Awareness of HPV Infection and Vaccination Among Teens in Urban School, Nigeria

To assess the level of awareness and knowledge of HPV infection and vaccination among 648 Teens from secondary schools and colleges in four metro cities of Port Harcourt Nigeria. Materials and methods: This cross-sectional study was conducted by from 1st March to 31st August, 2018. Girls of 13–19 years, with an average of 16 years are targeted. A written questionnaire with two parts has been applied. A preliminary written questionnaire included questions of HPV infection and vaccination awareness. Results: The study participants are poorly aware about HPV infection and vaccination but are intensely willing to know about it. 98% (n-632) are not aware of HPV infection, while, 98% (n–636) is not aware of the vaccination. Conclusions: This study brings out the unawareness about HPV infection and vaccination in urban adolescent in four metro cities in Port Harcourt Nigeria. Adolescent understanding and being aware of the HPV virus is needed to have successful vaccination programs in Nigeria.

Perinatal Outcomes of Babies Born with Fresh or Frozen-Thawed Testicular Sperm in Patients with Azoospermia

Aim: To compare the perinatal outcomes of pregnancies obtained with fresh or frozen-thawed sperm in patients who underwent surgical sperm extraction for the diagnosis of azoospermia. Materials and Methods: In this retrospective study, data were collected on couples who conceived following Intracytoplasmic Sperm Injection using surgically retrieved fresh or frozen-thawed sperm. Participants were divided into two equal groups as follows. Group 1 (n = 100) consisted of patients who underwent ICSI and subsequent embryo transfer using fresh testicular sperm and Group 2 (n = 100) consisted of patients who underwent ICSI by using frozen-thawed testicular sperm. Perinatal outcome was compared according to the use of fresh or frozen-thawed sperm. Primary outcome measures included clinical pregancy, miscarriage, live birth, congenital abnormality, birthweight, gestational age at delivery, stillbirth and neonatal death. Results: Live birth and clinical pregnancy rates were found to be significantly higher in patients who underwent ICSI/ET with frozen-thawed testicular sperm compared to fresh sperm group. The miscarriage rates were significantly lower in the frozen-thawed sperm group compared to the fresh testicular sperm group. Clinical pregnancy was detected in 18 cases, while no pregnancy was detected in 82 cases undergoing ICSI with fresh sperm. In the group where ICSI/ET was applied with frozen sperm, clinical pregnancy was detected in 51 cases, whereas pregnancy was not detected in 49 cases. In the frozen sperm group, in addition to C/S and multiple pregnancy rates, the number of babies with a birth weight below 2500 g was significantly higher than in the fresh sperm group. There was no significant difference between the groups in terms of minor and major congenital anomalies, birth weight, gestational age at delivery, stillbirth and neonatal death. Conclusion: Using fresh or frozen testicular sperm does not have a significant effect on perintal outcome in patients with azoospermia.

A 4 Year Experience with Copper T Intrauterine Contraceptive Device at Federal Medical Centre (Fmc), Katsina

Background: The prevalence of contraceptive use is still very low in Nigeria. Use of modern contraceptive methods has been shown to reduce unwanted pregnancy, high parity and maternal mortality. Objectives: The aim of this study is to determine the acceptance rate of intrauterine contraceptive method, the socio-demographic characteristics of its users, side-effects, discontinuation and the reason thereof, at Federal Medical Centre, Katsina. Method: A retrospective study that reviewed records of all clients who used intrauterine contraceptive method at the family planning clinic over a 4-year period (1st January 2011 to 31st December 2014). Results: Out of the 1892 family planning clients, 111 used IUCD, with IUCD acceptance rate of 5.87%. The modal age group was 20-24 years (30.0%). Most of them (n=54) were grandmultiparous (48.6%), and of Islamic faith (98%). Almost all the clients were married (97.8%), and majority had secondary education (71%). Thirty- ive (31.5%) of the users discontinued the method, with the commonest indication being desire for pregnancy (45.7%). No contraceptive failure was recorded during the study period. Conclusion: IUCD is the fourth commonly used method. Its use is influenced by maternal age, parity and literacy level. In spite of its long duration of action, most of the reversal was due to the desire for pregnancy. Acceptability of IUCD can be improved by health education, adequate counseling and careful client selection.

Difficult and Failed Tracheal Intubation in Obstetrics: A Seven-year Review in a Saudi Maternity Hospital

Background: Airway difficulty is a major contributor to mortality and morbidity during caesarean section (CS) under general anaesthesia. Though general anaesthesia is safe, the changes associated with pregnancy make securing airway more difficult. The purpose of this study was to investigate the pattern and factors associated with airway difficulty in the parturient in the region. Methods: This was a retrospective, descriptive study of parturients who suffered airway difficulty during caesarean section under general anaesthesia over seven-year period. Their medical records were reviewed and data collected included total CS done under general anaesthesia, age, weight, nature of airway difficulty, coexisting diseases, and timing of surgery, outcomes and Apgar scores. Data was analysed using SPSS version 23 for Windows®. Results: General anaesthesia was used in 51.3% of 10,275 CS with 42 documented as “difficult airway” giving 0.8% incidence and incidence ratio of 1:125. Failed intubation was recorded in 58% while difficult intubation was 42% of those with difficult airway. Among these, the CS was in 55% of cases “emergent”. The mean age was 33.32±5.96 years. The weight ranged from 60 to 163kg. Over 58% weighed more than 90kg. In 50% of cases, the airway was rescued with LMA and in 50%, reintubation succeeded. Outcome was good for mother and fetus in all cases. Conclusion: Obstetric airway difficulty remains a valid concern. Effort should be made to use regional anaesthesia to reduce the risk. High awareness and preparation during obstetric general anaesthesia are recommended.

Secondary Amenorrhea Due to Unusual Cause (Hematometrocolpos)

Hematometrocolpos usually caused by obstruction of lower genital tract, somewhere in the vagina such as Imperforated hymen. In our case there is no obstruction in the vagina, but started at the cervix in a form of membrane. This membrane extended in the vagina forming intavaginal cyst which filled with blood and by time gave the complete picture of hematometrocolpos. This case aged 53 years old, para7 and presenting to our clinic complaining of urinary retention burning of micturition and secondary amenorrhea for 9 months.

Optimal Duration of Progesterone Treatment before Cryopreserved-Thawed Embryo Transfer

Objective: To investigate the optimal duration of progesterone therapy before cryopreserved-thawed embryo transfer and its impact on clinical pregnancy and live birth rates. Methods: Five hundreds women undergoing cryopreserved-thawed embryo transfer were included in the study. These patients had a total of 500 embryos frozen on day 3 (n = 200), day 4 (n = 100), day 5 (n = 150) and day 6 (n = 50). Artificial endometrial preparation was successfully performed in all participants. If the endometrial thickness reached a minimum of 8 mm or in the presence of a triple-line view, the patients were divided into four different groups and each group into two subgroups according to the estimated duration of progesterone treatment to be used. Group 1 (n = 200): This group consisted of patients with day 3 embryo transfer. While 100 of 200 patients received embryo transfer after 3 days of progesterone treatment, the remaining 100 patients received embryo transfer after 4 days of progesterone treatment. Group 2 (n = 100): This group consisted of patients who underwent day 4 embryo transfer. While 50 of 100 patients had embryo transfer after 4 days of progesterone treatment, the remaining 50 patients received embryo transfer after 5 days of progesterone treatment. Group 3 (n = 150): This group consisted of patients who received day 5 embryo transfer. While 75 of 150 patients received embryo transfer after 5 days of progesterone treatment, the remaining 75 patients received embryo transfer after 6 days of progesterone treatment. Group 4 (n = 50): While 25 of 50 patients received embryo transfer after 6 days of progesterone treatment, the remaining 25 patients received embryo transfer after 7 days of progesterone treatment. The primary outcome measure of our study was to evaluate clinical pregnancy rate (CPR), ongoing pregnancy rate (OPR), live birth rate (LBR) and miscarriage rate per pregnancy. Results: Clinical pregnancy rates were found in 50 of 100 (50%) cases who were given progesterone for 3 days. Of the 100 cases who were given progesterone for 4 days, 40 clinical pregnancy was detected (40%). Both OPR and LBR were found to be significantly lower in patients who received 4 days of progesterone treatment compared to those given 3 days. The rates of miscarraige (9.09%) in patients who received progesterone treatment for 4 days were significantly higher than those who received progesterone for 3 days (5.8%). In Group 2 both OPR and LBR were found to be significantly lower in patients who received 5 days of progesterone treatment compared to those given 4 days. The rate of miscarraige (25.0%) was significantly higher in patients who received progesterone treatment for 5 days compared to those who received progesterone for 4 days (33.3%). When 75 patients in group III who underwent embryo transfer on the fifth day and received progesterone treatment for 5 days and 75 patients who were given progesterone treatment for 6 days were evaluated in terms of CPR, OPR and LBR the difference was statistically significant between the two gruops. When patients in group IV were evaluated in terms of CPR, OPR and LBR the difference was statistically insignificant. Conclusions: Extending the progestereone usage period one day before embryo transfer has been found beneficial in patients who have been transferred for only fifth day.

Endometrial HOXA10 mRNA Expression in PCOS Patients at High Risk for Ovarian Hyperstimulation Syndrome

Background: This study was designed to determine whether the risk of ovarian hyperstimulation syndrome (OHSS) contributes to the subfertility in PCOS. Endometrial HOXA-10 mRNA expression, a well-characterized gene essential to endometrial receptivity, was evaluated in PCOS patients whose embryos are planned to be frozen due to the risk of OHSSS. Methods: Twent-five women with PCOS in high risk group for OHSS and age and BMI matched 25 non-PCOS infertile patients were included the study. Five fertile women were accepted as positive control. Following egg collection each group of subject underwent total embryo freezing. After the egg collection, endometrial sampling was performed with a pipella cannula from each gruop of participant and fertile control. Expression levels of HOXA-10 mRNA were determined by RT-PCR. Gene expression results are presented as Ct (cycle threshold), ΔCt, and ΔΔCt. Reults: Average ΔCt value of HOXA-10 mRNA in PCOS, non-PCOS and fertile groups were found to 5.88, 6.77, and 7.79 respectively. Compared to endometrial HOXA-10 mRNA levels of fertile cases, the HOXA-10 mRNA levels of the patients in the PCOS group were found to be significantly lower (ΔCt 7.79 vs. ΔCt 5.88, p<0.002). Similarly, endometrial HOXA-10 mRNA levels in the non-PCOS control group were significantly lower than the HOXA-10 mRNA levels in the fertile group (ΔCt 6.77 vs. ΔCt 7.79, p<0.001). HOXA-10 mRNA levels in endometrial samples taken from patients in the PCOS group were found to be significantly lower than the HOXA-10 mRNA levels in non-PCOS control group. Conclusions: HOXA-10 mRNA levels were found to be lower in PCOS patients with high risk for OHSS compared to both fertile and infertile patients without PCOS. OHSS risk in PCOS decreases endometrial HOXA-10 mRNA expression.

Anaesthetic Management of Parturient with Motor Neuron Disease for Caesarean Delivery: Case Report

Motor neuron disease (MND) is a progressive neurodegenerative disease of unknown aetiology, which results in weakness of muscles of phonation, ambulation, deglutition and respiration. It has low prevalence but high disability and fatality. Death often follows respiratory failure. There is no known cure. It is extremely rare in pregnancy, but when it occurs, the respiratory compromise worsens and anaesthesia becomes challenging. There is no consensus yet on the choice of anaesthesia. We present a 29-year-old, 32-week parturient with MND who presented with severe dyspnea, orthopnea and was diagnosed with severe respiratory distress. She was admitted into ICU and given anticoagulant and steroid therapy. Sequential mini-dose combined spinal-epidural anaesthesia (CSE) was given and surgery performed in the semi-sitting position successfully. There was no deterioration of symptoms post anaesthesia. We conclude that CSE is adequate to manage parturient with MND who has severe orthopnea following respiratory muscle paresis.

Premature Babies Delivered by Assisted Reproductive Technology and Their Family Care Experience

Currently, the majority of couples who choose assisted reproductive technology (ART) have waited for and experienced the disappointment of natural conception. With the assistance of ART, they are finally able to “carry a baby to term.” This is wonderful for first-time parents. This case report involves a woman who delivered a premature baby weighing 1,520 g at 30+5 weeks using ART and her family care experience. During the period of care from October 23, 2016 to December 9, 2016, data were collected on this case through systemic assessment, clinical observation, and parental interview. Problems including gas exchange disorder, caregiver role tension, and the potential risk of parent-child attachment disorder were identified. In addition to providing appropriate medical care to maintain stable vital signs, we hoped to reduce the occurrence of comorbidities through a complete nursing assessment and comprehensive developmental care. We also attempted to build trust and to reduce parental anxiety and stress by providing relevant medical information and psychological support through active and proactive nursing care. The performance of “kangaroo care” with stable vital signs enhances parent-child attachment and a sense of involvement in the ongoing care of the infant. This strengthens the mother’s motivation and self-confidence in her caregiving role, enhances her sense of accomplishment as a mother, and promotes the growth and development of the infant after returning home. The weight of the infant reached 2,430 g before discharge. Before discharge, the mother was able to cite at least two caregiving skills and her eyes were no longer red from sobbing. We hoped that the parent-child attachment was well developed and that “kangaroo care” will assist the mother to face the future with a positive attitude after returning home. This article can be used as reference for nursing practitioners to improve the quality of care for premature babies.

Impact of Male Aging on Semen Parameters

Aim: To investigate the effect of increasing male age on the semen parameters including semen volume, sperm concentration, and progressive sperm motility. Materials and Methods: 1038 patients who applied to our IVF clinic for semen analysis or for infertility treatment were included in the study. The participants were divided into three age categories as follows: 680 participants (65.5%) aged 22-30, 139 participants (13.4%) aged 31-45 years, and 219 participants (21.1%) aged ≥45 years. Demographic and baseline clinical characteristics were recorded. The variables considered in this study were age and the following semen parameters: volume (ml); sperm concentration (millions/ml); and progressive sperm motility A+B (%). Normal semen values were defined based on the WHO criteria (World Health Organization, 2010). Results: The mean age of the participants was 33.1(± 4.8). The mean BMI of the participants was 24.1(± 2.8). The mean semen volume was 3.3 (± 1.5), the mean semen concentration was 43.6 (± 31.7), and the mean progressive sperm motility was 43.6 (± 10.1). There was a moderate negative correlation between paternal age and semen volume (r=-0.13) and sperm motility (r=-0.32), while there was a moderate positive correlation between paternal age and sperm concentration (r=0.24). The proportion of likelihood ratio measured between semen volume, sperm concentration, sperm motility and age was found to be 1 in patients between the ages of 22-30. The 22-30 age group does not have a decreasing or increasing effect on semen volume (OR: 1), sperm concentration (OR: 1) and motility (OR: 1). Regression analysis of patients in the 31-45 age group revealed no change in semen volume (OR: 0.99, 95% CI: 0.43-2.3, p <0.9), but an increase in sperm concentration (OR: 1.74, 95% CI: 1.13-2.7, p <0.01), and decreased sperm motility (OR: 0.28, 95% CI: 0.16-0.47, p <0.00). In the regression analysis of participants over the age of 45, semen volume (OR: 0.31, 95% CI: 0.19-0.53, p <0.00) and sperm motility (OR: 0.05, 95% CI: 0.03-0.08, p <0.00) decreased with age. No change was detected in the concentration (OR: 0.87, 95% CI: 0.63- 1.2, p <0.3). Conclusion: With increasing male age, semen volume and sperm motility begin to decrease. However, a significant decrease in sperm concentration does not occur until the age of 45.