Suppression of uric acid generation and blockade of glutathione dysregulation by L-arginine ameliorates dichlorvos-induced oxidative hepatorenal damage in rats

Dichlorvos is a known risk factor for organ toxicity. The liver and kidney are essential metabolic tissues but it is unclear whether or not there is associated redox dyshomeostasis in both organs in physiological and pathological states. Uric acid accumulation and glutathione dysregulation have been implicated in the aetiopathogenesis of organ damage. The antioxidant potentials of L-arginine have been shown in various conditions. The present study was thus designed to investigate the synchrony in hepatic and renal uric acid and glutathione status in dichlorvos-induced hepatorenal damage and to probe the possible therapeutic role of L-arginine. Twenty-one male Wistar rats were treated with standard rat diet and water, dichlorvos, or dichlorvos and L-arginine. Our findings revealed that dichlorvos significantly impaired hepatic and renal functions, increased hepatic and renal malondialdehyde, but reduced glutathione and activities of superoxide dismutase, catalase, and glutathione peroxidase. These events were accompanied by increased accumulation of plasma, hepatic, and renal uric acid as well as reduced body weight gain, and hepatic and renal weights. Histopathological examinations revealed hepatic and renal architectural derangement and cellular necrosis and degeneration in dichlorvos-exposed rats. Interestingly, L-arginine reversed dichlorvos-induced systemic, hepatic and renal synchronous redox dyshomeostasis. L-arginine administration also improved hepatic and renal cytoarchitecture. It is thus concluded that dichlorvos triggered synchronous uric acid generation and glutathione alterations in the liver and kidney. L-arginine confers protection against dichlorvos-induced hepatorenal damage via suppression of uric acid generation and blockade of glutathione dysregulation.

MATERNAL MORTALITY AUDIT IN A TERTIARY HEALTH INSTITUTION IN NIGERIA: LESSONS FROM DIRECT CAUSES AND ITS DRIVERS

INTRODUCTION

Nigeria has the second highest number of maternal deaths in the world.The study aimed at determining the causes of and non-obstetric contributors to maternal mortality at a tertiary referral hospital.

MATERIALS AND METHODS

It was a prospective audit of all consecutive maternal deaths in the hospital over a three-year period. Immediately after the death, information wvas retrieved via a data collection form. Data were analysed with SPSS-20.

RESULTS

Seventy deaths were examined over the study period. Maternal mortality ratio was 1,265/100,000 live births. The annual ratio decreased steadily over the study period. Most of the deaths were of multiparous women who had not received any antenatal care, and were mostly postpartum,within 24 hours of delivery. Most of them were critically ill on admission to the hospital. Major causes of death were haemorrhage (36%), sepsis (17%) and hypertensive disorders (16%).Delays were identified in 34.3% of cases; most (70.1%) were Phase III delays.

DISCUSSION

Direct causes of maternal mortality are consistent with those found in literature. Steps which the centre has been taken to counter direct and non-obstetric causes are discussed. Possible strategies to improve health financing and referral system are proffered.

Effect of storage and subsequent reheating on viability of Listeria monocytogenes on pork scrapple

We evaluated the fate of Listeria monocytogenes on commercial pork scrapple, a regionally popular, ready-to-eat (RTE) meat. We also conducted an informal survey to address consumer practices for storing and reheating scrapple. Of the 129 consumers who responded to at least one of the eight questions posed in the survey, about half (46.4%; 52 of 112) considered scrapple RTE, the majority (69.7%; 76 of 109) stored it in the refrigerator, and all (100%; 112 of 112) preferred to reheat it prior to consumption. Most respondents (83.9%; 94 of 112) reheated the scrapple by pan frying for 1 to 10 min at medium to high temperature. To study pathogen behavior, slices of pork scrapple were surface inoculated with a five-strain cocktail of L. monocytogenes (ca. 2.0 log CFU/g), vacuum sealed, and stored for up to 60 days. Pathogen levels increased to 8.9, 9.5, and 9.9 log CFU/g after 44 (4 degrees C), 21 (10 degrees C), and 5 (21 degrees C) days, respectively. When slices 1.3 cm (ca. 55 g) and 1.9 cm (ca. 85 g) thick were surface inoculated with L. monocytogenes (ca. 7.0 log CFU/g) and then reheated in a skillet (191 degrees C) for 0.5 to 4 min per side or to target instantaneous internal temperatures of 48.9 to 71.1 degrees C, it was possible to achieve pathogen reductions ranging from ca. 2.2 to 6.5 log CFU/g. These data confirm that in the unlikely event of postprocessing contamination of pork scrapple by L. monocytogenes, proper reheating can appreciably reduce levels of the pathogen before consumption.

Perceptions and attitudes of Nigerian women about the menopause

The attitudes of women to the menopause are strongly influenced by social, cultural and economic settings in which they live and may also reflect the differences in modes of treatment for or perception of its symptoms. The object of this study was to determine the perception and attitude of post-menopausal Nigerian women to the menopause. We interviewed 676 women who had experienced at least 24 months of amenorrhoea using a structured questionnaire. Menopause was considered a normal physiological manifestation of the ageing process by 95.56% of the respondents while 2.66% believed it was a disease condition. The majority of the women had a positive attitude to the menopause and indicated that it did not affect their relationships with their spouses or children. For most of the women (71.13%), sexual life ended with menopause. None of the women was on hormone replacement therapy but among those sexually active, reduced libido/frequency and vaginal dryness were reported by 24.59%. The most commonly reported advantage of menopause was freedom from cyclical bleeding. We conclude that although Nigerian post-menopausal women have a positive disposition towards menopause, they may have a significant reproductive health burden which has been tolerated for so long. It is important to determine the influence of sociocultural belief on sexuality after menopause and also evaluate the benefits of hormone replacement therapy in our environment.

Female genital mutilation - postcircumcision vulval complications in Nigerians

Female genital mutilation is a cultural practice that can adversely affect the health of women. Vulval complications of female circumcision in 39 patients managed at the University College Hospital, Ibadan, Nigeria over a period of 10 years were reviewed. The complications were: labial adhesions of varying degrees (51.3%) and clitoral retention cysts (48.7%). However, both types of complications occurred concurrently in two (5.1%) patients. All patients were treated surgically with good outcome. The only immediate complication of treatment was secondary haemorrhage in one patient with clitoral cyst. Regrettably, one patient with labial adhesion required a repeat surgical procedure 2 months later. The histological examination of all the retention cysts revealed epidermal inclusion cysts. Emphasising the reproductive health implications of female genital mutilation may prove an effective strategy towards eradication of the practice.

Emergency contraception: survey of knowledge, attitudes and practice of health care professionals in Ibadan, Nigeria

This survey was conducted to determine the knowledge, and prescribing attitudes of emergency contraception among healthcare professionals in Ibadan, Nigeria. A questionnaire was administered to 735 health care professionals in selected healthcare facilities in Ibadan. These facilities were randomly selected as part of an ongoing programme designed to introduce emergency contraceptive pills (ECPs) as a clinic based method of family planning in service delivery outlets in the city. The response rate was 87.5%, comprising nurses (59.3%) and physicians (25.0%). Others were pharmacists, social workers and administrators. The results revealed that healthcare professionals' knowledge of various methods that can be used emergency contraception is very low. Less than half (35.1%) of the respondents were aware that combined oestrogen/progestin or progestin-only pills can be used as emergency contraception. Similarly, only 26.7% and 13.3% of the respondents were aware that intrauterine contraceptive devices and mifepristone respectively could be used as emergency contraception. While only 16.3% of the respondents had ever prescribed the combined pills as emergency contraception, 10.9% and 8.2% had prescribed progestin-only pills and intrauterine contraceptive devices for this purpose in the past. Circumstances under which emergency contraception could be used vary among the respondents but 71.4% and 64.4% were of the opinion that condom breakage and sexual assault would be appropriate indications for its use. Two main sources, hospitals (68.4%) and pharmacies (8.8%) were identified by participants. It is apparent that one of the major barriers to frequent use of emergency contraception in Ibadan is the lack of awareness of its use by healthcare professionals. Therefore, there is an urgent need to educate these practitioners and include emergency contraception in the family planning curriculum of nursing and medical schools.

Gestational age at antenatal booking and delivery outcome

Antenatal care is a form of preventive medicine that pregnant women to allows maintain a state of good health throughout pregnancy, and to improve their chances of having a safe delivery of healthy infants. To achieve this aim, it is a widely held belief that pregnant women need to book early preferable before 14 weeks gestation. This is a retrospective study which reveals among others that late booking is still a common practice in the developing countries with average gestational age at booking being 23.59 (+/- 8.45) weeks, and only 14% of the women booked before the end of first trimester. Nulliparity or low parity was found to be the only factor that favoured early booking. However, gestational age at booking as a sole factor for predicting the pregnancy outcome was found to be insignificant as the outcome was same for early and late bookers. Unbooked pregnant women were found to be twice at risk of operative delivery, four times more likely to suffer delivery complications and twice likely to have low birthweight babies when compared to booked patients. In conclusion, findings of this study confirm the importance of antenatal care for better maternal and foetal outcome, however gestational age at booking as a sole factor is a poor predictor of pregnancy outcome. It is believed that this finding which is in tandem with the new WHO antenatal care protocol will generate divergent views among the health care givers and modify our current practice of Antenatal care to a more focused and effective risk assessment system.

Female condom awareness, use and concerns among Nigerian female undergraduates

A cross-sectional study of female condom awareness, usage and concerns among the female undergraduates of the University of Ibadan was conducted in September 2004. The results of 850 out of the 879 female students interviewed were used for analysis (96.6%). Over 80% had knowledge of the female condom as a form of modern contraception and the majority of them learnt about it through the mass media (39.9%) and health workers (34.4%). However, only 11.3% had ever used the female condom, with most (40%) using it to prevent both unwanted pregnancy and sexually transmitted infections including HIV (STI/HIV). The sexual partners' approval was appreciable, accounting for about 42.7% among those that had experience of the female condom usage. Major concerns mentioned such as difficulty of inserting it into the vagina and lack of sexual satisfaction, were not different from those in earlier studies. The result of this study looks promising judging from a high awareness level of the female condom, even though its usage is low. The female condom may be an alternative strategy to combat unsafe sexual practises and its sequelae in a country like Nigeria that is male dominated.

Repeat ipsilateral ectopic gestation: a series of 3 cases

Ectopic pregnancy remains an important cause of maternal mortality and morbidity as well as early foetal wastage in Nigeria and in other developing countries. We report 3 different cases of repeat ipsilateral ectopic pregnancy seen in the gynaecological emergency unit of the University College Hospital, Ibadan. Cases of repeat ectopic pregnancy often gives rise to diagnostic dilemma, and this becomes more difficult when it occurs at an ipsilateral location.

Experience with intravaginal misoprostol in the management of intra-uterine fetal death

This collaborative study between the departments of Obstetrics and Gynaecology of the University College Hospital, Ibadan and Federal Medical Centre, Abeokuta assessed the value of intravaginal misoprostol in the management of intra-uterine fetal death. Fifty-six women at gestational ages between 17 weeks and term admitted for intra-uterine death with no contraindications to misoprostol received 400mcg of misoprostol administered intravaginally 12-hourly, until the establishment of effective uterine contractions. The mean gestational age was 27.9 weeks+/-7.1(SD) and the mean Bishop score was 2.7+/-2.4(SD). The mean duration of onset of contractions was 5.0 hours+/-8.4 (SD); the mean induction-delivery interval was 17.5 hours+/-6.3(SD). Ninety three percent of the women had expelled within 48 hours. Successful induction was achieved in all women. Prophylactic vacuum aspiration was performed (lower gestation only) in 19.6% of cases. Fever, nausea and vomiting were the commonest side effects (7.1%). Neither gestational age nor the cervical score significantly affected the insertion-contraction or induction-delivery intervals. Intra-vaginal Misoprostol at the dosage administered is safe, effective and reduces staff workload.

Serum micronutrient levels, nucleic acid metabolism and antioxidant defences in pregnant Nigerians: implications for fetal and maternal health

Micronutrients regulate numerous metabolic processes in pregnancy but their possible antioxidant function and contributions of alterations in their metabolism to fetal and maternal morbidity and mortality have received insufficients attention. Serum levels of copper, manganese and zinc were determined in 40 pregnant Nigerian women spread across the three trimesters of pregnancy and compared with those of 25 non-pregnant women of similar demographic and anthropometric characteristics. Serum levels of uric acid were also determined in both groups of women. The mean serum levels of manganese and zinc were significantly lower in the pregnant than in the non-pregnant state (P<0.02, P<0.002), respectively. Unlike manganese and zinc, copper was significantly elevated in the pregnant than in the non-pregnant state. The endogenous anti-oxidant, uric acid, was also significantly reduced in the pregnant than in the non-pregnant state (P<0.001). Copper levels increased progressively in all the three trimesters of pregnancy compared with controls (P<0.001). However, zinc levels declined steadily in all the 3 trimesters, but only the level of the third trimester was significantly different from the non-pregnant state (P<0.05). Unlike zinc, uric acid rose consistently in all the 3 trimesters compared with the non-pregnant state. Manganese and uric acid were significantly more elevated in the third than the first trimester. One way analysis of variance (ANOVA) and multiple comparisons (Tukey HSD) show that the differences in the antioxidant levels can be ascribed mainly to the second and third trimesters. The prevalence of zinc deficiency was 4.0% in the non-pregnant state as compared to 22.5% in the pregnant subjects. The implications of micronutrient deficiencies and associated antioxidant status in pregnancy are discussed. Considering their role in pregnancy, prevention of such deficiencies and attendant oxidative stress may contribute to a reduction in the incidence of fetal and maternal ill-health, and complications of pregnancy. Interventions should be aimed mainly at the second and third trimesters.

Comparative evaluation of the effectiveness and safety of two regimens of levonorgestrel for emergency contraception in Nigerians

Emergency contraception was introduced in Nigeria over two decades ago, but few women have used this method even in emergency situations because of the side effects. To find an acceptable levonorgestrel regimen for emergency contraception in our community, the two-dose regimen 0.75-mg levonorgestrel 12 h apart (group A) and the single dose 1.5-mg levonorgestrel (group B) were studied in 1118 volunteers. Mild side effects such as nausea, vomiting, lower abdominal pains, menorrhagia, dizziness, headache, and breast tenderness were reported. Significantly more women in the high-dose group reported headache, breast tenderness, and heavy menstrual flow. Eleven pregnancies (1.0%) were reported (7 in group A and 4 in group B). The crude relative risk of pregnancies was similar in the two groups (RR = 0.71, 95% CI = 0.32-1.55; p > 0.05) [corrected]. On the other hand, the estimated effectiveness rate of 86.80% in group A was significantly lower than the 92.99% for group B (p < 0.05). The pregnancy rates increased with delay in starting treatment and if further acts of unprotected sexual intercourse took place after treatment. It was concluded that both regimens were effective and safe.

Isolated umbilical endometriosis--a rare finding

A 32 yr old multiparous Nigerian woman presented with histological confirmed umbilical endometriosis. There was no evidence of endometrotic deposits elsewhere. Apart from cyclical bleeding from the umbilicus, she was relatively free of any of the other signs and symptoms of Endometriosis. She had excision of the endometeriotic lesion and responded favourably to treatment. A high index of suspicion is required in making a diagnosis of endometriosis in remote extra pelvic sites especially with little or no characterisitic pointers to the disease.

Nutritive value of melon husk in the diet of chickens

A study was conducted to investigate the nutritive value of melon husk (MH). Results showed that MH was low in crude protein but very high in crude fibre, ash and ether extract. The elemental analysis showed that MH was also high in calcium and phosphorus content. However, when MH was incorporated into starter diets of chicks, body weight gain decreased with increase in the level of MH in the diets. Birds fed on a 10% MH diet were superior to others in body weight gain (10.45 g/bird/day). Results of feed intake and efficiency of feed utilization were also superior on 10% MH diet with values of 43.07 g/bird/day and 4.12 recorded, respectively. The dietary treatment had significant effect (p < 0.05) on the protein efficiency ratio, which decreased with increase in level of MH in the diets. However, there appeared to be no treatment effects on haematological parameters. Up to 10% MH can replace maize in the starter diet of cockerels without adverse effect on performance.

Pattern of condom use among commercial sex workers in Ibadan, Nigeria

Regular condom use has been proven to remarkably reduce the transmission of sexually transmitted diseases (STDs) and its regular use for casual and commercial sex is important for the success of any STD/AIDS control programme. We studied the pattern of condom use among commercial sex workers in Ibadan, Nigeria in an attempt to identify the factors associated with it. Two hundred and ninety-five commercial sex workers in 21 brothels were randomly selected, using a multi-stage sampling technique, from a total of 31 identified in the 5 local government areas that make up Ibadan municipality. They were administered a pre-tested, semi-structured questionnaire by trained research assistants. Results showed that over half (53.2%) of the respondents were in the 20-29 year age group and most (71.5%) had been in the profession for less than a year. Sixty-five (22.0%) had no formal education, 29.8 % had some secondary education whilst 22.4 % had completed secondary school. Their overall knowledge of sexually transmitted diseases (STDs) was rated as poor (20.7%), moderate (64.1%) and good (15.2%). Their perceived risk of contracting HIV/AIDS was low (21.7%) although 87.8% regard it as a health problem in Nigeria. Eighty-three percent of the respondents always insisted that their clients used condoms, 13.2% did so frequently whilst 1.4% only occasionally. Of those who asked clients to use condoms, 69.5% of the women would refuse sex without condoms, 49 (16.6%) would do nothing and have sex without condoms, but 4.4% would charge extra money. No factor was found to have a significant association with the practice of asking clients to use condoms or of refusing sex without condoms. We concluded that consistent condom use was high among sex workers in brothels in Ibadan and was independent of the sex workers knowledge and perception of STDs.

Serum immunoglobulins, total protein and albumin levels during UniplantR use by Nigerian women

The effects of UniplantR (a new, long-acting, 19-nor-progesterone derivative contraceptive) on serum immunoglobulins, albumin and total proteins were determined in Nigerian women during one year of use. Blood samples were collected prior to implant insertion and then at the third, sixth and twelfth months of use. All volunteers were in the reproductive age, healthy and had no contraindications to hormonal contraception. The mean levels of IgG (+/- SD) increased from pre-insertion to the twelfth month. When compared with the pre-insertion level (1,393.93 +/- 93.51 mg/dL), there are statistically significant increases in the mean values of IgG at three (1,457.19 +/- 78.41 mg/dL, p < 0.05), six (1,458.12 +/- 65.26 mgd/L, p < 0.05) and 12 months (1,499.56 +/- 87.60 mg/dL, p < 0.001). There were no statistically significant changes observed in the mean serum levels of IgA, IgM and total proteins during twelve months of implant use. These results indicate that while Uniplant does not seem to alter the levels of IgA, IgM, albumin and total proteins over a period of twelve months, it may induce significant increase in IgG levels. The raised mean serum levels of IgG may suggest an improved humoral immunity of Uniplant--a change that is potentially beneficial.

Experience with computed tomography (CT) pelvimetry in Ibadan, Nigeria: a preliminary report

Computed tomography (CT) pelvimetry has largely replaced conventional radiography in the antenatal assessment of pelvic dimensions, but its usefulness in the Nigerian setting is yet to be assessed. This study was undertaken to ascertain if there is a relationship between antenatal CT pelvimetric measurements and the mode of delivery at the end of the pregnancy. A group of thirty-one patients who had antenatal pelvimetry were categorised into two groups depending on whether they achieved vaginal delivery or not and the pelvimetric and other obstetrrc characteristics of the two groups were compared. The only parameters that showed statistically significant differences between the groups were the higher maternal height and the lower head circumference in the neonates of women achieving vaginal delivery. The findings suggest that fetal parameters may be more predictive of mode of delivery than absolute pelvic measurements.

Three decades of acquired gynaetresia in Ibadan: clinical presentation and management

A retrospective analysis of acquired gynaetresia (Vaginal Stenosis) managed at the University College Hospital Ibadan, Nigeria between 1967 and 1996 was conducted in terms of clinical presentation and management. The prevalence rate was 7/1000. The peak age incidence was 20-30 years. Chemical vaginitis resulting from insertion of caustic vaginal pessaries for various reasons was the major cause of acquired gynaetresia. Dyspareunia/apyreunia and vaginal stenosis/occlusion were the most common symptoms and clinical findings respectively. The various surgical treatment of acquired gynaetresia included one stage vaginoplasty, McIndole-Read's two stage vaginplasty, separation of labial agglutination, Williams's operation, and simple dilatation of the vagina. Successful correction was recorded in 68% of the patients while 28% had residual partial stenosis, 4% had complete stenosis and 6% were lost to follow-up. It was concluded that acquired gynaetresia is preventable. Efforts should be made by authorities to address this issue and create designated centres in the country for the management of these cases and training of junior gynaecologists.

Legal and regulatory aspects of prescribing and marketing emergency contraception in Nigeria

Emergency contraception remains so little used or understood and the lack of its awareness can be traced to a myriad of factors including legal and regulatory obstacles. The aim of this study was to determine the legal and regulatory aspects of dispensing or marketing a contraceptive method for reasons (especially emergency purposes) other than stated by the manufacturers. The existing drugs' and devices' regulatory systems in Nigeria, especially those governing family planning methods, were reviewed. A questionnaire was administered to 363 health workers, comprising of physicians, pharmacists, nurses and midwives, to determine the implications of dispensing some currently available oral contraceptives (OCs) for emergency purposes despite the fact that there is no explicit description of emergency use in the labelling of such drugs. In addition, in-depth interviews were conducted with regulatory bodies. It was observed that, with the exception of Postinor, the drug manufacturers' leaflets did not indicate that they could be used for emergency contraceptive purposes. Although 64.5% of the healthcare providers were aware that OCs and intrauterine contraceptive devices (IUCDs) can be used for emergency purposes, 42.1% actually prescribed or recommended them. Many health workers (62.3%) were unaware of any legal implication with regards to prescribing unregistered drugs in Nigeria. The existing guidelines stipulate that a manufacturer or marketer should 're-register' a product if a new indication or use not contained in the initial application was found later. To satisfy legal requirements, it does appear that the currently available OCs and IUCDs in Nigeria must be labelled and registered for emergency contraceptive purposes.

Evaluation of the Nigerian population policy--myth or reality?

The National Population Policy (NPP) was promulgated to improve the living standards and quality of life of Nigerians by reducing the persistently high level of fertility and population growth, and achieving an even rural-urban development. The aim of this study was to review Nigeria's demographic patterns in the last decade against the 1995 and AD 2000 benchmarks stipulated in the NPP. The results revealed that the total fertility rate fell significantly to 6.2 in the earlier half of the decade but is still far from the targeted figure of 4.0. The infant mortality rate had risen in the past five years, and although the crude death rate declined by 21.49% in 1995, it has remained stagnant since then. There has been no appreciable decline in the rate of natural increase which was expected to fall by 31.03% in AD 2000. The current contraceptive prevalence rate of 11.0% is a far cry from the targeted 80% set in the population policy. In general, the situation that influenced the decision to promulgate the NPP in 1988 has not improved much: the national decline in fertility is not appreciable neither is the increase in welfare significant. The key issues in the reproductive health sectors include the limited availability and poor quality of services, which lead to high maternal and infant mortality rates, inadequate adolescent outreach, and limited use of contraceptives. This evaluation of the policy's targets and objectives in the light of the 1995 and AD 2000 benchmarks reveals that the NPP has failed due to an underestimation of the huge financial resources required for implementation, lack of political will, poor and uncoordinated organisation, 'gender-divide' and the prolonged political instability in the country.

Adolescent contraception: survey of attitudes and practice of health professionals

In Nigeria, there is a persistent reluctance to provide adolescents with contraceptives and this is based largely on the premise that the culture does not support pre-marital sexual activity. However, several studies have revealed that a large number of adolescents are experiencing early sexual debut, some as early as 13 years. Furthermore, mortality resulting from termination of unwanted pregnancies is on the increase among Nigerian adolescents. The aim of this study is to assess the attitudes and practice of health workers in Ibadan regarding adolescent contraception. A structured questionnaire was administered to 735 health workers in selected hospitals and health facilities in Ibadan, Nigeria. Information relating to their practice and attitudes towards adolescent contraception was sought. The results revealed that while 58.9% of the respondents had counselled adolescents, only 30.7% had ever prescribed contraceptives for them. Among health workers that approved of family planning, 52.6% were favourably disposed to adolescent contraception while 23.9% were not. We observed that 40.2% of health workers that did not approve of family planning are not favourably disposed to adolescent contraception. Health workers who counsel adolescents on the use of contraceptives are more likely than those who do not to approve of its use. In addition, those who approve of family planning are 12 times more than those who do not, to have a favourable disposition to adolescent contraception. Perhaps, if providers are more receptive to adolescent contraception, the services will be more accessible to those who are sexually active. This will, no doubt, stem the incidence of unwanted pregnancies in our community.

Comparative analysis of blood plasma epidermal growth factor concentrations, hormonal profiles and semen parameters of fertile and infertile males

The relationship between male reproductive function and the blood plasma level of epidermal growth factor (EGF) is of interest in the light of the role that circulating EGF appears to play in regulating mouse spermatogenesis. We measured the concentrations of EGF in the blood plasma of 39 fertile men (sperm count > 20 x 10(6)/ml) and compared them with those of 31 infertile men (sperm < 20 x 10(6)/ml). Blood plasma levels of follicle stimulating hormone (FSH), luiteinising hormone (LH), prolactin and testosterone were also determined. The infertile patients had mean blood plasma EGF concentrations of 0.75 +/- 0.10 ug/L. The value was significantly lower than that of the fertile group (1.28 +/- 0.14 ug/L; P < 0.005). There were statistically significant differences between the fertile and infertile groups in sperm count, sperm viability, mean forward progression, testosterone, LH and FSH (P values between 0.0001 and 0.023). There was no significant difference in the prolactin concentrations between the two groups. Although overall average blood plasma EGF concentrations are significantly lower in the infertile males, regression analysis failed to reveal any direct relationships among the various parameters studied.

Perception and practice of emergency contraception by post-secondary school students in southwest Nigeria

A survey of 1500 students in post-secondary institutions in southwest Nigeria showed that the concept of emergency contraception (EC) was well known. Respectively, 32.4%, 20.4% and 19.8% knew that combined pills, progesterone only pills and intrauterine contraceptive device (IUCD) were usable for EC, while 56.7% mentioned the use of traditional methods. Only 11.8% had ever used either pills or IUCD and 10.7% had used a traditional method. Few students (11.5% and 2.3% respectively) knew the correct timing of EC pills and IUCD. The respondents reported varying circumstances under which EC was indicated but the majority cited condom breakage and sexual assault. The popular media represent the commonest source of information while hospitals/clinics were the commonest sources of procurement. About 37% of the respondents planned to use EC in future while 58% would not and 4.7% were uncertain. Reasons for these responses were explored.

The effects of nomegestrol acetate subdermal implant (Uniplant) on serum cholesterol, triglycerides, and lipoproteins in Nigerian users

The study was conducted to assess the effects of a nomegestrol acetate subdermal contraceptive implant (Uniplant(R)) on the lipid profiles of indigenous Nigerian women. Cholesterol content of the major lipoproteins, along with total cholesterol and triglycerides, were measured in fasting blood samples collected before implant insertion and then at months 1, 3, 6, and 12 of use. All volunteers were of the reproductive age, healthy, and had no contraindications to hormonal contraception. The mean levels of cholesterol and low density lipoprotein-cholesterol (LDL-C) increased gradually, albeit insignificantly, from insertion to month 12 of implant use. An initial decline in the mean levels of high density lipoprotein-cholesterol (HDL-C), reaching a minimal level (37.31 +/- 4.95 mg/dl) at month 3 of implant use, was observed. This was followed by a gradual rise that peaked (39.73 +/- 5.53 mg/dL) at month 12. These values were, however, not significantly different from the preinsertion value. The only significant difference (p <0. 005 ) was in the mean level of triglycerides at month 12 (90.90 +/- 17.75 mg/dL) when compared with the preinsertion mean level of 81.77 +/- 24.14 mg/dL. Both values were, however, within normal limits. These results indicate that Uniplant does not have a deleterious effect on the lipid profiles of Nigerian acceptors and can be safely prescribed to women seeking contraception.

Gossypol blood levels and inhibition of spermatogenesis in men taking gossypol as a contraceptive. A multicenter, international, dose-finding study

The safety and efficacy of gossypol continues to be controversial. The aim of this study was to evaluate gossypol as a contraceptive pill for men at doses lower than those previously prescribed and in men from various ethnic origin. A total of 151 men from Brazil, Nigeria, Kenya, and China were divided into two groups. Both groups received 15 mg gossypol/day for 12 or 16 weeks to reach spermatogenesis suppression. Subjects were then randomized to either 7.5 or 10 mg/day for 40 weeks. In addition, 51 men were enrolled as a control group. In all, 81 subjects attained spermatogenesis suppression. Only one man discontinued treatment because of tiredness. Potassium levels fluctuated within the normal range. FSH increased consistently. Testicular volume decreased, but after discontinuation, values returned to levels not statistically different from admission. Of 19 subjects on the 7.5 mg/day dose group, 12 recovered sperm counts >20 million/mL within 12 months of discontinuing gossypol. In the 10 mg/day group, sperm counts recovered in only 10 of 24 subjects. Eight of the 43 patients remained azoospermic 1 year after stopping gossypol. All men diagnosed with varicocele failed to reverse spermatogenesis suppression. Gossypol blood levels indicated that sperm suppression occurs independently of concentration, whereas spermatogenesis recovery appears to be concentration-dependent. Gossypol may become a medical alternative to surgical vasectomy when the delay in onset of infertility is acceptable. When taken for 1 year, gossypol causes no reduction in sexual desire or frequency of intercourse. The possibility of reversal, occurring in 51% of the men on this regimen within 1 year after stopping gossypol, is an advantage of this compound as compared with surgical sterilization in many parts of the world.

Seminal plasma zinc level in users of gossypol

Seminal plasma zinc levels were determined in 13 healthy male volunteers on gossypol, a triterpenoid aldehyde extracted to purity from cotton plant which has been found to be an orally active male fertility regulation agent that is simple, economical and reversible. Each subject was given 20 mg gossypol tablet daily until azoospermia occurred. Thereafter, a maintenance dose of 7.5 mg or 10 mg of gossypol was given orally to alternate subject. Each subject was followed up monthly for one year. Serial semen analysis and seminal plasma zinc levels were determined prior to and after administration of gossypol monthly for 52 weeks. The mean sperm count and motility decreased significantly until azoopermia occurred in all subjects at about the 20th week of follow up. However, there was no significant difference in the mean seminal plasma zinc levels throughout the period of observation irrespective of the dosage regimen of gossypol used by the subjects. It was concluded that gossypol has no effect on the seminal plasma zinc level in users of gossypol.

Results of a user satisfaction study carried out in women using Uniplant contraceptive implant

A study of the acceptability of Uniplant, a 12-month single implant of nomegestrol acetate, included 819 women from Africa, Latin America, and China, participating in a clinical trial of Uniplant. A standard, pre-coded questionnaire was specially designed for this purpose and applied at the moment of removal of implant, either at the end of 12 months of use or at the time of discontinuation for whatever reason. The level of satisfaction proved high when users' comparison with their previous contraceptive method, users' recommendation of Uniplant to others, users' intention to use the method in the future, and service satisfaction were taken into consideration. Uniplant was considered easy to use, safe (low risk of pregnancy), and also to cause fewer side effects than other methods. When asked about the least liked feature of Uniplant, almost half the respondents said that there was nothing that they disliked and about one-third mentioned the changes in their menstrual pattern. However, according to the clinical trial, over half of the Uniplant users have bleeding patterns similar to untreated cycles. The majority of respondents did not feel any discomfort during the procedure of insertion and removal of the implant. About 70% of patients in the study stated that they required contraception for more than one year and most of these women said that they did not mind having to change the implant every year.

Multicenter clinical trial on the efficacy and acceptability of a single contraceptive implant of nomegestrol acetate, Uniplant

Uniplant, a single Silastic implant containing nomegestrol acetate, provides contraceptive efficacy for one year. Uniplant use for one year was studied in 1,803 healthy women of reproductive age, enrolled from 10 centers in 9 countries, after informed consent. Implants were placed subdermally either in the upper arm or in the gluteal region. Two-hundred-seventy-six subjects discontinued prior to completing one year of study. Cumulative discontinuation rate at 12 months was 15.72%. Medical reasons for discontinuation were principally menstrual-related. Fifteen pregnancies occurred during the one year study period, resulting in a 12-month net cumulative pregnancy rate of 0.94%. Approximately 56% of subjects using Uniplant had bleeding patterns similar to normal menstruation. Results from this study confirm that Uniplant is an efficient, well tolerated, 12-month contraceptive implant, with the advantage of easier insertion and removal of the single implant compared to other multiple implant methods.

Comparative study on the efficacy, acceptability, and side effects of a contraceptive pill administered by the oral and the vaginal route: an international multicenter clinical trial

The objective of this multicenter randomized clinical trial was to compare the efficacy, acceptability, and occurrence of side effects associated with the oral versus vaginal route of administration of contraceptive pills. Eight hundred nineteen healthy, parous women of reproductive age were recruited at family planning clinics and research centers, members of the South to South Cooperation in Reproductive Health, in seven countries of the developing world. These women were randomly assigned to use either oral or vaginal administration of the same contraceptive pill, which contained 250 micrograms levonorgestrel and 50 micrograms ethinyl estradiol. No statistically significant differences were found in discontinuation rates between the two groups after 1 year. Involuntary pregnancy rates after 1 year were not statistically significantly different between the two groups. The vaginal route of administration appears to be as acceptable and efficacious as the oral route.

Antenatal care in developing countries

The problem of antenatal care in developing countries may be considered from two aspects: (a) areas where antenatal facilities are absent or are inadequate, and (b) areas where antenatal facilities are adequate but for some reasons are not adequately utilized. The solution to the first part of the problem would appear to be simple. The governments concerned should provide the required facilities. This obviously is not an easy task in many areas of the world, especially with the present profound economic depression in many developing countries. The people just have to use the facilities available to their best advantage, or do without the facilities. The second part of the problem presents more difficulties. Where antenatal facilities are available, inadequate utilization has been shown to be due to a number of factors: 1. The facilities are too distant or too expensive. It has been shown how the Nigerian authorities dealt with this problem in the Ibarapa district. However, it is a very expensive solution and few governments will be able to afford this. 2. Illiteracy or ignorance. The obvious solution to this difficulty is to educate the masses and a few governments have already embarked on these commendable programmes. Unfortunately, this procedure is expensive, may take a long time and, as already pointed out, even literate women may not use the antenatal services. 3. Traditional and cultural beliefs and prejudices. It has already been shown that this factor is a very important one in the population in developing countries, even among literate patients. The saying that 'old habits die hard' is probably apt here. Probably, with time, education and closer contact with the developed world, these prejudices will disappear. From the above observations, it would appear that an inexpensive short-term solution to the two parts of the problem mentioned above is for governments to train and use the TBAs who are already 'in our midst' and who already enjoy the confidence of the masses. The authorities, however, have to be very careful in integrating the TBAs into the health system. It has to be done very judiciously and tactfully, otherwise antagonism and unhealthy rivalry will be created between the TBAs and other members of the health team. They must be made to realize that they are a part of the health team.

Guinea pig testicular proacrosin-acrosin system: preliminary immunological characterization

In this study, immunochemical techniques were employed to examine the guinea pig (GP) testicular proacrosin-acrosin system. Monospecific polyclonal antibodies to the highly stable enzymatically active 34,000 molecular weight form of GP testicular acrosin were generated. Western blot analysis of acid extracts prepared from snap-frozen freshly excised GP testes revealed two major immunoreactive bands with mol. wts of approximately 62,000 and 48,000 and one minor band with an approximate mol. wt of 54-56,000. The 62,000 mol. wt molecule identified is in close agreement with the previously reported mol. wt for purified GP testicular proacrosin. Western blot analysis of different species of testicular acid extracts demonstrated the evolutionary relatedness of the proacrosin-acrosin systems since immunoreactivity was observed primarily with acid extracts from rodent species (rat, mouse and hamster) and not with extracts from evolutionarily less-related species (goat, ram and bovine). The majority of the cross-reactivity observed was characterized by immunoreactivity with the 62,000 and 48,000 mol wt molecules. The only species which exhibited cross-reactivity with the 54-56,000 mol. wt protein was rat. In addition, the iso-immunogenic and aspermatogenic properties of the 34,000 mol. wt form of GP testicular acrosin were examined. One out of five Hartley and one out of seven Strain 2 female GPs immunized and boosted with a total of 200 micrograms of purified protein exhibited increased levels of circulating anti-acrosin iso-antibodies. The antigenic specificity of the iso-antibodies observed in the two animals was verified by Western blot analysis. All other female animals, including two strain 13 GPs, exhibited very low or undetectable levels of such antibodies following immunization. One out of three male Hartley GPs immunized with 50 micrograms of the purified protein exhibited typical lesions of experimental allergic orchitis while none of a group of three animals developed lesions at a 5 micrograms dose. Taken together, these results suggest that the 34,000 mol. wt form of GP testicular acrosin is neither a highly potent iso-immunogen nor aspermatogenic autoantigen.

Progesterone in saliva as an index of ovarian function

Progesterone was assayed in samples of saliva collected daily throughout the menstrual cycle and correlated with corresponding daily concentrations of pregnanediol-3 alpha-glucuronide in early morning urine. Ovarian follicular growth was monitored on a daily basis with a real-time sector scanner. The concentrations of salivary progesterone shows a specific pattern with a mid-cycle rise and a peak in the luteal phase. The mean concentration in the follicular phase, as determined, was 40.4 pmol/l (range 15.3-110.7 pmol/l). It increased in the peri-ovulatory period to a peak of 201.1 pmol/l (range 46.4-289.8 pmol/l) 6 days following follicular rupture.

Guinea pig testicular proacrosin-acrosin system: further characterization of the active enzyme

In this paper, the characteristics of a highly stable, 34,000 molecular weight form of guinea pig (GP) acrosin are compared with those of acrosins from other mammalian species. GP acrosin, like acrosins from other species, is stable at pH 3.0, has a pH optimum of 8.0, and is inhibited by natural trypsin inhibitors and N-alpha-p-tosyl-L-lysine chloromethyl ketone. Its lack of inhibition by tosyl-phenylalanine chloromethyl ketone indicates that it has a specificity similar to trypsin but not chymotrypsin. The activity of GP acrosin was stimulated by Ca2+ below 75 mM. The enzyme was markedly inhibited by Hg2+, but only weakly inhibited by other metal cations. The disulfide reductants dithiothreitol and 2-mercaptoethanol both inhibited GP acrosin, as did the sulfhydryl reactant, iodoacetic acid. The Michaelis-Menten constant for GP testicular acrosin-catalyzed hydrolysis of the N-benzyloxycarbonyl-L-arginyl amide of 7-amino-4-trifluoromethylcoumarin at pH 8.0 was calculated from Lineweaver-Burk plots to give a value of Km = 2.0 x 10(-5) M with Vmax = 500 mumoles/min/mg protein. The corresponding lysine substrate, the N-benzyloxy-carbonyl L-lysine amide of 7-amino-4-trifluoromethyl-coumarin, had a higher Km = 4.6 x 10(-5) M and lower Vmax = 135 mumoles/min/mg protein, in accord with the substrate preference seen with other mammalian acrosins.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation of ovarian follicle size and the urinary excretion of oestrone glucuronide, luteinizing hormone and pregnanediol glucuronide in spontaneous cycles

Ovarian follicular development was investigated in 17 apparently normal women in whom ovulation was dated using real-time ultrasonography. Ultrasonic determination of follicular growth was performed on a daily basis with a real-time sector scanner, and correlated with daily concentrations of oestrone-3-glucuronide (E1-3-G), luteinizing hormone (LH) and the ratio of E1-3-G to pregnanediol-3 alpha-glucuronide (Pd-3 alpha-G) in early morning urine. The main results from ultrasonography showed that all patients except one developed follicles greater than 1.8 cm, with a mean growth rate of 0.18 cm/day. There was a statistically significant correlation between the mean follicular diameter and the mean concentrations of urinary E1-3-G (r = 0.95, P less than 0.001) and ratio of E1-3-G to Pd-3 alpha-G (r = 0.97, P less than 0.001) during the 8 days prior to ovulation.

Experimental allergic orchitis in mice: IV. Preliminary characterization of the major murine testis specific aspermatogenic autoantigen(s)

Active experimental allergic orchitis (EAO), characterized by inflammation of the testes (autoimmune orchitis), aspermatogenesis, epididymitis and vasitis was induced in mice using a panel of tissue antigens as immunogens. Immunization with allogeneic murine tissue homogenates emulsified in complete Freund's adjuvant (CFA) accompanied by the injection of pertussigen revealed that only adult murine testicular and epididymal homogenates are capable of eliciting murine EAO. All other tissue antigens studied including prepubertal mouse and epididymal homogenates failed to elicit significant disease. Immunization with xenogeneic testicular antigens also failed to elicit significant disease indicating that the major murine aspermatogenic autoantigen(s) is also highly species specific. Sensitization with allogeneic mouse testicular homogenates (MTH) from different disease resistant strains was for the most part no less potent in inducing significant disease than was immunization with mouse testicular homogenates from disease susceptible strains. However, testicular homogenates from NZB/B1NJUnm and MRL/MpJ-/+Unm mice were significantly less potent at inducing autoimmune epididymitis as compared to other strains, indicating possible interstrain differences in the immunogenicity of the aspermatogenic autoantigen(s) relevant to eliciting epididymitis. Attempts at solubilization and purification of the major murine aspermatogenic autoantigen(s) utilizing techniques employed for the purification of aspermatogenic autoantigens such as AP3 from guinea pig (GP) testes were unsuccessful. Additional extraction procedures resulted in solubilization of the relevant autoantigen(s) only after reduction in the presence of 6 M guanidine hydrochloride. These data suggest that: (1) there may be a much more limited number of aspermatogenic autoantigens in murine testes as compared to GP testes; (2) the disease inducing determinant(s) may be expressed as either a sequential antigenic determinant(s) or as an antigenic determinant(s) in the carbohydrate portion of a glycoprotein or glycopeptide; and (3) the disease inducing autoantigen(s) may be present in situ in a highly insoluble form requiring active processing within the target organ in order to generate soluble antigen capable of being seen by immune reactants.

Single serum progesterone measurement in the mid-luteal phase as an index of ovulation

Plasma progesterone levels were measured in three groups of cycles during which ultrasonic monitoring of follicular growth was performed to determine the day of follicular rupture and, thus, the mid-luteal phase when sample timing was optimal. This was in an attempt to fix accurately the lower limit of plasma progesterone in the mid-luteal phase that is associated with ovulation. Plasma progesterone levels were determined in fifteen normal cycles (group I), seventeen Clomid-treated cycles (group II) and seven conceptional cycles (group III), during which ultrasonic monitoring of follicular growth was performed. The day of sampling was also compared with the peak values of pregnanediol-3 alpha-glucuronide relative to the day of follicular rupture in corresponding cycles. This was to ascertain if sample timing was optimal. Progesterone levels in the treated cycles were generally higher than in spontaneous cycles. Results show that the mean value is statistically lower in groups I and II (t = -2.65 with 30 degrees of freedom), whereas there is no statistical difference between groups II and III or I and III. A level of 29.0 nmol/l (the lower value within 95% confidence interval in the conceptional group) is an appropriate lower index of ovulation.

Purification and initial characterization of guinea pig testicular acrosin

Guinea pig (GP) acrosin was purified following acid extraction of testicular acetone powder, pH precipitation of the soluble extract, gel filtration on Sephadex G-100, ion-exchange chromatography on SP-Sephadex, and affinity chromatography on Concanavalin A-Sepharose. Final purification was achieved by re-chromatography on Sephadex G-100. Enzymatic activity was detected by following the hydrolysis of N-benzyloxycarbonylarginyl amide of 7-amino-4-trifluoromethylcoumarin at 37 degrees C, pH 8.0, before and after activation. GP testicular acrosin exhibited a molecular weight of 48,000 by gel filtration and 34,000 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Following SDS-PAGE in gels containing 0.1% gelatin, protease activity was observed to comigrate with the major protein detected by silver staining. The purified GP acrosin showed cross-reactivity with a monospecific polyclonal rabbit antiserum directed against boar sperm acrosin and exhibited reversible pH-dependent activation. The physiochemical characteristics of the purified protein, including the amino acid composition, resemble those reported for acrosins from other species.