Serum copeptin and pregnancy outcome in preeclampsia

Background:

A number of biochemical predictors of preeclampsia have been reported, but little is known about their possible relationship with maternal and fetal outcomes. This study determined serum copeptin in pregnant women with preeclampsia and assessed its relationship with pregnancy outcomes.

Materials and Methods:

Thirty women with severe preeclampsia (SP), 30 with mild preeclampsia (MP), and 30 with uncomplicated pregnancy were enrolled into this study. Serum copeptin, creatinine, and liver function were determined using enzyme-linked immunosorbent assay and colorimetry as appropriate. Pregnancy outcomes, both maternal and fetal, were taken using standard methods.

Results:

Copeptin was significantly elevated in preeclampsia subjects compared with controls and in SP compared with MP. Assessing the diagnostic property of copeptin for preeclampsia, the area under the curve for copeptin was 0.99. Nine (30%) and 3 (10%) of SP and MP, respectively had abruptio placenta while 6 (20%), 2 (6.7%), and 1 (3.3%) still births were recorded in SP, MP, and controls, respectively. Neonates of mothers with preeclampsia had significantly lower birth weight, infant length, ponderal index, and head circumference compared with neonates of the controls. Copeptin had a significant inverse relationship with birth weight, ponderal index, head circumference, Apgar score, and infant length in neonates of mothers with preeclampsia.

Conclusion:

Serum copeptin level in the third trimester could predict preeclampsia and its elevation is associated with adverse perinatal outcome.     

Retarded hippocampal development following prenatal exposure to ethanolic leaves extract of Datura metel in wistar rats

Background:

Datura metel contains atropine alkaloids and has been used to treat complication like asthma and, bronchitis, because of its anticholinergic properties.

Aim:

This study aimed to determine the prenatal effects of ethanolic extract of D. metel leaves exposure on the development of hippocampus.

Materials and Methods:

Twenty rats (12 females and 8 males) were purchased. The females were grouped into four groups (A_D). Group A were given 500 mg/kg body weight of the extract on the first day of fertilization to the end of gestation period, Group B were given 500 mg/kg body weight on the 8^th day of fertilization to the end of gestation period, Group C were given 500 mg/kg body weight on 15^th day of fertilization to the end of gestation period and Group D were given normal saline throughout the gestation period.

Results:

Rats in Group A showed no implantation, rats in Group B had abortion on the 7^th day after administration, and rats in Group C gave birth with their litters showing retarded hippocampus development and neural degeneration and rats in Group D (control) showed normal development.

Conclusion:

Ethanolic extract of D. metel leaf is teratogenic in the late stage of pregnancy, is abortificient and can serve as a contraceptive.     

Intensive care management and outcome of women with hypertensive diseases of pregnancy

Introduction:

The burden of hypertensive diseases on the health care is enormous given to the high population in Sub-Saharan Africa and related disproportionate representation in global maternal mortality.

Materials and Methods:

All women with hypertensive diseases of pregnancy who got admitted into the general ICU of the University of Benin Teaching Hospital between January 2006 and December 2010 were studied. Only the records of women who completed 28 weeks of gestation and were admitted during labour and delivery or puerperium to the ICU were examined.

Results:

There were 13061 deliveries within the 5-year study period; 9301 by vaginal delivery and 3860 through Caesarean section. 52 (51.5%) of the obstetric patients had hypertensive diseases of pregnancy. Of 52 women with pre-eclampsia and eclampsia, 45/52 had caesarean section and 7/52 had SVD. Admission was mainly postpartum 48/52 (92.3%). 35/52 (67.3%) were transferred to the ward and 17 died (32.7%), giving the ICU maternal mortality rate of 307/1000 deliveries. 30 women developed pulmonary oedema alone or with renal impairment; 14 women were transferred and 16 died while 21 other patients who had renal impairment alone, HELLP, sepsis, etc were transferred out. There was about a 12-fold risk of death in the unit if the patient developed pulmonary oedema when compared to the other factors combined (p = 0.0002, RR = 11.7, 95%CI = 1.7 – 82.).

Conclusion:

Primiparity, unbooked status and caesarean delivery were leading factors for ICU admission in women with preeclampsia/eclampsia. The women who developed pulmonary oedema in the course of treatment had poor outcome and avoidance of pulmonary oedema may improve ICU outcome in women with preeclampsia/eclampsia.     

Prevalence of positive recto-vaginal culture for Group B streptococcus in pregnant women at 35-37 weeks of gestation

Background

Recto-vaginal colonization of Group B streptococcus (GBS) has been known as an important issue in mother and newborn''s health, which is getting frequent in developing countries. Screening test have been introduced and utilized in many countries and is recommended by many researchers. However, due to lack of information in prevalence of GBS, especially in Iran, there are doubts and controversies regarding whether it is necessary to execute any effort to run screening tests. The aim of this study is to determine the prevalence of positive recto-vaginal culture for GBS in pregnant women between 35-37 weeks of pregnancy in Tehran.

Methods

In this cross-sectional study, pregnant women in 35^th-37^th week of pregnancy were included. All hospitals in Tehran, Iran, were stratified and clustered, and the sampling was done randomly. All recto-vaginal samples were referred to Firoozgar Hospital''s pathology laboratory in less than an hour and the results were reported afterwards. Other demographic information and pregnancy and neonatal-related complications such as previous pre-term delivery, PROM (Premature rupture of membrane) and neonatal sepsis and maternal infection were evaluated.

Results

The prevalence of positive GBS cultures was 22.76% (234 Out of 1028). No significant difference was found in positive cultures with mother''s age, educational level, and history of pregnancy, maternal complications, and previous neonatal sepsis.

Conclusion

Due to similar results with other countries, recto-vaginal GBS culture screening is recommended in Iranian urban pregnant women regarding high prevalence and higher neonatal complication.     

Comparison of the Reference Intervals Used for the Evaluation of Maternal Thyroid Function During Pregnancy Using Sequential and Nonsequential Methods

Background:

Maternal thyroid dysfunction is common during pregnancy, and physiological changes during pregnancy can lead to the overdiagnosis of hyperthyroidism and misdiagnosis of hypothyroidism with nongestation-specific reference intervals. Our aim was to compare sequential with nonsequential methods for the evaluation of thyroid function in pregnant women.

Methods:

We tested pregnant women who underwent their trimester prenatal screening at our hospital from February 2011 to September 2012 for serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) using the Abbott and Roche kits. There were 447 and 200 patients enrolled in the nonsequential and sequential groups, respectively. The central 95% range between the 2.5^th and the 97.5^th percentiles was used as the reference interval for the thyroid function parameter.

Results:

The nonsequential group exhibited a significantly larger degree of dispersion in the TSH reference interval during the 2^nd and 3^rd trimesters as measured using both the Abbott and Roche kits (all P < 0.05). The TSH reference intervals were significantly larger in the nonsequential group than in the sequential group during the 3^rd trimester as measured with both the Abbott (4.95 vs. 3.77 mU/L, P < 0.001) and Roche kits (6.62 vs. 5.01 mU/L, P = 0.004). The nonsequential group had a significantly larger FT4 reference interval as measured with the Abbott kit during all trimesters (12.64 vs. 5.82 pmol/L; 7.96 vs. 4.77 pmol/L; 8.10 vs. 4.77 pmol/L, respectively, all P < 0.05), whereas a significantly larger FT4 reference interval was only observed during the 2^nd trimester with the Roche kit (7.76 vs. 5.52 pmol/L, P = 0.002).

Conclusions:

It was more reasonable to establish reference intervals for the evaluation of maternal thyroid function using the sequential method during each trimester of pregnancy. Moreover, the exclusion of pregnancy-related complications should be considered in the inclusion criteria for thyroid function tests.     

Preterm delivery and low maternal serum cholesterol level: Any correlation?

Background:

The study assessed whether low maternal serum cholesterol during early pregnancy is associated with preterm delivery.

Patients and Methods:

It was a prospective observational cohort study involving pregnant women at gestational age of 14-20 weeks over a period of 12 months. Blood samples were obtained to measure total serum cholesterol concentrations and the sera were then analysed enzymatically by the cholesterol oxidase: p-aminophenazone (CHOD PAP) method.

Results:

The study showed an incidence of 5.0% for preterm delivery in the low risk study patients. Preterm birth was 4.83-times more common with low total maternal cholesterol than with midrange total cholesterol (11.8% versus 2.2%, P = 0.024).

Conclusion:

Low maternal serum cholesterol (hypocholesterolaemia) is associated with preterm delivery. Optimal maternal serum cholesterol during pregnancy may have merit, therefore pregnant women should be encouraged to follow a healthy, balanced diet.     

Relevant Factors of Estrogen Changes of Myopia in Adolescent Females

Background:

Gender is one of the risk factors accounting for the high prevalence of adolescent myopia. Considerable research results have shown that myopia incidence of female is higher than that of male. This study aimed to analyze the correlation between ocular parameters and serum estrogen level and to investigate the vision changes along with estrogen change in menstrual cycle of adolescent females.

Methods:

A total of 120 young females aged between 15 and 16 years, diagnosed with myopia were recruited. Spherical lens, cylindrical lens, axis, interpupillary distance (IPD), and vision in each tested eye of the same subject were measured by automatic optometry and comprehensive optometry, with repetition of all measurements in the menstrual cycle of the 2^nd or 3^rd days, 14^th days, and 28^th days, respectively. Serum estradiol (E₂) levels were assayed by chemiluminescence immunoassay at the same three times points of the menstrual cycle mentioned above.

Results:

In young females with myopia, the spherical lens showed a statistically significant difference among all different time in menstrual cycle (all P < 0.0001). The cylindrical lens, axis, and IPD were changed significantly during the menstrual cycle (P < 0.05). The vision of the three different time points in menstrual cycle had a significant difference (χ² = 6.35, P = 0.042). The vision during the 14^th and 28^th day was higher compared to that on the 2^nd or 3^rd days (P = 0.021). Serum E₂ levels were significantly different at different time points in menstrual cycle (P < 0.05). E₂ levels reached its maximum value on the 14^th day and the minimum value on the 2^nd or 3^rd day.

Conclusions:

In adolescent females, the spherical lens and other related ocular parameters vary sensitively with different levels of E₂ in menstrual cycle. Vision in late menstrual stage is significantly higher than that in premenstrual stage.     

Serum lipid profile and uric acid levels in preeclampsia in University of Benin Teaching Hospital

Background:

Preeclampsia is a pregnancy-specific disease associated with significant maternal and perinatal mortality and morbidity. Lipid abnormality and elevated serum uric acid have been reported as early features of the disease. We aimed to detect the level of serum lipid profile and uric acid abnormalities in severe preeclamptics in Benin City and to measure their clinical significance.

Materials and Methods:

A prospective case-control study was conducted with subjects presenting with severe preeclampsia to the Obstetric Unit of the UBTH, Benin City. Fasting serum lipid profile and uric acid levels of 40 severe preeclamptic subjects and 80 gestation-matched normotensive controls were done at recruitment. The preeclamptic subjects were managed according to our departmental protocol which included stabilisation and delivery. Their sociodemographic and clinical characteristics were used to generate a database for analysis.

Results:

The mean serum uric acid level was 28% higher in severe preeclamptics than normotensive women (5.96 ± 2.54 mg/dl versus 4.30 ± 0.85; P = 0.005). There were statistically significant differences in levels of triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) between the preeclamptics and their normotensive controls (P = 0.006, P = 0.000, P = 0.000, respectively). Abnormal serum uric acid was associated with advanced maternal age (P = 0.000), early-onset preeclampsia (P = 0.000) and abnormal body mass index (BMI; P = 0.000). Low birth weight was more likely in preeclamptics with elevated serum uric acid levels (P = 0.041).

Conclusion:

Abnormality of serum uric acid in preeclampsia was significantly associated with increased frequency of complications but lipid profile abnormalities were not shown in the subjects studied. We recommend a larger scale study to determine lipid profile in normal and complicated pregnancies in our environment.     

Infections During Induction Therapy of Protocol CCLG-2008 in Childhood Acute Lymphoblastic Leukemia: A Single-center Experience with 256 Cases in China

Background:

Infections remain a major cause of therapy-associated morbidity and mortality in children with acute lymphoblastic leukemia (ALL).

Methods:

We retrospectively analyzed the medical charts of 256 children treated for ALL under the CCLG-2008 protocol in Beijing Children''s Hospital.

Results:

There were 65 infectious complications in 50 patients during vincristine, daunorubicin, L-asparaginase and dexamethasone induction therapy, including microbiologically documented infections (n = 12; 18.5%), clinically documented infections (n = 23; 35.3%) and fever of unknown origin (n = 30; 46.2%). Neutropenia was present in 83.1% of the infectious episodes. In all, most infections occurred around the 15^th day of induction treatment (n = 28), and no patients died of infection-associated complications.

Conclusions:

The infections in this study was independent of treatment response, minimal residual diseases at the end of induction therapy, gender, immunophenotype, infection at first visit, risk stratification at diagnosis, unfavorable karyotypes at diagnosis and morphologic type. The infection rate of CCLG-2008 induction therapy is low, and the outcome of patients is favorable.     

Correlation between maternal weight and insulin resistance in second half of pregnancy

Background:

In pregnancy, routine measurement of maternal weight gives a crude assessment of maternal and foetal well-being. Excess weight gain in pregnancy is related to increased risk for gestational diabetes mellitus (GDM), hypertension in pregnancy and foetal macrosomia. In the Nigerian context, lack of knowledge of pre-pregnancy weight coupled with late booking of women in pregnancy hinders accurate assessment of weight gain in pregnancy. The absolute maternal weight is often used as surrogate. This study evaluates the relationship between absolute weight in the second half of pregnancy and insulin resistance.

Patients and Methods:

The weight of hundred pregnant women was measured between 24 to 32 weeks of pregnancy and their insulin resistance was measured using Homeostatic Model Assessment (HOMA-IR) from fasting serum glucose and fasting serum insulin.

Results:

Twenty-six women had weight ≥95 kg and 74 women had weight of <95 kg. There was a significant positive correlation between weight and HOMA-IR (r = 0.248), fasting glucose (r = 0.198), and fasting insulin (r = 0.228), (P < 0.05). The mean weight, HOMA-IR, fasting glucose and fasting insulin were higher in women with weight ≥95 kg compared to those with less weight. Also maternal weight ≥ 95 kg was associated with severe insulin resistance, (Odds Ratio = 3.1).

Conclusion:

Absolute weight in pregnancy correlates well with insulin resistance. Women having weight ≥95 kg between 24-32 weeks of gestation were more likely to have severe insulin resistance with implications for increased risk of GDM and other complications.     

Monitoring the Progression of Renal Fibrosis by T2-weighted Signal Intensity and Diffusion Weighted Magnetic Resonance Imaging in Cisplatin induced Rat Models

Background:

Diffusion weighted imaging (DWI), with the applying of intravoxel incoherent motion model, has showed promising results in obtaining additional information about microperfusion and tubular flow associated with morphologic changes in chronic kidney diseases. The study aims to evaluate the potential of T2-weighted signal intensity (SI) and DWI with mono- and bi-exponential models to reflect the serial changes on cisplatin (CP) induced rat renal fibrosis models.

Methods:

Magnetic resonance exams were performed prior to and 2^nd day, 4^th day, 6^th day, 8^th day, 2^nd week, 3^rd week and 4^th week after CP injection at a 3.0T with an animal coil. Besides T2-weighted images (T2WI), DWI of 13 b values from 0 to 1500 s/mm² was acquired. Apparent diffusion coefficient (ADC), fluid fraction f, pure diffusivity D and pseudodiffusivity D* values were calculated. The regions of interest were placed on cortex (CO), outer stripe of the outer medulla (OM) and inner stripe of the outer medulla (OM), parameters were measured and compared among different time points. Five rats were scarified at each time point for pathological examination.

Results:

OM revealed remarkable hyperintense and broadened before it became an obscure thread, while CO demonstrated moderate hyperintense and IM didn’t show significant change on T2WI. On all three stripes, ADC values decreased firstly then kept increasing since the 4^th day; f values decreased on all stripes; D values had a tendency to increase with fluctuations but the changes didn’t achieve statistical significance; D* values increased at the 2^nd day then tended to be steady thereafter. Pathological findings revealed tubules epitheliums swelling followed by inflammation cells infiltration, interstitial fibrosis was observed since the 2^nd week.

Conclusions:

All of T2-weighted SI, ADC, and biexponential models parameters vary during fibrotic process; biexponential model is superior to monoexponential model in separating changes of microperfusion together with tubular flow from pure diffusion.     

Effect of maternal dietary intake on the weight of the newborn in Aligarh city, India

Background:

This study aimed (1) To record the nutrient intake of the respondents and compare the same with the available recommended dietary allowances (RDA). (2) To assess the correlation between maternal dietary intake and the weight of newborn.

Materials and Methods:

Two hundred and ninety two pregnant women. Study Area: Five hospitals of Aligarh city, Uttar Pradesh. Study Tool and Data Collection: Interview schedule was administered to record information regarding dietary intake and weight of newborn. The data collection was initiated in April 2009 and was completed in March’ 2010. Data Analysis: Statistical analysis was done by using version SPSS 17. Frequency distributions were calculated for all variables. Univariate and multivariate analysis were performed to determine the influence of the dietary intake on the birth weight of newborn.

Results:

Results revealed that the nutrient intake in all trimesters of pregnancy was lower as compared to RDA. There were significant correlations between the nutrient intake of the mothers and the weight of newborn in all trimesters of pregnancy (P=0.01).

Conclusion:

It was found that the dietary intake during all trimesters of pregnancy were significantly associated with the birth weight.     

Hypertensive disorders in pregnancy among pregnant women in a Nigerian Teaching Hospital

Background:

Hypertensive disorders in pregnancy (HDP) represent a group of conditions associated with high blood pressure during pregnancy. It is an important cause of feto-maternal morbidity and mortality, particularly in developing countries. The aims of the study were to find the prevalence of hypertensive disorders and its associated risk factors among women attending the antenatal clinic of Usmanu Danfodiyo University Teaching Hospital,(UDUTH) Sokoto.

Materials and Methods:

A longitudinal study of 216 consecutively recruited women that were less than 20 weeks pregnant at booking was carried out. Blood pressure was measured for each woman at booking and at subsequent visits. Urinalysis was done at booking and whenever blood pressure was elevated. Patients were followed-up to delivery and 6 weeks postpartum. Data entry and analysis was done using Statistical Analysis System (SAS) statistical package.

Results:

The prevalence of HDP in the study was 17% while preeclampsia was 6%. Previous history of preeclampsia (P < 0.001; Relative risk (RR) 4.2; conficence interval (CI) 2.144-6.812), multiple gestation (P < 0.03; RR 3.8; CI 1.037-6.235), gestational diabetes (P < 0.02; RR 4.8; CI 1.910-6.751) and obesity (P < 0.002; RR 2.7; CI 1.373-5.511) were the significant risk factors in the development of HDP among the study population.

Conclusion:

The prevalence of HDP in the study group is high. Therefore, paying attention to the risk factors will ensure early detection and prevention of the progression of the disease and its sequelae.     

Objective structured clinical examination vs traditional clinical examination: An evaluation of students’ perception and preference in a Nigerian medical school

Background:

Method of testing clinical competence of medical students in this setting has been controversial. This report evaluates the perceptions and preferences of 5^th and 6^th year medical students about traditional clinical examination (TCE) and objective structured clinical examination (OSCE).

Materials and Methods:

A cross-sectional study using a structured questionnaire, administered to 156 students, who had been previously exposed to TCE and OSCE.

Results:

There were 110 (70.5%) males and 46 (29.5%) females, with median age group of 26–30 years. One hundred and thirty-one respondents (84%) felt TCE is more difficult and 20 (12.8%) felt OSCE was more difficult. One hundred and forty-two (91%) felt OSCE was easier to pass, 8 (5.1%) felt TCE was easier to pass and 6 (3.8%) were undecided. Majority of the 5^th and 6^th year students (95.5% and 100%, respectively) preferred OSCE for assessment. In relation to validity and reliability of OSCE, 124 (79.5%) of all the students felt it provides a true measure of essential clinical skills, 130 (83.3%) felt its scores are standardised, 143 (91.7%) felt it is a practical and useful experience and 135 (86.5%) felt students’ personality, ethnicity and gender will not affect OSCE scores. Overall, there were no significant differences in preference and perceptions between 5^th and 6^th year students and between males and females.

Conclusion:

Students preferred OSCE as method of assessing clinical competence and considered it a more valid and reliable method of examination.     

Plasmodium falciparum parasitaemia among booked parturients who received two doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) in a tertiary health facility Southeast Nigeria

Background:

Malaria is preventable but has contributed significantly to maternal morbidity and mortality in our environment. Malaria parasitaemia during pregnancy is mostly asymptomatic, untreated but with complications.

Aim:

A follow-up study aimed at determining plasmodium falciparum parasitaemia and associated complications among booked parturient who had intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) compared with another study among unbooked parturients who did not take SP for intermittent preventive treatment in pregnancy (IPTp).

Materials and Methods:

This study was conducted in the labour ward complex of Federal Teaching Hospital, Abakaliki from March to May 2012. Five hundred booked parturients at term that received two doses of SP were consecutively recruited. A structured data collection sheet was administered to each parturient. Thick and thin blood films were prepared for quantification and speciation of parasitaemia, respectively. The haemoglobin concentration and birth weights were determined. Analysis was done with the Statistical Package for the Social Sciences (SPSS) software with level of significance at P value < 0.05.

Results:

The prevalence of malaria parasitaemia in the study was 59.6%. The mean age of parturients was 28.7 (5.5). The highest prevalence of malaria parasitaemia, 92% was found among the parturients aged ≤19 years. The association between age and parasitaemia was significant (x² = 16.496, P = 0.000). The median parity was 1.0 (3.0). The highest prevalence of asymptomatic parasitaemia, 65.5% was noted among the nulliparous parturients. The association between parity and parasitaemia was significant (x² = 11.551, P = 0.003). Majority of the parturients were of high social class. Those of the lowest social class (class 5) had the highest prevalence (80%) of parasitaemia. The association between social class and parasitaemia was significant (x² = 9.131, P = 0.003). Prevalence of anaemia in the study was 14%. The non-parasitaemic and parasitaemic parturients had mean haemoglobin concentrations of 12.7 g/dl and 10.4 g/dl, respectively. There was significant association between haemoglobin concentration and parasitaemia (x² = 39.143, P = 0.000). The prevalence of low birth weight was 3.0%. The relationship between birth weight and parasitaemia was significant (x² = 2.535, P = 0.000).

Conclusion:

The was reduction in asymptomatic malaria parasitaemia compared to parturients who had no SP though the prevalence was still high showing possibly increasing resistance to SP but the treatment was still very effective in reducing anaemia and low birth weight associated with malaria in pregnancy.     

Evaluation of Eight Different Clinical Staging Systems Associated with Overall Survival of Chinese Patients with Hepatocellular Carcinoma

Background:Hepatocellular carcinoma (HCC) is a common cancer in China,an area of high hepatitis B virus (HBV) infection.Although several staging systems are available,there is no consensus on the best ...     

Body mass index,pain and function in individuals with knee osteoarthritis

Background:

Obesity is a risk factor for progression of knee osteoarthritis (OA), and high body mass index (BMI) may interfere with treatment effectiveness on pain and function in individuals with knee OA. This study investigated the effects of BMI on pain and function during a four-week exercise programme in patients with knee OA.

Materials and Methods:

Forty-six (31 women and 15 men) participants with knee OA of different BMI categories (15 normal weight participants, 13 over weight participants and 18 obese participants), received standardised exercise therapy programme twice a week for 4 weeks. Outcome included a 10-point pain rating scale for pain-intensity and the western Ontario and McMaster university osteoarthritis index (WOMAC) for physical function.

Results:

Two-way repeated measure analysis of variance (ANOVA) on pain assessment score revealed a significant effect of time (F = 1049.401, P < 0.001) and group (F = 9.393, P < 0.001) on pain. Similar significant effect of time (F = 595.744, P < 0.001) and group (F = 5.431, P = 0.008) was obtained for WOMAC score on function. Post hoc analysis revealed significant difference between the normal weight and overweight group (t = 2.472, P = 0.016) and between normal weight and obese group (t = 3.893, P = 0.005) on pain outcome at the 4^th week post treatment. No significant difference was found at 4^th week post treatment on WOMAC scores (F = 2.010, P = 0.146).

Conclusion:

Exercise improved pain and function scores in OA patients across the BMI groups. Overweight independent of obesity may interfere with effectiveness of pain control during the symptomatic treatment of knee OA patients.     

Repetitive Transcranial Magnetic Stimulation for the Treatment of Restless Legs Syndrome

Background:

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique used to alter cortex excitability that has been proposed as an efficient method for treating brain hyperexcitability or hypoexcitability disorders. The aim of this study was to investigate whether high-frequency rTMS could have any beneficial effects in restless legs syndrome (RLS).

Methods:

Fourteen patients with RLS were given high-frequency rTMS (15 Hz, 100% motor threshold) to the leg representation motor cortex area of the frontal lobe for 14 sessions over 18 days. Patients were diagnosed according to the international criteria proposed by the International Restless Legs Syndrome Study Group in 2003. The International RLS Rating Scale (IRLS-RS), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale were used to evaluate the severity of RLS, sleep quality, anxiety and depression, respectively. The scale scores were evaluated at four-time points (baseline, end of the 14^th session, and at 1- and 2-month posttreatment). One-way analysis of variance was used to compare scale scores at different time points.

Results:

There was significant improvement in the IRLS-RS (from 23.86 ± 5.88 to 11.21 ± 7.23, P < 0.05), PSQI (from 15.00 ± 4.88 to 9.29 ± 3.91, P < 0.05), and HAMA (from 17.93 ± 7.11 to 10.36 ± 7.13, P < 0.05) scale scores at the end of 14^th session, with ongoing effects lasting for at least 2 months.

Conclusions:

High-frequency rTMS can markedly alleviate the motor system symptoms, sleep disturbances, and anxiety in RLS patients. These results suggest that rTMS might be an option for treating RLS.     

Prevalence and socio-demographic risk factors associated with psychoactive substance use in psychiatric out-patients of a tertiary hospital in Nigeria

Background:

The co-morbidity of psychoactive substance use and other mental disorders is a major challenge to the management of both conditions in several parts of the world. There is relative dearth of information on co-morbidity and its predictors in Nigeria. This study determined the prevalence and socio-demographic risk factors associated with psychoactive substance use in the psychiatric out-patients of a tertiary hospital in Nigeria.

Study Design:

A cross-sectional study.

Materials and Methods:

From routine clinic visits over a 4-month period, each consecutive 4^th adult patients (>18 years) who had previously attended the clinic at least for 1 year, completed a socio-demographic and semi-structured drug use questionnaires and interview with the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) to generate substance use diagnosis. Data was analysed using the statistical package for social sciences (SPSS), version 16. Level of significance was set at P < 0.05.

Results:

The lifetime prevalence for the use of substance was 29.3%, while that for multiple substances was 17.7%. The most commonly used substances were alcohol, cannabis and tobacco and they were also the ones mostly used in combination with one or the other. A total of 10.1% of the patients had a psychoactive substance use disorder. Being male, married with at least primary education and unemployed were significant risk factors for substance use.

Conclusion:

Psychoactive substance is common among the psychiatric outpatients of the hospital with males, those with formal education, the married and unemployed being at high risk of substance use.