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Item Society of obstetrics and gynecologOkapani, A.y of Nigeria – clinical practice guidelines: guidelines for the prevention of cervical cancer(Wolters Kluwer - Medknow, 2019) Ezechi, O. C.; Okusanya, B. O.; Aimakhu, C. O.; Adesina, O. A.; Ohihoin, A. G.; Usman, H. A.; Umeora, O. U.; Akinola, R. I.; Anorlu, R.; Sagay, S. A.; Audu, B.; Fasubaa, O.; Oguntayo, B. A.; Awolude, O. A.; Ezeanochie, M.; Fawole, A.; Ijaiya, M.; Onyebuchi, A.; Dattijo, L.; Osagie, O. E.; Fabanwo, A.; Iketbuson, F.; Fawole, A. O.; Afolabi, B.; Agbogoroma, C.; Sadauki, H.; Okapani, A.; Yakasai, Y.; Muthir, J.; Okonta, P.Clinical practice guidelines have been developed by professional societies globally. Each guideline although based on published scientific evidence reflected each country’s socioeconomic peculiarities and unique medical environment. The Society of Obstetrics and Gynaecology of Nigerian has published guidelines in other clinical areas; however, this is the first edition of practice guidelines for the prevention of cervical cancer. The Guidelines Committee was established in 2015 and decided to develop the first edition of this guideline following Delphi pool conducted among members which selected cervical cancer prevention as the subject that guideline is urgently needed. These guidelines cover strategies for cervical cancer prevention, screening, and management of test results. The committee developed the draft guideline during a 2‑day workshop with technical input from Cochrane Nigeria and Dr. Chris Maske, Lancet Laboratories, South Africa. The recommendations for each specific area were developed by the consensus, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the prevention of cervical cancer.Item Markers of lipid and protein peroxidation among Nigerian university students with dysmenorrhoea(Wolters Kluwer ‑ Medknow, 2018) Orimadegun, B. E.; Awolude, O. A.; Agbedana, E. O.Introduction: Oxidative stress has been associated with primary dysmenorrhea, but studies that have assessed multiple markers of peroxidation are scarce. This study investigated malondialdehyde (MDA), nitrotyrosine (3‑NT), and protein carbonyls (PrCarb) as markers of oxidative stress and antioxidant status by serum alpha tocopherol level in young Nigerian women with dysmenorrhea. Materials and Methods: In a case–control design, 45 female undergraduates who had had regular menses for at least six previous cycles were recruited consecutively from a university clinic as cases and 45 apparently healthy age‑matched counterparts in their hall of residences as controls. Serum levels of MDA, 3‑NT, and PrCarb were determined using standard methods, and the values were compared between cases and controls using Mann–Whitney U‑test and graphs. Results: Study participants’ ages range from 16 to 29 years (mean = 22.0 ± 3.1 years). Serum level of 3‑NT (45.89 ± 37.11 vs 21.27 ± 13.94 ng/mL) and MDA (0.75 ± 0.19 vs 0.45 ± 0.11 nmol/mL) was significantly higher in cases than controls. Plasma alpha tocopherol was significantly lower in cases (7.51 ± 1.95 μmol/L) than controls (8.98 ± 1.95 μmol/L). Conversely, PrCarb levels were not significantly difference between cases and controls. There were significant correlations between alpha tocopherol and 3‑NT (r = −0.285; P = 0.007) and MDA (r = −0.321; P = 0.002), whereas this relationship was not shown with PrCarb (r = −0.073; P = 0.496). Conclusion: Remarkable lipid and protein peroxidation observed in young Nigerian women with dysmenorrhea was accompanied by correspondingly low level of serum alpha tocopherol suggesting potential need for vitamin E supplementation.Item Burden of cytopaenia among HIV positive women at University College Hospital, Ibadan(2018-02) Adesina, O. A.; Fasola, F.; Adekanbi, O.; Ogunbosi, B.; Akinyemi, J.; Kuti, M. A.; Kuti, M. A.; Michael, O.; Fayemiwo, A.; Awolude, O.; Adewole, I.Introduction: Few studies have examined cytopaenia among HIV positive pregnant women. Objectives: To assess burden of cytopaenia among HIV positive pregnant women. Methodology: This cross-sectional study of women on HAART <6months, defined anemia as hematocrit <33%, leucopenia as total white blood cell count <3,000 cells/mm3 and thrombocytopenia as absolute platelet count <100,000 cells/mm3. Univariate and bivariate analyses were performed. Results: Over 8 years, of 1,197 women, the mean age was 29.02(±5.4) years and mean gestational age 25.9(±8.1) weeks. Prevalence of anaemia was 76.8%, leucopaenia 6.9% and thrombocytopenia 4.7%. The mean haematocrit was 28.5%(±4.5); median white blood count 5,500/mm3 ; median platelet count 200,000/mm3 and median CD4 323 cells/mm3. Mean haematocrit was highest (29.7%±5.3) in women in the first trimester but lowest (28.4% ±4.6) in women in second trimester (p=0.04). Compared with earlier trimesters, women in the third trimester had higher median white blood count (5,600 cells/mm3), higher neutrophil (61.0% ±11.2) but lower lymphocytes (28.3%± 9.2) (p=0.18; 0.00, 0.00). Median absolute platelet count was highest (206,000 cells/mm3) in the first trimester but lowest (195,000 cells/mm3) in third trimester (0.04). Women with lower CD4 had higher prevalence of cytopaenias. Conclusion: Cytopaenias are not uncommon in this population especially with lower CD4.Item Invasive cervical cancer in Ibadan: socio-sexual characteristic, clinical stages at presentation, histopathology distributions and HIV status(2019) Awolude, O. A.; Oyerinde, S. O.Background: Human Papillomavirus (HPV) infection persistence is the necessary but not sufficient cause of invasive cervical cancer (ICC). The effects of Human Immunodeficiency Virus (HIV) co-infection have been well documented. The purpose of this study was to describe our experience on the clinico-pathological characteristics of patients with cervical cancer and HIV status at a tertiary Hospital in Nigeria. Materials and Methods: This was a descriptive study among ICC patients presenting for clinical staging and biopsy for histological diagnosis at the Obstetrics and Gynaecology outpatient theatre of our hospital between January 2009 and February 2011. Results: Sixteen (6.8%) of the 248 patients with histologically confirmed ICC in this study were HIV positive. The mean age of all the participants was 55.4 (SD±10.2) years with the HIV positive patients’ younger than the HIV-negative and those that declined HIV testing. Coitarche was at lower age (18 [SD±4.4] vs 22[SD±3.4] years vs 24.5[SD±4.4], respectively). The modal lifetime sexual partners were four, one and two, respectively. Clinically, more HIV positive patients, presented at advanced stage of ≥ 2B. Also, the adenocarcinoma histological variant was slightly more among the HIV positive patients. Conclusion: HIV seemed relatively common among ICC patients and they presented at lower ages, at more advanced stages, earlier coitarche and more lifetime sexual partners. The proportion of adenocarcinoma histological types was slightly higher among the HIV positive patients compared with seronegative patients and those with unknown HIV status. Larger studies to substantiate these findings and ICC-HIV causal relationship are required.Item Serum adiponectin levels in normotensive and pre-eclamptic women at the University College Hospital, Ibadan, Nigeria(College of Medicine, University of Ibadan, Nigeria, 2018) Akinpelu, O. M.; Bello, F. A.; Awolude, O. A.; Adetayo, C. O.; Akinwunmi, B. O.; Odukogbe, A. A.Background: Adiponectin is a hormone produced mainly by adipocytes. The levels of adiponectin are inversely related to insulin resistance, hypertension and obesity. Physiological insulin resistance is exaggerated in pre-eclamptic women. The objective of the present study was therefore to compare serum adiponectin levels in pre-eclamptic patients and normotensive patients. Methods: This prospective study was conducted among one hundred and twenty women. Purposive sampling technique was used to select all consenting participants, consisting of sixty pre-eclamptic patients as cases and sixty normotensive pregnant women at comparable gestational age as control. Concentration of serum adiponectin was measured by using enzyme linked immunosorbent assay (ELISA) method. Results: Serum levels of adiponectin were significantly higher in the pre- eclamptic group(p<0.001). Body mass index was also significantly higher in women with pre eclampsia (p<0.01).In the pre-eclamptic patients, serum levels of adiponectin showed a weak negative correlation with BMI (r= -0.16, p= 0.22) and no correlation was found in normotensive patients. Conclusion: This study showed a clear distinction in the serum adiponectin concentration between preeclamptic and normotensive pregnant women. The impact of BMI on serum adiponectin in both groups also differs. Therefore, serum adiponectin may be useful in predicting pre-eclampsia.Item Cervical cancer worldwide(2018) Vu, M.; Yu, J.; Awolude, O. A.; Chuang, L.Cervical cancer is the forth most common cancer among women globally. The burden faced by low- and middle- income countries is significantly greater than high-income countries. The disparity is a direct result of the differences in resources. Developed nations have organized vaccination and screening programs that have decreased their cervical cancer incidence. More readily available personnel and technology exists to implement appropriate treatment modalities. However, for many underdeveloped nations, the scarcity of resources and infrastructure make such preventative and treatment programs limited or even nonexistent.Item Screen and triage by community extension workers to facilitate screen and treat: task-sharing strategy to achieve universal coverage for cervical cancer screening in Nigeria(2018) Awolude, O. A.; Oyerinde, S. O.; Akinyemi, J. O.Purpose Universal coverage of cervical cancer screening remains elusive in most low- and middle income countries (LMICs), home to the greatest burden of this preventable disease. Implementation of a cytology-based screening strategy in these countries is challenging. Also, there is shortage of health care workers (HCWs) to implement the low-technology, cheaper, but equally effective, methods like visual inspection with acetic acid. However, the implementation of HIV programs in LMICs has introduced the innovation of task shifting and task sharing, using the community health extension workers (CHEWs) and community health officers (CHOs) to complement clinical HCWs, especially at the primary health care, level with good outcome. Hence, this study leveraged this strategy. Methods We piloted a study to improve knowledge and practice skills of CHEWs and CHOs in a rural community of Oyo state, Nigeria, through training and participatory supervision to screen for cervical cancer using visual inspection with acetic acid and link positive cases for treatment with cryotherapy. Results A total of 51 HCWs, including doctors, nurses, CHEWs, and CHOs, were trained during the study to provide cervical cancer screening services. After the training, cervical cancer and its prevention knowledge improved from 52.4% before training to 91.5% immediate after training. Over 12 months, 950 eligible women were screened, of whom 848 (89.3%) were screened by CHEWs and CHOs. Of the 63 rescreened by CHEWs and CHOs (data grouped), and nurses, 88.1% and 92.3%, respectively, agreed with expert team review, with κ statistics of 0.76 and 0.84, respectively. Conclusion This pilot project showed the ability of CHEWs and CHOs to identify cervical dysplasiawas good and that of nurses was very good with appropriate competency training to achieve universal coverage of cervical cancer screening in LMICs.Item Demographic and epidemiological characteristics of HIV opportunistic Infections among older adults in Nigeria(2017) Akinyemi, J. O.; Ogunbosi, B. O.; Fayemiwo, A. S.; Adesina, O. A.; Michael, O.; Kuti, M. A.; Awolude, O. A.; Olaleye, D. O.; Adewole, I. F.Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.Item HCV co-infection is associated with metabolic abnormalities among HAART naïve HIV-infected persons(2017) Kuti, M. A.; Akinyemi, J. O.; Ogunbosi, B. O.; Kuti, K. M.; Adesina, O. A.; Awolude, O. A.; Michael, O. S.; Adewole, I. F.Objectives: To determine the metabolic abnormalities among Hepatitis C Virus (HCV) coinfected HAART naïve HIV infected persons within the adult ARV clinic of the University College Hospital/University of Ibadan, Ibadan, Nigeria Methods: This was a retrospective study involving the review of clinical records of newly recruited HIV-infected persons in the adult antiretroviral (ARV) clinic over a 12month period (January - December 2006). Baseline results for fasting plasma glucose (FPG) and fasting lipid profile were retrieved. Results: Out of the 1,260 HIV infected persons seen during the study period, HCV co-infection was found in 75 (6%) persons. The median values for total cholesterol, LDL-cholesterol and HDLcholesterol were lower in the HCV co-infected persons. HIV-HCV co–infection was associated with a 0.31 mmol/L depression in Total Cholesterol (TC). The median FPG concentration was significantly higher in HIV-HCV co–infected than HIV only infected persons (5.33mmol/L vs. 5.00mmol/L, p = 0.047). However, regression analysis showed there was no relationship between the HIV-HCV coinfected State and fasting glucose levels. Conclusion: HIV-HCV co-infection may be associated with a predictable decline in plasma cholesterol, but FPG may not be sufficient to demonstrate insulin resistance in these persons.Item External genital warts in HIV-infected patients with sexually transmitted infections in Ibadan, Nigeria(2017) Fayemiwo, S. A.; Adesina, O. A.; Akinyemi, J. O.; Michael, O. S.; Adekanmbi, O. A.; Awolude, O. A.; Kuti, M. A.; Odaibo, G. N.; Adewole, I. F.Background: Human Papilloma Virus (HPV) infection in the genital area is usually asymptomatic, and when symptomatic, manifests in cither benign or malignant forms. This study aims at providing information on the prevalence of external genital warts (EGWs) among people living with HIV (PLWHIVs) attending Antiretroviral Treatment (ART) clinic at the University College Hospital. Ibadan, Nigeria. Methods: This is a descriptive cross-sectional survey of PLWHIVs attending ART clinic between January 2006 and December 2007. Diagnosis of genital warts was based on the findings of typical lesions on the external genitalia, vaginal, cervix or perianal region after clinical examination and informed consent from each participant. Antibodies against Herpes and HPV were measured using, Enzyme-linked immunosorbent Assay (ELISA). Results: A total of 5.207 patients, 3519 female and 1688 males attended the ART clinic during the period. The mean age of the patients was 34,67 yrs (± 9.16). Five hundred and forty-two (10.0%) had various sexually transmitted infections (STIs). The prevalence of anogenital warts was 3.65% among the HIV-infected patients and 35.0 % among the subset of HIV- infected patients with STIs. The prevalence of genital warts was 1.5 times higher in treatment experienced patients (OR =1.46; 95%CI: 1.02,2.10). Genital wart was found to be associated with low CD4 count, high viral load, treatment- experience and non-use of condom during sexual intercourse. (P = 0.002). Conclusions: External genital warts are common among people living with HIV infection. According to the appropriate guidelines, HPV vaccine should also be offered to HIV-infectcd adolescents that are non-rcactivc to the virus.