Association between Placenta Malaria Parasites and Preeclampsia/Eclampsia among Parturient Mothers in Alex Ekwueme Federal University Teaching Hospital Abakaliki

In tropical countries, malaria and preeclampsia/eclampsia are common diseases of pregnancy;and placenta have been implicated in the pathophysiology of both disease processes. The two diseases have pathophysiologic similarities in the placenta such as placenta ischaemia, endothelial dysfunction and production of pro-inflammatory cytokine. Yet, there is paucity of studies on the association of these two disease processes. Determining the association between the two disease processes may help to unravel the pathogenesis of preeclampsia and also help in its prevention and patient management. Objective: Determined the association between placenta malaria parasitemia and preeclampsia/eclampsia among parturients at Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Methods: This was a case control study that was conducted in the Labour wards of department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA) and Mile 4 Missionary Hospital Abakaliki, a comprehensive health care centre in Abakaliki, Ebonyi state. It was conducted over a period of 6 months between 1st October 2021 and 31st March, 2022. The cases in this study were parturients that developed preeclampsia/eclampsia in the course of pregnancy, while the controls were parturient without preeclampsia/eclampsia. Interviewer-administered questionnaires were used to collect data on socio-demographic characteristics, obstetrics and medical histories. Histological examinations were conducted to isolate plasmodium falciparum parasites from placenta samples obtained from the maternal surface of the placenta. The data was processed using Epi Info software. Categorical variables were analyzed using Mc Nemar X2 test, with a p-value of 0.05 considered statistically significant. Logistic regression models were used to estimate the odds ratios (OR) and 95% CI of the association between placenta malaria parasites and preeclampsia/eclampsia was conducted. Relative risk with 95% CI was used to determine both fetal and maternal outcomes. Results: The prevalence of preeclampsia during the study period was 2.9%. Placenta malaria was positive in twenty one (21) of the 67 cases of preeclampsia/eclampsia analyzed, giving a prevalence of 31.3% and in eleven (11) out of 68 controls (normotensive) patients analyzed, giving a prevalence of 16.2%. The presence of placenta malaria significantly increased the odds of developing preeclampsia/eclampsia among parturients (OR = 2.4, 95% CI = 1.0 - 5.4, P value = 0.04). Presence of placenta malaria in mothers with preeclampsia/eclampsia was associated with adverse pregnancy outcomes such as cerebrovascular accident (RR = 19.2, 95% CI = 1.1 - 341.7, P value = 0.04), DIC (RR = 10.9, 95% CI = 1.4 - 88.0, P value = 0.02), abruptio placenta (RR = 2.4, 95% CI = 1.2 - 4.8, P value = 0.01), pulmonary edema (RR = 2.7, 95% CI = 1.1 - 25.9, P value = 0.03), IUGR (RR = 2.1, 95% CI = 1.1 - 4.5, P value = 0.03) and IUFD (RR = 3.8, 95% CI = 1.3 - 11.7, P value = 0.02). Presence of placenta malaria also increased the risk of NICU admission (RR = 2.6, 95% CI = 1.1 - 6.0, P value = 0.03), Low 1st minute APGAR score (RR = 2.7, 95% CI = 1.2 - 6.1, P value = 0.02) and Low 5th minute APGAR score (RR = 3.0, 95% CI = 1.0 - 8.6, P value = 0.04) among neonates delivered by mothers with preeclampsia/eclampsia. However, presence of placenta malaria did not significantly increase maternal and perinatal mortalities. Conclusion: There is a higher prevalence of placenta malaria among mothers with preeclampsia/eclampsia when compared with normotensive controls and this was associated with increased risk of certain maternal and perinatal morbidities. Placental malaria was not associated with increased risk of either maternal or perinatal mortality.

Prevalence of Dyspareunia and Its Effect on Sexual Life among Gynaecological Clinic Attendees in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria

Introduction: Dyspareunia is one of the most common complaints in gynae-cologic practice with tremendous effect on both quality of life and sexual rela-tionship of women. Objectives: To determine the prevalence of dyspareunia and its effect on sexual life among gynaecology clinic attendees in Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Materials and Methods: A cross-sectional study was conducted on consenting participants between 12th May 2016 and 25th July 2016. Anonymous self-administered questionnaires were used collection information on dyspareunia and its effect on sexual life at the Gynaecology clinic. The data was analyzed using Epiinfo version 7.1.5. Results: One hundred and four (104) women participated in this study. Most of the women studied were Igbos (95.19%), and were mainly between the age ranges of 21 - 30 years (66.35%). Most of them were married (89.42%), and were also mainly of the Pentecostal denomination (40.78%). The mean age at coitarche was 20.6 ± 3.95 years. Prevalence of dyspareunia was 36% and only 16% sought medical help. The various responses to dyspareunia were avoidance of sex 11%, reduced frequency of intercourse 8%, less desire for sex 19%, while majority of women with dyspareunia tolerated it (62%). Conclusion: The prevalence of dyspareunia is high in our society afflicting young women in their reproductive years with associated enormous stress on their sexual life.

Epidemiology and Management of Ectopic Pregnancy in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Southeast, Nigeria

Background: Ectopic pregnancy is a common cause of maternal morbidity and mortality in the 1st trimester of pregnancy;without timely diagnosis and intervention, ruptured ectopic pregnancy can become a life threatening condition. Objective: This study aims to give baseline indices on the incidence, clinical presentation, risk factors and the management of cases of ectopic pregnancy that presented in Alex Ekwueme Federal University Teaching Hospital, Abakaliki over a 5-year period. Materials and Method: This is a 5-year retrospective study of patients who were diagnosed with ectopic pregnancy between January 1st 2012 and December 31st 2016. The statistical analysis was done using SPSS version 22. Result: During the study period, there were 11,932 deliveries while 7725 Gynaecology patients were admitted. Over the same period there were 156 patients diagnosed and managed for ectopic pregnancy, accounting for 1.31% of all deliveries and 2.0% of all Gynaecological admissions. The modal age group was 26 - 30 years 68 (43.6%), 122 (78.2%) were married, while 34 (21.7%) were single. Nulliparous were 41 (26.3%) and primiparous were 33 (21.2%). The commonest presenting complaints were lower abdominal pain and amenorrhea, and the commonest identified risk factor was previous pelvic inflammatory disease. Most of the cases were ruptured prior to presentation and partial salpingectomy was the management in all tubal pregnancy while two cases were unruptured and had salpingostomy and another case was abdominal pregnancy and had exploratory laparotomy only. Out of 156 women that presented with ectopic pregnancy, 8 (5.1%) died before surgery could be done due to late presentation. Fifty-seven women presented in a state of shock and 9 (5.8%) of the cases were complicated with acute renal failure. Conclusion: Ruptured ectopic pregnancy is a major cause of maternal morbidity and early pregnancy loss. Late presentation is a common feature in our environment;hence widespread advocacy on case identification and early presentation is urgently needed.

Gestational Trophoblastic Diseases: A Review of the Clinical Presentation and Management at the Alex Ekwueme Federal University Teaching Hospital Abakaliki

Background: Gestational trophoblastic diseases (GTD) are potentially curable with retention of reproductive function once the correct diagnosis is made and treatment is commenced early with adequate follow up. Objective: The objective of this study was to determine the incidence, clinical presentation, management and treatment outcomes of gestational trophoblastic diseases in a tertiary hospital in Abakaliki, South-east Nigeria. Materials and Methods: This was a retrospective descriptive study of gestational trophoblastic diseases managed at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA) over a 6-year period. The statistical analysis was done using SPSS version 22. Results: The incidence of GTD was 4.6 per 1000 deliveries. Women who were less than 20 years and more than 40 years of age accounted for 5.9% and 23.5% of cases of GTD respectively. Women who were para 5 and above accounted for 76.5% of those who presented with GTD. All the patients presented with vaginal bleeding. Suction evacuation (76.5%) was the commonest form of treatment offered to women with GTD. The commonest complication was anaemia (94.1%). Maternal death due to GTD was 8.8%. Most (58.8%) of the patients did not turn up for follow-up. Conclusion: Gestational trophoblastic diseases has remained an important cause of maternal morbidity and mortality in our hospital due to poor compliance with follow-up. Call and recall system should be introduced in the management of patients with GTD to improve compliance to management standard.

Profile of Gynaecological Malignancies in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Southeastern Nigeria

Background: Comprehensive estimates of the incidence of gynaecological malignancies reported from Nigeria are very limited due to limitation in record maintenance. Female cancer is a public health problem the world over. The malignancies of the female genital organs are major causes of morbidity and mortality which necessitates data for policy formulation and health planning. Aim: To establish the profile of gynaecologic malignancies reported in our centre, with reference to incidence, histological subtypes and frequency of involvement at various sites and to compare the procured data with those from other national and international centers. Materials and Method: In this descriptive retrospective study, the records pertaining to all the pathological specimens categorized as gynaecological malignancies from January 1st, 2013 to December 31st, 2015 at our facility were studied and compared with the available international data. Data analysis was done using Epi Info software version 7.2.1 (CDC Atlanta Georgia). Result: Two hundred and eleven (211) cases of gynaecological malignancies were seen during the study period and this constituted 13.4% of gynaecological admissions. Cervical malignancies were the commonest constituting 49.2% of all gynaecological malignancies followed by ovarian malignancies (27.8%), endometrial cancers (11.9%), vulva (5.6%), choriocarcina (3.9%) and vagina (1.6%). The data obtained was compared with data from Surveillance, Epidemiology and End Result (SEER) programme in the United States and European Union. All malignancies except cervical cancers affected a younger age group at our centre. Cervical cancers presented at a relatively more advanced stage, Ovarian cancers were more localized, whereas uterine, vulva and vaginal cancers presented at a similar stages as compared to Western data. Conclusion: This study presents a composite data of Gynaecological malignancies from Southeast Nigeria. Advanced stage of presentation of cervical cancers suggests lacunae in screening programmes available. Compared with Western data, ovarian malignancies were more localized at presentation for which environmental or genetic factors may be responsible.

A Study on the Attitude and Preference of Antenatal Clinic Attendees to Companionship during Labour and Delivery in Alex Ekwueme Federal University Teaching Hospital, Abakaliki

Background: Labour is a stressful physical and psychological experience in a woman’s life, requiring optimal coping mechanism. Companionship provides such needed support in this vulnerable moment of women. The presence of a companion of the woman’s choice had been noted to have a positive influence on her satisfaction with the birth process. Objectives: To ascertain the attitude of antenatal clinic attendees to companionship in labour and delivery and their preferred companions. Methods: A descriptive cross sectional study was conducted between 10th June 2016 and 28th July 2016 on 297 antenatal clinic attendees at Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The respondents completed an anonymous, self-administered questionnaire assessing the attitude of antenatal clinic attendees to companionship in labour and delivery and their preferred companions. The data was analyzed using EpiinfoTM version 7.1.5. Results: A total of 297 pregnant women participated in the study. They were mainly Igbos (93.27%), and Christians (96.97%). Their ages ranged from 18 - 50 years with most of them between 21 - 30 years (68.35%). Most of the women had tertiary education (48%), and were unemployed (36.36%). Ninety two percent of the respondents wished for companionship in labour, while 32.66% has had companion in previous delivery(ies). All of the women that had experienced companionship expressed satisfaction with it. Majority of them preferred their Partners/Husbands as companions (47%). Conclusion: Majority of our women were desirous of companionship and preferred their partners/husbands.

Profiling the Socio-Demographic Characteristics and Outcome of Preterm Delivery in Alex Ekwueme Federal University Teaching Hospital Abakaliki

Background: Preterm delivery is a major cause of perinatal morbidity and mortality globally. In more than half of the cases, the exact cause is unknown and it is largely unpredictable. Certain maternal, social and demographic characteristics are risk factors and often help to predict and prognosticate the neonatal outcomes. Objective: This study was designed to determine the maternal socio-demographic characteristics and neonatal outcomes of patients managed for singleton preterm delivery in Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Method: This was a 4-year retrospective analysis of patients managed for preterm birth from 1st January 2012 through 31st December 2015. Results: Over the study period there were a total number of 623 singleton preterm deliveries in the facility, while there were 9647 deliveries in the facility;the preterm birth rate was 6.5% or 65 per 1000 deliveries. The mean maternal age was 28.79 ± 5.33 while the mean parity was 1.89 ± 1.98. The mean gestational age and birth weight were 33.67 ± 2.62 and 2.30 ± 0.78 kg respectively. Apgar score in 1 minute was 6.89 ± 3.27, while in the 5th minute was 7.95 ± 3.42. Majority of the patients were multiparous and booked for antenatal care in the facility. Most of the preterm labour started spontaneously and were delivered vaginally. The caesarean section rate in this study was 35.5%. Fetal distress and preeclampsia/eclampsia were the commonest indications for caesarean section. The male to female ratio was 1.1:1. Nearly half of the neonates were born with normal birth weight and 427 (68.5%) were alive at discharge. However, 196 (31.5%) suffered early neonatal death due to prematurity. Maternal parity, booking status and fetal weight were significant determinants of fetal outcome with a p-value 0.05. Conclusion: Birth weight was the most important determinant of neonatal survival and the unbooked patient was an important determinant of poor outcome. Booking for antenatal care and ensuring optimal weight at delivery would go a long way at reducing the poor neonatal outcome associated with preterm delivery.

The Relationship between the Weight of the Placenta and Birth Weight of Term Neonate Delivered in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria

Background: The placenta is in a key position to determine the final birth weight of foetuses because adequate placental function is necessary for delivery of nutrients, oxygen, and hormones to the foetus. The relationship between the placental weight and birth weight of the neonates has been reported from several publications but such reports from Abakaliki are lacking in literature. Aim: To determine the relationship between the placental weight and birth weight of the neonates delivered at term at the Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Method: It was a retrospective study conducted between 1st January 2015 and 31st December 2015. The statistical analysis was done using Epi Info software version 7.2.1 (CDC Atlanta Georgia). Result: The mean birth weight was 3344 ± 488 g while the mean placental weight was 617 ± 78 g. The mean placental weight to birth weight ratio (PBWR X 100) was 19.94% ± 4.2%. Increase in birth weight of the neonate was associated with a corresponding increase in placental weight with a strong statistical significance level (P = 0.968). One thousand nine hundred and five (90.5%) patients had PBWR that ranged between 15% and 24%, which was associated with good immediate neonatal outcome. The placental weight to birth weight ratio outside this range was associated with increased admission into NICU and perinatal mortality at an odd ratio of 0.5844 and a statistical significance level (P) of 0.0036. Conclusion: There is a positive correlation between placental weight and birth weight of the neonate. Knowing the PBWR at birth may help to know the foetus at risk of immediate poor neonatal outcome in order to expedite actions to prevent possible poor perinatal outcome.

Post Episiotomy Morbidity among Parturient in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State

Background: Episiotomy is a very common obstetric surgery, and it could be associated with serious complications. However, these complications largely are not noticed due to the shift of attention from mother to baby, after a successful delivery. Objective: To identify the morbidities associated with episiotomies and factors associated with such morbidities. Method: This was a questionnaire based cross sectional descriptive study among women who attended the Obstetric Department of Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State, between 1st July and 31st Nov, 2023. The study population consisted of parturients who had episiotomies in their previous confinements, attending either the antenatal clinic or the postnatal clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State. Results: Macrosomia was the most common indication of episiotomy at a rate of 31.6%. The majority of episiotomies were performed on the parturients in their first confinement at a rate of 64.5% and the majority of repairs were performed by the Registrar at a rate of 65.0%. Informed consent was obtained from 45.79% of parturients while 54.21% were not informed before the episiotomy was administered. Only 55.3% of the parturient received analgesia before episiotomy was administered. The majority of the parturients had their episiotomy repaired between 10 - 15 minutes at a rate of 40.3%. Postoperative pain at the rate of 44.5% was the most common complication and dyspareunia as a form of sexual complication was the commonest at a rate of 31.3%. Conclusion: The parturient needs to be properly counselled before administration of episiotomy and adequate analgesia should be given, as episiotomy is a surgical procedure. Proper training of health workers on both the technique of administering and repairing episiotomy is important. Restrictive use of routine episiotomy in primigravidae is advised to reduce the rate of episiotomy.

Adjuvant Rectal Diclofenac for Post Operative Analgesia after Caesarean Section—A Randomized Controlled Study

BACKGROUND: Pain management following caesarean section still remains a challenge in our environment. Most potent analgesics are either not readily available or expensive. Diclofenac suppository is an NSAID that can be used for postoperative analgesia. It is available and affordable. OBJECTIVE: To compare the efficacy and safety of combined rectal diclofenac and intramuscular pentazocine with intramuscular pentazocine alone for post operative pain control following lower segment caesarean section. METHODOLOGY: A total of 120 women who met the selection criteria scheduled for caesarean section under spinal anaesthesia with bupivacaine were randomized into two equal groups to receive either 75 mg diclofenac suppository 12 hourly for 24 hours or one anusol suppository (the placebo) 12 hourly for 24 hours. Both groups received pentazocine as primary analgesia. RESULT: The primary outcome measure is the proportion of patients with severe pain at 24 hours using the visual analogue rating scale. Secondary outcome measures are the time from surgery to ambulation, Passage of flatus, maternal satisfaction and presence of complications. Statistical analysis was done using spss version 22 and graph pad statistical package. Student T-test was used for continuous variables whereas chi square was used for categorical variables P CONCLUSION: Adjuvant rectal diclofenac is superior to pentazocine alone in the management of pain after caesarean section. Less number of patients had moderate to severe pain at 24 hours post operation. Maternal satisfaction in relation to pain management is better with diclofenac suppository. The levels of complications were comparable in both groups.

Determinants and Outcomes of Pregnancies among Booked versus Unbooked Patients in a Tertiary Hospital South East, Nigeria

Background: Inadequate antenatal care, both in coverage and standard, has been linked with poor pregnancy outcomes. In a resource poor setting, home delivery is considered very cheap, but the possible outcome of such pregnancies has been a subject of interest. This study evaluated the association of booking status with pregnancy outcomes. Objectives: To examine the factors that influence booking and impact of the booking status on pregnancy outcomes. Methods: This was a hospital-based prospective cohort study of 240 (120 booked and 120 un-booked) pregnant mothers selected through systematic random sampling. The study was carried out at the Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. Chi-square test, t-test and logistic regression were used for analysis. Results: The mean age of the participants was 30.39 ± 5.05 years and 29.05 ± 6.36 years respectively for the booked and unbooked. Marital status (OR = 6.35, 95% CI = 1.24 - 32.59), educational status (OR = 36.40, 95% CI = 5.26-152.83), place of residence (OR = 0.15, 95% CI = 0.06 - 0.41), partner’s support (OR = 0.05, 95% CI = 0.01 - 0.37), family support (OR = 0.03, 95% CI = 0.01 - 0.13), mode of delivery (OR = 0.23, 95% CI = 0.12 - 0.46), APGAR score in first minute (OR = 6.02, 95% CI = 2.45 - 14.83) and NBICU admission (OR = 3.75, 95% CI = 1.67 - 8.43) were associated with booked status. However, being unmarried, nulliparity/grandmultiparity, low level of education, blue colar jobs, low income, rural dwelling and poor partner and poor family support were associated with the unbooked. The booked parturients had a better perinatal outcome compared the unbooked. Conclusion/Recommendation: There was high prevalence of operative deliveries, perinatal morbidity and mortality among the unbooked mothers. Girl child education, employment and poverty alleviation would improve antenatal care utilization.

RTO装置在低温甲醇洗尾气VOCs治理中的工业应用

煤化工领域低温甲醇洗排放尾气的VOCs治理近年来得到了广泛关注。介绍了五室RTO工艺的原理、流程及在晋控金石化工公司低温甲醇洗尾气VOCs治理中的应用。装置运行情况表明:RTO装置可满足低温甲醇洗尾气VOCs治理的各项技术和环保要求,排放烟气满足相关标准;装置废气年处理量可达4.8×10^(4)万m^(3),排放烟气中的非甲烷总烃质量浓度降至10 mg/m^(3)~30 mg/m^(3);在处理废气中VOCs的同时可副产低压蒸汽,产生一定的经济效益。

Predictors of Abnormal Vaginal Discharge among Women of Reproductive Age in Southeast Nigeria

Background: An abnormal vaginal discharge is a common complaint among women of reproductive age, and it can indicate serious conditions like pelvic inflammatory disease and cervical cancer. This study aimed to assess the predictors of abnormal vaginal discharge in women of reproductive age group in Imo State, Southeast Nigeria. Methods: A cross-sectional study was conducted among 368 women of reproductive age group attending the clinic at Federal University Teaching Hospital Owerri, in Imo State, Nigeria. Respondents were recruited using a systematic sampling technique. Data were collected using a pre-tested interviewer-administered questionnaire. Multivariable analysis was performed to determine predictors of abnormal vaginal discharge. Statistical significance was set at p Results: The mean age of the respondents was 30 ± 4.5 years. Predictors of abnormal vaginal discharge were: age 36 - 45 years (OR: 4.5;95% C.I: 1.023 - 8.967, p = 0.041), being a student (OR: 2.4: 95% C.I: 1.496 - 7.336, p = 0.003), use of oral contraceptives (OR: 3.4;95% C.I: 1.068 - 6.932, p = 0.010), use of water cistern (OR: 4.7;C.I: 1.654 - 5.210, p = 0.028) anal hygiene practices (OR: 2.7;95% C.I: 1.142 - 4.809, p Conclusion: These findings suggest that targeted sexual and reproductive health interventions should be provided to reduce the risk of abnormal vaginal discharge in women of reproductive age group.

食品中赭曲霉毒素A检测方法研究进展

赭曲霉毒素是一种丝状真菌毒素,有A、B、C、D 4种化合物,受其污染的食品会对人体产生危害,尤其是赭曲霉毒素A的危害最为突出。目前,对食品中赭曲霉毒素A的检测方法主要有薄层色谱法、高效液相色谱法、液相色谱-串联质谱法、酶联免疫法、电化学传感器法以及荧光分析法,笔者通过梳理、分析上述检测方法的优缺点,提出:薄层色谱法、酶联免疫吸附等传统方法可在灵敏度和准确性等方面提升;高效液相色谱、液相色谱-串联质谱法等相对比较成熟的方法可在成本、选择性上进一步优化;电化学传感器、荧光传感器等这些具有绿色性和创新性的检测方法,如在电极材料制备技术、核酸适配体筛选及修饰技术上再提高,其应用前景必将更加广泛。

植物源抗氧化剂有效成分的提取研究进展

植物源抗氧化剂不但具有抗氧化功效,而且安全、无残留。分析溶剂提取法、超声波辅助提取法、超临界流体萃取法、微波辅助提取法及酶提取法等对植物源抗氧化剂有效成分提取效率的影响,为植物源抗氧化剂的提取与应用提供参考。

Significance of fostering the mental health of patients with diabetes through critical time intervention

BACKGROUND Critical time intervention(CTI)is an evidence-based model of practice that is time-limited and aims to provide support for most susceptible individuals during a transition period.AIM To examine the significance of fostering the mental health of diabetes patients through CTI using the scoping review methodology.METHODS As part of the scoping review process,we followed the guidelines established by the Joanna Briggs Institute.The search databases were Google Scholar,PubMed,Scopus,PsycINFO,Reference Citation Analysis(https://www.referencecitation-analysis.com/),and Cochrane Library.From these databases,77 articles were retrieved with the aid of carefully selected search terms.However,19 studies were selected after two reviewers appraised the full texts to ensure that they are all eligible for inclusion,while 54 papers were excluded.RESULTS This study revealed that diabetic patients who had experienced homelessness were at higher risk of being diagnosed with mental illness and that social support services are impactful in the management of the comorbidity of diabetes and mental health problems.In addition,this review reveals that CTI is impactful in enhancing the mental health of homeless patients during the transitional period from the hospital through social support services.CONCLUSION CTI is a promising intervention for alleviating mental health symptoms in homeless patients.Empirical studies are needed across the globe,involving both hospitalized and community-based patients,to determine how clinically effectively CTI is in managing the mental health of diabetics.

Culture, Beliefs, Attitude and Peer Group Influence on Female Genital Mutilation in Southeast Nigeria

Background: Female Genital Mutilation is still practiced in Ebonyi State in Southeast Nigeria, despite the complications that follows it and government legislation against the practice. Aim: To determine the impact of Culture, Beliefs, attitude and Peer Group Influence on the persistence Female Genital Mutilation practice in the State especially in the rural areas. Materials and Methods: Qualitative study that used Focused Group Discussion and In-depth interviews for data collection. Those willing and given consent were recruited into the group discussion according to age, marital status, educational level and their location in the state. In-depth interviews were used with the Stake Holders, Opinion Leaders, Traditional Rulers and the Clergy. Result: A total of 454 participants were recruited from the 13 local government areas of Ebonyi State but only 420 (92.5%) participated. The age ranges of participants were 25 to 35 years for single males and females while the married participants male and female were aged 35 to 70 years. One hundred single females (23.8%) and 94 single males (21.4%) participated while 97 (23.1%) married women and 95 (22.6%) married men participated. Out of the 26 health workers recruited only 22 (5.2%) participated. Four traditional rulers, 4 women leaders, 4 youth leaders and 2 clergy 12 (2.9%) in number had in-depth interviews. All the participants had knowledge of FGM and its practice. Rural health workers are getting more involved. ‘Female Genital Crushing’ is replacing actual cutting. The participants all agreed there is no benefit and the practice should stop. Conclusion: Female Genital Mutilation is secretly practiced and is getting replaced by “Female Genital Crushing” perpetrated by rural health workers as well as mothers, fathers, traditional birth attendants and the peer group playing a major role with low knowledge of the Law against Female genital mutilation.

Sub-Differential Characterizations of Non-Smooth Lower Semi-Continuous Pseudo-Convex Functions on Real Banach Spaces

In this paper, we characterize lower semi-continuous pseudo-convex functions f : X → R ∪ {+ ∞} on convex subset of real Banach spaces K ⊂ X with respect to the pseudo-monotonicity of its Clarke-Rockafellar Sub-differential. We extend the results on the characterizations of non-smooth convex functions f : X → R ∪ {+ ∞} on convex subset of real Banach spaces K ⊂ X with respect to the monotonicity of its sub-differentials to the lower semi-continuous pseudo-convex functions on real Banach spaces.

Prevalence and Viral Load Determination of Hepatitis B Virus among Hiv Seropositive Patients Attending Kogi State Specialist Hospital Lokoja, Kogi State

Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) share common risk factors and HBV occurs in people with HIV resulting in an increased risk for HIV/HBV co-infection. Globally, hepatitis B virus infection is of serious public health causing morbidity and mortality. The increasing incidence of liver diseases caused by HBV is emerging as a significant cause of morbidity and mortality among HIV-infected individuals. A clearer knowledge of HBV prevalence in Kogi State is important in order to educate, inform the population and control epidemics through extensive vaccination and treatment programme. The aim of this study was to determine the seroprevalence of Hepatitis B infection and to evaluate molecularly HBV infection among HIV seropositive individuals. Sera samples were obtained from 218 consented HIV participants and screened for HBsAg using the commercial membrane based rapid qualitative test kit and real-time PCR was performed using Tianlong to assay the virus quantitatively. A structured questionnaire was used to collect information on patient’s demographic variables and risk factors for HBV transmission. Overall, 17 of the participants were seropositive to HBsAg. There was a significant difference between the age distribution with (P-value = 0.006) and marital status with (P-value = 0.044). Type of marriage, occupation, place of residence and risk factors associated with HIV and HBV co-infection do not show significant differences. A total of 17 HBsAg positive samples were subjected to viral load analysis, out of which 7 were highly unsuppressed, 5 were suppressed while the remaining 5 were undetectable. This study confirmed a moderately high HIV/HBV co-infection rate (7.8%). The highly unsuppressed viral load obtained from the study is a potential risk for Hepatocellular carcinoma among the study population. Enlightenment programme on routes of virus acquisition with a view to reducing the morbidity and mortality of HIV/HBV co-infection should be intensified.

Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G6P1+4 with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.