Ectopic Pregnancy: Reasons for The High Tubal Rupture Rates In A Nigerian Population

Context: Nigeria has a high incidence of ruptured ectopic pregnancy. Identification of predisposing factors will help reduce morbidity and mortalityAim: To determine the reasons for the high incidence of ruptured ectopic pregnancy.Methods: All cases of ectopic pregnancies managed at Wesley Guild Hospital, Ilesha, Nigeria, between January 2004 and December 2008 were the subjects of this study. The case notes were reviewed to obtain information on the socio demographic characteristics of the patients, clinical history and operative findings.Results: Of the 1,048 gynaecological admissions during the study period 98(9.4%) were for ectopic pregnancy out of which76 (96.2%) were ruptured The mean age of the patients was 28.3 years (SD=5.1), majority (82.3%) were married and 68.4% have had one or more previous deliveries. Amenorrhea was present in 66(83.5%). Abdominal pain (98.%), dizziness (62.0%) and vaginal bleeding (44.3%) were the commonest symptoms. Only 30(38.0%) presented to any medical facility within 24 hours of onset symptom. The ectopic was tubal in 67(84.8%), abdominal in one and could not be specified in 11. Of the tubal pregnancies ampulla (49.3%), cornual (25.4%) and Isthmus (15..0%) were the commonest sites. All patients had laparotomy and salpingectomy. There was no maternal death.Conclusion: - In our community ectopic pregnancy tends to occur more often in parous women and are more commonly located in the isthmio cornual part of the tube. Besides, majority of our women present late making them more vulnerable to ruptured ectopic pregnancy.  Key Words: Ectopic, Pregnancy, Complications, Presentation

Application of a rule-based knowledge system using CLIPS for the taxonomy of selected Opuntia species

A rule based knowledge system was developed in CLIPS (C Language Integrated Production System) for identifying Opuntia species in the family Cactaceae, which contains approx. 1500 different species. This botanist expert tool system is capable of identifying selected Opuntia plants from the family level down to the species level when given some basic characteristics of the plants. Many plants are becoming of increasing importance because of their nutrition and human health potential, especially in the treatment of diabetes mellitus. The expert tool system described can be extremely useful in an unequivocal identification of many useful Opuntia species

Morbidity and mortality due to induced abortions: A 5-year review of cases in a Nigerian Teaching Hospital

Context: - There is evidence that doctors now perform a high proportion of induced abortions in Nigeria. There is therefore a need to assess the current status of morbidity from induced abortionAim: To determine the socio-demographic characteristics of patients with complications of induced abortions, type of complications and outcome of care.Methods: all cases of complications of induced abortions admitted at the Wesley Guild Hospital, Ilesha Nigeria between January 2004 and December 2008 were the subjects of this study. The case notes of the patients werereviewed to obtain information on the socio demographic characteristics of the patients, contraceptive usage, type of complications, and the outcome of care.Results: There were 1,048 gynaecological admissions during the study period with 84(8.0%) admitted for complications of induced abortions. The mean age of the patients was 23.0 years, 56.8% were single nulliparouswomen and 47.1% were students. The gestational age at abortion ranged between 4 and 16 weeks with a mean of 9.9 weeks ( SD=3.6). The abortion was carried out in private health institutions in 81.1% of cases. Retained product of conception(85.4 %) ,sepsis (55.4%) and haemorrhage (35.1%) were the most common complications. There were 3 maternal deaths, given a case fatality rate of 4.1%, and 13.Conclusion: The pattern of complication of induced abortion has changed with a reduction in the proportion of patients with sepsis and the case fatality.Key Words: Induced Abortions; Socio-demographic characteristics, complications, morbidity; mortalit

Audit of stillbirths in a Nigerian teaching hospital Kuti

Objective: The purpose of this study is to classify the stillbirths (SBs) in our institution and to determine the avoidable contributors using a pro forma that was developed in our perinatal unit.Materials and Method: All mothers who delivered SBs at Obafemi Awolowo University Hospitals Complex Ile‑Ife, Nigeria, from April 2014 to August 2015 were the subjects of this study. At our weekly perinatal mortality meeting, every SB was reviewed in detail to determine the cause of death and identify gaps in the care. The causes of fetal death were classified using three classification systems – Simplified CODAC, ReCoDe, and our newly developed Ife Perinatal Death Classification System. Remote contributors to fetal demise were assigned using a purpose–designed “Avoidable Factor Proforma” A SB was deemed avoidable if one or more factors were identified.Results: The total number of deliveries during the study was 2,142 with 109 SBs giving a gross SB rate of 51/1000 total births. The SB rate was significantly lower among booked patients than their unbooked counterparts (15 vs. 140 per 1000; P < 0.005). Antepartum death constituted 82.6% of SB among booked patients compared to 41.2% in the unbooked. The most common cause of SB among booked mother was intrauterine growth restriction (21.7%) while obstructed labor (23.3%) was the leading cause among unbooked mothers. Using our classification system, only 3.8% of SBs were unexplained, as against 5.7% for ReCode, and 26.4% for Simplified CODAC. Majority (81.7%) of the SBs were avoidable; and the most common avoidable factor was deficiency in health care. Access to the point of care was not associated with any of the avoidable deaths.Conclusion: Our SB rate remains unacceptably high, with a preponderance of antepartum deaths among booked patients. Majority of the SBs are avoidable dictating the need for training in modern methods of fetal surveillance and improved efficiency of our health‑delivery systems.Keywords: Avoidable Factors , Classification,. Stillbirth

An Optical Characterization of the Effect of High-Pressure Hydrodynamic Cavitation on Diesel

Most modern high-pressure common rail diesel fuel injection systems employ an internal pressure equalization system in order to provide the force necessary to support needle lift, enabling precise control of the injected fuel mass. This results in the return of a substantial proportion of the high-pressure diesel back to the fuel tank. The diesel fuel flow occurring in the injector spill passages is expected to be a cavitating flow, which is known to promote fuel ageing. The cavitation of diesel promotes nano-particle formation through induced pyrolysis and oxidation, which may result in deposit formation in the vehicle fuel system. A purpose-built high-pressure cavitation flow rig has been employed to investigate the stability of unadditised crude-oil derived diesel and a paraffin-blend model diesel, which were subjected to continuous hydrodynamic cavitation flow across a single-hole research diesel nozzle. Continuous in-situ spectral optical extinction (405 nm) has been employed to identify, determine and measure variations in fuel composition as a function of the cavitation duration. The results of two high-pressure diesel cavitation experiments are reported. The first dealt with the effect of injection pressure on the rate of induced variation in chemical composition of diesel, and concluded that faster degradation of the fuel occurred at higher pressure. The second experiment involved an investigation into the variation in composition occurring in diesel fuel and the paraffin-blend model diesel, subjected to cavitating flow over a longer duration. Observed differences suggest that the high-pressure cavitation resulted in hydrodynamic sono-chemical destruction of aromatics in the diesel, which is believed to lead to carbonaceous nano-particle formation

Effects of a Policy Development Process on Implementing an Equity-Based Policy

Unstable residential and inadequate academic environments lead to poor educational outcomes for low-income students in urban areas. In 2011, Ohio enacted a law to create a college preparatory boarding school (CPBS) for low-income students by 2013. However, Ohio\u27s CPBS has not yet been established, thereby denying these students an opportunity to attain skills needed to enter college. Using the policy feedback theory (PFT) and Fredrickson\u27s theory of social equity (SET) as foundations, the purpose of this qualitative study was to understand the nature of implementation barriers and propose solutions by exploring 2 successful CPBS programs in Maryland and Washington, D.C. The research questions focused on identifying implementation practices from the successful CPBS programs with the aim to propose options to implement Ohio\u27s law. Data were collected from a purposeful sample of 14 participants which included 2 Ohio legislators; public administrators, Ohio (7), Maryland (1), Washington, D.C (3); and 1 Ohio union leader, and a review of relevant public and official records. All data were deductively coded and subjected to a constant comparison analysis. Results showed that Ohio\u27s public education administrators were excluded from the CPBS policy\u27s design, unlike their peers. Further, Ohio\u27s CPBS law favored a particular stakeholder involved in its design and was not executed when Ohio\u27s education administrators and the entity disagreed over public assets ownership. The findings affirmed SET\u27s condition for an open and inclusive policy process and PFT\u27s claim that current policies affect resources and the paradigm for new policies. Positive social change implications from this study include recommendations to Ohio\u27s policymakers to create a more inclusive process involving parties willing to provide an effective learning environment for economically marginalized children

Ectopic Pregnancy: Reasons for the High Tubal Rupture Rates in a Nigerian Population

Context: Nigeria has a high incidence of ruptured ectopic pregnancy. Identification of predisposing factors will help reduce morbidity and mortalityAim: To determine the reasons for the high incidence of ruptured ectopic pregnancy.Methods: All cases of ectopic pregnancies managed at Wesley Guild Hospital, Ilesha, Nigeria , between January 2004 and December 2008 were the subjects of this study. The case notes were reviewed to obtain information on the socio demographic characteristics of the patients, clinical history and operative findings.Results: Of the 1,048 gynaecological admissions during the study period 98(9.4%) were for ectopic pregnancy out of which76(96.2%) were ruptured The mean age of the patients was 28.3 years (SD=5.1), majority (82.3%) were married and 68.4% have had one or more previous deliveries.Amenorrhea was present in 66(83.5%). Abdominal pain (98.%), dizziness (62.0%) and vaginal bleeding (44.3%) were the commonest symptoms. Only 30 (38.0%) presented to any medical facility within 24 hours of the onset of symptoms. The ectopic was tubal in 67(84.8%), abdominal in one and could not be specified in 11. Of the tubal pregnancies ampulla (49.3%), cornual (25.4%) and isthmus (15..0%) were the commonest sites. All patients had laparotomy and salpingectomy. There was no maternal death.Conclusion In our community ectopic pregnancy tends to occur more often in parous women and are more commonly located in the isthmio cornual part of the tube. Besides, majority of our women present late making them more vulnerable to ruptured ectopic pregnancy.Key Words: Ectopic, Pregnancy, Complications, Presentation

Clinical characterisation and management outcomes of COVID-19 infection in pregnancy in a Nigerian tertiary hospital

Background: Literature on the antenatal and perinatal management and outcomes of COVID-19 infection in pregnancy in Nigeria and sub-Saharan Africa is gradually emerging but sparse. There is an urgent need to build up the knowledge base of COVID-19 infection in Nigerian pregnant women. The objective of the current study was to determine the clinical characteristics and management outcomes of COVID-19 infection in pregnancy at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.Methods: A one-year retrospective review of all cases of COVID-19 infection in pregnancy managed at the OAUTHC. Relevant data were extracted from the case records of all cases managed using a purpose-designed proforma. Data collected was analysed using IBM-SPSS, version 24. Associations between categorical variables were assessed using chi square, with level of significance set at <0.05.Results: A total of 22 cases were managed. Majority (15, 68.2%) of the women were either asymptomatic or had mild symptoms. The commonest symptom was cough (8, 36.4%). The mean duration of admission was 6.6±4.2 days. The most common maternal and perinatal complication was preterm delivery/birth (3, 13.6%). There was no maternal mortality. The mean birth weight of the babies was 3226g±597g, with mean 1- and 5- minutes Apgar scores of 8.0±1.3 and 9.5±0.6 respectively.Conclusions: Although COVID-19 infection in pregnancy is an asymptomatic or mild infection in the majority of cases in Ile-Ife, Nigeria, it is associated with adverse maternal and perinatal outcomes. Further studies are recommended to determine transplacental transmission of COVID-19 infection and antibodies

A 12-month prospective study of intra-abdominal hypertension and abdominal compartment syndrome incidence and outcomes at a tertiary hospital in Nigeria

Background: Peritoneal sepsis is a life-threatening emergency, more so in the low- and middle-income countries (LMICs) where immediate hospital presentation for much needed urgent surgical care is the exception rather than the norm. Continued research into the multifactorial aetiopathogenesis responsible for the high level of morbidity and mortality is necessary. We aimed to determine the incidence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients presenting with generalized peritonitis in a tertiary hospital in Nigeria. Methods: We conducted a prospective study involving recruitment of consenting patients managed for generalized peritonitis over 12 months. Results: Fifty-seven consenting and appropriate patients were recruited over the course of the study and managed as per study protocol. The duration of symptoms ranged between 11 hours and 7 days. All patients had varying degrees of IAH and ACS at presentation with generalized peritonitis. A laparotomy with definitive surgery was done in 51 patients (89%), with 6 patients (11%) having only a bedside peritoneal drain inserted for decompression. Significant improvement of the respiratory rate (P &lt; 0.001), oxygen saturation (P = 0.041), and urinary output (P = 0.021) only occurred after decompression by laparotomy or tube drainage. The consecutive mean ± standard deviation (SD) intra-abdominal pressures measured, respectively, at presentation, immediately postsurgery, then postoperatively at 6 h, 24 h, and 72 h reflected significant improvement at each point (respectively in cmH2O: 11.4 ± 6.03, 6.58 ± 5.58, 5.78 ± 3.29, 4.73 ± 2.86, 6.72 ± 5.18; P &lt; 0.001). Conclusions: IAH and ACS are not uncommon in our setting, and ACS at presentation is a significant predictor of mortality in patients with peritoneal sepsis. Surgical decompression invariably leads to an improvement in all clinical variables investigated. Keywords: intra-abdominal hypertension; abdominal compartment syndrome; peritonitis; laparotomy; percutaneous catheter decompression; Nigeria

Clinical versus Sonographic Estimation of Foetal Weight in Southwest Nigeria

A prospective study was conducted at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, between 3 January and 31May 2004, to compare the accuracy of clinical and ultrasonographic estimation of foetal weight at term. One hundred pregnant women who fulfilled the inclusion criteria had their foetal weight estimated independently using clinical and ultrasonographic methods. Accuracy was determined by percentage error, absolute percentage error, and proportion of estimates within 10% of actual birthweight (birthweight of +10%). Statistical analysis was done using the paired t-test, the Wilcoxon signed-rank test, and the chi-square test. The study sample had an actual average birthweight of 3,255+622 (range 2,150–4,950) g. Overall, the clinical method overestimated birthweight, while ultrasound underestimated it. The mean absolute percentage error of the clinical method was smaller than that of the sonographic method, and the number of estimates within 10% of actual birthweight for the clinical method (70%) was greater than for the sonographic method (68%); the difference was not statistically significant. In the low birthweight (<2,500 g) group, the mean errors of sonographic estimates were significantly smaller, and significantly more sonographic estimates (66.7%) were within 10% of actual birthweight than those of the clinical method (41.7%). No statistically significant difference was observed in all the measures of accuracy for the normal birthweight range of 2,500-<4,000 g and in the macrosonic group (≥4,000 g), except that, while the ultrasonographic method underestimated birthweight, the clinical method overestimated it. Clinical estimation of birthweight is as accurate as routine ultrasonographic estimation, except in low-birthweight babies. Therefore, when the clinical method suggests weight smaller than 2,500 g, subsequent sonographic estimation is recommended to yield a better prediction and to further evaluate foetal well-being