Erratum

Cervical Cancer and Human Papilloma Virus Knowledge and Acceptance of Vaccination among Medical Students in Southwest NigeriaArticle first published in March 2015 (http://www.ajrh.info/home/issues.php?issue=current) and cited as : Cervical Cancer and Human Papilloma Virus Knowledge and Acceptance of Vaccination among Medical Students in Southwest Nigeria. Funmilayo F. Adejuyigbe , Balogun R. Balogun , Adekemi O. Sekoni and Adebukola A. Adegbola.The name of the corresponding author in the earlier publication was wrongly spelt. The complete name of the corresponding author is now correctly spelt in this publication.

Lactational Vitamin E Protects Against the Histotoxic Effects of Systemically Administered Vanadium in Neonatal Rats

Summary: The work investigated the protective role of lactational vitamin E administration on vanadium-induced histotoxicity. Three groups of Wistar rats, with each group comprising of two dams and their pups, were used in this study. Group I pups were administered intraperitoneal injection of sterile water at volumes corresponding to the dose rate of the vanadium (sodium metavanadate) treated group from postnatal day (PND) 1-14 while those in Group II were administered intraperitoneal injection of 3mg/kg vanadium from PND 1-14. Group III pups were administered intraperitoneal injection of 3mg/kg vanadium while the dam received oral vitamin E (500mg) concurrently every 72hours. The results showed that group II pups exhibited histopathological changes which included seminiferous tubule disruption of the testes characterised by vacuolar degeneration and coagulative necrosis of spermatogonia and Sertoli cells with reduction in mitosis, and areas of interstitial thickening with fibroblast proliferation. In addition, the lungs showed disruption of the bronchiolar wall and denudation of the bronchiolar respiratory epithelium while the liver showed hydropic degeneration and coagulative necrosis of the centrilobular hepatocytes. These histotoxic changes were ameliorated in the vanadium + vitamin E group. We conclude that lactational vitamin E protects against the histotoxic effects of vanadium and could be a consideration for supplementation in the occupationally and environmentally exposed neonates. However, caution should be taken in vitamin E supplementation because there is still equivocal evidence surrounding its benefits as a supplement at the moment.Keywords: Vanadium, Vitamin E, Histotoxicity, Antioxidant

Correlações entre força de preensão manual e variáveis antropométricas da mão de jovens adultos

O objetivo do estudo foi correlacionar a força de preensão palmar em diferentes posições de abertura, com variáveis antropométricas da mão. Participaram 73 voluntários de ambos os sexos (40 homens e 33 mulheres), com idade média de 23±4,61 anos. As medidas antropométricas largura da palma, comprimento do dedo indicador, espessura da palma, largura da mão, circunferência da palma e da mão foram realizadas bilateralmente. Para as medidas lineares, utilizou-se um paquímetro digital e, para as medidas de circunferência, a fita métrica. As medidas de força de preensão foram realizadas por meio de um dinamômetro hidráulico (UFTM) Jamar®. Os valores antropométricos foram correlacionados com as medidas de força nas cinco posições de abertura. Os homens e as mulheres tiveram maior força na mão direita e, entre as posições, a maior força dos homens foi na de número 3 (45,5±15,53 kgf) e das mulheres, na de posição 2 (25,5±6,28 kgf). Verificaram-se correlações significativas entre a força e os valores antropométricos nas medidas da largura da mão e circunferência da palma - que representam a maior medida transversal e o maior trofismo da mão, respectivamente, no grupo dos homens e a medida de comprimento do dedo, que representa a maior medida longitudinal no grupo das mulheres. Com isso, pode-se concluir que, para os homens, a maior força está relacionada à maior medida transversal e ao maior trofismo da mão e, para as mulheres, ao maior comprimento longitudinal da mão.The aim of this study was to correlate the grip strength of hand, in different opening positions, with hand anthropometric measures. The study included 73 volunteers (40 male and 33 female) with mean age of 23±4.61 years old. Anthropometric measures, such as palm width, forefinger length, palm thickness, hand width, palm and hand circumferences, were performed bilaterally. For linear measures, a digital caliper rule was used as well as a tape measure for circumference measures. Grip strength measures were performed by means of a Jamar® hydraulic dynamometer. Anthropometric values were correlated with strength measures in the five positions of the opening. Both men and women had greater strength in the right hand. Regarding the positions, the bigger strength of men was in the number 3 (45.5±15.53 kgf) and that of women in position 2 (25.5±6.28 kgf). Significant correlations were verified among strength and anthropometric values in the hand width measure and palm circumference - that represent the greater transversal measure and the greater throphism of left hand, respectively, in men's group -, and the finger length measure, that represents the greater longitudinal measure in women's group. Thus, it may be concluded that for men the greater strength is related to the greater transversal measure and to the greater throphism of hand, while for women, it is related to the greater longitudinal length of hand

All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: A protocol for a randomized trial [NCT00128076]

BACKGROUND: Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopic repair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair. METHODS/DESIGN: This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate-sized rotator cuff tears. A national consensus meeting of investigators in the Joint Orthopaedic Initiative for National Trials of the Shoulder (JOINTS Canada) identified this question as the top priority for shoulder surgeons across Canada. The primary outcome measure is a valid quality-of-life scale (Western Ontario Rotator Cuff (WORC)) that addresses 5 domains of health affected by rotator cuff disease. Secondary outcomes will assess rotator cuff functionality (ROM, strength, Constant score), secondary dimensions of health (general health status (SF-12) and work limitations), and repair integrity (MRI). Outcomes are measured at baseline, at 6 weeks, 3, 6, 12, and 24 months post-operatively by blinded research assistants and musculoskeletal radiologists. Patients (n = 250) with small or medium-sized cuff tears identified by clinical examination and MRI who meet eligibility criteria will be recruited. This sample size will provide 80% power to statistically detect a clinically important difference of 20% in WORC scores between procedures after controlling for baseline WORC score (α = 0.05). A central methods centre will manage randomization, data management, and monitoring under supervision of experienced epidemiologists. Surgeons will participate in either conventional or expertise-based designs according to defined criteria to avoid biases from differential surgeon expertise. Mini-open or all-arthroscopic repair procedures will be performed according to a standardized protocol. Central Adjudication (of cases), Trial Oversight and Safety Committees will monitor trial conduct. We will use an analysis of covariance (ANCOVA), where the baseline WORC score is used as a covariate, to compare the quality of life (WORC score) at 2 years post-operatively. As a secondary analysis, we will conduct the same statistical test but will include age and tear size as covariates with the baseline score. Enrollment will require 2 years and follow-up an additional 2 years. The trial will commence when funding is in place. DISCUSSION: These results will have immediate impact on the practice behaviors of practicing surgeons and surgical trainees at JOINTS centres across Canada. JOINTS Canada is actively engaged in knowledge exchange and will publish and present findings internationally to facilitate wider application. This trial will establish definitive evidence on this question at an international level

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Self-Esteem and Achievement Motivation as Predictors of Perceived Sense of Competence among Workers in a Nigerian University Teaching Hospital

This study explored the relationship between self-esteem, achievement motivation and perceived sense of competence among workers in a Nigerian university teaching hospital. Using a correlational design, one hundred and seventy (n=170) workers selected from different sections and clinics at a University teaching hospital in a south western state in Nigeria participated in the study. They comprised of males 85 (50%) and females 85 (50%) with ages ranged between 20 years and 55 years, and a mean of 32.39 years (SD= 7.13). The following instruments were used for data collection: self esteem scale developed by Adanijo and Oyefeso (1986), need for achievement scale developed by Edward (1954), perceived sense of competence scale developed by Wagner and Morse (1975) and modified by Synder and Morris (1978). Five hypotheses were tested using correlational statistics such as the Pearson r, Simple linear multiple regeression, independent t-test, and One-Way analysis of Variance. Results revealed that a positive relationship existed between achievement motivation (r = .52; p&lt;.01), self esteem (r = .65; p&lt;.01), and perceived sense of competence. There was a significant joint influence of achievement motivation, self-esteem, age and years of experience on perceived sense of competence (R2 = .55; F (4, 165) = 51.10; p&lt;.001). In addition, the independent contributions show significant independent influence of achievement motivation (&#223;=.37; t = 6.55; p&lt;.001), self-esteem (&#223;=.59; t = 9.90; p&lt;.001), and age (&#223;=-.16; t = 2.80; p&lt;.01) on perceived sense of competence. The meaning behind achievement motivation and self-esteem in relationship to perceived sense of competence is discussed, as well as the implication for these factors in enhancing the perceived sense of competence among workers. This will enable researchers and human resource professionals to look at the relationships among these variables in detail