Two-year surgical review of elective hysterectomy for non-oncological indications: experience from a tertiary centre

Background: This retrospective descriptive cross-sectional study was aimed at determining indications, surgical outcomes, complications and challenges of elective non-oncological hysterectomies performed at a tertiary referral centre over a 2-year period (1st December 2018 to 31st December 2019).Methods: With ethical approval, the medical records of all eligible women were retrieved, reviewed and analyzed. Measures of central tendencies, frequencies and percentages were used to compute the variables.Results: During the 2-year study period, a total of 245 elective non-oncological hysterectomies were performed. The age of the women ranged from 33 to 80 years with a mean age of 49.08 years; [standard deviation (SD): 8.88]. Women in the 40-49 year-old-age group constituted the majority 55.51% (n=136/245). Main indications were multinodular fibroid uterus (without menorrhagia), fibroid uterus with menorrhagia and genital prolapse. There was no case of laparoscopic hysterectomy. Majority (98.78%; n=242/245) of the hysterectomies were total hysterectomies. The commonest additional procedures performed was bilateral salpingo-oophorectomy (31.84%; n=78/245). Intra-operative complication rates were low: (0.40%; n=1/245) for bowel injury, bladder injury and bleeding from an ovary. Regional anaesthesia was the commonest type of anaesthesia (71.84%; n=176/245). The primary surgeon was above the level of a specialist in 99.19% (n=243/245) of cases.Conclusions: Most women had hysterectomy for non-oncological indications in their fourth and fifth decades of life on account of fibroid-related conditions and genital prolapse. There was no uptake of laparoscopic hysterectomy. Hysterectomies are generally safe in the hands of an experienced and skilled surgical team

Improving Primary Education in the Democratic Republic of the Congo: End-Line Results of a Cluster-Randomized Wait-List Controlled Trial of Learning in a Healing Classroom

RLOsWe used a cluster-randomized, wait-list controlled trial to examine impacts of a school-based social-emotional learning intervention on Congolese students and teachers. Seventy-six school clusters in two groups (A and B) were randomized to treatment or control. The groups differed in geographic location, accessibility, exposure to violence, and external donor investment. We estimated causal impacts in Group A, tested whether those impacts were replicated in Group B, and conducted sensitivity analyses on the pooled sample. Pooled analyses had higher statistical power and were therefore more likely to represent the true average impacts of the program. Improvements in students’ perceptions of school predictability and in addition and subtraction, geometry, and reading performance were specific to Group B. Only the effect on addition and subtraction remained significant in the pooled analysis. Improvements in teachers’ sense of accomplishment were found in Group A and remained significant in the pooled analysis. We detected no impacts on other outcomes. School-based interventions embedding social-emotional learning principles into the academic curricula are a promising but not yet proven approach to improving children’s outcomes in low-income countries affected by war

Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members

Sickle cell disease (SCD) is a life-threatening genetic disorder affecting nearly 100,000 individuals in the United States and is associated with many acute and chronic complications requiring immediate medical attention. Two disease-modifying therapies, hydroxyurea and long-term blood transfusions, are available but underused. To support and expand the number of health professionals able and willing to provide care for persons with SCD. Databases of MEDLINE (including in-process and other nonindexed citations), EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, TOXLINE, and Scopus were searched using prespecified search terms and keywords to identify randomized clinical trials, nonrandomized intervention studies, and observational studies. Literature searches of English-language publications from 1980 with updates through April 1, 2014, addressed key questions developed by the expert panel members and methodologists. Strong recommendations for preventive services include daily oral prophylactic penicillin up to the age of 5 years, annual transcranial Doppler examinations from the ages of 2 to 16 years in those with sickle cell anemia, and long-term transfusion therapy to prevent stroke in those children with abnormal transcranial Doppler velocity (≥200 cm/s). Strong recommendations addressing acute complications include rapid initiation of opioids for treatment of severe pain associated with a vasoocclusive crisis, and use of incentive spirometry in patients hospitalized for a vasoocclusive crisis. Strong recommendations for chronic complications include use of analgesics and physical therapy for treatment of avascular necrosis, and use of angiotensin-converting enzyme inhibitor therapy for microalbuminuria in adults with SCD. Strong recommendations for children and adults with proliferative sickle cell retinopathy include referral to expert specialists for consideration of laser photocoagulation and for echocardiography to evaluate signs of pulmonary hypertension. Hydroxyurea therapy is strongly recommended for adults with 3 or more severe vasoocclusive crises during any 12-month period, with SCD pain or chronic anemia interfering with daily activities, or with severe or recurrent episodes of acute chest syndrome. A recommendation of moderate strength suggests offering treatment with hydroxyurea without regard to the presence of symptoms for infants, children, and adolescents. In persons with sickle cell anemia, preoperative transfusion therapy to increase hemoglobin levels to 10 g/dL is strongly recommended with a moderate strength recommendation to maintain sickle hemoglobin levels of less than 30% prior to the next transfusion during long-term transfusion therapy. A strong recommendation to assess iron overload is accompanied by a moderate strength recommendation to begin iron chelation therapy when indicated. Hydroxyurea and transfusion therapy are strongly recommended for many individuals with SCD. Many other recommendations are based on quality of evidence that is less than high due to the paucity of clinical trials regarding screening, management, and monitoring for individuals with SCD