Evaluation of some anthropometric indices for the diagnosis of obesity in pregnancy in Nigeria: a cross-sectional study

Background

Obesity in pregnancy is a global health problem which is associated with poor pregnancy outcomes. The use of weight and height, measured at about ten weeks of gestation, to produce pre-gestational body mass index is recommended for the diagnoses of the condition but limitations abound in under resourced settings.

Objectives

To measure anthropometric indices such as mid upper arm circumference, calf circumference, waist circumference and waist to hip ratio, for identification of obesity in pregnancy.

Methods

Anthropometric measurements were carried out on cohorts of pregnant women from 4 hospitals in Enugu, South-eastern Nigeria.

Results

There were no significant difference in the mean mid upper arm circumference (MUAC) and calf circumference (CC) across the trimester groups. The mean values of waist circumferences, hip circumference and waist to hip ratios changed significantly across the trimesters. The 75^th percentile of MUAC (33 cm) and CC (39 cm) in all trimesters, had sensitivity and specificity of more than 70% for identifying obesity in pregnancy.

Conclusion

MUAC and CC values of 33cm and 39cm respectively might be reliable cut off points for diagnoses of obesity throughout pregnancy in Enugu, Nigeria     

Effect of hormone replacement therapy,tibolone and raloxifene on serum lipids,apolipoprotein A1, apolipoprotein B and lipoprotein(a) in Greek postmenopausal women

The aim of this study was to assess the effect of estrogen, two regimens of continuous combined hormone replacement therapy (HRT), tibolone and raloxifene on serum lipid, apolipoprotein A1 and B and lipoprotein(a) levels in Greek postmenopausal women. A total of 350 postmenopausal women were studied in a prospective open design. Women were assigned to one of the following regimens depending on the presence of risk factors for osteoporosis, climacteric symptoms and an intact uterus: conjugated equine estrogen 0.625 mg (CEE, n=34), continuous combined CEE 0.625 mg plus medroxyprogesterone acetate (MPA) 5 mg, (n=80), continuous combined 17β-estradiol 2 mg plus norethisterone acetate (NETA) 1 mg (n=58), tibolone 2.5 mg (n=83) and raloxifene HCl 60 mg (n=50). Forty-five postmenopausal women with no indications for HRT served as controls. Total cholesterol (TC), low-density lipoprotein (LDL) cholestrol and high-density lipoprotein (HDL) cholesterol, triglyceride (TG), apolipoprotein A1 (ApoA₁), apolipoprotein B (ApoB) and lipoprotein(a) (Lp(a)) levels were assessed in each subject at baseline, and at 6 and 12 months of therapy. All therapy regimens lowered TC levels compared to baseline (4.2-8.0% decrease). This effect was more prominent in the subgoup of women with high baseline TC levels (9.1-20.4% decrease). LDL cholesterol decreased significantly in CEE, CEE/MPA and raloxifene groups (?11.2%, ?11.9% and ?11.0%, respectively). Hypercholesterolemic women exhibited a steeper decrease in LDL cholesterol (10.6-27.8% in all therapy groups). TG levels increased significantly in the CEE and CEE/MPA groups (23.7% and 21.8%, respectively), while estradiol/NETA had no effect on TG levels. Tibolone decreased TG levels markedly, by 20.6%, while raloxifene had no TG-lowering effect. HDL cholesterol and ApoA₁ were increased by CEE and CEE/MPA (HDL cholesterol, 7.4% and 11.8%, respectively; ApoA₁, 17.8% and 7.9%, respectively) and decreased by tibolone (HDL cholesterol, ?13.6%; and ApoA₁, ?9.9%). All therapy regimens except raloxifene lowered Lp(a) levels, with tibolone having the more pronounced effect (?13.2 to ?29.0%). In conclusion, each therapy regimen had a different effect on lipid-lipoprotein levels, exerting favorable and unfavorable modifications. Hypercholesterolemic women seemed to benefit more from the cholesterol-lowering effect of estrogen replacement therapy/HRT. The choice for a particular regimen should be based on individual needs, indications and lipid-lipoprotein profile.     

The changing face of gastroschisis and omphalocele in southeast Georgia

Objective: To document trends in the clinical characteristics of gastroschisis and omphalocele in southeast Georgia, USA, from 1994 to 2002.

Methods: All babies with an abdominal wall defect in a 19-county region were referred to one Perinatal Center for genetic counseling, level II ultrasound scans, pregnancy follow-up and delivery. Karyotyping was offered for omphalocele, advanced maternal age, family history predisposing to aneuploidy, and gastroschisis with an additional anomaly.

Results: There were 64 patients, 34 with gastroschisis and 30 with omphalocele. From 1994 to 2002, the birth prevalence of gastroschisis was 1:3600 and omphalocele 1:3400, but from 2000 to 2002, gastroschisis increased to 1:1667, while omphalocele increased to only 1:2709. Gender distribution was different: for gastroschisis the M:F ratio was 1:2.1; for omphalocele the ratio was 1.7:1. In the patients with omphalocele, 90% had an amniocentesis and 9/27 were aneuploid: five had trisomy 18, three had trisomy 13 and one had trisomy 21. Seventy-six per cent of the patients with omphalocele had associated anomalies, but only 17.6% of those with gastroschisis. Mothers whose babies had gastroschisis showed a trend to progressively younger age, while no such trend was observed among mothers whose babies had omphalocele.

Conclusion: The birth prevalence of abdominal wall defects in general is increasing, but more notably for gastroschisis. Maternal age continues to decrease for gastroschisis. In the study population, gender distribution showed a statistically significant variation between the defects.     

A comparative study of bacterial isolates from the urine samples of AIDS and non—AIDS patients in Benue,Nigeria

ObjectiveTo determine the common bacterial causes of urinary tract infection and their antibiotic susceptibility pattern in AIDS patients versus non-AIDS patients.MethodsOne thousand consecutive AIDS patients with signs and symptoms of AIDS and non-AIDS patients (served as control) each on admission were recruited into the study between January 2005 to January 2008, in Federal Medical Center, Makurdi. Urine samples were collected with sterile universal bottles and analysed with appropriate laboratory methods and antibiotic susceptibility test was carried out by disk diffusion technique in accordance with National Committee for Clinical Laboratory Standards (NCCLS, now CLSI) criteria. The results were analysed using SPSS 11.0 statistical software.ResultsUrine samples of AIDS patients with urinary infection had a more spectrum of micro-organisms including Candida organisms, Pseudomonas aeruginosa and Staphylococcus aureus. Ceftriaxone, Ceftazidime or Ciprofloxacin had a remarkably high anti-bacterial activity across the two study groups. A general resistance was recorded in ampicillin, tetracycline and co-trimoxazole. There was no significant difference in antibiotic susceptibility patterns between AIDS and non-AIDS patients (P>0.05).ConclusionsA reduction in unnecessary use of antibiotics as well as infection control should be encouraged in our health facilities.     

HIV/AIDS related mortality among adult medical patients in a tertiary health institution in South–South,Nigeria

ObjectiveTo determine the causes of death among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients as a step to planning strategies to improve mortality from this condition.MethodsThis study retrospectively analyzed the mortality pattern of adult HIV/AIDS patients in the University of Calabar Teaching Hospital from January 2005 to December 2007. The data were obtained from sexually transmitted infection/acquired immunodeficiency syndrome (STI/AIDS) clinic register, admissions and discharge/death registers as well as the patients' case records and the hospitals monthly mortality reviews. Information obtained included age, sex, diagnosis and cause(s) of death. The causes of death considered were the direct causes of death, since the originating antecedent cause of death is the same in all the patients, in this case, HIV/AIDS. Data was analysed using Epi Info 2002.ResultsThe total number of mortalities during the study period was 350,100 were HIV positive representing 28.6% of all deaths. While advanced HIV/AIDS disease was the leading cause of death in our study representing 27.0%, tuberculosis was the single leading cause of deaths in HIV/AIDS patients constituting about 24.0% of deaths. This was followed by sepsis and septicaemia (13.0%), meningitis and encephalitis, and anaemia accounting for 11.0%, while respiratory diseases constituted 5.0% of the mortality burden. The highest number of deaths occurred in those aged between 21–50 years (82.0%).ConclusionsThe study has shown that HIV/AIDS is a major cause of morbidity and mortality in our hospital. The causes of death reflect the varied spectrum of infection and other forms of organ involvement that affect HIV/AIDS patients. The present dismal situation of adult patients living with HIV/AIDS calls for enhanced strategies to decrease the mortality trend observed in Nigeria and sub-Saharan Africa.     

Intensification of a triple-nucleoside regimen with tenofovir or efavirenz in HIV-1-infected patients with virological suppression

OBJECTIVE: To compare a quadruple-nucleoside with an efavirenz-containing regimen for treatment of HIV-1 infection. DESIGN: A randomized, open-label study of the AIDS Clinical Trials Group (ACTG). METHODS: Subjects receiving zidovudine/lamivudine/abacavir on ACTG 5095 with HIV-1 RNA less than 200 copies/ml were randomly assigned to intensify either with tenofovir or efavirenz. Subjects were followed for time to treatment failure, defined as either virological failure or treatment discontinuation. Analyses were intent-to-treat. RESULTS: One hundred and seventy subjects (21% women; 56% non-white) entered the study. At baseline, 95 and 73% had HIV-1-RNA levels less than 200 and 50 copies/ml, respectively; the median CD4 cell count was 453 cells/microl. Over a median 79 weeks follow-up, 165 (97%) completed the study, three (2%) discontinued, and two (1%) died. Treatment failure occurred in 31 subjects: 18 (21%) (quadruple nucleosides) and 13 (15%) (efavirenz-containing regimen); however the failure-time curves crossed and demonstrated a non-constant treatment effect over time, characterized by more early treatment failures on the efavirenz-containing regimen and more late treatment failures on the four-nucleoside regimen. HIV-1 RNA remained suppressed in more than 88% of subjects to less than 200 copies/ml and in more than 78% to less than 50 copies/ml at weeks 24, 48, and 72, without differences by treatment arm. There were no significant differences between the regimens in CD4 cell increases, time to new grade 3/4 adverse events, or adherence. CONCLUSION: The safety, tolerability, and efficacy of the four-nucleoside regimen were not significantly different from the efavirenz-containing regimen. These pilot data support further investigation of the quadruple-nucleoside regimen.