Comparison of Serum Calcium Level in Hypertensive and Normotensive Pregnant Women

Background: Calcium deficiency in pregnancy is linked to the risk of development of hypertensive disorders of pregnancy. At present,hypertensive disorders of pregnancy are among leading causes of maternal death in Nigeria. This study was aimed to compare the serumcalcium level of women with hypertensive disorders of pregnancy and normotensive controls. Methodology: This was a comparative descriptive study among patients with hypertensive disorders of pregnancy (45 pre‑eclampsia [PE] and 45 gestational hypertension [GH]) and comparative group of 45 normotensive pregnant women at Federal Medical Center, Abeokuta. Results: The serum calcium level in normotensive controls (mean ± standard deviation) was 2.64 ± 1.38 mmol/l, women with GH was 2.39 ± 1.15 mmol/l, and PE was 2.08 ± 0.76 mmol/l (P = 0.065). Hypocalcemia was found to have an incidence rate of 33% in normotensive  controls, 51.1% among GH, and 51.1% among PE. Conclusion: Pregnant women with hypertensive disorders of pregnancy showed nonsignificant difference in mean serum calcium level. Keywords: Calcium, gestational hypertension, hypertensive, normotensive, preeclampsi

Learning needs analysis to guide teaching evidence-based medicine: knowledge and beliefs amongst trainees from various specialities

<p>Abstract</p> <p>Background</p> <p>We undertook a needs assessment exercise using questionnaire survey of junior doctors' knowledge and beliefs concerning evidence-based medicine (EBM) and critical literature appraisal, as this is a core competence in postgraduate medical education.</p> <p>Methods</p> <p>We surveyed 317 junior doctors in various specialities in the UK West Midlands Deanery. Using validated questionnaires we compared the needs of different trainee groups. Results overall were internally consistent (Cronbach's alpha 0.929).</p> <p>Results</p> <p>Respondents' generally felt that they had poor training in EBM (Mean score 2.2, possible range 1 – 6) and that they needed more education (Mean score 5.3, possible range 1–6). Male trainees felt more confident at evaluating statistical tests than females (p = 0.002). Female trainees considered patient choice above the evidence more often than males (p = 0.038). Trainees from surgical speciality felt more confident at assessing research evidence (p = 0.009) whereas those from medical speciality felt more confident at evaluating statistical tests (p = 0.038) than other specialities. However, non-surgical specialities tended to believe that EBM had little impact on practice (p = 0.029). Respondents who had been qualified for 11 years or over felt overall more confident in their knowledge relating to EBM than those who had been qualified less than 10 years. In particular, they felt more confident at being able to assess study designs (p = < 0.001) and the general worth of research papers (p = < 0.001). Trainees with prior research experience were less likely to find original work confusing (p = 0.003) and felt more confident that they can assess research evidence (p = < 0.001) compared to those without previous research experience. Trainees without previous research experience felt that clinical judgement was more important than evidence (p = < 0.001).</p> <p>Conclusion</p> <p>There is a perceived deficit in postgraduate doctors' EBM knowledge and critical appraisal skills. Learning needs vary according to gender, place of basic medical qualification, time since graduation, prior research experience and speciality. EBM training curricular development should take into account the findings of our needs assessment study.</p

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Trends in misoprostol use and abortion complications: A cross-sectional study from nine referral hospitals in Nigeria.

ObjectiveThe study aimed to assess the use of misoprostol and complications associated with abortions in referral hospitals in Nigeria, a country with restrictive abortion laws.MethodsA cross-sectional study at nine referral hospitals in South-west Nigeria. Nine years' data were retrieved from medical records, including 699 induced abortions. Independent variable was the method of abortion; dependent variables were complications, need for treatment and mortality. Statistical significance was tested with Chi-square, Fishers' exact and chi-square for trend tests (pResultsThere were 699 induced abortions amongst 2,463 abortions found in records. Nearly 70% were surgical abortions, but misoprostol use significantly increased over the study period in a linear trend (Χ2 trend: 30.96, P ConclusionMisoprostol abortion has significantly increased over time, and was associated with less morbidity and need for further treatment, in this study. It appears to be the safer option

Efficacy of Admission Cardiotocography in Early Stage of Labour in Predicting Perinatal Outcome among Parturients in a Tertiary Health Facility in Ogun State, Southwest Nigeria

Background: Some fetuses will present with hypoxia at admission into the labour room and may not be able to withstand the stress of frequent and adequate uterine contractions. Admission cardiotocography (CTG) in early labour has been thought to be useful in detecting babies with such conditions therefore affording the obstetrician early intervention to prevent adverse perinatal outcome. Aim: This study aims to determine the predictive value of admission cardiotocogram in early labour in the early detection of fetal hypoxia and its adverse perinatal outcome. Patients,Materials and Methods: It was a prospective cross‑sectional study among low‑ and high‑risk pregnant women in a tertiary health institution in Abeokuta, Southwest Nigeria. Two hundred participants with singleton fetus in cephalic presentation were recruited consecutively at term in early first stage of labour and were subjected to 20 min admission CTG (ACTG). The resulting cardiotocograms were classified into reactive, suspicious or pathological and further management was based on the cardiotocogram findings. Perinatal outcomes were assessed and statistical analysis done using IBM SPSS version 20. The main outcome measures were mode of delivery and perinatal outcome using Apgar scores, neonatal pulse oximetry, and neonatal unit (NNU) admission. Results: Seventy percent of the participants were multipara, 42% were aged between 26 and 30 years. Suspicious and pathological CTGs were 9% and 1%, respectively. Operative delivery, birth asphyxia, and NNU admission of babies were more common among the non‑reactive (suspicious/pathological) CTG groups compared to reactive CTG group. The test, in predicting perinatal asphyxia, has low sensitivity (42.86%) and positive predictive values (15%) but high specificity (91.19%) and negative predictive values (97.78) Conclusion: ACTG is a simple, noninvasive screening tool in labour. It is highly effective in predicting fetuses unlikely to develop birth asphyxia but not so effective at predicting those likely to develop asphyxia. The test should be used with caution

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways