Prevalence, Outcome and Associated Factors among Adolescents Delivering at Mbarara Regional Referral Hospital

Globally, almost one in five women aged 20 to 24 (19 %) had a live birth by their 18th birthday. Adolescent pregnancies and deliveries are universally recognized to be associated with many complications. Although many studies have been done on adolescent mothers globally, not much has been documented on the prevalence, outcomes and associated factors especially in Uganda. This study aimed at finding out the prevalence of adolescent deliveries, delivery outcomes and potential factors influencing these outcomes among adolescent mothers at Mbarara Regional Referral Hospital (MRRH), in Southwestern Uganda. We conducted a cross sectional study at MRRH between June and October 2015. We consecutively sampled 786 adolescent mothers within 24 hours postpartum and obtained their characteristics and delivery outcomes. The prevalence of adolescent deliveries at MRRH was 23.4% of all deliveries. Majority of the participants were aged 18-19 years (median 18.5years, standard deviation 0.87).  Majority had only attained primary education and almost all (90.5%) were married. Most had an average of 3 antenatal care visits, delivered by spontaneous vaginal delivery (59.4%). Caesarian section rate was 39.4% with the main indication of contracted pelvis (45.8%).  Majority had good fetal outcome (80.7%) while 50.2% of mothers had poor outcome. The main obstetric complication was perineal tears (32.6%) followed by prolonged labour (23%). Being referred and delivery by vacuum delivery remained significantly associated with poor outcomes while episiotomy and delivery by Caeserian section were protective. The prevalence of adolescent deliveries at MRRH is high with most of adolescent mothers having poor sociodemographic characteristics. Commonest poor maternal outcome was perineal tears followed by prolonged labour. Fetal outcomes were good. Being referred and delivery by vacuum delivery were associated with poor outcomes while episiotomy and delivery by Caeserian section were associated with good fetal outcome. Keywords: adolescent delivery, delivery outcome, maternal outcome, fetal outcome, associated factor

Prevalence of and Factors Associated with Vulva Intraepithelial Neoplasia (VIN) among HIV Positive Women at Mbarara Regional Referral Hospital, Uganda

Background: Vulva intraepithelial neoplasia (VIN) is a noninvasive potential precursor of squamous cell carcinoma of the vulva. VIN is more prevalent in HIV-positive than HIV-negative women and if not identified and treated early, there is a high risk of progression to invasive cancer. Despite a large number of HIV-positive women getting care from Immunesuppression (ISS) clinic at Mbarara Regional Referral Hospital (MRRH), the local burden of VIN remains unknown in this group. Objective: To determine the prevalence and factors associated with vulva intraepithelial neoplasia (VIN) among HIV-positive women attending HIV care clinic at Mbarara Regional Referral Hospital (MRRH). Methods: This cross sectional study consisted of 225 HIV-positive women who attended the HIV care clinic at MRRH in a period of three months. Simple random sampling was used in the recruitment of study participants until the sample size was achieved. All participants underwent vulvoscopy. Any lesion detected was biopsied. Demographic and medical data were collected. The dependent variable was histologically confirmed VIN. Logistic regression analysis to assess association of factors with VIN was done. Results were presented in charts, graphs and tables.  Results: Two hundred and twenty five HIV-positive women were enrolled. Their median age was 33 years.  14 (6.22%) had VIN; of these, 9 had VIN-1, 4 had VIN-2 and 1 had VIN-3. All the study participants with VIN had Human papilloma virus (HPV) infection and were on antiretroviral therapy (ART). The symptoms of VIN included vulvar itching (43%), vulvar burning sensation (29%), and superficial dyspareunia (14%). Age, multiple sexual partners, age of sexual debut, menarche and genital warts were not significantly associated with VIN Conclusion: The prevalence of VIN among HIV-positive women attending HIV care clinic at MRRH is low. All participants with VIN had the following in common, HPV infection; vulva itching, vulva burning sensation and superficial dyspareunia. Recommendations: Since all cases of VIN had HPV infection we recommend that HPV vaccination should be included in HIV care to prevent VIN and consequently vulva cancer. We also recommend that all women with vulva itching, vulva burning and superficial dyspareunia should be screened for VIN. Key words: Vulva Intraepithelial Neoplasia (VIN), Human Immunodeficiency Virus (HIV

HARLEQUIN FETUS, A CASE REPORT.

Se presenta un caso de un recién nacido de 2900 gramos, sexo masculino y portador de un Síndrome del Feto en Arlequín, con manifestaciones fenotípicas de ectropion, eclabium, alopecia y queratosis palmar y plantar. Es una enfermedad autosómica recesiva  muy grave y rara. No se encontró antecedentes de consanguinidad en los padres. Se realiza una revisión de los elementos fundamentales de la fisiopatogenia.No se encontró en la literatura nacional un caso publicado similar.It is prsented a newborn case,male, 2900 grams, carrier of Harlequin Fetus Syndrome, with phenotipics of ectropion,eclabium, alopecia, palmar and plantar  keratosis.It is an autonomic, recesive,weird, and severe disease. There were not found consanguinity antecedents in the parents. The main pathophysiological elements were checked. In the national bibliography has not been published a similar case.

Characterization of the teaching formation of Basic General Physicians.

Se realizó una investigación educacional descriptiva   de carácter cualitativo con el objetivo de caracterizar epistemológicamente el estado actual de la formación docente del Médico General Básico, mediante talleres a especialistas y alumnos ayudantes de la carrera de medicina en la filial de Ciencias Médicas de Bayamo, en el periodo de septiembre a diciembre del 2010. El 100% de los participantes coincidieron en que la formación pedagógica es insuficiente y no tiene un papel importante en el curriculum actual para la formación del profesional de la salud, desvalorizando los beneficios que aportaría  para la formación profesional, el paciente y la sociedad.It was performed  a qualitative, descriptive and educational research with the objective to characterize epistemologically the present state of the basic general physician training by means of workshop for specialists and assistant students of medicine career in the filial of Medical Sciences, Bayamo since September to December 2010. The 100% of the participants agreed that the pedagogical training was inadequate and it doesn't have an important role in the present curriculum for the health professional training, devaluing the benefits that would contribute to the professional training, the patient and society

Prevalence and Factors Associated With Histological Chorioamnionitis among Term Women Delivering From Mbarara Regional Referral Hospital

Background: Chorioamninitis (CAM), is an acute inflammation of the membrane and chorion of the placenta which can either be clinical or histological. At Mbarara Regional Referral Hospital the prevalence and factors associated with histological chorioamnionitis are widely unknown. Objective: To assess the prevalence and factors associated with histological chorioamnionitis in term pregnancy among mothers delivering from Mbarara Regional Referral Hospital.   Methods: At inclusion in a cross-section, from December 2015 to February 2016, 136 women at term were interviewed. The placentas were evaluated, and diagnosis was based on histologic examination of the placenta. Placentas with microscopic evidence of inflammation of the membranes (infiltration of polymorphonuclear leukocytes and other immunocytes, such as macrophages and T cells) were considered positive for histological chorioamnionitis (HCA). Placental positive for HCA were scored and categorized as: Grade 1 (mild to moderate chorioamninitis) or Grade 2 (severe chorioamnionitis- three or more chorionic microabscesses). Logistic regression was used to determine factors associated with chorioamnionitis. The significant level of 5% was used. Odds ratios and their corresponding 95% CI were provided at both bivariate and multivariate analysis.   Results: Among the 129 placentas of mothers at term that were examined, histologogical chorioamnionitis was diagnosed (HCA-positive) in 34.1% of women. Duration of labor more than 18 hours was found to be associated with HCA (aOR=4.0, 95%CI:1.30-12.39, p=0.0267). There were 34 cases of HCA grade 1 among cases positive for HCA (81.8%).   Conclusions: In our study, the prevalence of HCA was found to be high and duration of labor more than 18 hours was found to be significantly associated with HCA. The proportion of grade 1 HCA among term women with HCA at MRRH is 81.8%

Consideraciones generales sobre la Enfermedad Hipertensiva del embarazo.

It was performed a revision article about some aspects of Hypertensive disease in pregnancy with the objective to update the topic and facilitate the educational information about the physiopathology, risk factors, prevention,  changes in different systems of the organism and their management. The bibliographical research was exhaustive, automatized in the magazines of the speciality that were published since 2003 to 2011, from every part of the world, in English or Spanish, circulating in the internet. It is concluded that until the current time the disease was maintained as a health problem that was not solved yet in the maternal infant care with several controversial aspects in the physiopathology, what brought difficulties in the prevention and precocious treatment of the disease.Se realizó un artículo de revisión sobre algunos aspectos de la Enfermedad Hipertensiva del Embarazo con el objetivo de actualizar e informar sobre el tema y facilitar información docente sobre la fisiopatología, factores de riesgo, prevención, cambios en diferentes sistemas del organismo y manejo. La búsqueda bibliográfica se realizó de forma exhaustiva, automatizada en las revistas de la especialidad,  publicadas del 2003 al 2011, de cualquier región del mundo, en idioma español e inglés que están  circulando en Internet. Se concluyó que hasta el momento actual la enfermedad se mantiene como un problema de salud no resuelto en la atención materno-infantil con numerosos puntos controvertidos en su fisiopatología, lo que dificulta la prevención y el tratamiento precoz de la misma

Incidence of Postpartum Infection, Outcomes and Associated Risk Factors at Mbarara Regional Referral Hospital in Uganda

Background: There is a paucity of recent prospective data on the incidence of postpartum infections and associated risk factors in sub-Saharan Africa. Retrospective studies estimate that puerperal sepsis causes approximately 10% of maternal deaths in Africa. Methods: We enrolled 4231 women presenting to a Ugandan regional referral hospital for delivery or postpartum care into a prospective cohort and measured vital signs postpartum. Women developing fever (\u3e 38.0 °C) or hypothermia (\u3c 36.0 °C) underwent symptom questionnaire, structured physical exam, malaria testing, blood, and urine cultures. Demographic, treatment, and post-discharge outcomes data were collected from febrile/hypothermic women and a random sample of 1708 normothermic women. The primary outcome was in-hospital postpartum infection. Multivariable logistic regression was used to determine factors independently associated with postpartum fever/ hypothermia and with confirmed infection. Results: Overall, 4176/4231 (99%) had ≥1 temperature measured and 205/4231 (5%) were febrile or hypothermic. An additional 1708 normothermic women were randomly selected for additional data collection, for a total sample size of 1913 participants, 1730 (90%) of whom had complete data. The mean age was 25 years, 214 (12%) were HIV-infected, 874 (51%) delivered by cesarean and 662 (38%) were primigravidae. Among febrile/hypothermic participants, 174/205 (85%) underwent full clinical and microbiological evaluation for infection, and an additional 24 (12%) had a partial evaluation. Overall, 84/4231 (2%) of participants met criteria for one or more in-hospital postpartum infections. Endometritis was the most common, identified in 76/193 (39%) of women evaluated clinically. Twenty-five of 175 (14%) participants with urinalysis and urine culture results met criteria for urinary tract infection. Bloodstream infection was diagnosed in 5/185 (3%) participants with blood culture results. Another 5/186 (3%) tested positive for malaria. Cesarean delivery was independently associated with incident, in-hospital postpartum infection (aOR 3.9, 95% CI 1.5– 10.3, P = 0.006), while antenatal clinic attendance was associated with reduced odds (aOR 0.4, 95% CI 0.2–0.9, P = 0.02). There was no difference in in-hospital maternal deaths between the febrile/hypothermic (1, 0.5%) and normothermic groups (0, P = 0.11)

Dinámica de la formación praxiológica docente del médico general básico

El análisis de las manifestaciones externas diagnosticadas en la formación actual del estudiante de medicina, permiten identificar insuficiencias en el proceso de valoración educativa del proceder médico en relación con la diversidad contextual, lo que limita la pertinencia de la formación de este profesional. El objeto y el campo de esta investigación están en el proceso de formación docente en ciencias médicas y su dinámica en el M G B. El objetivo es elaborar un sistema de procedimientos para la formación docente del M G B, sustentado en un modelo de la dinámica de la formación praxiológica docente del M G B. Se revela la lógica integradora de la sistematización de la práctica médico-pedagógica, que se dinamiza entre la valoración clínico-pedagógica y la intervención educativa en salud. Se valoró la pertinencia científica de los resultados investigativos y se corroboró la aplicación parcial del sistema de procedimientos propuestos, precisándose la argumentación pedagógica de la praxis del M G B y la sistematización de la Educación en el trabajo como una vía de solución al problema científico declarado

Dinámica de la formación praxiológica docente del médico general básico

El análisis de las manifestaciones externas diagnosticadas en la formación actual del estudiante de medicina, permiten identificar insuficiencias en el proceso de valoración educativa del proceder médico en relación con la diversidad contextual, lo que limita la pertinencia de la formación de este profesional. El objeto y el campo de esta investigación están en el proceso de formación docente en ciencias médicas y su dinámica en el M G B. El objetivo es elaborar un sistema de procedimientos para la formación docente del M G B, sustentado en un modelo de la dinámica de la formación praxiológica docente del M G B. Se revela la lógica integradora de la sistematización de la práctica médico-pedagógica, que se dinamiza entre la valoración clínico-pedagógica y la intervención educativa en salud. Se valoró la pertinencia científica de los resultados investigativos y se corroboró la aplicación parcial del sistema de procedimientos propuestos, precisándose la argumentación pedagógica de la praxis del M G B y la sistematización de la Educación en el trabajo como una vía de solución al problema científico declarado

Dinámica de la formación praxiológica docente en el Médico General

Background: the analysis of external manifestations that have been identified in the current training of medical students allows the identification of shortcomings in the process of educational assessment of medical behavior regarding contextual diversity, which limits the relevance of the training in these professionals. Objective: to develop a system of procedures for General Practitioner teaching training based on a model of the dynamics of teaching praxiological training. Methods: a qualitative study was conducted from April 2008 to December 2010 at the Medical University of Granma. Factual diagnosis revealed shortcomings in the use of educational tools for preventing diseases, and limitations in understanding the educational role of medical behavior for health education in a community diversity context. A system of procedures for the teaching training of Basic General Practitioners was developed and implemented based on a model of teaching praxiological training of these professionals. Results: with the use of achievement patterns, it was found that one hundred percent of teaching assistants acquired the basic knowledge on Pedagogy as a science for the tasks of prevention, promotion, diagnosis, treatment and rehabilitation. An assessment of the health situation in a maternity ward was achieved by making use of the clinical-epidemiological method with pedagogical arguments. Conclusions: the system of procedures that was developed proved to be relevant to facilitate the process of teaching praxiological training in General Practitioners in order to preserve the health of the individual, family and community.Antecedentes: el análisis de las manifestaciones externas diagnosticadas en la formación del estudiante de Medicina, permite identificar insuficiencias en el proceso de valoración educativa del proceder médico en relación con la diversidad contextual, lo que limita la pertinencia de la formación de este profesional. Objetivo: aplicar un sistema de procedimientos para la formación docente del Médico General sustentado en un modelo de la dinámica de la formación praxiológica docente. Método: se desarrolló una investigación cualitativa desde abril del 2008 hasta diciembre de 2010 en la Universidad de Ciencias Médicas de Granma. El diagnóstico fáctico reveló insuficiencias en la utilización de instrumentos educativos en la prevención de las enfermedades, y limitaciones en la comprensión educativa del proceder médico en la educación para la salud en la diversidad comunitaria. Se implementó un sistema de procedimientos para la formación docente del Médico General sustentado en un modelo para la formación praxiológica docente elaborado con este propósito. Resultados: se comprobó que el ciento por ciento de los alumnos ayudantes adquirieron los conocimientos básicos de la Pedagogía como ciencia para las tareas de prevención, promoción, diagnóstico, curación y rehabilitación y se logró el diagnóstico de la situación de salud en una sala de maternidad al hacer uso del método clínico- epidemiológico con argumentos pedagógicos. Conclusiones: el sistema de procedimientos elaborado demostró su pertinencia al favorecer el proceso de formación praxiológica docente en el Médico General en función de preservar la salud del sujeto, la familia y la comunidad