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Background: Caesarean section is the most significant obstetrics operative intervention globally. Good postoperative experience after caesarean section is important because there is need for the mother to recover from surgery and take care of her baby. The aim of this study was to assess the experience of women that had caesarean section in the first 24 hours postoperatively. Materials/methods: This was a cross-sectional study conducted among women that had elective and emergency caesarean section. They were followed up to 24 hours post-operative. The primary outcome measures were pain score and satisfaction. Secondary outcome measures were time of mobilization, time of commencement of oral feeds and time of initiation of breastfeeding. Data analysis was carried out using Statistical Package for Social Sciences version 22. Results: The median pain scores among those that had emergency and elective caesarean section ranged between 2 and 3 at all points of pain assessment. The satisfaction was good among 66.1% that had emergency caesarean section and 71.2% among those that had elective caesarean section. However, the difference was not statistically significant (χ2 = 0.546, p = 0.761). More than 90% of the participants that had either emergency or elective caesarean section did not ambulate within the first 24 hours after caesarean section and there was no association between the time of ambulation and the type of caesarean section (χ2 = 0.005, p = 0.941). Conclusion: The participants had adequate pain relief and majority were satisfied with the pain relief. However, the optimum satisfaction was not achieved. The participants did not ambulate early and did not initiate breast-feeding early. Recommendation: Further research is recommended to assess other factors that affect patient's satisfaction and ambulation so as to improve on patient's postoperative care.

Background and objective. Koch et al., reported that the Waist/Hip Index more accurately predicts cardiovascular risk factors and mortality. Huaman et al., reported that the Waist/Height Index can be used as a diagnostic test for metabolic syndrome, since it has a high significant value. To determine whether two anthropometric indices have sufficient prognostic efficiency or moderate prognostic efficiency by combining sensitivity and specificity using positive and negative likelihood ratios in a single expression. Material and methods. Quantitative epistemological approach. Descriptive observational epidemiological study without directionality and with prospective temporality. Three husband adult patients of both genders who attended the Integral Hospital "Jose Maria Morelos" were studied. As a reference test or Gold Standard was used the Lorentz Equation as a reference test. Results. The results for the positive likelihood ratios corresponded to 13.41 and 1.72 for the anthropometric indices Waist/Height Index and Waist/Hip Index, respectively. The results for the negative likelihood ratios corresponded, respectively, to 0.07 and 0.48 for the anthropometric indices Waist/Height Index and Waist/Hip Index. Conclusions. The best anthropometric index for the diagnosis of overweight and obesity pathological nutritional situations corresponds to the Waist/Height Index, since the results of the positive and negative likelihood ratios report sufficient prognostic efficiencies. On the other hand, the results of the positive and negative likelihood ratios report, respectively, negligible prognostic efficiency and poor prognostic efficiency for the Waist/Hip Index.

Bats have been reported as hosts of the Trypanosoma cruzi protozoan, the etiologic agent of American trypanosomiasis, an endemic zoonotic disease in México.To describe T. cruzi infection in bats from the states of Campeche and Yucatán, México.Captures were made from March to November, 2017, at three sites in Yucatán and one in Campeche. Up to four mist nets on two consecutive nights were used for the capture. The bats' species were identified and euthanasia was performed to collect kidney and heart samples for total DNA extraction. Trypanosoma cruzi infection was detected by conventional PCR with the amplification of a fragment belonging to the T. cruzi DNA nuclear.Eighty-six bats belonging to five families (Vespertilionidae, Noctilionidae, Mormoopidae, Phyllostomidae, and Molossidae) and 13 species (Rhogeessa aeneus, Noctilio leporinus, Pteronotus davyi, P. parnellii, Artibeus jamaicensis, A. lituratus, A. phaeotis, Glossophaga soricina, Carollia sowelli, Chiroderma villosum, Uroderma bilobatum, Sturnira parvidens, and Molossus rufus) were captured. Infection frequency by PCR was 30,2% (26/86) detected only in the renal tissue. The infected species were P. parnellii, G. soricina, A. lituratus, A. jamaicensis, S. parvidens, C. villosum, and R. aeneus.Our results confirmed the participation of several bat species as hosts in the T. cruzi transmission cycle in the region. Further studies are necessary to establish the importance of these animals in the zoonotic transmission of T. cruzi.Introducción. Los murciélagos se han reportado como huéspedes del protozoario Trypanosoma cruzi, agente etiológico de la tripanosomiasis americana, enfermedad zoonótica endémica en México. Objetivo. Describir la infección con T. cruzi en murciélagos capturados en los estados de Campeche y Yucatán, México. Materiales y métodos. Se realizaron capturas de marzo a noviembre de 2017 en tres sitios de Yucatán y uno de Campeche. Para la captura se emplearon hasta cuatro redes de niebla por dos noches consecutivas. Se identificó la especie de los murciélagos capturados y se les practicó la eutanasia para recolectar muestras de riñón y corazón, utilizadas posteriormente en la extracción de ADN total. La infección con T. cruzi se detectó por la amplificación con PCR convencional de un fragmento perteneciente al ADN nuclear de T. cruzi. Resultados. Se capturaron 86 murciélagos pertenecientes a cinco familias (Vespertilionidae, Noctilionidae, Mormoopidae, Phyllostomidae, Molossidae) y 13 especies (Rhogeessa aeneus, Noctilio leporinus, Pteronotus davyi, P. parnellii, Artibeus jamaicensis, A. lituratus, A. phaeotis, Glossophaga soricina, Carollia sowelli, Chiroderma villosum, Uroderma bilobatum, Sturnira parvidens y Molossus rufus). La PCR mostró una frecuencia de infección de 30,2 % (26/86), detectada únicamente en tejido renal. Las especies infectadas fueron P. parnellii, G. soricina, A. lituratus, A. jamaicensis, S. parvidens, C. villosum y R. aeneus. Conclusiones. Los resultados confirmaron la participación de varias especies de murciélagos como huéspedes en el ciclo de transmisión de T. cruzi en la región. Es necesario realizar más estudios para determinar la importancia de estos animales en la transmisión zoonótica de T. cruzi.

Proximal humerus chondrosarcoma is a rare localization of the common primary malignant cartilaginous tumor. Management is based on oncological surgical excision because of the inherent resistance to chemotherapy and radiation therapy. The most important prognostic factors with great impact on treatment strategy are histological grading and localization of the tumor. Proximal humerus chondrosarcoma carries a slightly better prognosis, especially for the low and moderate grade tumors. We present the case of a young patient with proximal humerus chondrosarcoma surgically managed in our Department, with the purpose of underlining the challenges posed by this localization for oncological excision and reconstruction but also the importance of histological grading for the treatment algorithm.

Background: Group B Streptococcus (GBS) is a major cause of bacterial infections in the perinatal period, of which colonization prevalence among Northern-Nigerian pregnant women is scarce. We attempted to determine 1) its prevalence, 2) risk factors for GBS colonization and 3) drugs-susceptibility. Methodology: This cross-sectional study involved 185 pregnant women between 35 - 37 weeks of gestation at tertiary health center of Sokoto, Nigeria. Vaginal/rectal swabs were collected, were cultured for GBS and tested for drug-susceptibilities. The study was conducted between December, 2017 and April, 2018. Results: One hundred and eighty five (185) pregnant women participated in this study. GBS vaginal-colonization-rate was 3.8% (7/185). A significance relationship was observed between GBS-colonization and socio-economic class, as 57.10% (4/7) of the GBS positive women were of low-socio economic class (p 0.035). No associations were observed between GBS-colonization and the followings: maternal age, parity, poor obstetric outcome-history. All the 7 GBS positive cultures were sensitive to Clindamycin. One was sensitive to both Clindamycin and Ceftriaxone. None was sensitive to Penicillin. Conclusion: The prevalence of GBS colonization was low in this area. Maternal socio-economic class is found to be a risk of GBS-colonization.

Bilateral tubal ligation is a form of female sterilization. It is the most commonly used method of family planning worldwide and it is a permanent method of fertility control. However the failure rate is 0.1 – 0.8%. A case report of a booked Gravida 5, Para 3+1, Alive 3 who had two previous Caesarean Sections and a previous Uterine Rupture is presented. She had a Bilateral Tubal Ligation (BTL) performed. She however presented six years after this with a spontaneous pregnancy. She presented in the first trimester, the pregnancy was followed up and she eventually had elective caesarean section and repeat bilateral tubal ligation.

Hepatitis B virus (HBV) is a major public health problem in sub-Saharan Africa with high morbidity and mortality. Vertical transmission is a significant contributor of new cases. The aim of this study was to determine the prevalence of HBV infection, to assess the immune competence of Hepatitis B (HB) viral infected pregnant women using lymphocyte transformation. It was a cross sectional comparative observational study. Simple random sampling technique was applied. One hundred HB infected pregnant women and one hundred controls were recruited. Data were analysed using SPSS (version 23) software. A P-value ≤ 0.05 was considered statistically significant. The results recorded showed a prevalence of 6.6%. The percentage lymphocyte transformation was significantly lower (p < 0.05) for HBV infected subjects compared with control. The rate of lymphocyte transformation with Phytohaemagglutinin was significantly lower (p < 0.05) when compared with Concanavalin A. Conclusively HB infection affects the adaptive immune response. Pregnant women should be screened for Hepatitis B surface Antigen (HBsAg) during routine Antenatal clinic and Concanavalin A based drugs should be recommended for HB infected pregnant women.

Hydroxyapatite (HA) covered implants are widely used in orthopedic reconstructive surgery. Their biological benefits were highlighted by several studies in the past decades in which the most important ones are the osteoconductive and osteoinductive capacity, which enhances osteoblast adherence, proliferation and bone extracellular matrix formation. In bone sarcomas the micro-environmental changes are crucial for tumor growth, new bone formation especially in osteoblastic osteosarcomas (OS). Nowadays limb sparing surgery and maintaining the quality of patient�s life are the main two goals in bone sarcoma treatment. The survival rate of patients with OS has been significantly improved in the past 3-4 decades due to the advanced chemotherapy protocols. The prognosis still depends on the early diagnosis and the histological type of the sarcoma. Tumor removal and reconstruction is a crucial moment for prognosis, studies showed that high grade sarcomas have a greater potential for local recurrence and early distant metastases. Metastasis can occur in early stages, even if there are not detectable at the time of surgery. Furthermore, the micro-environmental changes can facilitate sarcoma cell proliferation even if the tumor resection was performed in macroscopically normal bone tissue. We present a case of osteosarcoma in which local recurrence has occurred despite of chemotherapy and wide resection of the tumor. We can ask the following question can an implant increases the risk of local recurrence in sarcoma surgerys The aim of the study was to understand the underlying molecular pathway for sarcoma cell proliferation in HA covered implants.

The genes encoding α-1,3-glucanases (Agls; AglST1 and AglST2) from Streptomyces thermodiastaticus HF3-3 were cloned and were then expressed in Escherichia coli Rosetta-gami B (DE3). We purified the resultant histidine (His)-tagged α-1,3-glucanases (recombinant enzymes, rAglST1 and rAglST2). Both the recombinant enzymes were similar to the wild-type enzymes. We examined the effects of rAglST1 and rAglST2 on the formation and degradation of biofilms on glass plates with Streptococcus mutans NRBC 13955 by evaluating the biofilm content (%), release of reducing sugar (mM), release of S. mutans (log CFU/mL), and the biofilm structure using laser scanning microscopy (LSM). The results showed that after incubation for 16 h, rAglST1 and rAglST2 reduced the formation of biofilm to 52% and 49% of the control, respectively. The result may reflect the fact that the concentration of the reducing sugar and the number of S. mutans cells in the rAglATs-added medium were higher than in the control medium. After an 8-h treatment with rAglST1 and rAglST2, biofilms decreased to less than 60% of the control. The number of S. mutans cells in the reaction mixture gradually increased during the incubation period. The enzymes can degrade the biofilms that were pre-formed on the glass plate by more than 50% after a 30-min incubation in the presence of toothpaste ingredients (1% w/v of sodium fluoride, benzethonium chloride, and sodium dodecyl sulfate) at 50°C. Our study showed that rAglST1 and rAglST2 have advantageous properties for dental care applications.

Background: Semen analysis has remained an objective, inexpensive and readily available means of assessing male factor infertility. Aim and Objective: This study aims to determine the prevalence of male infertility, the types and semen quality among infertile couples attending infertility clinic at UDUTH, Sokoto. Materials and Method: This is a retrospective study carried out between January, 2012 to December, 2016. All case notes of infertile patients managed were retrieved The data obtained was analysed using SPSS version 20 and the results were presented in text, tables and charts. Results: Eight hundred and seventy-six out of 11,938 total gynaecological consultations over the study period were due to infertility, giving a prevalence of 7.3%. Among them, 34.4% (320) accounted for male factor infertility. The age ranged between 22 to 75 years with a mean of 37.44 years ± 7.44. Majority, 50.2% were within the ages of 35 - 44 years and up to 73.8% of them had at least secondary education and were mostly, 39.7% civil servants. Up to 75.4% had sperm abnormalities, among which 65% (196/301) had primary infertility while, 35% (105/301) had secondary infertility. About half of them (47.5% (153/301)) had Azoospermia, 22.3% (67/301) Oligospermia and only 30.3% (91/301) had a normal sperm count. More than half of them, 121/227 (53.3% had multiple abnormalities). Conclusion: Male factor infertility contributes significantly to the burden of infertility in our environment. Therefore, there is the need to create awareness so that males fully participate in the evaluation, as the blames are mainly on the females.

Background: A variety of anesthetic techniques have been used to make transvaginal oocyte retrieval (TVOR) safe and efficient. The optimal anesthetic technique during TVOR should provide safe, effective analgesia, few side effects, a short recovery time, and be nontoxic to the oocytes that are being retrieved. The concept of conscious sedation is widely accepted for the short-term management of pain. Objective: This study assessed patient's perception of pain using conscious sedation and in-vitro fertilization (IVF) outcomes. Materials and Methods: A cross sectional study of 71 eligible patients that underwent assisted reproduction program in our facility. All clients were treated with antagonist protocol for controlled ovarian hyperstimulation. Self-administered questionnaires were used as the research instrument. Pain was assessed using a 10 cm visual analogue scale (VAS), while client's overall satisfaction was rated using Likert scoring system. Results: Client aged 33.2 ± 4.2 years. Most of them had primary infertility with mean duration of 4.5 ± 2.9 years. Unexplained infertility was the commonest cause of infertility. The pregnancy rate per embryo transfer was 47.9%, miscarriage rate was 5.6%, while the live birth rate was 42.3%. The mean VAS scores at 1 h, 6 h, 24 h and at embryo transfer were 4.9 ± 1.7, 2.5 ± 1.2, 1.3 ± 0.9, and 0.5 ± 0.6, while the Likert score was 3.8 ± 1.1. Conclusion: Conscious sedation with Midazolam and Pethidine is a safe, effective, and acceptable method of analgesia/anesthesia for TVOR. However randomized prospective studies with larger sample sizes are recommended.

Background: Group B Streptococcus (GBS) infection is a major cause of bacterial infections in the peri-natal period. These include amnionitis, urinary tract infections and endometritis. At birth, 50-60% of the neonates born to colonized mothers have positive cultures taken from mucus membranes and the skin. Aim: The aim of this study is to determine prevalence of GBS colonization and compare the maternal and perinatal outcomes among GBS positive and GBS negative women within 7 days postpartum. Methodology: This was a longitudinal study among pregnant women between 35-37 weeks gestation attending antenatal clinic at Usman Danfodiyo University Teaching Hospital, Sokoto. Vaginal and rectal swabs were taken from the participants and cultured for growth of Group B Streptococcus within 24 hours. The participants were followed up to 7 days post-delivery with their newborns to determine the maternal and early neonatal outcomes. Results: One hundred and eighty five (185) women were recruited and 159 (85.9%) participants were available for follow-up to determining feto-maternal outcomes. Among the participants, 3.8% (7) had GBS vaginal colonization. There was no single case of early neonatal infection, intensive neonatal resuscitation nor neonatal mortality among both GBS positive and GBS negative women. Conclusion: It has been found that the prevalence of maternal GBS colonization during pregnancy was low and neither GBS colonization nor GBS non-colonization was associated with poor maternal or poor fetal outcomes.

Background: The Branham sign is a baroreceptor response that follows patent ductus arteriosus (PDA) closure. Although described in dogs following both interventional and surgical ductal closure, a direct comparison of the Branham sign elicited by these two techniques has not been made. Aim: Since closure with an Amplatz canine ductal occluder (ACDO) occurs over 10 minutes and surgical ligation (SL) is more rapid, we hypothesised that the Branham sign following occlusion of a PDA with an ACDO would be less severe than following SL.Methods: Clinical records of dogs diagnosed with left-to-right shunting PDA between 2008 and 2018 were retrospectively reviewed. Of 139 dogs undergoing PDA occlusion, only 41 dogs (ACDO n = 32, SL n = 9) were included after applying exclusion criteria. Heart rate and BP from occlusion time (T0) until thirty minutes post occlusion (T30) were recorded. Signalment and anaesthetic protocol were also recorded. The influence of age and weight on the haemodynamic variations was assessed. Haemodynamic variables and calculations were compared between and within groups using a repeated measures general linear model, and post hoc tests were applied if significance was identified.Results: A mild Branham sign was present in both groups, and haemodynamic changes were not significantly different between groups. In both groups, there was a significant decrease in HR (11 bpm, 5.3 – 16.3; p < 0.001) (10.4 %, 5.4 – 15.5; p < 0.001) and increase in diastolic BP (9.5 mmHg, 3 – 16; p = 0.002) (23.5 %, 7.1 – 39.9; p = 0.002), but systolic BP did not change significantly (p = 0.824). Age and weight did not influence Branham sign.Conclusion: The Branham sign in dogs is mild in both groups, lasts for at least 30 minutes, and is independent of the method of PDA closure.

Background Uterine fibroid is the most common benign tumour of the uterus and the exact cause is unknown. Vitamin D has been found to inhibit cell proliferation and enhance apoptosis in vitro. Aim The aim of this study is to compare the plasma level of Vitamin D among women with uterine fibroids and those without uterine fibroids. Materials and methods This was an analytical cross-sectional study conducted among women with uterine fibroids and those without uterine fibroids. An interviewer-administered questionnaire was used to obtain relevant information. Five millilitres of venous blood was obtained for plasma Vitamin D assay. Data analysis was performed using the SPSS version 22. Level of significance was set at P Results There were 100 participants recruited for the study. The mean age of the participants with uterine fibroid was 35.06 ± 6.6 years and that of controls was 33.28 ± 7 years. The mean plasma level of Vitamin D for all the participants was 12.47 ± 7.53 ng/ml. The mean plasma level of Vitamin D in those with uterine fibroids was significantly lower than in those without uterine fibroid (10.16 ± 7.78 vs. 14.35 ± 6.8; t = 2.517, P = 0.014). It also shows that 1 unit increase in Vitamin D level will reduce the risk of developing uterine fibroids by 8% (odds ratio = 0.92, 95% confidence interval = 0.86-0.99). Conclusion The predictors of uterine fibroids were fewer hours spent outdoors, middle social class and low Vitamin D levels.

Background: Episiotomy is a deliberate surgical incision of the perineum with the aim of increasing the vulval outlet to facilitate childbirth. However, it could be associated with some complications, such as pain, hemorrhage, and wound infection. It is a surgical procedure that requires adherence to basic surgical principles of providing adequate analgesia. Aim: To determine the efficacy of magnesium sulphate (MgSO4) as an adjunct to local anesthetics for analgesia during episiotomy repair among women that had vaginal delivery at Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, Nigeria. Subject and Methods: This was a single-blind randomized clinical trial. Pregnant women who had episiotomy during the study period were randomized into two groups. Those in Group A had xylocaine administered alone, whereas those in Group B had xylocaine + MgSO4 administered for repair of episiotomy. Pain was assessed by numeric rating scale at commencement of the repair, at 2 and 6 h after the repair. Patient's level of satisfaction, request for additional analgesia, and side effects were also assessed. Results: The pain score in the xylocaine + MgSO4 group was lower throughout the period of assessment. There was no significant difference in the pain scores between the two groups at 0 and 6 h. However, there was significant difference in the mean pain scores between the two groups at 2 h (P

The umbilical cord is the critical organ that links the placenta and fetus. The intrauterine conditions and fetal activity influences the umbilical cord length. The normal umbilical cord is spiraled. By ultrasound, the spiral nature of the umbilical cord can be demonstrated early in the i¬rst trimester. Most of the adverse pregnancy and perinatal outcomes are related to abnormal Umbilical Cord coiling Index (UCI). A 23 year booked G2P1+0 of about 4/12 pregnant is presented. She presented 4 h history of colicky lower abdominal pain and 1 h history of vaginal bleeding; there were passage of blood clot but no fleshy materials or vesicles. No history of urinary symptoms or trauma, she is not a known Diabetics, hypertensive or sickle cell diseases patient. On examination, was not in painful distress, not pale, afibrile (36.9°C), anecteric and no fedal edema. Other parameters were within normal limit. Pelvic examination reveals a vulva smeared with blood, the fetal membrane were bulging into the vagina, this rupture spontaneously, and the cervix was fully dilated. She was managed for inevitable abortion; she subsequently expelled a female abortus. The abortus and the placenta were taken for histology which shows ischemic infarction on the placental tissue and hyper coiling of the umbilical cord. She was placed on anti-malaria, antibiotics and heamatenics, and was discharged home for follow-up. Modern imaging techniques are useful in the evaluation of Umbilical Cord coiling Index especially during the second trimester. To predict the adverse prenatal and pregnancy outcomes with view of instituting appropriate measures to obviate them, therefore routine screening for the high index cases is suggested. Keywords: Umbilical cord, coiling index, torsion, intrauterine fetal death (IUFD).

Modern surgical management of extremity bone sarcomas is governed by limb-sparing surgery combined with adjuvant and neoadjuvant chemotherapy. All the resection and reconstruction techniques have to achieve oncologic excision margins, with survival rates and functional results superior to amputation. The main reconstruction techniques of bone defects resulted after resection are: modular endoprosthetic reconstruction; bone graft reconstruction; bone transport; resection arthrodesis; and rotationplasty. Oncologic resection and modular endoprosthetic reconstruction are the generally approved surgical options adopted for the majority of cases in major specialized bone sarcoma centres. Good basic principles, efficient multidisciplinary approach and sustained research in the field can provide a better future for the challenge posed by extremity bone sarcoma treatment. Cite this article: EFORT Open Rev 2019;4:174-182. DOI: 10.1302/2058-5241.4.180048

Premenstrual dysphoric disorder (PMDD) is a severe premenstrual disorder characterized by distressing symptoms and significant impairments in personal, social and professional functioning. The study aimed to determine the magnitude of Premenstrual syndrome (PMS) and PMDD among nursing students of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto State, Nigeria. A cross-sectional survey of 135 consenting female nursing students (basic and post basic) at UDUTH, Sokoto State Nigeria was conducted. Participants were interviewed using Socio-demographic and reproductive questionnaire, and Premenstrual Syndrome Screening Questionnaire (PMSSQ). Diagnosis of PMS and PMDD were made using Diagnostic and Statistical Manual 4th revised edition (DSM IV). Data were analyzed using Statistical Package for Social Sciences version 20th. Premenstrual syndrome affected 76.3% of the participants while 42.2% had PMDD. Among the participants, 9.6% suggested appropriate self-management strategy. The frequently reported symptoms of PMDD among the participants were reduced interest in school activities (54.9%), difficulty in concentration (57.0%), excessive sleep (47.8%), breast tenderness (54.5%) and interference with daily activities (41.5%). PMS and PMDD was prevalent among the nursing students. Majority lack appropriate self-treatment strategy. This strongly suggest the need to further educate the students on the implication of the disorder and the need to seek for expert management in severe cases. Self-management of Selective Serotonin Reuptake Inhibitors (SSRI’s) should be discouraged. Key words: Premenstrual syndrome, premenstrual dysphoric disorder, nursing students.

Osteosarcoma is the most common primary malignant bone tumor, with a higher prevalence among children and young adults. Its most frequent localization is in the distal femur, followed by the proximal humerus and the proximal femur. In this article, we will describe the case of a 25-year-old male patient who presented to our medical facility, accusing spontaneous pain and swelling, both originating from the left knee. The X-ray of the distal femur showed a heterogeneous mass around the left femoral metaphysis with massive periosteal reaction. The computerized tomography (CT) analysis revealed cortical destruction, with extra-compartmental localization. The patient has later undergone to an incisional biopsy. The histopathology report showed the presence of a chondroblastic osteosarcoma. According to the multidisciplinary diagnosis, the tumor was finallyclassified as type IIB on the Enneking classification. In such cases, the elective surgical procedure is reconstructive surgery, consisting of wide resection of the distal femur, followed by modular reconstruction. After the surgery, the patient’s condition improved significantly and the functional outcome of the reconstructed joint was also satisfying.

Prolonged obstructed labor is a critical intrapartum emergency. This intricacy is, however, unusual as a primary presentation of a giant bladder calculus. We report a case of a 25-year-old Para 6 + 1, who presented with a history of labor pains of 72 hours duration. She had background lower urinary tract symptoms with supra-pubic swelling and hematuria of 2 years duration. She had a single antenatal visit at 32 weeks however; no obstetric ultrasound scan was done before she went into labor. Examination revealed a highly placed fetal head with increase fetal heart rate. There was a hard mass bulging under the anterior vaginal wall. The diagnosis was a prolonged obstructed labor secondary to bladder mass with fetal distress was made. She had a caesarean section (CS) with the delivery of fresh stillborn. The bi-manually palpable bladder mass persisted post-CS. Her abdominopelvic ultrasound scan and abdominal X-ray post-CS revealed giant vesical calculus with obstructive uropathy. Urine microscopy culture and sensitivity yielded E. coli sensitive to Ciprofloxacin; other laboratory investigations were normal. She was treated for UTI and 2 weeks post-CS, she had opened cystolithotomy. The stone weighed 536 g. Her postoperative recovery was uneventful.

Introduction. Although most soft tissue tumors are benign, with a high healing rate after surgical excision, there is a variety of malignant tumors with differences in progression and prognosis. The study aims to assess the survival rate in patients diagnosed with this pathology, based on the patient’s characteristics (age, gender, race), as well as the tumor’s (histological type, differentiation degree, location and size). Materials and methods. The retrospective study included a group of 103 patients diagnosed in our department during 2010 and 2017. Considering the high healing rate of benign tumors, only the group of neoplastic patients (45 cases) was involved in the survival rate estimation, assessing tumor characteristics and individual comorbidities. Within this lot, we emphasized a predominance of neoplasm in patients aged over 50 years (32 cases), men (29 cases), and localization of the neoplasm in the thigh (23 cases). The predominant histopathological type, liposarcoma, was diagnosed in 67% of the cases, with dimensions over 6 cm and with local extension. Results. There have been significant variations in mortality between the different histological subtypes (liposarcoma vs. synovial sarcoma). Local recurrences were shown in 18 cases of liposarcoma in the first 2 years after the surgical excision, with an increased aggressiveness of this neoplasm in men over 50 years. 12 cases developed distant metastasis, and, until the end of the study, 7 deaths were reported in 3 cases involving associated comorbidities. Conclusions. The five-year survival is inversely proportional to the extent of the tumor and the local invasion, as well as to the age of the patient. It is difficult to appreciate an overall survival rate in the context of a heterogeneous group of tumors so it must be evaluated for every histological subtype taking into account the patient’s particularities.

As the population becomes more active and life expectancy increases, gonarthrosis has proportions of epidemics. Total knee arthroplasty (TKA) is an intervention that decreases pain and gives the patients the possibility of quickly returning to the desired level of activity. It is an intervention with a patient satisfaction rate of about 90-95% with a survival of the implant over 15 years of 90%. When dealing with TKA the following elements should be taken into account: clinical examination (walking analysis), leg deformities and knee alignment (foot deformation management), posterior tibial tendon dysfunction, cavovarus foot, posttraumatic deformity, neuropathic arthropathies, ankle arthrosis, foot deformities and knee arthroplasty. Ankle or foot deformity may be causes of progression of gonarthrosis or a TKA failure. Post-operative alignment of TKA is an extremely important element in the long-term survival of the prosthesis. By improving biomechanical alignment of the complete pelvic limb, TKA survival and patient satisfaction will increase.

Gastrointestinal colic in mares during early pregnancy may require general anesthesia for surgical correction. There is a scarcity of literature identifying anesthetic risk factors associated with negative outcome in the pregnant mare. In this case report, a seven-year-old Thoroughbred broodmare, presenting for the investigation and treatment of colic in the fifth month of pregnancy, underwent surgery for the correction of right dorsal displacement of the large colon. Intraoperatively, interventions for maternal hypoxemia and hypotension were necessary. The mare recovered well from general anesthesia and was discharged from the hospital eleven days postoperatively. In this case report, the successful anesthetic management of a pregnant broodmare is described, and all aspects that may improve the outcome for both mare and fetus are considered, with emphasis on the prevention of cardiovascular and respiratory disturbances.

Rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is currently the most widely used first-line therapy for aggressive B-cell lymphomas. However, many patients, including those with organ dysfunction, may not tolerate the toxicities associated with this regimen. Recent data from the phase III study group indolent lymphomas (StiL) non-Hodgkin lymphoma (NHL)-1 trial suggested that bendamustine plus rituximab were superior in effectiveness and tolerability compared to R-CHOP in the treatment of indolent and mantle cell lymphomas. Preliminary study has indicated the effective use of bendamustine alone or in combination in the treatment of aggressive B-cell lymphomas as well. A 70-year-old male with heavily treated relapsed diffuse large B-cell lymphoma (DLBCL) showed complete remission (CR) after receiving 8 cycles of rituximab in combination with bendamustine as 3rd line treatment. Bendamustine has demonstrated considerable efficacy and well-tolerated therapy in relapsed DLBCL patients. Our case report demonstrated that treating patients with bendamustinebased regimen, even in the setting of organ impairment and elderly is safe and effective. Given the increasing evidence of its effectiveness, further investigation of bendamustine’s safety and tolerability aspects in special groups is recommended such as those with renal impairment.

Background: Many rural areas, especially in developing world, the providers of obstetric care are either family physicians or general practitioners and most of these obstetric emergencies are seen in rural areas. Typical preeclampsia could be easily diagnosed due to it classical triad of maternal hypertension after 20 weeks and before 48 hours post-delivery, proteinuria and oedema. For atypical preeclampsia the diagnosis is usually missed due to its vague nature of presentation. The classical triad features may be absent and hence delayed in the management. Most cases of atypical preeclampsia are associated with high risk of maternal/foetal morbidity and mortality. Objective: The purpose of this case report is to update the knowledge of health care providers on the sundry presentation of atypical preeclampsia. Case summary: This report, describes a unique case of atypical preeclampsia, in which a normotensive primigravida at 37 weeks gestation, presented with severe headache and sudden loss of eyesight, with spot urine protein/creatinine ratio of 1.2, abnormal quadruple analytes (human chorionic gonadotrophin, alpha foetoprotein, inhibin -A and unconjugated oestriol ), platelets count of 96,700 per micro liter and packed cell volume of 24%. Conclusion: Absence of one or two of triad components should not preclude diagnosing preeclampsia, provided there are other features of organs/systems involvement.

The study aimed at assessing the effectiveness of the RA.DI.CA. splint in the management of temporomandibular joint disc displacement without reduction (ADDwoR) and jaw functional limitation. The authors developed a retrospective clinical study. A total of 2739 medical records were screened. One hundred and forty-one patients with chronic unilateral disc displacement without reduction and jaw limitation, treated with a multifunctional RA.DI.CA. splint, were enrolled. Temporomandibular pain, headache, familiar pain, neck pain, and emotional strain, maximum spontaneous mouth opening, and lateral excursions were evaluated at baseline (T0), after therapy (T1), and during the follow-up (T2). Descriptive statistical analysis was performed. Wilcoxon test assessed changes in symptomatology and functional aspects before and after treatment and between T1 and T2, with p &lt, 0.05. Ninety-nine patients (70%) declared themselves &ldquo, healed&rdquo, from jaw functional limitation with no residual painful symptoms, 31 (22%) improved their symptoms and jaw function, 11 (8%) reported no changes compared to T0 and no one worsened. As for all parameters analyzed, the comparison between the ones before and after treatment was statistically significant (p &lt, 0.05). The RA.DI.CA. splint proved to be highly performing and promoting functional and symptomatologic recovery, also in the medium and long term, through the restoration of the functional disc-condyle relationship and the healing of joint tissues.

Third-degree atrioventricular block is a haemodynamically unstable bradyarrhythmia frequently resulting in symptoms of lethargy, weakness and collapse. In this reported case, a four-year-four-month-old male neutered Cavalier King Charles spaniel diagnosed with third-degree atrioventricular block was referred for transvenous permanent pacemaker implantation. During induction of general anaesthesia the dog suffered cardiac arrest consistent with ventricular standstill, as indicated by cessation of ventricular electrical activity on the electrocardiogram monitor and the absence of a peripheral pulse. The prior placement of transthoracic pacing pads under sedation allowed for rapid commencement of temporary transcutaneous pacing and proved effective in achieving ventricular capture with re-establishment of cardiac output. The subsequent general anaesthesia for implantation of a permanent pacemaker was uneventful. This report considers the possible causes of ventricular escape rhythm suppression and highlights the importance of ensuring availability of a temporary pacing method from the outset when anaesthetising animals with unstable and symptomatic bradyarrhythmias.

Difficult or impossible tracheal extubation has previously been reported in the veterinary literature as a result of endotracheal tube (ETT) faults or due to their entanglement with oesophagostomy tubes. Inadvertent transfixation of the ETT to the trachea during oral–maxillofacial surgery is a reported causeof extubation complications in the human literature. In this case, an incident of accidental ETT cuff transfixation to the trachea of a dog undergoing surgical repair of a traumatic tracheal laceration is reported. General anaesthesia for tracheal surgery requires special consideration of airway management to reducecomplications. While precautions can be taken to avoid ETT placement within the surgical field, this cannot always be avoided and measures should be implemented for detection of transfixation. If tracheal extubation complications do arise, it is important to consider the differential causes and act quickly to resolve the problem and ensure minimal distress to the animal.

RESUMEN En este estudio se han sintetizado dos nuevos compuestos de coordinación de cobalto con pirazinamida: Co-PZA (1) y Co-PZA (2), a partir de dos sales precursoras de cobalto y el fármaco pirazinamida. El objetivo de este estudio ha sido elucidar la estructura química de cada complejo sintetizado mediante el uso de las técnicas de caracterización conocidas, así como evaluar y comparar su actividad biológica respecto al fármaco libre pirazinamida. Con respecto a la caracterización, se usaron las técnicas de análisis elemental de C, H y N, espectroscopía de absorción atómica de cobalto, análisis termogravimétrico, susceptibilidad magnética, espectroscopía de UV-Visible, infrarrojo y Raman. La actividad biológica fue evaluada determinando la concentración mínima inhibitoria en cultivos de Mycobacterium tuberculosis. La fórmulas moleculares propuestas a partir de los resultados de la caracterización fueron: [Co(PZA)2Cl2] para el complejo Co-PZA (1) y [Co(PZA)2(NO3)2].H2O para el complejo Co-PZA (2). Los dos complejos presentaron mayor capacidad antimicrobiana que pirazinamida. ABSTRACT In this study, two new cobalt with pyrazinamide (PZA) coordination compounds: Co-PZA(1) and Co-PZA (2) were synthesized from two cobalt precursor salts. The aim of this study is to elucidate the chemical structure of each synthesized complex by using characterization techniques, as well as to evaluate their anti-tuberculous activity compared to pyrazinamide. The characterization techniques comprised, C, H and N elemental analysis, atomic absorption spectroscopy of cobalt, thermogravimetric analysis, magnetic susceptibility, UV-Visible, infrared and Raman spectroscopy. The antibiotic activity was tested by determining the minimum inhibitory concentration in a Mycobacterium tuberculosis culture. The predicted molecular formulas from characterization results were: [Co(PZA)2Cl2] for Co-PZA (1) complex and [Co(PZA)2(NO3)2].H2O for Co-PZA (2) complex. The two complexes showed a higher antimicrobial capacity than pyrazinamide.

A 14 year old giant panda presented with unilateral scrotal swelling. Palpation and conscious ultrasound were suggestive of testicular neoplasia. Anaesthesia was required to obtain radiographs and magnetic resonance imaging (MRI). Immobilisation was achieved with ketamine and medetomidine, and anaesthesia was maintained with sevoflurane in oxygen. Tumours were discovered in both testes and castration was performed. Prior to surgery buprenorphine was administered by slow intravenous injection. Apnoea occurred after approximately 10 mcg/kg had been injected so administration was discontinued. Manual ventilation was required for the majority of the general anaesthetic duration. Spontaneous ventilation returned shortly before transfer to the recovery area. Intramuscular atipamezole administration did not induce a normal recovery; the panda remained profoundly sedated. Further atipamezole had no effect. Due to the apnoea associated with buprenorphine administration during general anaesthesia naltrexone was administered resulting in the panda standing within five minutes post injection.