Incidence, characteristics, pattern and management of ovarian cancer in Abuja, Nigeria

Background: The prevalence of ovarian cancer is thought to be increasing with huge burden of the disease with no comprehensive cancer center that can offer appropriate care in developing countries. However, little is known about the incidence, pattern and outcome of this disease in Abuja, Nigeria. Therefore, the aim of this study was to review the pattern of care offered to patients with ovarian cancer in our center and to evaluate patients’ outcome.Methods: This was a retrospective review of all the patients with histologically confirmed ovarian cancers admitted to the gynecological ward of the hospital over a period of 5 years. Relevant information was extracted from the ward register and patients medical case records. Data were analyzed using statistical package for social science version 23 and results were then presented in tables and chart.Results: Ovarian cancers constituted 19.6% and 5.6% of all gynecological cancers and all gynecological admissions respectively. The mean age at presentation was 50.2±8.5 years and premenopausal 32 (55%) constituting the majority. A large proportion 43 (74.1%) of the patients were parous. The commonest symptoms at presentation were abdominal swelling (86.2%), and abdominal pain (53.4%) with the majority 38 (65.5%) presenting in an advanced stage. The commonest histological type of ovarian cancers was epithelial accounting for 30 (51.7%) of all ovarian cancers. Common treatment modality was surgery and chemotherapy and majority 32 (55.3%) of the patients had cytoreductive surgery with 19 of them having optimum cytoreduction and 33 (57%) benefitted from chemotherapy. Lost to follow- up was significantly high (55%) and mortality rate was 15.5%.Conclusion: Cases of ovarian cancers are on the increase. Women presented at an advanced stage of the disease, which resulted in short survival times. Failure of optimal management was also worsened by poor compliance to treatment with high patients' default rate

Outcome of instrumental vaginal delivery in university of Abuja teaching hospital: a five-year review

Background: Most women will achieve spontaneous vaginal delivery; however, a few will need assistance in form of Instrumental vaginal delivery (IVD). These are employed to shorten the second stage on labour and to minimize the incidence of cesarean section. The aim of the study was to determine the prevalence and outcomes of instrumental vaginal delivery at the University of Abuja teaching hospital.Methods: This was a retrospective study of women who had instrumental vaginal delivery over a 5-year period at the University of Abuja teaching hospital. Data on socio-demographic variables, type of instrumental delivery performed, Apgar scores of neonates delivered, indications and complication were obtained from the labour ward registers and case notes of patients and entered into a proforma and analysed using SPSS software for Windows version 23.Results: Instrumental vaginal delivery (IVD) rate performed for both Vacuum or Forceps) was 0.99%, Forceps delivery was 0.30% and vacuum accounted for 0.69% of all deliveries. The mean maternal age was 27.53±5.5 years and 51 (54.8%) of the parturient were primigravidae, 55 (59.1%) were booked patients.  Delayed second stage of labour (38.7%) was the most common indications for IVD. Maternal complications noted were genital tract laceration 17 (18.3%) and primary post-partum haemorrhage 10 (10.8%). The mean APGAR scores was 6 and 8 in the first and fifth minutes respectively, live births were 85 (91.4%), stillbirths were 7 (7.5%) and one early neonatal death was recorded (1.1%) due to asphyxia as a result of difficult forceps delivery.Conclusions: The IVD rate at UATH is low with good maternal and fetal outcome and preference for vacuum delivery

Uptake of long-acting reversible contraceptives in north central Nigeria: a five-year review

Background: Long-acting reversible contraceptives (LARC) are methods used in the prevention of pregnancy that are long lasting. They are effective and efficacious methods of contraception and return to fertility after removal is prompt. Objectives was to determine the uptake of long-acting reversible contraception and assess the characteristics of acceptors of these methods in the area.Methods: This was a retrospective study of clients’ who visited the family planning unit of the University of Abuja teaching hospital over a 5-year period, from 01 January 2015 to 31 December 2019. Information on socio-demographic characteristics and specific methods selected were extracted from their records and represented on simple tables, graphs, and charts.Results: A total of one thousand eight hundred and ninety-one (1,891) clients accepted available methods of contraceptives during the five-year study period. One thousand seven hundred and twenty-four (1,724) accepted LARC (91.1%) while only one hundred and sixty-seven (167) accepted non-LARC (8.9%). Majority 946 (54.9%) of the clients that accepted LARC were aged between 30-39 years and clients less than 20 years were 22 (1.3%). Clients with parity 3 and above were 1162 (67.7%), and majority of LARC acceptors wanted more children 1145 (66.4%). Amongst the LARC acceptors, most of the clients opted for subdermal implant either Jadelle or Implanon 940(49.7%). Three hundred and ninety-eight (23.1%) discontinued a form of LARC during the study period while 1127 (65.4%) continued with one form of LARC or another.Conclusions: The uptake of LARC in this region is very high. Teenagers and low parity rarely attended the family planning clinic

Umbilical and middle cerebral arteries Doppler velocimetry in early and late onset pre-eclampsia

Background: Pre-eclampsia (PE) is a multisytemic disorder originating from the placenta with a high prevalence in sub-Saharan Africa. Early (34 weeks) – onset PE have different maternal and perinatal outcomes with overlapping clinical features. Differences in Doppler velocimetry pattern in these subgroups appears unsettled.Methods: In a prospective cohort study, 110 pregnant women with singleton pregnancy diagnosed with PE were recruited and had umbilical and middle cerebral arteries (MCA) Doppler velocimetry done. The pregnancies were followed up to delivery and outcome recorded and analysed using Microsoft excel 2013. Student t-test and Chi-squared test were used for continuous and categorical variables respectively. Level of significance was set at less than 0.05.Results: There were 53 (49.1%) women with early – onset preeclampsia and 55 (50.9%) with late-onset PE. The mean age of women was 30.30±5.2 years. The mean umbilical artery, middle cerebral artery pulsatility indices (PI) and cerebroplacental ratio (CPR) were 1.3±0.5, 1.1±0.5 and 1.1±1.2 respectively. There was statistical significant difference between the umbilical artery PI (p˂0.001), middle cerebral artery PI (p˂0.05) and CPR (p˂0.001) between early onset and late onset preeclamptic women. The resistance index and systolic diastolic ratio of both the umbilical and middle cerebral arteries were similar between the two groups (p>0.05).Conclusions: This study showed that umbilical and middle cerebral artery PI and CPR may be the most important Doppler parameters to watch-out for in monitoring women with PE

MasakhaNEWS: News Topic Classification for African languages

African languages are severely under-represented in NLP research due to lack of datasets covering several NLP tasks. While there are individual language specific datasets that are being expanded to different tasks, only a handful of NLP tasks (e.g. named entity recognition and machine translation) have standardized benchmark datasets covering several geographical and typologically-diverse African languages. In this paper, we develop MasakhaNEWS -- a new benchmark dataset for news topic classification covering 16 languages widely spoken in Africa. We provide an evaluation of baseline models by training classical machine learning models and fine-tuning several language models. Furthermore, we explore several alternatives to full fine-tuning of language models that are better suited for zero-shot and few-shot learning such as cross-lingual parameter-efficient fine-tuning (like MAD-X), pattern exploiting training (PET), prompting language models (like ChatGPT), and prompt-free sentence transformer fine-tuning (SetFit and Cohere Embedding API). Our evaluation in zero-shot setting shows the potential of prompting ChatGPT for news topic classification in low-resource African languages, achieving an average performance of 70 F1 points without leveraging additional supervision like MAD-X. In few-shot setting, we show that with as little as 10 examples per label, we achieved more than 90\% (i.e. 86.0 F1 points) of the performance of full supervised training (92.6 F1 points) leveraging the PET approach.Comment: Accepted to IJCNLP-AACL 2023 (main conference

Humoral immunological kinetics of severe acute respiratory syndrome coronavirus 2 infection and diagnostic performance of serological assays for coronavirus disease 2019: an analysis of global reports

As the coronavirus disease 2019 (COVID-19) pandemic continues to rise and second waves are reported in some countries, serological test kits and strips are being considered to scale up an adequate laboratory response. This study provides an update on the kinetics of humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and performance characteristics of serological protocols (lateral flow assay [LFA], chemiluminescence immunoassay [CLIA] and ELISA) used for evaluations of recent and past SARS-CoV-2 infection. A thorough and comprehensive review of suitable and eligible full-text articles was performed on PubMed, Scopus, Web of Science, Wordometer and medRxiv from 10 January to 16 July 2020. These articles were searched using the Medical Subject Headings terms 'COVID-19', 'Serological assay', 'Laboratory Diagnosis', 'Performance characteristics', 'POCT', 'LFA', 'CLIA', 'ELISA' and 'SARS-CoV-2'. Data from original research articles on SARS-CoV-2 antibody detection >= second day postinfection were included in this study. In total, there were 7938 published articles on humoral immune response and laboratory diagnosis of COVID-19. Of these, 74 were included in this study. The detection, peak and decline period of blood anti-SARS-CoV-2 IgM, IgG and total antibodies for point-of-care testing (POCT), ELISA and CLIA vary widely. The most promising of these assays for POCT detected anti-SARS-CoV-2 at day 3 postinfection and peaked on the 15th day; ELISA products detected anti-SARS-CoV-2 IgM and IgG at days 2 and 6 then peaked on the eighth day; and the most promising CLIA product detected anti-SARS-CoV-2 at day 1 and peaked on the 30th day. The most promising LFA, ELISA and CLIA that had the best performance characteristics were those targeting total SARS-CoV-2 antibodies followed by those targeting anti-SARS-CoV-2 IgG then IgM. Essentially, the CLIA-based SARS-CoV-2 tests had the best performance characteristics, followed by ELISA then POCT. Given the varied performance characteristics of all the serological assays, there is a need to continuously improve their detection thresholds, as well as to monitor and re-evaluate their performances to assure their significance and applicability for COVID-19 clinical and epidemiological purposes

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

MasakhaNEWS:News Topic Classification for African languages

African languages are severely under-represented in NLP research due to lack of datasets covering several NLP tasks. While there are individual language specific datasets that are being expanded to different tasks, only a handful of NLP tasks (e.g. named entity recognition and machine translation) have standardized benchmark datasets covering several geographical and typologically-diverse African languages. In this paper, we develop MasakhaNEWS -- a new benchmark dataset for news topic classification covering 16 languages widely spoken in Africa. We provide an evaluation of baseline models by training classical machine learning models and fine-tuning several language models. Furthermore, we explore several alternatives to full fine-tuning of language models that are better suited for zero-shot and few-shot learning such as cross-lingual parameter-efficient fine-tuning (like MAD-X), pattern exploiting training (PET), prompting language models (like ChatGPT), and prompt-free sentence transformer fine-tuning (SetFit and Cohere Embedding API). Our evaluation in zero-shot setting shows the potential of prompting ChatGPT for news topic classification in low-resource African languages, achieving an average performance of 70 F1 points without leveraging additional supervision like MAD-X. In few-shot setting, we show that with as little as 10 examples per label, we achieved more than 90\% (i.e. 86.0 F1 points) of the performance of full supervised training (92.6 F1 points) leveraging the PET approach

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries