Rh Blood Group Antigens and Alloimmunization Risk of Pregnant Women in South Western, Nigeria.

BACKGROUND: Rh blood group antigens are the second most important blood group antigens in clinical transfusion due to their immunogenicity and prevalence. Childbirth, miscarriage, and other obstetrics events are risk factors for alloimmunization in women which increases the likelihood of haemolytic blood transfusion reaction and hemolytic disease of the fetal/newborn (HDNF/B). Even though there are several data on the RhD status of our populations. However, there is a dearth of data on pregnant women's C, E, c, and e status, their alloimmunization risk, and rates in Nigeria. OBJECTIVES: This study aims to provide information on the distribution of the Rh major antigens and risk factors for alloimmunization in pregnant women in southwestern Nigeria. MATERIALS AND METHODS: This was a descriptive cross-sectional study of 133 pregnant women attending routine ante-natal clinics. Questionnaires were administered to collect biodata and obstetrics history. ABO blood grouping and Rh phenotyping were carried out on their blood samples using RAPID LABS Monoclonal Rhesus Typing Reagent. RESULTS AND DISCUSSION: Rh blood group antigen c was present in 100% of the women, followed by e (98.5%) and D (95.5%). C and E are the least prevalent antigens and probably the ones to which antibodies may be formed. The commonest Rh phenotype was Dce. Of all the pregnant women, alloimmunization was present in 0.8%. Of those who were RhD negative, alloimmunization was present in 16.7%. Pregnant women are more likely to be alloimmunized against C and E antigens than c and e antigens due to their low and high frequencies respectively.

CONTEXTE: Les antigènes du groupe sanguin Rh sont les seconds plus importants en transfusion clinique en raison de leur immunogénicité et de leur prévalence. L'accouchement, la fausse couche et d'autres événements obstétriques sont des facteurs de risque d'alloimmunisation chez les femmes, augmentant ainsi la probabilité de réactions hémolytiques lors de transfusions sanguines et de maladies hémolytiques du fœtus/nouveau-né (HDNF/B). Bien qu'il existe plusieurs données sur le statut RhD de nos populations, il y a un manque de données sur le statut des antigènes C, E, c et e chez les femmes enceintes, leur risque d'alloimmunisation et les taux associés au Nigéria. OBJECTIFS: Cette étude vise à fournir des informations sur la distribution des principaux antigènes Rh et les facteurs de risque d'alloimmunisation chez les femmes enceintes dans le sud-ouest du Nigéria. MÉTHODOLOGIE: Il s'agit d'une étude descriptive transversale de 133 femmes enceintes fréquentant les cliniques prénatales de routine. Des questionnaires ont été administrés pour collecter des données biodémographiques et des antécédents obstétriques. La détermination des groupes sanguins ABO et le phénotypage Rh ont été réalisés sur leurs échantillons de sang à l'aide du réactif de typage Rh monoclonal RAPID LABS. RÉSULTATS ET DISCUSSION: L'antigène c du groupe sanguin Rh était présent chez 100 % des femmes, suivi de e (98,5 %) et D (95,5 %). Les antigènes C et E sont les moins prévalents et probablement ceux contre lesquels des anticorps peuvent être formés. Le phénotype Rh le plus courant était Dce. Parmi toutes les femmes enceintes, l'alloimmunisation était présente chez 0,8 %. Parmi celles qui étaient RhD négatives, 'alloimmunisation était présente chez 16,7 %. Les femmes enceintes sont plus susceptibles de développer une alloimmunisation contre les antigènes C et E que contre les antigènes c et e en raison de leurs fréquences respectives faibles et élevées. MOTS-CLÉS: Antigènes du groupe sanguin Rh, Phénotype, Alloanticorps érythrocytaires, Femmes enceintes.

INTEREST IN FAMILY MEDICINE SPECIALIZATION AMONG MEDICAL UNDERGRADUATES OF THE UNIVERSITY OF IBADAN, NIGERIA.

BACKGROUND: One of the strategies adopted to improve interest in family medicine (FM) by many regions was the introduction of undergraduate family medicine training into the Medical School Curriculum. However, medical students' interest in FM has been reportedly low ranging from 3 - 29%. OBJECTIVES: This study described the pattern of medical students' specialty choices and assessed factors associated with interest in FM specialization among them. METHODS: Using a cross-sectional study design, total sampling of fourth to sixth-year medical students undergoing family medicine rotation as of November 2017 (N= 412) was done. The response rate was 75% (N=309). A pre-validated semi-structured, self-administered questionnaire was utilized to assess factors associated with respondents' interest in 12 medical specialties including FM. RESULTS: The respondents were predominantly male (67.3%), with a mean age of 23 (± 7.9) years. Most (83.4%) of them had at least one parent with tertiary school education. Fifteen (4.9%) of the respondents indicated a current interest in specializing in FM while 112 (36.2%) would consider FM in the future. A higher proportion of those with family members with FM specialization (28.6%) expressed current interest in FM while the female gender was associated with future consideration of FM. CONCLUSION: There is a low interest in FM specialization among medical students and this may be attributable to the fact that FM undergraduate training is relatively new in Nigeria. Further research on the role of mentorship and preceptorship on specialty choices of medical students needs to be carried out.

Knowledge and perception of family medicine among medical students at University of Ibadan, Nigeria

Background: Postgraduate training in Family Medicine in Nigeria began over three decades ago, but it was not until recently that the National University Commission (NUC) made it a policy for all Nigerian universities to include undergraduate Family Medicine training in their curriculum. This study aimed to assess the awareness and perception of Family Medicine among medical students at the University College Hospital (UCH), Ibadan. Method: A descriptive cross-sectional study was conducted over a period of four weeks (June 11­July 6, 2018) among 131 fourth-year, 118 fifth-year and 163 sixth-year medical students at UCH, Ibadan. Data were obtained using a self-administered questionnaire. Results: Data were collected from 309 (75% of the target population). The mean age of the respondents was 22.3 ± 2.3 years. The majority (74.4%) did not have a family member who was a doctor and only 2.3% had a family member who was specialising in Family Medicine. Most of the participants (68.9%) had good knowledge of Family Medicine, while 57.3% had good perception of Family Medicine as a specialty. Importantly, an increase in year of clerkship was associated with an increase in the knowledge of Family Medicine among the respondents. Conclusion: It was observed that with increase in length of exposure to Family Medicine as a specialty, knowledge and perception of the specialty improved among the medical students. It is imperative that all the medical schools in Nigeria implement the NUC directive and start undergraduate Family Medicine training

A prospective epidemiological study on odontogenic tumours in a black African population, with emphasis on the relative frequency of ameloblastoma.

The persistent view in the literature is that the relative frequency of ameloblastomas is higher in the black population than in Caucasians. The aim of this study was to determine the relative frequency of all odontogenic tumours (OT) in a 100% black population and to compare our findings with those of previous studies. A prospective study was undertaken of all patients presenting with OT to all 16 Nigerian departments of oral and maxillofacial surgery over a 4-year period. The following data were obtained: patient demographics, delay to presentation, extent of the lesion, and histological diagnosis. Six hundred and twenty-two cases were studied. A slight male preponderance was observed (male to female ratio 1.17:1). Patients ranged in age from 5 to 89 years, with a peak incidence in the third decade. The relative frequency of OT was 0.99 per million and that of ameloblastoma was 0.76 per million. Ameloblastoma was the most prevalent OT (76.5%), followed by adenomatoid odontogenic tumours (5.6%), odontogenic myxoma (4.5%), and keratocystic odontogenic tumours (KCOT) (3.1%). The relative frequency of ameloblastoma among Nigerians was not different from frequencies reported previously among Caucasian and Tanzanian black populations. KCOTs were, however, rarely diagnosed in Nigerians as compared to the white population in the Western world.

Prophylaxis versus pre-emptive antibiotics in third molar surgery: a randomised control study.

OBJECTIVES: This study was carried out to compare the efficacy of preoperative single bolus antibiotics with a 5 day- postoperative antibiotic regimen in reducing pain, swelling, and trismus, surgical site infection (SSI) and alveolar osteitis (AO) after third molar surgery. PATIENTS AND METHODS: A randomised experiment was done involving eighty-four patients. The patients were divided into two groups consisting of 42 patients each. A preoperative group was given an oral bolus of 2g amoxycillin capsules and 1g metronidazole tablets one hour before extraction, while those in the postoperative group were given a five-day regimen oral 500mg amoxycillin capsules thrice daily and 400mg metronidazole tablets thrice daily. The occurrence of postoperative pain, swelling, trismus, SSI and AO were compared between the groups. RESULTS: Seventy-nine patients completed the study; 38 patients in the preoperative group and 41 patients in the postoperative group. There was no difference between the groups in respect of the inflammatory complications. The four cases of AO occurred in the preoperative group. CONCLUSION: Single bolus antibiotic prophylaxis should be adequate for most cases of third molar surgery as the degree of degree of postoperative pain, swelling and trismus was similar in both groups. The use of single bolus antibiotic prophylaxis would also help reduce the cost of treatment in developing countries as well as reduce the risk of development of resistant strains. However, a five-day postoperative antibiotic regimen is advised in patient with risk factors for AO.

A prospective multicenter study of injury profile, severity and risk factors in 221 motorcycle-injured Nigerian maxillofacial patients.

OBJECTIVE: This 12-month prospective multi-center study was designed to ascertain the entire injury profile, injury severity, and risk factors in motorcycle injured Nigerian maxillofacial patients. METHODS: With a validated investigator-administered questionnaire, we obtained data from motorcycle-injured in- and out-patients managed in the maxillofacial units of four Nigerian teaching hospitals. Standardized information on host factors, agent, and type of crash as well as location, type, and extent of injury were elicited. Injuries were scored using the Facial Injury Severity and Abbreviated Injury scales (FISS, AIS). RESULTS: A significant male preponderance was observed (p = 0.003) with peak age 21-30 years; 62.7% of the patients were riders. Alcohol/substance abuse was implicated in 31.2% of riders, fatigue in 13.5%, and bad roads in 17.6%. The rate of helmet use was 3%. The predominant type of crash was head-on collision (HOC) 58%). Glasgow Coma Scale (GCS) score ranged from 5 to 15 with mean 13.3 (3.5); Facial Injury Severity Score (FISS) ranged from 1 to 11, mean 3.7 (1.9); and Abbreviated Injury Score was mostly 2. FISS was not significantly different between both genders (p = 0.26) and road types (p > 0.05). The mean FISS was greater with multiple passengers than with single or no passengers (p = 0.12) and lower with crashes involving motorcycles carrying heavier loads (p = 0.022). Six of the patients died (2.7% fatality) in the course of their hospitalization all within a month of injury. CONCLUSION: We advocate prompt legislation of a ban on greater than one passenger on a motorcycle, impaired (substance abuse) operation on a motorcycle, and stronger enforcement of speed limit and adoption of legislation that would make it mandatory to wear a full-face helmet when operating a motorcycle in Nigeria.

The use of thromboembolic prophylaxis by surgeons: A multicentre Nigerian study.

BACKGROUND: Despite the well known contributions of deep vein thrombosis and pulmonary embolism to perioperative deaths, these major causes of morbidity and mortality appear not to be given adequate attention by surgeons in our environment. OBJECTIVE: To study the practice of thromboembolic prophylaxis among surgeons in some sub-specialties in three Nigerian tertiary institutions. MATERIALS AND METHODS: A structured questionnaire was used to collect information from consultants in the surgical sub-specialties on the use of thromboembolic prophylaxis in their practice. RESULTS: Fifty nine adequately completed questionnaires were returned. Of this, only 28 (47.5%) used prophylaxis routinely in major surgeries. Use was most frequent in orthopaedics and least in ophthalmology and otorhinolaringology. Subcutaneous heparin was the most commonly employed agent and the most important indication for prophylaxis was a previous history of thromboembolism. CONCLUSION: The results obtained suggest low use of prophylaxis. Evidenced-based guidelines are available on antithrombotic and thrombolytic therapy with the benefits outweighing risks, burdens and costs. Therefore greater attention should be paid to antithrombotic measures by all the surgical sub-specialties and patients stratified according to risk.

Oral squamous cell carcinoma: a review of 246 Nigerian cases.

A review of 246 Nigerians with oral squamous cell carcinoma seen at the University College Hospital, Ibadan, over a 20-year (1976-1995) period was carried out. A prevalence rate of 1.2% was found with a male to female ratio of 1.5:1. Their ages ranged from 20 to 88 years with mean and median ages of 53.7 and 55.5 years respectively. The most common site was the palate while the least common was the buccal mucosa. Most patients presented later for treatment with advanced disease, but women tended to report earlier than men. Out of 125 patients who had definitive treatment, only 33 (26%) had adequate follow-up records and recurrence was noted in 13 (39%). The prevalence of oral squamous cell carcinoma is significant in this environment but patient awareness is still low. There is a need to step up awareness campaign programmes, provide more centres for cancer treatment and introduce mass screening programmes.