A randomized controlled trial of rectal versus intramuscular diclofenac for post-operative analgesia after open myomectomy.

AIM: To determine the efficacy and safety of rectal versus intramuscularly administered Diclofenac in reducing post-operative pain in the first 24 h after open-myomectomy. METHODS: A single blind, placebo controlled randomized trial consisting of 90 consenting women that had open-abdominal-myomectomy. They were randomized into two-groups (rectal-group and intramuscular-group) of 45 women (1:1 ratio). Rectal-group received 75 mg of Diclofenac suppository 12 hourly for 24 h and placebo (3 ml of intramuscular injection-water) 12hourly for 24 h while intramuscular-group received intramuscular Diclofenac 75 mg 12 hourly for 24 h and placebo (Anusol suppository) 12 hourly for 24 h. Both groups received intramuscular Pentazocine 30 mg 6 hourly for 24 h as primary analgesic after myomectomy. Pain was assessed using a Ten-Point Visual-Analogue-Scale. Participants' satisfaction of the mode of the pain relief was assessed using the Likert-scale after 24 h. The primary outcome was the pain score using the visual-analogue-scale. The secondary outcome-measures were participants' satisfaction after 24 h of administration of the drugs, the need and frequency of rescue-analgesia and maternal-side-effects. RESULT: The baseline socio-demographic characteristics were similar in both groups. There was no statistically significant difference between both groups in pain assessment at 1 h post-myomectomy (p-value > 0.05). However, the pain assessments at 6, 12, 18 and 24 h post-myomectomy were statistically significant with more pain in intramuscular-group when compared to rectal-group. Majority of participants in rectal-group were both very satisfied (35.6 %) and satisfied (55.6 %) when compared to intramuscular-group (11.1 %) and (31,1%) respectively (p-value < 0.05). Also majority of the participants in intramuscular-group were dissatisfied (17.8 %) with none of the participant showing any form of dissatisfaction (p-value < 0.05). Majority of the participant in rectal-group had no drug side effects when compared with intramuscular-group. Epigastric discomfort was commoner in rectal-group while drowsiness was commoner in intramuscular-group. CONCLUSION: Rectal Diclofenac with intramuscular Pentazocine is significantly associated with better effectiveness in pain reduction and maternal satisfaction when compared with intramuscular Diclofenac and intramuscular Pentazocine following open-myomectomy. While epigastric discomfort was the commonest side-effect in rectal-group, drowsiness was commoner in intramuscular-group. TRIAL REGISTRATION: Pan-African-clinical-trial-registry (PACTR); PACTR202206556144219.

Exercise has a positive impact on bone mineral density in seropositive human immunodeficiency virus: do health professionals know? / El ejercicio tiene un impacto positivo en la densidad mineral ósea en seropositivos al virus de la inmunodeficiencia humana: ¿lo saben los profesionales de la salud?

Introduction: Despite the concomitant negative effects of human immunodeficiency virus on bone mineral density in HIV-infected persons, studies on knowledge of effect of exercise on this health parameter in HIV population among health professionals seem unavailable. This study therefore examined knowledge on effect of exercise on BMD in HIV-infected persons among health professionals. Material and methods: This cross-sectional survey employed researcher designed, experts - validated questionnaire to enroll 434 respondents. The reliability coefficient “r” of the questionnaire was 0.75 with 92% response rate. Descriptive and inferential statistics were used to summarize and analyze the data respectively. The alpha value was set at 0.05. Results: Age range and mean age in years of the respondents were 21–59 and 35.88 ± 9.09 respectively; age group of 30–39 years predominated (45.3%). Males were in preponderance (52.4%), and most (74.4%) were married; while majority (54.7%) were nurses. Substantial proportion (54.2%) had less than good knowledge on the subject examined in this study. Significant difference (p < 0.05; p = 0.015) in knowledge on effect of exercise on BMD in HIV population existed among the professions. Post hoc showed that knowledge of the physicians (p = 0.001) and laboratory scientists (p = 0.029) were significantly higher than that of the nurses. Physiotherapists’ knowledge on this subject compared to that of other health professionals was statistically insignificant (p > 0.05). Conclusions: Knowledge on effect of exercise on BMD in HIV infected persons among health professionals was surprisingly below expectation, and therefore should be seen as a cause for concerned exercise scientists and public health experts. (AU)

Introducción: A pesar de los efectos negativos concomitantes del virus de la inmunodeficiencia humana sobre la densidad mineral ósea en personas con VIH, los estudios sobre el conocimiento del efecto del ejercicio sobre este parámetro de salud en la población con VIH entre los profesionales de la salud parecen no estar disponibles. Por lo tanto, este estudio examinó el conocimiento sobre el efecto del ejercicio en la DMO en personas infectadas por el VIH entre los profesionales de la salud.Material y métodos: esta encuesta transversal empleó un cuestionario validado por expertos y diseñado por investigadores para inscribir a 434 encuestados. El coeficiente de confiabilidad “r” del cuestionario fue de 0,75 con una tasa de respuesta del 92%. Se utilizaron estadísticas descriptivas e inferenciales para resumir y analizar los datos respectivamente. El valor alfa se fijó en 0,05. Resultados: El rango de edad y la edad media en años de los encuestados fueron 21-59 y 35,88 ± 9,09 respectivamente; Predominó el grupo de edad de 30 a 39 años (45,3%). Predominaron los varones (52,4%) y la mayoría (74,4%) estaban casados; mientras que la mayoría (54,7%) eran enfermeras. Una proporción sustancial (54,2%) tenía menos que un buen conocimiento sobre el tema examinado en este estudio. Existió una diferencia significativa (p < 0,05; p = 0,015) en el conocimiento sobre el efecto del ejercicio en la DMO en la población con VIH entre las profesiones. Post hoc mostró que el conocimiento de los médicos (p = 0,001) y los científicos de laboratorio (p = 0,029) fue significativamente mayor que el de las enfermeras. El conocimiento de los fisioterapeutas sobre este tema en comparación con el de otros profesionales de la salud fue estadísticamente insignificante (p > 0,05). Conclusiones: El conocimiento sobre el efecto del ejercicio sobre la DMO en personas infectadas por el VIH entre los profesionales de la salud fue sorprendentemente inferior a las expectativas ... (AU)

Preoperative vaginal cleansing with chlorhexidine solution in preventing post-cesarean section infections in a low resource setting: A randomized controlled trial.

INTRODUCTION: Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post-cesarean section infectious morbidities. MATERIAL AND METHODS: This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine-alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine-alcohol. All the women received pre- and postoperative antibiotics. The primary outcomes were endometritis and wound infections. RESULTS: Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16-0.53; P < .05). Foul-smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30-64.55; P < .001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54 ± 1.04 days compared with 6.01 ± 1.55 days, P < 0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species. CONCLUSIONS: Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post-cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.

Descriptive epidemiology of coronavirus disease 2019 in Nigeria, 27 February-6 June 2020.

The objective of this study was to describe the epidemiology of COVID-19 in Nigeria with a view of generating evidence to enhance planning and response strategies. A national surveillance dataset between 27 February and 6 June 2020 was retrospectively analysed, with confirmatory testing for COVID-19 done by real-time polymerase chain reaction (RT-PCR). The primary outcomes were cumulative incidence (CI) and case fatality (CF). A total of 40 926 persons (67% of total 60 839) had complete records of RT-PCR test across 35 states and the Federal Capital Territory, 12 289 (30.0%) of whom were confirmed COVID-19 cases. Of those confirmed cases, 3467 (28.2%) had complete records of clinical outcome (alive or dead), 342 (9.9%) of which died. The overall CI and CF were 5.6 per 100 000 population and 2.8%, respectively. The highest proportion of COVID-19 cases and deaths were recorded in persons aged 31-40 years (25.5%) and 61-70 years (26.6%), respectively; and males accounted for a higher proportion of confirmed cases (65.8%) and deaths (79.0%). Sixty-six per cent of confirmed COVID-19 cases were asymptomatic at diagnosis. In conclusion, this paper has provided an insight into the early epidemiology of COVID-19 in Nigeria, which could be useful for contextualising public health planning.