U. E. Williams

The Role of Radiotherapy and Chemotherapy in the Treatment of Primary Adult High Grade Gliomas: Assessment of Patients for These Treatment Approaches and the Common Immediate Side Effects

Gliomas are the commonest primary brain tumours in adults. They are usually classified and graded according to the criteria by the World Health Organisation. High-grade gliomas are the most malignant primary brain tumours. Conventional therapies include surgery, radiotherapy, and chemotherapy. The tumours often demonstrate high levels of resistance to these conventional therapies, and in spite of treatment advances the prognosis remains poor.

Factors associated with prehospital delay among stroke patients in a developing African country.

In Nigeria, stroke has remained the most frequent cause of neurological admissions (1) and a significant cause of mortality. Successful acute stroke treatment and improved outcomes critically depend on early hospital presentation. Several studies in developed countries have evaluated the factors causing prehospital delays (2). In this study we investigated delays in presentation of stroke patients and explored factors associated with such delays in a tertiary health center of Nigeria. To this end, we designed a prospective study of consecutive stroke admissions at the Emergency Department of the University of Calabar Teaching Hospital, Nigeria, over a six-month period (August 2012– January 2013). The time of stroke onset was defined as the time when the first symptom was noticed by the patient or a carer. Delay was defined as greater than three-hours from time of symptoms onset to presentation. Univariable and multivariable logistic regression analyses were used to explore factors associated with prehospital delay. Eighty-one consecutive patients (47 males, 58%; mean age, SD: 57·6 ± 12·1 years) were recruited.Only 17 (21%) of the patients arrived at the hospital within three-hours of stroke onset, while 53 (65·4%) patients arrived >24 h after symptom onset. None of the patients were brought by ambulance service. More than half of the patients (55·6%) had no knowledge of stroke symptoms. In univariable analysis lack of awareness of symptoms of stroke and referral from other facilities were associated with late presentation (Table 1). In multivariable logistic regression, only lack of awareness of the symptoms of stroke was associated with delayed presentation (OR: 7·43; 95% CI: 1·47– 37·4; P = 0·015) (Table 1). Our study in a developing country reports considerable prehospital delays in patients with acute stroke symptoms presenting at the emergency department, in line with other recent studies in developing and emerging economies (3–5). Our data highlight the need for educational programs in order to increase awareness of stroke in Nigeria, including stroke symptoms/warning signs and the limited time window for effective interventions.

Multidisciplinary Interventions in Motor Neuron Disease

Motor neuron disease is a neurodegenerative disease characterized by loss of upper motor neuron in the motor cortex and lower motor neurons in the brain stem and spinal cord. Death occurs 2–4 years after the onset of the disease. A complex interplay of cellular processes such as mitochondrial dysfunction, oxidative stress, excitotoxicity, and impaired axonal transport are proposed pathogenetic processes underlying neuronal cell loss. Currently evidence exists for the use of riluzole as a disease modifying drug; multidisciplinary team care approach to patient management; noninvasive ventilation for respiratory management; botulinum toxin B for sialorrhoea treatment; palliative care throughout the course of the disease; and Modafinil use for fatigue treatment. Further research is needed in management of dysphagia, bronchial secretion, pseudobulbar affect, spasticity, cramps, insomnia, cognitive impairment, and communication in motor neuron disease.

Disease Modifying Therapy in Multiple Sclerosis

Multiple sclerosis is an autoimmune disease of the central nervous system characterized by inflammatory demyelination and axonal degeneration. It is the commonest cause of permanent disability in young adults. Environmental and genetic factors have been suggested in its etiology. Currently available disease modifying drugs are only effective in controlling inflammation but not prevention of neurodegeneration or accumulation of disability. Search for an effective neuroprotective therapy is at the forefront of multiple sclerosis research.

Neuropsychiatric Impairment among Patients with Sickle Cell Anemia

Sickle cell anemia (SCA) is an inherited disorder of hemoglobin. Each year over 150,000 children in Africa are born with SCA. Cognitive impairment is a common complication of SCA. This case-control study evaluated cognitive function in 41 adolescents and adults with SCA and an equal number of healthy demographically matched controls using the community screening interview for dementia (CSID), Trail Making Test A (TMTA), Saint Louis University Mental Status examination (SLUMS), and Mini Mental State Examination (MMSE). Mood (anxiety and depression) was assessed using the Hospital Anxiety and Depression Scale (HADS). The controls had better total scores on all screening instruments; however, the difference between their performance and that of the SCA adults was not statistically significant; SLUM (p = 0.179), TMTA (p = 0.359), MMSE (p = 0.241), and CSID (0.494). On specific task, the controls performed significantly better based on SLUM (naming), p = 0.016; SLUM (repetition), p = 0.015; SLUM (recall), p = 0.003; and CSID (language expression), p = 0.001. The systolic blood pressure (SPB) was inversely correlated with the MMSE scores (p = 0.009). In addition, there was direct linear correlation between the creatinine levels and the MMSE scores (p = 0.009). The proportion of SCA patients compared with the controls that had abnormal mood were anxiety (7.3% vs. 4.9%), borderlinenanxiety (17.1% vs. 4.9%), depression (2.4% vs. 2.4%), and borderline depression (14.6% vs. 2.4%). SCA was associated with an increased prevalence of cognitive impairment in adults when compared to controls. SCA is associated with a higher proportion of mood abnormalities.

Predictors of Sleep Disorders among HIV Out-Patients in a Tertiary Hospital

Human immunodeficiency virus infected individuals have been shown to have a high prevalence of sleep disturbances. Both the effects of the virus and the antiretroviral drugs may cause sleep disturbances. We sought to determine the prevalence and predictors of sleep disorders amongst HIV seropositive adult subjects presenting at an outpatient hospital setting. One hundred and fifty six subjects were recruited for the study using a sleep disorder screening questionnaire. The mean ages of the participants were 38.7±9.23 and 39.5±9.23 for those with and those without sleep disorder respectively. The prevalence rate of sleep disorders was 46.2%. Elevated systolic blood pressure, lower CD4 count levels and being on the HAART combination TDF/3TC/ATZ/lpvr were associated with sleep disorders. The high prevalence rate observed necessitates routine screening for sleep disorders among HIV/AIDs patients.

Predictors of Cognitive Dysfunction among Patients with Moderate to Severe Chronic Kidney Disease

Cognitive dysfunction including dementia is a common complication of chronic kidney disease (CKD) that has just been recently appreciated. It has negative outcomes in the management of patients with CKD. This study explored the possible biochemical and clinical features of patients with CKD that can predict the occurrence of cognitive impairment in patients with moderate to severe CKD. We evaluate patients with stages 3-5 CKD for the occurrence and predictors of cognitive impairment. Multiple areas of cognitive function were tested in this single-center study using Community Screening Interview for Dementia (CSID) and Trial-Making Test A (TMTA)/Trial-Making Test B (TMTB). Cognitive impairmentnwas correlated with patients’ routine biochemical, hematological, and selected clinical parameters. We observed a negative correlation between cognitive impairment and patient’s serum calcium (r 5 0.240; p 5 0.033) and estimated Glomerular filtration rate (eGFR) (r 5 0.379; p 5 0.0006). Therefore, eGFR is an accurate predictor of cognitive dysfunction in patients with moderate to severe CKD. Early evaluation ofncognitive function in CKD is indeed advised for optimal outcome in the management of patients with CKD.

Prevalence and Pattern of Neurocognitive Impairment in Nigerians with Stages 3 to 5 Chronic Kidney Disease

Background. Cognitive impairment with its negative effect on quality of life has been reported in chronic kidney disease (CKD). The paucity of the literature on cognitive impairment in Africans with CKD prompted this study. Objectives. To determine the frequency and pattern of cognitive impairment in patients with stages 3 to 5 CKD. Methods. We studied 79 consecutive consenting adults with a National Kidney Foundation (NKF) stage 3 to 5 CKD based on their estimated glomerular filtration rate using the Cockcroft-Gault formula. The controls consisted of healthy demographically matched subjects. Community screening instrument for dementia (CSID), trail making test A (TMTA), and trail making test B (TMTB) were used for cognitive assessment. Results. More CKD patients had cognitive impairment compared with controls using CSID (51.9% versus 2.5%, P < 0.001); TMTA (53.2% versus 0%, P < 0.001); and TMTB (40% versus 0%, P < 0.001). The odds of having cognitive impairment increased in the presence of CKD when assessed using CSID (ORu2009=u20092.026; CIu2009=u20091.607–2.555); TMTA (ORu2009=u20093.13; CIu2009=u20092.40–4.09) and TMTB (ORu2009=u20093.22; CIu2009=u20092.42–4.25). CKD patients performed poorer on tests of executive function TMTA (P < 0.001) and TMTB (P < 0.001) while CSID showed significantly lower scores on multiple cognitive domains. Conclusions. Significant cognitive impairment in multiple domains exists among Nigerians with CKD.