Biochemical Assessment of Pregnancy-Related Physiological Changes in Renal Function

This study was aimed at determining biochemical markers of renal function in pregnant women in Kano State, Nigeria. Urea, electrolytes and creatinine were estimated from 45 pregnant women and 45 non pregnant apparently healthy, age-matched controls.  The result of the study showed significant difference (P<0.01) in urea, creatinine and bicarbonate levels between the pregnant and non- pregnant women but no significant difference (p>0.01) was observed in sodium, potassium and chloride levels between the two groups. Studies within the trimesters showed significant difference (p<0.05) in urea levels between the control group of the 1st and 2nd trimesters. Creatinine levels in the 2nd trimester (43.20±12.3) and 3rd trimester (41.40±5.45) were found to be significantly lower (p<0.05) compared to the control group (55.84±16.17). A significant difference in creatinine levels (p<0.05) between the 1st and 2nd and the 1st and 3rd trimesters was also recorded. The mean difference in bicarbonate levels in the 1st (22.33±1.84), 2nd (21.80±1.37) and 3rd(21.73±1.79) trimesters and the -control group (26.09±2.08) was significantly lower (p<0.05) with no significant difference within the trimesters. There was no significant difference (p>0.05) observed in sodium, potassium and chloride level between the control groups and the trimesters of pregnancy. The result obtained is indicative of normal renal function in the study groups

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