Patients In Ibadan Research Articles

Pattern, Interventions and Outcome of Post-Dural Puncture Headache Among Obstetric Patients in Ibadan

Background: Post-dural puncture headache (PDPH) is a complication of dura mater puncture. PDPH poses a problem in postpartum women; hence, there is a need to identify and promptly treat it using highly effective, non-invasive techniques that can be easily implemented in low-resource settings to reduce the burden and associated morbidity. Objective: To examine the interventions and outcomes of PDPH among women who had a subarachnoid block for obstetric indications at the University College Hospital, Ibadan. Methods: A prospective, cross-sectional study was conducted among women with a subarachnoid block for obstetric indications. A semi-structured interviewer-administered data collection form was used to assess pain at the onset of the headache and followed up to 72 hours post-treatment. Results: This study evaluated 26 pregnant women with PDPH. Most respondents (18; 69.2%) were ≥30 years old, had a normal BMI of 11 (42.3%), and 26.9% of the women had a prior history of PDPH. Subarachnoid block was performed by a registrar in 24 (92.3%) women. The majority (22; 84.6%) had only one attempt at dural puncture, all in a sitting position with the 25G-sized spinal needle in 96.2%. The headache was incapacitating in 9 (34.6%) cases and got worse in the upright position in 23 (88.5%) women. Conclusion: PDPH is a notorious morbidity in parturients, and steps should be taken to minimise the duration and effects of the condition. Prevention, prompt identification, diagnosis, and proactive treatment are desirable.

Postpartum length of hospital stay among obstetric patients in Ibadan, Nigeria

BackgroundPostpartum Length of hospital stay (PLOHS) is an essential indicator of the quality of maternal and perinatal healthcare services. Identifying the factors associated with PLOHS will inform targeted interventions to reduce unnecessary hospitalisations and improve patient outcomes after childbirth. Therefore, we assessed the length of hospital stay after birth and the associated factors in Ibadan, Nigeria.MethodsWe used the Ibadan Pregnancy Cohort Study (IbPCS) data, and examined the 1057 women who had information on PLOHS the mode of delivery [spontaneous vagina delivery (SVD) or caesarean section (C/S)]. The outcome variable was PLOHS, which was described as the time interval between the delivery of the infant and discharge from the health facility. PLOHS was prolonged if > 24 h for SVD and > 96 h for C/S, but normal if otherwise. Data were analysed using descriptive statistics, a chi-square test, and modified Poisson regression. The prevalence-risk ratio (PR) and 95% confidence interval (CI) are presented at the 5% significance level.ResultsThe mean maternal age was (30.0 ± 5.2) years. Overall, the mean PLOHS for the study population was 2.6 (95% CI: 2.4–2.7) days. The average PLOHS for women who had vaginal deliveries was 1.7 (95%CI: 1.5–1.9) days, whereas those who had caesarean deliveries had an average LOHS of 4.4 (95%CI: 4.1–4.6) days. About a third had prolonged PLOHS: SVD 229 (32.1%) and C/S 108 (31.5%). Factors associated with prolonged PLOHS with SVD, were high income (aPR = 1.77; CI: 1.13, 2.79), frequent ANC visits (> 4) (aPR = 2.26; CI: 1.32, 3.87), and antenatal admission: (aPR = 1.88; CI: 1.15, 3.07). For C/S: maternal age > 35 years (aPR = 1.59; CI: 1.02, 2.47) and hypertensive disease in pregnancy (aPR = 0.61 ; CI: 0.38, 0.99) were associated with prolonged PLOHS.ConclusionThe prolonged postpartum length of hospital stay was common among our study participants occurring in about a third of the women irrespective of the mode of delivery. Maternal income, advanced maternal age, ANC related issues were predisposing factors for prolonged LOHS. Further research is required to examine providers’ perspectives on PLOHS among obstetric patients in our setting.

EGFR and HER2 expression in cervical cancer patients in Ibadan, Nigeria.

Cervical cancer is a leading cause of cancer-related deaths in developing countries, including Nigeria where it is the second most common female malignancy. Studies from elsewhere have demonstrated the relationship between epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) and advanced cervical cancer. However, we are not aware of such studies in Nigerian patients. The main objective of the study was to determine the prevalence of EGFR or HER1 and HER2 protein expression in cervical cancers and to determine their impact on overall survival. Clinical data and formalin-embedded tissue blocks of 124 patients who presented in the Radiation Oncology Department, University College Hospital (UCH), from 2006 to 2015 and had their histological diagnosis at the Pathology Department, UCH were retrieved and analysed for EGFR and HER2 expression using immunohistochemistry. EGFR expression was analysed using the immunoreactivity score by Remmele and Stegner. HER2 was analysed using the Hercep® test kit guidelines. Survival analysis was done using Kaplan-Meier and Cox regression analysis. Missing data were reported as missing, not documented. EGFR (immunoreactivity score > 4) was overexpressed in 26.6% of the 124 cervical tissue samples tested. Most patients whose samples were positive for EGFR were young, had squamous cell carcinoma and advanced diseases. HER2 was overexpressed in two samples (1.6%). The 5-year overall survival rate of the patients was 28.3%. The 5-year survival rate of patients who were EGFR positive was 9.5% and 34.1% for those who were EGFR negative. Screening for EGFR should be considered in cervical cancer patients. HER2 was overexpressed in two cervical tissue samples in this study and may be of poor interest as a potential target in the management of cervical cancer patients. Large prospective multi-institutional studies should be considered to further explore the relationship between EGFR and survival in cervical cancer patients.

Platelet Indices in Drug Resistant Tuberculosis Patients in Ibadan

Platelet Indices in Drug Resistant Tuberculosis Patients in Ibadan

Antibiotic Susceptibility Patterns and Extended Spectrum Beta-Lactamase (ESBL) production in Enterobactericeae Isolated from Stool Samples of HIV and AIDS Patients in Ibadan, Nigeria

Background and Objectives: Abuse and indiscriminate use of antibiotics, prolong hospital admission, travel history, organ transplants, immunocompromised conditions and age are parts of the factors that contribute to development of antibiotic resistance and intestinal carriage of Extended Spectrum Beta-Lactamases (ESBL) Enterobacteriaceae. These bacteria affect the course and outcome of an infection and continue to pose a challenge to infection management worldwide. This study was carried out to determine the antimicrobial susceptibility patterns and prevalence of ESBL-producing Enterobacteriaceae isolated from stool samples of HIV and AIDS patients in Ibadan, Nigeria.
 Materials and Methods: One hundred stool samples were collected from consenting HIV and AIDS patients accessing care in Antiretroviral (ARV) Clinic in a secondary and a tertiary health care facility in Ibadan, Nigeria. Gram-negative bacteria were isolated and identified using conventional methods. Antimicrobial susceptibility test was carried out using the Kirby Bauer disc diffusion technique. Phenotypic detection of ESBL-producing isolates was carried out using Double Disc Synergy Test (DDST).
 Results: A total of 240 Gram-negative bacteria were isolated comprising 100 (41.6%) Escherichia coli, 33(13.8%) Klebsiella pneumonia, 27(11.3%) Serratia marcescens, 20(8.3%) Salmonella enterica, 9(3.8%) Proteus vulgaris, 13(5.4%) Proteus mirabilis, 21(8.8%) Citrobacter freundii and 17(7.1%) Enterobacter aerogenes. Out these, 56 (23.3%) were ESBL-producers; comprising 23(41.0%) Escherichia coli, 9(16.0%) Klebsiella pneumonia, 6(10.7%) Serratia marcescens, 5(8.9%) Salmonella enterica, 3(5.3%) Proteus vulgaris, 5(8.9%) Proteus mirabilis, 2(3.6%) Citrobacter freundii and 3(5.4%) Enterobacter aerogenes. Among the ESBL producers, 45 (80.3%) and 38 (67.8%) showed resistance to trimethoprim/sulfamethoxazole and aztreonam while 3 (3.5%) showed resistance to ertapenem. Also, 96.4% (54/56) of the ESBL producers were multidrug resistant.
 Conclusion: This study showed that HIV and AIDS patients are reservoirs of ESBL-producing Enterobacteriaceae through faecal carriage, presenting them as likely source of dissemination of ESBL producer in community and hospital settings.

Evaluation of a cryptococcal antigen lateral flow assay test for rapid detection of cryptococcal infection in HIV-negative patients in Ibadan, Nigeria

Background: A number of studies have been conducted in Nigeria on the prevalence of cryptococcal infections mostly on HIV-infected patients using culture, India ink and/or latex agglutination tests. These tests are either laborious, time-consuming and expensive or have low sensitivity, thus limiting their use. Cryptococcal antigen lateral flow assays (LFA) were introduced in the last decade as rapid user-friendly tests for diagnosis. In this study, we sought to determine the diagnostic accuracy of an LFA kit for the detection of cryptococcal antigen in the serum of HIV-negative patients with or without cerebrovascular accident (CVA) or stroke in University College Hospital, Ibadan, Nigeria.Methodology: The diagnostic accuracy of Dynamiker CrAg LFA was tested against BiosynexR CryptoPS on serum samples of 100 HIV-negative patients with and without stroke. Samples were tested and results interpreted in accordance with the manufacturer’s instructions. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios of the Dynamiker CrAg LFA were calculated by comparing with the BiosynexR CryptoPS as ‘gold standard’.Results: Overall, a total of 98 valid patient sample results were analysed; 17 samples (17.3%) were positive with Dynamiker CrAg LFA cryptococcal antigen and 16 samples (16.3%) were positive with BiosynexR CryptoPS. The sensitivity, specificity, PPV and NPV of Dynamiker CrAg LFA compared to the BiosynexR CryptoPS were 100%, 98.8%, 94.1% and 100% respectively, while the positive and negative likelihood ratios were 82 and 0 respectively.Conclusion: In comparison to the BiosynexR CryptoPS, the Dynamiker CrAg LFA is a highly sensitive and specific test for the detection of cryptococcal antigen in serum. The test kit should be considered as a screening device for cryptococcal infection both in outreach and clinical settings, especially in antiretroviral therapy (ART) centres.
 Keywords: Cryptococcus; evaluation; lateral flow assay; HIV-negative; stroke

Orofacial lesions associated with long-term highly active antiretroviral therapy among HIV-seropositive adults in Ibadan, Nigeria.

Introductionhighly active antiretroviral therapy (HAART) has contributed to a reduction in HIV- related oral lesions and improved quality of life among HIV seropositive patients. However, the therapy is not without its side effects. This study was aimed at assessing the self- reported orofacial manifestations due to long term use of HAART, as well as the pattern of oral lesions on examination.Methodsthis was a cross-sectional study conducted among HIV seropositive adult patients in Ibadan, who had been on HAART for at least two years. Data were collected using an interviewer-administered questionnaire. Clinical diagnosis of HIV-related oral lesions was made according to the EC-Clearinghouse criteria. Data analysis was done using SPSS version 25.Resultsthe study participants comprised of 227 HIV seropositive patients who were HAART experienced, with 54 (24%) males and 173 (76%) females. Their mean age (±SD) was 44.7 (±9.4) years. The participants CD4 count ranged from 13-1338cells/mm3, with a median count of 341 cells/mm3. About half (45%) of the participants noted one or more orofacial changes since they commenced HAART. These oral changes included dryness of mouth, burning sensation, abnormal taste, melanotic hyperpigmentation, oral thrush, ulcers, and parotid swelling. Most of those who reported oral changes had been on HAART over 10 years (p=0.03), and the changes were more reported among those on the first-line regimen.Conclusionmelanotic hyperpigmentation was the most common oral lesion found and burning mouth syndrome was the most commonly reported complain among HIV-seropositive adults who are on long-term HAART.

Incidence and reasons for leave against medical advice among orthopedic and trauma patients at the university college hospital Ibadan

<p><strong>Background:</strong> Leave against medical advice (LAMA) of hospitalized patients is an adverse clinical event in which a patient chooses to leave the hospital before it is medically advisable to do so and it negatively affects the treatment outcome. Because of this, the study was designed to determine the incidence of and indications for LAMA among orthopedic patients who presented at the accident and emergency department of the university college hospital, Ibadan.</p><p><strong>Methods: </strong>This was a prospective hospital-based study determining the incidence of LAMA among orthopedic patients who presented at the accident and emergency department of the university college hospital, Ibadan between September 2019 and March 2020.</p><p><strong>Results: </strong>A total of 289 patients with orthopedic conditions presented within the study period and about 12.46% of these LAMA. The male to female ratio observed in this study is 2:1. The age range was between 8 and 93 years. Trauma from motorbike and motor vehicle accidents accounted for over 80% of the etiology. The most important factor influencing LAMA is financial constraints (63.9%) and LAMA was signed mostly by the patients (25%).</p><p><strong>Conclusions: </strong>LAMA among orthopedic patients in Ibadan is mostly due to financial reasons, therefore, factors that will reduce the cost of management such as the accessibility to health insurance schemes will significantly reduce the incidence of LAMA among orthopedic patients in Nigeria.</p><p> </p>

Risk Factors Associated with MDR-TB among Tuberculosis Patients in Ibadan, Oyo state, Nigeria

Introduction: In Nigeria, patients accessing Directory Observed Therapy (DOTS) treatment are exposed to resistance to anti-TB drugs, hence is considered a priority, only few studies have focused on the relevant risk factors, Factors leading to development of drug resistance need to be understood to develop appropriate control strategies for national programsMethod: The study was a cross sectional study design. Multistage sampling technique was employed in the selection of 403 tuberculosis patients in Ibadan North Local Government Area of Oyo State. Data were collected using self-administered structured questionnaire, and analyzed using SPSS version 25. Level of significance was set at P<0.05.Results: Fifty three (13.2%) of the total respondent had Multidrug Resistant TB (MDR-TB) which is more among the males 36(67.9%) (p>0.05). Education and Occupation shows a significant association with MDR-TB, (χ2=24.640, p =0.007) and (χ2=14.416, p = 0.006) respectively,risk factors such asprevious TB treatment and Adherence with treatment regimen (r=0.270, p<0.05), HIV (r=0.168, p<0.05) and smoking (ß=0.107, t=2.144, p<0.05) were statistically associated with development of acquired MDR-TB.Conclusion: This finding revealed that Previous TB treatment andAdherence with treatment regimen were found to be the major risk factor for MDR-TB. Targeted educational intervention for patients and their contacts may minimize the nonadherence with prescribed TB treatment and lessen MDR-TB magnitude. High quality directly observed treatment should be strengthened to ensure that the previously treated patients can receive standard and regular regimens.
 Keywords: TB Patients, MDR-TB, tuberculosis, Risk factors. 
 
 French Title: Facteurs de risque associés à la MDR-TB parmi les patientstuberculeux à Ibadan, état d'Oyo, Nigéria
 Introduction: Au Nigéria, les patients accédant au traitement DOTS (Directory Observed Therapy) sont exposés à une résistance aux médicaments antituberculeux, ce qui est considéré comme une priorité, seules quelques études se sont concentrées sur les facteurs de risque pertinents. Les facteurs menant au développement d'être compris pour développer des stratégies de contrôle appropriées pour les programmes nationaux.Méthode de l'étude: L'étude était un plan d'étude transversale. Une technique d'échantillonnage à plusieurs degrés a été utilisée pour sélectionner 403 patients tuberculeux dans la région du gouvernement local d'Ibadan Nord de l'état d'Oyo. Les données ont été collectées à l'aide d'un questionnaire structuré auto-administré et analysées à l'aide de la version 25 du SPSS. Le niveau de signification a été fixé à P <0,05.Résultats de l'étude: Cinquante-trois (13,2%) des répondants totaux avaient une tuberculose multi résistante (MDR-TB), ce qui est plus parmi les hommes 36 (67,9%) (p> 0,05). L'éducation et la profession montrent une association significative avec la TB-MR, (χ2 = 24,640, p = 0,007) et (χ2 = 14,416, p = 0,006) respectivement, des facteurs de risque tels que le traitement antituberculeux antérieur et l'observance du schéma thérapeutique (r =0,270, p <0,05), le VIH (r = 0,168, p <0,05) et le tabagisme (ß = 0,107, t = 2,144, p <0,05) étaient statistiquement associés au développement de la TB-MR acquise.Conclusion: Ce résultat a révélé que le traitement antituberculeux antérieur et l'observance du schéma thérapeutique étaient les principaux facteurs de risque de TB-MR. Une intervention éducative ciblée pour les patients et leurs contacts peut minimiser la non-observance du traitement antituberculeux prescrit et réduire l'ampleur de la TB-MR. Un traitement de haute qualité directement observé doit être renforcé pour garantir queles patients précédemment traités puissent recevoir des schémas standards et réguliers.
 Mots-clés: Patients TB, MDR-TB, tuberculose, facteurs de risque

Faecal Carriage and Antibiotics Resistance Patterns of Campylobacter Species from HIV/AIDS Patients in Ibadan, Southwest Nigeria

Background: As a result of the low immunosuppressive condition of people living with Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS), they are at greater risk of Campylobacter infections but the use of antibiotics tends to reduce incidence. However, though this has reduced the incidence of the infection, there is likely development of antibiotic resistance with them thereby becoming asymptomatic carriers of drug resistant Campylobacter species.
 Aim: This study was carried out to determine the faecal carriage and antibiotic susceptibility pattern of Campylobacter species isolated from HIV patients in Ibadan, Nigeria.
 Methods: One Hundred stool samples were collected from HIV patients attending two Antiretroviral Clinics in Ibadan between February and March, 2017. Campylobacter species were isolated and identified using standard methods. Antibiotic susceptibility test of the isolates to amikacin, gentamycin, chloramphenicol, amoxicillin/clavulanate, cefixime, aztreonam, ciprofloxacin, cephalothin, nalidixic acid and ertapenem was done using disk diffusion method. 
 Results: The prevalence of Campylobacter species in the stool samples of the HIV/AIDS patients was 68%. A total of one hundred and twenty isolates were identified as C. upsaliensis 32(26.7%), C. jejuni 30(25%), C. lari 23(19.2%), C. coli 20(16.7%), and C. fetus 15(12.5%). The antibiotics susceptibility pattern of these isolates showed that 97(80.8%), 88(73.3%), 82(68.3%), 9(7.5%), 9(7.5%) and 12 (10.8%) were resistant to gentamycin, chloramphenicol, cefixime, amikacin, ciprofloxacin and ertapenem respectively. Moreover, 102 (85.0%) of the isolates were found to be multidrug resistant.
 Conclusions: The faecal carriage and high prevalence of antibiotic resistance of Campylobacter strains among the HIV/AIDS patients therefore present them as asymptomatic carrier and reservoir for dissemination of the bacteria.

Cognitive-behavioural factors associated with adherence to antiretroviral medication among HIV infected patients in Ibadan, Oyo state

Background: The initiation of antiretroviral therapy has brought about a huge transformation in HIV care and it has helped in saving millions of lives since its inception. Nevertheless, non-adherence poses a huge challenge to HIV care as this exposes the patients to opportunistic infections and brings about highly resistant viral strains. Therefore, this study assessed the cognitive-behavioural factors associated with the adherence to antiretroviral medication among HIV infected patients in Ibadan, Oyo State, Nigeria.Methods: A descriptive cross sectional study design guided by a behavioural theory was employed. Multistage sampling was employed in this study. Purposive sampling was used to select the hospitals and simple random sampling was used to select the respondents. A 42 item semi-structured questionnaire validated at 0.85 Cronbach alpha was used. Data were analysed using descriptive and inferential statistics at p<0.05.Results: The result showed a mean age of 42.11±11.60 years, while 238 (82.6%) of the respondents were female. The study revealed a positive attitudinal disposition of 54% and a negative perception of 51.5%. Optimal antiretroviral medication adherence among the respondents was 189 (65.6%). Attitude and perception showed a statistical correlation towards antiretroviral medication adherence where p=0.001 and p=0.000 respectively.Conclusions: Attitude and perception are major cognitive-behavioural factors that predicts antiretroviral medication adherence, hence, health promotion intervention that could modify these factors and improve antiretroviral medication adherence is highly recommended.

Epilepsy Care in Nigeria: Factors Influencing Default

Introduction: Epilepsy is a common cause of neurologic disability in developing countries where very few patients with the condition have organized regular follow up. This study was conducted to identify factors influencing default of adult epileptic patients in Ibadan.
 Methodology: This is a prospective study of subjects with epilepsy seen at the out-patient neurology clinic, University College Hospital, Ibadan Nigeria. A total of 147 patients with epilepsy were recruited consecutively. A structured questionnaire for obtaining information on their demographic characteristics, cost of transportation, estimated distance to the clinic, monthly clinic attendance and seizure frequency was initially applied to each patient who was assigned to be seen monthly for the next six months. Those that defaulted from any subsequent visit were identified and the questionnaire was applied to obtain the reason for default from them.
 Results: Male gender (p=0.0001), estimated distance (p=0.010), cost of transportation (p=0.013) and age below 40 years (p = 0.01) were identified to have influence on clinic default. But gender is the only significant predictors on clinic default at the multivariate analysis level.
 Conclusions: Creating more advocacy visits on dangers of clinic default, subsidising transportation and decentralising epilepsy care may improve clinic attendance and seizure control.

Phylogenetic analysis of hepatitis C virus among HIV/ HCV co-infected patients in Nigeria.

Hepatitis C virus (HCV) infection has been associated with liver disease including liver cirrhosis and hepatocellular carcinoma (HCC) in chronically-infected persons. However, in HIV/HCV co-infected patients, increased rate of progression to cirrhosis and HCC has been reported. Limited information exists regarding genetic variants of HCV circulating among co-infected patients, which could be important in the design of broadly protective vaccine and management of the disease. Here, we determined the genotypes of HCV isolates circulating among HIV/HCV co-infected patients in Ibadan, southwestern Nigeria. One hundred and twenty-five HIV/HCV IgM positive samples obtained from HIV laboratory, University of Ibadan were used for this study. HCV NS5B gene was amplified using polymerase chain reaction (PCR). The amplified NS5B gene was sequenced using gene specific primers. Twenty isolates were amplified, out of which 13 were successfully sequenced. Phylogenetic analysis of the 13 sequenced isolates showed three HCV subtypes 1a, 3a and 5a belonging to genotypes 1, 3 and 5 respectively. Ten isolates (77%) belong to subtype 5a, followed by 2 isolates (15%) subtype 1a and 1 isolate (8%) was subtype 3a. The predominant HCV genotype was 5, followed by genotype 1 (subtype 1a). The findings, as well as the observed mutations in NS5B gene, indicate the need for screening and monitoring of HIV/HCV co-infected patients. Further study to determine the phylogeny of isolates circulating in other parts of Nigeria will be carried out.

Pharmacotherapy Interventions and Barriers to Treatment of Sickle Cell Disease in Ibadan, Nigeria

Background:Sickle cell disease (SCD) is a hemoglobinopathy that characteristically gives rise to a number of complications triggered by hemolytic anemia and vaso-occlusion. The prevalence of the disease is highest in sub-Saharan Africa, with the highest being in Nigeria where it affects over 6 million people.In spite of its overwhelming burden in Nigeria and the serious complications that result as a consequence, there is little in terms of epidemiological data specific to Nigeria regarding morbidity and management of the disease. Treatment of SCD and its complications includes early screening, patient education, genetic counseling, prophylaxis in the form of penicillin, vaccinations, folate supplementation, and the appropriate use of hydroxyurea (HU). While the efficacies of these treatments have been well documented in the West, morbidity and mortality due to SCD is still a significant public health problem in Nigeria. Particularly, HU has proved to be an effective disease-modifying treatment in the West. Many believe HU to be under-prescribed in Nigeria,but there is conflicting evidence. This study sought to assess the use of disease-modifying and preventive treatments, as well as barriers to treatment of sickle cell disease patients in Ibadan, Nigeria.Methods:We surveyed 50 outpatients at the University College Hospital of Ibadan (UCH) about their past and current treatment of SCD. Patients above age 12 with a primary diagnosis of SCD of any genotype were included. IRB approval was obtained through the UCH Ethics Committee and the Dartmouth College Committee for Protection of Human Subjects. All surveys were done on paper, and were administered to participants non-literate in English through a trained interpreter. Responses were input into SurveyMonkey and Excel for descriptive statistical analysis.Results:Of the people that submitted survey responses, 54% were male and 45% were female. The majority of respondents (84%) indicated that they had the SS genotype, while 14% were of SC genotype and 2% were uncertain of their genotype. The majority of respondents were between the ages of 19-45, and the majority had completed a university degree or higher education. When asked about prevention of SCD crises, 73% of respondents indicated they plan to seek genetic counseling prior to having children. Eighty-two percent of respondents indicated that they have taken prophylactic anti-malarials, while fewer people indicated that they use mosquito nets regularly for prevention of malaria (62%). Complication rates arising from SCD are listed in Table 1. When asked about pharmacotherapy options for treatment of SCD, 96% of respondents had been prescribed folate, compared to the 14% and 46% of respondents who had been prescribed oral penicillin and HU therapies, respectively. Compliance of the above drugs was relatively high as well, as the percentage of people who indicated they have taken folate (90%), penicillin (14%), and HU (42%) correlated similarly with those who had been prescribed. While the rate of those who had taken HU seem relatively high, the majority of those who had taken HU were doing so through the clinical trials of the drug being held at UCH (69%), rather than through an outside prescriber (31%). Of the 22 respondents not taking HU, 5 (23%) indicated that they would like to be taking it but are not able to, compared to the 7% of people not on penicillin who would like to be taking it. The largest potential barriers to treatment were inability to get to a hospital or clinic when necessary (16%) and lack of information about treatment options (32%).Conclusions:The most common treatment for SCD was folate therapy, followed by HU. Many patients receiving HU were formerly or currently enrolled in the clinical trials being run at UCH, which may suggest that it is not commonly prescribed by their regular providers. Most patients had faced at least one complication from SCD, and feel that their biggest deficits in treatment of SCD stem from their inability to get to a clinic or hospital in the event of a complication, and lack of information of the breadth of options that exist for management. More investigation remains to be done about the reasons for decreased usage of HU therapy among providers in Nigeria, and the efficacy of this treatment among adult patients. Given the low utilization of HU in this region, more follow up studies should be done about barriers such as cost, compliance, and access. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The problem of resistance in Mycobacterium tuberculosis may be underestimated in Africa.

The true burden of tuberculosis (TB) and particularly multidrug-resistant (MDR) TB in Sub-Saharan Africa has remained underestimated. We investigated drug susceptibility profile and genetic diversity of Mycobacterium tuberculosis isolates collected from confirmed tuberculosis patients in Ibadan, southwestern Nigeria. We confirmed that from 74 randomly selected Mycobacterium tuberculosis isolates available for drug susceptibility testing in Ibadan, in 2011, 13.5% of them were MDR-TB. This figure is obviously above the national and World Health Organization figures.

Increased urinary sodium excretion is associated with systolic blood pressure in first degree relatives of hypertensive patients in Ibadan, Southwestern Nigeria.

IntroductionUnderstanding the risk factors of hypertension has led to a better understanding of the pathogenesis, prevention and reduction in morbidity of hypertension. It is well known that offsprings of hypertensive parents have an increased risk of developing hypertension. It is therefore necessary to explore the physiological differences between normotensive patients with and without a positive family history of hypertension with respect to their urinary excretion of sodium.MethodsThis study was carried out at the University College Hospital, Ibadan Nigeria, to determine if normotensive patients with a positive family history of hypertension are different with respect to their urinary excretion of electrolytes and blood pressure. It examined the relationship between 24-hour urinary excretion of sodium, chloride and potassium, urea and creatinine and blood pressure in subjects with and without family history of hypertension. It was a case-control study of sixty-two subjects: normotensive patients’ first degree relatives of primary hypertensive patients and normotensive patients without positive family history.ResultsThe mean (SD) systolic blood pressures for subjects with and without family history of hypertension were significantly different: 120.0(22.25) and 105.0(17.50) respectively, (p=0.001). The mean arterial blood pressures were significantly different: 86.4(10.2) mmHg and 80.1(8.1) mmHg respectively (p=0.010). The mean (SD) 24-hour urinary excretion of sodium for normotensive patients with and without positive family history of hypertension were 180.5 (45.50) mEq/L, and 156.0(36.25) mEq/L respectively. Systolic blood pressure and 24-hour urinary excretion of sodium was also higher in normotensive subjects with a positive family history of hypertension.ConclusionSystolic blood pressure and twenty-four hour urinary excretion of sodium were higher in normotensive subjects with a positive family history of hypertension than in those without a family history of hypertension.

Relationship between selected micronutrient deficiencies and oxidative stress biomarkers in diabetes mellitus patients with foot ulcers in Ibadan, Nigeria

Background/aim: Micronutrients are indispensable in the prevention of diseases and maintenance of good health. Their deficiencies have been implicated in several diseases associated with oxidative stress (OS). This study aimed at investigating the levels of some vitamins and minerals in association with OS markers in diabetic foot ulcer (DFU) patients in Ibadan, Oyo State, Nigeria. Materials and methods: Seventy DFU patients and 50 apparently healthy volunteers (controls) were recruited for the study. Blood samples of 10 mL were collected after a 10-h overnight fast from each participant after obtaining their consent. Levels of oxidative stress biomarkers such as lipid peroxide (LPO), 8-hydroxyl-2?-deoxyguanosine (8-OHdG), total antioxidant status (TAS), superoxide dismutase (SOD), and glutathione peroxidase (GPx) and micronutrients such as vitamin C, vitamin E, copper, selenium, and zinc were determined. Results: Significant increases in the levels of LPO and 8-OHdG and GPx activity were found in DFU patients compared to controls (P < 0.001). Significant decreases in vitamin C (P = 0.003), selenium, vitamin E, and TAS concentrations were detected between DFU patients and controls (P < 0.001). However, nonsignificant decreases in SOD activity and copper and zinc levels were observed when DFU patients and controls were compared (P > 0.05). Vitamin C was significantly positively correlated with GPx and selenium was significantly negatively correlated with 8-OHdG in the DFU group. However, nonsignificant correlations were observed between other micronutrients and oxidative stress biomarkers of both the DFU and control groups. Conclusion: Diabetes mellitus patients with foot ulcers may require micronutrient supplementation for proper control and maintenance of oxidant/antioxidant homeostasis.

Retinal vascular changes in hypertensive patients in Ibadan, Sub-Saharan Africa.

BackgroundEarlier studies in Nigeria reported the rarity of retinal vascular changes in hypertensives. The aim of this study was to describe the various retinal vascular changes in the hypertensive patients of Nigeria.Patients and methodsNine hundred and three hypertensive patients were studied. This study was approved by the ethical and research committee of the University of Ibadan and University College Hospital, Ibadan, Nigeria. Blood pressure and anthropometric measurements were measured. Cardiac echocardiography was performed on 156 patients. All patients had dilated fundoscopy and fundus photography using the Kowa portable fundus camera and an Apple iPhone with 20 D lens. Statistical analysis was done with Statistical Packages for the Social Sciences (Version 21).ResultsThe mean age of patients was 57 years with a male:female ratio of 1. No retinopathy was found in 556 (61.5%) patients. In all, 175 (19.4%) patients had features of hypertensive retinopathy. Retinal vascular occlusion was a significant finding in 121 patients (13.4%), of which branch retinal vein occlusion, 43 (4.7%), and central retinal vein occlusion, 30 (3.3%), were the most prominent ones in cases. Hemicentral retinal vein occlusion, 26 (2.9%), and central retinal artery occlusion, 17 (1.9%), were significant presentations. Other findings included nonarteritic anterior ischemic optic neuropathy in five (0.6%) patients, hypertensive choroidopathy in seven (0.8%) patients, and hemorrhagic choroidal detachment in five (0.6%) patients. Left ventricular (LV) geometry was abnormal in 85 (55.5%) patients. Concentric remodeling, eccentric hypertrophy, and concentric hypertrophy were observed in 43 (27.6%), 26 (17.2%), and 15 (9.7%) patients, respectively. LV hypertrophy was found in 42 (27%) patients, while 60 (39%) patients had increased relative wall thickness. In this study, bivariate analysis showed a correlation between LV relative wall thickness and severity of retinopathy in both eyes (Spearman’s coefficient 0.6; P=0.0004).ConclusionHypertensive retinal vascular changes are not rare in Ibadan.

Palliative Care: Supporting Adult Cancer Patients in Ibadan, Nigeria

Over 70% of adult cancer patients present late to hospital in Nigeria with devastating consequences. Yet, structured palliative care is only an emerging service in this country with population of over 160 million. Objective: To describe activities of the Ibadan palliative care group and review one year holistic care programme offered by the team to support patients and their families. Methodology: A retrospective study reviewed treatment notes of patients that were enrolled from January to December 2013. Information retrieved included bio-data, stage of cancer, presenting complaints, palliative care issues identified, services rendered, days on programme, outcome and challenges. Results: Structured Palliative care service consisting of hospital based care, day care and home based care commenced in 2008, being the first of such in Nigeria. The service was based at the University College Hospital, Ibadan and run in collaboration with Centre for Palliative care Nigeria, a non-governmental organization. 189 patients were seen within the year and 121 (64%) were adults with advanced cancer. There were 44 (36.4%) male and 77 (63.6%) female with age range 21 to 91 years. 89 (73.6%) had moderate to severe pain. Psychosocial issues were present in 73% and spiritual issues in 17.4%. Services that were offered despite major challenges of late referral and financial constraints provided pain and symptom control, counselling, education for patients and family, financial and spiritual support thus improving quality of life Conclusion: Patients and their families found that palliative care provided relief to pain and suffering. More can be achieved through training of more health professionals, increased public awareness of the services and government support.

Suicidal Behavior and Associations with Quality of Life among HIV-Infected Patients in Ibadan, Nigeria.

Suicidality has rarely been studied in HIV-infected patients in sub-Saharan Africa. This study explored suicidal behavior in a clinic sample of people living with HIV, in Nigeria. Consecutive patients were interviewed using the Composite International Diagnostic Interview (CIDI-10.0) and the World Health Organization Quality of Life (WHO-QOL-HIV-BREF). Associations of suicidal behavior were explored using logistic regression models. In this sample of 828 patients (71% female, mean age 41.3 ± 10 years), prevalence of suicidal behaviors were 15.1%, 5.8%, and 3.9% for suicidal ideation, plans, and attempts, respectively. Women were more likely than men to report suicidal ideation (odds ratio 1.7; 95% confidence interval 1.05-2.64). Depression and/or anxiety disorder was associated with increased odds of all suicidal behaviors. Suicidal behavior was associated with significantly lower overall and domain scores on the WHO-QOL. Suicidal behaviors were common and significantly associated with the presence of mental disorders and lower quality of life.