Sani A Abubakar

Incidence of dog bite injuries and clinical rabies in a tertiary health care institution: A 10-year retrospective study

BACKGROUND It is widely recognized that rabies is grossly under-reported even though it is a notifiable disease and a lack of accurate figures has rendered rabies a low public health and veterinary priority. This study aimed at determining the incidence of dog bite injuries and clinical rabies in a tertiary health care centre. MATERIALS AND METHODS Case records of patients managed at the accident and emergency unit of Ahmadu Bello University Teaching Hospital, Zaria, between June 2000 and May 2010 with diagnosis of dog bite and rabies were retrieved. Relevant clinical data were extracted using a structured questionnaire designed for the study. RESULTS Eighty-one persons out of 24,683 consultations in the accident and emergency unit presented with dog bite injuries with two clinical cases of human rabies. Mean age of victims of dog bite injuries was 21.1 ± 14.3 years and the majority (55.6%) were children. Males were more affected than females with a male:female ratio of 4.8:1, lower limb/buttock injuries were significantly higher in children than adults, but the adults sustained significantly more severe (type III) injury. The majority of dog bite injuries were washed with soap and irrigated with water or saline and 87.7% of the victim of dog bite received postexposure anti-rabies vaccine. CONCLUSION Hospital incidence of dog bite injuries was low, but the use of postexposure prophylaxis was high.

Type 2 diabetes mellitus and its risk factors among the rural Fulanis of northern Nigeria

BACKGROUND Information about diabetes mellitus (DM) from the rural populations in Nigeria, particularly among the rural Fulanis is limited. MATERIALS AND METHODS This was a cross-sectional study conducted in two rural districts of Sokoto State in Northern Nigeria. Using a modification of the WHO STEP wise approach to surveillance (STEPS) instrument, information on sociodemographic and anthropometric data was obtained. Either a casual or fasting plasma glucose (FPG) level was obtained in all subjects while oral glucose tolerance test was performed in a randomly selected group of 50 of the study participants. RESULTS Three hundred and ninety-three subjects participated in the study. The prevalence rates of DM, impaired fasting glycemia (IFG), and impaired glucose tolerance (IGT) were 0.8, 6.9, and 8%, respectively. The mean (SD) FPG was higher in males (5.1 ± 0.6 mmol/L) than in females (4.9 ± 0.6 mmol/l), but not statistically significantly (P = 0.20). The major risk factors for DM among the rural Fulani were obesity and increasing age. CONCLUSION The prevalence rates of DM and its principal risk factor obesity are low among the rural Nigerian Fulani. However, the prevalence of prediabetes is relatively high, a factor that may predispose to the future development of DM.

Sleep disturbances among patients with epilepsy in Nigeria

BACKGROUND There is a complex inter-relationship between sleep disorders and epilepsy, and there are few studies in Nigeria on sleep disorders in epilepsy. This study was carried out to determine the prevalence, pattern and predictors of sleep disturbances among persons with epilepsy (PWE). MATERIALS AND METHODS This was a multi-center, cross-sectional study of 124 PWE in Nigeria. A questionnaire was used to collect data on social and demographic variables, epilepsy- related variables and sleep disturbances in PWE. Exclusion criteria were mental retardation, and use of sedative drugs. The data was analyzed using Statistical Package for Social Sciences version 11.0 and P < 0.05 was considered as significant. RESULTS There were 77 males and 47 females with a mean age of 33.4 ± 13.1 years. The mean age of seizure onset was 23.7 ± 14.6 years, while the mean duration of epilepsy was 9.5 ± 9.4 years. The commonest type of epilepsy was secondarily generalized tonic-clonic seizures (62%). The prevalence of sleep disorders in PWE was 82%. Parasomnias occurred in 46%, followed by obstructive sleep apnea in 23%, insomnia (19%) excessive daytime sleepiness (EDS) (17%), and restless leg syndrome (11%). None of the socio-demographic or epilepsy- related variables was predictive of EDS or parasomnias in PWE (P > 0.05). CONCLUSION There is a high frequency of sleep disorders among PWE. Clinicians should screen PWE for sleep disturbances.

Low admission serum albumin as prognostic determinant of 30-day case fatality and adverse functional outcome following acute ischemic stroke

Introduction Over 80% of stroke deaths occur in low-income and middle-income regions of the world. Identification of predictors of mortality is vital so that prompt therapeutic measures could be instituted to improve outcome. Previous studies have identified factors such as stroke severity, stroke type, older age, impairment of consciousness and hyperglycaemia as predictors of mortality for acute stroke but mortality remain high among patients hospitalized for acute stroke. The study objective was to determine the association between admission serum albumin levels and short-term outcome following acute ischaemic stroke in Nigerians. Methods Consecutive first-ever acute ischaemic stroke patients were prospectively enrolled between February 2009 and May 2010. Stroke severity at presentation was determined using National Institute of Heath Stroke Score (NIHSS). Admission serum chemistry including albumin, were measured. Patients were then followed up for 30 days and outcome measures applied at the end of the study were 30-day mortality and functional outcome using the Modified Rankin Scale (MRS) and graded as favourable(MRS 0-3) or unfavourable(MRS 4-6). Relationship between serum albumin and stroke outcome was determined. Results 75 acute stroke cases were studied. Mean age was 57.68 ± 12.4 years. Outcome was favourable in 48% while 30-day case fatality was 17.3%. The mean age (61.13 years) of those with poor outcome was significantly higher than those with favourable outcome. Mean serum albumin (3.03g/dL) of those with favourable outcome was also significantly higher than (2.08g/dL) of those with unfavourable outcome (p=0.0001). Patients that died had significantly lower serum albumin (1.66g/dl) than survivors (p=0.0001).Receiver operating characteristics curve for optimal cut off point of serum albumin to predict survival or death within 30 days revealed area under the cure (AUC) of 0.870, p-value 0.0001, 95% C/I=0.759-0.982. Serum albumin of 1.55g /dL has sensitivity of 100% and specificity of 61.5%. NIHSS and serum albumin were predictors of poor outcome using multiple regression. Conclusion Low admission serum albumin was an independent determinant of poor outcome.

Idiopathic bilateral strio-pallido-dentate calcinosis (Fahr's disease): A case report and review of the literature

Bilateral calcification involving the basal ganglia (Fahrs disease) is a rare disease. A high index of suspicion is required to make clinical diagnosis; more so that the calcinosis may remain asymptomatic in a vast majority of cases. Movement disorder is by far the most common manifestation in symptomatic individuals. Fahrs disease is by no means absent in our environment, and increasing availability of a computed tomography-scan machine in Nigeria may enhance the case identification of Fahrs disease. This review presents a case of bilateral strio-pallido-dentate calcification; it also affirms the fact that Fahrs disease could present with hyperkinetic movement disorder (chorea) in our setting.

Profile of stroke patients seen in a tertiary health care center in Nigeria

Background: The profile of patients seen with acute stroke has been sparsely described in north-western Nigeria, even though stroke constitutes an important cause of severe disability in adults. Aims: (1) The primary aim is to determine the clinical and socio-demographic profile of stroke patients seen in a tertiary hospital. (2) The secondary aim is to determine the 30-day case fatality. Patients and Methods: A retrospective study carried out using the case records of patients admitted from January 2007 to December 2009 with the clinical diagnosis of stroke at Usmanu Danfodiyo University Teaching Hospital. Relevant clinical data were extracted using a structured questionnaire designed for the study. Results: A total of 370 case files with the clinical diagnosis of stroke were traced, but only 260 had complete information. The mean age of patients was 55.7 ± 14.3 years; hypertension (74.6%) was the most common modifiable risk factor for stroke followed by diabetes mellitus (8.8%). Stroke constituted 1.2% of all hospital admissions and 8.5% of death in the medical units. The 24-h and 30-day case fatalities were 11.9% and 38.4%, respectively. The mean duration of hospitalization for stroke survivors was 21 days, but the duration of hospitalization prior to death for those that died was 4 days. Conclusion: The 30-day case fatality of acute stroke was high and hypertension was the most common modifiable risk factor for stroke. Prompt and adequate measures should be taken to improve outcome of stroke.

Cardiac Troponin T and creatine kinase MB fraction levels among patients with acute ischemic stroke in Nigeria

Background: Stroke has been a global burden, with increasing morbidity and mortality. Serum cardiac troponin t (cTnT) and creatine kinase (CK-MB) fraction are reported to be elevated in patients admitted with acute ischaemic stroke and high level of these biomarkers indicated more severe stroke and neurologic deficit in some of the patients. Objective: To evaluate the serum levels cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in patients with acute ischaemic stroke and relate the analytes to severity of stroke. Method: Patients with clinical diagnosis of ischaemic stroke diagnosed, confirmed by brain Computerized Tomography scan and equal number of apparently healthy age and sex-matched were recruited. Serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) were analysed using ELISA method and Stroke severity was determined using National Institute of Health Stroke Score (NIHSS). Results: Mean serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in stroke patients were found to be higher than age sex matched control (p<0.05). NIHS Score of 12.2 ± 5.43 and 9.78 ± 3.97 were observed in Patients with elevated and normal cTnT respectively (p=0.009) while NIHS Score were similar in patients with elevated and normal CK-MB (p = 0.772). Conclusion: The mean values of serum cTnT and CK-MB were higher in acute ischaemic stroke patients compared to controls. Serum cardiac Troponin t level may be a significant biomarker of the severity of stroke.

A NATIONWIDE SURVEY OF PARKINSON DISEASE MEDICINES AVAILABILITY AND AFFORDABILITY IN NIGERIA: Parkinson disease medicines access in Nigeria

Limited access to medicines can impact negatively on outcomes in people with Parkinsons disease (PD). The study objectives were to determine the availability and assess the affordability of antiparkinsonian medications in pharmacies across Nigeria.

Metabolic syndrome in urban city of North-Western Nigeria: prevalence and determinants.

Introduction The aim of this study was to investigate the prevalence of metabolic syndrome in Sokoto metropolis of North-Western Nigeria. Methods A cross-sectional community based study was carried out. Four hundred and ten subjects (201 males and 209 females) were recruited for the study using a multi-stage sampling technique. Demographic and the life style data was obtained from the participants. Evaluation of anthropometric variables, fasting blood sugar, lipid profiles, insulin resistance and blood pressure was performed. The classification of metabolic syndrome was based on the NCEP ATP III guidelines. Results The mean (SD) age of the sample population was 39.6 (14.4) years. The mean (SD) age of the male subjects was 38.4(14.9) years and that of the females was 40.8(13.9) years (p> 0.05). The overall prevalence of metabolic syndrome was 35.1% with the females having 42.83% and the males 27.36%. The frequencies of metabolic syndrome parameters in the study subjects were low HDL (56.1%), hypertension (46.1%), dysglycemia (32.7%), central obesity (28%), and elevated triglycerides (22.4%). Most of the women had low HDL (62.2%) and central obesity elevated (49.8%). Conclusion Metabolic syndrome is common in residents of North-Western Nigeria, commoner in the females than males. Risk factors for metabolic syndrome should be detected in normal individuals for implementing effective preventive measures.

Oxidative stress among subjects with metabolic syndrome in Sokoto, North-Western Nigeria

Background: Oxidative stress is known to play a role in the pathophysiology of metabolic syndrome and its components. Racial differences may exist in the level of markers of oxidative stress and antioxidants in patients with metabolic syndrome. Aim: The aim of this study was to determine the oxidative stress and antioxidants status in subjects with metabolic syndrome in Sokoto, North-Western Nigeria. Methods: A cross-sectional community-based study was carried out. Two hundred subjects (96 males and 104 females) were recruited for the study using a multi-stage sampling technique. Demographic data were obtained from the participants. Evaluation of anthropometric variables, blood pressure, blood glucose levels, lipid profiles, plasma insulin levels, total antioxidant status, and oxidative stress markers was performed. Results: The subjects with metabolic syndrome had significantly higher malondialdehyde as compared to those without metabolic syndrome (236.4 [92.2] vs. 184 [63.2] nmol/l). The antioxidant enzymes (superoxide dismutase, glutathione peroxidase and catalase) were significantly lower in subjects with metabolic syndrome than in those without metabolic syndrome (11.3 [4.2] vs. 13.9 [4.1] U/ml, 160[42] vs. 220[32] U/ml, and 2.12 [0.2] vs. 2.42 [0.2] U/ml, respectively). Similarly, the antioxidant Vitamins (A, C, and E) levels were significantly lower in subjects with metabolic syndrome than in those without metabolic syndrome (7.1 [4.1] vs. 7.7 [4.2] μmol/L, 225 [55.3] vs. 227.6 [62.3] μmol/L, and 75.9 [13.9] vs. 82.8 [18.6] mg/dl, respectively). There was a positive correlation between components of metabolic syndrome and free radicals. Conclusion: Significantly increased oxidative stress and diminished antioxidant defenses were found among Nigerians with metabolic syndrome.