Aetiological Spectrum of Pancreaticobiliary Diseases in Adult Nigerians on Magnetic Resonance Cholangiopancreatography.

BACKGROUND: Imaging is vital for assessing pancreaticobiliary diseases. AIM: The aim of the study was to investigate the spectrum and pattern of pancreaticobiliary diseases in adult Nigerians using magnetic resonance cholangiopancreatography (MRCP). METHODS: This was a retrospective, descriptive cross-sectional study. The electronic radiological records of 110 adult Nigerians who had undergone MRCP were reviewed. The MRCP images were evaluated for bile duct dilatation, intraluminal filling defects, strictures, calculi, and other abnormalities. RESULTS: There were 45 males (40.9%) and 65 females (59.1%) aged 18-83 years, with a mean age of 51.93 ± 15.22 years. Jaundice (59.1%) and right hypochondrial pain (31.8%) were the most common presenting complaints. Gallstones (32.7%), common bile duct strictures (15.5%), choledocholithiasis (11.8%), pancreatic head carcinoma (10.9%), and gallbladder carcinoma (2.7%) were the most frequent abnormalities. There was biliary obstruction in 56.4% of participants, mostly at the distal and proximal common bile duct. Other findings include hepatomegaly (23.6%), hepatic cysts (6.4%), hepatic steatosis (0.9%), duodenal wall thickening (1.8%), and ascites (5.5%). MRCP was normal in 25 (22.7%) participants. CONCLUSION: Gallstones were the predominant pathology of the various pancreaticobiliary diseases, while Pancreatic head and gallbladder carcinoma were the most common malignant diseases.

Determinants of Suboptimal Peak Inspiratory Flow Rates among Patients with Chronic Obstructive Pulmonary Disease in Southwest, Nigeria.

BACKGROUND: Inhalational therapy is the cornerstone in the management of chronic obstructive pulmonary disease (COPD) patients. Patients' peak inspiratory flow impacts effective dry powder inhaler (DPI) delivery and management outcome. OBJECTIVE: This study assessed peak inspiratory flow rates (PIFR) and determined the factors associated with suboptimal inspiratory flow rates among COPD patients. METHODS: A descriptive cross-sectional study was conducted among 60 participants (30 stable COPD patients and 30 age-and-sex matched controls). Socio-demographic characteristics was obtained and spirometry was done for all participants. PIFR assessment was done using the In-Check Dial Meter and was categorized as suboptimal (< 60L/min) or optimal (≥ 60L/min). P values less than 0.05 were taken as statistically significant. RESULTS: Mean age of the COPD patients and healthy controls were both 67.8 ± 10.3 years, with 53.3% being females. Post-bronchodilation FEV 1/FVC% for COPD patients was 54.15 ± 11.27%. The mean PIFR among COPD patients was significantly lower than that of healthy controls, in all DPIs simulated, especially for Clickhaler (46.2±13.4 vs 60.5±11.4L/min, p<0.001). A significant proportion of COPD patients had suboptimal PIFR, in the simulated resistances against Clickhaler and Turbuhaler (70% vs 80%; p<0.001). Older age, shorter height and low BMI were associated with suboptimal PIFR among COPD patients. However, independent predictors of suboptimal PIFR were BMI, PEFR, FEV1% and FVC%. CONCLUSION: Suboptimal PIFR was found in a significant number of COPD patients when compared with healthy respondents. Routine assessment using In-Check Dial meter should be done to determine the suitability of dry powder inhalers for patients with COPD.

CONTEXTE: Le traitement par inhalation est la pierre angulaire de la prise en charge des patients atteints de bronchopneumopathie chronique obstructive (BPCO). Le débit inspiratoire de pointe des patients a une incidence sur l'efficacité de l'inhalateur de poudre sèche et sur les résultats de la prise en charge. OBJECTIF DE L'ÉTUDE: Cette étude a évalué les débits inspiratoires de pointe et déterminé les facteurs associés aux débits inspiratoires sousoptimaux chez les patients atteints de BPCO. MÉTHODES: Une étude transversale descriptive a été menée auprès de 60 participants (30 patients atteints de BPCO stable et 30 témoins appariés selon l'âge et le sexe). Les caractéristiques socio-démographiques ont été recueillies et une spirométrie a été effectuée pour tous les participants. L'évaluation du PIFR a été réalisée à l'aide du Dial Meter In-Check et a été catégorisée comme suboptimale (< 60L/min) ou optimale (≥ 60L/min). Les valeurs P inférieures à 0,05 ont été considérées comme statistiquement significatives. RÉSULTATS: L'âge moyen des patients atteints de BPCO et des témoins sains était de 67,8 ± 10,3 ans, avec 53,3 % de femmes. Le pourcentage de VEMS/FVC après bronchodilatation chez les patients atteints de BPCO était de 54,15 ± 11,27 %. Le PIFR moyen des patients atteints de BPCO était significativement plus faible que celui des témoins sains, pour tous les DPI simulés, en particulier pour le Clickhaler (46,2±13,4 vs 60,5±11,4L/min, p<0,001). Une proportion significative de patients atteints de BPCO avait un PIFR sous-optimal, dans les résistances simulées contre Clickhaler et Turbuhaler (70% vs 80% ; p<0.001). L'âge avancé, la petite taille et un faible IMC étaient associés à une PIFR sous-optimale chez les patients atteints de BPCO. Cependant, les prédicteurs indépendants du PIFR suboptimal étaient l'IMC, le DEP, le VEMS et la CVF. CONCLUSION: Un nombre significatif de patients atteints de BPCO présente un PIFR sous-optimal par rapport aux personnes interrogées en bonne santé. Une évaluation de routine à l'aide de l'appareil de mesure In-Check Dial devrait être effectuée pour déterminer si les inhalateurs de poudre sèche conviennent aux patients atteints de BPCO. Mots clés: Inhalateur de poudre sèche, Débit inspiratoire maximal, Fonction pulmonaire.

High Intensity Focused Ultrasound Treatment for Uterine Fibroid in a Nigerian Hospital: A Case Report and Review of Literature.

High intensity focused ultrasound (HIFU) is a non-invasive method of treating uterine fibroid that is based on the principle of using extracorporeal ultrasound to cause coagulative necrosis of uterine fibroid. While the technology has been used in other parts of the world, it is new in West Africa. The reported case was the first HIFU treatment of uterine fibroid in Nigeria. A 38-year-old woman was prepared for HIFU treatment of uterine fibroid. Abdomino-pelvic ultrasound scan, Magnetic Resonance Imaging (MRI) and pre-procedural bowel preparation were done. High intensity focused ultrasound (JC200) treatment was done under conscious sedation using average power of 400 Watts with total energy consumption of 278.0 Kilo Joules with total sonication time of 700 seconds. The patient was able to resume her daily activities one week post-HIFU procedure.

Ultrasons focalisés de haute intensité (HIFU)est une méthode non invasive de traitement des fibromes utérins à base sur le principe de l'utilisation d'ultrasons extracorporels pour provoquer nécrose coagulative du fibrome utérin. Alors que la technologie a été utilisé dans d'autres parties du monde, il est nouveau en Occident Afrique. Le cas signalé était le premier traitement HIFU de l'utérus fibrome au Nigeria. Une femme de 38 ans était préparée pour HIFU traitement du fibrome utérin. Échographie abdomino-pelvienne, Imagerie par résonance magnétique (IRM) et intestin pré-procéduralla préparation a été faite. Ultrasons focalisés de haute intensité (JC200) le traitement a été effectué sous sédation consciente en utilisant puissance moyenne de 400 Watts avec une consommation totale d'énergie de278,0 kilojoules avec un temps de sonication total de 700 secondes. Le patiente a pu reprendre ses activités quotidiennes une semaine après la procédure de HIFU.

Management of covid-19: a practical guideline for maternal and newborn health care providers in Sub-Saharan Africa.

COVID-19 is a pandemic that is currently ravaging the world. Infection rate is steadily increasing in Sub-Saharan Africa. Pregnant women and their infants may suffer severe illnesses due to their lower immunity. This guideline prepares and equips clinicians working in the maternal and newborn sections in the sub-region to manage COVID-19 during pregnancy and childbirth.

Menstrual Characteristics of sub-Sahara Black African Women with and without Endometriosis.

BACKGROUND: One gynecological disorder which is often a mystery to premenopausal women who are affected is endometriosis, a benign condition characterized by ectopic endometrium growing outside the uterus but behaving as if it is still within the uterus. MATERIALS AND METHODS: Hospital records of 226 women who consulted for fertility management at Nordica Fertility Center were surveyed retrospectively. These women were stratified by age into <35 years and >35 years and by BMI into <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight) and >30 (obese). There were 113 who had laparoscopic diagnosis of endometriosis and 113 without endometriosis but just infertility. STATA 13 statistical software was used for analysis of data. RESULTS: The mean (±sd) age of the women in the study was 34.3 (4.9) with no significant difference among those with (33.9 (4.3)) and without (34.6 (5.4)) endometriosis. There was a significant difference (t=-3.36, P-value=0.0005) in the mean BMI (Kg/m2) of women with endometriosis (25.8±4.9) compared to that of women without endometriosis (27.9±4.5). The probability of endometriosis among normal weight women was higher at age <35 years (OR=2.76, 95% Confidence Interval 1.33,5.73) than at age >35 years (OR=1.59, 95% Confidence Interval 0.62, 4.10). The mean (±SD) parity among those with endometriosis (0.13±0.34) was significantly lower (t-test=2.31; P-value=0.01) than that among women without endometriosis (0.28 ± 0.60). Primary infertility was more prevalent (62.0%) than secondary infertility (38.0%) among those with endometriosis while secondary infertility was more prevalent (55.8%) than primary infertility (44.3%) among those without endometriosis. The mean age (years) at menarche of women without endometriosis (13.3±1.6) was significantly higher (t-test=1.88, P-value=0.03) than that among those with endometriosis (12.9±1). Those with endometriosis were most likely to have dysmenorrhea alone, menorrhagia alone and both dysmenorrhea and menorrhagia concurrently than those without the disease. CONCLUSION: Anthropometric and abnormal menstrual profile of patients presenting with pelvic pain, co-morbidity of dysmenorrhea and menorrhagia, infertility and low parity can guide clinicians and gynecologist to make early and proper diagnosis of endometriosis for better treatment outcomes.

CONTEXTE: Un mal gynécologique qui est souvent un mystère pour les femmes préménopausées qui sont touchées est l'endométriose, une affection bénigne caractérisée par un endomètre ectopique poussant à l'extérieur de l'utérus mais se comportant comme s'il était toujours dans l'utérus. MATÉRIEL ET MÉTHODES: Les dossiers hospitaliers de 226 femmes ayant consulté pour la gestion de la fertilité au Nordica Fertility Center ont été étudiés rétrospectivement. Ces femmes ont été stratifiées par âge en <35 ans et> 35 ans et par IMC en <18,5 (poids insuffisant), 18,5 à 24,9 (normal), 25,0 à 29,9 (surpoids) et> 30 (obèse). Il y avait 113 qui avaient un diagnostic laparoscopique d'endométriose et 113 sans endométriose, mais juste l'infertilité. Le logiciel statistique STATA 13 a été utilisé pour l'analyse des données. RÉSULTATS: L'âge moyen (± sd) des femmes de l'étude était de 34,3 (4,9) sans différence significative entre celles avec (33,9 (4,3)) et sans (34,6 (5,4)) endométriose. Il y avait une différence significative (t = -3,36, valeur p = 0,0005) dans l'IMC moyen (Kg / m2) des femmes atteintes d'endométriose (25,8 ± 4,9) par rapport à celle des femmes sans endométriose (27,9 ± 4,5). La probabilité d'endométriose chez les femmes de poids normal était plus élevée à l'âge <35 ans (OR = 2,76, intervalle de confiance à 95% 1,33,5,73) qu'à l'âge> 35 ans (OR = 1,59, intervalle de confiance à 95% 0,62, 4,10). La parité moyenne (± ET) parmi les personnes atteintes d'endométriose (0,13 ± 0,34) était significativement plus faible (test t = 2,31; valeur p = 0,01) que chez les femmes sans endométriose (0,28 ± 0,60). L'infertilité primaire était plus fréquente (62,0%) que l'infertilité secondaire (38,0%) chez les personnes atteintes d'endométriose, tandis que l'infertilité secondaire était plus fréquente (55,8%) que infertilité primaire (44,3%) chez les personnes sans endométriose. L'âge moyen (années) à la ménarche des femmes sans endométriose (13,3 ± 1,6) était significativement plus élevé (test t = 1,88, valeur p = 0,03) que celui des femmes atteintes d'endométriose (12,9 ± 1). Les personnes atteintes d'endométriose étaient plus susceptibles de souffrir de dysménorrhée seule, de ménorragie seule et à la fois de dysménorrhée et de ménorragie en même temps que celles sans maladie. CONCLUSION: Le profil anthropométrique et menstruel anormal des patientes présentant des douleurs pelviennes, une comorbidité de dysménorrhée et de ménorragie, l'infertilité et une faible parité peuvent guider les cliniciens et le gynécologue pour faire un diagnostic précoce et approprié de l'endométriose pour de meilleurs résultats de traitement. Mots clés: femmes noires africaines, dysménorrhée, endométriose, infertilité, ménorragie, parité, profil menstruel, sub-saharienne.

Endometriosis and Infertility: An Appraisal of Articles.

BACKGROUND: Endometriosis is a common progressive gynecological disorder which often poses a mystery to women affected and to health care provider alike. It is a condition in which tissue that normally grows inside the uterus (endometrium) grows outside it. It is estimated that about 6-10% of women in the reproductive age group worldwide have endometriosis. This report is likely to be an underestimated figure because many are misdiagnosed, misinterpreted or mislabeled. Many women with endometriosis experience few or no symptoms but those symptomatic typically present with pelvic pain, infertility, or an adnexal mass, and may require surgery. No known established cause has been identiued to explain the link between endometriosis and infertility; however, several mech anisms have been proposed. While there is no cure for endometriosis, there are two types of interventions; treatment of pain and treatment of endometriosis-associated infertility. Treatment of endometriosis in the setting of infertility can be quite challenging both for the care giver and the affected individual.

Utility of a single mid-trimester measurement of plasminogen activator Type 1 and fibronectin to predict preeclampsia in pregnancy.

BACKGROUND: Preeclampsia (PE) is the second most common cause of maternal death after obstetric hemorrhage in Africa, a resource-limited region. This study was designed to examine the potential usefulness of a single screening plasma plasminogen activator inhibitor-1 (PAI-1) and fibronectin (FN) level for the prediction of PE in pregnant women. MATERIALS AND METHODS: In a cohort of 180 pregnant women who were normotensive at baseline, venous blood samples were obtained before 20 weeks of gestation for the assay of plasma levels of PAI-1 and FN levels measured by enzyme-linked immunoassay technique. Twenty nonpregnant normotensive women were also evaluated as a control group. Outcomes of gestation were evaluated and correlated with the plasma levels of PAI and FN measured at mid-trimester. Mean plasma values of PAI-1 and FN were also compared between the different outcome groups. RESULTS: Plasma PAI-1 level was significantly higher in the pregnant women (8.68 ± 0.56 ng/ml) than in nonpregnant controls (5.55 ± 0.32 ng/ml) (P = 0.01). However, plasma FN did not show any significant difference in pregnant women (2.60 ± 0.37 µg/ml) and nonpregnant controls (2.60 ± 0.23 µg/ml) (P = 0.9). Mid-trimester mean plasma PAI-1 level measured in women who developed PE (7.08 ± 5.49 ng/ml, n = 12) and gestational hypertension (GH) (9.78 ± 6.2 ng/ml, n = 13) was not significantly different in comparison to normotensive pregnant women (8.78 ± 5.63 ng/ml, n = 153) (P = 0.75). Likewise, the mean FN level in women who developed PE was also not significantly different from nonpreeclamptics; however, the FN level in the pregnant women who developed GH was significantly different from women who remained normotensive throughout pregnancy (P = 0.02). CONCLUSION: Single mid-trimester assessment of PAI-1 and FN levels in maternal plasma was not found to be useful in predicting PE as an outcome of pregnancy in the study population.

Roles of family dynamics on adherence to highly active antiretroviral therapy among people living with HIV/AIDS at a tertiary hospital in Osogbo, south-west Nigeria.

BACKGROUND: Adherence to highly active antiretroviral therapy (HAART) has been proven to be the only effective treatment for HIV/AIDS worldwide. Good adherence to HAART might require good family support. OBJECTIVE: To determine the family dynamics and social support of people living with HIV/AIDS (PLWHA) and its roles on HAART adherence at an ARV treatment clinic in Osogbo, Nigeria. METHOD: Descriptive cross-sectional study. Consenting PLWHA on HAART were interviewed using pre-tested semistructured questionnaire incorporating Perceived Social Support- Family Scale and Family APGAR. HAART adherence was measured using patient self report. RESULTS: A total of 379 PLWHA were interviewed. Their mean age was 40.8 (SD=9.9) years. Most (60.7%) were females. More than half (55.7%) were currently married and the majority (72.1%) had secondary education and were Yoruba (86.3%). Most respondents (95.5%) were adherent to HAART. Over 90% were satisfied with support received from their family while 82.3% were treated like other family members. Most attributed their HAART adherence to the care and support received from their family. CONCLUSION: Most PLWHA had good social support and were adherent to HAART.

Morbidity and mortality in sickle cell pregnancies in Lagos, Nigeria: a case control study.

Women with sickle cell disorder are historically known to have significant maternal and perinatal complications but recent studies from developed countries show a change in this trend. This study was a retrospective, case-controlled study of 75 women with haemoglobin SS (HbSS) and 150 with haemoglobin AA (HbAA). Data were analysed using chi(2)-test and independent t-test as appropriate. There were more perinatal (18.7 vs 8.8, p<0.05) and maternal (5.3% vs 0, p<0.05) deaths in HbSS women compared with HbAA. Birth weight, gestational age at delivery and 1 and 5 min Apgar scores were also significantly lower in the HbSS women. There was no significant difference in the incidence of pre-eclampsia and urinary tract infection between the two groups. Pregnancy in HbSS women is still fraught with maternal and fetal complications. Prospective studies may help clarify the relationship between SCD and specific maternal complications.

Adenosine deaminase activity in subjects with normal pregnancy, pregnancy induced hypertension and pre-eclampsia.

BACKGROUND: Both pregnancy and adenosine deaminase (ADA) are associated with depressed cellular mediated immunity. There is little information on ADA activity in pregnant Africans. OBJECTIVE: To determine the serum levels of adenosine deaminase (ADA) in normal pregnancy and pregnancy complicated by hypertension in Nigerian women. METHODS: One hundred and twenty-five pregnant women comprising 35 normal non-pregnant women, 35 normal pregnant women, 35 pregnant women with pregnancy induced hypertension and 20 patients with pre-eclampsia were recruited for the study. Serum adenosine deaminase enzyme (ADA) activity was measured by the Giusti and Galanti spectrophotometric method in all study subjects. RESULTS: The mean serum ADA level in the non-pregnant women was higher than that in the normal pregnant women (23.21 +/- 6.3 v 14.69 +/- 3.2, p<0.001). Amongst the pregnant women, mean serum ADA in the hypertensive and pre-eclamptic women was significantly higher than that in the normal pregnant group (p<0.001). CONCLUSION: These findings indicate a probable decrease in cellular immunity in normal pregnancy and an enhanced cell mediated immunity in pre-eclampsia.

Plasma total and ultrafiltrable calcium in normal pregnancy, hypertension in pregnancy and pre-eclampsia.

OBJECTIVE: To measure the ultrafiltrable and total plasma calcium in normal pregnancy and pregnancies complicated with hypertension and pre-eclampsia. PATIENTS AND METHODS: Total and ultrafiltrable calcium concentrations were measured in maternal plasma from non-pregnant (35), normal pregnant (35), Pregnancy induced hypertension (35) and pre-eclamptic (20) women. Plasma total calcium level was measured by the o'cresolphthalein method. Ultrafiltrate of plasma was obtained using the Amicon MPS-1 micro-partition device. RESULTS: There was no significant difference in the plasma total calcium level between the non- pregnant group and the pregnant group (normal, hypertensive and pre-eclamptic). However there was a significant reduction in the ultrafiltrable (protein free and complexed) calcium level in the pregnant group compared to the non-pregnant group (1.15mmol/L +/- 0.23 Vs 1.25mmol/L +/- 0.13) p<0.05. CONCLUSION: Measurement of the ultrafiltrable calcium in addition to total calcium assay may be more useful in assessing calcium status in normal and complicated pregnancies.

Research on medical migration from sub-Saharan medical schools: usefulness of a feasibility process to define barriers to data collection and develop a practical study.

CONTEXT: The maldistribution of physicians in sub-Saharan Africa is having serious impacts on population health. Understanding the effect requires investigation from both donor and recipient countries. However, investigation from the perspective of donor countries has been lacking. METHODS: This brief communication describes a model process for the design of a research project that addresses medical migration issues from the perspective of eight African medical schools. During an international meeting, the participants designed an initial "ideal" study, and then rapidly tested its feasibility through a brief survey, and group discussion through a listserv, teleconferences and one face-to-face meeting. FINDINGS AND PRACTICAL IMPLICATIONS: Innovative research ideas can be followed-up with surveys to test the feasibility of an "ideal" research design, modifying the design accordingly. This is currently occurring with our medical migration survey study.

Urgency of surgery and presence of maternal disease influence the choice of anaesthesia for Caesarean section at LUTH.

AIMS AND OBJECTIVES: Worldwide, Caesarean sections are commonly done under regional anaesthesia which offers numerous advantages over general anesthesia. However there are still indications for the use of general anaesthesia in obstetric practice. This includes emergent Caesarean sections. This study sought to determine the factors that inform the decision on the choice of anaesthesia for Caesarean section in a tertiary institution in Nigeria. PATIENTS AND METHODS: All patients scheduled for elective and emergency caesarean sections between January and December 2002 were prospectively studied. Study variables included age of mother, gestational age and parity. Urgency of surgery, indication for surgery, maternal pre-existing disease and the choice of anaesthetic technique were documented. Neonatal weight was recorded and outcome was assessed by Apgar score at 1 and 5 minutes, the presence of respiratory difficulties and the need for admission into the Neonatal unit. RESULTS: One hundred and ninety-six patients were studied. Elective surgery was performed for 17.3%, while 47.4% and 28.6% had urgent and emergency Caesarean sections respectively. Urgency of surgery was not documented in 6.7% of cases. Previous caesarean section was the commonest indication for elective procedures (47%), foetal distress for emergency (62.5%) and previous caesarean section in labour for urgent procedures (30.1%). General anaesthesia was employed in 33.2% of patients while regional anaesthesia was used in 66.8%. Fifty per cent of emergency cases had general anaesthesia. Regional anaesthesia was used in 72% of urgent and 85.3% of elective procedures. The commonest regional technique was spinal anaesthesia (60.7%). Nineteen per cent of our patients had a co-existing medical problem, and 73% of these received a spinal anaesthetic. More neonates delivered under general anaesthesia had respiratory difficulties at birth (p=0.002) and more were admitted to the Neonatal unit (p=0.031). CONCLUSION: The choice of anaesthesia depends on the urgency of surgery and the medical condition of the mother. General anaesthesia was more likely to be administered for bleeding emergencies and foetal distress. Spinal anaesthesia was preferred for elective and urgent cases or when maternal disease existed.

Bacterial flora of commonly used soaps in three hospitals in Nigeria.

OBJECTIVES: To obtain general information on soap use and soap bacterial flora, and to assess the risk of transmission of organisms from contaminated soap to patients. DESIGN: Descriptive study. SETTING: Three hospitals in an urban area of Lagos, Nigeria. A teaching (761 bed) hospital, a general hospital (a 51 bed secondary healthcare facility) and a private hospital (a 30 bed private community with a surgical specialty). RESULTS: Bar soaps were much more commonly used than liquid soaps. Out of the thirty six bar soaps and their receptacles studied, 19 (52.8%) were found wet, nine (25%) dry, five (13.9%) very dry, and three (8.3%) in a pool of water. A total of 39% soaps and 75% of receptacles were contaminated. Thirty three percent of the dry soaps and 68.4% of the wet soaps were contaminated. None of the very dry soaps and all in a pool of water were contaminated. The bacteria isolated from soaps included Pseudomonas aeruginosa (89.5%) and Klebsiella pneumoniae (10.5%), while Pseudomonas aeruginosa (70.6%), Klebsiella pneumoniae (14.7%), Staphylococcus aureus (11.8%) and Serratia marcescens (2.9%) were isolated from the receptacles. The antibiogram showed that the Pseudomonas aeruginosa isolated from the soaps and their containers (sinks) were distinct from those obtained from colonised or infected wounds. The soap contamination rates correlated with the conditions in which the soaps were kept. CONCLUSION: The type of soap containers in particular, played a vital role in keeping the soap dry or wet. In all the hospitals studied, the policies on soap use, if any, were not in agreement with the recommended guidelines. The healthcare workers need to be re-educated on these guidelines.

Regional versus general anaesthesia for caesarean section.

BACKGROUND: Regional and general anaesthesia (GA) are commonly used for caesarean section (CS) and both have advantages and disadvantages. It is important to clarify what type of anaesthesia is more efficacious. OBJECTIVES: To compare the effects of regional anaesthesia (RA) with those of GA on the outcomes of CS. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 1), MEDLINE (1966 to December 2005), and EMBASE (1980 to December 2005). SELECTION CRITERIA: Randomised and quasi-randomised controlled trials evaluating the use of RA and GA in women who had CS for any indication. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trials for inclusion, data extraction and trial quality. MAIN RESULTS: Sixteen studies (1586 women) were included in this review. Women who had either epidural anaesthesia or spinal anaesthesia were found to have a significantly lower difference between pre and postoperative haematocrit (weighted mean difference (WMD) 1.70, 95% confidence interval (CI) 0.47 to 2.93, one trial, 231 women) and (WMD 3.10, 95% CI 1.73 to 4.47, one trial, 209 women). Compared to GA, women having either an epidural anaesthesia or spinal had a lower estimated maternal blood loss (WMD -126.98 millilitres, 95% CI -225.06 to -28.90, two trials, 256 women) and (WMD -84.79 millilitres, 95% CI -126.96 to -42.63, two trials, 279 women). More women preferred to have GA for subsequent procedures when compared with epidural (odds ratio (OR) 0.56, 95% CI 0.32 to 0.96, one trial, 223 women) or spinal (OR 0.44, 95% CI 0.24 to 0.81, 221 women). The incidence of nausea was also less for this group of women compared with epidural (OR 3.17, 95% CI 1.64 to 6.14, three trials, 286 women) or spinal (OR 23.22, 95% CI 8.69 to 62.03, 209 women). No significant difference was seen in terms of neonatal Apgar scores of six or less and of four or less at one and five minutes and need for neonatal resuscitation with oxygen. AUTHORS' CONCLUSIONS: There is no evidence from this review to show that RA is superior to GA in terms of major maternal or neonatal outcomes. Further research to evaluate neonatal morbidity and maternal outcomes, such as satisfaction with technique, will be useful.

Spontaneous heterotropic pregnancy in sickle cell disease with survival of the abdominal pregnancy.

A case is presented of a spontaneously conceived heterotopic pregnancy in a 38-year-old Haemoglobin SS woman, with intrauterine foetal demise and survival of the extra-uterine pregnancy, which was an abdominal pregnancy. The diagnosis was not made until delivery. This report should create the awareness of the possibility of abdominal or heterotopic pregnancy in spontaneous cycles, particularly in patients with recurrent severe anaemia in pregnancy, whether or not they have haemoglobinopathies.

Seasonal and temporal variations in the population and biting habit of mosquitoes on the Atlantic coast of Lagos, Nigeria.

OBJECTIVES: To determine the hourly density of vector mosquitoes in coastal Nigeria, compare seasonal human-biting and sporozoite rates in the vector density, locate breeding sites of mosquitoes, and determine larval population at breeding sites. MATERIALS AND METHODS: Indoor and outdoor mosquitoes of a coastal Nigerian community were caught during early and late wet seasons and in the harmattan period, a time of dusty wind from the Sahara on the western coast of Africa. Larvae were collected from various locations during the study period. The mosquitoes were physically characterized and their salivary glands dissected for sporozoite rate. Larvae density was calculated. Human-biting rate was calculated for Anopheles gambiae complex. RESULTS: Of the 4,317 female A. gambiae complex collected during the night bait catches, 3,543 (82.1%) were from outdoors and 774 (17.9%) from indoors during the three seasons. The maximum human-biting rate approached 25/h and the sporozoite rate was almost 3.0%. These vector mosquitoes were mainly outdoor biting and midnight feeding. Of the 1,269 Anopheles mosquitoes collected with pyrethrum spray catches, 1,245 (98.1%) were A. gambiae complex. There was no significant difference in the entomological inoculation or sporozoite rates during the three seasons of study. There was a preponderance of A. gambiae complex larvae from larval collection. CONCLUSION: Findings from this study should be useful in the implementation of Integrated Vector Management for the control of malaria in coastal and noncoastal areas of Nigeria.

International training in medical education--the FAIMER institute 2002 fellowship experience.

The concept of Medical Education as a specific discipline has advanced significantly. The Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, USA was formed in the year 2000 to disseminate the concept to medical schools worldwide. FAIMER Institutes are 2-year long fellowship programs that were developed in 2001 to teach education methods and leadership skills to middle and senior level academicians from medical institutions in the developing world. In addition, the Institute fellows also carry out a curriculum innovation project in their institutions, in the interim period between two U.S. based workshops. This paper describes the experience of the authors and their co-fellows who participated in the 2002 FAIMER Institute and highlights the main learning points of the course.