Gestational trophoblastic disease in Abuth Zaria, Nigeria: A 5‑year review

Gestational trophoblastic diseases (GTD) includes a spectrum of diseases (tumor or tumor-like conditions) characterised by aberrant growth and development of the trophoblasts that may continue even beyond the end of pregnancy. It encompasses the benign trophoblastic disease (complete and partial moles), and the malignant trophoblastic diseases including the invasive mole (chorioadenoma destruens), choriocarcinoma, and Placental Site Trophoblastic Tumor (PSTT). This study was to determine the prevalence, risk factors, clinical presentation, diagnosis, treatment options and outcomes of GTD in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. A five-year retrospective study of patients with GTD managed at ABUTH, North-west Nigeria, from 1st January 2008 to 31st December, 2012 was undertaken. Data of all cases of GTD in the hospital over the 5 year period were obtained. The gynaecology ward and labour ward registers also provided information on the total number of gynaecological admissions and deliveries respectively. The data processing and analysis were carried out using the SPSS software version 16. The data obtained were expressed in percentages, means, and standard deviations. During the period of study there were 8,138 deliveries and 2,453 gynaecological admissions. There were 59 cases of GTD with 41 having choriocarcinoma, 18 molar pregnancies and no case of invasive mole or PSTT. Out of the 41 case folders retrieved, 23 were choriocarcinoma and 18 of molar pregnancies. The prevalence of GTD was 7.2 per 1000 deliveries (0.72% or 1 in 138 deliveries) and constituted 2.4% of gynaecological admissions. Hydatidiform mole (HM) occurred in 1 in 452 deliveries and choriocarcinoma occurred in 1 in 198 deliveries. Ages ranged from 19-49 years with mean of 32.5+ 5.0 years. Most (66.7%) cases of HM were 19-29years while 60.9% of choriocarcinoma cases were 30-39years. Majority of cases were multiparous. The antecedent events predating choriocarcinoma were Hydatidiform mole (31.7%), abortions (29.3%) and 2.4% followed term pregnancy. History of amenorrhea was present in all cases while vaginal bleeding occurred in 97.6%, pallor (87.8%), hyperemesis gravidarum (48.8%) and 4.9% came in shock. Consequently, common complications reported were haemorrhage (90.2%), anemia (87.8%) and shock (12.2%). Pregnancy test was positive in 90.2% of cases and serum beta hCG was done in 24.4% with more than half having a level >12,000miu/ml. All patients had pelvic ultrasound scan and snowstorm appearance occurred in 41% of benign GTD cases. Histology was used to confirm 56.1% cases of choriocarcinoma and 43.9% of molar gestation. Most (94.4%) of HM had suction evacuation while 95.6% of choriocarcinoma cases had chemotherapy, one case (2.4%) had Total Abdominal Hysterectomy. Contraception was used in 78% and common methods were male condom (41.5%) and 36.6% used combined oral contraceptive pills. Less than half (43.9%) had follow up for 6 months and 9.8% were seen for more than a year. Eight patients had subsequent pregnancies and there was one death in the series giving a case fatality of 2.4%. Gestational trophoblastic disease is a significant source of maternal morbidity with increased risk of mortality from complications if not detected early and treated promptly.Keywords: Choriocarcinoma; gestational trophoblastic disease; human chorionic gonadotrophin; hydatidiform mole; placental site trophoblastic diseas

Prevalence, Patterns and Cognitive Barriers to HIV Disclosure Intention Among Treatment-Seeking People Living with HIV

Background: Globally, the patterns, prevalence and cognitive barriers to Human-Immunodeficiency-Virus and Acquired-Immune-Deficiency-Syndrome (HIV/AIDS) disclosure among individuals diagnosed with HIV have continually been a source of concern, especially in developing countries. This been widely linked to most persistent problems thwarting the effort of authorities saddled with responsibilities of curbing the menace of HIV/AIDS in Africa at large. The unabated issues have been a primary global health concern. Methods: The study was carried out in the Heart to Heart (H2H) unit of Hematology Department of the Ondo State Teaching Hospital, Akure, Ondo State. The study incorporated a blend of a quantitative method (to explore the prevalence of disclosure and its socio-demographic prevalence) and qualitative method (to explore cognitive barriers to self-disclosure of HIV positive status. The quantitative data was gathered from three hundred and ninety (n=390) PLWHA and the qualitative data was gathered from nineteen (n=19) PLHIV. Results: The prevalence of low-disclosure intention among treatment-seeking people living with HIV/AIDS was pegged at 64.6%. Approximately 70% of the males and 60% of the females are not likely to disclose their HIV positive status. 65% of the PLHIV from monogamy family structure are not likely to disclose their HIV positive status. Anticipated stigmatization, disclosure self-efficacy, mood problems, health locus of control were identified as the major cognitive barriers to disclosure of HIV positive status. Conclusion: The study further concludes that anticipated stigmatization, disclosure efficacy, manifested mood problems (anxiety and depressive symptoms), and health locus of control were the implicated cognitive barriers to disclosure among a hospital-based PLHIV. The outcome was similarly Furthermore, the study revealed that the target of disclosure was major to secondary circle i.e. parents and siblings and not towards the primary circle, such as; spouse/girlfriend/boyfriend, children. Implications and recommendations were further discussed.

Association of Plasmid Bearing Multi Drug Resistant Bacteria with High Mortalities in Nigerian Poultry

Bacteriological investigations were carried out on reported cases of low and high mortalities in commercial poultry in the year 2007-2009 in commercial flocks of breeders, layers, broilers, chicks and growers. Pure bacterial isolates obtained from dead birds, mainly Gram negative,  were tested for their biochemical and antibiotic susceptibility profiles using Microscan® Dried Gram-negative Breakpoint Combo Pannels. The microscan panel analysis bacterial isolates for 24 biochemical tests and up to 25 antimicrobial agents following 16-20 hours of incubation at 35-37oC. Bacteria isolated were Escherichia coli, Salmonella Enteritidis, Salmonella Pullorum, Salmonella Gallinarum, Citrobacter youngae, Klebsiella ozaneae, Klebsiella variicola, Enterobacter cloaceae, Hafnia alvei, Pasteurella gallinarum and Pasteurella multocida. The bacterial isolates showed resistance to 6-23 of the 25 antibiotics tested. Tetracycline and ampicilllin were found as the least potent drugs, with 90 and 90.91% resistance respectively. Resistance was obtained against antibacterial agents that are not in use in Nigerian poultry industry, such as the cephalosporins, carbapenems, piperacillin, tircacillin, amikacin, tobramcycin and levofloxacin suggesting possible genetic contribution to resistance. Thirty-four (85%) of the 40 pathogenic bacteria isolates treated for plasmid profile were found to be carrying plasmids. Plasmid DNA size 11.50 kbp was commonly observed (about 65%) among all the plasmid borne mdr bacteria, plasmid DNA size 10kbp (incidence of about 22% in plasmid borne bacteria) as well as a 26.3 kbp plasmid DNA and a 6.6 kbp plasmid DNA. The susceptibility of the plasmid bearing bacteria to antibiotics was enhanced following plasmid curing with sodium deodecyl sulphate.  Antibiotic susceptibility testing should guide treatment in all infections where organism can be cultured in veterinary medicine practice Keywords: Antibiotics, high mortalities, multi-drug resistant bacteria, plasmid, poultry

Evaluation of Volumetric Properties of Cassava Peel Ash Modified Asphalt Mixtures

In continuance to providing a reliable and cost-efficient road construction material that would aid the development of sustainable pavements while also eradicating agricultural wastes to protect the environment, Cassava Peel Ash (CPA) modified asphalt mixture is seen to be one of the most viable options. This study aimed to determine the suitability of Cassava Peel Ash (CPA) in hot mix asphalt for improved pavement performance. Using response surface methodology, a central composite design was employed for the mix design parameters, namely coarse aggregate (CA), fine aggregate (FA), mineral filler (MF), bitumen content (BC), and cassava peel ash (CPA). CPA was used as a partial replacement for filler and varied between 0% and 20%. The BC varied between 4% and 8%, the MF varied between 15% and 20%, the FA varied between 10% and 14%, and the CA varied between 46% and 52%. The interactive effect between the mix design parameters on the volumetric properties of the asphalt mixtures was evaluated. The results obtained showed the Marshall stability, flow, density, volume of the void, and void in mineral aggregates of the asphalt mixtures at 1.8037–8.045 kN, 2.7-8.22 mm, 2.0426–2.3909%, 1.094–7.966% and 55.5105–93.1393% respectively. These results indicate that the interaction of CA, FA, MF, BC, and CPA influences the volumetric properties of asphalt mixtures. From the RSM analysis, a prediction model and an optimal condition of 4.018% asphalt content, 20% cassava peel ash, 46% coarse aggregate, 10% fine aggregate, and 15% mineral filler were achieved for the asphalt mixtures. Doi: 10.28991/CEJ-2022-08-10-07 Full Text: PD

Hysterectomies pattern at a tertiary healthcare center, northern Nigeria

Background: The uterus is an important female genital organ for menstrual and reproductive functions. However, there are various gynecologic and obstetric indications for carrying out hysterectomy.Objectives: To determine the indications and the patterns of hysterectomies done at Ahmadu Bello University Teaching Hospital, Zaria Nigeria.Materials and Methods: 5‑year retrospective descriptive study on patients who had hysterectomy done from 2011 to 2015.Results: The age range of the patients was 2–70 years with a mean of 48.6 ± 8.8 years. Hysterectomies constituted 19.3% of total gynecology surgeries done during the same period. Of these total abdominal hysterectomy 144 (87.8%) was the most common, next was vaginal hysterectomy with pelvic floor repair 13 (7.9%), and then subtotal hysterectomy was 7 (4.3%). The most common indication for total abdominal hysterectomy was multiple uterine fibroids, a benign uterine tumor.Conclusion: Hysterectomy is a common gynecological surgery which may be used to treat benign uterine pathologies, especially when there is no more desire for conception. It could also be lifesaving in uncontrollable postpartum hemorrhage as well as malignant pelvic organ pathologies, especially in early stages.Keywords: Gynecological surgery; hysterectomy, pattern; uterine fibroid

Demographics, Socio-Economic and Cognitive Skills as Barriers to Information Seeking in a Digital Library Environment

The chapter considers the importance of demographic and socio-economic factors as well as cognitive skills to information seeking in a digital library environment. Demographic factors such as age and gender were considered. Younger adults were found to respond positively to the demands of information seeking in the digital environment while their older counterparts are still struggling to come to terms with the changes. In the same vein, studies have revealed that the value placed on technology by men and women varies. While men express high level of confidence in navigating the digital environment, women still suffer low self-confidence in doing same. Identified socio-economic factors that also constitute a barrier to information seeking in a digital environment include income level, level of education, non-availability of ICT infrastructures and epileptic power supply especially in Africa among others. Unwillingness to see one’s needs as information needs, inability to articulate one’s information needs, unawareness of information sources, low self-efficacy, poor search skills among others were identified as cognitive barriers to information seeking in the digital environment. Based on the findings of this chapter, the study recommends that for persons who are adjudged to be the older generation, it is imperative for them to acquire requisite ICT skills that will make it easier for them to navigate the digital environment. There is also a clarion call on African leaders to provide infrastructures that will enable ICT to thrive as the digital environment is fast replacing the hitherto traditional one

Society of obstetrics and gynecology of Nigeria – Clinical practice guidelines: Guidelines for the prevention of cervical cancer

Clinical practice guidelines have been developed by professional societies globally. Each guideline although based on published scientific evidence reflected each country’s socioeconomic peculiarities and unique medical environment. The Society of Obstetrics and Gynaecology of Nigerian has published guidelines in other clinical areas; however, this is the first edition of practice guidelines for the prevention of cervical cancer. The Guidelines Committee was established in 2015 and decided to develop the first edition of this guideline following Delphi pool conducted among members which selected cervical cancer prevention as the subject that guideline is urgently needed. These guidelines cover strategies for cervical cancer prevention, screening, and management of test results. The committee developed the draft guideline during a 2‑day workshop with technical input from Cochrane Nigeria and Dr. Chris Maske, Lancet Laboratories, South Africa. The recommendations for each specific area were developed by the consensus, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the prevention of cervical cancer.Keywords: Cervical cancer; guideline; management; prevention; screening; Society of Obstetrics and Gynecology of Nigeria