Cognitive Functions in Patients with Clinically Stable (Mild to Moderate) Asthma in South West Nigeria: Assessment using Automated Neuropsychological Test Battery.

OBJECTIVE: Previous reports has shown that asthmatic patients with poor asthma control exhibited cognitive dysfunction. However, there is paucity of information on the cognitive functions of patients with clinically stable asthma particularly in sub-Saharan Africa. Subjects, study setting, materials and methods: This was a cross-sectional study conducted at the Federal Medical Centre, Owo, South West Nigeria from 2014-2016. Forty patients with mild to moderate asthma and forty matched (age, sex and educational status) non-asthmatic control subjects were included. Spirometry was done for all participants. Cognitive performance on domains of psychomotor speed, attention/concentration, memory and vigilance were assessed in all the participants using the Fepsy neuropsychological test battery Results: The mean age of the patients with asthma in years was 38.65±16.67 while that of the control subjects was 39.18±11.64 years. The patients with asthma had prolonged visual and binary choice reaction time relative to controls. Older asthmatic patients had prolonged visual and binary choice reaction time when compared to controls (p<0.05) while other socio-demographic clinical characteristics of the patients did not have impact on their cognitive performance (p>0.05). CONCLUSION: Cognitive performance was similar between the patients with mild to moderate asthma and non-asthmatic controls. Older asthmatic patients have impaired psychomotor speed relative to younger asthmatic patients.

APOL1, CDKN2A/CDKN2B, and HDAC9 polymorphisms and small vessel ischemic stroke.

OBJECTIVE: Worldwide, the highest frequencies of APOL1-associated kidney variants are found in indigenous West Africans among whom small vessel disease (SVD) ischemic stroke is the most common stroke phenotype. The objective of this study was to investigate the association and effect sizes of 23 selected SNPs in 14 genes of relevance, including the APOL1 G1 variants, with the occurrence of SVD ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. MATERIALS AND METHODS: Cases were consecutively recruited consenting adults (aged 18 years or older) with neuroimaging-confirmed first clinical stroke. Stroke-free controls were ascertained using a locally validated version of the Questionnaire for Verifying Stroke-Free Status (QVSFS). Logistic regression models adjusting for known vascular risk factors were fitted to assess the associations of the 23 SNPs in rigorously phenotyped cases (N = 154) of SVD ischemic stroke and stroke-free (N = 483) controls. RESULTS: Apolipoprotein L1 (APOL1) rs73885319 (OR = 1.52; CI: 1.09-2.13, P-value = .013), rs2383207 in CDKN2A/CDKN2B (OR = 3.08; CI: 1.15-8.26, P -value = .026) and rs2107595 (OR = 1.70; CI: 1.12-2.60, P-value = .014) and rs28688791 (OR = 1.52; CI: 1.03-2.26, P-value = .036) in HDAC9 gene were associated with SVD stroke at 0.05 significance level. Polymorphisms in other genes did not show significant associations. CONCLUSION: This is the first report of a specific association of APOL1 with a stroke subtype. Further research is needed to confirm these initial findings and deepen understanding of the genetics of stroke in people of African ancestry with possible implications for other ancestries as all humans originated from Africa.

2-(2-nitrovinyl)furan promotes oxidation of cellular proteins, lipids, and DNA of male rat liver and kidney.

The effect of 2-(2-nitrovinyl)furan on the redox status of male rat liver and kidney was evaluated. Twenty male rats were randomized into four groups; group A received olive oil and groups B, C, and D rats received 12.5, 25, and 50 mg/kg bodyweight of 2-(2-nitrovinyl)furan intraperitoneally, daily at 24 h interval, respectively, for 14 days. 2-(2-Nitrovinyl)furan significantly reduced (P < 0.05) alkaline phosphatase, alanine, and aspartate aminotransferase activities in male rat liver and kidney with a corresponding increase in serum. The activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, and levels of reduced glutathione/glutathione disulfide (GSSG) ratio in the liver and kidney of 2-(2-nitrovinyl)furan-treated rats decreased significantly (P < 0.05). In contrast, GSSG, protein carbonyl, conjugated dienes, lipid hydroperoxides, malondialdehyde, and fragmented DNA (%) in 2-(2-nitrovinyl)furan-treated rats increased significantly (P < 0.05). Overall, data from this study revealed that 2-(2-nitrovinyl)furan exhibited its toxic effect by suppressing or depleting the antioxidant systems.

Gastrointestinal complications in newly diagnosed Parkinson's disease: A case-control study.

BACKGROUND AND AIM: In spite of the overwhelming emphasis on motor symptoms in Parkinson's disease(PD), a number of studies have revealed that the non-motor symptoms including gastrointestinal, psychiatric and sleep symptoms have a greater influence on the quality of life of many patients. This study aimed to determine the frequencies of gastrointestinal symptoms in PD patients in comparison to healthy controls and to evaluate the relationship between these GI symptoms and severity of PD. METHODS: This cross-sectional study was conducted over a 2-year period. Consecutive new patients of Parkinson's disease were recruited at the neurology clinics of Aminu Kano Teaching Hospital (AKTH) and Murtala Muhammad specialist hospital (MMSH).Healthy age and sex matched volunteers constituted the control group. A structured, pre-tested, close-ended questionnaire inquiring about common gastrointestinal symptoms as well as demographic, and PD characteristics was administered to all cases and controls. PD severity was assessed using the Hoehn and Yahr scale (H and Y). RESULTS: A total of 80 patients and 80 controls were recruited during the study period. Their age ranged between 39 and 80 years. The mean age of the patients and controls were 61.1 ± 8.5 and 61.0 ± 8.4 years, respectively. The male to female ratio was 5:2. The most common gastrointestinal symptoms were constipation (48.8%), sialorrhea (18%), dysphagia (16.2%), difficulty in mastication (12.5%), and choking/aspiration (12.5%).When compared with age and sex-matched controls the differences in the occurrence of these symptoms were statistically significant.Constipation, dysphagia, difficult mastication, sialorrhea, and aspiration/choking were found to be more severe on the H and Y scale. CONCLUSION: Significant features of gastrointestinal dysfunction in PD include constipation, sialorrhea, dysphagia, difficult mastication and choking. These symptoms were significantly associated with increasing severity of Parkinson's disease.

The "obesity paradox" in Nigerians with heart failure.

BACKGROUND: Previous studies have suggested that a high body mass index (BMI) was associated with improved outcome in congestive heart failure (CHF). The aim of this study was to examine the relationship between BMI and echocardiographic variables of cardiac function in stable outpatients with heart failure. METHODS AND MATERIALS: This is a cross-sectional study in which the cardiology clinic out-patients of Obafemi Awolowo University Teaching Hospital with heart failure were recruited. Patients were categorized using baseline BMI as normal weight BMI = 18.5-24.9 kg/m(2) and overweight/obese (BMI > 25.0 kg/m(2)). Risks associated with BMI groups were evaluated and the data were analyzed with the aid of SPSS 15.0 software. RESULTS: Patients with higher BMI have higher left ventricular ejection fraction and fractional shortening and lesser tendency to have an abnormal left ventricular geometry and better functional (New York Heart Association) class of heart failure at presentation. CONCLUSION: Overweight and obese patients had less severe degree of heart failure than normal weight patients and efforts should be made to prevent excessive weight loss in patients with heart failure.

Patients' knowledge about their disorder: perspective of patients with epilepsy in a tertiary health facility in southwestern Nigeria.

OBJECTIVE: Previous studies have shown that patients with epilepsy do not have adequate knowledge about their disorder, suggesting that patient education is a vital part of comprehensive care for epilepsy. The goal of this study was to evaluate what Nigerian patients with epilepsy know about their disorder. METHODS: Forty-six patients with EEG- and clinically confirmed epilepsy participated in the study. The patients completed the Epilepsy Patients Knowledge Questionnaire. The questionnaire includes topics related to etiology of epilepsy, safety, compliance, legal issues of driving, and employment. The questionnaire scores were correlated with demographic variables, duration of epilepsy, and level of education of the patients. RESULTS: The mean age of the respondents was 26.78 ± 9.27 years; there were 27 males and 19 females. The mean duration of epilepsy in the group was 7.6 ± 7.5 years. The mean rates of correct responses to the issues of safety and compliance were 31.6 and 76.8%, respectively. The mean scores on legal issues of driving and employment were 45.7 and 42.4%, respectively. The lowest score (10.9%) was on the etiology of epilepsy. CONCLUSION: Nigerian patients with epilepsy lack adequate knowledge about their disorder, and there is a need for improved educational intervention in these patients.

Toxicological evaluation of aqueous extract of Aloe ferox Mill. in loperamide-induced constipated rats.

Aloe ferox Mill. is a widely used medicinal plant in South Africa for the treatment of many ailments including constipation. The present study evaluated the toxicological effect of aqueous leaf extract of the herb at 50, 100 and 200 mg/kg body weight for 7 days on the haematological parameters as well as liver and kidney function indices in loperamide-induced constipated rats. The extract did not cause any significant (p > 0.05) effect on the kidney and liver-body weight ratio as well as the kidney function indices including serum levels of creatinine, uric acid, urea, calcium and potassium ions at all the dosages investigated. Whereas the serum levels of total protein, albumin, bilirubin and gamma glutamyl trasferase (GGT) were not affected, the elevated activities of alkaline phosphatase (ALP), alanine transaminase (ALT) and aspartate transaminase (AST) in the untreated constipated animals were normalized following treatment with extract. The data obtained with respect to the haematological analysis indicated that the extracts had no significant (p > 0.05) effect on the haematological parameters with the exception of lymphocyte count which was increased in the untreated constipated rats. This was however attenuated after administering the herb. The available evidence in this study suggests that A. ferox may be safe as an oral remedy for constipation. Generally, the effect of the extract compared favourably well with senokot, a recommended drug for the treatment of constipation.

Toxicological evaluation of aqueous leaf and berry extracts of Phytolacca dioica L. in male Wistar rats.

Despite the widespread use of Phytolacca dioica L. in folklore medicine of South Africa, there is dearth of information on its safety/toxicity. The aim of this study was to evaluate the toxicological effect of aqueous leaf and berry extracts of the plant at different dosages for 14 days on the liver and kidney function indices in male Wistar rats. Phytochemical screening indicated that the extracts are rich in phytonutrients including alkaloid, tannin, saponins, phenolics, lectins and flavonoids; while triterpenoids and phlobatanins were absent. The extracts significantly reduced the body and absolute organ weights of the animals at all the dosages investigated. Whereas, significant increase was observed in the serum levels of alkaline phosphatase (ALP), gamma glutamyl transferase (GGT), alanine transaminase (ALT), aspartate transaminase (AST), bilirubin, calcium, creatinine, urea and uric acid; the serum concentration of total protein, albumin and globulin were reduced in the serum following treatment with the extracts. Generally, the effect of the herb appeared to be dosage dependent. This investigation clearly showed that P. dioica can impair normal hepatic and renal functions. This is an indication that the extracts may not be completely safe in male rats when continuously administered for 14 days.

Protective effect of Artemisia afra Jacq. on isoproterenol-induced myocardial injury in Wistar rats.

Artemisiaafra Jacq. ex Willd. is a widely used medicinal plant in South Africa for the treatment of various diseases. In this study, the effect of the herb on isoproterenol (ISO)-induced myocardial injury in rats was investigated. Pretreatment with the aqueous leaf extract of the plant at 100 and 200 mg/kg body weight for 30 days prevented the elevation of serum marker enzymes namely lactate dehydrogenase (LDH), aspartate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP) in myocardial injured rats. ISO-induced animals exhibited decreased levels of glutathione reductase (GR), glutathione peroxides (GPx), superoxide dismutase (SOD) and glutathione (GSH) in the heart, which were restored to near normal levels following treatment with the herb. The extract also attenuated lipid peroxidation (LPO) in the heart and improved the imbalance in lipid profile caused by ISO. The effect was more prominent at 200 mg/kg body weight. These findings revealed the cardioprotective effect of A. afra against isoproterenol-induced myocardial injury.

Performance and haematological indices in rats exposed to monocrotophos contamination.

Monocrotophos is an organophosphate pesticide used in agriculture to control insect pests. Changes in performance and haematological parameters (such as packed cell volume, white blood cells, neutrophils, eosinophils and lymphocytes) were used to assess the effect of the pesticide on rats chronically exposed to 12.5 parts per million (ppm), 25 ppm, 50 ppm, 100 ppm and 200 ppm for 10 days, while the control rats were placed on borehole water. Administration of the pesticide to the animals resulted in several physical deteriorations including appearance and agility. A significant reduction (p < .05) was observed in the weight gained by rats while the liver-to-body weight ratio increased significantly (p < .05) as the level of exposure to monocrotophos increased. Whereas packed cell volume, white blood cells and lymphocytes increased significantly (p < .05), neutrophils and eosinophils counts reduced significantly (p < .05) as the concentration of monocrotophos in the drinking water increased. Overall, the data indicated that exposure to monocrotophos portends serious consequences on the performance and haematological parameters of rats.

Potassium bromate content of selected bread samples in Ilorin, Central Nigeria and its effect on some enzymes of rat liver and kidney.

Bread samples from five different locations (Gaa-Akanbi, Saw-Mill, Oloje, Fate-Basin and Zango) in Ilorin metropolis, Central Nigeria were analyzed for their potassium bromate content before they were employed as a source of carbohydrate in the formulation of diet for albino rats. A total of sixty (60) albino rats (Rattus norvegicus) were grouped into six (6) of ten (10) rats each. The rats in the first group served as control and they were placed on diet formulated with bromate-free bread. Animals in Groups 2-6 were placed on diet formulated with bread samples obtained from the five different locations in Ilorin metropolis. At the expiration of thirty (30) days feeding period, the animals were sacrificed and blood samples, liver and kidney tissues were collected for the assay of ALP, AST and ALT activities. The results showed a significant reduction (p<0.05) in the activities of these enzymes in the tissues when compared with the control. However, a significant increase (p<0.05) was observed in the activities of the selected serum enzymes. Overall, the data indicate adverse effects on the liver and kidney of rats fed on diet containing potassium bromate.

Cognitive assessment in patients with epilepsy using the Community Screening Interview for Dementia.

OBJECTIVE: Epilepsy is the most common neurological disease worldwide. It may be complicated by cognitive impairments with consequent deleterious effects on education, vocation, and social and family life of affected individuals. We assessed the cognitive functions of Nigerian patients with epilepsy using the modified Community Screening Interview for Dementia (CSID) questionnaire. METHODS: Eighty-two subjects (41 patients with epilepsy and 41 normal controls) participated in the study. The CSID was used to assess language, memory, orientation, attention, calculation, and praxis. The SPSS statistical package was used for data analysis. RESULTS: The mean ages (in years) of patients with epilepsy and controls were 28.32+/-9.22 and 25.98+/-7.72, respectively. The patients with epilepsy performed poorly when compared with the controls (P<0.05) in the domains Language, Memory, Attention and Calculation, and Praxis, whereas there was no statistically significant difference between the patients and controls in Orientation scores. Duration of epilepsy and of antiepileptic drug (AED) therapy had a significant negative impact on all domains of the CSID (P<0.05), whereas type of AED used did not. The CSID had a sensitivity of 91.7%. CONCLUSION: This study showed that patients with epilepsy have significant cognitive impairments compared with controls, and duration of epilepsy and AED therapy have deleterious effects on their cognitive performance. In addition, the CSID has acceptable sensitivity and predictive value. It is recommended that cognitive function assessment should be an integral part of routine evaluation of patients with epilepsy.

Stroke-like syndrome in a middle aged Nigerian woman with metastatic brain cancer.

BACKGROUND: Metastatic brain cancer constitutes about 24 to 25 % of brain tumours worldwide and in Nigeria it constitutes about 40% of brain tumors. The clinical presentation of metastatic tumors may be atypical. OBJECTIVE: To present a middle aged Nigerian woman with a metastatic brain cancer who had a stroke-like syndrome. METHODS: The patient was a 47-year old woman who presented with a two-week history of progressive weakness of the right upper and lower limbs, associated with headache, blurring of vision and slurring of speech. There was a history of weight loss but no history of cough or evening pyrexia. She was not a known hypertensive or diabetic patient though, there were positive history of diabetes mellitus in her father and elder senior brother. Her other systemic review and past medical history were not contributory. RESULTS: Examination revealed a woman with expressive dysphasia and right spastic hemiparesis. Her pulse, blood pressure and heart sounds were normal. There was no carotid bruit. Imaging studies showed metastases in the brain, liver, chest, cervical lymph nodes and bone marrow. Cervical lymph node histology showed metastatic adenocarcinoma. She was managed with chemotherapy, steroids and other supportive therapy but she died on the 40th day of admission due to disease progression and aspiration pneumonitis. CONCLUSION: Metastatic brain cancer may manifest atypically. Physicians should screen any patient with stroke without any apparent risk factors for possibilities of underlying metastatic brain cancer.

Intellectual impairment in patients with epilepsy in Ile-Ife, Nigeria.

INTRODUCTION: Epilepsy is the most common non-infectious neurologic disease in developing countries such as Africa, including Nigeria. This study was designed to assess the intellectual performance of patients with epilepsy (PWE) in Nigeria hoping that the result will serve as the basis for educational, vocational, and social counseling. METHODS: Forty-one PWE were studied along with 41 age-, sex- and education-matched healthy controls. A questionnaire was developed and applied to all subjects and history was taken from patients and eyewitness. The intellectual function of each subject was assessed with the aid of Wechsler Adult Intelligence Scale adapted for Nigerians. All patients subsequently had electroencephalography (EEG) performed and the EEG findings were noted. SPSS statistical package was used to analyze the data. RESULT: The PWE performed poorly on the verbal IQ, performance IQ, and full scale IQ scores when compared with controls (P < 0.05) and 20% of PWE had mental retardation. Long duration of epilepsy, long duration of antiepileptic drug therapy, younger age at onset of epilepsy, increased frequency of seizures, and low educational status were found to have negative impacts on intellectual performance in PWE (P < 0.05) while seizure types and type of antiepileptic drugs (carbamazepine or phenytoin) did not influence intellectual performance. CONCLUSION: This study shows that PWE had significant intellectual impairment when compared with controls. In addition, long duration of epilepsy, long duration of AED therapy, earlier age of onset, increased seizure frequency, and low educational status had a negative impact on intellectual functioning in PWE.

Clinically diagnosed Guillain-Barre syndrome in Ile-Ife, Nigeria.

BACKGROUND: Guillain Barre Syndrome (GBS) is a neurological disorder that poses a great challenge to medical care. It affects all age groups, gender and socio-economic groups. OBJECTIVE: To determine the pattern of clinical presentation as well as the factors that determine morbidity and mortality in Guillain Barre Syndrome (GBS) patients. METHODS: The case records of all the patients with diagnosis of GBS from 1988-2005 were retrieved. Socio-demographic, clinical data and laboratory investigations were collated. RESULTS: There were a total of 14 patients managed during this period, which comprised seven males and seven females. The mean(SD) age was 23.6 (13.3) years. Nine (64.3%) patients were students, only one (8%) patient was a professional and the rest 4 (36%) were artisans. Five (36%) patients presented with weakness of both upper and lower limbs while another five (36%) patients presented with weakness of the lower limbs only and four (28%) patients had bulbar symptoms in addition to weakness of the upper and lower limbs. The most common prodromal symptoms were headache, fever and joint pains. The common symptoms at presentation were excessive sweating paraesthesia (43%), urinary hesitancy and retention (35%). Physical findings include Flaccid quadriparesis 13 (93%), autonomic dysfunction 9 (64.3%), sensory impairment (71.4%) and cranial neuropathies 6 (43.5%). Albuminocytological dissociation was present in the cerebrospinal fluid of five (56%) of nine patients who had lumbar puncture done and erythrocyte sedimentation rate (ESR) was elevated in five patients (38%). The sex, age presenting complaints and treatment given were found not to have correlation with clinical outcome. The pattern of motor paresis and the nature of discharge patient had were significantly correlated with clinical outcome. CONCLUSION: Guillain Barre syndrome present impotant challenge to medical care in Nigeria and it is hoped that this study would sensitize clinicians to the clinical burden of Guillain Barre syndrome among Nigerians.