Challenges to Thrombolysis in A Resource-Poor Setting- A Case Report

A major complication of acute ischemic stroke is death and disability. The emergence of reperfusion therapy in form of thrombolysis and endovascular thrombectomy has led to the reversal of this trend in high-income countries. Low- and middle-income countries are yet to benefit maximally from these time-bound treatment options due to some limitations. We intend to highlight some of these in this report. We report an 80-year-old male patient with hypertension and firstdegree AV block admitted 3 hours after the onset of stroke with National Institutes of Health Stroke Scale (NIHSS) score of 13 and Medical Research Council (MRC) muscle power grade 3 in both the left upper and lower limb. Urgent non-contrast brain CT revealed no evidence of hemorrhage. Intravenous tissue plasminogen activator (tPA) was administered at a dose of 0.6 mg/kg 9 hours after symptom onset. He made significant improvement afterward and was discharged. The challenges encountered in his management include prehospital and intrahospital delay, and unavailability of tissue plasminogen activator. There is a need for an improved healthcare delivery system in order to reduce the morbidity associated with acute ischemic stroke.

Neurocritical Care in Nigeria

Nigeria is the most populous country in Africa with an estimated 206 million inhabitants served by less than 300 neurologists and 131 neurosurgeons. Neurological conditions account for approximately 18% of all medical emergencies. Neurocritical care challenges in Nigeria are as complex as they are in other low-to-middle-income countries (LMICs). These include high burden of neurological diseases, poor pre-hospital care, delays in transfer, lack of neurocritical care equipment, and inadequate rehabilitative capacity. Neurocritical care units in Nigeria offer mostly limited multimodal monitoring due to out-of-pocket payment, and the success of repeat radiological imaging and blood work is low. Data gathering and outcome research in neurocritical conditions can help in clinical decision-making and enhance cost-effective clinical care. The concept of allocation requires that when medical resources are scarce, they must be efficiently utilized in the most judicious way so as to achieve the greatest possible benefit. A high degree of transparency is needed with regard to the principles, values and criteria employed to facilitate such triage decisions. Proper funding will help improve availability of equipment and drugs resulting in a higher quality of care and, subsequently, improvement in mortality. There is ample evidence that neurocritical care improves overall prognosis in neurocritically-ill patients. Neurocritical care units (NCCUs) are mostly unavailable in Nigeria, often resulting in poorer prognosis for patients. What is already known: Nigeria has an unacceptably huge deficit in the overall capacity for neurocritical care. The inadequacies affect a wide range of components - facilities, quantity and quality of personnel, and the unbearably high cost, among others. What this study adds: This article attempts to condense the challenges in one piece while highlighting previously obscure ones, with the aim of providing possible solutions to the lingering challenges in neurocritical care in Nigeria and, invariably, other LMICs. How this study might affect practice, policies or research: We envisage this article will stimulate the initial steps in a multipronged and data-driven approach to bridging the gap by government and relevant healthcare administrators.

10-Year Risk of Developing Type 2 Diabetes Mellitus: A Survey of Rural Communities in Southern Nigeria

BACKGROUND

The exponential rise in the prevalence of Type 2 Diabetes (T2DM) necessitates the introduction of strategies for early diagnosis to reduce the burden of the disease. This study assessed the prevalence of prediabetes and also determined the 10-year risk of developing T2DM in Southern Nigerian rural communities by adopting the validated Finnish Diabetes Risk Score (FINDRISC) tool.

METHODS

273 participants from 3 Southern rural communities aged 18 years and older were recruited in this cross-sectional study. Data in the FINDRISC stratification tool and Random Blood Glucose (RBG) variables were obtained for the participants. IBM SPSS version 21 was used to analyze the data with a level of significance put at p < 0.05.

RESULTS

The participants' mean age was 54.20±16.61 years. The prevalence of prediabetes among the study participants based on RBG was 4.8% (3.8% of males and 6.6% of females, respectively). Most of the study participants (41%) had a low risk of developing T2DM which meant that 1 in 100 participants would become diabetic in a 10-year period, based on the FINDRISC scale. Amongst the male participants, the Total Diabetes Risk Score (TDRS) showed significant positive correlation with the RBG (r=0.315, p=0.001); similarly, a weak positive correlation between TDRS and RBG was noted among female participants.

CONCLUSION

The propensity of developing T2DM in 10 years was indisputably low amongst rural dwellers in the Southern Nigerian rural communities studied. Further studies to compare the risk of developing T2DM between rural and urban communities would be required.

Nigerian resident doctors' work schedule: A national study

Background and Aim

The deleterious effects of Resident Doctors' (RDs') long duty hours are well documented. Driven by concerns over the physician's well-being and patient safety, the RDs' duty hours in many developed countries have been capped. However, in Nigeria and many African countries, there are no official regulations on work hours of RDs. This study evaluated the work schedule of Nigerian RDs and its impact on their wellbeing and patient safety.

Subjects and Methods

A national survey of 1105 Nigerian RDs from all specialties in 59 training institutions was conducted. With an electronic questionnaire designed using Google Forms, data on the work activities of RDs were obtained and analyzed using the IBM SPSS software version 24. The associations were compared using Chi-squared test with the level of significance set at < 0.05.

Results

The mean weekly duty hours (h) of the RDs was 106.5 ± 50.4. Surgical residents worked significantly longer hours than non-surgical residents (122.7 ± 34.2 h vs 100.0 ± 43.9 h; P < 0.001). The modal on-call frequency was two weekday on-calls per week (474, 42.9%) and two weekend on-calls per month (495, 44.8%), with the majority of RDs working continuously for up to 24 hours during weekday on-calls (854, 77.3%) and 48-72 hours during weekend on-calls (568, 51.4%), sleeping for an average of only four hours during these on-calls. The majority of RDs had post-call clinical responsibilities (975, 88.2%) and desired official regulation of duty hours (1,031, 93.3%).

Conclusion

The duty hours of Nigerian RDs are currently long and unregulated. There is an urgent need to regulate them for patient and physician safety.

Tramadol-Induced Acute Seizures: A Report of Three Cases

There is a rise in substance abuse in Nigeria and prescription drugs, particularly opioid analgesics, which are increasingly becoming a target of abuse. Abuse of the opiod tramadol has the potential to precipitate seizures. We present 3 cases of tramadol-induced seizures presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. The three patients were men, aged 22-40 years and abused other drugs including alcohol, cannabis and Rohypnol. This report illustrates the fact that tramadol abuse may be associated with acute seizures and it is reasonable to consider drug/opiod-induced seizure in every case of unexplained first episode of seizure in a young adult.

Functional properties of sesame (Sesamum indicum Linn) seed protein fractions

Abstract

This work evaluated the functional properties of sesame protein fractions in order to determine their potential in food applications. Sesame seed protein fractions were prepared according to their solubility: water-soluble (albumin), salt-soluble (globulin), alkaline-soluble (glutelin) and ethanol-soluble (prolamin). Globulin was the most abundant fraction, consisting of 91% protein, followed by glutelin, albumin and prolamin in decreasing order. Non-reducing sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) showed polypeptides of sizes ≥20 kDa for albumin while glutelin and globulin had similar polypeptide sizes at 19, 85 and 100 kDa. Prolamin had polypeptide sizes 20, 40 and 100 kDa. The albumin and globulin fractions had higher intrinsic fluorescence intensity (FI) values than the glutelin. Albumin had a higher solubility (ranging from 80 to 100%) over a wide pH range when compared with the other fractions. Water holding capacity (g/g) reduced from 2.76 (glutelin) to 1.35 (prolamin) followed by 0.42 (globulin) and 0.08 (albumin). Oil holding capacity (g/g) reduced from: 4.13 (glutelin) to 2.57 (globulin) and 1.56, 1.50 for albumin and prolamin respectively. Gelling ability was stronger for prolamin and glutelin than albumin and globulin, while higher emulsion (p < 0.05) quality was obtained for prolamin and albumin than for glutelin and globulin.

Graphical abstract

Cardiac autonomic neuropathy in adult epilepsy patients in a tertiary hospital in South-Western Nigeria

BACKGROUND

Cardiac autonomic neuropathy (CAN) resulting from seizures has been implicated in sudden unexpected death in epilepsy in persons with epilepsy (PWE), however, there are no previous studies of CAN in PWE from Nigeria.

OBJECTIVES

This study sought to determine the frequency and pattern of CAN in adult PWE in a tertiary hospital in South-western Nigeria and to determine the relationship between seizure variables and CAN.

METHODS

A cross-sectional study of 80 adult PWE and 80 matched controls aged between 18 and 60 years was carried out between March 2012 and June 2013 at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Demographic and clinical data were obtained from all the study participants. Anxiety was excluded using the Hamilton Anxiety Scale. Those with conditions that could affect autonomic function, such as chronic renal failure, heart failure, Parkinson's disease, diabetes mellitus, anxiety, and psychiatric disorders and pregnant women were excluded. Five bedside cardiovascular reflex tests were performed on each subject after baseline heart rate and blood pressure (BP) had been recorded.

RESULTS

The mean age of onset of epilepsy was 19 ± 10 years, whereas the mean duration of epilepsy was 10 ± 8 years. The mean seizure frequency was 14 ± 30 per month (median three seizures per month). Of the 80 patients evaluated, 42 (52.5%) had CAN, whereas none of the controls had CAN. Majority (69%) of the PWE with CAN had purely parasympathetic dysfunction, whereas 3% had purely sympathetic dysfunction and 10% had combined autonomic dysfunction. The PWE in this study had significantly lower tilt ratios and diastolic BP change with Isometric Hand grip as well as significantly higher systolic BP change on standing than the controls. Patients who had more than four seizures per month had higher odds of CAN than those with less frequent seizures (odds ratio 0.275, P value 0.023). Also, patients who had received treatment for less than 10 years were found to have greater odds of CAN than those who had received treatment for a longer period (odds ratio 11.676, P value 0.046).

CONCLUSION

CAN is common in adult PWE in South-Western Nigeria and the major predictors are short duration of treatment and frequent seizure episodes. Routine screening of these patients may help with early detection of autonomic dysfunction and provide an opportunity for intervention.

Effects of thermal processing on the nutritional and functional properties of defatted conophor nut (Tetracarpidium conophorum) flour and protein isolates

Conophor nut (Tetracarpidium conophorum) was processed using different heat treatments to explore its full potential as food ingredients. The raw, boiled, and toasted nuts were defatted and the proteins isolated by alkaline solubilization and isoelectric precipitation. The variously processed nuts were analyzed for the proximate and amino acid compositions, and functional properties. The protein contents of the isolate ranges between 86.86 g/100g and 87.74 g/100 g, about 1.5-fold higher than those of the defatted flour samples. The essential amino acids of the isolates ranged between 40.57%-41.55%. Glutamic acid, aspartic acid, and arginine were the most predominant amino acids, while methionine and lysine were the first and second limiting amino acids, respectively. The protein efficiency ratio, biological values as well as the functional properties of the proteins were improved with processing. These properties may enhance the potential use of conophor nut protein isolates as high-quality protein ingredient in food systems.

Spinal Cord Studies in the African Giant Rat (Cricetomys gambianus, Waterhouse)

The African giant rat, AGR, is known for advantageous behavioural patterns among which are cognition and dexterous locomotion. This study investigated the morphological, morphometric and possible functional aspects of the AGR spinal cord (SC) anatomy. Ten adult (5 males and 5 females) AGR were used to determine the gross and histological features of the SC which were typically of rodent features. The mean SC weight and length given as 2.50±0.24g and 15.87±0.24cm respectively for the male and 2.32±0.16g and 15.40±0.61cm for the female showed no sexual dimorphism. A positive linear relationship between the tail length and SC weight were found in both sexes (r =0.81 males; r =0.95 females) suggesting significant contribution of the filum terminale to SC weight. Forty-three internal structures including nuclear aggregations and tracts were traced. Eight nuclear aggregations of neurons involved in nociception and limb coordination were observed to be prominent and larger than in laboratory rats. Same was noted for the dorsal, ventral and lateral funicular tracts which control the limbic system. This study provides morphometric baseline research information and delineates the functional aspects of the AGR SC anatomy. The information provided further strengthens the drive proposing the AGR as an indigenous research model for regional anaesthesia and locomotor disease.

Physiochemical characteristics of flours of faba bean as influenced by processing methods

Wet- and dry-processing with and without heating treatments were used to dehull faba beans for preparation of flours from the cotyledons. Flour qualities were assessed by levels of tannin and trypsin inhibitor and other measures of proximate composition. High roasting temperature and shorter process time that improved the recovered cotyledon yields were verified significant by path analysis methodologies. In turn, the higher cotyledon recoveries correlated with higher protein levels and inversely with the measured tannin levels. Ash reductions were correlated to the wet processing options in hull removal while reductions in the insoluble dietary fiber were notably influenced by level of heating temperatures applied. Trypsin inhibitor levels ranged from 42 to 56% of the original with reductions tied to applications of wet and/or heat processing in each case improved by increased durations and temperatures of treatments.