Hyperemesis Gravidarum as a Cause of Pregnancy-related Acute Kidney Injury: A Case Report from Ile-Ife, South West Nigeria

Hyperemesis gravidarum (HG) complicated by acute kidney injury (AKI) is not commonly encountered in practice. Despite the extreme rarity of HG as a cause of AKI, health‑care providers should be aware of the likelihood of such a complication. The aim of the study was  to report a case of HG complicated by AKI. A 35‑year‑old G2P1+0 (one alive) female presented with progressively worsening nausea and  vomiting with associated weight loss and reduced urinary output at the gestational age of 17 weeks. Serum creatinine and urea values at  presentation were 883 µmol/L and 56 mmol/L, respectively. She, however, responded to intravenous fluid  therapy/replacement with subsequent normalization of serum urea and creatinine values and restoration of renal function. AKI can be a complication of HG. Individualized care of affected women will improve the prognosis. Keywords: Acute kidney injury, hyperemesis gravidarum, fluid therap

Plasma C-Reactive Protein and Selected Nutritional Indices in Elective Caesarean Section

Context: Caesarean Section (CS) is a major surgical procedure, often performed when a vaginal delivery is considered unsafe.Objective: This study was carried out to understand the interaction between acute phase proteins and nutritional factors consequent to caesarean section. The knowledge of this interaction is important for successful management of these patients.Methods: Plasma samples from fifty (50) pregnant women booked for elective caesarean section in Ibadan, Nigeria were collected on the day preceding surgery, one day and four days post-surgery to determine the levels of CRP, vitamin C, PCV, Total protein, albumin and globulin (Glb) levels. Results: The mean age of the patients studied was 32.29 + 3.66 years, range; 24 39 years. Significant elevations were observed in the levels of TP, Glb and CRP one day post-surgery (1DPS) compared with baseline (BS) (7.36 + 1.46) vs 6.56±1.30, (4.68 + 1.33) vs 2.70±1.51, (111.43 + 68.89) vs 6.00 ± 13.27 respectively, while albumin reduced significantly (2.68 + 1.08) vs 3.87±0 .63. Similar changes were observed on day 4. There was no significant change in the levels of Vitamin C.Conclusion: One of the positive predictive indicators of good outcome after caesarean delivery is adequate nutrition.Key Words: Elective caesarian section, acute phase proteins, nutritional factor

Prevalence of extended spectrum Beta-Lactamase producing Klebsiella species from patients’ specimens in a tertiary teaching hospital in Ile-Ife, Southwest Nigeria

Objective: This study determined the prevalence of ESBL genes amongst Klebsiella species isolated from patients’ specimens attending a Tertiary Teaching Hospital, in Ile-Ife, Southwest Nigeria. Methods: A cross sectional study of presumptive isolates of Klebsiella (n=180) were collected, after ethical approval in the microbiology laboratory. Isolates were identified to species level by conventional biochemical tests and MicrobactTM 24E Identification Kits. Antibiotic susceptibility testing was performed by the Kirby Bauer’s disk diffusion method. ESBL production was detected by the double disc synergy and ESBL genes by the multiplex PCR protocol. Results: The Klebsiella species identified were Klebsiella pneumoniae 95.6%, Klebsiella oxytoca 3.3%, Klebsiella ornithinolytica 0.6% and Klebsiella terrigena 0.6%. The prevalence of ESBL genes among the Klebsiella isolates was 47.2% , and the most common ESBL gene was blaSHV (38.9%), also 75% of the study isolates had MAR index greater than 0.2. Conclusions: The study establishes the prevalence of Extended Spectrum Beta-Lactamase producing Klebsiella sp in the hospital and identified the most prevalent ESBL genes circulating as blaSHV followed by blaTEM and blaCTX-M in this environment. This underscores the need for regular and continuous surveillance of antimicrobial resistance trend as a strong component of the antibiotics stewardship and infection prevention and control programs in the hospital. Keywords: Antibiotic Resistance; Klebsiella; ESBL

Randomization of two dosing regimens of vaginal misoprostol for cervical ripening and labor induction in a low resource setting

Objectives: To compare the effectiveness of two dosing regimens of vaginal misoprostol for cervical ripening and induction of labour.Materials and Methods: Pregnant women with singleton low risk pregnancy at term scheduled for elective induction of labour were randomized to  receive either 25 µg or 50 µg of vaginal misoprostol for pre.labour  cervical ripening. All the patients received antenatal care and delivered at the University College Hospital (UCH) from January 1st to May 31st 2006. A total of 128 patients were randomized; 65 patients received 25 µg and 63 patients received 50 µg of vaginal misoprostol.Results: Significantly higher number of patients in the 50 µg group   progressed to active labour as compared with the 25 µg group (95.2% versus 84.6%, P < 0.05). The need for oxytocin augmentation of labour was higher among the 25 µg as compared with 50 µg (39.7% versus 16.4%, P = 0.007). There was higher proportion of patients in the 50 µg group delivering vaginally within 24 hours as compared with the 25 µg group (98.2% versus 90.0%, P = 0.063). However, the mean interval between the first dose of misoprostol and vaginal delivery was not  statistically different in the two groups (754 } 362 minutes and 885 } 582 minutes, P = 0.152). The incidence of caesarean section was similar in the two groups (7.7% versus 11%, P = 0.580). Labour complications, such as precipitate labour, tachysystole and abnormal fetal heart rate patterns were greater in the 50 µg group.Conclusion: Twenty.five microgram of misoprostol appears to be as  effective as 50 µg for pre.induction cervical ripening and labour induction. Though 50 µg of vaginal misoprostol resulted in relatively faster delivery and less need for oxytocin augmentation, it was associated with more  labour complications as compared with 25 µg of misoprostol.Key words: Cervical ripening, labour induction, misoprosto

Planned cesarean myomectomy at term for huge intramural fibroids coexisting with pregnancy: A case report

With about 2–11% of pregnancy co‑existing with fibroids, one in 10 women will have complications related to myoma in pregnancy. The procedure of cesarean myomectomy has been much discouraged and the need to perform inevitable myomectomy during the cesarean section (CS) when fibroids obstruct wound closure has been presented. A case of a primigravida with huge uterine fibroids displacing the fetus into a persistent oblique lie and causing maternal discomfort is presented. A planned cesarean myomectomy was performed. Hemorrhage was controlled with tourniquet using Foley catheter, misoprostol, and high dose oxytocin infusion. The mother and baby had a satisfactory outcome. Elective cesarean myomectomy is safe but should only be done by an experienced surgeon and in centers equipped with facilities for comprehensive emergency obstetric care. Key words: Cesarean myomectomy; cesarean section; fibroids

Comparative biocidal activities of some crude plant species powders against the cowpea weevil (Callosobrochus maculatus (F.)(Coleoptera: bruchidae))

Callosobruchus maculatus is one of the most important pests of cowpea in storage causing severe economic damage to the grain. This study investigated the efficacies of three plant materials (Azadirachta indica, Calotropis procera and Chromolaena odorata) leaves against the cowpea weevil. Concentrations of 0.1, 0.25 and 0.5g of the plant powders were used on 10g of grains with 10 adult weevils in each and a Control (untreated) in triplicates. The results showed significant (P< 0.05) negatively effects of the plant materials on the survival of C. maculatus at the highest concentration. In all trails, mean daily mortality in adult C. maculatus were significantly(p<0.05) increased. All plant powder type were effective but concentration-dependent, with C. procera recording significantly (P < 0.05) higher mortality at the various concentrations while C. odorata, elicited the least mean daily mortality. The lowest LD50 (0.63g) was obtained with C. procera. These plants materials were found to also affect the egg-laying capacity of C. maculatus. Treatment with C. odorata recorded significantly(P<0.05) higher number of eggs laid at all concentrations, though the egg-laying capacity was also concentration-dependent; whereas C. procera recorded the least number of eggs laid. All the three plants powders tested demonstrated significant insecticidal potency on stored cowpea weevils, with C. procera and C. odorata showing significantly higher and lower insecticidal potentials respectively. These findings will help in solving problem associated with food security especially with respect to stored produce

Clinical utility of serum procalcitonin in adult patients admitted with community-acquired pneumonia in Ilorin, Nigeria

Objectives: The usefulness of biomarkers in community acquired pneumonia (CAP) has been under the research light with limited reports from Africa. This study aimed at evaluating the clinical usefulness of serum procalcitonin (PCT) in patients admitted with CAP in a tertiary hospital in Ilorin, Nigeria.Materials and Methods: This was prospective single center observational study of 102 admitted patients with clinical and radiologic features of CAP. All the patients had serum PCT assay, complete blood count, blood culture, sputum microbiology, and serological evaluation for atypical pathogens. Repeat PCT assay was done following 1 week of antibiotic therapy. The patients were classified into one of two diagnostic groups: Those with microbiologically confirmed bacterial CAP and those without bacterial CAP.Results: Over half (58/102; 56.8%) of the patients had microbiologically confirmed bacterial CAP. The baseline serum PCT concentrations were significantly higher in patients with bacterial CAP when compared to the non-bacterial CAP group (2.55 ± 0.14 vs. 0.94 ± 0.61 ng/ml; P < 0.001). There was also a statistically significant difference between the pre- and post-treatment serum PCT concentrations in the bacterial CAP group (P < 0.001) and the non-bacterial CAP group (P = 0.006). The area under the receiver operating characteristic (AUC) for pre-treatment PCT in diagnosing bacterial CAP was 0.795 (95% confidence level [CI]: 0.709–0.881) with a sensitivity of 67.2% and specificity of 79.5% at an optimal cutoff of 1.5 ng/ml. Overall, the biomarker was independently associated with white cell counts >10 × 109/L (AOR = 6.28; 95% CI: 1.30–30.32, P = 0.02). The baseline mean serum PCT levels were also significantly higher in patients admitted for 7 or more days (P = 0.010).Conclusion: Serum PCT had good diagnostic strength in patients admitted with bacterial CAP in Ilorin. The biomarker can also assist clinicians with predicting the pathogenic group and monitoring clinical progress of CAP

Antiretroviral Therapy‑related Problems among Human Immunodeficiency Virus‑infected Patients: A Focus on Medication Adherence and Pill Burden

Background: There are problems associated with antiretroviral therapy despite its achievement. Poor medication adherence and inability to tolerate large pill burden are major problems facing patients with chronic illnesses. These drug therapy problems are under-studied among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Nigeria. We evaluated adherence and pill burden among this set of patients in a tertiary hospital in Lagos. Methods: Data for eligible HIV‑infected adults were documented from case notes and through interviews using a well‑structured  questionnaire. Important details extracted were sociodemographics, pills information, and CD4 counts. The main outcome measures were drug adherence, as assessed by the four‑item Morisky Medication Adherence Scale and pill burden, as measured by daily pill >5. Results: Of the 296 patients, 219 (74%) were females. Median age (interquartile range) was 40 (35.0–47.7) years. Majority (262; 88.5%) were married, had at least a secondary education (142:48.0%), and CD4 count >500 cells/ml (215; 72.6%). Pill burden >5 pills/day was observed in 12.2% of the patients, while adherence was documented for 83.4% of the patients. Majority (259; 87.5%) were receiving fixed‑dose  combination of antiretroviral drugs. Forgetfulness (16.5%) and being too busy to take pills (10.5%) were the most common reasons for nonadherence. Pill burden in those who were not receiving fixed‑dose combination was significantly associated with medication nonadherence. However, only pill burden was found to be an independent prognosticator of non-adherance. (Odd ratio = 0.67, confidenceinterval = 0.03–1.66, P < 0.00). Conclusion: Medication nonadherence and pill burden were observed in more than one‑tenth of patients. These were the two major  antiretroviral therapy‑related problems reported in this study. Keywords: Adherence, antiretroviral therapy, human immunodeficiency virus, people living with human immunodeficiency virus/acquiredimmunodeficiency syndrome, pill burde

Synthesis and crystal structures of zinc(II) coordination polymers of trimethylenedipyridine (tmdp), 4-nitrobenzoic (Hnba) and 4-biphenylcarboxylic acid (Hbiphen) for adsorptive removal of methyl orange from aqueous solution

Two novel Zn(II) coordination polymers (CPs), [Zn(nba)2(tmdp)]n (1) and [Zn(biphen)2(tmdp)]n (2), were synthesised by reacting Zn(NO3)2·6H2O and 4,4′-trimethylenedipyridine (tmdp) with corresponding carboxylates: 4-nitrobenzoic (Hnba) and 4-biphenylcarboxylic acid (Hbiphen). Their structures were characterized by elemental analysis, IR spectroscopy, thermogravimetric analysis (TGA), powder X-ray diffraction (PXRD) and single-crystal X-ray diffraction. Compounds 1 and 2 are one-dimensional CPs with the zinc(II) carboxylate units bridged through the N-donor spacer ligand. The zinc (II) atom adopts a tetrahedral arrangement in 1 and 2 coordinated by two nitrogen atoms from two tmdp ligand molecules and two deprotonated oxygen atoms from two carboxylate ligand molecules. The adsorption capacities of MO in this study was found to be 546.31 mg/g and 22.67 mg/g for 1 and 2, respectively. DFT studies confirmed that adsorption is primarily due to π-π stacking and electrostatic interactions between MO and 1. It is noteworthy that binding energy (BE) values for 1 (-74.14 KJ/mol) and 2 (-61.11 KJ/mol) correlate reasonably well with the observed adsorption capacities of MO. The study demonstrated that 1 has higher adsorption efficiency in comparison to 2 and could be an effective and easily reusable adsorbent for the removal of MO from wastewater