University Of Uyo Teaching Hospital Research Articles

Seven-year review of paediatric mortality in the University Of Uyo Teaching Hospital, Uyo, Nigeria

Background: Childhood mortality has become one of the world’s targets for reduction as encapsulated in the Sustainable Development Goals (SDG). Although mortality among children aged younger than 5 years has declined globally in the past two decades, considerable geographical differences exist and remain disproportionately high in sub-Saharan Africa and Southeast Asia. Many hospital-based studies in Nigeria have shown the predominance of infectious diseases such as sepsis, bronchopneumonia, and HIV/AIDS as the leading causes of childhood mortality. Methods: The study was conducted at the Department of Paediatrics of the University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Nigeria. The study was a descriptive, cross-sectional and retrospective review of all the deaths among the hospitalized children from 1st January 2015 to 31st December 2021. Results: A total of 191 deaths in the Paediatrics Department of the University of Uyo Teaching Hospital were recorded, 99 males (51.3%) and 92 females (47.7%). This study shows that 27.00% of children who died where infants, 28.30% were children 1-5 years and 44.50% were children above 5 years. The commonest cause of childhood mortality in this study was severe sepsis (30.00%), followed by HIV/AIDS (11.40%), bronchopneumonia (9.84%). Conclusion: Most of the leading causes of childhood mortality in Nigeria are infectious diseases. These are largely preventable and leave room for improvement in our practice of Infection Prevention and Control (IPC), appropriate community education on hygienic practices and prevention of HIV/AIDS.

Prevalence and determinants of depression among patients attending adult HIV clinic of University of Uyo Teaching Hospital, Uyo, Southern Nigeria

Background: Mental health challenges particularly depression is common among people living with HIV/AIDS and has been largely neglected. This is of great concern because depression is associated with high morbidity among its sufferers. An assessment of depression among PLWHA and its predictors will enhance their quality of life and improve their health outcomes. Aim: To determine the prevalence and determinants of depression among patients attending the adult HIV clinic in University of Uyo Teaching Hospital, Uyo, Nigeria. Method: This was a cross-sectional descriptive study conducted at the adult HIV outpatient clinic of University of Uyo Teaching Hospital Uyo. A total of three hundred and fifty one eligible respondents were recruited over three months. Their levels of perceived social support, depression, HIV stigma and substance abuse were assessed using the Multidimensional Scale of Perceived Social Support (MSPSS), Patient Health Questionnaire 9 (PHQ 9), Internalized AIDS-related Stigma Scale and CAGE questionnaire respectively. Results: The mean age of the respondents was 39.8 ± 10.7 years. Two hundred and sixty six (75.8%) of the respondents were females, while eighty five (24.2%) were males. The overall prevalence of depression was 10%. Majority of respondents had disclosed their status and were experiencing HIV stigmatization representing 84.6% and 95.4% respectively. Most of the respondents (65.8%) had low perceived social support. Depression was found to be statistically associated with unskilled workers (χ2 = 13.08, p = 0.008), unmarried respondents (χ2 = 8.45, p = 0.03), low perceived social support (χ2 = 7.76, p = 0.02), shorter duration of ART use (χ2 = 8.41, p = 0.04), adverse life events (χ2 = 4.05, p = 0.04) and increasing levels of HIV stigma (χ2 = 7.66, p = 0.02) among the study participants. Conclusion: The findings of this study showed that the prevalence of depression in PLWHA was high. Therefore, the screening and prompt treatment of depression in HIV positive persons should be inculcated into their management plan. Furthermore, policies should be made to minimize discrimination and stigmatization of PLWHA in the communities and healthcare systems. Finally, the relevant stakeholders should work in unison to improve the social welfare conditions of HIV infected persons.

Prevalence and pattern of sleep problems among older persons attending a tertiary hospital in Nigeria

Background: Sleep disturbances are common symptoms in adults and are related to various factors, but they are not an inherent part of the ageing process. Objective: To determine the prevalence and pattern of sleep problems among older persons attending the General Out-patient Clinics in a tertiary health-care facility in Uyo, Nigeria. Materials and Methods: This was a hospital-based cross-sectional descriptive study on older persons attending the GOP clinics of the University of Uyo Teaching Hospital. Using a semi-structured interviewer administered questionnaire, information on the sociodemographic characteristics and the sleep history of the respondents were obtained. Data entry and analysis were done using Epi info® version 3.5.1. Results: The prevalence of sleep problems was 64.5% with early awakening being the commonest sleep problem (50.5%) experienced by the respondents. Conclusion: The prevalence of sleep problems is high in this study, and there is need for counselling of older persons on how to improve their sleeping habits.

Ileostomies for severely ill children with ileo-colic intussusception: our experience at the University of Uyo Teaching Hospital

Context: Complicated intussusception is associated with life-threatening intestinal gangrene and peritonitis. In critically ill children, a primary ileocolic anastomosis may increase their morbidity and mortality and, thus, a temporary ileostomy may be a safer option. Objective: The purpose of this study is to report the indications, outcomes, and complications after temporary ileostomies for infants with ileocolic intussusception in our institution. Materials and methods: This was a retrospective study of infants who had ileostomies created in our institution following complicated ileocolic intussusceptions between January 2014 and December 2022. The indications, postoperative complications, duration of hospital stay, and recovery were noted and compared. Results: Thirty-four infants had ileostomies created for complicated ileocolic intussusception during this period. There were 13 girls and 21 boys aged 3-10 months (median = 6 months). The indications for ileostomy were intestinal gangrene, colonic perforation, peritonitis, and haemodynamic instability. Ileostomies were created in the primary surgery in 24 patients while 10 had stomas created as a secondary procedure following an anastomotic dehiscence. Postoperative complications occurred in 25 patients (73.5%). Four children died shortly after surgery from the primary disease, while one child died from re-feeding syndrome. Children who required stoma creation following dehiscence of a primary anastomosis had more complications, a longer hospital stay, and a longer delay in commencing feeds. However, there was no difference in mortality rates or time of stoma closure. Conclusion: Temporary ileostomies could potentially reduce intussusception-related mortality and morbidity, ultimately improving the outcome of very ill infants.

Contraceptive methods continuation and its determinants among acceptors on repeat visits to a Nigerian University Teaching Hospital: a 10-year review

Background: Family planning is a known reproductive health modality for reducing the high maternal mortality in Nigeria. Contraceptive use and continuation is thus necessary to achieve its benefits. The study aimed to determine the contraceptive options and the factors associated with the continuation of contraceptive choices among women on repeat visits. Methods: This was a 10-year retrospective study of the family planning clinic register of all clients who presented for a repeat visit for contraceptive method continuation at the University of Uyo Teaching Hospital. Results: There were 6939 contraceptive acceptors on repeat visits aged between 14 and 50 years (mean 31.6 years, SD 5.4). The majority were 26 to 30 years (32.9%), had secondary education (54.6%), were multiparous (90.9%) and chose the subdermal implant (34.9%) and the intrauterine contraceptive devices (27.7%) for continuation. There was a significant association between the women`s age (Df=3, F=10.81, p<0.0001), their educational status (Df=6, Χ2=38.5583, p<0.0001), their parity (Df= 15, Χ2 =76.8644, p<0.0001) and the contraceptive method continued. Conclusions: An interest in long-acting reversible contraceptives for continuation was found, and this is significantly associated with their sociodemographic and obstetric characteristics; however, we recommend cross-sectional and focus-group inquiries among clients in the different contraceptive-specific categories for further information on the reasons for their choices at subsequent visits.

An Audit of Mortality Pattern in the Neonatology Unit of the University of Uyo Teaching Hospital, Uyo, Nigeria: A Seven-Year Review.

Most neonatal deaths occur in low and middle-income countries (LMICs). These deaths can be prevented through universal access to basic high-quality in-patient health services. Prematurity, neonatal sepsis, and perinatal asphyxia have been reported as the leading causes of in-patient neonatal deaths. This study aimed to assess the trend of neonatal mortality in our hospital, determine the pattern and causes of neonatal mortality, and evaluate the factors associated with neonatal mortality in our facility. This was a retrospective cross-sectional descriptive study conducted in the Special Care Babies Unit (SCBU) and Sick Babies Unit (SBU) of the University of Uyo Teaching Hospital, over seven years (2015-2021). Demographic, clinical, and mortality data was extracted from the case record files of patients into a structured proforma and analysed. There was a total of 228 deaths comprising 130 males (57.02%) and 98 (42.98%) females. The median age at demise was 4.00 (IQR = 1.00 - 12.00) days for both genders. The majority (71.50%) of deaths occurred in the Sick Babies Unit. More males died than females (57% vs 43%). The three leading causes of death were: prematurity (38.60%), neonatal sepsis (38.16%), and birth asphyxia (13.60%). The leading causes of neonatal mortality in our environment are prematurity and neonatal sepsis. There is a need for increased community education on antenatal care, training of traditional birth attendants, improved newborn transportation facilities, and provision of neonatal intensive care facilities.

Occurrence of high level methicillin resistance Staphylococcus aureus in patients from health facilities in Akwa Ibom State, Nigeria

Background: Methicillin resistant S. aureus (MRSA) has become a major public health predicament worldwide. This is owing to its involvement in the evolution of MDR strains and difficulty in therapeutic management of infected patients. This study was conducted to investigate the prevalence of methicillin resistance Staphylococcus aureus among patients in two health facilities in Akwa Ibom State, Nigeria. Materials and Methods: Clinical isolates of patients from University of Uyo Teaching Hospital (UUTH), Uyo and General Hospital, Ikot Abasi (GHIA) were investigated based on the strategic location of the hospitals. The study design was a descriptive cross-sectional study. Three hundred clinical samples were collected from male and female in and out-patients of all ages and processed using standard bacteriological methods. Detection of Staphylococcus aureus and MRSA strains were done according to standard protocols while antibiotic susceptibility testing of MRSA isolates was conducted using Kirby-Bauer disc diffusion method and interpreted following the CLSI 2021 guidelines. Results: The prevalence of MRSA strains in this study was 42.9%. Majority of patients with MRSA were from UUTH (44%) closely followed by patients from GHIA (40%). High antibiotics resistant rates of MRSA were recorded for ampicillin (96.6%), ciprofloxacin (73.3%), erythromycin (63.3%) and cotrimoxazole (60%). Gentamicin and ceftriaxone sensitivity rates were 53.3% and 63.4%, respectively. Conclusion: Health facilities in the state should institute effective antimicrobial stewardship, intensify surveillance and screening of Staphylococcus aureus for MRSA strains to guard against dissemination of multidrug resistant strains in both hospital and community settings because of the clinical implications.

Patients' perceived quality of the care provided during the management of HIV/AIDS in a tertiary care setting in Nigeria.

The provision of patient-centred care by clinicians is believed to improve patient satisfaction with care as well as the outcome of treatment. To assess the quality of personalized care provided to people living with HIV/AIDS in a typical Nigerian health care setting and its association with patients' knowledge and attitude towards HIV/AIDS and patients' knowledge and attitude towards antiretroviral therapy. The study was a cross sectional study carried out in the HIV/AIDS clinic of the University of Uyo Teaching Hospital, Nigeria. Data on the demographic and clinical details of the patients were obtained from patients' case notes using a suitably designed, pre-piloted data collection instrument. Furthermore, data on the quality of patient-centred care, patients' knowledge and attitude towards HIV/AIDS, and patients' knowledge and attitude towards antiretroviral therapy was obtained using 'Patient Assessment of Quality of Individualized care for Chronic Illness Scale', 'Patient knowledge and attitude towards HIV/AIDS questionnaire; and 'Patient knowledge and attitude towards antiretroviral therapy questionnaire', respectively.Quantitative data were analysed using Statistical Program and Service Solutions (SPSS) version 25.0 computer package. Descriptive statistics were used to summarize data, while inferential statistics were used where applicable with statistical significance set at p<0.05. The overall mean patients' satisfaction with individualized care score was 3.54 (SD = ±0.86; Max. = 5). The mean scores of the patients' knowledge and attitude towards HIV/AIDS were 6.80 (SD = ± 1.079; Max. = 8) and 5.5 (SD = ± 0.924; Max. = 7) respectively, while the mean scores of the patients' knowledge and attitude toward antiretroviral therapy were 5.7 (SD = ± 1.103; Max. = 10) and 4.2 (SD = ± 0.874; Max. = 6). Multivariate linear regression revealed that the quality of patient centred care was a predictor of knowledge and attitude towards antiretroviral therapy (B=0.511; CI = 95%, p = 0.024). The quality of patient-centred care provided to persons living with HIV/AIDS in the facility is satisfactory. Patients perceived quality of care appear to be a predictor of knowledge and attitude towards antiretroviral therapy.

Comparative assessment of medication knowledge among ambulatory patients: A cross-sectional study in Nigeria

BackgroundPatient knowledge on medication is considered a critical aspect of medication self-management by the patient. Medication education and counseling is an important component of pharmaceutical care services. ObjectiveThis study was aimed at evaluating the impact of medication education and counseling services offered to ambulatory patients receiving care in a typical Nigerian healthcare setting on the patients' knowledge of their medication. MethodsA cross sectional prospective study conducted at the outpatient pharmacy unit of University of Uyo Teaching Hospital, Nigeria. The patient population was divided into two arms: those who were yet to receive medication education/counseling – Arm 1, and those who had received medication education/counseling from the clinical pharmacist – Arm 2. A patient medication knowledge assessment questionnaire was used to assess patients' knowledge of their prescribed medication. Data obtained were analyzed using the IBM SPSS computer package version 25.0. ResultsThree hundred and ninety-one outpatients (196 in Arm-1 and 195 in Arm-2) participated in the study. There was a statistically significant difference in the mean medication knowledge score between patients in Arm-1 and those in Arm-2. Patients in Arm-2 had a statistically significant higher mean medication knowledge score than those in Arm-1 (5.228 versus 3.191; t = 10.152; P = 0.000). ConclusionOutpatients who received medication education and counseling from clinical pharmacists had better knowledge of their prescribed medications than those who were yet to receive this pharmaceutical intervention.

Hematological Profile Of Hiv/Aids Individuals With Opportunistic Respiratory Mycoses And Immune Status: A Cross Sectional Study In Uyo Nigeria

Hematological abnormalities are strong predictors of morbidity and mortality among HIV infection. This study was aimed to determine hematological indices, abnormalities and the immune status of HIV/AIDS subjects having opportunistic pulmonary mycoses in Uyo, Nigeria. A cross sectional study was adopted using 230 subjects with pulmonary symptoms attending the Anti-retroviral clinics in University of Uyo Teaching Hospital and Saint Luke’s Hosipital, Anua, Akwa Ibom State, Nigeria. The hematological parameters and CD4 counts was determined using blood and sputum was used for mycological examinations. Data was analysed using statistical package for the Social Sciences (SPSS) and was significant at p = 0.05. HIV subjects were more prevalent in female 98(68.89%) than male 56(31.11%). The most commonest fungi was Aspergillus niger (44.76%) and the least was Cryptococcus species (9.00%). The common hematological abnormality was anaemia with 86(86.9%), lymphopenia 33(33.3%) and thrombocytopenia 3(3.0%) among HIV/AIDS subjects with mycoses. The mean CD4 counts was 396.5±31.61 cells/µl (HIV) and 981.7±17.51 cells/µl (control individual). The CD4 counts below 200 cells/μl was observed in 19.4%(35) of AIDS patients. HIV/AIDS subjects with mycoses may develop hematological abnormalities such as anaemia, neutropenia and leucopenia due to low immune status.&#x0D; &#x0D;

Individualized patient care and clinical outcomes in HIV/AIDS management

Objectives: Individualized care has the potential to significantly improve health outcomes in patients with chronic conditions. This study was aimed at evaluating the quality of individualized care and its impact on clinical outcomes in patients with the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) receiving treatment in a resource-limited setting. Materials and Methods: The study was a cross-sectional prospective study carried out in the HIV/AIDS clinic of the University of Uyo Teaching Hospital, Nigeria. Data on the demographic and clinical details of the patients were obtained from patient’s case notes using a suitably designed, pre-piloted data collection instrument. Data on patients’ assessment of the quality of individualized care were obtained using a “Patient Assessment of Quality of Individualized Care for Chronic Illness Scale.” Quantitative data were analyzed using the IBM Statistical Product and Service Solutions version 25.0 computer package. Descriptive statistics was used to summarize data, whereas inferential statistics was used where applicable with statistical significance set at P &lt; 0.05. Results: The overall mean patients’ satisfaction with individualized care score was 3.54 (standard deviation = ±0.86; max. = 5). The majority of the patients (271) had a documented viral load of &lt;50 copies/mL, whereas 27% (109) of the patients had a recently documented CD4 count that was &gt;500 cells/mm3. Bivariate analysis showed that the quality of individualized care was positively correlated with the patients’ CD4 count (r = 0.036; P = 0.657). A negative correlation between the quality of individualized care and the patients’ viral load (r = −0.103; P = 0.177) was also found. Conclusion: Provision of individualized care to patients with HIV/AIDS may improve clinical outcomes. In making therapeutic decisions, clinicians should take into cognizance individual patients’ preferences and needs.

Clinicopathological pattern of breast lesions in children and adolescents.

Breast lesions are not common in children and adolescents. The aim of this study is to retrospectively survey the clinicopathological pattern of breast lesions in children and adolescents in our setting. This is a retrospective study of all breast specimens from children and adolescents that were histopathologically diagnosed in University of Uyo Teaching Hospital. The youngest patients seen were 11 years old, with mean age of 17.1 ± 1.91. The commonest clinical diagnoses were fibroadenoma (n=134, 72.4%). Thirty-five-point seven percent of the patients presented within 6 months of noticing the lump. The mean size of the lumps was 6.2cm ± 3.9. Fibroadenoma was the most common benign diagnosis and the most common histopathologic diagnosis in this study. The mean age of patients with fibroadenoma was 17.15±1.83. The pattern of breast lesions in adolescents in Uyo is similar to that from other parts of Nigeria.

Prevalence and predictors of hepatitis C infection among antenatal attendees in a tertiary hospital in Southern Nigeria.

Hepatitis C virus infection as it specifically relates to pregnancy has been a neglected condition, thus its recognition and treatment in pregnancy is relevant because of the risks of the long-term complications of the infection in the mother, potential effects of the infection on the pregnancy and risk of vertical transmission to the newborn. To determine the proportion of pregnant women with serologic markers of hepatitis C infection, identify risk factors as well as factors that predict the occurrence of the infection in them. Over a 3-week period, blood samples from 456 pregnant women were assessed for antibodies to hepatitis C virus, while a pre-tested questionnaire was used to obtain socio-demographic data and the presence of risk factors in the University of Uyo Teaching Hospital, Nigeria. The prevalence of HCV infection in pregnancy was 4.6%. No known risk factors for HCV infection in pregnancy were identified. Only increasing gestational age was a predictor of HCV infection in pregnancy in the study. The prevalence of hepatitis virus infection among the study population was high. Second trimester and increasing gravidity were protective of the infection in pregnancy. There is therefore need for introduction of general routine screening of all pregnant women presenting for antenatal care.

Predictors of Daily Utilization of Long-Lasting Insecticidal Nets for Malaria Prevention in Pregnancy among Antenatal Care Recipients in Southern Nigeria

Malaria remains a significant public health concern, particularly among pregnant women in sub-Saharan Africa. Long Lasting Insecticidal Nets (LLINs) have been recognized as an effective preventive measure against malaria transmission. However, the utilization of LLINs among pregnant women remains suboptimal. This study aimed to assess the level of daily LLIN utilization and identify its predictors among pregnant women receiving antenatal care in a tertiary healthcare centre in Southern Nigeria. A cross-sectional study was conducted among antenatal recipients at the University of Uyo Teaching Hospital in Uyo, AkwaIbom State. A total of 323 respondents were recruited for the study. Data were collected using a pre-tested semi-structured questionnaire. Multivariable logistic regression analyses were performed to identify predictors of daily LLIN usage. One hundred and twenty seven (39.3%) of the respondents had ever slept inside a LLIN during the index pregnancy, while 22.6% reported daily usage. LLIN ownership was reported by 47.7% of the respondents, highlighting a discrepancy between ownership and consistent use. Predictors of daily LLIN usage included LLIN ownership (aOR 3.83, 95% CI 1.95-7.48), absence of discomfort during LLIN use (aOR 9.33,95%CI 4.32-20.17), non-use of other malaria preventive measures (aOR 3.7,95% CI 11.51-8.93) and presence of mosquitoes in home dwelling (aOR 3.56 95%CI 1.35-9.37). Health education campaigns should emphasize the benefits of daily LLIN usage during pregnancy. Policy interventions are warranted to increase LLIN distribution and availability to pregnant women through antenatal care clinics.

Prevalence of hepatitis B virus infection among antenatal attendees in a university teaching hospital in Southern Nigeria

Objectives: The aim of the study was to determine the prevalence of HBV infection among pregnant women receiving antenatal care at the University of Uyo Teaching Hospital, Nigeria. Material and Methods: This was a cross-sectional study of 291 antenatal attendees over a period of 3 months. Blood samples from all consenting pregnant women were tested for hepatitis B surface antigen (HBsAg) and antibody, hepatitis B envelop antigen and antibody, and hepatitis C antibody serum markers for HBV infection. A structured questionnaire was used to obtain sociodemographic data and the presence of risk factors. Data obtained were analyzed using SPSS, version 17.0. Results: Twenty-three women (7.9%) tested positive for Hepatitis B core antibody, while 6 (2.1%) tested positive for HBsAg. None tested positive for Hepatitis B envelop antigen. Forty-one (14.1%) women showed evidence of post vaccination immunity while 8 (2.8%) had evidence of post-infection immunity. Two hundred and twenty-seven (78.0%) women were susceptible to HBV infection. Higher educational attainment correlated significantly with less risk of acquiring HBV infection (P = 0.003). Conclusion: Our study revealed an intermediate prevalence and low infectivity of HBV infection among our pregnant women. Government and non-governmental organizations should intensify efforts to create awareness about the disease through public enlightenment campaigns, as well as recall systems through systems of mobile communication.

Phenotypic detection of multi-drug resistant MBL-producing Gram-negative bacteria isolated from clinical samples of patients in hospitals in Akwa Ibom State, Nigeria

Metallo-beta-lactamase (MBL)-producing Gram-negative bacteria (GNB) continue to be a bane in the treatment of clinical infections in both community and hospital settings. Prompt detection of multidrug resistant (MDR) strains using antimicrobial susceptibility testing (AST) and MBL detection are vital for therapeutic options. The aim of this study was to determine the prevalence, distribution and antibiotic susceptibility of MDR and MBL-producing GNB from clinical samples in health facilities in Akwa Ibom State. A total of 480 samples comprising wound, urine and blood were collected aseptically from eligible in- and out-patients for the study and GNB were recovered from the samples using standard bacteriological techniques. The identification of isolated GNB, AST and detection of MBL-producing GNB were done using VITEK®2 COMPACT (Biomerieux) automated system, Modified Kirby Bauer disc diffusion method and IMP+EDTA CDT phenotypic method, respectively. Gram-negative bacterial growth was detected in 135 (77.1%.) cases with Escherichia coli (20.7%), Klebsiella pneumoniae (17.8%) and Burkholderia cepacia (14.1%) being the most preponderant isolates. Urine yielded more GNB, 45.2% than other samples. The isolates were sensitive to gentamicin (63%), imipenem (54.8%), and ofloxacin (46.7%) but showed high resistance to sulfamethoxazole-trimethoprim (78.5%), ceftriaxone (74.1%) and aztreonam (66.7%). The overall prevalence of MDR was 60% with the highest recorded in University of Uyo Teaching Hospital (UUTH), 64.8%. The overall prevalence of MBL producers was 39.3% with H. alvei, M. morgannii, P. mirabilis, R. radiobacter and P. aeruginosa being the majority, mostly from urine samples (47.5%) and UUTH health facility (43.7%). All MBL-producing GNB were MDR strains. Seven strains were pan-drug resistant. A combination of robust antibiotic and MBL screening of drug resistant GNB is essential for effective therapeutic decisions. Also, rational use of antibiotics, review of antibiotic usage policies and increased surveillance of MBL-producing GNB is strongly advocated.

Observed and Evaluated Service Quality on Patients Waiting Time of University of UYO Teaching Hospital using Queuing Models

Observed and Evaluated Service Quality on Patients Waiting Time of University of UYO Teaching Hospital using Queuing Models

Standard 12-Core Transrectal Ultrasound-Guided Prostate Biopsy, a Useful Tool in Screening for Prostate Cancer: A Prospective Study in Uyo, Akwa Ibom State, Nigeria

Introduction: Guided prostate biopsy is still relevant in confirming the diagnosis of suspected prostate cancer. Objective: This study evaluated the role of Transrectal Ultrasound (TRUS) guided biopsy along with histopathological evaluation in the detection of prostate cancer on the basis of abnormal digital rectal examination (DRE) findings and elevated prostate specific antigen levels (PSA). Participants and Methods: This prospective study was undertaken among consenting men aged 40 years and above screened for prostate cancer at the University of Uyo Teaching Hospital using targeted, stepwise protocol including DRE, PSA and standard 12-core transrectal ultrasound guided biopsy technique. Biopsy samples were sent for histopathological evaluation. Findings were documented, analyzed and presented in tables and figures. Results: Among 437 participants, abnormal DRE findings, elevated PSA level above 4.0 ng/ml and abnormal TRUS findings were 17.2%, 21.1%, and 17.3% respectively. Of 44 participants who had prostate biopsies with histopathologic assessment, benign prostatic diseases were 24 cases (54.5%), slightly outnumbering malignant prostatic diseases seen in 20 (45.5%).The prostate cancer detection and prevalence rates were 45.5% and 4.6% respectively. Prostatic adenocarcinoma (45.5%), nodular hyperplasia (45.5%), basal cell hyperplasia (6.8%) and high grade prostatic intraepithelial neoplasia (2.2%) were identified histologic subtypes. Nodular hyperplasia was commonly associated with chronic prostatitis (80.0%). A significant association between DRE findings, outline of prostate, and tumour subtype was ascertained. Conclusion: Targeted screening protocol encompassing TRUS guided 12- core biopsy is a final arbiter in the diagnosis of prostate cancer and has a fairly high prostate cancer detection rate of 45.5%.

Discontinuation Patterns Among Women Using Jadelle Contraceptive Devices in a Tertiary Hospital in South-South Nigeria

<i>Introduction</i>: The Jadelle subdermal contraceptive implant is a widely used hormonal contraceptive consisting of two rods, each consisting of a Levonorgestrel-releasing core encased in thin-walled silicon-rubber tubing. Our study examined the prevalence and discontinuation patterns of Jadelle among women in a Southern Nigerian Hospital. <i>Materials and Methods</i>: A review of the discontinuation patterns among Jadelle contraceptive device users in the University of Uyo Teaching Hospital over 3 years was carried out. The Case files of all clients who used Jadelle implant over the period were retrieved and analyzed. <i>Results</i>: Out of 2,980 clients using different contraceptive methods during the study period, 231 clients (7.8%) used the Jadelle implant. Of the 198 (85.7%) case notes available, most (52%) of them were aged 30-34 years, had attained a tertiary level of education (50.4%), and were grand-multiparous (50%). Fifty-six (56.6%) percent of clients used Jadelle for birth spacing while 44.5% used it for limiting family sizes. The most common menstrual pattern at 24 months follow-up was Amenorrhea (50%). Sixty clients (30.3%) discontinued the method for reasons which include the desire for pregnancy (48.3%), side effects (25%), change of method (11.5%), and husbands` view (5%). Discontinuation was more among the younger clients less than 36 years (86.7%). <i>Conclusion</i>: The Jadelle contraceptive device is associated with a number of side effects, however, the major reason for discontinuation was the desire for pregnancy, followed by the complications arising from Jadelle use. There is a need for more detailed client and spousal counseling, especially on the side effects of Jadelle to reduce discontinuation due to them.

Diabetic foot amputations in Nigeria; raising awareness to the burden of diabetic foot syndrome

Background: In recent times, our community has been inundated with an increasing number of amputees and of course an increasing number of people requiring lower limb prosthesis. We have also witnessed a surge in the prevalence of Diabetes, Diabetic Foot Syndrome and Diabetic foot gangrene.&#x0D; Aim: The aim of this study is to highlight the increasing contribution of Diabetic Foot Gangrene to our teaming population of Amputees and to emphasize that this can be ameliorated with definite, multidisciplinary Public Health Strategies aimed at increasing awareness to this ailment as well as early diagnosis and control of Diabetes.&#x0D; Methods: This was a descriptive, quantitative and prospective study of all amputations done at the University of Uyo Teaching Hospital and selected Private Hospitals in Uyo, Niger Delta region of Nigeria which is ongoing.&#x0D; Results: A total of 49 unilateral amputations of either the upper or lower limb were done. They were 21 Males and 28 Females. Patients in the 4th to 6th decades of life who had Diabetic foot gangrene, majority of whom were females were the highest number who underwent amputation 30 (61.2%). Most of the patients 27, out of 30 (90%) were diagnosed as Diabetic for the first time with foot gangrene. There is therefore a strong need to increase the awareness of our society to Diabetes and the negative effects of its complications particularly diabetic foot syndrome and gangrene.&#x0D; Conclusion: Diabetic foot gangrene was the commonest indication for amputation in this series and was responsible for 30 out of 49 (61.2%) amputations.