Caesarean section in a semi-rural hospital in Northern Namibia

BACKGROUND: Increasing caesarean sections rates (CSR) are a major public health concern and the prevention of the first caesarean section, which often leads to repeat operations, is an important issue. Analyzing caesarean sections can help to identify factors associated with variations in CSR and help to assess the quality of clinical care. METHODS: In a retrospective observational study, during a two year period, indications of 576 caesarean sections were analyzed using intra-operative internal pelvimetry and a record keeping system in a semi-rural hospital in Northern Namibia. RESULTS: Most caesarean sections were done for dystocia (34%) followed by repeat caesarean section (31%). The true conjugate (distance between the promontorium to mid pubic bone) was significantly smaller in these recurrent indication groups when compared to non recurrent indications. CONCLUSION: In this rural hospital the introduction of Delee Pelvimetry and a caesarean section record keeping system was found to be a simple and cheap method to analyse indications for caesarean sections, which may help in reducing unnecessary caesarean sections

2-Methyl-pentanoyl-carnitine (2-MPC) : a urine biomarker for patent Ascaris lumbricoides infection

Infections with intestinal worms, such as Ascaris lumbricoides, affect hundreds of millions of people in all tropical and subtropical regions of the world. Through large-scale deworming programs, World Health Organization aims to reduce moderate-to-heavy intensity infections below 1%. Current diagnosis and monitoring of these control programs are solely based on the detection of worm eggs in stool. Here we describe how metabolome analysis was used to identify the A. lumbricoides-specific urine biomarker 2-methyl pentanoyl carnitine (2-MPC). This biomarker was found to be 85.7% accurate in determining infection and 90.5% accurate in determining a moderate-to-heavy infection. Our results also demonstrate that there is a correlation between 2-MPC levels in urine and A. lumbricoides DNA detected in stool. Furthermore, the levels of 2-MPC in urine were shown to rapidly and strongly decrease upon administration of a standard treatment (single oral dose of 400 mg albendazole). In an Ascaris suum infection model in pigs, it was found that, although 2-MPC levels were much lower compared to humans, there was a significant association between urinary 2-MPC levels and both worm counts (p=0.023) and the number of eggs per gram (epg) counts (p<0.001). This report demonstrates that urinary 2-MPC can be considered an A. lumbricoides-specific biomarker that can be used to monitor infection intensity

Development and measurement of guidelines-based quality indicators of caesarean section care in the Netherlands: A RAND-modified delphi procedure and retrospective medical chart review

Background There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS) rates. Method Eighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery. Results The expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1) suspected fetal distress (frequency 17%, adh

Magnetite and Metal-Impregnated Magnetite Catalysts in Organic Synthesis: A Very Old Concept with New Promising Perspectives

Magnetite is a well-known material, with the impregnation of transition metals onto its surface being a very old protocol for preparing catalysts. However, only recently, the combination of both, magnetite and impregnation protocols, have been recognized as a powerful methodology to prepare catalysts. The impregnation protocol, of nearly all transition metals in the magnetite surface, has rendered the first generation of catalysts. These simple catalysts have been used in a very broad range of organic transformations. Thus, simple imine derivative formation or unknown reactions such as the direct cross β-alkylation of primary alcohols, through dehydrogenation, oxidation, addition, hydrogen autotransfer, and multicomponent reactions has been accomplished using these catalysts. In most cases, these catalysts could be just isolated by magnetic decantation and reused several times without a detrimental effect on the initial results. In some cases, the study of the surface of the catalyst by means of several surface characterization techniques has permitted to determine the real species involved in the process and their structural changes within the reaction cycles. Furthermore, the post-modification of the catalysts by reduction or oxidation of the immobilized metal, or by the addition of ligands, has enlarged the applicability of this type of catalysts.This work was supported by the current Spanish Ministerio de Economía y Competitividad (CTQ2011-24151) and by the University of Alicante

Impact of the structure and reactivity of nickel particles on the catalytic growth of carbon nanofibers

Abstract Catalytically grown fishbone carbon nanofibers (CNF), are prepared by the decomposition of carbon-containing gases (CH 4 , CO/H 2 or C 2 H 4 /H 2 ) over a silica-supported nickel catalyst and an unsupported nickel catalyst at 550 • C. It turns out that both the nickel particle size and the nature of the carbon-containing gas significantly affects the CNF growth process. We demonstrate that at the chosen temperature small supported nickel particles need a carbon-containing gas with a relatively low reactivity, like CH 4 or CO/H 2 , to produce CNF. The resulting fishbone CNF have a uniform and small diameter (25 nm). The CNF thus synthesized hold great potential, e.g. as catalyst support material. However, the large unsupported nickel particles only produce CNF using a reactive carbon-containing gas, like C 2 H 4 /H 2 . The CNF thus obtained show a variety of morphologies with a large range of diameters (50-500 nm). The CNF yield is a subtle interplay between the nickel particle size and consequently the exposed crystal planes on the one hand and the reactivity of the carbon-containing gas on the other