Adherence to highly active antiretroviral therapy in depressed patients with HIV/AIDS attending a Nigerian university teaching hospital clinic

Objective:  Key words:  Medication adherence; Depressive disorder; Highly Active Antiretroviral Therapy; HIV infectionTo determine the prevalence of depressive disorder in patients with HIV/AIDS receiving HAART; to determine the effect of depressive disorder on adherence to antiretroviral therapy; and to determine the significance of the association. Method: The study was conducted amongst outpatients of Ahmadu Bello University Teaching Hospital, Zaria. A sociodemographic and drug adherence questionnaire was administered. The Centre for Epidemiological Studies Depression Scale (CES-D) was used to screen for depressive symptoms while the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to confirm the diagnosis of depressive disorder. Results: A total of 310 patients with HIV/AIDS receiving HAART participated in the study. 68.4% were female and the mean age was 35.5 (± 8.97 years). 37.4% had secondary education, while 27.1% had tertiary education. Sixty-six participants (21.3%) had significant depressive symptoms while 14.2% met ICD-10 diagnostic criteria for depressive disorder. Overall, 73% of participants had good adherence to HAART. 63.6% of participants with depressive disorder had poor adherence to HAART compared to 21.1% of participants without depressive disorder (

Yam diseases and its management in Nigeria

This review presents different diseases associated with yam and the management strategies employed in combating its menace in Nigeria. The field and storage diseases are presented, anthracnose is regarded as the most widely spread of all the field diseases, while yam mosaic virus disease is considered to cause the most severe losses in yams. Dry rot is considered as the most devastating of all the storage diseases of yam. Dry rot of yams alone causes a marked reduction in the quantity, marketable value and edible portions of tubers and those reductions are more severe in stored yams. The management strategies adopted and advocated for combating the field diseases includes the use of crop rotation, fallowing, planting of healthy material, the destruction of infected crop cultivars and the use of resistant cultivars. With regards to the storage diseases, the use of Tecto (Thiabendazole), locally made dry gins or wood ash before storage has been found to protect yam tubers against fungal infection in storage. Finally, processing of yam tubers into chips or cubes increases its shelf live for a period of between 6 months and one year. Key words: Yam, field and storage diseases, resistant varieties, yam nematodes, disease management, fungicides, Nigeria. African Journal of Biotechnology Vol. 2 (12), pp. 497-502, December 200

Profile of clinically-diagnosed dementias in a neuropsychiatric practice in Abeokuta, South-Western Nigeria

Objective: Many subjects with dementia present primarily to neuropsychiatric practices because of behavioural and psychological symptoms (BPSD). This study reviewed the profile of clinically-diagnosed dementias and BPSD seen in a pioneer neuropsychiatric practice in Abeokuta, southwestern Nigeria over a ten year period (January1998 – December 2007). Methods: A review of hospital records of all patients with diagnoses of dementia or dementing illness using the ICD-10 criteria as well as specific diagnostic criteria for different dementia phenotypes. Associated BPSD, co-morbidities and treatments were also reviewed. Results: Out of a total of 240,294 patients seen over the study period, 108 subjects met clinical diagnostic criteria for probable dementia giving a hospital frequency of 45 per 100,000. Alzheimer’s disease (AD) and Vascular dementia (VaD) were the predominant phenotypes seen in 62 (57.4%) and 18 (16.7%) subjects respectively. Others include mixed dementia (4 cases), frontotemporal dementia (4 cases), Lewy body dementia (3 cases), alcohol-related dementia (3 cases), PD dementia (1 case) and unclassifiable (13 cases). Apathy, night time behaviour, aberrant motor behaviour, agitation and irritability were the most common BPSD features, while hypertension was the most common co-morbidity. Neuroleptics, anticholinergics and anti-hypertensives were most commonly prescribed. Anticholinesterase inhibitors were sparingly used. Conclusion: Probable AD was the most prevalent dementia phenotype seen in this practice. Increased awareness of dementia and better utilization of specific treatments are needed among psychiatrists and primary care practitioners in Nigeria.Keywords: Dementia phenotypes; BPSD; Neuropsychiatric practice; Nigeria; Afric

Uvulopalatopharyngoplasty: A Surgical Treatment of Obstructive Sleep Apnoea (OSA)

Snoring is now seen as one end of sleep-related breathing disorder resulting ultimately in obstructive sleep apnea. Uvulopalatopharyngoplasty (UPPP) is the first surgical procedure specifically designed to alleviate the abnormalities, although the use of laser appears to be the new trend. We present a case of Obstructive Sleep Apnoea (OSA) in an overweight young adult male which was corrected with the traditional UPPP. This paper also highlights the role of high index of suspicion and meticulous clinical decision making in the absence of sophisticated sleep studies

Management of lung cancer in Africa: Underdiagnosis and poor access to treatment – A close look at Nigeria and West African Sub-region

Lung cancer is of public health importance and imposes a great deal of socioeconomic and disease burden on the West African subregion and Nigeria in particular. It is one of the most common cancers worldwide and accounts for 11.4% of all new cancers. In this review, we did not find any well-coordinated lung cancer registry in either Nigeria or any other West African country. For us to attain any meaningful level of the interventional plan to address any identifiable deficiencies in the treatment of lung cancer in the West African subregion, it is imperative that a specific regional lung cancer registry with a regular audit of the reporting, is set up. There is an urgent need for further studies on the local risk factors predisposing to lung cancer, especially in the younger age group. Finally, intense pressure must be mounted on the governments within West Africa to implement the 15% GDP allocation to the health budget as agreed in the WHO/Abuja Declaration and to speed up efforts towards universal health insurance

Dementia incidence declined in African-Americans but not in Yoruba

INTRODUCTION: To compare dementia incidence of African-American and Yoruba cohorts aged ≥70 years enrolled in 1992 and 2001. METHODS: African-Americans residing in Indianapolis and Yoruba in Ibadan, Nigeria without dementia were enrolled in 1992 and 2001 and evaluated every 2-3 years until 2009. The cohorts consist of 1440 African-Americans, 1774 Yoruba in 1992 and 1835 African-Americans and 1895 Yoruba in the 2001 cohorts aged ≥70 years. RESULTS: In African-Americans, dementia and Alzheimer's disease (AD) incidence rates were significantly lower in 2001 than 1992 for all age groups except the oldest group. The overall standardized annual dementia incidence rates were 3.6% (95% confidence interval [CI], 3.2%-4.1%) in the 1992 cohort and 1.4% (95% CI, 1.2%-1.7%) in the 2001 cohort. There was no significant difference in dementia or AD incidence between the Yoruba cohorts. DISCUSSION: Future research is needed to explore the reasons for the differential changes in incidence rates in these two populations

Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty.

INTRODUCTION: Faculty are increasingly expected to teach about the impact of racism on health and to model the principles of health equity. However, they often feel ill-equipped to do so, and there is limited literature on faculty development on these topics. We developed a curriculum for faculty education on racism and actions to advance racial health equity. METHODS: The curriculum design was based on a literature review and needs assessments. Implementation consisted of four live virtual 1-hour sessions incorporating interactive didactics, cases, reflection, goal setting, and discussion offered to a multidisciplinary group of pediatric faculty at a children\u27s hospital. Topics included the history of racism, racism in health care, interacting with trainees and colleagues, and racial equity in policy. Evaluation consisted of pre- and postsurveys at the beginning and end of the curriculum and a survey after each session. RESULTS: A mean of 78 faculty members attended each session (range: 66-94). Participants reported high satisfaction and increased knowledge at the end of each session. Qualitative themes included self-reflection on personal biases, application of health equity frameworks and tools, becoming disruptors of racism, and the importance of systemic change and policy. DISCUSSION: This curriculum is an effective method for increasing faculty knowledge and comfort. The materials can be adapted for various audiences

APOE ε4 and the risk for Alzheimer disease and cognitive decline in African Americans and Yoruba

Background There is little information on the association of the APOEe4 allele and AD risk in African populations. In previous analyses from the Indianapolis-Ibadan dementia project, we have reported that APOE ε4 increased the risk for Alzheimer’s disease (AD) in African Americans but not in Yoruba. This study represents a replication of this earlier work using enriched cohorts and extending the analysis to include cognitive decline. Methods In this longitudinal study of two community dwelling cohorts of elderly Yoruba and African Americans, APOE genotyping was conducted from blood samples taken on or before 2001 (1,871 African Americans & 2,200 Yoruba). Mean follow up time was 8.5 years for African Americans and 8.8 years for Yoruba. The effects of heterozygosity or homozygosity of ε4 and of the possession of e4 on time to incident AD and on cognitive decline were determined using Cox’s proportional hazards regression and mixed effects models. Results After adjusting for covariates, one or two copies of the APOE ε4 allele were significant risk factors for incident AD (p < 0.0001) and cognitive decline in the African-American population (p < 0001). In the Yoruba, only homozygosity for APOE ε4 was a significant risk factor for AD (p = 0.0002) but not for cognitive decline (p = 0.2346), however, possession of an e4 allele was significant for both incident AD (p = 0.0489) and cognitive decline (p = 0.0425). Conclusions In this large longitudinal comparative study, APOE ε4 had a significant, but weaker, effect on incident AD and on cognitive decline in Yoruba than in African Americans. The reasons for these differences remain unclear