Synergistic action of carvedilol and clomiphene in mitigating the behavioral phenotypes of letrozole-model of PCOS rats by modulating the NRF2/NFKB pathway.

INTRODUCTION: Psychiatric and cognitive impairment has been observed in premenopausal women with a hormonal disorder called polycystic ovary syndrome (PCOS). This study aimed to explore the possibility of combining pharmacological agents: Carvedilol and Clomiphene citrate, with antiestrogenic, antioxidant and anti-inflammatory properties in letrozole-induced PCOS rats. METHODS: PCOS was induced in rats by the administration of letrozole (1 mg/kg) daily for 21 days. They were subsequently divided into four groups, each receiving either the vehicle or Clomiphene citrate (1 mg/kg) or Carvedilol or a combination of Clomiphene citrate and Carvedilol, respectively from days 22-36. Neurobehavioral studies were conducted on day 35 (Elevated plus maze and Y maze) and day 36 (Novel object recognition). The serum levels of the antioxidants Superoxide dismutase, Catalase, Interleukin 1B (IL-1B), and the gene expression of nuclear factor-erythroid factor 2-related factor 2 (Nrf2), Nuclear Factor k-Beta (NFKB), and acetylcholine esterase in the frontal brain homogenate was determined. RESULT: Both Carvedilol and the combination therapy reversed the anxiety-like behavior, while Clomiphene citrate and the combination therapy ameliorated the spatial and non-spatial memory impairment observed in PCOS rats. Carvedilol, Clomiphene citrate, and the combination therapy increased the serum concentration of SOD and Catalase and decreased the serum concentration of IL-1B. The combination therapy up-regulated the NRF-2, NFKB, and acetylcholine esterase gene expression. CONCLUSION: Study showed that the combination of carvedilol and clomiphene citrate has anxiolytic potential and improved cognitive functions in PCOS rats. This might have been achieved by carvedilol and clomiphene citrate's ability to modulate the cholinergic system and the Nrf2 pathway while downregulating the NFκB signaling pathway.

Adverse birth outcomes among women exposed to intimate partner violence in pregnancy in Ikere-Ekiti, South-west Nigeria: A prospective cohort study.

OBJECTIVE: Studies on birth outcomes associated with intimate partner violence in pregnancy in Nigeria are scarce. We aimed to evaluate adverse birth outcomes among women exposed to intimate partner violence in pregnancy in a Nigerian population. STUDY DESIGN: We performed a prospective cohort study involving 363 women with singleton pregnancies presenting for antenatal care between March 2019 and September 2019. Intimate partner violence was assessed with a validated self-administered questionnaire- ongoing abuse screen. We compared adverse birth outcomes between women that experienced intimate partner violence in pregnancy and those that did not. Multivariate logistic regression was used to adjust for confounders. RESULTS: Of the 363 pregnant women that completed the study, 56(15.4%) experienced intimate partner violence in pregnancy. Women who experienced intimate partner violence in pregnancy were significantly more likely to experience composite adverse birth outcome (53.6% compared with 20.2%,adjusted OR 4.72, 95% CI: 2.43-9.19, p < 0.001) preterm delivery (26.8% compared with 13.4%,adjusted OR 2.96, 95% CI: 1.34-6.50, p = 0.007), stillbirths(17.9% compared with 3.3%,adjusted OR 9.52, 95% CI: 3.96-22.90, p < 0.001) and neonatal intensive care unit admission (32.1% compared with 19.9%, adjusted OR 1.93, 95% CI: 1.19-10.60, p = 0.03). Mode of delivery and low birth weight did not differ significantly between the two groups. CONCLUSION: Intimate partner violence is associated with increased risk of preterm delivery, stillbirth and neonatal intensive care unit admission. There is a need to evaluate the effect of interventions on these adverse birth outcomes.

Predictors of Maternal Preference for Sex-Selective Pregnancy Termination in a Developing Nation with Restrictive Abortion Laws.

INTRODUCTION: The rapid and unexpected increase in the sex ratio at birth in Nigeria between 1996 and 2014 is yet to be fully explained. The contribution of sex-selective abortion has not been explored. METHODS: A cross-sectional survey of pregnant women was employed to address this need. RESULTS: Preference for sex-selective abortion was noted in 8.6% of the respondents. The association between parity ≥ 4 and preference for sex-selective abortion was statistically significant. Women who were child gender-biased were significantly more likely to prefer sex-selective abortion. Experiencing intimate partner violence, and having problems with in-laws for inability to give birth to their desired gender, were predictors of maternal preference for sex-selective abortion. Women who preferred sex-selective abortion, however, felt it was necessary to campaign against gender preference. CONCLUSION: Preference for sex-selective abortion exists in Nigeria, despite our restrictive abortion laws. However, the women's underlying reasons may include gender balancing in the family and an escape from discrimination. Improving contraceptive uptake, restriction of disclosure of fetal sex for non-medical indications, and sanctions against violent partners/oppressive in-laws are advocated. Rapid progress towards achieving a world free of the offensive gender inequalities that force women to opt for sex-selective abortion ab initio is desirable.

Perceptions and Practice of Early Diagnosis of Sickle Cell Disease by Parents and Physicians in a Southwestern State of Nigeria.

BACKGROUND: Early sickle cell disease (SCD) diagnosis has shown promise in combating SCD in many countries. The aim of this study was to assess the practice and perception of early SCD diagnosis among a group of parents and physicians in Nigeria. Patients and Methods. This was a cross-sectional descriptive study conducted to assess the opinions and practice of early diagnosis of SCD among 135 physicians caring for SCD patients and 164 mothers of children with SCD in a southwestern state of Nigeria. RESULTS: Most physicians 132 (97.8%) were aware of prenatal SCD diagnosis, but only 51 (37.8%) would recommend it. Most physicians 129 (95.6%) routinely recommend premarital SCD genetic counseling and testing, and 89 (65.1%) were aware of the national government newborn screening program but lesser proportion 75 (55.6%) were willing to recommend it. Amongst the mothers, 154 (94%) and 158 (96%) had encountered genetic counseling for SCD and were willing to offer newborn screening to their children, respectively. On the contrary, fewer mothers 42 (25%) were aware of prenatal SCD diagnosis, 28 (17%) were willing to partake in it, and 44 (26%) were undecided. There were discrepancies in the willingness by physicians to practice early SCD diagnosis and its uptake by mothers (p < 0.0001). The commonest reason given by both the physicians and mothers for not practicing SCD prenatal diagnosis was the high cost of the procedure. CONCLUSION: The perceptions and practice of early SCD diagnosis was suboptimal in the study locality. Scaling up awareness and universal coverage are required.

Poor prenatal service utilization and pregnancy outcome in a tertiary health facility in Southwest Nigeria.

INTRODUCTION: Poor prenatal service utilization is common in developing countries. However, the predictors and pregnancy outcomes of poor utilizers have not been fully examined in our setting. METHODS: Poor and good prenatal service utilizers were compared with respect to demographic characteristics and pregnancy outcomes in Ado-Ekiti, Nigeria. RESULTS: Poor utilizers were significantly more likely to be single mothers, with unemployed husbands/partners, but less likely to have labour induction compared with good utilizers. Also, the women with fewer than four antenatal visits had significantly more babies with low birth weight (18% versus 9.8%, p = 0.003), and 5-minute Apgar scores less than 7 (17.9% versus 10.1%, p = 0.023). Multivariate regression analysis revealed that having an unemployed husband/partner (adjusted odds ratio (AOR): 2.33; 95% Confidence Interval (C.I.): 1.24 - 4.38; p = 0.009), with low birth weight babies (AOR: 1.66; 95% C.I.: 1.01 - 2.73; p = 0.045), and delivering without induction of labour (AOR: 4.27; 95% C.I.: 2.38 - 7.64; p < 0.001) were independently associated with poor prenatal service utilization. CONCLUSION: Efforts devoted to identifying women who are likely to be non- and poor-utilizers of prenatal care are recommended. Scaling up awareness campaigns on maximizing the benefits of prenatal care, increasing the content quality of antenatal visits to give women a positive pregnancy experience and implementing a National Health Insurance package that strategically targets the most socially underprivileged classes are advocated to promote safe motherhood and the objectives of antenatal care.

Randomised Controlled Trial of Sublingual and Rectal Misoprostol in the Prevention of Primary Postpartum Haemorrhage in a Resource-Limited Community.

BACKGROUND/PURPOSE: Misoprostol is beneficial in preventing postpartum haemorrhage (PPH). However, there is no consensus yet as to which route will give the balance of efficacy, safety and patient preference, especially at the recommended dose of 600 mcg. This study compared the efficacy and adverse effects of rectal and sublingual misoprostol for the prevention of PPH. METHODS: In a prospective fashion, consenting eligible parturients were randomised into two groups to receive either 600 mcg of misoprostol rectally or sublingually after vaginal delivery. All study participants were followed up till 24 h postpartum. Primary outcomes were blood loss of 500 ml or greater and at least 10% change in peripartum haematocrit levels. RESULTS: Seven (6.7%) and 16 (15.7%) of the sublingual and rectal routes, respectively, had PPH. However, the odds of having PPH after rectal misoprostol were at least twice the odds after the sublingual route (p = 0.041). Also, the mean blood loss after the first, fourth and 24th hour postpartum were significantly higher after rectal administration. Although significantly more patients had shivering and pyrexia after sublingual misoprostol, it was acceptable to more participants than the rectal route. CONCLUSION: At the recommended dose, sublingually administered misoprostol ('the sweet of life') is associated with a lower incidence of PPH than the rectal route. Despite its higher incidence of shivering and pyrexia, it was accepted by more women than rectally administered misoprostol.ClinicalTrials.gov identifier PACTR201911500348367.

Obstetric Correlates of Maternal Falls in Southern Nigeria.

Falls during pregnancy can be associated with serious obstetric complications. Apart from sparse data highlighting traumatic outcomes, there are no studies identifying the obstetric correlates of maternal falls in Nigeria. A cross-sectional cohort survey of 1,175 women in five public health facilities in Ado-Ekiti was conducted to address this need. Fall rate was 25%; mothers who fell during pregnancy were significantly older, of higher parity, and with unintended/unwanted pregnancies than those who did not fall. Most of the reported falls occurred in the third trimester, with about 10% of the women falling at least thrice during the course of the pregnancy. More than half of the reported falls occurred while engaging in household chores and carrying child/object with compromised visibility of the feet and floor. Uterine contractions/abdominal pain was the commonest; 29 (76.3%), obstetric event attributed to the falls. Antepartum haemorrhage, 4 (10.5%), and ruptured membranes, 2 (5.3%), also occurred after falls, although it was rare and occurred with the same frequency as in the general population. Maternal age ≥ 30 years (odds ratio: 1.36; 95% C.I. 1.03 - 1.80, p = 0.031), multiparity (odds ratio: 1.54; 95% C.I. 1.15 - 2.07, p = 0.004), unintended pregnancy (odds ratio: 1.48; 95% C.I. 1.02 - 2.15, p = 0.037), and delivery age ≤ 40 weeks (odds ratio: 1.71; 95% C.I. 1.07 - 2.75, p = 0.026) were found to be independent risk factors for falls during pregnancy. Fall awareness campaigns and fall-preventing safety tips are advocated in women's clinics. Improving contraceptive uptake will reduce unintended pregnancies and the risk of pregnancy-related fall/injuries.

Human immunodeficiency virus awareness and condom use among female adolescent prostitutes in Lagos, Nigeria.

INTRODUCTION: The cornerstone of HIV prevention among female adolescent prostitutes is awareness promotion complemented with advocacy on consistent and correct use of condom. The study aimed at reviewing HIV awareness and condom use among female adolescent prostitutes in Lagos communities, Nigeria. METHODS: It was a mixed-method study realized through a questionnaire-based survey and in-depth interviews of adolescent sex workers in Oyingbo and Yaba communities of Lagos State, Nigeria; conducted between 1st of April, 2014 and 30th of September, 2014. SPSS version 17.0 and content analysis were used in analyzing quantitative and qualitative data respectively. RESULTS: 97.3% had heard about HIV/AIDS; with 86.9% being tested for HIV in the preceding 6 months. While there was consistent use of male condom in 99.7% of the respondents, 90% had experience with the use of female condom, however, 95.5% would allow non- use of condom for higher financial reward. CONCLUSION: Although the level of awareness of HIV/AIDS was high among the respondents, there is need to improve on the level of awareness and preventive strategies for HIV/AIDS, with more emphasis laid on the consistent and correct use of condom in this highly vulnerable class of people.

Spinal anaesthesia in a restless eclamptic with undiagnosed second twin: case report.

The use of sub-arachnoid block in a restless eclamptic is not very common. Studies have demonstrated some benefits of sub-arachnoid block over general anaesthesia in stable eclamptic but its role in the management of unstable eclampsia has not been established. Reported below is an eclamptic parturient who was restless despite magnesium sulphate regimen and possesed features suggestive of difficult airway who had uneventful subarachnoid- block for caesarean section.