<h2>What is acute kidney injury?</h2>Acute kidney injury (AKI) is a sudden decrease in the ability of the kidney to filter the blood, resulting in a reduction in urine production. This decrease disturbs the balance of body fluids and electrolytes, causing the body to retain wastes.Although a problem worldwide, acute kidney injury is more common in Africa than elsewhere. Available data indicates that the disease is common among 10 - 40% of adults in sub-Saharan Africa.<h2>Symptoms and signs of AKI</h2>Most patients do not know that they have an acute kidney injury because the condition does not often present with clinical symptoms. However, the following symptoms might be present in some:<ul><li>Decreased urine output</li><li>Edema: generalized body swelling</li><li>Hypertension</li><li>Weakness</li><li>Nausea</li><li>Coma, in severe cases</li></ul><h1>Classification of AKI</h1>Acute kidney injury is classified based on the location of the cause of the injury. The classifications could be:<ul><li>Pre-renal AKI - if the cause of the injury is before the kidney</li><li>Renal or intrinsic AKI - if the injury is within the kidney</li><li>Post renal AKI - if the injury is caused by factors after the kidney, such as the obstruction of the ureter, a tube that carries urine from the kidney to the bladder, by a stone.</li></ul>Only the intrinsic acute kidney injury represents true kidney disease. Pre-renal and post-renal forms of the disease are the consequences of non-kidney diseases that lead to a decreased glomerular filtration rate (GFR).<h2>Stages of acute kidney injury</h2>There are four main stages in the development of an acute kidney injury:<ul><li>Initiation</li><li>Oligo-anuria</li><li>Polyuria</li><li>Restitution</li></ul>These four stages restore kidney functions and should last a maximum period of three months, if the injury does not cause significant damage to the kidney.However, the injury can progress to a chronic kidney disease if it persists for more than three months.<h1>Causes of AKI in sub-Saharan Africa (SSA)</h1>The most common causes of acute kidney injury in Africa include:<ul><li>Malaria</li><li>HIV</li><li>Nephrotoxic agents such as traditional herbal concoctions</li><li>Envenomation from snakebite</li><li>Chronic conditions like diabetes mellitus and hypertension</li><li>Obstetric complications</li><li>Use of skin lightening (bleaching) creams containing mercury</li></ul><h2>Who is at risk of acute kidney injury?</h2>Anyone can come down with acute kidney injury but some classes of people are especially at higher risk. These sets of people include:<ul><li>People living with chronic illnesses like diabetes mellitus, hypertension, and sickle cell disease</li><li>Patients with sepsis</li><li>Patients with poorly treated urinary tract infection</li><li>People who abuse nonsteroidal anti-inflammatory drugs (NSAIDs)</li><li>Elderly patients</li><li>People with blocked urinary tract</li><li>Users of certain antibiotics like aminoglycosides</li><li>Patients with dehydration from diarrhea or exercise</li><li>Patrons of traditional practices that involve lacerations of people with unsterilised tools</li><li>People observing prolonged fasting without water</li><li>Poor people who drink herbal concoctions</li></ul>

The Burden Of Acute Kidney Injury (Aki) In Africa

The human heart pumps approximately 23,000 litres of blood throughout the body daily. Heart failure occurs when the heart fails to pump sufficient blood to meet the body’s needs.This article will explore the causes, prevention, and management of heart failure.<h2>What is heart failure?</h2>Heart failure is a complex clinical syndrome characterized by your heart’s inability to pump blood sufficiently to meet your body’s needs.Initially, your body compensates for the inadequate blood supply through different mechanisms, such as:<ul><li>Enlargement of the heart: your heart stretches to generate a greater force to pump blood.</li><li>Increased heart muscle mass: your heart muscles expand to generate a stronger force of contraction.</li><li>Narrowing of the arteries: your arteries, the blood vessels that carry blood from your heart, may narrow to increase the contracting pressure to help your failing heart maintain arterial pressure.</li><li>Blood shunting: If heart failure is severe, the body may redirect blood from peripheral areas like the skin to vital organs like the heart, kidneys, and brain.</li></ul>Because of these compensatory mechanisms, you may not have symptoms initially. However, the compensation is temporary and may not solve the underlying problem.If the heart failure is not properly managed, the compensatory mechanisms may fail, and you may start to have symptoms like breathlessness, fatigue, persistent dry cough, and other signs of heart failure.<h2>Signs and symptoms of heart failure</h2>Patients with &nbsp;heart failure may have signs and symptoms such as:<ul><li>Shortness of breath</li><li>Dry cough</li><li>Cold extremities with bluish lips</li><li>Pallor</li><li>Tiredness</li><li>Fatigue from &nbsp;minimum exertion</li><li>Swelling of the legs and/or abdomen from fluid retention</li><li>Poor appetite</li><li>Nausea</li></ul><h2>Types of heart failure</h2>Heart failure can be classified based on the location of the failure and the type of heart function that fails.<h3>Heart failure types based on location</h3>You could have either a right-side heart failure or a left-side heart failure.<ul><li>Right-sided heart failure affects the right side of the heart, where the right ventricle pumps blood to the lungs. When the right side fails, blood backs up into the veins, causing your legs, ankles, and abdomen to swell.</li><li>Left-sided heart failure occurs when the left ventricle can’t efficiently pump blood to the rest of the body. Fluid builds up in the lungs, causing shortness of breath.</li></ul>If the heart failure is from both the right and the left ventricles, it is called congestive heart failure.<h3>Heart failure types based on function</h3>Depending on which aspect of heart function that fails, you could experience either systolic heart failure or diastolic heart failure.<ul><li>Systolic heart failure happens when the heart can’t pump blood because it’s weak or enlarged.</li><li>Diastolic heart failure happens when the heart muscle doesn’t relax because it’s stiff, which leads to inadequate filling of the heart.</li></ul><h2>Causes of Heart Failure in Africa</h2>The causes of heart failure in Africa vary across the continent, but the common causes among the general population include:<ul><li>Hypertension</li><li>Coronary artery disease (CAD)</li><li>Cardiomyopathy</li><li>Rheumatic heart disease</li><li>Chronic lung disease</li><li>Pericardial diseases like constrictive pericarditis, pericardial effusion</li><li>HIV</li></ul>Hypertension is the leading cause of heart failure in &nbsp;Nigeria.Unlike hypertension, coronary artery disease (CAD) and its complications are less common in Africa but are gradually becoming more prevalent due to:<ul><li>Lifestyle modifications,</li><li>Smoking</li><li>Drinking of alcohol</li><li>Urbanization</li></ul>Other causes of heart failure include:<ul><li>Excessive salt intake</li><li>Smoking or sniffing tobacco of any kind</li><li>Excessive alcohol intake</li><li>Infection</li><li>Use of certain medications like anticancer drugs, stimulants, etc.</li><li>Autoimmune diseases like lupus erythematosus</li></ul><h2>Risk factors</h2>Risk factors for heart failure in sub-Saharan Africa include:<ul><li>Hypertension</li><li>Diabetes</li><li>Dyslipidaemia</li><li>Kidney disease</li><li>Smoking</li><li>High alcohol intake</li><li>Myocarditis</li><li>HIV</li><li>Pregnancy</li></ul>Other risk factors include:<ul><li>Rheumatic Heart Disease</li><li>Obesity</li><li>Dilated cardiomyopathy</li><li>Anaemia</li></ul><h2>Diagnosis</h2>Your doctor will take your medical history, examine you, and ask you to do:<ul><li>A chest x-ray,</li><li>An ECG (electrocardiogram)</li><li>Blood test</li><li>Echocardiogram</li></ul>A heart MRI or CT scan, PET scan, or angiogram may sometimes be requested.<h2>Treatment and Prevention of Heart Failure</h2>The treatment of heart failure depends on the cause of your heart failure and the type and severity of your heart failure.If the cause is hypertension, you may need to take anti-heart failure drugs plus anti-hypertensives and adjust your diet and lifestyle.If it’s an infection, you may need antibiotics.If the problem is with your heart valves, you may need surgery.If these treatments don’t work, a heart transplant may be recommended for you.Whatever the cause, heart failure management is both pharmacological and non-pharmacological.<h3>Pharmacological management</h3>This type of management includes drugs such as:<ul><li>Angiotensin receptor blockers (ARB)</li><li>Angiotensin-converting enzyme (ACE) inhibitors</li><li>Angiotensin receptor-neprilysin inhibitors (ARNIs)</li><li>Diuretics</li><li>Vasodilators</li><li>Digitalis</li><li>Beta-blockers</li><li>Aldosterone blockers</li><li>Statins</li></ul>The drugs help to<ul><li>Reduce your blood pressure</li><li>Relax your blood vessels</li><li>Reduce the amount of fluid and sodium in your body</li><li>Strengthen the contraction of your heart muscles</li><li>Reduce your heart rate</li><li>Reduce the level amount of unhealthy cholesterol in your blood</li></ul><h3>Non-pharmacological management</h3>This type of management does not include drugs. It only requires you to:<ul><li>Reduce your salt intake</li><li>Reduce your alcohol intake</li><li>Quit smoking</li><li>Exercise regularly as much as you can tolerate</li><li>Control your blood sugar if you’re diabetic</li><li>Reduce your body weight if you’re overweight or obese</li></ul>Heart failure caused by physical damage to the heart may require surgery, such as:<ul><li>Valvular repair or replacement</li><li>Device implantation</li><li>Heart transplantation</li></ul><h2>Complications of Heart Failure</h2>If your heart failure is not treated at all or is treated poorly, it may lead to life-threatening complications like congestive heart failure, which is a failure of both the right and left sides of your heart. This causes worse and more dangerous symptoms.Other complications of heart failure include:<ul><li>Pulmonary hypertension</li><li>Kidney or liver damage</li><li>Cardiac arrest</li><li>Pulmonary oedema</li><li>Irregular heartbeat</li><li>Stroke</li></ul><h2>What is the prognosis of heart failure?</h2>The outlook (prognosis) for heart failure is poor. People with the disease have a life expectancy of about five years from diagnosis, so it’s necessary to seek expert care as soon as you realise that your heart may be failing.<h2>Conclusion</h2>Heart failure is better prevented than treated. Once it has begun, there is no permanent cure, and no treatment can reverse the damage.If you’re at risk, like if you are hypertensive, have diabetes or any other chronic disease, adjust your diet and lifestyle as recommended, and be regular with your drugs and clinical checkups.Having heart failure doesn’t mean the end of the world. You can still enjoy life if you follow the steps outlined in this article and your doctor’s advice.

Heart Failure: Causes, Prevention and Management

Seeing your child’s first smile, watching their initial wobbly steps, and hearing their child begin to form words are all precious milestones that gladdens the heart. This growth comes from nutrients in &nbsp;foods children eat.Children’s food should be rich in essential nutrients delivered in the right balance. When this balance is not maintained or achieved, it can lead to malnutrition which affects the child’s well-being in several ways.Here are some key facts about malnutrition in Nigerian children:<ul><li>Approximately 37% of children (6 million) experience stunting (a condition whereby the child is too short for the age)</li><li>18% of children are affected by wasting (indicating low weight for height)</li><li>29% of children are underweight (which includes both acute and chronic malnutrition)</li></ul><h2>What is malnutrition?</h2>Malnutrition is an abnormality in nutrition. It occurs when there’s an imbalance in a child’s nutrient intake, either because the child takes too much or too little calories, carbohydrates, vitamins, proteins, or minerals. Malnutrition includes both undernutrition and overnutrition, which are consequences of either deficiencies or excesses of vital nutrients.<h2>Why are some children malnourished?</h2>Children are more likely to have shortages of both macronutrients and micronutrients due to their increased nutritional needs during growth. When they don’t get adequate food or don’t eat as they should, they may become malnourished.The consequences of malnutrition in children under five can include being underweight, stunted, or wasted, with or without edema (previously referred to as marasmus and kwashiorkor, respectively), and in severe cases, it can lead to death.Malnutrition represents a critical outcome of food insecurity among children in this age group. Acute malnutrition can result in illness, death, and long-term disabilities, as well as hinder cognitive and physical development, while also increasing the likelihood of concurrent infections.Each year, around 50 million children globally experience acute malnutrition. Despite the availability of treatment, accessing it can be difficult.<h2>Types of Malnutrition</h2>Malnutrition can be categorised primarily into two groups:<ul><li>Overnutrition</li><li>Undernutrition</li></ul><h2>Overnutrition</h2><img src="https://codahosted.io/docs/vGy0vUYPAR/blobs/bl-HxWcwum3M1/4ddf2240c4c154e7769456f036af7c769e0cf788152b81fbbd214f2eb5d3e68e09e94343ea4b014fefdf364c79dade48a04b6207adadca6da43dabf73c0013b1d0c9d77b0a8ae57495aa347b5115f5b100c8050f1e74e5ed8f2ee0769fb6a6325371a5bf" alt="image.webp">Overnutrition occurs when your child consumes more nutrients than their bodies need, resulting in excess body fat and related health risks.Children who are classified as overweight or obese face increased risks for a variety of health issues later in life, including:<ul><li>Heart disease</li><li>Diabetes</li><li>Certain types of cancer</li></ul>The occurrence of overnutrition is rising globally, with reports from unicef indicating that 5.7% of children under five were classified as overweight in 2020, an increase from 5.4% in 2000.<h2>Undernutrition</h2><img src="https://codahosted.io/docs/vGy0vUYPAR/blobs/bl--BNVi_pX26/1063b6bb5a83988cbbe2a0258d55aa28f29b9e04f8fe55023c1bcc1cc72e4bb30a96d54affb2cf8e604b4c6711a4dbf240e770335b1faaa4f0041274ecf11997abab58389b20ed7f6c45bed50faaf00883e7d352e9b639b6e88f3874525379f901c4874d" alt="image.webp">Photo by &nbsp;<a href="https://www.flickr.com/photos/dfid/5977576239">Cate Turton / Department for International Development</a> on <a href="https://www.flickr.com/">Flickr</a><a href="https://creativecommons.org/licenses/by/2.0/">(CC BY 2.0).</a>Undernutrition is when a child is not eating enough food or the right foods to meet their body's needs for energy and good health.Undernutrition poses a serious threat to the health and development of children. It can result in severe outcomes like protein-energy malnutrition, including a greater vulnerability to infections, hindered cognitive and physical growth, and, in extreme cases, death.Undernutrition can be further classified into four categories:<ul><li>Wasting (defined as low weight-for-height)</li><li>Stunting (defined as low height-for-age)</li><li>Underweight (defined as low weight-for-age)</li><li>Deficiencies in essential vitamins and minerals</li></ul>Each of these conditions can have a profound impact on a child's health and development.

Malnutrition in Under 5 Children

Seizure Disorders in Nigerian Children

Children's Health

Because only women have a Cervix, cervical cancer affects women in the cervix, the lower, narrow end of the uterus that connects to the vagina.<ul><li>Around 660,000 women were newly diagnosed with cervical cancer in 2022, making it the fourth most common cancer in women globally.</li><li>Cervical cancer is a largely preventable non-communicable disease, with effective strategies available for primary (vaccination), secondary (early detection), and tertiary (management of diagnosed cases) prevention.</li></ul>Everyone talks about Cancer and almost always generally. Breast cancer, lung cancer, and prostate cancer, these were familiar terms. Not much or anything at all is ever said about cervical cancer.&nbsp;<h3>What is Cervical Cancer?</h3>Cancer is a group of diseases where some of the body's cells grow uncontrollably and spread to other parts of the body.<ul><li>It accounts for death every two minutes and nearly 22.5% of those deaths occur in Africa.</li><li>About 8% of the cancer is associated with infections with high-risk strains of human papillomavirus (HPV)</li><li>More than &nbsp;75,000 new cases and close to 50,000 deaths are reported annually in sub-Saharan Africa</li><li>The World Health Organization projects that by 2030, cervical cancer will claim the lives of more than 443,000 women worldwide, with almost 90% of these fatalities in sub-Saharan Africa.</li></ul>A surge in cervical cancer cases threatens to reverse the advancements made by African women in reducing maternal mortality and enhancing life expectancy.&nbsp;<h1>What causes Cervical Cancer?</h1>The primary cause of cervical cancer is a long-lasting infection with specific types of human papillomavirus (HPV). HPV is a transmitted virus that spreads through sexual contact.Doctors estimate that at least half of sexually active individuals will contract HPV at some point in their lives; however, only a small percentage of women will develop cervical cancer.<h3>Who is at risk for cervical cancer?</h3>Cervical cancer is often associated with identifiable risk factors. Some of these factors can be modified, while others are beyond your control.Here are some risk factors you can control:<ul><li>Sexual intercourse at an early age:</li><li>HPV infection</li><li>HIV infection</li><li>Weakened immune system</li><li>Multiple pregnancies</li><li>Long term use of birth control pills</li><li>Smoking: Cigarette smoking has been linked to a heightened risk of cervical cancer.</li></ul>While these risk factors are controllable, some are not. Example of an uncontrollable risk factor:<ul><li>Family history</li><li>Age</li></ul><h2>How is cervical cancer diagnosed?</h2><img src="https://codahosted.io/docs/k8T9__Kot0/blobs/bl-yrISdcM-gw/49e6af9051a463d1579b8ac42b143c3ae429cf4600c661c8f3e78a62beb3fe9f87ad0f1e9a05b170bc0c3347f027558941ff4c974545d332c26725c961d4c97e11ef404daab8e95695f6e95daa537dd662479fedbe37a9d5528cfa04bac7979b72e593f6" alt="image.png">&nbsp;Her gynecologist had told her that her last heavy flow was due to something called an <a href="https://www.osmosis.org/answers/anovulatory-cycle">anovulatory cycle</a>, which happened because when she had her period her ovaries did not release an egg and It was “nothing to worry about”.&nbsp;So when it happened again in June, she didn’t think much of it until it refused to stop after the expected 3 - 5 days. Mrs B bled for days.&nbsp;She returned to the hospital and had several tests done. A full blood count, an ultrasound scan, her PCV, which indicates the blood level in her body, was normal. The abdominal ultrasound done didn’t show anything abnormal. The labs looked through her results and found nothing extraordinary. Until she did a urinalysis, and they discovered red blood cells in her urine.The doctor again reassured her and recommended she go for a biopsy, where a tiny cut of her cervix will be taken and viewed with a microscope. The biopsy report came back and the unimaginable had happened: Mrs B had cervical cancer.&nbsp;The urinalysis done &nbsp;in the lab, the red blood cells found in her urine, how did they know what it was? Why was her urine unusual today of all days?Cervical cancer develops slowly over many years, hence the need for regular Pap smear.A Pap smear is a process that screens for cervical cancer by collecting cervical cells from the lower part of the uterus that connects to the vagina. It can also reveal precancerous changes in these cells, enabling early intervention when required.The doctor explained to Sola that in the test, the nurse uses a speculum to gently open the vagina, providing access to the cervix. They then collect cell samples using a soft brush or spatula, which they preserve in a solution and send to a laboratory for analysis.The entire process typically takes just a few minutes and may cause slight discomfort, but it is usually not painful.To detect early signs of cancer, if positive, a biopsy is ordered.The biopsy could be any of the following:<ul><li>Colposcopic biopsy</li><li>Loop electrosurgical excision procedure (LEEP)</li><li>Cone biopsy</li><li>Endocervical curettage</li><li>Cold knife cone biopsy</li></ul>An HPV DNA test too can be ordered.When the biopsy test comes out as positive, further investigations would be required to determine if the cancer has spread (metastasized) and to what extent.The other test include:<ul><li>Renal function test</li><li>Liver function test</li><li>X-ray of bladder, bowels, intestines</li><li>Urine Test</li><li>Ultrasound</li></ul><blockquote><h3>Support Groups -</h3>Cancer changes dynamics of life for patient and family.Joining a cancer support group can provide emotional relief and connection with others facing similar challenges. Sharing experiences can help alleviate feelings of isolation.</blockquote>

Cervical Cancer Cases in Nigerian Women.

Women's Health

Dr Udoh WisdomEarly detection of cervical cancer is key to effective treatment, making regular Pap smear screenings essential.The HPV vaccine, now available in three different versions, provides crucial protection against the virus that often leads to cervical cancer.<h3>Early Stages</h3>In its early stages, cervical cancer typically does not present any symptoms, making early detection challenging. Symptoms often emerge only after the cancer has progressed.When early-stage cervical cancer symptoms do manifest, they may include:<ul><li>Irregular vaginal bleeding or heavier menstrual periods</li><li>Vaginal bleeding after menopause</li><li>Vaginal bleeding post-intercourse</li><li>Unusual vaginal discharge that may be watery, foul-smelling, or blood-stained</li><li>Pelvic pain or discomfort during intercourse</li></ul>As cervical cancer advances, symptoms may encompass those of early-stage cancer, along with:<ul><li>Painful or difficult bowel movements</li><li>Bleeding from the anus during bowel movements</li><li>Painful urination</li><li>Blood in the urine</li><li>Persistent lower back pain</li><li>Swelling in the legs</li><li>Abdominal pain</li><li>Fatigue</li></ul>These symptoms can also be found in other conditions other than cervical cancer. Consulting a Doctor is essential for an accurate diagnosis. Delaying treatment for cervical cancer due to ignored symptoms can lead to less effective management.

Dr. Udoh Wisdom

Heart Failure: Causes, Prevention and Management

Malnutrition in Under 5 Children

Stages and Prevention of Cervical Cancer in Nigerian Women