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International Journal of Women's Health Care

ISSN(p): | ISSN(e):2573-9506
Journal Papers (56) Details
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Indexed Journal

1 Health-Seeking Behaviour of Brothel-Based Female Sex Workers in the Management of Sexually Transmitted Infections in Urban Communities of Ogun State, Nigeria , Adeneye AK*, Mafe MA, Adeneye AA, Adeiga AA
Abstract Objective: This study examined the the health-seeking behaviour of female sex workers (FSWs) in the management of STIs. Methods: One hundred and thirty-one FSWs were interviewed using semi-structured questionnaires in Ogun State, South-West Nigeria. Results: Most (87.8%) of respondents interviewed knew condom use as the most effective way STIs including HIV can be prevented. About 24.0% and 94.0% of respondents consistently used condom during each round of sex with their regular/trusted sex partners and clients that ranged from2 to 9 and an average of 5 daily. Low (16.0%) self-perceived risk of STIs/HIV was reported among the FSWs despite their high-risk sexual activity. More than half of the respondents had good knowledge of signs and symptoms of STIs. In contrast, none of them knew that STIs can be asymptomatic. About 23.0% of the respondents have had STIs with 30.0% of these being recurring infections. Good health seeking behaviour was exhibited by respondents as most sought diagnosis (43.3%) and treatment (66.7%) for past STIs from medical doctors although many self-medication before reporting at the hospital for treatment. Moreover, 80.9% of respondents reported that they subject themselves to periodical medical examination. Conclusion: Results suggest the need for more educational interventions targeting this group emphasizing their high susceptibility to STIs/HIV, the significance of correct and consistent use of condoms for the prevention of STIs/HIV and the consequences of self-diagnosis and medication for STIs reported by many of the respondents.
2 Persistent Genital Arousal Disorder in Perimenopausal Woman: A Case Report , Rahman S M Atikur, Arafat S M Yasir*, Shahana Parveen and Qusar MMA Shalahuddin
Abstract Background Persistent Genital Arousal Disorder is a rare, distressing and embracing disorder with unknown patho-physiology. It was aimed at reporting a perimenopausal female with Persistent Genital Arousal Disorder responding with risperidone and carbamazepine along with proper counseling. Case A 49 year old female attended the Psychiatric Sex Clinic with the complaints of increased sexual urge which is uncomfortable, demands release and interferes with the social life for last 2 years. With appropriate evaluation of history, physical examination and laboratory investigation she was diagnosed as a case of Persistent Genital Arousal Disorder with proper exclusion of differentials and treatment started with medications and proper counseling. She responded with treatment and follow up of last 1 year revealed significant reduction of symptoms which enables herself to lead a distress free life physically, psychologically and socially. Conclusion There is paucity of documents regarding the patho-physiology, presentation, cultural variation, diagnosis and management guideline of Persistent Genital Arousal Disorder which demands more extensive research for evidence based guidelines.
3 Clinical Screening Strategies for Cervical Cancer, Chlamydia trachomatis Infection, and Bacterial Vaginosis in Pregnant Women in Hokkaido between 2004 and 2012: a Retrospective Study , Satoshi Shimano*, Takashi Yamada, Tomoko Sonoda, Tatsumi Yamaguchi, Masahiro Mizunuma, Mamoru Morikawa and Hisanori Minakami
Abstract Background We previously conducted an anonymous survey on universal screening for uterine cervical cancer (UCC), genital Chlamydia trachomatis (CT), and bacterial vaginosis (BV) among pregnant women in Hokkaido (Japan) in 2004, and the screening rates were 87.5% (49/56), 87.5% (40/56), and 57.1% (32/56), respectively. According to the Japanese guidelines for obstetric practice published in 2008 and revised in 2011, universal screening for UCC and genital CT is recommended, but not for all asymptomatic BV patients. We investigated how the screening rates changed from 2004 to 2012. Methods The number of obstetric care facilities in Hokkaido was 113 in 2004 and 97 in 2012. We conducted an anonymous survey on universal screening for UCC, genital CT, and BV and compared the results of the 2004 and 2012 surveys. Our questionnaires in 2004 and 2012 were similar with the exception of the questions about timing of genital CT and BV screenings and diagnostic methods for BV in 2012. Results Survey response rates in 2004 and 2012 were 49.6% (56/113) and 72.9% (70/96), respectively. There were 44,020 deliveries in 2004 and 38,686 in 2012. In 2012, a total of 98.7% (69/70), 100% (70/70), and 67.1% (47/70) of facilities participated in universal screening for UCC, genital CT, and BV, respectively. Compared to 2004, screening rates significantly increased for UCC and genital CT, but did not show a significant difference for BV. However, the number of patients who participated in the screening test for BV significantly increased from 60.1% in 2004 to 75.4% in 2012 (P < 0.001). Conclusions Universal screening for UCC and genital CT followed the guidelines, but not for BV, which showed an increase when compared to the survey in 2004. Obstetricians in Hokkaido are now starting to consider the importance of BV screening and treatment in early pregnancy
4 Urethral Mucosal Prolapse in girls in Abidjan (Cote d’Ivoire) , Dieth AG*, Tembely S, Mieret JC, ToureA, Yaokreh JB Kouamé YGS, Koffi M, Soro-Sounkéré M, Odehouri KT, Kouamé DB, Ouattara O, da Silva-Anoma S, Dick KR
Abstract Objective Urethral Mucosal Prolapse is a benign condition that is observed particularly in black girls. The benign nature of this disease contrasts with the anxiety of parents who attribute it to sexual abuse. This survey reported exclusively results of medical management of Urethral Mucosal Prolapse. Patients and Methods This retrospective study was conducted in CHU of Yopougon during 15 years from January 1998 to December 2012. All the patients in whom the surgical treatment was indicated at the outset of the disease were excluded from the study. The treatment consisted of the daily application of a dose of estrogen cream on the lump about the size of a hazelnut at the hypogastric region combined with a local antiseptic treatment as well as an antibiotic and a non-steroidal anti-inflammatory coverage. Results The patients were black Ivorian in 52 cases. They mean age was 4 years 8 months (1-11 years). In 87% of cases, genital hemorrhage was the telltale sign. In 36 patients the PMU was grade 4 (40.7%). The diagnosis was confirmed by clinical examination in all cases. Five cases were formally attributed to a rape. The total regression was observed before one month in 37 patients (68.5%). The average duration of treatment was 21 days (15-45 days). Two recurrences after early discontinuation of the hormonal treatment and 3 failures were identified; with a persisting residue of non-inflammatory ridge. The proposed surgical indication was rejected by parents in these 3 cases.
5 Umbilical Cord Blood , D’Agati Alfio, Leanza Vito, Leanza Gianluca, Carbonaro Antonio and Pafumi Carlo*
Abstract Umbilical cord blood (UCB) is widely considered as a potential alternative to bone marrow for haematopoietic stem cells. Efforts on UCB research have now taken a step further with the establishment of numerous cord blood banks throughout the world. In 15 months (from December 1999 to February 2001) we obtained 863 cord blood units by withdrawing residual blood from the placenta.The method of blood collection consisted of puncturing, with an 18-gauge needle, the umbilical cord vein and withdrawing the blood into a sterile bag immediately after clamping and newborn assistance. The blood was collected when the placenta was still in utero. Analysis of the blood was also performed to exclude any bacterial contamination. Among them 429 were collected from newborns delivered vaginally (Group 1) and 434 were collected from caesarean sections (Group 2). In this study we evaluated the volume of blood collected and the number of CD34+ cells contained in the foetal cord blood and we demonstrated that these two parameters were similar between the two groups; The higher median volume of blood collected from infant delivered through a caesarean section seems mainly due to the different clamping time rather than to the kind of delivery
6 Single Umbilical Artery , Leanza V, Carbonaro A, Pafumi C* , Leanza G and D’Agati A
Introduction The Umbilical Artery Unica is found in 0.2 to 1.1% of all fetuses. Their presence of AOU in itself does not cause any harm to the fetus and newborn. Sometimes, however, this abnormality occurs associated with chromosomal abnormalities and other abnormalities Structural. The chromosomal abnormalities account for about 5-10%; the most common are trisomy 13, 18 and 21. The non-chromosomal anomalies associated together account for about 22%: heart disease is the most frequent. 4-6% of fetuses with AOU in isolation have minor abnormalities at birth, whose ultrasound diagnosis is difficult or impossible. 25-30% of fetuses with AOU are suffering from intrauterine growth retardation (IUGR), and about a quarter of these born prematurely. Fetuses with AOU also feature a higher risk of death intrauterine and / or intrapartum.
7 Birth Spacing Influence on Maternal and Child Health in Nigeria , David Oladeji* and JA Ayangunna
Abstract The study established the influence of birth spacing on maternal and child health in Nigeria. A total of two hundred (200) nursing mothers that registered with the maternal and child care units of Obafemi Awolowo Teaching Hospital Complex in Ile-Ife area constituted the sample for the study. Their ages ranged from 20years to 55 years with a mean age of 34.5 years and standard deviation of 6.5. The two instruments used were author-constructed questionnaires with 0.66 and 0.69 reliability coefficient respectively. The data obtained were analyzed using multiple regression and chi-square statistics. The results obtained from the study indicated that, a combination of the six independent variables significantly predicted the dependent variable F= (115.813); R= .703, R2 = .494, Adj. R2 = .489; P<.05). The results also indicated that, significant relationship existed between the health histories (B = 5.755, T =8.844), behavior of individual women (B = 5.575, T = 2.284), utilization of reproductive health services (B = 5.558, T =8.495), family background (B = 5.121, T =10.633), contraceptive use (B= -2.670, T= 10.722) and socio-economic status (B =-2.648, T =6.322) and maternal and child health. The results further showed the significant position between health histories (X2 cal = 33.956) is the most potent factor followed behaviors of the individual women (X2 cal = 29.762); utilization of reproductive health services (X2 cal = 16.986); family backgrounds (X2 cal = 12.716); contraceptive use (X2 cal = 5.969); and socio-economic status (X2 cal = 1.268) and maternal and child health. Based on the results of these findings, it was recommended that nursing mothers should be made to be aware of the inherent dangers of inadequate birth spacing such as increased risk of premature membrane rupture, uteroplacental bleeding disorders, poor health for both the mother and the child, miscarriage or induced abortion and consequently death.
8 Differences in Associations of Menopausal Symptoms with Job-related Stress Factors in Full-time and Part-time Workers in Japan , Kazuyo Matsuzaki, Toshiyuki Yasui, Miwa Fukuoka and Hirokazu Uemura
Abstract Background: A large proportion of women in the workforce including part-time workers and full-time workers are in the period of menopausal transition. The degree and kind of menopausal symptoms may be different in full-time workers and part-time workers since the contents of job-related stress in full-time workers and part-time workers are different. We compared menopausal symptoms and job-related stress factors in full-time workers and part-time workers and the associations of menopausal symptoms with job-related stress in both groups. Methods: Health questionnaires including Greene’s climacteric scales and job-related stress scores were given to 613 female general workers aged 45-60 years in Japan. Results: Total Greene’s climacteric scores were not significantly different in full-time workers and part-time workers. Symptoms with high frequencies in both full-time and part-time workers were feeling tired or lacking in energy, loss of interest in sex and irritability. Scores for quantitative overload, qualitative overload and interpersonal relationships in full-time workers were significantly lower than those in part-time workers, while scores for physical overload and workplace environment in part-time workers were significantly lower than those in full-time workers. Psychological symptoms showed significant associations with job control, interpersonal relationships, workplace environment, job fitness and job satisfaction in full-time workers. Conclusions: The degree of job-related stress and the association of job-related stress with menopausal symptoms were different in full-time workers and part-time workers, though menopausal symptoms were similar in full-time and part-time workers. Different strategies for management of menopausal symptoms may be needed in full-time workers and part-time workers.
9 Psychosocial Factors Affecting Attitudes and Practices of Child Nutrition among Women in Ibadan Metropolis, Nigeria , Adijat Motunrayo ARIYO* and OLADEJI D
Abstract Good nutrition is nourishment for life. An adequate supply of food and proper nutritional habit are fundamental factors that place people of all races and developmental stages for healthy living. The study examined and analysed the psycho-social factors affecting the attitudes and practises of child nutrition among women in Ibadan metropolis. The study adopted a descriptive survey research design. The target population comprised all the mothers who brought their children to the hospitals and clinics in Ibadan metropolis. A random sampling of women with children of 130 respondents was made,using knowledge of nutrition, socioeconomic factors and family background criteria among other. A self-administered questionnaire as well as a structured interview schedule were used to collect the requisite data which includes maternal knowledge, attitude towards nutrition, and child feeding practises among other. The data was analysed using ANOVA and Regression statistics. The result of the study revealed a significant position ofmaternal knowledge of nutrition as it affects the psychosocial factors of age, occupation, and educational qualification (F=3.67, P<0.05). The result also revealed a multiple regression of 0.476 and 19.1% of the variance in knowledge was shown by the coefficient of determination (R² = 0.191). Based on the results of the study, maternal knowledge on nutrition should be encourage and human nutritionist should organise seminars, workshops and campaigns to further assist women on their children feeding practises and finally the observed psychosocial factors that are found to be relevant on child feeding practises should be encouraged.
10 Hand Hygiene Effectiveness in Surgical Units in Salmaniya Medical Complex , Majeda Shaker Mahdi
Abstract Hand hygiene is the primary measure in preventing and controlling health care-associated infections. World Health Organization (WHO) Guidelines have focused on staff awareness for the five moments and on improving compliance with hand hygiene; the objective of this study was to identify that HH is effective in surgical units of the secondary health care at one of the governmental hospital in the Kingdom of Bahrain. Materials and Methods: Hand hygiene survey was conducted in surgical care units, from 26-11-2015 till 29-11- 2015. Questionnaire was distributed to all health care workers. Total participants are 150. Results: Forty percent because of excess workload, thirty seven percent of the participants surveyed no disciplinary action for non-compliance and thirty six percent due to dryness and skin irritation. Conclusion: The results of study survey will determine to start the strategy plan additional to that, continuous observation, monitoring, feedback and awareness education programs will improve HCW compliance to hand hygiene practices
11 Dietary Management of Polycystic Ovarian Syndrome (Pcos) , Anita Mani
Introduction Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder found in women, which has increasingly become common now due to the changes in lifestyle. Explanation for the increasing number of incidents can be attributed to the change in diet in most parts of the world. PCOS is found in about 10 to 20% of women depending upon the geographical location. This disorder is characterized by irregular periods, Hirsuitism and other hyper androgenic symptoms, sub-fertility and also weight gain/obesity. Life style changes with alteration in diet and exercise are effective non-pharmacological methods in restoring reproductive function in PCOS [1]. The required dietary changes will be discussed in more details in this article
12 Pseudopregnancy ...a case report , Umme Salma Talukder
Introduction Pseudopregnancy is a condition in which there is a firm belief of a non-pregnant woman in her pregnancy. It is a cluster of many signs and symptoms which includes rare and strange phenomena like pseducyesis, delusion of pregnancy, false pregnancy, phantom pregnancy, historical pregnancy, simulated pregnancy etc. This case study along with the literature review will follow the scientific explanations and the strong societal pressure on women that precipitate and maintain this disease process
13 A Ruptured Spontaneous Heterotopic Tubal Pregnancy With a Viable Intrauterine Pregnancy , Ashley Wiltshire*, Diane Goh, Chukwuma I Onyeije and Veena N Rao
Introduction An ectopic pregnancy is a pregnancy located outside of the intrauterine cavity.They comprise 1-2% of all first trimester pregnancies and 6% of pregnancy related deaths in the United States. Ectopic pregnancies most commonly occur in the fallopian tube but can also implant in other locations, including the ovaries, peritoneal cavity, cesarean section scars and the cervix.
14 Silibinin in human breast cancer: Scope beyond placebo! , Sulbha Mittal*, Yashpal Verma and Karun Kamboj
Abstract Chemotherapies for breast cancer generally have strong cytotoxicity and severe side effects. Thus, significant emphasis has been placed on combinations of naturally occurring chemo preventive agents. Silibinin is a major bioactive flavonolignan extracted from milk thistle with known chemo preventive activity in various organs. However, the mechanism underlying the inhibitory action of Silibinin in breast cancer has not been completely elucidated. Several investigations have been and are being conducted, to study the effect of Silibinin in human breast cancer cells and protective effect in normal cells. The aim of the present article is to review and summarize the physical properties, mechanism of action, pharmacokinetics, role and potential of Silibinin in breast cancer
15 Remember the Ladies: Gender Equity for Corporate Compliance Programs Using Nanotechnology , Ilise L Feitshans
First Lady Abigail Adams was the wife of the second United States (U.S.) President and the mother of another U.S. President; she successfully ran a farm while her husband was away writing the Declaration of Independence. Her famous letters to her husband urged him to “Remember the Ladies” when declaring independent suffrage for humans who lacked the divine right of kings, and also described the hard work of managing a family business while raising and educating several children while combatting illness. Abigail Adams wrote a letter to her husband, John Adams, 95 days before Mr. Adams signed the Declaration of Independence “in the new code of laws which I suppose it will be necessary for you to make, I desire you would remember the ladies and be more generous and favourable to them than your ancestors”. Gender equity in the workplace is therefore an old problem, and a problem that has garnered significant attention in recent decades
16 The Effect of Electronic Medical Record Adaptation on Reported Medication Errors in Peripartum Care Areas , Joel E Barkley*, André B Valdez, Dean V Coonrod and Linda R Chambliss
Abstract Study Background: The purpose of this before-and-after study was to evaluate if adopting an electronic medical record affected reported medication errors on peripartum obstetrical wards at one hospital. Methods: A retrospective study of provider reported errors was conducted over a five-year period which included electronic record implementation. The error rate was calculated as the number of errors/patient days. Relative risk was calculated, and Chi-squared analysis was used to compare the proportion of errors before and after electronic record adoption. Results: The error rate was the same before and after implementation. After implementation, more errors were reported on the labor and delivery ward and fewer from the ante/postpartum ward; however, this was likely only transient. Conclusion: Implementation of an electronic medical record did not reduce overall medication error reporting rates.
17 Challenges to Implementation of an Incognito Embedded Patient Simulation Program to Improve System-Wide Public Health Threat Preparedness , Komal Bajaj, Syra S.Madad*, Adrienne Birnbaum , Jessica Pohlman, Juan R.Cruz, Katie Walker and Michael Meguerdichian
Abstract Introduction: Preparing a healthcare system for a special pathogen such as Zika Virus requires that frontline staff be trained to screen, test, educate and counsel at risk patients. The purpose of this manuscript is to describe an innovative intervention that includes an incognito embedded patient simulation and highlight solutions to challenges encountered during implementation. Methods: Incognito embedded patient simulations focusing on Zika preparedness were performed throughout 14 different institutions within one urban healthcare system that provide prenatal care. Challenges to safely and efficiently deploy the program were cataloged. Results Several key challenges were identified: 1) Creation of a patient within electronic health record 2) Ensuring proper patient identification 3) Securing the correct type of patient appointment 4) Patient testing congruent with patient condition 5) Data collection during simulation 6) Maintaining psychological safety before, during, and after a simulated event. Conclusions: This manuscript provides practical solutions to pitfalls encountered while conducting multiple incognito embedded patient simulations to a large, diverse healthcare system
18 Pycnogenol®, a Plant Extract for Women’s Health , Peter Rohdewald
Abstract The extract from the bark of the French maritime pine (Pinus pinasterAiton, subsp. atlantica), marketed as Pycnogenol® (Horphag Research, Ltd.), offers a wide range of benefits for women’s health and well-being. The present review summarizes results of clinical studies related to sex-specific diseases and troubles, affecting the reproductive system, as well as to some sex related diseases, which are more prevalent in women compared to men. The sex-specific diseases and troubles, which could be ameliorated by Pycnogenol, comprise dysmenorrhea, endometriosis, and low-back pain during pregnancy, post-partum hemorrhoids, menopausal symptoms and sexual behavior. The sex-related diseases, manifesting themselves predominantly in women, and having successfully treated with Pycnogenol, are venous diseases, as chronic venous insufficiency (CVI) and ulcers, osteoarthritis (OA) and cosmetic problems. The review reports significant results from clinical studies listed above and discusses the findings in brief. Results suggest that Pycnogenol, grace of its improvement of endothelial health and its anti-inflammatory properties, contributes to an improvement of women’s health in a non-hormonal way. Pycnogenol presents a safe and versatile food supplement.
19 Whether Recent Upswing in Women’s Empowerment has a Potential to Address Malnutrition among Women and Children? Evidence from Fourth Round of Indian Demographic Health Survey , Shri Kant Singh, Swati Srivastava, Gudakesh, Y. Vaidehi and Jitendra Gupta
Abstract Background: Socio-political status of women in India has been improved considerably in the last decades and has been perceived to be an important catalyst behind the improvement in maternal and child health situation. Many evil and masculine forces still prevail in the modern Indian society that resists the forward march of women folk. Methods: Using the information from the 4th round of National Family Health Survey (2015-16) and multivariate linear regression analysis this study explored that whether the recent swings of women empowerment has potential to address the nutritional status of women and children in India. Results: Result shows a considerable variation in level and inequality in women’s empowerment across states. Regression results shows a positive association between inequalities in possession of house/land, bank account, at least 10 years of schooling and working status of women with malnutrition among women and children; whereas negative relationship with household decision making and use of mobile. The study highlighted that there had been amelioration in the situation of women, but their true empowerment is still awaited. The study highlighted that inequalities in different dimensions of women’s empowerment are positively associated with nutritional status of women and children. Conclusions: The study concluded that inequalities in women’s empowerment are associated with nutritional status of women and children. Ensuring equity in women’s empowerment should be topmost priority through structural interventions. Many states have considerable gap in institutional births and colostrum’s feeding as well as 3+DPT and exclusive breastfeeding. Minimizing this missed opportunity may improve the nutritional status of women and children.
20 Eliciting the Patient Experience: Qualitative Interviews with Latina Patients with Chronic Pain to Improve Care , Grace L. Chen and Barbara R. Gottlieb*
Abstract Chronic pain is an increasingly common diagnosis in primary care and social determinants seen in community health center patients, as well as Latina women, strongly influence outcomes. As part of an internal quality improvement project, we interviewed patients with chronic pain (N=17) at an urban community health center. Interview themes point to the prevalence of psychosocial comorbidities and the all-consuming physical and emotional nature of chronic pain. Patients expressed interest in non-pharmacologic, mind-body approaches to pain treatment as well as support groups and health coaching. Based on patients’ experiences and feedback, we are designing a pilot group visit intervention.
21 Diagnostic Accuracy of Ultrasound Scanning In In-Utero Prediction of Fetal Gender , Chukwunwendu Aloysius Franklin Okeke, George Uchenna Eleje* and Joseph Ifeanyichukwu Ikechebelu
Abstract Background: Until recently, the ultrasound was the only non-invasive scientific way to learn the gender of the unborn baby. In developed countries, ultrasound practice has far been in existence for decades. However, in developing world, the advent of ultrasound was in the last three decades in majority of the centres. Thus gender assessment using ultrasound is an expertise that was acquired in the developing world in less than three decades in generality of cases. Objectives: This was to determine the accuracy of ultrasound in predicting the sex of baby in-utero. Methods: This study was conducted in Nnamdi Azikiwe University Teaching Hospital, and Life Specialist Hospital, both in Nnewi, south-east Nigeria. The accuracy of the ultrasound was related to the gestational age at which the ultrasound was done, body mass index (BMI), the presentation of the fetus and the experience of the Sonographer. The ultrasound scans were done by a Registrar in department of Obstetrics, a consultant in the same department and a consultant radiologist. Analysis was done using SPSS Package version [19]. Results: Three hundred and fifty one cases met the inclusion criteria and were finally used for analysis. This study revealed that the overall accuracy was 96%. In all, 14 cases were misdiagnosed out of 351 cases. Further analysis showed that 100% accuracy was obtained by the scans done by the consultants but 88.0% by the ones done by the registrar. Apart from experience, the BMI and presentation of the fetuses were contributory to the high accuracy. In patients with body mass index (BMI) <25 kg/m2 , the accuracy was 98.1% and 72.7% for cephalic and breech presenting fetuses respectively (p>0.05). Similarly, in patients with BMI of ≥25 but <30 kg/m2 , the accuracy was 93.3% and 66.7% for cephalic and breech presenting fetuses respectively. This too was not statistically significant (p>0.05). There was also no statistical significant difference in the accuracy of fetal sex determination between the two groups of women with respect to their BMI (p>0.05). None of the fetuses were in transverse lie and none had malformations of the external genitalia on delivery. Conclusion: Ultrasound remains a very important tool in the prediction of the sex of the fetus especially in developing country setting where there is high penchant for male babies. A good number of factors contribute to this accuracy
22 Uterine Carcinosarcoma: A Single Centre Retrospective Clinical Cohort Analysis , C Perna*, G Eminowicz, U Asghar, G Imseeh, AA Kirkwood, A Mitra, R Kristeleit and M.McCormack
Abstract Objective: Carcinosarcomas are rare, heterogeneous tumours with a poor prognosis and no well-defined treatment pathway. Through analysis of a cohort of University College London Hospital (UCLH) patients, we assessed potential known clinicopathological prognostic factors by looking at the association of baseline characteristics with progression free survival (PFS) and overall survival (OS). Methods: Women with uterine carcinosarcoma treated at UCLH from 2003 to 2014 were retrospectively identified and analysed. Clinicopathological data and treatment history were collected from patient records. Results: 73 patients were included. 69.9% were FIGO stage I/II, 62.2% had heterologous elements and 60.0% had lymphovascular space invasion (LVSI). Adjuvant chemotherapy and radiotherapy (RT) was received by 48% of patients, 27.4% had RT alone and 8.2%, chemotherapy alone. Median OS was 38.3 months and PFS 25.5 months. Two-year OS and PFS were greater in earlier stage disease (OS; 68.3% vs. 48.9%, PFS; 58.7% vs. 36.1%), homologous component (OS; 72.7% vs. 41.7%, PFS; 60.8% vs. 35.7%) and absence of LVSI (OS; 75.3% vs. 53.7%, PFS; 66.9% vs. 42.5%). Two years OS and PFS for patients who received adjuvant chemotherapy and RT was 64.9% and 58.2% respectively, which was similar to survival rate of those who received RT alone (OS 68.4% and PFS 57.4%). Patients who didn’t receive adjuvant treatment had worse survival (32.7% OS and 11.4% PFS). Conclusions: Patients receiving RT alone had similar survival to those receiving RT and chemotherapy. Patients who didn’t receive adjuvant treatment had the poorest survival
23 Improvement of Bacterial Vaginosis and Vulvovaginal Candidiasis with a New Lactobacillus Strains Association: A Pilot Study , Franco Vicariotto and Filippo Murina*
Abstract Bacterial vaginosis and vulvo-vaginal candidacies are bacterial infections widely spread among women in childbearing age. These infections are associated with altered or disturbed vaginal microbiota, in a condition defined as vaginaldysbiosis. Restoration of the lactobacilli flora seems a promising strategy for the treatment of these pathologies. The efficacy and safety of a new vaginal composition, containing three Lactobacillus strains selected for their activity against urogenital pathogens, was assessed in a pilot clinical trial for the treatment of bacterial vaginosis and vaginal candidacies. The study involved women with diagnosis of bacterial vaginosis (30) or vulvovaginal candidacies (24). Vaginal capsules, containing the three Lactobacillus strains, were administered following one application per die for ten consecutive days. Patients received gynecological examinations before and after treatment, with objective examination, assessment of clinical symptoms severity and vaginal wet mount microscopy. The treatment showed a complete resolution in 60% of bacterial vaginosis cases and around 40% in vulvo-vaginal candidacies cases. Further analyzing the subgroup characterized by a recurrent vaginal candidacy, the success rate was significantly higher than in the acute cases, showing a stronger effect of the product against persistent and chronic condition. The product showed a resolution of the vaginal dysbiosis through vaginal wet mount examination and no adverse effect were reported. In conclusion, the presented clinical data support the use of the Lactobacillus vaginal composition for the treatment of bacterial vaginosis and vulvo-vaginal candidacies.
24 Multiple Intraoral Venous Malformations In A Geriatric Patient- A Rare Case Report , S. Dangore-Khasbage*
Abstract Venous malformation (VM) is defined as a simple malformation with slow flow and an abnormal venous network. This is caused by a disturbance in the late stages of angiogenesis (trunal stage) resulting in the persistence of arteriovenous anastomosis present during embryonic life. This case report describes an unusual case of multiple intraoral venous malformations with questionable augmentation. A 65 year-old female had reported with a complaint of discomfort in mouth since 8 years. Intraoral examination revealed presence of six spherical swellings (three on dorsal surface of tongue, one on ventral surface of tongue and two on left buccal mucosa) with bluish-violet hue, approximately 2 to 3 cm in diameter each. On the basis of history and clinical findings, vascular malformation was provisionally suspected. Adequate imaging established the diagnosis. A review of clinical aspects, diagnostic procedures as well as therapeutic options currently available for venous malformations are discussed in this article.
25 Velamentous Cord Insertion – A Case Report , SK Kathpalia*, Lt Col Madhulima Saha, Pooja Sinha and Maj Prakash Bishnoi
Abstract Normally the umbilical cord is inserted into the central portion of placenta; at times the cord is inserted distally from the margin; onto the fetal membranes, called velamentous insertion. After the insertion the umbilical vessels traverse unsupported for a variable distance between amnion and chorion before reaching the placenta. These vessels can get compressed and torn especially in labour resulting in acute fetal distress and at times fetal death. We report a case where the cause of fetal distress during labour was compression of these vessels. There is a strong case of finding out site of cord insertion when the antenatal cases are undergoing routine sonography. Once abnormal insertion is detected then these pregnancies should be monitored closely as the chances of both antenatal and intranatal complications are higher in such pregnancies.
26 Wandering Spleen - A Rare Entity , Rita Mittal*, Bishan Dhiman and Jiten Sharma
Summary Wandering spleen is a rare differential diagnosis of an acute abdomen and must be suspected if a patient presents with abdominal pain along with a palpable lump and displacement of bowel to left upper quadrant and should be confirmed by CT scan. As the condition is very rarely diagnosed pre-operatively, it requires a very high index of suspicion.
27 Immunoglobulin Therapy in Infertile Women: Safety and Tolerance , Elena Santainés-Borredá*, Miguel Dolz-Arroyo , Ramón Camaño-Puig and Rosa-Ferrer Loro
Abstract Introduction and Objectives: According to most recent surveys, infertility rates are very high in Spain. Even so, current therapeutic options for increasing fertility are challenging. Immunological causes of infertility such as an increase in natural killer cells have been studied in recent work, for example by using immunoglobulins. Providing care and support for women during such treatments is the traditional responsibility of nursing professionals. The objective of this study was to understand how patients adapt to treatments with immuno globulins at FIV Valenciai . Methods: Retrospective observational study which monitored 40 intravenous immunoglobulin infusions: 400 mg/kg in 27 cases and 200 mg/kg in 13 cases. The state of women’s health was studied with home monitoring, and women’s answers about their health statuses were measured using Liker scales with four values. These identified the occurrence of symptoms and the need for analgesic therapy. The data was analyzed using SPSS. Results: Vital sign monitoring reflected values within the normal limits during all 40 infusions; the figures decreased slightly during the infusion but subsequently returned to normal. More women (59.3%) treated with 400 mg/kg intravenous immuno globulins (IVIG) manifested symptoms compared to 38.5% of women treated with 200 mg/kg IVIG (p = 0.185). The only common symptom that appeared was a headache which easily resolved after analgesic therapy. Conclusion: Nurses play a very important role in the implementation of IVIG therapy. These results show that women adhere well to this therapy at FIV Valencia and none of them reported any severe symptoms. Our findings may facilitate the design of future research studies aimed at improving care for infertile women.
28 Effects of Drugs Used to Treat Infertility on Periodontium and Periodontal Disease , Sunali S Khanna*, Prita A Dhaimade and Shalini Malhotra
Introduction Infertility has been described medically as the inability of a couple to achieve conception after a year or more of regular unprotected sexual intercourse or the incapacity to carry a pregnancy to a live birth [1]. The CDC statistics show that on an average one in every eight couple suffers from infertility [2]. The World Health Organization also shows a similar estimate of about 8-10% of the world population suffering from infertility problems [3]. The increasing stress, unhealthy lifestyle and increasing average age of couples opting to start a family in the developed and developing countries around the world are some of the major causes of infertility [4]. However, the tremendous advances in medical sciences in the last two decades have greatly increased the statistics of pregnancies among couples suffering from infertility problems. Some of these revolutionary therapies include hormonal therapy, artificial insemination, assisted reproductive technology (ART), In-Vitro fertilization (IVF), surrogacy etc [5].
29 Poor Ovarian Responder: A Challenge , Gita Khanna*, Trishya Reddy, Farhat Kazim and Arti Gupta
Introduction Assisted reproductive technology (ART) is rapidly progressing field with many new advances in the last decade in terms of clinical knowledge and technological development. The number of oocytes obtained after controlled ovarian stimulation is of central importance to reach the success in IVF. Poor ovarian responder poses a great challenge to present era of reproductive medicine. It is an important limiting factor in success of any treatment modality for Infertility. It indicates a reduction in quantity and quality of oocytes in women of reproductive age group. Evaluating Ovarian Reserve and individualizing the therapeutic strategies are very important for optimizing success rate. Early detection and active management are essential to minimize the need for egg donation.
30 Role of P-53 Gene in Preventing Breast Cancer , Aurelian Udristioiu* and Manole Cojocaru
Abstract Breast cancer affects more than one million patients annually in the world and is a leading cause of mortality. Histological type, grade, tumor size, lymph node involvement, and estrogen receptor and HER-2 receptor status, all influence prognosis and the probability of response to systemic therapies. P53 gene is mutated in about 30% of breast cancers/.The possible links between alterations of p53 and clinical or pathological features of breast tumors have been widely investigated. The first study to examine gene-expression patterns of breast cancer suggested that at least four major molecular classes of breast cancer exist: luminal-like, basal-like, normal like, and HER-2 positive. Basal-like breast cancer account for 15% of breast cancers and are often described as triple negative breast cancers (TNBCs). In fact, TNBCs, defined by lack of expression of estrogen receptor, progesterone receptor, and HER2, probably include both basal-like breast cancers and some poorly differentiated luminal breast cancers. They are also associated with a younger age and a poor prognosis. TNBCs also have an increased frequency of TP53 mutations. Recently, it was shown that mutant p53 status was a strongly unfavorable prognostic factor for relapse-free survival and overall survival only in a triple negative group in patients treated with adjuvant anthracycline-containing chemotherapy. Inflammatory breast cancer (IBC) is a clinical diagnosis known as the T4d category in the TNM classification. It is a distinct clinical subtype of locally advanced breast cancer (LABC), with a particularly aggressive behavior and poor prognosis. TP53 mutations are more frequent in inflammatory breast cancer (50%) than in non-inflammatory breast cancer (20–30%). The results from these studies served as the justification for attempts to vaccinate patients using p53-derived peptides, and a number of clinical trials are in progress. The most advanced work used a long synthetic peptide mixture derived from p53 (p53-SLP; Netherlands).The vaccine is delivered in the adjuvant setting and induces T helper type I response in the majority of patients. However, the response may not be potent enough to result in clinical benefit as a mono-therapy because most patients had T-helper cells that failed to produce key cytokines, indicating that this treatment should also be associated with another type of conventional or immunotherapy therapy.
31 Knowledge, Attitude, and Practice of Health Professionals Towards Labor Companion in Health Institutions in Addis Ababa , Sewit Getachew, Shiferaw Negash* and Lukman Yusuf
Abstract Background: The day of giving birth is a time of unique and intense absorption and learning for every parturient woman because of the interplay of a variety of stressors associated with childbirth such as pain, medical intervention, and hospitalization. Thus, women in labor have a profound need for companionship, empathy, help, and emotional support especially from family members and friends to meet to their needs that the health professional may not be able to address. There is strong evidence showing that continuous support during labor effectively improves delivery outcomes. It is factual that most of the facilities in Ethiopia do not have a policy that allows a companion in the delivery room to accompany the mother despite the dire need. The knowledge and attitude of health professionals towards this support system has an immense effect on the implementation of this policy by the institutions. Objective: To assess the knowledge, attitude, and practice of health professionals towards labor companion in the health institutions of Addis Ababa. Methods: Facility-based cross-sectional study in 30 health institutions of Addis Ababa was conducted using self-administered structured questionnaire from March 1 to June 30, 2016. The results were summarized using descriptive statistics. Bivariate logistic regression analysis and odds ratio along with 95% confidence interval was used to assess the degree of association between dependent and independent variables. The variables with significant association were entered into multivariate logistic regression model. Results: Among the total of 378 respondents, 275(72.8%) were females and 252(66.7%) were midwives. Most of the respondents, 239(93.4%) stated to have knowledge on the importance of labor companion but only 167(44.2%) had adequate knowledge. From the study participants, 239(63.2%) had positive attitude towards labor companion but only 139(36.8%) stated it is practiced in their institution. Having adequate knowledge is significantly associated with positive attitude. Health professionals working in private institutions and health centers have the practice of allowing labor companion better than those in government hospitals. Conclusion and recommendation: This study concluded that less than half of the study participants have adequate knowledge regarding the benefits of labor companion though majority have positive attitude. Health professionals should be updated on evidence-based support of labor companionship; and all the stakeholders involved should make the effort in bringing change towards labor companion.
32 POST CESEREAN WOUND SEPSIS: Recognizable Risks and Causes at a Rural Ugandan Hospital , Gideon K Kurigamba*, Dianah Namara, Irene Nanyanga, Haven Nahabwe and Birungi R. Mutahunga
Abstract Post cesarean wound sepsis refers to a superficial surgical site infection that occurs within 30 days of the operative procedure and involves only the skin or subcutaneous tissue of the incision, and at least a purulent drainage from the incision or isolation of Organisms on culture or one of the cardinal signs of inflammation. Wound sepsis increases morbidity, mortality and length of hospital stay (Oliver, et al). In Uganda, rates of severe wound infection are as high as 25% [1]. Caesarean section rates at the Bwindi community Hospital are 30% of the total deliveries. Purpose: To determine the factors associated with post cesarean wound sepsis among mothers at Bwindi Community Hospital. Methods: This was a retrospective cross sectional study. Consecutive sampling was used to obtain 50 files of mothers who got post cesarean wound sepsis and a matching equal sample of controls at Bwindi Community Hospital from July 2015 to June 2017. Results: The rate of post caesarean sepsis was 3.5%.Multiple factors were associated with postoperative wound sepsis; Age between 26-30 years(OR 3.46, p0.008), Parity of greater than 5(OR 3.14, p0.010), Duration of labor of 5 -8hrs or greater (OR 10.67, p0.013), delayed time of ambulation greater than 24-72hrs (OR 0.14, p<0.001), intra operative blood loss of 500- 1000mls or greater(OR 8.00, p0.023) and Post-operative administration of ampicillin and metronidazole (OR40.00,p<0.001). Conclusion: Post-operative wound sepsis in caesarean section is a relatively common occurrence in low-resource settings and mitigation of the multiple identified modifiable associated factors will greatly reduce patient morbidity and improve their outcomes.
33 Ionization Dosimetry Principles for Conventional and Laser-Driven Clinical Particle Beams , F Scarlat*, E Stancu, E Badita, A Scarisoreanu, C Vancea, I Calina, M Demeter, Fl Scarlat and R Chiru
Abstract In this paper after mentioning the clinical radiation fields of 20 keV-450 MeV/u, they are characterized by the number of particles and their energy. Particle energy is the quantity that determines radiation penetration at the depth at which the tumor is situated (Fig. 1). The number of particles (or beam intensity) is the second major quantity that assures the administration of the absorbed dose in the tumor. The first application shows the radiation levels planned for various radiation fields. Prior to interacting with the medium, the intensity (or energy fluence rate) allows the determination of energy density, energy, power and relativistic force. In the interaction process, it determines the absorbed dose, kerma and exposure. Non-ionizing radiations in the EM spectrum are used as negative energy waves to accelerate particles charged into special installations called particle accelerators. The particles extracted from the accelerator are the source of the corpuscular radiation for high-energy radiotherapy. Of these, light particle beams (electrons and photons) for radiotherapy are generated by betatron, linac, microtron, and synchrotron and heavy particle beams (protons and heavy ions) are generated by cyclotron, isochronous cyclotron, synchro-cyclotron and synchrotron. The ionization dosimetry method used is the ionization chamber for both indirectly ionizing radiation (photons and neutrons) and for directly ionizing radiation (electrons, protons and carbon ions). Because the necessary energies for hadrons therapy are relatively high, 50-250 MeV for protons and 100-450 MeV/u for carbon ions, the alternative to replace non-ionizing radiation with relativistic laser radiation for generating clinical corpuscular radiation through radiation pressure acceleration mechanism (RPA) is presented.
34 Holistic Approach is the Only Way to Increase Uptake of Family Planning Services , Navita Rahim
Abstract Holistic care is a comprehensive model for caring and proper guidance. Use of Family Planning (FP) services is still a question mark nowadays. One MWRA (Married women of reproductive age) in four (4) has an unmet need for contraception, which is the highest such rate in the region. Meeting unmet need for limiting can be accomplish by increasing the holistic approach, for family planning, three major components can be highlighted: Supply, the enabling environment and demand. Uptake of Family planning services can be enhancing, more successful and sustainable if multifaceted determinates included in interventions. Availability and quality of services and other supply-related issues is a major factor for not availing FP services. Improvement in family planning cannot be achieved without quality services. Quality is considered good when adequate infrastructure, supplies, and equipment are in place, and when well-trained, skilled, motivated, and supported staffs are available. Besides that, an enabling environment for health-seeking behavior is another factor for increasing services. An enabling environment requires adequate resources; effective leadership, management, and accountability. Engagement of governments, communities, and other members of civil society is critical to fostering an enabling environment. Furthermore, Improve knowledge of Family planning and cultivate a demand for services. The demand for FP exists in different forms: actual use and latent demand. Holistic, client-centered approach is the only way to make FP programming effective and successful ultimately, support health system.
35 Pain Neuroscience Education to Support Birth: A Feasibility Study , Sinéad Dufour*, Suzanne Dickie, Rebecca Grubb, Victoria Jelilyan, Jennifer Spreckley, and Alexandra Young
Abstract Purpose: This study explored the impact of a novel one-time workshop, aimed to empower women throughout their birth experience through the use of pain neuroscience education concepts. Methods: A pre-post cohort study design involving a 90-minute workshop with pregnant women in their third trimester. Education related to physiologic birth principles with an emphasis on pain neuroscience education and recent associated best practice guidelines represented the focus of the workshop. In addition to the collection of feasibility data outcomes were measured pre and post workshop as well as within the first 6 weeks post-partum. Results: A one-time workshop that focused on pain neuroscience education was feasible. All participants used pain modulating strategies based on the workshop content and 92% of participants reported they would recommend the workshop. Further the workshop and had a positive effect on outcomes. Specifically, significant improvements for selfefficacy were found post-workshop. Conclusion: Pain neuroscience education appears to be feasible to delivered in a one-time workshop format and appears to have the potential improve birth outcomes. Future to be delivered fully powered trials are required to adequately test and confirm these preliminary findings.
36 A Longitudinal Study on Women’s Knowledge of Male Circumcision, and its Influencing Factors in Zambia , Herbert Tato Nyirenda*, Selestine Nzala, Chris Mweemba, Herbert B.C Nyirenda and Tambulani C. Nyirenda
Abstract Aim: The aim of this study was to investigate Women’s Knowledge of Male Circumcision and its influencing factors between 2011 and 2013. Methods: The study was a prospective cohort study of post-Male Circumcision sexual behavior in Zambia and sampled a total of 1350 women aged 15-29 years. The study followed up women and collected data in three rounds using a self-administered structured questionnaire. The type of analysis involved univariate, bivariate and multivariate. Results: Close to three-quarters (72.5%) of the respondents had heard or were aware of male circumcision before it was described to them. Less than one third (29%) had average knowledge at baseline. The odds of having good and average knowledge versus poor knowledge was greater for following women; single women with circumcised primary sex partners (OR: 2.1, P<0.001, CI: 1.39-3.21); women who talked to a circumcised partner about male circumcision (OR: 2.12, P<0.001, CI: 1.93-2.31); women aged 20 to 29 years; women who had some education; women who were aware about male circumcision and had talked to a family member about male circumcision. Conclusion: It is evident from the findings that male circumcision campaigns might have failed to correctly educate women on the male circumcision and its protection.
37 Birth to Discharge: Neonatal Simulation Clinical Experiences , Cheryl L DeGraw
Abstract With an increase in nursing programs to combat the projected nursing shortage, there is more competition for clinical sites for Obstetric-Neonatal clinical rotations. Obstetric and neonatal simulation clinical experiences are being substituted for hospital clinical rotations and for lack of patients during clinical rotations. A technical college in Southeastern United States is using five-hour simulation clinical experiences, in which Obstetric and Neonatal high-fidelity manikins are utilized, as substitutes for hospital clinical rotations or lack of Obstetric-Neonatal patients. Neonatal nursing care is related to the type of disorder the pregnant patient is admitted with to the Antepartum/ Intrapartum Simulation Laboratory Hospital Unit. Three patient scenarios are used for the clinical experiences: neonates born to mothers with gestational diabetes, preeclampsia, or preterm labor. Neonatal complications such as hypoglycemia and prematurity are incorporated into the scenarios. Nursing students use fetal monitoring to identify fetal complications to provide appropriate nursing care to the neonate after delivery. This use of simulation clinical experiences has been endorsed by the National Council of State Boards of Nursing and the National League of Nursing as a substitute for hospital clinical rotations. The significance of using Obstetric-Neonatal simulation clinical experiences is increased understanding by nursing students of the entire antepartum through postpartum nursing care and discharge process. Using the high-fidelity manakins and fetal monitoring, nursing students can obtain hands-on experience when unable to obtain the clinical experience due to lack of a hospital rotation site or lack of patients during their hospital clinical rotation.
38 Management of Antenatal Pelvic Girdle Pain Study (MAPS): A Double Blinded, Randomised Trial Evaluating the Effectiveness of Two Pelvic Orthoses , Lee Cameron*, Jonathan Marsden, Karen Watkins and Jenny Freeman
Introduction Pelvic girdle pain (PGP) occurs in 70% of pregnant women; of whom 25% have severe pain and 8% severe disability requiring the use of crutches, wheelchair or confinement to bed [1]. Patients with pregnancy related PGP have been shown to have increased pelvic joint motion compared with healthy pregnant controls, probably due to a combination of hormonal and biomechanical factors, leading to an increase in pelvic joint laxity, changes in lumbopelvic posture and increase in shearing forces through pelvic joints, thus leading to pain [2,3]. PGP is difficult to manage; activities such as turning in bed, prolonged walking, or carrying items may cause pain; impacting negatively on quality of life [4]. In economic terms societal costs are significant, mainly as a consequence of work absenteeism; with 20% of people requiring an average of 7-11 weeks sick leave [5-8]. There are high direct health costs as well as increased health risks as women with PGP have a higher request for induction of labour and elective caesarean section to achieve symptomatic relief.
39 Attitude towards Access and Utilization of Maternal Health Services by Women at Sabon-Gari Local Government Area, Kaduna, Nigeria , A.O. Chris, G. James, S.I.R. Okoduwa*
Abstract Objective: Maternal deaths are alarmingly high globally due to relatively non-availability and non-use of maternal health services by a sizeable proportion of women in rural communities. Women in North-western Nigeria are presently experiencing the worst survival due to key components of maternal health services not being provided at Primary Health Centres (PHCs). The study, therefore, explores the attitude of women toward access and utilization of Maternal Health Services (MHS) provided by PHCs at Sabon-Gari Local Government area, Kaduna State, Nigeria. Study Design: A cross-sectional survey. Methods: A total of 392 women of reproductive ages (15-49 years) were administered questionnaires, out of which 389 were retrieved but only 385 correctly filled and were analyzed quantitatively. Quantitative method of data analysis was used to present the results. Results: It was observed that the mean age of the respondents was 29-35 years. The mean score of mothers access to maternal health services was 4.2 while the mean point for none acceptance for use of modern health services at PHCs was 2.6. Conclusion: Findings revealed that community encouraged women to access maternal health services available at primary health centres though most community members still do not fully accept the use of modern health services at primary health centres and this has posed a lot of problem to the health sector. Effective community enlightenment programmes should be put in place in the rural areas by government and non-governmental organizations to improve access and utilization of Maternal Health Services provided by Primary Health Centres.
40 Impact of Action II Petite Lady Laser Machine in the Treatment of Urinary Incontinence and Sexual Dysfunction in Female, Najwa Alfarra* and Waleed Altaweel
Abstract Background and Aims: Urinary incontinence & sexual Dysfunction is very common among female. It causes social or hygienic problem. Urinary incontinence is the uncontrolled leakage of urine. This condition affects about a third of the female population and is more common in women than in men5. Recently the Action II Petite Lady laser has attracted attention for urinary incontinence and sexual dysfunction as non-invasive way that is aimed at awakening a woman’s sensuality by tightening up their vaginal canal. The current study evaluated the clinical efficacy of the Action II Petite lady laser on the treatment of sexual dysfunction and urinary incontinence in females. Subjects and Methods: Thirty woman with Urinary incontinence & sexual Dysfunction, ages from 25 – 55 year were treated for four sessions two weeks apart between the first three sessions and one month apart between the third and fourth session with a 2940 nm Er: YAG via 90° and 360 scanning scopes. PFX2 assessments were performed at baseline, one –month post treatment and at 2 months’ post-treatment for vaginal muscle power. FSFI questionnaires were answered pre-post intervention, and bladder diaries were used. Subjective satisfaction was assessed about sexual satisfaction. Results: All subjects successfully completed the study with no adverse events. Significant improvement in vaginal muscle power was seen in all subjects at 2 months’ post-procedure based on the PFX2 values, sexual satisfaction as assessed by the subjects themselves 57.7% very satisfied and 42.3% moderately satisfied. The comparison between the means of the considered parameters before and after the treatment showed a very significant difference in reducing the symptoms of stress incontinence. Conclusions: Er: YAG laser treatment for urinary incontinence and sexual dysfunction produced significant improvement. With multicast delivered in the multiple micro pulse modes via 90 and 360scanning scopes, nonsurgical Er: YAG laser treatment was pain-free, safe, side effect free, easily tolerated and effective.
41 Bariatric Surgical Procedures Clinical Outcomes at Maternal and Fetal levels , Nancy Mohamed Ali Rund*, Samy Saad Mohamed Ali and Mohamed S. ElSerafy
Abstract Background: Maternal obesity a cornerstone challenging issue that raised concerns all over the world, improvements in bariatric surgery procedures made pregnancy after bariatric surgery a common clinical case scenario. However, researchers have increased concerns about clinical outcomes around the impact of bariatric surgery management interventions on maternal and fetal outcomes. Aim to assess and evaluate the clinical outcomes of bariatric surgical procedure on maternal and fetal levels Methodology: A prospective research study conducted fromApril 2013 till December 2018 on 180 study subjects that were recruited and categorized in two research study groups group I involved 45 cases that have undergone bariatric surgery and research group II involved 135 cases that are obese and didn’t undergo bariatric surgeries. Results: There was a statistically significantly lower frequency of Gestational diabetes (GDM) and Large for gestational age (LGA) in women of research group I (post bariatric surgery) (p value=0.028, 0.025, consecutively). The rates of macrosomia was lower in research group I, but not to a statistically significant level (p value=0.208). The rates of Small for gestational age (SGA) and Low birth weight (LBW) were statistically significantly higher among women of research group I (Pvalues =0.027, and 0.048,consecutively). The rates of preterm labor were higher, but not to a statistical significant level, among women of research group I(p value=0.762. The rates of Still birth (SB) and neonatal mortality were comparable in both researchgroups (Pvalues=0.999). Conclusions: There is positive impact of bariatric surgery on Gestational DM and Large for gestational age rates in obese cases, however preterm labor concerns in the current research requires future research efforts on multicentric fashion and larger sample sizes.
42 Effectiveness of Neuro Muscular Blockade in Conjunction of Low pneumoperitoneum in Resolving Postoperative Shoulder Pain in Laparoscopic Hysterectomy , Ekramy A. Mohamed* and Mohamed Sayed Fahim
Abstract Background: Laparoscopic hysterectomy procedures are evolving and upgraded leading to more enhanced patient care levels. Post-operative shoulder pain after laparoscopic pneumoperitoneum is a common concern among laparoscopic surgeons and an annoying symptom causing discomfort of cases. Aim: The research study investigates the difference between lowpressure level pneumoperitoneum 8mmHg in conjunction deep neuromuscular blockade in comparison to classic level pneumoperitoneum pressure 12mmHg in conjunction to moderate neuromuscular blockade if it could decrease the frequency of shoulder pain after performance of laparoscopic hysterectomy. Methodology: A prospective research study that recruited 32 study subjects were randomized to either deep neuromuscular blockade and 8mmHg pneumoperitoneum (research Group 8-Deep) or moderate neuromuscular blockade and 12mmHg pneumoperitoneum (research Group 12-Moderate)both research groups were equal in number and were observed postoperatively for pain using VAS scoring system. Conclusions and recommendations: The current research study reveal and displays that the conjunction of deep neuromuscular blockade and low pressure level pneumoperitoneum decreased the frequency and severity of shoulder pain after performance of laparoscopic hysterectomy in comparison to moderate level neuromuscular blockade and classic level –pressure pneumoperitoneum.
43 Sonographic 3D Features Correlated to Uterine Pathological Issues , Osama Ismail Kamel* and Karim Fahmy Sidhom
Abstract Background:Adenomyosis is a frequent gynecological disease of unknown etiology causing menstrual pain disorders and pelvic congestion, that definite histopathological based diagnosis of adenomyosis relies on the presence of endometrial glands and stroma within the myometrial tissue, junctional zone assessed sonographically could elucidate the nature of disease progressive pathological changes. Aim: To investigate the value and usefulness of Junctional Zone indices in suspicion and diagnosis of adenomyosis disease in correlation to histopathological findings. Methodology: A clinical research trial conducted on 200 research study subjects scheduled for hysterectomy procedure due to abnormal uterine bleeding and/or dysmenorrhea unresponsive to medical treatment performed at Ain Shams University maternity hospital from January 2018 till March2019, all research study subjects have undergone two-and three-dimensional transvaginal sonography before the day of surgery. Results: There was statistically significant difference between research groups (Adenomyosis of the inner myometrium, Serrated junctional zone, Linear junctional zone,) as regards 2 D features anechoic lacunae, asymmetric corpus myometrium, myometrial cysts, fan shaped shadowing, mean number of 2D features (p values <0.001), concerning 3 D features Mean JZmax, Mean JZdiff, JZ interruption, Sub endometrial lines and buds, mean number of 3D features (p values<0.001). Conclusions: Junctional zone changes could be denoting early phases of adenomyosis disease development furthermore the 3 D sonographic features implemented were considered and shown to be more valuable in elucidating the pathological changes confirmed by histopathological examination.
44 Sonographic 3D Features Correlated to Uterine Pathological Issues , Osama Ismail Kamel* and Karim Fahmy Sidhom
Abstract Background:Adenomyosis is a frequent gynecological disease of unknown etiology causing menstrual pain disorders and pelvic congestion, that definite histopathological based diagnosis of adenomyosis relies on the presence of endometrial glands and stroma within the myometrial tissue, junctional zone assessed sonographically could elucidate the nature of disease progressive pathological changes. Aim: To investigate the value and usefulness of Junctional Zone indices in suspicion and diagnosis of adenomyosis disease in correlation to histopathological findings. Methodology: A clinical research trial conducted on 200 research study subjects scheduled for hysterectomy procedure due to abnormal uterine bleeding and/or dysmenorrhea unresponsive to medical treatment performed at Ain Shams University maternity hospital from January 2018 till March2019, all research study subjects have undergone two-and three-dimensional transvaginal sonography before the day of surgery. Results: There was statistically significant difference between research groups (Adenomyosis of the inner myometrium, Serrated junctional zone, Linear junctional zone,) as regards 2 D features anechoic lacunae, asymmetric corpus myometrium, myometrial cysts, fan shaped shadowing, mean number of 2D features (p values <0.001), concerning 3 D features Mean JZmax, Mean JZdiff, JZ interruption, Sub endometrial lines and buds, mean number of 3D features (p values<0.001). Conclusions: Junctional zone changes could be denoting early phases of adenomyosis disease development furthermore the 3 D sonographic features implemented were considered and shown to be more valuable in elucidating the pathological changes confirmed by histopathological examination.
45 Sonographic 3D Features Correlated to Uterine Pathological Issues , Osama Ismail Kamel* and Karim Fahmy Sidhom
Abstract Background:Adenomyosis is a frequent gynecological disease of unknown etiology causing menstrual pain disorders and pelvic congestion, that definite histopathological based diagnosis of adenomyosis relies on the presence of endometrial glands and stroma within the myometrial tissue, junctional zone assessed sonographically could elucidate the nature of disease progressive pathological changes. Aim: To investigate the value and usefulness of Junctional Zone indices in suspicion and diagnosis of adenomyosis disease in correlation to histopathological findings. Methodology: A clinical research trial conducted on 200 research study subjects scheduled for hysterectomy procedure due to abnormal uterine bleeding and/or dysmenorrhea unresponsive to medical treatment performed at Ain Shams University maternity hospital from January 2018 till March2019, all research study subjects have undergone two-and three-dimensional transvaginal sonography before the day of surgery. Results: There was statistically significant difference between research groups (Adenomyosis of the inner myometrium, Serrated junctional zone, Linear junctional zone,) as regards 2 D features anechoic lacunae, asymmetric corpus myometrium, myometrial cysts, fan shaped shadowing, mean number of 2D features (p values <0.001), concerning 3 D features Mean JZmax, Mean JZdiff, JZ interruption, Sub endometrial lines and buds, mean number of 3D features (p values<0.001). Conclusions: Junctional zone changes could be denoting early phases of adenomyosis disease development furthermore the 3 D sonographic features implemented were considered and shown to be more valuable in elucidating the pathological changes confirmed by histopathological examination.
46 Endometrial Carcinoma staging Issues Laparotomy versus Laparoscopic Approach which is More Feasible and Safer? , Walid Mohamed Elnagar*, Mai Mohamed Abdelwahab and Mahmoud Abdou Yassin
Abstract Background: Surgical staging of endometrial cancer is considered one of the main pathways for managing those categories of cases. Uterine cancers are considered a challenging surgical scenario in many situations due to anatomical changes in tissue planes and metastatic disease besides the presence of obesity in many cases requiring management. Aim: To compare laparoscopy versus laparotomy for complete uterine cancer surgical staging. Methodology: Cases having clinical stage I to IIA endometrial carcinoma have been randomly allocated to laparoscopy or open laparotomy including hysterectomy, salpingo - oophorectomy, pelvic cytology, pelvic and para-aortic lymphadenectomy. The chief research study outcomes were the 6-week morbidity, mortality issues, hospitalization period and conversion rates from laparoscopy to laparotomy. Results: There was no statistical significant difference as regards the Surgical stage, tumor type, types and numbers of nodes of the studied research groups in which there was no statistical significant difference as regards surgical staging, tumor type observed, peritoneal cytology, type of nodes, no nodes, Para aortic nodes only, pelvic nodes only, both pelvic and para - aortic nodes, any pelvic node, no. of nodes median (IQR) values = 0.996, 0.998, 0.929, 0.607, 0.928, 0.669, 0.541, 0.562, 0.680, 0.934 consecutively. Conclusions and recommendations: The current research elucidates the privilege of laparoscopic surgical staging for early stage endometrial cancer, however future research studies are required to be performed in multi centric fashion and to put in consideration variability’s in BMI, coexisting medical morbidities e.g. DM, hypertension besides the racial and ethnic differences.
47 A Prevention Project to Increase Influenza Vaccination in The Community Through Health Literacy , Patience Ronke Akhimien
Introduction to Problem Influenza is a vaccine preventable viral disease of the respiratory tract that could become complicated with respiratory failure resulting in disability and death according to CDC (2013b). Even though influenza can possibly be prevented by vaccination, the death rate is still high worldwide due to misconceptions, biases, misbelieve and ignorance against the flu vaccine. Influenza could also cause gastrointestinal symptoms like diarrhea and vomiting leading to dehydration that could become fatal if not treated promptly and adequately. In the United States, influenza is seasonal and it is usually from October to April, sometimes it spreads all year round with seasonal peaks. According to Center for Disease Control and Prevention (CDC) flu activity report (https://www.cdc.gov/flu/about/ season/flu-season-2016-2017.htm), influenza starts in October and could stretch to May with December to March as peak months and could be around for the entire year.
48 Joined-Up Thinking in Global Health Education , Roger Worthington
Abstract The scope of global health is necessarily broad and healthcare professionals need special knowledge and skill to help them work effectively in any multi-cultural, multi-ethnic society. Without some form of training over and above traditional areas of core clinical skill, the healthcare needs of vulnerable populations could be left unmet, whether in low-middle income countries where health infrastructure is poorly developed or in high-income countries where ethnic minorities might struggle accessing the care that they need. Recognising that while healthcare provision is always subject to financial constraint, health is not a commodity to be traded, and nursing and healthcare leaders have a role to play in helping create an environment that is conducive towards enabling patients achieve optimum health. Potential barriers to achieving this include creeping commercialisation, weak systems of governance and lack of recognition for the ethical nature of much healthcare provision. The picture varies greatly between and within countries, between specialism’s and providers and between individuals. Global health education programmes should recognise the moral nature of the enterprise, which creates a need for informed leadership and robust systems of governance. Critical to raising awareness of the interconnected nature of global health is a realisation that 1) Healthcare provision is essentially a form of public service, 2) Systems of governance should be fit for purpose and work to promote patient’s best interests (above those of healthcare providers) and 3) Ethical consideration should be factored into all policy initiatives and programmes for the promotion of global health. Without these elements, policy makers could find it hard finding effective interventions to address global health problems, such as the need to reduce rates of infant mortality. Nursing and global health educators can play their part in helping to create an environment whereby leadership, governance and ethics work together in serving the interests of whole communities.
49 Do Physical Therapy Interventions Improve Urinary Incontinence and Quality of Life in patient with Multiple Sclerosis: A systematic Literature Review , Najwa Alfarra PT*, Hala Aldosary PT and Sultan Almefleh PT
Abstract Background: Multiple sclerosis (MS) presents with many symptoms, including urinary incontinence (UI) that physical therapy can play very important role, which is widely prevent, but the physical therapy management for UI in MS population lacks consensus. We analyzed the current evidence for effectiveness of physical therapy to decrease UI and improve quality of life (QOL) in population with MS. Purpose: To systematically review the literature and present the best available evidence for the efficacy and effectiveness of physical therapy intervention in treating the urinary incontinence for MS population and improve QOL. Data Source: Pub Med, Cochrane library, BMJ Group, BioMed Central, Wiley online library, Cumulative Index to Nursing and Allied Health Literature, and PEDro. Study Selection: 5 randomized, control trials (RCTs) and one clinical trial published in English from 2006- May 2019. Data Extraction: Any study concentrated on surgical or pharmaceutical treatment interventions, focused on bowel incontinence or were not within the physical therapy scope of practice. Data Synthesis: The study focuses on physical therapy intervention for MS patients with UI and randomized control study. Limitation of the Study: The reviewed study is limited to 6 randomized control trials. Conclusion: There is significant evidence that physical therapy interventions in MS patients with urinary incontinence are very effective and had significant change in reducing UI and increasing QOL.
50 Study of Knowledge, Attitudes and Practices (Kap) of Jordanian Women Aged 20- 65 Years towards Early Detection and Screening of Breast Cancer , Tala Hamadeh*, Taghreed Nusairat and Isra’a Abbadi
Abstract Breast cancer has been the most common cancer in the world with nearly 1.7 million new cases diagnosed in 2012. Particially in Jordan, a developing country with limited resources, breast cancer incidence and mortality rates have been doubling in the last decade The study of the knowledge, attitude, and practices of Jordanian women aged 20-65 years towards early detection and screening of breast cancer clearly highlights the level of awareness in the community and provide organizations a clear vision on how to effectively increase awareness and transform the concept of screening and early detection to practice. Objective: The study is aimed to explore the knowledge, attitude and practices (KAP) of the female population of Jordan ages from 20 to 65 years towards early detection and screening of breast cancer by assessing the overall awareness regarding breast cancer as well as their practices on detecting and screening for the disease. Method: A qualitative and quantitative interview was conducted with individuals (n=1502) that were randomly selected according to geographical distribution of female Jordanian nationals ages between 20 and 65 years old. The interview was done by the ‘Random Walk’ method and was aided by a Computer-Assisted Personal interviewing (CAPI). The data collected was analyzed using SPSS software, and tested for significance using t-test. Results: The study outcomes showed that 85% of the participants are aware of breast cancer. The source of their awareness was mainly through TV (72%) and the majority (73%) was not actively looking to increase their knowledge. Only 19% of participants are aware and underwent clinical breast examination (CBE) within the past year while only13% is familiar with mammogram and were subject to it. As for the visit to early detection clinics, 56 % of the Jordanians are welling to visit the clinic if they have doubt about breast cancer, while physician’s recommendation for detection and screening was only 9%. Finally, only 30% of participants believe greatly that breast cancer can be detected in early stages. Conclusion: The study shows that although most of the participants are familiar with breast cancer but the majority had little detailed knowledge while others had misconceptions and both are not seeking improvement leading to low acknowledgement and practices of early detection and screening.
51 Menstrual Dysfunction in Teens , Siniša Franji?
Abstract The first menstruation marks the moment in which a girl enters a completely new period of life and transforms into a woman biologically capable of achieving pregnancy and childbirth. By the time of maturation, puberty, in the girls between the 8th and 13th, it is coming to the so-called axial maturity - hypothalamus-pituitary-ovary. This period is often recognized by intense physical changes, i.e. by the development of the so-called secondary bodily traits - growth, body-shaped changes in girls, breast growth, hair growth on the vulva, and hair growth on axillary pits along with the first menstruation - menarche. The menstrual cycle includes the essence of women’s reproductive life - the ability to achieve pregnancy and childbirth.
52 Single Versus Continuous TAP blockage Technique for Management of Postoperative Hysterectomy Pain , Nancy Mohamed Ali Rund1 , Mahmoud Fathy Hassan, Mohammed A Taha Al Afifi, and Mohammed El Sayed Abdel Hameed
Abstract Background: Transversus abdominis plane blockage technique is performed by administration of local anesthetic agent between the abdominal muscle anatomical planes to block the somatic nervous innervation. Value of continuously infused local anesthetic agents via indwelling catheters in TAP blockage is an area of growing research interest. Aim: To compare the analgesic efficacy of single shot versus continuous transversus abdomin is plane (TAP) block in cases undergoing total abdominal hysterectomy. Methodology: All research study subjects enrolled had provided a written informed consent. The research study involved 60 cases having ASA scoring status 1 to 2(according to American society of Anesthesiologist scoring system), aged 35 to 60 years and scheduled to undergo total abdominal hysterectomy cases. All patients were categorized into two research groups in a random manner; single shot TAP research group (n=30 cases) and continuous TAP research group (n=30 cases). Results: VAS scoring (Visual Analog Scale for Pain) was statistically significantly lower among continuous TAP block research group in comparison to single shot TAP block research group at different time intervals,baseline,1 hour,12 hours 24 hours,36 hours 48 hours 60 hours (p values =0.000, 0.001, 0.001, 0.002, 0.026 consecutively). Conclusion and Recommendations: TAP blockage prolong the analgesic duration, reduces the VAS scoring particularly in continuous approach more than single shot postoperatively and reduces the requirements for Opioid consumption overall.
53 Lifestyle Issues and Prevention of Recurrent UTIs , Abdul Kader Mohiuddin
Recurrent UTIs (RUTIs) are mostly caused by frequent sexual intercourse, heterosexual lack of circumcision receptive anal intercourse (without a condom), multiple sexual partners (each sex partner shares his/her UGT microbiota with the other), use of spermicide and a new sexual partner, sexual intercourse with addicted partners, sexual intercourse with sex workers, sexual intercourse with online dating friends, sexual intercourse with a new sex partner within less than 2 months [9-20]. Traditional lifestyle factors such as fluid intake and diet are not considered independent risk factors now [15]. UTIs account for nearly 25% of all infections [16]. Sexual intercourse ≥3 times/week was associated with greater frequency of UTI [21]. Close proximity of the urethral meatus to the anus and shorter urethra, is a likely factor.
54 Pregnancy Induced Hypertension (PIH): Beyond Pregnancy , O Osman
Contrary to the belief that pregnancy-induced hypertension (PIH, or hypertensive disorders of pregnancy, HDP) and preeclampsia are benign conditions that do not extend harm past pregnancy, the evidence is growing that preeclampsia is a risk factor for future cardiovascular disease. Although most published data indicate that proteinuria during pregnancy does no long-term harm to the mother, more recent reports indicate that preeclampsia increases the risk of cardiovascular disease [1-7]. Recent research published on November 11, 2019 in the Journal of the American College of Cardiology confirms that women who have gestational hypertension or preeclampsia in at least one pregnancy have a higher cardiovascular risk than women without this history [7]. The authors conclude that a history of HDP can be a useful tool to refine atherosclerotic cardiovascular disease risk assessments. They added “However, future risk of diverse cardiovascular conditions in asymptomatic middle-aged women with prior HDP remains unknown”. They also argued that “hypertensive disorders of pregnancy are associated with accelerated cardiovascular aging and more diverse cardiovascular conditions than previously appreciated”, and commented that the cardiovascular risk after HDP is largely but not solely mediated by the development of chronic hypertension. Many authorities now regard pregnancy as a “cardiovascular stress test”.
55 Pregnancy Induced Hypertension (PIH): Beyond Pregnancy , O Osman
Contrary to the belief that pregnancy-induced hypertension (PIH, or hypertensive disorders of pregnancy, HDP) and preeclampsia are benign conditions that do not extend harm past pregnancy, the evidence is growing that preeclampsia is a risk factor for future cardiovascular disease. Although most published data indicate that proteinuria during pregnancy does no long-term harm to the mother, more recent reports indicate that preeclampsia increases the risk of cardiovascular disease [1-7]. Recent research published on November 11, 2019 in the Journal of the American College of Cardiology confirms that women who have gestational hypertension or preeclampsia in at least one pregnancy have a higher cardiovascular risk than women without this history [7]. The authors conclude that a history of HDP can be a useful tool to refine atherosclerotic cardiovascular disease risk assessments. They added “However, future risk of diverse cardiovascular conditions in asymptomatic middle-aged women with prior HDP remains unknown”. They also argued that “hypertensive disorders of pregnancy are associated with accelerated cardiovascular aging and more diverse cardiovascular conditions than previously appreciated”, and commented that the cardiovascular risk after HDP is largely but not solely mediated by the development of chronic hypertension. Many authorities now regard pregnancy as a “cardiovascular stress test”.
56 Pregnancy Induced Hypertension (PIH): Beyond Pregnancy , O Osman
Contrary to the belief that pregnancy-induced hypertension (PIH, or hypertensive disorders of pregnancy, HDP) and preeclampsia are benign conditions that do not extend harm past pregnancy, the evidence is growing that preeclampsia is a risk factor for future cardiovascular disease. Although most published data indicate that proteinuria during pregnancy does no long-term harm to the mother, more recent reports indicate that preeclampsia increases the risk of cardiovascular disease [1-7]. Recent research published on November 11, 2019 in the Journal of the American College of Cardiology confirms that women who have gestational hypertension or preeclampsia in at least one pregnancy have a higher cardiovascular risk than women without this history [7]. The authors conclude that a history of HDP can be a useful tool to refine atherosclerotic cardiovascular disease risk assessments. They added “However, future risk of diverse cardiovascular conditions in asymptomatic middle-aged women with prior HDP remains unknown”. They also argued that “hypertensive disorders of pregnancy are associated with accelerated cardiovascular aging and more diverse cardiovascular conditions than previously appreciated”, and commented that the cardiovascular risk after HDP is largely but not solely mediated by the development of chronic hypertension. Many authorities now regard pregnancy as a “cardiovascular stress test”.