Spectrum of endoscopic findings in Nigerians with dyspepsia.

BACKGROUND: Dyspepsia is a common gastrointestinal disorder originating from the gastroduodenal region, and is the most common indication for upper gastrointestinal tract endoscopy. There are differing information on the commonest endoscopic findings in patients with dyspepsia from Nigeria. OBJECTIVE: The aim of this study was to determine the spectrum of endoscopic findings in patients with dyspepsia. PATIENTS AND METHODS: This is a hospital-based prospective study carried out at the Endoscopy Unit of Federal Medical Centre, Yola from November, 2006 to May, 2010. Patients with clinical features of dyspepsia who underwent upper gastrointestinal tract endoscopy as part of their workup were recruited. Their biodata, history and duration of dyspepsia were noted on a proforma. The spectrum of endoscopic findings was also noted. RESULTS: A total of 259 patients with dyspepsia had upper gastrointestinal tract endoscopy. Ninety-nine (38.2%) were males while 160 (61.8%) were females, giving a male to female ratio of 1:1.6. Clinically significant endoscopic findings were seen in 241 (93.1%) patients while gastroduodenitis was the commonest finding. One hundred and two (39.4%) patients had two endoscopic findings, and 7 (2.7%) had three findings. CONCLUSION: Majority of patients with dyspepsia had clinically significant endoscopic findings. Gastroduodenitis was the commonest endoscopic finding.

Hepatitis B virus infection amongst pregnant women in North-eastern Nigeria- a call for action.

BACKGROUND: It is well known that Hepatitis B virus infection is endemic in Nigeria. Even though studies have been carried out on Hepatitis B virus infection in different parts of Nigeria, and in different sub-groups of individuals, information regarding the prevalence of Hepatitis B virus infection in pregnant women is scanty especially from the North-eastern region of Nigeria. We therefore determined the seroprevalence of Hepatitis B surface antigen (HBsAg) amongst pregnant women in North Eastern Nigeria. MATERIALS AND METHODS: A hospital-based cross-sectional study was carried out. The setting was the ante-natal clinic of the Federal Medical Centre, Yola, Nigeria. The duration of the study was from July 2008 to December 2008. Two hundred and thirty-one consecutively recruited pregnant women were screened for Hepatitis B surface antigen. Positive samples were re-tested using ELISA to eliminate false positives. Their biodata were obtained using a questionnaire to establish the presence of possible risk factors such as blood transfusion, surgery, etc. Written informed consent was obtained from each woman. RESULTS: Out of the 231 pregnant women tested, nineteen of them were seropositive for Hepatitis B virus infection giving an infection rate of 8.2%. Women in the age group 25-29 years had the highest HBV infection rate. CONCLUSION: This study confirms a high seroprevalence of Hepatitis B virus infect ion amongst pregnant women. It is recommended that pregnant women should be routinely screened for Hepatitis B virus infection as part of antenatal care services.

Management and health issues in women with epilepsy - a review.

Although epilepsy affects men and women equally, there are special implications for women, especially during their childbearing years, and particularly when pregnancy is contemplated. This review summarisesthe complexity and multifaceted nature of health issues affecting women with epilepsy (WWE) in general and epilepsy in women beyond childbearing age. The female sex hormones and their cyclic as well as age-related variations certainly influence seizure activity and epilepsy in women. Catamenial epilepsy is a multifaceted neuroendocrine condition in which seizures are clustered around specific points in the menstrual cycle, most often around perimenstrual or periovulatory period. There are special concerns for women of child bearing years with regard to contraception, pregnancy and teratogenicity that should be considered during counseling and selection of appropriate treatment.Although the majority of pregnant WWE experience normal pregnancies and deliveries, their children have a higher risk of birth defects. Individualised treatment coupling antiepileptic drug use (AED) and the specific phase of impact of the reproductive cycle must be considered in treatment selection. As the number of available treatment options for epilepsy increases, the optimal goal for the general practitioner is to work as a team with obstetricians and gynaecologists, and neurologists in an effort to ensure the best treatment of WWE

Hepatitis B Virus Infection amongst Pregnant Women in North-Eastern Nigeria- A Call for Action

Background: It is well known that Hepatitis B virus infection is endemic in Nigeria. Even though studies have been carried out on Hepatitis B virus infection in different parts of Nigeria; and in different sub-groups of individuals; information regarding the prevalence of Hepatitis B virus infection in pregnant women is scanty especially from the North-eastern region of Nigeria. We therefore determined the seroprevalence of Hepatitis B surface antigen (HBsAg) amongst pregnant women in North Eastern Nigeria. Materials and Methods: A hospital-based cross-sectional study was carried out. The setting was the ante-natal clinic of the Federal Medical Centre; Yola; Nigeria. The duration of the study was from July 2008 to December 2008. Two hundred and thirty-one consecutively recruited pregnant women were screened for Hepatitis B surface antigen. Positive samples were re-tested using ELISA to eliminate false positives. Their biodata were obtained using a questionnaire to establish the presence of possible risk factors such as blood transfusion; surgery; etc. Written informed consent was obtained from each woman. Results: Out of the 231 pregnant women tested; nineteen of them were seropositive for Hepatitis B virus infection giving an infection rate of 8.2. Women in the age group 25-29 years had the highest HBV infection rate. Conclusion: This study confirms a high seroprevalence of Hepatitis B virus infect ion amongst pregnant women. It is recommended that pregnant women should be routinely screened for Hepatitis B virus infection as part of antenatal care services

Hepatitis B Virus Infection amongst Pregnant Women in North-Eastern Nigeria- a Call for Action

Background: It is well known that Hepatitis B virus infection is endemic in Nigeria. Even though studies have been carried out on Hepatitis B virus infection in different parts of Nigeria; and in different sub-groups of individuals; information regarding the prevalence of Hepatitis B virus infection in pregnant women is scanty especially from the North-eastern region of Nigeria. We therefore determined the seroprevalence of Hepatitis B surface antigen (HBsAg) amongst pregnant women in North Eastern Nigeria. Materials and Methods: A hospital-based cross-sectional study was carried out. The setting was the ante-natal clinic of the Federal Medical Centre; Yola; Nigeria. The duration of the study was from July 2008 to December 2008. Two hundred and thirty-one consecutively recruited pregnant women were screened for Hepatitis B surface antigen. Positive samples were re-tested using ELISA to eliminate false positives. Their biodata were obtained using a questionnaire to establish the presence of possible risk factors such as blood transfusion; surgery; etc. Written informed consent was obtained from each woman. Results: Out of the 231 pregnant women tested; nineteen of them were seropositive for Hepatitis B virus infection giving an infection rate of 8.2. Women in the age group 25-29 years had the highest HBV infection rate. Conclusion: This study confirms a high seroprevalence of Hepatitis B virus infect ion amongst pregnant women. It is recommended that pregnant women should be routinely screened for Hepatitis B virus infection as part of antenatal care services

Non-motor symptoms of Parkinson's disease: diagnosis and management.

BACKGROUND: Non-motor symptoms (NMS) of Parkinson's disease (PD) are a key determinant of health, quality of life (QoL) and societal cost of PD. They are often less appreciated than motor symptoms but are important sources of disability for many PD patients. METHODS: Literature search was performed using the reference databases Medline, Science Citation Index and EMBASE. The keywords used were 'non-motor symptoms', Parkinson's disease, olfaction and constipation. Papers discovered by this search were reviewed, as were references cited therein. RESULTS: Contrary to common perception, many NMS of PD occur early in PD and some may even predate the diagnosis of PD that is based on motor signs. These include olfactory deficit, sleep problems such as rapid eye movement behaviour disorder, constipation and the more recently described male erectile dysfunction. CONCLUSION: There is compelling evidence that non-motor symptoms of PD play a dominant role in the QoL and disability of PD patients and the QoL of their 'informal' carers. Effective clinical management of PD therefore demands that these symptoms be identified and to the extent possible treated.

Current management of Parkinson's disease.

Although Parkinson's disease (PD) is still incurable, a large number of different treatments have become available to improve the quality of life and physical and psychological morbidity, and its early treatment is of prime importance. This article reviews the current situation of PD. This review was based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. The subject headings and keywords used were Parkinson's disease and therapeutic advances. Only articles written in English were included.The management of PD has evolved rapidly over the last 10 years with the advent of new drugs and new classes of drugs, but the currently available treatment methods are all symptomatic ones. However, some of these may have marginal disease-modifying effects. Progress in manufacture of newer drugs has markedly improved the treatment of early PD; however, the management of advanced Parkinson's symptoms remains a challenge. Currently no treatment has been proven to slow the progression of PD. Although symptomatic therapy can provide benefit for many years, PD will eventually result in significant morbidity.

Smokeless tobacco use in adult Nigerian population.

OBJECTIVES: The study aim was to establish the prevalence and determinants of smokeless tobacco use in Nigerian adults' population. METHODS: Across-sectional survey of 1776 adults in Yola, North-East Nigeria was carried out in June 2007.A modified World Health Organization (WHO) tobacco survey questionnaire was used for interview and data collection. RESULTS: Out of 1776 interviewed respondents, 133 (7.49%) were user of smokeless tobacco. Snuffing of tobacco powder was the most common method of using smokeless tobacco (6.8%). Fifteen (0.9%) chewed tobacco while only 2(0.1%) both chewed and snuffed tobacco. Social acceptance (21.8%) was the major reason for using smokeless tobacco. Males, 5 th and 6 th decades of life, poor education, lower socioeconomic class, Margi, Hausa and Fulani tribes were the determinants of smokeless tobacco use. About 89.5% of the smokeless tobacco users believed that smokeless tobacco was not harmful to their health. CONCLUSION: Although the prevalence of smokeless tobacco use was low among Nigerian adult population in this study. Ignorance of the potential health dangers of smokeless tobacco was rampant therefore; concerted efforts should be made to discourage the use of all forms of tobacco rather than concentrating on cigarette smoking.

Smokeless Tobacco Use in Adult Nigerian Population

The study aim was to establish the prevalence and determinants of smokeless tobacco use in Nigerian adults' population. Across-sectional survey of 1776 adults inYola; North-East Nigeria was carried out in June 2007.A modified World Health Organization (WHO) tobacco survey questionnaire was used for interview and data collection. Out of 1776 interviewed respondents; 133 (7.49) were user of smokeless tobacco. Snuffing of tobacco powder was the most common method of using smokeless tobacco (6.8). Fifteen (0.9) chewed tobacco while only 2(0.1) both chewed and snuffed tobacco. Social acceptance (21.8) was the major reason for using smokeless tobacco. Males; 5th and 6th decades of life; poor education; lower socioeconomic class; Margi; Hausa and Fulani tribes were the determinants of smokeless tobacco use.About 89.5of the smokeless tobacco users believed that smokeless tobacco was not harmful to their health. : Although the prevalence of smokeless tobacco use was low among Nigerian adult population in this study. Ignorance of the potential health dangers of smokeless tobacco was rampant therefore; concerted efforts should be made to discourage the use of all forms of tobacco rather than concentrating on cigarette smoking

Non-Motor Symptoms of Parkinson's Disease: Diagnosis and Management

Bacground: Non-motor symptoms (NMS) of Parkinson's disease (PD) are a key determinant of health; quality of life (QoL) and societal cost of PD. They are often less appreciated than motor symptoms but are important sources of disability for manyPDpatients. Methods:Literature search was performed using the reference databases Medline; Science Citation Index and EMBASE. The keywords used were 'non-motor symptoms'; Parkinson's disease; olfaction and constipation. Papers discovered by this search were reviewed; as were references cited therein. Results: Contrary to common perception; many NMS of PD occur early in PD and some may even predate thediagnosis of PD that is based on motor signs. These include olfactory deficit; sleep problems such as rapid eye movement behaviour disorder; constipation and the more recently described male erectile dysfunctionThere is compelling evidence that nonmotor symptoms of PD play a dominant role in the QoL and disability of PD patients and the QoLof their 'informal' carers. Effective clinical management of PD therefore demands that these symptoms be identified and to the extent possible treated

Non-Motor Symptoms of Parkinson's Disease: Diagnosis and Management

Non-motor symptoms (NMS) of Parkinson's disease (PD) are a key determinant of health; quality of life (QoL) and societal cost of PD. They are often less appreciated than motor symptoms but are important sources of disability for manyPDpatients. Literature search was performed using the reference databases Medline; Science Citation Index and EMBASE. The keywords used were 'non-motor symptoms'; Parkinson's disease; olfaction and constipation. Papers discovered by this search were reviewed; as were references cited therein. Contrary to common perception; many NMS of PD occur early in PD and some may even predate the diagnosis of PD that is based on motor signs. These include olfactory deficit; sleep problems such as rapid eye movement behaviour disorder; constipation and the more recently described male erectile dysfunction.There is compelling evidence that nonmotor symptoms of PD play a dominant role in the QoL and disability of PD patients and the QoLof their 'informal' carers. Effective clinical management of PD therefore demands that these symptoms be identified and to the extent possible treated

Delirium: issues in diagnosis and management.

Delirium is a disturbance of consciousness, cognition and perception that occurs frequently in medically ill patients. Although it is associated with increased morbidity and mortality, it is often not recognized and treated by physicians. Literature searches were conducted using MEDLINE with the following keywords/ phrases: delirium, acute confusion and management. Additional articles identified by hand-searching in major journals of medicine and psychiatry, and a review of references cited within these sources supplemented the search. In this article, the available published literature regarding the diagnosis, prevention and treatment of delirium is systematically reviewed. Prevention and treatment strategies do not need to be complex or expensive but require well-coordinated interventions from multiple disciplines, including nursing, psychiatry, neurology and primary care, as well as the cooperation and significant effort of family and friends. Atypical antipsychotic agents offer some advantages over haloperidol and in a limited number of studies appear safe and effective for delirium.

Comparison of two hospital stroke scores with computerized tomography in ascertaining stroke type among Nigerians.

BACKGROUND: Stroke, a major cause of morbidity and mortality is on the increase in Nigeria, routine Computerized Tomography (CT) for all Nigerians with stroke is not available to most doctors, and this poses management problems. We compared two available clinical scores with brain CT for the differential diagnosis of cerebral ischemia and hemorrhage among adult Nigerians with first-ever acute stroke. METHODS: The study was conducted at the State Specialist Hospital Maiduguri. Ninety-five adult Nigerians presenting with first-ever acute stroke onset within 48 hours were evaluated with the Siriraj Hospital Stroke (SHS) score on presentation and the Guy's Hospital Stroke (GHS) score 24 hours after admission. CT brain scan was considered as gold standard. These two stroke scores were compared with the results of CT brain and sensitivity, specificity; positive predictive and negative values were calculated. RESULTS: Applying the recommended optimum cut-off points for the 2 scores, diagnoses were classified by the Guy's Hospital Stroke and Siriraj Hospital Stroke score as probable hemorrhagic strokes (49% and 25% respectively) and probable ischemic (40% and 65% respectively). The remainder were classified as "uncertain." The prevalence of hemorrhage diagnosed by gold standard (CT) was 29.5% while the prevalence of ischemic stroke diagnosed by CT was 54.7%. The CT brain was normal in 15.8%. Sensitivity, specificity, positive predictive value and negative predictive value for cerebral hemorrhage was 0.64, 0.48, 0.4 and 0.71 for Guy's Hospital Stroke score and 0.35, 0.73, 0.4 and 0.68 for Siriraj Hospital Stroke score. CONCLUSION: It is evident from the study that these clinical scoring systems alone are not sufficient and one has to employ the use of computerized tomography scan in establishing stroke type in Nigerians with stroke.

A review of trigeminal autonomic cephalalgias: diagnosis and treatment.

BACKGROUND: The trigeminal autonomic cephalalgias (TACs) include cluster headache, paroxysmal hemicrania and short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing and its close relative short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms. The primary objectives of this review are to highlight what is known about the trigeminal autonomic cephalalgias, looking at clinical headache characteristics, recognised treatments, and interesting new developments in pathogenesis. METHOD: Literature search was performed using the reference databases Medline, Science Citation Index and the Cochrane Library. The keywords used were 'cluster headache, paroxysmal hemicrania, SUNCT. Papers discovered by this search were reviewed, as were references cited therein. RESULTS: Cluster headache has the longest attack duration and relatively low attack frequency. Paroxysmal hemicrania has intermediate neuralgiform head attack frequency. Shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing have the shortest attack duration and the highest attack frequency. CONCLUSION: The importance of diagnosing these syndromes resides in their excellent but highly selective response to treatment.

Upper gastrointestinal tract endoscopy indications in northern Nigeria.

Upper gastrointestinal tract endoscopy is one of the commonly performed endoscopic procedures, and has only recently become available in Nigeria. The indications for upper gastrointestinal tract endoscopy in three health facilities in Northern Nigeria were reviewed. Two hundred and sixty-nine patients were found to have undergone upper gastrointestinal tract endoscopy. Their ages ranged from 12-90 years with a mean of 48.1+16.2 years. There were 46.8% males and 53.2% females. The commonest indication for the procedure was dyspepsia (61.0%), followed by upper gastrointestinal bleeding, gastro-oesophageal reflux disease, gastric cancer, gastric outlet obstruction, acute exacerbation of peptic ulcer disease, dysphagia, epigastric mass, excessive salivation, abdominal pain, anaemia, chronic diarrhoea, haematochexia and persistent vomiting.

Prevalence and determinants of tobacco smoking among HIV patients in North Eastern Nigeria.

People living with human immune deficiency virus (HIV) infection who smoke tobacco are more likely to develop several opportunistic infections, and also suffer complications from antiretroviral medication than the non smokers of tobacco. The burden of tobacco smoking amongst people living with this infection is poorly understood in the African population. The aim of this study was to establish the prevalence and determinants of tobacco smoking among HIV patients in North Eastern Nigeria. We enrolled 312 adult HIV sero-positive patients attending the Federal Medical Centre Yola, Nigeria. A modified World Health Organisation (WHO) recommended questionnaire was used to obtain information from consented subjects. The prevalence of current cigarette smoking among HIV patients was 22.1%. The male to female ratio of smokers was 2:1. Peer pressure (25.8%) and pleasure (25.8%) were reported as the most common reasons for smoking tobacco. Multivariate analysis shows that male gender, age ranged 40-49 years, alcohol drinking and CD4 T lymphocyte count <200 cells/mm3 were positively associated with tobacco smoking. The prevalence of tobacco smoking among HIV patients in North Eastern Nigeria was high. Therefore, smoking should be discouraged in people living with HIV to reduce their morbidity and mortality.

Overview of somatization-diagnosis and management.

BACKGROUND: Neurologists and general practitioners frequently encounter patients with inexplicable, unintentionally produced somatic complaints otherwise known as somatoform disorders. METHODS: A literature search was performed including MEDLINE, as well as local and intemrnational journals using the following keywords/ phrases and crossreferencing: somatoform disorder, somatization, medically unexplained physical symptoms. RESULTS: Illness with excessive somatic preoccupation is difficult to diagnose or categorize reliably due to rigid diagnostic criteria that often overlap with several psychiatric disorders. CONCLUSION: Management of patients with dysfunctional somatoform disorders is complex and challenging, particularly when initiated in a neurology outpatient or inpatient setting. The acronym CARE-MD represents a comprehensive treatment regimen that can be used to decrease physician and patient frustration, dramatically minimise health care over utilization, and improve overall well-being for patients with somatoform disorders.

Delirium: Issues in Diagnosis and Management

Delirium is a disturbance of consciousness; cognition and perception that occurs frequently in medically ill patients. Although it is associated with increased morbidity and mortality; it is often not recognized and treated by physicians. Literature searches were conducted using MEDLINE with the following keywords/ phrases: delirium; acute confusion and management. Additional articles identified by hand-searching in major journals of medicine and psychiatry; and a review of references cited within these sources supplemented the search. In this article; the available published literature regarding the diagnosis; prevention and treatment of delirium is systematically reviewed. Prevention and treatment strategies do not need to be complex or expensive but require well-coordinated interventions from multiple disciplines; including nursing; psychiatry; neurology and primary care; as well as the cooperation and significant effort of family and friends. Atypical antipsychotic agents offer some advantages over haloperidol and in a limited number of studies appear safe and effective for delirium

Cigarette Smoking Habits among Adolescents in Northeast Nigeria

Tobacco smoking is a growing public health problem in the developing world. The health hazards of smoking are well documented; and prevention of smoking has been described as the single greatest opportunity for preventing noncommunicable disease in the world today. A cross-sectional survey was carried out to determine the cigarette smoking habits among adolescents in a rural setting in northeast Nigeria. One hundred and seventy-one (171) adolescents aged 12 to 17 were randomly selected from four districts of Yola south Local Government Area of Adamawa State. They responded to a modified version of the standard questionnaire recommended for surveying smoking habits in young people. Of 109 males; 44 (40) and 62 females fourteen (23) were current light smokers; with over 85of all smokers consuming fewer than 10 cigarettes a day. The prevalence of smoking in this study was 33.9. Over half of current smokers and ex-smokers started smoking between the ages of 13 and 15 years. The largest group of male and female smokers were influenced to start smoking by the relative influence of one or both parents; siblings; or friends; and only 25of males and 21.4of females were influenced by advertisements. Most respondents continued to smoke even when they were aware of the health hazards of smoking. Anti-tobacco education and awareness should be adopted in the curriculum of schools and colleges. All forms of tobacco advertising and promotional activities should be banned in Nigeria; and parents should be encouraged to adopt more responsible attitudes toward smoking in the home