Consideraciones generales sobre la Enfermedad Hipertensiva del embarazo.

It was performed a revision article about some aspects of Hypertensive disease in pregnancy with the objective to update the topic and facilitate the educational information about the physiopathology, risk factors, prevention,  changes in different systems of the organism and their management. The bibliographical research was exhaustive, automatized in the magazines of the speciality that were published since 2003 to 2011, from every part of the world, in English or Spanish, circulating in the internet. It is concluded that until the current time the disease was maintained as a health problem that was not solved yet in the maternal infant care with several controversial aspects in the physiopathology, what brought difficulties in the prevention and precocious treatment of the disease.Se realizó un artículo de revisión sobre algunos aspectos de la Enfermedad Hipertensiva del Embarazo con el objetivo de actualizar e informar sobre el tema y facilitar información docente sobre la fisiopatología, factores de riesgo, prevención, cambios en diferentes sistemas del organismo y manejo. La búsqueda bibliográfica se realizó de forma exhaustiva, automatizada en las revistas de la especialidad,  publicadas del 2003 al 2011, de cualquier región del mundo, en idioma español e inglés que están  circulando en Internet. Se concluyó que hasta el momento actual la enfermedad se mantiene como un problema de salud no resuelto en la atención materno-infantil con numerosos puntos controvertidos en su fisiopatología, lo que dificulta la prevención y el tratamiento precoz de la misma

Dinámica de la formación praxiológica docente en el Médico General

Background: the analysis of external manifestations that have been identified in the current training of medical students allows the identification of shortcomings in the process of educational assessment of medical behavior regarding contextual diversity, which limits the relevance of the training in these professionals. Objective: to develop a system of procedures for General Practitioner teaching training based on a model of the dynamics of teaching praxiological training. Methods: a qualitative study was conducted from April 2008 to December 2010 at the Medical University of Granma. Factual diagnosis revealed shortcomings in the use of educational tools for preventing diseases, and limitations in understanding the educational role of medical behavior for health education in a community diversity context. A system of procedures for the teaching training of Basic General Practitioners was developed and implemented based on a model of teaching praxiological training of these professionals. Results: with the use of achievement patterns, it was found that one hundred percent of teaching assistants acquired the basic knowledge on Pedagogy as a science for the tasks of prevention, promotion, diagnosis, treatment and rehabilitation. An assessment of the health situation in a maternity ward was achieved by making use of the clinical-epidemiological method with pedagogical arguments. Conclusions: the system of procedures that was developed proved to be relevant to facilitate the process of teaching praxiological training in General Practitioners in order to preserve the health of the individual, family and community.Antecedentes: el análisis de las manifestaciones externas diagnosticadas en la formación del estudiante de Medicina, permite identificar insuficiencias en el proceso de valoración educativa del proceder médico en relación con la diversidad contextual, lo que limita la pertinencia de la formación de este profesional. Objetivo: aplicar un sistema de procedimientos para la formación docente del Médico General sustentado en un modelo de la dinámica de la formación praxiológica docente. Método: se desarrolló una investigación cualitativa desde abril del 2008 hasta diciembre de 2010 en la Universidad de Ciencias Médicas de Granma. El diagnóstico fáctico reveló insuficiencias en la utilización de instrumentos educativos en la prevención de las enfermedades, y limitaciones en la comprensión educativa del proceder médico en la educación para la salud en la diversidad comunitaria. Se implementó un sistema de procedimientos para la formación docente del Médico General sustentado en un modelo para la formación praxiológica docente elaborado con este propósito. Resultados: se comprobó que el ciento por ciento de los alumnos ayudantes adquirieron los conocimientos básicos de la Pedagogía como ciencia para las tareas de prevención, promoción, diagnóstico, curación y rehabilitación y se logró el diagnóstico de la situación de salud en una sala de maternidad al hacer uso del método clínico- epidemiológico con argumentos pedagógicos. Conclusiones: el sistema de procedimientos elaborado demostró su pertinencia al favorecer el proceso de formación praxiológica docente en el Médico General en función de preservar la salud del sujeto, la familia y la comunidad

Measuring Post-Partum Haemorrhage in Low-Resource Settings: The Diagnostic Validity of Weighed Blood Loss versus Quantitative Changes in Hemoglobin

Background: Accurate estimation of blood loss is central to prompt diagnosis and management of post-partum hemorrhage (PPH), which remains a leading cause of maternal mortality in low-resource countries. In such settings, blood loss is often estimated visually and subjectively by attending health workers, due to inconsistent availability of laboratory infrastructure. We evaluated the diagnostic accuracy of weighed blood loss (WBL) versus changes in peri-partum hemoglobin to detect PPH. Methods: Data from this analysis were collected as part of a randomized controlled trial comparing oxytocin with misoprostol for PPH (NCT01866241). Blood samples for complete blood count were drawn on admission and again prior to hospital discharge or before blood transfusion. During delivery, women were placed on drapes and had pre-weighed sanitary towels placed around their perineum. Blood was then drained into a calibrated container and the sanitary towels were added to estimate WBL, where each gram of blood was estimated as a milliliter. Sensitivity, specificity, negative and positive predictive values (PPVs) were calculated at various blood volume loss and time combinations, and we fit receiver-operator curves using blood loss at 1, 2, and 24 hours compared to a reference standard of haemoglobin decrease of >10%. Results: A total of 1,140 women were enrolled in the study, of whom 258 (22.6%) developed PPH, defined as a haemoglobin drop >10%, and 262 (23.0%) had WBL ≥500mL. WBL generally had a poor sensitivity for detection of PPH (85%) in high prevalence settings when WBL exceeds 750mL. Conclusion: WBL has poor sensitivity but high specificity compared to laboratory-based methods of PPH diagnosis. These characteristics correspond to a high PPV in areas with high PPH prevalence. Although WBL is not useful for excluding PPH, this low-cost, simple and reproducible method is promising as a reasonable method to identify significant PPH in such settings where quantifiable red cell indices are unavailable

Puerperal sepsis, the leading cause of maternal deaths at a Tertiary University Teaching Hospital in Uganda

BACKGROUND: Maternal mortality is highest in sub-Saharan Africa. In Uganda, the WHO- MDG 5 (aimed at reducing maternal mortality by 75 % between 1990 and 2015) has not been attained. The current maternal mortality ratio (MMR) in Uganda is 438 per 100,000 live births coming from 550 per 100,000 in 1990. This study sets out to find causes and predictors of maternal deaths in a tertiary University teaching Hospital in Uganda. METHODS: The study was a retrospective unmatched case control study which was carried out at the maternity unit of Mbarara Regional Referral Hospital (MRRH). The sample included pregnant women aged 15–49 years admitted to the Maternity unit between January 2011 and November 2014. Data from patient charts of 139 maternal deaths (cases) and 417 controls was collected using a standard audit/data extraction form. Multivariable logistic regression analysis was used to assess for the factors associated with maternal mortality. RESULTS: Direct causes of mortality accounted for 77.7 % while indirect causes contributed 22.3 %. The most frequent cause of maternal mortality was puerperal sepsis (30.9 %), followed by obstetric hemorrhage (21.6 %), hypertensive disorders in pregnancy (14.4 %), abortion complications (10.8 %). Malaria was the commonest indirect cause of mortality accounting for 8.92 %. On multivariable logistic regression analysis, the factors associated with maternal mortality were: primary or no education (OR 1.9; 95 % CI, 1.0–3.3); HIV positive sero-status (OR, 3.6; 95 % CI, 1.9–7.0); no antenatal care attendance (OR 3.6; 95 % CI, 1.8–7.0); rural dwellers (OR, 4.5; 95 % CI, 2.5–8.3); having been referred from another health facility (OR 5.0; 95 % CI, 2.9–10.0); delay to seek health care (delay-1) (OR 36.9; 95 % CI, 16.2–84.4). CONCLUSIONS: Most maternal deaths occur among mothers from rural areas, uneducated, HIV positive, unbooked mothers (lack of antenatal care), referred mothers in critical conditions and mothers delaying to seek health care. Puerperal sepsis is the leading cause of maternal deaths at Mbarara Regional Referral Hospital. Therefore more research into puerperal sepsis to describe the microbiology and epidemiology of sepsis is recommended

Sensitivity and specificity of blood loss measurement by weight method at Varying time points and volumes of blood loss, compared to reference standard of >10% drop in haemoglobin.

<p>Sensitivity and specificity of blood loss measurement by weight method at Varying time points and volumes of blood loss, compared to reference standard of >10% drop in haemoglobin.</p

ROC curves comparing measured blood loss and Hb drop (standard) at different time points.

<p>ROC curves comparing measured blood loss and Hb drop (standard) at different time points.</p

Negative and positive predictive values of blood loss measurement by weight method versus a reference standard of >10% drop in haemoglobin.

<p>Negative and positive predictive values of blood loss measurement by weight method versus a reference standard of >10% drop in haemoglobin.</p

Measurement of PPH by haemoglobin drop and measured blood loss.

<p>Measurement of PPH by haemoglobin drop and measured blood loss.</p