Gender Differences in the Short and Long-Term Outcomes Following Rotational Atherectomy: A Meta-Analysis.

Rotational atherectomy (RA) is used to address complex calcified coronary lesions but data regarding the association between gender and outcomes of patients who underwent RA remain uncertain. We aimed to investigate the short- and long-term outcomes of patients who underwent RA based on gender. A systematic literature search was performed in PubMed, Embase, and Cochrane databases from its inception until August 2023 for relevant studies. Endpoints were pooled using the DerSimonian and Laird random-effects model as odd ratios (OR) with 95% confidence intervals (CIs). A total of 7 studies with 8,490 patients (2,565 women and 5,925 men) who underwent RA were included in the study. In terms of periprocedural outcomes, women had a higher risk of in-hospital mortality (OR 2.00, 95% CI 1.08 to 3.68, p = 0.03), coronary dissection (OR 1.80, 95% CI 1.05 to 3.10, p = 0.03), coronary perforation (OR 1.96, 95% CI 1.19 to 3.23, p = 0.01), and stroke (OR 4.22, 95% CI 1.06 to 16.82, p = 0.04) than men. There were no significant differences between women and men in terms of major adverse cardiovascular events (OR 1.43, 95% CI 0.69 to 2.94, p = 0.33), myocardial infarction (OR 1.35, 95% CI 0.87 to 2.08, p = 0.18), bleeding (OR 1.71, 95% CI 0.88 to 3.30, p = 0.11), and cardiac tamponade (OR 2.30, 95% CI 0.45 to 11.68, p = 0.32). Over a follow-up period of 3 years, the results of meta-analysis showed that women had a higher risk of all-cause mortality (OR 1.45, 95% CI 1.19 to 1.77, p <0.001), long-term major adverse cardiovascular events (OR 1.38, 95% CI 1.10 to 1.74, p = 0.01), and long-term stroke (OR 3.41, 95% CI 1.63 to 7.17, p <0.001). The risk of long-term myocardial infarction was found to be similar between both genders (OR 1.45, 95% CI 0.95 to 2.22, p = 0.09). In conclusion, female gender is associated with adverse periprocedural and long-term outcome after RA. Women consistently demonstrated higher risk of in-hospital mortality, coronary dissection, coronary perforation, and stroke in the periprocedural period. Long-term follow-up further highlighted a heightened risk for women in terms of all-cause mortality and stroke.

Depression and suicidal ideation among undergraduates in state tertiary institutions in Lagos Nigeria.

BACKGROUND: Depression is a common mental illness affecting majority of the world's population. However, evidence has shown that undergraduates are at an even higher risk compared to the general population, of developing depression due to the various challenges they face during that period. Suicide has been discovered to be the second leading cause of death among young people. Suicide ideation has been proven to be a predictor for not only suicide attempts but also completed suicides. Therefore, the aim of this study was to assess depression and suicidal ideation among undergraduates in the state tertiary institutions in Lagos, Nigeria. METHOD: This study was a descriptive, cross-sectional study carried out among undergraduates in two state tertiary institutions in Lagos, Nigeria using self-administered questionnaire. A total of 750 respondents were recruited using the multistage sampling technique. Data was analysed using SPSS version 27 and the level of significance was set at p -value < 0.05. RESULTS: The survey was conducted among undergraduates in the two state tertiary institutions in Lagos State: Lagos State University (48.3%) and Lagos State Polytechnic (51.7%). The mean age of the respondents was 21.5 (2.7) years. Majority of the respondents were females (54%), single (98.1%), Christians (70.3%), and the source of income of majority of the students was parents (72.8%). From the case vignette used in the questionnaire, 47.6% of the respondents were able to correctly identify depression. The prevalence of depression and suicidal ideation in this study was 22.5% and 21.6% respectively. Depression was statistically significantly associated with suicidal ideation (p < .001). Risk factors that were statistically significantly associated with depression and suicidal ideation were low self-esteem (p < .001), intake of recreational drugs (p < .001), alcohol dependence (p < .001), and positive history of bullying (p < .001). CONCLUSION AND RECOMMENDATIONS: The proportion of respondents with good knowledge of depression was not satisfactory. A strong relationship was found between depression and suicidal ideation indicating that people with depression are at a high risk of having suicidal ideation. Risk factors that were associated with depression and suicidal ideation were bullying, low self-esteem, intake of recreational drugs, alcohol dependence, poor academic performance, sexual assault and being hit by a partner. More works need to be done by the government and non-governmental organisations, school administration and parents to increase the awareness on the symptoms and manifestations of depression and reduce the burden created by some of the risk factors identified in this study to combat depression and suicidal ideation.

Determinants of antiretroviral treatment adherence among patients attending secondary health care facilities in north-east and south-west Nigeria: a comparative study.

BACKGROUND: Four decades after its discovery, HIV continues to be a major global public health issue, even with antiretroviral therapy (ART). Strict adherence to ART remains a challenge, with attendant implications for treatment success. This study aimed at comparing ART adherence between north-east and south-west Nigeria. METHODS: A comparative cross-sectional study was conducted in two regions in Nigeria among 400 HIV/AIDS patients on ART. Data were collected using a pre-tested, semi-structured interviewer-administered questionnaire. Multivariable analysis was performed to determine predictors of ART adherence in the regions. The level of significance was set at 0.05. RESULTS: The majority of respondents from both the north-east (87.5%) and south-west (92.5%) of Nigeria had good knowledge about ART. The self-reported adherence level was 90.0% in the north-east and 87.5% in the south-west. Predictors of ART adherence in the north-east were knowledge about ART (AOR 9.949; 95% CI 2.009-49.284) and transport costs to the clinic (AOR 0.177; 95% CI 0.047-0.661). In the south-west, education (AOR 0.198; 95% CI 0.047-0.832) and knowledge of ART (AOR 8.945; 95% CI 1.749-45.751) were identified as predictors of ART adherence. CONCLUSION: In both regions, knowledge about ART was appreciable, but adherence was sub-optimal. Strategies to support adherence should be tailored to specific predictors in each region.

Operationalizing the distribution of oral HIV self-testing kits to men who have sex with men (MSM) in a highly homophobic environment: the Nigerian experience.

BACKGROUND: Self-care health interventions are innovative approaches for improving health and achieving the sustainable development goals (SDGs). Men who have sex with men (MSM) have been disproportionately affected by Human Immunodeficiency Virus (HIV). In spite of this, stigma from healthcare workers has reportedly prevented MSM from accessing HIV testing in health facilities. This paper explored the operationalization of using key opinion leaders (KOLs) to distribute HIVST (HIV self-test) kits to MSM. This qualitative survey used a combination of in-depth interviews (IDI) with HIVST users and focus group discussions (FGDs) with KOLs to collect data three months after the distribution of the test kits by the KOLs. Thematic analysis of the data was carried out. RESULT: Three themes were generated namely: KOLs serve as a trusted resource to promote and support HIVST for the MSM community; Skills and qualifications required for KOLs to effectively distribute and promote uptake of HIVST; and Effective strategies used to create demand and promote uptake of HIVST. CONCLUSION: This study showed the practical steps involved in operationalizing KOL support system distribution of HIVST that positively influenced the testing experience for the participants irrespective of the HIV status and engagement in care. KOLs are a reliable resource to leverage for ensuring that HIV self-test kit is utilized and HIV positive individuals are linked to treatment and care in homophobic environments.

Knowledge and utilisation of National Health Insurance Scheme among adult patients attending a tertiary health facility in Lagos State, South-Western Nigeria.

BACKGROUND: Despite the creation of the National Health Insurance Scheme (NHIS) by the Nigerian government, most Nigerians are not covered by the scheme. AIM: The aim of this study was to assess the knowledge and utilisation of NHIS among adult patients who attended a tertiary health facility in Lagos state, South-Western Nigeria. SETTING: Outpatient clinic, Lagos State University Teaching Hospital, Ikeja, Lagos. METHODS: A descriptive cross-sectional study of 487 respondents recruited using a multi- stage sampling method. Data were collected using pretested semi-structured self-administered questionnaires, and analysis was done using Microsoft Excel 2007 and EPI Info 7 statistical software. Level of significance was set at p 0.05. Ethical approval was obtained from the Health Research Ethics Committee Lagos State university teaching Hospital. RESULTS: A total of 487 of the 500 self-administered questionnaires were retrieved and analysed, giving a response rate of 97.4%. The study showed that 80.7% of the respondents had poor knowledge of NHIS, only12.3% of the respondents had registered with the NHIS, and 43.8% of respondents who had not registered with NHIS claimed they do not know where to register. There was a statistically significant association between age and utilisation (p = 0.0007), marital status and utilisation of NHIS (p = 0.016), employment status and utilisation of NHIS (p = 0.001).Most (96%) of those who have utilised NHIS were satisfied with NHIS services. CONCLUSION: Majority of the respondents had poor knowledge of NHIS and also majority of those who had registered were satisfied with the scheme. There should be increased awareness campaigns so that all Nigerians can benefit from the scheme.

Knowledge and utilisation of National Health Insurance Scheme among adult patients attending a tertiary health facility in Lagos State, South-Western Nigeria

Background: Despite the creation of the National Health Insurance Scheme (NHIS) by the Nigerian government, most Nigerians are not covered by the scheme. Aim: The aim of this study was to assess the knowledge and utilisation of NHIS among adult patients who attended a tertiary health facility in Lagos state, South-Western Nigeria. Setting: Outpatient clinic, Lagos State University Teaching Hospital, Ikeja, Lagos. Methods: A descriptive cross-sectional study of 487 respondents recruited using a multi- stage sampling method. Data were collected using pretested semi-structured self-administered questionnaires, and analysis was done using Microsoft Excel 2007 and EPI Info 7 statistical software. Level of significance was set at p < 0.05. Ethical approval was obtained from the Health Research Ethics Committee Lagos State university teaching Hospital. Results: A total of 487 of the 500 self-administered questionnaires were retrieved and analysed, giving a response rate of 97.4%. The study showed that 80.7% of the respondents had poor knowledge of NHIS, only 12.3% of the respondents had registered with the NHIS, and 43.8% of respondents who had not registered with NHIS claimed they do not know where to register. There was a statistically significant association between age and utilisation (p= 0.0007), marital status and utilisation of NHIS (p= 0.016), employment status and utilisation of NHIS (p=0.001). Most (96%) of those who have utilised NHIS were satisfied with NHIS services. Conclusion: Majority of the respondents had poor knowledge of NHIS and also majority of those who had registered were satisfied with the scheme. There should be increased awareness campaigns so that all Nigerians can benefit from the scheme

A rural-urban comparison of ownership and utilization of Long-Lasting Insecticide Treated Nets among pregnant women in Ogun State Nigeria

Background:The use of Long-Lasting Insecticide Treated Nets(LLINs) in Africaincreasedmean birth weight by 55g, reduced the incidence of low birth weight by 23% and decreased miscarriages/stillbirths by 33%. However, the benefit of the LLINs may be limited by the rate of ownership and utilization by pregnant women.Objective:To determine and comparethe ownership and utilizationof LLINs among pregnant womenin urban and rural areas of Ogun State. Methods:A community-based comparative cross-sectional study on 72 and 74 pregnant womenliving in urban and rural areas, respectively of Ogun State was carried out. Using a multi-stage cluster sampling technique and apretested semi-structured interviewer-administered questionnaire,information on LLINs ownership and usewere obtained. Results:Ownership of LLINs was 81.1% in rural areas compared to 66.7% in urban areas. About 65%of participantsin rural versus 44.4% in urban areas slept under LLINs.The predictor ofownership of LLIN was age group15-24years [AOR 0.10 (95%CI 0.01 -0.56)]. The predictors of utilization of LLINs includedurban residence[AOR 0.29(95%CI 0.13 ­0.65)], age group15-24years[AOR 0.17 (95%CI 0.04 ­0.70)], registration of pregnancy for antenatal care [AOR 5.12 (95%CI 1.14 ­23.03)] and knowledge on prevention of malaria [AOR 4.94 (95%CI 1.51 ­16.17)].Conclusion:Pregnant womenshould visit ANCclinics regularly, and health education on malaria should focus more on the prevention ofmalaria as well as encouraging the consistent use of the nets, particularly in the urban areas

Risk factors for chronic kidney disease among patients at Olabisi Onabanjo University Teaching Hospital in Sagamu, Nigeria: A retrospective cohort study.

BACKGROUND: Chronic kidney disease (CKD) is common and often goes undetected and undiagnosed until the disease is well advanced and kidney failure is imminent. It is estimated that approximately 36 million Nigerians suffer from different stages of CKD, as one in seven Nigerians has kidney disease. METHODS: This research was a retrospective cohort study of 150 cases and 300 controls. Selection of subjects was by a retrospective review of records of in-patients from 2010-2013 in a state teaching hospital. Data was analyzed using Chi-square at 5% level of significance. RESULTS: Majority of subjects were between ages 20 - 29 years. The mean (SD) age of the cases was 40.6 (14.4) and controls was 38.6 (15.8). Ninety (60%) of the cases and 212(70.7%) of the controls were males (p= 0.023). Almost 87% of the cases and 42% of the controls ingest herbal concoction. Use of bleaching substances was more among the cases 20(13.4%) compared with the controls 2(0.7%), ( p= 0.001). Eight (5.3%) of the cases had family history of CKD while only 1(0.3%) of the control had similar history (p= 0.001). There were more cases (10.7%) with diabetic mellitus compared with the controls (2.7%), (p= 0.001). The number of cases with high blood pressure was more than the number of controls, (p-value <0.001). Sixty-four percent of the cases had history of chronic use of analgesic compared with 10.3% of the controls (p < 0.001). CONCLUSIONS: CKD is mostly found among men in their productive age, who were either diabetic or hypertensive with history of ingestion of herbal concoction and chronic use of analgesic. Individual should engage in regular medical check, modify their life style while government and health care providers increase awareness and campaign on the causes and risk factors of CKD.

Sexual risk history and condom use among people living with HIV/AIDS in Ogun State, Nigeria.

INTRODUCTION: The majority of human immunodeficiency virus (HIV) infections are acquired through unprotected sex between partners; only male or female condoms can reduce the chances of infection with HIV during a sexual act. AIM: This study was therefore designed to describe sexual risk history and identify factors associated with condom use among people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHAs) in Ogun State, Nigeria. MAIN OUTCOME MEASURES: Main outcome measures are sexual and HIV risk history, safe sex practices, and condom use. METHODS: This study is an analytical cross-sectional study. A total sample of all people living with HIV/AIDS attending secondary health facilities in Ogun State were recruited into the study. RESULT: A total of 637 were interviewed; median age at first sexual intercourse among the study participants was 19 years (mean age = 18.95, standard deviation [SD] = 4.148) with a median of two lifetime sexual partners (mean = 3.22, SD = 3.57). Majority (71.4%) of the respondents had not been diagnosed with a sexually transmitted infection other than HIV. Precisely 47.7% of men and 52.3% of women had two or more sexual partners in the last 6 months. Men were statistically significantly more likely to have multiple sexual partners when compared with women (P = 0.00). Significantly more women (69.8%) than men (30%) had sexual partners whose HIV status they did not know (P = 0.006). Predictors of condom use were individuals who had multiple sexual partners (odds ratio [OR] = 1.41, confidence interval [CI] = 1.05-1.83) and married (OR = 3.13, CI = 1.15-8.51) with higher level of education (OR = 2.78, CI = 1.39-5.79), with knowledge of partner's serostatus (OR = 2.53, CI = 1.50-4.28), and awareness of reinfection (OR = 1.90, CI = 1.22-2.95). CONCLUSION: The study indicates that the establishment of effective safe sex practices and condom use behavior among PLWHAs in low-income countries such as the study population requires adequate health education on the transmission of HIV/AIDS and the understanding of the dynamics of family life and gender issues.