Uterine rupture; An obstetric tragedy still with us. A six year review of cases in a specialist hospital, NorthWest Nigeria

Uterine rupture is a major cause of perinatal and maternal morbidity and mortality, it usually has a devastating outcome if not promptly attended to. The study determined the trends, risk factors, feto-maternal outcomes following uterine rupture as seen at ASYBSH. Method: The study was a retrospective review of cases of uterine rupture managed at the ASYBSH between March 2015 and February 2021. Records of the theatre and labour wards were searched and the folders of patients with uterine rupture were retrieved. Relevant information such as socio-demographic variables, booking status, clinical presentations were retrieved and entered into a structured profoma. Results: Deliveries in the hospital during the period were eleven thousand four hundred and twenty (11,420), out of which one hundred and fifty-six (156) were complicated by uterine rupture giving an overall incidence of 1.36 percent or one in every seventy-four (74) deliveries. Uterine rupture occurred mainly among women of low socio-economic status and high parity. The major predisposing factors were injudicious use of oxytocin (62.8%) prolonged obstructed labour (19.8%), previous caesarean section scar (8.5%), use of misoprostol (5.3%), fundal pressure (2.4%) and unexplained factors (1.2%) Conclusion: Uterine rupture remains a devastating obstetric calamity with a high incidence. Injudicious use of oxytocin, prolonged obstructed labour and previous caesarean section scar were the three leading predisposing factors identified in this study

Prevalence of Methicillin-resistant Staphylococcus aureus in the Surgical Wards of the Port-of-Spain General Hospital, Trinidad and Tobago / Prevalencia del estafilococo dorado resistente a la meticilina en las salas quirúrgicas del Hospital General de Puerto España, Trinidad y Tobago

ABSTRACT Objective: Methicillin-resistant Staphylococcus aureus (MRSA) is associated with soft tissue infections in surgical patients. In severe cases, it may result in pneumonia, septicaemia and osteomyelitis. Limited data are available with regard to its prevalence and associations in the Caribbean. This study aimed to assess the prevalence of MRSA in patients hospitalized in the surgical wards of the Port-of-Spain General Hospital (POSGH), Trinidad and Tobago, and determine associated risk factors. Methods: Over the period of April 1 to August 1, 2013, all patients from the surgical wards of the POSGH who had had wound swabs taken were identified. Demographic data included duration of hospital stay, surgical and medical history, antibiotic use and type of wound swab. Microbiological reports were then retrieved and analyses done. Results: A total of 153 patients had wound swabs taken. There were 38 patients (24%) infected with Staphylococcus aureus, with 15 (39.5%) growing MRSA. Increased susceptibility to MRSA was associated with age, gender, ethnicity, duration of hospital stay, co-morbidities, previous antibiotic use, previous surgery and the type of wound (p < 0.05). Conclusion: The prevalence of MRSA in the surgical wards of the POSGH was 39.5% of Staphylococcus aureus isolates. Risk factors included the age range of 60-69 years, patients with co-morbidities, hospital stays of longer than one week, previous surgery and prior use of antibiotics. We recommend more awareness of this problem in the practice of Caribbean medicine to improve infection rates.

RESUMEN Objetivo: El estafilococo dorado resistente a la meticilina (EDRM) se asocia con infecciones de tejidos blandos en pacientes quirúrgicos. En casos severos, puede dar lugar a pulmonía, septicemia y osteomielitis. Los datos disponibles con respecto a su prevalencia y asociaciones en el Caribe son limitados. Este estudio persigue evaluar la prevalencia de EDRM en pacientes hospitalizados en las salas quirúrgicas del Hospital General de Puerto de España (POSGH, siglas en inglés) en Trinidad y Tobago, y determinar los factores de riesgo asociados. Métodos: Durante el período del 1 de abril al 1 de agosto de 2013, fueron identificados todos los pacientes de las salas quirúrgicas del Hospital POSGH a quienes se les había practicado frotis de las heridas. Los datos demográficos incluyeron la duración de la estadía hospitalaria, las historias clínicas y quirúrgicas, el uso de antibióticos, y el tipo de frotis de la herida. Luego se obtuvieron los informes microbiológicos y se realizaron los análisis. Resultados: A un total de 153 pacientes se le tomaron frotis de heridas. Hubo 38 pacientes (24%) infectados con estafilococos dorados, de los cuales 15 (3.5%) presentaban EDRM creciente. El aumento de la susceptibilidad a EDRM se asoció con la edad, el género, la etnicidad, la duración de la estadía hospitalaria, las co-morbilidades, el uso previo de antibióticos, las cirugías previas, y el tipo de herida (p < 0.05). Conclusión: La prevalencia de EDRM en las salas quirúrgicas del Hospital POSGH fue 39.5% de aislados de estafilococos dorados. Los factores de riesgo incluyeron un rango de edad de 60-69 años, pacientes con co-morbilidades, estancia hospitalaria de más de una semana, cirugía previa, y uso previo de antibióticos. Recomendamos tomar más conciencia de este problema en la práctica médica en el Caribe a fin de mejorar las tasas de infección.

First line management of adult diabetic ketoacidosis patients

BackgroundiDiabetic Ketoacidosis [DKA] is a hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. It is a medical emergency with a significant morbidity and mortality. It is however a potentially reversible condition in case an emergency and immediate medical attention, prompt recognition, diagnosis and treatment were provided

Aim of the Study: was to leverage the current research data in order to construct a treatment guideline for diabetic ketoacidosis in the emergency department

Methods:A literature search was carried out on MEDLINE [including MEDLINE in-process], CINAHL,Embase and the Cochrane Library. Databases using [diabetic ketoacidosis] as a MeSH heading and as textword. High yield journals were also hand searched

Findings: The initial treatment phase aims to restore circulating volume, reduce blood glucose levels, to correct any electrolyte imbalances and to reduce ketone levels which in turn corrects the acidosis. Evidence also showed that there is no need for insulin bolus prior to starting an insulin drip in the treatment of diabetic ketoacidosis. Also, using beta-hydroxybutyrate at presentation can expedite diagnosis and therefore treatment. Implementing treatment guidelines into the emergency department may help expedite diagnosis and treatment

Conclusion: Prompt first line management of DKA is the most critical stage to profoundly reduce morbidity and mortality rates of this potentially fatal crisis. It's therefore crucial to follow the evidence-based guidelines and DKA protocol in the emergency department to expedite diagnosis, guide treatment, and improve continuity of care between the emergency department and the ICU as well as improving the clinical outcomes of patients with DKA. Initially, this will improve outcomes by decreasing the delay until treatment is initiated andprovide a continuum of treatment between the emergency department and the intensive care unit

Furthermore, the healthcare providersmust ensure that they have the ability to provide support and education to people at risk of developing DKA and those that have had an episode of DKA by spreading awareness and education to help reduce both the initial occurrence and recurrence of this often preventable life-threatening condition

In-hospital outcome of patients with cardiogenic shock complicating acute myocardial infarction: results from Royal hospital percutaneous coronary intervention registry, Oman

Objectives: Cardiogenic shock [CS] is still the leading cause of in-hospital mortality in patients presenting with acute myocardial infarction [AMI]. The aim of this study was to determine the in-hospital mortality and clinical outcome in AMI patients presenting with CS in a tertiary hospital in Oman

Methods: This retrospective observational study included patients admitted to the cardiology department between January 2013 and December 2014. A purposive sampling technique was used, and 63 AMI patients with CS admitted to [36.5%] or transferred from a regional hospital [63.5%] were selected for the study

Results: Of 63 patients, 73% [n = 46] were Omani and 27% [n = 17] were expatriates: 79% were male and 21% were female. The mean age of patients was 60 +/- 12 years. The highest incidence of CS [30%] was observed in the 51-60 year age group. Diabetes mellitus [43%] and hypertension [40%] were the predominant risk factors. Ninety-two percent of patients had ST-elevation MI, 58.7% patients were thrombolysed, and 8% had non-ST-elevation MI. Three-quarters [75%] of CS patients had severe left ventricular systolic dysfunction [defined as ejection fraction <30%]. Coronary angiogram showed single vessel disease in 17%, double vessel disease in 40%, and triple vessel disease in 32% and left main disease in 11%. The majority of the patients [93.6%] underwent percutaneous coronary intervention [PCI], among them 23 [36.5%] underwent primary PCI. In-hospital mortality was 52.4% in this study

Conclusions: CS in AMI patients presenting to a tertiary hospital in Oman have high in-hospital mortality despite the majority undergoing PCI. Even though the in-hospital mortality is comparable to other studies and registries, there is an urgent need to determine the causes and find any remedies to provide better care for such patients, specifically concentrating on the early transfer of patients from regional hospitals for early PCI

In vivo and in vitro efficacy of Nigella sativa aqueous extract on blastocystis hominis

Metronidazole [MTZ] was the most widely accepted treatment for Blastocystis hominis [B. hominis] with high treatment failure rate, resistance and potential mutagenic and carcinogenic effects so there is urgent need to find out new, effective and safe treatment against B. hominis. The present research aimed to evaluate the therapeutic effect of the aqueous extract of Nigella sativa [NS] at different doses on B. hominis in vitro and in vivo in comparison to MTZ as a control drug. Isolates of B. hominis were obtained from patients complaining of diarrhea and abdominal pain. Isolates were cultured in egg diphasic medium [LE] for in vitro study and to adjust proper inoculating dose for in vivo study. The aqueous extract of NS at concentrations of 100 and 500?g/ml showed a potent lethal effect on B. hominis isolates in vitro. Caecal tissue of experimentally infected and treated mice with two different doses of NS [250 and 500mg/kg/d] were examined histopathologically and compared with that of mice infected and treated by two doses of MTZ [62 and 125 mg/kg/d] as control drug and Infected untreated mice as negative control group. Histopathological examination of infected untreated group showed all pathological degrees in the caecal tissue while infected treated one showed remission of pathological changes especially with higher dose [500mg/kg]. Present study proved that N. sativa had inhibitory effect on B. hominis in vitro and prevented cytopathic effect in infected mice inoculated orally with B. hominis

Otorhinolaryngology trainees and the alternatives to surgical tracheostomy: a survey study

Objectives: Alternatives to surgical tracheostomy [AST] including submental [SMENI], submandibular [SMAN] and retromolar intubation [RMI] are fairly new and innovative airway procedures intended to avoid the complications of traditional surgical tracheostomy [ST]. The study aimed to document the responses of junior Otorhinolaryngologists, regarding the awareness and training of AST as well as dealing with its complications when performed by other specialty. According to our knowledge there is no similar survey in the English literature

Methods: Otorhinolaryngology residents/registrars in Ryad, Jeddah and Taif were surveyed between March 2013 and June 2014, enrolled and non-enrolled in Otorhinolaryngology-Head and Neck Surgery [ORL-HNS] training programs doctors were included, Consultants and Senior Consultants were excluded. it is a qualitative and cross sectional study. Senior consultants were excluded from this qualitative and cross-sectional survey

Results: A total of 59 participants responded to the questionnaire. Fifty-six [94.9%] were not familiar with AST, 52 [88.13%] supported the concept of AST, and 57 [96.6%] agreed the inclusion of AST in the ORL training programs. Thirty [50.8%] thought that AST will have a negative effects on ORL training, 47 [79.7%] would participate in any AST procedure, while 27 [45.8%] agreed to deal with AST complication if the procedure done by other specialty

Conclusion: The majority of the surveyed ORL residents and registrars were not familiar with AST, nevertheless, agreed to undergo further training and to included it in the training programs. However, reserved dealing with related complications once done by other specialty we recommend that the supervising training body training body consider including AST in the curriculum

Chemotherapy-induced febrile neutropenia in patients with breast cancer. A multivariate risk assessment model for first cycle chemotherapy

To identify factors that increase the risk of developing febrile neutropenia [FN] during the first cycle of chemotherapy in breast cancer patients. In this retrospective study, we reviewed the records of 211 patients with confirmed breast cancer treated with chemotherapy at the Princess Norah Oncology Center, King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia between January 2010 and May 2012. Statistical analysis was conducted using descriptive analysis, univariate, and multivariate logistic regressions. A multivariate regression of FN occurrence in the first cycle was developed. The median age of patients was 48 years. Febrile neutropenia was documented in 43 [20.3%] of 211 patients. Twenty-one [49%] of the 43 patients had FN during the first cycle of chemotherapy. A multivariate logistic regression revealed that age [odds ratio [OR] 1.059, 95% confidence interval [CI]: 1.007-1.114], non-anthracycline and/or taxane-based chemotherapy regimens [OR of 39.488; 95% CI: 4.995-312.187], and neo-adjuvant chemotherapy [OR of 8.282; 95% CI: 1.667-41.152] were the most important independent risk factors of FN. Identifying risk factors of FN may help to target high-risk patients with granulocyte colony-stimulating factor prophylaxis and reduce FN incidences, with subsequent morbidities and mortalities

Acute generalized exanthematous pustulosis in a patient with plaque psoriasis

Acute generalized exanthematous pustulosis [AGEP] is an acute febrile drug eruption characterized by sudden occurrence of numerous, non-follicular, pinhead-sized pustules. This usually occurs 3-5 days after the commencement of treatment. Development of pustular eruptions in patient with plaque psoriasis raises the differential diagnosis of AGEP versus pustular psoriasis of the Von Zumbusch type. Herein, we report a 56-year-old male who came into hospital with history of vomiting fresh blood. The patient was then admitted for management of hematemesis. He is a known case of psoriasis vulgaris, which was still present during admission. During admission, the patient developed pustular skin eruptions associated with fever 4 days after using clindamycin and ceftriaxone. Laboratory investigations revealed leukocytosis and neutrophilia. Histopathological examination showed sub-corneal neutrophilic collection and eosinophils in the papillary dermis. The pustular eruption disappeared completely within ten days after stopping clindamycin and ceftriaxone, confirming the diagnosis of AGEP

Detection of chronic typhoid carriers among food handlers in Wad Medani, Gezira state, Sudan

Typhoid fever remains a disease of major public health importance in the tropics. This cross sectional prospective descriptive study was carried out between July 2005 to July 2008 in Wad Medani Town. The objective of the study was to identify chronic typhoid carriers among food handlers in Wad Medani. To achieve this objective, Vi agglutination test was used to determine suggested typhoid carriers among food handlers then stool culture was performed on those with a positive Vi agglutination test. A questionnaire was designed to collect data from suggested typhoid carriers about hygienic practices during food handling and processing. The collected data were reviewed and coded. Data were analyzed using SPSS versions 10.0 software for tabulation and statistical analysis. The results showed that, ten percent of the examined food handlers were found positive typhoid carriers by Vi agglutination test, 48.5% of the suspected of typhoid carriers were found positive by stool culture, street vendors were more common among suspected typhoid carriers, all of whom had not received any health education about typhoid disease. The study suggested the following recommendations: Regular health authority inspection visitor food handling personnel specially street vendors to exclude typhoid carriers among them, education and training course in good hygienic practices should be provided to all food handlers specially typhoid carriers Food Control Department, Ministry of Health, Gezira State

Rhomboid flap- a primary cure for pilonidal sinus

To assess the complications, days off work, analgesia requirement and recurrence rate of radical excision and rhomboid flap reconstruction for treatment of sacro-coccygeal pilonidal sinus. Prospective. Al-Amiri Hospital, Kuwait. Two hundred and fifteen patients admitted for surgery of pilonidal sinus. Radical excision of pilonidal sinus with reconstruction using rhomboid flap under general anesthesia in prone position was performed. The patients were usually discharged 24 hours after surgery. Patients were followed up postoperatively for an average of 20 months [range 10-56 months]. They were observed for complications related to the procedure, recurrence, return to work and analgesia requirements. One hundred and seventy eight [82.2%] patients had primary healing, five [2.3%] had recurrence, fourteen [6.5%] had superficial wound infection, eight [3.7%] developed wound seroma and ten [4.65%] developed deep wound infection. The mean duration of follow up was twenty months. The return to work was within two weeks. The analgesia requirement was minimal. Treatment of pilonidal sinus using the rhomboid flap is a simple and safe procedure with low morbidity and recurrence rate

IgA nephropathy in the Caribbean / La mefropatía IgA en el Caribe

IgA nephropathy can be considered the most common cause of primary glomerulopathy in developed countries. There has been no report of cases of IgA nephropathy from Caribbean countries. The authors report five cases of IgA nephropathy from Trinidad and Tobago, and Guyana, diagnosed from biopsy studies. No cases were of African origin and some did not have the typical presentation associated with IgA nephropathy. Caribbean nephrologists are reminded that this entity can be seen in Caribbean patients and can only be diagnosed through immunofluorescence staining of renal biopsy specimen. This diagnosis is required for the proper management of patients with glomerular disease, particularly when there may be progression to end stage renal failure as can occur in up to twenty per cent of patients with IgA nephropathy. Accurate diagnosis is important, since disease recurrence can be seen in the transplanted kidney, but this does not often lead to graft failure.

La nefropatía IgA puede considerarse la causa más común de glomerulopatía primaria en los países desarrollados. No ha habido reportes de casos de nefropatía IgA de los países del Caribe. Los autores reportan cinco casos de nefropatía IgA de Trinidad y Tobago, y Guyana, diagnosticados a partir de estudios de biopsia. Ninguno de los casos fue de origen africano y algunos no presentaron las características típicas asociadas con la nefropatía IgA. Se les recuerda a los nefrólogos del Caribe que esta entidad puede ser observada en pacientes del Caribe y puede ser diagnosticada sólo mediante tinción por inmunofluorescencia de un espécimen de biopsia renal. Este diagnóstico es un requisito para el tratamiento adecuado de pacientes con la enfermedad glomerular, en particular cuando puede haber progresión al fallo renal en etapa terminal, como puede ocurrir hasta en el veinte por ciento de los casos con nefropatía IgA. El diagnóstico exacto es importante, ya que la recurrencia de la enfermedad puede verse en el riñón trasplantado, pero esto no conduce a menudo al fallo del injerto.

Spectrum of renal bone diseases in Sudanese children with chronic renal failure

Disturbance in mineral and bone metabolism are common in children with chronic kidney disease [CKD]. A large body of evidence indicates that renal osteodystrophy [ROD] affects skeletal growth and development and may result in increased morbidity and mortality. The purpose of this study is to determine the prevalence and types of ROD and to study the clinical and radiological manifestations of ROD. This is a cross-sectional survey of children with chronic renal failure in 5 main dialysis centers in Khartoum state. A designed questionnaire was conducted for data collection including personal details, social and dietary history, dialysis history and prescriptions, growth parameters, diagnosis, clinical picture, investigations and management. The study included 57 children with chronic renal failure [CRF] of whom the majority [75.4%] reached end stage renal failure [ESRD]. The cause of renal failure was undetermined in 28 patients [49.1%]. The mean duration on dialysis was 14 months. The majority of children [n=22] [44.8%] had moderate growth impairment. Renal osteodystrophy was documented in 36 patients [63.9%]. The most common clinical presentation of ROD were bone pain, joint pain and pruritis, they accounted for 58.8%, 52.9% and 52.9% respectively. The most common radiological findings were osteopenia [88.8%], subperiosteal bone resorption [72.2%] and delayed bone age [69.4%].The predominant pattern of ROD was secondary hyperparathyroidism [2ry HPTH] [52.6%]. Renal osteodystrophy is a common complication in Sudanese children with CRF with the predominance of secondary hyperparathyroidism. The management of children with CRF should be in a paediatric nephrology unit through a multidisciplinary team approach and the treatment should be individualized

Community perception of maternal mortality in northeastern Nigeria

This study was conducted to find out community's knowledge and perceived implications of maternal mortality and morbidity. The community members' perception on ways to prevent the scourge was also explored. It was a population- based qualitative study which took place in two urban and two rural communities in Borno state, Nigeria. A total of one hundred and sixty eight (168) community members participated in Focus Group Discussions (FGD) and in-depth interviews. Most agreed that there were maternal deaths in the communities. Many of the respondents identified at least two of the five main direct causes of maternal mortality that are universal. But many have misconceptions about the causes of maternal mortality. There were many implications narrated by the respondents and various suggestions made to improve on the poor Maternal Health in the areas. The knowledge and implications of maternal mortality was good in the areas and therefore intervention programs should exploit and capitalize on the linkages between the perceived implications and the causes of maternal deaths (Afr J Reprod Health 2008; 12[3]:27-34)

Chronic idiopathic ulcerative colitis in Saudi Arabia, a clinicopathological study of 76 cases

In this report we present our experience with 76 cases of chronic idiopathic ulcerative colitis [IUC] out of 1279 consecutive colorectal biopsies [6.0%], seen during an 11-year period [1983-1994], in a tertiary care teaching hospital. During the same period, 12 [0.8%] patients with Crohn's disease were seen. Of the 76 patients with IUC, forty-nine were male and 27 were female, with an age range of six to 88 years, a mean of 38 +/- 16 and a median of 36 years. Forty-nine patients were Saudi Nationals [27M, 22F], 21 were non-Saudi Arabs and six were Asians. In most patients, the onset of IUC was at 20 to 49 years [70%]. The disease duration at diagnosis ranged from one month to five years, with a median of 12 months. The follow-up period ranged from 13 months to 11 years, with a median of three years. Diarrhea, hematochesia and abdominal pain were the dominant symptoms. The disease grade was generally of mild to moderate severity [55 patients, 72%] and was of low stage [distal involvement in 69 patients, 91%]. The rarity of skin manifestations and of development of colonic cancer is to be noted in spite of the relatively short period of follow-up. Our findings compare with experience from the region, confirming the mild course of the disease as contrasted to Western experience. These findings will be discussed

Wilson's disease in Saudi Arabia: report of a Saudi Arab family

A Saudi family with Wilson's disease [hepatolenticular degeneration] is described. The index case presented with anicteric hepatitis and hydrops of the gallbladder. Neurological involvement appeared later. The diagnosis of Wilson's disease was based on the presence of Kayser-Fleischer rings, a low serum ceruloplasmin level, and an elevated urinary copper concentration. Histological examination of the liver biopsy specimen revealed active cirrhosis. Acute hepatic failure developed during D-penicillamine therapy. Continuation of the drug at a lower dose, along with other supportive measures, was successful in reversing this. After three years of therapy, the index patient's neurological signs disappeared, and liver function and gallbladder size and function returned to normal. Family screening revealed that three other siblings have the disease, and all have been treated with D-penicillamine. The parents are related but are asymptomatic. An unusual feature of the index case was the presence of a distended nonfunctioning gallbladder that reverted to normal with decoppering. Although D-penicillamine treatment possibly precipitated the acute hepatic failure, paradoxically it was also successful in treating it

study on pattern visual evoked response in papillitis and papilledema

Pattern VER was recorded from 30 eyes [20 patients], 14 eyes with papillitis [12 patients] and 16 eyes with early papilloedema due to benign increase of intracranial pressure [8 patients]. VER was recorded at time of presentation and after recovery, in active papillitis VER was present, with increased latency in 92.86 percent of cases and diminished amplitude in all cases. After recovery, latency remained high in 85.79 percent of cases while amplitude returned to normal in 92.79 percent of cases. So VER can be useful in the follow up of cases of papillitis and to evaluate the effectiveness of medical treatment. In cases of early papilloedema VER was present but with values which were more or less normal during the active disease [all cases were normal and after recovery [81.25 percent] of cases were normal]. Therefore, VER can be used with other clinical tests to differentiate papillitis from papilloedema because, VER alone is still not decisive and the interpretation of its results are still difficult

Endocapsular cataract extraction versus conventional extracapsular cataract extraction

The operative and postoperative findings of endocapsular cataract extraction were compared to conventional E.C.C.E. The anterior capsulotomy in the upper part of the anterior capsule of the lens was much easier and less complicated than 0 shaped capsulectomy of the conventional E.C.C.E. Lens nucleus delivery needed less counter pressure and corneal touch was avoided in endocapsular method. Cleaning of cortical remnant within the capsular bag was more complete and with reduced chance of posterior capsule rupture.Postoperative striate keratitis, uveitis secondary glaucoma were less in endocapsular surgery