Magnitude of diabetic peripheral neuropathy in Saudi Arabia: a systematic review and meta-analysis.

BACKGROUND: Diabetic peripheral neuropathy (DPN), due to its potential for causing morbidity and disability from foot ulcers and amputations, is increasingly becoming a source of concern in Saudi Arabia and worldwide. However, wide variability exists in the prevalence of DPN reported in previous studies in Saudi Arabia, limiting the utility of existing data in national public health policy. Therefore, the aim of this study was to systematically evaluate the magnitude of DPN in patients living with DM in Saudi Arabia in order to inform policymakers during the implementation of appropriate preventive and treatment strategies for DPN. METHODS: PubMed, Google Scholar, African Journals Online, Scopus, Web of Science, Embase, and Wiley Online Library were searched systematically to acquire relevant articles based on preset criteria. We evaluated heterogeneity and publication bias and employed a random-effects model to estimate the pooled prevalence of DPN from the included studies. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in conducting the meta-analysis. Analysis was performed using the STATA Version 12 software. RESULTS: Twelve studies with a total of 4,556 participants living with DM, of whom 2,081 were identified as having DPN were included in the meta-analysis. The overall prevalence of DPN was 39% (95% CI [30%, 49%]). Subgroup analysis based on diagnostic method showed that prevalence estimates for DPN using screening questionnaires and clinical examination were 48% (95% CI [46%, 50%]) and 40% (95% CI: [38%, 42%]), respectively, while the estimated prevalence using nerve conduction studies was 26% (95% CI [15%, 36%]). CONCLUSION: This study showed a high magnitude of DPN in Saudi Arabia (39%), thus highlighting the need for sustained efforts to reduce the prevalence of diabetes mellitus and DPN in the kingdom.

Prevalence of active epilepsy, lifetime epilepsy prevalence, and burden of epilepsy in Sub-Saharan Africa from meta-analysis of door-to-door population-based surveys.

BACKGROUND: There is marked variation in the prevalence of epilepsy across Sub-Saharan Africa (SSA). In order to accurately estimate the clinical and public health impacts of epilepsy in the region, robust and reliable epidemiological data are required for appropriate estimation of logistical, economical, and social impacts of epilepsy including policy formulation and intervention in the region. OBJECTIVE: We sought to evaluate the prevalence of active epilepsy (AE) and lifetime epilepsy prevalence in SSA using available data collected at community level. METHODS: We carefully searched online databases and identified the required articles using prespecified criteria. Random-effects model (REM) was used to estimate the active and lifetime prevalence from data generated from studies in SSA.. The burden of epilepsy, in terms of the number of people with the disease, was also obtained. Heterogeneity in the analysis was further explored using subgroup analysis and meta-regression techniques. RESULT: A total of 39 and 12 community-based door-to-door surveys addressing AE and lifetime epilepsy, respectively, from different countries of SSA met the inclusion criteria for the study. Random-effects model estimates of overall prevalence of epilepsy were 9 per 1000 persons (95% confidence interval (CI): 8.0-9.9 per 1000 persons) for AE and 16 per 1000 persons (95% CI: 12.3-19.7 per 1000 persons) for lifetime epilepsy. The prevalence was highest in the Central Africa subregion with 30.2 per 1000 persons (95% CI: 6.2 to 66.7 per 1000 persons). The prevalence of AE in the rural settlement was twice that of the urban settlements. About 9,596,551 (95% CI: 8,530,267-10,556,206) people with AE and 17,060,535 (95% CI: 13,115,286-21,005,784) people with lifetime epilepsy live in SSA. CONCLUSION: This study estimates the active (9/1000) and lifetime (16/1000) epilepsy with a remarkable burden of the disease in SSA. However, the prevalence, which is higher in the rural setting, varies within the subregion of SSA.

Prevalence and burden of epilepsy in Nigeria: A systematic review and meta-analysis of community-based door-to-door surveys.

BACKGROUND: Studies on prevalence of epilepsy in Nigeria yielded figures ranging between 3.1 and 37 per 1000, giving one of the widest variations in prevalence of epilepsy world over. In order to accurately estimate clinical and public health impacts of epilepsy in Nigeria, robust and reliable epidemiological data are required for an appropriate estimation of logistical, economical, and social impacts of epilepsy. OBJECTIVE: The objectives of the study were to determine, using meta-analysis, the prevalence of epilepsy by pooling data from community-based door-to-door surveys conducted in various parts of Nigeria, explore the existing variation in prevalence of epilepsy in Nigeria along geopolitical regions and settlement setting of the country, and then evaluate the burden of epilepsy in Nigeria. METHODS: Prevalence estimates were derived from a random effects meta-analysis of observational studies reporting the prevalence of epilepsy in Nigeria. The derived estimate for the prevalence of epilepsy was applied to the total populations in Nigeria to give an estimated burden of epilepsy in Nigeria. RESULT: Nine community-based door-to-door surveys, with quality data from different regions in Nigeria, were included. I-squared (I2) heterogeneity was 88.5%. Random effects model (REM) estimate of overall prevalence of epilepsy from the studies was 8 per 1000 (95% confidence interval (95% CI): 6-10). The prevalence was highest (11 per 1000) in the south western part of the country. It was also higher among the rural (15 per 1000 people) than the urban (6 per 1000) dwellers. The burden of epilepsy in Nigeria, based on the prevalence estimate was 1,280,000 persons (95% CI: 960,000-1,600,000 persons). CONCLUSION: In Nigeria, the estimated prevalence of epilepsy is 8 per 1000 people indicating a substantial burden of the disease in the country.

Economic evaluation of childhood epilepsy in a resource-challenged setting: A preliminary survey.

BACKGROUND: Considerable disease variability exists between patients with epilepsy, and the societal costs for epilepsy care are overall high, because of high frequency in the general population especially in children from developing countries. MATERIALS AND METHODS: A cross-sectional study where children with established diagnosis of epilepsy were interviewed using a semi-structured questionnaire. Prevalence-based costs were stratified by patients' sociodemographic characteristics and socioeconomic scores (SES). The 'bottom-up' and 'human capital' approaches were used to generate estimates on the direct and indirect (productivity losses) costs of epilepsy, respectively. All estimates of the financial burden of epilepsy were analyzed from the 'societal perspective' using IBM SPSS statistics software, version 20.0. RESULTS: The study had 103 enrollees with most in the age group of 0-5years (45.6%). Majority (61.3%) belong to the low socioeconomic class (Ogunlesi SES class IV and V) and reside (80.6%) in an urban setting. The total direct and indirect costs per month were ₦2,149,965.00 ($8497.88) and ₦363,187.80 ($1435.52), respectively. The cost of care per patient per annum was ₦292,794.50 ($1157.29), and the total cost for all the patients per year was ₦30,157,833.60 ($119,200.92). Investigative procedures are the principal cost drivers (₦15,861.17 or $18.15) comprising approximately 58.7% of the total direct costs per patient. CONCLUSIONS: Cost of investigations contributed immensely to the total direct cost of care in our study. With the present economic situation in the country, out-of-pocket payments may contribute significantly to catastrophic expenditures and worsening of secondary treatment gap in children with epilepsy.

Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria.

BACKGROUND: Coma occurring in the course of an illness ordinarily implies a poor prognosis and early prognostication is important for treatment decisions. The study was undertaken to study the factors associated with mortality in nontraumatic coma in a tertiary institution. MATERIALS AND METHODS: In this prospective observational study, adults with clinically confirmed coma Glasgow coma scale (GCS) score of ≤8, admitted consecutively to the emergency unit of a tertiary hospital in Northwestern Nigeria over a period of 18 months were recruited. Vital parameters, severity of coma by GCS and neurological signs were recorded. The etiology of coma was determined on the basis of history, clinical examination, and laboratory investigations. Outcome was determined within 1 month of onset of coma by patients' death or survival. RESULTS: A total of 194 patients (140 males and 54 females) were recruited with mean age was 53.7 ± 1.4. The predominant etiological factors were central nervous system (CNS) infections (28.9%), toxic and metabolic (28.9%), and stroke (23.7%). Overall, 1-month mortality was 49%. On univariate analysis, the factors that showed significant association with outcome were gender, blood pressure, GCS, breathing pattern, pupillary size, pupillary reaction, papiloedema, and abnormal posturing. Abnormal pupillary size, severe hypertension, and GCS score ≤5 were independent predictors of in-hospital 1-month mortality in nontraumatic coma. CONCLUSION: The independent important predictors of nontraumatic 1-month coma mortality in a developing country setting were GCS ≤ 5, abnormal pupillary size, and severe hypertension.

Normative data for ulnar nerve conduction and the influence of gender and height on ulnar nerve conduction velocity in healthy Nigerians.

Background: Despite the usefulness of ulnar nerve conduction studies in identifying disorders of ulnar nerves, there is a lack of normative values for the ulnar nerve in Nigerian population. Objective: The objective of the study was to generate normative values for motor and sensory ulnar nerve conduction studies (NCSs) in Nigerian population and to determine the influence of gender and height on ulnar nerve conduction velocity (NCV). Materials and Methods: A total of 200 healthy volunteers were selected after clinical evaluation to exclude common causes of ulnar neuropathy. We carried out NCS of ulnar nerves on all the healthy volunteers according to a standardized protocol. The NCS parameters included in the final analysis were amplitude, latency, NCV, and f-wave latency. Ethical approval was obtained for the study. Results: The mean ulnar nerve sensory velocity was 55.22 ± 5.67 with 2.5 and 97.5 percentile of 46.9 and 70.1, respectively. The mean latency of the ulnar nerve (sensory) was 2.97 ± 0.62 with 2.5 and 97.5 percentile of 2.00 and 4.52, respectively. The mean amplitude of the ulnar nerve (sensory) was 35.56 ± 9.97 with 2.5 and 97.5 percentile of 15.9 and 57.7, respectively). The ulnar NCV was significantly (P = 0.0202) higher in male. Mild inverse correlation (r = 0.2) was found between ulnar NCV and height of the participants (P = 0.0089). Conclusion: In the Nigerian population, normative values of motor and sensory ulnar nerve conduction parameters are similar to the existing values in the literature. The ulnar NCV appeared to be influenced by height and gender.

Résumé Contexte: Malgré l'utilité des études de conduction du nerf ulnaire pour identifier les troubles des nerfs ulnaire, il y a un manque de normative valeurs pour le nerf ulnaire dans la population nigériane. Objectif: L'objectif de l'étude était de générer des valeurs normatives pour les moteurs et études de conduction sensorielle du nerf ulnaire (NCS) dans la population nigériane et pour déterminer l'influence du sexe et de la taille sur le nerf ulnaire vitesse de conduction (NCV). Matériel et méthodes: Un total de 200 volontaires sains ont été sélectionnés après évaluation clinique pour exclure causes courantes de neuropathie ulnaire. Nous avons réalisé une NCS des nerfs ulnaire sur tous les volontaires sains selon un protocole standardisé.Les paramètres NCS inclus dans l'analyse finale étaient l'amplitude, la latence, la NCV et la latence de l'onde f. L'approbation éthique a été obtenue pour le étude. Résultats: La vitesse sensorielle moyenne du nerf ulnaire était de 55,22 ± 5,67 avec 2,5 et 97,5 percentile de 46,9 et 70,1, respectivement. La moyenne la latence du nerf ulnaire (sensoriel) était de 2,97 ± 0,62 avec 2,5 et 97,5 percentile de 2,00 et 4,52, respectivement. L'amplitude moyenne de l'ulnaire nerf (sensoriel) était de 35,56 ± 9,97 avec 2,5 et 97,5 percentile de 15,9 et 57,7, respectivement). Le NCV ulnaire était significativement (P = 0,0202)plus élevé chez les hommes. Une légère corrélation inverse (r = 0,2) a été trouvée entre la NCV ulnaire et la taille des participants (P = 0,0089). Conclusion: dans la population nigériane, les valeurs normatives des paramètres de conduction du nerf ulnaire moteur et sensoriel sont similaires aux valeurs existantes dans le Littérature. Le NCV ulnaire semble être influencé par la taille et le sexe. Mots-clés: Électromyographie, test de conduction nerveuse, Nigérians, normatif, nerf cubital.

Hemorrhagic infarctive stroke in COVID-19 patients: report of two cases and review of the literature.

There is growing evidence in support of ischemic stroke as a manifestation of COVID-19 infection. However, hemorrhagic transformation of ischemic stroke is rare. We present two cases of hemorrhagic infarction as presenting features in COVID-19 patients who did not have traditional cardiovascular risk factors for ischemic or hemorrhagic stroke. While the hemorrhagic infarct was from a large artery in one of the patients, the other patient had a small artery related hemorrhagic infarct. We highlighted the possible underlining mechanisms from the literature and the implication of hemorrhagic infarct for routine anticoagulant therapy in patients with COVID -19 related ischemic stroke.

Impact of a longitudinal faculty development program on the quality of multiple-choice question item writing in medical education.

Background: Like many other academic programs, medical education is incomplete without a robust assessment plan. Objective: The study aimed to evaluate the impact of longitudinal faculty development program (FDP) on the examination item quality (EIQ) from a cohort of medical college faculty members. Methods: Item analysis (IA) of multiple-choice questions (MCQs) from a cohort of medical tutors over a 3-year period (2017 [S1], 2018 [S2], and 2019 [S3]) before and following once-per-week FDP was conducted. The questions were from three randomly selected courses: man and his environment (MEV) from phase 1, central nervous system (CNS) from phase 2, and internal medicine (MED) from phase 3. Data assessed were 480 MCQs from the final exams in the courses. The parameters considered in IA were the difficulty index, index of discrimination, nonfunctional distractors (NFDs), distractor efficiency for each question item, and Cronbach's alpha (CA) for the test as a whole. Comparison over the 3 years was made using Fisher's exact test and repeated-measures ANOVA with Bonferroni test as post hoc test. Results: Overall, out of 480 MCQs, 272 had no NFD (52 [19.52%], 104 [38.24%], and 116 [42.65%] in 2017, 2018, and 2019, respectively) with a significant difference between S3, S2, and S1 (P < 0.0001). The mean CA for the exams in S1, S2, and S3, respectively, were 0.51, 0.77, and 0.84, P < 0.0001. Conclusion: There was an improvement in EIQ following the implementation of longitudinal FDP. Thus, the need for active training and retraining of the faculty for a better EIQ cannot be overemphasized.

RésuméContexte: Comme beaucoup d'autres programmes universitaires, la formation médicale est incomplète sans un plan d'évaluation solide. Objectif: L'étude visait à évaluer l'impact du programme longitudinal de formation professorale (FDP) sur la qualité des éléments d'examen (EIQ) d'une cohorte de membres du corps professoral des facultés de médecine. Méthodes: Analyse des éléments (IA) des questions à choix multiples (QCM) d'une cohorte de tuteurs médicaux une période de trois ans (2017 [S1], 2018 [S2] et 2019 [S3]) avant et après le déroulement du FDP hebdomadaire a été effectuée. Les questions venaient de trois cours choisis au hasard: l'homme et son environnement (MEV) de la phase 1, le système nerveux central (SNC) de la phase 2 et interne médecine (MED) de la phase 3. Les données évaluées étaient 480 QCM des examens finaux des cours. Les paramètres considérés dans IA étaient l'indice de difficulté, l'indice de discrimination, les distracteurs non fonctionnels (NFD), l'efficacité du distracteur pour chaque question et le alpha (CA) pour le test dans son ensemble. La comparaison au cours des 3 années a été faite en utilisant le test exact de Fisher et l'ANOVA à mesures répétées avec Test de Bonferroni comme test post hoc. Résultats: Dans l'ensemble, sur 480 QCM, 272 n'avaient pas de NFD (52 [19,52%], 104 [38,24%] et 116 [42,65%] en 2017, 2018 et 2019, respectivement) avec une différence significative entre S3, S2 et S1 (P <0,0001). L'AC moyenne pour les examens en S1, S2 et S3, respectivement, était de 0,51, 0,77 et 0,84, P <0,0001. Conclusion: Il y a eu une amélioration de l'EIQ après la mise en œuvre du FDP. Ainsi, la nécessité d'une formation active et d'un recyclage de la faculté pour un meilleur QEI ne peut pas être surestimée.

Methanol induced stroke: report of cases occurring simultaneously in two biological brothers.

Methanol bears semblance to ethanol in smell and taste, thus, individuals who indulge in alcohol may fall back on it in societies where alcohol consumption is illegal or difficult to come by despite the life-threatening neurologic sequelae of methanol toxicity. Stroke is an uncommon outcome of methanol poisoning. We presented two cases of methanol-induced infarctive and hemorrhagic stroke in biological brothers who were simultaneously involved in an illicit ingestion of methanol. One of them developed infarctive stroke while the other had infarctive stroke with hemorrhagic transformation. We have highlighted the differences and similarity in the course of their illnesses.

Neurocysticercosis in people with epilepsy in Sub-Saharan Africa: A systematic review and meta-analysis of the prevalence and strength of association.

PURPOSE: We analyzed studies on neurocysticercosis (NCC) and epilepsy across Sub-Saharan Africa (SSA) to determine the prevalence of NCC in people with epilepsy (PWE) and the strength of association of NCC with epilepsy in the region. METHODS: We conducted a systematic review of the existing literature on NCC and epilepsy in SSA. Diagnostic methods for NCC in the studies selected for our analysis included one or more of the following: positive brain CT, serum ELISA and serum EITB. A common prevalence and overall odds-ratio were then estimated using meta-analysis. RESULTS: A total of 25 (overall) and 20 (case-control) studies met the inclusion criteria for the prevalence and strength of association estimation, respectively. The overall prevalence estimate of NCC in PWE was 22 % [95 % confidence interval [CI]: 17-27.0 %). The figures were higher in the Southern and Eastern Africa sub-region (45 % and 25 % respectively) but lower in the Central and Western Africa sub-region (6 % and 15 % respectively). The prevalence of NCC estimate in PWE varied with method of diagnosis; with 29 % 18 % and 15 % in studies that used a minimum of Brain CT, ELISA and EITB respectively. The overall odds ratio was 2.4 (95 % CI 2.1-2.8), p < 0.0001. CONCLUSION: The overall prevalence of NCC in PWE in SSA was 22 %. The prevalence figure varied with the sub-region of SSA. The odd of NCC in PWE in SSA was 2.4. In spite of the sub-regional variation in NCC prevalence, this meta-analysis suggests that neurocysticercosis contributes significantly to epilepsy in SSA.

Study of electroencephalography in people with generalized epilepsy in a Saudi population.

BACKGROUND: Electroencephalography (EEG) remains a vital tool in the diagnostic evaluation of patients with epilepsy (GE), however, there is scarcity of information on the yield and potential clinical variables that are associated with EEG abnormalities in people with GE. OBJECTIVE: The study aimed to evaluate the yield and pattern of EEG abnormalities in patients with GE with the view to determining factors that are independently associated with abnormal EEG in them. METHODS: We characterized EEG features and evaluated associated factors in a sample of people with GE in a Saudi population. Standard definition of interictal epileptiform discharges was used. RESULTS: A total of 1105 (77%) out of 1436 GE patients had EEG. Five hundred and ninety-five (53.85%) patients had abnormal EEG. Factors associated with EEG abnormalities before adjustment for confounders were age, gender, duration of epilepsy, and seizure frequency. However, only frequency of seizure (P = 0.0018), gender (P < 0.0001), and age (P < 0.0001) were independently associated with EEG abnormalities. CONCLUSION: The study showed a modest yield (54%) of abnormal EEG in the cohort of patients with GE. Frequency of seizure, age, and gender, independently predicted the presence of EEG abnormality in people living with GE.

Electroencephalography abnormalities in generalized epilepsy and their predictors: A multicenter experience.

BACKGROUND: In spite of the overwhelming significance of knowledge of basic elements of electroencephalography (EEG) in its application to the diagnostic workup and the management of patients with suspected or already established generalized epilepsy (GE), there is a dearth of data on the pattern and utility of clinical variables that can independently determine EEG abnormalities in GE. OBJECTIVE: The study was designed to evaluate the frequency and pattern of EEG abnormality as well as assess the utility of clinical variables in predicting the likelihood of an abnormal EEG in GE. METHODS: It was a cross-sectional study involving the analysis of EEGs of consecutive patients with clinical diagnosis of idiopathic GE from three centers over a 7-year period. Information on sociodemographic and seizure variables was obtained. The International Federation of Societies for Electroencephalography and Clinical Neurophysiology definition of interictal epileptiform discharges (interictal epileptiform activity [IEA]) was adopted in the study. RESULTS:: A total of 403 patients comprising 242 (60%) males and 161 (40%) females with clinical diagnosis of GE had EEG. Their age ranged between 2 weeks and 70 years, with a median age of 21 years and an interquartile age of 26 years. Two hundred and thirty-seven (58.8%) and 213 (52.9%) patients had abnormal EEG and IEA, respectively. Before adjustment for confounders, female gender (P = 0.0001), pediatric age group (P = 0.0388), duration of epilepsy of 1-4 years (P = 0.01387), uncontrolled seizure (P = 0.0060), and seizure frequency (P = 0.0001) were significantly associated with the presence of abnormal EEG. However, age, female gender, poor seizure control, and seizure frequencies were the independent predictors of EEG abnormality. CONCLUSION: The study showed that about 58% of patients with GE patients had abnormal EEG. Age, poor seizure control, and high frequency of seizure were independent predictors of the presence of EEG abnormality.

Contexte: Malgré l'importance considérable de la onnaissance des éléments fondamentaux de l'électroencéphalographie (EEG) dans son application au bilan diagnostique et dans la prise en charge des patients atteints d'épilepsie généralisée (GE) suspectée ou déjà établie, on manque de données sur le profil. et l'utilité des variables cliniques qui peuvent déterminer indépendamment les anomalies EEG dans GE. Objectif: L'étude a été conçue pour évaluer la fréquence et le profil de l'anomalie EEG ainsi que pour évaluer l'utilité des variables cliniques dans la prédiction de la probabilité d'un EEG anormal dans GE. Méthodes: Il s'agissait d'une étude transversale impliquant l'analyse des EEG de patients consécutifs avec un diagnostic clinique de GE idiopathique à partir de trois centres sur une période de 7 ans. Des informations sur les variables sociodémographiques et de saisie ont été obtenues. La Fédération internationale des sociétés d'électroencéphalographie et de dé fi nition clinique de neurophysiologie des décharges épileptiformes intercritiques (activité épileptiforme inter-ictale [IEA]) a été adoptée dans l'étude. Résultats: Un total de 403 patients comprenant 242 (60%) mâles et 161 (40%) femelles avec le diagnostic clinique de GE avait EEG. Leur âge variait entre 2 semaines et 70 ans, avec un âge médian de 21 ans et un âge interquartile de 26 ans. Deux cent trente-sept (58,8%) et 213 (52,9%) patients avaient des EEG et IEA anormaux, respectivement. Avant ajustement pour les facteurs confondants, sexe féminin (P = 0,0001), groupe d'âge pédiatrique (P = 0,0388), durée de l'épilepsie de 1 à 4 ans (P = 0,01387), crise incontrôlée (P = 0,0060) et fréquence des crises (P = 0,0001) étaient significativement associés à la présence d'EEG anormal. Cependant, l'âge, le sexe féminin, le faible contrôle des crises épileptiques et la fréquence des crises étaient les prédicteurs indépendants de l'anomalie de l'EEG. CONCLUSION: L'étude a montré qu'environ 58% des patients avec GE avaient un EEG anormal. L'âge, le mauvais contrôle des crises et la fréquence élevée des crises étaient des prédicteurs indépendants de la présence d'une anomalie de l'EEG. Mots-clés: Anomalies, électroencéphalographie, épilepsie, généralisée.

Infratentorial posterior circulation stroke in a Nigerian population: Clinical characteristics, risk factors, and predictors of outcome.

BACKGROUND: Posterior circulation stroke (PCS), though less common, differs from stroke in anterior circulation in many aspects. Relatively, it portends a poorer prognosis. However, there is a paucity of data from African countries, in particular, where stroke is a menace. OBJECTIVE: The study aimed to evaluate the etiology, clinical characteristics, outcome, and predictors of outcome in a cohort of patients with IPCS in Northwestern Nigeria. MATERIALS AND METHODS: Out of 595 patients with stroke, we prospectively analyzed 57 patients with PCS in a Tertiary Care Center in Kano, Northwestern Nigeria. Patients were analyzed for demographic data, risk factors, clinical characteristics, stroke subtypes, mortality, and predictors of mortality. RESULTS: Posterior circulation ischemic stroke accounted for 57 (9.6%) of 595 of all strokes seen in the study period. They comprised 44 males (mean age 47.8 ± 17.7) and 13 females (mean age 46.3 ± 13.7). Overall, their age ranged between 24 and 90 (mean age 47.4 ± 16.7). However, 52.7% of the patients were < 45 years of age. The most common site affected was the cerebellum seen in 33 (57.9%) patients. Hypertension was the most common risk factor (86%). Headache and vertigo were the most common features accounting for 83.6% and 86.3%, respectively. Thirty-eight (66.7%) patients had an ischemic stroke. Twenty-one (36.8%) of the patients died during the 1-month period of follow-up. Independent predictors of death in the study were hyperglycemia on admission and hemorrhagic stroke. CONCLUSIONS: IPCS occurred in a relatively younger age group. Headache and vertigo were the most common symptoms. The independent predictors of death in the study were hyperglycemia at presentation and hemorrhagic stroke.

Depression in patients with epilepsy in Northwestern Nigeria: Prevalence and clinical correlates.

BACKGROUND: The impact of seizure disorder on people living with epilepsy (PWE) is worsened by the occurrence of comorbid psychiatric disorders, such as depression, which have been found commonly in PWE. Despite the dire consequences comorbid depression has on PWE, it still remains underdiagnosed and undertreated. OBJECTIVE: To determine the prevalence of depression and associated clinical factors in PWE in Northwestern Nigeria. MATERIALS AND METHODS: A total of 255 consecutive patients with epilepsy aged 18 years and above, from two health facilities, were recruited in this cross-sectional study. Following completion of a structured proforma detailing sociodemographic and seizure characteristics, Mini International Neuropsychiatric Interview was administered to diagnose depression in the patients. RESULTS: A total of 255 patients, with a mean age of 32 years (standard deviation = 1.31), comprising 147 (57.6%) males and 108 (42.4%) females were studied. Majority (79.2%) of the patients had primarily generalized seizure type. Overall, depressive disorder was present in 52 (20.4%) patients. A significant association was found between previous hospitalization for epilepsy (P = 0.009), increased frequency of seizures, (P = 0.004), and prolonged duration of epilepsy, (P = 0.006). The independent predictors of depression included duration of epilepsy (P = 0.0001), previous hospitalization for epilepsy (P = 0.011), and frequency of seizures (P = 0.028). CONCLUSION: Depression was common in PWE. Female gender, previous hospitalization for epilepsy, increased frequency of seizures and prolonged duration of epilepsy were associated with depression in PWE. Previous hospitalization for epilepsy, increased frequency of seizures, and prolonged duration of epilepsy were independent predictors of depression.

Pattern of in-patient neurologic review: An experience from a Tertiary Hospital North-Western Nigeria.

BACKGROUND: Increase in neurologic diseases burden has increased the demand for neurology services globally, despite the shortcomings of shortage and maldistribution of neurologists worldwide, including Sub-Saharan Africa. This has placed significant pressure on the few available neurologists to provide optimal and effective services in our resource-challenged settings. METHODS: Neurology referrals were prospectively reviewed over a period of 3 months. Sociodemographic characteristics of the patients, the initial diagnosis by the requesting team, the reasons for the consult/referral, the requesting personnel, duration of hospital stay before request, the time interval between receiving the request and review, the working and final diagnosis after the review, and the diagnostic outcome of neurologic review were analyzed using Predictive Analytics Software® version 18.0.0 for Windows (Chicago, Illinois, USA). RESULTS: Fifty-three hand written in-patient requests were reviewed over the period of study given an average rate of 4.4/week. The mean age was 50.8 ± 16.1 years, and the median length of stay before a review was 1 day (interquartile range: 1-2.5 days). Diagnostic outcome of the reviews were; new diagnoses in 4 (11.3%), the incorrect diagnosis changed in 8 (15.1%), contribution to the differential diagnosis in 15 (28.3%), and contribution to management plans in 24 (45.3%) patients. The association between diagnostic outcomes and mortality in our study was not statistically significant (χ2 = 6.66, P = 0.08). CONCLUSION: Our study showed that in-patient neurologic reviews led to significant improvement in diagnostic and management plans. Appropriate policy guidelines should focus more on efficient ways of maximizing benefits of these reviews to patients without overburdening the few available neurologists in our environment.

Related Factors and Predictors of Cognitive Dysfunction in Chronic Kidney Disease on Maintenance Hemodialysis in Nigeria.

BACKGROUND: Previous studies suggest a high frequency of cognitive impairment (CI) in persons with chronic kidney disease (CKD); however, factors associated with CI and predictors of CI in persons with CKD remain largely unclear. The aim of this study was to determine the factors associated with CI and predictors of CI in CKD patients on maintenance hemodialysis. MATERIALS AND METHODS: The first stage of the study included recruitment of 100 apparently healthy participants aimed at determining the reference values. The second stage of the study included eighty CKD patients on maintenance hemodialysis. The iron psychology (FEPSY) was used to assess the memory, psychomotor speed, concentration, and attention using simple auditory reaction time (ART) and visual reaction time (VRT) tasks, recognition memory tests (RMT), finger tapping task (FTT), and binary choice task (BCT). RESULTS: Using normative values generated in this study, 41 (51.3%) and 43 (53.8%) CKD patients had abnormal scores on ART dominant (D) and nondominant (ND) sides, respectively. Forty (50%) and 42 (52.5%) patients had abnormal scores on VRT D and ND sides, respectively. Twenty-one (26.3%) and 68 (85%) had abnormal scores on BCT and computer-assisted visual scanning task, respectively. Sixty-four (80%) and 65 (81.3%) had abnormal scores on RMT (words) and RMT, respectively. Fifty-two (65%) and 48 (60%) patients had abnormal scores on D and ND sides of (FTT), respectively. Factors associated with psychomotor speed impairment were duration of CKD from diagnosis (P = 0.0001 and 0.043 in D and ND ART, respectively), duration on dialysis (P = 0.0001 across board in D and ND ART as well as in D and ND VRT, respectively), and plasma urea (PU) and plasma creatinine (PCr) (P < 0.05). Factors found to be associated with memory impairment included age (P = 0.045 and 0.025 on words and figures RMT, respectively), PU (P = 0.002 and 0.005 on words and figures RMT, respectively), and PCr (P = 0.012 and 0.040 on words and figures RMT, respectively). Duration on dialysis (P = 0.032) and PCr (P = 0.001) were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD. CONCLUSION: Factors associated with psychomotor speed impairment were duration of CKD, duration on dialysis, and PU and PCr while age, PU, and PCr were associated with memory. Duration on dialysis and PCr were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD.

Cognitive function assessment in patients with end- stage renal disease in Nigeria: A single center experience.

AIM: The purpose of this comparative study was to evaluate cognitive function in end-stage renal disease (ESRD) patients in comparison with age, sex, and level of education-matched control. MATERIALS AND METHODS: This is a cross-sectional study involving 80 ESRD patients receiving maintenance hemodialysis treatment and recruited conservatively at the nephrology unit of our hospital. Eighty apparently healthy control, that were matched with the patients for age, sex and education, were also recruited. Following exclusion of depression and severe functional disability, a computer-assisted neuropsychological test, the FePsy, was used to assess  memory, psychomotor speed, concentration and attention using simple auditory and visual reaction time tasks, recognition memory tests (RMTs), finger tapping task, and binary choice task (BCT) for both the ESRD patients and controls. RESULTS: ESRD patients performed worse on simple auditory and visual reaction time tasks (P < 0.05), RMTs (P < 0.05), finger tapping task (P < 0.05), BCT, and computerized visual search task (P < 0.05). CONCLUSION: Performance in memory, psychomotor tasks, concentration, and attention tasks were found to be reduced among patients with ESRD compared with age, sex and level of education-matched control.

Epilepsy and education in developing countries: a survey of school teachers' knowledge about epilepsy and their attitude towards students with epilepsy in Northwestern Nigeria.

INTRODUCTION: Students living with epilepsy still find themselves confronted with social barriers that prevent them from academic achievements. OBJECTIVE: The aim of this study was to evaluate knowledge and attitudes of school teachers and to determine the factors associated with good knowledge and positive attitude among nursery, primary and secondary school teachers in Kano, Northwestern Nigeria. METHODS: A 20-item validated semi-structured questionnaire was self-administered to 200 teachers, selected through multistage sampling technique, in Kano, Northwestern Nigeria. RESULTS: The respondents comprised 124 (62%) males and 76(38%) females. Their age ranged between 17 and 55 with a median age of 26 years. All the respondents have heard or read about epilepsy, 13% have had students with epilepsy in their classes before, fifty one (25.5%) of them would object to having an epileptic child in their class. To one hundred and seventy one (85.5%) all seizures were convulsive, 81% of them admitted to not having adequate knowledge of the initial procedure should their student develop epileptic seizure, 60% believed that epileptic student should be separated from non-epileptic students in the classroom and 44.5% of them preferred alternative medicine. Overall, fifty nine (29.5%) teachers had fair to good knowledge about epilepsy. and one hundred and sixty four (82%) had positive attitude to students with epilepsy. Statistically significant association was found between level of education attained by the respondents and good knowledge about epilepsy as well as between female gender and good attitude. However, none of the variables was statistically significant predictor of knowledge or attitude among the respondents. CONCLUSION: There was low level of knowledge and misconceptions about epilepsy but fair attitude towards epileptic students in Northwestern Nigeria. Higher level of education of the teachers was significantly associated with good attitude.