Drug-induced dystonic reactions are common presentations to the emergency department. Two cases of acute dystonic reactions presenting as acute medical emergency illustrate the associated fatality and possibility of misdiagnosis. This case series reports two cases of medication-induced (haloperidol and metoclopramide) acute dystonic reactions presenting with torticollis, tongue protrusion, and respiratory distress which resolved with the administration of intramuscular biperiden and oxygen by facemask. In developing countries like Nigeria where atypical anti-psychotic medications with fewer and lesser troublesome side effects are not affordable to many, the training of physicians and other doctors should adequately include a high degree of clinical suspicion and knowledge of management of acute dystonic reactions.

Background: The coronavirus disease 2019 (COVID-19), a highly contagious infection first diagnosed in China has rapidly spread worldwide. The resultant pandemic has witnessed over one million deaths with unprecedented and severe disruption of socioeconomic activities and healthcare services globally. Hitherto, paediatric cardiac services in Nigeria were underdeveloped and the impact of this disease remains unexamined. Objectives: To evaluate the impact of COVID-19 pandemic on the paediatric cardiac services in Nigeria. Methods: Self-administered digital questionnaires were sent directly into the private accounts of Paediatric Cardiologists and Paediatric Cardiac Surgeons in Nigeria using the Nigerian Cardiac Society and the Association of Cardiovascular and Thoracic Surgeons of Nigeria Register. Thereafter, each person was contacted personally and requested to fill the questionnaires. Results: There were 31 (51.7%) respondents; 23 Paediatric Cardiologist and 8 Cardiac Surgeons, 28 (90.3%) practice in the public sector and the remaining practice privately. About a third reported temporary outpatient clinic closures. Others’ weekly clinic attendance dropped from an average of 17.55 ± 12.6 patients before to 3.90 ± 4.37 during the pandemic. Over 90% of respondents had instituted use of personal protective equipment in their centres. Over 70% of respondents reported suspension of procedures including echocardiography, pericardiocentesis, and partial exchange transfusion. Only one centre performed open-heart surgery during this period. Conclusions: Paediatric cardiac services in Nigeria are grossly inadequate and the COVID-19 pandemic has further worsened the plight of Nigerian children with heart disease.

This study investigated the effect of pre-exposure to caffeine on the onset of action of Pancuronium, a non depolarizing neuromuscular blocking drug. Using intraperitoneal(ip) administration, a graded dose of caffeine was administered to the albino rats before giving Pancuronium, and onset(time) of paralysis was measured. Twenty matured albino rats used for this study were randomly divided into four groups (Group i-iv). Group (i), control was given 0.1mg/kg pancuronium and onset of action was recorded., while group(ii-iv) serves as the experimental groups. Rats in groups (ii-iv) were exposed to 15mg/kg, 30mg/kg, and 45mg/kg of caffeine Thereafter, 30min before pancuronium o1img/kg was administered. The results obtained in this study indicated a dose-dependent increase in the onset of action of Pancuronium upon pre-exposure to caffeine, an effect that is more prominent at the medium and high doses (30mg/kg and 45mg/kg). The result also show that pre-exposure to caffeine delays the action or increases the onset of action of Pancuronium (a non depolarizing blocking drug) at neuromuscular junction and that effect of caffeine is dose dependent. However, from the result of this study,it may be suggested that the dose and time of last intake of caffeine should be considered before determining the dose of Pancuronium to be administered as adjunct to anesthesia in surgical process .