Sexual Dysfunction in a Nigerian Stroke Cohort: A Comparative Cross-Sectional Study

Sexual dysfunction is common among individuals who are post-stroke but this rarely attracts attention among clinicians during stroke management. The aim of this study was to assess prevalence of sexual dysfunction among Nigeria stroke survivors and their age and sex matched healthy controls, and determines the correlates of sexual dysfunction among stroke survivors. A comparative cross-sectional study of 121 stroke survivors and sex matched 121 healthy controls completed 14-item Changes in Sexual Functioning Questionnaire. Associated factors with sexual dysfunction were assessed. Male and female stroke survivors of similar age and healthy controls participated in the study. The stroke survivors had significant lower sexual functioning with higher prevalence of sexual dysfunction (84%) compared with healthy controls (35%) and these remained unchanged when stratified by gender and sexual response cycles. Females had consistent significant higher prevalence of sexual dysfunction than their male counterparts either as a stroke survivor (95 vs. 75%) or a healthy individual (50 vs. 21%). Only increase in age and female gender were significant correlates of sexual dysfunction. Every one-year increase in age has a 6.7% (OR 1.067, CI 1.012–1.125) increase in odds of having sexual dysfunction among stroke survivors. Female stroke survivors compared with male were seven times (OR 6.934, CI 1.645–29.226) more likely to be sexually dysfunctional. In conclusion, the stroke survivors have significant lower sexual functioning and higher sexual dysfunction compared with apparently healthy controls which suggest that stroke impacted sexual functionality in post-stroke individuals. Being a female and/or with increase in age are significant associated factors to low sexual functioning.     

Association between periodontal diseases and systemic illnesses: A survey among internal medicine residents in Nigeria

Objective

To assess internal medicine residents’ knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients’ periodontal health.

Methods

A cross-sectional survey using a self-administered questionnaire was conducted among internal medicine residents attending the Faculty of Internal Medicine 2014 Update Course organized by the National Postgraduate Medical College of Nigeria. Participants came from all over the country. Data on respondents’ demographic characteristics, periodontal disease knowledge, knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients’ periodontal health were collected. Data were analyzed using Epi INFO software. The Pearson chi square test was used to measure significant association between categorical variables such as the knowledge of periodontal disease and gender, age group and designation of the participants (p ⩽ 0.05).

Results

Of 150 questionnaires distributed, 123 were returned (82% response rate); 109 questionnaires were completed properly and included in the analysis. The most common source of residents’ information on oral health was television (59.4%). Only 11.2% of respondents were aware that gingival bleeding was the earliest sign of periodontal disease. Respondents correctly identified periodontal disease as a risk factor for coronary heart disease (45.9%), stroke (43.5%), hospital-acquired pneumonia (53.2%), diabetes mellitus (13.8%), and preterm birth (11%). Increased age (p = 0.032) and male gender (p = 0.022) were associated significantly with knowledge of periodontal disease as a risk factor for stroke. Higher designation (p = 0.002) and longer duration in residency training (p = 0.004) were associated significantly with knowledge of periodontal disease as risk factor for peripheral arterial disease. The majority (90.9%) of respondents had positive attitudes toward the referral of their patients for regular periodontal care.

Conclusions

Knowledge of periodontal disease as a risk factor for systemic illnesses among medical residents in Nigeria is inadequate. These relationships should be emphasized in continuing medical education courses.     

Haematopoietic stem cell transplantation in Nigerian sickle cell anaemia children patients

Background:

Sickle cell anaemia (SCA) remains associated with high risks of morbidity and early death. Children with SCA are at high risk for ischaemic stroke and transient ischaemic attacks, secondary to intracranial arteriopathy involving carotid and cerebral arteries. Allogeneic haematopoietic stem cell transplantation (HSCT) is the only curative treatment for SCA. We report our experience with transplantation in a group of patients with the Black African variant of SCA.

Patients and Methods:

This study included 31 consecutive SCA patients who underwent bone marrow transplantation from human leukocyte antigen (HLA)-identical sibling donors between 2010 and 2014 following a myeloablative-conditioning regimen.

Results:

The median patient age was 10 years (range 2–17 years). Before transplantation, 14 patients had recurrent, painful, vaso-occlusive crisis; ten patients had recurrent painful crisis in association with acute chest syndrome; three patients experienced ischaemic stroke and recurrent vaso-occlusive crisis; two patients experienced ischaemic stroke; one patient exhibited leukocytosis; and one patient exhibited priapism. Of the 31 patients, 28 survived without sickle cell disease, with Lansky/Karnofsky scores of 100. All surviving patients remained free of any SCA-related events after transplantation.

Conclusion:

The protocols used for the preparation to the transplant in thalassaemia are very effective also in the other severe haemoglobinopathy as in the sickle cell anaemia with 90% disease free survival. Today, if a SCA patient has a HLA identical family member, the cellular gene therapy through the transplantation of the allogeneic haemopoietic cell should be performed. Tomorrow, hopefully, the autologous genetically corrected stem cell will break down the wall of the immunological incompatibility.     

Connective tissue disease-–associated interstitial lung disease: an underreported cause of interstitial lung disease in Sub-Saharan Africa

Clinical Rheumatology - Interstitial lung disease (ILD) occurs in 15% of connective tissue disease (CTD) patients causing considerable morbidity and mortality. Data is scarce regarding its clinical...     

Comparison of identification and antimicrobial resistance pattern of Staphylococcus aureus isolated from Amassoma,Bayelsa state,Nigeria

Background

Staphylococcus aureus is often responsible for fatal infections and recent upsurge of resistant strains has resulted in therapeutic failure. The identification of this microorganism is a major challenge to medical microbiologists in developing countries.

Methods

One hundred and eighty five isolates which had been previously isolated from the nares of 185 healthy college students'' volunteers in Amassoma, Bayelsa State, South Nigeria were identified by MALDI TOF mass spectrometry, and PCR amplification of the spa gene. The identified isolates were compared with presumptive identities obtained by growth on MSA, tube coagulation and slide agglutination tests. Antimicrobial susceptibility testing of S. aureus isolates was performed by Kirby Bauer technique while MRSA was screened for by growth on chromlDTM MRSA plate and confirmed by PCR-amplification of mecA/mecC genes.

Results

From the 185 staphylococci that grew with yellow colonies on MSA, 24 were positive in the slide coagulase test, while 17 were positive in the tube coagulase test; MALDI TOF mass spectrometry and PCR amplification of the spa gene showed excellent concordance with the tube test, as all tube coagulase-positive strains were identified as S. aureus, while tube coagulase-test negative isolates in all cases were designated as other staphylococcal species by MALDI-TOF mass spectrometry and were spa PCR test negative. All S. aureus isolates were susceptible to clindamycin, vancomycin, fusidic acid, rifampicin and linezolid, while observed resistance to penicillin and trimethoprim were high. Only one MRSA strain was detected

Conclusion

The study confirms that the tube coagulase test is an accurate diagnostic method for identification of S. aureus, while growths on MSA and slide agglutination tests are inaccurate. We found a low prevalence of MRSA and a high rate of trimethroprim-resistance in the studied population.     

Focal segmental glomerulosclerosis and nephrotic syndrome in a child with embryonal rhabdomyosarcoma

A case of nephrotic syndrome (NS) and acute renal failure (ARF) associated with embryonal rhabdomyosarcoma (RMS) in a 10-year-old boy is reported. Ultrasound revealed irregular, echogenic, circumferential urinary bladder base mass, bilateral hydroureter and hydronephrosis. Histopathology of percutaneous renal and urethrocystoscopic biopsy specimens, respectively, revealed focal segmental glomerulosclerosis (FSGS) and embryonal RMS. Tumour remission was induced with pulse doses of intravenous vincristine, cyclophosphamide, methotrexate and actinomycin D over a 15-month period. He has been followed-up for 28 months and has maintained a drug-free tumour and proteinuria remission for 1 year. While some malignancies have been reported in association with NS, its occurrence in association with RMS is quite exceptional. We conclude that RMS may be associated with FSGS and NS. Effective treatment of the RMS was associated with sustained remission of the nephrotic proteinuria.     

Central nervous system congenital malformations in a developing country: issues and challenges against their prevention

Background

Little efforts are geared towards prevention of CNS anomalies in the developing countries.

Methods

A 1-year prospective cross-sectional analysis of the cases of CNS congenital anomalies seen in a Nigerian neurosurgical unit. This included both the children’s and parents’ sociodemographics, the profiles of the CNS anomalies, and the maternal obstetric health behaviors toward primary and/or secondary prevention of the anomalies. Statistical analysis was done with the Pearson’s chi-square (or Fishers’ exact) test. Level of significance set at P?<?0.05.

Results

There were 54 cases of cranial and spinal gross CNS anomalies, including 32 neural tube defects; two thirds of the parents were low-income earners, and half had only basic education. Thirty percent of the pregnancies were unbooked; the mean gestational age (GA) at booking and commencement of obstetric micronutrient supplementation was 4.6 months. No case had periconceptional folic acid supplementation. Obstetric ultrasonography was performed late in pregnancy (mean GA 6 months), made positive diagnosis of CNS anomaly in only 14%, and was performed mainly in unsupervised private clinic settings in 98%.

Conclusions

Little or no attention is currently paid to the prevention of CNS congenital anomalies in much of the low- and middle-income countries of the world. There is a great need to regulate the practice of obstetric ultrasonography in Nigeria. There is even a much greater, more fiercely urgent need to ensure periconceptional folic acid supplementation for all women of childbearing age through appropriate food fortification in these societies.