Audit of Stroke Admissions in a Tertiary Hospital in South East Nigeria.

INTRODUCTION: Stroke is one of the commonest causes of medical admissions and mortality in Nigeria. Documenting the pattern of stroke and risk factors for stroke is important not only for public health policy makers but also for physicians in implementing both primary and secondary preventive programs. OBJECTIVES: The aim of this study was therefore to document the pattern of stroke and risk factors for stroke in stroke patients admitted in a tertiary hospital in Enugu. METHODS: This was a cross-sectional descriptive study carried out at Enugu State University Teaching Hospital, Enugu. Data were analyzed using the SPSS version 26 (IBM Corporation, New York, USA). RESULTS: Data from 350 patients were included in the present study. The three commonest risk factors for stroke were diabetes (69.1%), hypertension (64.9%), and age 65 years and above (51.1%). A total of 74.9% of the patients had ischemic stroke and 25.1% had hemorrhagic stroke. Hemorrhagic stroke was significantly higher in patients < 50 years (46.5%) and people with hypertension, (31.7%). About 31.4% of the patients had two risk factors and 28.6% had three risk factors. Age 65 years and above positively correlated with having ischemic stroke and hypertension positively correlated with hemorrhagic stroke. When controlled for age, the correlation between hypertension and hemorrhagic stroke was still significant. CONCLUSION: The reported frequency of ischemic stroke was 74.9% and of hemorrhagic stroke was 25.1%. The commonest risk factors for stroke documented among stroke patients in a tertiary hospital in Enugu were diabetes, hypertension, and age 65 years and above. When controlled for age, the correlation between hypertension and hemorrhagic stroke was still significant.

INTRODUCTION: L'accident vasculaire cérébral (AVC) est l'une des causes les plus courantes d'admissions médicales et de mortalité au Nigeria. Il est important de documenter le profil des et les facteurs de risque des accidents vasculaires cérébraux sont importants non seulement pour le santé publique mais aussi pour les médecins dans la mise en œuvre des programmes de prévention primaire et secondaire. OBJECTIFS: L'objectif de cette étude était donc de documenter le modèle d'AVC et les facteurs de risque d'AVC chez les patients admis dans un hôpital tertiaire d'Enugu. MÉTHODES: Il s'agit d'une étude descriptive transversale menée à l'hôpital universitaire d'Enugu, Enugu. Les données ont été analysées à l'aide du SPSS version 26 (IBM Corporation, New York, USA). RÉSULTATS: Les données de 350 patients ont été incluses dans la présente étude. Les trois facteurs de risque d'accident vasculaire cérébral les plus courants étaient le diabète (69,1 %), l'hypertension (64,9 %) et l'âge de 65 ans et plus (51,1 %). Un total de 74,9 % des patients ont eu un AVC ischémique et 25,1 % un AVC hémorragique. L'AVC hémorragique était significativement plus élevé chez les patients < 50ans (46,5 %) et les personnes souffrant d'hypertension (31,7 %). Environ 31,4 % des patients présentaient deux facteurs de risque et 28,6 % trois facteurs de risque. Âge 65 ans et plus était positivement corrélé au fait d'avoir un AVC ischémique et l'hypertension était en corrélation positive avec l'AVC hémorragique. Après contrôle de l'âge, la corrélation entrel'hypertension et l'AVC hémorragique était toujours significative. CONCLUSION: La fréquence rapportée de l'accident vasculaire cérébral ischémique était de 74,9 %. et celle de l'AVC hémorragique était de 25,1 %. Les facteurs de risque les plus courants pour d'AVC documentés chez les patients victimes d'un AVC dans un hôpital tertiaire de Enugu étaient le diabète, l'hypertension et l'âge de 65 ans et plus. Lorsque l'âge, la corrélation entre l'hypertension et l'AVC hémorragique était toujours significative. MOTS CLÉS: AVC ischémique, AVC hémorragique, Facteurs de risque, Nigeria.

Determinants of Health-related Quality of Life in Persons with Epilepsy Seen at a Tertiary Hospital in North Western Nigeria.

INTRODUCTION: There is a growing global concern about the effect of epilepsy on the Health-Related Quality of Life (HRQoL) of the sufferers. AIM: This study assessed the determinants of HRQoL in persons with epilepsy (PWE) in a tertiary hospital in North Western Nigeria. METHODOLOGY: A cross-sectional study was carried out on 103 patients with epilepsy aged ≥ 18 years attending Neurology clinic. Ethical clearance was obtained from the Health Research Ethics Committee of the institution. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was administered to the participants. Statistical significance was set with p value at 0.05. The determinants of HRQoL was obtained by using univariate and subsequent multivariate logistic regression analysis. RESULT: The mean age of patients was 33.4±15.8 years. There were 54(52.4%) males and 49 (47.6%) females. The significant determinants of HRQoLfound were time of last seizure episode (OR = 7.50, 95% CI = 1.36 -41.20, p = 0.021) and social support (OR = 21.5, 95% CI = 3.67 - 125.68, p = 0.001). Following multivariate logistic regression analysis, social support (OR = 29.51, 95% CI = 2.87 - 302.66, p = 0.004) appeared as the independent determinant of HRQoLin PWE. CONCLUSION: Social support was the main determining factor of HRQoL in epilepsy patients in this study. Therefore there is the need to ensure a comprehensive care which should include health education, adequate seizure control and social support for epilepsy patients to improve their HRQoL.

Effect of Epilepsy and Antiepileptic Drugs Therapy on Erythrocyte Malondialdehyde and Some Antioxidants in Persons with Epilepsy.

BACKGROUND: Antiepileptic drugs are necessary for successful treatment of epilepsy. Unfortunately, epilepsy itself and some antiepileptic drugs have been documented to provoke or worsen seizure frequency by altering blood levels of some oxidants and antioxidants in persons with epilepsy. OBJECTIVE: This study investigated the effect of epilepsy and antiepileptic drugs on blood levels of some oxidants and antioxidants. METHODOLOGY: This was a cross-sectional case-control study. Blood samples were obtained from 35 antiepileptic drug-experienced persons with epilepsy; 35 antiepileptic-naive persons with epilepsy; and 35 age- and- sex matched apparently healthy controls; and analysed for malondialdehyde and antioxidants (uric acid, superoxide dismutase, glutathione peroxidase and catalase) using enzyme-linked immunosorbent assay. RESULTS: One-hundred and five (105) subjects (35 patients on antiepileptic drugs, 35 newly diagnosed, antiepileptic drug-naive and 35 healthy controls) were investigated. The median ages of antiepileptic drug-experienced, antiepileptic drug-naive and healthy participants were 30.0, 26.0 and 37.0 years respectively. Persons with epilepsy had significantly higher blood levels of malondialdehyde and uric acid and lower levels of enzymatic antioxidants than healthy controls. Also, persons with epilepsy on antiepileptic drug polytherapy had signi-ficantly higher blood levels of malondialdehyde and uric acid and lower levels of enzymatic antioxidants than antiepileptic drug-naive persons with epilepsy and persons with epilepsy on antiepileptic drug monotherapy respectively. CONCLUSION: Epilepsy and antiepileptic drug significantly altered blood levels of malondialdehyde, uric acid and enzymatic antioxidants and/or their homeostatic kinetics.

Aetiology and Precipitants of Epileptic Seizures among Nigerians Treated at Two Tertiary Hospitals in Kaduna State, Northern Nigeria.

BACKGROUND: Epilepsy is a common neurological illness in Nigeria with a prevalence of 5-37 per 1000 in a rural population. Several studies suggest that the prevalence of epilepsy is higher in developing than developed countries due to the preponderance of more risk factors in the former. This study investigated the aetiological factors and precipitants of epileptic seizures among patients attending outpatient clinics of two tertiary hospitals in Kaduna State, Northern Nigeria from October 2008 to April 2013. PATIENTS AND METHODS: Two hundred and forty two consecutive adult patients with history of at least 2 unprovoked afebrile seizures were investigated for seizure patterns, aetiological and precipitating factors through history, physical examinations, laboratory tests and electroencephalography. RESULTS: The male to female ratio of study population was 3 (69%): 1(31%), with respective mean ages of 29.5±12.4and 30.7 ± 16.0years. Their respective mean ages of onset of first seizures were 18.6 ±14.0and 20.9 ±17.4 years. 88% of seizures were of focal origin (complex partial, 80%; simple partial, 8%). Although the causes and precipitants were unknown in 41% and 68% of cases respectively; head injury, neonatal asphyxia and psychoactive substance abuse were prominent aetiological factors. CONCLUSION: Although majority of epileptic seizures in Kaduna State, Northern Nigeria were of focal origin, majority of causes and precipitants remained largely unknown.

Factors affecting epilepsy treatment outcomes in Nigeria.

OBJECTIVES: Epilepsy is a complex chronic illness with variable treatment outcomes determined by factors specific to each affected person. We investigated prognostic factors for epileptic seizure outcome after 2 years of anti-epileptic drug (AED) monotherapy. MATERIALS AND METHODS: Two hundred and thirty-four AED naïve epilepsy patients were started on AED monotherapy and monitored for 2 years for seizure control. Patients on AED polytherapy were excluded. Prognostic factors investigated were socio-demographics characteristics, age of onset of epilepsy, etiology and precipitants of seizures, presenting seizure types, duration of epilepsy before initiation of AED, family support for treatment, compliance to AED, and clinic attendance. RESULTS: Patients were 160 (68.4%) males and 74 (31.6%) females, with mean ages of 26.2 ± 10.4 and 30.7 ± 16.0 years, respectively. Mean age of onset of epilepsy was 19.0 ± 15.0 years. None of the patients was treated with AED for first seizures, although 75% received traditional and spiritual therapy. Majority were single and of low socioeconomic background, and treatment was funded mainly by parents/guardians. About 88% presented with partial seizures, and carbamazepine was the commonest AED used followed by phenytoin sodium. At the end of 2 years of AED, 147 (63%) achieved complete seizure control, and significant prognostic factors were female sex, age older than 20 years at presentation, secondary and tertiary education attainment, being employed, family support, regular clinic attendance, AED compliance, and generalized epilepsy. CONCLUSIONS: Patients with epilepsy are more likely to achieve complete seizure control when they are older, educated, and employed or supported by family members to buy their AEDs and attend clinics regularly.

The frequency and outcome of neuropathies among HIV/AIDS adults treated at a tertiary hospital in Kaduna State, Nigeria.

AIMS AND OBJECTIVES: Highly active antiretroviral therapy (HAART) has been shown to reduce AIDS- defining illnesses, including neuropathies. However, it has been postulated that an increase in age -, HIV- and HAART- related neurological complications will occur as HIV-infected persons live longer. This study investigated the frequency and outcome of neuropathies in relation to CD4+ cell count and HAART status of hospitalised HIV/AIDS patients in Shika. PATIENTS AND METHODS: Consecutive adult (e"15 years) non pregnant HIV- infected patients treated at Ahmadu Bello University Teaching Hospital Shika-Zaria from January 2006 to May 2013 with neuropathies were studied. Non HIV-infected patients with neurological disorders and HIV-infected patients without neuropathies were excluded. RESULTS: Of 5240 HIV/AIDS patients seen , 11% (566) presented with neuropathy at median CD4+ cell counts of 200 cells / ul, with yearly reduction of the frequency of patients with neuropathy from 3.9% in 2006 to 0.06% in 2013. Male: female ratio was 2:1 and respective mean years were 41.9±10.1: 45.3±17.4 (p<0.00). 253 (45%) were on HAART at presentation. 40 patients died and the mortality was associated with recurrent seizures, CD4+ cell counts d" 100 / ul, male sex, HAART-naivety and presence of co-morbidity and complications. CONCLUSIONS: The progressive reduction in the yearly frequency of neuropathy among HIV/AIDS patients suggests a beneficial effect of HAART on neuropathies. However, late presentation, low CD4+ cell counts and failure of patients to start HAART early were responsible for AIDS-related mortality thus highlighting the importance of early HIV screening and treatment.