Misdiagnosis of tuberous sclerosis in a Nigerian girl: A case report and review of literature

Tuberous sclerosis is a rare neuro-cutaneous syndrome, one of the phakomatosis, characterized by facial angiofibromas (adenoma sebaceum), mental retardation and epilepsy. This classic triad occurs in less than one half of patients, probably in one-third, thus requiring a high index of suspicion to diagnose. Consequently it may easily be misdiagnosed as neurofibromatosis or other medical conditions. This is a case report of tuberous sclerosis in a 13-year-old Nigerian girl that was misdiagnosed as neurofibromatosis because of her cutaneous lesions. This paper discussed the case and reviewed the literature. A comprehensive medical clerkship, thorough physical examination, high index of clinical suspicion and neuroimaging investigations are required to confirm diagnosis.Bourneville est un syndrome neuro-cutan\ue9 rare, de la phakomatosis, caract\ue9ris\ue9e par l\u2019angiofibromas du visage (ad\ue9nome sebaceum), retard mental et l\u2019\ue9pilepsie. Ce classique triade se produit au moins de la moiti\ue9 des patients, probablement \ue0 un tiers, n\ue9cessitant ainsi un indice \ue9lev\ue9 de suspicion \ue0 diagnostiquer. Par cons\ue9quent, il peut facilement \ueatre arrive comme Neurofibromatose ou d\u2019autres conditions m\ue9dicales. Il s\u2019agit d\u2019un rapport de cas de Bourneville dans une fille de moins de 13 ans qui \ue9tait arrive comme Neurofibromatose en raison de ses l\ue9sions cutan\ue9es. Ce document discut\ue9 du cas et revue de la litt\ue9rature. Un stage m\ue9dicale compl\ue8te, d\u2019un examen approfondi de la physique, index haute de suspicion clinique et enqu\ueates neuroimaging sont tenus de confirmer le diagnostic

Misdiagnosis of tuberous sclerosis in a Nigerian girl: A case report and review of literature

Tuberous sclerosis is a rare neuro-cutaneous syndrome, one of the phakomatosis, characterized by facial angiofibromas (adenoma sebaceum), mental retardation and epilepsy. This classic triad occurs in less than one half of patients, probably in one-third, thus requiring a high index of suspicion to diagnose. Consequently it may easily be misdiagnosed as neurofibromatosis or other medical conditions. This is a case report of tuberous sclerosis in a 13-year-old Nigerian girl that was misdiagnosed as neurofibromatosis because of her cutaneous lesions. This paper discussed the case and reviewed the literature. A comprehensive medical clerkship, thorough physical examination, high index of clinical suspicion and neuroimaging investigations are required to confirm diagnosis.Bourneville est un syndrome neuro-cutané rare, de la phakomatosis, caractérisée par l’angiofibromas du visage (adénome sebaceum), retard mental et l’épilepsie. Ce classique triade se produit au moins de la moitié des patients, probablement à un tiers, nécessitant ainsi un indice élevé de suspicion à diagnostiquer. Par conséquent, il peut facilement être arrive comme Neurofibromatose ou d’autres conditions médicales. Il s’agit d’un rapport de cas de Bourneville dans une fille de moins de 13 ans qui était arrive comme Neurofibromatose en raison de ses lésions cutanées. Ce document discuté du cas et revue de la littérature. Un stage médicale complète, d’un examen approfondi de la physique, index haute de suspicion clinique et enquêtes neuroimaging sont tenus de confirmer le diagnostic

Depressive symptoms in patients with epilepsy: Analysis of self-rating and physician's assessment

Background : Depression has significant negative impact on the quality of life in patients with epilepsy (PWE). Aim: This study assessed the prevalence of depression in PWE and the impact of seizure variables on the depression scores. Settings and Design : A case-control study of randomly selected PWE attending a tertiary hospital in a metropolitan, Nigeria. Materials and Methods : A total of 152 randomly selected subjects the Beck Depression Inventory (BDI) for quantitative assessment of depression, while the Hamilton Rating Scale for Depression (HRSD) was used by the investigators. Statistical Analysis : The Student t test assessed statistical significance of differences in the BDI and HRSD scores, whereas the scores were correlated with Pearson′s correlation coefficient. Logistic regression analysis and Chi-square test for trend assessed the impact of seizure variables on the scores. The level of significance was taken as P < 0.05. Results : The prevalence of depressive symptoms was 42% and 45% using the HRSD and BDI, respectively, with significant differences in the scores of the patients and controls on the both scales (P < 0.001). The PWE scores on both scales yielded a correlation coefficient of 0.8 indicating their utility in detecting depressive symptoms. Seizure control was the most potent predictor of depression (HRSD: P = 0.004; BDI: P = 0.001). Conclusions : Depressive symptoms are common in epilepsy. Early detection and prompt management are recommended. Good seizure control with an appropriate antiepileptic drug, among other interventional measures, may contribute to the prevention of depression in epilepsy

Usefulness of the HIV Dementia Scale in Nigerian patients with HIV/AIDS

Objective: Information on the cognitive complications of HIV/AIDS from sub-Saharan Africa, where statistics on HIV is alarming, is sparse because of lack of validated cognitive tools. This study assessed the usefulness and predictive validity of the HIV Dementia Scale (HDS) as a screening tool among HIV-positive Nigerian Africans. Design: HIV-positive patients were randomly selected over a period of two months. Setting: The HIV/AIDS outpatient clinic of the University teaching hospital, Benin City, Nigeria. Subjects: Asymptomatic and symptomatic HIV-positive patients were compared with age, sex and level of education-matched controls. Outcome measures: Cognitive performances on the modified HIV Dementia scale. Results: The performances of 160 HIV-positive (comprising 80 asymptomatic and 80 symptomatic) subjects were compared with 80 age, sex and level of education-matched HIV-negative subjects on the HDS. The mean HDS scores (maximum =12) were 10.78±1.18 (comparison subjects), 8.85±1.38 (asymptomatic) and 5.2±1.13 (symptomatic);

Development and pilot testing of an online module for ethics education based on the Nigerian National Code for Health Research Ethics

Abstract Background The formulation and implementation of national ethical regulations to protect research participants is fundamental to ethical conduct of research. Ethics education and capacity are inadequate in developing African countries. This study was designed to develop a module for online training in research ethics based on the Nigerian National Code of Health Research Ethics and assess its ease of use and reliability among biomedical researchers in Nigeria. Methodology This was a three-phased evaluation study. Phase one involved development of an online training module based on the Nigerian Code of Health Research Ethics (NCHRE) and uploading it to the Collaborative Institutional Training Initiative (CITI) website while the second phase entailed the evaluation of the module for comprehensibility, readability and ease of use by 45 Nigerian biomedical researchers. The third phase involved modification and re-evaluation of the module by 30 Nigerian biomedical researchers and determination of test-retest reliability of the module using Cronbach’s alpha. Results The online module was easily accessible and comprehensible to 95% of study participants. There were significant differences in the pretest and posttest scores of study participants during the evaluation of the online module (p = 0.001) with correlation coefficients of 0.9 and 0.8 for the pretest and posttest scores respectively. The module also demonstrated excellent test-retest reliability and internal consistency as shown by Cronbach’s alpha coefficients of 0.92 and 0.84 for the pretest and posttest respectively. Conclusion The module based on the Nigerian Code was developed, tested and made available online as a valuable tool for training in cultural and societal relevant ethical principles to orient national and international biomedical researchers working in Nigeria. It would complement other general research ethics and Good Clinical Practice modules. Participants suggested that awareness of the online module should be increased through seminars, advertisement on government websites and portals used by Nigerian biomedical researchers, and incorporation of the Code into the undergraduate medical training curriculum.</p

Development and pilot testing of an online module for ethics education based on the Nigerian National Code for Health Research Ethics

BACKGROUND: The formulation and implementation of national ethical regulations to protect research participants is fundamental to ethical conduct of research. Ethics education and capacity are inadequate in developing African countries. This study was designed to develop a module for online training in research ethics based on the Nigerian National Code of Health Research Ethics and assess its ease of use and reliability among biomedical researchers in Nigeria. METHODOLOGY: This was a three-phased evaluation study. Phase one involved development of an online training module based on the Nigerian Code of Health Research Ethics (NCHRE) and uploading it to the Collaborative Institutional Training Initiative (CITI) website while the second phase entailed the evaluation of the module for comprehensibility, readability and ease of use by 45 Nigerian biomedical researchers. The third phase involved modification and re-evaluation of the module by 30 Nigerian biomedical researchers and determination of test-retest reliability of the module using Cronbach’s alpha. RESULTS: The online module was easily accessible and comprehensible to 95% of study participants. There were significant differences in the pretest and posttest scores of study participants during the evaluation of the online module (p = 0.001) with correlation coefficients of 0.9 and 0.8 for the pretest and posttest scores respectively. The module also demonstrated excellent test-retest reliability and internal consistency as shown by Cronbach’s alpha coefficients of 0.92 and 0.84 for the pretest and posttest respectively. CONCLUSION: The module based on the Nigerian Code was developed, tested and made available online as a valuable tool for training in cultural and societal relevant ethical principles to orient national and international biomedical researchers working in Nigeria. It would complement other general research ethics and Good Clinical Practice modules. Participants suggested that awareness of the online module should be increased through seminars, advertisement on government websites and portals used by Nigerian biomedical researchers, and incorporation of the Code into the undergraduate medical training curriculum

A community-based case–control study of prevalence and pattern of cognitive impairments in patients with epilepsy residing in South-Eastern Nigeria

Background: Epilepsy is the commonest neurological disorder encountered in Sub-Saharan Africa. The quality of life of patients with epilepsy (PWEs) is adversely affected by cognitive impairments. Aim: This study investigated the prevalence and pattern of cognitive impairments in PWE in Ukpo community located in a South-Eastern state in Nigeria using Community Screening Interview for Dementia (CSID) and a computer-assisted cognitive test battery (FePsy). Methods and Patients: Fifty-one PWEs were studied and compared with 51 age-, sex-and level of education-matched healthy controls. Diagnosis of epilepsy was confirmed clinically with eye-witness corroboration. Sociodemographic data and information on epilepsy variables were obtained with the aid of a questionnaire. Cognitive domains assessed include language, memory, orientation, attention, psychomotor speed and constructional praxis. Results: The prevalence rate of cognitive impairment using total CSID score was 19.6%. Analysis of CSID scores revealed significant impairment in language (17.6%), memory (29.4%), orientation (15.7%), attention (7.8%) and constructional praxis (15.7%) compared to healthy controls. A similar pattern was observed with FePsy but with better sensitivity indices for detecting cognitive impairment. Conclusion: This study indicated significant prevalence rate of cognitive impairment among treatment-naïve PWE with profound affectation of memory, mental speed and language. In addition, the FePsy was found to be more sensitive and specific in assessment of cognitive function in PWE

Intellectual Impairment in Patients with Newly Diagnosed HIV Infection in Southwestern Nigeria

Neurocognitive impairment is a detrimental complication of HIV infection. Here, we characterized the intellectual performance of patients with newly diagnosed HIV infection in southwestern Nigeria. We conducted a prospective study at Owo Federal Medical Center by using the adapted Wechsler Adult Intelligence Scale (WAIS). The raw scores were converted to standardized scores (z-scores) and correlated with clinical and laboratory findings. Fifty-eight HIV positive patients were recruited; 72% were in WHO stages 3 and 4. We detected a high rate of intellectual impairment in HIV positive patients and controls (63.8% and 10%, resp.; P<0.001). HIV positive patients performed worse throughout the subtests of both verbal and performance intelligence quotients. Presence of opportunistic infections was associated with worse performance in the similarities and digit symbol tests and performance and full scale scores. Lower body weight correlated with poor performance in different WAIS subtests. The high rate of advanced disease stage warrants measures aimed at earlier diagnosis and treatment. Assessment of neurocognitive performance at diagnosis may offer the opportunity to improve functioning in daily life and counteract disease progression