Epilepsy in primary intracranial tumors in a neurosurgical hospital in Enugu, South‑East Nigeria

Background: Seizures may be manifestation of intracranial tumor (IT) and demand thorough neurological evaluation. This paper examines epidemiology, lesion characteristics and outcome of seizures associated with primary IT.Methods: Retrospective analysis of medical records, computed tomography and magnetic resonance imaging of patients diagnosed with IT who presented with seizure from 2003 to 2013 at Memfys Hospital for Neurosurgery Enugu. Postoperative seizure outcome was based on Engel classification and correlated with tumor histology, patient age, anatomical location, time of presentation and extent of tumor resection. Data were analyzed using descriptive and inferential statistics.Results: Sixty‑two patients (34.6%) presenting with seizures were analyzed. Peak age at presentation was in 6th decade. Age of seizure onset had bimodal peak at 4th and 6th decades. Apart from IT located in posterior fossa with mortality of 62.5%, postoperative mortality did not depend on anatomical location of tumor. Postoperative seizure outcome and mortality depend on tumor histology (P = 0.025) and preoperative seizure duration (P = 0.036). Seizure duration shorter than 1 month had poor postoperative seizure outcome and high mortality. Although more patients with meningioma experienced seizures compared to glioma (P = 0.025), there was no difference in proportion of patients with meningioma and glioma who presented with seizure (P = 1.00). Extent of resection predicts postoperative seizure outcome based on meningioma sub‑group analysis. Overall, 59.7% of patients had good postoperative seizure outcome, 21.0% had poor outcome and 19.3% died.Conclusion: Seizures of short duration, IT located in posterior fossa and gliomas are associated with poor postoperative seizure outcome and high patient mortality. Tumor histology does not seem to affect seizure predisposition. Most seizures associated with IT occur in fifth and sixth decades of life and affect frontal lobe most often.Key words: Intracranial tumors, postoperative seizure outcome, seizure

Pasteurella multocida Endocarditis with Septic Arthritis: Case Report and Review of the Literature

Background: There is a paucity of evidence regarding optimal management of Pasteurella spp. endocarditis. The authors report the first case of Pasteurella spp. endocarditis with septic arthritis and review the literature. Case Description: A 79-year-old patient with significant comorbidities, including prosthetic aortic valve, was admitted with left knee swelling, fever, and confusion, having been scratched by a cat 2-weeks prior. At presentation, there was a metallic click, a Grade 3 pan-systolic murmur and Grade 1 flow murmur audible on auscultation. Blood and synovial fluid cultures both isolated Pasteurella multocida, identified by matrix-assisted laser desorption ionisation–time of flight, which was sensitive to penicillin according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST); minimum inhibitory concentration: 0.094). The patient underwent joint washout and received intravenous piperacillin/tazobactam for 3 days before switching to benzylpenicillin once sensitivities were known. Due to continued pyrexia, a transthoracic echocardiogram was obtained, which revealed a small mobile mass on a thickened mitral valve suspicious for a vegetation. On review by the Infective Endocarditis team, conservative management was deemed best, given the presence of comorbidities. Despite requiring further joint washout due to persistent knee pain, the patient was successfully treated with 8 weeks of antibiotic therapy (24 days of benzylpenicillin monotherapy, 2 weeks of benzylpenicillin and ciprofloxacin, and 15 days ciprofloxacin monotherapy). Discussion: Previous literature reviews report a higher mortality of Pasteurella spp. endocarditis when managed without cardiac surgery, thus recommending surgery in all cases. The authors found these to have confounding factors, including inadequate duration of antimicrobials, aortic root abscess, and rapid progression to death. The authors’ case of Pasteurella spp. endocarditis, complicated by septic arthritis, showed successful therapy without cardiac surgery

Faith-based approach to improve menstrual hygiene management (MHM): challenges and successes

This paper examines faith-based organisations’ (FBOs) essential and effective approach to breaking the myths and silence surrounding menstruation, the provision of comprehensive menstrual information, menstrual hygiene management (MHM) and the assessment of an initiative integrating FBOs into the structure for shattering taboos around menstruation. Whereas substantial progress has been made to evolve more decent and socially acceptable approaches to MHM in recent times, the active role of FBOs in accelerating and enhancing better MHM has not been properly appraised or harnessed in Nigeria. As an integral part of the nascent collaboration between Daniel Iroegbu Global Health Foundation and Second Chance Initiative this synergic thrust is reaching FBOs to discuss this gap in MHM programming and seek newer realities in MHM. Addressing taboos and silence around menstruation requires a multi-sect oral collaboration and response similar to the approach currently in use for HIV/AIDS and Malaria morbidity response and control in Nigeria

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Addiction in the Light of African Values: Undermining Vitality and Community

In this article I address the question of what makes addiction morally problematic, and seek to answer it by drawing on values salient in the sub-Saharan African philosophical tradition. Specifically, I appeal to life-force and communal relationship, each of which African philosophers have at times advanced as a foundational value, and spell out how addiction, or at least salient instances of it, could be viewed as unethical for flouting them. I do not seek to defend either vitality or community as the best explanation of when and why addiction is immoral, instead arguing that each of these characteristically African values grounds an independent and plausible account of that. I conclude that both vitalism and communalism merit consideration as rivals to accounts that Western ethicists would typically make, according to which addiction is immoral insofar as it degrades rationality or autonomy, as per Kantianism, or causes pain or dissatisfaction, à la utilitarianism

Healing insanity: skills and expert knowledge of Igbo healers

This paper gives insight into how Igbo healers of Southern Nigeria conceive of insanity and apply endogenous knowledge and expertise to heal it, contrary to the belief that cosmopolitan orthodox medicine only can provide efficacious cure for insanity. Resort to community support and culture remains people\'s widely shared way of dealing with insanity and related disturbances. While pharmaceutical drugs are being made available to health seekers, local herbal and ritual resources as well as communicational and bodily skills do constitute the asset for holistic healing. Although research shows tensions between the local, Christian and biomedical views, the paper argues that effective healing tends to be successful when the etiology and treatment include due ancestral compliance work in harmony with people\'s views, emotions and life-worlds. The paper offers an endogenous theory of symbolic release underlying a genuinely Igbo cosmological and epistemological strategy, side by side with the ritual of tying and untying for releasing the forces hampered by intrusion, and for achieving treatment based on culturally meaningful herbal and animal resources. To rescue the help-seeking individual and kin-group, as a first principle, the forces that tie the afflicted need to be rusticated before effective results can be obtained with treatment. Résumé Cette communication expose la conception que les guérisseurs Igbos du Sud du Nigeria, se font de la folie, ainsi que la façon dont ceux-ci se servent des connaissances et de l'expertise endogène pour la guérir, contrairement à la croyance répandue selon laquelle seule la médecine orthodoxe cosmopolite serait en mesure de soigner la folie. Le recours au soutien et à la culture communautaires demeure une des méthodes les plus consensuelles de traitement de la folie et des troubles connexes. Même si les médicaments pharmaceutiques demeurent disponibles, les ressources aux herbes et rituelles locales, ainsi que les moyens communicationnels et corporels constituent un réel atout favorisant le traitement holistique de la démence. Même si les recherches effectuées ont relevé des tensions entre les conceptions locales, chrétiennes et biomédicales, cet article soutient que les traitements thérapeutiques se révèlent efficaces, lorsque léétiologie et la thérapie intègrent un savoir-faire ancestral, en symbiose avec les opinions, les émotions et les univers de vie des individus. Cette communication propose une théorie endogène de la libération symbolique, à la base d'une certaine stratégie cosmologique et épistémologique authentiquement Igbo, qui s'accompagne du rituel consistant à attacher et détacher, dans le but de libérer les forces tourmentées par l'intrusion, mais également dans le but de mettre en place un traitement basé sur des ressources aux herbes et animales ayant une certaine signification culturelle. Pour venir en aide à l'individu ou au groupe de personnes apparentées, il faut tout d'abord extraire de la personne les forces qui l'habitent, avant de pouvoir procéder à un traitement efficace.Africa Development Vol. XXX(3) 2005: 78–9

Quality assessment of palm oil sold in major markets in Abia State, Nigeria

This paper examines the quality of palm oil samples obtained from different locations in Abia State, Nigeria in terms of their physicochemical properties. The results obtained showed that the saponification value (SV) ranged from 129.04 – 198.03KOH/g of oil. The free fatty acid (FFA) of the palm oil samples ranged from 2.73 – 2.89mgKOH/g of oil, peroxide value (PV) 7.90 – 8.80meq/kg and the iodine value (IV) 52.61 – 53.48 Wiji's. The moisture content was in the range of 0.14-0.16% while the carotene content ranged from 1082 – 1458mg/kg. The results obtained after the analysis of variance (ANOVA) showed that there were no significant differences (P>0.05) in the specific gravity, smoke, flash and fire points, moisture content, saponification value, peroxide value and free fatty acid values of the palm oil samples. However, there were significant differences (

Bleeding in a 43 Year Old Female: A Rare Disease

A 43-year-old gravida 2 para 2 Caucasian female with a past medical history of menorrhagia secondary to uterine fibroids and thyroid disease presented to the emergency department with complaints of bruising in her oral mucosa and vaginal bleeding. One week prior to this presentation, she was transfused with two units of packed red blood cells because of symptomatic anemia secondary to menorrhagia. Physical examination was normal, except for petechiae on the abdomen and the lower extremities as well as purpuric lesions on the buccal mucosa. Blood work revealed thrombocytopenia. Posttransfusion thrombocytopenia was suspected. The patient was transfused with washed and leukoreduced platelets and treated with steroids and intravenous immunoglobulins. Laboratory studies demonstrated that she was homozygous for the HPA-Ib/1b platelet gene and positive antibodies against class 1 HLA and platelet glycoproteins. The patient responded well to treatment, with normalization of her platelet count

Seroprevalence of Hepatitis C antibodies amongst pregnant women attending antenatal clinic at Maiduguri, Nigeria

The Hepatitis C virus (HCV) infection may have a much greater effect on pregnancy and neonatal outcomes than previously reported, indicating that routine HCV screening in pregnant women may need to be reconsidered. Two hundred (200) serum samples from pregnant women attending  antenatal clinic at University of Maiduguri Teaching Hospital, Maiduguri north-eastern Nigeria were screened for HCV antibodies using the HCV rapid immunoassay test strip which detects antibodies to HCV in the serum or plasma. A structured questionnaire was administered to obtain the risk factors in the population that were associated with the virus infection. Of the total samples analysed, 12(6%) were positive for Hepatitis C virus antibodies. The highest prevalence was found among the age groups 20-29 with an overall number of 6(3.0%) being positive for the HCV. Considering occupational exposure, higher seroprevalence was recorded among the civil servants, with 9(4.5%) being positive. The prevalence of HCV was statistically significant (

Extreme value theory applied to the definition of bathing water quality discounting limits

The European Community Bathing Water Directive (European Parliament, 2006) set compliance standards for bathing waters across Europe, with minimum standards for microbiological indicators to be attained at all locations by 2015. The Directive allows up to 15% of samples affected by short-term pollution episodes to be disregarded from the figures used to classify bathing waters, provided certain management criteria have been met, including informing the public of short-term water pollution episodes. Therefore, a scientifically justifiable discounting limit is required which could be used as a management tool to determine the samples that should be removed. This paper investigates different methods of obtaining discounting limits, focusing in particular on extreme value methodology applied to data from Scottish bathing waters. Return level based limits derived from threshold models applied at a site-specific level improved the percentage of sites which met at least the minimum required standard. This approach provides a method of obtaining limits which identify the samples that should be removed from compliance calculations, although care has to be taken in terms of the quantity of data which is removed. (c) 2009 Elsevier Ltd. All rights reserve