A Review of the Evidence Base for Nutrition and Nutritional Supplements in Older Adults with Bipolar Disorder: A report from the OABD task force.

OBJECTIVES: To better understand the role of nutrition in older adults (aged 50 years or older) with bipolar disorders (OABD), we conducted a systematic review of the literature and appraise existing evidence. METHODS: Following PRISMA guidelines, we searched databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Register, FDA website, and clinical trial registries through 2019 for eligible reports. The search string combined MeSH terms for bipolar disorder, nutrition and older adults. This was supplemented by snowball searching of references in relevant studies and authors were contacted to request their work where necessary. All included studies were rated with the National Institutes of Health Study Quality Assessment Tools based on study designs. RESULTS: Of 2280 papers screened, ten studies including eight observational and two interventional studies. The topic foci of the papers examined several nutrients, (including vitamin B12, vitamin D, coenzyme Q10, homocysteine, and folate), nutritional deficiencies and biochemical correlates. The prevalence rates of deficiencies varied with specific nutrients (3.7% to 71.6% for Vitamin B12 and 34.6% for Vitamin D), and between inpatient versus outpatient populations. While nutritional interventions appeared to be associated with improvement in both affective and cognitive outcomes, the sample sizes of OABD varied and were generally small. CONCLUSION: While there is evidence for the benefits of nutritional interventions on affective, cognitive and overall outcome in OABD, the quality of the evidence is limited. Our findings underscore the need for high quality studies to inform evidence-based guidelines for nutritional assessment and supplemention in OABD.

Psychosocial Wellbeing of Nigerian Teachers in Special Education Schools.

While there is evidence that impaired psychosocial wellbeing can compromise the effective performance of work-related roles, little is known about the wellbeing of teachers working with children with developmental disabilities. We interviewed 68 special education schoolteachers (response rate = 70.8%) in a Nigerian state with 12-item General Health Questionnaire and an adapted Zarit Burden Interview. About four in every ten teachers had psychological distress, representing many-fold the rates reported in the general population, and significant burden was prevalent in 51.5%. Perceived burden correlated significantly with psychological distress, anxiety/depression and social dysfunction (rs = .3). While increased burden predicted psychological distress, longer teaching experience was protective against distress. These findings underscore the need for psychosocial support for special education schoolteachers to enhance their wellbeing and roles.

The impact of Worms and Ladders, an innovative health educational board game on Soil-Transmitted Helminthiasis control in Abeokuta, Southwest Nigeria.

In most endemic sub-Saharan African countries, repeated infections with soil-transmitted helminth (STH) occur as early as six weeks after the end of mass drug administration (MDA) with albendazole. In this study, we designed a new health educational board game Worms and Ladders and evaluated its potential to complement MDA with albendazole and reduce reinfection rates through the promotion of good hygiene practices among school-aged children. The evaluation employed a randomized control trial (RCT) design. Baseline knowledge, attitude and practices (KAP) relating to STH were obtained using a questionnaire from 372 pupils across six schools in Abeokuta, Nigeria. Schools were randomly assigned into intervention and control group, with the former and latter receiving Worms and Ladders and the common Snake and Ladder board game respectively. Fresh stool samples were also collected at baseline for STH diagnosis before administering 400mg single dose albendazole. Follow-up assessments of STH burden and KAP were conducted three and six months' post-intervention. Data generated from the study were analyzed using SPSS 20.0 software, with confidence interval set at 95%. Prevalence of STH dropped from 25.0% to 10.4% in the intervention group and 49.4% to 33.3% in the control group at three months' post-intervention. The prevalence further dropped to 5.6% in the intervention group at six months' post-intervention. However, it increased to 37.2% in the control group at six months' post-intervention. There was a significant difference (p<0.05) in prevalence after intervention among the groups. KAP on transmission, control and prevention of STH significantly improved (p<0.05) from 5.2% to 97.9% in the intervention group compared to 6.2% to 7.1% in the control group. The Worms and Ladders board game shows the potential to teach and promote good hygiene behavior among SAC. These findings posit the newly developed game as a reliable tool to complement mass drug administration campaigns for STH control.

Do genetic variations in proximal tubule transporters influence tenofovir-induced renal dysfunction? An exploratory study in a Ghanaian population.

OBJECTIVES: To assess associations between polymorphisms within genes encoding proximal tubule transporters implicated in tenofovir renal clearance and kidney tubular dysfunction (KTD), chronic kidney disease (CKD) and individual biochemical parameters. PATIENTS AND METHODS: The study included a cohort of HIV-positive Ghanaians receiving regimens containing tenofovir disoproxil fumarate (n = 66) for at least 6 months prior to study enrolment. SNPs in ABCC10, ABCC2 and ABCC4 were selected for analysis based on previous published associations. All SNPs were genotyped by real-time PCR allelic discrimination. Creatinine clearance (CLCR), serum and urine creatinine concentrations and biochemical measures of KTD were assessed. Statistical significance was determined through univariate linear or binary logistical regression (P ≤ 0.05). RESULTS: None of the SNPs evaluated was associated with CKD or KTD. A trend between body weight and higher incidence of CKD (P = 0.012, OR = 0.9) was observed. ABCC10 2843T>C (rs2125739) was significantly associated with lower log10 baseline creatinine (P = 0.001, ß= -0.4), higher baseline CLCR (P = 0.008, ß = 65.2) and lower CLCR after 1 year (P = 0.024, ß= -26.6). CONCLUSIONS: This study demonstrates an association of ABCC10 rs2125739 with indicators of declining renal function and builds on current knowledge of this interaction within a Ghanaian cohort.

POSTERIOR UVEAL EFFUSION POST TRABECULECTOMY IN UNILATERAL INFANTILE GLAUCOMA: A CASE REPORT AND MANAGEMENT CHALLENGES.

Choroidal effusion is an abnormal collection of fluid within the suprachoroidal potential space. It is a common complication following glaucoma filtering surgeries such as trabeculectomy. It is a clinical diagnosis that sometimes goes undetected or unreported, except when symptomatic. Reported incident rates is 7.9 - 18.8% for serous effusions and 0.7 - 3% for haemorrhagic effusions. This report aims to highlight a case of choroidal effusion after trabeculectomy and its management challenges. CASE REPORT: A seven year old boy presented to our facility with history of cloudy appearance of the right eye of five years duration. He was diagnosed with right infantile glaucoma. Intraocular pressures (IOP) were 44mmHg and 18mmHg right and left eyes respectively. Patient subsequently had right trabeculectomy. He developed hypotony at post-operative day two and a right choroidal effusion was noticed at post-operative day four. As a result of this, he initially had a right anterior chamber reformation with ocular viscoelastic on day seven. Later, a compression suture over the bleb and sclerostomy was performed 11 days post initial surgery. Choroidal effusion progressively regressed post-operatively and completely resolved at day five post-sclerostomy and effusion drainage. CONCLUSION: Choroidal effusion is a common complication after trabeculectomy in which conservative management results in resolution. However, when conservative management fails, surgical intervention should not be delayed to maximize good outcome.

Morinda lucida Aqueous Stem Bark Extract Ameliorates Hepato-Renal Dysfunctions in Experimental Diabetes Model.

Diabetes Mellitus (DM) is a leading pan-systemic endocrine disorder with attendant high morbidity and mortality owing to its deleterious effects on vital body organs caused by untreated chronic hyperglycemia, attendant oxidative stress and glycation processes. The present study is designed to investigate possible protective role and mechanism(s) of action 125-500 mg/kg/day of Morinda lucida aqueous stem bark extract (MLASE) on renal and hepatic functions in alloxan-induced hyperglycemic rats for 8 days. Forty-two alloxan-induced hyperglycemiic male Wistar rats were randomly allotted to Groups II-VI and orally treated with 10 ml/kg/day distilled water, 5 mg/kg/day glibenclamide, 125 mg/kg MLASE, 250 mg/kg MLASE, and 500 mg/kg/day MLASE, respectively. Group I normal rats served as untreated control and were orally treated with 10 ml/kg of distilled water, all under same sham-handling. Blood samples were taken for measurement of fasting blood glucose, renal and hepatic function profile. Liver and kidney tissue samples were taken for determination of the activities of oxidative stress markers such as malondialdehyde (MDA), reduced glutathione (GSH), and glutathione peroxidase (GPx), catalase (CAT) and superoxidase dismutase (SOD). Results showed that intraperitoneal injection with 120 mg/kg of alloxan in cold 0.9% normal saline reliably and significantly induced a steadily sustained hyperglycemia which were ameliorated by short-term oral treatment with 125-500 mg/kg/day of MLASE, dose dependently, similar to that ameliorated by the standard antihyperglycemic drug, glibenclamide. Similarly, MLASE significantly mitigated against derangements in the measured renal and hepatic function parameters as well as oxidative stress induced by alloxan-induced hyperglycemia. In conclusion, results of this study showed the protective role of 125-500 mg/kg/day of MLASE in chronic hyperglycemia-associated renal and hepatic dysfunctions which was mediated via antioxidant and free radical scavenging activities of MLASE.

Practice of hot abdominal compression among parturient women at the University College Hospital, Ibadan, Nigeria

Background: The postpartum period is an important period of excitement with the arrival of the newborn. The body then starts physiological adaptations to revert to the pregnancy states. These physiological adaptations can be associated with some cultural practices like hot abdominal compress (HAC) which may have harmful effects such as hot water burns, abdominal wrinkling and darkening. This study assessed the practice of HAC among mothers seen at the postnatal clinic of the University College Hospital (UCH), Ibadan, Nigeria. Methods: This was a cross-sectional study among 290 postpartum women recruited consecutively at the postnatal clinic in UCH between 1st December 2015 and 29th February 2016. Data collection was by pretested self-administered questionnaire and was analysed using SPSS version 22.0. p value was set at < 0.05. Results: The participants' mean age was 31.88 (SD+ 5.1 years), 97.2% of the women had ANC in formal setting and 53.8% had vaginal delivery. Of the 290 participants, 264 (91.0%) were aware of HAC and 51.7% practiced HAC. The return of uterus to normal size (34.7%) and mothers' encouragements (24.7%) were the commonest reason for practice of HAC. Mothers' and mothers-in-law' assisted with HAC in 46.2% and 36.6% of cases, respectively. More vaginally-delivered women practiced HAC (p < 0.001). Conclusion: This study showed that practice of postpartum HAC is high and the reasons for the practice are more of tradition and cultural beliefs. There is need for more studies to better understand this culturally deep-rooted practice

Practice of hot abdominal compression among parturient women at the University College Hospital, Ibadan, Nigeria

Background: The postpartum period is an important period of excitement with the arrival of the newborn. The body then starts physiological adaptations to revert to the pregnancy states. These physiological adaptations can be associated with some cultural practices like hot abdominal compress (HAC) which may have harmful effects such as hot water burns, abdominal wrinkling and darkening. This study assessed the practice of HAC among mothers seen at the postnatal clinic of the University College Hospital (UCH), Ibadan, Nigeria. Methods: This was a cross-sectional study among 290 postpartum women recruited consecutively at the postnatal clinic in UCH between 1st December 2015 and 29th February 2016. Data collection was by pretested self-administered questionnaire and was analyzed using SPSS version 22.0. p value was set at < 0.05. Results: The participants' mean age was 31.88 (SD+ 5.1 years), 97.2% of the women had ANC in formal setting and 53.8% had vaginal delivery. Of the 290 participants, 264 (91.0%) were aware of HAC and 51.7% practiced HAC. The return of uterus to normal size (34.7%) and mothers' encouragements (24.7%) were the commonest reason for practice of HAC. Mothers' and mothers-in-law' assisted with HAC in 46.2% and 36.6% of cases, respectively. More vaginally-delivered women practiced HAC (p < 0.001). Conclusion: This study showed that practice of postpartum HAC is high and the reasons for the practice are more of tradition and cultural beliefs. There is need for more studies to better understand this culturally deep-rooted practice

The Effect of Gene Variants on Levonorgestrel Pharmacokinetics When Combined With Antiretroviral Therapy Containing Efavirenz or Nevirapine.

Reduced levonorgestrel concentrations from the levonorgestrel contraceptive implant was previously seen when given concomitantly with efavirenz. We sought to assess whether single nucleotide polymorphisms (SNPs) in genes involved in efavirenz and nevirapine metabolism were linked to these changes in levonorgestrel concentration. SNPs in CYP2B6, CYP2A6, NR1I2, and NR1I3 were analyzed. Associations of participant demographics and genotype with levonorgestrel pharmacokinetics were evaluated in HIV-positive women using the levonorgestrel implant plus efavirenz- or nevirapine-based antiretroviral therapy (ART), in comparison to ART-naïve women using multivariate linear regression. Efavirenz group: CYP2B6 516G>T was associated with lower levonorgestrel log10 Cmax and log10 AUC. CYP2B6 15582C>T was associated with lower log10 AUC. Nevirapine group: CYP2B6 516G>T was associated with higher log10 Cmax and lower log10 Cmin . Pharmacogenetic variations influenced subdermal levonorgestrel pharmacokinetics in HIV-positive women, indicating that the magnitude of the interaction with non-nucleoside reverse transcriptase inhibitors (NNRTIs) is influenced by host genetics.

Pharmacogenetics of pregnancy-induced changes in efavirenz pharmacokinetics.

Pregnancy-induced physiological changes alter many drugs' pharmacokinetics. We investigated pregnancy-induced changes in efavirenz pharmacokinetics in 25 pregnant and 19 different postpartum women stratified from 211 HIV-positive women in whom a preliminary pharmacogenetic study had been undertaken. Despite significant changes in CL/F during pregnancy (42.6% increase; P = 0.023), median (range) Cmin was 1,000 ng/mL (429-5,190) with no significant change in Cmax (P = 0.072). However, when stratified for CYP2B6 516G>T (rs3745274) genotype, efavirenz AUC0-24 , Cmax and Cmin were 50.6% (P = 0.0013), 17.2% (P = 0.14), and 61.6% (P = 0.0027) lower during pregnancy (n = 8) compared with postpartum (n = 6) in 516G homozygotes, with values of 25,900 ng.h/mL (21,700-32,600), 2,640 ng/mL (1,260-3,490), and 592 ng/mL (429-917), respectively, and CL/F was 100% higher (P = 0.0013). No changes were apparent in CYP2B6 516 heterozygotes (14 pregnant vs. 7 postpartum). The clinical implications of these findings warrant further investigation.

A cross-sectional evaluation of the correlation between disease severity and quality of life in chronic rhinosinusitis patients in Nigeria.

Quality of Life (QoL) studies are increasingly being used as the primary outcome measure in chronic rhinosinusitis (CRS) globally. However, little is known about QoL and the interplay of identifiable factors on QoL in CRS in sub-Saharan Africa. This study investigated the correlation between disease severity and QoL in chronic rhinosinusitis patients. A total of 147 adults with subjective severity rating of CRS were studied. Participants were assessed using designed questionnaire, Individual Rhinosinusitis Symptom Severity Score Assessment (IRSSSA) and Rhinosinusitis Disability Index (RSDI) questionnaires to elicit socio-demographic/clinical profile, CRS symptom severity and QoL, respectively. The mean age of the participants was 36.86 ± 11.91 years. The mean severity score of all 147 CRS cases was 3.8 ± 1.13. The majority of participants (N = 80; 54.4 %) had moderate disease. The RSDI mean scores for the participants for overall HRQoL were 40.6 ± 19.8. (Median = 40; Range = 77), for physical domain 15.2 ± 7.7, functional domain 12.1 ± 6.4 and emotional domain 13.2 ± 8.2. The trend of association between the disease severity scores and the overall HRQoL on Pearson linear correlation indicates a positive linear association of worsening overall HRQoL with increasing disease severity (R = 0.83; P < 0.0001). The severity of CRS impacted negatively on the HRQoL. All domains were significantly affected by the disease severity particularly the physical domain. Patients adjudged severity of their disease and its' impact on their quality of life should be considered in the determination of the line of their management which could include psychosocial intervention.

Burnout among doctors in residency training in a tertiary hospital.

The mental health of doctors is an issue of growing concern all over the world as it frequently interplays with their professional trainings and responsibilities. This study was done to determine the pattern and correlates of burnout among 204 doctors undergoing residency training. Eligible participants were interviewed using designed questionnaire, General Health Questionnaire (GHQ-12) and Maslach Burnout Inventory (MBI). The mean age of participants was 33.44±4.50. Ninety-three (45.6%) respondents reported burnout in the dimension of emotional exhaustion (EE), 118 (57.8%) in the dimension of depersonalization (D), and 126 (61.8%) in the dimension of reduced personal accomplishment (RPA). Factors that were significantly associated with all the dimensions of burnout were perceived heavy workload and presence of emotional distress (based on GHQ score of ≥3). The perception of call duty as being not stressful was negatively predictive of burnout in the emotional exhaustion subscale (odds ratio [OR]=0.52; 95%confidence interval [CI]=0.29-0.97; p=0.03), while emotional distress was a positive predictor (OR=6.97; 95%CI=3.28-14.81; p<0.001]. Absence of doctor-to-doctor conflict negatively predicted burnout in the depersonalization subscale (OR=0.36; 95%CI=0.17-0.76); p<0.01), while older age (OR=0.66; 95%CI=0.47-0.95; p=0.03) and adequate support from the management (OR=0.45; 95%CI=0.22-0.90; p=0.02) constituted negative predictors of burnout in the reduced personal accomplishment subscale. Burnout is highly prevalent among resident doctors. Evolvement of comprehensive mental health services, training supports, conflict de-escalation/resolution mechanisms, and periodic assessment are indicated to mitigate work related distress with burn out among resident doctors, while improving their productivity.

Factors associated with anxiety disorders among HIV-positive attendees of an HIV clinic in Lagos, Nigeria.

Anxiety disorders (ADs) occurring in people living with HIV/AIDS (PLWHA) are often poorly identified in spite of the untold consequences that may result if not diagnosed and treated promptly. This study aimed to describe factors associated with ADs among PLWHA. Three hundred participants were administered sociodemographic/clinical profile questionnaires, and diagnoses of ADs were made using Schedule for Clinical Assessment in Neuropsychiatry (SCAN) based on International Classification of Diseases, 10th edition (ICD-10) criteria. In this study, 65 (21.7%) participants were diagnosed with ADs. A lack of family support, unemployment, younger mean age and being unmarried (P < 0.05) were factors associated with ADs in PLWHA; however, lack of family support (odds ratio [OR] = 0.458, 95% confidence interval [CI] = 0.254-0.827, P = 0.010), being unmarried (OR = 1.930, 95% CI = 1.046-3.560, P = 0.035) and unemployment (OR = 0.495, 95% CI = 0.264-0.926, P = 0.028) were the only factors that remained significant following logistic regression analysis. Prompt identification with active management of ADs and their associated factors among PLWHA are advocated. Further research on the risk factors for ADs is also warranted.