Relationship between glucose homeostatic disorders and testosterone in adult Nigerian women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is associated with hyperandrogenemia which is hypothesized to induce glucose homeostastic disorders among women with the syndrome. This study was thereby set to investigate the status of glucose homeostatic disorders and their relationship with testosterone among women with PCOS in Port Harcourt, Nigeria.Methods: This was a retrospective study of 224 women with PCOS who had visited a tertiary hospital in Nigeria over a 10-year period. The laboratory characteristics of these patients were evaluated. Records on age, fasting plasma glucose (FPG) and serum total testosterone (TT) were collected and analyzed using Shapiro-Wilk, descriptive, chi-square, Fisher’s exact, two-way analysis of variance, and Pearson’s tests. A p-value <0.05 was considered significant.Results: Glucose homeostatic disorders were documented in 49.1% of the study population. Impaired fasting glucose (IFG) and diabetes mellitus (DM) was observed among 37.5% and 11.6% of the study population respectively. There was difference in the mean TT levels among those with normal FPG, IFG, and DM (P<0.001). Those with DM had higher TT levels (2.47 ± 0.83 nmol/l) than those with IFG (2.12 ± 0.63 nmol/l) and normal glucose homeostatic status (1.63 ± 0.47 nmol/l). TT correlated positively with FPG among the overall study population (r=0.465; p-value = < 0.001), among those with IFG (r = 0.591; p-value=0.004), and among those with DM (r=0.404; p-value =0.012).Conclusions: Glucose homeostatic disorders are common among PCOS patients in our environment, especially among those with higher testosterone levels. This warrants screening of all PCOS patients for glucose disorders as part of their management strategies

Helminthiasis in pregnancy in the Niger - Delta Region of Nigeria

Background: Helminthic infestations during pregnancy have significant public health implications. This study seeks to determine the prevalence of intestinal helminths among pregnant women in the Niger Delta Region in Nigeria and to identify possible predisposing factors.Methods: Pregnant women attending antenatal clinics were randomly selected in 6 health facilities. Stool and blood samples were collected from each woman. The stool sample was examined for ova and cyst of parasites while blood samples were analyzed for eosinophil count and packed cell volume. Proforma designed for the purpose was used to obtain sociodemographic information. Students t-test was used to test relationship between variables with a p value &lt;0.05 considered statistically significant.Results: The mean age of the patients was 27.9±5.2 years and the mean gestational age was 27.635±.4 weeks. The overall prevalence of helminthiasis in pregnancy was 91 (22. 7%), with Ascaris lumbricoides and hookworm being the most predominant at 9. 7% and 8.2% respectively. The highest prevalence per health facility was in Emohua, a rural community with a prevalence of 48.5% and the least was at the University of Port Harcourt Teaching  Hospital with a prevalence of 17.8%. There were significant association of helminthiasis with eosinophilia, anaemia, clay (nzu) eating, socioeconomic class, and source of water.Conclusion: The prevalence of helminthiasis in pregnancy is high in the Niger delta region. It is associated with the lower socioeconomic class. Introduction of routine stool analysis and use of antihelminthic in pregnancy will help to reduce associated morbidity from intestinal helminth.Keywords: Helminthiasis; Pregnancy; Eosinophil Count; Anaemia; Nigeri

The impact of BMI on the plasma glucose and lipid status of women with polycystic ovary syndrome

Background: BMI status is theorized to impact on the plasma glucose and lipid parameters of women with polycystic ovary syndrome. Hence, this study was instituted to investigate this theory among women with polycystic ovary syndrome in Port Harcourt, Nigeria.Methods: Medical records of 231 women with PCOS visiting a tertiary health center over a consecutive 10-year period were retrospectively acquired and analyzed. The obtained records were age, weight, height, calculated BMI, fasting plasma glucose and lipid profile (total cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein). The records were analyzed using Shapiro-Wilk, descriptive, chi-square, two-way analysis of variance, and Pearson’s tests. A two-tailed p-value of <0.05 was considered significant.Results: Overweight and obesity was recorded among 33.3% and 45.5% of the study cohorts respectively. The obese cohorts had higher plasma levels and abnormal frequency of fasting glucose (<0.001), total cholesterol (<0.001), triglycerides (<0.001), high-density lipoprotein (<0.001) and low-density lipoprotein (<0.001) status than the normal weight and overweight cohorts. BMI correlated weakly with glucose (r=0.259; p = 0.003), inversely but weakly with high-density lipoprotein (r: -0.373 p<0.001) and weakly with triglycerides (r=0.316; p<0.001) among overweight cohorts. BMI correlated strongly with fasting glucose (r=0.578; p< 0.001), strongly with total cholesterol (r=0.840; p<0.001), moderately but inversely with high-density (r=-0.490; p=0.004), strongly with triglycerides (r=0.753; p<0.001) and strongly with low-density lipoprotein (r=0.759; p<0.001) among the obese cohorts.Conclusions: Abnormal plasma glucose and lipid parameters seem to be prevalent among obese PCOS patients. Therefore, weight reduction should be a therapeutic target during their treatment

Pattern of dyslipidemia among adult women with polycystic ovary syndrome in Port Harcourt, Nigeria

Background: Dyslipidemia is adjudged the most common metabolic disorder observed among women with polycystic ovary syndrome (PCOS). However, there is paucity of data to support this hypothesis in our region. Therefore, this study was structured to evaluate the pattern of dyslipidemia among women with PCOS in Port Harcourt, Nigeria.Methods: This was a retrospective study of 226 adult women with PCOS who had visited the Department of Chemical Pathology and Metabolic Medicine of a tertiary hospital in Nigeria over a 10-year period (1st January 2008 to 31st December 2017), aimed to evaluate the pattern of dyslipidemia in these women. Records on age, total cholesterol (Tc), triglycerides (Tg), high-density lipoprotein (HDL-c), and low-density lipoprotein (LDL-c) were collected and analyzed using Shapiro-Wilk, descriptive, chi-square, and Fisher’s exact statistics. Statistical significance was set at 0.05.Results: The mean age of the study population was 28.40 ± 5.75 and ranged from 18 - 42 years. Most of the study population (55.3%) were within the age group of 20 – 30 years. The most common lipid abnormalities observed among the study population were increased triglycerides (75.7%) and decreased HDL-c (61.1%) concentrations while the least was increased total cholesterol (17.7%) and LDL-c (14.5%). Dyslipidemia was observed in 80.1% of the study population and more frequent (51.9%) within the age group of 20-30 years.Conclusions: Dyslipidemia is common among young adult women with PCOS. Regular assessment for dyslipidemia should be mandatory in PCOS to mitigate the long-term consequences of its complications

Admission cardiotocography versus Doppler auscultation of fetal heart in high risk pregnancies in a tertiary health facility in Nigeria

Background: Admission cardiotocography (CTG) and intermittent auscultation (IA) of the fetal heart  might help to identify those foetuses that could not withstand the stress of labour and also predict neonatal outcome. The aim was to compare the associations of admission CTG findings and those of IA of the fetal heart with labour and neonatal outcome.Methods: It was a prospective COHORT study. 30 minutes admission CTG for each of the 387 participants was interpreted, using the FIGO 2015 guideline and physiological interpretation. Admission IA was also performed on the same patients. Women whose CTG showed chronic hypoxia had caesarean section while those with either suspicious or pathological CTG, had intrapartum fetal resuscitation. Those that responded proceeded to labour during which fetal condition was monitored with IA. Data was analysed using a statistical package for social science (SPSS) software, version 19.Results: 108 (28.57%) and 57 (15.08%) of the 378 participants had abnormal admission CTG and admission IA findings respectively. The sensitivity of abnormal admission CTG and IA to predict abnormal IA findings in labour were 70.59% and 41.18% respectively. Compared with admission IA, admission CTG was more likely to predict the following labour and neonatal outcomes: caesarean section rates 72 (70.59%) and 42 (41.18%) for admission CTG versus IA groups respectively; relative risk RR=1.714; 95% CI 1.317-2.231, 1 min Apgar score less than 7, 78 (89.66%) and 36 (41.38%); RR=2.167; 95% CI 1.670-2.810, 5 min Apgar score less than 7, 57 (90.48%) and 33 (52.38%); RR=1.727; 95% CI 1.347-2.215, admission to SCBU 51 (68%) and 30 (40%); RR=1.700; 95% CI 1.237-2.336, intrauterine fetal deaths and early neonatal death.Conclusions: Admission CTG was a better predictor of labour and neonatal outcome than admission IA. CTG was therefore highly recommended as an integral tool in the management of labour

Intermittent auscultation in obstetric practice in tertiary health facilities in Nigeria. Are we doing it correctly?

Background: Intermittent auscultation (IA) was the main method of foetal monitoring in Nigeria, with the pinard stethoscope more in use than the hand-held Doppler. Aim of the study to produce a guideline on IA, conduct an audit on its use and to give a recommendation for future practice. Methods: A mixed-method design-observational-descriptive, review and an audit carried out in tertiary centres in Rivers State, Nigeria. The WHO 2018, FIGO 2015 and other guidelines on IA were reviewed. Good practice points were extracted from the literatures and used to produce a guideline. 17 review criteria for the audit were chosen from the guideline and used to test 150 doctors, midwives and nurses. Data were analysed with Epi. info 2020. Results: A guideline on IA was created. Out of the 150 participants, correct answers to the questions were given as follows: foetal movements over the preceding 24 hours before IA,  determination of  foetal lie, assessment of presentation and position before IA and identification of point of application of foetal stethoscope on maternal abdomen by 121 (80.67%), 17 (11.33%) and 34 (22.67%) respectively; frequency of IA in the antenatal period, duration of IA and maternal pulse palpation during IA for 13-98 (8.67-65.33%), 121 (80%) and 0 (0%) respectively; in labour, questions on timing of IA, ruling out hypoxia in early labour,  determination of the baseline FHR  and recording of the findings on IA for 61-130 (40.67-86.67%); interval and duration of IA and management of abnormal findings in the antenatal period and in labour, interval and duration of IA at 2-18 (1.33-12%).Conclusions: The performance of IA by obstetric practitioners was poor; that may account for some of the wrong management plan in the antenatal and intra-partum periods. A quarterly or yearly drills on IA were therefore recommended.

Primary postpartum haemorrhage at the university of Port Harcourt teaching hospital: Prevalence and risk factors

Background: Postpartum haemorrhage (PPH) is a leading global cause of severe maternal morbidity and mortality. Approximately 14 million women suffer postpartum haemorrhage annually and at least 128,000 of these women bleed to death. Most of these deaths, which occur within four hours of delivery and are as a result of problems during the third stage of labour. Majority of PPH related deaths occur in developing countries of the world where facilities are poorly developed in addition to a paucity of trained attendants at delivery. The objective of this study was to determine the prevalence, risk factors, causes and outcome of primary postpartum haemorrhage at the University of Port Harcourt Teaching Hospital (UPTH), south-South, Nigeria.Method: This was a retrospective study of all consecutive births between January 1st and December 31st, 2014 at UPTH. The socio-demographic characteristics, mode of delivery, cause of primary postpartum haemorrhage, antenatal/ intrapartum risk factors, treatment received and outcome were extracted from the patients' case notes, entered into SPSS version 20.0 and analysed.Results: Of the 8,694 women who were delivered at the maternity unit of UPTH, 178 had  primary postpartumhaemorrhage giving a prevalencerateof 4.28%. Uterine atony was the leading cause and delivery by Caesarean section was the leading risk factor. There were 5 mortalities from primary postpartum haemorrhage.Conclusion: The prevalence of primary postpartum haemorrhage in UPTH is 4.28%. Uterine atony was the leading cause while Caesarean section was the commonest risk factor. Efforts should therefore, be made to reduce the caesarean section rate and improve surgical skills aimed at reducing blood loss at surgery.Keywords: Post-PartumHaemorrhage; Maternal Morbidity Mortality; Uterine Atony; Caesarean Sectio

Risk assessment and thromboprophylaxis for venous thromboembolism in the puerperium in a tertiary health facility in Nigeria

Background: Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality in the puerperium. Unfortunately in Nigerian tertiary institutions, there is paucity of information about its risk factors, screening for it, and its prophylaxis. The aim of the study therefore was to review the VTE risk and thromboprophylaxis in the puerperium at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria.Methods: A retrospective cross-sectional study carried out at the University of Port Harcourt Teaching Hospital (UPTH). The following data were extracted from the notes of 424 consecutive inpatients postnatal women who delivered from the 1st of January to the 30th of April 2020: history/demographic characteristics, risk factors for VTE using the RCOG Green top guideline No. 37a.of 2015 as a benchmark, thromboprophylaxis, diagnosis and treatment of VTE. Women with a VTE event in the preceding 4 months before pregnancy were excluded. Data was analysed using a statistical package for social science (SPSS) software, version 18.Results: Risk assessment for VTE and its prophylaxis in the puerperium were not routine practice at the UPTH. 420 (99.06%) out of the total 424 postpartum women that were assessed were at significant risk of developing VTE and therefore needed to be on thromboprophylaxis with low molecular weight heparin. Irrespective of the high prevalence of risk factors and the fact that 100 (23.58%) of the patients had symptoms and signs of VTE, no case of VTE was recorded in the study population. Paucity of information and lack of knowledge about the diseases may be responsible for that.Conclusions: 420 (99.06%) out of the total 424 puerperal women were at significant risk of developing VTE and therefore needed to be on thromboprophylaxis in the puerperium. It was therefore recommended that a national guideline on VTE in the puerperium be written, taking into consideration local disease topography, ethnic diversity and the level of economic development in Nigeria

Evaluation of reproductive profile in male albino rats following varied duration of administration with Revive capsule

Background: Revive capsule is a polyherbal formulation commonly used to treat erectile dysfunction or enhance libido in men. Some of the individual herbs used in the formulation of this drug have been known scientifically to affect various biochemical components of the human body; hence this study was aimed at evaluating the reproductive profile in male albino rats following varied duration of administration with Revive capsule.  Methods: A total of 42 male albino rats were used for the study, and were divided into six (6) groups of seven (7) rats each. They were allowed to acclimatize for two (2) weeks by maintaining 12-hour light and dark cycles daily, with access to standard feed and water ad libitum. Group A (negative control) rats were administered with distilled water once daily, while groups B, C, D, E and F were administered once daily with 72 mg/kg of Revive capsule for 1 week, 2 weeks, 3 weeks, 4 weeks and 6 weeks respectively. The rat dose administered was extrapolated from the human dose using the formula by Paget and Barnes. At the end of each treatment week, the rats were allowed to fast overnight, followed by their anaesthetization using chloroform, and blood sample collection via jugular vein puncture. Also, the testes were excised; the epididymis were also excised from the testes and used immediately for semen analysis, while the epididymis-free testes were examined histologically. Rat-specific test kits with ELISA method were used to analyze serum LH, FSH and testosterone.Results: The results showed a significant increase (p<0.05) in serum LH, FSH and testosterone levels, and a significant increase in sperm count and sperm quality parameters in the treatment groups compared to the negative control, with the maximum levels attained after 6 weeks of treatment (group F). Also, photomicrographs of histologically examined testes of the treatment groups appeared indifferent from those of the negative control.Conclusions: These findings may suggest that in using a rat model, treatment with Revive capsule at the appropriate dosage for 6 weeks is safe, and that, besides its acclaimed use in enhancing libido or treating erectile dysfunction, it may also be effective in promoting male fertility.