Balo's concentric sclerosis a rare variant of multiple sclerosis in a Nigerian adult male: A case report.

Background: Balo's concentric sclerosis (BCS) is a rare variant of multiple sclerosis (MS) that usually runs a benign course. Typically, brain magnetic resonance imaging (MRI) shows concentric lamella of areas of demyelination alternating with normal zones of myelin preservation. Clinically, it may be mistaken for other intracranial space-occupying lesions, especially in our subregion, where neuroimaging facilities are scarce or not affordable. The authors report a rare case of BCS in a young Nigerian male diagnosed and managed in Enugu, Nigeria. This is possibly the first reported case in sub-Saharan Africa. Case Description: The patient presented with behavioral changes, focal seizures, cranial neuropathy, long tract signs, and cerebellar dysfunction causing severe disability and functional impairment with a Modified Rankin Score (mRS) of 4. Brain MRI showed multiple heterogeneous lesions in the right cerebral hemisphere, brainstem, and cerebellum with features in keeping with BCS. Cerebrospinal fluid oligoclonal bands were negative and C-reactive protein was normal. He had high-dose steroids and immunosuppressive therapy. He made a gradual neurological improvement and significant symptom resolution and was able to return to work after a year (mRS-1). Conclusion: BCS is a rare variant of MS in sub-Saharan Africa. The mainstay of diagnosis is MRI which shows the typical concentric demyelinating pattern. Steroids and immunosuppressive therapy are effective in the treatment of BCS.

Obesity in patients with hypertension attending a medical outpatient clinic in a tertiary health facility in Enugu, Southeast Nigeria.

Introduction: The prevalence of obesity is increasing in sub-Saharan Africa which reflects the current global trend. Epidemiological data have consistently shown a strong relationship between obesity and hypertension in Africans, and this association is stronger for central obesity. The aim of this study was to describe the pattern of overweight/obesity among patients living with hypertension in a tertiary hospital in Enugu, Southeast Nigeria. Methods: This was a cross-sectional study conducted in the Medical Out-Patient Clinic of the Enugu State University Teaching Hospital in Enugu, Enugu State, Southeast Nigeria. Data were analyzed using the SPSS version 22. Results: Data were collected from a total of 450 consenting patients, most of whom 64% (288) were females. The mean body mass index (BMI) was 28.9 ± 6.1 kg/m2 higher in females than males (29.8 ± 6.5 kg/m2 vs. 26.7 ± 5.2 kg/m2, P < 0.001). The gender distribution of classes of obesity showed female preponderance. A little more than one-third of the patients were overweight, whereas about four out of every ten patients were obese. While overweight did not differ significantly across gendeWr (P = 0.67), more feWmales than males were significantly obese (P < 0.001). The age distribution of BMI showed increasing rates of underweight and decreasing rate of morbid obesity with age. About 86.8% of the females had substantially increased waist circumference compared to 26.5% of the males. Overall, 53% of the males and 97.6% of the females have abnormal waist circumferences. Waist-hip ratio was equally abnormal in 89.3% of the study population even though no statistically significant difference was observed across gender. Conclusion: Overweight and obesity are common among patients with hypertension as demonstrated in this study. There is need to set up an aspect of health education which specifically sensitizes the public against the untoward consequences of overweight and obesity.

RésuméIntroduction: La prévalence de l'obésité augmente en Afrique subsaharienne (ASS), ce qui reflète la tendance mondiale actuelle. Les données épidémiologiques ont constamment montré une forte relation entre l'obésité et l'hypertension chez les Africains et cette association est plus forte pour l'obésité centrale. Le but de cette étude était de décrire le schéma de surpoids / obésité chez les patients souffrant d'hypertension dans un hôpital tertiaire à Enugu, dans le sud-est du Nigeria. Méthodes: Il s'agit d'une étude transversale menée dans la clinique de consultations externes de l'hôpital universitaire d'Enugu State University à Enugu, dans l'État d'Enugu, dans le sud-est du Nigéria. Les données ont été analysées à l'aide de la version 22 de SPSS. Résultats: Les données ont été recueillies auprès d'un total de 450 patients consentants, dont 64% (288) étaient des femmes. L'IMC moyen était de 28,9 ± 6,1) kg / m2 plus élevé chez les femmes que chez les hommes 29,8 ± 6,5) kg / m2 contre 26,7 ± 5,2 kg / m2, p <0,001). La répartition par sexe des classes d'obésité a montré une prépondérance féminine. Un peu plus d'un tiers des patients étaient en surpoids, tandis qu'environ quatre patients sur dix étaient obèses. Bien que le surpoids ne diffère pas significativement selon le sexe (p = 0,67), plus de femmes que d'hommes étaient significativement obèses. (P <0,001). La répartition par âge de l'IMC a montré une augmentation du taux d'insuffisance pondérale et une diminution du taux d'obésité morbide avec l'âge. Environ 86,8% des femmes avaient considérablement augmenté le tour de taille, contre 26,5% des hommes. Dans l'ensemble, 53% des hommes et 97,6% des femmes ont des circonférences de taille anormales. Le rapport taille / hanche était également anormal et anormal dans 89,3% de la population étudiée, même si aucune différence statistiquement significative n'a été observée entre les sexes. Conclusion: Le surpoids et l'obésité sont courants chez les patients souffrant d'hypertension, comme démontré dans cette étude. Il est nécessaire de mettre en place un aspect de l'éducation sanitaire qui sensibilise spécifiquement le public aux conséquences fâcheuses du surpoids et de l'obésité.

Prevalence of active convulsive epilepsy in an urban slum in Enugu South East Nigeria.

PURPOSE: To determine the prevalence of active convulsive epilepsy and treatment gap in two Urban slums in Enugu South East Nigeria. METHODS: A 3 phase cross-sectional descriptive study was done to survey individuals ≥ 15 years in 2 slums in Enugu, South East Nigeria. RESULTS: The prevalence of epilepsy was 6.0 (95% CI: 5.9-6.0) per 1000 (men 4.4/1000, 95% CI: 2.3-6.4, women 7.8/1000, 95% CI: 4.9-10.4), p=0.06. The peak age of active convulsive epilepsy was 40-44 years (11.2 per 1000) with two smaller peaks at 25-29 and ≥ 50 years. The age and sex adjusted prevalence using WHO standard population and 2006 Nigerian census population were 5.9 per 1000 (95% CI: 4.0-7.9) and 5.4 per 1000 (95% CI: 3.4-7.4). CONCLUSION: The prevalence of epilepsy is high in urban slums in Enugu. Nationwide studies should be done to find out the true prevalence in the country.