Laparoscopy in gastro- intestinal tumors

Background: Cancer is a major public health problem worldwide. Many studies have shown that the completion of adjuvant chemotherapy improves the survival rate. Objectives: The aim of the current study was to discuss the efficacy and role of diagnostic and therapeutic laparoscopy as a new trend in managing gastrointestinal tumors. Patients and Methods: This prospective study included a total of 50 patients, whom had gastro-intestinal tumor diagnosed by tissue biopsy and histopathology attending at General Surgery Department, Sayed Galaal Al-Azhar University Hospital. The hospital statistically significant data for the included 50 patients, pre and post diagnostic laparoscopy and surgical intervention were collected and analyzed. Results: A significant percentage of intra-abdominal cancers prove to be inoperable because of metastatic or locally advanced disease despite a preoperative workup suggesting a potentially resectable disease. Conclusion: It could be concluded that diagnostic laparoscopy is accurate staging tool for gastro intestinal tumors as staging method prior to surgery that can change plan to start neoadjuvant chemotherapy (CTR) instead of surgery. Laparoscopic surgery shows also short post- operative patient stay at hospital and early start of CTR

Central corneal thickness and intraocular pressure in type II diabetes

Background: Diabetes is a rapidly-growing global health problem with a significant impact on morbidity and mortality due to diabetes-related complications. Objective: The purpose of this study was to assess the impact of type II diabetes on the central corneal thickness (CCT) and intraocular pressure (IOP). Patients and Methods: This prospective case-control study was performed at the ophthalmic department of Al-Zahraa University Hospital. It was conducted on 30 participants with type II diabetes and 10 healthy control (both eyes were included). Diabetics were categorized into 3 groups, diabetics without retinopathy, with non-proliferative diabetic retinopathy (NPDR) and with proliferative diabetic retinopathy (PDR).Each group contained 10 participants. Complete ophthalmic examination was done for all participants including, visual acuity, slitlamp, fundus examination, measurement of IOP and CCT. Fundus photography and measurement of glycosylated hemoglobin A1c (HbA1c) were done for diabetics. Results: Diabetics with PDR exhibited significantly higher IOP and CCT values compared to other groups. The IOP was significantly correlated with CCT and with the duration of diabetes. Conclusion: Diabetics with PDR had a significantly elevated IOP and thicker corneas than normal subjects. These data emphasize the importance of considering CCT measurements in diabetics for proper interpretation of IOP

Factors associated with acute kidney injury recovery in a tertiary hospital in Ghana: a prospective study

Introduction: acute kidney injury (AKI) is a challenging problem in developing countries due to late presentation of its victims to health care facilities. Data on the pattern of AKI, its outcome and factors associated with its recovery is scanty in developing countries therefore impeding AKI management. Aim: to study AKI recovery rate and its associated factors.Methods: an observational study conducted from September 2013 to June 2014 at Korle-Bu Teaching Hospital (KBTH). Participants were adults, admitted with AKI at KBTH. Kidney Disease: Improving Global Outcomes (KDIGO) criteria was used to diagnose and stage AKI.Results: mean age (SD) of the participants was 41.9 (± 19.2) years. About a third of the patients (34.6%) were less than 29 years with 30-39 years and 40-60 years constituting 23.0% and 23.6% respectively. Females were in the majority (56.0%). AKI stages I, II and III accounted for 11.0%, 6.8% and 70.7% respectively. Majority, 82.2% of the patients recovered their kidney function. Stage III AKI was significantly associated with decreasing odds of recovery [OR = 0.4, 95%CI = 0.4-2.6, p = 0.002]. In addition, normal blood sodium was associated with recovery from AKI [OR, 95%CI = 2.3, (1.1-5.3), p = 0.043]. Almost half (45.5%) presented with fever whereas 32.5% and 22.5% presented with peripheral oedema and pulmonary oedema respectively.Conclusion: the study demonstrated high kidney function recovery following AKI. Dominant clinical features were fever, peripheral and pulmonary oedema. Advanced stage was associated with poor recovery whereas normal serum sodium level improves kidney function recovery

A prospective review of eclampsia at a regional hospital, eastern Ethiopia: incidence, clinical correlates, management and pregnancy outcome

Objective: The aims of the study were to determine the incidence of eclampsia and describe its clinical correlates and pregnancy outcomes.Patients and Methods: A one-year prospective study of 93 cases of eclampsia using a structured questionnaire which included socio-demographic data, clinical presentation, work-up, management and feto-maternal outcomes was done at Karamara Regional Hospital, Eastern Ethiopia.Results: The incidence of eclampsia was 2.7% (93 in 3500 deliveries). Most of the cases were young (45%), nulliparous (70%) women who had not received any antenatal care (63%). Almost two thirds of the women (n=57, 61%) presented with eclampsia in antepartum, whereas 26 cases (28%) occurred in intrapartum, and there were 10 cases (11%) with eclampsia postpartum. Preceding symptoms were reported in 78.5 % of patients with severe hypertension recorded in 66%. The average gestational age at presentation was 32 weeks. Hydralazine was used for emergency control of hypertension in 91% of the cases. Magnesium was administered to 92 (99%) of the patients. Delay greater than 12h from admission to delivery occurred in 45% of the women with eclampsia. Cesarean section (CS) was performed in 14 (17%) and instrumental delivery in 15 (18%). The maternal and perinatal case fatality rates of eclampsia were 34.7% and 11% respectively.Conclusion: The incidence of eclampsia was very high with corresponding high maternal and perinatal deaths. The presentation of patients was late and the work up and management of cases substandard. Hence capacity building of health facilities, implementation of standard guidelines and criteria based auditing are recommended

Comorbidité diabète-obésité aspects épidémiologiques, cliniques, paracliniques et thérapeutiques à l'hôpital national de Niamey et à la polyclinique Magori : à propos d'une étude prospective sur 226 cas colligés allant du 25 janvier au 25 juillet 2018

Introduction : La croissance rapide de la prévalence du diabète sucré et de l'obésité dans les pays en développement et au Niger en particulier, constitue à la fois une réalité et une menace pour la santé comme dans tous les pays subissant la triple transition démographique, épidémiologique et nutritionnelle. Ces deux maladies sont une cause importante de mortalité et de multiples complications. Les enjeux médicaux et financiers font de ces deux maladies un problème majeur de santé publique. Objectif : Contribuer à l'amélioration de la prise en charge des patients vivant avec le diabète et l'obésité. Méthode : Il s'agissait d'une étude prospective transversale qui s'est déroulée en unité de diabétologie située dans le service de médecine interne de l'Hôpital National de Niamey et à la polyclinique Magori du 25 janvier 2018 au 25 juillet 2018. Résultats : L'étude avait concerné 226 patients diabétiques et obèses sur un ensemble de 1007 patients diabétiques consultés soit une fréquence de 22,55%. Le sexe féminin prédominait avec 74,80% pour un sex-ratio (H/F) de 0,33. La moyenne d'âge était de 52,06 ±12,54 ans. Au total 86,30% des patients résidaient en milieu urbain et 57,10% possédaient un niveau socioéconomique jugé moyen. 42,5% avaient une profession dont 33,20% n'avaient pas dépassés le niveau d'étude secondaire. Le diabète de type 2 avait été le plus retrouvé chez 85,80% avec une ancienneté moyenne de 7,35 ± 6,96 ans. Le dosage de l'HbA1c n'a pu être réalisé chez 32,2% de patients et parmi ces patients un déséquilibre du diabète (HBA1c ˂ 7%) a été retrouvé chez 68% de cas. La glycémie moyenne était de 9,08± 4,09 mmol/l avec des extrêmes allant de 1,68 mmol/l à 21,76 mmol/l. 81% des patients avaient une obésité selon l'indice de masse corporel avec une notion de diabète familiale chez 55,8% et une obésité familiale chez 50,9%. Le trouble de comportement alimentaire était le facteur Comorbidité diabete-obesité : Aspects épidémiologiques, cliniques, paracliniques et thérapeutiques déclenchant de l'obésité le plus fréquent chez nos patients soit 55,75%. L'obésité a précède la survenue de diabète chez 80,97% de nos patients. La moyenne de l'IMC était de 29,08±5,42kg/m². L'âge, l'HTA, la ménopause, la sédentarité et les dyslipidémies étaient les principaux facteurs de risque associés à la comorbidité diabète-obésité soit respectivement 52,65%, 52,65%, 44,24%, 26,54% et 18,14% de cas. Les aspects évolutifs ont été marqué par hypoglycémie dans 51,76% de cas, une neuropathie périphérique dans 57,07%, les infections uro-génitale dans 42,92% de cas, les complications métaboliques suivis des complications respiratoires et ostéo-articulaires dans respectivement 42,03%, 31,41% et 26,99%. Près de 80,10% de patients étaient sous mesures hygiéno-diététiques et 51,33% avaient une activité physique jugée régulière. Les antidiabétiques oraux étaient utilisés par 53,1% de nos patients, 42% étaient sous insuline et 46,01% faisaient souvent recours au traitement traditionnel. Une relation significative a été retrouvée entre le type de l'obésité et le sexe (p ˂ 0,0001) ; l'IMC et le sexe (p=0,035) ; le type et la durée d'évolution du diabète (p=0,012) ; le traitement aux ADO et l'âge (p=0,007) ; l'insulinothérapie et l'âge (p=0,001) ; la durée du diabète et ses complications chroniques (p=0,006) ; le type d'obésité et ses complications (p=0,027). Conclusion : L'épidémie de « diabésité » nécessite une véritable prise de conscience sur le plan politique et une prise en charge énergique d'un point de vue médical

Résultats de la cure de hernie inguinale de l'adulte selon 2 techniques : technique de Desarda et technique de Lichtenstein Etude prospective et descriptive sur 121 cas du 1er Septembre 2015 au 31 décembre 2017 dans le service de chirurgie A de l'Hôpital National de Niamey

Introduction : La hernie inguinale est une pathologie très fréquente en chirurgie générale. Au Niger, près d'un malade sur deux opérés en chirurgie l'est pour cette pathologie. Objectif : Analyser les résultats obtenus par la réalisation de la technique de Lichtenstein et celle de Desarda. Patients et méthode : Il s'agissait d'une étude prospective et descriptive sur 28 mois du 01 septembre 2015 au 31 décembre 2017 prenant en compte tous les patients opérés selon les 2 techniques. L'évaluation des résultats c'était basée sur la recherche des facteurs tels que la douleur chronique et ou la récidive pendant les consultations externes. Résultats : la serie comportait 121 patients dont 119 hommes (98,3%) et 2 femmes (1,7%). La technique de Desarda était réalisée chez 81 patients et celle de Lichtenstein chez 40 patients. Chez les patients jeunes (17 ans à 50 ans), la technique de Desarda était la plus utilisée tandis que la technique de Lichtenstein était plus utilisée chez les personnes âgées (sup a 50 ans) et ceux venus avec une récidive (n= 17). L'anesthésie locorégionale était le plus utilisé avec 99,2%. Le type 2 de Nyhus était prédominant avec 38% suivit du type 3b (30,5%). La douleur, le sérome, l'inflammation des bourses et l'hématome avec respectivement 3,4% ; 0,8% ; 4,9% et 0,8% représentaient les complications précoces. A 1 mois post opératoire, la technique de Lichtenstein avait plus entrainé de douleur avec 2 cas contre 1 cas. Le cas de sérome était observé dans le groupe de Lichtenstein. A 3 mois post opératoire, 1 cas de douleur dans le groupe de lichtenstein. Il n'y avait pas de récidive au bout d'un an de recul pour la majorité des patients. Conclusion : Les résultats du traitement de la hernie inguinale avec la technique de Desarda sont assez similaires à ceux rapportés par la technique de Lichtenstein. Cependant il est essentiel de connaitre leurs indications qui sont aujourd'hui claires dans la littérature

The effect of proximal anastomosis on the expansion rate of a dilated ascending aorta in coronary artery bypass surgery: a prospective study

Background: This study was designed to determine the short- and long-term effects of proximal aortic anastomosis, performed during isolated coronary artery bypass grafting (CABG) in patients with dilatation of the ascending aorta who did not require surgical intervention.Methods: The study was performed on 192 (38 female and 160 male patients; mean age, 62.1 ± 9.2 years; range, 42­80 years) patients with dilatation of the ascending aorta who underwent CABG surgery between 1 June 2006 and 31 May 2014. In group 1 (n = 114), the saphenous vein and left internal mammarian artery grafts were used, and proximal anastomosis was performed on the ascending aorta. In group 2 (n = 78), left and right internal mammarian artery grafts were used, and proximal aortic anastomosis was not performed. Pre-operatively and in the first and third years postoperatively, the ascending aortic diameter was measured and recorded using transthoracic echocardiography at four different regions (annulus, sinus of Valsalva, sinotubular junction and tubular aorta).Results: A statistically significant difference was found between the groups for the number of grafts used and the duration of aortic cross-clamping and cardiopulmonary bypass. No significant intergroup difference was seen for the mean diameter of the ascending aorta (p > 0.05). Annual changes in the aortic diameter were found to be extremely significantly different in both groups (p = 0.0001). Mean values of the aortic diameter at the level of the sinotubular junction and tubular ascending aorta, mean aortic diameters (p = 0.002 and p = 0.0001, respectively), annual increase in diameter (p = 0.0001 and p = 0.0001, respectively), and mean annual difference in diameter (p = 0.0001 and p = 0.0001, respectively) at one and three years postoperatively were statistically significantly different between the groups.Conclusion: In patients with ascending aortic dilatation who did not require surgical intervention and who had proximal anastomosis of the ascending aorta and underwent only CABG, we detected statistically significant increases in the diameter of the sinotubular junction and tubular aorta up to three years postoperatively

Allergie et sensibilisation aux criquets comestibles. Etude prospective à propos de 27 cas à l'Hôpital National Lamordé

INTRODUCTION : L'entomophagie est la consommation d'insectes comestibles, qui permet un apport protéique plus important que la viande bovine. Deux espèces d'insectes sont essentiellement consommées au Niger, les criquets Ornithacris Tubida Cavroisi et les éphémères. Le but de cette étude est d'apprécier la sensibilisation et les allergies aux criquets comestibles qui à notre connaissance n'ont pas été explorées à ce jour. Patients et méthode : Etude prospective allant de janvier à juin 2016 portant sur 27 patients présentant une sensibilisation et ou une allergie aux criquets sur une population de 155 patients présentant des manifestations cliniques d'allergie Résultats: La moyenne d'âge est de 25 ans avec un minimum d'âge de 9 ans et un maximum de 60 ans. La tranche d'âge de 21 à 30 ans est la plus fréquente avec 37,03 % contre 18,51% pour les personnes âgées de plus de 40ans. Les femmes sont les plus touchées avec 55,55%. Une notion d'antécédent familial de rhinoconjonctivite a été retrouvée dans 81,49% des cas. 59,26% de nos patients avaient un antécédent personnel de rhino-conjonctivite suivi de l'asthme 29,63%. 29,63% des cas présentaient une allergie après consommation des criquets, 70,37% étaient sensibilisés aux criquets. 7,41% de nos patients présentaient une mono sensibilisation aux criquets. Des co-sensibilisation criquet-crevette (85,19%), criquet-blatte (62,96%), criquet-acarien (48,14%) et criquet-crevette-blatte-acarien (29,62%) ont été retrouvés. Parmi les manifestations cliniques le syndrome oral était le symptôme le plus fréquent (6 patients sur 8), suivi de l'urticaire (4 patients), du vomissement (1 patient), de l'œdème du visage (1 patient) et de la dyspnée (1 patient). Un des patients a présenté une anaphylaxie de grade 3. Conclusion L'entomophage de plus en plus pratiquées dans nos régions présente un risque réel allergique d'autant plus qu'il peut exister des réactions croisées entre les différentes classes d'arthropodes

A Prospective Study on the Impact of Waiting Times for Radiotherapy for Cervical Cancer at Charlotte Maxeke Johannesburg Academic Hospital

Background. Radiotherapy plays a vital role in the management of cervical cancer. However; due to high patient load and limited resources; waiting lists are unacceptably long. This is a highly curable malignancy that often occurs in economically active; relatively young women. Thus; the impact of treatment delays on society is disproportionately large when compared to many other malignancies. Delays also impact negatively on the health care system and places further stress on an already burdened department. This prospective study aimed to evaluate the potential impact of radiotherapy delays Patients and methods. Eighty-one patients requiring radical radiotherapy for cervical cancer were selected. Patients were re-evaluated every four weeks while waiting; and again at simulation.Results. Median delay from first consultation to simulation was 55 days. Longer delays were not statistically correlated to tumour progression. Most of the upstaging occurred around 40 to 65 days. One in four patients received blood transfusions and required hospital admission. Four patients needed haemostatic brachytherapy for bleeding. Conclusion. A relationship between time waited and disease progression could not be proven. However; numbers were small and statistical tests were likely underpowered. The study does; however; highlight unacceptably long delays for radiotherapy and a wait of less than 40 days is recommended

A Prospective Study of Demographic Features and Quality of Life in HIV-Positive Women with Cervical Cancer Treated at Tygerberg Hospital

Background: Cervical cancer and human immunodeficiency virus (HIV) infection/acquired immune deficiency syndrome (AIDS) both have a high incidence in South Africa. Cervical cancer treatment of HIV-positive women poses challenges. Treatment-related changes in quality of life (QOL) of such women are important to future treatment protocols.Aim: To examine demographic data of HIV-negative and HIV-positive women at diagnosis of cervical cancer and describe their changes in QOL as a result of treatment.Methods and materials: All newly diagnosed patients with cervical cancer at Tygerberg Hospital were approached to participate in the study. The European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) and the Cervix Cancer Module (QLQ-CX24) were used. General QOL was measured with the EORTC QLQ-C30 and cervical-specific QOL with the QLQ-CX24 questionnaire. The patients completed the questionnaire at diagnosis; on completion of treatment and at 3 months' follow-up.Results: The study included a total of 221 women of whom 22% were HIV-positive; the latter were younger and of higher educational level than the rest. Mean monthly income and stage distribution was similar between the two groups. HIV-positive patients underwent radiation therapy more commonly than chemoradiation. HIV-positive women showed statistically significantly higher loss to follow-up during the study. HIV-positive women experienced no improvement in insomnia; appetite loss; nausea; vomiting; diarrhoea; social role or any of the sexual domains. In contrast; HIV-negative women experienced statistically significant improvement in all sexual domains other than sexual/vaginal functioning. The QOL improvement of HIV-negative women was statistically significantly greater than their HIV-positive counterparts in the majority of QOL domains. Global health improved in both groups; with HIV-negative women experiencing greater improvement. HIV-positive women experienced an initial decline of peripheral neuropathy (PN) symptoms post treatment with a return to pretreatment values at 3 months' follow-up. The change in PN was statistically significant between the HIV-negative and HIV-positive women.Conclusion: Demographic differences exist between the HIV-negative and HIV-positive groups. The differential outcome in the QOL of HIV-positive and HIV-negative women treated for cervical cancer might be related to persistence of AIDS-related symptoms on completion of cervical cancer treatment

Congenital Heart Disease in the Niger Delta region of Nigeria : a Four-Year Prospective Echocardiographic Analysis : Cardiovascular Topic

Introduction : Echocardiographic evaluation remains the gold standard for the diagnosis of structural cardiac disease. No previous prospective studies have been done on the prevalence of congenital heart disease (CHD) in the Niger Delta area. This study was done to determine the frequency and pattern of congenital heart disease; using echocardiography as a diagnostic tool. Methods : All patients presenting to the Paediatric Cardiology clinics of two centres; the University of Port Harcourt Teaching Hospital and the Paediatric Care Hospital between April 2009 and March 2013; were recruited and all had echocardiography performed.Results : Prevalence of CHD in this study was 14.4 per 1 000 children; 277 (83.4) of the patients had acyanotic CHD and 55 (16.6) had cyanotic CHD. Ventricular septal defect and tetralogy of Fallot were the commonest acyanotic and cyanotic heart defects; respectively.Conclusion : The high prevalence of CHD in this study is the highest in the country and Africa; and may be attributable to the increased oil spillage and gas flaring from petroleum exploitation in this region

Evaluation of clinical and pathological response after two cycles of neoadjuvant chemotherapy on Sudanese patients with locally advanced breast cancer

Background:The use of neoadjuvant chemotherapy in treating breast cancer has shown efficacy in downstaging primary tumors; and allows breast conservative surgery to be performed instead of mastectomy. This study aims to evaluate patterns of clinical and pathological response after two cycles of neoadjuvant chemotherapy in patients with locally advanced breast cancer.Materials and Methods:This is a prospective study. Ninety-eight patients who presented from April 2009 through May 2011 with locally advanced breast cancer and treated with neoadjuvant chemotherapy were included.Results:The clinical response rate was 83 ; 11 patients (11.2) had a complete clinical remission (cCR); 71 had a partial remission (72.4); 13 had stable disease (13.3); and 3 had progressive disease (3.1). Seven patients had complete pathological response. Conclusion:Neoadjuvant chemotherapy can achieve a high objective response rate in patients with locally advanced breast cancer even after two cycles. We recommend further research to find predictors for response

Head injury-a neglected public health problem: a four-month prospective study at Jimma University specialized hospital, Ethiopia

BACKGROUND: Trauma, especially head trauma, is an expanding major public health problem and the leading cause of death of the young and productive part of the world's population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. The intention of this study was to analyze head injury in a setting where most patients in low- and middleincome countries receive treatment, a referral hospital with general but no neurosurgical service like Jimma University Specialized Hospital. The study aims to provide surgeons, hospital managers and health planners working in similar set-ups with baseline information for further investigation and prevention programs intending to reduce the burden of head injury. METHODS: All head injury patients presented to Jimma University Specialized Hospital between March and June 2010 were included in this prospective research. Epidemiological, clinical and management data were collected for the study. RESULTS: Out of 52 patients, 47 were males. The median age was 20.0 years (SD=13.3). Fights (n=20, 38.5%) and road traffic accidents (n=19, 36.5%) were the most common causes of head injury. Half of the patients sustained mild and 36.5% sustained severe head injury. The initial GCS had a significant correlation with the outcome. The mortality rate was 21.2%. Of all patients 76.9% were managed conservatively. CONCLUSION: Prevention of road traffic accidents and improvement of conservative care were identified as major methods to reduce the burden of head injury in a set-up similar to Jimma. Further studies on head injury patients in low-income countries should be done

Breast Cancer Screening in a Resource Poor Setting: A Preliminary Report

Background: Breast cancer is a leading cause of death among Nigerian women. Patients typically present late with advanced and aggressive diseases from a younger age. Cure for breast cancer is only possible when the disease is discovered early and breast cancer screening greatly increases the chances of early detection. We present the results of a breast cancer screening program at the Taimako Breast and Cervical Cancer Screening Centre; Lafia; Nigeria. Methodology: This is a prospective study of subjects who presented to our breast cancer screening centre between May 2009 and April 2010. A community mobilization and awareness campaign was mounted 3 months before screening began. A structured questionnaire was administered on each subject to elicit demographic data and risk factors. Each had a clinical breast examination. Those 35 years and above had a mammography while those below 35 years had breast ultrasound scan. Where a lump was discovered; it was subjected to tissue biopsy and histology. Results: Two thousand and ninety five subjects were seen over the one year period. Mean age was 34 + 12 years. Mean age at menarche was at 14.3 + 1.7 years; mean parity was 3.6 +2.6. Two thousand and thirty six subjects (97.2) had some knowledge about breast cancer; 1;269 (60.5) had no formal education; 881(42.1) were petty traders while 501(23.9) were full time housewives. Four hundred and seventy (22.4) had a positive family history of breast disease; 437 (20.9) had history of use of oral contraceptives; and 9 (0.4) had a previous breast biopsy. Four hundred and sixty one (22.0) complained of breast discomfort; 184 (8.8) complained of breast lumps; but only 95 (4.6) of them had lump on clinical breast examination; while a further 8 (0.4) lumps were found on breast imaging. One thousand nine hundred (90.7) had normal breast screening results; 166 (7.9) had benign breast diseases and 29 (1.4) had breast cancer. Conclusion: Knowledge about breast cancer was high because of prior campaigns and should be encouraged. Proportion of subjects with breast cancer is low even though many complained of breast lumps on presentation. Majority of the lumps were found at clinical breast examination while mammogram had a very low yield. A treatment arm needs to be incorporated into the screening program to demonstrate survival benefit

Pattern of Cervical Dysplasia among Women of Reproductive Age in Zaria; Northern Nigeria

Background : Cervical cancer is a preventable and the most common female genital tract cancer despite the availability of screening services for precancerous lesions of the cervix. This study aims to determine the prevalence of cervical dysplasia in women of reproductive age in Zaria.Methodology: A prospective study of 131 women of child bearing age attending the family planning and Gynaecology clinics in Ahmadu Bello University Teaching Hospital; Zaria - Nigeria were recruited for the study after obtaining their consent. Cervical samples were collected and subjected to pap staining and cytological examination by a pathologist and classified using the Bethesda System. The data were processed using Statistical Package for the Social Sciences (SPSS) version 17. Bivariate analysis was done and the level of significance was set at a P 0.05.Results: Cervical dysplasia prevalence of 7.0 was found out of which High Grade Squamous Intraepithelial Lesion (HSIL) was 2.3 (n

Pattern of Cervical Dysplasia among Women of Reproductive Age in Zaria; Northern Nigeria

Background : Cervical cancer is a preventable and the most common female genital tract cancer despite the availability of screening services for precancerous lesions of the cervix. This study aims to determine the prevalence of cervical dysplasia in women of reproductive age in Zaria. Methodology: A prospective study of 131 women of child bearing age attending the family planning and Gynaecology clinics in Ahmadu Bello University Teaching Hospital; Zaria - Nigeria were recruited for the study after obtaining their consent. Cervical samples were collected and subjected to pap staining and cytological examination by a pathologist and classified using the Bethesda System. The data were processed using Statistical Package for the Social Sciences (SPSS) version 17. Bivariate analysis was done and the level of significance was set at a P 0.05. Results: Cervical dysplasia prevalence of 7.0 was found out of which High Grade Squamous Intraepithelial Lesion (HSIL) was 2.3 (n

Reducing Ventilator-Associated Pneumonia in Neonatal Intensive Care Unit Using "VAP Prevention Bundle"

Background and study aim : Ventilator-associated pneumonia (VAP) is a serious health care- associated infection, resulting in high morbidity and mortality. It also prolongs hospital stay and drives up hospital costs. Measures employed for preventing ventilator-associated pneumonia in developing countries are scarcely reported. The aim of the current work is to assess the efficacy of our designed "VAP prevention bundle" in reducing VAP rates in the neonatal intensive care unit (NICU). Patients and Methods: This prospective before-and-after study was conducted at Zagazig university hospital NICU; all neonates who had mechanical ventilation during the period from January 2013 to March 2014 for ≥48 hours were eligible after parental consent. VAP rates were evaluated before (phase-I) and after (phase-II) full implementation of the comprehensive preventive measures specifically designed by our infection control team. Results: Out of 143 mechanically ventilated neonates, 73 patients developed VAP (51%) throughout the study period (2500 mechanical ventilation days). The rate of VAP was significantly reduced from 67.8% (42/62) corresponding to 36.4 VAP episodes/1000 mechanical ventilation days (MV days) in phase-I to 38.2% (31/81) corresponding to 23 VAP/1000 MV days (RR 0.565, 95% confidence interval 0.408- 0.782, p= 0.0006) after VAP prevention bundle implementation (phase-II). Parallel significant reduction in MV days/case were documented in the post-intervention period (21.50±7.6 days in phase-I versus 10.36 ± 5.2 days in phase-II, p= 0.000). There were trends toward reduction in NICU length of stay (23.9±10.3 versus 22.8±9.6 days, p=0.56) and overall mortality (25% versus 17.3%, p=0.215) between the two phases which didn't reach statistical significance. The commonest micro-organisms isolated throughout the study were gram-negative bacteria (63/66, 95.5%) particularly Klebsilla pneumonia (55/66, 83.4%). Conclusion: The implementation of our multifaceted infection control bundle has resulted in a significant reduction of VAP rates, length of stay and hospital cost in our NICU. These rates are still far behind the internationally acknowledged ones

Predictors of vaginal delivery in nulliparous mothers

Background: Nulliparity is an obstetric high-risk group whose labor, compared with multiparae, are more likely to develop labor abnormalities that requires intervention. The aim of this report is todetermine factors that influence vaginal delivery in nulliparae. Materials and Methods: A prospective cross-sectional study was done on 286 eligible booked nulliparae in labor, to determine factors associated with vaginal delivery. Information about each patient's social demographic factors, and physical characteristics such as height and weight, events in labor and mode of delivery were recorded in the data sheet. Bivariate analysis was done using Chi square, while multivariate analysis was done using logistic regression. Level of significance was put at P < 0.05. Results: Of a total of 944 primigravidae delivered in the unit during the study period, 286 (30.3%) were eligible for the study. Vaginal delivery was achieved in 214 (74.8%) of the eligible parturient, while 72 (25.2%) had emergency caesarean delivery. Indications for the caesarean delivery were: failure to progress (46; 63.9%), fetal distress (20; 27.8%), maternal distress (5; 8.0%), and rapidly developing pre-eclampsia in labor (1, 0.3%). The birth weight of the baby ranged between 2.0 and 4.5 kg with mean weight of 3.1 ± 0.4 kg. Birth weight (odd ratio [OR] = 0.40, 95% confidence interval [CI] = 0.21-0.78), fetal head engagement in early labor (OR = 10.30, 95% CI = 1.35-78.69), and maternal body mass index (BMI) (odd ratio [OR] = 2.08, 95% confidence interval [CI] = 1.03-4.20) were found to be predictors of vaginal delivery. Conclusion: Normal range of maternal BMI, fetal head engagement and normal range of fetal birth weight were found to be the factors associated with vaginal delivery in nulliparae. Variations in these three factors may be the underlying reason for failure to progress, which is the most common indication for caesarean section among this population of parturient

Lack of Association of Glycated Haemoglobin with Blood Pressure and Subclinical Atherosclerosis in Black South Africans: a Five-Year Prospective Study

Objectives: Hypertension and diabetes are common in rapidly urbanising sub-Saharan African communities. However; lack of longitudinal data in these regions prevents adequate analysis of the link between measures of glycaemia and cardiovascular disease. Therefore; we examined the relationships of fasting glucose and glycated haemoglobin (HbA1c) with brachial and central blood pressure (BP); and measures of vascular structure and function after five years in black South Africans.Setting and subjects: Nine hundred and twenty-eight participants were included as part of the Prospective Urban Rural Epidemiological (PURE) study in the North West Province.Outcome measures: Fasting glucose; HbA1c and brachial BP at two time points were determined. Central BP; augmentation index (AI) and carotid intima-media thickness (CIMT) were taken at follow-up. Results: Fasting glucose [4.78 (3.50; 6.30) vs. 5 mmol/l (3.96; 6.42)]; HbA1c [5.6 (4.9; 6.3) vs. 5.9 (5.2; 6.9) and (37 vs. 41 mmol/mol)]; and BP (134/88.1 vs. 138/89.5 mmHg) increased significantly over five years (p-value 0.05). However; an association was absent between BP; AI or CIMT and either baseline or the five-year change in glucose or HbA1c. Multivariate analyses confirmed that neither glucose or HbA1c predicted changes in BP; CIMT or AI; but factors that did associate significantly were age; male gender; rural location; abdominal obesity; alcohol intake; total cholesterol to high-density lipoprotein ratio; C-reactive protein and antihypertensive medication (R2; ranging from 0.24-0.36).Conclusion: Although both BP and measures of glycaemia increased significantly over five years in black South Africans; glucose was not independently associated with BP or measures of large artery structure or function. We suggest that fasting glucose and HbA1c below the threshold of diagnosing diabetes should not be used in isolation to predict cardiovascular risk in African individuals