Annals of Clinical Sciences

PROCEEDINGS OF THE 8TH BIENNIAL FACULTY DAY AND SCIENTIFIC CONFERENCE OF FACULTY OF CLINICAL SCIENCES, COLLEGE OF MEDICINE, LAGOS STATE UNIVERSITY, IKEJA, LAGOS, NIGERIA, 2023

2024-02-01

PROCEEDINGS OF THE 8^TH BIENNIAL FACULTY DAY AND SCIENTIFIC CONFERENCE OF FACULTY OF CLINICAL SCIENCES, COLLEGE OF MEDICINE, LAGOS STATE UNIVERSITY, IKEJA, LAGOS, NIGERIA, 2023

NEUROFIBROMATOSIS IN PREGNANCY: A CASE REPORT

A. M. Olumodeji — 2024-01-25

This case report presents a 25-year-old primigravida diagnosed with Neurofibromatosis Type 1 (NF1) at 38 weeks gestation. The patient, with a familial history of similar skin lesions, complained of 24-hour liquor drainage and 8-hour labour pains. Clinical examination revealed café au lait spots and increasing cutaneous and subcutaneous NF lesions throughout pregnancy. While cardiovascular and neurosurgical assessments were unremarkable, an obstetric examination indicated a breech presentation. Routine screening identified the patient as hepatitis B-positive. Laboratory investigations showed no major abnormalities except for a breech presentation. A caesarean delivery was performed, resulting in the birth of a live male neonate with genus varus and bilateral talipes equinovarus. The newborn received timely hepatitis B immunoglobulin. The patient was discharged on the fourth postpartum day. This case underscores the challenges and considerations of managing pregnancies complicated by NF1, emphasising the need for multidisciplinary care.

The CHARACTERISTICS OF CONTRACEPTIVE USERS AND SIDE-EFFECTS PATTERN IN A SOUTH-WESTERN NIGERIAN FAMILY PLANNING CLINIC

T. A. Ottun — 2024-01-08

Background: We evaluated the characteristics of women assessing contraception and the pattern of side effects experienced at a family planning clinic in Lagos.

Methods: This was a retrospective descriptive analysis in which records of 1371 clients that accessed contraceptive services at the Family Planning Clinic, Obstetrics and Gynaecology Department, Lagos State University Teaching Hospital over a 4-year period were reviewed. The data obtained were analyzed using relevant descriptive and inferential statistics at a 95% confidence interval and p 0.05 significance.

Results: Of the 1371 clients who accessed the family planning clinic for contraception, about 53% were aged 30 to 39 years, and only one (0.1%) was male. About two-third (65.5%) had tertiary level of education, 56.2% were employed full-time, and 88.7% were multiparous. Intrauterine contraceptive devices were the most commonly used method, being used by 42.5% of women, and followed by sub-dermal implants (41.7%), while the least commonly used methods were mini-pills (0.1%) and vasectomy (0.1%). Chronic hypertension and obesity were the most frequent medical co-morbidities, occurring in 75 (5.5%) and 60 (4.4%) women, respectively. Menorrhagia and irregular menses were the leading reported side effects among contraceptive users, occurring in 0.6% and 0.3% of the women, accounting for 47.1% and 23.5% of reported side effects, respectively. There was a significant relationship between overweight and the side effects of contraceptives among the users (p = 0.043).

Conclusion: Relatively older reproductive-aged women seek contraceptive services at family planning clinics more commonly than younger girls and women, with extremely rare use of these facilities by males. IUDs and sub-dermal implants are the most commonly used long-acting contraceptives, and women who experienced side effects gained more weight than those with no side effects.

A CROSS- SECTIONAL SURVEY OF PERCEPTION, MYTHS AND MISCONCEPTIONS ABOUT COVID- 19 AMONG INTERNET USERS IN LAGOS DURING THE 2020 CORONAVIRUS PANDEMIC

M. R. Akinyinka — 2024-01-08

Background: Coronavirus disease, otherwise known as COVID 2019, is a novel disease first discovered in China in December 2019. There has been an unprecedented rise in the number of cases of this disease since its discovery, and millions have been infected worldwide. Nigeria has also been hard hit by COVID-19, and a lot of rumours and conspiracy theories have been circulated about the disease, which has served to produce myths and misconceptions that are counterproductive towards public health prevention and control methods for the prevention of the disease. This study aimed to assess the perception of COVID-19 and determine the prevalence of COVID-19 myths and misconceptions among the residents of Lagos State.

Methodology: This study was descriptive, cross sectional in design, and made use of a quick online quantitative data collection method. The study population was drawn from adult residents of Lagos State. Respondents were selected via an online convenience sampling method using various social media portals. The questionnaire was self-administered, and data was collected between November 2020 and January 2021. Ethical approval was obtained.

Results: There was a 98.2% response rate as 1,038 respondents accessed the questionnaire but 1,019 completed it, 57.5% of them being females, (51.9%) of the respondents were married and skilled professionals (48.6%). Almost all respondents (95.2%) had heard of COVID-19, with the most commonly known symptom being cough (93.6%). Two-thirds of respondents (66.6%) dispelled the 5G myth; about half (51.9%) knew that staying in high temperatures could not prevent infection, while over a quarter (28%) knew that chloroquine, antibiotics (40.8%), garlic, and ginger (45.5%) were not effective in the treatment and prevention of COVID-19.

Conclusion: Myths about COVID-19 are prevalent among internet users in Lagos. Community education and engagement via online media are recommended to dispel myths and encourage active prevention of the disease.

EVALUATION OF ADVANCED HIV STAGING AND CARDIAC TROPONIN I AS PREDICTORS OF ACQUIRED HEART DISEASES: A PROSPECTIVE CASE CONTROL STUDY OF LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC DYSFUNCTION AMONG CHILDREN IN ILORIN NIGERIA

S. O. Bello — 2024-01-08

Background: Left ventricular dysfunction consists of the systolic and diastolic components. The gold standard for assessing this important cardiac function is echocardiography. The performance of echocardiography is limited by the high cost of the equipment, the technical know-how required, and its affordability, especially in developing countries. This study determined the predictive factors of left ventricular systolic and diastolic dysfunction among children at a tertiary health facility in Ilorin, Nigeria.

Methodology: A prospective case-control study of subjects with left ventricular systolic and/or diastolic dysfunction recruited consecutively through the Paediatric Cardiology Clinic and an equally matched control using echocardiography over a 4-month period. HIV screening was done. Serum cardiac troponin I (cTnI) was assessed, and data was analysed with SPSS^® v 20, presented as tables or graphs. Multivariate logistic regression was done to determine the predictors of left ventricular dysfunction. The predictive performance and accuracy of cTnI were determined by the receiver operating characteristic (ROC) curve. A significant p is < 0.05.

Results: A total of 200 subjects (and controls) were studied. There was a significant association between myocardial injury (raised cTnI) and left ventricular dysfunction (p < 0.001). Most of the subjects with myocardial injuries have left ventricular dysfunction. Raised serum cTnI and the advanced stage of HIV are good predictors of left ventricular dysfunction.

Conclusions: There was a significant association between raised cTnI and left ventricular dysfunction. Immunosuppression and elevated cTnI are predictors of left ventricular dysfunction. Routine screening of children with raised cTnI and advanced HIV for left ventricular dysfunction using echocardiography is recommended.

THE DIRECT MEDICAL COST AND PATTERN OF ANTIDIABETIC THERAPY AMONG PATIENTS MANAGED IN A RESOURCE-POOR SETTING

O. O. Adesoye — 2024-01-25

Background: Diabetes mellitus is a prevalent disease in Sub-Saharan Africa with debilitating effects on health and socio-economic activities. Payment for health services, particularly the medications to manage the ailment, remains challenging and worsens a household's access to care. The study's objectives were to determine the total and mean drug costs of antidiabetic medications and drug prescription patterns among outpatients seeking diabetic care in a tertiary health facility.

Methodology: A cross-sectional study was conducted among 104 respondents using a systematic sampling technique at the endocrinology unit of Delta State University Teaching Hospital, Oghara, from July 14 to November 30, 2022. The monthly expenditures (total and mean) for drug payments were assessed, and the drug prescription pattern was similarly evaluated.

Results: The total and mean costs for antidiabetic medications were N1, 576, 458/$3,608.69, and N7, 436.07/$17.02 per month, respectively, with all (100%) respondents paying out-of-pocket for the drugs prescribed. Biguanides (metformin) 71 (68.2%) was the most prescribed drug among respondents attending the clinic, along with other antidiabetic medications.

Conclusion: The drug cost of treatment for type 2 diabetes mellitus amongst respondents at the facility was high and unsustainable, while everyone paid out-of-pocket, with biguanides being the most prescribed. Health subsidies in alignment with community-based contributory health insurance will help protect the vulnerable financially and improve access to antidiabetic care.

Keywords: Antidiabetic drugs, Medical cost, Prescribing pattern, Type 2 Diabetes Mellitus

ASSESSING MENSTRUAL HYGIENE PRACTICES AND ASSOCIATED FACTORS AMONG GIRLS ATTENDING PUBLIC SECONDARY SCHOOLS IN SOUTHWESTERN NIGERIA

B. I. Adebayo — 2024-02-01

Background: Menstrual hygiene is the practise of using clean materials that can be changed privately, safely, and hygienically to absorb menstrual blood for the duration of bleeding. Good hygiene practises are essential during menstruation to help prevent infections in women and girls. This study aimed at assessing the knowledge of menstrual hygiene among girls in public secondary schools, exploring their menstrual hygiene practises, and identifying major sources of information on menstruation and menstrual hygiene.

Methodology: A mixed-methods research study was employed, comprising quantitative and qualitative methods, involving 928 in-school adolescent girls in state public senior secondary schools (SS1 to SS3) aged between 10 and 19 years. A multistage sampling technique was employed in selecting participants. Quantitative and qualitative data were collected using a pretested self-administered questionnaire and focus group discussions, respectively.

Results: The majority of the respondents, between the ages of 14 and 16 years (62%), were Yoruba (64.1%) and practised Christianity (67.1%), with 83.4% of fathers and 79.7% of mothers having secondary education or higher. Over half of the respondents (55.4%) had poor knowledge of menstruation, while 73 (7.6%) had good knowledge, with the majority of the students (89.5%) obtaining information about menstruation from their mothers or a mother figure. 89.8% of the respondents used sanitary pads, while 73% preferred to take them home for disposal. Factors associated with good knowledge of menstrual hygiene are the class of the respondent, fathers' education, and mothers' education.

Conclusion: The study revealed a high number of the students had poor knowledge of menstruation. There is the need to provide interventions targeted at equipping them with the right information. However, the study reported good menstrual hygiene practises among the students, with the majority revealing they used disposable sanitary pads during menstruation.

REVIEW OF THE PATTERN OF ENDOCRINE ADMISSIONS AT THE EMERGENCY UNIT OF A TERTIARY HOSPITAL

A. O. Dada — 2024-02-01

Background: The medical emergency unit serves as the initial point of contact for individuals with acute medical conditions, including communicable and non-communicable diseases. Non-communicable diseases (NCDs) account for a significant proportion of global deaths, with a paradigm shift from communicable to NCDs. Understanding the patterns of medical admissions, particularly those related to endocrine disorders, is crucial for efficient healthcare delivery.

Methodology: This retrospective study was conducted at Lagos State University Teaching Hospital (LASUTH), Nigeria, focusing on endocrine-related admissions from January to December 2019. Data were collected from medical emergency records, including patient age, sex, and endocrine indication for admission. Statistical analysis was performed using SPSS version 26.

Results: The study included 126 endocrine-related admissions, with an average patient age of 59.5 years. More than 60% of patients were aged 60 or older, and females accounted for 57.9% of admissions. Hyperglycaemia, hypoglycaemia, and diabetes mellitus foot syndrome were the primary indications for admission. Diabetes-related emergencies, particularly hyperglycaemic emergencies, were the most common presentations. Older age groups were more commonly affected, possibly due to associated risk factors. Thyrotoxicosis presents less frequently.

Conclusion: Hyperglycaemic emergencies, notably related to diabetes, were the predominant cause of endocrine-related admissions in the medical emergency unit. This study highlights the importance of effective planning, delivery, and implementation of healthcare services to manage hyperglycaemic emergencies and other endocrine-related conditions in emergency settings. The findings underscore the need for guidelines tailored to the management of these conditions and call for further research to enhance health planning and emergency service delivery.

X-RAY FINDINGS IN DIABETES FOOT MELLITUS SYNDROME

O. A. Adegboyega — 2020-02-01

Background: In 2020, 537 million adults were known to have been affected by diabetes, and one out of every ten individuals has diabetes mellitus. Diabetic foot syndrome is believed to affect 6.3% of individuals worldwide. It is the commonest cause of hospital admission and often leads to limb amputations. Radiology plays an essential role in early diagnosis for effective management and follow-up. Peripheral neuropathy, infections, and micro- and macrovascular pathways are common causes of these DMFS which have high morbidity and mortality rates.

Methodology: A cross-sectional retrospective study spanning two years on 90 adult diabetic patients with foot syndromes in a tertiary health care centre in South West Nigeria analysed demographic information, common sites, comorbidities, and X-ray findings using SPSS 23.0. Non-diabetic patients and those with non-diabetic foot syndrome were excluded.

Results: Most participants were 61–70 years old (34.4%), and 80% had comorbidities. Only 6.7% had a positive family history of DM. 68.9% had no previous trauma before the onset of DMFS. The left foot was the most commonly affected (44.4%). Soft tissue swelling was the most common radiographic finding (15.6%). Calcaneal spurs, gangrene, and cellulitis were also seen in some participants. Osteopenia was a rare finding (1.1%).

Conclusion: X-rays are a good first imaging method, but a comprehensive diagnosis using multiple techniques is necessary for optimal patient care. Clinical evaluation can add value to X-ray imaging. This is important in resource-limited settings where financial constraints or fear of amputation may prevent seeking medical assistance.

THE DYSLIPIDEMIA AMONG PATIENTS WITH THYROID DYSFUNCTION IN AN URBAN TERTIARY HOSPITAL: A CROSSECTIONAL STUDY

A. O. Dada — 2024-02-01

Background: Thyroid disorders are endemic in iodine-deficient areas of the world, including Nigeria, and have been linked to disorders of lipid metabolism. Dyslipidemia has also been directly linked to an increased risk of atherosclerosis and ischemic events. The relationship of dyslipidemia to the various spectrums of thyroid disorders has not been well documented in this environment. This study aims to determine the prevalence and pattern of dyslipidemia among the different spectrums of thyroid disorders and also determine the associated factors.

Methodology: A cross-sectional study of one hundred and thirty-two patients who presented at the endocrinology clinic of Lagos State University Teaching Hospital, Ikeja, with a diagnosis of thyroid dysfunction from December 2022 to June 2023. Their physical and biochemical characteristics, as well as their fasting lipid profile, were measured. Statistical analysis was done using SPSS version 26.

Results: The mean age at presentation was 44.69±17.34 years (range 19-82 years), and the male-to-female ratio was 17:11. Hyperthyroidism, hypothyroidism, and euthyroidism were seen in 48%, 32%, and 11% of the study population, respectively, while subclinical hyperthyroidism and subclinical hypothyroidism each accounted for 5% of the patients. Dyslipidemia was found in 73% of cases of hyperthyroid subjects, 64% of hypothyroid subjects, and 57% of euthyroid subjects, with varying degrees of severity. The severity of dyslipidemia was not significant across the various spectrums of thyroid disorders (p = 0.53).

Conclusion: Dyslipidemia is common among thyroid disorder patients. Routine fasting lipid profile in thyroid dysfunctional states is advocated.