Treatment of SARS-CoV-2 (COVID-19): A safety perspective

The goal of this review is to report a balanced perspective of current evidence for efficacy of treatments for coronavirus disease 2019 (COVID-19) against the historical safety of these treatments as of May 2021. We preselected therapies of interest for COVID-19 based on national guidelines and modified over time. We searched PubMed and Medline for these specific COVID-19 treatments and data related to their efficacy. We also searched for prior randomized controlled trials of each therapy to assess adverse effects, and we obtained the Food and Drug Administration Approval label for this information. Several drugs have been approved for the treatment of COVID-19, and many more are under study. This includes dexamethasone, remdesivir, hydroxychloroquine/chloroquine, lopinvir/ritonavir, interferon or interleukin inhibitors, convalescent plasma and several vitamins and minerals. The strongest evidence for benefit is mortality benefit with dexamethasone in patients with COVID-19 and hypoxemia, although there is a signal of harm if this is started too early. There are several other promising therapies, like interleukin inhibitors and ivermectin. Hydroxychloroquine/chloroquine, lopinvir/ritonavir, and convalescent plasma do not have enough evidence of benefit to outweigh the known risks of these drugs.

Parents' perceptions of timing of initiation of sexuality discussion with adolescents in Anambra State, South Eastern Nigeria

STUDY OBJECTIVE

This study was aimed at determining the perception of the timing and practice of sexuality discussion among parents in South Eastern Nigeria.

DESIGN

A cross-sectional, descriptive, community-based study.

SETTING

The study was carried out in 3 randomly selected Local Government Areas in Anambra State, South Eastern Nigeria.

PARTICIPANTS

The study participants were parents with adolescent children resident in the study areas for at least 2 years.

RESULTS

Most parents opined that sexuality discussion should be initiated after puberty. Only 20% of them discussed reproductive health issues often with their adolescents, while another 20% never discussed such issues with their adolescent children. Topics most commonly discussed bordered on the adverse consequences of sex rather than measures for preventing them. About half of parents were willing to discuss contraception with their adolescent child. Predictors of parent-child communication were age, gender, and educational status.

CONCLUSION

Common reasons for low parental involvement in sexuality discussions were due to their lack of capacity and the perception that discussing such issues before puberty is ill timed. Therefore, measures should be taken to improve the capacity of parents to engage in such conversations to provide sexuality information to their teens.

Anaesthetic and obstetric challenges of morbid obesity in caesarean deliveries--a study in South-eastern Nigeria

BACKGROUND

Morbid obesity of parturient has become very important in perinatal medicine because of a worldwide obesity epidemic. Morbid obesity of parturient is reportedly associated with severely increased anaesthetic and obstetric risk.

OBJECTIVE

To determine the prevalence rate, anaesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre.

METHODS

The obstetric theatre records and case files were reviewed for caesarean deliveries in the University of Nigeria Teaching Hospital, Enugu, Nigeria from May 2008 to December 2010. A sample size of 250 patients, calculated based on a prevalence rate of 19%, confidence interval of 95% , a power of 80% and a finite population of zero was used to determine the prevalence rate of morbid obesity (Body Mass Index of greater than or equal to 35 kg/m(2)).

RESULTS

There were thirty-one patients with morbid obesity (12.4%). The average Body Mass Index (BMI) was 38.3 kg/m(2)(SD ± 2.99). Other findings included macrosomia (7 or 25.8%), gestational diabetes (13%) and pregnancy induced hypertension (7 or 22.5%).There were two neonatal deaths but no maternal deaths.

CONCLUSION

The prevalence rate of morbid obesity is about 10% in Nigerian women of child bearing age. This mirrors a World Health Organisation report published in the World Health Organisation Global Information Base.

Maternal mortality in health institutions with emergency obstetric care facilities in Enugu State, Nigeria

In order to assess the current level of maternal mortality in health institutions with comprehensive emergency obstetric care in Enugu State, South Eastern Nigeria, a retrospective analysis of maternal deaths for the years 1999-2003 was carried out to establish the maternal mortality ratios in the eligible health institutions. Each maternal death was studied in detail to establish the socio-demographic characteristics of the women who died; their referral sources, type of delay (if any), medical causes of death and their preventability. In-depth interviews of the service providers were carried out to throw more light on the maternal mortality situation in the state. Five out of seven eligible health institutions were studied. Within the 5-year period (1999-2003), there were 141 maternal deaths and 18,257 live births giving a maternal mortality ratio of 772 maternal deaths per 100,000. The folders of 89 out of the 141 women who died were retrieved. Of these 89 maternal deaths, 51.7% of them were unemployed, 52.4% were referred from private hospitals; type 3 delay was the commonest type of delay encountered in the care of the women. Referral delay was the main cause of delay accounting for 46.4% of all cases of type 3 delay. The leading causes of maternal deaths among the women were obstetric haemorrhage (19.1%), sepsis (18.0%), prolonged obstructed labour/ruptured uterus (16.9%) and pre-eclampsia/eclampsia (16.9%). The in-depth interviews corroborated the high maternal mortality ratio recorded and the type 3 delays in tackling obstetric emergencies. It also showed some discrepancies between reality and the health providers' perception of the magnitude of maternal mortality situation in the state. It was concluded that in health institutions in Enugu State with comprehensive emergency obstetric care facilities, the maternal mortality ratio remains high due to type 3 delays. Most of the referrals come from private hospitals, hence the need to retrain the private practitioners in emergency obstetric care.