DEMOGRAPHICS OF COLLABORATORS INVESTIGATING THE NIGERIAN MEDICAL AND DENTAL INTERNS: A MEDICAL INTERNSHIP TRAINING IN NIGERIA (MINTING) STUDY COLLABORATION

Introduction

The internship period is a peculiar time in a doctor's career, and some have described it as a "nuisance year" during which the junior doctor assumes many roles at the same time. Junior doctors especially house officers are faced with many unique challenges; this is even more pronounced in poor resource settings like Nigeria. This study aimed to unravel and improve understanding of the challenges faced by medical and dental interns in Nigeria.

Methodology

A nine-member House officers Research and Statistics Committee (HRSC) was immediately set up to include three senior colleagues - Senior Registrars and Registrar. To carry out her responsibility efficiently the committee created the House Officers Research Collaboration Network (HRCN), a 103- member team comprising medical and dental interns from across Nigeria under a collaborative - Medical INternship Training in Nigeria (MINTING) study.

Results

Out of a total of the 103 House Officers Research Collaboration Network, 80 of them participated in this survey giving a 78% response rate. Ten of the intern Collaborators had additional qualification and seven of them had BSc as an initial degree. About 66 % of the Collaborators have never authored any publication. Of the 27 that have published an article; three collaborators are said to have published 15, 13, 16 articles respectively. Male collaborators where more likely to have published at least one article in the past. Thirty one of the 80 Collaborators have never been in a research collaborative group prior to this MINTING collaborative.

Conclusion

This commentary is set out to describe in detail Nigerian House Officers initiative in terms of the structure, functions, operational modalities, and to investigate the demographics of the HRCN collaborators which showed that over two third of collaborators have never authored any publication and about a third of them have never been involved in collaborative research. We also believe the findings will serve as policy guide and benchmark in training the critical medical health force.

Genetic Epidemiology and Associated Diseases of APOL1: A Narrative Review

BACKGROUND

The Apolipoprotein 1 (APOL1) protein is a product of the human APOL1 gene located on chromosome 22q13.1 and performs functions including lipid transport and metabolism, programmed cell death, autophagy and innate immunity against intracellular pathogens. It is unique among its gene family in its possession of a signal peptide that confers on it the ability for export out of the cell and into the blood stream. The aim of this review is to explore the genetic epidemiology and biology of the APOL1 gene, describe its association with different renal and extra-renal disorders and highlight the timelines of the discoveries of the various associations.

METHODS

A literature search was carried out using combination of terms including "apolipoproteins", "apolipoprotein L", "APOL1", "genetics of APOL1", "Chronic Kidney Disease (CKD) and APOL1"," APOL1 and associated diseases" covering the period January 1990 to April 2020.

RESULTS

High frequency of the APOL1 gene arose as a result of natural selection in East and West Africa, regions endemic for Trypanosoma brucei infection. High frequencies are also reported among individuals of African ancestry in North America. APOL1 G1 and G2 variants protect against Trypanosoma brucei rhodesiense having overcome their virulence through the serum trypanolytic factor. Although protective against infection from trypanosomes, these alleles have also been shown to increase the risk of several disorders including various forms of chronic kidney diseases, schizophrenia, stroke, cancer, and pre - eclampsia.

CONCLUSION

The elucidation of the APOL1 gene has deepened understanding of racial disparities in health and disease. Growing understanding of the genetics and functions of APOL1 has potential to enhance translational benefits for development of new biomarkers, preventive and therapeutic interventions in the context of precision medicine.

Prevalence and Correlates of Frailty Syndrome among Older Adults Attending Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan

BACKGROUND

Frailty has emerged as an important clinical measurement among older adults because of its negative health outcomes.

OBJECTIVE

This study measured the prevalence and factors associated with frailty among older adults aged 60 years and above at a Geriatric Centre in Nigeria.

METHODS

In this descriptive cross-sectional study, 971 older adults were recruited consecutively. Data on sociodemographics characteristics and clinical parameters were obtained using an interviewer-administered questionnaire and physical examination performed. The Frailty syndrome and Frailty Index were assessed using the Fried Frailty Criteria (FFC) and Canadian Study of Health and Aging (CSHA) scale respectively. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05.

RESULTS

The mean age of the participants was 71.3 (± 7.1) years with a female to male ratio of 2.4:1. Based on FFC scale, 498 older persons (51.3%) had frailty syndrome while only 148 (15.2%) were frail using the CSHA scale. The measure of agreement (Kappa statistics) was 0.22 (p<0001) indicating weak agreement between the two scales. Logistic regression analysis revealed increasing age (OR=1.948 [1.219-3.113]), multiple morbidities (OR= 1.584, [1.177-2.201]), depression (OR= 5.050, [2.501-9.442,]), imbalance or increased risk of fall (OR 1.623, [1.192-2.211,]), and inability to perform IADL (OR= 0.599 [0.535-0.670,]) to be the most significant determinants of frailty syndrome while obesity (OR=0.660, [0.449-0.971]), unusually appeared a deterrent.

CONCLUSION

The prevalence of frailty syndrome was high among the older adults. Targeted and timely interventions on the modifiable factors may delay progression into frailty and the eventual negative health outcomes.

Tropical ataxic neuropathy: Findings of a neuroepidemiological survey of Odeda, southwest Nigeria

BACKGROUND

Tropical ataxic neuropathy seems to have dwindled in public health importance in Nigeria despite the high consumption of cassava-based meals by a huge proportion of people in local Nigerian communities. Yet a recent report suggest its persistence in the same ethnogeographic setting where it was first reported in Nigeria. Our objective was to investigate the prevalence of tropical ataxic neuropathy in Odeda, Ogun state, southwest Nigeria inhabited by a different ethnic group compared to Epe where the disease was first described.

METHODS

A two-stage, cross-sectional survey of Odeda local government area for the prevalence and profile of toxiconutritional neurological disorders was carried out between May and June 2015. A screening instrument was applied by trained non - medical interviewers with positive responders further evaluated by a neurologist.

RESULTS

2392 individuals aged 18 years or older were screened and had a mean age of 37.2 ± 16.1 years, were predominantly of Egba Yoruba ethnicity. Thirty nine cases of tropical ataxic neuropathy were diagnosed and crude prevalence rate was 16.3/1000 (95% CI 11.2-21.4/1000). Older age and rural residence were associated with higher prevalence. Distal sensory polyneuropathy was the most common feature whereas sensorineural deafness was the least common finding.

CONCLUSION

This report provides evidence that tropical ataxic neuropathy persists and in a wider geographic spread. Thus tropical ataxic neuropathy still remains a significant public health importance and concerted efforts are required to mitigate or eradicate tropical ataxic neuropathy in southwest Nigeria and other regions of Africa affected by cassava- related toxiconutritional disorders.

Stroke genomics in people of African ancestry: charting new paths

One in six people worldwide will experience a stroke in his/her lifetime. While people in Africa carry a disproportionately higher burden of poor stroke outcomes, compared to the rest of the world, the exact contribution of genomic factors to this disparity is unknown. Despite noteworthy research into stroke genomics, studies exploring the genetic contribution to stroke among populations of African ancestry in the United States are few. Furthermore, genomics data in populations living in Africa are lacking. The wide genomic variation of African populations offers a unique opportunity to identify genomic variants with causal relationships to stroke across different ethnic groups. The Stroke Investigative Research and Educational Network (SIREN), a component of the Human Health and Heredity in Africa (H3Africa) Consortium, aims to explore genomic and environmental risk factors for stroke in populations of African ancestry in West Africa and the United States. In this article, we review the literature on the genomics of stroke with particular emphasis on populations of African origin.

Seizure severity and health-related quality of life of adult Nigerian patients with epilepsy

OBJECTIVES

There is paucity of information about the association of seizure severity and quality of life in people with epilepsy (PWE) in sub-Saharan Africa. We evaluated the relationship of seizure severity to health-related quality of life of patients with epilepsy being followed up in an outpatient neurology clinic in southwestern Nigeria.

MATERIALS AND METHODS

Eighty-eight consecutive patients with epilepsy who met the recruitment criteria completed the study questionnaire in company of an eyewitness. The study questionnaire comprised of the National Hospital Seizure Severity Scale (NHS3), the Quality of Life Inventory in Epilepsy (QOLIE-31), and the Beck's Depression Inventory-II (BDI-II).

RESULTS

We found a minute association between seizure severity and QOLIE-31 total score (r = -0.262, P = 0.014). Increased seizure severity predicted a worse QOLIE-31 seizure worry (R(2) = 0.311, β = -0.289; P = 0.003). Of the seven seizure severity items, generalization of seizures and presence of falls were items that predicted a worse QOLIE-31 seizure worry score and time to recover predicted a worse QOLIE-31 total score.

CONCLUSIONS

Reducing seizure severity may be an alternate endpoint in epilepsy care in Nigeria (particularly difficult to control seizures) because of its practical clinical relevance in view of the fact that state-of-the-art epilepsy care is still farfetched.

Neuropsychiatric symptoms in Nigerian patients with Parkinson's disease

BACKGROUND

Neuropsychiatric symptoms are common in Parkinson's disease and may precede onset of motor symptoms. They are also known to increase caregiver's burden.

OBJECTIVE

The aim of this study was to assess neuropsychiatric symptoms in a cohort of Nigerian patients with idiopathic Parkinson's disease and compare with systemic hypertension.

METHOD

Fifty patients with idiopathic Parkinson's disease were compared with fifty demographically matched controls with systemic hypertension. Diagnosis of Parkinson's disease was based on the United Kingdom Parkinson Disease Society (UKPDS) Brain Bank Clinical diagnostic Criteria. Diagnosis of hypertension was based on recorded blood pressure of ≥140/90 mmHg on two different occasions. The Neuropsychiatric Inventory (NPI) was applied to caregivers of both patients and controls.

RESULTS

There were significant differences in frequency of neuropsychiatric symptoms in patients and controls (P < 0.05). Significant differences were found in mean distress scores for some neuropsychiatric symptoms and the total mean distress score. In all cases, patients with Parkinson's disease had higher scores when compared with controls. Severity of motor symptoms, as measured by the UKPDS, correlated with total NPI severity scores (P = 0.000).

CONCLUSION

Neuropsychiatric symptoms occur more frequently in Parkinson's disease than matched controls, and the presence of these symptoms is associated with caregivers' distress. There is a need for early and adequate treatment for motor and behavioural symptoms of Parkinson's disease.

Profile of clinically-diagnosed dementias in a neuropsychiatric practice in Abeokuta, south-western Nigeria

OBJECTIVE

Many subjects with dementia present primarily to neuropsychiatric practices because of behavioural and psychological symptoms (BPSD). This study reviewed the profile of clinically-diagnosed dementias and BPSD seen in a pioneer neuropsychiatric practice in Abeokuta, southwestern Nigeria over a ten year period (January1998 - December 2007).

METHODS

A review of hospital records of all patients with diagnoses of dementia or dementing illness using the ICD-10 criteria as well as specific diagnostic criteria for different dementia phenotypes. Associated BPSD, co-morbidities and treatments were also reviewed.

RESULTS

Out of a total of 240,294 patients seen over the study period, 108 subjects met clinical diagnostic criteria for probable dementia giving a hospital frequency of 45 per 100,000. Alzheimer's disease (AD) and Vascular dementia (VaD) were the predominant phenotypes seen in 62 (57.4%) and 18 (16.7%) subjects respectively. Others include mixed dementia (4 cases), frontotemporal dementia (4 cases), Lewy body dementia (3 cases), alcohol-related dementia (3 cases), PD dementia (1 case) and unclassifiable (13 cases). Apathy, night time behaviour, aberrant motor behaviour, agitation and irritability were the most common BPSD features, while hypertension was the most common co-morbidity. Neuroleptics, anticholinergics and anti-hypertensives were most commonly prescribed. Anticholinesterase inhibitors were sparingly used.

CONCLUSION

Probable AD was the most prevalent dementia phenotype seen in this practice. Increased awareness of dementia and better utilization of specific treatments are needed among psychiatrists and primary care practitioners in Nigeria.

Prevalence of asymptomatic left ventricular systolic dysfunction in hypertensive Nigerians: echocardiographic study of 832 subjects

BACKGROUND

We sought to determine the prevalence of echocardiographically determined left ventricular systolic dysfunction in asymptomatic hypertensive subjects seen in Abeokuta, Nigeria.

METHODS

Echocardiography was performed in 832 consecutive hypertensive subjects referred for cardiac evaluation over a three-year period.

RESULTS

Data were obtained in 832 subjects (50.1% women) aged 56.0 ± 12.7 years (men 56.9 ± 13.3 years, women 55.0 ± 12.0 years, range 15-88). The prevalence of left ventricular systolic dysfunction (LVSD) was 18.1% in the study population (mild LVSD = 9.6%, moderate LVSD = 3.7% and severe LVSD = 4.8%). In a multivariate analysis, male gender, body mass index and LV mass were the predictors of LVSD.

CONCLUSION

Significant numbers of hypertensive subjects in this study had varying degrees of left ventricular systolic dysfunction. Early introduction of disease-modifying drugs in these patients, such as angiotensin converting enzyme inhibitors or angiotensin receptor blockers may retard or prevent the progression to overt heart failure.

Frontotemporal dementia in a Nigerian woman: case report and brief review of the literature

Frontotemporal lobal degeneration (FTLD) is a clinically heterogeneous group of sporadic and familial neurodegenerative diseases characterized by dementia, alteration in language and/or behaviour, loss of executive skills and sometimes Parkinsonian features resulting from degeneration predominantly affecting the anterior frontal and temporal regions of the brain. Three main clinical subtypes including frontotemporal dementia (FTD), semantic dementia (SD) and progressive non-fluent aphasia (PNFA) have been described depending on the clinical phenomenology, the areas of the brain where the disorder begins and where the most extensive degeneration occurs. We describe a case of frontotemporal dementia in a 58 year old Nigerian woman and also review the current literature. Recent genetic studies have expanded the frontiers of knowledge about FTD while the search for appropriate drug treatments continues.

Unusual presentation of thyrotoxicosis--a case report and review of literature

BACKGROUND

The majority of patients with thyrotoxicosis are readily diagnosed clinically. It must be accepted however that not every patient presents with the characteristic picture. Thyrotoxicosis occasionally presents in an unknown or atypical fashion in which the diagnosis may not be obvious.

CASE REPORT

A 45-year-old woman presented with choreoathetoid movements of the right upper limb, persistent vomiting and generalized body weakness. Over the next few weeks, the clinical picture slowly evolved to give the characteristic symptoms and signs of thyrotoxicosis, which were not evident at presentation. Thyroid function tests revealed elevated serum thyroxine and triiodothyronine as well as low thyroid stimulating hormone concentrations, confirming the diagnosis of thyrotoxicosis.

CONCLUSION

This case illustrates unusual initial presenting features of thyrotoxicosis, which long preceded the development of the characteristic and more common manifestations. This led to a delay in the diagnosis. Awareness of these atypical presentations will further assist the physician to make a timely and cost effective diagnosis of this condition.