Summary Background The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and ...catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received. Methods We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with ESKD published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis. Findings Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident ESKD cohorts, 496 (16%) of 3197 adults in prevalent ESKD cohorts, and 107 (36%) of 294 children with ESKD died or were presumed to have died. 2508 (84%) of 2990 adults in incident ESKD cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent ESKD cohorts. 41 (1%) of 4483 adults in incident ESKD cohorts, 2280 (19%) of 12 125 adults in prevalent ESKD cohorts, and 71 (19%) of 381 children with ESKD received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis Interpretation Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa. Funding None.
Summary Background Access to diagnosis and dialysis for acute kidney injury can be life-saving, but can be prohibitively expensive in low-income settings. The burden of acute kidney injury in ...sub-Saharan Africa is presumably high but remains unknown. We did a systematic review to assess outcomes of acute kidney injury in sub-Saharan Africa and identify barriers to care. Methods We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles published between Jan 1, 1990, and Nov 30, 2014. We scored studies, and all were of medium-to-low quality. We made a pragmatic decision to include all studies to best reflect reality, and did a descriptive analysis of extracted data. This study is registered with PROSPERO, number CRD42015015690. Findings We identified 3881 records, of which 41 met inclusion criteria, including 1403 adult patients and 1937 paediatric patients. Acute kidney injury in sub-Saharan Africa is severe, with 1042 (66%) of 1572 children and 178 (70%) 253 of adults needing dialysis in studies reporting dialysis need. Only 666 (64%) of 1042 children (across 11 studies) and 58 (33%) of 178 adults (across four studies) received dialysis when needed. Overall mortality was 34% in children and 32% in adults, but rose to 73% in children and 86% in adults when dialysis was needed but not received. Major barriers to access to care were out-of-pocket costs, erratic hospital resources, late presentation, and female sex. Interpretation Patients in these studies are those with resources to access care. In view of overall study quality, data interpretation should be cautious, but high mortality and poor access to dialysis are concerning. The global scarcity of resources among patients and health centres highlights the need for a health-system-wide approach to prevention and management of acute kidney injury in sub-Saharan Africa. Funding None.
Introductio
Ce travail avait pour objectif d’évaluer la couverture vaccinale chez les patients en dialyse péritonéale et de déterminer les facteurs associés à la non-vaccination.Patients et ...méthodesIl s’agissait d’une étude multicentrique, rétrospective, descriptive et analytique, réalisée sur une période de 6 mois, dans 4 unités de dialyse péritonéale. Les patients en dialyse péritonéale depuis au moins 3 mois étaient inclus.RésultatsQuarante-neuf patients étaient inclus dans notre étude. Parmi eux 30 (61,2%) étaient vaccinés contre la COVID-19 avec un sex-ratio de 0,8. Il y avait 83% des patients qui avaient reçu 2 doses. Il y avait 63,3% des patients qui avaient reçu le vaccin d’AstraZeneca, 33,3% celui de Sinopharm et 3,4% celui de Johnson & Johnson. Les effets indésirables étaient principalement une douleur au niveau du point d’inoculation dans 100% des cas et un syndrome grippal dans 25% des cas. La raison de la non vaccination était dans 42% des cas une peur des effets secondaires des vaccins et/ou une minimisation de la gravité de la COVID-19. Parmi les patients vaccinés, 2 (6,6%) avaient été testés positifs à la COVID-19 après vaccination dont un avec une forme sévère 3 mois après le vaccin. La moyenne d’âge des patients vaccinés était significativement plus élevée (47,6 ans) que celle des non vaccinés (37,6 ans) (p=0,048).ConclusionIl est primordial de continuer à appliquer les mesures de prévention de la COVID-19 dans les différents centres de dialyse péritonéale et d’encourager la vaccination ou la complétion des schémas vaccinaux notamment chez les plus jeunes.
This paper emphasizes the role of
Panel Analysis of Nonstationarity in the Idiosyncratic and Common components
(PANIC) in purging effects of cross-country correlation and structural instability from ...the convergence equation. In doing so, we run some simulations to show that, in addition to controlling correlations, PANIC handles the presence of a single structural change naturally and then solves the problems of low power that it generates. Applications are also conducted using a sample of 20 OECD member countries and 20 countries in Sub-Saharan Africa.
Renal involvement occurs in approximately 5% of patients with Sjögren’s syndrome (SS). We reported the case of a 20-year-old African woman who was received for paralysis of 4 limbs secondary to ...hypokalemia. The diagnosis of renal tubular acidosis type 1 complicated by hypokalemia was retained. In the etiologic research of renal tubular acidosis type 1, primary SS was retained. The patient received symptomatic treatment based on potassium chloride, sodium bicarbonate, hydration, and a low protein diet. In terms of etiological treatment, she was put on corticosteroid and hydroxychloroquine. The outcome was favorable with correction of acidosis and hypokalemia.
Studies report a high prevalence of hypertension in lupus, reaching up to 74%. The incidence of hypertension in SLE patients is increased with the severity of the kidney damage. This work was carried ...out with the objective of determining the prevalence of hypertension in lupus nephritis and to seek the existence of an association between the presence of a proliferative glomerulonephritis and hypertension. Patients and Methods. This was a case-control study, carried out in the nephrology department of the Aristide Le Dantec University Hospital in Dakar. All records of patients with lupus nephritis over a 10-year period, from January 01, 2007, to December 31, 2016, were included. Results. During the study period, out of 64 lupus nephritis records collected, 28 patients had hypertension, for a hospital prevalence of 43.75%. The mean age of the patients was 30.64 years ± 10.44. There were 24 women and 4 men. The mean systolic blood pressure was 156 mmHg (110–220) and the mean diastolic blood pressure was 100 mmHg (80–130). The mean serum creatinine was 29.48 mg/l ± 24.99. The mean proteinuria was 4.50 g/24 h ± 2.87. Hypertriglyceridemia was observed in one patient. Hypercholesterolemia was present in 3 patients. HDL levels were normal in all patients and elevated LDL levels were noted in all 4 patients. None of our patients had diabetes. Class III was found in 11 cases, class IV in 14 cases, pure class V in 2 cases, and class II in 1 case. Hypertension was associated with the presence of proliferative glomerulonephritis (odds ratio, 7.45; 95% CI, 1.9 to 29.1; p=0.002). Conclusion. Hypertension is common in lupus nephritis. The presence of a proliferative glomerulonephritis is a risk factor for the development of arterial hypertension. Screening and adequate management of hypertension are essential for the prevention of the progression of chronic kidney disease in lupus.
The prevalence of chronic kidney disease and its risk factors is increasing worldwide, and the rapid rise in global need for end-stage kidney disease care is a major challenge for health systems, ...particularly in low- and middle-income countries. Countries are responding to the challenge of end-stage kidney disease in different ways, with variable provision of the components of a kidney care strategy, including effective prevention, detection, conservative care, kidney transplantation, and an appropriate mix of dialysis modalities. This collection of case studies is from 15 countries from around the world and offers valuable learning examples from a variety of contexts. The variability in approaches may be explained by country differences in burden of disease, available human or financial resources, income status, and cost structures. In addition, cultural considerations, political context, and competing interests from other stakeholders must be considered. Although the approaches taken have often varied substantially, a common theme is the potential benefits of multistakeholder engagement aimed at improving the availability and scope of integrated kidney care.
This paper proposes to reflect on the islamisation of Hausa poetry using the example of the wakoki (songs) of Maazou Dan Alalo. Maazou. Born between 1906 and 1910, at Kiyauka, Katsina in today’s ...Nigeria, he died on 29 November 2002. Though not a griot by birth, he became the bard of the chief of his village and later court griot to the Sultan of Damagram (Zinder). Islam, introduced in African milieus and in their cultural expressions, generated new religious and linguistic elements, while also producing novelties in their artistic and literary creativity and productions. One example, in the case of Zinder and of Dan Alalo’s wakoki, is the annexation of Islamic virtues in the praise songs of chiefs in Islamised African societies, in which political and religious time came to overlap. Islam was pressed into service to legitimise political rulers like the sultan. However, the sociocultural and political role of the griot took on a particular hue under colonial rule. Public amusement, panegyric of the great and wealthy took place in the overcast conditions of colonial occupation. In this context, Dan Alalo’s wakoki allow a close-up view of colonial history as lived experience, complete with of a range of inside insights on social dynamics, including changes in the power pyramid, strategies of adaptation and preservation of the elite, of the community, and of people’s dignity in particular. In this enterprise, the griot played – and was aware of playing – an invaluable role: in social commentary, censure and distraction. His multiple functions included providing a sense of continuity, protecting the dignity of local rulers and of the community as a whole, through the catharsis of humour, in particular.
Résumé Introduction :Peu de données sont disponibles dans la littérature concernant les patients en insuffisance rénale terminale traités initialement par hémodialyse chronique puis transférés en ...dialyse péritonéale. Le but de cette étude était d’évaluer les motifs de transfert des patients de l’hémodialyse chronique à la dialyse péritonéale et suivre leur devenir en dialyse péritonéale. Patients et Méthodes : Il s’agit d’une étude rétrospective, descriptive et analytique sur 17 ans au niveau de l’unité de dialyse péritonéale du CHU Aristide Le Dantec. Étaient inclus, les patients de plus de 18 ans en hémodialyse chronique pendant au moins 3 mois, puis transférés en dialyse péritonéale. Les données ont été collectées à partir des dossiers médicaux. Résultats : Vingt-six patients ont été colligés. L’âge moyen à l’initiation de la dialyse péritonéale était de 52,19±15,37 ans. Le sex-ratio était de 0,62. La principale néphropathie causale était la néphroangiosclérose (46,2%). Les motifs de transfert étaient le choix personnel (50%), les problèmes d’abords vasculaires (42,3%), l’intolérance hémodynamique (3,8%) et l’instabilité cardiovasculaire (3,8%). Concernant le devenir : 52,2% des patients étaient décédés, 43,5% remis en hémodialyse et 4,3% transplantés rénal. La moyenne de survie était de 503,000±108,343 jours. Le sexe féminin et l’abord vasculaire transitoire étaient des facteurs de risque de mortalité des patients transférés (OR=0,043 IC à 95% 1,085 ; 148,243 p=0,045) et (OR=0,047 IC à 95% 1,035 ; 112,840 p=0,048) respectivement. Conclusion : Le transfert de l’hémodialyse vers la dialyse péritonéale doit être anticipé dans notre contexte pour réduire la morbi-mortalité de nos patients sous dialyse chronique.
On international spillovers Bianco, Dominique; Niang, Abdou-Aziz
Economics letters,
10/2012, Letnik:
117, Številka:
1
Journal Article
Recenzirano
Odprti dostop
This study investigates the role of international spillovers in generating productivity gains for a panel of 24 OECD countries during the period between 1971 and 2004. We use recent techniques ...developed in a common factor framework to characterize the global interdependence implied by international spillovers and the diffusion mechanisms involved. Consistently with some recent studies in this field, the evidence suggests that there are substantial cross-country spillovers mainly related to R&D and human capital variables, which contribute significantly to productivity.
► We explore the relation between productivity and international spillovers. ► The econometric technique is based on a common factor analysis. ► Knowledge and human capital affect productivity through international spillovers.
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