Thyroid autoimmunity and early pregnancy loss in Jos, Nigeria

Background: Early pregnancy loss is a challenging experience for both the patient and the physician; it is unfortunately a common complication of human gestation. Early pregnancy loss is defined as the termination of pregnancy before 20 weeks of gestation or with a fetal weight of <500 g. Immunological disorders have been attributed to early pregnancy loss in addition to chromosomal abnormalities. Thyroid autoimmunity is one of the immunological causes of early pregnancy loss that has been poorly studied in sub‑Saharan Africa.Objective: This study was aimed at determining the relationship between early pregnancy loss and thyroid autoimmunity in Jos, North‑Central Nigeria.Patients and Methods: This was a case‑control study involving 44 women with a current history of miscarriage at an average gestational age of 11.57 ± 4.3 weeks (cases) and 44 pregnant women with previous history of delivery with no history of miscarriage(s) at a mean gestational age of 17.9 ± 4.9 weeks (controls). Serum thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) were assayed by Electro‑chemiluminescence immunoassay (ECLIA) using Cobas e411 auto analyzer (by Roche). The data obtained were analyzed using SPSS version 16.0.Results: TgAb was neither present in the cases nor in the control group. The prevalence for TPOAb was 11.4% for the cases and 4.5% for the controls. The difference in proportion was not statistically significant (P = 0.434).Conclusion: There was no statistically significant relationship between thyroid autoimmunity and early pregnancy loss.Keywords: Autoimmunity; pregnancy loss; thyroi

High-risk human papilloma virus and cervical abnormalities in HIV-infected women with normal cervical cytology

Background: The prevalence of High-Risk Human papilloma virus (HR-HPV), a necessary cause of invasive cervical cancer (ICC) is relatively high in HIV infected women. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) particularly in settings of HIV infection. Methods: Between May 2012 and June 2013 we conducted a colposcopic assessment of HIV-infected women with prior (NCC) and known HR-HPV status to compare cervical abnormalities in women with and without HR-HPV. Colposcopic examinations were done at the Operation Stop Cervical Cancer (OSCC) unit of the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Abnormal colposcopic finding (ACF) was defined as areas of aceto-white epithelium involving the squamo-coulumnar junction, areas of punctation, mosaic pattern or atypical vessels. We compared proportions of ACF as well as histologic grades of cervical intra-epithelial neoplasia (CIN) in women with or without HR-HPV. Statistical analysis was done on STATA. Results: We conducted colposcopic examinations in 78 out of 89 (86.5%) eligible women. The mean age of the cohort was 32.4 years (SD ±4.6) with a median 32 years (IQR 29–36). After a mean follow up time of 20.1 months from the initial cervical pap cytology and HR-HPV testing, we found 12 of 78 (15.4%) women with ACF. The odds for an ACF was statistically higher [OR = 4.0 (95% CI: 1.1-14.7)] in women with HR-HPV compared to those without. Of the twelve women with ACF, subsequent histologic examination of colposcopically directed cervical biopsies confirmed CIN 1 in 4 cases (33.3%), CIN 2 in 1 case (8.3%), CIN 3 in 2 cases (16.7%), carcinoma-in-situ (CIS) in 2 cases (16.7%), and normal cervix in 3 (25.0%). Overall, the proportion of women detected with any grade of CIN was 11.5% (9/78) and 6.4% (5/78) were CIN 2 or greater lesion (CIN2+). Conclusion: HIV-infected women with NCC and HR-HPV had a four-fold higher likelihood for an ACF. The practice of early colposcopic examination of HIV-infected women with prior NCC and HR-HPV may increase early detection of higher grade CIN and CIS cancer stages in our setting

Widespread sampling biases in herbaria revealed from large-scale digitization

SUMMARY 1. Non-random collecting practices may bias conclusions drawn from analyses of herbarium records. Recent efforts to fully digitize and mobilize regional floras online offer a timely opportunity to assess commonalities and differences in herbarium sampling biases. 2. We determined spatial, temporal, trait, phylogenetic, and collector biases in ~5 million herbarium records, representing three of the most complete digitized floras of the world: Australia (AU), South Africa (SA), and New England, USA (NE). 3. We identified numerous shared and unique biases among these regions. Shared biases included specimens i) collected close to roads and herbaria; ii) collected more frequently during biological spring and summer; iii) of threatened species collected less frequently; and iv) of close relatives collected in similar numbers. Regional differences included i) over-representation of graminoids in SA and AU and of annuals in AU; and ii) peak collection during the 1910s in NE, 1980s in SA, and 1990s in AU. Finally, in all regions, a disproportionately large percentage of specimens were collected by very few individuals. We hypothesize that these mega-collectors, and along with their associated preferences and idiosyncrasies, shaped patterns of collection bias via ‘founder effects’. 4. Studies using herbarium collections should account for sampling biases, and future collecting efforts should avoid compounding these biases to the extent possible.Organismic and Evolutionary Biolog

Contribution of direct obstetric complications to maternal deaths in Makurdi, North-Central Nigeria

Context: The Federal Medical Centre Makurdi is the only tertiary health institution in Benue State. Maternal deaths are a frequent occurrence in the centre thereby necessitating this study. Objective: To determine the maternal mortality ratio, the case fatality rate and the contribution of direct obstetric complications to these deaths. Subjects and Methods: A four month descriptive study of obstetric service data from 1 January to 30 April 2004.Results: During the study period, there were a total of 363 deliveries (52% unbooked, 48% booked, 20% DOC.) and 16 maternal deaths (94% were direct) giving a maternal mortality ratio of 4 408 / 100 000 deliveries.14 (87.5%) of the deaths were unbooked obstetric emergencies. The overall case fatality rate (CFR) was 21%. The contribution of each direct obstetric complication to the direct maternal deaths was as follows: obstructed labour/ ruptured uterus (53.3 %), postpartum haemorrhage (13.35%), puerperal sepsis (13.35 %), Eclampsia (6. 68 %), induced Abortion (6.68 %). The cause- specific CFR was in this order. Ruptured uterus 100%, Puerperal sepsis 100%, Abortion 25%, severe Preeclampsia/Eclampsia 20%, Obstetric haemorrhage 12.5%, obstructed labour 11.4%. The caesarean section rate was 15 %. Facilities to provide life saving functions were lacking and staff commitment was low. Conclusion: Urgent emergency obstetric care training of residents and provision of parenteral antibiotics, anticonvulsants, oxytocics and safe blood for transfusion is recommended. Keywords: maternal mortality, direct obstetric complications, Nigeria Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 22: 37-3

Elective caesarean sections at the Jos University Teaching Hospital

Context: Elective caesarean sections have been pronounced safer for both mother and fetus compared with emergency caesarean sections. Emergency caesarean sections however have continued to constitute the lion share of caesarean sections in our facility. Objective: To determine the caesarean section rate, examine the trend of elective caesarean sections and the indications for elective caesarean sections amongst our patients. Methodology: This was a retrospective study of the clinical records of all patients that had caesarean section in Jos Nigeria from January 1985 to December 2002, an 18-year period. Data on the number and type of caesarean section, age of patients and the indication for the elective caesarean section were extracted and analyzed. Results: A total number of 41 470 deliveries were conducted within the period of study. Out of these deliveries, 6 557 were caesarean sections giving a caesarean section rate of 15.8%. Elective caesarean sections were performed in 970 (14.8%), and emergency caesarean sections in 5 587 (85.2%) of all the caesarean sections. The rate of elective caesarean section increased from 8.9% in 1985-1986 to a rate of 22.5% in the last two years of the study period. Repeat caesarean section was the commonest indication for elective caesarean sections in 51.9% of the cases, followed by bad obstetric history (BOH) in 10.8%. Conclusions: Elective caesarean section accounted for 1 out of every 6 caesarean sections in the center. The commonest single indication for the elective caesarean section was repeat caesarean section for 2 or more previous caesarean sections. Keywords: elective, emergency, caesarean section, Nigeria Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 39-4

Seroprevalence of rubella virus infection in women with recurrent miscarriage: a case control study in Jos, Nigeria

Background: Recurrent pregnancy loss is an emotionally and physically tasking situation for couples, especially in developing countries where lack of children is a cultural taboo. Rubella infection in early conception has a 90% probability of developing congenital rubella  syndrome (CRS) or miscarriage. The aim of this study was to compare the seroprevalence of rubella virus infection in women with and without recurrent miscarriage. Methods: It was a hospital based case control study. Sampling was done by purposive. Subjects were recruited consecutively until the  required number was reached. Control subjects were selected by simple random sampling. Healthy postnatal women who consented for the study were asked to pick a piece of paper from a covered container, those who picked yes were then recruited. A semi structured researcher administered questionnaire was used to collect data. Enzyme-Linked Immunosorbent Assay (ELISA) was used to check for rubella specific IgG and IgM. We compared the prevalence of rubella virus infection in cases and controls by Chi-square analysis. A p-value < 0.05 was considered significant. Results: The overall mean age of the participants was 30.62±3.60 years. None of the participants had received rubella virus vaccination. The seroprevalence rates of rubella IgG and IgM among the cases were 85% and 16.7%, while in the controls were 80% and 13.3%. The prevalence of Primary + + rubella infection (IgG IgM ) was 10 (16.7%) and 8 (13.3%) among the cases and the controls respectively. Rubella virus + - seropositivity (IgG IgM ) was 68.3% among cases versus 66.7% - - among controls, and rubella virus seronegativity (IgGIgM) was 15.0% and 20.0% among cases and control respectively. Conclusion: The high seroprevalence of rubella virus infection observed in this study suggest that majority of women in our setting are exposed to rubella virus infection before pregnancy. There was no significant difference in the seroprevalence of rubella virus infection between women with and those without a history of recurrent miscarriage

Women\u27s experiences of unwanted pregnancy and induced abortion in Nigeria

A population-based study was conducted to determine the prevalence and pattern of abortion use among women in two communities of Nigeria. The results show a high frequency of reports of unwanted pregnancy and induced abortion among the women. Furthermore they suggest that detailed information can be obtained on abortion in areas with restrictive laws if a sensitive approach to interviewing is adopted. The results presented in this report have implications as the Nigerian government begins designing a set of realistic policies and programs to address the high rate of morbidity and mortality associated with induced abortion in that country. The report includes policy recommendations based on the findings presented

Labour outcome in patients admitted in the second stage of labour at Jos University Teaching Hospital, Jos, Nigeria

Context: Unsupervised or poorly monitored labour is associated with increased maternal and neonatal complications. Late presentation in labour is common place in this part of the world. Objective: To determine the reasons for coming in second stage of labour and compare the labour outcome with those admitted in the first stage of labour. Materials and Methods: This was a case control study conducted at the Jos University Teaching Hospital between September and November 2012. Results: Of the 617 total deliveries, 156 (25.3%) were admitted in second stage of labour. Majority of women (38.57%), (10.00%), (8.57%) stated transportation difficulties, fast progress of labour and husband not around respectively as the reason for coming in second stage of labour. Maternal complications like lower genital laceration (25.7% vs 8.6%), postpartum haemorrhage (7.1% vs 2.1%), and ruptured uterus (2.1%) were more common amongst the cases than the control. The total mean blood loss was similar in both groups. Complications of sickle cell crises, eclampsia, and anaemia including chorioamnionitis were found only among the cases. There were more spontaneous vagina deliveries amongst the cases while caesarean section and use of episiotomy were more amongst the control (P < 0.01). Instrumental delivery was similar in the two groups. Perinatal complications like fresh stillbirths (5.0%), early neonatal deaths (2.10%), birth asphyxia (5.4% vs 3.6%) and the need for admissions in special care baby unit (3.4% vs 0.7%) were more amongst the cases than the control. Conclusions: This study identified transportation problems, fast progress of labour, absence of husband at home when labour starts as major reasons for presenting in second stage of labour. Presenting in second stage of labour was associated with worse labour outcome