Grace Gwabachi EZEOKE
@unilorin.edu.ng
Lecturer, Faculty of Clinical Sciences
Lecturer, Faculty of Clinical Sciences
University of Ilorin
EDUCATION
University of Ilorin
RESEARCH, TEACHING, or OTHER INTERESTS
Health Professions, Obstetrics and Gynecology
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
SummaryBackgroundExcessive opioid prescribing following surgery contributes to the growing opioid crisis. Prescribing practices are modifiable, yet data to guide appropriate prescription of opioids at surgical discharge remain sparse. This study aimed to evaluate factors associated with opioid consumption following discharge from surgery.MethodsAn international prospective multicentre cohort study was performed recruiting adult patients undergoing common general, orthopaedic, gynaecological and urological surgery, with follow‐up 7 days after discharge. The primary outcome measures were the quantities of prescribed and consumed opioids in oral morphine milligram equivalents. Descriptive and multivariable analyses were performed to investigate factors associated with the primary outcome measures.ResultsThis analysis included 4273 patients from 144 hospitals in 25 countries. Overall, 1311 (30.7%) patients were prescribed opioids at discharge. For those patients prescribed opioids, mean (SD) 179 (240) oral morphine milligram equivalents were prescribed, yet only 81 (145) oral morphine milligram equivalents were consumed within the first 7 days after discharge. An increased dose of opioids prescribed at discharge was associated with an increased dose of opioids consumed during the follow‐up period (β = 0.33 (95%CI 0.31–0.34), p < 0.001). The risk of prescribing more opioids than patients consumed increased as quantities of opioids prescribed at discharge exceeded 100 oral morphine milligram equivalents, independent of patient comorbidity, procedure and pain. Patients were prescribed more than twice the quantity of opioids they consumed in the first 7 days following discharge from surgery.ConclusionsOur data suggest that the current quantities of opioids provided at discharge exceed patient needs and may contribute to increasing community opioid use and circulation.
, William Xu, Gordon Liu, Chris Varghese, Cameron Wells, Nicolas Smith, John Windsor, Lorane Gaborit, Sarah Goh, Aya Basam,et al.
Oxford University Press (OUP)
Abstract Background Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures. Methods This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge. Results The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1–30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80–100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. −1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not. Conclusion Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely.
Callistus Elegbua, Hadijat Raji, Sikiru Biliaminu, Grace Ezeoke, and Abiodun Adeniran
African Journals Online (AJOL)
Background: Available information remains limited on inter-pregnancy interval (IPI) and its effect on maternal health and pregnancy outcome.
 Objectives: To determine the effect of IPI on maternal serum ferritin, haematocrit and pregnancy outcome.
 Materials and methods: A prospective cohort study of 316 women categorized into WHO recommended IPI of ≥24 months (group I) and IPI <24 months i.e. short IPI (SIPI) as group II after matching for gestational age and social status. Serum ferritin and haematocrit levels were assayed in first and second trimesters; primary outcome measures were maternal serum ferritin, haematocrit and pregnancy outcome gestational age at delivery, birth and placental weights, APGAR scores and neonatal intensive admission). Participants were followed up until six-week post-delivery. Data analysis was with SPSS version 21.0; p<0.05 wassignificant.
 Results: Women in group I had higher mean serum ferritin (37.40±3.15 vs. 32.61±2.68; P<0.001), booking haematocrit (33.24±3.59 vs. 27.92±2.67; P<0.001) and mean birth weight (3100±310 vs. 2700±350; P<0.001). Antenatal hospital admission (P0.002), preterm delivery (P<0.001) and neonatal intensive care admission (P<0.001) were higher for group II. There was no maternal mortality; perinatal mortality was zero (group I) and 95/1000 livebirth (group II).
 Conclusion: Low serum ferritin, haematocrit and adverse neonatal outcomes were associated with SIPI.
 Keywords: Inter-pregnancy interval; serum ferritin; haematocrit; pregnancy outcome.
Abiodun Adeniran
Texila International Marketing Management
Vasectomy is a safe and effective permanent male contraceptive, although its acceptance remains low in low-income countries. A cross-sectional study was conducted at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between 1st July and 31st August 2020. Participants were 247 consenting male health care workers recruited using systematic sampling based on their profession. Data collection was through a self-administered questionnaire, and analysis was performed using IBM-SSPS Version 23.0; p-value<0.05 was significant. The modal age group was 31-39 years (61.1%), 96.8% had tertiary education, 63.2% were Doctors, 21.5% were Laboratory Scientists, 12.1% Pharmacists, 1.6% Nurses, and 1.6% Physiotherapists; 68.0% had two or more children. Awareness about vasectomy was 93.5%, the commonest source of information was the health facility (55.3%), 76.5% supports the role of men in family planning while 84.0% were willing to share family planning responsibility with their partners 16.6% intend to undergo vasectomy on completion of their family size. The identified hindrances to the uptake of vasectomy were fear that it may lead to sexual dysfunction (87.0%), fear of other side effects (70.3%), irreversibility of the procedure (37.0%), cultural factors (25.0%), and concerns about possible infidelity (20.9%). Knowledge about vasectomy was negatively associated with its uptake (p<0.001). This study reports aversion to vasectomy among male health workers despite adequate awareness and Knowledge due to concerns about possible side effects, including the irreversibility of the procedure. Therefore, while advocacy for vasectomy continues, researchers should expedite actions to make reversible male contraceptives readily available.
Saheed Olanrewaju Jimoh, GRACE GWABACHI EZEOKE, OLAYINKA RABIU BALOGUN, ADEMOLA POPOOLA, ABIODUN SULEIMAN ADENIRAN, and IS'HAQ FUNSHO ABDUL
Babcock Medical Society
Background: Leiomyoma is a benign smooth muscle mesenchymal tumor, usually of uterine origin but may rarelydevelop in the vaginal walls. Case presentation: A case of 40-year-old para 5+0 woman with anterior vaginal wall leiomyoma is reported. Thepresentation mimics that of uterovaginal prolapse and hence presents a diagnostic challenge. The unusualappearance of the protrusion, failure to reduce at any time even while lying down, and complete absence of urinarysymptoms raised the suspicion of a rare case. The diagnosis was made through examination under anesthesia,cystoscopy, and biopsy. Histological examination of the biopsy specimen confirmed vaginal wall leiomyoma. Thepatient had complete excision of the mass without any complications. Discussion and Conclusion: Vaginal wall leiomyoma is a rare benign vaginal lesion that can easily bemisdiagnosed. Diagnosis involves critical clinical evaluation, especially during pelvic examinations. Any vaginalprotrusion should be approached with a high index of suspicion, especially in patients of reproductive age.
GlobalSurg Collaborative Covidsurg Collaborative, Ergin Erginöz, Juan J. Segura-Sampedro and Fardis Vosoughi
Oxford University Press (OUP)
Abstract Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
Grace G Ezeoke, Abiodun S Adeniran, Kikelomo T Adesina, Adegboyega A Fawole, Munirdeen A Ijaiya, and Adebunmi O Olarinoye
African Journals Online (AJOL)
Background: Despite collaborative efforts aimed at its eradication, Female Genital Mutilation/Cutting (FGM/C) continuesin endemic areas.
 Objective: To evaluate the experience and preparedness of female adolescents to protect their future daughters from FGM/C.
 Methods: A cross-sectional survey involving adolescent secondary school girls in North Central Nigeria. Participants were secondary school students who completed the study’s self-administered questionnaire after informed parental or participant’s consent. Data management was with SPSS 20.0 (IBM, USA), P-value <0.05 was significant.
 Results: There were 2000 participants aged 13-19 years (mean 15.56±1.75), prevalence of FGM/C was 35.0%, awareness was 86.1%, mutilation was performed between infancy and eight years of age (mean 3.85±3.24 years), 644(32.2%) desire to mutilatetheir future daughters, 722(36.1%) expressed support for FGM/C and 63.1% of victims of FM/C reported adverse post-mutilation experiences. Support for FGM/C was associated with low social class (P0.0010), opinion that FGM/C has benefit (P0.001) and desire to mutilate future daughters (P0.001) while awareness of efforts to eradicate FMG/C was 813(40.7%).
 Conclusion: FGM/C remains prevalent with potential support for its continuation among female adolescents despite reported adverse post-mutilation experiences. The multi-pronged approach to eradicate FGM/C should prioritize re-orientation for adolescent girls, rehabilitation of mutilated girls and girl child formal education.
 Keywords: Female genital mutilation/cutting; female circumcision, harmful traditional practices, adverse childhood experiences.
Muhibat A. Afolabi, Grace G. Ezeoke, Rakiya Saidu, Munirdeen A. Ijaiya, and Abiodun S. Adeniran
Galenos Yayinevi
Objective: To compare the effectiveness of perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy. Material and Methods: A randomized controlled trial involving women with uterine leiomyoma who underwent abdominal myomectomy was conducted at a tertiary facility in Nigeria. Participants were recruited after they gave informed consent and randomized into group I (single dose 400 μg vaginal misoprostol one-hour before surgery) and group II (intraoperative pericervical hemostatic tourniquet). Eighty participants (40 in each group) were recruited. Uterine size was measured in centimeters above the pubic symphysis, and blood loss estimation involved direct volume measurement and gravimetric methods. The main outcome measures were intraoperative blood loss, blood transfusion, and recourse to hysterectomy. Ethical approval and trial registration were obtained; the data were analyzed using the SPSS software version 21.0; p<0.05 was considered significant. Results: Participants in group I had higher mean intraoperative blood loss (931.89±602.13 vs 848.40±588.85 mL, p=0.532), intra-operative blood transfusion rates (60 vs 55%; p=0.651) and mean units of blood transfused (1.30±1.20 vs 1.20±1.30; p=0.722) compared with group II. The mean uterine size (19.50±6.93 vs 20.05±6.98 cm; p=0.725) and number of fibroid nodules (11.25±7.99 vs 11.45±8.22; p=0.912) were comparable. The change in post-operative hematocrit was 2.66±2.21% vs 3.24±2.85% (p=0.315) and post-operation blood transfusion was 2.5 vs 5% (p=0.556). There was no recourse to hysterectomy in either of the study groups. While adverse effects of misoprostol occurred in 5 (12.5%) participants of group I. Conclusion: The effectiveness of perioperative vaginal misoprostol is comparable to intra-operative hemostatic pericervical tourniquet in reducing blood loss during abdominal myomectomy.
Kikelomo T. Adesina, Moninuola A. Ernest, Abiola O. Tobin, Salamat A. Isiaka-Lawal, Moshood F. Adeyemi, Adebunmi O. Olarinoye, and Grace G. Ezeoke
Informa UK Limited
Abstract Oral diseases have been shown to negatively affect pregnancy outcomes, yet, routine oral health care is not a component of the antenatal care package in Nigeria. This study was designed to describe the pattern of the oral conditions in pregnancy compared to the non-pregnant controls. Two hundred and twenty-five pregnant women and 166 non-pregnant controls were studied from two healthcare facilities in Ilorin. Oral-related complaints were assessed in the pregnant population while both of the groups had an oral cavity examination. The mean age of the respondents was 28.24 years ±4.77 and 80% had at least a secondary school level of education. The prevalence of oral complaints among the pregnant women was 19.1%. Gingivitis was more common among the pregnant women than the non-pregnant women, and more demonstrable on examination. Oral healthcare should be a component of the antenatal care in our environment. Impact statement What is already known on this subject? Women experience oral disorders in pregnancy, which may be worsened by the physiological changes in pregnancy. What do the results of this study add? This study has demonstrated a higher prevalence of gingivitis in the pregnant women than in the non-pregnant women on oral examination. The signs of gingivitis were higher than its related complaints. What are the implications of these findings for clinical practice and/or further research? Therefore, dental care and an examination should be part of a routine antenatal care package to prevent the unwanted pregnancy outcomes that are related to oral disorders.
P O Adeoye, A S Adeniran, K T Adesina, O A Ige, O R Akanbi, A Imhoagene, OOK Ibrahim, and G G Ezeoke
South African Medical Association NPC
Background Endometriosis is defined as the presence of endometrial tissue (stroma and functional glands) outside the uterine cavity in women of reproductive age. Ectopic sites are frequently located in the pelvis; extrapelvic sites have been reported in the gastrointestinal tract and thoracic cavity. Thoracic manifestation of endometriosis constitutes thoracic endometriosis syndrome (TES). Objectives To examine the presentation pattern and outcome of in the management of TES. Methods This study is a retrospective review of medical records of patients diagnosed with endometriosis at the University of Ilorin Teaching Hospital over a 3.5-year period from January 2014 to June 2017. Results A total of 21 patients presented with endometriosis, of whom 8 (38.1%) presented with TES. The most common variety of TES was catamenial pleural effusion (CPE) accounting for 75%, followed by catamenial chest pain (37.5%). Two patients (25%) each presented with catamenial pneumothorax and catamenial haemoptysis, while 1 (12.5%) had catamenial surgical emphysema. Closed thoracostomy tube drainage plus chemical pleurodesis was the most frequent intervention technique, accounting for 62.5%. Conclusion TES remains an uncommon entity, despite being the most common extrapelvic manifestation of endometriosis. CPE appeared to be the most common variant of TES in our environment. Currently available treatment options need to be improved, and more use made of video-assisted thoracoscopic surgery.
Munir’deen Ijaiya, Raji, Aboyeji, Adesina, Adebara, and Ezeoke
Informa UK Limited
Video abstract Video
Olushola Abejide Adegunloye and Grace Gwabachi Ezeoke
Oxford University Press (OUP)
BACKGROUND
The magnitude of sexual health problems and availability of treatment options in the local environment is yet to be documented; thus, there is an urgent need for this, as sexual dysfunction may be a real social and psychological problem, needing urgent attention.
OBJECTIVE
The aim of this study was to investigate the prevalence of sexual dysfunction and pattern of sexual health seeking behavior, among secondary school teachers in Ilorin, Kwara State Nigeria.
METHODS
450 teachers were invited to complete an anonymous self-administered sociodemographic questionnaire, as well as three other instruments measuring human sexuality and general mental health status.
MAIN OUTCOME MEASURES
The survey instrument used were the International Index of Erectile Function (IIEF-5), a modified Sexual Activity Questionnaire (SAQ), and the General Health Questionnaire -30 (GHQ -30). Result were compared with established normative data, and validated cut-off scores that were available.
RESULTS
A total of 417 teachers (93%) responded to the questionnaire. The following prevalence rates were found: female anorgasmia (40%), lubrication failure (30%), dyspareunia (12%), erectile dysfunction, premature ejaculation and male orgasmic disorder (23% each), loss of sexual desire (24%), sexual life dissatisfaction, and relationship dissatisfaction six months prior to interview (10% each), and GHQ-30 scores were significant in sexual dysfunction in both genders, except for female anorgasmia and premature ejaculation in males. However, a presence of psychiatric morbidity was significantly found in overall sexual life dissatisfaction, as well as relationship dissatisfaction. The pattern of sexual health help-seeking behavior showed that majority (53%) do not seek treatment. Of these 53%, many (44%) gave the reason that they thought it transient, ignorance of hospital treatment service (30%), and fear of stigma (26%); also, among those that sought treatment, 46% chose alternative medicine.
CONCLUSION
The prevalence of sexual dysfunctions found in this study is comparable to those reported in earlier Nigerian studies. Despite this and the significant "psychiatric morbidity" experienced in sexual difficulties, apparently no health services have been specially designed to address sexual dysfunction among the teacher's group or the general population at large. This study therefore draws urgent attention to the need for services geared towards alleviating sexual problems, more professional and patient education are recommended.