Role of the IL8 rs4073 polymorphism in central nervous system toxicity in patients receiving multidrug-resistant tuberculosis treatment.

OBJECTIVE: To determine the role of the IL8 rs4073 polymorphism in predicting the risk of central nervous system (CNS) toxicity in patients receiving standard pharmacological treatment for multidrug-resistant tuberculosis (MDR-TB). METHODS: A cohort of 85 consenting MDR-TB patients receiving treatment with second-line antituberculosis drugs had their blood samples amplified for the IL8 (rs4073) gene and genotyped. All patients were clinically screened for evidence of treatment toxicity and categorized accordingly. Crude and adjusted associations were assessed. RESULTS: The chief complaints fell into the following categories: CNS toxicity; gastrointestinal toxicity; skin toxicity; and eye and ear toxicities. Symptoms of gastrointestinal toxicity were reported by 59% of the patients, and symptoms of CNS toxicity were reported by 42.7%. With regard to the genotypes of IL8 (rs4073), the following were identified: AA, in 64 of the study participants; AT, in 7; and TT, in 11. A significant association was found between the dominant model of inheritance and CNS toxicity for the crude model (p = 0.024; OR = 3.57; 95% CI, 1.18-10.76) and the adjusted model (p = 0.031; OR = 3.92; 95% CI, 1.13-13.58). The AT+TT genotype of IL8 (rs4073) showed a 3.92 times increased risk of CNS toxicity when compared with the AA genotype. CONCLUSIONS: The AT+TT genotype has a tendency to be associated with an increased risk of adverse clinical features during MDR-TB treatment.

Role of the IL8 rs4073 polymorphism in central nervous system toxicity in patients receiving multidrug-resistant tuberculosis treatment / Papel do polimorfismo rs4073 do gene IL8 na toxicidade do sistema nervoso central em pacientes em tratamento para tuberculose multirresistente

ABSTRACT Objective: To determine the role of the IL8 rs4073 polymorphism in predicting the risk of central nervous system (CNS) toxicity in patients receiving standard pharmacological treatment for multidrug-resistant tuberculosis (MDR-TB). Methods: A cohort of 85 consenting MDR-TB patients receiving treatment with second-line antituberculosis drugs had their blood samples amplified for the IL8 (rs4073) gene and genotyped. All patients were clinically screened for evidence of treatment toxicity and categorized accordingly. Crude and adjusted associations were assessed. Results: The chief complaints fell into the following categories: CNS toxicity; gastrointestinal toxicity; skin toxicity; and eye and ear toxicities. Symptoms of gastrointestinal toxicity were reported by 59% of the patients, and symptoms of CNS toxicity were reported by 42.7%. With regard to the genotypes of IL8 (rs4073), the following were identified: AA, in 64 of the study participants; AT, in 7; and TT, in 11. A significant association was found between the dominant model of inheritance and CNS toxicity for the crude model (p = 0.024; OR = 3.57; 95% CI, 1.18-10.76) and the adjusted model (p = 0.031; OR = 3.92; 95% CI, 1.13-13.58). The AT+TT genotype of IL8 (rs4073) showed a 3.92 times increased risk of CNS toxicity when compared with the AA genotype. Conclusions: The AT+TT genotype has a tendency to be associated with an increased risk of adverse clinical features during MDR-TB treatment.

RESUMO Objetivo: Determinar o papel do polimorfismo rs4073 do gene IL8 na previsão do risco de toxicidade do sistema nervoso central (SNC) em pacientes em tratamento farmacológico padrão para tuberculose multirresistente (TBMR). Métodos: Amostras de sangue de uma coorte de 85 pacientes com TBMR que assinaram um termo de consentimento livre e esclarecido e que estavam recebendo tratamento com medicamentos antituberculosos de segunda linha foram amplificadas para o gene IL8 (rs4073) e genotipadas. Todos os pacientes foram avaliados clinicamente quanto a evidências de toxicidade do tratamento e categorizados de acordo com os achados. Foram avaliadas as associações brutas e ajustadas. Resultados: As principais queixas enquadraram-se nas seguintes categorias: toxicidade do SNC; toxicidade gastrointestinal; toxicidade cutânea; e toxicidade ocular e ototoxicidade. Sintomas de toxicidade gastrointestinal foram relatados por 59% dos pacientes, e sintomas de toxicidade do SNC foram relatados por 42,7%. Foram identificados os seguintes genótipos de IL8 (rs4073): AA, em 64 dos participantes; AT, em 7; TT, em 11. Houve associação significativa entre o modelo dominante de herança e toxicidade do SNC no modelo bruto (p = 0,024; OR = 3,57; IC95%: 1,18-10,76) e no ajustado (p = 0,031; OR = 3,92; IC95%: 1,13-13,58). O genótipo AT+TT do gene IL8 (rs4073) apresentou risco 3,92 vezes maior de toxicidade do SNC que o genótipo AA. Conclusões: O genótipo AT+TT tende a se associar a um maior risco de características clínicas adversas durante o tratamento da TBMR.

Normative data for ulnar nerve conduction and the influence of gender and height on ulnar nerve conduction velocity in healthy Nigerians.

Background: Despite the usefulness of ulnar nerve conduction studies in identifying disorders of ulnar nerves, there is a lack of normative values for the ulnar nerve in Nigerian population. Objective: The objective of the study was to generate normative values for motor and sensory ulnar nerve conduction studies (NCSs) in Nigerian population and to determine the influence of gender and height on ulnar nerve conduction velocity (NCV). Materials and Methods: A total of 200 healthy volunteers were selected after clinical evaluation to exclude common causes of ulnar neuropathy. We carried out NCS of ulnar nerves on all the healthy volunteers according to a standardized protocol. The NCS parameters included in the final analysis were amplitude, latency, NCV, and f-wave latency. Ethical approval was obtained for the study. Results: The mean ulnar nerve sensory velocity was 55.22 ± 5.67 with 2.5 and 97.5 percentile of 46.9 and 70.1, respectively. The mean latency of the ulnar nerve (sensory) was 2.97 ± 0.62 with 2.5 and 97.5 percentile of 2.00 and 4.52, respectively. The mean amplitude of the ulnar nerve (sensory) was 35.56 ± 9.97 with 2.5 and 97.5 percentile of 15.9 and 57.7, respectively). The ulnar NCV was significantly (P = 0.0202) higher in male. Mild inverse correlation (r = 0.2) was found between ulnar NCV and height of the participants (P = 0.0089). Conclusion: In the Nigerian population, normative values of motor and sensory ulnar nerve conduction parameters are similar to the existing values in the literature. The ulnar NCV appeared to be influenced by height and gender.

Résumé Contexte: Malgré l'utilité des études de conduction du nerf ulnaire pour identifier les troubles des nerfs ulnaire, il y a un manque de normative valeurs pour le nerf ulnaire dans la population nigériane. Objectif: L'objectif de l'étude était de générer des valeurs normatives pour les moteurs et études de conduction sensorielle du nerf ulnaire (NCS) dans la population nigériane et pour déterminer l'influence du sexe et de la taille sur le nerf ulnaire vitesse de conduction (NCV). Matériel et méthodes: Un total de 200 volontaires sains ont été sélectionnés après évaluation clinique pour exclure causes courantes de neuropathie ulnaire. Nous avons réalisé une NCS des nerfs ulnaire sur tous les volontaires sains selon un protocole standardisé.Les paramètres NCS inclus dans l'analyse finale étaient l'amplitude, la latence, la NCV et la latence de l'onde f. L'approbation éthique a été obtenue pour le étude. Résultats: La vitesse sensorielle moyenne du nerf ulnaire était de 55,22 ± 5,67 avec 2,5 et 97,5 percentile de 46,9 et 70,1, respectivement. La moyenne la latence du nerf ulnaire (sensoriel) était de 2,97 ± 0,62 avec 2,5 et 97,5 percentile de 2,00 et 4,52, respectivement. L'amplitude moyenne de l'ulnaire nerf (sensoriel) était de 35,56 ± 9,97 avec 2,5 et 97,5 percentile de 15,9 et 57,7, respectivement). Le NCV ulnaire était significativement (P = 0,0202)plus élevé chez les hommes. Une légère corrélation inverse (r = 0,2) a été trouvée entre la NCV ulnaire et la taille des participants (P = 0,0089). Conclusion: dans la population nigériane, les valeurs normatives des paramètres de conduction du nerf ulnaire moteur et sensoriel sont similaires aux valeurs existantes dans le Littérature. Le NCV ulnaire semble être influencé par la taille et le sexe. Mots-clés: Électromyographie, test de conduction nerveuse, Nigérians, normatif, nerf cubital.

Appraisal of the knowledge, attitude, perception and practices among northern Nigerians in the wake of the COVID-19 outbreak.

Aim: The aim of this study was to measure the knowledge, attitude, perception and practices of northern Nigerians toward the COVID-19 pandemic. Materials & methods: This was a questionnaire-based cross-sectional study and the data were analyzed using descriptive and inferential statistics. Results & discussions: There were 713 participants, of which 54.0, 57.4, 67.6, 36.2 and 28.9% were between 18 and 30 years of age, married, males, having bachelor's degree and civil servants, respectively. High level of knowledge, attitude, perception and practice was found. Pearson correlation analysis found strong positive (r = 0.622; p < 0.001) relationships between knowledge, attitude, perception (r = 0.454; p < 0.001) and at last, practice (r = 0.282; p < 0.001). Conclusion: Young, male and married northern Nigerians of high socio-economic status had better knowledge, attitudes, perceptions and practices toward COVID-19.

Molecular characterization and phylogenetic analysis of orf virus isolated from goats in Sokoto metropolis, Nigeria.

AIM: The aim of this study was to molecularly characterize orf virus isolated from clinical infections in goats in Sokoto metropolis. MATERIALS & METHODS: Embryonated chicken eggs were used to isolate orf virus according to the established protocol. Viral DNA was extracted and full coding region of B2L gene was amplified by polymerase chain reaction, sequenced and blasted for identification and phylogenetically analyzed. RESULTS AND DISCUSSION: The B2L gene sequences of the isolate showed slight variability (96-98.7%) with the reference sequences as it clustered within the same clade with Korean, Zambian and Ethiopian strains, signifying a close genetic relationship. Unique amino acid substitutions were noted. This is the first genetic characterization of B2L gene of orf virus circulating in Nigeria. CONCLUSION: This study has provided in sight into the genetic diversity of orf virus in the study area.

Outpatient prevention counseling for malaria in northwest Nigeria: A single-centre descriptive cross-sectional study

To assess the proportion of caregivers of children and patients who received malaria prevention counseling from their healthcare provider at the time of outpatient malaria treatment. Methods: This was a descriptive cross-sectional study involving 353 randomly selected adult patients and caregivers of children attending the general and paediatric outpatient clinics of a Nigerian hospital. An interviewer-administered questionnaire was used to collect data on participants' sociodemographics and last malaria-episode characteristics. Chi square test and logistic regression analysis were used to determine factors associated with and predictors of receiving malaria-prevention counseling, respectively. Results: The mean age of the respondents was (33.6±9.6) years; they were predominantly females (257, 72.8%). Most had at least secondary-level education (304, 86.1%); the family size was mostly 1-6 persons in 202 (57.2%) respondents. They were treated mostly by doctors 256 (72.5%), but only 132 (37.4%) received malaria prevention counseling. Educational-level (χ

Prevalence of hyperhomocysteinemia and hypovitaminosis B12 among acute ischemic stroke patients

Background: Deficiency of Vitamin B12 can lead to hyperhomocysteinemia. Hyperhomocysteinemia constitutes an abnormally high level of homocysteine in the serum, above the upper limit of normal for an environment. The two conditions are significant risk factors for the development of stroke. There is a paucity of data on the prevalence of these biochemical risk factors in stroke patients in our environment which brought about this study. Objective: The objective of the study was to determine how prevalent hyperhomocysteinemia and hypovitaminosis B12 are in acute ischemic stroke patients in Zaria. Materials and Mthods: This is a cross­sectional prospective study conducted from February 2014 to March 2015 in ABUTH Zaria. One hundred patients with clinical diagnosis of first­ever ischemic stroke confirmed by brain computed tomography scan, and another apparently healthy age­ and sex­matched one hundred controls were recruited. Their fasting serum homocysteine and Vitamin B12 were determined using the enzyme­linked immunosorbent assay technique. Prevalence of high homocysteine and low Vitamin B12 was determined.Results: Thirty­four percent (34%) of patients had high and 66% patients had normal serum homocysteine, whereas 81% of patients had low and 19% of patients had normal serum Vitamin B12, and the difference was found to be statistically significant (P < 0.05).There was significant negative correlation between serum homocysteine and Vitamin B12 among cases with P = 0.04 and r = −0.198.Conclusion: The Prevalence rates of hyperhomocysteinemia and hypovitaminosis B12 among ischemic stroke pateints were 34% and 81%, respectively

Solvent Extraction of Polyphenolics from the Indigenous African Fruit Ximenia caffra and Characterization by LC-HRMS.

Indigenous and non-commercial fruits can be an important source of antioxidant polyphenols; however, the identity and content of polyphenols from non-commercial fruits are often poorly described. The study aimed to extract, identify, and quantify polyphenols from the skin of the indigenous Africa fruit Ximenia caffra, using solvent extraction. Three solvents (hexane, acetone, and 70% v/v ethanol) over three extraction times (30, 60 and 120 min) were used in a 3² full factorial experimental design to determine effects on polyphenol recovery, and individual polyphenolics were characterised using liquid chromatography high-resolution mass spectrometry (LC-HRMS). Ethanol was the most effective extraction solvent, and extracts had high levels of total phenolics and flavonoids (65 mg gallic and 40 mg catechin equivalents per gram dry sample respectively), and high antioxidant activity (18.2 mg mL-1 ascorbic acid equivalents). LC-HRMS positively identified 16 compounds, of which 14 were flavonoids including flavonoid glycosides, and indicated that concentrations of some flavonoids decreased for extraction times beyond 60 min. It was concluded that the fruit of Ximenia caffra is rich in natural polyphenolic antioxidants; the present work identified and quantified a number of these, while also establishing suitable solvent extraction conditions for the recovery of these potentially high-value compounds.

Risk of Shiga Toxigenic Escherichia coli O157:H7 Infection from Raw and Fermented Milk in Sokoto Metropolis, Nigeria.

Escherichia coli O157:H7 is an enteric foodborne pathogen associated with life threatening disease conditions. The enterobacteria are frequently found in cattle gastrointestinal tract with high potential of contaminating animal products such as meat, milk, and cheese. A cross-sectional study was conducted to investigate the presence of Shiga toxin-producing Escherichia coli O157:H7 in milk products sold within Sokoto metropolis. Two hundred and sixty (260) samples (comprising 160 raw and 100 fermented milk samples) were collected from different sources within the study area. Bacteriological isolation and biochemical characterization yielded Escherichia coli with a detection rate of 9.23% (24/260). Molecular identification of the recovered isolates by PCR amplification of the Stx1 gene revealed Escherichia coli O157:H7 with a positive rate of 20.83% (5/24). The overall prevalence of E. coli O157:H7 was 1.92% (5/260) and the positive proportions for raw and fermented milk samples were 1.86% (3/160) and 2.0% (2/100), respectively. Fisher's Exact test showed a nonsignificant association between the isolates and the different milk types (p = 0.943; OR = 0.94; [95% CI: 0.154-5.704]). The results revealed presence of Escherichia coli O157:H7 in raw and fermented milk sold within Sokoto metropolis, Nigeria. The findings indicate possible feacal contamination of the milk products, with serious public health consequences. This necessitates the need to screen other milk products produced in the area such as butter and cheese. Health authorities in the State need to enlighten dairy farmers on the zoonotic potential of Escherichia coli O157:H7 and the role of cattle in the spread of the pathogen.

Raman Deuterium Isotope Probing Reveals Microbial Metabolism at the Single-Cell Level.

We illustrate that single-cell Raman microspectroscopy, coupled with deuterium isotope probing (Raman-DIP), provides a culture-independent and nondestructive approach to probe metabolic pathways of carbon substrates at the single-cell level. We found a distinguishable C-D vibration band at 2070-2300 cm-1 in single-cell Raman spectra (SCRS) when Escherichia coli used deuterated glucose and Pseudomonas sp. used deuterated naphthalene as sole carbon sources. The intensity of the C-D band is proportional to the extent of deuteration in the carbon source, and as little as 5% deuteration can be distinguished by analysis of SCRS. It suggests that Raman-DIP could be used to semiquantitatively and sensitively indicate the metabolism of deuterated carbon source in microbes. A lower lipid conversion rate of deuterated naphthalene compared to that of deuterated glucose was observed, presumably owing to different anabolic pathways and membrane alteration. Apart from the C-D band shift from C-H, SCRS also reveal several isotopic shifts of the phenylalanine band, of which the positions correlate well with a computational model. A reduction in phenylalanine deuteration in Pseudomonas sp. compared to that in E. coli is due to the dilution effect of different pathways of phenylalanine biosynthesis in Pseudomonas sp. Collectively, we demonstrate that Raman-DIP can not only indicate metabolic activity using deuterated carbon sources but also reveal different metabolic pathways by analyzing SCRS. By harnessing such low-cost and versatile deuterated substrates, Raman-DIP has the potential to probe a wide range of metabolic pathways and functions at the single-cell level.

Economic evaluation of childhood epilepsy in a resource-challenged setting: A preliminary survey.

BACKGROUND: Considerable disease variability exists between patients with epilepsy, and the societal costs for epilepsy care are overall high, because of high frequency in the general population especially in children from developing countries. MATERIALS AND METHODS: A cross-sectional study where children with established diagnosis of epilepsy were interviewed using a semi-structured questionnaire. Prevalence-based costs were stratified by patients' sociodemographic characteristics and socioeconomic scores (SES). The 'bottom-up' and 'human capital' approaches were used to generate estimates on the direct and indirect (productivity losses) costs of epilepsy, respectively. All estimates of the financial burden of epilepsy were analyzed from the 'societal perspective' using IBM SPSS statistics software, version 20.0. RESULTS: The study had 103 enrollees with most in the age group of 0-5years (45.6%). Majority (61.3%) belong to the low socioeconomic class (Ogunlesi SES class IV and V) and reside (80.6%) in an urban setting. The total direct and indirect costs per month were ₦2,149,965.00 ($8497.88) and ₦363,187.80 ($1435.52), respectively. The cost of care per patient per annum was ₦292,794.50 ($1157.29), and the total cost for all the patients per year was ₦30,157,833.60 ($119,200.92). Investigative procedures are the principal cost drivers (₦15,861.17 or $18.15) comprising approximately 58.7% of the total direct costs per patient. CONCLUSIONS: Cost of investigations contributed immensely to the total direct cost of care in our study. With the present economic situation in the country, out-of-pocket payments may contribute significantly to catastrophic expenditures and worsening of secondary treatment gap in children with epilepsy.

Large perturbations in CO2 flux and subsequent chemosynthesis are induced in agricultural soil by the addition of elemental sulfur.

The microbial contribution to soil organic matter has been shown to be much larger than previously thought and thus it plays a major role in carbon cycling. Among soil microorganisms, chemoautotrophs can fix CO2 without sunlight and can glean energy through the oxidation of reduced elements such as sulfur. Here we show that the addition of sulfur to soil results in an initial surge in production of CO2 through microbial respiration, followed by an order of magnitude increase in the capture of carbon from the atmosphere as elemental sulfur is oxidised to sulfate. Thiobacillus spp., take advantage of specific conditions to become the dominant chemoautotrophic group that consumes CO2. We discern the direct incorporation of atmospheric carbon into soil carbohydrate, protein and aliphatic compounds and differentiate these from existing biomass. These results suggest that chemoautotrophs can play a large role in carbon cycling and that this carbon is heavily influenced by land management practises.

Stroke in patients with diabetes mellitus: a study from North Western Nigeria.

BACKGROUND: Stroke is one of the major causes of morbidity and mortality worldwide and apart from being exceedingly harmful in diabetics, stroke is a disabling disorder. The study was undertaken to describe the clinical characteristics, outcome pattern and predictors of mortality in a cohort of diabetic patients presenting with stroke in two tertiary health facilities in North Western Nigeria. METHOD: Out of all stroke patients seen from June 2007 to February 2011, persons with diabetes mellitus presenting with stroke in the emergency unit of the two tertiary hospitals in Kano were consecutively recruited for the study. Classification of stroke into hemorrhagic and infarctive subtypes was based on brain computerized tomography (CT), brain magnetic resonance imaging (MRI) and World Health Organization (WHO) criteria. Follow-up period was for thirty days. RESULT: Out of the five hundred and thirty six stroke patients seen during the study period, 85 (15.9%) patients, comprising 48 (56.5%) males, had diabetes. Thirty eight (44.7%) of the identified diabetics were previously undiagnosed. Sixty four (75.3%) had infarctive stroke. One-month case fatality rate was 30.6%. Factors associated with death included male sex, past history of TIA, abnormal respiratory pattern, hemorrhagic stroke, aspiration pneumonitis, and worsening GCS. Aspiration pneumonitis and worsening GCS were independent predictors of one month mortality of stroke in the patients. CONCLUSION: In DM patients studied, infarctive stroke was more common, case fatality was 30.6%. Male gender, past history of TIA, abnormal respiratory pattern, hemorrhagic stroke, aspiration pneumonitis, and worsening Glasgow Coma Score (GCS) were associated with mortality. Aspiration pneumonitis and worsening GCS were independent predictors of one month mortality of stroke in diabetic patients.

Cognitive function assessment in patients with end- stage renal disease in Nigeria: A single center experience.

AIM: The purpose of this comparative study was to evaluate cognitive function in end-stage renal disease (ESRD) patients in comparison with age, sex, and level of education-matched control. MATERIALS AND METHODS: This is a cross-sectional study involving 80 ESRD patients receiving maintenance hemodialysis treatment and recruited conservatively at the nephrology unit of our hospital. Eighty apparently healthy control, that were matched with the patients for age, sex and education, were also recruited. Following exclusion of depression and severe functional disability, a computer-assisted neuropsychological test, the FePsy, was used to assess  memory, psychomotor speed, concentration and attention using simple auditory and visual reaction time tasks, recognition memory tests (RMTs), finger tapping task, and binary choice task (BCT) for both the ESRD patients and controls. RESULTS: ESRD patients performed worse on simple auditory and visual reaction time tasks (P < 0.05), RMTs (P < 0.05), finger tapping task (P < 0.05), BCT, and computerized visual search task (P < 0.05). CONCLUSION: Performance in memory, psychomotor tasks, concentration, and attention tasks were found to be reduced among patients with ESRD compared with age, sex and level of education-matched control.

Pattern of in-patient neurologic review: An experience from a Tertiary Hospital North-Western Nigeria.

BACKGROUND: Increase in neurologic diseases burden has increased the demand for neurology services globally, despite the shortcomings of shortage and maldistribution of neurologists worldwide, including Sub-Saharan Africa. This has placed significant pressure on the few available neurologists to provide optimal and effective services in our resource-challenged settings. METHODS: Neurology referrals were prospectively reviewed over a period of 3 months. Sociodemographic characteristics of the patients, the initial diagnosis by the requesting team, the reasons for the consult/referral, the requesting personnel, duration of hospital stay before request, the time interval between receiving the request and review, the working and final diagnosis after the review, and the diagnostic outcome of neurologic review were analyzed using Predictive Analytics Software® version 18.0.0 for Windows (Chicago, Illinois, USA). RESULTS: Fifty-three hand written in-patient requests were reviewed over the period of study given an average rate of 4.4/week. The mean age was 50.8 ± 16.1 years, and the median length of stay before a review was 1 day (interquartile range: 1-2.5 days). Diagnostic outcome of the reviews were; new diagnoses in 4 (11.3%), the incorrect diagnosis changed in 8 (15.1%), contribution to the differential diagnosis in 15 (28.3%), and contribution to management plans in 24 (45.3%) patients. The association between diagnostic outcomes and mortality in our study was not statistically significant (χ2 = 6.66, P = 0.08). CONCLUSION: Our study showed that in-patient neurologic reviews led to significant improvement in diagnostic and management plans. Appropriate policy guidelines should focus more on efficient ways of maximizing benefits of these reviews to patients without overburdening the few available neurologists in our environment.

Infratentorial posterior circulation stroke in a Nigerian population: Clinical characteristics, risk factors, and predictors of outcome.

BACKGROUND: Posterior circulation stroke (PCS), though less common, differs from stroke in anterior circulation in many aspects. Relatively, it portends a poorer prognosis. However, there is a paucity of data from African countries, in particular, where stroke is a menace. OBJECTIVE: The study aimed to evaluate the etiology, clinical characteristics, outcome, and predictors of outcome in a cohort of patients with IPCS in Northwestern Nigeria. MATERIALS AND METHODS: Out of 595 patients with stroke, we prospectively analyzed 57 patients with PCS in a Tertiary Care Center in Kano, Northwestern Nigeria. Patients were analyzed for demographic data, risk factors, clinical characteristics, stroke subtypes, mortality, and predictors of mortality. RESULTS: Posterior circulation ischemic stroke accounted for 57 (9.6%) of 595 of all strokes seen in the study period. They comprised 44 males (mean age 47.8 ± 17.7) and 13 females (mean age 46.3 ± 13.7). Overall, their age ranged between 24 and 90 (mean age 47.4 ± 16.7). However, 52.7% of the patients were < 45 years of age. The most common site affected was the cerebellum seen in 33 (57.9%) patients. Hypertension was the most common risk factor (86%). Headache and vertigo were the most common features accounting for 83.6% and 86.3%, respectively. Thirty-eight (66.7%) patients had an ischemic stroke. Twenty-one (36.8%) of the patients died during the 1-month period of follow-up. Independent predictors of death in the study were hyperglycemia on admission and hemorrhagic stroke. CONCLUSIONS: IPCS occurred in a relatively younger age group. Headache and vertigo were the most common symptoms. The independent predictors of death in the study were hyperglycemia at presentation and hemorrhagic stroke.

Related Factors and Predictors of Cognitive Dysfunction in Chronic Kidney Disease on Maintenance Hemodialysis in Nigeria.

BACKGROUND: Previous studies suggest a high frequency of cognitive impairment (CI) in persons with chronic kidney disease (CKD); however, factors associated with CI and predictors of CI in persons with CKD remain largely unclear. The aim of this study was to determine the factors associated with CI and predictors of CI in CKD patients on maintenance hemodialysis. MATERIALS AND METHODS: The first stage of the study included recruitment of 100 apparently healthy participants aimed at determining the reference values. The second stage of the study included eighty CKD patients on maintenance hemodialysis. The iron psychology (FEPSY) was used to assess the memory, psychomotor speed, concentration, and attention using simple auditory reaction time (ART) and visual reaction time (VRT) tasks, recognition memory tests (RMT), finger tapping task (FTT), and binary choice task (BCT). RESULTS: Using normative values generated in this study, 41 (51.3%) and 43 (53.8%) CKD patients had abnormal scores on ART dominant (D) and nondominant (ND) sides, respectively. Forty (50%) and 42 (52.5%) patients had abnormal scores on VRT D and ND sides, respectively. Twenty-one (26.3%) and 68 (85%) had abnormal scores on BCT and computer-assisted visual scanning task, respectively. Sixty-four (80%) and 65 (81.3%) had abnormal scores on RMT (words) and RMT, respectively. Fifty-two (65%) and 48 (60%) patients had abnormal scores on D and ND sides of (FTT), respectively. Factors associated with psychomotor speed impairment were duration of CKD from diagnosis (P = 0.0001 and 0.043 in D and ND ART, respectively), duration on dialysis (P = 0.0001 across board in D and ND ART as well as in D and ND VRT, respectively), and plasma urea (PU) and plasma creatinine (PCr) (P < 0.05). Factors found to be associated with memory impairment included age (P = 0.045 and 0.025 on words and figures RMT, respectively), PU (P = 0.002 and 0.005 on words and figures RMT, respectively), and PCr (P = 0.012 and 0.040 on words and figures RMT, respectively). Duration on dialysis (P = 0.032) and PCr (P = 0.001) were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD. CONCLUSION: Factors associated with psychomotor speed impairment were duration of CKD, duration on dialysis, and PU and PCr while age, PU, and PCr were associated with memory. Duration on dialysis and PCr were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD.

Prevalence and Correlates of HIV-Associated Neurocognitive Disorders (HAND) in Northwestern Nigeria.

HIV-associated Neurocognitive Disorders (HAND) are common among HIV-positive individuals. This study explored the prevalence and correlates of HAND in Nigeria. 80 HIV-positive and 40 HIV-negative adults selected from Aminu Kano Teaching Hospital (AKTH) received comprehensive evaluations. A multidomain neuropsychological test (MDNPT) battery assessing 7 domains was administered to the participants and their performance was combined with measures of functional status to classify impairments into various grades of HAND. Univariate and multivariate analyses were performed to identify correlates of symptomatic HAND. Among the HIV-positive individuals, 50% were highly active antiretroviral therapy-experienced (HAART+) and 50% were highly active antiretroviral therapy naive (HAART-). Symptomatic HAND was found among 40% of the HAART- individuals and 30% of the HAART+ individuals. Respective prevalence of HIV-associated dementia (HAD) was 23% and 5%, respectively (p = 0.0002). In a binary logistic regression model, only fewer years of education independently predicted symptomatic HAND [Odds Ratio (OR) = 1.2, 95% confidence interval (CI) = 1.04-1.44, p = 0.016]. The prevalence of HAND in Nigeria is high with HAD being commoner among HAART- patients. Provision of HAART and strict monitoring of patients at risk of HAND are needed to scale down the burden of the disease.

Hand washing practices and techniques among health professionals in a tertiary hospital in Kano

Background: The simple act of hand washing has been proven to reduce the risk of acquiring hospital infection; especially with the current concern of Ebola viral disease. Hospital acquired infections have contributed significantly to overall mortality and morbidity and health care cost. They report that hand washing remains at an unacceptable low level in most medical environments; with large numbers of doctors and nurses routinely forgetting to wash their hands before touching patients. Transmission of health-care-associated infections often occurs via the contaminated hands of health care workers. Materials and Methods: It was a descriptive cross-sectional study carried out among randomly selected doctors and nurses in Aminu Kano Teaching Hospital; Kano. The questionnaires were administered to the respondents during their ward rounds or clinic sessions. Results: One hundred and forty health professionals comprising 98 nurses and 42 doctors were studied. About 64.4% of them were aware of the World Health Organization (WHO) global hand washing day but only 15% stated the date correctly. About 99.3% of them believed that if hand washing is done correctly it can reduce the risk of infection. All (100%) of the health professionals use water and soap or hand rubs as agents of hand washing. About 93.6% were taught hand washing technique and 47% were aware of the five moments in hand washing but only 17% of them could list the five moments in hand washing. Only 25.7% health professionals knew the correct steps of hand washing (?2 = 2.444; df = 2; P = 0.295). Ninety-one percent of the health professionals had seen posters on hand washing. Majority (72.1%) adhered to principles of hand washing (?2 = 0.015; df = 1; P = 0.902) while 82.1% wash their hands before touching patients (?2 = 2.841; df = 1; P = 0.092). However; most of them (95%) washed their hands after touching patients and 97% washed their hands after handling body fluids or secretions from patients. On the other hand; only 39% health professionals washed hands before wearing hand gloves (?2 = 0.321; df = 1; P = 0.571) but 95% washed hands after removing the hand gloves. Ninety-nine percent washed their hands after visiting or using the restroom. Conclusion: This study underscores the need for continuous information and education of health professionals on the importance WHO global hand washing day. As doctors and nurses are important in the health care team; it is important to provide the appropriate knowledge and training regarding preventive practices of infectious diseases. Training and retraining of health professionals on correct steps of hand washing will encourage and remind them on the importance of washing hands before wearing gloves and before touching patients to reduce the risk of infection and cross infection

Dysmorphism in One of a Set of Male Twins; Could They have been Identical Twins? A Diagnostic Dilemma.

Twinning occurs worldwide, but Nigerian women of the southwest extraction record one of the highest rates in the world. Among the notable risk factors for fraternal twinning is advanced maternal age, which is also an independent risk factor for Down syndrome. Even as morphological characteristics can easily be applied to distinguish identical from fraternal twins, in cases of an associated dysmorphism, in any member of the couplet, it becomes a difficult tool to use, as has been observed in the case of a set of twins who were of the same sex, blood group, hemoglobin genotype, and shared the same placenta.