Relationship between Kidney Dysfunction, Stroke Severity, and Outcomes in a Nigerian Tertiary Hospital: A Prospective Study.

BACKGROUND: Stroke is a common neurologic disease associated with fatal outcomes. Kidney dysfunction may be an important predictor of stroke severity and outcome. AIM: To determine the relationship between kidney dysfunction at admission and stroke severity and 30-day outcome. MATERIALS AND METHODS: This was a prospective study that involved 150 stroke patients. Stroke severity at admission was assessed using the National Institutes of Health Stroke Scale (NIHSS). Renal dysfunction was assessed by the presence of albuminuria and or reduced glomerular filtration rate (GFR) at admission. Neurological outcome was assessed using mortality, modified Rankin Scale (mRS), and Glasgow Outcome Scale (GCS). RESULTS: The mean age of the study participants was 61.0 ± 13.2 years. Renal dysfunction was present in 66% of the participants while the case fatality rate of stroke was 26%. Poor neurological outcome at 30 days was found in 44.1% of survivors. Those with albuminuria had lower GCS (P = 0.041), lower GFR (P = 0.004), higher mRS score on day 14 (P = 0.041) and day 30 (P = 0.032), and higher NIHSS score (P = 0.034). Independent predictors of 30-day mortality were albuminuria (Adjusted Odd Ratio (AOR) 3.60, 95%CI: 1.07-12.17) and increasing NIHSS score (AOR = 1.15, 95%CI: 1.04-1.28). Lower GCS (P < 0.001), elevated white blood cells (P = 0.003), serum creatinine (P = 0.048), and NIHSS score (P < 0.001) were associated with poor neurological outcome. NIHSS score was the only significant predictor of neurologic outcome (AOR: 1.25; CI: 1.11-1.41; P ≤ 0.001). CONCLUSIONS: Kidney dysfunction was associated with stroke severity and mortality. However, it was not an independent predictor of neurological outcome.

Cognitive Functions in Patients with Clinically Stable (Mild to Moderate) Asthma in South West Nigeria: Assessment using Automated Neuropsychological Test Battery.

OBJECTIVE: Previous reports has shown that asthmatic patients with poor asthma control exhibited cognitive dysfunction. However, there is paucity of information on the cognitive functions of patients with clinically stable asthma particularly in sub-Saharan Africa. Subjects, study setting, materials and methods: This was a cross-sectional study conducted at the Federal Medical Centre, Owo, South West Nigeria from 2014-2016. Forty patients with mild to moderate asthma and forty matched (age, sex and educational status) non-asthmatic control subjects were included. Spirometry was done for all participants. Cognitive performance on domains of psychomotor speed, attention/concentration, memory and vigilance were assessed in all the participants using the Fepsy neuropsychological test battery Results: The mean age of the patients with asthma in years was 38.65±16.67 while that of the control subjects was 39.18±11.64 years. The patients with asthma had prolonged visual and binary choice reaction time relative to controls. Older asthmatic patients had prolonged visual and binary choice reaction time when compared to controls (p<0.05) while other socio-demographic clinical characteristics of the patients did not have impact on their cognitive performance (p>0.05). CONCLUSION: Cognitive performance was similar between the patients with mild to moderate asthma and non-asthmatic controls. Older asthmatic patients have impaired psychomotor speed relative to younger asthmatic patients.

Cognitive functions in newly diagnosed patients with HIV infection in a tertiary health facility: Assessment using community screening interview for dementia.

INTRODUCTION: Neurocognitive dysfunction is a detrimental complication of HIV infection. In this study we attempt to characterize the pattern of cognitive dysfunction in a sample of Nigerian patients with newly diagnosed HIV infection. METHODS: We conducted a prospective study in which 50 patients with newly diagnosed HIV infection were studied along with 50 normal control subjects. The participants were evaluated with the medical history, general, physical and neurological examination. Laboratory evaluation and chest X-Ray were done for all patients. The Community Screening Interview for Dementia (CSID) questionnaire was administered to all the study participants. RESULTS: About 70% of the patients were in advanced disease stage. The mean age (SD) of the patients and controls in years were 36.44 ± 8.22 and 35.40 ± 11.53 respectively. More than half (56%) of the patients had secondary level of education (12 years of education). About 20% of the patients had severe neurocognitive impairment while 48% had minor neurocognitive disorder. The patients with HIV infection performed poorly in the domains of language, memory, orientation, attention/calculation and praxis relative to controls (p < 0.05).There were no significant effect of gender, age, sex and level of education on cognitive functions in the patients (p > 0.05) but the presence of opportunistic infections had negative impact on the performances on orientation and total CSID scores in the patients with HIV infection (p < 0.05). CONCLUSION: Patients with newly diagnosed HIV infection have poor cognitive functions when compared to normal controls and some presence of opportunistic infections in the patient is a significant risk factor for cognitive impairment.

Risk factors for epilepsy in Nigerians - a cross-sectional case-control study.

OBJECTIVE: The identification of risk factors that predispose to development of epilepsy is crucial to its primary prevention. This study evaluated the risks conferred by some predisposing factors. PATIENTS AND METHODS: This cross-sectional analytical study assessed the relative contributions of various risk factors to development of epilepsy in 244 adult Nigerians with epilepsy compared with equal number of age- and sex-matched controls. Odds ratio and Fisher exact test were used to express significant association. RESULTS: Birth asphyxia (OR 6.87), recurrent childhood febrile convulsions (OR 5.74), central nervous system (CNS) infections (OR 3.38), head trauma (OR 1.82), rural dwelling without health care access (OR 2.44), and history of epilepsy in first-degree relatives (OR 3.44) were identified as significant risk factors for epilepsy. CONCLUSIONS: Prompt diagnosis and appropriate treatment for febrile diseases and CNS infections, use of head helmets and car seat belts would contribute to reduced incidence.

Profile of post-traumatic epilepsy in Benin City, Nigeria.

BACKGROUND: Post traumatic epilepsy is recurrent chronic seizures occurring after four weeks following brain injury. It commonly occurs after road traffic accidents thus making it a preventable cause of chronic seizures. The prevalence and pattern of this disorder is not known among Nigerian patients with epilepsy. OBJECTIVE: This study aimed at determining the prevalence of and predisposing type of head injury to developing post traumatic epilepsy. METHODS: We studied 244 consecutive patients with epilepsy attending the neurology clinic of a tertiary health facility in an urban Nigerian city by analyzing the details of their demographic and clinical data obtained with the aid of a structured questionnaire and from the Epilepsy Registry of a Neurology Unit between January and December 2006. RESULTS: Thirty-eight patients with a mean age of 38.6 +/- 7.3 years (age range 15- 75 years) had posttraumatic epilepsy comprising 15.57% of all cases of epilepsy. Thirty-three (86.8%) had closed head injury. Thirty-two (84.2%) of the patients had positive history of loss of consciousness. Twenty two patients (57.9%) sustained head injury from motor vehicle accidents. Majority of the patients had secondarily generalized seizures (73.7% of the cases). Twenty-seven (71.4%) of the 38 patients had seizure onset in the first year after brain injury. Depressed skull fracture (19/38; 50%) was the most common abnormal CT finding. CONCLUSION: Post traumatic epilepsy contributes significantly to the number of patients with epilepsy presenting to our neurology services. There is need to educate people on the usefulness of seat-belts and helmets while driving.

Tetanus - a Review of Current Concepts in Management

Tetanus is a vaccine preventable disease that yearly causes a total of 309;000 deaths. Reports showed up to 1 million cases annually; mostly in underdeveloped countries. Clostridium tetani; the causative organism; is widespread in the faeces of domestic animals and humans; while spores of C. tetani are abundant in soil and in the environment surrounding the habitation of humans and animals. In developing countries; mortality rates are as high as 28 per 100;000; in North America the rate is less than 0.1 per 100;000. Immunization programs clearly decreased neonatal tetanus deaths; and some recent evidence suggests progress in prevention throughout the World. Tetanus remains a great public health problem in developing countries such as Nigeria and it is associated with high mortality; but the understanding of the epidemiological aspects of this disease forms the basis of preventive strategies in any community. This paper reviewed the history; epidemiology and clinical diagnosis of tetanus and emphasized the current opinions in the management of tetanus outlining the various suggested treatment plans from experts in developing countries which form the basis for World Health Organization recommendations

Human Immunodeficiency Virus and the Nervous System: an Update with Emphasis on Developing Countries

Ten percent of patients that are diagnosed with AIDS also have some neurological complaint; 40present neurological signs or symptoms during the course of the infection; and 80of the autopsies present neurological alterations. Although much is known about the neuropathology of HIV infection; many important questions on its neuropathogenesis remain unanswered

Morbidity and mortality patterns among neurological patients in the intensive care unit of a tertiary health facility.

BACKGROUND/OBJECTIVE: The morbidity and mortality of neurological patients managed in the intensive care unit reflect the causes of neurological disorders and the effectiveness of management. METHOD: The morbidity and mortality patterns of neurological patients admitted into the intensive care unit of the University of Benin Teaching Hospital (UBTH), a tertiary health institution in Nigeria, was examined over an 18-year period (January 1985 to December 2003). A complete sampling frame was used with all patients' records scrutinized. RESULTS: A total of 187 patients, (16.6% of the total ICU admissions) with neurological morbidity were admitted during the period. We observed that morbidity was high for preventable etiologies--head injury (119 patients constituting 63.7%), tetanus (26 patients constituting 13.9%), hypertensive encephalopathy (12 patients constituting 6.4%) and meningitis (8 patients constituting 4.8%). The case fatality rates for these causes were 50.4%, 61.5%, 66.7% and 62.5% respectively. The case fatality rate for cerebral malaria was 100%. In addition, males (67.9%) were more likely to have trauma-related morbidity (P < .001) than females (32.1%). Overall mortality rate was high (52.4%) and calls for urgent attention. CONCLUSION: We concluded that preventable morbidities (head injury, tetanus, meningitis and hypertensive encephalopathy) accounted for fatality among neurological patients in the ICU, Benin City, Nigeria. Mortality was higher among those that required significant intensive interventions. Improved public awareness, traffic legislation, prompt emergency medical care and immunization against tetanus and meningitis should reduce morbidity and mortality.

Serum thyroglobulin autoantibody titres and immunoglobulin concentrations in Nigerians with goitre.

Using the tanned turkey red blood cell haemaglutination test, blood samples from 327 Nigerians with goitre were screened for the presence of thyroglobulin autoantibody. 15 (4.6%) were found to have significantly positive autoantibody titres while none of the 50 age and sex-matched normal controls and autoantibody. Of the 15 with significantly positive thyroglobulin autoantibody titres, only 2 were males, giving a male:female ratio of 1 to 6.5. The mean serum concentration of IgG in the positive cases (4,163 +/- 53.5 mg/100 ml) was significantly higher than either that of normal controls (3,044 +/- 147.6 mg/100 ml) of goiterous subjects with no thyroglobulin autoantibody (2,196 +/- 116.5mg/100ml). It was found that thyroglobulin autoantibody is an IgG immunoglobulin. It is concluded that autoimmune thyroid disease occurs in Nigerians with goitre and that females are affected more than males.