An audit of uterovaginal prolapse in Ogbomoso, south-west Nigeria

Objective: Uterovaginal prolapse (UVP) as a gynaecological problem is very common especially in multipara. This condition is important to gynaecologists practicing in Sub-Saharan Africa because of its strong link with multiparity, poor conduct of labour, and most importantly, its role as a cause of chronic morbidity in many post-menopausal women necessitating major gynaecological surgeries.Methods: A retrospective study of utero-vaginal prolapse to determine the prevalence, presentation , management patterns and complications of UVP at the Bowen University Teaching Hospital , Ogbomosho, Oyo State, Nigeria between January 1, 2010 and December 31, 2014. Relevant data were obtained from the case notes, which included age, parity, presenting symptoms, number of living children, types of delivery, types of surgical management and associated operative morbidity and mortality. The data were presented as simple percentages.Results: The prevalence of uterovaginal prolapse was 5.4%. The mean age at presentation was 51.4± 3.3 years. The mean parity was 4.2± 1.6. Fifty-six (90.3%) of them were at least 40 years old . Majority of the patients( 80.6%) were grand-multiparous. The commonest symptom was 'something coming down the vagina' in 96% of the study subjects. Difficult labour was found to be the most common associated factor in 47 (76.2%) of the patients Second degree prolapse was the commonest type of presentation (74.2%). The most common form of treatment offered was vaginal hysterectomy with pelvic floor repair, 46 (74.2%) of the patients. Twenty -four (38.7%) patients had vaginal pessaries inserted for various degrees of UVP.Conclusion: Uterovaginal prolapse is a common gynaecological condition of the parous and elderly postmenopausal women associated with a decreased body image and quality of life. Supervised hospital deliveries and limiting the family size by efficient contraception deserve priority attention to prevent this social malady.Keywords: Difficult labour, uterovaginal prolapse, hysterectomy, multiparit

Study of the fire performance of hybrid steel-timber connections with full-scale tests and finite element modelling

Connection design is critical in timber buildings since the connections tend to have lower strength than the structural members themselves and they tend to fail in a brittle manner. The effect of connection geometry on the fire performance of a hybrid steel-timber shear connection is investigated by full-scale testing. These tests were conducted by exposing the test specimens to the standard time-temperature curve defined by CAN/ULC-S101 (CAN/ULC-S101, 2007)

E7(7) formulation of N=2 backgrounds

In this paper we reformulate N=2 supergravity backgrounds arising in type II string theory in terms of quantities transforming under the U-duality group E7(7). In particular we combine the Ramond--Ramond scalar degrees of freedom together with the O(6,6) pure spinors which govern the Neveu-Schwarz sector by considering an extended version of generalised geometry. We give E7(7)-invariant expressions for the Kahler and hyperkahler potentials describing the moduli space of vector and hypermultiplets, demonstrating that both correspond to standard E7(7) coset spaces. We also find E7(7) expressions for the Killing prepotentials defining the scalar potential, and discuss the equations governing N=1 vacua in this formalism.Comment: 40 pages, final version to appear in JHE

State of the climate in 2013

In 2013, the vast majority of the monitored climate variables reported here maintained trends established in recent decades. ENSO was in a neutral state during the entire year, remaining mostly on the cool side of neutral with modest impacts on regional weather patterns around the world. This follows several years dominated by the effects of either La Niña or El Niño events. According to several independent analyses, 2013 was again among the 10 warmest years on record at the global scale, both at the Earths surface and through the troposphere. Some regions in the Southern Hemisphere had record or near-record high temperatures for the year. Australia observed its hottest year on record, while Argentina and New Zealand reported their second and third hottest years, respectively. In Antarctica, Amundsen-Scott South Pole Station reported its highest annual temperature since records began in 1957. At the opposite pole, the Arctic observed its seventh warmest year since records began in the early 20th century. At 20-m depth, record high temperatures were measured at some permafrost stations on the North Slope of Alaska and in the Brooks Range. In the Northern Hemisphere extratropics, anomalous meridional atmospheric circulation occurred throughout much of the year, leading to marked regional extremes of both temperature and precipitation. Cold temperature anomalies during winter across Eurasia were followed by warm spring temperature anomalies, which were linked to a new record low Eurasian snow cover extent in May. Minimum sea ice extent in the Arctic was the sixth lowest since satellite observations began in 1979. Including 2013, all seven lowest extents on record have occurred in the past seven years. Antarctica, on the other hand, had above-average sea ice extent throughout 2013, with 116 days of new daily high extent records, including a new daily maximum sea ice area of 19.57 million km2 reached on 1 October. ENSO-neutral conditions in the eastern central Pacific Ocean and a negative Pacific decadal oscillation pattern in the North Pacific had the largest impacts on the global sea surface temperature in 2013. The North Pacific reached a historic high temperature in 2013 and on balance the globally-averaged sea surface temperature was among the 10 highest on record. Overall, the salt content in nearsurface ocean waters increased while in intermediate waters it decreased. Global mean sea level continued to rise during 2013, on pace with a trend of 3.2 mm yr-1 over the past two decades. A portion of this trend (0.5 mm yr-1) has been attributed to natural variability associated with the Pacific decadal oscillation as well as to ongoing contributions from the melting of glaciers and ice sheets and ocean warming. Global tropical cyclone frequency during 2013 was slightly above average with a total of 94 storms, although the North Atlantic Basin had its quietest hurricane season since 1994. In the Western North Pacific Basin, Super Typhoon Haiyan, the deadliest tropical cyclone of 2013, had 1-minute sustained winds estimated to be 170 kt (87.5 m s-1) on 7 November, the highest wind speed ever assigned to a tropical cyclone. High storm surge was also associated with Haiyan as it made landfall over the central Philippines, an area where sea level is currently at historic highs, increasing by 200 mm since 1970. In the atmosphere, carbon dioxide, methane, and nitrous oxide all continued to increase in 2013. As in previous years, each of these major greenhouse gases once again reached historic high concentrations. In the Arctic, carbon dioxide and methane increased at the same rate as the global increase. These increases are likely due to export from lower latitudes rather than a consequence of increases in Arctic sources, such as thawing permafrost. At Mauna Loa, Hawaii, for the first time since measurements began in 1958, the daily average mixing ratio of carbon dioxide exceeded 400 ppm on 9 May. The state of these variables, along with dozens of others, and the 2013 climate conditions of regions around the world are discussed in further detail in this 24th edition of the State of the Climate series. © 2014, American Meteorological Society. All rights reserved

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Water ingestion affects orthostatic challenge-induced blood pressure and heart rate responses in young healthy subjects: gender implications

Evidence exists that women have lower orthostatic tolerance than men during quiescent standing. Water ingestion has been demonstrated to improve orthostatic tolerance in patients with severe autonomic dysfunction. We therefore sought to test the hypothesis that water ingestion would improve orthostatic tolerance in healthy young women more than in aged-matched men. Thirty seven (22 men and 15 women) healthy subjects aged 22.5± 1.7 and 21.5±1.4 (means±SD) respectively, ingested 50ml (control) and 500ml of water 40min before orthostatic challenge on two separate days of appointment in a randomized controlled, cross-over design. Seated and standing blood pressure and heart rate were determined. Orthostatic tolerance was assessed as the time to presyncope during standing. Ingesting 500ml of water significantly improves orthostatic tolerance by 22% (32.0 ± 5.2 vs 26.2 ± 2.4min; p< 0.05) in men and by 33% (24.2±2.8 vs 18.3 ± 3.2; p< 0.05) in women. Thirty minutes after ingesting 500ml of water, seated systolic blood pressure, diastolic blood pressure, pulse pressure and mean arterial pressure rose significantly in men while only systolic blood pressure and pulse pressure rose significantly in women. However ingesting 500ml of water did not have significant effect on seated heart rate in both men and women. Ingestion of 500ml of water significantly attenuated both the orthostatic challenge-induced increased heart rate and decreased pulse pressure responses especially in women. Diastolic blood pressure tended to be positively correlated with orthostatic tolerance strongly in men than in women. Pulse pressure correlated positively while heart rate correlated negatively to orthostatic tolerance in women but not in men independent of other correlates. Water ingestion is associated with orthostatic tolerance strongly in women but weakly in men independent of other correlates. In conclusion, the findings in the present study demonstrated that water ingestion caused improvement strongly in young women than in young men. This improvement is associated with increased pulse pressure and decreased tachycardiac responses during orthostatic challenge

Principles of geology

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