Validation Study of the Siriraj Stroke Score in North-east Nigeria

Background: The management and prognosis of stroke depends on the correct assessment of its pathological sub-type. It is therefore pertinent to have a simple and quick means of evaluating patients with stroke. The Siriraj stroke score (SSS) was developed in Thailand based on clinical parameters and have a good predictive value. This study aims at validating the Siriraj stroke score, as the predictive value of any diagnostic score depends on the prevalence of the disease in the community. Methodology: Patients who had stroke less than fourteen days before admission were enrolled into the study. Clinical variables for calculating the Siriraj stroke score were documented all patients subsequently had computerized tomography scan performed. A total of fifty patients were studied from University of Maiduguri Teaching Hospital and the State Specialist Hospital Maiduguri Results: Twenty-seven patients had infarction while twenty-three patients had hemorrhagic strokes respectively, based on the CT scan findings. The Siriraj stroke score correctly diagnosed fourteen as infarction and twenty as having hemorrhagic strokes, sixteen subjects were unclassified. The SSS correctly diagnosed thirteen cases as infarctive and seventeen as hemorrhagic strokes as confirmed by CT scan. The sensitivity and the predictive value of the SSS were 76.2% and 93% for infarction and 94.4% and 85% for hemorrhagic stroke respectively with overall accuracy of 84.6%. The clinical variables such as headache, vomiting and atheroma markers did not show discriminant value independently in differentiating CI and CH. However, level of Consciousness (coma) and diastolic blood pressure of greater than 110mmHg are discriminant variables in differentiating CI and CH. Conclusion: Siriraj stroke score is recommended to be used in this community especially where CT scan is not available or affordable and the physician wishes to start thrombolytic or/and anticoagulation therapy. Keywords: Stroke, Siriraj stroke score (SSS), North-east Nigeria Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 176-18

Awareness of warning signs among suburban Nigerians at high risk for stroke is poor: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Although stroke is a leading cause of morbidity and mortality in Nigeria, there is no information on awareness of its warning signs. This study was designed to assess awareness of stroke warning signs in Nigerians at increased risk.</p> <p>Methods</p> <p>A hospital-based cross-sectional study conducted at Irrua Specialist Teaching Hospital, in southern Nigeria. Patients with a diagnosis of hypertension, diabetes or both were interviewed for the warning signs of stroke in the outpatient clinic by trained interviewers. The main outcome measure was ability to identify at least one stroke warning sign.</p> <p>Results</p> <p>There were 225 respondents with a mean age of 58.0 ± 11.7 years. Only 39.6% could identify at least one stroke warning sign while the commonest sign identified was sudden unilateral limb weakness (24.4%). On multivariate logistic regression analysis, male sex (β = 0.26, 95% CI = 0.14–0.39, p < 0.001) and 11 or more years of education (β = 0.16, 95% CI = 0.03–0.29, p = 0.02) emerged the independent predictors of ability to identify at least one warning sign.</p> <p>Conclusion</p> <p>Awareness of stroke warning signs is poor among Nigerians at increased risk for the disease. Efforts should be made to improve on the level of awareness through aggressive health education.</p

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children &lt;18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p&lt;0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p&lt;0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p&lt;0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Production and use of two marine zooplanktons, Tigriopus japonicus and Diaphanosoma celebensis, as live food for red sea bream Pagrus major larvae

We evaluated the effectiveness of two representative marine zooplankton, the harpacticoid copepod Tigriopus japonicus and the euryhaline cladoceran Diaphanosoma celebensis, as live food for red sea bream Pagrus major larvae. Chicken-dropping extract (CDE) was applied to both zooplankton cultures to improve population growth. Population growth of both zooplankton was significantly enhanced by CDE supplementation (at 1 or 2 ml/l). The highest amount of docosahexaenoic acid (DHA) and higher DHA/eicosapentaenoic acid ratio were detected in T. japonicus, whereas D. celebensis showed similar values to that of Artemia. Effectiveness of both animals as live food was tested by rearing red sea bream larvae on them for 28 days and comparing the results with those for Artemia. There were no significant differences in total length (8.6 ± 1.1?8.7 ± 0.7 mm) or wet weight (8.2 ± 0.3?9.4 ± 0.1 mg) among fish larvae feeding on the three different zooplankton. Survival rate was significantly higher with T. japonicus (39.4 ± 3.1 %) than with D. celebensis (20.8 ± 3.8 %) and Artemia (16.7 ± 9.8 %). Viability was significantly higher in fish fed with T. japonicus (60.0 ± 27.8 %) and D. celebensis (60.0 ± 32.2 %) than in those fed with Artemia (44.4 ± 12.3 %). Fish fed with T. japonicus contained higher n-3 highly unsaturated fatty acids than those fed with D. celebensis and Artemia. It is concluded that T. japonicus and D. celebensis have high potential as live food in marine fish larviculture