Effect of premature rupture of membranes on the maternal and fetal prognosis during childbirth at the gynecology-obstetrics department of the Matam Communal Medical Center, Conakry, Guinea

Background: Premature rupture of membranes (RPM) is defined by rupture of the amnion and chorion before entering labor within 24 hours leading to vaginal discharge of amniotic fluid without uterine contractions. Objective of this study was to improving the management of premature Ruptures of the membranes received in the service.Methods: This was a descriptive and analytical prospective study lasting six months from January 1 to June 30 2016.Results: During the study period, we collected 108 cases of RPM out of 1543 deliveries, representing a hospital frequency of 7%. RPM had more frequently concerned pregnant women aged 25-29 (37.04%), housewife (37.03%), primiparous (45.37%) and referral (52.78%). 95.37% were single pregnancies with cephalic presentation (80%) received between 37-42 weeks (84.26%). Management mainly consisted of antibiotic prophylaxis (100%), fetal pulmonary maturation and childbirth. The vagina was the main mode of delivery (62.04%). The maternal prognosis was dominated by chorioamnionitis (12.96%). The fetal one was made up of respiratory distress (40.71%) and prematurity (12.39%).Conclusions: RPM is frequent at the Matam municipal medical center. It is essential for its prevention to ensure health education of the population in general and genital hygiene in particular, to make a coherent prenatal follow-up while putting a particular accent on the detection and the treatment of genital infections

Management of pre-eclampsia and its complications in the department of gynecology and obstetrics at Donka national hospital Conakry, Guinea

Background: Vascular-renal syndrome, also known as pre-eclampsia, is a condition specific to pregnancy, usually occurring in the last trimester of pregnancy. Pregnant women are sometimes at risk of unpredictable obstetrical complications such as: hemorrhage, kidney failure, HELLP syndrome, sometimes even brain damage requiring prompt care and multidisciplinary collaboration. Vascular-renal syndromes are the third leading cause of maternal death and also the world's leading cause of perinatal death. Objectives of this study were to analyse the management of vascular-renal syndromes. Calculate their frequency, describe the sociodemographic characteristics of patients, describe the clinical and biological signs of patients, evaluate the maternal-fetal prognosis.Methods: The study was conducted in the department of obstetrics and gynecology of Donka National Hospital. It was a prospective, descriptive, cross-sectional, 6-month study from March 1st to August 31st, 2015, of pregnant women with pre-eclampsia.Results: The study included 217 cases of pre-eclampsia out of a total of 3054 patients, i.e. a proportion of 7.10%. The proportion of pre-eclampsia was high in patients aged between 15 and 19 years, housewife, married, primary. The predisposing factors were primigestitis, obesity and twinkling. The clinic was dominated by headaches and visual disturbances. Severe preeclampsia in 78.49%, eclampsia in 21.65% or simple hypertension in 1.75%. Maternal and fetal complications were dominated by eclampsia 26.26%, PPH (2.63%), eclamptic coma (0.46%), acute fetal distress 27.19%, and fetal death in utero (11.40%). In order to improve maternal and fetal prognosis it is necessary to provide multidisciplinary care, which unfortunately is not always available in our context.Conclusions: Obstetric emergency is a frequent situation for which a better management would improve the maternal-fetal prognosis

Furthering new public management principles through financial reforms in post-1999 South Africa

Thesis (MPA)--Stellenbosch University, 2014.ENGLISH ABSTRACT: The purpose of this research is to describe how the reform of public finance undertaken in South Africa since 1999 has furthered the principles of new public management (NPM). The first part of the research outlines the history of public sector reform in South Africa in general, with particular emphasis on public finance. It also discusses how reform was initiated and supplemented by the principles of new public management with the adoption of the Public Finance Management Act, No. 1 of 1999 (PFMA, 1999). This is followed by a deep analysis and detailed discussion of key indicators and the mode of their collection. The final phase consists of a description of how new public management principles have impacted public finance management since 1999. The study concludes with recommendations for further research and for practice and policy. The results tend to show how some principles of NPM have furthered public finance reform in some areas while others are still lacking. However the lack of sufficient data results in gaps in the findings: this lack of data makes it difficult to portray a clear picture of the extent to which principles of NPM have been fully implemented. Thus one of the recommendations is that certain indicators should be investigated further to understand the phenomenon better; it is probable that in a few years sufficient data will be available to allow for trend assessments.AFRIKAANSE OPSOMMING: Die doel van hierdie navorsing is om te beskryf hoe hervorming van openbare finansies sedert 1999 in Suid Afrika onderneem is ten einde die beginsels van ‘nuwe openbare bestuur’ te bevorder. Die eerste gedeelte van die navorsing fokus op die Suid-Afrikaanse openbare sektor hervorming geskiedenis in die algemeen, met spesifieke fokus op openbare finansies. Dit beskryf hoe die Openbare Finansiële Bestuurswet, No 1 van 1999 (PMFA, 1999) hervorming en die beginsels van ‘nuwe openbare bestuur’ bevorder het. Dit word gevolg deur ‘n diep en deeglike bespreking van kern indikatore en die wyse waarop data versamel is. Die finale fase behels ‘n beskrywing van die bedra van openbare finansiële bestuur hervorming sedert 1999 tot die bevordering van ‘nuwe openbare bestuur’ beginsels. Die studie sluit af met aanbevelings vir praktyk en beleid asook verdere navorsing. Die resultate toon dat sommige van die beginsels van ‘nuwe openbare bestuur’ bevorder is deur openbare finansiële hervorming, terwyl ander steeds agterweë bly. ‘n Tekort aan genoemsame data lei egter tot leemtes in die bevindinge: die tekort aan data maak dit moeilik om ‘n duidelike prentjie te vorm oor die mate waartoe die beginsels van ‘nuwe openbare bestuur’ ten volle geïmplementeer is. Een van die kern aanbevelings is dus dat spesifieke indikatore verder ondersoek moet word om die verskynsel beter te verstaan; dit is waarskynlik dat genoegsame data in die toekoms koers berekenings moontlik sal maak wat verdere begrip sal bevorder

MECANISMES D'ACTION PRE-SYNAPTIQUES DES ANESTHESIQUES GENERAUX ET DU RILUZOLE

IL EST ACTUELLEMENT ADMIS QUE LES ANESTHESIQUES GENERAUX AGISSENT AU NIVEAU DU SYSTEME NERVEUX CENTRAL EN MODULANT LA TRANSMISSION SYNAPTIQUE. CETTE ACTION EST ESSENTIELLEMENT LIEE A LEURS EFFETS SUR UN CERTAIN NOMBRE DE RECEPTEURS POST-SYNAPTIQUES COUPLES A DES CANAUX IONIQUES. AINSI, LA POTENTIALISATION DE LA NEUROTRANSMISSION INHIBITRICE PAR LES ANESTHESIQUES VIA LE RENFORCEMENT DE L'ACTION DU GABA SUR SON RECEPTEUR DE TYPE A A ETE ABONDAMMENT DECRITE DANS LA LITTERATURE ET TIENT UNE PLACE PRIVILEGIEE. LA PLACE DES MECANISMES D'ACTION DES ANESTHESIQUES RESTE PLUS CONTROVERSEE. CE TRAVAIL EFFECTUE PARALLELEMENT A CEUX D'AUTRES EQUIPES A CONTRIBUE A DEMONTRER L'EXISTENCE D'ACTION DES ANESTHESIQUES AU NIVEAU PRE-SYNAPTIQUE. NOUS AVONS TRAVAILLE SUR DES MODELES DE SYNAPTOSOMES ET DE TRANCHES DE TISSU STRIATAL DE RAT. NOUS AVONS PU MONTRER : QUE LES ANESTHESIQUES VOLATILS MODULENT DE FACON COMPLEXE LA LIBERATION DE DOPAMINE ET DE GABA DANS LE STRIATUM, QUE LES TRANSPORTEURS DE LA DOPAMINE ET DU GABA SONT INHIBES PAR LES ANESTHESIQUES INTRAVEINEUX ET QUE LA SENSIBILITE DU TRANSPORTEUR DU GABA AUX ANESTHESIQUES INTRAVEINEUX DIMINUE AVEC LE VIEILLISSEMENT. NOS TRAVAUX ONT EGALEMENT PERMIS DE PROGRESSER DANS LA COMPREHENSION DES MECANISMES D'ACTION DU RILUZOLE, UN COMPOSE ORIGINAL, AYANT ENTRE AUTRES DES PROPRIETES ANESTHESIQUES ET NEUROPROTECTRICES IN VITRO. NOUS AVONS AINSI DEMONTRE SUR DES SYNAPTOSOMES QUE CET AGENT MODULE LA LIBERATION DE DOPAMINE VIA UNE ACTION SUR LES RECEPTEURS DU GLUTAMATE (NMDA ET KAINATE) ET LES CANAUX SODIQUES VOLTAGE-DEPENDANTS, MAIS N'A PAS D'EFFET SUR LA LIBERATION DE DOPAMINE DEPENDANTE DE L'ACETYLCHOLINE OU DES CANAUX CALCIQUES VOLTAGE-DEPENDANTS. D'AUTRE PART, LE RILUZOLE INHIBE L'ACTIVITE DE LA NITRIC OXIDE SYNTHASE (NOS) NEURONALE AU NIVEAU DE L'HIPPOCAMPE DE RAT. NOS DIFFERENTS TRAVAUX DEMONTRENT L'EXISTENCE D'EFFETS PRE-SYNAPTIQUES DES ANESTHESIQUES AUX CONCENTRATIONS CLINIQUES. CES RESULTATS SUGGERENT QUE LA MODULATION DES TRANSMISSIONS DOPAMINERGIQUES ET GABAERGIQUES PAR CES AGENTS POURRAIT PARTICIPER A LEUR ACTION HYPNOTIQUE.PARIS-BIUSJ-Thèses (751052125) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Chocs allergiques peranesthésiques

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Eye protection in anaesthesia and intensive care

International audienc

Raising awareness to prevent, recognise and manage acute pain during caesarean delivery ::the French Practice Bulletin

The incidence of acute pain during caesarean section varies between studies, with a reported rate ranging between 0.5%–17% for spinal anaesthesia and 1.7%–20% for epidural anaesthesia. Leaders from the French Club anesthésie-réanimation en obstétrique (CARO) convened to provide a clinical framework and practice bulletin to prevent, recognise and treat acute pain during caesarean section. First, a steering group agreed on 5 themes guiding quality of anaesthesia care for caesarean section: (1) appropriate neuraxial anaesthesia and testing of the surgical block prior to incision (PREVENTION); (2) appropriate organisation around decision to delivery time (COMMUNICATION); 3) appropriate management of pain before and/or after skin incision (RECOGNITION & RESPONSE); (4) appropriate prevention, identification and management of post-traumatic stress disorder (SCREENING, PREVENTION AND MANAGEMENT OF COMPLICATIONS); (5) management of medico-legal issues (MITIGATION). Then, an interdisciplinary multi-professional taskforce composed of obstetric anaesthesiologists, obstetricians, neonatologists, psychiatrists, midwifes, nurse anaesthetists, lawyers and patients, developed 23 statements that contribute to optimise care for caesarean section under neuraxial anaesthesia, of which 10 were deemed key recommendations. A decision-tree was built to optimise prevention, communication, recognition, response and management. The aim of this practice bulletin, which was endorsed by 6 societies, is to raise awareness on the risks associated with severe acute pain during caesarean section and to provide best clinical practices; pain during caesarean is not acceptable and should be prevented and managed by all stakeholders