Non-tubal Ectopic Pregnancy: Diagnosis and Management

Ectopic pregnancy is the leading cause of maternal mortality in the first trimester, and prompt diagnosis and intervention are essential to ameliorate its associated complications. A majority of ectopic pregnancies are tubal, but extra-tubal pregnancy may pose more challenges in diagnosis and treatment. Early diagnosis of extra-tubal pregnancies requires high index of suspicion using transvaginal ultrasound and at times complemented with the help of magnetic resonance imaging. Similar to tubal pregnancy, extra-tubal ectopic pregnancies can be treated using surgical approach via laparotomy versus laparoscopy, or medical intervention with methotrexate, potassium chloride and most recently, mifepristone and epidermal growth factor inhibitor (gefitinib). For abdominal and ovarian ectopic pregnancies, the best surgical approach is via laparotomy or laparoscopy, while for cervical ectopic pregnancy and cesarean scar pregnancy (CSP), initial medical treatment with methotrexate, then suction curettage under ultrasound guidance, or hysteroscopic resection can suffice. All patients with extra-tubal pregnancy should be well counseled about the associated complications, fertility preserving intervention, and need for prolong monitoring especially those that choose medical therapy

INTERPERSONAL COMMUNICATION, DEMOGRAPHIC VARIABLES AND RELATIONAL MAINTENANCE AMONG UNMARRIED POSTGRADUATE STUDENTS OF OBAFEMI AWOLOWO UNIVERSITY, ILE-IFE, NIGERIA

The study ascertained the level of relational maintenance among unmarried postgraduate students of Obafemi Awolowo University, Ile-Ife and as well as the relationship between interpersonal communication and relational maintenance among the postgraduate students of Obafemi Awolowo University Ile-Ife. Finally, it also examined the relationship between demographic variables and relational maintenance among the postgraduate students. These were with a view to providing useful information on relational maintenance among the unmarried postgraduate students. The study adopted survey design. The sample size comprised 600 postgraduate students selected from six selected faculties out of the thirteen Faculties in Obafemi Awolowo University, Ile-Ife, using multistage sampling technique. Thereafter, a total of 100 students were selected in each faculty using purposive sampling technique for those that were into dating relationship. One adapted and one self-constructed instruments were used to elicit information from the respondents. The adapted instrument was Relational Maintenance Scale (RMS) while Interpersonal Communication Inventory (ICI) was self-constructed. Percentages, frequency counts Pearson correlation and Chi-square were employed to analyze the data. The results showed that 24.8%, 52.5% and 22.7% of postgraduate students of Obafemi Awolowo Universities Ile-Ife demonstrated low, moderate and high levels of relational maintenance respectively. The study also indicated that there was a significant positive relationship between interpersonal communication and relational maintenance (r = 0.676, p > 0.05). Furthermore, the results showed significant relationship between sex of the students and relational maintenance (x2 =24.271; df = 564, p > 0.05). Finally, the results showed significant relationship between age of the students and relational maintenance (x2 = 47.837a; df = 564, p > 0.05). It was concluded that irrespective of the age of the students, most unmarried postgraduate students in the study area had moderate level of relational maintenance

Mo Fischer carbene complexes : a DFT study on the prediction of redox potentials

Please read abstract in the article.The University of the Free State; the National Research Foundation (NRF) in South Africa; the High-Performance Computing facility of the UFS, the Centre for High-Performance Computing (CHPC) of South Africa and the Norwegian Supercomputing Program.https://iopscience.iop.org/journal/1945-7111hj2022Chemistr

Vaginal Candida infection in pregnancy and its implications for fetal well-being

Vaginal Candida infection is one of the most common genital tract infections reported in pregnant women. This study was designed to determine the prevalence of vaginal Candida infection and pattern of Candida species isolates in the genital tract of pregnant women during antenatal period and in early labour; and the associated fetal outcome. The study was conducted at the antenatal clinic and labor ward of Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun State, Nigeria. High vaginal swabs were collected from 408 pregnant women at the antenatal clinic and repeated in early labour. The samples were processed to isolate Candida species. Data were analysed using Statistical Package for Social Science (SPSS) windows version 21.0 (IBM Corp., Armonk, NY, USA). Prevalence of Candida infection was significantly higher in early labour (46%) than during antenatal period (38%) (P=0.02). Candida albicans was the predominant isolate, followed by Candida glabrata and Candida tropicalis. Candida infection was associated with increased likelihood of low birth weight babies (AOR 2.8, CI: 1.1-6.8; P= 0.03). However there was no statistically significant effect of Candida infection on the likelihood of preterm delivery (AOR 1.4, CI: 0.7-2.6; P= 0.35). Routine screening and prompt treatment of women at risk of delivering low birth weight babies is advocated. Keywords: Candida; Pregnancy; Preterm birth; Prevalence   L'infection vaginale à Candida est l'une des infections des voies génitales les plus courantes signalées chez les femmes enceintes. Cette étude a été conçue pour déterminer la prévalence de l'infection vaginale à Candida et le profil des isolats d'espèces de Candida dans le tractus génital des femmes enceintes pendant la période prénatale et au début du travail; et l'issue foetale associée. L'étude a été menée à la clinique prénatale et au service d'accouchement de l'hôpital universitaire Olabisi Onabanjo de Sagamu, dans l'État d'Ogun, au Nigéria. Des écouvillons vaginaux élevés ont été prélevés sur 408 femmes enceintes à la clinique prénatale et répétés au début du travail. Les échantillons ont été traités pour isoler les espèces de Candida. Les données ont été analysées à l'aide de la version 21.0 de Windows Package for Social Science (SPSS) (IBM Corp., Armonk, NY, USA). La prévalence de l'infection à Candida était significativement plus élevée au début du travail (46%) qu'au cours de la période prénatale (38%) (P = 0,02). Candida albicans était l'isolat prédominant, suivi de Candida glabrata et Candida tropicalis. L'infection à Candida était associée à une probabilité accrue de bébés de faible poids à la naissance (AOR 2,8, IC: 1,1-6,8; P = 0,03). Cependant, il n'y avait aucun effet statistiquement significatif de l'infection à Candida sur la probabilité d'accouchement prématuré (AOR 1,4, IC: 0,7-2,6; P = 0,35). Le dépistage systématique et le traitement rapide des femmes à risque d'accoucher de bébés de faible poids à la naissance sont recommandés. Mots-clés: Candidose; Grossesse; Naissance prématurée; Prévalenc

Bacterial vaginosis in pregnancy and early labour using Nugent scoring and the implication on foetal outcome

Background: To compare the pattern of vaginal microflora during pregnancy with pattern in early labour using Nugent scoring and determine the effect of these changes on fetal outcome. Design: A prospective longitudinal study. Setting and Population: Pregnant women attending antenatal clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between June 2017 and May 2018. Methods: Consenting pregnant women who attended antenatal clinics were recruited. Vaginal secretions were obtained for Nugent scoring during pregnancy and at presentation in labour. Main Outcome Measures: Prevalence of abnormal vaginal flora in pregnancy and early labour, birth outcome, birth weight, gestational age at delivery, APGAR scores, need for neonatal ward admission. Results: Sixty-seven (33.3%) of pregnant women had abnormal flora which was consistent with bacterial vaginosis.At the presentation of these women in labour, 14.4% of them had bacterial vaginosis thus indicating a significant reduction in abnormal vaginal flora in labour compared to the proportion of abnormal flora in antenatal period(P<0.001). There were no significant differences in the fetal outcomes of mothers with bacterial vaginosis when compared with those with normal vaginal flora (P-value >0.05). Conclusions: Persistence of abnormal vaginal microflora from pregnancy till early labour did not seem to be associated with poorer foetal outcomes when compared with women with normal vaginal microflora in labour. The possibility of persistent infection or re-infection before labour may justify the need for re-evaluation of vaginal smears in the late third trimester to allow for prompt treatment before the onset of labour. Keywords: Bacterial vaginosis, foetal outcome, Lactobacillus, pregnancy, vaginal microflora. Funding: This research work was sponsored by the Tertiary Education Trust Fund, Nigeria (TETFund) with referencenumber OOU/IBR/010

Waist–Hip Ratio and Breast Cancer Risk in Urbanized Nigerian Women

Background: The aim of this study was to examine the relationship between waist–hip ratio and the risk of breast cancer in an urban Nigerian population. Methods: Between March 1998 and August 2000, we conducted a case–control study of hospital-based breast cancer patients (n = 234) and population-based controls (n = 273) using nurse interviewers in urban Southwestern Nigeria. Results: Multivariable logistic regression showed a significant association between the highest tertile of waist–hip ratio and the risk of breast cancer (odds ratio= 2.67, 95% confidence interval = 1.05–6.80) among postmenopausal women. No association was found in premenopausal women. Conclusion: The present study, the first in an indigenous African population, supports other studies that have shown a positive association between obesity and breast cancer risk among postmenopausal women

Diabetes mellitus caused by mutations in human insulin : analysis of impaired receptor binding of insulins Wakayama, Los Angeles and Chicago using pharmacoinformatics

Several naturally occuring mutations in the human insulin gene are associated with diabetes mellitus. The three known mutant molecules, Wakayama, Los Angeles and Chicago were evaluated using molecular docking and molecular dynamics (MD) to analyse mechanisms of deprived binding affinity for insulin receptor (IR). Insulin Wakayama, is a variant in which valine at position A3 is substituted by leucine, while in insulin Los Angeles and Chicago, phenylalanine at position B24 and B25 are replaced by serine and leucine respectively. These mutations show radical changes in binding affinity for insulin receptor. The ZDOCK server was used for molecular docking while AMBER 14 was used for the molecular dynamics study. The published crystal structure of insulin receptor bound to natural insulin was also used for molecular dynamics. The binding interactions and molecular dynamics trajectories clearly explained the critical factors for deprived binding to the insulin receptor. The surface area around position A3 was increased when valine was substituted by leucine, while at position B24 and B25 aromatic amino acid phenylalanine replaced by non-aromatic serine and leucine might be responsible for fewer binding interactions at the binding site of insulin receptor that leads to instability of the complex. In the MD simulation the normal mode analysis (NMA), rmsd trajectories and prediction of fluctuation indicated instability of complexes with mutant insulin in order of insulin native insulin < insulin Chicago < insulin Los Angeles < insulin Wakayama molecules which corresponds to the biological evidence of the differing affinities of the mutant insulins for the IR.The University of Pretoria Vice Chancellor’s postdoctoral fellowship and National Research Foundation (NRF), South Africa Innovation postdoctoral fellowship schemes.http://www.tandfonline.com/loi/tbsd202018-03-31hb2017Chemical Patholog

Spectroscopic characterization, DFT calculations, in vitro pharmacological potentials, and molecular docking studies of N, N, O-Schiff base and its trivalent metal complexes

In this study, trivalent metal complexes of the category: [M(L)(H2O)nCly] obtained from the interaction of metal3+ ion salts with organic N, N, O-Schiff base (HL) (where: HL = 4-{(Z)-((2-{(E)-((2-hydroxyphenyl)methylidene)amino}ethyl)imino)methyl}-2-methoxyphenol; n, y = 1 or 2 and M = Ti(III), Fe(III), Ru(III), Cr(III) and Al(III)) were synthesized and characterized viz molar conductance, FT-IR, and UV–Vis spectroscopies, elemental analyses, thermal analyses (TGA and DTA), and UV–Vis spectroscopy, theoretical calculations. A distorted octahedral structure around the metal ions was proposed based on the obtained experimental and calculated data. Thermal examination of the complexes signposts the step-by-step disintegration to give the final decomposition product as metal oxides. Moreover, DFT calculations were executed utilizing the B3LYP/LANL2DZ theory level, which revealed that the synthesized metal (III) complexes were more stable than the free ligand (HL). The value of ΔE for HL is 4.60 eV while the related values for the complexes of Cr(III) (C1), Ru(III) (C2), Fe(III) (C3), Al(III) (C4), and Ti(III) (C5) are respectively 2.59, 3.68, 3.15, 1.64, and 2.75 eV. Scavenging abilities of DPPH and ABTS radicals by the test compounds revealed promising antioxidant behavior. It was observed that the compounds are proficient DPPH radical scavengers in a dose-dependent configuration. Ru(III); IC50 = 1.69 ± 2.68 µM for DPPH and Ti(III); IC50 = 8.70 ± 2.78 µM for ABTS performed best. Similarly, the complexes demonstrated higher antimicrobial activities compared to HL against the designated strains, while ciprofloxacin acted as a standard antibiotic. Furthermore, the ligand and its most effective complexes C2 and C5 were docked against the targets S. aureus DNA gyrase (2XCT), S. pneumoniae DNA gyrase (5BOD), and E. coli DNA gyrase (5L3J). The binding sites were evaluated and the docking results showed that the studied molecules bind to the targets through classical O—H…O and/or N—H…O hydrogen bonds, as well as via hydrophobic contacts

PERCEPTION AND WILLINGNESS TO THE UPTAKE OF COVID-19 VACCINE AMONG HOUSEHOLD-HEADS IN A RURAL COMMUNITY OF SOUTH-WESTERN NIGERIA

Background: The COVID-19 pandemic and its vaccine have been met with varying perceptions that may have both negative and positive effects on the willingness to uptake the COVID-19 vaccine. The study is set to determine the perception and willingness of the household heads to the uptake of COVID-19 vaccine in a rural community in Southwestern, Nigeria. Materials and Methods: A cross-sectional study was carried out among 409 household heads selected through a multistage sampling technique. The instrument of data collection was a semi-structured interviewer-administered questionnaire using the Health Belief model constructs. Data were analyzed with IBM SPSS version 21.0 and Pearson's Chi-square test was used to determine the association between perception and willingness to uptake vaccine. P&lt;0.05 was taken as significant at 95% confidence interval. Results: The majority of the unvaccinated respondents in the study were not willing to take the COVID-19 vaccine (60.1%). There was a poor perception of the susceptibility/severity of unvaccinated respondents to COVID-19 infection and a poor perception of the benefit/barrier to the uptake of the COVID-19 vaccine. Perception of susceptibility and severity of COVID-19 infection were statistically related to the willingness to uptake the COVID-19 vaccine. Conclusion: There should be an increase in awareness campaigns to change the perception of people positively to COVID-19 infection and uptake of the COVID-19 vaccine

Challenges of Residency Training and Early Career Doctors in Nigeria Phase II: Update on Objectives, Design, and Rationale of Study

Background: Early career doctors (ECDs) are a dynamic and highly mobile group of medical and dental practitioners who form a significant proportion of the health workforce in Nigeria. The challenges of residency training and ECDs in Nigeria CHARTING Phase I study explored limited challenges affecting ECDs under the broad themes of demography, workplace issues, and psychosocial issues. The CHARTING II was expanded to provide wider insight into the challenges of ECDs in Nigeria. Objective: This protocol aims to provide clear objectives including description of objectives, design, and rationale for the conduct of the proposed CHARTING II study which seeks to explore other components under the various themes of demographic, workplace, psychosocial issues affecting the ECDs in Nigeria, and which were not explored under CHARTING I.   Methodology: This shall be a mixed study design that will combine qualitative and quantitative methods, to investigate 27 subthemes among 2000 ECDs spread across 31 centers, accredited by the Nigerian Association of Resident Doctors. Participants shall be selected using the multistage sampling method. The primary data will be generated using structured proforma and validated questionnaires,while administrative sources would serve as a source of secondary data. Data will be entered and analyzed using appropriate statisticalsoftware. Conclusion: CHARTING II study would provide more robust data and insight into the problems encountered by ECDs in Nigeria. This would in turn build a platform for institutional engagement and advocacy in order to drive relevant policies to mitigate these challenges. Keywords: Early career doctors, Nigeria, residency, resident doctors, trainin