Determinants/Predictors of QT Abnormalities in Patients on Psychotropic Medications in a Nigerian Tertiary Hospital.

Cardiovascular disease is a major global burden and a leading cause of premature death among patients with severe mental illness. Over time, research and clinical practice have paid increased attention to the impact of psychiatric medications on cardiac repolarization. In a resource-limited setting, it is common for psychotropic medications to be initiated and maintained in an outpatient setting without baseline or follow up ECG. This study evaluated the determinants and predictors of QT abnormalities among patient taking psychotropic drugs. We conducted a cross-sectional study in a population of 150 psychiatric patients on psychotropics and 75 controls. We studied the effects of various psychotropic drugs on QT dispersion (QTd) and corrected QT interval (QTc) as well as correlation with the types and dosages of psychotropic drugs used. All the subjects had detailed clinical examination and resting electrocardiogram (ECG) at 25 mm/sec done. QTc was determined using Bazett formula and QTd was determined by subtracting shortest from longest QT in 12-lead ECG. The prevalence of prolonged QTc and QTd as well as the mean QTc and QTd were significantly higher in patients than the control group. The mean QTc was significantly higher in patient on typical antipsychotics compared to those on atypical antipsychotics. Age, heart rate and antipsychotic dose in chlorpromazine equivalent were predictors of QTc with the heart rate being the most powerful predictor among them. Psychotropic drugs use is associated with QTc and QTd prolongation with age, heart rate and antipsychotic dose as predictors of QTc.

COVID-19 Pandemic- Ethical Challenges for Healthcare Workers Practicing in Resource-Limited Settings.

In this review, the ethical issues peculiar to the COVID-19 pandemics and the role of healthcare workers, especially those in resource-limited settings are x-rayed. We contend that there is a pressing ethical issue that needs urgent clarification on the rights and responsibilities of healthcare workers, especially in the current context of COVID-19 pandemic preparedness and responsiveness. We searched MEDLINE, Web of Science, EMBASE, Google Scholar, PUBMED related articles, newspaper articles, and online news sources for relevant information. The various professional codes of conduct (World Medical Association, Medical and Dental Council of Nigeria) were also consulted. The ethical principles of equitable distribution of healthcare resources, confidentiality with associated stigmatization, issues relating to duty to care by the healthcare workers and those pertaining to conduct of clinical trials and access to approved therapies or vaccines were highlighted in this study. We agree with the submission that healthcare workers only have a moral duty to treat patients with COVID-19 if the necessary protective equipment and adequate compensation are not provided. We argue that the duty of physicians and other healthcare workers to care for patients during pandemics such as COVID-19 is obligatory in the absence of required protective equipment and other forms of compensation. There is a need for the government and other stakeholders to put in place a National Pandemic /Epidemic Ethical Framework to address these identified ethical challenges.

Association between metabolic syndrome and healthcare work status in Ekiti State, Nigeria.

INTRODUCTION: metabolic syndrome portends an increased risk of cardiovascular events and death. Evidence showed that healthcare workers are at higher risk of cardiovascular events because of their engagement in night-shift work. Therefore, this study determined the association between metabolic syndrome and healthcare work status in Ekiti State, Nigeria. METHODS: this was a cross-sectional study involving 105 healthcare workers and 143 non-healthcare workers. The diagnosis of metabolic syndrome was made based on the International Diabetic Federation criteria: abdominal obesity plus, any two of: elevated blood pressure ≥ 130/85 mmHg or previous diagnosis of hypertension on the use of antihypertensive medications; impaired fasting glucose; elevated triglycerides; and low HDL-cholesterol. Factors associated with metabolic syndrome were analysed using univariable and multivariable analysis. RESULTS: men comprised 37.9% of the study population and the mean age was 42.1 ± 9.7 years. The prevalence of metabolic syndrome was similar in both groups (HCWs-29.5% vs non-HCWs- 28.0%, p-value=0.789); overall prevalence was 28.6%. Abdominal obesity, elevated total cholesterol and elevated LDL-cholesterol occurred more frequently in HCWs than in non-HCWs: (68.6% vs 55.2%, p-value=0.034; 65.7% vs 39.2%, p-value= < 0.001 and 50.5 vs 28.7%; p-value < 0.001) respectively. Female sex (aOR: 3.67, 95% CI: 1.74-7.45; p < 0.001) and obesity (aOR: 4.39, 95% CI: 2.31-8.37; p < 0.001) were associated with metabolic syndrome. CONCLUSION: a similar prevalence of metabolic syndrome was observed in the healthcare workers and the non- healthcare workers. However, abdominal obesity, elevated total cholesterol and elevated LDL-cholesterol occurred more frequently in healthcare workers than in non- healthcare workers.