Olusegun Adesola Busari

A review of stroke admissions at a tertiary hospital in rural Southwestern Nigeria

BACKGROUND Stroke is a common neurological disorder and is the third leading cause of death and a major cause of long-term disability. The disease is expected to increase in low- and middle-income countries like Nigeria. There is no information on stroke in rural Nigeria. OBJECTIVES To review the clinical patterns, risk-factors, and outcome of stroke in a tertiary hospital in rural Nigeria and examine the rural-urban variation of stroke hospitalization in Nigeria. MATERIALS AND METHODS We carried out a retrospective study of patients who had a clinical diagnosis of stroke at the Federal Medical Centre, Ido-Ekiti, South-western Nigeria between November 2006 and October 2009. RESULTS A total of 101 patients who had stroke were admitted during this review period, accounting for 4.5% of medical admission and 1.3% of total hospital admission. Women accounted 52.5% of cases, with a male to female ratio of 1 : 1.1. Their mean age was 68 ± 12 years. Stroke occurrences increased with age, as almost half (49.5%) of the cases were aged ≥70 years and majority (84.2%) of them were in low socioeconomic class. The mean hospital stay for stroke treatment was 12 ± 9 days, Glasgow coma score on admission was 11 ± 4. Ischemic stroke was 64.4%; hemorrhagic stroke, 34.7%; and indeterminate, 1.0%. Hypertension (85.2%), diabetes mellitus (23.8%), and tobacco smoking (22.8%) were the common identifiable risk factors for stroke. Of all the patients, 69% had ≥2 risk factors for stroke. Thirty-day case fatality was 23.8%; it increases with age and was higher among men than women (29.2 vs 18.9%) and in patients with diagnosis of hemorrhagic stroke (34.3 vs 18.5%). The numbers of identifiable risk factors of stroke has no effect on the 30-day case fatality. When compared with stroke in urban areas of Nigeria, we found no differences in frequency of hospitalization (1.3 vs 0.9 - 4%) and the major risk factor (hypertension). Hemorrhagic stroke was more common in urban than in the rural community (45.2 - 51 vs 34.7%) and the 30-day case fatality was lower in the rural community (23.8 vs 37.6 - 41.2%). CONCLUSION Stroke is also a common neurological condition in rural Nigeria, in view of the fact that almost 70% of the patients had ≥2 risk factors of stroke. We recommend that, sustainable, community-friendly intervention programmes are incorporated into the health care system for the early prevention, recognition, and modification of the risk factors in persons prone to the disease.

Evaluation of Current Knowledge, Awareness and Practice of Spirometry among Hospital -based Nigerian Doctors

BackgroundSpirometry is a cost-effective diagnostic tool for evaluation of lung function and for case-finding in a resource-limited setting. The acceptance of this test depends on the awareness of its indications and the ability to interpret the results. No studies have assessed the knowledge of spirometry among Nigerian doctors. The aim of this study was to evaluate the current knowledge, awareness and practice of spirometry among hospital-based Nigerian doctors.MethodsWe carried out a cross-sectional survey among 321 doctors working in Nigerian hospitals between March 2008 and June 2008. Information on knowledge, awareness, practice of and barriers to spirometry were obtained using a pre-tested, self-administered structured questionnaire and the data were then analysed.ResultsOf the 321 doctors that participated, 108 (33.6%) reported that they have good knowledge of spirometry. One hundred and ninety-five (60.7%) were aware of the importance of spirometry in aiding the diagnosis of respiratory diseases; 213(66.4%) were aware of the importance of spirometry in determining the severity of diseases. Medical school was the most common source of knowledge on spirometry (64.5%). Eighty-one (25.2%) doctors reported having a spirometer in their hospitals. Doctors having access to a spirometer used it more frequently for aiding the diagnosis of COPD (40.7% vs.27.5%) and for monitoring of asthma (18.5% vs.11.3%) than those without access to a spirometer. The doctors working in University Teaching Hospitals and Federal Medical Centres (FMC) (22.4% vs. 4.5%) and those having access to a spirometer (40.7 vs.11.3%) were very confident of interpreting spirometry results compared to those working in District and General Hospitals and without access to a spirometer. Irrespective of access to a spirometer or the type of hospital they were employed in, doctors reported that unavailability of a spirometer was the greatest barrier to its use (62.5%) followed by lack of awareness about its usefulness (17.2%).ConclusionThe knowledge and practice of spirometry were poor among hospital-based Nigerian doctors because of unavailability of spirometers in most hospitals. These findings have implications for further evaluation, planning and management of patient care in respiratory disease. Spirometers should be made available in all hospitals, and the knowledge of spirometry should be improved among doctors.

Male erectile dysfunction and microalbuminuria in adult nigerians with essential hypertension

Background: Microalbuminuria has been described as a marker of generalized vascular damage. Aims: The aim of the present study was to determine the prevalence of erectile dysfunction (ED) and microalbuminuria in adult male Nigerians with newly diagnosed hypertension. We also evaluated the relations between ED and microalbuminuria, electrocardiographic left ventricular hypertrophy, serum lipids, and cigarette smoking. Materials and Methods: A total of 81 male adult Nigerians with newly diagnosed hypertension were recruited into the study. There were also 75 age- and sex-matched healthy normotensive controls. ED was evaluated using a standardized questionnaire of the International Index of Erectile Function and microalbuminuria was determined using the Micra Test strips (Boehringer Manneheim GMBh, Mannheim, Germany). Results: Eighty-one hypertensive patients and 75 normotensive controls were studied. Mean age of the patients and the controls was 53.8 ± 5.6 and 51.2 ± 7.1 respectively. ED was found in 32.1% of the hypertensive patients and 16% of normotensive controls (P < 0.001). The prevalence of microalbuminuria was significantly higher in patients with ED than in those without it (65.4% vs. 23.6%, P < 0.0001). Conclusion: The study shows that ED and microalbuminuria are common in male adult Nigerians with hypertension. It also demonstrates that male ED is associated with an increased risk of cardiovascular disease.

Chloroquine-induced Acute Dystonic Reactions after a Standard Therapeutic Dose for Uncomplicated Malaria

Acute dystonic reactions (ADR) are extrapyramidal effects that usually occur after the initiation of a wide variety of drugs or triggering factors besides neuroleptics. We report the case of a 54-year-old man who was admitted with an approximately 10-hour history of muscle twitching around the eyes, face and neck after he took the first dose of oral chloroquine phosphate (1 g [600 mg base]) prescribed for uncomplicated malaria. He was given intravenous diazepam (10 mg statum) followed by 10 mg of oral diazepam 3 times a day. The symptoms improved within 30 minutes of treatment, and he was discharged 14 hours later after a complete recovery.

Awareness and practice of self breast examination among female nurses at the Federal Teaching Hospital Ido-Ekiti, Nigeria

Breast cancer is the most common female malignancy linked with high levels of morbidity and mortality in developing countries due to delayed diagnosis. This research assessed the knowledge of signs and risk factors of breast cancer and practice of self breast examination (SBE) among female nurses in a rural tertiary Hospital. Eighty-five nurses ages 20 to 60 years were sampled by simple randomization over a period of eight weeks through a self-administered semi-structured questionnaire. The analysis was done using statistical package for social science version 17. Sixteen (15.3%) nurses had adequate knowledge of breast cancer, having a relative with breast cancer (51.8%) and a woman of any age (56.5%) were recognized by majority as risk factors for breast cancer. Majority (68.2%) were not practicing monthly SBE and not confident on how to do it. This study pointed out the gaps in the knowledge and awareness of breast cancer and practice of SBE among the nurses. Opportunity should therefore be sought in various health facilities to educate nurses who are supposed to be closer to the patients.

Hyperuricemia and Its Correlation with Target Organ Damage and Electrocardiographic Changes in Newly Diagnosed Adult Nigerian Hypertensive Patients

The objective of the study was to determine the prevalence of Hyperuricemia and evaluate its correlation with target organ damage and electrocardiographic changes in newly diagnosed adult Nigerian hypertensive patients. It was a cross sectional study done at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. 150 untreated newly diagnosed hypertensive patients 18 years and above and 115 age and sex-matched normotensive individuals were recruited into the study. Data obtained was analyzed using Epi-Info version 6.04 and Statistical Package for Social Sciences (SPSS) version 14 computer software packages. The prevalence of Hyperuricemia was 36.7% and 17.4% in hypertensive patients and normotensive controls respectively. Mean serum UA in hypertensive patients and normotensive controls was 0.4±0.1mmol/l and 0.3±0.1mmol/l respectively (p 2 =23.97, p<0.0001). The study showed that Hyperuricemia is prevalent in adult Nigerians with newly diagnosed hypertension. Hyperuricemia was associated with left ventricular hypertrophy which is common target organ damage and confers an increased risk of cardiovascular events in systemic hypertension.

Hand Hygiene Facilities in the Clinical Laboratories of a Tertiary Health Facility in a Lassa Fever Endemic Country

Hand hygiene is a general term referring to any action of hand cleansing. It basically includes hand washing and hand rubbing. It is considered the most important simple measure for preventing the spread of pathogens generally and particularly in health-care setting. The objective of the survey was to evaluate the availability and accessibility of hand hygiene facilities in the clinical laboratories of a tertiary health facility in south west Nigeria. A previously used survey checklist assessing the condition of sink and other hand hygiene facilities in a health care setting was further modified and employed for data collection. Descriptive data analysis was done by calculating the frequencies. There were sixteen sinks in the laboratories where the survey was conducted. All the sixteen sinks were accessible to the users and were physically intact. Four (25%) of the sinks had damaged draining pipes. Half of the sinks had hand-held faucet. There was no sink with automated faucet. None of the faucets had water flowing when turned on at the time of the survey. Also, none had water flowed through it in the past 72 hours prior the survey according to users’ interview. Soap was available in only 6 (37.5%) of the sinks and there was no hand rub/ hand disinfectant or hand drying materials available. The survey has shown that there was a gross lack of hand hygiene facilities in the clinical laboratories of the tertiary health facility. There is an urgent need for critical stakeholders in the health sector to give policy and financial priority to provision of adequate modern hand hygiene facilities in all health care settings.

Novel structured teaching of HIV patients in resource-limiting settings: effects of learning outcomes on adherence to highly active antiretroviral therapy, hospitalization, immunologic recovery and mortality -

Background: Patient education is an important part of antiretroviral treatment and plays a cardinal role in adherence to highly active antiretroviral therapy. Aims: The objective was to compare a structured teaching method (STM) with traditional casual patient education method (TM) and evaluate its effectiveness on adherence to HAART, immunologic recovery, development of opportunistic infections, hospitalization and mortality. Materials and methods: This study was a hospital based, prospective cohort study of 620 (296 subjects and 324 controls) consecutive HIV patients admitted into the medical in-patient wards of the Federal Medical Centre, Ido-Ekiti, Nigeria, for various clinical conditions, between January 2006 and December 2012. A pre-test and post-test time series design was used for data collection using a 30-item knowledge and skills assessment schedule with items rated on a 5-point Linkert-type scale. The schedule was pre-tested on 20 patients with Cronbach’s score of 0.92 and a test-retest co-efficient of 0.89 at a 2-week interval. P value < 0.05 was considered significant. Results: Mean age was 28.7±6.9 years. Mean adherence rate for the subjects was 98.9±1.0% and for controls, 87.6±2.4% (p < 0.001). CD4+ T cell count increase was significantly more in subjects (238 vs 141, p < 0.001). Frequency of OI per patient per month was lower in subjects than in controls (0.51 vs 1.31, p =0.002). Mean number of readmissions per patient was 0.18±0.01 for subjects and 0.89±0.02 for controls (p = 0.0012). Subject group had shorter hospital stay (p = 0.002) and lower mortality (p = 0.008) for the controls. Conclusion: Structured teaching method has significant effect on adherence to HAART, immunologic recovery, development of OI, re-admission rate, hospital stay and mortality. This teaching method is novel and should be recommended as a core aspect of patient adherence counselling and education in antiretroviral treatment programme in resource-poor settings and globally

Intraventricular conduction blocks and microalbuminuria in Nigerians with essential hypertension

Objective: The objective of this study was to examine the prevalence and pattern of intraventricular conduction blocks in adult Nigerians with newly diagnosed essential hypertension and to determine the relationship between microalbuminuria and intraventricular conduction blocks. Methods: It was a cross-sectional study with nested case control. Ninety six patients were consecutively enrolled and compared with age- and sex-matched ninety six healthy normotensive individuals. Pre-tested questionnaire was used for data collection. The data collected was doubly entry into SPSS 20.0 software and analysed. P value < 0.05 was accepted as significance. Results: There were 52 (54.2%) male and 46 (45.8%) female hypertensive patients. Twenty one patients (21.9%) had intraventricular conduction blocks compared with 4 (4.2%) among the normotensive controls (21.9% versus 4.2%, P = 0.001) and left anterior fascicular block was the most frequent (38.1%). The prevalence of microalbuminuria was 32.3% in the hypertensive patients. Intraventricular blocks were significantly more common in hypertensive patients with microalbuminuria than in those without it (32.3% versus 16.9%, P=0.01). Conclusion: This study reveals that there is a high prevalence of intraventricular conduction blocks in adult Nigerians with newly diagnosed essential hypertension and left anterior fascicular block is the most common type. It also shows that the subset of hypertensive patients with microalbuminuria is more likely to have intraventricular blocks than those without it.

Intraventricular Conduction Blocks in Nigerians with Hypertensive Heart Disease

Amaç: Hipertansiyon tüm dünyada olduğu gibi Nijerya’da da yüksek prevalansa sahiptir. İntraventriküler iletim bloklarının hipertansiyonda morbidite ve mortaliteye katkıda bulunduğu bilinmektedir. Bu çalışmanın amacı, hipertansif kalp hastalığı olan erişkin Nijeryalılar’da intraventriküler iletim blok prevalansı ve kalıbının belirlenmesidir. Gereç ve Yöntem: Bu retrospektif çalışma, Ido-Ekiti, Nijerya’daki Federal Tıp Merkezi’nin Kardiyoloji Birimi’ne başvurmuş olan, hipertansif kalp hastalığına sahip erişkin hastaların istirahat halindeki 12-derivasyonlu elektrokardiyogramlarının değerlendirilmesini kapsamaktaydı. Toplanan veriler SPSS 20.0 yazılımı ile analiz edilmiştir. Bulgular: Hipertansif kalp hastalığı olan 543 erişkin Nijeryalı’nın istirahat halindeki elektrokardiyogramları çalışıldı. 336’sı (%61.9) erkek ve 207’si (%38.1) kadın olan hastaların ortalama ± standart sapma yaşları 61.3±9.7 yıl idi. Hastaların yaklaşık dörtte birinde (%24.7) intraventriküler iletim blokları vardı. Sol ön fasiküler blok tek başına ya da diğer bloklar ile kombinasyon halinde en sık gözlenen (%52.2) blok türüydü. İntraventriküler ileti blokları hipertansif kalp yetmezliği olan hastalarda istatistiksel olarak anlamlı olmasa da daha sık görülmekteydi (%23.9’a karşı %31.0, p=0.24). Sonuç: Bu çalışma hipertansif kalp hastalığı olan erişkin Nijeryalılar’da intraventriküler iletim blok prevalansının yüksek olduğunu göstermektedir. Kalp yetmezliği olan alt-grup, kalp yetmezliği olmayanlara göre daha yüksek bir prevalansa sahipti. En sık görülen blok tip sol ön fasiküler bloktu. Anahtar sözcükler: Hipertansiyon, kalp yetmezliği, intraventriküler ileti blokları, yetişkin Nijeryalılar ABS TRACT Intraventricular conduction blocks in Nigerians with hypertensive heart disease