Is hysterosalpingography still relevant in workup of infertility? A review article

Objective: To examine the current role of Hysterosalpingography in the investigation of the infertile couple in view of the increasing use of Laparoscopy in the evaluation and management of infertility.Materials: Electronic search of published literature was done using the Pubmed, Cochrane libraries and Google search engine. The search was restricted to English language articles.Conclusion: Hysterosalpingography is a simple method of evaluating fallopian tube patency and cervicouterine abnormalities. It is virtually non-invasive; and it can be therapeutic. HSG has a high specificity and a high positive predictive value; it also has a low complication rate. It requires less skill acquisition and necessary equipment are readily available. Laparoscopy should be performed in cases of abnormal hysterosalpingogram or persisting infertility in despite of normal HSG and other parameters

Assessment of Kara Abattoir Effluent on the Water Quality of Ogun River, Nigeria

Direct discharge of abattoir effluents into water bodies contributes to problem of water pollution. This study assessed the impact of Kara Abattoir effluents on Ogun River in Nigeria using standard methods to measure the physiological characteristics and heavy metal levels. The results made it evident that most of the chemical parameters in this study exceeded the accepted standards; phosphate was seen to range between 0.34-109mg/l with a mean value of 27.62mg/l. All the twelve heavy metals observed in the water samples were within acceptable limits. The most alarming result observed is the presence of a “too many to count” range of microbial load and faecal coliform which can be attributable to a major cause of diarrhoea, urinary tract infections, respiratory illness and other threat to human health. Ogun River serves as habitat to some organisms; and is also used for domestic activities by nearby communities; hence, urgent policy implementation is required.Keywords: Abattoir, Effluents, Ogun River, Pollutio

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 was 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.Keywords: Maternal mortality,delay

Knowledge and Practices of PMTCT among Health Care Providers in Private Hospital in Ilorin, Nigeria

Introduction: In the developed countries where mother to child transmission of the virus is still high preventing MTCT is essential and starts during the antepartum period where diagnosis can be made andantiretrovirals and other prevention strategies can be instituted. A  significant proportion of Maternity care and delivery services are rendered by private hospitals. Adequate knowledge by health care providers ofantiretroviral use and other PMTCT strategies will be required to ensure control of vertical transmission of the virus.Objective: To assess the knowledge and practice of PMTCT among health care providers in private health facilities in Ilorin, Nigeria.Method: This is a review of health care providers in private health facilities Ilorin, Nigeria, between December2011 and November2012. Information on biodata, general knowledge on HIV and PMTCT and practices done to prevent vertical transmission were collected with use of questionnaires and were analyzed using SPSS statistical software version 17.Result: 265 questionnaires were applied but 223 were complete and analyzed. Their age range was 20-62years; mean age was 32.45+7.0SDyrs and Mean working experience was 5.89+5.17SD yrs. Nurses constituted the greater percentage 64.1% of the health care providers. Knowledge that vertical transmission could be prevented was good (95.5%), however 15.2% felt HIV could be transmitted through sharing of spoon or eating together. Only 20% had training in PMTCT and 17% worked in health facilities where ARV was administered to HIV positive pregnant women. A larger number 72% referred the HIV positive women to other centres for antenatal care and delivery. Antiretroviral drugs administered to the mothers were, 42.1% administered single drug ARV therapy, 21.1% gave 2 ARV drugs which is not in any standard protocol while only 5.3%  administered 3 ARV drugs. Prophylactic ARV administration to the babies also revealed deficiencies.Conclusion: Knowledge and practice of PMTCT among health care providers in private sectors was poor. There were no clear cut guidelines for  antiretroviral drug administration for mothers and babies. Training and retraining on PMTCT should be encouraged.Keywords: Knowledge, Practice, health care provider, PMTC

Pharmacological Exposure of Pregnant Mothers in Ilorin, Nigeria

Context: Use of drug during pregnancy is a universal event. However, in developing countries, drug use is poorly controlled as most of the drugs could be obtained without prescription. This constitutes potential hazard both for the mother and the fetus.Objective: To determine the pattern of drug use (including alcohol and smoking) prescription and non prescription of drug by pregnant mothers in Ilorin, Kwara State, Nigeria.Study Design: A cross sectional study of pregnant mothers attending antenatal clinic of the University of Ilorin Teaching Hospital, Ilorin.Result: Four hundred 400 pregnant women participated in the study, 335 adequately completed questionnaire for data analysis. Majority of the respondents 273 (81.5%) had taken one or more drugs, 62 (18.5%) had not used any. Average number of drugs used was 2.7. Routine haematinics (folic acid and Ferrous Sulphate) are the common drug taken by 241 (81.5%) of the respondents. Anti malarial drugs were taken by 47 (14%) while herbal drug was taken by 41 (12.2%). Five (1.5%) of the respondents admitted to taking alcohol and only one woman (0.3%) admitted to smoking cigarette. One (0.3%) each of the respondents was on anti depressant and anticonvulsant drugs. Occupation was significantly related to herbal use. Parity was also significantly related to alcohol consumption and the use of unprescribed drugs.Conclusion: Drug use is common during pregnancy. Haematinics were the commonest drug used. Herbs are used to some extent and antimalarials are underutilized. Alcohol is minimally used and smoking during pregnancy is virtually non- existent. There is need to caution our pregnant mothers on the use of herbs as there is no full understanding of their pharmacokinetics

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria

Background. The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C).Objectives. To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it.Methods. A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of <0.05 was taken as significant.Results. Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 - 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future  daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as  wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this.Conclusion. Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C

Relationship Between Subchorionic Haematoma and Abdominal Massage in Pregnancy in the Niger Delta Region of Nigeria: A Pilot Study

Background: Abdominal massage (AM) in pregnancy is a common practice in the Niger Delta region of Nigeria. AM may cause events such as subchorionic haematoma (SAH) and increase the risk of miscarriages and adverse maternal and perinatal outcomes. Objective: To determine the relationship between AM and SCH in the Niger Delta region of Nigeria. Methods: A cross-sectional study was conducted from January to June 2022 at the Obstetrics and Radiology Units of four health facilities in Bayelsa State, Nigeria. Consenting eligible pregnant women presenting to the antenatal clinic during the first trimester were consecutively included. An obstetric ultrasound scan was performed transabdominal. Results: Of the 403 women recruited, 241 (59.8%) were aged (20 – 29 years). The mean age was 28.02 ± 5.99 years. The mean body mass index was 23.82±4.60 kg/m2. While 170 (42.2%) had undergone AM in the first trimester of the index pregnancy, 126 (31.3%) had vaginal bleeding, and SCH occurred in 109 (27.0%) women. Women who had AM had 210 (CI: 58 – 878) times the odds of having SCH and 3.3 (CI: 2.14 – 5.15) times the odds of vaginal bleeding than women who did not have AM. Only 2 (1.8%) women with SCH did not have AM. Conclusion: There exists a strong association between the occurrence of SCH among pregnant women who have had AM. More health education is needed for women in the Niger Delta region and Nigeria to eradicate the archaic practice and improve pregnancy outcomes

Developing a comprehensive information security framework for mHealth: a detailed analysis

It has been clearly shown that mHealth solutions, which is the use of mobile devices and other wireless technology to provide healthcare services, deliver more patient-focused healthcare, and improve the overall efficiency of healthcare systems. In addition, these solutions can potentially reduce the cost of providing healthcare in the context of the increasing demands of the aging populations in advanced economies. These solutions can also play an important part in intelligent environments, facilitating real-time data collection and input to enable various functionalities. However, there are several challenges regarding the development of mHealth solutions: the most important of these being privacy and data security. Furthermore, the use of cloud computing is becoming an option for the healthcare sector to store healthcare data; but storing data in the cloud raises serious concerns. This paper investigates how data are managed both on mHealth devices as well as in the cloud. Firstly, a detailed analysis of the entire mHealth domain is undertaken to determine domain-specific features and a taxonomy for mHealth, from which a set of security requirements are identified in order to develop a new information security framework. It then examines individual information security frameworks for mHealth devices and the cloud, noting similarities and differences. Furthermore, key mechanisms to implement the new framework are discussed and the new framework is then presented. Finally, the paper presents how the new framework could be implemented in order to develop an Advanced Digital Medical Platform

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe