Abstract
Science thrives on innovation. Necessary change in diagnosis and management approaches can only come through “thinking outside the box”. It will be unusual for things to change if the approach to diagnosis and treatment are static, unless by divine intervention. This journal is committed to bringing to readers’ attention any innovative approach to management to improve the standard of care.
Nephrotic syndrome comprises anasarca, massive proteinuria, hypoalbuminaemia and hypercholestrolaemia. Treatment of the oedema involves use of diuretics and repeated paracentesis combined with the infusion of salt-poor albumin, where available and affordable. Over time, the oedema becomes unresponsive to therapy and this can be a challenge. Peritoneovenous shunting is then considered at this stage. In the study by Hassan and colleagues in Ile-Ife, a modification was introduced whereby the ascitic fluid is drained intermittently into a sterile container and then infused into a peripheral vein using an infusion set as a one-way valve. Twenty six patients underwent the procedure and the authors reported significant changes in body weight, abdominal girth, urinary protein excretion, and serum albumin levels. There was no mortality. Although cost analysis was not carried out and the period of follow up of the patients appeared short, it can be assumed that this would be a very useful therapy for individuals with refractory oedema in nephrotic syndrome.
With the emerging problems of non-communicable diseases in developing countries, non-pharmacological methods are being employed in the form of physical exercises for health promotion. Martins and colleagues reported that supervised work-place exercise appeared superior to “unsupervised exercises-on-prescription” for the reduction of body weight and blood glucose levels in their patients that were followed up for 3 months. This agrees with the known benefits of exercise in preventing diabetes and obesity. Physical exercise has also been noted to improve cognitive performance. Once again, supervised exercise is being recommended as a great health promotion strategy.
Oxidative stress leads to cell death and may have a genetic basis but may be caused by vascular insufficiency, toxic exposure and metabolic damage. It occurs in many neurodegenerative conditions. Owoeye and colleagues, using Wistar rats, have reported on the beneficial effect of tomato pomace powder in the management of induced-sepsis. Tomato contains many active ingredients that promote health and it is available in abundance. It is anticipated that this finding would be translated for use in humans with sustained benefits. Three of the 15 manuscripts published in this issue of the journal have been highlighted. The others are no less interesting and contain one or two lessons that can improve patient management and/or be the subject of future studies.
Prof. A. Ogunniyi
Editor-in-Chief