ABSTRACTBackgroundThe ‘’Chain of Survival’’ (CoS), provides a structure to evaluate an emergency response system for out-of-hospital cardiac arrest (OHCA) in any community. This chain has not been previously evaluated in an African population. The aim of this study was to assess the effectiveness and efficiency of out-of-hospital CPR by evaluating the components of the CoS following sudden cardiac arrest in Nigeria.MethodologyThis was a prospective multicenter descriptive cross-sectional exploratory survey of epidemiology and outcome of sudden cardiac arrest (SCA) in adult Nigerians. The survey was conducted in six University teaching hospitals in the 6 geopolitical zones. Information concerning the patients were obtained from family member or an accompanying person, and hospital emergency department personnel. Exclusion criteria included age < 18 years, incomplete registered data, do not attempt resuscitation (DNAR) decision, and patients in whom resuscitation was not attempted. Primary outcome measures were return of spontaneous circulation (ROSC), survival to hospital admission and discharge.ResultsA total of 387 OHCA patients aged between 18 and 115 years met the inclusion criteria. They consisted of 62.5% males and 37.5% females, giving a male/female ratio of approximately 1.7:1, and the mean age was 49.9 ± 19.15 years. Most (55.6%) of the arrests occurred at home. Ninety-one-point seven percent (91.7%) of the arrests were witnessed. Calls were made to ambulance services but only in a third (34.6%) did ambulance arrive. The time taken for the ambulance to arrive at the call site ranged between 10 minutes and 60 minutes, with a mean time of arrival of 25.6 ±20.5 minutes. Only 14.3% of ambulances had facilities for both BLS interventions. Pre-hospital resuscitation was attempted in 15.2%. Pre-hospital ROSC was achieved in 3.6% of all the SCA events, but only 1.8% survived to hospital admission and were eventually discharged.ConclusionThe emergency response service to OHCA in Nigeria is very poor due to weaknesses in the critical components of the CoS. There is a need for regular evaluation of the effectiveness of the CoS to identify weaknesses, and efforts made to improve performance in every component of the chain, through community wide BLS training.Clinical PerspectiveWhat is new?This is the first large scale multi-center study in Nigeria, and probably in Africa, to evaluate the effectiveness and efficiency of the components of chain of survival in out-of-hospital cardiopulmonary resuscitation, reflecting the complex interplay of resources, setting and bystander engagement on the clinical outcomes of cardiac arrest.The emergency response service system for OHCA in Nigeria is very poor.This study revealed the shortcomings related to cardiopulmonary resuscitation due to resource-limitation, which bellies the practical difficulties inherent in implementing the scientific recommendations on resuscitation formulated primarily from the perspective of a high-resource environment by the International Liaison Committee on Resuscitation.Clinical implicationsThe shortcomings observed in cardiopulmonary resuscitation in this study calls for a well-organized, coordinated deliberate efforts to strengthen all parts of the chain of survival in a manner that emphasizes engagement from the community, and the development of locally implemented, strong pre-hospital chain of care, which is adaptable to the requirements of different cardiac emergencies.There should be a long-term, ongoing evaluation of the CoS to identify weaknesses and efforts made to improve performance in every community through a deliberate effort to ensure training on BLS for everyone (medical and non-medical), and from an early age.

BACKGROUND:The World Health Organization (WHO) non-laboratory cardiovascular disease (CVD) risk chart is sub-region-specific and is advocated in resource-constrained settings. However, the extent of agreement with laboratory-based assessment among hypertensive adults attending primary health centers (PHCs) in the West Africa sub-region remains unknown. This study compared 10-year CVD risk among adults with hypertension attending PHCs in Ghana and Nigeria. MATERIALS AND METHODS:This cross-sectional study recruited 319 adults with hypertension at PHCs in Ghana and Nigeria. All participants had their blood pressure, anthropometrics, fasting blood sugar, and fasting cholesterol measured following standard procedures. WHO laboratory and non-laboratory CVD risks were assessed and compared using Kappa statistics, correlation, and Bland-Altman Plot. RESULTS:The median (interquartile range) for laboratory-based and non-laboratory-based CVD risk scores were comparable [7.0 (4.0 11.0) vs. 7.0 (4.0 to 11.0), p = 0.914]. Of the 319 participants, laboratory-based assessment classified 214 (67.1%) as low risk, while 210 (65.8%) were classified as low risk using the non-laboratory method. Eleven (3.4%) and 14 (4.4%) participants were classified as high-risk using laboratory- and non-laboratory-based methods, respectively. Overall, there was a very good positive correlation between the CVD risk assessment methods (r = 0.948, p<0.001). For all participants combined, there was substantial agreement (Kappa statistics), with K = 0.766. Bland-Altman showed a mean bias of 0.15 (SD = 1.74) in favor of non-laboratory-based assessment of CVD with an upper limit of 3.57 and a lower limit of -3.26. CONCLUSION:There was substantial agreement between laboratory- and non-laboratory-based WHO CVD risk charts in this study. In low-resource settings, such as Ghana and Nigeria, the WHO non-laboratory CVD risk prediction model offers a huge opportunity for primary CVD prevention in adults with hypertension.

Nigeria has the highest reported incidence of peripartum cardiomyopathy worldwide. This open-label, pragmatic clinical trial randomized pregnant and postpartum women to usual care or artificial intelligence (AI)-guided screening to assess its impact on the diagnosis left ventricular systolic dysfunction (LVSD) in the perinatal period. The study intervention included digital stethoscope recordings with point of-care AI predictions and a 12-lead electrocardiogram with asynchronous AI predictions for LVSD. The primary end point was identification of LVSD during the study period. In the intervention arm, the primary end point was defined as the number of identified participants with LVSD as determined by a positive AI screen, confirmed by echocardiography. In the control arm, this was the number of participants with clinical recognition and documentation of LVSD on echocardiography in keeping with current standard of care. Participants in the intervention arm had a confirmatory echocardiogram at baseline for AI model validation. A total of 1,232 (616 in each arm) participants were randomized and 1,195 participants (587 intervention arm and 608 control arm) completed the baseline visit at 6 hospitals in Nigeria between August 2022 and September 2023 with follow-up through May 2024. Using the AI-enabled digital stethoscope, the primary study end point was met with detection of 24 out of 587 (4.1%) versus 12 out of 608 (2.0%) patients with LVSD (intervention versus control odds ratio 2.12, 95% CI 1.05–4.27; P = 0.032). With the 12-lead AI-electrocardiogram model, the primary end point was detected in 20 out of 587 (3.4%) versus 12 out of 608 (2.0%) patients (odds ratio 1.75, 95% CI 0.85–3.62; P = 0.125). A similar direction of effect was observed in prespecified subgroup analysis. There were no serious adverse events related to study participation. In pregnant and postpartum women, AI-guided screening using a digital stethoscope improved the diagnosis of pregnancy-related cardiomyopathy. ClinicalTrials.gov registration: NCT05438576 In this pragmatic, randomized clinical trial involving 1,196 pregnant and postpartum women from 6 hospitals in Nigeria, AI-based electrocardiogram screening proved accurate in detecting cardiomyopathies and suggests that it could improve detection of these conditions.

Red cell distribution width (RDW) quantifies the degree of variation in erythrocyte size, is identified as a potential marker of adverse cardiovascular events, and may be a surrogate marker for assessing cardiovascular disease (CVD) risk in low-resource settings. We evaluated RDW as a predictor of CVD risk compared to the World Health Organization (WHO) CVD risk score among adults with hypertension attending primary healthcare centers (PHCs) in Ghana and Nigeria. Adults with hypertension attending selected PHCs in Ghana and Nigeria participated in a cross-sectional study. Each participant underwent blood pressure (BP) measurement and laboratory evaluation (RDW, total cholesterol, and fasting blood sugar) following standard methods. We recruited 319 adults aged 40–74 years from the study sites. The mean (standard deviation) RDW was 13.96 (1.1

Background: Sickle cell disease (SCD) has evolved from a condition predominantly fatal in childhood to a chronic illness impacting many adults, including women of reproductive age. For females with SCD, pregnancy represents one of the greatest health threats, exacerbating existing health challenges and introducing new risks. Despite advancements in healthcare, routine screening for existing complications like pulmonary hypertension (PH) remains inconsistent, particularly in low- and middle-income countries (LMICs), where the prevalence of SCD is highest. Objective: This study aimed to assess the feasibility of screening for PH in pregnant women with SCD in LMICs, with the goal of enhancing maternal health outcomes in this vulnerable population. Study Design: A prospective multi-center feasibility study was conducted from September 2022 to February 2023 at teaching hospitals in Ghana and Nigeria. The study included pregnant women with SCD between 28 and 34 weeks of gestation. Screening for PH utilized a tricuspid regurgitation velocity (TRV) criterion (>2.5 m/s), with adherence to American Society of Echocardiography guidelines. Statistical analysis included descriptive statistics and proportions. Results: Among 3091 pregnant women attending antenatal care, 88 had SCD (2.8%), and 55 were eligible for the study. We recruited 44 participants (mean age 28.9 years, SD 4.8), with 48% (21/44) SS genotype and 52% (23/44) SC genotype. Most participants (95.3%) had normal TRV (<2.5 m/s), with only one showing elevated TRV, successfully referred. Protocol adherence was 100%. Antenatal outcomes showed 95% echo uptake and 95.7% retention to term whilst postnatal echo follow-up was 43.5%. Notably, 27.1% (10/37) of deliveries required neonatal intensive care unit admission, and 18.2% were preterm. The sole participant with PH required intensive care unit care and experienced a preterm delivery with neonatal death on day 5. Conclusion: Screening and referral for PH in pregnant women with SCD in LMICs are feasible but face challenges in early diagnosis, healthcare personnel availability, and postnatal follow-up. Strategic planning is crucial to address these challenges and improve outcomes in this high-risk population

Purpose Thyroid function alteration is linked to insulin resistance (IR). Limited and conflicting data exist on the thyroid-IR link in African women with hypertension, in the presence or absence of type 2 diabetes (T2DM). This investigation looks into the connection between free thyronine (FT3), free thyroxine (FT4), T3/T4 ratio, and IR in female hypertensive patients with or without T2DM. Methods A cross-sectional study on 122 female participants (≥ 18 years), categorized into three groups: 42 healthy controls, 40 hypertensive (HT), and 40 diabetic hypertensive (HT + DM) patients were recruited. Assessments and comparisons between the groups were made using baseline clinical and biochemical indicators. Results Mean waist circumference, systolic, and diastolic blood pressures were significantly higher in HT (p < 0.001) and HT + DM groups (p < 0.0001) compared to controls. Plasma FT3 levels were higher in HT (p = 0.042) and HT + DM (p = 0.012) compared to controls. HT group exhibited a higher T3/T4 ratio than HT + DM (p = 0.016). Mean HOMA-IR values were significantly elevated in HT (p = 0.044) and HT + DM (p = 0.047) compared to controls, with HT + DM having a higher HOMA-IR than HT. Conclusion These findings demonstrate that FT3 may be a better predictor of insulin resistance compared to FT4 or T3/T4 ratio in hypertensive females with or without type 2 DM.

BACKGROUND:The safety of the COVID-19 vaccines has been a topic of concern globally. This issue of safety is associated with vaccine hesitancy due to concerns about the adverse effects of the vaccines. Consequently, this study determined the short-term safety profile of the Oxford/AstraZeneca COVID-19 vaccine in Ekiti State, Nigeria.METHODS:Descriptive cross-sectional study conducted between May and July 2021 among individuals who had received the first dose of the first batch of the Oxford/AstraZeneca COVID-19 vaccine at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Nigeria. A Google form was used to collect data on the adverse effects of the vaccine.RESULTS:Out of over 1,000 individuals who were approached, 758 respondents completed the study. A large percentage (57.4%) of those who received the vaccines were healthcare workers. Adverse effects were reported in 70.8% of the participants with most manifesting on the first day of the vaccination. The predominant adverse effects were injection site soreness (28.5%), followed by fatigue (18.7%) and muscle pain (8.6%). There was no report of severe adverse effects such as anaphylactic reactions, thrombosis, myocarditis, transient myelitis, or Guillen-Barre syndrome.CONCLUSION:This study found that self-reported adverse effects of the Oxford/AstraZeneca COVID-19 vaccine were mild and short in duration. This outcome has promising implications for improving COVID-19 vaccine uptake in the immediate environment and Nigeria.

Atrial myxomas are rare cardiac tumors that usually present with diverse, unrelated symptoms. Conversely, heart failure (HF) is a common cardiac disorder that is mostly caused by uncontrolled systemic hypertension. It is a progressive cardiac disease that is managed with guideline directed medical therapy (GDMT). We present the case of a farmer who presented with typical symptoms of HF. Echocardiography however revealed an unusual cause of his symptoms-a huge mass in his left atrium (LA) prolapsing through the mitral valve, causing functional mitral stenosis. The mass is suspected to be an atrial myxoma. Surgical excision of this mass is proposed as the cure, which will obviate the need for continuous use of GDMT. This case report and literature review bring to fore the mechanisms by which atrial myxoma can cause HF and the other varied clinical presentations of atrial myxomas.

Given the growing global population of elderly individuals and the potential increase in alcohol-related issues among this group, it is essential to explore the factors that influence alcohol consumption in older adults. A descriptive cross sectional study was carried out in 3 primary health care centres in Ilorin, Northcentral Nigeria, involving consenting patients aged 60 years and above. Each participant completed a proforma designed by the researchers which had sections on socio-demographic variables and alcohol use. The Geriatric Depression Scale (short form) was used thereafter with a cut-off score of ≥ 6 to screen for a presence of depression. A total of 463 elderly patients participated in the study. Alcohol use was statistically significantly higher among males (x = 44.483, p<0.001), those who are married (x = 7.300, p <0.007) and elderly Christians (x = 7.121, p<0.008). The trend though not statistically significant was that those who lived alone, and those who felt lonely were more likely to use alcohol (x = 1.579, p< 0.209 and x = 0.094, p < 0.759 respectively). Probable depression was however not found to be statistically associated with alcohol use (x = 0.025, P < 0.874). There should be an increased index of suspicion by the primary care physicians to identify elderly patients who are at risk of engaging in alcohol use. This will assist in instituting early intervention programmes aimed at preventing alcohol related problems.

BACKGROUND:There are traditional barriers to accessing quality hypertension care in sub-Saharan Africa. Mobile phone technology is increasingly being used to overcome these barriers. This study assessed smartphone ownership and the willingness to receive mobile health services among patients with hypertension in Nigeria.METHODS:Four hundred and twenty-seven (427) patients with hypertension were recruited from two tertiary health institutions in Ekiti State, Nigeria. Questionnaires were fed into the Open Data Kit form, which was used to take data on mobile phone ownership, the willingness to receive and the preferred type of mobile phone-based hypertension health care services.RESULTS:Males were 37.2%. Mean age was 60.6 ± 15.3 years. Of the participants, 48.7% owned smartphones, 21.1% had regular internet subscription on their phones, 94.8% were willing to receive and pay mobile health services. Phone calls (48.0%) and text messages (31.6%) were the most preferred modes of receiving hypertension-related health education. Age category of 45-64 years was the only predictor of willingness to receive mobile health services.CONCLUSION:All our participants owned mobile phones, with 48.7% being smartphones and almost all the participants were willing to receive and pay for mobile health services for prevention, treatment and information on hypertension. Middle age was the only predictor of willingness to receive mobile health, and the most preferred choices were through phone calls and text messages. The above information will guide in the design of favourable mHealth interventions that will be ideal for our study population.

Background Every minute, six indigenous Africans develop new strokes. Patient-level and system-level contributors to early stroke fatality in this region are yet to be delineated. We aimed to identify and quantify the contributions of patient-level and system-level determinants of inpatient stroke fatality across 16 hospitals in Ghana and Nigeria. Methods The Stroke Investigative Research and Educational Network (SIREN) is a multicentre study involving 16 sites in Ghana and Nigeria. Cases include adults (aged >= 18 years) with clinical and radiological evidence of an acute stroke. Data on stroke services and resources available at each study site were collected and analysed as system-level factors. A host of demographic and clinical variables of cases were analysed as patient-level factors. A mixed effect log-binomial model including both patient-level and system-level covariates was fitted. Results are presented as adjusted risk ratios (aRRs) with respective 95% CIs. Findings Overall, 814 (21 center dot 8%) of the 3739 patients admitted with stroke died as inpatients: 476 (18 center dot 1%) of 2635 with ischaemic stroke and 338 (30 center dot 6%) of 1104 with intracerebral haemorrhage. The variability in the odds of stroke fatality that could be attributed to the system-level factors across study sites assessed using model intracluster correlation coefficient was substantial at 7 center dot 3% (above a 5% threshold). Stroke units were available at only five of 16 centres. The aRRs of six patient-level factors associated with stroke fatality were: low vegetable consumption, 1 center dot 19 (95% CI 1 center dot 07-1 center dot 33); systolic blood pressure, 1 center dot 02 (1 center dot 01-1 center dot 04) for each 10 mm Hg rise; stroke lesion volume more than 30 cm3, 1 center dot 48 (1 center dot 22-1 center dot 79); National Institutes of Health Stroke Scale (NIHSS) score, 1 center dot 20 (1 center dot 13-1 center dot 26) for each 5-unit rise; elevated intracranial pressure, 1 center dot 75 (1 center dot 31-2 center dot 33); and aspiration pneumonia, 1 center dot 79 (1 center dot 16-2 center dot 77). Interpretation Studies are needed to assess the efficacy of interventions targeting patient-level factors such as aspiration pneumonia in reducing acute stroke fatality in this region. Policy directives to improve stroke unit access are warranted. Funding US National Institutes of Health. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.

Introduction: Systemic hypertension (SH) contributes the highest number of deaths from cardiovascular diseases worldwide. Patients with resistant hypertension (RH) are more prone to hypertension-mediated organ damage. RH has not been well-studied in Africa, despite the fact that the prevalence of SH is highest in Africa. The aim of the study was to establish the prevalence and predictors of RH among out-patients managed in the cardiology unit of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Method: A cross-sectional study of 201 patients selected via systematic random sampling between April and September 2019. Results: Mean age of the participants was 59.6 (SD 13.8) years, females 58.7%, 32.3% were non-obese, 17 (8.5%) consumed alcohol and three (1.5%) smoked tobacco. 30 participants (14.9%) had co-morbid diabetes mellitus. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly higher among patients with RH 152.5 (SD 18) mmHg vs 131.9 (SD 18.4) mmHg (p<0.001) and 89.43 (SD 13.8) mmHg vs 79.46 (SD 10.5) mmHg (p=0.008). Eighteen patients (8.96%, 95% CI: 5.5-14%) had RH. The predictors of RH were obesity (OR= 3.754; p=0.009), SBP at patients’ first clinic visit, (OR=1.029, p=0.032), DBP at patients’ first clinic visit, (OR=1.048, p=0.014), and serum phosphorus, (OR=1.047, p=0.047). Conclusion: The prevalence of RH among our patients is low and is similar to that in studies with similar blood pressure cut-off values and case definition.

BACKGROUND:The drug use history of a patient is an essential component of a referral letter to a specialist clinic. It guides and enables appropriate patient management while improving the quality of care rendered. There is insufficient data regarding the quality of drug history information in referral letters in this setting.OBJECTIVE:To assess the adequacy of the information on drug history in referral letters received at the antiretroviral therapy (ART) specialist outpatient clinic at the University of Ilorin Teaching Hospital, Ilorin.METHODS:In a retrospective study conducted between January and June 2022, all referral letters received at the ART clinic on clinic days were reviewed for drug history information provided using a data capture form.RESULTS:A total of 142 referrals were reviewed and analyzed. The majority (99.3%) of the referral provided information on patients' socio-demographic characteristics. Most of the referrals (47.2%) were from Family medicine department of the hospital and information on drug history was only provided in 43.0% of the referral letters.CONCLUSION:This study concluded that drug history information was infrequently and incompletely documented in referral letters to an ART outpatient clinic. The use of a structured referral form may be useful and may help to improve the documentation of information on drug history by the referring doctor.

Background: The impact of foot ulceration on the psychosocial wellbeing of the Nigerian diabetic patients has not received enough attention. This study therefore attempted to evaluate the effect of diabetic foot ulcer on the quality of life of adults in a Nigerian diabetic population. Methodology: The impacts of diabetic foot ulcer (DFU) on the quality of life (QoL) of 104 adults living with diabetes were assessed using The Diabetes Foot Ulcer Scale and their determinants. Results: The mean QoL score was 42.25. Fifty-five (53.4%) had poor QoL status while 48 (46.6%) had good QoL. Determinants of poor QoL outcome include low socio-economic status (p = 0.017), lack of a tertiary education (p= 0.027), no diabetes-education (p = < 0.001), low socioeconomic status (p = 0.017), multiple ulcers (p = 0.022) and Wagner grade >3 ulcers (p = 0.004). Conclusion: Majority of patients with DFU in UITH, Nigeria have poor QoL and most of the predictors of poor QoL outcome are preventable and modifiable.

Introduction: Mental health disorders in undergraduates are often undetected and may predispose to other academic and social complications. The objective of the study is to determine the prevalence of probable psychiatric morbidity among students of University of Ilorin, Nigeria and the psycho- social factors that are associated with psychiatric morbidity in them. Methods: Socio-demographic questionnaire and the 12-item General health questionnaire (GHQ-12) were administered to 3,300 undergraduate students to assess psychosocial variables and psychiatric morbidity respectively. Results: About 23.5% of respondents scored >3 using the GHQ-12 questionnaire, signifying a likehood of psychiatric morbidity. Students from polygamous families were 1.3 times more likely to have GHQ scores of >3 than those from monogamous (OR=1.276, P=0.026). Those who had unemployed fathers were twice more likely to have a GHQ > 3 than those with employed fathers. (OR=2.084, P=0.005).Those who lived in houses with shared toilet facilities were 1.3 times more likely to have GHQ >3 (OR=1.310, P=0.028) Conclusion: This study calls for a careful consideration and modification of the various psychosocial factors associated with pschiatric morbidity in order to ensure a mentally healthy and vibrant student community.

Background: Smartphone use has been shown to have effects on psychological health outcomes. There is evidence that the psychological effects of smartphones on young people are significant. It is associated with anxiety, depression, and psychological distress in various populations. The tendency to spend cumulatively long durations exposed to smartphones is an emerging phenomenon among university undergraduates. This study aimed at determining the relationship between smartphone use and psychological distress in university undergraduates. Methods: Data for this cross-sectional study were collected from 3,325 undergraduates of the University of Ilorin, Nigeria in September 2021 using a Sociodemographic proforma, Smartphone Addiction Scale-Short version, and psychological distress was measured using the 12-item General Health Questionnaire (GHQ12). Data were analyzed using SPSS 23. Results: The mean age of respondents was 21.3+2.59 years, and 1835 (55.2%) of them were females. In addition, 3305 (99.4%) owned smartphones, and 720 (21.7%) had more than one smartphone. Psychological distress was present in 1097 smartphone users (33.2%). The level of study (P=0.002), presence of problematic smartphone use (PSU, P<0.001), total time spent on the phone per day (P=0.014), and the time spent on social media per day (P<0.001), as well as leaving the phone data on all day (P=0.001) and engaging in overnight calls or social media chats (P<0.026), Facebook (P=0.001), WeChat (P=0.001), and Snapchat (P=0.001), were significantly associated with psychological distress. Independent predictors of psychological distress were being in year 5 (OR=0.548, P=0.008), presence of PSU (OR=1.586, P<0.001), switching on phone data throughout the day (OR=1.388, P<0.001), and use of WeChat (OR=1.451, P<0.027) and Facebook (OR=0.703, P<0.001). Conclusion: Our findings revealed that important smartphone-related indices such as PSU, switching on phone data access all day, and WeChat were predictive of increased levels of psychological distress. Structured counselling about the productive use of smartphones should be administered in the early years of study for university undergraduates.

Background: Drug use is the most common option in treating disease conditions in clinical practice. Irrational prescription and use of medicine have become a major problem in Africa. The patterns of medication prescription in this environment have been under-studied. Evaluating these patterns is essential to provide information that may guide actions towards improving the prescription standards and mitigate the problems associated with irrational prescription and use of medicine. The study aimed to assess medication prescribing patterns by all cadres of doctors in the General Outpatient Department of the University of Ilorin Teaching Hospital (UITH) using the World Health Organization (WHO) prescribing indicators. Methods: It was a six-month retrospective study of medication prescription by all cadres of the doctors attending to outpatients in the General Outpatient Department of UITH between 1st July, 2022 – 31st December, 2022. A validated data capture form was used for the study following the WHO prescribing indicator guidelines. The results were displayed using the arithmetic means, frequencies, and percentages. Results were interpreted by the recommended ideal values by the WHO. Results: 1,650 prescriptions were reviewed, 914 were included in the study. This study found that all the analyzed prescription indices fell short of the WHO-recommended threshold. An average of 2.25 medications were prescribed per patient. The percentages of encounters with injections, antibiotics, and other medications by generic name were 87.2%, 66.9%, and 73.2%, respectively. 53.8% of the medications prescribed came from the essential medicine list. Conclusion: All medication prescribing indicators assessed were found to be below the ideal value recommended by WHO. Therefore, we advocated for the training of prescribers and the formulation of policies that will promote the prescription of medications in line with WHO guidelines.

Human immunodeficiency virus (HIV) disease is a chronic medical condition that requires lifelong treatment. Specialist care is of importance in its management and referral process to a specialist is mostly initiated through a referral letter. The ability to design a good management plan during consultation depends on the quality of clinical information in the referral. This study was designed to assess the information provided in referral letters presented to Antiretroviral Therapy (ART) outpatient specialist clinic in a tertiary hospital in Nigeria It was a retrospective study conducted between January and June 2022. All referral presented to ART clinic on clinic days were reviewed for information provided using a data capture form. A total of 142 referrals were analyzed. The majority of the referral provided information on patient identifiers. Information on clinical parameters considered important for quality review and management were generally unsatisfactory. Less than a quarter of the referral provided information on laboratory investigations like cluster of differentiation 4 count. Majority (97.9%) of the referrals stated the reason for the referral but physical examination findings and medication history were only reported in 38.7% and 43% respectively. Referral letters to ART clinic were deficient in the information needed for quality review. The deficiencies delayed patient management. Institution of measures to address the deficiencies will help to improve HIV care. The use of a structured referral form and training of doctors on the required information in a referral letter will also impact positively on HIV care.

Abstract Heart failure (HF) is a major cause of morbidity and mortality worldwide. Despite the advancement in its treatment the rate of rehospitalization of patients after treatment for HF is still high around the world. Studies assessing rehospitalization rates of HF patients are few in Nigeria. The objective of the study was to determine the 180-day rehospitalization rate and predictors of rehospitalization in acute HF patients managed in our Centre. The study was a retrospective cohort study of 148 patients with acute HF. The 180-day rehospitalization rate in our patients was 16.2%. The median time to rehospitalization was 61days. Serum urea (p=0.016), serum creatinine (p=0.033), admission eGFR < 60mls/min/1.73m2 (p=0.007), LVEF (p=0.045) were associated with rehospitalization. eGFR < 60mls/min/1.73m2 was an independent predictor of 180-day rehospitalization OR 5.4, (CI 1.701-7.690), p=0.014 suggesting 5 times greater likelihood of rehospitalization than patients with higher eGFR. The Kaplan-Meier survival curve for 180-day rehospitalization was plotted. In conclusion, the 180-day rehospitalization rate among our patients varies from other reported rates in our environment. Acute HF patients with renal dysfunction have a high likelihood of medium term rehospitalization and hence constitute an at-risk group for targeted intervention during admission.

Electrocardiography (ECG) is one of the most widely used recordings in clinical medicine. ECG deals with the recording of electrical activity that is generated by the heart through the surface of the body. The electrical activity generated by the heart is measured using electrodes that are attached to the body surface. The use of ECG in the diagnosis and management of cardiovascular disease (CVD) has been in existence for over a decade, and research in this domain has recently attracted large attention. Along this line, an expert system (ES) and decision support system (DSS) have been developed for ECG interpretation and diagnosis. However, despite the availability of a lot of literature, access to recent and more comprehensive review papers on this subject is still a challenge. This paper presents a comprehensive review of the application of ES and DSS for ECG interpretation and diagnosis. Researchers have proposed a number of features and methods for ES and DSS development that can be used to monitor a patient’s health condition through ECG recordings. In this paper, a taxonomy of the features and methods for ECG interpretation and diagnosis were presented. The significance of the features and methods, as well as their limitations, were analyzed. This review further presents interesting theoretical concepts in this domain, as well as identifies challenges and open research issues on ES and DSS development for ECG interpretation and diagnosis that require substantial research effort. In conclusion, this paper identifies important future research areas with the purpose of advancing the development of ES and DSS for ECG interpretation and diagnosis.