Ovarian hyperstimulation syndrome (OHSS): case report

There has been a rapid increase in the number of couples receiving treatment for infertility with Assisted Reproductive Technology (ART) in recent years. While there is robust evidence supporting the efficacy and safety of ART, it is important to be aware of the risks, the most serious of which is OHSS. A case of OHSS, a rare complication of COS, which is potentially fatal, is presented. Patient with secondary infertility (Para 0 + 1), who had had IVF - COS followed by oocyte retrieval and subsequent embryo transfer. She presented at Accident and Emergency Unit, Nairobi Hospital, with dyspnea, chest pain, abdominal pain and distension. A diagnosis of OHSS withpulmonary thromboembolism was made. She was admitted to Intensive care unit(ICU). She was managed with oxygen by mask, intravenous fluids, anticoagulant and albumen in Intensive Care Unit with fully recovery.The case study presents her clinical manifestations, investigation, progress, management, outcome and preventive measures

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 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

The Effect of two levels of counselling on acceptance, uptake and early outcomes of post-placental intra-uterine contraceptive device

Objective: To determine the effect of two levels of counselling on the provision of Intrauterine Contraceptive Device (IUCD) at six weeks post-partum of the postplacental intrauterine deviceSetting: Embu Provincial General Hospital, Kenya.Subjects: One hundred and thirty seven pregnant women at the gestation of 36 weeks to term, who attended Antenatal clinic and were followed until delivery and at six weeks post-partum.Design: A randomised “open-label” clinical trial.Results: One hundred and twenty seven study participants were enrolled and randomised to intensive (64 women) or routine FP counselling (63 women). Seventy eight per cent of women in the intensive FP counselled group and 66% in the routine FP counselled group accepted to have the post-placental IUCD inserted. There was no significant difference in uptake in the two-randomisation arms (p-value 0.232). Complications included expulsion (3.7%), allergic reaction (1.8%), pelvic infection (1.8%) and abdominal pain (1.8%).The post-placental IUCD is a favourable methodwith continuation rates (91%), client (88%) and reported partner (77%) satisfaction were notably high at six weeks. The most critical barrier to uptake was lack of trained medical personnel to insert the post-placental IUCD, which occurred in (60%) clients who had consented.Conclusion: The post-placental IUCD is an acceptable method among women irrespective of level of counselling. Intensive counselling did not significantly increase acceptance and uptake rates of post-placental IUCD insertion in comparison to routine counselling

FOOD SAFETY KNOWLEDGE, ATTITUDES AND PRACTICES OF FISH HANDLERS IN KIRINYAGA COUNTY MARKETS, KENYA

Fish and fish products have high nutritional value and are important in supplementing human diet. Fish products have little or no cholesterol and saturated fat, but instead have omega 3 and low-fat content essential for human health. Despite the high nutritional value of fish products, their consumption is hindered significantly by setbacks such as spoilage and foodborne diseases that spread through contamination in the fish supply chain. The objective of this study was to evaluate fish vendors' attitudes, knowledge, and practices on food safety in selected markets in Kirinyaga County that included Sagana, Tebere, Mwea, Ndia, Kianyaga, and Kerugoya markets. A structured questionnaire was administered to 54 fish vendors to collect information on fish safety, spoilage, risk factors, personal hygiene, food contamination, type of hazards, foodborne diseases and attitudes towards training on food safety. Statistical Package for Social Sciences (SPSS) version 22.0 was used to analyse the data from the respondents. The relationship between fish vendors’ demographic characteristics and risk factors was assessed using Spearman’s rank correlation coefficient. The majority of the fish vendors had a positive attitude towards education in hygiene practices (56%). There was a positive correlation between education and fish vendors' awareness of fish foodborne diseases at p<0.05. The study revealed that fish foodborne diseases awareness was positively influenced by respondents' level of experience and age. Moreover, there was also a significant (p˂ 0.05) positive correlation on the awareness of fish foodborne diseases with hygiene and food safety. Majority of the fish handlers had average level of knowledge, attitude and hygiene practices for food safety. These findings presented a foundation for formulating policies to increase food safety and hygiene practices of fish handlers in the region, thereby preventing foodborne diseases and postharvest losess. The results of this study can also form a basis for an indepth research for students and researchers in verious disciplines scuh as public health, marketing, community development and more

FOOD SAFETY KNOWLEDGE, ATTITUDES AND PRACTICES OF FISH HANDLERS IN KIRINYAGA COUNTY MARKETS, KENYA

Fish and fish products have high nutritional value and are important in supplementing human diet. Fish products have little or no cholesterol and saturated fat, but instead have omega 3 and low-fat content essential for human health. Despite the high nutritional value of fish products, their consumption is hindered significantly by setbacks such as spoilage and foodborne diseases that spread through contamination in the fish supply chain. The objective of this study was to evaluate fish vendors' attitudes, knowledge, and practices on food safety in selected markets in Kirinyaga County that included Sagana, Tebere, Mwea, Ndia, Kianyaga, and Kerugoya markets. A structured questionnaire was administered to 54 fish vendors to collect information on fish safety, spoilage, risk factors, personal hygiene, food contamination, type of hazards, foodborne diseases and attitudes towards training on food safety. Statistical Package for Social Sciences (SPSS) version 22.0 was used to analyse the data from the respondents. The relationship between fish vendors’ demographic characteristics and risk factors was assessed using Spearman’s rank correlation coefficient. The majority of the fish vendors had a positive attitude towards education in hygiene practices (56%). There was a positive correlation between education and fish vendors' awareness of fish foodborne diseases at p<0.05. The study revealed that fish foodborne diseases awareness was positively influenced by respondents' level of experience and age. Moreover, there was also a significant (p˂ 0.05) positive correlation on the awareness of fish foodborne diseases with hygiene and food safety. Majority of the fish handlers had average level of knowledge, attitude and hygiene practices for food safety. These findings presented a foundation for formulating policies to increase food safety and hygiene practices of fish handlers in the region, thereby preventing foodborne diseases and postharvest losess. The results of this study can also form a basis for an indepth research for students and researchers in verious disciplines scuh as public health, marketing, community development and more

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58\ub75%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31\ub72%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10\ub72%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12\ub73%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9\ub74%] of 7339 patients), middle (549 [14\ub70%] of 3918 patients), and low (298 [23\ub72%] of 1282) HDI (p&lt;0\ub7001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17\ub78%] of 574 patients in high-HDI countries; 74 [31\ub74%] of 236 patients in middle-HDI countries; 72 [39\ub78%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1\ub760, 95% credible interval 1\ub705\u20132\ub737; p=0\ub7030). 132 (21\ub76%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16\ub76%) of 295 patients in high-HDI countries, in 37 (19\ub78%) of 187 patients in middle-HDI countries, and in 46 (35\ub79%) of 128 patients in low-HDI countries (p&lt;0\ub7001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant