Lagos University Teaching Hospital Research Articles

Immunohistochemical and Clinicopathologic Profiling of Pituitary Adenomas at a Nigerian Tertiary Hospital

Background: Pituitary adenoma is the most common pituitary tumour and the third most common intracranial tumour worldwide. Only a few studies have been done in Africa on the immunohistochemical expression pattern and clinicopathologic presentations of the different hormonal subtypes of pituitary adenomas. Objective: To evaluate the immunohistochemical hormonal profiles and clinicopathologic behaviour of pituitary adenomas diagnosed within ten years at the Lagos University Teaching Hospital, Lagos, Nigeria. Methods: In this 10-year retrospective, cross-sectional study, all cases of pituitary adenomas diagnosed at the hospital mentioned above between 1 January 2009 and 31 December 2018 were analysed. Their paraffin-embedded tissue blocks were stained with haematoxylin and eosin and then with immunostains for growth hormome (GH), adrenocorticotrophic hormone (ACTH), thyroid stimulating hormone (TSH), follicular stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL), using their standard immunohistochemistry protocols. Results: Seventy pituitary adenoma cases were studied. The male-to-female ratio of the patients was 1.6:1. The median age was 45 years, and the peak age of occurrence was the fifth decade for both sexes. Most were null cell adenomas (44.7%) and FSH-beta gonadotrophs (22.9%). The least diagnosed were thyrotroph (1.4%) and corticotroph adenomas (1.4%). Most of the adenomas were macroadenomas, and the most common presenting symptom was visual impairment. Conclusion: Pituitary adenoma is commoner in males in their 5th decade of life at the Lagos University Teaching Hospital, Lagos, Nigeria. The null cell adenoma is the commonest type of pituitary adenoma diagnosed in the center, and the majority of the patient diagnosed with pituitary adenoma present late with complications of visual impairment.

Prevalence of anaerobic bacteria in surgical site infections in Lagos University Teaching Hospital.

Surgical site infection (SSI) is the second most common cause of nosocomial infection, after urinary tract infection. Sequelae of SSI include increased healthcare costs and worse patient outcomes. There is a paucity of research studies on the impact of anaerobic organisms on SSIs in Nigeria. The aim of this study was to determine the role of anaerobic bacteria in SSI encountered at the Lagos University Teaching Hospital (LUTH). A total of 438 patients were consecutively recruited into this study from general surgery, obstetrics and gynaecology and paediatric units of the LUTH from 1 July through 31 December 2019. Two surgical wound specimens were collected from all patients with suspected SSIs. One was for anaerobic culture using Brucella blood agar incubated in an anaerobic jar that secured anaerobiosis using the anaerobic gas pack. The other swab was used for aerobic culture on blood agar incubated on air at 37oC. Identifications and antibiotic sensitivity testing were performed according to standard laboratory procedures. The overall incidence of SSI in the study was 12.3%. The incidence of anaerobic SSI was 1.1%. The distribution of anaerobic infections by medical specialty unit was as follows; general surgery (1.6%), obstetrics and gynaecology (0.8%) and paediatrics (0.9%). Bacteroides species was the only anaerobic isolate. The risk factors associated with the development of SSI by multiple logistic regression analysis were duration of surgery greater than 2 h (OR 1.418; 95% CI 1.834-9.286; P = 0.001) and NNIS risk index 2 and 3 - (OR 2.165; 95% CI 2.366-32.086; P = 0.001). The prevalence of anaerobic SSI was 1.1%. Duration of surgery greater than 2 h and NNIS risk index 2 and 3 were independent predictors of SSI.

Predictive Value of Transrectal Ultrasonic Doppler and Elastographic Features in Prostate Cancer Detection in Lagos University Teaching Hospital.

This study aimed at determining the predictive value (PV) of transrectal ultrasonic Doppler and elastographic features in prostate cancer (PCa) detection among patients in Lagos University Teaching Hospital. This prospective study involved patients that underwent evaluation for PCa. Participants had digital rectal examination (DRE), prostate-specific antigen (PSA) assay, and transrectal ultrasound-guided prostate biopsy using colour Doppler (CD) and elastography. All cores were sent for histopathology. Data were analysed using Statistical Package for the Social Sciences Version 22.0. CD and elastography PV in PCa detection and their relationships to the Gleason score (GS) were analysed (P < 0.05). Seventy men (aged between 45 and 87 years) were enrolled. Forty-three (61.4%) patients had PCa with a mean age of 69.37 ± 8.22years. The sensitivity, specificity, positive PV (PPV), negative PV (NPV) and accuracy of CD were 8.50%, 97.44%, 64.10%, 66.42% and 66.31%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of elastography were 84.21%, 94.59%, 88.89%, 92.11% and 91.07%, respectively. There is a significant association between decreased elasticity (elastography) and PCa detection but a weak association between increased vascularity (CD) and PCa detection. A positive correlation exists between extent of prostatic stiffness and GS.

An evaluation of cephalometric predictors of anterior open bite; An assessment of dental and skeletal parameters in an orthodontic population.

Anterior open bite (AOB) malocclusion is one of the highly challenging malocclusions. Cephalometric radiographs have been used for the diagnosis of occlusal anomalies in the vertical and anteroposterior directions. This study aims to compare skeletal and dental features in open and non-open bite subjects to identify factors that help predict and categorize open bites in a Nigerian population. Pretreatment cephalometric radiographs of 82 patients were recruited into this study. This study comprised 41 AOB patients and 41 (Class 1 malocclusion) patients (control group). The radiographs were obtained from the orthodontic unit, Department of Child Dental Health of the Lagos University Teaching Hospital, Idi-Araba Lagos. Cephalometric tracing and analysis of the obtained radiographs were used to identify and compare the skeletal and dental differences between the two groups. The mean age of the participants was 20.47 ± 8.05 years. The patients consisted of 26 (31.7%) males and 56 (68.3%) females. There was a significant difference in the open bite depth indicator (ODI) of the open bite (P value < 0.001). There was a statistically significant increase in the vertical skeletal parameters - lower facial height (LFH), total facial height (TFH), posterior facial height (PFH), Frankfort-mandibular plane angle (FMA), mandibular-maxillary angle (MMA), and gonial angle in the AOB group compared to the control group. The vertical height of the dentoalveolar segments measured was all significantly increased in the open bite group compared to the control group. The results suggest that the skeletal and dental vertical parameters, including ODI of the open bite subjects, varied compared with the non-open bite subjects in the Nigerian population studied and could be used to predict AOB tendency.

Evaluation of Fusobacterium nucleatum in Amniotic Fluid of Women with Preterm Labour

Objective: The effect of Fusobacterium nucleatum, an oral commensal, on pregnancy outcomes is of global concern. This study screened for F. nucleatum and the fadA gene in amniotic fluid obtained from women presenting with preterm labour. Methods: This is a cross-sectional pilot study. Amniotic fluid was collected from women with preterm labour at Lagos University Teaching Hospital and analysed using conventional polymerase chain reaction (PCR). I6SrRNA species-specific primers were used to assess the presence of F. nucleatum species and fadA genes for virulence potentials. Questionnaire-based data obtained was analysed using SPSS version 20.0. and amplicon analysis was measured on base pairs. Results: Fourty participants had preterm deliveries between April and August 2018. Of these 34 (85%) were enrolled, out of which 25 amniotic fluid samples (AF) were collected. The mean age of the participants was 30.5 years. Among them, 10 (29.4%) were primigravida, and 24 (70.6%) were multigravida. Six (1.8%) of the women had a history of gestational diabetes, and four (1.2%) had hypertension. Only 4 (1.2%) were aware that bacteria could cause preterm labour. 11 (32%) visited the dentist during the period of their pregnancy. There was no amplification of 16SrRNA or the fadA genes in the tested samples. Conclusions: This study showed that preterm delivery was more common in multigravida pregnant women aged 31-35 years. Although some of the samples were cloudy and purulent, Fusobacterium nucleatum species-specific and virulent fadA genes were not detected in amniotic fluid obtained from the population of women with preterm labour studied.

Knowledge and attitude of sex education among secondary school students in south-western Nigeria: A cross-sectional study.

Sex education helps in preparing adolescents to have responsible attitudes and behaviour towards sex for a harmonious sexual life. This study assessed the level of knowledge and attitude towards sex education among secondary school students in an urban south-western Nigeria. The study adopted a descriptive cross-sectional design. Multistage sampling technique was used to select a sample size of 378 students from a population of 3674 students in public secondary schools. A pre-tested self-administered questionnaire with Cronbach' Alpha value of 0.76 was used for data collection. The approval of the study was obtained from the Human Research Ethics Committee of Lagos University Teaching Hospital. Data were analyzed using SPSS version 20. Chi-square test and multiple logistic regression were used for test of association among the variables at p < 0.05. Majority of the respondents 338 (89.9%) were between age 14-17 with mean age of 16 ± 5.22 years. Majority of the respondents 309 (82.1%) had a good knowledge of sex education. More than half, 216 (57.5%) of the respondents had positive attitude towards sex education. There was a significant relationship between knowledge and attitude of the respondents towards sex education (p = 0.01). Knowledge of sex education increases as class of students increases to SS2 = (OR = 7.750; 95% CI [3.268-18.378] and SS3 = (OR = 2.219; 95% CI [1.067-4.613] respectively. The study concluded that the respondents had good knowledge of sex education and there was a significant relationship between students' knowledge and attitude towards sex education. There is need for awareness and effective sex education among secondary school students. Teachers and parents should create the view of improving the attitude of secondary school students towards sex education.

Knowledge, Attitude, and Compliance with management of Patients with Selected Risk; Diabetes Mellitus &amp; Hypertension On Dementia in Selected Primary Health Care Centres in Nigeria: An Impetus for Primary Prevention of Vascular Dementia

AbstractBackgroundDementia is clinical syndrome, characterized by a progressive and irreversible loss of cognitive function, has seen a rapid increase in Nigeria over the past 20 years1. As access to healthcare improves, more people are living into old age and becoming at risk of developing the condition. In Nigeria, 55% of the population primarily rely on primary care centers for their health needs2. Studies have shown that the prevalence of hypertension and diabetes in Nigeria is increasing, and these are listed as risk factors for dementia by the World Health Organization3. Despite this, there has been limited research on the knowledge and compliance to treatment among those at high risk for dementia, who are crucial for reducing its prevalence. This study focuses on two common risk factors in Nigeria, hypertension and Type 2 diabetes mellitus.ETHICAL COMMITTEE APPROVAL: Obtained from the Human Research Ethical Committee of Lagos University Teaching Hospital, Nigeria. STUDY POPULATION: People with vascular risk factors (Hypertension &amp; Type 2 Diabetes Mellitus) attending primary care facilities in selected centers in Nigeria. Inclusion criteria:1. Patients 35 to &lt; 65 years.2. Patients with correct diagnosis of Hypertension3. Patients with correct diagnosis of Diabetes Mellitus4. Patients with at least basic primary school education Exclusion criteria:1. Patients who don’t pass the cognitive test.2. Patients with neuropsychiatric conditions3. Hypertension in pregnancy Study design: A clinic‐based descriptive cross‐sectional study.MaterialsMini mental State Exam tool prior to commencement of the questionnaire‐based interview. SPSS, structured interviewer‐based questionnaires.RESEARCH ASSISTANTS: Medical graduates of the College of Medicine, University of Lagos, Nigeria, are the field‐enumerators for this study.Results, Discussion &amp; ConclusionOngoing study FUNDING: Self‐funded

DISP-09. HISTOPATHOLOGIC AND MOLECULAR PROFILE OF GLIOMAS: A 9-YEAR RETROSPECTIVE STUDY OF CASES DIAGNOSED IN LAGOS NIGERIA

Abstract BACKGROUND The diagnosis and management of patients with brain tumors currently uses WHO defined morphologic and molecular features. However, neuro-oncology practice in low resource settings relies on histomorphology. This study aims to reclassify glioma cases diagnosed in the Department of Anatomic and Molecular Pathology Lagos University Teaching Hospital using the 2021 WHO classification. METHODS Fifty-six cases of glioma diagnosed between 2013 to 2021 were evaluated. Morphologic diagnosis was reassessed. Five-micron sections were obtained for immunohistochemistry (IHC), and genetic testing (DNA and RNA); after manual macrodissection for tumor enrichment using 10μm sections. IHC for IDH1-R132H, ATRX, BRAFV600E, P53,Ki67, and H3K27M and OncoScan chromosomal microarray analysis were performed. NGS mutation/fusion analysis and EPIC methylation array profiling are in progress. RESULTS Of 56 cases evaluated, median age was 22 years (range=1-60 years); 71% were males. The initial morphologic diagnosis include 21 pilocytic astrocytoma, 11 glioblastoma, 9 ependymoma, 7 diffuse astrocytoma, 3 anaplastic astrocytoma, 2 high-grade gliomas, 1 oligodendroglioma, 1 diffuse midline glioma, and 1 pleomorphic xanthoastrocytoma (PXA). Histomorphologic re-evaluation revealed discordant diagnosis in 29% (16/56) of cases. Of the 56 cases, 73% (41/56) had usable DNA yield and 38% (21/56) had DNA yield of ≥ 750ng. Chromosomal microarray analysis was completed for 50% (28/56) cases. The revised 2021 WHO diagnosis were: 5 glioblastoma, IDH-wildtype, 5 pilocytic astrocytoma, 4 glioma NEC, 3 posterior fossa ependymoma, group B, 3 PXAs, 3 astrocytoma, IDH-mutant, 2 pediatric low-grade glioma, 2 supratentorial ependymoma, ZFTA fusion-positive, 1 posterior fossa ependymoma, group A. In 71% (20/28) of cases, diagnosis was revised using the 2021 WHO criteria. CONCLUSION Most cases had usable DNA yield. Overall, hsitologic re-evaluation and molecular testing based on the 2021 WHO classification guidelines refined the diagnosis in 48% (27/56) of cases.

Gastrointestinal Bleeding in Children: The Role of Endoscopy and the Sheffield Scoring System in a Resource-Limited Setting.

To document the clinical presentation, endoscopic diagnosis, and Sheffield scores of children with gastrointestinal (GI) bleeding who were referred for endoscopy at the Lagos University Teaching Hospital. The participants who needed endoscopy based on clinical criteria and according to the Sheffield scores were also documented. This study analyzed the records of 111 children with GI bleeding retrospectively from January 2013 to January 2021, while 9 children were recruited prospectively from February 2021 to March 2022. Receiver operating curves and area under the curve were generated to test the ability of the Sheffield scores to predict rebleeds, mortality, and the need for endoscopic intervention for upper GI bleeds. One hundred and twenty participants were recruited. Ninety-one (75.8%) presented with upper GI bleeding (UGIB), while 29 (24.2%) had lower GI bleeding (LGIB). Only 70 (58.3%) (53 UGIB and 17 LGIB) had endoscopy performed. For UGIB, 5 (9.4%) had no source of the bleeding identified at endoscopy, 12 (22.6%) had variceal bleeding, and 36 (67.9%) had nonvariceal bleeding. Colonoscopy revealed juvenile polyps in 5 (29.4%), indeterminate colitis in 5 (29.4%), ulcerative colitis in 4 (23.5%), Crohn's disease in 1 (5.9%), and hemorrhoids in 2 (11.8%) participants, respectively. The Sheffield score was ≥8 in 42 (46.1%) of the participants who presented only with UGIB (hematemesis and melena). The scores were significantly related to the type of bleeds, rebleeds, and deaths (P = 0.00). The clinical and endoscopic findings in this study are similar to those reported previously. The Sheffield scoring was useful in assessing Nigerian children. However, due to limited access and other restraints, endoscopy was not performed on all the study participants even when the scoring system was suggestive. The availability, and therefore, utility of GI endoscopy in this setting are still suboptimal. The need for the provision of adequate equipment and resources and the training of personnel is thus recommended.

Epidemiology and survival outcomes of HIV-associated cervical cancer in Nigeria.

Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America's National Institutes of Health/National Cancer Institute funded project titled 'Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria'. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test. A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC +), and 47 (19.7%) were HIV-positive (HIV +/ICC +). The HIV +/ICC + patients were younger with median age 46 (IQR: 40-51) years compared to 57 (IQR: 45-66) among HIV-/ICC + (P < 0.001). Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV +/ICC + diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV-/ICC +. The HIV-/ICC + women had better OS compared to HIV +/ICC + participants (p = 0.018), with 12-month OS 84.1% (95%CI 75-90%) and 67.6% (95%CI 42-84%) respectively. ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival.

GLIOMA-02 HISTOPATHOLOGIC AND MOLECULAR PROFILE OF GLIOMAS: A 9-YEAR RETROSPECTIVE STUDY OF CASES DIAGNOSED IN LAGOS NIGERIA

Abstract BACKGROUND The diagnosis and management of patients with brain tumors currently uses WHO defined morphologic and molecular features. However, neuro-oncology practice in low resource settings relies solely on histomorphology. This study aims to reclassify glioma cases diagnosed in the Department of Anatomic and Molecular Pathology Lagos University Teaching Hospital using the WHO 2021 classification. METHODS Fifty-six cases of glioma diagnosed between 2013 to 2021 were evaluated. Morphologic diagnosis was reassessed. Five-micron sections were obtained for immunohistochemistry (IHC), and genetic testing (DNA and RNA) after manual macrodissection for tumor enrichment used 10-µm sections. IHC for IDH1-R132H, ATRX, BRAF-V600E, p53, Ki67 and H3-K27M and Oncoscan chromosomal microarray analysis were performed. NGS mutation/fusion analysis and EPIC methylation array profiling are in progress. RESULTS Of the 56 cases evaluated, median age was 22 years (range, 1-60); 71% were male. The initial morphologic diagnoses included 21 pilocytic astrocytoma, 11 glioblastoma, 9 ependymoma, 7 diffuse astrocytoma, 3 anaplastic astrocytoma, 2 high-grade gliomas, 1 oligodendroglioma, 1 diffuse midline glioma, and 1 pleomorphic xanthoastrocytoma (PXA). Histomorphologic re-evaluation revealed discordant diagnosis in 29% (16/56) of cases. Of the 56 cases, 73% (41/56) had usable DNA yield and 38% (21/56) had DNA yield of ≥750ng. Chromosomal microarray analysis was completed for 50% (28/56) cases. The revised WHO 2021 diagnosis was: 5 glioblastoma IDH-wildtype, 5 pilocytic astrocytoma, 4 glioma NEC, 3 posterior fossa ependymoma, group B, 3 PXA, 3 astrocytoma IDH-mutant, 2 pediatric low-grade gliomas, 2 supratentorial ependymoma, ZFTA fusion-positive, 1 posterior fossa ependymoma, group A. In 71% (20/28) of cases with molecular testing, diagnosis was revised using WHO 2021 criteria. CONCLUSION Most cases had usable DNA. Overall, histologic re-evaluation and molecular based on the WHO 2021 criteria refined the diagnosis in 48% (27/56) of cases.

Carotid Intima-Media Thickness and Its Correlation With Echocardiographic Left Ventricular Function and Geometry in Hypertensive Individuals: A Cross-Sectional Study.

Background It is important to consider left ventricular hypertrophy (LVH) and carotid intima-media thickness (CIMT) in assessing hypertensive patients' global cardiovascular risk profile, as LVH and arterial wall changes occur concurrently. This study aimed to assess the relationship between CIMT and left ventricular geometry and function in hypertensive patients. Methodology This cross-sectional study included 200 hypertensive individuals and sought to correlate their CIMT with left ventricular geometry and function in Lagos University Teaching Hospital. Hypertension was defined as blood pressure ≥140/90 mmHg or on treatment for hypertension presenting at the outpatient clinics. Patients who satisfied the inclusion criteria were recruited. Abnormal CIMT was defined as >0.9 mm. Patients' demographic data were obtained in addition to general characteristics, physical examination, transthoracic echocardiography, and CIMT. The statistical relationship between CIMT and left ventricular geometry and function was obtained and analyzed. Results Normal geometry and LVH were observed in 50.5% and 15.5%, respectively. Left ventricular geometry was associated with abnormal CIMT (χ2 = 31.688, p < 0.001). Furthermore, the mean left ventricular mass index was statistically different between abnormal and normal CIMT (97.84 ± 30.5 vs. 80.75 ± 15.6; p < 0.001). Regardingleft ventricular function, there was no significant difference in E-point septal separation, left ventricular fractional shortening, and left ventricular ejection fraction in abnormal versus normal CIMT groups. However, there was a significant association of CIMT with grades of diastolic dysfunction (χ2 = 7.069, p = 0.029). Additionally, individual parameters of diastolic dysfunction such as left atrial volume index and septal mitral were significantly different (p < 0.001). Conclusions There was an association between age, left ventricular geometry, diastolic function, and CIMT in hypertensive individuals. Therefore, it is beneficial to evaluate CIMT and for these patients to receive more targeted blood pressure control which may reduce the risk of cardiovascular diseases.

Development of an Extended Medical Diagnostic System for Typhoid and Malaria Fever

In developing countries like Nigeria, malaria and typhoid fever are major health challenges in society today. The symptoms vary and can lead to other illnesses in the body which include prolonged fever, fatigue, nausea, headaches, and the risk of contracting infection occurring concurrently if not properly diagnosed and treated. There is a strong need for cost-effective technologies to manage disease processes and reduce morbidity and mortality in developing countries. Some of the challenging issues confronting healthcare are lack of proper processing of data and delay in the dissemination of health information, which often causes delays in the provision of results and poor quality of service delivery. This paper addressed the weaknesses of the existing system through the development of an Artificial Intelligence (AI) driven extended diagnostic system (EDS). The dataset was obtained from patients’ historical records from the Lagos University Teaching Hospital (LUTH) and contained two-hundred and fifty (250) records with five (5) attributes such as risk level, gender, symptom 1, symptom 2, and ailment type. The malaria and typhoid dataset was pre-processed and cleansed to remove unwanted data and information. The EDS was developed using the Naive Bayes technique and implemented using software development tools. The performance of the system was evaluated using the following known metrics: accuracies of true positive (TP), true negative (TN), false positive (FP), and false negative (FN). The performance of the EDS was substantially significant for both malaria and typhoid fevers.

44-Year Temporal Trends and Causes of Maternal Mortality at the Lagos University Teaching Hospital, LUTH, Lagos, Nigeria (1976-2019)

ABSTRACT Background: Nigeria has committed to global initiatives aimed at improving maternal and child health. Institutional audit of maternal mortality over a long period can provide useful information on the trends in maternal death and the impact of interventions. Aim: To evaluate the trends in annual deliveries, maternal mortality ratio and causes of maternal death at a tertiary institution in Nigeria over a period of 44 years (1976–2019). Materials and Methods: We conducted a temporal trend analysis of annual births, maternal deaths, maternal mortality ratio (MMR), and ranking of causes of maternal deaths at a Teaching Hospital, in Southwest Nigeria using available data from 1976 to 2019. Overall and segmental annual percent change (APC) of the observed trends were conducted using Joinpoint version 4.5.0.1 software. Results: Over the 44-year study period, 1323 maternal deaths occurred at approximately 30 maternal deaths per annum. There was a four-fold increase in MMR from 881/100,000 total births in 1976 to 3389.8/100,000 total births in 2019, at an average increase of 3.1% per annum. (APC: 3.1%; P value &lt; 0.001). The leading causes of maternal mortality were hypertension, sepsis, haemorrhage, and abortion, which together contributed to more than 70% of maternal deaths. All the leading causes of maternal deaths except abortion had constant ranking during the study period. Conclusion: The four-fold increase in MMR at our hospital from 1976–2019 is worrying and may suggest that previous efforts at reducing maternal mortality in our institution did not lead to significant improvement toward the attainment of Sustainable Development Goal 3 (SDG3). The hospital increasingly managed complex cases especially the unbooked patients who were referred to the hospital as a last resort.

Salivary Buffering Capacity, Flow Rate and Calcium Levels in Children with and without Early Childhood Caries – a Comparative Study

Background: Early Childhood Caries (ECC) is a phenomenon that affects primary teeth in children below 6 years of age. Its severity could have a far-reaching impact on children with resultant effects on their quality of life. An assessment of a child's caries risk using saliva is a valuable non-invasive diagnostic tool utilised in preventing or reducing the impact of this condition.&#x0D; Objective: To assess the buffering capacity, flow rate and calcium levels of saliva in children and their association with ECC.&#x0D; Methodology: The study consisted of fifty (50) subjects aged 45 to 71 months recruited from Lagos University Teaching Hospital (LUTH) and staff primary school, Idi-Araba. Unstimulated saliva collected between 9 – 11 am was used to evaluate saliva's buffering capacity, flow rate and calcium levels in children with and without ECC.&#x0D; Results: The subjects were aged below 71 months (with a mean age of 56.66 ± 7.17 months). A major proportion (67.0%) of the component of the dmft was cavitated lesion related. The caries-free subjects had slightly higher mean rank values in salivary flow rate (MR = 27.52, U = 262, p = 0.325), slightly lower mean rank values in calcium level (MR = 24.64, U = 291, p = 0.677) and lower buffering capacity values than caries active subjects.&#x0D; Conclusion: The properties of saliva such as buffering capacity, flow rate and calcium level were not significantly different between the study groups. Therefore, there is no association between buffering capacity, flow rate, calcium level, and ECC. This implies that more investigations are required to evaluate the protective effects of other salivary physiochemical factors like antioxidants, other than those investigated in this study.&#x0D; &#x0D;

Prevalence and risk factors for hepatitis C virus infection among HIV positive patients at the Lagos University Teaching Hospital, Nigeria

Background: Worldwide, an estimated 58 million people have chronic hepatitis C virus (HCV) infection, with about 1.5 million new infections occurring per year. About 2.3 million people living with HIV globally have serological evidence of past or present HCV infection. The aim of this study was to determine the prevalence of active HCV infection and associated risk factors among HIV positive patients attending the HIV clinic, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria.&#x0D; Methodology: A cross sectional study was conducted to determine the prevalence of and risk factors for HCV infection among randomly selected HIV positive patients at the LUTH HIV clinic. Socio-demographic, clinical and laboratory data were collected from the participants using a structured questionnaire. Blood samples were collected and tested for HCV antibodies with an enzyme linked immunosorbent assay (CTK Biotech USA) and HCV RNA was detected using reverse transcriptase polymerase chain reaction assay.&#x0D; Results: One hundred and ninety-five HIV infected participants were recruited into the study of which 134 (68.7%) were females and 61 (31.3%) were males. The mean age of participants was 40.1±7.8 years. Of the 195 participants, 5 tested positive for antibody to HCV, giving a seroprevalence rate of 2.6% (95% CI = 0.8-5.9%). Of the 5 seropositive participants, HCV RNA was detected in 1 (20.0%), giving a prevalence of 0.5% (1/195) for active HCV infection. The seroprevalence of HCV in males of 4.9% (3/61) and females of 1.5% (2/134) was not significantly different (OR=3.41, 95% CI=0.56-20.98%, p=0.18). The mean log10 HIV viral load was significantly higher among participants seropositive for HCV (5.1±0.9 log copies/ml) than those seronegative (2.7±1.2 log copies/ml) (p &lt; 0.001). The mean duration of antiretroviral therapy was significantly lower among participants seropositive for HCV (2.6±1.3 years) than those seronegative (5.6±3.1 years) (p=0.004). The seroprevalence of HCV was significantly higher in those with CD4 count &lt;350 cells/mm3 (8.5%) than those with CD4 count &gt;350cells/mm3 (p=0.02). The seroprevalence of HCV in the HIV-positive participants was significantly associated with sexual partners (p=0.0473), with highest seroprevalence in those with ≥ 3 sexual partners (OR=11.625, 95% CI=1.049-128.83). Other risk factors were not significantly associated with seroprevalence of HCV (p&gt;0.05), while risk factors associated with active HCV infection could not be evaluated with the only one HCV RNA positive participant&#x0D; Conclusion: Although the prevalence of active HCV infection in HIV infected individuals in this study was apparently low (0.5%), screening with HCV antibody test and confirmation with HCV RNA PCR assay are recommended.

High SARS-CoV-2 seroprevalence in Lagos, Nigeria with robust antibody and cellular immune responses

BackgroundEarly evidence suggested that the impact of the COVID-19 pandemic was less severe in Africa compared to other parts of the world. However, more recent studies indicate higher SARS-CoV-2 infection and COVID-19 mortality rates on the continent than previously documented. Research is needed to better understand SARS-CoV-2 infection and immunity in Africa. MethodsIn early 2021, we studied the immune responses in healthcare workers (HCWs) at Lagos University Teaching Hospital (n = 134) and Oxford-AstraZeneca COVID-19 vaccine recipients from the general population (n = 116) across five local government areas (LGAs) in Lagos State, Nigeria. Western blots were used to simultaneously detect SARS-CoV-2 spike and nucleocapsid (N) antibodies (n = 250), and stimulation of peripheral blood mononuclear cells with N followed by an IFN-γ ELISA was used to examine T cell responses (n = 114). ResultsAntibody data demonstrated high SARS-CoV-2 seroprevalence of 72·4% (97/134) in HCWs and 60·3% (70/116) in the general population. Antibodies directed to only SARS-CoV-2 N, suggesting pre-existing coronavirus immunity, were seen in 9·7% (13/134) of HCWs and 15·5% (18/116) of the general population. T cell responses against SARS-CoV-2 N (n = 114) were robust in detecting exposure to the virus, demonstrating 87·5% sensitivity and 92·9% specificity in a subset of control samples tested. T cell responses against SARS-CoV-2 N were also observed in 83.3% of individuals with N-only antibodies, further suggesting that prior non-SARS-CoV-2 coronavirus infection may provide cellular immunity to SARS-CoV-2. ConclusionsThese results have important implications for understanding the paradoxically high SARS-CoV-2 infection with low mortality rate in Africa and supports the need to better understand the implications of SARS-CoV-2 cellular immunity.

DENTIST IN LEADERSHIP POSITION AS CHIEF EXECUTIVE OFFICER OF A LEADING TERTIARY HEALTH INSTITUTION IN NIGERIA.

This article was written with the aim of sharing the experience of the author as a dentist who served as a Chief Medical Director of Lagos University Teaching Hospital for a total of 8 years from 1998 to 2006. The authors discussed circumstances that led to his emergence as Chief Medical Director, the challenges he faced on the job, the significant achievements he made and his final exit from the job. It is hoped that every dentist that reads this article will have confidence to aspire for the job.&#x0D; The author concluded that on the basis of his experience, there should be increased participation of the private sector in funding and managing tertiary health institutions in Nigeria.&#x0D;

Nursing FORM) 2023(2024, Lagos University Teaching Hospital ADMISSION Form is out call (O8O3664O134 or O8O3664O134) Post-Basic Nursing form, Midwifery candidates must fulfil the following criteria: Candidates Call O8O3664O134 must possess five credits (Mathematics, English, Chemistry, Biology, Physics) in WAEC, NECO, NABTEB or a combination of WAEC and NECO. Please come with a photocopy of your results. All candidates should submit

Nursing FORM) 2023(2024, Lagos University Teaching Hospital ADMISSION Form is out call (O8O3664O134 or O8O3664O134) Post-Basic Nursing form, Midwifery candidates must fulfil the following criteria: Candidates Call O8O3664O134 must possess five credits (Mathematics, English, Chemistry, Biology, Physics) in WAEC, NECO, NABTEB or a combination of WAEC and NECO. Please come with a photocopy of your results. All candidates should submit

Clinical and Echocardiographic Correlates of Iron Status in Chronic Heart Failure Patients: A Cross-Sectional Descriptive Study.

Chronic heart failure (HF) is one of the conditions commonly seen in the medical outpatient departments, and iron deficiency (ID) has been reported as the commonest nutritional deficiency in these patients. The presence of ID may interfere with the clinical parameters of chronic HF. The relationship between iron status and chronic HF needs more attention and should be given more consideration in the evaluation of patients with chronic HF. The aim of the study was to determine the relationship, if any, between iron status and clinical/echocardiographic variables in chronic HF. A cross-sectional descriptive study was carried out at the Lagos University Teaching Hospital (LUTH), Nigeria, where 88 patients with chronic HF were recruited to participate in this study. The participants underwent clinical and laboratory assessments. Iron status was assessed with full blood count parameters; serum ferritin and transferrin saturation (Tsat) and its relationship with clinical parameters among these participants were also studied. No correlations existed between the duration of chronic HF and iron status when compared using Tsat. However, a significant weak negative correlation was observed between the duration of HF and the serum ferritin levels. The clinical characteristics of the HF participants with and without ID were compared. There was no significant difference in the frequency of prior hospitalization in both groups. However, a higher proportion of participants with severe HF (New York Heart Association (NYHA) classes III/IV) (n = 14; 46.7%) were iron-deficient compared to those with moderate chronic HF (NYHA II) (n = 11; 36.7%). This relationship was statistically significant. Left ventricular ejection fraction (LVEF) was similar in the iron-deficient and iron-replete groups (using serum ferritin or Tsat) both when compared as means and when compared after categorizing LVEF as HF with preserved ejection fraction (HFpEF) vs HF with reduced ejection fraction (HFrEF). There was no statistically significant correlation between the severity of ID and LVEF. Conclusion: A spectrum of clinical changes occurs in patients with chronic HF. ID can make these changes more profound and the condition less amenable to standard HF treatments. These patients may therefore benefit from further evaluation for this nutritional deficiency. Laboratory measurements including Tsat and serum ferritin may help in further assessment of select patients with worse and/or non-responsiveclinical parameters.