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Gadama Y, Du Preez M, Carr J, Theron S, Albertyn C, Ssebambulidde K, Saylor D, Brey N, Henning F. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and Human Immunodeficiency virus infection: dilemmas in diagnosis and management: a case series. J Med Case Rep 2023; 17:457. [PMID: 37845760 PMCID: PMC10580653 DOI: 10.1186/s13256-023-04191-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described autoimmune inflammatory disorder of the central nervous system (CNS). There is limited data on the association between Human Immunodeficiency virus (HIV) infection and MOGAD. We report three patients with HIV infection and myelin oligodendrocyte glycoprotein (MOG) antibodies in the setting of other central nervous system infections. CASE DESCRIPTIONS The first patient, a 44-year-old black African man, presented with acute disseminated encephalomyelitis (ADEM) with positive serum MOG antibodies. He made a significant recovery with corticosteroids but had a quick relapse and died from sepsis. The second patient, an 18-year-old black woman, presented with paraplegia and imaging revealed a longitudinally extensive transverse myelitis and had positive serum MOG antibodies. She remained paraplegic after methylprednisone and plasmapheresis treatments. Her rehabilitation was complicated by development of pulmonary embolism and tuberculosis. The third patient, a 43-year-old mixed-race woman, presented with bilateral painless visual loss. Her investigations were notable for positive MOG antibodies, positive Varicella Zoster Virus on cerebral spinal fluid (CSF) and hyperintense optic nerves on magnetic resonance imaging (MRI). Her vision did not improve with immunosuppression and eventually died from sepsis. CONCLUSION Our cases illustrate the diagnostic and management challenges of MOGAD in the setting of advanced HIV infection, where the risk of CNS opportunistic infections is high even without the use of immunosuppression. The atypical clinical progression and the dilemmas in the diagnosis and treatment of these cases highlight gaps in the current knowledge of MOGAD among people with HIV that need further exploration.
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Affiliation(s)
- Yohane Gadama
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - Marié Du Preez
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jonathan Carr
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sarel Theron
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Christine Albertyn
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kenneth Ssebambulidde
- Research Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Naeem Brey
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Franclo Henning
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Gadama Y. Functional neurological disorder is a feminist issue. J Neurol Neurosurg Psychiatry 2023; 94:873. [PMID: 37147118 DOI: 10.1136/jnnp-2023-331597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Yohane Gadama
- Division of Neurology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Aleisa F, Gadama Y, Saylor D. Overcoming Early Career Setbacks. Stroke 2023. [PMID: 37264915 DOI: 10.1161/strokeaha.121.035920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Farah Aleisa
- Department of Neuroscience, King Fahad Specialist Hospital in Dammam, Saudi Arabia (F.A.)
| | - Yohane Gadama
- Division of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa (Y.G.)
- Malawi-Liverpool Wellcome Trust Clinical Research Program, Kamuzu University of Health Sciences (KUHeS), Malawi (Y.G.)
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (D.S.)
- University Teaching Hospital, Lusaka, Zambia (D.S.)
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Gadama Y, Kamtchum-Tatuene J. Clinical Fellowship in a Foreign Country: Benefits, Challenges, Tips for Success. Stroke 2023; 54:e22-e24. [PMID: 36453270 DOI: 10.1161/strokeaha.122.039127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Yohane Gadama
- Division of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa (Y.G.).,Malawi-Liverpool Wellcome Trust Clinical Research Program, Kamuzu University of Health Sciences (KUHeS), South Africa (Y.G.)
| | - Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (J.K.-T.)
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Ransley G, Zimba S, Gadama Y, Saylor D, Benjamin L. Trends and Clinical Characteristics of HIV and Cerebrovascular Disease in Low- and Middle-Income Countries (LMICs) Between 1990 and 2021. Curr HIV/AIDS Rep 2022; 19:548-565. [PMID: 36264482 PMCID: PMC9759508 DOI: 10.1007/s11904-022-00627-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF THE REVIEW To describe trends and clinical characteristics of HIV and cerebrovascular disease between 1990 and 2021 in LMICs and identify the gaps in our understanding. RECENT FINDINGS In the era of antiretroviral therapy (ART), people living with HIV (PLWH) live longer and risk excess cerebrovascular events due to ageing and HIV-driven factors. Despite the highest burden of HIV infection in low-to-middle income countries, there is underreporting in the literature of cerebrovascular events in this population. We systematically reviewed published literature for primary clinical studies in adult PLWH and cerebrovascular disease in LMICs. The clinical phenotype of cerebrovascular disease among PLWH over the last three decades in LMICs has evolved and transitioned to an older group with overlapping cerebrovascular risk factors. There is an important need to increase research in this population and standardise reporting to facilitate understanding, guide development of appropriate interventions, and evaluate their impact.
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Affiliation(s)
- George Ransley
- grid.83440.3b0000000121901201National Hospital for Neurology and Neurosurgery, University College London Foundation Trust, London, UK
| | - Stanley Zimba
- grid.79746.3b0000 0004 0588 4220Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Yohane Gadama
- grid.11956.3a0000 0001 2214 904XDivision of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa ,grid.419393.50000 0004 8340 2442Malawi-Liverpool Wellcome Trust Clinical Research Program, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Deanna Saylor
- grid.79746.3b0000 0004 0588 4220Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia ,grid.21107.350000 0001 2171 9311Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Laura Benjamin
- grid.83440.3b0000000121901201National Hospital for Neurology and Neurosurgery, University College London Foundation Trust, London, UK ,grid.83440.3b0000000121901201MRC LMCB, University College London, Gower Street, London, WC1E 6BT UK
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Gadama Y, Chimatiro G, Nyondo-Mipando AL. Letter to editor regarding article "Clinical inter-professional education activities: Students' perceptions of their experiences". Malawi Med J 2021; 33:142-143. [PMID: 34777711 PMCID: PMC8560358 DOI: 10.4314/mmj.v33i2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yohane Gadama
- Malawi-Liverpool Wellcome Trust Clinical Research Program, Kamuzu University of Health Sciences (KUHeS).,Division of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | | | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family Medicine, Kamuzu University of Health Sciences (KUHeS)
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Ghaffari-Rafi A, Ghaffari-Rafi S, Lee RE, Aforlabi-Logoh I, Ko AWK, Gadama Y, Mehdizadeh R, Leon-Rojas J. Application of the sociology theory ethnomethodology to medical education: Utilization of small group learning to combat unconscious bias in patient care. Ann Med Surg (Lond) 2020; 57:17-19. [PMID: 32695334 PMCID: PMC7364049 DOI: 10.1016/j.amsu.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Arash Ghaffari-Rafi
- University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | | | - Rachel Elizabeth Lee
- University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | | | - Andrew Wai Kei Ko
- University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Yohane Gadama
- Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Rana Mehdizadeh
- University of Queensland, Faculty of Medicine, Brisbane, Australia
| | - Jose Leon-Rojas
- Universidad Internacional del Ecuador Escuela de Medicina, Quito, Ecuador
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Gadama Y, Kamtchum-Tatuene J, Benjamin L, Phiri T, Mwandumba HC. The significant gap between international standards and stroke management practices at Queen Elizabeth Central Hospital (Malawi): An audit report. Malawi Med J 2019; 31:249-255. [PMID: 32128035 PMCID: PMC7036432 DOI: 10.4314/mmj.v31i4.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background The Queen Elizabeth Central Hospital (QECH) is preparing to set up the first stroke unit in Blantyre, Malawi. We conducted this audit to assess current stroke management practices and outcomes at QECH and identify priority areas for intervention. Methods From April to June 2018, we prospectively enrolled patients with acute stroke and collected data on clinical presentation, cardiovascular risk factors, investigations and interventions, in-hospital outcomes, and follow-up plans after discharge. The American Heart Association/American Stroke Association (AHA/ASA) guidelines were used as the standard of care for comparison. Results Fifty patients with acute stroke were enrolled (46% women, 54% men). The mean age was 63.1 years (95% CI: 59.7-66.6). The diagnosis of stroke was based on the World Health Organization criteria. The diagnosis was made within 24 hours of admission in 19 patients (38%). Acute revascularisation therapy was not available. Forty-eight patients (96%) had their vital signs checked at baseline and <10% had their vital signs checked more than three times within the first 24 hours. Essential blood tests including random blood sugar (RBS), full blood count (FBC), urea/creatinine, and lipid profiles were performed in 72%, 68%, 48%, and 4%, respectively. An electrocardiogram was performed on 34 patients (68%). Blood pressure on admission was >140/90 mmHg in 34 patients (68%), including 4 with values >220/120 mmHg. Nine patients had an RBS >10 mmol/L and four received insulin. Prophylaxis for deep venous thrombosis was offered to 12 patients (24%). Aspiration pneumonia was reported in 16 patients (32%) and was the most common hospital complication. The mean duration of hospitalisation was 10.4 days (95% CI: 5.6-15.2), and case fatality was 18%. The modified Rankin scale at discharge was ≤2 in 32% of patients. Only four patients (8%) were transferred to a rehabilitation centre. At the time of discharge, only 32% of patients received education on stroke. Conclusion Acute stroke care is less than optimal in this setting. Simple interventions such as reducing the delay in making a stroke diagnosis, early swallow assessments, and closer monitoring of vital signs could make a significant difference in stroke outcome. Furthermore, treating cardiovascular risk factors and setting up health education programmes to improve secondary prevention represent key priorities.
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Affiliation(s)
- Yohane Gadama
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
- Institute of Neurology, University College London, London, UK
| | - Joseph Kamtchum-Tatuene
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Laura Benjamin
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
- Institute of Neurology, University College London, London, UK
- Institute of Infection and Global Health, University of Liverpool, UK
| | - Tamara Phiri
- Department of Medicine, Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi
| | - Henry C Mwandumba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Gadama Y, Kamtchum Tatuene J, Benjamin LA, Kamalo P, Mallewa M. Neurological letter from Malawi. Pract Neurol 2019; 19:356-359. [PMID: 31018991 PMCID: PMC6703127 DOI: 10.1136/practneurol-2019-002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Yohane Gadama
- Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi .,Institute of Neurology, University College London, London, UK
| | - Joseph Kamtchum Tatuene
- Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.,Faculty of Medicine and Dentistry, Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Laura A Benjamin
- Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.,Institute of Neurology, University College London, London, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Patrick Kamalo
- Department of Surgery, Collegeof Medicine, University of Malawi, Blantyre, Malawi
| | - Mac Mallewa
- Department of Paediatrics and Child Health, University of Malawi College of Medicine, Blantyre, Malawi
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Bates MJ, Gadama Y, Mbamba J, Manda-Taylor L. Equipping leaders in health in Malawi: Some personal reflections from a leadership skills-building workshop held at the College of Medicine, Blantyre, Malawi. Malawi Med J 2019; 30:134-136. [PMID: 30627343 PMCID: PMC6307068 DOI: 10.4314/mmj.v30i2.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Maya Jane Bates
- Department of Family Medicine, School of Public Health and Family Medicine, College of Medicine University of Malawi
| | | | | | - Lucinda Manda-Taylor
- Centre for Bioethics in Eastern and Southern Africa (CEBESA), College of Medicine, University of Malawi, Blantyre, Malawi.,Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi
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Gadama Y, Sheikh S, Chasela P. P17.25 Impact on compliance with the change of first line anti-retroviral drug regimens among patients attending anteretroviral therapy clinics in blantyre, malawi. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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