Gastrointestinal symptoms in pregnancy among antenatal clinic attendees in Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Northeast Nigeria

Background: Pregnant women are at increasing risk of GI symptoms such as nausea, vomiting and heartburns, most of these symptoms are as a result of the hormonal and physical changes associated with pregnancy. This study aimed to determine prevalence of gastrointestinal symptoms (GI) among pregnant women attending booking clinic at a Northeastern Nigerian Teaching Hospital.Methods: The study was a cross-sectional, questionnaire-based survey of four hundred and fifty-two pregnant women booking for antenatal care. Their sociodemographic variables as well as the presence or absence of gastrointestinal symptoms in index pregnancy were obtained at by the use of researcher-administered questionnaire. Data were analyzed and presented as frequencies and percentages. A 5% significance level (p <0.05) to test associations.Results: Two fifty-five women had heart burns (56.4%) while 235 (52.0%) had nausea in pregnancy, these were observed to be the most prevalent GI symptoms among the women. Diarrhea and hemorrhoids were the uncommon GI symptoms in the study population constituting 406 (89.5%), and 360 (79.6%) respectively. Easy fullness was noted in 39.8% of the women while vomiting was in 41.8% and constipation in 29% of the respondents. A significant association was observed (p value <0.05) between parity and development of anorexia and hemorrhoids in pregnancy (p values of 0.049 and 0.051 respectively) but not for the other symptoms.Conclusions: GI symptoms are common in pregnancy, the most prevalent symptoms are that of heart burns and nausea, while diarrhea is relatively uncommon

Pattern of Cancer in Bauchi: Report from a Departmental Cancer Registry

Context: Cancer ranks second among the major causes of death globally. A projection by 2020 indicated that developing countries wouldaccount for about 70% of total cancer‑related death worldwide. Despite the great threat posed by cancer to this region of the world,&nbsp; reliable statistics on the trends and patterns of cancer are rare. Aims: The aim of the study is to review the cases of cancer recorded in Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, from January 1, 2011 to December 31, 2019 Materials and Methods: This is a retrospective, descriptive study. Nine years records of all pathologically diagnosed cancer cases in the ATBUTH, Bauchi were retrieved, reviewed, and grouped in accordance with the International Classification of Diseases for Oncology. The results were presented as simple frequency tables and charts. Results: A total of 1284 cancer cases were diagnosed during the period, an average of 142.7 cases per annum. There was a female predominance of cancer cases (male: female ratio ‑ 1:1.53. The age range was from seven months to 95 years, with mean and medianages of 49.6 and 50 years, respectively. More than half of the cases were reported in the fifth to seventh decades of life. Prostate (14.6%)and non melanoma skin cancer (11.2%) were the most common cancers seen in males. In females, cancers of the cervix (37.9%) and thebreast (22.9%) were the most common. Conclusions: Breast cancer and cancer of the uterine cervix were the most common cancers in women in this review while prostate cancer was the most common cancer in men. The need to establish a hospital‑based and/or population‑based cancer registry that will generate reliable cancer data in our environment cannot be overemphasized. Keywords: Bauchi, breast, cancer, cervix, prostate, registr

Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID Multinational Cohort study

At the beginning of the COVID-19 pandemic, the extent of the risks of a COVID infection during pregnancy were unknown. During the start of the pandemic, there were only a few studies published comparing outcomes between pregnant women with and without COVID-19 infections. The INTERGROWTH-21st Consortium conducted a prospective, longitudinal, observational study (INTERCOVID), which assessed the association between COVID-19 and maternal/neonatal outcomes in pregnant women with a COVID-19 diagnosis compared with enrolled pregnant women without a COVID-19 diagnosis. This study enrolled patients from 43 hospitals in 18 different countries between March 2020 and October 2020. As a comparison group, the researchers enrolled 2 unmatched, consecutive, uninfected women immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care. Both women and neonates were followed until hospital discharge. COVID-19 was diagnosed by laboratory confirmation and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. The primary outcomes of the study were indices of maternal and severe neonatal/perinatal morbidity and mortality. In all, 706 pregnant women with a COVID-19 diagnosis and 1424 pregnant women without a COVID-19 diagnosis were enrolled. The women had broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Three hundred twenty-three women were overweight early in pregnancy (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were more likely to have preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27–2.43), severe infections (RR, 3.38; 95% CI, 1.63–7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13–8.10), maternal mortality (RR, 22.3; 95% CI, 2.88–172), preterm birth (RR, 1.59; 95% CI, 1.30–1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56–2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69–4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66–2.75). Women with a fever and shortness of breath were more likely to have severe maternal complications (RR, 2.56; 95% CI, 1.92–3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11–11.69). Women who were asymptomatic with a COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00–1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01–2.63). Among women who tested positive for COVID-19 (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18–3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66–1.85) was associated with increased risk for neonatal COVID-19 test positivity. In this study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications compared with pregnant women without a COVID-19 diagnosis. These findings highlight the importance of following the recommended COVID-19 preventative measures

Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study

Background: It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective: This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design: This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results: We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2.77 (95% confidence interval, 1.66–4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. Conclusion: COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Ovarian penetration by copper intrauterine device: A rare phenomenon

The insertion of a piece of object inside the uterus has been practiced as a form of birth control since antiquity; one of these devices used nowadays is the intrauterine contraceptive devices which have gained a wide range of acceptance because of their safety, efficacy, and cost-effectiveness. There have been cases of migration of intrauterine devices (IUDs) to adjacent peritoneal structures, but ovarian migration has not been widely reported in West Africa. This case report highlights one of the rare complications of IUD migrating to the left ovary of a 24-year-old woman with no complication. It is imperative that insertion should be done timely by well-trained personnel to avoid the incidence of complications

Polypectomy as a Complete Therapy for Leiomyosarcoma of the Cervix Uteri: An Unusual Treatment

Objectives: Leiomyosarcoma (LMS), which arises from the uterine cervix, is an extremely rare neoplasm and is presented with vaginal bleeding and discharge. In our case report, we intended to highlight the role of polypectomy as a practical option for routine hysterectomy and the surgical cure of cervical LMS. Case Report: A 50-year-old woman (Para 8+0, 6A) presented to the Gynecological Clinic of ATB University Teaching Hospital with vaginal discharge and fleshy mass protruding from the vulva. Examination revealed a cervical polyp on the anterior lip of the cervix. Polypectomy was performed subsequently, and histologic examination including immunohistochemical staining confirmed LMS of the uterine cervix. The patient underwent hysterectomy with bilateral salpingo-oophorectomy with the histological confirmation of a complete excision. Conclusions: Generally, no specific management option is taken for this tumor due to its rare occurrence. However, polypectomy with a wide excision of tumor margin could result in a complete cure, and prolonged survival as in the case presented. Accordingly, histological studies including special stainings may play a vital role in cancer diagnosis.</jats:p

Gastrointestinal symptoms in pregnancy among antenatal clinic attendees in Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Northeast Nigeria

Background: Pregnant women are at increasing risk of GI symptoms such as nausea, vomiting and heartburns, most of these symptoms are as a result of the hormonal and physical changes associated with pregnancy. This study aimed to determine prevalence of gastrointestinal symptoms (GI) among pregnant women attending booking clinic at a Northeastern Nigerian Teaching Hospital.Methods: The study was a cross-sectional, questionnaire-based survey of four hundred and fifty-two pregnant women booking for antenatal care. Their sociodemographic variables as well as the presence or absence of gastrointestinal symptoms in index pregnancy were obtained at by the use of researcher-administered questionnaire. Data were analyzed and presented as frequencies and percentages. A 5% significance level (p &lt;0.05) to test associations.Results: Two fifty-five women had heart burns (56.4%) while 235 (52.0%) had nausea in pregnancy, these were observed to be the most prevalent GI symptoms among the women. Diarrhea and hemorrhoids were the uncommon GI symptoms in the study population constituting 406 (89.5%), and 360 (79.6%) respectively. Easy fullness was noted in 39.8% of the women while vomiting was in 41.8% and constipation in 29% of the respondents. A significant association was observed (p value &lt;0.05) between parity and development of anorexia and hemorrhoids in pregnancy (p values of 0.049 and 0.051 respectively) but not for the other symptoms.Conclusions: GI symptoms are common in pregnancy, the most prevalent symptoms are that of heart burns and nausea, while diarrhea is relatively uncommon.</jats:p

Prevalence of pica among pregnant women attending antenatal clinic in a tertiary facility in Nigeria

One of the unusual symptoms observed among pregnant women is the aversion for non-food substances like sand, clay and ice. Pica is a form of eating disorder characterised by these symptoms. It occurs commonly in children and among pregnant women. This study aims to determine the prevalence and associated factors for Pica among booked patients in our institution. A prospective study was conducted among pregnant women at booking aged 11-45 years at the ATB University teaching Hospital Bauchi between 1st February to 31st of July 2019. All pregnant women who gave their consent were interviewed using a pretested questionnaire. The biodata, risk factors for Pica, occurrence in childhood and other social habits were recorded. The result showed a prevalence rate of pica at 38.9% with a craving for ice (18.7%), sand (14.7%) and others (55.11%). Pica was observed more in the day time (afternoon and evening) and most women having pica had a low level of education. Even though the prevalence of Pica appeared low in our environment, adequate counselling and appropriate treatment of women with this condition should be given more priority.</jats:p

Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study

Importance Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. Objective To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. Design, Setting, and Participants In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. Exposures COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. Main Outcomes and Measures The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity. Results A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63). Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity. Conclusions and Relevance In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures