Randomized study of antibiotic prophylaxis for general and gynaecological surgery from a single centre in rural Africa

In a district rural hospital in Uganda, 850 surgical patients were evaluated prospectively over a 3-year period to compare the clinical efficacy of conventional postoperative penicillin therapy with single-dose ampicillin prophylaxis for hernia repair and ectopic pregnancy, and with single-dose ampicillin-metronidazole prophylaxis for hysterectomy and caesarean section. The high rate of postoperative infection usually encountered in African hospitals after conventional treatment with penicillin for 7 days was significantly reduced with the new regimen: from 7.5 to 0 per cent in hernia repair and from 10.7 to 2.4 per cent in ectopic pregnancy; from 20.0 to 3.4 per cent in hysterectomy and from 38.2 to 15.2 per cent in caesarean section. Length of hospital stay and postoperative mortality rates were also significantly reduced. Single-dose ampicillin prophylaxis with or without metronidazole, although rarely used in developing countries, is more cost effective than standard penicillin treatment.

A seven week observational analysis of clinical activities in a North Italian orthopaedic hospital during the second wave of SARS-CoV-2 pandemic: far from usual volumes, but different from the first wave

Purpose

We previously described the radical changes occurred in an orthopaedic hospital in Milan (Italy) during the first SARS-CoV-2 pandemic outbreak. Currently, during the second wave, the situation is still far from normality. Here we describe the changes that took place, and are still ongoing, in the clinical practice.

Methods

Number and type of admissions, outpatients activity, ER and urgent procedures in SARS-CoV-2 negative and positive patients have been analyzed over seven weeks (October 26th–December 13th, 2020) and compared with the correspondent period in 2019 and the same timeframe during the first wave (February 24th–April 10th).

Results

2019 vs. 2020: Overall admissions decreased by 39.8%; however, while admissions for elective surgery dropped by 42.0%, urgent surgeries increased by 117.0%. Rehabilitation admissions declined by 85.2%. White and green priority ER consultations declined by 41.6% and 52.0%, respectively; yellow and red increased by 766.7% and 400.0%, respectively.

Second vs. first wave: Overall admissions increased by 58.6% with a smoother decrement in weekly admissions than during the first wave.

Disparity of acute admissions vs. rehabilitation expanded: Acute cases increased by 63.6% while rehabilitation cases decreased by 8.7%. Admissions to triage procedures increased by 72.3%.

Conclusions

Activity levels are far from normality during the second COVID-19 wave. Elective surgery and outpatients-related activities are still strongly limited compared to 2019 while the number of urgent cases treated increased consistently. SARS-CoV-2 positive emergencies are slightly higher than during the first wave. These important changes are expected to impact on health service and hospital budget for long.

Clinical aspects and imaging patterns with ultrasonography and endoscopy in hepatosplenic schistosomiasis in Uganda

In patients with hepato-splenic schistosomiasis, a close relationship between the grade of periportal fibrosis and portal vein diameter, spleen size and presence of oesophageal varices and their grade was found.

Posterior cruciate ligament-retaining and posterior-stabilized total knee arthroplasty: differences in surgical technique

The debate over the relative merits of substituting or retaining the posterior cruciate ligament in total knee arthroplasty is still ongoing. This article discusses the differences between the two procedures, considering the biomechanics and the surgical techniques involved.

Kaposi's sarcoma and AIDS in Uganda: its frequency and gastrointestinal distribution

The frequency and distribution of gastrointestinal Kaposi's sarcoma were investigated in 63 consecutive AIDS patients. The main risk factor for AIDS was heterosexual intercourse. Gastrointestinal lesions were found in 24 cases (38.1%): 12 patients (11.1%) had both upper and lower GI tract involvement, 7 patients (11.1%) had only oesophago-gastroduodenal lesions and 5 (7.9%) only lower tract disease. Our results show that in heterosexual Africans, the tumours closely resemble the tumours of western homosexuals in endoscopic appearance, in being multicentric and in the gastro-intestinal tract involved. We conclude that even in the heterosexual African AIDS population, the gastrointestinal tract is frequently involved and this phenomenon, if more widely studied might give us new elements about the aetiophatogenesis of Kaposi's sarcoma which is still unclear.