Etiology of major limb amputations at a tertiary care centre in Malawi

Introduction Amputations in low-and middle-income countries (LMICs) represent an important cause of disability and economic hardship. LMIC patients are young and suffer from preventable causes, such as trauma and trauma-related infections. We herein studied the etiology in amputations in a Malawian tertiary care hospital over a 9-year period. Methods Operative and anaesthesia logs at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, were reviewed for 2008–2016. Baseline demographic and clinical variables and type of amputation performed were collected. Only major limb amputations, defined as above or below the knee, above or below the elbow, and above the wrist, were included in this study. Results A total of 610 patients underwent 630 major amputations during the study period. Of these, 170 (27%) patients were female, and the median age of the cohort was 39 (interquartile range [IQR] 25–55). Of these patients, 345 (54.8%) had infection or gangrene recorded among the indications for amputation, 203 (32.2%) had trauma, 94 (14.9%) had cancer and 67 (10.6%) had documented diabetes. Women underwent diabetes-related amputations more often than men (37 out of 67, or 56.1%), and were significantly younger when their amputations were due to diabetes (median age 48 vs 53 years old, P=0.004) or trauma (median age 21 vs 30 years old, P=0.02). The commonest operative procedures were below the knee amputations, at 271 (43%), and above the knee amputations, at 213 (33.8%). Conclusion Amputations in Malawi affect primarily the young, in the most economically productive time of their lives, in contrast to amputees in high-income countries. Preventable causes, such as infection and trauma, lead to the majority of amputations. These etiologies represent an important primary prevention target for public health efforts in LMICs

‘Bordering’ Life: denying the right to live before being born

This study pushes the boundaries of the border thinking discourse to examine grassroots perceptions of foeticide together with how women are valued in a society that is underpinned by preference for a male child. Using a bordering conceptual framework, the paper re-visits the female positionality within epistemic locations of culture and societal values in both colonial and the modern Indian context. Grounded in primary research in the state of Haryana that exhibits lowest female to male ratio at birth in the country, the analyses indicate rigid or at best sluggish movements in social norms as the key driver for India’s declining sex ratio. The border thinking discourse further enables to situate the different aspects of female positionality and gender perceptions in the society into the specific domains of the bordering conceptual framework. This offers a novel approach to engage with social norms that border life and opportunities for females in the society

Healthy environments from a broad perspective : an overview of research performed at the unit Building Physics and Systems of Eindhoven University of Technology

The design and realization of a healthy indoor environment is a challenge that is investigated from different perspectives at the unit Building Physics and Systems (BPS; Faculty of Architecture, Building and Planning) of Eindhoven University of Technology. Performance requirements (for instance, with respect to air quality, thermal comfort and lighting) and performance based assessment methods are the point-of-departure, focusing at computational techniques supporting the design process. Different specific application fields such as dwellings, offices, schools, but also, operating theatres, churches, musea and multifunctional stadiums, underline the applied approach that is part of the research within the unit. In the design of healthy environments, the performance based design assessment is crucial in arriving at innovative design solutions and optimized indoor and outdoor environments. In this assessment computational support tools and experimental verification play an important role. However, assessing the right indicators in an objective way, applying the correct tools and correct application of these tools is not yet well established. Alongside, developments are still ongoing. The work performed in the unit by the different researchers relates to the research questions that can be derived from this notice. The paper gives an introduction to the Unit BPS and presents a brief overview of recent and ongoing research. An extensive list of references is provided for further reading and supports the conclusion that healthy environments can and should be addressed from a wide angle

Catalytic Intermolecular Hetero-Dehydro-Diels–Alder Cycloadditions: Regio- and Diasteroselective Synthesis of 5,6-Dihydropyridin-2-ones

A novel catalyzed intermolecular heterodehydro-Diels–Alder reaction between push–pull 1,3-dien-5-ynes and aldimines or silylaldimines is reported. The sequence is promoted both by gold(I) or silver(I) catalysts and leads to the diastereo- and regioselective formation of 5,6-dihydropyridin-2-onesMICINN (Spain) (grants CTQ2009-09949, CTQ2010-16790, PTA2008-1524-P contract to J.M.F.-G. and Ramon y Cajal postdoctoral contract to M.A.F.-R.) and FICYT (project IB08-088)This document is the Accepted Manuscript version of a Published Work that appeared in final form in Organic letters, copyright © American Chemical Society after peer review and technical editing by the publisher. To access the final edited and published work see http://pubs.acs.org/page/policy/articlesonrequest/index.htm

BIM aplicado ao projeto de fôrmas de madeira em estrutura de concreto armado

ResumoO Projeto Construtivo de Fôrmas de Madeira (PCFM) faz uso tradicionalmente de ferramentas CAD na representação bidimensional, limitando sua inserção no contexto de Building Information Modeling (BIM). Considerando que BIM se encontra em grande expansão no mercado nacional esta pesquisa visa apontar um caminho para se vencer esta limitação. Propõe-se uma biblioteca de componentes para o projeto de fôrmas de madeira, incluindo usos de BIM tais como a Modelagem, a Quantificação, a Simulação 4D e procedimentos associados. O método de pesquisa utilizado foi a Constructive Research. Os componentes para a biblioteca foram desenvolvidos na ferramenta BIM Revit Structure. A proposta foi validada: em ambiente de ensino, escritório de projeto e na prática. Verifica-se que a pesquisa é consonante com os poucos estudos internacionais pioneiros e semelhantes, sendo contextualizada para o cenário nacional. Observa-se também que todas as pesquisas que tratam de BIM associado a fôrmas requerem um modelo de informação que inclua a modelagem de fôrmas no mesmo. Desta forma, este estudo é também fundamental, pois amplia desdobramentos da incorporação de BIM na cadeia produtiva da construção civil

Headache and migraine during pregnancy and puerperium: the MIGRA-study

There is little prospectively gathered data on the course of headaches during pregnancy and postpartum, and the influence of breastfeeding is unclear. This is a large, prospective study, which invited all pregnant women in the catchment area during a defined period. All participants (n = 2,126) filled in questionnaires concerning headache. Among these, a total of 208 women with migraine according to the International Headache Society criteria also filled in detailed headache diaries during pregnancy and the puerperal period. Freedom from earlier headaches during pregnancy was significantly more common than new onset of headache during pregnancy (p < 0.001). This was not influenced by prior use of oral contraceptives. According to the diaries, there was a gradual decrease during pregnancy in the frequency of all headaches and of self-considered migraine. There was also a significant decrease in the duration of headaches (p < 0.001) during pregnancy compared to before. Earlier parity did not influence the course. Apart from a significant increase during the first week postpartum (p < 0.01), the overall occurrence of headaches during puerperium did not differ from the pregnancy period. Compared to pregnancy, there was a postpartum increase in the mean intensity (p < 0.01) and duration (p = 0.050) of headaches, as well as in the mean number of analgesics used (p < 0.001). Breastfeeding did not influence the occurrence of headaches postpartum. These data are of practical value for informing pregnant migraineurs about the typical clinical prospects and for giving advice on breastfeeding

Sleep duration, vital exhaustion and perceived stress among pregnant migraineurs and non-migraineurs

<p>Abstract</p> <p>Background</p> <p>Migraine has been associated with sleep disorders in men and non-pregnant women, but little is known about sleep complaints among pregnant migraineurs.</p> <p>Methods</p> <p>A cohort of 1,334 women was interviewed during early pregnancy. At the time of interview we ascertained participants' migraine diagnosis status and collected information about sleep duration before and during early pregnancy, daytime sleepiness, vital exhaustion and perceived stress during early pregnancy. Multivariable logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of short/long sleep duration, excessive daytime sleepiness, vital exhaustion and elevated perceived stress associated with a history of migraine.</p> <p>Results</p> <p>Approximately 19.4% of the cohort (n = 259) reported having a medical diagnosis of migraine prior to the study pregnancy. Compared with women without migraine, the multivariable-adjusted ORs (95% CI) among migraineurs for short sleep duration before and during early pregnancy were 1.51 (1.09-2.09), and 1.57 (1.11-2.23), respectively. The corresponding OR (95% CI) for long sleep duration before and during pregnancy were 1.33 (0.77-2.31) and 1.31 (0.94-1.83), respectively. A modest and statistically insignificant association between migraine history and excessive daytime sleepiness in early pregnancy was noted (OR = 1.46; 95% CI 0.94-2.26). Migraineurs had an increased risk of vital exhaustion (OR = 2.04; 95% CI 1.52-2.76) and elevated perceived stress (OR = 1.57; 95% CI 1.06-2.31). Observed associations were more pronounced among overweight migraineurs.</p> <p>Conclusions</p> <p>These data support earlier research documenting increased risks of sleep disorders among migraineurs; and extends the literature to include pregnant women. Prospective studies are needed to more thoroughly explore factors that mediate the apparent migraine-sleep comorbidity among pregnant women.</p