Awolowo University Teaching Hospitals Complex Research Articles

Feasibility, acceptability, and initial efficacy of empathic communication skills training to reduce lung cancer stigma in Nigeria: a pilot study.

Effective communication about cancer diagnosis and prognosis in sub-Saharan African oncology settings is often challenged by the cancer-related shame and stigma patients and families experience. Enhancing empathic communication between health care providers, including physicians and nurses, and oncology patients and their families can not only reduce cancer stigma but also improve patient engagement, treatment satisfaction, and quality of life. To reduce lung cancer stigma, we adapted an evidence-based empathic communication skills training intervention to reduce patients' experience of stigma in Nigeria and conducted a pilot study examining the feasibility and acceptability of the empathic communication skills training. Thirty health care providers, recruited from University College Hospital, Ibadan, and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, participated in a 2.25-hour didactic and experiential training session. Participant surveys were completed before and after the training. Overall, participants reported highly favorable training evaluations, with at least 85% of health care providers agreeing or strongly agreeing to survey items assessing training relevance, novelty, clarity, and facilitator effectiveness. Self-efficacy to communicate empathically with patients increased significantly from before-training (Mean [SD] = 3.93 [0.28]) to after-training (Mean [SD] = 4.55 [0.15]; t29 = 3.51, P < .05). Significant improvements were observed in health care provider reports of empathy toward lung cancer survivors and attitude toward lung cancer care as well as significant reductions in lung cancer blame were noted. The empathic communication skills training was feasible, well received by oncology clinicians in Nigeria, and demonstrated improvements in health care provider-reported outcomes from before- to after-training.

Vulva lesions seen at a tertiary health centre in southwest Nigeria

Background: Some researchers have emphasised the need for more studies on vulvar cancers. The aim of our study is to describe the vulvar lesions identified in biopsies seen in our department over a five-year period to serve as baseline data for future studies. Methods: We conducted a five-year cross-sectional study on all vulva specimens received by the department of Morbid Anatomy and Forensic medicine at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. From the departmental records, we retrieved data on the patients' biodata, medical history, and vulva lesion diagnosis. Results: We recorded 15 vulva biopsies during the study period, with an age range of 13 to 80 years. Two cases were benign tumours, and two cases were inflammatory in nature. A case of a pre-malignant lesion was seen. Nine cases were malignant tumours, all of which are epithelial in origin. We saw two non-neoplastic lesions. These are acute on chronic inflammation and lichen sclerosus et atrophicus. Of the malignant tumours seen, five were well-differentiated squamous cell carcinoma (SCC), two were moderately differentiated SCC, and two were cases of verrucous carcinoma. One case of verrucous carcinoma and a well-differentiated SCC had a background HIV. Conclusion: Vulva lesions are rarely seen at our centre. The absence of preinvasive lesions in our study may be due to the late presentation of cases in clinics or the reluctance of gynaecologists to take biopsies of non-tumoral lesions of the vulva. HIV may be associated with an increased risk of HPV-related cancers.

Head and Neck Lymphoma: Clinico-demographic Profile and Pattern of Presentations in a South Western Nigeria Tertiary Institution

Abstract&#x0D; Running title: A clinic-demographic profile and presentation of patient with head and neck lymphoma in a tertiary institution located in low-middle-income country.&#x0D; Introduction &#x0D; Lymphoma is the second most common malignancy occurring in the head and neck region. It is broadly classified into Hodgkins lymphoma (HL) and non-Hodgkins lymphoma (NHL). It affects nodal and extra-nodal. The clinical presentation is largely determined by the anatomic distribution of the disease, clinical stage of the disease, age of the patients and presence of underlying diseases.&#x0D; Aims and Objectives&#x0D; This study aims to analyse the presentation of head and neck lymphomas over a fifteen years period at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. The objectives include; to determine the prevalence and demographic indices (age and gender) of head and neck, document the histopathologic types, and determine the association between the anatomical sites and histopathologic subtypes of lymphomas&#x0D; Materials and Method&#x0D; This is a retrospective study among patients seen and diagnosed histologically with head and neck lymphomas between 2005 – 2019 at the departments of Oral Medicine and Pathology and Morbid Anatomy and Forensic Medicine, OAUTHC. Relevant record were retrieve from patient record and histological register from the hospital registry. Patients with incomplete data were excluded. The study was conducted in accordance with the Declaration of Helsinki, and approved by our institution Ethics Committee Board.&#x0D; Results &#x0D; A total number of 54 cases of head and neck lymphoma were analysed with a prevalence of 30.9%. Out of the 54 cases, 46 were NHL and 8 cases were HL with a ratio of 5.8:1 respectively. A male preponderance was observed (M: F; 2.4:1). The lesion commonly affects patients in 3rd and 4th decade of life. All the histologic variants were seen to affect males more than females except for the unclassified variant of HL which affected both sexes equally. Low-grade and intermediate grade NHL affected the older patients more while high grade and miscellaneous subtypes affected the younger males. The cervical lymph nodes were the most common nodal site while the jaw was the most common extra-nodal site. Eighteen (39.1%) cases of NHL were diagnosed histological as miscellaneous while high and low grade had seven (15.2%) cases each.&#x0D; Conclusion&#x0D; Head and neck lymphoma remain relatively rare. One of every six lymphoma seen was HL, with male preponderance. High grade lymphoma is seen more in the younger patient. Lymphoma affect cervical lymph node more while jaw was the most common extranodal site. Obesity may be a predisposing factor in our environment but require future study to confirm.

Hypertrophic pyloric stenosis in a toddler: An atypical presentation in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

Gastric outlet obstruction resulting from hypertrophic pyloric stenosis typically manifests in early infancy and seldom occurs after this period. The case is a 14-month-old toddler with multiple episodes of nonbilious, projectile vomiting with persistent hunger, and progressive weight loss for three weeks. The symptoms were preceded by ingestion of a water-based herbal concoction. His barium meal and abdominal ultrasonographic findings were diagnostic of hypertrophic pyloric stenosis (HPS), following which he had an initial pyloromyotomy, which failed before he later had pyloroplasty. The patient was subsequently discharged home four days after the second surgery and has remained stable since then. Although hypertrophic pyloric stenosis is uncommon beyond early infancy, it should be suspected in toddlers with persistent postprandial vomiting that is projectile and nonbilious. Early diagnosis is essential to limit malnutrition as well as other complications associated with HPS.

Indications and Outcomes of Medical Intensive Care Admissions in a Nigerian Tertiary Hospital

Background: The demand for intensive care is rising in many developing countries with specialties requiring specialized intensive care services. Medical conditions constitute a substantial proportion of demands for intensive care. Objectives: To determine the patients’ characteristics and outcomes of medical indications for intensive care unit (ICU) admissions in a Nigerian tertiary hospital. Methods: A retrospective descriptive study was conducted at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Southwest Nigeria. The data of all patients aged 16 years and above managed from 2010 to 2019 were extracted from the general ICU admissions book. The age, sex, indication for admission, need for mechanical ventilation, length of stay in the ICU and outcome of care were retrieved for analysis. Results: There were 255 patients with medical conditions, constituting 12.6% of all (3,213) ICU admissions during the study period. The male-to-female ratio was 1.3:1.0 and the age range was 16 to 89 years. The most common indication for admission was neurological illnesses (56.7%). Stroke accounted for 40.4% of all medical ICU admissions. The mean length of ICU stay was 4.9±5.95 days. A larger proportion of patients (75.0%) who had mechanical ventilation died compared to 25.0% who survived (p = 0.001). Conclusion: Neurological disorders, especially stroke, were the most common indications for ICU admission. Many medical conditions had high mortality rates and outcomes were notably poor for mechanically ventilated patients.

National health insurance scheme improves access and optimization of antimicrobial use in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

Nigeria instituted the National Health Insurance Scheme (NHIS) for universal health coverage. This study compared the NHIS and out-of-pocket (OOP) antibiotic prescribing with the World Health Organization (WHO) optimal values. A total of 2190 prescription forms from the NHIS and OOP were included in this study conducted at Obafemi Awolowo University Teaching Hospitals Complex, Nigeria from January 2021 to December 2022 and analysed using WHO drug prescribing guidelines. The average number of drugs per encounter was higher in the NHIS prescribing (χ2=58.956, p=0.00) than in OOP prescribing. The percentage of encounters with an antibiotic prescribed is higher in NHIS prescribing (χ2=46.034, p=0.000) than in OOP prescribing. The percentage of parenteral antibiotic prescribing is higher in OOP prescribing (χ2=25.413, p=0.000) than in NHIS prescribing. The percentage of antibiotic prescribed from the National Essential Medicine List is higher in NHIS prescribing (χ2=8.227, p=0.000) as well as the antibiotics prescribed from the Access category of the WHO Access, Watch and Reserve (AWaRe) Classification of antibiotics (χ2=23.946, p=0.000) when compared with OOP prescribing. Prescribing indicators show better performances with NHIS antibiotic prescribing and are closer to the WHO-recommended optimal values than in OPP prescribing. Hence NHIS prescribing can be an easy target for hospital antibiotic stewardship intervention for optimal antibiotic prescribing.

Impacted Mandibular Third Molar Prevalence and Patterns in a Nigerian Teaching Hospital: A 5-Year Retrospective Study

Mandibular third molars are the most commonly impacted teeth. The prevalence and pattern of impacted mandibular third molars in patients presenting to the Obafemi Awolowo University Teaching Hospitals Complex, a tertiary hospital in south-western Nigeria, are largely unknown. This retrospective study examined 469 patient records, extracting socio-demographic and clinical information for analysis. It also determined the prevalence and pattern of impacted mandibular third molars from January 2015 to December 2019. The positioning of impacted teeth was assessed via periapical radiographs utilizing Winter’s classification. Data were subjected to analysis with IBM SPSS version 20, utilizing frequencies, percentages, and likelihood ratios, with statistical significance set at p &lt; 0.05. The prevalence of impacted mandibular third molars within the study cohort was 2.51%, with a higher incidence observed in the 21–29 age group (p &lt; 0.001). Mesioangular impaction was the most prevalent, with pericoronitis being the primary reason for extraction, and periodontal pockets being the most common associated pathology.

The Effect of Platelet-Rich Fibrin on Post-Operative Inflammatory Sequelae after Mandibular Third Molar Surgery: A Randomized Controlled Trial

Background: Surgical extraction of impacted mandibular third molars is commonly associated with post-operative inflammatory sequelae, causing distress to patients and affecting their quality of life. This study aimed to investigate the effect of using autologous platelet-rich fibrin (PRF) on post-operative pain, facial swelling, and trismus following mandibular third molar surgery.&#x0D; Methods: In this single-blinded prospective randomized controlled trial, 90 participants aged 18-35 years were enrolled. Eligible patients underwent surgical extraction of impacted mandibular third molars under local anesthesia between October 2017 and June 2018 at the Oral and Maxillofacial Surgery clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Participants were randomly assigned to either the PRF group or the non-PRF group. PRF was placed in the extraction socket of the PRF group, while the non-PRF group received a blood clot. Post-operative pain, facial swelling, and trismus were measured as outcomes. Longitudinal data analysis using generalized estimating equations was employed, adjusting for confounding factors, with statistical significance set at p &lt; 0.05.&#x0D; Results: The PRF group exhibited significantly lower pain scores (3.02 mm; p &lt; 0.001), reduced facial swelling (0.55%; p = 0.01), and decreased trismus (4.52%; p = 0.05) compared to the non-PRF group.&#x0D; Conclusion: Placement of PRF in the extraction socket following mandibular third molar surgery resulted in decreased post-operative pain, facial swelling, and trismus. These findings suggest that PRF may have a beneficial impact on the inflammatory outcomes of third molar surgeries.&#x0D; &#x0D;

PITUITARY TUMORS-02 EVOLUTION OF PITUITARY SURGERIES TO THE TRANS-SPHENOIDAL APPROACH IN A NIGERIAN TEACHING HOSPITAL: LEANING ON LOCAL TRANSFER OF SKILLS

Abstract BACKGROUND Globally pituitary surgeries have evolved from transcranial surgeries (TCS) to transsphenoidal (TSS) as the standard of care. This is due to the many benefits of TSS over TCS. However, this evolution has been comparably slow in some parts of Africa. Before 2019, all sellar surgeries in our hospital, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife were done via TCS. To improve the quality of care to our patients, we started the TSS. The evolution into TSS involved local skill transfer. METHOD We collaborated with a neurosurgeon from another teaching hospital in Nigeria with expertise in TSS who visited three times. All patients had microscopic TSS. The equipment was sourced for by local neurosurgeons with backup brought by the visiting neurosurgeon. The brain scans were sent ahead, and the visiting surgeon arrived the day before surgery. We compared our experience of TCS over the last 10yrs with our recent TSS experience. RESULTS Sixty-nine sellar tumours were surgically operated over 10yrs. 7 of the recent cases had TSS, one was which was done entirely by the local team. There were 2 cases of mortality from the TCS while no mortality from the TSS. The complication rates for the TCS were diabetes insipidus (DI) (22%), Tumour bed hematoma requiring evacuation (10%), SSI (7%) and post-operative seizures (6%). Of the 7 TSS, one had DI, and another had CSF leak and tension pneumocephalus requiring evacuation. 78% of the TCS had intraoperative blood transfusion. None of the TSS had blood. Average post-operative hospital stay was 3 for the TCS and was 9 for the TCS. CONCLUSION Our experience with the TCS approach and evolution to the TSS showed the TSS to be better. While overseas training for skill enhancement is desirable, the transfer of local skills can enhance neurosurgery practice in developing countries.

Gynaecological Pan-endoscopy (Hystero-laparoscopy) in a tertiary health facility in Nigeria: A ten-year clinical audit

Objective: This study aims to determine the prevalence, indications, common findings, challenges, and complications of gynaecological pan-endoscopy in Obafemi Awolowo University Teaching Hospitals Complex, Osun State.&#x0D; Methods: It was a retrospective study. Records of patients who had gynaecological hysteroscopy and (or) Laparoscopy from 1st January 2012 to 31st December 2021 were retrieved, and relevant data were extracted and analyzed using the SPSS version 21.0&#x0D; Results: There were 2125 gynaecological surgeries within the study period, with 207 endoscopies giving a prevalence of 9.7%. Infertility 100 (51.5%) was the most common indication. Common findings were tubal block 45(33.6%) and intrauterine adhesions 19 (31.7%). The most common complication and challenge were shoulder tip pain 35(18.0%) and instrument failure 76 (39.2%), respectively. There is a statistically significant relationship between the occurrence of complications during Endoscopy and duration of surgery (X2 = 25.693, P= 0.000), endoscopy type (X2=21.636, P=0.000), and hospital stay (X2 = 63.213, P=0.000)&#x0D; Conclusion: The utilization rate of gynaecological pan-endoscopy could be higher and shows more skills, logistics, and staffing. Therefore, efforts should be intensified towards training and provision of up-to-date facilities for endoscopic surgery in our setting.

Decision-to-Delivery Interval and Obstetric Outcomes of Emergency Caesarean Sections in a Nigerian Teaching Hospital

Background: Prolonged Decision-to-Delivery interval (DDI) is associated with adverse maternal-foetal outcomes following emergency Caesarean section (EmCS). Objective: To determine the DDI, predictive factors, and the foeto-maternal outcomes of patients that had EmCS in a Nigerian Teaching Hospital. Methods: A descriptive study of all EmCS performed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, from 1st June 2020 to 31st May 2021, was conducted. Relevant data were extracted from the documentations of doctors, nurses and anaesthetists using a designed proforma. The data obtained were analysed using the IBM SPSS Statistics for Windows, version 25. Results: The median (IQR) DDI was 297 (175-434) minutes. Only one patient was delivered within the recommended DDI of 30 minutes. The most common cause of prolonged DDI was delay in procuring materials for CS by patients’ relatives(s)/caregiver(s) (264, 85.2%). Repeat CS (AOR = 4.923, 95% CI 1.09-22.36; p = 0.039), prolonged decision-to-operating room time (AOR = 8.22, 95% CI 1.87-8.66; p&lt;0.001), and junior cadre of surgeon (AOR = 25.183, 95% CI 2.698-35.053; p = 0.005) were significant predictors of prolonged DDI. Prolonged DDI &gt; 150 minutes was significantly associated with maternal morbidity (p = 0.001), stillbirth (p = 0.008) and early neonatal death (p = 0.049). Conclusion: The recommended DDI of 30 minutes for CS is challenging in the setting studied. To improve foeto-maternal outcomes, efforts to reduce the DDI should be pursued vigorously, using the recommended 30 minutes as a benchmark.

Fungal and Parasitic Diseases Seen in Tissue Biopsies at a Tertiary Health Center in Southwest Nigeria in a Five-Year Period

Aim: To describe the clinical and pathological features of the various fungal and parasitic diseases seen at our hospital over a five-year period.&#x0D; Study Design: This is a retrospective study of records of fungal and parasitic diseases.&#x0D; Place and Duration of Study: The study was done at the Department of Morbid Anatomy and Forensic Medicine of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife from January 2018 to December 2022.&#x0D; Methods: The tissue sections of each case went through routine processing in the histopathology laboratory. The slides of the sections were viewed using a simple binocular microscope. The slides were scanned using APERIO CS2 digital slide scanner.&#x0D; Results: Eight cases of fungal infections and eleven cases of parasitic infections were noted during the study period. Aspergillosis accounted for five of the fungal infections, while mucormycosis accounted for two nasal infections. Schistosomiasis accounted for six cases of parasitic infections.&#x0D; Conclusion: Aspergillosis was the most diagnosed fungal infection while Schistosomiasis was the commonest parasitic infection. Digital stain separation could be an added tool in identification of fungal and parasitic stages in histological tissue sections.

Dental anxiety, pain, and quality of life among exodontia patients: A cross-sectional study

Introduction: There are few studies on dental anxiety (DA) among patients who are planned for routine dental extraction compared with a plethora of published reports on DA and oral health-related quality of life (OHRQoL) in patients undergoing third molar surgery. Aim: This study aims to investigate anxiety level, pain experience and OHRQoL of patients scheduled for routine exodontia at a Nigerian tertiary hospital. Materials and Methods: This was a cross-sectional study conducted at the Oral Surgery clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from April to September 2019. DA, pain, and OHRQoL of participants were assessed using Corah’s DA Scale (DAS), Visual Analog Scale (VAS) and 14-item oral health impact profile (OHIP-14) questionnaire, respectively. Just before routine exodontia, the demographic variables of the participants were also recorded. Data were analyzed using R version 4.2.2. Results and Discussion: One hundred fifty-nine participants planned for routine exodontia of one or two permanent tooth/teeth with 41.7 ± 19.8 years mean age. The mean DAS score for the study population was 7.9 ± 3.6 (range: 4–18) with the proportion of dentally anxious patients (DAS score ≥13) being 15.1%. The majority (125; 78.6%) reported preexodontia dental pain VAS score of 4–10. Only 22.6% of the participants had their OHRQoL significantly impaired with OHIP-14 score of 29–56. Conclusion: The prevalence of DA among Nigerian adults scheduled for routine exodontia was 15.1%. At least seven in ten patients had moderate and severe dental pain, while one-fifth presented with significantly impaired OHRQoL.

Assessment of Health-Related Quality of Life of Cardiovascular Patient Caregivers in Obafemi Awolowo University Teaching Hospitals Complex, Nigeria

Assessment of Health-Related Quality of Life of Cardiovascular Patient Caregivers in Obafemi Awolowo University Teaching Hospitals Complex, Nigeria

Lidocaine 10% sprays versus oral diclofenac sodium for pain relief in women undergoing hysterosalpingography for infertility workup: A randomized clinical trial

ABSTRACT Background Tubal disease is the leading cause of female infertility in the West African sub-region and hysterosalpingography (HSG) is the first-line imaging technique in its assessment. HSG is an acutely painful procedure. Various studies on analgesia for HSG were inconclusive. We compared the efficacy of 10 mg lidocaine 10% spray and 50 mg oral diclofenac sodium for pain relief during HSG. Methods This randomized clinical trial was carried out at the Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria between December 2019 and December 2021, among one hundred and eight eligible women undergoing HSG as part of their infertility workup. Ethical clearance was obtained from the ethics committee of the hospital with Protocol number ERC/2019/01/14. They were randomized into two groups. One group of 54 patients received 10 mg of 10% lidocaine spray and an oral placebo, while the second group of 54 women had 50 mg of oral diclofenac sodium and normal saline spray. Pain scores were assessed using a 10 cm visual analog scale at cervical traction, instillation of contrast media, and thirty minutes after HSG. The mean pain scores, the need for additional analgesia, and the occurrence of adverse drug reactions were compared between the two groups. Result Those in the oral diclofenac group had significantly lower pain scores than the 10% Lidocaine group 30 minutes after HSG; 1.13 ± 1.06 Vs. 2.04 ± 1.26 (p < 0.001). The additional analgesic requirement also showed no statistically significant difference between the two groups. Conclusion This study showed that oral diclofenac sodium is comparable to lidocaine spray for pain relief during HSG. It also has the additional benefit of improved quality of life 30 mins after HSG as evidenced by effective pain relief. Consideration should be given to the use of oral diclofenac sodium for pain relief during and after HSG in well-selected patients.

A Comparative Study of Prostate Specific Antigen (PSA) Point-of-Care-Testing (POCT) Techniques

Background: Prostate Specific Antigen (PSA) testing is widely used to diagnose and monitor clinical progress in patients with prostate cancer. The availability of various new Point-of-Care-Testing (POCT) equipment for PSA demands that the performance characteristics of these equipment be assessed before introducing them into clinical use to ensure accuracy and reliability. Objectives: To compare the i-CHROMA® automated immunofluorescence serum total PSA assay with the Accubind® Enzyme Linked Immuno-Sorbent Assay (ELISA) as POCT among patients with suspected prostate cancer. Methods: The study was conducted at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. Blood samples drawn from 20 consecutively selected patients were analysed for PSA using the i-CHROMA® immunofluorescence kit once and with the Accubind® ELISA protocol twice. Results: The mean PSA using Accubind® ELISA was 12.9ng/ml, while it was 14.5ng/ml with the i-CHROMA® immunofluorescence assay. The bias between the two methods was 1.6ng/ml. The two methods had a good correlation: Passing Bablok regression equation was y = 1.264604x – 0.0300469, and the Spearman correlation coefficient between the two measurements was high (r = 0.956; Confidence Interval 0.889 - 0.983; p&lt;0.0001). Agreement between the two methods was statistically satisfactory as the mean values of the samples fell within the 95% Confidence Interval of the differences on the Bland Altman plot. Conclusion: The i-CHROMA® POCT assay showed good correlation and agreement with the well-known ELISA method. Therefore, the method is recommended for use in monitoring PSA in patients with prostatic cancer.

C-Reactive Protein as an Index of Early Diagnosis of Neonatal Sepsis

Introduction: Neonatal sepsis is a major cause of morbidity/mortality and the definitive diagnosis is an isolation of the pathogen from blood culture which might take 2-7 days. A test for early confirmation of infection is therefore required. C-reactive protein (CRP) is therefore suggested as an early screening tool in the diagnosis of neonatal sepsis.&#x0D; Aim: To determine the usefulness of CRP in the early diagnosis of neonatal sepsis among neonates.&#x0D; Study design: This was a prospective longitudinal study.&#x0D; Place of the study: Department of Paediatrics, Obafemi Awolowo University Teaching Hospital Complex Ile-Ife.&#x0D; Methods: Consecutive neonates were recruited. Blood culture was done and CRP was done at contact and 24 hours. Data were analysed and P = .05 was considered significant.&#x0D; Results: A total of 180 neonates comprising 106 (58.9%) males with a male to female ratio of 1.4:1 were studied. Thirty-two (17.8%) of the neonates had culture-proven sepsis with a prevalence of 10.1% among the inborn and 23.8% among the out-born with statistically significant difference (χ2 = 5.638, P = .018). The means of initial and repeat CRP for subjects with culture-proven sepsis were 41.4 (23.6) mg/l and 10.6 (4.3) mg/l respectively while subjects without sepsis were 9.2 (11.3) mg/l and 6.1 (2.6) mg/l respectively (P &lt; .001). The CRP has a sensitivity of 93.8%, specificity 91.9%, negative predictive value 98.6%, and positive predictive value of 71.4%. The area under the curve for the receiver operator characteristic curve for subjects with CRP ≥ 10mg/L and positive culture was 0.909 (P &lt; .001).&#x0D; Conclusion: The CRP has a high sensitivity, specificity, and negative predictive value and can therefore be used to screen neonates with sepsis.

Adverse Childhood Experiences, Arousal Predisposition and Sleep Disorders in Patients with Substance Use Disorder

Background: Different studies have documented positive associations between adverse childhood experiences (ACE) and psychoactive substance use disorder; arousability and sleep disorders; as well as positive associations between ACE and sleep disorders. There isa need to explore possible associations among ACE, arousability, and sleep disorders specifically in patients with substance use disorder in our local environment, hence this study. The objectives of the study were to determine the associations between ACE (on the one hand); arousability, and sleep disorders (on the other hand) in patients with substance use disorder. The other objective was to explore possible associations between arousability and sleep disorders in the same group of patients. The sleep disorders of interest in this study are insomnia, excessive daytime sleepiness (EDS), and poor sleep quality. Methods: Eighty-four (84) subjects who met the ICD-10 criteria for the diagnosis of psychoactive substance dependence from the Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, were consecutively recruited into the study. They were required to complete: Proforma on sociodemographic characteristics and drug use information; Adverse Childhood Experiences Questionnaire (ACE-Q); Arousal Predisposition Scale (APS); Insomnia Severity Index (ISI); Epworth Sleepiness Scale (ESS); and Pittsburgh Sleep Quality Index (PSQI). The data were analyzed using SPSS, version 23, and P˂ 0.01 was considered significant. Results: Eighty-two (82) of the subjects, representing 97.6 % of the total number, provided complete data for analyses. The age range of the 82 participants was from 19- 44 years, with a mean of 28.5 years (SD=7.3, SEM =0.8). There were 77 males (93.9 %) and five females (6.1 %). A total of 15 out of the 82 subjects (18.3 %) recorded ≥4 in ACE- Q. Twenty-one (25.6 %) met the requirement for arousability using the APS, 17 (20.7 %) had clinical insomnia, 22 (26.8 %) had EDS, while another 22 (26.8 %) had poor sleep quality. The common drugs of dependence used by the subjects were alcohol, cannabis, cocaine, methamphetamine, nicotine, opioids, and sedatives/hypnotics; either alone or in combination. The results showed that ACE was positively and significantly associated with arousability (χ 2 = 13.713, df =1, P = 0.000), insomnia severity (χ 2 = 20.274, df =1, P = 0.000), EDS (χ 2 = 12.461, df =1, P = 0.000), and poor sleep quality (χ 2 = 12.461, df =1, P = 0.000). There was a positive association between arousability and insomnia severity, a positive association between arousability and EDS, and a positive association between arousability and poor sleep quality. Conclusion: The findings showed that ACE and arousability may be significant factors contributing to sleep disorders among subjects with substance use disorders. The study therefore concludes that prevention of adverse experiences in childhood and adolescence is pivotal to the prevention of subsets of sleep disorders, in adult life.

Cytokeratin 19 (CK19) expression by thyroid neoplasms in a Nigerian tertiary health centre.

despite the observed appreciable sensitivity and specificity of the use of CK19 in predicting thyroid malignancies, there is still a paucity of information about its uses in Nigeria. Current information across the world is also scarce. This study was to review the histopathological diagnosis of thyroid neoplasms seen in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile Ife, using cytokeratin 19 immunohistochemical marker. a retrospective study of fifty-six cases of thyroid neoplasm seen over a period of twenty years was conducted. The tissue samples were subjected to immunohistochemical staining for CK19 using monoclonal antibodies. The expression of the markers on the various thyroid neoplasms was assessed histologically. the expression of CK19 was significantly higher in malignant thyroid neoplasms compared to benign neoplasms (p<0.05). The sensitivity and specificity for cytokeratin 19 were 90.0% and 75.0% respectively. diffuse immunohistochemical expression of CK19 is a strong indicator of thyroid malignancy. This biomarker can help in the diagnosis of thyroid neoplasms especially those with incomplete or equivocal histomorphology features.

Knowledge of Puerperal Psychosis among Pregnant Women Attending Antenatal Clinic in Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State

Objectives: Puerperal psychosis is the most severe and uncommon form of postnatal mental illness, with rates of 1-2 episodes per 1000 deliveries. The clinical onset is rapid, with the symptoms presenting as early as the first 2 to 3 days postpartum and the majority of episodes developing within the first 2 weeks after delivery. Therefore, this study seeks to assess the knowledge of causes/risk factors, signs &amp; symptoms, effects, and treatments/prevention of puerperal psychosis among pregnant women.&#x0D; Design: This descriptive study utilises a crosssectional design for data collection. The study was carried out at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife among pregnant women attending the antenatal clinics to assess their knowledge about puerperal psychosis. A sample of two hundred and fifty-five pregnant women was included in this study using the purposive sampling technique. Data collection was done through a self-administered structured questionnaire and the data collected were analysed using a statistical package for the social sciences version.&#x0D; Results: The result of this study showed that about one-fifth of the respondents had good knowledge of the causes/risk factors of puerperal psychosis, one-fourth had good knowledge of signs, symptoms, and effects of puerperal psychosis while the majority of the respondents had good knowledge on treatment/prevention of puerperal psychosis. Generally, this study concludes that about onefourth of the respondents attending the antenatal clinic in Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, had good knowledge about puerperal psychosis.&#x0D; Conclusion: This study concludes that although the majority of the respondents possess good knowledge of treatment and prevention of puerperal psychosis, only a few had good knowledge of the causes/risk factors as well as knowledge of signs, symptoms, and effects of puerperal psychosis.