Seminal fluid parameters of male partners of infertile couples seeking care at the Lagos University Teaching Hospital

Background: Seminal fluid analysis is essential in the evaluation of the male partner of infertile couple. Available data suggest an increase in male-related factors among infertile couples seeking fertility treatment. Seminal fluid analysis performed using standardized methods can identify several causes of male-factor infertility. The latest World Health Organization (2010) guidelines for the laboratory examination and processing of human semen allows for standardization and identification of the possible causes of male-factor infertility. This study aimed to determine the pattern of seminal fluid analysis of male partners of infertile couple presenting to the fertility (gynaecological and urological) clinics of the Lagos University Teaching Hospital (LUTH).Methods: This was a retrospective study of the semen parameters of male partners of infertile couple that were evaluated at LUTH, from January 2018 to December 2019. The medical records of all male partners of infertile couples who had seminal fluid analysis were reviewed and the relevant seminal fluid parameters were collected using a standardized questionnaire.Results: A total of 604 male partners of couples with infertility sought fertility treatment during the study period. Out of the 604, 502 (83.1%) of the participants had complete seminal fluid result and these data were included in final analysis. The mean (SD) age of subjects was 42.1 (7.7) years. About three-quarter (73.1%) of the subjects have abnormal semen parameters. The most frequent semen abnormality was asthenozoospermia (55.8%) followed by oligozoospermia (39.4%).Conclusions: Male factor is still common cause of infertility among infertile couple seeking treatment in our environment

Hysterosalpingography findings of female partners of infertile couple attending fertility clinic at Lagos University Teaching Hospital

Introduction: Hysterosalpingography (HSG) is an outpatient fluoroscopic method for the evaluation of the uterine cavity, fallopian tubes, and the surrounding peritoneal cavity. Female fertility depends greatly on normal female reproductive organs; hence tubal abnormalities may contribute significantly to female infertility. HSG is an invaluable screening tool in the evaluation of women with suspected tubal factor infertility. This study aims to review the HSG findings of women who sought fertility treatment at the Lagos University Teaching Hospital, Lagos (LUTH). Methods: this was a retrospective study of the pattern of HSG findings among female partners of infertile couples seeking fertility treatment at the LUTH, over a 2-year period, from January 2018 to December 2019. Results: a total of 266 medical records and HSG results were reviewed and included in the data analysis. The mean age (± standard deviation) was 38.4 (± 0.3) years with a range of 24 to 50 years. Most (80.5%) of the participants have secondary infertility and majority (65.4%) were nulliparous. Tubal pathology was the commonest abnormality detected on HSG in 54.9% of women. About one-third (30.8%) of women had bilateral tubal occlusion on HSG. With regards to the right fallopian tube, 43.2% of the participants had tubal occlusion, which differs from 41.7% on the left fallopian tube. Similarly, 10.2% of the women had hydrosalpinx on the left tube when compared with 9% on the right tube. Age (OR 1.055; 95% CI: 1.006, 1.106, p-value 0.028), and previous salpingectomy [OR 6.151; 95% CI: 1.335, 28.349] and myomectomy [OR 4.6; 95% CI: 1.814, 11.67] were identified as risk factors for tubal pathologies on HSG. Conclusion: tubal abnormalities are common findings on HSG and the identifiable risk factors for tubal pathologies include age, salpingectomy, and myomectomy. HSG remains a vital screening tool in the evaluation of tubal-factor infertility in Nigeria

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

A rare case of utero-vaginal prolapse seen at third trimester: case report and review of literature

Pelvic organ prolapse (POP) is an infrequent cause of morbidity in pregnancy. We presented a case of stage three uterovaginal prolapse that was first noticed in the third trimester. Management of POP is individualized and its determined by the severity of the symptoms, stage of the prolapse, gestational age, patient’s desire and expertise of the gynaecologist. Different options of management have been proposed ranging from conservative to laparoscopy, hysterectomy in women with no desire for further child bearing. Vaginal delivery is an option; however, most obstetricians opt for elective caesarean section at term.

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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

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