Medicine- Scholarly Publications

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    Open Access
    Outcome of Patients with Common Endocrine Diseases Who Had COVID-19 in two Centers in Lagos, Nigeria: A Cross-Sectional Study
    (West African College of Physicians and West African College of Surgeons, 2023-04-01) Oluwole, O.; Fashola, W.; Olopade, O.B.; Odeniyi, I.A.; Fasanmade, O.A.
    BACKGROUND: Endocrine diseases are ubiquitous. In our environment, diabetes mellitus (DM), obesity and thyroid disorders represent the most common examples. Diabetes mellitus is a global health problem with a myriad of complications. We sought to evaluate outcome in terms of fatality in those with common endocrine diseases who were infected with COVID-19. AIMS AND OBJECTIVES: To determine outcome in terms of mortality in patients with common endocrine diseases who contracted COVID-19. MATERIALS AND METHODS: We conducted an observational, descriptive, cross-sectional study with 120 participants drawn from the endocrinology/DM clinic at the Lagos University Teaching Hospital and Serenity Hospital, Surulere (a private medical clinic). Data collected included age, gender, type of endocrine disease, comorbid diseases, and COVID-19 status. Through charts from the medical records department, outcome of participants in terms of mortality was determined. RESULTS: Data of 120 subjects were analyzed. There were 61 males and 59 females, yielding a male:female ratio of 1:1. Mean age was 58 years and the mode was 46 years. Over half (88) of the patients had diabetes mellitus, 22 had obesity, and 17 had thyroid disorders. The case fatality rate of patients with endocrine diseases who had COVID-19 was 11%, with about 85% of these deaths occur in the elderly (those aged above 60 years). Ninety-two percent of the patients who died had type 2 DM. Approximately 80% of patients who were infected with COVID-19 had at least one co-morbid disease. CONCLUSION: Older age, type 2 diabetes mellitus, and the presence of at least one comorbidity was associated with increased mortality in patients with endocrine diseases who were infected with COVID-19 in our study
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    Open Access
    Metabolic Profile as a Predictor of Ischaemic Stroke: The Experience of a Rural Hospital in Nigeria
    (KEMRI, 2022-12) Olugbemide O; Bankole I; Alabi A; Dic-Ijewere M; Eregie A; Fasanmade OA
    BACKGROUND The metabolic profile which includes glycated haemoglobin, insulin resistance, pancreatic beta cell function and lipid profile is frequently deranged in acute ischaemic stroke. Stroke is a leading cause of death worldwide and an emerging cause of long-term disability and mortality in Africa. Our study aimed to determine the correlation between the metabolic profile and acute ischaemic stroke in a rural Hospital in Southern Nigeria. METHODOLOGY This was a prospective cross-sectional study. Fifty consecutive first-ever ischaemic stroke patients presenting within 72 hours of stroke were matched for age and sex with 3 control groups (49 persons with type 2 diabetes and hypertension, 49 persons with hypertension only and 57 apparently healthy individuals). Blood samples were obtained from all participants to determine glycated haemoglobin, fasting lipid profile, fasting plasma glucose, fasting insulin and C-peptide and random plasma glucose (in stroke cases at presentation). Insulin resistance and pancreatic beta-cell function were determined using the Homeostatic Model Assessment (HOMA). Data were analysed by multivariate and univariate statistics. RESULTS One hundred and two (49.8%) males and 103 (50.2%) females participated in the study. The overall mean age of the study participants was 61.6 ± 10.1 years. Compared with the control groups, predictors of acute ischaemic stroke were Fasting insulin (hyperinsulinaemia) [OR (95%CI) = 1.108 (1.043-1.178), p= 0.001], HOMA-β% [OR (95%CI) = 0.994 (0.990-1.001) p=0.006] and total cholesterol [OR (95%CI)= 0.009 (0.001- 0.012) p=0.022]. CONCLUSION In this study, hyperinsulinaemia, impaired beta-cell secretory function (HOMA-β) and elevated total cholesterol were found to be significant risk factors of ischaemic stroke. Hence, the need for regular screening to detect abnormal metabolic profiles and prompt treatment
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    Open Access
    Telemedicine ready or not? A cross-sectional assessment of telemedicine maturity of federally funded tertiary health institutions in Nigeria
    (Sage Journals, 2023-01-01) Olufunlayo, TF; Ojo, OO; Ozoh, OB; Agabi, OP; Opara, CR; Taiwo, FT; Fasanmade OA; Okubadejo NU
    Introduction and objective: Telemedicine has reinforced its position as a means for the continuity of healthcare services and a cost-effective approach to improving health equity as demonstrated during the COVID-19 pandemic. The preparedness of health systems for telemedicine is an indicator of the scalability of their services, especially during catastrophes. We aimed to assess the maturity and preparedness of federally funded tertiary health institutions in Nigeria, to deploy telemedicine as such data are currently lacking and are required to drive improvements in health services delivery. Methods: We conducted a cross-sectional survey of thirty randomly selected federally funded tertiary health institutions in Nigeria using the Pan American Health Organization’s tool for assessing the maturity level of health institutions to implement telemedicine between 17 September 2020 and 1 September 2021. Descriptive statistics were used for overall maturity levels and non-parametric tests to compare scores for overall maturity and specific Pan American Health Organization domains per region. The level of significance was set at p-value <0.05. Results: The response rate was 77.4% (24 of 30 randomly polled federally funded tertiary health institutions responded). Overall, the median telemedicine maturity level was 2.0 (1.75) indicating a beginner level. No significant inter-zonal difference in the median overall maturity level (p =0.87). The median maturity levels for telemedicine readiness in specific domains were organizational readiness – 2.0 (2.0), processes 1.0 (1.0), digital environment 2.0 (3.0), human resources 2.0 (1.0), regulatory issues – 1.5 (1.0) and expertise 2.0 (2.0); mostly at beginner level, with no inter-zonal differences. Most participating institutions had no initiatives in place for domains of processes and regulatory issues. Conclusions: The current telemedicine maturity level of federally funded tertiary health institutions in Nigeria is at the beginner level. This behoves policy-makers to advance the implementation and deployment of telemedicine nationwide as part of digital quality healthcare, to improve health equity and to ensure continuity of healthcare services in the event of another pandemic
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    Open Access
    Telemedicine ready or not? A cross-sectional assessment of telemedicine maturity of federally funded tertiary health institutions in Nigeria
    (Sage Journals, 2023-01) Olufunlayo, T.F; Ojo, O.O; Ozoh, O.B; Agabi, O.P; Opara, C.R; Taiwo, F.T; Fasanmade, O.A; Okubadejo, N.U
    Introduction and objective Telemedicine has reinforced its position as a means for the continuity of healthcare services and a cost-effective approach to improving health equity as demonstrated during the COVID-19 pandemic. The preparedness of health systems for telemedicine is an indicator of the scalability of their services, especially during catastrophes. We aimed to assess the maturity and preparedness of federally funded tertiary health institutions in Nigeria, to deploy telemedicine as such data are currently lacking and are required to drive improvements in health services delivery. Methods We conducted a cross-sectional survey of thirty randomly selected federally funded tertiary health institutions in Nigeria using the Pan American Health Organization's tool for assessing the maturity level of health institutions to implement telemedicine between 17 September 2020 and 1 September 2021. Descriptive statistics were used for overall maturity levels and non-parametric tests to compare scores for overall maturity and specific Pan American Health Organization domains per region. The level of significance was set at p-value <0.05. Results The response rate was 77.4% (24 of 30 randomly polled federally funded tertiary health institutions responded). Overall, the median telemedicine maturity level was 2.0 (1.75) indicating a beginner level. No significant inter-zonal difference in the median overall maturity level (p = 0.87). The median maturity levels for telemedicine readiness in specific domains were organizational readiness – 2.0 (2.0), processes 1.0 (1.0), digital environment 2.0 (3.0), human resources 2.0 (1.0), regulatory issues – 1.5 (1.0) and expertise 2.0 (2.0); mostly at beginner level, with no inter-zonal differences. Most participating institutions had no initiatives in place for domains of processes and regulatory issues. Conclusions. The current telemedicine maturity level of federally funded tertiary health institutions in Nigeria is at the beginner level. This behooves policy-makers to advance the implementation and deployment of telemedicine nationwide as part of digital quality healthcare, to improve health equity and to ensure continuity of healthcare services in the event of another pandemic.
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    Open Access
    Precipitating Factors for Diabetes Foot Ulcer in a Nigerian Tertiary Hospital
    (European- American Journals, 2018-05) Raimi, T.H; Fasanmade, O.A
    The diabetic foot ulcer (DFU) continues to afflict patients with diabetes despite the knowledge of its precipitants. Given the high cost of managing DFU, we sought to determine whether the immediate precipitating factors for the development of foot ulcerations have changed, in order to suggest effective preventive strategies. Methods: This is a descriptive study. The case records of patients admitted for diabetic foot ulcers at Lagos University Teaching Hospital between 2003-2005 were retrospectively reviewed. Information extracted from the notes included age, sex, duration and type of diabetes, fasting and or random/casual plasma glucose at presentation, grade of foot ulcer and the immediate precipitating factors. Results: Twenty-seven case records of patients with DFU were available for analysis. There were 15 (55.6%) males. The age range was 43-83 years with a mean of 61.04years. Type 2 diabetes was present in 92.6% of the patients, while the mean duration of diabetes was 7.98 years (range, 0-27years). Diagnosis of DM was made for the first time in 2(7.4%) of the patients at presentation of the foot problem. The mean admitting fasting and random plasma glucose were 133.3mg% (7.4mmol/L) and 227.2 mg% (12.6mmol/L) respectively. Of the 27 patients, 13 (48.1%) had lesions on the right foot while 6(22.2%) had bilateral DMFS. The majority (85.2%) of the patients had grades 2-4 ulcers. Trauma was the most frequent precipitant occurring in 33.3% of cases followed by tight/ inappropriate shoes or ill-fitting footwear (18.5%). Tinea pedis alone and burns precipitated DMFS in 7.4% and 3.7% of cases respectively, while both tinea pedis and inappropriate foot ware further contributed to DMFS in 3.7% of patients. In 29.6% of cases, the ulcers developed spontaneously. Conclusions/Recommendations: The immediate precipitating factors for diabetic foot ulcer remain unchanged, and can be prevented through patients’ adherence to diabetes treatment, and health education on proper foot care and foot ware practices