Background: Antenatal care is an important part of safe motherhood and plays a major role in maternal and perinatal mortality and morbidity reduction. Thus early antenatal bookings contribute immensely to good pregnancy outcome. Objective: To ascertain the factors that determine gestational age at booking in Lagos University Teaching Hospital (LUTH) and how these factors affect timing of seeking antenatal care in the hospital. Materials and Methods: A cross-sectional study of 302 consenting consecutive pregnant women attending the antenatal clinic in LUTH from October 2009 to April 2010. Results: The mean age of the women was 31.5 ± 5 years (range 17-46 years) and the mean gestational age at booking was 18.9 ± 7.8 weeks (range 6-40 weeks). The majority of women, booked at 20 completed weeks or less were 185 (61.3%), while 117 (38.7%) booked after 20 completed weeks. The main reason for early booking for most patients was physician referral in 36.8%, while 27.6% perceived benefit by husband, partner or patient was the reason for early booking. The main reason for late booking was late referral from the previous hospitals where they initially booked. Conclusion: Most of the women booked early did so as a result of their doctor's referral due to complications in pregnancy. Late booking was mainly due to late referrals from other hospitals.

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Introduction: Quality of life (QoL) assessment has become an integral component of the assessment of the holistic care of patients with chronic diseases, including sickle cell disease (SCD). Objective: To evaluate the quality of life in patients with SCD managed in our centre. Patients and Methods: Eighty consecutive patients with confirmed hemoglobin SS or SC were recruited. Age and sex-matched volunteers served as controls. Ethical approval was obtained from the Institutional Review Board and all participants gave informed consent. Information on socio-demographic, quality of life and clinical variables, including the presence of complications were recorded in a modified version of the WHO Quality of Life Brief version (WHOQOL-BREF) questionnaire. Data was analyzed using Microsoft Excel and SPSS 17 computer softwares. Descriptive statistics were used to represent socio-demographic variables while the Student t-test was used to explore relationship between the variables and the quality of life domains. Results: Significantly fewer participants with SCD are married compared to their age- and sex-matched controls (P = 0.01). Similarly, participants with SCD scored significantly lower in the physical and psychological domains as well as in overall QoL and general health domains compared to controls (P = 0.001). Avascular necrosis of the femur significantly affected the overall QoL and general health of participants with SCD, respectively while the means of the QoL assessment domains were not significantly different in participants with SCD with and without complications, except in the general health domain (P < 0.001). Conclusion: Avascular necrosis of the femoral head significantly affects overall QoL in participants with SCD.

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Background: The prevalence of diabetes mellitus (DM) among Nigerian adults is increasing. Besides the well-recognized microvascular complications of diabetes, there is also a growing epidemic of macrovascular complications. Patients with diabetes may not only have diabetes-related complications but may also have nondiabetes-related comorbidities. Aim: To determine the pattern of chronic diabetic complications and coexisting morbidities in patients attending the diabetic outpatient clinic of a tertiary health care center in Nigeria and the factors associated with the presence of complications. Materials and Methods: This was a cross-sectional descriptive survey carried out among patients attending the follow-up diabetic clinic of a tertiary health care center in Nigeria over a 3-month period. A systematic random sampling method was used and 422 eligible patients were selected and interviewed using pretested interviewer-administered questionnaires, after written informed consent was obtained. Data were analyzed using  Epi Info statistical package version 3.5.1. developed by Centers for Disease Control and Prevention (CDC) in Atlanta Georgia (USA). Results: Of the 422 patients interviewed, 400 (247 females and 153 males) had complete data for analysis. Eighty-eight patients had comorbidities, and the commonest was hypertension in 63 (71.6%). Out of the 61 patients who had complications, the majority, that is, 39 (63.9%) had eye complications. Factors significantly associated with the presence of diabetic complications were the duration of diabetes, marital status, and the presence of diabetic comorbidities. Conclusion: The frequency of diabetic complications and comorbidities is quite high in the patients studied. There is a need to improve the standard of care of patients and to ensure optimal blood glucose control. This will go a long way in reducing the frequency of complications and comorbidities.

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Introduction: Attendance at antenatal clinics, skilled care at delivery and timely access to postnatal care, immunization, and treatment in case of illness are essential to reducing adverse health outcomes in the community. This survey was conducted to identify the demographic and community members' preferences for health service facility for maternal and child care within the Mushin local government area (LGA). Materials and Methods: This descriptive cross-sectional survey was done among household residents in Mushin, Lagos to determine the healthcare provider preferences of residents for maternal and child services, severe and nonsevere illnesses in adults and children, as well as cases of behavioral illnesses. Results: The survey showed that a third (33%) of respondents expressed a preference for doctors in public health facilities for antenatal care and delivery. For severe childhood illnesses, the preference was for doctors in either private (45.1%) or public (44.1%) health facilities rather than nonphysicians. Regarding severe adult illnesses or behavioral illnesses, respondents preferred doctors in government facilities (48.1% and 59.9%, respectively). The educational level of household heads was positively associated with preference for maternal and child services in accredited health facilities and this association was statistically significant at P < 0.05. Conclusion and Recommendations: In view of the proximity of a tertiary health facility in Mushin LGA, the authors recommend further research into the decision-making dynamics within households in terms of preferences for healthcare provision.

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Background: Intensive Therapeutic Units (ITUs) are unfortunately the epicenters of hospital acquired infection (HAIs). Limited data is available regarding the burden of HAIs in Indian ITU, especially median time of its detection, prevalent organisms and its resistance patterns. We conducted a prospective surveillance aimed to determine the occurrence of device associated infections (DAIs) rate, magnitude of device associated infection cases per 1000 bed days, incidence of infections per 1000 device days and median time for detection of DAIs. Study population was taken from a 25 bedded intensive therapeutic unit (ITU), of a government teaching hospital in India. Methods: A prospective cohort study was performed over two years duration from June 2011 to May 2013. Total 596 patients who were admitted in the ITU for more than 48 hours were followed until discharge. CDC/NNIS system definitions for DAIs were used and rates were calculated. Data were analyzed with descriptive statistics. Results: Cumulative incidence rate of HAIs was 23.15 (138/596) and isolated DAIs was 19.96 (119/596). There was high device utilization mainly for urinary catheter (.838) and IV catheter (.742) than ventilator (.310) but the incidence density was more in ventilator associated infection(VAP-7.38%) than catheter associated urinary tract infection (CAUTI-7.21%) and catheter related blood stream infection (CRBSI-5.37%). Chi-square value for MV(mechanical ventilation) was found 42.59 (<0.001) and ODD Ratio (OR) was 6.8 at CI 3.44-13.67. For urinary catheter(UC) and IVCatheter Chi-square value was 1.13 and 1.94. OR was 1.67 (0.61-4.93) and 4.71 (0.67-94.03). Median time of acquiring VAP, UTI, BSI were maximum in between (9 to 11 days), (17 to 20 days) and (12 to 14) days respectively; indicates requirement of regular follow up of devices within thisZ periods. Major pathogens for VAP Klebsiella (28%), Acinetobacter(26.3%) and Pseudomonus (21%). For CAUTI Staphylococcus aureus (18.7%), pseudomonas and Klebsiella (14.6%) each. CRBSI mainly by gram positive Staphylococcus aureus (24.2%) and Coagulase negative Staphylococcus (12.1%), Acinetobacter (18.2%) and Staphylococcus aureus (15.2%). Conclusion: Although the distribution of pathogens was similar to previous reports, a high rate of device associated infection in ITU can be prevented by regular follow-up of devices, early change of invasive devices within its median time of infection or to avoid unnecessarily prolong use.

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Background: The relationship between infertility and hormonal variations has been variously documented, but little has been reported on the interactions between hormonal factors, homocysteine (Hcy), and female infertility. Objective: This study aimed to evaluate the relationship between plasma Hcy levels and hormonal variations in infertile women. Materials and Methods: This descriptive cross-sectional study was carried out among eligible infertile and fertile women seeking care at the Lagos University Teaching Hospital, Lagos, Nigeria. The subjects were 100 women referred for management of infertility, and the controls were 50 fertile women who had given birth within the past year. Fasting plasma levels of Hcy were estimated using enzyme immunoassay. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, prolactin, and progesterone were measured using  Access 2 (Immunoassay systems-beckman coulter, inc.250S.Kraemer blvd.Brea, ca 92821. U.S.A). Results: Mean plasma Hcy levels for subjects and controls were 9.50 ± 1.88 μmol/L and 9.44 ± 1.85 μmol/L, respectively, with no significant variation (P = 0.952). Plasma Hcy was not significantly associated with infertility and hormone levels. The mean serum levels of LH, FSH, and prolactin were significantly higher among subjects compared to controls. Conclusion: Hormonal variations observed in infertile women did not appear to significantly alter plasma Hcy levels, and hyperhomocysteinemia (HHcy) may not have significantly contributed to female infertility in our environment.

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Aims and objectives: The aim of this study is to determine the plasma levels of the liver enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and lactate dehydrogenase (LDH) in people with metabolic syndrome and to determine the association between the liver enzymes and obesity, insulin resistance, interleukin 6 (IL-6), and C-reactive protein (CRP) in adult Nigerians with metabolic syndrome. Materials and Methods: This was a case control study of 50 adult men and women with metabolic syndrome, and 50 age- and sex-matched males and females without metabolic syndrome. Metabolic syndrome was defined based on the National Cholesterol Education Program (NCEP)-Adult Treatment Panel III (ATPIII) criteria. Written informed consent was obtained from the participants. Sociodemographic and clinical data were collected using a structured questionnaire. Venous blood was collected after an overnight fast. The ethics committee of the Lagos University Teaching Hospital in Lagos, Nigeria, approved the study protocol. Comparison of continuous variables was done using the student's t-test. Regression and correlation analysis were used to determine the associations between variables. Statistical significance was set at P < 0.05. Results: There was a statistically significant increase in the liver enzymes ALP (P = 0.031), ALT (P = 0.019), and GGT (P = 0.037), as well as in the inflammatory markers CRP (P = 0.019) and the cytokine IL-6 (P = 0.040) between the two study groups. ALP and ALT showed significant correlation with waist circumference, BMI, fasting insulin, and waist/hip ratio (P < 0.05). Multivariate regression also identified ALT, AST, and ALP to be associated with IL-6 and CRP (P < 0.05). Conclusion: Liver enzyme levels were increased in metabolic syndrome and associated with obesity, fasting insulin, and CRP. Elevated liver enzymes may indicate dysmetabolism and increased cardiovascular risk in Nigerian adults with metabolic syndrome.

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Background and Objectives: Ultrasound-guided core needle or  tru-cut biopsy is a new concept in breast cancer diagnosis and treatment in developing countries, including Nigeria. A tru-cut biopsy is less invasive surgery, replacing diagnostic surgical biopsies in many institutions. It has a known sensitivity of 94-100%, whether performed with ultrasound or stereotactic guidance. The technique is reliable, simple, reproducible, and relatively cheap. Aims: This is a premier report of ultrasound- guided core biopsy of the breast in Nigeria. This study will evaluate the sampling adequacy and diagnostic accuracy of sonomammographic-guided tru-cut biopsies in determining the nature of a breast lump sent for histopathological analysis. Materials and Methods: A prospective study involving 40 women with clinical suspicion of breast cancer and/or Breast Imaging-Reporting and Data System (BI-RADS) category 3-5 referred for breast imaging at the Department of Radiology of the University College Hospital, Ibadan. Core biopsy was performed with a manual BARD Magnum™ gun, a General Electric GE Logiq P5 ultrasound unit with a high frequency linear transducer. Statistical Package for social sciences [SPSS] Software version 17.0 was used for statistical analysis. Results: Forty core needle biopsies (CNB) were performed on palpable masses. Histopathology confirmed cancer in 24 (60%), while 10 (25%) were benign. Invasive ductal carcinoma accounted for 88% of cancers. Sensitivity and specificity of the core biopsies was found to be 100% and 80%, respectively. Conclusion: Ultrasound-guided biopsy for breast lesion assessment in our center shows high accuracy in determining the nature of a breast lump. Its routine use in countries with limited resources is recommended.

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Background: Hepatitis B vaccine has been available since 1982; it is safe and 95% effective in the prevention of chronic infection in adults and children. People with reasonable exposure to blood and blood products (health workers and those in accident and emergency facilities) ought to be vaccinated against Hepatitis B. Materials and Methods: A descriptive cross-sectional study was carried out among the staff of an accident and emergency facility in Lagos, southwest Nigeria. A pretested, structured, and self-administered questionnaire was used for collection of data on the sociodemographic characteristics and the uptake of hepatitis B vaccination among the respondents. The uptake was based on whether the respondents had received the vaccine, the number of doses received (i.e., whether complete or not), and whether they were undergoing a postvaccination test. The responses on the uptake of hepatitis B vaccination was scored and graded as good (≥50%) and poor (<50%). Results: A total of 84 respondents participated in the study. The majority of them (84.5%) had poor uptake of hepatitis B vaccination and the mean uptake score (%) was 24.2 ± 25.0. Among the respondents, 47 (56.0%) had received at least a dose of the hepatitis B vaccine, 11 (13.1%) received the three complete doses, while only 7 (9.9%) did a postvaccination test to check immune status. Among the 37 respondents who did not receive any dose of the vaccine before the study was carried out, a majority of them (67.6%) cited nonavailability of the vaccine as the reason for this while four (10.8%) cited cost as the reason. Conclusion: The uptake of hepatitis B vaccination among the staff of the accident and emergency facility was poor mainly due to nonavailability of the vaccine. There is, therefore, a need for the government to provide this vaccine and make it available at an affordable cost for workers. In addition, an immunization policy should be put in place at the facility, and implementation and monitoring should be done to ensure that the staff are immunized and protected against the hepatitis B virus (HBV).

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Background: The concept and practice of day case surgery is becoming popular in the developing world due to certain apparent benefits. Effective audit is a valuable aspect of the progress of this practice. This study aims to carry out an audit of our day case surgery experience at the Lagos University Teaching Hospital, Lagos, Nigeria. Patients and Methods: We retrospectively reviewed the data of all general surgery day cases done between January 2011 and December 2013. The data obtained were patients' age, sex, diagnosis, surgeries performed, mode of anesthesia, and readmission rate. Results: A total of 453 day case general surgeries were performed. The age range of the patients was 14-82 years, with a median of 31 years. Local anesthesia was used on all patients. The most commonly performed procedures were excision of breast lumps (n = 267, 58.7%) and herniorrhaphies (n = 108, 23.8%). Other procedures included incisional biopsies (n = 17, 3.8%), lymph node biopsies (n = 13, 2.9%), and excision of lipomas (n = 10, 2.2%). There was no readmission or fatality. Conclusion: Day case surgery on suitably selected patients is practicable and safe in our environment. The provision of dedicated day case surgical units will greatly improve the practice.

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