What price a welcome? Understanding structure-agency in the delivery of respectful midwifery care in Uganda

Purpose – The purpose of this paper is to present the findings of research on mothers and midwives’ understanding of the concept of respectful care in the Ugandan public health settings. It focusses on one aspect of respect; namely communication that is perhaps least resource-dependent. The research found endemic levels of disrespect and tries to understand the reasons behind these organisational cultures and the role that governance could play in improving respect. Design/methodology/approach – The study involved a combination of in-depth qualitative interviews with mothers and midwives together with focus groups with a cohort of midwives registered for a degree. Findings – The findings highlight an alarming level of verbal abuse and poor communication that both deter women from attending public health facilities and, when they have to attend, reduces their willingness to disclose information about their health status. Respect is a major factor reducing the engagement of those women unable to afford private care, with health facilities in Uganda. Research limitations/implications – Access to quality care provided by skilled birth attendants (midwives) is known to be the major factor preventing improvements in maternal mortality and morbidity in low income settings. Although communication lies at the agency end of the structure-agency continuum, important aspects of governance contribute to high levels of disrespect. Originality/value – Whilst there is a lot of research on the concept of respectful care in high income settings applying this to the care environment in low resource settings is highly problematic. The findings presented here generate a more contextualised analysis generating important new insights which we hope will improve the quality of care in Uganda health facilities. Keywords: Leadership, Governance structures, Patient perspectives, Communication, Midwifery, Determinants of health Paper type Research pape

Effects of ovarian varicose vein on mitochondrial structure, malondialdehyde and prooxidants - Antioxidants balance in rat ovaries Efectos de las Venas Ováricas Varicosas sobre la Estructura Mitocondrial, Niveles de Malondialdehído y Balance Prooxidantes-antioxidantes en Ovarios de Ratas

Oxidative stress is increased in varicose veins. Many studies have implicated oxidative stress in the pathogenesis of infertility causing diseases of the female reproductive tract. The aim of this study was to determine whether varicocele can cause raised levels of reactive oxygen species and denaturation of mitochondrial structure in ovaries of female rats or not. In each experimental study, 15 weaning-age female rats were divided equally in 3 groups: Unilateral Varicose Vein (A), Sham (B) and Control (C) groups. Mitochondrial structure and malondialdehyde levels as a product of lipid peroxidation and Prooxidants-Antioxidants Balance were evaluated 60 days after intervention in proestrus stage. Comparisons between groups were made by the measured test. After 2 months, our results showed that mitochondrial structure ultra-structurally was denatured with histologic examination, malondialdehyde and prooxidants-antioxidants balance levels of left ovaries increased significantly in varicocele group compared to control and sham groups (P�0.05). In the right side, malondialdehyde increased significantly, but in prooxidantsantioxidants balance levels, there is no significant differences between groups. The data of control and sham groups were the same. These findings may support the concept that increased levels of malondialdehyde and PAB in varicocele may cause negative effects on fertility, so using antioxidants maybe useful. © 2015, International Journal of Morphology. All rights reserved

Burning Mouth Syndrome in Zahedan; the Southeast of Islamic Republic of Iran

Statement of Problem: Burning mouth syndrome (BMS) is characterized by a burning sensation in the tongue or other oral sites, usually in the absence of clinical and laboratory findings.Purpose: The aim of this study was to evaluate the main epidemiological and clinical features involved in burning mouth syndrome in Zahedan; southeast of Iran.Materials and Methods: In this case series study, 89 BMS patients were selected from those referred to the Department of the Oral Medicine, Faculty of Dentistry, and Khatam-ol-anbia, central hospital, Zahedan University of Medical Sciences, during2002 to 2003. The study group consisted of 62 female (69.7%) and 27 male (30.3 %)patients, with a mean age of 60.9 years, ranging from 40 to 89 years. In all cases a study protocol, specially designed for this disease was completed, including general, medical and oral information and an intraoral examination. Comparative and descriptivestatistical analysis was performed. The Chi-square test was considered significant at p<0.05.Results: The 50-59 years age group showed the highest prevalence among the studied cases (24.3%). The tongue was the most frequent location of symptoms, affected in 86 patients (96.6%). In addition to the burning sensation, 25.8% and 48.3% of the patientscomplained of oral dryness and dysgusia, respectively. Type III BMS was the most common subtype (50.6%). In women, 90.3% were postmenopausal. Type II diabetes was observed in 36% of the patients and 37.1% suffered from respiratory disease,23.6% from gastritis, 15.7% from liver diseases, 30.3% from renal disease, 40.4% fromhypertension and 43.8% had sleep disorders. Also, 52.8% revealed seasonal allergy,32.6% had temporomandibular joint disorders and 59.6% had poor oral hygiene.Conclusion: BMS is a complex and multifactorial disease process in which numerous possible etiologies must be eliminated before the proper treatment can be initiated

Ultrastructural Study of Neutrophils in Fetal Rat Spleen Following Lead Intoxication

Introduction: Lead is one of the heavy metals that have adverse effects on blood cellsand hemopoiesis. In this study the ultrastructure of neutrophils in fetal rat spleen wereinvestigated following lead intoxication. Material and Methods: Thirty female and 6 male Sprague-Dawley rats were chosenby simple random sampling. After mating the pregnant rats were classified into test and controlgroups. From the first day of pregnancy the test group was provided ad lib with watercontaining 0.13% lead acetate and the control group had access to distilled water. After birth 10newborn in each group were chosen by systematic random sampling. The spleens of thenewborn rats were fixed in a solution of 2% glutaraldehyde, and after processing, sections werestudied by a transmission electron microscope. Results: The ultrastructural changes included: irregular nuclei with deep invagination,plasma membrane pockets, presence of vacuoles with a heterogeneous material and anincreasing incidence of rough endoplasmic reticulum with dilated cisternae. No differencesbetween the groups were observed in the mitochondrial morphology and pattern of cytoplasmicgranules (primary granules with electron dense appearance and specific or secondary granuleswith less electron density and heterogeneous appearance). Conclusion: Lead transmitted via the placenta can affect the ultrastructure, and mostprobably the function, of fetal neutrophils. More attention must be given to the dangers of leadpollution of the environment and the need to eliminate exposure to lead in work place

Effects of L-NAME on morphometric parameters of stomach parietal cells in pregnant rats

Background: Considering nitric oxide (NO) has an important role in many biologic processes of cells and tissues such as in the digestive system and in this system act as a second messenger in pathological and physiological events in gastrointestinal region, in this study we investigated the effects of L-NG-Nitro arginine Methyl Ester (L-NAME) as the NO formation inhibitor on parietal cells of stomach in pregnant rats. Methods: Twenty four female rats were prepared and with eight weeks old and 200-250 g weight were used in this study. After matting of the female rats with the male rats, time of observing vaginal plaque considered as the zero day of pregnancy. Then the animals were divided into three groups of studying. Each group was containing eight rats. In this study, except the control group, the saline group received 2 ml/kg normal saline and experimental group received 20 ml/kg L-NAME interaperitoneally (IP), respectively on third, fourth, and fifth days of pregnancy for evaluation of its effects. On the 18th day of pregnancy, after anesthesia with ether, the animals were killed and dissected and the laparotomy was performed to separate the mother’s stomach. Then, the stomach was fixed in 10% formalin and after tissue passage, the sections were stained with Hematoxylin-Eosin (H&E). Then the changes of count and diameter in parietal cells were observed via light microscopy and Image Tools III. Results: Results of this study after analysis showed the significant changes in parietal cells count (mean 61.3±4.32) and its diameters (mean 16.12±1.18 µm) in L-NAME group in comparison to control and the sham groups in pregnant rats (P≤0.05). Conclusion: Results of this study showed L-NAME with effects on NO synthesis can reduce the count of parietal cells and increase its diameter in pregnant rats and has destructive effects on structure of stomach parietal cells in pregnancy rats

Compliance with measures among actors and lessons learnt in the management of COVID-19 institutional quarantine in Uganda

Introduction: To support COVID-19 containment measures, several countries implemented quarantine protocols. This study determined the level of compliance to COVID-19 quarantine measures, associated factors, and lessons learnt in institutional quarantine management in Uganda. Methods: This concurrent mixed methods study involved a cross-sectional survey among individuals who were in institutional quarantine and interviews with key informants, who were reached mostly through phone calls. Univariate, bivariate, and multivariable analysis were conducted to analyse quantitative data while qualitative data were analysed thematically with the aid of Atlas ti 7. Results: Compliance with quarantine measures at the individual level was moderate at 65.4 %. Factors associated with high compliance with measures were: older age (above 40 years) [APR = 1.30 (95 % CI: 1.04–1.63)], spending 14–15 days in quarantine [APR = 1.39 (95 % CI: 1.00–1.92)] and reporting a high Ministry of Health compliance [APR = 1.33 (CI: 1.11–1.58)]. The positive factors included the availability of guidelines, inspection of facilities and training of personnel. The challenges were related to long turnaround time for results and provision of personal protective equipment (PPE). Conclusion: Efforts to improve training, supervision and inspection of facilities, and provision of adequate PPE would improve compliance with quarantine measures

Mouse preantral follicle growth in 3D co-culture system using human menstrual blood mesenchymal stem cell

Follicle culture provides a condition which can help investigators to evaluate various aspects of ovarian follicle growth and development and impact of different components and supplementations as well as presumably application of follicle culture approach in fertility preservation procedures. Mesenchymal Stem Cells (MSCs), particularly those isolated from menstrual blood has the potential to be used as a tool for improvement of fertility. In the current study, a 3D co-culture system with mice preantral follicles and human Menstrual Blood Mesenchymal Stem Cells (MenSCs) using either collagen or alginate beads was designed to investigate whether this system allows better preantral follicles growth and development. Results showed that MenSCs increase the indices of follicular growth including survival rate, diameter, and antrum formation as well as the rate of in vitro maturation (IVM) in both collagen and alginates beads. Although statistically not significant, alginate was found to be superior in terms of supporting survival rate and antrum formation. Hormone assay demonstrated that the amount of secreted 17 β-estradiol and progesterone in both 3D systems increased dramatically after 12 days, with the highest levels in system employing MenSCs. Data also demonstrated that relative expression of studied genes increased for Bmp15 and Gdf9 and decreased for Mater when follicles were cultured in the presence of MenSCs. Collectively, results of the present study showed that MenSCs could improve indices of follicular growth and maturation in vitro. Further studies are needed before a clinical application of MenSCs-induced IVM is considered. © 2018 Society for Biology of Reproduction & the Institute of Animal Reproduction and Food Research of Polish Academy of Sciences in Olszty

Mouse preantral follicle growth in 3D co-culture system using human menstrual blood mesenchymal stem cell

Follicle culture provides a condition which can help investigators to evaluate various aspects of ovarian follicle growth and development and impact of different components and supplementations as well as presumably application of follicle culture approach in fertility preservation procedures. Mesenchymal Stem Cells (MSCs), particularly those isolated from menstrual blood has the potential to be used as a tool for improvement of fertility. In the current study, a 3D co-culture system with mice preantral follicles and human Menstrual Blood Mesenchymal Stem Cells (MenSCs) using either collagen or alginate beads was designed to investigate whether this system allows better preantral follicles growth and development. Results showed that MenSCs increase the indices of follicular growth including survival rate, diameter, and antrum formation as well as the rate of in vitro maturation (IVM) in both collagen and alginates beads. Although statistically not significant, alginate was found to be superior in terms of supporting survival rate and antrum formation. Hormone assay demonstrated that the amount of secreted 17 β-estradiol and progesterone in both 3D systems increased dramatically after 12 days, with the highest levels in system employing MenSCs. Data also demonstrated that relative expression of studied genes increased for Bmp15 and Gdf9 and decreased for Mater when follicles were cultured in the presence of MenSCs. Collectively, results of the present study showed that MenSCs could improve indices of follicular growth and maturation in vitro. Further studies are needed before a clinical application of MenSCs-induced IVM is considered. © 2018 Society for Biology of Reproduction & the Institute of Animal Reproduction and Food Research of Polish Academy of Sciences in Olszty