Stroke mortality and its predictors in a Nigerian teaching hospital

Background: Stroke is the third leading cause of death worldwide. Stroke mortality has been noted to be higher in blacks in biracial studies. There have been few studies on stroke mortality and its predictors in Nigeria. This study examines mortality of stroke and its predictors in a Northern Nigerian teaching hospital.Methods: This was a prospective study that was carried out at Jos University Teaching Hospital in Nigeria. One hundred and twenty stroke patients admitted into the medical wards within one year were assessed. Demographic data was recorded. Patients were examined and ancillary investigations were carried out. The deaths and predictors were recorded. Multivariate logistic regression was used to identify independent predictors of mortality.Results: There were one hundred and twenty participants. Forty two (35%), patients died. Most (76.2%) deaths occurred within the first week. Predictors of mortality on univariate analysis were age ≥ 60 years, male sex, loss of consciousness, high NIHSS score (≥16), the presence of co-morbid conditions and presence of complications. On multivariate analysis, the predictors of mortality were the presence of co-morbid conditions, GCS<10 and high NIHSS score.Conclusion: Stroke mortality was quite high in this study. Predictors of mortality were the indices of severity and the presence of co-morbid conditions.Key Words: Co-morbid conditions, Level of consciousness, Mortality, National Institute of Health Stroke Scale (NIHSS score), Predictors, Strok

The Pattern and Outcome of Chest Injuries in South West Nigeria

Objective: The pattern and management outcome of chest injuriespresenting to our tertiary university hospital located in a semi-urbanpopulation in the South West of Nigeria, has not been documentedpreviously. We therefore sought to identify factors that may contributeto mortality.Method: We analyzed 114 patients presenting to the Accident andEmergency Unit with chest trauma, prospectively entered into a database over a two year period.Results: Chest trauma accounted for 6% of all trauma admissionswith a male preponderance (M:F = 3.6:1). Rib fractures were the mostcommon injury (46.3%) while limb fractures were the most commonassociated injury (35.8%). Associated head injury accounted for mostdeaths (56%) in those with severe ISS. Majority of patients (51.8%)required only analgesics, while additional closed tube thoracostomydrainage was necessary (41.8%) in the others who suffered blunttrauma. Thoracotomy was indicated for only 5 (4.5%) penetratinginjuries. There is a rising trend towards penetrating gunshot injuries,with mortality increasing with age (p=0.03) and severity of associatedinjuries (ISS) (p=0.003).Conclusion: Majority of the patients required only minimal interventionwith chest drainage or analgesics, with low mortality. Increasingage and severity of injury contributed significantly to mortality. Initiationof care for chest trauma victims is still delayed in our centre

Recurrence of Malignant Pleural Effusion Following Pleurodesis: Is There a Difference Between Use of Povidone-Iodine or Cyclophosphamide?

Background: Malignant pleural effusion is associated with poor quality of life. The success of pleurodesis varies with different agents, with talc being the most effective. It is however not available in Nigeria. This study aimed to determine the efficacy of povidone iodine and cyclophosphamide, the two commonly available agents for pleurodesisMethods: A prospective simple randomized enrollment of consecutive patients with malignant pleural effusion over a five year period (2008- 2012).Results: Thirty four patients were analyzed with a M:F ratio of 1:2.4. Breast cancer was responsible for almost half (47.1%) of the effusions. Although the povidone iodine group was slightly younger both groups were similar. There was no difference in the effusion recurrence for both groups. Age, duration of symptoms and cancer type were not predictors of recurrence of effusion following pleurodesis.Conclusions: Both agents are readily available and perform well with minimal side effects. However, povidone iodine being cheaper may be a more affordable alternative.Key Words: Malignant effusion, Pleurodesis, Povidone-iodine, Cyclophosphamid

Predictors of in-hospital mortality among stroke patients in Uyo, Nigeria

Background: Stroke is the third leading cause of death in most industrialized countries. Several reports indicate that it is also becoming a major cause of morbidity and mortality in Nigeria and other developing countries.Aim: To identify risk factors and predictors of in-hospital mortality among patients admitted for stroke in a tertiary health institution in Nigeria.Methods: Case records of all patients admitted for stroke in the University of Uyo Teaching Hospital from January 2004 to December 2008 were retrieved and relevant data extracted and analysed.  The diagnosis of stroke was made on clinical grounds only.Results: Three hundred and seven patients with stroke were admitted during the study period. The mean ages were 58.3± 10 years and 58.4± 11.4 years for males and females respectively (p>0.05) indicating that stroke occurred in the sixth decade in both sexes. Systemic hypertension was the commonest risk factor .The overall in- hospital mortality was 24(7.8%) with majority of the mortality [22(7.2%)] occurring within the first seven days of admission. The duration of hospital stay did not influence mortality (p >0.05).Only the female gender and increasing pulse rate were identified as predictors of in hospital mortality (p <0.05).Conclusion: Most deaths from stroke occur in the first seven days of admission when proper intensive care is critical. The predictors of in-hospital mortality identified in this study add to the previously identified ones and should all be kept in view when managing these patients. The need for the establishment of stroke units especially in our tertiary health institutions is advocated. Keywords:  Stroke, Predictors, In-hospital mortality, Nigeri

Diagnostic utility of alpha‑fetoprotein and des‑gamma‑carboxyprothrombin in Nigerians with hepatocellular carcinoma

Background: Alpha-fetoprotein (AFP) and Des-gamma-carboxyprothrombin (DCP) have been extensively studied as biomarkers for the diagnosis of and prognostication in hepatocellular carcinoma (HCC). However there are only few reports on the clinical characteristics of hepatocellular carcinoma in relation to the combination of the two tumor markers in hepatitis B virus-related HCC.Aim: The aim of this study was to investigate the clinical characteristics of  HBVrelated HCC in relation to different sets of AFP and DCP values.Methods: Sixty two patients with untreated HCC were studied. The positive value of AFP was set at 20 1U/L while DCP positive value was set at 150 mAU/ml. Patients were divided into three groups: Group 1(n=36) with AFP ≥ 20 IU/L and DCP ≥ 150 mAU/ml. Group 2(n=24) with AFP <20 1U/L and DCP ≥ 150 mAU/ml. Group 3 (n=2) with AFP < 20 1U/L and DCP < 150 mAU/ml. There were no patients in group 4 meant for those with AFP ≥ 20 1U/L and DCP < 150 mAU/ml. Clinical and  laboratory variables were compared among the groups. Results: Clinical and laboratory variables were comparable among the groups with the exception of gender and values of serum alanine aminotransferase (ALT). Males were significantly more than females among the groups (p<0.03). ALT values were significantly different among the groups (p<0.006). Paired comparisons between the groups showed the mean values of serum ALT were significantly higher in group 2 than in group 1(p<0.003). The mean serum ALT values were also higher in group 2 than in group 3 (p <0.014). There was no significant difference between group 1 and group 3 (P = 0.124).Conclusion: HCC patients who are sero-positive for DCP and seronegative for AFP have significantly higher levels of serum ALT; serum ALT levels may be of diagnostic importance in AFP-negative, HBV-related HCC patients.Keywords: Alanine aminotransferase, alpha‑fetoprotein,  des‑gamma‑carboxyprothrombin, hepatitis B virus, hepatocellular carcinom

Ectopic Thoracic Kidney and End-Stage Renal Disease in a 38-Year-Old Nigerian

This patient is a 38-year-old housewife who presented with a one-month history of difficulty, in breathing, chest pain and bilateral leg swelling and had a blood pressure of 260/150 mmHg, features of malignant hypertension and hypertensive heart disease. Chest CT scan revealed a chest location of the left kidney. She also had elevated serum urea and creatinine and proteinuria (++). The right kidney was normally located with loss of corticomedullary differentiation. She is on maintenance haemodialysis and is being worked up for possible left nephrectomy

Diagnostic Utility of Alpha‑fetoprotein and Des‑gamma‑carboxyprothrombin in Nigerians with Hepatocellular Carcinoma

Background: Alpha-fetoprotein (AFP) and Des-gamma-carboxyprothrombin (DCP) have been extensively studied as biomarkers for the diagnosis of and prognostication in hepatocellular carcinoma (HCC). However there are only few reports on the clinical characteristics of hepatocellular carcinoma in relation to the combination of the two tumor markers in hepatitis B virus-related HCC. Aim: The aim of this study was to investigate the clinical characteristics of HBVrelated HCC in relation to different sets of AFP and DCP values. Methods: Sixtytwo patients with untreated HCC were studied. The positive value of AFP was set at 20 1U/L while DCP positive value was set at 150 mAU/ml. Patients were divided into three groups: Group 1(n=36) with AFP ≥ 20 IU/L and DCP ≥ 150 mAU/ml. Group 2(n=24) with AFP <20 1U/L and DCP ≥ 150 mAU/ml. Group 3 (n=2) with AFP < 20 1U/L and DCP < 150 mAU/ml. There were no patients in group 4 meant for those with AFP ≥ 20 1U/L and DCP < 150 mAU/ml. Clinical and laboratory variables were compared among the groups. Results: Clinical and laboratory variables were comparable among the groups with the exception of gender and values of serum alanine aminotransferase (ALT). Males were significantly more than females among the groups (p<0.03). ALT values were significantly different among the groups (p<0.006). Paired comparisons between the groups showed the mean values of serum ALT were significantly higher in group 2 than in group 1(p<0.003). The mean serum ALT values were also higher in group 2 than in group 3 (p <0.014). There was no significant difference between group 1 and group 3 (P = 0.124). Conclusion: HCC patients who are sero-positive for DCP and seronegative for AFP have significantly higher levels of serum ALT; serum ALT levels may be of diagnostic importance in AFP-negative, HBV-related HCC patients.Keywords: Alanine aminotransferase, alpha‑fetoprotein, des‑gamma‑carboxyprothrombin, hepatitis B virus, hepatocellular carcinom

Incidence and survival trends of lip, intra-oral cavity and tongue base cancers in south-east England

Background: Oral cavity cancers are on the increase in the UK. Understanding site-specific epidemiological trends is important for cancer control measures. This study demonstrates the changing epidemiological trends in lip, intra-oral cavity and tongue base cancers in south-east England from 1987 to 2006. Aim: Methods: This was a retrospective study using anonymised data obtained from the Thames Cancer Registry (TCR) London. Data were analysed using SPSS v.17 and survival analyses with Kaplan-Meier and Cox regression. Age standardisation of the incidence rates was performed. It was conducted in south-east England, which has an average population of 12 million. The study analysed 9,318 cases (ICD-10 code C00?C06, C14). Kent Research Ethics Committee UK granted ethical approval. Results: Oral cancers were more common in men, with male: female ratio of 1.6:1. Tongue cancers had the highest frequency at 3,088 (33.1%). Incidence varied with each cancer type. Mean incidence (per 1,000,000) ranged from 2.3 (lip cancer) to 13.8 (tongue cancer). There has been a statistically significant increase in incidence for cancers of the tongue base, other parts of tongue, gum and palate (p<0.001). Median survival time varied by sub-site, with lip cancer having the best median survival time (11.09 years) compared with tongue base cancer (2.42 years). Survival analyses showed worse prognosis for men, older age at diagnosis, and presence of synchronous tumours (p<0.001). Conclusion: There is a rising incidence of tongue and tongue base, gum and palate cancers in south-east England with wide variability in survival. Oral cancer awareness and screening programmes should be encouraged

Clinical Utility of Urinary β2-Microglobulin in Detection of Early Nephropathy in African Diabetes Mellitus Patients

Background. Studies have indicated that diabetic tubulopathy may occur earlier than glomerulopathy, therefore providing a potential avenue for earlier diagnosis of diabetic nephropathy. Urinary beta-2-microglobulin (β2m) was investigated in this study as a potential biomarker in the detection of early nephropathy in type 2 diabetics. Methods. One hundred and two diabetic subjects and 103 controls that met the inclusion criteria had data (sociodemographic, medical history, physical examination, and laboratory) collected. Urinary β2m levels and urinary albumin concentration (UAC) were determined. Results. Elevated urinary β2m was more frequent among the diabetics (52%, 95% CI: 42.1–61.8%) than among the controls (32%, 95% CI: 22.9–41.2%). The frequency of microalbuminuria was higher in the diabetics (35.3%, 95% CI: 25.9–44.7%) than in the controls (15.5%, 95% CI: 8.4–22.6%). There was a positive correlation between urinary β2m and UAC (rho = 0.38, p<0.001). Multivariate analysis showed BMI (OR: 1.23, 95% CI: 1.05–1.45), eGFR (OR: 0.97, 95% CI: 0.94–0.99), and presence of microalbuminuria (OR: 3.94, 95% CI: 1.32–11.77) as independent predictors of elevated urinary beta-2-microglobulin among the diabetics. Conclusion. Urinary β2m may be useful, either as a single test or as a component of a panel of tests, in the early detection of diabetic nephropathy

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

Nicola Wearne,1 Kajiru Kilonzo,2 Emmanuel Effa,3 Bianca Davidson,1 Peter Nourse,4 Udeme Ekrikpo,1,5 Ikechi G Okpechi1 1Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; 2Department of Medicine, Kilimanjaro Christian Medical College, Moshi, Tanzania; 3Department of Medicine, University of Calabar, Calabar, Nigeria; 4Division of Paediatric Nephrology, Red Cross War Memorial Children&rsquo;s Hospital, Cape Town, South Africa; 5Department of Internal Medicine, University of Uyo, Uyo, Nigeria Abstract: Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes. Keywords: dialysis cost, dialysis fluid, peritoneal dialysis, peritonitis, nephrology workforc