Analysis of the Cerebrospinal Fluid at Point of Care in Resource-Limited Setting: A Pilot Study.

BACKGROUND: In the face of an emergency, a decision on the need for a timely intervention must be made urgently especially when it has to do with the brain. This study was conducted to determine the usefulness of Urine combistix and glucometer as a "point of care" testing tool in the emergency analysis of cerebrospinal fluid (CSF) in resource-limited settings. METHODOLOGY: In this pilot cross-sectional study, CSF and blood glucose were simultaneously measured using a point of care glucometer and central laboratory. The CSF protein, glucose, blood and leucocytes were also assessed using the urine combistix strips. The CSF/blood glucose ratios obtained at the bedside with a glucometer versus those obtained by the central laboratory were also compared. RESULTS: Turn-around time for glucometer and Combistix analysis was 3.5minutes (3-4mins) versus 360minutes (300- 600minutes) for the laboratory. A strong correlation was observed amongst urine Combistix values for CSF protein, blood, leucocyte and glucose with those obtained from the laboratory (ROC of 0.875, sensitivity:75% and specificity: 100%). In addition, there was significant correlation of the CSF-blood glucose ratios from both the laboratory versus glucometer. CONCLUSION: This pilot study showed that a combination of Combistix analysis for CSF protein, glucose, blood and leucocyte values plus a glucometer analysis of CSF and blood glucose can serve as a reliable and accurate synergistic means for early diagnosis of CSF abnormalities particularly in patients suspected to have meningitis. Finally, it provides a template on which an accurate CSF diagnostic kit can be developed.

Determinants of Health-related Quality of Life in Persons with Epilepsy Seen at a Tertiary Hospital in North Western Nigeria.

INTRODUCTION: There is a growing global concern about the effect of epilepsy on the Health-Related Quality of Life (HRQoL) of the sufferers. AIM: This study assessed the determinants of HRQoL in persons with epilepsy (PWE) in a tertiary hospital in North Western Nigeria. METHODOLOGY: A cross-sectional study was carried out on 103 patients with epilepsy aged ≥ 18 years attending Neurology clinic. Ethical clearance was obtained from the Health Research Ethics Committee of the institution. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was administered to the participants. Statistical significance was set with p value at 0.05. The determinants of HRQoL was obtained by using univariate and subsequent multivariate logistic regression analysis. RESULT: The mean age of patients was 33.4±15.8 years. There were 54(52.4%) males and 49 (47.6%) females. The significant determinants of HRQoLfound were time of last seizure episode (OR = 7.50, 95% CI = 1.36 -41.20, p = 0.021) and social support (OR = 21.5, 95% CI = 3.67 - 125.68, p = 0.001). Following multivariate logistic regression analysis, social support (OR = 29.51, 95% CI = 2.87 - 302.66, p = 0.004) appeared as the independent determinant of HRQoLin PWE. CONCLUSION: Social support was the main determining factor of HRQoL in epilepsy patients in this study. Therefore there is the need to ensure a comprehensive care which should include health education, adequate seizure control and social support for epilepsy patients to improve their HRQoL.

Cardiac autonomic neuropathy in adult epilepsy patients in a tertiary hospital in South-Western Nigeria.

BACKGROUND: Cardiac autonomic neuropathy (CAN) resulting from seizures has been implicated in sudden unexpected death in epilepsy in persons with epilepsy (PWE), however, there are no previous studies of CAN in PWE from Nigeria. OBJECTIVES: This study sought to determine the frequency and pattern of CAN in adult PWE in a tertiary hospital in South-western Nigeria and to determine the relationship between seizure variables and CAN. METHODS: A cross-sectional study of 80 adult PWE and 80 matched controls aged between 18 and 60 years was carried out between March 2012 and June 2013 at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Demographic and clinical data were obtained from all the study participants. Anxiety was excluded using the Hamilton Anxiety Scale. Those with conditions that could affect autonomic function, such as chronic renal failure, heart failure, Parkinson's disease, diabetes mellitus, anxiety, and psychiatric disorders and pregnant women were excluded. Five bedside cardiovascular reflex tests were performed on each subject after baseline heart rate and blood pressure (BP) had been recorded. RESULTS: The mean age of onset of epilepsy was 19 ± 10 years, whereas the mean duration of epilepsy was 10 ± 8 years. The mean seizure frequency was 14 ± 30 per month (median three seizures per month). Of the 80 patients evaluated, 42 (52.5%) had CAN, whereas none of the controls had CAN. Majority (69%) of the PWE with CAN had purely parasympathetic dysfunction, whereas 3% had purely sympathetic dysfunction and 10% had combined autonomic dysfunction. The PWE in this study had significantly lower tilt ratios and diastolic BP change with Isometric Hand grip as well as significantly higher systolic BP change on standing than the controls. Patients who had more than four seizures per month had higher odds of CAN than those with less frequent seizures (odds ratio 0.275, P value 0.023). Also, patients who had received treatment for less than 10 years were found to have greater odds of CAN than those who had received treatment for a longer period (odds ratio 11.676, P value 0.046). CONCLUSION: CAN is common in adult PWE in South-Western Nigeria and the major predictors are short duration of treatment and frequent seizure episodes. Routine screening of these patients may help with early detection of autonomic dysfunction and provide an opportunity for intervention.

Th17 responses to pneumococcus in blood and adenoidal cells in children.

Pneumococcal infections cause a large global health burden, and the search for serotype-independent vaccines continues. Existing conjugate vaccines reduce nasopharyngeal colonization by target serotypes. Such mucosal effects of novel antigens may similarly be important. CD4+ Th17 cell-dependent, antibody-independent reductions in colonization and enhanced clearance have been described in mice. Here we describe the evaluation of T helper type 17 (Th17) cytokine responses to candidate pneumococcal protein vaccine antigens in human cell culture, using adenoidal and peripheral blood mononuclear cells. Optimal detection of interleukin (IL)-17A was at day 7, and of IL-22 at day 11, in these primary cell cultures. Removal of CD45RO+ memory T cells abolished these responses. Age-associated increases in magnitude of responses were evident for IL-17A, but not IL-22, in adenoidal cells. There was a strong correlation between individual IL-17A and IL-22 responses after pneumococcal antigen stimulation (P < 0·015). Intracellular cytokine staining following phorbol myristate acetate (PMA)/ionomycin stimulation demonstrated that  > 30% CD4+ T cells positive for IL-22 express the innate markers γδT cell receptor and/or CD56, with much lower proportions for IL-17A+ cells (P < 0·001). Responses to several vaccine candidate antigens were observed but were consistently absent, particularly in blood, to PhtD (P < 0·0001), an antigen recently shown not to impact colonization in a clinical trial of a PhtD-containing conjugate vaccine in infants. The data presented and approach discussed have the potential to assist in the identification of novel vaccine antigens aimed at reducing pneumococcal carriage and transmission, thus improving the design of empirical clinical trials.

Delirium in Elderly Patients:Frequency and Precipitants in a Tertiary Hospital Setting.

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.

Self-reported Sleep Disorder and Ambulatory Blood Pressure Phenotypes in Patients with or without Chronic Kidney Disease: Findings from Ibadan CRECKID Study.

BACKGROUND: Sleep disordered breathing has been closely linked to pathogenesis, poor control of hypertension, and progression of chronic kidney disease (CKD). Though hypertension and CKD are highly prevalent in Nigeria, the effects of sleep disorders on CKD and hypertension phenotypes have not been widely studied. This study investigated the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD. METHODS: Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP =140mmHg and/or DBP =90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2Equation and CKD was defined as eGFR<60ml/min/1.73m . RESULTS: A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; p<0.0001. CONCLUSION: This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.

Discordant rapid HIV tests: lessons from a low-resource community.

OBJECTIVES: HIV rapid antibody tests are widely used in Africa, but dual testing sometimes produces discordant results. It is not clear if discordant rapid HIV tests should always heighten suspicion by frontline health workers that early HIV infection is present. Some studies have reported that discordant rapid tests have value for identifying early HIV infection in high HIV prevalence populations. It is not known if rapid test performance influenced this conclusion, or if this observation will hold true for low HIV prevalence populations. We therefore explored the occurrence of discordant rapid HIV tests in a low-resource community. METHODS: A cross-sectional sample of HIV status-unaware adults with recent exposure to unsafe sex was assessed using a validated risk-based tool (University of North Carolina (UNC)-Malawi Risk Screening Score) for acute HIV infection. Participants received rapid testing with Determine™ HIV 1/2 and Uni-Gold™ HIV assays, plus plasma HIV-1 antigen testing with the COBAS® Ampliprep/COBAS® Taqman® HIV-1 assay, followed by western blot in those with detected HIV-1 antigen. RESULTS: Of 408 participants, 1.0% were confirmed to have established HIV infection. The discordance between rapid tests at initial screening was 2.45 and 2.94% when the two assays were used sequentially and simultaneously, respectively. Discordant rapid tests were strongly associated with risk scores > 2 [odds ratio (OR) 10.88; 95% confidence interval (CI) 2.35-50.43], and with detected HIV-1 RNA (OR 26.06; 95% CI 3.91-173.60). CONCLUSIONS: When the sample occurrence of discordance between the first and second tests is below 5%, discordant rapid tests in an adult with sexual risk behaviour should trigger strong suspicion of early HIV infection in low HIV prevalence populations.

Profile of HIV/AIDS Neurocognitive Impairment among HIV Positive Patients in North Central Nigeria.

BACKGROUND: Human Immunodeficiency Virus (HIV) dementia is an important complication in persons with HIV/AIDS, manifesting as neurocognitive and functional impairments which are detectable on neuropsychological testing. OBJECTIVE: To determine the profile of HIV/AIDS neurocognitive impairment and associated risk factors among adults with HIV infection in our center and determine its associative factors. METHODS: A total of 87 HIV-seropositive patients, aged between 18- 59 years were studied. Eighty seven (87) age, sex and education-matched HIV-seronegative individuals were recruited as controls. Clinical assessments were done using standardized questionnaires developed by the AIDS Clinical Trial Group (ACTG A5199). The study participants were screened for HIV associated dementia using the International HIV dementia scale (IHDS) and a 5-test neuropsychological battery. The scores of the neuropsychological parameters of the control subjects provided the normative data. The scores of the HIV-positive participants were compared against normative data. Multivariate logistic regression was carried out to determine significant predictors to HIV-associated neurocognitive impairment. RESULTS: The frequency of neurocognitive impairment from this study was 37.9%. Nineteen (2I.8%) patients had asymptomatic neurocognitive impairment (ANI), ten (11.5%) had mild neurocognitive disorder (MND) and four (4.6%) had HIV- associated dementia (HAD). There was a statistically significant difference in the test scores of all the cognitive domains between the persons living with HIV/AIDS and those without HIV infection, being higher in the HIV-subjects. Increased viral load and HIV positive patients not being on HAART were significantly associated with HIV-associated neurocognitive impairment (P<0.05). CONCLUSION: The frequency of neurocognitive impairment in HIV patients was quite high. Increased viral load and lack of treatment were associated factors, suggesting a need for early initiation of HAART. Neuropsychological testing will help identify the patients who need additional support in activities of daily living.

Cerebral Venous Thrombosis, Protein S Deficiency and Pregnancy Triad:A Case Report.

BACKGROUND: Cerebral venous sinus thrombosis (CVT) is an uncommon cause of stroke that is more prevalent among young adults and more so among women. Being an unusual site for venous thrombosis, its occurrence usually implies the presence of a thrombophilic disorder, inherited or acquired. Occasionally, multiple inherited or acquired risk factors for hypercoagulability may co-exist. In this report we present a case manifesting the triad of protein S deficiency, pregnancy and imaging-confirmed extensive CVT. CASE PRESENTATION: A 28-year-old primigravid woman presented with acute onset of severe headache, protracted vomiting, reduced consciousness, spastic quadriparesis and bilateral papilloedema. The serum D-Dimer assay was markedly elevated and brain computerized tomography scan revealed extensive thrombus involving superior and inferior sagittal sinuses, the straight sinus, the confluence of sinuses as well as the left transverse sinus. A hypercoagulability panel revealed protein S deficiency. She was treated with cerebral decompression and subcutaneous enoxaparin with remarkable clinical improvement in muscle power and consciousness level. Her pregnancy and delivery were otherwise normal. CONCLUSION: Hypercoagulability should be suspected in a pregnant woman presenting with stroke and a high index of suspicion is needed in making accurate diagnosis. The case highlights the importance of brain imaging in confirming the diagnosis.

Epidemiology of active epilepsy in a suburban community in Southeast Nigeria: A door-to-door survey.

CONTEXT: Epilepsy is one of the most common neurologic conditions afflicting an estimated 65 million people the world over. Current community-based data on the prevalence of active epilepsy in Africa are sparse. AIMS: This study was aimed at determining the prevalence and profile of active epilepsy in a suburban community in Southeast Nigeria. METHODS: It was a two phase cross-sectional descriptive study. In the first phase, those with possible active epilepsy were identified in a door-to-door survey using a modification of the World Health Organization Neuroscience research protocol. In the second phase, cases of active epilepsy were identified and the clinical forms of epilepsy diagnosed based on the International League against Epilepsy guidelines 1993. RESULTS: A total of 6,800 persons was screened in the first phase of the study. There were 29 cases (16 males and 13 females) of active epilepsy. The point prevalence of active epilepsy was 4.3/1,000 (95% confidence interval (95% CI): 2.7-5.9) for the total population, 4.9/1,000 (95% CI: 2.5-7.3) for males and 3.7/1,000 (95% CI: 1.7-5.7) for females. The age-adjusted prevalence for the total population was 4.1/1,000 (US Population 2000). Classified using clinical criteria only, generalized seizures occurred in 62.1% (n=18) while partial seizures occurred in 37.9% (n=11) of cases. CONCLUSIONS: The prevalence of active epilepsy in Southeast Nigeria is comparable to that found in developed and some developing countries but less than that reported in suburban Southwest Nigeria about three decades ago.

Seizure severity and health-related quality of life of adult Nigerian patients with epilepsy.

OBJECTIVES: There is paucity of information about the association of seizure severity and quality of life in people with epilepsy (PWE) in sub-Saharan Africa. We evaluated the relationship of seizure severity to health-related quality of life of patients with epilepsy being followed up in an outpatient neurology clinic in southwestern Nigeria. MATERIALS AND METHODS: Eighty-eight consecutive patients with epilepsy who met the recruitment criteria completed the study questionnaire in company of an eyewitness. The study questionnaire comprised of the National Hospital Seizure Severity Scale (NHS3), the Quality of Life Inventory in Epilepsy (QOLIE-31), and the Beck's Depression Inventory-II (BDI-II). RESULTS: We found a minute association between seizure severity and QOLIE-31 total score (r = -0.262, P = 0.014). Increased seizure severity predicted a worse QOLIE-31 seizure worry (R(2) = 0.311, ß = -0.289; P = 0.003). Of the seven seizure severity items, generalization of seizures and presence of falls were items that predicted a worse QOLIE-31 seizure worry score and time to recover predicted a worse QOLIE-31 total score. CONCLUSIONS: Reducing seizure severity may be an alternate endpoint in epilepsy care in Nigeria (particularly difficult to control seizures) because of its practical clinical relevance in view of the fact that state-of-the-art epilepsy care is still farfetched.

Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case-control study.

Background: Smoking is a major risk factor for the global burden of stroke. We have previously reported a global population attributable risk (PAR) of stroke of 12.4% associated with current smoking. In this study we aimed to explore the association of current tobacco use with different types of tobacco exposure and environmental tobacco smoke (ETS) exposure on the risk of stroke and stroke subtypes, and by regions and country income levels. Methods: The INTERSTROKE study is a case-control study of acute first stroke and was undertaken with 13,462 stroke cases and 13,488 controls recruited between January 11, 2007 and August 8, 2015 in 32 countries worldwide. Association of risk of tobacco use and ETS exposure were analysed with overall stroke, ischemic and intracerebral hemorrhage (ICH), and with TOAST etiological stroke subtypes (large vessel, small vessel, cardioembolism, and undetermined). Findings: Current smoking was associated with an increased risk of all stroke (odds ratio [OR] 1.64, 95% CI 1.46-1.84), and had a stronger association with ischemic stroke (OR 1.85, 95% CI 1.61-2.11) than ICH (OR 1.19 95% CI 1.00-1.41). The OR and PAR of stroke among current smokers varied significantly between regions and income levels with high income countries (HIC) having the highest odds (OR 3.02 95% CI 2.24-4.10) and PAR (18.6%, 15.1-22.8%). Among etiological subtypes of ischemic stroke, the strongest association of current smoking was seen for large vessel stroke (OR 2.16, 95% CI 1.63-2.87) and undetermined cause (OR 1.97, 95% CI 1.55-2.50). Both filtered (OR 1.73, 95% CI 1.50-1.99) and non-filtered (OR 2.59, 95% CI 1.79-3.77) cigarettes were associated with stroke risk. ETS exposure increased the risk of stroke in a dose-dependent manner, exposure for more than 10 h per week increased risk for all stroke (OR 1.95, 95% CI 1.69-2.27), ischemic stroke (OR 1.89, 95% CI 1.59-2.24) and ICH (OR 2.00, 95% CI 1.60-2.50). Interpretation: There are significant variations in the magnitude of risk and PAR of stroke according to the types of tobacco used, active and ETS exposure, and countries with different income levels. Specific strategies to discourage tobacco use by any form and to build a smoke free environment should be implemented to ease the global burden of stroke. Funding: The Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, and through unrestricted grants from several pharmaceutical companies with major contributions from Astra Zeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MERCK, Sharp and Dohme, Swedish Heart and Lung Foundation, UK Chest, and UK Heart and Stroke.

Epilepsy treatment gap: prevalence and associated factors in Southeast Nigeria.

OBJECTIVES: The treatment gap of epilepsy in developing countries is high, and data on the magnitude and causes of epilepsy treatment gap in Africa are sparse. We aimed to determine the prevalence and causes of epilepsy treatment gap among people with epilepsy in a Suburban community in Southeast Nigeria. MATERIALS AND METHODS: The direct method was used to determine epilepsy treatment gap in a two-phase cross-sectional study. Those with probable epilepsy were identified in a door-to-door survey using a modification of World Health Organization (WHO) protocol in the first phase. In the second phase, an epilepsy-specific questionnaire that was further designed to determine the magnitude and causes of epilepsy treatment gap was used. RESULTS: The overall treatment gap of epilepsy was 76% (n = 22/29). The major contributors to the overall treatment gap were people who were never diagnosed accounting for a diagnostic gap of 38% (n = 11/29) and those who were diagnosed but discontinued antiepileptic drug (AED) treatment of their own volition accounting for a therapeutic gap of 38% (n = 11/29). CONCLUSIONS: Epilepsy treatment gap in Southeast Nigeria is comparable to that in many developing countries. Fifty percent of the overall treatment gap was caused by patients discontinuing AED treatment of their own volition despite continuing fits. This result may indicate that perhaps with appropriate education on the need to adhere to therapy, the treatment gap in the community may be narrowed.

Illness concept among people with epilepsy and their caregivers and preferred treatment methods in a suburban community in Southeast Nigeria.

BACKGROUND: Epilepsy, one of the world's most prevalent chronic diseases is still regarded as a supernatural disease in many parts of the world. These superstitious and cultural beliefs tend to influence treatment seeking behavior of people living with epilepsy (PWE) and their caregivers. STUDY DESIGN: People living with epilepsy in a semi-urban community in Southeast Nigeria were identified in a two phase door-to-door cross-sectional descriptive study. Those identified and their caregivers were further interviewed to determine their concepts of the disease, their treatment (actual and preferred) and what informed treatment. RESULTS: We found 29 cases of active epilepsy, 16 (55.2%) males and 13 (44.8%) females. Witchcraft was held as a major cause of epilepsy in the community accounting for 36.2% (n=17) of the responses. The three major treatment modalities used were spiritual (healing churches), traditional (herbal medicines) and orthodox treatment with antiepileptic drugs. Spiritual treatment was the preferred treatment modality, though most (89.7%) have used traditional (herbal medicine) treatment at one point in the course of the disease. Beliefs on epilepsy and information on the disease obtained mostly from non-medical sources informed treatment. CONCLUSION: The epileptic population studied preferred spiritual treatment though use of traditional treatment was also common. Treatment seeking behavior was greatly influenced by their beliefs and information on the disease obtained mainly from non-medical sources.

The frequency and pattern of cardiac autonomic neuropathy (CAN) in type 2 DM patients in a diabetic clinic in Enugu South-East Nigeria.

STUDY OBJECTIVES: To determine the frequency, pattern and grades of cardiac autonomic neuropathy (CAN) in type 2 diabetic patients in a diabetes mellitus (DM) clinic in Enugu South-East Nigeria. METHODS: A cross sectional study of seventy (70) type 2 diabetic patients attending a DM clinic in Enugu South-East Nigeria was carried out. Cardiac autonomic function was determined using a battery of 5 noninvasive tests which include; Heart rate response (HRR) to Valsalva manoeuvre, HRR to deep breathing, HRR to standing, Resting heart rate, and Blood pressure (BP) response to standing. RESULTS: The frequency of cardiac autonomic neuropathy (CAN) in type 2 diabetic patients was 44.3%. Resting tachycardia was the most specific, HRR to Valsalva manoeuvre was most sensitive while BP response to standing had the best positive predictive value in detecting cardiac autonomic neuropathy. CONCLUSIONS: Cardiac autonomic neuropathy is a common complication in type 2 Diabetes Mellitus patients seen at Enugu. It is therefore recommended that tonomic function tests be part of the standard care of type 2 diabetic patients and appropriate management instituted for both primary and secondary prevention.

THE EARLY PHYSICIANS OF IBADAN MEDICAL SCHOOL: PROFESSOR ALEXANDER BROWN.

The paper chronicles the life and times of Professor Alexander Brown, the Foundation Professor and Head of the Department of Medicine at the University of Ibadan. The official opening of the University College Ibadan, Nigeria on 20 November 1957 as well as the graduation of the first set of clinical students in 1960 were glorious moments for Alexander Brown who laboured for 12years to witness these. He was also instrumental to the creation of the Department of Paediatrics (1962), Department of Radiology (1963) and the Medical Illustration unit of the hospital. Paediatrics and Radiology were initially units in the Department of Medicine. He played significant role in the development of postgraduate programmes in Cardiology, neuropsychiatry and nephrology units of the hospital and substantial role in the development of nursing education in the hospital. He was the brain behind the famous Ibarapa Community Health Project.

Hypertension and incident dementia in community-dwelling elderly Yoruba Nigerians.

OBJECTIVES: To investigate the relationship between hypertension and dementia incidence in community-dwelling elderly Yoruba (aged 70 years and above) because of sparse information on dementia and its risk factors in developing countries. MATERIALS AND METHODS: Community-based, prospective study of consenting elderly Yoruba using two-stage design. Blood pressure was measured during the baseline evaluation at 2001 and hypertension was defined as BP ≥ 140/90 mmHg. Diagnosis of dementia and normal cognition was by consensus using standard criteria. Non-demented subjects from the 2001 evaluation wave were re-evaluated during the 2004 and 2007 waves for dementia. Logistic regression was used to examine the association of baseline hypertension and incident dementia, after adjusting for age, gender, education, and histories of stroke and smoking. P-values <0.05 were considered significant. RESULTS: During the 6-year follow-up, 120 individuals developed dementia, while 1633 remained non-demented. The frequency of hypertension in the demented group was significantly higher than in the non-demented (70.0% vs 60.2%, P = 0.034). Baseline hypertension was a significant risk factor for dementia (OR = 1.52; 95% CI 1.01-2.30). Higher systolic, diastolic or pulse pressure was associated with increased risk (P < 0.05). Participants with diastolic BP ≥ 90 mmHg were at a significantly greater risk than those with readings below 70 mmHg (OR = 1.65; 95% CI 1.01-2.69). CONCLUSIONS: Hypertension was associated with increased risk of dementia in elderly Yoruba and its appropriate treatment may lower the risk.

Effect of stavudine-based antiretroviral therapy on the severity of polyneuropathy in HIV/AIDS patients: a preliminary report from Zaria, Northern Nigeria.

BACKGROUND: Stavudine, a nucleoside reverse transcriptase inhibitor, used as first-line antiretroviral drug in many developing countries is said to exacerbate distal symmetrical polyneuropathy in HIV/AIDS patients. OBJECTIVE: To evaluate the severity of distal symmetrical polyneuropathy in HIV/AIDS patients on stavudine-based antiretroviral therapy. METHODS: Two hundred and twenty consecutive HIV-infected antiretroviral-naive adults who were eligible for antiretroviral therapy were studied. Each patient was evaluated using a questionnaire, which contained bio-data and distal neurologic symptoms/signs adapted from the subjective peripheral neuropathy screen and the Leeds assessment of neuropathic symptoms and signs pain score. Patients were then put on stavudine, lamivudine and nevirapine. For three months, after which each patient was re-evaluated using the same protocol. Patients with other risk factors for distal symmetrical polyneuropathy were excluded from the study. RESULTS: Three months of antiretroviral therapy reduced the mean neuropathic symptoms and signs scores from 0.71 ± 0.76 to 0.26 ± 0.47 (P=0.00) and 0.72 ± 0.57 to 0.58 ± 0.55 (P=0.00) respectively. The number of patients with symptoms and signs also reduced from 97.8% to 24.4% and 65.9% to 55.0% respectively while the mean CD4+ count rose from 194.3 ± 80.4 cells per mL to 416.1±191.2 cells per mL of blood. CONCLUSION: Three months of stavudine-based antiretroviral therapy reduces the severity of distal symmetrical neuropathy in HIV/AIDS patients, but more studies are needed to evaluate the long-term neuropathic effect of stavudine on Africans.

Causes of medical coma in adult patients at the University College Hospital, Ibadan Nigeria.

AIMS AND OBJECTIVES: Diseases of medical origin leading to coma account for 3-15% of emergency hospital admissions in developed countries. There is dearth of data on causes of medical coma in adults in Nigeria in particular and Africa in general. This study is to determine the causes of coma in adult patients admitted at the medical emergency unit and wards of the University College Hospital (UCH) Ibadan. PATIENTS AND METHODS: A prospective study of two hundred consecutive adult unconscious patients seen at the medical emergency unit of UCH, Ibadan, from August 2004 to March 2005, was undertaken using a structured clinical history and physical examination protocol, and results of relevant diagnostic investigations, including post-mortem. RESULTS: Medical causes of coma constituted 10% of all emergencies and 3% of total hospital admissions respectively during the 8-month period. Sixty six percent were males. The age group 20-59 years were affected most (76.5%). Four commonest causes were: Acute stroke 33%), diabetic emergencies (12.5%), uraemic encephalopathy and meningitides (11% each). Four least causes were cerebral malaria (1.0%), hypertensive encephalopathy, alcohol and gamalline poisoning (0.5% each). Four common predisposing factors which also had significant male predominance were systemic hypertension (38.5%), diabetes mellitus (14%), alcohol and substance abuse (12.5%), and HIV/AIDS (11.5%). CONCLUSIONS: Hypertensive stroke and diabetic coma constituted the commonest medical causes of coma. Thus preventive measures such as public health enlightenment campaigns for lifestyle modifications, routine blood pressure and glucose examinations are necessary to avert their disastrous consequences.

Prognosis and outcome of acute stroke in the University College Hospital Ibadan, Nigeria.

BACKGROUND: Many factors influence the outcome of acute stroke, the third leading cause of morbidity and mortality globally. OBJECTIVE: To identify the determinants of outcome of acute stroke. MATERIALS AND METHODS: A prospectively study of 66 adult patients who presented to the medical emergency unit of University College Hospital (U.C.H), Ibadan, in coma from acute stroke, from August 2004 to March 2005, was undertaken after obtaining ethical clearance and written consent of the patients' relations. RESULT: Acute stroke constituted 33% of medical coma, 3.2% of hospital emergencies, 1.0% of total hospital admissions, and 7.3% of medical deaths during the study period. The stroke subtypes were intracerebral hemorrhage (78.8%) and large cerebral infarction (21.2%) with respective case fatalities of 69.7% and 13.6% at 4 weeks. Males constituted 75.8% of the patient population with sex-specific mortality of 68.2%. The highest age specific mortality of 65.2% was in the 40-59 years group. The common risk factors were systemic hypertension, obesity, alcohol/substance abuse, and diabetes mellitus. Co-morbidities included aspiration pneumonia, recurrent seizures, hyperglycemia, and sepsis. CONCLUSION: Age above 39 years, male gender, systemic hypertension, early onset of coma after stroke, and presence of co-morbidities were associated with poor stroke outcome.