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   2019| July-December  | Volume 17 | Issue 2  
    Online since July 8, 2019

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Relationship of maximum follicular size, age of woman, and reproductive implications in women attending fertility clinic in St. Margaret's Hospital, Lokoja, using Creighton Model FertilityCare™ System and NaProTECHNOLOGY
Francis Udoka Achebe
July-December 2019, 17(2):51-63
Background: Some authorities have found that, when the mean follicular diameter is >25 mm, the follicle is considered large, and these authorities are convinced that large follicles are biomarkers to ovarian pathology. Several studies have been carried out to determine the optimal maximum follicular size (MFS) that will be adequate before the use of human chorionic gonadotropin trigger to induce ovulation. None of these studies have considered the woman's age as a factor. An in vitro fertilization-based study has also shown that large leading follicles did not result in higher percentage of matured oocytes, and they even result in a lower live birth rate; however, we note that the ages of the women were not specifically mentioned in connection with the problems of large follicle. Subjects and Methods: We set out in this study to evaluate the relationship between the MFS and the woman's age both in our control group (fertile women) Group (A) and in the women attending fertility clinic Group (B). Using the Creighton Model Fertility Care System and NaProTECHNOLOGY, it was possible to determine when to start follicular tracking and also determine ultrasound diagnosis of ovulation by recording the MFS and the reduced size. Results: In both Group A and Group B, we discovered that the MFS reduces as woman's age increases. We also discovered that the average MFS in the Group B was higher for age compared with the Group A (P = 0.0043). There was also an association between these bigger follicles for age and low mid-luteal progesterone. This is probably the first study that describes the association of follicular size and woman's age and its possible link with ovulation defects. Recommendation: We have proposed that this phenomenon of large matured maximum follicle for age could be a contributory factor to infertility and miscarriages. We propose further studies to verify this hypothesis. Conclusion: Despite the high percentage of complete rupturing of follicles in the AB cycles in the Group (B) there are very high proportion having low mid luteal (P+7) Progesterone. This may be due to pathologies associated with big follicles for woman's age. The E2/Pg ratio study in luteal phase strongly suggested that the women in Group (B) that may have fertility challenge are those in subgroup of AB in Group (B). Therefore matured follicular size should be considered with the woman's age. If the follicles grows bigger away from the range for a woman's age it may be the marker for infertility or reproductive health challenges.
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Reduced sexual activity in pregnancy among Nigerian women: Assessing the associated factors
Joseph Odirichukwu Ugboaja, Chika Florence Ubajaka, Emmanuel Okwudili Oranu, Charlotte Blanche Oguejiofor, Chinekwu Sochukwu Anyaoku, Chukwunonso Isaiah Enenchukwu, Anthony Osita Igwegbe
July-December 2019, 17(2):37-42
Background: Studies show reduced sexual activity during pregnancy. This study aims to evaluate the associated factors with a view to guiding current efforts at improving sexual activity during pregnancy. Methods: This is a cross-sectional study of 430 pregnant mothers attending Antenatal Care clinic at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, using questionnaires. Data were analyzed with STATA software, version12.0 SE(Stata Corporation, TX, USA) utilizing multiple logistic regression model to evaluate the predictors of reduced sexual activity. Results: Reduced frequency of sex was reported by 331(77.2%) of the women. Women, who belonged to the Anglican denomination(adjusted odds ratio[aOR] = 3.84; 95% confidence interval[CI]: 1.53–9.59) and those in whom the husbands were worried about the safety of sex in pregnancy(aOR=2.24; 95% CI: 1.11–4.50), were more likely to report reduced sexual activity in pregnancy. Women, who had information about sex in pregnancy(aOR=0.40; 95% CI: 0.24–0.60) and who were aged 30years and above(aOR=0.47; 95% CI: 0.25–0.89), were less likely to report reduced sexual activity in pregnancy. There was no influence by education, occupation, and social class or having had a discussion on sex in pregnancy with a physician. Conclusion: The Anglican Christian denomination and partner's worry about the safety of sex in pregnancy are the key drivers of reduced sexual activity in pregnancy. We recommend that reproductive health managers take cognizance of this finding in designing strategies to improve sexual activity in pregnancy.
  7,650 384 1
Institutional-based study on the knowledge of appropriate timing, time and predictors of initiation of antenatal care in Lagos, Nigeria
Adeyemi Adebola Okunowo, Tolulope Temitayo Fasesin
July-December 2019, 17(2):43-50
Background: Antenatal care (ANC) is a specialized preventive health-care model that averts, detects, and promptly manages pregnancy- and nonpregnancy-related complications. These benefits are best harnessed when women initiate ANC early. Objectives: The study aimed to assess the knowledge of pregnant women on the ideal time to initiate ANC, determine their gestational age at antenatal booking, and examine the factors that influence it. Materials and Methods: The present study was a cross-sectional descriptive questionnaire-based survey carried out at the Lagos University Teaching Hospital, Lagos, Southwestern Nigeria. A total of 400 pregnant women who attended antenatal booking clinic and who gave informed consent were recruited by consecutive sampling. Participants' knowledge on timing of ANC, their gestational age at booking, and factors influencing their timing of booking were assessed using structured questionnaire. Data was analyzed using SPSS version 20.0. Results: Majority (88.9%) of respondents had good knowledge of the ideal time to initiate ANC even though 60.3% still started ANC late, commonly in the 2nd trimester with a mean gestational age at booking of 17.0 ± 7.2 weeks. Among the several factors associated with early antenatal booking, belief that early initiation of ANC is beneficial was the only significant independent factor that predicted early initiation of ANC (odds ratio = 5.06, P = 0.03). Conclusion: The incidence of early initiation of ANC is low among pregnant Nigerian women despite apparently good knowledge of the ideal time to initiate ANC. Appropriate intervention strategy that will translate knowledge to practice is advocated.
  4,922 385 1
Determinants of cervical cytological abnormalities among HIV-positive women receiving care in a tertiary health facility in Southeast Nigeria
Joseph Odirichukwu Ugboaja, Chika Florence Ubajaka, Emmanuel Okwudili Oranu, Charlotte Blanche Oguejiofor, Chinekwu Sochukwu Anyaoku, Chukwunonso Isaiah Enenchukwu, Anthony Osita Igwegbe
July-December 2019, 17(2):31-36
Background: HIV infection is associated with increased risk of precancerous and cancerous lesions of the cervix. There is a need to identify the women mostly at risk to guide cervical cancer screening efforts. The objective of this study was to evaluate the determining factors for premalignant lesions of the cervix among HIV-positive women attending the adult HIV clinic in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Materials and Methods: The Pap smears of 110 HIV-positive women were selected through purposive sampling and evaluated for premalignant lesions of the cervix using the Bethesda system of classification. STATA software, version12.0 SE (Stata Corporation, TX, USA; 1985), was used to analyze the data, and multiple logistic regression models were employed to determine the risk factors of premalignant lesions. P = 0.05 at 95% confidence interval was taken as statistically significant. Results: The prevalence of premalignant lesions of the cervix was 28.2%, and these constitute mainly of atypical squamous cells of undetermined significance(56.5%). Women with cervical cytological abnormalities have significantly lower mean age(35.39vs. 38.89; P =0.04), lower mean CD4 count (325.3vs. 648; P <0.01), and lower mean age of coitarche(15.89vs. 19.9; P <0.001). On bivariate analysis, the significant determinants of abnormal cervical cytology include CD4 count<300cells/mm3(odds ratio[OR] = 0.037; P <0.001), age<30years(OR=0.26; P <0.01), duration of illness of<5years(OR=0.34; P <0.05), and the use of highly active antiretroviral therapy(HAART) for<5years(OR=0.09; P <0.001). On multivariate analysis, CD4 count<300cells/mm3(adjusted OR[aOR] = 0.018; P <0.001) and the use of HAART for<5years (aOR=0.13; P <0.05) significantly predicted the presence of premalignant lesions. Conclusion: The determinants of cervical cytological abnormalities among the women were CD4 count<300cells/mm3 and the use of HAART for<5years. We recommend routine screening for cervical cancer among this class of women.
  4,246 365 -
Traumatic intrapericardial diaphragmatic hernia
Uchechukwu Agbeze Mba
July-December 2019, 17(2):64-67
This article describes the case of a 33-year-old male who sustained blunt trauma to his torso in a high-speed motor vehicle accident. He presented to the emergency room with abdominal pain, chest pain, dyspnea, distended neck veins, and shock. There was no history of pretraumatic chest symptoms or congenital abnormalities. Computed tomography (CT) of the chest showed bowel loops extending into the pericardium through a large rent in the diaphragm. A diagnosis of traumatic intrapericardial diaphragmatic hernia (TIPDH) was made. Hence, the patient was transferred to the theater where surgical mesh repair was done through an open laparotomy. TIPDHs are rare, forming about 0.9% of traumatic diaphragmatic hernias with only 96 cases reported in worldwide literature as at 2014. However, they are potentially life-threatening and require a high index of suspicion to diagnose. They often result from blunt abdominal trauma. Symptoms include chest pain, abdominal pain, and dyspnea, with or without features of cardiac tamponade or bowel obstruction. CT scan is the best diagnostic tool. Primary repair through open laparotomy is recommended in acute cases, with mesh reinforcement for large diaphragmatic tears to ensure the repair is tension-free.
  3,179 289 -
Investigation of malaria by microscopy among febrile outpatients of a semirural Nigerian medical center: What happened to malaria control programs?
Mahmood Dhahir Al-Mendalawi
July-December 2019, 17(2):68-68
  2,290 246 -