Massive haemoperitoneum from endometriosis masquerading as ruptured ectopic pregnancy: Case report

Endometriosis is a puzzling disease affecting women of reproductive age .Although it is diagnosed frequently, no consensus exists as to the aetiology of this enigmatic disease . Common locations of ectopic endometrial growths are in the abdomen involving the pelvic structures. Like in the uterine lining, these extra-uterine endometrial growths usually respond to hormones of the menstrual cycle. The tissues build up each month, break down and cause bleeding. However, unlike the lining of the uterus, endometrial tissues outside the uterus have no way of leaving the body. The result is internal bleeding, which if moderate to severe, may lead to massive haemoperitoneum. Philip et al , report an unusual cause of acutehaemoperitoneum in an asymptomatic woman with bleeding from the right uterine artery eroded by pelvic endometriosis. Areport of massive haemoperitoneum in pelvic endometriosis on progestogen treatment presenting as ruptured tubal ectopic pregnancy is presented

Quarter of a Century of Female Sterilization in Jos, Central Nigeria

The study was to assess the types and trend of female sterilization between January 1985 and December 2009 (25 years) in Jos, Central Nigeria. There were 25,313 new acceptors of modern contraceptive methods out of which 4,951 (19.6%) were female sterilizations. Minilaparotomy was the commonest method of female sterilization. Local anaesthesia was the commonest anaesthetic utilized. The women were mostly women of relatively older age, grandmultiparous and with large family size. The women were of mean of 38.4 years, and 60% had more than 5 children at the time of sterilization. Interval sterilization constituted 78.5% of the female sterilizations. The acceptance of female sterilization, however, has declined over the years, as acceptance of the long acting contraceptive implants increases. Female sterilization by minilaparotomy under local anaesthesia was found to be feasible, cost effective and acceptable by majority of clients, and  recommended for integration into minor gynaecological procedures in ourinstitutions (Afr J Reprod Health 2011; 15[1]: 101-106)

Indications for removal of etonogestrel implant within two years of use in Jos, Nigeria

Background: Implanon® is a new long-term and reversible sub-dermal contraceptive implant in Nigeria. It is a single rod containing 68mg of etonogestrel meant to offer contraception for three years and marketed by Organon.Objective: To determine the indications for removal of lmplanon® rods from clients within a two-year period.Design: A retrospective review of 30 consecutive lmplanon® removals within the study period.Setting: The fertility regulation unit of the department of obstetrics and gynaecology ofthe Jos University Teaching Hospital, North-Central Nigeria.Results: A total of 30 clients requested for and had their lmplanon® rods removed out of 669 insertions constituting 95.5% crude continuation rate in the second year. The clients were of mean age 31.4 ± 6.2 years, mean parity 2.9 ± 1.8 and mean number of living children 2.7 ± 1.6. There was an average weight gain of 1.9 kg. The most common indication for removal was menstrual disruption (33.3%). Desire for another pregnancyclosely followed (30.0%). Weight gain was another indication for discontinuation (13.3%). Two women were pregnant at insertion of the implant. There was one failure of the method with pregnancy as a result. Spousal disapproval was an indication for removal in two cases.Conclusion: Like all progestin-only contraceptive methods, menstrual disruption was the most common indication for removal of implants. Inadvertent insertion of implants with existing pregnancy is of concern and should be avoided as much as is possible. In doubtful cases at insertion, this insertion should be deferred or serum â-HCG should be assessed to exclude chemical pregnancy

Physician use of updated anti-virus software in a tertiary Nigerian hospital

While physicians are becoming increasingly dependent on computers and the internet, highly lethal malware continue to be loaded into cyberspace. We sought to assess the proportion of physicians with updated anti-virus software in Jos University Teaching Hospital Nigeria and to determine perceived barriers to getting updates. We used a pre-tested semi-structured selfadministered questionnaire to conduct a cross-sectional survey among 118 physicians. The mean age (±SD) of subjects was 34(±4) years, with 94 male and 24 female physicians. Forty-two (36.5%) of 115 physicians with anti-virus software used an updated program (95%CI: 27, 45). The top-three antivirus software were: McAfee 40(33.9%), AVG 37(31.4%) and Norton 17(14.4%). Common infections were: Trojan horse 22 (29.7%), Brontok worm 8(10.8%), and Ravmonlog.exe 5(6.8%). Internet browsing with a firewall was an independent determinant for use of updated anti-virus software [OR 4.3, 95%CI, 1.86, 10.02; P< 0.001]. Busy schedule, 40(33.9%) and lack of credit card 39(33.1%) were perceived barriers to updating antivirus software. The use of regularly updated anti-virus software is sub-optimal among physicians implying vulnerability to computer viruses. Physicians should be careful with flash drives and should avoid being victims of the raging arms race between malware producers and anti-virus software developers.Keywords: Anti-virus software; Computer security; Updates; Physicians; Nigeri

Manpower capacity and reasons for staff shortage in primary health care maternity centres in Nigeria: A mixed-methods study

The heart-breaking maternal and neonatal health indicators in Nigeria are not improving despite previous interventions, such as ‘Health for all’ and ‘Millennium Development Goals. The unattained health-related goals/targets of previous interventions put the success of the new Sustainable Development Goals in doubt if the existing paradigm remains unchanged. Thus, mere branding of health policies without improving what constitutes the health system such as manpower capacity and quality as well as staff-patients ratio will be wasteful efforts. This issue of global public health concern provided an indication for describing the capacity of manpower and reasons for staff shortage in primary level of health that are providing maternity services to women and their new-borns in Nigeria

A critical look on condoms

No Abstract

A critical look on condoms

No Abstract

Severe twin-to-twin transfusion syndrome in a scared uterus successfully treated with serial amnioreduction

Background: Twin-to-twin transfusion syndrome (TTTS) is a vascular abnormality unique to monochorionic pregnancies. The associated polyhydramniosportends significant risk to uterine rupture especially in a scared uterus. Serial amnioreduction is an established technique that reduces the risks of severe polyhydramnios thereby preventing overstretching of the uterus and ameliorates maternal symptoms.Methods: The case records of a patient who has had three previous caesarean sections and presented with respiratory distress following severe polyhydramnious were reviewed.Result: A total of 7,225mls of amniotic fluid was removed over a 3 month period; and grade II discordant intrauterine growth restriction (IUGR) was confirmed at delivery. Conclusion: Serial amnioreduction was successful in relieving maternal symptoms and prevented the risk of uterine rupture in a woman with three previous caesarean section scars.Keywords: Twin-to-Twin Transfusion Syndrome, Polyhydramnios, Amnioreduction