The Prevalence and Pattern of Admission Mortality among Acute Stroke Patients Managed at a Tertiary Hospital in Abakaliki, Nigeria: A Retrospective Study.

BACKGROUND: Stroke ranks as the second leading cause of mortality worldwide, following ischemic heart disease, and is expected to maintain this position through 2030. This neurological ailment is profoundly impactful, imposing a significant burden on health and the economy. In 2019 alone, it was responsible for 6.6 million fatalities and the loss of 143 million disability-adjusted life years (DALYs) across the globe. OBJECTIVES: This study highlighted the prevalence and pattern of admission mortality among acute stroke patients managed over 9 years in a private tertiary hospital in Abakaliki, Nigeria. METHODOLOGY: This was a retrospective hospital-based study conducted at a tertiary hospital in Abakaliki, Nigeria from January 2014 to December 2022. Relevant data were extracted from the patients' case notes and the sociodemographic, clinical and laboratory parameters of acute stroke survivors were compared with those of their dead counterparts. RESULTS: Out of the 172 (males - 57%; females - 43%) patients that fulfilled the inclusion criteria, 53 (30.81%) had haemorrhagic stroke while 119 (69.19%) had ischaemic stroke. The overall admission mortality rate was 15.12%, and it was more common in patients with haemorrhagic stroke, advancing age, severe hypertension, severe stroke, impairment of consciousness, renal dysfunction, hypernatremia, neutrophilic leucocytosis, and short admission duration. CONCLUSIONS: High mortality rates are linked to acute stroke admissions, particularly in cases involving haemorrhagic stroke, increasing age, severe hypertension, substantial stroke severity, impaired consciousness, renal dysfunction, hypernatremia, neutrophilic leukocytosis, and brief admission duration.

CONTEXTE: L'accident vasculaire cérébral (AVC) est la deuxième cause de mortalité dans le monde, après la cardiopathie ischémique, et devrait conserver cette position jusqu'en 2030. Cette affection neurologique a un impact profond, imposant une charge significative sur la santé et l'économie. En 2019 seulement, elle a été responsable de 6,6 millions de décès et de la perte de 143 millions d'années de vie ajustées sur l'incapacité (DALYs) dans le monde. OBJECTIFS: Cette étude a mis en évidence la prévalence et le modèle de la mortalité à l'admission chez les patients victimes d'AVC aigu gérés pendant 9 ans dans un hôpital privé tertiaire à Abakaliki, Nigéria. MÉTHODOLOGIE: Il s'agissait d'une étude rétrospective en milieu hospitalier menée dans un hôpital tertiaire à Abakaliki, Nigéria, de janvier 2014 à décembre 2022. Les données pertinentes ont été extraites des dossiers des patients et les paramètres sociodémographiques, cliniques et de laboratoire des survivants d'un AVC aigu ont été comparés à ceux de leurs homologues décédés. RÉSULTATS: Parmi les 172 patients (hommes - 57 % ; femmes - 43 %) qui remplissaient les critères d'inclusion, 53 (30,81 %) avaient un AVC hémorragique tandis que 119 (69,19 %) avaient un AVC ischémique. Le taux global de mortalité à l'admission était de 15,12 % et était plus fréquent chez les patients ayant un AVC hémorragique, un âge avancé, une hypertension sévère, un AVC sévère, une altération de la conscience, une dysfoncti on rénal e, une hyper natrémie, une l eucocytose neutrophilique et une courte durée d'admission. CONCLUSIONS: Les taux de mortalité élevés sont liés aux admissions pour AVC aigu, en particulier dans les cas d'AVC hémorragique, d'âge avancé, d'hypertension sévère, de sévérité importante de l'AVC, d'altération de la conscience, de dysfonction rénale, d'hypernatrémie, de leucocytose neutrophilique et de courte durée d'admission. MOTS-CLÉS: Facteurs de risque, Mortalité à l'admission, AVC aigu, Étude rétrospective.

PREVALENCE OF RENAL DYSFUNCTION IN ACUTE STROKE PATIENTS AT ABAKALIKI NIGERIA: AN OBSERVATIONAL STUDY.

Introduction: Renal dysfunction is commonly seen in hospitalized stroke patients. It serves both as a risk factor for stroke and as a complication of stroke. Renal dysfunction is a poor prognostic factor for stroke and increases the risk of recurrence. Despite the above poor indices, there is a paucity of data on the prevalence of renal dysfunction in acute stroke patients in Nigeria. Objective: It is against this background that this study was conducted to identify the prevalence and pattern of renal dysfunction among acute stroke patients who were managed at a Federal Teaching Hospital in Abakaliki Nigeria. Methodology: This is a cross-sectional observational hospital-based study undertaken at the Emergency unit of the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from October 2021 to April 2022 (7-month period). Result: Amongst the 210 acute stroke patients enrolled in the study, 51 (24%) had renal dysfunction with no age and sex predilection. Haemorrhagic stroke, alteration in consciousness, and anaemia were significantly associated with renal dysfunction. Conclusion: The prevalence of renal dysfunction following acute stroke is high and there is a need for assessment of renal functions in every acute stroke patient and institute prompt multi-disciplinary treatment.

Stroke Hexagon; Protocol for Reduction of Stroke Burden in Resource-Poor Settings.

BACKGROUND: Stroke is a neurological emergency, with high prevalence, especially in developing countries where it assumes an epidemic proportion. It is globally the second most common cause of death after ischemic heart disease. The poor indices reported in developing countries are multifactorial and related to late case presentation, ignorance, poverty, and unavailability of comprehensive and well-coordinated stroke care. OBJECTIVES: This manuscript identified and highlighted the available and cheap stroke management pillars in developing countries and recommended measures to strengthen the system to maximize the benefits in the reduction of morbidity and mortality from stroke. RESULTS: The identified stroke management pillars include stroke prevention, hyperacute stroke management, acute stroke management, stroke rehabilitation, stroke research, and stroke support. CONCLUSIONS: A coordinated and concerted stroke management protocol involving the stroke hexagon will reduce stroke morbidity and mortality in resource-poor settings. There is a need to sensitize the stakeholders in stroke management to assume more responsibility.

CONTEXTE: L'AVC est une urgence neurologique, avec une prévalence élevée, en particulier dans les pays en développement où il prend une ampleur épidémique. Il est mondialement la deuxième cause de décès la plus fréquente après la maladie cardiaque ischémique. Les mauvais indices rapportés dans les pays en développement sont multifactoriels et liés à une présentation tardive des cas, à l'ignorance, à la pauvreté et à l'absence de soins coordonnés et complets pour l'AVC. OBJECTIFS: Ce manuscrit a identifié et mis en évidence les piliers bon marché de la prise en charge de l'AVC dans les pays en développement et recommandé des mesures pour renforcer le système afin de maximiser les avantages dans la réduction de la morbidité et de la mortalité dues à l'AVC. RÉSULTATS: Les piliers identifiés de la prise en charge de l'AVC comprennent la prévention de l'AVC, la prise en charge hyperaiguë de l'AVC, la prise en charge aiguë de l'AVC, la rééducation post-AVC, la recherche sur l'AVC et le soutien aux personnes touchées par l'AVC. CONCLUSIONS: Un protocole de prise en charge de l'AVC coordonné et concerté impliquant l'hexagone de l'AVC réduira la morbidité et la mortalité liées à l'AVC dans les milieux à ressources limitées. Il est nécessaire de sensibiliser les parties prenantes à la prise en charge de l'AVC pour qu'elles assument davantage de responsabilités. Mots-clés: Hexagone de l'AVC, Protocole, Fardeau de l'AVC, Milieux à ressources limitées.

Sleep Health amongst Patients Attending Adult Neurology Clinic in Abakaliki, Nigeria.

BACKGROUND: Sleep health indicates how well an individual or population sleeps. Good sleep health is characterized by subjective satisfaction, sustained alertness during waking hours, appropriate timing, high efficiency, and adequate duration. Poor sleep health is associated with many short-term and long-term health consequences. There are limited data on the pattern of sleep health in Nigeria. Against this backdrop, we embarked on this study to determine the Pattern of Sleep Health among patients attending the Adult Neurology clinic in a Federal Teaching Hospital, in Abakaliki, Nigeria. METHODS: This is a cross-sectional observational hospital-based study undertaken at the Adult Neurology clinic of the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from July to September 2022. RESULTS: Out of the 267 patients recruited for the study, 19% had good sleep health with SATED scores of 8 to 10 while 81% had poor sleep health. The absence of alcohol abuse, cigarette smoking, and neurological diagnosis were statistically associated with poor sleep health with no sex and age predilection. The mean sleep duration was 7.5± 1.5 hours (male = 7.6 hours, female = 7.3 hours, 18- 64 years= 7.4 hours, ≥ 65 years =7.9 hours). Timing of sleep (mean= 0.97) was the least rated while sleep satisfaction (mean= 1.54) was the best-rated sleep dimension. CONCLUSION: Sleep health is very poor amongst patients attending the adult Neurology clinic at Abakaliki Nigeria and it is associated with smoking, absence of alcohol abuse, and neurological diagnosis. CONTEXTE: La santé du sommeil indique à quel point un individu ou une population dort. Une bonne santé du sommeil se caractérise par une satisfaction subjective, une vigilance soutenue pendant les heures d'éveil, un timing approprié, une efficacité élevée et une durée adéquate. Une mauvaise santé du sommeil est associée à de nombreuses conséquences sanitaires à court et à long terme. Il existe des données limitées sur le schéma de santé du sommeil au Nigéria. Dans ce contexte, nous avons entrepris cette étude pour déterminer le schéma de santé du sommeil parmi les patients fréquentant la clinique de neurologie pour adultes dans un hôpital d'enseignement fédéral à Abakaliki, Nigeria. MÉTHODES: Il s'agissait d'une étude observationnelle transversale réalisée à la clinique de neurologie pour adultes de l'hôpital universitaire fédéral Alex Ekwueme àAbakaliki, Nigeria, de juillet à septembre 2022. RÉSULTATS: Sur les 267 patients recrutés pour l'étude, 19 % avaient une bonne santé du sommeil avec des scores SATED de 8 à 10, tandis que 81 % avaient une mauvaise santé du sommeil. L'absence d'abus d'alcool, de tabagisme et de diagnostic neurologique était statistiquement associée à une mauvaise santé du sommeil, sans prédilection pour le sexe et l'âge. La durée moyenne du sommeil était de 7,5 ± 1,5 heures (homme = 7,6 heures, femme = 7,3 heures, 18-64 ans = 7,4 heures, ≥ 65 ans = 7,9 heures). Le timing du sommeil (moyenne = 0,97) était la dimension la moins bien notée, tandis que la satisfaction du sommeil (moyenne = 1,54) était la dimension la mieux notée. CONCLUSION: La santé du sommeil est très mauvaise chez les patients fréquentant la clinique de neurologie pour adultes à Abakaliki, au Nigéria, et elle est associée au tabagisme, à l'absence d'abus d'alcool et au diagnostic neurologique. Mots-clés: :Santé du sommeil, Clinique de neurologie,Abakaliki, Nigeria.

HAEMATOLOGICAL PARAMETERS AMONGST ACUTE STROKE PATIENTS MANAGED AT A TERTIARY HOSPITAL IN ABAKALIKI NIGERIA: A CASE-CONTROL STUDY.

Introduction: Changes in the haematological indices could have implications for stroke risk, management plan, and outcome. There are limited data on the pattern of haematological parameters of acute stroke patients in Nigeria despite its impact on stroke risk, management, and outcome. Objectives: To determine the pattern and the prognostic implications of the haematological parameters in acute stroke patients managed over a nine-year period at a Tertiary Hospital in Abakaliki Nigeria. Methodology: This was a retrospective hospital-based case-control study of the haematological parameters of acute stroke patients seen over a nine-year period at a tertiary hospital in Abakaliki Nigeria. Results: The mean total white blood cell count and percentage neutrophil in the case group were significantly higher than the control group while the mean packed cell volume did not show any significant difference. Further analysis of the case group revealed that the mean PCV was significantly lower among female folks, elderly age group, those with low education attainment, impaired renal status, short admission duration, haemorrhagic stroke, and admitting hypertension. On the other hand, mean total WBC count and differential neutrophils were significantly elevated among female folks, working-class age group, low educational status, longer admission duration, mortality, and haemorrhagic stroke. Conclusions: Elevated total white blood cell count and differential neutrophilia were significantly associated with acute stroke. Changes in haematological parameters have implications for stroke risk and outcome.

Longitudinal changes of blood parameters and weight in inoperable stage III NSCLC patients treated with concurrent chemoradiotherapy followed by maintenance treatment with durvalumab.

BACKGROUND: Investigating dynamic changes in blood-parameters and weight in patients with locally advanced non-small cell lung cancer (NSCLC) receiving durvalumab maintenance therapy after chemoradiotherapy (cCRT). Laboratory outcomes were determined based on the number of durvalumab administrations received. METHODS: Twenty-two patients completed platinum-based cCRT followed by maintenance treatment with durvalumab. Different parameters such as hemoglobin (Hb), leukocytes, Lactate dehydrogenase (LDH), C-reactive protein (CRP), body weight and albumin were analyzed before cCRT, after cCRT, 3, 6, 9 and 12 months after starting durvalumab maintenance. RESULTS: Sixteen (72.7%) patients were male; twelve (54.5%) and fifteen (68.2%) patients had non-squamous histology and Union for International Cancer Control (UICC) stage IIIB-C disease, respectively. Median follow-up time was 24.4 months; 12- and 18-months- progression-free and overall-survival rates were 55.0% and 45.0 as well as 90.2 and 85.0%, respectively. During maintenance treatment Hb increased by 1.93 mg/dl (17.53%) after 9 months (p < 0.001) and 2.02 mg/dl (18.46%) after 12 months compared to the start of durvalumab (p < 0.001). LDH decreased by 29.86 U/l (- 11.74%) after 3 months (p = 0.022). Receipt of at least 12 cycles of durvalumab was beneficial in terms of Hb-recovery (Hb 6 months: 12.64 vs. 10.86 [mg/dl]; Hb 9 months: 13.33 vs 11.74 [mg/dl]; (p = 0.03)). Median weight change [kilogram (kg)] was + 6.06% (range: - 8.89 - + 18.75%) after 12 months. The number of durvalumab cycles significantly correlated with total weight gain [kg] (Spearman-Rho-correlation: r = 0.502*). CONCLUSION: In the investigated cohort, no severe hematologic toxicity occurred by laboratory blood tests within 1 year of durvalumab maintenance therapy after cCRT for unresectable stage III NSCLC. Receiving at least 12 cycles of durvalumab appears to have a significant effect on recovery of hemoglobin levels and body weight.

The Efficacy of Local Infiltration Analgesia in the Control of Post-Operative Pain after Total Joint Replacement Surgeries.

BACKGROUND: Total joint replacement surgeries can produce severe pain in the post-operative period that can prolong the duration of hospital stay. The aim of the study, was to determine the efficacy of Local Infiltration Analgesia in the management of post-operative pain after total joint replacement. METHOD: This was a prospective study with patients recruited for the study divided into group A and B. Group A received intra-operative analgesic cocktail while those in group B (control group) received an equal volume of normal saline. Both groups received the same post-operative pain management protocol. Pain assessment in the post-operative period was done using the visual analogue scale, at 4 hours, 8 hours, 24 hours and 48 hours post surgery. Time to achieving assisted ambulation, occurrence of adverse events, and the number of times analgesic was administered for breakthrough pain were assessed. RESULTS: A total number of 50 patients who had either total joint arthroplasty (25 in each group) were recruited for the study. The Normal saline group had significantly higher VAS scores in the first 8 hours after surgery (p values 0.016 at 4 hours and 0.037 at 8 hours post-operation) while both groups had similar pain scores thereafter. Mobilization times were not significantly different between both groups and adverse events occurred with almost equal frequency in both groups. CONCLUSION: Periarticular local infiltration analgesia as part of multimodal pain control protocol is effective in the control of early post-operative pain after total joint replacement.

CONTEXTE: Les chirurgies de remplacement total de l'articulation peuvent produire une douleur intense pendant la période postopératoire qui peut prolonger la durée du séjour à l'hôpital. Le but de l'étude était de déterminer l'efficacité de l'analgésie locale par infiltration dans la gestion de la douleur postopératoire après une arthroplastie totale. MÉTHODES: Il s'agissait d'une étude prospective avec des patients recrutés pour l'étude ont été divisés en groupes A et B. Le groupe A a reçu un cocktail analgésique intra-op¼ratoire. tandis que les patients du groupe B (groupe témoin ont reçu un volume égal de solution saline normale. Les deux groupes ont reçu le même protocole de gestion de la douleur post-opératoire. L'évaluation de la douleur dans la période postopératoire a été réalisée à l'aide de l'échelle visuelle analogique, à 4 heures, 8 heures, 24 heures et 48 heures après l'opération après l'opération. Le temps nécessaire à l'obtention d'une l'ambulance assistée, la survenue d'événements indésirables et le nombre de fois où un analgésique a été administré en cas de percée de la évalués. RÉSULTATS: 50 patients ayant subi une arthroplastie totale (25 dans chaque groupe) ont été recrutés pour l'étude. Le groupe recevant du sérum physiologique présentait des scores VAS significativement plus élevés dans les 8 heures après l'opération (valeurs p de 0,016 à 4 heures et 0,037 à 8 heures après l'opération), alors que les deux groupes avaient des scores de douleur similaires par la suite. Les temps de mobilisation n'étaient pas significativement différents entre les deux groupes et les événements indésirables sont survenus à une fréquence presque égale dans les deux groupes. CONCLUSION: L'analgésie périarticulaire par infiltration locale dansle cadre d'un d'un protocole multimodal de contrôle de la douleur est efficace dans le contrôle de la douleur postopératoire précoce après une arthroplastie totale. Mots clés: Analgésie par infiltration locale; arthroplastie totale; arthroplastie; douleur postopératoire.

Prevalence of Hyponatremia in Acute Stroke Patients in a Federal Teaching Hospital, Abakaliki, Nigeria.

BACKGROUND: Hyponatremia is a common electrolyte imbalance which is readily observed in patients with neurological disorders such as stroke. It is associated with increased morbidity and mortality during and after hospitalization. There has not been any study to demonstrate the frequency of admission hyponatremia in acute stroke patients in Nigeria. It is against this backdrop that we embarked on this study to determine the frequency and pattern of admission hyponatremia in acute stroke patients in a Federal Teaching Hospital, Abakaliki, Nigeria. METHODS: This was a cross-sectional observational hospitalbased study undertaken at the Emergency unit of the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from November 2021 to April 2022. RESULTS: Amongst the 177 acute stroke patients enrolled in the study, 58 (32.8%) had hyponatremia. Advanced age, alteration in consciousness, and haemorrhagic (intracerebral and subarachnoid haemorrhage) stroke were significantly associated with presence of hyponatremia. CONCLUSION: Admission hyponatremia is prevalent amongst acute stroke patients in Abakaliki, Nigeria and commonly associated with advanced age, alteration in consciousness and haemorrhagic stroke.

CONTEXTE: L'hyponatrémie est un déséquilibre électrolytique commun qui est facilement observé chez les patients atteints de troubles neurologiques tels que l'AVC. Elle est associée à une morbidité et une mortalité accrues pendant et après l'hospitalisation. Aucune étude n'a été menée pour démontrer la fréquence de l'hyponatrémie à l'admission chez les patients victimes d'un AVC aigu au Nigeria. C'est dans ce contexte que nous avons entrepris cette étude pour déterminer la fréquence et les caractéristiques de l'hyponatrémie à l'admission chez les patients victimes d'un AVC aigu dans un hôpital universitaire fédéral à Abakaliki, au Nigeria. MÉTHODES: Il s'agissait d'une étude transversale d'observation en milieu hospitalier entreprise au service des urgences de l'Alex Ekwueme Federal University Teaching Hospital d'Abakaliki, au Nigeria, de novembre 2021 à avril 2022. RÉSULTATS: Parmi les 177 patients victimes d'un AVC aigu inscrits à l'étude, 58 (32,8 %) présentaient une hyponatrémie. L'âge avancé, l'altération de la conscience et l'AVC hémorragique (hémorragie intracérébrale et subarachnoïde) étaient significativement associés à la présence d'une hyponatrémie. CONCLUSION: L'hyponatrémie à l'admission est prévalente chez les patients victimes d'un accident vasculaire cérébral aigu à Abakaliki, au Nigeria, et est souvent associée à un âge avancé, à une altération de la conscience et à un accident vasculaire cérébral hémorragique. Mots clés: Accident vasculaire cérébral aigu, hyponatrémie, urgence médicale, Abakaliki, Nigeria.

Relationship between corneal biomechanical properties among pregnant women in a tertiary hospital in Nigeria.

OBJECTIVE: In Nigeria, many pregnant women as well as health-care providers are unaware of the effect of pregnancy on the eye. The present study investigated the changes in central corneal thickness (CCT), corneal sensitivity (CS), and intraocular pressure (IOP) among pregnant women in a tertiary hospital in Nigeria and the relationship between them. MATERIALS AND METHODS: A prospective longitudinal study was used. One hundred and thirty-four pregnant women attending the Obstetric Clinic of the University of Nigeria Teaching Hospital, Enugu, were consecutively recruited in their second trimester for the study. Changes in CCT, CS, and IOP were monitored at the second and third trimesters and 6-week postpartum. Data obtained were analyzed using Statistical Package for the Social Sciences version 20. The effect of duration of pregnancy on these variables was determined using simple linear regression and further analysis was done using Bonferroni's post hoc test. RESULTS: The women were aged 18-48 years, with a mean age of 30.81(±5.49) years and majority of them (61.2%) were multigravida. The duration of pregnancy varied inversely and significantly with CS (P < 0.05) and IOP (P < 0.000) with the least values recorded in the third trimester, while it varied directly and also significantly with CCT (P < 0.000) with the highest value obtained in the third trimester. A negative correlation that was significant only in third trimester was found between CCT and IOP (P < 0.02) and CS (P < 0.03). CONCLUSION: There was a progressive increase in CCT with a corresponding decrease in CS and IOP across the trimesters of pregnancy, but these changes reversed 6-week postpartum.

Investigating Groundwater Contamination Following the Disposal of Hospital Wastes in a Government Reserved Area, Enugu, Nigeria.

This study investigated the probable contamination of groundwater following hospital wastes disposal in a Government Reserved Area, Enugu, Nigeria. The ground water samples were collected from three distinct locations denoted as GW1, GW2 and GW3 at distances of about 100, 200 and 350 m respectively from the hospital location. The samples were collected during the dry season (December 2015, January and February 2016) and wet season (June, July and August 2016) and analyzed with standard procedures. The level of contamination of groundwater in the area was generally higher in the wet season than in dry season. The degree of contamination varies with distance and hence in the following order GW1 > GW2 > GW3 in both seasons. The study revealed the presence of both pathogenic and non-pathogenic organisms and values of the determined physicochemical ranged from (0.02 ± 0.01-272 ± 2.22 mg/L) in both seasons. The hospital management should develop effective ways to manage their wastes to protect the environment and public health.

Prediction of Normal Ovulation by Sonographic Folliculometry Involving Natural Cycles among Women in Ojo, Southwest Nigeria.

BACKGROUND: Accurate prediction of ovulation is important in the management of female infertility. AIM: To determine the sonographic sensitivity of reduction in follicular size and disappearance of ovarian follicle as predictors of imminent ovulation. METHODS: This was a longitudinal study involving 100 women between the ages of 18 and 35 years. Transvaginal sonography with 6.5 MHz probe frequency was performed with a General Electric (RT 2800) ultrasound machine. Dominant follicles were identified and measured in both the longitudinal and transverse planes and their disappearance was monitored prior to ovulation. Laboratory luteinizing hormone test strips were used to test serum samples collected daily from each patient to confirm the time of ovulation. RESULTS: Pre-ovulation follicular size among the subjects was in the range of 18-36 mm while the mean follicular size was 26.78 ± 4.03 mm. Prior to ovulation, disappearance and reduction in follicular size was noted in 59% and 41% of subjects, respectively. Luteinizing hormone test was also positive and peaked prior to ovulation in 92% of the subjects among whom follicles disappeared in 37% while their size reduced in 55%. There was no statistically significant difference between sonographic and laboratory findings (p > 0.05). Age, height, weight and body mass index do not have significant influence (p > 0.05) on follicular size and ovulation. CONCLUSION: Sonographic observation of complete disappearance of a dominant follicle and reduction in follicular size of surrogate follicles after follicular rupture appeared to be a reliable predictor of imminent ovulation.

Sonographic Biometry of Fetal Interorbital Distance as a Predictor of Gestational Age in Enugu, Southeast Nigeria.

OBJECTIVE: The objective of this study was to develop a sonographic technique for the measurement of fetal interorbital distance (IOD) for gestational age (GA) determination and to establish a normogram of IOD for the local population. METHODS: The fronto-transverse sonographic technique was established as a feasible and reproducible technique for IOD measurement. Two independent and experienced sonographers tested the technique and had a coefficient of variation of 17.64% and 19.72%, respectively, which is statistically insignificant. The established technique was used to measure the IOD of 320 fetuses from the 13th week to 40th week GA, while standard technique was used to measure biparietal diameter (BPD), head circumference (HC) and femur length (FL) of the fetuses. The data obtained were used to determine the regression equation GA = 6.24 + 4.89 IOD for the prediction of the gestational age. RESULTS: There was good correlation between IOD, BPD, HC and FL. The predicted normogram of IOD was compared with normogram of the Caucasian population. The result showed that there was no statistical difference between them (p < 0.05). CONCLUSION: Results from the study suggest that the fronto-transverse technique is a feasible and reproducible technique for IOD measurement and the established normogram of IOD can be a veritable statistic for GA prediction in our locality.

Knowledge of conversion disorder in children by pediatricians in a developing country.

INTRODUCTION: Conversion disorder (CD) in children presents the clinician with a diagnostic and treatment dilemma. Mistaking a physical condition for CD carries serious consequences for the child while continued investigation in line with physical disease in a child with CD also may expose the child to serious harm. MATERIALS AND METHODS: One hundred and seventy-four consenting doctors who attended a national conference of pediatricians were administered a 10 item questionnaire developed by the researchers. RESULTS: Only 5 (2.9%) of participants had good knowledge (scored above the mean plus one standard deviation of the score obtained by the psychiatry residents. Gender, rank, years of experience, availability of psychiatric service in center and duration of the psychiatry posting as the medical student could not differentiate those with good/fair knowledge from those without. However, those who have referred children for psychiatric assessment (P=0.015), those who believe that children can have CD (P=0.000) and those who are fairly confident that they could diagnose CD in children (P=0.000) had better knowledge of CD. CONCLUSION: Pediatricians have poor knowledge of CDs in children. Those that know that children could have the condition have confidence that they can identify children with the condition and have referred with mental health problems to psychiatrists have better knowledge than those who did not.

Sonographic Biometry of Normal Kidney Dimensions among School-age Children in Nsukka, Southeast Nigeria.

BACKGROUND: Some kidney diseases are usually associated with changes in kidney size. OBJECTIVE: To determine sonographically the normal limits and percentile curves of the kidney dimensions according to age, gender and somatometric parameters among school-age children. METHODS: A prospective cross-sectional research design and convenience sampling method were utilized. Participants included 947 normal subjects (496 boys and 451 girls) aged 6-17 years old. The sonographic examination was performed on a Shenzhen DP-1100 machine with 3.5 MHz convex transducer. Longitudinal and transverse dimensions of the kidneys were obtained in coronal plane with the subject in the supine or left lateral decubitus position. RESULTS: The means of right and left kidney lengths in mm were 79.6 ± 8.1 and 81.6 ± 8.3, respectively while that of the right and left kidney widths in mm were 35.03 ± 3.6 and 35.09 ± 3.6, respectively. Dimensions of the kidneys were not statistically different in boys and girls (p > 0.05). There was a statistically significant difference between right and left kidney length (p < 0.05). Height correlated best with both kidney lengths. Thus the normal limits, prediction models and percentile curves of kidney lengths were established with respect to height. CONCLUSION: Sonographic determination of pathologic changes in the size of the kidneys necessitates knowing the normal ranges of its lengths especially with respect to height in school-age children.

Spatiotemporal and seasonal transmission dynamics of Schistosoma haematobium and snail infectivity in Ase River catchment, Delta State, Nigeria.

Bulinus are intermediate snail hosts of Schistosoma haematobium. Despite their vectorial role, the transmission dynamics and infectivity of these intermediate snail hosts remain understudied in the Ase River. This longitudinal study evaluated the geospatial and seasonal transmission patterns and infectivity of three S. haematobium vectors between November 2020 and October 2022 in the Ase River catchment, Delta State, Nigeria. Eleven (11) geospatial water contact coordinates were mapped for monthly spatiotemporal collection of Bulinus species along the Ase River and its catchment, for two years. Snail sampling was performed for 45 min at each study site using scooping/hand-picking techniques and subsequently counted, identified and recorded. Snails of the Bulinus genus were individually placed in a beaker containing distilled water and exposed to light to shed cercariae which were identified to be human schistosome type. The number of infected snails for each month and season was also documented to analyze the spatiotemporal and seasonal transmission dynamics of infectivity. Out of the 2345 Bulinus snails collected, a total of 41.45% were found to be infected with S. haematobium. The monthly infectivity of Bulinus snails varied significantly (P < 0.05) throughout the study period (P = < 0.0001; F = 23.11; df = 11). Further analysis showed a strong significant association (χ2 = 23.57; df = 11; p = 0.015) between the study years. The Principal Component Analysis (PCA) results suggest that Bulinus infectivity within the Ase River catchment area was primarily associated with the months of February and January. B. truncatus consistently had the highest transmission potential, followed by B. globosus and B. senegalensis. ANOVA confirms that the monthly/study site infectivity and transmission potential in B. truncates, B. globosus and S. senegalensis were statistically, significant (P < 0.05). These results demonstrated a clear distinction in the patterns and relationships between the different months in terms of snail infectivity and seasonal transmission potential. This understanding will help in the continuous monitoring and targeted interventions to control schistosomiasis transmission in Ase River.

Evaluation of the antimalarial and CD4+ T-cell modulatory effects of leaf methanol extract of Phyllanthus muellerianus (Kuntze) Exell (Phyllanthaceae) in Plasmodium berghei-infected mice.

ETHNOPHARMACOLOGICAL RELEVANCE: Phyllanthus muellerianus (Kunze) Exell, a member of the Phyllanthaceae family, is a medicinal plant widely distributed in Africa. Decoctions from the leaves are used in Nigeria to treat fevers, convulsions, some neurological disorders and malaria. AIM OF THE STUDY: This study is to evaluate the anti-malarial properties of methanol extract of Phyllanthus muellerianus (MEPM) leaves and its ethyl acetate fraction using a murine malaria model infected with Plasmodium berghei. Additionally, we seek to investigate the potential modulatory effects of this extract and fraction on CD4+ T-cell populations in the context of malaria infection. MATERIALS AND METHODS: The anti-malarial effects of the leaf methanol extract of Phyllanthus muellerianus (MEPM) were screened using three established in vivo models of anti-plasmodial screening namely the curative, suppressive and prophylactic models. The methanol extract (MEPM) was afterwards fractionated into hexane (HFPM), ethyl acetate (EAFPM), and methanol (MFPM) fractions. In the pilot anti-malarial screening of the fractions, EAFPM exhibited the best antiparasitic activity. Subsequently, EAFPM was screened for anti-malarial activity using the three models above. The effects of the MEPM and EAFPM on haematological indices (Hb and PCV) of the inoculated animals were further screened and the mean survival time (MST) of the animals was monitored. CD4+ T cells of various groups were counted before and after treatment using a flow cytometer. The EAFPM was further subjected to HPLC analysis for identification of its major compounds. RESULTS: The EAFPM (100 and 200 mg/kg) elicited 88% and 93% cure respectively in the curative model, while artesunate (5 mg/kg,- the positive control) gave 87% protection. The MEPM and EAFPM also gave significant suppression of parasitemia in the suppressive model. The treated groups survived beyond 28 days as against 11 days by the control group (infected but not treated). The treated groups also prevented anaemia seen in the negative control. The EAFPM group significantly modulated the CD4+ T cell. Compounds identified were Gallocatechin, Quercetin -3-O-gallate, Ellagic acid, and Methylellagic acid rhamnoside). CONCLUSION: The study established that the leaf of Phyllanthus muellerianus possesses antimalarial activity, thus lending support to its use in the folkloric treatment of malaria.

HLA-DRB1*15:01 and the MERTK Gene Interact to Selectively Influence the Profile of MERTK-Expressing Monocytes in Both Health and MS.

BACKGROUND AND OBJECTIVES: HLA-DRB1*15:01 (DR15) and MERTK are 2 risk genes for multiple sclerosis (MS). The variant rs7422195 is an expression quantitative trait locus for MERTK in CD14+ monocytes; cells with phagocytic and immunomodulatory potential. We aimed to understand how drivers of disease risk and pathogenesis vary with HLA and MERTK genotype and disease activity. METHODS: We investigated how proportions of monocytes vary with HLA and MERTK genotype and disease activity in MS. CD14+ monocytes were isolated from patients with MS at relapse (n = 40) and 3 months later (n = 23). Healthy controls (HCs) underwent 2 blood collections 3 months apart. Immunophenotypic profiling of monocytes was performed by flow cytometry. Methylation of 35 CpG sites within and near the MERTK gene was assessed in whole blood samples of individuals experiencing their first episode of clinical CNS demyelination (n = 204) and matched HCs (n = 345) using an Illumina EPIC array. RESULTS: DR15-positive patients had lower proportions of CD14+ MERTK+ monocytes than DR15-negative patients, independent of genotype at the MERTK SNP rs7422195. Proportions of CD14+ MERTK+ monocytes were further reduced during relapse in DR15-positive but not DR15-negative patients. Patients homozygous for the major G allele at rs7422195 exhibited higher proportions of CD14+ MERTK+ monocytes at both relapse and remission compared with controls. We observed that increased methylation of the MERTK gene was significantly associated with the presence of DR15. DISCUSSION: DR15 and MERTK genotype independently influence proportions of CD14+ MERTK+ monocytes in MS. We confirmed previous observations that the MERTK risk SNP rs7422195 is associated with altered MERTK expression in monocytes. We identified that expression of MERTK is stratified by disease in people homozygous for the major G allele of rs7422195. The finding that the proportion of CD14+ MERTK+ monocytes is reduced in DR15-positive individuals supports prior data identifying genetic links between these 2 loci in influencing MS risk. DR15 genotype-dependent alterations in methylation of the MERTK gene provides a molecular link between these loci and identifies a potential mechanism by which MERTK expression is influenced by DR15. This links DR15 haplotype to MS susceptibility beyond direct influence on antigen presentation and suggests the need for HLA-based stratification of approaches to MERTK as a therapeutic target.

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 prevalence of orthostatic hypotension in type 2 diabetes mellitus patients in a diabetic clinic in Enugu South-East Nigeria.

BACKGROUND: Orthostatic Hypotension is a serious and common complication of diabetes mellitus. AIMS: To determine the prevalence and risk factors of Orthostatic Hypotension in type 2 diabetic patients in a diabetes mellitus clinic in Enugu South-East Nigeria. METHOD AND MATERIALS: A structured questionnaire was administered to the eligible and consenting seventy type 2 diabetes mellitus patients. The supine and erect blood pressures of each patient were recorded. The patients with Orthostatic Hypotension were compared with those without Orthostatic Hypotension for different clinical and biochemical parameters. STATISTICAL ANALYSIS USED: The data was analyzed using Statistical Package for Social Sciences (SPSS) version 19 software. Odds ratio was calculated for the presence of Orthostatic Hypotension amongst the variables and p-value < 0.05 was considered statistically significant. RESULTS: The prevalence of Orthostatic Hypotension in type 2 diabetic patients was 23.3%. Orthostatic Hypotension had statistically significant association with the presence of peripheral neuropathy, retinopathy and proteinuria. CONCLUSIONS: Orthostatic Hypotension is a common complication in type 2 diabetes mellitus patients seen at Enugu. It is recommended that measurement of erect and supine blood pressures should be part of the standard care of type 2 diabetic patients.