Eficacia del tratamiento con inyecciones intradérmicas de plasma rico en plaquetas para la alopecia androgenética en varones: estudio de «antes-después» / Efficacy of Platelet Rich Plasma Intradermal Injections for Androgenetic Alopecia Treatment in Males: A Before and After Study

ANTECEDENTES Y OBJETIVOS: El plasma rico en plaquetas es una fuente de factores de crecimiento utilizada recientemente en el tratamiento de la alopecia androgenética (AGA); sin embargo, la eficacia de este tratamiento sigue siendo controversial. Los objetivos del presente estudio son evaluar la eficacia del plasma rico en plaquetas en el incremento de la densidad capilar en varones con AGA, así como, determinar si existe una correlación entre la respuesta favorable a dicho tratamiento, con la edad del paciente, con el tipo de AGA y con el tiempo de evolución de esta. MATERIALES Y MÉTODOS: Se diseñó un estudio de «antes/después» y se incluyeron 30 varones. Estos pacientes no habían recibido ningún tratamiento para la AGA al menos en los 3 meses previos al estudio. Cada paciente recibió 3 inyecciones en intervalos de un mes. La densidad capilar de cada sujeto se midió manualmente mediante un dermatoscopio antes de la primera intervención y también a los 2 y 6 meses. Para determinar la eficacia del tratamiento se realizó un análisis comparativo. RESULTADOS: La densidad capilar se incrementó en un 19,17% después de la intervención (172,46 ± 59,04 cabellos/cm2 antes del tratamiento a 205,53 ± 68,20 cabellos/cm2 después de los 6 meses); los efectos secundarios fueron mínimos en el seguimiento a corto plazo. El patrón de alopecia de tipo vertex III fue el patrón que presentó una menor respuesta. No se objetivó ninguna correlación entre la respuesta favorable al tratamiento y la edad del paciente o la duración de la AGA. CONCLUSIÓN: Las inyecciones de plasma rico en plaquetas en pacientes varones con AGA tendrán un efecto favorable sobre la densidad capilar

BACKGROUND AND AIMS: Platelet rich plasma is a source of growth factors recently introduced to treat androgenetic alopecia (AGA) with conflicting results. Our aims are to assess the efficacy of platelet rich plasma in increasing hair density in males with AGA, and to investigate a correlation between positive response and each of patient's age and type and duration of AGA. MATERIALS & METHODS: This before and after study included 30 males with no history of hair treatments for at least 3 months prior to our study. Each patient received 3 injections at one-month intervals. Scalp hair density of each subject was measured manually by a dermatoscope before and following 2 and 6 months of the first intervention. Data were compared to evaluate efficacy. RESULTS: Hair density was increased by 19.17% following our intervention (172.46 ± 59.04 hairs/cm2 before treatment to 205.53 ± 68.20 hairs/cm2 after 6 months) with minimal short-term side effects. Type III vertex was the least responsive pattern and no correlation was observed between positive response and either patient's age or duration of AGA. CONCLUSION: Platelet rich plasma injections for men with AGA has a positive effect on hair density

Efficacy of Platelet Rich Plasma Intradermal Injections for Androgenetic Alopecia Treatment in Males: A Before and After Study. / Eficacia del tratamiento con inyecciones intradérmicas de plasma rico en plaquetas para la alopecia androgenética en varones: estudio de «antes-después¼.

BACKGROUND AND AIMS: Platelet rich plasma is a source of growth factors recently introduced to treat androgenetic alopecia (AGA) with conflicting results. Our aims are to assess the efficacy of platelet rich plasma in increasing hair density in males with AGA, and to investigate a correlation between positive response and each of patient's age and type and duration of AGA. MATERIALS & METHODS: This before and after study included 30 males with no history of hair treatments for at least 3 months prior to our study. Each patient received 3 injections at one-month intervals. Scalp hair density of each subject was measured manually by a dermatoscope before and following 2 and 6 months of the first intervention. Data were compared to evaluate efficacy. RESULTS: Hair density was increased by 19.17% following our intervention (172.46±59.04 hairs/cm2 before treatment to 205.53±68.20 hairs/cm2 after 6 months) with minimal short-term side effects. Type III vertex was the least responsive pattern and no correlation was observed between positive response and either patient's age or duration of AGA. CONCLUSION: Platelet rich plasma injections for men with AGA has a positive effect on hair density.

Viral clearance ameliorates hematological and inflammatory markers among diabetic patients infected with hepatitis C genotype 4.

The achievement of virological response in the treatment of hepatitis C virus (HCV) can improve the extrahepatic manifestations. The present study aimed to investigate the effect of HCV eradication after sofosbuvir/daclatasvir (SOF/DCV) therapy on hematological and inflammatory biomarkers in type 2 diabetic patients infected with HCV genotype 4. Between October 2017 and August 2018, among 145 patients with HCV genotype 4, 30 patients were enrolled in the study based on the fact that they have type 2 diabetes. Enrolled HCV-diabetic patients were treated for 12 weeks with SOF/DCV regimen. Patients were screened by laboratory investigations before treatment (baseline values) and after HCV treatment (post-treatment values). Additionally, 30 healthy individuals were enrolled as a control group. Among the patient's cohort, the sustained virological response was achieved by 100% of the treated patients after 12 weeks of SOF/DCV therapy. Moreover, the levels of insulin resistance (HOMA-IR), nitric oxide, interleukin-1ß, red cell distribution width, platelet distribution width, mean platelet volume were improved significantly (P < 0.001) in treated patients after successful viral clearance compared to baseline values. In addition, virological clearance exhibited positive correlations with interleukin-1ß, nitric oxide, leukocytes count, red cell distribution width, and mean platelet volume. In conclusion, the data suggest the potential amelioration effect of HCV eradication after treatment with SOF/DCV regimen on the inflammatory status among HCV-diabetic patients which is reflected by the noticeable improvement of altered hematological indices and inflammatory biomarkers.

Factors affecting utilization of obstetric ultrasound: a study of semi-urban pregnant women in a developing nation

Background: Ultrasound scanning presently forms an integral part of antenatal care around the globe. It is a common investigative tool in most public and private health facilities in developing countries. Routine obstetric ultrasound has been one of the most important advances in antenatal care worldwide. It is also useful in the early detection and monitoring of the conditions that give rise to fetal and maternal compromise and has become an indispensable adjunct to the management efforts of practitioners in this regard. Therefore, utilization of this innovation by pregnant mothers is paramount toward good outcome. Objective: The objective is to determine the factors affecting utilization of ultrasound by pregnant mothers attending antenatal care in Zaria Local Government, Kaduna State, Northern Nigeria. Materials and Methods: This cross­sectional descriptive was used to carry out the study among 200 pregnant mothers selected through multistage sampling technique. This study was conducted over a period of 6 months from November 6, 2017, to May 6, 2018, after approval was given by the ethical committee of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. A structured interviewer­administered, validated questionnaire was administered to each participant to ascertain the factors affecting utilization of obstetric ultrasound by pregnant women in Zaria Local Government, Kaduna State. Data were analyzed using IBM SPSS 22. Results: The data obtained from the questionnaire were scored for proper evaluation. Furthermore, all collected data were carefully tallied, various frequencies, ranges, and mean (standard deviation) were determined. Most (29.5%) of the respondents aged 20­24 years, majority (95.5%) were homemakers that are not gainfully employed. Majority of the respondents were Hausa (94.5) and Muslims (96.5%). The findings of this study have shown that educational status, husband occupation, and knowledge affect the utilization of ultrasound by respondents. Conclusion: The common factors that affect the utilization of obstetric scan in Zaria were knowledge, education background, and husband occupation. Attitude, age, and the occupation of the respondents do not affect the utilization of obstetrics scan in Zaria

Relationship between serum level of ionized calcium, magnesium, phosphate, vitamin D and parathyroid hormone with stages of CKD

Background: Chronic kidney disease is defined as either damage or a decreased Glomerular Filtration Rate of less than 60ml/min/1.73m2 for 3 or more months. There is destruction of renal mass with irreversible sclerosis and loss of nephron leading to a progressive decline in GFR.Secondary hyperparathyroidism hyperphosphataemia, hypocalcaemia and vitamin-D deficiency are common complications of CKD. Objective: To determine relationship between serum level of ionised calcium, magnesium, phosphate, vitamin-D and parathyroid hormone with stages of CKD. Method: This study was conducted at ABUTH Zaria. 125 consecutive adult patients in various stages of CKD who presented were enrolled and 125 apparently healthy matched for sex and age controls were also recruited. Results: 9% of patients were in stage-1, 16% in stage-2, 22% in stage-3, 12% in stage-4 and 41% in stage-5. Serum ionised calcium, vitamin-D and eCrCl showed a progressive decline as the stage of CKD advances, while serum phosphate, creatinine and iPTH showed a progressive increase as the stage of CKD advances. Changes in serum magnesium showed a slight change with advancing stages of CKD. The difference in mean serum levels of calcium, phosphorus, vitamin-D, parathyroid hormone, creatinine and eCrCl with different stages of CKD were statistically significant. eCrCl correlated negatively with phosphate and iPTH while serum creatinine correlated negatively with calcium and positively with phosphate and iPTH. Conclusion: Majority of CKD patients were in late stage. Correlation of analytes with stages was more in late stages and biochemical derangements occurred in late, rather than early stages of CKD

Factors associated with utilization of LLINs among women of child-bearing age in Igabi, Kaduna State, Nigeria.

BACKGROUND: The long-lasting insecticidal nets (LLIN) are effective against prevention of malaria and its utilization has been proven to save lives. Despite the mass distribution of LLIN, Nigeria remains the country with the highest malaria burden in Africa. The awareness of LLIN in Nigeria is high, but the utilization is low. The aim of this work is to describe factors associated with the utilization of LLIN among women of child-bearing age (WCBA) in Igabi, Kaduna, Nigeria. METHODS: A cross-sectional survey was conducted among 630 WCBA selected using a multi-stage sampling at 63 randomly selected villages in Igabi Local Government Area of Kaduna State. Trained female data collectors administered pre-tested structured questionnaires adapted from the Malaria Indicator Survey. Information collected were demographic profile, knowledge of LLIN as a preventive strategy for malaria, and LLIN ownership and utilization. LLIN utilization was assessed by identifying household members that slept under the hanged LLIN the night before the survey. Questions on the awareness of LLIN, ability to define what it is, use of LLIN, what differentiates LLIN from other bed nets, and duration of use before replacement, were scored and categorized as good, average and poor knowledge of LLIN. RESULTS: A total of 629 WCBA was sampled, their mean age (± SD) was 29.3 (± 6.2) years, 22.0% were pregnant, 40.5% had no formal education, 41.1% were employed, and 47.7% lived in rural communities. Awareness and good knowledge about LLINs for the prevention of malaria was 96.0% and 24.0%, respectively. The proportion of women who slept under a LLIN the night before the survey (utilization) was 70.0% and slightly higher (74.0%) among pregnant WCBA. Women who lived in rural communities were more likely to utilize LLINs compared to their urban counterparts (OR 3.4; 95% CI 2.3-4.9). Younger women (aged < 30 years) were less likely to utilize LLINs compared to the older women (OR 0.7; 95% CI 0.5-0.9). CONCLUSIONS: The knowledge of LLIN among WCBA was poor, but LLIN utilization was moderate. Living in rural communities and older WCBA were significant characteristics associated with LLIN utilization. Strategies that will improve the utilization of LLIN among the young and urban WCBA should be the focus of the Malaria Elimination Programme (MEP).

Comprehensive Examination of Therapies for Pain in Parkinson's Disease: A Systematic Review and Meta-Analysis.

Pain in Parkinson's disease (PD) is a debilitating symptom with a prevalence of 68%, yet is untreated 50% of the time. What is unclear, however, is which treatment is optimal for minimizing pain severity in PD. Thus, the objective of this systematic review and meta-analysis was to investigate the efficacy of a variety of novel, complimentary, and conventional treatments for pain in PD and elucidate which therapy is the most effective. A systematic search was performed using MEDLINE, PsycINFO, Embase, CINAHL, and CENTRAL databases. To identify additional articles, manual searches of reference lists of included trials were also searched. Major neurology conference proceedings occurring between January 2014 and February 2018 were also searched to identify unpublished studies that may be potentially eligible. Twenty-five randomized controlled trials that encompassed medical, surgical, and complementary therapies met our inclusion criteria and exhibited moderate quality evidence. Two reviewers conducted assessments for study eligibility, risk of bias, data extraction, and quality of evidence rating. A conservative random-effects model was used to pool effect estimates of pain severity. The greatest reductions in pain were found with safinamide (Standardized mean difference = -4.83, 95% CI [-5.07 to -4.59], p < 0.0001), followed by cannabinoids and opioids, multidisciplinary team care, catechol-O-methyltransferase inhibitors, and electrical and Chinese therapies. Moderate effects in reducing pain were in pardoprunox and surgery, while the weakest effects were in dopaminergic agonists and miscellaneous therapies. Safinamide is an important adjunct to standard parkinsonian medication for alleviating pain in PD.

GNAQ and GNA11 mutations and downstream YAP activation in choroidal nevi.

BACKGROUND: Mutations in GNAQ/11 genes are considered an early event in the development of uveal melanoma that may derive from a pre-existing nevus. The Hippo pathway, by way of YAP activation, rather than MAP kinase, has a role in the oncogenic capacity of GNAQ/11 mutations. METHODS: We investigated 16 nevi from 13 human eyes for driver GNAQ/11 mutations using droplet digital PCR and determined whether nevi are clonal by quantifying mutant nevus cell fractions. Immunohistochemistry was performed on 15 nevi to analyse YAP activation. RESULTS: For 15 out of 16 nevi, a GNAQ/11 mutation was detected in the nevus cells albeit at a low frequency with a median of 13%. Nuclear YAP, a transcriptional co-activator in the Hippo tumour-suppressor pathway, was detected in 14/15 nevi. CONCLUSIONS: Our analysis suggests that a mutation in GNAQ/11 occurs in a subset of choroidal nevus cells. We hypothesise that GNAQ/11 mutant-driven extracellular mitogenic signalling involving YAP activation leads to accumulation of wild-type nevus cells.

Cardiac Troponin T and creatine kinase MB fraction levels among patients with acute ischemic stroke in Nigeria.

BACKGROUND: Stroke has been a global burden, with increasing morbidity and mortality. Serum cardiac troponin t (cTnT) and creatine kinase (CK-MB) fraction are reported to be elevated in patients admitted with acute ischaemic stroke and high level of these biomarkers indicated more severe stroke and neurologic deficit in some of the patients. OBJECTIVE: To evaluate the serum levels cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in patients with acute ischaemic stroke and relate the analytes to severity of stroke. METHOD: Patients with clinical diagnosis of ischaemic stroke diagnosed, confirmed by brain Computerized Tomography scan and equal number of apparently healthy age and sex-matched were recruited. Serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) were analysed using ELISA method and Stroke severity was determined using National Institute of Health Stroke Score (NIHSS). RESULTS: Mean serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in stroke patients were found to be higher than age sex matched control (p<0.05). NIHS Score of 12.2 ± 5.43 and 9.78 ± 3.97 were observed in Patients with elevated and normal cTnT respectively (p=0.009) while NIHS Score were similar in patients with elevated and normal CK-MB (p = 0.772). CONCLUSION: The mean values of serum cTnT and CK-MB were higher in acute ischaemic stroke patients compared to controls. Serum cardiac Troponin t level may be a significant biomarker of the severity of stroke.

Prevalence and pattern of parasitic infestations among nomadic Fulani children in a grazing reserve in Northwestern Nigeria

Background: Nomadic pastoralists lack access to basic sanitary and health-care facilities mainly because their mode of life makes them a hard to reach group. In the Nigerian context, there is dearth of knowledge about the interplay between their lifestyle and health indices.Therefore, this study is aimed at determining the association between the prevalence of parasitic infestation among nomadic Fulani children in Ladduga grazing reserve, Kaduna, Northwestern Nigeria. Aim: The aim of this study was to assess the prevalence and pattern of parasitic infestation among nomadic Fulani children in Ladduga grazing reserve, Kaduna, Northwestern Nigeria. Materials and Methods: A cross-sectional descriptive study was conducted using questionnaires, physical examination, automated hemocytometry, enzyme-linked immunosorbent assay-based serum ferritin assay, and formol-ether concentration-based stool tests on 337 children (5­15 years) at Ladduga grazing reserve, Northwestern Nigeria. Data were analyzed using SPSS version 20.0. Results: The prevalence of parasitic infestation was 14.4% (49/337). The predominant parasites found were hookworm species, i.e., Necator americanus and Ancylostoma duodenale (46.9%) and Schistosoma mansoni (26.6%) while Ascaris lumbricoides, Hymenolepis nana, and Enterobius vermicularis accounted for 26.6%. Anemia was found in 40.4% (137/340) of the children with a statistically significant difference between younger (5­9 years) and older children (10­15 years; P < 0.05). Of those with parasites in the stools, 53% of children had anemia. Iron deficiency anemia was found in only 8.1% (4/49) of children. Conclusion: The prevalence of anemia was high in the studied population, but iron deficiency was not a major cause despite hookworm infestation, thus necessitating the need for further studies to identify other causes of anemia among this group

Tankyrase inhibition aggravates kidney injury in the absence of CD2AP.

Inappropriate activation of the Wnt/ß-catenin pathway has been indicated in podocyte dysfunction and injury, and shown to contribute to the development and progression of nephropathy. Tankyrases, multifunctional poly(ADP-ribose) polymerase (PARP) superfamily members with features of both signaling and cytoskeletal proteins, antagonize Wnt/ß-catenin signaling. We found that tankyrases interact with CD2-associated protein (CD2AP), a protein essential for kidney ultrafiltration as CD2AP-knockout (CD2AP-/-) mice die of kidney failure at the age of 6-7 weeks. We further observed that tankyrase-mediated total poly-(ADP-ribosyl)ation (PARylation), a post-translational modification implicated in kidney injury, was increased in mouse kidneys and cultured podocytes in the absence of CD2AP. The data revealed increased activity of ß-catenin, and upregulation of lymphoid enhancer factor 1 (LEF1) (mediator of Wnt/ß-catenin pathway) and fibronectin (downstream target of Wnt/ß-catenin) in CD2AP-/- podocytes. Total PARylation and active ß-catenin were reduced in CD2AP-/- podocytes by tankyrase inhibitor XAV939 treatment. However, instead of ameliorating podocyte injury, XAV939 further upregulated LEF1, failed to downregulate fibronectin and induced plasminogen activator inhibitor-1 (PAI-1) that associates with podocyte injury. In zebrafish, administration of XAV939 to CD2AP-depleted larvae aggravated kidney injury and increased mortality. Collectively, the data reveal sustained activation of the Wnt/ß-catenin pathway in CD2AP-/- podocytes, contributing to podocyte injury. However, we observed that inhibition of the PARylation activity of tankyrases in the absence of CD2AP was deleterious to kidney function. This indicates that balance of the PARylation activity of tankyrases, maintained by CD2AP, is essential for normal kidney function. Furthermore, the data reveal that careful contemplation is required when targeting Wnt/ß-catenin pathway to treat proteinuric kidney diseases associated with impaired CD2AP.

EVALUATION OF THE ENVIRONMENTAL NOISE LEVELS IN ABUJA MUNICIPALITY USING MOBILE PHONES.

BACKGROUND: Noise remains a nuisance which impacts negatively on the physical, social and psychological wellbeing of man. It aggravates chronic illnesses like hypertension and other cardiopulmonary diseases. Unfortunately, increased activities from industrialization and technological transfers/drifts have tumultuously led to increased noise pollution in most of our fast growing cities today and hence the need for concerted efforts in monitoring and regulating our environmental noise. OBJECTIVE: To assess the equivalent noise level (Leq) in Abuja municipality and promote a simple method for regular assessment of Leq within our environment. METHOD: This is a cross-sectional community based study of the environmental Leq of Abuja municipality conducted between January 2014 and January 2016. The city was divided into 12 segments including residential, business and market areas via the Abuja Geographic Information System. The major markets were captured separately on a different scale. Measurements were taken with the mobile phone softwares having validated this with Extech 407730 digital sound level meter, serial no Z310135. Leq(A) were measured at different points and hours of the day and night. The average Leq(A) were classified according to localities and compared with WHO standard safety levels. RESULTS: LeqD ranged 71-92dB(A); 42-79dB(A) and 69-90dB(A) in business/ parks, residential and market places respectively. The Night measurements were similar 18dB(A)-56dB(A) and the day-night Leq(A)=77.2dB(A) and 90.4dB(A) for residential and business zones. CONCLUSION: The night noise levels are satisfactory but the day and day-night levels are above the recommended tolerable values by WHO and therefore urgently call for awareness and legislative regulations.

Exome sequencing of a colorectal cancer family reveals shared mutation pattern and predisposition circuitry along tumor pathways.

The molecular basis of cancer and cancer multiple phenotypes are not yet fully understood. Next Generation Sequencing promises new insight into the role of genetic interactions in shaping the complexity of cancer. Aiming to outline the differences in mutation patterns between familial colorectal cancer cases and controls we analyzed whole exomes of cancer tissues and control samples from an extended colorectal cancer pedigree, providing one of the first data sets of exome sequencing of cancer in an African population against a background of large effective size typically with excess of variants. Tumors showed hMSH2 loss of function SNV consistent with Lynch syndrome. Sets of genes harboring insertions-deletions in tumor tissues revealed, however, significant GO enrichment, a feature that was not seen in control samples, suggesting that ordered insertions-deletions are central to tumorigenesis in this type of cancer. Network analysis identified multiple hub genes of centrality. ELAVL1/HuR showed remarkable centrality, interacting specially with genes harboring non-synonymous SNVs thus reinforcing the proposition of targeted mutagenesis in cancer pathways. A likely explanation to such mutation pattern is DNA/RNA editing, suggested here by nucleotide transition-to-transversion ratio that significantly departed from expected values (p-value 5e-6). NFKB1 also showed significant centrality along with ELAVL1, raising the suspicion of viral etiology given the known interaction between oncogenic viruses and these proteins.

Cost of illness in patients with mandibular fracture following road traffic crash and its socioeconomic implications in KANO STATE, NIGERIA.

BACKGROUND: The Upward trend in facial injuries following road traffic crashes has been attributed to increasing urbanization and industrialization. AIM: This study was conducted to determine the cost of illness for mandibular fractures and its socioeconomic implications. METHODOLOGY: All the consecutive patients with mandibular fractures following road traffic crashes that presented to the Aminu Kano Teaching hospital in Kano State were recruited over one year. RESULTS: A total of 50 patients were managed during the study period with 58% in the age range 21-30 years with mean of 27.9 ± 8.1 years, motorcycle-related road traffic crashes constituted the commonest aetiology. The cost of illness for mandibular fractures was N89, 312.20 ($488) per person. Cost of managing mandibular fractures was equivalent to 8.4% of the health care budget of the state and also equivalent to 15.2 % of the GDP per capita of the year of study surpassing the cost of illness for hypertension and diabetes. CONCLUSION: These findings highlight the need for policies that would ensure safe driving, enforce the use of safety gadgets, protocols for efficient fracture management and reduced hospital stay.

Stigmatization of people with mental illness among inhabitants of a rural community in northern Nigeria.

BACKGROUND: Despite the fact that mental illness is a common problem in society, people's perception of the mentally ill and community attitude towards them is still rather poor, making their rehabilitation and reintegration into society an uphill task. AIMS: To examine the stigmatization of people with mental illness within a rural community and identify the socio-demographic variables involved. METHOD: A cross-sectional descriptive study using a multi-stage random sampling technique to obtain data through an interviewer-administered questionnaire to 325 adult inhabitants of a rural community in Nigeria. RESULTS: The results showed widespread ignorance about causation, mode of transmission and remedies available for mental illness, with only 0.9% of respondents attributing mental illness to brain disease. The others attributed it to spiritual attack, punishment for evil doing and illicit psychoactive substance use, among other things. Negative views about the mentally ill were also widely expressed resulting in discriminatory practices. CONCLUSION: Stigmatization of people with mental illness is still rampant in our community. There is a need for adequate public education about the causes and mode of transmission of mental illness and the treatment options available in the community.

Costs and Patterns of Financing Maternal Health Care Services in Rural Communities in Northern Nigeria: Evidence for Designing National Fee Exemption Policy.

BACKGROUND: As population and access to information increases, so does the demand for health services. Unfortunately, many people who genuinely require these services do not usually have access to them. To increase access, various financing options have been used. Despite this, maternal morbidity and mortality rates remain high and spending is still largely out of pocket. This study assesses maternal health problems, preferred sources of care and the pattern of financing in a semi-rural community in North Western part of Nigeria. METHODOLOGY: A cross-sectional descriptive study design was used. The study population consisted of women within the reproductive age group who had experienced childbirth 12 months or less prior to the study. A sample size of 240 was drawn using cluster and random sampling techniques. Interviewer administered questionnaires were used and the results were analyzed using Statistical Package for Social Sciences (SPSS). RESULTS: The mean age of the respondents was 29 years and 49% had no personal income. Fever was the commonest problem. Although majority received antenatal care, those who lacked antenatal care mostly cited financial difficulties. Nearly half of the women delivered at home as opposed to a health facility. On average, women spent between Nigerian Naira (N) N1, 350-N14, 850 (USD$9-99) for a total package of maternal health services. Out of pocket spending by the husbands or household heads and the women themselves accounted for 73.3% of expenses. CONCLUSION AND PUBLIC HEALTH IMPLICATIONS: In Nigeria, women are still vulnerable to common and preventable causes of maternal morbidity and mortality due to lack of access to antenatal health care. Out of pocket spending is still a popular method of financing. Harmonization of fee exemption policies can improve access to maternal healthcare.

Colorectal carcinoma associated with schistosomiasis: a possible causal relationship.

The association between schistosomiasis and colorectal malignancy has long been suggested in the literature, but it is not uniformly accepted. In the Far East, considerable evidence supports an etiological link between Schistosoma japonicum and colorectal cancer. However, the available data regarding the role of Schistosoma mansoni in colorectal carcinogenesis are conflicting and most often do not show causality. We report on a patient with sigmoid colonic cancer coexisting with schistosomiasis, and we provide a comprehensive review of the literature regarding the epidemiology and pathobiology of this association.