A case series of masquerade postpartum haemorrhage

Postpartum hemorrhage (PPH) is an obstetric emergency with different causes. Management is directed towards the cause and can be medical or surgical. This is a case series report of four patients who presented to University College Hospital; Ibadan, Nigeria with PPH following emergency caesarean section (EMCS) with three performed for prolonged obstructed labour. All the cases had severe PPH, hemodynamic instability and presented 14 to 84 days post caesarean section. Surgical exploration revealed extension of caesarean incision into the uterine vessel with slipped ligature in two of them and bleeding vessel without ligature in the other two. Two had haemostasis secured with uterine artery ligation, one had repair of uterine incision extension while the 4th had hysterectomy. The length of hospital stay was 5 to 13 days. All recovered fully post-operatively and were discharge home in good clinical condition

Detection under Noise Using Component Improvement Strategy

Abstract Inaccuracy in signal detection due to presence of noise in signal is responsible for fading/interference, this noise needs to be reduced for optimal signal detection, and detection must be accurate enough to minimize the risk of false alarm. A noise reduction model was developed to improve signal detection using component improvement strategy. The system was implemented on MATLAB software package. It can be seen from the results that for a given probability of false alarm (P FA ), the detection performance increases monotonically with the ENR based on the balanced probability of not meeting target of 0.5. It can be generally concluded from the results of the study that signal detection could be fully enhanced with the application of six sigma component-based improvement system. This is an indication that component-based sigma improvement system played a significant role in signal detection performance

CHEMICAL BIO-COMPOUNDS AND FUNCTIONAL PROPERTIES OF RAW AND PROCESSED CUTTLEFISH, SEPIA OFFICINALIS (MOLLUSCA: CEPHALOPODA)

Cuttlefish is one of the most economically important cephalopods with rich taste and few inedible parts. The study was aimed at evaluating the nutrient, non-nutrients, free fatty acid and cholesterol compositions and functional properties of raw and processed Sepia officinalis using standard methods. Moisture and raw protein in raw sample of the cuttlefish were significantly higher (< 0.05) than in processed samples. Raw fat showed significant differences with fried sample having highest value (22.39±0.54 %) to raw (16.24±0.10 %) and boiled samples (4.09±1.42 %). Raw sample contained more ash with highest mg/100g levels of calcium, phosphorus, magnesium, iron and manganese. Processed cuttlefish registered significant reduction in levels of trypsin inhibitor, phytate and oxalate compared to the raw. Raw protein of fried cuttlefish exhibited positive relationships with all the non-nutritionalfactors while total ash only showed positive relationships with phytate ( = 0.998) and trypsin inhibitor ( = 0.999). Cholesterol content of raw cuttlefish was of 0.923±0.02 mg/100g being reducedby boiling (0.711±0.02 mg/100g) and increased by frying (1.037±0.02 mg/100g). A significantly high percentage of oleic was observed in fried cuttlefish (4.47±0.10) while boiled sample had the lowest value (1.4±0.05). The results showed significantly high percentage of water and oil absorbing capacities for raw cuttlefish while foam and emulsion stabilities were higher in the boiled sample. By frying, the highest foam and emulsion capacities of 8.8 and 4.4% respectively were obtained. The study suggests that Sepia officinalis will be highly desirable for preparing comminuted sausage products due to its good functional and nutritional properties

Factors associated with the awareness of vaginal fistula among women of reproductive age: findings from the 2018 Nigerian demographic health cross-sectional survey

Introduction Involuntary leakage of urine and or stool per vaginam (vaginal fistula) after childbirth remains a public health challenge in Africa and South East Asia. To the best of our knowledge, there is no previous national data that examined the awareness of vaginal fistula among women in Nigeria.Aim To determine the prevalence of awareness of urinary/faecal incontinence due to vaginal fistula, and the associated risk factors among women with no previous experience of incontinence.Methods We used a cross-sectional study, the 2018 Nigerian Demographic Health Survey, to analyse awareness of vaginal fistula among women with no previous leakage of urine or stool. The primary outcome was childbirth experience, and other variables were demographics, access to information and reproductive or sexual history. The descriptive, univariate and multivariable models were presented.Results Of 26 585 women interviewed, 50 (0.2%) who had experienced fistula were excluded from the risk factor analysis. The mean age of women with childbirth experience was 32.8±8.6 years, while that of women without childbirth experience was 20.3±6.2 years. The prevalence of vaginal fistula awareness was 52.0%. Factors associated with the awareness include the following: childbirth experience (adjusted OR (AOR)=1.14; 95% CI, 1.01 to 1.30); age of 20–24 years (AOR=1.36; 95% CI, 1.18 to 1.56) and older; currently working (AOR=1.35; 95% CI, 1.22 to 1.49) and ownership of a mobile phone (AOR=1.16; 95% CI, 1.05 to 1.27). Other associated factors include the following: having at least secondary education; wealth quintiles, ethnicity, regional location, religion, access to radio, newspaper and internet; age up to 17 years at first sex; history of previous termination of pregnancy and use of contraception.Conclusion A significant number of young women with no childbirth experience had low level of awareness. We recommend vaginal fistula awareness programmes that will target women at risk of vaginal fistula and the inclusion of other useful questions to improve the quality of information in future surveys

Bilateral Double Ureters with Bladder Neck Diverticulum in a Nigerian Woman Masquerading as an Obstetric Fistula

A 43-year-old woman presented with 20-year history of leakage of urine per vaginam. She had one failed repair attempt. Pelvic examination with dye test showed leakage of clear urine suggestive of ureterovaginal fistula. The preoperative intravenous urogram revealed duplex ureter and cystoscopy showed normally cited ureteric orifices with two other ectopic ureteric openings and bladder diverticula. The definitive surgery performed was ureteric reimplantation (ureteroneocystostomy) of the two distal ureteric to 2 cm superiolateral to the two normal orifices and diverticuloplasty. There was resolution of urinary incontinence after surgery. Three months after surgery, she had urodynamic testing done (cystometry), which showed 220 mLs with no signs of instability or leakage during filling phase but leaked on coughing at maximal bladder capacity. This is to showcase some diagnostic dilemma that could arise with obstetric fistula, which is generally diagnosed by clinical assessment

37-41Experimental Investigation of the Effect of Emulsifier Concentration on the Properties of Olechemical Oil Based Cutting Fluid

Abstract Experimental investigation of the effect of emulsifier concentration on the properties of olechemical-oil -based cutting fluid was studied. It was observed that as the emulsifier concentration increases from 2% to 8%, the kinematic viscosity increased. However, for emulsifier concentration of 10%, the kinematic viscosity started decreasing for all the temperature range used, although an increase was observed with increase in temperature. On the other hand, other properties such as thermal conductivity, pH value, flash and fire points increased as the concentration of the emulsifier was raised. However, microbial growth decreased as the pH value increased

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways