University Hospital of the West Indies

Abstract Background Skin wound closure is an integral step of caesarean section. Various skin wound closure techniques have been used. However, there is no definite evidence regarding the ideal method for skin closure during Caesarean section. This study, therefore, aimed to compare the use of tissue adhesives with subcuticular absorbable sutures for skin wound closure and to determine patient satisfaction and cosmetic outcomes with each technique. Methods This was a two-arm single-blinded superiority randomized controlled trial. Women who had undergone elective cesarean section and met the inclusion criteria were recruited from the antenatal clinic of the University College Hospital, Ibadan. The participants were randomized into either skin closure with Dermabond tissue adhesive (intervention) or Vicryl 2/0 sutures (control). A total of 192 participants were randomized in the study, with 96 participants in each arm. Results A total of 185 participants completed the study (Control-92, intervention-93) and were included in the analysis. The mean age of the participants was 32.4 (SD ± 5.37) years. Approximately 88.9% of the participants had above the primary level of education, mostly Yoruba, by tribe. The patients’ assessment of the cosmetic outcome of their surgical wound was significantly better for tissue adhesives (p = 0.008), whereas there was no difference when it was assessed by the plastic surgeon (p = 0.50) via the findings from the POSAS. Additionally, there was no significant difference in patient satisfaction with their scar following each closure technique (p = 0.27). The additional analgesia requirement in the first 24 hours after surgery (p < 0.001) and the duration of skin wound closure (3.32 min ± 2.27 for tissue adhesives; 6.52 min ± 2.97 for sutures; p < 0.01) were significantly lower in the tissue adhesive group. There was no significant difference in the rate of wound complications between the groups. Conclusion The cosmetic outcome and patient satisfaction with tissue adhesive are not superior to those with the use of subcuticular sutures. However, pain control and the speed of skin wound closure were significantly better with tissue adhesives. Trial Registration Trial registration was performed online via the Pan African Clinical Trials registry at https://pactr.samrc.ac.za and was retrospectively registered with the registration number PACTR202308768448394. Registered on 14th August 2023. Details of the study data and protocol can be accessed from the corresponding author.

<title>Abstract</title> <bold>Introduction</bold>: Spinal cord injury (SCI) is a debilitating condition with significant morbidity, affecting 250,000-500,000 people globally each year, predominantly due to road traffic accidents in Nigeria. Family caregivers play a critical role in SCI management, however, their treatment experiences remain under-researched in Nigeria. <bold>Aims</bold>: This study investigates caregivers’ treatment experiences and satisfaction with SCI care at a tertiary facility in South-West Nigeria, to inform quality improvements. <bold>Methods</bold>: A cross-sectional study was conducted with 108 family caregivers of SCI patients, selected via total sampling from hospital records. Data were collected using an interviewer-administered, semi-structured questionnaire adapted from the Picker In-Patient and Out-Patient Experience Surveys. The tool assessed socio-demographic characteristics, in-patient and out-patient experiences, and satisfaction. Data were analyzed using SPSS, with univariate, bivariate, and multivariate linear regression analyses at a 5% significance level. <bold>Results</bold>: Most caregivers were female (74.1%), middle-aged (mean 46.1 years), and Yoruba (80.6%). Road traffic accidents caused 83.3% of SCIs. In-patient care issues included prolonged stays (70.6%), equipment delays (50.5%), and unclear test explanations (67.0%). Out-patient care, accessed by 71.3%, showed dissatisfaction due to disrespect (40.3%), inadequate information (31.2%), and unaddressed visit purposes (42.9%). Satisfaction was 72% for in-patient and 62% for out-patient care. Lack of decision-making involvement (p=0.002), prolonged waits (p=0.024), and poor care coordination (p=0.018) predicted overall impression and reluctance to recommend the facility. <bold>Conclusion</bold>: Systemic deficiencies in care coordination, communication, and involvement drive caregiver dissatisfaction. Patient- and family-centered care models are recommended to enhance SCI management and outcome.

Background & Objectives The care of the critically ill adolescent in resource-constrained settings such as Nigeria until a few years ago was in the adult ICU (AICU). This care is provided mainly by the adult intensivists with the input from the paediatricians. In the last couple of years, however, paediatric critical care units managed by paediatric intensivists are gradually being established in Nigeria. This study looked at the clinical characteristics of adolescents managed in the adult ICU before the establishment of Paediatric ICU in our centre. This study was carried out to outline the clinical profiles and outcomes of adolescent patients admitted into the adult ICU. Methods This retrospective study was conducted on adolescents admitted over 5 years (2018 to 2022). Results The adolescent population comprised 113(38.6%) of the children and adolescents admitted. The male and female distribution was 65.5% and 34.5% respectively. The mean age was 14.3±2.8 years. The commonest indication for admission was post-surgical excision of intracranial tumours (22.1%). Meningitis with raised intracranial pressure accounted for 17.7% and Haemoglobinopathy with complications (Sepsis, Acute Chest Syndrome, Shock) constituted 10.6%. A third of the adolescent population required ventilation. Amongst ventilated patients, mortality was recorded in 44.1%. Mortality was significantly higher in ventilated than non-ventilated patients (p=0.01). The overall mortality rate was 36.3%. Conclusion The provision of critical care to the adolescent population is important, especially amongst those who require ventilatory support as they are at high risk of mortality.

Sickle cell disease (SCD) occurs in 2.8 % of our Jamaican antenatal population with homozygous HbSS being most associated with adverse maternal and perinatal outcomes. A retrospective comparative analysis of HbSS, HbSC and HbSβThal pregnancy outcomes at the University Hospital of the West Indies (UHWI) between January 2012 and December 2022 was conducted. Of 120 patients (138 pregnancies), obesity occurred in 36 % (20/56) of the 'non-HbSS' group, i.e.HbSβThal (55 %, 5/9) and HbSC (32 %, 15/47) combined vs. 9.7 % of the HbSS (8/82). HbSS patients had more crises requiring transfusions, acute chest syndrome (ACS), maternal 'near-misses' (OR=10.7, 95 % 3.5-32.3; p<0.001), hospitalizations (OR 7.6, 95 % CI 3.4-16.9; p<0.001), low birth weight (LBW) neonates (OR 3.1, 1.1-8.9; p=0.037) and preterm birth (OR=2.6, 1.2-5.8; p=0.018) compared to HbSC and HbSβThal. Low dose aspirin was prescribed in 43 %. Logistic regression showed those NOT on aspirin (n=76) had more miscarriages (22 v. 2 %), were LESS likely to have a live birth (75 v. 95 % (0.2, 0.04-0.57, p=0.005)), but surprisingly had fewer painful crises (28 v. 46 % (0.5, 0.03-0.9, p=0.03)). HbSS women had a 10-fold excess of maternal near-misses. Additional research may further clarify the effects of aspirin on pregnancy outcomes as related to SCD genotypes.

SinoNasal Microbiota Transfer (SNMT) was safe with immediate benefit in all recipients, with sustained improvement in two of three recipients for up to 180 days. The addition of antimicrobial photodynamic therapy worsened chronic rhinosinusitis. These promising SNMT results warrant further study of safety and efficacy.

Abstract Introduction Adolescence being the transition from childhood to adulthood may be associated with risky sexual behavior with consequences that may last a lifetime. Sex education for teenagers to encourage safe sexual practices is necessary to build a society of adults with healthy sexual lifestyle. The details of the source of information, level of knowledge and actual sexual practices among these adolescents will inform the approach to supplying adequate information. Objective The objective of the study is to demonstrate the level of knowledge of adolescents about safe sexual practices, contraceptives and their pattern of behavior. Methods Data regarding knowledge and sexual behavior was obtained from adolescents in a Sub-Urban high school with the aid of pre-tested self-administered questionnaire. The data was imputed and analyzed with the IBM SPSS software. Results A total of 107 adolescents aged 13 to 19years (mean - 16.078years) with average weight of 47.931Kg; 53(49.5%) were males and 54(50.5%) were females. About half (51.4%) practice Christianity and 48.6% practice Islamic religion and majority (96.3%) were in their penultimate class in high school. Majority of respondents (87.7%) reported having formal sex education, the commonest source of sex education was school in 76.9%, other sources of information were parents (11.0%), friends and peers (8.7%), mass media (4.4%) and siblings (2.2%). The quality of knowledge of these adolescents may be poor, as many as 25% of respondents think that casual sex does not predispose to infections and only 21.8% had any knowledge of modern contraceptives. Nearly one-quarter (23.36%) of respondents have commenced sexual activities with the mean age at coitarche being 12.38±2.38years; majority in this category (92%) being males. The commonest form of sexual practice is peno-vagina intercourse which is seen in 21.7% of respondents, 13.3% practice masturbation, 5.8% of respondents have had homosexual activities, 6.7% practice oral sex and 1.9% practice peno-anal sex. Among the sexually active respondents, 72% have had multiple sexual partners, 32% practice casual sex. Majority (92%) have used male condoms before but only 32% of sexually active respondents regularly use condoms. Majority (98%) of sexually naïve were contented with their status and 13% of sexually active respondents wished they had delayed sexual activities. Conclusions Although, intervention at adolescence with sex and reproductive health services offers the opportunity to form societies with healthy sexual lifestyle, the level of knowledge of sex education among adolescents in Sub-Urban communities remain poor yet a significant proportion of these Adolescents have commenced sexual activities with some practicing risky sexual behavior. Disclosure No.

Studies have shown improved survival among individuals with cancer with higher levels of social support. Few studies have investigated social support and overall survival (OS) in individuals with advanced prostate cancer in an international cohort. We investigated the associations of marital status and living arrangements with OS among individuals with advanced prostate cancer in the International Registry for Men with Advanced Prostate Cancer (IRONMAN). IRONMAN is enrolling participants diagnosed with advanced prostate cancer (metastatic hormone-sensitive prostate cancer, mHSPC; castration-resistant prostate cancer, CRPC) from 16 countries. Participants in this analysis were recruited between July 2017 and January 2023. Adjusting for demographics and tumor characteristics, the associations were estimated using Cox regression and stratified by disease state (mHSPC, CRPC), age (<70, ≥70 years), and continent of enrollment (North America, Europe, Other). We included 2,119 participants with advanced prostate cancer, of whom 427 died during up to 5 years of follow-up (median 6 months). Two-thirds had mHSPC. Most were married/in a civil partnership (79%) and 6% were widowed. Very few married participants were living alone (1%), while most unmarried participants were living alone (70%). Married participants had better OS than unmarried participants [adjusted HR: 1.44; 95% confidence interval (CI): 1.02-2.02]. Widowed participants had the worst survival compared with married individuals (adjusted HR: 1.89; 95% CI: 1.22-2.94). Among those with advanced prostate cancer, unmarried and widowed participants had worse OS compared with married participants. This research highlighted the importance of social support in OS within this vulnerable population.