Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi

<p>Abstract</p> <p>Background</p> <p>Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.</p> <p>Methods</p> <p>During a three month period, data from 2131 consecutive obstetric surgeries in 38 district hospitals in Malawi were collected prospectively. The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation. All these surgeries were conducted either by clinical officers or by medical officers.</p> <p>Results</p> <p>During the study period, clinical officers performed 90% of all straight caesarean sections, 70% of those combined with subtotal hysterectomy, 60% of those combined with total hysterectomy and 89% of those combined with repair of uterine rupture. A comparable profile of patients was operated on by clinical officers and medical officers, respectively. Postoperative outcomes were almost identical in the two groups in terms of maternal general condition – both immediately and 24 hours postoperatively – and regarding occurrence of pyrexia, wound infection, wound dehiscence, need for re-operation, neonatal outcome or maternal death.</p> <p>Conclusion</p> <p>Clinical officers perform the bulk of emergency obstetric operations at district hospitals in Malawi. The postoperative outcomes of their procedures are comparable to those of medical officers. Clinical officers constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians.</p

Mesoporous bubble-like manganese silicate as a versatile platform for design and synthesis of nanostructured catalysts

Chemistry - A European Journal2151882-188

Synthetic Architecture of Multiple Core–Shell and Yolk–Shell Structures of (Cu₂O@)_<i>n</i>Cu₂O (<i>n</i> = 1–4) with Centricity and Eccentricity

In this work, we describe a seed-mediated approach with successive Ostwald ripening to synthesize various multiple-shell core–shell and yolk–shell structures of (Cu₂O@)_<i>n</i>Cu₂O (<i>n</i> = 1–4). In particular, the structure formed in a previous step can serve as a newer-generation seed for a subsequent shell growth; a total of 20 representative structures have been thus synthesized in a step-by-step manner. With an increase in shell number <i>n</i>, in principle, 2^<i>n</i> shelled products can be fabricated, taking into account the centricity and eccentricity in their geometric symmetry. Synthetic chemistry and functions of chemical additives have also been investigated to explain the formation mechanism and to ensure the uniformity of the product. It has been found that symmetric or asymmetric Ostwald ripening during the hollowing process can be manipulated by controlling stirring conditions. Furthermore, optical properties of the resultant samples can be closely related to structural aspects of the products, such as the overall size, the thickness of shells, the number of shells, and, importantly, the centricity and eccentricity in the final products. To test their applicability, we have also studied the electrocatalytic properties of these complex structures in nonenzymatic glucose sensing. Quite encouragingly, (Cu₂O@)_<i>n</i>Cu₂O samples have shown an improved sensitivity as the number of thin shells increased

25-hydroxyvitamin D deficiency, exacerbation frequency and human rhinovirus exacerbations in chronic obstructive pulmonary disease.

BACKGROUND: 25-hydroxyvitamin D deficiency is associated with COPD and increased susceptibility to infection in the general population. METHODS: We investigated whether COPD patients deficient in 25-hydroxyvitamin D were more likely to be frequent exacerbators, had reduced outdoor activity and were more susceptible to human rhinovirus (HRV) exacerbations than those with insufficient and normal levels. We also investigated whether the frequency of FokI, BsmI and TaqIα 25-hydroxyvitamin D receptor (VDR) polymorphisms differed between frequent and infrequent exacerbators. RESULTS: There was no difference in 25-hydroxyvitamin D levels between frequent and infrequent exacerbators in the summer; medians 44.1 nmol/L (29.1 - 68.0) and 39.4 nmol/L (22.3 - 59.2) or winter; medians 24.9 nmol/L (14.3 - 43.1) and 27.1 nmol/L (19.9 - 37.6). Patients who spent less time outdoors in the 14 days prior to sampling had lower 25-hydroxyvitamin D levels (p = 0.02). Day length was independently associated with 25-hydroxyvitamin D levels (p = 0.02). There was no difference in 25-hydroxyvitamin D levels between baseline and exacerbation; medians 36.2 nmol/L (IQR 22.4-59.4) and 33.3 nmol/L (23.0-49.7); p = 0.43. HRV positive exacerbations were not associated with lower 25-hydroxyvitamin D levels at exacerbation than exacerbations that did not test positive for HRV; medians 30.0 nmol/L (20.4 - 57.8) and 30.6 nmol/L (19.4 - 48.7). There was no relationship between exacerbation frequency and any VDR polymorphisms (all p > 0.05). CONCLUSIONS: Low 25-hydroxyvitamin D levels in COPD are not associated with frequent exacerbations and do not increase susceptibility to HRV exacerbations. Independent of day length, patients who spend less time outdoors have lower 25-hydroxyvitamin D concentration

Scalable synthesis of urchin- and flowerlike hierarchical NiO microspheres and their electrochemical property for lithium storage

10.1021/am401330gACS Applied Materials and Interfaces5136292-629