Psychiatric manifestations and associated risk factors among hospitalised patients with COVID-19 in Edo State, Nigeria: a cross-sectional study.

OBJECTIVE: To estimate the prevalence of depression and anxiety and identify associated risk factors in hospitalised persons with confirmed COVID-19 in Edo, Nigeria. DESIGN: A multicentre cross-sectional survey. SETTING: Patients with COVID-19 hospitalised at the three government-designated treatment and isolation centres in Edo State, Nigeria. PARTICIPANTS: The study was conducted from 15 April to 11 November 2020 among 489 patients with confirmed COVID-19 and in treatment and isolation centres in Edo State, Nigeria. The mean age of participants was 43.39 (SD=16.94) years. Male participants were 252 (51.5%) and female were 237 (48.5%). MAIN OUTCOME MEASURES: The nine-item Patient Health Questionnaire for depression, (total score: 0-27, depression ≥10), Generalized Anxiety Disorder-7 for anxiety (total score: 0-21, anxiety ≥10), and social demographic and clinical characteristics for associated risk factors. RESULTS: Of the 489 participants, 49.1% and 38.0% had depressive and anxiety symptoms, respectively. The prevalence rates of depression, anxiety and combination of both were 16.2%, 12.9% and 9.0%, respectively. Moderate-severe symptoms of COVID-19, ≥14 days in isolation, worrying about the outcome of infection and stigma increased the risk of having depression and anxiety. Additionally, being separated/divorced increased the risk of having depression and having comorbidity increased the risk of having anxiety. CONCLUSION: A substantial proportion of our participants experienced depression, anxiety and a combination of both especially in those who had the risk factors we identified. The findings underscore the need to address modifiable risk factors for psychiatric manifestations early in the course of the disease and integrate mental health interventions and psychosocial support into COVID-19 management guidelines.

Acute kidney injury and mortality in pediatric Lassa fever versus question of access to dialysis.

OBJECTIVES: To assess the prevalence of acute kidney injury (AKI), and its impact on outcome in hospitalized pediatric patients with Lassa fever (LF). METHODS: We reviewed the presenting clinical and laboratory features and outcomes of 40 successive hospitalized children with PCR-confirmed LF. The diagnosis and staging of AKI was based on KDIGO criteria. We compared groups of patients using t- or χ2 tests as necessary, and took p-values <0.05 as indicative of the presence of significant differences. RESULTS: Sixteen (40%) children had AKI. Case fatality rate (CFR) was 9/16 (56%) in children with and 1/24 (4%) in those without AKI (OR [95% CI] of CFR associated with AKI = 29.57 [3.17, 275.7]). Presentation with abnormal bleeding (p = 0.008), encephalopathy (p = 0.004), hematuria plus proteinuria (p = 0.013), and elevated serum transaminase levels (p <0.02) were significantly associated with an increased prevalence of AKI. CONCLUSION: AKI prevalence in hospitalized pediatric patients with Lassa fever is high, and correlated with illness severity/CFR. The high prevalence underscores the need for access to hemodialysis, and clinical presentation and/or presence of hematuria plus proteinuria could serve as a ready prompt for referral for such specialized care.

Socio-demographic factors associated with overweight and obesity among primary school children in semi-urban areas of mid-western Nigeria.

BACKGROUND: Many developing countries are in a state of nutritional transition from prevalent under-nutrition to the emergent problem of over-nutrition (overweight and obesity), which is associated with increased morbidity and mortality, and whose complications can persist into adulthood with long-term consequences. However, data are limited on the risk factors for overweight and obesity (O&O) among primary school children, particularly those in rural and semi-urban areas in these countries. AIM AND OBJECTIVES: To determine the socio-demographic factors associated with overweight and obesity among primary school children in semi-urban areas. SUBJECTS AND METHODS: 1187 school pupils aged 6-11 years recruited from semi-urban areas using multistage sampling were interviewed for risk factors of overweight and obesity using a structured questionnaire. Nutritional status was assessed using body mass index and this was classified using a standard method. The proportions were compared using Pearson's chi-squared. Multivariate logistic regression analysis was also carried out with overweight and obesity as the dependent variable and socio demographic factors as independent variables. The level of statistical significance was set at p <0.05 in all the statistical analyses. RESULTS: Fifty-eight pupils (4.9%) had overweight and obesity while 1129 (95.1%) were either of normal nutritional status (1088, 91.6%) or were thin/severely thin (41, 3.5%). Among those with overweight and obesity, 41 (3.5%) were overweight and 17 (1.4%) obese. A higher prevalence of overweight and obesity was significantly associated (in unadjusted analysis) with female gender [unadjusted Odds Ratio, OR (95% CI) = 2.42 (1.37, 4.28)], attendance at private schools [OR (95% CI) = 3.34 (1.86, 6.00)], higher socio-economic status families [OR (95% CI) = 2.32 (1.65, 5.80)] and presence of a television in the pupil's bedrooms [OR (95% CI) = 2.22 (1.02, 4.82)] on bivariate analyses. However, only gender, school type and family socioeconomic status were independently associated with overweight and obesity on multivariate logistic regression analysis. CONCLUSION: We conclude that overweight and obesity among primary school pupils in semi-urban areas is associated with female gender, attendance at private schools and higher socioeconomic status families. Preventive programmes should accordingly be more directed at children from affluent families; particularly those who are females and those attending private schools.

Acute Abdomen in Pediatric Patients With Lassa Fever: Prevalence and Response to Nonoperative Management.

Few reports on the prevalence of acute abdomen (AAbd) in pediatric patients with Lassa fever (LF) are available, and no firm policy on its management exists. Here, we report on its prevalence in and the response to treatment among a cohort of children with confirmed LF. Six (10.3%) of 58 children with LF had AAbd, whereas 6 (2.8%) of 215 children with AAbd had LF. Nonoperative treatment was successful in 5 of the 6 children with both AAbd and LF. We conclude that AAbd is not uncommon in pediatric patients with LF, and it could be responsive to nonoperative treatment. Testing for LF in all children with febrile AAbd might be justified in areas in which LF is endemic.

Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting.

Background. The diagnosis and treatment of massive pericardial effusion and cardiac tamponade have evolved over the years with a tendency towards a more comprehensive diagnostic workup and less traumatic intervention. Method. We reviewed and analysed the data of 32 consecutive patients who underwent surgery on account of massive pericardial effusion and cardiac tamponade in a semiurban university hospital in Nigeria from February 2010 to February 2016. Results. The majority of patients (34.4%) were between 31 and 40 years. Fourteen patients (43.8%) presented with clinical and echocardiographic feature of cardiac tamponade. The majority of patients (59.4%) presented with haemorrhagic pericardial effusion and the average volume of fluid drained intraoperatively was 846 mL ± 67 mL. Pericardium was thickened in 50% of cases. Subxiphoid pericardiostomy was performed under local anaesthesia in 28 cases. No postoperative recurrence was observed; however 5 patients developed features of constrictive pericarditis. The relationship between pericardial thickness and development of pericardial constriction was statistically significant (p = 0.004). Conclusion. Subxiphoid pericardiostomy is a very effective way of treating massive pericardial effusion. Removing tube after adequate drainage (50 mL/day) and treatment of primary pathology are key to preventing recurrence. There is also a need to follow up patients to detect pericardial constriction especially those with thickened pericardium.

Brain sonography in African infants with complicated sporadic bacterial meningitis.

BACKGROUND: To determine the structural findings in brain sonography of African infants with complicated sporadic bacterial meningitis. MATERIALS AND METHODS: Retrospective assessment of medical records of patients who underwent brain sonography on account of complicated bacterial meningitis. The brain sonography was carried out over a 4-year period (between September 15, 2004 and September 14, 2008). RESULT: A total of 86 infants were studied (40 boys and 46 girls in a ratio of 1:1.1); more than 70% of the patients were aged below 6 months. Presenting complaint included convulsion with fever in 34 (39.53%), persistent fever 20 (23.26%), bulging fontanelles 8 (9.30%), coma 7 (8.14%) and sepsis with convulsion 6 (6.98%), among others. Patients' place of previous treatment included specialist hospitals 33 (38.37%), private hospitals 21 (24.42%), herbal home centres 12 (13.95%), nursing homes 8 (9.30%), patent medicine stores 7 (8.14%) and other non-doctor attended clinics 5 (5.81%) infants. The sonographic findings included hydrocephalus 36 (41.86%), cerebral infarction 12 (13.95%), encephalocoele 9 (10.49%) and intracerebral abscess 7 (8.14%) infants. Cerebritis 5 (5.81%), intracerebral hemorrhage 3 (3.49%), porocephalic cysts 2 (2.33%), cerebral oedema 2 (2.33%), intraventricular haemorrhage 1 (1.16%) and subdural collection 1 (1.16%) infants; 8 patients (9.30%) had normal findings. CONCLUSION: Hydrocephalus, cerebral infarction and intracerebral abscess were the most common complications elicited by sonography in this study. Early and adequate treatment with antibiotics in patients with persistent fever and convulsion with fever will reduce the complications of meningitis and its long-term neurological sequelae.