The cervical smear pattern in patients with chronic pelvic inflammatory disease

Background: Cancer of the cervix is the commonestmalignancy of the genital tract inNigeria. In an atmosphere of opportunistic screening due to lack of a national screening programme, studies are needed to determine patients at risk of premalignant lesions of the cervix. Goal: To determine cervical smear pattern in patients with chronic pelvic inflammatory disease and investigate the potential of chronic pelvic inflammatory disease as a risk factor to cervical dysplasia. StudyDesign: Case- control study. Setting : Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Subjects: Three hundred and sixty-nine premenopausalwomen attending the gynaecologic and family planning clinics ofAhmaduBelloUniversity TeachingHospitalZaria,Nigeria fromJanuary toDecember 2000. Results: Of the 369 women that had cervical cytology by Pap smear, 163 (44%) had chronic pelvic inflammatory disease (cases) while 206 (56%) were non chronic PID patients (control). There was no statistical significance in the mean age between the two groups. The mean age at first coitus and marriage of all the womenwere 17.92.7 years and 18.5 3.4 years respectively.Therewere 52 dysplastic smears encountered, giving a prevalence rate of 140/1,000 or 14% for Cervical Intraepithelial Neoplasia. There were higher cases of dysplasia in the chronic PIDgroup than in the control and this differenceswas statistically significant (p4) and age of first coitus less than 20 years. Only 10%of all thewomen screenedwere aware of both cervical cancer and Pap smear. Conclusion: Women with chronic pelvic inflammatory disease are probably at higher risk of developing cervical dysplasia than women without chronic pelvic inflammatory disease.Cervical cancer screening programmes should be intensified in chronic pelvic inflammatory disease patients.However, further studies are needed in our setting to verify the association between pelvic inflammatory disease and cervical dysplasia.Keywords:  Cervical smear, pelvic inflammatory disease, cervical cancer

Carcass Characteristics and Internal Organs of Broilers Fed Roasted Pride of Barbados Seedmeal

A feeding experiment was conducted at the poultry unit of the Teaching and Research Farm of the Oyo State College of Agriculture, Igboora located on latitude 71340 and longitude 31280E to evaluate the effects of dietary roasted pride of barbados seed meal on carcass characteristics and internal organ weights of broiler chickens. Seventy-two day old Marshal broiler chicks obtained from Obasanjo Farms, Igboora, Nigeria were divided into four treatments and each treatment was replicated three times with a total of six birds per replicate. The ripened seeds of pride of barbados obtained within Igboora metropolis were roasted at 100-1100C using open flame for seventeen minutes in an open pan. The seeds were considered roasted when about 75-80% of the seed cracked. The roasted pride of barbados seedmeal was included at different levels 5,10 and 15 percent respectively in broiler rations. The experiment lasted for eight weeks. There were significant variations (P<0.5) in the value of all the parameters except in the mean values recorded for lung and empty gizzards in some treatments. Higher values were recorded in 10% inclusion level of roasted pride of barbados seedmeal than all other treatments, while the least values were recorded in 0% inclusion level of roasted pride of barbados seedmeal. From this seedmeal in broiler ration was found to be beneficial at 10%. Keywords: Anti-nutritional factors; Broiler; Carcass; Internal organs; Proximate analysis, Roasted pride of barbados seedmeal.

A comparison of oral versus vaginal misoprostol for induction of labor at term, at the Ahmadu Bello University Teaching Hospital, Zaria

Background: The comparison of same,equal and low dose of misoprostol by the oral and vaginal routes for induction of labour at term requires further elucidation.Objective: To compare the efficacy and safety of 25 micrograms (ug) of oral misoprostol with 25ug vaginal misoprostol for induction of labor at term.Methods: A randomised control trial that involved 169 consented women with indication for induction of labor. A total of 85 women had oral misoprostol while 84 women had vaginal misoprostol. The oral misoprostol dose (25ug) was repeated every 2 hours, while the vaginal dose (25ug) was repeated every 6 hours for a maximum duration of 24 hours or when need arose for intervention. Data was analysed using SPSS version 20.Results: The mean induction-delivery interval was significantly shorter (18.48 +/- 2.01 vs. 22.82 +/- 2.50, P = 0.00), with more vaginal deliveries (88.2% vs. 85.7%, P = 0.00) in the oral group compared to the vaginal group respectively. The cardiotocographic abnormalities in the vaginal group were significantly higher than the oral group (8.3% vs. 1.2%, P = 0.03). There were more foetal distress and meconium stained liquor in the vaginal group but not statistically significant.Keywords: Efficacy; oral misoprostol; safety; vaginal misoprosto

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation

Retained Copper Sleeve and haematometria, an unusual complication of Copper-T use

Retained copper sleeve of copper-T IUCD and haematometria was observed in a patient. Same was retrieved with drainage of haematometria under general anesthesia with satisfactory outcome

Water absorption kinetics of five varieties of maize as affected by soaking conditions during processing of “Ogi”

This study determined the water absorption kinetics of five varieties of maize (A4W, C3Y, D8W, B2Y and E9W) during soaking for 12 to 96 h at varying soaking temperatures. Water absorption changes were evaluated based on a 5 × 2 × 9 factorial design (varieties × soaking methods×soaking periods). Soaking temperature (20, 30, 40 and 50OC) effects were investigated on the water absorption on a 5 × 4 × 6 factorial design (varieties×soaking temperature × soaking periods). The results revealed that the Peleg constant rate (k1) and capacity constant (k2) were statistically significant (p<0.05) and decreased with increase in soaking temperature. The equilibirium moisture content increased significantly (p<0.05) with increase in soaking temperature while the predicted time to attain equilibirum for B2Y were 49.67, 33.80, 24.58 and 23.73 hours for soaking temperature at 20, 30, 40 and 50oC, respectively. Similar trend was recorded for other maize varieties. The activation energy (Ea) of hydration were 96.06 kJmol-1 (C3Y), 53.60 kJmol-1 (A4W), 47.08 kJmol-1 (E9W), 39.71 kJmol-1 (B2Y) and 31.49 kJmol-1, respectively. Variety D8W with lower activation energy of hydration (Ea), high entropy (ΔS) and free energy (ΔG) was more thermally stable compared with other maize varieties. This study suggested information with beneficial energy saving effect, especicially for design processes and handling equipment for commercial production of “Ogi”.Keywords: Maize, Ogi, Rehydration, absoprtion rate, activation energy, peleg constan

Changes induced by soaking period on the physical properties of maize in the production of Ogi

This study was aimed at investigating the effect of soaking method and period on some selected physical properties on maize varieties. Five varieties of maize (A4W, C3Y, D8W, B2Y and E9W) were soaked for 12–96 h at ambient temperature of 28 and average hot temperature of 65°C as generally praciticed in the production of Ogi from cereals. Some selected physical properties were evaluated based on a 5 × 2 × 9 factorial design (varieties × soaking methods × soaking periods). The reseult revealed that the linear dimensions of the five varieties of soaked maize increased with increase in linear dimensions up to about 36th hour of soaking. The percentage increase in width was in the range of 5.482–9.67%, 4.064–8.25%, 3.76–6.81% and 0.88–1.81%, for C3Y, B2Y, D8W, A4W and E9W for both soaking conditions, respectively. Significant difference (p  0.05) in the values obtained for sphericity at soaking condition of 65°C compared with soaking at 28°C. This study showed that the period of soaking had significant effect (p < 0.05) in increasing the overall dimensions of maize grains up to 36th hour and thereafter witnessed an irregular pattern