Burden of Neonatal Surgical Conditions in Northern Ghana

World Journal of Surgery - Congenital anomalies have risen to become the fifth leading cause of under-five mortality globally. The majority of deaths and disability occur in low- and middle-income...     

Patient Experience and Outcomes of the Locally Organized ApriDec Medical Outreach Group

Background

Access to safe and effective surgery is limited in low and middle-income countries. Short-term surgical missions are a common platform to provide care, but the few published outcomes suggest unacceptable morbidity and mortality. We sought to study the safety and effectiveness of the ApriDec Medical Outreach Group (AMOG).

Methods

Data from the December 2017 and April 2018 outreaches were prospectively collected. Patient demographics, characteristics of surgery, complications of surgery, and patient quality of life were collected preoperatively and on postoperative days 15 and 30. Data were analyzed to determine complication rates and trends in quality of life.

Results

260/278 (93.5%) of patients completed a 30-day follow-up. Of these, surgical site infection was the most common complication (8.0%), followed by hematoma (4.1%). Rates of urinary tract infection were 1.2% while all other complications occurred in less than 1% of patients. There were no mortalities. With increasing time after surgery (0 to 15 days to 30 days), there was a significant improvement across each of the dimensions of quality of life (p < 0.001). All patients reported satisfaction with their procedure.

Conclusion

This study demonstrated that the care provided by AMOG group to the underserved populations of northern Ghana, yielded complication rates similar to others in low-resourced communities, leading to improved quality of life.

     

Possible mechanisms involved in the anti-nociceptive effects of hydro-ethanolic leaf extract of Ziziphus abyssinica

Context: Various parts of Ziziphus abyssinica Hochst ex. A. Rich (Rhamnaceae) have been used in Ghanaian and African traditional medicine as an analgesic. However, there are little scientific data to support the anti-nociceptive effects of the hydro-ethanolic leaf extract of Ziziphus abyssinica (EthE) as well as the possible mechanisms involved in its anti-nociceptive effects.

Purpose: To predict possible nociceptive pathways involved in the anti-nociceptive effects of EthE.

Materials and methods: The effect of EthE (30, 100 and 300?mg/kg) on intraplantar injection of pain mediators such as interleukin-1β, tumour necrosis factor-α, prostaglandin E₂ and bradykinin was evaluated in male Sprague Dawley rats using Randall–Selitto test for 5?h. The effect of specific antagonists to the opioidergic, adenosinergic, ATP-sensitive K⁺ channels, nitric oxide, serotonergic, muscarinic, adrenergic and voltage-gated calcium channel on the anti-nociceptive effect of EthE (100?mg/kg) was evaluated using the formalin test in male imprinting control region (ICR) mice for 1?h.

Results: Pretreatment of the rats with EthE significantly reversed the hypernociception induced by intraplantar injection of TNF-α (F_4,120?=?10.86, p?F_4,120?=?14.71, p?0.0001), bradykinin (F_4,80?=?12.52, p?0.0001) and prostaglandin E₂ (F_5,144?=?6.165, p?=?0.0001). The anti-nociceptive effect exhibited by EthE in the formalin test was reversed by systemic administration of N^G-l-nitro-arginine methyl ester, naloxone, theophylline and glibenclamide.

Conclusions: EthE inhibits hypernociception induced by TNF-α, IL-1β, bradykinin and prostaglandin E₂. EthE exhibited anti-nociceptive effects possibly mediated through opioidergic, adenosinergic, ATP-sensitive potassium channels and nitric oxide cyclic GMP pathways.