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issn:2229-774
1.  Obstetric predictors of hypertension: A cross-sectional study of women attending the postnatal clinic of Jos University Teaching Hospital 
Background:
Hypertensive disease in pregnancy (HDP) accounts for high mother and child morbi-mortality and predict future cardiometabolic diseases. This study aimed to identify obstetric predictors of HDP needing preventive action to reduce its consequences; when women present to antenatal clinic (ANC).
Materials and Methods:
Cross-sectional descriptive this was an Interviewer-administered semi-structured questionnaire-based study of the anthropometric, and blood pressure measurementsin attendees at the postnatal clinic (PNC) of Jos University with ANC records.
Setting:
Six weeks postnatal clinic (PNC) of Jos University Teaching Hospital (JUTH).
Results:
The following indices proved predictive of HDP and subsequent hypertension: weight (P = 0.009), hip circumference (P = 0.018), parity (P = 0.043), waist circumference (P = 0.00), abdominal height (P = 0.040), waist/height (P = 0.020), history of developing hypertension in previous pregnancy (P = 0.000), birth weight of baby (P = 0.02), and mode of delivery (P = 0.05).
Conclusion:
To initiate preventive action on ANC registration in mitigating effects of or outrightly preventing HDP, careful check on anthropometry as well as history of hypertension or operative/preterm delivery in a previous pregnancy is necessary
doi:10.4103/0300-1652.193856
PMCID: PMC5126743  PMID: 27942098
Hypertension; Nigeria; obstetric; predictors
2.  Dietary practices and nutritional status of under-five children in rural and urban communities of Lagos State, Nigeria 
Background:
Evidence shows that urban children generally have a better nutritional status than their rural counterparts. However, data establishing whether this difference in prevalence of undernutrition could be ascribed to difference in dietary practices are few.
Objective:
The aim of this study was to compare dietary practices and nutritional status of children in rural and urban communities of Lagos State, Nigeria.
Methods:
This was a comparative-analytical study conducted using the multistage sampling technique to select the study cases. A total of 300 mother–child pairs were studied, including 150 each from rural and urban communities. Data collected include demographics, socioeconomic characteristics, feeding practices and anthropometric measurements of the participants. Food intake data were collected using 24-h dietary recall. Malnutrition in children was determined by calculating the prevalence of low height-for-age (stunting), low weight-for-age (underweight), and low weight-for-height (wasting) using the World Health Organization cutoff points.
Results:
The prevalence of exclusive breastfeeding for 6 months (25.3% vs. 28.7%; P = 0.516), use of formula feeds (48.7% vs. 44%; P = 0.077), and mean age of child at introduction of semisolid foods (7.54 ± 4.0 months vs. 8.51 ± 7.3 months; P = 0.117) were not significantly different between urban and rural communities. The diversity of food choices and frequencies of consumption were similar between urban and rural communities. However, prevalence levels of underweight and stunted children were significantly higher in rural than that of urban communities (19.4% vs. 9.3%, P < 0.001 and 43.3% vs. 12.6%, P < 0.001, respectively).
Conclusions:
Other risk factors besides inappropriate feeding practices need to be considered for higher prevalence of undernutrition among children in rural communities.
doi:10.4103/0300-1652.193854
PMCID: PMC5126741  PMID: 27942096
Children; dietary practices; Nigeria; nutritional status; rural; urban
3.  Sociodemographic profiles and use-dynamics of Jadelle (levonorgestrel) implants in Jos, Nigeria 
Background:
Contraceptive implants (including Jadelle) are highly effective, safe, and easy to use and have a long duration of action. They do not interfere with intercourse with immediate return to fertility after removal. However, disruption of the menstrual bleeding pattern is almost inevitable and coercive prescription may be a problem because insertion and removal of implants are provider dependent. The objective of this study was to determine the sociodemographic profiles of acceptors of Jadelle and the reasons for discontinuation in Jos, Nigeria.
Materials and Methods:
This was a 6-year retrospective chart review carried out at the Jos University Teaching Hospital.
Results:
About 1401 women accepted Jadelle with a mean (±standard deviation) of 33.4 ± 5.9 years. About 88% of the women were Christians and almost three-quarters (73.5%) had at least secondary school education. The means of parity and number of children still alive at the time of accepting Jadelle were 4.1 and 3.8, respectively. Half of the women (49.5%) were breastfeeding and over half (55.9%) had future fertility desires at the time of commencing Jadelle. About 82% had previously used other contraceptives (mostly short-acting methods such as injectables, pills, and condoms), with only 18% starting Jadelle as the first-ever contraceptive method. About 90% of the women had regular menstrual cycles. The major reason for discontinuation of Jadelle was desire for pregnancy although menstrual pattern disruption was the most common reason for removal in the first 6 months of use.
Conclusion:
The main reason for discontinuation of Jadelle was to have more children although menstrual pattern disruptions accounted for earlier discontinuation.
doi:10.4103/0300-1652.193855
PMCID: PMC5126742  PMID: 27942097
Jadelle; Jos Nigeria; sociodemographic profile; use-dynamics
4.  Study of pentoxifylline effects on motility and viability of spermatozoa from infertile asthenozoospermic males 
Background:
The quality of semen is one of the major parameters in male infertility. Pentoxifylline, a methylxanthine derivative, is an agent primarily used in the treatment of intermittent claudication and other vascular disorders. Studies have shown that pentoxifylline enhances the quality and quantity of sperms. In this study, we have investigated the in vitro effects of pentoxifylline on viability and motility of spermatozoa in samples of infertile oligoasthenozoospermic males.
Materials and Methods:
In this observer-blinded clinical trial, semen samples of 25 infertile oligoasthenozoospermic males were collected in Alzahra Educational Medical Center of Tabriz University of Medical Sciences from August 2010 to August 2012. After the isolation of spermatozoa by the swim-up method, they were randomized into four groups in ISM1 environment: The controls treated normally: Group 1 treated by pentoxifylline at a dose of 50 μg/ml, Group 2 treated by pentoxifylline at a dose of 100 μg/ml, and Group 3 treated by pentoxifylline at a dose of 200 μg/ml. Sperm viability and motility were compared among the groups on 45 min, 24 h, 36 h, and 48 h intervals.
Results:
Mean percentages of live sperms were 98.40%, 51.40%, 20.60%, and 6.00% in control group and 98.40%, 69.20%, 38.60%, and 14.60% in Group 3 on the mentioned intervals, respectively. This mean percentage decrease of live sperms was significantly lower in Group 3 comparing with that of other groups (P = 0.01). Mean percentages of motile sperms were 54%, 8.40%, 2.80%, and 0% in control group; and 54%, 16%, 4.80%, and 1.40% in Group 3 on the mentioned intervals, respectively. There was not a significant difference between the four groups in this regard (P = 0.19).
Conclusion:
Pentoxifylline can enhance the viability of sperm of infertile oligoasthenozoospermic males with no significant effect on its motility.
doi:10.4103/0300-1652.193857
PMCID: PMC5126744  PMID: 27942099
Asthenozoospermia; pentoxifylline; sperm motility
5.  Abdominal wall endometrioma: Our experience in Vladimir, Russia 
Background:
Endometriosis is defined as an estrogen-dependent, benign inflammatory disease characterized by the presence of ectopic endometrial implants. Abdominal wall endometrioma (AWE) being a rare entity is a benign tumor defined as ectopic functional, endometrial tissue located in the abdominal wall.
Subjects and Methods:
A retrospective study of 23 female patients treated with AWE in four departments of three centers in Vladimir city, Russia, from January 2010 to December 2014 was performed.
Results:
In twenty patients (87%), AWE was symptomatic, and in three patients (13%), AWE was asymptomatic. Esquivel triad presented in 17 patients (74%), and modified Esquivel triad existed in 20 patients (87%). All 23 patients were operated, and AWE excision was performed. Recurrence occurred in 4 cases (17.4%) and was associated with postoperative pain and seroma.
Conclusion:
Postoperative pain for more than 7 days and seroma (on ultrasonography) seem to be associated with recurrence of AWE.
doi:10.4103/0300-1652.193858
PMCID: PMC5126745  PMID: 27942100
Abdominal wall endometrioma; endometriosis; recurrence; seroma; surgical excision
6.  Unintended pregnancy among antenatal women in a tertiary hospital in North Central Nigeria 
Background:
Unintended pregnancy is a pregnancy that is either unwanted or mistimed. The objectives of this study were to determine the prevalence of unintended pregnancy as well as to document the determinant factors among pregnant women attending antenatal clinic at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
Materials and Methods:
This was a descriptive, cross-sectional study of 300 women attending the antenatal clinic of the Teaching Hospital. Information on sociodemographic characteristics, desirability of the current pregnancy at the time of conception, and knowledge and practice of contraceptive methods were collected using a pretested questionnaire. The data obtained were analyzed using SPSS version 20. Chi-square test was used for tests of associations with the level of significance set at P < 0.05.
Results:
The average age of the respondents was 30.0 ± 4.7 years. Overall, 33.3% and 58.3% of the respondents attained secondary and tertiary levels of education, respectively. The prevalence rate of unintended pregnancy was 16%. Contraceptive awareness was quite high (259, 86.3%). However, contraceptive usage was low as 192 (61.9%) had never used any form of contraceptives. Univariate analysis using Chi-square test showed a statistically significant association between age and unwanted pregnancy (χ2 = 68.56, P < 0.001), as well as between parity and unwanted pregnancy (χ2 = 39.92, P < 0.001).
Conclusion:
The prevalence of unintended pregnancy among women attending antenatal clinic is high, possibly due to low contraceptive usage. Adequate information, education, and communication materials should be provided during antenatal health talks. Advocacy visits for community sensitization should also be increased.
doi:10.4103/0300-1652.193859
PMCID: PMC5126746  PMID: 27942101
Abuja; antenatal clinic; factors; prevalence; unintended pregnancy
7.  Quality of acute asthma care in two tertiary hospitals in a state in South Western Nigeria: A report of clinical audit 
Background:
To audit the quality of acute asthma care in two tertiary hospitals in a state in the southwestern region of Nigeria and to compare the clinical practice against the recommendations of the Global Initiative for Asthma (GINA) guideline.
Patients and Methods:
We carried out a retrospective analysis of 101 patients who presented with acute exacerbation of asthma to the hospital between November 2010 and October 2015.
Results:
Majority of the cases were females (66.3%), <45 years of age (60.4%), and admitted in the wet season (64.4%). The median duration of hospital stay was 2 days (interquartile range; 1–3 days) and the mortality was 1.0%. At admission, 73 (72.3%) patients had their triggering factors documented and 33 (32.7%) had their severity assessed. Smoking status, medication adherence, serial oxygen saturation, and peak expiratory flow rate measurement were documented in less than half of the cases, respectively. Seventy-six (75.2%) patients had nebulized salbutamol, 89 (88.1%) had systemic corticosteroid, and 78 (77.2%) had within 1 h. On discharge, 68 (67.3%) patients were given follow-up appointment and 32 (31.7%) were reviewed within 30 days after discharge. Less than half were prescribed an inhaled corticosteroid (ICS), a self-management plan, or had their inhaler technique reviewed or controller medications adjusted. Overall, adherence to the GINA guideline was not satisfactory and was very poor among the medical officers.
Conclusion:
The quality of acute asthma care in our setting is not satisfactory, and there is a low level of compliance with most recommendations of asthma guidelines. This audit has implicated the need to address the non-performing areas and organizational issues to improve the quality of care.
doi:10.4103/0300-1652.193860
PMCID: PMC5126747  PMID: 27942102
Asthma; audit; emergencies; guidelines; management
8.  Gentamicin-mediated ototoxicity and nephrotoxicity: A clinical trial study 
Background:
Aminoglycosides and mainly gentamicin are the most important antimicrobial agents. Two different methods of administration exist: Single and multiple doses. There has always been a controversy about the less harmful administration method, to minimize adverse effects of gentamicin – deafness and renal insufficiency. In this study, it was aimed to compare two different methods of administration to figure out the least harmful treatment method.
Materials and Methods:
In a clinical study, eighty patients aged 12–55 years who were admitted with sepsis syndrome were included in the study; they were divided into two groups: The first group received single-dose treatment (5 mg/kg) whereas the second group was treated with multiple doses (1.7 mg/kg three times a day) of gentamicin.
Results:
The results show that blood urea nitrogen (BUN) and creatinine (CR) levels were decreased in the first group. Both blood urea nitrogen and creatinine and also mean glomerular filtration rate was increased in the same group. In the second group, mean BUN and CR levels were increased while the GFR was decreased in the same group. There was also a gradual increase in GFR in the first group. GFR <80 was decreased from 20% to 5.1% in the first group while increased from 5% to 27.5% in the second group. Results of audiometric studies show 6.1% hearing problem in the first group and 12.8% in the second one.
Conclusions:
Results of the present study showed that nephrotoxicity and ototoxicity are minimized in single-dose administration compared to multiples doses.
doi:10.4103/0300-1652.193861
PMCID: PMC5126748  PMID: 27942103
Aminoglycosides; deafness; gentamicin; renal insufficiency
9.  Serum thyroid-stimulating hormone level and relation with size of hippocampus in patients with mild cognitive disorders 
Background:
Cognitive disorders and dementia are common problems, and Alzheimer's disease is one of the major leading causes of death worldwide. Thyroid hormone disorders as a common problem effect on hippocampus size which as a prognostic factor in dementia. The aim of the present study was to investigate the relationship between serum thyroid-stimulating hormone (TSH) level and the size of hippocampus in patients with mild cognitive disorders.
Materials and Methods:
In a descriptive-analytical study, 41 patients with symptoms of mild cognitive disorders whom referred to take the brain magnetic resonance image (MRI) in a radiology center under the direction of Tabriz University of Medical Sciences (Tabriz, Iran) were evaluated. The right and left hippocampal and brain volume was calculated by MRI at coronal T1-weighted. Serum TSH level was also measured in these patients. Correlation between serum TSH level and hippocampal volume size was evaluated.
Results:
Male to female ratio was 1.05:1 with mean age of 54.09 ± 3.11 years. Mean serum TSH level of patients was 1.55 ± 1.45 uU/ml. The right and left hippocampal volumes were 1.61 ± 0.42 and 1.62 ± 0.39 ml, respectively. There were slight negative correlations between the right and left hippocampal volumes with TSH level (r = −0.133 and r = −0.092, respectively). Correlations between the right and left hippocampal volumes with TSH level were not statistically significant (P = 0.406, P = 0.566, respectively).
Conclusion:
Based on findings of the present study, there was a weak negative correlation between serum level of TSH with the right and left hippocampal and brain volume ratio, but the correlation was not statistically significant. It seems that controlling of clinical or subclinical hypothyroidism may have a role in slowing of dementia progression and also have a preventive role.
doi:10.4103/0300-1652.193862
PMCID: PMC5126749  PMID: 27942104
Alzheimer's disease; dementia; hippocampus size; thyroid-stimulating hormone
10.  Buccal mucosal graft urethroplasty for proximal bulbar urethral stricture: A revisit of the surgical technique and analysis of eleven consecutive cases 
Background:
Urethral stricture disease is prevalent, and many surgical techniques have been developed to treat it. Currently, urethroplasty for bulbar strictures implies ventral or dorsal stricturotomy and a buccal mucosa graft (BMG) patch.
Objective:
To describe the surgical approach of the ventral patch BMG urethroplasty for proximal bulbar urethral stricture and to analyze 11 consecutive cases for whom the technique was used.
Patients and Methods:
The diagnosis of urethral stricture was confirmed with a combined retrograde urethrography and micturating cystourethrography. A single team exposed the urethra, harvested, and planted the BMG in the lithotomy position under general anesthesia. The oral preoperative preparation was done with oraldene (hexetidine) mouth wash three times daily beginning from the 2nd preoperative day. The buccal mucosa was harvested from the left inner cheek in all the patients. The donor site was left unclosed but packed with wet gauze. Data related to age, preoperative adverse conditions, stricture length, urine culture result, perineal/oral wound complications, postoperative residual urine volume, and duration of hospital stay were recorded.
Results:
Eleven patients with proximal bulbar urethral stricture had BMG urethroplasty from August 2013 to October 2015. Stricture length ranged from 2 to 5 cm. In six (54%) of the men, the stricture resulted from urethritis thereby constituting the most common etiology of urethral stricture in this study. The preoperative adverse conditions were age above 70 in three, diabetes mellitus in two, severe dental caries in one, and recurrent stricture in two. All of them were able to resume reasonable oral intake 72 h postoperatively. One (9.2%) had perineal wound infection, while two (18.2%) still had mild pain at donor site 4 weeks postoperatively. Ten (90.9%) of the 11 patients had <30 ml residual urine volume at 2 months of follow-up.
Conclusion:
Urethritis is still a common cause of urethral stricture in this rural community. Ventral onlay buccal mucosal graft urethroplasty for proximal bulbar urethral stricture is safe, even in certain adverse preoperative conditions. Buccal mucosa from the cheek is however now preferred.
doi:10.4103/0300-1652.190603
PMCID: PMC5036297  PMID: 27833245
Buccal mucosal graft; etiology; proximal bulbar; urethroplasty
11.  Short-term effects of lovastatin therapy on proteinuria of type 2 diabetic nephropathy: A clinical trial study 
Background:
Diabetic nephropathy (DN) is characterized by albuminuria, hypertension, and a progressive decline in glomerular filtration rate. The 3-hydroxy-3-methylglutaryl coenzyme A is a well-known agent that is active in lowering total plasma and low-density lipoprotein cholesterol (LDL-C) levels in cases with hypercholesterolemia. Hence, in this study, proteinuria changes at the beginning and after the withdrawal of lovastatin in patients with type 2 DN (T2DN) were studied.
Materials and Methods:
Lovastatin was administered for thirty male patients with T2DN and then was withdrawn. Twenty-four hours, urine creatinine and protein levels were determined.
Results:
The mean levels of total cholesterol and LDL-C were reduced without any change in the triglyceride (TG) level while the high-density lipoprotein cholesterol (HDL-C) level was increased. There was a reverse linear correlation between the changes in the level of HDL-C and the changes in the level of 24 h urine protein after 90 days of lovastatin therapy (P = 0.007, r = −0.484).
Conclusions:
Short-term 3-month lovastatin therapy has no effect on proteinuria levels in patients with T2DN despite the antihyperlipidemic effects and reverse correlation of proteinuria with HDL-C.
doi:10.4103/0300-1652.190600
PMCID: PMC5036295  PMID: 27833243
Diabetes type 2; nephropathy; proteinuria; statin
12.  Nigeria's National Health Act: An assessment of health professionals' knowledge and perception 
Background:
Nigeria's National Health Act 2014 (NHA 2014) was signed into law on October 31, 2014. It provides a legal framework for the regulation, development, and management of Nigeria's Health System. This study assessed the knowledge and perception of the NHA 2014 by health professionals.
Materials and Methods:
This was a descriptive, cross-sectional, questionnaire-based study conducted in December 2015, in Ota, Ogun State, Nigeria. Data entry and analysis were done using the Statistical Package for the Social Sciences version 16 (IBM SPSS, Chicago, IL, USA) statistical software, with Pearson's Chi-square, which is used to determine the associations between variables. Statistical significance was set at a P < 0.05.
Results:
The study population comprised 130 health professionals (medical doctors/dentists, nurses, pharmacists, laboratory scientists, and other health-related professionals) in attendance at a medical conference. The respondents' age ranged from 21 to 75 years with a mean age of 44.53 ± 12.46 years. Medical practitioners accounted for 82.3% of the respondents. Although most (79.2%) respondents had a good perception of the NHA 2014 with majority (86.2%) claiming they were aware of the act, majority (73.8%) exhibited poor knowledge of the act. A little more than half (53.1%) of the respondents believed that the NHA 2014 will help to reduce strike actions in the health sector.
Conclusion:
Although health professionals in Nigeria have good awareness and perception of the NHA 2014, their knowledge of the Act is poor.
doi:10.4103/0300-1652.190594
PMCID: PMC5036296  PMID: 27833244
Health professionals; knowledge; National Health Act 2014; perception
13.  Effect of submucosal or oral administration of prednisolone on postoperative sequelae following surgical extraction of impacted mandibular third molar: A randomized controlled study 
Background:
The aim of the study was to evaluate the effect of preoperatively administered submucosal and oral prednisolone on postoperative pain, facial swelling, and trismus following third molar surgery.
Patients and Methods:
This was a randomized controlled trial in which subjects were randomly distributed into three groups. Group A consisted of subjects who received 40 mg oral prednisolone; Group B consisted of subjects who received 40 mg submucosal injection of prednisolone while Group C consisted of subjects who did not receive prednisolone. Each group had 62 subjects. Measurements for facial width/facial swelling, pain, and mouth opening were recorded preoperatively and postoperatively. The postoperative evaluation points were postoperative days 1, 3, and 7. These measurements were compared with the preoperative values both within and among the groups.
Results:
Most of the subjects were in their third decade of life. A considerable increase in the mean postoperative values for pain, facial width and trismus was observed. Notably, subjects who did not receive prednisolone showed comparatively higher values for the measured parameters throughout the postoperative evaluation period. Subjects who received submucosal injection of prednisolone showed overall lower values compared to those who received oral prednisolone.
Conclusion:
The results of this study indicate that the administration of prednisolone has a significantly beneficial effect in ameliorating the postoperative sequelae of the third molar surgery. In addition, the effect of submucosally injected prednisolone is comparable to the orally administered prednisolone; indeed it shows superiority to the latter in a number of dimensions. Submucosal injection of prednisolone offers a simple, effective, easy, safe, and minimally invasive option to existing therapeutic methods of reducing these postoperative sequelae.
doi:10.4103/0300-1652.190599
PMCID: PMC5036298  PMID: 27833246
Sequelae; submucosal; third molar
14.  Malignant tumors of the larynx: Clinicopathologic profile and implication for late disease presentation 
Background:
Malignant laryngeal tumors are uncommon. Late presentation of the disease may worsen management outcomes. We described the epidemiologic, clinicopathologic profile, and management outcomes of laryngeal tumors in a tertiary health institution in Nigeria.
Materials and Methods:
An 11-year retrospective review of medical records of patients managed for malignant laryngeal tumor at the University College Hospital, Ibadan, Nigeria, was performed.
Results:
There were 97 patients comprising 74 (76.3%) males and 23 (23.7%) females with a mean age of 60.48 ± 12.15 years. The mean duration of illness was 7.3 ± 3.8 months. History of cigarette smoking and alcohol consumption was in 2.1% and 14.4% patients, respectively. The most common clinical presentations were hoarseness, cough, and dyspnea. Transglottis (91.8%) was the most common anatomic tumor location and 92.8% patients presented in advanced disease stage. Four histologic types were identified with squamous cell carcinoma accounting for 96.9%. About 92% patients had emergency tracheostomy and 56 (57.7%) patients had total laryngectomy. The postoperative complications were pharyngocutaneous fistula (5.2%) and peristomal recurrence (3.1%). The 5-year survival rate was 52.5%.
Conclusions:
Malignant laryngeal tumors are uncommon, but more females are getting the disease. Squamous cell carcinoma is the most common histologic variant. Late stage disease presentation and initial wrong diagnosis contributed to the poor management outcome.
doi:10.4103/0300-1652.190596
PMCID: PMC5036299  PMID: 27833247
Late disease presentation; malignant laryngeal tumor; peristomal recurrence; pharyngocutaneous fistula; tracheostomy
15.  Genital prolapse: A 5-year review at Federal Medical Centre Umuahia, Southeastern Nigeria 
Background:
Genital prolapse is an important cause of morbidity among postmenopausal and multiparous women especially in our environment where a high premium is placed on large family size. This study was done to determine the prevalence, risk factors, clinical presentation, and management options of genital prolapse.
Patients and Methods:
Data of those diagnosed with genital prolapse were retrieved from records in the clinic, wards, theater, and from patients' folders in the medical records department.
Statistical Analysis Used:
Data were analyzed using Statistical Package for Social Sciences version 20 with P < 0.05.
Results:
Genital prolapse accounted for 0.8% of gynecological clinic attendances and 5.2% of major gynecological operations. The mean age of patients was 56.7 ± 15.5 years. Farmers constituted 60.7% of the patients while 72.1% and 70.5% were postmenopausal and grandmultiparous women, respectively. The sensation of something coming down the vagina was the most common symptom noted in 98.4% of the patients. Most (23.0%) of the patients had unsupervised delivery at home. Uterovaginal prolapse was the most common (70.5%) type of genital prolapse, and third-degree uterovaginal prolapse was its most frequent presentation. Majority of the patients (44.4%) were managed expectantly while the most common surgery performed was vaginal hysterectomy with pelvic floor repair (33.3%).
Conclusion:
Widespread availability of antenatal services especially in the rural communities and limitation on family size can significantly reduce the burden of this disease.
doi:10.4103/0300-1652.190601
PMCID: PMC5036300  PMID: 27833248
Genital prolapse; umuahia; uterovaginal prolapse
16.  Quality of life and associated factors among poststroke clinic attendees at a University Teaching Hospital in Nigeria 
Background:
Quality of life (QOL) measures are effective in quantifying disease burden after stroke, more so than levels of debility. The objective of this study is to determine QOL and associated factors of stroke survivors in Lagos, Nigeria.
Materials and Methods:
Seventy stroke survivors (study sample) and seventy stable hypertensive patients (control sample) attending clinics at a Nigerian hospital were recruited for the study. Respondents were assessed using sociodemographic/clinical questionnaires, modified mini-mental state examination, modified Rankin Scale, schedule for clinical assessment in neuropsychiatry, and World Health Organization-QOL-BREF.
Results:
Mean ages of the study and control respondents were 57.43 (±9.67) years and 57.33 (±9.33) years, respectively. Each sample comprised 38 male and 32 female respondents. Stroke survivors were significantly more likely to: be unemployed (P = 0.001), pay more for healthcare (P = 0.001), consume alcohol (P = 0.02), and have physical impairments (P = 0.001) compared with control. The mean QOL scores of stroke survivors were significantly lower than controls across all spheres. Stroke survivors who were unemployed, younger, female, paying more for healthcare, more disabled, with right stroke lateralization, having comorbidities, and sexual dysfunction had significantly poorer QOL specific grades. Depression or anxiety poststroke was also associated with reduced QOL means scores.
Conclusion:
Besides, clinical variables such as levels of disability and stroke lesion lateralization, other factors such as unemployment, health costs, age, gender, and emotional problems influenced QOL after stroke.
doi:10.4103/0300-1652.190602
PMCID: PMC5036301  PMID: 27833249
Associated factors; clinic attendees; Nigeria; poststroke; quality of life; University Teaching Hospital
17.  Cytohistological discordance on gastrointestinal brushings: Facts unfolded 
Introduction:
Brush cytology is a rapid, cost-effective, and reliable tool to diagnose gastrointestinal tract (GIT) lesions in low-resource settings. Most of the studies on GIT brushings have focused on upper GI lesions. We have studied the diagnostic accuracy of brush cytology in the entire length of GIT and correlated the cytological diagnosis with histopathology. The aim of this study is to study diagnostic utility of brush cytology of GIT lesions in the context of correlation with biopsy and study the factors responsible for cytohistological discordance.
Materials and Methods:
A retrospective analysis of 101 cases of prebiopsy brush cytology samples of GIT lesions was done over a period of 1 year (June 2014 to May 2015). The cytological diagnosis was compared with histopathological diagnosis and percentage of correlation was calculated. The reasons for discordance were noted and studied.
Results:
The cytological diagnosis of 79 (78.2%) correlated with histopathological diagnosis. There was discordance in cytological and histological diagnosis in 22 cases (21.8%). Inadequacy of cytological sample and overlap of nuclear atypia caused by regenerative changes and malignancy were significant factors for cytohistological discordance.
Conclusion:
The diagnostic accuracy of brush cytology can be improved by taking appropriate measures to eliminate factors responsible for fallacies in cytological diagnosis.
doi:10.4103/0300-1652.190597
PMCID: PMC5036302  PMID: 27833250
Brushings; cytology; discordance; gastrointestinal
18.  Cross-sectional study on the obstetric performance of primigravidae in a teaching hospital in Lagos, Nigeria 
Background:
A woman carrying her first pregnancy is starting a new life, and this is a crucial time in her obstetric career. This study was aimed to compare the obstetric performance of primigravidae to that of the multigravidae with a view to suggesting ways of preventing the associated complications.
Patients and Methods:
The study was a cross-sectional case-control study carried out among women who delivered in the study center over a year period. Relevant data of primigravid parturients who delivered in the hospital were retrieved from the labor ward register, and an equal number of multigravidae who delivered during the same study were selected by simple random sampling as the control group.
Results:
Primigravidae constituted 15.3% of the total number of parturients seen during the study period. The age range of the primigravidae was 20–48 years and with a mean age of 28.24 ± 4.28 years. The obstetric complications seen in statistically significant proportion among the primigravidae case group include hypertensive disorder (P = 0.048), prolonged pregnancy (P = 0.039), prolonged labor (P = 0.006), oxytocin augmentation (P = 0.022), cephalopelvic disproportion (P = 0.001), obstructed labor (P = 0.008), instrumental delivery (P = 0.035), cesarean delivery rates (P = 0.011), and increased neonatal unit admission rate (P = 0.002).
Conclusion:
Primigravidity is a high-risk pregnancy with several associated obstetric complications. Primigravidae should, therefore, be managed by specialists in well-equipped hospitals that will provide comprehensive antenatal and intrapartum care which will eventually result in a satisfactory obstetric outcome.
doi:10.4103/0300-1652.190595
PMCID: PMC5036303  PMID: 27833251
Multigravidae; obstetric; performance; primigravidae
19.  The effect of deoxyribonucleic acid extraction methods from lymphoid tissue on the purity, content, and amplifying ability 
Background:
Nowadays, definitive diagnosis of numerous diseases is based on the genetic and molecular findings. Therefore, preparation of fundamental materials for these evaluations is necessary. Deoxyribonucleic acid (DNA) is the first material for the molecular pathology and genetic analysis, and better results need more pure DNA. Furthermore, higher concentration of achieved DNA causes better results and higher amplifying ability for subsequent steps. We aim to evaluate five DNA extraction methods to compare DNA intimacy including purity, concentration, and amplifying ability with each other.
Materials and Methods:
The lymphoid tissue DNA was extracted from formalin-fixed, paraffin embedded (FFPE) tissue through five different methods including phenol-chloroform as the reference method, DNA isolation kit (QIAamp DNA FFPE Tissue Kit, Qiagen, Germany), proteinase K and xylol extraction and heat alkaline plus mineral oil extraction as authorship innovative method. Finally, polymerase chain reaction (PCR) and real-time PCR method were assessed to compare each following method consider to DNA purity and its concentration.
Results:
Among five different applied methods, the highest mean of DNA purity was related to heat alkaline method. Moreover, the highest mean of DNA concentration was related to heat alkaline plus mineral oil. Furthermore, the best result in quantitative PCR was in proteinase K method that had the lowest cycle threshold averages among the other extraction methods.
Conclusion:
We concluded that our innovative method for DNA extraction (heat alkaline plus mineral oil) achieved high DNA purity and concentration.
doi:10.4103/0300-1652.188321
PMCID: PMC4995809  PMID: 27630381
Deoxyribonucleic acid concentration; deoxyribonucleic acid extraction; deoxyribonucleic acid purity; lymphoid tissue
20.  Adult intussusception: An 8 years institutional review 
Background:
Intussusception is a rare cause of intestinal obstruction in adults. Its diagnosis could be elusive based solely on clinical features because of protean presentation. Supplementary imaging allows for preoperative diagnosis, early institution of definitive management, and a better clinical outcome.
Patients and Methods:
Records of adults managed for intestinal obstruction by laparotomy in a surgical unit of a tertiary health facility were retrospectively examined. The subgroup having an intraoperative diagnosis of intussusception was extracted and analyzed. Data obtained included age, sex, and primary symptom at presentation. Presence of intestinal perforation, the histology of the lead point of resected tissues, and the final disposition of the patients were documented.
Results:
Four hundred and three patients underwent surgical management of intestinal obstruction. Eight patients (2%) had an intraoperative diagnosis of intussusception at laparotomy; four males and four females (male: female = 1:1). Abdominal pain was the presentation in 7 (87.5%) and anal protrusion in 1 (12.5%). Four patients (50%) had bowel perforation with peritonitis. Seven of the resected intestines had lead points which were benign. Two patients (25%) died from sepsis. Resection and anastomosis were done for all the patients.
Conclusion:
Intussusception in adults is uncommon but carries a high morbidity and mortality which can be reduced with a good clinical assessment, appropriate imaging, and early laparotomy.
doi:10.4103/0300-1652.188324
PMCID: PMC4995810  PMID: 27630382
Appropriate imaging; exploratory laparotomy; intussusception
21.  The relationship between malaria parasitemia, malaria preventive measures and average birth weight of babies in a tertiary facility in Owerri, Nigeria 
Background:
Despite the global efforts made to eradicate malaria, it continues to be a significant cause of morbidity and mortality in both neonates and the parturients. This study was done to determine the relationship between placental parasitemia, average neonatal birth weight and the relationship between the use of malaria preventive measures and the occurrence of placental parasitemia with the aim to improving maternal and neonatal outcome.
Patients and Methods:
This cross-sectional study was done at the labor ward unit of the Federal Medical Center, Owerri, from December 2013 to May 2014. It involved one hundred and eighty primigravidae and baby pairs recruited consecutively. Thick and thin blood films were made from maternal peripheral blood and placenta. The babies were examined and weighed immediately after delivery.
Results:
Most of the participants had only one dose of intermittent preventive therapy (75%) with statistically significant higher level of fever episodes (P < 0.0001). Forty participants (58.0%) did not use any form of malaria preventive measure in pregnancy (P < 0.0001) and had a significantly higher placental parasitemia when compared with their counterparts. Average birth weight of neonates with placental parasitemia in mothers who used intermittent presumptive therapy (IPT) only (t = 2.22, P = 0.005), and IPT + insecticide-treated net (ITN) (t = 7.91, P ≤ 0.000) was significantly higher than those who did not use any form of malaria prevention in pregnancy (t = 4.69, P ≤ 0.0001).
Conclusion:
Primigravidae with placental or maternal peripheral parasitemia who failed to use malaria preventive measures delivered babies with reduced average birth weight. A scheme aimed at making ITN readily available, and improving the girl child education is highly recommended.
doi:10.4103/0300-1652.188327
PMCID: PMC4995811  PMID: 27630383
Birth weight; malaria; Owerri; parasitemia
22.  Utility of a single mid-trimester measurement of plasminogen activator Type 1 and fibronectin to predict preeclampsia in pregnancy 
Background:
Preeclampsia (PE) is the second most common cause of maternal death after obstetric hemorrhage in Africa, a resource-limited region. This study was designed to examine the potential usefulness of a single screening plasma plasminogen activator inhibitor-1 (PAI-1) and fibronectin (FN) level for the prediction of PE in pregnant women.
Materials and Methods:
In a cohort of 180 pregnant women who were normotensive at baseline, venous blood samples were obtained before 20 weeks of gestation for the assay of plasma levels of PAI-1 and FN levels measured by enzyme-linked immunoassay technique. Twenty nonpregnant normotensive women were also evaluated as a control group. Outcomes of gestation were evaluated and correlated with the plasma levels of PAI and FN measured at mid-trimester. Mean plasma values of PAI-1 and FN were also compared between the different outcome groups.
Results:
Plasma PAI-1 level was significantly higher in the pregnant women (8.68 ± 0.56 ng/ml) than in nonpregnant controls (5.55 ± 0.32 ng/ml) (P = 0.01). However, plasma FN did not show any significant difference in pregnant women (2.60 ± 0.37 μg/ml) and nonpregnant controls (2.60 ± 0.23 μg/ml) (P = 0.9). Mid-trimester mean plasma PAI-1 level measured in women who developed PE (7.08 ± 5.49 ng/ml, n = 12) and gestational hypertension (GH) (9.78 ± 6.2 ng/ml, n = 13) was not significantly different in comparison to normotensive pregnant women (8.78 ± 5.63 ng/ml, n = 153) (P = 0.75). Likewise, the mean FN level in women who developed PE was also not significantly different from nonpreeclamptics; however, the FN level in the pregnant women who developed GH was significantly different from women who remained normotensive throughout pregnancy (P = 0.02).
Conclusion:
Single mid-trimester assessment of PAI-1 and FN levels in maternal plasma was not found to be useful in predicting PE as an outcome of pregnancy in the study population.
doi:10.4103/0300-1652.188337
PMCID: PMC4995812  PMID: 27630384
Fibronectin; plasminogen activator inhibitor-1; preeclampsia
23.  Evaluation of serum level of tumor necrosis factor-alpha and interleukin-6 in patients with congenital heart disease 
Background:
The objective of the study is to assess the levels of tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) in patients with congenital heart diseases (CHDs) and control.
Patients and Methods:
In this case-control study, sixty patients with CHD with ages of 1 month to 15 years and thirty healthy subjects were assessed. All objects measured in height, weight, age, sex, and body mass index (BMI). Patients diagnosed by echocardiography and patients’ blood samples were 3 ml and taken in the catheterization laboratory through catheter and kept for 60 min at a room with normal temperature and separated serum has been held. All samples in compliance with the cold chain carried out to biochemistry laboratory and finally the levels of serum TNF-α and IL-6 were measured by Elisa Kit. Data were analyzed with Statistical Package for Social Sciences version 20. Nonparametric tests by considering 95% confidence interval were applied.
Results:
The mean of age in cyanotic patients was 4.28 ΁ 3.44 years, a cyanotic was 3.12 ΁ 3.87 years and for the control group was 3.30 ΁ 3.61 years. Comparison of TNF-α (Mann-Whitney U-test = 56.62, P < 0.001), IL-6 (Mann-Whitney U-test = 313.5, P < 0.001), right ventricular (RV) pressure (Mann-Whitney U-test = 27, P < 0.001), pulmonary artery (PA) pressure (Mann-Whitney U-test = 618, P = 0.015), and BMI (Mann-Whitney U-test = 214.5, P < 0.001) in the case and control groups resulted in significant differences. To compare TNF-α (Chi-square = 57.82, P < 0.001), IL-6 (Chi-square = 54.70, P < 0.001), RV pressure (Chi-square = 71.35, P < 0.001), PA pressure (Chi-square = 5.92, P = 00.052), oxygen saturation (Chi-square = 74.70, P < 0.001), and BMI (Chi-square = 34.90, P < 0.001) in cyanotic, acyanotic, and control groups resulted that there were significant differences between these three groups except PA pressure.
Conclusion:
The findings of this study showed that in patients with CHD, serum levels of TNF-α increased but IL-6 not changed when compared to control and this increase in necrosis tumoral factor-α would be related with hypoxia and remarkable left to right shunt and caused growth retardation in these patients.
doi:10.4103/0300-1652.188353
PMCID: PMC4995815  PMID: 27630387
Acyanotic; congenital heart diseases; cyanotic; interleukin-6; tumor necrosis factor-alpha
24.  Outcome of radical retropubic prostatectomy at the Lagos State University Teaching Hospital 
Background:
Prostate cancer is the most commonly diagnosed cancer in men in Nigeria and most cases present when the disease is already in an advanced stage. Radical prostatectomy for early prostate cancer is therefore not a commonly performed operation by urologists in Nigeria. We have had training and significant experience in radical retropubic prostatectomy. We, therefore, report the outcome of our initial experience.
Materials and Methods:
We review the record of men with early prostate cancer who had radical retropubic prostatectomy in our institution from 2007 to 2015.
Results:
There were 34 men who had radical retropubic prostatectomy in the 8-year period of review. The youngest and oldest patients were aged 50 and 71 years, respectively. The mean age was 64.2 years. All the patients were diagnosed following 12-core ultrasound-guided transrectal prostate biopsy for elevated serum prostate specific antigen (PSA). The mean serum PSA was 15.3 (range 8.5-100.3) ng/ml. The disease was pT1, pT2, and pT3 in 6, 20, and 8 patients respectively. General anesthesia was employed in 28 (82.4%) patients and combined epidural and subarachnoid block anesthesia for 6 (17.6%) patients. The total duration of operation was 128-252 min (mean = 160 min). No blood transfusion was given in 5 (14.7%) patients while each of the remaining 29 (85.3%) patients had 2-5 units of blood intra- or post-operatively. There was no perioperative mortality. Complications include operation-induced erectile dysfunction in 12 (35.3%), major urinary incontinence in 1 (2.9%), lymphocele in 2 (5.9%), and reoperation due to anastomotic leak and right ureteric injury in 1 (2.9%). After a median follow-up of 42 months, disease recurrence has occurred in 3 (8.8%) patients 1 (2.9%) of whom has died of diabetic renal failure.
Conclusion:
Radical prostatectomy can be safely performed in men with early prostate cancer in Nigeria and should be offered to suitable patients.
doi:10.4103/0300-1652.188356
PMCID: PMC4995816  PMID: 27630388
Nigeria; outcome; prostate cancer; radical prostatectomy
25.  DNA methylation analysis of secreted frizzled-related protein 2 gene for the early detection of colorectal cancer in fecal DNA 
Background:
The early detection of colorectal cancer (CRC) with high sensitivity screening is essential for the reduction of cancer-specific mortality. Abnormally methylated genes that are responsible for the pathogenesis of cancers can be used as biomarkers for the detection of CRC. The methylation status of the secreted frizzled-related protein 2 (SFRP2) gene was evaluated for their use as a marker in the noninvasive detection of CRC.
Materials and Methods:
Methylation-specific polymerase chain reaction was performed to analyze the promoter CpG methylation of SFRP2 in the fecal DNA of 25 patients with CRC and 25 individuals exhibiting normal colonoscopy results.
Results:
Promoter methylation levels of SFRP2 in CRC patients and in healthy controls were 60% and 8%, respectively. Methylation of the SFRP2 promoter in fecal DNA is associated with the presence of colorectal tumors.
Conclusion:
Hence, the detection of aberrantly methylated DNA in fecal samples may present a promising, noninvasive screening method for CRC.
doi:10.4103/0300-1652.188357
PMCID: PMC4995817  PMID: 27630389
Colorectal cancer; DNA methylation; secreted frizzled-related protein; stool DNA test

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