Cardiovascular Risk Awareness, Exercise Practices and Metabolic Outcomes among Patients with Diabetes Mellitus in Northern Nigeria: A Cross-sectional, Multicentre Study.

BACKGROUND: Physical exercise helps to mitigate cardiovascular risks in people with diabetes mellitus (DM), but there are limited data in Nigeria. This study aimed to assess cardiovascular risk awareness, exercise practices and metabolic outcomes among Nigerians with diabetes. MATERIALS AND METHODS: We conducted a cross-sectional study at five tertiary hospitals using questionnaire interviews and clinical assessments. Participants' knowledge of cardiovascular risk factors and knowledge of exercise were assessed on 12- and 5-item scores, while exercise practices were classed as adequate if performed regularly on 3 or more days weekly for a total of 150 min or more based on the American Diabetes Association recommendations. Mean body mass index (BMI), blood pressure (BP), fasting blood glucose, serum haemoglobin A1C (HbA1c), lipid profile, urea, creatinine and uric acid were then compared among participant groups. RESULTS: We studied 426 participants with DM, 58.7% females. The mean age was 52.9 ± 13.1 years, with males significantly older than females (54.6 ± 12.2 vs. 51.8 ± 13.5 years; 95% confidence interval: 0.27-5.28, P = 0.03). The mean age at diabetes diagnosis was 44.8 ± 11.7 years, and the median duration of diabetes was 84 months. There was low knowledge of cardiovascular risk factors and low knowledge of exercise (mean scores of 2.94 and 2.31, respectively). Forty-three per cent of participants reported adequate exercise, which was significantly associated with younger age (P = 0.007), male gender (P = 0.001) and formal education (P = 0.021). Participants with adequate exercise had lower systolic BP and serum urea compared to those with inadequate exercise, but there were no significant differences in BMI, fasting glucose, HbA1c, serum lipids, creatinine or uric acid. CONCLUSION: Participants had low knowledge of cardiovascular risks and the appropriate exercise practices for diabetes patients. There is a need for better patient education on diabetes self-care and exercise at clinic visits.

Trends in pediatric tuberculosis diagnosis utilizing xpert Mycobacterium tuberculosis/Rifampicin in a poor-resource, high-burden region: A retrospective, multicenter study.

Background: The burden of tuberculosis (TB) in Nigeria remains high, and diagnosis in children, a challenge. We aimed to document yield from Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) as a mode of diagnosis for children and the variables associated with a positive result. Methods: This was a retrospective review of TB treatment cards of children aged 0-15 years managed from January 2017 to December 2021 across six public tertiary institutions in Nigeria. The data obtained were analyzed using the descriptive and inferential statistics. Statistical significance was set at P < 0.05. Results: Of 1489 children commenced on TB treatment, 1463 (97.9%) had sufficient data for analysis the median age of study participants was 60 months (interquartile range [IQR]: 24, 120), and 814 (55.6%) were males. Xpert MTB/RIF test was performed in 862 (59%) participants and MTB was detected in 171 (19.8%) participants, of which 6.4% (11/171) had RIF resistance reported. The use of Xpert MTB/RIF rose from 56.5% in 2017 to 64% in 2020 but fell to 60.9% in 2021. We found that older age (> 10 years), the presence of pulmonary TB (PTB), and a negative human immunodeficiency virus (HIV) status were associated with positive Xpert MTB/RIF tests (P = 0.002, 0.001, and 0.012, respectively). Conclusion: The utilization of Xpert MTB/RIF in children increased in the years before the COVID-19 pandemic. Factors associated with MTB detection by Xpert MTB/RIF include older age, the presence of PTB, and a negative HIV status. Clinical and radiological evaluation continues to play vital roles in the diagnosis of childhood TB in Nigeria.

Complex regional pain syndrome: A case report and review of the literature.

Background: Complex regional pain syndrome (CRPS) is a rare neuropathic pain disorder associated with severe pain, muscle weakness, limb edema and hyperhidrosis. Predisposing factors include fracture, surgery, stroke and spinal cord injury. CRPS may recur in the same limb or spread to other limbs to complicate management. Case Report: A 20-year old female with CRPS Type-I had sequential spread to all four limbs despite different treatment modalities, including medical therapy, nerve block, radiofrequency ablation and surgical sympathectomy. We discuss the therapeutic challenges and reviewed recent literature on current treatment options for CRPS Type-I. Conclusion: A multidisciplinary approach is needed for effective management of CRPS, and refractory disease may respond to intrathecal baclofen with morphine.

RésuméContexte: Le syndrome douloureux régional complexe (SDRC) est un trouble neuropathique rare associé à une douleur intense, une faiblesse musculaire, un dème des membres et une hyperhidrose. Les facteurs prédisposants comprennent la fracture, la chirurgie, l'AVC et les lésions de la moelle épinière. Le SDRC peut se reproduire dans le même membre ou se propager à d'autres membres pour compliquer la gestion. Rapport de cas: une femme de 20 ans atteinte du SDRC de type I s'est propagée séquentiellement aux quatre membres malgré différentes modalités de traitement, y compris une thérapie médicale, un bloc nerveux, une ablation par radiofréquence et une sympathectomie chirurgicale. Nous discutons des défis thérapeutiques et avons passé en revue la littérature récente sur les options de traitement actuelles pour le SDRC de type I. Conclusion: Une approche multidisciplinaire est nécessaire pour une gestion efficace du SDRC, et la maladie réfractaire peut répondre au baclofène intrathécal avec de la morphine.

Prestroke treatment of stroke risk factors: A cross-sectional survey in central Nigeria.

BACKGROUND: Stroke can be prevented with treatments targeted at hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation, but this is often hampered by under-diagnosis and under-treatment of those risk factors. The magnitude of this problem is not well-studied in sub-Saharan Africa. MATERIALS AND METHODS: We conducted a cross-sectional survey of stroke patients at a tertiary hospital during January 2010 to July 2013 to determine patient awareness of a pre-existing stroke risk factor and prior use of anti-hypertensive, anti-diabetic, antiplatelet and lipid-lowering agents. We also investigated whether gender and school education influenced patient awareness and treatment of a stroke risk factor prior to stroke. RESULTS: Three hundred and sixty nine stroke patients presented during the study period, of which 344 eligible subjects were studied. Mean age at presentation (±SD) was 55.8 ± 13.7 years, and was not different for men and women. Hypertension, hyperlipidemia, diabetes and atrial fibrillation were prevalent among 83.7%, 26.5%, 25.6% and 9.6% patients respectively. Awareness was high for pre-existing diabetes (81.8%) and hypertension (76.7%), but not for hyperlipidemia (26.4%) and atrial fibrillation (15.2%). Men were better educated than women (p = 0.002), and had better awareness for hyperlipidemia (37.3% versus 13.5%; p = 0.009). Men were also more likely to take drug treatments for a stroke risk factor, but the differences were significant. CONCLUSIONS: A high rate of under-diagnosis and under-treatment of hypertension, hyperlipidemia and atrial fibrillation contributes to the stroke burden in sub-Saharan Africa, especially among women. Public health measures including mass media campaigns could help reduce the burden of stroke.

Spinocerebellar ataxia type-7: Report of a family in Northwest Nigeria.

Spinocerebellar ataxia type-7 (SCA7) is a cytosine-adenine-guanine (CAG) repeat polyglutamine disorder characterized by progressive degeneration of the cerebellum, brainstem, spinal cord, and retina. Clinical features include progressive ataxia, visual loss, pyramidal weakness, sensory impairment, and dementia. Among the autosomal dominant cerebellar ataxias, SCA7 is relatively common in Scandinavia and South Africa but rare worldwide and is not previously reported in Nigeria. In this study, we describe a family in Katsina State, Northwest Nigeria, with nine individuals across three generations affected by the SCA7 phenotype. Analysis of DNA from proband and two affected relatives revealed 39 CAG repeat expansions in one allele of ataxin-7 in each.

Associations between Cognition, Gender and Monocyte Activation among HIV Infected Individuals in Nigeria.

The potential role of gender in the occurrence of HIV-related neurocognitive impairment (NCI) and associations with markers of HIV-related immune activity has not been previously examined. In this study 149 antiretroviral-naïve seropositive subjects in Nigeria (SP, 92 women and 57 men) and 58 seronegative (SN, 38 women and 20 men) were administered neuropsychological testing that assessed 7 ability domains. From the neuropsychological test scores was calculated a global deficit score (GDS), a measure of overall NCI. Percentages of circulating monocytes and plasma HIV RNA, soluble CD163 and soluble CD14 levels were also assessed. HIV SP women were found to be younger, more educated and had higher CD4+ T cell counts and borderline higher viral load measures than SP men. On the neuropsychological testing, SP women were more impaired in speed of information processing and verbal fluency and had a higher mean GDS than SN women. Compared to SP men, SP women were also more impaired in speed of information processing and verbal fluency as well as on tests of learning and memory. Numbers of circulating monocytes and plasma sCD14 and sCD163 levels were significantly higher for all SP versus all SN individuals and were also higher for SP women and for SP men versus their SN counterparts. Among SP women, soluble CD14 levels were slightly higher than for SP men, and SP women had higher viral load measurements and were more likely to have detectable virus than SP men. Higher sCD14 levels among SP women correlated with more severe global impairment, and higher viral load measurements correlated with higher monocyte numbers and sCD14 and sCD14 levels, associations that were not observed for SP men. These studies suggest that the risk of developing NCI differ for HIV infected women and men in Nigeria and, for women, may be linked to effects from higher plasma levels of HIV driving activation of circulating monocytes.

FEV1, FVC, FEV1 /FVVC as predictors of rhinitis among saw mill workers in north central Nigeria.

Background: Rhinitis is one of the commonest occupational related respiratory disorders that is only restricted to the upper airway but can involve the lower respiratory tract with considerable airflow limitation, this study was conducted assess the ventilator function of persons exposed to saw dust with rhinitis symptoms. Methods: This is a cross sectional study carried out among 200 randomly selected saw mill workers and 200 healthy staff of Jos University Teaching Hospital staff in Jos metropolis from September to November 2008. Data on sociodemographic variables, symptoms of rhinitis, etc was obtained using a modified semi structured British medical research council questionnaire while respiratory function data was measured using a spirometry. Result: A total of 400 responds comprising of 200 saw mill workers and 200 controls participated in this study. Based on diagnostic criteria. 43% of the subjects fit into diagnosis of rhinitis, 33% had asthma symptoms and 24 % did not fit into any category compared to none of < 5% of the control group. The ventilatory function based on FEV1, FVC, FEV1/FVC ratio and PEFR showed a significant decline when matched with controls and predicted value, suggesting an airflow limitation among the rhinitis group. Conclusion: Rhinitis associated with wood dust exposure is not restricted to airway but involves the entire respiratory tract with airflow limitation as one of its consequences.

Stroke risk factors, subtypes, and 30-day case fatality in Abuja, Nigeria.

BACKGROUND: Stroke is the second leading cause of death and the leading cause of adult disability worldwide. A better understanding of stroke risk factors and outcome may help guide efforts at reducing the community burden of stroke. This study aimed to understand stroke risk factors, imaging subtypes, and 30-day outcomes among adult Nigerians. MATERIALS AND METHODS: We prospectively recruited all patients presenting with acute stroke at the National Hospital Abuja between January 2010 and June 2012. We assessed clinical and laboratory variables, as well as brain computerized tomography, magnetic resonance imaging, and carotid Doppler ultrasound scans. We also assessed case fatality and functional outcome at 30 days after stroke. RESULTS: Of 272 patients studied, 168 (61.8%) were males. Age at presentation (mean ± standard deviation) was 56.4 ± 12.7 years in males and 52.9 ± 14.8 years in females (P = 0.039). Neuroimaging was obtained in 96.7% patients, revealing cerebral infarction (61.8%), intracerebral hemorrhage (ICH) (34.8%), and subarachnoid hemorrhage (SAH) (3.4%). Carotid plaques or stenosis ≥50% were detected in 53.2% patients with cerebral infarction. Stroke risk factors included hypertension (82.7%), obesity (32.6%), diabetes (23.5%), hyperlipidemia (18.4%), atrial fibrillation (9.2%), and cigarette smoking (7.7%). At 30 days after stroke, case-fatality rate was 18.8%, whereas modified Rankin Scale (mRS) scores for cerebral infarction, ICH, and SAH were 3.71, 4.21, and 4.56, respectively. Atrial fibrillation, a previous stroke, and age older than 50 years were all associated with worse mRS scores at 30 days. CONCLUSION: Although hypertension, obesity, diabetes mellitus, and atrial fibrillation were important stroke risk factors, in many patients, these were detected only after a stroke. While the commonest stroke subtype was cerebral infarction, observed in almost two-third of patients, SAH was associated with the highest case-fatality rate at 30 days of 44.4%. Larger population-based studies may provide additional data on stroke incidence and outcome among Nigerians.

NeuroAIDS in sub-Saharan Africa: a clinical review.

NeuroAIDS affects half of the 22 million people currently living with HIV/AIDS in sub-Saharan Africa, where cryptococcal meningitis alone is responsible for 504,000 deaths annually. A good understanding of NeuroAIDS may help improve disease-free survival in patients at risk and optimize resource utilization by caregivers. In this review, we aimed to provide a summary of major NeuroAIDS syndromes of relevance in Africa. We searched Medline for English language literature to identify relevant publications, using the search terms "NeuroAIDS" and "HIV AND nervous system." The most common NeuroAIDS syndrome is HIV-associated neurocognitive disorders (HAND), which affects over 1.5 million Africans yearly. While incidence of HAND has decreased with the use of highly active antiretroviral therapy, prevalence has increased due to longer life expectancy. Other NeuroAIDS syndromes include tuberculous meningitis and intracerebral tuberculoma, cryptococcal meningitis, toxoplasma encephalitis, progressive multifocal leukoencephalopathy, primary central nervous system lymphoma, stroke, and distal sensory polyneuropathy. NeuroAIDS care and research in Africa are hindered by resource limitations. Inadequate neuroimaging and laboratory facilities result in diagnostic delays and confusion, while limited access to drugs leads to inappropriate treatment. However, the situation may be improving. Better funding of HIV care by African governments and donor agencies have resulted in decreasing HIV prevalence and prolonged survival. Yet, central nervous system opportunistic infections remain important causes of death and disability among African patients with HIV/AIDS. There is the need for additional funding to improve access to antibiotics and to facilitate further research into NeuroAIDS and its treatment.

Myasthenia gravis: presentation and outcome in 104 patients managed in a single institution.

BACKGROUND AND OBJECTIVES: Few studies have attempted to delineate the clinical profile of myasthenia gravis (MG) among people of Arab ancestry. Therefore, we sought to clarify the clinical profile, the outcome of treatment and the role of thymectomy in non-thymomatous MG in Saudi Arabia. PATIENTS AND METHODS: We retrospectively studied 104 patients followed over a mean period of 7.2 years (range, 1 to 22 years) at the King Khaled University Hospital, Riyadh, Saudi Arabia. Disease outcomes were compared among thymectomized and non-thymectomized patients according to the post-intervention status criteria of the Myasthenia Gravis Foundation of America (MGFA). RESULTS: Age of onset was 22.5+/-9.3 years (meanA+/-SD) in females and 28.2+/-15.9 years in males, with peaks in the second and third decades among females and the third and fourth decades among males. At diagnosis, a majority of patients had moderate generalized weakness, equivalent to MGFA class III severity. After medical treatment with or without thymectomy, 9.6% of all patients had achieved complete stable remission, 3.8% had pharmacological remission, 27.9% had minimal manifestations, 23.1% were improved, 20.2% were unchanged and 15.4% were worse. Only thymectomized patients without a thymoma achieved remission, a significant benefit over those who had no thymectomy (P=.02). CONCLUSION: MG presents at a younger age among Saudi Arabs compared to other racial groups. Thymectomy conferred significant benefits towards achievement of remission.

The sympathetic skin response in diabetic neuropathy and its relationship to autonomic symptoms.

OBJECTIVE: To examine the utility of the sympathetic skin response SSR as a measure of impaired autonomic function among diabetic patients in Saudi Arabia. METHODS: In this case-control study, baseline SSR was obtained from 18 healthy subjects, followed by nerve conduction studies, and SSR testing on a consecutive cohort of 50 diabetic patients with peripheral neuropathy. The SSR in diabetic patients was compared between those with autonomic neuropathy and those without autonomic neuropathy. This study was conducted at the King Khaled University Hospital, Riyadh, Saudi Arabia, from June 2006 to June 2007. RESULTS: The SSR was present in all healthy subjects, and in 32 diabetic patients. Among 16 patients with autonomic neuropathy, the SSR was absent in 14 and present in 2, while 4 of 34 patients lacking evidence of autonomic neuropathy had absent SSR. Using Fisher's exact test, we found a strong association between absent SSR and autonomic neuropathy p<0.001, however, not with age or duration of diabetes mellitus. As a diagnostic test of autonomic neuropathy, the SSR had a sensitivity of 87.5%, a specificity of 88.2%, a positive predictive value of 77.8%, and a negative predictive value of 93.7%. CONCLUSION: Absence of the SSR is a reliable indicator of autonomic neuropathy among patients with diabetes mellitus in Saudi Arabia.

Multiple sclerosis with recurrent meningitis.

Multiple sclerosis is an autoimmune demyelinating disease that is rarely associated with aseptic meningitis. However, certain syndromes causing aseptic meningitis are often associated with central nervous system demyelination that mimics multiple sclerosis (MS). Since many of these syndromes are potentially treatable, unmasking an alternative diagnosis is essential whenever an MS-like illness and recurrent meningitis are encountered in the same patient. Yet, the search for an alternative diagnosis may be elusive sometimes, despite extensive and appropriate investigations. We present a young woman with an MS-like illness associated with recurrent meningitis over a 7-year period. After an exhaustive evaluation, we conclude that recurrent meningitis is an atypical manifestation of MS. If neurologists would appreciate this point, unrewarding and costly investigations may be avoided and appropriate therapy instituted when similar cases are encountered in clinical practice.

Genetics of ischemic stroke.

Stroke is the third leading cause of death and a major cause of disability worldwide. Most cases of ischemic stroke are attributable to hypertension and other risk factors, but in over 20% of cases, the cause is unknown. Recent research has implicated some novel genes in the etiology of ischemic stroke, including genes for soluble epoxide hydrolase (sHE), 5-lipoxygenase activating protein (FLAP) and phosphodiesterase 4D (PDE4D). Moreover, thrombophilic states such as prothrombin G20210A mutation and factor V Leiden are now known to cause arterial stroke as well as venous thrombosis. Meanwhile, the recent availability of enzyme replacement therapy for Fabry disease and the proven benefits of regular blood transfusion in certain patients with sickle cell disease have greatly altered the outlook of these devastating inherited disorders. Thus, our understanding of the role of genetic factors in stroke raises the prospects for accurate assessment of future stroke risk among susceptible individuals, in whom early preventive measures may be life-saving. Further research into the genetics of stroke will clearly compliment ongoing national and international efforts to reduce the global burden of stroke.

Activation of microglia in mice spinal cords following passive transfer of purified IgG from patients with amyotrophic lateral sclerosis.

OBJECTIVE: To determine whether IgG from amyotrophic lateral sclerosis (ALS) patients could cause activation of microglia, proliferation of astrocytes, and infiltration by lymphocytes within mice spinal cords. METHODS: A group of 5 mice received injections of IgG purified from sera of patients with ALS. A control group of 5 mice received IgG from healthy humans, whilst a third group of 2 mice served as non-injected controls. One mouse served as a positive control and was injected with lipopolysaccharide, a known activator of microglia. Mice were culled after one week, for immunocytochemistry of spinal cord sections to localize the complement receptor CD11b on activated microglia, glial fibrillary acidic protein on astrocytes, and CD4 and CD8 receptors on lymphocytes. Histological examination was used to determine the presence of inflammatory reaction. This work was conducted at the Institute of Neurology, Queen Square London, United Kingdom, from January to July 2004. RESULTS: There was no significant difference in activation of microglia between mice injected with ALS IgG and mice injected with control IgG (p = 0.631), although mice injected with ALS IgG exhibited greater microglial activation than non-injected mice (p = 0.044). Proliferation of astrocytes was not significantly different between the 3 groups. CD4 and CD8 lymphocytes were both absent in mice injected with ALS IgG, mice injected with control IgG and non-injected mice. CONCLUSION: Activation of microglia following passive transfer of IgG from ALS patients to mice represents a non-specific inflammatory response, rather than a primary mechanism for motor neuron degeneration.