Prevalence and factors associated with chronic kidney disease among medical inpatients at the Kenyatta National Hospital, Kenya, 2018: a cross-sectional study

The burden of chronic kidney disease (CKD) is increasing worldwide. Few studies in low and low-middle income countries have estimated the prevalence of CKD. We aimed to estimate prevalence and factors associated with CKD among medical inpatients at the largest referral hospital in Kenya. Methods We conducted a cross-sectional study among medical inpatients at the Kenyatta National Hospital. We used systematic sampling and collected demographic information, behavioural risk factors, medical history, underlying conditions, laboratory and imaging workup using a structured questionnaire. We estimated glomerular filtration rate (GFR) in ml/min/1.73m 2 classified into 5 stages; G1 (≥ 90), G2 (60-89), G3a (45-59), G3b (30-44), G4 (15-29) and G5 (<15, or treated by dialysis/renal transplant). Ethical approval was obtained from Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (KNH-UoN ERC), approval number P510/09/2017. We estimated prevalence of CKD and used logistic regression to determine factors independently associated with CKD diagnosis. Results We interviewed 306 inpatients; median age 40.0 years (IQR 24.0), 162 (52.9%) were male, 155 (50.7%) rural residents. CKD prevalence was 118 patients (38.6%, 95% CI 33.3-44.1); median age 42.5 years (IQR 28.0), 74 (62.7%) were male, 64 (54.2%) rural residents. Respondents with CKD were older than those without (difference 4.4 years, 95% CI 3.7-8.4 years, P = 0.032). Fifty-six (47.5%) of the patients had either stage G1 or G2, 17 (14.4%) had end-stage renal disease; 64 (54.2%) had haemoglobin below 10g/dl while 33 (28.0%) had sodium levels below 135 mmol/l. ). History of unexplained anaemia (aOR 1.80, 95% CI 1.02-3.19), proteinuria (aOR 5.16, 95% CI 2.09-12.74), hematuria (aOR 7.68, 95% CI 2.37-24.86); hypertension (aOR 2.71, 95% CI 1.53-4.80) and herbal medications use (aOR 1.97, 95% CI 1.07-3.64) were independently associated with CKD. Conclusion Burden of CKD was high among this inpatient population. Haematuria and proteinuria can aid CKD diagnosis. Public awareness on health hazards of herbal medication use is necessary.

An Ecological Assessment of the Physico-chemical and Biological Water Quality in a Sub-urban Area in Cameroon: Case of the Ngoumou Rural Council

A Nested K-Nearest Prognostic Approach for Microwave Precipitation Phase Detection over Snow Cover

Monitoring changes of precipitation phase from space is important forunderstanding the mass balance of Earth's cryosphere in a changing climate.This paper examines a Bayesian nearest neighbor approach for prognosticdetection of precipitation and its phase using passive microwave observationsfrom the Global Precipitation Measurement (GPM) satellite. The method uses theweighted Euclidean distance metric to search through an a priori databasepopulated with coincident GPM radiometer and radar observations as well asancillary snow-cover data. The algorithm performance is evaluated using datafrom GPM official precipitation products, ground-based radars, andhigh-fidelity simulations from the Weather Research and Forecasting model.Using the presented approach, we demonstrate that the hit probability ofterrestrial precipitation detection can reach to 0.80, while the probability offalse alarm remains below 0.11. The algorithm demonstrates higher skill indetecting snowfall than rainfall, on average by 10 percent. In particular, theprobability of precipitation detection and its solid phase increases by 11 and8 percent, over dry snow cover, when compared to other surface types. The mainreason is found to be related to the ability of the algorithm in capturing thesignal of increased liquid water content in snowy clouds over radiometricallycold snow-covered surfaces

Correlation between malnutrition and health-related quality of life (HRQOL) in elderly Iranian adults

Canine circoviral hemorrhagic enteritis in a dog in Connecticut

A 5-mo-old Bassett Hound–Labrador Retriever cross was autopsied following a bout of lethargy, inappetence, and bleeding gums. Mucous membranes were white, and the small intestine was blue-black; the colon contained black feces. The spleen was swollen, and multiple lymph nodes were enlarged and hemorrhagic. Microscopically, the small intestine had focal crypt cell necrosis and circumferential transmural vasculitis, the latter the cause of infarction and the blue-black coloration. Lymphocytes were necrotic in spleen and lymph nodes, and erythrophagocytosis was present in some nodes. Vasculitis was present in brain, meninges, lung, liver, and kidneys. Electron microscopy revealed aggregates of 15–18 nm round viral particles in damaged crypt cells and in the endothelium of small blood vessels. Electron-dense intracytoplasmic inclusions consisting of paracrystalline-arrayed virus were demonstrated in macrophages in medullary lymph node sinuses. These virions were identified as circovirus, which was confirmed by real-time PCR and sequencing.

Effect of Sphenopalatine Ganglion Block With Bupivacaine on Postoperative Pain in Patients Undergoing Endoscopic Sinus Surgery

Background Postoperative pain is one of the most complications in endoscopic sinus surgery. We aimed to evaluate the effect of the sphenopalatine ganglion block (SPGB) with bupivacaine on postoperative pain in patients undergoing endoscopic sinus surgery. Methods and Materials: In this clinical trial, 40 patients who indicated functional endoscopic sinus surgery were selected and then divided into 2 parallel groups as intervention and control. The intervention group was received 1.5 mL of bupivacaine 0.5% (injected to sphenopalatine ganglion) and while control was injected 1.5 mL of normal saline at the same injection site. Also, the visual analogue scale (VAS) was recorded immediately after anesthesia, along with 6, 12, 24, 48 h, 7 days, and 21 days after the operation for all patients.Results Immediately after anesthesia, as well as 6, 12, and 24 h after the operation, VAS in the intervention group was significantly lower than in the control group ( P   .05, for both). Also, the rescue analgesia in the intervention group was significantly lower than in the control group ( P  = .01).Conclusion SPGB with bupivacaine 0.5% (1.5 mL) was a simple, effective, safe, and noninvasive method for the management of postoperative pain in the patients undergoing endoscopic sinus surgery.

A New Promising Third Generation CAR-CD30 T-Cell Therapy for CD30+ Lymphoma

Home-Based Assessment of Patient Reported Outcome Measures Using a Smartphone App Platform: A Feasibility Study

Association of diet and headache

The global prevalence of migraine as a primary headache has been estimated as 14.4% in both sexes. Migraine headache has been ranked as the highest contributor to disability in under 50 years old population in the world. Extensive research has been conducted in order to clarify the pathological mechanisms of migraine. Although uncertainties remains, it has been indicated that vascular dysfunction, cortical spreading depression (CSD), activation of the trigeminovascular pathway, pro-inflammatory and oxidative state may play a putative role in migraine pain generation. Knowledge about pathophysiological mechanisms of migraine should be integrated into a multimodal treatment approach to increase quality of life in patients. With respect to this, within the integrative health studies growing interest pertains to dietary interventions. Although the number of studies concerning effects of diet on headache/migraine is not yet very large, the current article will review the available evidence in this area. All publications on headache/migraine and dietary interventions up to May 2019 were included in the present review through a PubMed/MEDLINE and ScienceDirect database search. According to the current findings, Ketogenic diet and modified Atkins diet are thought to play a role in neuroprotection, improving mitochondrial function and energy metabolism, compensating serotoninergic dysfunction, decreasing calcitonin gene-related peptide (CGRP) level and suppressing neuro-inflammation. It can also be speculated that prescription of low glycemic diet may be promising in headache/migraine control through attenuating the inflammatory state. Moreover, obesity and headaches including migraine could be attributed to each other through mechanisms like inflammation, and irregular hypothalamic function. Thereby, applying dietary strategies for weight loss may also ameliorate headache/migraine. Another important dietary intervention that might be effective in headache/migraine improvement is related to balance between the intake of essential fatty acids, omega-6 and omega-3 which also affect inflammatory responses, platelet function and regulation of vascular tone. Regarding elimination diets, it appears that targeted these diets in migraine patients with food sensitivities could be effective in headache/migraine prevention. Taken together, dietary approaches that could be considered as effective strategies in headache/migraine prophylaxis include weight loss diets in obese headache patients, ketogenic and low-calorie diets, reducing omega-6 and increasing omega-3 fatty acid intakes.

Hospitalized elder abuse in Iran: a qualitative study

Background Elder abuse is a serious violation of human rights and a worldwide issue. Upon hospital admission, elderly patients become vulnerable and susceptible to abuse. Understanding the issues perceived as abuse by the elderly patients and their family members allows us to identify, manage, and prevent elder abuse; especially in hospital settings. The present study aimed to identify and describe the abuse of hospitalized elders from the perspective of patients and their family members. Methods The present exploratory qualitative study was conducted from October 2017 to September 2018 at six different teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The target population was elderly patients in different wards across various hospitals and their family members. Based on the purposive sampling method, 16 hospitalized elderly patients and 11 family members were recruited and interviewed. The data were analyzed using the inductive content analysis method in accordance with the process described by Elo and Kyngas (J Adv Nurs 62:107–15, 2008). Results Based on the analysis of the interview data, four main categories were extracted and classified as Micro-level, Meso-level, Exo-level, and Macro-level issues. Conclusion Hospitalized elder abuse is a multi-dimensional phenomenon caused by personal and professional factors as well as issues related to the inadequate physical environment and organizational structure. To prevent the occurrence of elderly abuse, it is recommended to train hospital staff, rearrange the physical environment, reform the organizational structure, and better plan and manage the financial, physical, and human resources.