Emergency obstetrics care in a Nigerian tertiary hospital: a 20 year review of umblical cord prolapse

Context: Umbilical cord prolapse is an obstetric emergency associated with high perinatal morbidity and mortality unless prompt delivery by the fastest and safest route is carried out. Objectives: To determine the incidence ofumbilical cord prolapse, predisposing factors, and fetal outcome. Study design, setting and subjects: A20 year retrospective study of all women who presented with umbilical cord prolapse atUniversity of MaiduguriTeachingHospital,Maiduguri.North-EasternNgeria. Results: During the study period there were 27,753 deliveries and 75 women had cord prolapse, giving the incidence of 1 in 370 deliveries (0.27%). Significantly more patients with non vertex presentation, twins and preterm delivery had cord prolapse. The highest occurrence was in those with unengaged presenting part(65.2%), spontaneous rupture of membrances(62.1%) and grandmultiparous women(57.6%). Caeserean section was carried out in 50% of cases, with mean decision-delivery interval of 77.1+- 21.7 minutes and 28/33(84.9%) of babies deliveredwithin 60minute had normalApgar scores. The Knee-chest position was most commonly used method of alleviating cord compression while arrangement for caesarean section was being made.The perinatalmortalitywas 27.3%. Conclusion: umbilical cord prolapse is a brisk obstetric emergency with high perinatalmorbidity andmortality unless prompt delivery is undertaken. Better communication and prompt response to emergency by the theatre teamto reduce the decision-delivery intervalwould improve the perinatal outcome.Keywords: Umblical cord, grandmultiparous, Apgar, asphyxia, perinatal mortality and perinatal outcom

The prevalence of ectopic pregnancy in Jos, North Central Nigeria: a reproductive health challenge

Background: Ectopic pregnancy is a life threatening gynecological emergency with a rising incidence of maternal morbidity especially in resource poor settings. Most cases present in the emergency unit when ruptured.Objective: The objective of this study was to determine the prevalence, identifiable risk factors, clinical presentation and management outcome of ectopic pregnancy.Method: This was a retrospective review of cases of ectopic pregnancies seen and managed in the gynecological unit of Plateau State Specialist Hospital (PSSH) Jos from 1st September 2012 to 31st August, 2017. The medical records of the patients managed for ectopic pregnancy as well as the delivery register from the labor room, theater register and gynecological admissions during the study period were retrieved. The data were collected with the aid of data entry form designed for this purpose. The relevant data collected were analyzed using epi info 16 version and presented in tables.Results: During the period, a total number of 13,596 deliveries were recorded while there were 2067 gynecological admissions. One hundred and seventy two (172) patients had ectopic pregnancies accounting for 1.27% of all deliveries and 8.3% of gynecological admissions. The mean age of the patients was 29±5years. The peak age group was 20-25 years (32.0%); 92(53.5%) had secondary school as their highest level of education; 135(78.5%) were married and 49(28.4%) were multigravida. All the patients; 172(100%) presented with a history of abdominal pain while 8(4.7%) presented in shock. A total of 161(93.6%) were diagnosed based on history and clinical examination findings; 152(88.4%) had trans-abdominal scan and 12(7.0%) had abdominal paracentesis (though frowned at in modern day practice). The commonest identifiable risk factors for ectopic pregnancies were pelvic inflammatory disease(PID) in 111(64.5%) of patients followed by previous history of abortions in 17(9.9%) of patients. A total number of 169(98.3%) of the patients had total salpingectomy for ruptured ectopic pregnancies via open abdominal surgeries with 87(50.6%) done on the right fallopian tubes. Three (1.7%) of the patients had oophorectomy. Eighty one(47.1%) of the patients had blood transfusion with no case fatality.Conclusion: Ectopic pregnancy still remains a major health challenge among women of reproductive age group in Nigeria. Efforts should therefore be directed at prompt and timely management to reduce maternal morbidity and mortality in developing countries, availability and accessibility of contraceptive methods, accessibility to healthcare centers and affordable healthcare, proper treatment of PID, use of better technologies in management of cases and human capacity development.Keywords: Prevalence, reproductive age group, ectopic pregnancy, resource poor settings, life threatening, emergenc

Novel <i>GREM1 </i>Variations in Sub-Saharan African Patients With Cleft Lip and/or Cleft Palate

Objective: Cleft lip and/or cleft palate (CL/P) are congenital anomalies of the face and have multifactorial etiology, with both environmental and genetic risk factors playing crucial roles. Though at least 40 loci have attained genomewide significant association with nonsyndromic CL/P, these loci largely reside in noncoding regions of the human genome, and subsequent resequencing studies of neighboring candidate genes have revealed only a limited number of etiologic coding variants. The present study was conducted to identify etiologic coding variants in GREM1, a locus that has been shown to be largely associated with cleft of both lip and soft palate. Patients and Method: We resequenced DNA from 397 sub-Saharan Africans with CL/P and 192 controls using Sanger sequencing. Following analyses of the sequence data, we observed 2 novel coding variants in GREM1. These variants were not found in the 192 African controls and have never been previously reported in any public genetic variant database that includes more than 5000 combined African and African American controls or from the CL/P literature. Results: The novel variants include p.Pro164Ser in an individual with soft palate cleft only and p.Gly61Asp in an individual with bilateral cleft lip and palate. The proband with the p.Gly61Asp GREM1 variant is a van der Woude (VWS) case who also has an etiologic variant in IRF6 gene. Conclusion: Our study demonstrated that there is low number of etiologic coding variants in GREM1, confirming earlier suggestions that variants in regulatory elements may largely account for the association between this locus and CL/P. </jats:sec

Evaluation of the Nigerian national antiretroviral (ARV) treatment training programme

There is an understanding that greater availability of HIV treatment for the 40.3 million people currently infected with HIV is a humanitarian imperative that could prolong the lives of millions, restore economic productivity, and stabilise societies in some of the world's hardest-hit regions. The Nigerian government recognises that the country has the third highest burden of infection, with people living with HIV estimated to total 4.0 million, and so in 2002 commenced the implementation of one of Africa's largest antiretroviral (ARV) treatment programmes. A successful ARV programme requires that all components of a functional management system be put in place for effective and efficient functioning. This would include logistics, human resources, financial planning, and monitoring and evaluation systems, as well as sustainable institutional capacities. The Nigerian national ARV treatment training programme was conceived to meet the human resource needs in hospitals providing ARV therapy. This paper reports on the evaluation of the training programme. It examines knowledge and skills gained, and utilisation thereof. Recommendations are made for improved training effectiveness and for specific national policy on training, to meet the demand for scaling up therapy to the thousands who need ARV. Keywords: ARV, training, evaluation, HIV, health care providerJournal of Social Aspects of HIV/AIDS Research Initiatve Vol. 3 (3) 2006: pp. 488-50

Prevalence of hyperemesis gravidarum and associated risk factors among pregnant women in a tertiary health facility in Northeast, Nigeria

Background: One of the commonest symptoms observed in pregnant women before the 20th week of gestation is nausea and vomiting, an exaggeration of these symptoms hyperemesis gravidarum (HEG) could result in maternal and fetal catastrophes and even death. The objective of this study was to determine the prevalence and associated risk factors for hyperemesis gravidarum among pregnant women at booking.Methods: A prospective institutional based study design was done among 452 pregnant women seen at booking in a tertiary hospital in Northeast Nigeria from the 1st February 2019 to 30th June 2019. Data was summarized using descriptive statistics. OR was used to measure significant risk.Results: The observed prevalence of hyperemesis gravidarum among pregnant women in the study is 44.9%. The Majority (81.4%) of these women were between the age range of 21 and 35 years. Mean age of 27 years. Multiparity (33.4%), previous (44.9%) and family history of HEG (31.6%) were identified as important risk factors for developing HEG. Grand multiparity (11.5%) and gestational age less than 13 weeks (6.64%) were however less likely observed to be risks for HEG.Conclusions: HEG is a common problem in pregnancy with almost half of the number of pregnant women at booking affected. Multiparity and past history of HEG are pointers to developing the condition and it should be looked out for among at risk group of pregnant women, so that early intervention can be instituted to avoid any possible adverse outcome

An open-label pilot single-subject study to monitor the impact of a Food-Based enteral formula on faecal short-chain fatty acid concentrations in children admitted to intensive care with sepsis

Background: Non-digestible dietary fiber undergoes fermentation by the intestinal microbiota to produce short-chain fatty acids (SCFAs). Intestinal SCFAs control the production of T-helper cells, antibodies and are involved in maintaining homeostasis of the mucosal system. Sepsis is the leading cause of mortality in hospitalised children and is treated with antibiotics which disrupts the normal maturation of the microbiome causing dysbiosis. This study assessed the impact of a high-fibre Food-Based formula on feed tolerance and faecal SCFA concentrations in children admitted to intensive care with sepsis. Methods: An open-label single-subject study was based on repeated observations over 14 days in children admitted to intensive care with sepsis who commenced a high-fiber Food-Based enteral formula Compleat®Paediatric, (Nestle Health Science). Stool samples were collected to measure SCFA concentrations (acetate, butyrate and propionate). A Wilcoxon Signed-Rank test was used to measure change in SCFA concentrations. Other data collection included feed tolerance, anthropometrics, antibiotic administration and inflammatory markers. Results: Twenty children with sepsis were recruited over six months. The mean age was 10.8 years (±5.6 years SD). The most common sepsis-related organ failure was the respiratory tract (50 %). The mean duration of mechanical ventilation was 9 days (±4 SD), 25 % of children were treated with more than two antibiotics during their time in intensive care. Faecal propionate and butyrate concentrations were maintained during the children's time in intensive care. Stool frequency reduced from 2.6 per day (±1.08 SD) at baseline to 1.2 per day (±0.45 SD) after one week in intensive care (p < 0.004). Conclusion: In this pilot study children admitted to intensive care with sepsis tolerated a Food-Based formula. Faecal butyrate and propionate concentrations were maintained whilst feeding on a high fiber Food-Based formula. Further research is warranted to assess whether a Food-Based formula is superior to a standard enteral formula in preserving the intestinal microbiota, thereby mitigating gastrointestinal complications associated with antibiotic-related dysbiosis

Maternal and fetal determinants of perinatal transmission of HIV among HIV positive mothers attending ANC at a northern Nigerian tertiary health institution

Objective: To ascertain the major determinants of perinatal transmission of HIV among HIV positive women attending ANC and delivery at the University of Maiduguri Teaching Hospital, Maiduguri.Patients and methods: A prospective case control study of 52 HIV positive pregnant women who were attending ANC and delivery at university of Maiduguri Teaching Hospital (UMTH) was carried out. Known HIV positive mothers sent from the adult HIV clinic and those found during ANC HIV screening and diagnosis using rapid tests were recruited, while Fetal diagnosis of HIV was done using polymerase chain reaction (PCR) technique at 6 and/or at 12 weeks of birth age. Socio demographic and obstetrics history were obtained and analyzed using SPSS version 11 and test of significance was carried out using chi square tests.Results: Of the 52 women that were found to be HIV positive, the perinatal transmission rate was 11.5%. Elective caesarean section (ELCS) was offered to 11(21.2%) and all the babies delivered through ELCS were negative for HIV. Advanced maternal age (X2 =33.53 P &lt;0.001), Low CD4 count (X2 =15.58 P =0.016), high maternal viral load (X2 =21.85 P =0.005), prematurity (X2 = 9.872 P= 0.007), low birth weight (X2 = 63.80 P &lt; 0.001) and birth asphyxia(X2 = 24.149 P&lt; 0.001) were the major determinants of perinatal transmission of HIV infection in this study.Conclusion: The perinatal transmission of HIV is high. Prompt identification of both maternal and fetal risks' factors and Effective interventions aim at minimizing the impact of these factors before or during pregnancy will help to lower some of the preventable determinants of perinatal transmission.Recommendations: A prenatal and antenatal risks reduction strategy should be advocated. All effort should be geared toward identifying those positive and minimized or modify risks factors through behavior change, prompt initiation of treatment and prophylaxis for those found positive with a view to reduce the incidence of perinatal transmission.Key Words: perinatal transmission, HIV, maternal, fetal determinants, Maidugur

Active tuberculosis among adult HIV-infected patients accessing antiretroviral therapy in a tertiary health facility in Lafia, northcentral Nigeria

Background: Tuberculosis and Human Immunodeficiency Virus (HIV) co-infection is a major problem in Nigeria and other countries that are ravaged by a high burden of both diseases. The World Health Organization (WHO) reports that the risk of developing active tuberculosis (TB) among people living with HIV is 16-27 times that of HIV negative persons. Although antiretroviral therapy (ART) reduces the risk of developing TB, there are factors which predispose those on ART to TB. This study sought to determine the prevalence of TB among adults on ART in our facility and identify the predisposing factors. Methodology: This was a retrospective study utilizing data from clinical records (folders and electronic) of adult HIV patients who are accessing ART in our facility and have been on ART for at least 6 months. A proforma was used to collect data including demographic, clinical, ART and laboratory information of the patients. The data were entered into SPSS version 23 and analyzed using descriptive statistics and bivariate analysis. Associations were tested using Chi square with 95% confidence level. Results: A total of 457 patients were studied, aged 18-69 years (mean age 38.3± 10 years), and 72.4% females. Majority were married (81%), unemployed (53.8%), had mean baseline CD4 cell count of 267.4 ± 185 cells/mm3 and a mean duration on ART of 100.9± 39 months. Seventeen point three percent of the patients had a previous history of TB before or within 6 months of commencement of ART. Thirteen (2.8%) of the patients had active TB while on ART. Majority of those who had active TB were females (76.9%), married (76.9%), unemployed (46%), had no previous history of TB (53.8%), baseline CD4 cell count of ≤ 350 cells/mm3 and were on first line ART medication. There was however no significant statistical association of active TB with any of these factors. Conclusion: Few patients had active TB while on ART in this study. The high frequency of TB in those who had low baseline CD4 cell count and baseline WHO stage shows the importance of early initiation of ART in people living with HIV (PLHIV). There is need for regular screening of PLHIV for TB and innovative approaches to get people with HIV to know their TB status as well as early commencement of ART. Keywords: Human immunodeficiency virus, Active Tuberculosis, Antiretroviral therapy

A case of rabies outbreak in a bull-calf from Nigeria

This paper describes a rabies outbreak in a bull-calf which led to euthanasia following manifestation of clinical signs of the disease. Infection was confirmed using a rapid immunochromatographic test of the homogenates from brain tissues (the brain stem, hippocampus and cerebellum) sample. Exposure to rabies virus (RABV) had resulted due to an attack by a free-roaming dog (FRD). Mass vaccination campaigns against rabies and improving biosecurity measures to limit access of free-roaming dogs to farms can prevent the occurrence of RABV in dogs, livestock animals and personnel at risk in Nigeria