Knowledge and practice of female secondary school students aboutHIVand sexually transmitted infections in Enugu, South East Nigeria

Purpose: The purpose of this study was to determine the knowledge and practice of female secondary school students to sexually transmitted infections in Enugu, South East Nigeria.These could pose as barriers to effective sexual education and impair case management within the community.Methods: This study was cross-sectional and descriptive in design using a self- administered custom designed multiple choice questionnaire with sections on general information on sexually transmitted infections, awareness and perception of such infections. Ethical clearance and informed consent were obtained.Results: There were 183 respondents with a mean age of 15.9 ± 1.3 years, all female.There was a high level of awareness of HIV (97.8%) and STIs (94.5%).While 74.3% had correct knowledge of modes of transmission,60.7% incorrectly identified casual contact as modes of transmission of HIV. Only 59% correctly identified all the HIV prevention methods tested, while 74.9% practiced all modes of prevention. The median aggregate score for knowledge of transmission and prevention was 72.2%, while it was 62.5% for good prevention practice. The older students were more likely to be sexually active.Conclusion: Female secondary school students in Enugu had a high level of awareness for sexually transmitted infections, especially for HIV. However, in-depth knowledge regarding mode of transmission and prevention was sub-optimal.There is a need to strengthen public and school based sexual health education in Nigeria.Keywords: Sexually transmitted infections, knowledge, female students, Nigeri

Tropical Diabetic Hand Syndrome

Any adult with diabetes in the tropics with hand cellulitis, infection and gangrene qualifies for tropical diabetic hand syndrome (TDHS). We reviewed a 39‑year‑old woman with a 3‑week history of swelling of the left index finger following an insect bite. The swelling progressively increased in size, was very painful, and extended to the palm. There was no history or symptoms suggestive of chronic complications of diabetes. Random blood sugar on presentation was above 600 mg/dl using a glucometer. Examination revealed an edematous left palm draining pus from multiple sinuses, necrotic and gangrenous left index finger extending down to just above the thenar eminence. A diagnosis of TDHS in a patient with hyperosmolar state was made. She was managed accordingly and subsequently underwent aggressive debridement and desloughing. Two fingers were amputated and the wound was allowed to heal by secondary intention.Keywords: Diabetes, Hyperglycemia, Nigeria, Tropical diabetic hand syndrom

Knowledge, attitude and practice towards epilepsy among secondary school students in Enugu, South East Nigeria

AbstractPurposeThe purpose of this study was to determine the knowledge and attitude of secondary school students to epilepsy and its treatment that could pose as barriers in the treatment and care of epilepsy patients within the community.MethodsThis study was cross-sectional and descriptive in design using a self administered custom designed multiple choice questionnaire with sections on general information on epilepsy, awareness and perception of epilepsy, treatment of epilepsy/seizures and attitude towards people living with epilepsy.ResultsOut of 969 questionnaires analyzed, the majority of the students (87.6%) had heard of epilepsy as a disease. The commonest sources of information were the electronic media (36.4%) and family members (25.6%). More than half (59.4%) had witnessed a convulsion in the past and 8.9% had a family member with epilepsy. Jerking (50.6%) and loss of consciousness (47.4%) were identified as the commonest manifestations of epilepsy. Epilepsy was considered a psychiatric disorder by 51.9% and as an infectious disease by 40.6%. About 39.3% considered epilepsy to be due to spiritual causes, old age or poisoning/bad blood. A total of 63.1% regarded orthodox medicine and prayers as the best means to treat epilepsy, while 6.8% chose herbal remedies. Concerning first aid treatment, 50.6% agreed that an object should be inserted into the mouth, while 49.5% would call for medical help and 28.8% would remove the person from harm. On attitude, 64.9% would not keep a friend with epilepsy, 69.1% would not play with someone with epilepsy, 84.2% would not marry someone with epilepsy. 41.1% of the students said that people with epilepsy should neither marry while 42.2% say they should not have children. Only 39.1.5% had an overall positive attitude towards people living with epilepsy.ConclusionsThere is a persisting poor knowledge, attitude and practice of epilepsy among secondary school students in SE Nigeria. Efforts should be made to include basic facts about disorders with social consequences such as epilepsy in school health education curriculum

EpiNet as a way of involving more physicians and patients in epilepsy research: validation study and accreditation process

Objective EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator‐led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet‐First trials. Methods Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet‐First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false‐positive errors and could make only one error regarding seizure classification. Results Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet‐First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70. Significance We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet‐accredited and to participate in these investigator‐led clinical trials

Knowledge of medical students about epilepsy: Need for a change

Purpose: Though most doctors in their professional life will provide care for people with epilepsy, many will not get further training in their professional life. There may be other barriers, perceived or not, to providing care to people living with epilepsy by doctors which need to be approached in the medical undergraduate curriculum and medical continuing education. The aim of this study was to determine the knowledge gaps of medical students on basic issues regarding epilepsy that could be useful in preparing training material for the students and continuous medical education for doctors working in the community.Materials and Methods: This cross-sectional and descriptive study was carried out in one of the medical schools in Enugu metropolis. Data collection was done using a semi-structured validated questionnaire.Results: Seizure was regarded as a movement disorder by 10.3% of the students. The rank of causes of epilepsy given by respondents was brain injury (88%), brain tumor (87%) genetics (62.3%), and strokes (55.1%). Significantly more students who did neurology posting correctly answered that stroke is a risk factor (P < 0.001), disagreed that sleep deprivation is a risk factor (P = 0.04), and recognized different seizure types (P < 0.001–0.002). The mean score was 17.8 ± 2.3% (71.2 ± 9.2%); significantly higher in those who did neurology posting. Students scored lowest on questions regarding risk factors and duration of treatment.Conclusion: The content of medical curriculum in Africa should emphasize not only the content of lectures on epilepsy but also the need for students to go through neurology posting during their training. The outcome would be both better knowledge and improved physician–patient relations.Keywords: Epilepsy, knowledge, medical students, Nigeri

The pattern of significant lesions found in computerized tomography scan of recurrent seizure patients at a center in Enugu, Nigeria

Introduction: Seizures are common reasons for neurologic consultations and investigations. In the absence of magnetic resonance imaging, computerized tomography scanning of the brain is a reliable and cheaper alternative. Little is known about the pattern of brain lesions in patients with recurrent seizures in Nigeria.Objectives: To determine the pattern of significant intracerebral lesions in patients presenting with recurrent seizures in a tertiary hospital in Enugu. Methods: All the medical and computer tomography records of patients with a clinical diagnosis of recurrent seizures were reviewed. The study duration was 11 years (January 2003 to December 2013). Relevant data were obtained and  statistical analysis was done using SPSS version 19 and GraphPad Prism 6. Results: The diagnostic yield of CT was 55.1%. Twenty (9.3%) individuals had two lesions each. The significant findings were tumors (20.4%), encephalomalacia (18.9%) and strokes (7.7% (ischemic stroke, 4.1%, intracerebral hemorrhage,  3.1%, subarachnoid hemorrhage/intraventricular hemorrhage, 0.5%).  Hydrocephalus (HCP) was found in 18 (9.2%) cases, and 30% of them occurred together with other lesions. The diagnostic yield increased with age reaching 84.4% from the age of 60 years. Only patients with encephalomalacia were statistically older than those with normal imaging.Conclusion: Computed tomography scan has a high diagnostic yield, especially in elderly patients with recurrent generalized seizures. Brain tumors,  encephalomalacia, and HCP are most common causes of recurrent seizures in the adults.Keywords: Computed tomography, Nigeria, recurrent seizures, space‑occupying lesions, stroke

Pattern and location of intracerebral hemorrhage in Enugu, South‑East Nigeria: A review of 139 cases

Introduction: The incidence rates and location of nontraumatic intracerebral hemorrhage (ICH) have been shown to vary between population and races. Knowledge of ICH patterns may give some insight into the etiology of ICH and help reduce its burden particularly among Africans where health infrastructure is poorly developed. We present a retrospective review of ICH using a modern neuroimaging technique.Objectives: To determine the pattern and location of ICH among patients presenting in a tertiary hospital in Enugu.Methods: All the medical and computer tomography records of patients with a clinical diagnosis of hemorrhagic stroke with the location of hemorrhage clearly specified and complete patients’ data were reviewed. The study duration was 11 years (January 2003 to December 2013). Relevant data were obtained, and statistical analysis was done using SPSS version 19 (IBM Corporation, New York, USA).Results: A total of 139 (17.4%) out of 799 scans done over the period under review were analyzed. The frequency of lobar and deep cerebral hemorrhages (LH and DCHs) was 46.8% and 53.2%, respectively. The most common types of hemorrhage in men and women were deep cerebral (52.2% and 55.3%, respectively). Five percent (7/139) of all hemorrhages occurred in the cerebellum. Age distribution of the location of ICH shows that LHs peaked at 16 39 years while DCHs peaked at 40–49 years. There was not statistically significant difference between mean ages of occurrence of LH and hemorrhages of other locations.Conclusion: Frequency of LH and DCH varied with age as LH peaked before the age of 40 while deep cerebral at 40–49 years. The age distribution of different types of ICH may suggest a higher role of other factors apart from hypertension. Further studies are required to establish the risk factors of LH and DCHs in our environment.Keywords: Deep cerebral hemorrhage, intracerebral hemorrhage, lobar hemorrhage, Nigeri

The Pattern of Significant Lesions Found in Computerized Tomography Scan of Recurrent Seizure Patients at a Center in Enugu, Nigeria

Introduction: Seizures are common reasons for neurologic consultations and investigations. In the absence of magnetic resonance imaging, computerized tomography scanning of the brain is a reliable and cheaper alternative. Little is known about the pattern of brain lesions in patients with recurrent seizures in Nigeria. Objectives: To determine the pattern of significant intracerebral lesions in patients presenting with recurrent seizures in a tertiary hospital in Enugu. Methods: All the medical and computer tomography records of patients with a clinical diagnosis of recurrent seizures were reviewed. The study duration was 11 years (January 2003 to December 2013). Relevant data were obtained and statistical analysis was done using SPSS version 19 and GraphPad Prism 6. Results: The diagnostic yield of CT was 55.1%. Twenty (9.3%) individuals had two lesions each. The significant findings were tumors (20.4%), encephalomalacia (18.9%) and strokes (7.7% (ischemic stroke, 4.1%, intracerebral hemorrhage, 3.1%, subarachnoid hemorrhage/intraventricular hemorrhage, 0.5%). Hydrocephalus (HCP) was found in 18 (9.2%) cases, and 30% of them occurred together with other lesions. The diagnostic yield increased with age reaching 84.4% from the age of 60 years. Only patients with encephalomalacia were statistically older than those with normal imaging. Conclusion: Computed tomography scan has a high diagnostic yield, especially in elderly patients with recurrent generalized seizures. Brain tumors, encephalomalacia, and HCP are most common causes of recurrent seizures in the adults.Keywords: Computed tomography, Nigeria, recurrent seizures, space‑occupying lesions, stroke

Neurological Disease Burden in two Semi-urban Communities in South East Nigeria

BACKGROUND: Neurological disorders are a significant cause of morbidity and mortality worldwide. Urban hospital -based studies give some perspectives on the burden of neurological disease but there are no community- based studies from South East Nigeria.AIM: This study sought to screen for the scope and pattern of neurological dysfunction affecting inhabitants of two semi-urban communities in Enugu, South East Nigeria.METHODS: A descriptive, cross- sectional, questionnaire- based study of inhabitants living in Alfred Camp and Udi Siding communities in Enugu was carried out in March 2008. Using a structured questionnaire, house- to- house interview of the residents was conducted by doctors trained for this purpose. Residents' knowledge and experience of clinical features that suggest neurological dysfunction were ascertained. Informed consent was obtained and ethical approval obtained from the Ethics Committee of the University of Nigeria Teaching Hospital Enugu. Data obtained was analyzed using SPSS version 13.5.RESULTS: Completed questionnaires were 239 in number. There were 138 males and 101 females with age range of 18 -75 years. Most respondents, 127 (53.1%), were aged 21 -30 years. Pain syndromes were most common with headache, low back pain and neuropathic pain accounting for the top 3 neurological disorders.CONCLUSION: This study has suggested that pain syndromes affect large numbers of people ordinarily resident in semi-urban communities in Enugu, South East Nigeria. These syndromes have an effect on quality of life. There is need for further large scale studies as well as increased public health strategies for addressing neurological diseases including pain disorders.KEY WORDS: burden; neurological disease; Nigerian communitie

Levetiracetam-induced rage and suicidality: Two case reports and review of literature

Background: Levetiracetam-induced rage is a rare neurobehavioral adverse effect of levetiracetam that is characterized by seething rage, uncontrollable anger, fits of fury, depression, violence, and suicidal tendencies. It occurs more in patients with prior mood or psychotic disturbances. No such case has been reported in Nigeria. Method: We report two cases of levetiracetam-induced rage. The first patient was a 29-year-old male with a 14-year history of intractable posttraumatic epilepsy. He was initially placed on sodium valproate and phenobarbitone and later had phenobarbitone replaced with levetiracetam. Within the first week of initiating levetiracetam, he became aggressive, bursted into fits of fury, and attacked his siblings. Levetiracetam was stopped, and the seething rage ceased only to reappear when it was reintroduced; hence, the complete withdrawal of levetiracetam. Naranjo probability score for adverse drug reaction was 8. Results: The second patient was a 23-year-old lady who developed seething rage and made several attempts to kill herself with a knife following addition of levetiracetam to the clonazepam and carbamazepine that she was taking for treatment-resistant epilepsy. Withdrawal and reintroduction of levetiracetam by the relatives led to cessation and reemergence, respectively, of the rage and suicidal tendencies. Naranjo score was 8. Levetiracetam was discontinued. Conclusion: Neuropsychiatric evaluation for prior mood or psychiatric disorders in those initiating levetiracetam therapy is suggested alongside monitoring for early features of levetiracetam-induced rage by both caregivers and physicians. This will help stem the morbidity and potential mortality associated with this life-threatening adverse drug reaction