Subject(s)
Chlorpromazine/adverse effects , Neuroleptic Malignant Syndrome/etiology , Tetanus/drug therapy , Adult , Humans , MaleABSTRACT
Forty five epileptics were observed for non-compliance or default over 2 1/2 years. There were 39 episodes of non-compliance among 19 patients. Six patients had 3 or 4 episodes of non-compliance. Thirteen patients gave their reasons as non-availability of drugs or excessive cost of drugs. Drowsiness or confusion over drug dosages was the reason given by 3 others. Three other patients unilaterally suspended medication. Eighteen patients had defaulted. Twelve of them were males. Three had defaulted after only a single clinic attendance. Seizures in 9 patients were in temporary control immediately prior to default. It is suggested that otherwise well epileptics should be managed in their local community. As a matter of urgency governments need to provide drugs at subsidised rates and provide a mechanism for distributing them efficiently.
Subject(s)
Epilepsy/drug therapy , Treatment Refusal , Adult , Anticonvulsants/administration & dosage , Anticonvulsants/adverse effects , Anticonvulsants/economics , Community Health Services , Continuity of Patient Care , Female , Humans , Male , NigeriaABSTRACT
34 patients with tetanus were studied; all had normal serum proteins and albumin. Only 3 samples of cerebrospinal fluid (CSF) contained cells (a few polymorphonuclear leucocytes). Protein levels in the CSF were elevated in 26 patients (76.5%); 11 cases with clinically mild tetanus had a mean CSF protein of 400 +/- 250 mg/litre (normal 100-400 mg/litre), while the CSF protein levels of 10 patients who died (mean 1596 +/- 985 mg/litre; P less than 0.005) and those of 4 others with severe disease who absconded were much higher (mean 1220 +/- 562 mg/litre; P less than 0.005). As a group, 19 patients with severe disease including the 10 fatal cases also had significantly higher mean CSF protein values (1582 +/- 938 mg/litre; P less than 0.005) than did the mild cases. Immunochemical analysis of the proteins using a radial immunodiffusion assay showed that these proteins were immunoglobulin G (IgG). Polyacrylamide gel electrophoresis demonstrated an oligoclonal gammaglobulin pattern, suggesting intrathecal IgG synthesis in these patients. These studies suggest that measurement of CSF proteins may supplement clinical evaluation in tetanus and that there may be a local immune stimulus (perhaps a tetanus antigen or to some other mitogen) in the central nervous system.
Subject(s)
Cerebrospinal Fluid Proteins/analysis , Immunoglobulins/cerebrospinal fluid , Tetanus/cerebrospinal fluid , Adolescent , Adult , Electrophoresis, Polyacrylamide Gel , Female , Humans , Immunoglobulin G/cerebrospinal fluid , Male , Tetanus/immunologyABSTRACT
During an epidemic of meningococcal meningitis in Nigeria a patient developed pericarditis and acute urinary retention in addition to arthritis and cutaneous vasculitis. The occurrence of these complications in the same temporal pattern suggests that immunological mechanisms were responsible for their causation.
