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.

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.