Obstetric and newborn outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women at the university college hospital Ibadan

There remains uncertainty about the impact of HIV on pregnancy outcomes and effects of highly active antiretroviral therapy on fetal development. This study describes obstetric outcomes among HIV positive parturients at the University College Hospital, Ibadan. HIV positive parturients were identified in the birth register. During the 30-month period, 318 of 6203 deliveries were HIV positive (5.1%) with 97.6% record retrieval. The mean age of the HIV positive parturients was 31.66 years (± 4.66); the mean gestational age at delivery was 38.02 weeks (± 2.75) and the mean birth weight 2.85kg (±0.59). There were 35.8% (109) preterm births, 2.9% stillbirths and 21.5% low birth weights. The regimen most commonly (198, 64.5%) used was a non-nucleoside reverse transcriptase (NNRTI) based HAART. Preterm births were similar following spontaneous vaginal delivery (31.5%) and elective section (31%) but higher (41.3%) with emergency section (ñ=0.4).On univariate analysis, the preterm infants had lower mean birth weights (2.46±0.61 vs 2.96±0.44; ñ=0.000). The proportion of preterm births was higher among Low birth weight infants (71.9% vs 28.1%; ñ=0.00). Variables with more preterm births were age >35 years (51.6%), ≤6years of schooling (51.5% vs 48.4%) and being on combination ARV (PI, 37.5% or non-PI, 36.2%). However, these differences did not attain statistical significance. Low birth weight infants had mothers who had higher mean ages (33.28 years ± 4.59 vs 31.28 years ± 4.59, ñ= 0.02), lower mean gestational age at delivery (35.72 weeks ± 3.16 vs 38.49 weeks ± 2.1, ñ= 0.00). Variables with more low birth weight include <12years of schooling and being on mono/ dual therapy (31.8%). These differences were not statistically significant. On logistic regression, factors that retained an association with low birth weight were mean maternal age at delivery (ñ= 0.002; â= 0.904; 95% CI, 0.848 – 0.966) and being on mono/ dual therapy (ñ= 0.039; â= 3.042; 95% CI, 1.055 – 8.768). The only factor that retained an association with preterm birth was mean maternal age at delivery (ñ= 0.015; â= 0.935; 95% CI, 0.886 – 0.987). HIV positive (especially older) women, have high rates of preterm deliveries and low birth weights. The beneficial effects of HAART on mother-to-child transmission are indisputable but monitoring antiretroviral therapy in pregnancy remains a priority and antenatal surveillance should include fetal growth assessment.

De novo domestication of wild tomato using genome editing

Breeding of crops over millennia for yield and productivity1 has led to reduced genetic diversity. As a result, beneficial traits of wild species, such as disease resistance and stress tolerance, have been lost2. We devised a CRISPR–Cas9 genome engineering strategy to combine agronomically desirable traits with useful traits present in wild lines. We report that editing of six loci that are important for yield and productivity in present-day tomato crop lines enabled de novo domestication of wild Solanum pimpinellifolium. Engineered S. pimpinellifolium morphology was altered, together with the size, number and nutritional value of the fruits. Compared with the wild parent, our engineered lines have a threefold increase in fruit size and a tenfold increase in fruit number. Notably, fruit lycopene accumulation is improved by 500% compared with the widely cultivated S. lycopersicum. Our results pave the way for molecular breeding programs to exploit the genetic diversity present in wild plants

Process and outcome measures of quality of care at the diabetes outpatient clinic, University College Hospital, Ibadan

Objective: The study aims to assess the quality of care provided at a diabetes outpatient clinic of a tertiary hospital in Nigeria using quality indicators approved by the National Diabetes Quality Improvement Alliance (NDQIA).Materials and Methods: The medical records of patients who had visited the clinic at least two times within a 12 months period preceding the index visit were reviewed during a 5 month period. Process measure indicators, approved by the NDQIA (evaluating the functioning of the clinic) and outcome measures, published by the American Diabetes Association, (evaluating the health status of the attending patients) were retrieved from the medical records.Results: The 332 records reviewed showed that the most consistently performed process measures were blood pressure and weight measurement (>90%). Foot examination was done infrequently (10.5%). Less than 50% had at least an annual low‑density lipoprotein cholesterol (LDL‑C) and hemoglobin A1c testing done. The mean (standard deviation) HbA1C (%), LDL‑C (mg/dL) systolic blood pressure (SBP) (mmHg), and diastolic blood pressure (DBP) (mmHg) were 7.6 (2.0), 107.3 (31.5), 134.3 (20.8), 79.5 (11.0), respectively. HbA1C >8.0%, LDL‑C >130 mg/dL, SBP >130 mmHg, and DBP >90 mmHg) were observed in 34.8%, 21.1%, 40.4%, and 23.8%, respectively.Conclusion: Although the organization of the outpatient services allowed for good performance with regards to “free” services such as blood pressure and weight measurement, it performed suboptimally for foot examinations. Performance indicators that required payment were consistently underperformed. Regular assessment of the quality of care may help in the identification of opportunities for improvement in the organization and delivery of care.Key words: Diabetes, outpatient, qualit

Sociodemographic characteristic of anaemic gravidae at booking: A preliminary study liesha, Western Nigeria

No Abstract. Nigerian Journal of Medicine Vol. 14(2) 2005: 151-15