Background: A lot has been documented about the pathophysiology and clinical presentation of coronavirus disease 2019 (COVID-19). We compared the clinical features of real-time reverse transcriptase polymerase-chain-reaction (RT-PCR) confirmed COVID-19 positive and negative patients admitted in Lagos State. Methods: Medical records of all patients admitted in 15 isolation centres across Lagos state between 27^th February 2020 and 30^th September 2020, were abstracted and reviewed. We compared the clinical features, co-morbidities and clinical outcomes of COVID-19 positive and negative patients. Results: A total of 3157 records of patients admitted in 15 isolation centres in Lagos State were reviewed of which 302 (9.6%) tested negative to RT-PCR COVID-19. There was no gender difference between COVID-19 positive and negative patients (P = 0.687). The average age of the negative patients was higher (46.8 ± 18.3 years) than positive patients (41.9 ± 15.5 years) (P < 0.001). A higher proportion of the COVID-19 negative patients had co-morbidity (38.1% vs. 27.8%), were symptomatic (67.5% vs. 44.6%) and higher mortality (21.9% vs. 6.6%) than positive patients (P < 0.001). The percentages with hypertension (26.2% vs. 21.0%, P = 0.038), diabetes (17.2% vs. 9.4%, P < 0.001), cardiovascular disease (2.3% vs. 0.9%, P < 0.029) and cancer (2.3% vs. 0.5%, P < 0.002) were more among patients without COVID-19. More patients without COVID-19 presented with fever (36.1% vs. 18.8%), cough (33.7% vs. 23.1%) and breathlessness (40.8% vs. 16.1%) than the positive patients (P < 0.001). Conclusion: Anosmia and dysgeusia were strongly associated with COVID-19. Clinical decision-making should only be used to prioritise testing and isolation of patients suspected to have COVID-19, especially in settings with limited access to diagnostic kits.

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Introduction: Coronavirus disease 2019 (COVID-19), a highly transmissible viral infection has spread worldwide causing exponential increase in morbidity and mortality. But so far, there is limited information available to describe the presenting characteristics, outcomes and treatment modalities of COVID-19 patients in Nigeria. This study aimed to describe the demographic and clinical characteristics, underlying comorbidities, treatment modalities and outcomes of patients isolated and treated in a repurposed COVID-19 isolation and treatment centre in Abuja, Nigeria. Materials and Methods: A retrospective study which reviewed the medical records of 300 confirmed COVID-19 patients isolated and treated according to the World Health Organisation and Nigeria Centre for Disease Control guidelines between 22^nd July and 26^th October, 2020 in ThisDay Dome Isolation and Treatment Centre. Data collected from the medical records include demographics, clinical features, treatment measures and outcomes. Results: Out of 300 patients studied, 61.0% were male. The mean age of the participants was 38.2 ± 14.7. Less than half of the patients (40.3%) had one or more underlying comorbidities with hypertension the most common co-morbidity. Majority (62%) of patients were mildly symptomatic, 33% were asymptomatic while only 2% were severely symptomatic. The most common presenting symptoms include cough 34.0%, fever 30.3%, anosmia 28.7% and dysgeusia 22.7%. Older age (P < 0.001), tertiary education and the presence of underlying comorbidity (P < 0.001) were significantly associated with symptomatic presentation of COVID-19. The median duration of time between positive laboratory testing and presentation for treatment was 5 days (0–29). All patients were treated with a combination of Ivermectin, Azithromycin, Zinc and Vitamin C with no recorded death. The median length of stay at facility was 9 days. Conclusion: Close attention should be given to patients with co-morbidities as an inefficient management of such co-morbidities could lead to mortalities which may not be directly attributable to COVID-19.

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Background and Aims: There is a high possibility of transmitting the coronavirus (severe acute respiratory syndrome coronavirus 2) in the orthodontic clinic because orthodontists and their patients are in very close contact when orthodontic care is being given. The aim of this study was to evaluate the knowledge and perception of Nigerian orthodontists and orthodontic residents about the risks of COVID-19 as well as the extra-protective infection control measures that need to be taken. Materials and Methods: This was a descriptive, cross-sectional study. The questionnaires were distributed and retrieved from consenting participants through an online platform. The questionnaires were analysed using the Statistical Package for the Social Sciences software version 23. The results were presented in tables and charts. Results: Out of a total of 90 members on the association's WhatsApp group as at the time the study was being conducted, a total of 48 respondents participated in this study. There were more females (60.4%) than males. Majority (97.9%) of the respondents agreed/strongly agreed that an infected patient could infect the orthodontic clinic staff members with COVID-19 while most were of the view that debonding (95.8%) and retainer delivery (70.8%) posed a risk for spread of the virus. More than half of the respondents (52.1%) considered it necessary to change N95 masks after each patient as an extra-protective measure against COVID-19. Conclusions: Majority of the respondents knew about the risks that COVID-19 posed to different aspects of orthodontic practice and were also knowledgeable about some of the extra-protective measures that they should take. There is a need to improve the knowledge of the participants concerning the use of appropriate mouth rinses to reduce the risks of transmission of COVID-19 in the dental/orthodontic clinic.

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Background: Poor compliance with recommended hand hygiene practise by health-care workers is an emerging public health threat associated with significant morbidity, mortality and spread of multidrug-resistant microorganisms. Objective: This study assessed the effect of voice reminder on compliance with recommended hand hygiene practise among the baseline, and post-intervention compliance with recommended hand hygiene among health-care workers using the WHO checklist for observation of 5-moments of hand hygiene of health-care workers in Kano. Methods: Quasi-experimental study design was used. A total of 408 (204 in each arm) baseline and post-intervention observations were conducted in two hospitals in Kano, selected using a multistage sampling technique. Voice reminders were installed in the intervention hospital, and post-intervention observation was conducted 3 months after introducing a voice reminder. SPSS version 22.0 was used for data analysis. Relationship between variables was tested using χ² and McNemar's test within the groups at 0.05 α-level of significance. Results: Baseline compliance with hand hygiene in the intervention and control hospitals were 31.4% and 48.0%, respectively. Post-intervention compliance in the intervention and control hospitals were found to be 78.0% and 65.2%, respectively. Voice reminder improved compliance with hand hygiene practise when compared with baseline by +148% (P# = 0.3) in the intervention hospital compared with +36% (P# =0.1) in the control hospital. The differences were not statistically significant post-intervention when compared with the baseline. Conclusions: Voice reminder intervention improved hand hygiene compliance among health-care workers in the intervention hospital compared with the control hospital. Voice reminders should be provided in the hospitals by stakeholders. This can help in improving compliance with hand hygiene among health-care workers and reducing the burden of hospital-acquired infections due to the hands of health-care workers.

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Background: The modern arterial tourniquet is an automatic tourniquet system which contains many features that help to minimise complications and improve safety. However, the non-pneumatic tourniquet is still in use, a practice that may be commoner in resource-constrained settings. This study was conducted to investigate the types of tourniquet available and used by orthopaedic surgeons in Nigeria as well as the practical aspects and complications of their use of the tourniquet. Materials and Methods: At an Annual General Meeting/Scientific Conference of Nigerian Orthopaedic Association, a survey was conducted among orthopaedic surgeons using a pre-tested self-administered questionnaire which contained questions on types of tourniquet, practical aspects of the use of tourniquet and complications. Results: The non-pneumatic tourniquet was usually used by 60.2% of the respondents and 58.1% of those who had both pneumatic and non-pneumatic tourniquets used the latter more commonly. In most cases, the tourniquet was applied by surgeons or surgical residents on the arm or thigh. Surgeons who had ever used the tourniquet in diabetic patients were 71.6% while 29.5% had used it in patients with sickle cell disease. Tourniquet duration was usually 1½ h and 2 h in the upper and lower limbs, respectively. The two most common complications were tourniquet palsy and tourniquet pain. Conclusions: The non-pneumatic tourniquet was more commonly used than the pneumatic tourniquet. Application of the tourniquet on sites other than the thigh and the upper arm were uncommon. The most common complication was neurologic injury.

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Uterine malformations are often asymptomatic but can be associated with a wide range of reproductive problems. We report a case of uterine fusion defect diagnosed intra-operatively in a 20-year-old primigravida who had elective caesarean section at term on account of breech presentation at term. Intraoperative findings included a cone-shaped uterus with narrowed fundus and the appendages emerging at the fundus and lower uterine segment on the right and left respectively. This is a rare fusion defect and makes a case for review of the existing uterine malformation classification systems, to make it all encompassing.

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Background: Understanding pattern and outcome of traumatic spinal cord injury (TSCI) will inform better management which expectedly would improve prognosis and minimise complications. Methods: A retrospective study was carried out on all managed TSCI cases from January 2009 to December 2018. Sociodemographic characteristics, injury type, cause and complications were extracted from patients' registers and case folders. Descriptive statistics summarised the data, and Fisher's exact test analysed associations between variables. Results: Eighty-one cases met the inclusion criteria and were analysed. Most cases (91.4%) were males, aged 18–39 years (65.4%) and were civil servants (37.0%). Road traffic accident (RTA) was the leading cause of injury (37.0%) and incomplete lesion predominated (69.1%). Cases referred for physiotherapy constituted 77.8%, only 14.8% of cases recovered without neurological deficits. On discharge, most patients were wheelchair bound (33.3%). Region of spine affected showed significant association with complications developed (P = 0.01). RTA caused more dead as a cause of injury was found to be significantly associated with outcome (P = 0.04). Referral for physiotherapy showed significant association with outcome (P = 0.01), so also, region of spine affected with outcome (0.01). The study found a significant association between type of injury and functional status (P = 0.01). Conclusions: The study concludes that young adults of working class were mostly affected, and RTA and gunshots injuries were the leading causes of TSCI. Findings such as the association found between regions of spine affect and complication developed on admission will help healthcare providers identify those susceptible and offer prompt preventive measures.

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Background: Various regional anaesthetic techniques are used for post-mastectomy pain relief; however, thoracic paravertebral block (TPVB) has shown some advantages over other methods. This study sought to demonstrate the post-operative benefit of pre-operative TPVB in patients scheduled for simple mastectomy. Methods: The study was carried out on 60 adult female patients with the American Society of Anesthesiologists physical status Class I to III scheduled for unilateral mastectomy. Pre-operatively, a nerve stimulator was used to locate the paravertebral space thereafter bupivacaine with adrenaline or saline was injected into the space. Post-operatively, intravenous morphine patient controlled analgesia was commenced in the two groups for 24 h after the surgery. In addition, intravenous paracetamol 15 mg/kg was administered 6 hourly for 24 h in both groups. Results: The 24 h morphine consumption was significantly reduced in the bupivacaine group compared to the control group (P = 0.000). The Numerical pain rating score was significantly lower in the bupivacaine group than in the control group in the 1^st 6 h; P = 0.001. The time to first request for analgesia was significantly longer in the bupivacaine group than the control group (P = 0.000). Nausea was the major side effect detected and this was significantly higher in the control group (P = 0.024). The morphine sparing effect was 65.7% in the bupivacaine group. Conclusion: The study showed that bupivacaine-based TPVB provided an effective post-operative analgesic and opioid-sparing effect for simple mastectomy when compared with a saline-based control group that received only intravenous morphine patient controlled analgesia and paracetamol.

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Context: Ovarian tumours are known to be diverse biologically, varying from non-malignant to malignant tumours having implication on course of the management and prognosis. To address the paucity of such study on ovarian neoplasm from our region of West Bengal, we planned and executed this study. The aim of the study was to analyse the distribution of various ovarian tumours and classify them according to the biological behaviour, age, laterality, and mode of the presentation. Setting and Design: It was a retrospective study done in a tertiary care center of Kolkata, India. Methodology: A retrospective data of 4 years comprising 84 cases were included in the study from January 2016 to December 2019. All the slides were retrieved from the archives and re-evaluated and cross-checked with patients' clinical history, demographic, and macroscopic findings. Results: Out of these 84 tumours, maximum cases were of surface epithelial neoplasms (69%) followed by germ cell tumours (26.1%). Age interval of 19–40 years accounted for the highest number of individuals with equal predominance of both sites of the ovary. Serous cyst adenocarcinoma was the most common malignant tumour. Conclusion: Histological examination remains the mainstay in the early diagnosis of ovarian tumours and facilitates timely appropriate management of patients, and hence, reduces overall mortality in women.

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Background: With the advent of endoscopic sinus surgery, the variant neurovascular relations of the sphenoid sinus are important to surgeons to minimise the iatrogenic complications. This study elucidates the variant neurovascular relations of the sphenoid sinus in adult Nigerians. Materials and Methods: This study was conducted at the Radiology Department of Delta State University Teaching Hospital after institutional approval. Brain computed tomography images of 336 patients, aged ≥20 years and spanning over 5 years' duration were utilised. We evaluated the sphenoid sinus for protrusion and dehiscence of neurovascular structures bilaterally. The position of the optic nerve in relation to the sinus was classified from Type 0–4. The Statistical Package for the Social Sciences software version 23 was used for the data analysis. The Chi-square test was used to probe for the association between the variants with regard to side and gender. P < 0.05 was considered statistically significant. Results: Dehiscence and protrusion of the internal carotid artery (ICA) occurred in 34, 10.1% and 83, 24.7% patients correspondingly. The dehiscence of optic, maxillary and Vidian nerves was (26, 7.7%), (60, 17.9%), and (53, 15.8%), whereas the frequency of their protrusion was (50, 14.9%), (76, 22.6%) and (87, 25.9%), respectively. All these variants except the ICA and maxillary nerve dehiscence showed a significant association with the side of occurrence (P = 0.001). Out of the 672 optic canals evaluated bilaterally, a preponderance of Type I (534, 79.5%) was observed followed by II (96, 14.3%), IV (35,5.2%), III (7, 1.0%) and Type 0 (0, 0%). Conclusion: Our study has shown that the neurovascular relations of the sphenoid sinus vary from previously documented reports, thus confirming the need for pre-operative evaluation.

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Background: Waterpipe smoking (WPS) has been reported to have a wide range of damaging health effects on pulmonary and cardiovascular systems. Studies suggest that waterpipe tobacco smoking is associated with reduced harm perceptions, mental health problems and the use of psychoactive substances. We investigate the patterns of use and the association of WPS with anxiety, poly-tobacco and alcohol use in Lagos, Nigeria. Materials and Methods: A cross-sectional study design was used to assess the data from 818 adolescents and adults in Lagos State, Nigeria. An online questionnaire obtained demographic information, waterpipe, e-cigarette, alcohol and other tobacco product use from respondents. Anxiety was assessed using the validated Generalised Anxiety Disorder 7-point scale. Bivariate and multivariate logistic regression analysis was used to identify the factors associated with waterpipe ever-use. P < 0.05 was considered statistically significant. Results: The mean (standard deviation) age of respondents was 23.43 (±3.96), over half were female (55.2%) and a majority had a college diploma or more (88.59%). Among study participants, 18.58% reported waterpipe ever-use. Among ever waterpipe users, 17.33% reported current use (past 30-days), with a majority having smoked waterpipe in a bar or pub. Alcohol use (P < 0.001), e-cigarette ever-use (P: 0.010) and poly-tobacco ever-use (P: 0.030) were significantly associated with higher odds of waterpipe use in the multivariate regression model. Further, there was a lower likelihood of waterpipe ever-use in the bivariate regression model among respondents with mild and moderate to severe anxiety levels than those with normal anxiety levels (P: 0.030); however, this association was no longer significant in the adjusted model. Conclusions: Our findings suggest a relatively high prevalence of WPS in Lagos, Nigeria. Concurrent alcohol consumption, e-cigarette and poly-tobacco use are associated with WPS, and most waterpipe smokers have normal anxiety levels. The Nigerian Government should consider surveillance measures for WPS and a more comprehensive smoke-free policy.

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Introduction: Existing evidence suggests that barotitis media (BM) is common among air travellers, and it has the potential to cause severe discomfort and sometimes permanent hearing and balance deficits. It has not been studied in Nigeria. Objective: This study aimed to assess the pre-air travel health-seeking behaviour, prevalence of BM, knowledge of BM and its associated factors among a cohort of outpatients with a history of recent air travel in Kano, Nigeria. Materials and Methods: This questionnaire-based survey involved 97 participants systematically and proportionately selected from adult patients or caregivers of children with recent air travel history attending two outpatients clinics over 7 weeks. Information on biodata, pre-air travel advice-seeking behaviours, air travel experience and BM knowledge were obtained. Data were analysed using the descriptive statistical methods, Chi-square or Fisher's exact tests and odds ratio (OR). Results: Most participants were male (54.6%) with tertiary education (87.6%); the prevalence of BM was 44.3% (43/97). Only 2.1% (2/97) had ever sought pre-air travel advice from a doctor; 83.5% (81/97) had heard of BM before; 42% had adequate knowledge of BM. Employment status (Fisher's exact, P = 0.001), clinic at recruitment (Fisher's exact, P = 0.00008), duration of last flight (Fisher's exact, P = 0.0001) and persistent ear-pain after landing (Fisher's exact, P = 0.001) were significantly associated with participants' knowledge of BM. Persistent ear-pain after landing was the predictor of BM knowledge (OR = 0.04, 95% confidence interval [0.002–0.67], P = 0.025). Conclusion: The BM knowledge level of this cohort suggests the need for further studies to ascertain the complete picture and justify improved pretravel education of air travellers in our setting.

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