Twin births in the university of Portharcourt teaching hospital Portharcourt:a 6 year review

Objective:To provide information on twin births and associated factors in Port barcourt South South Nigeria.Methods:Data on twin deliveries from 1st January 2003 to 31st December 2008 were collected and analysed.This included the maternal age and parity,gestation age,Apqar scores,sex and birth weight of twins.Results:A total of 11042 deliveries occurred over the study period with 333 being twins giving a twin rate of 1∶33.Male twins constituted 48% of twin births with male to female ratio of 1∶1.08.The mean age and parity of mothers were 29.6 years and 2.5 respectively.Presentation of the cephalic/cephalic for the first and second twins was the most common(63.4%).Severe birth asphyxia(first minute Apgar score 1-3)occurred in 3.9% of twins.Male-male twin pair occurred in 28.5% of twins,male-female in 39% while female-female occurred in 32.5%.The Caesarian section rate was 48%.Conclusion:The twining rate in this study is high.In this locality,there is a need for early ultrasound scanning of pregnant women particularly those of parities 1 to 3 and those aged 25-34 years in whom highest rates of twinning occurred to detect twinning when present and refer them to sufficiently equipped centres for adequate antenatal and perinatal care.

Prevalence and Predictors of Non-Uptake of HIV Voluntary Counseling and Testing among Undergraduates of Tertiary Institution in Abia State, Nigeria

Background: One of the key strategies in the HIV/AIDS prevention and control programs in Nigeria is Voluntary HIV counseling and testing (VCT). However, its utilization among young adults, particularly undergraduates, is very low. The aim of the present study was to determine the prevalence and predictors of non-uptake of VCT among undergraduates. Methods: A cross sectional study using quantitative methods was conducted. Using simple random sampling, three faculties were selected out of nine and 422 respondents were selected from three faculties. Interviews were conducted using pre-tested semi-structured questionnaires. Data analysis was done using statistical package for social sciences version 20. Prevalence was measured by the percentage of respondents that had never used VCT. Analytical statistics were done using chi-square test to measure strength of association between VCT uptake and knowledge and attitude of respondents. Association with P-value < 0.05 was considered significant. Logistic regression was used to identify predictors of non-uptake of VCT. The associations were presented as odds ratios (OR) and 95% confidence intervals. Results: Overall, 59.3% of respondents were knowledgeable about VCT while majority, 64.7% had negative attitude towards it. Knowledge (X2 = 9.89, P-value < 0.001) and attitude (X2 = 10.78, P-value < 0.001) showed statistically significant association with VCT uptake. The prevalence of non-uptake of VCT among the respondents was 82.7%. Ignorance, fear of positive test, stigma and discrimination were found to be strong predictors of non-uptake of VCT. OR 1.874 (1.058 - 3.289), P < 0.001;OR 2.455 (1.308 - 4.608), P < 0.000 and OR 2.318 (1.299 - 4.128), P < 0.000 respectively. Conclusions: VCT uptake among undergraduates was low and determined by VCT-related ignorance, poor attitude, fear of positive result and HIV/AIDS-related stigma/discrimination. In order to change the narrative, HIV/AIDS prevention and control programs in Nigeria should address the identified predictors of non-VCT uptake. There is a need to focus on young adults when designing, expanding and implementing VCT services in the country.

Neonatal mortality in a tertiary hospital in Southern Nigeria

Objective: With improved and sustained efforts in the prevention and management of pneumonia, diarrhea and vaccine preventable diseases, neonatal mortality is increasingly becoming a major contributor to childhood mortality particularly in developing countries. Evaluation of neonatal mortality pattern is an essential step in the effort to curb its incidence. We therefore, set out to determine the neonatal mortality pattern and its associated factors in a tertiary hospital in southern Nigeria. Methods: This is a retrospective study of neonatal mortality in a tertiary hospital from August 2004 to July 2007(a 3 year period). Data obtained include total live births, neonatal deaths, relevant information on pregnancy, labour and delivery, neonatal morbidity and duration of life. Results: There were a total of 3,051 live births and 44 neonatal deaths with a neonatal mortality rate of 14.4/1000 live births. Early neonatal mortality constituted 81.8%of over all neonatal mortality with the major causes being prematurity 40% severe birth asphyxia 29.5%and neonatal sepsis 18.3%. Low birth weight babies (<2500 grams) constituted 55.5% of total neonatal mortality. Conclusion: Early neonatal mortality constitutes an overwhelming proportion of neonatal mortality in Southern Nigeria. This can be significantly curtailed by reducing the incidence and death from prematurity, severe birth asphyxia and neonatal sepsis.

Refractory Oedema of Nephrotic Syndrome in a Resource Poor Setting: A Case Presentation

Background: Oedema, a constant feature of childhood nephrotic syndrome can be severe, enough to cause respiratory embarrassment. It can also be refractory to diuretic monotherapy. In such cases, combination of salt poor albumin (SPA) infusion and diuretics has remained the best treatment option. However, the cost of SPA has made it practically unavailable in resource-poor settings. It becomes a therapeutic dilemma when nephrotic syndrome patients of financially-constrained caregivers present with refractory anasarca in a resource-poor settings. Case review: We present a seven-year-old boy with relapsed steroid sensitive nephrotic syndrome who presented to Abia State University Teaching Hospital Aba, in respiratory distress with anasarca and a weight of 58 kilograms. SPA could not be accessed due to financial constraints. A decision to use fresh whole blood in the place of SPA, in combination with frusemide, achieved a lifesaving diuresis and regression of the anasarca. Conclusion: Whole blood is a good alternative for the treatment of refractory oedema in children with nephrotic syndrome in resource poor settings.

Baseline survey of pregnant women's knowledge of treatment to prevent mother- to-child human immunodeficiency virus transmission in a resource limited setting

Despite continuing advances in scientific knowledge about treatments to prevent mother-to-child(MTCT)of the human immune deficiency virus(HIV),there is a paucity of data on pregnant women’s knowledge of treatments to prevent MTCT of HIV in Aba,South Eastern Nigeria.We investigated pregnant women’s knowledge of the availability of treatments to prevent MTCT of HIV in the low resourced setting of Aba town in South Eastern Nigeria.A descriptive study involving 100 consecutive and consenting patients at the antenatal clinic of Abia State University Teaching Hospital(ABSUTH),Aba,South Eastern Nigeria over the period 1st November, 2007 to 30th November,2007.Using a structured questionnaire,the respondents’sociodemographic data were obtained as well as their knowledge of the availability of treatments to prevent mother to child HIV transmission in pregnant women and self-reported data on their having ever tested for HIV.Knowledge regarding availability of treatment to prevent mother to child transmission of HIV was good as 95%of the respondents were aware that such treatment was available.Knowledge that treatment is available to help someone infected by HIV to live longer was also good as 96% of the respondents were aware of the availability of such treatment.Seventy one percent of the respondents had ever tested for HIV.The levels of knowledge regarding the availability of treatment to prevent mother to child HIV transmission and to help someone infected with HIV are good.Thus, utilization of anti-retroviral prophylaxis amongst HIV infected pregnant women in this community would be expected to be high if the drugs were available.This will reduce the impact of HIV,especially in children.

Pregnant women's knowledge of perinatal HIV infection in a resource limited setting

The purpose of the study was to assess pregnant women s knowledge of perinatal human immunodeficiency virus (HIV) infection.A descriptive study involving 100 consecutive and consenting patients at the antenatal clinic of Abia State University Teaching Hospital(ABSUTH),Aba,South Eastern Nigeria,over the period 1st November, 2007 to 15th January,2008 was done.Using a structured questionnaire,the respondents’sociodemographic data were recorded as well as their knowledge of perinatal HTV infection.Although 85%of the pregnant women were aware of perinatal HTV transmission,only 69%knew that if a baby tested positive to HIV at delivery,it meant that the mother is infected with HIV.Fifty one percent of the pregnant women wrongly thought that all babies bom to mothers with HIV also get infected whilst 83%knew that HTV can be transmitted through breast feeding.The pregnant women demonstrated an incomplete knowledge of perinatal HTV transmission. The findings of this study underscore the continued need for intensified health education about prevention of perinatal HTV infection in our community in order to reduce the impact of HIV,especially in

Evaluation of utilization of antenatal services by mothers of babies with severe birth asphyxia

Objective:To evaluate the utilization of antenatal services by mothers of babies delivered with severe birth asphyxia at the University of Port Harcourt Teaching Hospital(UPTH) Port Harcourt,Nigeria.Methods: A case control study of the utilization of antenatal services by 97 mothers of newborns with severe birth asphyxia delivered at UPTH from 1st February to 31st October 2009 compared with mothers of newborns with normal Apgar scores was done.Relevant pregnancy,birth,family and social history was obtained by personal interviews and referral to case notes.Results: Significantly more of the mothers of babies with normal Apgar score booked early(4 months or less) and had up to 8 or more antenatal visits prior to delivery than mothers of asphyxiated babies 86(88.6%) vs 68(70.2%),P=0.002;93(95.7%) vs 68(70.2%),P=0.001 respectively.Significantly more subjects 56(57.7%) than the controls 45(46.4%) were primiparous,P= 0.04.Also,significantly more subjects 19(19.5%) suffered delay prior to intervention in labour than the controls 5(5.1%),P=0.004.Conclusion: Primiparity,delayed booking,inadequate antenatal visits and late intervention in labour have been identified as significant contributors to severe birth asphyxia.

Relationship between Binge Eating Disorder (BED) and Development of Metabolic Syndrome (METs): A Systematic Review

Binge Eating Disorder (BED) or uncontrolled food consumption is strongly associated with metabolic syndrome as a significant risk factor for health. Metabolic Syndrome (MetS) is characterized by central adiposity, high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, hypertension, and increased fasting blood glucose. Approximately 9% of the general population suffer from Binge eating disorder (BED), a significant risk factor for Metabolic Syndrome (MetS). This study evaluates the association between Binge Eating disorder (BED) and Metabolic Syndrome (MetS) development through a systematic review. Through analysis of previous studies, we discovered that 93 percent of those with BED had metabolic syndrome parameters in a series of investigations on BED conducted in general care. This systematic review aims to connect the frequency of binge-eating episodes and the development of metabolic syndrome. We have extracted five major studies (n = 5) through screening following systematic review standards.

Tuberculosis of the Spine (L5, S1) Secondary to Scrofuloderma with Viral Warts in a 15-Year-Old Male

We report this case of a 15-year-old male who presented to the children outpatient clinic (CHOP) of Abia State University Teaching Hospital (ABSUTH), Aba on the 5th of November 2015. He had tuberculosis (TB) of the skin (scrofuloderma) which was not diagnosed and had received treatment other than anti-TB medication. He now presented 9 years after with multiple body discharging sinuses, cicatricial skin lesions, tuberculosis of the spine (L5, S1) with contracture of the Achilles Tendon and genital warts. Subsequent treatment with full anti-TB drugs led to resolution of his illness. A higher index of suspicion is required for early diagnosis of extrapulmonary TB. Prompt and adequate treatment with anti-TB medication ensures cure in such cases. Appropriate control program is also known to improve the outcome and reduce sequelae.

Uterine choriocarcinoma: A gynaecological masquerader case report and review of the literature

Background: Choriocarcinoma is a rare clinical condition, and its diagnosis may be difficult, especially in resource-limited settings. Case Presentation: A 38-year old para 2 woman is with a 4-month history of intractable vaginal bleeding and offensive vaginal discharge, but without antecedent pregnancy. She had previously been managed at various tertiary medical institutions where several pelvic ultrasound scans and even histology of endometrial curette could not clinch the diagnosis. The diagnosis of choriocarcinoma was made by a serial strip-based pregnancy testing, which was still positive at 1:200 dilutions. She was treated with chemotherapy involving Adriamycin, Cyclophosphamide, Methotrexate and Folinic acid. Conclusion: The diagnosis of choriocarcinoma may be difficult especially when it develops ab initio without preceding abortion, molar or term pregnancy. In settings where serum hCG assay may be not available, the simple strip-based pregnancy test in dilution could be helpful in its diagnosis and treatment monitoring.

A Rare Classical Presentation of Bardet-Biedl Syndrome in a Three-Year-Old Male from South East Nigeria: A Case Report

Bardet-Biedl Syndrome (BBS) is a rare autosomal recessive ciliopathy characterized by obesity, post-axial polydactyly, renal abnormalities, mental retardation, pigmentary retinopathy and hypogenitalism. Diagnosis is rare in early childhood, and only few of the features are present at that age. This is because the disease is slow evolving. However, it is possible to find majority of the component of this syndrome in very young children. A 3-year old very obese male presented with clinical features of sepsis and congestive cardiac failure. He is a product of non-consanguineous marriage with unremarkable family history. Both parents are of the Ibo tribe in Nigeria. Polydactyly was noticed at birth. There was delay in some aspects of his developmental milestone. Examination revealed mild hypertelorism and retrognathia, polydactyly of both feet with syndactyly of the big and second toes. Other findings were short broad hands, mottled pigments on the retina, moderate mental retardation, hypogenitalism, nephrotic syndrome, renal tubulopathy, hyperglycaemia and hypopigmented skin lesions. A case of BBS with all the primary features and some secondary manifestations in a very young child is hereby reported. A high index of suspicion for BBS should be shown in any young child with at least one of the features of this syndrome. This will enhance earlier diagnosis and improve disease outcome.

Lymphoma in Two Siblings: A Plausible Case of Familial Lymphoma?

We repot two cases of lymphoma manifesting in siblings, one is Hodgkin’s lymphoma (HL) and the other is Non-Hodgkin’s lymphoma (NHL) in a nuclear family. Each presented a year apart. The patients were well and alive as at the time of this report and did not show any signs of the disease. There was no history of tuberculosis (TB) or contact with any one with TB. Other common lymphadenopathy associated conditions were excluded and histology of excised lymph nodes was confirmatory of the lymphomas. We were constrained by facilities on the demonstration of Ebstein Barr Viruses (EBV) or genetic associations. This is the first plausible case of reported familial lymphoma in Nigeria.