Nura Alkali - Academia.edu (original) (raw)

Papers by Nura Alkali

Nigerian Postgraduate Medical Journal, Apr 1, 2024

PubMed, Apr 1, 2008

Objective: To examine the utility of the sympathetic skin response SSR as a measure of impaired a... more 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.

Nigerian Journal of Medicine, 2019

Brittle asthma, even though it is thought to be a rare form of Asthma, may form the bulk of our d... more Brittle asthma, even though it is thought to be a rare form of Asthma, may form the bulk of our difficult to treat asthma and frequently unresponsive exacerbation. Brittle Asthma. Brittle asthma is a rare form of severe asthma characterized by a wide variation of Peak Expiratory Flow (PEF) 1 , in spite of high doses of inhaled steroids and bronchodilator therapy. Brittle asthmatic patients have very serious and often, life threatening, attacks. There are two forms of brittle asthma. Case Presentation We present the cases of a 45yr old Nurse anesthetics who was diagnosed >5yrs ago and a 56yr old unemployed who was diagnosed >15yrs ago. Both have been stable for years on add on maintenance therapy with high doses of inhaled corticosteroid and β 2 agonist as oral salbutamol and an inhaler therapy during exacerbation. Recently, both patients noticed worsening of symptoms despite high dose therapy, They have been in and out of hospital recently for uncontrolled asthma. They later had to be admitted in ICU because of respiratory insufficiency. These two lapsed into brittle asthma with recurrent bronchospasm, due to repeated to anesthetic agents and environmental exposure at home respectively. Keywords: Brittle Asthma, Peak Expiratory Flow (PEF), Respiratory Insufficiency, environmental exposure

PubMed, Oct 1, 2008

Stroke is the third leading cause of death and a major cause of disability worldwide. Most cases ... more 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.

The potential role of gender in the occurrence of HIV-related neurocognitive impairment (NCI) and... more 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. Percent-ages 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 SPmen. On the neuropsychological testing, SP women were more impaired in speed of information process-ing and verbal fluency and had a higher mean GDS than SN women. Compared to SPmen, SP women were also more impaired in spee...

Complications during strokes adversely affects outcome. This study sought to assess the types and... more Complications during strokes adversely affects outcome. This study sought to assess the types and frequency of complication occurring in African stroke patients. The study population consisted of 524 patients admitted for stroke during the period January 2005 to May 2011. We recorded clinical state and all complications during hospital stay and follow–up. Deaths within this period were also recorded. A total of 201 (38.4%) of stroke patients had complication during admissions and follow-ups. The most common complications were aspiration pneumonia 65 (12.4%), depression 48 (9.2%), urinary tract infection 33 (6.3%), pressure sore 20 (3.8%), contractures 18 (3.4%), seizure 16 (3.1%) and hyperglycaemia 12 (2.3%). Forty-eight (9.2%) patients had more than one complication. Urinary tract infection was commoner in females (P = 0.015). Sixty–day fatality was higher in those with complications (P = 4 (OR, 2.0; 95% CI, 1.19 – 3.32. P = 0.009), admission NIHSS > 11 (OR, 2.2; 95% CI, 1.46 – ...

Neurology, 2012

Objective: To examine outcomes on neuropsychological (NP) testing among individuals at risk for d... more Objective: To examine outcomes on neuropsychological (NP) testing among individuals at risk for developing HIV-related neurocognitive impairment (NCI) in Nigeria. Background With 3.3 million infected, Nigeria has the 2 nd highest burden of HIV/AIDS. In the pre-antiretroviral therapy (ART) era up to 50% of infected individuals manifested NCI. In the context of expanded ART access in Nigeria and other low income countries understanding the prevalence and longitudinal impacts of NCI on patient outcomes is vital to sustainable programs. Design/Methods: ART-naive seropositive (SP) and seronegative (SN) control subjects are recruited at two antiretroviral treatment clinics in Nigeria. NP test data obtained at the time of study enrollment were analyzed. Multiple regression analyses were performed with HIV serological status, education, and ethnicity included as covariates. Effect sizes were determined by estimation of the Cohen9s d statistic. Results: 30 SP (23 in WHO stage I, four in stage II, three in stage III and one in stage IV) and 51 SN subjects were enrolled. The mean age and sex ratios were similar for the two groups; however, the SP group had a lower level of education (p=0.03). Significant relationships were found for HIV serostatus with performance on the overall NP battery (p=0.0096) and on tests of learning (p=0.0085), speed of information processing (p=0.01); executive function (p=0.01); and memory (p=0.02). Effect sizes for these analyses ranged between 0.34-0.36. On the full battery, 14 SP (46%) had scores >1 SD below the mean of the controls; of these, 7 (23%) had scores >2 SD below the mean. Ethnicity and education did not impact performance on the tests. Conclusions: HIV- related neurocognitive abnormalities were frequent in this patient group, who overall presented in the earlier stages of infection. Additional studies are underway to further define the clinical and virological associations for NCI with HIV infection in Nigeria. Supported by: National Institute of Mental Health, NIH. Disclosure: Dr. Royal has received personal compensation for activities with MedImpact Healthcare Systems, Inc.Dr. Royal received research support from EMD-Serono, Inc., Genzyme, Teva Neuroscience, Biogen and Novartis. Dr. Blattner has nothing to disclose. Dr. Cherner has nothing to disclose. Dr. Abimiku has nothing to disclose. Dr. Adebamowo has nothing to disclose. Dr. Johnson has nothing to disclose. Dr. Alabi has nothing to disclose. Dr. Alkali has nothing to disclose. Dr. Mamadu has nothing to disclose. Dr. Okwuasaba has nothing to disclose. Dr. Agala has nothing to disclose. Dr. Gupta has nothing to disclose. Dr. Hendrix has nothing to disclose. Dr. Eyzaguirre has nothing to disclose. Dr. Aragbada has nothing to disclose. Dr. Ojo has nothing to disclose. Dr. Adebiyi has nothing to disclose.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Dear Colleagues and Friends, This year's meeting will be held in Baltimore Sunday, October 14-Wed... more Dear Colleagues and Friends, This year's meeting will be held in Baltimore Sunday, October 14-Wednesday, October 17. Leading virologists will descend upon the City to share and examine innovative scientific breakthroughs in HIV/AIDS biology-from basic science to clinical research. We will also hear from distinguished experts on HIV-associated diseases and malignancies. Additionally, we will again include our popular Special Symposium on Africa to review and address the development of clinical research capacity on the continent and issues related to health care delivery in resource-poor countries.

NATIONAL JOURNAL OF NEUROLOGY, 2019

Objectives: Aspiration pneumonia is a common complication in patients with stroke, having a negat... more Objectives: Aspiration pneumonia is a common complication in patients with stroke, having a negative influence on morbidity and mortality. This study sought to assess the frequency of aspiration pneumonia and the independent predictors for its development among Nigerian patients with stroke. Methods: Five hundred and twenty-four stroke patients were prospectively enrolled during the study period at the University of Maiduguri Teaching Hospital, Maiduguri, from January 2005 and May 2011. All patients who developed aspiration pneumonia during hospital stay and follow–up were recorded. A student’s t-test and a Pearson chi-square analysis was used to compare baseline characteristics of subjects who developed aspiration pneumonia and those who did not. A multiple logistic regression was used to assess the independent predictors of aspiration pneumonia. We also recorded the rate of deaths and duration hospital stay within this period. Results: Aspiration pneumonia occurred in 65 (12.4%) ...

Annals of African Medical Research

Stroke education programs at schools and colleges help to promote public knowledge of stroke, but... more Stroke education programs at schools and colleges help to promote public knowledge of stroke, but the impact in Nigeria is not well known. This study assessed stroke-related knowledge and attitudes among university students in Nigeria, where health studies are parts of college curricula. This was a cross-sectional study of students at three universities in Northeast Nigeria. Using questionnaire survey, we assessed biographical data and participant knowledge of the primary site, warning signs and risk factors of stroke. Responses were graded on a knowledge score, where ≥2.5 points indicated adequate knowledge. Data were analyzed with the SPSS version 21 program. We studied 824 participants, 67.1% males. Males were older than females (mean age ± SD: 27.42±5.58 years versus 26.27±5.31 years; P = 0.009; 95% CI: 0.29 – 1.99) and 14.5% participants had stroke lectures during general studies. Major sources of stroke knowledge were personal discussions (44.6%) and internet websites (24.5%)....

Annals of African Medical Research, 2020

Nigeria’s tertiary hospitals have faced public criticisms over substandard services and poor infr... more Nigeria’s tertiary hospitals have faced public criticisms over substandard services and poor infrastructure reported in the mass media during early to mid-2019. Peer-reviewed studies in the medical literature have painted similar pictures of poor healthcare quality at most of the nation’s public hospitals. For instance, studies have revealed tertiary hospitals lacking vital equipment needed for emergency care of acute asthma and obstetric hemorrhage, while hospital administrators complain of insufficient personnel made worse by inadequate electricity from the national grid, poor government funding and bureaucratic bottlenecks undermining staff recruitment and training. This grim situation is at total variance with global best practices for tertiary healthcare adopted by many countries. Matters may yet get worse with Nigeria now in the midst of a coronavirus epidemic and its potential to overburden weak healthcare systems unless urgent efforts are made to improve healthcare quality. ...

Background: The emergence and spread of drug-resistant tuberculosis (DR-TB) has become the major ... more Background: The emergence and spread of drug-resistant tuberculosis (DR-TB) has become the major concern in global TB control nowadays due to its limited therapy options and high mortality. An evaluation of the epidemiological trends of DR-TB in Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, of which TB incidences is remarkable, is essential but lacking. Aim: There has been a steady rise in MDR-TB in Nigeria between 2009 and 2014 and the number of patient enrolled is still well below the estimated 21,000 cases of MDR-TB. Few studies on the trends of MDR-TB was done in Nigeria. This study is center based survey to understand the burden and dynamics of DR-TB for effective planning and positioning of the health care centers in order to mitigate, treat and reduce the burden of DR-TB. Method: This study is cross sectional study which looked into the presumptive DR-Tb register at the Bacteriology laboratory of AT-BUTH for a period of 24 months, between November 2014 to October 2016, patient data for acid fast bacilli (AFB) smear and Xpert MTB/RIF assays were obtained. Socio demographic data including age, sex, were collected and clinical data including treatment history, prior TB contact, cavity, and bilateral disease on chest radiology were available. Results: Multidrug-resistant TB (MDR-TB) was found to be on the increase with more males (15%) affected compared to female (8%), Majority of the positive cases 8% were among those age 26-35 yrs and 2% among the elderly patient age ≥ 55 yrs. 2.3% of the study subject had MDR-TB/HIV co infection. There were more male co infected patients 5.9% compared to female co infected patient 2.6% among the MDR-TB positive subject (P = 0.619). It is essentially an acquired condition, 17% among retreatment compared to 5% among new cases (P = 0.000). Conclusion: MDR-TB is on the increase it is essentially an acquired condition with mal preponderance, its association with HIV disease is still on the lower side compared to studies in advanced countries poor diagnostic technique for immunocompromised host with pauci bacillary disease could be a factors for low levels noticed in poor countries.

Nigerian Journal of Clinical Practice, 2019

Osmotic demyelination syndrome (ODS) is a life-threatening neurological condition often associate... more Osmotic demyelination syndrome (ODS) is a life-threatening neurological condition often associated with rapid correction of hyponatremia. While ODS is thought to be rare, with prevalence rates of not more than 0.5% in autopsy series, mortality rates are as high as 90% in some studies. Thus, timely diagnosis and life-saving treatment rest on a high index of suspicion among clinicians. In this report, we discuss the case and literature review of a 45-year-old female with sepsis, acute kidney injury, and spontaneous hypernatremia who developed ODS but responded to therapy with high dose steroids, antibiotics, and supportive care.

Background: Nigeria suffered waves of Highly Pathogenic Avian Influenza (HPAI) outbreaks that pea... more Background: Nigeria suffered waves of Highly Pathogenic Avian Influenza (HPAI) outbreaks that peaked twice in February 2006 and February 2007. The outbreaks affected 3,057 commercial and rural household farms causing 1.3 million of the country’s poultry destroyed. Aim: The burden of Influenza is likely to be under estimated and because of the unstable nature of the virus it calls for the mapping of this virus to specific region, this study therefore seeks to identify the types, prevalence, strain, predilection of the organism so as to monitor the occurrence of influenza in this part of the country with the aim of providing a base line level of intervention of influenza virus and find the candidate virus for vaccine selection and production. Methods: This study is a cross sectional survey, our target populations were all pediatric and adult patients admitted at the pediatrics and internal medicine department of ATBUTH who has met the criteria for presence of cough, fever (> 37oC),...

International Research Journal of Medicine and Medical Sciences, 2017

Background: Nigeria suffered waves of Highly Pathogenic Avian Influenza (HPAI) outbreaks that pea... more Background: Nigeria suffered waves of Highly Pathogenic Avian Influenza (HPAI) outbreaks that peaked twice in February 2006 and February 2007. The outbreaks affected 3,057 commercial and rural household farms causing 1.3 million of the country's poultry destroyed. The burden of Influenza is likely to be under estimated and because of the unstable nature of the virus it call for the mapping of this virus to specific region, this study therefore seeks to identify the types, prevalence, strain, predilection of the organism so as to monitor the occurrence of influenza in this part of the country with the aim of providing a base line level of intervention of influenza virus and find the candidate virus for vaccine selection and production. This study is a cross sectional survey, our target populations were all pediatric and adult patients admitted at the pediatrics and internal medicine department of ATBUTH who has met the criteria for presence of cough, fever (>37 o C), nasal congestion and dyspnoea. Samples were collected and analyzed using the polymerase chain reaction (PCR), for the presence and sub typing of influenza viruses in respiratory specimens. Overall 5% of the samples collected tested positive for human influenza type A and B. During average epidemics, overall attack rates are estimated to be 10-20%, but in certain susceptible populations such as schoolchildren or nursing home residents, attack rates of 40-50% may occur. 60% of the positive results were among the female samples where as 40% from the male samples.

Annals of African Medicine, 2020

Background: Complex regional pain syndrome (CRPS) is a rare neuropathic pain disorder associated ... more 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.

Pak J Med Sci October- …, 2006

Objective: Epidemiologic evidence suggests that raised plasma homocysteine is an independent risk... more Objective: Epidemiologic evidence suggests that raised plasma homocysteine is an independent risk factor for ischaemic stroke. However, other studies found no association between plasma homocysteine and stroke. Our objective was to determine the relationship between plasma homocysteine concentrations and ischaemic stroke in the Nigerian population where there is no existing published data. Design: Case-control study.

Background: Adverse effects from second line drugs used in MDRTB treatment include neuropsychiat... more Background: Adverse effects from second line drugs used in MDRTB treatment include neuropsychiatric effects which are usually very significant as they may cause anxiety and lead to default and poor adherence by patients if quick recognition and intervention is not available. This case series aims highlight the occurrence of cycloserine related psychosis among patient on treatment for MDR-TB in Nigeria, with the objective of promoting adequate evaluation and quick response and treatment to this important ADR. Method: The case records of 3 patients from two MDR-TB in-patient treatment centers in Nigeria and a review of the existing literature was utilized. Results: An association was found with the use of Cycloserine and development of Psychosis during the management of these patients with MDR-TB. Early recognition and quick treatment is required to ensure treatment continuation and resolution of the ADR. Conclusion: Patients with MDR-TB on Cycloserine containing CAT IV regimen sh...

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria

Rhinitis is one of the commonest occupational related respiratory disorders that is only restrict... more 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. 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. 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...

Annals of African Medical Research

Alcohol is consumed in almost all countries worldwide. Heavy drinking can reduce the body’s sensi... more Alcohol is consumed in almost all countries worldwide. Heavy drinking can reduce the body’s sensitivity to insulin, which can trigger type 2 diabetes mellitus. Diabetes can complicate chronic pancreatitis, which is overwhelmingly caused by heavy alcohol drinking. Alcohol is also high in calories, with heavy drinkers liable to obesity and a higher risk of type 2 diabetes mellitus. Similarly, cigarette smoking is associated with increased risk of type 2 diabetes mellitus among both middle-aged and elderly men and women. Nigeria is one of the three largest tobacco markets in Africa with a population of almost 13 million smokers. Northeast Nigeria ranks 3rd among the six geopolitical zones, with a smoking rate of 6.1%. In this study, we evaluated the risks of diabetes mellitus associated with alcohol consumption and cigarette smoking in Gombe State, Northeast Nigeria. This cross-sectional survey was conducted in a two-stage cluster sampling scheme based on existing administrative divisi...

Nigerian Postgraduate Medical Journal, Apr 1, 2024

PubMed, Apr 1, 2008

Objective: To examine the utility of the sympathetic skin response SSR as a measure of impaired a... more 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.

Nigerian Journal of Medicine, 2019

Brittle asthma, even though it is thought to be a rare form of Asthma, may form the bulk of our d... more Brittle asthma, even though it is thought to be a rare form of Asthma, may form the bulk of our difficult to treat asthma and frequently unresponsive exacerbation. Brittle Asthma. Brittle asthma is a rare form of severe asthma characterized by a wide variation of Peak Expiratory Flow (PEF) 1 , in spite of high doses of inhaled steroids and bronchodilator therapy. Brittle asthmatic patients have very serious and often, life threatening, attacks. There are two forms of brittle asthma. Case Presentation We present the cases of a 45yr old Nurse anesthetics who was diagnosed >5yrs ago and a 56yr old unemployed who was diagnosed >15yrs ago. Both have been stable for years on add on maintenance therapy with high doses of inhaled corticosteroid and β 2 agonist as oral salbutamol and an inhaler therapy during exacerbation. Recently, both patients noticed worsening of symptoms despite high dose therapy, They have been in and out of hospital recently for uncontrolled asthma. They later had to be admitted in ICU because of respiratory insufficiency. These two lapsed into brittle asthma with recurrent bronchospasm, due to repeated to anesthetic agents and environmental exposure at home respectively. Keywords: Brittle Asthma, Peak Expiratory Flow (PEF), Respiratory Insufficiency, environmental exposure

PubMed, Oct 1, 2008

Stroke is the third leading cause of death and a major cause of disability worldwide. Most cases ... more 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.

The potential role of gender in the occurrence of HIV-related neurocognitive impairment (NCI) and... more 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. Percent-ages 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 SPmen. On the neuropsychological testing, SP women were more impaired in speed of information process-ing and verbal fluency and had a higher mean GDS than SN women. Compared to SPmen, SP women were also more impaired in spee...

Complications during strokes adversely affects outcome. This study sought to assess the types and... more Complications during strokes adversely affects outcome. This study sought to assess the types and frequency of complication occurring in African stroke patients. The study population consisted of 524 patients admitted for stroke during the period January 2005 to May 2011. We recorded clinical state and all complications during hospital stay and follow–up. Deaths within this period were also recorded. A total of 201 (38.4%) of stroke patients had complication during admissions and follow-ups. The most common complications were aspiration pneumonia 65 (12.4%), depression 48 (9.2%), urinary tract infection 33 (6.3%), pressure sore 20 (3.8%), contractures 18 (3.4%), seizure 16 (3.1%) and hyperglycaemia 12 (2.3%). Forty-eight (9.2%) patients had more than one complication. Urinary tract infection was commoner in females (P = 0.015). Sixty–day fatality was higher in those with complications (P = 4 (OR, 2.0; 95% CI, 1.19 – 3.32. P = 0.009), admission NIHSS > 11 (OR, 2.2; 95% CI, 1.46 – ...

Neurology, 2012

Objective: To examine outcomes on neuropsychological (NP) testing among individuals at risk for d... more Objective: To examine outcomes on neuropsychological (NP) testing among individuals at risk for developing HIV-related neurocognitive impairment (NCI) in Nigeria. Background With 3.3 million infected, Nigeria has the 2 nd highest burden of HIV/AIDS. In the pre-antiretroviral therapy (ART) era up to 50% of infected individuals manifested NCI. In the context of expanded ART access in Nigeria and other low income countries understanding the prevalence and longitudinal impacts of NCI on patient outcomes is vital to sustainable programs. Design/Methods: ART-naive seropositive (SP) and seronegative (SN) control subjects are recruited at two antiretroviral treatment clinics in Nigeria. NP test data obtained at the time of study enrollment were analyzed. Multiple regression analyses were performed with HIV serological status, education, and ethnicity included as covariates. Effect sizes were determined by estimation of the Cohen9s d statistic. Results: 30 SP (23 in WHO stage I, four in stage II, three in stage III and one in stage IV) and 51 SN subjects were enrolled. The mean age and sex ratios were similar for the two groups; however, the SP group had a lower level of education (p=0.03). Significant relationships were found for HIV serostatus with performance on the overall NP battery (p=0.0096) and on tests of learning (p=0.0085), speed of information processing (p=0.01); executive function (p=0.01); and memory (p=0.02). Effect sizes for these analyses ranged between 0.34-0.36. On the full battery, 14 SP (46%) had scores >1 SD below the mean of the controls; of these, 7 (23%) had scores >2 SD below the mean. Ethnicity and education did not impact performance on the tests. Conclusions: HIV- related neurocognitive abnormalities were frequent in this patient group, who overall presented in the earlier stages of infection. Additional studies are underway to further define the clinical and virological associations for NCI with HIV infection in Nigeria. Supported by: National Institute of Mental Health, NIH. Disclosure: Dr. Royal has received personal compensation for activities with MedImpact Healthcare Systems, Inc.Dr. Royal received research support from EMD-Serono, Inc., Genzyme, Teva Neuroscience, Biogen and Novartis. Dr. Blattner has nothing to disclose. Dr. Cherner has nothing to disclose. Dr. Abimiku has nothing to disclose. Dr. Adebamowo has nothing to disclose. Dr. Johnson has nothing to disclose. Dr. Alabi has nothing to disclose. Dr. Alkali has nothing to disclose. Dr. Mamadu has nothing to disclose. Dr. Okwuasaba has nothing to disclose. Dr. Agala has nothing to disclose. Dr. Gupta has nothing to disclose. Dr. Hendrix has nothing to disclose. Dr. Eyzaguirre has nothing to disclose. Dr. Aragbada has nothing to disclose. Dr. Ojo has nothing to disclose. Dr. Adebiyi has nothing to disclose.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Dear Colleagues and Friends, This year's meeting will be held in Baltimore Sunday, October 14-Wed... more Dear Colleagues and Friends, This year's meeting will be held in Baltimore Sunday, October 14-Wednesday, October 17. Leading virologists will descend upon the City to share and examine innovative scientific breakthroughs in HIV/AIDS biology-from basic science to clinical research. We will also hear from distinguished experts on HIV-associated diseases and malignancies. Additionally, we will again include our popular Special Symposium on Africa to review and address the development of clinical research capacity on the continent and issues related to health care delivery in resource-poor countries.

NATIONAL JOURNAL OF NEUROLOGY, 2019

Objectives: Aspiration pneumonia is a common complication in patients with stroke, having a negat... more Objectives: Aspiration pneumonia is a common complication in patients with stroke, having a negative influence on morbidity and mortality. This study sought to assess the frequency of aspiration pneumonia and the independent predictors for its development among Nigerian patients with stroke. Methods: Five hundred and twenty-four stroke patients were prospectively enrolled during the study period at the University of Maiduguri Teaching Hospital, Maiduguri, from January 2005 and May 2011. All patients who developed aspiration pneumonia during hospital stay and follow–up were recorded. A student’s t-test and a Pearson chi-square analysis was used to compare baseline characteristics of subjects who developed aspiration pneumonia and those who did not. A multiple logistic regression was used to assess the independent predictors of aspiration pneumonia. We also recorded the rate of deaths and duration hospital stay within this period. Results: Aspiration pneumonia occurred in 65 (12.4%) ...

Annals of African Medical Research

Stroke education programs at schools and colleges help to promote public knowledge of stroke, but... more Stroke education programs at schools and colleges help to promote public knowledge of stroke, but the impact in Nigeria is not well known. This study assessed stroke-related knowledge and attitudes among university students in Nigeria, where health studies are parts of college curricula. This was a cross-sectional study of students at three universities in Northeast Nigeria. Using questionnaire survey, we assessed biographical data and participant knowledge of the primary site, warning signs and risk factors of stroke. Responses were graded on a knowledge score, where ≥2.5 points indicated adequate knowledge. Data were analyzed with the SPSS version 21 program. We studied 824 participants, 67.1% males. Males were older than females (mean age ± SD: 27.42±5.58 years versus 26.27±5.31 years; P = 0.009; 95% CI: 0.29 – 1.99) and 14.5% participants had stroke lectures during general studies. Major sources of stroke knowledge were personal discussions (44.6%) and internet websites (24.5%)....

Annals of African Medical Research, 2020

Nigeria’s tertiary hospitals have faced public criticisms over substandard services and poor infr... more Nigeria’s tertiary hospitals have faced public criticisms over substandard services and poor infrastructure reported in the mass media during early to mid-2019. Peer-reviewed studies in the medical literature have painted similar pictures of poor healthcare quality at most of the nation’s public hospitals. For instance, studies have revealed tertiary hospitals lacking vital equipment needed for emergency care of acute asthma and obstetric hemorrhage, while hospital administrators complain of insufficient personnel made worse by inadequate electricity from the national grid, poor government funding and bureaucratic bottlenecks undermining staff recruitment and training. This grim situation is at total variance with global best practices for tertiary healthcare adopted by many countries. Matters may yet get worse with Nigeria now in the midst of a coronavirus epidemic and its potential to overburden weak healthcare systems unless urgent efforts are made to improve healthcare quality. ...

Background: The emergence and spread of drug-resistant tuberculosis (DR-TB) has become the major ... more Background: The emergence and spread of drug-resistant tuberculosis (DR-TB) has become the major concern in global TB control nowadays due to its limited therapy options and high mortality. An evaluation of the epidemiological trends of DR-TB in Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, of which TB incidences is remarkable, is essential but lacking. Aim: There has been a steady rise in MDR-TB in Nigeria between 2009 and 2014 and the number of patient enrolled is still well below the estimated 21,000 cases of MDR-TB. Few studies on the trends of MDR-TB was done in Nigeria. This study is center based survey to understand the burden and dynamics of DR-TB for effective planning and positioning of the health care centers in order to mitigate, treat and reduce the burden of DR-TB. Method: This study is cross sectional study which looked into the presumptive DR-Tb register at the Bacteriology laboratory of AT-BUTH for a period of 24 months, between November 2014 to October 2016, patient data for acid fast bacilli (AFB) smear and Xpert MTB/RIF assays were obtained. Socio demographic data including age, sex, were collected and clinical data including treatment history, prior TB contact, cavity, and bilateral disease on chest radiology were available. Results: Multidrug-resistant TB (MDR-TB) was found to be on the increase with more males (15%) affected compared to female (8%), Majority of the positive cases 8% were among those age 26-35 yrs and 2% among the elderly patient age ≥ 55 yrs. 2.3% of the study subject had MDR-TB/HIV co infection. There were more male co infected patients 5.9% compared to female co infected patient 2.6% among the MDR-TB positive subject (P = 0.619). It is essentially an acquired condition, 17% among retreatment compared to 5% among new cases (P = 0.000). Conclusion: MDR-TB is on the increase it is essentially an acquired condition with mal preponderance, its association with HIV disease is still on the lower side compared to studies in advanced countries poor diagnostic technique for immunocompromised host with pauci bacillary disease could be a factors for low levels noticed in poor countries.

Nigerian Journal of Clinical Practice, 2019

Osmotic demyelination syndrome (ODS) is a life-threatening neurological condition often associate... more Osmotic demyelination syndrome (ODS) is a life-threatening neurological condition often associated with rapid correction of hyponatremia. While ODS is thought to be rare, with prevalence rates of not more than 0.5% in autopsy series, mortality rates are as high as 90% in some studies. Thus, timely diagnosis and life-saving treatment rest on a high index of suspicion among clinicians. In this report, we discuss the case and literature review of a 45-year-old female with sepsis, acute kidney injury, and spontaneous hypernatremia who developed ODS but responded to therapy with high dose steroids, antibiotics, and supportive care.

Background: Nigeria suffered waves of Highly Pathogenic Avian Influenza (HPAI) outbreaks that pea... more Background: Nigeria suffered waves of Highly Pathogenic Avian Influenza (HPAI) outbreaks that peaked twice in February 2006 and February 2007. The outbreaks affected 3,057 commercial and rural household farms causing 1.3 million of the country’s poultry destroyed. Aim: The burden of Influenza is likely to be under estimated and because of the unstable nature of the virus it calls for the mapping of this virus to specific region, this study therefore seeks to identify the types, prevalence, strain, predilection of the organism so as to monitor the occurrence of influenza in this part of the country with the aim of providing a base line level of intervention of influenza virus and find the candidate virus for vaccine selection and production. Methods: This study is a cross sectional survey, our target populations were all pediatric and adult patients admitted at the pediatrics and internal medicine department of ATBUTH who has met the criteria for presence of cough, fever (> 37oC),...

International Research Journal of Medicine and Medical Sciences, 2017

Background: Nigeria suffered waves of Highly Pathogenic Avian Influenza (HPAI) outbreaks that pea... more Background: Nigeria suffered waves of Highly Pathogenic Avian Influenza (HPAI) outbreaks that peaked twice in February 2006 and February 2007. The outbreaks affected 3,057 commercial and rural household farms causing 1.3 million of the country's poultry destroyed. The burden of Influenza is likely to be under estimated and because of the unstable nature of the virus it call for the mapping of this virus to specific region, this study therefore seeks to identify the types, prevalence, strain, predilection of the organism so as to monitor the occurrence of influenza in this part of the country with the aim of providing a base line level of intervention of influenza virus and find the candidate virus for vaccine selection and production. This study is a cross sectional survey, our target populations were all pediatric and adult patients admitted at the pediatrics and internal medicine department of ATBUTH who has met the criteria for presence of cough, fever (>37 o C), nasal congestion and dyspnoea. Samples were collected and analyzed using the polymerase chain reaction (PCR), for the presence and sub typing of influenza viruses in respiratory specimens. Overall 5% of the samples collected tested positive for human influenza type A and B. During average epidemics, overall attack rates are estimated to be 10-20%, but in certain susceptible populations such as schoolchildren or nursing home residents, attack rates of 40-50% may occur. 60% of the positive results were among the female samples where as 40% from the male samples.

Annals of African Medicine, 2020

Background: Complex regional pain syndrome (CRPS) is a rare neuropathic pain disorder associated ... more 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.

Pak J Med Sci October- …, 2006

Objective: Epidemiologic evidence suggests that raised plasma homocysteine is an independent risk... more Objective: Epidemiologic evidence suggests that raised plasma homocysteine is an independent risk factor for ischaemic stroke. However, other studies found no association between plasma homocysteine and stroke. Our objective was to determine the relationship between plasma homocysteine concentrations and ischaemic stroke in the Nigerian population where there is no existing published data. Design: Case-control study.

Background: Adverse effects from second line drugs used in MDRTB treatment include neuropsychiat... more Background: Adverse effects from second line drugs used in MDRTB treatment include neuropsychiatric effects which are usually very significant as they may cause anxiety and lead to default and poor adherence by patients if quick recognition and intervention is not available. This case series aims highlight the occurrence of cycloserine related psychosis among patient on treatment for MDR-TB in Nigeria, with the objective of promoting adequate evaluation and quick response and treatment to this important ADR. Method: The case records of 3 patients from two MDR-TB in-patient treatment centers in Nigeria and a review of the existing literature was utilized. Results: An association was found with the use of Cycloserine and development of Psychosis during the management of these patients with MDR-TB. Early recognition and quick treatment is required to ensure treatment continuation and resolution of the ADR. Conclusion: Patients with MDR-TB on Cycloserine containing CAT IV regimen sh...

Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria

Rhinitis is one of the commonest occupational related respiratory disorders that is only restrict... more 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. 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. 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...

Annals of African Medical Research

Alcohol is consumed in almost all countries worldwide. Heavy drinking can reduce the body’s sensi... more Alcohol is consumed in almost all countries worldwide. Heavy drinking can reduce the body’s sensitivity to insulin, which can trigger type 2 diabetes mellitus. Diabetes can complicate chronic pancreatitis, which is overwhelmingly caused by heavy alcohol drinking. Alcohol is also high in calories, with heavy drinkers liable to obesity and a higher risk of type 2 diabetes mellitus. Similarly, cigarette smoking is associated with increased risk of type 2 diabetes mellitus among both middle-aged and elderly men and women. Nigeria is one of the three largest tobacco markets in Africa with a population of almost 13 million smokers. Northeast Nigeria ranks 3rd among the six geopolitical zones, with a smoking rate of 6.1%. In this study, we evaluated the risks of diabetes mellitus associated with alcohol consumption and cigarette smoking in Gombe State, Northeast Nigeria. This cross-sectional survey was conducted in a two-stage cluster sampling scheme based on existing administrative divisi...