Conservative approaches to postpartum haemorrhage.

Postpartum haemorrhage (PPH) and PPH-related deaths are disproportionately higher in low-income countries, with sub-Saharan Africa and Southern Asia accounting for approximately 85% of the global burden of PPH-related maternal deaths. Although PPH-related mortality is directly related to the amount and duration of bleeding, the high maternal death burden in resource-limited countries suggests that a great majority of these deaths would be avoidable with the appropriate resources and effective use of evidence-based interventions. Non-surgical management is often the first-line approach for PPH, but conservative surgical interventions may be required if bleeding persists or if the underlying cause is not responsive to the initial conservative measures. The appropriate interventions should be selected based on the individual's specific circumstances and clinical condition.

Survival outcomes following interval versus primary debulking surgery in advanced epithelial ovarian cancer: A retrospective cohort study in Lagos, Southwest Nigeria.

Background: There is conflicting evidence regarding the survival benefit of interval debulking surgery (IDS) compared to conventional treatment with primary debulking surgery (PDS) in women with advanced epithelial ovarian cancer (EOC). Objectives: We compared the survivals following PDS followed by adjuvant chemotherapy (ACT) versus IDS after neoadjuvant chemotherapy (NACT) in women with advanced EOC at the gynaecological oncology unit of a tertiary referral centre in Lagos, Southwest Nigeria. Methods: The data of 126 women with advanced EOC who had standard treatment with either PDS and ACT or NACT and IDS between January 2008 and December 2017 were analyzed. Kaplan-Meier estimates of progression-free (PFS) and overall survival (OS) time stratified by the types of upfront debulking surgery were calculated and compared by employing the log-rank test statistics. Cox proportional hazard models were then used to estimate hazard ratios of the association between the type of surgical debulking and survivals while adjusting for all necessary covariates. Results: We recorded no statistically significant differences in PFS (adjusted hazard ratio=1.28, 95% confidence interval 0.82-2.01, P=0.282) and OS (adjusted hazard ratio=1.23, 95% confidence interval 0.68-2.25, P=0.491) between IDS and PDS among women with advanced EOC. Conclusions: There is a need for a larger prospective multicenter study to further compare the impact of upfront surgical debulking types on the survival of women with advanced EOC in our setting. In the meantime, giving interval debulking surgery after a few courses of neoadjuvant chemotherapy should be an acceptable standard of care for women with advanced EOC.

Serum Calcium and Magnesium Levels in Women with Uterine Fibroids at a University Teaching Hospital in Southwest Nigeria: A Comparative Cross-Sectional Study.

Background: Studies have suggested the potential roles of serum trace elements such as calcium and magnesium in the development of uterine fibroids. Aims: This study compared magnesium and calcium serum levels in reproductive-age women with and without uterine fibroids in Lagos, Southwest Nigeria. Methods: A comparative cross-sectional study of 194 parity-matched women with or without a sonographic diagnosis of uterine fibroids enrolled at a university teaching hospital in Lagos, Southwest Nigeria. Participants' sociodemographic, ultrasound, and anthropometric information as well as the estimated serum levels of calcium and magnesium were collected for statistical analyses. Results: This study found significant negative associations between low serum calcium levels and uterine fibroids (adjusted odds ratio= 0.06; 95% CI: 0.004, 0.958; p=0.047), uterine size (p=0.004), and the number of fibroid nodules (p=0.030). However, no significant association was observed between serum magnesium levels and uterine fibroids (p=0.341). Conclusion: The findings of this study suggest the promising role of calcium-rich diets and supplements in the prevention of uterine fibroids among Nigerian women. However, future longitudinal studies are required to further evaluate the potential role of these trace mineral elements in the development of uterine fibroids.

Use of exchange blood transfusion in the management of severe COVID-19 infection in pregnancy: experience from Lagos, Nigeria.

Coronavirus disease 2019 (COVID-19) presents with symptoms that may be mild or severe. The individual with the severe form of the disease usually presents with a constellation of respiratory symptoms typical of acute respiratory distress syndrome. In this report, we present our experience of the successful management of an oxygen-dependent pregnant woman with severe COVID-19 infection who had 2 sessions of partial exchange blood transfusion. We discussed the principles that informed this intervention and the need to adopt this novel approach in the care of severe COVID-19 infection.

Prevalence and Risk Factors of Genital Human Papillomavirus Infections among Women in Lagos, Nigeria.

Regional variations exist in HPV prevalence worldwide despite reports of high prevalence rates among African women. Limited data on genital HPV prevalence necessitated this study with the aim of determining the prevalence of genital HPV and associated risk factors among women in Lagos, Nigeria. Exfoliated cervical cells were collected with consent from 165 women using a cervical brush. Viral DNA was extracted and amplified by nested PCR using two sets of consensus primers (MY09/11 and GP5+/6+). An unconditional logistic regression model was used to identify predictors of HPV positivity. The HPV prevalence was 81.82% in all women and 87.59% in women with normal cytology. The risk of HPV infection was significantly increased among women who had a history of STI (odds ratio (OR) 3.94; 95% confidence interval (CI): 1.51-10.25, p = 0.005) while there was a significantly reduced risk of HPV infection among those who used condoms (odds ratio (OR) 3.94; 95% confidence interval (CI): 0.18-0.91, p = 0.03). The HPV prevalence observed shows an increased transmission of the virus in Lagos, Nigeria. Therefore, there is a need for intense public awareness and the implementation of early detection tests, treatment, and vaccination to prevent an increase in cervical cancer cases in Lagos, Nigeria.

Willingness and motivations towards volunteering during the COVID-19 pandemic: A cross-sectional survey among final year medical students in Lagos, Nigeria.

Introduction: Increasing manpower capacity to meet the demands in the healthcare system is important during health emergencies. Medical students have roles to play during a pandemic but their involvement in these duties should be voluntary. The objective of this study was to assess the willingness and motivations of final year medical students in Lagos, Nigeria towards volunteering during the COVID-19 pandemic. Methods: A descriptive cross-sectional study was conducted among medical students in their sixth (final) year of study at the two public Universities in Lagos, Nigeria using total population sampling technique. A web-based questionnaire was used for data collection and data were analysed using SPSS. Logistic regression analysis was used to predict the willingness to volunteer. Results: The mean age of the respondents was 23.4 years ±â€¯2.6SD and 62.6% were female. About 65.9% of the medical students were willing to volunteer. Motivational factors which include self-rated good health status [OR: 2.1(95%CI: 1.16-3.6)], self-rated competence to work as a COVID-19 volunteer [OR: 6.5(95%CI: 3.61-11.54)] and availability of adequate protection and personal protective equipment [OR: 3.3(95%CI: 1.74-6.33)] significantly increased the odds of willingness to volunteer after controlling for other variables. Respondents' opinions on settings where medical students can serve as volunteers during the COVID-19 pandemic include case management (21.7%) and telemedicine (85.8%). Conclusion: Medical students are willing to volunteer during the COVID-19 pandemic. There is a need to prepare and motivate the final year medical students by developing their skills to improve their competence and by providing adequate protection for the willing students to function as volunteers.

Use of exchange blood transfusion in the management of severe COVID-19 infection in pregnancy: experience from Lagos, Nigeria

Coronavirus disease 2019 (COVID-19) presents with symptoms that may be mild or severe. The individual with the severe form of the disease usually presents with a constellation of respiratory symptoms typical of acute respiratory distress syndrome. In this report, we present our experience of the successful management of an oxygen-dependent pregnant woman with severe COVID-19 infection who had 2 sessions of partial exchange blood transfusion. We discussed the principles that informed this intervention and the need to adopt this novel approach in the care of severe COVID-19 infection.

Chemotherapy induced neutropenia and febrile neutropenia among breast cancer patients in a tertiary hospital in Nigeria.

PURPOSE: This study assessed the incidence of chemotherapy-induced neutropenia and febrile neutropenia (FN) while identifying their associated factors. METHODS: A prospective cross-sectional study was conducted among 113 female chemotherapy-naïve breast cancer patients over a 2-year period. Socio-demographic, clinical and haematological data were obtained via semi-structured interviews and from medical case files. Blood samples for complete blood count parameters were collected 2 weeks after each course of chemotherapy. The National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 was used to assess FN, neutropenia and their severity. RESULTS: The incidence of neutropenia and FN among the patients was 31.9% and 5.3%, respectively. Throughout all courses of chemotherapy (n = 502), there were 57 (11.4%) neutropenic episodes with 6.6% mild, 3.4% moderate and 1.4% severe neutropenia. The incidence of neutropenia decreased with increasing chemotherapy courses, with a rate of 14.2% and 4.9% after the first and last course, respectively. Factors associated with the risk of developing neutropenia include increasing age (p = 0.014), Eastern Cooperative Oncology Group performance score ≥ 1 at presentation (p = 0.033) and presence of bone metastasis (p = 0.002). CONCLUSION: One in three breast cancer patients in this study developed neutropenia while on chemotherapy but no independent risk factors were identified for FN among these patients. This study has, therefore, provided the preliminary data necessary for further independent validation of the identified risk factors for FN in a more robust and well-designed study within our clinical practice setting in Nigeria.

Volunteering during the COVID-19 pandemic: Attitudes and perceptions of clinical medical and dental students in Lagos, Nigeria.

BACKGROUND: Volunteering within the health-care sector is crucial during pandemics. This study aimed to assess the attitudes and perceptions of clinical medical and dental students in Lagos, Nigeria, about volunteering during the coronavirus disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted amongst medical and dental students undergoing clinical postings at the two public universities in Lagos, Nigeria, using total population sampling. Data were collected using a web-based questionnaire and analysed using Statistical Package for the Social Sciences. Chi-square test and logistic regression analysis were used to test for association at the level of significance of 5%. RESULTS: The mean age of the respondents was 23.3 years ± 2.6 standard deviation and 62.5% were females. The majority (82.9%) of the respondents agreed to volunteer if provided with adequate personal protective equipment (PPE) and if adequately trained to do so (79.3%). Although perceived as dangerous, the majority (91.2%) of the respondents considered volunteering during the COVID-19 pandemic as a form of educational experience. Compared to the final-year students, penultimate year students were more likely to volunteer in the event of a health manpower shortage. The final-year students were more likely to volunteer if government made the request. Female students were more likely than male students to volunteer even if they were not compensated but would require parental approval. CONCLUSION: Medical and dental students perceived their involvement during the COVID-19 pandemic as a form of educational experience but would require adequate training and PPE. There is a need to train and provide adequate PPE for them to function as volunteers.

Predictors of Survival Outcomes After Primary Treatment of Epithelial Ovarian Cancer in Lagos, Nigeria.

PURPOSE: This study was designed to investigate the clinicopathologic predictors of progression-free survival (PFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC) following primary treatment in Lagos, Nigeria. MATERIALS AND METHODS: Using data from a retrospective cohort of 126 patients who received treatment for EOC between 2010 and 2018, we identified 83 patients with a complete clinical record for subsequent data analysis. Patients' demographics and updated 2-year follow-up status were abstracted from medical records. Kaplan-Meier survival curves were compared using the log-rank test, and Cox proportional hazard models were used for multivariate analysis to identify independent predictors of survivals following treatment in EOC patients. RESULTS: The median PFS and OS were 12 and 24 months, respectively. After adjusting for covariates in the multivariate analysis, younger age ≤ 55 years (hazard ratio [HR] = 0.40; 95% CI, 0.22 to 0.74; P = .01) and International Federation of Gynecology and Obstetrics (FIGO) stage I/II (HR = 0.02; 95% CI, 0.01 to 0.08; P = .01) were independent predictors of improved PFS, whereas being premenopausal (HR = 2.34; 95% CI, 1.16 to 4.75; P = .02) was an independent predictor of reduced OS after 2-year follow-up. CONCLUSION: PFS could be predicted by the age and FIGO stage of the disease, whereas menopausal status was predictive of OS in patients with EOC. This knowledge should form the basis for counseling patients with ovarian cancer during their primary treatment and lend support to the importance of aggressive follow-up and monitoring for the older, premenopausal patients and those with an advanced stage of epithelial ovarian cancer. However, robust longitudinal research should be carried out to provide additional reliable insight to this information.

Risk predictors of early recurrence in women with epithelial ovarian cancer in Lagos, Nigeria.

INTRODUCTION: epithelial ovarian cancer (EOC) is the most lethal gynaecological cancer with a recurrence rate as high as 85% after an initial treatment. However, there are currently no reliable means of predicting the risk of recurrence after first-line treatment. This study investigated the risk factors that predict early recurrence of EOC after primary treatment among women in Lagos, Nigeria. METHODS: this was a retrospective cohort study involving the review of all histologically confirmed EOC patients managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. A study proforma was used to retrieve relevant information and descriptive statistics were computed for all data. The associations between variables were tested and multivariate analysis was done to adjust for all the possible characteristics that predict early EOC recurrence. RESULTS: the rate of recurrence of EOC was 76.4%. Suboptimal debulking surgery is the only independent predictor of early tumour recurrence. CONCLUSION: women should be adequately counselled and encouraged to report their symptoms early to ensure optimal primary treatment. Strategic efforts should also be made to further improve subspecialty training programs and skills development in gynaecological oncology in Nigeria and sub-Saharan Africa.

Serum vitamin D deficiency and risk of epithelial ovarian cancer in Lagos, Nigeria.

The studies that have evaluated the association between vitamin D and risk of ovarian cancer have reported inconsistent findings. Many of these studies were carried out in regions with relatively low sunshine all year round unlike in Africa. This study was aimed to determine the relationship between vitamin D deficiency and epithelial ovarian cancer (EOC) amongst women in Lagos, Nigeria. We conducted a case-control study involving women with histologically confirmed EOC (case group) and an equal number of healthy women without cancer (control group) treated at the gynaecological oncology units of two public tertiary hospitals in Lagos, Nigeria, between 1 August, 2016 and 31 May, 2017. Relevant information was obtained from the participants using a structured interviewer-administered questionnaire, and then, venous blood samples were collected and analysed for serum 25-hydroxyvitamin D levels using the CALBIOTECH® 25(OH) vitamin D ELISA kit. The descriptive statistics were conducted for all relevant data, and the multivariable analysis using binary logistic regression model was performed to examine the association between vitamin D deficiency and EOC after adjusting for all possible confounders. The mean age of the participants was 50.6 ± 11.1 years. There was no statistically significant association between serum vitamin D deficiency and EOC (p = 0.09). However, 10 mmol/L change in circulating vitamin D levels was associated with EOC amongst the study participants (adjusted odds ratio 0.96; 95% confidence interval 0.93-0.99; p = 0.04), but following adjustment for potential confounders in a multivariable analysis, there was no statistically significant relationship observed with EOC (adjusted odds ratio 0.99; 95% confidence interval 0.97-1.00; p = 0.06). In addition, there was no evidence of an interaction effect between these confounders and change in circulating 25(OH)D levels in relation to the risk of EOC. The study revealed no statistically significant association between the circulating levels of vitamin D and the risk of EOC. A better assessment of sun exposure in the future as well as better dietary compositional data may help to clarify whether the association between vitamin D and EOC actually exists. Therefore, the future large prospective longitudinal studies are recommended to further examine this relationship and then evaluate the possible need for vitamin D supplementation in women with an increased risk of EOC in Nigeria.

Caesarean delivery of first prediagnosed COVID-19 pregnancy in Nigeria.

The COVID-19 pandemic is currently causing widespread infection and deaths around the world. Since the identification of the first case in Nigeria in February 2020, the number of confirmed cases has risen to over 9,800. Although pregnant women are not necessarily more susceptible to infection by the virus, changes to their immune system in pregnancy may be associated with more severe symptoms. Adverse maternal and perinatal outcomes have been reported among pregnant women with COVID-19 infection. However, literature is scarce on the peripartum management and pregnancy outcome of a pregnant woman with COVID-19 in sub-Saharan Africa. We report the first successful and uncomplicated caesarean delivery of a pregnant woman with COVID-19 infection in Nigeria.

Association between maternal serum homocysteine concentrations in early pregnancy and adverse pregnancy outcomes.

Background: There is still conflicting evidence on the extent to which maternal hyperhomocysteinemia is a risk factor for pregnancy complications. Aims: The study aimed to investigate the impact of elevated maternal homocysteine concentrations on adverse pregnancy outcomes among Nigerian women in Lagos. Materials and Methods: This was a prospective cohort study conducted at the Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. Participants were enrolled during the first trimester of pregnancy following which relevant data were obtained by the interview. Fasting blood samples were collected for the measurement of maternal homocysteine concentration using the enzyme-linked immunosorbent assay method. Pregnancy outcomes and complications were obtained by abstracting the antenatal, delivery, and newborn medical records. Preterm births, low-birth weight (LBW), and antepartum fetal death were used as confirmatory outcome variables in the final analysis. Descriptive statistics for all data were computed using SPSS version 22.0. The associations between the variables were tested and multivariate analyses were used to study the effects of the major baseline characteristics on the pregnancy outcome. P < 0.05 was considered statistically significant. Conclusions: The prevalence of hyperhomocysteinemia among mothers in Lagos was relatively low. The associations between hyperhomocysteinemia and adverse pregnancy outcomes could have implications in future for the prevention of these adverse outcomes. Results: Hyperhomocysteinemia was recorded in 41 (24.6%) patients. Women with a high homocysteine concentration and those with a normal homocysteine level did not differ significantly in terms of age (P = 0.684), level of education (P = 0.866), and parity (P = 0.647). Women with hyperhomocysteinemia had an approximately twelve-fold higher risk of preterm birth (P = 0.001) and a ten-fold higher risk of delivering a term neonate with LBW (P = 0.004), but had no risk of antepartum fetal death (P = 0.118) compared to women with a normal homocysteine concentration.

RésuméHistorique: Il existe encore des preuves contradictoires sur la mesure dans laquelle l'hyperhomocysteinemia maternel est un facteur de risque de complications de grossesse. Objectifs: L'étude visait à étudier l'impact des concentrations élevées d'homocystéine maternelle sur les résultats défavorables de la grossesse chez les Femmes nigérianes à Lagos. Matériel et Méthodes: Il s'agissait d'une étude de cohorte prospective menée à l'Hôpital universitaire d'enseignement de Lagos, Idi-Araba, Lagos, Nigeria. Les participants ont été inscrits au cours du premier trimestre de la grossesse, après quoi les données pertinentes ont été obtenues par l'entrevue. Des échantillons de sang à jeun ont été prélevés pour la mesure de la concentration maternelle d'homocystéine utilisant le méthode d'essais immunosorbent. Les résultats et les complications de grossesse ont été obtenus en reprochant le prénatal, l'accouchement, et le médical nouveau-né medical Dossiers. Les naissances prématurées, le faible poids à la naissance (LBW) et la mort fœtale antepartum ont été utilisés comme variables de résultats confirmatoires dans l'analyse finale. Les statistiques descriptives pour toutes les données ont été calculées à l'aide de la version 22.0 du SPSS. Les associations entre les variables ont été testées et multivariées ont été utilisées pour étudier les effets des principales caractéristiques de base sur les résultats de la grossesse. P 0,05 a été considéré statistiquement Important. Résultats: Hyperhomocysteinemia a été enregistré dans 41 (24,6%) Patients. Les femmes à forte concentration d'homocystéine et celles qui un niveau normal d'homocystéine n'a pas différé significativement en termes d'âge (P - 0.684), niveau d'éducation (P - 0.866), et parité (P - 0.647). Femmes l'hyperhomocysteinemia présentait un risque environ douze fois plus élevé de naissance prématurée (P - 0,001) et un risque dix fois plus élevé d'accouchement un terme nouveau-né avec LBW (P - 0,004), mais n'avait aucun risque de mort fœtale antepartum (P - 0,118) par rapport aux femmes ayant une homocystéine normale Concentration. Conclusions: La prévalence de l'hyperhomocysteinemia chez les mères à Lagos était relativement faible. Les associations entre L'hyperhomocysteinemia et les résultats défavorables de grossesse pourraient avoir des implications à l'avenir pour la prévention de ces résultats défavorables.

Prevalence and foetomaternal effects of iron deficiency anaemia among pregnant women in Lagos, Nigeria.

Anaemia in pregnancy is a major health problem and an important cause of adverse foetomaternal outcomes in developing countries. Iron deficiency is the cause of the overwhelming majority of the cases of anaemia in pregnancy. Iron deficiency anaemia (IDA) has been linked with adverse foetal and maternal outcomes. This study investigated the prevalence of IDA and evaluated its effects on foetomaternal outcomes among parturients in Lagos, Nigeria. This was a cross-sectional study that enrolled 220 women aged 15-49 years with singleton gestation at term, between May 1, 2016, and March 31, 2017. Participants were selected by systematic sampling and baseline data were collected through interviews. Venous blood samples were obtained to measure haemoglobin and serum ferritin concentrations, and the associations between IDA (defined as anaemia and iron deficiency) and pregnancy outcomes were examined. A P-value <0.05 was considered as statistically significant. The prevalence of IDA was 12.3%. Routine antenatal iron supplementation (adjusted odds ratio 0.18, 95% confidence interval 0.07-0.46; P = 0.001) and interpregnancy interval of at least 2 years (adjusted odds ratio 0.20, 95% confidence interval 0.05-0.97; P = 0.021) have significant association with IDA. Iron deficiency anaemia was not significantly associated with adverse perinatal outcomes but there were significant associations with increased risk of blood transfusion (P = 0.001) and maternal infectious morbidities such as puerperal pyrexia (P = 0.041) and wound infection (P = 0.020). IDA is still a fairly common condition among parturients in Lagos and it's mostly associated with maternal peripartum morbidities. Adequate pregnancy spacing through the use of effective contraception and routine antenatal iron supplementations in pregnancy is a recommended preventive measure against IDA and its adverse sequelae. Future studies should adopt the use of transferrin saturation (TSAT) in compliment with serum ferritin assay as a more sensitive marker of iron deficiency.

Human papillomavirus and cervical cancer.

Cervical cancer is by far the most common HPV-related disease. About 99.7% of cervical cancer cases are caused by persistent genital high-risk human papillomavirus (HPV) infection. Worldwide, cervical cancer is one of the most common cancers in women with an estimated 528,000 new cases reported in 2012. Most HPV infections clear spontaneously but persistent infection with the oncogenic or high-risk types may cause cancer of the oropharynx and anogenital regions. The virus usually infects the mucocutaneous epithelium and produces viral particles in matured epithelial cells and then causes a disruption in normal cell-cycle control and the promotion of uncontrolled cell division leading to the accumulation of genetic damage. There are currently two effective prophylactic vaccines against HPV infection, and these comprise of HPV types 16 and 18, and HPV types 6, 11, 16 and 18 virus-like particles. HPV testing in the secondary prevention of cervical cancer is clinically valuable in triaging low-grade cytological abnormalities and is also more sensitive than cytology as a primary screening. If these prevention strategies can be implemented in both developed and developing countries, many thousands of lives could be saved.

Association between maternal serum homocysteine concentrations in early pregnancy and adverse pregnancy outcomes

There is still conflicting evidence on the extent to which maternal hyperhomocysteinemia is a risk factor for pregnancy complications. Aims: The study aimed to investigate the impact of elevated maternal homocysteine concentrations on adverse pregnancy outcomes among Nigerian women in Lagos. Materials and Methods: This was a prospective cohort study conducted at the Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. Participants were enrolled during the first trimester of pregnancy following which relevant data were obtained by the interview. Fasting blood samples were collected for the measurement of maternal homocysteine concentration using the enzyme-linked immunosorbent assay method. Pregnancy outcomes and complications were obtained by abstracting the antenatal, delivery, and newborn medical records. Preterm births, low-birth weight (LBW), and antepartum fetal death were used as confirmatory outcome variables in the final analysis. Descriptive statistics for all data were computed using SPSS version 22.0. The associations between the variables were tested and multivariate analyses were used to study the effects of the major baseline characteristics on the pregnancy outcome. P < 0.05 was considered statistically significant. Results: Hyperhomocysteinemia was recorded in 41 (24.6%) patients. Women with a high homocysteine concentration and those with a normal homocysteine level did not differ significantly in terms of age (P = 0.684), level of education (P = 0.866), and parity (P = 0.647). Women with hyperhomocysteinemia had an approximately twelve-fold higher risk of preterm birth (P = 0.001) and a ten-fold higher risk of delivering a term neonate with LBW (P = 0.004), but had no risk of antepartum fetal death (P = 0.118) compared to women with a normal homocysteine concentration. Conclusions: The prevalence of hyperhomocysteinemia among mothers in Lagos was relatively low. The associations between hyperhomocysteinemia and adverse pregnancy outcomes could have implications in future for the prevention of these adverse outcomes

Human papillomavirus and cervical cancer.

Cervical cancer is by far the most common HPV-related disease. About 99.7% of cervical cancer cases are caused by persistent genital high-risk human papillomavirus (HPV) infection. Worldwide, cervical cancer is one of the most common cancer in women with an estimated 528,000 new cases reported in 2012. Most HPV infections clear spontaneously but persistent infection with the oncogenic or high-risk types may cause cancer of the oropharynx and anogenital regions. The virus usually infects the mucocutaneous epithelium and produces viral particles in matured epithelial cells and then causes a disruption in normal cell-cycle control and the promotion of uncontrolled cell division leading to the accumulation of genetic damage. There are currently two effective prophylactic vaccines against HPV infection, and these comprise of HPV types 16 and 18, and HPV types 6, 11, 16 and 18 virus-like particles. HPV testing in the secondary prevention of cervical cancer is clinically valuable in triaging low-grade cytological abnormalities and is also more sensitive than cytology as a primary screening. If these prevention strategies can be implemented in both developed and developing countries, many thousands of lives could be saved.

Trend and Characteristics of Endometrial Cancer in Lagos, Nigeria.

BACKGROUND: Endometrial cancer occupies the 2nd or 3rd position in the hierarchy of common gynecological cancers in many low- and middle-income countries. However, little is known about its epidemiology, trend and characteristics in many African countries including Nigeria. The study aims to describe the trend in the prevalence, risk factors, symptomatology and types of endometrial cancers in Lagos, Nigeria. MATERIALS AND METHODS: A five-year descriptive retrospective study of the case records of women diagnosed with endometrial cancer at the Lagos University Teaching Hospital from 1 January 2008 to 31 December 2012. Relevant information was retrieved and data analysis was done using SPSS version 20.0. RESULTS: Endometrial cancer was the third most common gynecological malignancy (16.0%) with a rise in its prevalence rate, from 0.9% in 2008 to 1.4% in 2012. It occurred commonly in postmenopausal (81.8%) and parous women with mean age of 62.2 ± 5.5years, median parity of 4, and mean BMI of 32.3 ± 6.4kg/m2. Most women presented with postmenopausal bleeding (88.6%), vaginal discharge (36.4%), usually in stage I (45.5%) and III (22.7%) disease. The most common risk factors for endometrial cancer were advanced age (90.9%) and overweight/obesity (90.9%). Type 1 endometrial cancers accounted for 68.2% of cases, while serous papillary adenocarcinoma was the most common type 2 endometrial cancer. CONCLUSION: There is a rising trend in the prevalence of endometrial cancer in Lagos, Nigeria, with type 1 endometrial cancer being the most common type. Most women present in the postmenopausal period with early stage disease.

Review of immunohistochemical typing of endometrial carcinoma at the Lagos University Teaching Hospital.

BACKGROUND: Categorization of endometrial carcinomas as type I and II provides useful insights into their different risk factors, pathogenesis and biologic behaviours. AIM: To determine the immunohistochemical classifications of endometrial carcinomas in Nigerian women. DESIGN: A retrospective review of histopathologic slides of cases of endometrial carcinomas seen at the Lagos University Teaching Hospital (LUTH) over a 5-year period. The slides were reviewed, and the diagnoses made according to the WHO nomenclature. The classification of endometrial carcinomas into Type I and II was made by immunohistochemistry using antibodies to ER, PR, p53 and Ki-67. RESULTS: Eight cases of endometrial adenocarcinoma were reported accounting for 53.3% of all endometrial malignancies. Of these, only 1 case showed the classic type I immunophenotype while type II staining pattern was seen in 4 cases. The remaining 3 cases had equivocal immunophenotypes: one was p53+ but showed ER+, PR+ and high Ki-67 index; the second was p53-, ER+, PR+ but had a high Ki-67 expression; while the last was p53-, but ER-, PR- and had high Ki-67 expression. CONCLUSION: Endometrial carcinomas in Nigerian women are more likely to be type II carcinomas. A reasonable proportion of the cases were equivocal thus requiring further categorization with molecular studies.