Immune Dysfunction in HIV infected stroke patients: Role of low CD4 counts

Whether or not low CD4 count directly contributes to stroke among HIV infected stroke patients is yet to be elucidated. This study aimed to ascertain the role of low CD4 count in the pathophysiology of stroke in HIV infection. This was a hospital-based, case-control study. Sixty five (65) consecutive stroke patients (36 males and 29 females) aged 20-68 years and sixty five (65) age-and-sex matched controls were enrolled. A structured questionnaire was administered. Neurological examination was performed and computed tomography scan of the brain done. Blood samples were taken for HIV 1&2 screening using ELISA method. Positive test using two different kits constituted a positive result. CD4 count was determined by western blot method. The mean CD4 count of HIV positive stroke patients (224.92 cells/cm3) is significantly lower (P <0.001) than that of HIV negative patients (690.67 cells/cm3). Nine out of thirteen (9/13, 69%) HIV positive stroke patients have CD4 <200 cells/μl. In addition to the conventional risk factors for ischemic stroke in HIV-infected patients, immune dysfunction (low CD4 count) is an important and significant modifiable risk factor of ischemic stroke event among HIV infected adult population of Northeastern Nigeria. Consequently, better understanding and awareness of the role of low CD4 count in the pathogenesis of stroke among HIV adults in this environment may provide a roadmap for controlling one of the deleterious non-opportunistic neurologic complication of HIV infectionKeywords: CD4 count, HIV, Immune Dysfunction, Strok

Collet-sicard syndrome: case report of a rare presentation of metastatic gastric adenocarcinoma.

Collet-Sicard is a rare syndrome that involves paralysis of unilateral lower cranial nerves (IX, X, XI and XII) due to lesions at the base of the skull. It is associated with various neoplastic and non-neoplastic aetiologies. Case Report: We report the case of an adult who presented with an 8 months history of dysphagia, dysphonia, supraclavicular lymphadenopathy, unilateral facial and shoulder weakness. A diagnosis of metastatic adenocarcinoma was confirmed by tissue biopsy. This is a case report of an unusual presentation of Collet-Sicard syndrome secondary to metastatic gastric carcinoma. Because of delay in reporting to hospital and diagnosis, the patient died while being worked-up for radiotherapy and surgery. Conclusion: Delay in diagnosis of Collet-Siccard syndrome is common, and this condition should be considered in patients who present with a constellation of lower cranial nerve palsies.&nbsp

Seroprevalence of IgG anti- T. Gondii antibody among HIV-infected patients in Maiduguri, north eastern Nigeria.

Background: Toxoplasma gondii infection is one of the commonest opportunistic infections in HIV-infected patients, with the fatal consequences of toxoplasmic encephalitis particularly in advanced disease. However, data regarding T.gondii infection in the setting of HIV/AIDS are scant in Nigeria. Objective: To determine the seroprevalence of T.gondii amongst HIV-infected patients as well as to determine the correlation between anti-T.gondii IgG titre and the CD4+ cell count/HIV-1 RNA viral load. Method: A cross sectional study in which a total of 190 subjects were involved i.e. 110 newly diagnosed HAART naïve HIV-positive patients and 80 apparently healthy HIV-negative age- and-sex matched controls that were selected by simple random sampling method. Results: The age range of the study population was 20-64 years. The mean ages of male subjects for both HIV-positives and controls were 37.52 ±8.20 years and 35.79 ±12.31years, respectively, (p= 0.462). On the other hand, the mean ages of female subjects for both HIV-positives and controls were 29.90 ±6.98 years and 32.30 ±10.29 years, respectively, (p=0.149). Twenty one subjects (19.1%) among HIV-positives and 1 (1.25%) HIV-negative tested positive for anti-T.gondii IgG, respectively, (p= 0.000). The prevalence rate ration of anti-T. gondii IgG of HIV positives compared to HIVnegatives was 15.28. Significant proportion of anti-T.gondii positive subjects presented with AIDS defining illnesses compared with their anti-T.gondii negative counterparts. Conclusion:The study has shown that anti-T.gondii IgG is about 15 times more prevalent among HIV positive patients compared to controls. Routine screening for T.gondii IgG anti-body is therefore recommended for all HIV-infected subjects at the facility as well as commencement of chemoprophylaxis against Toxoplasmic encephalitis in HIV-infected patients with CD4+ cell count of <100 cells/ml

Epidemiology of Epilepsy in Nigeria: A Community-Based Study From 3 Sites

BACKGROUND: We determined the prevalence, incidence, and risk factors for epilepsy in Nigeria. METHODS: We conducted a door-to-door survey to identify cases of epilepsy in 3 regions. We estimated age-standardized prevalence adjusted for nonresponse and sensitivity and the 1-year retrospective incidence for active epilepsy. To assess potential risk factors, we conducted a case-control study by collecting sociodemographic and risk factor data. We estimated odds ratios using logistic regression analysis and corresponding population attributable fractions (PAFs). RESULTS: We screened 42,427 persons (age ≥6 years), of whom 254 had confirmed active epilepsy. The pooled prevalence of active epilepsy per 1,000 was 9.8 (95% confidence interval [CI] 8.6-11.1), 17.7 (14.2-20.6) in Gwandu, 4.8 (3.4-6.6) in Afikpo, and 3.3 (2.0-5.1) in Ijebu-Jesa. The pooled incidence per 100,000 was 101.3 (95% CI 57.9-167.6), 201.2 (105.0-358.9) in Gwandu, 27.6 (3.3-128.0) in Afikpo, and 23.9 (3.2-157.0) in Ijebu-Jesa. Children's significant risk factors included febrile seizures, meningitis, poor perinatal care, open defecation, measles, and family history in first-degree relatives. In adults, head injury, poor perinatal care, febrile seizures, family history in second-degree relatives, and consanguinity were significant. Gwandu had more significant risk factors. The PAF for the important factors in children was 74.0% (71.0%-76.0%) and in adults was 79.0% (75.0%-81.0%). CONCLUSION: This work suggests varied epidemiologic numbers, which may be explained by differences in risk factors and population structure in the different regions. These variations should differentially determine and drive prevention and health care responses

CURRENT EVIDENCE FOR THE ROLE OF ANTI-NEURONAL ANTIBODIES IN PARANEOPLASTIC NEURONAL DISORDER

Paraneoplastic Neurologic syndromes (PNS) are rare heterogeneous group of disorders associated with cancer, caused by mechanisms other than, direct infiltration, metastasis, infection, coagulopathy, metabolic and nutritional deficits or consequences of therapy. These syndromes can affect any area of the nervous system, including central nervous system, peripheral and autonomic nervous system, neuromuscular junction, and muscles. Over the last five decades three waves of interest are noted in paraneoplastic neurological syndromes: First, the clinical and pathological recognition of PNS; and then the discovery of immunological mechanisms characterized by the presence of antibodies and associated cytotoxic T cell responses against intracellular antigens, and more recently, the surge of antibodies ('onconeural' antibodies) against synaptic and cellular surface proteins Although paraneoplastic neurological syndromes are uncommon and not completely understood, their antibody associations are important because of the antibody's aetiological connection with the underlying neoplasm. The paraneoplastic autoantibody may provide a roadmap to early diagnosis of the underlying neoplasm, prompt treatment of which can sometimes improve the neurological outcome. The disorder often predate the diagnosis of the underlying neoplasm, providing a pathway for detecting cancer at an earlier and amenable stage. Evaluations for paraneoplastic antibodies are sometimes negative but do not rule out the diagnosis of a paraneoplastic disorder. Therefore, relevant clinical presentations should suggest a paraneoplastic syndrome, even in the absence of paraneoplastic antibodies and prompt search for occult neoplasm.</jats:p

Gender variation in the risk of stroke among HIV- infected patients in north-eastern Nigeria.

Recent Epidemiologic evidence suggested that Acquired Immunodeficiency Syndrome (AIDS) increases the chances of suffering from stroke, several literatures contained reports of thrombotic episodes occurring in patients with HIV infection; and various abnormalities predisposing to a hypercoagulable state have also been reported in such patients. Risk of stroke in non-HlV patients is higher in men than in women when considering individuals younger than age 80 years. However, few data exist to quantify the role of gender variation in the risk of stroke among HIV- infected stroke patients especially in the study area; the aim of this study was to find out if the baseline variables, including gender play a significant role in the risk of stroke among HIV- Infected stroke patients. Method: This was a Hospital based case-control study. Sixty-five (65) stroke patients aged 20-68 years and sixty-five (65) age and sex matched controls were enrolled. A structured questionnaire was administered. Neurological examination was performed and computed tomography scan of the Brain done. Blood samples were taken for HIV 1&amp; 2 screening using DETERMINE kit ELISA method. Double ELISA confirmed positive results. CD4 count was determined by flow cy tome try and serum chemistry was also carried out. Results: The risk of HIV infection among stroke cases was significantly higher than in control subjects 13 (20%) versus 3 (4.6%), respectively; (p-value &lt;0.008). Odds ratio for HIV infection among stroke patients was 5.17. Statistical analyses of other variables showed that, female gender; young age and low CD, count were significantly associated with the risk of developing ischaemic stroke. Conclusion: Human Immunodeficiency virus infection is a significant risk factor for ischaemic stroke in the adult population of Northeastern Nigeria and that, the female preponderance as well as, the low mean CD, count among HIV Sero-positive stroke patients in this study reflect the demography of HIV in our Hospital. Therefore, considering HIV in the differential diagnosis of ischaemic stroke of unknown origin especially in young female adults is worthwhile in Northeastern Nigeria and that, further methodologically sound studies are needed to better define the epidemiology of AlDS-associated cerebrovascular disease in the Nigerian populatio

Overall and cause-specific premature mortality in epilepsy: A systematic review

BACKGROUND: We conducted a systematic review to ascertain the overall mortality and causes of premature mortality in epilepsy. METHODOLOGY: We searched PubMed and Embase to identify relevant articles reporting mortality in epilepsy. An assessment of the methodological quality and overall quality of evidence of the identified studies was done using appropriate checklists. We extracted data from these studies reporting measures of overall and cause-specific mortality in epilepsy. RESULTS: Sixty-three articles from fifty-six cohorts met the eligibility criteria, thirty-three population- or community-based and twenty-three hospital- or institutional-based studies. The majority of studies are from high-income countries (HIC). These studies reported overall excess mortality for people with epilepsy, with wide variability reported for population- or community-based studies and from low- and middle-income countries (LMIC). Twenty-seven articles from twenty-three cohorts reported measures of mortality for cause-specific mortality in epilepsy. People with epilepsy from HIC and LMIC have a higher risk of dying from various causes compared with the general population. Those in LMIC, however, have a particularly high chance of dying from external causes such as drowning and suicide. We observed a decrement over time in measures of overall and cause-specific mortality in cohorts. CONCLUSIONS: Despite the heterogeneity in reports, our findings support the suggestions that people with epilepsy have an increased risk of premature mortality from various causes. Further work is needed to elucidate the mechanisms, to determine biomarkers for predicting those at risk, and to understand the implications of counseling and preventive strategies

Translation and validation of an epilepsy-screening questionnaire in three Nigerian languages

OBJECTIVE: We describe the development, translation and validation of epilepsy-screening questionnaires in the three most popular Nigerian languages: Hausa, Igbo and Yoruba. METHODS: A 9-item epilepsy-screening questionnaire was developed by modifying previously validated English language questionnaires. Separate multilingual experts forward- and back-translated them to the three target languages. Translations were discussed with fieldworkers and community members for ethnolinguistic acceptability and comprehension. We used an unmatched affected-case versus unaffected-control design for the pilot study. Cases were people with epilepsy attending the tertiary hospitals where these languages are spoken. The controls were relatives of cases or people attending for other medical conditions. An affirmative response to any of the nine questions amounted to a positive screen for epilepsy. RESULTS: We recruited 153 (75 cases and 78 controls) people for the Hausa version, 106 (45 cases and 61 controls) for Igbo and 153 (66 cases and 87 controls) for the Yoruba. The sensitivity and specificity of the questionnaire were: Hausa (97.3% and 88.5%), Igbo (91.1% and 88.5%) and Yoruba (93.9% and 86.7%). The three versions reliably indicated epilepsy with positive predictive values of 85.9% (Hausa), 85.4% (Igbo) and 87.3% (Yoruba) and reliably excluded epilepsy with negative predictive values of 97.1% (Hausa), 93.1% (Igbo) and 95.1% (Yoruba). Positive likelihood ratios were all greater than one. CONCLUSIONS: Validated epilepsy screening questionnaires are now available for the three languages to be used for community-based epilepsy survey in Nigeria. The translation and validation process are discussed to facilitate usage and development for other languages in sub-Saharan Africa