Background: Chronic kidney disease (CKD) has become a public health concern and may be complicated by cognitive impairment (CI) contributing significantly to morbidity and poor prognosis. This hospital-based study aimed at determining the prevalence and the determinants of CI among CKD patients in Nigeria. Materials and Methods: A total of 190 CKD patients and a 100 healthy control subjects completed this cross-sectional study. Sociodemographic data and history of common clinical features of CKD were obtained with the use of interviewer administered semi-structured questionnaires. The six-item cognitive impairment test was used for assessment of cognitive function of patients and controls. Results: The prevalence of CI in Stages 3, 4, and 5 CKD patients were 24.0%, 41.6%, and 46.2%, respectively with overall prevalence of 35.3% while only 6.0% of controls had CI (P = 0.03). The most potent determinants of CI were low hematocrit (odds ratio [OR] =3.50), low serum bicarbonate levels (OR = 2.20), and high serum urea (OR = 2.11). Conclusion: CKD is associated with significant CI in Nigerian patients especially with progressive deterioration in renal function. There is a need for regular evaluation of CKD patients for cognitive deficits.

Background: Stroke in young adults is relatively uncommon. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most valuable tools for the diagnosis of stroke. Recent data on stroke in young adults in Nigeria is sparse. The aim of this study is to document the imaging pattern in young patients aged 15-45 years with suspected cerebrovascular accidents (CVA) in the Nigerian environment. Materials and Methods: This was a retrospective study of 69 patients aged 15-45 years, with clinical diagnosis of stroke, referred for neuro-imaging, from October 2008 to November 2013. All patients with the clinical diagnosis of stroke within this age group were recruited into the study. Images were obtained from a four slice channel general electric CT machine and a 0.2 Tesla Siemens Magnetom Concerto MRI scanner. Results: A total of 69 patients (44 males and 25 females) were studied. Sixty out of 69 (87.0%) patients were accurately diagnosed with CVA, with 9 (13.0) cases of misdiagnoses. A total of 21 (35%) out of the 60 cases confirmed on imaging had intracerebral hemorrhage (ICH), 10 (16.7%) had subarachnoid hemorrhage (SAH) and 29 (48.3%) had cerebral infarct (CI). Hypertension was the common risk factor for all stroke subtypes. The most common location for ICH, was the basal ganglia in 8 (38.8%), while the commonest pattern for CI, was lacunar infarct in the basal ganglia (51.7%). Conclusion: The incidence of hemorrhagic CVA (ICH and SAH combined) was slightly higher than ischemic CVA in this study. Lacunar infarcts in the basal ganglia and also ICH in the basal ganglia were the most common patterns, both are strongly linked to hypertension. A diagnostic protocol of stroke in young adults, to include neuroimaging and other ancillary investigations is advocated for stroke in young adults as some of the etiologies are treatable.

Objective: The objective was to develop a case-pattern model for Lassa fever (LF) among humans and derive predictors of time-trend point distribution of LF cases in Liberia in view of the prevailing under-reporting and public health challenge posed by the disease in the country. Materials and Methods: A retrospective 5 years data of LF distribution countrywide among humans were used to train a time-trend model of the disease in Liberia. A time-trend quadratic model was selected due to its goodness-of-fit (R² = 0.89, and P < 0.05) and best performance compared to linear and exponential models. Parameter predictors were run on least square method to predict LF cases for a prospective 5 years period, covering 2013-2017. Results: The two-stage predictive model of LF case-pattern between 2013 and 2017 was characterized by a prospective decline within the South-coast County of Grand Bassa over the forecast period and an upward case-trend within the Northern County of Nimba. Case specific exponential increase was predicted for the first 2 years (2013-2014) with a geometric increase over the next 3 years (2015-2017) in Nimba County. Conclusion: This paper describes a translational application of the space-time distribution pattern of LF epidemics, 2008-2012 reported in Liberia, on which a predictive model was developed. We proposed a computationally feasible two-stage space-time permutation approach to estimate the time-trend parameters and conduct predictive inference on LF in Liberia.

Background: Epilepsy audit provides positive feedback to physicians that could assist in improving the quality of health care services provided for patients. This study was carried out to evaluate care given to people with epilepsy with the aim of determining potentials for improvement. Materials and Methods: Medical records of patients with uncomplicated epilepsy who have attended the neurology clinic at the University of Ilorin Teaching Hospital for not less 12 months between years 2011and 2013 were reviewed. Results: A total of 125 patients were as evaluated; of which 64 (51%) were males and 61 (49%) were females. Their median age was 26 (21-40) years and median seizure duration of 9 (4-15) years. Close to 65% of the patients were below 30 years of age. Most patients (68%) were referred by general practitioners/family physicians. Generalized epilepsy was the predominant seizure type seen in 73 (58%) patients. Majority of patients (76%) were on antiepileptic drug (AED) monotherapy, and 28 (22%) were on two AEDs combination. Eighty-one patients (64%) used carbamazepine either singly (63%) or in combination (18%) at an average dose of 600 mg/day. The two other common AEDs used were: Sodium valproate (45%) and phenobarbitone (9%). Fifty-one patients (41%) had good seizure control (no seizure in preceding 1 year), 34 (27%) had partial control (<12 attacks/year) and 41 (36%) had poor control (>1 attack/month). Overall, 66 patients (48%) had their medication changed between 2 and 3 times in the course of treatment, and the most common reason was poor seizure control. Twenty-one (21%) did not comply with the use of given AED. Conclusions: Less than half of our patients had good epilepsy control. To improve on drug compliance attending physicians need to prescribe more of the relatively cheaper AED like the phenobarbitone and to optimize drug dosage before switching to another.

Background: There is a complex inter-relationship between sleep disorders and epilepsy, and there are few studies in Nigeria on sleep disorders in epilepsy. This study was carried out to determine the prevalence, pattern and predictors of sleep disturbances among persons with epilepsy (PWE). Materials and Methods: This was a multi-center, cross-sectional study of 124 PWE in Nigeria. A questionnaire was used to collect data on social and demographic variables, epilepsy- related variables and sleep disturbances in PWE. Exclusion criteria were mental retardation, and use of sedative drugs. The data was analyzed using Statistical Package for Social Sciences version 11.0 and P < 0.05 was considered as significant. Results: There were 77 males and 47 females with a mean age of 33.4 ± 13.1 years. The mean age of seizure onset was 23.7 ± 14.6 years, while the mean duration of epilepsy was 9.5 ± 9.4 years. The commonest type of epilepsy was secondarily generalized tonic-clonic seizures (62%). The prevalence of sleep disorders in PWE was 82%. Parasomnias occurred in 46%, followed by obstructive sleep apnea in 23%, insomnia (19%) excessive daytime sleepiness (EDS) (17%), and restless leg syndrome (11%). None of the socio-demographic or epilepsy- related variables was predictive of EDS or parasomnias in PWE (P > 0.05). Conclusion: There is a high frequency of sleep disorders among PWE. Clinicians should screen PWE for sleep disturbances.

Context: Optic atrophy is a clinical sign and not a disease. The etiology of optic atrophy is diverse, some of which may be life threatening. Patients and Methods: A retrospective review of the medical records of all adult patients aged 16 years and above with nonglaucomatous optic atrophy at the eye clinic of the University of Benin Teaching Hospital over a 4-year period was conducted. Results: One hundred and four patients had nonglaucomatous optic atrophy. There were 58 males and 46 females with a male:female of 1.3:1. Their ages ranged from 16 to 83 years with a mean age of 49.2 ± 17.74 years. Majority (75%) of the patients were in the age range of 31-70 years. One hundred and fifty-seven eyes were affected with bilateral involvement in 53 patients. The etiology was unknown in 47 (45.2%) patients. Choriodoretinal disease 24 (23.1%), trauma 14 (13.5%), toxic-nutritional 8 (7.7%) and compressive lesions 5 (4.8%) were the most common among the known etiologies. Conclusion: Optic atrophy is the end result of injury to the anterior visual pathway from a myriad of disease processes. A broad knowledge of the etiology of optic atrophy is needed to make a diagnosis .

Background: When there is an insurgency, the use of force in the form of weaponry, is employed. This may lead to the total breakdown of law and order, resulting in destruction of life and property. Health workers may be killed or captured, and, health facilities destroyed or stretched beyond their functional capacity. This is a report of experience with injuries seen in a tertiary hospital in north eastern Nigeria, under an insurgency situation. Materials and Methods: After obtaining clearance from the medical Ethics Committee of UMTH, we reviewed the case files of all patients treated for injuries sustained as a result of the Boko Haram insurgency from January 2009 to December 2013. Those brought in dead, were not included in the study. Results: We reviewed the case files, theatre notes, admission and discharge registers of 1339 cases. 1223 (91.3%) of the victims were males, while 116 (8.7%) were females. Gunshot wounds accounted for 1229 (91.8%) of the injuries, bomb blast 90 (6.7%), others 15 (1.1%) knife (Cut throat) 4 (0.3%) and road traffic accident 1 (0.01%). Casualties were made up of civilians 1144 (85.4%), the joint task force (a force made up of the Military, Police, Customs and Immigration, against the insurgents) 117 (8.7%), and insurgents 22 (1.6%). The ages of the patients ranged from 1 to 80 years, peaking at the 21-40 age brackets (796 or 59.4%). The extremities were most affected, 734 (54.8%), followed by the torso 423 (31.6%), multiple injuries 93 (6.9%) and head and neck 89 (6.6%). 1226 (91.6%) of the victims survived while 113 (8.4%) died from their injuries. This followed massive blood loss from injuries to the torso 69 (61.1%) multiple injuries 15 (13.3) and extremities 6 (5.3%). Others causes were fatal injuries to the head and neck 22 (19.5%) and 90% burns following bomb blast 1 (0.9%). Conclusion: Injuries resulting from insurgency will continue to be a problem in many developing countries because their health facilities in terms of personnel and materials are ill prepared for such a situation .