Profile of Acute Poisoning among Adult Patients at the Emergency Room of a Tertiary Hospital, South-western Nigeria.

BACKGROUND AND OBJECTIVE: Acute poisoning often presents as an acute medical condition necessitating prompt medical care. Few data exist on adult poisoning and management protocol often are inadequate. Assessing the cases may inform a more robust protocol for case management, necessitating this study. The objective was to assess cases of acute poisoning and determine the agents as well as their outcomes. METHODS: This was a retrospective study involving 53 adult cases of acute poisoning at the emergency room (ER) of a tertiary hospital over 5 years (2016­2020). The ER register was assessed for the gender, type of agent and outcome of the medical condition. Cases admitted to the ward were followed up to determine their outcomes. RESULTS: There were more males, 34 (64.2%) than females. 19 (35.8%) with a mean age of 29.2 ± 13.5 years and 24.6 ± 8.2 years respectively. Organophosphates accounted for 22 (41.5%) of cases followed by a cocktail of unknown mixture in 12 (22.6%) and paraquat in 6 (11.3%) cases. Alcohol, medications, and alkali were responsible for 5 (9.5%), 4 (7.5%) and 4 (7.5%) cases respectively. Mortality was recorded in 11 (20.8%) of cases this was mostly associated with paraquat. In addition, 1 (1.9%) case was referred to another facility while 2 (3.8%) cases required longer hospital stay. More than 50% of the cases were discharged within 24 to 48 hours while 6 (11.3%) cases were discharged against medical advice. CONCLUSION: Organophosphate appears to be the most common agent responsible for acute poisoning in adults in this environment and young male adults have a higher risk. Most of the poisoning cases were discharged however, mortality was high, particularly among those with paraquat poisoning.

CONTEXTE ET OBJECTIF: L'intoxication aiguë se présente souvent comme une condition médicale aiguë nécessitant des soins médicaux rapides. Il existe peu de données sur l'empoisonnement chez les adultes et le protocole de gestion est souvent inadéquat. L'évaluation des cas peut éclairer un protocole plus robuste pour la gestion des cas, ce qui nécessite cette étude. L'objectif estd'évaluer les cas d'intoxication aiguë et de déterminer les agents ainsi que leurs résultats. MÉTHODES: Il s'agissait d'une étude rétrospective portant sur tous les cas d'intoxication aiguë auxurgences d'un hôpital tertiairesur une période de 5 ans (2016-2020). Le registre des urgences a été évalué pour le sexe, le type d'agent et l'issue de l'état de santé. Les cas renvoyés au service ont fait l'objet d'un suivi pour déterminer les résultats. RÉSULTATS: La proportion de bières était plus élevée que celle des femmes (64,2 % contre 35,8 %) avec un âge moyen de 29,2 ±13,5 ans et 24,6 ±8,2 ans respectivement. L'organophosphate représentait 41,5 % des cas, suivi du mélange cocktail (22,6 %) et du paraquat (11,3 %). L'alcool, les drogues et les alcalis étaient responsables de 9,4 %, 7,6 % et 7,5 % respectivement. Mortalité wtelle qu'enregistrée dans 20. 8 % des cas; 1,9 % ont été référés tandis que 3,8 % ont dû rester plus longtemps à l'hôpital. Plus de 50 % des cas ont reçu leur congé dans les 24 à 48 heures, tandis que 11,3 % ont reçu leur congé contre avis médical. Le paraquat était le plus souvent responsable de la mort, tandis que l'alcool, les alcalis et les opioïdes avaient le même taux de mortalité. Neuf (17,0 %) des 11 (20,8 %) mortalités étaient des hommes CONCLUSION: La mortalité par intoxication aiguë est élevée et l'empoisonnement au paraquat est l'agent le plus mortel suivi par l'organophosphate. Les jeunes hommes sont prédisposés à l'empoisonnement par l'organophosphate ou le paraquat pour lesquels la mortalité est élevée. Mots-clés: Empoisonnement, Paraquat, Urgence, Organophosphate, MMortalité.

Plasma and Tissue Trace Element Levels in Drug Naïve Patients with Schizophrenia in a Tertiary Health Facility in Southwest Nigeria.

BACKGROUND: Trace elements are involved in oxidation reduction reactions in the body, including the central nervous system. The relationship between trace elements and psychiatric disorders have not been extensively investigated in the local population. We assessed the relationships between selected trace elements and schizophrenia. METHODS: A cross-sectional study of 70 newly diagnosed participants with schizophrenia, mean age = 33.6 ±10.7 years were recruited by simple random sampling. Sixty age-matched healthy subjects, mean age of 34.2 ± 7.9 years were recruited as control. Plasma Zn, Cu, Mn and Se were measured using atomic absorption spectrophotometer while toe nail Zn, Cu, Mn and Se were measured using inductively coupled plasma optical emission spectroscopy in both participants and controls. Illness severity was assessed using PANSS score. RESULTS: Mean plasma Zn, Cu and Mn were significantly lower in patients with schizophrenia than in control (p<0.001) while mean concentration of plasma Se was significantly higher in patients with schizophrenia than in control (p<0.001). Mean concentration of toenail Zn, Cu and Mn were significantly lower among schizophrenic group than in control group (p<0.001), however, mean toe nail Se level was similar in schizophrenic and control groups. In logistic regression, low plasma levels of Zn (Odds Ratio = 2.296, p<0.001), Cu (p<0.001), Mn (p<0.001) and Se (p<0.001) were independently associated with schizophrenia. There was no significant relationship between plasma Zn, Cu, Mn and Se and severity of illness using PANSS score. CONCLUSION: There is a possibility that low levels of Zn, Cu and Mn are involved in the aetiopathogenesis and progression of schizophrenia.

CONTEXTE: Les oligo-éléments participent aux réactions d'oxydoréduction dans l'organisme, y compris dans le système nerveux central. La relation entre les oligo-éléments et les troubles psychiatriques n'a pas été étudiée de façon approfondie dans la population locale. Nous avons évalué les relations entre certains oligo-éléments et la schizophrénie. MÉTHODES: Une étude transversale a été menée auprès de 70 participants atteints de schizophrénie, dont l'âge moyen était de 33,6 ± 10,7 ans, recrutés par échantillonnage aléatoire simple. Soixante sujets sains appariés selon l'âge, âgés en moyenne de 34,2 ± 7,9 ans, ont été recrutés comme témoins. Le Zn, le Cu, le Mn et le Se du plasma ont été mesurés à l'aide d'un spectrophotomètre d'absorption atomique, tandis que le Zn, le Cu, le Mn et le Se des ongles des orteils ont été mesurés à l'aide d'une spectroscopie d'émission optique à plasma à couplage inductif chez les participants et les témoins. La gravité de la maladie a été évaluée à l'aide du score PANSS. RÉSULTATS: La concentration plasmatique moyenne de Zn, Cu et Mn était significativement plus faible chez les patients atteints de schizophrénie que chez les témoins (p<0,001), tandis que la concentration moyenne de Se était significativement plus élevée chez les patients atteints de schizophrénie que chez les témoins (p<0,001). La concentration moyenne de Zn, Cu et Mn étaient significativement plus faibles dans le groupe schizophrène que dans le groupe témoin (p<0,001), cependant, le niveau moyen de Se dans les ongles des orteils était similaire dans les groupes schizophrènes et témoins. Dans la régression logistique, de faibles niveaux plasmatiques de Zn (Odds Ratio = 2,296, p<0,001), Cu (p<0,001), Mn (p<0,001) et Se (p<0,001) étaient indépendamment associés à la schizophrénie. Il n'y avait pas de relation significative entre le Zn, Cu, Mn et Se plasmatiques et la gravité de la maladie selon le score PANSS. CONCLUSION: Il est possible que de faibles niveaux de Zn, Cu et Mn soient impliqués dans l'étiopathogénie et la progression de la schizophrénie. Mots clés: Spectroscopie d'absorption atomique, spectroscopie d'émission optique du plasma à couplage inductif, score PANSS (Positive and Negative Syndrome Scale), schizophrénie, oligo-éléments.

Assessment of Risk Factors for Metabolic Syndrome in Adolescents with Obesity in Ile-Ife, South West Nigeria.

BACKGROUND: Metabolic syndrome (MS) is the occurrence of risk factors which increase the risk for cardiovascular diseases and type 2 diabetes mellitus. These risks factors include abdominal obesity, hypertension, increased triglycerides (TG), elevated blood glucose, and reduced high-density lipoprotein cholesterol (HDL- C). MS is now increasingly reported among children and adolescents. OBJECTIVES: To assess risk factors for MS in adolescents with and without obesity. METHODS: One hundred and twenty-five adolescents with obesity and an equal number of age- and sex- matched adolescents without obesity from secondary schools in Ile- Ife were studied. Weight, height, waist circumference, body mass index (BMI), and blood pressure (BP) were determined. Seven mls of venous blood from each participant (collected after a 12 hour overnight fast) were processed and analysed for total plasma cholesterol, triglycerides, HDL-C and fasting plasma glucose (FPG). Low density lipoprotein - cholesterol (LDL-C) was determined using Friedewald formula. Data was analysed using independent samples t-test, Chi-square test, Fisher's exact test and Pearson's correlation analysis. P- value was set at ˂ 0.05. RESULTS: Adolescents with obesity had elevated systolic (122.03 ± 13.93 mmHg vs 109.82 ± 12.07 mmHg; t= 7.40, p= 0.001) and diastolic blood pressures (76.06 ± 10.22 mmHg vs 66.78 ± 9.18 mmHg; t= 7.55, p= 0.001) compared with non- obese adolescents. Significant differences in mean HDL-C (0.97 ±0.28mmol/L vs 1.11 ± 0.38mmol/L; t= -3.40, p= 0.001) and FPG (4.30 ± 0.78mmol/Lvs 3.95 ± 0.83mmol/L; t= 3.45, p = 0.001) in adolescents with and without obesity were observed. MS was present in 18 adolescents with obesity (predominantly males) and absent in adolescents without obesity. CONCLUSION: Older male adolescents with obesity are at increased risk of MS. Low HDL- C, elevated BP and abdominal obesity were the most frequently identified risk factors.

Oxidative stress markers and disease severity among children with sickle cell anaemia

Background: Sickle cell anaemia has been associated with oxidative stress. Total Antioxidant Capacity (TAC), Total Oxidant Status (TOS) and Oxidative Stress Index (OSI) are cumulative markers of oxidative stress. Objective: To evaluate the serum levels of oxidative stress markers in children with sickle cell anaemia (SCA) and determine the relationship between these markers and disease severity. Method: One hundred and fifty-six children, comprising 78 with SCA, aged 1 - 15 years and 78 age- and sex-matched Haemoglobin AA controls were studied. Serum TOS, OSI, and TAC were determined using ELISA kits. The severity of the SCA was determined using clinical and laboratory parameters. Result: Children with SCA had lower mean serum TAC (0.83±0.31UAE) than controls (1.19±0.24UAE) with p< 0.001) but positive correlation with TOS (r = 0.3, p = 0.008) and OSI (r = 0.6, p < 0.001). Conclusion: Children with SCA had lower TAC but higher TOS and OSI than matched controls. Oxidative stress markers had a significant relationship with SCD severity

Malondialdehyde and antioxidant enzymes in second and third trimesters of pre-eclamptic Nigerian women.

AIM AND OBJECTIVE: To determine changes in malondialdehyde (product of lipid peroxidation) and antioxidant enzymes (Superoxide Dismutase, Glutathione Per-oxidase) levels in pre-eclamptic Nigerian women PATIENTS AND METHODS: A Total of 100 subjects each for pre-eclamptic,apparently normal and non pregnant women were recruited into the study.Venous blood samples were taken from the participants during second and third trimesters of pregnancy and at the point of contact for non pregnant women. Malondialdehyde, glutathione peroxidase and superoxide dismutase were measured accordingly from plasma and haemolysate prepared from whole blood.Variables were analysed using SPSS version 16, taking level of significance to be 0.05 RESULTS: Plasma malondialdehyde in the third trimester (3.13±0.61umol/l) of pre-eclamptic subjects was higher than in the second trimester (3.00±1.21umol/l).Plasma malondialdehyde in the third trimester of normal pregnancy (2.03±0.71umol/l) was also found to be significantly higher than in the second trimester (1.65±0.62umol/ l)(p<0.0001). Glutathione peroxidase in pre-eclamptic subjects was significantly higher in the third trimester (2804.11±1573.00U/L) as compared to the second trimester (2655.00±1751.30U/L), p= 0.0001.Glutathione peroxidase activity in the third trimester of normal pregnancy(3339.50±1733.80U/L) was also found to be higher than in the second trimester(3023.50±1115.90U/L)(p=0.131). Superoxide dismutase activity was significantly lower in the third trimester of pre-eclamptic pregnancy when compared to second trimester (110.40±59.47 Vs 118.01±64.41 U/ ml)(p<0.039) .Similarly,superoxide dismutase activity was significantly lower in the third trimester of normal pregnancy (110.40±59.47U/ml) than in the second trimester(153.01±71.85U/ml)(p<0.0001). CONCLUSION: There was an increased level of lipid peroxidation products,malondialdehyde in subjects with pre-eclampsia. This was more in the third trimester. There was an increased oxidative stress in pre-eclampsia as evidenced also by low serum level of superoxide dismutase in the third trimester.Diet rich in antioxidant enzyme might be beneficial.

Depressed antioxidant status in pregnant women on iron supplements: pathologic and clinical correlates.

Iron (Fe) remains a commonly prescribed supplement in pregnancy. Its possible pathologic potential is either uncommonly considered or ignored. We determined the antioxidant status in pregnant women with and without Fe supplements. Fifty-eight apparently healthy pregnant women on Fe supplements were selected for the study from the antenatal clinic of the University College Hospital, Ibadan, Nigeria. Fifty-five aged matched pregnant women who were not on Fe from various parishes of the Christ Apostolic Church, Ibadan (non-drug using Christian sect) were randomly selected as controls. Both groups were classified according to the trimesters of pregnancy. The gestational age in both pregnant women on Fe supplements and non-supplement pregnant women was similar. Fruit and vegetables consumption was higher in the supplement than in the non-supplement group (57.2% vs. 37.3%). Anthropometric indices, weight, height, and BMI, were also similar. But while the weight of the Fe supplement group decreased by nearly 3% in the third trimester, it increased by over 10% (p < 0.00) in the non-supplement group in the same period. Serum Fe level was significantly higher in the supplement than the non-supplement group (p < 0.001). In contrast, the levels of the antioxidants, ascorbic acid, copper (Cu), zinc (Zn), and bilirubin were all significantly decreased (p < 0.05, p < 0.001, p < 0.05, and p < 0.05, respectively). Uric acid level though also lower in the supplement group did not reach statistical significance (p > 0.05), while vitamin E was similar in both groups. There was relative stability of all antioxidants except uric acid, which declined from the first to the last trimester in the non-supplement group. The significantly higher Fe level in the second trimester was sustained in the third trimester though to a lesser degree (p < 0.05) and associated with significant decreases in the following antioxidant levels in the supplement group, ascorbic acid, bilirubin, Cu, and Zn (p < 0.02, p < 0.02, p < 0.02, and p < 0.001, respectively). Uric acid and vitamin E though lower in the supplement group were not significantly different. Remarkably, percentage changes between the first and third trimesters revealed that serum Fe increased by over 116% in the Fe supplement group, while it only increased by over 50% in the non-supplement group. This was associated with 23.50% decrease in ascorbate level (p < 0.003) in the supplement group, while it decreased by only 3.70% in the non-supplement group (p > 0.05). Again vitamin E decreased by 17.22% in the supplement group, while it decreased by only 7.30% in the non-supplement group during the period. Uric acid and bilirubin levels decreased by similar proportions during the period, while Zn decreased by 18.55% in the supplement group and by 14.86% in the non-supplement group. In contrast Cu increased by 7.20% in the supplement group, while it increased by only 2.96 in the non-supplement group. Additionally, all the antioxidants in the supplement group except vitamin E, viz, ascorbic acid, bilirubin, Cu, uric acid, and Zn, were significantly inversely correlated with serum Fe level (r - 0.299, p < 0.05, r - 0.278, p < 0.05, r - 0.383, p < 0.05, and r - 0.0369, p < 0.05). These data imply markedly depressed antioxidant status in the Fe supplement pregnant group with attendant oxidative stress (most probably pro-oxidant Fe-induced). This is associated with molecular and cellular damage as well as a number of pathologic and clinical correlates that underlie the exacerbation of morbidity and mortality in maternal and child populations, particularly in the developing countries. This appears to call for serious caution and prior evaluation of antioxidant and Fe status and during the use of Fe supplements in pregnancy for monitoring and prognostic purposes and to avert or ameliorate oxidative stress-induced pathologies in maternal and fetal systems.

Decreased thiamine and magnesium levels in the potentiation of the neurotoxicity of lead in occupational lead exposure.

The relationship between blood lead (Pb) and serum levels of calcium and of neural nutrients such as thiamine and magnesium (Mg) has been determined in a Nigerian population that is occupationally exposed to Pb. Forty-seven male Pb workers were recruited as test subjects and 25 males unexposed to Pb served as controls. The test subjects were classified into three groups, based on severity of exposure to Pb. Blood lead (BPb) and the serum levels of Mg, thiamine, and calcium were determined in both test subjects and controls. The mean blood Pb level was not significantly higher in Pb workers. In contrast, Mg and thiamine levels were significantly decreased (p<0.05; p<0.01, respectively). However, the calcium level was not significantly lower in test subjects than in controls. Also, there was a significant negative correlation between serum thiamine and blood Pb levels (r=-0.50; p<0.01). Furthermore, there was a significant negative correlation between serum calcium and BPb levels (r=-0.41; p<0.01). This study has shown that relatively low BPb levels can enhance Pb absorption and also potentiate Pb neurotoxicity in the presence of decreased serum thiamine and Mg levels.

Vitamin A status of pregnant Nigerian women: relationship to dietary habits and morbidity.

Vitamin A status of pregnant Nigerian women has been determined by measurement of retinol concentration in plasma samples obtained from pregnant subjects, using a spectrophotometric method. The relationship between vitamin A status, dietary habits and morbidity pattern was also examined. Two hundred (200) consecutive pregnant women registered for antenatal clinic at the Obafemi Awolowo University Teaching Hospitals Complex within a period of eight (8) weeks were recruited as subjects. The subjects were aged 15-43 years (mean 27.2 years), and were at different stages of pregnancy. Semi-structured questionnaires were administered on the subjects to obtain data on dietary habits, present health status and obstetric history. Vitamin A deficiency (plasma retinol concentration < 0.35 micromol/L) is found in 17.5% of the subjects, while 37% and 45.5% have borderline (plasma retinol concentration 0.35-0.70 micromol/L) and normal (plasma retinol concentration > 0.70 micromol/L) vitamin A status respectively. There is a significant relationship between frequent micturition and vitamin A status (chi-square = 0.39: P < 0.05). There is no relationship between maternal age and vitamin A status. Although about 80% of the subjects consumed red palm oil daily, about 64% would heat the oil to smoking for at least 10 minutes, before adding to stew during cooking. Green vegetables were also boiled in hot water before adding to sauce, while liver is consumed on just about three days per month. The findings reported in this study have further strengthened the claim that vitamin A deficiency is fairly prevalent in pregnant Nigerian women, underlining the need for prompt and effective intervention.

Antioxidant status of adult Nigerian asthmatics: implications for prognosis.

Serum antioxidant status of 50 (19M, 31F) adult asthmatic patients, aged 40 to 50 yr and attending the medical outpatient clinic of the University College Hospital, Ibadan, has been assessed, by measurement of serum ascorbic acid, copper, zinc, albumin, uric acid and magnesium levels, to determine the relationship between antioxidant status and severity of bronchial asthma. Twenty-five (25) age matched adults (10M, 15F) served as controls. The test subjects were classified into two groups (1&2) based on the degree of respiratory distress. Questionnaires were also used to obtain data on subjects' fruit and vegetable intake. Fruit and vegetable intake was similar in patients and controls, 96% and 100% respectively reporting adequate intake. Copper (Cu) level was not significantly different between patients and control subjects, but was significantly higher in female asthmatics than in males (p < 0.05). Magnesium (Mg) level was also lower in asthmatics than in control subject (p < 0.001). Plasma Zinc level was not different between patients and control (p > 0.05). The levels of the other antioxidants, vitamin C, uric acid and albumin were all lower in asthmatics than in controls (p < 0.05, p < 0.001, p < 0.001) respectively. The magnesium level of group 2 (severe asthmatics) was lower than in controls (p < 0.05) unlike moderate asthmatics (group 1) which do not differ significantly from controls. These findings support the emerging concept that antioxidants are consumed in this inflammatory disease and that a corresponding increase in antioxidant supply may improve prognosis for bronchial asthma.

Decreased serum magnesium and zinc levels: atherogenic implications in type-2 diabetes mellitus in Nigerians.

Serum magnesium, zinc and total cholesterol were evaluated in 40 Nigerian patients suffering from type-2 diabetes mellitus (21M, 19F) and 20 (14M, 6F) apparently normal non diabetic control subjects. The mean age of the diabetic patients was similar to that of controls (p > 0.05). The mean duration of the disease was (4.7 + 0.7 SEM) in these patients. Fasting blood glucose and total cholesterol were significantly higher in diabetics than in non diabetic control subjects (p > 0.001). The serum total cholesterol showed inter-group variation when the patients were classified into four different age groups. In contrast, the serum level of magnesium (Mg) and zinc (Zn) were significantly lower in diabetics than in controls (p > 0.001). There were no significant correlation between glucose and the minerals, Mg. and Zn. Serum total cholesterol showed a significant positive correlation with magnesium (r = 0.6: p > 0.001), while the correlation with zinc was not significant. In type-2 diabetic mellitus the concentration of both Mg and Zn levels were significantly reduced, probably suggesting lower antioxidant status in this condition. The implication is the greater susceptibility to LDL-cholesterol oxidation. The attendant risk of development of premature Coronary Heart Disease is discussed. Magnesium and zinc are nutritional minerals that play crucial roles in the regulation of carbohydrate and lipid metabolism.

Plasma glucose levels in exclusively breastfed newborns in the first 48 hours of life in Ile-Ife, Nigeria.

This study aims to determine the effectiveness of exclusive breastfeeding of newborns in maintaining a normal blood glucose level in the first 48 hours of life. One hundred and twelve consecutive newborns were initially recruited and 91 completed the study. All neonates of mothers with complicated pregnancy such as diabetes, hypertension and infections were excluded from the study. Maternal and cord glucose estimation were carried out within 30 minutes of delivery. All mothers were assisted in positioning and attaching their babies to the breast. All newborn were weighed and glucose levels were measured at 24 and 48 hours of life before breastfeeding. All mothers were euglycaemic while seven neonates had plasma glucose level less than 1.7 mmol/l at birth. Only one neonate had persistent hypoglycemia from birth to 12 hours of age and required treatment. All other neonates had blood glucose level above 1.7 mmol/l at 24 and 48 hours of life. The weight loss was 0.176 +/- 0.134 kg and 0.211+/-0.157 kg at 24 and 48 hours respectively. We therefore conclude that the exclusively breastfed newborns have adequate glucose supply and are not at risk of having hypoglycemia in the first 48 hours of life.