Neuro-epidemiology of Acute Stroke Syndrome in the Adult Emergency Department of a Tertiary Hospital in a Resource-limited Environment of South-eastern Nigeria.

Background: Globally, acute stroke is one of the leading causes of preventable emergency hospital admissions. It is emerging as an important cause of disability and mortality among adult Nigerian Africans in the emergency department(ED) of Nigerian hospitals. Aim: The study was designed at reviewing epidemiology of acute stroke syndrome in the adult ED of a tertiary hospital in South-east Nigeria. Study Design: This was a retrospective descriptive study. Place and Duration of Study: The study was carried out on patients with acute stroke syndrome at the ED of Federal Medical Centre, Umuahia, Nigeria over a five year period from January 2008 to December 2012. Methods: The sources of data were from medical records, patients’ case notes; ED admission registers and nurses report books. Information collected were age, sex, place of the incidence, time of presentation to the ED, duration of symptoms at presentation, month (season) of occurrence, type of stroke, number of episodes and associated clinical conditions. Operationally, time of presentation to the ED was categorized into two: day time was defined inclusively as time period from 6.00 am to 6.00 pm while night time referred exclusively to the time period from 6.00 pm to 6.00 am Nigerian time. Early presentation to the ED meant that the victim arrived the ED of the hospital inclusively within 1 hour of the occurrence of the acute stroke while those that arrived after 1 hour were defined as late presentation to the hospital. Results: The age ranged from 36 years to 95 years with mean age of 68.2±7.4 years. There were 155 (58.3%) males and 111 (41.7%) females with male to female ratio of 1.4: 1. The incident predominantly occurred at home (77.8%), 239 (89.8%) had duration of symptoms more than 1 hour at presentation, 162 (60.9%) presented during the night time, 158 (59.4%) occurred during dry season, 157 (59.1%) had repeat episode, 199 (74.8%) were ischemic stroke and the most commonly associated clinic-medical condition was hypertension (80.1%). Conclusion: There was variability in the epidemiology of stroke with ischemic stroke being the pre-eminent type and hypertension the most associated clinical condition. The incident occurred predominantly among male gender, elderly patients, at home, during dry season and most of the patients presented late to the ED and at night time. Interventional strategies aimed at risk reduction, early presentation to dedicated and responsible stroke units and centres are advocated.

Type 2 Diabetes Mellitus in Ambulatory Adult Nigerians: Prevalence and Associated Family Biosocial Factors in a Primary Care Clinic in Eastern Nigeria: A Cross-sectional Study.

Background: Type 2 diabetes mellitus is a multi-factoral medical condition that aggregates in the family and has implications for family health. Research analyses of determinants of type 2 diabetes mellitus have demonstrated the interactions and clustering of family biosocial factors in its epidemiology. Aim: To determine the prevalence of type 2 diabetes mellitus and describe the associated family biosocial factors in ambulatory adult type 2 diabetic Nigerians in a primary care clinic in Southeastern Nigeria. Study Design: This was a cross-sectional study. Seven hundred and fifty patients were screened for diabetes mellitus and thirty five of them who had diabetes mellitus were age and sex matched with thirty five non-diabetic, non-hypertensive patients for the determination of the association with family biosocial factors. Place and Duration of Study: The study was carried out at a primary care clinic in Umuahia, South-eastern Nigeria in May 2011. Methodology: Data on family biosocial factors were obtained using pretested, structured and interviewer-administered questionnaire. Diabetes mellitus was defined using American Diabetes Association criterion. Results: The prevalence of type 2 diabetes mellitus was 4.7%. Eleven (1.5%) of the diabetic patients were newly diagnosed in the hospital. There were fourteen (40.0%) males and twenty one (60.0%) females with sex ratio of 1:1.5. The age ranged from 28-82 years with mean age of 47±11.2 years. The middle aged adults were predominantly affected. Family biosocial factors significantly associated with type 2 diabetes were family history of hypertension (P=.006) and diabetes mellitus (P=.048). A significantly higher proportion of the diabetic patients had family history of hypertension compared to the non-diabetic and non-hypertensive subjects. The diabetic patients were one and half times more likely to have family history of hypertension compared to their non-diabetic and non-hypertensive counterparts. Conclusion: The study has shown the prevalence of type 2 diabetes mellitus with predilection for middle aged adult Nigerians. The associated family biosocial factors were family history of hypertension and diabetes mellitus. Screening adult Nigerians with family history of hypertension and diabetes mellitus for diabetes mellitus is recommended in primary care setting for familycentred preventive care.

Hyperuricaemia and its Relations with Serum Lipid Abnormalities in Untreated, Newly Diagnosed Adult Nigerian Hypertensive Patients.

Aims: To determine the prevalence of hyperuricaemia in adult Nigerians with untreated newly diagnosed hypertension and to evaluate its relations with serum lipid abnormalities. Study Design: Cross-sectional study. Place and Duration of Study: General Out-patient Department, Medical Out-patient Department and Emergency Room of the University of Ilorin Teaching Hospital, Ilorin, Nigeria between May 2007 and October 2007. Methodology: One hundred and fifty (150) untreated newly diagnosed hypertensive patients 18 years and above and one hundred and fifteen (115) age and sex-matched normotensive individuals were recruited into the study. Thorough clinical evaluation and laboratory investigations were done for both patients and controls including serum uric acid and serum lipid profile. Atherogenic ratio (Total cholesterol/Low density lipoprotein-cholesterol) was calculated for both patients and controls. Results: Of the one hundred and fifty newly diagnosed hypertensive patients, 52 (34.7%) were males and 98 (65.3%) females, with a range of 19-85 years and a mean age (±SD) of 50.412.3 years. Among the normotensive controls, 49 (42.6%) were males and 66 (57.4%) females with range of 23-80 years and a mean (±SD) of 50.712.7 yrs. Mean serum UA in hypertensive patients and normotensive controls was 0.40.1 mmol/l and 0.30.1 mmol/l respectively. Hyperuricaemia was found in 36.7% of hypertensive patients and 17.4% of normotensive controls (P<0.001). Serum UA was significantly higher in hypertensive patients than in normotensive controls (P<0.0001). Among hypertensive patients high TC and high LDL-c were the most prevalent types of serum lipid abnormalities. There was a significant positive correlation between serum UA and TG (r=0.21, P = 0.01). Conclusion: The study shows that hyperuricaemia and serum lipid abnormalities are prevalent among adult Nigerians with hypertension. There was a significant correlation between serum uric acid and serum triglyceride. This study recommends routine measurement of serum uric acid in both newly diagnosed hypertensive patients as well as those on antihypertensive drugs.