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Comparison of Transvaginal Ultrasound, Saline Infusion Sonohysterography versus Diagnostic Hysteroscopy in Evaluation of Endometrial Cavity Pathology amongst Women with Abnormal Uterine Bleeding in Low Resource Setting

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Open Journal of Obstetrics and Gynecology 2020年第5期10卷 644-656页

作者： Jayni Dedhia Gichuhi J.Wanyoike Ojwang B.Shadrack madadi m.obimbo Rafique B.Parkar Elijah Kwasa Department of Obstetrics&Gynaecology University of NairobiNairobiKenya Department of Anatomy University of NairobiNairobiKenya Consultant Obstetrician&Gynecologist NairobiKenya Consultant Radiologist NairobiKenya

Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between may and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy menstrual Bleeding (HmB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The inc

关键词： Abnormal Uterine Bleeding Transvaginal Sonography Saline Infusion Sonohysterography Hysteroscopy

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Policy and research frame of the coronavirus disease 2019(COVID-19)pandemic:reflections on urban informality

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Global Health Journal 2021年第1期5卷 12-17页

作者： Israel Nyaburi Nyadera Francis Onditi moses madadi obimbo Samson Kinyanjui muchina Department of Government and Public Administration Institute of Social SciencesUniversity of MacaoAvenida da Universidade TaipaMacaoChina Department of Political Science Institute of Social SciencesAnkara Yildirim Beyazit UniversityGüvenevler Mah.Cinnah Cad.No.16 Cankaya Ankara 0680Turkey Department of International Relations School of Diplomacy and International RelationsRiara UniversityP.O.Box 49940-00100NairobiKenya Department of Human Anatomy School of MedicineUniversity of NairobiP.O.Box 30197-00100NairobiKenya School of medicine University of OxfordOxford OX12JDUnited Kingdom Kenya medical Research Institute P.O.Box 54840-00200 Off Mbagathi RoadNairobiKenya

How has the informality of urban slums exposed a gap in policy formulation and research questions in the wake of the coronavirus disease 2019(COVID-19)pandemic?This paper seeks to identify the appropriate questions and policy frame that would assist future researchers and policymakers on the subject of pandemics in densely populated urban *** authors argue that the nexus between asking the appropriate questions and developing appropriate policy response measures during a pandemic can significantly impact the outcome of the *** paper examines how the government of Kenya's response to the COVID-19 pandemic reveals a deep-rooted socio-economic and cultural inequality when"blanket"policies are adopted without taking into consideration the tnique dynamics characterizing the *** findings show that the effectiveness of implementing COVID-19 containment policies such as lockdowns,the cession of movement,working from home,distance learning,and social distancing are affected by other factors such as the nature of jobs,one's income levels,where someone lives,cultural beliefs,access to water,sanitation,intemet,and medical *** means that a significant number of people within the society experience a double tragedy from the pandemic and impact of government response *** most of the existing literature has focused on the causes,spread,and impact of the pandemic on health institutions,economies,and public health with little emphasis on the impact on policy measures especially on the vulnerable segments of the *** paper,therefore,looks at the question of how the various public health intervention strategies disrupt or construct the livelihood of the already complex informal *** provides policymakers and researchers with a number of questions that can frame policy and research during a pandemic with important consideration to urban informality.

关键词： Coronavirus disease 2019(COVID-19) Urban informality Pandemic Policy Research

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