Objective To evaluate the accuracy of antenatal sonographic measurement of lower uterine segment (LUS) thickness in the prediction of risk of uterine rupture during a trial of labor (TOL) in women with a previous Cesarean section (CS). Methods 0.94 (95% CI,. The pooled sensitivity and specificity of full LUS thickness for cut-offs between 2.0 and 3.0 mm was 0.61 (95% CI,; cutoffs between 3.1 and 5.1 mm reached a sensitivity and specificity of 0.96 (95% CI,

Summaryobjectives To evaluate former Buruli ulcer disease (BUD) patients to assess the factors associated with functional limitations and subsequent employment or schooling.methods The previously validated Buruli ulcer functional limitation score (BUFLS) questionnaire and interviews about educational and professional consequences incurred by BUD.results Of 638 participants, 362 (57%) had a functional limitation after a median period of almost 4 years after treatment for BUD. A lesion on a joint, older age, female gender, a lesion on a distal part of an extremity and a persistent wound were found to be independent risk factors for stopping work or education. The same risk factors applied to the development of a functional limitation. Both functional limitations and financial difficulties due to BUD disease often led to job loss and school dropout.conclusions Rehabilitation programmes are urgently needed to diminish the suffering from the functional limitations and employment or schooling problems caused by BUD.

Background: The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). Methods: LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8:00 AM and 7:59 PM, and as 'night-time' when induction was between 8:00 PM and 7:59 AM. Results: Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P¼0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P¼0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P¼0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09e1.90; P¼0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89e1.90; P¼0.15). Conclusions: Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events. Clinical trial registration: NCT01601223.

We studied hospital records of 750 consecutive Buruli ulcer patients in a highly endemic area in Amansie West, Ghana. Although more Buruli ulcer lesions were found on the right side of the body, comparison of lesions on arms and legs showed a bilaterally symmetrical distribution. Upper and lower extremities were affected equally by Buruli ulcers, if correction was made for differences in body surface area. Patients from outside the Amansie West district presented significantly more often with ulcerated lesions, which were more often located on a joint, than patients who lived in Amansie West, suggesting that longer travel distance might have caused delay. Our observations of a bilaterally symmetrical distribution of lesions on extremities and equal upper and lower extremity involvement are compatible with a mode of transmission that involves passive exposure of exposed body parts. An asymmetrical distribution of lesions was found in an earlier study, suggesting transmission by vegetation near the ground, through activities like farming or play. Perhaps, transmission in or near water, e.g. by bites of infected aquatic insects, might favour the pattern of distribution of lesions that we found.

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Along with the increasing rate of cesarean section (CS) births has been a concomitant decrease in the rate of vaginal birth after cesarean (VBAC), mostly due to concerns about uterine rupture during a trial of labor (TOL). The risk of uterine rupture in laboring women with a previous CS must be balanced against the increasing current and future risk of peripartum hysterectomy with repeat cesarean. Improved prediction of uterine rupture could allow women at low risk to have a TOL, and those at high risk for uterine rupture could undergo a planned CS. Thinning in the lower uterine segment (LUS) measured by ultrasonography is a possible predictor of uterine rupture. The present study was performed to identify an optimal LUS thickness cutoff value and to define groups of women with a history of previous CS to whom TOL either should not be offered or could be offered safely.PubMed and EMBASE were searched for relevant articles published during 1980 to 2011. Included studies reported on pregnant women with at least 1 prior CS and on the sonographic appearance of the LUS during pregnancy in relation to uterine defects observed during or immediately after delivery. Studies were scored on methodologic and clinical characteristics. For each study, a 2 Â 2 table was constructed, cross-classifying LUS thickness measured by ultrasound and the presence of LUS defect after delivery. Sensitivity and specificity were determined for each study in the receiver operating characteristic (ROC) space along with a corresponding summary ROC curve.From an initial 147 citations, 21 studies (all cohort design) were included and involved 2776 women. The median sample size was 71 (range, 10Y642; interquartile range, 149.5). Lower uterine segment measurements were obtained at 34 to 39 weeks' gestation. Cutoff values used to define an insufficient LUS ranged from 0.5 to 3.0 mm in studies measuring myometrial LUS thickness and from 1.5 to 5.1 mm in those using full LUS thickness. Full LUS thickness measurement using cutoffs of 2.0 to 3.0 mm had a specificity of 0.91 (95% confidence interval [CI], 0.80Y0.96) at a sensitivity of 0.61 (95% CI, 0.42Y0.77). Full LUS thickness measurement using cutoffs of 3.1 to 5.1 mm had a specificity of 0.63 (95% CI, 0.30Y0.87) at a sensitivity of 0.96 (95% CI, 0.89Y0.98). The accuracy of transvaginal or transabdominal sonography could not be compared statistically because of the limited number of studies.The main finding is the strong negative correlation between LUS thickness and risk of uterine defect. The similar shapes of the ROC curves for myometrial and full LUS thickness indicated no significant difference in accuracy, shape, and position. An ideal screening test to predict uterine rupture could affect medical decision making by allowing accurate selection of women with a scarred uterus unlikely to have uterine rupture and thus able to have a TOL.

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