Rupture of a previously scarred uterus during second trimester misoprostol-induced labour for a missed abortion: A case report

Misoprostol is useful in ripening the cervix prior to mid-trimester termination of pregnancy. It is particularly indicated in cases of missed abortions whether the uterus is scarred or not. The procedure is safe in the majority of cases. We present a case of uterine rupture during induction of labour with vaginal misoprostol for a missed abortion at 23 weeks gestation in a woman with one previous lower segment caesarean scar. We decided to present this case in order to alert practitioners that although the practice is safe in the majority of cases, there are risks of uterine rupture. Clinics in Mother and Child Health Vol. 3(1) 2006: 501-50

Readmission and death after an acute heart failure event: predictors and outcomes in sub-saharan africa: results from the thesus-hf registry

Aims: Contrary to elderly patients with ischaemic-related acute heart failure (AHF) typically enrolled in North American and European registries, patients enrolled in the sub-Saharan Africa Survey of Heart Failure (THESUS-HF) were middle-aged with AHF due primarily to non-ischaemic causes.We sought to describe factors prognostic of re-admission and death in this developing population. Methods and results: Prognostic models were developed from data collected on 1006 patients enrolled in THESUS-HF, a prospective registry of AHF patients in 12 hospitals in nine sub-Saharan African countries, mostly in Nigeria, Uganda, and South Africa. The main predictors of 60-day re-admission or death in a model excluding the geographic region were a history of malignancy and severe lung disease, admission systolic blood pressure, heart rate and signs of congestion (rales), kidney function (BUN), and echocardiographic ejection fraction. In a model including region, the Southern region had a higher risk. Age and admission sodium levels were not prognostic. Predictors of 180-day mortality included malignancy, severe lung disease, smoking history, systolic blood pressure, heart rate, and symptoms and signs of congestion (orthopnoea, peripheral oedema and rales) at admission, kidney dysfunction (BUN), anaemia, and HIV positivity. Discrimination was low for all models, similar to models for European and North American patients, suggesting that the main factors contributing to adverse outcomes are still unknown. Conclusion: Despite the differences in age and disease characteristics, the main predictors for 6 months mortality and combined 60 days re-admission and death are largely similar in sub-Saharan Africa as in the rest of the world, with some exceptions such as the association of the HIV status with mortality

A survey of knowledge, attitudes and practice of emergency contraception among university students in Cameroon

<p>Abstract</p> <p>Background</p> <p>Unsafe abortion is a major public health problem in low-and-middle income countries. Young and unmarried women constitute a high risk group for unsafe abortions. It has been estimated that widespread use of emergency contraception may significantly reduce the number of abortion-related morbidity and mortality. The purpose of this study was to evaluate the knowledge, attitudes and experiences on emergency contraceptive pills by the university students in Cameroon in order to develop and refine a national health programme for reducing unwanted pregnancies and their associated morbidity and mortality.</p> <p>Methods</p> <p>A convenient sample of 700 students of the University of Buea (Cameroon) was selected for the study. Data was collected by a self-administered, anonymous and pre-tested questionnaire.</p> <p>Results</p> <p>The response rate was 94.9% (664/700). General level of awareness of emergency contraceptive pills was 63.0% (418/664). However, knowledge of the general features of emergency contraceptive pills was low and misinformation was high among these students. Knowledge differed according to the source of information: informal source was associated with misinformation, while medical and informational sources were associated with better knowledge. Although the students generally had positive attitudes regarding emergency contraceptive pills, up to 65.0% (465/664) believed that emergency contraceptive pills were unsafe. Those with adequate knowledge generally showed favourable attitudes with regards to emergency contraceptive pills (Mann-Whitney U = 2592.5, p = 0.000). Forty-nine students (7.4%) had used emergency contraceptive pills themselves or had a partner who had used them.</p> <p>Conclusion</p> <p>Awareness of emergency contraception pills by Cameroonian students is low and the method is still underused. Strategies to promote use of emergency contraception should be focused on spreading accurate information through medical and informational sources, which have been found to be reliable and associated with good knowledge on emergency contraceptive pills.</p

The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

BACKGROUND: The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. METHODS AND FINDINGS: We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. CONCLUSION: The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed

Effects of taxation on social innovation and implications for achieving sustainable development goals in developing countries : a literature review

In developing countries, taxation is perceived as a brake on economic growth. Indeed, taxes in most of these countries are not sufficiently adapted to the specificity of the taxpayer and often do not consider the weak administrative capacity of the countries in the region. In this context, reforms have been initiated over the last decade to create tax environments that encourage savings, investment, entrepreneurship, and social innovation. This study provides an overview of research on the effects of taxation on social innovation and the corresponding implications for the achievement of Sustainable Development Goals (SDGs) in developing countries, taking three approaches: thematic, chronological, and methodological. Most studies agree that high taxes in business undermine social innovation and thus the achievement of SDGs, as social innovation is known to be a driver of most SDGs and business the vehicle. The majority of the selected studies used primary data collected from samples whose representativeness with respect to the population concerned (notably businesses) is still not explicitly justified

Optimisation de la production d'éthanol par les techniques d'hydrolyse de l'amidon de manioc et la fermentation de la levure de bière (Saccharomyces cerevisiae)

Nous avons évalué les paramètres optimum pour la production d'alcool à partir de l'efficacité d'hydrolyse de l'amidon: chimique (HCl), enzymatique (amylase de Aspergillus niger ou de malt) et mixte (chimique et enzymatique). La fermentation alcoolique par la levure de bière est suivie, à travers l'influence du pH, de la température, du substrat et de la durée. La méthode la plus efficace est l'hydrolyse mixte avec 82% à 86% de rendement et la moins efficace est l'hydrolyse chimique avec 31% de rendement. La teneur en alcool augmente avec la concentration en substrat jusqu'à un optimum à 200 g/l. Le rendement le plus élevé pour la production d'alcool est 47,9%. Les conditions les plus favorables sont: 50 g/l de sucre, pH de 6, 30oC et 36 h de fermentation pour une meilleurerentabilité. On peut optimiser ces résultats en utilisant des technologies plus efficaces pour l'hydrolyse de l'amidon. Il vaut mieux produire l'éthanol à partir d'une fermentation contrôlée pour éviter les intoxications provoquées par le méthanol.Mots clés: fermentation alcoolique, Saccharomyces cerevisiae, amidon de manioc, Aspergillus niger, malt, amylases.Optimum parameters suitable for alcohol production were set up. We tested the efficiency of starch hydrolysis using three methods: hydrochloric acid; enzymatic using microbial Aspergillus niger amylases or malt amylases, mixed hydrolysis combining chemical and enzymatic methods. Alcoholic fermentation was assessed using yeast and wort hydrolysis of starch. The pH, temperature, substrate content and duration of the fermentation were studied. The most efficient method is the mixed chemical and enzymatic hydrolysis because it yielded 82 to 86% and the least efficient is chemical hydrolysis which yielded 31% compared to glucose fermentation. Alcohol concentration increased with substrate concentration to an optimum at 200 g/l. The highest alcohol yield was 47.9%. The optimum parameters for alcohol production using yeast were: 150 g/l, pH of 6, 30oC and duration of 36 h for the best profitability. These results could be improved by using more efficient technology for starch hydrolysis and alcohol production through high ethanol and substrate tolerance. The production of ethanol using established technology is recommended in order to avoid methanol intoxication from uncontrolled fermentation.Key words: alcoholic fermentation, Saccharomyces cerevisiae, cassava starch, Aspergillus niger, malt, amylases