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

Assessment of respiratory symptoms and lung function among textile workers at Kano Textile Mills, Kano, Nigeria

Background: The number of textile industries in Nigeria with large work force is on the rise. There is thus the need to assess medical challenges of its workers, one of which is respiratory ailments. Although much has been written about the subject globally, only few studies have been done in Nigeria. This study aims to address this gap.Objective: A cross-sectional study was undertaken to determine the prevalence of respiratory symptoms and pulmonary functions among Textile Workers in Kano, Nigeria.Materials and Methods: A cross sectional study was done, Two hundred male workers exposed to raw cotton dust and its end products in a Textile Company and 200 unexposed workers with similar age- and gender-matched were investigated. Their forced vital capacity (FVC), forced expiratory volume in one second (FEV11), and peak expiratory flow rate (PEFR) were determined with a flow-sensing spirometer and Wright's peak flow meter.Results: Exposed workers generally complained of cough, phlegm production, rhinitis, wheezing, chest pain, and breathlessness. Unexposed worker has a significant lower frequency (P < 0.001) of symptoms as well as higher (P < 0.001) forced vital capacity (FVC), forced expiratory volume in one second (FEV11), and peak expiratory flow rate (PEFR) than exposed workers. The reduction in ventilatory function of exposed from predicted values for Nigerian men was significantly higher (P < 0.001) than unexposed workers. The smokers among the exposed and unexposedworkers had significantly lower lung function values than nonsmokers.Conclusion: Respiratory symptoms were more prevalent among workers in most dusty sections of the factory. Use of protective mask should be enforced. Workers in the spinning and weaving sections of the company compared with workers in other sections had the lowest lung function indices

Case Report - Histoplasmosis: An elusive re‑emerging chest infection

An immunocompetent patient presenting with disseminated histoplasmosis and superior vena cava obstruction. Features at presentation were in keeping with tuberculosis. Histology of bronchoalveolar lavage specimen clinches the diagnosis of histoplasmosis

Microcystin Prevalence throughout Lentic Waterbodies in Coastal Southern California.

Toxin producing cyanobacterial blooms have increased globally in recent decades in both frequency and intensity. Despite the recognition of this growing risk, the extent and magnitude of cyanobacterial blooms and cyanotoxin prevalence is poorly characterized in the heavily populated region of southern California. Recent assessments of lentic waterbodies (depressional wetlands, lakes, reservoirs and coastal lagoons) determined the prevalence of microcystins and, in some cases, additional cyanotoxins. Microcystins were present in all waterbody types surveyed although toxin concentrations were generally low across most habitats, as only a small number of sites exceeded California's recreational health thresholds for acute toxicity. Results from passive samplers (Solid Phase Adsorption Toxin Tracking (SPATT)) indicated microcystins were prevalent throughout lentic waterbodies and that traditional discrete samples underestimated the presence of microcystins. Multiple cyanotoxins were detected simultaneously in some systems, indicating multiple stressors, the risk of which is uncertain since health thresholds are based on exposures to single toxins. Anatoxin-a was detected for the first time from lakes in southern California. The persistence of detectable microcystins across years and seasons indicates a low-level, chronic risk through both direct and indirect exposure. The influence of toxic cyanobacterial blooms is a more complex stressor than presently recognized and should be included in water quality monitoring programs

Microcystin Prevalence throughout Lentic Waterbodies in Coastal Southern California.

Toxin producing cyanobacterial blooms have increased globally in recent decades in both frequency and intensity. Despite the recognition of this growing risk, the extent and magnitude of cyanobacterial blooms and cyanotoxin prevalence is poorly characterized in the heavily populated region of southern California. Recent assessments of lentic waterbodies (depressional wetlands, lakes, reservoirs and coastal lagoons) determined the prevalence of microcystins and, in some cases, additional cyanotoxins. Microcystins were present in all waterbody types surveyed although toxin concentrations were generally low across most habitats, as only a small number of sites exceeded California's recreational health thresholds for acute toxicity. Results from passive samplers (Solid Phase Adsorption Toxin Tracking (SPATT)) indicated microcystins were prevalent throughout lentic waterbodies and that traditional discrete samples underestimated the presence of microcystins. Multiple cyanotoxins were detected simultaneously in some systems, indicating multiple stressors, the risk of which is uncertain since health thresholds are based on exposures to single toxins. Anatoxin-a was detected for the first time from lakes in southern California. The persistence of detectable microcystins across years and seasons indicates a low-level, chronic risk through both direct and indirect exposure. The influence of toxic cyanobacterial blooms is a more complex stressor than presently recognized and should be included in water quality monitoring programs

Cross-sectional study evaluating the impact of SARS-CoV-2 variants on Long COVID outcomes in UK hospital survivors

OBJECTIVES: COVID-19 studies report on hospital admission outcomes across SARS-CoV-2 waves of infection but knowledge of the impact of SARS-CoV-2 variants on the development of Long COVID in hospital survivors is limited. We sought to investigate Long COVID outcomes, aiming to compare outcomes in adult hospitalised survivors with known variants of concern during our first and second UK COVID-19 waves, prior to widespread vaccination. DESIGN: Prospective observational cross-sectional study. SETTING: Secondary care tertiary hospital in the UK. PARTICIPANTS: This study investigated Long COVID in 673 adults with laboratory-positive SARS-CoV-2 infection or clinically suspected COVID-19, 6 weeks after hospital discharge. We compared adults with wave 1 (wildtype variant, admitted from February to April 2020) and wave 2 patients (confirmed Alpha variant on viral sequencing (B.1.1.7), admitted from December 2020 to February 2021). OUTCOME MEASURES: Associations of Long COVID presence (one or more of 14 symptoms) and total number of Long COVID symptoms with SARS-CoV-2 variant were analysed using multiple logistic and Poisson regression, respectively. RESULTS: 322/400 (wave 1) and 248/273 (wave 2) patients completed follow-up. Predictors of increased total number of Long COVID symptoms included: pre-existing lung disease (adjusted count ratio (aCR)=1.26, 95% CI 1.07, 1.48) and more COVID-19 admission symptoms (aCR=1.07, 95% CI 1.02, 1.12). Weaker associations included increased length of inpatient stay (aCR=1.02, 95% CI 1.00, 1.03) and later review after discharge (aCR=1.00, 95% CI 1.00, 1.01). SARS-CoV-2 variant was not associated with Long COVID presence (OR=0.99, 95% CI 0.24, 4.20) or total number of symptoms (aCR=1.09, 95% CI 0.82, 1.44). CONCLUSIONS: Patients with chronic lung disease or greater COVID-19 admission symptoms have higher Long COVID risk. SARS-CoV-2 variant was not predictive of Long COVID though in wave 2 we identified fewer admission symptoms, improved clinical trajectory and outcomes. Addressing modifiable factors such as length of stay and timepoint of clinical review following discharge may enable clinicians to move from Long COVID risk stratification towards improving its outcome

Transformation, adaptation and development: relating concepts to practice

In recent years there has been a growing number of academic reviews discussing the theme of transformation and its association with adaptation to climate change. On the one hand this has stimulated exchange of ideas and perspectives on the parameters of transformation, but it has also given rise to confusion in terms of identifying what constitutes a non-incremental form of adaptation on the ground. What this article aims to do instead is help researchers and practitioners relate different interpretations of transformation to practice by proposing a typological framework for categorising forms of change that focuses on mechanisms and objectives. It then discusses how these categorisations link to the broader conceptions and critiques noted above, with the idea that this will enable those who seek to analyse or plan adaptation to better analyse what types of action are potentially constitutive of transformation. In doing so, it should equally assist in the identification and specification of critical questions that need to be asked of such activity in relation to issues of sustainability and equity. As the term transformation gains ground in discussions of climate change adaptation, it is necessary to take a step back, review quite what commentators mean when they use the word, and consider the implications on people, especially the most vulnerable and marginalised, of “doing” or promoting transformation in its different forms

Pulmonary function tests in patients with Parkinsonfs disease: A case.control study

Background: In Parkinsonfs disease (PD), morbidity and mortality are commonly caused by respiratory disorders from pulmonary function impairments. Aim: The study aims to evaluate pulmonary functions in  a cohort of patients with PD in comparison with age..and sex.matched control.Methods: Pulmonary function test (PFT) was conducted using the Spirolab Spirometry kit, and results of forced vital capacity (VC), forced expiratory volume 1 (FEV1), FEV1/VC, and peak expiratory flow rate (PEFR) were obtained from 78 PD patients and 78 healthy controls.Results: A total of 78 patients and 78 age-and sex-matched control comprising 60 (76.9%) males and 18 (23.1%) females were evaluated. The mean age ± standard deviation of the patients were 62.32 ± 8.67 and 62.31 ± 8.66, respectively; the difference in their age was not statistically significant (P = 0.993). The majority (38.5%) of the patients was in stage II of Hoehn and Yahr of PD. Vital capacity (VC) in PD patients and control was 2.481 and 3.106; the difference was statistically significant (P < 0.0001). The mean FEV1 in PD patients and control were 1.887 and 2.494; the difference was statistically significant (P < 0.0001). The mean FEV1/VC percent in PD patients and control were 75.812 and 80.303; the difference was statistically significant (P < 0.0001). The mean PEFR in PD patients and control were 45.58 and 67.46; the difference was statistically significant (P < 0.0001). Considering PD arm of the study, withthe exception of FEV1/VC, there was significant negative correlation between all the parameters of PFT and patients age (VC, FEV1, PEFR, r = .422 and P = 0.0001, r = .391 and P = 0.0001, and r = .0.244 and P = 0.031, respectively).Conclusion: In this study, the values of the evaluated PFTs (VC, FEV1, FEV1/VC, and PEFR) parameters were signi.cantly lower in PD compared with age..and sex.matched control.Key words: Nigeria, Parkinsonfs disease, pulmonary function

Clinical profile and outcome of adult tetanus in Kano

Introduction: Though tetanus is rare in the developed countries of the world, it remains a major public health hazard in the developing world like Nigeria despite availability of inexpensive vaccine. We undertook a 6-year study of all tetanus cases managed at two tertiary centres in Kano.Methodology: Demographic and clinical data of all adult tetanus patients managed at Aminu Kano Teaching Hospital and Murtala Muhammad Specialist Hospital, Kano between January 2004 to December 2009 were collected and analyzed.Results: A total of 146 patients were admitted in the two facilities out of which complete data was obtained from 126 patients. All patients had generalised tetanus. There were 93 (73.8%) males and 33 (26.2%) females. Their age ranges between 17 and 62 years; mean (35.2 ± 1.3) years. Majority of the patients were in the age bracket of 21 – 30 years with most (50.8%) being farmers. The most common portal of entry was leg wound while portal of entry was not identifiable in 37 (29.4%) patients. Incubation period was less than 48 hours in 46 (51.7%) and period of onset was less than 48 hours in 64 (50.8%) patients. Aspiration pneumonitis and laryngospasm were documented complications in 12 (9.5%) and 26 (20.6%) of the patients, respectively. The overall mortality rate was 46%.Conclusion: Tetanus remains an important disease with substantial mortality in Kano. The males and farmers are most frequently affected. The overall mortality rate was 46% with the value being highestamong severe (87.2%) and the very severe (92.3%) cases