Suppression of uric acid generation and blockade of glutathione dysregulation by L-arginine ameliorates dichlorvos-induced oxidative hepatorenal damage in rats.

Dichlorvos is a known risk factor for organ toxicity. The liver and kidney are essential metabolic tissues but it is unclear whether or not there is associated redox dyshomeostasis in both organs in physiological and pathological states. Uric acid accumulation and glutathione dysregulation have been implicated in the aetiopathogenesis of organ damage. The antioxidant potentials of L-arginine have been shown in various conditions. The present study was thus designed to investigate the synchrony in hepatic and renal uric acid and glutathione status in dichlorvos-induced hepatorenal damage and to probe the possible therapeutic role of L-arginine. Twenty-one male Wistar rats were treated with standard rat diet and water, dichlorvos, or dichlorvos and L-arginine. Our findings revealed that dichlorvos significantly impaired hepatic and renal functions, increased hepatic and renal malondialdehyde, but reduced glutathione and activities of superoxide dismutase, catalase, and glutathione peroxidase. These events were accompanied by increased accumulation of plasma, hepatic, and renal uric acid as well as reduced body weight gain, and hepatic and renal weights. Histopathological examinations revealed hepatic and renal architectural derangement and cellular necrosis and degeneration in dichlorvos-exposed rats. Interestingly, L-arginine reversed dichlorvos-induced systemic, hepatic and renal synchronous redox dyshomeostasis. L-arginine administration also improved hepatic and renal cytoarchitecture. It is thus concluded that dichlorvos triggered synchronous uric acid generation and glutathione alterations in the liver and kidney. L-arginine confers protection against dichlorvos-induced hepatorenal damage via suppression of uric acid generation and blockade of glutathione dysregulation.

Neonatal neuroblastoma with adrenal primary and metastasis to the liver: A case report and a review of literature.

We report the case of a 23-day-old neonate with neuroblastoma (NBL) in the right adrenal gland and widespread metastases to the liver. This raises the possibility of foetal NBL, which was missed during periodic ultrasonography done during the mother's pregnancy. We hope that this report would increase the awareness of physicians about foetal, congenital and neonatal NBL; and of sonographers about space-occupying lesions in the foetus. The clinicopathologic features and the management of neonatal NBL are discussed.

MATERNAL MORTALITY AUDIT IN A TERTIARY HEALTH INSTITUTION IN NIGERIA: LESSONS FROM DIRECT CAUSES AND ITS DRIVERS.

INTRODUCTION: Nigeria has the second highest number of maternal deaths in the world.The study aimed at determining the causes of and non-obstetric contributors to maternal mortality at a tertiary referral hospital. MATERIALS AND METHODS: It was a prospective audit of all consecutive maternal deaths in the hospital over a three-year period. Immediately after the death, information wvas retrieved via a data collection form. Data were analysed with SPSS-20. RESULTS: Seventy deaths were examined over the study period. Maternal mortality ratio was 1,265/100,000 live births. The annual ratio decreased steadily over the study period. Most of the deaths were of multiparous women who had not received any antenatal care, and were mostly postpartum,within 24 hours of delivery. Most of them were critically ill on admission to the hospital. Major causes of death were haemorrhage (36%), sepsis (17%) and hypertensive disorders (16%).Delays were identified in 34.3% of cases; most (70.1%) were Phase III delays. DISCUSSION: Direct causes of maternal mortality are consistent with those found in literature. Steps which the centre has been taken to counter direct and non-obstetric causes are discussed. Possible strategies to improve health financing and referral system are proffered.

Bilateral tubal gestation associated with schistosomiasis in an african woman.

Background. The incidence of tubal ectopic gestation caused by schistosomiasis induced tubal pathology is undocumented in this environment, which may be due to rarity of this pathology. Bilateral tubal gestation is common in patients that have undergone in vitro fertilization. We report a hitherto undocumented case of spontaneous bilateral ectopic gestation following tubal schistosomiasis. Case Report. Mrs. OB was a 32-year-old G4P3(+0) (3 alive) woman who complained of abdominal pain and bleeding per vaginam of 4 and 2 days' duration respectively following 8 weeks of amenorrhea. A clinical impression of ruptured ectopic gestation was confirmed by ultrasound scanning. She had bilateral salpingectomy with histology of specimens showing bilateral ectopic gestation with Schistosoma haematobium induced salpingitis (findings of Schistosoma haematobium ova noted on slide). Conclusion. Schistosoma induced salpingitis is a rare but possible cause of bilateral tubal gestation.

Diagnostic value of high resolution ultrasound in localisation of the undescended testis in children.

BACKGROUND: The use of ultrasonography in the pre-operative localisation of undescended testes has become controversial due to fears about its accuracy. This study was designed to ascertain the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography in the localisation of the undescended testes in children. PATIENTS AND METHODS: A prospective evaluation of all boys undergoing operation for undescended testes at the Lagos University Teaching Hospital, Idi-Araba, Lagos, over a 12 month period was performed. The pre-operative clinical and ultrasound findings were compared with the findings on surgical exploration. RESULTS: Forty boys with 52 undescended testes were studied. The mean age of the boys at the time of surgery was 4.0 ± 0 years (range 1-11 years). Forty-six (88.5%) testes were localised pre-operatively by ultrasound- 20 of 22 (90.9%) palpable testes and 26 of 30 (86.7%) non-palpable testes. Intra-operatively, 49 (94.2%) of the undescended testes were found while 3 (5.8%) were absent/vanishing testes. Ultrasound evaluation had an accuracy of 86.5%, sensitivity of 89.8%, and specificity of 33.3%, PPV of 95.7% and a NPV of 16.7%. CONCLUSION: Ultrasound assessment is beneficial in pre-operative evaluation of children with undescended testes.

Effect of storage and subsequent reheating on viability of Listeria monocytogenes on pork scrapple.

We evaluated the fate of Listeria monocytogenes on commercial pork scrapple, a regionally popular, ready-to-eat (RTE) meat. We also conducted an informal survey to address consumer practices for storing and reheating scrapple. Of the 129 consumers who responded to at least one of the eight questions posed in the survey, about half (46.4%; 52 of 112) considered scrapple RTE, the majority (69.7%; 76 of 109) stored it in the refrigerator, and all (100%; 112 of 112) preferred to reheat it prior to consumption. Most respondents (83.9%; 94 of 112) reheated the scrapple by pan frying for 1 to 10 min at medium to high temperature. To study pathogen behavior, slices of pork scrapple were surface inoculated with a five-strain cocktail of L. monocytogenes (ca. 2.0 log CFU/g), vacuum sealed, and stored for up to 60 days. Pathogen levels increased to 8.9, 9.5, and 9.9 log CFU/g after 44 (4 degrees C), 21 (10 degrees C), and 5 (21 degrees C) days, respectively. When slices 1.3 cm (ca. 55 g) and 1.9 cm (ca. 85 g) thick were surface inoculated with L. monocytogenes (ca. 7.0 log CFU/g) and then reheated in a skillet (191 degrees C) for 0.5 to 4 min per side or to target instantaneous internal temperatures of 48.9 to 71.1 degrees C, it was possible to achieve pathogen reductions ranging from ca. 2.2 to 6.5 log CFU/g. These data confirm that in the unlikely event of postprocessing contamination of pork scrapple by L. monocytogenes, proper reheating can appreciably reduce levels of the pathogen before consumption.

Male participation in pregnancy and delivery in Nigeria: a survey of antenatal attendees.

This was a cross-sectional study carried out on 462 pregnant women attending antenatal care in Ibadan, Nigeria. The study's aims were to assess the level of participation of Nigerian men in pregnancy and birth, the attitude of the women and likely targets for improved care delivery. Three hundred and forty-nine women (75.5%) were aware that husbands could participate in childbirth. Most women did not think it was their husbands' place to attend antenatal clinic (48.3%) or counselling sessions (56.7%). Nearly all husbands (97.4%) encouraged their wives to attend antenatal clinic - paying antenatal service bills (96.5%), paying for transport to the clinic (94.6%) and reminding them of their clinic visits (83.3%). Three hundred and thirty-five husbands (72.5%) accompanied their wives to the hospital for their last delivery, while 63.9% were present at last delivery. More-educated women were less likely to be accompanied to the antenatal clinic, while more-educated men were likely to accompany their wives. Yoruba husbands were less likely to accompany their wives, but Yoruba wives with non-Yoruba husbands were 12 times more likely to be accompanied. Women in the rural centre were less likely to receive help with household chores from their husbands during pregnancy, while educated women were more likely to benefit from this. Monogamous unions and increasing level of husbands' education were associated with spousal presence at delivery. It appears that male participation is satisfactory in some aspects, but increased attendance at antenatal services and delivery would be desirable.

Gestational age at antenatal booking and delivery outcome.

Antenatal care is a form of preventive medicine that pregnant women to allows maintain a state of good health throughout pregnancy, and to improve their chances of having a safe delivery of healthy infants. To achieve this aim, it is a widely held belief that pregnant women need to book early preferable before 14 weeks gestation. This is a retrospective study which reveals among others that late booking is still a common practice in the developing countries with average gestational age at booking being 23.59 (+/- 8.45) weeks, and only 14% of the women booked before the end of first trimester. Nulliparity or low parity was found to be the only factor that favoured early booking. However, gestational age at booking as a sole factor for predicting the pregnancy outcome was found to be insignificant as the outcome was same for early and late bookers. Unbooked pregnant women were found to be twice at risk of operative delivery, four times more likely to suffer delivery complications and twice likely to have low birthweight babies when compared to booked patients. In conclusion, findings of this study confirm the importance of antenatal care for better maternal and foetal outcome, however gestational age at booking as a sole factor is a poor predictor of pregnancy outcome. It is believed that this finding which is in tandem with the new WHO antenatal care protocol will generate divergent views among the health care givers and modify our current practice of Antenatal care to a more focused and effective risk assessment system.

Female condom awareness, use and concerns among Nigerian female undergraduates.

A cross-sectional study of female condom awareness, usage and concerns among the female undergraduates of the University of Ibadan was conducted in September 2004. The results of 850 out of the 879 female students interviewed were used for analysis (96.6%). Over 80% had knowledge of the female condom as a form of modern contraception and the majority of them learnt about it through the mass media (39.9%) and health workers (34.4%). However, only 11.3% had ever used the female condom, with most (40%) using it to prevent both unwanted pregnancy and sexually transmitted infections including HIV (STI/HIV). The sexual partners' approval was appreciable, accounting for about 42.7% among those that had experience of the female condom usage. Major concerns mentioned such as difficulty of inserting it into the vagina and lack of sexual satisfaction, were not different from those in earlier studies. The result of this study looks promising judging from a high awareness level of the female condom, even though its usage is low. The female condom may be an alternative strategy to combat unsafe sexual practises and its sequelae in a country like Nigeria that is male dominated.

Repeat ipsilateral ectopic gestation: a series of 3 cases.

Ectopic pregnancy remains an important cause of maternal mortality and morbidity as well as early foetal wastage in Nigeria and in other developing countries. We report 3 different cases of repeat ipsilateral ectopic pregnancy seen in the gynaecological emergency unit of the University College Hospital, Ibadan. Cases of repeat ectopic pregnancy often gives rise to diagnostic dilemma, and this becomes more difficult when it occurs at an ipsilateral location.

Experience with intravaginal misoprostol in the management of intra-uterine fetal death.

This collaborative study between the departments of Obstetrics and Gynaecology of the University College Hospital, Ibadan and Federal Medical Centre, Abeokuta assessed the value of intravaginal misoprostol in the management of intra-uterine fetal death. Fifty-six women at gestational ages between 17 weeks and term admitted for intra-uterine death with no contraindications to misoprostol received 400mcg of misoprostol administered intravaginally 12-hourly, until the establishment of effective uterine contractions. The mean gestational age was 27.9 weeks+/-7.1(SD) and the mean Bishop score was 2.7+/-2.4(SD). The mean duration of onset of contractions was 5.0 hours+/-8.4 (SD); the mean induction-delivery interval was 17.5 hours+/-6.3(SD). Ninety three percent of the women had expelled within 48 hours. Successful induction was achieved in all women. Prophylactic vacuum aspiration was performed (lower gestation only) in 19.6% of cases. Fever, nausea and vomiting were the commonest side effects (7.1%). Neither gestational age nor the cervical score significantly affected the insertion-contraction or induction-delivery intervals. Intra-vaginal Misoprostol at the dosage administered is safe, effective and reduces staff workload.

Serum micronutrient levels, nucleic acid metabolism and antioxidant defences in pregnant Nigerians: implications for fetal and maternal health.

Micronutrients regulate numerous metabolic processes in pregnancy but their possible antioxidant function and contributions of alterations in their metabolism to fetal and maternal morbidity and mortality have received insufficients attention. Serum levels of copper, manganese and zinc were determined in 40 pregnant Nigerian women spread across the three trimesters of pregnancy and compared with those of 25 non-pregnant women of similar demographic and anthropometric characteristics. Serum levels of uric acid were also determined in both groups of women. The mean serum levels of manganese and zinc were significantly lower in the pregnant than in the non-pregnant state (P<0.02, P<0.002), respectively. Unlike manganese and zinc, copper was significantly elevated in the pregnant than in the non-pregnant state. The endogenous anti-oxidant, uric acid, was also significantly reduced in the pregnant than in the non-pregnant state (P<0.001). Copper levels increased progressively in all the three trimesters of pregnancy compared with controls (P<0.001). However, zinc levels declined steadily in all the 3 trimesters, but only the level of the third trimester was significantly different from the non-pregnant state (P<0.05). Unlike zinc, uric acid rose consistently in all the 3 trimesters compared with the non-pregnant state. Manganese and uric acid were significantly more elevated in the third than the first trimester. One way analysis of variance (ANOVA) and multiple comparisons (Tukey HSD) show that the differences in the antioxidant levels can be ascribed mainly to the second and third trimesters. The prevalence of zinc deficiency was 4.0% in the non-pregnant state as compared to 22.5% in the pregnant subjects. The implications of micronutrient deficiencies and associated antioxidant status in pregnancy are discussed. Considering their role in pregnancy, prevention of such deficiencies and attendant oxidative stress may contribute to a reduction in the incidence of fetal and maternal ill-health, and complications of pregnancy. Interventions should be aimed mainly at the second and third trimesters.

Comparative evaluation of the effectiveness and safety of two regimens of levonorgestrel for emergency contraception in Nigerians.

Emergency contraception was introduced in Nigeria over two decades ago, but few women have used this method even in emergency situations because of the side effects. To find an acceptable levonorgestrel regimen for emergency contraception in our community, the two-dose regimen 0.75-mg levonorgestrel 12 h apart (group A) and the single dose 1.5-mg levonorgestrel (group B) were studied in 1118 volunteers. Mild side effects such as nausea, vomiting, lower abdominal pains, menorrhagia, dizziness, headache, and breast tenderness were reported. Significantly more women in the high-dose group reported headache, breast tenderness, and heavy menstrual flow. Eleven pregnancies (1.0%) were reported (7 in group A and 4 in group B). The crude relative risk of pregnancies was similar in the two groups (RR = 0.71, 95% CI = 0.32-1.55; p > 0.05) [corrected]. On the other hand, the estimated effectiveness rate of 86.80% in group A was significantly lower than the 92.99% for group B (p < 0.05). The pregnancy rates increased with delay in starting treatment and if further acts of unprotected sexual intercourse took place after treatment. It was concluded that both regimens were effective and safe.

Nutritive value of melon husk in the diet of chickens.

A study was conducted to investigate the nutritive value of melon husk (MH). Results showed that MH was low in crude protein but very high in crude fibre, ash and ether extract. The elemental analysis showed that MH was also high in calcium and phosphorus content. However, when MH was incorporated into starter diets of chicks, body weight gain decreased with increase in the level of MH in the diets. Birds fed on a 10% MH diet were superior to others in body weight gain (10.45 g/bird/day). Results of feed intake and efficiency of feed utilization were also superior on 10% MH diet with values of 43.07 g/bird/day and 4.12 recorded, respectively. The dietary treatment had significant effect (p < 0.05) on the protein efficiency ratio, which decreased with increase in level of MH in the diets. However, there appeared to be no treatment effects on haematological parameters. Up to 10% MH can replace maize in the starter diet of cockerels without adverse effect on performance.

Isolated umbilical endometriosis--a rare finding.

A 32 yr old multiparous Nigerian woman presented with histological confirmed umbilical endometriosis. There was no evidence of endometrotic deposits elsewhere. Apart from cyclical bleeding from the umbilicus, she was relatively free of any of the other signs and symptoms of Endometriosis. She had excision of the endometeriotic lesion and responded favourably to treatment. A high index of suspicion is required in making a diagnosis of endometriosis in remote extra pelvic sites especially with little or no characterisitic pointers to the disease.

Three decades of acquired gynaetresia in Ibadan: clinical presentation and management.

A retrospective analysis of acquired gynaetresia (Vaginal Stenosis) managed at the University College Hospital Ibadan, Nigeria between 1967 and 1996 was conducted in terms of clinical presentation and management. The prevalence rate was 7/1000. The peak age incidence was 20-30 years. Chemical vaginitis resulting from insertion of caustic vaginal pessaries for various reasons was the major cause of acquired gynaetresia. Dyspareunia/apyreunia and vaginal stenosis/occlusion were the most common symptoms and clinical findings respectively. The various surgical treatment of acquired gynaetresia included one stage vaginoplasty, McIndole-Read's two stage vaginplasty, separation of labial agglutination, Williams's operation, and simple dilatation of the vagina. Successful correction was recorded in 68% of the patients while 28% had residual partial stenosis, 4% had complete stenosis and 6% were lost to follow-up. It was concluded that acquired gynaetresia is preventable. Efforts should be made by authorities to address this issue and create designated centres in the country for the management of these cases and training of junior gynaecologists.

Serum immunoglobulins, total protein and albumin levels during UniplantR use by Nigerian women.

The effects of UniplantR (a new, long-acting, 19-nor-progesterone derivative contraceptive) on serum immunoglobulins, albumin and total proteins were determined in Nigerian women during one year of use. Blood samples were collected prior to implant insertion and then at the third, sixth and twelfth months of use. All volunteers were in the reproductive age, healthy and had no contraindications to hormonal contraception. The mean levels of IgG (+/- SD) increased from pre-insertion to the twelfth month. When compared with the pre-insertion level (1,393.93 +/- 93.51 mg/dL), there are statistically significant increases in the mean values of IgG at three (1,457.19 +/- 78.41 mg/dL, p < 0.05), six (1,458.12 +/- 65.26 mgd/L, p < 0.05) and 12 months (1,499.56 +/- 87.60 mg/dL, p < 0.001). There were no statistically significant changes observed in the mean serum levels of IgA, IgM and total proteins during twelve months of implant use. These results indicate that while Uniplant does not seem to alter the levels of IgA, IgM, albumin and total proteins over a period of twelve months, it may induce significant increase in IgG levels. The raised mean serum levels of IgG may suggest an improved humoral immunity of Uniplant--a change that is potentially beneficial.

Pattern of condom use among commercial sex workers in Ibadan, Nigeria.

Regular condom use has been proven to remarkably reduce the transmission of sexually transmitted diseases (STDs) and its regular use for casual and commercial sex is important for the success of any STD/AIDS control programme. We studied the pattern of condom use among commercial sex workers in Ibadan, Nigeria in an attempt to identify the factors associated with it. Two hundred and ninety-five commercial sex workers in 21 brothels were randomly selected, using a multi-stage sampling technique, from a total of 31 identified in the 5 local government areas that make up Ibadan municipality. They were administered a pre-tested, semi-structured questionnaire by trained research assistants. Results showed that over half (53.2%) of the respondents were in the 20-29 year age group and most (71.5%) had been in the profession for less than a year. Sixty-five (22.0%) had no formal education, 29.8 % had some secondary education whilst 22.4 % had completed secondary school. Their overall knowledge of sexually transmitted diseases (STDs) was rated as poor (20.7%), moderate (64.1%) and good (15.2%). Their perceived risk of contracting HIV/AIDS was low (21.7%) although 87.8% regard it as a health problem in Nigeria. Eighty-three percent of the respondents always insisted that their clients used condoms, 13.2% did so frequently whilst 1.4% only occasionally. Of those who asked clients to use condoms, 69.5% of the women would refuse sex without condoms, 49 (16.6%) would do nothing and have sex without condoms, but 4.4% would charge extra money. No factor was found to have a significant association with the practice of asking clients to use condoms or of refusing sex without condoms. We concluded that consistent condom use was high among sex workers in brothels in Ibadan and was independent of the sex workers knowledge and perception of STDs.

Experience with computed tomography (CT) pelvimetry in Ibadan, Nigeria: a preliminary report.

Computed tomography (CT) pelvimetry has largely replaced conventional radiography in the antenatal assessment of pelvic dimensions, but its usefulness in the Nigerian setting is yet to be assessed. This study was undertaken to ascertain if there is a relationship between antenatal CT pelvimetric measurements and the mode of delivery at the end of the pregnancy. A group of thirty-one patients who had antenatal pelvimetry were categorised into two groups depending on whether they achieved vaginal delivery or not and the pelvimetric and other obstetrrc characteristics of the two groups were compared. The only parameters that showed statistically significant differences between the groups were the higher maternal height and the lower head circumference in the neonates of women achieving vaginal delivery. The findings suggest that fetal parameters may be more predictive of mode of delivery than absolute pelvic measurements.

Legal and regulatory aspects of prescribing and marketing emergency contraception in Nigeria.

Emergency contraception remains so little used or understood and the lack of its awareness can be traced to a myriad of factors including legal and regulatory obstacles. The aim of this study was to determine the legal and regulatory aspects of dispensing or marketing a contraceptive method for reasons (especially emergency purposes) other than stated by the manufacturers. The existing drugs' and devices' regulatory systems in Nigeria, especially those governing family planning methods, were reviewed. A questionnaire was administered to 363 health workers, comprising of physicians, pharmacists, nurses and midwives, to determine the implications of dispensing some currently available oral contraceptives (OCs) for emergency purposes despite the fact that there is no explicit description of emergency use in the labelling of such drugs. In addition, in-depth interviews were conducted with regulatory bodies. It was observed that, with the exception of Postinor, the drug manufacturers' leaflets did not indicate that they could be used for emergency contraceptive purposes. Although 64.5% of the healthcare providers were aware that OCs and intrauterine contraceptive devices (IUCDs) can be used for emergency purposes, 42.1% actually prescribed or recommended them. Many health workers (62.3%) were unaware of any legal implication with regards to prescribing unregistered drugs in Nigeria. The existing guidelines stipulate that a manufacturer or marketer should 're-register' a product if a new indication or use not contained in the initial application was found later. To satisfy legal requirements, it does appear that the currently available OCs and IUCDs in Nigeria must be labelled and registered for emergency contraceptive purposes.