Factors associated with hospitalisation and mortality among people with Parkinson's disease: Analysis of a large UK primary care database

Background: Parkinson’s disease (PD) is characterised by worsening motor symptoms, falls/fractures and infections with disease progression, leading to hospitalisation and in some instances, death. Quality data on hospitalisation and mortality in PD is lacking. Objective: To investigate hospitalisation, mortality and incidence of PD over time in UK primary care setting. Methods: Through a systematic review and meta-analysis, estimates of the pooled prevalence of common reasons for hospitalisation was calculated. Three cohort studies using data from The Health Improvement Network (THIN) were conducted in the period 2006-2016: [1] Incidence of PD; [2] Mortality and [3] Hospitalisation in PD. Findings: In the review, from the nine included eligible studies, the main reasons for hospitalisation and their pooled prevalence among PwPD were infections (22%,95%CI:16%-30%), worsening motor features(19%,95%CI:13%- 27%), falls/fractures(18%,95%CI:14%to21%), cardiovascular comorbidities (13%,95%CI:9%-18%), neuropsychiatric (8%,95%CI:4%-13%) and gastrointestinal complications(7%,95%CI:4%-11%). In my empirical studies, the incidence of recorded PD gradually decreased using the stricter case definitions but remained stable using the broadest case definition over time. For the strictest case definition (diagnostic Read code and at least two prescriptions of antiparkinsonian medication), the incidence of PD was 60.42 in 2006 and dropped to 42.24 cases per 100,000 person years at risk (PYAR) in 2016 and for the broadest case definition (diagnosis Read code or symptom Read code or at least one prescription of antiparkinsonian medication), the incidence of PD was 149.20 cases in 2006 and this reduced slightly to 143.70 cases per 100,000 PYAR in 2016. 10,104 incident PD cases were identified and matched with 55,664 people without PD. Overall, rates of hospitalisation (IRR:1.33, 95%CI:1.29-1.37) and mortality (IRR:1.14, 95%CI:1.09-1.20) were higher in PwPD than those without. Hospitalisation rates were higher among people with PD (PwPD) in the younger age-group than those without PD in the same age-group. Other sociodemographic factors had no impact on hospitalisation and mortality in PD. PwPD were more often admitted with falls/fractures, infections, gastrointestinal complications, dementia, psychosis/hallucinations, postural hypotension, electrolyte disturbances, stroke, and surgical procedures compared to those without PD. Further results showed a widening mortality gap between PwPD and the general population. Conclusions: PD is associated with increased hospitalisation and mortality. The complications of motor and non-motor features of PD are amongst the main reasons for admission, some of which could be managed pro-actively to avoid admissions and maybe prevent death. Future studies should be directed at exploring effectiveness of preventive strategies to reduce hospitalisations and maybe mortality among PwPD

Medication Related Cutaneous Disorders in End Stage Renal Disease Patients in Lagos

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Depression among Patients with Parkinson's Disease in a Nigerian Tertiary Hospital

Background There is increasing evidence that Parkinson's disease (PD) can cause depression. This dimension has not been sufficiently studied particularly among Nigerian Africans. Our aim was to  determine the frequency and severity of depression among patients with PD and to compare this with their healthy counterparts.Methods 36 conservative patients with a clinical diagnosis of PD had the Beck Depression Inventory-Il administered to them. A structured questionnaire interview and a 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. An equal number of age and sex matched controls were also recruited for the study.Results Of the 36 PD patients, 83.3% had persistently low mood. Based on their Beck Depression Inventory score, 25% had mild depression, 18% had moderate depression and 16.7% had severe depression. Depression was worse with disease severity.Conclusion Patients with PD had a higher frequency of depression compared to their healthy counterparts. A multidisciplinary approach to the management of PD that includes depression-reducing interventions is required for this population of patients.Keywords: Depression, Parkinson's disease, BDI-I

Change in the incidence of Parkinson’s disease in a large UK primary care database

Parkinson’s disease (PD) has the fastest rising prevalence of all neurodegenerative diseases worldwide. However, it is unclear whether its incidence has increased after accounting for age and changes in diagnostic patterns in the same population. We conducted a cohort study in individuals aged ≥50 years within a large UK primary care database between January 2006 and December 2016. To account for possible changes in diagnostic patterns, we calculated the incidence of PD using four case definitions with different stringency derived from the combination of PD diagnosis, symptoms, and treatment. Using the broadest case definition, the incidence rate (IR) per 100,000 person years at risk (PYAR) was 149 (95% CI 143.3–155.4) in 2006 and 144 (95% CI 136.9–150.7) in 2016. In conclusion, the incidence of PD in the UK remained stable between 2006 and 2016, when accounting for age and diagnostic patterns, suggesting no major change in underlying risk factors for PD during this time period in the UK

Fixed Drug Eruptions (FDE) in an Urban Centre in South-South Nigeria

Background Fixed drug eruptions are adverse cutaneous reactions to ingested drugs, characterized by  the formation of solitary or multiple erythematous patches, plaques, bullae or erosions that reoccur at an identical skin site within hours of re ingestion of the offending drug. The objective of this study was to describe the epidemiology of Fixed drug eruptions with the identification of common causative drugs among patients at the dermatology clinic of an urban tertiary hospital in the South-south region ofNigeria.Methods All consecutive patients with a diagnosis of fixed drug eruptions seen at the dermatology clinic  between January 2005 to January 2013 were included in the study. The diagnosis of fixed drug eruptions was made based on clinical findings of lesion (s) of the same form occurring twice or more at the same  sites as a result of a readministration of a causative drug, and confirmation by a challenge test.Results The diagnosis of fixed drug eruption was made in 99 out of5106 (1.93%) patients, with a slight female dominance. FDE affected all age groups, the youngest presented at 9months of age and the oldest at 86years. Majority of patients (66. 7%) did not know the offending drug. The most implicated drugs  were the sulphonamides (21.2%), followed by antibiotics made up of ampiclox, tetracycline and penicillin ( 4.04%) and Non steroidal anti inflammatory drugs (3.03%). The commonest site of presentation was the face (32%), especially the mucosa of the mouth, followed by generalized presentation (28%).The frequency of Lower limb presentation was (13%),followed by the upper limb (11%) and the trunk(7.1%). Conclusion Fixed drug eruptions are a cause for great concern to the patient. Consistent with some other studies sulphonamides, clotrimoxazole and fansidar were the most implicated drugs.Keywords Fixed drug eruptions; Epidemiology: Out Patient clinic; Nigeria

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

Case Report of a 52 Year Old Hypertensive with Cerebral Toxoplasmosis as a Stroke Mimic

Background The diagnosis of acute ischaemic stroke is sometimes straightforward. The sudden onset of  a focal neurologic deficit in a recognizable vascular distribution with a common presentation - such as  hemiparesis, facial weakness and aphasia - identifies a common syndrome of acute stroke. I But differential diagnostic problems remain because there are some non-vascular disorders which "mimic"  stroke. Such mimics have clinical pictures that appear identical to stroke. I However, standard acute neuroimaging with non-contrast CT scanning will discover some of these mass lesions mimicking stroke. We therefore present a brief case report on cerebral toxoplasmosis as a stroke mimicMethods The case records of a patient who presented with cerebral toxoplasmosis mimicking a stroke and a review of the literature using google, Medline and PubMed search as well as available literature on the subject were utilized.Results We present a 52 year banker, a known hypertensive of2 years duration who claims good  adherence to medications. He presented to us 16 days after he a history of inability to move the left side  of his body and other neurologic features suggestive of a right hemispheric ischaemic stroke. Brain CT showed features of cerebral toxoplasmosis and he was found to be seropositive HIV 1. The patient was  placed on pyrimethamine, sulphadiazine, dexamethasone, antihypertensives and HAART. He made  remarkable improvement on discharge and follow up.Conclusion It is important for physicians to have a high index of suspicion for stroke mimics and ensure that radiologic brain imaging is done in all suspected stroke patients in order to ensure appropriate  diagnosis and treatment as in this index case

Quality of Life of People Living with HIV/AIDS in Port Harcourt, Nigeria

Background: With the advent of free treatment with highly active anti-retroviral therapy across Nigeria, people living with HIV I AIDS (PLWHA) now live longer. However, the burden of the disease still remains high. Aside from quantity of life lived, quality oflife(QOL) as a second key component of the burden of the  disease has therefore come to the fore. There is increasing body of literature on quality of life among  PLWHA from other parts of the country. However, there is still paucity of data in our environment. This study assessed the QOL of PLWHA attending the anti-retroviral clinic in the University of Port Harcourt  Teaching Hospital, Port Harcourt, South - South region of Nigeria.Methods: A descriptive cross-sectional study design was used. Five hundred (500) PLWHA attending the Anti-retroviral Clinic of the University of Port Harcourt Teaching Hospital, were consecutively selected. A questionnaire, administered at interview was used to obtain socio-demographic and medical data. The WHOQOL-HN bref was used to assess the quality of life of each study participant.Results: The mean age ofthe respondents was 37.67 ± 12.1years (range 18-70 years). Two hundred and fifty-six (53%)of the participants were males. 269  (53.8%) were married and 216(80.2%) had spouses who were positive. The QOL mean scores were highest for the environment domain (18.49 ± 2.09) and spirituality I religion I personal beliefs domain (15.52 ± 1.41). Physical health (13.13 ± 1. 70) and psychological domain (13.35 ± 1.31) had QOL mean scores  which were similar. The overall QOL mean scores were lowest in social relationships (12.64 ± 2.17) and level of dependence domains (12.69 + 1.30). A significant  difference in the mean QOL scores was observed among men (12.87 ± 1.04) compared to women (12.48 ± 1.46) in the level of dependence (p=O.OO).Conclusion: The lower mean score in social relationship and level of dependence domain may suggest the fear of stigmatization and discrimination. Any intervention targeted at improving the quality of life among this group must address this fear. Keywords: PLWHA; Quality of life; WHOQOL-HNbref; South-South; Nigeria

Seroprevalence of human T lymphotropic virus antibodies among healthy blood donors at a tertiary centre in Lagos, Nigeria

Introduction: Transmission of human T-lymphotropic viruses (HTLV) occurs from mother to child, by sexual contact and blood transfusion. Presently, in most centres in Nigeria, there is no routine pre-transfusion screening for HTLV. The study aims to determine the prevalence of HTLV-1 and HTLV-2 among healthy blood donors at a tertiary centre in Lagos. Methods: A cross-sectional study was carried out at the blood donor clinic of the Lagos State University Teaching Hospital (LASUTH), Ikeja. About 5mls of venous blood was collected from each subject into a sterile plain bottle after obtaining subject's consent. The serum separated and stored at -200C. Sera were assayed for HTLV by an enzyme-linked immunoassay (ELISA) for the determination of antibodies to HTLV 1 and HTLV -2. Western blot confirmatory testing was done on reactive samples. All donors were also screened for HIV, HBsAg and HCV by rapid kits. Results: The seroprevalence of HTLV -1 by ELISA was 1.0% and 0.5% by Western Blot among blood donors. A total of 210 healthy blood donors were enrolled. Only 2 (1.0%) blood donors were repeatedly reactive with ELISA test. On confirmatory testing with Western Blot, 1 (0.5%) blood donor was positive for HTLV. All the healthy blood donors were negative for HIV, HbsAg and HCV. None of the 210 blood donors had been previously transfused; as such no association could be established between transfusion history and HTLV positivity among the blood donors. Conclusion: The seroprevalence of HTLV in this environment is low among healthy blood donors

Seroprevalence of human T lymphotropic virus antibodies among healthy blood donors at a tertiary centre in Lagos, Nigeria

Introduction: Transmission of human T-lymphotropic viruses (HTLV) occurs from mother to child, by sexual contact and blood transfusion. Presently, in most centres in Nigeria, there is no routine  pre-transfusion screening for HTLV. The study aims to determine the prevalence of HTLV- 1 and HTLV-2 among healthy blood donors at a tertiary centre in Lagos.Methods: A cross-sectional study was carried out at the blood donor clinic of the Lagos State University Teaching Hospital (LASUTH), Ikeja. About 5mls of venous blood was collected from each subject into a  sterile plain bottle after obtaining subject's consent. The serum separated and stored at -200C. Sera were assayed for HTLV by an enzyme-linked immunoassay (ELISA) for the determination of antibodies to HTLV 1 and HTLV -2. Western blot confirmatory testing was done on reactive samples. All donors were also screened for HIV, HBsAg and HCV by rapid kits. Results: The seroprevalence of HTLV -1 by ELISA was 1.0% and 0.5% by Western Blot among blood donors. A total of 210 healthy blood donors were enrolled. Only 2 (1.0%) blood donors were repeatedly reactive with ELISA test. On confirmatory testing with Western Blot, 1 (0.5%) blood donor was positive for HTLV. All the healthy blood donors were negative for HIV, HbsAg and HCV. None of the 210 blood donors had been previously transfused; as such no association could be established between transfusion history and HTLV positivity among the blood donors. Conclusion: The seroprevalence of HTLV in this environment is low among healthy blood donors.Key words: Seroprevalence, HTLV, healthy blood donors, Nigeri