Obafemi Awolowo University Teaching Hospitals Research Articles

Endoscopic management of postcholecystectomy complications at a Nigerian tertiary health facility

BackgroundCholecystectomy and common bile duct exploration for biliary stone disease are common hepatobiliary surgeries performed by general surgeons in Nigeria. These procedures can be complicated by injury to the biliary tree or retained stones, requiring repeat surgical intervention. This study presents the experience of using endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary surgery complications at the academic referral center of Obafemi Awolowo University Teaching Hospital (OAUTHC) Ile-Ife, Nigeria.MethodsAll patients with postcholecystectomy complications referred to the endoscopy unit at OAUTHC from March 2018 to April 2023 were enrolled. Preoperative imaging included a combination of abdominal ultrasound, CT, MRI, magnetic resonance cholangiopancreatography (MRCP), and T-tube cholangiogram. All ERCP procedures were performed under general anesthesia.ResultsSeventy-two ERCP procedures were performed on 45 patients referred for postcholecystectomy complications. The most common mode of presentation was ascending cholangitis [16 (35.6%)], followed by persistent biliary fistula [12 (26.7%)]. The overall median duration of symptoms after cholecystectomy was 20 weeks, with a range of 1-162 weeks. The most common postcholecystectomy complication observed was retained stone [16 (35.6%)]. Other postcholecystectomy complications included bile leakage, bile stricture, bile leakage with stricture, and persistent bile leakage from the T-tube in 12 (26.7%), 11 (24.4%), 4 (8.9%), and 2 (4.4%) patients, respectively. Ampullary cannulation during ERCP was successful in all patients (45, 100%). Patients with complete biliary stricture (10/12) required hepaticojejunostomy.ConclusionEndoscopic management of postcholecystectomy complications was found to be safe and reduce the number of needless surgeries to which such patients are exposed. We recommended prompt referral of such patients for ERCP.

Factors Affecting Satisfaction With the Process of Orthodontic Treatment in Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife

Objectives: This study aims to determine the factors contributing to patient satisfaction with orthodontic treatment at Obafemi Awolowo University Teaching Hospital Complex. The specific objectives were to identify factors improving and negatively impacting patient satisfaction, and determine the level of patient satisfaction. Methods: A cross-sectional study design was employed, which involved patients attending the orthodontic clinic at Obafemi Awolowo University Teaching Hospital Complex. A self-administered questionnaire assessed patient demographics, satisfaction levels, and factors influencing satisfaction. Data analysis was performed using descriptive statistics, chi-square tests, and mean scores. Results: Of the 67 respondents, 91% reported satisfaction with their orthodontic treatment. The doctor-patient relationship received the highest mean satisfaction score, while psycho-social improvement received the lowest. Dissatisfied patients were predominantly females in the 21-30 age group. Factors such as dento-facial and dental function improvements significantly affected satisfaction levels. Conclusion: The majority of orthodontic patients at Obafemi Awolowo University Teaching Hospital Complex reported satisfaction with their treatment. Improving patient communication, managing expectations, and addressing dento-facial and dental function improvements can enhance satisfaction levels. Strengthening the doctor-patient relationship and optimizing clinic experiences can improve patient satisfaction.

Delays in Presentation, Diagnosis, and Treatment Among Patients With GI Cancer in Southwest Nigeria.

The incidence of GI cancers is increasing in sub-Saharan African countries. We described the oncological care pathway and assessed presentation, diagnosis, and treatment intervals and delays among patients with GI cancer who presented to the Obafemi Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria. We analyzed data from 545 patients with GI cancer in the African Research Group for Oncology (ARGO) database. We defined presentation interval as the interval between symptom onset and presentation to tertiary hospital, diagnostic interval as between presentation and diagnosis, and treatment interval as between diagnosis and initiation of treatment. We considered >3 months, >1 month, and >1 month to be presentation, diagnosis, and treatment delays, respectively. We compared lengths of intervals using Mann-Whitney U tests and logistic regression. The most frequent cancer types were pancreatic (32%) and colorectal (28%). Most patients presented at stages III (38%) and IV (30%). The median presentation interval was 84 days (IQR, 56-191), and 49% presented after 3 months or longer. The median diagnosis and treatment intervals were 0 (IQR, 0-8) and 7 (IQR, 0-23) days, respectively. There was no relationship between age, sex, education, or distance to tertiary hospital and presentation delay, but patients with stage III to IV versus I to II had higher odds of presentation delay (odds ratio [OR], 1.68 [95% CI, 1.13 to 2.50]). Among patients with pancreatic cancer, older patients were less likely to have a diagnosis delay (OR, 0.50 [95% CI, 0.25 to 0.98]). About half of patients with GI cancer in Ile-Ife, Nigeria, did not present to tertiary hospitals until more than 90 days after noticing symptoms. Efforts are warranted to improve public knowledge of GI cancer symptoms and to strengthen health systems for prompt diagnosis and referral to specialty care.

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

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

Vulva lesions seen at a tertiary health centre in southwest Nigeria

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

Effects of cotton plant (Gossypium herbaceum Linn.) extracts on some vancomycin and methicillin-resistant pathogenic bacteria

Bacterial resistance to antibiotics is a serious global problem, hence attention is being turned to plants as alternative source of antimicrobial to combat the menace of antibiotic resistance among pathogenic microorganisms. This study explores the antibacterial properties of Gossypium herbaceum leaf extracts against a spectrum of antibiotic-resistant bacteria such as Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, sourced from clinical isolates at Don Bosco Catholic Laboratory and Obafemi Awolowo University Teaching Hospital in Nigeria. The research utilized cold extraction methods with methanol and n-hexane solvents to prepare the extracts, which were then analyzed for their phytochemical composition, revealing the presence of flavonoids, steroids, tannins, terpenoids, and glycosides. Antibacterial activity was assessed using the disc diffusion method, with the extracts showing varying zones of inhibition; n-hexane extracts produced zones between 21.35 mm and 4.10 mm, while methanol extracts showed zones between 18.75 mm and 5.05 mm at a concentration of 200mg/mL. Minimum inhibitory concentrations (MIC) were determined, with n-hexane extracts ranging from 25 mg/mL to 6.25 mg/mL and methanol extracts from 50 mg/mL to 6.25 mg/mL. Further analysis of the bioactive fractions was conducted through Fourier Transform Infrared Spectroscopy (FTIR), which identified six distinct bioactive compounds in the methanol extract, including alkenes, alcohols, amines, phenols, nitro compounds, and alkanes. Plasmid profiling indicated the presence of plasmids in clinically significant pathogens like P. aeruginosa and S. aureus, suggesting a potential mechanism for their antibiotic resistance. Overall, the study highlights the significant antibacterial activity of G. herbaceum extracts against resistant bacteria and suggests their potential as alternative antimicrobial agents in combating antibiotic resistance, which is a growing global health concern.

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

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

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

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

Doctor’s Communication Skills and Mode of Communication as Determinants of Quality Patient Care Management in Two Selected Teaching Hospitals in Southwest Nigeria

Quality patient care management is a systematic way to measuring, recording, monitoring, and continually improving efficiency, accessibility to high-quality healthcare, and patient satisfaction. Doctors in the teaching hospitals are at the center of research activities since intense patient care management are usually carried out by them. Previous studies have found that doctors seem not to be working towards quality patient care management in their teaching hospitals which could largely be attributed to certain factors such as doctor’s communication skills and doctors’ mode of communication. Using descriptive research design of the correlational type, the population comprised 658 doctors in two teaching hospitals namely Ekiti State University teaching hospital (EKSUTH) and OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITAL (OAUTHC). Two stage stratified sampling technique (proportional type) was used to select samples from the population of the three doctors cadre in the two selected teaching hospitals. A sample fraction of 3/10 was used across all the cadre to get a total size of 197 for both selected teaching hospitals. A self-structured questionnaire comprising five sections was validated. Out of the 197 copies of the questionnaire administered, 187 representing 94.9% were retrieved and used for analysis. Descriptive statistics of frequency counts, percentages and means were used to analyze the research questions, while correlation and regression were used to test the hypotheses at 0.05 level of significance. There is positive weak relationship between doctors’ communication skills and quality patient care management (r = 0.357, p&lt; 0.05). Doctors’ communication skills, and doctors mode of communication play vital roles in quality patient care management. Associations have been identified between these factors and quality patient care management. It is established by the study that doctors’ communication skills and modes monotonically influenced quality patient care management. Doctors’ communication skills and modes of doctor’s communication has positive effect while no effect on the quality of patient care management. Therefore, it is recommended that the hospital should channel more efforts and resources to improve the standard of communication skills of the doctors.

Knowledge, Attitudes, and Practice of chemotherapy management among nurses at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria

ObjectiveCancer is a leading global health challenge with increasing morbidity and mortality. In Nigeria, cancer leads to over 100,000 new cases and 70,000 deaths annually. In resource-constrained countries such as Nigeria, registered nurses (RNs) that provide oncology care lack specialty education in oncology nursing care. Nigerian nurses are the largest portion of the healthcare workforce and can play a key role in improving oncology care. This study aimed to assess RNs' knowledge, willingness, and ability to perform tasks related to chemotherapy administration and symptom management, assess current practices, identify available resources, and identify gaps in RNs’ knowledge of oncology care. MethodsA descriptive, correlational, Institutional Review Board (IRB)-approved study was conducted using a modified Knowledge, Attitudes, and Practice questionnaire and a questionnaire adapted from the Organizational Readiness to Change Assessment. The principle investigator (PI) adopted the role as an observer to witness an accurate picture of nursing practice at Obafemi Awolowo University Teaching Hospital (OAUTH) and identify gaps in education and knowledge around oncology nursing care. A Research Electronic Data Capture database was developed using paper-formatted questionnaires that were exported to Excel for statistical analysis. ResultsThis study supports findings from literature highlighting that nurses working in oncology units lack specialized oncology training, which leads to gaps in knowledge and practice. Questionnaire responses and clinical observations at OAUTH support RNs’ willingness to learn skills related to oncology nursing care. Nurses are self-aware that they have more to learn about how to prepare and administer chemotherapy, and 90% of nurses reported that an ongoing chemotherapy training program would be helpful at OAUTH. ConclusionsBy identifying gaps in education and knowledge about oncology care and by identifying available resources, an oncology training program could be developed for nurses working in oncology units at OAUTH and other Nigerian hospitals, leading to improved oncology patient care and outcomes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prevalence and patterns of breast white adipose tissue inflammation among American Black women and indigenous Nigerian women with early-stage breast cancer.

e12560 Background: Racial disparities in breast cancer outcomes pose a major public health challenge. Complex interactions between social determinants of health and tumor biology, mediated by obesity and adiposity, may play an important role in these disparities. White adipose tissue inflammation (WATi) of the breast, which is histologically defined by the presence of crown-like structures (CLS-B), occurs in the setting of excess adiposity and promotes tumor growth via elevated levels of aromatase, proinflammatory growth factors, and metabolic dysregulation. Here we examined relationships between race, body mass index (BMI), and WATi in two cohorts of patients with early-stage breast cancer: 1) American Black women and 2) indigenous Nigerian women. Methods: Non-tumor breast WAT specimens were collected from patients undergoing mastectomy for treatment or prevention of breast cancer at Memorial Sloan Kettering Cancer Center (MSK) in the US and Obafemi Awolowo University Teaching Hospital (OAUTH) in Nigeria. WATi was defined by the presence of CLS-B as detected by CD68 immunostaining. All tissue analyses were performed at MSK. Associations among BMI and WATi were tested within each cohort using Kendall’s tau rank correlation and compared between cohorts using Pearson's Chi-squared test. Results: A total of 224 American women were enrolled at MSK between 2011-2018, of whom 39 self-reported Black race. At OAUTH, 97 Nigerian women were enrolled between 2018-2022. Invasive carcinoma was present in 32 American Blacks and 97 Nigerians. Of those with invasive carcinoma, the prevalence of WATi among American Black women was 72% vs. 37% in the Nigerian cohort ( p&lt;0.001). In the US cohort, there was no significant difference between the prevalence of WATi among Black vs. non-Black patients (72% vs. 62%; p=0.3). 44% of American Blacks were obese and 34% overweight compared with 27% and 39% of Nigerians, respectively (p=0.07). The prevalence of WATi varied by BMI category within each cohort, as shown. Overweight/obesity was associated with WATi in the Nigerian (p=0.009) and American cohorts (p&lt;0.001); a trend was observed in the American Black subgroup (p=0.13). Conclusions: Breast WATi and obesity were more prevalent among American Black women with breast cancer compared with Nigerian women. These findings highlight the need for further investigation of environment, lifestyle patterns, and body composition differences between indigenous and diaspora populations. [Table: see text]

Abstract 31: Does Receipt of Resource-Adapted Guideline-Concordant Breast Cancer Care Improve Outcomes? A Retrospective Study of 517 Breast Cancer Patients in Southwest Nigeria

Abstract Purpose: The NCCN Harmonized Guidelines for sub-Saharan Africa (SSA) provide evidence-based recommendations for standardized breast cancer (BC) care that are resource-appropriate, regionally developed and endorsed. This study aims to evaluate the proportion of BC patients receiving guideline concordant care in Southwest Nigeria, and their survival outcomes. Methods: A retrospective analysis was performed of consecutive patients diagnosed with non-metastatic BC at Obafemi Awolowo University Teaching Hospital, a public referral hospital in Ife, Nigeria. The NCCN Harmonized Guidelines for SSA - Breast Cancer, version 4.2021 were used to define concordant care, following the minimum practice standards for lower resource environments. Concordance was estimated with exact 95% confidence intervals. Overall survival (OS) was estimated with Kaplan Meier methods. Results: Between January 2016-December 2021, 517 patients were diagnosed with non-metastatic BC (stage I/II: n=101, 20%; stage III: n=416, 80%). Median age was 49y. Diagnostic work-up was guideline-concordant in 6.4% (n=33/517; 95%CI 4.4-8.8%). 98% (n=508/517) received a pre-treatment tissue diagnosis, 86% (n=373/435) completed an appropriate metastatic work-up, but only 18% (n=91/516) underwent breast imaging and 28% (n=142/517) had hormone receptor testing. Locoregional treatment concordance was 3.7% (n=19/517; 95% CI 2.2-5.7%) overall. 43.1% (n=223/517) of patients underwent surgery and 4.3% (n=22/517) received adjuvant radiation where indicated. 24% (n=122/517) received adjuvant chemotherapy. Guideline concordance was highest for neoadjuvant systemic treatment (55%, n=181/329; 95%CI 49-60%), followed by hormonal therapy where hormone receptor status was known (47%, n=24/51; 33-62%). Median follow-up was 17 months (IQR: 3-40). 3-year OS was 70% (59-84%) for stage I/II patients and 46% (40-53%) for stage III. Improved OS was seen across all major treatment categories for stage III patients who received guideline-concordant care compared to those who did not. Conclusion: Concordance with resource-adapted, regional practice guidelines for BC was low. Under-utilization of surgery, limited access to radiation and low rates of hormone receptor testing/therapy were key drivers of this finding. The association of concordant care with improved OS supports the utility of the guidelines &amp; identifies areas where investments to strengthen care through guideline adherence could lead to better survival outcomes. Citation Format: Anna Dare, Olalekan Olasehinde, Matteo Di Bernardo, Funmiola Wuraola, Leye Omisore, Tosin Omoyiola, Israel Owoade, Mary Ogunyemi, Rivka Kahn, T Peter Kingham, Olusegun Alatise, Anya Romanoff. Does Receipt of Resource-Adapted Guideline-Concordant Breast Cancer Care Improve Outcomes? A Retrospective Study of 517 Breast Cancer Patients in Southwest Nigeria [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 31.