Stroke: Critical appraissal of intensive care management

Background: Stroke is a common medical condition in the medical units.Stroke patients are usually managed on the medical wards while some that needs organ support are admitted into the intensive care unit.However there is conflicting data on the benefits or otherwise of admitting stroke patients into the intensive care unit.This necessitated this study to know how much benefit is derived from admitting stroke patients into the intensive care unit.Aim and Objective: The study aims at the benefits of admitting stroke patients into the intensive care unit.The objective included studying the prognostic factors that determines the outcome of stroke patients admitted into the intensive care unit.Methodology: The case files of all patients admitted and managed in the intensive care unit of LAUTECH teaching hospital between 2002 and 2014 were retrieved and were analysed.The factors used in analyzing included the type of stroke,the age of the patients,the Glasgow Coma scale at admission,the need for intubation and mechanical ventilation as well as the percentage mortality in each subsets.Results: A total of 48 patients were admitted over the study period of which 19 were males and 29 were females.The percentage mortality in females was 78.95 while mortality in males was 62.5%.The higher the age the worse the prognosis, the higher the GCS the better the prognosis. Patients that were intubated and ventilated had percentage mortality of 68.8%.and better than non ventilated patients.The hemorrhagic strokes also carries worse prognosis.Conclusion: The admission of stroke patients to the intensive care unit should be individualized considering the above mentioned prognostic factors.However patients that are likely to benefit from intensive care unit should be admitted early for them to derive the maximum benefits.Keywords:Stroke,Intensive care unit,prognosis,benefit

Influence of Age and Neurotoxic HAART Use on Frequency of HIV Sensory Neuropathy

Background. Sensory neuropathy (SN) is one of the most common AIDS-associated neurologic disorders especially in the era of highly active antiretroviral therapy (HAART). The aim of this study was to determine the prevalence of SN among highly-active-antiretroviral-therapy- (HAART-) experienced and HAART-naïve HIV-positive individuals and to investigate the relationship to demographic, clinical, and laboratory factors. Methods. 323 patients with HIV infection (142 on HAART and 181 HAART naïve) were enrolled in a cross-sectional neuropathy screening program. Data was collected using structured questionnaires which contained the brief peripheral neuropathy screening tool of AIDS Clinical Trial Group protocol. Neuropathy was defined by the presence of at least 1 clinical sign in a distal, symmetrical pattern. Patients were classified as symptomatic if they described aching, stabbing, or burning pain, paresthesia, or numbness in a similar distribution. Demographic, clinical, and laboratory details were documented as risk factors. Result. The prevalence of sensory neuropathy was 39.0% (126/323), (of which 29/126 (23%)) were symptomatic. Amongst those on HAART, 60/142 (42.3%) had SN compared to 66/181 (36.5%) HAART-naïve individuals (P = 0.29). On multivariate analyses, the independent associations with SN were increasing age (P = 0.03) and current exposure to stavudine (P = 0.00). Gender (P = 0.99) height (P = 0.07) use of HAART (P = 0.50), duration of HAART treatment (P = 0.10), and lower CD4 count (P = 0.12) were not associated with an increased SN risk. Conclusion. HIV SN remains common despite improved immunologic function associated with HAART and decreased neurotoxic HAART use. In this cross-sectional analysis, age and stavudine-based therapies were the independent risk factors

Identification of ascorbic acid and phytochemical profiles of Scotch Bonnet pepper (Capsicum chinense) using High-Performance Liquid Chromatography-Ultraviolet Detector (HPLC-UV)

Researchers have discovered that red and green scotch peppers are extremely rich in phytochemicals and that these secondary metabolites are connected to several biological processes in the human body. This study aimed to determine the numerous phytochemicals present in scotch pepper seeds, flesh, and red and green varieties. The samples were pulverized after being air-dried. The phytochemicals and ascorbic acid contents were examined using a High-performance Liquid Chromatography-Ultraviolet  detector (HPLC-UV). Twelve phytochemicals and ascorbic acid were identified in the flesh and seed of red scotch pepper, with lycopene having the highest content (83.10 mg/kg), the ascorbic acid content of 8.80 mg/kg; moreover, the seed of red scotch pepper revealed twelve phytochemicals and lycopene being the highest content (75.60 mg/kg) and ascorbic acid content of 6.80 mg/kg, furthermore, fourteen phytochemicals were identified in the flesh of red scotch bonnet pepper with lycopene the highest quantity (86.00 mg/kg) and ascorbic content of 10.60 mg/kg. Twelve phytochemicals were identified in the flesh and seed of green scotch bonnet pepper, lycopene (68.70 mg/kg) being the highest content, ascorbic acid content (6.50 mg/kg), twelve phytochemicals were revealed in the flesh of green pepper and lycopene had highest quantity (76.30 mg/kg), in the seed of green pepper, the lycopene content was 68.70 mg/kg. However, it has been shown that capsaicin, dihydrocapsaicin, and lutein concentrations varied, with red scotch pepper flesh having the highest concentration of capsaicin (7.50 mg/kg). The lycopene and ascorbic acid contents of flesh were the highest (86.00 mg/kg) and (10.60 mg/kg). The study's findings showed that red pepper flesh was better than other components that were looked at.

New-Onset Seizures in HIV Patients on Antiretroviral Therapy at a Tertiary Centre in South-West, Nigeria

Background: Seizures are associated with neurological manifestations of HIV. They may be the presenting symptom and can occur at any disease stage. Aim: To determine the frequency and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection. Methods: A study of an HIV-infected patient cohort on highly active anti-retroviral therapy (HAART) in the out-patients clinic of the Lagos state university teaching hospital, Nigeria. In a cross-sectional design, 308 HIV infected patients were recruited over a period of 1 year. Cases with a first seizure during this period were further examined. Details of demographic data, the first seizure date, seizure characteristics, neurologic complications and CD4 count at the time of the seizure were documented. Results: A total of 20 (6.5%) had new-onset seizures during the study period. 6/20 (30%) were males and 14/20 (70%), females. Their ages ranged between 22 - 51 years with a mean of 34.2 ± 8.7 years. The seizure was focal in 2/20 (10%) of cases and generalised in 90% (18/20) of cases. A total of 13/20 (65%) had recurrence of their seizures. None of the cases had focal neurological deficit at the time of the first seizure. The mean CD4 count was 165.3 ± 145.7. The mean duration on HAART was 19.5 ± 12.7 months. Cases with CD4 counts ≤200 cells/mm3 constituted 70% (14/20) whilst those with CD4 counts >200 made up 30% (6/20) [p = 0.666]. Conclusions: Seizures remain a significant neurological manifestation of HIV infection and has a high recurrence rate. It occurs more commonly in the advanced stage with severe immune suppression and may be attributable to HIV encephalopathy. Early treatment would reduce the burden and improve patient’s quality of life

The Protective Effect of Polyphenol - Rich Extract of Syzygium cumini Leaves on Cholinesterase and Brain Antioxidant Status in Alloxan - Induced Diabetic Rats

Syzygium cumini leaves are used locally especially in Nigeria for the treatment \ management of diabetes mellitus and Alzheimer’s disease. This study was designed to investigate the effects of polyphenols extracted from Syzygium cumini l eaves on the occurrence of oxidative stress in the brain of rats with diabetes, which can trigger Alzheimer’s disease by determining both in vitro and in vivo c holinesterase, the antioxidant defense system, and the extent of oxidative damage. The effect of polyphenols extracted from Syzygium cumini leaves was investigated on in vitro c holinesterase. Thereafter, the extract (400 mg/kg body weight) of both free and bound polyphenols was administered orally to alloxan - induced rats, and the effect were monitore d on in vivo c holinesterase, superoxide dismutase, catalase, glutathione peroxidase, reduced glutathione, lipid peroxidation and hydroperoxides. The extract demonstrated inhibitory effects against in vitro c holinesterase. A significant reduction in the c ho linesterase activities increased the activities of superoxide dismutase, catalase, glutathione peroxidase, and reduced glutathione. A reduction in lipid peroxidation and hydroperoxide concentrations was observed in the brain of diabetic rats treated with p olyphenols extracted from Syzygium cumini leaves. This study suggests that the polyphenols of Syzygium cumini leaves have anti - Alzheimer and antioxidant boosters, as well as antiperoxidative activities. Therefore, the plant is recommended for both diabetic and Alzheimer’s disease patients worldwid

Clinical profile of parkinsonism and Parkinson's disease in Lagos, Southwestern Nigeria

<p>Abstract</p> <p>Background</p> <p>Current data on the pattern of parkinsonism and Parkinson's disease in Nigerians are sparse.</p> <p>This database was designed to document the clinical profile of PD in Nigerians, and compare this to prior observations.</p> <p>Methods</p> <p>A database of patients presenting to the Neurology out-patients clinic of the Lagos University Teaching Hospital was established in October 1996. Demographic and clinical data at presentation (disease stage using Hoehn and Yahr scale; 'off' state severity on the Unified Parkinson's disease Rating Scale) were documented for patients diagnosed with parkinsonism between October 1996 and December 2006. Cases were classified as Parkinson's disease or secondary parkinsonism (in the presence of criteria suggestive of a secondary aetiology).</p> <p>Results</p> <p>The hospital frequency of parkinsonism (over a 2-year period, and relative to other neurologic disorders) was 1.47% (i.e. 20/1360). Of the 124 patients with parkinsonism, 98 (79.0%) had PD, while 26 (21.0%) had secondary parkinsonism. Mean age (SD) at onset of PD (61.5 (10.0) years) was slightly higher than for secondary parkinsonism (57.5 (14.0) years) (P = 0.10). There was a male preponderance in PD (3.3 to 1) and secondary parkinsonism (2.7 to 1), while a positive family history of parkinsonism was present in only 1.02% (1/98) of PD. There was a modestly significant difference in age at onset (SD) of PD in men (60.3 (10.4)) compared to women (65.2 (7.9)) (T = 2.08; P = 0.04). The frequency of young onset PD (≤ 50 years) was 16.3% (16/98). The mean time interval from onset of motor symptoms to diagnosis of PD was 24.6 ± 26.1 months with majority presenting at a median 12 months from onset. On the H&Y scale, severity of PD at presentation was a median 2.0 (range 1 to 4). PD disease subtype was tremor-dominant in 31 (31.6%), mixed 54 (55.1%) and akinetic-rigid 14 (14.3%). Hypertension was present as a co-morbidity in 20 (20.4%), and diabetes in 6 (6.12%).</p> <p>Conclusions</p> <p>The clinical profile of PD in Nigerians is similar to that in other populations, but is characterized by delayed presentation as has been reported in other developing countries. Young-onset disease occurs but may be less commonly encountered, and frequency of a positive family history is lower than in western populations.</p

APOE E4 is associated with impaired self-declared cognition but not disease risk or age of onset in Nigerians with Parkinson's disease

The relationship between APOE polymorphisms and Parkinson's disease (PD) in black Africans has not been previously investigated. We evaluated the association between APOE polymorphic variability and self-declared cognition in 1100 Nigerians with PD and 1097 age-matched healthy controls. Cognition in PD was assessed using the single item cognition question (item 1.1) of the MDS-UPDRS. APOE genotype and allele frequencies did not differ between PD and controls (p > 0.05). No allelic or genotypic association was observed between APOE and age at onset of PD. In PD, APOE ε4/ε4 conferred a two-fold risk of cognitive impairment compared to one or no ε4 (HR: 2.09 (95% CI: 1.13-3.89; p = 0.02)), while APOE ε2 was associated with modest protection against cognitive impairment (HR: 0.41 (95% CI 0.19-0.99, p = 0.02)). Of 773 PD with motor phenotype and APOE characterized, tremor-dominant (TD) phenotype predominated significantly in ε2 carriers (87/135, 64.4%) compared to 22.2% in persons with postural instability/gait difficulty (PIGD) (30/135) and 13.3% in indeterminate (ID) (18/135, 13.3%) (p = 0.037). Although the frequency of the TD phenotype was highest in homozygous ε2 carriers (85.7%), the distribution of motor phenotypes across the six genotypes did not differ significantly (p = 0.18). Altogether, our findings support previous studies in other ethnicities, implying a role for APOE ε4 and ε2 as risk and protective factors, respectively, for cognitive impairment in PD

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Measurement of the Diffusivity and Solubility of Methane into Aqueous TBAB

Natural gas is a relatively clean burning fuel that can be used for cooking, heating and electricity generation. To adequately meet the developing world’s growing demand needs for natural gas it is necessary to have adequate infrastructure for gas transportation and storage. Historically, natural gas has been stored either in underground geological formations or above ground as either Compressed Natural Gas (CNG) or Liquefied Natural Gas (LNG). All of the previously noted storage technologies are mature technologies, but also technologies that require large capital investments. As a lower cost alternative to CNG storage, a number of researchers [1] have proposed using gas hydrates and, more recently, semiclathrates as a medium for above-ground natural gas storage. Gas hydrates are ice-like compounds, formed in the presence of water and light gases that have the ability to entrap large volumes of gas at conditions that are much milder than those needed to store natural gas as either CNG or LNG. Semiclathrates are similar compounds to gas hydrates. However, the presence of a quaternary ammonium salt leads to semiclathrates being able to form at conditions that are even milder than those required for gas hydrate formation. Several experimental analyses have been carried out in order to determine the three-phase (solid-liquid-vapour) equilibrium conditions at which semiclathrates form. However, in order to more thoroughly evaluate the feasibility of using semiclathrates for gas storage purposes it will be necessary to know the solubility of the gas in the solution as well as the diffusivity of the gas in the solution. Originally, the aim of the study was to modify an existing experimental apparatus and to measure the solubility and diffusivity of methane gas in aqueous solutions of tetra-n-butyl-ammonium bromide (TBAB) at conditions close to semiclathrate formation conditions. However, as the experiments proceeded, it was found that maintaining a constant pressure in the reactor was not straight forward. Thus, the main focus of the thesis shifted to establishing an adequate control strategy. Three control strategies were tried; PID control, on-off control and on-off control plus an inline microflow metering valve. For each strategy, several runs were carried out in an attempt to measure the solubility and diffusivity. Each of the experimental runs took close to a month to complete, after which time it was concluded that only an on-off controller with an inline microflow metering valve was capable of providing the appropriate control needed to maintain a constant pressure in the reactor. Following the experiments, the diffusivity and solubility of methane in aqueous TBAB solutions were regressed from the experimental data using the finite acting model and the infinite acting model as utilized in the original work of Etminan [2]. From the analysis of the experimental data, the diffusivity and solubility were seen to follow the expected trend; the diffusivity increases and the solubility decreases with temperature, at a constant pressure

Effect of Lanthanum Strontium Manganese Oxide (LaSMnO3) Nanoparticle on mouse Testosterone and Fertility

Intraperitoneal administration of Lanthanum strontium manganese oxide (LaSMnO3) a new class of magnetic nanoparticle on mouse testosterone and fertility was investigated.&nbsp; For this, experimental mice divided into 4 groups (n=5); group I, II, III and IV were treated with vehicle (control), 5, 10 and 20 µg/kg/day of LaSMnO3 for 21 days respectively. Five animals from each group were sacrificed at interval of 0, 7, 14 and 21 days, however, after twenty-one days of the treatment, animals in all groups were allowed to cohabited with untreated female mice for fertility study. Toxic effects of LaSMnO3 on the testosterone and sperm parameters were analyzed. Effect on ROS and anti-oxidative biomarkers were also measured. Significant decrease (p&lt;0.05) of epididymal spermatozoa motility and numbers was measured revealing the cytotoxicity effects of this nanomaterial. Light microscopic study revealed changes in the cauda epididymal sperm morphology. Failure of the fertility in LaSMnO3-treated mice as evidenced by the significant reduction in the average number of implantation in females mated with the treated males. Depletion of testicular testosterone hormone level by high dose of LaSMnO3 (20µg/kg/day) shows a reduced testicular androgen synthesis. This study therefore, shows the potential adverse effect of LaSMnO3 on male fertility. Keywords: Lanthanum strontium manganese oxide nanoparticle, animal models, toxicity, fertilit