Introduction: Ensuring access to quality caesarean section (CS) care is a key millenium development strategy and the next sustainable development goal to reduce maternal and infant mortality. The WHO recommends that the caesarean section rate should not exceed 10-15%. The objective of our analysis is to document the variability of caesarean section rates in Sub-Saharan Africa. Material and method: we carried out a review of 26 studies for the simple proportions of events using the R metafor package (Viechtbauer, 2010). The studies were selected in the following way: the type of study, target population and keys words (such as intra operative complications, caesarean section utilization, maternal mortality or perinatal mortality or morbidity and caesarean section, Africa south of the Sahara or sub Saharan Africa). We performed a random-effects meta-analysis, and heterogeneity was assessed using the I 2 value. Result: the overall proportion of caesarean sections is 19% (14%-24%) for 26 selected studies. The I 2 index is equal to 99.92%, suggesting a very high level of heterogeneity. Journal impact factors accounted for this heterogeneity. Conclusion: the best CS rate is the one that gives the best outcome with regard to foetal and maternal benefi t. This rate may vary as obstetric problems differ from one country to another. Studies published in higher impact journals tend to report a lower proportion of CS than articles published in lower impact journals.

No abstract

whether there were any differences in the patient experience for patients undergoing this type of surgery at our facility. Methods All patients undergoing forearm/hand fixations between May and November 2020 at a large teaching hospital were studied retrospectively. Cases with any RA component were compared with GA-only cases. Time in recovery, time to discharge, nausea, pain scores and post-operative opioid requirements were studied. Ethical approval was not required for this study, as per our local committee. Results 105 patients were included with results shown below. The breakdown of cases as wrist, proximal to wrist, and distal to wrist procedures were broadly similar in the RA group and GA group (78%,5%,17% vs. 89%,4%,7%) respectively. The incidence of severe pain was 3.5% (RA) vs. 41% (GA). The incidence of nausea was 2.5%(RA) vs. 9%(GA).

Introduction: Nine randomized trials in early breast cancer(EBC) have demonstrated an advantage of aromatase inhibitors(AI’s) over tamoxifen in disease-free survival. Joint symptoms are common toxicities and lead to treatment interruption in up to 20% in case of severe aromatase-induced arthralgia(AIA). During menopause levels of markers of inflammation such as IL-1b, TNF-alpha and IL-6 increase. We hypothesized that estrogen deprivation by aromatase inhibition could be associated with similar changes in these markers and that this could play a role in AIA. In an earlier study, similar toxicities were observed in patients(pts) treated with a recombinant form of IL-6. In several cell types it has been shown that ligand activated estrogen receptor blocks nuclear factor kappa beta controlled gene transcription of IL-6. Aim of the study: We initiated a prospective open-label study to examine the role of inflammatory cytokines and other serum markers(CRP and hormones) in the pathogenesis of AIA. Methods: 29 evaluable postmenopausal pts with hormone sensitive, Her 2 negative EBC stage I-III, with baseline G0-1 arthralgia were included. Before chemotherapy, at baseline, at month 3, 6, 9, 12 and 18 after AI initiation, serum samples were taken for CRP and hormones (estradiol, androstenedion) and cytokines were analyzed with a human cytokine 25-plex panel. A detailed rheumatologic questionnaire and Visual Analog Scale(VAS) was performed at each visit. Arthralgia grading was assessed using the CTCAE criteria 4.0. The T-test and the Wilcoxon Signed Rank test were used to look for the difference in terms of IL-6, Il-1b, IL-8, TNF, CRP, estradiol and androstenedion between G0 versus G1-2-3 arthralgia. Results: The mean age was 56 yrs. (34-72yrs). All patients were treated with surgery followed by concomitant chemoradiation and letrozole (31) or anastrazole (1). In 16 pts G1 arthralgia was present before the start of the chemotherapy. Grade 2 and 3 arthralgia appeared at mth 3. The proportion of pts with grade 2 remained more or less the same, while grade 3 pts declined from month 6 onwards and disappeared at month 18. Grade of arthralgia at different time pointsArthralgiamth omth 3mth 6mth 9mth 12mth 18G045231911618G1553954615955G202319222927G30158560 There was a significant correlation between the grade of arthralgia and the VAS score at all-time points (p<0.05). CRP levels were significantly higher in the patients with arthralgia at month 3 (p<0.001) and 6 (p<0.005). Patients with G2-3 arthralgia had higher estradiol levels at mth 3 (p<0.001) and 6 (p<0.001).Cytokine results are currently available for the first 12 patients only. In these preliminary data, IL-6 levels were significant higher in the pts with arthralgia before initiation of AI ‘s. The examination of correlations during AI treatment needs the analysis of the full cohort. Conclusion: This study indicates that both menopause and AIA have inflammatory mediators (IL6 and CRP) that correlate with the degree of lowering of estradiol levels. This is consistent with the regulation of IL-6 by the ligand activated ER through NFkB in vitro. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-13-06.

No abstract