Tramadol-induced intracerebral hemorrhage: A rare case report.

A previously healthy middle-aged man with no vascular risk factors developed a hemorrhagic stroke. He had been using tramadol due to erectile dysfunction for 2 years. So, the patient developed right basal ganglia due to tramadol addiction.

Lateral medullary syndrome: uncommon form of brainstem stroke.

Lateral medullary syndrome (LMS) is a less common form of a brainstem stroke. It is the result of occlusion of the posterior inferior cerebellar artery (PICA). It is caused by atherosclerosis, thrombosis, or emboli from another source. Case Presentation: A 60-year-old male patient presented to the emergency department with vertigo, vomiting, slurred speech, hiccups, and left-side weakness associated with paresthesia for 1 day. He had a past medical history of uncontrolled hypertension and a smoking habit. The neurological examination revealed ataxia, and left hemiparesis associated with paresthesia. A cranial nerve examination revealed slight right-sided ptosis, mouth deviation, and loss of sensory sensation on the right side of the face. Brain MRI showed right medullary infarct consistent with LMS. Electrocardiogram, echocardiography, and vertebral artery color Doppler were normal. He was admitted to the neurology ward and was treated with low molecular weight heparin 60 mg subcutaneously, aspirin 300 mg, neuroprotective agents, and antihypertensive treatment. After 6 days of medical treatment, his condition has improved massively (dysarthria and dysphagia disappeared). He was discharged for physical rehabilitation. Clinical Discussion: LMS (Wallenberg syndrome) is one of the brainstem stroke syndromes caused by occlusion of PICA. Vertigo, vomiting, dysphagia, dysarthria, ipsilateral ataxia, Horner's syndrome, and contralateral hemiparesis define this syndrome. Brain MRI is necessary for diagnosis alongside clinical syndrome. Conclusion: LMS is a rare form of brainstem stroke and carries a favorable prognosis if early hospitalization and treatment is applied. Brain MRI, including diffusion sequence, is the most useful diagnostic tool for detecting LMS.

A survey of contagious ecthyma and molecular characterization of Orf virus in sheep and goats in Nigeria (2014-2016).

Background: Outbreaks of contagious ecthyma (CE) are frequently reported in sheep and goat flocks in Nigeria with severe clinical outcomes. CE is a debilitating and economically important disease primarily affecting sheep and goats caused by the Orf virus (ORFV). Despite field reports of CE in the country, there is no concise country-wide epidemiological data on the disease and limited genetic data of circulating Nigerian ORFV are available in the public domain. Aim: An epidemiological survey of CE and molecular characterization of ORFV circulating in Nigeria from 2014 to 2016. Method: Data were collected using designed questionnaires, administered to veterinarians and farmers in selected States of Nigeria. Samples were collected during passive surveillance for CE from 2014 to 2016 which were analyzed by polymerase chain reaction (PCR). The A32L and B2L genes of circulating ORFV were also characterized. Results: Analysis of the questionnaire showed that 69.54% (n = 82/118) of the farmers claimed to have experienced CE in their flocks with average morbidity and mortality rates of 25% and 15%, respectively. A total of 113 veterinarians participated in the study, with 69.9% (n = 79) familiar with CE and claimed CE causes morbidity rates of 25%-37% and mortality rates of 10%-15% in sheep and goats. Laboratory results revealed that ORFV was detected in 72% (18/25) of outbreak samples analyzed by real-time PCR. Phylogenetic analysis of A32L and B2L genes revealed that Nigerian ORFV sequences belong to clusters I and II and are similar to viruses from India, Ethiopia, and China. Conclusions: This study is the first nationwide epidemiological data on the status of CE in sheep and goats in Nigeria. It is also the first report of molecular characterization of two genes of ORFV circulating and causing outbreaks in small ruminants in the country. This study showed that CE is under-reported, widespread and of economic importance to sheep and goat farmers in Nigeria.

Spontaneous Bilateral Basal Ganglia Hemorrhage Due to Severe Hypertension.

Introduction: The basal ganglia, which comprise many subcortical nuclei, constitute an integrated functional unit of the brain. Spontaneous hemorrhage of the basal ganglia is mostly unilateral and secondary to uncontrolled hypertension. Simultaneous bilateral basal ganglia hemorrhage (SBBGH) is very rare. So far, only 40 cases have been documented so far. Case Presentation: Here, we report a 37-year-old man with a past medical history of uncontrolled hypertension who was brought to the emergency department due to severe headache, worsening confusion, and right-sided weakness for 2 days. An urgent non-contrast brain CT performed immediately revealed bilateral intracerebral hemorrhage (ICH) of the same age in the basal ganglia. On admission, blood pressure was 220/120. Other vital signs were normal. The patient was admitted to the ICU, IV antihypertensive and antiedema medications were given. After clinical improvement, he was transferred to the neurology ward on the fifth day. After another 5 days in the neurology inpatient ward, the patient clinically improved and was referred to the rehabilitation department. Conclusion: Due to the rarity of SBBGH, it is particularly interesting to report this remarkable case of a man with simultaneous spontaneous bilateral ganglia hemorrhage secondary to uncontrolled hypertension.

Economic assessment of a community-based care package for people with lower limb disorder caused by lymphatic filariasis, podoconiosis and leprosy in Ethiopia.

We conducted an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine healthcare in Gusha cluster, Guagusa Shikudad district, northwest Ethiopia. The healthcare package included training patients in lower limb hygiene and skin care and provision of shoes, hygiene supplies and medication. The implementation activities included training events, workshops, awareness raising, self-help groups, supportive supervision, staff secondments and advisory board meetings. The cost of implementing the care package in Gusha cluster, with a population of 30 558 people, was 802 655 Ethiopian birr (ETB) (£48 159) and the cost of delivering care to 235 participants was 204 388 ETB (£12 263), or 870 ETB (£52) per person. There was a 35% decrease in the mean disability scores (measured using the World Health Organization Disability Assessment Schedule 2.0) and a 45% improvement in the dermatology-specific quality of life (measured using the Dermatology Life Quality Index) at the 3-month follow-up compared with baseline. There were reductions in the number of days with symptoms, days off usual activities/work and days with reduced activity due to illness, all of which were statistically significant. Our pilot suggests that integration of the care package into routine healthcare in Ethiopia may be effective in improving health-related quality of life and disability and reducing time out of economic activity due to illness.

First report of camel contagious ecthyma in Nigeria.

Camel contagious ecthyma (CCE) is a viral disease of camelids that is caused by a Parapoxvirus (PPV) which is a DNA virus of the viral family: Poxviridae. Diseases affecting camels in Nigeria are scarcely reported. CCE or the laboratory detection of camel PPV (CPPV) has not been reported in Nigeria. This study investigated and described the clinical presentation of CCE and molecular detection of CPPV in Nigeria. Suspected cases of CCE were reported in a farm, live animal market and abattoir, in three different states (Bauchi, Plateau and Zamfara) in Northern Nigeria. Skin scabs, lungs, liver and intestine samples were collected. Polymerase chain reaction (PCR) was carried out using the primers which targets the RPO30 gene fragment of the genus PPV. The clinical signs observed from the suspected cases of CCE were proliferative skin lesions, papules, scabs on the lips and nares. CPPV was detected in 80.0% (4/5) of the samples collected by PCR. CCE was diagnosed based on clinical signs and PCR results. This is the first report of CCE in Nigeria. Further studies should be carried out to genetically characterize the CPPV circulating in Nigeria.

Association of blood lead level with neurological features in 972 children affected by an acute severe lead poisoning outbreak in Zamfara State, northern Nigeria.

BACKGROUND: In 2010, Médecins Sans Frontières (MSF) investigated reports of high mortality in young children in Zamfara State, Nigeria, leading to confirmation of villages with widespread acute severe lead poisoning. In a retrospective analysis, we aimed to determine venous blood lead level (VBLL) thresholds and risk factors for encephalopathy using MSF programmatic data from the first year of the outbreak response. METHODS AND FINDINGS: We included children aged ≤5 years with VBLL ≥45 µg/dL before any chelation and recorded neurological status. Odds ratios (OR) for neurological features were estimated; the final model was adjusted for age and baseline VBLL, using random effects for village of residence. 972 children met inclusion criteria: 885 (91%) had no neurological features; 34 (4%) had severe features; 47 (5%) had reported recent seizures; and six (1%) had other neurological abnormalities. The geometric mean VBLLs for all groups with neurological features were >100 µg/dL vs 65.9 µg/dL for those without neurological features. The adjusted OR for neurological features increased with increasing VBLL: from 2.75, 95%CI 1.27-5.98 (80-99.9 µg/dL) to 22.95, 95%CI 10.54-49.96 (≥120 µg/dL). Neurological features were associated with younger age (OR 4.77 [95% CI 2.50-9.11] for 1-<2 years and 2.69 [95%CI 1.15-6.26] for 2-<3 years, both vs 3-5 years). Severe neurological features were seen at VBLL <105 µg/dL only in those with malaria. INTERPRETATION: Increasing VBLL (from ≥80 µg/dL) and age 1-<3 years were strongly associated with neurological features; in those tested for malaria, a positive test was also strongly associated. These factors will help clinicians managing children with lead poisoning in prioritising therapy and developing chelation protocols.