A patient with sporadic Creutzfeldt-Jakob disease: challenges of rare diseases in the COVID-19 era.

We describe a patient who presented to hospital during the coronavirus disease 2019 (COVID-19) pandemic with sporadic Creutzfeldt-Jakob disease (sCJD). The case demonstrates the typical clinical, radiological and laboratory features of this condition. It also highlights some of the challenges associated with diagnosis and care of patients with rare diseases such as sCJD, and how these have been intensified by COVID-19.

Bench to bedside of neural stem cell in traumatic brain injury.

Traumatic brain injury (TBI) is one of the leading causes of major disability and death worldwide. Neural stem cells (NSCs) have recently been shown to contribute to the cellular remodelling that occurs following TBI and attention has been drawn to the area of neural stem cell as possible therapy for TBI. The NSCs may play an important role in the treatment of TBI by replacing the damaged cells and eventual remyelination. This paper summarized a critical assessment of recent data and developed a view comprising of six points to possible quality translation of NSCs in TBI.

Parkinsonism caused by adverse drug reactions: a case series.

INTRODUCTION: Parkinsonism puts a high direct cost burden on both patient and caregiver. Several reports of drug-induced parkinsonism have been published, but to the best of our knowledge, there has not been any report of quinine or halothane inducing parkinsonism. CASE PRESENTATION: We describe two cases of parkinsonism possibly caused by adverse drug reaction to quinine in a 29-year-old black Nigerian woman and to halothane in a 36-year-old black Hausa (Nigerian) man who received it as general anaesthesia for appendicectomy in our teaching hospital. CONCLUSION: These are two unusual cases of parkinsonism caused by adverse drug reactions to high-dose quinine and to halothane as general anaesthesia. We consider that these two cases are important in bringing this potential side-effect to the attention of both pharmacologists and primary care physicians as these are two of the most commonly used medications in our clinics. We conclude that parkinsonism should be included among the adverse drug reactions to high-dose quinine and halothane general anaesthetic.

The place of L-dopa/carbidopa in persistent vegetative state.

BACKGROUND: The prevalence of persistent vegetative state (PVS) is estimated to be 40 to 168 per million person-years in the United States. Studies in the industrialized world have shown that the quality of life of persons with PVS is severely compromised and with paucity of data on treatment of persons with PVS. This is the first time a report of treatment of PVS with a known medication is being reported from Nigeria or sub-Saharan Africa. Our objectives were to prospectively follow up some cohorts of patients diagnosed to have PVS by a reliable and valid criteria and to look out for any response to L-dopa/carbidopa administration. DESIGN: This was a prospective case series. SETTING: The study was performed from a tertiary center. METHODS: We adopted the Multisociety Task Force of the American Academy of Neurology diagnostic criteria for PVS and minimally conscious state, and the Royal College of Physicians differential diagnostic criteria were used to include patients for the study. We also carried out detailed neurological examination of the unconscious patient to include or exclude subjects for the study. RESULTS: For the outcome measure, we adopted the ASPEN working group criteria for minimally conscious state. After 2 to 5 months of administration of L-dopa/carbidopa; 4 patients (4 = 36.4%) showed significant clinical improvement. Two (2 = 18.2%) who did not improve eventually died. One case (case 5) died after a second bleed. CONCLUSION: There were some remarkable responses to L-dopa/carbidopa after about 2 to 6 months of therapy.

Irritable bowel syndrome among patients attending General Outpatients' clinics in Jos, Nigeria.

Irritable bowel syndrome (IBS) is a common disorder in the Western world. Its prevalence is yet to be fully determined in the African setting. This was a cross-sectional study of patients attending three General Outpatient clinics in Jos, Nigeria. Four hundred and eighteen randomly selected patients were interviewed using a structured questionnaire based on the Rome II diagnostic criteria for IBS. Excluded from the study were patients with established organic disease, memory problems, and pregnant women. Eighteen patients were excluded based on these criteria and 400 were analysed using Epi Info 2000 (Atlanta, Georgia, USA) statistical computer software. One hundred and thirty-two (33%) out of the 400 patients fulfilled the criteria for the diagnosis of IBS, the female to male ratio being 1.13 : 1. IBS was significantly associated with increasing age (P=0.03) and depression (P<0.001). The prevalence of IBS is high among patients attending primary care in the African setting with depression being the likely reason for seeking care.

Clinically diagnosed diabetic neuropathy: frequency, types and severity.

OBJECTIVE: Studies of frequency of occurrence of diabetic neuropathy are few, and available studies were limited to the southern part of Nigeria. The objectives of the study were to determine the frequency of occurrence and grades of diabetes peripheral neuropathy using clinical measures. PATIENTS AND METHODS: Consecutive patients with diabetes mellitus attending the Jos University Teaching Hospital were recruited as the study population, including 120 diabetics and 60 age-matched, nondiabetic controls. A standard proforma based on the Michigan Neuropathy Screening Instrument (MNSI) was employed to screen for diabetic neuropathy. RESULTS: The frequency of occurrence of diabetic peripheral neuropathy was 75%. For the specific types of peripheral neuropathy, sensorimotor neuropathy was the commonest (40.4%, chi(2)=29.1; p<0.001). There was no significant difference, with severity of peripheral neuropathy among diabetics, when compared by gender. (Chi square=3.03, P value=0.081). CONCLUSION: The frequency of occurrence of peripheral neuropathy among diabetics in Jos University Teaching Hospital from this study is rather high.