A systematic analysis of neurologic manifestations of Long COVID in Nigeria.

Long COVID, also called post-acute sequelae of SARS-CoV-2 infection (PASC) affects millions of people in the world. The neurologic manifestations of PASC (Neuro-PASC) are among the most debilitating but they are largely unreported in Africa. We sought to compare the demographics, symptoms and cognitive profile of post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients in Nigeria. In this cross-sectional study performed at the Lagos University Teaching Hospital, 106/2319 (4.6%) SARS-CoV-2 positive individuals contacted via telephone reported Neuro-PASC symptoms with a higher frequency in PNP than in NNP individuals ((23/200 (11.5%) vs. 83/2119 (3.9%), p = < 0.0001). The predominant neurologic symptoms at any time during the disease course were difficulty remembering / brain fog (63/106; 59.4%), fatigue (59/106; 55.7%), sleep problems (34/106; 32%), headache (33/106; 31%), paresthesia (12/106; 11.3%), and myalgia (10/106; 9.4%). Of 66 participants with Neuro-PASC who underwent in-person neurological evaluation and cognitive screening, all had normal scores on the Intervention for Dementia in Elderly Africans cognition screen, while 11/65 (16.9%) that completed the Montreal Cognitive Assessment had results consistent with mild cognitive impairment (3/16 PNP (18.8%) and 8/49 NNP (16.3%); p = 1.0). Finally, 47/66 (71.2%) had digit span test scores consistent with mild cognitive dysfunction (12/16 PNP (75%) and 35/50 (70%) NNP; p = 1.0). Our findings reveal the previously unrecognized occurrence of Neuro-PASC among COVID-19 survivors in Nigeria and highlight the need for improved screening and diagnosis of Neuro-PASC in our population. Development of cognitive support services for persons suffering from Neuro-PASC in Nigeria is warranted.

Uncovering the genetic basis of Parkinson's disease globally: from discoveries to the clinic.

Knowledge on the genetic basis of Parkinson's disease has grown tremendously since the discovery of the first monogenic form, caused by a mutation in α-synuclein, and with the subsequent identification of multiple other causative genes and associated loci. Genetic studies provide insights into the phenotypic heterogeneity and global distribution of Parkinson's disease. By shedding light on the underlying biological mechanisms, genetics facilitates the identification of new biomarkers and therapeutic targets. Several clinical trials of genetics-informed therapies are ongoing or imminent. International programmes in populations who have been under-represented in Parkinson's disease genetics research are fostering collaboration and capacity-building, and have already generated novel findings. Many challenges remain for genetics research in these populations, but addressing them provides opportunities to obtain a more complete and equitable understanding of Parkinson's disease globally. These advances facilitate the integration of genetics into the clinic, to improve patient management and personalised medicine.

GBA1 rs3115534 Is Associated with REM Sleep Behavior Disorder in Parkinson's Disease in Nigerians.

BACKGROUND: Rapid eye movement (REM) sleep behavior disorder (RBD) is an early feature of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Damaging coding variants in Glucocerebrosidase (GBA1) are a genetic risk factor for RBD. Recently, a population-specific non-coding risk variant (rs3115534) was found to be associated with PD risk and earlier onset in individuals of African ancestry. OBJECTIVES: We aimed to investigate whether the GBA1 rs3115534 PD risk variant is associated with RBD in persons with PD. METHODS: We studied 709 persons with PD and 776 neurologically healthy controls from Nigeria. All DNA samples were genotyped and imputed, and the GBA1 rs3115534 risk variant was extracted. The RBD screening questionnaire (RBDSQ) was used to assess symptoms of possible RBD. RESULTS: RBD was present in 200 PD (28.2%) and 51 (6.6%) controls. We identified that the non-coding GBA1 rs3115534 risk variant is associated with possible RBD in individuals of Nigerian origin (ß, 0.3640; standard error [SE], 0.103, P = 4.093e-04), as well as in all samples after adjusting for PD status (ß, 0.2542; SE, 0.108; P = 0.019) suggesting that although non-coding, this variant may have the same downstream consequences as GBA1 coding variants. CONCLUSIONS: Our results indicate that the non-coding GBA1 rs3115534 risk variant is associated with an increasing number of RBD symptoms in persons with PD of Nigerian origin. Further research is needed to assess if this variant is also associated with polysomnography-defined RBD and with RBD symptoms in DLB. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Achieving a robust mentoring and research capacity program in a LMIC - the BRAINS faculty development model.

BACKGROUND: A research and training program (RTP) was carried out to build the capacity of faculty and improve the culture of research in the College of Medicine, University of Lagos (CMUL), Nigeria. METHODS: Realist-guided mixed methods evaluation of the BRAINS project was carried out using secondary data generated during the 5-years (2015 - 2020) of project implementation. Capacity building workshops and mentored research activities targeted at faculty in the CMUL were conducted. Overall, 1,418 participants attended the workshops in batches. Among the participants, forty-five faculty received grants and were mentored by senior professionals (local & international) to conduct research. Data were extracted from all project-related documents including coursework biodata, workshop evaluation forms, quarterly project reports, and end- of-project reports, submitted by the mentees, minutes of meetings, and the proposal submitted for funding. It was in the form of continuous variables and prose (sentences & stories). Quantitative data were analysed with IBM SPSS statistics version 20. Mean knowledge score and mean difference was calculated, paired t-test was carried out using p < 0.05 to determine statistical significance. The prose was thematically analysed to generate themes and narratives. Both were subsequently combined for interpretation and used to refine the initial programme theory into an evidence-informed theory. RESULTS: Twelve courses were deployed, and 1,418 participants (47.8% males and 52.2% females) from medical, nursing, and allied medical departments were trained. Eighty participants were trained in Responsible Conduct of Research and eighty-one on Manuscript Writing over three years. A comparison of the pre/post-test knowledge scores showed a positive mean difference. Thematic analysis of workshop data produced three thematic domains representing effectiveness and gains namely: cognitive, reward, and behavioural. 45 trainees were awarded grants and mentored, and analysis of mentee's data generated 4 themes: Achieving a robust mentoring program; Benefits of the mentoring program; Resilience in research; Improving the mentoring program. CONCLUSION: By contributing to the body of knowledge available on RTPs, this evaluation identified key components that contributed to the success of the project and developed a model for achieving a robust training and mentoring program which can be replicated in other LMICs.

A preprogram appraisal of factors influencing research productivity among faculty at college of medicine, University of Lagos.

Background: A defining feature of any university is its dedication to scholarly activities, leading to the generation of knowledge and ideas Research productivity is a measure of achievement of a scholar. The number of research publications in peer-reviewed journals is an important criterion for assessing productivity and prestige in the academia. Aims and Objectives: This cross-sectional descriptive study assessed the level of research productivity (RP) among junior faculty at the College of Medicine, University of Lagos, and investigated factors affecting their research output prior to the implementation of a 5-year training grant funded by the National Institutes of Health. Methods: Seventy junior faculty members attended a pre-program training, and the self-reported number of peer-reviewed publications (PRPs) was used as an indicator. Intrinsic and extrinsic factors influencing RP among the attendees were assessed and ranked. Results: The majority (42/70, 60%) of the respondents had <10 PRPs. The median (interquartile range) number of PRPs was 7 (3-18). A desire for the development of their personal skills, contribution to society, and personal research interests topped the list of intrinsic factors influencing RP. Work flexibility, research autonomy, and scholarly pursuits were the bottom three. A desire for promotion, respect from peers, and increased social standing were the top three extrinsic factors, while monetary incentives, employment opportunities, and the need to attend conferences were the lowest three. The top barriers to RP were lack of resources and lack of mentoring. Perceived older age, lack of time, and motivation were the lowest three barriers. Older age and professional cadre were associated with increased RP (P < 0.05). Conclusion: Among the participants, research output appears to be motivated primarily by a desire for personal development,promotion, and respect from peers. Lack of access to resources was the main barrier to increased RP. These factors may need to be considered when developing programs designed to promote RP.

RésuméContexte: Une caractéristique déterminante de toute université est son dévouement aux activités savantes, menant à la génération de connaissances et d'idées La productivité de la recherche est une mesure du rendement d'un chercheur. Le nombre de publications de recherche dans des revues à comité de lecture est un critère important pour évaluer la productivité et le prestige de l'académie. Buts et objectifs: Cette étude descriptive transversale a évalué le niveau de productivité de la recherche (RP) parmi les professeurs débutants du Collège de médecine de l'Université de Lagos et a examiné les facteurs affectant leurs résultats de recherche avant la mise en œuvre d'une subvention de formation de 5 ans. financé par les National Institutes of Health. Méthodes: Soixante-dix facultés juniors ont suivi une formation préalable au programme et le nombre autodéclaré de publications évaluées par des pairs a été utilisé comme indicateur. Les facteurs intrinsèques et extrinsèques influençant la RP chez les participants ont été évalués et classés. Résultats: La majorité (42/70, 60%) des répondants ont utilisé moins de 10 publications évaluées par des pairs. Le nombre médian (intervalle interquartile) de PRP était de 7 (3­18). Le désir de développer leurs compétences personnelles, leur contribution à la société et leurs intérêts personnels en recherche figuraient en tête de liste des facteurs intrinsèques influençant la productivité de la recherche. La flexibilité du travail, l'autonomie de recherche et les activités universitaires étaient les trois derniers. Un désir de promotion, le respect des pairs et une position sociale accrue étaient les trois principaux facteurs extrinsèques, tandis que les incitations monétaires, les possibilités d'emploi et la nécessité d'assister à des conférences étaient les trois plus faibles. Les principaux obstacles à la productivité de la recherche étaient le manque de ressources et le manque de mentorat. L'âge avancé perçu, le manque de temps et la motivation étaient les trois obstacles les plus bas. L'âge avancé et les cadres professionnels étaient associés à une augmentation de la RP (P <0,05). Conclusion: parmi les participants, les résultats de la recherche semblent être principalement motivés par un désir de développement personnel, de promotion et de respect de la part des pairs. Le manque d'accès aux ressources était le principal obstacle à l'augmentation de la productivité de la recherche. Ces facteurs peuvent devoir être pris en compte lors de l'élaboration de programmes conçus pour promouvoir la productivité de la recherche.

Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa.

INTRODUCTION: The impact of Obstructive sleep apnea (OSA) in worsening outcomes is profound, especially in the presence of comorbid conditions. This study aimed to describe the proportion of patients at a high risk of OSA in our practice setting. METHODS: The STOP BANG questionnaire and the Epworth Sleepiness scale were used to assess for OSA risk and excessive daytime sleepiness respectively. Hospitalized patients and out-patients were recruited. Intergroup differences in continuous variables were compared using the analysis of variance. The proportion of patients with high risk of OSA and excessive daytime sleepiness was presented as frequencies and group differences compared with the Pearson χ(2) test. Independent risk predictors for OSA were assessed in multivariate logistic regression analysis. RESULTS: A total of 1100 patients (53.4% females) participated in the study. Three hundred and ninety nine (36.3%) had a high risk of OSA, and 268 (24.4%) had excessive daytime sleepiness. Of the participants with high OSA risk, 138 (34.6%) had excessive daytime sleepiness compared to 130 (18.5%) of those with low OSA risk (p). CONCLUSION: A significant proportion of patients attending our tertiary care center are at high risk of OSA.

Predictors of short-term intra-hospital case fatality following first-ever acute ischaemic stroke in Nigerians.

OBJECTIVE: To determine the predictors of 30-day intra-hospital case fatality rate in patients with first-ever acute ischaemic stroke, attending a tertiary care hospital in Western Nigeria. STUDY DESIGN: A cross-sectional observational study. PLACE AND DURATION OF STUDY: This study was conducted at the Lagos University Teaching Hospital, Lagos, Nigeria between February 2003 and May 2004 (16 months). METHODOLOGY: One hundred consecutively consenting patients admitted within 72 hours of onset of first-ever acute ischaemic stroke were studied. Uniform information was obtained using a standard format documenting demographic information, stroke-related symptoms and signs, risk factor profile, admission Glasgow Coma Score (GCS), stroke severity, admission Random Blood Glucose (RBG) and presence of complications. All patients were closely followed-up to monitor progress and document any complications. The end point was mortality or survival at 30 days from stroke onset. RESULTS: The 30-day case fatality rate was 28%. In univariate analysis, the factors predicting mortality were admission stroke severity, admission hyperglycaemia, admission level of consciousness, and presence of any complication during the hospitalization period. Of these factors, presence of complications had the strongest correlation with 30-day case fatality (r = 0.52; p = 0.001). CONCLUSION: Presence of complications was the most important predictor of short-term mortality in Nigerians with firstever acute ischaemic stroke. Prevention, early detection, and aggressive intervention to treat complications may reduce the unacceptably high mortality rate of ischaemic stroke in our environment.