Obstetric fistulae repair in a Nigerian Tertiary Health Institution; Lessons learnt from the outcome of care

This was a hospital based retrospective study of one hundred and fifty-five women managed for obstetric vesicovaginal fistula at the University College Hospital, Ibadan Nigeria from 2000 till 20006. The objective of the study was to document the types of obstetric vesico-vaginal fistula and also describe factors that may influence the outcome of successful repair.The pattern of the fistulae managed were Midvaginal (45.8%),  juxtacervical (38.7%) and juxtaurethral (15.5%). Gynaecologists performed 61.7% of cases using the vaginal route while urologists repaired the rest abdominally. Bivariate analysis showed that younger age at presentation, gravidity, VVF type (Anatomic and Kees Waaldijk), number of previous repairs, and presence of rectovaginal fistula and duration of urinary incontinence prior to repair were statistically significantly related to outcome of repair. Multiple logistic regression models revealed age at presentation (95% CI OR = 1.18 – 9.09) and duration of incontinence (95% CI OR = 1.39 – 13.64) as significant predictors. It is recommended that early presentation for repair and capacity building of specialist trainees will assist in the effective management and other interventions to eliminate obstetric fistula. Above all, governments at all levels should either subsidize or make antenatal care free so as to reduce the incidence of childbirth complications including vesico-vaginal fistula.Keywords: Obstetric fistula, vesico-vaginal fistula (VVF), obstructed labou

Effects of Phosphorous Application on Growth Performance, Yield and Nutritional Value of Cockscomb ( Celosia argentea L)

Effects of phosphorous (P) level on performance, yield and nutritional value of Celosia argentea L. were evaluated with the aim of determining the P level that supports the best growth, yield and nutritional qualities of the crop. The levels of P were: normal (1.348 mg\ub7kg-1 of P/pot, NP), medium (6.743 mg\ub7kg-1 of P/pot, MP), high (13.48 mg\ub7kg-1 of P/pot, HP) and no P application (control, CP). The crop growth rate (CGR) increased with increase in phosphorus gradients (NP = 0.05 g/m2\ub7d-1, MP = 0.09 g/m2\ub7d-1 and HP = 0.12 g/m2\ub7d-1). High and medium P rates increased the relative growth rate (RGR), HP had the highest RGR (0.05 g\ub7g-1/day) followed by MP (0.04 g\ub7g-1/day). Addition of P increased leaf area (LA) of C. argentea. Crude protein of the control was higher (5.56%) compared to the other P treatments (NP = 5.14, MP = 5.11 and HP = 5.03%). Phosphorus applications were beneficial for growth and enhancement of nutritional quality of C. argentea. NP and MP are recommended for growing this vegetable crop

Knowledge and use of emergency contraception by medical doctors on internship in a tertiary healthcare facility in Nigeria

Context: Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access.Aims: To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs).Settings and Design: A cross.sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria.Materials and Methods: A pretested self.administered questionnaire was used to obtain data from consenting participants.Statistical Analysis Used: Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used.Results: The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape.96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31.10.01), religion (OR = 0.26; 95% CI OR =  0.11.0.630) and marital status (OR = 0.19; 95% CI = 0.07.0.56). Conclusion: The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in.service training  should focus more on EC to improve the quality of their knowledge and  attitude towards it.Key words: Emergency contraception, knowledge, Medical Doctor, Nigeri

The efficacy of preopoerative instruction in reducing anxiety following gyneoncological surgery: a case control study

<p>Abstract</p> <p>Background</p> <p>This is a quasi-experimental case control research focusing on the impact of systematic preoperative instruction on the level of postoperative anxiety in gyneoncologic patients. The population studied consists of the gyneoncologic surgery patients admitted to the Gynecologic Oncology Service at Zekai Tahir Burak Gynecology Training and Research Hospital from May to September 2010.</p> <p>Patients and methods</p> <p>Through a random sampling, 60 patients were recruited in each group. The study group was given a systematic preoperative instruction while the control group was given routine nursing care. Patients were interviewed in the postoperative period and anxiety was measured. The data-collecting tool consisted of the Individual Information Form and the State-Trait Anxiety Inventory. The collected data were analyzed by using the SPSS Program to find the frequency, the percentage, the mean and the standard variables, and the hypothesis was tested with Chi-square, variance, and t-independent test.</p> <p>Results</p> <p>It was found that the incidence rates from the post-operative anxiety score of the study group were lower than those of the control group (p < .05). The results of this research demonstrated that gyneoncologic surgery patients who were given systematic preoperative instruction felt less anxious than the ones who were given merely a routine nursing care.</p> <p>Conclusions</p> <p>Results of this study suggest that preoperative instruction programs aiming at informing gyneoncologic surgery patients at the preoperative stage should be organized in hospitals and have an essential role.</p

Timing of antenatal care for adolescent and adult pregnant women in south-eastern Tanzania

Early and frequent antenatal care attendance during pregnancy is important to identify and mitigate risk factors in pregnancy and to encourage women to have a skilled attendant at childbirth. However, many pregnant women in sub-Saharan Africa start antenatal care attendance late, particularly adolescent pregnant women. Therefore they do not fully benefit from its preventive and curative services. This study assesses the timing of adult and adolescent pregnant women's first antenatal care visit and identifies factors influencing early and late attendance.\ud The study was conducted in the Ulanga and Kilombero rural Demographic Surveillance area in south-eastern Tanzania in 2008. Qualitative exploratory studies informed the design of a structured questionnaire. A total of 440 women who attended antenatal care participated in exit interviews. Socio-demographic, social, perception- and service related factors were analysed for associations with timing of antenatal care initiation using regression analysis. The majority of pregnant women initiated antenatal care attendance with an average of 5 gestational months. Belonging to the Sukuma ethnic group compared to other ethnic groups such as the Pogoro, Mhehe, Mgindo and others, perceived poor quality of care, late recognition of pregnancy and not being supported by the husband or partner were identified as factors associated with a later antenatal care enrolment (p < 0.05). Primiparity and previous experience of a miscarriage or stillbirth were associated with an earlier antenatal care attendance (p < 0.05). Adolescent pregnant women started antenatal care no later than adult pregnant women despite being more likely to be single. Factors including poor quality of care, lack of awareness about the health benefit of antenatal care, late recognition of pregnancy, and social and economic factors may influence timing of antenatal care. Community-based interventions are needed that involve men, and need to be combined with interventions that target improving the quality, content and outreach of antenatal care services to enhance early antenatal care enrolment among pregnant women

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children &lt;18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p&lt;0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p&lt;0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p&lt;0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Vaginoplasty case series at the University College Hospital Ibadan

Transverse vaginal septum is a benign condition with the septum occurring at various levels within the vagina; it may occur in the upper third, mid-vaginal or lower third. A report of five cases of transverse vaginal septum managed at the University College Hospital between January, 2006 and December, 2009. Three were cases of congenital transversevaginal septum while the other two were cases of acquired transverse vaginal septum. Diagnosis of congenital transverse vaginal septum was made following history of primary amenorrhea, pelvic examination revealing a vaginal septum. In addition, a pelvic mass and ultrasound findings of haematocolpos and haematometria were present in the first case. Diagnosis of acquired vaginal septum was made following history ofsecondary amenorrhea, cyclical abdominal pain and pelvic examination findings of gynaetresia and vaginal septum. In all but one, surgical resection of the transverse vaginal septum was performed, followed by lining of the vagina by split thickness skin graft (STSG): the McIndoe-Read operation. All the procedures were performed in conjunction with the Plastic surgeon. They were seen at the Gynaecology clinic post operatively at two weeks, six weeks, three and six months respectively. Four out of the five cases successfully menstruated following surgery. The fifth case waslost to follow up. The first case was able to achieve successful coitus. None of the cases required blood transfusion nor suffered serious complications such as fistula formation. However, in two cases there was premature expulsion of the mould one of which was due to vaginal infection leading to sloughing and secondary skin grafting.Key words: Cryptomenorrhoea, haematocolpos, vaginal septum, vaginoplasty