Stroke in Developing Countries: Experience at Kano, Northwestern Nigeria

Objectives: As no report on the clinical pattern of stroke in Kano is available, we sought to determine the stroke types, the risk factors associated with stroke, reasons for delay presentation, management issues and outcome of stroke in Kano, Northwestern Nigeria.Methods: In this prospective study, consecutive patients that were admitted to the medical wards of the two tertiary hospitals; Aminu Kano Teaching Hospital (AKTH), Kano and Murtala Muhammad Specialist Hospital, (MMSH) Kano, from June 2008 to June 2010 were recruited in the study. Diagnosis of stroke and its type were determined by clinical and neuroimaging techniques. Risk factor analysis was made based on clinical, laboratory and other relevant investigational data. The case fatality at 24 hours and 7 days were recorded. The survivors were followed in neurology clinics for 6 months; status of disability on admission and at discharge was recorded using modified Rankin disability scale.Results: Over a period of 3 years, a total of 273 comprising 179 males and 94 females (m: f = 2:1) stroke patients were recruited. Their age ranged between 18 and 90 with a mean age of 55 yrs (sd-16.5) but the mean age was 52 (s.d =17.6) in males and 60 (s.d= 11.5) in females. The peak age was in the seventh decade. One hundred and seventy four (63.7%) had infarctive stroke while ninety nine (36.3%) had haemorhagic stroke (91 intracerebral and 8 subarachnoid haemorhage). Reasonsfor the delay included delay referral from private hospital (49.1%), visit to traditional homes before coming to hospital (10.6%), treatment at home (7%), transportation problem (32.2%) and others (1.1%). Overall one hundred and seventy one (63%) survived and one hundred and two (37%) died. The case fatality for stroke was 10% in the first 24 hours and 22% at 7 days. Conclusion: The clinical pattern and outcome of stroke found in this study are similar to that reported in other geopolitical zones of Nigeria and other developing countries

Electrodiagnostic evaluation of median nerve conduction in Type II diabetes mellitus patients that were asymptomatic for peripheral neuropathy: a case control study

Background: Diabetic neuropathy (DN) is a potentially debilitating complication of diabetes mellitus but many of the diabetic patients are often asymptomatic of DN, thereby, placing them at high risk of developing debilitating complications like diabetic hand and foot.Aim: The study was designed to evaluate median nerve conduction of T2DM patients that were asymptomatic for neuropathy and compare their findings with age and sex-matched healthy individuals.Methods: The median motor and sensory nerve conduction study was conducted on 100 type 2 diabetic (T2DM) patients and 100 healthy volunteers, matched for age and sex-matched control. Median nerve motor and sensory proximal and Distal latency (DL), Amplitude and Conduction Velocity (CV) as well as motor f-reponse were measured using Nihoen Kohden EMG Machine and standardized techniques of measurement in the course of the study were adhered to.Results: On comparison of the median nerve motor and sensory parameters, the median nerve (motor and sensory) distal latencies and f-responses were significantly lower in the control group while the median nerve conduction velocities and amplitudes were significantly higher in the T2DM group. Conclusion: The study showed significant impairment of median nerve conduction parameters in T2DM patients who did not have any feature suggestive of peripheral neuropathy when compared with apparently healthy individuals. Thus high index of suspicion as well as early screening for peripheral neuropathy in diabetes is further emphasized.Keywords: Median nerve, diabetic neuropathy, electrodiagnostic evaluation, conduction velocity, latenc

An analysis of postdural puncture headache in obstetric patients: A study from Kano, Nigeria

Background: One of the complications of spinal anesthesia is postdural puncture headache. Many risk factors have been identified which when addressed could reduce the incidence.Objectives: This was a prospective study that analyzed the incidence, onset and severity of postdural puncture headache among pregnant women who had cesarean section under a subarachnoid block in Aminu Kano Teaching Hospital, Kano, Nigeria.Patients and Methods: Spinal anesthesia was performed on 146 patients using size 25‑ or 26‑gauge Quincke, Whitacre, or Sprotte needles. Patients were followed up to determine the incidence, onset, and severity of post spinal headache. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 18.0 (SPSS Inc., SPSS Statistics for Windows, Chicago, IL, USA). Demographic variables were presented using tables while summary was done using means, standard deviation, and percentages. Test of association was done using Fisher’s Exact test. A P value < 0.05 was considered statistically significant.Results: The overall incidence of postdural puncture headache was 15.8% with all cases presenting within the first 24 hours. Most patients rated their headache as mild to moderate on a 10‑cm visual analogue scale.Conclusion: Traumatic Quincke spinal needle is associated with high incidence of postdural puncture headache and therefore we recommend the use of atraumatic pencil tip needle especially in obstetric anesthesia.Key words: Cesarean section; postdural puncture headache; spinal anesthesia

Biological sample donation and informed consent for neurobiobanking: Evidence from a community survey in Ghana and Nigeria

Copyright: \ua9 2022 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Genomic research and neurobiobanking are expanding globally. Empirical evidence on the level of awareness and willingness to donate/share biological samples towards the expansion of neurobiobanking in sub-Saharan Africa is lacking. Aims To ascertain the awareness, perspectives and predictors regarding biological sample donation, sharing and informed consent preferences among community members in Ghana and Nigeria. Methods A questionnaire cross-sectional survey was conducted among randomly selected community members from seven communities in Ghana and Nigeria. Results Of the 1015 respondents with mean age 39.3 years (SD 19.5), about a third had heard of blood donation (37.2%, M: 42.4%, F: 32.0%, p = 0.001) and a quarter were aware of blood sample storage for research (24.5%; M: 29.7%, F: 19.4%, p = 0.151). Two out of ten were willing to donate brain after death (18.8%, M: 22.6%, F: 15.0%, p<0.001). Main reasons for unwillingness to donate brain were; to go back to God complete (46.6%) and lack of knowledge related to brain donation (32.7%). Only a third of the participants were aware of informed consent (31.7%; M: 35.9%, F: 27.5%, p<0.001). Predictors of positive attitude towards biobanking and informed consent were being married, tertiary level education, student status, and belonging to select ethnic groups. Conclusion There is a greater need for research attention in the area of brain banking and informed consent. Improved context-sensitive public education on neurobiobanking and informed consent, in line with the sociocultural diversities, is recommended within the African sub region

Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe

Epidemiology of neurodegenerative diseases in sub-Saharan Africa: a systematic review

BACKGROUND:Sub-Saharan African (SSA) countries are experiencing rapid transitions with increased life expectancy. As a result the burden of age-related conditions such as neurodegenerative diseases might be increasing. We conducted a systematic review of published studies on common neurodegenerative diseases, and HIV-related neurocognitive impairment in SSA, in order to identify research gaps and inform prevention and control solutions. METHODS: We searched MEDLINE via PubMed, 'Banque de Donnees de Sante Publique' and the database of the 'Institut d'Epidemiologie Neurologique et de Neurologie Tropicale' from inception to February 2013 for published original studies from SSA on neurodegenerative diseases and HIV-related neurocognitive impairment. Screening and data extraction were conducted by two investigators. Bibliographies and citations of eligible studies were investigated. RESULTS: In all 144 publications reporting on dementia (n=49 publications, mainly Alzheimer disease), Parkinsonism (PD, n=20), HIV-related neurocognitive impairment (n=47), Huntington disease (HD, n=19), amyotrophic lateral sclerosis (ALS, n=15), cerebellar degeneration (n=4) and Lewy body dementia (n=1). Of these studies, largely based on prevalent cases from retrospective data on urban populations, half originated from Nigeria and South Africa. The prevalence of dementia (Alzheimer disease) varied between <1% and 10.1% (0.7% and 5.6%) in population-based studies and from <1% to 47.8% in hospital-based studies. Incidence of dementia (Alzheimer disease) ranged from 8.7 to 21.8/1000/year (9.5 to 11.1), and major risk factors were advanced age and female sex. HIV-related neurocognitive impairment's prevalence (all from hospital-based studies) ranged from <1% to 80%. Population-based prevalence of PD and ALS varied from 10 to 235/100,000, and from 5 to 15/100,000 respectively while that for Huntington disease was 3.5/100,000. Equivalent figures for hospital based studies were the following: PD (0.41 to 7.2%), ALS (0.2 to 8.0/1000), and HD (0.2/100,000 to 46.0/100,000). CONCLUSIONS: The body of literature on neurodegenerative disorders in SSA is large with regard to dementia and HIV-related neurocognitive disorders but limited for other neurodegenerative disorders. Shortcomings include few population-based studies, heterogeneous diagnostic criteria and uneven representation of countries on the continent. There are important knowledge gaps that need urgent action, in order to prepare the sub-continent for the anticipated local surge in neurodegenerative diseases

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke - the second leading cause of death worldwide - were conducted predominantly in populations of European ancestry(1,2). Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis(3), and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach(4), we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry(5). Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries.</p

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke — the second leading cause of death worldwide — were conducted predominantly in populations of European ancestry1,2. Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis3, and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach4, we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry5. Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries

Median Nerve Conduction in Healthy Nigerians: Normative Data

Background: Because of lack of local normative data, electrodiagnostic laboratories in Nigeria apply standard values generated in the USA and Europe to diagnose different median nerve abnormalities. Aim: To develop normative values for motor and sensory median nerve conduction studies (NCSs) in Nigerian population. Subjects and Methods: In a cross‑sectional study design, a total of 200 healthy volunteers were selected after clinical evaluation to exclude systemic or neuromuscular disorders. NCS of the median nerves was conducted on all the healthy volunteers according to a standardized protocol. The data included in the final analysis were amplitude, latency, and nerve conduction velocity. Ethical approval was obtained for the study. Results: The reference range for median nerve (motor) velocity, distal latency, and amplitude were 49.48–66.92, 1.95–4.52, and 4.3–11.3, respectively. The reference range for median nerve F‑wave latency was 44.8–70.5. The reference range for median nerve (sensory) velocity, distal latency, and amplitude were 44.8–70.5, 1.98–4.52, and 16.6–58.4, respectively. Conclusion: Reference values for the nerve conduction parameters of the median (motor and sensory) in the study population were similar to those obtained in the literature.Keywords: Median nerve, Nerve conduction studies, Normal value