Obstetrics and Gynaecology- Scholarly Publications

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    Open Access
    Genital Injuries in Civil Urban Population
    (Lagos Journal of Surgery- Department of Surgery, College of Medicine, University of Lagos, 1999) Osegbe, D.N; Ekeke, O.N; Ukpong, A.E; Kanu, O.O; Ogunbamise, O.O; Adegbola, O.
    To assess the pattern of genital injuries in an urban Nigeria population, 34 evaluable patients managed in our service in the past 5 years were studied. The patients were young and there was a strong male preponderance (1 6: l). The injury mechanism was penetrating and gunshot by armed robbers inflicted complex and severe iniuries. Iniuryto hospital time and injury to intervention fime in hospital were prolonged in many. Circumcision related penile iniury followed by armed robbery gunshot topped the chart of aet1010gy. Infection at 63% was a maior source of high morbidity and prolonged hospital stay. Gunshot wounds were managed by extensive debridement and delayed primary suturing. The testes were explored in all violent injuries to the scrotum. Fractured penis was treated by immediate penile degloving and suturing of the breach in tunica albuginea with restoration of erection. Penile amputations, managed by naked eye re-apposition failed. Orchidectomy was performed for shattered testis. Only one patient required blood transfusion. Associated iniuries were common and urethral damage ranked highest. One death occurred but this was not owing to genital iniury per se. Genital iniury is uncommon but will rise with increasing violence in civil society. Early, and expert intervention hold the key to satisfactory outcome
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    Open Access
    Instrumental deliveries and outcome in a British district general hospital
    (Nigerian Quarterly Journal of Hospital Medicine, 2002) Afolabi, B.B.
    Full Text Attached
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    Open Access
    Africa can solve its own health problems. Africa needs less globalisation and more real assistance
    (BMJ, 2002) Afolabi, B.B.
    The article by Holmes and the accompanying commentaries essentially aim to explore the evidence for the efficacy and effectiveness of the psychotherapies and how this should be applied in everyday clini≠cal practice.1It is ironic that the arguments against cognitive therapy include numerous instances of idiosyncratic use of research evidence.Firstly, for example, in his commentary Bolsover selects three studies to support hisview that the evidence base for cognitive therapy is weak. We would challenge him to apply his arguments to the seven systematic reviews of cognitive therapy in the Cochrane Database and the Database of Abstracts of Reviews of Effectiveness.2Holmes and also Bolsover cite a single paper to suggest that cognitive therapy isless effective in the real world of clinical practice than in university based clinicaltrials. This caricature may have applied tosome trials conducted 30 years ago but isirrelevant now. To give just two examples,recent trials of cognitive therapy for chronic depression specifically recruited individualswho were depressed despite adequate trialsof pharmacotherapy and psychotherapy.3Also, the Cochrane review of cognitivetherapy for schizophrenia includes exam≠ples of “real world” interventions.
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    Open Access
    Telemedicine: Definition, Benefits and Limitations
    (Nigerian Quarterly Journal of Hospital Medicine, 2003) Okoromah, C.N.; Afolabi, B.B.
    Advances in information and telecommunication technology have brought about new opportunities and capabilities to the delivery of health care services, but these are not without limitations and threats. Telemedicine encompasses my medical activity involving an element of distance and telecommunication in doctor-patients interaction. it may serve as a valuable tool for providing much needed medical services to underserved rural areas in resource poor countries. It allows better utilization of scare medical personnel and resources and promise to enhance continued medical education of young doctors, nurses and other health care practitioners in rural areas, both in training and in established practices. A practical, cheap, “store and forward, electronic mail-based communication may be used to send patients data with image file attachments for expert consultation any where in the world. Issues of major concern in telemedicine are related to security and confidentially of patient data. The cost of establishing telemedicine in resource poor countries must be balanced against need for drugs, medical equipment central control. There is need for national and international central control bodies to license and supervise telemedicine practices. This paper reviews aspects of telemedicine including its clinical applications, cost effectiveness and limitations.
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    Open Access
    Fasting plasma glucose levels in normal pregnant Nigerians
    (J Obstet Gynaecol, 2003) Afolabi, B.B.; Abudu, O.O.; Oyeyinka, O.
    Summary A study was undertaken to determine a reference value for fasting plasma glucose in a group of apparently normal pregnant Nigerian women. Three hundred and twenty women were tested; 260 pregnant and 60 non-pregnant. There were 60, 100 and 100 subjects in the first, second and third trimesters, respectively. Fasting plasma glucose was measured in each of the women using the glucose oxidase method. The mean fasting plasma glucose level was 4.64+0.79 mmol/l in the control group and 3.72+0.58, 3.78+0.81 and 3.81+0.85 mmol/l in the first, second and third trimesters of pregnancy, respectively. Mean fasting plasma glu￾cose+ 2 standard deviations (SD) of all the pregnant women was 5.3 mmol/l, which is much lower than the World Health Organisa￾tion value for the diagnosis of diabetes mellitus.
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    Open Access
    Insulin Response to Oral 50gms glucose load Screening for gestational diabetes mellitus
    (Nigerian Society of Endocrinology and Metabolism, 2003) Adegbola, O; Banmeke, A; Ajayi, G.O.
    Objective : To study the insulin response to oral 50 grammes glucose load DESIGN: Cohort Study. Setting: Antenatal patients of Lagos University Teaching Hospital. Subjects: Women with abnormal response to 50 grammes glucose load ( 140 mg/dl after one hour) - test and women with normal response to the same glucose load (c 140mg.jdl after one hour)- control. Result: The mean plasma glucose was found to oe statistically significantly tugner in the test groups than in the control groups for both the tasting and one hour glucose levels without any statistically significant change in the plasma fasting insulin level and the plasma one hour insulin levels tol both groups. Conclusion: Failure of a higher insulin response to glucose load has a role to play in the deterioration ot glucose tolerance in pregnancy
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    Open Access
    Medical Informatics in Clinical Practice: An Overview
    (Nigerian Quarterly Journal of Hospital Medicine, 2003) Okoromah, C.N.; Afolabi, B.B.
    Health and patients care is data intensive and involves a wide spectrum of information and often may involve input from other clinical departments and ancillary of clinical support department. For efficient care patients data should be integrated and accessible throughout clinics and hospital. Clinical departmental computer systems can enhance the collection,. Distribution and interpretation of patients data. Providing a high-quality service to patients involves having the right information at the right place and at the right time. Computer technology and networking have revolutionized access and transmission of medical knowledge. Medical informatics involves the use of computer system-analytic tools to support patients of public health care and this forms the basis of hospital information systems. Although the subject of medical informatics has been popularized over two decades in many countries including South African, it remains a largely unexplored subject in the Nigerian medical community. Knowledge and practice and application of computer technology in both private and public Nigeria educational and health institutions are largely rudimentary of non-existent. Yet, health information systems hold tremendous benefits for improving the quality of care including effective utilization of scare human resources. This review article is providing and overview on medical informatics and to stimulate interest in computer support in health care in our locality.
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    Open Access
    Spinal and general anaesthesia for emergency caesarean section: effects on neonatal Apgar score and maternal haematocrit
    (Niger Postgrad Med J, 2003) Afolabi, B.B.; Kaka, A.A.
    This is a prospective comparative study to determine the effect of the type of anaesthesia used for emergency Caesarean section on neonatal and maternal outcome. The patients were recruited into the study after being given either general or spinal anaesthesia. Neonatal outcome was assessed using Apgar scores and need for respiratory assistance at birth. Maternal outcome was assessed using the difference between pre- and post-operative packed cell volumes (PCV), need for blood transfusion and estimated blood loss. The groups were matched for pre-existing risk factors. Apgar scores at 1 and 5 minutes were found to be significantly lower for the general anaesthesia group (GA) than the spinal anaesthesia group (SA) and need for respiratory assistance was greater for the GA group. Difference between pre- and post-operative PCV and need for blood transfusion were also significantly greater in the GA group. This study confirms that the current practice of spinal anaesthesia for Caesarean section in the Lagos University Teaching Hospital is a good one, but further studies need to be done to assess other outcome variables.
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    Open Access
    Maternal Mortality in Africa
    (Friary Press Dorchester UK, 2003-03) ADEGBOLA, O; Oye-Adeniran, B.A; Igwillo, C
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    Glucose and Insulin in amniotic fluid in Nigerian Women
    (Nigerian Society of Endocrinologist and Metabolism, 2004) Ajayi, G.O; Omilabu, S.A; Oshundiya O.O; Adegbola, O.
    Objective To evaluate the glucose and insulin levels in amniotic fluid and compare with maternal blood glucose levels. Setting: Antenatal patients of the Lagos University Teaching Hospital Subjects: Forty-six pregnant women with indications for prenatal diagnosis had mid or late trimester amniocentesis under ultrasound guidance. The duration of the study was from February 2002 to June 2003 Results: The mean gestational age at amniocentesis was 30. 5+6. I weeks and the mean amniotic fluid insulin was 25.2 + Il .3 micro U/ml. Also the mean amniotic fluid glucose was 55. 5+12.4mg/dl while the mean maternal random blood glucose of 86.2 + 15.8mg/dI. Conclusion: Fetoplacental glucose steal phenomenon may be a common occurrence in our pregnant women, coupled With the fact that fetal hyperinsulinism obtained from this study may account for the supposedly low incidence of detection of gestational diabetes mellitus in our women
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    Open Access
    Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria
    (Cochrane Database Syst Rev, 2004) Okoromah, C.A.; Afolabi, B.B.
    Abstract Background: The main treatment for cerebral malaria is parenteral antimalarials. Mannitol and urea are used as adjunct therapy for cerebral malaria, but the World Health Organization does not recommend them. Objectives: To compare mannitol or urea to placebo or no treatment for treating children and adults with cerebral malaria. Search strategy: We searched the Cochrane Infectious Diseases Group Specialized Register (June 2004), CENTRAL (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to June 2004), EMBASE (1974 to June 2004), LILACS (1982 to June 2004), and reference lists of articles. We contacted relevant organizations and researchers. Selection criteria: Randomized and quasi-randomized controlled trials comparing mannitol or urea to placebo or no treatment in children and adults with cerebral malaria. Data collection and analysis: No trials met the inclusion criteria. Main results: No trials met the inclusion criteria. Reviewers' conclusions: We identified no randomized or quasi-randomized controlled trials to support or refute the use of mannitol or urea as adjuncts for treating cerebral malaria in clinical practice. This is likely to require a multicentre trial.
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    Open Access
    Urethral prolapse in a five-year-old girl
    (Nigerian Journal of Paediatrics, 2004) Ekure, E.N.; Okoromah, C.N.; Afolabi, B.B.; Okechukwu, S.E.
    Urethral prolapse is a rare cause of vaginal bleeding in prepubertal females and occurs most commonly in black people. It is characterized by a sliding outward of the urethral mucosa around the entire urethral meatus. Because it can present with vaginal bleeding in a child, it can be mistaken for sexual abuse. We report a five-year-old girl with urethral prolapse that was mistaken for complications of sexual abuse. She was treated by complete excision of the urethral prolapse with satisfactory result.
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    Open Access
    Prolactin and Dehydroepiandrosterone (DHEA) in Nigerian Females
    (Nigerian Society of Endocrinology and Metabolism, 2004) Ajayi, G.O; Omilabu, S; Adegbola, O; Wellington, J; Adeyemi, R
    Objective: To evaluate whether there is any correlation between P/ olaclin and dehydroepiandrosterone (DHEA) level in Nigerian women being managedfor infértility. Setting: Gynaecological Outpatient Clinic of the Lagos University Teaching Hospital (LUTH). Subjects: Eighty one women investigated for infertilityfrom July 2002 10 July 2003 had their blood ussuyedfor prolaclin and DHEA. Results: The mean prolactin level of 15.17±13.88ng/ml was slightly higher than acceptable high limit of normal (15ng/ml) with 28.4% ofwomen accounting for this high value. The mean DHEA was 12.51±9.6Sng/ml and also higher (25% higher) than acceptable high limit of normal (9.8ng/ml) with 43.2% ofthese women accounting for this high value. There was a strong correlation between prolactin and DHEA (R = 0.06; P values = 0.033196) Conclusion: Prolaclin rise is associated Wilh subsequent rise ofDHEA and possibly other adrenal androgens which may potentiate the suppression of ovarian function ofprolactin. It is recommended that serum androgens should be assayed whenever there is a high Prolactin level.
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    Open Access
    Tri-iodo Thyronine (T3), Thyroxine (T4) and Thyroid Stimulating Hormone (TSH) in Nigerian females being managed for infertility.
    (Nigerian Society of Endocrinologist and Metabolism, 2004) Adegbola, O; Ajayi, G.O.; Omilabu, S; Wellington, J; Adeyemi, R
    Objective: To evaluate Tri-iodothyronine (T3), Thyroxine (T4) and Thyroid Stimulating Hormone (TSH) in NigerianFema/es managed for infertility. Setting: Gynaecological Outpatient Clinic of the Lagos University Teaching Hospital (LUTH) Subjects: One hundred and thirty five women attending the gynaecological outpatient clinic of LUTH for infertility evaluation for 2hyrs: from February 2001 to July 2003, had their blood T3, T4 and TSH assayed using enzyme immuno-assay test. Results: The mean age of these women was 33.4+54 years while their mean parity was 2.3+1.3. Also the mean day of cycle the tests were done was 16.6+7.3 day. The mean T3 was 35.96+ 88.34ng/mI and is much higher (over eighteen times more) than the acceptable high limit of normal of 1.85ng/ml. The range ot the T3 values was however wide (0.01 — 370), while 41.5% of these women had higher than normal values The meanT4 was 12.7+ 11.9pg/dI and is slightly raised above the acceptable high limit of normal of 12pWdl correlation between T4 and TSH as well as between T3 and T4. Conclusion: T3 hyperthyroidism was noted in 41.5% of these women with 31. % of them also showing very low TSH values which may suggest hyperthyroidism. The strong correlation between T3 and TSH implies that 31.1 % to 41.5% of women attending infertility clinic may have thyroid disorders. These values are high enough to recommend that T3, T4 and TSH should be requested routinely as pad of the investigations required in evaluation of infertility.
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    Open Access
    Intramuscular arteether for treating severe malaria
    (Cochrane Database Syst Rev, 2004) Afolabi, B.B.; Okoromah, C.N
    Abstract Background: Quinine and artemisinin drugs are used in severe malaria, but quinine resistance is increasing. Arteether is a recently developed artemisinin derivative that is oil soluble, has a long elimination half life, and is more stable than other derivatives. Objectives: To compare intramuscular arteether with other antimalarial drugs to treat severe malaria. Search strategy: We searched the Cochrane Infectious Diseases Group Specialized Register (August 2004), CENTRAL (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to August 2004), EMBASE (1980 to August 2004), U.S. National Library of Medicine (NLM) Gateway (1953 to 1965), Web Science Citation (1981 to August 2004), LILACS (August 2004), Google search engine (August 2004), conference proceedings, and reference lists. We also contacted researchers, organizations, and pharmaceutical companies to help identify trials. Selection criteria: Randomized and quasi-randomized controlled trials of intramuscular arteether in adults and children with severe malaria. Data collection and analysis: We independently assessed the methodological quality of the trials and extracted data, and analysed data using Review Manager 4.2. Main results: Two small trials (n = 194) met the inclusion criteria. Both trials compared arteether with quinine in children with cerebral malaria and reported on similar outcomes. There was no statistically significant difference in the number of deaths (relative risk 0.75, 95% confidence interval 0.43 to 1.30; n = 194, 2 trials), neurological complications (relative risk 1.18, 95% confidence interval 0.31 to 4.46; n = 58, 1 trial), or other outcomes including time to regain consciousness, parasite clearance time, and fever clearance time. The meta-analyses lack statistical power to detect important differences. Reviewers' conclusions: More trials with a larger number of participants are needed before a firm conclusion about the efficacy and safety of arteether can be reached.
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    Open Access
    What is the optimum maternal haemoglobin concentration level for a normal birth weight in Lagos?
    (Tropical Journal of Obstetrics and Gynaecology, 2004) Afolabi, B.B.; Akinola, O.I.
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    Open Access
    Prolactin and Dehydroepiandrosterone (DHEA) in Nigerian males
    (Nigerian Society of Endocrinologist and Metabolism, 2004) Adegbola, O; Ajayi, G.O.; Wellington, J; Adeyemi, R
    Objective: To evaluate the correlation between prolactin and dehydroepiandrosterone (DHEA) levels in men who were co-investigated with their wife for infertility. Setting: Gynaecologjcal Outpatient Clinic of the Lagos University Teaching Hospital (LUTH) Subjects: Fifty two men who were co-investigated with their wives for infertility at the gynaecological outpatient clinic, Lagos University Teaching Hospital (LUTH) from July 2002 to July 2003, had their blood assayed for prolactin and dehydroepiandrosterone (DHEA). Results: The mean prolactin level of I. 9±10.3ng/mI was within the laboratory normal limit but 28.8% of these men had concentration more than the laboratory high limit of normal of j5ng/ml. The mean DHEA level of 12.8±9.2ng/ml was not much different from the laboratory high limit of normal of 12.5ng/mI but 46.2% of them had levels greater than this laboratory high limit of normal. There was no correlation between pro/actin, DHEA and body mass index. Conclusion: The mean prolactin was within normal limit while the mean DHEA was just slightly higher than normal. No correlation between prolactin, DHEA and body mass index in the males
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    Open Access
    Future of Medical Education in Nigeria
    (Archives of Ibadan Medicine, 2005) Olapade-Olaopa, E.O.; Afolabi, B.B.; Falase, O.A.
    As societies continue to change, medicaleducationhasto adjust regularly in response to these changes in order to remain relevant The Nigerian society and its medical schools are no exception, and the future of medical education in the country is dependent on the development of curricula that take the changes in the society into consideration. Medical schools are now expected to offer 'socially responsive' medical education. By this, it is expected that medical school curricula should be directed at producing graduates that would have a positive impact on the public and population health of their host environment, and thus should be guided by the same whilst ensurinq that global standards of medical education are maintained. This considered, doctors are now expected to acquirecompetencies that would meetthe current needs of their society during their traininq. Furthermore,the scientific bases of medicineare universal and there is a highdegreeof equivalence in medical schools worldwide. As such, common international standards can and have been defined for basic medical education.
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    Future of Medical Education in Nigeria
    (Archives of Ibadan Medicine, 2005) Olapade-Olaopa, E.O.; Afolabi, B.B.; Falase, O.A.
    ABSTRACT Societies continue to change and medical education has to adjust regularly in response to these changes in order to remain relevant.Inaddition, the scientific bases of medicine are universal and there is a high degree of uniformity in medical schools worldwide. As such, common international standards can and have been defined for basic medical education. This considered, doctors are now expected to acquire competencies that would meetthe current needs of their society while ensuring that global standards of medical education are maintained during their training. In summary, current and future medical practice requires graduates with excellent clinical, research, computer and entrepreneuri.al skills, and who possess a problem-solving and a life-long learning attitude. This article focuses on the aspects of medical education considered to be central to the production of doctors with these skills. These are curriculum review, web-based learning, healthcare informatics and the involvement of stakeholders.
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    Open Access
    Intravaginal misoprostol versus Foley catheter for cervical ripening and induction of labor
    (Int J Gynaecol Obstet, 2005) Afolabi, B.B.; Oyeneyin, O.L.; Ogedengbe, O.K.
    Objective: To compare the efficacy and safety of 100 microg of intravaginal misoprostol with intracervical Foley catheter for cervical ripening and induction of labor. Method: One hundred women being induced in the Lagos University Teaching Hospital, Nigeria, were randomized to receive a single 100 microg dose of misoprostol intravaginally or intracervical insertion of Foley catheter. Data analyses were by the Student's t-test and chi-square test. Result: Misoprostol was more effective in terms of induction to delivery interval (11.84+/-5.43 versus 20.03+/-4.68 h, P<0.05), change in Bishop score, and number delivered within 24 h, in patients with a one-time successful induction. Uterine hyperactivity and rupture were more frequent in the misoprostol group. Conclusion: A single 100 microg dose of intravaginal misoprostol is more efficacious than intracervical insertion of Foley catheter for cervical ripening and induction of labor. Further studies using lower doses are needed to determine the safest dose.