Successful multiple-dose methotrexate therapy for unruptured repeat ectopic pregnancy with high β-human chorionic gonadotropin value: a case report

Successfully managing an unruptured ectopic pregnancy necessitates prioritizing the preservation of fertility as the primary objective. Medical management is traditionally considered to be more successful at lower ß- human chorionic gonadotropin (HCG) values. However, there is emerging evidence that successful treatment can be achieved with modification of dosage regimen in the presence of high β-HCG value. We reported the successful management of a case of unruptured repeat ectopic pregnancy in a patient with high β-HCG. Mrs PA is a 25-year-old G4P0+3 with previous right salpingectomy due to ruptured ectopic gestation who presented with an ultrasound diagnosis of unruptured left tubal ectopic gestation at a gestational age of 6 weeks. The pre-treatment quantitative β-HCG level was 7066 IU/l. She had multiple dose methotrexate therapy which was well tolerated with normalization of β-HCG levels within 44 days. Hysterosalpingography done six (6) months post-treatment demonstrated patent left fallopian tube. She subsequently had spontaneous conception of an intrauterine pregnancy 16-months post-treatment. The pregnancy was carried to term and culminated in successful delivery at term. Multiple-dose chemotherapy was successful in this patient with high β-HCG level with no reported adverse effect

Breast cancer mortality in a resource-poor country: A 10-year experience in a tertiary institution

Introduction: Breast cancer is a major global public health problem accounting for massive morbidity and significant mortality worldwide. Factors contributing to breast cancer mortality have been a topic of intense research and discussion in the scientific world. There is, however, a dearth of information on the incidence of breast cancer mortality in most resource-poor countries including Nigeria. Available data from most African workers on breast cancer focused on incidence, risk factors, and complications rather than mortality. The unique ethnic heterogeneity of Abuja and its peculiar lifestyle (as compared to other Nigerian cities) provides added impetus for assessing breast cancer mortality in one of the Nigeria's fastest growing cities. This study is carried out in a 400-bedded public tertiary hospital in Abuja, the capital of Nigeria. Materials and Methods: A retrospective review of all breast samples in the department of histopathology over a decade is performed supported by clinical information from the medical record archives. Results: Of 2292 breast samples received in the department, 35.3% (n = 810) are malignant out of which 10.6% (n = 86) died. Breast cancer incidence increased from 29 in 2005 to 141 by 2013 while mortality declined from 11 to 9 over the same period. A crude fatality rate of 3.7% is observed. The ages of the decedents ranged from 20 to 90 years with a mean of 43.5 years. Infiltrative ductal carcinoma accounts for the largest mortality with 87.4%. Conclusion: Breast cancer is an important cause of mortality among females and efforts at early detection and treatment should be intensified

Implementation and Evaluation of Obstetric Early Warning Systems in Tertiary care Hospitals in Nigeria

Obstetric Early Warning Systems (EWS) use combined clinical observations to predict increased risk of deterioration and alert health workers to institute actions likely to improve outcomes. The objective of this study was to explore the experience of health workers about the implementation of an obstetric EWS and assess its effectiveness as an alternative clinical monitoring method compared to standard practice. This mixed-method study included obstetric admissions (n=2400) to inpatient wards between 01/08/2018 and 31/03/2019 at three Nigerian tertiary hospitals (1 intervention and two control). Outcomes assessed were the efficiency of monitoring and recording vital signs using the patient monitoring index and speed of post-EWS trigger specialist review. These were evaluated through a review of case notes before and four months after EWS was introduced. Qualitative data was collected to explore healthcare workers’ views on EWS’ acceptability and usability. EWS was correctly used in 51% (n=307) of the women in the intervention site. Of these women, 58.6% (n=180) were predicted to have an increased risk of deterioration, and 38.9% (n=70) were reviewed within 1 hour. There was a significant improvement in the frequency of vital signs recording in the intervention site: observed/expected frequency improved to 0.91 from 0.57, p<0.005, but not in the control sites. Health workers reported that the EWS helped them cope with work demands while making it easier to detect and manage deteriorating patients. Nurses and doctors reported that the EWS was easy to use and that scores consistently correlated with the clinical picture of patients. Identified challenges included rotation of clinical staff, low staffing numbers and reduced availability of monitoring equipment. The implementation of EWS improved the frequency of patient monitoring, but a larger study will be required to explore the effect on health outcomes. The EWS is a feasible and acceptable tool in low-resource settings with implementation modifications

Prevalence and risk factors associated with intradialysis mortality among renal failure patients in a tertiary hospital in a developing nation

Background: Hemodialysis is associated with potential risk of intradialysis death as a complication. We set out to determine some predialysis factors associated with intradialysis death in hemodialysis patients. Materials and Methods: We retrospectively reviewed the records of 457 patients who had hemodialysis at our facility over a 5-year period. Demographic and clinical data of patients who died during dialysis were compared with a control group made of the survivors of hemodialysis. Data was analyzed using SPSS IBM version 20. Numerical data were reported as mean ± SD. Comparison of means of continuous variables was done using student t-test. Chi square was used for comparing proportions. Multivariate logistic regression was done to determine the independent determinants of intradialysis mortality. P value < 0.05 was considered significant. Results: Of the 457 patients who had hemodialysis, 20 (4.4%) died while on hemodialysis during the review period. They were aged 47.35 ± 21.16 years (range, 16-85 years). The deceased were more likely to be elderly (P = 0.003), have pre dialysis hypotension (P < 0.004), depressed level of consciousness (P < 0.0001), predialysis pulmonary edema, and hospital admission (P = 0.047). Multivariate regression analysis identified low Glasgow coma scale (coma) as an independent risk factor for intradialysis death (P < 0.017). Conclusion: Intradialysis mortality risk is increased in a setting of elderly patients, impaired level of consciousness, pulmonary edema, and predialysis hypotension