Pre-Caesarean Section Vaginal Preparation with Chlorhexidine Solution in Preventing Puerperal Infectious Morbidities: A Randomized Controlled Trial.

BACKGROUND: Globally, peripartum or puerperal infections account for about one tenth of maternal mortality, most of which occur in low income countries. Therefore, vaginal preparation with an antiseptic prior to a caesarean delivery could be considered an additional measure to prevent subsequent infectious morbidities. OBJECTIVES: To evaluate vaginal preparation with 0.3% chlorhexidine solution in the prevention of endometritis, surgical site infection and post-operative fever following emergency caesarean section. METHODS: This prospective randomized controlled trial (RCT) was conducted among 240 participants planned for emergency caesarean sections (CS) at term in the University of Medical Sciences Teaching Hospital Complex, Ondo State, Nigeria. Participants were randomised into either group "A" (study) or "B" (control). The former had vaginal preparation with 0.3% chlorhexidine gluconate immediately after anaesthesia while the latter received normal saline. Participants were followed up post-operatively during which clinical features of puerperal infectious morbidities were observed for each during admission as well as 8th and 14th days after delivery. RESULTS: The rate and risk of endometritis were significantly lower in the study group compared to the control; 5.0% versus 13.3%, respectively (chi squared =5.004; p=0.042, RR = 0.38; 95% CI = 0.15-0.94; p = 0.042; RRR = 0.62). Post-operative fever and surgical site infection, were also lower in the study group compared to the controls, but the difference was not statistically significant. CONCLUSION: When compared to placebo, pre-caesarean section vaginal preparation with 0.3% chlorhexidine solution significantly reduced only the rate and risk of post-operative endometritis among infectious morbidities.

CONTEXTE: À l'échelle mondiale, infections péripartum ou puerpérales représentent environ un dixième de la mortalité maternelle, dont la plupart se produisent dans les pays à faible revenu. Par conséquent, la préparation vaginale avec un antiseptique avant un accouchement par césarienne pourrait être considéré comme un mesure supplémentaire pour prévenir les morbidités infectieuses subséquentes. OBJECTIFS: Évaluer la préparation vaginale avec 0.3%solution de chlorhexidine dans la prévention de l'endométrite, site chirurgical infection et fièvre postopératoire après une césarienne d'urgence section. MÉTHODES: Cet essai prospectif randomisé contrôlé (ECR)a été menée auprès de 240 participants prévus pour une urgence césariennes (CS) à terme à l'Université des sciences médicales Complexe hospitalier universitaire, État d'Ondo, Nigéria. Les participants étaient randomisé dans le groupe "A" (étude) ou "B" (témoin). Celui-là avait une préparation vaginale avec 0.3 % de gluconate de chlorhexidine immédiatement après l'anesthésie alors que ce dernier a reçu une solution saline normale. Les participants ont été suivis postopératoirement au cours desquels des caractéristiques de morbidité infectieuse puerpérale ont été observées pour chaquelors de l'admission ainsi que les 8ème et 14ème jours après la livraison. RÉSULTATS: Le taux et le risque d'endométrite étaient significativement plus faibles dans le groupe d'étude par rapport au groupe témoin; 5.0 % contre 13.3 %, respectivement (chi carré =5.004; p=0.042, RR = 0.38; 95% CI = 0.15­0.94; p = 0.042; RRR = 0.62). Fièvre postopératoire et infection du site chirurgical, étaient également plus faibles dans le groupe d'étude par rapport aux témoins, mais lela différence n'était pas statistiquement significative. CONCLUSION: Par rapport au placebo, pré-césarienne préparation vaginale avec une solution de chlorhexidine à 0.3% significativement réduit uniquement le taux et le risque d'endométrite postopératoire chez morbidités infectieuses. Mots-clés: Chlorhexidine, Préparation Vaginale, Infection Puerpéral emorbidité, Césarienne, Endométrite, Fièvre Postopératoire, Infection Du Site Chirurgical.

THE TOOTH SHADE MATCHING ABILITY AMONG DENTAL PROFESSIONALS: A COMPARATIVE STUDY.

Background: Shade matching presents a complex and multidimensional process that involves the cognitive ability of the operator. Hence, dental professionals need to have high shade matching skill. Objective: To compare the shade matching ability among three categories of dental professionals and assess the inter-examiner reliability of the visual shade selection. Methods: This was a cross sectional study involving conventional visual tooth shade selection by three categories of dental professionals. Twenty four patients that met the selection criteria were included in the study and Ethical approval duly obtained. Visual shade selection using vital classical shade guide was done by calibrated 3 categories of the dental professionals. Data collected was analysed using IBM SPSS with statistical significance placed at p ≤0.05. Results: There were 9 (37.5%) male and 15 (62.5%) female participants with mean age ±SD of 39.9 ± 18.47 years. In the shade selection, the dental surgery technician and the house officer agreed in 2 (7.7%) teeth, dental surgery technician and consultant in 6 (23.1%) teeth while the house officer and consultant did so for 8 (30.8%) teeth. The three examiners agreed on shades selected for only 1 (3.8%) tooth. Inter-examiner reliability was 0.11. Shades selected by the consultant matched that of the spectrophotometer in 3 of the 26 teeth (11.5%) being the best. Conclusion: Inter-examiner reliability was very low in the conventional visual shade selection. Experience and training in colour science and shade selection may play a role in correct tooth shade selection.

The influence of the design of mandibular major connectors on gingival health.

BACKGROUND: The objective of this study was to assess the influence of lingual bar and lingual plate major connectors on plaque retention and gingival health among patients who presented in University College Hospital (UCH), Ibadan, Nigeria. METHODS: This comparative intervention study was carried out among fifteen patients aged 28 to 60 years with Kennedy class III lower edentulous arch. Two metal dentures with different major connector designs (lingual plate and lingual bar) were fabricated for each patient. After professional scaling and polishing, a baseline score of the oral hygiene was done using the plaque index of Sillness and Loe and the gingival health using the gingival index of Loe and Sillness. Each patient was randomly assigned either a denture with the plate or bar design to use for three months and then recalled for reassessment of oral hygiene and gingival health. Professional scaling and polishing was done post removal and a new baseline assessment of oral hygiene and gingival health recorded. The dentures were now exchanged and the second major connector design inserted. Each patient was recalled for reassessment of the oral hygiene and gingival health after three months. The level of plaque accumulation and gingival inflammation with the use of lingual plate and bar dentures were determined and compared. RESULTS: There was no statistically significant difference in the mean plaque index score for the lingual bar design at three months and the mean plaque index score at three months for the lingual plate (p > 0.05). However, a statistically significant lower mean gingival index score was noted three months post insertion for lingual bar designs when compared to plate designs. CONCLUSION: Within the limitation of this study, better gingival health was noted with the bar designs when compared with the plate designs.

Molecular approaches to the identification of Bulinus species in south-west Nigeria and observations on natural snail infections with schistosomes.

The current study considers the distribution of a small sample of 138 Bulinus snails, across 28 localities within eight Nigerian states. Snails were identified using a combination of molecular methods involving both DNA sequencing of a partial cytochrome oxidase subunit 1 (cox1) fragment and restriction profiles obtained from ribosomal internal transcribed spacer (its) amplicons. The results showed that the majority of Bulinus samples tested belonged to the species Bulinus truncatus while only two were Bulinus globosus. The use of RsaI restriction endonuclease to cleave the ribosomal its of Bulinus, as a method of species identification, was adopted for the majority of samples, this being a quicker and cheaper method better suited to small laboratory environments. Polymerase chain reaction (PCR) amplification of the schistosome Dra1 repeat within each of the collected Bulinus samples was employed to determine the extent and distribution of infected snails within the sample areas. Successful amplification of the Dra1 repeat demonstrated that 29.7% of snails were infected with schistosomes. Sequencing of the partial schistosome its from a small subset of snail samples suggested that some snails were either penetrated by both Schistosoma haematobium and Schistosoma bovis miracidia or hybrid miracidia formed from the two species.

Urinary schistosomiasis transmission in Epe, an urban community of Southwest Nigeria.

BACKGROUND: A survey of Schistosoma haematobium infection in Epe, an urban community in Lagos State, Southwest Nigeria, was carried out to ascertain the possibility that schistosomiasis, otherwise considered a rural disease, could reach urban populations. MATERIALS AND METHODS: About 100 ml of voided urine samples from 200 pupils aged 6-13 years [109 (54.5%) males and 91 (45.5%) females], attending an Anglican primary school, Ebute Afuye, and a community primary school, Erepoto, were examined parasitologically for hematuria and S. haematobium ova following informed consent obtained from their parents/guardians. All samples were screened using polymerase chain reaction (PCR) amplification of the schistosome Dra1 gene. Fourteen Bulinus snails collected from the two sites, Ebute Afuye (6) and Erepoto (8), were screened for schistosome infection by the PCR amplification of the schistosome Dra1 gene. PCR-RFLP of the snails' its region was analyzed for species identification and a subregion of the cox1 gene from four infected snails (two from each site) was amplified and sequenced. RESULTS: In the Anglican primary school, Ebute Afuye, and community primary school, Erepoto, 16% and 29% were positive for hematuria, and 16% and 17% had schistosome ova, respectively. PCR analysis showed that 57% and 40% were positive for the infection in Anglican primary school, Ebute Afuye, and community primary school, Erepoto, respectively. PCR screening of the snails confirmed that four from Ebute Afuye and three from Erepoto were infected with schistosomes. PCR-RFLP showed that all the 14 snails were Bulinus truncatus while phylogenetic analysis of the sequenced partial cox1 gene corroborated the PCR-RFLP results. CONCLUSIONS: There was a high prevalence of S. haematobium infection among the participants detected by PCR, which was able to detect infection in cases otherwise shown to be negative by hematuria. We also observed that B. truncatus is one of the snail species responsible for the transmission of urinary schistosomiasis in the Epe community. For national control programs, it is very important that trends in the prevalence and intensity of schistosomiasis in urban cities be monitored.

Squamous cell abnormalities in exfoliated cells from the urine of Schistosoma haematobium-infected adults in a rural fishing community in Nigeria.

Schistosoma haematobium infection is endemic in Nigeria, with substantial transmissions in all the states of the federation and a high prevalence rate in schools. Literature has linked bladder cancer, mostly squamous cell type, with long-term S. haematobium infections. The objective of this descriptive study was to screen exfoliated cells in the urine of S. haematobium-infected patients for squamous cell abnormalities through cytopathological examinations. Study participants were drawn from Imala Odo, a community near Oyan Dam in Abeokuta North Local Government Area, Ogun state, Southwest Nigeria. Due to a considerable day-to-day variation of S. haematobium eggs in urine, 3 rounds of 200 ml of urine samples were collected on 3 different days from 32 infected patients and 10 uninfected controls and examined. Cytological preparations of the infected 15 males and 8 females and 10 controls (5 males and 5 females) were screened for squamous cell abnormalities. Severely dysplastic to frankly malignant squamous cells were observed in 1 (3.1%) male and 2 (6.3%) females, while no abnormality was observed in the controls.

Detection of schistosomes polymerase chain reaction amplified DNA by oligochromatographic dipstick.

The applications of highly specific and sensitive molecular techniques based on polymerase chain reaction (PCR) have constituted a valuable tool for the diagnosis of schistosomiasis and also for the detection of schistosome infections in the snail intermediate hosts. The common method of detecting PCR amplicons is gel electrophoresis in the presence of ethidium bromide, a carcinogen, which is followed by UV transillumination. Other methods, which are available for detecting PCR products, are real-time PCR, PCR-enzyme-linked immunosorbent assay (PCR-ELIZA) and mass spectrometry but they are cumbersome while they are sometimes complex and expensive. Therefore, a simple method of PCR product detection would be a welcome idea and a most valuable tool particularly in disease endemic countries with limited research facilities and resources. In this study, we applied a simple and rapid method for the detection of Schistosoma haematobium and Schistosoma mansoni PCR amplified DNA products using oligochromatographic (OC) dipstick. The amplicons are visualized by hybridization with a gold conjugated probe, while a control for the chromatographic migration is incorporated in the assay. The lower detection limit observed was 10fg of genomic DNA from each of the two species, while the dipstick was also specific for each of the species used in this study.

Distribution of the molecular forms of Anopheles gambiae and pyrethroid knock down resistance gene in Nigeria.

We investigated the distribution of the molecular M and S forms of Anopheles gambiae and the knock down resistance (kdr) gene associated with pyrethroid and DDT resistance in A. gambiae s.s. at 13 localities across Nigeria. Two-three days old adult female mosquito reared from larval collections were tested using standard WHO procedures, diagnostic test kits and impregnated papers to assess their pyrethroid resistance status. Specimens were identified by PCR assays and characterized for the kdr gene. DNA from adult A. gambiae s.s. collected from human dwellings were also tested for the presence of the kdr gene. The overall collection was a mix of the molecular M and S forms across the mangrove (63:37%), forest (56:44%), and transitional (36:64%) ecotypes, but almost a pure collection of the S form in the Guinea and Sudan-savanna. Results of insecticide susceptibility tests showed that mosquitoes sampled at seven localities were susceptible to permethrin, deltamethrin, and DDT, but populations of A. gambiae resistant to these insecticides were recorded at six other localities mainly in the transitional and Guinea-savanna ecotypes. The kdr gene was found only in the molecular S forms, including areas where both forms were sympatric. The overall kdr frequency was low: <47% in forest, 37-48% in the transitional, and 45-53% in Guinea-savanna. The data suggest that pyrethroid resistance in A. gambiae in Nigeria is not as widespread when compared to neighbouring West African countries.

Pharyngeal airway changes associated with mandibular advancement.

This study analyzes changes in the anteroposterior dimension of the oropharynx as determined from lateral cephalometric radiographs on 26 patients who have undergone mandibular advancement. Increases in the sagittal dimensions of the oropharynx were unpredictable and tended to decrease with time, suggesting that mandibular advancement may be an unreliable method of treating obstructive sleep apnea. The most stable long-term results were found in those cases with narrowing of the oropharynx preoperatively.