Determinants of anemia among pregnant women attending a tertiary hospital, Mogadishu, Somalia: unmatched case-control study.

OBJECTIVE: The objective of this study was to identify the factors associated with anemia among pregnant women attending a tertiary referral hospital in Mogadishu, Somalia. METHODS: An unmatched case-control study was conducted on pregnant women who visited the antenatal clinics of a tertiary referral hospital between March and July 2021. The study recruited pregnant women who had a hemoglobin level of <11 g/dL into the anemic group, while those with hemoglobin levels ≥11 g/dL were included in the non-anemic group. Demographics, clinical, obstetrics, nutrition-related, hygiene- and sanitation-related, and parasitic infection-related data were collected. RESULTS: A total of 449 pregnant women (399 anemic and 50 non-anemic) participated in the study. A total of 224 (56.7%) in the anemic group and 31 (62.0%) in the non-anemic group did not consume any dark green, leafy vegetables such as spinach, bukurey, cagaar, and koomboow (p=0.040). Notably, 255 (63.9%) in the anemic group and 21 (42.0%) in the non-anemic group had a middle-upper arm circumference <23 cm. More than half of anemic [335 (84%)] and non-anemic [46 (92.0%)] were classified under low dietary diversity score. Majority of the study participants, 288 (72.4%) of the anemic and 39 (78%) of the non-anemic groups, used pit toilets in dwellings, and 70.2% (134/191) of the anemic and 64.4% (246/382) of the non-anemic groups disposed of solid waste in open fields. CONCLUSION: This study demonstrated that women who consumed green vegetables such as spinach, bukurey, cagaar, and koomboow in their diet had middle-upper arm circumference less than 23 cm, and those with low dietary diversity significantly developed anemia during pregnancy.

Determinants of anemia among pregnant women attending a tertiary hospital, Mogadishu, Somalia: unmatched case-control study

SUMMARY OBJECTIVE: The objective of this study was to identify the factors associated with anemia among pregnant women attending a tertiary referral hospital in Mogadishu, Somalia. METHODS: An unmatched case-control study was conducted on pregnant women who visited the antenatal clinics of a tertiary referral hospital between March and July 2021. The study recruited pregnant women who had a hemoglobin level of <11 g/dL into the anemic group, while those with hemoglobin levels ≥11 g/dL were included in the non-anemic group. Demographics, clinical, obstetrics, nutrition-related, hygiene- and sanitation-related, and parasitic infection-related data were collected. RESULTS: A total of 449 pregnant women (399 anemic and 50 non-anemic) participated in the study. A total of 224 (56.7%) in the anemic group and 31 (62.0%) in the non-anemic group did not consume any dark green, leafy vegetables such as spinach, bukurey, cagaar, and koomboow (p=0.040). Notably, 255 (63.9%) in the anemic group and 21 (42.0%) in the non-anemic group had a middle-upper arm circumference <23 cm. More than half of anemic [335 (84%)] and non-anemic [46 (92.0%)] were classified under low dietary diversity score. Majority of the study participants, 288 (72.4%) of the anemic and 39 (78%) of the non-anemic groups, used pit toilets in dwellings, and 70.2% (134/191) of the anemic and 64.4% (246/382) of the non-anemic groups disposed of solid waste in open fields. CONCLUSION: This study demonstrated that women who consumed green vegetables such as spinach, bukurey, cagaar, and koomboow in their diet had middle-upper arm circumference less than 23 cm, and those with low dietary diversity significantly developed anemia during pregnancy.

Need for standardization in the use of structures in the intensity-modulated radiation therapy planning of head and neck cancers, a GORTEC study.

BACKGROUND: Most radiotherapy structures contoured on CT scans during IMRT planning are defined by the ICRU, forming part of standard practice. Associated dose-volume constraints serve as parameters for dose computation algorithms to produce optimized dose maps. On the ground, however, physicists/dosimetrists routinely delineate auxiliary "non-standard" radiotherapy structures (nsRS). MATERIALS/METHODS: From 287 patients' data, five categories of nsRS were identified. Inter-center, inter-patient variability, and temporal trends in nsRS use were investigated. Relation of nsRS with topological complexity, plan quality, calculated quality assurance (QA) and expert QA, was investigated using machine learning classification. RESULTS: nsRS accounted for 19.2% of all structures. Average number of nsRS per patient was 8.92 ± 6.70. Variation coefficient across centers was > 70% for nsRS frequency. There was no effect of patient volume per center on averaged nsRS number between low, intermediate, and high-volume centers. No temporal trends in nsRS use were detected at the high-volume centers, except for an increase in 'forced-dose' nsRS (p = 3.08 × (10)^(-5)) at one center. Machine learning prediction accuracy including nsRS features were 0.70 ± 0.06 for topological complexity, 0.58 ± 0.05 for calculated QA and 0.72 ± 0.05 for expert QA. CONCLUSION: Use of nsRS is frequent but heterogeneous and should be standardized further in line with ICRU initiatives in IMRT planning. Use of nsRS should be documented with respect to the need for nsRS from dose computation algorithms of treatment planning systems and IMRT machines in terms of modulation capacity and plan robustness.

Postpartum depressive symptoms in women with female genital mutilation in Somalia.

OBJECTIVES: This study aimed to identify associated factors for postpartum depression (PPD) among women with female genital mutilation (FGM) in Somalia. METHODS: This was a cross-sectional study conducted between February and May 2021 in Somalia Mogadishu-Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia. Mothers with any known chronic disease, or psychiatric disorders and who refused to participate were excluded from the study. The cutoff point for depression was defined as ≥13 points according to the Edinburgh Postnatal Depression Scale. RESULTS: Out of 446 postpartum mothers, 267 (59.9%) had increased depressive symptoms in the early postpartum period. PPD scale scores of mothers who were very poor were significantly higher depression scores than their counterparts (p = .002). Education level, place of residence, occupational status, number of children, type of FGM, and the presence of perineal tear did not differ significantly between depressed and non-depressed groups. CONCLUSIONS: Women with FGM had increased depressive symptoms in the early postpartum period in Somalia. In addition, women who had lower income had higher PPD scores than their counterparts. Further studies are needed to develop a deeper understanding of the relationships between FGM and PPD and its causes.

Effect of COVID-19 pandemic on female sexual function in women with female genital mutilation.

We aimed to evaluate the impact of the COVID-19 pandemic on female sexual function in women with female genital mutilation (FGM) in Somalia. This cross-sectional study was conducted on women with FGM attending the gynaecologic outpatient clinic of our hospital, between March and June 2021, using a validated Female Sexual Function Index (FSFI) questionnaire with a physical examination based on FGM typing. Those women who refused to participate, those with mental illness, uncontrolled systemic disease, drug, alcohol, or khat addiction, pregnant, genital prolapse, gynaecological or urological cancer, previous pelvic surgery, premature ovarian failure, genital skin diseases, drug use that affects sexual function and those with or suspected of having COVID-19 infection were excluded. A total of 201 sexually active women enrolled, with a mean age of 29 (14-55) years. Comparison of FSFI scores and the COVID-19 pandemic, a statistically significant worsening in the mean FSFI scores and all its domains (p<.001, for each). All of the domains of the FSFI were determined higher before and during the pandemic except pain. There is a decline in female sexual functioning during the COVID-19 outbreak in women with FGM. FGM is a major public health concern necessitating urgent response in Somalia.Impact statementWhat is already known on this subject? As it stands, there is a body of research on sexual behaviour during COVID-19 pandemic, but a lack of conclusive evidence. However, our knowledge of the sexual function of women with FGM during the COVID-19 pandemic is largely based on very limited data.What do the results of this study add? There is a decline in female sexual functioning during COVID-19 pandemic in women with female genital mutilation in Somalia.What are the implications of these findings for clinical practice and/or further research? FGM is a major public health problem necessitating urgent response worldwide. There is an urgent need to implement FGM prevention programmes and raise public awareness in order to eradicate this harmful practice.

Percutaneous Transforaminal Endoscopic Removal of Spinal Shrapnel.

BACKGROUND: Gunshot injuries are one of the most common causes of the penetrating injuries of the spine. The victims of these injuries usually have neurologic deficits. Percutaneous endoscopic lumbar surgery is one of the most popular surgical spine interventions. We report a case with incomplete radiculopathy due to shrapnel located in L5 foramen that was removed by percutaneous endoscopic technique. CASE DESCRIPTION: A 23-year-old man sustaining a gunshot injury penetrating to the abdomen presented to our hospital. His first examination revealed a single gunshot wound with entry hole in the left low lumbar region without exit hole and right lower abdominal quadrant tenderness. Plain radiographs and computed tomography showed a bullet in the abdomen and left L5 transverse process fracture and shrapnel in L5 foraminal zone. The bullet was removed by abdominal surgeons without any surgical plan for the shrapnel in the foramen. He was referred to our clinic 3 weeks after discharge. Without any further neurologic deterioration, he had uninterrupted severe pain that was mostly unbearable during the night. Despite gradually increasing dosages of different drugs, his pain relief was insufficient. Percutaneous transforaminal endoscopic removal of the shrapnel was planned. CONCLUSIONS: Despite the absence of a universally approved algorithm in the treatment of spinal gunshot injuries, endoscopic technique can be kept in mind for a minimal access and invasiveness in case of indication for removal. With experience in endoscopic procedures and familiarity with surgical anatomy, the treatment of this unique case was completed successfully.

Increased cytotoxic potential of infrequent triterpenoid saponins of Cephalaria taurica obtained through alkaline hydrolysis.

Phytochemical investigations of the aerial parts of the plant Cephalaria taurica Szabó. (Caprifoliaceae) have resulted in the isolation of nine oleanane-type triterpenoid saponins, of which two still remain undescribed. The structures of tauricosides A and B were characterized based on NMR analysis, HRESIMS spectrometry, and chemical evaluations. The saponins tauricosides A and B have been rarely reported in the literature due to the presence of eight sugar moieties, and this is also the first report of saponins containing eight sugar moieties in the Caprifoliaceae family. The cytotoxic activities of tauricosides A and B, their undescribed prosapogenins, aglycone hederagenin, and n-butanol extract of C. taurica against the cancerous cells A-549, HeLa, PANC-1, and SH-SY5Y and the noncancerous HEK-293 cells were evaluated by the MTT method. Although tauricosides A and B and the crude n-butanol extract did not exhibit any activity at the tested concentrations on all the tested cells, after alkaline hydrolysis, the cytotoxic activity potential of the compounds was obviously improved. The most active compound, obtained after the alkaline hydrolysis of tauricoside B, showed a significant inhibitory effect, which was higher than that of the standard, commercially available drug doxorubicin, on the cancerous A-549, HeLa, PANC-1, and SH-SY5Y cells with IC50 values of 9.04, 8.75, 6.87, and 4.32 µM, respectively. In addition, prosapogenin, obtained after the alkaline hydrolysis of tauricoside A, exhibited considerable cytotoxic activity on the cancerous A-549, HeLa, PANC-1, and SH-SY5Y cells, with IC50 values of 13.19, 10.32, 11.91, and 7.49 µM, respectively. In conclusion, the alkaline hydrolysis of the saponins (tauricosides A and B) obviously improved their cytotoxic activity potential.

The biochemical and histological analysis of subcutaneous calcitonin and intramedullary methylprednisolone on bone repair after bone marrow ablation: an experimental comparative study in rats.

BACKGROUND: Although, glucocorticoid (GC) and calcitonin-induced changes in bone repair have been studied previously, the exact effects of these on fracture healing remain controversial. Hence, the purpose of this experimental study is to determine biochemical and histological effects of locally administrated GC and systemically administrated calcitonin on the kinetics of healing response after bone marrow ablation in rats. METHODS: After having undergone marrow ablation, a steroid-treated group of rats (n = 24) received a single dose of intramedullary methylprednisolone (2 mg/kg), a calcitonin-treated group (n = 24) received intermittently administrated subcutaneous salmon calcitonin (16 IU/kg), and a control group (n = 24) received intramedullary saline (25 µl). RESULTS: Blood samples taken on days 1, 3, 7, 9, and 15 after ablation showed an increase in serum calcium, alkaline phosphatase (ALP), and phosphate levels in the Calcitonin and Control groups. Levels of calcium and ALP peaked on day 7 after ablation. However, an increase in phosphate levels indicated a biphasic reaction that peaked on the third and ninth day after ablation. Hypercalcemia was not observed in Steroid group because of the inhibition of osteoclastic bone resorption. In that group, the serum levels of ALP and phosphate were lower than baseline levels. The levels of urinary calcium excretion peaked 3 to 7 days after marrow ablation in the control group and 7 to 9 days after that procedure in the steroid group. Histologic evaluation showed that the rats in the control group demonstrated the expected healing period according to the histological grades and that a delay in healing occurred in the calcitonin group after day 9 because of the inhibition of osteoclastic bone resorption. All rats in the steroid group exhibited a decrease and delayed healing response. CONCLUSION: Total serum calcium, phosphate, and ALP levels increased after bilateral tibial bone marrow ablation and urine calcium and hydroxyproline excretion also increased as a factor of bone resorption. Subcutaneously administrated salmon calcitonin did not affect biochemical changes after marrow ablation. Single-dose intramedullary methylprednisolone inhibited extra-tibial bone resorption induced by cytokines after bone marrow ablation.

Effectiveness of Computed Tomography Guided Percutaneous Radiofrequency Ablation Therapy for Osteoid Osteoma: Initial Results and Review of the Literature.

BACKGROUND: The aim of this retrospective study is to determine our experience of technique success rate, complications and clinical results in long term follow up for computed tomography (CT)-guided radiofrequency ablation [RA] therapy for osteoid osteoma (OO). MATERIAL/METHODS: We performed RA therapy to 18 patients with OO referred to interventional radiology from other clinics primarily from orthopedics; between January 2011 to May 2014. Daytime and nighttime pain intensity of 18 patients was noted according to visual analog scale (VAS). After procedure pain intensity was compared with before one. We also discussed other factors can affect it. RESULTS: All procedures were completed technically successful for all patients [100%]. We did not experience any major complication or mortality. However we had 3 minor complications. Pain came back in 1 patient after 5 months from procedure and it was considered as recurrence. Dramatic pain intensity fall was seen in patients after procedure, both daytime and nighttime. However we did not find and statistically significant change in comparison of pain intensity reduce and time needed to return back to routine life when using patients demographic data and lesion size. CONCLUSIONS: CT guided RA therapy of OO is minimally invasive, effective and secure procedure.

[Anterior cruciate ligament injuries: does surgical treatment with autograft versus allograft option affect the clinical results?]. / On capraz bag yaralanmalari: otogreft ve allogreft seçenekleriyle cerrahi tedavi klinik sonuçlari etkiler mi?

BACKGROUND: We investigated the clinical outcome of anterior cruciate ligament (ACL) reconstructions with allograft or autograft. METHODS: We retrospectively evaluated 82 patients who underwent arthroscopic ACL reconstruction with anterior tibial tendon (ATT) allograft (n = 52) or quadrupled hamstring tendon (QHT) autograft (n = 30). The patients were assessed using the IKDC (International Knee Documentation Committee) and Lysholm knee scores and functional (one leg hop) and laxity (pivot-shift, Lachman, anterior drawer) tests. RESULTS: The two groups were similar with respect to age and sex distribution, operated side, preoperative period and associated injuries (p > 0.05). Results were satisfactory in both groups, but there was no statistically significant difference between the groups with respect to IKDC and Lysholm scores, functionality and ligament laxity (p > 0.05). However, effusions were more frequent in the QHT group compared to the ATT group. CONCLUSION: Our results suggest that differences in graft options for ACL reconstruction have no effect on the clinical outcome. Allografts with to-be-developed solutions to immune response may be a good alternative in ACL reconstruction.

Interobserver reliability in evaluation of pedicle screw positions inserted with a modified technique.

The aim of this study was to evaluate a new technique for insertion of pedicle screws. The position of the screws was assessed on postoperative plain radiographs and computed tomography (CT) scans, and the interobserver reliability in evaluation of the pedicle screw positions was studied. The technique was applied to insert 201 pedicle screws in 27 patients with various spine conditions. The positions of the screws were evaluated blindly by two independent orthopaedic surgeons and two independent radiologists. Interobserver reliability was evaluated separately for analysis of plain radiographs and CT scans, as well as for the different spinal segments and for the different spine conditions treated. The rate of malpositioned screws was between 6.5% and 32.8% in plain radiographs and between 3.5% and 6.5% in CT scans according to the different observers. In plain radiographs, the rates of malpositioned screws in the upper thoracic, lower thoracic and lumbosacral spine segments were between 3.8%-39.6%, 10.0%-36.3%, 4.4%-23.5%, respectively. In CT scans, the rates of malpositioned screws in the upper thoracic, lower thoracic and lumbosacral spine segments were between 3.8%-13.2%, 2.5%-8.8%, and 0%, respectively. Interobserver reliability was found to be poor in radiographs and fair in CT scans. The technique used for insertion of pedicle screws was found to be simple and reproducible. Assessment of the screw positions with only plain radiographs was not found reliable. A detailed and standard classification system should be developed in order to improve interobserver reliability in assessing the positions of the screws.

[The effect of bone marrow ablation on regional biomechanical properties of rat tibia]. / Kemik iligi ablasyonunun siçan tibiasinin bölgesel biyomekanik özellikleri üzerine etkileri.

OBJECTIVES: Regional (metaphyseal-diaphyseal) biomechanical properties of normal rat tibia, and changes on these biomechanical properties after bone marrow ablation, a model of fracture healing, were examined. METHODS: The study included 24 Sprague-Dawley rats that underwent tibial marrow ablation, and eight control rats with no surgical procedure. Proximal metaphyseal, proximal diaphyseal, distal diaphyseal, and distal metaphyseal samples were prepared from the tibias of all rats. In the control group, stiffness (elastic modulus, E), strength (maximum strength, Smax), and toughness (total energy absorption, U) parameters of the regional tibial segments were evaluated under compression loads. In the experimental group, compression was applied following bone marrow ablation on days 1, 3, 7, 9, and 15, and ablation-induced changes in the regional biomechanical properties were studied. RESULTS: The lowest E, Smax, and U values were obtained from the proximal metaphysis. The highest E and Smax values were from the distal diaphyseal, and the highest U values were from the proximal diaphyseal regions. In ablation-induced rats, decreases were observed in all the mechanical test values during days 1 to 7, followed by slight increases on days 7 to 9, and eventual decreases on days 9 to 15. There were significant differences between the two groups with respect to biomechanical parameters (p<0.05), but no significant differences were found between the tibial regions (p>0.05). CONCLUSION: Biomechanically, the most resistant and the weakest anatomic regions of normal rat tibia are the diaphyseal region and proximal metaphysis, respectively. The metabolic changes occurring after bone marrow ablation lead to changes in the mechanical properties of the tibia. The most affected tibial segments from ablation-induced intramedullary injury are the metaphyseal segments.

[The evaluation of patients undergoing total knee arthroplasty with or without patellar resurfacing]. / Total diz protezi uygulamalarinda patella eklem yüzeyi degistirilen ve degistirilmeyen olgularin degerlendirilmesi.

OBJECTIVES: We evaluated the clinical and radiographic results of total knee arthroplasty (TKA) with or without patellar resurfacing. METHODS: The study included 149 knees of 126 patients who underwent TKA for primary knee osteoarthritis with (59 knees, group 1) or without (90 knees, group 2) patellar resurfacing. Clinical evaluations were made with the knee and function scores of the Knee Society, and patella scoring system; radiographic evaluations included changes in the joint line, Insall-Salvati ratio, lateral patellofemoral angle, and congruency angle. The mean follow-up period was 66.7 months (range 34 to 123 months) in group 1, and 68.1 months (range 30 to 117 months) in group 2. RESULTS: Although postoperative knee and function scores showed significant improvements in both groups (p<0.001), these did not reach significance between the two groups (p>0.05). The mean patella scores did not differ significantly, either (p>0.05). Postoperative radiographic assessments did not show significant differences between the two groups with respect to mechanical axis values, patellar tilt, and lateral subluxation (p>0.05). Symptomatic patellar subluxation, dislocation, fracture or rupture of the extensor mechanism did not occur in any of the treatment groups. None of the patients required revision associated with the patella and patellar prosthesis. CONCLUSION: Our findings suggest that patellar resurfacing is not necessary other than patients with significant degeneration of the patellar surface.

Enhancement of tendon-bone healing of anterior cruciate ligament grafts by blockage of matrix metalloproteinases.

BACKGROUND: The use of soft-tissue grafts for anterior cruciate ligament reconstruction delays the healing process. This delay may be due to biochemical and/or biomechanical insults. We hypothesized that the blocking effect of alpha2-macroglobulin on synovial matrix metalloproteinase activity may enhance the healing of tendon graft in a bone tunnel. METHODS: The study was performed on twenty-eight healthy, skeletally mature New Zealand White rabbits. Each rabbit underwent bilateral anterior cruciate ligament reconstruction with use of the ipsilateral semitendinosus tendon. Alpha-2-macroglobulin (alpha2-macroglobulin) was injected into the knee joint in one limb, and the contralateral limb served as a control. The rabbits were killed two weeks (fourteen rabbits) or five weeks (fourteen rabbits) after the operative procedures. The presence of matrix metalloproteinases in synovial fluid, and the blocking effect of alpha2-macroglobulin on them, were determined with enzymatic assays. Healing between the tendon and the bone tunnel was assessed morphologically by determining the presence of fibrovascular tissue and collagen fibers. Healing also was assessed quantitatively by measuring the ultimate load to failure of the reconstructed complex. RESULTS: There was an increase in matrix metalloproteinases in the control group; in contrast, there was a decrease in the study group (p < 0.05). In the control specimens, the fibrovascular tissue at the bone-tendon interface had developed into dense connective tissue with poor vascularization. In the treated specimens, the bone tunnel had more areas of denser connective-tissue ingrowth. The interface tissue was more mature and contained numerous perpendicular collagen bundles (Sharpey fibers). The ultimate load to failure was significantly greater in the alpha2-macroglobulin-treated specimens than in the untreated controls at both two and five weeks. CONCLUSIONS: The present study demonstrated that alpha2-macroglobulin blockade of matrix metalloproteinases can enhance bone-tendon healing. This effect of alpha2-macroglobulin could occur through its effect solely on collagenase or on a subset of matrix metalloproteinases that are present at the healing interface.

Surgical treatment of sprengel's deformity: a modified Green procedure.

Twelve cases of Sprengel's deformity were treated surgically by a modification of Green's procedure. After clavicular osteotomy, all muscular attachments to the scapula were freed; an omovertebral band if present was cut and the scapula was rotated and moved caudal to a more normal position, to be sutured into a pocket of the latissimus dorsi. The patients included 10 female and 2 male patients (age range at the time of operation: 3 to 9 years; mean: 5.2 years). The deformity involved the left shoulder in 8 patients, the right shoulder in 4. All patients were followed for an average of 2 years (range: 6 months to 4.5 years). The range of flexion improved from an average of 95 degrees to 105 degrees and the range of abduction from an average of 81 degrees to 97 degrees. Cosmesis was improved in all 12 patients but three patients had an unsightly surgical scar. Surgical treatment by a modified Green procedure for patients with Sprengel's deformity is indicated when the patient and family want cosmetic or functional improvement.