Medium-term carbohydrate tolerance improves and then deteriorates with advancing pregnancy in urban Nigerian women

Background: It has been reported that carbohydrate metabolism does not deteriorate in pregnancy in the African, an observation at variance with general teaching. Objective: To determine the effect of pregnancy on medium term carbohydrate metabolism Methods: Medium term carbohydrate metabolism was evaluated in pregnant and non-pregnant Nigerian women using changes in Glycoted Plasma Proteins (GPP) as a surrogate for medium-term carbohydrate metabolism. Study subjects included women in all three trimesters of pregnancy, a group of non-pregnant women with normal carbohydrate metabolism and another group of women with confirmed diabetes already on treatment but not pregnant. Fasting plasma glucose was determined by the glucose oxidase method while GPP was determined using a modification of the thiobarbituric method with correction for levels of total plasma proteins (TPP). Average values are presented as mean (SD) while relationship between variables were determined using Pearson product moment correlation coefficients. Significance of p values of determinations is set at

Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Surgical procedures often lead to both intrinsic and extrinsic infections. In order to improve on recovery of patients, investigations were carried out on samples collected from patients during and after surgery. Laboratory analysis was performed on wound swabs from incision, colon segments, scrapes, tissues, pus and catheter specimen urine. The samples were cultured on MacConkey and Blood agar and incubated aerobically at 370C for 16-24 hours. Thereafter, isolates were identified using standard microbiological methods. Results showed that isolates from wound were also found on endogenous indicators of surgery. Klebsiella species from incision was 15 (18.75%) while those from colon segment was 30(37.6%), scrapes 8(16%) and pus 3(7.5%). Acinetobacter species found on incision was 15(7.5%) and pus 7(2.3%). Pseudomonas species was distributed on incision 5(2.5%), colon segment 4(5%), tissue 3(1.6%), scrapes 5(10%) and pus was 5(12.5%). Staphylococcus aureus which was isolated from incision was 2(1%), while scrapes and pus were 5(10%) and 7(17.5%) respectively. Catheter associated urinary tract infections yielded significant bacteriuria (64.7%), almost twice the rate of non-significant bacteriuria (35.3%); indicating the need to remove all catheters as soon as possible. Antibiogram of isolates of Klebsiella pneumoniae with resistance pattern: ApGnNaNt, Escherichia coli (ApCtNaTtCm) and S. aureus (ApChCxErPn) with plasmid sizes in the range (30.2-52.51Kb) were common to both indicators and wound, showing that the pathogens were the same clusters. This study demonstrated surgical procedures as precursory to intrinsic infections and that bacterial pathogens found on wounds and endogenous indicators of surgery are links to intrinsic infection. The study therefore emphasizes the need to culture wounds promptly to effect speedy recovery of patients who have undergone surgery. Key Words: Bacterial pathogens, Endogenous indicators, NosocomiaI infection, Surger

Formulation studies on the seeds of Ricinus Communis Linn. fam. Euphorbiaceae

Ricinus communis Linn. Family- Euphorbiaceae (castor oil plant) has been used widely as a contraceptive herbal drug in Nigeria, Africa and some countries in the Middle East. The efficacy of the seeds as a contraceptive drug has been confirmed by many scientists working independently in different locations around the world. With adequate information on the efficacy of these seeds, it became necessary to conduct a formulation study in order to develop a suitable and stable dosage form for this drug. The physical and chemical properties of the seeds used locally in Nigeria were determined and did not differ significantly from the properties of R. communis L. described in the African Pharmacopoeia. A total ash of 3.1% and alcohol soluble extractive value of 52.4% were obtained for the seeds while phyto-chemical screening revealed that the seed extract contained steroids and alkaloids. For safety and efficacy, the LD50 was determined and was found to be 13.17g/kg. The formulation studies revealed that 10 %starch mucilage was the best binder for the formulation of the granules while lactose at aconcentration of 75% was the best diluent for the drug. Characterization of the dosage forms produced showed that increases in compression pressure resulted in correspondent increase in the hardness, tensile strength, packing fractions and disintegration time. Administration of the dosage forms to albino rats, showed significant contraceptive activity (80%)

Prenatal Diagnosis: Appraisal Of Awareness And Utlization Among Health Workers In South Western, Nigeria

Objective: To appraise the level of awareness about prenatal diagnosis among health workers in southwestern Nigeria and its utilization. Methodology: Questionnaires were administered to 270% were in randomly selected from private and public health institution in south western Nigeria. Result: The distribution of health workers showed that 6.3.7% were in public and 36.7% were in private health institutions. Generally, majority (55.5%) were aware of prenatal diagnosis. Only 95 (35.2%) respondents were aware of the existence of a prenatal diagnosis unit in Nigeria. The present level of awareness was considered inadequate by 195 (72.2)% respondents. Major ways of improving the awareness and utilization were through its incorporation into undergraduate training curriculum (31.5%) and academic programme (23.1%). Majority (78.2%) of health workers have never referred patients for prenatal diagnosis in Nigeria. Low level of awareness (48.0%) and high cost of service (28.0%) were the constraints most frequently identified. Conclusion: The awareness of prenatal diagnosis among health workers in south western Nigeria is grossly inadequate. Similarly, its utilization is poor. Ways of improving on this is suggested. KEY WORDS: Prenatal diagnosis (PND), awareness, utilization Nigerian Journal of Clinical Practice Vol.6(1) 2003: 46-4

The Association Between Cancer Of The Breast And The Abo And Rhesus D Antigen Phenotypes In Lagos, Nigeria; A Case-Control Study

Objective: To determine whether inheritance of ABO and Rhesus D antigen phenotypes constitute a risk factor for development of cancer of the breast. Design: A case-control study. Setting: Patients with histologically diagnosed cancer of the breast referred to Radiotherapy department of the Lagos University Teaching Hospital over a six-month period were included in the study (cases). Healthy blood donors at the Donors Clinic of the hospital over the same period of time were also studied (Control A). Women attending family planning clinic were also studied and referred to as Control B. Materials & Methods: Routine ABO and Rhesus D-phenotyping was carried out on washed red cell specimens of all cases and controls. The odds that cancer of the breast was due to presence of a given phenotype were determined (odds of cases). The odds that the given phenotype is present in the normal population without cancer of breast was also determined (odds of control). The Odds Ratio (OR) given by odds of cases/odds of control served as an estimate of the Relative Risk (RR) that the given phenotype is associated with the cancer of the breast. Result: 107 cases, 2.243 controls A and 122 controls B were studied. Of the cases, only one was a male, the others were females. Their ages ranged between 24 and 85 years with a median of 45 years. The controls A were all males with ages ranging between 22 and 55 years. Controls B were females with ages ranging between 21 and 47 years. A,B,O, AB, Rhesus D positive and Rhesus D negative phenotype distribution amongst the cases, controls. A and B were 28,22,54,3,97 and 10,589,440,1143,71,2142 and 101,27,25,70,.0,117 and 5 respectively. Of all the phenotypes, only the inheritance of Rhesus D antigen gave a relative risk (RR) significantly below unity. RR=0.45. Standard error=0.76 and p. 0.05 when cases were compared with control B. Conclusion: Negative association was established between inheritance of Rhesus D antigen and the development of cancer of the breast. Rhesus D antigen phenotype may be protective against cancer of the breast. KEYWORDS; ABO Blood group, Rhesus D blood group, relative risk, attributable risk, Absolute risk. Carcinoma of the Breast. Nigerian Journal of Clinical Practice Vol.5(2) 2002: 81-8

Lung ultrasound for detection of pulmonary complications in critically ill obstetric patients in a resource-limited setting

Critically ill parturients have an increased risk of developing pulmonary complications. Lung ultrasound (LUS) could be effective in addressing the cause of respiratory distress in resource-limited settings with high maternal mortality. We aimed to determine the frequency, timing of appearance, and type of pulmonary complications in critically ill parturients in an obstetric unit in Sierra Leone. In this prospective observational study, LUS examinations were performed on admission, after 24 and 48 hours, and in case of respiratory deterioration. Primary endpoint was the proportion of parturients with one or more pulmonary complications, stratified for the presence of respiratory distress. Secondary endpoints included timing and types of complications, and their association with "poor outcome," defined as a composite of transfer for escalation of care or death. Of 166 patients enrolled, 35 patients (21% [95% CI: 15-28]) had one or more pulmonary complications, the majority diagnosed on admission. Acute respiratory distress syndrome (period prevalence 4%) and hydrostatic pulmonary edema (4%) were only observed in patients with respiratory distress. Pneumonia (2%), atelectasis (10%), and pleural effusion (7%) were present, irrespective of respiratory distress. When ultrasound excluded pulmonary complications, respiratory distress was related to anemia or metabolic acidosis. Pulmonary complications were associated with an increased risk of poor outcome (odds ratio: 5.0; 95% CI: 1.7-14.6; <i>P</i> = 0.003). In critically ill parturients in a resource-limited obstetric unit, LUS contributed to address the cause of respiratory distress by identifying or excluding pulmonary complications. These were associated with a poor outcome