Introduction: The occurrence of acute decompensation in patients with background chronic kidney disease (CKD) is very common and further worsens the patient's outcome. Because of the limited data on the risk factors and outcomes of acute-on-chronic kidney failure (ACKF), we sought to assess the common causes of acute decompensation in non-dialytic CKD patients necessitating emergency dialysis and to assess the relationship between these risk factors and outcomes. Materials and Methods: We analysed the data of adults ACKF patients admitted to the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, between December 2009 and March 2011. One hundred and sixty-three CKD patients with AKI were recruited. Laboratory data, including complete blood count, biochemical and microbiological analyses, were documented. Two-dimensional and Doppler echocardiography was performed where indicated. Multivariable logistic regression analysis was used to analyse the association between the risk factors for ACKF and in-hospital mortality. Results: The median age was 39 (28–52) years, with male preponderance (76.7%). The common causes of acute decompensation of CKD identified were heart failure (41.7%), malignant hypertension (39.9%), sepsis (35.6%), nephrotoxins (20.9%) and hypovolemia (16. 9.8%). In-hospital mortality was recorded in 34.4% of the patients. Adjusted odds of in-hospital mortality were significantly increased in the presence of heart failure (odds ratio [OR], 2.93 [95%, 1.14–7.55]; P = 0.026) and malignant hypertension (OR, 3.69 [1.15–11.81]; P = 0.028). Conclusion: The risk factors for ACKF such as heart failure and malignant hypertension are also the independent predictors of in-hospital mortality. Given the high mortality rates, aggressive management of these precipitants could be life-saving.

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Conns syndrome is a known cause of secondary hypertension. It is not commonly reported in low-income nations like Nigeria and many cases could be wrongly managed as primary hypertension due to low index of suspicion on the part of the clinicians, inadequate diagnostic tests or non-availability of funds for these tests. This could lead to poor treatment outcome. We present the case management of the patient and reviewed the literature. A 58-year-old male with history of poor blood pressure control, recurrent body weakness and palpitation was referred to the nephrology unit for further management. Examination revealed thickened arterial wall, elevated blood pressure, an enlarged heart and a fourth heart sound. The serum potassium was low, this was corrected. Laboratory investigations revealed elevated urine potassium and serum aldosterone-to-renin ratio. Ultrasound scan showed normal-sized echogenic kidneys, electrocardiogram showed left ventricular hypertrophy (LVH) and echocardiogram showed LVH, mild left ventricular dilatation and mild aortic valve regurgitation. Computed tomography revealed bilaterally enlarged adrenal glands. He was managed for Conns syndrome and responded well to salt restriction, eplerenone and other BP-lowering drugs. This case confirms that with a very high index of suspicion and the availability of specific laboratory tests and advance radiological investigations, more cases of Conns would be diagnosed and patients are more likely to receive better treatment with more favourable outcome.

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Liver cirrhosis (LC) is a disease of the liver characterised by replacement of the normal liver architecture by nodules. It is a disease that is commonly diagnosed at a late stage in Nigeria. Chronic hepatitis B infection is the most common cause of LC in Nigeria, probably followed by chronic hepatitis C virus (HCV) infection and alcohol consumption. LC often transforms to hepatocellular carcinoma (HCC) and this may be diagnosed for the first time at presentation. In fact, most HCC in Nigeria occur on a background of LC in up to 80% of cases. Few cases of LC that are therefore diagnosed at an early stage will need good clinical and laboratory assessment and skilled management to mitigate early transformation to HCC. The pathogenesis and pathogenetic pathways LC transforms to HCC as well as the roles chronic hepatitis B virus and HCV play in the transformation are highlighted. In addition, the detection of early onset of HCC in the cirrhotic liver and the challenges of investigation modalities and treatment are the highlights of this review article.

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Background: In Sub-Saharan Africa, with high rates of infant mortality, only 33% of infants are exclusively breastfed. Objective: This study investigated factors influencing exclusive breastfeeding (EBF) practice among mothers working at a prominent teaching hospital in South West Nigeria. Materials and Methods: One hundred and sixty mothers comprising seven categories of staff were randomly selected from various departments at the teaching hospital in south-Western Nigeria. Demographic data and perceptions of the participants were obtained through the use of a self-structured questionnaire. Data were analysed with SPSS at a 5% level of significance. Results: Participants' mean age was 37.7 ± 5.6 years. Majority (96.3%) of the respondents were aware of EBF practice. Many participants (95%) opined that EBF is economical and the knowledge that it can reduce the risk of premenopausal breast cancer (80.6%) by 50% are the most important encouraging factors. Very busy work schedules and inadequate creche facilities in proximity to the hospital constituted the major constraints to EBF. The practice of EBF for the infants of respondents at the hospital was put at 53.1%. The study showed there is no (P = 0.219) significant relationship between the education level of the mothers and the practice of EBF. This is the same (P = 0.332) with respect to mothers' professions. However, a statistically significant (P = 0.008) relationship between respondents' level of awareness and EBF practice was found. Conclusions: Effective practice of EBF among mothers was mainly hindered by busy work schedules. The promotion of EBF should include programmes involving nursing mothers and other members of the public. Facilities such as crèche should be provided by government and private organisations at various workplaces to make EBF easily practicable.

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Context: The lack of proven treatment for COVID-19 compounded by limitless information on supposed useful remedies has led to a surge in self-medication (SM). A Google Trends search showed that the search for SM and related terms increased during the current pandemic. Aims: The main aims of this study were to explore the prevalence, patterns and determinants of SM amongst residents in an Semi-urban community located in Southern Nigeria, during the COVID-19 pandemic period. Settings and Design: This cross-sectional study was conducted in a semi-urban Nigerian community from April to June 2020. Subjects and Methods: The stratified sampling method was used to select 384 study participants from the five wards in the community. A structured questionnaire was used to obtain socio-demographic data, psychographic information and history of SM since the onset of the pandemic. Statistical Analysis Used: The statistical analysis used was SPSS 22.0 (IBM SPSS Statistics, New York, USA). Results: The overall prevalence of SM was 25.5%; of these, 8.2% self-medicated for prevention or treatment of COVID-19 infection. Chloroquine (CQ) tablets were ingested by 46.6% of those who self-medicated. Those in Class I occupational level had five times the odds of self-medicating compared to those in Class V (P = 0.035). Conclusions: A quarter of the respondents practised SM during the COVID-19 pandemic; one-third of these self-medicated to prevent or treat COVID-19. The most frequent drug used for prophylaxis and treatment of COVID-19 was CQ. Higher income and occupational level were associated with SM.

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