Nura Hamidu Alkali

Objectives: Dyslipidemia is prevalent among Nigerians with diabetes mellitus (DM), but its treatment has not been well-studied. The objective of this study was to determine the prevalence, treatment rates and control of dyslipidemia among DM patients in northern Nigeria. Methods: We conducted a multicenter, cross-sectional study of dyslipidemia in DM patients, and noted cardiovascular disease (CVD) risk factors, lipid-lowering treatments, body mass index, blood pressure, HbA1c, lipid profile, glomerular filtration rate and proteinuria. Outcome measures were the rate and treatment of dyslipidemia and attainment of low density lipoprotein cholesterol target for primary prevention of CVD. Binomial logistic regression was used to analyze associations between participant characteristics and dyslipidemia. Hosmer-Lemeshow goodness-of-fit test was used to evaluate the model fit. Statistical analysis was performed with the SPSS version 25 program. Results: The study enrolled 403 participants (58.8% females), of whom 59.6% had dyslipidemia. Besides DM and dyslipidemia, other risk factors for CVD were hypertension (56.8%), obesity (52.6%), chronic kidney disease (36.5%), atrial fibrillation (7.9%), heart failure (5.0%), cigarette smoking (4.7%), excess alcohol use (2.0%), and previous CVD (14.4%). Logistic regression analysis showed dyslipidemia was significantly associated with female gender (odds ratio = 1.68, P = 0.029) and proteinuria (odds ratio = 2.26, P = 0.004). Among those with dyslipidemia, 51.3% took lipid-lowering treatments comprising statins (50.8%) and clofibrate (2.9%). None took other lipid-lowering treatments, and only 17.1% attained the target for primary prevention of CVD. Conclusion: Three-fifths of patients had dyslipidemia, but only a sixth attained the treatment target. Treatment for dyslipidemia included statins and fibrates, but not niacin, ezetimibe, bempedoic acid, icosapent ethyl, inclisiran or PCSK9 inhibitors recommended for those who failed intensive statin therapy. There is the need for better access to non-statin treatment and physician adherence to clinical practice guidelines.

Objectives: Dyslipidemia is prevalent among Nigerians living with diabetes, but the rate and extent of treatment have not been well-studied. The objective of this study was to determine the prevalence, treatment rates and control of dyslipidemia among diabetes patients in northern Nigeria. Methods: We conducted a multicenter, cross-sectional study of diabetes clinic patients. We noted cardiovascular risk factors, lipid-lowering treatments and examination findings, including body mass index, blood pressure, glycated hemoglobin, lipid profile, glomerular filtration rate and urinalysis. Outcome measures were the rate of dyslipidemia, the proportion of patients treated for dyslipidemia, and the proportion of patients with low density lipoprotein cholesterol goal and target for primary prevention of cardiovascular disease. Results: The study enrolled 403 participants (58.8% females), of whom 59.6% had dyslipidemia. Female gender and proteinuria were independently associated with dyslipidemia, with odds ratios of 1.74 and 2.26, respectively. Other cardiovascular risk factors of participants were hypertension (56.8%), obesity (52.6%), chronic kidney disease (36.5%), atrial fibrillation (7.9%), heart failure (5.0%), cigarette smoking (4.7%), excess alcohol use (2.0%), and previous cardiovascular disease (14.4%). In those with dyslipidemia, 51.3% took lipid-lowering treatments comprising statins (49.6%), clofibrate (1.7%) and statins combined with clofibrate (1.2%). None took other lipid-lowering treatments beside dietary control, probably due to high costs compared to statins. Only 17.1% of all participants attained the target for primary prevention of cardiovascular disease in people with diabetes. Conclusion: Most patients had dyslipidemia, which was more prevalent in females. Only a sixth of all patients had attained the treatment target. Treatment for dyslipidemia was limited to statins and fibrates, contrary to guideline recommendations for the use of ezetimibe, bempedoic acid, icosapent ethyl, or PCSK9 inhibitors for those who failed intensive statin therapy. There is a need for physician adherence to practice guidelines for the treatment of dyslipidemia, and improved access to treatment in northern Nigeria.

Objective: Epilepsy prevalence varies widely across Nigeria, with rates ranging from 3.1 to 37.0/1000 population. There have been no studies on epilepsy prevalence and treatment gap in the Northeast Region of Nigeria. This study aimed to study epilepsy prevalence and the epilepsy treatment gap (ETG) in an urban and a rural community in Northeast Nigeria. Design: Cross-sectional, community-based survey. Setting: Epilepsy screening of residents in two communities in Northeast Nigeria using a WHO screening tool and a validated study questionnaire from 1 March to 10 June 2022. Participants: 8599 community residents aged ≥2 years. Outcome measures: Prevalence of epilepsy, active epilepsy, ETG and associated factors. Results: We screened 8599 residents, of whom 88 had epilepsy. Crude epilepsy prevalence was 10.2 per 1000 and was three times higher in the rural than in the urban community (18.5 vs 6.4; χ ² =26.79, p2 =0.087, p=0.768). Logistic regression analysis showed that the ETG was associated with a lack of counselling (OR 15.8, 95% CI 3.5 to 70.7, p<0.001) but not a prior diagnosis of epilepsy, sex, age, marital status, urban versus rural residence or distance to the health centre ≥2 versus <2 km. Among 20 participants with epilepsy, electroencephalography suggested focal epilepsy in four participants, generalised epilepsy in eight and normal findings in eight, while brain CT scans in six participants were all normal. Conclusion: The prevalence of epilepsy in Bauchi State was within the range reported in Nigeria but three times higher in the rural than in the urban community. A high ETG was associated with poor counselling of people with epilepsy. Epilepsy counselling, health education and wider access to neurology services could reduce the burden of epilepsy in Northeast Nigeria.

Background: Physical exercise helps to mitigate cardiovascular risks in people with diabetes mellitus (DM), but there are limited data in Nigeria. This study aimed to assess cardiovascular risk awareness, exercise practices and metabolic outcomes among Nigerians with diabetes. Materials and Methods: We conducted a cross-sectional study at five tertiary hospitals using questionnaire interviews and clinical assessments. Participants’ knowledge of cardiovascular risk factors and knowledge of exercise were assessed on 12- and 5-item scores, while exercise practices were classed as adequate if performed regularly on 3 or more days weekly for a total of 150 min or more based on the American Diabetes Association recommendations. Mean body mass index (BMI), blood pressure (BP), fasting blood glucose, serum haemoglobin A1C (HbA1c), lipid profile, urea, creatinine and uric acid were then compared among participant groups. Results: We studied 426 participants with DM, 58.7% females. The mean age was 52.9 ± 13.1 years, with males significantly older than females (54.6 ± 12.2 vs. 51.8 ± 13.5 years; 95% confidence interval: 0.27–5.28, P = 0.03). The mean age at diabetes diagnosis was 44.8 ± 11.7 years, and the median duration of diabetes was 84 months. There was low knowledge of cardiovascular risk factors and low knowledge of exercise (mean scores of 2.94 and 2.31, respectively). Forty-three per cent of participants reported adequate exercise, which was significantly associated with younger age ( P = 0.007), male gender ( P = 0.001) and formal education ( P = 0.021). Participants with adequate exercise had lower systolic BP and serum urea compared to those with inadequate exercise, but there were no significant differences in BMI, fasting glucose, HbA1c, serum lipids, creatinine or uric acid. Conclusion: Participants had low knowledge of cardiovascular risks and the appropriate exercise practices for diabetes patients. There is a need for better patient education on diabetes self-care and exercise at clinic visits.

Stroke education programs at schools and colleges help to promote public knowledge of stroke, but the impact in Nigeria is not well known. This study assessed stroke-related knowledge and attitudes among university students in Nigeria, where health studies are parts of college curricula. This was a cross-sectional study of students at three universities in Northeast Nigeria. Using questionnaire survey, we assessed biographical data and participant knowledge of the primary site, warning signs and risk factors of stroke. Responses were graded on a knowledge score, where ≥2.5 points indicated adequate knowledge. Data were analyzed with the SPSS version 21 program. We studied 824 participants, 67.1% males. Males were older than females (mean age ± SD: 27.42±5.58 years versus 26.27±5.31 years; P = 0.009; 95% CI: 0.29 – 1.99) and 14.5% participants had stroke lectures during general studies. Major sources of stroke knowledge were personal discussions (44.6%) and internet websites (24.5%). Only 15.7% participants correctly identified the brain as the primary site of stroke, while knowledge of one or more stroke warning signs and risk factors were noted in 42.2% and 49.6%, respectively. Mean knowledge score was 1.08 ± 0.99. Adequate knowledge of stroke was noted in 13.2% participants, and was higher in females (17.7% versus 10.7%; P = 0.01). Logistic regression analysis showed significant associations between adequate knowledge of stroke with female sex (OR 1.8; 95% CI: 1.2 – 2.8; P = 0.008) and a history of stroke in close relatives (OR 1.7; 95% CI: 1.1 – 2.6; P = 0.025) but not with age, academic discipline or stroke lectures. University students in Northeast Nigeria have low knowledge of stroke, which is worse in males. Although health issues are taught at universities, little is taught on stroke, suggesting a need to prioritize stroke knowledge in the university curriculum.

Nigeria’s tertiary hospitals have faced public criticisms over substandard services and poor infrastructure reported in the mass media during early to mid-2019. Peer-reviewed studies in the medical literature have painted similar pictures of poor healthcare quality at most of the nation’s public hospitals. For instance, studies have revealed tertiary hospitals lacking vital equipment needed for emergency care of acute asthma and obstetric hemorrhage, while hospital administrators complain of insufficient personnel made worse by inadequate electricity from the national grid, poor government funding and bureaucratic bottlenecks undermining staff recruitment and training. This grim situation is at total variance with global best practices for tertiary healthcare adopted by many countries. Matters may yet get worse with Nigeria now in the midst of a coronavirus epidemic and its potential to overburden weak healthcare systems unless urgent efforts are made to improve healthcare quality. A practical and effective way to improve healthcare quality is via strict enforcement of minimum healthcare standards in line with global best practices and the regulatory provisions of the nascent National Tertiary Health Institutions Standards Committee established by the National Health Act 2014.

Background: Complex regional pain syndrome (CRPS) is a rare neuropathic pain disorder associated with severe pain, muscle weakness, limb edema and hyperhidrosis. Predisposing factors include fracture, surgery, stroke and spinal cord injury. CRPS may recur in the same limb or spread to other limbs to complicate management. Case Report: A 20-year old female with CRPS Type-I had sequential spread to all four limbs despite different treatment modalities, including medical therapy, nerve block, radiofrequency ablation and surgical sympathectomy. We discuss the therapeutic challenges and reviewed recent literature on current treatment options for CRPS Type-I. Conclusion: A multidisciplinary approach is needed for effective management of CRPS, and refractory disease may respond to intrathecal baclofen with morphine.

Snakebite is a major cause of death and disability in developing countries. The common clinical features of snake envenomation include bleeding, acute kidney injury, dilated pupils and muscle paralysis resulting from the deleterious effects of venom toxins on human plasma proteins, cell membranes, muscle fibers and vascular endothelium. Snakes also harbour pathogenic organisms that may infect bite victims during envenomation, but few studies have described this phenomenon. We herein report a rare case of acute transverse myelitis occurring after snakebite in Northeast Nigeria, and discuss the possible role of bacteria and viruses after excluding other potential causes of myelopathy. This knowledge may help improve the care of snakebite victims among internists and emergency physicians.

Spinocerebellar ataxia type-7 (SCA7) is a cytosine-adenine-guanine (CAG) repeat polyglutamine disorder characterized by progressive degeneration of the cerebellum, brainstem, spinal cord, and retina. Clinical features include progressive ataxia, visual loss, pyramidal weakness, sensory impairment, and dementia. Among the autosomal dominant cerebellar ataxias, SCA7 is relatively common in Scandinavia and South Africa but rare worldwide and is not previously reported in Nigeria. In this study, we describe a family in Katsina State, Northwest Nigeria, with nine individuals across three generations affected by the SCA7 phenotype. Analysis of DNA from proband and two affected relatives revealed 39 CAG repeat expansions in one allele of ataxin-7 in each.

Background: Stroke can be prevented with treatments targeted at hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation, but this is often hampered by under-diagnosis and under-treatment of those risk factors. The magnitude of this problem is not well-studied in sub-Saharan Africa. Materials and Methods: We conducted a cross-sectional survey of stroke patients at a tertiary hospital during January 2010 to July 2013 to determine patient awareness of a pre-existing stroke risk factor and prior use of anti-hypertensive, anti-diabetic, antiplatelet and lipid-lowering agents. We also investigated whether gender and school education influenced patient awareness and treatment of a stroke risk factor prior to stroke. Results: Three hundred and sixty nine stroke patients presented during the study period, of which 344 eligible subjects were studied. Mean age at presentation (±SD) was 55.8 ± 13.7 years, and was not different for men and women. Hypertension, hyperlipidemia, diabetes and atrial fibrillation were prevalent among 83.7%, 26.5%, 25.6% and 9.6% patients respectively. Awareness was high for pre-existing diabetes (81.8%) and hypertension (76.7%), but not for hyperlipidemia (26.4%) and atrial fibrillation (15.2%). Men were better educated than women (p = 0.002), and had better awareness for hyperlipidemia (37.3% versus 13.5%; p = 0.009). Men were also more likely to take drug treatments for a stroke risk factor, but the differences were significant. Conclusions: A high rate of under-diagnosis and under-treatment of hypertension, hyperlipidemia and atrial fibrillation contributes to the stroke burden in sub-Saharan Africa, especially among women. Public health measures including mass media campaigns could help reduce the burden of stroke. Contexte:L'AVC peut être évitée avec des traitements ciblant l'hypertension, le diabète sucré, hyperlipidémie et la fibrillation auriculaire, mais cela est souvent entravée par le sous-diagnostic et sous-traitement de ces facteurs de risque. le l'ampleur de ce problème ne sont pas bien étudié en Afrique sub-saharienne. Matériels et Méthodes: Nous avons mené une enquête transversale des patients d'AVC dans un hôpital tertiaire au cours Janvier 2010 à Juillet 2013 pour déterminer la sensibilisation des patients d'un facteur de risque d'accident vasculaire cérébral préexistante et l'utilisation préalable du antihypertenseur, antidiabétique, anti-agrégant plaquettaire et des agents hypolipidémiants. Nous avons également cherché à savoir si le sexe et l'école l'éducation a influencé la sensibilisation et le traitement d'un facteur de risque d'accident vasculaire cérébral avant AVC patient. Résultats: Trois cent soixante-neuf patients d'AVC présentés au cours de la période d'étude, dont 344 éligibles les sujets ont été étudiés. L'âge moyen à la présentation (± écart-type) était de 55,8 ± 13,7 années, et n'a pas été différent pour les hommes et femmes. Hypertension, l'hyperlipidémie, le diabète et la fibrillation auriculaire étaient fréquentes chez les 83,7%, 26,5%, 25,6% et 9,6% des patients, respectivement. La sensibilisation a été élevé pour le diabète pré-existant (81,8%) et l'hypertension (76,7%), mais pas hyperlipidémie (26,4%) et la fibrillation auriculaire (15,2%). Les hommes étaient plus instruits que les femmes (p = 0,002), et avait une meilleure prise de conscience de l'hyperlipidémie (37,3% versus 13,5%; p = 0,009). Les hommes étaient également plus susceptibles de prendre traitements médicamenteux pour un facteur de risque d'accident vasculaire cérébral, mais les différences étaient significatives. Conclusions: Un taux élevé de sous-diagnostic et sous-traitement de l'hypertension, l'hyperlipidémie et l'auriculaire fibrillation contribue à la charge de l'AVC en Afrique sub-saharienne, en particulier chez les femmes. Mesures de santé publique y compris les campagnes médiatiques pourrait aider à réduire le fardeau de la course. Mots-clés: Fibrillation auriculaire, le diabète, l'hyperlipidémie, l'hypertension, accident vasculaire cérébral