Challenges of Case Management of COVID-19 in University of Uyo Teaching Hospital: A One-Year Experience

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a global pandemic. Older people and those with poorly controlled co-morbidities have higher risk of mortality. This study was conducted to highlight the clinical features, challenges of management and outcome for the patients we have seen in our centre over the past one year. METHODS: This was a retrospective cross-sectional study involving all patients admitted in the COVID-19 Isolation unit of University of Uyo Teaching Hospital (UUTH) from June, 2020­May, 2021. Clinical and laboratory information were obtained from the patient case notes. Ethical clearance for the conduct of the study was obtained from the Ethics committee, UUTH, Uyo. Data was analysed with STATA version 13. RESULTS: Thirty-three (37.9%) patients were COVID-19 PCR positive. The mean ± SD age of COVID-19 PCR positive patients was 57.3 ± 13.4 years with majority (69.7%) being above 50 years. There was a male preponderance (75%). Eleven (34.4%) patients died while 21(65.6%) were discharged. The highest co-morbidity associated with COVID-19 mortality was diabetes mellitus (7 out of 11; 63.6%). There was a poor uptake of supportive investigations for the management of COVID-19 patients. A raised body temperature (P=0.0006), a low SPO2(0.00004), high respiratory rate (0.0009) on admission and shorter duration of admission (0.0002), were associated with mortality. CONCLUSION: The presence of co-morbidities, fever, low SPO2 and high respiratory rates on admission are associated with increased mortality from COVID-19 disease. A paucity of supportive investigations was a major challenge to COVID-19 management. We therefore recommend the strengthening of our laboratory capacity.

Effect of branched and straight chained alcohols on performance of crude oil demulsifiers

ABSTRACT: Unwanted crude oil emulsions occur in many stages of oil production, transportation, and processing. The huge cost resulting from corrosion of transport system and production facilities, because of the presence of water is a major challenge to the oil industry and the global economy. However, the addition of alcohols to demulsifiers has been reported to enhance their efficiency in removing water from emulsions. There is therefore the need to identify the best type of alcohols and optimize this process of addition. Consequently in this work, the effect of different straight and branched chain alcohols on the performance enhancement of demulsifiers was investigated using four different crude oil emulsion samples. The results showed that straight alcohols performed better when compared to branched chain alcohols under all conditions of temperature. This may be due to their slow mobility particularly in stable emulsions

Contraceptive Practice in a Tertiary Hospital in South-South Nigeria

Background: The high maternal and infant mortality in sub-Saharan Africa has been associated with unplanned pregnancy; high parity and short birth intervals. Use of effective contraceptive methods significantly reduce maternal and infant mortality and improved quality of life. This study determines the contraceptive practice among clients in a tertiary hospital. Method: The record cards of all clients that accepted contraceptive methods in the family planning clinic at the University of Uyo Teaching Hospital; Uyo over a 7-year period were reviewed. Results: There were 1094 new contraceptive acceptors during the study period. The modal age group of the clients was 25 - 34 years (59.3); majority of the clients were multiparous (59.8); christians (99.6) and 71.0had at least secondary school education. The most commonly accepted contraceptive methods were the intrauterine contraceptive device (45.0) and oral contraceptive pills (28.1); while clinic personnel (63.1); and friends and relatives (20.1) were the most common sources of information on contraception. Conclusion: Intrauterine contraceptive device and oral contraceptive pills were the most frequently accepted methods of contraception. We advocate increase in the contraceptive options including implants. The print and electronic media should be more involved in the awareness programs on contraception

A Controlled study of effect of counseling on psychological symptoms among people living with HIV/AIDS in Uyo, Nigeria

Psychological symptoms are common complications of HIV/AIDS. More often; decision making during management neglects the use of counseling; a common but important therapy in people living with HIV/AIDS. The increasing morbidity due to maladjustment to supportive care often results in poor quality of life. The objectives of this study were to determine the effect of counseling in people living with HIV/AIDS and compare the levels of anxiety and depression in them. Four hundred and twenty newly diagnosed persons living with HIV/AIDS referred to the University of Uyo Teaching Hospital in January 2007 were randomly divided into two groups; 1 and 2. Group 1 was instantly assessed for symptoms of anxiety and depression; using the Hospital Anxiety and Depression Scale (HADS); while; Group 2 was assessed one month later after undergoing intensive counseling. A total of 392 respondents; consisting of 210 in group 1 and 182 in group 2 were analyzed; 28 (13.3) respondents in group 2 defaulted from the clinic and were excluded from the study. The sociodemographic characteristics of the respondents in both groups were similar. Majority; 162 (77.1) respondents in group 1 and 137 (58.8) in group 2 aged between 20-49 years. Although; anxiety and depression were markedly reduced in 137 (34.9) and 35 (19.2) respondents in group 2 with counseling compared to 199 (50.8) and 90 (42.8) respondents in group 1 without counseling; the demographic variables of the respondents did not influence the level of anxiety and depression. However; depression was high in 24 (54.9) respondents in group 2 who had counseling and were unemployed; depression was associated with occupation (P0.04). Counseling reduces psychological symptoms in people living with HIV/AIDS. Therefore its use should be encouraged in people living with the disease to boost self-esteem needed for improved quality of life

A review of t the prevalence and rate of utilisation of measures offered to HIV-positive women during delivery in a tertiary hospital in South-South Nigeria

Background: Vertical or mother-to-child transmission of HIV which accounts for over 90 of paediatric HIV infection is increasingly becoming a major mode of transmission in developing countries. Aim: To determine the prevalence of HIV infection among pregnant women that deliver at the University of Uyo Teaching Hospital and also review the interventions they are offered when they present in labour. Methods: The case records of all HIV positive patients who delivered between 1st July 2005 and 31st December 2007 were reviewed. Results: There were 2;851 deliveries out of which 188 patients were HIV positive giving a prevalence of 6.6. The modal age group of the HIV-positive patients was 26-30 years (40.4). Most (68.6) of the patients were multiparous and 89.3of them had regular antenatal care in the hospital. HIV was diagnosed in the antenatal clinic in 71.8of the patients. Most (72.3) of them had a single dose of nevirapine in labour while 5.8received highly active anti-retroviral therapy. About 63.8of the patients had spontaneous vertex delivery while 33.5were delivered by Caesarean section. All the babies had single doses of nevirapine within 72 hours of birth. Most (84.0) of the mothers chose to feed their babies exclusively with breast milk substitutes. There were 3 maternal (1.6) and 16 (8.5) perinatal deaths.Conclusion: The prevalence of HIV infection among women who deliver in our hospital (6.6) is relatively high. The treatment of HIV positive pregnant women in labour with respect to the prevention of mother-to-child transmission fell short of acceptable standards in some of our patients. Efforts should be made to ensure the adoption of anti-retroviral therapy as recommended in the Nigerian national guidelines

Basal and Squamous Cell Carcinomata on the Same Patients: Report of Two Cases in Aibinos

Background: Skin cancer is the most common cancer among the lightly pigmented individuals in Europe; North America and Australia. It occurs infrequently in darkly pigmented individuals because they have more melanin. Melanin and albinism are a known risk factors for skin cancers in Africans. Those already treated for skin cancer run a risk of developing another skin cancer. Method: Two case reports of albinos who developed basal cell carcinoma (BCC) and squamous cell carcinomata (SCC) later are presented. The two female albinos aged 61 and 21 years had BCC and SCC involving the left arm and the dorsum of the left hand in case1 and involving the face and the medial side of the right elbow in case 2. Both patients had numerous actinic keratoses that indicated chronic exposure to sunlight. Results: The outcome was good for the BCC's as the wounds healed post excision. There was no evidence of recurrence when the patients represented with SCC at 12 and 18 months respectively. Conclusion: Albinos run a risk of developing both BCC and SCC with chronic exposure to sunlight. Health education strategies on the need for early institution of preventive measures and follow up are emphasised as they run a risk of developing another cancer

Profile of intrauterine contraceptive device acceptors at the University of Uyo Teaching Hospital, Uyo, Nigeria

Background: Use of modern contraceptive methods has been shown to reduce unwanted pregnancy; high parity and maternal mortality. Intrauterine contraceptive devices which are among the safest and most effective reversible contraceptives available; are particularly suitable for women in developing countries as they are affordable; convenient to use; do not require re-supply visits and are very cost-effective. The aim of this study is to determine the socio-demographic characteristics of intrauterine contraceptive device acceptors; the pattern of insertions and complications at the University of Uyo Teaching hospital; Uyo. Method: The record cards of all clients who had intrauterine contra- ceptive device inserted at the family planning clinic over a six-year period were reviewed. Results: During the study period; there were 852 new contraceptive acceptors out of which 39.7accepted the intrauterine contraceptive device. The modal age group of the clients was 25-29 years (32.5). Acceptance of intrauterine contraceptive device was most common among multiparous clients (65.1). Majority of the acceptors were married (90.0); Christians (98.8) and 72.8had at least secondary school education. Clinic personnel (65.7) and friends/relatives (21.3) were the most common sources of information on contraception. Most (93.5) of the clients had their intrauterine contraceptive devices inserted within 7 days of menstruation. Lower abdominal pain (5.5) and vulval/vaginal itching (5.3) were the most common complications. Conclusion: The acceptors of intrauterine contraceptive devices in our center were young; multiparous and educated women. Increasing mass media involvement in the dissemination of accurate information about intrauterine contraceptive devices to the general populace; the introduction of postpartum and post-abortal intrauterine contraceptive device insertions and the encouragement of our grandmultiparous women to accept intrauterine contraceptive device would lead to an increase in its acceptance and use

Seasonal variation in admission for heart failure, hypertension and stroke in Uyo, south-eastern Nigeria

Background:Seasonal variation in hospitalization for cardiovascular disease has been described in thetemperate regions of the world as well as in Northern Nigeria. Increase admission rates during the coldseasons have been reported in these areas. No studies have been done in Southern Nigeria. This studyis thus aimed at describing the seasonal variation in admissions for heart failure, uncontrolledhypertension and hypertension related-stroke in Southern Nigeria.Methods:Hospital records of patients admitted to the medical wards of the University of Uyo Hospital(UUTH) with heart failure of all causes, uncontrolled hypertension and hypertension­related stroke(Cerebrovascular accident) between January 1998 and December 2001 were used. Epi-Info 2002software was used to analyze data.Results:Of the 3500 patients admitted during the study period 542 (15.3%) were on account of heartfailure, uncontrolled hypertension and hypertension related cerebrovascular accident (CVA). The meanage of patients was 52±12.8 years. The average monthly admission was eleven (11). More admissionswere recorded in the rainy (cold) season than in the dry (hot) season. The observed difference washowever statistically significant only for heart failure and uncontrolled hypertension (P<.05).Conclusion:Admissions for heart failure and uncontrolled hypertension are therefore more during thewet (cold) season in southern Nigeria. This may be attributed to the high default rate to follow up visitin this season when agriculturalactivity is intense and less attention given to medical care. This leads topoor compliance to medications and clinical deterioration. The already bad road network both in ruraland urban centers also become worse at this time making access to medical care difficult. Facilities andmeasures should thus be put in place to provide adequate medical care for these patients during thatperiod of the yea

Kaposi Sarcoma: Changing Trend in Calabar; South Eastern Nigeria

Background/objective: Kaposi sarcoma (KS) is now the most frequently reported malignant skin tumour in some areas of Africa and was endemic in Africa before the advent of the human immunodeficiency virus (HIV) infection. The prevalence has increased with the emergence of HIV infection. The objective of this report is to describe the frequency; current clinical pattern; and anatomic distribution of KS in Calabar; south-eastern Nigeria and compare this with total malignant skin tumour. Method: All the patients with histologic diagnosis of KS presenting to the University of Calabar Teaching Hospital from January 2005 and December 2006 were analyzed as part of the wider study of malignant skin tumorus. Diagnosis of HIV was based upon enzyme linked immunosorbent assay. Results: In our study; there were 11 patients (7 males and 4 females); with a male: female ratio of 1.75: 1. This was the commonest malignant skin tumor (38) followed by squamous cell carcinoma (SCC) (34.5) and the age ranged from 21 - 60 years (mean 42.9years). Nine patients (81.8) were HIV positive including the 4 females (age ranged from 21 -45 years) and 2(18.2) HIV negative; aged 59 and 60years. The lower limb was the commonest site (50). Atypical lesions involved the eyelids/ nose and penis. Conclusion: KS is now the commonest malignant skin tumour in our region with the HIV related KS as the commonest clinical type. Successful prevention and treatment of HIV infection would reduce the prevalence of this tumour

Infertility among Nigerian Couples as seen in Calabar

Objective: This study was conducted to determine the infertility pattern among Nigerian couples in Calabar and to examine the outcome of our management strategies.Methods: A retrospective descriptive design study based on findings from the clinical files of infertile couples presenting at the gynaecology and the male fertility clinics of University of Calabar Teaching Hospital over a five-year period (2001-2005). Data were collected from all the documented clinical and laboratory findings.Results: The obvious causes of infertility constituted 58in females; 30in males and 12in both partners. Primary infertility was found in 69.7of males and 34.5of females and secondary infertility in 30.3of males and 65.5of females. Infection appears to be a strong predisposing factor to infertility in both male and female patients in our study population. Pregnancy was achieved in 24of our female patients who had tubal surgery; while 69of our males who had varicocelectomy had improvement in seminal fluid parameters.Conclusion: Prevention and prompt treatment of infection; particularly the sexually transmitted infections could be beneficial in the reduction of infertility among couples