Course and outcome of obstetric patients admitted to a University Hospital Intensive Care Unit

Background: Obstetric Critical Care is an important service in the reduction of maternal morbidity and mortality, but few developing country data are available.Objectives: To review all maternity patients admitted to the ICU over a seven year period to determine the causes and outcomes of these admissions and the frequency and causes of maternal morbidity and mortality.Design: Retrospective patient file and ICU chart review.Subjects: ICU Charts and medical files of obstetric patients admitted to the ICU at The Aga Khan University Hospital between (November 2003 – November 2010) were reviewed.Setting: The ICU at The Aga Khan University Hospital, Nairobi, Kenya.Results: Fourty two obstetric patients were admitted to the intensive care unit for the period of November 2003 to November 2010. This constituted 0.24% of deliveries and 1.25% of ICU admissions. Seventeen patients (52%) were in the age group 30 to 40 years, 13 patients (45%) were on their second pregnancy, and 15 patients (51%) were at term. Twenty five patients (76%) did not have prior co-morbidities. Indications for ICU admission were haemorrhage 15 (44%), sepsis nine (26%), help syndrome four (12%), thromboembolism two (6%), cardiomyopathy two (6%) and anaemia two (6%). The duration of stay ranged from two to 35 days with a mean of seven and median of two days. The outcome was19 patients (58%) were discharged home, 11 patients (33%) deaths and three patients (9%) were transferred to the National referral hospital- their survival outcome unknown. Case fatality rates were three of four patients (75%) for HELLP syndrome, four of fifteen patients (26.7%) for haemorrhage and three of ten patients (30%) after sepsis.Conclusion: Critical Care Obstetrics is vital to the reduction of maternal morbidity. The main indications for ICU admission may be unpredictable but are largely preventable by improved and timely antenatal and intrapartum care. For the few but very sick patients requiring ICU care, a team based approach, as is achieved using the ‘closed’ care model may be feasible. Support to peripheral obstetric facilities via public private partnership initiatives is necessary. Healthcare planners and financiers should factor in critical care obstetric needs. Provision of a planned level of obstetric intensive care with the associated triage and referral infrastructure is a priority for the Region. As part of the drive towards Millennium Development Goal 5, health care financing models should support this essential component of life saving care, through all available channels including public private partnership

Active flutter control for flexible vehicles, volume 1

An active flutter control methodology based on linear quadratic gaussian theory and its application to the control of a super critical wing is presented. Results of control surface and sensor position optimization are discussed. Both frequency response matching and residualization used to obtain practical flutter controllers are examined. The development of algorithms and computer programs for flutter modeling and active control design procedures is reported

Opportunities and Challenges in Realizing Universal Access to Obstetric Ultrasound in Sub-Saharan Africa

The potential benefits of obstetric ultrasound have yet to be fully realized in sub-Saharan Africa (SSA), despite the region bearing the greatest burden of poor perinatal outcomes. We reviewed the literature for challenges and opportunities of universal access to obstetric ultrasound and explored what is needed to make such access an integral component of maternity care in order to address the massive burden of perinatal morbidity and mortality in SSA. Original peer-reviewed literature was searched in various electronic databases using a ‘realist’ approach. While the available data were inconclusive, they identify many opportunities for potential future research on the subject within the region that can help build a strong case to justify the provision of universal access to ultrasound as an integral component of comprehensive antenatal care

Opportunities and Challenges in Realizing Universal Access to Obstetric Ultrasound in Sub-Saharan Africa

The potential benefits of obstetric ultrasound have yet to be fully realized in sub-Saharan Africa (SSA), despite the region bearing the greatest burden of poor perinatal outcomes. We reviewed the literature for challenges and opportunities of universal access to obstetric ultrasound and explored what is needed to make such access an integral component of maternity care in order to address the massive burden of perinatal morbidity and mortality in SSA. Original peer-reviewed literature was searched in various electronic databases using a ‘realist’ approach. While the available data were inconclusive, they identify many opportunities for potential future research on the subject within the region that can help build a strong case to justify the provision of universal access to ultrasound as an integral component of comprehensive antenatal care

Human resource inequalities at the base of India's public health care system

This paper examines the extent of inequalities in human resource provision at India's Heath Sub-Centres (HSC) - first level of service provision in the public health system. ‘Within state' inequality explained about 71% and ‘between state’ inequality explained the remaining 29% of the overall inter-HSC inequality. The Northern states had a lower health worker share relative to the extent of their HSC provision. Contextual factors that contributed to ‘between’ and ‘within’ district inequalities were the percentages of villages connected with all-weather roads and having primary schools. Analysis demonstrates a policy and programming need to address ‘within State’ inequalities as a priority

Maternal tetanus toxoid vaccination and neonatal mortality in rural North India

Objectives: Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India. Methods and Findings: Using the third round of the Indian National Family Health Survey (NFHS) 2005-06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) vaccination. The odds of all-cause neonatal death were reduced following one or more antenatal dose of TT with odds ratios (OR) of 0.46 (95% CI 0.26 to 0.78) after one dose and 0.45 (95% CI 0.31 to 0.66) after two or more doses. Reported utilisation of antenatal care and iron-folic acid supplementation did not influence neonatal mortality. In the statistical model, 16% (95% CI 5% to 27%) of neonatal deaths could be attributed to a lack of at least two doses of TT vaccination during pregnancy, representing an estimated 78,632 neonatal deaths in absolute terms. Conclusions: Substantial gains in newborn survival could be achieved in rural North India through increased coverage of antenatal TT vaccination. The apparent substantial protective effect of a single antenatal dose of TT requires further study. It may reflect greater population vaccination coverage and indicates that health programming should prioritise universal antenatal coverage with at least one dose

Notes on the observation of a Taliabu Masked Owl Tyto nigrobrunnea on Taliabu Island, Indonesia

No abstract availabl

Control for Uterine Fibroid Embolisation- An Initial Experience in East Africa

Uterine fibroid embolisation (UFE) generates moderate to severe post-procedural pain. We present a case series of 24 patients who underwent UFE during our first experience in managing the sometimes excruciating pain that accompanies embolisation of the uterine arteries. We also show the evolution of our protocol for post-procedural pain management from a first to second round of procedures

A bioinformatics approach to the development of immunoassays for specified risk material in canned meat products

A bioinformatics approach to developing antibodies to specific proteins has been evaluated for the production of antibodies to heat-processed specified risk tissues from ruminants (brain and eye tissue). The approach involved the identification of proteins specific to ruminant tissues by interrogation of the annotation fields within the Swissprot database. These protein sequences were then interrogated for peptide sequences that were unique to the protein. Peptides were selected that met these criteria as close as possible and that were also theoretically resistant to either pepsin or trypsin. The selected peptides were synthesised and used as immunogens to raise monoclonal antibodies. Antibodies specific for the synthetic peptides were raised to half of the selected peptides. These antibodies have each been incorporated into a competitive enzyme-linked immunosorbent assay (ELISA) and shown to be able to detect the heat-processed parent protein after digestion with either pepsin or trypsin. One antibody, specific for alpha crystallin peptide (from bovine eye tissue), was able to detect the peptide in canned meat products spiked with 10% eye tissue. These results, although preliminary in nature, show that bioinformatics in conjunction with enzyme digestion can be used to develop ELISA for proteins in high-temperature processed foods and demonstrate that the approach is worth further stud