Learning Styles of Physiotherapy and Medical Students in a Nigerian University.

BACKGROUND: Knowledge of students learning style is important in order for an instructor to be able to determine and select the appropriate teaching techniques for effectiveness and maximized student learning during a class session. OBJECTIVES: This study was aimed at exploring the learning preferences of physiotherapy and medical students in a regional university in Nigeria. METHODS: A sample of 263 undergraduate physiotherapy and medical students in the clinical phase of their studies at the University of Maiduguri participated in this cross-sectional survey study. The participants completed a two part question-naire. Part I of the questionnaire elicits sociodemographic information such as age, gender and programme and level of study, while part II consists of a 24-item self-administered Learning Style Inventory that elicited information on the students' preferences on learning their subjects. RESULTS: These cohorts of medical and physiotherapy students were evenly divided between visual and auditory learning preferences. While for the medical students, the males tend to be visual learners more frequently than their female counterparts, gender difference in types of learning preference was not observed for the physiotherapy students. CONCLUSION: This study affirms the heterogeneity in students' learning preferences, and also suggests the need for instructors in health disciplines to always consider blending appropriate voice and audios with pictures, photos and visual effects in other to maximize students learning especially during teaching sessions.

Childhood rhabdomyosarcoma in Kano, Nigeria: a retrospective analysis of 52 cases.

BACKGROUND: Rhabdomyosarcoma is the most common soft tissue sarcoma in children ≤ 15 years of age. There is, however, a paucity of reports on the pattern of its occurrence in Nigeria and other parts of Africa. OBJECTIVE: The aim of this review is to highlight the age and sex distribution, anatomical location and morphological characteristics of rhabdomyosarcoma among children in Kano, northwestern Nigeria. PATIENTS AND METHOD: This is a 14 year retrospective study of all cases of rhabdomyosarcomas occurring in children diagnosed at the Pathology Department of Aminu Kano Teaching Hospital, Kano, Nigeria. Clinical data obtained included sex, age, tumour site and histologic subtype. RESULTS: Fifty two children were seen with a male to female ratio of 1 : 1.3. The ages of these Patients ranged from 4 months to 15 years with a mean (SD) age of 6.99 (4.1) years and peak age frequency in the 0 to 5 years age group. The embryonal variant was the most common histological subtype (69%). The others were alveolar (27%) and pleomorphic (4%) variants. The head and neck was the most affected region (44%) and the most common primary site was the orbit (19.2%). CONCLUSION: Rhabdomyosarcoma is the most common childhood soft tissue sarcoma in Kano. It occurs in females more frequently than males and the most common histologic subtype is embryonal rhabdomyosarcoma affecting predominantly the orbit.

The neurology of HIV infection--a review of the literature.

BACKGROUND: The nervous system is widely involved in the course of infection with the human immunodeficiency virus (HIV). The manifestation may be a direct effect of the virus, the result of opportunistic infections or secondary malignancies, or a result of the therapy of various aspects of the disease. This review looks at these neurological consequences of HIV infection. METHODS: The review was sourced mainly by Medline search using the search terms HIV, AIDS and neurology. Relevant journals were subsequently studied. RESULTS: The major neurological manifestations of HIV infection are toxoplasmosis, cryptococcal meningitis, AIDS dementia complex, primary lymphoma, tuberculosis, progressive multifocal leukoencephalopathy, herpes zoster, Bells palsy, peripheral neuropathy, and vacuolar myelopathy. The overall effect of these is the acceleration of progression of the disease. About 30% of the mortality in HIV infection is attributed to neurological diseases. CONCLUSION: The nervous system is significantly affected in HIV infection and the impact on morbidity and mortality is profound. All effort should be made to ensure early recognition and amelioration of the various nervous systems complications of HIV infection.

The value of the mini mental state examination in Nigerian epileptics.

This study assessed the role of the Mini Mental State examination (MMSE) in detecting cognitive impairment in Nigerian epileptics. The performance of 65 epileptics on the MMSE was compared with that in 65 age- and education-matched controls. There were significantly more epileptics than controls with cognitive dysfunction and the epileptics also had significantly worse scores on the MMSE. The tests of attention, three-item recall and reading were the aspects of the MMSE that were most impaired in the epileptics.

The determinants of seizure severity in Nigerian epileptics.

BACKGROUND: Epilepsy is a chronic disease and the control of seizures is central to its management. While seizure frequency has been the traditional index of epilepsy control. severity of seizures is probably as important as seizure frequency in this regard. Seizure severity scales have therefore been developed to assess the impact of antiepileptic drugs on seizure control. The eight items of the national hospital seizure severity scale were applied in this study to Nigerian subjects with epilepsy to determine which aspects of seizure severity were considered relevant from the patients' perspective. MATERIALS AND METHODS: Twenty-eight confirmed subjects with epilepsy at the University College Hospital, Ibadan, were studied. The National Hospital seizure severity scale questionnaire was administered to all subjects. This assesses generalisation of seizures, falls, injuries, urinary incontinence, warning interval before loss of consciousness, automatisms and time of recovery on a graded scale. RESULTS: The most frequent indices of seizure severity in Nigerian epileptics is the generalisation of seizures in 85.7% of subjects, incontinence of urine in 78.6%, absence of protective warning time in 75% and occurrence of serious injuries in 71.5%. Occurrence of falls and disruptive automatisms were less frequent. Seizure severity scores were worse in subjects with longer duration of epilepsy and in those on monotherapy. CONCLUSIONS: The indices of seizure severity that occurred most frequently in Nigerian subjects with epilepsy were generalisation of seizures, incontinence of urine, absence of protective warning time and serious injuries. These may need to be addressed in the management of epilepsy patients. Subjects on monotherapy in this study had worse seizure severity scores and this may indicate the need to consider early rational polytherapy in order to improve seizure control.

Hypoglycaemic hemiparesis in a Nigerian alcoholic.

Alcoholism is rarely reported as a clinical problem in Nigerians. This report is of a Nigerian alcoholic who presented with chest infection and alcohol withdrawal symptoms and subsequently developed transient hemiparesis which responded to correction of hypoglycaemia. Hypoglycaemia should be considered in all alcoholics presenting with hemiparesis.

Peripheral neuropathy in Nigerian subjects with chronic renal failure.

BACKGROUND: Chronic Renal Failure (CRF) is common in Nigeria and has a high prevalence in the young age groups. While peripheral neuropathy is reported to be the commonest neurological complication in patients with CRF, its frequency and nature have not been documented in Nigerian subjects. The unavailable or expensive intervention measures in Nigeria make it imperative to consider all presenting features of CRF in order to improve its morbidity. METHODS: Twenty-one subjects with chronic renal failure at the University College Hospital, Ibadan, were studied. Chronic renal failure was confirmed by ultrasound scan, urea and creatinine values, 24 hour urinary creatinine values and clinical features of uraemia of more than 6 months. Excluded were subjects with diabetes mellitus, alcoholism, etc. All subjects had full neurological examination done and peripheral neuropathy was taken as the presence of two or more abnormal findings on peripheral nervous system examination. RESULTS: Peripheral neuropathy was documented in 6 (28.5%) of the subjects. The finding of peripheral neuropathy was associated with older age of subjects and longer duration of illness. It was not related to the serum levels of urea or creatinine. CONCLUSIONS: Peripheral neuropathy occurs in Nigerian CRF patients and is related to longer duration of illness, but not to prevailing serum urea or creatinine levels. Morbidity could be improved in these patients irrespective of severity of renal function if the symptoms of peripheral neuropathy are detected and treated.

Performance of normal Nigerian students on the mini-mental state examination.

BACKGROUND: Cognitive dysfunction is a feature of many diseases and the impact is especially relevant in the young. While there are many sophisticated tests of cognitive function, the shorter Mini Mental State examination (MMSE) is the most widely used screening test. In Nigeria where cognitive function is not routinely assessed in the management of cases, the MMSE is probably the most practical test of cognitive function to be promoted. This is because it is easy to administer and to interpret. There is however a need to define the performance of normal Nigerian subjects on the MMSE to make its use more relevant. METHODOLOGY: Seventy normal adolescents attending a secondary school in Ibadan, Nigeria, were administered the MMSE. Excluded were subjects with a history of mental impairment or medical disorders known to influence cognitive function. All subjects were tested only once. RESULTS: Normal MMSE scores were obtained by 88.6% of subjects while 11.4% of the subjects were found to be mildly or moderately cognitively impaired. More than 55% of the subjects did not obtain full scores with test of orientation in place while 30% and 34.3% respectively did not obtain full scores with tests of orientation in time and of attention respectively. Males and females performed equally with regard to the test items except for a non-statistically significant better performance of the females with test of three-item recall (p = 0.09). CONCLUSION: Abnormalities on the MMSE in Nigerians should be interpreted with caution as more than 10% of subjects may have abnormal scores. Tests of orientation and of attention are particularly likely to indicate abnormal cognitive function even in subjects with overall scores in the normal range. There may be a need to modify the MMSE to make it more applicable to young Nigerian subjects.

The quality of life of chronic epileptic patients in Ibadan, Nigeria.

Epilepsy is a disease that significantly impairs the quality of life of the sufferers. Measures of quality of life have been developed to assess the overall impact of management on the patients. While studies on quality of life have been previously carried out in Nigerians, a standardised and validated inventory has not been used for this purpose because these are just being developed. Thirty-two epileptics (24 males and 8 females) attending the Neurology clinic of the University College Hospital, Ibadan, were studied. Each subject had complete physical examination and elecroencephalography. A short screening quality of life questionnaire (QOLIE 10) was administered to the subjects during routine clinic visits. The commonest aspect of quality of life affected in the subjects was feeling of energy, which was impaired in 15 (46.8%) subjects. This was followed by memory problems in 11 (34.4%). Fear of experiencing the next seizure was reported by eight (25.8%) of subjects. Only five (16.7%) and three (10.3%) of the subjects respectively reported work and social limitations like attending social occasions. No subject reported difficulty with driving or operating machinery, or mental disturbances. Energy and memory deficits are the major problems affecting the quality of life of epileptics in this study. Most subjects did not consider physical and social limitations important.

The profile of stroke in Nigeria's federal capital territory.

The pattern of stroke has been well characterized in many settings in Nigeria. The profile of stroke, has, however, not been previously reported from Nigeria's new federal capital. The aim of this study was to characterize the pattern of stroke in a specialist centre in Nigeria's federal capital territory over a 5-year period.

Stroke: a review with an African perspective.

The frequency of stroke and stroke-associated mortality are higher in Blacks than in other races. Several of the known risk factors for stroke, such as hypertension, diabetes and obesity, are more common in Blacks than Whites, and sickle-cell disease and HIV infection are stroke risk factors with particular relevance to Africans. Although the facilities for accurate stroke diagnosis and classification are unavailable in most parts of Africa, careful analysis of the clinical features can minimize the rates of misdiagnosis and misclassification. The high levels of stroke-attributable morbidity and mortality observed in Africans could be markedly reduced by instituting primary and secondary preventive measures and by educating health-care professionals on stroke-management strategies.

The quality of hospital records of urethral catheterisation.

BACKGROUND: This prospective and retrospective study carried out over a period of one month (50 patients) looked at the quality of hospital records of urethral catheterisation with reference to the hospital protocol. The patients were catheterised on general surgical wards as well as in theatre. RESULTS: The quality of hospital records of this procedure was poor and a number of complications noted. CONCLUSIONS: Good documentation of urethral catheterisation would result in a better quality of audit and, therefore, identify potential ways of minimising complications. We recommend this by regular audit of hospital records, re-inforcement of protocols and informed consent of this procedure, with particular reference to theatre.

The significance of autonomic symptoms in Nigerian diabetics.

Diabetes mellitus is the most common endocrine disorder worldwide and disturbance of autonomic function is a frequent complication. Symptoms of autonomic neuropathy are however non-specific and the aetiology is multifactorial in diabetics. This study was carried out to determine the relationship between symptoms of autonomic neuropathy and pathology of the autonomic nervous system in diabetic patients. A hundred diabetics were studied, 50 with, and 50 without symptoms of autonomic neuropathy. Objective test of autonomic function used were the heart rate responses to deep breathing, to standing and to the Valsava manoeuvre; and the blood pressure responses to standing and to sustained handgrip. There was no significant difference between diabetics with symptoms suggestive of autonomic neuropathy, and those without, with regard to findings on autonomic function testing. While the symptoms were unreliable in determining the presence of autonomic neuropathy, they were significantly related to poor glycaemic control and to peripheral neuropathy (P < 0.01). The symptoms of autonomic neuropathy are non-specific in Nigerian diabetics and may reflect poor glycaemic control rather than autonomic neuropathy. Autonomic function tests should be carried out in diabetics suspected of having autonomic neuropathy.

Immunogenicity of recombinant hepatitis B vaccine among infants of mothers with active schistosomiasis.

A study of the immunogenicity of a recombinant hepatitis B vaccine was conducted among 385 Egyptian infants, 191 (49.6%) of whom were born to mothers with moderately active Schistosoma mansoni infection (mean egg count = 224 eggs/g of feces). All mothers were seronegative for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen. Infants were vaccinated with a 2.5-microg dose of this vaccine, given along with diphtheria, tetanus, and pertussis (DTP) vaccine, at the ages of two, four, and six months. Serum samples taken from each infant at nine months of age were tested for HBsAg, antibody to hepatitis B core antigen, and quantitatively for antibody to hepatitis B surface antigen (anti-HBs). There was no significant difference (P = 0.1) between anti-HBs titers in infants of S. mansoni-infected mothers (mean = 539 mIU/ml) and in infants of noninfected mothers (mean = 377 mIU/ml). This study shows that there was no apparent effect of maternal schistosomiasis infection on the immune response of these infants to vaccination.

Hepatitis C antibody prevalence in blood donors in different governorates in Egypt.

Markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were sought in serum samples from 2644 blood donors in 24 of Egypt's 26 governorates. Of the 2644 samples, 656 (24.8%) were shown to contain anti-HCV immunoglobulin G antibody by Abbott second generation enzyme immunoassays (EIA). Of 85 EIA-positive samples tested by recombinant immunoblot assay, 72 (85%) were positive. HCV seroprevalence in the governorates ranged from zero to 38%; 15 governorates (62%) had an HCV antibody prevalence greater than 20%, and 6 (25%) greater than 30%. Governorates with higher sero-prevalences were located in the central and north-eastern Nile river delta, and south of Cairo in the Nile river valley. Subjects from areas in and adjoining the Sinai peninsula, in the eastern and western desert, and in southernmost Egypt, had the lowest prevalence of HCV antibody. The large urban governorates of Cairo and Alexandria had antibody prevalences of 19% and 11%, respectively. A total of 39.4% subjects had evidence of HBV infection (and-HBV core antigen total antibody). HCV infections were detected more frequently in donors with markers for HBV infections than in uninfected subjects (36% versus 18%, P < 0.001).

Comparative study of the immunogenicity and safety of two dosing schedules of hepatitis B vaccine in neonates.

Healthy Egyptian neonates born to hepatitis B surface antigen (HBsAg)-seronegative mothers were randomly enrolled in one of three vaccination schedules. A dose of 2.5 micrograms of recombinant HB vaccine was given at birth, two, and six months of age (group A) or two, four, and nine months of age (group B). These two groups and a third control group (group C) also were given the other routine childhood vaccines (BCG, DPT, polio, and measles). Blood samples were taken one month after the third vaccine dose in groups A (seven months of age) and B (10 months of age), and a second follow-up blood sample was taken at the age of 18 months for all three groups. Sera were tested for HBsAg and antibody to hepatitis B core antigen, and quantitatively for antibody to hepatitis B surface antigen (anti-HBs) using commercial enzyme immunoassay kits. The vaccine was well tolerated and side effects were limited to local soreness, redness, or temporary swelling. Among 590 infants who were followed-up, good (51-300 mIU anti-HBs/ml) or excellent (> 300 mIU/ml) immune responses occurred in 85% of the infants in group A and in 96% in group B. Geometric mean titers of anti-HBs at the first and second follow-up were 306 and 55 mIU/ml in group A, and 1,492 and 147 mIU/ml in group B. The recombinant HB vaccine is safe and immunogenic when given in three doses of 2.5 micrograms in either regimen, but delay of the booster dose of the vaccine until nine months after birth produced a higher immune response.

Recurrence of Rift Valley fever in Egypt.

Rift Valley fever (RVF) has been recorded in man and in domestic animals in Egypt after a 12-year absence. Human infections were first noted in the Aswan Governorate in late May, 1993. Only cases of ocular disease, an infrequent and late manifestation, were reported. Of 41 cases, 35 were tested serologically and 27 (77%) had RVF virus-specific IgM antibodies. An estimated 600-1500 infections occurred in the region. Abortions in cattle and buffalo were seen concurrently and antibodies to RVFV were present in 39% of domestic livestock, presumably unvaccinated. RVFV was isolated from an aborted water buffalo fetus.

Acute sporadic hepatitis E in an Egyptian pediatric population.

A study was conducted to determine the etiology of acute hepatitis among 261 children (age range 1-11 years) living in Cairo, Egypt. A blood sample was obtained from each subject when initially evaluated and a questionnaire was used to collect demographic and risk factor data. Sera were tested by enzyme immunoassay for acute hepatitis A (anti-hepatitis A virus IgM), hepatitis B (anti-hepatitis B core antigen IgM and hepatitis B surface antigen [HBsAg]), hepatitis C (total anti-HCV), delta hepatitis (total anti-delta), and cytomegalovirus infection (anti-CMV IgM). In addition, hepatitis E virus (HEV) infection was diagnosed using a new Western blot technique to test patients with non-A, non-B hepatitis for anti-HEV IgM. Among 261 children, acute hepatitis A was diagnosed in 85 (32.6%) patients, acute hepatitis B in 19 (7.3%), delta hepatitis in 3 (1.1%), mixed hepatitis A and B infection in 2 (0.8%), CMV infection in 1 (0.4%), hepatitis E in 58 (22.2%), and non-A, non-B hepatitis of unknown type in 51 (19.5%). Forty-two (16.1%) subjects had HBsAg without other markers of acute infection. Risk factor analysis indicated that patients living in homes not connected to a municipal source of water were at increased risk of hepatitis E infection. These data provide additional evidence that hepatitis E virus is a common cause of acute sporadic hepatitis in children living in Egypt.