Nerve conduction study findings and their predictors in clinically diagnosed patients with carpal tunnel syndrome in a Saudi population.

BACKGROUND: Despite the reports of carpal tunnel syndrome (CTS) being commonplace in Saudi Arabia, there is scarcity of cross-sectional or prospective studies detailing the profile of nerve conduction study (NCS) findings in patients with CTS. OBJECTIVE: The study aimed to evaluate the neurophysiologic profile of CTS with the view to finding the determinant of abnormal findings in clinically diagnosed cases of CTS in a population of Saudis. METHODS: Nerve conduction study was performed on consecutive patients with clinically diagnosed CTS. Median sensory, ulnar sensory, radial sensory median motor and ulnar motor nerves were assessed. The nerve conduction parameters measured were median and ulnar sensory peak latency, amplitude and velocity. Median conduction velocity, distal latency, and amplitude were also measured. Comparative median-ulnar and median-ulnar-digit 4 studies were done and the severity of CTS was determined. Data was analyzed using STATA software version 12. RESULTS: A total of 152 patients, comprising 59 males and 93 females (mean age of 42.7 years) with clinically diagnosed CTS were seen during the study period. About 72.4% patients had numbness and paresthesia in the affected fingers, 66.5% had pain in the hands, and 10.5% had weakness in the affected hands. Majority of the patients (62%) had bilateral clinical features. Carpal tunnel syndrome was confirmed with NCS in 84 (55.26%) patients. Presence of weakness in the affected hand, positive Phalen' sign, and positive Tinel's sign in patients appear to predict [6.1 (1.2-30.7), 3.9 (1.2-30.2), and 4.9 (1.4-17.0) respectively] abnormal NCS findings after adjustment for age, gender and the presence of DM. CONCLUSION: The study revealed that over half of the patients with CTS had NCS/ Electromyography (EMG) abnormalities. Presence of hand muscles weakness, positive Phalen and Tinel's signs predict abnormal findings on NCS/EMG in patients with CTS.

Epilepsy treatment gap in Sub-Saharan Africa: Meta-analysis of community-based studies.

OBJECTIVE: To evaluate the prevalence, highlight the variation and determine the trend over time, of epilepsy treatment gap (ETG) in Sub-Saharan Africa (SSA). METHODS: We systematically searched PubMed, MEDLINE, Embase, ISI databases, and African Journal Online (AJOL). We determined the pooled prevalence estimate of ETG and the degree of heterogeneity in the region. Further subgroup analysis by sub-region, settlement setting, and cutoff adopted for active epilepsy in the studies was carried out. Meta-regression technique was also used to determine the trend of the ETG magnitude over time. RESULTS: Twenty-three studies from SSA met the inclusion criteria. We found a high level of discordance among the studies that were included. Collectively, the estimated ETG was 68.5% (95% CI: 59.5%-77.5%). On subgroup analysis, the prevalence of the ETG was 67% (95% CI: 52%, 83%) in the Western, 68% (95% CI: 56%, 80%) in the Eastern, and 63% (95% CI: 53%, 73%) in the Southern Africa sub-regions. On stratified analysis based on 1-year, 5-year, and 2-year cutoffs for definition of active epilepsy, the prevalence figures for the ETG were 71% (95% CI: 56%, 85%), 55% (95% CI: 33%, 77%), and 57% (95% CI: 43%, 71%), respectively. Meta-regression result suggested that the prevalence of the ETG decreases by approximately by 0.006 per year. CONCLUSION: The study showed a high prevalence of ETG, higher than the average for resource poor countries, and twice in rural compared with urban settlements in SSA.

Development and Optimization of a Starch-Based Co-processed Excipient for Direct Compression Using Mixture Design.

The development of novel excipients with enhanced functionality has been explored using particle engineering by co-processing. The aim of this study was to improve the functionality of tapioca starch (TS) for direct compression by co-processing with gelatin (GEL) and colloidal silicon dioxide (CSD) in optimized proportions. Design of Experiment (DoE) was employed to optimize the composition of the co-processed excipient using the desirability function and other supporting studies as a basis for selecting the optimized formulation. The co-processed excipient (SGS) was thereafter developed by the method of co-fusion. Flow and compaction studies of SGS were carried out in comparison to its parent component (TS) and physical mixture (SGS-PM). Tablets were prepared by direct compression (DC) containing ibuprofen (200 mg) as a model for poor compressibility using SGS, Prosolv®, and StarLac® as multifunctional excipients. The optimized composition of SGS corresponded to TS (90%), GEL (7.5%), and CSD (2.5%). The functionality of SGS was improved relative to SGS-PM in terms of flow and compression. Tablets produced with SGS were satisfactory and conformed to USP specifications for acceptable tablets. SGS performed better than Prosolv® in terms of disintegration and was superior to StarLac with respect to tensile strength and disintegration time. The application of DoE was successful in optimizing and developing a starch-based co-processed excipient that can be considered for direct compression tableting.

Post-renal transplant infections: single-center experience from Nigeria.

BACKGROUND: Infections are the leading cause of hospitalization and mortality in transplant recipients. Nigeria has a growing number of renal transplant recipients. The aim of this study was to determine the pattern of infections in renal allograft recipients in one of the major renal transplant centers in Nigeria. METHODS: All case records of renal allograft recipients on follow-up were retrieved. Those that had infection at any time after transplantation were selected. Demographic and clinical information was collected and analyzed. RESULTS: Thirty-three case records were analyzed, out of which 24/33 (72.7%) were males, with a mean age of 42.3 years (± 7.38). The median duration of developing infection post transplant was 270 days (range 2-2190). Most of the infections occurred after 6 months in 15/33 (45.5%). Urinary tract infection was the most common infection, noted in 13/33 (39.4%), followed by pneumonia, which was seen in 12 (33.3%), 9/12 (75%) of which were culture-positive. There were 2 cases (5.6%) of tuberculosis and 1 case (2.8%) of cytomegalovirus colitis. Out of the 9 culture-positive pneumonia cases, 6 (66.7%) were caused by gram-negative pathogens, with Pseudomonas aeruginosa being the most common isolate seen in 3/9 (33.3%) of the patients. Among those with urinary tract infection, Escherichia coli and Klebsiella species were isolated with equal proportion in 3/13 (23.1%), while Enterococcus faecalis was the most common isolate in 4/13 (30.8%). Overall infection-related mortality was 10/33 (30.3%), out of which 5/10 (50%) of deaths were from pneumonia. CONCLUSION: Post-transplant infection surveillance must be strengthened. The role of multidrug-resistant gram-negative bacteria in post-renal transplant infection in Nigeria needs to be evaluated.

Prevlaence of chronic kidney disease markers in Kumbotso rural Northern Nigeria.

BACKGROUND: Data- on the epidemiology of Chronic Kidney Disease (CKD) from sub-SaharanAfrica are sparse. We investigated the prevalence of CKD and its early markers in Kumbotso, a rural community in northern Nigeria. METHODS: A total of 480 individuals were randomly selected from the general population using multistage stratified random sampling. Relevant- demographic and clinical data were obtained using a structured questionnaire. Biological samples (urine and blood) were drawn for relevant investigations. RESULTS: CKD (estimated glomerular filtration rate [eGFR <60 mls/min) was found in 117 participants (26%). Proteinuria was present in 106 persons (23.6%) and haematuria in 7 individuals (1.6%). The most common CKD stage was stage 1 (20%). CKD was associated with hypertension (P=0.002), diabetes (P=0.001), high cholesterol (P=0.030), smoking (P=0.015), increasing BMI (P=0.020), and increasing age (P=0.003). After adjusting for potential confounding with logistic regression modeling we found BMI, family history of hypertension, history of diabetes mellitus and family history of renal disease to be independent predictors of CKD. CONCLUSIONS: Early markers of CKD are common among rural inhabitants of northern Nigeria and this call for concerted efforts towards institution of preventive measures.

New-onset diabetes after renal transplantation: a case series as seen in a Nigerian kidney transplant population.

New-onset diabetes after transplantation (NODAT) is an important metabolic complication of transplantation because of its associated morbidity and mortality. Risk factors for NODAT include those known to cause diabetes mellitus in non-transplant patients as well as transplant-specific factors. This study was aimed at illustrating the presentation and management of NODAT in three kidney transplant recipients in our center and reviewing the literature. To our knowledge, this is the first report from Nigeria. Two of the patients were males of ages 60 and 36 years, respectively, while the third was a female aged 25 years. They were all receiving prednisolone, two were on tacrolimus, and one was on cyclosporine as part of their immunosuppressive regimens. They developed NODAT at varying times post transplant, ranging from 3 months to 6 years. Two patients were managed with oral hypoglycemic agents and one with insulin. One patient died of hemorrhagic stroke. We conclude that NODAT occurred in our kidney transplant recipients and recommend that physicians should have a high index of suspicion in order to make an early diagnosis and institute appropriate management to reduce morbidity and mortality.

A report of three consecutive pregnancies in a kidney transplant recipient and the challenges in their management in a poor resource setting.

Kidney transplant recipients (KTR) have a good outcome of pregnancies. However the mother and the child are increasingly at higher risks of complications compared to the general population. The management of these pregnancies is associated with greater challenges and is better if managed by both the obstetrician and the transplant physician. Kidney transplant is available in few centres in Nigeria and the post transplant population is increasing, but to our knowledge no report on pregnancy management in KTR has been published. We present a 25 years old Nigerian who had a live related kidney transplant and later had 3 consecutive pregnancies and review the relevant literature. She was placed on oral contraceptive pills for 2 years after transplantation. She enjoyed a stable allograft function with no rejection episode, no proteinuria, had a good blood pressure control and pelvic ultrasound scan was essentially normal. She conceived her first pregnancy 26 months post transplant however she developed spontaneous abortion at 3 months gestation. She conceived her second pregnancy 33 months post transplant which was supervised by the obstetrician and the transplant physician. She had complications including urinary tract infection, anaemia and dyslipidaemia and delivered a live baby girl weighing 2.4 Kg by spontaneous vaginal delivery at 36 weeks gestation. She conceived her 3rd pregnancy 8 months later which was also carried to term and had a vaginal delivery of a live baby girl weighing 2.55 kg. This report highlights the successful management of pregnancies in KTR and the challenges faced in a poor resource setting.

Anaemia and its response to treatment with recombinant human erythropoietin in chronic kidney disease patients.

BACKGROUND: The introduction of erythropoietin has transformed the management of anaemia in CKD, with considerable benefits which includes enhanced quality of life, increased exercise capacity and improved cardiac function. There is paucity of data on the beneficial effects of this treatment from this environment. OBJECTIVE: The aim of this work was to study the pattern and response of anaemia and its response to treatment with recombinant human erythropoietin(r-HuEpo) in CKD patients in Nigeria. METHODS: This was a prospective study in which 20 CKD patients who satisfied the inclusion criteria were recruited consecutively. Subcutaneous r-HuEpo was administered to each of the study patients, starting with a weekly dose of 50 iu per kg and titrated according to haemoglobin (Hb) response, which was monitored fortnightly throughout the study period with the aim of achieving a target Hb of 11g per dl. RESULTS: The patients studied were anaemic with mean Hb of 7.36(1.05) g/dl. The anemia was normocytic normochromic in 85% of the patients. All the patients responded to treatment with r-HuEpo with the mean Hb rising from 6.74(0.70)g per dl to 11.64(0.37) g/dl and 7.64(1.19) to 11.98(0.45) g/dl in those on maintenance haemodialysis and pre-dialysis patients respectively. The patients reached the target Hb of 11g/dl within 8 weeks in predialytic CKD patients and within 10 weeks in those on maintenance haemodialysis. CONCLUSION: Anaemia is mostly normocytic normochromic in CKD patients in our environment and r-HuEpo therapy is effective in correcting the anaemia.

Blood pressure control among treated hypertensives in a tertiary health institution.

BACKGROUND: Goal blood pressure (BP) was defined by the JNC VI and the World Health Organization-International Society of Hypertension (WHO/ISH) as <140 mm Hg systolic and <90 mm Hg diastolic for the general and <130 mm Hg systolic and <85 mm Hg diastolic for special high-risk populations. It is well established that adequate BP control characterizes only a fraction of treated hypertensive patients. The importance of tight BP control has been established in preventing cardiovascular morbidity and mortality METHODS: We performed cross-sectional studies on the current status of BP control among treated hypertensive in our center. One hundred consecutive patients with essential hypertension who have been attending the out patient hypertension clinic and have been on treatment for at least 6 months were recruited. The pre treatment BP and BP records in the previous 2 visits were noted. Patients were said to have good BP control if their BPs are < 140/90 mmHg (<130/80 mmHg for high risk patients) at the time of the study and in the last visit. RESULTS: There were 49 males and 51 female (M: F; 1:1), aged 26 to 85 (mean 52.33 +/- 12.29) years. The duration of hypertension ranged 6 months to 30 (mean 7.37 +/- 7.1) years. The duration of treatment in our centre was 6 months to 10 (mean 3.22 +/- 2.23) years. Blood pressure was controlled in 33 (33%) of the patients. Pre-treatment mean blood pressure was significantly higher than the BP value at the time of the study (155.87 +/- 26.02/97.81 +/- 11.89 mmHg versus 143.40 +/- 24.14/86.53 +/- 12.71 mmHg) (p<0.05). Diuretics were the commonest antihypertensive prescribed either alone or in combination (69%), followed by a calcium antagonist (56%) and centrally acting drugs (38%). Twenty seven were on single antihypertensive, 43 (43%) on 2, 25(25%) on 3 and 5 (5%) on 4 classes of antihypertensive. Blood pressure control was associated with taking more than one antihypertensive medication and compliance. CONCLUSION: Control of BP in patients receiving antihypertensive drugs is still far from optimal in the study population in Nigeria just as in other countries. Many patients had multiple cardiovascular risk factors. Adherence to medication should be encouraged.

Post kidney transplant tuberculosis in Nigeria: a case report.

BACKGROUND: Tuberculosis has been reported to be one of the most serious bacterial infections after transplant and occur up to 20 times more frequently in transplant recipients than in the general population. Renal transplant is available in few centers in the country and the post transplant population is increasing, but to our knowledge no case of post transplant tuberculosis has been reported in this environment. METHOD: The case report of a 35 year old Nigerian who had live related kidney transplant and later developed post transplant disseminated Tuberculosis is presented and the relevant literature is reviewed. RESULTS: A 35 year old university graduate had a live related kidney transplant in our center. He had stable allograft function on immunosuppressive regimen consisting of Cyclosporin, Azathioprine and Prednisolone, and presented with features of disseminated tuberculosis involving the cervical lymph nodes and chest with associated deterioration of allograft function. He was successfully treated with 2 months initial phase of quadruple anti tuberculosis drugs including Isoniazid, Rifampicin, Pyrazinamide and Ethambutol and four months continuation phase with Isoniazid and Rifampicin. He showed remarkable clinical improvement and reversal of the allograft dysfunction. CONCLUSION: This case illustrates one of the post transplant infectious complications seen in our environment and its successful treatment, and highlighted the need for Tuberculosis prophylaxis in transplant recipients in countries with high incidence of tuberculosis.

Physical exercise and health: a review.

BACKGROUND: Physical activity results in increased exercise capacity and physical fitness, which may lead to many health benefits. Individuals who are more physically active appear to have lower rates of all-cause mortality, probably due to a decrease in chronic diseases including coronary artery disease (CAD). This may result from an improvement in cardiovascular risk factors in addition to enhanced fibrinolysis, improved endothelial function, decreased sympathetic tone, and other yet undetermined factors. METHODS: We reviewed the literature on physical activity and health with particular reference to the benefits derivable by engaging in regular physical activity. The MEDLINE/PUBMED and bibliographic searches for English language studies were used. RESULTS: Physical inactivity is now considered a risk factor for Cardiovascular diseases (CVD). Regular exercise results in an increase in exercise capacity and lower myocardial oxygen demand leading to cardiovascular benefits, including lower mortality rates. Physically active individuals suffer from fewer ailments than do less-active individuals. Physical activity reduces cardiovascular risk through lowering of blood pressure, improved glucose tolerance, reduced obesity, improvement in lipid profile, enhanced fibrinolysis, improved endothelial function and enhanced parasympathetic autonomic tone. CONCLUSION: Physical exercise has many health benefits and the evidence for this continues to accumulate. Health care professionals should incorporate counselling to patients for physical exercise in their daily clinical practice, while health policy makers and community physicians should see to implementation of this at the community level.

Ischaemic heart disease in Aminu Kano Teaching Hospital, Kano, Nigeria: a 5 year review.

BACKGROUND: Socio-economic changes and rural urban migration have led to emergence of non-communicable disease including ischaemic heart disease (IHD) and many others. The actual prevalence of IHD in Nigeria is not known. The non communicable disease (NCD) survey sought to determine the prevalence of major risk factors, rather than the prevalence of the disease itself. The prevalence is generally considered low in Nigeria but the current impression about its importance stems mostly from anecdotal reports. We therefore set out to describe the prevalence as well as the spectrum of IHD at Aminu Kano Teaching Hospital, Kano. METHOD: Between July 2000 and June 2005, we reviewed the prevalence as well as the spectrum of presentation of IHD in Aminu Kano Teaching Hospital. Information was obtained from the medical records of patients in the medical unit of the hospital. Age, sex, diagnosis, risk factors for IHD, other relevant clinical and laboratory data and outcome of patients for myocardial infarction (MI) were extracted from the records. Data was analyzed using SPSS version 10.0 software. RESULTS: There were 5124 medical patients admitted over the period under review, out of which 1347 had cardiovascular diseases. Forty six patients were diagnosed to have IHD giving it a prevalence of 0.9% of medical conditions and 3.4% of all cardiovascular cases. There were 33 males and 13 females (M : F = 2.5:1). Twenty two patients (47.8%) had myocardial infarction, 14 (30.4%) had ischemic cardiomyopathy and 10 (21.7%) had angina. The patients consist of 41 (89.1%) Nigerians, 3 (6.5%) Lebanese, 1 (2.2%) Indian and 1 (2.2%) Pakistani. The risk factors found were Hypertension in 37 (80.4%) of patients, diabetes in 16 (34.8%), and Dyslipidaemia in 20 (43.5%). Others were cigarette smoking and obesity. CONCLUSION: IHD is an important cause of morbidity and mortality in our population. There is need for us to be on the alert and prepare ourselves to manage these cases. Focus should be on preventive cardiology.

Post transplant Kaposi's sarcoma among Nigerians: a report of two cases.

With the establishment of kidney transplant centres in Nigeria and increase in the number of kidney transplant recipients returning home for follow up after successful transplant abroad, an increasing number of patients with post transplant complications are likely to be seen. There is the need for physicians vested with the care of these patients to be aware of the post transplant complications so that early diagnosis and effective treatment can be instituted so as to save both the patient and the allograft. Two out of seventeen renal transplant recipients followed up in our unit had post renal transplant Kaposi's sarcoma. Both were successfully treated with withdrawal of cyclosporin, reduction of other immunosuppressives and introduction of low dose Mycophenolate Mofetil (MMF). One had a course of radiotherapy followed by weekly intravenous vincristine and the other only had vincristine with complete remission of the lesions in both patients. Post transplant Kaposi's sarcoma occurs in Nigerian transplant patients and this report highlights the need for increased awareness and high index of suspicion of post transplant Kaposi's sarcoma among kidney transplant recipients.

Outcome and complications of permanent hemodialysis vascular access in Nigerians: a single centre experience.

BACKGROUND: It is widely accepted that autogenous arteriovenous fistula (AVF) carries less morbidity and mortality compared to all other forms of vascular accesses in maintenance hemodialysis patients. There is paucity of data on vascular access from sub-Saharan Africa. The aim of this study was to assess the outcome and complications of permanent vascular access in our center. MATERIALS AND METHODS: The study is a prospective, hospital-based, longitudinal study. All consecutive patients on maintenance hemodialysis in Aminu Kano Teaching Hospital who were referred to the surgical unit of for creation of permanent hemodialysis vascular access were included in the study. The patient's clinical and demographic data were documented. Data about vascular access types, outcomes, and complications were obtained over a 1-year period from the time of vascular access creation. RESULTS: One hundred and seventy four patients were operated upon between January 2008 and December 2010 with a mean age of 46.4 years (range 18-76 years) and a male to female ratio of 1.5:1. Brescio--Cimino fistula was performed in 110 (63.2%) patients, brachiocephalic (Kauffmann) fistula in 51(29.3%), and synthetic graft in 1 (0.6%) patients respectively. Ten patients (5.7%) had brachio-brachial transposition arteriovenous fistula and 2 patients (1.1%) had transposition graft using harvested long saphenous vein. One-year patency rate was 63.2%. Complications encountered include AVF failure in 47(27.3%), steal syndrome in 2(1.1%), distal venous insufficiency in 2(1.1%), and false aneurysm in 6(3.5%) patients. CONCLUSION: The outcome of permanent vascular access is favorable in our patient population with a one-year patency rate of 63.2%. The first choice of vascular access in our maintenance dialysis population should be AVF.

Fistula-in-Ano Complicated by Fournier's Gangrene Our Experience in North-Eastern Region of Nigeria.

BACKGROUND: Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. METHODS OF STUDY: Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. RESULTS: A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture of the perianal abscess. 6 (60%) of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50%) and fistulotomy in 3 (30%) patients. Another 30% had fistulotomy and continuing sitz bath. CONCLUSION: Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier's gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene.

Meta-Analysis of Randomized Controlled Trials on Androgens versus Erythropoietin for Anaemia of Chronic Kidney Disease: Implications for Developing Countries.

Androgens which are relatively cheap were used in the treatment of anaemia in dialysis patients before the advent of Erythropoietin (EPO). However, there are concerns about their efficacy and side effects. Aims. To examine the efficacy and harms of androgens for the treatment of anaemia of chronic kidney disease (CKD) compared to EPO. Settings and Design. A systematic review and meta-analysis using an a priori protocol. Methods and Materials. We searched several databases for randomized controlled trials using the key terms anaemia, chronic kidney disease, and androgens, without language restrictions. We also searched reference lists of relevant articles. Statistical Analysis Used. Data was analyzed using Review manger 5 software. We summarized treatment effects as relative risks and mean differences, with 95% confidence intervals using a random-effect model. We tested for heterogeneity with Chi(2) and the I(2) statistics. Results. We identified four eligible trials involving 114 participants, majority (83.33%) of whom were males, mostly over 50 years of age. The pooled difference in mean haemoglobin between the nandrolone and EPO arms at the end of the trials was -0.11 (CI -0.80 to 0.58) which is not statistically significant. Conclusions. This meta-analysis revealed no difference between nandrolone and EPO for the treatment of anaemia of CKD in men over 50 years. Therefore, nandrolone can be used for the treatment of anaemia of CKD in this category of patients, in resource-limited countries. However, further studies are needed to determine the long-term safety of nandrolone in men over 50 years old, as well as its effectiveness and safety in females in general, and males less than 50 years of age.