Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Rupture of a Pregnant Uterus in a Primigravida: A Case Report

Uterine rupture is a common obstetric complication in developing countries. Primigravidity is now commonly associated with uterine rupture. We present a case of uterine rupture in an unbooked primigravida who had induction of labor with oxytocin and was given 50ug of misoprostol about 3 hours after commencing oxytocin when it was adjudged patient was not contracting well. Operative findings include a female fresh stillbirth weighing 3.4kg partly in the peritoneal cavity, a transverse uterine rupture at the lower segment, hemoperitoneum of approximately 2 liters. The peritoneum was lavaged and repair was done without bilateral tubal ligation

The Trend of Twin Pregnancy Over a 5-year Period in a University Teaching Hospital in Lagos, Nigeria

Twin pregnancy is associated with increased perinatal mortality, preterm deliveries and maternal complications, especially in developing countries. The obstetrics result of twin deliveries at the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria between January 2002 and December 2006 were reviewed. Within the 5-year period, there were 314 twin deliveries out of 13,351 total deliveries giving an incidence of 1 in 42.6 or 23.5/1000. Perinatal death was over one and a half times greater than that in singleton deliveries (149.7 and 89.7/1000 deliveries respectively). Majority (61.8%) of the patients was booked and there was no relationship with parity. There was no particular trend in the incidence over the 5-year period. Preterm delivery occurred in 25% of the twins and prematurity accounted for about one-quarter of all perinatal deaths which was the highest. The perinatal mortality ratio between the booked (67/1000) and the unbooked (308/1000) cases was 1 in 5. There was no change in the trend of twinning rate. The antenatal booking and delivery in a specialist centre will reduce the morbidity and perinatal mortality associated with twin pregnancies. Keywords: Trend, perinatal mortality, twins

Maternal Tetanus in Pregnancy: Medical Management and Spontaneous Vaginal Delivery at Term: A Case Report.

A 30-year old pregnant woman presented at 30 weeks gestation with inability to open the mouth, eat or swallow and abdominal pain of two weeks duration having sustained abrasive injuries and laceration to the face 10 days earlier. Provocative spasms and risus sardonicus were found on examination. She was managed with intravenous infusions, metronidazole and diazepam. She resumed oral feeds two weeks later and was discharged home after 4 weeks of admission. She later had vaginal delivery at term with both mother and fetus being in good condition

Pelvic Organ Prolapse in Lagos, Nigeria

Background Although not a life threatening condition, pelvic organ prolapse can affect a woman’s quality of life by limiting physical, social, psychological and sexual functions. There is paucity of publication on the subject in Nigeria. We determined the incidence, pattern of presentation, factors determining treatment modalities and complications associated with surgical management of pelvic organ prolapse at the Lagos State University Teaching Hospital. Methods Retrospective review of all cases of pelvic organ prolapse managed between 1st January 1999 and 31st December 2008 was done. Data was analyzed using the Epi info version 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta, USA. Results The incidence of pelvic organ prolapse in this study was 0.74 per 1000 gynaecological consultations. The majority of the subjects were above 40 years and 64% were grandmultipara. The commonest presenting symptom was protrusion from the vagina which occurred in 96% of the subjects. Vaginal hysterectomy and pelvic floor repair was the commonest mode of management and was associated with higher post operative morbidity than other procedures. Conclusion Older and grand multiparous women are the principal sufferers of pelvic organ prolapse. Prevention through modification of obstetric risk factors, provision of adequate maternity care and family planning services is recommended. Key Words: pelvic organ prolapse, Lagos, Vaginal Hysterectomy