Seizure variables and cognitive performance in patients with epilepsy

Background and Purpose Epilepsy is highly prevalent in developing African countries with significant morbidity, social stigmatization, poor quality of life and preventable mortality. There are scanty reports on the contributions of seizure variables like seizure types, frequency of seizures, duration of epilepsy, age at onset and anti-epileptic drugs to cognitive disturbances in Nigerian Africans. This study assessed the effects of seizure variables on the cognitive performances of patients with epilepsy. Methods The cognitive functions of 41 patients with epilepsy and 41 controls were assessed with a computerassisted cognitive test battery, Iron Psychology (acronym - FePsy) using the simple and complex reaction time tasks for mental speed, recognition memory test (RMT) for memory and continuous performance test for attention. Results The cognitive performances of the patients using complex reaction time and the recognition memory tasks were worse than those of the controls (pConclusions The seizure variables negatively affected cognitive performances of Nigerian patients with epilepsy. Cognitive assessment is recommended as part of regular evaluation of patients with epilepsy

Agricultural Productivity Growth and Incidence of Poverty: An Experience from Africa

This study investigates the effects of agricultural productivity growth on poverty.  Using Food and Agriculture Organisation (FAO) data covering two decades (1971-2009) we determined the relationship between agricultural productivity and poverty. Malmquist Index Total Factor Productivity (TFP) was used as indicator of agricultural productivity while Human Development Index (HDI) was adopted as proxy for poverty. Further analysis was carried out to determine whether the performance of factor productivity is due to change in technology or technical efficiency. The result of Malmquist TFP index analysis showed that the average TFP growth over the period was found to be 0.2 percent per annum with large variation in growth rate across the sampled countries.  Twenty-two countries representing about 52% of the total sample experienced productivity growth and this is largely due to technological change.  Congo and Somalia experienced decline in growth and this may be attributed to the incidence of war and civil unrest which have adverse effect on growth.  Overall, the continent experienced improvement in technology with 2.1 percent upward shift in the production frontier and 1.8 percent decline in efficiency.  Regional comparison of agricultural productivity growth reveals that East, South and North Africa experienced growth of 3.3, 2.6 and 3.6 percent respectively.  There were declines in agricultural productivity in West and Southern Africa regions as a result of reduction in efficiency. The analysis of agricultural productivity growth on poverty shows a positive and significant relationship between indicators of the two variables.  Specifically, the result indicates that a unit increase in productivity growth will lead to 0.69 percent change in human development index and conversely poverty.  Further analysis revealed that the unit improvement in technological change will cause about 1.3 percent improvement in human development index. The study concludes that agricultural productivity growth is pro-poor and effective strategy to reduce poverty in Africa.  It is recommended that relevant policies to address the constraints to technology progress and efficiency should be promoted to improve productivity growth and reduce poverty. Key Words: Malmquist index, Total Factor Productivity, Technology, Efficiency, Agricultural Productivity, Poverty, Africa

Frailty and mortality among older patients in a tertiary hospital in Nigeria

Background: This study determined the frailty status and its association with mortality among older patients.Design: A prospective cohort design.Setting: Study was conducted at the medical wards of University College Hospital, Ibadan, Nigeria. Participants and study tools: Four hundred and fifty older patients (>60 years) were followed up from the day of admission to death or discharge. Information obtained includes socio-demographic characteristics and clinical frailty was assessed using the Canadian Study of Health and Aging (CSHA) scale. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05.Results: Overall, frailty was identified in 285 (63.3%) respondents. Mortality was significantly higher among frail respondents (25.3%) than non-frail respondents (15.4%) p=0.028. Logistic regression analysis showed factors associated with frailty were: male sex (OR=1.946 [1.005–3.774], p=0.048), non-engagement in occupational activities(OR=2.642 [1.394–5.008], p=0.003), multiple morbidities (OR=4.411 [1.944–10.006], p<0.0001), functional disability (OR=2.114 [1.029–4.343), p=0.042], malnutrition (OR=9.258 [1.029–83.301], p=0.047) and being underweight (OR=7.462 [1.499–37.037], p=0.014).Conclusion: The prevalence of frailty among medical in-hospital older patients is very high and calls for its prompt identification and management to improve their survival.Keywords: Frailty, Mortality, Older patients, in-hospital, NigeriaFunding: The study was self-funded by the author

Impairment of pneumococcal antigen specific isotype-switched IgG memory B-cell immunity in HIV infected Malawian adults

Pneumococcal disease is associated with a particularly high morbidity and mortality amongst adults in HIV endemic countries. Our previous findings implicating a B-cell defect in HIV-infected children from the same population led us to comprehensively characterize B-cell subsets in minimally symptomatic HIV-infected Malawian adults and investigate the isotype-switched IgG memory B-cell immune response to the pneumococcus. We show that similar to vertically acquired HIV-infected Malawian children, horizontally acquired HIV infection in these adults is associated with IgM memory B-cell (CD19+ CD27+ IgM+ IgD+) depletion, B-cell activation and impairment of specific IgG B-cell memory to a range of pneumococcal proteins. Our data suggest that HIV infection affects both T-cell independent and T-cell dependent B-cell maturation, potentially leading to impairment of humoral responses to extracellular pathogens such as the pneumococcus, and thus leaving this population susceptible to invasive disease.Oluwadamilola H. Iwajomo, Adam Finn, Abiodun D. Ogunniyi, Neil A. Williams, Robert S. Heyderma

The Contribution of Dysphagia to Acute Stroke Morbidity and Mortality in Nigeria: A Prospective Study

Background: The assessment of time-trend morbidity and mortality in acute stroke is critical to clinical policy decisions and resource allocation. Objectives: To determine the prevalence of dysphagia in acute stroke and the impact of dysphagia on short term stroke outcome (30 days post-stroke). Methods: This was a prospective longitudinal study. Bedside screening for dysphagia modified Rankin score (MRS) and Barthel Index (BI) were performed on acute stroke patients on day 1, day 7, day 14 and day 30 after stroke to determine the frequency of dysphagia. Patients with dysphagia were then compared with age- and gender-matched controls (stroke patients without dysphagia) in terms of stroke characteristics and 30-day outcome. Results:Of the recruited 200 patients, 99 (49.5%) had dysphagia. Patients with intracerebral haemorrhagic stroke had a significantly higher prevalence of dysphagia (64% vs 36%; p Conclusion: Severe stroke, subcortical stroke and haemorrhagic stroke types were significantly associated with dysphagia at baseline. Dysphagia adversely influenced 30-days morbidity and case fatality in this cohort of acute stroke patients

Time of presentation of stroke patients for CT imaging in a Nigerian tertiary hospital

Background: Neuroimaging is the cornerstone for guiding thrombolytic and interventional therapy for stroke. Beneficial outcome can only be obtained within a rather short time of less than 3-4.5 hours of symptom onset. Challenges in developing countries like Nigeria often lead to delayed presentation of stroke patients in hospitals. We sought to study the time and pattern of presentation of stroke patients for CT imaging in a Nigerian tertiary hospital.Methods: Of the 271 stroke patients who had cranial CT between 2008 and 2010, eighty-three (30.6%) with full retrievable CT records, were included in this study. They were categorized into six time groups cross-tabulated with their CT findings.Results: Forty-two patients (50.6%) had cerebral infarction while 23 (27.7%) had haemorrhagic stroke. However, 18 (21.7%) patients had apparently normal CT findings. The mean presentation time for CT imaging was 70 hours (SD ±94 hours). Only 31% of all stroke patients presented for CT imaging within 12 hours, and none, within 3 hours. Forty-six percent did not present within 24 hours of symptom onset. Significantly more patients with ischemic stroke (72.3%) than hemorrhagic stroke (27.7%) presented after 12 hours of ictus (X2 = 4.027 d=1, P =0.045). Age (X2=0.008, P =0.931) and gender (X21.742, d=1,P =0.187) had no statistically significant relationship with the time of presentation for CT imaging.Conclusion: None of our patients met the time criteria for thrombolytic therapy. Ischemic stroke patients presented for imaging later than patients with intracerebral haemorrhage. There is a need to increase the awareness regarding early recognition, presentation and diagnosis of stroke for timely intervention in Nigeria.Keywords: Time, Stroke, CT Imaging, Nigeri

Group B Streptococcus Carriage during Late Pregnancy in Ile-Ife, Nigeria

This study determined the prevalence of Group B Streptococcus (GBS) in late pregnancy and the antimicrobial susceptibility of isolated GBS as well as the impact of GBS infections on pregnancy related clinical outcome with a view of providing an epidemiological baseline data for policy formulation in the teaching hospital. It is an observational and cross-sectional hospital based study. One hundred and fifty pregnant women from 35-40 weeks of gestation were purposively selected and included in the study from May to December 2010. Vaginal swab samples were aseptically collected from the subjects after informed consent. The samples were assayed for presence of GBS. The susceptibility pattern of the isolated GBS to different antibiotics were assessed using disc diffusion and agar dilution techniques based on the Clinical and Laboratory Standards institute(CLSI) standards. The result showed prevalence of 11.3% GBS vaginal colonization which increased with age. There was no significant association between GBS colonization status and age (p >0.05)), gestational age (p >0.05)), gravidity (p >0.05) and obstetric risk factors (p >0.05)). There was no incidence of GBS infection observed. Although, all (17) the GBS isolates were 100% resistance to penicillin, ampicillin, cefoxitin and clindamycin. Resistance to cefotaxime (11.8%), erythromycin (64.7%) and vancomycin 70.6% were observed. Group B Streptococcus colonization in vagina in late pregnancy has been established in the antenatal clinic of the teaching hospital with the attendant risk to the fetus in the population of those affected. There were high and multiple resistance patterns of the GBS isolates to different antibiotics in this study. This calls for a review of the present hospital policy to include the routine screening of GBS during antenatal visits and surveillance

Urinary Pathogens and Their Antimicrobial Susceptibility in Patients with Indwelling Urinary Catheter

The indwelling urinary catheter (IUC) is the most significant risk factor for developing nosocomial urinary tract infections (UTIs). In order to determine the spectrum of bacterial etiology and antibiotic resistance pattern of uropathogens causing catheter associated UTI, a convenient sample size of ninety-two (92) patients on urethral catheter was investigated. Ethical approval for the study was obtained from the OAUTHC research and ethical committee. Catheter stream urine samples were obtained from all patients and cultured on appropriate culture media. Suspected isolates were identified by a combination of standard tests and using MICROBACT GNA12A/B/E. Susceptibility of the isolates against thirteen (13) antibiotics was performed by the disc diffusion method. Significant bacteriuria was observed in 60.9% (56) catheter specimen urine (CSU) received, while 39.1% (36) were culture negative. Of the 56 positive culture, the predominant organisms were Klebsiella oxytoca, 28.6 %( 16), Proteus vulgaris, 23.2% (13) and Staphylococcus aureus, 12.5% (7). Overall, the antimicrobial susceptibility results showed that all the isolates were highly resistant to the antibiotics tested. Over 50% resistance was recorded for trimethoprim/sulfamethoxazole, gentamicin and amoxicillin/clavulanic acid. More than 25% of the isolates were resistant to nitrofurantoin. This study indicates that catheter stream UTI caused by multiply resistant bacteria are common in our hospital. There is a need to establish standard guidelines on the care of catheter for all units in the hospital with a view to preventing nosocomial infections associated with the use of the catheter in patients. We also advocated prudent use of antibiotics. Key words: Antibiotic resistance, Urinary catheter, Uropathogens, Urinary tract infectio

Funding, Communication and Marketing as Correlates of Library Service Delivery to Persons With Hearing Impairment, PWHI, in Nigeria

This study investigated the extent to which funding, communication and marketing predict library service delivery to Persons With Hearing Impairment, PWHI, in Nigeria. Descriptive survey research design was adopted. Two states were randomly selected from each of North-Central, North-West, South-South and South-West geo-political zones. They are the Federal Capital Territory, FCT, Abuja, Niger State, Kaduna State, Kebbi State, Edo State, Delta State, Oyo State and Ondo State respectively. FCT was considered a state in the study because, it has a standard facility for the research. One school of the deaf with standard library was randomly selected from each of the eight states. Purposive sampling technique was used to select the Federal College of Education (Special) Oyo, being the only higher institution for special students in Nigeria, and also to select one public library from each of the eight states. Moreover, random sampling technique was used to select one academic library from each of the eight states. Finally, purposive sampling technique was used to select one each of central market, church, mosque in the states capital so as to interview the public PWHI. Total enumeration sampling technique was used to select 687 respondents comprising 218 senior class two students, 148 NCE III students of FCE (Special) Oyo, who made use of PWHI resources in the college library, 8 school of the deaf librarians, 13 FCE (Special) librarians, 97 academic librarians, 48 public librarians and 168 pubic PWHI. Three instruments were used: Library Service Delivery to Students with Hearing Impairment Questionnaire (x=0.84) (Students), Library Service Delivery to People with Hearing Impairment Questionnaire (x=0.81) (librarians) and Interview Checklist (x=0.69) (Public PWHI). Data were analysed using descriptive statistics, Pearson’s product moment correlation and multiple regression

Prognosis of non traumatic coma: The role of some socio-economic factors on its outcome in Ibadan, Nigeria

Background : Coma occurring in the course of an illness, irrespective of cause, traditionally implies a poor prognosis and many factors may determine its outcome. These factors must be identified and possibly stratified in their order of importance. This research seeks to identify these factors and how they influenced the outcome of non-traumatic coma in our environment. Methods : Two hundred consecutive patients, aged 18-79 years who met the inclusion criteria, the Glasgow coma scale (GCS) score of < 8, history and physical findings suggestive of medical illness, no head trauma or sedation, were recruited into the study from August 2004 to March 2005 at the University College Hospital (UCH), Ibadan, after obtaining institutional ethical clearance and consent from patients\u2032 guardians. Detailed history of illness including the bio-data and time to present to the hospital and treatments given were noted. Thereafter, the clinical course of the patients was monitored daily for a maximum of 28 days during which the support of the family and/ or the hospital social welfare was evaluated. Results : During the 8-month period of the study, 76% (152) of the patients died while 24% (48) survived. The following factors were associated with high mortality rate: inability to confirm diagnosis (100%), poor family support (97.1%), delay in making a diagnosis within 24 h (85.4%), poor family understanding of disease (84.1%), need for intensive care admission and management (83.3%), poor hospital social welfare support (82.4%), presentation to UCH after 6 h of coma (76.7%), and referral from private health facilities (75.7%). Others include substance abuse (100%) and seropositivity to HIV (96%) and hepatitis B surface antigen (92%) antibodies, among others. Conclusion : This study has demonstrated that socio-economic factors such as gender, occupation, risky lifestyle behaviors, late presentation or referral to hospital, late diagnosis and treatment, and poor family support contributed to poor outcome of nontraumatic coma. It is hoped that improvement, modification, or correction of these factors may improve coma outcome