enalapril-induced hypotension suggested a greater fall in subjects on the thiazide. The 95% confidence limits for the thiazide-enalapril difference in antihypertensive action at the end of the study was 39.5 to -7.5 mm Hg systolic and 22.0 to -6.6 mm Hg diastolic. The maximal blood pressure fall after hydrochlorothiazide was positively correlated with age (r = 0.50; p less than 0.05), whilst that of enalapril was inversely related age to (r = -0.57, p less than 0.05). The results are compatible with the notion that ACE inhibitor monotherapy may be less effective than thiazide diuretic treatment in African and black patients with essential hypertension. The findings also support the concept that age and racial factors may influence the response to antihypertensive treatment.

Adult↗
PubMed1989

A common anti-DNA antibody idiotype and anti-phospholipid antibodies in sera from patients with schistosomiasis and filariasis with and without nephritis.

The serum concentration of a public idiotype (16/6 ID), originally identified on a human hybridoma-derived monoclonal anti-DNA antibody, was raised in patients with S. mansoni and filariasis with or without nephritis, compared to patients with S. haematobium (in which nephritis does not occur) or idiopathic nephritis not associated with infection. There was no significant difference in 16/6 ID levels between patients with or without renal disease, whether associated with S. mansoni or filarial infection. The 16/6 ID-positive antibodies did not bind to native or denatured DNA, using competitive fluid-phase inhibition studies. Anti-cardiolipin antibody (ACA) concentration was increased in patients with either S. mansoni or filarial infection. In filariasis, both IgG and IgM ACA isotypes were elevated, irrespective of the presence of nephritis. In S. mansoni infection, IgA ACA were limited to patients with renal disease, and IgG ACA isotype to patients without overt nephritis. Both isotypes of anti-cardiolipin antibody correlated with levels of the 16/6 ID in patients with S. mansoni or filariasis. The 16/6 idiotype was therefore a feature of chronic helminthic infection, but was not related to anti-DNA antibody levels or specificity. The occurrence of nephritis as a complication of these infections was not related to the prevalence of the 16/6 idiotype.

Antibodies, Antinuclear↗
PubMed1988

Prolonged prednisolone therapy in adult nephrotic syndrome: a preliminary study.

Twenty-five adult Nigerian patients suffering from the nephrotic syndrome with normocomplementaemic mesangiocapillary glomerulonephritis were studied. Twelve of these were treated with prednisolone at a dose of 1.5 mg/kg body weight/day, with maximum dose of 90 mg/day initially for 2 weeks. Thereafter, a quarter of the daily dose was given on alternate days for a period varying from 6 to 12 months. The 13 others were similarly followed up on a dietary and diuretic regime alone. Oedema disappeared completely in all the steroid group except one, whilst it persisted in five of the controls. Proteinuria persisted in all the controls but remitted in five of the test patients. Renal function deteriorated with rising plasma creatinine in five of the controls, in contrast with one of the test patients. The beneficial effect of prednisolone observed here calls for further long-term studies.

Adolescent↗
PubMedDate not supplied

Rheumatoid factor and rheumatoid factor isotypes in loiasis with and without accompanying glomerulonephritis.

We have studied the distribution of rheumatoid factor isotypes amongst patients with loiasis with and without accompanying glomerulonephritis to determine the possible role of rheumatoid factor antiglobulins in this disease. Our findings indicate an increase in both immunoglobulin (Ig) G and IgM rheumatoid factor isotypes in patients with filariasis alone as well as in patients with accompanying glomerulonephritis. No association with IgA rheumatoid factor was found. The raised IgG and IgM rheumatoid factor levels did not correlate with corresponding IgG and IgM levels.

Adolescent↗
PubMedDate not supplied

The pattern of acute toxic nephropathy in Ife, Nigeria.

All cases of acute renal failure (ARF) seen over a two year (1993-94) period were evaluated. Those that had acute toxic nephropathy were further studied to determine the aetiologic agents involved, the clinical features and the effect of available treatment on its prognosis. Ten cases (33.3%) out of 30 ARF had toxins responsible for their renal failure. They were 8 males and 2 females. Agents responsible were green water in 2, naphthalene containing remedies in 2 and analgesic combination in 1 while herbal remedies were implicated in 5 cases. Anuria was a prominent feature occurring in 9 (90%) of the patients. The patients were uraemic with a mean serum creatinine of 1460 +/- 485.0 umol/1 and urea of 33.1 +/- 5.3 mmol/1 on admission. They were all anaemic with packed cell volume less than 18% in eight of the patients. Six (60%) of the patients required haemodialysis while 4 were managed conservatively. Prognosis was good as 8 (80%) of the patients survived and were followed up in the clinic for periods anging 6 to 18 months and their serum creatinine and urea levels normalised. It is concluded that acute toxic nephropathy is common in our practice, and it is eminently preventable. The prognosis is good if dialytic therapy is available.

Acute Kidney Injury↗
PubMedDate not supplied

What does the presence of hypertension portend in the Nigerian with non insulin dependent diabetes mellitus.

132 Nigerians with Non Insulin -dependent diabetes mellitus (NIDDM) were divided into two groups (NIDDM) patients with hypertension and those without) and their clinico-laboratory parameters were studied and analyzed. Their mean age (SD) was 59.5+/-9 years. Body mass index (BMI) was 25.2+/-3.5 kg/m2 and the duration of DM was 6.9+/-6 years. The prevalence of hypertension was 55(41.6%) No significant difference were observed in the age, sex ratio and BMI of both groups but the duration of DM showed a statistical difference between the two groups. However, laboratory parameters such as fasting blood glucose, serum urea, creatinine clearance and degree of proteinuria all showed statistically significant difference between the hypertensive and normotensive groups. Also the hypertensive diabetic group were observed to have more end organ damage i.e peripheral neuropathy, diabetic retinopathy and diabetic nephropathy than the normotensive diabetics. We conclude that, hypertension in NIDDM patients has prognostic implications and so more aggressive efforts be made in detecting and controlling hypertension in DM patients.

Age Distribution↗
PubMedDate not supplied

Glomerular filtration rate in Nigerian children with homozygous sickle cell disease.

The study proposed to assess glomerular filtration rate as determined by endogenous creatinine clearance in steady state Nigeria children with homozygous sickle cell disease and normal controls. Twenty-four hours urinary creatinine clearance was estimated over a 6-month period in 54 steady-state homozygous sickle cell disease and 57 normal control children aged 5 to 13 years. Each child was admitted and a 24-hour urine sample (8.00 am to 8.00 am) was collected both for volume measurement and creatinine concentration determination. Blood was also collected from each child 30 minutes to end of urine collection for plasma creatinine concentration determination, haematocrit and reticulocyte counts. The results were compared between the two groups of children using student's t-test and the chi (X2) square test where necessary. The mean glomerular filtration rates +/- SD (ml/min/1.73 M2) for homozygous sickle cell disease children and normal controls were not significantly different (p > 0.05). Glomerular filtration rate did not differ significantly between the age groups in both patients and normal controls; haematocrits correlated weakly with glomerular filtration rates in the patients (r = +0.213; p < 0.001). Nigerian children with homozygous sickle cell disease who are in steady states have normal glomerular filtration rate that is hardly influenced by increasing age and low haematocrit level.

Adolescent↗