Can artificial intelligence detect type 2 diabetes in women by evaluating the pectoral muscle on tomosynthesis: diagnostic study.

OBJECTIVES: This retrospective single-center analysis aimed to evaluate whether artificial intelligence can detect type 2 diabetes mellitus by evaluating the pectoral muscle on digital breast tomosynthesis (DBT). MATERIAL METHOD: An analysis of 11,594 DBT images of 287 consecutive female patients (mean age 60, range 40-77 years) was conducted using convolutional neural networks (EfficientNetB5). The inclusion criterion was left-sided screening images with unsuspicious interpretation who also had a current glycosylated hemoglobin A1c (HBA1c) % value. The exclusion criteria were inadequate imaging, history of breast cancer, and/or diabetes mellitus. HbA1c values between 5.6 and 6.4% were categorized as prediabetic, and those with values ≥ 6.5% were categorized as diabetic. A recorded HbA1c ≤ 5.5% served as the control group. Each group was divided into 3 subgroups according to age. Images were subjected to pattern analysis parameters then cropped and resized in a format to contain only pectoral muscle. The dataset was split into 85% for training and 15% for testing the model's performance. The accuracy rate and F1-score were selected as performance indicators. RESULTS: The training process was concluded in the 15th epoch, each comprising 1000 steps, with an accuracy rate of 92% and a loss of only 0.22. The average specificity and sensitivity for all 3 groups were 95%. The F1-score was 0.95. AUC-ROC was 0.995. PPV was 94%, and NPV was 98%. CONCLUSION: Our study presented a pioneering approach, applying deep learning for the detection of diabetes mellitus status in women using pectoral muscle images and was found to function with an accuracy rate of 92%. CRITICAL RELEVANCE STATEMENT: AI can differentiate pathological changes within pectoral muscle tissue by assessing radiological images and maybe a potential diagnostic tool for detecting diabetes mellitus and other diseases that affect muscle tissues. KEY POINTS: • AI may have an opportunistic use as a screening exam for diabetes during digital breast tomosynthesis. • This technique allows for early and non-invasive detection of diabetes mellitus by AI. • AI may have broad applications in detecting pathological changes within muscle tissue.

What is the margin of error of surgeons and radiological imaging in diagnosing acute appendicitis?

Background: Acute appendicitis is the most common emergency requiring surgical intervention in general surgery. Negative appendectomy is defined as the removal of a pathologically normal appendix. Aim: In this study, we aimed to show our negative appendectomy rate. Materials and Methods: This study was carried out among 2990 patients who were operated on for appendicitis between 2015-2020 at the Health Sciences University, Istanbul Kanuni Sultan Suleyman Training, and Research Hospital. Accrual and historical records of the patients were analyzed using NCSS (Number Cruncher Statistical System) 2007 Statistical Software (Utah, USA) package program. The results were evaluated at the significance level of P < 0.05. Results: The mean age of all patients was 33. Of the patients, 1011 were women and 1979 were men. 27 of the women patients were pregnant. We requested a blood test (WBC count) and an abdominal ultrasound for all our patients who came with the complaint of abdominal pain in the right lower quadrant. Negative appendectomy was performed with ultrasonography in 622 patients with pathological diagnoses of lymphoid hyperplasia and fibrous obliteration (20.8%). We had abdominal computerized tomography (CT) for 285 patients and abdominal magnetic resonance imaging (MRI) for 16 of 27 pregnant women (59.25%) due to unclear clinical picture. Diagnostic laparoscopy was performed in 36 of the patients who underwent CT and 4 of the patients who underwent MRI since the diagnosis could not be made. We performed unnecessary appendectomy in 21.2% of the patients. Conclusion: With the increasing clinical follow-up experience of surgeons and developing technology in radiology, our aim is to minimize the negative appendectomy rate as much as possible.

The effect of systemic hypertension on prostatic artery resistive indices in patients with benign prostate enlargement.

Background: To investigate the effect of systemic hypertension on the prostatic artery resistive indices by a comparative ultrasonographic evaluation of the prostate gland in normotensive and hypertensive patients with benign prostatic enlargement (BPE). Materials and methods: The participants had BPE and presented at the outpatient urologic clinic of a tertiary hospital. They were divided into normotensive and hypertensive groups. Each group had fifty patients. Calculation of international prostate symptom score, measurement of blood pressure, and transrectal ultrasonographic evaluation were done. Results: The mean age for the normotensive and hypertensive groups were 66.9 ± 9.8 and 66.0 ± 10.7 years, respectively (P = 0.662). Patients with hypertensive BPE had a significantly higher mean transitional zone volume, transitional zone index, presumed circle area ratio, quality of life score, and prostatic arterial resistive indices than the age-matched normotensive BPE patients. Conclusion: Patients with BPE and with hypertension had significantly higher prostate arteries resistive indices than normotensives with BPE. Even in patients with BPE and controlled hypertension, the prostatic artery resistance indices were still elevated than that of normotensive men with BPE.

Pattern of Treatment Initiation and Outcomes for Patients With Metastatic Non-small Cell Lung Cancer in Ontario.

INTRODUCTION: The impact of diagnosis and treatment delay on outcomes in advanced non-small cell lung carcinoma (NSCLC) is not well understood. In this study, we examined the effect of the length of time to the first chemotherapy treatment initiation and the other factors affecting overall survival. METHODS: This retrospective study used data from the Institute of Clinical Evaluative Sciences and identified 4520 patients in Ontario who were diagnosed with stage IV NSCLC between 2007 and 2016, treated using chemotherapy. We adjusted the analysis for location (rural vs urban), gender, distance from the nearest cancer center, first chemotherapy treatment used, income, and age.  Results: Type of the chemotherapy, length of time to the first treatment, and distance from the nearest cancer center had a statistically significant impact on survival. Paclitaxel was associated with decreased risk of death compared to vinorelbine (Hazard Ratio (HR)=0.835, 95%CI 0.753-0.925), gemcitabine (HR=0.916, 95%CI 0.998-0.826), and docetaxel (HR=0.771, 95%CI 0.994-0.513). Every additional 10 km distance from the nearest cancer center was associated with a 0.5% increased risk of death (HR=1.005, 95%CI 1.000-1.010). A longer time to the first treatment was associated with increased survival. In fact, every 10 days increase in wait time was associated with a 0.5% decrease in the risk of death (HR=0.995, 95%CI 0.993-0.998).  Conclusion: Chemotherapy treatment using paclitaxel and living closer to the cancer center is associated with better survival. A longer time between diagnosis and treatment leading to better survival could perhaps be explained by patients on the "sicker" end of the spectrum receiving treatment sooner.

Early-Stage Non-Small Cell Lung Cancer Stereotactic Body Radiation Therapy Outcomes in a Single Institution.

Introduction The gold standard treatment of stage I non-small cell lung cancer (NSCLC) is surgical resection. For medically inoperable patients, stereotactic body radiation therapy (SBRT) can provide comparable local control (LC) and overall survival (OS). The objectives of this study are to determine the three-year LC and OS for SBRT compared to early-stage NSCLC patients treated with alternative radiation modalities at our institution. Materials and methods This retrospective study included a total of 139 consecutive patients who were diagnosed with stage I (T1-2 N0 M0) NSCLC and treated with radiation therapy at our institution between 2015 and 2020. Patient demographics and clinical data were obtained from chart reviews. Treatment subgroups were: SBRT (48Gy/4 or 60Gy/8), hypofractionation (60Gy/15), conventional fractionation (60Gy/30 or 50Gy/20), and palliative radiation (20Gy/5, 30Gy/10, or 40Gy/15). Kaplan-Meier curves were plotted for LC and OS. We also performed Cox's proportional hazard regression analysis. Results The median patient age was 74 (range 52-91). The numbers of patients in each treatment subgroup were: SBRT (44), hypofractionation (78), conventional fractionation (8), and palliative (9). Differences in age, gender, and histopathological cell type between subgroups were not statistically significant. Metastatic progression was the most common outcome amongst treatment failures, followed by local recurrence and regional spread. Median post-treatment follow-up in months for each subgroup was: SBRT (20.2), hypofractionated (20.7), conventional fractionation (13.9), and palliative (14.4). Post-treatment three-year LC was found to be significantly better with SBRT (94%) versus hypofractionation (71%), conventional fractionation (80%), and palliative (71%). OS at three years were SBRT (67%), hypofractionation (59%), conventional fractionation (66%), and palliative (44%). As a whole, 72% (100/139) of patients had biopsy-proven NSCLC. Analysis showed biopsy status had no statistical significance with regards to LC or OS. Every 20 years of age had a 3.2x risk of death (95% CI: 1.425-7.268). Concerning the treatment modalities, there were significant differences for the hazard of death compared to SBRT: hypofractionation had 2.58x increased risk while palliative had 5.83x increased risk. The proportion of patients who experienced post-treatment radiation pneumonitis or dermatitis were: SBRT (7%, 2%), hypofractionation (8%, 3%), conventional fractionation (13%, 25%), and palliative (0%, 0%), respectively. No patients who experienced grade III or higher toxicities were observed as defined by Common Terminology Criteria for Adverse Events (CTCAE).  Conclusion Our experience confirms SBRT can provide durable three-year local control with a comparable rate of post-treatment complications versus other radiation modalities for early-stage NSCLC. SBRT appears to be non-inferior to hypofractionation with regards to three-year LC.

Is food insecurity a problem among the elderly in Sharpeville, South Africa?

The objective of this study was to determine the prevalence of food and nutrition insecurity and assess the socio-demographic factors associated with food and nutrition insecurity among 146 free-living elderly persons attending a care centre in Sharpeville, South Africa. Measurement instruments included socio-demographic-, 24-hour-recall and dietary diversity questionnaires and the validated household food insecurity access scale/score (HFIAS). Data were analysed with IBM SPSS Software, version 25.0. The prevalence of food insecurity from HFIAS was 60% (n = 87), with a variety of balanced responses being employed. Significant relationships were observed between HFIAS and age (r = 0.301; p = 0.000) and with household income (r = -0.258; p = 0.007). An association was observed between HFIAS and marital status (p = 0.005). Regression analysis showed that age and being single were predictors of food and nutrition insecurity. This study indicated a problem of household food insecurity with poor dietary intakes among these elderly people, mostly due to poverty and being single. More research on associations between food security and socio-economic variables is needed to plan and implement appropriate strategies to address food and nutrition insecurity in South Africa.

The effect of Ultraviolet-B irradiation on the photodegradation of ciprofloxacin and norfloxacin as inhibitors of bacterial DNA replication and cell division in urea medium.

Ciprofloxacin hydrochloride and Norfloxacin are second-generation fluoroquinolone antibiotic against bacterial DNA gyrase, which reduces DNA strain throughout replication. As DNA gyrase is essential through DNA replication, subsequent DNA synthesis and cell division are inhibited. Direct photolysis of fluoroquinolones was studied by using UV irradiation in the presence or absence of other substances that generate free radicals. This study aimed to assess the effect of Ultraviolet B (UVB) irradiation in removing ciprofloxacin and norfloxacin by using a simulating model of wastewater contained urea at pH 4. A known concentration of ciprofloxacin and norfloxacin were prepared in an appropriate aqueous solution in presence or absence 0.2M urea and adjusted at pH 4. The dis-solved drugs were irradiated with UVB-lamp in a dark place for 60 minutes. The percent of removal and the rate of elimination (k) of each drug were calculated. The direct photolysis effect of UVB irradiation was observed with ciprofloxacin which amounted to 24.4% removal compared with12.4% removal of norfloxacin after 60 minutes of irradiation. The effect of UVB irradiation was enhanced by urea to reach 38.9% and 15% for ciprofloxacin and norfloxacin. The calculated k of ciprofloxacin has amounted to three folds of that of norfloxacin. Direct photolysis of ciprofloxacin and norfloxacin can be achieved simply by using a simulation model of 0.2 M urea and UVB irradiation at pH 4. UVB is highly effective in removing ciprofloxacin compared with norfloxacin by 2-3 folds.

Diagnostic performance of transrectal ultrasound for prostate volume estimation in men with benign prostate hyperplasia.

BACKGROUND AND AIM: Despite transrectal ultrasound (TRUS) being regarded as gold standard for prostate volume estimation, concerns have been raised in the literature concerning its accuracy especially in men with above-average prostate volumes. We aimed to evaluate the performance of TRUS for prostate volume estimation in a cohort of sub-Saharan African men since they are known to have relatively large mean prostate volumes. METHODS: This was a prospective study of 77 sub-Saharan African men who had open simple prostatectomy for benign prostate hyperplasia (BPH). Pre-operative TRUS determined total prostate volume (TPV) and transition zone volume (TZV). Following surgical enucleation, the adenoma was weighed (EPW) and its volume (EPV) also determined by fluid displacement. TRUS was repeated six weeks post-operatively to calculate the TRUS-estimated specimen volume (TESV). RESULTS: The mean EPV, EPW, TRUS-estimated TZV, TRUS-estimated TPV and TESV were 79.1 ± 62.9 ml, 79.1 ± 62.9 g, 53.3 ± 28.5 ml, 93.1 ± 48.9 ml and 69.9 ± 44.6 ml, respectively. Pearson's correlation showed a perfect relationship between EPW and EPV with no difference in their mean values (r = 1.000; P < .001). Pearson's correlation between TRUS-estimated TPV vs EPV, TRUS-estimated TZV vs EPV, and between TESV vs EPV were 0.932, 0.865 and 0.930, respectively (P = .0000). TRUS significantly under-estimated the TZV and TESV by 25.8 ml and 9.2 ml, respectively; unrelated to the severity of prostate enlargement. CONCLUSION: TRUS underestimates prostate volume, independent of prostate size. We propose simple formulae that could be used to improve the prostate volume determination from TRUS, especially if magnetic resonance imaging is not readily available or contraindicated.

An audit of surgical site infection following open prostatectomy in a Nigerian Teaching Hospital.

BACKGROUND: Surgical site infections (SSI) are a potential cause of morbidity and increased cost of care after operations such as open prostatectomy. OBJECTIVE: To audit the occurrence of SSI after open prostatectomy at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. METHODS: A review of all patients who underwent open prostatectomy over a ten-year period (July 2005 to June 2015). Data analysis was done using the statistical package for social sciences version 21. Association between variables was determined using Chi-square or Fisher's exact test as appropriate. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 247 open prostatectomy surgeries were reviewed, with the patients' ages ranging from 43 - 91 years and a mean age of 67.0 ± 8.8 years. Elective procedures were 98.8% while the remaining 1.2% were emergency cases. There were 24 (9.8%) surgical site infections. The duration of admission of the patients with SSI ranged from 6 - 15 days with a mean of 9.5 ± 3.2 days, as against 4 - 9 days (mean of 5.0 ± 2.1days) for those without SSI. All the patients with SSI were successfully managed with no resultant mortality. Risk factors identified for SSI were emergency surgery (p=0.001), obesity (p<0.0001), diabetes mellitus (p=0.008), smoking (p<0.0001), pre-operative catheterization (p<0.0001), excessive haemorrhage (p<0.0001) and post-operative suprapubic bladder drainage (p<0.0001). CONCLUSION: SSI is a recognized complication of open prostatectomy. Identified risk factors for its occurrence from this audit are emergency operation, obesity, diabetes mellitus, smoking, pre-operative catheterization, excessive haemorrhage and post-operative suprapubic bladder drainage. Age, approach to prostatectomy (retropubic vs transvesical), incision type (lower midline vs pfannenstiel), level of the surgeon, catheter type and modality of irrigation were however not significant risk factors for post-prostatectomy SSI in this study.

Retrospective case series describing the efficacy, safety and cost-effectiveness of a vial-sharing programme for canakinumab treatment for paediatric patients with cryopyrin-associated periodic syndrome.

BACKGROUND: Cryopyrin-associated periodic syndrome (CAPS) is a rare autoinflammatory disease, caused by gain of function mutation in NLRP3 resulting in excess production of interleukin-1 (IL-1). Canakinumab is a human monoclonal antibody against Interleukin-1 beta (IL-1ß), licensed for the treatment of CAPS. The objective of the study was to describe the feasibility and cost-effectiveness of a canakinumab vial-sharing programme for paediatric patients with CAPS. METHOD: Retrospective case series and clinical service description of a national specially commissioned CAPS clinic at Great Ormond Street Hospital (GOSH). Effectiveness was assessed using a CAPS disease activity score (DAS) and serum amyloid A protein (SAA). Adverse events were collected to determine safety. The number of canakinumab vials saved was considered when investigating the cost-effectiveness of vial-sharing. RESULTS: Nineteen/20 (95%) of our paediatric patients achieved minimally active clinical disease activity with canakinumab monotherapy; and 75% achieved both minimally active clinical disease and serological remission using a pre-specified definition based on the CAPS DAS and SAA level. Canakinumab was well tolerated, with only one child developing an infection requiring hospitalisation during the study. Canakinumab vial sharing resulted in 117 vials of canakinumab saved over a 24-month period, equating to a direct drug-related cost saving of £1,385,821, and a conservative estimated 5-year cost-saving of £3,464,552.50. CONCLUSION: We provide further evidence for the effectiveness and safety of canakinumab in children with CAPS, and highlight the cost-effectiveness of a vial-sharing programme for this high cost medicine. We suggest that this could have important implications for the delivery of other high cost medicines used in paediatric practice.

PME and Other ESBL-Positive Multiresistant Pseudomonas aeruginosa Isolated from Hospitalized Patients in the Region of Kurdistan, Iraq.

Nosocomial infections occur worldwide and also in the Kurdistan region. Frequently patients colonized with multiresistant Pseudomonas aeruginosa isolates are encountered in many hospitals. As information is lacking with respect to the mechanisms of resistance responsible for the multiresistant character of the P. aeruginosa isolates and their genetic relationship, isolates were prospectively collected and characterized with respect to their mechanism of resistance. During 2012 and 2013, 81 P. aeruginosa isolates were collected from three teaching hospitals in the city of Erbil, Iraq. Susceptibility testing was performed using the VITEK-2 system. Isolates were screened for the presence of extended-spectrum ß-lactamases (ESBLs) and for the presence of metallo ß-lactamases (MBLs). The presence of serine carbapenemases was detected by PCR. The genetic relationship of the isolates was demonstrated by amplified fragment length polymorphism (AFLP). Susceptibility results revealed high rates of resistance against all classes of antibiotics except polymyxins. Genetic characterization demonstrated the presence of ESBL-genes, that is, blaVEB (30%) and blaPER (17%), also ESBL blaPME was detected in four isolates. AFLP typing revealed clonal spread of blaVEB, blaPER, and three clusters of blaOXA-10-positive isolates. Only one isolate was MBL (blaVIM) positive. Of a selected number of isolates (n = 11), whole-genome sequencing analysis revealed that these isolates belonged to "high-risk" MLSTs ST244, ST235, ST308, and ST654. This study reveals the presence and clonal spread of widely resistant high-risk clones of P. aeruginosa in Iraqi Kurdistan. As far as we are aware, this is the first report of multiple, polyclonal, PME producing P. aeruginosa outside the Arabian Peninsula.

Peculiarities and management challenges of advanced renal cell carcinoma incidentally discovered in pregnancy.

Our aim is that urologists, gynecologists, nephrologists, and general practitioners will be reminded that diagnosis of renal malignancies sometimes require a high index of suspicion as they may remain asymptomatic in advanced stages; even as they can also rarely co-exist with and cause peculiar challenges in pregnancy.

Posterior Urethral Valves in Children: Pattern of Presentation and Outcome of Initial Treatment in Ile-Ife, Nigeria.

BACKGROUND: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. MATERIALS AND METHODS: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. RESULTS: Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within the first 30 days of life and those who presented afterwards were 325 (±251) µmol/L and 141 (±100) µmol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 µmol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. CONCLUSIONS: The initial treatment outcome was good but most had poor prognostic factors.

Aminoglycosides induce fragility of human red cell membrane: an in vitro study.

OBJECTIVES: It is well-known that aminoglycosides are ototoxic and nephrotoxic. Recent advances in pharmacology research suggest that the red cell used as a carrier of aminoglycosides. This study aimed to find the effect of aminoglycosides on the human red cell membrane using osmotic fragility test. MATERIALS AND METHODS: This study was conducted in Rizgari Teaching Hospital in Erbil, Iraq. The effect of aminoglycosides, namely gentamicin, amikacin, and spectinomycin, on human red cells was investigated. The effects of aminoglycosides were evaluated by osmotic fragility test using fresh human blood in the presence of aminoglycosides in concentrations of 10-160 µg/mL. RESULTS: The results showed that aminoglycosides drugs shifted the osmotic fragility curve to some extent, and this effect was well observed with spectinomycin. The hemolysis did not depend on the concentration of aminoglycosides. The concentration of sodium chloride to induced 50% hemolysis is higher in presence of gentamicin, amikacin and spectinomycin (at 160 µg/mL) than corresponding control and this account to an increment in hemolysis percents of 1.88, 1.5 and 1.06%, respectively. CONCLUSION: Aminoglycosides induce human red cell membrane fragility in a concentration-independent manner.

Is obesity associated with iron status in the elderly? A case study from Sharpeville, South Africa.

OBJECTIVE: To investigate the relationship between poor Fe status and overweight or obesity in elderly respondents in South Africa. DESIGN: Cross-sectional, observational baseline survey. SETTING: Sharpeville, South Africa. SUBJECTS: A sample size calculation determined a representative sample of 104 randomly selected elderly (≥60 years) respondents. Measurements included weight, height, biochemical and haematological parameters. Measured BMI was used to categorise the respondents into normal weight, overweight and obese groups. RESULTS: The majority of the women were overweight (28·4%) or obese (54·6%); 58% of the respondents had normal Fe status, 15% were classified as Fe depleted, 9% as Fe deficient and 13% as Fe-deficient anaemic. Ten per cent of the respondents had low Hb levels with no other low Fe status parameters, and were thus anaemic due to other causes. A significant correlation (r = 0·318, P < 0·001) existed between BMI and high-sensitivity C-reactive protein (hs-CRP). hs-CRP was negatively correlated to serum Fe levels (r = -0·319, P < 0·001). No significant relationships existed between BMI and Fe status parameters. CONCLUSIONS: A coexistence of obesity and poor Fe status were observed in these elderly respondents. The positive relationship between hs-CRP and BMI indicated chronic inflammation in the higher BMI groups. The negative relationship between hs-CRP and serum Fe indicated that lower serum Fe levels were related to the inflammation linked with higher BMI. A relationship between obesity-related chronic, low-grade inflammation and poor Fe status has been found in adults, but the significance of the current study is that this relationship was also confirmed for elderly persons.

Socio-Economic Variables and Nutrient Adequacy of Women in the Vaal Region of South Africa.

The aim of this cross-sectional, observational baseline survey was to examine the association between nutrient intakes and selected socio-economic variables in 722 women, aged 19 to 90 years living in peri-urban settlements. Measurements included socio-demographic data and 24-hour recall dietary intake data. The results showed poor nutrient intakes with the Estimated Average Requirement (EAR) not met for the mean intakes of all nutrients except carbohydrates, phosphorus, and vitamin B12. The inadequate energy intakes were significantly higher among the women who had lower education (p = .015), lower income (p = .028), and were unemployed (p = .015). The epidemiological value of the study findings is in the contribution to the rationale of appropriate interventions such as income-generating projects as well as household agricultural projects to improve food and nutrient intakes.

Pendulous urethral stricture: peculiarities and relevance of longitudinal penile fascio-cutaneous flap reconstruction in poor resource community.

PURPOSE: To describe peculiarities of pendulous urethral stricture in South Western Nigeria and how prevalent social and environmental factors have made longitudinal distal penile island flap the preferred option for reconstruction of pendulous urethral stricture in such a poor resource community. MATERIALS AND METHODS: All patients presenting with stricture located in the pendulous urethra in 3 hospitals in south western Nigeria, over a 5 year period were interviewed and had urethral reconstruction using longitudinal distal penile fascio-cutaneous island flap under spinal anesthesia. RESULTS: Thirty four cases were treated by this method during this period. Complications were found in 4 patients (11.8%) which include urethrocutaneous fistula, penile skin necrosis and wound infection. All cases had satisfactory overall outcome. CONCLUSION: Longitudinal penile fascio-cutaneous flap remains a viable option for a single stage repair of urethral stricture especially in poor resource communities.

Bilateral choanal atresia in a 7-year-old boy: a case study.

Choanal atresia is a developmental failure of the nasal cavity to communicate with nasopharynx. It can be membranous or bony; unilateral or bilateral; complete or incomplete. Bilateral choanal atresia is less common and usually present in neonatal period with severe respiratory distress. Imaging provides definitive diagnosis by choanography. This report shows the value of computed tomography in the diagnosis of choanal atresia in a patient that presented with bilateral choanal atresia, undiagnosed until about seven years.

Palatal avulsion injury by a foreign body in a child.

A 6-year-old girl who claimed to have fallen while playing with metal rod that resulted in palatal avulsion injuries was presented. Neither of the parents was around when the incidence happened. She was brought to the hospital because of pain, bleeding from the mouth, drooling of saliva mixed with blood and inability to feed or phonate appropriately. Examinations of the oral cavity revealed a triangular area of avulsion in the posterior aspect of the hard palate extending to the soft palate. She had examination under anaesthesia and wound repaired with 3-0 vicryl interrupted sutures after thorough wound debridement. She did well and was discharged from the clinic.

Breakfast, midday meals and academic achievement in rural primary schools in Uganda: implications for education and school health policy.

BACKGROUND: Underachievement in schools is a global problem and is especially prevalent in developing countries. Indicators of educational performance show that Uganda has done remarkably well on education access-related targets since the introduction of universal primary education in 1997. However, educational outcomes remain disappointing. The absence of school feeding schemes, one of the leading causes of scholastic underachievement, has not been given attention by the Ugandan authorities. Instead, as a national policy, parents are expected to provide meals even though many, especially in the rural areas, cannot afford to provide even the minimal daily bowl of maize porridge. OBJECTIVE: To assess and demonstrate the effect of breakfast and midday meal consumption on academic achievement of schoolchildren. DESIGN, MATERIALS AND METHODS: We assessed household characteristics, feeding patterns and academic achievement of 645 schoolchildren (aged 9-15 years) in Kumi district, eastern Uganda, in 2006-2007, using a modified cluster sampling design which involved only grade 1 schools (34 in total) and pupils of grade four. Household questionnaires and school records were used to collect information on socio-demographic factors, feeding patterns and school attendance. Academic achievement was assessed using unstandardized techniques, specifically designed for this study. RESULTS: Underachievement (the proportion below a score of 120.0 points) was high (68.4%); in addition, significantly higher achievement and better feeding patterns were observed among children from the less poor households (p<0.05). Achievement was significantly associated with consumption of breakfast and a midday meal, particularly for boys (p<0.05), and a greater likelihood of scoring well was observed for better nourished children (all OR values>1.0). CONCLUSION: We observed that underachievement was relatively high; inadequate patterns of meal consumption, particularly for the most poor, significantly higher scores among children from 'less poor' households and a significant association between academic achievement and breakfast and midday meal consumption.