Women's perspectives on epilepsy and its sociocultural impact in south western Nigeria

Background There has been little study of the specific implications of living with epilepsy for women in societies where they already face gender based marginalization. Purpose Understanding the sociocultural aspects of epilepsy in women will help to improve the management of epilepsy in the community. Methods A series of six focus groups were held in urban and rural Southwest Nigeria.Results Epilepsy was commonly attributed to a spiritual attack, witchcraft and other supernatural causes. Denial of the diagnosis of epilepsy was common among women with nocturnal or focal seizures. Majority of women with epilepsy preferred multiple modalities of care in the following order: traditional, spiritual and western. The cost of traditional care was astronomical and most were already impoverished by the time they sought western care. WWE experienced stigma, social exclusion, isolation particularly from paternal relations, in -laws, and community members. Epilepsy related stigma contributed to schooling problems, difficulty in getting married, separation, divorce and problems with childcare and role fulfilment. One unanticipated result of this study was that public announcements made to identify rural study participants created a demand for western health services in rural populations previously unaware that epilepsy could be controlled through western medication.Conclusion Women with epilepsy face significant and persistent social, economic and cultural barriers. There is the need to educate women, their family and community members to reduce misconceptions and stigma. Community based medical treatment can be improved by taking into consideration the surrounding social, economic and cultural challenges faced by women with epilepsy. The care of epilepsy need to be incorporated into the primary health care system; regular awareness campaigns to be carried out in order to improve knowledge and attitudes and reduce stigma and social exclusion of women with epilepsy. Specific social welfare programmes and educational programme should be established to encourage the full integration of women with epilepsy in the society

Ophthalmic manifestations in patients with intracranial tumours

Introduction L’étude a pour but d’apprécier les manifestations ophtalmologiques des patients présentant des tumeurs cérébrales au Nigéria dans un hôpital tertiaire. Méthode Il s’agit d’une étude rétrospective avec une revue des tumeurs cérébrales dans le Neurosurgical Unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile- Ife de janvier 2003 à décembre 2007. L’analyse des données, diagnostique, acuité visuelle, et prise en charge, ont été analysées selon la fréquence en utilisant avec la version 1 11 SPCS . L’acuité visuelle a été classifiée selon celle de l’OMS. Résultat Sur un total de 94 patients, 88 patients ont été revus. Il s’agissait de 53 patients de sexe masculin et 35 de sexe féminin. La moyenne d’âge était de 36.2 plus ou moins 20 ans. 14 patients ont été pris en charge par les ophtalmologistes. La répartition des tumeurs était la suivante: méningiomes, 36,4 %, craniopharyngiomes, 13,6 % et gliomes, 9,1 %. 67,9 % des patients se plaignaient de troubles visuels à l’admission dont 46,6 % avec une baisse importante et 12,5 % une vision double. Il a été objectivé une artrophie optique dans 23,9 % . 46 malades (52 %) étaient aveugles et 14 (16 %) avaient un trouble visuelimportant. Conclusion Les troubles visuels sont des manifestations cliniques fréquentes de présentation des tumeurs cérébrales. Une information médicale précoce est requise

New onset neuromyelitis optica in a young Nigerian woman with possible antiphospholipid syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Devic's neuromyelitis optica is an inflammatory demyelinating disease that targets the optic nerves and spinal cord. It has a worldwide distribution and distinctive features that distinguish it from multiple sclerosis. There has been no previous report of neuromyelitis optica from our practice environment, and we are not aware of any case associated with antiphospholipid syndrome in an African person.</p> <p>Case presentation</p> <p>We report the case of a 28-year-old Nigerian woman who presented with neck pain, paroxysmal tonic spasms, a positive Lhermitte's sign and spastic quadriplegia. She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome. Her initial magnetic resonance imaging showed a central linear hyperintense focus in the intramedullary portion of C2 to C4. Repeat magnetic resonance imaging after treatment revealed resolution of the signal intensity noticed earlier.</p> <p>Conclusion</p> <p>Neuromyelitis optica should be considered in the differential diagnoses of acute myelopathy in Africans. We also highlight the unusual association with antiphospholipid syndrome. Physicians should screen such patients for autoimmune disorders.</p

Narrative exposure therapy for survivors of human trafficking: feasibility randomised controlled trial

Background Human trafficking is a grave human rights violation and a major public health concern. Survivors present with high rates of mental health problems including post-traumatic stress disorder (PTSD). Studies of effective treatments for PTSD in survivors of human trafficking are lacking. Narrative exposure therapy (NET) is an effective PTSD treatment for multiple, prolonged and complex trauma, but its efficacy has not been rigorously tested in survivors of human trafficking. Aims To test the feasibility and acceptability of a randomised controlled trial (RCT) offering NET as a treatment for PTSD in trafficking survivors with a history of multiple traumatic events, as well as providing preliminary evidence regarding its efficacy (trial registration: ISRCTN95136302). Method A single-blind RCT compared NET with a wait-list control in survivors of trafficking with PTSD (n = 25). In the NET arm of the study, participants attended a mean of 17 sessions. Results NET was well tolerated by participants. There were significant reductions in PTSD, depression and anxiety symptoms post-treatment in the NET group but no significant change in the wait-list group. Conclusions The results indicate that NET is a promising and acceptable treatment for trafficking survivors. Psychological therapy in an RCT design can be safely delivered to this vulnerable group, although modifications are required to ensure their holistic needs are properly addressed

Review of adult head injury admissions into the intensive care unit of a tertiary hospital in Nigeria

Background: Head injury is frequently associated with death and disability and imposes considerable demands on health services. Outcome after head injury is closely related to prompt management, including prevention of secondary brain injury and intensive care unit (ICU) management. This study aimed at determining the aetiological spectrum, injury characteristics, ICU admission patterns, and treatment outcomes of adult head-injured patients at a sub-Saharan tertiary hospital.Methods: A retrospective study on adult head-injured patients admitted to the ICU of a sub-Saharan tertiary hospital between July 2000 and June 2010.Results: A total of 198 head-injured adult patients were managed in the ICU during the study period. This included 128 males and 70 females with a male-to-female ratio of 1.8:1. The most common mode of injury was road traffic accident. All the patients admitted to ICU had either moderate or severe head injury, with 73.7% having severe head injury. About 26.3% of the patients had associated cervical spine injuries and 50% had various musculoskeletal and soft tissue injuries. Cranial computed tomography findings included brain contusions and intracranial haematomas. Mean duration of ICU stay was 18 days (range 24 hours-42 days), with 89.9% discharged out of ICU care. The overall mortality was 10.1%, although only 36.9% had satisfactory outcomes, as determined by the Glasgow Outcome Scale. Outcome had statistically significant (P &lt; 0.05) relationship with severity of head injury and surgical intervention.Conclusions: Head injury management in the ICU requires an approach to ensure prevention of secondary brain injury; appropriate and early neuroimaging to diagnose lesions that would benefit from timely surgical intervention; as well as management of fluid, electrolyte and haematological derangements.Keywords: head injury; admissions; IC

Eggshell calcification after intrathyroidal hemorrhage of retrosternal thyroid

We report a rare event of old hemorrhage into a thyroid causing respiratory distress. A 67-year-old man with chronic cough and recent dysphagia was found to have a retrosternal mass extending into the visceral mediastinum on chest roentgenogram. A computed tomographic (CT) scan confirmed eggshell callcification, which was 53 × 53 × 80 mm in size a retrosternal thyroid mass and revealed significant tracheal deviation to the right due to an extensive mass surrounded by a calcificated capsule in the left lobe of the thyroid gland with extension to the upper mediastinum. He successfully underwent left lobectomy of the thyroid gland with sternotomy. The pathological examination revealed intrathyroidal hemorrhage of the thyroid gland with massive intracystic old bleeding

Narrative exposure therapy for survivors of human trafficking: feasibility randomised controlled trial

BACKGROUND: Human trafficking is a grave human rights violation and a major public health concern. Survivors present with high rates of mental health problems including post-traumatic stress disorder (PTSD). Studies of effective treatments for PTSD in survivors of human trafficking are lacking. Narrative exposure therapy (NET) is an effective PTSD treatment for multiple, prolonged and complex trauma, but its efficacy has not been rigorously tested in survivors of human trafficking. AIMS: To test the feasibility and acceptability of a randomised controlled trial (RCT) offering NET as a treatment for PTSD in trafficking survivors with a history of multiple traumatic events, as well as providing preliminary evidence regarding its efficacy (trial registration: ISRCTN95136302). METHOD: A single-blind RCT compared NET with a wait-list control in survivors of trafficking with PTSD (n = 25). In the NET arm of the study, participants attended a mean of 17 sessions. RESULTS: NET was well tolerated by participants. There were significant reductions in PTSD, depression and anxiety symptoms post-treatment in the NET group but no significant change in the wait-list group. CONCLUSIONS: The results indicate that NET is a promising and acceptable treatment for trafficking survivors. Psychological therapy in an RCT design can be safely delivered to this vulnerable group, although modifications are required to ensure their holistic needs are properly addressed

Modelling of moisture diffusivity during solar drying of locust beans with thermal storage material under forced and natural convection mode

This study investigated the modelling of moisture diffusivity of processed locust beans under forced and natural convection mode using solar drying with thermal storage materials (gravel). The experimental data obtained were fitted into eleven existing thin layer models and the best model choice was based on a comparison of statistical parameters including determination coefficient (R2), reduced chi-square (ᵪ2), root mean square error (RMSE), square error sum (SSE) and normalised root mean square error (NRMSE) between the experimental and predicted data. The results showed that the Lewis model gave the best description of solar drying of locust beans under forced and natural convection mode. Thus, this model may be adjudged to represent the drying characteristics of locust beans in a thin layer within the experimental range of study. The obtained moisture diffusivity values were 2.73496 and 1.82331 � 10-11 m2/s for the solar drying of locust beans under forced and natural convection mode respectively. The predicted Arrhenius constant and activation energy values were respectively 2.54 � 10-11 m2/s and 21.65 kJ/mo

Bacterial infections in Lilongwe, Malawi: aetiology and antibiotic resistance

<p>Abstract</p> <p>Background</p> <p>Life-threatening infections present major challenges for health systems in Malawi and the developing world because routine microbiologic culture and sensitivity testing are not performed due to lack of capacity. Use of empirical antimicrobial therapy without regular microbiologic surveillance is unable to provide adequate treatment in the face of emerging antimicrobial resistance. This study was conducted to determine antimicrobial susceptibility patterns in order to inform treatment choices and generate hospital-wide baseline data.</p> <p>Methods</p> <p>Culture and susceptibility testing was performed on various specimens from patients presenting with possible infectious diseases at Kamuzu Central Hospital, Lilongwe, Malawi.</p> <p>Results</p> <p>Between July 2006 and December 2007 3104 specimens from 2458 patients were evaluated, with 60.1% from the adult medical service. Common presentations were sepsis, meningitis, pneumonia and abscess. An etiologic agent was detected in 13% of patients. The most common organisms detected from blood cultures were <it>Staphylococcus aureus</it>, <it>Escherichia </it><it>coli</it>, Salmonella species and <it>Streptococcus pneumoniae</it>, whereas <it>Streptococcus pneumoniae </it>and <it>Cryptococcus neoformans </it>were most frequently detected from cerebrospinal fluid. <it>Haemophilus influenzae </it>was rarely isolated. Resistance to commonly used antibiotics was observed in up to 80% of the isolates while antibiotics that were not commonly in use maintained susceptibility.</p> <p>Conclusions</p> <p>There is widespread resistance to almost all of the antibiotics that are empirically used in Malawi. Antibiotics that have not been widely introduced in Malawi show better laboratory performance. Choices for empirical therapy in Malawi should be revised accordingly. A microbiologic surveillance system should be established and prudent use of antimicrobials promoted to improve patient care.</p

Paediatric brought-in-dead at a tertiary health facility in South western Nigeria: Patterns and drivers

Background: ‘Brought- in-dead’ (BID) refers to the demise of an individual before presentation to a health facility. This study assessed the pattern of paediatric BID cases seen at a tertiary health facility in southwest Nigeria. Method: A cross-sectional, descriptive study was done at the Children Emergency Ward (CEW) of the hospital between January 2014 and December 2018. The patterns of BID cases and presumed causes of death were determined using a standardized checklist adapted from the WHO verbal autopsy instrument. Results: Ninety-eight BID cases were seen during the study, constituting 2.5% of total patients seen during the period. The median (IQR) age of cases was 24.0 (8.75 – 63.0) months and 72.4% were under-fives. Most had symptoms related to the haematologic (36.7%), respiratory (24.5%) or digestive (20.4%) systems. Severe anaemia 31(31.6%), gastroenteritis 19 (19.4) and aspiration 17 (17.3%) were the most common causes of death. The median (IQR) duration of illness before presentation was 3.0 (1.0 – 7.0) days but most presented from 4 – 7 days of illness. A significant relationship was found between the duration of illness and whether or not pre-hospital treatment was received (p &lt; 0.0001). Unprescribed drugs purchased over the counter were the most commonly used treatment in 79.1% of cases (p &lt; 0.0001). Conclusion: This study has highlighted the prevalence and pattern of paediatric BID in a tertiary health facility in southwest Nigeria and the factors that were associated with it. More efforts need to be geared towards community sensitization and pediatric health care to prevent factors drivingits menace