Stroke mortality and its predictors in a Nigerian teaching hospital

BackgroundStroke is the third leading cause of death worldwide. Stroke mortality has been noted to be higher in blacks in biracial studies. There have been few studies on stroke mortality and its predictors in Nigeria. This study examines mortality of stroke and its predictors in a Northern Nigerian teaching hospital.MethodsThis was a prospective study that was carried out at Jos University Teaching Hospital in Nigeria. One hundred and twenty stroke patients admitted into the medical wards within one year were assessed. Demographic data was recorded. Patients were examined and ancillary investigations were carried out. The deaths and predictors were recorded. Multivariate logistic regression was used to identify independent predictors of mortality.ResultsThere were one hundred and twenty participants. Forty two (35%), patients died. Most (76.2%) deaths occurred within the first week. Predictors of mortality on univariate analysis were age ≥ 60 years, male sex, loss of consciousness, high NIHSS score (≥16), the presence of co-morbid conditions and presence of complications. On multivariate analysis, the predictors of mortality were the presence of co-morbid conditions, GCS<10 and high NIHSS score.ConclusionStroke mortality was quite high in this study. Predictors of mortality were the indices of severity and the presence of co-morbid conditions.     

Informant reports of changes in personality predict dementia in a population-based study of elderly african americans and yoruba.

OBJECTIVE: The authors conducted a longitudinal, population-based survey of African Americans in Indianapolis, Indiana, and Yoruba in Ibadan, Nigeria, using the Community Screening Interview for Dementia to assess the predictive value of informant reports of changes in personality on incident dementia and Alzheimer disease. METHODS: In all, 3,021 subjects had informants' reports of changes in personality and dementia status (2,084 subjects residing in Ibadan and 937 subjects residing in Indianapolis). RESULTS: After adjusting for demographic, cognitive, and functional characteristics in two markedly different populations, socioeconomically and culturally, subjects with changes in personality had approximately twice the odds of having dementia as subjects with no change in personality. CONCLUSION: The finding that in two markedly different populations, personality change is a significant predictor of future dementia, independent of cognition and functional status, should make clinicians particularly sensitive to these reports when they occur in their elderly patients.     

Development and clinimetric testing of willingness to pay tool for physiotherapy

Background: Lack of technical knowledge on Willingness to Pay (WTP) for health services may have contributed to paucity of WTP studies in physiotherapy.

Objective: To develop and establish clinimetric properties of WTP tool for physiotherapy.

Methods: A WTP tool with five sections exploring information on socio-demographics, physiotherapy experience, satisfaction with physiotherapy, cost of physiotherapy services and patients’ preferences for physiotherapy was developed. The WTP tool was tested for content validity, readability and thereafter completed on test–retest after one-week interval by 97 consenting physiotherapy outpatients. Intra-class correlation coefficient (ICC) with 95% confidence intervals and Cronbach’s alpha (α) were used to assess the data for reliability and internal consistency.

Results: The tool's readability indicated a Flesch-Kincaid Grade Level and Reading Ease scores of 5.6 and 66.7 respectively. ICC for aggregate score of ‘patients’ satisfaction’ was ‘moderate’ (0.644, p?<?0.05), while the ‘cost of physiotherapy services’ section was ‘excellent’ (0.837, p?<?0.05). The internal consistency of the ‘satisfaction with physiotherapy’ (0.783, p?<?0.05) and ‘cost of physiotherapy services’ (0.911, p?<?0.05) sections were ‘excellent’. The stability of the different sections of the instrument over one week period, as reflected by the ICC, ranged from ‘poor’ to ‘excellent’. Also, the Cronbach’s alpha and the ICC for the WTP characteristics were ‘poor’ to ‘excellent’, respectively.

Conclusion: The WTP tool for physiotherapy appears comprehensible and reliable among patients with chronic conditions attending the physiotherapy clinic. Availability of this WTP tool will promote studies examining the demand for physiotherapy services.     

APOE epsilon4 is not associated with Alzheimer's disease in elderly Nigerians

Since 1992, research teams from Indiana University and the University of Ibadan have been collecting and comparing data from two diverse, elderly populations to identify risk factors for dementia and Alzheimer's disease. Apolipoprotein E (APOE) was genotyped in 2,245 Nigerian samples. Of these, 830 had a diagnosis: 459 were normal, and 140 had dementia including 123 diagnosed with Alzheimer's disease. In contrast with other populations, the APOE epsilon4 allele was not significantly associated with Alzheimer's disease or dementia. This lack of association in the Yoruba might reflect genetic variation, environmental factors, as well as genetic/environmental interactions.     

Management of ovarian lesions diagnosed during infancy

PurposePrior studies of infant ovarian cysts have recommended intervention for those larger than 4 cm. We reviewed the natural history and features of those managed operatively versus nonoperatively.MethodsA retrospective study was performed of ovarian lesions in children < 1 year-old from 2000 to 2014.ResultsForty patients were identified. Twenty-eight (70%) underwent operative management, while 12 (30%) were managed conservatively, including one undergoing aspiration. The mean age at surgery was 125 days. All but one patient (96%) had evidence of antenatal torsion intraoperatively or on final pathology. All resected lesions were benign. Ultrasound findings more common in those undergoing surgery included intracystic debris (p < 0.001), fluid–fluid or fluid–debris levels (p = 0.002), absence of Doppler flow (p = 0.014), solid components (p = 0.04), and calcifications (p = 0.001). Cysts managed nonoperatively had an average diameter of 2.5 cm, compared to 5.1 cm in the operative group (p < 0.001). Three of the lesions managed nonoperatively had a diameter greater than 3.5 cm (mean 5.1 cm) and were followed for an average of 153 days until resolution.ConclusionsThe majority of infant ovarian lesions were excised, although none were malignant. Aspiration or observation of larger cysts was feasible and safe. Ovarian cysts in this age group should be considered for nonoperative management and closely followed.Level of evidenceIIC.     

Conditions associated at death with specific types of completed stroke in patients with and without hypertension: a case-control study

Potential risk factors for various types of stroke were studied using a case-control study design. All 1978 US death certificates for which the registered underlying cause of death was subarachnoid hemorrhage (SAH), cerebral hemorrhage (CH), or cerebral infarction (CI) were identified. The frequency with which other conditions appeared on the death certificates of cases with and without hypertension was compared with controls. These data provide new information, such as the occurrence of peripheral vascular disease in association with SAH, the risk of CH in epileptic and cirrhotic patients, and the association of benign neoplasms of the nervous system, motor neuron disease, and 'paralysis agitans' with CI.     

Ectopic pregnancy in a defined Nigerian population

All cases of ectopic pregnancy in the Ile-Ife teaching hospital between 1977 and 1987 were reviewed. The incidence per 1000 births was 4.76, and this condition accounted for 2.75% of all gynecological admissions. The associated mortality was low (0.5%). An increasing incidence was observed during the study period, as was an increasing proportion of nulliparous patients. Tubal damage from pelvic infections might account for the trends.