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Background@#One of the strategies adopted by the Department of Health (DOH) to improve maternal outcomes is the systems approach which means understanding extensively how the system operates to determine factors affecting the delivery of services. In 2014, Albay province responded by adapting and implementing the Maternal, Newborn and Child Health, and Nutrition (MNCHN) Service Delivery Network Guidelines. However, no external monitoring and evaluation have been done to assess the compliance of birthing facilities to these guidelines. @*Objectives@#To determine Legazpi city’s obstetric service delivery network functionality and to compare government and private primary level birthing facilities in terms of 1) governance; 2) human resources; 3) protocols; 4) transportation and communication; and 5) emergency drugs and equipment. @*Materials and Methods@#A cross-sectional study using the referral system assessment (RSA) questionnaire translated into a scorecard with a review of secondary data on high-risk pregnancies, referral rates, and maternal mortalities was done on eight facilities in Legazpi City. @*Results@#Overall, none of the health facilities assessed were fully-functional. Privately owned facilities scored highest in emergency drugs and equipment (83.3%) and lowest in human resources (38.9%). Government facilities scored highest in emergency drugs and equipment (88.9%) but lowest in transportation and communication (44.4%). Statistically significant differences were observed for human resources (p-value=0.0180), wherein public facilities garnered higher scores, and in transportation and communication (p-value=0.0294), private facilities showed better scores. Only one maternal death in 418 referrals was reported.@*Conclusion@#Overall, the health facilities varied in the level of functionality in terms of SDN guidelines.
Subject(s)
Birthing CentersABSTRACT
RNA interference induced by small interfering (siR¬NA) has shown great potential in disease treatment.However, due to the poor stability of siRNA and lack of targeting, it is still challenging to deliver siRNA to target tissues/cells and induce gene silencing.Aptamer is a kind of oligonucleotide sequence that can specifically recognize the target.Covalently binding aptamers with siRNA or linking with other siRNA carriers can guide siRNA into target tissues/cells.In this review we summa¬ rize the research progress in the design strategy and application of aptamer-based targeted deliver)' of siRNA in the treatment of diseases in recent years, and discuss the challenges and pros-pects of aptamer-mediated siRNA deliver>r in clinical transforma¬tion.
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Background@#Since 1976, Bicol Region had higher maternal mortality ratio (MMR) than the Philippine average and became the fourth region with the highest MMR in 2012. Looking at trends of maternal health outcomes and determining risk factors among mothers who died may guide interventions to reduce MMR.@*Objectives@#To determine the changes in maternal mortality ratio (MMR) in the Bicol region from 2004 to 2017 and determine the sociodemographic profile of pregnant women who died from 2015 to 2018. @*Materials and Methods@#A records review of Bicol?s Regional Field Health Services Information System from 2004 to 2017 and maternal death review reports from 2015 to 2018 was done. Changes in MMR was determined using Poisson regression. The sociodemographic characteristics and causes of maternal deaths were analyzed using frequencies and proportion. @*Results@#From 2004 to 2017, MMR of 100.9 remained higher than the regional target of 31.6. Significant reductions in MMR were achieved in 2007 to 2008 and in 2011 to 2012 wherein MMR ranged between 75.3 to 89.3. However, by the end of 2012, maternal deaths again increased which reached 122.5 in 2017. From the maternal death reviews, it was observed that 29.5% of maternal deaths were aged 35 years and above and 7.5% were less than 20 years old. Mothers who had more than five pregnancies were 30.1% of total deaths. In terms of place of death, 15.7% died at home or in-transit to referral facilities. Hemorrhage or hypertension-related causes were the leading reasons for maternal deaths. @*Conclusion@#Significant reduction in MMR was not sustained after 2012 and higher deaths were reported in the succeeding years. Maternal deaths can be further reduced by using a systems approach, by promoting family planning, and by strengthening service delivery networks to effectively manage hemorrhage and hypertension-related emergencies.
Subject(s)
Maternal Mortality , Maternal HealthABSTRACT
Inflammatory Bowel Disease(IBD) is concerned with heredity,dysimmunity,environment and others,its characterized by chronic or relapsing inflammation within the gastrointestinal.IBD including two independent disease ulcerative colitis and crohn′s disease.In recent years with the incidence of IBD increased year by year,more women in reproductive age facing drug treatment.This article elucidated the effect of IBD and its treatment on perinatal.
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Background: It is a well-established obstetric practice to use a vacuum device to assist in delivery of the fetal head at cesarean delivery. As a vacuum sauce, the hospital piped-vacuum supply is often used. However, no study has compared the safety and efficacy of vacuum-assisted delivery with the traditional manual extraction. Objective: Compare the safety and efficacy of delivery of the high floating fetal head using a soft cup vacuum extractor with the traditional manual extraction. Methods: This randomized study included 90 cases of caesarean sections with vacuum-assisted delivery using the soft cup vacuum extractor (V group) and 90 cases of caesarean sections with manual extraction of the head (M group). The hospital piped-vacuum supply was used to develop the required vacuum. Operative and postoperative maternal and neonatal data of importance were analyzed using Student t-test for continuous variables and Chi Square test for categorical variables. Results: The U-D interval (the time of entry into the uterus until the full delivery of the fetal head) was significantly prolonged (p<0.001) in M group (86.3±53.9 and 65.3±31.2 seconds, respectively). Mean blood loss in the V group was higher (576.7±182.9 mL and 504.4±204.9 mL, respectively). However, this difference was not statistically significant (p=0.306). There was no difference in the Apgar scores and resuscitation in the newborns of the two groups. Infants did not show evidence of any scalp remarks. Conclusion: The extraction of the fetal head at caesarean section with vacuum extractor was a non-traumatic and rapid method that did not need the prolonged fundal compression and thus avoid unwanted consequences.
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Objective To evaluate the predictive performance of propofol target-controlled infusion (TCI) system incorporating the Schnider pharmacokinetic parameters in Chinese patients. Methods Forty ASA Ⅰ or Ⅱ patients, aged 25-45 yr, with body mass index 20-25 kg/m2 , scheduled for gynecological laparoscopic surgery un der general anesthesia, were enrolled in this study. Anesthesia was induced with TCI of propofol (target plasma concentration (Cp) 3 μg/ml) and remifentanil (Cp 4 ng/ml) . Propofol was infused by Orchestra TCI system incorporating the Schnider pharmacokinetic parameters. Tracheal intubation was facilitated with rocuronium 0.6 mg/kgafter the patients lost consciousness. The patients were mechanically ventilated. PETCO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with TCI of remifentanil (Cp 4 ng/ml) and propofol (Cp 3-5 μg/ml) and intermittent iv boluses of atracurium 0.2 mg/kg. BIS value was maintained at 40-45. Venous blood samples were obtained at 15, 30, 45 and 60 min after pneumoperitoneum for measurement of blood propofol concentrations by high performance liquid chromatography with fluorescence detector. Performance error, median prediction performance error, median absolute performance error, wobble and divergence of propofol TCI system were calculated. Results The value for performance error was 21 % (13%), for median prediction performance error 6.7 % (37.4%),for median absolute performance error 19% (18%), for divergence - 0.65%/h (0.82%/h) and for wobble 16.3% (15.2% ) . Conclusion The accuracy of propofol TCI system incorporating the Schnider pharmacokinetic parameters is high in Chinese patients and its predictive performance is acceptable clinically.
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Retinoblastoma is the most common intraoeular malignant tumor in children.In its treatment,drug therapy is one of the most effective and irreplaceable methods.To reduce the toxicity of drugs,enhance the therapeutic effect and lessen drug resistance, some new drug deliver systems and new medicines for retinoblastoma are coming into being.Ophthalmic arterial infusion,fibrin sealant and iontophoresis are newly-found drug deliver systems.And the latest drugs under research include nutlins,phenoxazine derivative Phx-1,combretastatin A4 phosphate,2-deoxy-d-glucose and histone deacetylase inhibitors,etc.The following text is focused on the two aspects of the drug therapy for retinoblastoma.
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Objective To study the effects on electroporation of Qingfengteng cataplasma transdermal absorption and describe the characteristics of animal pharmacokinetics of it.Methods Two-chamber diffusion cell was used and the plasma drug concentration was determined by HPLC.The application of AIC theory to analysis of the compartmentally based model of sinomenine transdermal delivery by electroporation.Results The Cmax,Ka,and AUC0→∞ of electroporation was larger than those of passive diffusion;t1/2(Ka)and tmax of electroporation were reduced compared with passive diffusion.The drug concentration-curve equation were C=2.884?(e-0.056 t-e-0.232 t)and C=2.512?(e-0.058 t-e-0.149 t)for electroporation and passive diffusion,respectively.Conclusion The change of in vivo drug concentration of Qingfengteng calaplasma transdermal absorption by electroporation could be analized in accordance with mammillary one-compartment open model.The etrectroporation technology could sharply enhance the bioavalibility compared with the passive diffusion.