Psychosocial Factors Associated with Substance Use among Secondary School Students in Ilorin, Nigeria.

BACKGROUND: Adolescent substance use is a global concern. Identifying factors associated with it can help in preparing prevention programmes. OBJECTIVES: The objectives were to determine the sociodemographic factors associated with substance use and the prevalence of associated psychiatric morbidity among secondary school students in Ilorin. MATERIALS AND METHODS: Instruments used were a sociodemographic questionnaire, a modified WHO Students' Drug Use Survey Questionnaire, and the General Health Questionnaire-12 (GHQ-12) which was used to determine psychiatric morbidity, using a cut-off score of 3. RESULTS: Substance use was associated with older age groups, male gender, parental substance use and poor relationship with parents, and urban location of school. Reported religiosity did not confer protection against substance use. The overall prevalence of psychiatric morbidity was 22.1% (n= 442). Psychiatric morbidity was more common among users of opioids, organic solvents, cocaine and hallucinogens, with current opioid users having ten times the odds of psychiatric morbidity. CONCLUSION: Factors influencing adolescent substance use serve as a substrate for interventions. A good relationship with parents and teachers are protective factors, while parental substance use calls for holistic psychosocial support. The association of substance use with psychiatric morbidity highlights the need to incorporate behavioural treatment in substance use interventions.

CONTEXTE: La Consommation de Substances Psychoactives chez les Adolescents est une Préoccupation Mondiale. L'Identification des Facteurs qui y sont Associés Peut Aider à Préparer des Programmes de Prévention. OBJECTIFS: Déterminer les facteurs socio-démographiques associés à la consommation de substances psychoactives chez les élèves du secondaire à Ilorin. Déterminer la prévalence de la morbidité psychiatrique chez les étudiants et son association avec la consommation de substances. MATÉRIAUX ET MÉTHODES: Les instruments utilisés étaient un questionnaire sociodémographique, un questionnaire modifié de l'enquête de l'OMS sur la consommation de drogues par les étudiants, et le Questionnaire de santé générale-12 (GHQ-12) qui a été utilisé pour déterminer la morbidité psychiatrique, en utilisant un score seuil de 3. RÉSULTATS: La consommation de substances psychoactives était associée à des groupes d'âge plus élevés, au sexe masculin, à la consommation de substances psychoactives par les parents et à une mauvaise relation avec les parents, ainsi qu'à la localisation urbaine de l'école. La religiosité déclarée ne confère pas de protection contre la consommation de substances. La prévalence globale de la morbidité psychiatrique était de 22,1% (n= 442). La morbidité psychiatrique était plus fréquente chez les consommateurs d'opioïdes, de solvants organiques, de cocaïne et d'hallucinogènes, les consommateurs actuels d'opioïdes ayant dix fois plus de chances de souffrir de morbidité psychiatrique. CONCLUSION: Les facteurs qui influencent la consommation de substances psychoactives chez les adolescents servent de substrat aux interventions. Une bonne relation avec les parents et les enseignants sont des facteurs de protection, tandis que la consommation de substances par les parents nécessite un soutien psychosocial global. L'association entre la consommation de substances et la morbidité psychiatrique souligne la nécessité d'intégrer un traitement comportemental dans les interventions en matière de consommation de substances. Mots clés: Santé des adolescents, médecine des adolescents, services de santé mentale en milieu scolaire, consommation d'alcool avant l'âge légal, toxicomanie, oral, pédopsychiatrie. Traduit avec.

Benefits, disadvantages and challenges of virtual conferencing in the COVID-19 era: Adjusting to the new normal

Objective: The COVID-19 pandemic has had tremendous effect on the medical and scientific community. Measures instituted to curb the spread of the disease such as physical distancing and ban on large gatherings have significantly altered conferencing activities of medical professional associations. With no end in sight to the pandemic, it is certain that medical professional associations may have to make do with purely virtual or hybrid conferencing for some time to come. The objective of this paper is to highlight the benefits, disadvantages and challenges of virtual conferencing Methods: We searched Pubmed, Embase, Scopus, and AJOL databases from January 1, 2021 to December 31, 2021 for publications describing the benefits, disadvantages and challenges of virtual conferencing during the pandemic. This, together with authors' experience formed the resource base for this work. Conclusion: We propose ways the scientific community in Nigeria can maximize the virtual conferencing while the pandemic lasts. We also advocate increased discussion about how to improve the virtual conferencing culture and the development of guidelines for purely virtual or hybrid scientific conferences

Objectif de l'étude: La pandémie de COVID-19 a eu un effet considérable sur la communauté médicale et scientifique. Les mesures instituées pour freiner la propagation de la maladie, telles que l'éloignement physique et l'interdiction des grands rassemblements, ont considérablement modifié les activités de conférence des associations professionnelles médicales. Sans fin en vue de la pandémie, il est certain que les associations professionnelles médicales devront se contenter de conférences purement virtuelles ou hybrides pendant un certain temps encore. L'objectif de cet article est de mettre en évidence les avantages, les inconvénients et les défis de la conférence virtuelle. Méthodes de l'étude : Nous avons effectué des recherches dans les bases de données Pubmed, Embase, Scopus et AJOL du 1er janvier 2021 au 31 décembre 2021 pour trouver des publications décrivant les avantages, les inconvénients et les défis des conférences virtuelles pendant la pandémie. Ceci, combiné à l'expérience des auteurs, a constitué la base de ressources pour ce travail. Conclusion : Nous proposons des moyens pour que la communauté scientifique du Nigéria puisse maximiser les conférences virtuelles pendant la durée de la pandémie. Nous préconisons également une discussion accrue sur la manière d'améliorer la culture des conférences virtuelles et l'élaboration de lignes directrices pour les conférences scientifiques purement virtuelles ou hybrides

Prevalence of left ventricular diastolic dysfunction in newly diagnosed Nigerians with systemic hypertension: a pulsed wave Doppler echocardiographic study.

BACKGROUND: Systemic hypertension is a common cause of left ventricular diastolic dysfunction. However, its prevalence in Nigerians with untreated systemic hypertension is unknown. OBJECTIVE: To determine the prevalence of left ventricular diastolic dysfunction in newly diagnosed Nigerians with systemic hypertension using Doppler transmitral inflow and pulmonary venous flow velocities. METHODS: Two-dimensional echocardiography including Doppler was performed on 150 newly diagnosed cases of systemic hypertension and 150 normotensive controls. They were divided into hypertensives without left ventricular hypertrophy and those with left ventricular hypertrophy based on echocardiographically determined left ventricular mass index. Pulsed Doppler transmitral inflow and the pulmonary venous flow waves were used to categorise the patterns of diastolic dysfunction. RESULTS: The hypertensives and the normotensive controls were comparable in their baseline characteristics. The E/A ratio differed significantly between hypertensives with and without left ventricular hypertrophy and controls (1.00+0.30, 1.04±0.42, 1.33±0.27, p < 0.001). Left ventricular diastolic dysfunction occurred in 62% of systemic hypertension and 11.3% of the controls. Impaired relaxation was the commonest pattern (84.9%) of diastolic dysfunction. CONCLUSION: Our study showed that left ventricular diastolic dysfunction is prevalent in Nigerians with newly diagnosed systemic hypertension and effort should be made to routinely screen for them.

The Role of Echocardiography in the Management of Stroke

BACKGROUND: Echocardiography is increasingly being used as a screening test to identify sources of cardiogenic embolism in patients with ischemic stroke or transient ischaemic attack (TIA). However; no consensus exists presently on the utilization of this imaging facility in individuals with stroke. OBJECTIVE: To evaluate the yield of transthoracic echocardiography in patients with ischaemic stroke with a view to providing guidance in its use in clinical management of stroke. METHODS: One hundred and twenty-six consecutive stroke patients with 90 controls were recruited prospectively. Patients were examined echocardiographically for evidence of intramural thrombus; congenital defects; valvular heart disease; wall motion abnormalities and intra-cardiac masses using twodimensional; m-Mode and Doppler facilities. RESULTS: Potential cardiac source of emboli (CSE) was identified in 23.0of the stroke patients. Those who had CSE identified aged 53.0(20.8) years were younger (p=0.0001) than those who did not have CSE; 57.2 (13.5) years. Five (4.0) patients had rheumatic valvular heart disease with demonstrable clots in the left atrium. On the other hand; four(3.2) patients had RHD without thrombi seen. Two patients had biventricular thrombi. One of these patients had giant clots within the ventricles and multiple freely mobile thrombi in right ventricle without obvious cardiac structural defect. CONCLUSION: Young stroke or transient ischaemic attacks patients who have clinical signs suggesting the heart as the potential CSE should have low threshold for echocardiography. However; there is a need for rationalisation of request for echocardiography where such clinical signs are absent

Prevalence of QTc prolongation in adult Nigerians with chronic heart failure.

BACKGROUND: The heart rate corrected QT interval (QTc) on the electrocardiogram (ECG) has been proposed as a risk factor for ventricular arrhythmias and death in apparently healthy populations, patients with myocardial infarction and diabetes mellitus. However, data on the significance of QTc prolongation in heart failure are scarce. OBJECTIVE: Our objective was to examine the prevalence of QTc prolongation in adult Nigerians with heart failure and its association with arrhythmias. METHODS: Ninety consecutive patients with heart failure were recruited along with 90 age-and sex-matched controls. All the subjects had a 12-lead ECG and a rhythm strip (lead II). The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using a 2D guided m-mode and Doppler echocardiogram respectively. RESULTS: The mean age of the patients was 51.9 (16) years compared with 50.3 (15.2) years for the control group, p = 0.47. Mean left ventricular ejection fraction was significantly lower in the patients than in the controls (38.9 (11)% versus 72.2 (8)%), p = 0.001. The mean QTc was significantly prolonged in the patients than in the controls (0.472 (0.036) versus 0.390(0.032) respectively), p = 0.001. The prevalence of QTc prolongation was 63% in the patients against 4.4% in the controls. There was a significant association between ventricular arrhythmias and QTc prolongation. CONCLUSION: The results of this study shows that there is a high prevalence of QTc prolongation in adult Nigerians with heart failure and this may be harbinger for ventricular arrhythmias and sudden death.

Intracardiac tumor: a risk factor for stroke in the young--a case report.

BACKGROUND: Stroke occurs commonly in individuals above 65 years, 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. OBJECTIVE: 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 posterior mitral valve leaflet. CONCLUSION: 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.

Prognostic significance of QT interval prolongation in adult Nigerians with chronic heart failure.

BACKGROUND AND OBJECTIVES: Prognostic survival studies for heart-rate corrected QT interval in patients with chronic heart failure are few; although these patients are known to have a high risk of sudden cardiac death. This study was aimed at determining the mortality risk associated with prolonged QTc in Nigerians with heart failure. MATERIALS AND METHOD: Ninety-six consecutive patients with heart failure were recruited with 90 age and sex-matched controls. All the subjects had a 12-lead electrocardiogram at a paper speed of 25 mm/sec and a rhythm strip (lead II) at 50 mm/sec. The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using 2D guided M-mode and Doppler echocardiogram respectively. They were followed-up for six months. RESULTS: Ninety-one patients and 90 controls completed the study. Five patients were lost to follow-up. The mean age (51.9 +/- 16 years) of the patients was similar to that of the controls (50.3 +/- 15) (P = 0.475). Twenty-eight (30.8%) patients died after 6 months of follow-up against none of the controls. The mean QTc was significantly longer in the non-survivors (0.494 +/- 0.027) than in the survivors (0.462 +/- 0.035) (P = 0.0001). The percentage mortality in patients with prolonged QTc against those with normal QTc was 41% and 14% respectively (P = 0.001). In the stepwise regression analysis, QTc was an independent predictor of mortality (R = 0.412, R2 = 0.17, P= 0.001). CONCLUSION: QTc prolongation is a predictor of mortality in CHF and may be an important adjunct in risk stratification of patients with heart failure.

Systolic hypertension in adult Nigerians with hypertension.

OBJECTIVE: To determine the prevalence of both systolic and diastolic hypertensions in relation to age and their impacts on target organ among adult Nigerians with hypertension. DESIGN: Observational study. PLACE AND DURATION OF STUDY: The Cardiovascular Clinic of the University of Ilorin Teaching Hospital, Nigeria, from July 2002 to June 2003. PATIENTS AND METHODS: Newly diagnosed adult hypertensives, with blood pressure >or= 140/90mmHg, taken twice with mercury column sphygmomanometer at 3 weeks interval, were studied. The total number of hypertensive patients treated over this period was also taken into consideration. The newly diagnosed hypertensives were classified using JNC VI classification. The frequency of occurrence of target organ damage such as Left Ventricular Hypertrophy (LVH), heart failure, renal impairment etc. was charted according to systolic and or diastolic pressures. The occurrence of systolic or diastolic blood pressure was also related with the age of the patients. Blood metabolic parameters were compared in both systolic and diastolic blood pressures for their possible contributory role. RESULTS: Two thousand seven hundred and ninety-two adult hypertensive patients were managed over the study period. Of them, 218 (7.8%) were newly diagnosed and studied. There were 94 males and 124 females. Seventy-seven (35.3%) were aged 60 years and above with equal frequency in the gender. One hundred and seventy-eight (81.7%) cases had combined systolic and diastolic pressures. Twenty-nine (13.3%) patients had systolic hypertension. Twenty-five (86.2%) of these 29 were aged 50 years and above and 20 (69.0%) were aged 60 years and above. Eleven (5.0%) patients had isolated diastolic hypertension and they were all in the age bracket 40-49 years. Systolic blood pressure was found to be rising with advancing age while diastolic blood pressure peaked at mid 40's and declined. Target organ damage occurred more frequently with systolic hypertension and advancing age than with diastolic hypertension. CONCLUSION: Systolic hypertension occurred more frequently in this series of adult Nigerians with hypertension. It was higher with advancing age and associated with more target organ damage than the diastolic hypertension.

Comparative analysis of lipid profiles among patients with type 2 diabetes mellitus, hypertension and concurrent type 2 diabetes, and hypertension: a view of metabolic syndrome.

Type 2 diabetes mellitus and hypertension are independent risk factors for atherosclerotic lesions that are partly linked with dyslipidaemia. This risk is additive when diabetes and hypertension occur concurrently. In order to determine if concurrent type 2 diabetes and hypertension results in putative increases in dyslipidaemia in a Nigerian population, we compared the plasma lipid levels, atherogenic index and prevalence of dyslipidaemia among age and sex-matched indigenous Nigerians with type 2 diabetes, hypertension and concurrent diabetes and hypertension. Age and sex-matched healthy Nigerians that are free of diabetes and hypertension served as controls. The patients as a whole were more likely to have dyslipidaemia than controls (p < 0.05). High-density lipoprotein cholesterol was similar among patients and controls. Mean total cholesterol, high-density lipoprotein cholesterol; low-density lipoprotein cholesterol and triglyceride levels, atherogenic index and prevalence of dyslipidaemia did not differ significantly among patients with hypertension, diabetes, and concurrent hypertension and diabetes (p = 0.99 for each parameter). It is concluded that concurrent hypertension and type 2 diabetes does not result in a more severe dyslipidaemia than when either of the two conditions occurs in isolation. We attribute this to the common pathogenic link between hypertension, diabetes and dyslipidaemia in metabolic syndrome. Evidence, albeit indirect, of this syndrome among native Africans is, therefore, provided.

Determinants of prognosis among black Africans with hypertensive heart failure.

One hundred and seven consecutive Black Africans hypertensive heart failure patients made of 52 Gambians and 55 Nigerians (51 males + 56 females) aged 53.6 +/- 12.1 years were followed-up for 12 months or till death. One-year survival curve was determined using Kaplan-Meiers method. The survivors and the deceased were compared using univariate and multivariate analysis. Mean blood pressures were 180.4 +/- 28.2 mmHg (range: 130-250 mmHg) systolic and 117.0 +/- 12.9 mmHg (range: 100-160 mmHg) diastolic. Duration of hypertension ranged from 0.5 to 23 years. The rate of undetected hypertension was 44%. Overall one-year survival rate was 71%. Twenty two percent of deaths occurred within the first 3 months of HHF. One-year survival rate among the survivors of this period was 89.4%. A strong negative correlation existed between cumulative survival and the duration of heart failure (y = 0.9812, x(2) = 0.1173, R = 0.965). Compared to the survivors, the deceased had significantly higher systolic blood pressure (191.9 +/- 32.2 mmHg versus 175.1 +/- 25.2 mmHg; P < 0.05), diastolic blood pressure (123.7 +/- 15.8mmHg versus 114.3 +/- 10.3 mmHg; P < 0.05), cardiothoracic index (69.2 +/- 3.9% versus 66.2 +/- 4.2%; P < 0.05) and serum creatinine (148.6 +/- 42.2 umol/L versus 113.8 +/- 36.4 umol/L; P < 0.05). Compared to the patients aged 40 or more years, patients aged below 40 years had significantly lower one-year survival rate (41.7% versus 74.1%; P < 0.05). One-year survival rate was significantly higher among patients on captopril medication than those without (75% versus 52.6%; P < 0.05). However, only serum creatinine had statistically differing values between the deceased and survivors (df = 1 SS = 10272, F = 7.60, p = 0.007). Basic clinical and biochemical parameters could therefore be useful prognostic markers in hypertensive heart failure.

Relation of electrocardiographic left ventricular hypertrophy to blood pressure, body mass index, serum lipids and blood sugar levels in adult Nigerians.

Left ventricular hypertrophy (LVH) is considered an independent risk factor even in the absence of systemic hypertension. Electrocardiographic (ECG) LVH with repolarisation changes has been found in some countries to carry more coronary risk than LVH alone. How far this observation is true among adult Nigerians is not known. We therefore decided to study adult Nigerians with ECG-LVH with or without ST-T waves changes and compare them with normal age matched controls (without ECG-LVH) in relation with established modifiable risk factors such as systemic hypertension (BP), body mass index (BMI), fasting blood sugar (FBS) and serum lipids such as total cholesterol (Tc), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG). Adult Nigerians who were consecutively referred to the ECG laboratory were randomly recruited. Three hundred patients were studied. Their blood pressures (BP) as well as body mass indices were recorded after recording their resting 12 read ECG using portable Seward 9953 ECG machine. Their waist-hip ratio (WHR) was also recorded. Blood samples were taken to determine their fasting blood sugar and serum lipids. Their ECG tracings were read by the cardiologists involved in the study while the blood samples were analysed by the chemical pathologist also involved in the study. At the end of the ECG reading, the patients were divided into 3 groups according to whether there was no ECG-LVH (control group A), ECG-LVH alone (group B), and ECG-LVH with ST-T waves changes (group C). One hundred and fifty (50%) patients belonged to group A, 100 (33.3%) patients to group B and 50 (16.7%) group C. Group B patients were found to have higher modifiable risk factors in form of systemic BP. Tc, LDL-C, and WHR compared to group A. However, the group C patients had increased load of these coronary risk factors in terms of BP elevation, higher BMI, FBS, and scrum cholesterol compared to group B. In addition, more female patients were involved in group C. The mean age of group C patients compared to group B was also significantly higher (P<0.001) even though no significant age difference was noted between group C and group A patients. It is concluded that Nigerians with ECG-LVH with ST-T waves changes have increased risk of cardiovascular risk factors compared to normal group A patients and even patients with EGC-LVH (group B) alone. Hence, they represent subset of patients to be aggressively followed up with multiple risk factors intervention.