Secondary prevention of cervical cancer by screen-and-treat approach among HIV negative women in Faith Alive Hospital, Jos Nigeria

Background: Cervical cancer is the second most common cancer among women in Nigeria and the leading cause of cancer-related death in sub-Saharan Africa.  In low-income settings, visual inspections with acetic acid (VIA) and Lugol’s iodine (VILI); and subsequent treatment of cervical precancerous lesions with thermal ablation remains the practical approach for secondary prevention. Objectives were to determine prevalence of pre-cancerous cervical lesions, prevalence of suspected cervical cancer, and associated risk factors. Methods: A retrospective study on sexually active HIV negative women aged 16-55 years screened for cervical cancer using VIA/VILI within 16 months period in Faith Alive Hospital Jos.  Data were analyzed using IBM-SPSS 26. Socio-demographic characteristics and screening results were presented in frequency tables; and logistic regression was performed to determine risk factors for cervical pre-cancerous lesions. Results: 1,073 HIV negative women were screened for cervical cancer using VIA/VILI. 82 (7.6%) tested positive, 30 (2.8%) had suspected cancer with modal age distribution of 36-45 years. Higher positivity yield (58.6%) was found in ages between 36 and ≥55 years while the less positivity yield (41.4%) was found ages ≤35 years. Parity ≥3 had 1.8 fold risk association with precancerous lesion. Conclusions: Our study revealed high prevalence of cervical pre-cancerous lesions among HIV negative women, modal age distribution for suspected cancer and parity ≥3 being significant risk factor. Thus, “screen-and-treat” approach to cervical cancer prevention by VIA/VILI and thermal ablation in resource constraint settings should be undertaken until widespread HPV testing to triage clients is possible

Correlation of Level of Serum 25-Hydroxy Vitamin D and Gleason Score as a Measure of Aggressiveness of Prostate Cancer in Black Africans

Background Cancer of the prostate (CaP) is the second most commonly diagnosed cancer worldwide and the sixth leading cause of death from cancer in males. . Black men of African descent have higher risk for developing prostate cancer and are most likely to present at a younger age with more advanced disease and a poorer disease prognosis. Objective To determine if there is a relationship between the level of serum 25 hydroxy vitamin D and aggressiveness of prostate cancer using the Gleason score in black Africans in Jos. Methods A cross sectional study conducted among fifty patients presenting at the urological surgical out-patient clinics of the Jos University Teaching Hospital who were evaluated to have a clinical diagnosis of prostate cancer and scheduled for prostate biopsy. Blood samples for serum 25-hydroxy vitamin D were assayed using the ELISA technique, prostate biopsy was done and only those histologically confirmed to be prostate cancer were analysed. Data was collected using a proforma with statistical analysis done using SPSS(R) version 23 and Spearman’s rank correlation test used with a p-value < 0.05 considered significant. Results Fifty patients with histologically proven prostate cancer was studied whose age ranged from 50-89 years with a predominant age group 70-79 years (70.0±7.9).The mean level of serum 25-hydroxy vitamin D was 37.90ng/ml±17.92. All patients in the study had adenocarcinoma as the histologic type with a mean Gleason score of 9.36±13.14. A Spearman’s rank order correlation was statistically significant (rs (50) = -0.423, p = 0.002). Conclusion A Spearman’s rank order correlation shows a moderate negative correlation between the serum 25- hydroxy vitamin D and Gleason score (rs (50) = -0.423, p = 0.002.Thus, serum 25-hydroxy vitamin D assay can be used to prognosticate in patients with cancer of the prostate

Combining the IADPSG criteria with the WHO diagnostic criteria for gestational diabetes mellitus optimizes predictability of adverse pregnancy outcome

Background: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, yet there are no universally accepted diagnostic criteria for GDM. The International Association of Diabetes in Pregnancy Study Group (IADPSG) and World Health Organization′s (WHO) diagnostic criteria are commonly used criteria, although clinical outcome data of diagnostic performance of these diagnostic criteria are limited. This study examines the IADPSG and WHO criteria for predicting adverse pregnancy outcomes. Materials and Methods: This longitudinal study involved 130 pregnant women who underwent Oral Glucose Tolerance Testing (OGTT) during 24-32 weeks of gestation. Fasting, 1-hour and 2-hour glucose were measured. Participants were classified as GDM and non-GDM women based on the IADPSG and WHO diagnostic criteria. Five pregnancy outcomes were observed, namely, pre-eclampsia, shoulder dystocia or birth injury, birth weight ≥4.0 kg, clinical neonatal hypoglycaemia and birth asphyxia. Results: Twenty-eight participants (21.5%) had GDM by the IADPSG criteria (GDM IADPSG ) and 21 (16.2%) women had GDM by the WHO criteria (GDM WHO ). Only 15 women (11.5%) met the criteria for GDM by both criteria. The association of GDM with macrosomia was stronger in GDM WHO women [Odds ratio (OR) =13.1, 95% confidence interval (CI) = 3.4-50.6] compared to the GDM IADPSG women (OR = 5.3, 95% CI 1.5-18.9). Macrosomia or at least one adverse outcome were more likely in GDM patients who met the diagnostic criteria by both the IADPSG and WHO criteria (P = 0.001). Conclusion: A diagnosis of GDM that meets both the WHO and IADPSG criteria provides stronger prediction for adverse pregnancy outcome than a diagnosis that meets only WHO or IADPSG criteria

Gestational age at booking for Antenatal Care and the pregnancy outcome at Faith Alive Hospital, Jos, Nigeria

Background: Early initiation of antenatal care is believed to improve maternal and foetal outcome. We sought to ascertain gestational age at booking and the outcome of these pregnancies at a faith based hospital in northern Nigeria. Methods: A retrospective descriptive study of patients who booked for antenatal care at the Faith Alive Hospital, Jos, st st Nigeria between 1 January, 2010 to 31 December, 2017 was done. Information regarding demographics, gestational age at booking and outcome of these pregnancies were analyzed. Result: During the study period, 3739 women registered for antenatal care. Majority of women were 20-24years (n= 1252 , 33.5 %) while The mean age was 28 ± 4years Of these women, 96.2% were married , 75.2% were Christians, 43.8% had secondary level of education and 41.2% were traders. st Furthermore, 23.2% of the clients booked in the 1 trimester in 2010, decreased to 17.3% in 2012 but progressively increased to 35.2% , 40.2% and 53.4% in 2014, 2015 and 2017 respectively. There was a significant statistical association between parity, marital status and educational status with late booking for antenatal care. Clients who booked late for antenatal care had poorer neonatal outcomes (low birth weight, still births and birth asphyxia) compared to those who booked early. Conclusion: Late initiation of antenatal care is common in our environment and associated with poorer neonatal outcomes.&nbsp; Nonetheless, a progressive improvement in early bookings was noticed with improved pregnancy outcome. Key Words: Gestational age, booking, pregnancy outcome, Faith Alive, Jo

Cardiovascular disease risk profile in Nigerian school children

>Background: Cardiovascular disease (CVD) is a major cause of death among adults worldwide. It is acknowledged that its risk factors have their roots in childhood. The present study evaluated CVD risk factors in primary school children in a Nigerian peri-urban setting.Methodology: This cross-sectional study was carried out in two primary schools in Jos South local government area, Plateau State, Nigeria. The 241 children studied were chosen using a systematic random sampling technique to select the children from each school. Pretested questionnaire was used to elicit the information on family characteristics and individual characteristics while standard anthropometric and laboratory procedures were used in evaluating the CVD risk factors.Results: Overall, 137 (56.8%) were females (M:F = 0.76), 151 (62.7%) were from the middle class, 59 (24.5%) from lower class while 31 (12.9%) were from the upper class. The overall prevalence of at least one cardiovascular risk factor was 54%. Sedentary lifestyle was the most common CVD risk factor in 32.4% of subjects followed by obesity (13.7%), adverse CVD event in family (11.6%), high low-density cholesterol (10.3%), high total cholesterol (TC) (9.1%), and hypertension (9.1% combine, 7.1% diastolic, and 5.8% systolic). Linear regression analysis showed that body mass index (BMI) for age (β = 0.41, P < 0.001), systolic blood pressure (BP) (β = 0.94, P = 0.03), diastolic BP (β =1.26, P = 0.01), and TC (β = 0.07, P = 0.04) significantly rise with age. BMI for age (P = 0.02) was significantly higher in female subjects compared with their male counterparts.Conclusions: From the findings of the present study, interventions related to modifiable risk factors, such as encouragement of physical exercise and sports in schools, healthy and prudent diet, and weight control programs should be undertaken early in life so as to help control the development of and the epidemic of CVD in later life

Non-technical skills training for Nigerian interprofessional surgical teams: a cross-sectional survey

Abstract Introduction Non-technical skills (NTS) including communication, teamwork, leadership, situational awareness, and decision making, are essential for enhancing surgical safety. Often perceived as tangential soft skills, NTS are many times not included in formal medical education curricula or continuing medical professional development. We aimed to explore exposure of interprofessional teams in North-Central Nigeria to NTS and ascertain perceived facilitators and barriers to interprofessional training in these skills to enhance surgical safety and inform design of a relevant contextualized curriculum. Methods Six health facilities characterised by high surgical volumes in Nigeria’s North-Central geopolitical zone were purposively identified. Federal, state, and private university teaching hospitals, non-teaching public and private hospitals, and a not-for-profit health facility were included. A nineteen-item, web-based, cross-sectional survey was distributed to 71 surgical providers, operating room nurses, and anaesthesia providers by snowball sampling through interprofessional surgical team leads from August to November 2021. Data were analysed using Fisher’s exact test, proportions, and constant comparative methods for free text responses. Results Respondents included 17 anaesthesia providers, 21 perioperative nurses, and 29 surgeons and surgical trainees, with a 95.7% survey completion rate. Over 96% had never heard of any NTS for surgery framework useful for variable resource contexts and only 8% had ever received any form of NTS training. Interprofessional teams identified communication and teamwork as the most deficient personal skills (38, 57%), and as the most needed for surgical team improvement (45, 67%). There was a very high demand for NTS training by all surgical team members (64, 96%). The main motivations for training were expectations of resultant improved patient safety and improved interprofessional team dynamics. Week-long, hybrid training courses (with combined in-person and online components) were the preferred format for delivery of NTS education. Factors that would facilitate attendance included a desire for patient safety and self-improvement, while barriers to attendance were conflicts of time, and training costs. Conclusions Interprofessional surgical teams in the Nigerian context have a high degree of interest in NTS training, and believe it can improve team dynamics, personal performance, and ultimately patient safety. Implementation of NTS training programs should emphasize interprofessional communication and teamworking