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

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

Renal dysfunction and 30-day mortality risk in patients with acute stroke

Background: Chronic kidney disease (CKD) and stroke constitute worldwide public health problems with rising incidence, prevalence and poor outcomes. While the link between renal dysfunction and myocardial infarction is well established, the link with stroke has been less well investigated. In this study, the prevalence and prognostic implication of renal dysfunction in patients admitted with acute stroke was assessed.Methods: This was a prospective observational study of 130 patients with first-ever stroke admitted within 7 days of stroke onset and followed up for 30 days. The study outcome measure was 30-day mortality. Stroke subtype was verified by a computerized tomography (CT) scan of the brain. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the 4-variable Modification of Diet in Renal Disease (MDRD) equation. Renal dysfunction was defined as eGFR < 60 mL/min/1.73 m2 and significant proteinuria was defined as urinary protein excretion ≥ 0.5 g in 24 hours. The Cox proportional hazards regression model was used to determine the relationship between GFR, proteinuria and 30-day mortality.Results: The majority of the patients studied (56%) were male and their mean age was 61.3 ± 13.9 years. Ischaemic stroke was the most common stroke subtype, accounting for 74% of all cases. Overall, 38% of patients had reduced eGFR < 60 mL/min/1.72 m2 while 35% had significant proteinuria. eGFR < 60 mL/min/1.73 m2 (hazard ratio, HR 3.59, 95% CI 1.03–13.26, p < 0.001) and proteinuria (HR 1.86, CI 1.00–8.14, p = 0.035) were independent predictors of mortality. Other independent predictors were age > 70 years, haemorrhagic stroke subtype, CNS score < 6.5 and random blood glucose > 7.8 mmol/L.Conclusions:Renal dysfunction is common among adult Nigerian patients with acute stroke. Both reduced eGFR and proteinuria were independent predictors of 30-day mortality in these patients

Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa

Introduction: The impact of Obstructive sleep apnea (OSA) in worsening outcomes is profound,  especially in the presence of comorbid conditions. This study aimed to describe the proportion of patients at a high risk of OSA in our practice setting.Methods: The STOP BANG questionnaire and the Epworth Sleepiness scale were used to assess for OSA  risk and excessive daytime sleepiness respectively. Hospitalized patients and out-patients were  recruited. Intergroup differences in continuous variables were compared using the analysis of variance. The proportion of patients with high risk of OSA and excessive daytime sleepiness was presented as frequencies and group differences compared with the Pearson χ2 test. Independent risk predictors for OSA were assessed in  multivariate logistic regression analysis. Results: A total of 1100 patients (53.4% females) participated in the study. Three hundred and ninety nine  (36.3%) had a high risk of OSA, and 268 (24.4%) had excessive daytime sleepiness. Of the participants with high OSA risk, 138 (34.6%) had excessive daytime sleepiness compared to 130 (18.5%) of those with low OSA risk (p). Conclusion: A significant proportion of patients attending our tertiary care center are at high risk of OSA.Key words: Obstructive sleep apnea, excessive day time sleepiness, tertiary hospital, Nigeria

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

Integrated and patient-centred management of Parkinson’s disease:a network model for reshaping chronic neurological care

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Analysis of Nigerians with Apparently Sporadic Parkinson Disease for Mutations in LRRK2, PRKN and ATXN3

Several genetic variations have been associated with Parkinson disease in different populations over the past few years. Although a considerable number of worldwide populations have been screened for these variants, results from Sub-Saharan populations are very scarce in the literature. In the present report we have screened a cohort of Parkinson disease patients (n = 57) and healthy controls (n = 51) from Nigeria for mutations in the genes PRKN, LRRK2 and ATXN3. No pathogenic mutations were found in any of the genes. Hence, common pathogenic mutations in these genes, observed in several different populations, are not a frequent cause of Parkinson disease in Nigeria

Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria

<p>Abstract</p> <p>Background</p> <p>To study the frequency and pattern of use of complementary and alternative medicine (CAM) in patients with essential hypertension attending a tertiary hypertension clinic.</p> <p>Methods</p> <p>Two hundred and twenty-five consecutive hypertensive patients attending the hypertension clinic of the Lagos University Teaching Hospital over a 3-month period were interviewed. Socio-demographic data, duration of hypertension, clinic attendance, current blood pressure, and compliance to conventional medications was documented. CAM utilization was explored using both structured and open-ended questions.</p> <p>Results</p> <p>There were 90 (40%) male and 135 (60%) female patients with mean age ± SD overall was 55.1 ± 12.4 years. 88 (39.1%) of the respondents used CAM. Herbal products were the most commonly used CAM type. Amongst the CAM users, the most common herbal product used was garlic (69.3%). Others were native herbs (25%), ginger (23.9%), bitter leaf (<it>Vernonia amygdalina</it>) (9.1%), and aloe vera (4.5%). 2.5% used spiritual therapy. There was no difference in the clinical characteristics, socio-economic status, and blood pressure control of CAM users and non-users. Patients who utilized CAM had higher BMI compared with those who did not, but the difference was not statistically significant (mean BMI ± SD of 29.1 ± 5.6 vs 27.1 ± 5.9 kg/m²; P = 0.05).</p> <p>Conclusion</p> <p>A significant proportion of hypertensive patients attending our tertiary facility and receiving conventional treatment also use CAM therapies. Clinicians need to be aware of this practice, understand the rationale for this health-seeking behaviour, proactively enquire about their use, and counsel patients regarding the potential of some of the therapies for adverse reactions and drug interactions.</p

Underrepresented Populations in Parkinson's Genetics Research: Current Landscape and Future Directions

BACKGROUND: Human genetics research lacks diversity; over 80% of genome-wide association studies have been conducted on individuals of European ancestry. In addition to limiting insights regarding disease mechanisms, disproportionate representation can create disparities preventing equitable implementation of personalized medicine. OBJECTIVE: This systematic review provides an overview of research involving Parkinson's disease (PD) genetics in underrepresented populations (URP) and sets a baseline to measure the future impact of current efforts in those populations. METHODS: We searched PubMed and EMBASE until October 2021 using search strings for "PD," "genetics," the main "URP," and and the countries in Latin America, Caribbean, Africa, Asia, and Oceania (excluding Australia and New Zealand). Inclusion criteria were original studies, written in English, reporting genetic results on PD from non-European populations. Two levels of independent reviewers identified and extracted information. RESULTS: We observed imbalances in PD genetic studies among URPs. Asian participants from Greater China were described in the majority of the articles published (57%), but other populations were less well studied; for example, Blacks were represented in just 4.0% of the publications. Also, although idiopathic PD was more studied than monogenic forms of the disease, most studies analyzed a limited number of genetic variants. We identified just nine studies using a genome-wide approach published up to 2021, including URPs. CONCLUSION: This review provides insight into the significant lack of population diversity in PD research highlighting the immediate need for better representation. The Global Parkinson's Genetics Program (GP2) and similar initiatives aim to impact research in URPs, and the early metrics presented here can be used to measure progress in the field of PD genetics in the future. © 2022 International Parkinson and Movement Disorder Society