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.     

Vernal keratoconjunctivitis and intestinal parasitic infestations in black children

The study aimed at finding out any association between vernal keratoconjunctivitis (VKC) and intestinal worm infestations in black children in Nigeria. This is a report of a case-control study of a total of 117 cases of VKC and 198 controls, who were newly presenting to two hospitals in Ibadan. The controls were comparable to the cases in many respects. While 67 (57%) of cases admitted to previous passage of worms, 59 (50.5%) children actually had parasitic infestations. Of these 59 children, 30 (51%) were due to roundworm, 12 (20%) to hookworm, 14 (24%) to protozoal infestation and others, e.g., tapeworms, 13 (5%). Among controls, 36.8% had parasitic infestation, out of which roundworms were responsible for 11.6%, hookworms 7.6%, protozoa 14.1% and others 3.5%. Children with VKC have almost twice (odds ratio = 1.68) the risk of having been infested by worms. Both older age in children and roundworm infestation were not independent risk factors for VKC. There was no significant association among all ages, sex, hookworm and other worms with VKC. Deworming may prove beneficial for children with VKC; however, more studies with appropriate design are required to prove this.     

Retinoblastoma presenting with a cheek mass

This is a report of a case of retinoblastoma that mimicked Burkitt's lymphoma by presenting with a left proptosis and a right cheek mass. With the aid of fine-needle aspiration cytology, the diagnosis was established as retinoblasstoma and a left modified exenteration was performed. The patient had adjuvant chemotherapy and radiotherapy to the left orbit and the right maxilla with regression. At 12 months postoperatively, there was no evidence of recurrence, and the patient was still hale and hearty. In conclusion, this patient had left retinoblastoma with metastasis to the contralateral jaw. It is important to note that orbital Burkitt's lymphoma can be a differential diagnosis of retinoblastoma.     

Ophthalmic assessment in black patients with vitiligo

The objective of this study was to describe and estimate the prevalence of pigmentary disturbances occurring in the eyes of patients presenting with vitiligo in a teaching hospital in Ibadan, Nigeria. Patients presenting with vitiligo to the dermatology clinic of the University College Hospital between March and December 2001 were referred to the eye clinic of the same hospital for ophthalmic evaluation. Patients were assessed by visual acuity, intraocular pressure, refraction, slit-lamp biomicroscopic evaluation of the anterior segments and funduscopic examination of the two eyes. Visual fields estimation was done using the Goldman's perimeter. A total of 26 patients were referred to the eye clinic. Of these, only 17 patients were considered evaluable for the study. There were seven males and eight females. The age range was 5-30 years. The largest extent of vitiligo recorded in the study population was 25% of the body surface area. The duration of the vitiligo was two months to 3 1/4 years. None of the patients complained of any visual disturbance. All ophthalmologic assessment profiles were normal for all patients. One of the patients had poliosis. No pigmentary disturbance of the eyes was noticed in any of our patients. Pigmentary changes were not seen in these groups of blacks with vitiligo.     

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.