Preoperative pain treatment in acute abdomen in Osogbo,Nigeria: a randomized double-blind placebo-controlled study

Background

Withholding analgesics in acute abdomen for fear of masking clinical features and impairing diagnosis and decision-making is still being practiced despite recent evidence to the contrary. This study assesses the effect of preoperative analgesia on clinical findings, clinical diagnosis, and decision-making in patients with non-trauma acute abdomen.

Method

This is a randomized, double-blind, placebo-controlled study using Tramal, a brand of tramadol, at the ED of LAUTECH Teaching Hospital Osogbo, Nigeria. Ninety-five patients between 18–60 years received Tramal (n?=?46) or placebo (n?=?49). The pain score, clinical findings, provisional diagnosis, and treatment plan were noted before and 15–20 min after administration of the analgesic or placebo. The final diagnosis arrived at after adequate investigation or operation was considered the gold standard. The pain scores, diagnosis, treatment plan, and decision between the two groups were compared. Statistical analysis was by SPSS 16. Results were considered statistically significant at p?<?0.05.

Results

Demography and case distribution were similar in both groups. The improvement in pain was greater in the Tramal group (p?=?0.001). The abdominal palpation findings were also better in the Tramal group (p?=?0.02). There were more changes in the diagnosis after use of Tramal (p?=?0.01). There were more changes in the decision in the Tramal group (p?=?0.03). Most of the changes in diagnosis and decision in the Tramal group were for the better.

Conclusion

The preoperative use of Tramal in acute abdomen improved the experience of pain and did not adversely affect the accuracy of the diagnosis or decision-making.

     

Australian midwives' perspectives on managing obstetric care of women living with female genital circumcision/mutilation

Female genital mutilation (FGM) or female circumcision is a global health issue with increasing international migration of affected women and girls to countries unfamiliar with the practice. Western health care providers are unfamiliar with FGM, and managing obstetric care presents challenges to midwives who are in the forefront of care provision for the women. The participants in this Heideggerian qualitative interpretive study elucidated the strategies they used in overcoming the particular physical, emotional, and gynecological health issues with which mutilated women present. Ongoing emphases on women-centered, culturally competent maternity care are germane to optimal maternity care of circumcised women.     

“You take the private part of her body, … you are taking a part of her life”: Voices of circumcised African migrant women on female genital circumcision (FGC) in Australia

ABSTRACT

Western countries working toward eradication of female genital mutilation require better inclusion of women originally from countries where the practice is prevalent. However, few authors have examined the knowledge, attitudes, and experiences of circumcised African migrant women in western countries. Our findings from 40 responses from self-reported survey and five in-depth interviews show that the participating African migrant women know the reasons behind female genital circumcision (FGC), are living with the negative consequences of FGC, and have a zero tolerance attitude toward the practice. Circumcised women are in the best position to define their health needs and champion global efforts to eradicate FGC.     

Glycemic control and its association with sociodemographics,comorbid conditions,and medication adherence among patients with type 2 diabetes in southwestern Nigeria

ObjectiveWe determined the prevalence of poor glycemic control and associations with sociodemographics, comorbid conditions, and medication adherence among patients with type 2 diabetes mellitus (T2DM) at a tertiary hospital in southwestern Nigeria.MethodsWe conducted a retrospective observational study among 300 patients with T2DM using systematic random sampling. We used a semi-structured questionnaire to collect information on respondents’ sociodemographic profile, lifestyle, comorbid conditions, and antidiabetic medications. Adherence was determined using the Morisky Medication Adherence Scale. Fasting blood samples were tested using a glycated hemoglobin marker. Multivariate logistic regression was used to identify factors associated with poor glycemic control.ResultsRespondents’ mean age was 61.9 ± 11.8 years. The prevalence of poor glycemic control was 40.0% (95% confidence interval [CI]: 34.4%–45.8%). The adjusted odds ratio (95% CI) for factors associated with poor glycemic control was 2.522 (1.402–4.647) for older age, 1.882 (1.021–3.467) for low income, 1.734 (1.013–3.401) for obesity, 2.014 (1.269–5.336) for non-initiation of insulin therapy, and 1.830 (1.045–3.206) for poor medication adherence.ConclusionOlder age, lower income, obesity, non-initiation of insulin, and poor medication adherence were associated with poor glycemic control. These variables may help clinicians identify patients at high risk of poor glycemic control.     

Effect of Cadmium Stress on Non-enzymatic Antioxidant and Nitric Oxide Levels in Two Varieties of Maize (<Emphasis Type="Italic">Zea mays</Emphasis>)

Cadmium (Cd) is one of the most toxic heavy metals that inhibit physiological processes of plants. Hence, the present study sought to investigate the effect of cadmium-contaminated seeds from two varieties of maize (Zea mays) on non-enzymatic antioxidant and nitric oxide levels. Seeds of yellow and white maize were exposed to different concentrations of Cd (0, 1, 3 and 5 ppm) for two weeks. The results from this study revealed that both varieties of maize bio-accumulate Cd in leaves in a dose-dependent manner. In addition, Cd exposure caused a significant (p?<?0.05) decrease in total phenolic, GSH and nitric oxide (NO) levels at the highest concentration tested when compared with control. Therefore, the observed decrease in NO and endogenous antioxidant status by Cd treatment in maize plants could suggest some possible mechanism of action for Cd-induced oxidative stress and counteracting effect of the plants against Cd toxicity.     

How Effective is the Treatment of Locally Advanced and Metastatic Breast Cancer in Developing Centres?: A Retrospective Review

Background

The use of chemotherapy in advanced metastatic breast cancer remains a subject of controversy. The thought of MicKinnon et al (early 1950s) that the course of breast cancer was unaffected by chemotherapy has been refuted by results of treatment in the developed countries. The poor result of treatment in developing centres still compares with prechemotherapy era. Consequently, The McKinnon''s thought may still lurk. We compared the survival of chemotherapy treated with chemotherapy untreated cancer of breast patients.

Method

Records of breast cancer patients who presented and died between January 2010 and May 2014 were reviewed. The primary outcome was overall survival. Records of patients that received chemotherapy with or without other tumor directed specific therapy were compared with records of patients who did not receive any tumor directed therapy.

Result

Thirty-one patients received chemotherapy while 25 patients did not. All were females, more than 90% were of the patients had advanced or metastatic disease. Treatments were not biologically directed and treatment plans were largely compromised and suboptimal. The overall mean survival was 19.2 ±9.2 months, and the median duration was 17.5 months(range 6–44months). The overall survival was not statistically different between the two groups (p= 0.230, unequal variance assumed). The objective of using neoadjuvant chemotherapy for fungating lesions was not achieved.

Conclusion

In advanced and metastatic breast cancer, outcomes of patients who receive suboptimal regimen of cytotoxic chemotherapy do not differ from chemotherapy untreated patients.     

Managing family life while studying: single mothers' lived experience of being students in a nursing program

Evidence suggests that single parent families are more likely to be affected by social problems associated with poor health and poverty. Single parent families are growing in number and are overwhelmingly headed by women. Despite their increasing number and their level of vulnerability, the lived experiences of single mothers have attracted little attention in the literature. Still little is known about many aspects of life as experienced by single mothers. Nursing is a profession that is dominated by women, and every year a number of single mothers enroll in undergraduate nurse education programs. Currently, there is little information about the experiences of women who are single mothers, undertaking a nursing degree in a university. This paper reports a study that explored the lived experiences of five single mother undergraduate nursing students. van Manen's phenomenological method informed the design and conduct of the study. Findings were grouped into the following themes: being exhausted all the time; being overwhelmed with worries; and being hopeful of the future. Findings of this study revealed that the single mothers' major health concerns were chronic tiredness and overwhelming worries. However, their being in the university was perceived as being health promoting and restoring to their self-esteem. Implications for educators, health providers and women's health services are drawn from the findings.     

Effect of elastic compression stockings on venous hemodynamics during walking

PURPOSE: Venous hemodynamics evaluated during walking better reflect changes that occur under active physiologic conditions than do conventional static modes of exercise such as tip-toe exercise, knee bending, or dorsiflexion. We prospectively studied the efficacy of air-plethysmography (APG) in monitoring venous hemodynamics during ambulation, and with this method we determined the hemodynamic effects of graduated elastic compression stockings on the lower limb during walking at various speeds. METHODS: The residual volume fraction (RVF%) during treadmill walking was monitored with APG in 10 limbs with primary chronic venous insufficiency (CVI)(CEAP(2-4)) at four speeds (1.0, 1.5, 2.0 and 2.5 km/h consecutively), with and without elastic compression (21 mm Hg at the ankle). The method was validated in comparison with standard APG, which is based on tip-toe exercise. RVF obtained during treadmill walking at 1.5 km/h was correlated with RVF measured with standard APG in 30 subjects: 12 healthy volunteers, 11 patients with primary CVI, and 7 postthrombotic limbs. Data were analyzed with nonparametric statistics. RESULTS: RVF measurements during walking were reproduced with an intra-day coefficient of variation of 5.1% to 16.5%. RVF during walking correlated well with RVF during standard APG (tip-toe) (r = 0.5, P =.004). At each of the investigated walking speeds, stockings improved venous hemodynamics by decreasing RVF, from a median of 50.5% without stockings to 40.5% with stockings at 1.0 km/h (19.8% decrease), from 49% to 39.5% at 1.5 km/h (19.4% decrease), from 50.5% to 41% at 2.0 km/h (18.8% decrease), and from 53% to 45.5% at 2.5 km/h (14.2% decrease) (all speeds, P <.02). Efficacy of the stockings in decreasing RVF (percent change in RVF) was similar across the spectrum of examined speeds (P =.47). During walking with elastic stockings, nominal RVF values were also similar across the spectrum of walking speeds, except at 2.5 km/h (P =.012). During walking without stockings, RVF did not change with treadmill speed, nor did it differ from that obtained with conventional APG (tip-toe) (P =.46). The percentage decrease in RVF generated with elastic stockings correlated with the venous filling index (r = 0.73, P =.017) at 1.0 km/h. CONCLUSIONS: APG is a reproducible and valid method for monitoring venous hemodynamics during walking. Graduated elastic compression stockings significantly improved venous hemodynamics by reducing RVF in limbs with primary CVI at all examined walking speeds (1.0 to 2.5 km/h). The effect was linearly correlated with the amount of reflux (1.0 km/h). The modified application of APG during walking offers a new noninvasive method for assessment of venous hemodynamics in limbs with CVI, enabling quantification of the actual effect of elastic compression therapy during ambulation.     

Determinants of Delayed Presentation and Advanced-Stage Diagnosis of Breast Cancer in Africa: A Systematic Review and Meta-Analysis

Background/Objective: Breast cancer (BC) mortality is exceptionally high in Africa due to late presentation and advanced-stage diagnosis. Previous studies examining barriers to early BC presentation are markedly inconsistent, showing conflicting findings within and between African regions, making resource allocation and designing interventional campaigns challenging. Our objective was to assess the strength or magnitude of the association between determinants/risk factors and delayed presentation/advanced-stage diagnosis of BC in Africa. Methods: Electronic searches in PubMed, AJOL, Google, ResearchGate, ScienceDirect, and PubMed Central found eligible articles between 2000 and 2020. The meta-analytical procedure in Meta-XL used the quality effect model. I-squared (I2) above 75% indicated high heterogeneity. The summary effect size was the odds ratio with 95% confidence intervals. Results: The effect of socio-economic and demographic determinants on delay varies across African regions. Low level of education (1.63, 95% CI 1.01-2.63), and not performing breast self examination (BSE) (13.59, 95% CI 3.33-55.4) were significantly associated with delayed presentation. Younger patients had more significant delays in West Africa (WA, 1.41, 95%CI 1.08-1.85), and the reverse occurred in North Africa (0.68, 95%CI 0.48-0.97). Lack of BC knowledge (1.59, 95% CI 1.29-1.97), not performing BSE, or no history of undergoing clinical breast examination (CBE) (2.45, 95% CI 1.60-3.40), were associated with advanced-stage disease at diagnosis. Older patients had significantly more advanced disease in WA, and the reverse occurred in South Africa. Aggressive molecular BC subtypes [Triple negative (OR 1.62, 95% CI 1.27-2.06) or HER2 positive (1.56, 95% CI 1.10-2.23)] were significant determinants of advanced-stage diagnosis. Conclusion: Promoting early presentation and reducing advanced-stage BC throughout Africa should focus on modifiable factors, including providing quality education, improving breast health awareness and BC knowledge, and developing strategies to increase BSE and CBE. Interventions targeting socio-demographic determinants should be context-specific.