Profile and Correlates of Sleep Quality and Obstructive Sleep Apnoea among Young Persons in Ibadan, Southwestern Nigeria

BACKGROUND

Sleep breathing disorders (SDB), especially obstructive sleep apnoea (OSA), are poorly studied in the young population. This study aimed to determine the prevalence of OSA and its associated risk factors among young persons.

METHODS

A cross-sectional study design was used, and participants aged 16-35 years were recruited from five tertiary institutions in Ibadan, South Western, Nigeria. The study used a structured questionnaire, stadiometer, weighing scale, tape measure, and digital blood pressure machine to collect data. Patient Health Questionnaire (PHQ 9), Generalized Anxiety Disorder-7(GAD-7), and Pittsburgh sleep quality index (PSQI) were used to assess depression, anxiety, and sleep quality respectively. To assess the risk of OSA, we used both the STOP-Bang questionnaire and the NOSAS score. The Statistical Package for the Social Sciences version 23 was used to analyse the data, and statistical significance was set at <0.05.

RESULTS

A total of 354 participants were included in this report with a mean age of 21.2±3.5 years. The female: male ratio was 1.9:1. The mean ±standard deviation of PSQI, GAD-7 score and PHQ-9 were 2.2±1.1, 12.4±5.1 and 15.0±5.4 respectively. The following percentages of participants were found to be at low, intermediate, and high risk for OSA: 94.1%, 5.6%, and 0.3%, respectively. This study showed that age and GAD-7 score were independently associated with the PSQI score while age, body mass index, neck cuff size and PHQ-9 score for OSA score.

CONCLUSION

There is a burden of OSA among this population of young people; and modifying anthropometric and psychosocial factors can help mitigate the risk of OSA outcomes.

RELATIONSHIP BETWEEN SELECTED TRADITIONAL & NOVEL ANTHROPOMETRIC PARAMETERS AND BLOOD PRESSURE AMONG YOUNG PEOPLE

Background

Many anthropometric measures have been developed in the last two decades to evaluate cardiovascular health and disease. However, the relationship between these measures and blood pressure is not commonly explored among young population.

Objective

This study sought to explore the relationship between selected traditional and novel anthropometric metrics and blood pressure among young people as part of ThE profile of anthRopometRy And psyChosocial issuEs on campus (TERRACE) study.

Methods

A total of 375 participants were included in the study. Basic demographic details, standard methods were used to measure blood pressure, and anthropometric measures Height, weight, waist circumference, hip circumference, and neck circumference were measured. Derived waist and hip indices included the waist-hip ratio, waist-to-height ratio, weight-adjusted waist index, abdominal volume index, neck-to-height ratio, and conicity index. The linear relationships between the anthropometric parameters and systolic blood pressure, diastolic blood pressure, and pulse pressure were explored. Those that were strongly correlated, moderately correlated, weakly correlated, and effectively uncorrelated were graded 0.50-1.0, 0.30-0.49, 0.10-0.29, and less than 0.10, respectively. The analysis was done using SPSS version 23. A p-value <0.05 was considered significant.

Results

The mean age ±standard deviation(SD) and proportion of females were 21.1±3.5 years and 245 (65.3%), respectively. The mean ±SD systolic blood pressure, diastolic blood pressure, and pulse pressure were 109.2 11.2 mmHg, 67.5±8.8 mmHg, and 41.6±11.1 mmHg, respectively. Most of the variables have a statistically significant relationship with the blood pressure parameters; however, all are neither moderately nor strongly correlated.

Conclusion

Most of the anthropometric indicators, including the novel ones, are correlated with BP parameters in this young population. However, further research is needed to unravel newer one with better correlations in this population.

Clinical characteristics and predictors of human mpox outcome during the 2022 outbreak in Nigeria: a cohort study

BACKGROUND

Research from sub-Saharan Africa that contributes to our understanding of the 2022 mpox (formerly known as monkeypox) global outbreak is insufficient. Here, we describe the clinical presentation and predictors of severe disease among patients with mpox diagnosed between Feb 1, 2022, and Jan 30, 2023 in Nigeria.

METHODS

We did a cohort study among laboratory-confirmed and probable mpox cases seen in 22 mpox-treatment centres and outpatient clinics across Nigeria. All individuals with confirmed and probable mpox were eligible for inclusion. Exclusion criteria were individuals who could not be examined for clinical characterisation and those who had unknown mortality outcomes. Skin lesion swabs or crust samples were collected from each patient for mpox diagnosis by PCR. A structured questionnaire was used to document sociodemographic and clinical data, including HIV status, complications, and treatment outcomes from the time of diagnosis to discharge or death. Severe disease was defined as mpox associated with death or with a life-threatening complication. Two logistic regression models were used to identify clinical characteristics associated with severe disease and potential risk factors for severe disease. The primary outcome was the clinical characteristics of mpox and disease severity.

FINDINGS

We enrolled 160 people with mpox from 22 states in Nigeria, including 134 (84%) adults, 114 (71%) males, 46 (29%) females, and 25 (16%) people with HIV. Of the 160 patients, distinct febrile prodrome (n=94, 59%), rash count greater than 250 (90, 56%), concomitant varicella zoster virus infection (n=48, 30%), and hospital admission (n=70, 48%) were observed. Nine (6%) of the 160 patients died, including seven (78%) deaths attributable to sepsis. The clinical features independently associated with severe disease were a rash count greater than 10 000 (adjusted odds ratio 26·1, 95% CI 5·2-135·0, p<0·0001) and confluent or semi-confluent rash (6·7, 95% CI 1·9-23·9). Independent risk factors for severe disease were concomitant varicella zoster virus infection (3·6, 95% CI 1·1-11·5) and advanced HIV disease (35·9, 95% CI 4·1-252·9).

INTERPRETATION

During the 2022 global outbreak, mpox in Nigeria was more severe among those with advanced HIV disease and concomitant varicella zoster virus infection. Proactive screening, management of co-infections, the integration and strengthening of mpox and HIV surveillance, and preventive and treatment services should be prioritised in Nigeria and across Africa.

FUNDING

None.

Atypical presentation of mpox in Irrua environs: a case report

BACKGROUND

Mpox, previously known as monkeypox, -is an orthopoxvirus infection of the skin and previously a public health emergency of international concern. It reemerged in Nigeria over 5 years ago and has since spread to other parts of the world. This is a case report of a confirmed patient who was managed at Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria before the global surge. This report shows peculiar differences from previous patients managed at the same center in terms of the relatively prolonged eruptive phase, possible seasonal occurrence of mpox in the community, and some traditional care for mpox and skin rashes. It also corroborates previous reports of possible sexual transmission of mpox in Nigeria before the report from the global outbreak.

CASE PRESENTATION

The patient is a 30-year-old Nigerian male artisan with a 2-month history of raised rashes on the body that started on the genitals then involved other parts of the body. There was history of sore throat and unprotected sex with a female partner with similar rash whose other sexual history could not be ascertained. There was also history of "seasonal" rash in his village for about 7 years prior to his symptoms. Examination showed multiple vesicles and some nodules (ulcerating, healing, and healed) on the face, trunk, limbs, gluteal region, scrotum, palms, and sole, an almost circumferential penile ulcer, and lymphadenopathy. Polymerase chain reaction skin samples sent for mpox returned positive, while retroviral and coronavirus disease 2019 screenings were negative. He was managed in isolation while contact tracing in the affected community was initiated.

CONCLUSION

Atypical presentations of mpox, as managed in Irrua before the global surge, emphasize the varied spectrum of presentations (typical and atypical) in Nigeria. Therefore, there is a need for a higher index of suspicion for the uncommon presentations which will strengthen case recognition, case management, and community-based interventions as well as surveillance in the prevention and control of mpox in Irrua, its environs, Nigeria, and the world.

Mpox in pregnancy: Management, risks and challenges in Africa and lessons from the COVID-19 pandemic

Data on mpox in pregnancy are currently limited. Historically, only 65 cases in pregnancy have been reported globally since mpox was discovered in 1958. This includes 59 cases in the current outbreak. Vertical transmission was confirmed in one patient. Pregnant women are at high risk of severe disease owing to immunological and hormonal changes that increase susceptibility to infections in pregnancy. African women appear to be at higher risk of mpox infection and adverse outcomes in pregnancy for epidemiological and immunologic reasons, in addition to the background high rates of adverse feto-maternal outcomes in the region. This risk is potentially heightened during the COVID-19 pandemic due to the possibility of mpox virus exportation/importation as a result of the lifting of movement restrictions and trans-border travels between countries affected by the current outbreak. Furthermore, coinfection with mpox and COVID-19 in pregnancy is possible, and the clinical features of both conditions may overlap. Challenges of diagnosis and management of mpox in pregnancy in Africa include patients concealing their travel history from healthcare providers and absconding from/evading isolation after diagnosis, shortage of personal protective equipment and polymerase chain reaction testing facilities for diagnosis, vaccine hesitancy/resistance, and poor disease notification systems. There is a need for local, regional and global support to strengthen the capacity of African countries to address these challenges and potentially reduce the disease burden among pregnant women in the continent.

Androgenetic alopecia: Traditional cardiovascular risk factors, metabolic syndrome, and component traits among Nigerian adults

Background

Androgenetic alopecia (AGA) has been linked to cardiovascular diseases (CVDs) and metabolic syndrome (MetS). Works on AGA, cardiovascular risk factors (CVRFs) and MetS are rare among Nigerians.

Aim

This study set out to determine the relationship among CVRFs, MetS, and AGA.

Subjects and Methods

This is a cross-sectional study done among adults who were 18 years and above in selected communities in Ogbomoso on 260 consenting AGA participants as well as 260 age controls without AGA. They were matched for age and sex using a multistage sampling method. Anthropometric measurements, fasting blood glucose, and lipid profile samples were collected. MetS was diagnosed using International Diabetes Federation criteria. Data were analyzed using IBM SPSS version 20. Ethical approval was gotten before commencement of the study (LTH/OGB/EC/2017/162).

Result

Metabolic syndrome in AGA was higher than in controls (8.08% vs. 7.69%, p = 0.742). AGA was significantly associated with elevated mean systolic blood pressure (SBP) (p = 0.008), low High Density Lipoprotein (HDL-c) (p < 0.001), alcohol intake (p < 0.001), dyslipidaemia (p = 0.002), and sedentary lifestyle (p = 0.010). The correlates of AGA severity in male and female gender are age (p < 0.001 and 0.009 respectively), SBP (p = 0.024) and abdominal obesity (p = 0.027) in male gender.

Conclusion

AGA in Nigerians is associated with dyslipidaemia, alcohol intake, and sedentary lifestyle. AGA severity is related to age, higher mean SBP, abdominal obesity and low HDL-c in male and age, and Body mass index in females. Nigerians with AGA should be screened for dyslipidaemia and counseled against the use of alcohol and sedentary lifestyle.

Vitamin D Level in Patients Receiving Highly Active Antiretroviral Therapy in LAUTECH Teaching Hospital, Ogbomoso

BACKGROUND AND OBJECTIVE

Hypovitaminosis D is a worldwide disorder, with a high prevalence in the general population. This study aims to assess the serum vitamin D level and its relationship with cluster for differentiation; CD4+T cells among HIV infected individuals on HAART.

METHODS

This is a cross-sectional study conducted among 150 subjects attending the infectious disease Clinic of LAUTECH Teaching Hospital, Ogbomoso and presently on antiretroviral treatment. Serum from blood samples collected was analyzed and diagnostic cut-off of (<30ng/ml) and (> 30ng/ml) were used as Deficient and Sufficient vitamin D respectively. Variables such as duration on ART, CD4 count and viral load were extracted from case notes of subjects.

RESULTS

There was disproportionately more female than malesubjects with a male to female ratio of 1:3. Subjects were aged between 16 and 73 years with a mean age of 41.57 ± 10.62. Few subjects (5.3%) were underweight, 23.3% were overweight, and 26% were obese. The median CD4 count was 241.5 cells/mm3 and 72% of subjects were immunosuppressed. The prevalence of vitamin D deficiency was 45.3% (n=68). CD4 count was associated with the level of serum vitamin D, p-value < 0.05.

CONCLUSION

Vitamin D deficiency was prevalent among the studied HIV population. Our study found a significant correlation between serum vitamin D level and CD4 counts. It may be concluded that highly antiretroviral therapy HAART, improves CD4 level when there is sufficient vitamin D level, however, this merits further extensive exploration.

Striae Distensae: A Cross-Sectional Study of Risk Factors and Quality of Life among Nigerians

BACKGROUND

Striae distensae is a common affliction of darkly pigmented skin. The pattern, risk factors and impact of striae distensae on the Quality of Life (QoL) have not been widely examined.

OBJECTIVE

To document the prevalence, pattern, risk factors and impact of striae distensae on the QoL of sufferers.

METHODS

520 adults were included through a crosssectional design. Demographic and striae distensae-related clinical parameters were documented and QoL evaluated using Skindex-29 and DLQI.

RESULTS

Mean age of participants was 24.10±5.44years. Participants with striae distensae were significantly females (71.9% vs 28.1%, p<0.001) and mild (61.9%) and moderate (32.5%) striae distensae were prevalent. Higher total mean ± SD and mean ranked scores correlated with single status (p<0.001 and p=0.017) and striae distensae severity (p<0.001 and p=0.035) on Skindex and DLQI, respectively. Singles with striae distensae had significantly higher scores on symptom/feeling (p<0.001), daily activities (p=0.003), relationship (p=0.043), leisure (p=0.004), treatment (p=0.011) and work/school (p=0.014) on DLQI. Striae distensae was associated with higher emotion (p<0.001) and functioning (p<0.001) scores on Skindex-29. In regression analysis, age < 30years OR-1.219 (CI: 1.062, 1.400, p=0.005), was a predictor of severe QoL impairment on Skindex-29 and age <30 years OR-1.130 (CI: 1.022, 1.250, p=0.017), obesity OR=1.091, 95% (CI 1.008;1.181, p=0.032) and concern about striae distensae OR-2.482 (CI: 1.392, 4.425, p=0.002) on DLQI.

CONCLUSION

Psychologic evaluation might be indicated in cases of singles with moderate-severe striae distensae and impaired QoL. Predictors of impaired QoL include young age, high BMI, and concerns about striae distensae.

Hyper-Immunoglobulin E Syndrome and Squamous Cell Carcinoma of the Lower Lip: A Case Report

Hyperimmunoglobulin E syndrome is a Primary Immuno-deficiency Syndrome (PIDS) characterized by high serum immunoglobulin E, eczema rash and recurrent sinopulmonary and skin infections. In this report, we present a case of squamous cell carcinoma of the lower lip in a young patient with Hyper IgE syndrome. The patient had initially developed a chronic non-healing ulcer and a biopsy done revealed a squamous cell carcinoma. Immunodeficiency has been recognized as an essential risk factor for cancer through immune dysregulation and defective immunosurveillance.

Exploring Issues and Challenges of Leadership among Early Career Doctors in Nigeria Using a Mixed-Method Approach: CHARTING Study

(1) Background: leadership behaviour is a poorly explored phenomenon among early-career doctors (ECDs). Good leadership is vital in maximising the effective management of patients in a clinical setting. While a good number of studies, though with small sample surveys, have researched the role of leadership in clinical setting quantitatively, qualitative investigations are yet to be done in Nigeria. This study aims to explore the attitudes, skills, and experience of ECDs in Nigeria on issues pertaining to leadership in a medical setting, using a mixed-method approach. (2) Methods: we conducted two sessions of key informant focus group discussion (FGD) that involved 14 ECD leaders in Nigeria, exploring their leadership experience in a clinical setting. Furthermore, we used a self-administered questionnaire to quantitatively survey 474 ECDs from seven Nigerian teaching hospitals to explore their attitudes, skills, and experience on issues pertaining to medical leadership. (3) Results: taking on leadership roles is a common phenomenon (52.7%) among the surveyed ECDs; however, the medical leadership position can be very challenging for ECDs in Nigeria. Despite the fact that many (91.1%) of the surveyed ECDs perceived leadership skills as essential skills needed by a doctr, many (44.1%) of them were yet to be formally trained on medical leadership. About three out of every 10 (23.6%) of surveyed ECDs that have ever held leadership positions in a medical setting experienced major leadership challenges while in such office due to their lack of training on leadership skills. Leadership skill acquisition programmes are highly recommended to become an integral part of medical training programmes in Nigeria. (4) Conclusion: there is a need for a structured leadership skill acquisition programme for ECDs in Nigeria. This programme will help in the robust delivery of highly effective healthcare services in Nigeria, as effective leadership is crucial to patient care services.

Idiopathic scrotal calcinosis: report of 2 cases, and review of pathogenesis and factors that determine patients' acceptance of surgical treatment

Introduction

Idiopathic scrotal calcinosis is a benign and rare disease of the scrotal skin that presents as solitary or multiple asymptomatic calcified nodules in the absence of systemic disorders of calcium/phosphorus balance.

Case reports

We report the management of 2 cases and review the literature with comments on factors that determine acceptance or otherwise of surgical treatment. Our patients were 29 and 33 years old and presented with nodular scrotal lesions. Through multiple elliptical incisions, all nodules were excised from patient 1, but patient 2 refused surgery. Reasons for rejection included fear of future reproductive performances. Histology shows calcium deposition in basophilic globules of varying sizes and shapes within the reticular dermis, multinucleated giant cells, dense collagenous stroma, areas of fibrosis, and sparse lymphocytic infiltrate.

Conclusion

In the management of idiopathic scrotal calcinosis, factors that determine acceptance of surgical treatment could include impaired quality of life, reduced self-esteem, fear of future sexual dysfunction, and development of complications.