Aliyu Ibrahim

Neurocognitive impairment in HIV-1-infected adults in Sub-Saharan Africa: a systematic review and meta-analysis

OBJECTIVE To estimate the burden of HIV neurocognitive impairment (NCI) among adult patients on and off antiretroviral therapy (ART) in Sub-Saharan Africa. METHODS Estimates were derived from a random effects meta-analysis of prospective studies reporting HIV status, utilization of ART, and the presence of NCI determined using the International HIV Dementia Scale. RESULTS Sixteen studies with quality data from seven countries in Sub-Saharan Africa up to June 2012 were included. Among HIV patients, the frequency of NCI pre-ART was 42.37% (95% confidence interval (CI) 32.18-52.56%), and among those on ART for ≥6 months was 30.39% (95% CI 13.17-47.61%). Respective NCI estimates in studies from Uganda were 46.49% (95% CI 30.62-62.37%) and 28.50% (95% CI -1.31-58.30%). NCI was more common among patients with a concomitant psychiatric ailment. HIV-positive patients compared to HIV-negative controls were predisposed to NCI (odds ratio (OR) 6.49, 95% CI 1.68-25.08); the estimated unadjusted attributable risk of HIV infection leading to NCI was 85%. Meta-regression showed no associations between age, gender, CD4 cell counts, or years of education with NCI. Patients on ART were less likely to have NCI compared to HIV-infected pre-ART patients, with OR 0.36 (95% CI 0.19-0.69). In longitudinal studies with the same patients followed before and at ≥6 months after ART, the OR of NCI after ART compared to pre-ART was 0.23 (95% CI 0.14-0.37). The combined burden of NCI among pre-ART and on-ART patients in Sub-Saharan Africa was estimated at 8,121,910 (95% CI 5,772,140-10,471,680). No publication bias was observed, although residual confounding from differing environmental factors, stages of HIV infection, and viral clades might be a limitation. CONCLUSIONS HIV strongly predisposes to NCI leading to a huge burden in Sub-Saharan Africa, and scale-up of ART can substantially reduce it.

Prevalence and Correlates of HIV-Associated Neurocognitive Disorders (HAND) in Northwestern Nigeria

HIV-associated Neurocognitive Disorders (HAND) are common among HIV-positive individuals. This study explored the prevalence and correlates of HAND in Nigeria. 80 HIV-positive and 40 HIV-negative adults selected from Aminu Kano Teaching Hospital (AKTH) received comprehensive evaluations. A multidomain neuropsychological test (MDNPT) battery assessing 7 domains was administered to the participants and their performance was combined with measures of functional status to classify impairments into various grades of HAND. Univariate and multivariate analyses were performed to identify correlates of symptomatic HAND. Among the HIV-positive individuals, 50% were highly active antiretroviral therapy-experienced (HAART+) and 50% were highly active antiretroviral therapy naive (HAART−). Symptomatic HAND was found among 40% of the HAART− individuals and 30% of the HAART+ individuals. Respective prevalence of HIV-associated dementia (HAD) was 23% and 5%, respectively (p = 0.0002). In a binary logistic regression model, only fewer years of education independently predicted symptomatic HAND [Odds Ratio (OR) = 1.2, 95% confidence interval (CI) = 1.04–1.44, p = 0.016]. The prevalence of HAND in Nigeria is high with HAD being commoner among HAART− patients. Provision of HAART and strict monitoring of patients at risk of HAND are needed to scale down the burden of the disease.

Prevalence and burden of human immunodeficiency virus and hepatitis B virus co-infection in Nigeria: a systematic review and meta-analysis.

Background: Studies on HIV/HBV co-infection in Nigeria yielded prevalence ranging between 10% and 70%, giving the widest variation in prevalence of HIV/HBV co-infection from studies emanating from any country all over the world. However, estimation of clinical and public health impacts of HIV/HBV co-infection requires a robust and reliable epidemiological data for an appropriate estimation of the logistical, economic, and humanitarian impact of the two viruses in Nigeria. Objective: The aim of this review was to estimate the prevalence and burden of HBV infections in HIV-infected patients in Nigeria. Methods: Estimates were derived from a random effects meta-analysis of observational studies reporting the prevalence of HBV/HIV in Nigeria. The derived estimate for the prevalence of HBV/HIV co-infection was applied to the total HIV-infected populations in Nigeria to give an estimated burden of HBV/HIV co-infection in Nigeria. Result: Thirty three studies with quality data from seventeen states in Nigeria, up to December 16, 2013, were included. I-squared heterogeneity was 98%. Random effect model (REM) estimate of prevalence among HIV-infected patients from the 33 studies was 15% (95% CI 13-17). The prevalence of HIV/HB co-infection among attendees of HIV clinics was 17% [95% CI 13-20], among pregnant HIV-infected patients were 10% [95% CI 6-15], 12% [95% CI 6-17] among HIV-infected children and among newly discovered HIV-infected voluntary blood donor (VBD) patients 10% [95% CI 6-15]. Meta- regression showed no significant associations between the mean age of the patients, the proportion of female patients, year of the study and prevalence of co-infection. The burden of HBV/HIV co-infection in Nigeria, based on the estimate, was 984 000 C.I. [852 800-1115 200]. Conclusion: In Nigeria, the estimated prevalence of HBV/HIV infection is 15% resulting in a substantial burden for the country.

Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria.

Background: Coma occurring in the course of an illness ordinarily implies a poor prognosis and early prognostication is important for treatment decisions. The study was undertaken to study the factors associated with mortality in nontraumatic coma in a tertiary institution. Materials and Methods: In this prospective observational study, adults with clinically confirmed coma Glasgow coma scale (GCS) score of ≤8, admitted consecutively to the emergency unit of a tertiary hospital in Northwestern Nigeria over a period of 18 months were recruited. Vital parameters, severity of coma by GCS and neurological signs were recorded. The etiology of coma was determined on the basis of history, clinical examination, and laboratory investigations. Outcome was determined within 1 month of onset of coma by patients’ death or survival. Results: A total of 194 patients (140 males and 54 females) were recruited with mean age was 53.7 ± 1.4. The predominant etiological factors were central nervous system (CNS) infections (28.9%), toxic and metabolic (28.9%), and stroke (23.7%). Overall, 1-month mortality was 49%. On univariate analysis, the factors that showed significant association with outcome were gender, blood pressure, GCS, breathing pattern, pupillary size, pupillary reaction, papiloedema, and abnormal posturing. Abnormal pupillary size, severe hypertension, and GCS score ≤5 were independent predictors of in-hospital 1-month mortality in nontraumatic coma. Conclusion: The independent important predictors of nontraumatic 1-month coma mortality in a developing country setting were GCS ≤ 5, abnormal pupillary size, and severe hypertension.

Performance of Community Screening Instrument for Dementia in Screening for HIV-Associated Neurocognitive Disorders in Nigeria

Background: Cognitive function of HIV-infected patients in Nigeria has been studied using the community screening instrument for dementia (CSI-D) battery. However, its ability to detect HIV-associated neurocognitive disorders (HAND) is unclear. The study assessed the CSI-D battery in detecting HAND. Methods: Age, sex and education matched 30 HIV-positive and 30 HIV-negative subjects were administered the CSI-D battery. An extensive multi-domain neuropsychological tests (MDNPT) battery was used as gold standard. Measures of functional status including personal assessment of own functioning inventory (PAOFI), instrumental activities of daily living (IADL) and Beck depression inventory (BDI) were also administered. Diagnostic accuracy indices of the CSI-D were determined from a receiver operator characteristic (ROC) curve. Linear associations were explored using correlation coefficient. Results: HIV-positive subjects performed significantly worse than HIV-negative subjects in several domains across the 2 batteries. Large effect sizes were found in verbal fluency (COWAT), verbal learning, memory recall and language comprehension. Significant correlations between the two batteries were seen in all the domains except motor function. Subjects with HAND but normal on CSI-D scored poorly on motor function test. The area under the ROC curve was 0.79; 95 % confidence interval (CI) of 0.68-0.90, p < 0.0001. At cut-off score of ≤ 63, the CSI-D had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 77%, 63%, 55% and 61% respectively. Conclusion: CSI-D has good psychometric properties for use as a screening tool for HAND. The addition of test of motor function is advisable to complement it.

Familial dextrocardia in a Nigerian family

Click on the link to view the Letter. Nigerian Medical Journal | Vol. 54 | Issue 4 | July-August | 2013

Pica in children with tetralogy of Fallot: Report of two cases

Cyanotic congenital heart disease is a high iron-requiring illness; therefore affected children may be prone to iron deficiency if not actively sorted and treated. Among problems associated with iron deficiency is pica; the consumption of non-food substances for non-nutritive purposes. Children with pica are at risk of other health hazards like lead toxicity, Intestinal obstruction and parasitic infections from the contaminated substances consumed; however, this is often a forgotten problem in children with cyanotic heart disease; therefore two cases of pica in children with tetralogy of Fallot are reported.

Rodenticide poisoning in an unusual setting and its management challenges in a resource.limited setting: Report of three cases

Organophosphate poisoning occurs worldwide. Both sexes are equally affected and accidental poisoning is commonest between the ages of 2 and 8 years. The use of organophosphate as homemade insecticide has exposed children to the risk of organophosphate toxicity; furthermore, poor regulation of these hazardous chemicals makes them easily accessible to individuals. The case of three siblings who ate fried fish poisoned with organophosphate meant to serve as bait for rodents in the farm is reported. Key words : Children, organophosphate, poison

Related Factors and Predictors of Cognitive Dysfunction in Chronic Kidney Disease on Maintenance Hemodialysis in Nigeria.

Background: Previous studies suggest a high frequency of cognitive impairment (CI) in persons with chronic kidney disease (CKD); however, factors associated with CI and predictors of CI in persons with CKD remain largely unclear. The aim of this study was to determine the factors associated with CI and predictors of CI in CKD patients on maintenance hemodialysis. Materials and Methods: The first stage of the study included recruitment of 100 apparently healthy participants aimed at determining the reference values. The second stage of the study included eighty CKD patients on maintenance hemodialysis. The iron psychology (FEPSY) was used to assess the memory, psychomotor speed, concentration, and attention using simple auditory reaction time (ART) and visual reaction time (VRT) tasks, recognition memory tests (RMT), finger tapping task (FTT), and binary choice task (BCT). Results: Using normative values generated in this study, 41 (51.3%) and 43 (53.8%) CKD patients had abnormal scores on ART dominant (D) and nondominant (ND) sides, respectively. Forty (50%) and 42 (52.5%) patients had abnormal scores on VRT D and ND sides, respectively. Twenty-one (26.3%) and 68 (85%) had abnormal scores on BCT and computer-assisted visual scanning task, respectively. Sixty-four (80%) and 65 (81.3%) had abnormal scores on RMT (words) and RMT, respectively. Fifty-two (65%) and 48 (60%) patients had abnormal scores on D and ND sides of (FTT), respectively. Factors associated with psychomotor speed impairment were duration of CKD from diagnosis (P = 0.0001 and 0.043 in D and ND ART, respectively), duration on dialysis (P = 0.0001 across board in D and ND ART as well as in D and ND VRT, respectively), and plasma urea (PU) and plasma creatinine (PCr) (P < 0.05). Factors found to be associated with memory impairment included age (P = 0.045 and 0.025 on words and figures RMT, respectively), PU (P = 0.002 and 0.005 on words and figures RMT, respectively), and PCr (P = 0.012 and 0.040 on words and figures RMT, respectively). Duration on dialysis (P = 0.032) and PCr (P = 0.001) were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD. Conclusion: Factors associated with psychomotor speed impairment were duration of CKD, duration on dialysis, and PU and PCr while age, PU, and PCr were associated with memory. Duration on dialysis and PCr were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD.

Cognitive function assessment in patients with end- stage renal disease in Nigeria: A single center experience

Aim: The purpose of this comparative study was to evaluate cognitive function in end-stage renal disease (ESRD) patients in comparison with age, sex, and level of education-matched control. Materials and Methods: This is a cross-sectional study involving 80 ESRD patients receiving maintenance hemodialysis treatment and recruited conservatively at the nephrology unit of our hospital. Eighty apparently healthy control, that were matched with the patients for age, sex and education, were also recruited. Following exclusion of depression and severe functional disability, a computer-assisted neuropsychological test, the FePsy, was used to assess memory, psychomotor speed, concentration and attention using simple auditory and visual reaction time tasks, recognition memory tests (RMTs), finger tapping task, and binary choice task (BCT) for both the ESRD patients and controls. Results: ESRD patients performed worse on simple auditory and visual reaction time tasks (P < 0.05), RMTs (P < 0.05), finger tapping task (P < 0.05), BCT, and computerized visual search task (P < 0.05). Conclusion: Performance in memory, psychomotor tasks, concentration, and attention tasks were found to be reduced among patients with ESRD compared with age, sex and level of education-matched control.