Lagos University Teaching Hospital

The advancements and challenges of surgical interventions for Parkinson's disease (PD), a neurodegenerative disorder characterized by the progressive loss of dopaminergic neurons. We provided a comprehensive overview of the limitations of pharmacological treatments and emphasize the necessity for surgical options in advanced cases. By critically analyzing various surgical techniques such as Deep Brain Stimulation (DBS), ablative procedures like pallidotomy and thalamotomy, and emerging methods such as focused ultrasound and gene therapy, we reviewed and evaluated their efficacy, risks, and impact on patients' quality of life. Furthermore, we also focused on the ethical considerations and complications associated with these interventions, while also examining future directions for surgical innovation aimed at overcoming current limitations. This review article underscores the significance of a multifaceted approach in treating PD, combining surgical, pharmacological, and rehabilitative therapies to enhance patient outcomes.

Abstract Background Acute respiratory infection (ARI) remains a leading cause of morbidity and mortality among children under five in Nigeria. Although polluting cooking fuels are widely considered a key risk factor, their effects may be shaped by broader socioeconomic and geographic conditions. This study examined both individual and structural determinants of ARI and assessed how these factors intersect to pattern risk. Methods We analysed data from 28,728 children under five in the 2024 Nigeria Demographic and Health Survey. Three ARI definitions were applied. Survey-weighted quasibinomial logistic regression estimated associations between ARI and cooking fuel type, child age and sex, household wealth quintile, residence type, geopolitical zone, and parental education. To examine intersectional patterning, we conducted a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), constructing strata defined by combinations of cooking fuel, wealth, residence, and geopolitical zone. The intraclass correlation coefficient (ICC) quantified between-strata variance. Results Strict ARI prevalence was 1.9%, and 8.3% of children had broader respiratory symptoms. In unadjusted analyses, polluting fuel use was associated with higher odds of respiratory symptoms (OR 1.85, 95% CI 1.43–2.39). After adjustment, this association was substantially attenuated, indicating confounding by structural factors. Child age was the most consistent predictor: children aged 24–59 months had about half the odds of strict ARI compared with infants (aOR 0.53, 95% CI 0.41–0.68). Geopolitical zone showed the strongest overall association. MAIHDA revealed that 9% of total ARI variance lay between intersectional strata (ICC = 0.09), and this variance was not explained by child age or sex. The population-attributable fraction for polluting fuel declined from 41.4% to 12.4% after adjustment. Conclusions ARI risk among Nigerian children is shaped more by structural and geographic inequalities than by household fuel use alone. Equity-focused, subnational policies addressing intersecting socioeconomic and regional disadvantage are needed to reduce the ARI burden.

ObjectiveTo compare demographics, comorbidities, neurologic symptoms, quality of life, and cognitive outcomes among adult individuals with neurologic manifestations of post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) across countries with varying income levels: the United States (U.S.), Colombia, Nigeria, and India.MethodsIn this multi-country observational study, participants were evaluated in hospital clinics and recruited from institutional databases between 2020 and 2025. Patients were categorized as post-hospitalization Neuro-PASC (PNP) or non-hospitalized Neuro-PASC (NNP). Cognitive assessments were performed using the NIH Toolbox (U.S. and Colombia), the Montreal Cognitive Assessment (Nigeria), or the Mini-Mental State Examination (India).ResultsA total of 3,157 participants were enrolled (652 PNP; 2,505 NNP). PNP patients were predominantly male except in the US, while NNP patients were predominantly female, except in India. The most frequent neurologic symptoms were brain fog, myalgia, dizziness, headache, and sensory disturbances, with frequency highest in the U.S. and lowest in India. There were significant differences for most neurologic and non-neurologic symptoms of PASC, driven by higher frequencies in U.S. and Colombia in both PNP and NNP cohorts. In addition, cognitive impairment measured with different instruments varied across countries for both PNP and NNP groups. Multiple correspondence analysis showed clustering of symptom burden between U.S./Colombia and Nigeria/India.ConclusionNeuro-PASC presents globally but symptom burden, and psychological distress vary across regions, likely influenced by sociocultural factors, healthcare access, and diagnostic tools. These findings highlight the need for culturally-adapted screening and post-COVID care worldwide.

ObjectiveThe study examined the association between adiponectin levels and markers of Insulin Resistance (IR) in obese and non-obese adults with type 2 diabetes. Insulin Resistance was estimated using HOMA-IR, while group differences were assessed using appropriate statistical tests. Multiple linear regression was applied to evaluate associations between adiponectin and obesity indices while adjusting for HOMA-IR.ResultsMean serum adiponectin did not differ significantly across obese diabetics, non-obese diabetics, and controls (5.9 ± 3.6 µg/mL, 6.4 ± 3.2 µg/mL, and 6.8 ± 3.5 µg/mL, respectively; p = 0.13). Mean HOMA-IR values were comparable among obese diabetics (1.4 ± 2.1), non-obese diabetics (1.3 ± 1.0), and controls (1.1 ± 0.6). In multivariable regression models, serum adiponectin was not independently associated with obesity indices or HOMA-IR (all p > 0.05). Serum adiponectin levels were not significantly different across the study groups, although numerically lower values were observed in obese individuals with diabetes. No significant relationship was found between adiponectin and clinical or biochemical markers of IR. These findings suggest that adiponectin may have limited utility as an isolated marker of IR in Nigerian adults with type 2 diabetes and underscore the need for larger, longitudinal studies to clarify its role.

Quinolines are well-established scaffolds in drug discovery and form the core of many FDA-approved medicines. Among their reduced analogues, hexahydroquinolines (HHQs) have gained increasing attention due to their structural adaptability and broad pharmacological relevance. Research has largely focused on the 1,4,5,6,7,8-hexahydroquinoline framework, although interest in other variants, including 2-oxo derivatives, is steadily growing. This review summarizes recent progress in HHQ chemistry, with emphasis on synthetic strategies and emerging therapeutic applications. Traditional multicomponent reactions such as the Hantzsch, Antaki, and Stankevich methods are discussed alongside more recent green synthetic strategies, including the use of natural and heterogeneous catalysts, catalyst-free protocols, and alternative activation techniques such as ultrasonication. These sustainable protocols often provide improved yields under milder conditions and shorter reaction times. A recurring feature of HHQ synthesis is the preferential formation of 5-oxo derivatives. The mechanistic basis for this structural dominance and the synthetic approaches for the other underexplored HHQ chemotypes are examined. From a biological perspective, HHQs have demonstrated notable activity across several therapeutic areas, including antiprotozoal potential against Plasmodium falciparum, Leishmania species, and Toxoplasma gondii, with several compounds exhibiting dual-stage or transmission-blocking effects. Additional reports also include their usage as modulators of multidrug resistance in cancer cells, antimicrobial, anti-inflammatory, antioxidant, and cardiovascular activities. This review aims to provide a focused and practical reference for researchers engaged in heterocyclic drug design and development involving hexahydroquinoline scaffolds.

Prostate adenocarcinoma and chromophobe renal cell carcinoma (ChRCC) are two distinct urologic malignancies with different prognoses and treatment approaches. The occurrence of both tumors in the same individual is highly unusual. We describe the case of a 69-year-old man with a long-standing history of hypertension who had previously undergone prostatectomy for benign prostatic hyperplasia. In 2022, he re-presented with recurrent lower urinary tract symptoms. Biopsy confirmed acinar adenocarcinoma of the prostate (Gleason 4+3), and magnetic resonance imaging (MRI) staged the disease as T3aN0M0. He was treated with high-dose-rate (HDR) brachytherapy followed by external beam radiotherapy (EBRT). Two years later, a right renal mass was detected. While the initial histology favored oncocytoma, immunohistochemistry revealed strong cytokeratin (CK)7 expression with focal CD117 staining, confirming the eosinophilic subtype of ChRCC. This case illustrates the importance of thorough histopathologic work-up of renal lesions, the diagnostic value of immunohistochemistry, and the need for careful follow-up in patients with complex urologic histories.

Secondhand smoke (SHS) exposure remains a critical global health threat, causing an estimated 1.3 million deaths annually and classified by the World Health Organization (WHO) as a Group 1 carcinogen with no safe level of exposure. In Nigeria, SHS contributes substantially to both communicable and non-communicable diseases despite the National Tobacco Control Act (NTCA) of 2015, which incorporates key provisions of the WHO Framework Convention on Tobacco Control (FCTC); however, enforcement gaps and limited public awareness continue to undermine its effectiveness. This study assessed the prevalence of SHS exposure and examined associations between socio-demographic characteristics, knowledge of tobacco legislation, and perceived risks of SHS among 399 non-smoking adults recruited through systematic sampling in Ajah and Obalende motor parks in Eti-Osa LGA, Lagos State. Using a modified Global Adult Tobacco Survey (GATS) questionnaire, data were analyzed with IBM SPSS version 21, employing descriptive statistics, Chi-square tests, and multivariate logistic regression at a significance level of p ≤ 0.05. The prevalence of SHS exposure was 54.6%, notably higher among middle-aged men, individuals with lower educational attainment, and frequent users of motor parks. Although 69.8% of respondents demonstrated good perceived risk of SHS - reflecting awareness of its respiratory, cardiovascular, and carcinogenic harms - knowledge of the NTCA was poor (44.2%), indicating that understanding of health risks has not translated into awareness of legal protections or compliance with smoke-free regulations. These findings underscore the high burden of SHS exposure in outdoor transport settings, exceeding previously reported indoor rates, and highlight the urgent need for strengthened enforcement of smoke-free laws, improved public education on tobacco legislation, and targeted interventions within motor parks to reduce SHS exposure and protect public health.