Gastrointestinal complications in stroke survivors.

The objective of this study was to highlight the gastrointestinal problems that occur in stroke survivors, which may also reduce their quality of life. Stroke patients admitted over an 18-month period were evaluated for common gastrointestinal symptoms as well as type and site of stroke. Symptoms evaluated included vomiting, dysphagia, constipation, masticatory difficulties and sialorrhea among others. Similar symptoms were sought for among controls. There were 54 experimental and 46 control subjects consisting of 25 (46.3%) men and 29 (53.7%) women and 32 (69.6%) men and 14 (30.4%) women respectively. The dominant gastrointestinal symptom was constipation 14 (25.9%), followed by masticatory difficulty 11 (20.4%). Other significant gastrointestinal (GI) symptoms and signs were incomplete bowel evacuation, fecal incontinence, sialorrhea, and dysphagia. There was no significant difference in GI symptoms in either sex, site or type of stroke, except that constipation and incomplete evacuation were commoner in ischaemic stroke. It is advocated that feeding and bowel care should be instituted among stroke patients.

Retrospective analysis of typhoid fever in a tropical tertiary health facility.

A retrospective analysis of cases diagnosed as typhoid fever over a ten-year period at the University College Hospital, Ibadan, Nigeria was carried out to assess the presentation pattern, laboratory investigation, mortality and mode of therapy. Incidence was of typhoid fever was highest in the dry months of the year. The mean age of survivors and the dead are 25.7 and 21.9 years respectively. Most of the patients presented with fever, abdominal pains and other gastrointestinal symptoms such as vomiting, constipation and diarrhoea. There was no specific temperature pattern but pulse rate > or = 120/minute was significantly associated with mortality. The commonest complication was intestinal perforation followed by haemorrhage with septic shock playing a prominent role in mortality. Mortality rate of 22.2% was recorded which is not significantly different from the 24% recorded at the same centre over three decades ago and most of them died within nine days of admission with 50% dying within 3 days. Most patients were scantily investigated with poor yield on blood, stool and urine cultures. Widal's test was not a favoured investigation and was not helpful in diagnosis. Chloramphenicol was the drug of choice as monotherapy, while metronidazole and gentamicin were used in cases of gut perforation. It is concluded that typhoid fever is still a major health concern in the tropics and efforts need to be geared up to combat this preventable scourge by improvement in basic necessities of life such as potable water, hygienic food in addition to health education.