KNOWLEDGE OF EMERGENCY CONTRACEPTION AND PREDICTORS OF ITS USE AMONG FEMALE UNDERGRADUATES IN TWO NIGERIAN UNIVERSITIES.

Background: Unintended pregnancies contribute to the high burden of unsafe abortion, maternal deaths and morbidities among undergraduates. Objective: To assess the determinants of good knowledge and evaluate the trends in the practice of Emergency Contraception (EC) among female undergraduates. Methods: This was a cross sectional study involving four hundred and twenty female undergraduates from two universities in Ibadan, Nigeria. Participants were recruited from their hostels and classrooms. Data collection was done using self-administered questionnaires and good knowledge was defined as three correct answers to five questions testing knowledge. The questionnaires also addressed their practices of EC. The data was stored on the computer, cleaned and analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. Statistical significance was set at p <0.05. Results: Two hundred and fourteen (51.0%) participants were aware of EC and the common sources were friends (43.4%), media (42.9%) and pharmacies (42.0%). One hundred and sixty-four participants (39.1%) had good knowledge of EC. Participants in the age group 20-24 years, second year of study, those who were aware of EC and had ever used EC were associated with good knowledge. Less than half (48%) of the sexually active participants used EC in the past six months and Levonogestrel (51%) was the commonest EC used. Menstrual irregularity and abdominal pain were the major side effects of EC. Conclusion: The practice of EC is poor and with poor knowledge demonstrated among female undergraduates. There is therefore the need to improve information and access to EC in the university community.

PUERPERAL SEPSIS AT UNIVERSITY COLLEGE HOSPITAL, IBADAN: A 10-YEAR REVIEW.

Background: Puerperal sepsis is one of the leading causes of pregnancy-related maternal morbidity and mortality in developing countries. This study explored the complications, treatment modalities, and management outcomes of puerperal sepsis. Methods: A 10-year retrospective review of women managed for puerperal sepsis at University College Hospital, Ibadan, Nigeria between January 2009 and December 2018. Information on their socio-demographic and obstetrics characteristics, presenting complaints, treatment modalities, complications, and outcomes were obtained from the medical records. Data was analyzed with SPSS version 20. Descriptive statistics was done and results were presented in tables and chart. Results: The prevalence of puerperal sepsis during the period reviewed was 0.83%. The mean age of the women was 29.0±6.7 years. The primiparous women 53(33.5%) were mostly affected. Klebsiella spp 25(15.8%) was the most common organism isolated and most sensitive to the third generation of Cephalosporin and Quinolones. Anaemia 90(56.8%) was the most common complication and all the women had intravenous antibiotics while about half (46.5%) of those with abdominopelvic collections were managed surgically via laparotomy. The case fatality rate was 16.5%. Conclusion: Despite the low prevalence of puerperal sepsis within the period reviewed, a high case fatality was recorded. Cephalosporin and Quinolones should be considered in managing puerperal sepsis in our facility but more importantly prevention of maternal sepsis is essential.

HEALTHCARE FINANCING FOR ANTENATAL CARE AND DELIVERY SERVICES IN A TERTIARY HEALTH FACILITY IN SOUTH-WEST NIGERIA.

Background: Universal health coverage and healthcare financing for maternal health services are essential for quality care, prevention of complication and a reduction in maternal morbidity and mortality. Objective: To evaluate the modes of healthcare financing for antenatal and delivery care among pregnant women in a tertiary health facility in South-West Nigeria. Methods: This is a four-year retrospective review of maternal healthcare financing models adopted by pregnant/postpartum women at the antenatal clinic and labour/delivery unit. Data for health financing in antenatal booking clinic for a four-year period from 2016-2019 and labour & delivery for a two-year period from 2018 and 2019 were reviewed. The information collected were - number of women that paid out-of-pocket for services, number of women that paid for services using health insurance and other means of payment during the period. Data were analysed using SPSS version 23. Result: A total of 7,129 women accessed antenatal care services during the period under review. About 58.9% of the women paid for antenatal care services out-of-pocket, 36.6% were covered under the health insurance (social and private health insurance). A total of 2,881 women accessed delivery services at the health facility. About 66.4% of the women paid out-of-pocket for both caesarean section and vaginal delivery. Prepaid health insurance was used by about 31% of the women. Conclusion: Health insurance has been available for over a decade; however prepaid healthcare financing model remains less popular. Out-of-pocket payment constitutes the predominant mode of healthcare financing for maternal healthcare among pregnant women at the tertiary health facility. The out-of-pocket payment exposes the pregnant women and her family to financial burden and catastrophic spending especially in obstetric emergency.

Tumour cell membrane laminin expression is associated with basal-like phenotype and poor survival in Nigerian breast cancer.

INTRODUCTION: Laminin is a glycoprotein with diverse functions in carcinogenesis including cell proliferation, invasion, metastases and epithelial-mesenchymal transition (EMT). In breast cancer (BC) laminin expression is speculated to be associated with unfavourable clinicopathological and molecular characteristics. We hypothesize that laminin expression would contributed to the aggressive nature of basal like and triple negative BC phenotype observed in Black women. METHODS: The expression of laminin was determined in a well-characterised Nigerian cohort of 255 BC using tissue microarray and immunohistochemistry. Laminin expression was compared with clinical, pathological and survival characteristics. RESULTS: Laminin was expressed in 146 (57.3%) cases and significantly correlated with younger age at diagnosis (p=0.005), premenopausal status (p=0.003), expression of EGFR (p=0.002), ID4 and MTA1, basal cytokeratin 5/6, p53, and triple negative tumours (all p<0.001). In addition, there was an inverse association of laminin expression with E-cadherin (p=0.03), ER and PgR (all p<0.001) and a trend with BRCA1 (p=0.05). Univariate survival analysis showed tumours positive for laminin had significantly poorer breast cancer specific survival (BCSS, p=0.009) and disease free interval (p=0.03), but not associated in Cox multivariate analysis. CONCLUSION: This study demonstrates that laminin expression may have important roles in the aggressive nature observed in the basal-like and triple negative molecular subtype of Nigerian BC women.

Clinico-pathological study of female genital malignancies in Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.

OBJECTIVE: To ascertain the pattern and frequency of female genital malignancies among the different age groups, the common presenting complaints of cervical cancer patients and stages of presentation as seen in Sagamu, Ogun State. METHODOLOGY: A retrospective analysis of reports of formalin fixed paraffin embedded tissue blocks and slides of all female genital samples received at Morbid Anatomy & Histopathology Department of Olabisi Onabanjo University Teaching Hospital, Sagamu from January 1st, 2003 to June 30th, 2012. The personal data and clinical history were retrieved from laboratory forms and the patients' case files. RESULTS: The age range of patients whose specimens were reviewed was between 21-85 years. Cancers of the cervix accounted for majority (65.1%) of the cases followed by ovarian cancer (23.2%) and cancer involving the uterus (10.5%). Sixty-six percent of the cervical cancer patients are 50 years and above. Majority of the cervical cancer cases (82.2%) were squamous cell carcinoma. The common clinical features were post-menopausal bleeding (53.3%), vaginal discharge (43.3%), and intermenstrual bleeding (16.7%). The interval between onset of symptoms and seeking of healthcare was 6.7 ± 3.66 months. Stage IIIB cervical cancer was seen in 40% of the cervical cancer patients analyzed while no case of Stage IA was seen. Ninety-three percent of these patients were referred for radiotherapy. CONCLUSION: Cancer of the cervix is the commonest gynaecological malignancy and most patients presented late. Free or government subsidized cervical cancer screening programmes and awareness campaign is highly recommended.

Clinicopathological and molecular significance of Sumolyation marker (ubiquitin conjugating enzyme 9 (UBC9)) expression in breast cancer of black women.

The majority of breast cancers (BC) in Nigerian women are triple negative and show breast cancer-associated gene 1 (BRCA1) deficiency as well as the basal like phenotype, with a high mortality rate. In contrast to the well-defined predictive factors for the hormonal therapy, there is a paucity of information on the BRCA1 deficiency breast tumor biology, particularly among African women. BRCA1 Sumoylation (UBC9) has been speculated to be involved in the ER transcription activity, BRCA1 deficiency and triple negative BC. We therefore hypothesized that UBC9, a SUMOylation marker, may have contributed to the aggressive nature of BRCA1 tumor phenotype observed in Nigerian women. This study investigated the immunoprofiles of UBC9 in tissue microarray (TMA) of 199 Nigerian women and correlated their protein expression with clinical outcome, pathological responses and the expression of other biomarkers to demonstrate the functional significance in Nigerian women. The protein expression of UBC9, as compared with other biomarkers, showed an inverse correlation with steroid hormones (ER, progesterone (PgR)), BRCA1, p27, p21 and MDM4, and a positive correlation with triple negative, basal cytokeratins (CK14 and CK5/6), epidermal growth factor receptor (EGFR), basal-like breast cancer phenotype, p53, phosphoinositide-3-kinases (PI3KCA), placental cadherin, (P-cadherin) and BRCA1 regulators (metastasis tumor antigen-1 (MTA1). Survival analysis showed that those tumors positive for UBC9 expression had a significantly poorer breast cancer-specific survival (BCSS) as compared with those showing negative expression. UBC9 remained an independent predictor of outcome for BCSS. This study demonstrates that UBC9 appears to play an important role in the tumor biology of Nigerian women. Therefore, a novel UBC9 targeted therapy in black women with BC could enhance a better patient outcome.

Molecular characteristics and prognostic features of breast cancer in Nigerian compared with UK women.

Although breast cancer (BC) incidence is lower in African-American women compared with White-American, in African countries such as Nigeria, BC is a common disease. Nigerian women have a higher risk for early-onset, with a high mortality rate from BC, prompting speculation that risk factors could be genetic and the molecular portrait of these tumours are different to those of western women. In this study, 308 BC samples from Nigerian women with complete clinical history and tumour characteristics were included and compared with a large series of BC from the UK as a control group. Immunoprofile of these tumours was characterised using a panel of 11 biomarkers of known relevance to BC. The immunoprofile and patients' outcome were compared with tumour grade-matched UK control group. Nigerian women presenting with BC were more frequently premenopausal, and their tumours were characterised by large primary tumour size, high tumour grade, advanced lymph node stage, and a higher rate of vascular invasion compared with UK women. In the grade-matched groups, Nigerian BC showed over representation of triple-negative and basal phenotypes and BRCA1 deficiency BC compared with UK women, but no difference was found regarding HER2 expression between the two series. Nigerian women showed significantly poorer outcome after development of BC compared with UK women. This study demonstrates that there are possible genetic and molecular differences between an indigenous Black population and a UK-based series. The basal-like, triple negative and BRCA1 dysfunction groups of tumours identified in this study may have implications in the development of screening programs and therapies for African patients and families that are likely to have a BRCA1 dysfunction, basal like and triple negative.

Squamous cell carcinoma of the conjunctiva in Sagamu, Nigeria--a review and 2 case reports.

AIM: To review the current literature on squamous cell carcinoma [SCC] of the conjunctiva and report 2 presentations in Sagamu, Nigeria since the availability of histopathological services. METHODS: The available literature using e-medicine and pubmed internet websites were summarized. The 2 cases seen by the first author since histopathological services started at Olabisi Onabanjo University Teaching Hospital [O.O.U.T.H.], Sagamu were summarized using the case note records and the pathological reports of their surgical specimens. RESULTS: The 2 cases showed the variable ways SCC of the conjunctiva can present in an equatorial African country like Nigeria. DISCUSSION: Limbal interpalpebral conjunctival lesions should arouse the possibility of this rare neoplasia even in patients with no evidence of predisposing factors. CONCLUSION: Even though SCC of the conjunctiva is commoner in Caucasians, its possible presentations should be kept in mind in equatorial non-Caucasian populations like Nigeria.

Endometrial carcinoma following treatment for breast carcinoma in a Nigerian female. A case report and review of the literature.

Tamoxifen is the primary hormonal therapy for breast cancer as well as its chemoprevention. It is used in the management of breast cancer because of its anti oestrogenic effect. It is however an agonist on the endometrium with undesirable effects of endometrial proliferation with the risk of endometrial hyperplasia and carcinoma. Several authors have reported cases of endometrial hyperplasia and carcinoma following tamoxifen therapy for breast carcinoma. No such report has been made from Nigeria . This paper presents the first case of endometrial carcinoma following tamoxifen therapy for breast carcinoma in a 52 year old Nigerian female. It also highlights the recommended guidelines for the follow up of women with breast cancer on tamoxifen therapy.

Surgical complications from local herbal practitioners: report of five cases.

Over a 12-month period, five patients (out of a total of 72) with serious complications resulting from use of herbs by traditional healers were seen at the surgical unit of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The age range was one and a half to five years with a mean age of 23.4 +/- SD years and a male to female ratio of 3:2. All the cases were misdiagnosed and mismanaged and ended up with various complications. Such as penile amputations, digital necrosis, upper and lower limb gangrene as well a severe sepsis among others. Ignorance, cultural beliefs and attitudes, delusion, poverty and inaccessibility to orthodox medical practice were some of the factors responsible for the patronage of traditional healers.

Rectal carcinoma in a nine-year-old Nigerian male child: case report.

Carcinoma of the colon and rectum are rare in children and under the age of 40 years. A case of coro-rectal carcinoma in a nine-year-old Nigerian male child is reported. Family history was significant in the patient, it revealed that his father died three years earlier because of chronic diarrhoea and mucoid stool with associated on and off constipation and one of his elder brothers died eight years ago of colonic cancer at the age of twenty years. Exploratory laparotomy was done for the patient which revealed fixed rectosigmoid tumour with metastases to the liver, omentum and small intestine and ascites was also found. Hartmann's procedure with sigmoid colostomy was performed and the tumour was resected. Histological report of the biopsy specimen was consistent with poorly differentiated adeno-carcinoma. To the best of our knowledge, the youngest patient recorded in the literature is seven years old, which is younger than our patient, but this is still the youngest in our records.

Malignant Breast Lessions At Olabisi Onabanjo University Teaching Hospital (O.O.U.T.H), Sagamu-a Histopathological Review.

Various reports suggest an increasing incidence of breast cancer in Nigeria. The large volume of literature published on the subject of breast cancer bear witness to the interest shown in the subject. We therefore carried out a review of 50 cases of breast cancer recently confirmed histologically by our unit to study their characteristics and compare these with previous reports. A 2- years retrospective review of all histologically diagnosed carcinoma of the breast at Olabisi Onabanjo University Teaching Hospital, Sagamu from 2002-2003 was carried out. The peak age of occurrence was between 40-49 years with mean age of 47.5years. Invasive ductal carcinoma was predominant histologic type in 94% of cases and 72% presented late with advanced disease (Manchester stages 111 and 1V) with dismal prognosis. Surgery was the mainstay of treatment for both early and late disease. To ensure early and prompt detection, presentation and treatment, emphasis should be placed on female education, increasing awareness and encouraging breast self-examination. There is also a need for cancer registration centre in the hospital and a multicentred, controlled study of breast cancer in Nigeria.

Schistosomiasis--An unusual cause of abdominal pseudotumor.

Schistosomiasis is a common parasitic disease in the tropical and subtropical regions of Africa, Asia, South America and the Caribbean. It is the second most common parasitic infection of humans after malaria. Acute and chronic clinical presentations of S. monsoni are well described. Presentation as a pseudotumor is considered rare. We present a case of a 58-year-old Nigerian who presented with recurrent abdominal pain and abdominal mass of one-year duration. Stool was negative for schisostomal eggs, but histological specimen obtained from surgical resection of part of the caecum showed S. mansoni. The case was treated successfully by excisional biopsy and praziquantel therapy. A review of the literature is discussed.

Post-treatment hypomenorrhoea--a clinical indicator of long-term successful outcome of transcervical resection of the endometrium.

This study aims to evaluate the long-term effectiveness and define one of the indicators of successful outcome of endometrial resections. The study was carried out in a district general hospital setting. This was a retrospective analysis of 54 consecutive women who underwent endometrial resection over a 5-year period. Three (5.5%) complications were noted. Two were primary haemorrhage and one was a postoperative vaginal discharge. Eighty per cent of the patients expressed satisfaction with the outcome of their treatment. Expression of satisfaction at a later date was related to reduced menstrual flow at 6 months (0.005

Chemoprevention of 2-acetylaminofluorene-induced hepatotoxicity and lipid peroxidation in rats by kolaviron--a Garcinia kola seed extract.

The effect of kolaviron, a mixture of Garcinia biflavonoid 1 (GB1), Garcinia biflavonoid 2 (GB2) and kolaflavanone, used in the treatment of various ailments in southern Nigeria on hepatotoxicity and lipid peroxidation induced by 2-acetylaminofluorene (2-AAF) in rats was investigated. The ability of butylated hydroxyanisole (BHA) to attenuate the toxic effect of 2-AAF was also examined. Kolaviron administered orally to rats at a dose of 100mg/kg body weight twice a day for 1 week before challenge with 2-AAF (200mg/kg feed) and continuously for 3 weeks at a single dose of 200mg/kg body weight reversed the 2-AAF-mediated decrease in final body weight and relative organ weights, especially the liver. BHA was administered at a dose of 7.5g/kg feed to the animals for 4 weeks. The extract decreased significantly the 2-AAF-mediated increase in the activity of aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase and ornithine carbamyl transferase by 58%, 62%, 60% and 67%, respectively. BHA elicited respectively 55%, 63%, 57% and 65% reduction in the 2-AAF induced-increase in the activities of these enzymes. Histological examination of the liver slices correlated with the changes in serum enzyme alterations. Similarly, kolaviron decreased the 2-AAF reduction of 5'-nucleotidase and glucose-6-phosphatase activities by 63% and 60%, respectively while BHA elicited 59% and 61% decrease in the activities of these enzymes. Simultaneous administration of kolaviron with 2-AAF inhibited microsomal lipid peroxidation as assessed by the thiobarbituric acid reacting substances (TBARS) formation by 66%. BHA produced a 64% reduction in TBARS formation. In the present study, kolaviron appears to act as an in vivo natural antioxidant and an effective hepatoprotective agent and is as effective as BHA.

Invasive cervical carcinoma in two sisters

The occurence of pre-invasive cervical carcinoma among siblings and in mother-daughter pairs has been reported previously in Europe. Invasive cervical cancer diagnosed in two Nigerian sisters within a period of three months is reported. It is suggested that sisters and daughters of patients with cervical cancer may be at a higher risk of developing the lesion because of similar socio-economic and cultural backgrounds and should therefore have regular cervical screening