Dietary treatment is important for the management of Parkinson&am... more Dietary treatment is important for the management of Parkinson's disease (PD). Our objective was to describe the dietary habits and assess the nutritional status of Ghanaian patients with PD. This study is part of a larger project, for which Ghana has been selected as a pilot country. Fifty-five Ghanaian patients with PD and 12 healthy Ghanaian controls were recruited. We assessed nutritional status, investigated dietary habits, and assessed the prevalence of the nutritional complications of PD (e.g., constipation and dysphagia). The mean daily caloric intake was about 1200 kcal/d in patients with PD and in controls. The typical diet was based on semisolid foods, usually vegetable soups accompanied by cereal flour or root starch or sometimes chicken or fish. The intake of milk and its derivatives was low. The prevalences of constipation and dysphagia in patients with PD were 49% and 21%, respectively. This study has yielded information that could be useful for the study of the management of PD and for the assessment of response to therapy.
The leucine-rich repeat kinase 2 (LRRK2) gene is associated with autosomal dominant Parkinson dis... more The leucine-rich repeat kinase 2 (LRRK2) gene is associated with autosomal dominant Parkinson disease (PD) [1]. Its most common mutation G2019S may account for 3–6% of familial and 1–2% of sporadic PD cases. This mutation’s frequency may range from\0.1% in Asia to 43% in North Africa, even in apparently sporadic cases [2, 3] because of its low penetrance [4]. To date, this is the first screening of LRRK2 mutations in Ghana and only the third in a subSaharan African country [5, 6]. Fifty-four black African individuals meeting the UK Brain Bank criteria for PD were consecutively recruited between December 2008 and March 2011 from three outpatient clinics in Ghana. Every index case was reviewed by a neurologist specialized in movement disorders (R.C.). PD individuals were unrelated, with the exception of two sisters. At least one first-degree relative with tremors/possible PD has been reported in ten families (11 cases), suggesting a potential autosomal dominant (n = 7) or recessive (n = 3) pattern of inheritance. Control subjects (n = 46) had similar age and the same ethnicity as the cases, and no neurological disease or family history of tremors/PD (Table 1). Cases and controls were equally balanced among the three hospitals. The study was approved by the local ethics committee and all participants gave written consent before recruitment. Genomic DNA extraction was performed from saliva using the Oragene method (DNA Genotek, Ottawa, ON, Canada). The LRRK2 analysis was based on sequencing of exon41 (including G2019S and I2020T) and exon31 (including R1441G/C/H). LRRK2 exon41 and exon31 with their intron–exon boundaries were amplified by PCR using primers and condition previously reported [7]. Mutation analysis of the PCR purified product was performed by direct sequencing using the Big Dye Terminator Kit (version1.1, Applied Biosystems). Sequences were run on an ABI Prism 3130 XL Genetic Analyzer (PE Applied Biosystem) and the electropherograms analyzed with SeqScape software (Applied Biosystems). LRRK2 exon41 and exon31 screening did not reveal any mutation in cases and controls. We identified one heterozygous intron substitution IVS41 ? 30A [ G in a healthy subject and heterozygous IVS30-6C [ T in two PD and one healthy control. These variants have never been associated to a pathogenic mechanism and they are likely to be rare polymorphisms. Electronic supplementary material The online version of this article (doi:10.1007/s00415-011-6210-y) contains supplementary material, which is available to authorized users.
Additional file 1. Questionnaire for data collection. Data on participants characteristics were c... more Additional file 1. Questionnaire for data collection. Data on participants characteristics were collected via interviews using standardized questionnaires. The questionnaire abstracted information regarding the following demographics (gender and age), childâ s knowledge of causes of malaria, helminth infections and schistosomiasis, deworming, availability of toileting facilities in household, sources of household water, childâ s activity in any river and parent/guardian educational level. We also determined the household socio-economic status using proxy measures based on the World Bank asset scores for Ghana. For each enrolee, anthropometric measurements including height and weight were determined.
Introduction: Parkinson’s disease is one of the common neurodegenerative diseases especially amon... more Introduction: Parkinson’s disease is one of the common neurodegenerative diseases especially among old age people. Majority of the population effected by this lives primarily in Asian countries. The natural history, diseases course and clinical scenario has been well established in most western developed countries, but the situation is still unclear in Asia. So, aim of this study was to evaluate the epidemiological scenario of Parkinsonism in central Asian land locked country, Mongolia, with no previous established data. Methods: This study was conducted at Central university hospital, UlanBator, Mongolia for a period of 3 years from June 2007 till July 2010. A total of 63 patients presenting with symptoms and later on confirmed as cases of Parkinsonism were recruited. Presenting age, gender, family history and concomitant diseases were particularly stressed. Mode of presentation was defined in clinical terms. All the data was analyzed by SPSS version 12. Results: Out of a total 63 patients, 44% were females. The mean ± SD age of participants was 54±7 years. 52% subjects had familial history of either Parkinsonism or related psychosomatic disorder. 32% subjects were smokers, primarily the males. 47% and 29% were hypertensive and diabetics respectively. 26% had concomitant psychiatric diseases like depression, anxiety or memory dysfunctions. The participants were well aware regarding the diseases course and 81% were already on related medications. Conclusions: The prevalence of Parkinsonism in Mongolia is slightly lower than that in Western countries. However, comparison of incidence was difficult because of the small number of studies. The clinical scenario of presentation clearly reflects that advancing age, concomitant disorders and male gender are at higher risk of developing the disease. Family history is also a strong factor for its determination.
The natural pattern of progression of Parkinson’s disease is largely unknown because patients are... more The natural pattern of progression of Parkinson’s disease is largely unknown because patients are conventionally followed on treatment. As Parkinson’s disease progresses, the true magnitude of the long-duration response to levodopa remains unknown, because it can only be estimated indirectly in treated patients. We aimed to describe the natural course of motor symptoms by assessing the natural OFF in consecutive Parkinson’s disease patients never exposed to treatment (drug-naïve), and to investigate the effects of daily levodopa on the progression of motor disability in the OFF medication state over a 2-year period. In this prospective naturalistic study in sub-Saharan Africa, 30 Parkinson’s disease patients (age at onset 58 ± 14 years, disease duration 7 ± 4 years) began levodopa monotherapy and were prospectively assessed using the Unified Parkinson’s disease Rating Scale (UPDRS). Data were collected at baseline, at 1-year and 2-years follow-up. First-ever levodopa intake induced ...
Empanelment is a foundational strategy for building or improving primary health care systems and ... more Empanelment is a foundational strategy for building or improving primary health care systems and a critical pathway for achieving effective universal health coverage. However, there is little international guidance for defining empanelment or understanding how to implement empanelment systems in low- and middle-income countries. To fill this gap, a multi-country collaborative within the Joint Learning Network for Universal Health Coverage developed this empanelment overview, proposing a people-centered definition of empanelment that reflects the responsibility to proactively deliver primary care services to all individuals in a target population. This document, building on existing literature on empanelment and representing input from 10 countries, establishes standard concepts of empanelment and describes why and how empanelment is used. Finally, it identifies key domains that may influence effective empanelment and that must be considered in deciding how empanelment can be impleme...
Purpose: To report the first case of ophthalmia due to contact with cobra venom in the Volta Regi... more Purpose: To report the first case of ophthalmia due to contact with cobra venom in the Volta Region, Ghana. Methods: An ointment containing vitamin A was applied to treat the patient’s unilateral defects in the corneal epithelium and the consequent diminished visual acuity. Results: Healing of the corneal epithelium and improvement of visual acuity were observed after only 1 day. Conclusions: This case suggests that consequences of cases of cobra venom spitting in the eyes can be minimal if immediate treatment is provided.
During the past decade, a number of large drug trials suggested that the initiation of levodopa t... more During the past decade, a number of large drug trials suggested that the initiation of levodopa therapy should be delayed to reduce the risk of motor complications in patients with Parkinson's disease. However, the relative contribution of the cumulative exposure to levodopa and of disease progression to the pathophysiology of motor fluctuations and dyskinesias is still poorly understood. In this 4-year multicentre study, we investigated a large cohort of patients with Parkinson's disease in a sub-Saharan African country (Ghana), where access to medication is limited and the initiation of levodopa therapy often occurs many years after onset. The primary objective was to investigate whether the occurrence of motor complications is primarily related to the duration of levodopa therapy or to disease-related factors. Study design included a cross-sectional case-control analysis of data collected between December 2008 and November 2012, and a prospective study of patients followe...
Dietary treatment is important for the management of Parkinson&am... more Dietary treatment is important for the management of Parkinson's disease (PD). Our objective was to describe the dietary habits and assess the nutritional status of Ghanaian patients with PD. This study is part of a larger project, for which Ghana has been selected as a pilot country. Fifty-five Ghanaian patients with PD and 12 healthy Ghanaian controls were recruited. We assessed nutritional status, investigated dietary habits, and assessed the prevalence of the nutritional complications of PD (e.g., constipation and dysphagia). The mean daily caloric intake was about 1200 kcal/d in patients with PD and in controls. The typical diet was based on semisolid foods, usually vegetable soups accompanied by cereal flour or root starch or sometimes chicken or fish. The intake of milk and its derivatives was low. The prevalences of constipation and dysphagia in patients with PD were 49% and 21%, respectively. This study has yielded information that could be useful for the study of the management of PD and for the assessment of response to therapy.
The leucine-rich repeat kinase 2 (LRRK2) gene is associated with autosomal dominant Parkinson dis... more The leucine-rich repeat kinase 2 (LRRK2) gene is associated with autosomal dominant Parkinson disease (PD) [1]. Its most common mutation G2019S may account for 3–6% of familial and 1–2% of sporadic PD cases. This mutation’s frequency may range from\0.1% in Asia to 43% in North Africa, even in apparently sporadic cases [2, 3] because of its low penetrance [4]. To date, this is the first screening of LRRK2 mutations in Ghana and only the third in a subSaharan African country [5, 6]. Fifty-four black African individuals meeting the UK Brain Bank criteria for PD were consecutively recruited between December 2008 and March 2011 from three outpatient clinics in Ghana. Every index case was reviewed by a neurologist specialized in movement disorders (R.C.). PD individuals were unrelated, with the exception of two sisters. At least one first-degree relative with tremors/possible PD has been reported in ten families (11 cases), suggesting a potential autosomal dominant (n = 7) or recessive (n = 3) pattern of inheritance. Control subjects (n = 46) had similar age and the same ethnicity as the cases, and no neurological disease or family history of tremors/PD (Table 1). Cases and controls were equally balanced among the three hospitals. The study was approved by the local ethics committee and all participants gave written consent before recruitment. Genomic DNA extraction was performed from saliva using the Oragene method (DNA Genotek, Ottawa, ON, Canada). The LRRK2 analysis was based on sequencing of exon41 (including G2019S and I2020T) and exon31 (including R1441G/C/H). LRRK2 exon41 and exon31 with their intron–exon boundaries were amplified by PCR using primers and condition previously reported [7]. Mutation analysis of the PCR purified product was performed by direct sequencing using the Big Dye Terminator Kit (version1.1, Applied Biosystems). Sequences were run on an ABI Prism 3130 XL Genetic Analyzer (PE Applied Biosystem) and the electropherograms analyzed with SeqScape software (Applied Biosystems). LRRK2 exon41 and exon31 screening did not reveal any mutation in cases and controls. We identified one heterozygous intron substitution IVS41 ? 30A [ G in a healthy subject and heterozygous IVS30-6C [ T in two PD and one healthy control. These variants have never been associated to a pathogenic mechanism and they are likely to be rare polymorphisms. Electronic supplementary material The online version of this article (doi:10.1007/s00415-011-6210-y) contains supplementary material, which is available to authorized users.
Additional file 1. Questionnaire for data collection. Data on participants characteristics were c... more Additional file 1. Questionnaire for data collection. Data on participants characteristics were collected via interviews using standardized questionnaires. The questionnaire abstracted information regarding the following demographics (gender and age), childâ s knowledge of causes of malaria, helminth infections and schistosomiasis, deworming, availability of toileting facilities in household, sources of household water, childâ s activity in any river and parent/guardian educational level. We also determined the household socio-economic status using proxy measures based on the World Bank asset scores for Ghana. For each enrolee, anthropometric measurements including height and weight were determined.
Introduction: Parkinson’s disease is one of the common neurodegenerative diseases especially amon... more Introduction: Parkinson’s disease is one of the common neurodegenerative diseases especially among old age people. Majority of the population effected by this lives primarily in Asian countries. The natural history, diseases course and clinical scenario has been well established in most western developed countries, but the situation is still unclear in Asia. So, aim of this study was to evaluate the epidemiological scenario of Parkinsonism in central Asian land locked country, Mongolia, with no previous established data. Methods: This study was conducted at Central university hospital, UlanBator, Mongolia for a period of 3 years from June 2007 till July 2010. A total of 63 patients presenting with symptoms and later on confirmed as cases of Parkinsonism were recruited. Presenting age, gender, family history and concomitant diseases were particularly stressed. Mode of presentation was defined in clinical terms. All the data was analyzed by SPSS version 12. Results: Out of a total 63 patients, 44% were females. The mean ± SD age of participants was 54±7 years. 52% subjects had familial history of either Parkinsonism or related psychosomatic disorder. 32% subjects were smokers, primarily the males. 47% and 29% were hypertensive and diabetics respectively. 26% had concomitant psychiatric diseases like depression, anxiety or memory dysfunctions. The participants were well aware regarding the diseases course and 81% were already on related medications. Conclusions: The prevalence of Parkinsonism in Mongolia is slightly lower than that in Western countries. However, comparison of incidence was difficult because of the small number of studies. The clinical scenario of presentation clearly reflects that advancing age, concomitant disorders and male gender are at higher risk of developing the disease. Family history is also a strong factor for its determination.
The natural pattern of progression of Parkinson’s disease is largely unknown because patients are... more The natural pattern of progression of Parkinson’s disease is largely unknown because patients are conventionally followed on treatment. As Parkinson’s disease progresses, the true magnitude of the long-duration response to levodopa remains unknown, because it can only be estimated indirectly in treated patients. We aimed to describe the natural course of motor symptoms by assessing the natural OFF in consecutive Parkinson’s disease patients never exposed to treatment (drug-naïve), and to investigate the effects of daily levodopa on the progression of motor disability in the OFF medication state over a 2-year period. In this prospective naturalistic study in sub-Saharan Africa, 30 Parkinson’s disease patients (age at onset 58 ± 14 years, disease duration 7 ± 4 years) began levodopa monotherapy and were prospectively assessed using the Unified Parkinson’s disease Rating Scale (UPDRS). Data were collected at baseline, at 1-year and 2-years follow-up. First-ever levodopa intake induced ...
Empanelment is a foundational strategy for building or improving primary health care systems and ... more Empanelment is a foundational strategy for building or improving primary health care systems and a critical pathway for achieving effective universal health coverage. However, there is little international guidance for defining empanelment or understanding how to implement empanelment systems in low- and middle-income countries. To fill this gap, a multi-country collaborative within the Joint Learning Network for Universal Health Coverage developed this empanelment overview, proposing a people-centered definition of empanelment that reflects the responsibility to proactively deliver primary care services to all individuals in a target population. This document, building on existing literature on empanelment and representing input from 10 countries, establishes standard concepts of empanelment and describes why and how empanelment is used. Finally, it identifies key domains that may influence effective empanelment and that must be considered in deciding how empanelment can be impleme...
Purpose: To report the first case of ophthalmia due to contact with cobra venom in the Volta Regi... more Purpose: To report the first case of ophthalmia due to contact with cobra venom in the Volta Region, Ghana. Methods: An ointment containing vitamin A was applied to treat the patient’s unilateral defects in the corneal epithelium and the consequent diminished visual acuity. Results: Healing of the corneal epithelium and improvement of visual acuity were observed after only 1 day. Conclusions: This case suggests that consequences of cases of cobra venom spitting in the eyes can be minimal if immediate treatment is provided.
During the past decade, a number of large drug trials suggested that the initiation of levodopa t... more During the past decade, a number of large drug trials suggested that the initiation of levodopa therapy should be delayed to reduce the risk of motor complications in patients with Parkinson's disease. However, the relative contribution of the cumulative exposure to levodopa and of disease progression to the pathophysiology of motor fluctuations and dyskinesias is still poorly understood. In this 4-year multicentre study, we investigated a large cohort of patients with Parkinson's disease in a sub-Saharan African country (Ghana), where access to medication is limited and the initiation of levodopa therapy often occurs many years after onset. The primary objective was to investigate whether the occurrence of motor complications is primarily related to the duration of levodopa therapy or to disease-related factors. Study design included a cross-sectional case-control analysis of data collected between December 2008 and November 2012, and a prospective study of patients followe...
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