Preeclampsia: a review of the evidence.

Preeclampsia is a common complication of pregnancy associated with high maternal and perinatal morbidity and mortality especially in developing countries. There is considerable progress in the understanding of the pathophysiology and the management of the diseases, although the aetiology and primary pathology remained elusive. Integration of current evidence in the clinical management of the condition has witnessed improved maternal and fetal outcomes in many societies. In developing countries variations in management often not based on current evidence accounts for comparatively higher morbidity and mortality. This article aims to provide an overview of our present understanding of preeclampsia help care providers and our managers focus practice and policy to reflect existing evidence.

Colposcopy: the scientific basis.

Colposcopy was first introduced in 1925 in Germany by Hans Hinselman. A colposcopeworks on the hypothesis that by magnifying the cervix and applying good illumination, early stages of cervical cancer could be picked -up. Other workers in the field include Schiller, Papanicolou, and Ayres who all contributed to the early detection of cervical cancer. The basic issue is the transformation zone (TZ). It is an area that forms from squamous metaplasia of columnar epithelium. The area where the two epithelia meet is referred to as the squamo-columnar junction SCJ. It is the most important landmark in cytology and colposcopy, where 90% of cervical neoplasm originates. More units are incorporating colposcopy into their practice so as to improve care of women with abnormal smears. Therefore, understanding of the scientific basis of colposcopy is important in carrying out the procedure according to agreed international standards.

Gynecological malignancies in Aminu Kano Teaching Hospital Kano: a 3 year review.

OBJECTIVE: To study the pattern of gynecological malignancies in Aminu Kano Teaching Hospital. MATERIALS AND METHODS: This was a retrospective observational study carried out in the Gynecology Department of Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria between October 2008 and September 2011. Case notes of all patients seen with gynecological cancers were studied to determine the pattern, age and parity distribution. RESULTS: A total of 2339 women were seen during the study period, while 249 were found to have gynecological malignancy. Therefore the proportion of gynecological malignancies was 10.7%. Out of the 249 patients with gynecological malignancies, most (48.6%) had cervical cancer, followed by ovarian cancer (30.5%), endometrial cancer (11.25%) and the least was choriocarcinoma (9.24%). The mean age for cervical carcinoma patients (46.25 ± 4.99 years) was higher than that of choriocarcinoma (29 ± 14.5 years) but lower than ovarian (57 ± 4.5years) and endometrial (62.4 ± 8.3 years) cancers. However, the mean parity for cervical cancer (7.0 ± 3) was higher than those of ovarian cancer (3 ± 3), choriocarcinoma (3.5 ± 4) and endometrial cancer (4 ± 3). The mean age at menarche for women with cervical cancer (14.5 ± 0.71 years) was lower than for those with choriocarcinoma (15 ± 0 years), ovarian (15.5 ± 2.1 years) and endometrial (16 ± 0 years) cancers. There was one case of vulva cancer and none with vaginal cancer. CONCLUSION: Cervical cancer was the most frequent malignant tumor and the least was choriocarcinoma. Estimates of this important public health problem need to be addressed in various regions of Nigeria.

Ruptured tubal molar pregnancy.

Molar pregnancies in most instances develop within the uterine cavity, but may occur at any site. Ectopic molar pregnancy is a rare event. The objective of this study was to present a case of ruptured tubal molar gestation, discuss its clinical features and ways to improve diagnostic accuracy. A 35-year-old woman presented with features suggestive of ruptured tubal ectopic pregnancy. There was neither any evidence at the time of presentation to suspect a molar gestation, nor ß human chorionic gonadotrophin (ßhCG) hormone estimation was done, but only a clearview pregnancy test was carried out. She had total left salpingectomy and histological evaluation of the specimen revealed complete hydatidiform mole. The hCG level normalized within 3 weeks of follow-up. Clinical features of ectopic molar pregnancy may be indistinguishable from non-molar ectopic pregnancy. We recommend ßhCG estimation as well as histological examination of the surgical specimen for all patients coming with features suggestive of ectopic pregnancy.

Prevalence of female genital mutilation among female infants in Kano, Northern Nigeria.

OBJECTIVES: To determine the prevalence and type of female genital mutilation (FGM) among female infants, reasons and attitude of the mothers to the practice. DESIGN: A cross sectional descriptive study. SETTING: Tertiary centre in Kano Northern Nigeria. METHOD: A Pretested questionnaire was administered for mothers of female infants presenting for routine immunization in Aminu Kano Teaching Hospital (AKTH). A total of 250 questionnaires were administered, but only 200 were properly filled and this was used for the analysis. MAIN OUTCOME MEASURES: Prevalence and type of FGM, reason for and attitude of mothers towards FGM. RESULTS: Twenty-six infants had FGM during the period of study, giving a prevalence rate of 13 %. The mean age at cutting was 8 days ± 7.3. The commonest type of FGM was type I accounting for 96.2 % of the cases. Tradition/culture was the commonest reason for mutilation accounting for 73.1 %, other reasons included; religious in 11.5 %, hygienic in 11.5 % and to preserve virginity in 3.8 %. Traditional barbers were the commonest operators in 80.8 % of cases, followed by the nurse/midwife in 15.4 % of cases. The fathers were the main decision makers in 46.2 %, followed by both parents in 26.9 % and grandparents in 15.4 % of the cases. 84 % of mothers were not in support of the practice. Thirteen percent of the clients would circumcise all their daughters. Forty-eight percent of the clients were of the opinion that FGM cause harm to the victims. Four percent of those whose daughters were yet to be circumcised will do so later. CONCLUSION: Female genital cutting is still practiced in our environment. Educational enlightenment is fundamental in changing public opinion as well as in offering reasonable alternative to FGM. Campaign against the practice of FGM should be encouraged to eradicate its practice.

Introduction of an innovation for the reduction of maternal mortality in Kano State, northern Nigeria: a case study of magnesium sulphate.

In this project, sponsored by the McArthur Foundation and the Population Council, magnesium sulphate was introduced in February 2007 to 10 general hospitals in Kano State, northern Nigeria. Changes were monitored via data collected at the hospital. At an initial training of the trainers' workshop, 25 master trainers were trained. They then conducted step down trainings and trained 160 clinical providers. Within 12 months, 1045 patients were treated with magnesium sulphate. The attributable deaths from eclampsia fell by 42.4%. The community became aware of an improved outcome for eclampsia. The providers expressed satisfaction with the outcome of the treated patients. Four of the master trainers trained 30 clinical providers from the other 25 general hospitals. Initiatives for the reduction of maternal mortality should be evidence-based.

Specific dermatoses of pregnancy: a review.

BACKGROUND: Some dermatoses worsen during pregnancy, some improve, yet others have unpredictable course. OBJECTIVE: To conduct evidence-based search, and review of current management of specific dermatoses of pregnancy. METHODS: Comprehensive literature search was conducted, with Medline and Cochrane Database regarding skin diseases in pregnancy from 1990- 2005. International pharmaceutical abstracts science search (1997- 2003) was used for search references found in the articles. All articles selected for inclusion in this review were evaluated critically with regards to their impact factor, source, and evidence based contribution on this topic as measured by their citation index and the journals they were published in. This review was limited to specific dermatoses of pregnancy generally and some of the skin disorders modified by pregnancy. RESULTS: Intrahepatic cholestasis of pregnancy should be managed as high risk pregnancies as several investigations have shown foetal complications. Recent randomised trials have demonstrated beneficial effects of ursodeoxycholic acid (UDCA) in intrahepatic cholestasis of pregnancy (ICP). Pruritice ruption of pregnancy is associated with multiple pregnancies. It has variable clinical features and has to be differentiated from pemphigoid gestationis, which is associated with an increased incidence of both prematurity and small for date's babies. Prurigo of pregnancy is extremely itchy with papules appearing on the extensor surfaces of the limbs and trunk. It has no maternal risk. The eruptions in pruritic folliculitis of pregnancy clear spontaneously in the postpartum period, with no associated morbidity either in the mother or baby. CONCLUSION: Some skin diseases like obstetric cholestasis may have adverse foetal outcome, while other disorders like pruritic folliculitis of pregnancy have no significant effect on either the mother or baby.

Spectrofluorimetric assay method for glutathione and glutathione transferase using monobromobimane.

The primary role of glutathione transferase is to defend an organism from toxicities through catalyzing the reaction of glutathione (GSH) with potentially toxic compounds or metabolites to their chemically and biologically inert conjugates. The objective of the study was to develop a simple and sensitive spectrofluorimetric assay method for glutathione transferase using monobromobimane (MBB), a non fluorescent compound with electrophilic site. MBB slowly reacted with glutathione to form fluorescent glutathione conjugate and that the reaction was catalysed by glutathione transferase. Both non-enzymatic and enzymatic reaction products of MBB, in presence of GSH in phosphate buffer (pH 6.5), were measured by following increase of fluorescence at wavelength of 475nm. For validation of the assay method, the kinetic parameters such as the apparent Michaelis-Mente constants and maximum rates of conjugate formation as well as the specific activity of rat hepatic glutathione transferase were determined. The method was found to be sensitive, thus, applied to measure glutathione contents of crude preparation of rat hepatic cytosol fraction.

In vitro availability of chloramphenicol in the presence of cadmium and lead salts.

Metal ions have been reported to form chelate complexes with certain drug molecules especially those that contain ligand donor atoms. In this study, the in vitro availability of chloramphenicol in the presence of Pb and Cd was evaluated. These studies were carried out in simulated gastric juice (0.1M HCl) and intestinal pH (pH 9) at 37°C over period of 180 minutes. A double scanning UV/VIS spectrophotometer (Helios Zeta, Model 164617) was used to analyze drug content by measuring absorbance at 278 nm. An overall chloramphenicol availability of 89, 88.6 and 86% was achieved in simulated gastric juice for chloramphenicol alone, in the presence of Pb, and of Cd respectively. The corresponding availabilities observed in simulated intestinal pH were 82.5, 63.2 and 63.2%. The presence of Pb and Cd did not significantly affect the overall availability of chloramphenicol in simulated gastric juice. However, the availability of the drug was significantly decreased by Pb and Cd in simulated intestinal pH. The results of this study indicate that the availability of chloramphenicol may be reduced in the presence of Pb and Cd especially from the intestine, which may result in therapeutic failure.

An improved high-performance liquid chromatographic determination of chloroquine and its major metabolite, desethylchloroquine, in human plasma.

Samples were extracted with n-hexane and the organic layer was rejected. 10 microl aliquots of the aqueous layer were injected onto the column. Amodiaquine was used as the internal standard. The UV detector response was linear over the range 0-1000 ng/ml with a correlation coefficient of 0.9987; the detection limits with respect to chloroquine and desethylchloroquine were found to be 20 ng/ml and 10 ng/ml respectively. Within-day and between-day assay variation was generally < 5%. No interference from endogenous constituents was observed. The utility of the method was demonstrated by determining chloroquine and its major metabolite, desethylchloroquine in plasma samples from six healthy human volunteers following a single oral dose of 600 mg of chloroquine. The procedure is simple and requires small volumes of plasma.

Effect of Tamarindus indica. L on the bioavailability of ibuprofen in healthy human volunteers.

The influence of Tamarindus indica L fruit extract incorporated in a traditional meal on the bioavailability of Ibuprofen tablets 400 mg dose when given concurrently was studied in 6 healthy human volunteers. There was a statistically significant increase in the plasma levels of Ibuprofen and its metabolites hydroxy-ibuprofen and carboxy-ibuprofen respectively, when the meal containing Tamarindus indica fruit extract was administered with the ibuprofen tablets than when taken under fasting state or with the meal without the fruit extract. The C(max), AUC(0-6 hr) and Ka for ibuprofen increased from 38 +/- 0.70 microg/ml to 42 +/- 0.98 microg/ml (p > 0.05); and 28.03 +/- 2.40 microg/ml x hr to 56.51 +/- 0.16 microg/ml x hr (p < 0.05) and 1.048 +/- 0.02hr(-1) to 2.781 +/- 0.11 hr(-1) (p < 0.05) respectively. There was no change in the t(max) (120.00 +/- 0.43m) but there was a decrease in the k(el) from 0.63 +/- 0.20 hr(-1) to 0.46 +/- 0.11 hr(-1) (p<0.05). Similarly the C(max), AUC(0-6 h) and Ka for hydroxy-ibuprofen rose from 43 +/- 0.76 microg/ml to 45 +/- 0.16 microg/ml (p < 0.05); 39.04 +/- 2.30 microg/ml x hr to 59.49 +/- 2.39 microg/ml.hr in (p < 0.05) and 1.498 +/- 0.79hr(-1) to 3.442 +/- 0.23 hr(-1) (p < 0.05) respectively; while the C(max), AUC(0-6 h) and Ka for carboxy-ibuprofen rose from 48 +/- 0.7 microg/ml to 51 +/- 0.16 microg/ml (p < 0.05); 41.972 +/- 0.68 microg/ml x hr to 63.948 +/- 0.12 microg/ml x hr (p < 0.05) and 1.649 +/- 0.08 hr(-1) to 4.187 +/- 0.42 hr(-1) (p < 0.05) respectively. The study has indicated that Tamarindus indica L. fruit extract significantly increased the bioavailability of Ibuprofen.

Effect of sodium/potassium salt (potash) on the bioavailability of ibuprofen in healthy human volunteers.

The influence of sodium/potassium salt water extract incorporated in a traditional meal on the bioavailability of Ibuprofen tablets 400mg dose was studied in 6 healthy human volunteers. There was a statistically significant decrease in the plasma levels of ibuprofen, and its metabolites, hydroxy-ibuprofen and carboxy-ibuprofen, respectively, when the meal containing sodium/potassium salt extract was administered with the ibuprofen tablets than when taken under fasting state or with the meal without the fruit extract. The Cmax, AUC0-6hr and Ka for ibuprofen decreased from 38.04 +/- 0.70microg/ml to 20.06 +/- 1.21microg/ml (p<0.05); 28.030 +/- 2.40microg/ml.hr to 14.180 +/- 1.12microg/ml.hr (p<0.05) and 1.048 +/- 0.02hr(-1) to 0.602 +/- 0.03hr(-1). Similarly, the Cmax for hydroxy-ibuprofen and carboxy-ibuprofen decreases from 43.04 +/- 0.76microg/ml to 27.21 +/- 0.24microg/ml (p<0.05) and 48 +/- 0.71microg/ml to 31.08 +/- 0.12microg/ml (p<0.05) respectively; while AUC0-6hr for hydroxy-ibuprofen decreased from 34.120 +/- 0.49microg/ml.hr to 16.410 +/- 0.27microg/ml.hr while that of carboxy-ibuprofen decreased from 36.121 +/- 1.97microg/ml.hr to 19.278 +/- 0.92microg/ml.hr respectively. The Kel for hydroxy-ibuprofen increased from 0.71 +/- 0.94 hr(-1) to 0.81 +/- 0.21 hr(-1) (p<0.05) respectively. The study has indicated that sodium/potassium salt extract significantly decreased the bioavailability of ibuprofen.

Effect of Tamarindus indica L. on the bioavailability of aspirin in healthy human volunteers.

The influence of Tamarindus indica L. fruit extract incorporated in a traditional meal on the bioavailability of aspirin tablets 600 mg dose was studied in 6 healthy volunteers. There was a statistically significant increase in the plasma levels of aspirin and salicylic acid, respectively, when the meal containing Tamarindus indica fruit extract was administered with the aspirin tablets than when taken under fasting state or with the meal without the fruit extract. The Cmax, AUC0-6h and t1/2 for aspirin increased from 10.04 +/- 0.1 mg/ml to 28.62 +/- 0.21 mg/ml (P < 0.05); 14.03 +/- 0.11 mg/ml.h to 86.51 +/- 0.21 mg/ml.h (P < 0.085) and 1.04 +/- 0.12 h to 1.50 +/- 0.44 h (P < 0.05) respectively. There was no change in the tmax (0.50 +/- 0.17 h) but there was a decrease in the kel from 0.633 +/- 0.22 to 0.463 +/- 0.29 (P < 0.05). Similarly, the Cmax, AUC0-6h and kel for salicylic acid rose from 43.84 +/- 0.21 mg/ml to 68.19 +/- 0.71 mg/ml (P < 0.05); 171.59 +/- 0.07 mg/ml.h to 266.22 +/- 0.21 mg/ml/.h (P < 0.05) and 7.37 +/- 0.29 to 19.30 +/- 0.21 (P < 0.05), respectively. The tmax decreased from 2.0 +/- 0.18 h to 1.0 +/- 0.08 h (P < 0.05) and t1/2 from 0.25 +/- 0.21 h to 0.184 +/- 0.11 h (P < 0.05). The study has indicated that Tamarindus indica L. fruit extract significantly increased the bioavailability of aspirin.