Background : A large number of women undergo caesarean section throughout the world. These women pass through a period of post operative pain and a morbidity period. These women translate into a substantial portion of population and hence there is a load on the financial resources of healthcare system. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load but also help in early recovery of the patient. Aim : The aim of this study is to compare the effects of alternative techniques for closure of subcutaneous fat and skin on maternal health and use of healthcare resources in caesarean section. Materials and Methods : Patients undergoing Caesarean section were divided in two groups of one thousand patients each. Patients with hematological disorders or a malignancy, diabetes, septicemia or chorioamnionitis were excluded from the study. In all the patients, after stitching the uterus, the rectus sheath was stitched with thread vicryl No.1 (synthetic absorbable braided sutures with polyglycolic acid, polycaprolactone and calcium stearate coating), using a round body needle. Then the patients were divided into two groups. In group I, vicryl No.1 thread used in stitching of the rectus sheath was continued into the skin with application of subcuticular stitches, after securing the edges with a knot. In group II, after stitching the rectus sheath with vicryl No. 1, the thread was cut and interrupted sutures were applied in subcutaneous fat with thread vicryl No. 2. Skin was stitched with subcuticular stitches using proline 2, a non-absorbable propylene suture. The two groups of patients were observed for the duration of surgery, post-operative pain in stitches, patient satisfaction about removal of stitches, evidence of wound infection or seroma, and cosmetic results. Results : It was noted that the duration of surgery in group I was on average 7.5 minutes less as compared to the duration in group II. Patients in group I were more satisfied with the results of the surgery and were relieved to know that their stitches did not need to be removed. Conclusion: Although no difference was found in the rates of wound infection and formation of scar tissue between the group I and group II, the duration of surgery was less and the patients were more satisfied in group I.

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Aim: To determine the prevalence of urinary tract infection (UTI) in Okada, a rural community in Nigeria, and the effect of age and gender on its prevalence as well as the etiologic agents and the susceptibility profile of the bacterial agents. Patients and Method: Clean-catch midstream urine was collected from 514 patients (49 males and 465 females). The urine samples were processed and microbial isolates identified. Susceptibility testing was performed on all bacterial isolates. Result: The prevalence of urinary tract infection was significantly higher in females compared to males (female vs. male: 42.80% vs. 10.20%; OR = 6.583. 95% CI = 2.563,16.909; P < 0.0001). Age had no effect on the prevalence of UTI. Escherichia coli was the most prevalent isolate generally and in females, while Staphylococcus aureus was the predominant isolate causing urinary tract infection in males. The flouroquinnolones were the most active antibacterial agents. Conclusion: An overall prevalence of 39.69% was observed in this study. Females had a 3 to 17 fold increase risk of acquiring UTI, than their male counterpart. Escherichia coli were the predominant isolates causing UTI.

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Background: Every year, millions of people are exposed to avoidable, life-threatening risks through the trans­fusion of unsafe blood. Aim : To determine the sero-prevalence of Syphilis among pre-transfused blood in the University of Benin Teaching Hospital, Benin-City, Nigeria. Material and Methods : The detection of Treponema pallidum IgG/IgM was based on the principle of double antigen sandwich immunoassay, in which purified recombinant antigens are employed sufficiently to identify antibodies to Syphilis. The outcomes of interest included the proportion of Syphilis positive units of pre-transfused donor blood, the source of blood and the total number of units of blood processed in the hospital blood bank. Results : Two hundred proportionally selected commercial and targeted donors' blood samples were screened for Treponema pallidum, and 8% (n = 16) were found to be positive (95% confidence intervals 9.21-22.79). Syphilis seropositivity was found to be significantly higher in commercial donors (p<0.05). The likely risk of iatrogenic transfusion related Treponema pallidum infection was estimated to be 384 cases/ year at the present rate of utilization of donor blood at the University of Benin Teaching Hospital. Conclusion : There is a risk of iatrogenic transfusion-transmitted Treponema pallidum in the study hospital. There is, therefore, a need for screening blood donors for circulating antibodies to syphilis infection and other transfusion transmissible infections prior to allogeneic transfusion both in Nigeria and the world over, which may help in avoiding transfusion related Syphilis and its probable long-term effects. Blood that is positive for Syphilis should be discarded, and the affected donor treated appropriately.

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Background : Otitis Media continues to be a major presentation in the ear, nose and throat clinic. Aim : This study aimed to isolate, characterize and identify the bacteriological and mycological etiologic agents of otitis media in Benin city. Patients and Methods : Ear discharge from 569 (299 males and 270 females) patients diagnosed clinically of otitis media between August 2009 and August 2010 were processed to recover the bacterial and fungal etiologic agents. Susceptibility test was performed on all bacterial isolate. Result : Pseudomonas aeruginosa (28.3%) was the predominant bacteria isolate causing otitis media followed by Staphylococcus aureus (21.0%), Klebsiella sp (8.9%), Proteus sp (8.2%), Alkaligenes spp (4.3%), Streptococcus pneumoniae (3.9%), Escherichia coli (3.0%) and Citrobacter freundi (1.7%). Fungi isolated were Aspergillus niger (9.2%), Candida albicans (5.4%), Candida tropicalis (3.0%), Aspergillus flavus (2.1%) and Candida parasilopsis (1.5%). 413 had a single organism isolated from the middle ear culture while twenty (3.51%) patients had mixed organisms isolated. Infection was highest among 0 - 5 years, and lowest among aged 18 - 23. All bacterial isolates were poorly susceptible to the antibacterial agents. Conclusion : The study uncovers a high frequency of bacteria associated otitis media with the finding of fungi too as a significant etiologic agent.

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Background : Tai Chi is a famous training method in China, and jogging is a popular kind of exercise both in Austria and China. Nevertheless, there is little information concerning online monitoring of biosignals during both training activities in parallel. Within the last years innovative scientific monitoring tools for evaluating features of neurocardial fitness have been developed. Aims : The goal of this study was to demonstrate heart rate and heart rate variability analysis for the first time during Tai Chi and jogging. Volunteers and Methods : Continuous electrocardiographic monitoring over a period of 75 minutes was performed simultaneously in two healthy volunteers using the same type of equipment (medilog AR12 systems). Two healthy persons (both male, 49 years and 52 years, respectively), both hobby sportsmen, were monitored continuously during two resting periods before and after active sport and also during Tai Chi and jogging, respectively. Results : Data acquisition was performed without any technical problems in both subjects. Poincaré plots of sequential R-R intervals (beat to beat variability) show two ellipses of different shape and magnitude. During resting periods blood pressure effects can be clearly seen in one subject (jogging). The same effects, however reduced, are obvious in the other volunteer during Tai Chi. Conclusions : The present investigations during Tai Chi and jogging highlight the potential value of heart rate and heart rate variability monitoring even under difficult conditions. The innovative kind of analysis helps to show how well the human body reacts to sport, stress and recovery.

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Background : Onchocerciasis is a disease with a spectrum of manifestations suffered by different infected people. Based on individual perceptions and manifestations presented, demand for the drug Ivermectin was due to different motives and priorities during mass distribution programmes. Subjects and Method: This study presents findings from a sample of 594 persons out of a total of 35,763 treated individuals who voluntarily demanded Ivermectin treatment during a community-based Ivermectin distribution exercise. The distribution, which took place in 2008, was mass distribution of the microfilaricide to control onchocerciasis in endemic communities of Ezinihitte in the Imo River Basin of Nigeria. The subjects who were selected by quota sampling procedure on the basis of community and gender, were asked to rank-order six plausible reasons for seeking treatment in terms of their order of importance in motivating them to demand Ivermectin. Results: "To gain treatment and prevention of Skin Problems" and "Desire to be De-wormed" ranked first and second respectively. "To gain promotion of general wellbeing" and "To improve state of vision and prevent blindness" ranked third and fourth respectively. In the fifth and sixth rank-order positions were "To prevent hanging groin" and "to prevent/relieve enlargement of the scrotum or clitoris" in that order. A test of hypothesis to determine if there was significant agreement among treated persons on the rank order of importance of their reasons for demanding Ivermectin gave a Kendall's Coefficient of Concordance of W = 0.62, p <.001. Conclusion: The findings are interpreted within the framework of the major postulations of the health belief model with consideration to perceptions of severity of the conditions and belief that submitting to treatment will abate the perceived risk of the conditions. The role of endemicity of specific manifestations of onchocerciasis in lay assessment of risk of this disease is also discussed.

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Context: Wandering spleen is an unusual condition characterized by the absence or maldevelopment of one or all of the ligaments securing the spleen in its normal position in the left upper abdomen. Pedicular tortion with a complete vascular disruption is a rare but known potential complication of this mostly congenital disorder. Spontaneous hemoperitoneum with acute abdomen however, is a life threatening situation that has not been adequately reported in the adult literature. Case Report: A forty four year old man presented to the emergency department with an acutely distended and rigid abdomen. His past medical history was only significant for mild mental retardation. The patient denies prior abdominal operation or recent trauma. On initial examination, he appeared to be anxious, pale, and tachycardic. Fullness in the midpelvic region was easily appreciated on palpation. An enlarged pelvic spleen and free intraperitoneal fluid consistent with blood were seen on a CT scan. The patient was promptly taken for an exploratory laparotomy where a large rush of blood was encountered upon entering the abdomen. A volvulus of the splenic pedicle with an infarcted spleen was found mandating a splenectomy. Conclusions : Abnormally located spleen, splenomegaly, and finding of hemoperitoneum are highly suggestive of wandering spleen with tortioned pedicle. Despite its life threatening presentation, immediate laparotomy and splenectomy invariably result in good outcome.

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Background : The ventilation ( ) response to inspired CO ₂ has been extensively studied, but rarely with concentrations >10%. Aims : These experiments were performed to determine whether would increase correspondingly to higher concentrations and according to conventional chemoreceptor time delays. Materials and Methods : We exposed anesthetized dogs acutely, with and without vagotomy and electrical stimulation of the right vagus, to 20-100% CO ₂ -balance O ₂ .and to 0 and 10% O ₂ -balance N ₂ . Results : The time delays decreased and response magnitude increased with increasing concentrations (p<0.01), but at higher concentrations the time delays were shorter than expected, i.e., 0.5 s to double at 100% CO ₂ , with the response to 0% O ₂ being ~3 s slower. Right vagotomy significantly reduced baseline breathing frequency (fR), increased tidal volume (VT) and increased the time delay by ~3 s. Bilateral vagotomy further reduced baseline fR and , and reduced the response to CO ₂ and increased the time delay by ~12 s. Electro-stimulation of the peripheral right vagus while inspiring CO ₂ caused a 13 s asystole and further reduced and delayed the response, especially after bilateral vagotomy, shifting the mode from VT to fR. Conclusions : Results indicate that airway or lung receptors responded to the rapid increase in lung H ⁺ and that vagal afferents and unimpaired circulation seem necessary for the initial rapid response to high CO ₂ concentrations by receptors upstream from the aortic bodies.

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Context: Bullous allergic reactions are inflammatory skin disorders, presenting usually as a result of some type of reaction to medication. Case Report: A 67-year-old female was evaluated for the presence of diffuse patches of erythema, microvesiculation, vesicles, crusts, and oozing of sudden appearance on the extremities and on the rest of the body after taking sulfamethoxazole in combination with trimethoprim. Skin biopsies for hematoxylin and eosin examination, as well as for direct immunofluorescence and immunohistochemistry analysis were performed. H&E staining demonstrated classic features. Direct immunofluorescence revealed strong deposits of fibrinogen in the vessels of the skin. The immunohistochemistry stain showed strong positivity of myeloperoxidase within the blister cavity. The distribution of the vessels around the inflammatory process were noticed by using antibodies to CD34 as well to collagen IV. Conclusions: sulfamethoxazole is catalysed by CYP2C9 and/or myeloperoxidase. Thus, myeloperoxidase appears to be of importance in this disorder.

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Most of tumors found in the pancreas are adenocarcinoma of the pancreas. A small number of tumors in the pancreas, such as islet cell tumors or neuroendocrine tumors, papillary cystic neoplasms, lymphoma, acinar cell tumors, metastatic tumors to the pancreas often, have a far better prognosis, and the majority of these tumors are non-malignant or benign. The author reviewed the recent literatures, and summarized where the tumor comes originally in the pancreas, what is the type of the tumor, and how to treat the tumor.

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