Pre-Caesarean Section Vaginal Preparation with Chlorhexidine Solution in Preventing Puerperal Infectious Morbidities: A Randomized Controlled Trial

BACKGROUND

Globally, peripartum or puerperal infections account for about one tenth of maternal mortality, most of which occur in low income countries. Therefore, vaginal preparation with an antiseptic prior to a caesarean delivery could be considered an additional measure to prevent subsequent infectious morbidities.

OBJECTIVES

To evaluate vaginal preparation with 0.3% chlorhexidine solution in the prevention of endometritis, surgical site infection and post-operative fever following emergency caesarean section.

METHODS

This prospective randomized controlled trial (RCT) was conducted among 240 participants planned for emergency caesarean sections (CS) at term in the University of Medical Sciences Teaching Hospital Complex, Ondo State, Nigeria. Participants were randomised into either group "A" (study) or "B" (control). The former had vaginal preparation with 0.3% chlorhexidine gluconate immediately after anaesthesia while the latter received normal saline. Participants were followed up post-operatively during which clinical features of puerperal infectious morbidities were observed for each during admission as well as 8th and 14th days after delivery.

RESULTS

The rate and risk of endometritis were significantly lower in the study group compared to the control; 5.0% versus 13.3%, respectively (chi squared =5.004; p=0.042, RR = 0.38; 95% CI = 0.15-0.94; p = 0.042; RRR = 0.62). Post-operative fever and surgical site infection, were also lower in the study group compared to the controls, but the difference was not statistically significant.

CONCLUSION

When compared to placebo, pre-caesarean section vaginal preparation with 0.3% chlorhexidine solution significantly reduced only the rate and risk of post-operative endometritis among infectious morbidities.

Phytomodulatory effects of silver nanoparticles on Corchorus olitorius: Its antiphytopathogenic and hepatoprotective potentials

This study has reported the effects of biogenic silver nanoparticles (AgNPs) using cocoa pod extract on physiological tolerance indices, antioxidant activity and hepatoprotective potentials of Corchorus olitorius as well as its efficiency for controlling soil phytopathogens. C. olitorius seeds were grown in soil prepared with water (control), 0.05, 0.1, 0.15 and 0.2 mg AgNPs/g soil. C. olitorus grown with AgNPs had significantly (p < 0.05) higher free radical scavenging ability, ferric reducing ability, percentage germination, vigour indices, longer roots and shoots as well as lower moisture content over control. C. olitorius grown with AgNPs attenuated hydrogen peroxide (H₂O₂)-mediated reduction in catalase concentrations and H₂O₂-induced malondialdehyde elevations in liver. Efficiency of AgNPs to reduce soil phytopathogens (fungi and nematodes) revealed significant (p < 0.05) reduction in the incidences of soil and shoot Meloidogyne spp., Aspergillus terreus, A. niger, Fusarium spp. and Cladosporium spp. with increase in concentrations of AgNPs. More efficiently, there was complete extermination of A. niger and Fusarium spp. in the leaves of C. olitorius grown with AgNPs. Results in this study have shown the positive influence of AgNPs on C. olitorius by strengthening its resistance against fungi, and nematodes, improvement of its shelf-life, modulation of antioxidant activities and promotion of liver-detoxifying potentials.

Urinary schistosomiasis transmission in Epe, an urban community of Southwest Nigeria

Background:

A survey of Schistosoma haematobium infection in Epe, an urban community in Lagos State, Southwest Nigeria, was carried out to ascertain the possibility that schistosomiasis, otherwise considered a rural disease, could reach urban populations.

Materials and Methods:

About 100 ml of voided urine samples from 200 pupils aged 6–13 years [109 (54.5%) males and 91 (45.5%) females], attending an Anglican primary school, Ebute Afuye, and a community primary school, Erepoto, were examined parasitologically for hematuria and S. haematobium ova following informed consent obtained from their parents/guardians. All samples were screened using polymerase chain reaction (PCR) amplification of the schistosome Dra1 gene. Fourteen Bulinus snails collected from the two sites, Ebute Afuye (6) and Erepoto (8), were screened for schistosome infection by the PCR amplification of the schistosome Dra1 gene. PCR-RFLP of the snails’ its region was analyzed for species identification and a subregion of the cox1 gene from four infected snails (two from each site) was amplified and sequenced.

Results:

In the Anglican primary school, Ebute Afuye, and community primary school, Erepoto, 16% and 29% were positive for hematuria, and 16% and 17% had schistosome ova, respectively. PCR analysis showed that 57% and 40% were positive for the infection in Anglican primary school, Ebute Afuye, and community primary school, Erepoto, respectively. PCR screening of the snails confirmed that four from Ebute Afuye and three from Erepoto were infected with schistosomes. PCR-RFLP showed that all the 14 snails were Bulinus truncatus while phylogenetic analysis of the sequenced partial cox1 gene corroborated the PCR-RFLP results.

Conclusions:

There was a high prevalence of S. haematobium infection among the participants detected by PCR, which was able to detect infection in cases otherwise shown to be negative by hematuria. We also observed that B. truncatus is one of the snail species responsible for the transmission of urinary schistosomiasis in the Epe community. For national control programs, it is very important that trends in the prevalence and intensity of schistosomiasis in urban cities be monitored.

Pharyngeal airway changes associated with mandibular advancement

This study analyzes changes in the anteroposterior dimension of the oropharynx as determined from lateral cephalometric radiographs on 26 patients who have undergone mandibular advancement. Increases in the sagittal dimensions of the oropharynx were unpredictable and tended to decrease with time, suggesting that mandibular advancement may be an unreliable method of treating obstructive sleep apnea. The most stable long-term results were found in those cases with narrowing of the oropharynx preoperatively.