Investigation of natural radionuclides and radiation shielding potential of some commonly used building materials in Northwestern Nigeria.

This study assessed the gamma-ray shielding potential of clay, sand, gypsum and kaolin commonly used as a building material in Northwestern, Nigeria. The radiological status of the samples was first evaluated by determining the activity concentrations of 238U, 232Th and 40K using NaI (Tl) detector after which elemental composition and mass density were determined using Neutron Activation Analytical Technique. After which the mass attenuation coefficients (MAC), linear attenuation coefficients (LAC), half value layer (HVL), tenth value layer (TVL), and effective atomic number (Zeff) were determined experimentally and theoretically using standard point sources of 137Cs and 60Co photon peaks (0.662 and 1.332, 1.173) MeV and Py-MLBUF software. The activity concentrations were found to range from 51 to 59 Bq kg-1 with a mean value of 59 Bq kg-1 for 238U, 24 to 27 Bq kg-1 with a mean value of 29 Bq kg-1 for 232Th, and 219 to 247 Bq kg-1 with a mean value of 247 Bq kg-1 for 40K which were about within the world recommended values of 33, 45 and 420 Bq kg-1 respectively. The results of the elemental compositions show that Si, Al, K, Fe, and Ba in clay and sand samples have concentrations in the range of 36.83-78.48%, 1.92-26.05%, 6.33-21.96%, 2.39-19.09%, and 0.09-1.44%, respectively, while in kaolin and gypsum, results revealed that Si, Al, K, Fe, and Ca range between 0.34 and 65.52%, 1.14-35.82%, 0.00-12.12%, 0.00-5.77%, and 0.00-96.6%, respectively. However, the concentrations of other elements such as Mg, Ti, Mn, Zn, Na, and Ba varied significantly with the samples. The results showed that clay has an average density of 1.96 g/cm3, sand has 2.32 g/cm3, kaolin has 2.63 g/cm3, and gypsum has the highest density with a value of 2.66 g/cm3 compared to other samples. During the measurements, a thallium-activated sodium-iodide NaI (TI) detector was used. A narrow beam transmission geometry condition was adopted for the measurements to ensure minimal scattered radiation. Absorption and attenuation of gamma beams as a function of sample thickness against gamma energy generally exhibit an increasing gamma ray behaviour as the sample thickness increases from 1 to 3 cm. The results showed that the gypsum, kaolin, sand, and clay were capable of attenuating 63.5%, 61.5%, 58.4%, and 44.2 of gamma-ray photons of energy 0.662 MeV at 3 cm thickness %, respectively, and 40.6%, 32.9%, 30.6%, and 27.3% of gamma energy 1.332 MeV at 3 cm thickness, respectively. The results showed that MAC, LAC, and Zeff of all the samples decreased with an increase in photon energy, while those of HVL and TVL increased. The experimental results for all the gamma-ray shielding parameters were found to be in good agreement with the theoretical values obtained using Py-MLBUF. The results have shown that all the samples have similar photon attenuation behaviours; however, gypsum has the best shielding potential than kaolin and this is attributed due to its highest density value.

Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria.

BACKGROUND: High HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria. METHODS: A cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software. RESULTS: Of 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48, p = 0.009), postmenopausal status (aOR = 7.69, p = 0.000), and women with no history of prior IUCD use (aOR = 5.94, p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17, p = 0.000), prior use of IUCD (aOR = 0.32, p = 0.004), prior use of condom (aOR = 2.50, p = 0.003) and had co-morbidities (aOR = 0.46, p = 0.009) were more likely to have had a Pap test in the past. CONCLUSIONS: The majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions.

RARE PRESENTATION OF FLORID VULVA WARTS - A CASE REPORT AND REVIEW OF LITERATURE.

Background: Condyloma acuminata is an extremely common cutaneous sexually transmitted disease often diagnosed clinically, on the basis of its warty, cauliflower, and verrucous appearance. It is caused by the "low risk" Human papillomavirus types 6 and 11 in 90 percent of cases. The immune system plays a critical role in determining the course of viral infection, with immune-suppression and advanced age increasing the risk for long term wart persistence. Treatment options include the use of a wide variety of topical medications as well as surgical excision by cauterisation. Patient: A rare case of florid vulvar warts in a 21-year old nulliparous immuno-competent woman is presented and the literature reviewed. She had a 7-month history of progressive vulva swelling with associated itching, contact bleeding, and malodorous discharge. It measured about 14 × 10 cm in dimensions, occupying the posterior two-thirds of the labia majora and minora and obliterating the posterior commissure. Intervention: There was no positive response to Podophyllin application, however, it was eventually excised and histologic analysis excluded malignancy. Conclusion: Florid vulvar warts though rare in immune-competent patients, could occur. Patients with persistent and recurrent infection often require surgical procedures as was performed in our patient with the possibility of speedy recovery and restoration of normal anatomy and cosmesis.

Methylated spirit versus chlorhexidine gel: A randomized non-inferiority trial for prevention of neonatal umbilical cord infection in Jos, North-Central Nigeria.

BACKGROUND: Omphalitis is an important cause of neonatal sepsis (NNS) and mortality. Quantitative estimates of risk of omphalitis-related neonatal death is about 10%-19%. Topical applications of antiseptics have been shown to reduce this risk burden but has not been well investigated. AIM: To demonstrate non-inferiority of methylated spirit to chlorhexidine (CHX) gel for prevention of omphalitis, NNS and mortality at day 28. METHODS: This was a randomized, non-inferiority trial of methylated spirit versus CHX gel with 161 and 162 mother-baby pairs, respectively, conducted between July 2017 and May 2018. SPSS version 23.0 was used for data analysis to examine for incidence of omphalitis, time-to-cord separation, NNS and mortality. Relative risk and 95% confidence interval were used as point and interval estimates, respectively, with a non-inferiority margin of 10% set for CHX gel while a P values <0.05 was statistically significant. RESULTS: The median age of newborns was 18 h; (IQR: 8-24) h with the risk of omphalitis being 2% higher with CHX gel compared to methylated spirit (RR = 1.020; 95% CI; 0.988-1.053; P = 0.053). The median times-to-cord separation were 7.0 days (IQR: 2-17) and 7.0 days (IQR: 2-18) for methylated spirit and CHX gel, respectively (mean difference: ‒0.2145; 95% CI = ‒0.9085-0.4759; P = 0.544). There was no difference in the risks of NNS and mortality among those treated with methylated spirit compared to those exposed to CHX gel (RR: 1.0; 95% CI = 0.984-1.017; P = 1.000) and (RR: 1.0; 95% CI = 0.994-1.018; P = 0.986) respectively. CONCLUSIONS: There is no evidence that 96% methylated spirit is inferior to 4% CHX gel in preventing neonatal omphalitis; hence, it may be considered a safe and effective alternative where CHX gel is unavailable.

"Anterior interosseous nerve syndrome (Kiloh Nevin Syndrome) revealing Gantzer muscle and simultaneous myasthenia gravis".

There hasn't been a previous case report of the anterior interosseous nerve injury secondary to the presence of the muscle of Gantzer in a patient with myasthenia gravis in literature before. The anterior interosseous nerve compressive syndrome, also known as Kiloh-Nevin syndrome, is a rare disorder comprising less than 1% of all upper limb neuropathies. Establishing the etiology of anterior interosseous nerve compressive syndrome is challenging because of the lack of specific clinical findings or testing. Herein is the case of a 46 years-old male presented with left eye ptosis, ophthalmoparesis, diplopia, and right-hand weakness. On physical examination, the Pinch Grip test was positive. Electromyography studies showed neurogenic atrophy in the muscles innervated by the anterior interosseous nerve, as well as a pathological decrement of the muscle action potential of more than 10% on repetitive nerve stimulation. Concluding that the presence of the Gantzer muscle caused anterior interosseous nerve compressive syndrome was mainly a diagnosis of exclusion, after careful consideration of other possible etiologies including carpal tunnel syndrome, cervical radiculopathy, and Parsonage-Turner Syndrome. Even though anterior interosseous nerve compressive syndrome is very rare, clinical suspicion ought to arise in the presence of weak radial flexor digitorum profundus and flexor pollicis longus muscles. This case highlights the importance of a thorough medical history, a meticulous physical examination, and particularly the significance of electromyography studies in diagnosing different neuropathological entities. When appropriate, these steps offer information crucial to the differential diagnosis and eventual surgical management, assisting physicians in making informed and accurate treatment decisions.

Application of the research electronic data capture (REDCap) system in a low- and middle income country- experiences, lessons, and challenges.

The challenges of reliably collecting, storing, organizing, and analyzing research data are critical in low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa where several healthcare and biomedical research organizations have limited data infrastructure. The Research Electronic Data Capture (REDCap) System has been widely used by many institutions and hospitals in the USA for data collection, entry, and management and could help solve this problem. This study reports on the experiences, challenges, and lessons learned from establishing and applying REDCap for a large US-Nigeria research partnership that includes two sites in Nigeria, (the College of Medicine of the University of Lagos (CMUL) and Jos University Teaching Hospital (JUTH)) and Northwestern University (NU) in Chicago, Illinois in the United States. The largest challenges to this implementation were significant technical obstacles: the lack of REDCap-trained personnel, transient electrical power supply, and slow/intermittent internet connectivity. However, asynchronous communication and on-site hands-on collaboration between the Nigerian sites and NU led to the successful installation and configuration of REDCap to meet the needs of the Nigerian sites. An example of one lesson learned is the use of Virtual Private Network (VPN) as a solution to poor internet connectivity at one of the sites, and its adoption is underway at the other. Virtual Private Servers (VPS) or shared online hosting were also evaluated and offer alternative solutions. Installing and using REDCap in LMIC institutions for research data management is feasible; however, planning for trained personnel and addressing electrical and internet infrastructural requirements are essential to optimize its use. Building this fundamental research capacity within LMICs across Africa could substantially enhance the potential for more cross-institutional and cross-country collaboration in future research endeavors.

Draft Genome Sequences of Mycoplasma mycoides subsp. mycoides Strains APF9 and AP108, Isolated in Nigeria in 2014 to 2016.

Mycoplasma mycoides subsp. mycoides is the etiological agent of contagious bovine pleuropneumonia (CBPP). While several findings on CBPP prevalence in Nigeria were documented, no data were reported about the genomic characterization of Nigerian M. mycoides subsp. mycoides strains. Here, we present the draft genome sequences of two novel M. mycoides subsp. mycoides strains isolated in Nigeria.

Eukaryotic initiation factor 4E-binding protein 1 (4E-BP1): a master regulator of mRNA translation involved in tumorigenesis.

Protein synthesis activity is abnormally enhanced in cancer cells to support their uncontrolled growth. However, this process needs to be tightly restricted under metabolic stress-a condition often found within the tumor microenvironment-to preserve cell viability. mTORC1 is critical to link protein synthesis activity to nutrient and oxygen levels, in part by controlling the 4E-BP1-eIF4E axis. Whereas mTORC1 and eIF4E are known pro-tumorigenic factors, whose expression or activity is increased in numerous cancers, the role of 4E-BP1 in cancer is not yet definitive. On the one hand, 4E-BP1 has tumor suppressor activity by inhibiting eIF4E and, thus, blocking mRNA translation and proliferation. This is corroborated by elevated levels of phosphorylated and hence inactive 4E-BP1, which are detected in various cancers. On the other hand, 4E-BP1 has pro-tumorigenic functions as it promotes tumor adaptation to metabolic and genotoxic stress by selectively enhancing or preventing the translation of specific transcripts. Here we describe the molecular and cellular functions of 4E-BP1 and highlight the distinct roles of 4E-BP1 in cancer depending on the microenvironmental context of the tumor.

Treatment Discontinuation in Adult HIV-Infected Patients on First-Line Antiretroviral Therapy in Nigeria.

BACKGROUND: Retention in care and treatment services is critical to health outcomes of individuals diagnosed and living with HIV. We evaluated the incidence of and risk factors for treatment discontinuation (TD) in a large adult HIV population on ART in Nigeria. METHOD: A retrospective cohort study of adult HIV patients initiated on first-line ART between 2004 and 2011 at the Jos University Teaching Hospital (JUTH) in Nigeria. Follow up information of participants was retrieved from various sources (patient visit database, pharmacy data and patients charts) up to the end of 2012. The primary study endpoint was TD, defined as discontinuation of ART for any reason, including death or loss to follow-up (lack of pharmacy pick-up for periods≥12 months). The Incidence and hazard for TD were estimated by Kaplan-Meier and Cox proportional regression analysis, respectively. RESULT: Overall, 3,362 (28%) patients discontinued treatment during 49,436 person-years (py) of follow-up (incidence rate (IR) 6.8 TD per 100 py). The hazard of treatment discontinuation decreased with increasing age (adjusted hazard ratio (aHR 0.99; 95% CI 0.98-0.99). Other independent risk factors for treatment discontinuation were: being unmarried (aHR 1.24; 95% CI: 1.12-1.38), having primary or secondary level of education as compared to tertiary level education (aHR 1.24; 95% CI: 1.12-1.40) and average percent adherence to drug refill visits<95% (adjusted hazard ratio (aHR) 2.13; 95% CI: 1.9-2.40). Compared to tenofovir, greater hazard of TD was noted in patients initiated on ART containing didanosine (aHR) 1.73; 95% CI: 1.03-2.91), but lower in those initiated on zidovudine containing regimen (aHR 0.77; 95% CI: 0.69-0.86). CONCLUSION: Long-term treatment discontinuation rate in this study was comparable to estimates in resource-rich countries. Younger patients, as well as patients with lower educational levels and those with poor adherence had significant hazards for treatment discontinuation and should be the target of interventions to reduce treatment discontinuation and improve retention, especially within the first year of ART.

BODY WEIGHT CHANGES IN WOMEN USING IMPLANON IN JOS, NIGERIA.

BACKGROUND: The fear of weight gain is one of the adverse events that make women to discontinue Implanon® (etonorgestrel) contraceptive. Black women are more prone to gain weight with the use of such progestogen-only contraceptives than women of other racial groups. The weight of women is also an important consideration since it influences the concentration of the active drug and may predispose to failure at a higher weight profile.Information on weight changes with the use of etonorgestrel implant is scarce in our sub-region. We therefore explored the direction and extent of weight changes among women in different weight categories and determined the predictors of the final body weight during use of Implanon®. MATERIALS AND METHOD: This was a retrospective study of all women that accepted implanon at the Family Planning Unit of the Jos University Teaching Hospital, Jos Nigeria from March 2007 to March 2014. Data analysis was carried out using Stata version 12.1. The socio-demographic data and reproductive histories were extracted from the records and the duration of use of the implant, reasons for discontinuation and the initial weight and at follow up were analysed. RESULTS: Over 99% of the women who had Implanon® were parous and the commonest contraceptive they had used previously was the injectables. However, almost a quarter (22.8%) were accepting Implanon® as their first ever contraceptive method. The mean baseline weight was 64.4 ± 12.1 kg and the median weight was 63.0 kg. The average months of use of Implanon® in this study was 27 months and there was a mean increase in body weight of 2.5 kg during the study. However, there was a broad variability in the individual change in body weight with about 38.6% losing weight or not having any net weight change. Over three-fifths (61.4%) of the women had a net weight gain while using Implanon®. Of these women, 36.0% gained 1-5 kg, 19.2% gained 6-10 kg, 4.2% gained 11-15 kg and 2.0% gained more than 16 kg with the maximum gain at 26 kg. The mean weight changes were 0.8 kg, 1.6 kg, 3.2 kg and 3.3 kg respectively for the first, second, third and fourth years of Implanon® use respectively. Implanon® was removed on account of weight gain in 3.8% of those women who had removed the implant. There was no statistically significant difference in weight gain among the different weight categories: women who had an initial weight above 90 kg gained less than 1 kg compared to those who had normal weight (for this study <70 kg) at the baseline that gained on average more than 2.0 kg. The most significant predictor of the final body weight with Implanon® use was the initial body weight which predicts it in 83.5% of the time (p-value 0.000, CI 0.99, 1.05). CONCLUSION: There was a broad variability in weight changes with the use of Implanon® and the initial body weight is the most significant predictor of the final body weight. Therefore implanon can be used by women of all weight categories including those considered to be obese.

DECLINING PREVALENCE OF HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS AMONG FEMALE SEX WORKERS IN JOS, NORTH-CENTRAL NIGERIA.

BACKGROUND: Female Sex Workers (FSWs) are key reservoirs of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) from which transmission to the general population fuels epidemics. STIs amplify HIV infectiousness and susceptibility. We determined the status of HIV and STIs among brothel-based FSWs in Jos as part of an ongoing prevention intervention. METHOD: Between January and May 2012, consenting consecutive brothel-based FSWs were recruited from previously designated brothels across Jos. HIV counseling and testing as well as screening for gonorrhoea, syphilis, trichomonasis, candidasis and Bacteria vaginosis (BV) were performed. Positive cases were provided free treatment and follow-up at Solat Women Hospital, Jos. Ethical clearance was obtained from Jos University Teaching Hospital (JUTH) ethical committee. RESULT: Two hundred FSWs aged 27.6 ± 4.6 years (range 15-55 years) were recruited and of these, 47 (23.5%) were HIV Positive, 20 (10.0%) had syphilis, 9 (4.5%) had Neisseria gonorrhea, 3 (1.5%) had Trichomonas vaginalis and 86 (43.0%) had BV. The association between HIV and bacterial vaginosis was statistically significant (OR of 2.2, 95% CI of 1.1-4.2, P-value=0.02). In comparison to similar prevalence in 2006, the current findings represent 51.5% decline in HIV prevalence, 40.8% decline for syphilis and over 83.3% decline in prevalence for Trichomonas vaginalis. There was no significant change in the prevalence of Neisseria gonorrhoea and BV. CONCLUSION: The prevalence of HIV and STIs among brothel-based FSWs in Jos remain unacceptably high, although, there is a declining trend. A comprehensive HIV prevention program targeting these women is required to block transmission to the general population.

Non-intubated Ambulatory Anaesthesia for Diagnostic gynaecological laparoscopy.

BACKGROUND: General endotracheal relaxant anaesthetic technique is favoured for laparoscopic gynaecological procedures, in order to prevent inadequate ventilation, regurgitation and aspiration resulting from pneumoperitoneum and steep trendelenburg position during the procedure. However, simple brief laparoscopic procedures have been performed safely over the years in adult population using alternative airway devices. We report our experience over a fifteen-year period, of using general anaesthesia by face mask ventilation for short diagnostic laparoscopy in gynaecologic practice. PATIENTS & METHODS: A retrospective, cross- sectional observational study involving 823 consecutive elective patients for diagnostic gynaecological laparoscopic procedures. The 823 patients were classified as American society of Anesthesiologists (ASA) I or II patients and were studied over the fifteen year period. They were all premedicated with atropine & metoclopramide after overnight fast, and had general anaesthesia by facemask with assisted ventilation; using thiopentone for induction, paracetamol & piroxicam for analgesia and oxygen-halothane via Bain's breathing circuit for maintenance. Monitoring procedures employed in this study included pulse rate (PR), non-invasive blood pressure (NIBP) and oxygen saturation (SPO2). RESULTS: Out of a total of 823 patients studied, majority (93.8%) of the patients were investigated for infertility. The mean duration for the procedure was 18.2±2.5 minutes. The complications observed included post-operative nausea and vomiting in 58(7.0%) of the patients, regurgitation & desaturation in 2(0.2%) of patients each, while laryngeal spasm & colonic insufflations each occurred in 1(0.1%) patient. Three patients (0.3%) had unplanned admission for observation overnight. There was no case of mortality. CONCLUSION: General anaesthesia by facemask ventilation is a safe alternative to endotracheal intubation for short diagnostic gynaecological laparoscopy when fasting guidelines are observed.

Total abdominal hysterectomy for benign gynaecological conditions at a University Teaching Hospital in Nigeria.

BACKGROUND: Hysterectomy is one of the most commonly performed major gynaecological procedures in women. Total abdominal hysterectomy (TAH) for benign disorders is commonly performed in Jos University Teaching Hospital and this study aimed at ascertaining its frequency in relation to other major gynaecological operations, demographic features of the patients, indications and safety of the procedure in this institution. MATERIALS AND METHODS: A retrospective descriptive study of consecutive patients who had elective total abdominal hysterectomy performed for various benign indications during the study period from January 2001 to December 2008 was conducted. Data extracted from the case files included age, parity, presenting symptoms, indications for the surgery, intraoperative findings and post-operative complications. Data was analysed with 2008 EPI-info version 3.5.1. RESULTS: Total abdominal hysterectomy accounted for 18.2% of all major gynaecological operations. Majority of the women were in their fifth decade of life (65.9%) and parity of five and above (46.4%). The most common indications were uterine fibroid with or without menorrhagia (60.6%) and cervical intraepithelial neoplasia (27.0%). Post-operative morbidity was recorded in 40 (17.7%) of cases. Post-operative wound infection (52.5%) and fever (30.0%) accounted for the majority of the complications. There was no mortality. CONCLUSIONS: Total abdominal hysterectomy for benign conditions is relatively common and safe in this centre. The review of the antibiotic regimes for chemoprophylaxis may help in reducing the post-operative infection rate associated with the operation.

Substance abuse among antenatal patients at jos university teaching hospital, north central Nigeria.

BACKGROUND: Substance use in this country, among pregnant women, is a recent phenomenon as our women embrace western culture. More worrisome is the current finding showing no 'safe' level of alcohol exposure for possible adverse effect or harm to the developing child to occur. AIMS AND OBJECTIVES: To determine what substances are used and the prevalence of substance use among pregnant women attending the antenatal clinic of the Jos University Teaching Hospital, Jos, Northcentral Nigeria. DESIGN: Cross-sectional study. SETTING: Jos University Teaching Hospital. RESULTS: A total of 557 women were administered the pre-tested questionnaire. The mean age was 29.1 years, with a range of 15 to 48 years. The prevalence rate of substance used among the pregnant women was 43.8%. In all, 244 of the 557 women were taking one substance or the other. About 61.9% of the women abuse Kolanuts. There was no significant difference in the age group between those who sue it and those who do not (p-value 0.7411). Other substances were chlorpheniramine 10.6%, alcohol 8.6%, diazepam 4.5% and promethazine 2.5%, cigarettes/tobacco 2.9%, phenobarbitone 2.9%, cocaine 2.5%, codeine 2.0%, and marijuana 1.6%. A significant number 22.8% admit to using other substances in pregnancy. The commonest reason given for substance use is to control nausea and vomiting of early pregnancy. CONCLUSION: Nigerian pregnant women use and abuse a wide variety of substances and drugs during pregnancy just as their counterparts in the developed world. The high prevalence observed in this study was largely due to the consumption of locally available substances.

Withholding breast milk for HIV exposed infants in sub-Saharan Africa: benefit or harm?

Feeding options for HIV exposed infants has remained topical and controversial in most settings of sub-Saharan Africa. This commentary, expresses the author's opinions on this topical issue for and against breastfeeding or infant formula, with supporting evidence drawn from relevant literature on researches conducted in settings of sub-Saharan Africa. At the moment, it seems sensible to recommend that health care workers and policy makers should explore the options of making breastfeeding safer rather than withholding it for sub-Saharan African HIV exposed infants. It is hoped that when Highly Active Antiretroviral Therapy (HAART) becomes universally accessible and available to HIV infected women in sub-Saharan Africa, breast milk HIV transmission will be a rare event and the health benefits of breastfeeding for the infant and mother will be maximized.

Ectopic pregnancy in Jos Northern Nigeria: prevalence and impact on subsequent fertility.

BACKGROUND: Ectopic pregnancy remains a major gynaecological problem in contemporary gynaecological practice. Not only do women die from this disease, but also of greater clinical importance is the indirect morbidity of poor fertility prognosis and adverse outcome in subsequent pregnancies. We were interested in documenting the prevalence of ectopic pregnancy and its impact on subsequent fertility. METHODOLOGY: This retrospective descriptive study was done at the Jos University Teaching Hospital. The case notes of all patients who had tubal ectopic pregnancy managed in JUTH between January 1997 and December 2000 were retrieved. Subsequent fertility and reproductive outcome were assessed among women who reported back for follow up fora minimum period of twelve months post surgery. The data was analyzed using frequencies. RESULTS: During the study period, January 1997 and December 2000 a total of 168 ectopic pregnancies were managed and 9,638 deliveries occurred during the same period. This gives a prevalence rate of 1.74%. Of the 168 cases of ectopics, 130 case records containing relevant information were retrieved (77.4%) and this constituted the sample population for the study. Majority (53.8%) of the women were between 20 and 29 years. Majority of the women were either nulliparous or primiparous (23.8% and 20.0% respectively). Tubal rupture occurred in 86.9% of the women at the time of laparotomy. Total salpingectomy was the surgical modality in 77.7% of the cases. The right fallopian tube was affected in 66.2% and the left 33.8% of the cases. The contralateral fallopian tube was grossly normal in 73.1% of cases. Of the 64 women who were followed up for a minimum of 12 months, 40.6% achieved viable intra uterine pregnancies, 6.3% had a repeat ectopic pregnancy in the contra lateral tube and 53.1% were unable to achieve pregnancy. CONCLUSION: Ectopic pregnancy is prevalent in our environment affecting mainly young women of low parity who desire future pregnancies. The subsequent impact on future fertility of these women could be improved if efforts are focused on early diagnosis to prevent tubal rupture. Early diagnosis prior to rupture offers opportunity for medical management and conservative surgical procedures that are proven to improve future fertility prognosis.

Underutilization of vaginal hysterectomy and its impact on residency training.

BACKGROUND: The advantages of vaginal hysterectomy over abdominal hysterectomy include lower morbidity, shorter hospital stay, and reduced cost to the patient. It is, therefore, important to pass the required skill for vaginal hysterectomy unto trainees. OBJECTIVE: To determine the proportion of vaginal hysterectomies done in a residency training institution in Nigeria and its possible impact on the proficiency of future gynaecologists in performing the procedure. METHODS: A chart review was done on all documented cases of hysterectomies for benign gynaecological conditions done in Jos University Teaching Hospital, over a four-year period (January 2002 to December 2005). Case files of patients who had hysterectomy during the study period were retrieved and the relevant information obtained for analysis of frequencies and percentages. RESULTS: A total of 94 hysterectomies for benign gynaecological conditions were done during the study period. Nine (10%) vaginal hysterectomies were done. All the vaginal hysterectomies performed were for uterovaginal prolapse by consultants. However, 45 (53%) of the abdominal hysterectomies were performed by consultants and 40 (47%) by residents. CONCLUSION: This study suggests that residents exposure and training on the act of vaginal hysterectomy is inadequate. This has potential implications on future gynaecologist proficiency to perform this method of surgery that has documented advantages and better outcome for patients.

The impact of HIV/AIDS epidemic on the choice of specialties among medical students and house officers in Jos, Nigeria.

BACKGROUND: HIV/AIDS is a scourge that has seriously compromised the lives of millions of people, especially those living in sub-Saharan Africa. With continued high prevalence, there is a high risk of healthcare workers, especially those in the surgical specialties, acquiring the infection. This study was done to investigate the impact of HIV on the choice of surgical specialties in a training institution located in Jos, north-central Nigeria. We hypothesized that the awareness of the risk of acquiring infections associated with surgical practice has no significant impact on the choice of surgical specialties among final-year medical students and house officers at our institution. METHOD: A cross-sectional questionnaire based survey was conducted on final-year medical students and house officers during their training in Jos University Teaching Hospital (JUTH), Jos. Two hundred questionnaires were randomly distributed to final year medical students and house officers who volunteered to participate in the survey. The completed questionnaires were returned to the researchers and information obtained was analyzed using Epi info 3.3. RESULTS: Of the 200 questionnaires distributed, 135 with relevant information were returned for analysis, giving a response rate of 67.5%. Of these respondents, 96.3% said they planned to specialize after their basic medical training and the majority of these (97.8%) were aware of the increased risk associated with surgical specialties, with 83.7% acknowledging the transmission of HIV and hepatitis B as being the greatest risk. About 53.0% of the respondents said they planned to pursue surgical specialties. Fifty three percent (53.3%) and sixteen percent (16.3%) based their choice of specialty on job satisfaction and favourable work schedule respectively. The knowledge of the risk of acquiring HIV/AIDS affected choice of specialty in only 21% of the respondents. CONCLUSION: The awareness of most recently graduated medical doctors and final-year medical students of the risk of acquiring HIV in surgical specialties seems to have not deterred them from wanting to pursue surgical specialties. We recommend improvements in the work environment and adherence to universal precautions to reduce the risk of transmission of HIV and other infections to surgeons practicing in the region.

Uterine rupture in a primigravida presenting as an acute abdomen post delivery: a case report.

BACKGROUND: Spontaneous rupture of the uterus in primigravida is a rare event reported in the literature. Rupture of the uterus usually presents as an acute life-threatening condition with symptoms and signs that makes diagnosis relatively easy particularly when there is history of obstructed labour and other risk factors. A case of uterine rupture in a primigravida with clinical signs evolving insidiously post delivery is being reported. METHOD: A review of the case record of a primigravida who developed acute abdomen post delivery and the relevant literature search was done with pubmed using, uterus, rupture, primigravida, oxytocin use, and vaginal delivery as key words. RESULT: A 22-year old primigravida who had spontaneous vaginal delivery developed acute abdomen post delivery subsequently had a laparotomy for suspected intra abdominal abscess and was found to have ruptured uterus. Repair of the uterus was done and post operative recovery was uneventful. Subsequent history from the patient revealed previous termination of a 5 month pregnancy 3 years before. CONCLUSION: This report highlights the need to suspect the possibility of uterine rupture as a differential diagnosis of acute abdomen post delivery particularly if there is past history of manipulations involving the uterus.

Rapid HIV testing and counselling in labour in a northern Nigerian setting.

Between April and August 2004, all pregnant women in labour at JUTH, were offered rapid HIV testing and counselling with opportunity to decline testing. HIV positive women were offered the standard nevirapine mono-therapy prophylaxis regimen (HIVNET 012). Four hundred and thirty (99.8%) of the 431 pregnant women who were offered rapid HIV testing and counselling, agreed to test. A sero-conversion rate of 2.1% (5 of 235) was found among women who had previously tested negative for HIV during the index pregnancy. A seroprevalence rate of 9.6% (16 of 166) was found among women with unknown HIV status. One patient who had an indeterminate HIV status prior to labour tested positive in labour. Rapid HIV testing and counselling in labour is a useful practice in high prevalence settings since it detects a substantial number of HIV-infected women and HIV-exposed babies that would otherwise have missed interventions to prevent MTCT.