A case series of masquerade postpartum haemorrhage

Postpartum hemorrhage (PPH) is an obstetric emergency with different causes. Management is directed towards the cause and can be medical or surgical. This is a case series report of four patients who presented to University College Hospital; Ibadan, Nigeria with PPH following emergency caesarean section (EMCS) with three performed for prolonged obstructed labour. All the cases had severe PPH, hemodynamic instability and presented 14 to 84 days post caesarean section. Surgical exploration revealed extension of caesarean incision into the uterine vessel with slipped ligature in two of them and bleeding vessel without ligature in the other two. Two had haemostasis secured with uterine artery ligation, one had repair of uterine incision extension while the 4th had hysterectomy. The length of hospital stay was 5 to 13 days. All recovered fully post-operatively and were discharge home in good clinical condition

CHEMICAL BIO-COMPOUNDS AND FUNCTIONAL PROPERTIES OF RAW AND PROCESSED CUTTLEFISH, SEPIA OFFICINALIS (MOLLUSCA: CEPHALOPODA)

Cuttlefish is one of the most economically important cephalopods with rich taste and few inedible parts. The study was aimed at evaluating the nutrient, non-nutrients, free fatty acid and cholesterol compositions and functional properties of raw and processed Sepia officinalis using standard methods. Moisture and raw protein in raw sample of the cuttlefish were significantly higher (< 0.05) than in processed samples. Raw fat showed significant differences with fried sample having highest value (22.39±0.54 %) to raw (16.24±0.10 %) and boiled samples (4.09±1.42 %). Raw sample contained more ash with highest mg/100g levels of calcium, phosphorus, magnesium, iron and manganese. Processed cuttlefish registered significant reduction in levels of trypsin inhibitor, phytate and oxalate compared to the raw. Raw protein of fried cuttlefish exhibited positive relationships with all the non-nutritionalfactors while total ash only showed positive relationships with phytate ( = 0.998) and trypsin inhibitor ( = 0.999). Cholesterol content of raw cuttlefish was of 0.923±0.02 mg/100g being reducedby boiling (0.711±0.02 mg/100g) and increased by frying (1.037±0.02 mg/100g). A significantly high percentage of oleic was observed in fried cuttlefish (4.47±0.10) while boiled sample had the lowest value (1.4±0.05). The results showed significantly high percentage of water and oil absorbing capacities for raw cuttlefish while foam and emulsion stabilities were higher in the boiled sample. By frying, the highest foam and emulsion capacities of 8.8 and 4.4% respectively were obtained. The study suggests that Sepia officinalis will be highly desirable for preparing comminuted sausage products due to its good functional and nutritional properties

Factors associated with the awareness of vaginal fistula among women of reproductive age: findings from the 2018 Nigerian demographic health cross-sectional survey

Introduction Involuntary leakage of urine and or stool per vaginam (vaginal fistula) after childbirth remains a public health challenge in Africa and South East Asia. To the best of our knowledge, there is no previous national data that examined the awareness of vaginal fistula among women in Nigeria.Aim To determine the prevalence of awareness of urinary/faecal incontinence due to vaginal fistula, and the associated risk factors among women with no previous experience of incontinence.Methods We used a cross-sectional study, the 2018 Nigerian Demographic Health Survey, to analyse awareness of vaginal fistula among women with no previous leakage of urine or stool. The primary outcome was childbirth experience, and other variables were demographics, access to information and reproductive or sexual history. The descriptive, univariate and multivariable models were presented.Results Of 26 585 women interviewed, 50 (0.2%) who had experienced fistula were excluded from the risk factor analysis. The mean age of women with childbirth experience was 32.8±8.6 years, while that of women without childbirth experience was 20.3±6.2 years. The prevalence of vaginal fistula awareness was 52.0%. Factors associated with the awareness include the following: childbirth experience (adjusted OR (AOR)=1.14; 95% CI, 1.01 to 1.30); age of 20–24 years (AOR=1.36; 95% CI, 1.18 to 1.56) and older; currently working (AOR=1.35; 95% CI, 1.22 to 1.49) and ownership of a mobile phone (AOR=1.16; 95% CI, 1.05 to 1.27). Other associated factors include the following: having at least secondary education; wealth quintiles, ethnicity, regional location, religion, access to radio, newspaper and internet; age up to 17 years at first sex; history of previous termination of pregnancy and use of contraception.Conclusion A significant number of young women with no childbirth experience had low level of awareness. We recommend vaginal fistula awareness programmes that will target women at risk of vaginal fistula and the inclusion of other useful questions to improve the quality of information in future surveys

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research