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Papers by ENAJITE OKAKA

Research paper thumbnail of Relationship between Kidney Dysfunction, Stroke Severity, and Outcomes in a Nigerian Tertiary Hospital: A Prospective Study

Nigerian Journal of Clinical Practice, Oct 31, 2023

Research paper thumbnail of Factors associated with blood pressure control in predialysis chronic kidney disease patients: Short-term experience from a single center in Southern Nigeria

Nigerian Journal of Clinical Practice, 2017

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Research paper thumbnail of Spot assessment of chronic kidney disease risk factors in a market population in Benin City

African Journal of Medical and Health Sciences, 2013

recently, Afolabi et al. [5] reported a prevalence of 10.4% in a family practice population while... more recently, Afolabi et al. [5] reported a prevalence of 10.4% in a family practice population while Abioye-Kuteyi et al. [6] reported a 19.9% prevalence of undetected renal disease following screening of a rural population in Nigeria. A history of diabetes, hypertension (HTN) or cardiovascular disease confers the highest risks for developing CKD. [7] Other risk factors for CKD include hyperlipidemia, obesity, metabolic syndrome, human immunodeficiency virus infection, hepatitis C infection, positive family history of kidney disease and the use of potentially nephrotoxic drugs. The most common causes of CKD among Nigerians are glomerulonephritis, HTN, diabetes and obstructive

Research paper thumbnail of Awareness Level of Kidney Diseases among Non-Medical Students in Benin City, Nigeria

Journal of Medicine and Biomedical Research, 2012

Background: End-stage renal disease (ESRD) is on the increase globally. Renal replacement therapy... more Background: End-stage renal disease (ESRD) is on the increase globally. Renal replacement therapy and management of the ESRD patient is very expensive. Patients with ESRD in Nigeria and their relatives have to bear the cost of treatment. Prevention is thus the best option. Knowledge of kidney disease in the population will aid its prevention. Objective: The aim of this study was to determine the knowledge of kidney diseases among non-medical university undergraduates. Methods: A 13-item self administered questionnaire on knowledge of kidney rd th diseases was offered to 3 and 4 year students of the University of Benin studying Linguistics, Electrical Engineering and Accounting. The data obtained was analysed using SPSS version 16. Results: Out of 350 questionnaires administered, 295 were returned. Respondents were made up of 183 (62%) males and 112 females (38%) with a male to female ratio of 1.6:1. The mean age of respondents was 27.8±3.2years with a range of 18-37years. Five percent of the respondents did not know the number of kidneys in the body. Twenty-eight percent did not know the location of the kidneys in the body. Their knowledge of the causes of kidney disease was poor; 44% were aware that diabetes mellitus could cause kidney disease and only 25% knew of the association between kidney disease and hypertension. Fortyeight percent of respondents believed in alternative medicine such as spiritual healing, herbal therapy and urine therapy for the treatment of kidney disease. Their knowledge of haemodialysis as a mode of treatment for kidney failure was poor (37%) but 89% was aware of kidney transplantation as an option for renal replacement therapy. Conclusion: The knowledge of the respondents on kidney diseases was poor. There is a need for enlightenment programmes to improve awareness of Nigerians about kidney diseases.

Research paper thumbnail of Hyperglycemic crisis precipitated by Lassa fever in a patient with previously undiagnosed type 2 diabetes mellitus

Nigerian Journal of Clinical Practice, 2014

Hyperglycemic crisis (HC) is an acute complication of diabetes mellitus (DM) that is commonly pre... more Hyperglycemic crisis (HC) is an acute complication of diabetes mellitus (DM) that is commonly precipitated by infections and non-compliance with therapy. Viral precipitant of HC is uncommon. To report a rare case of HC unmasked by Lassa fever in a patient previously not known to have diabetes mellitus. A 54 year old lady presented with complaints of generalized body weakness, inability to pass stool, and fever. There was no abdominal pain, vomiting and nausea. There were no features of DM. She is not a known case of diabetes mellitus or hypertension. Patient does not drink alcoholic beverages. There was no history of bleeding from any orifices. She was acutely ill-looking, afebrile, not pale, anicteric, nil pedal oedema. Pulse rate was 110 beats per minute, regular, normal volume. Blood pressure was 110/80 mmHg. Respiratory rate was 26 cycles/minute, breath sound was vesicular. Abdomen was full and moved with respiration. There were no areas of tenderness, no organomegaly, no ascites, and bowel sounds were normoactive. Neurologic examination revealed a conscious patient who was restless. Casual blood glucose was 600mg/dl. Urinalysis: Glycosuria (+++), HbA1c was 12.4%. Lassa PCR done was positive. Patient was managed for hyperglycemic crisis with intravenous normal saline and soluble insulin. She was also commenced on Ribavirin but died of complications of lassa fever. Lassa fever should be included as a precipitant of hyperglycemic crisis in endemic countries.

Research paper thumbnail of Urinary N-acetyl-beta-d-glucosaminidase levels in diabetic adults

Journal of laboratory physicians, 2019

Diabetes mellitus (DM) is known to be one of the most common causes of end-stage renal disease. T... more Diabetes mellitus (DM) is known to be one of the most common causes of end-stage renal disease. The disease is usually not detected on time, because of the large functioning reserve of the kidney. Currently used markers (serum creatinine, creatinine clearance, urea, and electrolytes) remain relatively normal even when more than 50% of the renal nephron is not functioning. The aim of this study was to determine the level of urinary N-acetyl-beta-d-glucosaminidase (NAG) in diabetic adults in comparison with some currently used markers. A total of 56 diabetic patients between the ages of 23 and 63 were used for this study and 30 nondiabetic between the ages of 18 and 62 were used as control. The diabetic patients were classified into three groups based on how long they have been diagnosed: <2 years (25), 2-5 years (30), and >5 years (25). Spot midstream urine samples were collected into sterile containers, and blood samples were collected into plain tubes. All the analyses were done spectrophotometrically. Creatinine clearance was calculated using the Cockcroft-Gault Equation. There was a significant increase (P < 0.01) in NAG values of 2-5 years and above 5 years and control. The urinary microalbumin concentration of controls was significantly different (P < 0.05) only with those who have had DM for <2 years. Urinary creatinine concentration of control was significantly higher (P < 0.05) than values of all the diabetic groups. There was a significant increase (P < 0.01) in creatinine clearance of control group and those who have had DM for <2 years. It is thus concluded that urinary NAG can be used as an early marker in the diagnosis of diabetic nephropathy since urinary NAG increases first before the other markers analyzed in this current study begins to increase.

Research paper thumbnail of Prescription pattern of antihypertensive medications and blood pressure control among hypertensive outpatients at the University of Benin Teaching Hospital in Benin City, Nigeria

Malawi medical journal, Aug 23, 2017

Background The prevalence of hypertension and attendant cardiovascular disease burden is increasi... more Background The prevalence of hypertension and attendant cardiovascular disease burden is increasing globally. Auditing antihypertensive prescriptions and assessing patients with hypertension for blood pressure (BP) control are important steps on the path to reducing hypertensionrelated morbidity, mortality, and health expenditure. This study assessed the prescription pattern of antihypertensive medications and BP control among hypertensive outpatients at the University of Benin Teaching Hospital in Benin City, Nigeria. Methods This was a cross-sectional descriptive study that involved 224 hypertensive patients. Information obtained from participants included sociodemographic data, duration of hypertension, history of diabetes mellitus, and number and classes of antihypertensive medications used. Good BP control was defined as a mean BP less than 140/90mmHg. Results The mean age of hypertensive subjects was 59.6 ± 12.2 years, with a male:female ratio of 1:1.9 and a median duration of hypertension of 5 years. Twenty-four participants (10.7%) had both hypertension and diabetes. The common classes of antihypertensive medications used were diuretics, calcium channel blockers (CCB), and angiotensin converting enzyme inhibitors (ACEIs). Forty participants (17.8%) were on monotherapy, while the rest were on multidrug therapy. The most commonly prescribed antihypertensive combination was diuretic + ACEI/angiotensin receptor blocker (ARB), followed by diuretic + CCB + ACEI/ARB. Good BP control was observed in 120 participants (53.6%). The proportion of patients with good BP control was largest among patients on monotherapy and those with tertiary education, though these observations were not statistically significant. Conclusions The pattern of prescribed antihypertensive medications complied with recommended guidelines. Blood pressure control amongst hypertensive patients was unsatisfactory. More efforts should be geared towards better BP control.

Research paper thumbnail of Determinants of Interest in Nephrology Career Choice among Internal Medicine Junior Residents in Nigeria

PubMed, Jan 30, 2023

Introduction: There has been decreased interest in postgraduate nephrology training over the year... more Introduction: There has been decreased interest in postgraduate nephrology training over the years. This trend could worsen the shortage of nephrologists and inability to meet the health needs of patients with kidney diseases if not urgently addressed. Aim: To determine interest in and determinants of nephrology career choice among junior internal medicine residents in Nigeria. Methodology: This was a cross-sectional study that enrolled 273 junior residents in internal medicine across Nigeria. A self-administered questionnaire that was adapted from two previous studies was used for data collection. Results: The mean age of the respondents was 33.6±4.4 years with a male: female ratio of 1.8:1. This study showed that 16.8% and 21.6% of junior residents in internal medicine considered nephrology as their first and second choice area to specialize, respectively. Factors that ranked high as determinants of a decision to do nephrology were personal interest (94.3%), opportunities to perform renal procedures (93.3%), and exposure to nephrology training (85.7%). Factors that discouraged a choice of nephrology according to respondents were high mortality of renal patients (67.3%), poor outcomes of renal patients (70.2%), in ability to fund treatment by renal patients (66.1%), unsatisfactory life-work balance among nephrologists (60.7%), and late presentation of renal patients (59.0%). Others were high workload compared to available doctors (59.0%) and poor job satisfaction (55.4%). Factors that could stimulate more interest in nephrology according to respondents included creation of better working environment with adequate equipment for training (96.3%), provision of health insurance with adequate coverage for renal patients (97.4%), and increased government support for renal care services (99.3%). Conclusion: There is a need to promote and sustain interest of residents in nephrology by ensuring improved survival of patients through better access to renal care, ensuring an adequate and well motivated work force, provision of adequate facilities and health insurance services.

Research paper thumbnail of An audit of chronic kidney disease risk factors in type 2 diabetic patients in a tertiary hospital in Southern Nigeria

Highland Medical Research Journal, 2015

Research paper thumbnail of Twenty-one-year-old male with congenital anomalies, obstructive uropathy and chronic renal failure: is this a case of Townes Brocks syndrome?

PubMed, Mar 1, 2007

Townes Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear... more Townes Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear anomalies/hearing loss, limb defects, anal, genitourinary, eye, spine anomalies, heart defects and sometimes mental retardation. This report presents the case of a 21-year-old secondary school leaver as a likely case of Townes-Brocks syndrome. He was born with congenital abnormalities consisting of fixed flexion deformities of hands, wrist and elbows, urethral meatal stenosis, scoliosis and aortic stenosis. He was diagnosed with obstructive uropathy at the age of 19 years and subsequently developed chronic renal failure. The report aims to highlight the need for early recognition of potentially preventable conditions, which, if left unattended to, can lead to unnecessary fatality.

Research paper thumbnail of Physicians’ perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study

PLOS ONE

Introduction Task sharing and task shifting (TSTS) in the management of hypertension is an import... more Introduction Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization’s recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians’ perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS. Materials and methods This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TS...

Research paper thumbnail of Cost Evaluation of Haemodialysis for End Stage Renal Disease Patients: Experience from Benin City, Nigeria

Annals of Biomedical Sciences, 2013

Research paper thumbnail of Chronic kidney disease: sonographic/clinical findings at the University Of Benin Teaching Hospital

Annals of Biomedical Sciences, Apr 6, 2017

Research paper thumbnail of Financial implications of anemia management in anaemic chronic kidney disease patients in South-South Nigeria

Annals of Biomedical Sciences, 2017

Research paper thumbnail of Haematological Indices and Iron Status in Pre-Dialysis Chronic Kidney Disease Patients

PubMed, Jan 31, 2024

Background: Chronic kidney disease (CKD) is associated with haematological changes, the commonest... more Background: Chronic kidney disease (CKD) is associated with haematological changes, the commonest being anaemia. The number and function of white blood cells (WBC) and platelets are equally affected. Iron deficiency is a common cause of anaemia in the CKD population and anaemia has been associated with reduced cardiac function, increased rates of hospitalization, morbidity and mortality. This study aimed to determine the haematological indices and iron status among pre-dialysis CKD patients. Method: A hospital-based cross-sectional study involving 95 predialysis CKD patients and 95 age- and sex-matched apparently healthy controls. Full blood count, peripheral blood film, serum ferritin, transferrin saturation, C-reactive protein (CRP), electrolytes, urea and creatinine, serum folate and vitamin B12 were done in all study participants. Comparisons were made between results obtained from participants in both groups. Result: The mean ages were 58.1 ± 14.9 years and 58.3 ± 15.0 years in the CKD group and controls, respectively. The male:female ratio was 1:0.9 in both groups. The prevalence of anaemia was 51.6% and 3% in patients with CKD and controls, respectively. There was no significant difference in the total WBC count, neutrophil and lymphocyte differentials, platelet count, serum vitamin B12 and folate in patients with CKD and controls. The prevalence of iron deficiency among patients with CKD was 32.6%, of which 62.5% were absolutely iron-deficient while 37.5% were functionally iron-deficient. The median ferritin and CRP were also higher in CKD. (p =0.001). Conclusion: Anaemia and iron deficiency are common in predialysis CKD patients. Early diagnosis and treatment are important to avoid the problems associated with them. Mots-clés: Maladie rénale chronique, Anémie, Carence en fer, Pré-dialyse.

Research paper thumbnail of Twenty-one-year-old male with congenital anomalies, obstructive uropathy and chronic renal failure: is this a case of Townes Brocks syndrome?

Nigerian journal of clinical practice, 2007

Townes Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear... more Townes Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear anomalies/hearing loss, limb defects, anal, genitourinary, eye, spine anomalies, heart defects and sometimes mental retardation. This report presents the case of a 21-year-old secondary school leaver as a likely case of Townes-Brocks syndrome. He was born with congenital abnormalities consisting of fixed flexion deformities of hands, wrist and elbows, urethral meatal stenosis, scoliosis and aortic stenosis. He was diagnosed with obstructive uropathy at the age of 19 years and subsequently developed chronic renal failure. The report aims to highlight the need for early recognition of potentially preventable conditions, which, if left unattended to, can lead to unnecessary fatality.

Research paper thumbnail of Estimated glomerular filtration rate and risk of survival in acute stroke

Journal of the Neurological Sciences, 2013

Objective: To assess the risk of survival in acute stroke using the MDRD equation derived estimat... more Objective: To assess the risk of survival in acute stroke using the MDRD equation derived estimated glomerular filtration rate. Design: A prospective observational cross-sectional study. Setting: Medical wards of a tertiary care hospital. Subjects: Eighty three acute stroke patients had GFR calculated within 48 hours of admission after basic data were captured. Outcome measures: Stroke outcome was defined as either discharged or still-in-care (survived) or all cause in-hospital death. GFR was estimated by the MDRD equation, stroke severity was assessed by the Canadian Neurological Scale (CNS). Data were compared between the GFR groups of < 60ml/min and ≥ 60ml/min. Relative risks (RR) and odds ratios (OR) for stroke outcomes (survival and death) were estimated between the GFR groups and the homogeneity of the odds ratios among the different layers of stroke severity (CNS < 6.5 and ≥ 6.5) was determined by Breslow-Day and Tarone's test. Matanel Hazensel and Cochran's tests were used to determine conditional independence and the common odds ratio with stroke severity as a layering variable. Results: No significant differences were found between the age and sex distribution of the two GFR groups. Serum urea and creatinine and CNS were significantly different between the GFR groups (p<0.001, <0.001, <0.001). RR of survival and death for the GFR groups-less than 60ml/min and above or equal to 60ml/min were (0.425 and 1.204) and (2.360 and 0.830). The OR of survival for GFR below 60ml/min compared to GFR above or equal to 60ml/min was 0.353. There was homogeneity across the two layers of stroke severity (CNS score less than 6.5 and above or equal to 6.5), p=0.612 and 0.612. Conclusion: Independent of stroke severity, GFR is a surrogate in the assessment of the risk of survival in acute stroke

Research paper thumbnail of Protein energy wasting in pre-dialysis chronic kidney disease patients in Benin City, Nigeria: A cross-sectional study

PLOS ONE

Introduction Protein energy wasting (PEW) is common among chronic kidney disease (CKD) patients, ... more Introduction Protein energy wasting (PEW) is common among chronic kidney disease (CKD) patients, especially those with advanced stage. It worsens frailty, sarcopenia and debility in CKD patients. Despite the importance of PEW, it is not routinely assessed during management of CKD patients in Nigeria. The prevalence of PEW and its associated factors were determined in pre-dialysis CKD patients. Methods This was a cross-sectional study that involved 250 pre-dialysis CKD patients and 125 age- and sex- matched healthy controls. Body mass index (BMI), subjective global assessment (SGA) scores and serum albumin levels were used in PEW assessment. The factors associated with PEW were identified. P-value of < 0.05 was taken as significant. Results The mean age of CKD and control group were 52.3±16.0 years and 50.5±16.0 years, respectively. The prevalence of low BMI, hypoalbuminaemia and malnutrition defined by SGA in pre-dialysis CKD patients were 42.4%, 62.0% and 74.8%, respectively. Th...

Research paper thumbnail of nnamdi ezekiel Ojimadu2

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will app... more Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:

Research paper thumbnail of Obstructive Nephropathy in a Kidney Care Hospital in Southwest Nigeria: The need for early screening and prevention

Journal of Medicine in the Tropics, 2017

Background: Most of the preventive efforts in Nephrology are focused on hypertension and diabetes... more Background: Most of the preventive efforts in Nephrology are focused on hypertension and diabetes mellitus. Obstructive Nephropathy (ON) which is a relatively common cause of CKD in Nigeria has not received adequate attention. This study reviewed the clinical profile of patients with ON at a Kidney hospital with the aim of identifying areas where preventive strategy should be targeted. Materials and Methods: This was a 3 year retrospective study that reviewed records of patients managed for ON in a Kidney hospital in Southwest Nigeria. Results: Thirty patients managed during the review period had ON with a prevalence of 7.0%. The mean age of the patients was 63.4 ± 12.08 years. Twenty-three (76.7%) were males and 7(23.3%) were females. The mean packed cell volume, creatinine and estimated glomerular filtration rate at presentation were 25.17 ± 7.84%, 920.41 ± 642.79 micromol/l and 14.27 ± 15.45mls/min/1.72 m2 respectively. Common aetiologies of ON were prostate cancer 13(43.3%), urolithiasis 6(20.0%), and cervical cancer 5(16.7%). Identified renal co-morbidities were hypertension 21(70.0%), diabetes mellitus 4(13.3%) and urinary tract infection in 11(36.7%). Anemia was present in 27(90.0%), hyperkalemia in 16(53.3%) and metabolic acidosis in 23(76.7%). Twenty-one (70.0%) had stage 5 CKD. A higher proportion of patients with malignancies had stage 4 and 5 CKD. Twenty-one (70.0%) had haemodialysis. Conclusion: Majority of patients with ON presented late and required hemodialysis. The common causes of ON were prostate cancer, stones, and cervical cancers which are largely preventable or treatable. Screening for prostate and cervical cancer and human papilloma virus vaccination of at risk population is highly recommended.

Research paper thumbnail of Relationship between Kidney Dysfunction, Stroke Severity, and Outcomes in a Nigerian Tertiary Hospital: A Prospective Study

Nigerian Journal of Clinical Practice, Oct 31, 2023

Research paper thumbnail of Factors associated with blood pressure control in predialysis chronic kidney disease patients: Short-term experience from a single center in Southern Nigeria

Nigerian Journal of Clinical Practice, 2017

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Research paper thumbnail of Spot assessment of chronic kidney disease risk factors in a market population in Benin City

African Journal of Medical and Health Sciences, 2013

recently, Afolabi et al. [5] reported a prevalence of 10.4% in a family practice population while... more recently, Afolabi et al. [5] reported a prevalence of 10.4% in a family practice population while Abioye-Kuteyi et al. [6] reported a 19.9% prevalence of undetected renal disease following screening of a rural population in Nigeria. A history of diabetes, hypertension (HTN) or cardiovascular disease confers the highest risks for developing CKD. [7] Other risk factors for CKD include hyperlipidemia, obesity, metabolic syndrome, human immunodeficiency virus infection, hepatitis C infection, positive family history of kidney disease and the use of potentially nephrotoxic drugs. The most common causes of CKD among Nigerians are glomerulonephritis, HTN, diabetes and obstructive

Research paper thumbnail of Awareness Level of Kidney Diseases among Non-Medical Students in Benin City, Nigeria

Journal of Medicine and Biomedical Research, 2012

Background: End-stage renal disease (ESRD) is on the increase globally. Renal replacement therapy... more Background: End-stage renal disease (ESRD) is on the increase globally. Renal replacement therapy and management of the ESRD patient is very expensive. Patients with ESRD in Nigeria and their relatives have to bear the cost of treatment. Prevention is thus the best option. Knowledge of kidney disease in the population will aid its prevention. Objective: The aim of this study was to determine the knowledge of kidney diseases among non-medical university undergraduates. Methods: A 13-item self administered questionnaire on knowledge of kidney rd th diseases was offered to 3 and 4 year students of the University of Benin studying Linguistics, Electrical Engineering and Accounting. The data obtained was analysed using SPSS version 16. Results: Out of 350 questionnaires administered, 295 were returned. Respondents were made up of 183 (62%) males and 112 females (38%) with a male to female ratio of 1.6:1. The mean age of respondents was 27.8±3.2years with a range of 18-37years. Five percent of the respondents did not know the number of kidneys in the body. Twenty-eight percent did not know the location of the kidneys in the body. Their knowledge of the causes of kidney disease was poor; 44% were aware that diabetes mellitus could cause kidney disease and only 25% knew of the association between kidney disease and hypertension. Fortyeight percent of respondents believed in alternative medicine such as spiritual healing, herbal therapy and urine therapy for the treatment of kidney disease. Their knowledge of haemodialysis as a mode of treatment for kidney failure was poor (37%) but 89% was aware of kidney transplantation as an option for renal replacement therapy. Conclusion: The knowledge of the respondents on kidney diseases was poor. There is a need for enlightenment programmes to improve awareness of Nigerians about kidney diseases.

Research paper thumbnail of Hyperglycemic crisis precipitated by Lassa fever in a patient with previously undiagnosed type 2 diabetes mellitus

Nigerian Journal of Clinical Practice, 2014

Hyperglycemic crisis (HC) is an acute complication of diabetes mellitus (DM) that is commonly pre... more Hyperglycemic crisis (HC) is an acute complication of diabetes mellitus (DM) that is commonly precipitated by infections and non-compliance with therapy. Viral precipitant of HC is uncommon. To report a rare case of HC unmasked by Lassa fever in a patient previously not known to have diabetes mellitus. A 54 year old lady presented with complaints of generalized body weakness, inability to pass stool, and fever. There was no abdominal pain, vomiting and nausea. There were no features of DM. She is not a known case of diabetes mellitus or hypertension. Patient does not drink alcoholic beverages. There was no history of bleeding from any orifices. She was acutely ill-looking, afebrile, not pale, anicteric, nil pedal oedema. Pulse rate was 110 beats per minute, regular, normal volume. Blood pressure was 110/80 mmHg. Respiratory rate was 26 cycles/minute, breath sound was vesicular. Abdomen was full and moved with respiration. There were no areas of tenderness, no organomegaly, no ascites, and bowel sounds were normoactive. Neurologic examination revealed a conscious patient who was restless. Casual blood glucose was 600mg/dl. Urinalysis: Glycosuria (+++), HbA1c was 12.4%. Lassa PCR done was positive. Patient was managed for hyperglycemic crisis with intravenous normal saline and soluble insulin. She was also commenced on Ribavirin but died of complications of lassa fever. Lassa fever should be included as a precipitant of hyperglycemic crisis in endemic countries.

Research paper thumbnail of Urinary N-acetyl-beta-d-glucosaminidase levels in diabetic adults

Journal of laboratory physicians, 2019

Diabetes mellitus (DM) is known to be one of the most common causes of end-stage renal disease. T... more Diabetes mellitus (DM) is known to be one of the most common causes of end-stage renal disease. The disease is usually not detected on time, because of the large functioning reserve of the kidney. Currently used markers (serum creatinine, creatinine clearance, urea, and electrolytes) remain relatively normal even when more than 50% of the renal nephron is not functioning. The aim of this study was to determine the level of urinary N-acetyl-beta-d-glucosaminidase (NAG) in diabetic adults in comparison with some currently used markers. A total of 56 diabetic patients between the ages of 23 and 63 were used for this study and 30 nondiabetic between the ages of 18 and 62 were used as control. The diabetic patients were classified into three groups based on how long they have been diagnosed: <2 years (25), 2-5 years (30), and >5 years (25). Spot midstream urine samples were collected into sterile containers, and blood samples were collected into plain tubes. All the analyses were done spectrophotometrically. Creatinine clearance was calculated using the Cockcroft-Gault Equation. There was a significant increase (P < 0.01) in NAG values of 2-5 years and above 5 years and control. The urinary microalbumin concentration of controls was significantly different (P < 0.05) only with those who have had DM for <2 years. Urinary creatinine concentration of control was significantly higher (P < 0.05) than values of all the diabetic groups. There was a significant increase (P < 0.01) in creatinine clearance of control group and those who have had DM for <2 years. It is thus concluded that urinary NAG can be used as an early marker in the diagnosis of diabetic nephropathy since urinary NAG increases first before the other markers analyzed in this current study begins to increase.

Research paper thumbnail of Prescription pattern of antihypertensive medications and blood pressure control among hypertensive outpatients at the University of Benin Teaching Hospital in Benin City, Nigeria

Malawi medical journal, Aug 23, 2017

Background The prevalence of hypertension and attendant cardiovascular disease burden is increasi... more Background The prevalence of hypertension and attendant cardiovascular disease burden is increasing globally. Auditing antihypertensive prescriptions and assessing patients with hypertension for blood pressure (BP) control are important steps on the path to reducing hypertensionrelated morbidity, mortality, and health expenditure. This study assessed the prescription pattern of antihypertensive medications and BP control among hypertensive outpatients at the University of Benin Teaching Hospital in Benin City, Nigeria. Methods This was a cross-sectional descriptive study that involved 224 hypertensive patients. Information obtained from participants included sociodemographic data, duration of hypertension, history of diabetes mellitus, and number and classes of antihypertensive medications used. Good BP control was defined as a mean BP less than 140/90mmHg. Results The mean age of hypertensive subjects was 59.6 ± 12.2 years, with a male:female ratio of 1:1.9 and a median duration of hypertension of 5 years. Twenty-four participants (10.7%) had both hypertension and diabetes. The common classes of antihypertensive medications used were diuretics, calcium channel blockers (CCB), and angiotensin converting enzyme inhibitors (ACEIs). Forty participants (17.8%) were on monotherapy, while the rest were on multidrug therapy. The most commonly prescribed antihypertensive combination was diuretic + ACEI/angiotensin receptor blocker (ARB), followed by diuretic + CCB + ACEI/ARB. Good BP control was observed in 120 participants (53.6%). The proportion of patients with good BP control was largest among patients on monotherapy and those with tertiary education, though these observations were not statistically significant. Conclusions The pattern of prescribed antihypertensive medications complied with recommended guidelines. Blood pressure control amongst hypertensive patients was unsatisfactory. More efforts should be geared towards better BP control.

Research paper thumbnail of Determinants of Interest in Nephrology Career Choice among Internal Medicine Junior Residents in Nigeria

PubMed, Jan 30, 2023

Introduction: There has been decreased interest in postgraduate nephrology training over the year... more Introduction: There has been decreased interest in postgraduate nephrology training over the years. This trend could worsen the shortage of nephrologists and inability to meet the health needs of patients with kidney diseases if not urgently addressed. Aim: To determine interest in and determinants of nephrology career choice among junior internal medicine residents in Nigeria. Methodology: This was a cross-sectional study that enrolled 273 junior residents in internal medicine across Nigeria. A self-administered questionnaire that was adapted from two previous studies was used for data collection. Results: The mean age of the respondents was 33.6±4.4 years with a male: female ratio of 1.8:1. This study showed that 16.8% and 21.6% of junior residents in internal medicine considered nephrology as their first and second choice area to specialize, respectively. Factors that ranked high as determinants of a decision to do nephrology were personal interest (94.3%), opportunities to perform renal procedures (93.3%), and exposure to nephrology training (85.7%). Factors that discouraged a choice of nephrology according to respondents were high mortality of renal patients (67.3%), poor outcomes of renal patients (70.2%), in ability to fund treatment by renal patients (66.1%), unsatisfactory life-work balance among nephrologists (60.7%), and late presentation of renal patients (59.0%). Others were high workload compared to available doctors (59.0%) and poor job satisfaction (55.4%). Factors that could stimulate more interest in nephrology according to respondents included creation of better working environment with adequate equipment for training (96.3%), provision of health insurance with adequate coverage for renal patients (97.4%), and increased government support for renal care services (99.3%). Conclusion: There is a need to promote and sustain interest of residents in nephrology by ensuring improved survival of patients through better access to renal care, ensuring an adequate and well motivated work force, provision of adequate facilities and health insurance services.

Research paper thumbnail of An audit of chronic kidney disease risk factors in type 2 diabetic patients in a tertiary hospital in Southern Nigeria

Highland Medical Research Journal, 2015

Research paper thumbnail of Twenty-one-year-old male with congenital anomalies, obstructive uropathy and chronic renal failure: is this a case of Townes Brocks syndrome?

PubMed, Mar 1, 2007

Townes Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear... more Townes Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear anomalies/hearing loss, limb defects, anal, genitourinary, eye, spine anomalies, heart defects and sometimes mental retardation. This report presents the case of a 21-year-old secondary school leaver as a likely case of Townes-Brocks syndrome. He was born with congenital abnormalities consisting of fixed flexion deformities of hands, wrist and elbows, urethral meatal stenosis, scoliosis and aortic stenosis. He was diagnosed with obstructive uropathy at the age of 19 years and subsequently developed chronic renal failure. The report aims to highlight the need for early recognition of potentially preventable conditions, which, if left unattended to, can lead to unnecessary fatality.

Research paper thumbnail of Physicians’ perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study

PLOS ONE

Introduction Task sharing and task shifting (TSTS) in the management of hypertension is an import... more Introduction Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization’s recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians’ perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS. Materials and methods This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TS...

Research paper thumbnail of Cost Evaluation of Haemodialysis for End Stage Renal Disease Patients: Experience from Benin City, Nigeria

Annals of Biomedical Sciences, 2013

Research paper thumbnail of Chronic kidney disease: sonographic/clinical findings at the University Of Benin Teaching Hospital

Annals of Biomedical Sciences, Apr 6, 2017

Research paper thumbnail of Financial implications of anemia management in anaemic chronic kidney disease patients in South-South Nigeria

Annals of Biomedical Sciences, 2017

Research paper thumbnail of Haematological Indices and Iron Status in Pre-Dialysis Chronic Kidney Disease Patients

PubMed, Jan 31, 2024

Background: Chronic kidney disease (CKD) is associated with haematological changes, the commonest... more Background: Chronic kidney disease (CKD) is associated with haematological changes, the commonest being anaemia. The number and function of white blood cells (WBC) and platelets are equally affected. Iron deficiency is a common cause of anaemia in the CKD population and anaemia has been associated with reduced cardiac function, increased rates of hospitalization, morbidity and mortality. This study aimed to determine the haematological indices and iron status among pre-dialysis CKD patients. Method: A hospital-based cross-sectional study involving 95 predialysis CKD patients and 95 age- and sex-matched apparently healthy controls. Full blood count, peripheral blood film, serum ferritin, transferrin saturation, C-reactive protein (CRP), electrolytes, urea and creatinine, serum folate and vitamin B12 were done in all study participants. Comparisons were made between results obtained from participants in both groups. Result: The mean ages were 58.1 ± 14.9 years and 58.3 ± 15.0 years in the CKD group and controls, respectively. The male:female ratio was 1:0.9 in both groups. The prevalence of anaemia was 51.6% and 3% in patients with CKD and controls, respectively. There was no significant difference in the total WBC count, neutrophil and lymphocyte differentials, platelet count, serum vitamin B12 and folate in patients with CKD and controls. The prevalence of iron deficiency among patients with CKD was 32.6%, of which 62.5% were absolutely iron-deficient while 37.5% were functionally iron-deficient. The median ferritin and CRP were also higher in CKD. (p =0.001). Conclusion: Anaemia and iron deficiency are common in predialysis CKD patients. Early diagnosis and treatment are important to avoid the problems associated with them. Mots-clés: Maladie rénale chronique, Anémie, Carence en fer, Pré-dialyse.

Research paper thumbnail of Twenty-one-year-old male with congenital anomalies, obstructive uropathy and chronic renal failure: is this a case of Townes Brocks syndrome?

Nigerian journal of clinical practice, 2007

Townes Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear... more Townes Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear anomalies/hearing loss, limb defects, anal, genitourinary, eye, spine anomalies, heart defects and sometimes mental retardation. This report presents the case of a 21-year-old secondary school leaver as a likely case of Townes-Brocks syndrome. He was born with congenital abnormalities consisting of fixed flexion deformities of hands, wrist and elbows, urethral meatal stenosis, scoliosis and aortic stenosis. He was diagnosed with obstructive uropathy at the age of 19 years and subsequently developed chronic renal failure. The report aims to highlight the need for early recognition of potentially preventable conditions, which, if left unattended to, can lead to unnecessary fatality.

Research paper thumbnail of Estimated glomerular filtration rate and risk of survival in acute stroke

Journal of the Neurological Sciences, 2013

Objective: To assess the risk of survival in acute stroke using the MDRD equation derived estimat... more Objective: To assess the risk of survival in acute stroke using the MDRD equation derived estimated glomerular filtration rate. Design: A prospective observational cross-sectional study. Setting: Medical wards of a tertiary care hospital. Subjects: Eighty three acute stroke patients had GFR calculated within 48 hours of admission after basic data were captured. Outcome measures: Stroke outcome was defined as either discharged or still-in-care (survived) or all cause in-hospital death. GFR was estimated by the MDRD equation, stroke severity was assessed by the Canadian Neurological Scale (CNS). Data were compared between the GFR groups of < 60ml/min and ≥ 60ml/min. Relative risks (RR) and odds ratios (OR) for stroke outcomes (survival and death) were estimated between the GFR groups and the homogeneity of the odds ratios among the different layers of stroke severity (CNS < 6.5 and ≥ 6.5) was determined by Breslow-Day and Tarone's test. Matanel Hazensel and Cochran's tests were used to determine conditional independence and the common odds ratio with stroke severity as a layering variable. Results: No significant differences were found between the age and sex distribution of the two GFR groups. Serum urea and creatinine and CNS were significantly different between the GFR groups (p<0.001, <0.001, <0.001). RR of survival and death for the GFR groups-less than 60ml/min and above or equal to 60ml/min were (0.425 and 1.204) and (2.360 and 0.830). The OR of survival for GFR below 60ml/min compared to GFR above or equal to 60ml/min was 0.353. There was homogeneity across the two layers of stroke severity (CNS score less than 6.5 and above or equal to 6.5), p=0.612 and 0.612. Conclusion: Independent of stroke severity, GFR is a surrogate in the assessment of the risk of survival in acute stroke

Research paper thumbnail of Protein energy wasting in pre-dialysis chronic kidney disease patients in Benin City, Nigeria: A cross-sectional study

PLOS ONE

Introduction Protein energy wasting (PEW) is common among chronic kidney disease (CKD) patients, ... more Introduction Protein energy wasting (PEW) is common among chronic kidney disease (CKD) patients, especially those with advanced stage. It worsens frailty, sarcopenia and debility in CKD patients. Despite the importance of PEW, it is not routinely assessed during management of CKD patients in Nigeria. The prevalence of PEW and its associated factors were determined in pre-dialysis CKD patients. Methods This was a cross-sectional study that involved 250 pre-dialysis CKD patients and 125 age- and sex- matched healthy controls. Body mass index (BMI), subjective global assessment (SGA) scores and serum albumin levels were used in PEW assessment. The factors associated with PEW were identified. P-value of < 0.05 was taken as significant. Results The mean age of CKD and control group were 52.3±16.0 years and 50.5±16.0 years, respectively. The prevalence of low BMI, hypoalbuminaemia and malnutrition defined by SGA in pre-dialysis CKD patients were 42.4%, 62.0% and 74.8%, respectively. Th...

Research paper thumbnail of nnamdi ezekiel Ojimadu2

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will app... more Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:

Research paper thumbnail of Obstructive Nephropathy in a Kidney Care Hospital in Southwest Nigeria: The need for early screening and prevention

Journal of Medicine in the Tropics, 2017

Background: Most of the preventive efforts in Nephrology are focused on hypertension and diabetes... more Background: Most of the preventive efforts in Nephrology are focused on hypertension and diabetes mellitus. Obstructive Nephropathy (ON) which is a relatively common cause of CKD in Nigeria has not received adequate attention. This study reviewed the clinical profile of patients with ON at a Kidney hospital with the aim of identifying areas where preventive strategy should be targeted. Materials and Methods: This was a 3 year retrospective study that reviewed records of patients managed for ON in a Kidney hospital in Southwest Nigeria. Results: Thirty patients managed during the review period had ON with a prevalence of 7.0%. The mean age of the patients was 63.4 ± 12.08 years. Twenty-three (76.7%) were males and 7(23.3%) were females. The mean packed cell volume, creatinine and estimated glomerular filtration rate at presentation were 25.17 ± 7.84%, 920.41 ± 642.79 micromol/l and 14.27 ± 15.45mls/min/1.72 m2 respectively. Common aetiologies of ON were prostate cancer 13(43.3%), urolithiasis 6(20.0%), and cervical cancer 5(16.7%). Identified renal co-morbidities were hypertension 21(70.0%), diabetes mellitus 4(13.3%) and urinary tract infection in 11(36.7%). Anemia was present in 27(90.0%), hyperkalemia in 16(53.3%) and metabolic acidosis in 23(76.7%). Twenty-one (70.0%) had stage 5 CKD. A higher proportion of patients with malignancies had stage 4 and 5 CKD. Twenty-one (70.0%) had haemodialysis. Conclusion: Majority of patients with ON presented late and required hemodialysis. The common causes of ON were prostate cancer, stones, and cervical cancers which are largely preventable or treatable. Screening for prostate and cervical cancer and human papilloma virus vaccination of at risk population is highly recommended.