GBA1 rs3115534 Is Associated with REM Sleep Behavior Disorder in Parkinson's Disease in Nigerians

BACKGROUND

Rapid eye movement (REM) sleep behavior disorder (RBD) is an early feature of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Damaging coding variants in Glucocerebrosidase (GBA1) are a genetic risk factor for RBD. Recently, a population-specific non-coding risk variant (rs3115534) was found to be associated with PD risk and earlier onset in individuals of African ancestry.

OBJECTIVES

We aimed to investigate whether the GBA1 rs3115534 PD risk variant is associated with RBD in persons with PD.

METHODS

We studied 709 persons with PD and 776 neurologically healthy controls from Nigeria. All DNA samples were genotyped and imputed, and the GBA1 rs3115534 risk variant was extracted. The RBD screening questionnaire (RBDSQ) was used to assess symptoms of possible RBD.

RESULTS

RBD was present in 200 PD (28.2%) and 51 (6.6%) controls. We identified that the non-coding GBA1 rs3115534 risk variant is associated with possible RBD in individuals of Nigerian origin (β, 0.3640; standard error [SE], 0.103, P = 4.093e-04), as well as in all samples after adjusting for PD status (β, 0.2542; SE, 0.108; P = 0.019) suggesting that although non-coding, this variant may have the same downstream consequences as GBA1 coding variants.

CONCLUSIONS

Our results indicate that the non-coding GBA1 rs3115534 risk variant is associated with an increasing number of RBD symptoms in persons with PD of Nigerian origin. Further research is needed to assess if this variant is also associated with polysomnography-defined RBD and with RBD symptoms in DLB. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Identification of genetic risk loci and causal insights associated with Parkinson's disease in African and African admixed populations: a genome-wide association study

BACKGROUND

An understanding of the genetic mechanisms underlying diseases in ancestrally diverse populations is an important step towards development of targeted treatments. Research in African and African admixed populations can enable mapping of complex traits, because of their genetic diversity, extensive population substructure, and distinct linkage disequilibrium patterns. We aimed to do a comprehensive genome-wide assessment in African and African admixed individuals to better understand the genetic architecture of Parkinson's disease in these underserved populations.

METHODS

We performed a genome-wide association study (GWAS) in people of African and African admixed ancestry with and without Parkinson's disease. Individuals were included from several cohorts that were available as a part of the Global Parkinson's Genetics Program, the International Parkinson's Disease Genomics Consortium Africa, and 23andMe. A diagnosis of Parkinson's disease was confirmed clinically by a movement disorder specialist for every individual in each cohort, except for 23andMe, in which it was self-reported based on clinical diagnosis. We characterised ancestry-specific risk, differential haplotype structure and admixture, coding and structural genetic variation, and enzymatic activity.

FINDINGS

We included 197 918 individuals (1488 cases and 196 430 controls) in our genome-wide analysis. We identified a novel common risk factor for Parkinson's disease (overall meta-analysis odds ratio for risk of Parkinson's disease 1·58 [95% CI 1·37-1·80], p=2·397 × 10-14) and age at onset at the GBA1 locus, rs3115534-G (age at onset β=-2·00 [SE=0·57], p=0·0005, for African ancestry; and β=-4·15 [0·58], p=0·015, for African admixed ancestry), which was rare in non-African or non-African admixed populations. Downstream short-read and long-read whole-genome sequencing analyses did not reveal any coding or structural variant underlying the GWAS signal. The identified signal seems to be associated with decreased glucocerebrosidase activity.

INTERPRETATION

Our study identified a novel genetic risk factor in GBA1 in people of African ancestry, which has not been seen in European populations, and it could be a major mechanistic basis of Parkinson's disease in African populations. This population-specific variant exerts substantial risk on Parkinson's disease as compared with common variation identified through GWAS and it was found to be present in 39% of the cases assessed in this study. This finding highlights the importance of understanding ancestry-specific genetic risk in complex diseases, a particularly crucial point as the Parkinson's disease field moves towards targeted treatments in clinical trials. The distinctive genetics of African populations highlights the need for equitable inclusion of ancestrally diverse groups in future trials, which will be a valuable step towards gaining insights into novel genetic determinants underlying the causes of Parkinson's disease. This finding opens new avenues towards RNA-based and other therapeutic strategies aimed at reducing lifetime risk of Parkinson's disease.

FUNDING

The Global Parkinson's Genetics Program, which is funded by the Aligning Science Across Parkinson's initiative, and The Michael J Fox Foundation for Parkinson's Research.

Achieving a robust mentoring and research capacity program in a LMIC - the BRAINS faculty development model

BACKGROUND

A research and training program (RTP) was carried out to build the capacity of faculty and improve the culture of research in the College of Medicine, University of Lagos (CMUL), Nigeria.

METHODS

Realist-guided mixed methods evaluation of the BRAINS project was carried out using secondary data generated during the 5-years (2015 - 2020) of project implementation. Capacity building workshops and mentored research activities targeted at faculty in the CMUL were conducted. Overall, 1,418 participants attended the workshops in batches. Among the participants, forty-five faculty received grants and were mentored by senior professionals (local & international) to conduct research. Data were extracted from all project-related documents including coursework biodata, workshop evaluation forms, quarterly project reports, and end- of-project reports, submitted by the mentees, minutes of meetings, and the proposal submitted for funding. It was in the form of continuous variables and prose (sentences & stories). Quantitative data were analysed with IBM SPSS statistics version 20. Mean knowledge score and mean difference was calculated, paired t-test was carried out using p < 0.05 to determine statistical significance. The prose was thematically analysed to generate themes and narratives. Both were subsequently combined for interpretation and used to refine the initial programme theory into an evidence-informed theory.

RESULTS

Twelve courses were deployed, and 1,418 participants (47.8% males and 52.2% females) from medical, nursing, and allied medical departments were trained. Eighty participants were trained in Responsible Conduct of Research and eighty-one on Manuscript Writing over three years. A comparison of the pre/post-test knowledge scores showed a positive mean difference. Thematic analysis of workshop data produced three thematic domains representing effectiveness and gains namely: cognitive, reward, and behavioural. 45 trainees were awarded grants and mentored, and analysis of mentee's data generated 4 themes: Achieving a robust mentoring program; Benefits of the mentoring program; Resilience in research; Improving the mentoring program.

CONCLUSION

By contributing to the body of knowledge available on RTPs, this evaluation identified key components that contributed to the success of the project and developed a model for achieving a robust training and mentoring program which can be replicated in other LMICs.

Tramadol and Codeine Stacking/Boosting Dose Exposure Induced Neurotoxic Behaviors, Oxidative Stress, Mitochondrial Dysfunction, and Neurotoxic Genes in Adolescent Mice

In spite of the increasing epidemic of pharmaceutical opioids (codeine and tramadol) misuse and abuse among the adolescents, little is known about the neurotoxic consequences of the widespread practice of tramadol and codeine abuse involving increasing multiple doses across days, referred to as stacking and boosting. Hence, in this study, we replicated stacking and boosting doses of tramadol, codeine alone, or in combination on spontaneous motor activity and cognitive function in adolescent mice and adduced a plausible mechanism of possible neurotoxicity. Ninety-six adolescent mice were randomly distributed into 4 groups (n = 24 per group) and treated thrice daily for 9 days with vehicle, tramadol (20, 40, or 80 mg/kg), codeine (40, 80, or 160 mg/kg), or their combinations. Exposure of mice to tramadol induced hyperactivity and stereotypic behavior while codeine exposure caused hypoactivity and nootropic effect but tramadol-codeine cocktail led to marked reduction in spontaneous motor activity and cognitive function. In addition, tramadol, codeine, and their cocktail caused marked induction of nitroso-oxidative stress and inhibition of mitochondrial complex I activity in the prefrontal cortex (PFC) and midbrain (MB). Real-time PCR expression profiling of genes encoding neurotoxicity (RT) showed that tramadol exposure upregulate 57 and downregulate 16 neurotoxic genes, codeine upregulate 45 and downregulate 25 neurotoxic genes while tramadol-codeine cocktail upregulate 52 and downregulate 20 neurotoxic genes in the PFC. Findings from this study demonstrate that the exposure of adolescents mice to multiple and increasing doses of tramadol, codeine, or their cocktail lead to spontaneous motor coordination deficits indicative of neurotoxicity through induction of oxidative stress, inhibition of mitochondrial complex I activity and upregulation of neurotoxicity encoding genes in mice.

A preprogram appraisal of factors influencing research productivity among faculty at college of medicine, University of Lagos

Background

A defining feature of any university is its dedication to scholarly activities, leading to the generation of knowledge and ideas Research productivity is a measure of achievement of a scholar. The number of research publications in peer-reviewed journals is an important criterion for assessing productivity and prestige in the academia.

Aims and Objectives

This cross-sectional descriptive study assessed the level of research productivity (RP) among junior faculty at the College of Medicine, University of Lagos, and investigated factors affecting their research output prior to the implementation of a 5-year training grant funded by the National Institutes of Health.

Methods

Seventy junior faculty members attended a pre-program training, and the self-reported number of peer-reviewed publications (PRPs) was used as an indicator. Intrinsic and extrinsic factors influencing RP among the attendees were assessed and ranked.

Results

The majority (42/70, 60%) of the respondents had <10 PRPs. The median (interquartile range) number of PRPs was 7 (3-18). A desire for the development of their personal skills, contribution to society, and personal research interests topped the list of intrinsic factors influencing RP. Work flexibility, research autonomy, and scholarly pursuits were the bottom three. A desire for promotion, respect from peers, and increased social standing were the top three extrinsic factors, while monetary incentives, employment opportunities, and the need to attend conferences were the lowest three. The top barriers to RP were lack of resources and lack of mentoring. Perceived older age, lack of time, and motivation were the lowest three barriers. Older age and professional cadre were associated with increased RP (P < 0.05).

Conclusion

Among the participants, research output appears to be motivated primarily by a desire for personal development,promotion, and respect from peers. Lack of access to resources was the main barrier to increased RP. These factors may need to be considered when developing programs designed to promote RP.

Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa

Introduction

The impact of Obstructive sleep apnea (OSA) in worsening outcomes is profound, especially in the presence of comorbid conditions. This study aimed to describe the proportion of patients at a high risk of OSA in our practice setting.

Methods

The STOP BANG questionnaire and the Epworth Sleepiness scale were used to assess for OSA risk and excessive daytime sleepiness respectively. Hospitalized patients and out-patients were recruited. Intergroup differences in continuous variables were compared using the analysis of variance. The proportion of patients with high risk of OSA and excessive daytime sleepiness was presented as frequencies and group differences compared with the Pearson χ² test. Independent risk predictors for OSA were assessed in multivariate logistic regression analysis.

Results

A total of 1100 patients (53.4% females) participated in the study. Three hundred and ninety nine (36.3%) had a high risk of OSA, and 268 (24.4%) had excessive daytime sleepiness. Of the participants with high OSA risk, 138 (34.6%) had excessive daytime sleepiness compared to 130 (18.5%) of those with low OSA risk (p).

Conclusion

A significant proportion of patients attending our tertiary care center are at high risk of OSA.

Relationship between admission serum C-reactive protein and short term outcome following acute ischaemic stroke at a tertiary health institution in Nigeria

BACKGROUND

There is evidence of an association between mediators of inflammation, particularly C-reactive protein (CRP), and outcome of acute ischaemic stroke. This provides a potential opportunity for interventions aimed at improving outcome. There is sparse data exploring the role of inflammatory markers such as CRP and stroke outcome in Africans. The study objective was to determine the association between admission serum CRP levels and short-term outcome in the Nigerian patient presenting with acute ischaemic stroke.

MATERIALS AND METHODS

Consecutive patients hospitalized for first-ever acute ischaemic stroke at the Lagos University Teaching Hospital, Lagos, Nigeria, were prospectively enrolled between October 2007 and June 2008. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Serum CRP was determined on samples obtained within 7 days of stroke onset. All stroke patients were followed up till day 30 post-stroke. Outcome measures were 30 day Glasgow outcome scale score and functional impairment on the modified Rankin Scale (mRS). An age- and gender-matched healthy control group had serum CRP determined at inclusion. Elevated CRP was defined as any level above the cutoff (mean +2 x standard deviation of CRP level of controls).

RESULTS

Eighty patients with acute ischaemic stroke (47 men and 33 women) and 40 controls (27 male and 13 female) (P = 0.47) were studied. Mean age in cases was 59.1 ± 15.0 years. Mean CRP was significantly higher in stroke cases than controls (17.7 ± 14.4 mg/L versus 1.1 ± 1.7 mg/L respectively) (P < 0.00001). The frequency of elevated CRP (>4.5 mg/L) was 76.3% in stroke (N = 61) and 5% (N = 2) in controls (P < 0.0001). The case fatality rate in stroke with elevated CRP (32.8%) was significantly higher than stroke with normal admission CRP (0%; P = 0.015). The association of higher admission CRP with fatality () was statistically significant (P < 0.0001). Amongst survivors, mean CRP levels were markedly higher in the patients with unfavorable motor outcome (moderate/severe disability; n = 22; 21.5 ± 11.1) compared to those with favorable outcome (mild disability; n = 38; 6.5 ± 6.2) (P < 0.00001). In multivariate regression analysis, only high NIHSS score (P = 0.004) and admission CRP (P = 0.008) were independently associated with case fatality.

CONCLUSIONS

Elevated admission CRP and high NIHSS score are independent predictors of short-term case fatality and adverse functional outcome following acute ischaemic stroke in Nigerians.

Echocardiographic patterns in treatment-naïve HIV-positive patients in Lagos, south-west Nigeria

Introduction

Cardiovascular abnormalities are common in HIV-infected patients, although often clinically quiescent. This study sought to identify by echocardiography early abnormalities in treatment-naïve patients.

Methods

One hundred patients and 50 controls with no known traditional risk factors for cardiovascular disease were recruited for the study. The cases and controls were matched for age, gender and body mass index. Both groups had clinical and echocardiographic evaluation for cardiac abnormalities, and CD₄ count was measured in all patients.

Results

The cases comprised 57 females (57.0%) and 43 males (43.0%), while the controls were 28 females (56.0%) and 22 males (44.0%) (χ² = 0.01; p = 0.913). The mean age of the cases was 33.2 ± 7.7, while that of the controls was 31.7 ± 9.7 (t = 1.02; p = 0.31). Echocardiographic abnormalities were significantly more common in the cases than the controls (78 vs 16%; p = 0.000), including systolic dysfunction (30 vs 8%; p = 0.024) and diastolic dysfunction (32 vs 8%; p = 0.002). Other abnormalities noted in the cases were pericardial effusion in 47% (χ² = 32.10; p = 0.000) and dilated cardiomyopathy in 5% (five); none of the controls had either complication. One patient each had aortic root dilatation, mitral valve prolapse and isolated right heart dilatation and dysfunction.

Conclusion

Cardiac abnormalities are more common in HIV-infected people than in normal controls. A careful initial and periodic cardiac evaluation to detect early involvement of the heart in the HIV disease is recommended.

Plasma homocysteine level and its relationship to clinical profile in Parkinson's disease patients at the Lagos University Teaching Hospital

BACKGROUND

Hyperhomocysteinaemia (HHcy) is as a long-term sequelum of levodopa therapy in Parkinson's disease (PD). Information on its frequency and effects in Africans with PD is sparse.

OBJECTIVE

To determine the frequency of HHcy and its relationship to clinical features of PD in African patients.

METHODS

Using a case-control design, 40 consecutively attending PD patients and 40 age- and gender-matched healthy volunteering controls were studied. Parkinson's disease cases were evaluated for disease and treatment characteristics, using the Unified Parkinson Disease Rating Scale (UPDRS) motor and activities of daily living scores and disease stage (Hoehn and Yahr scale). Fasting total plasma homocysteine (Hcy) was determined in all subjects. Hyperhomocysteinaemia was defined as a Hcy level above the 90th percentile for the controls.

RESULTS

Mean Hcy was 13.8 ± 5.4mmol/L in PD and 12.4±3mmol/L in controls (P>0.05). Hyperhomocysteinaemia (Hcy > 16.26umol/L) occurred in nine (22.5%) PD patients (all on levodopa) and 6 (15%) controls (P>0.05). Mean duration of levodopa use was 92 ± 105.3 months in PD with HHcy compared to PD patients with normal Hcy 33.9 ± 33.2 (p < 0.05). Disease severity and disability were similar regardless of Hcy levels. None of current age, disease duration, Hoehn and Yahr stage, UPDRS scores, total levodopa dose and duration was independent predictor of homocysteine level.

CONCLUSION

There is increased occurrence of hyper-homocysteinaemia in Nigerian subjects with Parkinson's disease, receiving Levodopa. This hyperhomocysteinaemia is more common with prolonged use but appears to have no relationship with disease severity or disability.

A preliminary study of the frequency of focal neurological deficits in HIV/AIDS patients seropositive for Toxoplasma gondii IgG in Lagos, Nigeria

BACKGROUND

Cerebral toxoplasmosis is a common cause of focal neurologic deficits in HIV/AIDS. Financial constraints and access to neuroradiological facilities limit definitive diagnosis and first-line treatments are largely expensive and cumbersome.

OBJECTIVE

This study examined the frequency of focal neurological signs in HIV/AIDS patients with positive Toxoplasma gondii IgG antibodies (and thus at high risk of reactivation), and the relationship to CD4 count.

METHODS

Using a case-control design, T. gondii IgG serology was determined in 83 HIV/AIDS patients on HAART and 42 HIV seronegative controls. Neurological evaluation and CD4 count (mm3) was conducted in all subjects.

RESULTS

A total of 71 (85.5%) HIV/AIDS patients were seropositive for T. gondii IgG. The IgG seroprevalence was 84.8% for cases with CD4 count < 200 and 86.0% with CD4 < or = 200 (P = 0.46). Of the cases with positive Toxoplasma antibodies, the frequency of neurological lateralizing signs was higher in those with CD4 count < 200 (32.6%) compared to persons with CD4 count > or = 200 (7.1%) (chi2 = 4.90, Fisher exact P <0.01). The mean CD4 count of cases with lateralizing signs was 113.7 +/- 113.9 in contrast to 254.0 +/- 218.9 in those without lateralizing signs (P < 0.01).

CONCLUSION

In our study, a higher frequency of focal neurological signs was found in the T. gondii seropositive HIV/AIDS patients with a higher degree of immune compromise (CD4 count < 200). We suggest the adoption of routine prophylactic anti-toxoplasma therapy in this subgroup given that cerebral toxoplasmosis is a leading cause of intracranial space occupying lesions in HIV/AIDS.

Predictors of short-term intra-hospital case fatality following first-ever acute ischaemic stroke in Nigerians

OBJECTIVE

To determine the predictors of 30-day intra-hospital case fatality rate in patients with first-ever acute ischaemic stroke, attending a tertiary care hospital in Western Nigeria.

STUDY DESIGN

A cross-sectional observational study.

PLACE AND DURATION OF STUDY

This study was conducted at the Lagos University Teaching Hospital, Lagos, Nigeria between February 2003 and May 2004 (16 months).

METHODOLOGY

One hundred consecutively consenting patients admitted within 72 hours of onset of first-ever acute ischaemic stroke were studied. Uniform information was obtained using a standard format documenting demographic information, stroke-related symptoms and signs, risk factor profile, admission Glasgow Coma Score (GCS), stroke severity, admission Random Blood Glucose (RBG) and presence of complications. All patients were closely followed-up to monitor progress and document any complications. The end point was mortality or survival at 30 days from stroke onset.

RESULTS

The 30-day case fatality rate was 28%. In univariate analysis, the factors predicting mortality were admission stroke severity, admission hyperglycaemia, admission level of consciousness, and presence of any complication during the hospitalization period. Of these factors, presence of complications had the strongest correlation with 30-day case fatality (r = 0.52; p = 0.001).

CONCLUSION

Presence of complications was the most important predictor of short-term mortality in Nigerians with firstever acute ischaemic stroke. Prevention, early detection, and aggressive intervention to treat complications may reduce the unacceptably high mortality rate of ischaemic stroke in our environment.

Prevalence and clinical characteristics of headache in medical students of the University of Lagos, Nigeria

We investigated the 1-year prevalence, clinical features and mode of treatment of headache in medical students of the University of Lagos, Nigeria, using a self-administered headache questionnaire. Headache prevalence was 46.0% and was significantly higher in women than in men (62.8% vs. 34.1%). Prevalence of tension-type headache was higher than that of migraine (18.1% vs. 6.4%). Although tension-type headache had a similar prevalence in both sexes (male 17.3%, female 19.2%), migraine was three times more common in women (10.9% vs. 3.2%). A family history of headache was present in 22.0%. Only 4.6% sought medical assistance, whereas 68.2% took non-prescription drugs, mainly simple analgesics. Specific drugs for migraine and tension-type headache were rarely used. In conclusion, 1-year headache prevalence is high among medical students at this university. The low consultation rate and the rarity of usage of specific anti-headache drugs probably reflect inadequacies in the management of primary headaches in this population.

Factors influencing non-compliance with anti-hypertensive drug therapy in Nigerians

BACKGROUND

Non-compliance with antihypertensive drug therapy can have a negative impact on cardiovascular outcome. The objective of this study was to determine compliance rate with anti-hypertensive therapy and factors affecting compliance among patients attending a Nigerian tertiary hospital.

METHODS

A cross sectional study was conducted on 225 black hypertensive patients attending a tertiary clinic in Lagos, Nigeria. Demographic data, current anti-hypertensive therapy, compliance with prescribed therapy, factors affecting compliance and BP were documented via an investigator administered questionnaire and open-ended interviews.

RESULTS

In this study, 77(34.2%) of the hypertensive patients were non-compliant. Blood pressure control was significantly better among compliant patients (45.9%) than in non-compliant patients (27.3%) (x(2) = 7.35 p=0.007). Gender, age, number of drugs used, educational level and presence of co-morbidities did not affect compliance. The major reasons for non-compliance were miscellaneous factors (60%) related to both patient's attitudes and beliefs (reflecting ignorance),and consultation failure on the part of clinicians. Lack of finances and side effects of medications accounted for 23.8% and 16.2% of non-compliances respectively.

CONCLUSION

Although lack of finances is the single most self reported reason, miscellaneous factors related to patients' attitudes and belief contribute frequently. Incorporating patient education and counselling in routine follow-up may improve compliance, BP control, and ultimately impact positively on cardiovascular outcome.

Prospective case-control study of interictal depression and suicidal ideation in Nigerians with epilepsy

BACKGROUND

Co-morbid depression and suicidal ideation in people with epilepsy (PWE) in developing countries are under-recognised, and so may be consequently undertreated. This study was designed to determine the frequency and clinical correlates of interictal depression and suicidal ideation in PWE.

PATIENTS AND METHODS

Using a prospective design, we evaluated 96 PWE and two groups of controls (103 age- and sex-matched population controls and 13 persons with DSM - IV diagnosis of major depression (controls with depression - CWD) without epilepsy. Depression was assessed using Zung Self-rating depression scale (scores =40 indicating depression).

RESULTS

Depression was more prevalent in PWE (25/96 i.e. 26.0%) than normal controls (10/103 i.e. 9.7%) (P = 0.004). Suicidal ideation scores were similar for depressed PWE and depressed normal controls (1.7 +/-1.0 v. 1.5 +/- 1.0; P>0.05), but significantly higher in CWD (2.61.3; P=0.04). Among PWE, mean duration of epilepsy (years) was the only variable significantly related to depression (i.e. 12.7 8.8 in depressed PWE v. 8.3 6.6 in non-depressed PWE (P=0.01).

CONCLUSION

Depressive symptomatology is a frequent co-morbidity in our tertiary care population of PWE. However, suicidal ideation is less common in contrast to persons with major depression.

Comparative study of the effect of tocotrienols and -tocopherol on fasting serum lipid profiles in patients with mild hypercholesterolaemia: a preliminary report

OBJECTIVES

Hypercholesterolaemia is a risk factor for cardiovascular diseases. Tocotrienols reportedly possess hypocholesterolaemic activity. This study examined the effect of tocotrienols (T3) in TOCOVIDTM Suprabio TM on serum lipids. Patients and Methods :A randomised (2:1), open-label study of patients with mild hypercholesterolaemia (= 5.18mmol/L to <7.77mmol/L) and one additional cardiovascular risk factor was carried out. Subjects received either tocotrienols (as TOCOVIDTM Suprabio TM ) (n=28) or vitamin E (a-tocopherol) 500mg daily (n=16). Fasting lipids were compared at baseline and after 4 weeks therapy.

RESULTS

Following 4 weeks therapy, mean +/- SD total cholesterol declined significantly in the tocotrienol group (from 6.10+/-0.66 to 5.47+/-1.16; P=0.02) compared to the a-tocopherol group (from 5.92+/-0.52 to 5.47+/-0.76; P>0.05). Mean LDL-C levels (mmol/L) were also significantly reduced in the tocotrienol group (3.82+/-0.85 to 3.24+/-1.26; P=0.04), but not in those on a-tocopherol (3.84+/-0.75 to 3.28+/-0.94; P>0.05). There were no significant changes in HDL-C and triglycerides in both groups. The tocotrienol group experienced a net decline in TG (7.1+/-31.4 %; P>0.05) while the a-tocopherol group had a net increase at week 4 (38.6+/-61.7%; P>0.05).

CONCLUSION

The study adds to existing evidence of the favourable effect of tocotrienols on total cholesterol and LDL-C. However, the results need further evaluation.

Magnitude and gender distribution of obesity and abdominal adiposity in Nigerians with type 2 diabetes mellitus

BACKGROUND

Obesity and abdominal adiposity are associated with increased cardiovascular morbidity in diabetes. This study evaluated their magnitude and gender distribution in Nigerians with Type 2 DM attending a tertiary care clinic.

PATIENTS AND METHODS

258 consecutive patients with type 2 DM were evaluated. Base line characteristics (gender, age, duration of DM), weight, height, waist circumference (WC), and hip circumference were recorded. Body mass index (BMI), waist-hip ratios (WHR), and waist-to-height ratios (WHtR) were calculated for each patient.

RESULTS

Despite similar demographics (mean age and duration of DM), the prevalence of of DM was significantly higher in females (35/135 i.e.25.9% compared to 13/123 i.e. 10.6% in males) (2; P=0.007). Median BMI (27.1 v. 25.6), WHtR (0.58 v. 0.54), and frequency of elevated WC (71.9% v. 21.1%) and elevated WHR (94.1% v. 49.6%) were all significantly higher in females compared to males (P<0.05). Amongst obese persons, the magnitude of obesity and abdominal adiposity was also significantly higher in females as exemplified by median BMI (females: 34.3 v. males 31.6; P=0.014) and median WHtR (0.70 v. 0.64; P=0.0016).

CONCLUSIONS

The evident gender disparity of obesity and abdominal adiposity in females with type 2 DM represented by this cohort buttresses the need to focus on obesity management in African women with DM as a special at-risk group in order to minimize the potential for adverse cardiovascular outcome.

Longitudinal study of mortality predictors in Parkinson's disease in Nigerians

Parkinson's disease (PD) has been associated with increased mortality. The mortality in Nigerians has not been described. This study was designed to assess mortality in PD and relate it to gender, age at onset of PD and at baseline, and duration of PD. A case-control study of 28 PD and 28 age- and sex-matched controls from similar geographic locality was conducted. Baseline clinical characteristics of the PD patients and controls were documented at study inception. Cases and controls selected between January and June 1997 were followed up after a 6-year interval (May 2002). The case fatality rate (CFR) in PD was 25% compared to 7.1% in controls (Mantel-Haenszel test, P=0.07). PD survivors (compared to PD patients who died) were significantly younger both at study onset (mean age 59.8 +/- 10.3 v. 72.3 +/- 6.8; P=0.002) and at onset of PD (mean age 57.3 +/- 10.3 v. 69.3 +/- 6.5; P=0.003), and had significantly less severe disease at baseline (mean Hoehn & Yahr stage 2.1 < or = 0.7 v. 2.9 +/- 1.1; P=0.04). CFR was significantly higher in PD cases aged =70 years at study onset (Mantel-Haenszel test, P=0.004) and at onset of PD (Mantel-Haenszel test, P=0.001), but not in age-matched controls. PD affecting Nigerians is associated with increased mortality as has been demonstrated in other geographic locations. Factors associated with increased mortality include advanced age, older age at onset of PD, and more severe disease.

Frequency and predictors of autonomic dysfunction in Parkinson's disease: a study of African patients in Lagos, Nigeria

The degenerative changes in PD also affect the autonomic nervous system. The frequency and predictors of such involvement in Africans with PD has not been reported.

OBJECTIVE

i) To determine the frequency and type of autonomic dysfunction in Nigerians with idiopathic Parkinson's disease (PD). ii) To determine the predictors of autonomic dysfunction in PD.

METHODS

Cardiovascular autonomic function assessed in 33 study subjects with PD and 33 age-matched controls, utilising heart rate variability to deep breathing, standing and the Valsalva manoeuvre, and the blood pressure (BP) response to standing. The results were compared based on treatment category, grade of severity on the Columbia scale of Hoehn and Yahr, duration of PD, age at onset of PD, present age and occurrence of autonomic symptoms.

RESULTS

Parasympathetic function was abnormal in 51.5% of PD subjects, significantly higher than controls (P<0.001). Of these, 76.5% had early parasympathetic involvement and 23.5% definite parasympathetic involvement. Age above 65 years (at time of study or onset of PD) was the only clinical variable associated with parasympathetic autonomic dysfunction (p<0.05). Symptoms dysfunction occurred in 60.6% of PD patients and only 6.1% of controls (p<0. 001). There was however no demonstrable relationship between the occurrence of symptoms and objective evidence of autonomic dysfunction: 41.2% of PD patients with parasympathetic dysfunction had no symptoms.

CONCLUSION

Autonomic dysfunction was found to be common in Africans with PD, particularly those above 65 years and tends to affect the parasympathetic system. However, the abnormality may be detectable even before symptoms appear. As such, we recommend that cardiovascular tests of autonomic function be a routine aspect of the evaluation of PD patients, especially with advancing age.

Diagnostic issues in cerebral malaria: a study of 112 adolescents and adults in Lagos, Nigeria

OBJECTIVE

To determine the accuracy of initial diagnosis of cerebral malaria in adolescents and adults presenting at our tertiary centre and identify the clinical and laboratory parameters helpful in distinguishing cerebral malaria from other differential diagnosis.

METHODS

A retrospective review of 112 adolescents and adults initially diagnosed as having cerebral malaria was carried out. Clinical features (risk factors, mode of presentation, clinical course and final diagnosis) and laboratory parameters (level of parasitaemia, haematologic and biochemical values) were documented.

RESULTS

A correct diagnosis was made in 52 patients (46.4%), with septicaemia (20.5%) and meningitis (15.2%) accounting for most misdiagnosis. The majority of correctly diagnosed were aged 11-25 years (92.3%), and a predisposing factor was identifiable in 46.2%. Parasitaemia was predominantly moderate to heavy in correctly diagnosed cases, compared to those misdiagnosed in whom it was mild to moderate. Case fatality was higher for misdiagnosed cases (18.6%).

CONCLUSION

The probability of an alternate diagnosis amenable to other treatment regimes should always be explored. This is particularly important in patients of middle age and those with either absent predisposing factors or mild parasitaemia, in order to reduce case fatality.