Risk Factors for Postcesarean Wound Infection in a Tertiary Hospital in Lagos, Nigeria.

BACKGROUND: There has been a global increase in cesarean section rates. While this has improved perinatal outcome, it is associated with complications such as wound infection. We determined risk factors for cesarean section wound infection in a tertiary hospital in Lagos, Nigeria. MATERIALS AND METHODS: We prospectively studied a cohort of 906 women who had cesarean section at the Obstetrics Unit of the Lagos State University Teaching Hospital between January 1, 2011, and December 31, 2011. A comparison was made between 176 women who had wound infection and 730 women who did not using logistic regression. RESULTS: Of the 2134 deliveries during the study, 906 (42.5%) had cesarean section and of which 176 (19.4%) had wound infection. Independent risk factors for wound infection were: preoperative anemia (adjusted odds ratio [aOR] = 1.88; 95% confidence intervals [CI] = 1.03-3.41; P = 0.0396), presence of diabetes mellitus (aOR = 7.94; 95% CI = 1.60-39.27; P = 0.0111), HIV infection (aOR = 6.34; 95% CI = 1.74-23.06; P = 0.0051), prolonged operation time (aOR = 2.30; 95% CI = 1.19-4.42; P = 0.0127), excessive blood loss at surgery (aOR = 5.05; 95% CI = 2.18-11.66; P = 0.0002), and chorioamnionitis (aOR = 9.00; 95% CI = 1.37-59.32; P = 0.0224). CONCLUSIONS: Patients with HIV infection, diabetes mellitus, preoperative anemia and chorioamnionitis have an increased risk of postcesarean wound infection as is when surgical time exceeds 1 h or when associated with blood loss >11.

Comparison of Papanicolaou Smear Quality with the Anatomical Spatula and the Cytobrush-Spatula: A Single-Blind Clinical Trial.

BACKGROUND: The Papanicolaou (Pap) smear is a standard test for cervical cancer screening; however, the most important challenge is high false-negative results due to inadequate sampling using the Ayres spatula. The cytobrush has been used in combination with the Ayres spatula (cytobrush-spatula) in an attempt to improve the quality of smears with additional costs. The aim of this study was to compare the Pap smear quality with the anatomical spatula (with extended tip) and the cytobrush-spatula. MATERIALS AND METHODS: This was a prospective single-bind clinical trial. One hundred and ten sexually active women aged between 22 and 65 years were randomized into groups, each having two smears at the same time: one with a cytobrush-spatula and another with an anatomical spatula. Fifty-five patients were randomized to have the anatomical spatula first to obtain their smears and 55 were randomized to have the cytobrush-spatula first to obtain their smears. Slides were assessed by a pathologist. RESULTS: There was no significant difference in the quality of the smears using the two devices with respect to cellular adequacy (P = 0.3532), absent blood staining (P = 0.7766), presence of endocervical cells (P = 0.3502), and evidence of transformation zone sampling using the Bethesda criteria (0.4028). Kappa analysis shows moderate inter-rater agreement between the two devices by ability to show evidence of transformation zone using British Society for Clinical Cytology and Bethesda criteria. CONCLUSIONS: There was no significant difference in the quality of smears obtained using the two different methods. The anatomical spatula can be used as a single device in conventional cytology in place of the cytobrush-spatula with the aim of improving the quality of smears without necessarily increasing the cost.

Comparison of papanicolaou smear quality with the anatomical spatula and the cytobrush­spatula: asingle-blind clinical trial

Background: The Papanicolaou (Pap) smear is a standard test for cervical cancer screening; however, the most important challenge is high false-negative results due to inadequate sampling using the Ayres spatula. The cytobrush has been used in combination with the Ayres spatula (cytobrush­ spatula) in an attempt to improve the quality of smears with additional costs. The aim of this study was to compare the Pap smear quality with the anatomical spatula (with extended tip) and the cytobrush­spatula. Materials and Methods: This was a prospective single-bind clinical trial. One hundred and ten sexually active women aged between 22 and 65 years were randomized into groups, each having two smears at the same time: one with a cytobrush­spatula and another with an anatomical spatula. Fifty-five patients were randomized to have the anatomical spatula first to obtain their smears and 55 were randomized to have the cytobrush­spatula first to obtain their smears. Slides were assessed by a pathologist. Results: There was no significant difference in the quality of the smears using the two devices with respect to cellular adequacy (P = 0.3532), absent blood staining (P = 0.7766), presence of endocervical cells (P = 0.3502), and evidence of transformation zone sampling using the Bethesda criteria (0.4028). Kappa analysis shows moderate inter-rater agreement between the two devices by ability to show evidence of transformation zone using British Society for Clinical Cytology and Bethesda criteria. Conclusions: There was no significant difference in the quality of smears obtained using the two different methods. The anatomical spatula can be used as a single device in conventional cytology in place of the cytobrush­spatula with the aim of improving the quality of smears without necessarily increasing the cost