Association between serum vitamin D status and uterine leiomyomas: a case-control study.

OBJECTIVE: Uterine leiomyoma is a common gynecological condition that negatively affects women's quality of life. Vitamin D plays an important role in tumor development and progression. However, clinical studies comparing serum vitamin D levels between women with and without uterine leiomyomas are limited and inconclusive. This study aimed to compare serum vitamin D levels in women with and without uterine leiomyomas. METHODS: This hospital-based case-control study included 150 women who visited a gynecological clinic. The cases included 75 women with uterine leiomyoma, whereas the controls included 75 age-and parity-matched participants without uterine leiomyoma. Serum vitamin D levels were measured in each participant and volumes of the uterine leiomyomas were determined using the water displacement method following myomectomy. The statistical significance was inferred at P<0.05. RESULTS: The mean serum vitamin D level was 15.26±4.96 ng/mL and 22.45±6.93 ng/mL for the case and control groups, respectively. The difference was statistically significant (t-value -7.302 and P<0.001). Within the fibroid group, nine (12.0%), 49 (65.33%), and 17 (22.67%) participants had vitamin D deficiency, insufficiency, and sufficiency, respectively; and in the control group, two (2.67%), 24 (45.33%), and 39 (52.0%) participants had vitamin D deficiency, insufficiency, and sufficiency, respectively. There was significant negative correlation between the fibroid volume and the serum vitamin D level (r=-0.591, P<0.001). CONCLUSION: Women with uterine leiomyoma had lower vitamin D levels than women in the control group. Lower vitamin D levels were associated with larger fibroid masses. Therefore, vitamin D supplementation may reduce fibroid growth and development.

Exploring physicians' experiences under the national health insurance scheme in Southeastern Nigeria.

BACKGROUND: A number of low-and middle-income countries have implemented National Health Insurance Schemes (NHIS) as part of efforts to increase access to quality healthcare and financial protection from regressive out-of-pocket payments. This study explored physicians' experiences under the Nigerian (NHIS) to identify factors that may influence efficient health care delivery. METHODS: A convenient sample of 85 physicians residing in South-East Nigeria who had active contracts with the NHIS were surveyed via self-administered questionnaire for this study. Descriptive statistics were used to summarize the data while Kruskal-Wallis tests were used to determine if there were statistically significant associations between physician professional characteristics and their responses to key statements that assessed their experiences and behavior. Also, thematic analysis was used to assess additional qualitative data provided by study participants. RESULTS: Provider experiences were affected by the perceived inadequacy of reimbursement rates, delays in payment and services not covered by the NHIS. Participants' responses to statements on inadequacy of reimbursement was significantly associated with location using Kruskal-Wallis test (χ2 (1) = 7.24, p = 0.027) while billing patients for services not covered under the NHIS was significantly associated with length of years of practice (χ2 (1) = 15.5, p = 0.001) and place of employment (χ2 (1) = 5.82, p = 0.054). CONCLUSION: Physician experiences and challenges they face under the NHIS program in Nigeria have unintended effects on the delivery of health care services. It is imperative that these issues are addressed to improve health service delivery.

Primary Infertility Secondary to Posterior Urethral Valve.

A 34-year-old civil servant presented to our facility, following a referral from a gynecologist who was also seeing the wife. The man presented with a history of anejaculation and the inability to impregnate his wife after 23 months of marriage. History, physical examination, and ancillary investigation led to a diagnosis of primary infertility secondary to posterior urethral valve which was subsequently ablated. Three weeks after ablation, he started ejaculating, and 2 months later, the wife became pregnant.

Accuracy of a combined insulin-like growth factor-binding protein-1/interleukin-6 test (Premaquick) in predicting delivery in women with threatened preterm labor.

PURPOSE: To determine values of combinations of interleukin-6 (IL-6)/cervical native insulin-like growth factor-binding protein-1 (IGFBP-1)/total IGFBP-1 (Premaquick©) in predicting spontaneous deliveries and spontaneous exclusive preterm deliveries in women with threatened preterm labor. METHODS: Women with singleton pregnancies between gestation age (GA) of 24 weeks and 36 weeks and 6 days with preterm labor were recruited during a prospective multicenter study. Premaquick© was positive when at least two of three biomarkers were positive. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were estimated for both prediction of spontaneous deliveries and spontaneous exclusive preterm deliveries. RESULTS: Ninety-seven (99.0%) out of 98 women enrolled were analyzed. Based on delivery status 7/14 days post-enrollment of general study population, Premaquick© had a sensitivity of 87.1/85.7%, a specificity of 92.4/96.8%, a PPV of 84.4/93.8% and a NPV of 93.9/92.3% for prediction of spontaneous delivery. Predictive accuracy of Premaquick© test in relation to days of enrollment were: 90.7% (≤7 days) and 92.8% (≤14 days). For women enrolled at GA <35 weeks, Premaquick© had a sensitivity of 100.0/87.5%, a specificity of 94.1/96.9%, a PPV of 70.5/87.5%, a NPV of 100.0/96.9% and an accuracy of 95.0/95.0% for prediction of preterm delivery within 7/14 days of enrollment, respectively. PPV was most significantly different in both groups when outcomes were compared between 2 days and 14 days post-enrollment (P<0.001). CONCLUSION: This novel triple biomarker model of native and total IGFBP-1 and IL-6 appears to be an accurate test in predicting spontaneous deliveries and spontaneous exclusive preterm deliveries in threatened preterm labor in singleton pregnancies.