Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria

The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01January 2020 to 30 June 2020.Methods: A cross-sectional study using a piloted and researcher assistant-administered questionnaire.Results: Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30­39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12­23 months. From participants' responses, it seems that Etonogestrel implants may be offered from as early as 15­20 years of age. Conclusion: Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.Keywords: early removal; etonogestrel; subcutaneous contraceptive; implant; Pretoria; community health centre; weight gain; vaginal bleeding.

Application study of early removal of drainage tube in rapid recovery of patients with thyroid cancer / 中国实用护理杂志

Objective:To explore the clinical application effect of early removal of drainage tube in rapid postoperative recovery of patients with thyroid cancer.Methods:A total of 90 thyroid cancer patients admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from June 2018 to June 2019 were selected and divided into a control group and a study group according to the order of operation time. Patients in the control group were given routine extubation, and patients in the study group were removed early during rapid recovery after surgery. The complication rate, postoperative hospital stay, satisfaction, extubation time distribution, and drainage port healing rate 3 days after surgery were compared between the two groups of patients.Results:In the study group, the incidence of complications after drainage tube removal during rapid recovery after surgery was 6.7% (3/45), which was significantly lower than that of the control group, 26.7% (12/45), and the difference was statistically significant ( χ2 value was 6.48, P <0.05). The postoperative hospital stay in the study group was (3.25±0.89) days, and the satisfaction score was (97.83±7.25), which was significantly shorter than the control group's (5.68±0.96) days and (92.36±12.19). The difference was statistically significant ( t value was 12.45, 2.59, P <0.05). Conclusions:Early removal of the drainage tube during rapid postoperative recovery of patients with thyroid cancer can effectively reduce the trauma of the drainage tube orifice, shorten the hospital stay, and improve patient satisfaction.

Clinical features and management of ocular lesions after stings by hymenopteran insects.

We describe the ocular alterations and the management after stings from Hymenopteran insects. In all the five patients, the insect was identified as bee. The patients presented with significant corneal edema, which resolved dramatically in three of them after removal of stingers. Among the other two one went for permanent corneal decompensation and the other developed Intumuscent cataract with increased intraocular pressure. Although a rare occurrence, ocular trauma caused by Hymenopteran insects has a potential to cause severe ocular damage in humans. A high level of clinical suspicion and immediate removal of the stingers along with administration of high doses of topical and systemic steroids is a must to prevent chances of permanent corneal damage and intraocular complications.

Acute Anal Pain due to Ingested Bone Fragments

Impacted bone fragment in the anal canal must not be overlooked as an unusual cause of acute anal pain. Eight cases of acute anal pain arising from impaction of ingested bone fragment within the anal canal were treated over a 4-year period. The eight cases were similar in presentation and outcome. There were six males and two females (age 45~65 years). Seven patients presented within a day of the sudden onset of severe anal pain, and one patient presented with obscure anal pain of three days. In two patients, this pain was aggravated by attempts to defecate. Inspection showed mild to marked spasm of the anal sphincter with no obvious cause for the anal pain. Digital rectal examination revealed spiculated bony fragments impacted in the anal canal at the dentate line in seven cases, and at the anorectal junction in one case. In one case, a fish bone was found penetrating into a hemorrhoid, causing edema and prolapse. In another case, a tiny fish bone was found impacting in a nylon seton applied to a fistulotomy wound. In a third case, a linear fish bone was found penetrating into an anal papilla. Six fish bones and one chicken bone were removed using forceps under proctoscopy. One fish bone was removed at the time of digital rectal examination. Sigmoidoscopy was then performed to assess anorectal injury. Pain relief was immediate, and no sequelae were noted on review at 6 weeks. In all cases, the diagnosis was readily made on simple digital rectal examination, and early removal of the bone fragment resulted in immediate pain relief without complications. Eight cases of acute anal pain due to impaction of ingested bone fragment in the anal canal are reported, and the related literature is reviewed.

Early Evacuation of Massive Subretinal Hemorrhage with Low-dose Tissue Plasminogen Activator

Massive subretinal hemorrhage may develop secondary to choroidal neovascularization. The poor visual prognosis associated with submacular hemorrhage can be explained by preexisting abnormality of photoreceptorretinal pigment epithelium-Bruch's membrane complex and fibrin-mediated injury to the outer segment of photoreceptor. An animal experiment showed that subretinal fibrin induced irreversible damage to the retina within 24 hours. We use recombinant tissue plasminogen activator(rt-PA), at doses(3 microgram substantially lower than previously reported, to aid in the surgical evacuation of massive subretinal hemorrhage within 2 days of its development. The subretinal hemorrhage in both patients developed in association with age-related macular degeneration. Postoperative corrected visual acuity improved from counting fingers to 0.3 in one patient and from hand motion to 0.04 in the other. There has been no complication except ocular hypertension which is medically controllable. Subfoveal neovascularization explains poor postoperative vision in one case. It seems that visual recovery is facilitated by early evacuation of massive subretinal hemorrhage and by using low-dose rt-PA. Low-dose rt-PA may minimize the risks of intraocular hemorrhage and retinal toxicity.