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

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

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

Non-Motor Features in Parkinson's Disease Patients Attending Neurology Clinic at a Tertiary Institution in Nigeria: A Preliminary Report

Background: The clinical course of Parkinson's disease (PD) is not limited to motor symptoms (tremor, bradykinesia, rigidity, gait problems and imbalance). A variety of non-motor symptoms (NMS) such as psychiatric, gastrointestinal, cognitive, sudomotor, autonomic, sleep and sensory disorders which occur commonly are usually underappreciated as features of PD. This is a short report which documents NMS in a group of PD patients in Port Harcourt.Method: Thirty -six patients with Parkinson's disease attending the neurology clinic of University of Port Harcourt Teaching Hospital were studied. The characteristics of the PD subjects and some non-motor symptoms were documented from direct interview as part of a larger study investigating Health related quality of life in PD.Results: Mean age was 64.3 ± 10.9 years (range 43- 86) and 27 were subjects were males and 9 were females. Persistent low mood was reported in30(83.3%), 27 (75%) had body pains and olfactory problems, 17 ( 47.2%) reported drooling of saliva and difficulty remembering events. 11 (30.6%) and 12 (33.3%) reported excessive daytime sleepiness and difficulty falling asleep respectively. Difficulty swallowing was reported in 7 (19.4%) and sweatingdisturbance in 10 (27.8%) patients.Conclusion: Non-motor symptoms occur in PD patients in Port Harcourt, Nigeria and awareness needs to be created among patients and health care providers on the presence and burden of NMS in PD patients in order to offer holistic care and improve quality of life in PD patients.Keywords: Non-motor symptoms; Parkinson's disease; Nigeri