scholarly journals Pitfalls in Diagnosing Heterotopic Pregnancy in Sub-Saharan Africa: A Case Report at the Yaounde University Teaching Hospital (Cameroon)

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Andre Ngandji Dipanda ◽  
Jovanny Tsuala Fouogue ◽  
Valere Koh Mve ◽  
Bruno Kenfack ◽  
Jean Dupont Ngowa Kemfang
Keyword(s):  
Teaching Hospital ◽  
Clinical Signs ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Heterotopic Pregnancy ◽  
Resource Poor ◽  
Wrong Diagnosis ◽  
Gestational Sac ◽  
Sub Saharan ◽  
Ectopic Pregnancies

Heterotopic pregnancy (HP) is a dizygotic twin pregnancy in which one gestational sac is intrauterine and the other is extrauterine. The prevalence of HP is unknown in Cameroon where the diagnosis is difficult and usually fortuitous like in other resource-poor settings. We herein depict pitfalls and delays in the diagnosis and management of a ruptured heterotopic pregnancy at the Yaounde University Teaching Hospital. After a wrong diagnosis and inadequate treatment, our patient presented at our emergency unit with severe pelvic pain and clinical signs of hemoperitoneum with shock. She underwent a total left salpingectomy through laparotomy. She had a complete spontaneous abortion five days after the surgery. Given that sonography is not routinely available in emergency departments in resource-poor settings, it may be relevant for practitioners to always bear HP in mind when facing ruptured ectopic pregnancies.

scholarly journals Myomectomy under Cervico-Isthmic Tourniquet: Experience of the Gynecologic-Obstetric Department at the University Teaching Hospital of Cocody (Abidjan)

2021 ◽  
pp. 1-3
Author(s):  
Adjoby Cassou Roland ◽  
◽  
Akobé Priva ◽  
Keyword(s):  
Blood Loss ◽  
Teaching Hospital ◽  
Foley Catheter ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Control Group ◽  
Sub Saharan ◽  
The University ◽  
Control Study

Objective: To report the experience of Cocody’s University Teaching Hospital in the practice of myomectomies under cervico-isthmic tourniquet and to assess its impact on per and post-operative blood loss. Methodology: It was a case control study covering a 10-year period (that is from January 2009 to December 2018), and a population of 600 patients divided into two groups (A and B). The first (A) includes all patients admitted and operated on uterine myomas after the introduction of a cervico-isthmic tourniquet (CIT) by Foley catheter (case) and the second all patients admitted and operated on without CIT(Control). Results: The average age of patients was 37 years with extremes of 24 and 50 years They were nulligestous in 38.3% of cases and nulliparous in 61.7% of cases. Hemorrhagic complications made up 65% of the surgical indications. The practice of myomectomy under cervico-isthmic tourniquet was associated with a relatively significant reduction in the duration of intervention including 20 minutes of time saved and a considerable reduction in blood loss(p<0,001). Blood loss was estimated at 438.8 ml (+/- 127) in the CIT group, compared to 685.4 ml (+/- 182) in the control group(p<0,001). The postoperative hemoglobin rate in the cervico-isthmic tourniquet patients was 10.1 g/dl compared to 8.7 g/dl in the non-distort patients(p<0,0012). No complications related to the presence of CIT were observed after sufficient follow-up. The length of stay in the hospital was estimated to be 2.8 days compared to 4.4 days in patients who did not use a tourniquet (p=0,15). Conclusion: The use of the cervico-isthmic tourniquet in myomectomy, considerably limiting blood loss and reducing postoperative morbidity, appears to be an alternative to blood transfusion in countries of sub-Saharan Africa, where the dispensing of blood products remains a problem.

Characteristics, physiology and mortality of intubated patients in an emergency care population in sub-Saharan Africa: a prospective cohort study from Kigali, Rwanda

2021 ◽  
Vol 38 (3) ◽  
pp. 178-183
Author(s):  
Gabin Mbanjumucyo ◽  
Adam Aluisio ◽  
Giles N Cattermole
Keyword(s):  
Endotracheal Intubation ◽  
Teaching Hospital ◽  
Univariate Analysis ◽  
Outcome Data ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Rapid Sequence Intubation ◽  
Shock Index ◽  
Success Rates ◽  
Sub Saharan

BackgroundFormalised emergency departments (ED) are in early development in sub-Saharan Africa and there are limited data on emergency airway management in those settings. This study evaluates characteristics and outcomes of ED endotracheal intubation, as well as risk factors for mortality, at a teaching hospital in Rwanda.MethodsThis was a prospective observational study of consecutive patients requiring endotracheal intubation at the University Teaching Hospital of Kigali ED conducted between 1 January and 31 December 2017. A standardised data collection tool was used to record patient demographics, preintubation clinical presentation, indication for intubation, vital signs. medications and equipment used, and periintubation complications. The primary outcome was in-hospital mortality. Univariate associations were determined for risks of mortality.ResultsOf 198 intubations were analysed, 72.7% were male and the median age was 35 years (IQR 23–51). Airway protection was the most common indication for intubation (73.7%). Rapid sequence intubation was performed in 74.2% of cases; sedative-only facilitated intubation in 20.6% and non-drug assisted in 5.2%. The most common agents used were Ketamine for sedation (85.4%) and vecuronium for paralysis (65.7%). All patients were successfully intubated within three attempts, 85.4% on the first attempt. During intubation, 23.1% of patients experienced hypoxia, 6.7% aspiration and 3.6% cardiac arrest. Median ED length of stay was 2 days. Outcome data were available for 164 patients of whom 67.7% died. Bonferroni-corrected univariate analysis demonstrated that mortality was associated with higher postintubation shock index (p=0.0007) and lower postintubation systolic blood pressure (SBP) (p=0.0006).ConclusionThe first-attempt and overall success rates for intubation in this ED in Rwanda were comparable to those in high-income countries (HIC). Mortality postintubation is associated with lower postintubation SBP and higher postintubation shock index. The high complication and mortality rates suggest the need for better resources and training to address differences in compared with HIC.

scholarly journals Prevalence of HIV in surgical patients at the Rivers State University Teaching Hospital

2021 ◽  
Vol 11 (3) ◽  
pp. 115-119
Author(s):  
Eli S ◽  
Aaron FE ◽  
Okagua KE ◽  
Omodu OJ ◽  
Iyama AC
Keyword(s):  
Teaching Hospital ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Surgical Patients ◽  
State University ◽  
Cross Sectional ◽  
Highly Active ◽  
Sub Saharan ◽  
Rivers State

Background: With the high prevalence of HIV in Sub-Saharan Africa, screening for this viral infection is a routine in many health institutions prior to surgery, the world has recorded success story in the research of HIV especially with the advent of Highly Active Anti-Retroviral Therapy (HAART) this disease burden has been reduced globally. The prevalence of HI in Nigeria is 1.4%. Aim: To determine the prevalence of HIV in surgical patients at the Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Rivers State, Nigeria. Method: This was a cross sectional study of ANC attendees at the RSUTH, from January 1st to June 31st, 2019. They were surgical patients who were systematically selected, information was obtained from patients case notes with a structured proforma. The information obtained was coded and analyzed using SPSS version 25. Result: A total of 370 patients were attended to pre-operatively. There were 146 (39.5%) males and 224 (60.5%) females. The mean age was 31 years. One hundred and ninety four (52.4%) were obstetrics and gynaecological surgeries while 176 (47.6 %) were non-gynaecological surgeries. The commonest indication for surgery was caesarean representing 126 (34.1%) of the subjects.The prevalence of HIV in surgical patients was 8 (2.1%). Three (1.6%) of the obstetrics and gynaecological patients had HIV compared to 1(0.5%) non-obstetrics and gynaecological patient. Conclusion: The study revealed that prevalence of HIV in surgical patients at the RSUTH was high (2.1%). HIV infection was thrice as common in obstetrics and gynaecological patients compared with other surgical disciplines. There is need to step up surveillance amongst ANC attendees who are reflection of the populace in this region.

scholarly journals Rare heterotopic pregnancy after frozen embryo transfer: a case report and literature review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xianping Wang ◽  
Ding Ma ◽  
Yangang Zhang ◽  
Yanhua Chen ◽  
Yuxia Zhang ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Left Kidney ◽  
Frozen Embryo Transfer ◽  
Heterotopic Pregnancy ◽  
Psoas Major Muscle ◽  
History Of ◽  
Gestational Sac ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
Psoas Major

Abstract Background Heterotopic pregnancy occurred after frozen embryo transfer with two D3 embryos, and the case had a history of bilateral salpingectomy due to salpingocyesis. An ectopic heterotopic pregnancy was implanted in the left psoas major muscle, which has not been previously reported. Case presentation A 33-year-old woman presented with left back pain after curettage due to foetal arrest in the uterus without vaginal bleeding and spotting, and painkillers relieved the pain initially. When the painkillers ceased to work, the patient returned to the hospital. The β-human chorionic gonadotropin (β-hCG) level remained increased compared with the time of curettage, and a diagnosis of retroperitoneal abdominal pregnancy was suggested by ultrasonography and computerized tomography (CT) with the gestational sac implanted in the left psoas major muscle at the left hilum level. Laparotomy was performed to remove the ectopic pregnancy. During the operation, we carefully separated the adipose tissue between the space of the left kidney door and left psoas major muscle, peeled away the gestational sac that was approximately 50 mm × 40 mm with a 25-mm-long foetal bud, and gave a local injection of 10 mg of methotrexate in the psoas major muscle. Fifty days later, β-hCG decreased to normal levels. Conclusion It is necessary to pay more attention to the main complaints to exclude rare types of ectopic pregnancies of the pelvis and abdomen after embryo transfer.

scholarly journals An afebrile heartwater-like syndrome in goats

2013 ◽  
Vol 84 (1) ◽  
Author(s):  
Rhoda Leask ◽  
Kenneth P. Pettey ◽  
Gareth F. Bath
Keyword(s):  
Clinical Signs ◽  
Control Measures ◽  
Sub Saharan Africa ◽  
Limiting Factor ◽  
Febrile Reaction ◽  
Presumptive Diagnosis ◽  
Appropriate Treatment ◽  
Sub Saharan ◽  
Characteristic Features ◽  
And Control

Heartwater is a serious limiting factor for sheep and goat production in the major endemic area of sub-Saharan Africa and therefore most knowledge, research and control methods originate from this region. Whilst the usual or common clinical presentations can be used to make a presumptive diagnosis of heartwater with a good measure of confidence, this is not always the case, and animals suffering from heartwater may be misdiagnosed because their cases do not conform to the expected syndrome, signs and lesions. One aberrant form found occasionally in the Channel Island breeds of cattle and some goats is an afebrile heartwaterlike syndrome. The most constant and characteristic features of this heartwater-like syndrome comprise normal temperature, clinical signs associated with generalised oedema, and nervous signs, especially hypersensitivity. The presumption that the disease under investigation is the afebrile heartwater-like syndrome entails a tentative diagnosis based on history and clinical signs and the response to presumed appropriate treatment (metadiagnosis). The afebrile heartwater-like syndrome presents similarly to peracute heartwater but without the febrile reaction. Peracute cases of heartwater have a high mortality rate, enabling confirmation of the disease on post-mortem examination. Recognition of the afebrile heartwater-like syndrome is important to prevent deaths and identify the need for appropriate control measures.

scholarly journals The Scope and Appetite for Technology-Assisted Sensitivity Reviewing of Born-Digital Records in a Resource Poor Environment

2018 ◽  
pp. 175-182 ◽  
Author(s):  
Alistair G. Tough
Keyword(s):  
Effective Means ◽  
Sub Saharan Africa ◽  
Public Records ◽  
Digital Repositories ◽  
Resource Poor ◽  
Preliminary Research ◽  
Sub Saharan ◽  
The University ◽  
Limited Demand ◽  
Assessing Sensitivity

Concerns about sensitive content in born-digital records seem to be a major factor in inhibiting the deposit of public records in dedicated digital repositories in Western countries. These concerns are much exacerbated by the changed nature of the process of reviewing records. The University of Glasgow, working in collaboration with the Foreign and Commonwealth Office, received funding to investigate the technology-assisted sensitivity reviewing of born-digital records. As part of this research, some preliminary research in a commonwealth country in Sub-Saharan Africa was carried out. The research, reported in this chapter, was carried out in Malawi by the late Dr. Mathews J. Phiri. He found that already there is a real, albeit limited, demand for technology-assisted sensitivity reviewing of born-digital records in Malawi. The available evidence suggests that within the next decade there is likely to be an increase in the need for effective means of assessing sensitivity in born-digital records.

E-Service Innovation in Rural Africa Through Value Co-Creation

2017 ◽  
pp. 355-373
Author(s):  
Anna Bon ◽  
Jaap Gordijn ◽  
Hans Akkermans
Keyword(s):  
Business Model ◽  
Service Innovation ◽  
End Users ◽  
Sub Saharan Africa ◽  
Resource Poor ◽  
Local Stakeholders ◽  
Rural Africa ◽  
Sub Saharan ◽  
Electricity Infrastructure

E-Services have great potential, even in resource-poor environments such as in sub-Saharan Africa. However, contextual factors pose significant challenges for development, feasibility, deployment and sustainability of e-services. This chapter presents a case of e-service value co-creation in a rural context, with targeted end users in regions characterized by limited electricity infrastructure and poor or absent internet, strong diversity in languages spoken, high illiteracy rates and limited purchasing power. It offers a methodology to upfront analyze business model sustainability for e-service innovation in severely resource-constrained contexts. This is illustrated by an extensive case study in which a voice-based microblogging e-service was developed and deployed with local stakeholders in rural Mali.

Sign in / Sign up

Export Citation Format

Share Document