Mustapha Danesi

Prevalence of Stroke in an Urban, Mixed-Income Community in Lagos, Nigeria

Background: The burden of cerebrovascular disease in developing countries is projected to be on the rise. However, data on the current epidemiology of stroke in Africa are sparse. Methods: Using a 3-staged method, we conducted a door-to-door study of stroke in an urban, mixed-income community in Lagos, Nigeria. We used a modification of the WHO protocol in the first stage, a stroke-specific questionnaire in the second stage and neurological examination of all persons screening positive for stroke in the third stage. We also examined an equal number of stroke-negative persons. Results: Overall, the crude prevalence rate of stroke in urban Nigeria was 1.14/1,000 (males: 1.51; females: 0.69). The age-adjusted prevalence rates per 1,000 (adjusted to the USA population 2000) in mid-decade strata showed a trend of increasing prevalence with advancing age as follows: 35–44 years = 0.009, 45–54 years = 0.33, 55–64 years = 0.71, 65–74 years = 0.98, 75–84 years = 2.04 and >85 years = 0.74. Conclusions: Stroke prevalence rates in urban Nigeria are lower than those in most developed countries. The lower rates may be related to lower incidence and higher stroke mortality in developing countries.

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

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

Exploratory study of plasma total homocysteine and its relationship to short-term outcome in acute ischaemic stroke in Nigerians

BackgroundHyperhomocysteinemia is a potentially modifiable risk factor for stroke, and may have a negative impact on the course of ischaemic stroke. The role of hyperhomocysteinemia as it relates to stroke in Africans is still uncertain. The objective of this study was to determine the prevalence and short-term impact of hyperhomocysteinemia in Nigerians with acute ischaemic stroke. We hypothesized that Hcy levels are significantly higher than in normal controls, worsen stroke severity, and increase short-term case fatality rates following acute ischaemic stroke.MethodsThe study employed both a case-control and prospective follow-up design to study hospitalized adults with first – ever acute ischaemic stroke presenting within 48 hours of onset. Clinical histories, neurological evaluation (including National Institutes of Health Stroke Scale (NIHSS) scores on admission) were documented. Total plasma Hcy was determined on fasting samples drawn from controls and stroke cases (within 24 hours of hospitalization). Outcome at 4 weeks was assessed in stroke patients using the Glasgow Outcome Scale (GOS).ResultsWe evaluated 155 persons (69 acute ischaemic stroke and 86 healthy controls). The mean age ± SD of the cases was 58.8 ± 9.8 years, comparable to that of controls which was 58.3 ± 9.9 years (T = 0.32; P = 0.75). The mean duration of stroke (SD) prior to hospitalization was 43.5 ± 38.8 hours, and mean admission NIHSS score was 10.1 ± 7.7. Total fasting Hcy in stroke patients was 10.2 ± 4.6 umol/L and did not differ significantly from controls (10.1 ± 3.6 umol/L; P = 0.88). Hyperhomocysteinemia, defined by plasma Hcy levels > 90th percentile of controls (>14.2 umol/L in women and >14.6 umol/L in men), was present in 7 (10.1%) stroke cases and 11 (12.8%) controls (odds ratio 0.86, 95% confidence interval 0.31 – 2.39; P > 0.05). In multiple regression analysis admission NIHSS score (but not plasma Hcy) was a significant determinant of 4 week outcome measured by GOS score (P < 0.0001).ConclusionThis exploratory study found that homocysteine levels are not significantly elevated in Nigerians with acute ischaemic stroke, and admission Hcy level is not a determinant of short-term (4 week) stroke outcome.

Influence of Age and Neurotoxic HAART Use on Frequency of HIV Sensory Neuropathy

Background. Sensory neuropathy (SN) is one of the most common AIDS-associated neurologic disorders especially in the era of highly active antiretroviral therapy (HAART). The aim of this study was to determine the prevalence of SN among highly-active-antiretroviral-therapy- (HAART-) experienced and HAART-naïve HIV-positive individuals and to investigate the relationship to demographic, clinical, and laboratory factors. Methods. 323 patients with HIV infection (142 on HAART and 181 HAART naïve) were enrolled in a cross-sectional neuropathy screening program. Data was collected using structured questionnaires which contained the brief peripheral neuropathy screening tool of AIDS Clinical Trial Group protocol. Neuropathy was defined by the presence of at least 1 clinical sign in a distal, symmetrical pattern. Patients were classified as symptomatic if they described aching, stabbing, or burning pain, paresthesia, or numbness in a similar distribution. Demographic, clinical, and laboratory details were documented as risk factors. Result. The prevalence of sensory neuropathy was 39.0% (126/323), (of which 29/126 (23%)) were symptomatic. Amongst those on HAART, 60/142 (42.3%) had SN compared to 66/181 (36.5%) HAART-naïve individuals (P = 0.29). On multivariate analyses, the independent associations with SN were increasing age (P = 0.03) and current exposure to stavudine (P = 0.00). Gender (P = 0.99) height (P = 0.07) use of HAART (P = 0.50), duration of HAART treatment (P = 0.10), and lower CD4 count (P = 0.12) were not associated with an increased SN risk. Conclusion. HIV SN remains common despite improved immunologic function associated with HAART and decreased neurotoxic HAART use. In this cross-sectional analysis, age and stavudine-based therapies were the independent risk factors.

Frequency of cognitive impairment and depression in Parkinson's disease: A preliminary case-control study

Background: This study aimed to determine the frequency of cognitive impairment and depression in our Parkinsons Disease (PD) and their relationship with disease severity and disability. Patients and Methods: A total of 40 PD patients and 40 age-, sex-, and educationally matched controls were studied. The Unified Parkinson Disease Rating Scale (UPDRS) Motor and Activities of Daily Living (ADL) scores and the Hoehn and Yahr (HY) stage were documented. Depression was assessed using the Zung Self-Rating Depression Scale (ZSDS), while cognition was evaluated using a composite score of the mini-mental state examination (MMSE) score and category fluency score. Results: A total of 55% (22/40) of PD and 10% (4 of 40) of controls had depression (P<0.001). A total of 60% of PD (24/40) and 5% of controls (2/40) had cognitive impairment (P<0.001). Both NMS coexisted in 16 of 40 PD (40%) compared with none of the controls (P<0.001). UPDRS (motor and ADL) scores and HY stage were significantly worse with impaired ZSDS scores - P 0.001. UPDRS ADL was significantly impaired by the presence of cognitive impairment. Coexisting depression and cognitive impairment were associated with significant worsening of all scores of severity and disability. Conclusion: Cognitive impairment and depression accompany our PD and are related to disability and worsening disease severity.

Comparison of supine and sitting positions cervical traction on cardiovascular parameters, pain and neck mobility in patients with cervical spondylosis

Chih-Chien Hu is specialized in joint reconstruction and serves as lecturer of the institute. He finished his clinical fellowship training in Chang Gung Memorial Hospital and Dorr Institute. He has published several peer-reviewed articles in the field of joint reconstruction including Journal of Arthroplasty. Large-diameter head metal-on-metal total hip arthroplasty using a modified Watson-Jones approach and novel reduction techniqueNaomi Schlesinger is the Chief of the Division of Rheumatology and Rheumatology fellowship program director at UMDNJ/Robert Wood Johnson Medical School in New Brunswick, NJ, where she is Professor of Medicine in the Department of Medicine. She is a noted authority in the field of gout, having published papers regarding the diagnosis, treatment, and better understanding of the pathogenesis of gout. She is the author of over 190 scientific articles, abstracts, book chapters and reviews. She is currently the President of the New Jersey Rheumatology Association. In addition she is the Co-chair, American College of Rheumatology Crystal Study Groupas well as the Co-chair, American College of Rheumatology Abstract Reviewer Selection Process: Metabolic and Crystal Arthropathies. She has a special interest in evidence-based medicine and serves as a co-facilitator of the Acute Gout Review Group for Cochrane International Collaboration as well as a member of the OMERACT Gout Special Interest Organizing Group. Crystal: Diagnosis and management of goutObjective: This study investigated the cardiovascular responses and side effects during cervical traction (CT) in sitting and supine positions; and also to compare the effects of both positions on pain and neck mobility in patients with cervical spondylosis. Methods: One hundred (100) patients were assigned into two groups (A and B) with 50 patients in each group. Group A patients were treated with CT in supine position, Transcutaneuos Electric Nerve Stimulation (TENS), massage and exercise, so also were patients in Group B, but the CT was applied in sitting position. Cardiovascular parameters, PR interval and QRS complex were assessed and analysed during CT for 15 minutes. Pain intensity and neck mobility were also assessed and analysed for 4 weeks. Analysis of variance (ANOVA) and post-hoc test were used to determine significant difference in the cardiovascular and ECG parameters. Man Whitney U test was used to compare mean pain intensity between the two groups, while Wilcoxon signed ranks test was used to compare mean pain intensity within the same group. Also t-test was used to analyse significant difference for cervical mobility. The level of significance was put at P 0.05). Twenty four (9 and 15 in supine and sitting positions CT respectively) patients experienced different side effects during CT application, with the neck muscle tenderness the mostly occurred in the two groups. Also, the study reveals the effectiveness of the two traction positions in terms of pain relief and enhance neck mobility in the subjects studied. But the supine CT position recorded a higher mean difference. Conclusion: Findings from the study supports the use of either the supine and sitting positions CT in the management of patients with cervical spondylosis, but the supine position proved to be a better option.Purpose: Coxitis knee is a condition defined as secondary osteoarthritis of the knee joint due to contralateral or ipsilateral hip disorder. Total knee arthroplasty (TKA) has become a successful operation for relief of pain and improvement of function in patients with osteoarthritis of the knee. In this study, we investigated the usefulness of TKA for coxitis knee and the early outcomes of patients undergoing this procedure. Materials and Methods: Five knees with coxitis were treated using primary TKA. The average patient age was 73.0 years. One patient had fusion of the contralateral hip joint due to tuberculous arthritis, three patients had functional leg length discrepancy due to severe osteoarthritis of the contralateral hip joint, and one patient is after total hip arthroplasty of the contralateral hip joint. The surgery was indicated because of advanced symptomatic osteoarthritis of the knee. Results: Before surgery, the averaged femoro-tibial angle (FTA) was 167.8°, and after surgery this was improved to 173.2°. A constrained TKA implant was needed in two knees due to severe valgus deformity and insufficiency of the collateral ligaments. Functional leg length discrepancy was not improved by TKA, and the two affected patients required corrective shoes. None of the patients had serious complications during the postoperative period, and all became able to walk with cane. No radiolucent line or instability of the knee joint was seen in any of the patients. Conclusion: TKA is a safe and reliable procedure for pain relief and functional improvement in patients with coxitis knee. However, functional leg length discrepancy is not improved by TKA. Further long-term observation for recurrence of knee joint deformity or instability will be required.Patient specific induced pluripotent stem (IPS) cells are powerful tool for autologous cell therapy and tissue engineering. IPS cells can be generated from different tissue sources, including skin, muscle and fat. IPS cells generated from patients with genetic disorders capture the disease genotype in the cell, making them a good model for studying the pathology of the disease. In addition, provides suitable in vitro model for testing different therapeutic approaches like drug and gene therapies. FSHD is one of the most common inherited myopathies, caused by a contraction within a subtelomeric array of D4Z4 repeats 4q35.2. It is characterized by atrophy of facial, shoulder and upper arm muscles. Within each D4Z4 repeat is embedded a double homeobox gene (DUX4, double homeobox, chromosome 4). DUX4 is specifically detected in biopsy sample from FSHD patients. Furthermore, it was shown to be expressed in FSHD cultured myoblasts, but not in the cells from healthy donors. We showed that DUX4 expressed in high levels induced rapid cell death and in the low levels interfere with cell cycle. Furthermore missregulates myogenesis by blocking terminal differentiation of myotubes. We generated IPS from myoblasts from seven FSHD patients and controls using four reprogramming factors, Sox2, Klf4, Oct4 and c-Myc. Generated IPS line were characterized by expression of pluripotent markers and formation of teratomas. To have adequate cells for study the mechanism of FSHD and tissue engendering, we corrected the affected locus by removing 4qA161 allele. We targeted FSHD-iPS cells using zinc finger nucleases and linear targeting vector bearing a single homology arm, neo cassette and human artificial telomeric repeat. Expression analyses using RTPCR revealed that selected neo resistant IPS clones did not transcript DUX4 as original FSHD-IPS cells. To derivate myoblast from IPS cells we had to recapitulate myogenesis during embryogenesis. Firstly, we generated mesenchymal cells using EB culturing system and cocktail of mesoderm specific growth factors. Mesenchymal stem cells (named IPS-MSC) were characterized by surface markers CD73 and CD105, and ability for adipogenic and osteogenic differentiation. Myoblasts were generated from IPS-MSC by transduction with Myf5. Stably transfected cells in proliferation medium were able to expand more than 20 passages. They had typical myoblast surface marker and gene expression profile. Under specific conditions myoblast generated from IPS cells were able to fuse in terminally differentiated myotubes.R arthritis is a systemic auto-immune disease. Symmetrical inflammatory polyarthritis is the primary clinical manifestation. The arthritis usually begins in the small joints of the hands and the feet, spreading later to the larger joints. The inflamed joint lining or synovium extends and then erodes the articular cartilage and bone, causing joint deformity and progressive physical disability. RA is a disease where joints are commonly involved. The hands and wrists are affected in approximately 90% of RA patients, and these joints may show unique changes over time. Early in RA, joint tenderness and subtle swelling are observed, but after months to years the synovitis becomes proliferative and destructive. The tissue within the joint becomes boggy to the touch then typical joint deformities appear. Physiotherapy is can be used in the treatment of RA. These include: 1. Cold/hot applications 2. Electrical stimulation 3. Rest and splinting 4. Massage therapy 5. Therapeutic exercise. Cold/Hot application is well known that cold application is mostly used in acute stages whereas hot is used in chronic stages of RA. By using heat, analgesia is accomplished, muscle spasm relieved. Transcutaneous electrical nerve stimulation (TENS) is a widely used form of electro analgesia. TENS is thought to produce analgesia according to the gate control theory. The electrical stimuli delivered by TENS units can be varied to suit patient tolerance, as well as to produce the best efficacy. Massage Therapy is a commonly used treatment tool that improves flexibility, enhances a feeling of connection with other treatment modalities, improves general well being, and can help to diminish swelling of inflamed joints. Rest and Splinting treatment the joints should be put into rest during the acute stage of the disease. Bed rest relieves the pain in cases of extensive joint involvement. It is critical, at this stage, to put the joints into rest at a functional position. Orthosis and splinting are used to diminish pain and inflammation, to prevent development of deformities. Mitesh Patel, Orthop Muscul Syst 2013, 2:2 http://dx.doi.org/10.4172/2161-0533.S1.012