Correlation of Lead Poisoning and Intelligence Status of School Children in a Southern Nigerian Urban City.

BACKGROUND: Lead is a heavy metal of utmost public health significance in Nigeria. It is a known neurotoxin that impairs neurotransmission and brain function resulting in cognitive and motor deficits. Ingestion of lead contaminated food or water is the major route of exposure to lead manifesting as neurologic symptoms which can interfere with the intelligence of school children. AIM: To correlate the Intelligence quotient scores with the blood lead levels of primary school children in Southern Nigeria. METHODS: The study was a descriptive cross-sectional study amongst primary school pupils, conducted in Asaba, the capital of Delta state, Nigeria. Goodenough-Harris "Draw a Person Test" validated by Ebigbo and Izuora in Enugu, Nigeria was used to assess the intelligence of the pupils while blood lead levels was measured with Flame Atomic Absorption Spectrophotometer (FAAS). RESULTS: Three hundred and twenty subjects were recruited. Seventy-one subjects did not have lead poisoning (22%) while two hundred and forty-nine subjects had lead poisoning (77.8%). Mild, moderate and severe level lead poisoning constituted 22.5% (56/249), 28.1% (70/249) and 49.4% (123/249) respectively. Seventy percent (225) subjects had optimal IQ while 95 subjects had sub-optimal IQ and mean IQ score was 92.9 ± 25.1. There was no association and correlation between IQ status and levels of lead poisoning. CONCLUSION: A significant proportion of school children had optimal level of intelligence despite the high prevalence of lead poisoning seen among them. There was no association or correlation between different levels of childhood lead poisoning and Intelligence quotient status.

CONTEXTE: Le plomb est un métal lourd de la plus haute importance pour la santé publique au Nigeria. C'est une neurotoxine connue qui altère la neurotransmission et la fonction cérébrale entraînant des déficits cognitifs et moteurs. Ingestion de plomb contaminé la nourriture ou l'eau est la principale voie d'exposition au plomb qui se manifeste comme symptômes neurologiques, ce qui interfère avec l'intelligence des écoliers. OBJECTIF: Corréler les scores du quotient intellectuel avec letaux de plomb dans le sang des enfants des écoles primaires dans le sud du Nigéria. MÉTHODES: L'étude était une étude transversale descriptive parmi les élèves de l'école primaire, menée à Asaba, la capitale de l'État du Delta, Nigéria. Goodenough-Harris "Dessinez une personne Test" validé par Ebigbo et Izuora à Enugu, Nigeria a été utilisé pour évaluer l'intelligence des pupilles pendant que le sang mène les niveaux ont été mesurés avec l' Absorption Atomique de Flamme Spectrophotomètre (FAAS). RÉSULTATS: Trois cent vingt sujets ont été recrutés. Soixante et onze sujets n'avaient pas d'empoisonnement au plomb (22 %) alors que deux cent quarante-neuf sujets avaient une intoxication au plomb (77.8%). Intoxication au plomb légère, modérée et sévère constituaient 22,5 % (56/249), 28,1 % (70/249) et 49,4 % (123/249) respectivement. Soixante-dix pour cent (225) sujets avaient un QI optimal tandis que 95 sujets avaient un QI sous-optimal et le score de QI moyen était92,9 ± 25,1. Il n'y avait pas d'association et de corrélation entre État du QI et niveaux d'empoisonnement au plomb. CONCLUSION: Une proportion importante d'écolier savaient un niveau d'intelligence optimal malgré la forte prévalence de empoisonnement au plomb vu parmi eux. Il n'y avait pas d'association ou corrélation entre les différents niveaux de plomb infantile empoisonnement et statut du quotient intellectuel. Mots-clés: Empoisonnement au plomb, intelligence, enfance.

Retrospective assessment of neonatal morbidity and mortality in the special care baby unit of a private health facility in Benue State, North Central Nigeria

Background: Newborn morbidity and mortality have remained unacceptably high in developing countries despite consistent efforts at controlling the scourge. Unlike in developed countries where neonatal mortality rate ranges between 1 and 5 per 1000 live births, average neonatal mortality rate in Nigeria is 36 per 1000 live births. The majority of the causes of death are largely preventable with timely low cost interventions. This study was structured to determine the pattern of morbidity and mortality amongst babies admitted in the Special Care Baby Unit of Madonna hospital Makurdi, Nigeria.Methods: The records of neonates admitted into the Special Care Baby Unit (SCBU) over a tenyear period (2005-2015) were retrospectively reviewed. Information obtained included the sex, age at admission, gestational age, birth weight, reasons for admission and outcome of treatment.Results: A total of 1,121 babies were admitted during the period under review. The male female ratio was 1.2:1.The majority of the babies were aged between 2-7 days with a mean 6.17.+ 7.01 The mean weight on admission was 2807+907g. Neonatal sepsis, jaundice, low birth weight and birth asphyxia were the most common morbidities. The overall mortalityrate was 14.1%; however, proportionate mortality due to low birth weight was highest (26.4%), followed by tetanus (23.5%), asphyxia (20.8%), Respiratory tract infection (13.8%), meningitis (13.3%), sepsis (10.3%), jaundice (9.6%), and diarhoea (4.0%)Conclusion: Neonatal mortality rate in the study was high. The major causes of admission are preventable. Strengthening perinatal care, emergency obstetric care services and neonatal resuscitation skills are necessary to reduce the neonatal mortality

First line fertility treatment strategies regarding IUI and IVF require clinical evidence.

The advent of intracytoplasmic sperm injection (ICSI) has contributed to a significant growth in the delivery of assisted conception technique, such that IVF/ICSI procedures are now recommended over other interventions. Even the UK National Institute for Health Care Excellence (NICE) guidelines controversially recommends against intrauterine insemination (IUI) procedures in favour of IVF. We reflect on some of the clinical, economic, financial and ethical realities that have been used to selectively promote IVF over IUI, which is less intrusive and more patient friendly, obviates the need for embryo storage and has a global application. The evidence strongly favours IUI over IVF in selected couples and national funding strategies should include IUI treatment options. IUI, practised optimally as a first line treatment in up to six cycles, would also ease the pressures on public funds to allow the provision of up to three IVF cycles for couple who need it. Fertility clinics should also strive towards ISO15189 accreditation standards for basic semen diagnosis for male infertility used to triage ICSI treatment, to reduce the over-diagnosis of severe male factor infertility. Importantly, there is a need to develop global guidelines on inclusion policies for IVF/ICSI procedures. These suggestions are an ethically sound basis for constructing the provision of publicly funded fertility treatments.

Semen characteristics in consecutive ejaculates with short abstinence in subfertile males.

This study reports the favourable semen characteristics of 73 subfertile oligozoospermic men with short abstinence periods up to 40 min. Semen characteristics were compared between initial and consecutive ejaculate showing improved semen parameters: progressive grade A spermatozoa, morphology and sperm concentration. Median concentrations in initial and consecutive ejaculates were 10 million/ml and 17 million/ml, respectively. The second sample had a higher median normal morphology (7% versus 6%, P < 0.001). The median of non-progressive spermatozoa (Grade C) was significantly lower in the consecutive sample than the initial sample (0% versus 5%, P < 0.01). Medians for slow progression spermatozoa (B grade) and immotile spermatozoa (D grade) were lower in the consecutive samples (20% versus 13%, P < 0.01 and 60% versus 50%, P < 0.001, respectively). The median for rapid motility (Grade A) was significantly higher in the consecutive sample than the first (30% versus 5%, P < 0.001). Overall median progressive motility as benchmarked by the WHO 2010 criteria was significantly higher in the consecutive sample (43% versus 25%, P < 0.001). Semen analyses of consecutive semen samples collected 30 min (mean) apart in oligozoospemic men should be checked routinely for diagnostic purposes and for managing potential subfertility treatment.

Prevalence of diarrhea disease and risk factors in Jos University Teaching Hospital, Nigeria.

BACKGROUND: Diarrhea is widely recognized as a major cause of childhood morbidity and mortality in many developing countries, particularly in sub-Saharan Africa. According to World Health Organization (WHO) report in the African region, diarrheal diseases are still leading causes of mortality and morbidity in children under five years of age. This same report indicates that each child in the said region has five episodes of diarrhea per year and that 800,000 die each year from diarrhea and dehydration. MATERIALS AND METHODS: This study examined diarrheal morbidity and associated risk factors in children under five years in Jos. A total of 340 children were seen in the Diarrhea Training Unit (DTU) of the Jos University Teaching Hospital (JUTH), Jos, over a period of 24 months (Jan 2008-Dec 2009). A semi-structured interviewer administered questionnaire was used to generate the data. All women whose children presented with diarrhea were interviewed and data generated analyzed using Epi info version 3.5.1 statistical software. RESULTS: During the study period, 13,076 children were seen in our facility, of which 340 were suffering from diarrhea, thus giving a diarrhea prevalence of 2.7%. There were 183 (54%) male and 157 (40%) female children seen with diarrhea. The mean age was 11 ± 8.5 months. The mean duration of diarrhea was found to be 4 ± 3.6 days. A majority of children were aged less than 6 months, consisting of 235 infants, 95 toddlers, and 10 pre-schoolers. Of the number of women seen, 242 (61%) had at least primary education, while 98 (29%) had no formal education. Diarrheal episodes were found to have a bivariate association with mothers' educational status, family type, family size, breastfeeding, and sex of child. However, only mother's educational status, diarrhea in other sibling, and breast feeding were significantly associated with the occurrence of diarrhea. Although there were more male children with diarrhea, the odds of having diarrhea was not significantly related to sex. CONCLUSION: Our study demonstrated an important relationship between diarrheal morbidity and low maternal education, nonexclusively breastfed infant, and previous diarrheal episode in a sibling. It thus meant that diarrhea morbidity is still an important problem for infants in our environment. Moreover, maternal education and exclusive breastfeeding are still relevant viable measures in curbing diarrhea in infants.

Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: how accurate and consistent are health-care professionals?

OBJECTIVES: To evaluate the observer accuracy and intra-observer test-retest reliability of visual estimation of blood loss by midwives and obstetricians. METHODS: This was a prospective, single-blinded observational study conducted at a London teaching hospital. The accuracy of visually estimating five maternity pads that had been soaked with 25, 50, 100, 150 and 200 ml of blood was assessed. The reproducibility in estimating the same volume (two sets of pads soaked with 50, 100, 150 and 200 ml of blood randomly placed at separate stations) was evaluated by asking participants to visually estimate these volumes. RESULTS: Although there is a tendency to overestimate, the mean percentage difference (estimated-actual volumes) was not significantly different among consultants, trainees and midwives. Visual estimations were especially inaccurate with smaller volumes, which could be overestimated by up to 540%. Test-retest reliability was poor for the larger volumes but statistically acceptable for the smaller volumes, although the difference between the two estimates of the same volume could be as much as 300%. CONCLUSIONS: Visual estimations were inaccurate by health-care professionals who have a tendency to overestimate. Experience did not appear to have a confounding effect on accuracy. Further training in visual assessment skills is necessary in order to improve the clinicians' estimation.

Obstructive nephropathy and chronic kidney disease secondary to uterine leiomyomas.

We present three cases of chronic kidney disease secondary to large fibroid uterus. The difficulties experienced in their clinical management and a review of literature is outlined.

Pregnancy outcomes of women with pruritus, normal bile salts and liver enzymes: a case control study.

BACKGROUND: Obstetric cholestasis (OC) is associated with increased maternal and perinatal complications. Nevertheless, data on pregnancy outcomes of women who experience pruritus on a transient basis, but have normal bile salts and liver function tests (LFT) is scarce. METHODS: The maternal and fetal outcomes of 144 women with pruritus but normal bile salts and LFTs were compared with the next delivered patient without itch who matched for age, ethnicity and parity. RESULTS: The study and control groups had similar mean gestational ages at delivery and birth weights (p>0.05, t test). However, women with pruritus were more likely to have meconium-stained liqor, abnormal intrapartum cardiotocography and postpartum hemorrhage (PPH) (p<0.05, Fisher's exact test). There appears to be a trend towards a higher rate of instrumental delivery (p=0.07) in the study compared to the control group, although this did not reach statistical significance. CONCLUSION: This study suggests that women who have transient pruritus with normal bile salts and liver biochemistry appear to have higher intrapartum and postpartum complications and require increased vigilance. In order to evaluate this finding, further prospective studies will be required.

Is there still a role for emergency cerclage in the developed world? An experience from a London district hospital.

INTRODUCTION: Cervical incompetence appears to have a greater prevalence in the developing world, which possibly extends to multi-ethnic communities in the UK. Emergency cerclage has been found to have a relative degree of success in patients detected on ultrasound or presenting clinically. Our study aimed to look at the emergency cerclage outcome in the multi-ethnic population of our district hospital. METHODS: Sixty-two cases of cervical cerclage were reviewed retrospectively from 2000 to 2006 with 16 cases being emergencies. Maternal history, presentation, operation details and outcome were recorded. RESULTS: Of the 16 emergency cases, 8 were successful (delivery over 24 weeks gestation), 7 failed and 1 had not yet delivered. The failure rate was found to be significantly higher in the black African women (P = 0.04). Diagnosis by ultrasound as opposed to clinical presentation was associated with a better outcome (P = 0.03). The most significant determinant of outcome was the presence of coliforms on presentation, all of which failed (P = 0.007). CONCLUSION: In this small sample of patients requiring emergency cerclage, findings are suggestive of a poor outcome in black African women, which may be related to previous obstetric history. Similarly the presence of infection especially coliforms is also associated with poor prognosis, while ultrasound diagnosis of dilating cervix rather than clinical diagnosis had a better outcome. Early screening for infection, use of prophylactic antibiotics and sonographic monitoring are likely to improve the success rate of emergency cervical cerclage.

Myasthenia gravis and pregnancy.

Myasthenia gravis (MG) is a chronic autoimmune disorder of neuromuscular transmission characterized by varying degrees of weakness and easy fatigability of the skeletal muscles. Precipitants of myasthenic symptoms or crises include physical and emotional stress, systemic illness, infections, hypo or hyperthyroidism, pregnancy, any type of surgery with general anaesthesia as well as corticosteroids. The authors report two cases of MG in pregnancy and discuss briefly the various aspects of the disease course and management in pregnancy. As MG occurs predominantly in women of reproductive years, it is important that obstetricians are aware of this condition and its management in pregnancy.

An audit of gynaecological procedures in Jehovah's Witnesses in an inner city hospital.

A retrospective study of Jehovah Witness women between January 1994 and December 2003 was performed. Gynaecologists are concerned about operating on Jehovah's Witnesses because of the potential for haemorrhage during surgery. Jehovah's Witnesses do not accept donor blood but some will permit their own blood to be stored pre-operatively and administered during surgery if deemed necessary. Approximately 150,000 Jehovah's Witnesses live in the UK but little on gynaecological procedures in Jehovah's Witnesses has been published. There were 64 procedures (14 major, 18 intermediate and 32 minor) in 53 women with a median age of 42 years. There were no perioperative deaths, but postoperative anaemia was common. Our study showed that major, intermediate and minor gynaecological procedures can be performed without significant morbidity on Jehovah's Witnesses but a protocol should be available to outline management of those who refuse blood.

The value of saline salpingosonography as a surrogate test of tubal patency in low-resource settings.

BACKGROUND: Tubal factor, which accounts for 15-30% of infertility in all women, is common in developing countries with high rates of pelvic inflammatory disease but limited resources. It is possible to outline the fallopian tubes by injecting isotonic saline transcervically during transvaginal ultrasound scanning of the pelvis, and both color flow Doppler and 3-dimensional scanning modes have been employed to improve visualization of the tubes, with varying success. METHOD: We investigated the value of saline salpingosonography (SSG), using 2-dimensional transvaginal ultrasound scanning, as a screening test of tubal patency in 113 women by comparing SSG findings to those at HSG or laparoscopy. RESULTS: The findings at SSG correlated well with the results of HSG or laparoscopy, with an overall concordance of 82.5%. SSG was more accurate at diagnosing patent tubes than blocked tubes and was well tolerated. The results are, however, unreliable when it is difficult to inject the saline and when the patient experiences severe pain during the procedure. CONCLUSION: SSG is a useful screening tool for investigating infertility, particularly in low-resource settings.

Familial prevalence of uterine fibroids is associated with distinct clinical and molecular features.

BACKGROUND: Although uterine fibroids are very common, their pathogenesis and clinical behaviour are poorly understood. Since they may be prevalent in some families, we investigated whether such a prevalence was associated with distinctive clinical and molecular features. METHODS: A case-control questionnaire study of 300 multi-ethnic women with uterine fibroids at a London university hospital was undertaken, with review of case notes and immunohistochemical determination of vascular endothelial growth factor (VEGF-A) in fibroids. RESULTS: When compared with families with sporadic fibroids, familial prevalence of fibroids was associated with a higher incidence of abdominal swelling (59.1% versus 41.6%; P=0.037), menorrhagia (84.4% versus 51.9%; P=0.042), dysmenorrhoea (64.4% versus 46.3%; P=0.004), dyspareunia (43.2% versus 27.9%; P=0.012) and family history of cancers (52.3% versus 32.4%; P<0.01). The fibroids were also more multiple (mean +/- SEM: 7 +/- 0.86 versus 3 +/- 0.42; P<0.011) and strong VEGF-A expression in fibroids was more common in the familial group (64% versus 28%). Racial distribution was the same in both groups (blacks 49%, whites 33.4%, others 18.6%). CONCLUSIONS: Familial prevalence of uterine fibroids is associated with distinct clinical and molecular features that differ from those found when fibroids occur sporadically in families.

Commentary: Polycystic ovarian disease (PCOD): a misnomer, looking for a new name.

This commentary highlights controversies associated with the nomenclature of polycystic ovarian disease (PCOD). It also deals with the authors' suggestion for the new name of polyfollicular ovarian disease (PFOD).

Histopathologic diagnoses of lymphadenopathy in children in Jos, Nigeria.

Histopatholgical findings in 242 lymph node biopsies received in Jos University Teaching Hospital over a 10-year period (1988-1997) were reviewed. Tuberculosis is the most predominant lesion (33.05%), followed closely by the non-Hodgkin's lymphoma (31.4%). Burkitt's lymphoma accounting for one-quarter of all the cases of non-Hodgkin's lymphoma had a peak age range of 8-10 years. Hodgkin's lymphoma, chronic non-specific lymphadenitis, sinus histiocytosis, reactive hyperplasia, metastatic carcinoma, dermatopathic lymphadenitis, Kaposis sarcoma and sarcoidosis accounted for 2.9%, 14.46%, 9.9%, 4.96%, 1.7%, 0.4%, 0.8% and 0.4% respectively. The cervical region was the commonest site affected (54.1%), followed by mesenteric (22.3%), axillary (13.2%) and inguinal (10.3%). BCG immunization was carried out only on 121(50%) of cases, out of which 60 had tuberculosis and 54(22.3%) received no BCG immunization, while 67(27.7%) had no records of BCG immunization. Only 5(2%) had HIV screening done, out of which one was positive.

Assessment of the bone status of Nigerian children and adolescents with sickle cell disease using calcaneal ultrasound and serum markers of bone metabolism.

Growth and skeletal maturation are impaired in sickle cell disease (SCD). SCD is also associated with decreased bone mineral density (BMD) as determined by dual X-ray and photon absorptiometry. Quantitative ultrasound (US), which is as good a predictor of fracture as absorptiometry, provides additional information about bone architecture and elasticity. It is not known if the quantitative US parameters, broadband ultrasound attenuation (BUA) and speed of sound (SOS), are affected in children and adolescents with SCD. We therefore compared the bones of 80 children with SCD in Nigeria to those of age- and gender-matched controls using calcaneal ultrasound and the serum bone markers N-telopeptide of type1 collagen (NTx) and bone-specific alkaline phosphatase (BSAP), which are indicators of bone resorption and formation, respectively. BUA, which is reflective of BMD, was significantly lower for both the male and female SCD subjects compared with controls (86 vs 113 dB/MHz, P < 0.001 and 87 vs 100 dB/MHz, P < 0.001, respectively). However, SOS, which is more indicative of bone elasticity, was significantly different only for the male SCD subjects. Both NTx and BSAP were significantly reduced in the serum of the male and female SCD subjects. Correlations between BUA and serum NTx were found for both female controls and SCD subjects (r = 0.58, P < 0.001 and r = 0.32, P = 0.05, respectively), but not for the male subjects or controls. Significant correlations between BUA and BSAP were observed only for the female controls. In summary, we have shown that US analysis, in combination with serum markers of bone metabolism, can be used to distinguish bone development in children with SCD from that of nonaffected controls.