Results of the PeRception of femOroaCetabular impingEment by Surgeons Survey (PROCESS)

Purpose

Currently, there is a lack of high-level evidence addressing the variety of treatment options available for patients diagnosed with femoroacetabular impingement (FAI). The objective was to determine the current state of practice for FAI in Canada.

Methods

A questionnaire was developed and pretested to address the current state of knowledge among orthopaedic surgeons regarding FAI treatment using a focus group of experts, reviewing prior surveys, and reviewing online guidelines addressing surgical interventions for FAI. The membership of the Canadian Orthopaedic Association (COA) was surveyed through email and mail in both French and English.

Results

Two hundred and two surveys were obtained (20 % response rate), of which 74.3 % of respondents manage patients under age 40 with hip pain. Most surgeons (62 %) considered failure of non-operative management as the most important indication for the surgical management of FAI, usually by treating both bony and soft tissue damage (54.4 %). The majority of surgeons were unsure of the existence of evidence supporting the best clinical test for FAI, the use of a diagnostic intra-articular injection for diagnosis of FAI, and for non-operative management of FAI. One in four respondents supported a sham surgery (24.8 %) control arm for a trial evaluating the impact of surgical intervention on FAI.

Conclusions

This survey elucidates areas of research for future studies relevant to FAI and highlights controversial areas of treatment. The results suggest that the current management of FAI by members of the COA is limited by a lack of awareness of high-level evidence.

Level of evidence

III.     

Pancreatic-type hyperamylasemia and hyperlipasemia secondary to ruptured ovarian cyst: a case report and review of the literature

Background: Although salivary-type hyperamylasemia is known to occur with ovarian pathologies such as salpingitis and adenocarcinoma, pancreatic-type hyperamylasemia and hyperlipasemia are considered to be highly specific for pancreatitis. Objectives: To discuss the interpretation of hyperamylasemia in the context of acute abdominal pain, implications for management, and to review the literature relating to non-pancreatic causes of hyperamylasemia and hyperlipasemia. Case Report: We present the case of a 25-year-old woman who presented with an acute abdomen and a markedly elevated pancreatic-type amylase and lipase in whom acute pancreatitis was suspected. Further investigations showed that the underlying pathology was actually a ruptured ovarian cyst causing massive intra-abdominal hemorrhage and necessitating emergency laparotomy. Conclusions: This case represents an initial report of pancreatic-type hyperamylasemia and hyperlipasemia occurring with ovarian pathology and hemoperitoneum. Although these derangements may have been secondary to peritoneal irritation, this case raises the possibility that ovarian tissue is able to secrete large amounts of pancreatic-type amylase and lipase in addition to salivary-type amylase. Clinicians should be aware that simultaneous elevations of both enzymes are not necessarily pathognomic of acute pancreatitis.     

Dietary Risk Assessment and Consumer Awareness of Mycotoxins among Household Consumers of Cereals,Nuts and Legumes in North-Central Nigeria

This study characterized the health risks due to the consumption of mycotoxin-contaminated foods and assessed the consumer awareness level of mycotoxins in households in two north-central Nigerian states during the harvest and storage seasons of 2018. Twenty-six mycotoxins and 121 other microbial and plant metabolites were quantified by LC-MS/MS in 250 samples of cereals, nuts and legumes. Aflatoxins were detected in all food types (cowpea, maize, peanut and sorghum) except in millet. Aflatoxin B₁ was the most prevalent mycotoxin in peanut (64%) and rice (57%), while fumonisin B₁ occurred most in maize (93%) and beauvericin in sorghum (71%). The total aflatoxin concentration was highest in peanut (max: 8422 µg/kg; mean: 1281 µg/kg) and rice (max: 955 µg/kg; mean: 94 µg/kg), whereas the totals of the B-type fumonisins and citrinin were highest in maize (max: 68,204 µg/kg; mean: 2988 µg/kg) and sorghum (max: 1335 µg/kg; mean: 186 µg/kg), respectively. Citrinin levels also reached 51,195 µg/kg (mean: 2343 µg/kg) in maize. Aflatoxin and citrinin concentrations in maize were significantly (p < 0.05) higher during storage than at harvest. The estimated chronic exposures to aflatoxins, citrinin and fumonisins were high, resulting in as much as 247 new liver cancer cases/year/100,000 population and risks of nephrotoxicity and esophageal cancer, respectively. Children who consumed the foods were the most vulnerable. Mycotoxin co-occurrence was evident, which could increase the health risk of the outcomes. Awareness of mycotoxin issues was generally low among the households.     

Hormone replacement therapy and outcomes for women with non-small-cell lung cancer: can an association be confirmed?

Background

A recent report suggested that women who had been taking hormone replacement therapy (hrt) experienced significantly decreased survival after a lung cancer diagnosis. Given the large cohort of women who have received hrt, it is important to try to confirm that association.

Methods

We reviewed female patients diagnosed with lung cancer at our institution between January 1999 and December 2003 for age at diagnosis, disease stage, treatment, smoking history, hrt, performance status, weight loss, age at menopause, and overall survival. Patients were excluded if they had small-cell lung cancer or an unknown primary cancer, or if they had had previous or synchronous non-lung, non-skin cancers. Statistical analysis used the chi-square test for categorical variables and the Kaplan–Meier method and Cox regression model for univariate and multivariate analyses of overall survival.

Results

Of 397 eligible patients, most (68%) were stage iii or iv. The group included very few never-smokers (5%). The proportion of patients with experience of prior or current hrt was 29%, and no effect on overall survival was observed. Median survival was 13 months in the non-hrt group and 14 months in the hrt group. Significant factors predicting for overall survival included performance status, stage, and weight loss.

Conclusions

Stage, performance status, and weight loss are the most powerful predictors of survival for women with non-small-cell lung cancer. As compared with non-hrt users, patients with prior hrt use did not have inferior outcomes, failing to duplicate previously published results.     

Misoprostol for induction of labour: a survey of attitude and practice in southwestern Nigeria

BACKGROUND: Although supported by research evidence, misoprostol for induction of labour remains contentious. OBJECTIVE: To assess perception and practice of obstetricians regarding use of misoprostol for labour induction. METHODOLOGY: Cross-sectional questionnaire-based survey of Senior Registrars and Consultant Obstetricians in southwestern Nigeria. RESULTS: One hundred and six questionnaires were completed (52.8% Consultants; 47.2% Senior Registrars). Most respondents (96, 90.6%) employ misoprostol for induction in both live and dead fetuses with majority having personally prescribed misoprostol for cervical ripening or induction of labour (97.2 and 79.3%, respectively). Fetal tachycardia, hyperstimulation and ruptured uterus were the commonly reported complications. Twenty-six respondents (24.5%) reported being aware of maternal death in relation to misoprostol use. Only 52.9% of the respondents have protocols guiding misoprostol use in their hospitals. More than half of respondents administer misoprostol 50 mug or higher 6 hourly. Most (92, 87.6%) believe that research evidence backs use of misoprostol for the indication; 89.5% of respondents support use of misoprostol. Most respondents (90, 86.5%) disagree with the notion that misoprostol is too dangerous for induction; only 26 respondents (25.1%) considered oxytocin a better choice for induction; 93 respondents (88.6%) agreed that, given cautious use, misoprostol is safe for induction, while 86 respondents (81.9%) considered misoprostol a cost-effective intervention for labour induction in developing countries. Though senior registrars and younger consultants tended to report side effects more frequently than older consultants, they were more likely to support misoprostol for induction of labour than older consultants. This differences were however not statistically significant (P > 0.05). CONCLUSION: Misoprostol is widely utilized by obstetricians for induction of labour in southwestern Nigeria. Fetal and maternal side effects are commonly experienced. We recommend urgent adoption of evidence-based guidelines in every unit using the drug to prevent complications.     

Forensic Investigation of mass disasters in Nigeria: A review

This paper is to establish the present state of things in the country in terms of legal framework and the availability of personnel with a view to presenting an overview of proper mass disaster investigations. This is a retrospective review of mass disasters in Nigeria that occurred within the last 20 years. The study therefore reviews the state of the forensic investigation of the mass disasters as well as the efforts made to identify the victims of the disaster. The process of proper forensic investigation from the stage of evaluation of the scene and recovery process to the final identification of victims are presented to serve as a protocol for the country. The assessment of the present state of preparedness in Nigeria is also examined with a view to improving the practice to international standards. Data were retrieved from official documents from the aviation industry as well as Nigeria news reports. The standard protocols for disaster victim identification were retrieved from the guide released by the INTERPOL. The state of preparedness of the country and recommendations for improvement are presented. The Federal government and the states of the federation should without further delay put in place the process of reviewing the law of Coroner''s system and provide the enabling environment for the proper forensic investigation. The training curriculum of the first responders should incorporate mass disaster investigations in order to produce efficient officers and personnel. A functional disaster victim identification (DVI) team is strongly advocated to incorporate different professionals involved in mass disaster management.     

Desmoplastic fibroma of the ulna bone

A fibroma is a benign tumour composed of fibrous connective tissue and they can grow in all organs. They can be classified based on consistency into hard or soft fibroma, based on histological characteristics into desmoplastic, chondromyxoid, ossifying, non-ossifying fibroma. They can also be classified based on tissue of origin or location in the body, it can also be classified into superficial or deep fibroma. This is a report of a 15-year-old Nigerian boy with a recurrent left ulnar tumour which was rapidly growing and has been excised three times. Preoperative investigations, i.e., plain radiograph, full blood count and fine needle aspiration cytology were done. Patient could not afford CT scan which was requested for. First excision was in 2009. Recurred within 1 year and had a repeat excision in 2011. He had a second recurrence 9 months after and had to have another excision. The last tumour excision left only the part of the left ulna that forms the proximal radioulnar joint and elbow joint. Patient has been followed up after the last excision for 18 months with no recurrence.     

An investigation on the influence of steroidal contraceptives on milk lipid and fatty acids in Hungary and Thailand. WHO Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on oral contraceptives

A double-blind clinical trial to examine the effects of oral and long-acting injectable contraceptive steroids on milk lipid and its fatty acid content has been done in Szeged, Hungary, and Khon-Kaen, Thailand. In Szeged, a combined and a progestin-only pill did not significantly alter total milk lipid. In Khon-Kaen, treatment with the combined pill was followed by a significant increase in the proportion of milk lipid. In the group treated with the long-acting injectable contraceptive, depot-medroxyprogesterone acetate (DMPA), the milk lipid decreased significantly in the first six weeks in comparison with the control group and the individual pretreatment values. A similar but weaker effect was noticed with the progestin-only pill in Khon-Kaen. Few consistently significant differences were found in the shorter chain fatty acids (myristic, lauric and palmitic acids) during treatment. The percentage proportions were increased during the combined pill treatment in Szeged and Khon-Kaen, and reduced in DMPA and progestin-only treatment in Khon-Kaen milks. The possibility that these reflected a response to a milk volume decrease in the combined pill treatment and a reduction in milk lipid synthesis in association with DMPA and the progestin-only pill is discussed. In Khon-Kaen, linoleic acid (which is not synthesized in the body) was increased by comparison with the controls, as a percentage proportion of the fatty acids in the progestin-only and DMPA groups. Calculation of the amounts of linoleic acid per litre of milk revealed that there had been a significant decrease of linoleic, eicosadienoic, dihommo-gamma-linolenic, arachidonic, docosatetraenoic acids in the w6 family and alpha-linolenic acid in the w3 family in the first two post-treatment visits (3 and 4). This reduction in essential fatty acid output follows the reduction in milk volume. In Khon-Kaen, the combined pill group showed a significant decrease compared with the controls, in the proportions of dihommo-gamma-linolenic acid. The difference in response of the mothers in Khon-Kaen and Szeged is discussed in relation to their different nutritional backgrounds.     

Implications of Psychosocial Factors as Precipitant of Asthma Attack Among a Sample of Asthmatics

Objective. To explore the relationship between psychosocial factors and asthma. Methods. One hundred consecutive asthmatics were screened using the 30-item version of the General Health Questionnaire (GHQ-30), Present state examination (PSE) and a socio-demographic schedule incorporating psychosocial variables. Chi-squared test, student “t” test and discriminant analysis were used in analysis. Results. Among the asthmatics studied 36% had psychopathology. Psychosocial variables significantly associated with psychopathology include worrying, crying, fighting, anger, marital tension, and menstruation. The presence of multiple psychosocial variables was significantly associated with psychopathology. Conclusion. Psychosocial variables predict the presence of psychopathology.     

Seasonal variation of births in rural southwestern Nigeria

A total of 12 708 live births registered between 1965 and 1975 in Igbo Ora, a rural area in southwestern Nigeria, were examined for seasonal variation using trigonometric regression analysis. The monthly number of registered births showed a significant seasonal pattern with a peak in May and corresponding minima in November. The extent of the seasonal variation above and below the annual mean was about 7%. There has been no significant shift in both the month of peak occurrence and the magnitude of the variation within the 11-year period of study. It is thought that the observed seasonal pattern may be related to climatic factors as well as sociocultural patterns of life associated with cyclical farming activities characteristic of a predominantly agricultural community.