Decentralizing postabortion care in Senegal with misoprostol for incomplete abortion

Objective

To expand access to postabortion care (PAC) services in Senegal by introducing misoprostol as a first-line treatment at the community level.

Methods

The present prospective study enrolled 481 women seeking treatment for incomplete abortion at 11 community health posts in Senegal between September 2011 and August 2012. Participants were given 400 μg of sublingual misoprostol and asked to return to the clinic 1 week later to confirm clinical status. At study completion, all women were asked to respond to a series of questions regarding their experience with this method. All care was provided by nurse midwives.

Results

All but three of the study women (99.4%; 474/477) had successful complete abortion after taking misoprostol. Almost all women were satisfied or very satisfied with the treatment (99.6%; 469/471), would select the method again if needed (98.9%; 465/470), and would recommend the method to a friend (99.8%; 468/469).

Conclusion

The results provide further evidence that 400 μg of misoprostol is highly effective for first-line treatment of incomplete abortion. Furthermore, this regimen can be fully provided by nurse midwives, and can be easily and successfully introduced in community health settings where other methods of PAC may not previously have been available. Clinicaltrials.gov: NCT01939457     

La tuberculose péritonéale: étude rétrospective de 61 cas à l’hôpital Principal de Dakar

Aims

To describe the characteristic features (epidemiological, clinical, paraclinical, therapeutic and evolutive) of peritoneal tuberculosis in Senegal.

Patients and methods

Retrospective study, which included all cases of peritoneal tuberculosis identified at Principal hospital in Dakar between the 1 January 1996 and 30 June 2006.

Results

Sixty-one cases of peritoneal tuberculosis were included in ten years and six months. The mean age of patients was 36 years, and the sex ratio was 0.9. Ascites associated with fever was the most common symptom. The ascitic fluid was exudative in 92.4% and lymphocytic in 90.5%. Peritoneal tuberculosis was isolated in 70.5% of cases and associated with pleural effusion in 21%, lung involvement in 13% and liver involvement in 3.2%. The HIV was positive in 4.5% of patients who were tested. The definite diagnosis was based on laparoscopy associated with peritoneal biopsy showing granulomatous lesions in 70% of cases. The outcome was favourable in all cases after antituberculous therapy.

Conclusion

Peritoneal tuberculosis occurs in young adult with a discrete female predominance in this series. It must be suspected in the presence of any lymphocytic and exudative ascites associated with fever. The definite diagnosis is based on laparoscopy with peritoneal biopsy. The outcome is generally favourable with antituberculous treatment.     

Comparison of time-resolved and continuous-wave near-infrared techniques for measuring cerebral blood flow in piglets

A primary focus of neurointensive care is monitoring the injured brain to detect harmful events that can impair cerebral blood flow (CBF), resulting in further injury. Since current noninvasive methods used in the clinic can only assess blood flow indirectly, the goal of this research is to develop an optical technique for measuring absolute CBF. A time-resolved near-infrared (TR-NIR) apparatus is built and CBF is determined by a bolus-tracking method using indocyanine green as an intravascular flow tracer. As a first step in the validation of this technique, CBF is measured in newborn piglets to avoid signal contamination from extracerebral tissue. Measurements are acquired under three conditions: normocapnia, hypercapnia, and following carotid occlusion. For comparison, CBF is concurrently measured by a previously developed continuous-wave NIR method. A strong correlation between CBF measurements from the two techniques is revealed with a slope of 0.79±0.06, an intercept of -2.2±2.5 ml∕100 g∕min, and an R2 of 0.810±0.088. Results demonstrate that TR-NIR can measure CBF with reasonable accuracy and is sensitive to flow changes. The discrepancy between the two methods at higher CBF could be caused by differences in depth sensitivities between continuous-wave and time-resolved measurements.     

Résécabilité des cancers localement avancés du col utérin après radiothérapie externe néoadjuvante

Introduction

Cervical carcinomas are common in developing countries. More than 60% of all cases are locally advanced, considered as unresecable oncologically because of the frequent pelvic structures involvement.

Objective

The aim of this article is to evaluate the surgical resection of locally advanced of the cervical carcinoma after neo-adjuvant external beam radiotherapy.

Patients and method

It was a retrospective study and we enrolled 48 cervical carcinomas staging FIGO: IIA: 18.8%, IIB: 58.3%, III: 16.7% and IVA: 6.2% with objective response and operated after neo-adjuvant radiotherapy from 2000 to 2003. The mean age was 48.8 years old and squamous cells carcinomas represented 95.8%. We studied surgical assessment, macroscopic residual tumour, histological evaluation and follow-up.

Results

The mean delay of the surgery was 13.2 weeks. We realized radical hysterectomy Piver??s type 3 in 75.0%, type 2 in 8.3%, and extrafacial hysterectomy in 12.5%. Pelvic lymphadenectomy has been done in 26 cases. We noted 15 haemorrhages, 2 wounds of bladder and ureteri, 2 urinary fistulas and 1 radic cystitis. Two patients died of pulmonary embolism. Macroscopic residual tumour noted in 29.2%. For the 30 cases with histological evaluation, complete sterilization was 60.0% and partial sterilization 40.0%. The mean follow-up was 40 months. The rate of local control was 60.4%. A 36 months survival was 55.0%, without residue 68.0% vs 20.0% and without recurrence 92.0% vs 10.0%.

Conclusion

Very few patients presenting locally advanced cervical carcinoma benefit treatment. Our results may be validated by cases control studies between patient treated by exclusive radiotherapy and patient treated by radiotherapy follow-up of surgery.