Oladapo Olayemi

Significant Bacteriuria Among Asymptomatic Antenatal Clinic Attendees In Ibadan, Nigeria

Untreated asymptomatic bacteriuria can lead to urinary tract infection (UTI) in pregnancy with devastating maternal and neonatal effects such as prematurity and low birth weight, higher fetal mortality rates and significant maternal morbidity. We carried out a two year (April 2007 to March 2009) cross-sectional epidemiological study to determine the prevalence of significant bacteriuria among asymptomatic antenatal clinic attendees at two antenatal clinics (ANCs) in University College Hospital and Adeoyo Maternity Hospital, both in Ibadan, Nigeria. All consenting ANC attendees without UTI were enrolled in the study. Urine specimens of 5 to 10 ml collected from each subject were examined microscopically for white blood cells, red blood cells and bacteria. The specimens were further cultured on MacConkey agar using a sterile bacteriological loop that delivered 0.002 ml of urine. Colony counts yielding bacterial growth of more than 105/ml of pure isolates were considered significant. Of the 473 subjects studied, 136 had significant bacteriuria, giving a prevalence rate of 28.8%. The highest age specific prevalence (47.8%) was found in the 25–29 year olds while only one (0.7%) was found in the teenage group. A large percentage (64.0%) of subjects with significant bacteriuria had tertiary education, compared with 4.4% who had no formal education but the association was not statistically significant (X2 = 0.47, p = 0.79). The majority (75.8%) of subjects with significant bacteriuria had no previous history of abortion, while 20 (14.7%) had one previous abortion and only three (2.1%) admitted to three previous abortions (X2 = 5.16, p = 0.16). The majority (69.8%) of those with significant bacteriuria presented at second trimester while 38 (28.0%) presented at third trimester (X2 = 6.5, p = 37). Only 22 (4.6%) of the studied subjects presented at first trimester, and 3 (13.7%) of these had significant bacteriuria. The prevalence of asymptomatic bacteriuria is high among this study population. Hence we suggest that advocacy programs be initiated to urge pregnant women to access ANC services early in pregnancy.

Patterns and predictors of self-medication amongst antenatal clients in Ibadan, Nigeria

Background: Self-medication is widely practiced in the study area, as many drugs are available over-the-counter, in addition to the use of local herbal preparations. Also, apprehension about the dangers of drug use in pregnancy appears to affect the compliance of prescribed medication. This study assess the drug use profile of an antenatal population. Materials and Methods: This was a questionnaire-based descriptive study of 410 antenatal clients attending primary, secondary and tertiary centers in Ibadan, Nigeria. The variables analysed were demographic data of respondents and level of health care received. Outcome measures were use of prescribed drugs, self-medication or herbal preparations. Chi-tests and logistic regression were used for statistical analysis. Results: All patients on prescribed medication for medical conditions claimed to be compliant with their drugs. Exactly 19.2% admitted to self-medication, mostly hematinics and pain-relieving pills (acetaminophen). No one admitted to alcohol or tobacco use, but 46.3%, especially attendees of the rural center (OR 5.79; 95% CI 2.56-13.10), ingested herbal concoctions while pregnant. Married women (OR 0.2; 95% CI 0.05-0.75) or those whose spouses had higher education (OR 0.43; 95% CI 0.21-0.89) were less likely to practice self-medication, while hypertensive women were more likely to practice it (OR 22.54; 95% CI 3.81-133.49). Conclusions: Social support has a role in safe drug use practices. This should be used to advantage by encouraging partners’ attendance at antenatal sessions. Patients need counseling on the dangers of procuring their usual prescription drugs without consultation. Use of herbal concoctions needs to be explored in the community.

Role of elevated immunoglobulin E levels in suppurative otitis media

Abstract Background and Objectives: An association between suppurative otitis media (SOM) and allergy has been reported in about 80% of patients with allergy. However, there is controversy regarding their relationship and the concept of middle-ear allergic response. We test the hypothesis that increased secretion of IgE in the middle ear is higher in chronic than in acute SOM. Methods: Allergy skin testing and enzyme-linked immunoassay of specimens of middle-ear secretions and sera were analysed. Results: Paired sera and middle-ear secretions (MES) from 37 subjects with SOM, 20 chronic (CSOM) and 17 acute (ASOM), and sera of 15 controls selected from children without otitis media were analysed. There were 30 males and 27 females aged between 6 months and 9 years, mean (SD) 6 years (3.26). A history of allergy and skin test positive to one or more of dust, house dust mite, mould, cockroach and poultry feathers were found in 80% of CSOM, 47% ASOM and 33% controls. The mean IgE levels in sera were: controls 52.1 mg/dL, ASOM 63.9 mg/dL and CSOM 79.2 mg/dL; the MES levels were: AOM 60.4 mg/dL and CSOM 102.0 mg/dL. The MES to serum IgE ratios were 0.75 for ASOM and 1.4 for CSOM. The serum IgE ratio of controls to ASOM was 1.22 and to CSOM was 1.5. Multivariate analysis of the mean showed significant correlation between IgE level of MES in ASOM and CSOM (p=0.04) but no correlation between IgE levels in control and ASOM sera (p=0.10), control and CSOM sera (p=0.7) or AOM and CSOM sera (p=0.3). Conclusion: Allergy appears to play a contributory role in CSOM and elevated IgE in the MES suggests a likely mucosal response.

Influence of duration of sexual cohabitation on the risk of hypertension in nulliparous parturients in Ibadan: A cohort study

Background:  Hypertensive disorders of pregnancy are an important cause of maternal mortality in this environment, it accounts for about 20% of all maternal deaths in pregnancy in Nigeria.

The role of ethnicity on pain perception in labor among parturients at the university college hospital Ibadan

Aims:  In developing countries, the major mechanism by which parturients cope with labor pain is psychological. This study aims to assess the effect of ethnicity on the perception of pain by parturients in labor at the University College Hospital, Ibadan.

Urinary pathogens and drug susceptibility patterns of urinary tract infections among antenatal clinic attendees in Ibadan, Nigeria

Aim:  To determine the bacterial agents involved in urinary tract infections in pregnant women and their antibiotic susceptibility patterns in Ibadan, Nigeria.

Correlation between Serum Immunoglobulin G and Hearing Threshold among Elderly Subjects with Age-Related Hearing Loss

Background and Purpose: This study was based on the hypothesis that suboptimal immune response and low serum immunoglobulin G (IgG) may predispose to age-related hearing loss (ARHL), and the objective was to determine the serum levels of IgG and hearing thresholds of apparently healthy elderly subjects and assess their correlation. Method: This prospective study involved 126 participants ≧60 years old who were found to be free of any medical conditions. Pure-tone averages for both the speech (500–2,000 Hz) and high frequencies (3,000–8,000 Hz) and serum IgG levels were determined. Using 30 dB as cut-off for hearing loss, the correlation with serum IgG was assessed. Results: There were 59 males and 67 females with a mean age ± SD of 67.0 ± 2.7 years. Speech frequency hearing loss was seen in 30.2%, while high-frequency hearing loss accounted for 74.6%. In the speech frequencies, the mean ± SD of serum IgG among subjects with normal hearing was 11.3 ± 3.9 g/l, while among those with hearing loss it was 8.3 ± 3.3 g/l (p = 0.01). In the high frequencies, the mean ± SD values of serum IgG among the subjects with normal hearing was 11.1 ± 2.3 g/l, while among those with hearing loss it was 8.7 ± 1.9 g/l (p = 0.01). Conclusion: Low serum IgG may be a contributory factor to the development of ARHL among the elderly. However, a longitudinal study involving intervention with immunoglobulin supplementation may further confirm this role.

Randomized controlled trial comparing 200 μg and 400 μg sublingual misoprostol for prevention of primary postpartum hemorrhage

To compare efficacy and adverse effects of 200 μg and 400 μg misoprostol for prevention of postpartum hemorrhage (PPH).

Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): protocol and statistical analysis plan for a randomized controlled trial.

Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. Tranexamic acid has the potential to reduce bleeding and a large randomized controlled trial of its effect on maternal health outcomes in women with PPH (The WOMAN trial) is ongoing. We will examine the effect of tranexamic acid on fibrinolysis and coagulation in a subset of WOMAN trial participants. Methods: Adult women with clinically diagnosed primary PPH after vaginal or caesarean delivery are eligible for inclusion in the WOMAN trial. In a sub-group of trial participants, blood samples will be collected at baseline and 30 minutes after the first dose of tranexamic acid or matching placebo. Our primary objective is to evaluate the effect of tranexamic acid on fibrinolysis. Fibrinolysis will be assessed by measuring D-dimers and by rotational thromboelastometry (ROTEM). Secondary outcomes are international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, haemoglobin and platelets. We aim to include about 180 women from the University College Hospital, Ibadan in Nigeria. Discussion: This sub-study of WOMAN trial participants should provide information on the mechanism of action of tranexamic acid in women with postpartum haemorrhage. We present the trial protocol and statistical analysis plan. The trial protocol was registered prior to the start of patient recruitment. The statistical analysis plan was completed before un-blinding. Trial registration: The trial was registered: ClinicalTrials.gov, Identifier NCT00872469 https://clinicaltrials.gov/ct2/show/NCT00872469; ISRCTN registry, Identifier ISRCTN76912190 http://www.isrctn.com/ISRCTN76912190 (Registration date: 22/03/2012).

Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, double-blind, placebo-controlled trial

Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. We evaluated the effect of TXA on fibrinolysis and coagulation in a sample of WOMAN trial participants. Methods: Adult women with a clinical diagnosis of PPH were randomised to receive 1 g TXA or matching placebo in the WOMAN trial. Participants in the WOMAN trial at University College Hospital (Ibadan, Nigeria) also had venous blood taken just before administration of the first dose of trial treatment and again 30 (±15) min after the first dose (the ETAC study). We aimed to determine the effects of TXA on fibrinolysis (D-dimer and rotational thromboelastometry maximum clot lysis (ML)) and coagulation (international normalized ratio and clot amplitude at 5 min). We compared outcomes in women receiving TXA and placebo using linear regression, adjusting for baseline measurements. Results: Women (n=167) were randomised to receive TXA (n=83) or matching placebo (n=84). Due to missing data, seven women were excluded from analysis. The mean (SD) D-dimer concentration was 7.1 (7.0) mg/l in TXA-treated women and 9.6 (8.6) mg/l in placebo-treated women (p=0.09). After adjusting for baseline, the D-dimer concentration was 2.16 mg/l lower in TXA-treated women (-2.16, 95% CI -4.31 to 0.00, p=0.05). There was no significant difference in ML between TXA- and placebo-treated women (12.3% (18.4) and 10.7% (12.6), respectively; p=0.52) and no significant difference after adjusting for baseline ML (1.02, 95% CI -3.72 to 5.77, p=0.67). There were no significant effects of TXA on any other parameters. Conclusion: TXA treatment was associated with reduced D-dimer levels but had no apparent effects on thromboelastometry parameters or coagulation tests. Registration: ISRCTN76912190 (initially registered 10/12/2008, WOMAN-ETAC included on 22/03/2012) and NCT00872469 (initially registered 31/03/2009, WOMAN-ETAC included on 22/03/2012).