Vaginal fluid urea and creatinine, an untapped diagnostic tool for premature rupture of membranes.

PURPOSE: The diagnosis of premature rupture of membranes (PROM) can be difficult in equivocal cases. This study was designed to test the validity of vaginal fluid urea and creatinine in the diagnosis of PROM against the gold standard, the Amnisure ROM test™ METHODS: The study was a prospective observational study. All consenting eligible pregnant women between gestational ages of 28 weeks to 41 weeks + 6 days were recruited from the obstetrics emergency and antenatal clinic of the Federal medical centre, Keffi. Patients with history of drainage of liquor were recruited as the case group, and controls who match for age, parity and gestational age were recruited from the antenatal clinic to constitute the control group. Vaginal fluid aspirated was assessed in the laboratory for urea and creatinine levels and an Amnisure ROM test™ done. The sensitivity, specificity, negative and positive predictive values of vaginal fluid urea and creatinine were assessed in the diagnosis of PROM. RESULTS: Vaginal fluid urea and creatinine had sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), respectively, of 94%, 82%, 93.18% and 83.93%, and 98%, 90%, 97.82% and 90.74%. The cutoff values for vaginal fluid urea and creatinine were 1.25 mg/dl and 0.23 mg/dl, respectively. CONCLUSIONS: This study has found that vaginal fluid urea and creatinine are very effective tests in diagnosis of PROM. It is a cheaper and more readily available alternative to the Amnisure test. It is especially useful in our environment, especially in cases of equivocal PROM, as a cost-effective means to confirm the diagnosis. TRIAL REGISTRATION NUMBER (NIGERIA CLINICAL TRIAL REGISTRY): 72961653, retrospectively registered on the 2020-07-09.

Ultrasound Measurement of Placental Thickness: A Reliable Estimation of Gestational Age in Normal Singleton Pregnancies in Nigerian Women.

Purpose: The aim of this article is to evaluate the accuracy of placental thickness (PT) in determination of gestational age (GA) in normal singleton foetuses. Materials and Methods: The study was a cross-sectional descriptive study which recruited consecutively a total of 406 pregnant women with singleton pregnancies (at 15-40 weeks of gestation), referred for routine obstetric ultrasound (US) scan at the National Hospital, Abuja from October to December 2019. Biparietal diameter (BPD), femur length (FL), head circumference (HC), abdominal circumference (AC), and PT were measured using standard protocols. All measurements were calculated by taking three best measurements, and the mean of the measurements was taken and recorded for each participant. Pearson's correlation analysis was computed to determine linear relationships between variables. A significant statistical level was determined at a critical value of P < 0.05. Results: The mean age was 31.8 ± 4.8 years. The mean PTs in the second and third trimesters were 23.2 ± 3.1 and 34.1 ± 3.7 mm, respectively. PT had a linear relationship and a statistically significant positive correlation (r=0.99, P = 0.00) with GA. There was also a statistically significant positive correlation between PT on the one hand, and BPD, AC, HC, FL, PT, and GA, on the other hand. Conclusion: There was a significant and strong positive correlation between PT and GA. The study shows that US measurement of PT is a reliable method of estimating GA in singleton pregnancies in Nigeria.

Sonographic Evaluation of the Gallbladder in Adult Patients With Type 2 Diabetes Mellitus.

INTRODUCTION AND AIM: Diabetes mellitus (DM) is one of the most common non-communicable diseases worldwide. Diabetics with autonomic neuropathy tend to have larger gallbladder (GB) with poor contraction after fatty meals predisposing them to gallstones and cholecystitis. This may be prevented and treated if detected early using ultrasound. This study sonographically evaluated the GB in adults with type 2 diabetes and compared the findings with a non-diabetic age and sex-matched control group. METHODS: In this case-control study, 120 patients with type 2 diabetes and 120 non-diabetic controls between the ages of 18 and 80 years at National Hospital Abuja had their GB evaluated after eight hours of overnight fast using B-mode ultrasound. The data were analyzed using IBM SPSS version 20.0 (Armonk, NY: IBM Corp.) and presented in tables. RESULT:  There were 60 males and 60 females with mean ages of 53.3 and 52 years for the cases and controls, respectively. The average fasting gallbladder volume (FGBV) in diabetics (34.51 + 3.16cm3) was higher than that of controls (27.17 + 1.25cm3). Eleven (9.2%) diabetics had gallstone (GS), while none was detected in controls. The GB wall thickness was significantly higher in diabetics than in the controls (0.28 ± 0.06 cm vs 0.25 ± 0.04 cm). CONCLUSION: A significant proportion of type 2 diabetics had higher FGBV, GB wall thickness, and presence of gallstone compared to the non-diabetic controls. B-mode ultrasound is a very important non-invasive and accurate tool for detecting these changes early.

Bland-Altman Plot: Agreement Between Ultrasound-measured Placenta Thickness and Other Biometric Parameters in the Determination of Gestational Age.

Purpose: The aim of this article is to evaluate the agreement of placenta thickness (PT) with other foetal biometric parameters in the determination of gestational age (GA) in normal singleton foetuses. Materials and Methods: The study was a cross-sectional descriptive study conducted among 406 consecutively recruited pregnant women with singleton foetuses at 15-40 weeks of gestation at the National Hospital, Abuja, Nigeria from October to December 2019. Biparietal diameter (BPD), femur length (FL), head circumference (HC), abdominal circumference (AC), and PT were measured using standard measurement protocols. Bland and Altman (BA) plots were used to compare PT and other foetal biometric parameters. The significant statistical level was determined at a critical value of P < 0.05. Results: The mean age of study participants was 31.8 ± 4.8 years. The BA plot of PT and HC demonstrated a normal distribution; the mean difference was around zero (3.968) and 95% of the measurements fell within 2SD of the mean. The BA plot of HC and AC measurements also showed that the 95% limits of agreement for differences fell within 10% of the mean of the measurements (-4.236 to 15.987 with a mean difference of 5.876), indicating good agreement between the two pairs of variables. However, BA plots between PT and BPD as well as PT and FL showed no agreement. Conclusion: This study indicates that there is good agreement or comparability between PT and HC measurements as well as between PT and AC measurements. Hence, either HC or AC measurements may be interchangeable with PT measurements in the ultrasound determination of GA. However, PT measurements did not agree well with BPD and FL measurements, respectively.

Suffering in silence: pregnant women's experience of urinary incontinence in Zaria, Nigeria.

OBJECTIVE: To determine the prevalence and severity of urinary incontinence during pregnancy in Zaria, Nigeria. STUDY DESIGN: This was a descriptive, cross-sectional study in which 204 apparently healthy pregnant women attending routine antenatal care (ANC) at the Ahmadu Bello University (ABU) Teaching Hospital in Zaria, Nigeria were screened for urinary incontinence using the International Consultation on Incontinence Questionnaire on Urinary Incontinence (ICIQ-UI Short Form) UK English Version. Nurses working in the antenatal clinic were trained on how to help respondents (most of whom were not literate) to respond to the questions. Uni- and bivariate analysis was performed on the data using SPSS version 15 for Windows. RESULTS: The prevalence rate of all types of urinary incontinence during pregnancy was 21.1% in the study population. Stress urinary incontinence was the most common type accounting for 60.5%. The majority of the expectant mothers (74.4%) reported leaking no more than once a week; in 90% of them the volume was small in amount. The modal ICIQ score for urinary incontinence was 3 for the study population. The majority (83.4%) of the incontinent women felt their symptom did not interfere with their daily routines. CONCLUSIONS: About one-fifth of pregnant women in this setting experienced urinary incontinence which they did not report to their primary care providers. Awareness needs to be created for antenatal clients and providers on how to recognize symptoms and manage them. The ICIQ questionnaire has simplified this process.

Clinical presentation of adults with pulmonary tuberculosis with and without HIV infection in Nigeria.

Our aim was to describe the frequency of HIV infection among patients with tuberculosis and compare their characteristics with patients with TB but not infected with HIV. Patients with cough >3 weeks duration attending 8 hospitals in Abuja, Nigeria were screened with smear microscopy and culture and tested for HIV. Chest X-rays were graded by 2 readers. 731 (62%) of 1186 patients had positive cultures and 353 (48%) of these 731 patients were smear positive. 1002 (85%) patients were tested for HIV and 546 (55%) were positive. 53% (329/625) of the culture positive patients and 58% (217/377) of the culture negative patients were HIV positive. Anorexia, weight loss, low BMI (<18.5), haemoglobin (<11 gm/dl) and albumin and high ESR and liver enzymes were more frequently observed among patients with TB coinfected with HIV than in patients without HIV. Coinfected patients had less cavitations and lung involvement on X-rays than patients without HIV. In conclusion, the prevalence of HIV is very high among patients with TB in Abuja, Nigeria. The presence of HIV decreases the sensitivity of smear microscopy and complicates the diagnosis of TB. Selected clinical and laboratory parameters could be used to identify individuals with TB who are likely to be coinfected with HIV.