A missed cornual ectopic pregnancy: a case report

Ectopic pregnancies continue to be among the leading causes of maternal mortality globally. Cornual pregnancies are types of ectopic pregnancies that occur in the interstitial part of the fallopian tube and invades the uterine wall. We report a case of cornual ectopic pregnancy at 26 weeks that was missed and only diagnosed at autopsy following rupture and death of the pregnant woman. This case emphasizes the importance of a detailed carefully performed ultrasonography in the first trimester for all pregnant women.

Evaluation of urinalysis parameters and antimicrobial susceptibility of uropathogens among out-patients at University of Cape Coast hospi

Background: Urinary tract infection (UTI) is a major global public health issue. The gold standard for diagnosing UTI is urine culture. This is however labour intensive and time consuming. Many prescribers therefore rely on urinalysis in diagnosing UTI. This study sought to evaluate the performance of some parameters of urinalysis as predictors of urine culture positivity. The common causative agents and their antibiotic susceptibility patterns were also determined. Methods: A cross sectional study was carried out at the University of Cape Coast Hospital from July 2017 – December 2017 among out-patients. The performance characteristics of leukocyte esterase (3+) and nitrite reactions were estimated and compared with urine culture. Antimicrobial susceptibility tests were done using disc diffusion technique described by Kirby-Bauer. Results: Prevalence of UTI in this study was 30.0% (64/213). The most prevalent pathogen was E. coli (20, 31.2%), followed by S. saprophyticus (9, 14.1%). Most of the bacteria (52, 94.5%) were sensitive to amikacin, followed by ciprofloxacin (42, 76.3%). The most sensitive (94.4%) of the parameters was pus cells [>5 white blood cells (WBC) per high power field (HPF)] and the least sensitive was the nitrite test (21.0%). The leukocyte esterase test showed the highest accuracy of 91.1%. Conclusion: The study supports the recommendation of the use of oral ciprofloxacin as the first line treatment of uncomplicated UTI by the Ghana Standard Treatment Guidelines (2017). Funding: No funding was provided for this study. Keywords: urine tract infection, urinalysis, uropathogens, Cape Coas

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways