Tertiary Hospital In Ibadan Research Articles

Effectiveness of wastewater treatment plant at the removal of nutrients, pathogenic bacteria, and antibiotic-resistant bacteria in wastewater from hospital source.

This study is aimed at assessing the effectiveness of hospital's wastewater treatment plant (WWTP) in removing nutrients, pathogenic bacteria, and addressing antibiotic resistance using a case study of a tertiary hospital in Ibadan, Nigeria. During the dry and wet seasons in the month of July and December, respectively, samples were collected, and analyzed using standard guidelines to examine significant physicochemical parameters of the WTTP; to evaluate the removal efficiency of biological oxygen demand (BOD) and chemical oxygen demand (COD), and to examine the prevalence of pathogenic and antibiotic-resistant bacteria. The results of this study showed that during the dry season, certain parameters exceeded acceptable limits, including temperature, total suspended solids (TSS), total dissolved solids (TDS), phosphate, and nitrate. Although there were reductions in BOD (1555mg/L to 482mg/L) and COD levels (3160mg/L to 972mg/L), they remained above acceptable limits by World Health Organization. In the wet season, the level of COD (20mg/L) in the effluent was within acceptable limit, while the BOD (160mg/L) was above the acceptable limit. The WWTP effectively removed nutrients and reduced the microbial load, as evident from the absence of fecal coliforms in the effluent in both seasons. In respect to BOD removal efficiency, the level of purification of wastewater by the WWTP was 69% during the dry season, while the removal efficiency of COD was 83.54% which showed the efficiency of the WWTP at the removal of COD. However, antibiotic resistance was still present. The study concludes that while the WWTP effectively addressed nutrients and microbial load, additional measures such as tertiary treatment methods like chlorination and UV radiation are necessary to tackle antibiotic resistance. This is crucial to prevent the release of antibiotic-resistant bacteria into the environment, safeguarding human health, animals, plants, and overall environmental well-being.

Differences in Burn Wound Size Estimation Between Points of Referral and the Burn Unit: Experience at a Major Burn Center in Southwestern Nigeria

Background. Accurate burn wound size estimation is important for resuscitation and subsequent management. It is also important for the development of referral guidelines in Nigeria. Objective. To establish whether a significant discrepancy exists in burn size estimation between referral centers and burn units. Methods. A retrospective review of burn patients managed at the burn unit of a premier tertiary hospital in Ibadan, southwestern Nigeria, between January 1, 2016, and October 31, 2019 was conducted. Patients’ demographic and other characteristics, inclusive of TBSA estimation from point of referral and the burn unit, were retrieved and analyzed. Results. A total of 96 burn injury records were found for the study period, with a male-to-female ratio of 1.3:1. Thirty-five records (36.5%) included no burn size estimation by the referring physician. There was a statistically significant difference in TBSA estimation between referring physicians and burn unit physicians (P = .015). Burn wounds were more likely to be overestimated than underestimated (P = .016). Overestimation is more likely with minor burns and in pediatric patients. Underestimation was more likely in adults. Conclusion. There is a significant difference in burn size estimation between burn unit physicians and referring physicians. This finding underscores the need for continuous education on burn estimation to aid proper referral and management.

A Comparative Review of the Efficacy of 24-HourVersus 48-Hour Dose Regimen of Amoxicillin/Clavulanic Acid Prophylaxis forpostoperative infections following elective Caesarean Section at the University College Hospital, Ibadan, Nigeria: A Randomized Clinical Trial

Objectives: To compare the efficacy of 24hour versus 48hour prophylaxis of amoxicillin/clavulanic acid in the prevention of postoperative infections. Study Design: This study was a randomized controlled clinical trial conducted in a tertiary hospital in Ibadan, Nigeria. Two hundred and fifty -two pregnant women scheduled for elective caesarean section were randomly assigned into two groups. After the initial pre-incision antibiotic administration, group A received the Amoxicillin/Clavulanic Acid for 24 hours while group B received the same drug for 48hours. Main Outcomes: Participants were examined on the 3rd, 10th and 17th post-operative days for evidence of infections. All entry and analysis of data was by computer using the Statistical Package for Social Sciences version 22 (IBM, New York). Statistically significant differences were determined at p value of < 0.05. Results: The incidence of postoperative wound infection, postoperative fever and endometritis in this study was 5.2%, 9.1% and 5.6% respectively. There was no significant differences in the incidence of postoperative wound infection, postoperative fever and endometritis between the two regimens of antibiotics. Conclusion: A 24-hour prophylactic regimen of amoxicillin/clavulanic acid is adequate following caesarean section and prolonged use of antibiotics is generally unnecessary, costly and inadvertently increases antibiotics resistance

Erectile Dysfunction among Male Infertile Men Attending the Surgical Outpatient Clinic in a Tertiary Hospital in Nigeria over a 7-Year Period—A Single Surgeon’s Experience

Background: There is misconception about male Infertility and erectile dysfunction (ED) with poor health seeking behaviour in our clime. This study aims at finding the association between erectile dysfunction and male infertility in Ibadan. Methods: This was a retrospective comparative study that analysed records of all men with male infertility between May 2016 and April 2023 at the surgical outpatient in a tertiary hospital in Ibadan. Data included demography, social habit, the severity and prevalence of ED, and type of infertility. The data were analysed with a Statistical Package for the Social Sciences (SPSS) version 25. Logistic regression analysed the association between male infertility and erectile dysfunction. A p-value of < 0.05 was regarded as statistically significant. Results: A total of 109 cases of male infertility of which 65 (59.6%) had ED. The overall mean age for primary and secondary infertility were 37.62 ± 6.95years and 40.62 ± 8.322 years respectively (t=2.892; p< 0.004). The mean age for absence and presence of ED were 39.08 ± 6.61years and 39.56 ± 7.94years respectively (t=0.340; p= 0.734). There is association between alcohol consumption and ED (χ2=6.969; p< 0.008). Similarly, statistically significant association between the ED and the type of infertility as mild, mild-moderate, and moderate ED were commoner among men with primary infertility and all men with severe ED had secondary infertility (χ2=12.283; p<0.015). Conclusions: The prevalence of erectile dysfunction among male infertility was 59.6% with statistically significant association between the severity of ED and male infertility. Public awareness is advocated.

Fetal Echocardiography Audit in a Tertiary Hospital in Ibadan, Nigeria

Background: Delayed detection of congenital heart diseases in low- and middle-income countries (LMICs) contributes to the poor outcome of infants with cardiac anomalies. Fetal echocardiography (FE) can detect heart defects in-utero as early as the 18th gestational week (GA), giving parents and medical professionals time to prepare for the baby's delivery and appropriate treatment. University College Hospital, Nigeria, is one of the few centres in Nigeria where FE is performed. Objectives: To examine the indications for referral for FE and the diagnoses made in our first four years of performing FE. Methods: FE was performed in the antenatal clinic of the University College Hospital, Ibadan, Nigeria, using the GE Voluson P6 machine with a 2-6-RS probe. Demographic information was obtained from the antenatal clinic records of the women who had FE using a semi-structured questionnaire. FE diagnoses were retrieved from the FE register. Results: A total of 129 women whose records were available were recruited for this study. The mean age of the women was 31.7±5.5 years. Forty-two women (32.6%) were referred because of echogenic foci, making this the most common indication for FE. Twenty-nine (22.5%) fetuses had structural heart defects, the most common being Ventricular Septal Defect. Conclusion: There is a need for Obstetricians and Paediatricians to be aware of the indications for fetal echocardiography and refer women appropriately.

Immunohistochemical Profiling of HER-2/neu, Steroid Hormone Receptors and KI-67 Biomarkers in A Cohort of Nigerian Women with Breast Cancer.

Progressive improvement in the accuracy of profiling of hormone receptors in breast cancer provides the basis for targeted endocrine therapy, a major pillar of multimodal breast cancer treatment. However, the disparity in findings from comparatively smaller sample-sized studies in West Africa has led to somewhat conflicting conclusions and recommendations. This study investigates the immunohistochemical (IHC) profile of breast cancer specimens for estrogen receptor (ER), progesterone receptor (PR), human epidermal receptor-2 (HER2)/neu, and Ki-67 in a tertiary hospital in Ibadan, Nigeria over 12 years. We reviewed 998 IHC reports, documented clinicopathologic parameters, computed patterns of biomarkers, and stratified them based on the American Society of Clinical Oncology/College of American Pathologists recommendations. Descriptive analysis including frequency, mean, and median were generated from the data extracted. Out of the 998 cases, 975 (97.7%) were females and 23 (2.3%) were males. The mean age was 48.84 ± 11.99 years. Open biopsies were the most common types of specimens (320, 41.6%): lumpectomy and incisional biopsy of ulcerated, fungating or unresectable tumours. In those cases, 246 (32.0%) were samples of breast-conserving or ablative surgical extirpation (mastectomy/wide local excision/quadrantectomy), and 203 (26.4%) were obtained by core needle biopsies. Invasive ductal carcinoma was the most common histopathological type (673, 94.5%). The majority of graded tumours were intermediate grade (444, 53.5%). Four hundred and sixty-nine (48.4%) were ER positive, 414 (42.8%) were PR positive, and 180 (19.4%) were HER2/neu positive. Three hundred and thirty-four (34.0%) were triple-negative. Eighty-nine cases had Ki-67 staining done, and of these 61 (68.5%) had positive nuclear staining. Steroid hormone receptors and HER-2/neu proportions in our cohort are likely to be more representative than the widely varied figures hitherto reported in the sub-region. We advocate routine IHC analysis of breast cancer samples as a guide to personalized endocrine therapy.

COVID-19 vaccine hesitancy among Nigerians living with non-communicable diseases: a qualitative study

ObjectivesThe discovery and subsequent manufacture of various types of COVID-19 vaccines were considered a breakthrough in the fight against the COVID-19 pandemic. Initially, limited supplies of COVID-19 vaccines warranted vulnerable...

Leadership styles and their outcomes: a study of a Nigerian hospital middle management nurses

PurposeThis study was conducted to identify and explore the leadership styles and the leadership outcomes of the middle management nurses in a large tertiary hospital in Ibadan, the capital of Oyo state of Nigeria. This study aims to explore and describe the perception of staff nurses (SNs) about their nurse managers’ (NMs) leadership styles, to investigate the leadership outcomes of NMs as perceived by their SNs and to investigate what are the best predictors of the leadership outcomes among the perceived leadership styles.Design/methodology/approachThirty-six variables of the MLQ-5X were compressed into the nine psychological constructs, as proposed by Avolio and Bass (2004). Four items of each of the nine sub-scales were combined together, to form the independent variables. The nine items of the leadership outcomes were compressed into three composite variables as: the Leader’s perceived influence as being effective in leading the group variable, it has four items; the Leader’s perceived influence as being satisfactory to the group being led variable, it has two items; and lastly, the Leader’s perceived influence to encourage the staff.FindingsWhen all the three leadership sub-scales were combined as one total leadership outcome, the regression analysis showed that four leadership constructs were the predictors of the leadership outcome, that is, idealized attribute (ß = 0.173, p = 0.011), intellectual stimulation (ß = 0.171, p = 0.016), individualized consideration (ß = 0.240, p = 0.001) and contingent reward (ß = 0.194, p = 0.006). The coefficients and the p-values of the remaining five leadership constructs are as shown in Table 1.Research limitations/implicationsThis study has many limitations. One, the respondents were not randomly sampled, so the results cannot be generalized outside of UCH, Nigeria. It is also a one-time survey.Practical implicationsManagers who regularly practice transformational leadership (TFL) would be able to encourage their SNs to put in their best for the greater good of the organization. In this study, three sub-scales of the TFL, that is, idealized attribute, intellectual stimulation and individualized consideration were found to be strong predictors of leadership outcomes. Leaders who are able to treat their staff with care and concern for the individual, able to mentor, advise, coach and develop their staff are likely to also see improved staff satisfaction and extra effort in staff performance. This is especially necessary in sub-Saharan African countries, including Nigeria.Social implicationsIt is therefore strongly recommended that middle management nurses in UCH should continue to strive and improve on their TFL skills as well as their contingent reward styles of leadership. Vesterinen et al. (2012) said that NMs who can observe their own behaviour and its effects on employees can adjust to a better leadership style. In particular, individualized consideration skills such as coaching, mentoring, advising, developing and showing concern for the individual needs of their staff would encourage SNs to put in extra effort and be more satisfied with their leaders.Originality/valueTo the best of the author’s knowledge, this is his original research work and it has never been published elsewhere. The whole work was however submitted for a PhD thesis to the University of Salford.

Axillary nodal metastasis and resection margins as predictors of Loco Regional Recurrence in Breast Cancer Patients.

Surgical resection margins (RM), axillary nodal involvement and lymph node ratio (LNR) determine loco-regional control (LRC) in breast cancer management. Late presentation precludes breast conservation therefore surgical option is usually mastectomy and adjuvant chemoradiation minimize loco-regional recurrence (LRR). We investigated the prognostic role of lymph nodes positive for malignancy (pN), LNR and RM on LRR of breast cancer in a tertiary hospital in Ibadan, Nigeria. Longitudinal cohort study of 225 females with breast carcinoma managed and followed up for 5-years with end point of LRR or not. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with LRR. The receiver-operator curve was plotted to determine the proportion of metastatic lymph nodes which predicted LRR. Ninety-nine percent had modified radical mastectomy and 163 (72.4%) had negative resection margins. A mean of 11 axillary lymph nodes were harvested at surgery. The age, positive resection margin and number of harvested nodes with malignant cells are associated with LRR. The overall 5-year LRR rate was 16%. LRR is dependent on lymph node involvement as well as and tumor aggressiveness.

Early Experience with Laparoscopic Surgery for Undescended Testis at a Tertiary Hospital in Ibadan (2015-2019)

Background: Undescended testis (UDT) is of concern to the patient. If not treated may be complicated by trauma, torsion, male sub-fertility, and testicular cancer. In Nigeria it is commonly treated by open orchidopexy or orchidectomy. We report our experience with the laparoscopic management of undescended testes in the Western part of Nigeria.
 Methodology: The aim of this study was to report our early experience with the laparoscopic treatment of undescended testis in our centre. The study was conducted between January 2015 and December 2019. The data studied were age, unilateral or bilateral UDT, operation performed, pre-and intra-operative findings, operation time, and the outcome. The data were represented in tables and with operative pictures. Ethical clearance was obtained.
 Results: A total 12 patients were treated which consisted of 7 children and 5 adults with a mean age of 11 (6-17) years and 35.2 (29-42) years respectively. Preoperatively, 9 patients had transperitoneal laparoscopic orchidopexy, orchidectomy or varicocelectomy. The laparoscopic findings were peeping testis (5), intraabdominal testis (8), intracanalicular (5), and one absent testis. All the post-orchidopexy testes remained in the scrotum at 18 months of follow up. In the adults, there was improvement in the semen parameters in 2 men while 3 had persistent azoospermia.
 Conclusion: In our setting, laparoscopy for undescended testis is feasible, safe, diagnostic, and therapeutic. In infertile men with undescended testis and unilateral varicocele, laparoscopic varicocelectomy results in improved semen quality.

Effect of a Brief Supportive and Educational Intervention on the Psychological Well-Being of Mothers with Babies in Neonatal Wards of a Tertiary Hospital in Ibadan, Nigeria.

OBJECTIVETo assess the effect of a supportive educational intervention on the psychological wellbeing of mothers whose babies were admitted to Neonatal Care Unit (NCU) in Nigeria.METHODSControlled trial involving 41 mothers whose babies were consecutively admitted into two NCUs (21 in the intervention group and 19 controls). The intervention group received two group-based sessions which included psychological coping strategies, and familiarity with NCU environment, equipment, personnel and procedures. The control group received usual care. Outcome measures were depressive symptoms (Edinburg Postnatal Depression Scale—EPDS), stress-related to NCU (Parental Stressor Scale: Neonatal Intensive Care Unit—PSS: NICU) and post-traumatic symptoms (Impact Event Scale-Revised—IES-R).RESULTSDifference-in-Differences (DiD) analysis showed a difference of −4.70 in PSS: NICU score in favour of the intervention group which was statistically significant [F(3, 75) = 9.47, p < 0.0001, R2 = 0.28]. The differences in EPDS (0.91) and IES-R (2.55) were not statistically significant [F(3, 75) = 10.10, p = 0.74] and [F(3, 75) = 10.13, p = 0.73], respectively. All the mothers in the treatment group expressed satisfaction with the intervention.CONCLUSIONThis brief group-based supportive educational intervention for mothers with babies in NCU was feasible, acceptable and helpful in reducing stress related to NCU. Larger controlled trials are recommended to establish the generalizability of these findings in this region.LAY SUMMARYBabies born too early and or with complications require admission to special hospital called Neonatal Care Unit (NCU) to help them to survive. However, parents whose babies are admitted to NCU can find the experience frightening. We examined how to reduce the fear and stress mothers in Nigeria experience when their babies are admitted to NCU.We had two groups of mothers. The first group made up of 21 mothers was taught how to cope with the stress of having a baby in NCU. They were also shown how the various equipment in the NCU work, what the staff in NCU do and what types of things need to be done to help their babies. The second group of 19 mothers received usual care but did not have the extra teaching the first group received. After 2 weeks, we checked the level of depression and stress the mothers in both groups had compared with the level before the first group received the extra teaching.We found that mothers in the first group who received the extra teaching were less stressed about having their babies in the NCU compared with the mothers that did not receive the teaching.

Prevalence of extended beta-lactamase-producing Pseudomonas aeruginosa isolated from human immunodeficiency virus patients in Ibadan, Nigeria

BackgroundThe aim of this study was to determine the occurrence and production of Extended-Spectrum Beta-Lactamases (ESBLs) and Metallo Beta-Lactamases (MBLs) in P. aeruginosa isolated from HIV-infected patients from a hospital in Ibadan, Nigeria using currently available phenotypic tests and real-time PCR of selected reference genes. MethodsThis was a cross sectional study and samples were aseptically collected from consenting HIV infected patients between April and May 2018 at a tertiary hospital in Ibadan, Nigeria. Pseudomonas species were isolated from stool samples using Pseudomonas Base Agar and were identified by standard protocol. Phenotypic detection of ESBL and MBL was carried out using the disk potentiation test. Antibiotics susceptibility testing was done using Kirby-Bauer disk diffusion technique against ceftazidime and cefepime, amoxicillin-clavulanate, aztreonam, trimethoprim, gentamicin, ciprofloxacin and imipenem. Using Real-Time PCR, ESBL and beta-lactamase encoding genes such as blaTEM, blaSHV, AmpC, blaCTX and blaKPC in the ESBL-producing Pseudomonas aeruginosa isolated from the HIV-infected patients stool samples. Data were analyzed using descriptive statistics and chi-square test. ResultsThe Pseudomonas species comprised 95.3% P. aeruginosa and 4.7% P. fluorescens, of which 29.1% produced ESBL, but none produced MBL. All ESBL-producers showed resistance to trimethoprim and ciprofloxacin while, 20.0% were resistant to aztreonam, but none resist imipenem. In the ESBL-producing isolates, AmpC and blaTEM genes were detected while, blaSHV, blaCTX and blaKPC genes were not detected. ConclusionThe ESBL-production was only detected in Pseudomonas aeruginosa isolates out of which only AmpC and blaTEM genes were detected. The ESBL and ESBL genes detection in the Pseudomonas aeruginosa and multidrug-resistant strains portend public health threat among the studied patients. Hence, it is recommended that indiscriminate use of antibiotics among people living with HIV should be discouraged. Secondly, because of the AmpC significance in the provision of high levels of beta-lactams antibiotic resistance, especially the third generation cephalosporins commonly used for treatments, further research is hereby recommended.

Incidence of postpartum urinary retention in a tertiary hospital in Ibadan, Nigeria.

To determine the incidence of postpartum urinary retention (PUR) after vaginal delivery and associated risk factors. A total of 250 women were recruited following vaginal delivery at the UCH, Ibadan. Sociodemographic and obstetrical data were collected using a pro forma. Transabdominal ultrasound scan of the urinary bladder was performed 6hours after delivery to estimate the post-void residual bladder volume (PVRBV) of participants. PVRBV was compared with obstetrical characteristics and labor events. Data collected were analyzed using SPSS 17.0. The level of statistical significance was set at P value less than 0.05. The incidence of PUR was 17.6%. Women with PUR, had longer duration of first stage (591 versus 501minutes; P=0.001), and second stage (50 versus 32minute; P<0.001) of labor compared with those without PUR. There was evidence that augmentation of labor (P<0.01), catheterization during labor (P<0.01), perineal injury (P<0.01), and episiotomy (P<0.01) were associated with developing PUR. Also, women with PUR were more likely to experience storage and obstructive urinary symptoms than those without PUR. Resolution of PUR occurred within 24hours. This study showed that postpartum urinary retention is relatively common following vaginal delivery. Awareness of risk factors will increase index of suspicion especially in women with storage and obstructive symptoms.

Risk factors of heart failure among patients with hypertension attending a tertiary hospital in Ibadan, Nigeria: The RISK-HHF case-control study

AimHypertension is the leading cause of heart failure (HF) in sub-Saharan Africa. Preventive public health approach to reduce the scourge of HF must seek to understand the risk factors of HF in at-risk populations. The aim of this study was to characterize the risk factors of HF among patients with hypertension attending a cardiology clinic.Methods and resultsOne hundred and one (101) case-control age- and sex-matched pairs were recruited. The study population were adults with a clinical diagnosis of hypertensive HF (cases) and individuals with systemic hypertension without HF. They were interviewed and evaluated for cardiovascular risk factors. Associations between variables were tested with chi square test, Fisher’s exact test and independent sample t test as appropriate. Logistic regression modelling was used to determine the independent risk factors of hypertensive HF (HHF) in the study population while ‘punafcc’ package in stata12 was used to calculate the population attributable fraction (PAF) of the risk factors. Suboptimal medication adherence was the strongest adverse risk factor of HHF (medium adherence aOR: 3.53, 95%CI: 1.35–9.25; low adherence aOR: 9.44, 95%CI: 3.41–26.10) with a PAF of 67% followed by dipstick proteinuria (aOR: 4.22, 95%CI: 1.62–11.02; PAF: 34%) and alcohol consumption/day per 10grams (aOR: 1.23, 95%CI: 1.02–1.49; PAF: 22%). The protective risk factors of HHF were use of calcium channel blockers (aOR 0.25, 95%CI: 0.11–0.59; PAF: 59%), then daily fruits and vegetable consumption (aOR 0.41, 95%CI: 0.17–1.01; PAF: 46%), and eGFR (aOR 0.98, 95%CI: 0.96–0.99; PAF: 5.3%).ConclusionsThe risk factors of HHF are amenable to lifestyle and dietary changes. Public health interventions and preventive cardiovascular care to improve medication adherence, promote fruit and vegetable consumption and reduce alcohol consumption among patients with hypertension are recommended. Renoprotection has utility in the prevention of HF among hypertensives.

Spectrum and pattern of distribution of findings in patients with dyspepsia undergoing oesophago-gastro-duodenoscopy at a Tertiary Hospital in Ibadan, south west, Nigeria

ABSTRACT Introduction: Dyspepsia is a symptom complex with varied underlying etiologies. The underlying etiology determines the precise treatment and prognosis though Helicobacter pylori infection plays a central role. The aim of this study was to describe the spectrum and pattern of distribution of findings in patients with dyspepsia undergoing oesophago-gastro-duodenoscopy at the University College Hospital, Ibadan. Methods: A retrospective analysis of computerized database patients with dyspepsia who underwent oesophago-gastro–duodenoscopy from 2015 to 2019. Results: A total of 1,373 procedures were done and dyspepsia was the indication in 736 (53.2%) comprising 317 (43.1%) male and 405 (55%) female (P< .001). The age ranged from 18 to 100 with a mean of 50 ± 15 years. The age group 40–59 years had the highest representation (P = .00). The esophageal mucosa was normal in 592 (80.4%) while 45 (6.1%) and 36 (4.9%) patients had esophagitis and esophageal candidiasis, respectively. In the stomach, 230 (31%) patients had normal mucosa while 433 (57.5%) and 40 (5.4%) patients had gastritis and gastric ulcers, respectively. Antrum was the most commonly involved site by the gastritis and ulcers in 236 (55.8%) and 24 (60%) patients, respectively. The mean age of those with non-ulcer dyspepsia was 49.8 ± 15 while that of those with organic dyspepsia was 55.7 ± 13.7 years (P= .01). Furthermore, there was a significant correlation between the age group and organic dyspepsia (P = .00). The first part of the duodenum was normal in 594 (80.7%) while bulbar duodenitis was seen in 106 (14.4%). Conclusion: In our practice, OGD in patients with dyspepsia is either normal or yielded few abnormalities. The most common abnormalities were gastritis, duodenitis, esophagitis and gastric ulcers. Gastritis and ulcers were antral predominant and gastric ulcers were more common than duodenal ulcers. There was a significant relationship between increasing age and organic dyspepsia.

Development and Validation of a Electrocardiographic Diagnostic Score of Heart Failure Among Patients with Hypertension Attending a Tertiary Hospital in Ibadan, Nigeria: The RISK-HHF Case-Control Study.

ObjectivesHypertension is the leading cause of HF in sub-Saharan Africa. Electrocardiography (ECG) is a cheap and easily available stratification tool for the diagnosis and prognostication of individuals with hypertension. The aim of this study was to develop an ECG-based HF diagnostic score among patients with hypertension attending a specialist cardiology clinic.MethodsOne hundred and one (101) case-control age- and sex-matched pairs were recruited. The study population were adults with a clinical diagnosis of hypertensive HF failure (cases) and systemic hypertension without HF (controls). Participants underwent clinical assessment and ECG. Associations between ECG variables and HF risk were tested with chi square test. Logistic regression modelling (age- and sex adjusted) was trained on a random subset of participants and tested on the remaining participants to determine the ECG abnormalities that are diagnostic of HF and develop a HF diagnostic score. The HF diagnostic score was then validated in an independent dataset of the ECG-Hypertension Audit. Goodness of fit and c-statistics of the HF summed diagnostic score in the training, testing and validation datasets are presented. A two-sided p value of <0.05 was considered statistically significant.ResultsThe independent ECG diagnostic markers of HF among hypertensive patients in this study in decreasing order of effect size were sinus tachycardia (aOR: 7.72, 95% CI: 2.31-25.85). arrhythmia (aOR: 7.14, 95% CI: 2.57-19.86), left ventricular hypertrophy (aOR: 4.47; 1.85-10.77) and conduction abnormality (aOR: 3.41, 95% CI: 1.21-9.65). The HF summed diagnostic score showed excellent calibration and discrimination in the training (Hosmer Lemeshow p = 0.90; c-statistic 0.82; 95% CI 0.76–0.89) and test samples (Hosmer Lemeshow p=0.31; c-statistic 0.73 95% CI 0.60 to 0.87) of the derivation cohort and an independent validation audit cohort (Hosmer Lemeshow p = 0.17; c-statistic 0.79 95% CI 0.74 to 0.84) respectively. The model showed high diagnostic accuracy in individuals with different intermediate pre-test probabilities of HF.ConclusionsA ECG based HF score consisting of sinus tachycardia, arrhythmia, conduction abnormality and left ventricular hypertrophy is diagnostic of HF especially in those with intermediate pre-test probability of HF. This has clinical importance in the stratification of individuals with systemic hypertension.

Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria.

IntroductionOncologic surgical extirpation, the mainstay of loco-regional disease control in breast cancer, is aimed at achieving negative margins and lymph node clearance. Even though axillary lymph nodal metastasis is a critical index of prognostication, establishing the impact of lymph node ratio (LNR) and adequate surgical margins on disease-specific survivorship would be key to achieving longer survival. This study examines the prognostic role of pN (lymph nodes positive for malignancy), LNR and resection margin on breast cancer survival in a tertiary hospital in Ibadan, Nigeria.MethodsWe conducted a longitudinal cohort study of 225 patients with breast carcinoma, documented clinico-pathologic parameters and 5-year follow up outcomes – distant metastasis and survival. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with patients’ survival. The receiver operating characteristic curve was plotted to determine the proportion of metastatic lymph nodes which predicted survival. The survival analysis was done using Kaplan–Meier method.ResultsSixty (26.7%) patients of the patients had positive resection margins, with the most common immuno-histochemical type being Lumina A. 110 (49%) patients had more than 10 axillary lymph nodes harvested. The mean age was 48.6 ± 11.8 years. Tumour size (p = 0.018), histological type (p = 0.015), grade (p = 0.006), resection margin (p = 0.023), number of harvested nodes (p < 0.01), number of metastatic nodes (p < 0.001) and loco-regional recurrence (p < 0.01) are associated with survival. The overall 5-year survival was 65.3%.ConclusionUnfavourable survival outcomes following breast cancer treatment is multifactorial, including the challenges faced in the multimodal treatment protocol received by our patients.

Breast Cancer Knowledge Assessment of Health Workers in Ibadan, Southwest Nigeria.

PURPOSEBreast cancer is the most common cancer among women, and in low- to middle-income countries late-stage diagnosis contributes to significant mortality. Previous research at the University College Hospital, a tertiary hospital in Ibadan, Nigeria, on social factors contributing to late diagnosis revealed that many patients received inappropriate initial treatment.METHODSThe level of breast cancer knowledge among health practitioners at various levels of the health system was assessed. We developed a tool tailored to local needs to assess knowledge of symptoms, risk factors, treatments, and cultural beliefs. The recruitment included doctors, nurses, and pharmacists in public hospitals, physicians and pharmacists in private practice, nurses and health care workers from primary health care centers, community birth attendants, and students in a health care field from state schools.RESULTSA total of 1,061 questionnaires were distributed, and 725 providers responded (68%). Seventy-eight percent were female, and > 90% were Yoruba, the dominant local ethnic group. The majority were Christian, and 18% were Muslim. Median knowledge score was 31 out of 56, and the differences in scores between health care worker types were statistically significant (P < .001). Nearly 60% of the participants believed breast cancer is always deadly. More than 40% of participants believed that keeping money in the bra causes breast cancer, and approximately 10% believed that breast cancer is caused by a spiritual attack.CONCLUSIONOur questionnaire revealed that, even at the tertiary care level, significant gaps in knowledge exist, and knowledge of breast cancer is unacceptably low at the level of community providers. In addition to efforts aimed at strengthening health systems, greater knowledge among community health care workers has the potential to reduce delays in diagnosis for Nigerian patients with breast cancer.

Economic burden of seizure disorders on medication adherence and treatment outcomes of people with epilepsy in a Tertiary Hospital in Ibadan, Nigeria

Introduction: The burden of seizure disorder in relation to adherence and outcome has not then explored in many developing countries.Objective: The study aimed at estimating the economic burden of seizure disorder on the patient and their caregivers.Methods: A Structured and pretested self-administered questionnaire was used to obtain information from the participants. Information was also retrieved from patients’ case notes using a structured data form. Participants’ self-report on medication adherence was assessed using Morisky’s Medication Adherence Scale (MMAS-4). Cost of management (direct cost only) of the disorder was based on patients and families perspective. Data were analyzed with SPSS version 23. Relationship between duration of use of AntiEpileptic Drugs (AEDs) and adherence level was tested using Pearson moment product correlation and p <0.05 considered significant.Results: One third (19, 37.8%) of the patients were diagnosed with mixed seizure. Carbamazepine was the most commonly prescribed medication (60.8%). Only 18 (35.3%) had high adherence to prescribed medication(s) of which 3 (5.9%) had seizure remission for the past one year. Forgetfulness (31; 60.8%) and cost of medication(s) (24, 47.1%) were the most common reason(s) for non-adherence. Medical bill of 34 (66.7%) of the participants were paid by parents and relatives. Average monthly income of employed participants was ₦56,781.2 ($177.4). Average monthly cost of management per patient obtained was ₦11,723.9 ($36.6). The mean cost of AEDs (₦99,061.1±59,569.7) among adherent group was less than and non-adherent group (₦113,546.9±63,301.6). There is a significant negative correlation between years of use of AEDs and medication adherence score (r = - 0.3, p = 0.04).Conclusion: Economy burden of seizure is huge among the participants. Medical bills of more than two-third of them was borne by caregivers while those employed spent one-fifth of their monthly income on the disorder. Treatment outcome was poor due to high level of non-adherence to medication(s) associated with financial constrain. Measure to improve adherence and ease of financial burden among seizure disorder patients is highly essential.Keywords: Seizure disorders, Adherence, Cost, AED, Outcome

Self-reported training needs among physicians in a tertiary institution, Southwest, Nigeria: An application of hennessy-hicks training needs assessment tool

Background: To keep pace with existing as well as emerging public and population health challenges, continuing in-service professional development (CPD) of physicians is paramount. This study assessed the training needs of physicians in a tertiary hospital in Ibadan, South-West, Nigeria. Methods: This study utilized a descriptive cross-sectional design. Three hundred and fifty-five physicians were randomly selected. Data were collected with the aid of the Hennessy-Hicks Training Needs Assessment tool. The instrument has five broad sub-sections: Research/audit, communication/teamwork, clinical tasks, administration, and management/supervisory tasks. In all, these subsections are made up of 30 items with their roles/tasks and were used to assess the training needs of individual study respondents. Charts and proportions were utilized to present the CPD training needs reported by physicians. Mann–Whitney U test was used to examine the difference in training needs between consultants and resident doctors. Results: A larger proportion of the study respondents were middle-aged adults. Respondents' ages were fairly distributed across the varying age brackets. Respondents within the age bracket 35–39 were the highest (30.36%), followed by those within ages 30–34 years (24.09%). With regard to training needs and capacity development, research/audit skills had the highest need (0.83). Furthermore, training that enhances managerial/supervisory skills had a rating of 0.68. Clinical tasks and administration tasks have the same rating (0.63), whereas communication/teamwork had the lowest rating. Consultants expressed higher training needs compared with resident doctors across all task domains. Conclusion: Quest for skills in research had the topmost priority among physicians, and thus, majority were likely to be receptive to training and acquisition of new skills. Future CPD training should reflect the critical needs for performance improvement, as indicated in this study.