RELATIONSHIP OF MEAN PLATELET VOLUME TO SEVERITY AND SHORT-TERM OUTCOME OF ACUTE ISCHEMIC STROKE.

Introduction: Despite the considerable number of clinical studies conducted, questions on the importance of the determinants of outcome after ischaemic stroke still exits. Methodology: Eighty consenting acute ischaemic stroke patients presenting to the emergency unit of Federal Teaching Hospital Gombe, along with 80 age and sex-matched controls were recruited. All the subjects were examined after relevant clinical history and stroke severity was determined using the NIHSS score. A brain imaging computed tomography or magnetic resonance imaging (CT/MRI) was performed for each patient and the stroke outcome of each patient was documented at the end of 30 days. MPV was assayed using the Sysmex KX-21N automated haematology analyser. Result: The mean age of patients 59.74±14.44 years was similar to the mean age of controls 59.80±14.08 years; P=0.947. The gender distribution between the two groups was also similar (p=0.436). Systemic hypertension was the most common modifiable risk factor for stroke accounting for 58.8%. The MPV of stroke patients 10.51 ± 0.88fl was significantly higher than that of controls 9.86±0.88fl p=0.0001 with a reference interval of 9.10-10.62fl using controls. Patients with MPV ≥10.62fl were categorized as high MPV range. The majority of patients in the high MPV category had significantly severe stroke with NIHSS score >16 p=0.001. No significant relationship was observed between the high MPV category and functional outcome based on mRS category p=0.101, The effect of MPV in the prediction of mortality remained significant (OR: 4.58, P= 0.012) in the multivariate regression model after controlling for other factors associated with mortality in acute ischemic stroke. A significant relationship was observed between MPV and infarct volume on the ROC curve and the area under the curve was 0.684 and an MPV value of 9.85fl was determined at 90% sensitivity and specificity of 50%. Conclusion: The study shows that MPV is associated with stroke severity and can be used as a marker to predict mortality in acute ischaemic stroke.

Nerve conduction study findings and their predictors in clinically diagnosed patients with carpal tunnel syndrome in a Saudi population.

BACKGROUND: Despite the reports of carpal tunnel syndrome (CTS) being commonplace in Saudi Arabia, there is scarcity of cross-sectional or prospective studies detailing the profile of nerve conduction study (NCS) findings in patients with CTS. OBJECTIVE: The study aimed to evaluate the neurophysiologic profile of CTS with the view to finding the determinant of abnormal findings in clinically diagnosed cases of CTS in a population of Saudis. METHODS: Nerve conduction study was performed on consecutive patients with clinically diagnosed CTS. Median sensory, ulnar sensory, radial sensory median motor and ulnar motor nerves were assessed. The nerve conduction parameters measured were median and ulnar sensory peak latency, amplitude and velocity. Median conduction velocity, distal latency, and amplitude were also measured. Comparative median-ulnar and median-ulnar-digit 4 studies were done and the severity of CTS was determined. Data was analyzed using STATA software version 12. RESULTS: A total of 152 patients, comprising 59 males and 93 females (mean age of 42.7 years) with clinically diagnosed CTS were seen during the study period. About 72.4% patients had numbness and paresthesia in the affected fingers, 66.5% had pain in the hands, and 10.5% had weakness in the affected hands. Majority of the patients (62%) had bilateral clinical features. Carpal tunnel syndrome was confirmed with NCS in 84 (55.26%) patients. Presence of weakness in the affected hand, positive Phalen' sign, and positive Tinel's sign in patients appear to predict [6.1 (1.2-30.7), 3.9 (1.2-30.2), and 4.9 (1.4-17.0) respectively] abnormal NCS findings after adjustment for age, gender and the presence of DM. CONCLUSION: The study revealed that over half of the patients with CTS had NCS/ Electromyography (EMG) abnormalities. Presence of hand muscles weakness, positive Phalen and Tinel's signs predict abnormal findings on NCS/EMG in patients with CTS.

Epilepsy treatment gap in Sub-Saharan Africa: Meta-analysis of community-based studies.

OBJECTIVE: To evaluate the prevalence, highlight the variation and determine the trend over time, of epilepsy treatment gap (ETG) in Sub-Saharan Africa (SSA). METHODS: We systematically searched PubMed, MEDLINE, Embase, ISI databases, and African Journal Online (AJOL). We determined the pooled prevalence estimate of ETG and the degree of heterogeneity in the region. Further subgroup analysis by sub-region, settlement setting, and cutoff adopted for active epilepsy in the studies was carried out. Meta-regression technique was also used to determine the trend of the ETG magnitude over time. RESULTS: Twenty-three studies from SSA met the inclusion criteria. We found a high level of discordance among the studies that were included. Collectively, the estimated ETG was 68.5% (95% CI: 59.5%-77.5%). On subgroup analysis, the prevalence of the ETG was 67% (95% CI: 52%, 83%) in the Western, 68% (95% CI: 56%, 80%) in the Eastern, and 63% (95% CI: 53%, 73%) in the Southern Africa sub-regions. On stratified analysis based on 1-year, 5-year, and 2-year cutoffs for definition of active epilepsy, the prevalence figures for the ETG were 71% (95% CI: 56%, 85%), 55% (95% CI: 33%, 77%), and 57% (95% CI: 43%, 71%), respectively. Meta-regression result suggested that the prevalence of the ETG decreases by approximately by 0.006 per year. CONCLUSION: The study showed a high prevalence of ETG, higher than the average for resource poor countries, and twice in rural compared with urban settlements in SSA.

Knowledge, attitude, and practice of diabetic retinopathy among physicians in Northwestern Nigeria.

BACKGROUND: Diabetic retinopathy (DR) is the leading cause of preventable blindness in the productive population that poses a considerable global public health burden. OBJECTIVE: The objective of this study is to assess the knowledge, attitude, and practice of DR screening among physicians in Northwestern Nigeria. Materials and Methods: Survey responses were obtained from 105 physicians in 4 tertiary hospitals using a Likert scale questionnaire. The internal consistency of the questionnaire was calculated using Cronbach's alpha coefficient. Principal component analysis was used for data reduction and grouping with the varimax rotation method, and the factors were extracted based on an Eigenvalue> 1. RESULTS: Most of the respondents (78.8%) were aware of the most effective method of delaying the onset of DR and frequency of eye examination (94.1%). Lack of ophthalmoscopes (70.6%) and dilating eye drops (50.6%) form important barriers to performing a good eye examination. CONCLUSION: DR screening among physicians practicing in Northwestern Nigeria was suboptimal, which prompts the need for improved training of physicians managing persons with diabetes on eye examination in a bid to strengthen DR screening and reduce the burden of visual impairment in our environment.

Cognitive functions in newly diagnosed patients with HIV infection in a tertiary health facility: Assessment using community screening interview for dementia.

INTRODUCTION: Neurocognitive dysfunction is a detrimental complication of HIV infection. In this study we attempt to characterize the pattern of cognitive dysfunction in a sample of Nigerian patients with newly diagnosed HIV infection. METHODS: We conducted a prospective study in which 50 patients with newly diagnosed HIV infection were studied along with 50 normal control subjects. The participants were evaluated with the medical history, general, physical and neurological examination. Laboratory evaluation and chest X-Ray were done for all patients. The Community Screening Interview for Dementia (CSID) questionnaire was administered to all the study participants. RESULTS: About 70% of the patients were in advanced disease stage. The mean age (SD) of the patients and controls in years were 36.44 ± 8.22 and 35.40 ± 11.53 respectively. More than half (56%) of the patients had secondary level of education (12 years of education). About 20% of the patients had severe neurocognitive impairment while 48% had minor neurocognitive disorder. The patients with HIV infection performed poorly in the domains of language, memory, orientation, attention/calculation and praxis relative to controls (p < 0.05).There were no significant effect of gender, age, sex and level of education on cognitive functions in the patients (p > 0.05) but the presence of opportunistic infections had negative impact on the performances on orientation and total CSID scores in the patients with HIV infection (p < 0.05). CONCLUSION: Patients with newly diagnosed HIV infection have poor cognitive functions when compared to normal controls and some presence of opportunistic infections in the patient is a significant risk factor for cognitive impairment.

Median Nerve Conduction in Healthy Nigerians: Normative Data.

BACKGROUND: Because of lack of local normative data, electrodiagnostic laboratories in Nigeria apply standard values generated in the USA and Europe to diagnose different median nerve abnormalities. AIM: To develop normative values for motor and sensory median nerve conduction studies (NCSs) in Nigerian population. SUBJECTS AND METHODS: In a cross-sectional study design, a total of 200 healthy volunteers were selected after clinical evaluation to exclude systemic or neuromuscular disorders. NCS of the median nerves was conducted on all the healthy volunteers according to a standardized protocol. The data included in the final analysis were amplitude, latency, and nerve conduction velocity. Ethical approval was obtained for the study. RESULTS: The reference range for median nerve (motor) velocity, distal latency, and amplitude were 49.48-66.92, 1.95-4.52, and 4.3-11.3, respectively. The reference range for median nerve F-wave latency was 44.8-70.5. The reference range for median nerve (sensory) velocity, distal latency, and amplitude were 44.8-70.5, 1.98-4.52, and 16.6-58.4, respectively. CONCLUSION: Reference values for the nerve conduction parameters of the median (motor and sensory) in the study population were similar to those obtained in the literature.

Pulmonary function tests in patients with Parkinson's disease: A case-control study.

BACKGROUND: In Parkinson's disease (PD), morbidity and mortality are commonly caused by respiratory disorders from pulmonary function impairments. AIM: The study aims to evaluate pulmonary functions in a cohort of patients with PD in comparison with age- and sex-matched control. METHODS: Pulmonary function test (PFT) was conducted using the Spirolab Spirometry kit, and results of forced vital capacity (VC), forced expiratory volume 1 (FEV1), FEV1/VC, and peak expiratory flow rate (PEFR) were obtained from 78 PD patients and 78 healthy controls. RESULTS: A total of 78 patients and 78 age- and sex-matched control comprising 60 (76.9%) males and 18 (23.1%) females were evaluated. The mean age ± standard deviation of the patients were 62.32 ± 8.67 and 62.31 ± 8.66, respectively; the difference in their age was not statistically significant (P = 0.993). The majority (38.5%) of the patients was in stage II of Hoehn and Yahr of PD. Vital capacity (VC) in PD patients and control was 2.481 and 3.106; the difference was statistically significant (P < 0.0001). The mean FEV1 in PD patients and control were 1.887 and 2.494; the difference was statistically significant (P < 0.0001). The mean FEV1/VC percent in PD patients and control were 75.812 and 80.303; the difference was statistically significant (P < 0.0001). The mean PEFR in PD patients and control were 45.58 and 67.46; the difference was statistically significant (P < 0.0001). Considering PD arm of the study, with the exception of FEV1/VC, there was significant negative correlation between all the parameters of PFT and patients age (VC, FEV1, PEFR, r = -422 and P = 0.0001, r = -391 and P = 0.0001, and r = -0.244 and P = 0.031, respectively). CONCLUSION: In this study, the values of the evaluated PFTs (VC, FEV1, FEV1/VC, and PEFR) parameters were significantly lower in PD compared with age- and sex-matched control.

Gastrointestinal complications in newly diagnosed Parkinson's disease: A case-control study.

BACKGROUND AND AIM: In spite of the overwhelming emphasis on motor symptoms in Parkinson's disease(PD), a number of studies have revealed that the non-motor symptoms including gastrointestinal, psychiatric and sleep symptoms have a greater influence on the quality of life of many patients. This study aimed to determine the frequencies of gastrointestinal symptoms in PD patients in comparison to healthy controls and to evaluate the relationship between these GI symptoms and severity of PD. METHODS: This cross-sectional study was conducted over a 2-year period. Consecutive new patients of Parkinson's disease were recruited at the neurology clinics of Aminu Kano Teaching Hospital (AKTH) and Murtala Muhammad specialist hospital (MMSH).Healthy age and sex matched volunteers constituted the control group. A structured, pre-tested, close-ended questionnaire inquiring about common gastrointestinal symptoms as well as demographic, and PD characteristics was administered to all cases and controls. PD severity was assessed using the Hoehn and Yahr scale (H and Y). RESULTS: A total of 80 patients and 80 controls were recruited during the study period. Their age ranged between 39 and 80 years. The mean age of the patients and controls were 61.1 ± 8.5 and 61.0 ± 8.4 years, respectively. The male to female ratio was 5:2. The most common gastrointestinal symptoms were constipation (48.8%), sialorrhea (18%), dysphagia (16.2%), difficulty in mastication (12.5%), and choking/aspiration (12.5%).When compared with age and sex-matched controls the differences in the occurrence of these symptoms were statistically significant.Constipation, dysphagia, difficult mastication, sialorrhea, and aspiration/choking were found to be more severe on the H and Y scale. CONCLUSION: Significant features of gastrointestinal dysfunction in PD include constipation, sialorrhea, dysphagia, difficult mastication and choking. These symptoms were significantly associated with increasing severity of Parkinson's disease.

Stroke in young adults: a prospective study from northwestern Nigeria.

Background. Stroke is an important cause of morbidity and mortality in young adults especially in developing countries. This two-centre prospective study aimed at reviewing the pattern, types, and case fatality of stroke in the young adults in Northwestern part of Nigeria. Methods. Consecutive patients aged 18-40 years admitted to the medical wards of two tertiary hospitals from June 2008 to August 2010 were recruited. Relevant clinical data were obtained from the patients.The survivors were followed up in neurology clinics for 6 months. Results. A total of 71 patients aged 18-40 yrs, (mean age was 31.9 ± 6) comprising 52(73%) males and 19(23%) females were enrolled. Forty two (59.1%) patients had infarctive stroke. The risk factors included hypertension (74.7%) patients, smoking (50.7%), hypercholesterolemia (9.9%), non-hypertensive cardiac diseases (8.5%), HIV (8.5%), diabetes mellitus (4.2%) cocaine and amphetamine (2.8%), and sickle cell disease (2.8%). Only twelve (17%) patients presented within the first 6 hours of onset of stroke. Seventeen (23.9 %) patients died, case fatality in the first 24 and 72 hrs was 4.2% and 19.7%, respectively. Conclusion. Our data suggests that stroke in young adults is not as uncommon as previously suggested. Hypertension, smoking, hypercholesterolemia, cardiac diseases and HIV are the most common risk factors.

Profile and outcome of non-traumatic paraplegia in Kano, northwestern Nigeria.

AIM: This study was aimed to identify the clinical and radiological profile of non-traumatic paraplegia and the various etiologies associated with the condition. MATERIALS AND METHODS: A review of the clinical and radiological presentations of adult patients presenting with non-traumatic paraplegia managed at the Aminu Kano Teaching Hospital (AKTH) and Murtala Specialist Hospital (MMSH), Kano, from June 2006 to November 2009 was carried out. Patients underwent a detailed clinical evaluation followed by laboratory investigation and neuroimaging studies and were followed up for 9 months to asses outcome and complications. RESULTS: 98 patients with non-traumatic paraplegia consisting of 71 males and 27 females (M:F: 5:2) were seen. The age range of the patients was between 16 and 76 years, with a mean age of 40 years (SD = 15.3) years; 54 (55%) of the patients presented after 2 months of the onset of paraplegia. The commonest symptoms were weakness of the lower limbs (100%), loss of sensation (55%), sphincteric disturbance (50%) radicular pain and paresthesia (38.4%), back pain (21.4%) and erectile dysfunction (40%). All the patients had X-ray of the spine; 26.3% had Magnetic Resonance Imaging (MRI) spine. The commonest etiological factors were tuberculosis (TB) (44.4%), transverse myelitis (13.1%), Guillain-Barre syndrome (9.1%), metastatic spinal disease (4%), and HIV myelopathy (4%). However, the cause could not be identified in 14 (14%) of the patients. The commonest site of affectation in those with TB spine was lower thoracic (53.8%) and upper lumbar (23.1%) vertebrae. CONCLUSION: Clinical profile of non-traumatic paraplegia in Kano, northwestern Nigeria, is similar to that reported elsewhere in Africa, with spinal tuberculosis and transverse myelitis accounting for over half the cases.

Profile and Outcome of Non-Traumatic Paraplegia in Kano; Northwestern Nigeria

Aim: This study was aimed to identify the clinical and radiological profile of non-traumatic paraplegia and the various etiologies associated with the condition. Materials and Methods: A review of the clinical and radiological presentations of adult patients presenting with non-traumatic paraplegia managed at the Aminu Kano Teaching Hospital (AKTH) and Murtala Specialist Hospital (MMSH); Kano; from June 2006 to November 2009 was carried out. Patients underwent a detailed clinical evaluation followed by laboratory investigation and neuroimaging studies and were followed up for 9 months to asses outcome and complications. Results: 98 patients with non-traumatic paraplegia consisting of 71 males and 27 females (M:F: 5:2) were seen. The age range of the patients was between 16 and 76 years; with a mean age of 40 years (SD = 15.3) years; 54 (55) of the patients presented after 2 months of the onset of paraplegia. The commonest symptoms were weakness of the lower limbs (100); loss of sensation (55); sphincteric disturbance (50) radicular pain and paresthesia (38.4); back pain (21.4) and erectile dysfunction (40). All the patients had X-ray of the spine; 26.3had Magnetic Resonance Imaging (MRI) spine. The commonest etiological factors were tuberculosis (TB) (44.4); transverse myelitis (13.1); Guillain-Barre syndrome (9.1); metastatic spinal disease (4); and HIV myelopathy (4). However; the cause could not be identified in 14 (14) of the patients. The commonest site of affectation in those with TB spine was lower thoracic (53.8) and upper lumbar (23.1) vertebrae. Conclusion: Clinical profile of non-traumatic paraplegia in Kano; northwestern Nigeria; is similar to that reported elsewhere in Africa; with spinal tuberculosis and transverse myelitis accounting for over half the cases

Pattern of neurological admissions in the tropics: Experience at Kano, Northwestern Nigeria.

BACKGROUND: Kano is the most populated state in Nigeria with a population totaling 9,383,682. The pattern of neurologic diseases in this area is not known. OBJECTIVE: To determine the of pattern of neurologic diseases warranting admission in a tertiary hospital in Kano and compare it with those elsewhere in the country with the view to using the data generated as a baseline for planning purposes and for future studies. MATERIALS AND METHODS: The medical records of all cases admitted with neurologic diseases in the Aminu Kano Teaching Hospital, Kano between January 2005 and September 2008, were retrospectively reviewed and the frequency of neurologic diseases, sex, age, and outcome of these diseases analyzed. RESULT: Stroke, predominantly ischemic, accounted for 77.6% of the neurological cases for the period of study. Central nervous system infections, comprising mainly of meningitis and tetanus, accounted for 6.6% (64) and 3% (29) of cases, respectively. The myelopathies were the cause of neurologic admissions in 5.4% (53) with paraplegia and quadriplegia resulting from myelopathies accounting for 5% (49) and 0.4% (4) of the cases. Hypertensive encephalopathy and status epilepticus as the causes of admissions accounted for 1.6% each. Gullain Barre syndrome, Parkinson's disease, and cerebral malaria were relatively rare causes of neurologic admissions in this study. The average duration of hospitalization was 25 days, and regarding outcome, 219 (22.4%) of these cases died. CONCLUSIONS: Stroke appeared to be the most common neurologic admission and the most common cause of neurologic and medical death in Kano as observed in other regions of the country and a little over one-fifths of stroke patients die. Central nervous system infections mainly meningitis and tetanus are the next common cause of admission. In view of these findings, the provision of a regional stroke unit, the improvement of the sanitary conditions of the home and environment; the widespread use of immunizations against meningitis, tetanus cannot be over-emphasized. These interventions will go a long way to reduce morbidity and mortality of stroke and neurologic infections.

Gastrointestinal complications in stroke survivors.

The objective of this study was to highlight the gastrointestinal problems that occur in stroke survivors, which may also reduce their quality of life. Stroke patients admitted over an 18-month period were evaluated for common gastrointestinal symptoms as well as type and site of stroke. Symptoms evaluated included vomiting, dysphagia, constipation, masticatory difficulties and sialorrhea among others. Similar symptoms were sought for among controls. There were 54 experimental and 46 control subjects consisting of 25 (46.3%) men and 29 (53.7%) women and 32 (69.6%) men and 14 (30.4%) women respectively. The dominant gastrointestinal symptom was constipation 14 (25.9%), followed by masticatory difficulty 11 (20.4%). Other significant gastrointestinal (GI) symptoms and signs were incomplete bowel evacuation, fecal incontinence, sialorrhea, and dysphagia. There was no significant difference in GI symptoms in either sex, site or type of stroke, except that constipation and incomplete evacuation were commoner in ischaemic stroke. It is advocated that feeding and bowel care should be instituted among stroke patients.