The enigma of neuroinflammation

Prakash N Tandon

Neurology India 2017 65(4):703-705



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Lumbar extradural arteriovenous malformation mimicking a schwannoma in a child: Rare presentation of neurofibromatosis type-1

Gandham E Jonathan, Bijesh R Nair, Vivek Joseph, Sunithi Mani, Geeta Chacko

Neurology India 2017 65(4):900-902



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Inflammation and aneurysms

Sudheer Ambekar

Neurology India 2017 65(4):706-707



http://ift.tt/2tKMK9v

Atypical pantothenate kinase-associated neurodegeneration with novel genetic mutation

Anil V Israni, Anirban Mandal

Neurology India 2017 65(4):914-915



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Alarm criteria for motor evoked potentials

Parthasarathy D Thirumala, Jessie Huang, Indraneel S Brahme, Karthy Thiagarajan, Hannah Cheng, Donald J Crammond, Jeffrey Balzer

Neurology India 2017 65(4):708-715

Objective: To evaluate three commonly used alarm criteria for interpreting the significance and diagnostic value of transcranial motor evoked potential (TcMEP) changes during spinal surgery. Materials and Methods: A systematic literature search was performed using PubMed/MEDLINE, Web of Science, and EMBASE from 1945 to January 2014. We included all those studies that were (1) randomized controlled trials, prospective studies, or retrospective cohort studies, (2) conducted among patients undergoing surgery on the spine or spinal cord with TcMEP monitoring, (3) conducted in a group of ≥50 patients, (4) that were inclusive of immediate postoperative neurological assessment (within 24 h), and (5) which were published in English. Results: Twenty-five studies involving 9409 patients were included. The incidence of neurological deficits was 1.82%. The overall sensitivity and specificity of all reported TcMEP changes was 82.1% (95% confidence interval [CI]: 73–88.6%) and 95.7% (95% CI: 93.7–97.1%), respectively. The sensitivity and specificity of each alarm criteria were evaluated: 50% reduction in amplitude, sensitivity 63.2% (95% CI: 47–76.8%), and specificity 96.7% (95% CI: 96.4–99.2%); 80% reduction in amplitude, sensitivity 71.7% (95% CI; 42–89.9%), and specificity 98.3% (95% CI: 96.4–99.2%); total signal loss, sensitivity 30% (95% CI: 17.6–46.4%), and specificity 99.3% (95% CI: 98.6–99.7%). Conclusions: No statistically significant differences between using reductions in amplitude of 50% and 80% as alarm criteria were found in terms of sensitivity and specificity. Total loss was found to have a statistically significant increase in specificity. TcMEP monitoring is a highly specific and sensitive diagnostic tool for the detection of neurological defects during spinal surgery.

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Author's Reply: Myotonic dystrophy: The occurrence of early-onset cataract

Constantinos Papadopoulos, Grigoris Panagopoulos, Kyriaki Kekou, Vassilios Fardis, Sofia Kitsiou-Tzeli, George K Papadimas

Neurology India 2017 65(4):923-923



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Motor evoked potential alarm criteria: Not yet at the finish line

Vedantam Rajshekhar, Srinivasa Babu

Neurology India 2017 65(4):716-717



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The cover page

Neurology India 2017 65(4):693-693



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Molecular mechanisms of the intracranial aneurysms and their association with the long noncoding ribonucleic acid ANRIL – A review of literature

Jiang Che

Neurology India 2017 65(4):718-728

Long noncoding ribonucleic acids (RNAs) are important regulators of gene expression. Antisense noncoding RNA in the INK4 locus (ANRIL), which was coded on the Chr9p21.3 loci, participates in the pathogenesis of tumor, coronary artery disease, type 2 diabetes mellitus, and other diseases. A genome-wide association study indicated ANRIL to be a candidate gene that may lead to the development of an intracranial aneurysm (IA) formation. However, the detailed molecular mechanisms are unknown and have not been studied. Through reviewing the molecular mechanisms responsible for the development of IA and the regulation pathway of ANRIL, this paper presents four possible molecular mechanisms that may be responsible for the influence of ANRIL on the development of IAs, that is, cell cycling, Krüppel-like factor 2 (KLF2), caspase recruitment domain family member 8, and retinoid metabolism. ANRIL may become a molecular marker or therapeutic target of IA in the future. To the best of our knowledge, this is the first paper elucidating the molecular linkage between ANRIL and IAs.

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Reversed Robin Hood syndrome treated with verapamil

Karim M Mahawish

Neurology India 2017 65(4):880-882



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Arthroscopic outside-in meniscal repair: A short-term clinical experience

Ranti O Babalola, Emmanuel A Laiyemo, Shopekhai E Itakpe, Christian Madubueze, Olaoluwa M Shodipo

African Journal of Medical and Health Sciences 2017 16(1):1-5

Objective: Meniscal injuries are very common knee injuries that are presented to an orthopaedic surgeon. The goal of our study was to assess the early outcome of outside-in meniscal repair in the management of meniscal tears. Patients and Methods: This study was a prospective case series conducted at the National Orthopaedic Hospital, Lagos. Consecutive cases of patients with meniscal tears who met the inclusion criteria were recruited. Anterior cruciate ligament reconstruction was performed with semitendinosus autograft. Meniscal repair was performed arthroscopically by only two surgeons using the outside-in technique with size 2 polydioxanone suture. The Western Ontario and McMaster University Evaluation Tool (WOMET) score was computed during the pre-operative stage and at least 6-months post-operatively as outcome measure. The visual analogue scale (VAS) and WOMET scores in the pre- and post-operative periods were noted. Results: Five patients with injured menisci underwent meniscal repair. The median duration of follow-up was 14 months (range 8–30 months). Using Barret's criteria, we determined that a clinically healed meniscus was obtained in only 2 (40%) patients. The WOMET score improved from a mean of 46 (±18) to 20 (±10.7) between the pre- and post-operative stages, and the mean VAS score decreased from 4.6 (±0.5) to 2.5 (±1.3). Discussion: The poor health-seeking behaviour in our environment would explain the delayed presentations of our patients. However, it has been established that chronic tears do heal. Outside-in technique remains at the moment our method of choice for meniscal repair because of the challenges we face for equipment and funding of health care in our environment. Trephination of the meniscus was performed to improve the chances of healing. Using Barret's criteria, we had a healing rate of 40% (2). Conclusions: The outside-in technique remains an option for the treatment of chronic tears with good clinical improvement in the short term.

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Qualitative study on determinants of HIV risk behaviors among Nigerian seafarers

Ibitein N Okeafor, Chukwuma U Okeafor

African Journal of Medical and Health Sciences 2017 16(1):6-11

Background: Seafarers constitute a highly mobile population who are vulnerable to acquiring and transmitting human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) due to their engagement in HIV risk behaviors. Hence, this study aimed to identify the determinants of HIV risk behaviors among seafarers. Materials and Methods: The study was conducted among Nigerian seafarers in Port Harcourt Seaport, Rivers State Nigeria. A qualitative study was employed using a total of four focus group discussions (FGDs) and comprised of three male groups and one female group. Snow-ball method of sampling was used to recruit participants. Data were collected using a FGD guide. Thematic analysis was performed using QSR NVivo version 10 software (QSR International Pty Ltd., Melbourne, Australia). Data were presented as quotes and charts. Results: The study had a total of 28 participants and comprised of 24 males and four females. The mean age of all participants was 39.3 ± 7.8 years. The participants were knowledgeable on HIV/AIDS risk behaviors. The major determinants of these behaviors as revealed by the participants were lack of self-discipline and not being God-fearing (individual-level factors). Other determinants were long duration (more than 6 months) on sea and not traveling with spouse during sea voyage (seafaring-related factors). The determinants on environment of the port and government-related factors included the presence of brothels in port areas and the absence of sensitization visits, respectively. Conclusion: The study noted varying determinants of HIV risk behaviors from individual level to the government level. The authors advocate the need for peer education among seafarers as well as the implementation of HIV enlightenment programs to discourage HIV risk behaviors.

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A case report of complete tibia diaphysis extrusion in chronic osteomyelitis

Thaddeus C Agu

African Journal of Medical and Health Sciences 2017 16(1):68-71

Late presentation to hospital is still a common occurrence in Nigeria. Chronic osteomyelitis of the tibia is not an uncommon infective condition in a 4-year-old boy, but delaying the search for hospital treatment until a full length of the diaphysis is extruded is uncommon. He complained of pain and fever and was noticed by the mother to be listless and was no longer playful. Over several months, his condition seemed to be improving, but a large bone was sticking out of a sinus. It was at this advanced stage that the patient was brought to our level II surgical facility. The entire tibia diaphysis was removed as a sequestrum, and the boy was ambulant again after 11 weeks. The aim of this report is to highlight this unusual condition and the need for continued health education as well as for the clinician not to despair in the management of similar neglected cases in a resource-poor setting.

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Glaucoma medication adherence in an adult population in Nigeria

Jennifer A Ebeigbe

African Journal of Medical and Health Sciences 2017 16(1):12-18

Introduction: Glaucoma is a common and potentially blinding condition, which can be managed with the use of appropriate medication therapy. For the medication to be effective, there has to be strict adherence to drug regimen. However, this is not usually the case for many glaucoma patients. The aim of this study was to identify the barriers and facilitators related to glaucoma medication adherence among an adult population. Materials and Methods: Forty-nine participants who had been diagnosed with glaucoma and had been on glaucoma medications for at least a year were recruited and interviewed. They were aged between 18 and 70 years with a mean age of 54 years. The one-on-one in-depth interviews were recorded using an audio recorder. Data obtained were transcribed and analysed using rank ordering to determine the degree of importance. Results: Results identified eight barriers to drug adherence among which were finance/cost of medication (195), forgetfulness (160) and side effects of drops (155). Other barriers were difficulty with drop administration (143), busy schedule (130) and non-availability of eye drops (122) among others. Facilitators identified included fear of blindness (185), desire for improved vision (152) and knowledge about the disease (112). Other facilitators were convenience of eye drop schedule (99), availability of drops (91) and use of alarms (89) among others. Conclusion: Understanding these factors would help eye care practitioners to advice their patients better and greatly slow down the progression of the disease.

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Determinants of occupational health and safety: Knowledge, attitude, and safety practices toward occupational hazards of sawmill workers in Egor Local Government Area, Edo State

Amenze O Onowhakpor, Gabriel O Abusu, Bunmi Adebayo, Hendrith A Esene, Obehi H Okojie

African Journal of Medical and Health Sciences 2017 16(1):58-64

Background: Sawmilling operations involve a lot of manual handling which exposes the workers to numerous occupational health hazards, which can impact on their occupational health and safety. The knowledge, attitude and safety practices of sawmill workers are paramount for the mitigation and control of these hazards to ensure optimal health and safety. Objectives: This study assessed the knowledge, attitude and safety practices of sawmill workers towards occupational health hazards in Egor Local Government Area, Edo State. Materials and methods: A descriptive cross sectional study was carried out amongst 178 sawmills workers selected using stratified sampling technique. Structured interviewer's administered questionnaires were used for data collection. Data was analysed with statistical package for scientific solutions version 21.0 software. Univariate and bivariate analysis were done and level of significance was set at P<0.05. Results: The mean age (standard deviation) of respondents was 34.69±9.91. One hundred and seventy five (98.3%) of the respondents were males. A majority 165 (92.7%) of the respondents were aware of dust and noise 160 (89.9%), as occupational hazards in sawmill. One hundred and forty eight (83.1%) of the respondents had positive attitude towards occupational health hazards in sawmill while almost three fifth 103 (57.9%) of the respondent had poor work safety practices. Conclusion: Majority of the sawmill workers had fair knowledge of occupational hazards and positive attitudes towards occupational hazards. However, poor safety practices were evident. There is need to improve the knowledge of sawmill workers in relation to occupational hazards and safety practices so as to mitigate its negative consequences.

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A 4-year retrospective review of stillbirths at the Federal Teaching Hospital, Abakaliki, Southeast Nigeria

Anthony T Agbata, Justus N Eze, Chukwuemeka I Ukaegbe, Bartholomew N Odio

African Journal of Medical and Health Sciences 2017 16(1):19-24

Objective: Stillbirth is one of the most common adverse outcomes of pregnancy, yet among the least studied. The objective of this study was to estimate stillbirth rate and describe maternal and obstetric characteristics of stillbirths at the Federal Teaching Hospital, Abakaliki (FETHA), Ebonyi State, southeast Nigeria. Material and Methods: This was a 4-year review of stillbirths at the FETHA, from January 2012 to December 2015. All stillbirth folders were retrieved and relevant information entered in a proforma designed for the study. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 24.0 (IBM Corp., Armonk, NY). Stillbirth rate was calculated as a proportion of total births. Results were presented as mean ± standard deviation, rates, and percentages/proportions. Results: A stillbirth rate of 41.4 was calculated for this study. The mean age for stillbirth was 28.8 years ± 5.4 (range 17–45 years). The median parity was 3, with a range of 0 to 13. About 68.8% or 276/401 of the women were unbooked. Among women who had stillbirths, only about 14% had tertiary education. Women of low social class constituted the greatest percentage (73.5%) who experienced stillbirth. The proportion of male stillbirths was higher than female stillbirth (54.1% or 216/392). About 58.4% or (230/394) of the stillbirths turned out to be macerated. In about 22.4% of cases, the immediate complication leading to stillbirth was not indicated. None of the stillbirths had autopsy performed. Conclusion: The stillbirth rate of 41.4 per 1000 observed at the study center was high. This reflects the overall picture in developing countries. A major finding from the study is the absence of postmortem examination to determine cause of stillbirth. This may be a major challenge in the effort to reduce stillbirth rate in resource-poor setting like ours.

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Musculoskeletal hydatid masquerading as malignancy: A diagnostic dilemma

Mir Abdul Wahid, Sheikh Zahoor Ahmed, Haji Altaf Gowher, Azhar Jan Butoo, Syed Arshad Ahmed, Mushood Ghulam Nabi

African Journal of Medical and Health Sciences 2017 16(1):75-77

Hydatid cyst in the iliac bone is rare and is usually an incidental finding at any site other than liver and lung. It is a zoonotic disease which is due to infection with larval stage of Echinococcus granulosus. The disease is chronic, and cysts can be lodged in different organs. It has cosmopolitan distribution and impacts on health and economic indices in many countries throughout the world. Therefore, accurate information on the distribution of the disease is first step for the control and prevention. We present an unusual case of hydatid cyst found in the right iliac bone extending into the gluteal region.

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Neural tube defects and maternal characteristics in a North Indian Province

Yogender S Kadian, Roopa Malik, Nirmala Duhan, Kamal N Rattan

African Journal of Medical and Health Sciences 2017 16(1):25-29

Background: Neural tube defects (NTD) affect fewer than 2 per 1000 pregnancies, account for a major burden on healthcare globally and have wide geographic prevalence. The present study was carried out with the aim to evaluate the maternal characteristics in cases of babies born with various neural tube defects in a tertiary care centre in Northern India. Methods: This retrospective analytical study was carried out by accessing and analyzing the medical case records of women who delivered babies with neural tube defects between January 2005 to December 2008 in the Department of Obstetrics and Gynaecology at Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India. Results: Sixty seven babies had neural tube defects thus accounting for a NTD prevalence of 2.62/1000 births. Among these, there were 48 cases of anencephaly, 15 cases of meningocele and/or meningomyelocele, 4 cases of spina bifida occulta. Anencephaly was most prevalent in primiparous women of low literacy aged between 21–25 years. Similar trends were visible in meningomyelocele and spina bifida groups. Most women in the study were homemakers with almost equitable distribution in rural and urban areas. No preponderance of any particular blood group was evident for any of the neural tube defects. Conclusion: Neural tube defects affect a substantial number of newborns in India. Lower age and parity, low literary and rural residence are some of the maternal factors associated with increased risk of these disorders. Preventive strategies like periconceptional folic acid supplementation and health education may help reduce the incidence of these conditions even in low resource settings.

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Computed tomography findings in pediatric traumatic head injury in Abuja, Nigeria

Ukamaka D Itanyi, Hadijat O Kolade-Yunusa

African Journal of Medical and Health Sciences 2017 16(1):52-57

Background: Pediatric traumatic brain injury (TBI) remains one of the leading causes of acquired disability and death in children. The morbidity and mortality associated with significant intracranial injury may be ameliorated by early diagnosis and treatment. Cranial computed tomography (CT) is a reliable imaging method for identification of intracranial lesions in patients with head trauma. Aim: To document the radiologic features of cranial CT in pediatric head trauma patients in a Tertiary Hospital in Abuja, Nigeria. Method: This was a retrospective, cross-sectional study of cranial CT findings in 104 pediatric head trauma patients visiting a tertiary referral hospital in Abuja Nigeria from January 2014 to January 2017. Numerical and graphical descriptors were used to summarize the data. In all statistical tests, significance level was set at an alpha level of 0.05. Result: Ages of studied patients ranged from 3 months to 18 years with mean age of 9.7 (SD 5.4) years with males dominating (66.35%). Road traffic accident, RTA occurred in 82 (79.6%) as the commonest etiologic factor across all age groups with slight dominance in children older than 16 years. Radiologic abnormalities were seen in 89 (85.6%), especially in males. Fractures coexisting with intracranial lesions were the most prevalent findings occurring in 43 (41.3%) patients. Hemorrhagic contusion was the commonest intracranial pathology. Diffuse brain lesions were seen exclusively in patients with clinically severe brain injury. Conclusion: RTA is the commonest etiology of pediatric TBI in our environment with combined fractures and coexisting intracranial hemorrhages as the prevalent finding.

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Chronic kidney disease risk factors in workers of an agricultural research institute in Southern Nigeria

Enajite I Okaka, Bibiana O Eiya, Afeaje B Olokor, Ikponmwosa O Iyawe, Chimezie G Okwuonu, Oluseyi A Adejumo, Odigie E Ojeh-Oziegbe, Frank A Imarhiagbe, Evelyn I Unuigbe

African Journal of Medical and Health Sciences 2017 16(1):30-35

Background: The incidence and prevalence of chronic kidney disease (CKD) is on the increase worldwide. Treatment for end-stage kidney disease constitutes a huge burden on the economy of nations affected. Early identification, modification, and treatment of CKD risk factors are the best options. Objective: This study assessed common CKD risk factors in a population of workers in an organization. Materials and Methods: A cross-sectional survey that involved 242 workers in an agricultural research institute. CKD risk factors assessed were hypertension (HTN), hyperglycemia, abdominal obesity using waist–hip ratio (WHR), general obesity using body mass index (BMI), proteinuria, and serum creatinine. Results: The prevalence of HTN, elevated blood sugar, general obesity, abdominal obesity, proteinuria, and elevated serum creatinine were 47.1, 9.7, 14.2, 66.5, 5.9, and 20.4%, respectively. Older participants were more likely to have elevated blood pressure, BMI, WHR, and blood sugar serum creatinine. Being a known hypertensive was associated with elevated BMI, WHR, and blood sugar compared with those without a previous diagnosis of HTN. Conclusion: The presence of HTN and being middle aged to elderly was associated with higher CKD risk. Workers in organizations should have mandatory annual screening for CKD and its risk factors to aid risk modification, early detection, and treatment.

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