Human Immunodeficiency Virus And The Nervous System: An Update With Emphasis On Developing Countries

Ten percent of patients that are diagnosed with AIDS also have some neurological complaint, 40% present neurological signs or symptoms during the course of the infection, and 80% of the autopsies present neurological alterations. Although much is known about the neuropathology of HIV infection, many important questions on its neuropathogenesis remain unanswered

Informed Consent and Community Engagement in Genomic Research

The introduction of genomic research to, and emergence of biobanks in, sub-Saharan African countries raise ethical issues that require urgent attention. Firstly, there are concerns about whether individuals and communities would agree to participate in this type of research especially considering how communitarianism may affect their decision-making process. Secondly, there are controversies over whether the informed consent process as it is applied to other biomedical researches would be appropriate for genomic research in sub-Saharan Africa. And thirdly, the components of engagement of culturally distinct communities in genomic research are not yet clarified. Although community engagement during the recruitment stage have been described, there is dearth of information on effective strategies beyond this stage and which model is the most appropriate for sub-Saharan African settings. Therefore, my research explored the opinions of indigenous potential research participants on involvement in genomic research and to storage and export of their biospecimens, assessed the roles of community leadership in and perceptions of community engagement and informed consent processes in genomic research and biomedical researchers’ views. To obtain data for my qualitative study which is based on a methodological design adapted from grounded theory, I interviewed thirty biomedical researchers recruited from a research institution situated within the selected community, four community leaders and two community health workers; and conducted fifteen focus group sessions comprising 50 potential research participants organized by age and sex, namely: 1) adult (>30 years) males, 2) adult females, 3) youth (18-30 years) males, and 4) youth females. A mixed age-group was conducted to probe different views between the age groups. The data were transcribed verbatim and analyzed iteratively using constant comparative method to develop themes with the aid of Atlas-ti. The potential research participants would not agree to donation, storage or export of their samples unless they trusted the researchers to use their samples in an ethical manner, but the biomedical researchers felt that they would agree if the community leaders approved of the research. There was consensus between the adult research participants and the biomedical researchers on the appropriateness of blanket consent type for genomic research but the community leaders, health workers and the youths prefer either reconsenting or delegated consent. Married adult female participants would consult their husbands before agreeing to participate. All participants agreed on the gatekeeping role of the community leadership. The themes on community engagement reflected a strategic model of four stages, namely: community approach, community interphase, community integration, and post-research cordiality, as the crucial phases for ensuring effective community participation. There was discordance and clear division between the adults and youths regarding the decision to participate in genomic research based on commitment to communal values. Adults based their decision to participate on altruism and furthering the common good while youths based their decision on personal benefits and preferences and considered the views and welfare of family members and neighbours. This discordance suggests a generational shift, so I conceptualized a model of relative solidarity, which is different from communal solidarity typical of African communitarianism, for genomic research participation. To foster relational ethics, protect prospective research participants and ensure the success of genomic research, I proposed a strategic model of flow dynamics between the researcher(s), the community leaders, and potential research participants for effective community engagement. These findings suggest the need for a closer look at strategies for implementation of community engagement and informed consent in genomic research in this region. I recommend further studies on this emerging area of medical research

Morbidity and Mortality Patterns among Neurological Patients in the Intensive Care Unit of a Tertiary Health Facility

Background/Objective: The morbidity and mortality of neurological patients managed in the intensive care unit reflect the causes of neurological disorders and the effectiveness of management.Method: The morbidity and mortality patterns of neurological patients admitted into the intensive care unit of the University of Benin Teaching Hospital (UBTH), a tertiary health institution in Nigeria, wasexamined over an 18-year period (January 1985 to December 2003). A complete sampling frame was used with all patients’ records scrutinized.Results: A total of 187 patients, (16.6% of the total ICU admissions) with neurological morbidity were admitted during the period. We observed that morbidity was high for preventable etiologies – head injury(119 patients constituting 63.7%), tetanus (26 patients constituting 13.9%), hypertensive encephalopathy (12 patients constituting 6.4%) and meningitis (8 patients constituting 4.8%). The case fatality rates forthese causes were 50.4%, 61.5%, 66.7% and 62.5% respectively. The case fatality rate for cerebral malaria was 100%. In addition, males (67.9%) were more likely to have trauma-related morbidity(

Tetanus – A Review Of Current Concepts In Management

Tetanus is a vaccinepreventable disease that yearly causes a total of 309,000 deaths. Reports showed up to 1 million cases annually, mostly in underdeveloped countries. Clostridium tetani, the causative organism, is widespread in the faeces of domestic animals and humans, while spores of C. tetani are abundant in soil and in the environment surrounding the habitation of humans and animals. In developing countries, mortality rates are as high as 28 per 100,000; in North America the rate is less than 0.1 per 100,000. Immunization programs clearly decreased neonatal tetanus deaths, and some recent evidence suggests progress in prevention throughout the World. Tetanus remains a great public health problem in developing countries such as Nigeria and it is associated with high mortality, but the understanding of the epidemiological aspects of this disease forms the basis of preventive strategies in any community. This paper reviewed the history, epidemiology and clinical diagnosis of tetanus and emphasized the current opinions in the management of tetanus outlining the various suggested treatment plans from experts in developing countries which form the basis for World Health Organization recommendations

Acute Intermittent Porphyria In A Young Nigerian Child: A Case Report

Acute intermittent porphyria (AIP) is a rare autosomal dominant inherited disorder of heme biosynthesis which manifest with neurovisceral symptoms. Its manifestation in children before the age of puberty is said to be very rare and suggest homozygous state when it does occur before puberty. AIP mimics many other disorders and so may be easily missed leading to delay in appropriate management and poor prognosis. The authors report a case of AIP in a 5 year old boy from Nigeria.Key words: Acute, intermittent, porphyria, young, child, Nigeria

Does Pre-Hospital Care Affect the Outcome of Tetanus Patients? - An Analysis of cases Seen At a Tertiary Hospital in Nigeria.

Tetanus remains one of the major public health hazards of the developing world. It is an infective, but potentially preventable, disease caused by Clostridium tetani. Majority of affected persons in developing countries commonly seek medical attention with "first care providers" before coming to the secondary or tertiary health institutions. This is particularly prevalent in Africa, and Nigeria is not an exemption. We sought to determine the effect of the care given to tetanus patients on their outcome, prior to their presentation at our Teaching Hospital. The data for all tetanus cases seen between 1990 and 2000 were collected prospectively. Forty-eight (82.8%) of the 66 patients received one form of care before presenting to us. Most of the patients were first seen at private clinics and these cases were noted to be severe, with an attending higher mortality. All cases seen at the traditional homes were mild. We recommend the introduction of health education seminars on wound care and prevention of tetanus for the different cadres of personnel involved in the primary health care delivery. Key Words: Tetanus, Outcome, Mortality, Pre-Hospital, Care. Nigerian Medical Practitioner Vol.44(1) 2003: 19-2

Women’s Issues and Epilepsy: A Look at Health Care Practitioners

Previous reports from developed countries indicated that health care professionals had poor knowledge of women’s issues and epilepsy and the women with epilepsy may not be adequately informed about their illness. Health care professionals that attended the 18th Pan African Association of Neurological Sciences in Yaounde, Cameroun were asked to complete the knowledge of women issues and epilepsy (KOWIE) II questionnaire. A totalof 55 health care professionals participated in the survey. 67.3% were males while 32.7% were females. The mean age of the respondents was 39.35 (+12.07) years. About thirty six percent of the respondents were neurologists, 27.3% were in Internal Medicine while the rest comprised of general practitioners, pediatric neurologists, neurosurgeons, neuroscience nurses and neurophysiologists. There was poor knowledge of the effect of sex hormones on seizure threshold during menstrual cycles while only one fourth of the respondents were aware of the high incidence of sexual dysfunctions in women with epilepsy. About half of the respondents were aware of the deleterious effect of antiepileptic drugs on bone health. Their knowledge was better on pregnancy related issues such as the importance of administration of vitamin K to neonates of women with epilepsy to prevent haemorhagic disease of the newborn, the need for women with epilepsy to continue anti-epileptic drugs during pregnancy. More than half of the respondents were aware that the best antiepileptic drugs in pregnancy is the one that is most appropriate for the patients seizure type or syndrome. However there was no relationship between the number of years in practice or the number of patients seen per month by the respondents and the survey accuracy score. But the specialty of the respondents influenced the survey score as the paediatric and adult neurologists had the highest survey accuracy score. This study showed that the paediatric and adult neurologists were better informed on women’s  issues and epilepsy than other clinical neuroscientists