Prevalence of vaginal group-b-streptococcus, antibiotic and antigen sensitivity amongst parturients at the federal medical center owerri, Nigeria

BACKGROUND: Group B streptococcus (GBS) is one of the principal agents of early onset neonatal sepsis, pneumonia and meningitis with significant morbidity for newborns and parturients.AIM: This study was done to determine the prevalence of vaginal group B streptococcus amongst parturients in FMC Owerri. It also aimed to elucidate the antibiotic sensitivity of the strains of GBS isolated while comparing the sensitivity of antigen detection tests of GBS to culture.PATIENTS AND METHODS: This cross-sectional study was done at the labour ward and lying-in units of the Federal Medical Center, Owerri,from February 2015 to October, 2015. It involved one hundred and eighty (180)womenrecruitedsystematically. Two swab samples, high vaginal and rectal were collected from the parturients intrapartum and cultured. The babies were examined and weighed immediately after delivery, seen on the second and tenth days after delivery for features of fever or any other complaints. RESULTS: The overall prevalence of GBS amongst parturients was found to be 6.1%. Prevalence of vaginal colonization was 3.3% and that of the rectum was 2.8%, (2c=0.1282, df=1,p=0.502). Neonates with colonized mothers all had complaints of fever postpartum which was statistically significant (=55.86, df=1, p<0.001). All the microbes showed 100% sensitivity to penicillin G, erythromycin, gentamycin and ceftriaxone. Antibiotic resistance was discovered in augmentin (67%), Cloxacillin (55.6%) and ofloxacin (33.3%). Antigen detection tests gave Sensitivity=100%, specificity=96.4%, positive predictive value (PPV) = 64.7%, negative predictive value (NPV) =100%. Detection in both vaginal (=60.290, p=0.000) and rectal (=50.799, p=0.000) samples were statistically significant. CONCLUSION: The prevalence of GBS in parturients in the Centre is low. Strains of GBS isolated amongst the sampled population in FMC Owerri had a high sensitivity to penicillin G, erythromycin, gentamycin and 3 generation cephalosporins. Antigen detection method for screening of GBS though very sensitive is however not specific with a significant false positive detection rate due to antigen cross reaction. It is however recommended that antigen detection be employed as intrapartum measure in high risk cases to reduce turnover time whilst supported by culture results later. There was associated significant neonatal sequaelae and further research to establish causal relationship will be advised

Giant Mucinous Cystadenoma in Nnewi, Nigeria.

Mucinous ovarian tumors are the second commonest type of epithelial ovarian tumors. Most of these tumors are benign. Occasionally, these tumors may reach enormous dimensions without being symptomatic. We reported the occurrence of a huge benign ovarian tumor (mucinous cystadenoma) in Nnewi. The data were collected from history taking, clinical examination, laboratory investigation, ultrasonographic examination, operative findings and histopathological examination of the surgical specimen. The case was reported as a massive ovarian mucinous cystadenoma. This case report emphasizes the importance of a thorough evaluation of women who presented with vague abdominal pain. Although the condition is very rare, it is potentially hazardous if early diagnosis and timely intervention is not instituted.

Pattern and predictors of partner disclosure of HIV status among HIV positive pregnant women in Nnewi Nigeria.

BACKGROUND: Sub-Saharan Africa has continued to bear the greatest burden of HIV/AIDS epidemic in the world. Partner disclosure of status may create opportunities for support or rejection. OBJECTIVE: This study evaluated the pattern of partner disclosure of HIV positive women, their partners' reaction and factors that affect disclosure of HIV status to partners. METHODOLOGY: This was a descriptive cross-sectional study conducted among pregnant women in Nnamdi Azikiwe University Teaching Hospital Nnewi An interviewer-administered questionnaire was used to obtain relevant information from the subjects. Data was analysed using SPSS version 20 software. RESULTS: One hundred and twenty six women participated in this study. The mean age of the women was 30.4 years +/- 5 while the mean parity was 2.6 +/- 1. All the patients had at least primary education with 63.5% having secondary education as the highest educational attainment. One hundred and sixteen (92.1%) were in monogamous marriage. One hundred and fourteen 90.5%) had disclosed their HIV status to their partners. Eighty-three (66.7%) of the women did this by self. Partners initial reaction was supportive in 84 (66.7%) of the women. Partner's subsequent reaction showed that 103 (81.2%) were supportive, 7 (5.6%) were indifferent while 4 (3.2%) were abusive and violent. The partner's HIV status showed that 54 (42.9) tested positive to HIV antibodies while 52 (41.3%) tested negative to HIV antibodies and 20 (15.9%) do not know partner's HIV status. There was strong correlation between disclosure of HIV status with monogamous marriage and duration of illness. CONCLUSION: The partners' reaction to HIV status of their female partners was largely supportive. Disclosure of HIV status should be encouraged in view of the needed support of the partner in management of these women.

Vaginal myomectomy of a prolapsed gangrenous cervical leiomyoma.

We report a challenging case of a huge gangrenous prolapsed cervical leiomyoma in a multiparous HIV positive lady. A 37-year-old para 3 lady presented with a progressively increasing irreducible mass protruding out per vaginam, 3 months duration of heavy menses, and symptoms of a urinary tract infection. We performed a vaginal myomectomy and she did well postoperatively. A prolapsed gangrenous cervical leiomyoma is a rare condition with only a few cases reported in the literature. Vaginal myomectomy for this condition can be performed in experienced hands without difficulties.

Vaginal hysterectomy in a Nigerian tertiary health facility.

BACKGROUND: Despite evidence that vaginal hysterectomy offers advantages in regard to operative time, complication rates and return to normal activities, gynaecologists remain reluctant to change their practice patterns because of concerns about safety and feasibility of the vaginal approach. We reviewed cases of vaginal hysterectomies done in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria over a ten year period. METHOD: This is a retrospective analysis of cases of vaginal hysterectomy that were done in the hospital between 1st January 1998 and 31st December 2007. Data was analyzed with Epi info version 3.3.2. Outcome measures include duration of hospital stay, indication for the surgery, postoperative morbidity and mortality and the need for blood transfusion. RESULT: Hysterectomy accounted for 224 of 1,370 gynaecological surgeries (16.4%). Vaginal hysterectomy was responsible for 47 (21.0%) of these 224 cases and accounted for 3.7% of all gynaecological surgeries. Majority of the patients were in the 7th decade of life with a mean age of 65.2 +/- 6.8. Most (87.5%) patients were retired farmers and grandmultiparous with a mean parity 6.5 +/- 2.4). Utero-vaginal prolapse was the only indication for the surgery. The only postoperative complication accounted was febrile morbidity which was reported in 5 (10.6%) of the patients had febrile morbidity. There were no cases of conversion to abdominal procedure. All the surgeries were done by the consultants. CONCLUSION: Vaginal hysterectomy was safe and associated with minimal morbidity to the patient. The only indication was uterovaginal prolapse and all the procedures were done by the consultants. There is need to transfer the skill to the Residents.