Prevalence and Epidemiological Characteristics of Anogenital Warts Among Recently Diagnosed HIV-Positive Women on Antiretroviral Therapy in Lagos, Nigeria.

Background Anogenital warts (AGWs) are a prevalent condition resulting from human papillomavirus (HPV) infection, which is the most frequently encountered sexually transmitted infection (STI) on a global scale. Women who are HIV-positive experience a disproportionately high burden of AGWs compared to other populations. It is imperative to comprehend the epidemiological factors linked to the disease within this particular at-risk population. Objectives The objective of the study was to ascertain the prevalence of AGWs and its demographic and socio-biological epidemiological features among recently diagnosed HIV-positive women (HPW) in Lagos, Nigeria. Materials and methods The research was a descriptive cross-sectional study conducted among a sample of 420 recently diagnosed HPW. The study was conducted at the HIV clinic of a tertiary health institution located in Lagos, Nigeria. The participants clinically diagnosed with AGWs were classified as the study group, while individuals without AGWs were classified as the comparison group. Interviewer-administered pretested questionnaires were utilized to gather pertinent demographic and socio-biological epidemiological data from the participants involved in the study. The data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, USA). Results The prevalence of AGWs among recently diagnosed HPW was found to be 8.5% (34/402). These warts were frequently observed on the vulvar labia (35.3%, 12/34), vaginal walls (14.7%, 5/34), and perianal region (14.7%, 5/34). It is worth noting that over a third of cases (35.3%, 12/34) involved multiple areas within the anogenital region. The diagnosis of AGWs was found to have significant associations with occupation (p=0.005), marital status (p<0.001), and educational status (p=0.028). The majority of HPW diagnosed with AGWs were unemployed (32.4%, 11/34), single (47.1%, 16/34), and did not have tertiary education (94.1%, 32/34). The utilization of oral contraceptive pills (OCPs), smoking, low CD4 count, and high viral load were the significant socio-biological factors associated with the diagnosis of AGWs (p<0.001, respectively). Conclusion The study found that the prevalence of AGW among HPW was 8.5% (34/402). Several epidemiological factors, including occupation, marital status, education, CD4 count, viral load, history of OCP use, and smoking, were found to be significantly associated with the diagnosis of AGW. There is a need to conduct more comprehensive studies to thoroughly assess the impact of these epidemiological factors.

Pattern of Gynaecological Malignancies at a University Teaching Hospital in Southwest Nigeria: A 5-Year Review.

Background: The study determined the pattern and distribution of gynaecological cancer cases seen at a university teaching hospital in southwest Nigeria over a 5-year period. Methodology: It was a 5-year retrospective review of all gynaecological cancer cases seen and managed at the hospital from 1 September 2013 to 31 August 2018. Results: A total of 6247 gynaecological admissions and 902 gynaecological cancers were seen in the hospital during the study period accounting for a proportion of 14.4%. Of these 902 cases, 835 (92.6%) women had their detailed records available for data extraction and analyses. Cervical cancer was the most commonly seen malignancy (61.7%). The mean age of the patients was 52.5 ± 12.4 years with the largest proportion of the women being in the age group of 50-59 years (26.9%). A large proportion (35.6%) of the patients had a parity of 5 or more with an overall median parity of 4 (IQR, 1-5) while the largest proportion (59.1%) were postmenopausal women. The highest mean age was seen in women with vulvar cancer (67.2 ± 0.6 years) while the lowest was in those with sarcoma botryoides (12.3±1.01 years). Conclusion: There was a steady annual increase in the number of gynaecological cancer cases at the hospital during the period under review. The most common cancers seen in this study are associated with advanced age, increased parity and postmenopausal status. There is a need for improved public enlightenment on the importance of routine screening and for consistent government policy on the institution of an effective organised screening programme for cervical cancer.

Predictors of Survival Outcomes After Primary Treatment of Epithelial Ovarian Cancer in Lagos, Nigeria.

PURPOSE: This study was designed to investigate the clinicopathologic predictors of progression-free survival (PFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC) following primary treatment in Lagos, Nigeria. MATERIALS AND METHODS: Using data from a retrospective cohort of 126 patients who received treatment for EOC between 2010 and 2018, we identified 83 patients with a complete clinical record for subsequent data analysis. Patients' demographics and updated 2-year follow-up status were abstracted from medical records. Kaplan-Meier survival curves were compared using the log-rank test, and Cox proportional hazard models were used for multivariate analysis to identify independent predictors of survivals following treatment in EOC patients. RESULTS: The median PFS and OS were 12 and 24 months, respectively. After adjusting for covariates in the multivariate analysis, younger age ≤ 55 years (hazard ratio [HR] = 0.40; 95% CI, 0.22 to 0.74; P = .01) and International Federation of Gynecology and Obstetrics (FIGO) stage I/II (HR = 0.02; 95% CI, 0.01 to 0.08; P = .01) were independent predictors of improved PFS, whereas being premenopausal (HR = 2.34; 95% CI, 1.16 to 4.75; P = .02) was an independent predictor of reduced OS after 2-year follow-up. CONCLUSION: PFS could be predicted by the age and FIGO stage of the disease, whereas menopausal status was predictive of OS in patients with EOC. This knowledge should form the basis for counseling patients with ovarian cancer during their primary treatment and lend support to the importance of aggressive follow-up and monitoring for the older, premenopausal patients and those with an advanced stage of epithelial ovarian cancer. However, robust longitudinal research should be carried out to provide additional reliable insight to this information.

Predictors, barriers and motivating factors for human papillomavirus vaccination and testing as preventive measures for cervical cancer: A study of urban women in Lagos, Nigeria.

Human papillomavirus (HPV) vaccination and HPV based cervical screening are scientifically proven ways to prevent and eliminate cervical cancer (CC). Unfortunately, these measures are yet to be widely accepted or utilized. Our study aimed to explore the individual-related factors that predict HPV vaccination and testing, its motivating factors and barriers among urban women in Lagos, Nigeria. This was a descriptive cross-sectional study among 208 consenting women who attended a community health awareness program in Surulere, Lagos, Nigeria, in September 2019. Structured questionnaires were interviewer administered and analysis was done using SPSS version 23. The uptake of HPV vaccination and testing was 29.0% and 3.0% respectively. Being employed [adjusted odds ratio (AOR) = 60.45, CI = 10.64-343.46, P < 0.001] and unmarried (AOR = 33.33, CI = 12.5-100.0, P < 0.001) predicted HPV vaccination uptake while being unmarried was the only predictor of uptake of HPV testing [crude odds ratio (COR) = 7.69, CI = 1.01-100.00, P = 0.039]. Knowing someone with CC (AOR = 21.64, CI = 4.87-96.16, P < 0.001) and being unmarried (AOR = 5.56, CI = 1.45-20.00, P = 0.012) predicted increased willingness to be vaccinated. Being unmarried (AOR = 5.26, CI = 1.89-14.29, P = 0.002) and knowing someone with CC (AOR = 6.41, CI = 2.68-15.33, P < 0.001) predicted willingness to do HPV testing. Recommendation by healthcare provider (HCP), friends/relatives and media were major motivators for HPV vaccination & testing while fear, cost, no recommendation by HCP, inaccessibility & lack of awareness were major barriers. There is need to urgently address these identified factors that affect HPV vaccination and testing in order to improve its acceptability and uptake rate in our environment.

Good clinical practice advice for the management of patients with gynaecological cancer during the COVID-19 pandemic in Nigeria and other resource-constrained countries.

The impact of the COVID-19 pandemic on healthcare services in settings with under-resourced health systems such as that of Nigeria is likely to be substantial in the coming months. The gynaecological oncology services still need to be prioritised as an essential core health service. There are increasing concerns from both physicians and patients regarding how to manage patients diagnosed with cancer during this pandemic as evidence suggests a substantial increase in the risk of COVID-19-related deaths amongst patients with cancer. However, we recognise that despite this great challenge, we must continue to provide the highest quality of care to the patients, whereas, at the same time, ensure adequate safety not only for the patients and their families but also for the entire oncology team. We advocate that due to the widespread travel restrictions and inability to refer patients for the highest level of care at this period, centres without radiotherapy facilities as seen in most resource-limited settings should always consider lower level care options such as the use of chemotherapy pending when there is a better access to these facilities. We, therefore, developed this good clinical practice advice to staff of the gynaecological oncology unit in the centre and other resource-constrained settings for the management of patients with gynaecological cancer during the COVID-19 pandemic.

Primary vaginal leiomyosarcoma: case report of a rare gynaecological malignancy and diagnostic challenge in a resource-constraint setting.

Primary vaginal leiomyosarcoma (VLMS) is an extremely rare variant of primary vaginal cancers with very poor prognosis irrespective of the stage at presentation and the type of treatment received. It is easily recurrent and has a high propensity for haematogenous spread especially to the lungs. We present the case of a 34-year-old Para 1 + 1 (1 alive) woman with recurrent vaginal mass of 8 years duration after two surgical excisions without histological evaluation. She had examination under anaesthesia and a wide local excision of the vaginal mass. Histological examination of the mass revealed poorly differentiated VLMS with positive surgical margins and she was commenced on adjuvant chemo-radiation. Histological evaluation remains the hallmark for diagnosing rare malignancies like VLMS, which unfortunately is not a standard practice in some resource-constraint settings.

Good clinical practice advice for the management of pregnant women with suspected or confirmed COVID-19 in Nigeria.

The impact on healthcare services in settings with under-resourced health systems, such as Nigeria, is likely to be substantial in the coming months due to the COVID-19 pandemic, and maternity services still need to be prioritized as an essential core health service. The healthcare system should ensure the provision of safe and quality care to women during pregnancy, labor, and childbirth, and at the same time, maternity care providers including obstetricians and midwives must be protected and prioritized to continue providing care to childbearing women and their babies during the pandemic. This practical guideline was developed for the management of pregnant women with suspected or confirmed COVID-19 in Nigeria and other low-resource countries.

Evaluation of maternal serum levels of dehydroepiandrosterone sulphate and its association with successful labour outcome among parturients undergoing spontaneous labour at term.

This study evaluated maternal serum levels of dehydroepiandrosterone sulphate (DHEAS) in spontaneous labour and its association with successful labour at term. A cross-sectional observational study was carried out on 140 parturients. Their blood samples were collected in active labour; allowed to clot, centrifuged, separated and stored at -20 °C before analysis for DHEAS was done using the ELISA method. Labour was termed successful when vaginal delivery was achieved. Serum DHEAS levels were higher among parturients with successful labour compared to women with unsuccessful outcome (p = 0.001). DHEAS level was also higher among parturients who did not require oxytocin augmentation compared with those who required it (p = .001). The odds ratio and incidence of successful labour increased significantly as DHEAS level increased above a critical value of 1.5 µg/ml (p = .001). The association between serum DHEAS level and successful labour remained significant after adjusting for other variables (p = .002).

A successfully managed spontaneous heterotopic pregnancy diagnosed in the second trimester of pregnancy.

Spontaneous heterotopic pregnancy (HP) is a very rare and fatal condition that could result in significant maternal morbidity and mortality if prompt diagnosis and appropriate interventions are not instituted at the right time. Unfortunately, this life-threatening condition may be easily misdiagnosed in early pregnancy due to its rarity, vague clinical presentation and the presence of an intrauterine pregnancy which may confuse an inexperienced clinician. The aim of management is to excise the ectopic gestation while preserving the intrauterine pregnancy, if alive. We present a case of spontaneous HP that had complete excision of the ectopic gestation and a live delivery of the intrauterine pregnancy at term.