The question of the early diagnosis of asymptomatic and subpatent malaria in pregnancy: Implications for diagnostic tools in a malaria endemic area.

Objectives: Malaria in pregnancy (MIP) is a major healthcare challenge in low-income countries with high malaria endemicity. Early but accurate diagnosis and appropriate treatment is the hallmark of preventing disease progression/adverse outcomes in the mother, foetus and neonates. We assessed the comparative diagnostic performance of Malaria Rapid Diagnostic Test (mRDT), microscopy and PCR for malaria diagnosis in pregnant women for early detection of asymptomatic malaria in pregnant women. Study design: Five hundred and twenty Pregnant women attending study clinics within Ikene and Remo North LGAs with gestational age between 16 and 29 weeks, willing and consented; were enrolled into the study. Blood samples collected via venepuncture were screened for malaria using microscopy, mRDTs kits, and PCR techniques on their first visit (V1) and at delivery. The parasite positivity rates, sensitivity and specificity were calculated and compared for each technique using PCR as the standard. Data was entered into REDCap® online database and analysis done using Stata and MedCalc®. Results and conclusions: Average age of enrolled women was 28.8 years and mean gestational age was 21.0 weeks. The parasite positivity rates were 4.3%, 8.8% and 25.0% for microscopy, mRDT and PCR at V1 and was 2.4%, 3.4% and 43.4% at delivery, respectively. Sensitivity for microscopy and mRDT was 11.2% and 30.3% respectively at V1, while specificity was 98.2% and 98.5%. At delivery, the sensitivity reduced to 1.6% and 4.9%; while specificity was 96.9% and 97.6% respectively. Only 2.3% cases correlated with all three diagnostic methods. Our data showed a decrease in sensitivity of the diagnostic methods as pregnancy progressed, which may be due to very low parasitaemia, but high specificity. Our study demonstrated a high rate of subpatent parasitaemia amongst pregnant women. This finding therefore raises the question of the effect of subpatent parasitaemia on the health of the mother and foetus.

Stroke in Africa: profile, progress, prospects and priorities.

Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.

Point prevalence of Cryptosporidium oocyst in calves grazing along River Rima bank in Sokoto, Nigeria.

The present study was conducted to investigate the point prevalence of Cryptosporidium oocysts infection in calves grazing along the bank of Rima River Sokoto in October 2011. The river bank is a converging zone for domestic animals reared in different quarters of the town and the surrounding settlements. A total number of 2,959 cattle were enumerated out of which 147 (4.97%) were calves. Faecal samples were collected from 100 (68.02%) calves by convenient sampling technique. Formol-Ether sedimentation and modified Ziehl-Neelsen staining techniques were used to identify the Cryptosporidium oocysts in the faecal samples. Faecal consistency was also used to identify diarrhoeic and non-diarrhoeic calves. Cryptosporidium oocysts were identified in 33 (33.0%) of the calves examined. The detection rate was higher among the male calves (38.46%) than females while the Rahaji breed had the highest prevalence of 62.5%. A total of 6 (18.18%) among the positive cases were diarrhoeic. The differences in prevalence based on sex, breeds and presence of diarrhoea were not statistically significant. Calves may become sources of Cryptosporidia infection to man and other animals in the study area through unrestricted movements and interactions with the environment.

Neuropsychiatric and parkinsonian manifestations of dementia: a case report in a Nigerian woman.

Neuropsychiatric manifestations sometimes referred to as behavioral and psychological symptoms (BPSD) are not uncommon in dementias, especially in moderate-to-severe cases. When these symptoms occur in the setting of Parkinsonism, fluctuating cognition, visual hallucinations and neuroleptic sensitivity, then the most likely diagnosis is dementia with Lewy bodies (DLB). Although this type of dementia is not infrequently encountered in primary care, it may be missed because of its tricky modes of presentation. We report a clinically diagnosed DLB in a 67-year-old Nigerian female to raise awareness among primary care and mental health practitioners in order to enhance better detection and treatment, especially in the setting of a developing economy.

Antibacterial Effect of Some Nigerian Medicinal Plants on Drug-Resistant Salmonella Species Isolated from Enviromental Sources

Sensitivity of Salmonella species isolated from different environmental sources to the extracts of Azadirachita indica; Psdium guajava; Kigelia africana and Aloe microcarpa was investigated. Susceptiblity of the isolates to amoxicillin; ofloxacin; tetracycline; gentamicin; nalixidic acid; nitrofuratoin and cotrimoxazone was also examined. The sensitivity assay was done using agar dilution technique at concentrations ranging from 0.5 to 20v/v. The concentration of all the extracts of the experimental plants that inhibited the growth of Salmonella species ranged from 10 to 20v/v with minimum inhibitory concentration of 5.0v/v. All the extracts at concentration of 20v/v exhibited 100growth inhibition on Salmonella isolates. All the isolates exhibited resistance patterns ranging from 50 to 100against the antibiotics examined. Anti-nutrients constituents detected in all the plants materials were alkaloids (1.29-3.57); tannins (4.69-6.33); saponins (2.45-7.57); phenols (0.26- 0.60) and Flavonoids 0.41-1.00. The need to source for anti-typhoidal drugs from medicinal plants is discussed

A randomised controlled trial of uterine exteriorisation and non-exteriorisation at caesarean section.

BACKGROUND: There is not enough information to evaluate the routine use of exteriorisation of the uterus for repair of the uterine incision and further studies are needed to examine the value of exteriorisation of the uterus at caesarean section as against non-exteriorisation. AIMS: To assess intraoperative and postoperative morbidity following exteriorisation of the uterus at caesarean section as compared to those with non-exteriorisation. METHODS: A randomised controlled trial at Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria. Two hundred and ten women were randomised to either exteriorisation (N = 105) or non-exteriorisation group (N = 105). Statistical analysis using SPSS compared intraoperative and postoperative outcome. The outcome measures include intraoperative blood loss, number of analgesic dose, difference in operating time, febrile morbidity, intraoperative complications, and duration of hospital stay. RESULTS: There were significant reductions in intraoperative blood loss (P < 0.05), number of analgesic dose (P < 0.05) and duration of hospital stay (P < 0.05) in the uterine exteriorisation group as compared to those in the non-exteriorisation group. There was no significant difference in operating time, febrile morbidity, intraoperative complications and operating time. The period for return of bowel function was significantly longer in the exteriorisation group. CONCLUSION: Exteriorisation of uterus at caesarean section is associated with less intraoperative blood loss, less number of analgesic dose and shorter hospital stay.