Pattern of Clinical and Laboratory Presentation of Cerebral Malaria among Children in Nigeria.

Introduction: Cerebral malaria (CM) is the most lethal form of severe malaria with high case fatality rates. Overtime, there is an inherent risk in changing pattern of presentation of CM which, if the diagnosis is missed due to these changing factors, may portend a poor outcome. Variations in the pattern of clinic-laboratory presentations also make generalization difficult. This study was, therefore, set out to report the pattern of clinical and laboratory presentation of CM. Methods: This was a cross-sectional study among children aged 6 months to 14 years admitted with a diagnosis of CM as defined by the World Health Organization criteria. A pretested pro forma was filled, and detailed neurological examination and laboratory (biochemical, microbiology, and hematology) investigations were done. P <5% was considered statistically significant. Results: Sixty-four children were recruited with a mean age of 34.9 ± 24.9 months and a male-to-female ratio of 1.9:1. There were 87.5% of under-five children. Fever (96.9%) was the major presenting feature closely followed by convulsions (92.2%). Convulsions were mainly generalized (94.9%) and multiple (76.5%). Profound coma (Blantyre coma score of 0) was present in 12.5% of cases, and the leading features on examination were fever (84.4%) and pallor (75.0%). Retinal vessel whitening (48.4%) was the most common funduscopic abnormality. Metabolic acidosis (47.9%), severe anemia (14.1%), hyperglycemia (17.2%), and hypoglycemia (7.8%) were seen among the children. Few (1.6%) had hyperparasitemia and bacteremia (3.2%). Conclusion: Early recognition of the clinical presentation and prompt management may improve the outcome of cerebral malaria.

Depression and quality of life among pregnant women in first and third trimesters in Abeokuta: A comparative study.

Background: Pregnancy is a dynamic time during which a woman's emotional state may undergo extensive change. There have been conflicting views about the magnitude of emotional turmoil that occurs during pregnancy. Some investigators suggest that pregnancy is a time of particularly good psychological adjustment; others have reported high levels of psychological challenge. Aim: Our study aimed to compare the prevalence and correlates of depression in the first and third trimesters of pregnancy and to determine the relationship between quality of life and depressive disorder. Setting: The antenatal clinic of the State Hospital, Ijaiye. Method: A descriptive, comparative study of depressive disorder and the quality of life between first- and third-trimester pregnant women (confirmed through a pregnancy test and an abdominopelvic ultrasound). Result: For each trimester, 285 participants were recruited. The prevalence of depression among the pregnant women who participated in the study was 7.2%. In the first trimester of pregnancy, the prevalence of depression was 30 (10.5%), while it was 11 (3.9%) in the third trimester of pregnancy. Collectively, the relationship between depression and QoL was significant in the overall domain, satisfaction with general health domain (t = 2.27; p = 0.03), psychological domain (t = 2.74; p = 0.010, and environmental domain (t = 4.57; p ≤ 0.01). Conclusion: Our study also highlights the need to pay closer attention to the psychological well-being and quality of life of all pregnant women and not just on their physical health and the baby's well-being.

Psychoactive substance use among outpatients with severe mental illness: A comparative study.

BACKGROUND: Despite several studies on the prevalence and pattern of substance use in Nigeria, there is little information on substance use in patients diagnosed with serious mental illness (SMI) such as schizophrenia and bipolar affective disorder (BD). AIM: The aim of the study was to compare the pattern of psychoactive substance use among outpatients with BD and schizophrenia. SETTING: The study was conducted in a neuropsychiatric hospital in Nigeria. METHODS: Seventy five consecutive patients with a MINI-PLUS diagnosis of BD were compared with an equal number of patients obtained by systematic random sampling with a MINI-PLUS diagnosis of schizophrenia. RESULTS: The respondents with schizophrenia were aged 18-59 years (37.2 ± 9.99) and were predominantly young adult (49, 65.3%), men (46, 61.3%), who were never married (38, 50.7%). Overall, lifetime drug use prevalence was 52%, while for current use, overall prevalence was 21.3%. Participants with BD were aged 18-63 years (36.7 ± 10.29) and were predominantly young adult (53, 70.7%), women (44, 58.7%), who were married (32, 42.7%), with tertiary education (31, 41.3%). Overall, lifetime drug use prevalence was 46.7%, while current overall prevalence was 17.3%. These rates (lifetime and current) for both diagnostic groups are higher than what was reported by the World Health Organization in the global status report of 2014 (0% - 16%). The statistically significant difference between the two diagnostic groups was related to their sociodemographic and clinical variables and psychoactive substance use. CONCLUSION: Psychoactive substance use remains a burden in the care of patients diagnosed with schizophrenia and BD. Future policies should incorporate routine screening for substance use at the outpatient department with a view to stemming the tide of this menace.

Psychoactive substance use among outpatients with severe mental illness: A comparative study

Background: Despite several studies on the prevalence and pattern of substance use in Nigeria, there is little information on substance use in patients diagnosed with serious mental illness (SMI) such as schizophrenia and bipolar affective disorder (BD).Aim: The aim of the study was to compare the pattern of psychoactive substance use among outpatients with BD and schizophrenia.Setting: The study was conducted in a neuropsychiatric hospital in Nigeria.Methods: Seventy five consecutive patients with a MINI-PLUS diagnosis of BD were compared with an equal number of patients obtained by systematic random sampling with a MINI-PLUS diagnosis of schizophrenia. Results: The respondents with schizophrenia were aged 18­59 years (37.2 ± 9.99) and were predominantly young adult (49, 65.3%), men (46, 61.3%), who were never married (38, 50.7%). Overall, lifetime drug use prevalence was 52%, while for current use, overall prevalence was 21.3%. Participants with BD were aged 18­63 years (36.7 ± 10.29) and were predominantly young adult (53, 70.7%), women (44, 58.7%), who were married (32, 42.7%), with tertiary education (31, 41.3%). Overall, lifetime drug use prevalence was 46.7%, while current overall prevalence was 17.3%. These rates (lifetime and current) for both diagnostic groups are higher than what was reported by the World Health Organization in the global status report of 2014 (0% ­ 16%). The statistically significant difference between the two diagnostic groups was related to their sociodemographic and clinical variables and psychoactive substance use.Conclusion: Psychoactive substance use remains a burden in the care of patients diagnosed with schizophrenia and BD. Future policies should incorporate routine screening for substance use at the outpatient department with a view to stemming the tide of this menace

Perceived expressed emotions in relatives of patients with severe mental illness: A comparative study.

There is paucity of studies on expressed emotion (EE) in families of patients with severe mental illness in sub-Saharan Africa. This study aimed to assess and compare the levels of expressed emotion (LEE) in relatives of patients with schizophrenia and bipolar affective disorder attending an out-patient clinic in Southwestern Nigeria. One hundred and forty consecutive clinic attendees with Mini-Plus diagnosis of schizophrenia and bipolar affective disorder and 140 accompanying relatives were recruited. The patients and relatives were interviewed using a socio-demographic questionnaire. The perceived level of expressed emotion was assessed using the client version of the Level of Expressed Emotion Questionnaire (LEEQ). Although, the prevalence of high expressed emotion was higher among relatives of patients with schizophrenia when compared with relatives of patients with bipolar affective disorder (41% vs 37%), the difference was not statistically significant. The socio-demographic characteristics of the relatives of patients with these disorders were not significantly related to high EE. High expressed emotion is just as prevalent among relatives of patients with bipolar affective disorder as among relatives of patients with schizophrenia and clinicians should give similar attention to early detection of high EE and intervention in this population of patients and their relatives.