To determine the activities of oxidative stress markers and lipid profiles of patients with polycystic ovary syndrome (PCOS) in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria.
This was a ...nested case-control study consisting of 50 PCOS patients and 50 healthy women of the same age range without any evidence of PCOS. The study measured the levels of malondialdehyde (MDA), activity of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), total antioxidant capacity (TAC); concentrations of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C), as well as high-density lipoprotein cholesterol (HDL-C) using standard spectrophotometric methods. Anthropometric indices were also assessed.
-values of <0.05 were taken to be statistically significant.
There were significantly higher levels of MDA (
=0.002), lower activity of SOD (
<0.001), and lower TAC (
=0.001) in PCOS patients when compared with the controls. There were higher concentrations of TC (
=0.017) and LDL-C
=0.012) in PCOS patients than in controls. Significant differences were not observed between the 2 groups in terms of the activity of GSH-Px, as well as the concentrations of HDL-C and TG. The body mass index, waist circumference, and waist-hip ratio were all significantly higher in PCOS patients.
This study revealed higher levels of MDA, as well as lower activity of SOD and TAC, among PCOS patients. Furthermore, there were higher levels of TC and LDL-C among the PCOS patients. Hence, monitoring these parameters may improve the clinical management of PCOS.
Accurate HIV testing in pregnancy is critical to the prevention of mother to child transmission of HIV infection and linkages to other preventive strategies.
This study determined the sensitivity, ...specificity negative and positive predictive value of serial rapid testing of HIV among pregnant women in Nnewi, south east Nigeria.
This was a comparative descriptive study conducted over a 4-month period. Serial rapid testing algorithm was compared with conventional ELISA testing after obtaining informed consents from the pregnant women. All positive and discordant results were confirmed with western blot HIV test. Participants also completed a questionnaire. Data analysis was done using SPSS version 20.
A total of 166 pregnant women participated in this study. The mean age of the participants was 29 ± 4.3 years. The HIV prevalence was highest in the 25-29 years category. This was also the modal age category. Majority of the women were multiparous. The prevalence of HIV infection was 12 %. The sensitivity, specificity, negative and positive predictive value of serial rapid HIV testing was 95, 100, 99.3 and 100 % respectively.
The sensitivity of the serial rapid test algorithm was high but still lower than the WHO recommended 99 % and above. The 100 % specificity and positive predictive value makes it a good diagnostic test strategy. There is need for regular review of HIV test kits and policy.
To determine accuracy and costs of placental α-microglobulin-1 (PAMG-1) test compared to standard clinical assessment (SCA) for diagnosing rupture of membranes (ROM).
A multicenter double-blind study ...of consecutive women with symptoms and signs of ROM in Nnamdi Azikiwe University Teaching Hospital, Nnewi and University of Nigeria Teaching Hospital, Enugu, both in south-east Nigeria using SCA for ROM and the PAMG-1 test was done. ROM was diagnosed if two out of three methods from SCA (pooling, positive nitrazine test or ferning) were present and confirmed post-delivery based on presence of any two of these clinical criteria: delivery in 48 h to 7 days, evidence of chorioamnionitis, membranes overtly ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. A cost-analysis was also done. The outcome measures included sensitivity, specificity, accuracy and costs for the two tests.
Accuracy, sensitivity and specificity for the PAMG-1 test were 97.2%, 97.4% and 96.7%, higher than for SCA which were 83.7%, 87.9% and 70.5%, respectively (P < 0.001). Accuracy of SCA was higher at less than 34 weeks than 34 weeks or more (88.3% vs 81.4%) while the PAMG-1 test performed equally at both gestational age categories (96.1% vs 97.7%). In women without pooling, accuracy of the PAMG-1 test was 96.7%, while it was 40.0% with SCA. Analysis showed that the overall cost of SCA was 45% higher than the PAMG-1 test.
This study confirms that the PAMG-1 test has a consistently high diagnostic accuracy at all gestational ages and with equivocal cases of ROM. The PAMG-1 test appears less costly than SCA.
To compare the efficacy and safety of intravenous and intramuscular oxytocin in preventing atonic primary postpartum haemorrhage in the third stage of labour.
A double-blind randomised clinical study ...on consenting women without risk factors for primary postpartum haemorrhage in labour at term. Two hundred and thirty-two women were randomly allotted into intravenous (
= 115) and intramuscular (
= 117) oxytocin groups in the active management of the third stage of labour. All participants received 10 IU of oxytocin, either IV or IM, and 1 ml of water for injection as a placebo via a route alternate to that of administration of oxytocin within 1 min of the baby's delivery. The primary outcome measures were mean postpartum blood loss and haematocrit change. Trial Registration No.: PACTR201902721929705.
The baseline socio-demographic and clinical characteristics were similar between the two groups (
> 0.05). There was no statistically significant difference between the two groups with regards to the mean postpartum blood loss (254.17 ± 34.85 ml
249.4 ± 39.88 ml;
= 0.210), haematocrit change (2.4 (0.8%)
2.1 (0.6%);
= 0.412) or adverse effects (
> 0.05). However, the use of additional uterotonics was significantly higher in the intravenous group (25 (21.73%)
17 (14.53%);
= 0.032).
Although oxytocin in both study groups showed similar efficacy in terms of preventing atonic primary postpartum haemorrhage, participants who received intravenous oxytocin were more likely to require additional uterotonics to reduce their likelihood of having an atonic primary postpartum haemorrhage. However, both routes have similar side effect profiles.
Objectives. The aim of this study is to determine the effect of interpregnancy interval (IPI) on the incidence of placenta previa and placenta accreta spectrum disorders in women with a previous ...cesarean section. Methods. A prospective cohort three-center study involving parturients who had previous cesarean section was conducted. Participants were included if pregnancy has lasted up to 34 weeks. Parturients with co-existing uterine fibroids, multiple gestations, premature rupture of membranes, and those with prior postcesarean delivery wound infection were excluded. The eligible women recruited were distributed into two groups, namely, short (<18 months) and normal (18–36 months) IPI. The outcome measures were incidences of placenta previa and placenta accreta spectrum disorder and factors associated with the occurrence of placenta previa. A univariate analysis was performed using the chi-square test or Mann–Whitney U test, wherever appropriate, to examine the significance of the differences in clinical variables. Results. A total of 248 women met the inclusion criteria. The incidence of placenta previa by ultrasound was 8.9% and 4.0% for short and normal IPI (odds ratios = 2.32; 95% confidence intervals = 0.78–6.88; p=0.13), respectively. The incidence of placenta accreta spectrum disorder was 1.6% and 0.8% for short and normal IPI (odds ratios = 2.02; 95% confidence intervals = 0.18–22.13; p=0.57), respectively. The only observed significant difference between the clinical variables and placenta previa is the number of cesarean sections (p=0.02) in women with short IPI. Conclusion. A short interpregnancy interval does not significantly affect the incidence of placenta previa and placenta accreta spectrum disorder following a cesarean section. There is a need for further study with large numbers to corroborate these findings in low- and middle-income settings.
Uterine leiomyoma is a common gynecological condition that negatively affects women's quality of life. Vitamin D plays an important role in tumor development and progression. However, clinical ...studies comparing serum vitamin D levels between women with and without uterine leiomyomas are limited and inconclusive. This study aimed to compare serum vitamin D levels in women with and without uterine leiomyomas.
This hospital-based case-control study included 150 women who visited a gynecological clinic. The cases included 75 women with uterine leiomyoma, whereas the controls included 75 age-and parity-matched participants without uterine leiomyoma. Serum vitamin D levels were measured in each participant and volumes of the uterine leiomyomas were determined using the water displacement method following myomectomy. The statistical significance was inferred at P<0.05.
The mean serum vitamin D level was 15.26±4.96 ng/mL and 22.45±6.93 ng/mL for the case and control groups, respectively. The difference was statistically significant (t-value -7.302 and P<0.001). Within the fibroid group, nine (12.0%), 49 (65.33%), and 17 (22.67%) participants had vitamin D deficiency, insufficiency, and sufficiency, respectively; and in the control group, two (2.67%), 24 (45.33%), and 39 (52.0%) participants had vitamin D deficiency, insufficiency, and sufficiency, respectively. There was significant negative correlation between the fibroid volume and the serum vitamin D level (r=-0.591, P<0.001).
Women with uterine leiomyoma had lower vitamin D levels than women in the control group. Lower vitamin D levels were associated with larger fibroid masses. Therefore, vitamin D supplementation may reduce fibroid growth and development.
Summary Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to ...assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov , number NCT00872469 ; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 1·5% of 10 036 patients vs 191 1·9% of 9985 in the placebo group, risk ratio RR 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 1·2% in the tranexamic acid group vs 127 1·7% in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 3·6% patients in the tranexamic acid group vs 351 3·5% in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 5·3% deaths or hysterectomies in the tranexamic acid group vs 546 5·5% in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation.
•This study was conducted in two tertiary health institutions in Anambra state of southeastern Nigeria.•It compared the adequacy of Pap smears obtained with two sampling devices- the wooden Ayre’s ...spatula and the Papcone®.•The adequacy of smears obtained with Papcone® was significantly better than those of wooden Ayre’s spatula.•Papcone® should always be preferred, especially in developing countries where liquid-based cytology is not yet routine.
This is a comparative study on the adequacy of cervical smears obtained using the Papcone® sampling device or wooden Ayre’s spatula conducted from two tertiary health facilities –– Nnamdi Azikiwe University Teaching Hospital Nnewi and Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka, in Anambra State, Nigeria. Slides from smears obtained using both devices were read by a cytopathologist blinded for the study. The primary outcome was the proportion of smears with an adequate endocervical component. Significantly higher adequate cervical smears were obtained in 177/192 (92.2%) women using the Papcone® sampling device, compared to 152/192 (79.2%) using wooden Ayre’s spatula (p < 0.001). Kappa analysis showed moderate inter-rater agreement between the two devices. We recommend the use of the Papcone device when it is available, as the adequacy of cervical smears obtained with the Papcone® was better than that obtained using wooden Ayre’s spatula.
To our knowledge, there is no prior randomized study on the utility of Syferol-IHP (blend of virgin coconut oil and
oil) when coadministered with a triple therapy schedule.
This study determined the ...efficacy and safety of Syferol-IHP as adjunct to conventional triple therapy for the treatment of peptic ulcer disease (PUD).
A pilot double-blind randomized trial was conducted in patients with confirmed diagnosis (endoscopy-guided biopsy) of PUD. Eligible patients were randomized to Pylorest (a three-in-one tablet containing rabeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg) and Syferol-IHP for 2 weeks, followed by rabeprazole and Syferol-IHP for 2 weeks or Pylorest and placebo for 2 weeks, followed by rabeprazole and placebo for 2 weeks. Repeat endoscopy-guided biopsy and histology were done 4 weeks posttherapy. Primary outcome measures were the healing of ulcer and eradication of
. Secondary outcome measures were the disappearance of epigastric pain, gastritis, and duodenitis. Analysis was by intention-to-treat.
Of the 63 patients enrolled, 60 patients had complete evaluation, with 37 patients receiving Pylorest and Syferol-IHP and 23 patients receiving Pylorest and Placebo. Healing of the PUD in favor of Pylorest and Syferol-IHP was significantly higher for gastric ulcer (RR=0.000, 95% CI=undefined,
=0.048) but not for duodenal ulcer (RR=0.400, 95% CI=0.07-2.37,
=0.241).
eradication was 100% with Syferol-IHP vs 50% with placebo (
=0.066). Epigastric pain (reduction to 16.2% vs 43.5%;
=0.021), gastritis (reduction to 13.5% vs 39.1%;
= 0.024), and duodenitis (reduction to 0% vs 8.7%;
=0.327) were observed in the Syferol-IHP and Pylorest vs placebo and Pylorest groups, respectively. Adverse events (RR=0.971, 95% CI=0.46-2.04,
=0.937) and laboratory parameters were not significantly different pre- and posttherapies (
>0.05, for both groups).
Although both treatment arms were equally safe, co-administration of Syferol-IHP and triple therapy is more efficacious than triple therapy alone for treating PUD. Pan African Clinical trial registry identifier number is PACTR201606001665364.
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