Selfmonitoring of blood glucose practices by people living with diabetes who use their personal glucometers in Port Harcourt, Niger Delta Region, Nigeria

Self-monitoring of blood glucose (SMBG) assists persons living with diabetes with the day-to-day behavioral and therapeutic adjustments to their diabetes care. It is a cheaper and more available alternative to glycated haemoglobin (HbA1c) in Nigeria for monitoring glycaemic control. Information on SMBG practices of Nigerians living with diabetes using their personal glucometers is scanty. The aim of the study is to assess the intensity and frequency of SMBG by glucometer owners, and the extent the patients and/or the health care providers (HCP) utilize SMBG to achieve personalized treatment goals via behavioral/treatment adjustments. This was a cross sectional study carried out among persons living with diabetes that accessed diabetes care at the diabetes clinic of the University of Port Harcourt Teaching Hospital (UPTH) and using their personal glucometers. They were consecutively recruited. Data obtained by using intervieweradministered questionnaires were analyzed using SPSS version 20.0, and pvalue <0.05 was considered significant. A total of 128 persons living with diabetes participated in the study of which 40 (31%) were males and 88 (69%) were females; the mean age of the subjects was 52.05 ± 11.24 years with a range of 26–70 years. The majority of the study subjects (72%) were in the active working age group (25–60years). The highest frequency of glucometer use was in the 26 subjects (20%) who checked their blood glucose every morning while 62 (48%) of the subjects checked their blood glucose any morning they felt like. Most of the subjects (60%) did not have any recording device. Glucometer owners were not just the insulin-requiring people living with diabetes as more than half of the subjects, 66 (52%) were on oral anti diabetic drugs (OAD) only. Glucometer ownership was mainly by those that were in the working age group. SMBG protocol (frequency) was variable and SMBG data were not maximally utilized.Keywords: Self-monitoring of blood glucose; Personal glucometer; Diabetes; Blood glucos

Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis.

INTRODUCTION: HIV-associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub-Saharan Africa (SSA). We performed a systematic review and meta-analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings. METHODS: We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized-controlled trials (RCTs) or investigator-managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short-term (in-hospital or two weeks), medium-term (up to 10 weeks) and long-term (up to six months). RESULTS AND DISCUSSION: Seventy-nine studies met inclusion criteria. In routine care settings, pooled short-term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole-based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short-term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short-term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized-controlled trials. Few studies evaluated long-term outcomes. CONCLUSIONS: Mortality rates from HIV-associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV-associated meningitis in the region

Reliability and Diagnostic Performance of CT Imaging Criteria in the Diagnosis of Tuberculous Meningitis

The original publication is available at http:// www.plosone.orgPublication of this article was funded by the Stellenbosch University Open Access Fund.Introduction: Abnormalities on CT imaging may contribute to the diagnosis of tuberculous meningitis (TBM). Recently, an expert consensus case definition (CCD) and set of imaging criteria for diagnosing basal meningeal enhancement (BME) have been proposed. This study aimed to evaluate the sensitivity, specificity and reliability of these in a prospective cohort of adult meningitis patients. Methods: Initial diagnoses were based on the CCD, classifying patients into: ‘Definite TBM’ (microbiological confirmation), ‘Probable TBM’ (diagnostic score $10), ‘Possible TBM’ (diagnostic score 6–9), ‘Not TBM’ (confirmation of an alternative diagnosis) or ‘Uncertain’ (diagnostic score of ,6). CT images were evaluated independently on two occasions by four experienced reviewers. Intra-rater and inter-rater agreement were calculated using the kappa statistic. Sensitivities and specificities were calculated using both ‘Definite TBM’ and either ‘Definite TBM’ or ‘Probable TBM’ as gold standards. Results: CT scan criteria for BME had good intra-rater agreement (k range 0.35–0.78) and fair to moderate inter-rater agreement (k range 0.20–0.52). Intra- and inter-rater agreement on the CCD components were good to fair (k = ranges 0.47–0.81 and 0.21–0.63). Using ‘Definite TBM’ as a gold standard, the criteria for BME were very specific (61.5%–100%), but insensitive (5.9%–29.4%). Similarly, the imaging components of the CCD were highly specific (69.2–100%) but lacked sensitivity (0–56.7%). Similar values were found when using ‘Definite TBM’ or ‘Probable TBM’ as a gold standard. Discussion: The fair to moderate inter-rater agreement and poor sensitivities of the criteria for BME suggest that little reliance should be placed in these features in isolation. While the presence of the CCD criteria of acute infarction or tuberculoma(s) appears useful as rule-in criteria, their absence is of little help in excluding TBM. The CCD and criteria for BME, as well as any new criteria, need to be standardized and validated in prospective cohort studies.Funding: KB received funding from the Discovery Foundation (Academic Fellowship Award; http://www.discovery.co.za/portal/loggedout-individual/discoverycommunity- about), College of Neurology of South Africa (K.M. Browse Award; http://www.collegemedsa.ac.za/Default.aspx ) and the University of Stellenbosch. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Publisher's versio

Top ten disease seen at the children\'s out patient clinic of a young Nigerian Teaching Hospital: the ABSUTH experience

No Abstract.JOMIP Vol. 5 2004: pp. 4-

Breaking the intergenerational transmission of poverty through good nutrition

No Abstrac

Patterns Of Morbidity Requiring Admission Into The Children's Ward Of Abia State University Teaching Hospital Aba

To determine the pattern of morbidity in patients admitted into the paediatric wards of Abia State University Teaching Hospital Aba. The study showed that most of those admitted were less than five years of age but more than 1 year old 40.5%. This is followed by infants more than 1 month of age 24.8% and neonates contributing 12.6% of admission into the ward. The study also revealed a high incidence of malaria and its complications 39.7%. Acute respiratory infections contributed 12.7% of ailments leading to admission while neonate's disorders yielded 11.8%. Those admitted for Diarrhoeal disorders made up 89% while those for surgery were 7.2%. Patients admitted following Accidents and Trauma yielded 5.1%. A call is therefore being made for better health education campaign to reduce these preventable causes for admission. Families should be enlightened on ways to prevent home accidents by way of housing modification and supervision of very young children during play. This will prevent the rising trend of accidents as a cause of admission in our crowded cities. Journal of Medical Investigation and Practice Vol. 4: 2003: 23-2

Neurologic infections in a Nigerian university teaching hospital

BACKGROUND: Neurologic infections are an important cause of morbidity and mortality especially worldwide but much more in the African continent. The frequency of the different types of neurologic infections and their mortality in this part of Nigeria is not known. OBJECTIVES: To review cases admitted into the main tertiary referral center in Rivers State of Nigeria with neurologic infections over a 10-year period and to determine the types of infections, their frequency and the mortality METHODS: Case notes of all admissions into the medical wards of UPTH, Port Harcourt between April 1993 and March 2003 were reviewed. Cases admitted with neurologic infections were extracted and analyzed for the study. RESULTS: Of the 1395 patients admitted with neurologic disorders during the study period, 311 (22.3%) had neurological infections. The M:F ratio and mean age of patients with neurolgic infections were 1.7:1 and 34.1 years respectively. The most common infections identified were meningitis 136(43.7%), tetanus 90(28.9%), Pott's disease with cord compression 30(9.6%), viral meningoencephalitis 27(8.7%) and tuberculous meningitis (TBM) 19(6.1%). The case fatality was high: meningitis 49.3%, tetanus 47.8%, Pott's disease23.3%, meningoencephalitis 44.4% and TBM 68.4% CONCLUSIONS: Preventable neurologic infections are a very important cause of morbidity and mortality in this environment. Cases presenting with suspicious neurologic infections should be referred to centers where specialized care can be institute

Non accidental, non surgical trauma in childhood-the Southern Nigeria experience

No Abstract.ABSUMSAJ Vol. 3 (1) 2006: pp.42-4

LES MALADIES NEUROLOGIQUES OBSERVEES EN HOSPITALISATION, SUR UNE PERIODE DE 10 ANS DANS LA REGION DU DELTA AU NIGERIA NEUROLOGIC ADMISSIONS IN THE NIGER DELTA AREA OF NIGERIA – A TEN YEAR REVIEW (English)

Background: The Niger-delta area of Nigeria constitutes about 20% of the population of the nation. The pattern of neurologic diseases in this area is not known. Objective: The study was undertaken to determine the pattern of these diseases, compare this with those elsewhere and to have a baseline for future studies. Methods: The medical records of all cases admitted with neurologic diseases in the University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt between April 1993 and March 2003 were retrospectively reviewed and the frequency of neurologic diseases, sex, age and outcome of these diseases analyzed. Results: Neurologic diseases constituted 1.5% and 33.1% of hospital and medical admissions respectively with M: F ratio of 1.4:1 and mean age of 52.6 years. The five topmost diseases were stroke (61.6%), meningitis and encephalitis (13.4%), tetanus (6.5%), spinal cord diseases (6.5%) and epilepsy (3.8%). Apart from stroke, the others were commoner in the young. Other neurologic diseases were rare causes of neurologic admissions. Neurologic deaths constituted 3.7% and 28.9% of hospital and medical deaths respectively. The common causes of neurologic deaths were stroke (65%), meningitis and encephalitis (18.7%) and tetanus (8.5%). Conclusions: Neurologic diseases are common in this part and have a similar pattern as in other parts of southern Nigeria. Stroke and CNS infections are a major cause of morbidity and mortality. This finding makes the establishment of regional stroke units; improvement of the sanitary conditions of the home and environment, widespread use of immunizations for those at risk a matter of urgent healthcare priority. Keywords: Africa, Epidemiology, Neurologic disease, Neurology, Nigeria, Stroke units, Afrique, maladies neurologiques, Nigéria, unité d\'urgence neuro-vasculaire, épidémiologie RESUME Introduction: Le Delta du Niger constitue environ 20 % environ de la population du Nigeria, et le profil des affections neurologiques de cette région n\'est pas connu. Objectif: L\'étude présentée a pour but de déterminer les aspects de ces maladies neurologiques en les comparant avec celles menées par d\'autres équipes. Le travail servira de base pour mener d\'autres études ultérieures. Méthode: Les données médicales de tous les cas admis à l\'université de Port Harcourt entre avril 1993 et mars 2003 ont été examinées rétrospectivement à partir des dossiers d\'hospitalisation. La fréquence de maladie neurologique, le sexe, l\'âge et l\'évolution ont été analysés. Résultats: Les maladies neurologiques représentent 1,5 % et 33,1 % des admissions respectivement en hospitalisation et sur l\'ensemble de la pathologie médicale. Le ratio homme / femme est de 1,4: 1 avec une moyenne d\'âge de 52,6 ans. Les cinq maladies les plus fréquemment observées ont été: les accidents vasculaires cérébraux (61,6 %, les méningites et encéphalites (13,4 %) le tétanos (6,5 %), les maladies de la moelle épinière (6,5 %) et les épilepsies (3,8 %). En dehors des accidents vasculaires cérébraux, ces affections sont communes aux jeunes. Les autres affections neurologiques sont rares. Les décès imputables à la pathologie neurologique représentaient 3,7 % et 28,9 %, respectivement au niveau hospitalier et au plan médical. La cause de décès la plus importante a été les accidents vasculaires cérébraux suivis des méningites et encéphalites (18,7 %) et tétanos (8,5 %) Conclusion: Les affections neurologiques habituellement rencontrées ont un aspect similaire à celles observées dans le sud du Nigéria. Les AVC et les affections du système nerveux sont les principales causes de morbidité et de mortalité. Ces données impliquent la mise en place d\'unités régionales d\'AVC de même que l\'amélioration des conditions sanitaires de l\'environnement et de l\'habitat et l\'élargissement des vaccinations. Mots-clefs: Afrique, maladies neurologiques, Nigéria, unité d\'urgence neuro-vasculaire, épidémiologie. Af. Jnl. Neurological Sci Vol.23(1) 200

Phaeochromocytoma and reversible myocardial ischaemia in a 23-year old female

Background: Phaeochromocytoma is a rare neuroendocrine tumour with highly variable clinical presentation including serious and potentially lethal cardiovascular complications. Aim: To present a case of myocardial ischaemia in Phaeochromocytoma which was reversed after surgery. Setting: University of Port Harcourt Teaching Hospital (UPTH). Case report: A young female undergraduate aged 23 years presented with recurrent blackouts, paroxysmal hypertension which was resistant to several anti- hypertensive drugs and marked postural drop was referred from a private clinic to UPTH. Rest electrocardiogram (ECG) showed ischaemic changes and right axis deviation. Ultrasound scan and computerised tomographic (CT) scan showed a mass on the anteromedial portion of the left kidney with centrally located cystic areas. The 24-hour urine level of vanillyl mandelic acid (VMA) was normal. The tumour was excised by open surgery and histopathological findings confirmed Phaeochromocytoma. The ECG changes reversed after surgical excision. There was no recurrence or metastasis postoperatively after a long term follow up of 5 years. Her blood pressure remained normal postoperatively without taking antihypertensive medication. Conclusion: Phaeochromocytoma is a catecholamine secreting neuroendocrine tumour with a high cardiovascular morbidity and mortality. ECG features of myocardial ischaemia can be reversed by surgical intervention. Keywords: Phaeochromocytoma, Reversible myocardial ischaemia, Surgical interventionPort Harcourt Medical Journal Vol. 2 (3) 2008: pp. 263-26