Spontaneous splenic rupture in pregnancy: a case report

Spontaneous splenic rupture in pregnancy is a rare condition, associated with very high maternal mortality rate and fetal wastage. It is frequently misdiagnosed at presentation. We report a case of a 33-year-old, gravida 2, para 1 lady at 29 weeks' gestation with spontaneous splenic rupture, which was initially diagnosed as hypovolaemic shock due to ruptured uterus. Spontaneous splenic rupture as a cause of shock and abdominal pain should be considered whenever uterine rupture is suspected in the second half of pregnancy.Keywords: Spontaneous, spleen, rupture, pregnancy, twin

The role of cytokines as inflammatory mediators in preeclampsia

Introduction: this study is to determine the concentrations of IL-6, TNF 5, and C reactive protein (CRP) in women with severe preeclampsia, andcompare with those of gestational age- matched normotensive pregnant women and to correlate CRP levels with markers of organ damage inwomen with preeclampsia.Methods: this was a case control study of fifty women with severe preeclampsia and fifty gestational age matched pregnant women with normal blood pressure. The women were drawn from The Antenatal Clinic of The Lagos University Teaching Hospital. Severe pre eclampsia was defined as systolic blood pressure ;160 mmHg and/or diastolic blood pressure ;110mmHg and ;2+ of proteinuria. After obtaining an informed consent, each participant completed a structured questionnaire. The questionnaire sought information on socio-demographic and clinical data. From each participant, mid-stream urine was collected for urinalysis and culture, and blood sample was collected for biochemical analysis. Comparisons of continuous variables and categorical variables were done using the Student's t test and Chi square test respectively. Correlation analysis was used to determine the associations between variables. Statistical  significance was set at P Results: the women were similar in their socio demographic characteristics. There was a statistically significant difference in the systolic blood pressure ( p < 0.0001), diastolic blood pressure ( p < 0.0001), uric acid ( p < 0.0001), AST ( p < 0.0001), ALP ( p < 0.0001), creatinine ( p < 0.0013), GGT ( p < 0.005), IL 6 ( p < 0.021), CRP ( p < 0.0002), and TNF 5 ( p < 0.023), between the group with severe preeclampsia and the group with normal blood pressure. This study also reports a significant association between CRP and systolic blood pressure, diastolic blood pressure, uric acid AST and ALP (pConclusion: the inflammatory cytokines, IL6, TNF 5 and CRP are elevated in severe preeclampsia and may mediate some of the clinical manifestations of the disorder. A role may exist for anti inflammatory  agents in the management of women with preeclampsia

Knowledge of and attitude toward human papillomavirus infection and vaccines among female nurses at a tertiary hospital in Nigeria

Christian Chigozie Makwe, Rose Ihuoma AnorluDepartment of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, NigeriaBackground: Persistent infection with high-risk types of human papillomavirus (HPV) is a prerequisite for the development of cervical cancer. Highly immunogenic HPV vaccines have been developed and licensed for the primary prevention of cervical cancer in some developed and developing countries. This calls for assessment of the knowledge of the HPV infection and the acceptability of the HPV vaccines among health care providers.Objective: The aim of this study was to assess awareness and knowledge of HPV infection and vaccines and to assess attitude toward these vaccines among female nurses at Lagos University Teaching Hospital, Lagos, Nigeria.Study design: The study was a cross-sectional, descriptive study using a pretested, structured, anonymous, self-administered, 19-item questionnaire.Results: A total of 178 female nurses were interviewed during a 4-week period. The mean age of respondents was 37.1 ± 3.1 years. Almost all (99.4%) of the respondents had heard of cervical cancer, while about 85% of them had heard of HPV infection. Only a quarter (25.3%) of respondents had heard of the HPV vaccines, and of those only 26.7% knew the vaccines were for the prevention of cervical cancer. Most (70.2%) of the nurses expressed a desire to be vaccinated and 120 (67.4%) supported the vaccination of preadolescent girls. Those who expressed a willingness to be vaccinated were more likely to recommend HPV vaccination for preadolescent girls.Conclusion: Overall, there was a poor knowledge of the HPV vaccines among female nurses at Lagos University Teaching Hospital. Despite this poor knowledge, most of the nurses expressed a strong desire to be vaccinated and their intention to recommend it for preadolescent girls. The main reason given overall for not recommending the vaccines was lack of information. There is an urgent need to bridge this information gap.Keywords: HPV, immunization, cervical cance

Plasma Homocysteine and Haematological Changes in Infertile Women in Lagos, Nigeria

Hyperhomocysteinemia has been described as a risk factor for infertility and adverse pregnancy outcomes such as recurrent/early pregnancy loss, pre-eclampsia and intrauterine growth restriction. Although Nigeria has a high prevalence of infertility, the contribution of homocysteine to female infertility is yet to be studied. This study aim to find possible relationship between elevated plasma homocysteine level and infertility. This descriptive cross-sectional study was carried out among eligible infertile and fertile women seeking care at the Lagos University Teaching Hospital. The subjects were 100 infertile women randomly selected from the fertility clinic, and the controls were 50 fertile women that have given birth in the last one year. Fasting plasma levels of homocysteine were estimated using enzyme immunoassay technique, while anticoagulated whole blood sample was used to evaluate haematological parameters (Hb, WBC, MCV, MCH, MCHC, RDW %), using the HMX haematology autoanalyser by Beckman Coulter. Statistical analysis was performed using the Chi-square and simple logistic regression model for associations and Student t-test for mean differences. Statistical significance was set at p-value <0.05. Among infertile women, 34.0% (n=34) complained of primary infertility while 66.0% (n=66) had secondary infertility. Mean plasma homocysteine level of subjects and controls were 9.50 ± 1.88μmol/L and 9.44 ± 1.85μmol/L respectively. In the control group, the 95th percentile for homocysteine level was 12.0μmol/L. Differences in mean plasma homocysteine levels between the subjects and controls were not statistically significant (p=0.952).Mean values of haematological parameters did not vary significantly in both groups except for a marginal increase in WBC count of infertile women. Hyperhomocysteinemia may not be a major factor in female infertility in our environment.Key words: Plasma homocysteine, Female infertility, Haematological parameter

Screening for HIV, Hepatitis B, and Chlamydia in Couples Seeking Assisted Reproductive Technology at a Private Health Facility

Background: Infertile couples are increasingly seeking assisted reproductive technology (ART), especially those with tubal factor and male factor infertility. It is important for assisted reproduction centres to have a well-defined protocol for the routine screening of reproductive tract infections based on local prevalence of the diseases or specific considerations. There is paucity of data on the rationale for the screening of HIV, HBV and chlamydia infection among infertile couples seeking ART in Nigeria.Objective: The study is to assess the need for routine screening of infertile couples for HIV, HBV and Chlamydia infections before commencement of treatment.Methods: This is a retrospective, cross-sectional, descriptive study of 321 infertile couples, who sought ART at the Omni Medical Centre during a two-year period. After obtaining consent, the couples were routinely screened for HIV antibody, Hepatitis B surface antigen and chlamydial antibody. The recommended standard immunoassay tests were used for the screening. The couples had pre-test and post-test counselling.Results: Of the 321 infertile couples, 68.8% had secondary infertile. The median duration of infertility was 60 months with a range of 12 to 360 months. The mean age for females was 35.9 ± 6.1 years and for their male partners was 41.7 ± 6.6 years. Overall, the prevalence of HIV, HBV and chlamydia among the couples were 2%, 2.8% and 3.7% respectively.Conclusion: The prevalence rates of HIV, HBV and chlamydial infections were generally low among infertile couples seeking ART. However, routine screening should be offered to infertile couples seeking ART as part of infection control and prevention, and for medico-legal reasons.Keywords: HIV, HBV, Chlamydia, Infertility, Assisted conception, Nigeri