Role of a diagnostic laboratory in the management of diabetes mellitus

To elucidate the role of a modern diagnostic laboratory in the management of diabetesmellitus Available literature on local and international studies on the role of the laboratory in the management of diabetesmellitus Preclinical diagnosis of diabetes mellitus, good monitoring of short, medium and long-term glycaemic control necessary to avoid diabetic complications in poor resource settings are now possible with modern diagnostic laboratories. Creating the required awareness on the roles of a diagnostic laboratory in the management of diabetesmellitus is needed now more than ever before in resource poor nations otherwise the success achieved by the developed world where diabetic patients become insulin independent after islet cell transplant with glucocorticoid free immunosuppression cannot be attained in the near future. Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.68-7

Musculoskeletal Tuberculosis: A Prospective Study

Background: Tuberculosis of the bone and joint is undertreated in the North-East sub region of Nigeria due to lack of knowledge of the disease, especially amongst Medical Officers who treat patients in most General hospitals. Most patients treated for osteoarthritis are indeed articular tuberculosis.Objective: To determine the incidence of this disease in our environment and proffer treatment regiments.Methods and Design: This is a three year (2000-2003) prospective study of the patients with diagnosis of muscularskeletal TB seen UMTH. All patients had complete history and clinical examinations conducted by the teams. Investigations included X-rays, Mantoux and full blood count (FBC) and ESR. Few of the patients were also tested for HIV. Diagnosis was based on history, X-ray features of TB of the bone and joints, Mantoux, raised ESR and physical findings. Extent of the severity of disease was measured by the degree of pain, physical disability and deformity and X-ray findings. Neurological complications were treated with spinal support in addition to drug treatment. Two of our patients had spinal surgery,(decompression) when they developed spondylosis three years after treatment. Treatment was by the use of INH, Rifampicin and Pyrazinamide at the appropriate doses for the patients' ages and weights. Ethambutol was included in those with disseminated disease while anti-retroviral drugs were added for those with positive and confirmed tests. The response to treatment was assessed using ESR, clinical improvement and followed up for three to seven years.Results: Fifty-four patients were enrolled into this study, aged 4 to 82 years. Thirty-five (64.8%) were males while 19 (35.2%) females. Forty-one (75.9%) of the patients had Pott's disease, 12 (22.2%) had TBOA, while 1 (1.9%) had Pott's disease and TBOA. Forty-four (81.5%) patients were treated with drugs alone, 8 (14.8%) had spinal support in the form of cossets or scotch cast jackets. Only 6 (11.11%) of the patients were admitted due to inability to walk because they were paraplegic. Eighty-one percent success rate was achieved using INH,Pyrazinamide(PZN) and Rifampicin for ten months. Forty-four of the patients (81.5%) got better and had no recurrence of symptoms 3-7 years of follow up. Five (9.3%) of the patients could not complete the treatment due to cost of the drugs, 1 (1.9%) relapsed and was found to be HIV positive and was lost to follow up, one (1.9%) died of PTB and HIV complications and one (1.9%) got better and was lost to follow up after the 6th month of treatment.Conclusion: Tuberculosis of the spine, bone and joints is under diagnosed and under treated. Successful treatment can be achieved using INH, PZN and Rifampicin.Key words: TB Spine, TB Bone and Joints, Incidence andResponse to proffered treatment

Possible role of HIV in stroke: HIV status of stroke patients as seen in A Tertiary Hospital

Background: Stroke has been reported as a complication of HIV/AIDS. However, sparse data exists to quantify the risk of AIDS-associated stroke. The purpose of this study was to determine the HIV status of stroke patients; as well as the frequency of well-established stroke risk factors disease. Method: This was a hospital-based, case-control study. Sixty five (65) consecutive stroke patients (36 males and 29 females) aged 20-68 years and sixty five (65) age-and-sex matched controls were enrolled. A structured questionnaire was administered. Neurological examination was performed and computed tomography scan of the brain done. Blood samples were taken for HIV 1&2 screening using ELISA method positive test using two different kits constituted a positive result. Result: The frequency of HIV infection among stroke cases was significantly higher than in controls 13 (20%) versus 3 (4.6%): p-value <0.016. Odds ratio 5.17. Conclusion: Human Immunodeficiency virus infection might be a risk factor for ischemic stroke in the adult population of North-eastern Nigeria. Therefore, a longitudinal community based study is suggested to further elucidate the relationship between HIV infection and risk of stroke

Serum Antiphospholipid Antibodies Among Healthy Adults In Northeastern Nigeria

Background: Antiphospholipid antibodies have been associated with variety of conditions. There is no standard health associated reference values required for the interpretation of antiphospholipid antibodies result available among adults in North- eastern Nigeria and Nigeria in general. The aim of this study is to determine the normal serum level (cutoff point) in healthy adult Nigerians. The need or otherwise for stratification of the reference values by sex would also be determined. Methods: Seventy-six healthy adults\' medical students and health workers were enrolled in the study over the period of twelve consecutive months. Blood samples were taken for quantification of antiphopholipid antibodies using Enzyme Linked Immunosorbent Assay (ELISA) technique. Apparently healthy adults age between 16-50years who are neither human immunodeficiency virus positive nor VDRL positive were included in the study. Reference values were calculated by parametric method. Results: The mean serum concentration of IgG Antiâ2GP1 for the sample population was 21.43 ± 9.43 U/ml. The mean serum concentration of IgG Antiâ2GP1 for males was 18.6 ± 7.6 U/ml while for the female sample population was 22.7±10.2U/ml. There is no gender variation (P > 0.05). Conclusion: The reference value for serum antiphospholipid antibodies in healthy adults in Northeastern Nigeria was 21.43 ± 9.43 U/ml. The reference values should be used in this environment for both sexes. Extension of the scope of the study to cover the entire homogenous society of Northern Nigeria is recommended. Nigerian Journal of Clinical Practice Vol. 10 (3) 2007 pp. 213-21

Clinico-pathologic presentation and management of neurofibromatosis type 1(Von Recklinghausen′s) disease among north-eastern Nigerians: A six year review

Objective: Neurofibromatosis type 1 is not an uncommon disorder, its prevalence is said to be around 1 in 2000-4000 live birth. It has diverse manifestations that may affect any part of the body and present to clinician of any specialty, however, little or no attention have been given to area of neurological, ophthalmological and auditory complications in these patients. This study is aimed at evaluating the clinical, histological presentation and to highlight the need of multi disciplinary approach in the management of this condition. Methodology: The case records of patients who presented with clinical signs and request form with histologically proven neurofibrom atosis were retrieved and reviewed from University of Maiduguri Teaching Hospital and Federal Medical Center Azare from January 2000-December 2005. The clinical characteristics, histological reports and complications were evaluated. Information such as the age, sex, site and histological diagnosis were extracted from the patient′s case notes and histology request form. Results: Forty seven patients fulfill the diagnostics criteria of the national institute of health consensus development conference NIHCDC. The age range was 10-65yrs, with the mean of 27.85yrs. There were 23 males and 24 fern ales, sixteen patients had a positive family history of sim ilar condition in a first degree relative and three are from same parents. Forty one had cutaneous fibroma (87.2%) while 6 (12.8%) were plexiform. Twenty-nine patients had cafe a laic lesion (61.7%), while 30(63.8%) presented with axillaiy and or inguinal freckling. One of the cases presented with osseous lesion and hypertension. The commonest site of neurofibroma was the trunk 16(34%), head and face 11(23%), then the lower limb 10(21.8%). Treatment modality was mainly excision of neurofibroma. Conclusion:This study have documented that NF1 is not an uncommon disorder in this region and has no sex predilection and present commonly within the second and third decade of life when dermal neurobribroma start to occur in the skin; the trunk, head and face being the commonest area of affliction. Attention is to be paid to neurological, ophthal nological and auditory systems in the evaluation of the patients and to follow up these patients for a long time to evaluate the long term complications

The Nigeria Parkinson Disease Registry: Process, Profile, and Prospects of a Collaborative Project

BACKGROUND: Clinical disease registries are useful for quality improvement in care, benchmarking standards, and facilitating research. Collaborative networks established thence can enhance national and international studies by generating more robust samples and credible data and promote knowledge sharing and capacity building. This report describes the methodology, baseline data, and prospects of the Nigeria Parkinson Disease Registry. METHODS: This national registry was established in November 2016. Ethics approval was obtained for all sites. Basic anonymized data for consecutive cases fulfilling the United Kingdom Parkinson's Disease Brain Bank criteria (except the exclusion criterion of affected family members) are registered by participating neurologists via a secure registry website (www.parkinsonnigeria.com) using a minimal common data capture format. RESULTS: The registry had captured 578 participants from 5 of 6 geopolitical zones in Nigeria by July 2019 (72.5% men). Mean age at onset was 60.3 ± 10.7 years; median disease duration (interquartile range) was 36 months (18–60.5 months). Young‐onset disease (<50 years) represented 15.2%. A family history was documented in 4.5% and 7.8% with age at onset <50 and ≥ 50, respectively. The most frequent initial symptom was tremor (45.3%). At inclusion, 93.4% were on treatment (54.5% on levodopa monotherapy). Per‐capita direct cost for the registry was $3.37. CONCLUSIONS: This is the first published national Parkinson's disease registry in sub‐Saharan Africa. The registry will serve as a platform for development of multipronged evidence‐based policies and initiatives to improve quality of care of Parkinson's disease and research engagement in Nigeria

Identification of genetic risk loci and causal insights associated with Parkinson\u27s disease in African and African admixed populations: a genome-wide association study

\ua9 2023 Elsevier LtdBackground: An understanding of the genetic mechanisms underlying diseases in ancestrally diverse populations is an important step towards development of targeted treatments. Research in African and African admixed populations can enable mapping of complex traits, because of their genetic diversity, extensive population substructure, and distinct linkage disequilibrium patterns. We aimed to do a comprehensive genome-wide assessment in African and African admixed individuals to better understand the genetic architecture of Parkinson\u27s disease in these underserved populations. Methods: We performed a genome-wide association study (GWAS) in people of African and African admixed ancestry with and without Parkinson\u27s disease. Individuals were included from several cohorts that were available as a part of the Global Parkinson\u27s Genetics Program, the International Parkinson\u27s Disease Genomics Consortium Africa, and 23andMe. A diagnosis of Parkinson\u27s disease was confirmed clinically by a movement disorder specialist for every individual in each cohort, except for 23andMe, in which it was self-reported based on clinical diagnosis. We characterised ancestry-specific risk, differential haplotype structure and admixture, coding and structural genetic variation, and enzymatic activity. Findings: We included 197 918 individuals (1488 cases and 196 430 controls) in our genome-wide analysis. We identified a novel common risk factor for Parkinson\u27s disease (overall meta-analysis odds ratio for risk of Parkinson\u27s disease 1\ub758 [95% CI 1\ub737–1\ub780], p=2\ub7397 7 10−14) and age at onset at the GBA1 locus, rs3115534-G (age at onset β=–2\ub700 [SE=0\ub757], p=0\ub70005, for African ancestry; and β=–4\ub715 [0\ub758], p=0\ub7015, for African admixed ancestry), which was rare in non-African or non-African admixed populations. Downstream short-read and long-read whole-genome sequencing analyses did not reveal any coding or structural variant underlying the GWAS signal. The identified signal seems to be associated with decreased glucocerebrosidase activity. Interpretation: Our study identified a novel genetic risk factor in GBA1 in people of African ancestry, which has not been seen in European populations, and it could be a major mechanistic basis of Parkinson\u27s disease in African populations. This population-specific variant exerts substantial risk on Parkinson\u27s disease as compared with common variation identified through GWAS and it was found to be present in 39% of the cases assessed in this study. This finding highlights the importance of understanding ancestry-specific genetic risk in complex diseases, a particularly crucial point as the Parkinson\u27s disease field moves towards targeted treatments in clinical trials. The distinctive genetics of African populations highlights the need for equitable inclusion of ancestrally diverse groups in future trials, which will be a valuable step towards gaining insights into novel genetic determinants underlying the causes of Parkinson\u27s disease. This finding opens new avenues towards RNA-based and other therapeutic strategies aimed at reducing lifetime risk of Parkinson\u27s disease. Funding: The Global Parkinson\u27s Genetics Program, which is funded by the Aligning Science Across Parkinson\u27s initiative, and The Michael J Fox Foundation for Parkinson\u27s Research