The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Objective : Information on the current burden of stroke in Africa is limited. The aim of this review was to comprehensively examine the current and projected burden of stroke in Africa.
Methods : We systematically reviewed the available literature (PubMed and AJOL) from January 1960 and June 2014 on stroke in Africa. Percentage change in age-adjusted stroke incidence, mortality and disability-adjusted life years (DALYs) for African countries between 1990 and 2010 were calculated from the Global Burden of Diseases (GBD) model-derived figures.
Results : Community-based studies revealed an age-standardised annual stroke incidence rate of up to 316 per 100 000 population, and age-standardised prevalence rates of up to 981 per 100 000. Model-based estimates showed significant mean increases in age-standardised stroke incidence. The peculiar factors responsible for the substantial disparities in incidence velocity, ischaemic stroke proportion, mean age and case fatality compared to high-income countries remain unknown.
Conclusions : While the available study data and evidence are limited, the burden of stroke in Africa appears to be increasing.

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The burden of stroke in Africa: a glance at the present and a glimpse into the future.

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1208&context=eastafrica_fhs_sonam

Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

The portrayal of mentally ill persons in movies and television programs has an important and underestimated influence on public perceptions of their condition and care. Movie stereotypes that contribute to the stigmatization of mentally ill persons include the mental patient as rebellious free spirit, homicidal maniac, seductress, enlightened member of society, narcissistic parasite, and zoo specimen. The authors suggest that mental health professionals can fight this source of stigma by increasing their collaboration with patient advocacy groups in monitoring negative portrayals of mentally ill people, using public information campaigns such as Mental Illness Awareness Week to call attention to the process of stigmatization, and supporting accurate dramatic and documentary depictions of mental illness.

Homicidal maniacs and narcissistic parasites: Stigmatization of mentally ill persons in the movies.

Background: Interest in surgical careers among medical students has declined over the past decade. Multiple explanations have been offered for why top students are deterred or rejected from surgical programs, though no consensus has emerged. Methods: We conducted a review of the literature to better characterize what factors affect the pursuit of a surgical career. We searched PubMed and EMBASE and performed additional reference checks. Agency for Healthcare Research and Quality (AHRQ) and Newcastle–Ottawa Education scores were used to evaluate the included data. Results: Our search identified 122 full-text, primary articles. Analysis of this evidence identified 3 core concepts that impact surgical career decision-making: gender, features of surgical education, and student “fit” in the culture of surgery. Conclusion: Real and perceived gender discrimination has deterred female medical students from entering surgical careers. In addition, limited exposure to surgery during medical school and differences between student and surgeon personality traits and values may deter students from entering surgical careers. We suggest that deliberate and visible effort to include women and early-career medical students in surgical settings may enhance their interest in carreers in surgery.

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A systematic review of the factors affecting choice of surgery as a career.

Background: The burden of Neurological diseases may be on the increase especially in developing countries. Improved outcome in these settings may require appreciation of the spectrum of Neurological diseases and the impediments to their management. We aim to determine the profile of neurological admissions and the challenges of managing these diseases at the University of Nigeria Teaching Hospital Enugu South East Nigeria. Methods: Analysis of Neurological admissions into the medical wards of the University of Nigeria Teaching Hospital Enugu from January 2003 to December 2007. Results: Neurological admissions comprise about 14.8% of medical admissions. There were 640 (51%) males and 609 (49%) females. The spectrum of neurological diseases were stroke 64.9%, central nervous system infections (21.8% ), HIVrelated neurological diseases 3.5%, hypertensive encephalopathy (3.4%), dementia (3%), subarachnoid haemorrhage (2.2%), Guillian Barre syndrome (1.2%), Parkinson's disease (1.1%), myasthenia gravis (1.0%), motor neurone disease and peripheral neuropathy and accounted for 0.8% and 0.6% respectively. Overall, non infectious disease accounted for 78.2% of neurological admissions while infectious diseases accounted for 21.8%. Conclusion: A wide spectrum of neurological diseases occurs in our setting. The high incidence of CNS infections indicates that efforts should be geared towards preventive measures. A major challenge to be addressed in the management of neurological diseases in our setting is the lack of specialized facilities. Key words: Profile, neurological admissions, Enugu

Profile of neurological admissions at the University of Nigeria Teaching Hospital Enugu.

Purpose The purpose of this study was to determine the knowledge and attitude of secondary school students to epilepsy and its treatment that could pose as barriers in the treatment and care of epilepsy patients within the community. Methods This study was cross-sectional and descriptive in design using a self administered custom designed multiple choice questionnaire with sections on general information on epilepsy, awareness and perception of epilepsy, treatment of epilepsy/seizures and attitude towards people living with epilepsy. Results Out of 969 questionnaires analyzed, the majority of the students (87.6%) had heard of epilepsy as a disease. The commonest sources of information were the electronic media (36.4%) and family members (25.6%). More than half (59.4%) had witnessed a convulsion in the past and 8.9% had a family member with epilepsy. Jerking (50.6%) and loss of consciousness (47.4%) were identified as the commonest manifestations of epilepsy. Epilepsy was considered a psychiatric disorder by 51.9% and as an infectious disease by 40.6%. About 39.3% considered epilepsy to be due to spiritual causes, old age or poisoning/bad blood. A total of 63.1% regarded orthodox medicine and prayers as the best means to treat epilepsy, while 6.8% chose herbal remedies. Concerning first aid treatment, 50.6% agreed that an object should be inserted into the mouth, while 49.5% would call for medical help and 28.8% would remove the person from harm. On attitude, 64.9% would not keep a friend with epilepsy, 69.1% would not play with someone with epilepsy, 84.2% would not marry someone with epilepsy. 41.1% of the students said that people with epilepsy should neither marry while 42.2% say they should not have children. Only 39.1.5% had an overall positive attitude towards people living with epilepsy. Conclusions There is a persisting poor knowledge, attitude and practice of epilepsy among secondary school students in SE Nigeria. Efforts should be made to include basic facts about disorders with social consequences such as epilepsy in school health education curriculum.

Knowledge, attitude and practice towards epilepsy among secondary school students in Enugu, South East Nigeria

Purpose The understanding of the opinions of the Nigerian public about epilepsy and its treatment is relevant to the reduction of the large treatment gap that exists in management of the condition. The major aim of this study was to determine the knowledge and attitudes of urban dwellers to epilepsy and its treatment and to identify the gaps in knowledge that could pose as barriers in the treatment and care of epilepsy patients within the community. Method This cross-sectional and descriptive study was carried out in one of the districts of Enugu metropolis, Nigeria. Data collection was by means of a semi-structured validated questionnaire. Results The mean score in knowledge was low, 48.1±18.8%; higher in females (50.6±18.6%, p =0.03 and those who had witnessed seizures in the past 49.7±18.8, p Conclusion The level of knowledge of epilepsy in among urban dwellers in SE Nigeria is low and fraught with misconceptions and gaps. There were no significant differences in the attitude scores of respondents with different levels of education. There is a need for a multi-faceted educational interventions directed at improving the awareness and understanding of the condition by all segments of the society.

Knowledge, attitude and practice of epilepsy among community residents in Enugu, South East Nigeria

Background: Depression is a common psychiatric disorder in epilepsy patients. A bidirectional interaction is thought to be present between epilepsy and depression. There are few studies of this relationship in Nigerian Africans. Objectives: This was a cross-sectional study of the frequency and pattern of depression in a cohort of epilepsy patients in Enugu, South East Nigeria. Materials and Methods: Adult patients with epilepsy seen at the University of Nigeria Teaching Hospital, Enugu, from May to September 2009 were assessed for depression using the Becks Inventory for Depression. Informed consent was obtained from each patient. Clinical data obtained were analyzed using Statistical Package for the Social Sciences, version 15. The hospital’s ethical review committee approved the study. Results: In all, 83 subjects were studied (50 males and 33 females). They were aged from 18 to 75 years, with an average of 29.87 years. Most subjects were <25 years of age, single (53, 64%) and had at least secondary school education (65, 78%). Depression was present in 71 (85.5%) subjects – minimal 57 (68.7%), mild 10 (12%), and moderate 4 (4.8%). No case of severe depression was seen. Patients <25 years of age were the most affected. Depression was not significantly associated with age, gender, seizure type, or educational level. Conclusion: A significant proportion of Nigerian African epilepsy patients have depression, which may be easily overlooked, with far-reaching consequences on patients’ quality of life, morbidity, and mortality rates. There is need to regularly assess for and manage epilepsy-related depression in this population.

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O. S. Ekenze

Papers

Profile of neurological admissions at the University of Nigeria Teaching Hospital Enugu.

Knowledge, attitude and practice towards epilepsy among secondary school students in Enugu, South East Nigeria

Knowledge, attitude and practice of epilepsy among community residents in Enugu, South East Nigeria

Depression in Patients with Epilepsy: A Study from Enugu, South East Nigeria

Perception of epilepsy among public workers: Perspectives from a developing country