Etiology and electroclinical pattern of late onset epilepsy in Ibadan, Southwestern Nigeria

BackgroundLate onset epilepsy (LOE) is a common neurological problem throughout the world. It is an area that has not been fully explored in the developing countries like Nigeria. The aim of the present study is to  determine the pattern of presentation of late onset epilepsy with the view to identifying the etiologic as well as describe their electro-clinical pattern.Methods120 consecutive patients presenting at the University College Hospital with LOE were recruited. A  detailed history was obtained in every case, and complete neurological examination was performed. EEGs were done in all patients. Contrast CT Scans and MRI were performed.ResultOne hundred and twenty subjects comprising 71 (59.2%) males and 49 (40.8%) females were studied. The ages of the patients ranged between 25 and 85 years with a mean of 53years (sd =14.6). The ages at onset of epilepsy ranged between 25 and 84 years with a mean of 52 (sd=14.8). All the subjects had classifiable seizure types, 31 (25.8%) had generalized seizure. The most common type of seizure was partial seizure diagnosed in 89 (74.2%) subjects. Fifty two (43.3%) of the subjects had abnormal neurological findings. Twenty one (30.9%) had cerebral infarcts and 20 (29.4%) had cerebral tumor. Those with symptomatic epilepsy were more likely to have neurologic deficit, simple partial seizure, secondarily generalized seizure, focal epileptiform discharges and focal slow waves.ConclusionThe most common abnormalities in LOE were cerebral infarct and brain tumor. A careful history, neurological examination and an EEG are adequate in the initial work-up of patients with LOE

Profile of Generic and Disease-Specific Health-Related Quality of Life Among Nigerians with Parkinson's Disease

Background There is mounting evidence that Parkinson's disease causes significant disability and  impairs health-related quality of life. However, this dimension has not been fully characterised, particularly among Africans. We examined the generic and diseasespecific health related quality of life profiles of Nigerian Africans with Parkinson's disease in comparison to demographically-matched controls.Methods Thirty-six consecutive Nigerian patients with Parkinson's disease were assessed using a battery comprising of the Parkinson's disease questionnaire-39 (a disease-specific instrument), and the EQ- 5D (a generic instrument whose maximum score of 1.00 indicates best quality of life). A structured questionnaire interview and a complete neurological examination including the Hoehn and Yahr stage of illness scale and the motor section of the Unified Parkinson's  Disease Rating Scale were performed on the same day. Thirtysixages and gender- matched apparently healthy controls were also assessed.Results There was no significant difference in age between the patients (64.3 + 10years) and controls (63. 7 + 9 years). The patients had significantly poorer EQ-5D score (0.31 + 0.23) compared to the  controls (0.84+ 0.12 for the controls, P< 0.001). The Parkinson's disease questionnaire- 39demonstrated poor quality of life in patients with the poorest performances in the mobility, activities of daily living and emotional well-being dimensions. However the social support dimension was not impaired.Conclusion Patients with Parkinson's disease had much poorer generic and specific health related quality of life in comparison to their healthy counterparts. Management should be multi disciplinary in order to holistically improve quality of life in all affected domains.Keywords Parkinson's disease; Health Related Quality of Life; Nigeri

Frailty and mortality among older patients in a tertiary hospital in Nigeria

Background: This study determined the frailty status and its association with mortality among older patients.Design: A prospective cohort design.Setting: Study was conducted at the medical wards of University College Hospital, Ibadan, Nigeria. Participants and study tools: Four hundred and fifty older patients (>60 years) were followed up from the day of admission to death or discharge. Information obtained includes socio-demographic characteristics and clinical frailty was assessed using the Canadian Study of Health and Aging (CSHA) scale. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05.Results: Overall, frailty was identified in 285 (63.3%) respondents. Mortality was significantly higher among frail respondents (25.3%) than non-frail respondents (15.4%) p=0.028. Logistic regression analysis showed factors associated with frailty were: male sex (OR=1.946 [1.005–3.774], p=0.048), non-engagement in occupational activities(OR=2.642 [1.394–5.008], p=0.003), multiple morbidities (OR=4.411 [1.944–10.006], p<0.0001), functional disability (OR=2.114 [1.029–4.343), p=0.042], malnutrition (OR=9.258 [1.029–83.301], p=0.047) and being underweight (OR=7.462 [1.499–37.037], p=0.014).Conclusion: The prevalence of frailty among medical in-hospital older patients is very high and calls for its prompt identification and management to improve their survival.Keywords: Frailty, Mortality, Older patients, in-hospital, NigeriaFunding: The study was self-funded by the author

Alzheimer's disease diagnosis and management: Perspectives from around the world

Alzheimer's disease (AD) and other dementias are a global challenge. Early diagnosis is important to manage the disease. However, there are barriers to diagnosis that differ by region. Researchers from Brazil, China, Nigeria, Spain, and Sweden have identified key barriers to AD diagnosis in their countries. In Brazil, socioeconomic inequalities and poor recognition of dementia by physicians can prevent diagnosis. In China, a very large population and lack of physician training in dementia make diagnosis problematic. In Nigeria, socioeconomic inequalities and cultural stigma can stand in the way of diagnosis. In Spain, patient hesitancy and an overloaded health-care system are barriers to diagnosis. In Sweden, inconsistent use of biomarkers is a prominent barrier to diagnosis of AD. To support diagnosis, more focus is needed on education of patients and physicians, increased use of support services, and improved access to biomarkers to accurately diagnose AD

Dyslipidemia, altered erythrocyte fatty acids and selenium are associated with dementia in elderly Nigerians

Dyslipidemia, reduced omega-3 and -6 fatty acids and antioxidative nutrients are modulatory risk factors associated with dementia. Diet, genetics and environment interact with nutritional metabolism and susceptibility to neurodegeneration. This study investigated the relationship between erythrocyte fatty acids and selected antioxidant nutrients in elderly Nigerians with vascular dementia (VD) and Alzheimer\u2019s disease (AD). Forty VD (69.03\ub18.19 years) twenty AD (71.06\ub15.0 years) and forty control (67.5\ub16.8 years) subjects were studied. Anthropometric indices, blood pressure (BP) and body mass index (BMI) were measured in all subjects. Venous blood sample was drawn from all subjects and erythrocytes separated for the determination of fatty acids. Plasma lipids, selenium and vitamin E levels were also measured. There were no differences in BMI, weight and height among the three groups except for systolic BP that was lower in VD (148.3\ub141.8mmHg) than AD (156\ub136mmHg). Docosahexanoic acid and eicosapentanoic acid were lower in VD (6.3\ub12.2 and 2.0\ub11.6% total fatty acids [TFA]) and AD (5.4\ub13.1 and 3.0\ub11.7 %TFA) respectively than in controls (8.9\ub13.8 and 6.0\ub14.7%TFA). No variation was recorded in linolenic and arachidonic acids. Significant increases in triglycerides, LDL-cholesterol and decreased HDL-cholesterol were observed in both VD and AD when compared to controls (p<0.05 in all cases). Plasma selenium levels were significantly decreased in VD and AD than in controls. Eicosapentanoic and linolenic acids concentrations were negatively correlated with plasma total cholesterol. Low levels of erythrocyte omega-3 fatty acids and plasma selenium concentrations are associated with occurrence of vascular dementia and Alzheimer\u2019s disease in elderly Nigerians

Aerobic exercise in HIV-associated neurocognitive disorders : protocol for a randomized controlled trial

BACKGROUND : Since the introduction of antiretroviral therapy (ART), the incidence of HIV-associated dementia has drastically fallen. Despite using ART, people living with HIV continue to experience less severe but limiting forms of HIV-associated neurocognitive disorder (HAND). People living with HIV who are on ART and experiencing symptoms of HAND may benefit from aerobic exercise. OBJECTIVE : This protocol describes a randomized controlled trial designed to determine the effects of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. METHODS : At least 68 patients diagnosed with HAND will be randomly placed into either an aerobic exercise group or control group. Patients in the aerobic exercise group will perform a moderate intensity workout on a stationary bicycle ergometer, 3 times a week for 12 weeks. We will measure the primary outcomes including neurocognitive performance, prevalence of HAND, viral load, and CD4 count. We will evaluate postexercise neurocognitive performance using reliable neuropsychological tests relevant to people living with HIV, in line with the Frascati criteria. We will assess secondary outcomes such as quality of life, activity limitation, and social participation using the World Health Organization Quality of Life (WHOQOL)-Brief, and the Oxford Participation and Activities questionnaire. We will use exploratory statistics to test the data for normality and homogeneity. We will analyze the effect of the exercise program on HAND using relative risk (RR) and absolute risk reduction (number needed to treat). Analysis of covariance will be run to estimate the effect of exercise on quality of life and activity and participation level. RESULTS : This funded trial was approved by the Institutional Review Board in May 2020. The protocol was approved on June 15, 2020. Enrollment commenced in January 2021 and was completed in May 2021. Over 60% of the participants were recruited at the time of first submission to JMIR Mental Health. Data curation is still ongoing; hence, data analysis is yet to be executed. Study outcomes are expected to be published in March 2022. CONCLUSIONS : This is a protocol for a randomized controlled trial that aims to evaluate the effect of a 12-week aerobic exercise program on HAND in Southeastern Nigeria.SUPPLEMENTARY MATERIALS : APPENDIX 1. Beck Depression Inventory.APPENDIX 2. Alcohol Use Disorder Identification Test (AUDIT).APPENDIX 3. Drug Abuse Screening Test.APPENDIX 4. International HIV Dementia Scale.APPENDIX 5. Controlled Oral Word Association Test (COWAT) (Verbal Fluency Test).APPENDIX 6. Hopkin Verbal Learning Test-Revised.APPENDIX 7. Trail Making Test A & B.APPENDIX 8. Digit span test.APPENDIX 9. Lawton Instrumental Activities of Daily Living (IADL) scale.APPENDIX 10. The World Health Organization Quality of Life (WHOQoL) Bref.APPENDIX 11. Oxford Participation and Activities Questionnaire (Ox-PAQ).APPENDIX 12. Physical Activity Readiness Questionnaire.APPENDIX 13. Adverse events form.The National Student Financial Aid Scheme (NSFAS) via the University Pretoria Doctoral Research Bursary.http://www.researchprotocols.orgPhysiotherap

Normative scores for select neuropsychological battery tests for the detection of HIV‑associated neurocognitive disorder amongst Nigerians

BACKGROUND : The study aimed to derive socio‑demographic–corrected norms for selecting neuropsychological (NP) battery tests for people living with HIV (PLWHIV) in Nigeria. This cross‑sectional study was conducted amongst patients who attended the general outpatient clinic and junior staff of the University of Nigeria Teaching Hospital (UNTH), Ituku‑Ozalla. AIMS AND OBJECTIVES : To determine the normative scores for select neuropsychological battery test for the detection of neurocognitive disorder amongst Nigerians PLWHIV. A sample of 92 individuals received voluntary HIV testing. METHODS : Eligibility criteria were being HIV negative, aged 18–64 years and formal education. We undertook a brief neuromedical examination to identify putative exclusion criteria. We sampled four NP tests covering seven cognitive domains and the motor speed component of the International HIV Dementia Scale (IHDS‑MS). We presented the normative scores using statistics of mean, median, standard deviation (SD), kurtosis and skewness. RESULTS : All the participants were Nigerians aged 18–64 years. Most (74.1%) of the participants were females. The mean and median ages of the participants were 42.6 ± 11.42 years and 44 years, respectively. The effect of gender on NP performance was limited to the digit span test (DST)‑forwards, while education affected all expect IHDS‑MS and DST‑backwards. The cut‑off scores for defining mild and severe impairment varied (moving from 1SD to 2SD) for all cognitive domains except for IHDS‑MS and DST. CONCLUSIONS : With these preliminary normative scores, it will be easier to identify and classify the severity of neurocognitive impairment amongst PLWHIV in Nigeria, thus facilitating the goal of keeping HIV‑associated dementia to a minimum. The lack of variability in the IHDS‑MS and DST is unfavourable.http://www.npmj.orgam2023Physiotherap

Competency-based medical education in two Sub-Saharan African medical schools.

Background Relatively little has been written on Medical Education in Sub-Saharan Africa, although there are over 170 medical schools in the region. A number of initiatives have been started to support medical education in the region to improve quality and quantity of medical graduates. These initiatives have led to curricular changes in the region, one of which is the introduction of Competency-Based Medical Education (CBME). Institutional reviews This paper presents two medical schools, Makerere University College of Health Sciences and College of Medicine, University of Ibadan, which successfully implemented CBME. The processes of curriculum revision are described and common themes are highlighted. Both schools used similar processes in developing their CBME curricula, with early and significant stakeholder involvement. Competencies were determined taking into consideration each country’s health and education systems. Final competency domains were similar between the two schools. Both schools established medical education departments to support their new curricula. New teaching methodologies and assessment methods were needed to support CBME, requiring investments in faculty training. Both schools received external funding to support CBME development and implementation. Conclusion CBME has emerged as an important change in medical education in Sub-Saharan Africa with schools adopting it as an approach to transformative medical education. Makerere University and the University of Ibadan have successfully adopted CBME and show that CBME can be implemented even for the low-resourced countries in Africa, supported by external investments to address the human resources gap