Female genital tract cancers in Sagamu, southwest, Nigeria

Objective: To describe pattern of female genital tract cancers seen at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria.Design: This is a retrospective review of all cases of female genital tract cancers managed at the Gynaecology department of OOUTH, Sagamu, Nigeria.Setting: OOUTH is a tertiary health institution of the State’s university and it takes referrals from within and outside the State.Subjects: Case records of all female genital tract cancers managed between January 2004 and December 2013 were retrieved and analysed using SPSS version 16.0.Results: There were 2059 women treated for various gynaecologic conditions, 179 (8.7%) were cases of female genital tract cancers and 161 records were available for analysis. Cervical cancer constituted the commonest (51.6%), followed by ovarian (35.4%), endometrial (9.9%), and choriocarcinoma (1.9%). There were no cases of vaginal and fallopian tube cancers. The lowest mean age was found in choriocarcinoma (36.60 ±4.50 years) and highest in vulvar cancer (70.00 ±2.82 years). The mean ages for cervical, endometrial and ovarian cancers were (51.98±12.39), (65.38±7.24), and (54.42±10.51) years respectively. Similarly the least mean parity was found in choriocarcinoma (2.33±1.52), and the highest in vulvar cancer (6.00±1.44). The mean parity for cervical, endometrial, and ovarian were (4.10±1.49), (3.06±1.48), and (3.72±1.68) respectively. These differences are statistically significant, age; F= 7.61, p<0.0001, and parity; F= 3.27, p= 0.013.Conclusion: Incidence of cervical, endometrial, and ovarian cancers remain high and presentations are at late stages. There is a need to improve on cervical cancer screening, and for the attending physicians to improve on their indices of suspicions as regards endometrial and ovarian cancers

Rheumatoid Arthritis Associated with Pulmonary Fibrosis in Nigerians: Two Case Reports

Rheumatoid arthritis may sometimes present with extra-articular involvement, pulmonary involvement is not common. Rheumatoid arthritis has been reported among Nigerians and extra-articular manifestations are rarely seen. One of the patients was misdiagnosed and mismanaged as a patient with pulmonary tuberculosis. The study is to demonstrate that rheumatoid arthritis is not as rare as previously reported in Nigeria and its pulmonary involvement can mimic tuberculosis or other granulomatous lung disorder. Clinical and serological acumen are necessary to distinguish between the two. Two diagnosed patients with rheumatoid arthritis and pulmonary involvement seen at Olabisi Onabanjo University Teaching Hospital (OOUTH), are hereby presented

Age at menarche and menstrual pattern in secondary schoolgirls in Sagamu

Menarche is the first menstruation in the life of a woman. Menstrual pattern involves the length of bleeding, the length of the cycle and other associated events such as pain ( ). Dysmenorrhoea has been identified as a reason for school absenteeismin girls. To determine the mean age at menarche and pattern of menstruation in the sub-urban district of Southwestern Nigeria and to demonstrate the influence of pre-menarcheal education on the attitude of the respondents. Students in senior secondary classes were randomly selected from seven Secondary Schools in thetown. The tool was a self administered simple questionnaire and analysis was done using SPSS 11.0 statistical package. The mean age at menarche was 13.8 (±1.3) and the range were 10 to 18 years. The mean length of the cyclewas 26.9 (±3.7) and the range was from 14 days to 32 days. The duration of flow ranged from 1 day to 13 days with a mean of 4.6 (± 1.2) days. Fifty three point four percent of the respondents had varying severity of dysmenorrhoea. There is a better perception of dysmenorrhoea in girls who had pre-menarcheal education (p=0.000). Mean menarcheal age of 13.8 (±1.3) days compared favourably with findings in recent studiesand also agree with declining trends over the past decades. Pre-menarcheal education will improve perception of dysmenorrhoea and thus reduce school absenteeismresulting fromit.Keywords: Menarche,Menstrual Pattern, Schoolgirls, Sagam

Effect of pre-operative sub-lingual misoprostol versus intravenous oxytocin on Caesarean operation blood loss

Background: Caesarean operation remains the most common abdominal surgery in women and has immense benefits to both mother and baby when employed. Haemorrhage, however, remains the greatest challenge associated with its outcome.Objective: To compare the effectiveness of pre-operative sub-lingual misoprostol with intravenous oxytocin administered after delivery of the neonate in minimising blood loss at Caesarean operationDesign: A prospective study.Results: The mean blood loss was significantly lower in misoprostol group compared to oxytocin group (517.32mls versus 621.22mls; p = 0.005). The drop in haematocrit was significantly lower in misoprostol group than the oxytocin group, (400μg-misoprostol versus oxytocin: 1.88 versus 3.04; p=0.0001). Side effects of chills, shivering and pyrexia were noted more with the use of misoprostol.Conclusion: Pre-operative sub-lingual misoprostol is more effective than intravenous infusion of oxytocin in reducing blood loss at Caesarean section operation. However, occurrence of transient side effects of chills, shivering and pyrexia were noted more with use of misoprostol

Menarche and critical weight hypothesis revisted in Sagamu, Southwest Nigeria

Background: Menarche is the age at first menstruation in a girl child. Values vary globally, influenced by factors that included gene, race, industrialization, and nutrition. Attainment of a critical weight before menarche had been hypothesized and found applicable in studies from different countries, Nigeria inclusive.Objective: To re-evaluate age of menarche in our practice using the prospective method of evaluation and establish if the critical weight hypothesis is applicable in our settingDesign: Cohort of 63 secondary schoolgirls were longitudinally followed up for twenty-four months to obtain accurate age, weight and height at point of menarche.Results: Mean age at menarche in this study was 13.65(±1.26) years and the range was between 10 and 16 years. Similarly, the means and ranges for weight and height were 45.9(±0.90) [43.8-48.1] kilograms and 156.16(±1.77) [149-161]. Using logistic regression correlation, while accounting for other variables, demonstrated stronger correlation between age at menarche and weight than menarche and height.Conclusion: Study demonstrated leveling off of menarche at between 13 and 14 years in our practice and agreed with hypothesis of critical weight of between 45 and 46kg. The heights of our girls at menarche compared with global average of 155 and 156cm

Anti-diabetic and phytochemical analysis of sutherlandia frutescens extracts

In Africa, the importance of medicinal plants in folklore medicine and their contribution to primary healthcare is well recognized. Across the continent, local herbal mixtures still provide the only therapeutic option for about 80% of the population. The vast floral diversity and the intrinsic ethnobotanical knowledge has been the backbone of localized traditional herbal medical practices. In Africa, an estimated 5400 of the 60000 described plant taxa possess over 16300 therapeutic uses. Similarly, with a therapeutic flora comprising of approximately 650 species, herbal medical practitioners in South Africa, make use of a plethora of plants to treat different human diseases and infections. Over the years, studies have identified numerous plant species with potential against chronic metabolic diseases including type 2 diabetes mellitus (T2DM). Globally, the incidence and prevalence of T2DM have reached epidemic proportions affecting people of all ages, nationalities and ethnicity. Considered the fourth leading cause of deaths by disease, T2DM is a global health crisis with an estimated diagnosis and mortality frequency of 1 every 5 seconds and 1 every 7 seconds respectively. Though the exact pathophysiology of T2DM is not entirely understood, initial peripheral insulin resistance in adipose tissue, liver, and skeletal muscle with subsequent pancreatic β-cell dysfunction resulting from an attempt to compensate for insulin resistance is a common feature of the disease. The current approach to treating T2DM is the use of oral antidiabetic agents (OAAs), insulin, and incretin-based drugs in an attempt to achieve glycaemic control and maintain glucose homeostasis. However, conventional anti-T2DM drugs have been shown to have limited efficacies and serious adverse effects. Hence, the need for newer, more efficacious and safer anti-T2DM agents. Sutherlandia frutescens subsp. microphylla is a flowering shrub of the pea family (Fabaceae/Leguminaceae) found mainly in the Western Cape and Karoo regions of Southern Africa. Concoctions of various parts of the plant are used in the management of different ailments including T2DM. However, despite extensive biological and pharmacological studies, few analyses exist of the chemical constituents of S. frutescens and no Triple Time of Flight Liquid Chromatography with Mass Spectrometry (Triple TOF LC/MS/MS) analysis has been performed. The initial aim of this study was to investigate the phytochemical profile of hot aqueous, cold aqueous, 80% ethanolic, 100% ethanolic, 80% methanolic and 100% methanolic extracts of a single source S. frutescens plant material using colorimetric and spectrophotometric analysis. The hot aqueous extractant was found to be the best extractant for S. frutescens, yielding 1.99 g of crude extract from 16 g fresh powdered plant material. This data suggests that application of heat and water as the extractant (hot aqueous) could play a vital role in extraction of bioactive compounds from S. frutescens and also justifies the traditional use of a tea infusion of S. frutescens. Colorimetric analysis revealed the presence of flavonoids, flavonols, tannins, and phenols in all extracts with varying intensity. The organic extracts 100% methanol, 80% and 100% ethanol exhibited high color intensity (+++) for flavonoids and flavonols respectively, while all the extracts exhibited a moderate color intensity (++) for tannins and phenols. Spectrophotometric analysis of S. frutescens extracts revealed that all the organic extracts contained a significantly higher concentration (in mg/g of extract) of flavonols and tannins when compared to the aqueous extracts. All extracts contained approximately equal levels of phenols. These data confirm the presence of all four groups of bioactive phytocompounds in the S. frutescens extracts used in this study, and also confirm that different solvent extractants possess the capability to differentially extract specific groups of phytocompounds. in individual extracts. Further comparison of these compounds with online databases of anti-diabetic phytocompounds led to the preliminary identification of 10 possible anti-diabetic compounds; α-Pinene, Limonene, Sabinene, Carvone, Myricetin, Rutin, Stigmasterol, Emodin, Sarpagine and Hypoglycin B in crude and solid phase extraction (SPE) fractions of S. frutesecens. Furthermore, using two hepatic cell lines (Chang and HepG2) as an in-vtro model system, the anti-T2DM properties of crude aqueous and organic extracts of S. frutescents was investigated and compared. Both aqueous and organic extracts of S. frutescens were found to decrease gluconeogenesis, increase glucose uptake and decrease lipid accumulation (Triacylglycerol, Diacylglycerol, and Monoacylglycerol) in Chang and HepG2 hepatic cell cultures made insulin resistant (IR) following exposure to high concentration of insulin and fructose. Using real-time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), the aqueous and organic extracts of S. frutescens were confirmed to regulate the expression of Vesicle-associated membrane protein 3 (VAMP3), Mitogen-activated protein kinase 8 (MAPK8), and Insulin receptor substrate 1 (IRS1) in insulin resistant hepatic cells. IR-mediated downregulation of VAMP3, MAPK8, and IRS1 mRNA in IR HepG2 hepatic cell cultures was reversed in the presence of aqueous and organic extracts of S. frutescens. The hot aqueous extract displayed the highest activity in all the assays, while all the organic extracts displayed similar potency. In conclusion, this study reports that aqueous and organic extracts of S. frutescens possess numerous anti-diabetic compounds that can be further investigated for the development of new, more efficacious and less toxic anti-diabetic agents. The presence of multiple compounds in a single extract does suggest a synergistic or combinatorial therapeutic effect. These findings support the burgeoning body of in-vivo and in-vitro literature evidence on the anti-diabetic properties of S. frutescens and its use in folklore medicine

Menopause in Sagamu, southwest Nigeria

Background: As woman ages there is associated decline in her ovarian function until there is eventual cessation of menstruation (the menopause). Menopause is associated with alteration in the physiological, biochemical and psychological environment of the woman, the perception of which varies among women based on their sociocultural, educational and racial factors.Objective: To demonstrate average age at menopause and common menopausal complaints most commonly experienced by our menopausal women.Design: A questionnaire based descriptive cross-sectional study of 402 women aged between 44 and 65 years attending out-patient clinics and who had experienced at least 24 continuous months of amenorrhoea.Setting: Study was undertaken at the Olabisi Onabanjo University Teaching Hospital, Sagamu, a tertiary health institution in southwestern Nigeria.Method: Women aged between 44 and 65 years and whose last menstruation was at least 24 months earlier were interviewed using structured questionnaire.Results:Four hundred and two out of 410 women interviewed correctly answered the questionnaire for analysis, (mean age 53.59 ⚜ 5.12 years). The mean age of menopause was 48.91±2.58 years (range 41-57 years). The median and the modal ages at menopause were 49.00 years. Two hundred and twelve (52.7%) women experienced no symptoms. Of the 190 women that experienced symptoms hot flushes was the symptom that was most commonly experienced, and the least was depression; no respondent reported any episode of fracture.Conclusion: The mean age at menopause in our practice is lower than the global average. Menopause in our women is commonly complaints free. The less parous and more educated a woman the poorer her perception of menopausal symptoms

Correlates of the adoption of soil conservation practices by Iowa farmers

Factors important to farmers\u27 differential adoption of soil conserving practices have been well studied. But one factor that has received surprisingly little attention is the tenure status of the operator i.e., whether an owner-operator, part-owner, or tenant. The few studies that have tested for the importance of tenure have often reached contradictory conclusions. The present study tests for differences in the relative adoption of soil conservation practices by three tenure groups;Three measures of adoption--behavioral adoption, psychological adoption of recommended mechanical plans, and psychological adoption of recommended vegetative plans--were used in this study. Farm operators were classified into three tenure groups i.e., owners, part-owners, and tenants. The hypotheses about factors important to adoption were first tested for all operators, and then separately for each tenure group. Both bivariate and multivariate analyses were made;Tenure status was found to be important in the way that five factors (i.e., education, farm size, debt level, off-farm work, and number of implemented practices) affected adoption. The proportion of the variance in conservation adoptions was only 12% to 13% for all farmers, but jumped to 24% to 55% for owner operators, 9% to 20% for part-owners, and 35% to 76% for tenants. It was also found that the correlates of conservation adoption found for all farmers differ from those identified for specific tenure groups

Condom Use among Young African American Men: Implications for Planning Interventions

Condom Use among Young African American Men: Implications for Planning Interventions Sexually transmitted diseases, including HIV, continue to present significant public health problems affecting young people in the United States, especially African Americans. While African Americans make up about 12% of the U.S. population, in 2010 they accounted for 44% of new HIV infections in 2010 and 48% of all persons living with AIDS in 2007. The 2010 data shows that of these new cases, 38% occurred among African American males ages 13-24 years old. Correct condom use remains a challenge in this population and efforts to increase condom use among minority males has been a formidable challenge. This paper reports the results of formative research conducted in order to guide the development of an intervention to increase consistent, effective condom use for young African American males. Methods: A snowball sampling approach was used to recruit participants. African American males, ages 18-24, who self-reported as sexually active were eligible to participate in one of four focus groups or one of six individual interviews. All study events were conducted at community locations. Each event was audiotaped and notes were taken. Analysis was performed using using NVivo-9. The coding strategy included emic and etic codes and a coding tree was developed which was used to identify themes. Results: A total of 36 African American males between the ages of 18-24 (mean 20.7 years) took part. In general, participants felt condom use was highly influenced by contextual factors including partner interest, partner communication, length of relationship and trust. Condom use was also influenced by a sense of invincibility and being caught up in the moment. Notably, most sexual activity occurred outside of a relationship, most often within the party scene or as quickly arranged hook-ups. Analysis: In order to ensure maximum impact on the development of the intervention, the results from this formative phase were viewed through the Transtheoretical Model of Behavior Change (TTM) and most participants would be described as being in the pre-contemplation or contemplation stages of behavioral change. While all participants expressed some understanding of the risks of unprotected sex, many did not connect risks to consequences. While the data did not indicate that condom use behavior was likely to change in the short-term (less than 6 months), several participants were contemplating making a change. Discussion: The snowball sampling approach allowed us to understand the participants’ social network and allowed us to consider social influences as well as about individual attitudes and beliefs. In the TTM frame, interventions designed for this population need to include contemplators and pre-contemplators and should focus on modification of cognition, affect and behaviors. Our research also shows that several of the underlying assumptions of TTM are at odds with the framework within which sex often occurs for this population and condom use decisions are highly influenced by the social context. In light of the results, the intervention placed condom use into a health promotion context. It combines group activities and one-on-one interaction. Group activities can impact shared values and beliefs and, thus, the intervention builds social support for behavior changes while addressing individual capacity

Assessing the knowledge of emergency medical care personnel in the Free State, South Africa, on aspects of paediatric pre-hospital emergency care

Introduction: in South Africa in 2016, injuries accounted for 4 483 deaths of children aged 0-4 years. Prior studies have reported that, in some parts of the country, poor pre-hospital clinical care is a key contributor to the morbidity and mortality of critically ill and injured children. A key component of a coordinated emergency health care system are emergency medical care (EMC) personnel. Here, we assess the knowledge of EMC personnel employed by the Free State Department of Health on aspects of paediatric pre-hospital emergency care. Methods: this descriptive study used a questionnaire survey to obtain data on the knowledge of Free State EMC personnel on aspects of paediatric pre-hospital emergency care. Results: only 197 of the initial 250 questionnaires distributed were returned, giving a response rate of 78.8%. More than half (51.2%) of the participants across the five districts had inadequate knowledge of paediatric pre-hospital emergency care. The majority of EMC personnel could not calculate the paediatric blood pressure for age and did not know the paediatric Glasgow Coma Scale (74.0% and 53.4% respectively; P < 0.0001 in both cases). Participants attributed inadequate knowledge to limited exposure to paediatrics cases, insufficient training, limited scope of practice, and lack of equipment. Conclusion: enhancing the knowledge and skills of EMC personnel in paediatrics pre-hospital care through a short learning programme or continuous professional development programme, and providing adequate paediatric emergency equipment, will ensure that comprehensive pre-hospital emergency care is given to paediatric patients in the province