Sonohysterography: Time to step up its use in gynaecologic imaging in west Africa

Sonohysterography is a simple, safe and convenient technique that is easily and rapidly performed in the ultrasound room; yet the technique seems to be underutilized in West Africa. We present two cases that weresuccessfully done in our centre followed by detailed description, uses and challenges of the technique, with the hope of encouraging clinicians and sonographers in the sub-region to step up its use. Two women were referred for evaluation of their endometrial cavities on account of increasingly heavy menstrual bleeding. Sonohysterography revealed intracavity uterine masses with hyperechoic focal thickening highly suggestive of endometrial polyps; histology confirmed the diagnosis of endometrial polyps. Sonohysterography is an affordable and feasible diagnostic modality for evaluating the endometrial cavity. Where equipment and skill permit, the technique should be used more often in the West African sub-region.Keywords: Sonohysterography, transvaginal sonography, gynaecologic imaging, West Afric

Can Oral Zinc Supplementation Reduce Relapses in Childhood Steroid-Sensitive Nephrotic Syndrome? A Systematic Review

Ngozi R Mbanefo,1 Samuel N Uwaezuoke,1 Chizoma I Eneh,2 Chioma L Odimegwu,1 Ugo N Chikani,1 Uzoamaka V Muoneke,1 Charles E Nwolisa,3 Kenneth E Odo,1 Francis N Ogbuka,2 Anthony T Akwue4 1Department of Pediatrics, the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, Enugu, Nigeria; 2Department of Pediatrics, Enugu State University Teaching Hospital Enugu, Enugu, Nigeria; 3Department of Pediatrics, Federal Medical Centre, Owerri, Imo State, Nigeria; 4Emergency Department, ASEER Field Hospital, Al Rabwah, Kingdom of Saudi ArabiaCorrespondence: Samuel N Uwaezuoke, Tel +2348033248108, Email [email protected]: Frequent relapses and steroid dependence are common treatment challenges of steroid-sensitive nephrotic syndrome (SSNS) in children. Acute respiratory infection (ARI) is the most frequently reported trigger of relapse. Given the role of zinc supplementation in preventing ARI, some studies show that this targeted intervention may reduce relapses in childhood SSNS.Aim: This systematic review aimed to determine if oral zinc supplementation can significantly reduce relapses in this disease.Methods: We searched the PubMed and Google Scholar electronic databases for interventional and observational analytical studies without limiting their year or language of publication. We selected studies with primary data that met our inclusion criteria, screened their titles and abstracts, and removed duplicates. We used a preconceived structured form to extract data items from selected studies and conducted a quality assessment of randomized controlled trials (RCTs) and non-randomized studies with the Cochrane collaboration tool and the Newcastle Ottawa Scale, respectively. We qualitatively synthesized the extracted data to validate the review’s objective.Results: Eight full-text articles were selected, comprising four RCTs and four observational analytical studies. Two of the RCTs had a high risk of bias in three parameters of the Cochrane collaboration tool, while three non-randomized studies had low methodological quality. A total of 621 pediatric patients with SSNS were investigated in the eight studies: six participants dropped out in one study. Three RCTs indicate that zinc supplementation may lead to sustained remission or reduction in relapse rate. Similarly, three observational analytical studies suggest a significant relationship between reduced serum zinc levels and disease severity.Conclusion: Despite the association of zinc deficiency with increased morbidity in SSNS and the reduction of relapse rates with zinc supplementation, there is no robust evidence to recommend its use as a therapeutic adjunct. We recommend more adequately-powered RCTs to strengthen the current evidence.Keywords: acute respiratory infection, frequent relapses, nephrotic syndrome, childhood, zinc supplementatio

Development of a text messaging system to improve receipt of survivorship care in adolescent and young adult survivors of childhood cancer

PurposeThis study aimed to develop and examine the acceptability, feasibility, and usability of a text messaging, or Short Message Service (SMS), system for improving the receipt of survivorship care for adolescent and young adult (AYA) survivors of childhood cancer.MethodsResearchers developed and refined the text messaging system based on qualitative data from AYA survivors in an iterative three-stage process. In stage 1, a focus group (n = 4) addressed acceptability; in stage 2, key informant interviews (n = 10) following a 6-week trial addressed feasibility; and in stage 3, key informant interviews (n = 23) following a 6-week trial addressed usability. Qualitative data were analyzed using a constant comparative analytic approach exploring in-depth themes.ResultsThe final system includes programmed reminders to schedule and attend late effect screening appointments, tailored suggestions for community resources for cancer survivors, and messages prompting participant feedback regarding the appointments and resources. Participants found the text messaging system an acceptable form of communication, the screening reminders and feedback prompts feasible for improving the receipt of survivorship care, and the tailored suggestions for community resources usable for connecting survivors to relevant services. Participants suggested supplementing survivorship care visits and forming AYA survivor social networks as future implementations for the text messaging system.ConclusionsThe text messaging system may assist AYA survivors by coordinating late effect screening appointments, facilitating a partnership with the survivorship care team, and connecting survivors with relevant community resources.Implications for cancer survivorsThe text messaging system has the potential to improve the receipt of survivorship care