ABSTRACT
Background Hypertensive disorders of pregnancy are the leading causes of both maternal morbidity and maternal mortality. Hypertensive disorders are acute obstetric emergencies, which refer to various life-threatening medical challenges known to develop during pregnancy, labor, and delivery, requiring urgent attention to reduce blood pressure (BP) for the benefit of the affected mothers and infants. Hydralazine and labetalol have been widely used as the first-line medications in the management of severe hypertension during pregnancy. However, the choice between these two drugs lacks clear evidence regarding their safety and superiority. Several studies have attempted to study intravenous (IV) labetalol versus hydralazine, but very few such comparison studies have been conducted in Africa. Objective To compare the effectiveness of IV labetalol and IV hydralazine in reducing systolic and diastolic BP in pregnant women with severe hypertension. Also, to determine the time required for hydralazine and labetalol to lower BP to ≤150/100 mmHg, the number of doses needed for each drug, and evaluating maternal and perinatal outcomes. Study design This study employed an open-label randomized clinical trial design conducted in the labor, delivery, and antenatal ward of the Central and Stella Obasanjo Hospital in Benin City. A total of 120 women with severe pregnancy-induced hypertension were randomly assigned to two groups: Group X, consisting of 60 pregnant women, received IV hydralazine at a slow rate of 5 mg for five minutes, repeated every 20 minutes (maximum of five doses) until a blood pressure of ≤150/100 mmHg was achieved. Group Y, also consisting of 60 pregnant women, received IV labetalol in escalating doses of 25, 50, 75, 75, and 75 mg (maximum of 300 mg) every 20 minutes until the blood pressure reached ≤150/100 mmHg. Statistical analysis was performed using SPSS version 23 (IBM Inc., Armonk, New York). Result IV hydralazine achieved the target BP in an average time of 45.80 +/- 25.17 minutes, while IV labetalol took an average of 72.67 +/- 41.80 minutes (p=0.001). The number of doses required to reach the target BP differed significantly between the two drugs. Hydralazine required an average of 1.72 +/- 0.904 doses, whereas labetalol required an average of 3.72 +/- 1.782 doses (p=0.0001). While 45% of women in the hydralazine group attained the target BP with a single dose of hydralazine, only 31.1% of women in the labetalol group were able to attain the target BP with a single dose of labetalol (p=0.02). Overall, target BP was achieved in 55 out of 60 women (91.7%) who were randomized to receive IV hydralazine, whereas 45 out of 60 women (75%) who received IV labetalol achieved the target blood pressure. While hydralazine demonstrated more favorable results in terms of achieving target blood pressure, there were higher incidences of maternal adverse effects in the hydralazine group compared to the labetalol group. However, these adverse effects were not severe enough to warrant discontinuation of the medication. Conclusion IV hydralazine showed faster achievement of the target BP and a lower number of doses required compared to IV labetalol. Additionally, a higher percentage of women in the hydralazine group achieved the target BP with a single dose. However, there were more maternal adverse effects associated with hydralazine, although they were not severe. Perinatal outcomes did not differ significantly between the two groups.
ABSTRACT
Introduction Oral health has been linked to aspects of individual knowledge, attitude, and practices. In Nigeria, the increased prevalence of poor oral hygiene has been attributed behavioral factors. Behavioral aspects that include the increased intake of sugary foods and beverages, and lack of proper oral hygiene have been touted as the main causes of poor oral hygiene among university students. The knowledge of oral health is vital owing to its contribution to better oral health; however, unless students develop good oral habits and attitudes and subsequently put them into practice, very little will be realized with regard improvement in oral health and hygiene. Objective This research aimed to explore the knowledge, attitude, and practice of dental care among the University of Calabar students. Method This study was a descriptive cross-sectional study conducted between 2016 and 2017. A standardized questionnaire was used to collect data from 430 student participants in a university using a multi-stage random technique. An inferential statistical approach was adopted to test the relationships represented in the tables. Data were analyzed using the statistical package for social sciences, version 20.0. Result The study included 430 participants, 239 (55.6%) females and 191 (44.4%) males. The survey revealed that 94% of the 404 respondents agreed that poor dental care can cause dental diseases, while only 6% disagreed. Regarding excessive drinking of water, 91% of the respondents agreed that it cannot cause dental disease, 4.2% agreed it could, and 4.8% did not know. Furthermore, 60.2% of the 430 respondents acknowledged that genetic inheritance could cause dental disease, while 21.4% disagreed, and 18.4% did not know. Finally, 74.9% of the respondents knew that trauma to the teeth could cause dental disease, while only 9.3% thought that trauma could not cause illness to the teeth. Regarding attitude to dental care, 232 (54%) respondents agreed that visiting the dentist was necessary, while 164 (38.1%) strongly agreed. Only eight (1.9%) strongly disagreed, while five (1.2%) disagreed that visiting the dentist was necessary. Moreover, 82% of the respondents agreed that bad breath was associated with poor dental care, with 195 (45.3%) respondents strongly agreeing and 158 (36.7%) agreeing. However, 37 (8.6%) disagreed, and 16 (3.7%) strongly disagreed, while 24 (5.6%) were indifferent. As regards practice, most respondents used the up-down technique when brushing their teeth (62.8%), while 17.4% brushed left-right and 19.8% used both methods. Moreover, 67.4% of the respondents brushed twice daily, 26.5% brushed once daily, and only 6.1% brushed after every meal. About half of the students spent one to three minutes brushing their teeth (50.5%), while the other half spent more time. Over half of the students replaced their toothbrushes every three months (57.7%), with the most common reason for replacement being the fraying of bristles. However, the use of dental floss was found to be low. Conclusion The utilization of dental care facilities was low among most University of Calabar students, who did not see the need for dental clinic visits unless they had dental needs. The lack of dental visits was attributed to perceived high dental costs and a lack of time. Targeted interventions and educational programs that address these barriers could promote better oral hygiene practices among the students.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a relatively new disease with high morbidity and mortality. Information about the prevalence of infections in pregnancy could help identify herd immunity, project epidemics, and decide policy guidelines. OBJECTIVES: The aim of this study was to determine the infection susceptibility risk of COVID-19 in pregnancy, to determine the prevalence of COVID-19 antibodies (IgG & IgM), and to evaluate the determinants of COVID-19 antibody positivity in pregnancy. MATERIALS AND METHODS: This was an analytical cross-sectional study involving 258 consenting pregnant women recruited at Irrua Specialist Teaching Hospital, Edo State, Nigeria. Of these, 179 participants were recruited from the antenatal clinic, and 79 from the gynecology emergency unit. A structured questionnaire was administered at baseline. Venous blood was obtained at enrolment to test for total antibodies using ELISA. A nasopharyngeal swab was simultaneously obtained for COVID-19 PCR for all participants. Umbilical cord blood was taken after delivery in those who had positive serology. Socio-demographic variables and clinical presentation of respondents were considered as exposure variables, and this was cross-tabulated with outcome variables in bivariate analysis using chi-square with a level of significance at a P-value less than 0.05. Variables in bivariate analysis of chi-square that have a P-value less than 0.2 were entered into a logistic regression using multivariate logistic models. RESULTS: The study detected active COVID-19 infections among 7.4% (19/258) of the study participants. The study demonstrated a seroprevalence of COVID-19 antibodies in 62.4% (161/258) of the participants at recruitment and showed a strong correlation between working in the healthcare setting and living in an urban environment. Our study also reported 5.3% (8/152) of cord blood antibody positivity among study participants. The concentration of maternal immunoglobulin strongly and positively correlated with cord blood seropositivity. CONCLUSION: Prevalence estimates are an underestimate of the actual proportion of pregnant women with prior COVID-19 exposure as observed in the study discrepancy of confirmed PCR infection and evidence of previous infection from serology. The study also highlighted a low efficiency of placental transfer of COVID-19 antibodies at birth among those who were seropositive at baseline and showed that maternal antibody levels play an important role in determining the efficiency of placenta transfer of COVID-19 antibodies in pregnancy.
ABSTRACT
Hypertension is the most common modifiable risk factor for cardiovascular and cerebrovascular diseases. In the last two decades, the guidelines have evolved tremendously from areas with no recommendations for screening or treatment to targeted recommendations for some at-risk groups. We sought to go through the literature that provided guidelines for the management of hypertension at any point in time over the last 22 years from 2000 to 2022. We searched four databases: PubMed, Embase, Google Scholar, and Cochrane, using specified search terms. The keywords used were "hypertension" and "guidelines." We combined them using the Boolean operators (AND, OR) and searched for articles. A total of 2461 publications were initially identified; 348 publications were excluded after screening for full-text availability. The full-text articles were further filtered based on title and abstract screening. Following this, a total of 1443 articles were excluded. The remaining 670 full-text articles were assessed for eligibility. Of the 670 full-text articles, 480 were excluded based on exclusion criteria, and following the full-text article screening, 190 articles met the final inclusion criteria. Most of these guideline evolutions concerned establishing and adjusting thresholds for the subgroups of the elderly population and patients with diabetic kidney disease, chronic kidney disease, and stroke. Furthermore, the medications of choice are now guided by the stage of disease, presence or absence of comorbidities, and other relevant information, as opposed to ethnicity, which was previously a heavy yardstick for medication choice.
