Pattern and risk factors of non-fistulous urinary incontinence among gynaecological clinic attendees in a Nigeria tertiary health institution

Background: Urinary incontinence is the involuntary loss of urine. It is rarely disclosed by the patients and usually under-reported. Objective of this study was to determine the prevalence, pattern and risk factors of non-fistulous urinary incontinence among women attending gynaecological clinics in Calabar, Nigeria.Methods: This was a cross-sectional study of 658 women attending gynecological clinic from June 2018 to June 2019. English version of International consultation on incontinence questionnaire-urinary incontinence-short form (ICIQ-UI-SF) was used to obtain data. Statistical analysis was done using SPSS version 22.Results: The prevalence of urinary incontinence was 16.1%. Stress incontinence was the commonest of urinary incontinence (73.3%), other types were urge incontinence (17.2%) and mixed incontinence (9.5%). Independent risk factors for urinary incontinence were 40 years and above (AOR = 5.610; p<0.001), parity ≥3 (AOR = 4.454; p<0.001), lower educational level (primary) (AOR = 2.588; p<0.001), vaginal/instrumental deliveries (AOR = 4.358; p<0.001), carrying heavy load (AOR = 3.688; p<0.001) and farming (AOR = 3.510; p<0.001).Conclusions: Non-fistulous urinary incontinence is common among women in our environment. Stress urinary incontinence was the most common type. Advanced age, higher parity, vaginal and instrumental deliveries and farming were independent risk factors for urinary incontinence

Utilization of Insecticide Treated Net and Intermittent Preventive Treatment among Pregnant Women in Ogoja Local Government Area, Cross River State, Nigeria

Malaria in pregnancy is a major public health problem in Nigeria. Available data indicates that malaria parasitemia is highly responsible for 70.5% morbidity in pregnancy and 11% of maternal related-deaths. This study was aimed at assessing the level of utilization of insecticide treated net (ITN) and intermittent preventive treatment (IPT) among pregnant women in Ogoja Local Government Area, Cross River State, Nigeria. A cross-sectional descriptive study design was used. A semi-structured questionnaire was designed to generate data from 422 respondents who were selected using simple and systematic sampling techniques; out of which 403 questionnaires were considered valid for analysis. This study was carried out from February to May, 2013. Data generated were analyzed using Statistical Package for Social Sciences (SPSS version 20.0) and results were presented in tables. Findings from this study shows that all respondents 403 (100%) reported to have been told about ITN out of which 222 (55.1%) respondents have used insecticide treated net. Based on frequency of  ITN use, only 98 (24.3%) respondents use Insecticide treated net always, 124 (30.7%) use ITNs sometimes and 181 (44.9%) had never used insecticide treated net before. Reasons for inconsistency or non-usage were largely because it causes heat 136 (46.4%) and inhalation of poisonous chemicals used in treating the net 78 (26.6%). Only 79 (19.6%) respondents were aware of intermittent preventive treatment (IPT) and 75 (94.9%) indicated antenatal clinic as their main source of information. Sulphadoxine-Pyrimethamine was identified by 64 (81.0%) respondents as the drug recommended for IPT use. A few respondents 57 (14.1%) reported to have received IPT drug during antenatal clinic while 346 (85.9%) have not received any IPT drug before since their coming to the ANC center. Community-based interventions on malaria control should be intensified to increase awareness and use of malaria preventive measures in rural settings especially among the vulnerable population. Keywords: Malaria, Insecticide Treated Net, Intermittent Preventive Treatment, pregnant women

Acute Transient Stress Induced Adrenal Hypertrophy and Adrenal Medullary Hyperactivity

Objectives: Adrenal gland hypertrophy can be related to acute stress with abnormal adrenal function tests. It may not always need treatment. Material and methods: An acute presentation of adrenal gland hypertrophy following an abdominal emergency, with subsequent hypoadrenalism was investigated. Results: Adrenal medullary and cortical function fully recovered without treatment. Conclusions: We postulate that the adrenal glands became enlarged and hypertrophied during an acute stress event, possibly caused by acute adrenal medullary hypersecretion and subsequent cortical hyposecretion. A wait and watch policy should be followed if no other clinical symptoms and signs of adrenal disease are present. CT scan remains an important diagnostic tool

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

Comprehensive geriatric assessment in older people : an umbrella review of health outcomes

Background: Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older Methods: Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. Results: Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P &amp;lt; 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75–0.89), risk of falls (RR = 0.51; 95%CI: 0.29–0.89), and pressure sores (RR = 0.46; 95%CI: 0.24–0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54–0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64–0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department. Conclusions: CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings