Increased Risk of Migraine among Students with Asthma: Results of Headache and Asthma Study among University Students.

BACKGROUND: Several studies in developed countries have investigated the relationship between migraine and asthma. OBJECTIVE: To examine the relationship between asthma and migraine among university students in a low middle-income country. METHODS: We conducted a cross-sectional study across three universities in the middle belt region of Nigeria. A self-administered questionnaire developed from the International Classification of Headache Disorders was used to screen for migraine. The European Community Respiratory Health Survey (ECRHS) survey tool screened for asthma and its related conditions. Migraine was diagnosed in subjects with recurrent, moderate to severe unilateral throbbing headaches associated with nausea, vomiting, or visual disturbances. Asthma was defined as reporting a previous asthma attack or currently taking asthma medication within the preceding 12 months. RESULTS: The frequency of asthma was significantly higher among those with migraine than those without migraine (28.6% vs. 9.0%). Conversely, migraine was significantly prevalent in participants with asthma (7.1%vs. 1.9%). On multivariate analysis, there were significant associations between migraine and asthma [aOR = 2.56 (95% CI 1.15-5.77)]. Other factors associated with migraine were female gender [aOR = 2.22 (95% CI 1.06-4.65)] and family history of recurrent headache in firstdegree relatives [aOR = 4.03 (95% CI 1.15-5.77)]. CONCLUSION: Our study shows an increased frequency and risk of migraine in participants diagnosed with asthma and vice versa. These results support the bidirectional association between migraine and asthma. Physicians, therefore, should be aware of the possibility of migraine in patients with asthma who complain of headaches.

CONTEXTE: Plusieurs études menées dans des pays développésvont étudié la relation entre la migraine et l'asthme. OBJECTIF: Examiner la relation entre l'asthme et la migraine chez les étudiants universitaires d'un pays à faible revenu intermédiaire. MÉTHODES: Nous avons mené une étude transversale à travers trois universités dans la région de la ceinture centrale du Nigéria. Un questionnaire auto-administré élaboré à partir de la Classification internationale des troubles de la céphalée a été utilisé pour dépister la migraine. L'enquête de la Communauté européenne sur la santé respiratoire (ECRHS) outil d'enquête dépisté pour l'asthme et ses affections connexes. La migraine a été diagnostiquée chez des sujets présentant des maux de tête lancinants unilatéraux récurrents, modérés à sévères associés à des nausées, des vomissements ou des troubles visuels. L'asthme était défini comme la déclaration d'une crise d'asthme antérieure ou en cours de prise médicaments contre l'asthme au cours des 12 mois précédents. RÉSULTATS: La fréquence de l'asthme était significativement plus élevée chez les personnes souffrant de migraine que chez celles sans migraine (28,6% vs 9,0%). Inversement, la migraine était significativement répandue chez participants asthmatiques (7,1 % contre 1,9 %). Sur l'analyse multivariée, il y avait des associations significatives entre la migraine et l'asthme [aOR = 2,56 (IC à 95 % 1,15-5,77)]. Autres facteurs associés à la migraine étaient le sexe féminin [aOR = 2,22 (95 %IC 1,06­4,65)] et antécédents familiaux de maux de tête récurrents chez les parents de premier degré [RA = 4,03 (IC à 95 % 1,15-5,77)]. CONCLUSION: Notre étude montre une augmentation de la fréquence etrisque de migraine chez les participants ayant reçu un diagnostic d'asthme et de viceVersa. Ces résultats soutiennent l'association bidirectionnelle entre migraine et asthme. Les médecins devraient donc: être conscient de la possibilité de migraine chez les patients asthmatiques qui se plaignent de maux de tête. Mots-clés: Migraine, Maux de tête, Asthme, Allergie, Association, Relation.

Magnesium Supplementation did not affect the Antiseizure Property of Ketogenic Diet but Reduced Lipid Dysmetabolism.

BACKGROUND: Ketogenic diets (KD) have been used globally in epilepsy management. Similarly, supplementation of diets with magnesium has been associated with disease prevention and improvement. However, the effect of magnesium (Mg) supplementation in conjunction with KD on epilepsy has not yet been investigated. We hypothesized that magnesium supplementation in KD would improve the effectiveness of the diet. METHODS: Forty-eight male Wistar rats were used for the study. The animals were fed on 4 diet types: I-normal rat chow (ND), II-ND with Mg supplement (ND+Mg), III-medium chain ketogenic diet (KD) and IV-KD with Mg supplement (KD+Mg). Animals in each group were divided into 3: experimental, control and observatory. The experimental drug was intraperitoneal Pentylenetetrazole (PTZ) administered at 25 mg/kg. The rats were observed for 2 hours after the drug administration and induced seizures noted. The levels of serum electrolytes and plasma lipid levels were determined using standard methods. RESULTS: The seizure latency was significantly prolonged 60.8±0.5mins in group III compared with 8.7±2.1mins in group I (p<0.05). The seizure duration was 42.5±2.5mins in group III and 142.3±4.7 in group I (p<0.05). With Mg supplementation, seizure latency was 62.6±1.5mins in group IV and 7.9±0.7mins in group I (p<0.05). The seizure duration was 45.5±4.5min in group IV and 139.3±3.9mins in group II (p< 0.05). The KD-fed rats showed a tendency to develop dyslipidemia as evidenced by elevated Total Cholesterol /HDL and LDL/HDL (2.32±0.32 and 1.19±0.08) in group III, which was reversed in the KD+Mg fed group IV (1.96±0.32 and 1.08±0.09) with p<0.05. CONCLUSION: Mg supplementation of KD did not affect its antiseizure property and does not confer antiseizure effect on ND. Mg supplement showed a tendency to reduce derangement in lipid metabolism associated with KD.

Antiseizure Effects of Ketogenic Diet on Seizures Induced with Pentylenetetrazole, 4-Aminopyridine and Strychnine in Wistar Rats.

The ketogenic diet (KD) is a cheap and effective alternative therapy for most epilepsy. There are paucity of experimental data in Nigeria on the usefulness of KD in epilepsy models. This is likely to be responsible for the poor clinical acceptability of the diet in the country. This study therefore aimed at providing experimental data on usefulness of KD on seizure models.  The study used 64 Wistar rats that were divided into two dietary groups [normal diet (ND) and ketogenic diet (KD)]. Animal in each group were fed for 35days. Medium chain triglyceride ketogenic diet (MCT-KD) was used and it consisted of 15% carbohydrate in normal rat chow long with 5ml sunflower oil (25% (v/w). The normal diet was the usual rat chow. Seizures were induced with one of Pentelyntetrazole (PTZ), 4-Aminopyridine (AP) and Strychnine (STR). Fasting glucose, ketosis level and serum chemistry were determined and seizure parameters recorded. Serum ketosis was significantly higher in MCT-KD-fed rats (12.7 ±2.6) than ND-fed (5.17±0.86) rats. Fasting blood glucose was higher in ND-fed rats (5.3±0.9mMol/l) than in MCT-KD fed rats (5.1±0.5mMol/l) with p=0.9. Seizure latency was significantly prolonged in ND-fed compared with MCT-KD fed rats after PTZ-induced seizures (61±9sec vs 570±34sec) and AP-induced seizures (49±11sec vs 483±41sec). The difference after Str-induced seizure (51±7 vs 62±8 sec) was not significan. The differences in seizure duration between ND-fed and MCT-KD fed rats with PTZ (4296±77sec vs 366±46sec) and with AP (5238±102sec vs 480±67sec) were significant (p<0.05), but not with STR (3841±94sec vs 3510±89sec) respectively. The mean serum Na+ was significantly higher in MCT-KD fed (141.7±2.1mMol/l) than ND-fed rats (137±2.3mMol/l). There was no significant difference in mean values of other serum electrolytes between the MCT-KD fed and ND-fed animals. MCT-KD caused increase resistance to PTZ-and AP-induced seizures, but has no effect on STR-induced seizures. This antiseizure property is probably mediated through GABAergic receptors (PTZ effect) and blockade of membrane bound KATP channels (AP effect) with some enhancement by serum ketosis.

Knowledge and practice of hypertensive patients as seen in a tertiary hospital in the middle belt of Nigeria.

BACKGROUND: Hypertension remains the commonest non-communicable disease in Nigeria and a leading cause of cardiovascular morbidity and mortality. Knowledge and practice among hypertensive patients were therefore assessed as a prelude towards attaining better blood pressure control. MATERIALS AND METHOD: 224 consecutive hypertensive patients were prospectively studied using a pre-tested questionnaire. RESULTS: Majority of the hypertensive patients attending University of Ilorin Teaching Hospital were either traders or business men/women (44.5%). Only 35.8% had their blood pressure well controlled and about 61% were diagnosed for the first time to be hypertensive in the teaching hospital. 34% of the patients commuted a distance of more than 5 km to the hospital to receive antihypertensive care. 52% and 25% of the patients checked their blood pressure monthly and three-monthly respectively. One patient volunteered history of smoking. 48% and 51.8% knew that smoking increases the propensity to develop complications and that exercise is beneficial for the control of blood pressure respectively. Knowledge of the possible complications of hypertension was very poor as 58.9% of the patients scored less than average. Only 41.1% and 1.8% of the patients were aware that excessive salt and fat intake could adversely affect the control of hypertension respectively. CONCLUSION: Blood pressure control is still unacceptably poor among hypertensive Nigerians. This may not be unconnected with the poor knowledge of hypertension and adverse practices by the patients.

Glycated haemoglobin and glycaemic control of diabetics in Ilorin.

OBJECTIVES: With increasing adoption of Western Lifestyle in Nigeria, the incidence of Diabetes Mellitus is on the increase in the country with its attendant complications. The objective of this study was to determine the prevalence of patients at risk of developing diabetic complications in Ilorin, Nigeria, among our patients with diabetes mellitus. METHODS: A cross-sectional study of diabetic patients attending the University of Ilorin Teaching Hospital ted haemoglobin as an index of medium term glucose control was assayed in established diabetics. The result obtained was evaluated against the bench mark HbA1c value of 7.2% for the development of complication. RESULTS: Fifty-six percent of the subjects were females and all of them were forty years and above in age. Only four percent of the patients were below the age of forty years. Seventy-two percent of the subjects had diabetes for less than 10 years. Only female patients had BMI values greater than 30 kg/m2. About 64% of the patients had HbA1c value > 7.2%. More males (73.7%) had HbA1c 7.2% than females (64.5%) (P < 0.05). The patients had a mean HbA1c value of 8.0%, while the mean HbA1c in the control was 5.2%. These two mean HbA1c values gave a P-value of 0.0001 on Student t-test. The female diabetic patients had a mean HbA1c value of 7.8% (SD = 1.96) against the value of 5.1% (SD = 1.13) for the female control patients (P-value of 0.0001). Similarly, the male patients and male control subjects had mean HbA1c values of 8.1% (SD = 1.96) and 5.6% (SD = 1.00) respectively with P-value of 0.0001. The control subjects had a mean fasting blood glucose level of (+/- SD) 4.93 +/- 1.09 mmol/L and the corresponding value for the diabetics was 8.5 +/- 4.2 mmol/L. when these two values were compared we got a P-Value < 0.05. CONCLUSIONS: The mean HbA1c values between the patients and the control subjects were significantly different. Diabetics in our environment with mean HbA1c value of 8.0% are prone to developing complications because of poor glycaemic control. We therefore advise that, periodic estimation ofglycated haemoglobin be carried out along side fasting blood glucose, in our diabetics.

Pattern and outcome of medical admission of elderly patients seen at University of Ilorin Teaching Hospital, Ilorin.

The elderly are increasingly been hospitalised into medical wards in Nigeria and little information is currently available on this group of patients. The objective of this study was to describe the demographic, clinical characteristics and outcome of management of elderly patients admitted into medical wards at the University of Ilorin Teaching Hospital Ilorin, Nigeria. A retrospective study in which hospital records of patients admitted between years 2001 to 2004 were reviewed. Information obtained included gender, occupation, diagnosis, investigations, duration of stay and outcome management. A total of 4113 adults were admitted into the medical wards within the period under review. Of these, 456 were aged 60 years and above. The elderly patients accounted for 11.1% of total hospitalisation into the medical wards. The mean age of the patients was 69 +/- 9 years with male:female ratio of 243:105. The 3 most common diagnoses were: hypertensive heart failure (HHF), 19%; cerebrovascular accident (CVA), 12%; and tuberculosis (TB), 11%. The mean duration of hospitalisation was 15.6 +/- 13.8 days. Cases of mortality had significantly higher value of mean serum potassium, urea and creatinine, compared to those with favourable outcome and were eventually discharged home. A total of 192 patients (55.2%) were discharged home, while 109 (31%) died giving in-hospital mortality of 31.7%. Majority of the deaths (75%) occurred within 14 days of hospitalisation. Significantly higher number of patients died within the first seven days compared to those discharged (P<0.01). The mean duration of hospital stay was 15.6 +/- 13.8 days. Patients with favourable outcome spent a mean of 18.5 +/- 14.1 days while cases of mortality had a mean of 10.4 +/- 8.8 days in hospital before death. Geriatric patients constituted more than a tenth of total hospitalisation into UITH medical wards. They accounted for a significant proportion of in-hospital mortality. Since a third of the death occurred within the first few days of admission, improvement in the management of acute medical cases especially in the elderly is urgent needed. This will ensure survival of greater number of patients and thus reduces mortality.

A 12-year review of cases of adult tetanus managed at the University College Hospital, Ibadan, Nigeria.

In this review, hospital case records of 202 adult tetanus managed between January 1990 and December 2001 in a tertiary institution in Southwestern Nigeria were reviewed. The mean age of the patients was 36.1+/-17.8 years with male:female ratio of 2.2:1 and an overall mortality rate of 64%. Patients with unfavourable outcomes spent 4.5+/-0.41 days compared with 16.6+/-1.2 days by those who survived. Factors associated with poor prognosis are age >60 years (P=0.029), incubation period <7 days (P=0.007), period of onset <48 h (P=0.0001), tachycardia with pulse rate >120/min (P=0.001) and spasm (P=0.002). Gender (P=0.11), post-injury vaccination (P=0.48) and types of antibiotics administered (P=0.49) were not significantly associated with increased mortality. The three most common complications were aspiration pneumonitis, sepsis and urinary bladder obstruction while complications with highest mortality (100%) were sepsis and cardiac arrest.

Andropause: an emerging world health problem.

Andropause is an emerging clinical concept that is gaining an increasing recognition, as the world becomes more aging. The clinical features though subtle are easy to identify and appropriate treatment of diagnosed cases will to a goodextent alleviate a lot of age-related complaints and improve the general quality of life in the elderly men. Low level of clinical suspicion secondary to inadequate knowledge about this clinical entity remains the major obstacle to appropriate treatment. In this review, the literature has been perused and the definition, epidemiology, pathophysiology, clinical features, diagnosis and treatment are outlined.

Prevalence and determinants of erectile dysfunction among people with type 2 diabetes in Ilorin, Nigeria.

STUDY OBJECTIVES: To determine the prevalence and determinants of Erectile Dysfunction (ED) among men with Type 2 diabetes mellitus. MATERIALS AND METHODS: Seventy-seven adult men with Type 2 Diabetes Mellitus were assessed for Erectile Dysfunction using the 'IIEF-5' questionnaire. They were also assessed for the presence of certain clinical factors in other to determine their degree of correlation with ED. RESULTS: The mean age of the study subjects was 56.8(+/-2.4) years. Almost all (96.1%) were married. Forty-four (56.4%) men volunteered a history of Erectile Dysfunction. When assessed with the 'IIEF - 5' questionnaire, the prevalence of any degree of ED was 74% while moderate to severe ED was found in 39(51%) of the patients. The only clinical variables that had statistically significant correlation with ED were the age of the patients (p=0.04) as well as the duration of diabetes (p=0.04). CONCLUSION: - Erectile Dysfunction is a very common condition among men with Type 2 Diabetes mellitus in Ilorin, Nigeria and should therefore be routinely sought for by the clinicians. The two clinical factors that confer significant risk to development of ED, from this study are non-modifiable. More emphasis should therefore be placed on treatment rather than the prevention of this condition.

Diagnosis of gestational diabetes mellitus in Nigerian pregnant women--comparison between 75G and 100G oral glucose tolerance tests.

STUDY OBJECTIVE: To compare the diagnostic performances of 75g and 100g oral glucose tolerance tests in detecting Gestational Diabetes Mellitus in Nigerian pregnant women. MATERIALS AND METHODS: 248 women in 3rd trimester attending antenatal clinic of the Lagos University Teaching Hospital, Lagos, between November 1997 and July 1999 were randomly subjected to standard oral glucose tolerance tests (OGTT). 110 had 100g OGTT while 138 had 75g OGTT. The plasma glucose response (PGR) was assessed and glucose tolerance status of each patient was determined using WHO (1985) criteria to interpret 75g OGTT and National Diabetes Data Group (NDDG) (1979) criteria for 100g OGTT. The PGR in the two study groups were compared. The prevalence rates of GDM using either of the two criteria were evaluated and compared. Incidences of foetal macrosomia in GDM cases diagnosed by either set of criteria were also compared. RESULTS: The mean age of the study subjects was 30.7(+/-4.2) years while the BMI was 25.4(+/-4.9) kg/m2. The mean parity was 1.33. Traditional risk factors for GDM were found in 47.5% of them. The plasma glucose response (PGR) to 100g OGTT was found to be higher than that of 75g OGTT at 1 hour, 2hour and 3 hour sampling times but the difference was only significant at 3rd hour (p values = 0.68, 0.137, 0.007 respectively). The total area under the glucose response curve (AUC) for 75g OGTT was 345.1 (+/-49.5) AAU while for 100g OGTT, it was 363.4(+/-61.4) AAU. The difference was not statistically significant (p value >0.05). The prevalence rate of GDM diagnosed by 75g OGTT was 11.6% while that of 100g OGTT was 4.5 %. The difference was significant (p value = 0.04). The incidence rate of foetal macrosomia among GDM cases diagnosed by 100g OGTT was 66.7% as against 23.1% among those diagnosed by 75g OGTT. Statistical difference could not be determined because of the small number. CONCLUSION: Plasma glucose response to OGTT among Nigerian pregnant women has little or no respect for the load of the glucose administered. 100g OGTT- based NDDG criteria was more stringent than 75g OGTT-based WHO criteria in identifying GDM. However it appears to be more specific for detecting the complications associated with the condition though it will require a larger study to validate this claim.