Lagos State University Teaching Hospital Research Articles

Paediatric rheumatology in Nigeria: history, challenges and the future.

Pediatric rheumatology is a relatively new subspecialty in Nigeria. For many years, rheumatic disease had not been well-recognized or studied in Nigeria, so there has been a low suspicion index. The clinical presentation of most pediatric rheumatic diseases (PRDs) mimics non-rheumatic diseases making it a diagnostic challenge most of the time. The story has changed in Lagos since the creation of a pediatric rheumatology unit at the Lagos State University Teaching Hospital. There is now a high index of suspicion for these diseases in the hospital but no one knows about what is happening in the other 35 states of the country who do not have a pediatric rheumatologist. Major challenges being faced presently are poor awareness among healthcare workers and the community, high cost of investigations and medications, lack of pediatric rheumatologists in most hospitals in the country, lack of pediatric rheumatology training centers for both undergraduate and postgraduate training, and lack of research data. The healthcare community in Nigeria is looking forward to a future where pediatric rheumatology will be highly recognized and established.

Perceived Factors Influencing Postpartum Weight Gain among Nursing Mothers Attending Postnatal Clinic at Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria

This research was carried out to assess the factors influencing postpartum weight gain among nursing mothers attending Post-natal Clinic at Lagos State University Teaching Hospital, Ikeja. Three objectives guided the study which were to identify the factors influencing postpartum weight gain, to assess the perception and attitude towards postpartum weight gain among the nursing mothers. A cross-sectional research design was adopted for the study, in which only one hundred and eighty-eight (188) of them met the inclusion criteria. Questionnaire was the instrument for data collection, data was analyzed using SPSS version 25, and presented on frequency percentage tables. Findings from the study revealed that the perceived factors influencing weight gain after childbirth among nursing mothers was mainly post-natal in nature; due to the use of family planning method 109(57.8%); followed by the consumption of fast food 93(49.3%); and inadequate physical exercise 66(35.2%) as the main factors. Their perceptions towards postpartum weight gain was majorly poor as 139(73.9%) of them affirmed that there is satisfaction with their present weight. An evaluation of their attitude towards weight gain after childbirth revealed an overall negative attitude towards the concept, as majority 132(70.4%) of them agreed that family planning can cause nursing mothers’ weight gain; about half 95(50.7%) of them attested to exercise being necessary after delivery to maintain healthy weight among nursing mothers. The study found a significant relationship between the perception and attitude of nursing mothers towards postpartum weight gain (r = .863; p < .05). Based on these findings, the study concluded that there is an urgent need to positively improve nursing mothers’ perception in order to improve their attitude towards weight gain after birth, through ante-natal health education, sensitization programmes and community mobilization addressing factors negatively influencing mothers’ perception and attitude towards postpartum weight gain especially during the ante-natal period.

Factors Associated with Clinical Pregnancy following Assisted Reproductive Technology: A Comparative Cross-Sectional Study

Abstract Background: Over the years, the numbers of centres performing assisted reproductive technology (ART) have increased in urban regions of Africa. We reviewed a 10-year record of ART in a public hospital in a bid to determine the pregnancy rate and identify factors associated with achieving clinical pregnancy. Materials and Methods: This was a retrospective, analytical, cross-sectional study of 604 women who had undergone in vitro fertilisation (IVF) or IVF/intra-cytoplasmic sperm injection, over a 10-year period, at the [Institute of Fertility Medicine, Lagos State University Teaching Hospital]. Data were obtained from the medical records of couples who had undergone IVF at the study location and analysed using relevant descriptive and inferential statistics. Regression analysis was used to determine possible predictors of clinical pregnancy outcomes at 95% confidence level and significant P value of <0.05. Results: The clinical pregnancy rate observed was 23.7%. Women aged ≥35 years of age had 2.9 odds of achieving pregnancy compared to women <35 years of age. The quality of embryo and dose of the follicle-stimulating hormone used were not significantly different when compared in pregnant and non-pregnant women (P = 0.612 vs 0.881). Endometrial preparation techniques, number of embryos transferred, types of embryos transferred, sperm quality, and source of gametes used were not significantly different in pregnant and non-pregnant women. There was a 0.77 odds of achieving pregnancy when a day-5 embryo was used compared to a day-3 embryo (P = 0.008). Conclusion: Overall, these results emphasise the multifaceted nature of IVF outcomes, urging further research to elucidate the intricate factors influencing success rates in assisted reproduction.

Evaluation of health records management systems of Lagos State University Teaching Hospital, Nigeria

Evaluation of health records management systems of Lagos State University Teaching Hospital, Nigeria

Lecithin-cholesterol acyltransferase and paraoxonase-1 levels in atherosclerotic cardiovascular disease patients in Nigeria.

Recent evidence has linked changes in plasma lecithin-cholesterol acyltransferase (LCAT) and paraoxonase-1 (PON-1) levels with increased risk for development of premature atherosclerotic cardiovascular disease (ASCVD) in different populations. However, studies on this in Nigeria and sub-Saharan Africa are scarce. This study assessed the association between reduced plasma LCAT and PON-1 levels and an increased risk of ASCVD, and their potential as biomarkers for ASCVD. Atherosclerotic cardiovascular disease patients and healthy controls were randomly selected for this cross-sectional case-control study from the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria, between March 2022 and March 2023. Plasma LCAT and PON-1 were determined by sandwich enzyme-linked immunosorbent assay, while the lipid profile was measured by spectrophotometry. A total of 153 ASCVD patients (mean age: 52.92 ± 10.24 years) and 50 healthy controls (mean age: 46.96 ± 11.05 years) were included in the analyses. Stastistically significant increases were observed in the mean body weight, hip circumference, waist circumference, waist-to-hip ratio, body mass index, diastolic and systolic blood pressure (all p ≤ 0.001), and pulse rate (p = 0.003) compared to the control values. Statistically significant increases were also observed in the mean plasma total cholesterol, triglycerides, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol (all p ≤ 0.001). In contrast, the mean plasma high-density lipoprotein cholesterol, LCAT, and PON-1 (p ≤ 0.001) were notably reduced compared to the control values. The present study provides supportive evidence that changes in plasma LCAT and PON-1 could predispose individuals to risk of premature ASCVD. Plasma LCAT and PON-1 may serve as independent markers or complement other established cardiovascular disease markers to discriminate the risk of ASCVD when it is unclear.

Detection and Antimicrobial Susceptibility of Candida Species Isolated from the Urine of Patients in a Tertiary Health Facility, Southwest Nigeria

Aims: This study aimed to identify and determine the antimicrobial susceptibility profiles of Candida species causing UTI among patients attending a tertiary Teaching Hospital, in southwest Nigeria. Study Design: Comparative cross-sectional study. Place and Duration of Study: Lagos State University Teaching Hospital, Ikeja, Nigeria between June 2017 and February, 2018. Methodology: A total of 250 participants whose provisional diagnosis was candiduria were recruited for this study. Urine samples were collected from consenting participants early in the morning into sterile wide mouth universal containers. These samples were cultured aerobically on Blood agar, Cystine-Lactose-Electrolyte Deficient (CLED) agar and Sabouraud dextrose agar (SAB) at 370C within 1 to 2 days. The isolates were profiled into species level using microscopic, biochemical test, chromogenic media (Chrom agar Candida) and Analytical Profile Index (API) 32C examination analysis. Results: An overall rate for Candidiasis in this study was 12.8% (32/250). The rate was higher in female 17.5% compared to 6.5% in their male counterparts (p=0.014). Highest rate of infections peaked at 28.6% among age group 83-92 years and lowest (6.7%) in age group 23-32 years. A total of 11 (4.4%) urine culture from participants produced C. albicans pure fungi isolates. However, by gender, this was statistically significant (p=0.003). A total of 81 bacterial (32.4%) and fungal isolates 32 (12.8%) were isolated and profiled. Distribution of Candida species indicated highest incidence in age range 31-40 years, followed by 21-30years and age 61-70 years age brackets. The isolated species were Candida albicans 11(34.4%), C. tropicalis 8(25%), C. parapsilopsis 6(19%), C. krusei 2(6.3%) and C. hellenica 1(3.1%). Sixty to seventy percent of fungal isolates were susceptible to ketoconazole and fluconazole while the susceptibility pattern of Candida species to itraconazole, terbinafine and nystatin varied between moderately susceptible to resistance. All the Candida isolates were resistant to griseofulvin. However, C. albicans was found to be the major Candida species causing Candidal urinary tract infection. The only C. hellenica isolated was resistant to all the antifungal drugs were approved except nystatin. Conclusion: High profile of Candida isolates and related UTI microbes were found in this study. There is need for advocacy for the use of API and Chrom agar Candida for routine diagnosis for Candida identification. Nevertheless, the Candida isolates were mostly susceptible to ketoconazole and Fluconazole but only the isolates were griseofulvin resistant.

Exploring Serum Vitamin D, Sex Hormones, and Lipid Profile Disparities in Women With and Without Polycystic Ovarian Syndrome: A Case-Control Study.

Background Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. It is characterized by dyslipidemia, hormonal imbalances, and metabolic dysfunctions.Vitamin D deficiency may be implicated in the pathogenesis of PCOS, potentially exacerbating its metabolic syndrome. However, the exact interplay between these factors remains underexplored. Aim This study aimed to evaluate serum levels of vitamin D and its association with modalities of PCOS among women with PCOS and healthy controls. Methods This was a hospital-based case-control study where 60 women newly diagnosed with PCOS and 56 non-PCOS controls were consecutively recruited within a 10-month period. The women aged 20-40 were recruited at the gynecology clinics of Lagos State University Teaching Hospital and Lagos Island Maternity Hospital. PCOS was diagnosed using the Rotterdam's criteria. The biodata, anthropometry, clinical features, serum vitamin D, cortisol, progesterone, testosterone, estradiol, prolactin, anti-Mullerian hormone (AMH), thyroid-stimulating hormone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), insulin, fasting blood glucose (FBG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and very-low-density lipoprotein cholesterol (VLDL-C) levels of PCOS-diagnosed women were assessed and compared with those of women without PCOS. The exclusion criteria comprised known diabetics, women with gynecological pathologies such as fibroids, and womenon medications affecting the study analytes or hormones. Statistical analyses included chi-square or Fisher's exact tests for categorical variables, student t-test for continuous variables, and Pearson's correlation for assessing relationships between continuous variables. The significance level was set at p<0.05 and a confidence interval of 95%. Results Individuals with PCOS exhibited a younger mean age (26.90±3.73 versus 29.95±5.00 years, p=0.001) and a higher prevalence of irregular menstrual patterns (46.7% versus 14.3%, p=0.0001) and acne (58.3% versus 37.5%, p=0.025). Moreover, PCOS was associated with elevated levels of TC (p = 0.03), TG (p = 0.03), LDL-C (p = 0.014), FBG (p = 0.001), LH:FSH ratio (p = 0.002), AMH (p = 0.0001), and testosterone (p = 0.003), but low progesterone (p = 0.001) and vitamin D (p = 0.033), alongside a higher incidence of vitamin D deficiency (33.3% versus 26.1%) and insufficiency (66.7% versus 56.5%). Additionally, significant but weak correlations were observed between serum vitamin D levels and waist-hip ratio (r = 0.4, p = 0.016) and FBG (r = -0.4, p = 0.036) in the PCOS group, suggesting potential metabolic implications. Conclusion The PCOS subjects in this study had decreased vitamin D and progesterone levels, with elevated concentrations of testosterone, AMH, lipid profile (TC, LDL, and TG), FBG, and LH:FSHratio. Studies on the therapeutic effect of vitamin D administration in managing PCOS will need to be further evaluated.

Statistical evaluation of effect of anthropometric measurements on adolescent idiopathic scoliosis

Scoliosis is a deformity in which there is sideways curvature to the spine. Curves are often S shaped or C shaped. Most common type is the idiopathic type which occurs in 10-12 years of age and early teens, females are more affected than males while the body is growing fast and the curve is commonly to the right side of the body. It however affect all ages of about 3% of general population. This study was set out to evaluate statistically, the effect of age, gender and anthropometric measurements (such as height, weight and body mass index) to the curve formed using 51 patients from Lagos State University Teaching Hospital, Ikeja. It was discovered from the analysis that the ailment is common among females than males. The result also shows that the curve is most common to right hand side. The test of hypothesis conducted reveals that the anthropometric measurements of height, weight and body mass index though positively correlated with but do not have significant effect on the Adolescent Idiopathic Scoliosis curve.

A Survey on Comparison Between Blood Loss During Cesarean Section with Use of Calculation Method and Visual Estimation

Abstract Context: Cesarean section (CS) is a life-saving alternative to vaginal delivery in several maternity units globally and is a risk factor for postpartum hemorrhage (PPH). Its rate has increased globally with wide variability amongst and within various countries. Aim: The aim of the study was to compare blood loss with the calculation method and visual estimation during a CS. Materials and Method: A randomized, double-blind, two-center study of 130 consenting pregnant women who were scheduled for either elective or emergency Lower segment caesarean section (LSCS) at the Institute of Maternal and Child Health, Lagos State University Teaching Hospital (LASUTH) and the Federal Medical Center, Ebute-Metta (FMCEB), Lagos. Data Analysis: Data were imported into Stata version 17 (StataCorp, USA) software for analysis. Student’s t-test or Mann-Whitney U test was utilized to compare continuous variables such as age and estimated blood loss among the tranexamic and placebo groups. Result: The mean age of the participants was 30.8 ± 4.76 years, and about 16% of the participants were nulliparous. There was a statistically significant difference in the calculated estimated blood loss between the intervention and the placebo arm of the study (P value &lt; 0.0001). The mean postoperative blood loss was about 347 ml higher among the placebo group as compared to the intervention (tranexamic acid) group (835.61 ± 400.03 ml vs. 488.12 ± 289.90 ml). Conclusion: Prophylactic use of intravenous tranexamic acid as an adjunct to uterotonic at CS is efficacious in the optimal estimation of blood loss and prevention of post-partum hemorrhage.

Clinicopathological determinants of suicidal thoughts and behavior in patients with post-stroke depression in South-West Nigeria

ObjectiveTo evaluate the clinico-pathological determinants of suicidal thoughts and behavior in patients with post-stroke depression (PSD) in a teaching hospital in south-west Nigeria. MethodA cross-sectional study was carried out in Lagos State University Teaching Hospital and it involved 89 consecutively selected outpatients with post-stroke depression (diagnosed using the depression module of Mini International Neuropsychiatric Inventory). Socio-demographic and clinical factors questionnaire, Mini-Mental State Examination, National Institute of Health Stroke Scale, and Beck Scale of Suicidal Ideation (BSSI) were administered to the participants. BSSI total score was used as a measure of suicidal thoughts. Ethical approval was obtained from the ethics and research committee of Lagos State University Teaching Hospital. ResultTime since stroke (the time since onset of the most recent stroke) had a significant negative correlation with suicidal thoughts (r = −0.263, p = 0.013). In the same vein, the probability of attempting suicide significantly reduces with time since stroke, Odds Ratio = 0.925, p = 0.047. ConclusionSuicidal thoughts and behavior occur early in patients with post-stroke depression. The identification of shorter time since stroke as a correlate of suicidal thoughts and behavior among this patient population underscores the need for performing early assessment and prompt intervention for the at-risk individuals.

A population-based estimation of maternal mortality in Lagos State, Nigeria using the indirect sisterhood method

BackgroundPregnancy and delivery deaths represent a risk to women, particularly those living in low- and middle-income countries (LMICs). This population-based survey was conducted to provide estimates of the maternal mortality ratio (MMR) in Lagos Nigeria.MethodsA community-based, cross-sectional study was conducted in mapped Wards and Enumeration Areas (EA) of all Local Government Areas (LGAs) in Lagos, among 9,986 women of reproductive age (15–49 years) from April to August 2022 using a 2-stage cluster sampling technique. A semi-structured, pre-tested questionnaire adapted from nationally representative surveys was administered using REDCap by trained field assistants for data collection on socio-demographics, reproductive health, fertility, and maternal mortality. Data were analysed using SPSS and MMR was estimated using the indirect sisterhood method. Ethical approval was obtained from the Lagos State University Teaching Hospital Health Research and Ethics Committee.ResultsMost of the respondents (28.7%) were aged 25–29 years. Out of 546 deceased sisters reported, 120 (22%) died from maternal causes. Sisters of the deceased aged 20–24 reported almost half of the deaths (46.7%) as due to maternal causes, while those aged 45–49 reported the highest number of deceased sisters who died from other causes (90.2%). The total fertility rate (TFR) was calculated as 3.807, the Lifetime Risk (LTR) of maternal death was 0.0196 or 1-in-51, and the MMR was 430 per 100,000 [95% CI: 360–510].ConclusionOur findings show that the maternal mortality rate for Lagos remains unacceptable and has not changed significantly over time in actual terms. There is need to develop and intensify community-based intervention strategies, programs for private hospitals, monitor MMR trends, identify and contextually address barriers at all levels of maternal care.

Suicidal behaviour among patients with congestive cardiac failure in a Nigerian teaching hospital.

Suicidal behaviour is an established psychiatric complication of congestive cardiac failure (CCF), contributing significantly to morbidity and death by suicide. The magnitude and risk factors for suicidal behaviour among patients with CCF are yet to be unpacked, especially in developing nations such as Nigeria. To determine the prevalence of suicidal behaviour and the risk factors associated with suicidal behaviour, among patients with CCF in Nigeria. Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. A cross-sectional study was conducted among 98 randomly selected patients with a diagnosis of CCF. Participants were assessed with a socio-demographic and clinical factors questionnaire and Beck Scale of Suicidal Ideation. Chi-square test, t-test and logistic regression were used to analyse data. The prevalence of suicidal ideation and suicidal attempt among patients with CCF was 52% and 1%, respectively. No socio-demographic factor was significantly associated with suicidal ideation. Clinical factors associated with suicidal ideation were age at diagnosis (p = 0.042), aetiology of CCF (p = 0.001) and severity of CCF (p = 0.032). Only the severity of CCF (odds ratio [OR] = 20.557, p = 0.014) predicted suicidal ideation among patients with CCF. Suicidal behaviour constitutes a huge burden among the outpatient CCF population. The identification of clinical risk factors for suicidal ideation (age at diagnosis, aetiology and severity of CCF) further illuminates a pathway to mortality among patients with CCF. The findings lend a voice to the need for screening for suicidal behaviour, suicide prevention programmes, surveillance systems and government policies that support mental health for patients with CCF.

Assessment of Levels of Occupational Stress among the Intensive Care Workers in a Selected Hospital in Lagos State

Background: Working in an Intensive Care Unit (ICU) comes with a great deal of physical, emotional, and psychological strain that can get worse with time if not properly managed. Numerous factors contribute to the extreme levels of stress experienced by healthcare professionals, such as long and demanding work hours, the burden of paperwork and legal matters, the disruption of work-life balance, the complexity of shared decision-making, and the high expectations placed ICU workers by on both patients and carers. Some outcomes of occupational stress among intensive care workers include bad safety culture, poor standard of care for patients and depression. Research Objective: The Purpose of the study was to ascertain the levels of occupational stress among the intensive care workers of a hospital. Methodology: The research was a cross-sectional descriptive study conducted in Lagos State University Teaching Hospital (LASUTH). An aggregate of 108 intensive care workers were sampled for the study. A pre-tested, semi-structured self-administered questionnaire was used to gather the data, and the statistical package for social sciences, SPSS version, was used for analysis. The means and standard deviations, or the median and interquartile range, were used to express continuous variables. The expressions for categorical variables were frequencies accompanied by percentages. The study employed chi square statistics to evaluate the correlation between categorical variables. Results: There is an average prevalence of stress among intensive care workers of LASUTH. Recommendation: Staff sshould undergo training on stress handling, in order to be able to manage their individual stressors and reduce the overall stress.

Attitude to cervical cancer screening and human papillomavirus testing experience in self-sampled Nigerian women.

Cervical cancer is a disease of major public health significance which can be prevented by adequate screening. This study assessed the level of cervical cancer knowledge, attitude to screening and human papillomavirus testing experience in women who self-sampled for cervical cancer screening. A descriptive cross-sectional study involving 790 women that had human papilloma virus (HPV) testing at the gynae-oncology unit of the Lagos State University Teaching Hospital. Participants were assessed of their cervical cancer screening knowledge, attitude and HPV testing experience. High risk HPV (hr-HPV) nucleic acid testing was funded by the Clinton Health Access Initiative. Majority (76.71%) of the respondents exhibited a high level of knowledge of cervical cancer, its causes, risk factors and prevention; and a positive experience with HPV self-sampling reported in 98.1%. hr-HPV positive rate was 13.4%. The most common reason (43%) for not having a cervical screening done was lack of a doctor's request. The most commonly known method of cervical screening by the respondents was Pap Smear test (55.31%). There is need for more education to improve the level of awareness and uptake of hr-HPV testing for cervical cancer in Lagos. Health care providers are not offering cervical cancer screening enough and this needs to be explored more in future studies.

Abstract 1013: Strengths, weaknesses, opportunities, and threats of conducting clinical trials in Nigeria: The IRONMAN study

Abstract Background: The need to increase understanding of prostate cancer (CaP) is ever increasing. Unfortunately, there is limited understanding of how CaP affects men of African ancestry (MAA) despite significant disparities in CaP prevention, diagnosis, and treatment due to genetic and sociobehavioral factors. Conducting CaP clinical trials (CTs) in Africa presents multiple opportunities to improve upon collective knowledge of CaP in MAA experiences, expand patient access to CTs, and provide opportunities for African scientists and urologists to contribute to research on the global stage. The International Registry of Men with Advanced Prostate Cancer (IRONMAN) seeks to reduce CaP disparities by sponsoring sites throughout Africa. Four Prostate Cancer Transatlantic Consortium (CaPTC) institutions in Nigeria currently participate in IRONMAN: University of Ilorin Teaching Hospital, Federal Medical Center, University of Maiduguri, and Lagos State University Teaching Hospital. Because CTs of this scale are infrequently conducted in Africa, there are special considerations when conducting CTs in low-middle-income countries (LMICs) like Nigeria. Methods: Hourlong interviews dedicated to site staff were conducted via Zoom in Spring 2023 (four total). Interviews utilized a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis approach. Each interview was recorded, transcribed, and validated by study staff for accuracy. Themes from each were inductively coded and then collated across all four sites. Results: The urologists, oncologists, phlebotomists, pathologists, nurses, research coordinators that make up the study teams identified the holistics of conducting the IRONMAN study at their sites. Strengths included a large patient population to recruit from and appropriate resources to conduct the study (ex., lab space, clinical knowledge, staffing levels). Weaknesses included the social determinants of health that negatively impact patient participation, limited biorepository space to store samples, and the need for patient-physician trust. The greatest opportunity presented was Nigerian institutions joining more CTs in the future, particularly multi-site global trials. Described threats included staff turnover, national stability, and increased economic disparities. Discussion: While increasing the overall number of CTs in Africa is a noble cause, sponsors and institutions should note the unique circumstances in implementing CTs in Africa when designing CTs and recruiting sites. Listening to the experiences of study teams is pivotal in ensuring CTs are Africa-minded - they will be complimentary to established research infrastructure, appropriately funded, and culturally responsive all in the name of equitable research. By doing so, ethical compliance and quality data collection will ensue and reduce disparities at the micro, mezzo, and macro levels. Citation Format: Opeyemi Oreoluwa Bolajoko, Parisa Fathi, Oluwaseyi Toye, Dottington D. Fulwood, Ademola Popoola, Chidiebere Ogo, Hassan Dogo, Omolara Fatiregun, Anthonia Sowumi, Paul Jibrin, Mutiu A. Jimoh, Faruk Mohammed, Folakemi Odedina, Prostate Cancer Transatlantic Consortium. Strengths, weaknesses, opportunities, and threats of conducting clinical trials in Nigeria: The IRONMAN study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1013.

The Role of Tranexamic Acid in Preventing Primary Post-Partum Haemorrhage During Caesarean Section: A Randomized Control Trial

Background: Primary postpartum haemorrhage (PPH) is a leading cause of maternal mortality in Ni-geria. Caesarean section (CS), though a life-saving alternative to vaginal delivery in several maternity units globally, is a risk factor for PPH. Its rate has increased globally with wide variability amongst various countries. Although tranexamic acid (TXA) is an affordable medication that has been widely investigated for the treatment of PPH, its role as prophylaxis against PPH during Caesarean section has not been well characterized in our environment. Methods: A randomized, double-blind, two-center study of 130 consenting pregnant women who were scheduled for either elective or emergency LSCS at the Institute of Maternal and Child Health, Lagos State University Teaching Hospital (LASUTH) and Federal Medical Center, Ebute-Metta (FMCEB) Lagos. Data was imported into Stata version 17 (StataCorp, USA) software for analysis. Results: The mean age of the participants was 30.8 ± 4.76 years. The prevalence of PPH among the placebo group was four times that of the Tranexamic acid group. (P-value &lt; 0.0001). There was a sta-tistically significant lower estimated blood loss in the intervention compared to the placebo arm of the study (P-value &lt; 0.0001) Conclusion: Prophylactic use of intravenous Tranexamic acid as an adjunct to uterotonic at caesarean section is efficacious in reducing blood loss and preventing post-partum haemorrhage.

Evaluating mean platelet volume and platelet distribution width as predictors of early-onset pre-eclampsia: a prospective cohort study

BackgroundPlatelets are pivotal players in the pathophysiology of pre-eclampsia, with observed lower counts in affected individuals compared to normotensive counterparts. Despite advancements, the elusive cause of pre-eclampsia persists, motivating intense global efforts to identify reliable predictors. The currently recommended predictors of pre-eclampsia are not readily available in many resource-limited regions like Nigeria. This cohort study explores the potential of mean platelet volume (MPV) and platelet distribution width (PDW) as predictive markers of early-onset pre-eclampsia. Both platelet indices are components of the full blood count, a widely available routine test in pregnancy.MethodsIn this prospective cohort study, 648 healthy pregnant women attending antenatal care at Lagos State University Teaching Hospital and General Hospital Ifako-Ijaiye, Lagos, were recruited between 14-18weeks gestational age. Platelet count (PC), MPV and PDW were measured from their venous blood at recruitment. Participants were monitored until 34weeks of gestation, focusing on the occurrence of early-onset preeclampsia as the outcome of interest. Individuals with chronic medical conditions were excluded from the study. Data analysis involved t-test, Chi-Square and Mann–Whitney U tests, with statistical significance set at a confidence level of 95% and p < 0.05. Sensitivity, specificity, and predictive values were determined using receiver operating characteristics (ROC) curves.ResultsThe incidence of early-onset pre-eclampsia in the study was 5.9%. Women who later developed pre-eclampsia had higher median MPV and PDW at 14-18weeks (10.8 fl. and 24.8 fl.) compared to normotensive women (8.1 fl. and 13.3 fl.)(p < 0.001). The median PC was lower in pre-eclamptics (190 × 103/µl) compared to normotensives(264 × 103/µl)(p < 0.001). Using Youden’s test, cut-off values identified: PC < 211.5 × 103/µl, MPV > 9.4 fl., and PDW > 21.3 fl., predicted early-onset pre-eclampsia with 96.6% sensitivity and 65.6% specificity for PC; 79.3% sensitivity and 97.7% specificity for PDW; and 82.8% sensitivity and 96.1% specificity for MPV. Cut-offs of PC < 185 × 103/µl, MPV > 10.7 fl., and PDW > 28.3 fl., predicted severe early-onset pre-eclampsia with 100.0% sensitivity and 90.9% specificity for PC, 100.0% sensitivity and 99.4% specificity for MPV, and 100.0% sensitivity and 99.8% specificity for PDW, with corresponding area under the ROC curves of 0.983, 0.996, and 0.998, respectively.ConclusionThe evaluation of MPV and PDW between 14 and 18 weeks of gestation appears to be a reliable predictor of severe early-onset pre-eclampsia.

Effect of A Nurse-Led Interactive Education On Perception of Disease Risk Among Nurses in Lagos State University Teaching Hospital, Lagos

This research examines the influence of nurses' perceptions of the risk associated with COVID-19 on public health outcomes, with a specific emphasis on LASUTH, a vital healthcare referral centre in Lagos, Nigeria. The study utilises a quasi-experimental pre-/post-test approach to evaluate the efficacy of nurse-led interactive education in influencing nurses' perceptions of COVID-19 risk. The cohort included 527 nurses from LASUTH. The data was gathered by a validated questionnaire, whereas the intervention consisted of a nurse-led interactive training session. The statistical analyses, both descriptive and inferential, were performed using SPSS version 25. The results demonstrate changes in nurses' views after the intervention. At first, 6.8% of individuals held negative impressions, which subsequently rose to 10.2%. The percentage of fair opinions declined from 27.1% to 20.3%, whilst the percentage of excellent perceptions saw a little rise from 66.1% to 69.5%. The average perception score reduced from 13.2±3.47 to 12.5±3.76, indicating a rise in awareness and changed attitudes after the intervention. The results indicate a reduction in the level of intense anxiety towards the virus, from 27.1% to 22%. There is also an increased level of worry over mortality, as well as a greater recognition of the need of preventative actions. The intervention significantly altered the nurses' sense of danger. The results also verified a substantial disparity (p &lt; 0.05) in the perceptions before and after the intervention, so providing evidence to reject the null hypothesis. This research highlights the efficacy of treatments led by nurses in altering perceptions of COVID-19 risks, offering valuable information for public health initiatives and interventions.

The Role of Artificial Intelligence and Machine Learning in Healthcare: Implications for Actuarial Models and Predictive Analytics in Lagos State Nigeria

This paper examined the role of artificial intelligence and machine learning in healthcare using implications for actuarial models and predictive analytics in Lagos State, Nigeria. Four research questions guided the study. The descriptive survey research design was adopted for this study. The population of this study comprised of all the healthcare professionals in Lagos State University Teaching Hospital (LASUTH) and all actuarial managers from the 27 insurance companies in Lagos State, Nigeria. The purposive sampling technique was used to select an actuarial manager from each of the 27 insurance companies in Lagos State, making a total of 27 actuarial managers that participated in the study. Purposive sampling technique was also used to select 30 healthcare professionals in LASUTH. In total, the sample size consisted of 57 respondents. The study used a structured questionnaire called “Role of Artificial Intelligence and Machine Learning in Healthcare Questionnaire” (RAIMLHQ) to gather data on the application of AI and ML in healthcare. The questionnaire was divided into two sections and responses were based on a 4-point Likert scale. The researchers administered the questionnaire directly, and descriptive statistics were used to analyze the bio-data. The results showed that healthcare professionals and actuarial managers had low knowledge of AI and ML’s application in healthcare. However, they rated AI and ML technologies as effective in improving healthcare outcomes in Lagos State. Furthermore, they agreed on the implications of integrating AI and ML into actuarial models for healthcare insurance in Lagos State.

Non-scarring alopecia in systemic lupus erythematosus patients at the Lagos State University Teaching Hospital: a cross-sectional study of prevalence, pattern, trichoscopy features and histopathological analysis.

trichoscopic and histopathological evaluation of non-scarring systemic lupus erythematosus (SLE) alopecia is uncommon. We aimed to document the prevalence, pattern of hair loss, trichoscopic and histopathologic differences between systemic lupus erythematosus patients with and without hair loss. this was a cross-sectional comparative study of 75 systemic lupus erythematosus patients, 36 with hair loss from February to December 2020. Trichoscopic evaluation was conducted on all 75 patients. Twenty-three patients (12 with hair loss and 11 without) had scalp biopsies with mucin deposit evaluation. Disease activity was documented using the SLE disease activity index. Data was analyzed using SPSS 22. the mean age of the patients was 33.7 ± 12.4 years. Non-scarring alopecia was observed in 48%. The pattern of hair loss was <4 patches in 44.4%, mild diffuse in 25%, and severe diffuse in 30.6%. Disease activity was mild in 38.9%. Hair shaft changes included thin hair (97.2%), decreased number of hairs per follicular unit (97.2%), hypopigmented hair (85.7%), and follicular red dots (27.8%). Significant differences between the two groups were; a reduction in size and number of sebaceous glands on histopathology, hair shaft, and scalp pigmentary changes in the hair loss group. the prevalence of non-scaring alopecia is high in SLE patients with patchy type as the commonest pattern. Trichoscopic and histopathologic differences exist in SLE patients with and without hair loss and the normal-appearing scalp in SLE patients is involved in the inflammatory process. Hair shaft thinning, hypopigmentation, and scalp pigmentary changes occur in SLE.