The role of spirituality and religiosity in psychoactive substance use among adolescents in a Nigerian Hospital

Objective: Adolescence is a transition period where drug experimentation is common. Spirituality and religiosity have been recognized by literature as having a possible role in stabilizing good physical and mental health. To compare the religiosity and spirituality among adolescents abusing a psychoactive substance and those not abusing psychoactive substances in a Nigerian hospital Methods: This was a cross-sectional descriptive study conducted among adolescent patients admitted to the drug rehabilitation unit and adolescents attending the General Outpatient Department of the ABUAD Multisystem Hospital, Ado-Ekiti. The Daily Spiritual Experience Scale and Centrality of Religiosity Scale were used Results: The prevalence of high religiosity and spirituality among the respondents was 57.9% and 56.1%. The prevalence of high religiosity and spirituality among respondents not abusing psychoactive substances was 62.9% and 62.6% respectively, while the level of high spirituality and religiosity among respondents abusing psychoactive substances was 53.0% and 49.1% respectively. A significant proportion of the respondents who had a low level of religiosity (55.9%) abused psychoactive substances than respondents who do not abuse psychoactive substances (45.7%) (X2=7.694 p=0.006). Similarly, more proportion of respondents who had a low level of spirituality (57.4%) abused psychoactive substances than respondents who do not abuse psychoactive substances (44.2%). The observation is statistically significant (X2=11.1, p<0.001). In addition, there was a significant positive correlation between the spirituality and religiosity scores among the respondents (r =0.50, p<0.001)  Conclusion: Psychoactive drug use among the respondent was associated with both low religiosity and spirituality. Therefore, religious activities should be encouraged among adolescents

Intracardiac tumor: A risk factor for stroke in the young –A case report

Stroke occurs commonly in individuals above 65years, especially in the background of atherosclerosis and other risk factors. In young persons below 45 years it is a rare disorder with devastating sequelae on the affected individual. Presently there are few reports on the aetiology/risk factors for stroke in young adults in Nigeria. This is due to limited facility for thorough investigation; therefore management of such cases poses a diagnostic challenge. In this report we present a case of embolic stroke in a male undergraduate that began with two brief episodes of transient left sided weakness before a completed stroke four hours later. 2-D echocardiography showed that the likely source of emboli to be a non-pedunculated left atria tumour attached to the root of posteriormitral valve leaflet. Intracardiac mass should be considered a possible risk factor for ischemic stroke in young adult, especially in the absence of other risk factors such as connective tissue disorders, HIV/AIDS, hemoglobinopathy or use of recreational drugs. High index of suspicion is required in order not to overlook such source of emboli. Early diagnosis offers the best panacea for a definitive therapy and prevention of stroke recurrence with its devastating sequelae.Intracardic tumour, risk factor, stroke . Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp. 82-8

Regional research priorities in brain and nervous system disorders

The characteristics of neurological, psychiatric, developmental and substance-use disorders in low-and middle-income countries are unique and the burden that they have will be different from country to country. Many of the differences are explained by the wide variation in population demographics and size, poverty, conflict, culture, land area and quality, and genetics. Neurological, psychiatric, developmental and substance-use disorders that result from, or are worsened by, a lack of adequate nutrition and infectious disease still afflict much of sub-Saharan Africa, although disorders related to increasing longevity, such as stroke, are on the rise. In the Middle East and North Africa, major depressive disorders and post-traumatic stress disorder are a primary concern because of the conflict-ridden environment. Consanguinity is a serious concern that leads to the high prevalence of recessive disorders in the Middle East and North Africa and possibly other regions. The burden of these disorders in Latin American and Asian countries largely surrounds stroke and vascular disease, dementia and lifestyle factors that are influenced by genetics. Although much knowledge has been gained over the past 10 years, the epidemiology of the conditions in low-and middle-income countries still needs more research. Prevention and treatments could be better informed with more longitudinal studies of risk factors. Challenges and opportunities for ameliorating nervous-system disorders can benefit from both local and regional research collaborations. The lack of resources and infrastructure for health-care and related research, both in terms of personnel and equipment, along with the stigma associated with the physical or behavioural manifestations of some disorders have hampered progress in understanding the disease burden and improving brain health. Individual countries, and regions within countries, have specific needs in terms of research priorities.Fil: Ravindranath, Vijayalakshmi. Indian Institute of Science; IndiaFil: Dang, Hoang Minh. Vietnam National University; VietnamFil: Goya, Rodolfo Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Bioquímicas de La Plata ; ArgentinaFil: Mansour, Hader. University of Pittsburgh; Estados Unidos. Mansoura University; EgiptoFil: Nimgaonkar, Vishwajit L.. University of Pittsburgh; Estados UnidosFil: Russell, Vivienne Ann. University of Cape Town; SudáfricaFil: Xin, Yu. Peking University; Chin

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Case Report on A 13 Year Old Nigerian Boy with Gilles De La Tourette Syndrome

Case report on a 13 year old Nigerian boy with Gilles de la Tourette's syndrome, an uncommon disorder of movement and sound. The diagnosis was based on clinical features of multiple motor tics, followed by vocal tics that started in childhood complicated by mood swings and poor academic performance. This case brings to fore the need for a high index of clinical suspicion as well as a need for proper documentation with accurate clinical diagnosis and that this disease cuts across racial and cultural divides

Stroke Among Young Adults at the LAUTECH Teaching Hospital, Osogbo, Nigeria

Background: Stroke in young adults is relatively rare and there are very few hospital reports about it in Nigeria. The aetiologic mechanisms of stoke among young adults are quite distinct from those of the adults' populations.Objective: The purpose of this retrospective study was to determine the frequency, aetiologic mechanisms and prognosis of stroke among young adults at the LAUTECH Teaching Hospital Osogbo Nigeria.Methods: The study was both retrospective and descriptive. Case notes of stroke patients aged 16-45 years managed at the LAUTECH Teaching Hospital Osogbo from June 2005 till February 2008 were retrieved. Demographic data, clinical profile of stroke, laboratory investigation results and treatment outcomes were collated. Clinical diagnosis and classification of stroke was mainly clinical using the WHO clinical criteria. Only 3 patients had cranial CT scan.Results: Out of the total number of 208 stroke patients managed during this period, 27(12.9%) were aged 45 years and below. This comprised of 17 males and 10 females. The age range was between 23-45 years. Using the WHO clinical criteria, there were 14 cases of heamorrhagic CVD and 13 cases of ischaemic CVD. The three cranial CT scan that were done revealed cerebral infarction which was consistent with the clinical diagnosis. Severe hypertension was found in 16 (59.2%) patients on admission.3 patients had clinical and electrocardiographic evidence of rheumatic heart disease with infective endocarditis.Other risk factors included Sickle cell disease, cardiac arrhythmias etc. 8 out of the 27 patients died giving a percentage mortality of 29.6% and 7 patients were discharged against medical advice.Conclusion: Heamorrhagic stroke was slightly more frequent than ischaemic CVD. Systemic hypertension was also found to be prevalent among these young Nigerian adults with stroke. However, it was difficult to unravel the aetiologic mechanisms of stroke in this study because of paucity of investigations.Keywords: Stroke, young adults, hospital, Nigeria

Acute Stroke at The University College Hospital Ibadan, Nigeria: Clinical Profile and Predictors of 30-day Mortality

Stroke is a common public health problem in Nigeria and a leading cause of hospitalization in neurological services. Currently, there is limited information on predictors of early mortality in hospitalized patients in this region. The objectives of this study were to determine the 30-day case fatality rate as well as predictors of early mortality after stroke. This was a prospective study of all stroke patients admitted to the University College Hospital Ibadan Nigeria between July 2002 and September 2003.The diagnosis of stroke was mainly clinical using the WHO clinical criteria. Only 21 patients had Cranial CT scans due to the frequent breakdown of the machine during the study and the high cost of the investigation procedure. Predictors of 30-Day mortality: GCS140mg/dl, Age>70 years, NIHSS score>20, Heamorrhagic stroke, Systolic and Diastolic Hypertension were studied in all the patients. A total of 135 patients were enrolled in the study, comprising 74 males (54.8%) and 61 women (45.2%). Mean age was 62.3±12.Ischaemic CVD accounted for 71% of all cases while ICH was 22% and SAH was 7%. The over-all mortality was 15.5% and was closely related to the NIHSS score, level of consciousness (GCS) and associated complications such as raised intracranial pressure and aspiration pneumonia. NIHSS score > 20 was the only significant independent predictor of thirty days mortality in this study. The case fatality rate in this study was relatively lower than the value obtained in most previous hospital reports from Nigeria and Africa. This may be due to improved stroke care among others in this centre.Key words: Stroke, case fatality rate, predictors of 30- day mortalit

Tetanus remains a formidable health challenge in Nigeria: The experience from a single Teaching Hospital in Osun State, Nigeria.

Background: Tetanus, though an eminently preventable disease still ranks as a leading cause of death in Nigeria as well as in other developing countries. Reported mortality for severe tetanus varies from 20-60% and depends on the availability and quality of intensive care. Farmers and artisans are mostly affected.Objectives: This retrospective study was carried out to determine the pattern of clinical presentation of tetanus, the immunization status, case fatality rate and factors influencing mortality.Methods: Case notes of patients (age > 10 and above) managed for tetanus from 2004–2008 at LAUTECH Teaching Hospital Osogbo were retrieved. Demographic, clinical data, laboratory investigation results and response to treatment were collated. The data obtained were analysed using the SPSS version 15 Statistical package.Results: Over the 5-year period,80 cases of tetanus were managed in the medical wards of LAUTECH Hospital Teaching Osogbo. However, the medical records of 12 of them could not be retrieved, leaving 68(85%) for analysis. This comprised of 45 males and 23 females. Tetanus was highest in the third decade of life. The commonest portal of entry was the lower limb (n = 43). Only one subject was fully vaccinated and received booster dose of vaccine. Thirtyone (31)out of the 68 patients died giving a case fatality rate of 51.5%.Conclusion: The mortality of tetanus is still very high from this retrospective study. The rate of immunization against tetanus was dismally low. Active immunization should be given to all Nigerians particularly those in the vulnerable group.Keywords: Tetanus, frequency,clinical types and mortalit