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IMMUNOPATHOLOGY OF AMOEBIASIS IN IBADAN
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Strengthening health education component of health care delivery system for the achievement of health for all Nigerians
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RELIGIOUS AND SOCIO-DEMOGRAPHIC FACTORS INFLUENCING UTILIZATION OF ANTENATAL CARE SERVICES IN ILESA, OSUN STATE, NIGERIA
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Page will reload when a filter is selected or excluded.- Nigeria 4 results 4
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- Amoebiasis exemplifies a disease of protean manifestations which presents many perplexing problems. In this thesis an attempt is made to define a number of the wide variations which have been observed in the pathological manifestations of the disease. The work consists of both retrospective and prospective Studies. The retrospective study involved a review of the 7922 protocols of the autopsies at the University College Hospital, Ibadan, during the ten year period 1958 to 1967. 135 cases in which lesions of amoebiasis were described, were selected for special study using 276 cases of other diarrhoeal diseases as controls. The results of this review defined the pathology and complications of amoebiasis seen at the UCH, during the period covered by this study. A prospective study which included field surveys. laboratory studies on patients and controls; and in-vitro studies of the parasite was also carried out. Parasitological, biochemical and immunological techniques were applied in the prospective study of 1291 subjects in a field survey. In addition some 200 hospital materials were included in the prospective study. The results obtained provided the basis for the suggestions made concerning the different methods that can be applied to the future study of the prevalence of amoebiasis in any given population exposed to the risk of infection by Entamoeba histolytica. Local (Ibadan) strains of Entamoeba histolytica have been successfully cultured and the in-vitro characteristics studied. From the materials provi.ded by the in-vitro cultures of the organism, investigations have been made on E. histolytica antigens and the corresponding antibodies produced in man. The results of these investigations have been utilized in immunological studies, designed to define the mechanism of production of some of the problems posed by amoebic infections. The severity and high fatality of the disease in pregnancy and puerperium, was studied in detail. The observation that amoebiasis tends to be more severe and to have a higher mortality in pregnant and puerperal women was made only recently. At the time the present studies were planned, the association of pregnancy with severe amoebiasis had not been well established, and the mechanism for this association was unknown. It was, however, wall known that pregnant women were more liable to severe for-ms of certain other infectious diseases and it was considered possible that a similar mechanism might be operating in the case of amoebiasis. The present work confirms these clinical observations. Thus from the statistical analyses of the results of both the autopsy and prevalence studies, it became evident that the high fatality of amoebiasis during pregnancy and the early puerperium was not fortuitous but real. A fulminating type of lesion affecting the whole length of the large bowel is commoner in pregnant women and in those in the early puerperium dying of amoebiasis, than in any other cases of amoebiasis seen at autopsy. Furthermore, the biochemical and immunological studies help to throw some light on the mechanism of the selectivity of Infection by E. histolytical. These same results, also provide some explanation for the severity of amoebiasis during pregnancy and the allied states. The conclusions, support the hypothesis of lowered resistance to infectious diseases during pregnancy. Speculative submissions are, therefore, made on the defective immune mechanism occurring during pregnancy and the early puerperium. Thus, the inability of pregnant women to produce 'sufficient antibodies' to amoebic infections, demonstrated by the reactivity of the immunoglobulins in amoebiasis, confirms the suspicion of the existence of a derangement of host-defence mechanisms during pregnancy. This raises the hope and encourages future search for the specific serum agents) which may account for the deranged immune mechanism. On similar basis, the characterization of amoebic antigens together with that of the corresponding antibodies, offers a new field in the study of the immunopathology of amoebiasis. In conclusion, from the combined autopsy, prevalence, in-vitro experimental, biochemical, and immunological studies, it is submitted: 1. That the association of pregnancy with the severe form of amoebiasis at least, in this part of the world, is one of the perplexing problems posed by the disease. 2. That chronic amoebic infection is associated with the development of growth-inhibiting factors in the serum, for example, in patients with amoebic liver abscess. 3. That, on the contrary, growth promoting factors were demonstrated in the sera of pregnant/puerperal women with or without acute amoebic dysentery. 4. It is suggested that the severity of the disease in pregnant/puerperal women is a reflection of the derangement of immune response during pregnancy, with particular reference to the production of serum immunoglobulins. 1 results 1
- Anomaly screening 1 results 1
- Ante-Natal 1 results 1
- Autopsy 1 results 1
- BACKGROUND: Renal cell carcinoma is the most lethal urological cancer and contributes significantly to morbidity and mortality due to cancers of the urogenital tract. In routine diagnostic surgical pathology practice of renal tumours, immunohistochemistry is a helpful ancillary technique after routine H & E. The role of renal immunohistochemistry is explored in this study. MATERIALS AND METHODS: The paraffin-embedded tissue blocks of all the confirmed cases of renal cell carcinoma seen at the University College Hospital (UCH), Ibadan, during the 10-year study period of 2007 to 2016 were retrieved, sectioned and immunohistochemistry done using monoclonal antibodies for EMA, Vimentin and CD117 following standard protocols. Frequency statistics and chi-square were applied to data to determine proportions and associations using the Statistical Package for the Social Sciences (SPSS) version 23. RESULTS: A total of 48 cases of renal cell carcinoma were seen within the study period that met the inclusion criteria for the study. The age range of the patients was between 3 to 76 years with an average age of 44.17 years. The male-to-female ratio was 1:1.3. Fuhrman Grade 2 nuclei were predominant (43.75%) while Fuhrman Grade 4 nuclei had the lowest frequency (6.25%). EMAstaining patterns for the different histological patterns of RCC showed no statistically significant difference while Vimentin and CD117 staining patterns showed a statistically significant difference. There was no statistically significant difference observed between the staining patterns of all three markers and the nuclear grades of the cases of RCC. CONCLUSION: This study demonstrated the usefulness of Vimentin and CD117 in differentiating chromophobe variant of renal cell carcinoma from other subtypes while EMA showed variable expression across the various subtypes. WAJM 2023; 40(10); 1035 -1040. 1 results 1
- BACKGROUND: The morbidity and mortality caused by breast cancer can be decreased by early detection with breast self‑examination (BSE).The objective of this study was to determine the prevalence and the factors determining the practice of BSE. MATERIALS AND METHODS: The study was conducted on 140 women aged above 18 years who presented consecutively in a General Outpatient’s clinic in a tertiary hospital in Nigeria. This was the baseline study from an intervention study which looked at the effect of demonstration of BSE on improving Clinical Breast Examination (CBE) among two groups of respondents. Structured questionnaires were validated and administered by an interviewer and the data were analyzed using Statistical Package for Social Sciences (SPSS) version 12. RESULTS: The overall self-reported prevalence of BSE practice was 62.1% among the respondents. Older women (16, 76.2%), married women (63, 65.6%) and women with tertiary education (51, 68.9%) had the highest prevalence of BSE practice. Prevalence rate was highest for civil servant (25, 78.1%), P = 0.04. The practice of BSE was higher among women with a previous history of breast disease (15, 68.2%) and in respondents with a family history of breast disease (7, 63.6%), Only 11 (12.6%) performed BSE as per guidelines, which was once in a month. CONCLUSION: The prevalence of BSE was found to be high, especially in those with tertiary education and in those with a past personal or family history of breast disease. In resource‑constrained countries, BSE is a screening tool that can be employed to help reduce the breast cancer burden because routine mammography screening is not yet feasible. Women need to be informed about the when and how to perform BSE 1 results 1
- Background: Congenital anomalies are among the leading causes of fetal and infant morbidity and mortality worldwide. Prenatal ultrasound (US) screening has become an essential part of antenatal care in the developed world. Such practice is just evolving in die developing countries such as Nigeria. The aim of this article is to present our initial experience and demonstrate the effectiveness of a prenatal US screening program in detecting congenital malformation in a developing country. Materials and Methods: This was a prospective evaluation of the prenatal .US screenings conducted at a major referral hospital in Southwestern Nigeria All pregnant women referred to the antenatal clinic for mid-trimester screening during the period of study were assessed. Results: Two hundred and eighty-seven pregnant women (5 with twin gestations) were presented for fetal anomaly scan during the study period. Twenty-nine anomalies (9.9%) were detected among the scanned population. Sixteen of the anomalies were followed to delivery/termination with a specificity of 93.5%. The commonest malformations were demonstrated in the genitourinary tract (34.5%) followed by malformations within the central nervous system (27.6%). Six (20.6%) of the anomalies were lethal. Five of the anomalies were surgically collectable. Conclusion: Institutions and hospitals across Nigeria and other low- and middle-income countries need to develop policies and programs that would incorporate a standardized routine screening prenatal US in order to improve feto-maternal well-being and reduce the high perinatal mortality and morbidity in developing nations. 1 results 1
- Background: Herbal bitters are used for diverse diseases based on the manufacturers’ assertions. However, little is known about their toxicity profile. Objective: The safety profile of two commonly used herbal bitters in Nigeria (Fidson bitter® and Daily living bitter®)was evaluated in rats. Materials and Methods: Single oral dose, 2 g/kg, of each reconstituted bitter extract was administered to male and female rats in acute toxicity test. Animals were observed for 14 days for behavioral changes and mortality. In sub-acute oral toxicity experiment, 250 mg/kg and 500 mg/kg of each bitter was separately administered daily to different groups of male Wistar rats for 30 days. Safety profile of concurrent administration of these bitters was also assessed. Histopathological, hematological, and clinical chemistry indices were evaluated. Results: The LD50 was found to be >2 g/kg. Daily living bitter® (DLB) had no significant effect on any of the indices evaluated (P>0.05). However, Fidson bitter® caused significant reductions in white blood cells count (WBC) compared with the control. Concomitant administration of the bitters resulted in significant (P<0.05) weight gain (up to 33 %), reduction in WBC and congestion of the liver without corresponding increase in liver biomarkers. Conclusion: Daily living bitter® was safe in sub-acute administration while Fidson bitter®and combination of the two bitters reduced white blood cell count. Hence, caution should be exercised in using Fidson bitter® or combination of the two bitters in humans as findings suggest possibility of immune suppression. 1 results 1
- Background: Intussesception is a mojor cuase of intestinal obstruction in children and can be treated operatively or non-operatively. Surgery is associated with mortality rates, in dveloping countries of 8.5% to 18%. Hydrostatic reduction is a cost effective treatment that can lower the mortality rate in resource poor settings. However, the teachnique is not widely performed inspite of the advantages. Objectives: We reviewed factors influencing the current practice of hydrostatic reduction of intussusception by radiologists in Nigeria. Materials and Methods: A survey of radiologists was conducted using structured self adminsitered questionnaires. Strenght of assocition between the practice of hydrostatic reduction and variables related to the workforce was evaluated using Fisher's exact test. Result: Fifty-one participants were studied. Three (18.8%) hospitals have at least one consultant radiologist focusing on pediatric surgeon or more. Hydrostatic reduction is practiced in hospitals with a radiologist with interest in pediatric radiology, (p=0.002). Lack of expertise was given as the main reason why hte other hospitals have not commenced the procedure. 1 results 1
- Background: Malaria in pregnancy remains a significant cause of feto‑maternal morbidity and mortality especially in regions of high prevalence like Nigeria. Intermittent preventive therapy (IPT) for malaria is an important measure to abate this menace. Aim: The aim is to determine the uptake and effectiveness of IPT in relation to the occurrence of malaria, despite the use of IPT in pregnancy. Patients, Materials and Methods: This was a cross‑sectional study conducted in UCH, Ibadan from October 1, to December 31, 2020. A total of 150 postpartum women were selected using the total sampling technique of all consenting participants. Structured questionnaires were used for data collection. Results: About 87.7% of the respondents took IPT in the index pregnancy. Of these, 15.4%, 50.8%, and 33.8% of participants took one, two, and three doses, respectively. The factors that determined intermittent preventive treatment for malaria in pregnancy (IPTp) uptake include occupation (P = 0.001), booking status (P = 0.002), antenatal care attendance (P = 0.001), and level of IPTp awareness (P = 0.002). About 48.0% of respondents indicated that they were treated for malaria in the index pregnancy. Meanwhile, only about 15.3% of those who took IPT were treated for malaria in pregnancy. It was found that the use of IPT (P = 0.03) and an increasing number of IPT doses used (P = 0.03) were associated with a reduction in the prevalence of malaria in pregnancy. Conclusion: The uptake of the current recommendation for IPT‑SP that stipulates the use of monthly doses of IPT till delivery with a target of a minimum of three doses was quite poor. There is therefore an urgent need for widespread awareness and implementation of the World Health Organization and national guidelines on prevention of malaria. The prevalence of malaria declined with the number of doses of IPT‑SP used by the respondents. This emphasizes the need for adequate dosing of IPT. 1 results 1
- Background: Malaria remains one of the major causes of morbidity and mortality among under-five (U5) children in Nigeria. Though different environmental factors have been assessed to influence the distribution and transmission of malaria vectors, there is a dearth of information on how housing type may influence malaria transmission among U5 children in Nigeria. This study assessed the relationship between housing type and malaria prevalence among U5s in Nigeria. Methods: A cross-sectional analysis of the nationally representative 2015 Nigeria malaria indicator survey data was done. A representative sample of 8148 households in 329 clusters was selected for the survey. Children aged 6–59 months in the selected households were tested for anaemia and malaria using the rapid diagnostic test (RDT) and the microscopy. Data were analysed using descriptive statistics, Pearson Chi square (χ2) and logistic regression models at 5% level of significance. Results: The odds of malaria infection was significantly higher among older children aged 24–59 months (aOR = 4.8, CI 2.13–10.99, p < 0.001), and children who lived in houses built completely with unimproved materials (aOR = 1.4, CI 1.08–1.80, p = 0.01). Other predictors of malaria infection include living in a rural area (aOR = 1.5, CI 1.25–1.91, p = 0.01), ever slept under a long-lasting insecticide-treated net (aOR = 1.1, CI 0.26–4.79, p = 0.89) and in a room not sprayed with insecticide (aOR = 1.2, CI 0.64–2.31, p = 0.56). Children who were malaria positive showed a higher prevalence of severe anaemia on RDT (87.6%) and Microscopy (67.4%) than those who were not anaemic (RDT = 31.6%, Microscopy = 12.9%). Conclusions: Non-improved housing predicted malaria infection among U5s in Nigeria. Improved housing is a promising means to support a more integrated and sustainable approach to malaria prevention. Education of the Nigerian people on the role of improved housing on malaria protection and empowerment of the public to adopt improved housing as well as overall enlightenment on ways to prevent malaria infection can help to augment the current malaria control measures among U5 children. 1 results 1
- Background: Maternal mortality in Liberia is one of the highest in Sub Saharan Africa. Post partum family planning (PPFP) can reduce the risk of maternal mortality by preventing unwanted and closely spaced pregnancies. Yet, the uptake of PPFP is low in Liberia. Objective: We investigated the barriers to acceptance of PPFP use among women in Montserrado County, Liberia. Materials and Methods: Across-sectional facility based survey was conducted using a multistage sampling technique to select 378 women within 12 months’ post partum period. Results: About half of our respondents were were married, 66.4% had at least secondary education and 92.1% were Christians. The most commonly reported barriers were the fear of side effects(22.0%) and the post partum abstinence (22.2%). Binary logistic regression analysis showed that being within the early post partum period, i.e., within the first 6 months (adjusted odds ratio [AOR] = 0.23, 95% confidence interval [CI] [0.09–0.60] and lack of access to PPFP [AOR = 0.22, 95% CI [0.09–0.52]). Importantly, women who were married [AOR = 1.686, 95% CI (0.65, 4.36)] and those who were aware of PPFP [AOR 3.69, 95% CI (1.224, 11.096)] increased the likelihood of using PPFP. Conclusion: Important barriers to the utilisation of PPFP in Liberia were being within early post partum period, lack of access and awareness of PPFP including myths and misconception. Therefore, health communication targeting mothers for PPFP at every contact with maternal and childcare services should be encouraged 1 results 1
- Background: Pregnancy in sickle cell disease (SCD) patients is associated with increased risk of fetomaternal morbidity and mortality. With improvements in management, education, awareness, and nutrition, more patients with SCD are maximizing their reproductive potential. Objectives: This review examined the pattern of complications and obstetrics outcomes of patients with SCD in a tertiary health facility. Materials and Methods: A descriptive retrospective study of 106 pregnant SCD patients who delivered at the University College Hospital, Ibadan between 1st January 2008 and 31st December 2017. Information on their demographic, medical and obstetrics characteristics, complications and outcome were obtained from their case notes using a pre-designed proforma. Data were analyzed using SPSS version 23. Results: Of the 106 cases reviewed, 64 (60.38%) had sickle cell anaemia (haemoglobin SS), 39 (36.79%) had haemoglobin SC and 3 (2.83%) had haemoglobin CC. The mean maternal age was 29.6±4.7 years. Majority, 83(78.3%), booked for antenatal care at mean gestational age (GA) of 19.4±8.7 weeks while the mean GA at delivery was 39.0±1.73 weeks. Bone pain crisis (38.8%) was the commonest non-obstetrics complication with 63.2% occurring among the HBSS genotype. The common obstetrics complications were preterm contraction, intrauterine fetal death (IUFD), and preeclampsia (each occurring among 27.3%). Overall, there were 84.9% live births and the overall fetomaternal outcome was satisfactory in 38.7%. Conclusion: Sickle cell disease in pregnancy has remained associated with increased risk of bone pain crises as well as preterm contractions, IUFD and preeclampsia. A multidisciplinary team approach is essential in ensuring a positive pregnancy outcome. 1 results 1
- Background: Surgical outcomes study for individual nations remains important because of international differences in patterns of surgical disease. We aimed to contribute to data on post-operative complications, critical care admissions and mortality following elective surgery in Nigeria and also validate the African Surgical Outcomes Study (ASOS) surgical risk calculator in our adult patient cohort. Materials and methods: We conducted a 7-day, national prospective observational cohort study in consented consecutive patients undergoing elective surgery with a planned overnight hospital stay following elective surgery during a seven-day study period. The outcome measures were in-hospital postoperative complications, critical care admissions and in-hospital mortality censored at 30 days. Also, we identified variables which significantly contributed to higher ASOS surgical risk score. External validation was performed using area under the receiver operating characteristic curve (ROC) for discrimination assessment and Hosmer–Lemeshow test for calibration. Results: A total of 1,425 patients from 79 hospitals participated in the study. Postoperative complications occurred in 264(18.5%, 95% CI 16.6–20.6), 20(7.6%) of whom were admitted into the ICU and 16(6.0%) did not survive. Total ICU admission was 57 (4%), with mortality rate of 23.5% following planned admission and overall in-hospital death was 22(1.5%, 95% CI 0.9–2.2). All prognostic factors in the ASOS risk calculator were significantly associated with higher ASOS score and the scoring system showed moderate discrimination (0⋅73, 95% CI 0.62–0.83). Hosmer–Lemeshow χ2 test revealed scale was well calibrated in the validation cohort. Conclusion: NiSOS validates the findings of ASOS and the ability of the ASOS surgical risk calculator to predict risk of developing severe postoperative complications and mortality. We identified failure-to-rescue as a problem in Nigeria. Furthermore, this study has provided policy makers with benchmarks that can be used to monitor programmes aimed at reducing the morbidity and mortality after elective surgery. We recommend the adoption of the ASOS surgical risk calculator as a tool for risk stratification preoperatively for elective surgery. 1 results 1
- Background: The African continent is behind by a wide margin in the childhood vaccination race which contributes significantly to the high childhood morbidity and mortality rate from vaccine-preventable diseases in the continent. Some African countries are still struggling to achieve routine immunization coverage for all recommended expanded program on immunization vaccines. Aim: In this study, we aimed to identify the barriers hindering childhood immunization in Africa and to identify the remarkable progress made so far. Materials and Methods: Peer-reviewed articles published in English that focused on the barriers to childhood immunization in Africa and the progress made so far was reviewed. This was achieved by searching relevant search terms in PubMed, Google Scholar, Wiley Online Library, and CINAHL databases dating back from January 2000 to June 2022. Result: A total of 30 papers were reviewed. The barriers include parents’ education status, economic status, and gender/age; place of birth and place of residence; cultural beliefs and religious affiliations; fear of contracting diseases and lack of trust in health public institutions; vaccine awareness and delivery; and dose-specific delays. The achievements include international support and oriented actions, plans for technological integration and its implementation, and domestic immunization-oriented actions and research work. Conclusion: Childhood immunization is still low in Africa with the majority of the countries yet to realize the global immunization targets. Technologies and immunization-related interventions have been implemented to support Africa but more concerted effort and aid are required to reduce vaccine-preventable deaths to the bare minimum. 1 results 1
- Background: The orbit is a bony cavity within the skull that is composed of many structures which may undergo neoplastic transformation. Failure to diagnose the tumour and determine its extent may lead to high morbidity and mortality. The aim of this study was to evaluate the role of computed tomography in the diagnosis of orbital tumours in our centre. Materials and methods: Computed Tomography images acquired from a multi-sliced CT machine, tissue diagnoses obtained from histopathology reports and patients' clinical records were reviewed. The data were analyzed and presented using frequency tables, percentages and charts as appropriate. Results: Sixty six patients made up of 34 (51.6%) males and 32 (48.4%) females were studied. The ages ranged between 1 and 80 years with a mean of 35 years. Majority (50%) of the patients were in their 4th – 6th decades of life. While secondary orbital tumours were seen in 42 (63.6%) patients, primary tumours occurred in 23 (34.8%) cases. Metastatic deposit was seen in 1 (1.6%) patient. Bone was the most commonly affected orbital tissue. The CT diagnoses of benign and malignant tumours were accurate when compared with histopathological diagnoses in 80.6% and 96.7 % of the cases respectively. Conclusion: Computed Tomography is useful in characterizing the nature, precise location of a lesion within the orbit and to demonstrate the extension of the orbital lesion into contiguous structures. This study showed that Computed tomography is also a useful imaging technique in the diagnosis of orbital tumours with high concordance rate when compared with histological diagnoses. 1 results 1
- Background: Traumatic Brain Injury (TBI) is a significant cause of morbidity and mortality worldwide. Our previous studies showed a high frequency of motor vehicle accidents among neurosurgical patients. However, there is a dearth of data on head injuries in children in Nigeria. Aims: To determine the epidemiology of paediatric traumatic brain injuries. Setting and Design: This is a prospective analysis of paediatric head trauma at the University of Benin Teaching Hospital, a major referral centre for all traumatic brain injuries in Nigeria between October 2006 and September 2011. Materials and Methods: We studied the demographic, clinical and radiological data and treatment outcomes. Data was analysed using statistical package for the social sciences (SPSS) 16.0. Results: We managed 127 cases of paediatric head injuries, 65 boys and 62 girls representing 13% of all head injuries managed over the 5-year period. They were aged 3 months to 17 years. The mean age was 7.4 years (median 7 years) with peak incidence occurring at 6-8 years i.e. 31 (24.4%) cases. Motor vehicle accidents resulted in 67.7%, falls 14% and violence 7%. The most frequent computed tomography finding was intracerebral haemorrhage. Mean duration of hospitalization was 18 days (median 11 days). Eleven patients died, mortality correlating well with severity and the presence of intracerebral haematoma. Conclusion: Head injuries in children are due to motor vehicle and motor vehicle-related accidents. Hence, rational priorities for prevention of head injuries in children should include prevention of vehicular, especially pedestrian, accidents in developing countries 1 results 1
- Breast self‑examination 1 results 1
- C-Kit (Tyrosine kinase 1 results 1
- CD 117) 1 results 1
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