Characteristics of abortion care seekers in south-western Nigeria

This prospective hospital-based study was carried out to understand the characteristics of abortion care seekers in south-western Nigeria. Information was obtained from a total of 1876 women seeking abortion at hospitals using a questionnaire. The results show that majority (60%) were between the ages of 15 and 24 years, of which adolescents between the ages of 15 and 19 years constituted 23.7%. Most (63.2%) of the respondents were unmarried, but married women also constituted a significant proportion (30.2%) of the abortion care seekers. Students were the single highest group, while the predominant economic activity was trading (26.7%). Respondents terminated their pregnancies mainly because they were students or because they did not desire to have children. Most (35.5%) of the women were introduced to providers by friends. Average contraceptive prevalence among the abortion care seekers was 27.4%. It is obvious from the results that young persons, especially in-school adolescents, should be targeted for comprehensive sexuality education especially in view of the current HIV/AIDS pandemic.     

The dopamine D2 receptor is expressed in GH3 cells.

Some pituitary tumours respond to dopamine by decreasing the release of prolactin and/or GH and by inhibition of tumour growth. Certain tumours are unresponsive. Dopamine D2 receptor high-affinity binding is impaired in these tumours, and the rat GH3 cell line behaves in a similar way. The hypothesis that the dopamine-binding defect results from impaired D2 receptor gene expression has been tested in the present study. On Northern blots, D2 receptor mRNA was present in both normal rat pituitary cells and in GH3 cells. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis identified a putative D2 receptor protein in normal and GH3 cell membranes. The lack of effect of dopamine in GH3 cells does not reflect the absence of D2 receptor gene expression.     

Association between mutations in Plasmodium falciparum chloroquine resistance transporter and P. falciparum multidrug resistance 1 genes and in vivo amodiaquine resistance in P. falciparum malaria-infected children in Nigeria

This study investigated the association between Plasmodium falciparum chloroquine resistance transporter (pfcrt) T76 and P. falciparum multidrug resistance gene 1 (pfmdr1) Y86 alleles and in vivo amodiaquine (AQ) resistance, as well as the clearance of parasites harboring these two alleles in children treated with AQ in southwest Nigeria. One hundred one children with acute uncomplicated P. falciparum malaria infections were treated with the standard dosage of AQ and followed-up for 28 days. Blood samples were collected on filter paper samples at enrollment and during follow-up for identification of parasite genotypes and pfcrt and pfmdr1 mutations using polymerase chain reaction and restriction fragment length polymorphism approaches. Parasitologic assessment of response to treatment showed that 87% and 13% (RI) of patients were cured and failed treatment, respectively. Although infections in patients were polyclonal (as determined by merozoite surface protein 2 genotyping), the presence of both mutants pfcrtT76 and pfmdr1Y86 alleles in parasites is associated with in vivo AQ resistance (odds ratio = 7.58, 95% confidence interval = 1.58-36.25, P = 0.006) and is selected by the drug in children who failed AQ treatment. Treatment failure with the combination of mutant pfcrtT76 and pfmdr1Y86 alleles as well as the ability of patients to clear these resistant parasites is dependent on age, suggesting a critical role of host immunity in clearing AQ-resistant P. falciparum. The combination of mutant pfcrtT76 and pfmdr1Y86 alleles may be useful markers for monitoring the development and spread of AQ resistance, when combining this drug with other antimalarials for treatment of malaria in Africa.     

The Empiric Use of Palm Kernel Oil in Neonatal Skin Care： Justifiable or Not？

Palm kernel oil is a vegetable oil derived from Elaeis guineensis and widely used in neonatal settings for skin care.It is a good emollient with a beneficial effect in moisturizing the skin and preventing transdermal heat and water loss.However,it’s putative roles in the prevention or treatment of fatty acid deficiency is still controversial.So is its function in the improvement of neurological development from its long-chain polyunsaturated fatty acids? We set out in this review to verify whether its empiric use in this context has any scientific justification and is recommendable.Although there is evidence that it has emollient and moisturizing properties necessary for softening the skin and restoring elasticity,controversy subsists on its other nutritional and neurodevelopmental properties.     

Blood transfusion requirements in cleft lip surgery

Objective

Cleft lip surgery is a common procedure performed by surgeons worldwide. The aim of the study was to determine blood transfusion requirements and factors influencing blood transfusion in cleft lip surgery.

Methods

Transfusion rate in 100 consecutive patients who had cleft lip surgery was prospectively evaluated at the Lagos University Teaching Hospital, Nigeria. Data collected included age and sex of patients, type of cleft defects, type of surgery done, preoperative haematocrit, duration of surgery, amount of blood loss during surgery, the number of units of blood cross-matched and those used. Cardiovascular parameters at the point of transfusion were also recorded. Each patient was made to donate a unit of homologous blood prior to surgery.

Results

Mean estimated blood loss during surgery was 26.5 ± 47.1 ml. Most patients (92%) lost between 2 and 50 ml of blood. Mean estimated blood loss in unilateral cleft lip surgery was not significantly differently from that of bilateral cleft lip surgery (P = 0.46). Only five patients (5%) required blood transfusion. The mean blood transfused was 50.0 ± 16.9 ml. All the patients transfused had a preoperative haematocrit of <30% (23-27%). The cross-match-to-transfusion ratio for cleft surgery was 20. The transfusion index was 0.05 and overall blood-ordering quotient was 20.

Conclusion

Cleft lip surgery is a low volume blood loss surgery. Homologous blood donation prior to cleft lip surgery in patients with preoperative haematocrit of 30% or more is not necessary. For patients with preoperative haematocrit of less than 30%, type and screen of donated blood should be adequate.     

Pudendal thigh flap in the treatment of acquired gynatresia from caustic pessaries

Objectives

To evaluate the use of vaginoplasty with the pudendal thigh flap in patients with gynatresia caused by herbal pessaries in a multidisciplinary context.

Methods

The study included patients with herbal-pessary-induced vaginitis and gynatresia. Surgical treatment consisted of vaginoplasty with the pudendal thigh flap; patients with associated fibroids had a myomectomy during the same setting. The severity of the stenosis and the outcome after surgery were assessed with rating scales devised for the present study.

Results

The study included 21 patients (mean age 36.05 ± 1.69 years, range 18-50 years). The most common reason for herbal pessary use was fibroids with infertility. Prior to presentation, most patients had already undergone a median of 2 procedures involving vaginal adhesiolysis and dilatations without improvement. In total, 17 (80.9%) patients underwent surgery. Of these, 6 (35.3%) presented with both fibroids and gynatresia. Before surgery, all patients had poor sexual function with apareunia. Postoperatively, 11 (64.7%) patients reported painless sexual intercourse.

Conclusion

Joint management by plastic surgeons and gynecologists using the pudendal thigh flap for vaginoplasty in caustic gynatresia resulted in a functional vagina. Simultaneous myomectomy and vaginoplasty in patients with fibroids and gynatresia was safe.     

Post-menopausal cyclic eruptions: autoimmune progesterone dermatitis.

Two cases of autoimmune progesterone dermatitis (AIPD) are reported. The patients developed a recurrent eruption, primarily on the extremities after receiving oral oestrogen/progesterone replacement for the treatment of climacteric symptoms. The diagnosis was confirmed in one of the cases who had intradermal progesterone injection producing an early positive reaction. One case required transient prednisolone therapy and both eventually resolved completely. Aetiological postulates are discussed.     

Positive benefits of a pharmacist-managed hypertension clinic in Nigeria

OBJECTIVE: The aim of this study was to determine whether the provision of further practice-based support by pharmacists will bring about improved outcomes for blood pressure (BP) control in middle-aged and elderly Nigerian hypertensive patients managed with combination diuretics (amiloride hydrochloride 5 mg+hydrochlorothiazide 50 mg) and/or methyl dopa at the primary care level. DESIGN AND SETTING: This was a 1-year prospective, randomized cohort study of the outpatients of a state comprehensive health centre in South-western Nigeria. Free primary health services including free drugs were provided for all patients. PATIENTS AND METHOD: The study population comprised 51 Nigerian patients with uncomplicated hypertension aged 45 years or more, with a 0.2-3.0-year history of hypertension, registered at the Comprehensive Health Centre, Ife between October 2002 and March 2003. They were invited into the pharmacist-managed hypertension clinic and followed for the study period. Participating pharmacists counselled for current medication, personalized goals of lifestyle modification stressing weight loss and/or increased activity, increased patient awareness by providing relevant education about hypertension and associated/related diseases, adjusted drug therapy to optimize effectiveness and minimize adverse events, utilized treatment schedules that enhanced patients' adherence to therapy, and monitored treatment outcomes between enrollment and return visits. Patient satisfaction and the number of treatment failures within 6 months post enrollment were compared with retrospective data from our earlier study involving physician-managed patients under a similar setting. RESULTS: Uncontrolled BP reduced from 92 to 36.2% by 10.15+/-5.02 days after enrollment. Treatment failures were observed at 5.9% of the total return visits (n=184) within 6 months. CONCLUSION: Pharmacist-managed hypertension clinics can improve BP control, reduce treatment failure and increase patient satisfaction.