Managing Endometriosis in sub-Saharan Africa: Emerging Concepts and New Techniques

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The case for gynaecologist-led point of care ultrasound services in sub-Saharan Africa

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Fracture healing following high energy tibial trauma: Ilizarov versus Taylor Spatial Frame

Introduction: The optimal treatment of high energy tibial fractures remains controversial and a challenging orthopaedic problem. The role of external fi xators for all these tibial fractures has been shown to be crucial. Methods: A fi ve-year consecutive series was reviewed retrospectively, identifying two treatment groups: Ilizarov and Taylor Spatial Frame (TSF; Smith & Nephew, Memphis, TN, US). Fracture healing time was the primary outcome measure. Results: A total of 112 patients (85 Ilizarov, 37 TSF) were identifi ed for the review with a mean age of 45 years. This was higher in women (57 years) than in men (41 years). There was no signifi cant difference between frame types (p=0.83). The median healing time was 163 days in both groups. There was no signifi cant difference in healing time between smokers and non-smokers (180 vs 165 days respectively, p=0.07), open or closed fractures (p=0.13) or age and healing time (Spearman's r=0.12, p=0.18). There was no incidence of non-union or re-fracture following frame removal in either group. Conclusions: Despite the assumption of the rigid construct of the TSF, the median time to union was similar to that of the Ilizarov frame and the TSF therefore can play a signifi cant role in complex tibial fractures

Minimum intervention dentistry in resource challenged practice environments

This paper highlighted the clinical strategies for implementing minimum intervention dentistry (MID) in dental practice and in dental education in resource challenged practice environments (developing economies). The objectives of each of the 4 phases of minimum intervention treatment plan (MI Identify, MI Prevent, MI Restore and MI Recall) were highlighted and three levels of caries risk (Low risk, High risk and Super high risk) were adopted with the appropriate targeted preventive non restorative treatments. Three evaluation rating scales were introduced (early recall evaluation rating scale, caries control evaluation rating scale and oral health outcome evaluation rating scale) for monitoring the success or failure of counselling, the targeted preventive (non-surgical) treatments and the oral health outcome. Practitioners and academics in resource challenged practice environments should embrace MID with open minds, its goal is maximum preservation of healthy oral tissues with oral health promotion and targeted preventive non- surgical treatments as its cornerstones. Furthermore, MID is mercury free and will safeguard our environment from mercury pollution for the benefit of future generations. Keywords: Minimum intervention dentistry, mercury free dentistry, dental practice, dental education, resource challenged practice environment

Lessons from mercury dental amalgam phase down for developing economies

This paper highlighted six pertinent issues that developing economies should focus on with regards to mercury dental amalgam phase down. The need to set up structures for monitoring and evaluation of materials and technologies used in clinics, laboratories and hospitals was discussed as well as the need to provide research data on mercury pollution that may be peculiar to developing economies. The urgent needs to update dental schools' curricula and update the training of general Dental practitioners were also discussed. Aframework for curriculum development, review and update was proposed using the Minimum Intervention Treatment Plan (MITP). Two other caries management pathways-the International Caries Classification and Management System Caries Management Pathway (ICCMS-CaMP) and the Caries Management by Risk Assessment (CAMBRA-CaMP) were also highlighted. A “frog-leaping' phase down approach was proposed that took cognizance of the poor infrastructure for waste management in developing economies. Opportunities for new oral health policy initiatives with regards to integration of oral health into national and international health agenda were also discussed. Keywords:Mercury, dental amalgam, phase down, lessons, curriculum update

To determine the optimal ultrasonographic screening method for rectal/rectosigmoid deep endometriosis:ultrasound "sliding sign", transvaginal ultrasound direct visulization or both?

Introduction: The study aim was to evaluate the transvaginal sonography (TVS) “sliding sign” alone, direct visualization of the bowel with TVS, and the combination of both methods (ie “sliding sign” and direct visualization of the bowel), to determine the optimal TVS method for the prediction of rectal/rectosigmoid deep endometriosis (DE). Material and methods: Multicenter prospective observational study (January 2009-February 2017). All women underwent TVS to determine whether the “sliding sign” was positive/negative and whether rectal/rectosigmoid DE was present, followed by laparoscopic surgery. The association between a negative TVS “sliding sign” alone and the direct visualization of a rectal/rectosigmoid DE nodule alone during the TVS were correlated with the presence of rectal/rectosigmoid DE at laparoscopy. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) were evaluated. Data were analyzed using Fisher's exact test. Results: During the recruitment period, 410 consecutive women with suspected endometriosis were included. Complete TVS and laparoscopic surgical outcomes were available for 376 of the women (91.7%). Complete TVS and laparoscopic data were available for 376 women. Of the 376 women 76 (20.2%) had rectal/rectosigmoid DE at laparoscopy. The accuracy, sensitivity, specificity, PPV, NPV, positive and negative LRs for each method to predict bowel DE were: negative “sliding sign”: 87%, 73.7%, 90.3%, 65.9%, 93.1%, 7.62, and 0.29, respectively; direct visualization: 91.0%, 86.8%, 92.3%, 74.2%, 96.5%, 11.3, and 0.14, respectively; combined approach: 90.2%, 69.7%, 95.3%, 79.1%, 92.6%, 14.94, and 0.32, respectively. A negative TVS “sliding sign” was significantly associated with the need for bowel surgery (P < 0.05). Conclusions: The combination of the TVS “sliding sign” and direct visualization of the bowel during TVS appears to provide the most accurate assessment for the identification of rectal/rectosigmoid DE preoperatively

Managing Caesarean Scar Pregnancy in low Resource Settings: 2 Case Reports and a Description of Transrectal Ultrasound guided Surgical Approach (TRUGA).

Caesarean scar pregnancy (CSP) occurs when an embryo implants in a previous caesarean section scar. It has a reported incidence of 1 in 1800. Various surgical and medical techniques have been described in case reports for the management of CSP. These techniques are usually undertaken in tertiary level units with significant resource availability. In this paper, we present a new clinical perspective for the management of CSP in low resource settings and describe the steps involved in a transrectal ultrasound guided approach with dilatation of uterine cervix and subsequent evacuation of uterine contents (TRUGA with D&amp;C).Keywords: caesarean scar pregnancy, transrectal ultrasound guided surgical approach.RésuméLa grossesse de la cicatrice césarienne (GCC) se produit lorsqu'un implant d'embryon dans une précédente cicatrice césarienne. Il a une incidence déclarée de 1 à 1800. Les techniques chirurgicales et médicales diverses ont été décrites dans les rapports de cas de la gestion du GCC. Ces techniques sont habituellement effectuées dans les unités de niveau supérieur avec la disponibilité des ressources importantes. Dans cet article, nous présentons un nouveau point de vue clinique pour la gestion du GCC dans les milieux à faibles ressources et nous faisons une description des étapes d'une approche guidée des ultrasons transrectaux avec une dilatation du col de l'utérus et l'évacuation éventuelle du contenu utérin (FARR avec D &amp; C). Mots-clés: grossesse de la cicatrice césarienne, approche chirurgicale guidée de l’échographie transrectale

Patients’ Management Patterns for Restorative Treatment Procedures: A 4-Year Overview at the Restorative Clinic of a Tertiary Hospital in Nigeria

Objective:&nbsp;To determine the patients’ management pattern for restorative treatment procedures at the Restorative Dentistry Clinic at the Lagos State University Teaching Hospital (LASUTH).&nbsp;Material and Methods:&nbsp;A descriptive and retrospective study design was employed to determine patients’ management patterns for the restorative treatment procedures at the Restorative Dentistry Clinic at LASUTH. Treatment records of patients who attended the Restorative Clinic at the Lagos State University Hospital, Ikeja, Lagos, Nigeria, from 2011 to 2014 were reviewed; the effective treatments during the period under review were recorded as treatment procedures and were recorded as operative, endodontic, fixed prosthodontics, and removable procedures.&nbsp;Results:&nbsp;A total of 14,437 (75%) operative; 1,353 (7.0%) endodontic; and 559 (2.9%) fixed prosthodontics and 2,852 (14.9%) removable prosthodontic procedures were carried out during the period under review. This study showed that operative procedures were the most performed restorative procedures, whereas removable prosthodontics and endodontic procedures ranked second and third, respectively, to operative procedures. Fixed prosthodontics procedures were the least performed restorative procedures.&nbsp;Conclusion:&nbsp;This study showed that more efforts were being expended by dentists on operative services compared to endodontic, removable, and fixed prosthodontics services combined. Comprehensive studies, embracing all disciplines of dentistry, should be carried out to determine the level of demand and clinical relevance of procedures in clinical dental practice and hence to set specific and general objectives of dental education for the populace. Access to dental health Insurance services should also be increased in the country

Modern cemented Furlong hemiarthroplasty: Are dislocations rates better?

BACKGROUND: Dislocation following hip hemiarthroplasty is a major complication with increased mortality and morbidity. Data looking at dislocation following contemporary bipolar stems are lacking in literature. METHODS: Retrospective review of our prospective national hip fracture database over a two-year period. Group 1 comprised of consecutive patients receiving bipolar Furlong prosthesis (N222) while Group 2 was made up of a historical cohort (uncemented; N254). Clinical and radiological records were reviewed to determine dislocation rates, causes and associative factors of dislocations. Data were analysed using SPSS. RESULTS: Following 476 hemiarthroplasties performed during the study period, 12 (2.5%) dislocations were reported (eight in Group 1; four in Group 2). There was no significant difference in dislocation rates (3.6% vs 1.6%) between groups (p = 0.159). Subgroup analysis of Group 1 demonstrated a significant difference in dislocations with Furlong cemented (6%) as compared with Furlong uncemented (0%) hemiarthroplasties (p = 0.024). Following dislocation, death rates increased to 8.3% from 1.7% in both groups. CONCLUSION: There is a statistically significant increase in dislocation rate following use of cemented Furlong prosthesis when compared to similar uncemented prosthesis at the same treatment period. However, when compared to traditional uncemented prosthesis, there is no difference in dislocation rates