The Role of Ultrasonography in In-vitro Fertilization And Embryo Transfer (IVF-ET)

BACKGROUND: Although ultrasonography was introduced into Obstetrics and Gynaecology by a British Gynaecologist over five decades ago, the requirement for formal training in its use by gynecologists in Nigeriais just beginning to catch on, despite its indispensible role in various aspects of our clinical practice.OBJECTIVE: To describe the role of ultrasonography in in-vitro fertilization and the indispensability of the instrument to reproductive medicine.METHOD: A review of literature written in English language on the use and application of ultrasonography in in-vitro fertilization was done. The review covered articles published between 1980-2012.RESULTS: Ultrasound is the most versatile method for pre-treatment assessment in IVF being the dominant instrument for assessing ovarian reserve, pelvic pathologies and for assessing the uterine cavity. Theability of ultrasonography to measure endometrial thickness in addition to detecting uterine masses gives it an edge over laparoscopy/hysteroscopy as a diagnostic procedure in uterine cavity assessment, although hysteroscopy has the advantage of therapeutic potential. Similarly, ultrasonography is superior to biochemical methods for follicular monitoring because of its ability to demonstrate the number and sizes of follicles, and guide preparations for oocyte retrieval. The relative easeof ultrasound guided oocyte retrieval; its less technical demands and the possibility of conducting the procedure under local anaesthesia have made ultrasound guided oocyte retrieval more popular across the world.Randomized controlled trials show that ultrasoundguided transfer techniques have better outcomes than the clinical touch technique in terms of on-going pregnancies and clinical pregnancies. Ultrasonographyis now the key instrument for diagnosing and monitoring pregnancy following embryo transfer, biochemical methods being complimentary.CONCLUSION: Ultrasonography is now the single most important  instrument in in-vitro fertilization programmes and gynaecologists with interest in reproductive medicine need necessarily to obtain a formal training in its use.KEY WORDS: ultrasonography, in-vitro fertilization, infertility, assisted reproduction technolog

Effect of ethanol extract of Pyrenacantha staudtii leaves on carbontetrachloride induced hepatotoxicity in rats

The effect of ethanol extract of Pyrenacantha staudtii leaves on carbontetrachloride (CCl4) induced hepatotoxicity in rats was studied. Sixteen male wistar rats of 100-170g body weight divided into four groups of four rats each, designated – group I, II, III and IV were used. Groups II, III and IV were injected intraperitoneally with 5ml/kg body weight of CCl4; control was injected with 5ml/kg body weight corn oil. After 48hrs, groups III and IV were administered with 750mg/kg and 1500mg/kg body weight of the extract respectively and the rats sacrificed after 5 days. Phytochemical analysis of the extract revealed the presence of alkaloids, glycosides, saponnins, carbohydrates, tannins, flavonoids and resin. Result from the study showed that bothconcentrations of the extract (750mg/kg and 1500mg/kg body weight) significantly reduced (

Linear regression models for quantitative assessment of left ventricular function and structures using M-mode echocardiography

Changes in left ventricular structures and function have been reported in cardiomyopathies. No prediction models have been established in this environment. This study established regression models for prediction of left ventricular structures in normal subjects. A sample of normal subjects was drawn from a large urban population. Echocardiographic end diastolic diameters, end systolic diameters, posterior wall thicknesses in both systole and diastole, septal wall thicknesses in both systole and diastole were used to calculate left ventricular mass, left ventricular mass index, relative wall thickness and fractional shortening. Heights, weights, ages, and blood pressures of subjects were obtained. Pearson’s correlation coefficients were computed. Tests were two tailed with P < 0.05 indicating statistical significance. Three hundred and twenty two normal subjects of Ibo descent were enrolled in this study as volunteers between June, 2006 and April, 2007. Correlation coefficients between measured left ventricular structures and functions, and some anthropometric variables were computed. Linear regression models for the prediction of left ventricular structures were established. Prediction models for left ventricular structures have been established and could be useful inassessing morbidity in cardiomyopathies

Antimicrobial activities of methanolic extract of Gongronema latifolia stem on clinical isolate of Escherichia coli from diarrhoea patients

This study was carried out to investigate the antimicrobial activities of Gongronema latifolia stem extract on clinical isolates of Escherichia coli from diarrhoea patients. Twenty five isolates of E. coli were obtained from stool samples of diarrhoea patients within the ages of 1-5 in Nsukka Health Centre, Nsukka. The antimicrobial activity of the methanolic extract was then carried out using agar cup diffusion technique. The result of the study showed that the E. coli was moderately sensitive to methanolic extract of G. latifolia stem. This shows that in the treatment of infections caused by E. coli, methanolic extract of G. latifolia stem may be used

Risks associated with subsequent pregnancy after one caesarean section: A prospective cohort study in a Nigerian obstetric population

Context: Aversion for cesarean delivery is common in our practice and risks associated with caesarean section may contribute to this phenomenon.Objective: The objective of this study was to estimate the risks associated with subsequent pregnancies in women with one previous cesarean section in a low resource setting.Setting and Design: A prospective cohort study carried out at two major tertiary maternity centers in Enugu.Materials and Methods: Maternal and perinatal outcomes were compared between women with one previous caesarean and women who had only previous vaginal deliveries.Statistical Analysis Used: Analysis was performed with SPSS statistical software version 17.0 for windows (IBM Incorporated, Armonk, NY, USA) using descriptive and inferential statistics at 95% of the confidence level confidence.Results: A total of 870 women were studied. These were divided into 435 cases and 435 controls. The absolute risk of cesarean section in a  subsequent pregnancy in women with one previous cesarean was 75.8% (95% confidence interval [CI]: 72.0, 80.0). Cesarean section was  significantly commoner in women with one previous cesarean comparedwith those who had previous vaginal delivery (Relative risk [RR] =3.78; 95% CI: 1.8, 6.2). Placenta praevia (RR = 5.0; 95% CI: 2.6, 7.2.), labor dystocia (RR = 6.4, 95% CI: 3.2, 11.2) intrapartum hemorrhage (RR = 5.0, 95% CI: 2.1, 9.3) primary postpartum hemorrhage (RR = 5.0, 95% CI: 1.5, 4.3.), blood transfusion (RR = 6.0, 95% CI: 3.4, 10.6) and Newborn special care admission (RR = 2.5; 95% CI: 1.1, 4.9) were significantly more common in women with one previous cesarean compared with those with previous vaginal deliveries. The absolute risk of failed trial of vaginal birth after a cesarean was 45% (95% CI: 38.5, 51.5).Conclusion: Women who have one previous C.section face a markedly  increased risk of repeat caesarean sections and feto.maternal  complications in subsequent pregnancies. There is a need for doctors in Nigeria to be mindful of these risks while offering primary cesarean section in this low resource setting.Key words: Absolute risks, pregnancy after caesarean, primary cesarean sectio

Current approaches for assessment and treatment of women with early miscarriage or ectopic pregnancy in Nigeria: A case for dedicated early pregnancy services

Context: It has been suggested that women with early miscarriage or ectopic pregnancy are best cared for in dedicated units which offer rapid and definitive ultrasonographic and biochemical assessment at the initial review of the patient.Aims: To describe the current protocols for the assessment and treatment of women with early miscarriage or ectopic pregnancy as reported by  Nigerian Gynecologists, and determine if dedicated early pregnancy  services such as Early Pregnancy Assessment Units could be introduced to improve care.Settings and Design: A cross.sectional survey of Nigerian Gynecologists  attending the 46th Annual Scientific Conference of the Society of  Gynaecology and Obstetrics of Nigeria.Materials and Methods: This was a questionnaire.based study.Statistical Analysis: Data analysis was by descriptive statistics using Statistical Package for the Social Sciences software, version 17.0 for Windows (IBM Corporation, Armonk, NY, USA).Results: A total of 232 gynecologists working in 52 different secondary and tertiary health facilities participated in the survey. The mean age of the respondents was 42.6 } 9.1 years (range 28-70 years). The proportion of gynecologists reporting that women with early miscarriage or ectopic  pregnancy were first managed within the hospital general emergency room was 92%. The mean reported interval between arrival in hospital and first ultrasound scan was 4.9 } 1.4 hours (range .-8 hours). Transvaginal scan was stated as the routine initial imaging investigation by only 17.2% of respondents. Approximately 94.8% of respondents felt that dedicated early pregnancy services were feasible and should be introduced to improve the care of women with early miscarriage and ectopic pregnancy.Conclusions: Reported protocols for managing early miscarriage or ectopic pregnancy in many health facilities in Nigeria appear to engender  unnecessary delays and avoidable costs, and dedicated early pregnancy services could be both useful and feasible in addressing these  shortcomings in the way women with such conditions are currently  managed.Key words: Early pregnancy assessment units, ectopic pregnancy,  gynaecological ultrasonography, miscarriage,ultrasonograph

Variations in the prevalence of point (pre)hypertension in a Nigerian school-going adolescent population living in a semi-urban and an urban area

<p>Abstract</p> <p>Background</p> <p>Hypertension has been shown to start in early life and to track into adulthood. Detecting adolescents with hypertension and prehypertension will aid early intervention and reduce morbidity and mortality from the disorders. This study reports the point-prevalence of the two disorders in a semi-urban and an urban population of school-going adolescents in Nigeria.</p> <p>Methods</p> <p>A total of 843 adolescents from two places of domicile were studied. Their blood pressures and anthropometric indices were measured using standard protocol. Point-hypertension and point-prehypertension were defined with respect to each subject's gender, age and height. The prevalence of the disorders was calculated and reported age-wise and nutritional status-wise.</p> <p>Results</p> <p>The prevalence of point-prehypertension in the semi-urban area was 22.2% (20.7% for girls and 23.1% for boys) while it was 25.0% (21.8% for girls and 29.2% for boys) in the urban area. The prevalence of point-hypertension was 4.6% (4.1% for girls and 4.8% for boys) in the semi-urban area and 17.5% (18.0% for girls and 16.9% for boys) in the urban area. Point-prehypertension was not detected among the thin subjects of both places of domicile. The prevalence of point-prehypertension was similar in both the urban and semi-urban areas among the subjects who had normal BMI-for-age, and over-weight/obese subjects respectively. From the semi-urban to the urban area, the prevalence of point-hypertension increased approximately 3-folds among thin and normal BMI-for-age subjects, and 10-folds among overweight/obese subjects. Systolic hypertension was more preponderant in both the semi-urban and urban areas.</p> <p>Conclusions</p> <p>The prevalence of both disorders is considerably high in the studied populations. Urgent pediatric public health action is needed to address the situation.</p

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030