Etiologic dilemma and challenges of management of nodular vasculitis in tertiary health-care facility: A case report.

Nodular vasculitis is a rare inflammatory disease of the skin and subcutaneous fat tissue, characterized by crops of small, tender, erythematous nodules on the legs, mostly on the calves and shins. We present a 17-year-old adolescent female who presented with a six-month history of cough; recurrent fever and bilateral lower limb multiple ulcerated nodules of 1-month duration. Clinical examination revealed generalized lymphadenopathy with bilateral pitting leg edema which had multiple nodules and discoid ulcers extending from the groin to the ankles and discharging purulent fluid. Tests for human immunodeficiency virus and tuberculosis were negative. Histology of nodule biopsy revealed extensive caseous and coagulative fat necrosis, granulomatous inflammation with epitheloid macrophages and multinucleated giant cells surrounding the necrosis, and lymphoid infiltration of vessel walls with fibrous thickening of the intima, typical of Whitfield-type erythema induratum. There was initial but very transient response to antibiotic treatment, with further deterioration and eventual death from overwhelming sepsis.

Serum Immunoglobulin E and Vitamin D Levels in Asthma Patients in Enugu, Nigeria: Association with Asthma Control.

BACKGROUND: Asthma symptoms are often mediated by changes in immune responses to allergens measured by the levels of immunoglobulin E (IgE) and non-protein regulators such as 25-hydroxycholecalciferol (25 (OH) vitamin D3). The relationship between serum levels of IgE, 25 (OH) Vitamin D3, and asthma control in asthma patients remains unclear. OBJECTIVE: To measure the serum IgE and 25 (OH) vitamin D3 levels in asthma patients and determine their relationship with patient's asthma control. METHODS: This was a cross-sectional study of children and adults with asthma aged 5 to 60 years old; and their controls seen in a tertiary hospital in Enugu, south eastern Nigeria from October 2018 to January 2019. Serum levels of IgE, and 25 (OH) vitamin D3 were determined by sandwich enzyme-linked immunosorbent assay (ELISA); and compared between groups using the Student's t-tests. Association between IgE, 25 (OH) vitamin D3 levels, and asthma control were determined using the Chi-square. RESULTS: Sixty-five (65) asthma patients and thirty-three (36) non-asthma controls were studied. Mean serum level of IgE (411.32± 220.18 IU/ml) was significantly raised in asthma patients compared to controls (163.51 ± 186.36 lU/ml); p=0.001. There was no significant difference in mean 25 (OH) vitamin D3 levels in asthma (68.55 ± 25.91 ng/ml) compared to controls (77.25 ± 34.01 ng/ml); p=0.153. No significant association was found between patient's asthma control status, and serum IgE and 25 (OH) vitamin D3 levels. CONCLUSION: Asthma control status was not associated with Immunoglobulin E and 25 (OH) vitamin D3 levels in those studied. More robust study is required to evaluate the relationship between asthma control, IgE and vitamin D levels.

BACKGROUND: Les symptômes de l'asthme sont souvent médiés par des changements des réponses immunitaires aux allergènes, mesurées par les taux d'immunoglobuline E (IgE) et de régulateurs non protéiques tels que le 25- hydroxycholécalciférol (25 (OH) vitamine D3). La relation entre les niveaux sériques d'IgE, de 25 (OH) vitamine D3 et le contrôle de l'asthme chez les patients asthmatiques n'est pas claire. OBJECTIF: Mesurer les taux sériques d'IgE et de 25 (OH) vitamine D3 chez les patients asthmatiques et déterminer leur relation avec le contrôle de l'asthme chez les patients. MÉTHODES: Il s'agit d'une étude transversale d'enfants et d'adultes asthmatiques âgés de 5 à 60 ans; ainsi que de leurs témoins vus dans un hôpital tertiaire d'Enugu, dans le sud-est du Nigeria, d'octobre 2018 à janvier 2019. Les taux sériques d'IgE et de 25 (OH) vitamine D3 ont été déterminés par dosage immuno-enzymatique en sandwich (ELISA); et comparés entre les groupes à l'aide des tests t de Student. L'association entre les niveaux d'IgE, de 25 (OH) vitamine D3 et le contrôle de l'asthme a été déterminée à l'aide du chi carré. RÉSULTATS: Soixante-cinq (65) patients asthmatiques et trentetrois (36) témoins non asthmatiques ont été étudiés. Le taux sérique moyen d'IgE (411,32 ± 220,18 UI/ml) était significativement plus élevé chez les patients asthmatiques que chez les témoins (163,51 ± 186,5 UI/ml); p=0,001. Il n'y avait pas de différence significative dans les taux moyens de 25 (OH) vitamine D3 chez les asthmatiques (68,55 ± 25,91 ng/ml) par rapport aux témoins (77,25 ± 34,01 ng/ml); p=0.153. Aucune association significative n'a été trouvée entre le statut de contrôle de l'asthme du patient et les taux sériques d'IgE et de 25 (OH) vitamine D3. CONCLUSION: Le contrôle de l'asthme n'était pas associé aux taux d'immunoglobulines E et de 25 (OH) vitamine D3 chez les personnes étudiées. Une étude plus solide est nécessaire pour évaluer la relation entre le contrôle de l'asthme, les taux d'IgE et de vitamine D. Mots clés: 25 hydroxyl vitamine D3, Immunoglobuline E, Contrôle de l'asthme, Enfants, contrôle, Enfants.

Screen viewing practices and caregivers' knowledge of the health-related effects in children and adolescents in a Nigerian Urban City.

Background: Globally, a dramatic increase in the use of television and digital media has been observed among children and adolescents in recent times. The possible health-related effects of frequent and prolonged screen media viewing on these children and adolescents have triggered many concerns among researchers. Aim: The study is aimed to determine the screen media viewing practices and caregivers' level of knowledge about the health-related effects of prolonged screen viewing time on their children. This was a descriptive cross-sectional study among caregiver/child and adolescent dyads on outpatient clinic visits. Subjects and Methods: Respondents (caregivers/children's pairs) were consecutively recruited, and data was obtained using an unambiguous pre-tested semi-structured questionnaire comprising four domains: socio demographic characteristics; screen media viewing characteristics, perception of the health related effects of prolonged viewing time, and measures to limit prolonged screen viewing time in children. Descriptive and inferential statistics were done using Statistical Package for Social Sciences (SPSS) version 22.0 at a level of statistical significance P < 0.05. Results: Of the 205 respondents studied, the majority (67.8%, fathers and 76.1%, mothers) had tertiary education. The daily mean time spent by children watching television/screen media was 2 (± 1.58) hours. Up to 89.3% of the caregivers established good standards for healthy screen-viewing in their homes. However, 52.7% of them had poor knowledge of the health-related problems of increased viewing time. Socio-economic class (P = 0.002) and knowledge level of the parents (P = 0.000) were significant predictors limiting children's screen-viewing time. Conclusion: Increasing screen media viewing is common among the children studied. The majority of the caregivers had poor knowledge of health-related effects of prolonged viewing time despite high educational attainment. There is a need to enlighten caregivers on the possible health effects of excess screen media viewing so as to enable them to institute stringent measures to limit the attendant health consequences on the children.

Psychological Distress among Caregivers of Children Admitted into the Children Emergency Room of a Nigerian Tertiary Hospital.

BACKGROUND: Many caregivers experience significant psychological burden which may impact on the management of a sick child. OBJECTIVE: To determine the prevalence and associated factors of psychological distress among caregivers of children admitted at the Children Emergency Room. METHODS: This was a descriptive cross-sectional study among caregivers of children who were hospitalized for at least 24 hours. The 28-item General Health Questionnaire (GHQ 28) was used to assess the psychological distress among the caregivers. GHQ scores were stated as means ± standard deviation (SD). Chi-square or Fisher's exact test was used to test for association between sociodemographic variables and psychological distress. Mean GHQ scores in the various domains of psychological dysfunction were compared among groups using the independent sample t-test; at p<0.05. RESULTS: Of the 97 caregivers who participated in the study, 96 had their data analyzed. The caregivers were aged 19 to 63 (mean 34.25 (8.46)) years; 86 (89.7%) were females and 48 (50%) had tertiary education. The prevalence of psychological distress among the care givers was 69.8%. Caregivers had high levels of anxiety but low levels of depression. Those with lower educational attainment had higher scores on severe depression domain (p = 0.001). Unemployed caregivers had higher mean scores on the anxiety/insomnia (p = 0.039) and social dysfunction domains (p = 0.031). Those with large family sizes scored higher on the anxiety/insomnia domain (p = 0.03). CONCLUSION: Psychological distress was high among caregivers of children admitted at the children emergency room.

CONTEXTE: De nombreux aidants éprouvent une expérienceimportante charge psychologique pouvant avoir une incidence sur la prise en charge d'un malade enfant. OBJECTIF: Déterminer la prévalence et les facteurs associés de détresse psychologique chez les personnes qui s'occupent d'enfants admis à l'Salle d'urgence pour enfants. MÉTHODES: Il s'agissait d'une étude transversale descriptive parmi les soignants d'enfants qui ont été hospitalisés pendant au moins 24 heures. Le Questionnaire général sur la santé (QGH) en 28 éléments a été utilisé pour évaluer la détresse psychologique chez les soignants. Les scores GHQ étaient indiqué comme moyen ±'écart-type (ET). Chi-carré ou Fisher's le test exact a été utilisé pour tester l'association entre sociodémographiques variables et détresse psychologique. Scores GHQ moyens dans les domaines différentes de dysfonctionnement psychologique ont été comparés entre les groupes à l'aide du test t de l'échantillon indépendant; à p<0.05. RÉSULTATS: Sur les 97 aidants qui ont participé à l'étude, 96 leurs données ont été analysées. Les aidants étaient âgés de 19 à 63 ans (moyenne 34.25 (8.46)) ans; 86 (89.7 %) étaient des femmes et 48 (50 %) avaient l'enseignement supérieur. La prévalence de la détresse psychologique chez les les soignants étaient 69.8 %. Les aidants avaient des niveaux élevés d'anxiété, mais faibles niveaux de dépression. Ceux dont le niveau de scolarité est inférieur avaient des scores plus élevés dans le domaine de la dépression sévère (p = 0.001). Les aidants au chômage avaient des scores moyens plus élevés sur l'anxiété / insomnie (p = 0.039) et les domaines de dysfonctionnement social (p = 0.031). Ceux qui ont les grandes familles ont obtenu des scores plus élevés dans le domaine de l'anxiété / insomnie (p = 0.03). CONCLUSION: La détresse psychologique était élevée chez les aidants naturels des enfants admis à la salle d'urgence des enfants. Mots-clés: Soignant, enfants, urgence, détresse psychologique, Stitués dans la prise en charge des patients atteints de LA COVID-19.

Microbiological profile and antibiotic resistance pattern of empyema thoracis in Calabar, Nigeria.

Targeted empirical antibiotic therapy based on local microbiology and antibiotic resistance patterns is essential for the treatment of empyema thoracis. Our retrospective review of 105 pleural empyema culture and sensitivity reports aimed at determining the causative microorganisms and their antimicrobial resistance pattern. Of 105 pleural aspirate samples, 46 (43.8%) were positive on culture. Gram-negative organisms (n = 43) were the predominant isolates, the commonest of which was Klebsiella pneumoniae. It was concluded that empyema thoracis is predominantly caused by Gram-negative organisms in our locality. This should guide protocols on the initiation of empirical therapy.

Comparison of age-based weight estimation with actual measured weight in children aged one to twelve years in Enugu.

AIMS: This study was carried out to evaluate the degree of accuracy of age-based weight estimation methods in assessing the weight of the Nigerian child. METHOD: The weights of one thousand, four hundred and fifty-six (1,456) children were measured and compared with the updated Advanced Paediatric Life Support (APLS), Best guess, Nelson and Luscombe & Owen methods. RESULT: The updated APLS, Nelson and Luscombe & Owen methods underestimated the weights in younger children while overestimating in older ones. Best guess overestimated the weights across all ages. The Nelson formula had the best agreement within 10% and 20% of the measured weights among all methods. A linear regression analysis produced an equation for weight estimation: weight (W) = 2.058 Y + 9.925, where W is weight in kilogram and Y is the age in years. CONCLUSION: None of the weight estimation formulae assessed was entirely accurate in our study, though the Nelson method showed superior agreement.

The prevalence of allergic diseases among children with asthma: What is the impact on asthma control in South East Nigeria?

BACKGROUND: Allergic diseases are known to occur in children with asthma and its coexistence with asthma may impact on asthma control in affected children living in a low-income country. The study is to determine the allergic profile of children with asthma and the association with asthma control and attendant social risk factors. MATERIALS AND METHODS: This was a cross-sectional study of consecutively enrolled children with physician diagnosed asthma, attending clinics in a tertiary center in Nigeria. The presence of asthma, allergy types, and asthma control levels were determined using the Gobal initiative on asthma (GINA), international study of asthma and allergy in childhood and asthma control test questionnaires, respectively. RESULTS: There were 207 children with asthma enrolled from the Pediatric Asthma Clinic at University of Nigeria Teaching Hospital, Enugu. The median age was 10 years and interquartile range of 7-11 years. There were 127 (61.4%) from middle and high socioeconomic class and 86.5% who lived in the urban areas. Of the study participants, 41.5% had one or more allergy symptoms; rhinitis (33.3%), conjunctivitis (29.0%), and dermatitis (7.2%). Allergy symptoms persisted from infancy in 55.9%. Children from large families had a lower prevalence of allergies. Having any allergy symptom and belonging to a small-sized family were both associated with asthma exacerbations. Most children studied, (69.1%) had their asthma under control. Allergy persistence from infancy and type of allergy were not significantly associated with the level of asthma control. CONCLUSION: Allergic diseases are common in children with asthma in our environment, but did not significantly impact on asthma control. Socioeconomic factors such as urbanization and family size had effects on the achievement of asthma control but not on allergy status.

Physical growth and nutritional status assessment of school children in Enugu, Nigeria.

BACKGROUND: Physical growth of a child is a reflection of its state of nutrition. In some developing countries such as Nigeria with changing economy and rapidly growing population, the nutritional status of the children is a reflection of the general well-being of the society. MATERIALS AND METHODS: This was a descriptive cross-sectional study in which participants were selected using a multistage sampling method. Heights and weights of randomly selected school children aged 6-12 years were measured using standard protocols. Weight-for-age, height-for-age, and body mass index (BMI)-for-age expressed as Z-scores were used to characterize the nutritional status. Descriptive statistics was used to determine the frequency and standard deviations (SDs) of the anthropometric measurements. Age and gender differences in the mean body weight, height, and BMI were evaluated using an independent samples t-test. Significant levels were set at P< 0.05. RESULTS: A total of 1305 males and 1311 females were enrolled in the study. The mean age was 8.9 ± 1.9 years. Their mean height, weight, and BMI were 136.6 ± 10.2 cm, 29.7 ± 7.7 kg, 15.7 ± 2.4 kg/m2, respectively. Their mean ± SD scores of the WAZ, HAZ, and BAZ were 0.33 ± 1.20, 0.78 ± 1.17, and - 0.51 ± 1.27, respectively. A majority (78.9%, 2090/2616) were in the normal growth category. Wasting, overweight, obesity, underweight, and stunting were noted in 9.3% (243/2616), 6.3% (166/2616), 4.4% (117/2616), 0.9% (26/2616), and 0.4% (13/2616) of the children, respectively. Wasting was more in males (P = 0.069), and overweight was more in females (P = 0.138). CONCLUSION: A majority of the children have normal growth with the remainder in both extremes of malnutrition. Institution of school-feeding programs in all Nigerian schools as well as nutrition education/campaign directed at parents and their children will help forestall the double burden of under- and over-nutrition among our children.

Demographic, socio-economic and clinical characteristics: implications for time to presentation at a Nigerian tertiary ophthalmic outpatient population.

OBJECTIVE: To investigate the associations between time to presentation, and sociodemographic and clinical characteristics of new adult ophthalmic outpatients at the University of Nigeria Teaching Hospital (UNTH), Enugu, between March and August 2010. STUDY DESIGN: Hospital-based case-control study. METHODS: Consecutive new ophthalmic outpatients at UNTH were categorized into controls (early presenters, i.e. <3 months after onset of current eye disease) and cases (late presenters, i.e. >3 months after onset of current eye disease). Relevant data were obtained from the participants' case notes and interviews. Descriptive statistics yielded frequency distributions; bivariate and multivariate comparisons were used to test the significance of associations. P < 0.05 was considered to indicate significance. RESULTS: Eight hundred and twenty-four subjects [454 males and 370 females, mean age 39.2 (standard deviation 1.2) years, range 19-82 years] participated in this study. There were 370 early presenters and 454 late presenters. Multivariate analysis found that late presentation was significantly associated with age >50 years [odds ratio (OR) 1.34, 95% confidence interval (CI) 1.28-2.22; P < 0.01], female gender (OR 1.63, 95% CI 1.52-2.11; P < 0.01), residence >20 km from UNTH (OR 0.65, 95% CI 0.38-0.89; P = 0.0212), individual-level deprivation (OR 0.69, 95% CI 0.55-0.92; P = 0.0324) and subnormal visual acuity at presentation (OR 1.32, 95% CI 1.05-1.76; P = 0.0353). CONCLUSIONS: At UNTH, most new adult ophthalmic outpatients present >3 months after onset of their current eye disease. Measures to overcome age-, gender- and distance-related causes of late presentation, grassroots economic empowerment of the feeder population and public education about eye health are required.

Perception of intimate pelvic examination by gynaecological clinic attendees in rural Southeast Nigeria.

CONTEXT: Intimate gynaecological examinations are part of the necessary retinue in gynaecological consultation and management. OBJECTIVE: To evaluate women's perception of digital and speculum vaginal examinations in rural Southeast Nigeria. METHODS: This was a prospective descriptive study. Gynaecologic clinic attendees in a Mission hospital in rural Nigeria were interviewed using a pre-tested questionnaire over a 3-year period. RESULTS: Four hundred and eighty-six women with a mean age of 35.2 ± 8.1 years were interviewed. They presented mainly for infertility (36.8%), menstrual abnormalities (31.1%) and early pregnancy complications (10.7%). Over a quarter of the women felt embarrassed at vaginal examination and 37.2% found it a bit painful or felt discomfort. In spite of the discomfort, 73.7% believed vaginal examination was necessary and over 95% indicated readiness to undergo such examination in future if necessary. CONCLUSION: Performing intimate gynaecological examination should be a carefully planned procedure with patient's consent, and performed conscientiously taking patient's feelings and emotions into consideration, to engender confidence.

Ruptured uterus: the unabating obstetric catastrophe in South eastern Nigeria.

BACKGROUND: Ruptured uterus is an obstetric catastrophe and results in significant maternal and perinatal morbidity and mortality in Nigeria. METHODS: To review the incidence and management of ruptured uterus over the 8-year period (2000-2004 and 2007-2009) and analysis of records of cases of ruptured uterus during the period under review in a descriptive study. RESULTS: The incidence of uterine rupture is 1 in 81 deliveries with a contribution of 13.8% to maternal mortality in Ebonyi State University Teaching Hospital, Nigeria. There was high fetal wastage as 99 (97.1%) of the babies died. The highest incidence of ruptured uterus was found in the para 2-4 group. Teenagers constituted 4 (3.96%) of the cases. Majority of the rupture, 69 (65.4%) occurred anteriorly. Fifty-seven (56.4%) had only repair of the rupture done. The greatest complication was septicemia, which occurred in 32 (31.7%) of the patients. CONCLUSION: The incidence of uterine rupture is very high in our center. It is one of the highest causes of maternal and perinatal morbidity and mortality. There should be a multi-pronged effort aimed at improving the utilization of medical services by the populace and the health institutions offering efficient obstetric emergency care.

Uterine rupture at a secondary hospital in Afikpo, Southeast Nigeria.

INTRODUCTION: Uterine rupture is an obstetric catastrophe that is associated with high maternal and perinatal mortality rates. Its incidence is high in developing countries. In Nigeria, the incidence of uterine rupture continues to increase due to poverty, illiteracy, ignorance, the lack of quality obstetric care and bad governance. METHODS: A retrospective review was conducted of all cases of ruptured uterus seen at the Mater Misericordiae Hospital in Afikpo, Nigeria between January 2001 and December 2007. RESULTS: There were a total of 51 ruptured uteri out of 4,361 deliveries, yielding a ratio of one in 86. A total of 19 (37.3 percent) patients had a scarred uterus, while 32 (62.7 percent) had an intact uterus, yielding a scarred to unscarred uterus ratio of one in 1.7. The mean maternal age was 32.0 years, and the mean parity was 3.4. Patients with a scarred uterus had a lower mean age and parity. 29 (56.9 percent) cases were unbooked, out of which seven (24.1 percent) had a scarred uterus. Obstructed labour (88.2 percent), grandmultiparity (27.5 percent) and abnormal lie (9.8 percent) were the main causes of rupture. 39 (76.5 percent) patients had their labour managed at home or by traditional birth attendants before presentation. 45 (88.2 percent) patients underwent uterine repair alone, five (9.8 percent) had uterine repair with bilateral tubal ligation and one (two percent) had a hysterectomy. Three maternal deaths occurred, yielding a case fatality rate of 5.9 percent. The perinatal mortality rate was 84.6 percent. CONCLUSION: Health education, the provision of quality obstetric care, improved governance and monitoring of the activities of traditional birth attendants may help to reduce the menace of uterine rupture.

The incidence, pattern and management outcomes of early pregnancy losses at the Ebonyi State University Teaching Hospital, Abakaliki.

BACKGROUND: Early pregnancy losses are a source of deep emotional trauma to any woman, her family and the attttending Gynaecologist. This study evaluated the prelence, pattern and management outcomes of such losses at a tertiary Health Institution. METHODS: Data of all women who suffered early pregnancy losses between 1st January, 2002 and 31st December, 2004, were reviewed in a descriptive study. Information obtained from their case notes which related to the early pregnancy event, their socio demographics, obstetric history and management outcomes were collated. Univariate analysis was performed and frequency tables and figures were constructed where appropriate. RESULTS: Early pregnancy losses comprised miscarriages, molar pregnancy and ectopic gestations accounted for 32.1% of all gynaecological admissions during the period. Miscarriages were the commonest diagnosis and incomplete abortion constituted the bulk of this. Women of all parities were involved but rate of loss increased down the socio economic class strata. Majority were unbooked. A maternal mortality rate of 1.8% attended all forms of early pregnancy losses during the period. CONCLUSION: Early pregnancy loss constitutes a major gynaecological problem in our centre. Health care providers must institute prompt and appropriate clinical management for a good clinical outcome.

Factors That Affect Medical Students' Performance in Anatomy in the University Of Nigeria

Background: Much attention has been drawn to the area of medical education in contemporary times with the aim of developing effective teaching strategies in our medical schools. Objectives: To identify the problems encountered by students in the study of Anatomy and suggest ways of enhancing their performance in the subject.Materials and Methods: Three hundred structured; pretested self administered questionnaires were applied to medical students of the Faculty of Medical Sciences; University of Nigeria Enugu Campus (UNEC); who had spent at least two years in the medical school. Data analysis was by SPSS version 15.Results: Of the 300questionnaires; 201(67.0) were correctly filled and analysed. One hundred and three (51.2) of the respondents were females; 163 (81.1) were aged 21 to 30 years and 105(52.3) had spent more than two years in the medical school. One hundred and eleven (55.2) believed that dissection followed by audio-visual aids 101(50.3) offered students adequate exposure to the learning of anatomy. One hundred and eleven; (55.2) also implicated overcrowding as a major cause of students' aversion for dissection leading to inadequate exposure to the subject and the resultant poor performance. One hundred and seven (53.2) believed that the preparatory period for 2nd MBBS exams should be extended so as to offer students adequate exposure to laboratory specimens.Conclusion: Over-population causes inadequate exposure of students to anatomical specimens and thus affects their performance negatively

Avulsion of the perineal body in a single nulliparous woman following a motorcycle accident: a case report.

Miss OO was seen at the gynaecology clinic in April 2008 with history of a road traffic accident three years earlier. She was thrown off a motorcycle and fell astride a culvert, sustaining perineal injury. She was treated at a private hospital, but subsequently developed faecal incontinence and was usually soiled with faecal matter during coitus. Examination revealed loss of perineal body and reconstruction was done, with success. With increase in motorcycle accidents on our roads, many more gynaecologically-related traumas are bound to occur. Proper and timely referral will lead to improved management with reduced psychosocial trauma. Organized awareness creation programmes will reduce these accidents in the long-term.

Successful intrauterine pregnancy following salpingostomy; case report.

BACKGROUND: Ectopic pregnancy occurs more in young women who still desire children. Because of tubal rupture, salpingectomy which leads to tubal loss and reduced reproductive potentials is the commonest management option. This is a case report of a primipara who had ruptured left tubal ectopic pregnancy managed by salpingectomy and later had unruptured heterotopic pregnancy involving the contralateral tube and managed by salpingostomy, after which she had spontaneous abortion of the associated intrauterine pregnancy. RESULT: Initial marital disharmony, followed by an uneventful intrauterine pregnancy carried to term with caesarean delivery of a live female baby. CONCLUSION: In well-selected cases, conservative tubal surgeries should be encouraged in preference to radical surgeries in the management of unruptured tubal pregnancies.

Nigerian male sexual activity during pregnancy.

OBJECTIVES: To determine the prevalence of extra-marital sexual affairs as well as other aspects of male sexual behavior during pregnancy in Nigeria. METHODS: A questionnaire survey of the husbands of consecutive women who delivered in three tertiary care centers in south-eastern Nigeria within an 8-week period. The data were analyzed by means of simple percentages and descriptive and inferential statistics, using t-tests, chi-square tests and regression equations at the 95% confidence level. RESULTS: 279 (88.3%) of the 316 eligible husbands responded to the questionnaire. A total of 78 (28.0%) of the respondents engaged in extra-marital sexual relationships during pregnancy. Of the respondents, 36.6% and 32.3% experienced a decrease in achievement of erection and orgasm, respectively. While libido decreased in 41.9%, coital frequency declined in 72.4% of the respondents. On univariate analysis, respondent's age > or = 40 years, duration of marriage > or = 5 years, having an extra-marital sexual partner and beliefs that coitus during pregnancy should be less frequent or can cause miscarriage were significant predictors of reduced coital frequency while a belief that coitus enhances fetal well-being was a significant predictor of increased coital frequency during pregnancy (P<0.05 for each variable). On multivariate logistic regression, three factors were statistically significant predictors of reduced coital frequency - age > or = 40 years (OR=2.3; 95% C.I., 1.9-2.3) and beliefs that coitus during pregnancy can cause miscarriage (OR=1.9; 95% C.I., 1.5-2.3) and should be less frequent (OR=1.9; 95% C.I., 1.8-2.5). CONCLUSIONS: Personal beliefs significantly affect sexual relationships between Nigerian husbands and their pregnant wives, making approximately one-third of husbands engage in extra-marital relationships as a way to satisfy their unmet sexual need during pregnancy. There is a need to educate husbands and their pregnant wives on sexual matters during pregnancy.