Suicidal behaviour among patients with congestive cardiac failure in a Nigerian teaching hospital.

Background: Suicidal behaviour is an established psychiatric complication of congestive cardiac failure (CCF), contributing significantly to morbidity and death by suicide. The magnitude and risk factors for suicidal behaviour among patients with CCF are yet to be unpacked, especially in developing nations such as Nigeria. Aim: To determine the prevalence of suicidal behaviour and the risk factors associated with suicidal behaviour, among patients with CCF in Nigeria. Setting: Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Methods: A cross-sectional study was conducted among 98 randomly selected patients with a diagnosis of CCF. Participants were assessed with a socio-demographic and clinical factors questionnaire and Beck Scale of Suicidal Ideation. Chi-square test, t-test and logistic regression were used to analyse data. Results: The prevalence of suicidal ideation and suicidal attempt among patients with CCF was 52% and 1%, respectively. No socio-demographic factor was significantly associated with suicidal ideation. Clinical factors associated with suicidal ideation were age at diagnosis (p = 0.042), aetiology of CCF (p = 0.001) and severity of CCF (p = 0.032). Only the severity of CCF (odds ratio [OR] = 20.557, p = 0.014) predicted suicidal ideation among patients with CCF. Conclusion: Suicidal behaviour constitutes a huge burden among the outpatient CCF population. The identification of clinical risk factors for suicidal ideation (age at diagnosis, aetiology and severity of CCF) further illuminates a pathway to mortality among patients with CCF. Contribution: The findings lend a voice to the need for screening for suicidal behaviour, suicide prevention programmes, surveillance systems and government policies that support mental health for patients with CCF.

Plasma paraoxonase-1 activity levels in patients with type 2 diabetes mellitus in Lagos State University Teaching Hospital, Lagos, Southwest Nigeria: a cross-sectional study.

Introduction: paraoxonase 1 (PON1) is a high-density lipoprotein (HDL) associated enzyme that has anti-inflammatory, anti-atherogenic, and antioxidant functions. PON1 is noted to be a determinant of resistance to the development of atherosclerosis through hydrolysis of phospholipid and cholesteryl ester hydroperoxides. This study was designed to assess PON1 activity levels among patients with type 2 diabetes mellitus (T2DM) in Southwest Nigeria. Methods: this was a cross-sectional study done over a period of six months. A total of 138 participants; 69 with T2DM and 69 apparently healthy controls were recruited for this study. Fasting plasma glucose (FPG), HDL cholesterol (HDL-c), and PON1 activity were analyzed in the participants. The comparison of the mean between the groups of participants was assessed using the independent student t-test while the Mann-Whitney U test was used to compare two medians. The p-value was set at 0.05. Results: mean age for participants with T2DM was 54.90 ± 8.1 years and the healthy control group was 54.12 ± 8.4 years, with a p-value of 0.549. The male-to-female ratio was 0.47 for both participants with T2DM and healthy controls. Participants with T2DM had significantly higher median glucose concentration of 109.18 mg/dl compared with 82.58 mg/dl among controls, p-value <0.001. Median serum HDL-c was lower in diabetics compared to controls (52.66 mg/dl vs 57.92 mg/dl; p-value < 0.001). PON1 activity was lower in T2DM compared with that of the controls (690.11 pmol/min/ml vs 3379.7 pmol/min/ml; p-value <0.001). Paroxonase 1 showed a non-significant positive correlation with HDL-c and a negative correlation with FPG, and body mass index (BMI). Conclusion: these findings suggest that PON1 activity is lower in T2DM compared to healthy controls and a lower PON1 activity level was seen among female diabetics compared with the male diabetics.

Prevalence and Predictors of Post-Thyroidectomy Voice Dysfunction in a Nigerian Cohort.

BACKGROUND: Advances in surgical techniques have significantly improved the safety of thyroidectomy. Quality of life issues, such as voice changes, however continue to be important considerations. This study evaluated the prevalence and determinants of voice changes following thyroidectomies for non-malignant goiters in a Nigerian Hospital. METHODOLOGY: Consecutive adults who had thyroidectomy for non-malignant goiters were evaluated. Preoperatively, each participant had laryngoscopy and voice assessment using the Voice Handicap Index-10. At surgery, the intubation difficulty score, size of endotracheal tubes, and duration of operation were recorded. Laryngoscopy and VHI-10 assessments were repeated 1 week, 1 month, and 3 months after surgery. Pre and postoperative assessments were compared. RESULT: Fifty-four patients completed the study. Subtotal thyroidectomy was the commonest operation performed in 17 patients (31.48%), with 14 (25.93%) having total thyroidectomy. Baseline median VHI-10 score was 6.5(IQR-10). Five patients had abnormal preoperative laryngoscopy findings (benign vocal cord lesions). Postoperatively, seven patients had endoscopic evidence of vocal cord paralysis, six were unilateral while one was bilateral. Ten patients (18.5%) had early voice changes. Median VHI-10 score at one week was significantly higher than baseline (10 vs. 6.5, p = 0.01). At 3 months, VHI-10 reverted back to baseline in five of the ten patients while five patients (9.3%) had persistent voice changes. Abnormal endoscopic findings predicted the occurrence of early postoperative voice changes. CONCLUSION: Thyroidectomy for non-malignant goiters is associated with transient voice changes, many of which revert to normal over time. Abnormal endoscopic findings predict its occurrence.

Assessment of Ventricular Repolarization in Sickle Cell Anemia Patients: The Role of QTc Interval, Tp-e Interval and Tp-e/QTc Ratio and Its Gender Implication.

BACKGROUND: Many specific and non-specific electrocardiographic abnormalities including ventricular arrhythmias have been reported in subjects with sickle cell anemia (SCA). In SCA patients, cardiac electrical abnormalities may be the leading cause of increased risk of arrhythmias. The corrected QT (QTc) interval, peak to the end of the T wave (Tp-e) interval and associated Tp-e/QTc ratio are promising measures of altered ventricular repolarization and increased arrhythmogenesis risk. AIM: This study assessed ventricular repolarization abnormalities in subjects with SCA using the QTc interval, Tp-e interval and Tp-e/QTc ratio, and also evaluated the gender differences in these parameters, as well as their determinants. METHODS: Sixty subjects with SCA and 60 healthy control subjects, matched for age and gender, were studied. All participants underwent physical examination, hematological and biochemical evaluation, and 12-lead electrocardiography (ECG) recording. QT and Tp-e intervals were measured from the ECG, and the QTc interval was calculated using Bazett's formula. Tp-e/QT and Tp-e/QTc ratios were also derived. RESULTS: QT and QTc intervals were prolonged in subjects with SCA. Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were prolonged in male SCA subjects, with a paradoxical shortening in female SCA subjects. Plasminogen activator inhibitor-1 (PAI-1) was an independent determinant of QTc, while body mass index (BMI) was an independent determinant of both Tp-e interval and Tp-e/QTc ratio. CONCLUSION: Our results suggest an elevated risk for ventricular arrhythmogenesis in male SCA subjects. Furthermore, increased BMI and PAI-1 level are possible markers of ventricular repolarization abnormalities in SCA subjects.

Assessment of Plasma Sodium to Potassium Ratio, Renal Function, Markers of Oxidative Stress, Inflammation, and Endothelial Dysfunction in Nigerian Hypertensive Patients.

BACKGROUND: This study investigated plasma sodium/potassium ratio, markers of oxidative stress, renal function, and endothelial dysfunction in hypertensive Nigerians. MATERIALS AND METHODS: Five hundred forty-nine volunteers consisting of three hundred and twenty-four hypertensive and two hundred twenty-five controls participated in this study. Blood samples were collected from the participants and were analyzed for electrolytes, markers of oxidative stress, endothelial dysfunction, renal function, and inflammation, using ion-selective electrodes, spectrophotometric, and enzyme-linked immunosorbent assay methods, respectively. RESULTS: The mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure, and body mass index (BMI) were significantly elevated among the hypertensive group when compared with control (p < 0.001). The mean sodium increased, while potassium and bicarbonate (HCO3 -) decreased (p < 0.001) in hypertensive volunteers. The sodium-potassium ratio (Na+/K+) and urea were raised (p < 0.001) in the hypertensive group when compared with the control. Glutathione, superoxide dismutase, nitric oxide (NO), and catalase were significantly reduced (p < 0.001) while malondialdehyde (MDA), high-sensitivity C-reactive protein (hs-CRP), and ferritin were raised significantly (p < 0.001) in hypertensive participants. The odds of hypertension and its complications increased (p < 0.001) with an increase in BMI, Na+/K+, hs-CRP, MDA, and ferritin and a decrease in estimated glomerular filtration rate (eGFR), glutathione, superoxide dismutase, and catalase. CONCLUSION: An increase in Na+/K+, urea, hs-CRP, ferritin, MDA, and BMI and a decrease in eGFR, glutathione, and superoxide dismutase were associated with an increased risk of hypertension complication. Abnormal values of markers of oxidative stress, inflammation, and endothelial function could impact deleterious effects on the cardiovascular system among hypertensive Nigerians. A decreased bicarbonate possibly suggests an occult acid-base imbalance among hypertensive volunteers.

Heart rate variability and arrhythmic patterns of 24-hour Holter electrocardiography among Nigerians with cardiovascular diseases.

BACKGROUND: Facilities for Holter electrocardiography (ECG) monitoring in many Nigerian hospitals are limited. There are few published works in Nigeria on the use of 24-hour Holter ECG in cardiac arrhythmic evaluation of patients with cardiovascular diseases. OBJECTIVE: To study the clinical indications, arrhythmic pattern, and heart rate variability (HRV) among subjects referred for 24-hour Holter ECG at our Cardiac Care Unit. METHODS: Three-hundred and ten patients (134 males and 176 females) were studied consecutively over a 48-month period using Schiller type (MT-101) Holter ECG machine. RESULTS: Out of the 310 patients reviewed, 134 were males (43.2%) and 176 were females (56.8%). The commonest indication for Holter ECG was palpitation followed by syncope in 71 (23%) and 49 (15.8%) of subjects, respectively. Premature ventricular complex and premature atrial complex were the commonest types of arrhythmia in 51.5% and 15% subjects, respectively. Ventricular arrhythmia was more prevalent in dilated cardiomyopathy patients (85.7%). The HRV of subjects with palpitation, stroke, and diabetes mellitus with autonomic neuropathy, using standard deviation of normal to normal intervals average (milliseconds), were 107.32±49.61, 79.15±49.15, and 66.50±15.54, respectively. The HRV, using standard deviation of averages of normal to normal intervals average (milliseconds), of patients with palpitation, stroke, and diabetes mellitus with autonomic neuropathy were 77.39±62.34, 57.82±37.05, and 55.50±12.71, respectively. CONCLUSION: Palpitation and syncope were the commonest indications for Holter ECG among our subjects. The commonest arrhythmic patterns were premature ventricular complex and premature atrial complex, with ventricular arrhythmia being more prevalent in dilated cardiomyopathy. There was a reduction in HRV in patients with stroke and diabetic autonomic neuropathy.

Pattern of arrhythmias among Nigerians with congestive heart failure.

BACKGROUND: In patients with heart failure, death is often sudden due to life-threatening arrhythmias. This work was carried out to evaluate the pattern of arrhythmias in Nigerians with heart failure. MATERIALS AND METHODS: Thirty subjects with congestive heart failure (CHF), 30 subjects with hypertensive heart disease, and 15 normal subjects with no obvious features of heart disease were evaluated with resting and 24-hour electrocardiographic monitoring and transthoracic echocardiography. Data were analyzed with one-way analysis of variance with post hoc Duncan's analysis, Fisher's exact test, and linear regression analysis using SPSS version 16. RESULTS: CHF subjects had more instances of supraventricular tachycardia (P=0.005), ventricular extrasystoles (P<0.001), bigeminy (P<0.001), trigeminy (P<0.001), couplets (P<0.001), triplets (P<0.001), and nonsustained ventricular tachycardia (VT) (P=0.003) than the other two control groups. They also showed a significantly longer VT duration (4.6±5.6 seconds) compared with the other groups (P<0.001). Linear regression analysis showed a significant direct relationship between VT and the maximum number of ventricular extrasystoles per hour (P=0.001). CONCLUSION: Cardiac arrhythmias are common in subjects with CHF and are more frequent when compared with patients with hypertensive heart disease and normal subjects.

The effect of psychological distress on medication adherence in persons with HIV infection in Nigeria.

BACKGROUND: A high level of adherence to prescribed antiretroviral (ARV) regimens is required to achieve and maintain suppression of human immunodeficiency virus (HIV) replication and prevent drug resistance. OBJECTIVE: This study aimed to determine the possible relationship between psychopathology and ARV medication adherence in Nigeria. METHOD: Persons with HIV infection (N=182) completed various questionnaires on sociodemographic and clinical details, general psychopathology, self-esteem, and medication adherence. RESULTS: Low medication adherence was reported in 26.9% of the participants; significant correlates included presence of psychopathology and perceived poor social support. CONCLUSION: The success of any intervention policy for HIV-infected persons in sub-Saharan Africa must consider both low level of medication adherence and its associated factors.

Post-traumatic stress disorder (PTSD) after stigma related events in HIV infected individuals in Nigeria.

BACKGROUND: One of the most distressing concerns of many people living with HIV in sub-Saharan Africa is the stigma. Intense stigma may be traumatic. This study aimed to investigate the probability and correlates of Posttraumatic stress disorder (PTSD) following intense stigmatizing events and situations in HIV infected individuals in Nigeria. METHODS: Adult sero-positive attendees of an HIV care centre (N = 190) completed questionnaires regarding sociodemographic and clinical details; the 12-item General Health Questionnaire (GHQ-12) and the Rosenberg's Self-Esteem Scale. The clients were then interviewed for the presence of stigma related PTSD with a modified version of the mini international neuropsychiatry interview (MINI). RESULTS: About 2/3 of the participants had experienced at least an intense HIV-related stigmatizing event or situation. The rate of HIV-stigma related PTSD was 27.4%. Independent predictors of HIV stigma-related PTSD included past history of traumatic events (Single event, OR 2.28, 95% CI 1.08-4.73; Multiple events, OR 9.47, 95% CI 2.97-32.20), low self esteem (OR 6.52, 95% CI 2.59-16.55), poor level of social support (OR 3.33, 95% CI 1.24-9.79) and presence of general psychopathology (OR 2.18, 95% CI 1.07-4.44). CONCLUSION: PTSD may not be specific to traumatic events alone. There is a possibility of PTSD after an intense stigmatizing event or situation. While the validity for the validity of HIV-stigma related PTSD warrants further investigation, stigma needs to be considered when planning rehabilitation strategies for HIV infected individuals in sub-Saharan Africa. A closer attention to self esteem, level of social support and presence of psychopathology is needed in these individuals.

Relationship between depression and quality of life in persons with HIV infection in Nigeria.

OBJECTIVE: Despite the fact that two-thirds of all the people with HIV live in sub-Saharan Africa, little is known about the emotional state and quality of life (QOL) of subjects with HIV in this region. The objective of this study was to evaluate the association between clinical depression and quality of life in a group of HIV sero-positive subjects in Nigeria. METHODS: Subjects with HIV infection (n = 87) completed a questionnaire detailing sociodemographic and HIV related variables. The subjects were assessed for the diagnosis of depression using the Mini International Neuropsychiatric Interview (MINI) and their subjective health related quality of life (QOL) was assessed using the short version of the WHO quality of life scale (WHOQOL-BREF). RESULTS: There were 25 (28.7%) subjects with diagnosis of depression. Lower educational level correlated with poorer QOL in all the domains of WHOQOL-BREF except the "social relationship" domain. Also, poor social support correlated with poorer QOL scores on domains of "physical health" and "social relationship" and presence of medical problems was significantly associated with poorer scores on domains of "physical health" and "psychological health." Diagnosis of depression was significantly correlated with poorer QOL in all domains except the "social relationship" domain. CONCLUSION: Poorer health related QOL in Nigerian subjects with HIV was associated with depression, lower educational and socioeconomic levels, and poor social support. Early identification and referral of patients with depression needs to be incorporated into intervention programs designed for HIV infected individuals in this region.

Psychiatric disorders among the HIV-positive population in Nigeria: a control study.

OBJECTIVE: This article estimates the point prevalence of psychiatric disorders in a sample of HIV-positive subjects in Nigeria in comparison with normal HIV-negative controls and evaluates the possible sociodemographic and clinical correlates of psychiatric disorders in HIV-positive subjects. METHODS: HIV-positive subjects (n=88) and HIV-negative healthy controls (n=87) were assessed for their current diagnosis of DSM-IV psychiatric disorders via the Mini International Neuropsychiatric Interview. Sociodemographic and clinical details were also obtained. RESULTS: The rate of psychiatric disorders in subjects with HIV was 59.1% compared to 19.5% in subjects without HIV infection [odds ratio (OR)=5.95, 95% confidence interval (CI)=3.02-11.75]. The subjects with HIV had significantly higher rates of affective disorders (OR=3.58, 95% CI=1.44-8.94), anxiety disorders (OR=3.57, 95% CI=1.65-7.72), and psychotic disorders (OR=1.10, 95% CI=1.01-1.12) than healthy controls. The factors significantly associated with psychiatric disorders include poor level of social support and stage of the disease. CONCLUSION: Psychiatric disorders are common in our Nigerian subjects with HIV, and the rates are significantly higher when compared to the healthy general population. Proactive identification and treatment of mental disorders should be integrated into HIV intervention policies in this region.