Evaluation of Vesicouterine Fistula with Ultrasonography in a Resource-constrained Setting

Objective: To determine the role of ultrasonography in the evaluation of patients with vesicouterine fistula. Methodology: This was a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria between January 2015 and November 2016. Ethical clearance was obtained from Ethics and Research Committee of the National Obstetric Fistula Centre, Abakaliki, Nigeria. A total of 25 patients had vesicouterine fistula during the study period. The records of 22 patients who had pelvic ultrasonography were reviewed and formed the basis of this study. Results: The mean age of the study population was 30.1±6.2 years. Pelvic ultrasonography revealed a communication between the uterus and the bladder in 19 (86.4%) of patients which is suggestive of vesicouterine fistula. Three patients (13.6%) had normal sonographic assessment. All patients were successfully repaired. Conclusion: Ultrasonography appears to be a useful, cheap, quick and readily available means of evaluating vesicouterine fistula in a resource-constrained setting. It provides an added advantage to clinical diagnosis in the evaluation of vesicouterine fistula. Keywords: Vesicouterine fistula, urogenital fistula, ultrasonography

Management of Rectovaginal Fistulas at the National Obstetric Fistula Centre, Abakaliki over a 5-year Period

Objective: To share our experience in the management of rectovaginal fistula. Methods This was a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria. The case folders of patients that had rectovaginal fistula between January 2012 and December 2016 were reviewed. Data was analyzed using the Statistical Package for Social Sciences, version 21. Results The records of 21 out of 26 patients who had rectovaginal fistula were available for review. The mean age was 31 ± 9 years. Majority (95.24%) were Christians. Twenty (95.24%) of  the cases were low rectovaginal fistula. The risk factors for rectovaginal fistula were mainly episiotomy, perineal tears during labour and prolonged obstructed labour Two (10%) out of the 20 patients that had surgery had minor complications. There was no mortality. The success rate after the first repair was 85% for those that were offered surgery. Conclusion The study suggests a good outcome for the patients reviewed with minimal complications. Keywords: Rectovaginal fistula, episiotomy, perineal tear

In vivo and in silico toxicity profiling of aerial part of Andrographis paniculata revealed potential to precipitate organs toxicity

The many medicinal properties of Andrographis paniculata have made it an important resource in drug discovery. The commonly used powdered aerial part of A. paniculata is however a subject of abuse occasioned by indiscriminate use, raising safety concerns. In this study, we evaluated the safety profile of the suspension of the powdered aerial part of A. paniculata in male and female rats using single and repeated dose toxicity profiling, and the in silico toxicity profiling of its known phytochemicals, with a view to establishing organs safety. Our results showed significant sex dependent alterations in key haematological and biochemical indices. Significant alteration in liver and kidney histo-architectures were consistent with the observed significant increase in AST/ALT ratio and with the in silico toxicity screening of A. paniculata phytochemicals, including andrographolide, which showed potential for hepatotoxicity, binding of proteins and DNA, and inhibition of hERG II. We conclude that, while taking advantage of the many medicinal benefits of this plant, the unguarded and indiscriminate uses may precipitate organ toxicity, induce cellular alteration and potentiate possible cardiovascular risk