Intern's experiences with episiotomy and its repair

Background: Episiotomy ­an incision of the perineum at the time of vaginal delivery is a common obstetric procedure. If the repair is inadequately done, it may leave the woman suffering from perineal pain and other long term conditions with serious impact on the woman's health and social wellbeing. The importance of skill in the obstetric procedure of episiotomy and its repair cannot be over emphasized. Objectives: The study aims to determine the interns' training and experience with episiotomy and its repair. Materials and Methods: A questionnaire study of medical interns' who had their houseman ship at the Federal Medical Centre Owerri, over a period of two years between 2003 and 2005. Results were analyzed with the SPSS version 10. Results: 70 (77.7%) of the 90 interns to whom the questionnaire was administered responded correctly. They had an average age of 28.81 ±3.36 years. 44 (62.9%) had a formal demonstration on episiotomy repair done at their medical training institution. 56 (80%) of the interns were comfortable with episiotomy repair while 14 (20%) were not. 10 (45.45%) of the females and 4 (8.33%) of the males were not comfortable with episiotomy repair. 30% of those who got their skill on episiotomy repair at the period of houseman ship were not comfortable with the procedure as opposed to 4.3% of those who had a formal training at their medical training institution. Discussion: A formal demonstration at the medical school of training does not appear to be a constant event in the medical schools as only 62.9% of the interns in this study accepted receiving such. However, despite the above, 80% of these interns' were comfortable with the repairs of episiotomy. Conclusions: It would be preferred if a formal demonstration is given on this procedure while a student is still in training

Impetigo in Children: a Clinical Guide and Treatment Options

Impetigo is a contagious; superficial bacterial infection of the skin; most frequently encountered in children. Causative organisms are almost always Staphylococcus aureus or streptococci; or a combination of the two. Predisposing factors are nasal and perineal colonisation; overcrowding; poor personal hygiene; minor skin trauma and preexisting skin diseases with disrupted skin barrier function; like eczema. Infection is mainly acquired through contact with sufferers or nasal carriers. Treatment should be given to avoid spread of the disease; and to minimise the risk of infecting others. Although the majority of cases of impetigo are self-limiting; under certain circumstances complications like toxic shock syndrome; staphylococcal osteomyelitis; septic arthritis and pneumonia can occur. Furthermore; certain strains of group A ?-haemolytic streptococci causing impetigo may result in poststreptococcal glomerulonephritis; just like streptococcal throat infections can result in rheumatic fever in children; but the pathogenesis remains poorly understood. It appears to be due to abnormal immune response or hypersensitivity to streptococcal antigens

La gangrene perineo-scrotale : etiologies et therapeutiques : a propos de 60 cas

Objective To assess the epidemiological and diagnostic aspects; treatment and early and late outcomes of perineo-scrotal gangrene. Patients et Methods We report on 60 cases collected over a period of 14 years. The patients' mean age was 40 years. All patients were males. Twenty of them had diabetes. An aetiology was found in 47 cases. It was a urologic aetiology in 27 cases and a proctologic aetiology in 20 cases. 13 cases were considered as primitive and classified as Fournier's Gangrene. All patients were admitted to the emergency unit and underwent a large debridement with urinary diversion. A colostomy was done in 25 cases. A hyperbaric oxygenotherapy was administered in 30 cases. Results Ten patients died after a week due to a delayed diagnosis. 39 patients were cured primarily without sequelae and 11 others after reconstructive surgery using a cutaneous graft in 10 cases and a musculo-cutaneous graft in one case. Conclusion 20of cases of perineo-scrotal gangrene are idiopathic. Given the high mortality and morbidity; an early treatment associating intensive care; triple antibiotherapie; large debridement and; if possible; hyperbaric oxygenotherapy is necessary