Effect of sub-clinical hypothyroidism on clinical severity in first-ever acute ischemic stroke.

BACKGROUND: Subclinical hypothyroidism has been documented to have a positive effect on the clinical presentation and outcome in acute ischemic stroke. OBJECTIVE: To determine the prevalence of subclinical hypothyroidism in first ever ischemic strokes and to evaluate its effect on the clinical presentation. METHODS: Using a cross-sectional study design, 138 patients diagnosed with first ever ischemic stroke within 7 days of onset were included in the study. Each participant had documentation of demographic data, followed by a detailed neurological examination. Stroke severity on admission was recorded using the National Institute of Health Stroke Scale (NIHSS) and blood samples for free thyroxine (T4) and thyroid stimulating hormone (TSH) were taken within 24h of onset of symptoms. For analysis, the patients were divided into two groups: those who had elevated TSH level (> 2.5 mlU/L) with normal FT4 level were assigned to the sub-clinical hypothyroidism group whilst those with normal thyroid function were assigned to the control group. All values were compared between the two groups. RESULTS: The study population comprised of a total number of 138 participants with mean age of 63.4 +/- 12.9 years. The females were 56 (40.6%) and the males were 82 (59.4%). A total number of 11 (7.9%) had subclinical hypothyroidism whilst 127 participants (92%) had normal thyroid functions. The mean NIHSS score of cases with SCH on admission was significantly lower than that of those with normal thyroid functions (6.73 +/- 3.6 vs. 11.1 +/- 6.3, p=0.025). A significantly higher proportion of patients in the SCH group had mild neurologic deficits on admission compared with the group with normal thyroid functions (81.8% vs 24.4%, p < 0.001). CONCLUSION: Our study has suggested that subclinical hypothyroidism appears to confer a neuroprotective effect in acute ischemic stroke.

Quality of Sleep in an HIV Population on Antiretroviral Therapy at an Urban Tertiary Centre in Lagos, Nigeria.

Aim. To determine the prevalence of sleep disturbance and its associated characteristics in HIV-positive outpatients on HAART using the PSQI. Methods. Using a cross-sectional design, 300 patients attending the outpatient HIV/AIDS clinic at the Lagos State University Teaching Hospital were recruited. Baseline data obtained included the participants' demographic data, educational qualification, and marital status. Their treatment history, including duration since HIV diagnosis, the most recent CD4 cell count, and current antiretroviral therapies, was obtained from their case records. Each participant completed the PSQI questionnaire and those with scores ≥5 were diagnosed with poor sleep quality. Results. The participants were made up of 70.7% females and 29.3% males. Their ages ranged between 18 and 74 years with a mean of 38.9 ± 10.3 years. According to the PSQI, 59.3% reported poor sleep quality. The mean score of those with poor quality sleep (9.2 ± 3.3) was comparable to that of those with good quality sleep (1.26 ± 1.4). P < 0.001. Significant differences were observed in all the individual components of the PSQI (P < 0.001). On multivariate analyses, the independent associations with sleep quality were the duration since HIV diagnosis (P = 0.29), efavirenz based regimen (P < 0.001), and lower CD4 cell count (P < 0.001). Conclusions. Sleep disturbances are quite common in the HIV population even in the era of HAART. Early recognition via routine assessment and effective treatments could prevent the resultant complications and improve quality of life.

Primary headache disorders at a tertiary health facility in Lagos, Nigeria: prevalence and consultation patterns.

BACKGROUND: Primary headaches are underdiagnosed and undertreated, with a significant impact on social activities and work. AIM: To determine the last-year prevalence and health care utilization pattern of primary headaches at a tertiary centre. METHODS: A cross-sectional study was carried out amongst staff of the Lagos State University Teaching Hospital in Lagos, Nigeria. 402 staff members were selected by simple random sampling and administered a detailed structured headache assessment questionnaire. Migraine and tension-type headache were diagnosed according to the criteria of the International Headache Society (2004). RESULTS: The participants comprised 168 males and 234 females. The mean age was 36.9 ± 7.9 years. The overall headache prevalence was 39.3% with female predominance (P < 0.0001). Tension-type headache was the most prevalent at 72.8% and migraine at 18.9%. Unclassifiable headache constituted 8.2%. Migraine headache showed female preponderance (P = 0.000). 80.4% of participants did not seek medical consultation compared with 19.6% who did (P = 0.000). Of the latter, 83.9% consulted the general practitioner (GP), whilst 16.1% consulted the neurologist. CONCLUSIONS: Primary headache prevalence is high in our population. It is not recognised as that requiring care by most of the staff of this tertiary health facility; thus education is required to increase health care utilization.

Prevalence of Priapism and Its Awareness amongst Male Homozygous Sickle Cell Patients in Lagos, Nigeria.

Background. Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Impotence and infertility are major problems in male sickle cell disease patients, and priapism has been implicated as a cause of impotence and infertility. The aim of this study is to determine priapism prevalence and assess the knowledge of male homozygous male patients about it in Lagos, Nigeria. Methods. A cross-sectional study was conducted amongst male homozygous sickle cell disease patients of Lagos State University Teaching Hospital. Pretested questionnaires were distributed to determine the prevalence and assess their knowledge on priapism. Data were analyzed using SPSS version 16.0. Results. A total of 114 consenting subjects filled the questionnaires, 85 of 114 (74.6%) had not heard about priapism before this study. A total of 77 of 114 (67.5%) did not know that they are at risk of priapism. Whilst 84 of 114 (73.7%) were not aware that priapism is a complication of SCD. The majority, 94 of 114 (82.5%), were not aware that priapism could cause impotence. Conclusion. There is a need to create more awareness about this complication amongst sickle cell disease patients in order to stem the incidence of impotence and infertility amongst them.

Improving case fatality rate of adult tetanus in urban Nigeria: focus on better facilities of care.

Tetanus is a life threatening preventable infection with a high mortality. Our aim was to determine the current case fatality rate at our centre in a retrospective case review of patients aged > 10 years who had been hospitalized with tetanus between August 2006 and July 2011. We show the intrahospital case fatality rate. Data are based on 176 cases for which we had sufficient information. There was a preponderance of males (3.09:1); 167 (95%) had generalized tetanus and nine (5%) had localized tetanus. The overall case fatality rate was 56.2% and was higher in males (64.4%) than females (27.9%; P = 0.0001). In a multivariate analysis, older age (P = 0.000), male gender (P = 0.005) and a longer duration of admission (P = 0.004) were significant determinants of outcome. The case fatality rate of tetanus has declined at our centre from 70% between January 2004 and March 2006 to 56.2% currently. Improved facilities are required in order to significantly reduce adverse outcome from tetanus.