ISSN (Print): 2327-669X

ISSN (Online): 2327-6703

Editor-in-Chief: Jing Sun

Website: http://www.sciepub.com/journal/AJPHR

   

Article

Outcome of Obstructed Labor in North-west Rwanda, Unmatched Case-control Study

1Department of Obstetrics and Gynecology, Ruhengeri Hospital, Musanze, Rwanda

2Athena Institute, VU University, Amsterdam, The Netherlands


American Journal of Public Health Research. 2016, 4(5), 191-195
doi: 10.12691/ajphr-4-5-6
Copyright © 2016 Science and Education Publishing

Cite this paper:
Richard Kalisa. Outcome of Obstructed Labor in North-west Rwanda, Unmatched Case-control Study. American Journal of Public Health Research. 2016; 4(5):191-195. doi: 10.12691/ajphr-4-5-6.

Correspondence to: Richard  Kalisa, Department of Obstetrics and Gynecology, Ruhengeri Hospital, Musanze, Rwanda. Email: kalichard@gmail.com

Abstract

Obstructed labor (OL) needs to be addressed effectively so as to reduce maternal morbidity and mortality and also improve fetal outcome. We conducted this study to establish the incidence, predisposing factors of OL and to compare birth outcome of OL to normal labor from three rural district hospitals in north-west Rwanda. Retrospective case–control design of women with OL from January to December 2011. OL was diagnosed as documentation of any or all the four pre-specified criteria and these were; i) crossed action line on partogram, ii) membranes ruptured, iii) oxytocin augmentation done, iv) and in second stage when was assisted vaginal delivery performed. Any cases with documented OL and fulfilled all our four pre-specified criteria were considered “with diagnosis”. The remaining cases were considered “without diagnosis”. The cases were retrospectively collected from the patients’ case files at the hospital archives office. Controls were women who had spontaneous vaginal delivery (SVD) or were delivered by vacuum extraction without OL as a complication. For every case, three consecutive patient’s file were picked and retrieved as controls. All available case files were retrieved from hospital’s archives office. Every fourth woman was recorded as OL. The incidence of documented OL with diagnosis was (n=299; 3.7%) and without diagnosis was (n=1780; 21.9%). The predisposing factors for OL were maternal age <19 years, primiparas status, attending < 4 antenatal care (ANC), no formal or primary education and being resident of one specific district. Maternal complications were two and half times higher among women with OL (n=252/2079; 12.1%) compared to those with SVD (n=327/6054; 5.4%), with OR 2.5 (2.0-3.0). Puerperal sepsis and transfusion were more common in women with OL. There was significant difference in the rate of the composite maternal outcome between OL and SVD (4.10% vs. 2.0%; OR 1.9, 95% CI 1.6-4.7) and after adjusting for confounding variables with multivariable logistic regression (OR = 3.1, CI: 1.9-8.7; p = <0.01). There were 28 maternal deaths from the three hospitals giving maternal mortality ratio of (n=28/8133; 344/100,000 live births), of which 4 maternal deaths were due to OL with a case fatality rate of 0.19%. Perinatal mortality rate in OL was (n=123; 59 per 1000 OLs) compared to SVD (n=169; 28 per 1000 SVDs). OL is over diagnosed by the clinicians from rural Rwanda. Increasing clinical skills and a good documentation for the progress of labor is paramount for early identification and prevention of OL, in order to improve care for both women and infants. Improving girl child education, referral system, quality of ANC, availing comprehensive obstetric care in nearby health institution are recommended to prevent OL and its complications.

Keywords

References

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Article

Incidence of Acute Myocardial Infarction in Patients with Diabetes and Its Association with Mortality and Cardiopulmonary Complications in Puerto Rico

1Universidad de Las Americas, Quito, Ecuador

2American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda

3Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, United States

4University of Puerto Rico Medical Science Campus, San Juan, Puerto Rico


American Journal of Public Health Research. 2016, 4(6), 196-201
doi: 10.12691/ajphr-4-6-1
Copyright © 2016 Science and Education Publishing

Cite this paper:
Romina Altamirano, Michael Caponigro, Gabriela Carrion, Juan Carlos Zevallos, Grettel Castro, Juan A. González Sánchez, Noël C. Barengo. Incidence of Acute Myocardial Infarction in Patients with Diabetes and Its Association with Mortality and Cardiopulmonary Complications in Puerto Rico. American Journal of Public Health Research. 2016; 4(6):196-201. doi: 10.12691/ajphr-4-6-1.

Correspondence to: Noël  C. Barengo, Department of Medical and Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, United States. Email: nbarengo@fiu.edu

Abstract

Diabetes mellitus (DM) patients are at an increased risk of acute myocardial infarction (AMI). Adequate DM control may reduce in-hospital mortality and cardio-pulmonary complications after an AMI. The objective of this study was to determine whether uncontrolled DM in patients with an incidental AMI was associated with an increased risk of in-hospital mortality and selected cardio-pulmonary complications. A secondary data analysis of the Puerto Rican Cardiovascular Surveillance System during 2007, 2009, and 2011 was conducted. The study included men and women living in Puerto Rico who were hospitalized due to an incidental AMI and had information on HbA1c measurement (n=220). Patients were divided according to their HbA1c levels into two groups (i) <7% (controlled); and (ii) >7% (uncontrolled). Mortality and complications were defined according to ICD-9 codes. Univariate and multivariate logistic regression models were used to test for associations between HbA1c and mortality and cardio-pulmonary outcomes. The model was adjusted for gender, obesity (BMI >30kg/m2), hyperlipidemia, hypertension, chronic obstructive pulmonary disease, smoking, insurance and age. The results revealed no statistically significant association between the controlled and the uncontrolled DM patients and mortality, respectively cardiopulmonary complications (unadjusted OR 2.1; 95% CI: 0.7-6.4; adjusted OR 2.4; 95% CI: 0.5-10.5). The uncontrolled DM group was statistically significantly younger than those with controlled DM (mean age 65.2 vs. 71.1 years; p-value 0.002). There was no statistically significant difference in the prevalence of uncontrolled DM between patients with complications (80%) and those without complication (66%; p=value 0.203). AMI patients with uncontrolled DM did not have an increased risk of mortality and cardiopulmonary complications compared to patients with controlled DM. This needs further evaluation in a larger study population and DM patients with an AMI should have HbA1c measured to estimate their risk of complications.

Keywords

References

[1]  International Diabetes Federation, IDF Diabetes Atlas 7th Edition, International Diabetes Federation, 2015. [E-book] Available: www.diabetesatlas.org.
 
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[5]  Stolker, J., Sun, D., Conaway, D., Jones, P., Masoudi F., Peterson, P, “Importance of Measuring Glycosylated Hemoglobin in Patients With Myocardial Infarction and Known Diabetes Mellitus,” The American Journal of Cardiology. 105(8). 1090-1094. April 2010.
 
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[12]  Chan, C., Li, R., Chan, J., Zhang, Q., Chan, C., Dong, M, “ The Value of Admission HbA1c Level in Diabetic Patients With Acute Coronary Syndrome,” Clinical Cardiology. 34(8). 507-512. June 2011.
 
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[14]  Cakmak, M., Cakmak, N., Cetemen, S., Tanriverdi, H., Enc, Y., Teskin, O, “The value of admission glycosylated hemoglobin level in patients with acute myocardial infarction,” Canadian Journal of Cardiology. 24(5). 375-378. May 2008.
 
[15]  Timmer, J., Ottervanger J.P., Bilo, H.J., Dambrink, J.H, “Prognostic value of admission glucose and glycosylated haemoglobin levels in acute coronary syndromes,” QJM. 99(4). 237-243. April 2006.
 
[16]  Strojek, K., Raz, I., Jermendy, G., Gitt, A., Liu, R., Zhang, Q, “Factors Associated With Cardiovascular Events in Patients With Type 2 Diabetes and Acute Myocardial Infarction,” The Journal of Clinical Endocrinology & Metabolism. 101(1). 243-253. January 2016.
 
[17]  Ahn, J., Hong, T., Park, J., Lee, H., Oh, J., Choi, J, “Clinical influence of early follow-up glycosylated hemoglobin levels on cardiovascular outcomes in diabetic patients with ST-segment elevation myocardial infarction after coronary reperfusion,” Coronary Artery Disease. 26(7). 555-561. November 2015.
 
[18]  Britton, K., Aggarwal, V., Chen, A., Alexander, K., Amsterdam, E., Fraulo, E, “No association between hemoglobin A1c and in-hospital mortality in patients with diabetes and acute myocardial infarction,” American Heart Journal. 161(4). 657-663. April 2011.
 
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Article

The Response of Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pneumoniae to Plant Derived Nutraceuticals

1Department of Biology, Chemistry and Environmental Science, Northern Caribbean University, Mandeville, Jamaica, W.I.


American Journal of Public Health Research. 2016, 4(6), 202-206
doi: 10.12691/ajphr-4-6-2
Copyright © 2016 Science and Education Publishing

Cite this paper:
Joneshia Bryan-Thomas, Patience Bazuaye-Alonge, Vincent Wright. The Response of Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pneumoniae to Plant Derived Nutraceuticals. American Journal of Public Health Research. 2016; 4(6):202-206. doi: 10.12691/ajphr-4-6-2.

Correspondence to: Patience  Bazuaye-Alonge, Department of Biology, Chemistry and Environmental Science, Northern Caribbean University, Mandeville, Jamaica, W.I.. Email: patience.alonge@ncu.edu.jm

Abstract

Objective: The present study evaluated the antimicrobial properties of selected plant derived nutraceuticals against Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pneumoniae. Material and Method: The plants utilized were Zingiber officinale, Aloe barbadensis miller, Alipina galanga, Allium sativum, three varieties of Allium cepa, and Moringa oleifera. Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pneumoniae were the microorganisms employed in the study due to the frequency with which they are implicated in several infections and diseases such as boils, skin infections, respiratory diseases and food poisoning. Standard microbiological methods were employed. The microorganisms were collected and identified by a microbiologist and the plant samples were identified by an agronomist. The microoganisms were sub-cultured and the disc diffusion and turbidity testing techniques were applied. Combination tests were done with each herb aimed at ascertaining the efficacy of the herbs. Results: The findings demonstrated that garlic in all its concentrations, with both methods (disc diffusion and turbidity) and in all combinations produced remarkable zones of inhibitions against all microorganisms (Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pneumoniae). Ginger showed no zone of inhibition regardless of combinations, except when combined with garlic. The variety of onions used showed intermediate zones while Alipina galanga and Moringa oleifera showed no visible antimicrobial properties. Conclusion: Garlic and the variety of onions used, in all dilutions were seen to possess antimicrobial properties against Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pneumoniae when compared to the conventional antibiotics used.

Keywords

References

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