An analysis of the outcomes of cervical cone biopsies performed in a low resource setting.

Following skills transfer to this low resource setting, we carried out a descriptive analysis of the outcomes of all cone biopsies performed for women with cervical intra-epithelial neoplasia 3 (CIN 3). We also compared two methods of cone biopsy. All the women had follow-up smear tests at 6 and 18 months. There were no cases of CIN 3 at follow-up. 80% had normal smears at 18 months and 20% had CIN 1. Compared with knife cone biopsy, women who had an electric knife (hand-held diathermy blade) cone biopsy had a significantly smaller volume of mean blood loss (55.5mls ± 15.9 vs 153.3ml ± 40, p < 0.001). With appropriate skills transfer, women with CIN 3 in a low resource setting can be effectively treated with conisation procedures. The diathermy knife is preferred to cold knife because of its associated low blood loss.

Evaluation of diagnostic performances of visual cervical inspection with acetic acid and colposcopy in Benin city, Nigeria.

OBJECTIVE: To determine the performance indicators of visual inspection with acetic acid (VIA) and colposcopy to detect cervical premalignant lesions. METHODS: A prospective cross-sectional study evaluating performance indicators of visual cervical inspection with acetic acid and colposcopy using directed biopsy for histopathology as the reference standard in a Colposcopy unit at a referral tertiary hospital in Nigeria. Consecutive sample of 212 apparently healthy, ambulant, asymptomatic women with an intact uterus and with no past history of cervical neoplasia were recruited. RESULTS: A total of 195 women had VIA and satisfactory colposcopy with directed biopsy. Overall test positivity was 29.7% for VIA, 36.9% for colposcopy and 32.8% for histology of colposcopically directed biopsy. Using CIN 2 as the disease threshold; the sensitivity, specificity, positive predictive value and negative predictive value of VIA were 70.8%, 67.0%, 29.3% & 94.9% while those of colposcopy were 87.5%, 97.7%, 84.0% &98.2%,respectively. CONCLUSION: Although the test characteristics of both VIA and colposcopy appear satisfactory in this study, the data suggests that colposcopy performs better than VIA in the diagnosis of cervical neoplasia. However, in view of its ease of administration and low logistic requirements, VIA still has a vital role to play in population-based screening in our environment.

Physical after effects and clients satisfaction following colposcopy and cervical biopsy in a Nigerian population.

BACKGROUND: Although Nigeria has a high prevalence of cervical cancer, screening services including colposcopy and directed cervical biopsy are not widely available. OBJECTIVES: A prospective study among 111 women who had colposcopy and cervical biopsy following an abnormal Pap smear result at the University of Benin Teaching Hospital in Nigeria. It explored physical after effects experienced and satisfaction of clients after the procedure. RESULTS: The mean age of the population was 49.5±8.7 years (range, 30 - 64 years) and majority (64.9%) had tertiary education. Overall, 69 women (62.2%) reported physical effects following the procedure. Common physical effects experienced included spotting blood per vaginam (65.2%), pain (34.8%) and vaginal discharge (17.4%). Spontaneous resolution of symptoms occurred within 48 hours in 90.9% of those who reported physical effects. Clients who experienced physical after effects were significantly older (p=0.002) and had tertiary education (p=0.019). Majority of the women (94.6%) were satisfied with the screening services and more than 97% were willing to accept a repeat procedure. CONCLUSIONS: Although majority of the clients who had colposcopy and cervical biopsy reported they experienced physical side effects, more than 97% were willing to have a repeat procedure. This information can assist colposcopic service providers in counseling clients.

Plasma vitamin C levels and risk of preterm prelabour rupture of membranes.

PURPOSE: Preterm prelabour rupture of membranes (PPROM) is a leading cause of preterm births. Its attendant contribution to maternal and perinatal morbidity and mortality makes it imperative to identify factors that may help prevent this condition. This study examined the association between plasma vitamin C concentration and the risk of (PPROM) amongst pregnant women in a tertiary hospital setting. METHODS: This was a prospective cross sectional study conducted at the Obstetric and Gynaecology Department of University of Benin Teaching Hospital (UBTH), Benin City. The study was in two phases, first a pilot study to determine baseline plasma vitamin C concentration amongst pregnant women in UBTH was conducted. In the main study 80 pregnant women were recruited into two groups of those with PPROM (40 cases) and those without PPROM (40 controls) matched for gestational age. Plasma vitamin C concentration was determined for all study participants and their sociodemographic characters were used to generate a database for analysis. RESULTS: In the pilot study, plasma vitamin C concentration decreased with increasing gestational age of pregnancy. In the main study plasma vitamin C concentration was significantly lower in women with PPROM than controls without PPROM, 0.53 ± 0.05 vs. 0.58 ± 0.05 mg/dl; P = 0.0001. Both groups (case and control) were comparably matched in age, parity and social class. There was a significant association between low vitamin C levels and the occurrence of PPROM (95% CI 1.53-11.88; P = 0.008). CONCLUSION: Plasma vitamin C was found to be lower in women with PPROM. Low plasma vitamin C concentration may thus be an associated risk factor for PPROM. Hence improved dietary or drug supplements may be a useful adjunctive strategy to reducing the incidence of PPROM and its attendant adverse sequelae. While this intervention is advocated, further multicentre investigation of the effects of vitamin C on risk of preterm PROM is suggested.

Effect of chlorpheniramine on the pharmacokinetics of and response to chloroquine of Nigerian children with falciparum malaria.

Chlorpheniramine (CP), a histamine H1-receptor antagonist, enhances the efficacy of chloroquine (CQ) in acute uncomplicated falciparum malaria. The effects of this combination therapy on the pharmacokinetic disposition of CQ is, however, unpredictable. A standard treatment with 25 mg CQ base per kg bodyweight was orally administered over 3 days, alone or in combination with CP, to 17 semi-immune Nigerian children with Plasmodium falciparum parasitaemia attending hospital in Lagos, Nigeria, and observed for 28 days. Whole-blood CQ concentrations were monitored 14 times during the follow-up by high-performance liquid chromatography analysis of blood dried on filter paper. Parasitaemia was determined on thick blood films stained with Giemsa, and treatment failures were established following the WHO classification for CQ resistance. Our pharmacokinetic data showed that the peak whole-blood CQ concentration was significantly increased (P < 0.05) by CP administration, and the time to achieve the peak was reduced in the presence of CP. The area under the first-moment drug-concentration-time curve was also significantly increased (P < 0.05) by CP administration. Treatment with CQ-CP combination resulted in a shorter parasite clearance time (2.0 +/- 0.5 days) and a higher cure rate (87.5%) compared to treatment with CQ alone (3.5 +/- 0.5 days; 66.7%). Our data suggest that CP enhanced the efficacy of CQ against resistant P. falciparum in acute uncomplicated malaria by increasing the uptake/concentration of CQ in resistant parasites.

Changes in service organization: antenatal care policy to improve attendance and reduce maternal mortality.

High cost and delay in service purchase are major contributory factors to the decline of utilization of maternity services at the UBTH.

Spinal cord injuries in Enugu, Nigeria--preventable accidents.

This is a review of 72 patients who were treated for Spinal Cord Injuries in the University of Nigeria Teaching Hospital, Enugu, Nigeria, during the period January 1980 to January 1985. There were 20 patients who had tetraplegia as a result of their injuries and 52 with paraplegia. All the patients were treated conservatively. The catchment area of the hospital is in the rain forest belt of West Africa where tall palm trees grow. Palm tree climbers use jigs which are woven from palm fronds. The climbing jigs are prone to snapping during periods of low humidity between the months of November and March. During this period of the year the tensile strength of the jigs is greatly reduced. Our experience is that the commonest cause of spinal cord injury is a fall from palm trees. Climbers should be educated about the time related jig failure, falls and subsequent spinal cord injury. Alternative sources for stronger materials for weaving jigs, and increased growing of shorter species of palm trees from which harvesting of palm nuts take place at ground level are advocated. Other causes of spinal cord injuries and preventive measures are discussed.