Serum leptin levels and relationship with maternal weight gain at term among obese and non-obese pregnant women in Enugu, Nigeria: a comparative cross-sectional study

OBJECTIVE

To determine and compare the mean maternal serum leptin levels, the prevalence of high serum leptin levels and mean gestational weight gain at term among obese and non-obese pregnant women in Enugu, Nigeria.

METHODS

This cross-sectional comparative study enrolled obese and non-obese pregnant women. The serum leptin levels of the women were determined using an enzyme-linked immunosorbent assay kit. Anthropometric and sociodemographic data were obtained and compared. Mean weight gain during pregnancy was determined.

RESULTS

A total of 170 pregnant women were included in the study. The mean ± SD serum leptin level (99.39 ± 50.2 ng/ml) and the prevalence of hyperleptinaemia (81 of 85 patients; 95.3%) among the obese pregnant women at term were significantly higher than those of the non-obese pregnant women (48.98 ± 30.35 ng/ml/65 of 85 patients; 76.5%). The mean percentage weight gain was significantly higher in the non-obese women compared with the obese women at term. The predictors of high maternal serum leptin level at term among the participants were the employment status and levels of education of the participants.

CONCLUSION

Maternal serum leptin level, maternal weight gain and prevalence of hyperleptinaemia at term were significantly higher in the obese compared with the non-obese pregnant women.

Knowledge Levels and Predictors of Venous Thromboembolism among Pregnant Women in Nigeria: A Cross-Sectional Survey for the 'Move for Flow' Programme

BACKGROUND

Pregnancy is a significant risk factor for Venous Thromboembolism (VTE) which results in high maternal and perinatal morbidity and mortality rates. Awareness creation is one of the preventable strategies of VTE. To this effect, we designed the 'Move for Flow' program aimed at maternal health education on VTE, its symptoms and preventive strategies. For the best implementation of this program, the current knowledge level of the relevant population is of great interest in guiding the program design and implementation.

AIM

To assess the knowledge levels of VTE among Nigerian pregnant women.

METHODOLOGY

In this cross-sectional survey, 1000 pregnant women residing in Enugu, Nigeria, completed a structured questionnaire which assessed their knowledge of VTE, its risk factors and prevention strategies. Quantitatively, their knowledge levels were categorized as no, poor, average and good knowledge.

RESULTS

The majority of the respondents did not know about pregnancy-related deep vein thrombosis (DVT) (80.8%) and pulmonary embolism (PE) (88.9). Predictors of DVT knowledge levels include husbands' level of education (at most secondary education) (AOR = 4.2; 95%CI = 2.554-6.816; p = <0.001) and maternal age (AOR = 0.9; 95% CI = 0.930-0.999; p = 0.044) while predictors of PE knowledge level include husbands' level of education (at most secondary education) (AOR = 2.1; 95%CI = 1.005-4.436; p = 0.048) and maternal occupation (professionals) (AOR = 0.4; 95% CI = 0.219- 0.794; p = 0.008).

CONCLUSION

Pregnant women are unaware of pregnancy-related VTE in Enugu, Nigeria. Immediate designing and implementation of the 'Move for Flow' program are recommended to improve maternal knowledge levels of VTE.

COVID-19 in hematological malignancies: Case series and literature review

Earlier reports suggest that cancer patients were twice more likely to contract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this report, we describe two patients with hematological malignancies seen at the peak of the first wave of the coronavirus disease 2019 pandemic. A 61-year-old man was referred to our urology unit he was diagnosed with nodular hyperplasia and multiple myeloma and commenced on bortezomib, thalidomide, and dexamethasone combination chemotherapy. He developed a cough and fever, with SPO2 86%, He was positive for SARS-CoV-2 and died a few days later. A 42-year-old man with Hodgkin lymphoma on treatment with Adriamycin, bleomycin, vincristine, and dacarbazine with positive SARS-CoV-2 exposure was diagnosed with pleural effusion at A/E. Three days postadmission, his condition worsened with low SPO2 despite intranasal oxygen. He died after testing positive for SARS-CoV-2. Patients with hematological malignancies tend to have a greater risk of SARS-COV-2 infection and severe disease due to immunosuppression from cancer and its treatment.

Adherence to prophylaxis and bleeding outcome: A multicenter Nigerian study

In Nigeria, low-dose prophylaxis is the standard of care as it reduces bleeding, development of target joints, arthropathy, and improvement of quality of life. Non-adherence or poor adherence can prevent the achievement of these outcomes. The levels and determinants of (non-)adherence among persons with haaemophilia (PWH) in Sub-Saharan Africa have not been evidenced. We aimed to evaluate self-reported adherence among PWH, provide evidence of determinants/predictors of adherence, and establish the associations between nonadherence and presence of target joints and annualized bleed rate. A cross-sectional survey of 42 participants on low-dose prophylaxis recruited during outpatient appointments in 5 haemophilia treatment centers in Nigeria. We used the validated Haemophilia Regimen Treatment Adherence Scale- Prophylaxis (VERITAS -Pro), 24 questions on six subscales (time, dose, plan, remember, skip, and communicate) questionnaire. The options of VERITAS -Pro were represented in a 5 Likert scale and the possible subscale ranged from 4 points (most adherent) to 20 points (least adherent) and the possible total score ranged from 24 (most adherent) to 120 (least adherent) the cutoff for overall adherence put at > 61 to indicate nonadherence. Information on the presence of target joints, the number of target joints, and annualized bleeding rates were collected from medical files. The mean age of the participants was 9.79 (6.29) years, with 96.6% having hemophilia A and 79.3% having target joints. Overall adherence to the prophylaxis regimen was 81.0%. The mean total VERITAS-Pro for the adherent group and the non-adherent group was 37.35 ±9.08 and 63.0± 6.37, respectively. The mean subscale scores for the adherent group ranged from 0.67 (communication) to 8.68 (planning), while the mean subscale scores range from 1.0 communication to 13.88 (planning) for the nonadherent group. The mean difference of all except the dosing subscale was statistically significant with p<0.05. Only the skipping subscale showed a statistically significant positive correlation with ABR in the non-adherent group p = 0.02. The findings indicate that adherence was very good, and most were in communication with their treatment centers. The skipping subscale was significantly associated with ABR for the nonadherent group. Interventions aimed at improving adherence are the key to better treatment outcomes. A multicenter study was needed to assess the reason for poor adherence.

Iron supplementation and blood donation in Nigeria: Effect on Hemoglobin, red cell indices, and iron stores - The ranferon™ study

Background

Iron-deficiency anemia is an important limiting factor to a sustainable supply of blood units, especially in low- and middle-income countries. Blood transfusion practice in Nigeria is poorly developed and structured with paucity of voluntary nonremunerated blood donors and high rate of donor deferrals resulting from low hemoglobin (Hb) levels.

Aims

This study aimed to assess the effect of daily supplementation of iron using Ranferon-12 on Hb level, red blood cell (RBC) indices, iron level, ferritin level, and Hb recovery in blood donors in Nigeria.

Methodology

This longitudinal study was conducted at a tertiary hospital blood transfusion center from March to July 2020. Blood samples of regular donors were collected at three points in the study for the measurement of Hb and hematocrit (HCT); RBC indices including mean cell volume (MCV), mean cell hemoglobin (MCH), and Mean cell haemoglobin concentration (MCHC); and iron stores including serum iron, serum ferritin, and serum transferrin. The first point was at recruitment before donation of one unit of blood; the second point after the blood donation; and the third point at 6 weeks post blood donation. Following donation, participants were placed on Ranferon capsules (iron fumarate - 100 mg elemental iron) and 100 mg of tablet Vitamin C, for 6 weeks.

Results

There was a moderate significant positive correlation between administration of Ranferon and change in the values of HCT, MCV, MCH, red cell distribution width, ferritin, and transferring (P < 0.05). Percentage recovery of Hb, red cell indices, and iron stores parameters after 6 weeks of daily Ranferon ranged between 89% and 100%.

Conclusion

Iron supplementation using Ranferon capsule daily for 6 weeks enhances recovery of Hb, red cell indices, and iron stores with attainment of benchmark Hb levels for donation.

Contributions of von Willebrand factor to clinical severity of sickle cell disease: a systematic review and metanalysis

AIM

To evaluate the contributions of VWF to the clinical manifestation and severity of SCD.

DESIGN

A systematic review of peer-reviewed articles published in English. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

METHODS

The data sources for the review included MEDLINE, PubMed, CINAHL, and Academic Search Complete. Articles that applied a quantitative approach to the investigation of the relationship of vWF with clinical manifestations and severity indices were included. The risk of bias assessment was carried out with a mixed-method appraisal tool. We computed I ² to estimate the degree of heterogeneity.

RESULT

There was a significantly higher level of VWF in SCD than in the control (d = 2.7, Z = 4.865, P < 0.001, I ² = 96.41%). Significant positive correlations were obtained for the relationship of VWF with vasoocclusive crisis (r= 0.277, Z= 5.077, P < 0.001, 1 ² =15.62), rate of hemolysis (r=0.441; Z= 4.440, I ² = <1%), extracellular haemoglobin (r=-0.397, Z=-4.155, I ² =<1%) and CRP (r = 0.331, Z = 4.566, P < 0.001, I ² < 1%).The VWF is important in determining the clinical severity of sickle cell disease, which constitutes a putative therapeutic target. More work is required to understand the causal direction underlying the association between VWF levels and the clinical severity of sickle cell disease and the potential role that VWF plays in the clinical manifestations of sickle cell disease.

PROTOCOL REGISTRATION

The protocol was registered with PROSPERO (CRD42021262625).

Prevalence of venous thromboembolism risk factors in hospitalized patients at the University of Nigeria Teaching Hospital, Enugu Nigeria

Background: Venous thromboembolism (VTE) is a common and lethal disease. Assessing the risk factors will help to modify exposures. Aim: This study, assessed VTE risk factors in hospitalized patients at the University of Nigeria Teaching Hospital, Enugu. Patients and Methods: This was an observational, case-control study. Three hundred and fifty (350) patients were recruited for the study: This comprised 150 medical patients, 140 surgical patients and a population of 60 healthy control group. Subjects were evaluated once using the Caprini risk assessment model (RAM). Results: Over 50% of all hospitalized patients, were at risk for VTE. Surgical patients were at a higher risk than medical patients. Hemoglobin concentration was associated with the risk of VTE in surgical patients, while d-dimer was associated with VTE risk in medical patients. Conclusion: This study shows a high prevalence of VTE risk factors among hospitalized patients at the University of Nigeria Teaching Hospital. Keywords: Venous Thromboembolism; Risk factors; D-dimer; Patients;  Nigeria.

Determinants of Obstetricians' Pattern of Care for Sickle Cell Disease in Pregnancy

BACKGROUND

Pregnancy in sickle cell disease (SCD) is high risk. With improved comprehensive obstetric care, pregnant females with SCD can achieve successful pregnancy outcomes, especially in resource-poor settings.

OBJECTIVES

To determine the predictors of Obstetricians' pattern of care for SCD in pregnancy in Nigeria.

MATERIALS AND METHODS

Self-administered, pre-tested, pre-validated questionnaires containing 18 questions on demographic details of obstetricians, and their pattern of practice towards antenatal care for pregnant SCD patients were distributed to attendees of the 2018 conference of the Society of Obstetrics and Gynaecology of Nigeria (SOGON). Regression analysis was done to determine the possible predictors, and a significant level was <0.05.

RESULT

Almost all the respondents (98.4%) considered pregnancy in SCD as high risk, and 96.2% proposed for preconception care in a tertiary hospital. The majority, (62%) agreed that antenatal visits in the first and second trimesters should be more frequent. The majority (96.2%) reported they would routinely order urine tests among other investigations. Majority of respondents,74.9% and 98.4% knew that foetal medicine specialists and haematologists should be part of preconception care team, respectively. Respondents' practice centre and designation, significantly contributed to their "willingness to consult a haematologist" (P = 0.004)," and willingness to consult a foetal specialist" (P = 0.047), while practice centre and practice population significantly contributed to their response to "ideal centre for management of SCD pregnancy": (P = 0.049), (P = 0.024) respectively.

CONCLUSION

Obstetricians' level of training, practice centre, and practice population of pregnant women with SCD are significant contributors to their pattern of care towards antenatal care for pregnancy in SCD.

Prevalence of venous thromboembolism and its associations in a large racially homogenous population of sickle cell disease patients

To determine the prevalence of venous thromboembolism (VTE) among adult sickle cell disease (SCD) patients in Nigeria.

METHODS

This was a multicentre retrospective study in which the medical records of adult SCD patients were reviewed. Information on demographics, steady-state haemogram, clinical phenotypes, duration of follow-up, history of VTE including risk factors and management was collected.

RESULTS

Of the 509 SCD patients with a median (IQR) duration of follow-up of 2 years, 10 (2.0%) had VTE (9 DVT and 1 PE). Their median (IQR) age was 27 (22.8-30.3) years. Identifiable risk factors for VTE included positive family history (2, 20%) surgery, splenectomy, paraplegia and cancer (1, 10% each). No risk factor was identifiable in four persons. VTE had no significant association with age and gender. VTE was significantly associated with the following events: acute chest syndrome [p = .002, odds ratio (OR) 8, 95% CI 2.2-28.9], osteonecrosis [p = .012, OR 5.24, 95% CI, 1.45-18.91] and vaso-occlusive crisis [p = .035]. Also significantly associated with VTE were pulmonary hypertension [p = .001, OR 23.3, 95%CI 5.18-105.06] and stroke [p = .032, OR 9.35, 95%CI 0.87-53.25].

CONCLUSION

The prevalence of VTE among SCD patients in Nigeria is low. It is significantly associated with vaso-occlusive crisis, pulmonary hypertension and stroke.

Clinical Audit of Low Dose Prophylaxis Programme for Nigerian Children with Haemophilia

INTRODUCTION

The evidence of benefits for prophylaxis especially low dose prophylaxis is incontestable yet most children in developing countries as Nigeria do not have access to this treatment protocol.

AIM

The aim was to audit the low dose prophylaxis treatment in Nigerian children with haemophilia.

METHODOLOGY

A multicentre clinical audit of five haemophilia treatment centres; University of Nigeria Teaching Hospital Enugu, Lagos University Teaching Hospital, National Hospital Abuja, University of Port Harcourt Teaching Hospital Port Harcourt, and Federal Teaching Hospital Gombe. Eighteen children with mild-severe haemophilia were enrolled into low-dose prophylaxis treatment programme. The reduction of joint bleeding, improvement of joint function and Quality of Life (QoL) during prophylaxis were analysed.

RESULTS

In total 18 children - 17males and 1 female (median age 8 years) were enrolled. The median duration of observation was 7 months (range 3-15months). Seven of the children were on primary prophylaxis (41%) while 10 of the children (59%) were on secondary prophylaxis. The number of joint bleeds decreased from a total of 162 (individual range 5-20, mean 10.3) to 42 (range 0-7, mean 3.0) during the observation period with an overall reduction of 74%. Joint function improved in 94.1% of disease joints, while only 5.6% reported no improvement (due to poor compliance). School attendance improved in all subjects, sports participation and daily activity improved moderately.

CONCLUSION

Low dose prophylaxis was beneficial in reduction of joint bleeds, improvement of joint function and improvement of QoL of Children with haemophilia in Nigeria.

Does Sickle Cell Disease Protect against HIV Infection: A Systematic Review

OBJECTIVE

The aim of this systematic review was to investigate whether sickle cell disease (SCD) protects against human immunodeficiency virus (HIV) infection by determining the association between SCD and the incidence and virulence of HIV infection.

METHODS

This is a systematic review that used MEDLINE, PubMed, CINAHL, and Academic Search Complete as data sources. Articles describing the relationship of SCD with HIV infection were included in this review. The effect measures were converted to correlation coefficients and synthesized accordingly to examine the putative protective role of SCD against HIV infection. Independent full-text screening and data extraction were conducted on all eligible studies. The risk of bias was assessed using the mixed methods appraisal tool. We employed a random-effects model of meta-analysis to estimate the pooled prevalence. We computed Cochrane's Q statistics, I2, and prediction interval to quantify effect size heterogeneity.

RESULTS

SCD reduces the risk of HIV infection by 75% (odds ratio [OR] = 0.25; r = -0.36, p < 0.001; I2 = 71.65). There was no publication bias (Egger's t value = 0.411; p = 0.721). Similarly, risk of HIV virulence was reduced by 77% (OR = 0.23; r = -0.38; p < 0.001; I2 = 63.07). The mechanisms implicated in the protective influence of SCD include autosplenectomy, reduced CCR5 expression, and increased expression of heme and iron-regulated genes.

CONCLUSIONS

SCD appears to protect against HIV infection and slows HIV progression.

Sero-prevalence of Hepatitis B virus infection: A cross-sectional study of a large population of health care workers in Nigeria

Background

Hepatitis B virus (HBV) infection has been recognized globally as a major public health challenge necessitating a global call for increased awareness, patients' identification, and development of activities for prevention and control of the disease. Consequently, massive health education campaigns and screening exercises have been mounted globally to mark the World Hepatitis Day (WHD).

Aims

As part of WHD 2016 activities, we undertook a survey and screening of health care workers in order to raise awareness, identify patients and contribute to the Global Health Strategy goal of eliminating HBV infection by the year 2030.

Method

This was a cross-sectional analytical study done at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria. Hospital workers voluntarily presented themselves to be screened using a rapid test kit and completing a semi-structured investigator-administered questionnaire.

Results

A total of 3123 participants were studied. The mean age of the participants was 39.4 ± 9.6 years. The seroprevalence of HBV infection was 2.3%. Most (97.0%) of the participants had previously heard about HBV infection and over two thirds (68.1%) could correctly identify risk factors and modes of transmission of HBV. Twenty-eight and a half percent of the participants knew their hepatitis B virus status prior to the study.

Conclusion

The seroprevalence of HBV among healthcare workers in Enugu, Nigeria is relatively low compared to figures from other African countries. The healthcare workers have considerable knowledge of the disease. However, the observed knowledge gaps in awareness and screening need to be addressed.

ABO blood group as a biomarker of preeclampsia among antenatal clinic attendees in Nigeria

Background

The clinical application of the ABO blood group is not limited to transfusion medicine but extends to other aspects of medicine. Its impact on preeclampsia is controversial.

Aim

To determine the association of ABO blood group type with preeclampsia.

Subjects and Methods

This was a cross-sectional analytical study of 66 women with preeclampsia and 81 apparently healthy women controls carried out in a tertiary health institution. The case and control groups were consecutively recruited during antenatal clinic visits and matched for age, parity, and gestational age. Data on demographics and the ABO blood group of the two groups of individuals were obtained. The analysis was both descriptive and inferential using the statistical package for social sciences (SPSS) version 21 (Chicago Il, USA). A P value of <0.05 was considered statistically significant.

Results

The mean age of the participants was 30.6 (4.9), 95% CI: 27.76-33.95. The majority of the women were ≤40 years (98.5%) and multigravidae constituted 81.8%. Forty-six (69.7%) women with preeclampsia had blood group O and 20 (30.3%) had a non-O blood group. Forty-nine (60.5%) of the controls had blood group O and 32 (39.5%) had a non-O blood group. The observed difference was not statistically significant (OR 1.50; 95% CI: 0.75-3.0; P = 0.26). The odds ratio for developing preeclampsia was 0.83 (95% CI: 0.37-1.91; P = 0.67) for the primigravidae. The non-O blood groups were more likely to present with symptoms than the O group (P < 0.01). Twenty-six (39.4%) women with preeclampsia had a mild disease while 40 (60.6%) had severe disease.

Conclusion

Women with non-O blood groups are not at increased risk of developing preeclampsia but are more likely to be symptomatic than the O group.

Novel Coronavirus Infection: A Review on Haematological Markers of Disease Severity

The Corornavirus Disease (COVID-19) virus infection has a wide range of presentation- asymptomatic, mild, severe and critical forms that often lead to death from respiratory failure. There is a strong relationship between the severity of COVID-19 infection and some haematological parameters. Patients often present with lymphocytopenia at diagnosis despite having a normal total white cell count. The degree of lymphocytopenia could predict the progression to pneumonia and subsequent need for ventilator support due to respiratory failure. Apart from lymphocytopenia, thrombocytopenia has been linked with increased severity of COVID-19 symptoms. The lymphocyte-platelet ratio has been found to a better marker for disease severity than isolated lymphocytopenia or thrombocytopenia. COVID-19 patients have been found to be at increased risk of Venous Thromboembolism (VTE). There is elevation of D-dimers, abnormalities of the Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) among hospitalised COVID-19 patients. This has necessitated the use of prophylactic anticoagulation even in the early phases of the infection.

Cancer prevention, the need to preserve the integrity of the genome at all cost

Introduction

The entire genetic information carried by an organism makes up its genome. Genes have a diverse number of functions. They code different proteins for normal proliferation of cells. However, changes in the base sequence of genes affect their protein by-products which act as messengers for normal cellular functions such as proliferation and repairs. Salient processes for maintaining the integrity of the genome are hinged on intricate mechanisms put in place for the evolution to tackle genomic stresses.

Aim

To discuss how cells sense and repair damage to their deoxyribonucleic acid (DNA) as well as to highlight how defects in the genes involved in DNA repair contribute to cancer development. Methodology: Online searches on the following databases such as Google Scholar, PubMed, Biomed Central, and SciELO were done. Attempt was made to review articles with keywords such as cancer, cell cycle, tumor suppressor genes, and DNA repair.

Results

The cell cycle, tumor suppression genes, DNA repair mechanism, as well as their contribution to cancer development, were discussed and reviewed.

Conclusion

Knowledge on how cells detect and repair DNA damage through an array of mechanisms should allay our anxiety as regards cancer development. More studies on DNA damage detection and repair processes are important toward a holistic approach to cancer treatment.

Prevalence and predictors of placental malaria in human immunodeficiency virus-positive women in Nigeria

BACKGROUND

Human immunodeficiency virus (HIV)-infected pregnant women have alterations in cellular and humoral immunity that increase the risks to placental malaria infection.

AIM

This study aimed at determining the prevalence and predictors of placental malaria among HIV-positive women in Nigeria.

MATERIALS AND METHODS

It was a longitudinal cohort study of pregnant women receiving antenatal care at a tertiary hospital in Nigeria. Peripheral blood sample for packed cell volume estimation and placental blood sample for malaria parasite estimation were collected from each participant at a presentation in labor and upon delivery, respectively.

RESULTS

The Prevalence of placenta malaria (68.6%) and anemia (66.7%) in HIV-positive women were significantly higher than the prevalence of placental malaria (35.3%) and anemia (44.1%) in HIV-negative control (P < 0.001 and P = 0.001 respectively). The employment status was the only sociodemographic factor significantly associated with the development of placental malaria in HIV-positive women (odds ratio: 21.60; 95% confidence interval: 7.1-66.2; P< 0.001).

CONCLUSION

The prevalence of placental malaria is very high among HIV-positive women in Nigeria. Scaling up free distribution of insecticide treated nets in the short term and employment opportunities of HIV-positive women, in the long run, may reduce the prevalence of placental malaria in our population.

Understanding the RECORDS 3 Trial and its impact on anticiagulation practice in resource poor countries

Venous thromboembolism is a significant cause of mortality and morbidity in patients following major orthopaedic surgeries. The RECORDS 3 trial revolutionised anticoagulation practice especially in patients with total knee arthroplasty and challenging the strong hold of warfarin and heparin in anticoagulation practice. With all these novel agents shifting the paradigm in anticoagulation management, Cost, in accessibility and lack of awareness of the availability of the agents amongst clinicians and surgeons alike are some factors militating against the use of these agents in patients in resource poor countries.

Prevalence of sexual dysfunction among females in a university community in Enugu, Nigeria

BACKGROUND

Female sexual dysfunction is a common, condition that significantly reduces the quality-of-life of the affected persons. Unfortunately, because of the veil of secrecy that shrouds discussions on human sexuality, there has been limited research on this topic in some sociocultural settings.

AIM

The aim was to determine the prevalence and some sociodemographic factors associated with sexual dysfunction in females in a university community at the University of Nigeria, Enugu Campus, Enugu State, Nigeria.

SUBJECTS AND METHODS

This is a cross-sectional study involving 500 females recruited randomly in a tertiary institution in Nigeria. A self-administered structured pretested questionnaire on sexual activity was administered (the Female Sexual Function Index [FSFI]). Statistical analysis was performed using SPSS software package (Version 17.0, Chicago, IL, USA). Multiple logistic regression was used to determine the relationship between the sociodemographic factors, and the total FSFI scores dichotomized as normal and reduced sexual function. In addition, multiple linear regression was used to determine the relationship between the six different domains scores and the continuous values of the total score. For all, calculations, P < 0.05 was considered as statistically significant at 95% confidence interval (CI).

RESULTS

The prevalence of female sexual dysfunction (FSFI score ≤ 26.50) was 53.3%. The highest prevalence occurred in the 41-50 years age group (73.3%; 66/90), married and living together 56.4% (123/218) and had postsecondary education (56.1%; 137/244). Only age significantly predicted female sexual function (P = 0.007; 95% CI; 0.691-0.943). Marital status, religion, ethnic group, and educational qualification had no significant effect (P < 0.05). The total FSFI significantly increase as desire increases (P = 0.002; 95% CI = 0.817-3.573).

CONCLUSION

Female sexual dysfunction is common in the university environment, with the highest prevalence occurring in 41-50 years age group.

Clinical and Laboratory Predictors of Frequency of Painful Crises among Sickle Cell Anaemia Patients in Nigeria

INTRODUCTION

The severity of Sickle Cell Anaemia (SCA) in terms of frequency of painful Vaso-Occlusive Crises (VOC) may be affected by clinical and haematological parameters amongst others. Elucidation of these factors in a given disease prevalent environment is necessary for prompt and effective management of patients with frequent painful VOC.

AIM

This study aimed at determining the clinical and laboratory predictors of frequency of painful VOC among SCA patients in Enugu, Southeastern Nigeria.

MATERIALS AND METHODS

It was a cross-sectional study of 100 consecutive SCA patients receiving care at the University of Nigeria Teaching Hospital, Enugu, Nigeria between May 2012 and February 2014. The eligible patients were categorized into two groups namely; Group A and Group B. Group A/study group (severe disease) comprised SCA patients who had experienced three or more painful crises (≥3 crises) in the last one year preceding the study but, currently in steady state, while Group B/control group (mild-moderate disease), comprised SCA patients matched for age, sex, highest educational status, and occupation but who have had no painful crisis or had only one or two painful crises (0-2 crises) in the last one year preceding the study and currently in steady state.

RESULTS

The overall mean age of the patients was 18.4±12.2 (range=2-52) years. The mean values of the haematological parameters including haemoglobin concentration, white cell count, platelet count, and neutrophil count were significantly higher in those with severe crises than mild-moderate crises (p<0.05). Sickle cell related complications including Avascular Necrosis (AVN) and leg ulcers were significantly higher in the study group than the control group (p<0.05).

CONCLUSION

There was significant association between the frequency of crises and haemogblobin level, platelet and neutrophil counts and some clinical parameters: AVN, nephropathy and stroke. Future preventive interventions for reduction in frequency of crisis amongst patients with SCA could be targeted at controlling the blood levels of the identified haematological parameters.

Molecular characterization of exon 28 of von Willebrand's factor gene in Nigerian population

BACKGROUND

Polymorphisms in von Willebrand factor (VWF) gene are an important contributor to the expression of VWF gene and differences in ethnic distribution of these single nucleotide polymorphisms (SNPs) exists.

AIMS

Our objective was to molecularly characterize the exon 28 of the VWF gene in the three major ethnic groups of Nigeria.

SUBJECTS AND METHODS

We recruited 90 subjects, 45 had a history of bleeding. Questions included those used in the Zimmerman Program for the Molecular and Clinical Biology of von Willebrand disease (VWD), and the bleeding scores were calculated using the Molecular and Clinical Markers for the Diagnosis and Management of type 1 VWD scoring system. Full blood count, coagulation profile, VWF:antigen level and VWF:collagen-binding activities were carried out. Data were analyzed using GraphPad Prism (5.03). GraphPad Software, Inc USA. The BigDye terminator chemistry was used to determine the nucleotide sequences of VWF gene (exon 28).

RESULTS

Eight SNPs were identified, rs 216310 (T1547), rs 1800385 (V1565L), rs1800384 (A1515), rs1800383 (D1472H), rs 1800386 (Y1584C), rs 216311 (T1381A), rs 216312 (intronic) and rs 1800381 (P1337).

CONCLUSION

The SNPs rs 216311, rs 1800383 and rs 1800386 associated significantly with bleeding in study subjects. rs1800386 occurred in all with bleeding history, no ethnic variations were noted.

Benefit incidence analysis of free insecticide treated nets distribution in urban and rural communities of Enugu state, South East Nigeria

BACKGROUND

Malaria is a leading cause of mortality as well as a barrier to economic and social development in developing countries. The use of insecticide-treated nets (ITNs) for malaria vector control is effective in controlling malaria attacks in pregnant women and under-5 children. The Nigerian government, in its bid to achieve the Millennium Development Goal (MDG) 4 and 5 distributes free ITNs to pregnant mothers and under-five children in the Roll Back Malaria programme (RBM).

AIM

This study compared the benefit incidence analysis of this government program between urban and rural areas.

MATERIALS AND METHODS

Pretested, semi-structured questionnaires were administered to 150 pregnant women and also 150 mothers of under-5 children, who were randomly selected from each of the two communities (rural and urban) from a local government area (LGA) in Enugu state, Nigeria. The study was conducted within the rainy season periods (March-August) of 2008. The information obtained included some socio-economic variables, accessibility, usage and benefits of usage of ITNs. Data entry and analyses were done using the Statistical Package for Social Sciences (SPSS) version 15.0(Chicago IL, USA). Student's t-test and Chi-square were used for comparison where appropriate. Significant values were taken as P value. Value of less than 0.05 was considered significant.

RESULTS

The respondents' mean monthly expenditures on food utilities and anti-malarials in the rural area and urban areas were N266.1 (74.02), range (143.3-395) and N473 (90) range (380-495.7) respectively (P < 0.001). Within each socio-economic stratum (SES), the average monthly expenditure in the urban community was higher than that of the rural community except for least poor SES (P < 0.05). For the urban community, 106 (71.6%) respondents used ITNs as against 99 (66.9%) in the rural community [P = 0.778, OR = 1.3 (95% CI: 0.76, 2.05)]. Also, ITNs were always accessible to 112 (75.7%) and 54 (36.5%) respondents in the urban and rural communities respectively [P < 0.001, OR = 5.4 (95% CI: 3.28, 8.96)]. In the urban community, 130 (87.7%) respondents expressed some benefit from ITNs as against 123 (83.1%) respondents from the rural community [P = 0.258, OR = 1.5 (95% CI: 0.76, 2.28)].

CONCLUSION

Most pregnant women and mothers of under-five children in the rural study area belong to the poorest socio-economic classes and they spend less on anti-malarial treatment. Majority of the free ITN's beneficiaries in both urban and rural study areas have used and benefitted from them.

The effect of free distribution of insecticide-treated nets on asymptomatic Plasmodium parasitemia in pregnant and nursing mothers in a rural Nigerian community

INTRODUCTION

Malaria is a major public health problem in Nigeria, with adverse outcomes on the poor, pregnant women and children living in rural communities. A major component of current intervention in roll back malaria (RBM) initiative is vector control and insecticide-treated nets (ITNs).

AIMS AND OBJECTIVE

This research studied the impact of free distribution of ITNs on malaria parasitemia in a rural community in Nigeria.

MATERIALS AND METHODS

This is a longitudinal survey involving 990 pregnant and nursing mothers who received free ITNs between February 2007 and September 2008. Blood samples were collected at contact, then every 2 months to check for malaria parasites using standard methods.

RESULT

There was a sustained but insignificant rise in asymptomatic malaria parasitemia post-distribution of ITNs.

CONCLUSION

We conclude that ITN intervention remains important in malaria prophylaxis but must be complemented with awareness campaigns and other vector control strategies.

Malaria parasitaemia among pregnant women in a rural community of eastern Nigeria; need for combined measures

Malaria in pregnancy is a major contributor to adverse maternal and perinatal outcome. In hyper endemic areas like ours, it is a common cause of anaemia in pregnancy in both immune and non-immune individuals and is aggravated by poor socioeconomic circumstances. The aim of this study is to assess the prevalence of asymptomatic malaria parasitaemia among pregnant women in a rural setting. 272 pregnant women, aged between 18 and 40 years in some remote rural areas of Ebonyi State, Nigeria were recruited between January 2007 and March 2008.Their blood samples were collected and examined for malaria parasite, haemoglobin and packed cell volume using standard methods. Our results showed 59.9% prevalence of parasitaemia with the highest prevalence occurring in the first trimester [84.1%]. Among the positive cases, mild parasitaemia was recorded in 47.2% moderate parasitaemia in 37.4% while severe parasitaemia was recorded in 15.3% of cases. These differences were statistically significant [P<0.016]. Furthermore the distribution of malaria densities in different gravidity groups showed an inverse relationship, 45.4% in primigravidae, [31.9%] in secundigravidae and [10.4%] among people with more than five pregnancies. These findings were statistically significant [P<0.0001]. The prevalence of anaemia in pregnancy in this study was 62.4%. Apart from the use of nets, drugs and vector control, the prevention of malaria in pregnancy in very poor socioeconomic settings should make provision for nutritional support.

The influence of parity on the gestational age at booking among pregnant women in Enugu, South East Nigeria

Antenatal care utilization is influenced by several factors. Due to our peculiar socioeconomic and cultural circumstances, gestational age at booking may be affected by certain variables. The aim of this study was to determine the influence of parity and other socio demographic factors on gestational age at booking amongst pregnant women in Enugu, South Eastern Nigeria. This is a prospective multicenter survey of randomly selected 928 pregnant women attending antenatal care for the first time in three hospitals in Enugu between January 1, 2006 to December 31, 2007. The average age was 30.22 +/- 5.2 years. The average age of the primigravidae at booking was 29.16 +/- 5.6 years.The average gestational age at booking for all the pregnant women studied was 26.12 +/- 7.6 weeks. Parity significantly [P < 0.05] influenced the gestational age at booking. Parity age for primagravidae group was 24.0 +/-7.9 weeks. Parity age for multigravidae was 27.16 +/- 7.5 weeks while for grandmultiparous women it was 26.12 +/- 7.6 weeks. Occupation did not have significant influence on gestational age at booking. It is concluded that parity significantly influenced the gestational age at booking in Enugu.

Placenta percreta: a review of literature

BACKGROUND

Placenta percreta is a very rare but serious complication of pregnancy. Diagnosis is difficult. Uterine perforation and invasion into adjacent organs makes life threatening haemmorrhage inevitable. Management is usually based on intraoperative findings from case reports.

METHOD

Literature on clinical decisions, diagnostic and treatment modalities were critically reviewed using PUBMED and MEDLINE computerized search. Additional Information was also obtained by cross referencing, texts and journals in the medical library of University of Nigeria.

RESULTS

Most of the literature was from developed countries with very little report from our environment. There was lack of comprehensive management plan in most textbooks.

CONCLUSION

Rare complications are usually very difficult to manage due to lack of experience. It is thus important to identify the patients at risk, attempt to make antenatal diagnosis and involve experienced obstetricians in management.

Intraoperative uterine packing with mops: an effective, but under utilized method of controlling post partum haemorrhage-experience from South Eastern Nigeria

BACKGROUND

Uterine packing is a simple noninvasive technique for controlling postpartum haemorrhage. However, its effectiveness has been underestimated and the procedure underutilized leading to lack of experience and expertise especially in the intraoperative usage of mops. The aim of the study was to re-evaluate the significance of intraoperative uterine packing in controlling post partum haemorrhage and preserving menstrual and reproductive functions.

METHOD

Twenty cases of intraoperative uterine packing with mops performed by the authors over a three-year period (December 2000-December 2003) at three different hospitals were reviewed. Mops were removed after 24 hours.

RESULTS

The mean age of the patients was 28.9 +/- 5.6 years, and the mean parity 3.1 +/- 1.8. The mean estimated blood loss was 1500 + 461.1 millilitres and the mean number of units of blood transfused was 1.45 + 1.2. The commonest indication for surgery was placenta praevia (55%). None needed further treatment.

CONCLUSION

In carefully selected cases, intraoperative uterine packing is a simple and effective life saving option in our local environment with peculiar beliefs, lack of equipment and expertise.