Psychiatric morbidity in stroke patients attending a neurology clinic in Nigeria

Back ground

Stroke produces a wide range of mental and emotional disorders. Neuropsychiatric complications associated with stroke may have negative effects on the social functioning, overall quality of life and the recovery of motor functioning of stroke survivors.

Objective

To determine the prevalence and nature of psychiatric morbidity among stroke patients attending neurology outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria.

Methods

All patients with stroke aged 18 years and above at an outpatient neurology clinic in Ilorin, Nigeria were assessed for mental and emotional disorders using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) over one year (March 2009 to February 2010).

Results

Overall prevalence of psychiatric morbidity was 36.0% (30/83) among 83 patients who constituted the study population. Specific diagnoses recorded were depression (19.2%), generalised anxiety disorder (9.6%), harmful alcohol use (2.4%); dementia, somatoform disorder, phobia and delusional disorder each had a prevalence of 1.2%. Clinical and sociodemographic variables were not significantly associated with psychiatric morbidity.

Conclusion

Psychiatric disorders are often associated with stroke. Identifying and treating stroke patients with these psychiatric co-morbidities could thus help to improve the overall quality of life of these patients.     

Effects of alcohol on systemic and pulmonary hemodynamics in normal humans

Even at low doses, alcohol has been reported to impair left ventricular pump function. To characterize further the effects of alcohol on the normal cardiovascular system, using the Swan-Ganz thermodilution catheter, we studied 6 healthy physicians, aged 27-36 years, while they were lightly intoxicated. Within a period of 30 min the subjects ingested 0.5 g/kg of ethanol diluted to 15% (w/v) in fruit juice. Hemodynamic measurements were obtained before the first ingestion and every half-hour thereafter for 2 hours. A peak blood ethanol concentration (mean +/- SE) of 13.3 +/- 1.6 mmol/l (0.61 mg/dl) was recorded at 60 min. Unexpectedly, pulmonary artery pressure rose during the early part of the increasing blood ethanol phase, probably due to pulmonary vascular constriction. At 30 min, the systolic pulmonary artery pressure had increased by 10% (p less than 0.05) and the diastolic pressure by 14% (p less than 0.001); both returned to baseline levels by the end of the experiment. Calculated pulmonary vascular resistance rose from a baseline value of 0.50 +/- 0.30 to 0.85 +/- 0.34 units (p less than 0.01) at 30 min. Left ventricular preload decreased significantly during the declining blood ethanol phase: mean pulmonary capillary wedge pressure decreased from 12 +/- 3 to 10 +/- 2 mmHg (p less than 0.01), and mean right atrial pressure decreased significantly. This study suggests that alcohol causes changes in cardiac function by altering its loading conditions. The combined diuretic and systemic venodilatory actions of alcohol provide the most probable explanation for the decrease in preload.     

Comparison of new alcohol use test, the Helsinki Alcohol Use Test questionnaire, and Alcohol Use Disorders Identification Test and laboratory markers serum gamma-glutamyl transferase and carbohydrate-deficient transferrin

The purpose of the present study was to compare and evaluate the new Helsinki Alcohol Use Test (HAUT) and Alcohol Use Disorders Identification Test (AUDIT) as screening instrument in the general working population. The relationship between the HAUT and serum gamma-glutamyl transferase (GGT), and carbohydrate-deficient transferrin (CDT) was also evaluated. Our results seem to indicate that the HAUT has good performance as screening instrument for alcohol-related problems in the general population.     

The fixation properties of carbon fiber-reinforced liquid crystalline polymer implant in bone: an experimental study in rabbits

A novel composite material with ultra-high strength and a low elastic modulus called carbon fiber-reinforced liquid crystalline polymer (LCP/CF) has been developed. We studied the fixation properties of an intramedullary LCP/CF rod in rabbit bone. The medullary canals of both femora were reamed with a drill 3.2 mm in diameter starting from the trochanteric fossa in eleven New Zealand White rabbits weighing on average 4.8 kg. A smooth LCP/CF rod 3.2 mm in diameter and 50 mm in length was introduced into the medullary canal of both femora. The follow-up intervals were 0, 6, 12, and 52 weeks. The upper part of the harvested femora was cut into two pieces, each 25 mm in length. A mechanical push-out test was performed within 48 h to determine bone-implant interface attachment strength in the proximal (cancellous) and distal (cortical) locations. The mean push-out strength values at 0, 6, 12, and 52 weeks were 61, 250, 382, and 612 KPa in the cancellous location and 0, 32, 41, and 68 KPa in the cortical location, respectively. The strength of the bone/implant interface appeared to be quite low, similar to other uncoated or nonporous implants, but it was found to increase with time.     

Controlled trial of continuous inflating pressure for hyaline membrane disease

A controlled trial of elective intervention with continuous inflating pressure (CIP) was performed in infants with severe hyaline membrane disease who weighed more than 1000 g at birth. Infants entered the trial if their arterial oxygen tension (PaO2) fell below 60 mmHg while breathing a fractional inspired oxygen concentration (F1O2) greater than 0-95. 11 out of 12 infants in the CIP-treated group and 10 out of 12 in the control group survived. 7 treated and 6 control infants required mechanical ventilation. When CIP was started the Pao2 of the treated infants increased, and they breathed high concentrations of oxygen for a significantly shorter period than the control infants. During the 31-month duration of the trial 107 other infants with severe hyaline membrane disease were admitted who did not meet the criteria for entry to the trial. 37 survived after breathing high concentrations of oxygen (F1O2 greater than 0-60) spontaneously without any ventilatory assistance, and the remaining 70 infants were already being ventilated on their arrival in the unit, usually because they had required mechanical ventilation during transfer from other hospitals. The neonatal survival rate for those infants born in this hospital during the study period was 88% (50 out of 57 infants) and for those referred from other hospitals it was 69% (51 out of 74 infants). The maximum further increase in overall survival rate that might have been achieved in our population of infants if CIP had been initiated very early in the course of the illness was 5%--i.e. from 77% (101/131) to 82% (107/131).     

Thrombosis at venous insertion sites after inferior vena caval filter placement

Color Doppler flow imaging or compression ultrasound (US) was used to prospectively determine frequency of thrombosis at 54 venous insertion sites (47 in common femoral veins, seven in right internal jugular veins) after percutaneous placement of Greenfield filters for interruption of the inferior vena cava. Fifty-one filters were successfully placed in 51 patients with a dilator set or a balloon angioplasty catheter. Nine focal thrombi were detected in the common femoral vein (19%) and one in the right internal jugular vein (14%). Use of dilators induced eight thrombi (24%), compared with two (10%) from balloon catheters. The left common femoral vein had a high frequency of thrombosis, regardless of dilation technique (five of nine). Of nine patients with acute common femoral vein thrombosis, four became symptomatic within 10 days after the procedure. Patients may remain asymptomatic or have delayed symptoms; thus, US is valuable for determining patients at risk of thrombosis of the common femoral vein.