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”.
57 Delay in Making Decision to Seek Institutional Delivery Service Utilization and Associated Factors among Mothers Attending Public Health Facilities in Dawuro Zone, Southern Ethiopia , Terefe Dodicho
Abstract Background: Delay in institutional delivery refers to the time interval from the first onset of labour to start to receiving first healthcare. Delay in deciding to seek care (first delay), identifying and reaching medical facility (second delay), and receiving adequate and appropriate treatment (third delay) are three major factors that contribute to maternal death in developing countries. The time interval from the first onset of labour to decision to seek emergency obstetric care from health facility and time longer than the expected time (one hour) is considered as first delay. Objective: This study was aimed to investigate delay in deciding to seek institutional delivery care and associated factors among mothers attending public health facilities in Dawuro zone. Methods: Institution based cross-sectional study was employed from March 1-30, 2017. Consecutive sampling technique was used to interview mothers who presented to health facilities to receive delivery service. Data were collected using structured interviewer administered questionnaire. Results: Total of 394 mothers were participated in the study. One hundred sixty six [42%] of the study subjects were delayed in making decision to seek delivery service utilization from health facilities. A significant relationship was found between mother’s residence in rural areas, mother’s educational level primary and below, average monthly income of the family < 1000 ETB & mother’s antenatal care visit less than 4 times and first delay (maternal delay to seek institutional delivery care). Conclusion: Significant number [42%] of mothers delayed in making decision to seek delivery service utilization from health facilities. Therefore, strategies to identify determinants of delay in making decision to seek institutional delivery service and enhance practices for further reduction in this delay is needed.
58 The Prevalence, Risk Factors, and Bacterial Profile of Cesarean Surgical Site Infections at a University Teaching Hospital in South Western Uganda , Joseph Isanga, Byaruhanga Emmanuel, Kayondo Musa, Mugisha Julius, Leevan Tibaijuka, Mayanja Ronald and Joseph Ngonzi*
Abstract Introduction: The single most important risk factor for post-partum maternal infection is Cesarean section (C/S) with a 5-20-fold greater risk for infection compared to a vaginal delivery. Post Cesarean wound infection is diagnosed in 2.5 to 16 percent of patients. Early wound infections (in the first 24 to 48 hours) are usually due to group A or B beta-hemolytic streptococcus and are characterized by high fever and cellulitis while later infections are likely due to Staphylococcus epidermises or aureus, Escherichia coli, or Proteus species. Objectives: To determine the prevalence, risk factors and bacterial profile of wound sepsis following Cesarean at Mbarara Regional Referral Hospital (MRRH). Methods: A cross sectional study of mothers who delivered by Cesarean at MRRH was conducted. Mothers were recruited consecutively until the sample size was achieved. The main dependent variable was wound sepsis confirmed by a positive culture for microorganisms. Results: Of the 359 mothers recruited in the study, 54 (15.5%) developed Cesarean wound sepsis. The risk factors associated with post Cesarean wound sepsis were severe anemia, lack of preoperative antibiotics use, poor antenatal attendance, mothers referred from peripheral health facilities, abnormal Body Mass Index (BMI), diabetes mellitus, more than five vaginal examinations, prolonged rupture of membranes before C/S, and prolonged labour. Staphylococcus aureus was isolated in 48.2% of all the septic cases and most of the bacterial isolates were susceptible to ceftriaxone, ceftazidime, ciprofloxacin and nalidixic acid and resistant to penicillin. Conclusion: The prevalence of post Cesarean wound sepsis is high with staphylococcus aureus being the most common bacteria isolated in infected wounds. Most of the bacteria were susceptible to third generation cephalosporins and quinolones. Antibiotics use was protective against developing wound sepsis.
59 Factors Associated With Severe Maternal Outcomes at a Regional Referral Hospital in South-Western Uganda: A Case-Control Study , Mugisha Dale, Rodgers Kajabwangu, Horace Mayengo, Baraka Munyanderu, Asanairi Baluku, Anthony Manyang, Jolly Joe Lapat, Wasswa Ssalongo, Musa Kayondo, Ronald Mayanja, Adeline A Boatin and Joseph Ngonzi*
Abstract Background: The Sustainable Development Goal target is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. Severe maternal outcome studies offer a panoramic assessment of obstetric care. Objective: The study aimed at determining the factors associated with severe maternal outcomes among women admitted at the obstetrics and gynecology ward of Mbarara Regional Referral Hospital. Methods: In an unmatched case control (1:2) study conducted between February and May 2018, 162 pregnant women admitted on the obstetrics and gynecology ward of Mbarara Regional Referral Hospital, or who had delivered within the past 42 days were recruited. Near miss cases were defined based on the WHO criteria. Near-miss cases and events, maternal deaths and their causes were retrospectively reviewed. Three categories of risk factors (socio-demographic, obstetric and health system) were examined. P-values <0.05 were considered statistically significant. A multivariable logistic regression model was used to identify factors associated with severe maternal outcomes. All analyses were performed using Stata software (Version 12.0, StataCorp, and College Station, TX). Results: In the four-month period there were 2301 live births, there were 45 near miss cases and 9 maternal deaths resulting in a severe maternal outcome ratio of 23.5/1000 live births, maternal near miss ratio of 19.6/1,000 live births, maternal near-miss mortality ratio of 5 and mortality index of 16.7%. Severe obstetric hemorrhage (33%), ruptured uterus (27.8%), sepsis or severe systemic infection (16.7%) and hypertensive disorders in pregnancy (16.7%) were the direct causes of severe maternal outcomes. About seventy-seven percent (77.8%) of the mothers with severe maternal outcomes were referred in from the peripheral health facilities, with a 4-time risk increased risk of a severe maternal outcome (aOR, 4.00; 95 % CI, 1.84-6.66, p-<0.001). Conclusion: Of the severe maternal outcomes, direct causes were the most prevalent and most of which are preventable. Being referred in was significantly associated with severe maternal outcomes. The maternal near miss indicators indicate need for improved quality.
60 Prevalence of HIV Sero-discordance among Couples in Sub Saharan Africa, 2019, Systematic Review and Meta Analysis , Mihretie Gedfew*, Melaku Desta, Belayneh Mengist, Hailie Amaha, Dessalegn Hailie and Bekalu Bewket
Abstract Background: HIV/AIDS ranks among the world’s most devastating diseases because it spreads rapidly through sexual intercourse (90-95%) and mainly affects young people in their most productive years especially discordant couples are at continuous risk for acquiring the infection. But many individuals are unaware of their partner’s and their own Sero status. So this Meta-analysis aimed to assess the prevalence of HIV Sero discordance among adult discordant couples in Sub Saharan Africa, 2019. Methods: published and unpublished studies were searched systematically using electronic databases such as Google scholars, Medline, hennery, Scopes and Pub Med. All observational studies, which were assessing and reporting the prevalence of HIV sero discordance were identified and included in analysis. Investigators using a data extraction tool did data extraction. STATA statistical software version 14 was used for data analysis. The I2 test was used to evaluate study heterogeneity, the random effect model was used to estimate the pooled association, and the Egger test was used to check for publishing bias. Results: Ten studies met the inclusion criteria and were included in the Meta - analysis. The findings of these 10 studies revealed that there was 23.77 (95 percent CI: 10.48, 37.09) pooled prevalence of sero discordance. The highest prevalence of HIV sero discordance was found in Uganda and SSA OR: 49.2 (95% CI = (47, 50.9) and OR: 43 (95% CI = (41, 45) respectively. Conclusion: In this Meta-analysis the pooled prevalence of HIV sero discordant was high in Africa.
61 Innovative Approach to Vaginal Drug Delivery , Shihata Alfred A* and Brody Steven
Abstract Introduction: The vagina is an ideal site for drug delivery, particularly for those drugs associated with women’s reproductive health. For years traditional applicators have been the primary method used to deliver therapeutic creams into the vagina. The applicator’s lack of efficacy is mainly attributed to the vagina’s rhythmic muscular contractions, which naturally flush out any substances from its canal. As a self-cleaning organ; the vagina not only expels cervical secretions and menstrual blood, but also any therapeutic creams, which will render them less effective. Objectives: • To provide women with an alternative to vaginal applicators, which will increase the time of contact between the therapeutic vaginal preparations and the cervix. • Explore the possibility of topical treatment of Bacterial Vaginosis and Candida infections using a new cervical barrier called FemCap; where it is used as a delivery system for antibacterial and antifungal preparations. Methodology: To prove this concept we recruited 30 women to insert a stained gel (Gentian Violet dye) with a vaginal applicator and another 30 women to insert the same gel with the FemCap. We then compared the retention and distribution of the stained gel over the cervix and we photographed the cervices at 12 and 24 hours. Results: None of the participants reported any side effects using the stained gel with either device. Women reported leakage while using the vaginal applicator and did not have any with the FemCap. Women who used the applicator had no visible stained gel over the cervix after 12 hours of insertion. Cervical photographs have shown that the FemCap participants retained the stained gel on the cervix more than 24 hours after insertion. Conclusion: This pilot study has proved the concept that FemCap is more efficient than the vaginal applicator in delivering vaginal preparations to cervix and vagina. The FemCap can shield the cervix from sperm penetration and potentially from STI organism’s invasion. Further studies should be conducted to explore the possibility of treating Bacterial Vaginosis, Candida topically and some STIs.
62 Need-Based Holistic Treatments for Endometriosis in Women , Shannyn R Snyder*, Misky M Sharif, and Grace E Snyder
Abstract Endometriosis is a debilitating disease that affects approximately 200 million women across the globe [1]. There are numerous difficulties in assessing the number of women who suffer from this disease including insufficient diagnostics, under-reporting, and the lack of recognition of chronic pain in women. Although some mainstream treatments exist, which are considered to be “traditional” such as pharmaceuticals aimed at hormone control and pain reduction, there is no one-size-fits all approach that works for all women, and as of now, there is no known cure for the disease. This paper aims to share other potential treatments for endometriosis and similar female reproductive diseases which cause chronic pain. Further, the aim is to urge a multidisciplinary approach by medical practitioners, physical therapists, practitioners of Eastern, ancient, and spiritual healing and holistic medicines, and others who can combine their areas of expertise to create a wider encompassing treatment plan that considers both the physical and mental aspects of this disease.
63 The Role for Intra-Partum Antibiotics in Previously GBS-Colonised Pregnancies, Not So Straightforward After All: A Case Study , Jon Wei Tan, Jill Cheng Sim Lee* and Lay Kok Tan
Abstract Background: Group B Streptococcus (GBS) is the most frequent pathogen involved in early-onset infection in newborn infants. The incidence of early-onset GBS disease (EOGBS) is estimated at 0.4 and 0.57 per 1000 births in the United States of America and the United Kingdom respectively. It is clear that administration of intrapartum antibiotics (IAP) significantly reduces risk of EOGBS (RR 0.17, 95% CI 0.04 to 0.74; number needed to treat to benefit 25, 95% CI 14 to 100), hence institutes such as the Royal College of Obstetrics and Gynecology (RCOG), and American College of Obstetrics and Gynecology (ACOG), have released clinical practice guidelines (CPGs) with the aim to improve the standard of care in GBS screening and IAP for the prevention of EOGBS in neonates. CPGs guide clinicians in their management based on a consensus of care drawn from clinical evidence and offer a standard of care for them to fall back on to guard against medical malpractice litigation. However, deviation from the intended clinical context or the failure to recognize the limits of such guidelines could compromise patient safety. Aim: The aim of this case study is to highlight the role and limitations of clinical practice guidelines in medical practice, through a case of an early onset GBS infection in a neonate that was a result of selectively applying the RCOG and ACOG guidelines outside their intended context. Conclusion: The case illustrates the importance of applying guidelines correctly within the appropriate clinical context but serves also as a reminder for clinicians to understand the limitations of them when accounting for other co-conditions patients often present with in daily medical practice.
64 A Cross Sectional Survey on Socio Demographic Profile and Work-Related Health Risks of Bangladeshi Female Sex Workers , Bahauddin Bayzid, Mohammad Kamrujjaman*, Md Rejwan Gani Mazumder, SM Mustofa Kamal, Md Soriful Islam, Sujon Hosen and Jalal Uddin
Abstract Background: Commercial sex is one of the leading occupational health risks in Bangladesh. Knowing health risks in female sex workers is of great importance for protection. Various work-related factors are in charge to develop the health risks. The current study aimed to find out the socio demographic profile and work-related health risks among female sex workers. Methods: The study design was a cross-sectional survey. The sample comprised 315 female sex workers with an age range of 18-49 years. A purposive sampling techniques were used and data were obtained by face to face interview with a structured administered questionnaire. Data were analyzed using the SPSS software (version 20.0). P-value represented as chi-square test and level of significance (p<0.05). Results: Sexual, emotional and physical assault along with urinary tract infection and musculoskeletal pain were the prevailing work-related health risks found in this study. Results indicated that brothels were the highest place of work among female sex workers. Most of the participants knew about sexually transmitted diseases and infections but some appeared not consistently use a condom. Age group 20-40 years were the vulnerable group for the sex work. Most participants reported poor level of education, as well as low economic conditions. However, there was a significant (p<0.05) relationship found between work-related health risks and place of working. Conclusion: This study concluded that female sex workers confronted significant risks of work-related health. Some workrelated and socio demographic factors are sensible to develop health risks. Increasing awareness and educational support might help to reduce the work-related health risks among female sex workers.
65 Reference Range of Prolactin level in Sudanese non Pregnant Women Living in Khartoum State (Pilot Study) , Monera A Sidig, Ibrahim A Ali* and OA Musa
Abstract Background: Prolactin is synthesized by the lactotrophs, which represent approximately 15% of the tissue in the anterior lobe of the pituitary. Is secreted in pulstile fashion with 4-14 pulses per day, it is normal level about 40-530 IU/L the number of lactotrophs increases during pregnancy and lactation when the demand for prolactin is increased. The objective of this study is to assess the normal prolactin level among non-pregnant Sudanese women in Khartoum state. Methods: The study involved 20 non-pregnant Sudanese women aged between 18-35 years old in Khartoum state and the normal prolactin level was evaluated using the Immune-enzymometric Assay. Results: The Mean of prolactin level was 188.61 iu/l while the range between 92.1 to 241 iu/l with a lower maximum than international level and lower range than the local lab reference. There was significant correlation of prolactin with age, which decreased with age. Conclusion: There was a narrow range of prolactin level in this study with lower maximum value than the international prolactin level.
66 Does the Physical Therapy Intervention Improve Female Sexual Dysfunction in Saudi Society? , Najwa Alfarra PT* and HalaAldosary PT
Abstract Introduction: Sexual dysfunction refers to a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle traditionally includes excitement, plateau, orgasm, and resolution. Desire and arousal are both part of the excitement phase of the sexual response. The literature review confirmed that the sexual dysfunction is common, 43 % of women and 31 % of men report some degree of difficulty, it is a topic that many people are hesitant to discuss. But the treatment options are available [1]. The literature also supports the use of pelvic floor exercise in order to improve sexual function. The health concept for women magazine reported that the Neo-control magnetic chair improved the sexual dysfunctions in women specially the orgasm problems [2]. Objective: The objective of the study is to explore the role of the physical therapy intervention for the female sexual dysfunction in Saudi Arabia. Methods: Thirty women had sexual dysfunction, were evaluated by muscle power (Oxford scale) before and after the treatment, and FSFI questioners were answered before and after the completion of the treatment. Main Outcome Measures: The domain scores of the female sexual function index (FSFI), included desire, arousal, lubrication, orgasm, satisfaction, and pain, were calculated. The supervised pelvic floor muscle training, core strengthening pelvic exercises were conducted for 30 minutes, and magnetic field “neocontrol chair” frequency 50HZ, 15 sec. on, 1 sec. off for 20 min. power 75-80%, twice a week for six weeks(12 sesssions). Muscle power (Oxford scale) was measured before and after the treatment. Results: All subjects successfully completed the study with no adverse events significant improvement in sexual function as assessed by the FSFI, sex desire improved by 80%, sexual arousal improved by 86%, lubrication and orgasm improved by 80%, general satisfaction 87%, 73% pain free through intercourse. Muscle power were improved from 1-2 out of 5 to 3+ out of 5. Conclusion: The physical therapy intervention which include pelvic floor exercise, core strengthening exercise and magnetic field had improved the sexual function in female Saudi society.
67 Postpartum Family Planning Utilization and Associated Factors among women who gave birth in the past 12 months, Hawassa Town, Southern Ethiopia: a community based cross-sectional study , Kebede Tefera* and Mulugeta Abuye
Abstract Background: Addressing family planning in the postpartum period is crucial for better maternal, neonatal and child survival because tenable women to achieve healthy interval between births. Many women do not realize that they are at a risk for pregnancy during this period. Thus, the objective of this study was to assess the utilization of postpartum family planning services among postpartum women and associated factors in Hawassa, Ethiopia. Methods: A community based cross-sectional study was conducted among 381 women in Hawassa City from April to May 2018 in Hawassa City. Study subjects were selected by systematic random sampling technique. Structured questionnaire was used to collect the data through interview. Data analyzed by SPSS 20. Multi-variable logistic regression was used and significance declared at p-value ≤ 0.05. Results: The prevalence of contraceptive utilization was found to be 147 (38.6%) among women in the postpartum period. The majority of current contraceptive users were injectable (35.4%).The odds of postpartum family planning utilization was statistically significantly associated with received FP education after delivery at immunization service [AOR=4.11; 95% CI ; 2.143,7.864 ], mothers’ discussion with husband on family planning issue [AOR=9.7; 95% CI;4.15, 22.6], Family planning problem [AOR=0.5;95% CI; 0.28,0.89 ], 0-6 month of postnatal period [AOR=0.23; 95% CI;0.124, 0.430] and 1-4 number of pregnancy [AOR=0.05; 95% CI; 0.0124, 0.170] History of abortion [AOR=0.23; 95% CI;0.124, 0.430] . Conclusion: Postpartum family planning use is still low. Consequently, this finding implies the need to get better with those factors to enhance the uptake of postpartum modern contraceptive through well-organized family planning education and follow up for the reproductive age women
68 Using GH-Method: Math-Physical Medicine, Mentality-Personality Modeling, and Segmentation Pattern Analysis to Compare Two Clinic Cases About Linkage Between T2d Patient’s Psychological Behavior and Physiological Characteristics , Gerald C Hsu
Introduction The Author Has Contemplated a Specific Question Why do some type 2 diabetes (T2D) patients choose to face serious complications, including death, rather than change their lifestyle in order to control their diabetic conditions? This paper utilized segmentation pattern analysis to analyze two different clinic cases linking T2D patient’s personality traits and psychological behavior with diabetes physiological characteristics.
69 Using GH-Method: Math-Physical Medicine to Investigate the Impact of Different Intensity of Exercise on Postprandial Plasma Glucose (No. 65) , Gerald C Hsu
Introduction The data-set is provided by the author, who uses his own type 2 diabetes (T2D) metabolic conditions control, as a case study via the “math-physical medicine” approach of a non-traditional methodology in medical research. Math-physical medicine starts with the observation of the human body’s physical phenomena (not biological or chemical characteristics), collecting elements of the disease related data (preferring big data), utilizing applicable engineering modeling techniques, developing appropriate mathematical equations (not just statistical analysis), and finally predicting the direction of the development and control mechanism of the disease. This paper is based on a big data collected from a period of 1,449 days from 5/1/2015 to 4/19/2019, with 4,347 post-meal exercise or walking steps per meal and measured postprandial plasma glucose or PPG (mg/dL). This dataset is provided by a long-term type-2 diabetes patient under a lifestyle management program.
70 Characteristic Pattern Study of the Glucose Waveforms Using GH-Method: MathPhysical Medicine (No. 276) , Gerald C Hsu
Introduction This paper describes the research results of the waveform characteristic patterns of daily finger and sensor glucoses, postprandial plasma glucoses (PPG), and fasting plasma glucoses (FPG) over a period of 2+ years.
71 Investigation of the triangular dual-correlations among weight, glucose, and blood pressure for 6.5 years using GH-method: math-physical medicine (No. 299) , Gerald C Hsu
Abstract The author uses the math-physical medicine approach to investigate three sets of correlation between: (1) Weight vs. Glucose - Weight is measured in early mornings and Glucose consisting of daily average glucose, including both fasting plasma glucose (FPG) and three postprandial plasma glucose (PPG). (2) Weight vs. blood pressure (BP) - BP is measured in early mornings. (3) Glucose vs. BP. He utilized both time-series and spatial analysis of his “daily data” in comparison with his “annual data”. His selected study period is 6.5 years (2,394 days) from 1/1/2014 through 7/23/2020. The reason he chose this specific time period is due to his blood pressure (BP) data collection starting on 1/1/2014, while both weight and glucose data were collected since 1/1/2012. It is clear that, through statistical methods of time-series and spatial analysis, all of these three biomarkers, weight, glucose, and BP are correlated to each other. However, the following order ranking of correlation coefficients remain to be true between daily data and annual data: M1&M2 > M2&M3 > M1&M3 Daily: 81% > 54% > 50% Annual: 89% > 83% > 76% By reducing your body weight, your glucose values will then be lower. This strong relationship is the most obvious correlation. Similarly, your blood pressure will be lower when your glucose value is low. Finally, weight loss helps your blood pressure reduction as well. The author’s statistical analyses are based on his 100,000+ personal biomarker’s data within the last 6.5 years (2,394 days) has further proven a simple and clean conclusion that has already been observed by many clinical physicians and healthcare professionals from their patients.
72 A postprandial plasma glucose (PPG) comparison study between pre-COVID-19 and during COVID-19 using GH-Method: math-physical medicine (No. 317) , Gerald C Hsu
Abstract The author utilizes quantitative analysis results based on diabetes control for two periods: the pre-COVID-19 period, from 5/5/2018 to 1/18/2020, and the COVID-19 period, from 1/19/2020 to 8/24/2020, within a duration of 2.3 years. Special attention has been placed on his specific lifestyle management during the COVID-19 quarantine period from 1/19/2020 to 8/24/2020. The COVID-19 period has a lower average Finger PPG (-6 mg/dL) along with a lower sensor PPG (-12 mg/dL). By comparing these two periods, the two glucose waveforms are similar in shape (with high correlation coefficient) and the differences between these two curves at each time instant are quite close to each other (about 12 mg/dL glucose difference). As a result, during this period, the author achieved 0.3% to 0.4% lower HbA1C value. COVID-19 is more than 100x worse compared to the fatal respiratory illness known as severe acute respiratory syndrome or SARS that occurred in 2003, in regard to its spreading speed, fatality number, and emotional impact on the world population. People belonging to the “vulnerable” groups, such as the elderly with existing chronic diseases and history of complications require special consideration to their health conditions and lifestyle management during the COVID-19 period. However, during this period, the author collected better results with his diabetes control in terms of both PPG and HbA1C values. The knowledge and experience he acquired in the past 10 years of medical research and his developed mathematical metabolism index model along with four diabetes prediction tools assisted him in many ways. As a result, he achieved a reduction of -6 mg/dL for finger PPG, -12 mg/dL for sensor PPG, -13 mg/dL for K-line PPG, and -0.3% to -0.4% for HbA1C. In fact, he turned the COVID-19 crisis into his health advantage!
73 Successful Management of Stress Urinary Incontinence in Women by a Contraceptive Device FemCap™ Pilot Study , Alfred Shihata*, Steven A Brody, Julia Barrett-Mitchell,
Abstract Background: Women suffer silently from stress urinary incontinence (SUI). SUI is under-reported by women and under-diagnosed and treated by doctors. Treatment with pessaries is conservative and has significant limitations. These limitations include displacement, erosion, ulceration, and urethral obstruction. (SUI) is very prevalent among women of all ages, particularly menopausal women. The first line of SUI treatment is the ring pessary; however, more pessaries of different shapes and sizes have been introduced to achieve better results. Objectives: To provide women with a safer, more effective device to treat SUI. Materials and Methods: The FemCap combines the ring and space-occupying pessary features into one device, making it much more successful. The bowl of the dome of the FemCap covers the cervix and prevents it from prolapsing. The rim fits snugly into the vaginal fornices that support the bladder neck. The brim flares outward, pushing against the cystocele and the urethrocele anteriorly to restore the urethra and the bladder’s anatomy. Forty-one women who had had significant SUI were recruited and asked to compare their experience for one week before using the FemCap and two weeks later. The FemCap was self-inserted and removed by the participants. Results: Thirty-four women out of 41 were completely dry after two weeks of using the FemCap, while four women were partially dry, and three women did not notice any change. The participants reported no side effects, and pelvic examinations did not show any erosion or ulceration of the vagina. Conclusion: The FemCap is safe and effective in restoring the bladder and urethra’s anatomy, which could make it ideal for the treatment and prevention of mild to moderate SUI. More studies are warranted to prove the utility of the FemCap further to manage SUI.
74 Reproductive Health Commodity Security Analysis and Planning System (RAPSYS): A Synergistic Study Model , Bongs Lainjo
Abstract Maternal and infant morbidity and mortality remain a global challenge and based on latest reports, mitigation efforts have not been encouraging. Unsustainable fertility rates continue to rise unabated in low and middle-income countries (LMICs). Reasons for these dismal performances include limited access to quality services, qualified staff, poor logistics management and lack of commodities. Reproductive Health Commodity Security Analysis and Planning System (RAPSYS) model is focused on mitigating these challenges. The participatory model is based on implemented results. It is defined by key themes. The systems use expert experience to develop effective strategies: qualitative assessment, Delphi ranking, action plan, commodity projection and monitoring framework. Evidence indicates that the conventional approach in program design and implementation continues to show different levels of understanding of the expected outcomes. This model has helped vulnerable countries in streamlining their interventions, making them more result-based, efficient, effective, sustainable and accountable. There is convincing evidence that the complications involved in designing development interventions have become more convoluted, unstructured, and poorly coordinated. This outlook has resulted in many cases producing inadequate and dismal outcomes. The relevant tasks are daunting. This framework – implemented in Asia - is part of an initiative to help refine current processes and procedures.
75 The Danger Within: Covid-19 Affinity for ACE2 receptors in Adipose Tissue and Testes. The Protective Effects of Estradiol, Fitness and Weight Management , XanyaSofra
Abstract The imminent danger of the Covid-19 pandemic has accelerated research in pharmaceuticals designed to interfere with the virus’ entry into the body via ACE2 receptors, or the viral RNA replication that often overwhelms immune defences. The scope of this review was to elucidate the main human vulnerabilities like certain organs’ enrichment in ACE2 receptors increasing viral affinity to males, the aged and certain pre-existing conditions including diabetes, CVD and pulmonary diseases, that deteriorate with increasing obesity, inflammation and toxicity. The current perspective focuses on the primary components of dysregulated health predisposing individuals to Covid-19, including hormonal imbalance,increased lipids and lipoproteins, thyroid dysfunction, degraded fitness, and age-related testosterone decline accompanied by cortisol increase that provokes stress eating behaviours and weight accumulation.We examined the molecular dynamics illustrating the action of new therapeutics necessary for Covid-19 patients; theestradiol advantage hypothesis; alternative therapies including hormone replacement procedures andmesenchymal stem cells; plus preventive and protective interventions. Obesity increases the probability of Covid-19 infection due to its abundance of ACE2 receptors.Physical activitymay decrease Covid-19 vulnerability, due to the diminished ACE-2 expression in the muscle. There are a number the fat managementsolutions featuring lasers and radiofrequency which, however do not enhance fitness. Seven recently published clinical studies with a total of 95 subjects, 73 males and 22 females, demonstrated visceral fat reduction combined with increasedskeletal muscle mass. A metanalysis performed on their data revealeda statistically significant decrease in several variables including BMI, lipids, lipoproteins, toxicityand inflammation as measured by CRP, Creatinine and Bilirubin, andoptimally healthier levels ofCortisol, Testosterone, Free T3,IGF-1, Insulin, and the appetite controlling hormones Leptin and Ghrelin.
76 Ongoing Research for Managing Stress Urinary Incontinence in Women with a FDA Approved Device, The FemCap™ , Shihata Alfred*, Brody Steven A and Linderoth, Birgit
Abstract Background: The previous successful pilot study led the inventor to expand into Sweden and increase the number of participants. We also expanded the research comparing the FemCap to other Pessaries on the market. Pessary treatment is conservative with significant limitations. These limitations include displacement, erosion, ulceration, and urethral obstruction. Stress urinary incontinence (SUI) is prevalent particularly among menopausal women. The first line of SUI treatment is the ring pessary however, a variety of different pessaries have been introduced into the market with hope of achieving better results. Objectives: To provide women with a safer, more effective device to treat SUI. Materials and Methods: The FemCap combines the features of the ring and space- occupying pessaries into one device, which makes it more successful. The Bowl of the Dome of the FemCap covers the cervix and prevents it from prolapsing. The Rim fits snugly into the vaginal fornices that supports the bladder neck. The Brim flares outward pushing against the cystocele and urethrocele anteriorly to restore the anatomy of the urethra and the bladder. We recruited 118 women who had significant SUI and asked them to compare their experience for one week before using the FemCap and one week after. The FemCap was self-inserted and removed by the participants. Results: Only 100 women completed the study 94 were completely dry after one week, while 6 women were not satisfied with the results. No side effects were reported by the participants and pelvic examinations did not show any erosion or ulceration of the vagina. Conclusion: The FemCap is safe and effective in restoring the anatomy of the bladder, and urethra, which could make it ideal for the treatment and prevention of mild to moderate SUI. More studies are warranted to further prove the utility of the FemCap to manage SUI.
77 Role of Anxiety and Depression in Altering Immune System Associated with Breast Cancer. Systematic Review , Masoumeh Ahmed Kazemi, Hamid Yahay Hussain
Abstract Background: Focusing on basic and clinical research, psycho-neuroimmunology researchers are looking at how the factors that cause anxiety and depression and their negative emotions can affect physiological and health conditions. Clinical studies have shown that the central nervous system is associated with endocrine and immune systems. Objectives: To investigate the impact of depression and anxiety on developing breast cancer through immune disturbance pathway Methodology: The present study is a descriptive review of systematic review studies conducted in accordance with the guidelines for preferred cases for reporting systematic and meta-analysis review articles (prisma). Electronic databases including ISI Web of Knowledge, PubMed, and Scopus, were searched from 2012 to 2020. The search strategy psychological, immune response, anxiety disorder, depression, and psychoneuroimmunology. Additionally, we searched the references of retrieved articles to find additional included a combination of the following Medical Subjects Headings (MeSH) terms: breast cancer, potentially related studies. We have considered herbal therapies, which were applied orally, or topically. The content of all articles was evaluated qualitatively after extracting from the desired databases with PRISMA checklist. Results: the impact of psychological problems on people’s illness is very large, when people have a lot of psychological pressure, the incidence will be higher than ordinary people. Health Psychology considers human health to be a complex entity and believes that disease is not caused by a single factor but is the product of biological, psychological, and social factors. Recent research has previously confirmed the effect of psychosocial factors such as stress and how it reacts to the onset and course of the disease. Most of the patients with malignant tumor had negative emotional problems such as anxiety and depression. Depression in cancer is markedly different from depression in healthy individuals, and involves a unique symptomatology and a strong biological etiology. Conclusions: A better understanding of the bidirectional communication between the neuroendocrine and immune systems could contribute to new clinical and treatment strategies.
78 Investigate the Challenges and Opportunities of Female Headed Households and Women Farmers in Male-Headed Households in Non-Agricultural Livelihood Diversification Strategies: The Case of Shebel Berenta District, Amhara Region, Ethiopia , Eyayu Kasseye Bayu
Abstract It is universally accepted as the fact that agriculture sector is incapable of creating sufficient gainful employment, food security and spurring economic growth in rural areas of developing countries. Even if our country Ethiopia practice agriculture for a long period, expected outcome is not attained on a sustainable basis to the livelihood of the households and food insecurity until now a day due to limited attention for the high potential of the non-farm sector in the government policies and strategies. Similarly, the challenges and opportunities of women headed households and male headed households in non-agricultural livelihood diversification strategies still uncovered in the rural economy of Ethiopia. Therefore the purpose of this study was to explore the challenges and opportunities of women headed households and male headed households in non-agricultural livelihood diversification in case of Shebel Berenta Woreda. Qualitative research method with the case study design was employed for data collection and data analysis. Qualitative data were collected from 10 interviewees, seven key informants, 28 focus group discussants and observation and the data analyzed via thematically. The result revealed that negative outlook to handicrafts, shortage of working capital, limited market demands, the absence of institutional support, lack of skill training, absence of technology, and laws and regulation were challenges women faced to participate in NFA. While, the presence of family support, natural resources, business plan preparation and mutual support in their own association where the opportunities for women to participate in NFA. In line with the problems identified, the local government should work on awareness creation and education, provision of support, built local infrastructure, provision of credit and training
79 Oncology during the dreadful COVID-19 pandemic: Indian perspective , Vivek Thakur, Basanti Mazumdar, Dhruba Banik, Abhay Kumar, Avir Sarkar
Abstract As the emaciated healthcare system is attempting to break the tide of the novel coronavirus pandemic across the globe, the highest cost of this fight is being borne by the non-COVID patients across the third world countries. With the suspension of non-emergency services including OPDs and elective surgeries in majority of the hospitals across the country, routine treatments seemed to suffer the most. This temporary pause and containment were more detrimental to patients suffering from malignancy. Fate of thousands of patients seems to hang by a fine thread now.
80 Audit of Maternal Deaths in the Context of the Free Obstetrical Care at the Maternity of the Ignace Deen National Hospital of Conakry Chu , Baldé Ibrahima Sory*, Baldé Ousmane, Diallo Fatoumata Bamba, Sylla Ibrahima, Diallo Mariama, Sow Alhassane II, Diallo Ibrahima Tangaly, Sy Telly
Abstract Objectives: To describe the evolution of half-yearly maternal mortality ratios, to describe the socio-demographic characteristics of the patients who died in the facility, to analyse the causes and determining factors of maternal deaths that have occurred in the facility, and to implement strategies to reduce this maternal mortality. Methodology: this was a descriptive, cross-sectional and analytical study carried out at the maternity ward of the Ignace Deen National Hospital of the Conakry University Hospital with data collection in two phases, including a retrospective lasting 6 months from July 1 to December 31, 2018, and the other prospective for a period of 18 months from January 1, 2019, to June 30, 2020. Result: During the study period, 224 deaths were recorded out of a total of 8,539 live births, for an intra-hospital maternal mortality ratio of 2,623.25 per 100,000 live births. The profile of women at risk of maternal death was as follows: patients aged 20-31 (56.26%), married (87.6%), low-income (41.96%), multiparous (33, 1%), evacuated from a peripheral maternity hospital (79.91%), multi guest (34.9%). The majority of deaths occurred within the first 24 hours (75%). The majority of deaths were due to direct obstetric causes: postpartum haemorrhage (52.68%), eclampsia (21.88%). Indirect obstetric causes were dominated by anaemia (16.07%). But in some cases, two or even three factors were associated with the occurrence of the same maternal death. The most frequently encountered obstetric period of death was postpartum (77.68%). The average recovery time was 31.96 minutes. The lack of blood products and the inadequacy of the technical platform were the main associated factors. Also, it appears that all our cases of death were preventable. The causes of the dysfunctions were attributable: to the person by their attitude (delay in specific care); in the hospital for the lack of equipment and blood products and in the consultation. Free obstetric care was not complete in some cases. Conclusion: maternal mortality is a major health problem in our structure. Its reduction requires the mobilization of all actors in society involving good health education; improving the quality of prenatal consultations and emergency obstetric care by consciously taking charge of staff and strengthening the technical platform.
81 Study of the Déterminants of Stillbirths in the Reference Health Centers of Sélingué and Yorosso (Sikasso Region) From January 1, 2015, to December 31, 2017 , Mamadou BERTHE*, Mamadou SIMA, Fatou DIAWARA, Diakaridia KONE, SAMAKE Alou, DOUMBIA Kounandy, DIALLO Cheickna, TERERA Ibrahim, TEGUETE Ibrahima, TRAORE Youssouf, SANGHO Hamadoun, SYLLA Mariam, DOUMBIA Seydou
Abstract Background: Stillbirths remain a major public health problem in sub-Saharan Africa and Mali. According to routine data collected from 2008 to 2016 in Sikasso, the health district of Sélingué had the highest stillbirth rate in the region (51.7 (‰) births) and that of Yorosso had the lowest (13.7 (‰) births). This led us to initiate this study to study the determinants of stillbirths in the Reference Health Centers of the two districts from January 1, 2015, to December 31, 2017. Methods: It was a case-control study of 440 cases including 110 cases and 330 controls in each of the Health Centers. The statistical analysis was done on SPSS version 20 and the writing was done on Word. The value of p<0.05 was found to be statistically significant. Result: The prevalence’s of stillbirths were 28, 6 ‰ in Sélingué and 140 ‰ in Yorosso. The Multivariate Analysis Yielded the Following Results: 1. Women who have not had an antenatal care have a 3 to 4 times higher risk of stillbirths than those who have had antenatal care (OR=3.87; CI: [1.86-8.04]; p=0.000); ambulance transport is a protective factor compared to other means of transport (OR: 0.27; CI: [0.09; 0.77];p=0.015); The following reasons for evacuation were risk factors for stillbirths: painful uterine contractions (OR: 4.23; CI: [1.55-11.55]; p=0.005) and stationary dilatation (OR: 6.04; CI: [1.11; 32.85], p=0.037). 2. In Yorosso, the multivariate analysis selected antenatal care as the only statistically significant risk factor for stillbirths. Women who did not have antenatal care were 4 times more likely to give birth to stillbirths than those who did (OR=4.27; CI: [1.08-16.88]; p=0.038). Conclusion: In light of these results, we believe that emphasis should be placed on the importance of prevention by strengthening antenatal care and improving evacuation conditions.
82 The Developmental Stage at Cryopreservation in Assisted Reproduction: A Systematic Review and Meta-Analysis of Pregnancy Outcomes , Jason Yen-Ping Ho*, Andrew Chao-Hung Lai
Abstract To date, there is no consensus in embryo developmental stages for cryopreservation. The present study aimed to investigate the impact of embryo developmental stages at cryopreservation on pregnancy outcomes of frozen embryo transfer. Systematic review and meta-analysis of relevant studies identified through MEDLINE literature search was performed. The primary outcome was live birth/delivery rate, and the secondary outcomes included implantation rate, ongoing pregnancy rate, clinical pregnancy rate, miscarriage rate, and multiple pregnancy rate. The protocol of this systematic review has been registered on PROSPERO 2017 (registration number: CRD42017072828). Five studies met the eligibility criteria were included in the present review. The outcomes of embryos frozen at different stages but transferred at the same stage were analyzed and compared. Embryos frozen at non-blastocyst showed a significant higher delivery/live birth rate than those cryopreserved at blastocyst (odds ratio=1.37; 95% confidence interval, 1.13-1.66) in the setting of frozen embryo transfer with blastocysts. There was only a limited number of studies with analyzable data for comparisons. The literature varied substantially in study design and methodology applied. Although a significant difference was observed toward an improved delivery/live birth rate for blastocyst transfer with embryos frozen at non-blastocyst stage, future studies are required to further corroborate this finding
83 Client Satisfaction with Contraceptive Counseling and Associated Factors in Public Health Institutions: A Cross-Sectional Study Design , Getahun Tesfaye, Leul Deribe, Jembere Tesfaye
Abstract Objective: The main objective of the study was to assess client satisfaction with contraceptive counseling and associated factors among women attending the family planning clinics in Asella town public health institutions, Ethiopia. Methods: Study subjects were selected using systematic random sampling and data were collected using interviewer administered and entered into software for analysis. Multivariate logistic regression model was used to predict the relation between variables and a significant of statistics was assured using 95% CI and p value < 0.05 was considered as significant predictor. Results: This study revealed that 62.8% of the study respondents were satisfied with contraceptive counseling. Multiple logistic regression models showed that, being urban in residence, time taken to reach nearby health facility, being asked reproductive history, explained side effects, privacy ensured, asked worries and concern about the method and use of the leaflet were predictors associated with client satisfaction with contraceptive counseling. Conclusions: About 62.8% of clients were satisfied with contraceptive counseling. Being urban in residence, time taken to reach nearby health facilities, explains side effects, being asked reproductive history, worries and concern about the method and use of the leaflet were factors associated with client satisfaction with contraceptive counseling.
84 Health Systems Strengthening in Post Conflict Reconstruction: Reflection on Uganda , Helen Kezie-Nwoha and Abigail Uchenna Emelonye
Abstract This article attempted to define health, health care and health systems and further discussed health reconstruction approaches and why it is important, particularly in post war situations and more specifically in the context of the post war health system development and strengthening in Uganda. In a bid to interrogate to what extent women’s health and gender perspectives have been integrated in post conflict reconstruction in Uganda, this article further adopted a gender lens to examine the health sector plans in Uganda.
85 The Association Between Serum Estradiol and Progesterone On the Same Day of FET and The Pregnancy Outcome; A Cross Sectional Study , Kamal Eldin Abdalla Rageh*, Ahmed Abdul- Azim Barakat, Nada Ahmed Barakat
Abstract Research Question Precise timed synchronization between endometrium and the embryo is essential for high implantation and pregnancy rate, it is worthy to mention that endometrial thickness is not the only factor, E2 and P levels are also regularly monitored for endometrial receptivity. So, we decided to go for this study, to investigate the impact of serum E2 and P levels on the same day of embryo transfer on pregnancy outcomes for FET cycles. Design This was a retrospective cross sectional study for 402 FET cycles which conducted between April 2018 and May 2019. All participants started endometrial preparation for FET with 6 mg/day oral estradiol for 13 days. When endometrium reached 8 mm or greater, patients were initiated on both micronized vaginal and oral P treatment. On FET day, serum level of E2 and P were assessed. Then, transfer of PGT euploid embryos was performed. 12 days’ later pregnancy test was assessed, and then 4 weeks after FET date ultrasound was scheduled to check the viability and the clinical pregnancy. Results The mean E2 value was 931.41 ± 438.65 pg/ml, while mean P value was 8.47 ± 9.4 ng/ml. 240 out of 402 cases got pregnant (59.7%) while the clinical pregnancy rate was 53.9% with no correlation between serum (E2, P & E/P ratio) and the outcome. Conclusion Our results revealed that the association between E2 and P on FET day and the pregnancy outcome is still not proven and those markers can’t serve as predictors for the outcome.
86 Nerve Sparing Reduction Clitoroplasty in a Case of Congenital Adrenal Hyperplasia , Bibi Zainab*, Mohammad Moinuddin
Abstract Adrenogenital syndrome, or Congenital Adrenal Hyperplasia, is caused by a congenital insufficiency of the enzyme 21-hydroxylase, which is responsible for converting cortisol into cholesterol. Because of virilizing effect of androgens and its over- production, girls develop clitoral hypertrophy or Clitoromegaly. Clitoromegaly is an embarrassing condition, causing psychological stress to young girls and, hence requiring intervention. The goals of clitoroplasty are to achieve normal genital anatomy and to preserve tactile sensation with a satisfactory sexual response. We present a case of Adrenogenital syndrome with Clitoromegaly managed by reduction Clitoroplasty, preserving the dorsal neurovascular bundle and extensive network of nerves around the corpora to the glans and there by preserving the tactile sensation of the clitoris.
87 Egocentric Networks and HIV in Pregnant and Breastfeeding Women Attending Antenatal Care in Lusaka, Zambia , Kellie Freeborn*, Maria C Ramos , Dana K. Pasquale, Rose Lungu, Benjamin H Chi, Oliver Mweemba
Abstract Human immunodeficiency virus (HIV) has a disproportionate effect on pregnant and breastfeeding women in sub-Saharan Africa. This study used egocentric social network analysis (SNA) to compare the social and sexual networks of HIV-negative and HIV-positive women attending an antenatal care (ANC) clinic in Lusaka, Zambia. In order to assess risk and protective factors for HIV acquisition and transmission, variables included self (ego) sociodemographic characteristics, main partner characteristics, features of the relationship between ego and her main partner, alter attributes, alter-ego ties, and alter-alter ties. Associations between the independent variables and ego HIV status were identified using bivariate tests. Logistic regression analyses were performed to assess the relationship between predictors and ego HIV status when multiple variables were included in the same model. Overall, 219 participating women (69 HIV-positive, 150 HIV-negative) nominated 1095 alters. Compared to HIV-negative egos, HIV-positive egos were older, had main partners who were more likely to consume alcohol before sex, disclosed their HIV status to fewer alters, had fewer alters with whom they had daily interactions, and had more alters who were HIV-positive or HIV-unknown. Number of alters who were HIV-positive or HIV-unknown and non-disclosure of HIV status were the greatest risks (with the effect of HIV-positive or HIV-unknown being of a slightly greater magnitude than non-disclosure of HIV status), which places breastfeeding women, their partners and their infants at risk of preventable HIV infection.
88 Is there an association of bone mineral density and risk of breast cancer in postmenopausal Saudi women? , Saleh Othman
Abstract Several studies revealed an association between high bone mineral density (BMD) and the increased risk for developing breast cancer (BC). Aim: Explore if there is an association between BMD and BC risk in postmenopausal Saudi (PMS) women. Material and Method: In a retrospective cohort study of 1145 PMS women age range from 46 – 85 year (mean = 55 year). The average time period of menopause 4 years.We reviewed BMD of all patients performed between October 2012 and November 2018. All patients had BMD measurements of lumbar spine L2-L4 and right femoral neck in gm/cm². Results: The T-score was used for analysis of the results. Among the total patient studied 195 (17%) were found to have BC group 1 (G1) while 950 (93%) without BC group 2(G2). Analysis of lumbar spine T-score in G1 showed that: 29 % had osteoporosis, 37% osteopenia and 34% had normal BMD and in G2 40% had osteoporosis, 31% osteopenia and 29 had normal values. Results showed prevalence of osteoporosis in G1 was significantly lower than in G2 (p =0.002) while there was no significant difference between the two groups with osteopenia and normal BMD results (p = 0.06 and 0.205 respectively). Conclusion: PMS women with BC had higher BMD at time of diagnosis compared to their counterpart without BC.
89 Comparison between Laparoscopic, Abdominal, and Vaginal Hysterectomy in the Treatment of Gynecological Disease: A Retrospective Review Over Five Years , Jihad Al Hasan, Mauhammad Mousa, Zaynab Haroun, Kariman Ghazal
Abstract Background: Hysterectomy is one of the most common gynecological surgery worldwide. It is usually performed through the abdominal, vaginal or laparoscopic routes. The objective of this study was to evaluate the role of laparoscopic, vaginal and abdominal hysterectomy in the management of gynecological conditions in terms of operative outcomes, such as operating time and estimated blood loss, as well as complication rates. Methods: This was a retrospective cohort study carried out over a 5-year period (2016-2020) at Zahraa University Hospital. Patients who underwent abdominal vaginal, and laparoscopic hysterectomies performed for the treatment of multiple gynecological disease during that period were included. Results: A total of 222 patients were included in the study, 168 (75.7%) patients in the abdominal hysterectomy group, 7 (3.2%) in the vaginal group, and 47 (21.1%) in the laparoscopic group. The mean age was 49.83±9.28 years for the abdominal, 67.14±13.79 for the vaginal, and 47.26±6.77 years for the hysterectomy groups. The most common indication for hysterectomy was the presence of uterine fibroids in the abdominal and laparoscopic groups (47.6% vs. 31.9% respectively) whereas it was pelvic organ prolapse for all patients in the vaginal group. Around 18% in the abdominal group had abnormal uterine bleeding compared to 6.4% in the laparoscopic group. Endometrial hyperplasia was the indication for 9.5% of the patients in the abdominal group while it was 25.5% for the laparoscopic group. Surgery duration was significantly the shortest for abdominal hysterectomy (2.30±0.92 hours), followed by vaginal hysterectomy (2.86±0.24 hours), and the longest was for laparoscopic hysterectomy (4.14±0.90 hours) (p-value<0.0001). The size of the uterus was slightly larger in the abdominal hysterectomy group though the difference was not significantly different. There were no significant differences in pre- and post-operative hemoglobin, or in estimated blood loss among the groups. There were no complications in the vaginal group. The rate of complications was similar between the abdominal and laparoscopic groups (15.5% vs. 17.0% respectively). The most common type of intraoperative complication in the abdominal group was bleeding requiring transfusion (34.6%), followed by bladder injury (11.5%). Only one patient in the laparoscopic group had intra-operative complication (bladder injury). As for post-operative complications, urinary retention and pyrexia related to wound infection were the most common in the abdominal group (7.7%). Seven patients in the laparoscopic group had post-operative complications. Most patients were readmitted to the hospital (98.8% vs. 100.0% vs. 95.7% in the abdominal vs. vaginal vs. laparoscopic groups respectively). Conclusion: Laparoscopic hysterectomy is associated with less morbidity, and shorter hospital stay than the other techniques, but it has longer operating time and requires laparoscopic instrument and surgical skills. Advances in equipment, surgical techniques, and training make laparoscopic hysterectomy an efficient and well-tolerated technique.
90 Hematological Characteristics During the Third Trimester of Pregnancy in a Population of Low and High Socio-Economic Levels in Lubumbashi , Chola Mwansa Joseph*, Mwembo Tambwe Albert, Ngwe Thaba Jules, Kapya Mukeya Gabriel, Munkana Ndudula Arthur, Cham Lubamba Chamy, Kinenkinda Kalume Xavier, Kakudji Luhete Prosper, Kakoma Sakatolo Zambèze Jean-Baptiste, Kalenga Muenze Kayamba Prosper
Abstract Background: During pregnancy, many hematologic changes occur to meet the demands of the developing fetus. The objective of this study was to describe the hematological characteristics in the third trimester in a population of low and high socioeconomic levels in Lubumbashi, in relation to the WHO and China reference values. Methodology: A descriptive cross-sectional observational study was carried out in Lubumbashi, among pregnant women received during the third trimester antenatal consultations in apparent good health. A total of 128 pregnant women with a monofetal pregnancy of at least 27 weeks of amenorrhea in apparent good health were selected and divided into two groups of low and high socioeconomic levels. Blood was drawn and analyzed on the CYANHEMATO machine. Results: Hemoglobin (HB) averages were 9.63 ± 1.52 and 11.19 ± 1.07 g / dl respectively in the low and high socioeconomic levels population. The majority of patients in the two populations were in the reference range for red blood cell (RBC) count from 2.75 to 4.64 1012 / l. The average values of hematocrit (HCT), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) in Lubumbashi were lower than in the China population : 28.39 ± 4.21 versus 32.47 ± 3.46% ; 67.34 ± 9.50 versus 74.38 ± 8.15 fl and 22.96 ± 3.56 versus 25.71 ± 3.23 pg for reference values of 36% ; 90.8 fl and 30.5 pg, respectively. As for the red blood cell distribution width (RDW), it was higher in the low socio-economic level population (16.86 ± 3.40%) than in the high socio-economic level population (14.90 ± 2.25%) with a difference highly significant (p <0.0001). Conclusion: The RBC and RDW were significantly increased in Lubumbashi, while HB. HCT, MCV and MCH were decreased. The mean corpuscular hemoglobin concentration (MCHC) did not present any particularity.
91 Accuracy of Preoperative Pelvic Ultrasound in Predicting Uterine Weight Across Varying Pathologies , Rohan V Hattiangadi*, Daniel W Szydlo, Marisa M Dahlman
Abstract Objectives: The purpose of this study is to evaluate the accuracy of preoperative pelvic sonography in predicting the weight of a non-gravid uterus at the time of hysterectomy. Additionally, the study seeks to examine the effect of varying uterine pathologies on the accuracy of these predictions. Methods: This was a retrospective comparative study in a tertiary care hospital with a total of 318 patients who underwent pelvic ultrasound, with reported uterine volumes, prior to undergoing hysterectomy in 2018. Estimated uterine weights from preoperative pelvic ultrasounds were compared to actual uterine weights from post-hysterectomy pathology reports. A Bland-Altman plot was constructed to determine intermethod agreement with 95% limits of agreement. Simple linear regression analysis was used to correlate estimated and actual uterine weights. Multivariable linear regression was performed, allowing for subgrouping by uterine pathology. Results: While a strong positive correlation was identified between the two measurements (r = .93, p <.01), the Bland-Altman analysis showed that actual uterine weight ranged from 0.51 to 1.99 times the magnitude predicted by preoperative ultrasound. These wide deviations in intermethod agreement were similar amongst the various uterine pathologies. Multivariable linear regression analysis demonstrated the difference in estimated and actual uterine weight was 2 to 3.5 times larger for patients with endometrial pathology, adenomyosis, and leiomyomata as compared to normal uteri (p < .03). Conclusion: This study shows that in 95% of cases, actual uterine weight ranged from half to twice as large as estimated by preoperative pelvic ultrasound. Uterine pathology had a significant impact on the reliability of ultrasound for estimation of uterine weight. In gynecologic practices where preoperative estimations of uterine weight are instrumental in choosing a surgical approach for hysterectomy, reliance on pelvic ultrasound as a means of predicting uterine weight should be carefully considered.
92 Practical Activities for Cognitive Stimulation of Turner Girls, Teenagers and Women: A Guide for Themselves and their Families , Fátima do Carmo Fonseca Ricardi*, Lia Leme Zaia, Ivete Pellegrino Rosa
Objective To provide at no cost to parents or guardians of girls or teenagers and to women, all with Turner syndrome: A. Simple and effective activities (for frequent performance) and without any contraindication, directed towards specific cognitive stimulation. B. Other useful recommendations.
93 The Diagnostic Dilemma of Ascites in Women , Bibi Zainab*, Abdul Rahman, Fatima Moinuddin, Mohammad Moinuddin
Abstract Introduction: Ascites is the pathological accumulation of fluid within the peritoneal cavity. The most common causes of ascites are liver disease, vascular occlusion, congestive heart failure, pericarditis or nephrotic syndrome. We present to you case series of ascites as a common presentation in women, but each case with a different etio-pathogenesis related to gynecological benign disease. This case series highlights the importance, to consider gynecological problems among the potential differential diagnoses in women with ascites for early diagnosis and timely intervention. Methods: We identified 5 female patients older than 18 years who presented with ascites as a common clinical presentation and we reviewed their medical records to assess demographic data, clinical presentation, imaging findings, co-morbid conditions, histo-pathologic features, pharmacologic therapies and surgical intervention. Results: In all the five female patients, ascites was clinically diagnosed and confirmed with ultrasound of pelvis and abdomen. One of them noted to have pelvic tuberculosis, which was confirmed with endometrial biopsy and treated with antitubercular medication. One patient was diagnosed with adenomyosis and one other patient was diagnosed with leiomyoma, both patients were treated with total abdominal hysterectomy. One of the patients was diagnosed with endometriosis on laparotomy who was treated with gonadotrophin releasing hormone analogues. One of them was diagnosed with right sided ovarian fibroma, treated with right oophorectomy. All these patients had ascites as a common clinical presentation but with different underlying gynecological etiopathogeneses. The appropriate diagnosis and timely intervention in the above 5 cases resulted in complete resolution of symptoms. Conclusion: As a healthcare worker, initial evaluation of a female patient with ascites, should rely on a detailed history and physical examination. In women with ascites, gynecologic problems should be considered among the potential differential diagnosis for appropriate management and timely intervention.
94 Thematic Dynamics of Internet of Things (IoT): Impact on Digital Personalized Healthcare (PHC) , Bongs Lainjo
Abstract Information technology has continued to shape contemporary thematic trends. Advances in communication have impacted almost all themes ranging from education, engineering, healthcare, and many other aspects of our daily lives. This paper attempts to review the different dynamics of the thematic IoT platforms. A select number of themes are extensively analyzed with emphasis on data mining (DM), personalized healthcare (PHC), and thematic trends of a select number of subjectively identified IoT-related publications over three years. In this paper, the number of IoT-related-publications is used as a proxy representing the number of apps. DM remains the trailblazer, serving as a theme with crosscutting qualities that drive artificial intelligence (AI), machine learning (ML), and data transformation. A case study in PHC illustrates the importance, complexity, productivity optimization, and nuances contributing to a successful IoT platform. Among the initial 99 IoT themes, 18 are extensively analyzed using the number of IoT publications to demonstrate a combination of different thematic dynamics, including subtleties that influence escalating IoT publication themes. Based on findings amongst the 99 themes, the annual median IoT-related publications for all the themes over the four years were increasingly 5510, 8930, 11700, and 14800 for 2016, 2017, 2018, and 2019 respectively; indicating an upbeat prognosis of IoT dynamics. And finally, the vulnerabilities that come with the successful implementation of IoT systems are highlighted as part of the research. Security continues to be an issue of significant importance.
95 Heterotopic Pregnancy in Natural Conception – A Case Report , Rizwan Khalid*, Sidra Rizwan
Abstract Heterotopic gestation is very rare in natural conception but can be common with assisted reproductive techniques; a high index of suspicion can help in timely diagnosis and appropriate intervention. We report a case of heterotopic pregnancy in a 32-year-old woman presented with hemoperitoneum from ruptured right sided tubal pregnancy with live intrauterine gestation at 12 weeks of amenorrhea, diagnosed on clinical and ultrasound examination.
96 Markedly Raised Ca-125 In A Case of Bilateral Ovarian Endometriosis Mimicking Ovarian Cancer: A Case Report , Pradip Kumar Saha, Aruna Singh, Rashmi Bagga, Aashima Arora, Geetika Thakur
Abstract We report a case of bilateral endometriosis with very high Serum CA 125 levels who presented with pain abdomen. Intra operative finding suggestive of stage IV endometriosis which finally proved in histopathological report. We conclude that very high CA 125 may not be always indicative of ovarian cancer
97 Teenage Pregnancy During a Pandemic , Michael Mncedisi Willie
Background Covid-19 and lockdown have put a strain on all aspects of life, including the economic and social climate and challenges of accessing essential services. Many non-essential health services had to be limited. In some instances, the fear of contracting the disease at the facility level results in many patients being denied or having delayed access to primary health services. COVID-19 was prioritized over other conditions, and all these factors saw a decline in patients’ health-seeking behavior for essential and primary healthcare. A reduction of movement was required, which led to reductions in the acquiring of antenatal or postnatal care. Reduced access to maternal healthcare was observed during lockdowns, including limited access to antenatal care resources, limited social support and other uncertainties. The ongoing lockdowns left many women without access to time-sensitive maternal and reproductive health care, from routine gynaecological check-ups to prenatal care to abortion. The unfortunate by-product of this shift is the de-prioritization of other essential health care services, such as access to contraception.
98 On the Contentment of Modern Women and the Survival of the West , Paul T E Cusack
As any red-blooded male would try to understand, is the issue of what women want? What do they really want? In this paper, I consider what I think they want. It is from years of thinking about the problem.
99 Analysis of the Prevalence of Urinary Incontinence in Women Living in a Rural Commune , Katarzyna Juszczak*, Tatiana S?omiana-Amjedullah, Magdalena Pisarska-Krawczyk
Abstract Introduction: Urinary incontinence (UI) is one of the most common chronic diseases in women. It is estimated that around 17%-60% of women of different ages are affected in Poland [1,2]. Urinary incontinence involves an involuntary leakage of urine from the urethra in conditions associated with an increase in intra-abdominal pressure, e.g., during coughing, exertion or sneezing, and affects women twice as often as men [3]. Research Aim: Analysis of the prevalence of urinary incontinence in women living in a rural commune. Materials and Methods: The group of research participants comprised 130 women, randomly selected and living in a rural commune in Wielkopolska Province. The respondents completed an anonymous survey containing 31 questions about urinary incontinence. The study was conducted at the patients’ houses, during appointments, and in a PHC nurse’s office. Results: The group of patients subjected to the study comprised 130 women of different ages. The most numerous group, 46.2% (n=60), consisted of women aged 30 to 60, 29.2% (n=38) were women over 60 years of age and 24.6% (n=32) were those under 30 years of age. From among the female population surveyed, urinary incontinence occurred in 50.7% (n=66), whereas 49.3% (n= 64) did not experience any UI. While analyzing the results regarding uncontrolled urinary incontinence, the researchers found that it had lasted for over 4 years in 22.3% (n = 29), from 3 to 4 years in 13.8% (n = 18), from 1 to 2 years in 10% (n = 13) and under a year in 4.6% (n = 6). The study showed a relationship between the occurrence of UI and selected variables such as age, BMI, and number of deliveries. Conclusions: • Urinary incontinence is common among the female population being studied, which confirms the thesis of a “silent epidemic”. • The factors predisposing to the occurrence of urinary incontinence among the women surveyed include age, BMI and the number of deliveries.
100 Fresh Frozen Plasma in Recurrent Pregnancy Loss Due to Factor XIII Val34Leu: Case Series , Alaa Ismail*, Anas Ismail, Mohammed Joudeh
Abstract Background: Recurrent Pregnancy Loss (RPL) is defined as three or more consecutive pregnancy losses before 24 weeks of gestation, whereas on clinical grounds many clinicians consider RPL as two or more non-consecutive pregnancy losses. Many causes of PRL have been identified including uterine anomalies, chromosomal aberrations, antiphospholipid antibodies, infections and others. However, the major cause of RPL remains unidentified. A unique coagulation abnormality that has been recently linked to RPL is Factor XIII Val34Leu mutation. Our case study concentrates on the possible benefit of FFP in treating women with RPL who are homozygous for this mutation. Case Presentation: This was a prospective case-series study conducted in Gaza of three pregnant patients who presented to our fertility clinic with history of RPL. The cases were investigated for causes of RPL and no known cause was identified. They were screened for Factor XIII Val34Leu mutation for which they were positive. There is little, if any, evidence regarding the best management option in such cases as Factor XIII Val34Leu is not recognized as one of causes of RPL. We decided to treat those patients with Fresh Frozen Plasma (FFP) based on the evidence that Factor XIII dysfunction may lead to improper implantation with poor pregnancy support and thus, pregnancy loss. The three patients had uneventful pregnancy course, and all delivered healthy babies. Conclusion: Homozygous mutation of Factor XIII Val34Leu might have a role in unexplained RPL. FFP is a promising adjuvant therapy in such cases to avoid further pregnancy loss.
101 Idiopathic Intracranial Hypertension: Description of an Atypical Case , Siri Laura*, Gaiero Alberto, Maritano Lorenza, Vaira Massimo, Anselmo Marco, Polvicino Mario, Calia Stefano, Gaggero Roberto, Cohen Amnon
Abstract Background: When dealing with severe and worsening headache with oculomotor dysfunction, it is necessary to take into account the possibility of idiopathic intracranial hypertension (IHH), though it is a rare condition. We present an atypical case of IHH in a 4-year-old patient with no apparent risk factors. Methods: IHH was diagnosed by exclusion, by ocular fundus examination, liquor cerebrospinalis examination, anatomical cerebral magnetic resonance imaging (MRI) and MR angiography (MRA). At the onset of symptoms, the patient was treated with a diuretic and steroid therapy. Results: After one year of medical therapy, we observed headache recurrence with positive ophalmological assessment and positive cerebral MRI. Medical treatment was deemed ineffective and it was necessary for the patient to undergo surgical intervention. Conclusion: We report a case of severe and chronic headache with oculomotor dysfunction in a young, pre-adolescent patient. This case is atypical because of the young age of the patient, and it being refractory to medical therapy. This case confirms that when dealing with severe headache in young patients, it is necessary to take into account any rare cause of symptomatic headache.
102 Basic Ionization Dosimetry for Radiological Protection Management , F Scarlat*, E Stancu, A Scarisoreanu
Abstract Management of exposure to ionizing radiation based on the three principles of radiological protection (justification, optimization, and dose limits) requires precision and accuracy of the entire dosimetry chain starting with the absorbed dose and ending with the effective dose. Approved absorbed dose limits below about 100 mSvper five years are important to prevent the induction of stochastic effects.In this sense, the paper reviews the basics of exposure to external and internal radiation using ionization dosimetry. After presenting the characteristics of ionizing radiation, radiometric quantities (Φ, , Ψ,Ψ?) and dose constants (ΓX, ΓK, ΓD), the paper presents, first, the basic dosimetry quantities (X, K, D), the factors calibration coefficients (NX, NK, ND,), photon interaction coefficients (µ/ρ, µtr /ρ, µab /ρ), electron interaction coefficients (Scol , Srad , L?).Continue with the quantities of radiological protection valid for external and internal radiation exposure (DTR, HT , E), based on the quality factor and the radiation and tissues weighting factors(Q, wR, wT), which in turn are based on RBE and the risk coefficients(Ra,Rr,s),to prevention of stochastic effects. Next, the quantities of protection for external exposure, operational quantities of area (H * (10), H ‘(d, Ω)) and individual monitoring (HP (10), HP (d)), quantities of radiological protection for internal exposure, in the MIRD methodology, (D?= A?S S(rS ←rT)) and in the ICRP methodology, (HT (50), E (50)) based on the nuclear decay law. Derived quantities for internal exposure control (ALI, DAC), Radon exposure to air (WL, WLM) and dose limits are shown. The paper concludes with the formula for the annual effective dose,E(mSv) =HP (10) + E (50) +Esub(DAC) +E(mSv←WLM), for workers and members of the public
103 The Evolving Role of Microrna Subtypes 21, 155 and 10b as Oncogenes and Biomarkers in Breast Cancer in a Decade: A Systematic Review Article , Mubarak Elnour*, Nagham Eltayeb, Arwa Esam, Shiraz Faisal, Nuha M. Elhassan
Abstract Breast cancer is a malignant disease with a high incidence worldwide in women- and to less extent in men-, thus remains a health burden. miRNA plays a key role in the development and prognosis of breast cancer; as a single miRNA has the ability to regulate multiple gene targets and adversely alter their expression. In this review, we attempt to systematically analyze the rapidly accumulating body of research regarding the role of miRNAs subtypes particularly as oncogenes and biomarkers in breast cancer, and their clinical implications. A total of 11 pertinent articles in the past 10 years were extracted from high-rank reviews, analyzed, and summarized. Amongst many (eight miRNA subtypes), three subtypes (miR21, 155, and 10b) were selected in order to evaluate the validity of their oncogenicity as well as their diagnostic value as biomarkers.
104 P53 Gene Mutation Associated With Worse Clinicopathological Characteristic in Breast Cancer , Fitreena Anis Amran*, Imran Abdul Khalid, Badrul Hisyam Yahaya
Abstract Background: P53 is a tumour suppresor gene. In breast cancer, p53 gene mutation were noted with frequency of about 30% (range 15 to 71%) and associated with poor prognosis. This study was performed to determine p53 mutation association with clinicopathological characteristic in breast cancer and to assess the suitability of patients’ serum to detect p53 autoantibody. Methods: This study conducted in Hospital Seberang Jaya and Institut Perubatan dan Pergigian Termaju, Universiti Sains Malaysia. Sixty-four breast cancer patients with available fresh breast cancer tissue that been kept under -80°C and with complete clinicopathological, data involve in this study. These fresh breast tissues DNA extracted and 10sampels sent for DNA sequencing. The remaining 54samples proceeded with Polymerase Chains Reaction analysis based on the result from DNA sequencing. The serum of these patients was also taken for p53 autoantibody study using ELISA method. Results: The mean age of the patients in this study was 52.45±9.51 yrs. Most of the patients were Malay with 67.2% followed by Indian and Chinese with 17.2% and 15.6% respectively. 51.6%, of these patients undergone CT scan staging and 14.1% has distant metastases. p53 gene mutation prevalence showed rs1042522 only has 15.7% mutation. There was 54.7% Deletion A and 45.3% Wild Type A detected in rs59758982, 87.5% Deletion A and 12.5% Wild Type A in rs35069695 and 92.2 % recorded for Deletion GAA in rs376546152. There was no significant result between these mutation with breast cancer molecular classification and breast cancer aggressiveness except for rs59758982 shows significant result with p value 0.04 (p <0.05). In regards on for p53 serum autoantibodies, 20.3% of the patients noted to be positive but it has no significant association with p53 gene mutations. Conclusion: In this study, tissue p53 genetic mutation has no significant association with clinicopathological characteristic of breast cancer and the use of serum p53 autoantibody as biomarkers is inconclusive.
105 A Giant Pediculated Vulvar Lesion: A Case Report , Pegah Arfae, Zahra Honarvar*
Abstract Angiofibroma is a benign mesenchymal tumor. Its clinical presentation is nonspecific and similar to other vulvar tumors. Angiofibroma has good prognosis, despite some risk of recurrence. We present a 44-year-old woman with a bulky left vulvar lesion.
106 Marital Status Independently Predicts Survival in Patients with Small Cell Lung Cancer: A SEER Database Analysis  , Pei Luo#*, Keyu Zhao#, Liping Yang, Xin Yao, Chao Pan, Aijing Bao, Can Huang, Jun Guo*
Abstract Purpose: This study will investigate the relationship between marital status and prognosis in small cell lung cancer patients. Methods: Patients of SCLC was selected from the SEER database (1973-2013) and the patient sinformation. Kaplan-Meier analysis, log-rank test and Cox regression model were used for studying patient prognosis. Result: 27069 SCLC patients eligible for inclusion were screened from the SEER database. Kaplan-meier test showed that the median OS values were 8, 7, 6 months in married, single and SDW patients, respectively. Conclusion: This study shows that marital status is an independent prognostic factor for overall survival in SCLC patients. Married patients with small cell lung cancer have better prognosis than those who were divorced/separated, widowed and single. 
107 Early Detection and Pelvic Floor Rehabilitation for Sexual Dysfunction with or Without Incontinence in the Breast Cancer  , Najwa Alfarra*, Khulood Alrashid, Tola Akomolafe
Abstract Introduction: Sexual health is an important aspect of human life, and cancer should not change that. Data suggested that issues related to sexual function are quite common among women treated for cancer ranged from 30% to 100% [1]. However, clinicians often spend little to no time on the topic. However, the treatment options are available. The literature also supports the use of pelvic floor exercises and dilators to improve sexual function and urinary incontinence in women and specially those presenting with orgasm problems [2]. Objective: To explore the effectiveness of the pelvic floor rehabilitation on sexual dysfunction or sexual dysfunction combined with incontinence in the Saudi breast cancer survivors during, or post chemotherapy intervention. Methods: Thirty breast cancer women who had either sexual dysfunction, or sexual dysfunction combined with incontinence, during or post chemotherapy were evaluated using the Oxford scale for muscle power assessment before and after the intervention. Additionally, FSFI & UDI-6 questionnaire responses were received and analyzed before and after the pelvic floor rehabilitation. The supervised pelvic floor rehabilitation (which included the pelvic floor muscle training (seven Yoga poses: Mountain pose, Tree pose, standing forward bend pose, worrier pose, bridge pose, bound angle pose, and seated twist pose), manual therapy, and dilator) were conducted for 45 minutes once a week for eight weeks (a total of 8 sessions). Main Outcome Measures: The domain scores of the Female Sexual Function Index-Breast cancer (FSDI-BC) which included desire, arousal, lubrication, orgasm, satisfaction, and pain, were calculated. Furthermore, the domain of the Urinary Distress Inventory (UDI-6) which included frequent urination, urgency leakage, activity leakage, leakage with coughing or sneezing, difficulty emptying the bladder, and pain or discomfort in the lower abdominal or genital area were also analyzed. Muscle power (Oxford scale) was measured before and after the treatment. Results: All subjects successfully completed the study with no adverse events. Significant improvement in sexual function as assessed by the FSFI-BC indicated that sex desire improved by 86%, sexual arousal improved by 83%, lubrication improved by 76.3%, orgasm improved by 70%, general satisfaction improved by 44-54%, 73.3% felt pain minor, and 23% free of pain during intercourse. Muscle power as measured by the Oxford scale improved from grade 1 or 2 out of 5 to3 or 3+ out of 5. Significant improvement in UDI-6 were also observed in all participants by 80%. Conclusion: In this study, we observed the influence of chemotherapy side effects for breast cancer on women’s quality of life, sexual function and continence. The study confirmed that Pelvic floor muscle training, manual therapy and dilator use showed significant improvement in the symptoms of continence and sexual function in breast cancer patients.
108 A Clinical Research of Ceritinib Treating Patients with ALK-Positive Advanced Non-small Cell Lung Cancer with Brain Metastasis , Saiqiong Cui, Xin Liu, Dan Li, Dafu Yang, Zhaoxia Dai*
Abstract Objective: As a second-generation oral anaplastic lymphoma kinase (ALK) inhibitor, ceritinib was recommended as posterior line therapy in patients with crizotinib resistance or intolerance. While in the real world, the clinical efficacy and safety of ceritinib, 450mg/d, taken with a low-fat meal in crizotinib resistant patients, especially with brain metastases, are still to be further investigated. Methods: This retrospective analysis was conducted on patients with ALK- positive advanced non-small cell lung cancer (NSCLC) between May 2017 and December 2020 in our hospital, who were crizotinib resistant or intolerant. The aim was to analyze the clinical efficacy and safety of ceritinib as posterior line therapy in patients, especially in those with brain metastases, and to further explore the efficacy against rare fusion of ALK and the option after ALK inhibitor resistance. RECIST (1.1) criteria were adopted, and for relevant statistical analysis, RStudio was used. Results: Of the 13 cases treated with ceritinib, 8 were treated as second-line therapy, 5 as third-line or fourth-line treatment. Of the total, 12 had brain metastases, 3 had received brain radiotherapy previously, and 1 had received surgical treatment for brain metastases previously. There were 8 cases evaluated as partial remission (PR), 2 evaluated as stable disease (SD), and 3 unevaluable for the response. There were 1 case of PKNOX2-ALK fusion and 1 case of IGR-ALK fusion observed as rare ALK fusion, and intracranial lesions were evaluated as PR for both. There were 6 cases received subsequent targeted therapy after progression of ceritinib, including 5 with alectinib and 1 with ensartinib, all of which showed response. In 13 cases, by the terminal time of follow-up, median progression-free survival (PFS) was 7.4 m, disease control rate (DCR) was 76.92%, overall response rate (ORR) was 61.54%, and median overall survival (OS) was 25.4m. In 12 cases with brain metastasis, 9 were suitable for intracranial response evaluation, of which, 1 case achieved CR for intracranial lesions, 7 achieved PR and 1 SD was observed, ORR was 88.89%, and DCR was 100%. The adverse events rate of any grade was 91.67%, the common adverse events were diarrhea (46.15%), AST level increased (41.67%), ALT level increased (33.33%), increased GGT (33.33%), increased ALP (25.00%), nausea (16.67%), increased creatinine (16.67%). Other reported AEs were cough, vomiting, dizziness, arthralgia and fatigue, 1 case (8.33%) each. Conclusion: Ceritinib 450mg taken with taken with low-fat meal showed good efficacy and safety in crizotinib resistant patients with central nervous system metastasis, and it is effective in some cases with rare fusion of ALK.
109 The Effect of Social Media Use on Women’s Symptom Relieving Practices for Genital Infection , Merve Gül Şahin1*, Betül Özen2
Abstract Background: The aim of this descriptive and correlation study is to determine how the use of social media affect women’s symptom relieving practices for genital infections. Methods: The sample of the study consisted of 315 women who applied to Erciyes University Health Application and Research Centre Gynaecology Outpatient Clinic and were diagnosed with genital infection between September and December 2019. The data were collected with the “Introductory Information Form”, “Genital Hygiene Behaviour Inventory”, “Information Form on Genital Infection/Symptom Relieving Practices and Use of Social Media”. The data were analysed in the IBM SPSS (Statistical Package for Social Sciences) v.22 software. Results: Women with genital infection obtained 79.51 ± 9.59 points from the “Genital Hygiene Behaviour Inventory” and women who had a high level of education and spent money easily for their daily needs had higher mean scores from “Genital Hygiene Behaviour Inventory”. Conclusion: Women who were previously diagnosed with genital infection and did not get information about genital infection obtained lower mean scores from “Genital Hygiene Behaviour Inventory”. Women who did not use social media obtained lower mean scores from “Genital Hygiene Behaviour Inventory”.
110 The Relationship of Fetal Adrenal Gland Size with Fetal Liver Length and Fetal Abdominal Wall Fat Thickness in Mothers with and Without Gestational Diabetes , Ensi Khalili Pouya, Elham Keshavarz, Moein Moradpour*, Elham Tavakkol, Farshid Abolghasemzade, Shahnaz Mohammadi, Zahra Ghomi, Hamideh Zeidabadi, Mehdi Khazaei 
Abstract Background: Given the possible association between maternal diabetes status and metabolic disorders in the fetus, such as hepatic dysfunction or subcutaneous fat mass, it is expected that there is a close relationship between fetal adrenal gland volume and these two indicators. Aim: We decided to examine the relationship of fetal adrenal gland size with fetal liver length and fetal abdominal wall fat thickness in mothers with gestational diabetes and to compare it with non-diabetic mothers. Methods: This cross-sectional study was performed on 40 pregnant women in the third trimester of pregnancy suffering gestational diabetes under insulin therapy as the cases and 40 age and gestational age-matched pregnant women without diabetes as the controls. An ultrasound was performed for all participants in the third trimester of pregnancy to assess adrenal gland size, liver dimensions and fetal abdominal wall fat thickness. Results: The fetuses in diabetic group was found to have adrenal glands with significantly higher mean width, but with lower height leading similarity in mean adrenal volume as compared to non-diabetic group. The mean fetal abdominal wall fat thickness was significantly higher in diabetic than in non-diabetic groups. In diabetic groups, we found a direct association between height of adrenal gland and fetal abdominal wall fat thickness (p = 0.001). The length of adrenal gland was also positively associated with abdominal wall fat thickness (p = 0.001). However, in non-diabetic group, we found no association between adrenal height and fetal abdominal wall fat thickness. Measuring liver length in the two groups showed significantly higher mean value in diabetic than in non-diabetic groups. No association was revealed between adrenal volume and liver length in diabetic group. In non-diabetic group, there was a significant direct association between adrenal volume and liver length (p = 0.008). Conclusion: Gestational diabetes is directly associated with increasing fetal abdominal wall fat thickness and liver length in fetus. The dimensions of adrenal gland in fetus are also associated with fetus abdominal wall fat thickness and liver length probably independent to maternal diabetic status.