Annals of Clinical Sciences

THE FREE RECTUS FEMORIS MUSCLE FLAP AS A VERSATILE FLAP OPTION FOR LOWER EXTREMITY RECONSTRUCTION

Sun, 07 Jul 2024 00:00:00 +0000

Background: Reconstruction of extensive lower extremity defects, especially those of the distal third of the leg, continues to pose a reconstructive challenge to plastic surgeons. Free flaps have been described as the gold-standard for these reconstructions, with commonly preferred options including the free anterolateral thigh and latissimus dorsi flap. In our experience, the free rectus femoris flap is a good alternative, owing to its technical ease of harvest, satisfactory pedicle length and calibre, and minimal donor site morbidity. We describe our experience with this flap in twenty-one patients.

Methodology: This was a retrospective study conducted in the Departments of Plastic Surgery of the National Orthopaedic Hospital, Igbobi, Lagos; Lagos State University Teaching Hospital, both in Lagos, Nigeria, and National Orthopaedic Hospital, Dala, Kano; over a three-year period, between January 2019 and December 2022. All surgeries had the first author (AOA) as the lead surgeon. Biodata, indication, site of defect, pedicle length and calibre, duration of surgery, recipient vessels and post-operative complication profile were all assessed.

Results: A total of twenty-one patients were included in the study; 18 males and 3 females, with age range of 8 to 54 years. The majority of the defects were post-traumatic (81.8%), followed by post-sequestrectomy defects for osteomyelitis management (13.6%), while post- extirpation of tumours accounted for the least (4.5%). The average duration of flap harvest was 40 minutes, while average duration of entire surgery was 335 minutes. There was full flap survival in 59% and partial flap loss in 27.7%. Complete flap loss was recorded in 18.2% of cases. Donor site complications were minor and included superficial wound infection and hypertrophic scarring.

THE PERCEPTION OF UNDERGRADUATE STUDENTS OF A COLLEGE OF MEDICINE ON THE EFFECTIVENESS OF VIRTUAL TEACHING DURING THE COVID-19 PANDEMIC

Sun, 07 Jul 2024 00:00:00 +0000

Background: The emergence of the SARS-CoV-2 infection in December 2019 led to significant disruption in traditional teaching and learning activities and the adoption of emergency remote teaching (ERT) and virtual platforms globally. This study aimed to determine the perception of students about the effectiveness, advantages, disadvantages, and challenges experienced with online teaching engagement during the COVID-19 pandemic.

Methodology: A web-based survey of the classes via WhatsApp platforms was conducted among undergraduate students enrolled at the Lagos State University College of Medicine for the 2020–2021 academic session. The responses were exported and analysed using SPSS version 26.

Result: A total of four hundred and thirty-one (431) students participated, with an age range of 18–30 years and a mean of 22.1±2.8 years. About two-thirds of the respondents were female, and the majority (66%) enrolled in medicine and surgery degrees. The mean score for the usefulness of online teaching was 4.12 ± 2.37 on a scale of 10. The most common perceived disadvantages of online teaching are being less interactive (46.3%) and boring (38.4%), while the most perceived advantages are the ease of studying at home (47.8%) and its flexibility (46.3%). The most common reasons for non-attendance at the online lecture are financial (204, 59.8%) (Lack of data), followed by poor internet connectivity (177, 57.9%). About 80% of the students experienced poor internet connectivity, 68% were distracted by activities in their homes, and 75% concluded that online teaching did not sufficiently enrich their academic knowledge. Headaches and eye aches were reported as health challenges following online teaching by 102 (30%) and 74 (21.7%), respectively.

Conclusion: This study revealed students' experiences with virtual learning and the barriers to its effectiveness in delivering the curriculum. The faculty and policymakers need to address the issues highlighted by the students to improve student experiences with such engagements.

URIC ACID AND OTHER RISK FACTORS OF CARDIOVASCULAR DISEASES IN HYPERTENSIVE PATIENTS IN SOUTHERN PART OF NIGERIA

Augustine Onovuakpo Eguvbe, Dirisu, Efe — Sun, 07 Jul 2024 00:00:00 +0000

ABSTRACT

Background: There is an increased prevalence of hypertension especially in low and middle-income countries. Hyperuricaemia is linked with an increased risk for hypertension, independent of typical risk factors of hypertension. Also, serum uric acid concentrations have been linked with an increased risk of cardiovascular disease. This study was aimed at evaluating the serum uric acid levels in hypertensive patients and comparing it with other risk factors of cardiovascular disease.

Methodology: This was a hospital-based cross-sectional study carried out between October 2022 and December 2023 at the Delta State Central Hospital, Warri. The study included 200 participants with hypertension and 100 healthy controls.

Results: Uric acid level ranged from 0.08 – 0.58 mmol/L in the hypertensives with a mean of 0.24 ± 0.11 mmol/L. In the controls, the mean value was 0.16 ± 0.07 mmol/L. The difference in mean was statistically significant (p < 0.001). Forty-two (21.0%) of the hypertensives compared to 5 (5.0%) of the controls had hyperuricaemia (p = 0.005). In the hypertensives, uric acid correlated positively with BMI (r = 0.330, p = 0.001) and weight circumference (r = 0.263, p = 0.003). Similarly, in the controls, there was a positive correlation between uric acid level and BMI (r = 0.458, 0.001).

Conclusion: Serum uric acid levels were significantly higher in the hypertensive patients than in the normotensive controls. There was a significant positive correlation between uric acid and BMI and WC in the hypertensive population and a significant positive correlation between uric acid and BMI in the controls.

Keywords: Hypertension. Uric acid, body mass index, estimated glomerular filtration rate, waist circumference.

CAESAREAN SECTION INDICATIONS AND OUTCOMES AT A PUBLIC HOSPITAL IN LAGOS, NIGERIA: A 2-YEAR REVIEW

Sun, 07 Jul 2024 00:00:00 +0000

Background: Caesarean delivery is one of the most commonly performed surgical procedures in obstetrics. This study was conducted to determine the caesarean section rate and indications for caesarean section at the study centre.

Methods: An institutional-based retrospective descriptive study of all caesarean sections with completed data in the case notes using a structured questionnaire to collect data. The Statistical Package for Social Sciences version 22 (SPSS) was used. A two-sided P-value, that is, p < 0.05, was considered statistically significant.

Results: During the study period, there were 4100 deliveries of which 1811 were caesarean sections giving a caesarean section rate of 44%. The commonest indication for primary caesarean section was cephalopelvic disproportion while a previous caesarean section was the commonest for elective caesarean section.

Conclusions: The caesarean section in this study triples the recommended upper limit by the World Health Organisation. Ensuring the woman merit the primary caesarean section, appropriate case selection for VBAC to reduce caesarean section, and good government policy to avoid incessant health care provider industrial action will contribute to the reduction in the caesarean section.

Keywords: caesarean section rate, incidence, indications, Lagos, pregnant women

PREVALENT SKIN DISEASES IN ELDERLY DERMATOLOGY PATIENTS: A RETROSPECTIVE ANALYSIS

Sun, 07 Jul 2024 00:00:00 +0000

Background: The documentation of the spectrum of skin diseases in individuals aged 60 years and over is not readily done despite older individuals accounting for a large percentage of dermatology patients. The study aimed to document the spectrum of skin diseases diagnosed in dermatology patients aged 60 years and over, and to conduct a gender based comparison of diagnoses.

Methodology: This was a retrospective cross-sectional study of 482 patients aged 60 years and over who attended the outpatient dermatology clinic of the Lagos State University Teaching Hospital, between January 2017 and December 2022. Sociodemographic data: age, gender and diagnoses were documented. Diagnoses were coded using the ICD-10 code. Clinical diagnoses were compared between males and females. Data was analyzed using SPSS version 25. Frequency and means are presented. Chi-squared, Fischers’ exact test and the Student‘t’ test were utilized for comparisons and significance. A p-value <0.05 was considered significant for all statistical tests.

Results: Patients aged 60 years and above accounted for 14.4% of the dermatology patients. The population was 43% male with a mean age (± SD) of 38.6 (17.5) and an age range of 60 to 98 years. Non-infectious diseases accounted for 71% of the diagnoses, followed by infectious diseases at 14.9% and tumours at 14.1%. The commonest group of diseases diagnosed were the eczemas and dermatitis (26.8%), papulosquamous diseases (8.5%) and fungal infections (7.7%). On comparison of diagnosis between males and females, autoimmune connective tissue diseases was more in females (p=0.0219) while urticaria and angioedema (p= 0.0379) were significantly more diagnosed in men.

HOW AWARE ARE PATIENT ABOUT THEIR ILLNESS BEFORE PRESENTATION TO A GENERAL OUT-PATIENT CLINIC IN A TERTIARY HOSPITAL IN SOUTH-SOUTH REGION OF NIGERIA

Eguono Marian Ebereghwa , Omonigho Gloria Orhe , Blaise Ebiringa Anyanwu — Sun, 07 Jul 2024 00:00:00 +0000

Background: Background: In recent times, the doctor is no longer the first source of contact for health problems. Health information can be obtained from different sources, which can influence perception of medical knowledge of an individual. The study assessed how aware are patients about their illness before clinical encounter, their preferred sources of health information and the reasons for their choice.

Methodology: A cross sectional study conducted at the Family Medicine Clinic, Delta State University Teaching Hospital, Oghara, Nigeria. Participants, aged 18 years and above were recruited using systematic random sampling method. Interviewer administered questionnaire was used to obtain data. Data was analyzed using Statistical Product and Service Solution version 22.

Results: The study recruited 225 participants with the mean age of 43.42 ± 15.33years, with more females (60.0%) than males (40.0%). Study found that 44.4% had an idea or knew something about their illness prior to consultation and 64.0% got the information from a doctor. Almost all (90.0%) the participants who knew something about their illness indicated that this influenced their decision to visit the health facility, as 72.0% reported better treatment as their reason for hospital visit while 16.9% opted for specialist opinion. Doctors were the most preferred source of health information (48.9%). This was followed by chemist/pharmacist (19.6%), nurse (9.3%) and internet (7.1%). An almost equal proportion of participants indicated easy access (44.8%) and reliable (40.0%) as the reasons for their preferred source of health information.

MULTIPLE INTELLIGENCES AS PROPHYLAXIS AGAINST “JA’PA” SYNDROME: EFFECT OF ENTREPRENEURIAL KNOWLEDGE ON NIGERIA OPTION IN EMERGING WORKFORCE FROM LAGOS STATE UNIVERSITY COLLEGE OF MEDICINE (LASUCOM)

THERESA JOHN, WAIDI AKINGBADE, RAFIU OKUNEYE, OLAWALE OLATEJU — Sun, 07 Jul 2024 00:00:00 +0000

Background: Heath professions entrepreneurship in Nigeria is still too low to cover the vast opportunities of diversified roles in the Nigerian Health Sector that could be areas of job satisfaction and wealth generation for migrating (“ja’pa”) young health professionals (YHPs). Each person can have multiple intelligences and can be strong or weak in particular intelligences. With respect to migration and entrepreneurial intentions, we may improve certain intelligences in emerging workforce through educational intervention.

Purpose: We investigated the effect of Intelligence on Entrepreneurship in graduating YHPs of Lagos State University College of Medicine using indicators of multiple intelligences. The aims were to evaluate the effect of Transformative Knowledge on Entrepreneurial Confidence; the effect of Entrepreneurial Knowledge on Entrepreneurial Confidence; the extent to which Transformative Knowledge affects Nigeria Option; and the extent to which Entrepreneurial Knowledge affects Nigeria Option.

Methodology: A structured 5-point Likert scale questionnaire was used to survey the group of YHPs that completed a 3-day transformative course on entrepreneurship.

Results: Correlation of indicators of Intelligence and Entrepreneurship were positive, moderate to strong, and Pearson’s r(21) ranged from 0.54 to 0.68. Transformative Knowledge significantly contributes towards the variability in Entrepreneurial Confidence and Nigeria Option (36.27% and 29.18 % respectively, p<0.05 in both cases). Entrepreneurial Knowledge significantly (p<0.05) contributes 46.21% and 42.68% to variability in Entrepreneurial Confidence and Nigeria Option respectively. The results reveal a link between education and “ja’pa” syndrome. Transformative Knowledge and Entrepreneurial Knowledge gained through a specialized motivational training on entrepreneurship correlate positively and significantly with both Entrepreneurial Confidence and Nigeria Option.

Conclusion: Transformative entrepreneurial training is related to the option of emerging workforce to stay in Nigeria and may be able to curb excessive brain drain of YHPs. Personal vision and mission should be greater than push or pull factors awaiting the young health professional on graduation.

KNOWLEDGE AND AWARENESS OF DECEASED DONOR KIDNEY TRANSPLANT AMONG TEACHING HOSPITAL STAFF: IMPLICATIONS FOR LAGOS, NIGERIA

Mumuni Amisu, DR SOTUBO S.O, A. Odeyemi, J. Awobusuyi — Sun, 07 Jul 2024 00:00:00 +0000

Background: The scourge of chronic kidney disease (CKD) is alarming and its of significant increasing public health challenge, especially in developing countries. Deceased Kidney transplant (DKT) though not popular, still remains a viable option of treatment. It can reduce the waiting list period for recipients in need of donors. However, there is a palpable gap in knowledge, legal instruments and socio-cultural beliefs which could mitigate against the acceptance of deceased donors in our locals. The study aimed to assess the knowledge and perception of hospital staff about deceased KT. We believe the studied population should have basic knowledge regarding deceased KT. They play a critical role in disseminating awareness to the public about deceased KT in a bid to popularize the practice in our context as most populous African countries.

Methodology: This was a cross-sectional, descriptive study of a teaching hospital staff conducted from November 2023 to February 2024 by applying pretest self-addressed questionnaires, to assess demographic data, knowledge and perceptions of the respondents. The data obtained were analyzed using SPSS version 26 and associations were tested using Pearson's Chi square test while independent predictors of knowledge and perceptions of cadaveric KT were determined by logistic regression.

Results: Two hundred and forty completed electronic questionnaires from the respondents were analyzed. The mean age of respondents was 41.0+/-10.1 with female: male ratio of 2:1. Two hundred and ten (87.5%) knew about brain dead donation while 164 (64.3%) had knowledge about cardiac death donation. Only 176 (74.3%) respondents had strong attitudes towards deceased K.T. Impacts of the cultural and religious beliefs by the respondents were 158 (65.9%) and 192 (80%) respectfully. Forty eight (20%) of the participants were aware of the impending Lagos state legislation on deceased donor KT.

PRIMARY CARE SURGERY IN FAMILY MEDICINE DEPARTMENT LAGOS STATE UNIVERSITY TEACHING HOSPITAL (LASUTH): A 7-YEAR REVIEW OF DAY CASE SURGERIES AND OUTCOMES

Sun, 07 Jul 2024 00:00:00 +0000

Background: The World Health Organization (WHO) has identified the training of Family Physicians (FPs) as critical to meeting the primary care surgery needs of the underserved populations. Many countries including high income ones have reported increased health coverage for patients when FPs are equipped and allowed to perform procedures for common and life-saving medical conditions.

Objective: To review the surgeries performed by the Family Medicine department LASUTH and their outcome over a period of seven years and compare the outcomes with the standard.

Methodology: It was a retrospective review of records of patients who had surgeries and other procedures from 2015 to October 2022. A total of 1001 surgeries and procedures were carried out, however only 953 had the required information for analysis. Analysis was done using SPSS version 25.

Result: Majority of the patients (46.5%) were between the ages of 20-39 years. Over half (56.2%) of the patients were females. Excision biopsy for breast lump was the most common surgery (42.6 %) followed by Herniorrhaphy (29.5%) and Lipoma excision (12.3%). Majority of the histology reports were benign lesions, however there were six masses excised.

Conclusion: The findings from this review reinforces the critical role of family physicians in providing surgical care especially in this era of shortage of surgeons in Nigeria and worldwide. Primary surgery is an essential part of Family Medicine curriculum and its practice should be encouraged to get best outcomes as part of multidisciplinary care.

DETERMINANTS OF BLOOD PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS ATTENDING THE FAMILY MEDICINE CLINIC, LAGOS STATE UNIVERSITY TEACHING HOSPITAL (LASUTH), LAGOS, NIGERIA

Sun, 07 Jul 2024 00:00:00 +0000

Background: Hypertension is one of the most prevalent non-communicable diseases and contributes largely to disability-adjusted life years (DALYs). It is a major cause of cardiovascular disease and premature death worldwide. Several factors have been reported to affect blood pressure control including age, gender, marital status, self-care practices among others. The study aimed to determine the determinants of blood pressure control among hypertensive patients in LASUTH to modify these factors to improve blood pressure control, reduce morbidity, mortality, and improve quality of life.

Methodology: A descriptive hospital-based cross-sectional study was conducted among 407 hypertensive patients. An interviewer-administered questionnaire was used to obtain relevant data.

Results: A total of 407 participants were enrolled in the study. The age range of the participants was 36-86 years. The modal age category of participants was between 61-70 years (39.6%) with a mean age of 65.25+10.7 years. Over three-quarters (76.4%) of the participants were females. About 60% of the respondents (56.8%) had good blood pressure control. The sociodemographic and clinical factors associated with blood pressure control were gender (p=0.045), employment status (p=0.048), number of antihypertensive drugs (p=0.031), and practice of home monitoring of blood pressure (p=0.007). The independent predictors of controlled blood pressure control were gender; (OR- 1.547, P-0.046; 95% CI: 1.034-2.484); employment status; (OR-2.028, P- 0.014; 95% CI: 1.140-3.608), the practice of home blood pressure monitoring; (OR-2.078, p-0.003; 95% CI: 1.277-3.380) and number of antihypertensive drugs; two drugs: (OR-1.886, p-0.026, 95% CI: 1.079-3.297) and one drug: (OR- 2.392 p-0.005; 95% CI:1.298-4.408).