Beyond the Recruitment Pipeline: A Call to Action for Centering the Success of Under-represented Minority Trainees in Obstetrics and Gynecology.

Just like all aspects of the American experience, racism has had a significant presence in Obstetrics and Gynecology (OBGYN). Black physicians in OBGYN face unique challenges in training programs, having to learn a specialty while combating racial macroaggression and microaggressions constantly and, often, in isolation. We present the stories of black OBGYNs who have sustained such an experience while also offering equitable and actionable solutions to improve clinical training environments.

Use of a proximal humeral plate for a paediatric peri-prosthetic femoral fracture.

In this case an 18-year-old female with cerebral palsy sustained a peri-prosthetic femoral fracture adjacent to a blade plate previously inserted for a femoral varus osteotomy. The injury was treated using a long proximal humeral locking plate. The existing blade plate was removed. The fracture was reduced and held, and a 10-hole PHILOS™ plate applied with near anatomical reduction. There were no post-operative complications. Radiographic union was confirmed at 11 months. To our knowledge, this is the first reported use of a PHILOS™ plate in the management of a femoral peri-prosthetic fracture and successfully demonstrated a straightforward method for revision fixation.

Iron Deficiency Anaemia among Women of Reproductive Age in Nine Administrative Regions of Ethiopia

Background: Iron deficiency anaemia (IDA) is one of the most common causes of nutritional problem; and is of great public health significance affecting children; adolescents and women of reproductive age world wide. The magnitude of IDA in the general population of Ethiopia has not yet been well documented. Objective: To estimate the magnitude of IDA among women of reproductive age in nine administrative regions. Methods: A cross-sectional study of analytical nature was conducted in 270 clustered villages drawn from 9 administrative regions of the country between June and July 2005. A total of 22;861 women of reproductive age (15-49 years) were examined clinically for pallor and 5of these subjects were systematically selected and assessed further for their haemoglobin (Hgb) and serum ferritin (SF) status. Results: The prevalence rate of clinical anaemia; anaemia; ID (iron deficiency) and IDA were 11.3; 30.4; 49.7and 17.0respectively. The majority of anaemic women were in the category of mild (19.3) to moderate (10.3) and severe anaemia was 0.9. A significantly higher proportion of clinical anaemia [26.7(95CI: 24 to 28)]; anaemia (Hgb) [79.4(95CI: 72 to 86)]; ID [65.1(95CI: 72 to 86)] and IDA [58.0(95CI: 55 to 76)] was observed in Afar signifying distinct regional variation. The most affected age groups were those between 36-49 years and the difference noted was statistically significant. Conclusion: This study substantiates the existence of mild to moderate form of IDA among women of reproductive age and underlines the need for iron supplementation to all reproductive women during the antenatal period with more attention to the most affected regions

Pattern of hospitalizations for angioedema in New York between 1990 and 2003.

BACKGROUND: The epidemiologic characteristics of angioedema have not been well described in the United States, especially regarding hospitalization patterns. This fact is particularly relevant given the increased use of angiotensin-converting enzyme inhibitors, a known cause of angioedema. OBJECTIVE: To profile hospital admissions for angioedema in New York State with respect to age, sex, race, comorbidities, and year. METHODS: A database of all acute hospitalizations in New York State was examined between 1990 and 2003. Patient admissions that had the principal admission diagnoses of angioedema and other acute allergic disorders (anaphylaxis, urticaria, or allergy unspecified) were extracted. Characteristics of angioedema admissions were tabulated and compared with those of other acute allergic disease admissions with respect to demographic variables and comorbidities. RESULTS: There were 6,775 hospitalizations for angioedema during the study period. The number of angioedema hospitalizations increased progressively from 293 in 1990 to 636 in 2003, which exceeded the number of hospitalizations for anaphylaxis that year. African Americans constituted 42% of the angioedema admissions despite being less than 16% of the state population. The increase in hospitalizations for angioedema was most marked in patients with a diagnosis of hypertension, and for each study year, patients admitted with angioedema were consistently older than those admitted with other allergic disorders. CONCLUSIONS: Angioedema has become the most common nonasthmatic acute allergic disorder that results in hospitalization in New York State. The predilection for angioedema occurring in patients with hypertension suggests that angiotensin-converting enzyme inhibitor use may play a role in this trend.

Malnutrition and iron deficiency in lactating women in urban slum communities from Addis Ababa, Ethiopia.

OBJECTIVE: To determine the status of iron deficiency anaemia (IDA) and malnutrition in lactating women. DESIGN: A cross-sectional study. SETTING: Six urban slum communities in Teklehaimanot district, Addis Ababa. SUBJECTS: One thousand and seventeen lactating women were enrolled and assessed for their haemoglobin (Hgb), serum ferritin level and body mass index (BMI) during the month of March 2001. Iron deficiency anaemia was considered when Hgb and serum ferritin concentrations were less than 12gm/dl and 12 microg/l respectively, whereas, a BMI less than 18.5% kg/m2 was considered malnourished. MAIN OUTCOME MEASURES: Determinations of haemoglobin, serum ferritin and BMI measurements. RESULTS: The overall prevalence of iron deficiency anaemia (IDA) and protein energy malnutrition in the slum communities was 22.3% and 27.1% respectively. The mean age of mothers (28.4 +/- 6.12 years) indicates that prevalence of malnutrition and iron deficiency anaemia was higher among younger mothers than among older mothers. The prevalence of malnutrition was positively correlated with the serum ferritin concentration status, of the mothers (r=0.12, p=0.2, RR=1.03). CONCLUSION: It is observed that malnutrition and IDA are major health problems and therefore, an appropriate nutrition intervention package to improve the nutrition situation of the communities is recommended.

Daily versus weekly iron supplementation and prevention of iron deficiency anaemia in lactating women.

OBJECTIVE: To demonstrate the effectiveness and social feasibility of weekly versus daily iron supplementation in preventing and treating iron deficiency anaemia among anaemic mothers. DESIGN: A longitudinal in nature. SETTING: Seven urban slum communities in Teklehaimanot Wereda, Addis Ababa, Ethiopia. SUBJECTS: Two hundred seven eligible mothers were assigned to the daily supplementation, weekly supplementation or control groups following randomisation between March and May 2001. The daily supplemented groups (n=71) received 60 mg of elemental iron containing 300 mg ferrous sulphate and 400 microg folic acid from Monday to Friday. The weekly group (n=68) received one tablet once a week every Monday supervised while the control group (n=68) was advised to take no medications without the knowledge of the investigators until the completion of the study. To eliminate a major source of variation, subjects participating in the study were de-wormed at the beginning of the study. MAIN OUTCOME MEASURES: Haemoglobin and serum ferritin concentrations were compared before and after the intervention among the groups. RESULTS: The mean haemoglobin (Hgb), and serum ferritin concentration (SFC) at baseline were practically similar among the groups. Haemoglobin levels significantly increased at the end of the study in all the groups and the proportion of anaemia decreased from 6.9% to 1.6% in the daily, 6.7% to 1.7% in the weekly supplemented and 6.7% to 6.1% in the control groups. The difference noted between the daily and weekly supplemented groups was not significant. The improvement of SFC concentration was better in the daily than the weekly group but not statistically significant. Daily supplementation schedule caused more side effects and lower compliance level than the weekly supplementation schedule. CONCLUSION: Weekly supplementation is simple, comparable to daily supplementation and economically advantageous. Thus, it is recommended to adopt the strategy for controlling anaemia. Further because of higher compliance rate and lower side effects, it is deemed to be socially feasible.

Retinopathy in patients of Tikur Anbessa Hospital diabetic clinic.

A total of 302 diabetic patients were selected from regular attendants of the Tikur Anbessa Hospital (TAH) diabetic clinic to determine the prevalence of retinopathy from December 1994 to March 1995. The mean age was 41.4 +/- 14.4 years (range 14-85). There were 160 males (53%) and 142 females (47%). One hundred forty (46%) were type 1 and 162 (53.6%) were type 2. The mean duration of diabetes was 9.4 +/- 5.4 years and the mean Hemoglobin Alc (HbAlc) was 10.4 + 2.2%. On the day of the examination the mean fasting blood glucose (FBG) and random blood glucose (RBG) were 195.5 +/- 79.9 mg/dl and 273.1 +/- 114.5 mg/dl respectively. The mean serum total cholesterol, triglycerides, LDL, VLDL and GDL were 166.5 +/- 45.5 mg/dl, 129.9 +/- 92.4 mg/dl, 94.5 +/- 36.4 mg/dl, 24.4 +/- 15.1 mg/dl and 44.3 +/- 11.5 mg/dl respectively. The overall prevalence of retinopathy was 37.8% out of which 108 patients (36.1%) had background retinopathy and 5 patients (1.7%) had proliferative retinopathy. The retina could not be visualized in three patients because of dense cataract. Retinopathy correlated positively with age, duration of diabetes and blood pressure respectively, however no significant correlation was seen with mean total HgAlc and serum lipids. Prevalence of retinopathy was comparable in type 1 and type 2 (p > 0.05). The prevalence of retinopathy in our patients relative to the duration of diabetes mellitus is high. Therefore, improving facilities for the diagnosis and treatment of retinopathy is recommended.

Profile of coronary artery risk factors in Ethiopian diabetic patients.

OBJECTIVES: To assess the coronary artery risk factors in Ethiopian diabetic patients. DESIGN: A cross sectional study done on a representative sample of diabetic patients to evaluate the coronary risk factors. SETTING: Hospital-based study. SUBJECTS: A total of 302 diabetic patients randomly selected from the 3000 regularly attending diabetic patients in the Tikur Anbessa Hospital Diabetes Centre of whom 161(53.3%) were males, 141(46.7%) were females, 140(46.4%) were Type 1 and 162(53.6%) were Type 2. OUTCOME MEASURES: Assessment of the coronary risk factors in diabetic patients. RESULTS: There were 20(6.6%) smokers and no ex-smokers. All smokers were males of whom five (25%) were Type 1 and 15(75%) were Type 2. Hypertension and obesity were found in 64(21.2%) and 69(22.8%) patients respectively. Sixty one (20.2%) patients and 43(14.2%) patients had hypercholesterolaemia and hypertriglyceridaemia respectively. CONCLUSION: Our diabetic patients share the risk factors for developing coronary artery disease like any other diabetic patient in the developed countries but at a lower level.

Interrelationship between vitamin A, iodine and iron status in schoolchildren in Shoa Region, central Ethiopia.

A total of 14,740 schoolchildren in seven provinces of Shoa Administrative Region in Central Ethiopia were surveyed for the prevalence of goitre, xerophthalmia and anaemia. Haemoglobin and packed cell volume were assessed in 966 children in one province while an in-depth study was conducted on 344 children in the same province and two others. Goitre, xerophthalmia (Bitot's spots) and clinical anaemia were observed in 34.2, 0.91 and 18.6% respectively of the children. Most biochemical variables were within the normal range while those of haemoglobin (Hb), mean corpuscular Hb concentration (MCHC) and urinary I excretion were lower, and mean corpuscular volume, mean corpuscular Hb (MCH), and immunoglobulins G and M were higher. Hb was strongly correlated with retinol, ferritin, MCHC, MCH, packed cell volume and erythrocyte count while retinol formed a triad with transthyretin (TTR) and retinol-binding protein (RBP) which were all correlated with one another. Total and free thyroxin and total and free triiodothyronine were positively correlated as were the concentrations of the total and free hormones. Thyrotropin (TSH) was negatively correlated with total and free thyroxin and positively correlated with free triiodothyronine. Thyroxin and triiodothyronine in both free and combined forms were all correlated with thyroxin-binding globulin which in turn was negatively correlated with the triad retinol, RBP and TTR. The triad was also negatively correlated with C-reactive protein. Urinary I excretion was positively associated with total thyroxin and negatively associated with TSH. The anaemia found was not nutritional in origin but due to the effect of infestation with intestinal parasites and malaria.