Effect of pre-operative sub-lingual misoprostol versus intravenous oxytocin on Caesarean operation blood loss

Background: Caesarean operation remains the most common abdominal surgery in women and has immense benefits to both mother and baby when employed. Haemorrhage, however, remains the greatest challenge associated with its outcome.Objective: To compare the effectiveness of pre-operative sub-lingual misoprostol with intravenous oxytocin administered after delivery of the neonate in minimising blood loss at Caesarean operationDesign: A prospective study.Results: The mean blood loss was significantly lower in misoprostol group compared to oxytocin group (517.32mls versus 621.22mls; p = 0.005). The drop in haematocrit was significantly lower in misoprostol group than the oxytocin group, (400μg-misoprostol versus oxytocin: 1.88 versus 3.04; p=0.0001). Side effects of chills, shivering and pyrexia were noted more with the use of misoprostol.Conclusion: Pre-operative sub-lingual misoprostol is more effective than intravenous infusion of oxytocin in reducing blood loss at Caesarean section operation. However, occurrence of transient side effects of chills, shivering and pyrexia were noted more with use of misoprostol

Free Radical Attack on Membrane Lipid and Antioxidant Vitamins in the Course of Pre-Eclamptic Pregnancy

Background: Despite the volume of knowledge and daily reports on pre-eclampsia, its pathogenesis is still yet to be ascertained. Oxidative stress (oxidant (free radical) in excess of antioxidant) injury is one of the recently suggested pathogenetic mechanisms. This study, however, was designed to determine second and third trimesters of plasma malondialdehyde (product of free radical attack on membrane lipid) and vitamins C and E in pre-eclamptic Nigerian women.Subjects and methods: A Total of 100 subjects, each for pre-eclamptic, apparently normal and non-pregnant women qualified for the study. Venous blood samples were taken in the second and third trimesters of pregnancy and at the point of contact for non-pregnant women. Variables were analyzed using SPSS version 16, taking level of significance to be 0.05.Results: Plasma malondialdehyde in the third trimester of normal pregnancy (2.03±0.71μmol/l) was found to be significantly higher than the one in the second trimester (1.65±0.62μmol/l) (p<0.0001). For pre-eclamptic subjects, the malondialdehyde in the third trimester (3.13±0.61μmol/l) was also higher than the malondialdehyde in the second trimester (3.00±1.21μmol/l).The mean vitamin C values for subjects with normal pregnancy were similar in the second and third trimesters (38.25±19.66 vs. 38.66±19.40; p=0.882). For subjects with pre-eclampsia, the mean Vit C values were also similar in the 2nd and 3rd trimesters (35.05±18.37 vs. 37.20±24.44μmol/l;p=0.175).Mean vitamin E values in the second and third trimesters were also similar for subjects with normal pregnancy (28.62±13.85 vs. 28.50±13.35μmol/l;p=0.950). A similar finding was observed in pre-eclamptic subjects (25.09±12.79 vs. 28.00±14.83μmol/l;p=0.067).Conclusion: There was an increased product of membrane lipid attack (malondialdehyde) with no change in plasma levels of vitamins C and E as pregnancy advances into the third trimester of both normal and pre-eclamptic pregnancies. Antioxidant vitamins may not be useful in stopping the progression of free radical attack on membrane lipid to control pre-eclampsia.Keywords: Lipid peroxidation, Malondiadehyde, Free radical, Pre-eclampsia, Trimester, Vitamin

The Changes in China's Forests: An Analysis Using the Forest Identity

Changes in forest carbon stocks are a determinant of the regional carbon budget. In the past several decades, China has experienced a pronounced increase in forest area and density. However, few comprehensive analyses have been conducted. In this study, we employed the Forest Identity concept to evaluate the changing status of China's forests over the past three decades, using national forest inventory data of five periods (1977–1981, 1984–1988, 1989–1993, 1994–1998, and 1999–2003). The results showed that forest area and growing stock density increased by 0.51% and 0.44% annually over the past three decades, while the conversion ratio of forest biomass to growing stock declined by 0.10% annually. These developments resulted in a net annual increase of 0.85% in forest carbon sequestration, which is equivalent to a net biomass carbon uptake of 43.8 Tg per year (1 Tg = 1012 g). This increase can be attributed to the national reforestation/afforestation programs, environmentally enhanced forest growth and economic development as indicated by the average gross domestic product

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defi ned criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specifi c DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defi ned criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specifi c DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI)

Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe

Role of routine semen culture in evaluation of male infertility

No Abstract

Extra Ovarian Serous Cystadenocarcinoma in the Broad Ligament

The embryonic remnants of the gonadal ridge and the genital duct apparatus, the Mullerian apparatus, remain atretic throughout the life of a woman. The definitive organs arising from these, the Ovary, Fallopian tubes, Uterus, Cervix and the Broad ligaments share common coelomic origin. Epithelial metaplasia in any of these organs may differentiate along any of the cell lines in these definitive organs. A. M. was a 52-year old para3+1 woman who presented with eighteen month history of increasing abdominal pain and discomfort, nine months history of progressive abdominal swelling, distension and weight loss. She had ascites that was cytologically positive for malignant cells. Abdominal ultrasonogram and other clinical indices were in keeping with advanced ovarian disease. At surgery findings were 1,450 mls of bloodstained ascitic fluid, uterus of about 16 weeks size, grossly normal ovaries and a huge multi-nodular and friable right broad ligament tumour. She had total abdominal hysterectomy, bilateral salpingo-oophorectomy and infra-colic omentectomy. The broad ligament mass was excised along with the delivery of the uterus, and revealed moderately differentiated serous cyst adenocarcinoma. This presentation demonstrates a rare condition of serous cystadenocarcinoma in the broad ligament found in our practice

Cervical Cytology in Sagamu Nigeria

Cervical cancer is the commonest female genital tract cancer and second to breast in cancer deaths worldwide. In sub-Saharan Africa it is the commonest cancer and most common cause of cancer deaths in women. The incidence keeps declining in the advanced and industrialized countries of the world due to effective screening programme. The gold standard tool for effective screening programme is the cytology based Pap smear test. The human and material requirements for Pap smear and cytology make it less practicable for effective coverage in poor resource countries thus resulting in less than 5% of women needing screening being covered. The incidence of CIN has been variously quoted between 2% and 12.5% worldwide. To determine the incidence of CIN in women who attend the well women clinic for cervical cancer screening in our hospital. Case records and cytology results of all women who attended Well Women Clinic of our hospital between January, 2005 and December, 2013 were reviewed and analysed using the SPSS version 16.0 statistical package. Four hundred and sixty-seven women had cervical cancer screening using Pap smear and cytology during the study period. Twenty-nine (6.5%) had smear showing intraepithelial neoplasia and 19 (4.1%) of these were high grade lesions. Finding of 6.5% prevalence rate of cervical intraepithelial neoplasia, and with over half of these being high grade lesions in this study, justifies the need to intensify screening of women, especially those in the reproductive age group.Keywords: Cervical; Cytology; Sagamu; Nigeria

Knowledge of emergency contraception among students in a tertiary institution in a developing country

Abiodun Adeniyi Adewunmi,1 Kabiru Afolarin Rabiu,1 Adetokunbo Olufela Tayo,1 Tawakwalit Abimbola Ottun,1 Bolu Sunday Adeboye,2 Raheem Akinwunmi Akindele31Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja-Lagos, 2Department of Obstetrics and Gynaecology, State Specialist Hospital Akure Ondo State, 3Department Of Physiology, Obafemi Awolowo College Of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, NigeriaBackground: Emergency contraception (EC) has been available in developing countries without prescription for some time. There is, however, little research into the extent of the knowledge of mode of action, effectiveness, and availability of this form of contraception in rural areas.Objectives: To assess the knowledge of EC with respect to mode of action, effectiveness, and availability in rural areas among students in a tertiary institution in a developing country.Methods: A questionnaire was distributed to tertiary students in a university in rural area in a developing country. This questionnaire asked about their knowledge of the mode of action of EC, its availability over the counter, its cost, and the student's willingness to purchase it.Results: Some 488 of the 500 questionnaires were returned. One hundred and eight (22.1%) of the students had used EC or bought it for a girlfriend at some stage in the past. Two hundred and forty four (50.0%) knew the correct timeframe for its use, while 201 (41.2%) were not aware of its availability over the counter in pharmacies, and 150 (30.7%) felt unable to purchase EC in a pharmacy where they are known. One hundred (20.5%) of the participants were aware of the cost of EC.Conclusion: The students had good knowledge of the timeframe for the use of EC, but lacked information regarding the availability and the cost of EC in the community.Keywords: developing country, emergency contraception, knowledg

Factors associated with acceptability of child adoption as a management option for infertility among women in a developing country

Adeniyi Abiodun Adewunmi,1 Elizabeth Arichi Etti,1 Adetokunbo Olufela Tayo,1 Kabiru Afolarin Rabiu,1 Raheem Akinwunmi Akindele,2 Tawakwalit Abimbola Ottun,1 Fatimat Motunrayo Akinlusi11Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja-Lagos, 2Department of Physiology, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu-Ogun State, NigeriaBackground: Adoption as a treatment option for infertility amongst those that cannot access and/or afford assisted reproduction is not well accepted in developing countries. This study sets out to determine the willingness of infertile women in developing countries to adopt a child and factors that influence women's attitude to adoption.Methods: We conducted a questionnaire survey of consecutive infertile patients who attended the gynecological clinic of a regional teaching hospital over a 2-month period. Information on demographics, fertility history, and attitude to adoption was obtained, and the data were analyzed using SPSS version 16.0. Tests of statistical significance were used where appropriate at the 95% confidence level.Results: The majority of respondents were aware of child adoption, and the most common source of information was friends (47.8%), followed by the media (39.7%); 42.6% of respondents were willing to adopt if their infertility became intractable. The main reasons given by those unwilling to adopt were culture (78.3%) and family constraints (13.45%). On univariate analysis of factors associated with a favorable or unfavorable attitude to adoption, awareness of adoption (P = 0.002), duration of infertility > 5 years (P = 0.015), no living child (P = 0.007), tertiary education (P < 0.001), pressure from parents (P = 0.041), household yearly income ≥ $650 (P < 0.001), and belief that treatment will bring about the desired results (P < 0.001) were significant, and all except awareness of adoption turned out to be significant on multiple logistic regression analysis.Conclusion: There was a high level of awareness about child adoption among all respondents. However, the acceptability of adoption was significantly lower among poor women and those with limited education. Community advocacy and mobilization, especially through the media as well as via health care providers, will go a long way towards enlightening and enhancing the uptake of adoption among women in Nigeria.Keywords: infertility, adoption, developing country, Nigeri