Influence of pregnancy and lactation on vitamin D serum levels and antioxidant status in randomized women in Zaria.

Pregnancy and lactation are normal physiological conditions that tend to influence numerous biological processes. The aim of this study was to identify the impact of pregnancy and lactation on serum vitamin D level and antioxidant status in some women in Zaria, Nigeria. A cross­sectional descriptive study conducted at Ahmadu Bello University Teaching Hospital, Zaria for a period of three (3) months. Blood samples were collected, serum catalase, superoxide dismutase, lipid peroxidation and vitamin D, were determined using standard methods. Data were presented as mean ± SD, analysis was performed using one-way ANOVA and Pearson's correlation analysis. Values were considered significant at p ≤ 0.05. There was a significant difference (p < 0.01) serum malondialdehyde level, superoxide dismutase activity and glutathione peroxidase activity during the various trimesters of pregnancy and lactating group. However, the levels of these markers were highest in the lactating group. Furthermore, serum level of vitamin D and catalase activity was highest in the 2nd trimester and lowest in the control and lactating group respectively.  Pregnancy and lactation altered serum level of Vitamin D, CAT, SOD, MDA and GPx suggesting a variation in oxidative stress at different trimester of pregnancy and lactation. Key words: Pregnancy, lactation, oxidative stress, vitamin D.

Physiological Changes in Serum Calcium, Phosphate, Vitamin D, Parathyroid Hormone and Calcitonin During Pregnancy and Lactation in Randomised Population of Zaria Women.

Pregnancy and lactation are usual but stressful physiological conditions accompanied by changes in calcium and phosphate metabolism and their regulatory hormones which may lead to calcium-related disorders in pregnant women. This study aimed to evaluate the changes in serum levels of calcium, phosphate, vitamin D and their regulatory hormones in pregnant and lactating women in Zaria, Nigeria. A cross­sectional descriptive study was conducted at Ahmadu Bello University Teaching Hospital, Zaria for three (3) months. Blood samples were collected, anthropometric measurements (weight, height and body mass index) of 179 women were taken. Serum calcium, phosphate, vitamin D, parathyroid hormone and calcitonin were determined using standard methods. Data were presented as mean ± SD, analysis was performed using one-way ANOVA and Pearson's correlation analysis. Values were considered significant at p ≤ 0.05. There was a significant decrease in serum calcium concentration (p < 0.01) during the third trimester of pregnancy and lactation. An increase in serum concentration of vitamin D, parathyroid hormone, and calcitonin in the 2nd trimester and a decrease during the third trimester and lactation although not statistically significant when compared with the control. There was a negative correlation between serum calcium concentration and gestational age (r = 0.255) while no correlation between gestational age and serum phosphate concentration. Changes in serum calcium, vitamin D, parathyroid hormone and calcitonin during pregnancy and lactation has been demonstrated suggesting a relationship between calcium metabolism and these hormones at some stages of pregnancy.

A Comparison of Two Regimens for Post-Caesarean Section Analgesia in a Tertiary Health Centre in Northern Nigeria.

BACKGROUND: Post-caesarean section pain is a problem i n our environment. Though many modalities for pain management exist, there is the need to investigate safer and affordable regimens that will provide adequate analgesia with minimal side effects and with ease of administration. Alternating doses of intramuscular acetaminophen and intramuscular pentazocine was studied as an alternative to provide safe and effective post-caesarean section analgesia. Its effectiveness and side effect profile in our environment have not been previously investigated. AIMS AND OBJECTIVES: The study aimed to compare the analgesic and side effect profile of intramuscular pentazocine with another regimen involving alternating doses of pentazocine and acetaminophen within the first 48hours after surgery. DESIGN OF THE STUDY: This was a prospective, comparative and randomized study among 142 women who voluntarily consented to the study and had elective caesarean section from May 2014 to May 2015 at the Ahmadu Bello University Teaching Hospital, Zaria. Setting: The Study was conducted at the obstetrics and gynecology department of the teaching hospital of Ahmadu Bello University, Zaria. MATERIALS AND METHODS: Consecutive eligible pregnant women who were slated for elective caesarean section were recruited at the antenatal clinic unit of the department and randomized using the WINPEPI software by Abramson to either receive intramuscular pentazocine or alternating doses of pentazocine and acetaminophen over the first 48hours after surgery. The pain scores, side effect profile and the time taken for the return of bowel sounds were compared among the two groups using relevant statistical methods with IBM SPSS version 20 with Z tests and chi-square to test for strength of relationships of variables. The level of significance was 0.05. RESULTS: The average age of the participants was 29.82years with standard deviation 6.138; 64.8% were Hausa-Fulani, 71.83% were Muslims, 45.07% were unemployed, 97.89% were married, 42.2% were multiparous, 59.86% booked in our centre and 59.2% were having their first caesarean section. Seventy-six participants received combination of injection pentazocine/acetaminophen while 66 received pentazocine injection alone. The drop-out rate was 8.5%. There was no statistically significant difference in the pain scores both on the visual analogue scale and the verbal rating scale in the first 48hours in both groups, no difference in the need for rescue analgesics (p=0.709), time taken for the return of bowel sounds (P=0.391), incidence of side effects (p=0.394) and participants' level of satisfaction (p=0.255). CONCLUSION: Both regimens were comparable in analgesic efficacy, incidence of side effects and satisfaction levels.

BACKGROUND: La douleur de la césarienne est un problème dans notre environnement. Bien que de nombreuses modalités de gestion de la douleur existent, il est nécessaire de rechercher des régimes plus sûrs et abordables qui fourniront une analgésie adéquate avec des effets secondaires minimes et une facilité d'administration. L'alternance de doses d'acétaminophène intramusculaire et de pentazocine intramusculaire a été étudiée comme une alternative pour fournir une analgésie post-césarienne sûre et efficace. Son efficacité et son profil d'effets secondaires dans notre environnement n'ont pas été étudiés auparavant. BUTS ET OBJECTIFS: L'étude visait à comparer le profil analgésique et des effets secondaires de la pentazocine intramusculaire avec un autre schéma impliquant des doses alternées de pentazocine et d'acétaminophène dans les 48 heures après l'opération. CONCEPTION DE L'ÉTUDE: Il s'agissait d'une étude prospective, comparative et randomisée menée auprès de 142 femmes qui avaient volontairement consenti à l'étude et ayant subi une césarienne élective de mai 2014 à mai 2015 à l'hôpital universitaire Ahmadu Bello, Zaria. Cadre : L'étude a été menée au département d'obstétrique et de gynécologie de l'hôpital universitaire de l'Université Ahmadu Bello, Zaria. MATÉRIEL ET MÉTHODES: Les femmes enceintes admissibles consécutives qui devaient subir une césarienne élective ont été recrutées dans l'unité de clinique prénatale du département et de l'hôpital et randomisées à l'aide du logiciel WINPEPI d'Abramson pour recevoir soit la pentazocine et d'acétaminophène au cours des 48 heures suivant l'opération. Les scores de douleur, le profil des effets secondaires et le temps nécessaire au retour des bruits intestinaux ont été comparés entre les deux groupes en utilisant des méthodes statistiques pertinentes avec version 20 d'IBM SPSS avec des tests Z et des tests de chi-deux pour vérifier la force des relations entre les variables. variables. Le niveau de signification était de 0,05. RÉSULTATS: L'âge moyen des participants était de 29,82 ans avec un écart type de 6,138 ; 64,8% étaient Hausa-Fulani, 71,83% étaient musulmans, 45,07% étaient sans emploi, 97,89 % étaient mariés, 42,2 % étaient multipares, 59,86 % avaient réservé dans notre centre et 59,2 % subissaient leur première césarienne. Soixante-seize participantes ont reçu une combinaison d'injection pentazocine/ acétaminophène tandis que 66 ont reçu l'injection de pentazocine seule. Le taux d'abandon était de 8,5 %. Il n'y avait pas de différence statistiquement significative dans les scores de douleur sur l'échelle visuelle analogique et l'échelle d'évaluation verbale au cours des 48 premières heures dans les deux groupes, pas de différence en ce qui concerne le besoin d'analgésiques de secours (p=0,709), le temps nécessaire au retour des bruits intestinaux (P=0,391), l'incidence des effets secondaires (p=0,394) et le niveau de satisfaction des participants (p=0,255). CONCLUSION: Les deux schémas thérapeutiques étaient comparables en termes d'efficacité analgésique, l'incidence des effets secondaires et le niveau de satisfaction. Mots clés: Analgésie, césarienne, comparatif, pentazocine, acétaminophène, intramusculaire.

A COMPARATIVE STUDY OF INTRAMUSCULAR ACETAMINOPHEN VERSUS INTRAMUSCULAR PENTAZOCINE AS LABOUR ANALGESIA IN ZARIA, NORTHWESTERN NIGERIA.

BACKGROUND: Intramuscular pentazocine is a common labour analgesic in Zaria, Nigeria due to its low cost and availability. Though also cheap and readily available the use of intramuscular acetaminophen is not popular and hence the need for a comparative study. AIM & OBJECTIVES: To compare the efficacy of intramuscular acetaminophen versus intramuscular pentazocine on women in labour as well as the effects of both drugs on APGAR scores of their newborn. METHODOLOGY: A randomized, comparative study was conducted on 188 eligible, parturients from June to September, 2013. The subjects were selected during antenatal classes and early active labour, counseled, taught about the pain scoring systems after obtaining written consent from them. Randomization was done using the WINPEPI software by Abrahamson in order for each woman in labour to receive either intramuscular acetaminophen 15mg/kg stat or pentazocine 1mg/kg at cervical dilatation of 4-6cm. The data obtained included the patients demographics, hourly pain scores, APGAR scores, patients' satisfaction and side effects. RESULTS: The mean age was 28.1years ± SD 5.2years. The majority of the subjects (53.5%) were Hausa-Fulani and 70.1% were muslims; 64% were booked for antenatal care while 58.5% had received secondary school education. The average duration of labour was 5.4hours. Acetaminophen was administered to 91(48%) subjects while pentazocine was administered to 97(52%). Sixty-nine percent and 80% experienced adequate pain relief in the acetaminophen and pentazocine groups respectively at one hour. The pain scores was statistically significant at one hour but comparable in both groups afterwards: p=0.01, 0.52, 0.338 and 0.389 at 1(st), 2(nd), 3(rd) and 4(th) hours on the linear/visual analogue scale and comparable on the verbal rating scale. There was no difference in the 1(st) and 5(th) minute APGAR scores of the babies delivered (p=0.24 and 0.63 respectively). Patients' satisfaction was comparable but the pentazocine group experienced more side effects. CONCLUSION: Intramuscular acetaminophen gave comparable labour analgesia with fewer side effects when compared with pentazocine.

Anogenital distance and umbilical cord testosterone level in newborns in Zaria, Northern Nigeria.

The anogenital distance (AGD) is the distance between the anus and the base of the penis in males and anus to fourchette (AF) distance in females and is a sexually dimorphic index that, on average, is twice as great in males as in females, so it is used as an indicator of appropiate masculine development. In this study, the anogenital distance (AGD) and anthropometric measurements such as birth weight, birth length, head circumference and placenta weight of 200 newborns (100 male, 100 female) were taken and umbilical cord serum was assayed for testosterone concentration using Radioimmunoassay (Microwell). Data obtained were analysed using Student t-test and Pearson's Correlation Analysis as applicable. Results revealed that mean total anogenital distance was 22.53±0.70mm, and it was significantly higher in males: 31.11±0.64mm than in females: 13.89±0.26mm and we observed that there was positive correlation between birth weight and AGD in females. In males head circumference correlated positively with AGD. The mean cord testosterone concentration was 2.78±0.30ng/ml in males and 2.09±0.22ng/ml in females and did not have any significant correlation with anogenital distance. It was concluded that AGD of the population studied, though high was not significantly higher than AGD in other parts of the world and umbilical cord testosterone level did not have any significant effect on AGD.

Reproductive health in Nigeria.

BACKGROUND: Adolescents have special reproductive health needs, but these peculiar needs are often unmet in many cultures and countries. METHODS: A cross-sectional study involving adolescents in three secondary schools in a northern Nigerian setting. Demographic characteristics as well as reproductive health issues (adolescent sex, abortion, sexual experience) among the students were surveyed. RESULTS: Of the 1070 students that fully participated in the survey, 539 (50.4%) were girls and 531 (49.6%) boys. They were aged 10 - 27 years (median 16 Years). Five hundred forty three (50.7%) were Christians and 499 (46.6%) Muslims. Nine hundred and four (84.5%) of the students knew about abortion. On their view about reasons why adolescents indulge in premarital sex, 574 (53.6%) felt it was to please boyfriend/girlfriend, 391 (36.5%) to experiment with sex, 312 (29.6%) to test fertility and 239 (22.3%) felt it was to stop painful menstruation. One hundred thirty five (12.6%) have had sex and 15 - 19 years age group were more likely to be sexually active. Twelve (1.1%) of the girls had been pregnant once - four times before and all had an abortion. Children of civil servants were significantly more likely to be sexually active compared to other groups of children (p <0.05). All the respondents knew one or more complication of abortion to include inability to get pregnant in future 682 (63.7%), abdominal pain 589 (55%) and painful menstruation 427 (39.9%). CONCLUSION: Adolescents are unique in every way including issues of reproductive health. The age at sexual debut in this setting is early. There is a need to include reproductive health education in the curriculum of secondary schools. This should help the adolescents to obtain the correct information from the right source.