Audit on the first obstetric ultrasound in a tertiary health facility in the Niger Delta and its implications for maternal foetal care

Background: The study was prompted by the heterogeneity in the content and the performance of dating or first obstetric ultrasound) scans in Nigeria. The primary aim of the study therefore was to determine whether the conduct of the scans conform to international norms. The secondary goal was to access the implications of the scans for maternal and foetal care.Methods: The study was of mixed design-observational, cross-sectional with audit component, carried out at the Rivers State university teaching hospital (RSUTH), Nigeria from November, 2020 to February 2021. A literature search was carried out on the subject and standards were deduced from the review. 417 consecutive patients were recruited from the antenatal clinic and data on their history and the conduct of the scans were collected. The content of individual scan report was compared with international norms. Data were analysed using Epi. Info 2018 software.Results: There were no guidelines nor uniformity in the conduct of dating or first obstetric ultrasound scans at the RSUTH. Out of the total 408 scan reports, 108 (26.47%) and 300 (73.53) took place inside and outside the RSUTH respectively. The gestational ages at the scans ranged from 8 to 41 weeks. Appropriate biometric parameters were used in 115 (28.19%) reports while in the rest, inappropriate or incomplete parameters were used. Furthermore, the following were not on the menu for the first obstetric scans: determination of chorionicity/amnionicity in multiple pregnancies, anomaly scan, screening for chromosomal abnormalities, foetal growth restriction (FGR), preeclampsia, preterm labour and for morbid adherence of the placenta. The deficiencies in the first obstetric ultrasound would likely lead to wrong dating and inaccurate growth assessment with associated adverse maternal and foetal outcomes, including wrong timing for obstetric interventions and also increased prevalence of those conditions that were not screened for.Conclusions: Absence of guidelines, inaccurate dating and foetal growth assessment and non-performance of important obstetric screening procedures were likely to lead to adverse maternal foetal outcomes. There was therefore urgent need to formulate national guidelines on the subject, adopt effective referral cascade for scans and to introduce practical approach to training in maternal foetal medicine in tertiary institutions in Nigeria.

Relationship between Poverty and Risky Sexual Behaviours among Adolescents in Rivers State, Nigeria: A Questionnaire – Based Survey

Background: Adolescents are sexually active and tend to initiate sexual activity at an early age; this has remained a public health concern due to the associated reproductive health risks. , This study was designed to evaluate the relationships between poverty and risky sexual behavior among senior secondary school students in Rivers State, Nigeria. Materials and Methods: A questionnaire-based survey was conducted among 823 students from selected senior secondary schools of Rivers State, Nigeria. The questionnaire consists of two section A and section B and was designed in hardcopy, and distributed to the respondents using one-to one method with the aid of research assistants. The respondent’s consent was duly sought and obtained. The respondent’s private information was treated with confidentiality. Obtained data were exported into Excel software version 2007 and the analysis was done with computer software package, SPSS version 21.0(IBM Corp, Armonk, NY, USA, 2012). Descriptive statistics showing the frequencies and percentages were used to explain the data as appropriate and inferential statistic (Binary Logistic regression) was used to determine the association between poverty and risky sexual behaviour of adolescents. A p value less than 0.05 was set as level of statistical significance. Results: The result of the study indicated that the majority 698(86.6%) of the respondents who reported high poverty engaged in risky sexual behaviour compared to 5(2.69%) of those who reported low poverty.  The full model as a whole showing the chi-square analysis result revealed a significant association between poverty and sexual behaviour (χ2 (1, N=823) =3465, P< 0.001). The result of the study further demonstrated that those who indicated been poor were 3.27 times more likely to have sexual intercourse compared to those without peer pressure (OR=3.27, 95%CI: 2.22-4.81). Conclusion: There was significant association between poverty and sexual behaviour and that those who indicated been poor were 3.27 times more likely to have sexual intercourse compared to those without peer pressure

Relationship between Poverty and Risky Sexual Behaviours among Adolescents in Rivers State, Nigeria: A Questionnaire – Based Survey

Background: Adolescents are sexually active and tend to initiate sexual activity at an early age; this has remained a public health concern due to the associated reproductive health risks. , This study was designed to evaluate the relationships between poverty and risky sexual behavior among senior secondary school students in Rivers State, Nigeria. Materials and Methods: A questionnaire-based survey was conducted among 823 students from selected senior secondary schools of Rivers State, Nigeria. The questionnaire consists of two section A and section B and was designed in hardcopy, and distributed to the respondents using one-to one method with the aid of research assistants. The respondent’s consent was duly sought and obtained. The respondent’s private information was treated with confidentiality. Obtained data were exported into Excel software version 2007 and the analysis was done with computer software package, SPSS version 21.0(IBM Corp, Armonk, NY, USA, 2012). Descriptive statistics showing the frequencies and percentages were used to explain the data as appropriate and inferential statistic (Binary Logistic regression) was used to determine the association between poverty and risky sexual behaviour of adolescents. A p value less than 0.05 was set as level of statistical significance. Results: The result of the study indicated that the majority 698(86.6%) of the respondents who reported high poverty engaged in risky sexual behaviour compared to 5(2.69%) of those who reported low poverty.  The full model as a whole showing the chi-square analysis result revealed a significant association between poverty and sexual behaviour (χ2 (1, N=823) =3465, P< 0.001). The result of the study further demonstrated that those who indicated been poor were 3.27 times more likely to have sexual intercourse compared to those without peer pressure (OR=3.27, 95%CI: 2.22-4.81). Conclusion: There was significant association between poverty and sexual behaviour and that those who indicated been poor were 3.27 times more likely to have sexual intercourse compared to those without peer pressure

Abnormalities of semen parameters among male partners of infertile couples in a sub-urban tertiary hospital in Nigeria

Background: Infertility is a common reason for gynecological clinic visits in Nigeria. Men contribute significantly to the cause of infertility; however male factor infertility remain underreported compared to commonly reported female factor infertility. This study aimed to evaluate the abnormalities of semen parameters among male partners of infertile couples in Irrua Specialist Teaching Hospital in Edo State, Nigeria. Methods: A prospective cross-sectional study of 285 semen samples of male partners of infertile couples was conducted at Irrua specialist teaching hospital. The laboratory staff carried out analysis of the semen samples using set parameters outlined by the World Health Organization laboratory manual for the examination and processing of human semen. Socio-demographic data of the participants was also taken in a proforma. The data obtained was then analyzed with the Statistical Package for Social Sciences. Results: The age range of participants in this study was 20 to 65 years, with a mean age of 33.38 years. A total of 80.7% of the cases reviewed had one or more abnormal semen parameters. In 45.6%, 51.6%, and 47.0% of the analyzed samples, sperm cell count, morphology and total motility were below the WHO reference level, respectively. The severe forms of abnormal semen analysis findings detected in this study were asthenozoospermia (47%), oligozoospermia (15.8%), azoospermia (45.6%), and oligoasthenoteratozoospermia (15.5%). There was also statistically significant finding of rising cases of oligospermia with increasing age among the participants Conclusions: Male factor infertility although grossly under reported, contributes significantly to the burden of infertility in our setting. There is a need to raise awareness so that men are properly evaluated and treated

Platinum and Palladium Complexes Containing Cationic Ligands as Catalysts for Arene H/D Exchange and Oxidation

No AbstractPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/77957/1/ange_201002351_sm_miscellaneous_information.pd

Assessment of risk factors and glycosylated haemoglobin in early pregnancy as predictors of diabetes in pregnancy

Background: The aim of the study was to determine the performance of history of risk factors and universal HBA1c testing as screening tools for diabetes mellitus in the first trimester of pregnancy using OGTT as a gold standard. Methods: A prospective cross-sectional study conducted between 8 and 13±6 weeks in 305 consecutive pregnancies in the antenatal clinics of the University of Port Harcourt Teaching (UPTH) and Rivers State University Teaching Hospital (RSUTH) between January and August 2020. Each woman had oral glucose tolerance test (OGTT), and glycosylated haemoglobin (HBA1c) levels estimation. Multivariate logistic regression analysis was carried out with history of risk factors and HBA1c level as independent variables and OGTT as the dependent variable for the assessment of their predictive performances. Results: The prevalence of DM was 28.85%, 2.62% and 31.48% for GDM, pre-gestational and for both respectively. Family history of DM was associated with high specificity (91.4%) and negative predictive value (NPV) of 68.7% but low sensitivity (9.4%) and positive predictive value (PPV) (33.3%). The receiver operator characteristic curve for HBA1c revealed a significant area under the curve value: 0.653 (CI: 058-0.72), p<0.01. The optimal cut-off for HBA1c from Youden index was 5.25%. HBA1c levels had high specificity (88.5%) and NPV (75.2%) with low sensitivity (36.5%) and PPV (59.3%). Multivariate logistic regression analysis showed HbA1c as the only independent predictor of GDM (p=0.0001). Conclusions: The high prevalence of diabetes (31.48%), underscores the need for universal screening in early pregnancy. The high NPV and specificity of the risk factors for GDM and HBA1c levels better predict pregnancies that are not likely to develop GDM, but they are not suitable for diagnosis because of the low sensitivity and PPV

A systematic study on Pt based, subnanometer-sized alloy cluster catalysts for alkane dehydrogenation: effects of intermetallic interaction

Platinum-based bimetallic nanoparticles are analyzed by the application of density functional theory to a series of tetrahedral Pt3X cluster models, with element X taken from the P-block, preferably group 14, or from the D-block around group 10. Almost identical cluster geometries allow a systematic investigation of electronic effects induced by different elements X. Choosing the propane-to-propene conversion as the desired dehydrogenation reaction, we provide estimates for the activity and selectivity of the various catalysts based on transition state theory. No significant Brønsted-Evans-Polanyi-relation could be found for the given reaction. A new descriptor, derived from an energy decomposition analysis, captures the effect of element X on the rate-determining step of the first hydrogen abstraction. Higher activities than obtained for pure Pt4 clusters are predicted for Pt alloys containing Ir, Sn, Ge and Si, with Pt3Ir showing particularly high selectivity

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Impact of indoor environmental quality on occupant well-being and comfort : a review of the literature

Indoor environmental quality (IEQ) and its effect on occupant well-being and comfort is an important area of study. This paper presents a state of the art study through extensive review of the literature, by establishing links between IEQs and occupant well-being and comfort. A range of issues such as sick building syndrome, indoor air quality thermal comfort, visual comfort and acoustic comfort are considered in this paper. The complexity of the relationship between occupant comfort and well-being parameters with IEQ are further exacerbated due to relationships that these parameters have with each other as well. Based on the review of literature in these areas it is established that design of buildings needs to consider occupant well-being parameters right at the beginning. Some good practices in all these different areas have also been highlighted and documented in this paper. The knowledge established as part of this paper would be helpful for researchers, designer, engineers and facilities maintenance engineers. This paper will also be of great benefit to researchers who endeavour to undertake research in this area and could act as a good starting point for them. Keywords Occupant well-being; Indoor environment quality; Occupant comfort; Offices; Green building