Hyponatraemia during Low-Dose Carbamazepine Therapy

We report the syndrome of inappropriate antidiuresis as a much earlier side-effect of carbamazepine administration in a 29-year Nigerian female patient with generalized tonic-clonic seizures. Although asymptomatic, the biochemical abnormality improved after discontinuation of carbamazepine.Hyponatraemia developed after rechallenge with controlled release carbamazepine. The authors suggest that serum sodium levels be carried out before commencement of carbamazepine and caution be used inprescribing carbamazepine to patients with low or borderline low sodium value

Smokeless tobacco use in adult Nigerian population

The study aim was to establish the prevalence and determinants of smokeless tobacco use in Nigerian adults' population.Across-sectional survey of 1776 adults inYola, North-East Nigeria was carried out in June 2007.A modified World Health Organization (WHO) tobacco survey questionnaire was used for interview and datacollection. Out of 1776 interviewed respondents, 133 (7.49%) were user of smokeless tobacco. Snuffing of tobacco powder was the most common method of using smokeless tobacco (6.8%). Fifteen (0.9%) chewedtobacco while only 2(0.1%) both chewed and snuffed tobacco. Social acceptance (21.8%) was the major reason for using smokeless tobacco. Males, 5th and 6th decades of life, poor education, lower socioeconomic class, Margi, Hausa and Fulani tribes were the determinants of smokeless tobacco use.About 89.5% of the smokeless tobacco users believed that smokeless tobacco was not harmful to their health. : Although the prevalence of smokeless tobacco use was low among Nigerian adult population in this study. Ignorance of the potential health dangers of smokeless tobacco was rampant therefore; concerted efforts should be made to discourage the use of all forms of tobacco rather than concentrating on cigarette smoking

Comparison of Two Hospital Stroke Scores with Computerized Tomography in Ascertaining Stroke Type Among Nigerians

Background: Stroke, a major cause of morbidity and mortality is on the increase in Nigeria, routine Computerized Tomography (CT) for all Nigerians with stroke is not available to most doctors, and this poses management problems. We compared two available clinical scores with brain CT for the differential diagnosis of cerebral ischemia and hemorrhage among adult Nigerians with first-ever acute stroke. Methods: The study was conducted at the State Specialist Hospital Maiduguri. Ninety-five adult Nigerians presenting with first-ever acute stroke onset within 48 hours were evaluated with the Siriraj Hospital Stroke (SHS) score on presentation and the Guy's Hospital Stroke (GHS) score 24 hours after admission. CT brain scan was considered as gold standard. These two stroke scores were compared with the results of CT brain and sensitivity, specificity; positive predictive and negative values were calculated. Results: Applying the recommended optimum cut-off points for the 2 scores, diagnoses were classified by the Guy's Hospital Stroke and Siriraj Hospital Stroke score as probable hemorrhagic strokes (49% and 25% respectively) and probable ischemic (40% and 65% respectively). The remainder were classified as "uncertain." The prevalence of hemorrhage diagnosed by gold standard (CT) was 29.5% while the prevalence of ischemic stroke diagnosed by CT was 54.7%. The CT brain was normal in 15.8%. Sensitivity, specificity, positive predictive value and negative predictive value for cerebral hemorrhage was 0.64, 0.48, 0.4 and 0.71 for Guy's Hospital Stroke score and 0.35, 0.73, 0.4 and 0.68 for Siriraj Hospital Stroke score. Conclusion: It is evident from the study that these clinical scoring systems alone are not sufficient and one has to employ the use of computerized tomography scan in establishing stroke type in Nigerians with stroke.Fond: La course, une cause importante de la morbidit\ue9 et la mortalit\ue9 est en augmentation du Nig\ue9ria, la tomographie automatis\ue9e par routine (CT) pour tous les nig\ue9riens avec la course n'est pas \ue0 la disposition de la plupart des m\ue9decins, et ceci pose des probl\ue8mes de gestion. Nous avons compar\ue9 deux points cliniques disponibles au cerveau CT pour le diagnostic diff\ue9rentiel de l'isch\ue9mie et de l'h\ue9morragie c\ue9r\ue9brales parmi des nig\ue9riens d'adulte avec la premi\ue8re course aigu\ueb. M\ue9thodes: L'\ue9tude a \ue9t\ue9 entreprise \ue0 l'h\uf4pital Maiduguri de sp\ue9cialiste en \ue9tat. Quatre-vingt-quinze nig\ue9riens d'adulte se pr\ue9sentant avec le premier d\ue9but aigu de course dans un d\ue9lai de 48 heures ont \ue9t\ue9 \ue9valu\ue9s avec les points de la course d'h\uf4pital de Siriraj (SHS) sur la pr\ue9sentation et les points de la course de l'h\uf4pital du type (GHS) 24 heures apr\ue8s admission. Le balayage de cerveau de CT a \ue9t\ue9 consid\ue9r\ue9 comme \ue9talon or or. Ces points de deux courses ont \ue9t\ue9 compar\ue9s aux r\ue9sultats du cerveau de CT et de la sensibilit\ue9, sp\ue9cificit\ue9 ; des valeurs pr\ue9dictives et n\ue9gatives positives ont \ue9t\ue9 calcul\ue9es. R\ue9sultats: Appliquant les points optima recommand\ue9s de coupure pour les 2 points, des diagnostics ont \ue9t\ue9 classifi\ue9s par les points de course de l'h\uf4pital du type et de course d'h\uf4pital de Siriraj en tant que les courses h\ue9morragiques probables (49% et 25% respectivement) et isch\ue9mique probable (40% et 65% respectivement). Le reste ont \ue9t\ue9 classifi\ue9s comme \uab incertain. \ubb La pr\ue9dominance de l'h\ue9morragie diagnostiqu\ue9e par l'\ue9talon or or (CT) \ue9tait 29.5% tandis que la pr\ue9dominance de la course isch\ue9mique diagnostiqu\ue9e par CT \ue9tait 54.7%. Le cerveau de CT \ue9tait normal dans 15.8%. La sensibilit\ue9, la sp\ue9cificit\ue9, la valeur pr\ue9dictive positive et la valeur pr\ue9dictive n\ue9gative pour l'h\ue9morragie c\ue9r\ue9brale \ue9taient 0.64, 0.48, 0.4 et 0.71 pour les points de course de l'h\uf4pital du type et 0.35, 0.73, 0.4 et 0.68 pour des points de course d'h\uf4pital de Siriraj. Conclusion: Il est \ue9vident de l'\ue9tude que ces seuls syst\ue8mes de notation cliniques ne sont pas suffisants et on doit utiliser l'utilisation du balayage automatis\ue9 de tomographie en \ue9tablissant la course saisissent des nig\ue9riens avec la course

Delirium: Issues in diagnosis and management

Delirium is a disturbance of consciousness, cognition and perception that occurs frequently in medically ill patients. Although it is associated with increased morbidity and mortality, it is often not recognized and treated by physicians. Literature searches were conducted using MEDLINE with the following keywords/ phrases: delirium, acute confusion and management. Additional articles identified by hand-searching in major journals of medicine and psychiatry, and a review of references cited within these sources supplemented the search. In this article, the available published literature regarding the diagnosis, prevention and treatment of delirium is systematically reviewed. Prevention and treatment strategies do not need to be complex or expensive but require well-coordinated interventions from multiple disciplines, including nursing, psychiatry, neurology and primary care, as well as the cooperation and significant effort of family and friends. Atypical antipsychotic agents offer some advantages over haloperidol and in a limited number of studies appear safe and effective for delirium.D\ue9lire est une perturbation. de conscience, cognition et de perception qui se produit fr\ue9quemment en m\ue9dicalement malades. M\ueame s\u2019il est associ\ue9 \ue0 une augmentation de la morbidit\ue9 et mortalit\ue9, Il est souvent pas reconnus et trait\ue9 par les m\ue9decins. Litt\ue9rature recherches ont \ue9t\ue9 effectu\ue9es en utilisant MEDLINE avec les mots cles/phrases suivantes: d\ue9lire, confusion aigue, et de Gestion. Articles suppl\ue9mentaires identifi \ue9 \ue0 la main dans les grandes feuilles de m\ue9decine et de psychiatrie, la recherche et d\u2019un examen des r\ue9f\ue9rences cit\ue9es dans ces sources compl\ue9t\ue9 la recherche. Dans cet article, le disponible publi\ue9 litt\ue9rature concernant le diagnostic, la pr\ue9vention et traitement de d\ue9lire est syst\ue9matiquement examin\ue9. La pr\ue9vention et strat\ue9gies de traitement ne doivent pas \ueatre complexes ou on\ue9reux mais n\ue9cessite interventions bien coordonn\ue9es de plusieurs disciplines, y compris les soins infi rmiers, psychiatrie, neurologie et de soins primaires, ainsi que la coop\ue9ration et effort important de la famille et amis. Agents antipsychotiques atypiques offre certains avantages sur Halop\ue9ridol et dans un nombre limit\ue9 d\u2019\ue9tudes s\u2019affi chent sans danger effi cace et de d\ue9lire

Unmet needs in asthma treatment in a resource-limited setting: Findings from the survey of adult asthma patients and their physicians in Nigeria

Introduction: The prevalence of asthma in our society is rising and there is need for better understanding of the asthma patients’ perception andtreatment practice of physicians. The study was aimed at determining asthma attitudes and treatment practices among adult physicians andpatients in Nigeria, with the goal of identifying barriers to optimal management.Methods: To assess asthma attitudes, treatment practices and limitations among adult physicians and patients in Nigeria, a questionnaire survey was conducted among 150 patients and 70 physicians.Results: Majority (66.7%) of the patients reported their asthma as  moderate to severe, 42.7% had emergency room visit and 32% had admission due to asthma in the previous 12 months. Physicians and patients perceptions significantly differed in the time devoted to  educational issues (31.4% vs.18.7%) and its contents: individual  management plan (64.3% vs.33.3%), correct inhaler technique (84.0% vs.71.0%), medication side effects (80.0% vs.60.0 %) and compliance 100% of time (5.7% vs. 18.7%). Patients reported that non-compliance with medication causes increased symptoms (67.0%), exacerbations (60.0%), bronchodilator use (56.0%), urgent physician visit (52.0%) and hospitalizations /ER visits (38.7%). Asthma medication in patients caused short term (10.7%) and long term side effects (20.0%). Due to side  effects, 28.0% skipped and stopped their medications. Most physicians (85.7%) and patients (56.0%) agreed on the need for new medication options. The need for new medication in patients was strongly related to asthma severity, limitation of activities, side effects, cost and lack of satisfaction with current medication. With the exception of pulmonologists, physicians did not readily prescribe ICS and their prescriptions were not in line with treatment guidelines.Conclusion: This study has highlighted the gaps and barriers to asthma treatment which need to be addressed to improve the quality of care in Nigeria

Hepatitis C virus infection in Nigerians with diabetes mellitus

ABSTRACT It has been reported from several Caucasian studies that there is an epidemiological association between hepatitis c virus infection and diabetes mellitus. The objective of this study was to determine whether any such relationship exists in a black African population. To determine the prevalence of Hepatitis C virus infection in Nigerians with diabetes mellitus in North-Eastern Nigeria. Hospital -based cross-sectional study. Medical out-patient clinic and the Blood bank of the Federal Medical Centre, Yola. Nigeria. From June, 2008 to December 2009, Two hundred and eighty consecutively recruited diabetes mellitus patients comprising 108 males and 172 females were screened for HCV infection. These were compared with five hundred and ninetyfive voluntary blood donors who were screened during the same period. Serological testing for HCV infection was carried out with anti-HCV using Enzyme Linked Immuno-sorbent Assay (ELISA) method. The bio-data of the patients, history and duration of diabetes mellitus, history of jaundice, blood transfusion were recorded on a proforma. Out of the 280 diabetes mellitus patients tested, twenty-six were positive for anti-HCV antibodies giving an infection rate of 9.3% compared with fourteen subjects out of 595 voluntary blood donors 2.4% (p=0.0000105). History of blood transfusion, and jaundice was positively correlated with presence of HCV infection in diabetic patients. Hepatitis C virus is more common in Nigerian patients with diabetes mellitus than in non-diabetic control subjects. It may be necessary to screen patients with diabetes mellitus for hepatitis c virus infection particularly those with history of blood transfusion and jaundice

Stroke scores and CT scan in ascertaining type of stroke.

Background: Stroke, a major cause of morbidity and mortality is on the increase in Nigeria, routine Computerized Tomography (CT) for all Nigerians with stroke is not available to most doctors, and this poses management problems. We compared two available clinical scores with brain CT for the differential diagnosis of cerebral ischemia and hemorrhage among adult Nigerians with first-ever acute stroke.Methods: The study was conducted at the State Specialist Hospital Maiduguri. Ninety-five adult Nigerians presenting with first-ever acute stroke onset within 48 hours were evaluated with the Siriraj Hospital Stroke (SHS) score on presentation and the Guy’s Hospital Stroke (GHS) score 24 hours after admission. CT brain scan was considered as gold standard. These two stroke scores were compared with the results of CT brain and sensitivity, specificity; positive predictive and negative values werecalculated. Results: Applying the recommended optimum cut-off points for the 2 scores, diagnoses were classified by the Guy’s Hospital Stroke and Siriraj Hospital Stroke score as probable hemorrhagic strokes (49% and25% respectively) and probable ischemic (40% and 65% respectively). The remainder were classified as “uncertain.” The prevalence of hemorrhage diagnosed by gold standard (CT) was 29.5% while the prevalence of ischemic stroke diagnosed by CT was 54.7%. The CT brain was normal in 15.8%. Sensitivity, specificity, positive predictive value and negative predictive value for cerebral hemorrhage was 0.64, 0.48, 0.4 and 0.71 for Guy’s Hospital Stroke score and 0.35, 0.73, 0.4 and 0.68 for SirirajHospital Stroke score. Conclusion: It is evident from the study that these clinical scoring systems alone are not sufficient and one has to employ the use of computerized tomography scan in establishing stroke type in Nigerians with stroke

Delirium: Issues in diagnosis and management

Delirium is a disturbance of consciousness, cognition and perception that occurs frequently in medically ill patients. Although it is associated with increased morbidity and mortality, it is often not recognized and treated by physicians. Literature searches were conducted using MEDLINE with the following keywords/ phrases: delirium, acute confusion and management. Additional articles identified by hand-searching in major journals of medicine and psychiatry, and a review of references cited within these sources supplemented the search. In this article, the available published literature regarding the diagnosis, prevention and treatment of delirium is systematically reviewed. Prevention and treatment strategies do not need to be complex or expensive but require well-coordinated interventions from multiple disciplines, including nursing, psychiatry, neurology and primary care, as well as the cooperation and significant effort of family and friends. Atypical antipsychotic agents offer some advantages over haloperidol and in a limited number of studies appear safe and effective for delirium

Non-Motor Symptoms of Parkinson's Disease: Diagnosis and Management

Non-motor symptoms (NMS) of Parkinson's disease (PD) are a key determinant of health, quality of life (QoL) and societal cost of PD. They are often less appreciated than motor symptoms but are importantsources of disability for manyPDpatients. Literature search was performed using the reference databases Medline, Science Citation Index andEMBASE. The keywords used were 'non-motor symptoms', Parkinson's disease, olfaction and constipation. Papers discovered by this search werereviewed, as were references cited therein. Contrary to common perception, many NMS of PD occur early in PD and some may even predate thediagnosis of PD that is based on motor signs. These include olfactory deficit, sleep problems such as rapid eye movement behaviour disorder, constipation and the more recently described male erectile dysfunction.There is compelling evidence that nonmotor symptoms of PD play a dominant role in the QoL and disability of PD patients and the QoLof their 'informal' carers. Effective clinical management of PD thereforedemands that these symptoms be identified and to the extent possible treated.Keywords: Non motor symptoms, Parkinson's disease, Non motor questionnaire, Constipation, Olfaction, male erectile dysfunctio

Neurologic Manifestations of Liver Disease

Neurologic symptoms can be observed in patients with either acute or chronic liver failure. This review describes the clinical features of hepatic encephalopathy (HE) associated with acute liver failure or liver cirrhosis,diagnostic approaches, and current therapeutic concepts. A striking feature of HE is the reversibility of symptoms. In addition, it gives a short overview of current knowledge about hepatitis C virus (HCV) infection-associatedcognitive declin