Morinda lucida reduces contractility of isolated uterine smooth muscle of pregnant and non-pregnant mice

The present work investigated the effect of Morinda lucida (M. lucida) extract on isolated uterine smooth muscle of pregnant and non-pregnant mice. Pregnant and non-pregnant mice were pretreated with oral stilboesterol (0.1mg/kg body weight) and killed by cervical dislocation. Thin strips of the uterus were cut and mounted in a 20-ml organ bath containing De Jalon solution bubbled with 95%O2-5% CO2 gas mixture. The strips were connected to a force transducer coupled to a Grass 7D Polygraph for the recording of isometric tension. Effects of graded concentrations of oxytocin (OXY; 10-5–10-2 mol/L), acetylcholine (ACh; 10-9-10-5 mol/L) and M. lucida extract (0.015–1.5mg/ml) were recorded. Fresh uterine strips were then incubated with M. lucida extract for 5mins and cumulativeresponse to OXY was repeated. Another set of fresh strips was incubated in L-NAME for 15mins and the cumulative responses to M.lucida extract were repeated. OXY resulted in increased contractileresponses in both pregnant and non-pregnant uterine muscles. M. lucida resulted in relaxation of the uterine smooth muscle in both pregnant and non-pregnant mice at all doses. However, at 1.500mg/ml,M. lucida completely blocked spontaneous uterine contractions. Following incubation with L-NAME, M. lucida extract led to a slightly greater relaxation of the uterine strips. In conclusion, M. lucidareduced contractility of uterine smooth muscle in both pregnant and non-pregnant mice as well as blocking contractile responses to OXY and Ach in uterine smooth muscle of pregnant and nonpregnantmice. There was no significant alteration of M. lucida activity by L-NAME suggesting that the action of the compound on uterine muscle is not associated with impaired nitric oxide synthase

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26 of infants (580/2,265; range, 0�100; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received �1 antimicrobial agent (92, antibacterial; 19, antifungal; 4, antiviral). The most common reasons for antibiotic therapy were �rule-out� sepsis (32) and �culture-negative� sepsis (16) with ampicillin (40), gentamicin (35), amikacin (19), vancomycin (15), and meropenem (9) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26), amikacin (20), and meropenem (16) were the most prescribed agents. Length of therapy for culture-positive and �culture-negative� infections was 12 days (median; IQR, 8�14) and 7 days (median; IQR, 5�10), respectively. Mortality was 6 (42, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Funding: Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship © 2021 The Author

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Qualitative methods in operations research on contraceptive distribution systems: A case study from Nigeria

This article discusses the application of qualitative methods in operations research on a family planning service delivery system. Market traders in Ibadan, Nigeria were trained to sell oral contraceptives, condoms, and spermicidal foaming tablets in a collaborative research project of the Fertility Research Unit of the University College Hospital, Ibadan, and the Center for Population and Family Health of Columbia University. Focus group discussion, participant observation, and semi-structured interviews were used to investigate the cultural acceptability of distribution of contraceptives in the market places and the motivations of participating traders. The strength of the market associations was a factor influencing acceptance of the project and the number of customers for the traders' other wares were found to positively influence the volume of sales of contraceptives. Traders were motivated by the status associated with participating in a program of a well-known health institution. Findings from qualitive research suggest areas for quantitative studies and vice versa in an interactive process.qualitative methods operations research contraceptive sales Yoruba markets

Perceived family-related stressors and clinical manifestations of patients with psychosomatic morbidity attending general outpatient clinic university college hospital

Background: Depression, anxiety and somatoform disorder account for psychosomatic morbidity (PSM), the most prevalent mental disorder encountered in primary care. Prominent clinical manifestations of PSM can result from perceived stress and are general and unspecified symptoms (GUS) which most times are unexplained. These symptoms vary in individuals, usually multiple and affect different body parts. Studies have shown that stress relating to health, work and financial problems is common among primary health care attendees, but association with pattern and extent of PSM has not been widely studied in Nigeria.Objective: This study sought to explore the relationship between severity of patients' clinical manifestations and perceived family related stressors (PFRS).Method: The study span for three months, during which 1402 patients ≥18 years who presented at the out-patient clinic for various complaints were encountered. The sample size was determined using the prevalence of 63.1%. for psychosomatic disorder from Ogunsemi et al's study. A sample of 360 patients with varying forms of PSM identified by ≥ 5 from symptoms in the primary evaluation of mental disorder- patient health questionnaire somatoform, anxiety and depression modules (PRIME-MD PHQ SADs) was recruited consecutively out of the patients encountered during the study period. The clinical manifestations of these patients were categorized using international classification for primary care second electronic version (ICPC-2E). The ICPC-2E was modified by the addition of somatic symptoms observed to be peculiar in people with PSM in the study area. The Social Readjustment Rating Scale (SRRS) was used to explore the PFRS. Data were analyzed using statistical package for Social Sciences soft ware version 17. Tables and diagrams in form of graphs, charts were used for relevant variables. Cross tabulations of some independent variables and dependent variable were analyzed using independent t-test and analysis of variance. Statistical significance level was set at p ≤ 0.05.Results: The age of respondents ranged between 18 and 80 years with mean age of 42.2 years + 15.2. Two-thirds of them (67.8%) were females and majority had married once 76.4% [this comprised those that were living with their spouses (62.5%), separated/divorced (3.1%) and widowed (10.8%), while (23.6%) were never married. Commonest complaints observed were GUS (23.3%), cardiovascular system complaints (14.2%), gastrointestinal (11.9%), musculoskeletal complaints (11.4%), gynaecological symptoms (10.6%), neurological (8.6%) and symptoms from other body parts constituted 20%. GUS complaints in this study contained additional features (crawling body sensation, sensation of pain or heaviness in the head, peppery body sensation, migratory body pains and migratory body movement) included in the modified ICPC-2E classification. Almost all respondents screened in with PSM (95.6%) had somatoform disorder by the (PRIME MD) PHQ-SAD questionnaire used.The second and third parts of PHQ-SADS diagnosed that only few have depressive disorder (40%) and anxiety disorder (44.4%). The mean scores for PFRS were higher in respondents with moderate to severe PSM. However, respondents with anxiety related symptoms are more likely to have greater PFRS (p = 0.03).Conclusion: GUS were predominant complaints identified in patients with PSM in this study. Females tend to perceive more psychosocial stressors when compared with males and are more likely to report their symptoms. The study finding suggests that risk factor for a severe manifestation of patients with PSM is higher PFRS

Connaissance de la santé sexuelle et de la reproduction, les besoins éducatifs et comportementaux des adolescents encore à l’école au sud du Nigéria

Adolescence is marked by progression from the appearance of secondary sexual characteristics to sexual and reproductive maturity. Curiosity about bodily changes is heightened. However, adolescents’ perceived sexuality education needs have been poorly documented. A survey of 989 adolescents from 24 North-Eastern Nigerian secondary schools yielded information on socio-demographic characteristics, reproductive health knowledge, sexual activities and sexuality education needs. Of the interviewed respondents, 72% of females had experienced menstruation. Overall, 9% were sexually active, 3.1% knew when ovulation occurs, 47% knew pregnancy could result from first coitus and 56% knew of contraception. 84% opined that adolescents should be given sexuality education but only 48.3% had received any. Sexuality education should be provided for in-school adolescents through their preferred and reliable sources of information (Afr J Reprod Health 2009; 13[4]:37-49).L’adolescence est marquée par une progression à partir de la parution des caractéristiques sexuelles secondaires jusqu’à la maturité sexuelle et de la reproduction. La curiosité à l’égard des modifications physiologiques augmente. Une enquête sur 989 adolescents venant de 24 écoles secondaires du nord-est du Nigeria a donné des renseignements sur les caractéristiques socio-démographiques, la connaissance de la santé de la reproduction, les activités sexuelles et les besoins de l’éducation sexuelle. Parmi les enquêtés, 72% des femelles ont subi la menstruation. Dans l’ensemble, 9% étaient sexuellement actives, 3.1% savaient quand l’ovulation se produit, 47% savaient qu’il est possible de devenir enceinte dès le premier coϊt et 56% connaissaient la contraception. 84% étaient d’opinion que les adolescents doivent avoir l’éducation sexuelle, mais seuls 48,3% l’ont jamais eu. Il faut mettre l’éducation sexuelle sur le programme scolaire des adolescents encore à l’école à travers leurs sources sérieuses d’information (Afr J Reprod Health 2009; 13[4]: 37-49)