Epidemiology of low back pain: frequency, risk factors, and patterns in South-South Nigeria.

Introduction: Low back pain (LBP) is a prevalent musculoskeletal condition that poses significant public health challenges. However, its epidemiology in Sub-Saharan Africa, especially in rural settings, remains largely unexplored. This study aimed to determine the epidemiology of LBP in a Nigerian Teaching Hospital. Material and methods: This was a retrospective review of the records of all LBP cases seen at the rheumatology clinic from 2018 to 2022 in a Teaching Hospital in South-South Nigeria. The sociodemographic and clinical data, including disability scores, was extracted from the patients' medical records. The data was analyzed using IBM SPSS version 25, and the level of significance was set at p < 0.05. Results: Among 1,580 patients, 319 (20.2%) reported LBP. The mean age was 59.51 ±10.21, and the peak age incidence was 51-60 years. Low back pain was more prevalent in females (61.4%). Work-related factors (47.3%) such as heavy lifting (26.3%), prolonged sitting (19.4%), and poor posture (27.9%) were the prominent risk factors. Sedentary behavior (11.5%) and obesity (16.9%) contributed. Common clinical manifestations included difficulty standing or bending (73%), walking difficulties (67.7%), sleep disturbances (51.4%), and radicular pain (45.8%). Common etiologies were spondylosis (66.5%), spondylolisthesis (22.3%), disc prolapse (19.4%), spinal canal stenosis (15.4%), muscle spasm (12.2%), and tuberculous spondylitis (9.7%). Acute and chronic LBP constituted 12.2% and 79.9% of cases, respectively. In terms of disability, 33.5% had minimal, 44.5% had moderate, 15.4% had severe, and 6.6% had crippling disabilities. Conclusions: Mechanical causes were the most implicated in LBP. Work-related factors and lifestyle choices contribute to the occurrence of LBP. Adjusting posture and lifestyle modification reduces LBP risk. Understanding its epidemiology is crucial for optimizing care and implementing preventive strategies.

Clinical and laboratory profile of systemic lupus erythematosus patients at a rural tertiary centre in South-South Nigeria: experience from a new rheumatology clinic.

OBJECTIVES: Systemic lupus erythematosus (SLE) is an autoimmune disorder with a poorly understood aetiology. It predominantly affects females and has a variety of clinical manifestations. In Nigeria, there are limited data on the prevalence and burden of the disease. This study aimed to determine the clinical and laboratory profiles of SLE patients seen in a new rheumatology clinic in South-South Nigeria. MATERIAL AND METHODS: This was a retrospective cross-sectional study conducted over five years (January 2016 to December 2020). The case files of patients that satisfied the diagnosis of SLE were reviewed. The diagnosis was based on the 1997 update of the American College of Rheumatology revised criteria for the classification of SLE. The sociodemographic, clinical, and immunological data were extracted from case records. Data analysis was carried out using IBM SPSS statistics® 2012 version 21.0. RESULTS: Fifty-two patients were diagnosed with SLE, giving a frequency of 4.7%. Forty-seven (90.4%) of the study participants were females, with a female-to-male ratio of 9.4 : 1. The mean age of the study group was 28.42 years. The mean duration of disease before diagnosis was 4.04 months with a range of 1-15 months. The patients had various organ system manifestations, with polyarthritis being the commonest (86.5%). Others included mucocutaneous (78.8%), haematological (69.2%), serositis (40.4%), renal (38.5%), and neurological (25%) manifestations. Antinuclear antibody (ANA) assay and anti-double-stranded DNA were positive in 100% and 69.2% of patients, respectively. All patients were placed on steroids, and 96.2% had hydroxychloroquine. None of the patients were on biologic disease-modifying antirheumatic drugs. CONCLUSIONS: This study's results are consistent with data from other African countries. To fully understand the burden and epidemiology of SLE in Nigeria, a larger prospective study is needed.

The impact of ocular manifestations of rheumatoid arthritis on the health-related quality of life and the functional ability of black Africans.

Objectives To determine the patterns, predictors and overall impact of ocular manifestations of rheumatoid arthritis (RA) on the health-related quality of life and disability index. METHODS: A total of 50 Nigerian patients with RA were studied. Full ocular evaluation was done to determine the presence of each defined ocular manifestation of RA. All patients completed the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) questionnaires. RESULTS: The mean ± SD age of the patients was 47.2 ± 12.5 years. A total of 42 cases of ocular diseases were found in 23 (46%) patients. Keratoconjunctivitis sicca was found in 15 (30%) patients; cataract, 13 (26%); scleritis/episcleritis, 4 (8%); disk edema, 4 (8%); glaucoma, 3 (6%); ulcerative keratitis, 1 (2%); vitreitis, 1 (2%); and macula edema, 1 (2%) patient. There is an association of the presence of ocular manifestations with the physical component summary (PCS) [T = - 3.398, P = 0.001] and the mental component summary (MCS) [T = - 2.616, 0.012] of the SF-36 but not with the HAQ-DI (T = 1.685, 0.099). Following multiple regression analysis, the predictors of the presence of ocular manifestations were age greater than 45 years and positive anti-citrullinated protein antibody. Following linear regression analyses, Steinbrocker's functional class independently predicted the PCS while both Steinbrocker's functional class and female sex predicted the MCS. CONCLUSIONS: The development of ocular disorders associated with RA is associated with a significant negative impact on the quality of life of the patients.

A comprehensive analysis of stroke admissions at a rural Nigerian tertiary health facility: Insights from a single-center study.

Objectives: This research intended to examine the demographic and clinical attributes of stroke admissions in a rural Nigerian hospital. Materials and Methods: A retrospective analysis of stroke admissions was conducted over 1 year. All necessary data were obtained from patients' records and SPSS was employed for data analysis. P < 0.05 was deemed significant. Results: There were 52 stroke cases, accounting for 5.9% of medical admissions. The patients' mean age was 62.81 ± 12.71 years, while females constituted 51.9% of cases. Common risk factors included hypertension (76.9%), hyperlipidemia (38.5%), alcohol (26.9%), and diabetes mellitus (26.9%). Clinical manifestations included hemiparesis/plegia (84.6%), altered consciousness (63.5%), slurred speech (61.5%), cranial nerve deficit (61.5%), aphasia (42.3%), and headache (34.6%). Ischemic stroke (71.2%) predominated over hemorrhagic stroke (28.8%). The average hospitalization duration was 17.62 ± 8.91 days, and the mean onset to arrival time was 121.31 ± 136.06 h. Discharge and mortality rates were 82.7% and 13.5%, respectively. The association between stroke subtypes and mortality was significant (P = 0.001). Conclusion: Stroke constitutes a significant portion of medical admissions in Nigeria, with ischemic stroke being more prevalent. High mortality rates underscore the urgent need to manage risk factors to prevent stroke.

Pattern of systemic lupus erythematosus in NIGERIA: a multicentre descriptive hospital-based study.

INTRODUCTION: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with manifestations ranging from mild to life-threatening organ dysfunction. There is wide variability in the reported incidence and prevalence rate globally, particularly in low and middle-income countries. Nigeria had very few isolated reports of SLE from private and public hospitals Therefore, we conducted this large multi-center descriptive study to determine the sociodemographic, clinical profile, laboratory patterns, and treatment among Nigerian lupus patients. METHODS: A retrospective hospital-based study of all SLE patients seen over 4 years (January 2017 to December 2020) was conducted at 20 rheumatology clinics spread across the 6 geopolitical zones of Nigeria. All patients 18 years and above satisfying the American College of Rheumatology (ACR) 1997 and/or the Systemic Lupus International Collaboration Clinics (SLICC) 2012 classification criteria for SLE were enrolled. Patients with other Rheumatic and Musculoskeletal Diseases (RMDs) not in keeping with SLE and Patients with incomplete data were excluded. Data was analysed using SPSS version 23.0 software. RESULTS: A total of 896 patients with SLE were included in the final analysis with a mean age ± SD of 34.47 ± 11 and a female to male ratio of 8.1:1. Synovitis was reported by 61.6% of patients, while 51%, 19.9% and11.4% patients reported acute, sub-acute and chronic lupus rashes respectively. ANA was positive in 98.0% with titers ranging from 1:80 to 1:64,000. CONCLUSION: SLE is not rare in Nigeria. Most patients were female in their 3rd to 4th decades of life. There is a delayed presentation to a rheumatology facility. Arthritis and mucocutaneous manifestations were the most frequent presentation. Key Points •This study presents the first national data on SLE in Nigeria •This study showed that SLE is not rare in Nigeria in contrast to previous reports •There appear to be ethnic disparity in the frequency of lupus among Nigerians •Nigerians with lupus have very high titer of ANA.

Cardiac Tamponade, an Unusual First Presentation of Systemic Lupus Erythematosus: A Case Report in a Rural Tertiary Hospital.

Systemic lupus erythematosus (SLE) is a condition that manifests in a variety of ways. Although pericarditis and pericardial effusion are frequent cardiac manifestations of SLE, cardiac tamponade is rarely reported, especially as the initial manifestation of the disease. We describe a 38-year-old Nigerian lady who presented with three months of progressive dyspnea. She had intermittent fever, tachycardia, tachypnea, hypotension, jugular vein distension, and muffled heart sounds. Echocardiography confirmed cardiac tamponade. The ANA, anti-dsDNA, and anti-Sm antibodies were positive. She had a high ESR and low levels of blood complements. The diagnosis of SLE was established based on the 2019 EULAR/ACR classification criteria. She was treated with intravenous methylprednisolone, oral prednisolone, and hydroxychloroquine after undergoing an emergency echo-guided pericardiocentesis. She responded well to treatment, and she is currently being followed up on an outpatient basis. Clinicians should consider SLE as a differential when evaluating patients with pericardial effusion, as an accurate and timely diagnosis could be lifesaving.

Medical Admissions in a Rural Teaching Hospital in Southern Nigeria: A Retrospective Review.

Background: Hospital-based morbidity and mortality records reflect the health status of host communities. This helps policymakers and industry actors plan and allocate resources for health services, research, training, and development. This study aimed to determine the pattern and outcome of medical admissions in a Nigerian teaching hospital. Methodology: This was a three-year retrospective review from 2019 to 2021.Data on morbidity and mortality were extracted from ward registers. The relevant data was analysed using the IBM SPSS software. Tests were considered significant at p values of less than 0.05. Results: A total of 2544 patients were admitted during the study period. There were 1420 females (55.8%) and 1124 males (44.2%), and the majority (36.9%) of patients were middle-aged. The mean age was 53.81 ± 18.81 years, and the mean duration of hospital stay was 9.07 ± 8.41 days, with 97.2% of the patients spending less than 30 days on admission. Non-communicable diseases (70.6%) were the most common causes of admissions. The top disease-specific causes of admissions were diabetes mellitus with its complications (14.9%), renal failure (11.8%), heart failure (9.2%), hypertension and its emergencies (9.2%), stroke (7.8%) and tuberculosis (7.0%). Cardiology (15.5%), endocrinology (15.1%), nephrology (15.0%), pulmonology (14.8%), and neurology (13.3%) accounted for the majority (86.4%) of the admissions. The major causes of death were renal failure (16.2%), stroke (15.8%), diabetes mellitus and its complications (12.5%) and HIV/AIDS (8.7%). The majority (86.7%) of patients were discharged, 10.4% died, 2.2% were discharged against medical advice, and 0.7% were referred. Conclusion: The study found an increased burden of non-communicable diseases relative to communicable diseases. Effective health education and promotion initiatives must be implemented to combat the impact of the increasing prevalence of these diseases.

Metoclopramide-induced Acute Dystonia Misdiagnosed as an Epileptic Seizure in a Lupus Patient.

Acute dystonic reactions are the most prevalent extrapyramidal adverse effects associated with metoclopramide. It could be mistaken for a variety of other conditions, such as seizures, tetanus, and encephalitis, to name a few possibilities. We present a case of a 26-year-old female misdiagnosed as having an epileptic seizure who was rushed to the emergency unit with an involuntary bilateral upward deviation of the eyes, spasm, stiffness, lateral deviation of the neck, and protrusion of the tongue. Symptoms occurred 36 hours after the commencement of metoclopramide, used to treat nausea and vomiting in the referring hospital. All the laboratory work was normal. The drug was discontinued and 5 mg of intravenous biperiden was administered. The symptoms subsided in about 10 minutes with no recurrence. Metoclopramide-induced acute dystonia not only creates an anxious environment for patients but may also be life-threatening. Due to the high probability of misdiagnosis, detailed drug history and a high index of suspicion are critical in making the correct diagnosis.

Coexistence of Systemic Lupus Erythematosus and Syringomyelia: A Case From a Rural Center in Nigeria.

Systemic lupus erythematosus and syringomyelia are two distinct conditions with different pathogenetic pathways as well as diverse genetic and clinical characteristics. The coexistence of these two conditions has not been previously documented in the literature. We describe a 38-year-old male who presented with progressive bilateral weakness and pain in the lower limbs and loss of sphincteric functions three years following a diagnosis of lupus nephritis. Relevant autoantibody testing, hypocomplementemia, and biopsy-proven membranous lupus nephritis confirmed the diagnosis of systemic lupus erythematosus and magnetic resonance imaging of the spine confirmed the presence of syringomyelia. Therapy for lupus nephritis was instituted accordingly, while the patient was referred for neurosurgical intervention. The mechanism underlying syrinx formation in this patient is uncertain and, thus, further research is critical in this area.

Relationship Between Disease Severity and Resting Electrocardiograms of Adults With Sickle Cell Anemia in a Tertiary Institution in Southern Nigeria.

Introduction Sickle cell anemia (SCA) in adults has many clinical manifestations. These manifestations are due to effects of recurrent hemolysis, anemia, and ischemia-reperfusion injury on various organs, including the heart. These factors determine the severity of the disease. Objectives The aim of the study was to assess the severity of SCA using a scoring system consisting of clinical and laboratory parameters. In addition, the study aimed to determine the electrocardiographic abnormalities in the adult SCA population. Study design This was a cross-sectional, observational study conducted in the medical outpatient clinic of Irrua Specialist Teaching Hospital, Irrua, Nigeria. Methodology Sixty SCA patients who were older than 18 years old were recruited for this study between February 2017 and January 2018. Sixty healthy individuals matched for age and sex were recruited to serve as controls. Patients who were pregnant or having an acute crises were excluded from the study. Each participant had an electrocardiogram and a SCA severity score was calculated using their clinical history and complete blood count. Data analysis was carried out using the IBM Statistical Package for Social Sciences Statistics® software, version 21 (IBM SPSS Statistics for Windows, Armonk, NY) and statistical significance assigned to p-values less than 0.05. Results Severity scores for SCA ranged between 7 and 24, with a mean score of 14.5 ± 4.04. Out of the 60 patients, 14 (23.3%), 39 (65%), and seven (11.7%) participants met criteria for mild, moderate, and severe disease, respectively. Tachycardia, prolonged QTc, and the presence of ST-segment and T-wave abnormalities were significantly associated with severe SCA (p = 0.024, p = 0.027, and p = 0.018, respectively). There was positive correlation between SCA severity scores and P-wave duration (r = 0.327, p = 0.011), QRS dispersion (r = 0.298, p = 0.021), QTc interval (r = 0.332, p = 0.010), and QTc dispersion (r = 0.320, p = 0.013). Conclusion This study demonstrated that moderate and severe forms of SCA are common in our region. Tachycardia, left atrial abnormality, prolonged corrected QT interval, and the presence of ST-segment and T-wave changes are electrocardiographic findings associated with more severe forms of the disease. These abnormalities are significant etiologies of cardiac morbidity and mortality in SCA.

Fibromyalgia in HIV-positive patients in Nigeria: A cross-sectional prospective study.

BACKGROUND: Fibromyalgia is a chronic pain syndrome of unknown etiology characterized by chronic widespread musculoskeletal pain and tenderness. It affects the quality of life of patients and has been associated with the human immunodeficiency virus (HIV). The study aimed to determine the prevalence of fibromyalgia in HIV-positive patients and assess the effect of fibromyalgia on their functional status. METHODOLOGY: This was a cross-sectional study comprising 160 treatment-naive HIV-positive patients and 160 age- and sex-matched HIV-negative controls. The diagnosis of fibromyalgia was based on the 2011 modification of the 2010 American College of Rheumatology diagnostic criteria by assessing the widespread pain index and symptom severity score. The severity of fibromyalgia was assessed with the revised fibromyalgia impact questionnaire. RESULTS: The prevalence of fibromyalgia in HIV-positive individuals was found to be 10.6%, which was significantly higher compared with controls (3.1%; P = .008). There was no significant association between fibromyalgia and age, gender, or occupation. There was a significant relationship between CD4 count levels (P < .001), WHO clinical stage (P < .001), and fibromyalgia. A statistically significant higher score on the Revised FM Impact Questionnaire was found in HIV-positive individuals with fibromyalgia (P < .001). CONCLUSION: The study found that HIV-positive patients had a significantly higher incidence of fibromyalgia than controls and this was related to active indices of HIV disease. Fibromyalgia had a greater clinical impact on HIV patients than in controls. As a result, fibromyalgia should be identified and treated in people living with HIV.