Routine point-of-care ultrasound (POCUS) assessment of gastric antral content in traumatic emergency surgical patients for prevention of aspiration pneumonitis: an observational clinical trial.

BACKGROUND: Polytrauma patients are at a higher risk of delayed gastric emptying. To assess the gastric volume, a reliable diagnostic tool is needed to prevent the occurrence of aspiration pneumonia, which remains a serious complication associated with anesthesia. Gastric antral ultrasound can provide reliable information about the size of the gastric antrum in traumatized patients undergoing emergency surgery. METHODS: A prospective observational study of 45 polytrauma patients undergoing emergency surgery under general anesthesia was carried out. Prior to induction of anesthesia in the emergency department, gastric ultrasound was performed for qualitative and quantitative assessment of the gastric antrum in a supine position and right lateral decubitus (RLD) position. This was followed by routine placement of the nasogastric tube to aspirate and calculate the volume of the stomach contents. RESULTS: Of the 45 polytrauma patients, the risk assessment of aspiration and the anesthesia technique changed in 14 patients (31.1%) after the gastric ultrasound examination. A very good relationship existed between the expected stomach volume at the RLD position and the suction volume in the nasogastric tube. In all cases, no aspirations were documented. CONCLUSION: Ultrasound examination of the stomach in polytrauma patients allows assessing the size and type of stomach contents. The data obtained can influence the choice of anesthesia technique and reduce the risk of aspiration pneumonia. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov . registry number: NCT04083677 on September 6, 2019.

Decision-making in the practice of female genital mutilation or cutting in Sudan: a cross-sectional study.

BACKGROUND: Female genital mutilation or cutting (FGM/C) is a form of violence against women and girls that is widely performed in about 30 countries in Africa, Middle East and Asia. In Sudan, the prevalence of FGM/C among women aged 15-49 years was 87% in 2014. Little is known about household decision-making as it relates to FGM/C. This study aimed to understand the key people involved in FGM/C-related decisions, and to assess predictors of households' decision to cut or not cut the youngest daughter and the reasons for these decisions. METHODS: We drew on household survey data collected as part of a larger cross-sectional, mixed methods study in Sudan. The analytical sample comprised of data from 403 households that both reported that they had discussion around whether to cut the youngest daughter aged 19 years or younger and arrived at a decision to either cut or leave her uncut. Descriptive statistics summarizing the people involved in FGM/C-related decisions and the reasons for decisions are presented. We also present logistic regression analyses results summarizing predictors of households' decision to leave the youngest daughter uncut. RESULTS: Household decision-making on FGM/C involved discussions among the nuclear and extended family, and non-family members. Mothers and fathers were found to be the key decision makers. A greater proportion of fathers were involved in instances where the final decision was to leave the daughter uncut. Thirty-six percent of households decided to leave the youngest daughter uncut. State of residence, mothers' level of education and FGM/C status and exposure to FGM/C-related information or campaigns were associated with households' decision to leave the daughter uncut. Health concerns were the most commonly cited reason for deciding not to cut their daughters (57%), while custom or culture was the most commonly cited reason for households deciding to cut their daughter (52%). CONCLUSION: FGM/C-related decisions result from deliberations that involve many people. Our findings underscore the important role that fathers play in decision-making and highlight the need to involve men in FGM/C programs. Findings also stress the need to understand and address the drivers of FGM/C.