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BACKGROUND: Stroke is the second cause of mortality and the foremost leading cause of disability globally. Many potential biomarkers have been described to contribute to prognosticating the severity in the acute phase of stroke as well as help with risk stratification. Copeptin, an inactive peptide that is produced in an equimolar ratio to arginine vasopressin and adequately mirrors an individual's stress response to acute illnesses like acute ischaemic stroke as evidenced by elevated or increasing levels is being explored in this study to determine its relationship with acute stroke severity and infarct size on admission. METHODS: This is a cross-sectional study of 80 neuroimaging-confirmed acute ischaemic patients who presented within seven days of symptom onset and 80 control subjects. The ischaemic stroke cases had stroke severity and infarct volume determined on admission by the National Institute of Health Stroke Scale (NIHSS) and neuroimaging (brain CT/MRI). A baseline serum copeptin level was measured in the study subjects. Spearman correlation and Kruskal Wallis test were used to determine the relationship between serum copeptin level with admission NIHSS and infarct size respectively. The receiver operating characteristic (ROC) curve was calculated to determine the sensitivity and specificity of copeptin to predict severity and outcome. RESULTS: The mean age of the study group was 61.3 ± 12.7 years with 55.0% males and 45.0% females. The serum level of copeptin was significantly higher in the stroke cases with a median of 28.6 pmol/L (interquartile range (IQR)- 15.4-31.6 pmol/L) versus 8.8 pmol/L (IQR- 3.2- 10.7 pmol/L) among the stroke-free controls (p= 0.001) at a statistically significant level. There was a weak correlation between copeptin and NIHSS calculated at admission to measure stroke severity (r- 0.02, p= 0.873). Patients with infarct sizes in the fourth quartile (infarct sizes greater than 18.78 cm3) had higher copeptin levels, though this was not statistically significant (H= 2.88; p= 0.410). Admission serum copeptin did not show a statistically significant prognostic value in predicting stroke severity and mortality in stroke patients who presented within seven days of symptom onset with an area under curve (AUC) of 0.51 (95% CI: 0.36-0.65; p= 0.982). CONCLUSION: In this study, copeptin was higher among the stroke cases compared with the stroke-free controls which suggests a significant prognostic value in risk stratification in the acute phase of stroke; however, this did not significantly correlate with stroke severity and thus warrants further study in this field to elucidate it's fascinating potential as a prognostic biomarker (especially in the acute period) as this may enable allocation of a better-focused therapy for stroke patients.
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Background: To determine the level of knowledge and challenges associated with learning movement disorders among final-year medical students. Methodology: A cross-sectional survey of 79 final-year medical students at the Madonna University, Elele, Rivers State. Consenting students filled out the study questionnaire, which consisted of socio-demographic variables and questions on the knowledge and challenges of learning movement disorders. Data were collected and analysed using the Statistical Package for Social Sciences Version 20. Results: The mean age of the study participants was 27.41±2.78 years, with a male-to-female ratio of 1.3:1. Almost (91.1%) all the study participants had heard about parkinsonism from their lectures, followed by chorea (88.6%). More than half of the participants knew about one type of movement disorder or the other. Forty-three (54.4%) students expressed difficulty understanding movement disorder lectures. Inadequate exposure to patients with movement disorders and lack of audiovisual aids to enhance learning experience were the greatest challenges in learning movement disorders. Conclusion: Parkinsonism was the most recognized movement disorder among the study participants. More than half of the participants admitted to having challenges with movement disorder lectures. Paucity of movement disorders cases during clinical rotation and lack of teaching aids were cited as major challenges affecting learning and appreciation of movement disorder lectures. Medical educators are encouraged to deploy appropriate methods that optimize learning experience among medical students during movement disorder lectures.
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Background: Stroke is a common neurological disorder with a huge global burden in terms of mortality and morbidity. Epidemiological evidence has shown that modifiable risk factors are responsible for more than 90% of all strokes. Stroke outcome in hospitalized patients is influenced by several variables, such as socio-demographic factors, stroke subtype, and admission severity. The interaction between stroke outcomes and these parameters is often complex. The study is aimed to profile hospitalized stroke patients and determine outcome predictors. Methodology: A descriptive retrospective study of 100 patients hospitalized for acute stroke. Their medical records were reviewed for demographic and clinical variables and relevant data were retrieved and analysed using appropriate statistical methods. Results: Of the 100 acute stroke patients studied, 36% were men and 64% were women. The mean age was 65.16±15.72. About 78%had ischemic stroke while 21% had haemorrhagic strokes. The commonest risk factor was hypertension (71.2%). On multivariate analysis, stroke subtype and admission duration were significantly linked to stroke outcome. Conclusion: Ischemic stroke comprises more than two-thirds of stroke admissions, with hypertension being the most common risk factor and stroke case fatality of 23%. Stroke subtype and admission duration significantly predicted stroke outcomes. The need to step up measures aimed at improving acute stroke care in hospitalized patients is imperative as this will hopefully improve overall outcomes in resource constraint settings such as Nigeria.
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Background: The fear of neurology and neurosciences has been referred to as neurophobia. Neurophobia is a global phenomenon, that is worse in sub-Saharan Africa due to its impact on the already established huge gap in the neurologist-to-population ratio. The need to identify modifiable factors that could curb neurophobia stirred the current study, which aimed to determine the correlates of neurophobia among undergraduate clinical students. Methodology: A cross-sectional design was adopted involving 173 undergraduate clinical students selected via stratified sampling. Content validated, self-administered questionnaire was utilized to obtain data on the perception of neurology, neurophobia, and demographic/academic-related characteristics. Bivariate and multivariate analyses were performed at the 0.05 significant level. Results: The mean age (±SD) of the participants was 25.8(±2.2) years with a male-to-female ratio of 1:1.2. More than half of the undergraduate clinical students perceived neurology as being badly taught (77.5%), difficult to learn (83.2%), and with complex clinical examination (85.5%). The prevalence of neurophobia was 76.3% (n=132). The significant correlate of neurophobia was perceived poor knowledge of neurology. Students with poor perceived knowledge of neurology were about two times more likely to have neurophobia than those with perceived good knowledge (AOR=2.14; 95%CI: 1.04-4.41). Conclusion: Approximately 8 in 10 undergraduate clinical students in Nigeria have neurophobia and the significant determining factor is their perceived poor knowledge. The need to adopt educational models that would strengthen academic prowess in neurology is strongly advocated as most of the students felt that the course was being badly taught. Key Messages: Neurophobia among clinical undergraduate students is rampant, and without timely educational intervention, the existing wide gap in the neurologist-to-population ratio could worsen. Our findings highlight the dire need to institute educational models tailored to attaining better teaching aids, peer discussions, and bedside teaching among clinical undergraduate students.
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Background: Repetitive seizures are neurological emergencies which may occur in people with epilepsy. Ascertaining the incidence of these episodes of such seizures in the community is wrought with many challenges and few reports exist in sub-Saharan Africa, a region with a high burden of epilepsy. The aim of this study was to describe the caregiver reported frequency of acute recurrent seizures in people with epilepsy attending neurology outpatient clinic in Enugu. Methods: This cross-sectional study was performed in the medical out-patient clinics in Enugu Nigeria. Data were collected using a structured questionnaire from an existing epilepsy register. Cluster seizures were defined as frequent repetitive seizures (two or more) occurring more than usual within a week. Epilepsy was defined based on ILAE criteria. Results: A total of 73(45.3%) reported a lifetime history of cluster seizures; similar in males 39(48.1%) and females 34(45.9%). P=0.73. About36.4% and 38.2% of PWE who had a history of traumatic brain injury and stroke had also experienced at least one SC. A large proportion of PWE with SC also had experienced status epilepticus in the past. Seizure cluster was correlated by older age of onset, having various forms of seizures and longer seizure freedom. Conclusions: The reported lifetime history of cluster seizures among people with epilepsy attending a tertiary hospital clinic is high. This may suggest both poor seizure control and severity. Careful patient education will improve both adherence and emergency management of epilepsy to reduce the morbidity of epilepsy in the community.