Virilized external genitalia in young girls: clinical characteristics and management challenges in a low-resource setting

OBJECTIVE

Virilization of the external genitalia in young girls (VEG) manifests mostly as ambiguity of the genitalia and elicits concerns and uncertainties especially in settings with poor awareness. This study evaluates the profile and challenges of VEG in southeast Nigeria.

METHODS

We analyzed 23 children with VEG managed in 2 referral centers in southeast Nigeria from June 2005 to January 2013.

RESULTS

They presented at median age of 13.3 months (interquartile range [IQR] 3 months-3 years). The cases included 3 (13%) of Prader type 1, 6 (26%) of type 2, 11 (48%) of type 3, and 3 (13%) of type 4. Five of the Prader type 3 and all 3 cases of Prader type 4 were reared as male prior to presentation. Following evaluation, all the cases were assigned female gender at a mean age of 2.7 years (range 2 months-10.5 years). Appropriate feminizing genitoplasty was undertaken in all the cases and after a follow-up period of 3 months to 5 years (mean 2 years), 2 patients developed vaginal stenosis, and 3 cases had surgical wound infection. Poor awareness, delayed presentation, inadequate facilities, and lack of trained manpower were the challenges in the management of the cases.

CONCLUSION

VEG in our setting is associated with delayed management. Focused health education and public awareness programs, and improved healthcare funding may improve outcome and minimize the need for gender reassignment.

Anti-nutritional factors in the roots of a local cultivar of Moringa oleifera (Lam)

The evergreen plant, Moringa oleifera (Lam) has been known to have both medicinal and nutritional properties, thus its wide use in traditional medicine in Africa and Asia. The roots, in particular, have been reported to possess antibiotic, anti-tumour and anti-oxidative activities. This study therefore seeks to determine the levels of the anti-nutritional factors and other proximate analyses in the roots of a local cultivar of Moringa oleifera which might be responsible for such activities. The concentrations of oxalates and phytates in the roots were determined using the methods of Munro and Bassir and Griffith and Thomas, respectively. The methods of Association of Analytical Chemists (AOAC) were used to estimate the amount of tannins, saponins and cyanogenic glycosides while the Technicon sequential Multi-sample amino acid analyzer (TSM) was used determine the amino acid concentration in the roots. Tannins (45 mg 100 g(-1)) and oxalates (17.08 mg 100 g(-1)) were present in the roots at higher levels while saponins (4.20mg 100 g(-1)), cyanogenic glycosides (2.72 mg 100 g(-1)) and phytates (0.07 mg 100 g(-1)) occurred at much lower levels. The roots contained (Mean +/- Standard Error of mean) %crude lipid (6.33 +/- 1.64), %crude proteins (5.02 +/- 1.52), %carbohydrates (76.75), %ash (4.97 +/- 0.53) and %moisture (6.93 +/- 0.58). The roots lacked the water-soluble vitamins pyridoxine, riboflavin and thiamine but contained ascorbic acid (48.13 mg 100 g(-1)) and niacin (5.83 mg 100 g(-1)). This study has shown that Moringa oleifera roots are rich in anti-nutritional factors and that is why they are widely used in traditional medicine in Africa, Asia and Americas for its medicinal importance.

Effect of soaked Moringa oleifera seeds on growth rates and the levels of some biochemical parameters in albino rats

Moringa oleifera is a multipurpose tree, cultivated in the tropics and sub-tropics for its nutritional and therapeutic properties. The raw matured seeds which have been reported to be used as food and clarifying agent of turbid water caused growth retardation in albino rats and this might have been due to its antinutritional contents. Owing to these adverse factors, the effect of soaking the seeds for 30 min and then compounding it as feeds was done. Its effect on growth rate and the level of some biochemical parameters on rats were investigated. The Wistar albino rats were fed for 21 days and their weights measured at 2 days interval. Aspartate and Alanine transaminases, Alkaline phosphatase and total bilirubin levels were assayed using Automated Vitros 350 Chemistry Analyzer. The growth rates of rats fed with the commercial rat pellets, Casilan diet and the processed Moringa seed diet had a range of 80.06 +/- 3.54 to 100.98 +/- 5.37, 66.70 +/- 7.54 to 55.23 +/- 7.47 and 52.99 +/- 4.15 to 35.47 +/- 2.26, respectively. The parameters assayed for the group that received the processed Moringa seed diet are 144.00 +/- 16.80 (AST), 41.00 +/- 7.05 (ALT), 66.50 +/- 8.80 (ALP) and 12.45 +/- 1.18 (Total Bilirubin). The one-way ANOVA statistical analysis indicated that there was no significant change in the parameters of all the groups at 95% significance level (p < 0.05). Hence, the soaked Moringa oleifera seed did not support growth in the animal subjects and also did not pose a threat to the liver. However, it is better to develop more suitable processing methods to improve the seed's nutritional capabilities.