Diagnostic accuracy of transvaginal ultrasonography and hysterosalpingography in the detection of uterine cavity pathologies among infertile women.

Background: Uterine cavity pathology may affect the endometrium or myometrium, resulting in distortion of the uterine cavity, and is responsible for 2%-5% of infertility. The methods for its assessment usually involve imaging modalities like pelvic ultrasonography, often transvaginal-(TVS), and hysterosalpingography-(HSG), with hysteroscopy-(HSC) as the gold standard. However, HSC is not readily available in resource-poor-settings. Purpose: To determine and compare the diagnostic accuracy of TVS and HSG in detecting uterine cavity pathology using HSC as a gold standard. Materials and Methods: A cross-sectional analytical study of consenting infertile women for evaluation of the uterine cavity using transvaginal-ultrasonography, hysterosalpingogram, and hysteroscopy. The primary-outcome-measures were the sensitivity, specificity, and accuracy of TVS and HSG in detecting uterine cavity abnormalities using HSG as the gold standard. Results: Eighty-eight participants were analysed for this study. The lesions confirmed on HSC were intrauterine-adhesions (43.1%), endometrial polyps (14.8%), submucous fibroids (18.2%), intrauterine-septum (13.6%), and cavity distortion (14.8%). The overall sensitivity with TVS was 57.7%, with a specificity of 97.6%, a positive-predictive-value (PPV) of 88.2%, and a negative-predictive-value (NPV) of 88.2%, giving a percentage-accuracy of 88.2%. In comparison, HSG had a sensitivity of 72.1%, a specificity of 99.4%, a PPV of 97.4%, and an NPV of 92.0%, giving an overall accuracy of 92.9%. The detection rates of TVS and HSG in this category were: fibroids (97.7% vs 89.8%; p = .0004) and adhesions (73.9% vs 87.5%; p = .0002), respectively. Conclusion: HSG appears to be the superior modality for detection of obliterative uterine cavity pathologies, while TVS is better suited for myometrium and endometrial lesions.

Awareness and attitudes toward voluntary counseling and testing for HIV/AIDS among law undergraduates in tertiary institutions in southeast Nigeria.

OBJECTIVE: To determine the knowledge of and attitudes toward voluntary counseling and testing (VCT) for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among undergraduates of a law faculty in tertiary institutions in Anambra State in southeast Nigeria. STUDY DESIGN: This was a cross-sectional, questionnaire-based survey conducted among law undergraduates in Anambra State using a multistage, random sampling method. The respondents were all full-time law students and were aged from 15-42 years with a mean of 21.06 +/- 3.0 years and a modal age of 20-24 years. In all, 210 (71.4%) of the students were aware of VCT for HIV/AIDS, while 84 (28.6%) of the respondents had no knowledge of it. The most common sources of information about VCT for HIV/AIDS were electronic media (114 [38.8%]) followed by churches (67 [22.8%]) and print media (44 [15.0%1). Although a majority of respondents had a positive attitude toward VCT for HIV/AIDS, 20% of them disapproved of VCT, and this is quite high considering their educational status. CONCLUSION: Public health education, awareness programs and VCT centers dedicated to young people should be established.

Efficacy of zinc supplementation for the treatment of dysmenorrhoea: a double-blind randomised controlled trial.

OBJECTIVES: To determine the efficacy of zinc sulfate supplementation in managing dysmenorrhoea. METHODS: In total, 103 high school students were randomised into an experimental arm (52 students) and a control arm (51 students) and received 40-mg zinc sulfate or placebo, respectively, over three cycles. Primary outcome measures were the mean Visual Analogue Scale score, which measured pain over three cycles, and the frequency of nausea and vomiting. Secondary outcomes were the use of additional analgesics and the frequency of allergic reactions. RESULTS: Fifty participants were analysed in each group. Mean pain scores were not significantly different between the groups before administering zinc sulfate therapy. Following the intervention, the mean pain scores for the treatment (2.80 ± 2.28) and placebo (3.48 ± 2.85) groups were not significantly different in the first cycle; however, scores in the treatment group were significantly better in the second (2.56 ± 1.97 vs 3.80 ± 2.77) and third (1.95 ± 1.72 vs 3.95 ± 2.82) cycles. No significant differences were observed between the groups in the nausea and vomiting incidence and the requirement for additional analgesics. CONCLUSIONS: Zinc sulfate reduces dysmenorrhoea severity with minimal or no adverse effects, especially with more than one cycle of usage.Trial Registration Number: PACTR202105843292338. The trial is publicly available and was registered at www.pactr.org on 25 May 2021.

Teenage pregnancies: a lingering obstetric problem in Nigeria.

OBJECTIVE: To determine the teenage pregnancy rate, associated epidemiological factors, outcome and complications in a Nigerian tertiary hospital. DESIGN: A 5 year retrospective study of women presenting with teenage pregnancies, between 1st of January, 2004 and 31st of December, 2008 was done. METHODS: The obstetric variables from 72 cases of teenage pregnancies and 89 selected controls aged 20-24 years were compared. Chi-square was used to compare some of the variables. The level of statistical significance was set at p < 0.05. RESULTS: The prevalence of teenage pregnancy was 2.7%. The age range was from 14-19 years with a mean age of 17.8 +/- 1.2 years. 33 (45.8%) women among the study group were single while 39 (54.2%) were married. There was a statistically significant difference in the marital status between the study and control groups (x2 = 41.80, p = 0.001). Interestingly, the teenage group were mainly primiparous women (63.9%) compared to the adults who were mostly nulliparous. Ante-partum complications such as anaemia, mal-presentations and ante-partum haemorrhage were commoner in the teenage pregnancy group. Prolonged labour, preterm labour, intra-uterine growth restriction, premature rupture of fetal membranes and caesarean deliveries were commoner in the teenage group, but not to a significant level. CONCLUSION: Promoting education of the girl-child and economic empowerment of teenage girls will reduce the incidence of teenage pregnancy and the high complication rate associated with it.

Female genital mutilation and obstetric outcome: A cross-sectional comparative study in a tertiary hospital in Abakaliki South East Nigeria.

BACKGROUND: Female genital mutilation (FGM) is an assault on womanhood. OBJECTIVE: To compare the obstetric outcome between parturient with genital mutilation with a cohort that has no genital mutilation. MATERIALS AND METHODS: This cross-sectional prospective study was done in the labour ward of Federal Teaching Hospital Abakaliki between 1st January 2013 and 31st December 2013. The obstetrics outcome of 260 consenting healthy parturients with FGM in the 1st stage of labour was compared with 260 cohorts with no FGM and also in labour. Data were obtained with a structured questionnaire and analysed using IBM SPSS Statistic version 20. Simple percentage odd ratio and Chi-square were used for data analysis at a p-value of < 0.05. RESULTS: The mean age and gestational age of the women were 27.9 ± 4.8 years and 38.9 ± 1.5 weeks respectively. Majority of the women, 308 or 77.0%, belonged to social class 4 and 82.0% had Type 2 FGM. More than 90.0% of the women had a vaginal delivery and the 2nd stage of labour lasted more than 2 h in 13.4% of the women (OR = 0.78 95% CI 0.64-0.97). Parturient with FGM had increased odd of perineal tear (OR = 0.76 95% CI 0.63 - 0.91) and episiotomy (OR = 1.69 95% CI 1.17-2.45). The mode of delivery and neonatal Apgar scores were not significantly influenced by the presence of FGM (P > 0.05). CONCLUSION: The study has shown that FGM in labour increases the odds of developing perineal trauma which may be associated with a host of short- and long-term complications. We recommend continued awareness creation to stop FGM.

Uterine leiomyoma associated non-puerperal uterine inversion misdiagnosed as advanced cervical cancer: A case report.

INTRODUCTION: Uterine inversion is an un-common complication of parturition which often occurs in the immediate postpartum period. The chronic (non-puerperal) uterine inversion is rarer and most times tumour associated. PRESENTATION OF CASE: A 51-year old grand multiparous lady presented with a month history of abnormal vaginal bleeding associated with offensive vaginal discharge, lower abdominal pain and dizziness. The initial evaluation suggested severe anaemia secondary to advanced cervical cancer. Examination under anaesthesia (EUA), staging and biopsy was attempted but this was however inconclusive due to profuse haemorrhage. A repeat EUA revealed chronic uterine inversion secondary to fundal submucous uterine leiomyoma. Myomectomy was done with tissue histology confirming benign uterine leiomyoma. Two weeks later, a modified Haultain's procedure was done followed by simple hysterectomy and posterior colpoperineorrhaphy. She had satisfactory recovery. DISCUSSION: This is the first reported case of chronic non-puerperal uterine inversion in our hospital. When it occurs, it is usually tumour associated with the commonest tumour being prolapsed myoma and leiomyosarcoma. The diagnosis is based on high index of suspicion. CONCLUSION: Chronic uterine inversion is a rare gynaecological condition and can be misdiagnosed as advanced cervical cancer or other causes of severe genital haemorrhage in women. A high index of suspicion is needed for its proper diagnosis. Sometimes, an EUA and biopsy was required to determine the cause here and conveniently it could be described as a "gynaecolological near miss".

Knowledge, awareness and perception of sexually transmitted diseases (STDs) among Nigerian adolescent girls.

Knowledge, awareness and perception of STDs among 983 adolescent female high school students at Onitsha, Nigeria is analysed. There was good general awareness of the common STDs, HIV/AIDS: 93.6% (n=920), gonorrhoea: 76.3% (n=750); syphilis: 69.1% (n=679), while the least was chlamydial disease: 6.6% (n=65). Knowledge of causes of STDs was high. Viruses were identified as the most common cause of STDs by 75.3% (n=740) of the respondents, followed by bacteria by 64.1% (n=630), while 17.8% (n=175) of the students believed that poison/witchcraft caused STDs. Surprisingly, 35.5% (n=349) identified herbs and natural medicines as effective remedies for these STDs; 56.7% (n=557) identified antibiotics as treatment for STDs, 33.8% (n=331) antiviral drugs, while a high percentage of the students believed in prayer houses as a remedy: 30.3% (n=298). The most common source of information was through the school: 80.6% (n=792), followed by television: 80.1% (n=787); radio accounted for 73.1% (n=719) and health workers for 64.1% (n=630). Awareness about preventive measures was as follows: abstinence 67.4% (n=663), mutual fidelity 56.7% (n=557) and condoms 54.8% (n=539).