Analysis of Perinatal Mortality at a Teaching Hospital in Dar es Salaam, Tanzania, 1999-2003

We conducted a retrospective analysis of perinatal mortality at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania 1999-2003 in order to categorise/classify perinatal deaths as well as to identify key factors in perinatal care that could be improved. Data were retrieved from the MNH obstetric database and causes of early neonatal deaths were traced from the neonatal ward register. The study includes all foetuses weighing ≥500g. A modified Nordic-Baltic classification was used for classification of perinatal deaths. Over a 5-year period there were 77,815 babies born with a perinatal mortality rate of 124 per 1000 births, 78% of which was labour related stillbirth. The PMR was 913/1000 for singleton births and 723/1000 for multiple births for babies weighing less than 1500 grams and 65/1000 for singleton births and 116/1000 for multiple births for babies weighing 2500 grams or more. Babies weighing less than 1500 grams contributed 26% of PMR, whereas 41% occurred in babies weighing 2500 grams or more. The majority (79%) of neonatal deaths had Apgar scor

Staffing needs for quality perinatal care in Tanzania

In Tanzania maternal and perinatal mortalities and morbidities are problems of public health importance, and have been linked to the shortage of skilled staff. We quantified the available workforceand the required nursing staff for perinatal care in 16 health institutions in Dar es Salaam. WHO safe motherhood needs assessment instruments were used to assess the availability of human resources,WHO designed Workload Indicators for Staffing Need (WISN) and Tanzanian standard activities and components of the workload for labour ward nursing were used to calculate nurse staffing requirementsand WISN ratios. There was a severe shortage of essential categories of health staff for perinatal care in all institutions. The ranges of WISN ratios for nursing staff working in the municipal hospitals’ labourwards were; nurse officers 0.5 – 1, trained nurses/midwives 0.2 - 0.4 and nurse assistants 0.1. These findings reflect extremely huge perinatal care workload pressure and suggest the urgent need for morestaff in order to achieve the global millennium development goals set for maternal and infant survival (Afr J Reprod Health 2008; 12[3]:113-124)

Lymph node tissue kallikrein-related peptidase 6 mRNA: a progression marker for colorectal cancer

BACKGROUND: A most important characteristic feature for poor prognosis in colorectal cancer (CRC) is the presence of lymph node metastasis. Determination of carcinoembryonic antigen (CEA) mRNA levels in lymph nodes has proven powerful for quantification of disseminated tumour cells. Here, we investigate the utility of human tissue kallikrein-related peptidase 6 (KLK6) mRNA as a progression biomarker to complement CEA mRNA, for improved selection of patients in need of adjuvant therapy and intensified follow-up after surgery. METHODS: Lymph nodes of pTNM stage I-IV CRC-(166 patients/503 lymph nodes) and control (23/108) patients were collected at surgery and analysed by quantitative RT-PCR. RESULTS: Lymph node KLK6 positivity was an indicator of poor outcome (hazard ratio 3.7). Risk of recurrence and cancer death increased with KLK6 lymph node levels. Patients with KLK6 lymph node levels above the 90th percentile had a hazard ratio of 6.5 and 76 months shorter average survival time compared to patients with KLK6 negative nodes. The KLK6 positivity in lymph nodes with few tumour cells, that is, low CEA mRNA levels, also indicated poor prognosis (hazard ratio 2.8). CONCLUSION: In CRC patients, lymph node KLK6 positivity indicated presence of aggressive tumour cells associated with poor prognosis and high risk of tumour recurrence. British Journal of Cancer (2012) 107, 150-157. doi: 10.1038/bjc.2012.220 www.bjcancer.com Published online 14 June 2012 (C) 2012 Cancer Research U

Visualization of Merging Flow by Usage of PIV and CFD with Application to Grate-Kiln Induration Machines

One way to upgrade iron ore is to process it into pellets. Such a process includes several stages involving complex fluid dynamics. In this work, focus is on the grate-kiln pelletizing process and especially on the rotary kiln, with the objective to get a deeper understanding of the aerodynamics in order to improve the combustion. A down-scaled, simplified model of the real kiln is created and both numerical and experimental analyses of the flow field are performed. Conclusions are that steady state simulations can be used to get an overview over the main features of the flow field. Precautions should though be taken when analyzing the recirculation zone since steady state simulations do not capture the transient, oscillating behavior of the flow seen in the physical experiment. These oscillations will under certain conditions considerably affect the size of the recirculation zone

Secondary Flow in Semi-Circular Ducts

Turbulent secondary flows are motions in the transverse plane, perpendicular to a main, axial flow. They are encountered in non-circular ducts and can, although the velocity is only of the order of 1-3% of the streamwise bulk velocity, affect the characteristics of the mean flow and the turbulent structure. In this work, the focus is on secondary flow in semi-circular ducts which has previously not been reported. Both numerical and experimental analyses are carried out with high accuracy. It is found that the secondary flow in semi-circular ducts consists of two pairs of counter rotating corner vortices, with a velocity in the range reported previously for related configurations. Agreement between simulation and experimental results are excellent when using a second moment closure turbulence model, and when taking the experimental and numerical uncertainty into account. New and unique results of the secondary flow in semi-circular ducts have been derived from verified simulations and validating laser-based experiments

Biomarker selection for detection of occult tumour cells in lymph nodes of colorectal cancer patients using real-time quantitative RT–PCR

Accurate identification of lymph node involvement is critical for successful treatment of patients with colorectal carcinoma (CRC). Real-time quantitative RT–PCR with a specific probe and RNA copy standard for biomarker mRNA has proven very powerful for detection of disseminated tumour cells. Which properties of biomarker mRNAs are important for identification of disseminated CRC cells? Seven biomarker candidates, CEA, CEACAM1-S/L, CEACAM6, CEACAM7-1/2, MUC2, MMP7 and CK20, were compared in a test-set of lymph nodes from 51 CRC patients (Dukes' A–D) and 10 controls. Normal colon epithelial cells, primary tumours, and different immune cells were also analysed. The biomarkers were ranked according to: (1) detection of haematoxylin/eosin positive nodes, (2) detection of Dukes' A and B patients, who developed metastases during a 54 months follow-up period and (3) identification of patients with Dukes' C and D tumours using the highest value of control nodes as cutoff. The following properties appear to be of importance; (a) no expression in immune cells, (b) relatively high and constant expression in tumour tissue irrespective of Dukes' stage and (c) no or weak downregulation in tumours compared to normal tissue. CEA fulfilled these criteria best, followed by CK20 and MUC2

A longitudinal study of perceived health during pregnancy: antecedents and outcomes

Perceived health was studied longitudinally in a sample of 364 nulliparous women. Psychosocial, contextual, and biomedical factors were taken into account to predict medically relevant versus benign symptoms which were then used to predict perceived health over time. The results of structural equation modeling showed that pregnancy adjustment and medically relevant symptoms which were affected by social support, perceived stress, and negative affect predicted later perceived health. The outcomes of perceived health were examined during the third trimester in terms of medical care utilization and emergency room visits. Perceived health solely accounted for medical care utilization, while emergency room visits were accounted by medical care utilization and perceived stress

Colonic Health in Hospitalized Horses Treated with Non-Steroidal Anti-Inflammatory Drugs - A Préliminary Study

peer reviewe

Nutrient density of beverages in relation to climate impact

The food chain contributes to a substantial part of greenhouse gas (GHG) emissions and growing evidence points to the urgent need to reduce GHGs emissions worldwide. Among suggestions were proposals to alter food consumption patterns by replacing animal foods with more plant-based foods. However, the nutritional dimensions of changing consumption patterns to lower GHG emissions still remains relatively unexplored. This study is the first to estimate the composite nutrient density, expressed as percentage of Nordic Nutrition Recommendations (NNR) for 21 essential nutrients, in relation to cost in GHG emissions of the production from a life cycle perspective, expressed in grams of CO2-equivalents, using an index called the Nutrient Density to Climate Impact (NDCI) index. The NDCI index was calculated for milk, soft drink, orange juice, beer, wine, bottled carbonated water, soy drink, and oat drink. Due to low-nutrient density, the NDCI index was 0 for carbonated water, soft drink, and beer and below 0.1 for red wine and oat drink. The NDCI index was similar for orange juice (0.28) and soy drink (0.25). Due to a very high-nutrient density, the NDCI index for milk was substantially higher (0.54) than for the other beverages. Future discussion on how changes in food consumption patterns might help avert climate change need to take both GHG emission and nutrient density of foods and beverages into account