Increased Risk of Migraine among Students with Asthma: Results of Headache and Asthma Study among University Students.

BACKGROUND: Several studies in developed countries have investigated the relationship between migraine and asthma. OBJECTIVE: To examine the relationship between asthma and migraine among university students in a low middle-income country. METHODS: We conducted a cross-sectional study across three universities in the middle belt region of Nigeria. A self-administered questionnaire developed from the International Classification of Headache Disorders was used to screen for migraine. The European Community Respiratory Health Survey (ECRHS) survey tool screened for asthma and its related conditions. Migraine was diagnosed in subjects with recurrent, moderate to severe unilateral throbbing headaches associated with nausea, vomiting, or visual disturbances. Asthma was defined as reporting a previous asthma attack or currently taking asthma medication within the preceding 12 months. RESULTS: The frequency of asthma was significantly higher among those with migraine than those without migraine (28.6% vs. 9.0%). Conversely, migraine was significantly prevalent in participants with asthma (7.1%vs. 1.9%). On multivariate analysis, there were significant associations between migraine and asthma [aOR = 2.56 (95% CI 1.15-5.77)]. Other factors associated with migraine were female gender [aOR = 2.22 (95% CI 1.06-4.65)] and family history of recurrent headache in firstdegree relatives [aOR = 4.03 (95% CI 1.15-5.77)]. CONCLUSION: Our study shows an increased frequency and risk of migraine in participants diagnosed with asthma and vice versa. These results support the bidirectional association between migraine and asthma. Physicians, therefore, should be aware of the possibility of migraine in patients with asthma who complain of headaches.

CONTEXTE: Plusieurs études menées dans des pays développésvont étudié la relation entre la migraine et l'asthme. OBJECTIF: Examiner la relation entre l'asthme et la migraine chez les étudiants universitaires d'un pays à faible revenu intermédiaire. MÉTHODES: Nous avons mené une étude transversale à travers trois universités dans la région de la ceinture centrale du Nigéria. Un questionnaire auto-administré élaboré à partir de la Classification internationale des troubles de la céphalée a été utilisé pour dépister la migraine. L'enquête de la Communauté européenne sur la santé respiratoire (ECRHS) outil d'enquête dépisté pour l'asthme et ses affections connexes. La migraine a été diagnostiquée chez des sujets présentant des maux de tête lancinants unilatéraux récurrents, modérés à sévères associés à des nausées, des vomissements ou des troubles visuels. L'asthme était défini comme la déclaration d'une crise d'asthme antérieure ou en cours de prise médicaments contre l'asthme au cours des 12 mois précédents. RÉSULTATS: La fréquence de l'asthme était significativement plus élevée chez les personnes souffrant de migraine que chez celles sans migraine (28,6% vs 9,0%). Inversement, la migraine était significativement répandue chez participants asthmatiques (7,1 % contre 1,9 %). Sur l'analyse multivariée, il y avait des associations significatives entre la migraine et l'asthme [aOR = 2,56 (IC à 95 % 1,15-5,77)]. Autres facteurs associés à la migraine étaient le sexe féminin [aOR = 2,22 (95 %IC 1,06­4,65)] et antécédents familiaux de maux de tête récurrents chez les parents de premier degré [RA = 4,03 (IC à 95 % 1,15-5,77)]. CONCLUSION: Notre étude montre une augmentation de la fréquence etrisque de migraine chez les participants ayant reçu un diagnostic d'asthme et de viceVersa. Ces résultats soutiennent l'association bidirectionnelle entre migraine et asthme. Les médecins devraient donc: être conscient de la possibilité de migraine chez les patients asthmatiques qui se plaignent de maux de tête. Mots-clés: Migraine, Maux de tête, Asthme, Allergie, Association, Relation.

Outpatient burden of adult respiratory diseases in University of Ilorin Teaching Hospital, Nigeria.

Background: Respiratory diseases constitute a significant cause of morbidity globally. There is limited information on the epidemiology of respiratory diseases in North Central Nigeria particularly with the changing trend in risk factors. Aim: This study aimed at evaluating the pattern and morbidity related to respiratory diseases among adult outpatients attending a chest clinic in a tertiary healthcare facility, especially with increasing environmental pollution and biomass exposure globally. Patients And Methods: This was a retrospective review of the case records of 338 newly referred patients seen in the chest clinic of the University of Ilorin Teaching Hospital (UITH) with respiratory illnesses over a 2-year period (January 2017-December 2018). Results: The mean age of the recruited patients was 47.6 ± 19.8 years with a male to female ratio of 1.1:1. Microbiologically confirmed tuberculosis (30.2%), chronic obstructive pulmonary disease (COPD) (24.3%), and bronchial asthma (17.8%) were the commonest conditions managed in the clinic. Overall, noncommunicable respiratory diseases (61.2%) constituted a larger proportion of cases when compared to infective respiratory conditions. Almost 90% of the patients were never smokers. Systemic hypertension (15.1%) and human immunodeficiency virus infection (3.6%) were the commonest comorbid illnesses. Conclusion: Although tuberculosis constituted the most observed single condition, noncommunicable respiratory diseases predominated cumulatively among the new cases seen in the chest clinic of UITH, Ilorin. This raises the need for significant attention in terms of prevention and management of noncommunicable respiratory diseases, which appear to be on the uprising.

Assessment of Post-Treatment Health-Related Quality of Life among Patients with Pulmonary Tuberculosis in Ilorin, Nigeria.

BACKGROUND: A lot of attention has generally been given to the microbiology and treatment of pulmonary tuberculosis with relatively limited consideration on its impact on the physical, psychological and social domains of the individual especially after successful drug treatment. AIM AND OBJECTIVES: This study aimed at assessing the health-related quality of life (HRQoL) and related factors among individuals who had successfully completed treatment for pulmonary tuberculosis (PTB) in Ilorin. METHODS: This was a hospital based cross-sectional study at the pulmonary outpatient clinics of the University of Ilorin Teaching Hospital and Kwara State Specialist Hospital, Sobi, Ilorin. HRQoL assessment was conducted in 308 consenting patients who had been certified microbiologically cured for bacteriologically confirmed PTB in the preceding three years using the validated St. George's Respiratory Questionnaire (SGRQ). All subjects also had plain chest radiograph done for assessment of the presence and extent of lung parenchymal damage. RESULTS: The overall total median percentage HRQoL score was 18.5 (7.9-28.2) with the highest score in the activity component [33.7 (18.3-41.8)] and least scores in the impact component [10.0 (0.0-21.9)]. The independent predictors of impaired HRQoL were age > 40 years (p= 0.007), absence of formal education (p=0.004), mMRC score >1 (p= 0.002), PTB retreatment (p=<0.001) and radiographic scores >3 (p= <0.001). CONCLUSION: There is impaired HRQoL following treatment for PTB in Ilorin. Hence, there is a need to incorporate HRQOL assessment as an adjunct outcome measure after PTB treatment especially in those with the above identified risk factors.

Clinicopathological Pattern and Management of Primary Lung Cancer in Ilorin, Nigeria.

BACKGROUND: Lung cancer incidence and mortality rates have increased in some low and medium-resourced countries. OBJECTIVES: This study aimed to describe the clinicopathological pattern and management of lung cancer seen in our setting. METHODS: We reviewed cases of pulmonary neoplasm diagnosed and managed at the University of Ilorin teaching hospital over eight years. Cases with tissue diagnosis were enrolled in the study and relevant clinical data were collected from the medical record using a proforma. DESIGN: Hospital-based retrospective study. RESULTS: Out of the 71 cases of primary lung cancer reviewed, 44(62%) were males and the male to female ratio was 2:1. The mean age was 62±14 years and the occurrence was highest in aged 50-69 years. Thirty (42.3%) with histories of tobacco smoking were males. Adenocarcinoma accounted for 34(54.9%), 23(32.4%) were squamous cell carcinoma, 2(2.8%) were large cell carcinoma and 6(8.5%) were other histological variants. The majority (82.7%) presented at stage III-IV lung cancers, 56.3% had malignant pleural effusion and 74.6% received palliative care. Thirty-eight (53.3%) had chest tube drainage, 19(26.7%) underwent chemical pleurodesis and 22(31.0%) received Cisplatin-based systemic chemotherapy. One patient had curative surgery and none received radiotherapy. At 12 months, 4 (5.6%) were still alive, 14(19.7%) cases had medical records of their death and 53(74.7%) were lost to follow up. CONCLUSION: This study has highlighted the clinicopathological trend, high rate of mortality and late presentation of lung cancer in our setting. There is a need to increase the awareness of the warning signs and risk factors to ensure early detection and facilitate curative therapy.

CONTEXTE: L'incidence du cancer du poumon et les taux de mortalité ont augmenté dans certains pays à faibles et moyennes ressources. OBJECTIFS: Cette étude visait à décrire le modèle clinicopathologique et la prise en charge du cancer du poumon observé dans notre milieu. MÉTHODES: Nous avons passé en revue les cas de néoplasme pulmonaire diagnostiqués et pris en charge à l'hôpital universitaire de l'Université d'Ilorin pendant huit ans. Les cas avec diagnostic tissulaire ont été inclus dans l'étude et les données cliniques pertinentes ont été collectées à partir du dossier médical à l'aide d'un formulaire. CONCEPTION: étude rétrospective en milieu hospitalier. RÉSULTATS: Sur les 71 cas de cancer du poumon primitif examinés, 44 (62%) étaient des hommes et le ratio homme / femme était de 2:1. L'âge moyen était de 62 ± 14 ans et la fréquence était la plus élevée chez les 50 à 69 ans. Trente (42,3%) ayant des antécédents de tabagisme étaient des hommes. L'adénocarcinome représentait 34 (54,9%), 23 (32,4%) étaient des carcinomes épidermoïdes, 2 (2,8%) étaient des carcinomes à grandes cellules et 6 (8,5%) étaient d'autres variantes histologiques. La majorité (82,7%) des cancers du poumon de stade III-IV, 56,3% ont eu un épanchement pleural malin et 74,6% ont reçu des soins palliatifs. Trente-huit (53,3%) ont eu un drainage par sonde thoracique, 19 (26,7%) ont subi une pleurodèse chimique et 22 (31,0%) ont reçu une chimiothérapie systémique à base de cisplatine. Un patient a subi une chirurgie curative et aucun n'a reçu de radiothérapie. À 12 mois, 4 (5,6%) étaient encore en vie, 14 (19,7%) cas avaient un médical de leur décès et 53 (74,7%) étaient perdus de vue. CONCLUSION: Cette étude a mis en évidence la tendance clinicopathologique, le taux élevé de mortalité, et la présentation tardive du cancer du poumon dans notre milieu. Il est nécessaire d'accroître la sensibilisation aux signes avant-coureurs et aux facteurs de risque pour assurer une détection précoce et faciliter la thérapie curative. MOTS CLÉS: Clinico-pathologique, modèle, prise en charge, cancer du poumon, néoplasme, Nigéria.

Acute Oxygen Therapy on Hospital Wards in Low Middle-Income Country: Experience from a Referral Centre in Ilorin, Nigeria.

BACKGROUND: Oxygen is like any other medication that can cause severe consequences if administered inappropriately. OBJECTIVE: To audit the pattern of acute oxygen therapy on regular hospital wards of a referral centre in Ilorin, Nigeria. METHODS: We reviewed 150 patients that received or had a prescription for acute oxygen therapy in three months and extracted relevant information using a proforma. RESULTS: About one-third of the patients (30%) were >65 years of age and the male to female ratio was 1:1. The commonest indication and medical condition for acute oxygen administration were hypoxemia (70.7%) and pneumonia (26.0%), respectively. Pneumonia accounted for most (41.2 %) of the oxygen therapy in childhood. The majority of patients (88.0%) had written order for oxygen prescription, 40.7% had a prescription to target oxygen saturation and only 31.3% achieved their target saturation. Oxygen prescription was adequate (documentation of delivery device, flow rate of oxygen, and target oxygen saturations) in 40.7% of patients. The assessment, monitoring and titration of oxygen therapy were adequate in 92.7%, 65.3% and 28 % of patients respectively. Overall mortality was 27.3% in patients receiving acute oxygen supplementation. Eleven patients had unstable COPD, and 63.6 %, 54.5 % and 45.6 % of them had adequate oxygen prescription, monitoring and titration respectively. The challenges to oxygen use were faulty delivery devices, emptied oxygen cylinders, inability to routinely do arterial blood gas analysis and lack of hospital oxygen protocol. CONCLUSION: The current practice of acute oxygen therapy is not satisfactory and interventions are advocated to improve the healthcare providers' administration of oxygen.

Profile of patients with chronic obstructive pulmonary disease in Ilorin who were never-smokers.

BACKGROUND: The most recognized risk factor for chronic obstructive pulmonary disease (COPD) worldwide is cigarette smoking. However, recent surveys have revealed an increasing trend from nonsmoking causes especially from biomass exposure. This study, therefore, aimed to determine the proportion of patients and the clinical pattern of COPD among never-smokers in Ilorin. SUBJECTS AND METHODS: This is a retrospective study in which case records of patients with clinical diagnosis of COPD from January 2013 to December 2017 were reviewed. Data were collected with respect to their sociodemographic characteristics, clinical details, comorbid illnesses, and severity of the disease. RESULTS: A total of 135 case records of patients with COPD were reviewed, of which 66 had spirometric confirmation of the disease. In all, 38 (57.6%) of them were never-smokers with a male-to-female ratio of 1:1.1. The mean age of the subjects was 64.5 ± 11.7 years. Cough and exertional dyspnea were the most common symptoms (89.5% each), and systemic hypertension was the most common comorbid illness. Firewood exposure constituted the most common nonsmoking risk factor (47.4%), and the majority of the patients had mild COPD. When compared with ever-smokers, the mean post bronchodilator lung function parameters were found to be significantly better in never-smokers. CONCLUSION: Over half of COPD cases in Ilorin were never-smokers with firewood exposure as the main risk factor. This study has further highlighted the need for increased awareness of the hazards of biomass fuel exposure in our setting.

Physical and socioeconomic impact of asthma in Nigeria: Experience of patients attending three tertiary hospitals.

BACKGROUND: Understanding the impact of asthma is the key to optimal care. OBJECTIVE: To determine the physical, economic, and social impact of asthma from the perspectives of individual patients in Nigeria. METHODS: This was a multicenter study of 172 adult asthma patients attending tertiary hospitals. We assessed the different impact of asthma in the preceding 12 months using a questionnaire. Physical impact (such as daily activity/chores, sport/exercise, and sleep quality), social impact (such as job loss, mental anguish, employer, and peers discrimination) and economic impact (like savings, indebtedness, mortgage/asset, and school or work absence). RESULTS: The physical, social and economic impacts were perceived by 59.3%, 47.7%, and 51.2% of patients, respectively. The physical impacts were poor sleep (44.2%), limitation of daily activity/chores (38.4%), and sporting/exercise (39.5%). The economic impacts were reduced savings (38.4%) and indebtedness (17.4%). Absence from school and work were respectively reported by 75% of students and 38.3% of workers. Socially, 34.9% reported mental torture, 10.5% changed job, 4.7% experienced discrimination and 3.5% lost their jobs due to asthma. Asthma-related emergency department visit was 42% and hospitalization was 32.6%. The physical impact was associated with non-adherence to ICS and persistent asthma symptoms. Economic impact was associated with asthma hospitalization, work absenteeism, comorbidity, and National Health Insurance (NHIS) coverage. Male sex and lack of post-secondary education were associated with social impact. CONCLUSION: Asthma causes broad and substantial physical and socioeconomic impacts in our sample of patients. Exploring these impacts and engaging the patient is imperative for holistic management and good health outcomes.

Lung cancer awareness and anticipated delay before seeking medical help in the middle-belt population of Nigeria.

SETTING: Ilorin metropolis in the middle-belt region of Nigeria. OBJECTIVES: To determine the awareness about warning signs and risk factors for lung cancer and the anticipated delay before seeking medical care in the middle-belt population of Nigeria. DESIGN: This was a cross-sectional study performed among 1125 adults. Lung cancer awareness measure (Lung CAM) was administered face to face by trained interviewers. RESULTS: The respondents' Lung CAM score was low for warning signs and risk factors for lung cancer. Apart from tobacco smoking (69.9%) and air pollution (56.4%), other risk factors were poorly recognised by respondents. Higher education and income and having a relative or friends who had previously had lung cancer were significantly associated with awareness about warning signs and risk factors. The majority (66.8%) would seek help before 2 weeks if they noticed a warning sign. Anticipated delay was associated with non-recognition of any warning sign (OR 3.09, 95%CI 2.26-4.22), lower education (OR 1.90, 95%CI 1.40-2.57), lower income (OR 1.86, 95%CI 1.26-2.75) and males (OR 1.50, 95%CI 1.15-1.97). CONCLUSION: The awareness of lung cancer warning signs and risk factors are not satisfactory in Nigeria. There is a need to increase awareness about the condition to prevent delays in seeking medical help.

Ethno-veterinary medicine: screening of Nigerian medicinal plants for trypanocidal properties.

Trypanosoma congolense and T. brucei bloodstream form parasites were propagated axenically in suitable standard media at 34 degrees C. The effects of 33 plant extracts, fractions and pure compounds were evaluated on two clones of T. brucei and drug-sensitive and multi-drug-resistant clones of T. congolense. The cytotoxic activity of the trypanocidal extracts was also evaluated on calf aorta endothelial cells in vitro. Of the extracts tested, 22% killed T. congolense IL 1180 at a concentration of 100 microg/ml while 18% killed 90-100% of T. brucei ILTat 1.4 at the same concentration. However, 6% of the active extracts killed 93% of a dyskinetoplastid form of T. brucei IL Tat 1.1, indicating that the intact kinetoplast is a target of some of the compounds tested. Of the 12 extracts that displayed activity against drug sensitive trypanosomes, 66.7% had trypanocidal activity on a multi-drug-resistant clone, T. congolense IL 3338. The extracts of Eugenia uniflora, Acacia artaxacantha, Terminalia ivorensis, T. superba and Alchornea cordifolia had median lethal concentrations of between 13 and 69 microg/ml on both the drug-sensitive, IL 1180 and multi-drug-resistant clone, IL 3338. The median lethal doses of the active plant extracts on the calf aorta endothelial cells varied between 112 and 13750 microg/ml while the calculated selective indices ranged between 0.71 and 246.8 indicating bright prospects for the development of some of these extracts as potential trypanocidal agents.

Antimicrobial activity of Trichilia heudelotti leaves.

Diterpenes and phenolic acids, including the new compounds 12 beta-hydroxysandaracopimar-15-ene (4) and 2-propionoxy-beta-resorcylic acid (8) have been isolated from Trichilia heudelotti leaves. The methanol extract showed antimicrobial activity concentrated in the ethyl acetate fraction and some of its constituents.

A new bioactive thiophenolic glycoside from the leaf of Massularia acuminata (g. Don Bullock) ex Hoyle (Rubiaceae).

BACKGROUND: Massularia acuminata is a small tree or shrub of tropical rainforest. The leaves are used in Nigerian ethno-medicine for the treatment of microbial infections and pharmacological report suggested the leaf extract as possessing antioxidant activity. This study was therefore carried out to determine the most antioxidant and antimicrobial active fraction(s) of Massularia acuminata leaf and the constituent(s) responsible for the activities. MATHERIALS AND METHODS: The leaf of Massularia acuminata was investigated for in vitro antioxidant and antimicrobial activities, using a 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay and agar dilution method respectively. RESULTS: The ethyl acetate fraction demonstrated the best activities among the partitioned fractions tested. Bioassay guided purification of the most active ethyl acetate fraction led to isolation of a new thiophenolic glycoside, characterized as 4-(3',3'-dihydroxy-1-mercaptopropyl)phenyl glycosylpyranoside. CONCLUSION: The isolated compound from the leaf of Massularia acuminata demonstrated antioxidant and antimicrobial activities and may be responsible for the activities of leaf extract and its ethyl acetate fraction, hence this may justify its ethnomedicinal use.

Antimicrobial and antioxidant activities of some Nigerian medicinal plants.

Ten Nigerian plants suggested from their ethnomedical uses to possess antimicrobial and antioxidant activities were studied for their anti-microbial and anti-oxidant properties. Antimicrobial activity was tested against Escherichia coli NCTC 10418, Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus subtilis, Candida albicans, Candida pseudotropicalis and Trichophyton rubrum (clinical isolate). Trichilia heudelotti leaf extract showed both antibacterial and antifungal activities and was the most active against all the strains of bacteria tested. Boerhavia diffusa, Markhamia tomentosa and T. heudelotti leaf extracts inhibited the gram negative bacteria E. coli and P. aeruginosa strains whereas those of M. tomentosa, T. heudelotti and Sphenoceutrum jollyamum root inhibited at least one of the fungi tested. At a concentration of 312 microg/ml, hexane and chloroform fractions of T. heudelotti extract inhibited 6 and 14% of the fifty multi-drug resistant bacteria isolates from clinical infections, respectively. At < or = 5 mg/ml, the CHCl(3) (64%) and aqueous (22%) fractions of T. heudelotti and those of CHCl(3) (34%) and EtOAC (48%) of M. tomentosa gave the highest inhibition that was stronger than their corresponding methanol extracts. The corresponding EC(50) of the extracts on M. acuminata, T. heudelotti, E. senegalensis and M. tomentosa were 4.00, 6.50, 13.33, and 16.50 ig/ml using the TLC staining and 1,1-dipheyl-2-picry-hydrazyl (DPPH) free radical scavenging assay. Therefore, leaf extracts of M. tomentosa and T. heudelotti, especially the latter, possess strong antimicrobial and antioxidant activities and should be further investigated. These activities justified the ethnomedical uses of these plants.

Phytochemical and pharmacological investigation of the cardioactive constituents of the leaf of Dysoxylum lenticellare.

The cardiac effects of the leaf extract and 11 isolated pure compounds have been examined on isolated, spontaneously beating, atrial muscles of the rat. Using nor-adrenaline (8 X 10(-7)M) and acetylcholine (4 X 10(-8)M) as reference drugs and normal saline (equivalent volume) as control, the crude extract of Dysoxylum lenticellare (8 X 10(-4) g/ml) induced negative chronotropic and positive inotropic responses on the isolated cardiac muscle preparations. The extract demonstrated significant (p less than 0.05-0.01) cardioactivity as attested to by its positive inotropic and/or negative chronotropic activities on the rat atrial preparations. Of the pure isolates tested, 7, 8, and 9 demonstrated significant cardiac effects. Although the precise mechanism of action of the extract or pure isolates on the atrial myocardium has not been fully determined, available experimental data suggest that the extract and pure isolates act directly on the cardiac muscle. Alkaloids 7, 8, and 9 manifest cardiac effects similar to that of the crude extract but of lesser magnitude. Some indirect effects of these isolates may, however, be associated with the manifested activities.

New pyrazole alkaloids from the root bark of Newbouldia laevis.

The root bark of Newbouldia laevis afforded withasomnine, 4'-hydroxywithasomnine, 4'-methoxywithasomnine, newbouldine, 4'-hydroxynewbouldine, and 4'-methoxynewbouldine. 4'-Methoxywithasomnine and 4'-methoxynewbouldine are new natural products.