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, 2020-May, 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.

CONTEXTE ET OBJECTIFS: La maladie de coronavirus 2019 (COVID-19) est une pandémie mondiale. Les personnes âgées et celles qui présentent des comorbidités mal contrôlées ont un risque de mortalité plus élevé. Cette étude a été menée pour mettre en évidence les caractéristiques cliniques, les défis de la gestion et le résultat des patients que nous avons vus dans notre centre au cours de la dernière année. MÉTHODES: Il s'agissait d'une étude transversale rétrospective impliquant tous les patients admis dans l'unité d'isolement COVID- 19 de l'University of Uyo Teaching Hospital (UUTH) de juin 2020 à mai 2021. Les informations cliniques et de laboratoire ont été obtenues à partir des notes de cas des patients. L'autorisation éthique pour la réalisation de l'étude a été obtenue auprès du comité d'éthique de l'UUTH, Uyo. Les données ont été analysées avec STATA version 13. RÉSULTATS: Trente-trois (37,9%) patients étaient positifs à la PCR COVID-19. L'âge moyen ± SD des patients positifs au COVID-19 PCR était de 57,3 ± 13,4 ans, la majorité (69,7%) ayant plus de 50 ans. Il y avait une prépondérance masculine (75 %). Onze (34,4 %) patients sont décédés et 21 (65,6 %) sont sortis de l'hôpital. La comorbidité la plus importante associée à la mortalité de COVID-19 était le diabète miletus (7 sur 11 : 63 : 6 %). Les investigations de soutien pour la gestion des patients COVID-19 ont été peu utilisées. Une température corporelle élevée (P=0,0006), une faible SPO2 (0,00004), une fréquence respiratoire élevée (0,0009) à l'admission et une durée d'admission plus courte (0,0002) étaient associées à la mortalité. CONCLUSION: La présence de comorbidités, de fièvre, d'une faible SPO2 et d'une fréquence respiratoire élevée à l'admission est associée à une mortalité accrue de la maladie de COVID-19. Le manque d'investigations de soutien a été un défi majeur pour la gestion de la maladie COVID-19. Nous recommandons donc le renforcement de la capacité de nos laboratoires. Mots clés: COVID-19, défis, gestion des cas, Nigeria.

Etiology and Clinical Evaluation of Patients with Bronchiectasis in a Tertiary Hospital in Nigeria.

BACKGROUND: Bronchiectasis is often considered an orphan disease in developed societies. This may not be the case with low-income countries. Currently there is a paucity of data on the pattern and presentation of this condition in Nigeria. OBJECTIVE: This study was undertaken to determine the frequency and pattern of presentation of bronchiectasis in a tertiary healthcare facility in Uyo, South-South, Nigeria. METHODS: We carried out a three-year prospective study of adult patients aged between 15-85 years diagnosed with bronchiectasis in the University of Uyo Teaching Hospital in Uyo, Nigeria between 2016 and 2019. RESULTS: Eighty-two patients were identified from the clinic register. Out of these, 76 were recruited into the study; made up of 44(57.9%) males and 32 (42.1%) females. The average age of the patients was 49.7 ± 14.1 years. Sixteen (21.1%) of the patients were HIV positive. Forty-four (57.9%) patients had previously been treated for pulmonary tuberculosis. Majority of the patients; 72 (94.7%) had chronic productive cough. Sixty-four (84.2%) had at least one episode of exacerbation within the last 12 months while 36(47.4%) had a severe exacerbation requiring hospitalisation. Hospitalisation was associated with several factors with the strongest contributor being the presence of respiratory distress on physical examination (OR 15.4 p= 0.002). CONCLUSION: Bronchiectasis is not an uncommon disease amongst our patients. A previous history of pulmonary tuberculosis is the commonest associated predisposing medical condition. There is a high rate of exacerbation among these patients with respiratory distress as the strongest predictor of hospitalisation.

CONTEXTE: La bronchectasie est souvent considérée comme une maladie orpheline dans les sociétés développées.Ce n'est peut-être pas le cas dans pays à faible revenu. Actuellement, il y a une pénurie de données sur les caractéristiques et la présentation de cette maladie au Nigeria. OBJECTIF: Cette étude a été entreprise pour déterminer la fréquence et le mode de présentation de la bronchectasie dans un établissement de soins tertiaires à Uyo, dans le sud-sud du Nigeria. MÉTHODES: Nous avons mené une étude prospective sur trois ans auprès de patients adultes âgés de 15 à 85 ans chez qui on a diagnostiqué une bronchectasie dans l'hôpital universitaire d'Uyo, à Uyo, entre 2016 et 2019. Uyo, au Nigeria, entre 2016 et 2019. RÉSULTATS: Quatre-vingt-deux patients ont été identifiés à partir du registre de la clinique registre. Parmi ceux-ci, 76 ont été recrutés dans l'étude ; composés de 44 (57,9 %) hommes et 32 (42,1 %) femmes. L'âge moyen des patients était de 49,7 ± 14,1 ans. Seize (21,1 %) des patients étaient séropositifs. Quarante-quatre (57,9 %) patients avaient déjà été traités pour une tuberculose pulmonaire.La majorité des patients ; 72 (94,7%) avaient une toux productive chronique. Soixante-quatre (84,2 %) ont eu au moins un épisode d'exacerbation au cours des 12 derniers mois, tandis que 36 (47,4 %) ont eu une exacerbation sévère nécessitant une hospitalisation. L'hospitalisation était associée à plusieurs facteurs, le facteur le plus important étant la présence d'une présence d'une détresse respiratoire à l'examen physique (OR 15.4 p= 0.002). CONCLUSION: La bronchectasie n'est pas une maladie rare parmi nos patients. Un antécédent de tuberculose pulmonaire est l'état médical prédisposant le plus fréquent.ll existe un taux élevé d'exacerbation chez ces patients, la détresse respiratoire étant le facteur prédictif le plus fort d'hospitalisation. MOTS CLÉS: Étiologie, Caractéristiques cliniques, Bronchiectasie, Exacerbation, Hospitalisation.

Psychological distress and health-related quality of life among stable patients with bronchiectasis.

BACKGROUND: Bronchiectasis is characterized by chronic symptoms and impaired physical activity. Anxiety and depression usually complicate chronic illness. Thus, underdiagnosis of psychological distress in bronchiectasis may lead to increased morbidity and mortality. AIMS: The aim of this study is to evaluate the impact of physical illness on psychological distress and its association with health-related quality of life (HRQOL). SUBJECTS AND METHODS: This is a cross-sectional study of adults with bronchiectasis. Patients completed a study questionnaire, the hospital anxiety and depression scale and the World Health Organization quality of life brief (WHOQOL-BREF) questionnaire. Physical examination was conducted on all participants. RESULTS: 103 patients were recruited for this study: 54 males (52.4%) and 49 females (47.6%). The average age of the patients was 49.12 ± 14.37 years. The most common predisposing factor for bronchiectasis amongst the patients was previous pulmonary tuberculosis (51 patients, 49.5%). Chronic productive cough, which was reported by 98 of the subjects (95.15%), was the most common symptom. 89 subjects (86.41%) reported episodes of shortness of breath, 82 (79.61%) reported at least one episode of exacerbation, while 52 subjects (50.49%) were hospitalized for bronchiectasis in the previous 12 months. 23 subjects (22.3%) had anxiety and 32 (31.1%) had depression. Anxiety and depression were significantly associated with indicators of severe disease. The subjects recorded low HRQOL scores across all domains. Psychological distress displayed a significant negative association with all the quality-of-life domains except between anxiety and social interaction. CONCLUSION: Symptoms of depression and anxiety are common among patients with bronchiectasis and these symptoms have a negative impact on HRQOL.

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.

Safety Practices and Covid-19 Antibody Positivity among Health Care Workers in a Tertiary Hospital in Southern Nigeria.

INTRODUCTION: The COVID-19 pandemic has surpassed 211 million cases and 4.4 million deaths globally. Seroprevalence among Health care workers (HCWs) ranges from 10.6% (Qatar) to 45.1% in Southwest Nigeria. We surveyed Staff of the University of Uyo Teaching Hospital (UUTH), Uyo - Nigeria to determine the prevalence of IgM and IgG seropositivity, compliance with safety practices and IgG seropositivity risk factors. METHODS: A cross-sectional survey of 180 asymptomatic hospital staff done in July 2020. A 33-item structured questionnaire was completed after informed consent with adequate safety practice defined as ≥75% compliance rate. The COVID-19 IgM/IgG Rapid Test Cassette (Zhejiang Orient-Gene Biotech, China) was used. Statistical analysis was done using SPSS version 20 with p ≤ 0.05 considered significant. Ethical approval was obtained prior to the study. RESULTS: The 166 participants (64.5% female) with valid results had a mean age of 38.8±7.9 years. Twenty five patients were IgM positive (15.1%) while 47 were IgG positive (28.3%). Only hand hygiene was adequate (90.4%) with social distancing and face mask usage inadequate at 55% and 60.2% respectively. Compared to those aged <30years, staff aged 30-39years and 40- 49years had significantly lower odds of IgG positivity (0.01 and 0.02 respectively). Nurses/CHOs and Administrative staff had significantly higher associations with IgG seropositivity compared to Doctors. CONCLUSION: Over a quarter of HCWs in UUTH Nigeria had positive COVD-19 IgG. Safety practices were mostly inadequate with Nurses and Administrative staff having higher risk of IgG seropositivity. Improved compliance with safety practices by hospital staff may reduce prevalence rates. Keywords: Safety practices, COVID-19, antibody positivity, health care worker, Nigeria.

INTRODUCTION: La pandémie de COVID-19 a dépassé les 211 millions de cas et 4,4 millions de décès dans le monde. La séroprévalence parmi les travailleurs de la santé (TS) varie de 10,6% (Qatar) à 45,1% dans le sud-ouest du Nigeria. Nous avons mené une enquête auprès du personnel de l'University of Uyo Teaching Hospital (UUTH), Uyo - Nigeria pour déterminer la prévalence de la séropositivité IgM et IgG, la conformité aux pratiques de sécurité et les facteurs de risque de la séropositivité IgG. MÉTHODES: Une enquête transversale auprès de 180 membres asymptomatiques du personnel hospitalier réalisée en juillet 2020. Un questionnaire structuré de 33 items a été rempli après consentement éclairé, les pratiques de sécurité adéquates étant définies comme un taux de conformité ≥ 75 %. La cassette de test rapide COVID-19 IgM/IgG (Zhejiang Orient-Gene Biotech, Chine) a été utilisée. L'analyse statistique a été réalisée à l'aide de SPSS version 20, avec p ≤ 0,05 considéré comme significatif. L'approbation éthique a été obtenue avant l'étude. RÉSULTATS: Les 166 participants (64,5 % de femmes) ayant des résultats valides avaient un âge moyen de 38,8±7,9 ans. Vingt-cinq patients étaient positifs aux IgM (15,1%) tandis que 47 étaient positifs aux IgG (28,3%). Seule l'hygiène des mains était adéquate (90,4 %), la distance sociale et l'utilisation du masque facial étant inadéquates (55 % et 60,2% respectivement). Par rapport aux personnes âgées de moins de 30 ans, le personnel âgé de 30 à 39 ans et de 40 à 49 ans présentait une probabilité significativement plus faible de positivité aux IgG (0,01 et 0,02 respectivement). Les infirmières/chefs de service et le personnel administratif présentaient des associations significativement plus élevées avec la séropositivité IgG par rapport aux médecins. CONCLUSION: Plus d'un quart du personnel soignant de l'UUTH Nigeria présentait des IgG positives au COVD-19. Les pratiques de sécurité étaient généralement inadéquates, les infirmières et le personnel administratif présentant un risque plus élevé de séropositivité aux IgG. Un meilleur respect des pratiques de sécurité par le personnel hospitalier pourrait réduire les taux de prévalence. MOTS CLÉS: Pratiques de sécurité, COVID-19, positivité des anticorps, personnel de santé, Nigeria.

Comparability of serum creatinine-Based glomerular filtration rate equations in West African adult communities.

BACKGROUND: The clinical diagnosis of chronic kidney disease (CKD) is based on estimated glomerular filtration rate (GFR) using serum creatinine-based equations. Many formulas are used in estimating GFR. OBJECTIVES: We set out to determine the degree of agreement between the Cockcroft-Gault (CG), 4-variable Modification of diet in renal disease (MDRD). Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in our indigenous population. PATIENTS AND METHODS: Adult participants were recruited across all sectors of life, education, and occupation. Blood pressure, fasting blood glucose, lipid profile, urinalysis, serum creatinine, and anthropometry were measured. Estimated GFR (eGFR) was computed using CG, MDRD, and CKD-EPI equations with and without the race factor. The Lin's concordance index (rho_c) and Bland-Altman analysis were used to determine the degree of agreement between various pairs of creatinine-based eGFR equations [MDRD with the race factor (MDRDw)]; MDRD without the race factor (MDRD); CKD-EPI with race factor (CKD-EPIw); CKD-EPI without the race factor (CKD-EPI), and the CG equation. RESULTS: Two hundred and sixty-one adults, mean age 47.5 ± 9.9 years, 45.2% females participated in the study. Hypertension prevalence in the study population was 41.4 (95% CI 35.3-47.6%) while diabetes mellitus was 8.1% (95% CI 5.0-12.0%). The proportion of individuals with eGFRCKD-EPI less than 60 ml/min/1.73 m2 was 17.6 (95% CI 13.2-22.8%). All pairs of rho_c were lower than the threshold of 0.9 except for eGFRCKD-EPI versus eGFRCKD-EPw. CONCLUSION: There is significant discordance in the eGFR obtained from the various serum creatinine-based GFR equations in our population suggesting the need to validate these equations and determine the best equation for our general population.

Knowledge, Attitude and Practice of HIV Post-Exposure Prophylaxis among Medical Doctors in a Tertiary Hospital in Nigeria.

BACKGROUND AND OBJECTIVES: Healthcare workers are exposed to accidental infections from contaminated body fluids in the course of their duties. HIV post-exposure prophylaxis (PEP) is the measure instituted to manage exposure to potentially contaminated body fluids and prevent HIV infection. Ignorance of the appropriate measures to take may increase the risk of acquiring HIV infection from accidental exposure. This survey was conducted to assess the knowledge, attitude and practice of HIV PEP among doctors in a tertiary hospital. METHODS: This was a cross-sectional survey. A pretested structured questionnaire was administered on randomly selected doctors from all clinical departments of a tertiary hospital. The questionnaire assessed the knowledge, attitude and practice of HIV PEP according to the WHO guidelines. A score of > 75% was adequate for each area. RESULTS: Fifty-one completed questionnaires were returned out of 56 giving a response rate of 91%. The total knowledge score was 60.0 ± 10.2% (mean ± SD). The total score in attitude towards PEP was 66.5 ± 12.2% while for practice it was 47.5 ± 27.0%. There was a significant correlation between participant's knowledge and practice (rho = 0.316, p <0.05) as well as between attitude and practice (rho= 0.393, p< 0.01). There was no significant difference in scores in relation to the cadre or department. CONCLUSION: This study reveals that the knowledge, attitude and practice of HIV PEP among doctors is generally not adequate. Enhanced education will reduce the risk of accidental HIV infection among doctors.

Chronic Obstructive Pulmonary Disease (COPD): A Review of the Clinical Management

Chronic Obstructive Pulmonary disease (COPD) is one of the most common chronic respiratory diseases which contribute significantly to the burden of non-communicable diseases(NCDs). With the increasing prevalence of COPD in developing countries a good knowledge of the diagnosis and adequate management are important tools for both primary care and specialist physicians to ensure appropriate treatment.Methods: Review of the available literature on the subject was done through Medline and Google search utilizing the following keywords COPD; epidemiology; pathogenesis and management.Result: Spirometry is an important tool in the diagnosis and staging of COPD. Various treatment targets aimed at improving breathing and the quality of life in patients are available.Conclusion: New therapies that have the potential to improve disease outcome are urgently needed

An Overview of Chronic Obstructive Pulmonary Disease (COPD): Epidemiology and Pathogenesis

Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic respiratory diseases which contribute significantly to the burden of non-communicable diseases. With the increasing prevalence of COPD in developing countries a good knowledge of disease burden and process is essential.Methods: Review of the available literature on the subject was done through Medline and Google search utilising the following keywords COPD; epidemiology; pathogenesis and management.Result: COPD which is increasing in prevalence has varied pathogenetic mechanisms which are influenced by both intrinsic and extrinsic environmental promoters.Conclusion: The prevalence of COPD is increasing especially in developing countries. The pathogenesis is multifactorial and current understanding provides insights that are expected to improve on treatment and outcome

Diverse blood exposures associated with incident HIV infection in Calabar, Nigeria.

Few types of blood exposures have been assessed in relation to incident HIV infection in sub-Saharan Africa, despite evidence that penile-vaginal sex cannot account for the epidemic in the region. To investigate correlates of incident HIV infection in Calabar, Nigeria, we surveyed clients at voluntary HIV counselling and testing centres. Participating clients who tested multiple times were generally similar to those testing only once in terms of demographic characteristics, sexual and blood exposures and HIV prevalence. Blood exposures were common. Serial testers had a 10% annual incidence of HIV infection. Seroconverters and seronegative serial testers were similar on most demographic characteristics and sexual exposures. However, seroconverters were more likely than seronegatives to report blood exposures during the test interval, both for most specific exposures as well as summary measures of blood exposures. In particular, seroconverters were substantially more likely to report one of a set of blood exposures that cannot be explained as a consequence of unprotected vaginal sex or of health care for symptoms of HIV infection (adjusted odds ratio = 6.6, 95% confidence interval = 1.2-38). The study design we used is an inexpensive approach for describing the local epidemiology of HIV transmission and can also serve as the foundation for more definitive investigations that employ contact tracing and sequencing of HIV DNA.

Community-Based Survey of Unwanted Pregnancy in Southwestern Nigeria

Unwanted pregnancy; and consequently unsafe abortion; remains major reproductive health problems in Nigeria that needs to be tackled. Unfortunately; there is a dearth of information on this problem at the community level. This study therefore examined the prevalence of unwanted pregnancy in the community as well as associated factors including the views; perceptions and attitudes of community members towards unwanted pregnancy and the pattern of help-seeking behaviour on unwanted pregnancy. Information was obtained from 3;743 women in urban and rural communities in two Nigerian states of Lagos and Edo. At some point in life; 26.6 of the respondents had had unwanted Pregnancy while abortion prevalence was 21.7 . Short birth intervals (21.1 ); high cost of raising children (20.1 ); interruption of education (20.1 ) and being unmarried (17.3 ) were the most common reasons for not wanting pregnancies. Most of the respondents (91.3 ) were aware of some form of contraception but ever-use rate was only 36.6 while current use rate was 23.4 . Both abortion and contraceptive use were significantly associated with increasing levels of education. Unwanted pregnancy constitutes a problem even at the community level and more research is needed to understand the persistent disparity between contraceptive knowledge and usage; as increased usage will reduce unwanted pregnancy and induced abortion