Multicenter inter-examiner agreement trial for the validation of simplified POPQ system

Introduction and hypothesis

The primary aim of this study was to evaluate the inter-examiner agreement of a previously described simplified pelvic organ prolapse quantification (S-POP) system in a multicenter, prospective, randomized, blinded fashion. Pelvic organ prolapse quantification (POPQ) system??s use in daily practice is hampered due to perceived complexity and difficulty of use. The S-POP was introduced in order to make the POPQ user-friendly and increase its usage (Swift et al. in Int Urogynecol J 17(6):615?C620, 2006).

Methods

Five hundred eleven subjects underwent two separate pelvic exams in random order by two blinded examiners employing the S-POP at 12 centers around the world. Data were compared using weighted kappa statistics.

Results

The weighted kappa statistics for the inter-examiner reliability of the S-POP were 0.87 for the overall stage, 0.89 and 0.81 for the anterior and posterior vaginal walls, 0.82 for the apex/cuff 0.89, and 0.84 for the cervix and vaginal fornix, respectively.

Conclusion

There is an almost perfect inter-examiner agreement of the S-POP system for the overall stage and each point within the system.     

Occupational exposure,attitude to HIV-positive patients and uptake of HIV counselling and testing among health care workers in a tertiary hospital in Nigeria

Health care workers (HCWs) are at risk of occupational exposure to HIV. Their attitude to HIV-positive patients influences patients’ willingness and ability to access quality care. HIV counselling and testing (HCT) services are available to inform HCWs and patients about their status. There is little information about HCT uptake and attitude to HIV-positive patients among HCWs in tertiary health facilities in Nigeria. The aim of this study was to determine occupational exposure and attitude to HIV-positive patients and level of uptake of HCT services among HCWs in a tertiary hospital in Nigeria. A cross-sectional design was utilized. A total of 977 HCWs were surveyed using semi-structured, self-administered questionnaires. Nurses and doctors comprised 78.2% of the respondents. Their mean age was 35?±?8.4 years. Almost half, 47.0%, reported accidental exposure to blood and body fluids (BBFs) in the preceding year. The main predictor of accidental exposure to BBFs in the last year was working in a surgical department, OR?=?1.7, 95% CI (1.1–2.6). HCWs aged <40 years, OR?=?5.5, 95% CI (1.9–15.9), who had worked for >5 years, OR?=?3.6, 95% CI (1.4–9.3) and who work in nursing department, OR?=?6.8, 95% CI (1.7–27.1) were more likely to be exposed to BBFs. Almost half, 52.9%, had accessed HCT services. Predictors for HCT uptake were age <40 years OR?=?1.6, 95% CI (1.1–2.4), having worked for >5 years OR?=?1.5, 95% CI (1.03–2.2) and working in medical department OR?=?1.7, 95% CI (1.1–2.8). Respondents in nursing departments were more likely to require routine HIV test for all patients, OR?=?3.9, 95% CI (2.4–6.2). HCWs in the laboratory departments were more likely to believe that HIV patients should be on separate wards, OR?=?3.6, 95% CI (1.9–7.0). HCWs should be protected and encouraged to access HCT services in order to be effective role models in the prevention of HIV/AIDS.     

Adherence to antiretroviral therapy among HIV-infected prisoners: a systematic review and meta-analysis

Data on antiretroviral therapy (ART) adherence among prison inmates are limited and not previously synthesized in a systematic manner. The objective of this study was to provide accurate and up-to-date ART adherence estimates among prison inmates. We searched electronic databases for all studies reporting adherence as a primary or secondary outcome among prison inmates. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity and publication bias were assessed. Eleven studies involving 2895 HIV-infected prison inmates were included. The studies were carried out between 1992 and 2011 and reported between 1998 and 2013. A pooled analysis of all studies indicated a pooled estimate of 54.6% (95% confidence interval 48.1–60.9%) of prison inmates had adequate (≥95%) ART adherence. The adherence estimates were significantly higher among cross-studies and studies that used self-reported measures. In summary, our findings indicate that optimal adherence remains a challenge among prison inmates. It is crucial to monitor ART adherence and develop appropriate interventions to improve adherence among these population.     

Point-of-admission hypothermia among high-risk Nigerian newborns

Background

Facilities which manage high-risk babies should frequently assess the burden of hypothermia and strive to reduce the incidence.

Objective

To determine the incidence and outcome of point-of-admission hypothermia among hospitalized babies.

Methods

The axillary temperatures of consecutive admissions into a Nigerian Newborn Unit were recorded. Temperature <36.5°C defined hypothermia. The biodata and outcome of these babies were studied.

Results

Of 150 babies aged 0 to 648 hours, 93 had hypothermia with an incidence of 62%. Mild and moderate hypothermia accounted for 47.3% and 52.7% respectively. The incidence of hypothermia was highest (72.4%) among babies aged less than 24 hours. It was also higher among out-born babies compared to in-born babies (64.4% vs 58.3%). Preterm babies had significantly higher incidence of hypothermia (82.5%) compared with 54.5% of term babies (RR = 1.51; CI = 1.21 – 1.89). The incidence of hypothermia was also highest (93.3%) among very-low-birth-weight babies. The Case-Fatality-Rate was significantly higher among hypothermic babies (37.6% vs 16.7%; RR = 2.26, CI = 1.14 – 4.48) and among out-born hypothermic babies (50% vs 17.1%; RR = 0.34, CI = 0.16 – 0.74). CFR was highest among hypothermic babies with severe respiratory distress, sepsis, preterm birth and asphyxia.

Conclusion

The high incidence and poor outcome of hypothermia among high-risk babies is important. The use of the 'warm chain' and skin-to-skin contact between mother and her infant into routine delivery services in health facilities and at home may be useful.     

Transbuccal fentanyl for rapid relief of orthopedic pain in the ED

Objectives

This study's objectives were to assess administration of a rapidly dissolving transbuccal fentanyl tablet to patients in emergency department (ED) with orthopedic extremity pain. The main end point was time required to achieve a 2-point drop on a 0 to 10 pain scale.

Methods

In this double-blind trial, subjects received either transbuccal fentanyl, 100 μg, and a swallowed placebo, or a swallowed oxycodone/acetaminophen, 5/325-mg pill, and a nonanalgesic transbuccal comparator. Pain assessment occurred every 5 minutes for an hour, and vital signs were monitored for 2 hours.

Results

Transbuccal fentanyl was associated with faster pain relief onset (median, 10 vs 35 minutes; P < .0001). Secondary end points (pain relief magnitude, rescue medication rate, subject preference for medication on future visit) favored transbuccal fentanyl. No vital sign abnormalities or significant side effects occurred in the ED or on 100% next-day follow-up.

Conclusions

Transbuccal fentanyl shows promise for continued investigation as a means to safely provide rapid and effective pain relief for ED patients.     

A comparative study of academic achievement of children with sickle cell anemia and their healthy siblings

BACKGROUND: Sickle cell anemia (SCA) could impact negatively on academic performance of affected children. Reports so far have been inconsistent. OBJECTIVE: To do a comparative analysis of academic performance of Nigerian children with SCA and their siblings. METHODS: We studied sessional aggregate scores, pass rates and percentage scores in four core subjects (mathematics, English language, integrated science and social studies), as well as the total number of days of school absence of 52 school-age children (6-17 years) with sickle cell anemia and 42 siblings of similar sociodemographic characteristics, over one academic session. FINDINGS: School absence among the SCA patients was significantly higher than that of siblings (9.3+/-5.5 days/school year and 4.3+/-2.6 days/school year, respectively, mean+/-SD, p<0.05). Although the mean sessional aggregate score for patients was comparable with that of the siblings, there was a significantly larger proportion of below-average pupils among the patients. The mean percentage scores of the patients on mathematics, English language, integrated science and social studies compared well with those of the siblings. There was no significant correlation between school absence and academic achievement of the study population. CONCLUSION: More children with SCA are underachievers in this study, and their school underachievement is not associated with the observed higher school absence.     

Prevention and management of ureteric injuries

Ureteric injury is one of the most serious complications of gynaecological surgery with important medico-legal considerations. This review is aimed at understanding the anatomy of the ureter, sites of ureteric injuries, types and causes of injury, simple preventive measures and management.     

SARS-CoV-2 Omicron variant (B.1.1.529): A concern with immune escape

Omicron, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant that is now spreading across the world, is the most altered version to emerge so far, with mutations comparable to changes reported in earlier variants of concern linked with increased transmissibility and partial resistance to vaccine-induced immunity. This article provides an overview of the SARS-CoV-2 variant Omicron (B.1.1.529) by reviewing the literature from major scientific databases. Although clear immunological and clinical data are not yet available, we extrapolated from what is known about mutations present in the Omicron variant of SARS-CoV-2 and offer preliminary indications on transmissibility, severity, and immune escape through existing research and databases.     

A review of wildlife tourism and meta-analysis of parasitism in Africa’s national parks and game reserves

Parasitology Research - The recent increase of parasitic diseases associated with wildlife tourism can be traced to human contact with wildlife and intense modification of wildlife habitat. The...