Multiple uterine fibroids in an 18-year-old: a case report and review of literature

Uterine fibroids are benign monoclonal neoplasms arising from smooth muscle cells in the uterine wall. They are common  gynaecological tumours in women of reproductive age, but, a rare occurrence in adolescence. We present a case of a Nigerian 18-year-old undergraduate with abnormal uterine bleeding and abdominal swelling with a clinical diagnosis of uterine fibroids. She had an open abdominal myomectomy. Histology confirmed uterine fibroids. There is need for medical practitioners to consider this condition as a differential diagnosis especially among this group of women albeit a rare occurrence. Keywords: uterine fibroid, gynaecological tumours, reproductive age, myomectomy, Nigeri

Prognostic performance of pretreatment systemic immune-inflammation index in women with epithelial ovarian cancer

Purpose: This study investigated the prognostic performance of the systemic immune-inflammation index (SII) in patients with epithelial ovarian cancer (EOC) in Lagos, Nigeria. Methods: We performed a secondary analysis of the data of 91 women who had treatment for EOC between 2009 and 2018. The associations between pretreatment SII and survivals were tested. Results: Pretreatment SII more than 610.2 was a significant independent predictor of reduced progression-free survival (HR = 2.68; 95% CI, 1.17 to 6.09) while SII greater than 649.0 was a significant independent predictor of reduced 3-year overall survival (HR = 2.01; 95% CI, 1.01 to 3.99). Conclusion: These findings suggest that high SII may be a potential prognostic indicator and useful marker for more intensive surveillance and design of personalized treatment in patients with EOC

Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial

Purpose We assessed the impact of mHealth on Pap test screening uptake and also determined the factors that affect screening uptake among women in Lagos, Nigeria. Materials and Methods A randomized controlled trial was carried out among women in two tertiary health institutions in Lagos, Nigeria, between July 2020 and March 2021. Participants were randomly assigned to either a text message (mHealth) intervention or usual care arm. The main study outcome was the uptake of Pap smear testing within 6 months of enrollment in the study. We tested the associations between two groups of continuous variables using the unpooled independent-sample t-test (normal distribution) and that of two groups of categorical variables with the chi-square (χ2) test. Using a multinomial logistic regression model, we adjusted for relevant sociodemographic and clinical predictors of uptake of Pap smear screening. Statistical significance was defined as P < .05. Results There was a significantly higher rate of uptake of Pap smear screening among women in the mHealth arm compared with those in the usual care arm (51.0% v 35.7%, P = .031). Following adjustment in the final multivariate model, level of income (odds ratio [OR] = 5.13, 95% CI, 1.55 to 16.95), awareness of Pap smear (OR = 16.26; 95% CI, 2.49 to 76.64), General Outpatient clinic attendance, and introduction of mHealth intervention during follow-up (OR = 4.36; 95% CI, 1.44 to 13.22) were the independent predictors of Pap smear uptake. Conclusion The use of mHealth technologies intervention via short-text message services is a feasible solution for cervical cancer prevention in low- and middle-income countries, and thus, the widespread use of mHealth services by health care providers and policymakers could contribute to the implementation of cervical cancer prevention services in Nigeria and in the settings of other low- and middle-income countries

Ovarian reserve in nigerian women with sickle cell anaemia: a cross- sectional study

Abstract Introduction Sickle cell disease is the most common monogenetic disorder worldwide. There have been reports of endocrine dysfunction and gonadal failure among affected individuals, especially in males. The findings on ovarian reserve and failure in women with sickle anaemia have been inconsistent. Aim and objective The aim of this study was to determine and compare the ovarian reserve of Nigerian women with and without sickle cell anaemia attending a University Teaching Hospital. Study Design This cross-sectional study was carried out at the Adult Sickle Cell Clinic and the Community Health Clinic of the Lagos University Teaching Hospital. Methodology A total of 166 participants who met the selection criteria, were recruited for the study. The study population consisted of two groups of women matched for age: 83 women with HbSS and 83 women with HbAA. The haemoglobin phenotype of each participant was determined on alkaline electrophoresis (pH 8.4) before analysis. Serum Anti-Mullerian Hormone (AMH) was determined using Enzyme-linked immunosorbent assay (ELISA) method (Calbiotech Inc. USA, Catalog no AM448T). Results The mean ± SD of serum AMH level in women with HbSS was 3.64 ± 0.65 ng/mL and was lower than that of women with HbAA 7.35 ±1.19 ng/mL (p < 0.001). Serum AMH negatively correlated with age in both study groups (HbAA and HbSS). Also, a significant negative correlation was found between serum AMH and BMI in women with HbAA. Conclusion The study showed diminished ovarian reserve in women with HbSS when compared to age-matched women with HbAA

Women's knowledge of cervical cancer and uptake of Pap smear testing and the factors influencing it in a Nigerian tertiary hospital

Background: Both the incidence and burden of cervical cancer have been drastically reduced in the developed world, due to the practice of regular cervical cancer screening with Pap smear. Unfortunately, the disease is still the most common gynaecological cancer, and the second leading cause of female cancer mortality in Nigeria, with up to 80% of women with cervical cancer ultimately succumbing to the disease. Objective: We examined the knowledge of cervical cancer and uptake of Pap smear screening among women attending obstetric and gynaecological outpatient clinics at the Lagos University Teaching Hospital in Lagos, Nigeria, and the factors that affect it. Methods: The study was a descriptive cross-sectional study derived from a cohort of 225 pregnant and non-pregnant women using a structured questionnaire to assess their knowledge of cervical cancer, uptake of Pap smear and factors that affect them. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The knowledge of women in this study regarding symptoms and risk factors of cervical cancer was very poor (40.0% and 15.6%, respectively), despite a 78.5% awareness rate. Likewise, the uptake of Pap smear was very low (22.9%), with an awareness rate of 55.1%. The major reasons for having a Pap smear were recommendation from doctors/nurses (89.4%) and fear of developing cervical cancer (23.4%), while the reasons for not having a Pap smear were lack of awareness (53.8%) and non-recommendation of the test by doctors/nurses (31.0%). Prior counseling by doctors/nurses and knowing someone with cervical cancer significantly increased the knowledge of cervical cancer and the uptake of Pap smear, while high level of education was significantly associated only with increased knowledge of cervical cancer and awareness of Pap smear, but not its uptake. Conclusion: Our study indicates that when healthcare providers supply regular health education and recommendation of Pap smear test, this will increase the knowledge of cervical cancer and its screening, and reduce the burden of the disease. Keywords: Knowledge of cervical cancer, Risk factors for cervical cancer, Symptoms of cervical cancer, Uptake of pap smear, Nigeri

Prognostic performance of pretreatment systemic immune-inflammation index in women with epithelial ovarian cancer

Purpose: This study investigated the prognostic performance of the systemic immune-inflammation index (SII) in patients with epithelial ovarian cancer (EOC) in Lagos, Nigeria. Methods: We performed a secondary analysis of the data of 91 women who had treatment for EOC between 2009 and 2018. The associations between pretreatment SII and survivals were tested. Results: Pretreatment SII more than 610.2 was a significant independent predictor of reduced progression-free survival (HR = 2.68; 95% CI, 1.17 to 6.09) while SII greater than 649.0 was a significant independent predictor of reduced 3-year overall survival (HR = 2.01; 95% CI, 1.01 to 3.99). Conclusion: These findings suggest that high SII may be a potential prognostic indicator and useful marker for more intensive surveillance and design of personalized treatment in patients with EOC

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways