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An incisional hernia may occur in women following laparotomy. Obesity has become an increasing non-communicable public health problem in middle and low-income countries. Also, the caesarean section has been on the increase even among obese women. The study aimed to evaluate the outcome of care and determine the association between caesarean section and obesity in the development of incisional hernias among women who underwent laparotomy for various indications in Enugu, Nigeria. A retrospective study of women who underwent incisional hernia repair between January 2010 and December 2020 at the 2 tertiary hospitals in Enugu, Nigeria, was carried out. The following parameters were assessed; age, predisposing factors, presence and absence of obesity and the class of obesity, comorbidity, presenting symptoms, duration of symptoms before presentation, the interval between presentation and intervention, intra-operative finding, the definitive operative procedure performed, complications of treatment, and outcome of treatment. A total of 46 patients were evaluated. Their mean age was 44 years. Caesarean section and obesity were the most frequently performed laparotomy (31/46, 67.5%) and most common comorbidity (41/46, 89.2%) respectively among the participants. The majority of the patients (44/46, 95.7%) had mesh repair of the incisional hernia, and most had no post-operative complications. There was no significant relationship between incisional hernia and obesity, p = 0.446. There was no mortality. In conclusion, caesarean section, a frequently performed laparotomy, and obesity as comorbidity were frequently associated with the occurrence of incisional hernia among the participants. The use of appropriate mesh and techniques were associated with good results and reduced recurrence.

BackgroundPregnancy, especially in the third trimester, is associated with changes in the fibrinolytic system that supports clot formation and reduces hemorrhagic risk. Imbalance in the system may occur and can be assessed by plasmin generation (PG). Certain factors are known to affect PG.AimTo assess PG and its determinants during pregnancy using plasma D-dimer and plasmin-antiplasmin (PAP) complex levels.MethodsHealthy pregnant women in the third trimester of pregnancy were systematically recruited. Using the ELISA method, venous blood samples were taken to assess D-Dimer and PAP complex plasma levels. IBM Statistical Package for Social Sciences (SPSS) version 21 was used for statistical analysis.ResultsWe studied a total of 41 subjects with a mean age ±SD and gestational age ±SD of 30.68±4.69years and 34.78±3.34weeks, respectively. The mean ± SD values of the D-Dimer and PAP complex were 194 ± 24 ng/mL and 175 ± 11 ng/mL, respectively. D-Dimer and PAP complex positively correlated with age, GA, and BMI classification. However, only age was statistically significant (p-value 0.032 and 0.016, respectively). In addition, the multiple linear regression model showed that with every unit increase in age, D-Dimer and PAP complex increased by 2.0 (95% CI 0.4 – 3.6) ng/mL and 0.8 (95% CI 0.1 – 1.5) ng/mL respectively, after controlling for GA and BMI.ConclusionD-Dimer and PAP levels increased with increasing age during the third trimester of pregnancy, showing that the woman’s age is an independent determinant of PG in the third trimester.

Background: Human immunodeficiency virus (HIV) infection is a leading cause of morbidity and mortality among women of reproductive age and it is a major contributor to maternal, infant and child morbidity and mortality. Globally, in 2015, an estimated, 78 million people had become infected with HIV while 35 million people had died from Acquired Immune Deficiency Syndrome (AIDS)-related illness since the start of the epidemic. In Nigeria, a national HIV prevalence rate of 3.4% was reported in 2012 with 1.3% in Enugu State. HIV retesting is a WHO recommendation that was adopted by Nigerian her national guideline. The essence of antenatal HIV retesting includes the identification of pregnant women who were first tested during their window periods and subsequently sero-converted, and those who acquired new HIV infection after their initial screening test given the fact that a single HIV testing may not be enough to diagnose HIV with findings of high rates of incident HIV infection during pregnancy and at the post-partum periods. It has been shown that the rate of MTCT was higher from sero-converting women compared with women with already established HIV infection. Hence, this study which gave a clue to the rate of HIV sero-conversion among our antenatal women which may possibly popularize the concept of retesting especially among these women. Aim: To determine the prevalence of HIV sero-conversion and the associated risk factors among previously sero-negative antenatal clinic attendees in Enugu State University of Science and Technology Teaching Hospital, (ESUTTH). Methods: This was a prospective, cohort study involving 415 sero-negative HIV women recruited from antenatal clinic in ESUTH from January to April, 2019 and followed up for 12 weeks. Information on their socio-demographic characteristics, pregnancy history, sexual lifestyle, and clinical profile were obtained using an interviewer-administered questionnaire. HIV tests were done at booking and repeated after 12 weeks using the Rapid Diagnostic Test kits by the parallel algorithm format. Data was analyzed with the IBM SPSS version 23.0. Measures of associations were determined with the Chi-Square test and binary logistic regression. P-value < 0.05 was assessed as statistically significant. Results: The mean age of the participants was 29.44±4.91SD years with a range of 16-43 years. Majority of them were married (397; 95.7%) and had post-secondary education (321; 77.3%). The incidence of HIV sero-conversion was 1.0%. Less than 35 years of age, being single, tobacco use, multiple sexual partners in pregnancy and knowledge of partners’ HIV status were significantly associated with HIV sero-conversion (p < 0.05). However, none of these factors was a significant predictor following logistic regression. Conclusion: The rate of HIV sero-conversion in pregnancy is of public health importance in Enugu and obligatory repeat testing, especially among women with these identified associated risk factors is therefore advised to forestall the menace of HIV to the child and the society at large.

BackgroundTo our knowledge, there is no prior randomized trial on the effectiveness of Mojeaga remedy (a special blend of Alchornea, Pennisetum, and Sorghum extracts) when co-administered with standard-of-care for correction of anemia in obstetrics practice. This study determined the efficacy, safety and tolerability of Mojeaga as adjunct to conventional oral iron therapy for correction of anemia in obstetric population.MethodsA pilot open-label randomized clinical trial. Participants with confirmed diagnosis of anemia in three tertiary hospitals in Nigeria were studied. Eligible participants were randomized 1:1 to either Mojeaga syrups 50 mls (200mg/50mls) administered three times daily in conjunction with conventional iron therapy (Mojeaga group) for 2 weeks or conventional iron therapy alone without Mojeaga (standard-of-care group) for 2 weeks. Repeat hematocrit level were done 2 weeks post-initial therapy. Primary outcome measures were changes in hematocrit level and mean hematocrit level at two weeks post therapy. Maternal adverse events and neonatal outcomes (birth anomalies, low birthweight, preterm rupture of membranes and preterm labor) were considered the safety outcome measures. Analysis was by intention-to-treat.ResultsNinety five participants were enrolled and randomly assigned to the Mojeaga group (n=48) or standard-of-care group (n=47). The baseline socio-demographic and clinical characteristics of the study participants were similar. At two weeks follow-up the mean rise in hematocrit values from baseline (10.42±4.13% vs 6.36±3.69%;p0.05).ConclusionMojeaga represents a new adjuvants for standard-of-care option for patients with anemia. Mojeaga remedy is safe for treating anemia during pregnancy and puerperium without increasing the incidence of congenital anomalies, or adverse neonatal outcomes. Clinical Trial Registration: www.pactr.samrc.ac.za: PACTR201901852059636 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5822).

Background Globally, millions of children are involved in child labour. However, low- and middle-income countries are mostly hit. This study examined the predictors of child labour among public secondary school students in the Enugu metropolis. Methods This was a descriptive cross-sectional study of 332 junior secondary students attending public schools in Enugu metropolis, Nigeria. Multistage sampling technique was used to select the six secondary schools and the students that participated in the study. Data collection was done from September to October 2018. Pretested structured, interviewer-administered questionnaire was used for data collection. The questionnaire contained information on the sociodemographic variables, the kind of work done by the respondents and the number of working hours spent weekly. UNICEF’s standard indicator for child labour was used to estimate the prevalence of child labour. Logistic regression was used to identify socioeconomic predictors of child labour. Results The prevalence of overall child labour was 71.7%, while for domestic and economic child labour prevalence were 52.1 and 34.0%, respectively. About 35.2% of the respondents worked under hazardous conditions while 8% were forced to work. Two-thirds (236, 65%) of the respondents who have heard about child labour perceived it as wrong. The child labourers mainly worked to render financial assistance to their parents. The predictors of child labour were class of study (AOR = 2.208 (95% CI: 1.199–4.066) and weekly income earned (AOR = 0.316 (95% CI: 0.176–0.567). Conclusion The prevalence of child labour among junior students in public secondary schools in Enugu is high, and is predicted by the level of schooling and income earned. Economic and social reforms could contribute to addressing the predictors of child labour.

Cervical Cancer Is Preventable Using Vaccines Given To Adolescents In Three Doses. The Affordability Of These Vaccines And People’s Willingness To Pay (WTP) Could Affect The Uptake Of The Vaccines, Especially In Developing Countries. The Study Aimed To Determine The Willingness To Pay For The Vaccines And Identify The Factors Associated With Different Levels Of WTP Among The Participants. A Cross-Sectional Study Of 377 Female Teachers In The Enugu Metropolis Was Undertaken Between July And October 2017. A Structured Pre-Tested Interviewer-Administered Questionnaire Was Utilized For The Collection Of Data. Willingness To Pay Was Determined By The Contingent Valuation Method Utilizing The Bidding Game Technique To Estimate The Maximum Amount Each Participant Would Pay For The Three Doses Of The HPV Vaccine. Data Were Analyzed Using SPSS Version 20. The Average Monthly Income Of The Participants Was 152.18 USD (₦56307.91), With A Range Of 5.41-2162.16 USD (₦2,000 – 800,000). A Considerable Proportion (74.3%) Of The Respondents Was Willing To Pay Out Of Pocket For The Vaccine. The Average Maximum Willingness To Pay For The Three Doses Of The Bivalent Vaccine Was 15USD, Far Below 63USD, Which Was The Lowest Cost For The Three Doses Of The Vaccine In Nigeria. Small Family Size (P

Highlights • Gauze sponge transmigration over 5years from the peritoneal cavity to the external urethral meatus is rare but possible. • There have been few reported cases of gossypiboma due to under reporting for fear of litigation but the true incidence may be much higher. • Migration of gossypiboma from initial site is a rare entity and could pose some diagnostic difficulties. • High index of suspicion and prompt diagnosis of gossypiboma is key to management to help reduce the high morbidity that is associated with the condition. • Gossypiboma in the urinary bladder though rare but can be prevented through appropriate documentation and recounting of all surgical sponges and instruments used during surgeries., Introduction Gossypiboma denotes a mass of cotton retained in the body following surgery. Migration of gossypiboma from initial site is a rare entity and could pose some diagnostic difficulties. Migration of gauze sponge has been reported to occur in several organs of the body. There have been few reported cases but the true incidence may be much higher due to under reporting for fear of litigation. Presentation of case We present an unusual case of a 58-year-old grand multiparous woman who had gauze retention for 5 years following a hysterectomy and presented with acute urinary symptoms. The gauze sponge transmigrated from the peritoneal cavity to the bladder and was partially extruded through the external urethral meatus. She had laparotomy for the removal of gauze sponge with good outcome. Discussion Retained foreign body especially surgical sponges (gossypiboma) infrequently occurs and can be a source of great concern to the surgeon and patient. Foreign bodies inside the body cavities and organs can present with several non-specific clinical features that can make diagnosis difficult. Migration of surgical sponge (gauze, mops) into the urinary bladder is uncommon when compared to other abdominal and pelvic viscus. A gossypiboma in the peritoneal cavity creates a fistulous tract through the thick wall of the urinary bladder from long period of chronic inflammation as seen in the index case where the previous surgery was performed 5 years prior to onset of symptoms. Due to the non-specific presentations of gossypiboma, especially those in the bladder, several investigative modalities need to be employed to help make a prompt diagnosis. Most long-standing cases would require laparotomy due to the dense adhesions that occur around the site of the gossypiboma. Lack of appropriate diagnosis leaves the patient with recurrence of distressful symptoms and the consequent morbidities. Conclusion Transmigration of a gauze sponge over 5 years from the peritoneal cavity into the urinary bladder and through the external urethral meatus following a hysterectomy is a rare occurrence and can present diagnostic difficulties. High index of suspicion, prompt diagnosis and management will help reduce the high morbidity that is associated with the condition as in the case reported.

Congenital anomalies of the uterus may result from maldevelopment, abnormal fusion or failure of recanalisation of the paramesonephric (Müllerian) ducts. They are uncommon and are associated with various fertility and pregnancy outcomes. Uterine anomalies have been associated with infertility and pregnancy-related complications. Some cases of successful pregnancies among women with a bicornuate uterus have been reported. However, successful twin pregnancy in a bicornuate uterus is very rare. We report the case of a 24-year-old primigravida who presented with a retained second twin secondary to an undiagnosed bicornuate uterus. An abdominal examination revealed an enlarged abdomen with the uterus tilted to the right and also a palpable firm mass on the left iliac fossa. The retained foetus was presenting cephalic, and the foetal heart rate was 118 bpm. A diagnosis of a retained second twin secondary to a suspected uterine anomaly and suspected foetal distress was made. An emergency caesarean section revealed two horns of the uterus, each having a fallopian tube, an ovary and a cervix. Both cervices opened into one vagina. A 3.0 kg live male baby was successfully delivered through a transverse incision on the lower segment of the right horn of the uterus. The client had an uneventful recovery and was discharged home together with her babies after 4 days. In conclusion, congenital anomalies of the uterus should be considered in cases of a retained second twin. A prompt and accurate diagnosis followed by appropriate management will go a long way in ensuring a good outcome, as was had in this case.

Introduction:cervical cancer is a major cause of morbidity and mortality in women and vaccination of adolescents with human papilloma virus (HPV) vaccines is a major preventive strategy for this cancer. Despite the usefulness of cervical cancer vaccines, significant gaps still exist in the level of awareness and acceptability of the vaccine among women. This study aimed to determine the level of awareness, acceptability, and identify the factors associated with the uptake of this vaccine by female secondary school teachers in Enugu, Nigeria. Methods:a cross-sectional study of 377 female teachers in Enugu metropolis was undertaken between July and October 2017. A structured interviewer-administered pretested questionnaire was used for data collection and SPSS used for analysis. Results:less than half (41.9%) of the respondents had good knowledge of the cervical cancer vaccine. The majority of the respondents (93.6%) accepted the vaccine and will recommend it for their children and students. Only 14.6% and 9.0% of the respondents have taught their students about cervical cancer or HPV vaccines and had a programme in their school that addresses cervical cancer or cervical cancer vaccination respectively. Only 3.4% of the respondents have been vaccinated while 5.6% of their children or relatives have received the HPV vaccine. Previous vaccination of participants (p = 0.000), existing programmes addressing cervical cancer in schools of respondents (p = 0.000), participants having taught students about cervical cancer (p = 0.025) and high economic status (p = 0.013) significantly increased the likelihood of participants vaccinating their adolescent daughters/relatives. Extremes of age (p = 0.001) and being the head of their families (p = 0.002) significantly reduced the likelihood of the daughters/relatives to be vaccinated. Only previous history of vaccination of the respondents predicted the vaccination of their children and relatives (AOR = 6.069; 95% CI; < 0.0001-0.041). Conclusion:the overall knowledge of the HPV vaccine was low but the acceptability was high among respondents who were aware of the vaccines. Vaccine uptake among children/family members of the respondents was low. The introduction of cervical cancer vaccination education of the teachers in the secondary schools will help improve cervical cancer vaccination and the uptake among adolescent´s populations in the country.

Introduction: Routine urinary catheterisation during elective caesarean section is a common practice. However, this practice involves some urinary bladder morbidities. Aim: To determine the effect of non-catheterisation of the urinary bladder on the incidence of significant bacteriuria and other perioperative urinary bladder morbidities during elective caesarean section in Enugu, Nigeria. Materials and Methods: A multicentre, non-inferiority randomised controlled study was conducted. The study centres were the University of Nigeria Teaching Hospital (UNTH), Mother of Christ Specialist Hospital (MOCSH), and Blessed Assurance Specialist Hospital (BASH), all in Enugu State, Southeast Nigeria. A total of 264 eligible consenting term pregnant women who had a caesarean section in these three specialist centres in Enugu, Nigeria over a one-year period were recruited and they completed the study and their results were analysed. Study group (A) did not receive urethral catheterisation while the control group (B) had urethral catheterisation on the operating table and the catheters were removed 24 hours after the surgery. Clean catched urine samples were collected from each participant 72 hours after the surgery for urine microscopy and culture. The primary outcome measure was the incidence of significant bacteriuria 72 hours postoperatively while the secondary outcome measures included incidence of intraoperative bladder injury (accidental cystostomy), primary postpartum haemorrhage and urinary retention. Results: Nine (6.8%) women in the non-catheter group (n=132) had significant bacteriuria as against 17 (12.9%) women in the catheter group (n=132), (Relative Risk (RR)=0.5 (95% CI: 0.24-1.14) p=0.098). Urinary retention was observed in 10.6% (14/132) of the non-catheter group while there was no case of urinary retention in the control group (p

Introduction:the prevalence of cervical squamous intraepithelial lesion is not well appreciated in most low-income countries. This study aimed to determine the level of awareness, prevalence and the pattern of squamous intraepithelial lesions and predictors for abnormal pap smear reports (development of pre-malignant lesions of the cervix) among women attending various clinics in a tertiary health facility in Enugu, Nigeria. Methods:a cross-sectional study of 207 female patients attending various clinics of Enugu State University Teaching Hospital, Parklane, Enugu between June and August 2017 was undertaken. Structured interviewer-administered questionnaires were used for data collection while cervical smears were collected from the patients and sent for cytology. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 22.0. The results were presented as means, standard deviations, frequencies and proportions. Pearson´s Chi-square test was used to test for associations between categorical variables and statistical significance was set at a p-value of < 0.05. Results:the levels of awareness of cervical cancer and the screening methods among the respondents were 76.8% and 36.7% respectively. The overall knowledge of cervical cancer and its screening was poor (6.8% and 29.0% respectively). The prevalence of pre-malignant lesions of the cervix among the respondents was 15.0% with low grade squamous intraepithelial lesion (LGSIL) having the highest frequency (38.7%). Among all the other risk factors for the development of premalignant lesions of the cervix among the respondents, a report of abnormal pap (positive) smear report was significantly associated with only age ≥35 years (χ2=5.723; p=0.017). The same age of 35 years and above also correctly predicted abnormal pap smear reports among other factors (AOR = 3.02, 95% CI = 1.16 - 7.89, p = 0.024). Conclusion:the awareness of cervical cancer and cervical cancer screening was high but the overall knowledge on cervical cancer and its screening was very poor among the respondents. The prevalence of pre-malignant lesions of the cervix was high, and the commonest abnormal smear was LGSIL. Only age 35 years and above correctly predicted the occurrence of abnormal pap smear reports among the respondents.

Background: Urethral injury in children is uncommon, and its treatment is challenging. This study evaluated our experience in the management of urethral injuries in children who presented at the paediatric surgical unit of a teaching hospital in Enugu, Nigeria. Methods: The medical records of patients younger than 15 years old admitted to our centre with urethral injury from January 2008 and December 2017 were reviewed retrospectively. Results: During the period of the study, 11 cases (all male) were managed. The mean age of the patients at presentation was 11 years. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the most injured part of the urethra. All the patients had urethroplasty through the perineal approach. There was 90% success at first instance. One patient required redo urethroplasty. Conclusion: Urethral trauma is associated with considerable morbidity. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the part of the urethra most affected. Transperineal urethroplasty was an effective modality of treatment.

The cost of obstetric care could hinder the capacity of human immune-deficiency virus (HIV) positive women to receive adequate care during pregnancy and delivery. This study was aimed at determining the relationship between antenatal/delivery care cost and delivery place choice among HIV positive women in Enugu metropolis. This was a cross-sectional study of 232 post-partum HIV-positive women who came for 6-weeks post-natal visit. Data were analysed using SPSS version 20. The ethical clearance number obtained at UNTH on 18/11/2015 was NHREC/05/01/2008BFWA00002458-1RB00002323. The average obstetric care cost among the respondents was N55,405.67 (US$346.28). The delivery cost (

Background Millions of children have been identified globally to be involved in child labour with low-income countries being mostly hit. This study was aimed at assessing child labour and its predictors among public secondary school students in Enugu metropolis. Methods The study was a descriptive cross-sectional study of 332 junior secondary school students attending public secondary schools in Enugu metropolis, Nigeria. A structured interviewer-administered questionnaire was used for data collection and analyses were done using SPSS version 23 and STATA Software. The level of statistical significance was set at 5% p-value. Results The prevalence of overall child labour among the respondents was high (71.7%) likewise its different categories: domestic (52.1%) and economic (34.0%) child labour. About 35.2% of the respondents worked under hazardous conditions while 8% were forced to work. Approximately 65% (236) of the respondents who had heard about child labour perceived it as wrong. They mainly worked to render financial assistance to their parents. Class of study (AOR = 2.208 (95% CI: 1.199–4.066) and weekly income earned (AOR = 0.316 (95% CI: 0.176–0.567) predicted child labour among the respondents. Conclusion The prevalence of child labour among public secondary schools in Enugu was high and the predictors were the class of the respondents and the weekly income they made. This may imply that child labour in Enugu was driven by poverty as respondents who earned higher were more involved in child labour thereby calling for concerted economic and social reforms to reduce this menace.

Introduction: Cervical cancer is a leading cause of cancer-related mortality in Sub-Saharan Africa. Although the disease is largely preventable via routine cervical cancer screening, the uptake is ridiculously poor in the sub-region. In Nigeria, current efforts are directed at counselling and screening of eligible women in health care facilities. Therefore, the routine post-natal clinic visit at six weeks postpartum provides a good opportunity to offer cervical cancer screening services. Aim: To compare the acceptability of Pap-test and prevalence of abnormal cervical cytology between post-natal clinic attendees and other non-pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Materials and Methods: A cross-sectional analytical study was conducted from January to November 2014 in which acceptability and Pap-test results of 172 women attending the post-natal clinic were compared with an equal number of non-pregnant women from gynaecology and family planning clinics of the hospital. Both groups were selected by systematic sampling method. Outcome measures for each group included the prevalence of abnormal Pap-test and the proportion of women that accepted the Pap-test after appropriate cervical cancer education. Statistical analyses were both descriptive and inferential at 95% confidence level. Results: Prior to the study, 44.2% (76/172) of participants in postpartum group, and 47.7% (82/172) in control group were aware of Pap-test (p=0.473); while 9.3% (16/172) and 10.5% (18/172) had used Pap-test in the two groups respectively (p=0.718). All participants in each group accepted the Pap-test after cervical cancer education. Prevalence of cervical Squamous Intraepithelial Lesion (SIL) in the postpartum group was similar to that of the control group (OR: 1.8; 95%CI: 0.75-4.10; p=0.21). The most common SIL in both groups was low-grade squamous intraepithelial lesion. There was no statistically significant difference in the distribution of SIL categories (p>0.05). Conclusion: Acceptability and outcome of Pap-test are similar in post-natal and non-pregnant women in Enugu, Nigeria. Post-natal clinic visit provides an effective opportunity for routine cervical cancer information and screening in Nigeria.

Introduction: Uterine involution, a physiological process in which the uterus reverts to prepregnant size, occurs during puerperium. The latter is a time of substantial maternal risk. Ultrasound is considered the most appropriate tool in monitoring the progression of uterine involution because it is cheap, convenient and repeatable with no radiation risk. Aim: To sonographically evaluate the involution of the uterus and uterine cavity in postpartum women in Enugu, Nigeria. Materials and Methods: This was a prospective longitudinal cohort study on 400 postpartum women at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Transabdominal ultrasonography to measure uterine dimensions was done on day 1, day 3 and day 42 of puerperium using a 3.5-5 MHz curvilinear probe of a portable ALOKA ultrasound machine. Statistical analysis was done with the Statistical Package for Social Sciences (SPSS) software version 20.0. The uterine dimensions were expressed as mean±standard deviation and student's t-test analysis was used to compare the values for day 1, day 3 and day 42 of puerperium. Regression analysis was carried out to measure the relationship between uterine measurements on days 1, 3 and 42. A p-value of

Background Dyslipidaemia and hypertension are established major risk factors for cardiovascular diseases. The suggested roles of miRNA-122 and ADAM17 in lipid metabolism can therefore be applied in the management of metabolic disorders. The authors’ aim was to determine the association between miRNA-122 and ADAM17, as well as the association between miRNA-122 and lipid fractions, in the study participants. Method A comparative cross-sectional study was conducted among 200 hypertensive patients and 100 non-hypertensive adult controls between May, 2015, and June, 2016, in Nigeria. Lipids were analysed with spectrophotometric methods whereas ADAM17 and miRNA-122 were analysed with enzyme linked immunosorbent assay and quantitative polymerase chain reaction, respectively. Results The mean (standard deviation [SD]) ages of 200 hypertensives and 100 controls were 56.3 (6.9) and 54.9 (8.3) years, respectively. miRNA-112 and ADAM17 had significantly higher values among dyslipidaemic individuvals compared with non-dyslipidaemic participants. The correlation between miRNA-122 and ADAM17 levels was strongly positive, r=0.82, p Conclusion In this study, miRNA-122 showed a strong correlation with ADAM17 and a positive correlation with LDL-cholesterol and total cholesterol. These findings support the stimulant roles of miRNA-122 and ADAM17 in lipid metabolism and thus could be used in the management of dyslipidaemia.

Background and Aims: Although pregnancy and labor are considered physiological processes, the potential for catastrophic complications is constant and may develop rapidly. There is growing evidence that admission of high-risk patients into the Intensive Care Unit (ICU) is associated with a reduction in maternal mortality. This study was aimed at reviewing all obstetric patients admitted into the ICU. Materials and Methods: This was a retrospective study of all obstetric patients who were admitted into the ICU between January 1, 2012, and December 31, 2013. Results: There were 89 obstetric patients admitted and managed at the ICU out of 5176 deliveries, thereby accounting for 1 admission in 58 deliveries. Majority of the patients were between 26 and 30 years, primiparous, and unbooked. The indications for ICU admission in this study were ruptured uterus (36.0%), eclampsia (22.5%), obstetric hemorrhage (19.1%), septicemia (10.1%), severe preeclampsia (6.7%), and obstructed labor (6.7%). The maternal and perinatal mortality was 13.5% and 47.2%, respectively. Maternal unbooked status was significantly associated with maternal mortality ( P &*#60; 0.05). Conclusion: Ruptured uterus was the most common indication for ICU admission in the center. Maternal mortality was significantly associated with unbooked status. This underscores the importance of booking for antenatal care, prompt presentation at the hospital during emergencies, skilled birth attendance, and provision of adequate facilities for the management of critical obstetric cases in this environment.

Highlights • Placenta percreta causing hemoperitoneum and intrauterine death can easily be misdiagnosed. • Uterine rupture is rare in unscarred uterus and in absence of trauma. • Placenta percreta is an unusual cause of uterine rupture. • Placental percreta is an unusual cause of heamoperitoneum and intra-uterine death., Introduction Placenta percreta is a rare; a life-threatening disorder of placentation and one of the components of the placenta accreta spectrum. It can lead to uterine rupture, an obstetric catastrophe that can be associated with increased maternal and fetal morbidity and mortality. Presentation of case We present an unusual case of spontaneous uterine rupture due to placenta percreta in an unscarred uterus of a multiparous woman leading to spontaneous intrauterine fetal death. She presented with hypovolaemic shock following spontaneous rupture of the uterus and subsequent intra-peritoneal bleeding. Discussion Uterine rupture occurs commonly in a scarred uterus from some form of trauma or injudicious use of oxytocics. However, uterine rupture occurring in the absence of prior scar or use of oxytocics is a rarity. Placenta percreta is an unusual cause of uterine rupture and subsequent intra-uterine fetal death. Placenta percreta occurs when the uterine wall is invaded by the placenta up to the level of the serosa. A high index of suspicion and thorough review of the patient is required for making this diagnosis. Misdiagnosis is associated with dare consequences of increased maternal morbidity and mortality. Conclusion Placenta percreta is a rare disorder of placentation that can cause uterine rupture which can easily be misdiagnosed. Prompt diagnosis and institution of the appropriate care can help prevent catastrophic outcomes as demonstrated in the case reported.

OBJECTIVE To determine the accuracy of a semi-quantitative interleukin-6 (IL-6) vaginal secretion rapid test (Chorioquick) for detecting chorioamnionitis in women with premature rupture of membranes (PROM). METHODS A prospective cohort study in five tertiary hospitals in Nigeria involved women with confirmed PROM at term and preterm PROM with or without suspected chorioamnionitis from August 1, 2017, to October 31, 2018. Cervicovaginal fluid samples were tested for chorioamnionitis using the Chorioquick test. Samples were repeated at decision to deliver. The test was considered positive if at least the indicator 'IL-6 low' of the three Chorioquick biomarkers (low, medium, high) was positive, or negative if none of the biomarkers were positive. Chorioamnionitis was histologically confirmed post-delivery using three tissue samples. Primary outcome measures were sensitivity, specificity, and accuracy. RESULTS Of 73 women, on histological confirmation, 39 were true positive and 29 were true negative (for chorioamnionitis) to the Chorioquick test at repeat assessment. Overall, the Chorioquick test had a sensitivity of 97.5% (95% confidence interval [CI] 85.3-99.9), specificity 87.9% (70.9-96.0), and accuracy 93.2% (79.5-99.1). Sub-group analysis of women

Context: Ovarian cancer is responsible for more deaths per year than all other gynaecological cancers combined, and its overall mortality is high because of late presentation. Aims: To evaluate the predictors of knowledge of the symptoms and the risk factors of ovarian cancer among female healthcare providers in Enugu, Nigeria. Settings and Design: Cross-sectional survey conducted at the University of Nigeria Teaching Hospital (UNTH), Enugu from June to August 2018. Subjects and Methods: A self-administered, structured questionnaire on symptoms and risk factors of ovarian cancer was given to 422 randomly selected female healthcare providers working at UNTH. Statistical Analysis: Data were analysed using SPSS version 22.0 for Windows (Chicago, IL, USA). Predictors of knowledge level were determined using logistic regression. P < 0.05 was considered statistically significant. Results: Mean age of the respondents was 39.22 ± 7.89 years. Less than 50% of participants know the other symptoms of ovarian cancer outside increased abdominal size (n = 268, [63.5%]). Also

Introduction: HIV-positive women are more likely to develop cervical neoplasm. HIV-positive women with low CD4 T-lymphocyte cell count may be more predisposed to cervical squamous intraepithelial lesions (SILs). This study aimed to determine the association between low cellular immunity of HIV positive women, and the prevalence and grade of cervical squamous intraepithelial lesions. Materials and Methods: Pap smear was carried out on two cohorts of Highly Active Anti Retroviral Therapy (HAART) experienced HIV-positive women (178 per group) at the AIDS Prevention Initiative in Nigeria-Centre for Disease Control Adult Anti-Retroviral clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria from June to November, 2012. The study group had CD4 cell count of < 200 cells/µl while the control group had CD4 cell count of ≥200 cells/µl. Results: The mean CD4 cell counts of participants in the study (low CD4) group was 127.9 ± 47.49 cells/ml while that of the control (high CD4) group was 489.2 ± 186.36 cells/ml (p < 0.001). The prevalence of SIL was 10.2% (18/176) for the low CD4 group, and 5.7% (10/176) for the high CD4 group [OR = 1.9 (95% CI: 0.85, 4.22)]. The commonest category of SILs identified was Low-grade Squamous Intraepithelial Lesion (LSIL), thus 11 (6.3%) in the study versus 7 (4.0%) in the control group (p = 0.703). Conclusion: Prevalence of cervical SILs among HIV positive women on HAART in Enugu, Nigeria is low and has no significant relationship with their CD4 cell count.