Lagos State University Teaching Hospital Research Articles

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.

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.

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.

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.

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.

Suicidal Ideation among a Sample of Students in Nigeria

Suicide is a growing public health problem all over the world. It may be ranked as one of the major leading cause of death among college and university students. Against this background, this study explored the influence of perfectionism and academic stress on suicidal ideation among medical students. Purposive and simple random techniques were used to select a total number of 296 students (105 males: 191 females) from Lagos State University Teaching Hospital, Lagos State. The age of the participants ranged from 17 to 30 years (Mean=21.50, SD=2.52). Three hypotheses were formulated and tested with Multiple Regression Analysis. Results showed that perfectionism had no significant influence on suicidal ideation. However, it was revealed that academic stress had a significant prediction with suicidal ideation. In the same direction, perfectionism and academic stress had significant and joint prediction on suicidal ideation. Therefore, it is recommended that in order to address academic stress that can induce suicidal ideation among medical students, government in collaboration with school management should develop, implement and monitor psychological programs aimed primarily at alleviating academic stress among students and especially among medical students.

Prevalence and Factors Associated with the Severity of Anaemia among Patients on Chronic Haemodialysis in Lagos, Nigeria

Background: Anaemia is a global public health problem with high mortality and morbidity. It is also a common consequence of chronic kidney disease (CKD). There is a paucity of data on the actual burden of anaemia among patients on chronic haemodialysis (CHD) in Lagos, Nigeria. Objectives: To determine the prevalence and factors associated with the severity of anaemia among Nigerian patients undergoing chronic haemodialysis. Methods: This was a retrospective analysis of adult patients with end-stage renal disease (ESRD) on maintenance haemodialysis at the Lagos State University Teaching Hospital, Ikeja, Lagos. The data extracted from the clinical case files included the bio-demographic and clinical parameters, including the treatment modalities. Results: A total of 92 patients comprising 69 (75%) males and 23 (25.0%) females with the overall mean age of 48.2±14.0 years were included. Hypertension was the commonest aetiology of CKD and the average duration of haemodialysis was 16.6 months. The commonest access route for haemodialysis was a central line while 96.7% and 81.5% received erythropoietin and intravenous iron sucrose respectively. Seventy-three (79.3%) patients have had intra-dialysis blood transfusions in the past. Mild, moderate, and severe anaemia were recorded in 17%, 67%, and 16% respectively. The use of erythropoietin, iron sucrose, and increased frequency of blood transfusions correlated with the severity of anaemia. Conclusion: Anaemia is highly prevalent among patients with CKD on chronic haemodialysis. Increased frequency of blood transfusions, inadequate utilization of erythropoietin, and iron sucrose administration are predictors of anaemia severity.

A decennial cross-sectional review of assisted reproductive technology in a Tertiary Hospital in Southwest Nigeria

BackgroundThe World Health Organization recommends that Assisted Reproductive Technology be complementary to other ethically acceptable solutions to infertility. Whereas fertility centres are increasing in number in urban regions of Africa, published reports of their performance are sparse. We present a 10-year review of assisted reproductive technology performed in a public tertiary centre in Lagos, Nigeria.MethodsThis was a hospital-based, retrospective, cross-sectional review of 604 women, over a 10-year period that had in-vitro fertilization or in-vitro fertilization with intra-cytoplasmic sperm injection at the Institute of Fertility Medicine, Lagos State University Teaching Hospital. Data obtained were expressed in descriptive statistics and Pearson correlation was used to determine the strength of linear relationship between two continuous variables at a significance level of p < 0.05.ResultsThe mean age of the women was of 37.7 ± 6.2 years and 89.7% had no previous parous experience. About 27.2% of the male partners had normal seminal fluid parameters while 4.6% had azoospermia. Median serum follicle stimulating hormone of the women was 8.1 IU/L and median serum anti-mullerian hormone was 6.3 pmol/L. There was weak positive correlation between age and serum follicle stimulating hormone (r = 0.306, p < 0.001); weak negative correlation between age and serum anti-mullerian hormone (r = -0.48, p < 0.001) and very weak correlation between body mass index and serum follicle stimulating hormone (r = 0.173, p = 0.011). In-vitro fertilization and intra-cytoplasmic sperm injection was the method of fertilization used in 97.4% of the cases and 81.8% of embryos formed were of good quality. Most women (94.5%) had 2 embryos transferred and 89.9% had day-5 embryo transfer done. About 1 in 4 of the women (143/604, 23.7%) had clinical pregnancy and 49.7% of women who got pregnant had delivery of a live baby at term while 11.9% had preterm delivery of a live baby.ConclusionDespite increasing use and success of assisted reproductive technology in south-western Nigeria, there is room for improvement in clinical pregnancy rates and live birth rates post- assisted reproductive technology. Complication rates are desirably low.

Cancellation of Elective Oral and Maxillofacial Surgery, a Tertiary Hospital Experience.

Cancellation of elective surgery is said to occur when a patient's name appears on the operation list, but the operation is not done on the intended date. Cancelling elective surgeries is a long-standing problem faced by many countries worldwide. Reasons for cancellation of surgery vary from one hospital to another. The goal of this study was to identify factors associated with the cancellation of scheduled Oral and maxillofacial surgeries in the Lagos State University Teaching Hospital. Cancellations of elective scheduled operations from January 2021 to July 2022 were reviewed retrospectively. All cancellations were recorded in a predesigned form which included information about the age of the patient, hospital identification number, date of cancellation, type of operation, the Surgeon and the Anaesthetist, preoperative anaesthetic evaluations, any associated medical problems and the presumed reasons for cancellations for in-patients and day case surgery. Patients who died before the time of their scheduled surgery were excluded. 80 patients had their operation cancelled on the day of surgery, and the rate of cancellations was 44.2%. The most common causes of cancellations were patient-related (50%), accounting for up to half of the cancellations. The major reason for cancellation under the administrative category was insufficient time in the theatre to complete the operation list (18.8%). Financial constraint (16.3%) on the day of the surgery was noted more among planned day case procedures and delayed laboratory results (12.5%); oftentimes, covid test results were the major reasons for cancellations under the patient-factors category. The rate of cancellation in this study was high, most of which are patients related. Administrative-related reasons were also identified. However, in most cases, these cancellations can be avoided.

Pattern of Tooth Extraction and Use of Space Maintainers in Paediatric Dental Patients in Lagos State University Teaching Hospital, Ikeja

The primary dentition is essential in the maintenance of normal occlusion in the permanent dentition. Both dentitions enhance aesthetic, speech and are functional in nature. Early loss of the primary dentition necessitates the placement of space maintainers. This study determined the pattern of tooth extraction of patients attending the paediatric dental clinic in Lagos State University Teaching Hospital, Ikeja and the use of space maintainers. A retrospective study carried out using the dental records of patients who attended the Paediatric dental clinic, Lagos State University Teaching Hospital, Ikeja, Lagos. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 20 (IBM, New York). The prevalence of tooth extraction was 49.8% among a population of 410 subjects with a total of 353 extracted teeth. The male to female ratio was 1:1.37. Majority (58.3%) of the subjects had only one tooth extracted. The commonest reason for extraction was retained primary teeth (35.8%). The commonest arch and segment of extraction was the mandible (56.1%) and the anterior teeth (51.0%). The commonest tooth extracted was upper right primary central incisor (7.6%). The most common space maintainer was band and loop. Retained teeth was the most common reason for tooth extraction followed by sequelae of dental caries, caries and trauma. This highlights the need for implementation of oral health prevention policies with regards to the use of fluoride, fissure sealants, silver diamine fluoride increased awareness of safety protocols to mitigate traumatic injuries and introduction of dental health education programs in schools and community.

E34 Coexisting sickle cell disease and autoimmune diseases among Nigerian children

Abstract Introduction Patients with sickle cell disease (SCD) do have a defective activation of the alternate complement pathway which increases their risk of having infections. This is thought to predispose to autoimmune disease (AID) in them. However, there is paucity of data on coexisting AID and SCD in children which may be due to under diagnosis as a result of overlapping symptoms of the two disease conditions. Objectives To highlight the clinical features, diagnostic challenge and importance of early recognition and treatment of autoimmune diseases in children with sickle cell disease. Methods Retrospective review of records of four children with sickle cell disease who were diagnosed with autoimmune diseases at the paediatric Rheumatology Clinic of Lagos State University Teaching Hospital (LASUTH) between May 2018 to February 2023. Results Case 1 15 –year –old girl known haemoglobin SC patient of haematology unit who was referred to rheumatology unit with history of worsening jaundice, abdominal swelling, headache, constitutional symptoms, left knee pain, and two episodes of blood transfusion within two months. Initally being managed for hyperhaemolytic and vaso-occlusive crisis but later referred to rheumatology unit on suspicion of autoimmune disease due to recurrent anaemia, and five episodes of blood transfusion within two months. ESR was 65 mm/h, ANA of 1:2560, positive anti-smith antibodies, elevated urine protein creatinine ratio (UPCR), low C3 and C4 and positive direct coomb’s test. Diagnosis was juvenile systemic lupus erythematosus (JSLE). She had pulse methylprednisolone, oral prednisolone, hydroxychloroquine and mycophenolate mofetil. She has improved clinically and being followed up in clinic. Case 2 10-year-old girl, known sickle cell anaemia patient who had unproductive cough of one-month duration and chest radiograph findings of bronchiectatic and fibrotic changes in the right upper/middle lobes with reduction in lung volume. Gene xpert was negative for tuberculosis but chest CT showed honeycombing in the right upper lobe implying Interstitial lung disease. Further investigations showed ESR of 5, ANA of 1:1280, borderline anti-dsDNA, positive anti-SM/RNP, normal urinalysis, normal renal function and restrictive lung disease on spirometry. She is being managed as a case connective tissue disorder with associated Interstitial Lung Disease. She is presently on mycophenolate mofetil and being followed up in clinic. Case 3 11-year-old female living with sickle cell anaemia who presented with inflammatory arthritis of the small joints of the hands, elbows and knees of nine-month duration, sclerodactyly, contractures of the PIP of the fingers, narrowing of oral aperture, generalized hypopigmented macules and abnormal nailfold capillaroscopy. ANA was 1:640, positive anti-Scl 70, negative anti-centromere, ESR of 130 mm/h, thrombocytosis, severe restriction on spirometry and features of interstitial lung disease on HRCT of the chest. She commenced mycophenolate mofetil, prednisolone and nifedipine. She later had 2 doses of rituximab due to slow clinical improvement and is being followed up. Case 4 13-year-old female with sickle cell anaemia who presented with recurrent fever &amp; severe haemolytic anaemia requiring frequent blood transfusions (13 pints of blood over 6 months!!!). Initial diagnosis was septicaemia, and autoimmune haemolytic anaemia. Following rheumatology review, ANA was 1:640, positive anti-DsDNA, negative anti-Smith antibodies, ESR of &amp;gt; 150mm/h, elevated UPCR and pancytopaenia. She was later diagnosed with Lupus nephritis. She had Mycophenolate mofetil, prednisolone and hydroxychloroquine. She died of acute lupus flare 4 weeks after discharge from the hospital. Conclusions Physicians should have high index of suspicion for possible association of sickle-cell disease and autoimmune diseases so as not to delay definitive diagnosis and initiation of appropriate treatment.

A Comparative Study of Health-Related Quality of Life among Adults with Pulmonary Tuberculosis in Southwest Nigeria

Background: Current models of care for tuberculosis (TB) focus on bacteriological cures with less emphasis on the effect of TB on physical, mental, and social well-being. There is also a paucity of data on normative values for Nigeria against which health-related quality of life (HRQOL) measures of TB patients could be assessed. The objective of this study was to compare HRQOL of adults diagnosed with TB against a comparator group from similar socio-demographic backgrounds.&#x0D; Methods: A comparative cross-sectional study was undertaken with 210 patients with pulmonary TB and a comparator group of 285 individuals from catchment communities. The World Health Organization Quality of Life Questionnaire-Short Version (WHOQOL-BREF) was used to assess HRQOL. Patients were selected using a multi-stage sampling technique. Data were analysed using IBM-SPSS version 23. A multiple linear regression model was used to identify potential predictors of HRQOL. Ethical approval was obtained from the Lagos State University Teaching Hospital health research ethics committee.&#x0D; Results: More than half of the TB patients and those in the comparator group were men (63.3% and 59.0%, respectively), and their mean ages were 36.40±11.76 years and 36.69±12.30 years, respectively. Respondents with TB had significantly lower HRQOL domain scores across all domains (p&lt;0.001). Domain scores for HRQOL ranged between 45.3 ±14.5 (environmental domain) and 50.9±17.3 (social relationships). Independent predictors of quality of life among TB patients included education, employment, and socio-economic status. &#x0D; Conclusion: Tuberculosis was significantly associated with an impairment in health-related quality of life. The environment domain was most affected among respondents with PTB. Employment status, socio-economic class and educational level were predictive of HRQOL.

Making the Transition From Cardiac Missions to Autonomous Heart Surgery at a Nigerian Teaching Hospital: Challenges and Lessons Learned

Open-Heart Surgery at the Lagos State University Teaching Hospital (LASUTH) commenced in 2004. Early years were based on a Cardiac Mission Model, but since 2017 the focus was on the transition to a Local Team Model with autonomous Open-Heart Surgery. The aim of this study is to describe our progress in making this transition, highlight lessons learned, and detail the outstanding challenges to be overcome. This study is a retrospective analysis of prospectively maintained data from the LASUTH cardiothoracic database and Nigeria Open-Heart Surgery Registry between November 2004 and December 2021. Data extracted included patient demographics, EuroSCORE II, operative procedure, operative category, lead surgeon, complications, and outcomes. Over the study period, 100 operations were done over 2 time periods, 51 operations between 2004 - 2011 (Cardiac Mission Period) and 49 operations between 2017 - 2021 (Transition Period). In the Cardiac Mission Period, 21.6% of the operations were done by the Local Team and in the Transition Period this increased to 85.7% of the operations completed. Overall mortality was 14%, dropping from 17.6% in the Cardiac Mission Period to 10.2% in the Transition Period. The Local Team is now gradually taking on more diverse cases while striving to maintain good outcomes. Our institution has successfully made the transition from Cardiac Missions to Autonomous Open-Heart Surgery without an increase in mortality and a gradual increase in surgical volumes. Lessons learned included a strategy to focus on adult surgery, avoidance of high-risk cases, and moving from free surgery toward an appropriate cost structure for program sustainability. Contributory factors to the successful transition include the active support of the hospital management (provision of appropriate infrastructure and equipment, investment in training of the Local Team), continued humanitarian international collaborations focused on skill transfer, and maintenance of Local Team skills by collaborations with other active cardiac centers in Nigeria. Remaining challenges include financing to bridge equipment gaps, maintenance and replacement of equipment as well as the evolution of a national health insurance schema that would ideally support Open-Heart surgery for Nigerian patients. Until that time, patients & programs must rely on supplemental funding of surgery to increase surgical volumes.

Age and reason of first visit among children seen at the paediatric dental unit of the Lagos state university teaching hospital

Background: A child’s first dental visit gives parents an opportunity to get guidance regarding their child’s oral hygiene, dietary practices, oral habits and prevention of traumatic injuries and oral diseases. It also provides an opportunity for parents to address their concerns and questions regarding their child’s oral care. Aim: To determine the age and the purpose of first visit among children seen at the paediatric dental clinic of Lagos State University Teaching Hospital. Methodology: This is a retrospective study where the dental records of children between the age of 0 and 16 years were reviewed from January 2018 till May 2022. Statistical analysis was done using IBM SPSS software (version 23.0; IBM Corporation, Armonk, NY, USA). Continuous data are presented as means with standard deviation, whereas categorical variables are presented as frequencies and percentages. Descriptive statistics and Chi‑square analysis were conducted, and the level of significance was set at P &lt; 0.05. Results: Four hundred and ten children were seen, during the period under review. There were 199 (48.5%) males and 211 (51.5%) females. The major reason for presentation was dental caries (47.1%). Majority (31.5%) of those who presented during this period were aged 7 – 9 years. Children with special health care needs constituted about 2% of the population. Conclusion: Dental clinic presentations in our environment are more associated with curative rather than preventive visits. More females were seen at the dental clinic compared to males. The main reason for presentation at the dental clinic was dental caries.

Burden of respiratory morbidity amongst survivors of COVID-19 infection in Lagos, Southwest Nigeria

&lt;b&gt;Background&lt;/b&gt;: COVID-19 disease is associated with long-term effects in some survivors. There exists dearth of information about the burden of respiratory morbidity among COVID-19 survivors in Nigeria. This study was designed to identify the common respiratory symptoms of long COVID-19 to educate and increase index of suspicion of healthcare practitioners caring for such patient for optimal care.&lt;br /&gt; &lt;b&gt;Material and methods&lt;/b&gt;: This is a cross-sectional survey that took place at the adult pulmonology clinic of Lagos State University Teaching Hospital Ikeja. The individuals who were treated for PCR confirmed COVID-19 infection referred for unresolved symptoms 4 weeks following discharge that consented were recruited. A proforma was used to obtain information on socio-demographic characteristics, medical history, and comorbidities. The degree of dyspnea was assessed using MRC(Medical Research Council) dyspnea scale while the functional capacity of patients was assessed using Six-minute walk test (6mwt). The analysis of the data collected was done using descriptive statistics, and chi-square was used to test for association.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: Ninety-four subjects participated. The mean age of participants was 49.48±17.8 years, with male: female ratio of 1:1.1. The median duration of admission due to COVID-19 infection was 10.0 (7.0-15.8) days. The common symptoms were fatigue (85.1%), loss of smell (71.3%), dyspnea 53(56.4%), and Cough (62.8%). Dyspnea was present in 62.8% using the MRC dyspnea scale, while the 6-meter walk test showed inadequate functional capacity in 61.7%, and both showed significant association. (X&lt;sup&gt;2&lt;/sup&gt;=18.606, P=0.001*)&lt;br /&gt; &lt;b&gt;Conclusion&lt;/b&gt;: Respiratory morbidity remains a significant post covid condition. There is a need to raise awareness amongst healthcare workers, particularly within the primary healthcare setting for early identification and referral of COVID-19 survivors with prolonged respiratory symptoms to pulmonology clinics for optimal care. There is also a need for further research on predictors of post COVID syndrome and treatment modalities.

Clinical Presentation of Uterine Leiomyoma and the Outcome of Surgical Management Options in a Nigerian Tertiary Health Facility

Background: Effective treatment intervention for uterine leiomyoma is essential to prevent morbidities and associated potential mortalities. Objective: To determine the prevalence, clinical presentation of uterine leiomyoma and the outcome of surgical management options at the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria. Methods: This was a descriptive retrospective study of cases of uterine leiomyoma from 01 January 2012 to 31 December 2016. The medical records of all patients with the diagnosis of leiomyoma were retrieved. Information was obtained on socio-demographics, clinical presentation, types of surgical treatment and associated postoperative complications. Results: Three hundred and thirty-five cases of leiomyoma were managed out of 1835 major gynaecological cases giving a period prevalence of 18.3%. However, only 134 case folders were available for analysis. The mean age of the women was 38.5±6.7 years. Only 21 (15.7%) cases presented within a year of the onset of symptoms. The surgical interventions used included myomectomy and hysterectomy but the former was the commonest with a frequency of 73.4%. There were no significant differences in the prevalence of postoperative complications between patients who had myomectomy and hysterectomy (p&gt;0.05 in each case). Conclusion: Uterine leiomyoma is a common gynaecological condition. There is a need to create awareness of the need to present early to the hospital so that less invasive treatment options can be explored.

Risk factors for osteoporosis among postmenopausal women in a Nigerian teaching hospital.

Osteoporosis is a progressive bone disease characterized by a reduction in bone mass and density, leading to bone fragility and an increased risk of sustaining fractures. Several studies have shown that the risk for osteoporosis increases with age and after menopause. A cross-sectional study was undertaken of 422 postmenopausal women at the Family Medicine Clinic of the Lagos State University Teaching Hospital (LASUTH). Variables such as socio-demographic characteristics, anthropometric indices, and lifestyle habits of participants were assessed. In addition, bone mineral density was measured using a validated portable dual-energy X-ray absorptiometry scanner. The results of the bone mineral density were analyzed based on T-scores. The mean age of the study subjects was 59.8± ±6.4 years, while the mean age at menopause was 50.15 ± 4.1 years. The majority of the subjects were obese (41.5%), while the prevalence of osteoporosis and osteopenia was 15.1% and 30.6%, respectively. The use of oral steroids was associated with osteoporosis (P < 0.05). We recommend regular bone mineral density screening of postmenopausal women at the primary care level for early diagnosis and treatment of osteoporosis to prevent fragility fractures.