Sleep quality and associated factors among patients with chronic kidney disease in Nigeria: a cross-sectional study

OBJECTIVE

Poor sleep quality adversely affects the overall well-being and outcomes of patients with chronic kidney disease (CKD). However, it has not been well studied in Africans with CKD. We determined the prevalence of poor sleep quality and associated factors among patients with CKD.

DESIGN

This was a cross-sectional study that involved patients with CKD .

SETTINGS

The study was carried out in the outpatient clinic of nine hospitals in Nigeria.

METHODS

Sleep quality, depressive and anxiety symptoms and quality of life (QoL) were assessed among 307 patients with CKD using Pittsburgh Sleep Quality Index Questionnaire, Hospital Anxiety Depression Scale Questionnaire and 12-item Short Form Health Survey Quality of Life Questionnaire, respectively. The prevalence of poor sleep quality and associated factors were determined. A p<0.05 was considered as statistically significant.

RESULTS

The mean age of the study participants was 51.40±15.17 years. The male:female ratio was 1.5:1 One hundred and twenty-one (39.4%) of the patients were on maintenance haemodialysis (MHD). The prevalence of poor sleep quality, anxiety symptoms and depressive symptoms among the patients was 50.2%, 37.8% and 17.6%, respectively. The prevalence of poor sleep quality in the CKD stages 3, 4, 5 and 5D was 38.1%, 42.6%, 52.2% and 58.7%, respectively. The prevalence of poor sleep quality was significantly higher in MHD patients compared with predialysis CKD (59.5% vs 43.6%; p=0.008). Factors associated with poor sleep quality were CKD stage (p=0.035), anaemia (p=0.003), pruritus (p=0.045), anxiety symptoms (p≤0.001), depressive symptoms (p≤0.001) and reduced QoL (p≤0.001). On multivariate analysis, factors associated with poor sleep were anxiety (AOR 2.19; 95% CI 1.27 to 3.79; p=0.005), anaemia (AOR 5.49; 95% CI 1.43 to 21.00;p=0.013) and reduced physical component of QoL (AOR 4.11; 95% CI 1.61 to 10.47; p=0.003).

CONCLUSION

Poor sleep quality is common among patients with CKD especially in the advanced stage. The significant factors associated with poor sleep quality were QoL, anaemia and anxiety symptoms. These factors should be adequately managed to improve the overall outcomes of patients with CKD.

Diabetes Mellitus and Energy Dysmetabolism in Alzheimer's Disease: Understanding the Relationships and Potential Therapeutic Targets

Over the last century, there has been a gradual but sustained increase in life expectancy globally. A consequence of increased life expectancy is an associated rise in the prevalence of agerelated chronic debilitating neurodegenerative disorders, such as Alzheimer's disease (AD), Parkinson's disease, Huntington's disease, and multiple sclerosis. These disorders, which are generally characterised by the loss of motor/sensory neurons and cognitive decline, have continued to confound researchers who are working tirelessly to define their pathogenetic mechanisms and develop effective therapies. In the last few years, there has been increasing evidence of the existence of a relationship between energy metabolism and neurodegeneration, with reports that type 2 diabetes mellitus increases the risk of AD. Evidence from preclinical and epidemiologic studies has associated dysmetabolism and dysmetabolic syndromes with the development of neurodegenerative changes. More recently, diabetes mellitus and energy dysmetabolism have been linked to the aetiopathogenesis of AD. Moreover, metabolic hormones, including ghrelin, leptin, insulin, and insulin-like growth factor (IGF)-1, have been reported to play key roles in the regulation of neuronal injury and loss in neurodegenerative diseases like AD. In this narrative review, we examine the current scientific evidence regarding the role of dysmetabolism (including diabetes mellitus and metabolic syndrome) in AD and how it impacts disease progression and the development of novel therapies in AD.

Prepubertal Continuous Dietary Folate Fortification Enhances the Brain Function of Adult Mice by Modulating Antioxidant Status, Inflammation, and Brain Neurotransmitter Levels

BACKGROUND

The benefits of folic acid supplementation have been documented in several studies. However, while evidence exists regarding its benefits for growth and haematologic parameters, its possible effects on the brain have been less examined.

OBJECTIVES

The study aimed to examine the benefits of dietary folic acid supplementation (beginning in the prepubertal period) on neurobehaviour, oxidative stress, inflammatory parameters, and neurotransmitter levels in adult mice.

METHODS

Forty-eight prepubertal male mice were assigned into four groups of 12 animals each. Mice were grouped into normal control (fed standard diet) and three groups fed folic acid supplemented diet at 2.5, 5, and 10 mg/kg of feed. Animals were fed a standard diet or folic acid-supplemented diet for eight weeks during which food intake and body weight were assessed. On postnatal day 78, animals were exposed to the open-field, Y-maze, radial arm maze, elevated plus maze, bar test, and models of behavioural despair. 24 hours after the last behavioural test, animals were made to fast overnight and then sacrificed by cervical dislocation. Blood was then taken for the assessment of blood glucose, leptin, and insulin levels. Homogenates of brain tissue were prepared and used for the assessment of biochemical parameters.

RESULTS

Results showed a concentration-dependent increase in body weight, and improved antioxidant status, memory scores, and acetylcholine levels. Also, a decrease in food intake, blood glucose, insulin, and leptin levels was observed. A reduction in open-field behaviour, anxiety-related behaviour, and proinflammatory markers, was also observed.

CONCLUSION

The beneficial effect of prepubertal continuous dietary folate fortification on the brain (as the animal ages) has been shown in this study.

Substance use and substance use disorders in Africa: An epidemiological approach to the review of existing literature

The relationship between man and substances that have abuse potentials, and whose use has been associated with the development or progression of substance use disorders has continued to evolve in terms of geography, economic implications, and time. History shows that local plants with psychoactive constituents can get exported worldwide through global travel, commerce, or even conquest. Time and globalization also change people’s relationship with substances of abuse; hence, an area that was initially alien to certain substances might evolve to becoming a trafficking hub, and then a destination. A case in point is Africa where a rapidly increasing prevalence of substance use/abuse and substance use disorder among adolescents and young adults is putting enormous strain on the economy, healthcare system, and society at large. However, there appears to be a paucity of scientific literature and data on the epidemiology, risk assessment, and contributing factors to substance use and the development of substance use disorders across Africa. In this narrative review, we examine extant literature (PubMed, Google scholar, Medline) for information on the prevalence, trends, and influencers of substance use and the development of substance use disorders. This is with a view of understanding the determinants of substance use and factors that influence the development of substance use disorders in the region, and how this information can be channeled towards developing a comprehensive intervention and treatment program.

Microbiome-Based Therapies in Parkinson's Disease: Can Tuning the Microbiota Become a Viable Therapeutic Strategy?

Progressive neurodegenerative disorders such as Parkinson's disease (PD) have continued to baffle medical science, despite strides in the understanding of their pathology. The inability of currently available therapies to halt disease progression is a testament to an incomplete understanding of pathways crucial to disease initiation, progression and management. Science has continued to link the activities and equilibrium of the gut microbiome to the health and proper functioning of brain neurons. They also continue to stir interest in the potential applications of technologies that may shift the balance of the gut microbiome towards achieving a favourable outcome in PD management. There have been suggestions that an improved understanding of the roles of the gut microbiota is likely to lead to the emergence of an era where their manipulation becomes a recognized strategy for PD management. This review examines the current state of our journey in the quest to understand how the gut microbiota can influence several aspects of PD. We highlight the relationship between the gut microbiome/microbiota and PD pathogenesis, as well as preclinical and clinical evidence evaluating the effect of postbiotics, probiotics and prebiotics in PD management. This is with a view to ascertaining if we are at the threshold of discovering the application of a usable tool in our quest for disease modifying therapies in PD.

The prevalence and correlates of anxiety and depression amongst essential workers during the COVID-19 lockdown in Ekiti State, Nigeria

Background

Essential workers are imperative in the fight against the coronavirus disease (COVID-19) pandemic.

Aim

To assess the prevalence and factors associated with anxiety and depression among essential workers during the COVID-19 pandemic and lockdown.

Setting

This study was set in Ekiti State, Nigeria.

Method

This was a cross-sectional study involving essential workers in Ekiti State Nigeria, during the COVID-19 pandemic and lockdown. A total of 588 essential workers were sampled. Online socio-demographic variables and the Hospital Anxiety and Depression Scale, a 14 item self-reported questionnaire were used.

Results

The prevalence of anxiety and depression among the respondents was 93.4% (CI = 91.2–95.2) and 64.3% (CI = 60.4–68.4) respectively. Among the health workers, the prevalence of anxiety and depression were 96.5% (CI =94.8–98.1) and 66.5% (CI = 60.5–69.8) respectively while the prevalence of anxiety and depressive symptoms among non- health workers were 84.6% (CI = 78.7–90.1) and 61.5% (CI = 54.2–69.4) respectively. The odds ratio (OR) of depressive symptoms was increased among, respondents who were not satisfied with the support they received from the government during the pandemic (AOR = 2.071, CI = 1.350–2.213), respondents that were 35 years and younger (AOR = 1.512, CI = 1.033–2.213) and reduced amongst Christians (AOR = 0.501, CI = 0.286–0.879). The odd of anxiety was increased among health workers compared to non-health workers (AOR = 3.700, CI = 1.744–7.851) and the odds of anxiety was reduced among respondents with previous history of mental illness (AOR = 0.215, CI = 0.049–0.943).

Conclusion

Anxiety and depressive symptoms were common mental illness among essential workers working during the COVID-19 lockdown, therefore their mental health should be adequately considered to sustain the fight against the virus.

High level of perceived stress among essential workers during the COVID 19 lockdown in a Nigerian state

Background: COVID-19 pandemic caused unexpected socio-economic changes globally. This study determined the prevalence and factors associated with perceived stress among essential workers during the COVID-19 lockdown in Ekiti State, Nigeria.Method: A cross-sectional descriptive study that involved 588 essential workers in Ekiti State, Nigeria during the COVID-19 lockdown. The Perceived Stress Scale was used in the study Chi-square test of statistical significance and multivariate analysis using binary logistic regression were used in the analysis and the level of statistical significance was determined by a p-value of <0.05.Results: The prevalence of high perceived stress levels among all the respondents, health workers, and non-health workers were 64.1% (63.3-70.6), while health workers and non-health workers had a prevalence of 70.1% (65.5 -73.3) and 56.5% (23.5-38.7) respectively. The majority of the respondents related their sources of stress to inadequate transportation (63.3%), hearing of COVID related news (47.4%), and lack of finance (55.1%). Using Logistic Regression respondent respondents who were not satisfied with the support they received from the government during the pandemic had three fold high stress levels than respondents who were satisfied with the support received from the government [AOR= 3.228, (CI= 1.771- 5.886)]. Furthermore, the odd of the high stress level was one fold increased among male respondents than female respondents [AOR = 1.08 CI= (1.410-6.215). Conclusion: Stress management is recommended given the high-stress level among essential workers.   French title: Niveau de stress perçu chez les travailleurs essentiels pendant le casanier du COVID-19 dans l'état d'Ekiti, au Nigéria Contexte général de l'étude : La pandémie de COVID-19 a provoqué des changements socio-économiques inattendus dans le monde. Cette étude a déterminé la prévalence et les facteurs liés au stress perçu à un niveau parmi les travailleurs essentiels pendant la période de confinement du COVID-19 dans l'état d'Ekiti, au Nigéria.Méthode de l'étude : Une étude descriptive transversale qui a impliqué 588 travailleurs essentiels dans l'état d'Ekiti, au Nigéria, dans le cadre du confinement COVID-19. L'échelle de stress perçu a été utilisée dans le test du Chi carré de l'étude et une analyse multi variée a été utilisée. Le niveau statistiquement significatif a été déterminé par une valeur p < 0,05.Résultats de l'étude: Le total des répondants non-agents de santé et agents de santé présentait une prévalence de niveaux élevés de stress perçu de 64,1% (63,3-70,6), 56,5% (23,5-38,7) et 70,1% (65,5 - 73,3). La majorité des répondants ont lié leurs sources de stress à un transport inadéquat (63,3 %), à l'audition de nouvelles liées à COVID (47,4 %) et au manque de financement (55,1 %) En utilisant la régression logistique, les répondants qui étaient insatisfaits du soutien gouvernemental pendant la pandémie avaient des niveaux de stress trois fois plus élevés que les répondants qui étaient insatisfaits du soutien gouvernemental [AOR= 3.228, (IC= 1.771-5.886)]. De plus, l'impair du niveau de stress élevé était un fois plus élevé chez les hommes interrogés que chez les femmes [AOR = 1,08 IC = (1,410-6,215).Conclusion : La gestion du stress est recommandée étant donné le niveau de stress élevé chez les travailleurs essentiels.

Evaluation of the Behavioural, Antioxidative and Histomorphological Effects of Folic Acid-supplemented Diet in Dexamethasone-induced Depression in Mice

BACKGROUND

The effect of folic acid in mitigating depression has remained pivotal in research.

OBJECTIVE

To determine the effects of folate supplementation on neurobehaviour oxidative stress and cerebral cortex histomorphology in the dexamethasone mouse model of depression.

METHODS

Male mice were assigned to six groups (A-F) of 10 mice each. Animals in groups A and D were fed a standard diet, while those in B and E were fed folic acid supplemented diet (25 mg/kg of feed), while C and F were fed folate supplemented diet at 50 mg/kg of feed for 8 weeks. At the beginning of the sixth 6th week, mice in groups A-C were administered distilled water, while animals in groups D-F were administered dexamethasone (DEX) at 4 mg/kg body weight by gavage. Open-field, forced swim, and tail-suspension tests were conducted at the end of the experimental period, following which animals were euthanised and blood was taken for the estimation of Malondialdehyde (MDA), reduced Glutathione, Glutathione Peroxidase, Catalase activity, and Superoxide Dismutase. Sections of the cerebral cortex were prepared for histological examination.

RESULTS

Folic acid supplementation increased body weight, locomotor, rearing and self-grooming behaviours, and decreased immobility time in the tail suspension and forced swim tests. There was also a reduction of lipid peroxidation and an increase in the antioxidant status. Folic acid supplementation was also found to be protective against the development of dexamethasone-induced changes in body weight, open-field behaviours, behavioural despair, oxidative stress and cerebrocortical morphology.

CONCLUSION

Folic-acid supplementation improves the behavioral, some antioxidant, and cerebral morphological parameters.

Prevalence and correlates of psychiatric morbidity, comorbid anxiety and depression among medical students in public and private tertiary institutions in a Nigerian state: a cross-sectional analytical study

Introduction

the study assessed the prevalence and factors associated with psychiatric morbidity (an array of psychological disorders), and comorbid anxiety and depression among medical students in Ekiti State, Nigeria.

Methods

a cross-sectional study of medical students in two universities (one public and one private) in Ekiti state was conducted. A semi-structured questionnaire with adapted questions from the General Health Questionnaire and Hospital Anxiety and Depression Scale was used to obtain information on socio-demographic characteristics, psychiatric morbidity and comorbid anxiety and depression. Data was collected from April 2019 to August 2019. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.

Results

a total of 944 medical students participated in the survey. The overall prevalence of psychiatric morbidity and comorbid anxiety and depression among the respondents was 25.0% (CI = 22.1-27.8) and 14.3% (CI = 12.3-16.5) respectively. The factors independently associated with psychiatric morbidity included being a student of a private institution [adjusted odds ratio [AOR] =6.533, [95% confidence interval [C.I] =3.298-12.940], average academic performance [AOR =1.711, [95% C.I =1.173-2.496], below average academic performance [AOR =2.425, [95% C.I =1.313-4.478], and having a father or a mother with highest level of formal education below first degree [AOR =3.147, [95% C.I =1.579-6.272] and [AOR =2.053, [95% C.I =1.074-3.927] respectively. The factors independently associated with comorbid anxiety and depression were being a student receiving less than one dollar equivalent per day as allowance [AOR = 1.953, [95% C.I = 1.135-3.360] and being a student from the Igbo ethnic group [AOR = 0.533, [95% C.I = 0.333-0.853].

Conclusion

the prevalence of psychiatry morbidity and comorbid anxiety and depression was high among medical students in Ekiti State, Nigeria. Periodic medical [mental health] screening for medical students may be appropriate to screen, detect and manage psychiatric comorbidities. This will help to ensure optimal mental health for this group of university students.