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

Estimating the burden of selected non-communicable diseases in Africa: a systematic review of the evidence

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa

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

ANTIPYRETIC EFFECT OF RAUWOLFIA VOMITORIA IN RABBITS

The aqueous extract of the leaves of Rauwolfia vomitoria (family, Apocynaceae) in a dose of 1.2 gkg-1 given orally produced a decrease in temperature from 42.0oC to 40.0oC in about 2 hours in rabbits infected with Klebsiella aerogenes. Key Words: Rauwolfia vomitoria, Apocynaceae, antipyretic, Klebsiella aerogenes Nig. J. Nat Prod. And Med. Vol.3 1999: 77-7

Cases of ectopic pregnancies as seen in Lagos State University Teaching Hospital, Ikeja, Nigeria

Objective: To determine the prevalence rate, the major forms of ectopic pregnancy and to correct some of the inadequacies in filling of the laboratory forms. Materials and Methods: Relevant data on 91 ectopic pregnancy specimens received at the Lagos State University Teaching Hospital (LASUTH), Ikeja between May 1 2001 and 30 November 2004 were collected from the laboratory forms and analyzed. Results>/b>: A total of 91 ectopic pregnancy cases were received during the 3 year period. The total gynaecological and pregnancy-related specimens were 613 and 472 respectively. Ectopic pregnancy accounted for 14.4% of all the gynaecological and 19.28% of pregnancy-related specimens received in the laboratory. The ages of the patients presenting with ectopic pregnancies ranged from 17 to 36 years with the age group 25 – 29 years representing the highest percentage of 51.6%. The ages of the patient studied were not recorded in 62.2% of cases. 96.70% of the pregnancy specimens were tubal while ovarian occurred in 3.3% of cases. Each of the fallopian tubes had 50% chance of being involved. The sites of the tubal ectopic pregnancy were not specified in 73.2% of cases. A case of bilateral ectopic pregnancy was received. The tubes were recorded as having ruptured in 37.8% of cases. Results showed that lymphocytes are the commonest inflammatory cells seen in the fibro-muscular wall of the fallopian tubes. Conclusion: The rate of ectopic pregnancy is on the increase in Lagos(1). The high rate of tubal rupture associated with ectopic pregnancy can be reduced through the creation of better awareness of this condition in the society, as this will ensure early presentation and referral of cases to hospital. Doctors should be encouraged to fill the relevant portions of the laboratory forms correctly before sending specimens to the laboratories. Keywords: Ectopic pregnancy, Incidence rate, Histopathological laboratory forms Nigerian Journal of Health and Biomedical Sciences Vol. 5 (2) 2006: 79-8

Comparing the specificity and sensitivity of nitrate and leucocyte tests on multistick in screening for urinary tract infections amongst pregnant woment at Lagos State University Teaching Hospital Ikeja, Nigeria

No Abstract

Effects of Short and Medium Term use of Artesunate on Fertility in Male Rats

The effects of artesunate on major sperm parameters and testicular history in wistar rats were examined. Sixteen sexually mature wistar rats weighing 150-180gm were divided into 4 groups and administered 2mg/kg or 1mg/kg of the drug for period ranging 2-8weeks. Control animals were administered water only. All animals were allowed food and water ad-libitum. At the end of these periods, the animals were euthanized and their cauda epididymes, testes, prostrate and seminal vesicles were neatly removed from them. Major sperm parameters were obtained from the epididymal sperm and the testis prepared and examined histologically. Results showed normal to raise sperm parameters in both groups treated for 2 weeks. Sperm density in millions/gm of testes in groups 2 and 3 which received different doses of the drug for 2 weeks was 62.0+10.2 and 65.6+13.8 respectively compared to 52.1+11.0 in control rats. However after 4 weeks on the drug all major parameters were significantly depressed. Sperm density was 20.3+1.5 and abnormal sperm rate 71.7% compared to 52.1+11.0 and 26.7+2.3% in control animals respectively. This study suggests that under certain conditions, artesunate will suppress spermatogenesis. Until exhaustive studies of the drug\'s effects on fertility are accomplished, it must be used with appropriate caution in young people. Keywords: Artesunate, spermatogenesis, sperm parameters. Nigerian Journal of Health and Biomedical Sciences Vol. 7 (2) 2008: pp. 18-2

Effects of Supplementation with Forage Resources from Natural Pasture on the Growth Performance and Ruminal Fermentation of Grazing Calves in Dry Season.

The feeding value of forage resources from the natural pasture as dry season feed supplements for grazing calves was evaluated. Sixteen cross bred calves (White Fulani X ’dama) with initial body weights of 82.5-87.0 kg were grouped into four treatments with four animals per treatment. The treatments consist of sole grazing (SG) in the natural pasture, grazing + hay (G+H), grazing + Leucaena leucocephala leaves (G+LL) and grazing + silage (G+S). The study lasted for 84 days growth trial and 7 days digestibility trial. Rumen fluid was sampled at the end for pH, ammonia nitrogen and volatile fatty acids determination. Average daily gain (2.2, 7.5, 9.5 and 8.5 kg) for SG, G+H, G+LL and G+S, respectively (P &lt; 0.05) among treatments. Ruminal ammonia concentration was in the order of G+LL&gt; G+S&gt; G+H and SG (P &lt; 0.05). The study showed that all the grazing animals that were supplemented increased in weight and had better rumen fermentation, indicating relatively better feeding value. Hence resources from natural pastures, if well managed in form of hay and silage, can be good supplements especially in the dry season when forages in most pastures are in short supply and low in quality.Keywords: Natural pasture; Leucaena leucocephala leaves; hay; silage; rumen parameters