Readmission rates and outcomes in adults with and without COVID-19 following inpatient chemotherapy admission:A nationwide analysis

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases.However,little focus has been given to its effect on cancer treatment.AIM To determine the effect of COVID-19 pandemic on cancer patients’care.METHODS A retrospective review of a Nationwide Readmission Database(NRD)was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy(IPCT)during the COVID-19 pandemic in 2020.Two cohorts were defined based on readmission within 30 d and 90 d.Demographic information,readmission rates,hospital-specific variables,length of hospital stay(LOS),and treatment costs were analyzed.Comorbidities were assessed using the Elixhauser comorbidity index.Multivariate Cox regression analysis was performed to identify independent predictors of readmission.Statistical analysis was conducted using Stata■Version 16 software.As the NRD data is anonymous and cannot be used to identify patients,institutional review board approval was not required for this study.RESULTS A total of 87755 hospitalizations for IPCT were identified during the pandemic.Among the 30-day index admission cohort,55005 patients were included,with 32903 readmissions observed,resulting in a readmission rate of 59.8%.For the 90-day index admission cohort,33142 patients were included,with 24503 readmissions observed,leading to a readmission rate of 73.93%.The most common causes of readmission included encounters with chemotherapy(66.7%),neutropenia(4.36%),and sepsis(3.3%).Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts.The total cost of readmission for both cohorts amounted to 1193000000.00 dollars.Major predictors of 30-day readmission included peripheral vascular disorders[Hazard ratio(HR)=1.09,P<0.05],paralysis(HR=1.26,P<0.001),and human immunodeficiency virus/acquired immuno-deficiency syndrome(HR=1.14,P=0.03).Predictors of 90-day readmission included lymphoma(HR=1.14,P<0.01),paralysis(HR=1.21,P=0.02),and peripheral vascular disorders(HR=1.15,P<0.01).CONCLUSION The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT.These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.

Theoretical knowledge and psychomotor skill acquisition of basic life support training programme among secondary school students

BACKGROUND: The aim of the study is to evaluate the theoretical knowledge and psychomotor skill acquisition of basic life support(BLS) by a group of secondary school students in Nigeria pre and post BLS training. METHODS: This was quasi-experimental study design with 210 participants. They were taught on adult BLS and all the participants practiced BLS on a Resusci-Anne manikin immediately after the training. Data were collected using American Heart Association(AHA) structured questionnaire and psychomotor skills checklist for BLS at baseline, and post BLS training.RESULTS: The pre-training knowledge score was 1.9±1.4. This increased after the BLS training to 11.4±2.4, and the mean difference between the pre and post BLS training scores was 9.48571. Pre-training psychomotor skill score was 0.00±0.00, this increased to 8.9±1.9 after the training, and the mean difference was 8.90000. The knowledge and psychomotor skill difference between pre and post BLS training was signifi cant(P<0.000).CONCLUSION: Most Nigerian secondary school students were not knowledgeable about BLS. Therefore, there is need for the creation of more awareness among the students.

Clinical and investigative correlates of etiologic risk factors on treatment outcome of intrauterine adhesion in women with infertility: A descriptive study

Background: Intrauterine adhesion is a clinical entity that may present with subfertility. However, outcome of management depends on severity of intrauterine adhesion and type of treatment intervention employed. Objective: To evaluate clinical and investigative correlation of etiologic risk factors of intrauterine adhesion on fertility and pregnancy outcome following treatment. Patients and Methods: A 5 years prospective observational study. Treatment employed includes transvaginal blind intrauterine adhesiolysis, insertion of inert intrauterine device or inflated Foley’s catheter balloon and oestrogen therapy. Inclusion criteria are intrauterine adhesion as the only identifiable cause of infertility and post treatment follows up for at least a year. Results: Over a period of 5 years, 63 patients with mean age of 31.6 years and age range of 21 to 42 years were managed. Etiologic risk factors were dilatation and curettage 33 (52.4%), vacuum aspiration 13 (20.6%), myomectomy 11 (17.5%) and caesarean section in 6 (9.5%) patients. Of the 63 patients, 28 conceived giving a pregnancy rate of 44.4%. Nine out of the 28 patients that conceived had miscarriage, giving a miscarriage rate of 32.1%. The highest pregnancy rate and lowest miscarriage rate were recorded in the subgroup that had vacuum aspiration as their etiologic risk factor. Late pregnancy complications encountered are preterm contractions 5 (26.3%), placenta praevia 4 (21.1%), morbidly adherent placenta 5 (26.3%) and preterm delivery in 2 (10.5%) patients. Route of delivery was per vaginum in 13 (68.4%) patients and by caesarean section in 6 (31.6%) patients. Live birth rate was 89.5% (17/19 deliveries). There was no maternal mortality recorded. Conclusion: Compared to other risk factors, uterine vacuum aspiration was associated with higher fertility rate and better pregnancy outcome.

Heterotopic tubal pregnancy with live twin birth complicating ovulation induction assisted cycle

Heterotopic pregnancy is an uncommon clinical entity in Nigeria even though some of the risk factors are highly prevalent in the population. We report a case of heterotopic pregnancy following ovulation induction with clomiphene citrate. A favourable outcome resulting in live twin birth was recorded despite the presence of poor clinical features that affects pregnancy and foetal outcome.

Correlation between Abdominal Ultrasonographic Findings and CD4 Cell Count in Adult Patients with HIV/AIDS in Jos, Nigeria

Acquired Immunodeficiency Syndrome (AIDS) is caused by Human Immunodeficiency Viruses (HIV) resulting in progressive destruction of cell mediated immunity. The abdominal manifestations of AIDS are related to the level of CD+4 cells count as well as viral load. Abdominal ultrasound examination is easy to perform, non-invasive, inexpensive, readily available and reproducible investigation which provides valuable information about abdominal findings in AIDS. The objective of the study was to evaluate abdominal ultrasound findings in adult HIV/AIDS patients in Jos, Plateau State, Nigeria and correlate these findings with the patients’ CD+4 counts. A cross-sectional study of abdominal ultrasound findings of adult patients with HIV/AIDS was conducted over a period of six months. The abdominal ultrasound findings and CD+4 counts were studied. Two hundred (40%) of the patients had normal abdominal ultrasound, while 60% (300) had various abnormalities. The common abnormalities included increased liver parenchymal echogenicity in 25.0%, hepatomegaly in 23.4%, splenomegaly in 6.6%, increased splenic echogenicity in 6.2% and thickened gallbladder wall in 12.6%, elevated renal parenchymal echogenicity in 6.4%, enlarged kidneys in 2.6%, lymphadenopathy in 6.0%, and ascites in 2.4%. Pelvic abscess was the least pathology in 0.2%. Most of the findings did not correlate with the patients’ CD+4?count except for lymphadenopathy and ascites. Although abdominal ultrasound examination is invaluable in the management of these patients, however, it has not shown to be useful in predicting the patients’ immune status.

Huge Broad Ligament Leiomyoma: A Case Report

The broad ligament is the commonest extra uterine site for the occurrence of leiomyoma but with a very low incidence rate. Because of its overall low incidence rate, it poses both clinical and radiological difficulty in differentiating with an ovarian tumour. We report a case of a 31-year-old unmarried nullipara (para 0 + 0) who presented with 12-month history of progressive abdominal swelling, three-month history of pelvic pain and one-month history of prolonged heavy menstrual flow. Examination of the abdomen showed a 36-week-size mass which was multi-lobulated, firm, non tender and slightly mobile extending to the xyphisternum. On abdominal ultrasonography scan, the uterus was deviated to the contra lateral side with a huge, irregular mass measuring 24 × 18 cm posterior to the uterus. She had laparotomy and four fibroid seedlings were removed. The largest was a broad ligament myoma which measured 24 × 17 × 12 cm and weighed 3883 g.

The burden of gynecological cancer management in Northern Nigeria

Background: Carcinoma of the Cervix is one of the gynecologic cancers. Gynecological cancer is a scourge in the developing nations because of the burden of cervical cancer. Carcinoma of the cervix is the leading cause of cancer death in women. The costs of treatment of cancers generally are very high and this has made care very difficult in the developing nations. The question therefore is who bears the cost and whose responsibilities? Aims and Objective: To study the economic burden of cancers on the patient, and how they source for these funds. To determine how the lack of funds or otherwise has affected their care. To assess their perception of who should bear the cost of this care. Methodology: It is a prospective study of all consecutive patients that attended the Gynecologic clinic of our unit between 2nd January 2010 and 30th June 2010. Data were analyzed using Excel statistical package. Result: A total of 93 patients were interviewed. A majority of 70 (76%) of the patients had Carcinoma of the cervix. The mean age of there husbands was 58 years. Most of them were either farmers (21%) or retired civil/public servants (15%) and earn between 700 - 1700 dollars per year. A large group of the patients were full time House wives (48%), while Petty trading and farming account for 13.3% each. The women earn less than 500 dollars per year. Only 50% received assistance, from family members (35.8%) or relatives (29.6%). More than 50% of them have spent between 1000 - 3000 dollars for their health bills. It was sad to note that 40% of them have no hope of help/assistance from anywhere. A majority of 83.3% believe that the government should come to their aids. Conclusion: In the developing nations, poverty still remains major problem, where people still earn less than a dollar per day. In essence prevention is paramount;otherwise most of our women who escaped maternal mortality may end up being a victim of cancer death.

Suicidal Ideation among Depressed People Living with HIV/AIDS in Nigeria, West Africa

Objective: Transient suicide thoughts are common to some people throughout the course of HIV disease and often do not indicate significant risk of suicide. However, persistent suicidal thoughts with associated feelings of hopelessness and intent to die are very serious and must be assessed promptly and carefully. The aim of this study, therefore, was to examine the relationship between depression, hopelessness, psychosocial stressors and suicidal ideation in PLWHAs. Methods: This was a hospital based, cross sectional, descriptive study, of one hundred and seventy depressed adult HIV/AIDS patients of Kwara State Specialist Hospital, Ilorin. Depression and suicidal assessment were evaluated using the PHQ-9 scale. A score of >9 or any affirmative response to question 9 of the PHQ-9 scale necessitated suicidal risk assessment. The social determinant questionnaire was used to evaluate social cohesion and negative life events. Results: The prevalence of depression among the HIV/AID patient was 56.7%. Twenty nine (17.1%) were hopeless, twenty eight (16.5%) had at one time or the other thought of taking their lives, six (3.5%) had plan to take their lives. There was strong statistical association between depression, hopelessness (p-value = 0.000) thought of taking life (p-value = 0.000) and plan to take their lives (p-value = 0.030). Conclusion: The significant correlations between hopelessness, depression and suicidal ideation are important markers that should alert clinicians to underlying suicide risk in HIV-positive patients. In addition, low social cohesion and stressful life events were found to be risk factors for depression and suicide. Clinicians should routinely enquire about suicidality in PLWHAs to assist early diagnosis and intervention.

Malignant Mixed Mullerian Tumours (Carcinosarcoma of Uterine Cervix) (MMMT): Case Report and Review of Literature

Carcinosarcoma of the uterine cervix are very rare malignancy of the female reproductive tract with poor prognosis. Only fifty cases have been reported in literature until 2013. We report a 49 years old Para 7 + 3 presenting with vaginal bleeding, offensive discharge with intermittent abdominal pain. On examination an impression of a cervical polyp was made. She had total abdominal hysterectomy and bilateral salpingoophorectomy. The histological diagnosis of carcinosarcoma of the uterine cervix was made. She had chemoradiation therapy as adjuvant therapy in view of the diagnosis. Although cancer of the cervix is the second commonest cancer worldwide and the leading cause of cancer death in women, this particular histological variant is very rare, as such no standard protocol of management developed for it yet and it carries a very poor prognosis.

Abscess rate of patients with penetrating abdominal injury in Zaria

Background: Penetrating abdominal injury occurs when a foreign object pierces the skin. The morbidity and mortality associated with penetrating abdominal trauma is related to the intra-abdominal complications. This study is, therefore, intended to determine the abscess rate resulting from penetrating abdominal trauma in Ahmadu Bello University Teaching Hospital Zaria. Method: A 6-year (January 2006-December 2011) retrospective study of penetrating abdominal trauma emphasizing on the rate of development of intra-abdominal abscess. Information was obtained from patients’ case notes, operating room log books and surgical audit data. Information extracted included cases of penetrating abdominal trauma, intra-operative findings and cases of intra-abdominal abscesses. Results: A total of 39 cases of penetrating abdominal trauma were treated within this period of six years. 3 (7.7%) were treated in 2006, 6 (15.4%) in 2007, 3 (7.7%) in 2008 and 11 (28.2%) in 2009, 8 (20.5%) in 2010, 9 (23.1%) in 2011. 26 (66.7%) were adult while 13 (33.3%) were paediatric cases. The male were 37 (94.9%) and the female were 2 (5.1%), with a sex ratio of 18.5:1 (male to female). The age range was 5 -60 years (39.92 mean). The commonest cause of injury was road traffic accident. At exploration, 13 (33.3%) had organ injury only, 17 (43.6%) suffer from both organ injury and intra-peritoneal emorrhage, 9 (23.1%) had retroperitoneal haemorrhage only. The intra-abdominal abscess rate of penetrating abdominal injury in Zaria was found to be 2.6%. Conclusion: Contamination from either foreign object or organ injury is found to increase the risk of post-operative intra-abdominal abscess. In this center, the abscess rate of penetrating abdominal trauma is comparatively low.

Investigation Correlates of Chlamydia Anti-Body Testing and Hysterosalpingography among Women with Tubal Infertility

Background:?Chlamydia trachomatis?infection is an important preventable cause of infertility. In women, up to 70% of genital infection with?Chlamydia trachomatis?are asymptomatic. In the management of infertility patients, a lot of clinicians or centres do not routinely screen for?Chlamydia trachomatis?infection. Hence all patients being investigated for infertility may potentially be at risk of tubal blockage in addition to non-tubal factor aetiology. Those with primary tubal blockage also are at risk of worsening of the blockage. Objective: To determine if there is a relationship between IgG and IgM Chlamydia antibody testing (CAT) and tubal factor infertility. Design: It was a cross sectional descriptive study. Method: The sera of 400 consecutive consenting infertile patients presenting to the gynaecological clinic of the Ahmadu Bello University Teaching Hospital, Zaria, Northern Nigeria were tested for Chlamydia antibodies using ELISA IgG and IgM kits produced by Diagnostic Automation, Inc., 23961 Craftsman Road, Suite D/E/F, Calabasas, CA 91302, USA. Results: Up to 264 (66%) of the patients had tubal factor, 64 (16%) had uterine, 56 (14%) had ovarian, 50 (12.5%) had male while 40 (10%) had others. The causative factors were not mutually exclusive. The sero-prevalence of IgG and IgMChlamydia trachomatis?amongst patients with tubal infertility were 35.6% and 35.6% respectively. There was a stronger significant relation (P = 0.008) between IgM sero-positivity which suggests recent infection and tubal infertility. The relation between IgG sero-positivity which suggest chronic infection and tubal infertility was also significant (P = 0.036) but relatively lower. Conclusion: The sero-prevalence of?Chlamydia trachomatis?infection, IgG and IgM was significantly higher among the sub-population with tubal infertility. Chlamydia antibody testing (CAT) has predictive value for tubal infertility.

Anesthesia for Cesarean Delivery in a Low-Resource Setting, an Initial Review

Background: Bearing in mind the recent advances in obstetric anesthesia, the safety of both mother and child is of paramount importance, especially in a setting where resources are limited. We set out to find the pattern of cases presenting for cesarean delivery and the types of anesthesias provided for the management of these patients. Methods: A retrospective survey was conducted involving all anesthetics provided for cesarean delivery from January 2006 to December 2009 in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Information such as age, indications and anesthetic technique, including drugs used, were extracted from patients’ records. Data were subjected to statistical analysis using Statistical Package for Social Sciences (SPSS) version 17.0. Results: There were a total of 577 anaesthetics conducted for cesarean delivery during the period under review out of 4277 live births, giving a cesarean delivery rate of 13.5%. General anesthesia (GA) was administered on 266 (46%) of these patients, while 279 (48%) cases were done under subarachnoid block(SAB). 16 (3%) patients had combined GA and SAB, while 16 (3%) patients received epidural anesthesia. There were 302 emergency cesarean deliveries out of 577 cases, giving an emergency cesarean delivery rate of 52%. The commonest indication for cesarean delivery was two previous cesarean deliveries. Conclusion: A large percentage of our obstetric cases are being done under general anesthesia. Though majority of the conducted regional anesthesia were spinals (SAB), only a few cases were done under epidural block. Subspecialty training of anesthetists will go a long way to improve the current trends.

Acceptability of HIV Testing and Counseling by Antenatal Clients of a Tertiary Institution in Northern Nigeria

Background: HIV testing and counseling (HTC) plays a central role in specific prevention of mother-to-child transmission (PMTCT) interventions, as these interventions depend on the woman knowing her HIV status. Over ninety percent of HIV infection in children is acquired through mother-to-child transmission. Objectives: This study assessed pregnant women’s knowledge of HIV/AIDS, their awareness of HIV testing and counseling, and compared the uptake of HTC to the previously practiced voluntary counseling and testing (VCT) in a teaching hospital in northern Nigeria. Materials and Methods: A pre-tested, structured interview questionnaire was administered on a cross-section survey of 270 antenatal clients in Ahmadu Bello University Teaching Hospital (ABUTH), Nigeria. Information about knowledge of HIV/AIDS and attitude towards HTC was elicited among respondents. Results: Eighty-nine percent of respondents were aware of HIV/AIDS.?The knowledge of route of disease transmission was high, with 87.4% and 81.1% of studyparticipants mentioning sexual activity and mother-to-child transmission, respectively. Majority of respondents (98.9%) were aware of HTC and approved of it (91.1%) while 7.8% declined and the remaining 1.1% were undecided. Fourteen percent of respondents didn’t approve of retesting in labour. Sixty-eight percent of respondents were aware of interventions to prevent mother-to-child transmission of HIV. Switching from VCT to HTC has dramatically improved the uptake of testing from 78.9% in 2006 to 91.1% in 2012. Conclusion: Routine HIV testing and counseling is more acceptable than voluntary counseling and testing among antenatal clients. Although the awareness and uptake of HTC were quite high among the antenatal clients, there is still a need to intensify health education and incorporate husbands into the counseling session when necessary to convince the remaining minority who are still ignorant of the benefits of HTC.

Maternal Mortality and Morbidity Will Not Reduce in Low Resource Countries without the Anaesthetists’ Involvement

Background: Maternal and foetal mortality is unacceptably high in most resource-limited countries?and the practice of obstetric anaesthesia has an important influence on outcome for both mother and baby. The much needed close co-operation and collaboration between obstetricians and obstetric anaesthetist providers is crucial for the safety and comfort of parturients, particularly in low-resource environments. The current global maternal mortality is approximately 400 per 100,000 deliveries, with a range of 7 - 740 deaths per 100,000, demonstrating the inequality between the rich and poor countries. Many of the deaths could have been prevented by better essential obstetrics services including safe anaesthesia and surgery, provided such services are made available in?a timely manner. Conclusion: Maternal mortality in low resource countries has its basis complex?social, economic and political factors, underpinned by a lack of resources. Many of these factors are difficult and slow to resolve and are not specific to maternal health. Comprehensive essential?obstetric care services at the district hospital level (first referral level) should include all the above?plus safe surgery, safe anaesthesia, and blood transfusion. Government, donor agencies and all stakeholders must recognize the crucial role of anaesthesia in providing emergency obstetric care in hospitals. Advocacy by all concerned will help direct the scarce resources to the appropriate areas of need which includes provision of adequate facilities and manpower for safe anaesthesia.

Use of oral ketamine for analgesia during reduction/manipulation of fracture/dislocation in the Emergency Room: An initial experience in a low-resource setting

Background: The use of ketamine for relief of procedure-related pain is limited in our environment. Ketamine, a phencyclidine derivative commonly used for induction and maintenance of anaesthesia, is administered routinely via the intravenous and intramuscular routes. One of the concerns while using ketamine for analgesia via these two routes is that the drug may produce anaesthesia, rather than analgesia alone. Aims and Objectives: We sought to find out if ketamine given via the oral route could be used to provide analgesia during minor orthopaedic procedures in the emergency room. We also wanted to find out if there were side-effects peculiar to the oral route. Methods: A prospective observational pilot study in consecutive patientswith fractures/dislocation in our Emergency Room was recruited into the study. All patients gave informed consent. Reduction of fractures was done 15 minutes following the administration of ketamine 5 mg/kg orally. The patients were observed during and after the procedure and the findings entered into a proforma. The data obtained were analyzed using simple statistical methods and the results presented in a table. The findings are discussed. Results: There were 9 males and 2 females with an age range of 4 yrs to 48 yrs. Pain levels were assessed using verbal rating scales. Seven patients (64%) had severe pain before administration of ketamine while 2 patients (18%) each had mild and moderate pain respectively. Four patients had Colle’s fracture only and 1 patient had a Colle’s fracture with a supracondylar femoral fracture. Two patients had tibial fractures, one patient had a complete knee dislocation, while 2 others had ulnar/radial fractures. One other patient had humeral and tibial fractures. For up to 15 minutes after the procedures all but one patient were pain-free. Five (5) patients (45.5%) were noticed to have drowsiness, 3 patients (27%) were sedated while 2 patients (18%) had no side-effects at all. Five (5) patients (45.5%) reported excellent analgesia while 6 patients (64%) said the intra and post procedure analgesia was very good. Conclusions: Oral ketamine may be useful in providing analgesia for minor procedures in the emergency room. Ketamine when sweetened with a soda drink appears to be palatable with a rapid onset of action and few side effects. Thus ketamine given orally may be a cheaper and more accessible option for effective pain-relief in the emergency room. There is a need to conduct more studies on a larger number of patients.

A Study of the Behavioural Factors Associated with Low Uptake of Intra-Uterine Contraceptive Device in Zaria, Northern Nigeria: A Qualitative Survey

Aim: To document reasons for the low uptake of Copper 380A contraceptive in Zaria, Northern Nigeria. Study Design: Qualitative analysis from In-depth interviews (IDI) and Focus group discussions (FGD). Setting: Zaria, Northern Nigeria. Methods: Five high volume public facilities within Zaria metropolis were selected for the study (the teaching hospital, two district hospitals serving the metropolis and two primary care centers). The most experienced provider in each of these facilities was engaged in an IDI to explore reasons for the low uptake of IUD from their perspective. Similarly, a session of FGD was conducted in each of the facility involving at least eight family planning clients who were para 4 or more and not using the IUD. Results: There were a total of 397 new clients that were served various methods of contraceptive across the five facilities three months prior to the study. Intrauterine device only accounted for 11.8% of these clients while Injectable was responsible for 62% of clients. 72% of the IUD insertions took place in the teaching hospital. There were no IUD insertions in the two primary care centers within the last three months prior to study. Conclusion: Misconceptions, lack of information concerning IUD particularly at the primary care levels, lack of male involvement and providers’ incompetence were the main barriers to accessing IUD services in Zaria, Nigeria. In the course of this investigation, local Ethics were observed.

Uptake of Hormonal Implants Contraceptive in Zaria, Northern Nigeria

Objective: To document our experience on the use of Jadelle/Implanon contraceptives that was recently introduced into Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. It is pertinent to generate data on the experiences in the use of this contraceptive in a cross sectional study within Zaria, Northern Nigeria. Method: Data on consecutive clients that accepted Jadelle/ Implanon from June 2009 to November 2013 at ABUTH were extracted from their cards and analyzed using SPSS version 17. Out of a total of 11,502 clients that were for contraception during the period under review, 798 accepted Jadelle/Implanon accounting for 7% of the total clients. All the clients were married. About 67.8% were Muslims while 27.2% were Christians and 5% belong to other sect. 4140 (36%) had tertiary education. Most of the client has been on one form of modern contraception;only 16% were first time users who accepted implant after counselling. 37% of the?clients are full time housewives. The discontinuation rate was found to be 26% for Jadelle and 19%?for Implanon. No pregnancy was recorded during this period. Conclusion: Jadelle/Implanon account for 7% of contractive uptake and a high discontinuation rate was found among the users.

Pregnancy Specific Beta-1 Glycoprotein in Women with Eclampsia, Kaduna State, Nigeria

This was a comparative cross-sectional study of eclamptic and normal healthy pregnant women conducted in kaduna State, Nigeria to determine Pregnancy Specific beta-1 Glycoprotein (PSG-1) levels in the peripheral blood of third trimester women with eclampsia (EC;n = 38), normal healthy pregnant and non pregnant women controls (PC;n = 25 and NPC;n = 25 respectively), age and parity matched, attending labour rooms/wards and Antenatal Clinics (ANC) of Ahmadu Bello University Teaching Hospital Shika, Zaria and four other Hospitals in Kaduna state, Nigeria. Participants with smear positive malaria, seropositive for human immunodeficiency virus (HIV) or any other known clinical infection were excluded from this study. Pregnancy specific beta-1 glycoprotein levels were estimated using Quantikine ELISA kits. Data obtained were analyzed using SPSS version 20.0 (Chicago, USA) and Graph pad Prism 6.0. Results were expressed as mean ± standard deviation while Kruskal Wallis test was used to determine the significant differences. A p-value of less than 0.05 was considered to be significant. The mean serum level of PSG-1 in EC was 2.53 ± 0.11 pg/ml, PC;2.56 ± 0.03 pg/ml) and NPC;0.62 ± 0.20 pg/ml. There was no significant difference between EC and PC (P > 0.05). Pregnant women (with and without EC) had significantly higher mean serum values compared to NPC p < 0.05. While pregnancy was associated with high levels of PSG-1, the study did not support the hypothesis of low PSG-1 level in EC. A longitudinal study to capture changes in PSG-I levels in the course of pregnancy as they manifest is recommended.

HIV Infection among Under-Five Malnourished Children in Kano State

Objective: Human Immunodeficiency Viral infection and Protein Energy Malnutrition (PEM) are highly prevalent in Nigeria and when they occur together, the outcome is usually severe as both conditions lead to immune suppression. HIV alone accounts for 14.0% of childhood mortality even though children constitute only 6% of global HIV infection burden. The objective of the study was to determine the prevalence of HIV infection among malnourished children below 5 years in Kano State, Nigeria. Methods: A total of 400 malnourished children were randomly selected and tested for the presence of HIV I & II using parallel ELISA rapid test kits, Stat park and Determine (both immunochromatographic techniques). Findings: Thirty-one samples were found to be positive to HIV 1 giving a prevalence of 7.8%. There was no statistically significant difference between sexes when male to female ratio was 1:1.3 and peak age of presentation was 2 -3 years. Sixty-four percent (64.0%) were presented with severe form of HIV infection (stage 4) according to WHO paediatric HIV clinical stage and about half of them came with marasmus by the Wellcome classification of malnutrition. There was no significant association between the type of malnutrition and the severity of HIV infection at present, (p value > 0.05). The commonest signs and symptoms were oral candidiasis (67.7%), lymphadenopathy (44.0%), fever (64.5%) and cough (54.8%). Sixty-four percent of the children were from polygamous families. There was a significant statistical correlation between polygamy and incidence of HIV infection, (p 0.01). Only 45.0% of the women were aware of their HIV status prior to this study. Seventy-four percent (74.0%) of those who were aware of their status had no knowledge of the prevention of mother to child transmission (PMTCT) services and even for those who were aware, none of them accessed the care. Conclusion: A population based HIV screening is therefore recommended while perinatal HIV screening and PMTCT services need to be expanded.

Experience with Prosthetic Valve Replacement in Indigents with Rheumatic Heart Disease in Nigeria: 10-Year Follow-Up

Purpose: Active heart surgery programs are few in sub Saharan Africa outside of South Africa, with majority being low volume centers performing small numbers annually. We reviewed our long term outcome to identify factors associated with increased morbidity and mortality, to guide future choice of prosthetic valves in our mostly indigent patients afflicted with rheumatic valvular disease. Methods: Retrospective analysis of patients who underwent heart valve replacement at Lagos State University and Ahmadu Bello University Teaching Hospitals from November 2004 to February 2009. Results: Twenty six patients, 19 (73.1%) females, age 12 - 47;mean 26.69 ± 9.87 years, underwent heart valve replacement. 19 (73.1%) patients had mitral and 7 (26.9%) aortic valve replacement. Mechanical valve was implanted in all except in 2 (7.7%) patients. Left ventricular ejection fraction was >50% in 14 (53.8%), 24 (92.3%) were in New York Heart Association class III/IV, 10 (38.5%) had severe pulmonary hypertension and logistic euroscore was 5.84 ± 3.81. Operative mortality was 11.5% (3/26) and morbidity 7.7% (2/26). Follow-up for survivors was 83.0 ± 27.9 months. 10-year freedom from bleeding and thromboembolism was 70.0% and survival 86.0%. Linearized rate for bleeding was 4.58 and thromboembolism 1.52. Conclusion: Late complications in survivors were primarily anticoagulant related occurring predominantly in child bearing age females especially during pregnancy. Bleeding complications were often associated with noncompliance due to poor socioeconomic status. With average life expectancy of 53 years for females, bioprosthetic valves despite higher structural failure rate, may be best suited especially in child bearing age females still desirous of childbirth to decrease valve related complications. Longer duration of follow-up and meta-analysis of future reported series from the sub region may help clarify the optimal prosthetic valve in sub Saharan Africa with its known poor health infrastructures and delivery system.