Ahmad Abefe Sanusi

Stroke remains one of the leading causes of disability worldwide. Arm function recovery is essential for stroke survivors' ability to perform activities associated with daily living. Consequently, impairment in arm function is a significant target for stroke survivors' physical or robotic rehabilitation. This study aims to explore the barriers and facilitators to the implementation of a robotic rehabilitation programme for stroke survivors in a resource-poor setting. A cross-sectional design with a qualitative approach was chosen. A semi-structured, interview-based questionnaire was administered and data were collected from stroke survivors presenting at the adult neurology clinic of two tertiary institutions in Nigeria. Data from the interview-based questionnaire were analyzed using descriptive statistics. A total of 52 stroke survivors participated and were interviewed. More than half (55.8%) of the respondents were elderly, with a male-to-female ratio of 1.6:1. Majority of respondents (58%) had no idea about the use of robotics for stroke rehabilitation. About 44% of the respondents believe that the major determinant of interest in robotics will be favourable outcome after trials on other participants. Lack of financial support and transportation aid constitute barriers, while creation of awareness and the availability of transportation aid from home to hospital were the major facilitators to participation. These findings highlight the fact that most stroke survivors in the resource-poor setting were not aware of the usefulness of robotics in stroke rehabilitation. Hence, increasing knowledge and creating awareness about robotic rehabilitation will make it more readily acceptable for stroke survivors. KEYWORDS: Barrier, Facilitator, Robotic rehabilitation, Stroke survivors, Implementation.

Serum biomarkers, such as glial fibrillary acidic protein (GFAP), have been proposed to accurately assess stroke severity and prognosis. However, there is limited published data on their potential role in resource-limited settings where the stroke burden is highest. The study aims to determine the predictive value of the serum level of GFAP in assessing the severity and functional outcome of acute stroke. This prospective cohort study recruited forty consecutively presenting stroke subjects each for both ischaemic stroke and intracerebral haemorrhage at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife with forty apparently healthy controls. Serum concentrations of GFAP were measured using Enzyme-Linked Immunoassays, and the data were analyzed using Statistical Package for the Social Sciences software with significance at p<0.05. The median serum GFAP levels among apparently healthy controls, ischaemic stroke group and the ICH group at admission were 18.04 pg/ml, 24.10 pg/ml, and 33.33 pg/ml respectively. At admission, there was a significant difference in the median serum GFAP level in the ICH and apparently healthy control group as well as in the ischaemic stroke group and apparently healthy control group (p = 0.001). The study found no significant correlation between admission NIHSS and serum GFAP levels in both the ischaemic stroke group and the ICH group. In the ICH group, there was an inverse correlation between median serum GFAP level at day 7 and Barthel index at day 7 (p = 0.021) and day 30 (p = 0.001), but a positive correlation with modified Rankin score at day 30 (p = 0.001). The study found that routine screening for serum GFAP level at admission in ischaemic stroke and ICH does not predict acute stroke severity and does not correlate with functional outcomes. However, Serum GFAP level at day 7 correlated with 30-day functional outcomes for ICH and its usefulness may be explored further in larger studies.

Purpose: Migraine is a common neurological disorder diagnosed using the International Classification of Headache Disorders (ICHD). Beta-endorphin has pain-reducing properties and may serve as a future prognostic marker for migraine. This study aimed to assess the clinical characteristics of migraine and compare serum beta-endorphin levels in migraine patients and healthy controls among young undergraduate students.Methods: This comparative cross-sectional study was conducted among undergraduate students at Obafemi Awolowo University, Nigeria. Fifty participants with migraine headaches were recruited using purposive sampling according to the ICHD-3 criteria. Healthy controls were recruited using convenience sampling and matched for age and sex. A study questionnaire was administered to all participants. Serum beta-endorphin concentrations in both migraineurs and healthy controls were measured using enzyme-linked immunosorbent assays. The beta-endorphin levels between migraine patients and healthy controls were compared using the Mann-Whitney U-test. The data were analyzed using SPSS version 26.0. A p-value of <0.05 was considered statistically significant.Results: A total of 12 males and 38 females were recruited in both groups.The most commonly used medication for acute migraine treatment was paracetamol, while amitriptyline was the most frequently used prophylactic. Median serum beta-endorphin levels were significantly lower in the migraine group, at 385.4 pg/mL (328.5–423.4 pg/mL), compared to the control group, at 442.9 pg/mL (357.5–477.6 pg/mL) (p=0.01). Conclusion: Serum beta-endorphin levels were significantly lower in young adults with migraine, suggesting a potential role for reduced endogenous analgesia in migraine pathophysiology. This supports the potential utility of beta-endorphin as a prognostic biomarker for migraine.

Background: Adequate sleep is crucial for well-being. Long hours of work observed among resident and intern doctors disrupt sleep and promote health risks and sleep-induced morbidity and mortality. Aim: This study aimed to examine the impact of extended work hours on the quality, patterns, and sleep duration among ID and RD in Nigeria. Methods: This analytical cross-sectional study involved participants from hospitals across Nigeria's six geopolitical zones. Data were collected via a 32-item electronic questionnaire assessing socio-demographic details, sleep history, daytime sleepiness, and insomnia severity. Statistical analysis was performed using Stata 18 software. Bivariate analysis was done using the appropriate tools. The Jonckheere–Terpstra test was used to compare the weekly work hours in the Insomnia Severity Score categories. Results: Significant daytime sleepiness was reported among interns and resident doctors, with mean (SD) Epworth Sleepiness Scale scores of 11.04 (4.702) for residents and 10.91 (4.202) for interns. The insomnia severity scores were also in the moderate to high categories, with a mean (SD) of 9.77 (6.659) for residents and 11.39 (6.143) for interns. Burnout symptoms were frequently reported among 70 residents (42.9%) and 20 (33.9%) interns. An increased prevalence of specific sleep disorders, particularly insomnia, nightmares, and sleep-related breathing problems, was observed. Conclusion: The study found that resident and intern doctors in Nigeria suffer from poor sleep quality and burnout syndrome, highlighting the significant burden of sleep-related issues that could negatively impact their work performance and the quality of patient care.

Suicide neuropathology is a multifactorial phenomenon influenced by psychological, social, and environmental factors. Researchers have primarily focused on the role of neurotransmitters, such as serotonin, in suicide. A deficiency in serotonin input to the anterior cingulate cortex and ventral prefrontal cortex is associated with suicide and suicidal behaviour and is linked to decision-making and suicide intent. The serotonin hypothesis proposed that low levels of serotonin in the brain contribute to an increased risk of suicidal behaviour. However, subsequent studies have produced mixed and inconsistent results, indicating that the relationship between serotonin and suicide is not straightforward. Recent research has expanded the focus to structural and functional brain abnormalities associated with suicidal behaviour. Advances in neuroimaging techniques have allowed researchers to investigate the brain's anatomy, connectivity, and activity patterns in individuals at risk of suicide. Genetic studies have provided insights into the genetic basis of suicide risk, with certain genetic variations associated with increased susceptibility to suicidal behaviour. Studies have found increased levels of pro-inflammatory markers in the brains of individuals who died by suicide, suggesting a link between inflammation and suicide risk. A drug targeting the glutamate pathway, ketamine, has recently drawn attention for its ability to rapidly treat depressive symptoms and holds great promise as a potential antisuicidal drug. Overall, further research is needed to better understand the neuropathological mechanisms underlying suicidal behaviour.

Purpose Sleep medicine is a rapidly growing field of Medicine globally. However, studies are lacking on the knowledge of Nigerian medical and dental students on sleep and the different types of sleep disorders. Thus, we assessed the knowledge, interest and awareness of Nigerian medical and dental students about sleep medicine. We also determined the factors associated with sleep knowledge among the medical and dental students. Methods We conducted this cross-sectional study from June to September 2021, among medical students at the Obafemi Awolowo University, Ile-Ife, Nigeria. The students’ knowledge of sleep was assessed with the Assessment of Sleep Knowledge in Medical Education (ASKME) survey. The participants were classified as having low or high scores based on the proportion who gave a correct answer to 60% of the questions. Results Among the 488 students who completed the questionnaire, there was a male preponderance (55%). About three-quarters of the respondents (376, 77%) had a low sleep knowledge score. Age, year of study, and awareness about sleep medicine were the predictors of sleep knowledge. Conclusion A significant proportion of the medical students had poor sleep knowledge scores. There is a need to incorporate teaching sleep medicine in the curriculum of medical students early in their training.

An acute ischemic stroke, though carrying the risk of debilitating complications, is a preventable and treatable disease. Thrombolysis and endovascular thrombectomy are important components of its management. However, various challenges in resource-poor countries like Nigeria and other developing nations pose a great limitation in the timely intervention of ischemic stroke treatment. The challenges include late presentation, poor awareness of stroke symptoms even among health care workers, poor ambulance service/transportation network, intra-hospital delay, particularly in neuroimaging, and the unavailability of tissue plasminogen activator (alteplase/tenecteplase). We report a 32-year-old African man with an antecedent history of suspected migraine headaches with aura and a family history of hypertension and stroke, admitted 7½ hours after onset of stroke symptoms, scoring 13 on the National Institutes of Health Stroke Scale (NIHSS) with Medical Research Council (MRC) muscle power grades 1 and 3 on the right upper and lower extremities, respectively. Urgent non-contrast brain CT revealed only a hyperdense sign in the left middle cerebral artery (MCA). Intravenous tissue plasminogen activator (tPA) was administered at a lower dose of 0.6 mg/kg, 15½ hours after symptom onset, and a CT angiogram done 24 hours post-thrombolysis showed partial recanalization of the M1 segment of the MCA and intermediate collateral supply (Alberta stroke program early CT {ASPECT} score: 6). By the third day of admission, he had made a significant clinical improvement and was discharged home able to walk unsupported on the fourth day.