Prevalence of preoperative anxiety and its contributing factors in adult patients undergoing elective orthopaedic surgery at an academic hospital in South Africa: a pilot study

Preoperative anxiety potentially results in perioperative anaesthetic complications. This study aimed to determine the prevalence of preoperative anxiety in adult patients scheduled to undergo elective orthopaedic surgery at an academic hospital in South Africa and identify contributory factors. Methods: This cross-sectional study included all patients scheduled for elective orthopaedic surgery the following day from 25 July to 3 November 2021. An adapted version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used. Four questions determined the patients' anxiety and two questions their desire for more information about their forthcoming anaesthesia and surgery. A 5-point Likert scale was used to capture the patients' responses to the APAIS questions. Data on other possible contributory factors to preoperative anxiety were collected using a questionnaire. Results: Of the 88 patients, 82 (93.2%) were included in the study. A total of 40 (48.8%) patients had an APAIS score of ≥ 11, indicating anxiety. A high need-for-information score (≥ 8) was found in 31 (37.8%) patients. A significant association between patients with a higher anxiety score and a higher need-for-information score (p = 0.0063) was identified. Other non-significant factors associated with a higher anxiety score included a lower level of education and no postoperative home support. Conclusion: Patients with a high need for information tended to be more anxious on the day before surgery. The APAIS could be introduced in preoperative ward admissions to identify these patients and provide an appropriate level of counselling about their planned procedure. Counselling might reduce their preoperative anxiety, but further research needs to confirm this assertion. Larger studies are recommended to determine the influence of other factors contributing to preoperative anxiety

Troubleshooting obstetric spinal anaesthesia at district hospital level

Obstetric spinal anaesthesia is routinely used in South African district hospitals for caesarean sections, providing better maternal and neonatal outcomes than general anaesthesia in appropriate patients. However, practitioners providing anaesthesia in this context are usually generalists who practise anaesthesia infrequently and may be unfamiliar with dealing with complications of spinal anaesthesia or with conversion from spinal to general anaesthesia. This is compounded by challenges with infrastructure, shortages of equipment and sundries and a lack of context-sensitive guidelines and support from specialised anaesthetic services for district hospitals. This continuous professional development (CPD) article aims to provide guidance with respect to several key areas related to obstetric spinal anaesthesia, and to address common concerns and queries. We stress that good clinical practice is essential to avoid predictable, common complications, and hence a thorough preoperative preparation is essential. We further discuss clinical indications for preoperative blood testing, spinal needle choice, the use of isobaric bupivacaine, spinal hypotension, failed or partial spinal block and pain during the caesarean section. Where possible, relevant local and international guidelines are referenced for further reading and guidance, and a link to a presentation of this topic is provided.Keywords: anaesthesia; resource-limited settings; emergency surgery; obstetric spinal anaesthesia; anaesthetic complications; caesarean section.

Intention to Use Maternal Waiting Homes and Related Factors among Pregnant Women in Metu Woreda, Western Ethiopia

BACKGROUND: Maternity Waiting Homes are houses built in the healthcare settings that lodge pregnant women in their term state of pregnancy to prevent labor and delivery-related complication. This study aimed to estimate the extent of pregnant women's intention to use Maternal Waiting Homes and identify its associated factors in Metu Woreda, Western Ethiopia. METHODS: A community-based cross-sectional study was conducted from March 1-30, 2018. We used a systematic sampling method to select the study participants and Binary logistic regression analysis was used to identify factors associated with the intention of the women to use Maternal Waiting Homes. RESULTS: A total of (97%) of respondents' questionnaires were found complete and analyzed for this study. Almost half (48.8%) of the pregnant women who participated in the study were planned to use Maternal Waiting Homes in their prospective delivery. Based on multivariate logistic regression analysis; being illiterate and/or less educated in their educational status, having a history of using Maternal Waiting homes, and receiving a number of times antenatal care services were found statistically significantly associated with intention of the women to use Maternal Waiting Homes. CONCLUSION: It is trivial that more than half of the pregnant women who participated in the study were unintended to use Maternal Waiting Homes. Educational status, a number of times attending antenatal care services and experience of using Maternal Waiting Homes were found statistically significantly associated with women's intention to use Maternal Waiting Homes

Ureteroscopy Outcome and Its Determinants in a Resource-Limited Setting

Ureteroscopy is a major diagnostic and therapeutic technique for lesions of the ureter and intrarenal collecting system. METHODS: A retrospective chart review was done at St. Paul's Hospital Millennium Medical College, Ethiopia to determine the outcome of ureteroscopy and factors affecting it. The study period was from January 2018 to April 2018. Multivariate analysis was done to determine factors affecting stone clearance and success rate. RESULT: One hundred six patients who underwent semirigid ureteroscopy were included in the study. The male-to-female ratio was 1.8:1. The mean age of the patients was 36.4 years (±12.6). Ninety-six (90.6%) patients were found to have ureteric stones, while 9(8.5%) patients had a ureteric stricture. Ureteroscopy therapeutic interventions for stones were successful in 89 (92.7%) patients. The mean procedure time and postoperative hospital stay were 44 minutes (±23.7) and 2.5 days (±2.5) respectively. Intraoperative complications (ureteric avulsion, hemorrhage, and ureteral perforations) occurred in 6(5.7%) patients. The stone clearance rate was 54.7% (52). The site of obstruction was passed in 93 patients making the success rate of the procedure 87.7%. The absence of intraoperative complications was significantly associated with success rate. Patients with intraoperative complications have low success rate (20%) compared to patients without complications (92.3%), p=0.42. CONCLUSION: Semirigid ureteroscopy had a good success rate, especially for stones in the distal ureter and if there is no flexible ureteroscope, it is an acceptable alternative

Evaluation of complications of extracapsular cataract extraction performed by trainees

Background: Cataract extraction is the most common intraocular surgery taught to residents. Aim: This study aims to review the complications of trainee-performed extracapsular cataract extraction (ECCE) so as to identify the steps in which the trainee can benefit from closer supervision and practice. Subjects and Methods: This was a descriptive retrospective study of complications in the initial 150 ECCE with intraocular lens implant performed by two Ophthalmologists; from the University of Nigeria Teaching Hospital; Enugu; who visited a high volume training center. Both the intraoperative and early post-operative complications were studied. Data entry and analysis were performed descriptively using the Statiscal Package for the Social Sciences; SPSS version 15.0 (Chicago; IL; USA). Results: The age range of the patients was 40-95 years. The intraoperative complications included capsular flaps 12/161 (7.5); posterior capsule rent; 10/161 (6.2) and vitreous loss; 8/161 (5.0). Corneal complications (striate keratopathy; superior corneal edema; generalized corneal edema and corneal folds) ranked highest in post-operative complications accounting for 34 (56/164). Conclusions: Performance of adequate and proper anterior capsulotomy; minimal handling of the cornea and avoidance of posterior capsular rent are some of the challenges of the trainee in mastering ECCE. Stepwise supervised training can help a trainee master these steps while keeping the complications at acceptably low levels

Surgical-Site Infection Following Cesarean Section in Kano; Nigeria

Objectives: To determine the prevalence, risk factors and common bacterial pathogens for surgical site infection (SSI), following cesarean section (CS). Materials and Methods: A retrospective case-control study of patients delivered by CS in Aminu Kano Teaching Hospital, Kano, Nigeria. The cases were the patients whose CS was complicated by SSI; they were matched by other patients delivered by CS who had had no SSI as controls. Hospital records of cases and controls were compared.Results: Four hundred and eighty five hospital records were available for review, 44 (9.1%) had SSI. Statistically significant determinants of infection are: Long duration of labor before CS (P<0.001), Long operation time (P=0.009), heavy intraoperative blood loss and blood transfusion (P<0.001). Eleven (25%) of the cases had CS due to obstructed labor compared to 15.3% of controls. Staphylococcus aureus was isolated in 31.8% of the cases. Cephalosporins and quinolones were the most sensitive antibiotics.Conclusion: The incidence of SSI following CS in our unit was 9.1%. Most cases followed prolonged obstructed labor, with long operation time and heavy blood loss. Staphylococcus aureus sensitive to cephalosporins was the most frequently isolated pathogen. Strategies for preventing prolonged obstructed labor and appropriate antibiotic prophylaxis may prove effective

Complications chirurgicales des avortements clandestins: à propos de 51 cas observés dans deux hôpitaux de Yaoundé

Le but de cette étude était de décrire les complications des avortements provoqués dans la clandestinité et imposant un traitement chirurgical. Il s'agit d'une étude rétrospective transversale portant sur les malades opérés dans les services de Chirurgie de l'Hôpital central et du Centre Hospitalier Universitaire de Yaoundé du 1er Janvier 2004 au 31 Décembre 2008. Les variables d'étude étaient l'âge, le statut matrimonial, les antécédents gynécologiques, les antécédents d'avortement antérieur, le mode, l'indication chirurgicale et l'état général des patientes; les lésions découvertes en peropératoire, leur traitement et l'évolution postopératoire. Cinquante une patientes ont été retenues pour cette étude menée pendant une durée de quatre ans, soit une moyenne de 12,7 cas par an. L'âge des patientes variait entre 15 ans et 41 ans avec une moyenne de 30 ans; 33 patientes (64,7%) avaient un âge situé entre 15ans et 25 ans. 6 patientes (11,7%) étaient multipares et 4 patientes étaient primipares (7,8%). Treize patientes (25,42%) avaient déjà subi une interruption volontaire de grossesse sans complication. Quarante-neuf patientes (96%) étaient arrivées avec un tableau de péritonite ; 43 patientes (84,22%) étaient classées ASA III (American Association of Anesthesiologists). Les lésions chirurgicales étaient à type de perforations ou de déchirures utérines dans 20 cas (39,21%), annexielles dans 9cas (17,64%), digestives dans 16 cas (31,37%) et urinaires dans 4 cas. Le traitement a associé au traitement de la péritonite, les sutures utérines, digestives et vésicales ; les gestes d'exérèse comprenaient deux hystérectomies et cinq salpingectomies. Il a été réalisé des gestes de dérivation dont deux cystostomies et deux colostomies. La mortalité était de 15,6%. L'étude recommande une éducation des femmes en matière de contraception et de planning familial, et surtout une politique sociale permettant de réduire le nombre des avortements clandestins