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Background and purpose: Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA). Patients and methods: This observational study is based on 2,971,357 primary TKAs reported in 2010–2020 to national/regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries. Results: ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register). Conclusion: The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries.

Abstract Background The etonogestrel subdermal implant is the most efficacious hormonal contraceptive currently available and provides 99.7% effective contraception. However, similar to other hormonal contraception, its effectiveness is compromised with the use of cytochrome P450 inducing drugs resulting in an unplanned pregnancy. Despite this risk, little is known about the outcome of concomitant use of rifampin and contraceptive implants. Case presentation A 24-year-old woman was provided with an etonogestrel implant in September 2018. In July 2020, she was started with rifampin based anti-tuberculosis for tuberculosis of the lymph nodes. In December 2020, she presented to the family planning clinic of St. Paul’s Hospital Millennium Medical college with a diagnosis of failed implant and second-trimester pregnancy at a gestational age of 19 weeks. The etonogestrel implant was removed and the patient was linked to antenatal care follow up. Conclusion Concomitant use of hepatic cytochrome P450 enzyme-inducing medications with certain hormonal contraceptives may reduce effectiveness resulting in unintended pregnancy. Women should be given detailed counseling about the potential for drug interactions and a multidisciplinary approach with consultation or referral to reproductive health specialists is crucial for optimal management of women who are at increased risk of contraceptive failure and unintended pregnancy.

Abstract Background Conjoined twins are a rare clinical event occurring in about 1 per 250,000 live births. Though the prognosis of conjoined twins is generally low, there is limited evidence as to the optimal method of pregnancy termination, particularly in cases of advanced gestational age. We report a successful dilation and evacuation (D&E) done for conjoined twins at 22 weeks of gestation. Case presentation A 20-year-old primigravid woman was diagnosed with a conjoined, thoraco-omphalopagus twin pregnancy after undergoing a detailed two-dimensional (2D) fetal ultrasound anatomic scanning. Assessment and counseling were done by a multidisciplinary team. The team discussed the prognosis and options of management with the patient. The patient opted for termination of pregnancy. Different options of termination were discussed and the patient consented for D&E, with the possibility of reverting to hysterotomy in case intraoperative difficulty was encountered. A 2-day cervical preparation followed by D&E was done under spinal anesthesia and ultrasound guidance. Conclusion In this patient, D&E was done successfully without complications. Adequate cervical preparation, pain control, and ultrasound guidance during the procedure are critical for optimal outcomes. A literature review of methods of pregnancy termination for conjoined twins in the second trimester revealed 75% delivered vaginally through medical induction while 18% underwent cesarean section. Only one other report described successful D&E for conjoined twins after 20 weeks. D&E can be safely performed for carefully selected cases of conjoined twins beyond 20 weeks’ gestations avoiding the need for induction or hysterotomy.

Objective: To document the use of Foley catheter as an alternative to osmotic dilators for cervical preparation before second trimester dilation and evacuation at a tertiary setting in Ethiopia Methods: This is a retrospective case series conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from April 1, 2021 to August 30, 2021. Forty-three cases of dilation and evacuation (D&E) in which overnight intra-cervical Foley catheter placement was used to prepare the cervix were reviewed. Data were analysed using SPSS version 23 and simple descriptive statistics were applied to analyze the clinical characteristics of study subjects and procedure outcomes. Percentages and frequencies were used to present the findings. Results: The calculated median gestational age was 21.4(17–24.2) weeks. Around 40%(17/43) of cases had cervical dilation of 3 to 4 cm, with another 33% (14/43) achieving cervical dilation of 1.5 to 2.5 cm. Additional dilation during the procedure was required only in 12 cases (28%) prior to D&E procedure. In 36 cases (84%), the procedure was attended by family planning fellow. Conclusion: Cervical preparation using overnight Foley catheter before second-trimester D&E resulted in majority of the cases requiring no additional dilation immediately prior to D&E procedure. Where osmotic dilators are not available, Foley catheter can be an alternative method to prepare the cervix prior to D&E procedures. Implications: In the absence of osmotic dilators, Foley catheter can be used as an alternate, and readily available means of cervical preparation for second trimester D&E procedures

Background: Current literature recommends inducing fetal demise prior to second trimester medication abortion beyond 20 weeks of gestation. There is inadequate literature regarding the practice and effectiveness of this procedure in low-income countries. This study aimed at documenting the effectiveness of intra-cardiac lidocaine and intra-amniotic digoxin at inducing fetal demise before second trimester medication abortion in an Ethiopian setting. Methods: This is a retrospective chart review conducted at St. Paul's Hospital Millennium Medical College, in Ethiopia. A total of 65 cases of feticide administration before 2nd trimester medication abortion between 20 and 28 weeks of gestation (From April 1, 2021 to September 30, 2021) were reviewed. The primary outcome was cessation of fetal cardiac activity the day after the first feticide injection. Data were extracted by reviewing maternal charts using a data extraction tool prepared in English. Data were analyzed using SPSS version 23. Simple descriptive statistics were used to analyze baseline characteristics and fetal demise outcomes. Results were presented in percentages and frequencies. Results: More than three quarters of the feticide injections were with intra-amniotic digoxin, while the rest (24.6%, 16/65) were with intra-cardiac lidocaine. Injection of digoxin or lidocaine was effective at inducing fetal demise the day after administration in 92.3% (60/65) of the cases. Intracardiac lidocaine administration was 100% (16/16) effective at inducing fetal demise within the day after the injection while the effectiveness of digoxin within the same period was 89.8%. Conclusion: In this study, both intra-amniotic digoxin and intra-cardiac lidocaine were effective at inducing fetal demise, which is in support of findings from similar previous studies. Implications: In an Ethiopian setting, both intra-amniotic digoxin and intra-cardiac lidocaine injections are effective at inducing fetal demise before second trimester abortion beyond 20 weeks of gestation within the next day after feticide administration.

Introduction The current evidence on the efficacy of antibiotic-loaded bone cement (ALBC) in reducing the risk of periprosthetic joint infections (PJI) after primary joint reconstruction is insufficient. In several European countries, the use of ALBC is routine practice unlike in the USA where ALBC use is not approved in low-risk patients. Therefore, we designed a double-blinded pragmatic multicentre register-based randomised controlled non-inferiority trial to investigate the effects of ALBC compared with plain bone cement in primary total knee arthroplasty (TKA).Methods and analysis A minimum of 9,172 patients undergoing full-cemented primary TKA will be recruited and equally randomised into the ALBC group and the plain bone cement group. This trial will be conducted in Norwegian hospitals that routinely perform cemented primary TKA. The primary outcome will be risk of revision surgery due to PJI at 1-year of follow-up. Secondary outcomes will be: risk of revision due to any reason including aseptic loosening at 1, 6, 10 and 20 years of follow-up; patient-related outcome measures like function, pain, satisfaction and health-related quality of life at 1, 6 and 10 years of follow-up; risk of changes in the microbial pattern and resistance profiles of organisms cultured in subsequent revisions at 1, 6, 10 and 20 years of follow-up; cost-effectiveness of routine ALBC versus plain bone cement use in primary TKA. We will use 1:1 randomisation with random permuted blocks and stratify by participating hospitals to randomise patients to receive ALBC or plain bone cement. Inclusion, randomisation and follow-up will be through the Norwegian Arthroplasty Register.Ethics and dissemination The trial was approved by the Western Norway Regional Committees on Medical and Health Research Ethics (reference number: 2019/751/REK vest) on 21 June 2019. The findings of this trial will be disseminated through peer-reviewed publications and conference presentations.Trial registration number NCT04135170.

Background. Giant hydronephrosis is a rare urologic problem defined as a collection of more than one liter of urine in the collecting system. The radiologic appearance may mimic benign cystic disease of the kidney. We report a case of giant hydronephrosis in a 32-year-old female who presented with progressive abdominal swelling of two-year duration, caused by ureteropelvic junction obstruction with more than nine liters of urine in the collecting system. Conclusion. Giant hydronephrosis is a rare differential diagnosis for cystic intra-abdominal mass in adults with progressively increasing abdominal swelling. CT and MRI are important in confirming the diagnosis by localizing the origin of the swelling. Management depends on the underlying cause and appearance of the diseased kidney.

Clinicians have used feticidal agents prior to second trimester abortion for many years. Despite the widespread use of various agents to induce fetal demise, a comprehensive or systematic review of the evidence is lacking on the safety, effectiveness, and most effective routes of administration. Objectives: To evaluate the existing drugs and routes of administration used in inducing fetal demise prior to abortion, and to determine the safety, effectiveness, and acceptability of these feticidal agents. Methods: We searched PubMed, EMBASE, CINAHL, POPLINE, and Global Index Medicus to identify studies describing pharmacologic agents used to induce fetal demise prior to termination of pregnancy. We included randomized controlled trials and observational studies comparing digoxin, potassium chloride (KCL), and lidocaine to induce fetal demise. We included studies that evaluated the primary outcomes of safety and effectiveness, including success in achieving fetal demise, induction to expulsion time for medical abortion, dilation and evacuation time, as well as maternal side effects and complications. Two authors independently screened abstracts and full texts. One reviewer extracted data from the included studies, which was counterchecked by a second reviewer. Results: We identified eight studies that met inclusion criteria: three randomized controlled trials, and five observational studies. A total of 4505 women received drugs to induce fetal demise at 17 to 38 weeks' gestation, including digoxin (n=4174), KCL (n=324), and lidocaine (n=7). Intra-fetal digoxin was superior to intra-amniotic digoxin in achieving fetal demise (OR 3.51, 95% CI 1.60, 7.78). Intracardiac KCL 15% 2–3 mL reduced induction to expulsion time by 320 min (p

This survey aimed to establish nutrition-related knowledge, attitudes and practices, and to observe how gender influences household food-related decision-making processes in the Sasakawa Africa Association (SAA) intervention areas in the Oromia and Southern Nation Nationalities and People regions of Ethiopia. The findings would inform implementation of communication for nutrition social and behaviour change among small-holder farmers as part of the SAA corporate strategy on nutrition-sensitive agriculture. The study population was smallholder farmers supported by SAA from which 311 respondents were selected through multistage sampling. Data were collected via a mixed methods approach consisting of a household survey, focus group discussions (FGDs) and key informant interviews (KIIs). Quantitative data were analysed using descriptive statistics while qualitative data was analysed using a narrative and content approach. The study focused on knowledge, attitudes and practices related to production and consumption of micronutrient-rich foods. Majority (59.5%) of the respondents were male. Men were the main decision makers on staple or commercial food crop production and proportion of produced crops to be consumed at home or sold in the market. Women mainly made decisions regarding production and consumption of fruits and vegetables, intra-household food distribution, preservation and storage. There was a lack of knowledge on iron and vitamin A fortified or biofortified sources of food. Nearly three quarters (72%) of women did not meet the minimum dietary diversity for women, a proxy indicator of adequacy of micronutrient intake and diet quality. The mean dietary diversity score was 3.8 with animal source foods being the least consumed. Not having sufficient money to buy food, unavailability of different food groups and poor intra-household food distribution were among the key reasons for lack of diverse diets. Majority of the respondents were aware of the importance of production and consumption of micronutrient-rich foods. However, there was a gap in practice and awareness about biofortified and fortified foods. While most of the respondents had produced fruits and vegetables in home gardens in the three months prior to this survey, more than half (54%) of the respondents thought it was not likely that they would produce fruits and vegetables for home consumption. More targeted nutrition campaigns are required to increase the ability of small-holder farmers to adopt best practices while reducing the barriers associated with access and consumption. Promotion of fruit and vegetable production in home gardens could be considered as option for improving household dietary quality as well as empowering women to make more decisions. Key words: Sasakawa Africa Association, Small-holder farmers, Nutrition, Knowledge, Practices, INTRODUCTION Malnutrition in all its forms is a global burden that leads to serious public health risks and incurs high economic costs. Improvements in nutrition contributes significantly to stimulating economic [...]

Objective: To assess the outcome of women presenting with nonpalpable contraceptive implants to a referral center in Ethiopia. In addition, we discuss our approach and experience with localization and removal of nonpalpable contraceptive implants. Methods: We conducted a facility‐based retrospective review of patients evaluated for a nonpalpable contraceptive implant between September 2019 and March 2022 at St. Paul's Hospital Millennium Medical College (SPHMMC) located in Addis Ababa, Ethiopia. SPHMMC is a tertiary teaching hospital with Obstetrics and Gynecology (OBGYN) residency as well as a Family Planning fellowship program. The present study was approved by the institutional review board of SPHMMC. Results: Of the 68 patients reviewed, 48 were referred from other facilities. A total of 24 (35.3%) patients had at least one previous failed attempt at removal before referral. On ultrasound examination, 27 (40.3%) implants were found below the muscle fascia. Implant removal procedures were successfully done at the outpatient clinic in 65 (95.6%) patients including 40/40 (100%) suprafascial and 25/27 (92.6%) subfascial implants. Removal of subfascial implants was performed in the operating room in two patients. We failed to localize the device in one patient currently on follow‐up. All removals were performed by OBGYNs with subspecialty training in family planning or current fellows supervised by subspecialists. No post‐procedure complications have been documented. Conclusion: Our findings show that with meticulous evaluation and careful patient selection, localization and removal of nonpalpable implants in outpatient settings are successful. Initial ultrasonography minimizes delays and allows for same‐day implant localization and removal. Synopsis: Localization and removal of nonpalpable implants need careful evaluation. Specialized centers are essential to care for these patients and referral pathways should be arranged. [ABSTRACT FROM AUTHOR]

There is a clear and urgent call to transform our food systems as a critical nexus to tackle ongoing global climate, biodiversity, equity, and nutrition crises. Many food and agricultural innovations are being developed and scaled but these innovations often target sector-specific problems and remain disconnected from the more complex demand for transformative change at scale. To bridge this demand for systemic change within the innovation ecosystem, initiatives are applying various approaches such as visioning, holistic assessments, innovation portfolio management and multistakeholder co-creation. Here we report on insights from applying a food systems tailored backcasting approach in a diversity of settings since 2021, including a national food system dialogue, a youth business innovation challenge, a landscape multi-stakeholder platform, a public-private sector co-learning session, an agroecological transitions program, and a hybrid food systems university course for graduate students and global professionals. We thereby build on existing literature and case studies of how change happens (or does not happen) and aim to use those insights to support food systems change makers. Across these settings, the backcasting approach asks participants to connect innovations with broader systems-change visions, to anticipate tradeoffs for multiple food system outcomes and population groups, and to cross sectoral boundaries. The use cases demonstrate that the backcasting process contributes to changes in views, practices and structures that participants work with. Specifically, it supports moving beyond “silver bullet” innovation approaches, the bundling of social and technical innovations, and building action-oriented cross-sectoral bridges. Food systems change is complex and innovations alone are insufficient to address its complexity. But innovations can play a positive role if connected to more holistic systems-change processes and goals. Considering strengths and limitations of the backcasting approach, the diversity of practical applications supports its potential to connect innovations to holistic food systems visions, to strengthen cross-sectoral collaboration and to bundle social and technical innovations for desirable food systems change.

Abstract Objective: To develop a healthy diet for Ethiopian women closely resembling their current diet and taking fasting periods into account while tracking the cost difference. Design: Linear goal programming models were built for three scenarios (non-fasting, continuous fasting and intermittent fasting). Each model minimised a function of deviations from nutrient reference values for eleven nutrients (protein, Ca, Fe, Zn, folate, and the vitamins A, B1, B2, B3, B6, and B12). The energy intake in optimised diets could only deviate 5 % from the current diet. Settings: Five regions are included in the urban and rural areas of Ethiopia. Participants: Two non-consecutive 24-h dietary recalls (24HDR) were collected from 494 Ethiopian women of reproductive age from November to December 2019. Results: Women’s mean energy intake was well above 2000 kcal across all socio-demographic subgroups. Compared to the current diet, the estimated intake of several food groups was considerably higher in the optimised modelled diets, that is, milk and dairy foods (396 v. 30 g/d), nuts and seeds (20 v. 1 g/d) and fruits (200 v. 7 g/d). Except for Ca and vitamin B12 intake in the continuous fasting diet, the proposed diets provide an adequate intake of the targeted micronutrients. The proposed diets had a maximum cost of 120 Ethiopian birrs ($3·5) per d, twice the current diet’s cost. Conclusion: The modelled diets may be feasible for women of reproductive age as they are close to their current diets and fulfil their energy and nutrient demands. However, the costs may be a barrier to implementation.