Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial

Background

Contraception is a major component of reproductive health. Assessing the levels of contraceptive awareness and use helps to identify potential areas of intervention. Hence, this study was conducted to assess awareness, practice and associated factors of modern contraceptives among street women in North-West Ethiopia.

Methods

A cross-sectional study was conducted on 204 street women from Gondar and Bahir Dar cities. Participants were recruited from “cluster” sites such as main road sides, isolated slum areas, around Churches and/or Mosques (in the mornings of Sundays and other religious feast days) and streets where street women usually reside and/or sleep. Data were collected using a pre-tested and structured interview questionnaire in local language (Amharic) after informed verbal consent. Data were then entered into SPSS version 16.0 for analysis. Binary logistic regression models were fit to assess associations and control confounding. Associations were measured by the Odds ratio and its 95% confidence interval.

Results

The mean (±SD) age of participants was 30.9 (± 8.7) years. Majority (90.7%) had ever heard about modern contraceptives. Nearly half (47.1%) had ever used and a third (34.3%) were current users. Three quarter of the current users (74.3%) were using injectables while 10% were on long acting or permanent methods. Marital status (AOR=2.81), family size (AOR=2.67) and age of 25–34 years (AOR=3.45) were associated with modern contraceptive use.

Conclusions

Current contraceptive use among street women is satisfactory considering their life styles and living conditions. However, further research is required to explain perceptions and hidden barriers.     

Co-existence of nasopharyngeal carcinoma and sinonasal paraganglioma: a case report

Paragangliomas are very rarely seen in the nose, paranasal sinuses and nasopharynx. The development of paraganglioma concurrently with nasopharyngeal carcinoma in the same region has not been reported to date. In this study we reported a 59-years-old a female case of nasopharyngeal carcinoma who underwent radiotherapy six years ago and got the diagnosis of sinonasal paraganglioma in the same region during follow-up and underwent nasal endoscopic excision.     

Results of surgical treatment for pulmonary aspergilloma with 26 cases in six years: a single center experience

Surgery for pulmonary aspergilloma is reputed to be risky. We analyzed our results of the surgical treatment for pulmonary aspergilloma. Between 2003 and 2009, 26 patients underwent thoracotomy for treatment of pulmonary aspergilloma in our center. Results were evaluated retrospectively. There were 5 female and 21 male patients, with a mean age of 44 ± 11.6 years (28-70). The patients were divided into two groups, group A (simple aspergilloma; n= 8) and group B (complex aspergilloma; n= 18). Major underlying diseases were tuberculosis (61.5%). The most common indication for operation was hemoptysis (57.6%). Of our patients, 23% were complaining of massive hemoptysis or recurrent hemoptysis. Other patients were complaining of mild symptoms and some of them were totally asymptomatic. We performed 15 (57.6%) lobectomies (3 with associated segmentectomies), 8 (30.6%) segmentectomies/wedge resections, 2 (7.6%) pneumonectomies, and 1 (3.8%) cavernoplasty. Postoperative complications occurred in 15 (57.6%) patients. Complications occurred in 72.2% patients of complex aspergilloma, whereas 25% occurred in simple aspergilloma (p= 0.03). Major complications included prolonged air leak, empyema, air space. One patient who underwent lobectomies for complex aspergilloma developed bronchopleural fistula and died of respiratory failure on the 20th postoperative day. Operative mortality was 3.8%. The average postoperative hospital stay was 12.9 days. The mean follow-up period was average 44 months. The actuarial survival at 3 years was 90% and 100% for complex aspergilloma and simple aspergilloma, respectively (p> 0.05). There was two recurrence of disease (8%). But no recurrence of hemoptysis. Low morbidity rate may have been due to the selection of patients with localized pulmonary disease in this study. Surgical resection of asymptomatic or symptomatic pulmonary aspergilloma is effective in preventing recurrence or massive hemoptysis for patients whose condition is fit for pulmonary resection with reasonable mortality, morbidity and survival rates.     

Regional migratory osteoporosis: case report of a patient with neuropathic pain

Regional migratory osteoporosis (RMO) is an idiopathic disorder characterized by severe periarticular pain, transient and migratory arthralgia, and osteoporosis. Osteoporosis in this disease may appear in the form of local regional osteoporosis and bone marrow edema or generalized osteoporosis. It occurs most commonly in middle-aged men and late second or third trimester pregnant women. The laboratory findings of the disease are usually normal and do not demonstrate apparent anomalies. The presence of bone marrow edema on MRI is its characteristic finding. RMO can only be separated from transient osteoporosis of hip and avascular necrosis with migration to other joints. Clinically, RMO progresses in three stages: increasing pain and disability, radiological findings (osteopenia), maximalization of symptoms, and finally, the regression of the disease and radiological changes. In this case report, we present a 29-year-old woman whose symptoms had first appeared at the second trimester of pregnancy and migrated both to the other joints in the proximo-distal direction and to the adjacent bones within the same joint. She also had symptoms such as hyperalgesia, hyperesthesia and hypertrichosis along with neuropathic pain, which she described as a burning, biting, and prickling type of pain at the right leg. The neuropathic pain of the patient was resistant to medical treatment. We believe that this case was worth reporting because of the obstinate clinical course of the patient’s disease and her severe neuropathic pain that was resistant to treatment.     

Prosthetic aortic valve abscess producing left main coronary artery occlusion in a patient with type IV dual left anterior descending coronary artery

A 22-year-old female with a history of aortic and mitral valve replacement was admitted with a 4-week history of dyspnea and chest pain. Emergency coronary angiography revealed not only external compression of the left main coronary artery due to an aortic root abscess, but also the dual left anterior descending artery arising from the left and right coronary sinus. Although aortic root abscess is a well recognized complication of aortic valve endocarditis, coronary artery compression is an unusual mode of presentation. The binary distribution of the left anterior descending artery may limit the extent of ischemic insult to the anterior wall and thus led to a more insidious clinical course.     

Diagnostic importance of MRI and CT scans for synovial osteochondromatosis of the temporomandibular joint

Since synovial chondromatosis (SC) clinically mimics symptoms of internal derangements of the TMJ, the diagnostic value of MRI and CT, overlooked for years, is discussed in the presented case. Multiple amorphous calcifications in the left infratemporal fossa and upper synovial compartment of the TMJ were detected on the CT and MRI scans. The patient underwent open TMJ arthrotomy and removal of 15 calcified loose bodies. SC may be diagnosed radiographically when sclerosis of the glenoid fossa, soft tissue edema, and intraarticular radio-opaque loose bodies are detected. Advanced imaging of the TMJ, such as MRIs and CTs, are indispensible methods to obtain differential diagnoses for long-standing suspicious pathologies of the temporomandibular joint.