Comparing the outcomes of labour induction with misoprostol and dinoprostone at Amino Kano teaching Hospital Kano Norhtwest Nigeria

Context: Induction of labour is an old procedure performed to artificially terminate pregnancy for various indications in the interest of the mother, the fetus or both. The aim is to achieve vaginal delivery. Various methods have been in use which include the use of Misoprostol, Dinoprostone, oxytocin infusion and others. In an effort to determine which agent gives better outcome studies were carried out comparing the agents with one another.Objectives: To compare the outcomes of labour induced with Misoprostol and Dinoprostone and to determine the incidence of induction of labour at Aminu Kano Teaching Hospital Kano Nigeria.Materials and Methods: The study was restrospective involving a total of 364 patients admitted for labour induction between January 2005 to December 2009. Out of this 274 were induced with Misoprostol and 90 were induced with Dinoprostone.Results: The incidence of labour induction is 2.35%. The indications include postdatism, Hypertensive disorders of pregnancy, PROM, IUFD and others such as Sickle cell disease, and Diabetes Mellitus. The most common indication was postdatism 45.9%. The success rate was 83.9% for Misoprostol and 82.2% for Dinoprostone. There is a statistically significant difference in terms of shorter induction delivery interval in favour of Misoprostol. There were less number of babies with APGAR score less than 6 in the Misoprostol group. There is no statistically significant difference in terms of the spontaneous vaginal deliveries and caesarean section rates between the two groups.Conclusion: The rate of induction of labour in the centre is 2.35%. Misoprostol was found to be a more efficient and safer agent for induction of labour if the procedure is well managed. It was associated with shorter induction delivery interval without compromising the fetomaternal outcome compared to Dinoprostone.Keywords: Induction of Labour, Misoprostol, Dinoprostone, OutcomeTrop J Obstet Gynaecol, 30 (1), April 201

A 5 year review of the prevalence and feto-maternal outcome of eclampsia at Aminu Kano teaching hospital.

Background: Eclampsia remains a serious obstetric disorder in tropical obstetric practice. Provision of quality antenatal care is essential in reducing its incidence.Objective: To determine the prevalence and socio demographic characteristics of patients with eclampsia and also the feto-maternal outcome.Study Design: A 5-year retrospective study on eclampsia in Aminu Kano Teaching Hospital, Kano.Results: There were a total of 13,750 deliveries and 240 eclamptic patients during the study period, giving a prevalence of 1.75%. About 49.28% of the eclamptic patients were adolescents compared with 7.25% in the control group and 59.42% of them were primigravidas compared with 12.56% in the control group. About 91.30% of the cases were Hausas and 77.77% were from Kano metropolis. Also 82.9% of the cases were unbooked and 51.29% of them were delivered via caesarean section compared with 10.63% in the control group. Maternal mortality occurred in 12.08% of the cases compared with 0.97% in the control group. Perinatal mortality occurred in 22.71% of the cases compared with 3.86% in the control group.Conclusion: Eclampsia is one of the serious emergencies seen in Sub-Saharan Africa and is associated with increased perinatal morbidities and mortalities. Providing good quality antenatal care coupled with improving emergency capability of hospitals and establishg an intensive care unit for the care of eclamptic patients are essential in reducing maternal and perinatal morbidities and mortalities from the disease.Keywords: Eclampsia, Feto-maternal outcome, AKTH Kano

The Genetic and Molecular Studies of Hepatitis C Virus: A Review

The role of Hepatitis viruses, particularly Hepatitis c virus (HCV) as human pathogen and their transmission have been of interest over the years. The virus is a small (55-65nm in size), included in Group IV, enveloped, positive sense, single stranded RNA virus, the family Flaviviridae, genus Hepacivirus, and Hepatitis c virus type species. Based on genetic differences between HCV isolates, the virus species is classified into six genotypes (1-6) with several subtypes within each genotype (represented by letters). Persistent infection with Hepatitis c virus (HCV) has emerged as one of the primary causes of chronic liver disease with an estimated 170 million people infected by HCV, more than 4 times the number of people living with HIV throughout the world. The present review looks at the genetic and molecular nature of this virus with the view to provide more information about its biology which may be useful to the present and feature researchers. Key words: Hepatitis c virus, biology, genome, chronic, liver, diseas

Uterine rupture an obstetrics catastrophy; incidence, risk factors, management and outcome at Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria

Context: Ruptured uterus is still an important obstetrics complication because it contributes significantly to both maternal and foetal morbidity and mortality in our setting. Therefore there is a need to further evaluate its causes and the outcome of its management.Objective: To determine the incidence, risk factors, management and outcome of ruptured uterus in our centre and thus provide a baseline data on the subject for comparison in the future as the hospital is now upgraded to a Teaching Hospital.Materials and Methods: A two year retrospective review carried out on 67 patients that were managed for uterine rupture during the study period. Data was obtained from patients' case files, labour ward registry, theatre registry, admission /discharge registry and entered into a proforma. Descriptive analysis was done with SPSS software (version16.0).Results: There were a total of 19,412 deliveries in the review period out of which there were 67 ruptured uteri. The incidence of ruptured uterus is 0.35% and the common risk factors include high parity, exposure to oxytocin in labour, scar on the uterus, prolonged labour and unbooked status. Foetal mortality was 100% and maternal mortality 13.4%.Wound sepsis/dehiscence, vesicovaginal fistula and anaemia were the common complications in this study.Conclusion: Ruptured uterus remains an important obstetrics problem in our centre. It is associated with high maternal mortality and foetal mortality. More effort is needed to reduce this obstetrics problem.  Key Words: Uterine rupture, Risk factors, Management, outcome, Bauch

Ectopic Pregnancy in Bauchi, North-East Nigeria

Background: Ectopic pregnancy is an important life-threatening emergency and a cause of reproductive morbidity and mortality especially in developing countries. The significance of ectopic pregnancy in our environment lies in its late presentations with its attendant consequences compounded by structurally weak health systems. This is at variance with the global trend of early diagnosis and conservative approach to thiscondition.Objective: To assess the incidence, presentation and management of ectopic pregnancy (EP), in Bauchi north-east Nigeria over a two-year period.Methods: This was a retrospective study of cases of EP managed at gynaecological unit of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi between 1st of January 2009 and 31st December 2010.Results: During the period under review, a total of 19,412 deliveries were recorded in the hospital and 119 ectopic pregnancies were managed. This gives an incidence of 0.61%. Majority of the patients were 30 yearsand below with mean age of 26.8 years. The common clinical features at presentation were abdominal pain (95%), amenorrhea (87%), vaginal bleeding (51.5%). More than half of the patients were in shock (51.4%)before intervention. Seventy patients (69%) had the EP on the right tube, 10(9.9%) on the left tube while the side was not stated in 20 patients (20.8%). The mode of surgical treatment in majority of the patients wasunilateral salpingectomy 83(82.2%); one patient (1%) had bilateral salpingectomy while the type of surgical operation was not stated in 13 cases (12.9%). None of the patients had minimal access surgery, medical or conservative management. Anaemia (65.3%) was the commonest post-operative complication. Case fatality was 4%.Conclusion: Late presentation of EP was the commonest way of  presentation in our centre. Laparotomy with salpingectomy was the main modality of management. This has adverse effect in a society which placeshigh premium on child bearing. Reproductive health education and strengthening support services like blood transfusion services are needed. Provision of minimal access approach facilities and other forms of conservative management for those that present early should be considered.Keywords: Ectopic pregnancy, incidence, presentation and management at a newly established teaching hospital, Nigeri

Feasibility trial for primary stroke prevention in children with sickle cell anemia in Nigeria (SPIN trial)

The vast majority of children with sickle cell anemia (SCA) live in Africa, where evidence-based guidelines for primary stroke prevention are lacking. In Kano, Nigeria, we conducted a feasibility trial to determine the acceptability of hydroxyurea therapy for primary stroke prevention in children with abnormal transcranial Doppler (TCD) measurements. Children with SCA and abnormal non-imaging TCD measurements (≥200 cm/s) received moderate fixed-dose hydroxyurea therapy (∼20 mg/kg/day). A comparison group of children with TCD measurements <200 cm/s was followed prospectively. Approximately 88% (330 of 375) of families agreed to be screened, while 87% (29 of 33) of those with abnormal TCD measurements, enrolled in the trial. No participant elected to withdraw from the trial. The average mean corpuscular volume increased from 85.7 fl at baseline to 95.5 fl at 24 months (not all of the children who crossed over had a 24 month visit), demonstrating adherence to hydroxyurea. The comparison group consisted of initially 210 children, of which four developed abnormal TCD measurements, and were started on hydroxyurea. None of the monthly research visits were missed (n = total 603 visits). Two and 10 deaths occurred in the treatment and comparison groups, with mortality rates of 2.69 and 1.81 per 100 patient-years, respectively (P = .67). Our results provide strong evidence, for high family recruitment, retention, and adherence rates, to undertake the first randomized controlled trial with hydroxyurea therapy for primary stroke prevention in children with SCA living in Africa

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

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone