Screening for gestational diabetes: evaluation of prevalence in age-stratified subgroups at Central hospital Warri Nigeria

Background: The prevalence of gestational diabetes depends on the method of diagnosis as well as ethnic background. Maternal age has also been identified as a factor, but has not been given much attention. The notion of gestational prediabetes has also speculated, but is equally yet to be a focus in discussion. Aim: This work aimed at evaluating the screening for gestational diabetes in Central Hospital, Warri; to determine prevalence of gestational diabetes in the general population and in stratified age groups. The other objective was to investigate the effectiveness and use of the methods of diagnosis. Materials and Methods: This was a retrospective review of laboratory data of de-identified antenatal patients. Hospital records of gestational diabetes from 2013 to 2015 were obtained from the Central Hospital, Warri. Data collected included age of the de-identified patients, blood glucose results and whether the test was fasting or random. Other information was the month/year of test. A total of 3 589 results were analyzed. Results: Averaged prevalence of 5.85% is identified. Fasting blood sugar (FBS) measurement was used more and it also identified more positives (9%) compared to random blood sugar (<2%). On a dichotomous age group, prevalence of gestational diabetes appeared low in women below 25 years compared to those ≥26 years old. In a more stratification of age groups, potential antepartum prediabetes in pregnancy was lower in women above 40 years old relative to the younger age subpopulations (p < 0.000001). No significant variation was observed in level of usage of either method between months/years. Conclusion:  There is an ongoing good practice of using affordable screening test, which is FBS. The significant finding was that there may be up to 9% prevalence of GDM and that this number may erroneously be lower if random blood glucose measurement is used. Another worthy observation was that the prevalence in stratified age groups was non-directional, especially as prediabetes appears higher in the younger age subpopulation

Right Ampullary Ectopic Pregnancy Following Bilateral Tubal Ligation Using Spring Clips.

Pregnancy is unlikely to occur in women who have undergone sterilization. However when it occurs, there is a substantial risk that it will be an ectopic pregnancy. We report a case of right unruptured ampullary ectopic gestation following tubal sterilization with spring clips 6 years prior to presentation. The likely aetiology may be spontaneous reanastomosis.Keywords: Ectopic, Bilateral Tubal ligation, Spring Clips

Implication of oestrogen in the development of breast cancer: a brief narrative review

The presence of hormones in milk and dairy foods was discussed decades ago but more concerns were with respect to finding hormones as biomarkers in milk for diseases and pregnancy diagnosis. Considerable amount of studies demonstrated that milk is essential for infants growing and immunity, while increasing body of evidence are indicating possible negative impact on human health including the role of some estrogens in the initiation and provoking of breast cancer. In this brief narrative, we reviewed recent data on oestrogens and breast cancer risk including comparative levels of hormones in cow milk, risk of breast cancer attributable to intake of different foods and lifestyle factors. Empirical findings indicate that consumption of cow milk is probably being over-emphasized as source of exogenous oestrogen, whereas control of alcohol as well as obesity and physical activity are under-emphasized in discourses on preventive protocols.

Evaluation of acetylator phenotype of isoniazid among tuberculosis patients in delta state Nigeria: update on management of toxicity

Background: In 1996, acetylator phenotype of thirteen consenting tuberculosis patients who were being treated with isoniazid was briefly examined as part of an MSc biochemistry program. Initial agenda were to determine the half-life of isoniazid and evaluate potential toxicity associated with long-term treatment regimen. This report presents findings of the study, but with the aim of providing an update on diagnosis and monitoring of the treatment of tuberculosis by laboratory methods.Methods: Firstly, the report submitted for the award of MSc Biochemistry was reviewed and reformatted. Secondly, a follow up survey was performed to determine the current practice at the general hospital and ‘tuberculosis and leprosy’ referral centres where the original study was carried out. Thirdly, a brief literature review was performed for any potential update on clinical practices.Results: The study has shown that 53.8% of patients are fast acetylators (t½2.5 hr). The follow-up on current practice indicates that molecular technology has been introduced, but limited to susceptibility testing. Whether a patient could be a fast acetylator (requiring long term drug regimen) or slow acetylator (deserving short term drug regiment) is very much appreciated, but test is neither available, nor considered. Conventional diagnostic indices applicable for clinical laboratory monitoring in a drug-responsive patient in terms of efficacy and toxicity of the treatment are discussed.Conclusions: Development of molecular technology has improved and revolutionized TB diagnosis, especially drug resistance testing. However, it is still limited to being an add-on test to conventional microscopy if a new patient is to be initially investigated for pulmonary TB.

Clinical laboratory testing for smoking toxicity: implications for early identification of respiratory diseases

Smoking toxicity has short and long term clinical effects and also leads to organ damage. However, clinical assessment in the context of early identification of smoke toxicity by evidence-base pathology is yet to be practiced. The present study was aimed to assess the knowledge and practice of health practitioners regarding clinical laboratory testing of smoking toxicity, with a view to generate a debate on why and how to test. In this pilot study, various health practitioners and students were asked via interviews about laboratory testing of smoking toxicity. There is considerable dismissal of ‘why’ to test and up 57% responded that it was unnecessary. However, there is general opinion that laboratory routine tests can be used to identify toxicity. It appears that there is a gap between knowledge and practice of clinical laboratory testing of cigarette toxicity. Students and health practitioners have the knowledge on smoke toxicity but this requires articulation into evidence-base pathology for early identification and intervention of subclinical pathology in smoking toxicity, especially before noticeable organ damage

Utilization of insecticide treated nets against malaria among pregnant women in Southern Nigeria

Malaria remains one of the most important causes of maternal and child morbidity and mortality in sub-Saharan African, despite the availability of effective intervention. Pregnant women are susceptible to symptomatic malaria due to the invasion of the placenta by Plasmodium. There are public health endeavours in promoting use of insecticide treated nets (ITNS), but there is dearth of data on effectiveness of such endeavour. This narrative review looks briefly at the historical background of use of ITNS against malaria, Government policy and program evaluation process on free ITNS for vulnerable groups, relevance of knowledge in use of insecticide treated nets among pregnant mothers, and the role of attitude and practice on effective use of ITNS in prevention of malaria. There is evidence that relatively few people in high-risk regions access and use ITNS. The low utilization of ITNs attributable to perceived cost, inability to adjust to size of the beds, and side-effects heat and ventilation when slept under it

Evaluation of oxidative stress and whole blood viscosity for clinical laboratory testing of smoking toxicity

Background: There are no clearly established clinical biochemical markers for cigarette smoking despite the knowledge that cigarette smoking is a risk factor for various diseases, especially cardiovascular complications of respiratory pathologies. However, there are reports of significant increases in blood viscosity and oxidative stress among smokers. The main objective of the study was to ascertain the association of toxicity from cigarette smoking on whole blood viscosity in our data.Methods: This study analysed the archived clinical data of 20 cigarette smokers and 20 apparently healthy individuals.Results: The data show that on average, oxidative stress levels are relatively the same between groups, while whole blood viscosity is statistically significantly lower in non-smokers compared to smokers.Conclusions: This report suggests that oxidative stress induced whole blood hyper-viscosity could be a valid biomarker for laboratory testing of smoking toxicity among cigarette smokers

Evaluation of utilization of insecticide treated nets among pregnant women in Bayelsa State of Nigeria: a case study of Sagbama community

Background: There has been a roll back mosquito (RBM) program in Nigeria. This study was carried out to determine the effectiveness and utilization of insecticide treated nets (ITNs) among pregnant women in Bayelsa State, Nigeria.Methods: A descriptive survey design was used to assess usage and patient experience. A total of 250 completed survey were returned out of 260 questionnaires distributed. Statistical analysis was in frequency counts and percentages.Results: Over 55% of respondents are aware that the best way to prevent malaria in pregnancy is to always sleep in ITNs. 20% of the respondents lack ITNs due to non-availability in the clinic or unaffordability in the market. Among those that own ITNs, only 31% utilize it every day. Suffocation and skin irritation were reasons for non-utilization. On effectiveness, among those who use their ITNs, 24.3% never suffered malaria or mosquito bite.Conclusions: ITNs utilization seems to have reached the RBM target. However, the study shows patient experience that use of ITNs seems to have limited effectiveness in prevention of malaria during pregnancy, while affordances and quality are barriers to utility. Ministry of Health and especially antenatal and community healthcare workers need to intensify health education campaign to improve attitude and practice of ITNs utility among pregnant mothers. Manufacturers of ITNs also need to improve on the quality of ITNs to reduce skin irritation or suffocation in order to encourage usage among pregnant mothers

Consumption and factors associating the provision of fruits and vegetables to children in Bayelsa state of Nigeria

Background: The provision of adequate nutrition is of the utmost importance for the promotion of optimal growth and development in the early stages of human life as well as the stimulation of immune system function to combat infections. Therefore, this study aimed to assess the level of consumption and the factors affecting the provision of fruits and vegetables to children in Bayelsa state of Nigeria. Methods: This was a population-based survey conducted among 360 parents/caregivers of children aged 5 years and below randomly selected from Bayelsa state, Nigeria. The data for this study was collected with in-person interviews utilizing a standardized questionnaire. The results were presented in frequency and percentage. The level of significance was determined using a confidence interval of 95% and p&lt;0.05. Results: Most of the respondents 355 (98.6%) were female with the age range 25-44 making 86.65% of the total population. Findings show that 40.8% of respondents gave their children fruits and vegetables only once a week while 3.6% gave their children fruits and vegetables 4 times and above a week. The majority of respondents 240 (66.7%) indicated that the high cost of fruits and vegetables was the main factor that affected consumption of fruits and vegetables. Conclusions: The findings demonstrated a low consumption level of fruits and vegetables among the children in Bayelsa state. Therefore, health professionals should be obliged to educate parents and caregivers of children on adequate provision of fruits and vegetables for their children

An evaluation of intra-operative and post-operative blood loss in total knee arthroplasty at the National Orthopaedic Hospital, Lagos

Background: Total knee replacement is a rewarding and reliable procedure, producing a lasting relief to severe knee pains. However, significant blood loss usually in the post-operative period may be a challenge, necessitating prompt restoration of circulating blood volume to minimize morbidity and mortality. The aim of this study was to evaluate blood loss after total knee replacementPatients and Methods: A prospective study of blood loss after Total Knee Arthroplasty in 53 patients in the National Orthopaedic Hospital, Lagos. Consecutive patients with established indications, presenting for total knee arthroplasty were recruited into the study after obtaining their consent.Results: The mean intra-operative blood loss was 342.4 mls, with a range of 50 - 1500 mls. The mean post-operative blood loss and total blood loss were 603.6 mls and 940.3 mls respectively, showing a strong positive correlation (r = 0.884, p &lt; 0.01). The average pre-operative and post-operative haemoglobin concentration were 12.5 ± 1.2 g/dl and 9.8 ± 0.9 g/dl, respectively. The mean haemoglobin loss was 2.6 ± 1.2 g/dl (r = 0.46, p &lt; 0.001).Conclusion: Post-operative blood loss as measured by suction drainage, is a good predictor of total blood loss, showing a strong and positive correlation.Keywords: Total Knee Arthroplasty, Blood loss, Tourniquet, Surgical time