Pattern of gynaecological consultations at Ladoke Akintola University of Technology Teaching Hospital

No Abstract

In vitro induction of rat liver mitochondrial membrane permeability transition pore opening by solvent extracts of Momordica charantia leaves

Alteration of mitochondrial functions such as permeability transition (PT), a process associated with the uncoupling of oxidative phosphorylation, has been found to play a vital role in the apoptotic process induced by certain anti-cancer agents. When triggered, PT facilitates the release of mitochondrial apoptogenic proteins which in turn activate the caspase cascade of apoptosis. Thus, this study investigated the in vitro effects of varying concentrations (0.2, 0.4, 0.6, 0.8 and 1.0 mg/ml) of different leaf extracts [Crude Water-Soluble Extract (CWSE), Decoction (DE) and Methanol Extract (ME)] of Momordica charantia (M. charantia), a purported anti-cancer plant of the family Cucurbitaceae on normal rat liver mitochondria. Opening of mitochondrial membrane permeability transition pore (MMPTP) was spectrophotometrically assayed under succinate-energized condition. Results obtained showed concentration-dependent and significant (P<0.05) increases in the extents to which MMPTP opening was induced by the three extract types when compared with the control group. Inductions caused by CWSE and DE increased with increasing concentrations while those caused by ME decreased with increasing concentrations, giving the maximum induction at 1.0 mg/ml (8.1-fold increase) of CWSE and the least induction at 1.0 mg/ml (4.3-fold increase) of ME, respectively. Spermine, a reference inhibitor of MMPTP opening, reversed all observed openings. These results indicate that the tested leaf extracts of M. charantia are potent (CWSE being the most potent) MMPTP opening inducers and the pathway by which M. charantia causes apoptosis in cancer cells is probably mitochondrial-mediated (intrinsic).Keywords: Mitochondrial membrane permeability transition pore (MMPTP), Momordica charantia, Apoptosis, Spermine

Self-medication with antibiotics for the treatment of menstrual symptoms in southwest Nigeria: a cross-sectional study

Background: Self-medication with antibiotics is an important factor contributing to the development of bacterial antibiotic resistance. The purpose of this study was to evaluate the prevalence of self-medication with antibiotics for the treatment of menstrual symptoms among university women in Southwest Nigeria. Methods: A cross-sectional survey was administered to female undergraduate and graduate students (n = 706) at four universities in Southwest Nigeria in 2008. The universities were selected by convenience and the study samples within each university were randomly selected cluster samples. The survey was self-administered and included questions pertaining to menstrual symptoms, analgesic and antibiotic use patterns, and demographics. Data were analyzed using descriptive statistics and logistic regression. Results: The response rate was 95.4%. Eighty-six percent (95% CI: 83-88%) of participants experienced menstrual symptoms, and 39% (95% CI: 36-43%) reported using analgesics to treat them. Overall, 24% (95% CI: 21-27%) of participants reported self-medicated use of antibiotics to treat the following menstrual symptoms: cramps, bloating, heavy bleeding, headaches, pimples/acne, moodiness, tender breasts, backache, joint and muscle pain. Factors associated with this usage were: lower levels of education (Odds Ratio (OR): 2.8, 95% CI: 1.1-7.1, p-value: 0.03); nonscience major (OR: 1.58, 95% CI: 1.03-2.50, p-value: 0.04); usage of analgesics (OR: 3.17, 95% CI: 2.07-4.86, p-value: <0.001); and mild to extreme heavy bleeding (OR: 1.64, 95% CI: 1.01-2.67, p-value: 0.05) and pimples/acne (OR: 1.57, 95% CI: 0.98-2.54, p-value: 0.06). Ampicillin, tetracycline, ciprofloxacin and metronidazole were used to treat the most symptoms. Doctors or nurses (6%, 95% CI: 4-7%), friends (6%, 95% CI: 4-7%) and family members (7%, 95% CI: 5-8%) were most likely to recommend the use of antibiotics for menstrual symptoms, while these drugs were most often obtained from local chemists or pharmacists (10.2%, 95% CI: 8-12%). Conclusions: This is the first formal study to report that approximately 1 out of 4 university women surveyed in Southwest Nigeria self-medicate with antibiotics to treat menstrual symptoms. This practice could provide monthly, low-dose exposures to antibiotics among users. Further studies are necessary to evaluate the impacts of selfmedication on student health

Predictors of vaginal delivery in nulliparous mothers

Background: Nulliparity is an obstetric high-risk group whose labor,  compared with multiparae, are more likely to develop labor abnormalities that requires intervention. The aim of this report is todetermine factors that influence vaginal delivery in nulliparae.Materials and Methods: A prospective cross-sectional study was done on 286 eligible booked nulliparae in labor, to determine factors associated with vaginal delivery. Information about each patient’s social demographic factors, and physical characteristics such as height and weight, events in labor and mode of delivery were recorded in the data sheet. Bivariate analysis was done using Chi square, while multivariate analysis was done using logistic regression. Level of significance was put at P &lt; 0.05.Results: Of a total of 944 primigravidae delivered in the unit during the study period, 286 (30.3%) were eligible for the study. Vaginal delivery was achieved in 214 (74.8%) of the eligible parturient, while 72 (25.2%) had emergency caesarean delivery. Indications for the caesarean delivery were: failure to progress (46; 63.9%), fetal distress (20; 27.8%), maternal distress (5; 8.0%), and rapidly developing pre-eclampsia in labor (1,  0.3%). The birth weight of the baby ranged between 2.0 and 4.5 kg with mean weight of 3.1 ± 0.4 kg. Birth weight (odd ratio [OR] = 0.40, 95% confidence interval [CI] = 0.21-0.78), fetal head engagement in early labor (OR = 10.30, 95% CI = 1.35-78.69), and maternal body mass index(BMI) (odd ratio [OR] = 2.08, 95% confidence interval [CI] = 1.03-4.20) were found to be predictors of vaginal delivery.Conclusion: Normal range of maternal BMI, fetal head engagement and normal range of fetal birth weight were found to be the factors associated with vaginal delivery in nulliparae. Variations in these three factors may be the underlying reason for failure to progress, which is the most common indication for caesarean section among this population of parturient.Keywords: Emergency caesarean section, labor, nulliparae, primigravidae, vaginal deliver

Outcome of Breech Deliveries at a Tertiary Health Institution in Southwestern Nigeria.

The aetiology of breech presentation is not clear, however, several factors had been found to be associated with increased risk of breech presentation. The mode of delivery of breech presentation for optimum neonatal outcome had been a subject of controversy over the years. The present study is a retrospective analysis of the outcome of singleton breech delivery at a tertiary health institution. The incidence of singleton breech delivery during the study period was 2.9%. The maternal age ranged between 16 and 44years with a mean age of 30.05±5.53; primiparous were 32(37.2%), while multiparous were 54(62.8%). External cephalic version was attempted, but failed in one case; assisted vaginal breech delivery was conducted in 19(22.0%) cases, 47(54.7%) were delivered by emergency Caesarean section, and 20(23.3%) had elective Caesarean section. Asphyxia was present in 14(77.8%), 31(66.0%) and8(40.0%), of babies , delivered by assisted vaginal breech delivery, emergency Caesarean section, and elective Caesarean section, respectively (df = 2, p= 0.042). This study showed that elective Caesarean delivery gives the best neonatal outcome for breech presenting fetuses.Booking status positively impart fetal outcome, therefore provision and utilization of good quality antenatal care will go a long way to reduce the incidence of unbooked emergencies that significantly contribute to the poor neonatal outcome in breech deliveries.Key words: breech presentation, mode of delivery, neonatal outcom

Intrauterine Contraceptive Device Discontinuation Among Women in Osogbo, Western Nigeria

The aim of this retrospective study is to determine the duration of use, and the factors responsible for the discontinuation of intrauterine contraceptive device by the clients attending a tertiary health institution family planning clinic. Most of the clients 1070(71.7%) made intrauterine contraceptive device their choice of contraceptive method, and duration of use was between 1 and 79 months. The most frequent reason for discontinuing IUD was the desire to get pregnant (51.0%), and this was followed by menorrhagia (10.4%). In conclusion, more effort should be directed to counseling for adherence to the IUD use to ensure longer duration of use. Provision of the levonorgestrel intrauterine system which reduces bleeding and dysmenorrhoea, in our clinic may increase the continuation rate of IUD.Key words; IUD, duration of use, discontinuation, factors