Actos cotidianos de resistencia en el embarazo para prevenir la morbimortalidad materna / Everyday acts of resistance in pregnancy to prevent maternal morbidity and mortality

Resumen Objetivo: Analizar acciones de mujeres indígenas respecto a su cuidado durante el embarazo a través de prácticas cotidianas, nombradas como actos cotidianos de resistencia. Material y métodos: Se realizó un estudio cualitativo etnometodológico en Cuetzalan, Sierra Norte de Puebla, México; se aplicaron 93 cuestionarios a mujeres indígenas embarazadas; a 67 de ellas se les aplicaron entrevistas semiestructuradas. Se realizó análisis crítico del discurso. Resultados: Se identificaron tres actos cotidianos de resistencia para el cuidado del embarazo: 1) Convivencia comunitaria; 2) Movilidad para la atención prenatal, y 3) Saberes del cuidado del embarazo. En conjunto, los actos describen acciones preventivas de morbilidad partiendo de la percepción cultural de riesgo en mujeres embarazadas de un contexto sociocultural y económicamente vulnerable. Conclusiones: El conjunto de prácticas cotidianas para el cuidado del embarazo por las mujeres debe ser reconocido como acciones inmediatas de prevención en pro de la salud materna.

Abstract Objective: To analyze actions of indigenous women regarding their care during pregnancy through daily practices that we name as everyday acts of resistance. Materials and methods: A qualitative ethnomethodological study was carried out in Cuetzalan, Sierra Norte de Puebla, México; 93 questionnaires were applied to pregnant indigenous women, 67 of them were semi-structured interviews. Also, a critical discourse analysis was performed. Results: Three everyday acts of resistance were identified for pregnancy care: 1) Community coexistence; 2) Mobility for prenatal care, and 3) Beliefs in pregnancy care. Altogether the acts describe preventive morbidity actions based on the cultural perception of risk in pregnant women within a context sociocultural and economically vulnerability. Conclusions: The set of daily practices in prenatal care by women, must be recognized as immediate preventive actions in favor of maternal health.

Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature / Achados placentários na pré-eclâmpsia pré-termo e a termo: Uma revisão integrativa da literatura

Abstract Introduction Preeclampsia (PE) is a pregnancy complication associated with increased maternal and perinatal morbidity and mortality. The disease presents with recent onset hypertension (after 20 weeks of gestation) and proteinuria, and can progress to multiple organ dysfunction, with worse outcomes among early onset preeclampsia (EOP) cases (<34 weeks). The placenta is considered the root cause of PE; it represents the interface between the mother and the fetus, and acts as a macromembrane between the two circulations, due to its villous and vascular structures. Therefore, in pathological conditions, macroscopic and microscopic evaluation can provide clinically useful information that can confirm diagnosis and enlighten about outcomes and future therapeutic benefit. Objective To perform an integrative review of the literature on pathological placental findings associated to preeclampsia (comparing EOP and late onset preeclampsia [LOP]) and its impacts on clinical manifestations. Results: Cases of EOP presented worse maternal and perinatal outcomes, and pathophysiological and anatomopathological findings were different between EOP and LOP placentas, with less placental perfusion, greater placental pathological changes with less villous volume (villous hypoplasia), greater amount of trophoblastic debris, syncytial nodules, microcalcification, villous infarcts, decidual arteriolopathy in EOP placentas when compared with LOP placentas. Clinically, the use of low doses of aspirin has been shown to be effective in preventing PE, as well asmagnesium sulfate in preventing seizures in cases of severe features. Conclusion The anatomopathological characteristics between EOP and LOP are significantly different, with large morphological changes in cases of EOP, such as

Resumo Introdução A pré-eclâmpsia (PE) é uma complicação da gravidez associada ao aumento da morbidade e mortalidade materna e perinatal. A doença se apresenta com hipertensão de início recente (após 20 semanas de gestação) e proteinúria, que pode progredir para disfunção de múltiplos órgãos, com resultados piores entre os casos de início precoce (<34 semanas). A placenta é considerada a principal causa da PE, representando a interface entre a mãe e o feto, e atuando como uma macromembrana entre as duas circulações, devido às suas estruturas vilosas e vasculares, demodo que, em condições patológicas, avaliações macroscópicas e microscópicas podem fornecer informações clinicamente úteis, que podem fornecer diagnóstico, prognóstico e benefício terapêutico. Objetivo Realizar uma revisão integrativa da literatura para compreender e descrever os achados placentários patológicos associados à pré-eclâmpsia e seus impactos nas manifestações clínicas. Resultados Os casos de início precoce apresentaram piores desfechos maternos e perinatais, e os achados fisiopatológicos e anatomopatológicos foram diferentes entre as placentas de início precoce e início tardio, commenor perfusão placentária, maiores alterações patológicas placentárias commenor volume viloso (hipoplasia vilosa), maior quantidade de debris trofoblásticos, nódulos sinciciais, microcalcificação, infartos vilosos, arteriolopatia decidual em placentas de início precoce quando comparadas com placentas de início tardio. Clinicamente, o uso de baixas doses de aspirina tem se mostrado significativo na prevenção da PE, assim como o sulfato de magnésio na prevenção de convulsões na doença com manifestações de gravidade. Conclusão As características anatomopatológicas entre a pré-eclâmpsia precoce e tardia são significativamente diferentes, com grandes alterações morfológicas nos casos de início precoce, como hipóxia, infartos vilosos e hipoplasia, entre outros, na tentativa de estabilizar o fluxo sanguíneo para o feto. Portanto, um entendimento comum do exame macroscópico básico e dos padrões histológicos da lesão é importante para maximizar o benefício diagnóstico, prognóstico e terapêutico do exame da placenta e, consequentemente, reduzir os riscos para a mãe e o feto.

Morbimortalidad de las reintervenciones en la cirugía abdominal urgente y electiva / Morbidity and Mortality for Re-interventions in Urgent and Elective Abdominal Surgery

Introducción: Las reintervenciones en la cirugía abdominal, son causa de una alta mortalidad en los servicios de cirugía general. Objetivo: Caracterizar morbimortalidad de las reintervenciones de la cirugía abdominal urgente y electiva en el servicio de cirugía general del Hospital Universitario "Manuel Ascunce Domenech". Métodos: Se realizó un estudio observacional descriptivo transversal, de los pacientes que requirieron de reintervención quirúrgica abdominal. El universo estuvo conformado por 236 pacientes que cumplieron con los criterios de inclusión. Se utilizaron métodos estadísticos descriptivos y cálculos con valores porcentuales. Resultados: Predominó el grupo de edades de 40-49 años, así como el sexo masculino, con un 25 por ciento y 64,8 por ciento, respectivamente. En cuanto al tiempo en que se realizó la reintervención 72,5 por ciento se realizó luego de las 48 horas. El 88,6 por ciento de los pacientes resolvió la causa que lo originó en la primera reintervención. Las causas más frecuentes fueron la peritonitis generalizada seguida de los abscesos intrabdominales con un 19,5 por ciento y 17,4 por ciento respectivamente. La mortalidad fue de 30,1 por ciento y el tromboembolismo pulmonar la causa directa de muerte en 12,3 por ciento de los casos. Conclusiones: Casi la totalidad de los casos fueron reintervenidos luego de las 48 horas y las dos terceras partes resolvieron en la primera intervención. La peritonitis generalizada y los abscesos intrabdominales fueron la causa de la reintervención en un número importante(AU)

Introduction: Abdominal surgery re-interventions cause high mortality in general surgery services. Objective: To characterize morbidity and mortality of urgent and elective abdominal surgery re-interventions in the general surgery service of Manuel Ascunce Domenech University Hospital. Methods: A cross-sectional, descriptive, observational study was carried out with patients who required abdominal surgical re-intervention. The universe consisted of 236 patients who met the inclusion criteria. Descriptive statistical methods and calculations with percentage values were used. Results: There was a predominance of the age group 40-49 years and the male sex, accounting for 25 percent and 64.8 percent, respectively. Regarding time of performance of re-intervention, 72.5 percent was carried out after 48 hours. 88.6 percent of the patients had, in the first re-intervention, a solution for the cause that originated it. The most frequent causes were generalized peritonitis, followed by intraabdominal abscesses, accounting for 19.5 percent and 17.4 percent, respectively. Mortality was 30.1 percent and pulmonary embolism was the direct cause of death in 12.3 percent of cases. Conclusions: Almost all the cases were re-intervened after 48 hours and two thirds had a solution the first re-intervention. Generalized peritonitis and intraabdominal abscesses were the cause of re-intervention, in a significant number(AU)

Factors Predicting Heart Failure in Children Admitted to a Pediatric Emergency Ward in a Developing Country

Abstract Background Heart failure is an important cause of morbidity and mortality in children. Objective To determine the clinical characteristics of children with acute heart failure syndrome in the emergency ward of River state university teaching hospital, Nigeria and identify factors associated with poor outcomes. Methods This was an 18month retrospective review of the acute heart failure register. Poor outcome measures were defined as the persistence of heart failure after 4 days on admission or death. Results Ninety-two (4.1%) of 2,244 children admitted were in heart failure, Non-cardiac disorders [bronchopneumonia 32(36%), sepsis 21(24%), severe malaria 10(11%), sickle cell anaemia 8(9%) and tuberculosis 3(3%)] contributed to 74(83%) while congenital heart disease(CHD) was 15(17%). Seventy-four (83%) were discharged, 10(11%) died and 4(5%) left against medical advice. The median time to resolution of heart failure was significantly 24 hours longer for malnourished children than those with normal-nutritional status, 72Vs48hrs, log rank:0.001. Those with modified Ross score of >7 and sepsis were more likely to die, OR,8.8(95% CI,1.2 to 72.5,p = 0.02) and 3.9(95% CI,1.01 to 15.2;p =0.04). Age <2yrs(OR,3.1,CI,1.2 to 8.5,p = 0.02), and CHD (OR 3.6,95% CI,1.1 to 12,P=0.02) were associated with a higher likelihood of having a poor outcome. Each unit increase in weight for age Z score of 1, decreased the odds of having a poor outcome, OR,0.77 (95% CI,0.63 to 0.95)p=0.016. Conclusion Heart failure in our setting is predominantly caused by non-cardiac disorders. Modified Ross score of >7 and sepsis are risk factors for mortality in children with heart failure. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Hyperuricemia as an Early Marker in Predicting the Mortality and Morbidity in Patients with Sepsis

Introduction: Serum uric acid can be used as a marker ofoxidative stress, and poor prognosis in patients with sepsis,since high levels of oxy radicals, lower oxidant level in sepsispatients result in multi organ failure. Raised uric acid isassociated with chronic diseases and is used as a prognosticindicator of severe infection as it acutely activates varioustranscription factors. Aim: This study aims to understandthe correlation between hyperuricemia and the mortality andmorbidity rate in patients with clinically suspected sepsis(based on Qsofa Criteria - Quick sepsis related organ failure).The secondary end points of the study are to understandcorrelation between hyperuricemia in clinically suspectedsepsis patients and Acute kidney injury, acute respiratorydistress syndrome, and duration of stay in the hospital.Material and methods: We conducted a prospective cohortstudy in clinically suspected sepsis patients {based on theQsofa Criteria} between September2017-2018 in a tertiarycare center in AJ Institute Of Medical Sciences in South India.Patients or their medical power of attorneys provided writteninformed consent. A total no of 60 patients were enrolled basedon the inclusion criteria, clinically suspected sepsis patientsaged more than 18 years. All pregnant female, patients fromoutside facility admitted in the medical intensive care unit formore than 24 hours were excluded. For the purpose of ourstudy we defined hyperuricemia as greater than or equal to7 mg/ dl in both males and females. Patients were divided intwo groups based on the uric acid levels. The first group hadclinically suspected sepsis patients with uric acid levels morethan 7 and the second group had clinically suspected sepsispatients with uric acid level less than 7.Results: More than half of the patients, 55%, with high uricacid were found to be males. The overall mortality rate inpatients with high uric acid levels was found to be 90%. Theprobability of having hyperuricemia with acute kidney injurywas around 92.9%.Conclusion: Hyperuricemia was associated with poorprognosis in clinically suspected sepsis patients

Surveillance and response of hepatitis B virus in Hong Kong Special Administrative Region, 1988–2014

The World Health Organization (WHO) Western Pacific Region with an estimated 160 million chronic hepatitis B virus (HBV) carriers in 2007 bears a significant burden of HBV-related mortality and morbidity. Most Member States in the region have an estimated chronic HBV infection proportion of more than 8% in their adult population, which is the highest worldwide. The WHO Regional Office for the Western Pacific published the first Regional Plan for Hepatitis B Control in January 2003. This plan is updated periodically with a consistent ultimate goal of achieving a chronic HBV infection rate of less than 1% in the region. Viral hepatitis is a statutorily notifiable disease in Hong Kong Special Administrative Region (SAR). The Central Notification Office of the Department of Health receives notifications with pre-defined case definitions. In July 2011, Hong Kong SAR was verified by the WHO Regional Office for the Western Pacific as having successfully achieved the goal of hepatitis B control. Liver cancer was the third leading cause of cancer death in Hong Kong SAR in 2012, and evidence showed that 75–80% of liver cancer cases were related to chronic HBV infection. This report reviews the surveillance data of HBV infections in Hong Kong SAR from 1988 to 2014 and discusses the responses and existing gaps to achieve the WHO goal in the local context.

Comparison of different scoring systems in patients undergoing colorectal cancer surgery for predicting mortality and morbidity.

BACKGROUND: Preoperative risk estimation evaluating mortality and morbidity might help surgical decision. AIMS: The aim of this study was to compare the sensitivities of physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM), portsmouth‑POSSUM (P‑POSSUM), colorectal‑POSSUM (CR‑POSSUM), the Association of Coloproctology of Great Britain and Ireland colorectal cancer model (ACPGBI CRC) and revised ACPGBI CRC scoring systems that are used for evaluating mortality and morbidity in colorectal surgery performed in third‑level healthcare centers. SETTINGS AND DESIGN: A retrospective analysis has been performed on 335 consecutive patients undergoing colorectal cancer surgery between 2002 and 2012. MATERIALS AND METHODS: Mortality and morbidity risks of 335 patients who underwent colorectal cancer were evaluated using these scoring systems and the results were compared with actual mortality and morbidity within postoperative 30‑day that extend the duration of hospital stay. STATISTICAL ANALYSIS USED: The receiver operating characteristic (ROC) curves were designed to identify the score values. RESULTS: Results of POSSUM and P‑POSSUM systems showed statistical differences compared with those of CR‑POSSUM, ACPGBI CRC and revised ACPGBI CRC systems (P < 0.05). P‑POSSUM was found to be the best scoring system for predicting mortality risk, although all scoring systems seem to be appropriate for this parameter. On the other hand POSSUM, which can predict morbidity, was found to have moderate differentiation ability due to the magnitude of the area under the ROC curve. CONCLUSIONS: Despite altering patient demographics and surgical conditions, POSSUM seems to lead as the best scoring system for predicting mortality and morbidity among others including those most‑recently proposed.

Analytical study of 50 cases of fetal growth restriction.

The objective of the study is to earlier diagnose the cases of FGR (Fetal growth restriction) and to identify the possible causes and management option to prevent further damage and to study the fetomaternal outcome and improve fetomaternal outcome in FGR cases. Methods: This is an analytical study of 50 cases of FGR pregnancies done during the period of 1st April 2013 to 31st March 2014. Data was collected from the OPD books and indoor case papers of patients attending routine antenatal care and emergency services provided by obstetrics and gynaecology department of our institute. Results: 50 cases of FGR were studied. Various possible etiological factors were studied like presence of anaemia, hypoproteinemia and PIH, maternal pre-pregnancy weight, and average weight gain during pregnancy. Among them, malnutrition (64%) was the commonest aetiology of FGR followed by PIH (44%). Ante partum surveillance was done by serial fundal height measurement, maternal weight gain monitoring and serial ultrasound. 40% patients were having severe oligoamnios and 30% were having altered Doppler waveforms. Operative interference was required in 44% cases. 30 babies out of 50 were admitted to NICU. And perinatal mortality was 13.72%. Conclusion: Timely diagnosis, proper management at all levels in well-equipped centre can definitely prevent morbidity and mortality from FGR. Improving pre-pregnancy health, ensuring better antenatal care, effective use of contraception, preventing teenage pregnancies, stop smoking are some preventive measures.

O-POSSUM and P-POSSUM for evaluation of operative risk of aged patients in orthopedic department / 中华创伤杂志

Objective To retrospectively review the mortality and morbidity after orthopedic surgery for aged patients with reference to orthopedic version physiological and operative severity score for the enumeration of mortality and morbidity (O-POSSUM) and Portsmouth POSSUM (P-POSSUM) and validate the score' s accuracy in operative risk prediction.Methods O-POSSUM and P-POSSUM for mortality and morbidity were applied to 839 aged patients who had undergone orthopedic surgery between January 2008 and December 2011.Observed mortality and morbidity were compared with the expected values.Results O-POSSUM predicted 230 morbidities,but the observed value was 182 (x2 =2.718,P ＞ 0.05).O-POSSUM predicted 46 deaths,higher than the observed 3 deaths (x2 =38.870,P＜0.01).P-POSSUM predicted 16 deaths,higher than the observed 3 deaths (x2 =8.997,P ＜ 0.01).Conclusions O-POSSUM accurately predicts postoperative morbidity in aged orthopedic patients.However,O-POSSUM and P-POSSUM overpredicts the mortality and should be used with caution.

Application of dynamic APACHEⅡscore and POSSUM score in patients with severe acute pancreatitis / 中国基层医药

Objective To discuss the value of combining the physiological and operative severity score for enumeration of mortality and morbidity(POSSUM)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)in severe acute pancreatitis(sAP).Methods 60 cases of SAP were divided into surgery group(n=15)and non-surgical group(n=45),Non-surgical group was vahde with APACHE Ⅱ score,the surgery group with POSSUM score,decided to continue conservative treatment or surgery treatment,Observation of two ways with the complications and death.Results The rates of compHcafions and death were(0.37±0.08)and(0.27±0.09)in Single-operation group(n=15)higher than(0.76±0.14)and(0.61±0.15)in surgical group(n=11)(t1=3.125,t2=3.211,P＜0.01);APACHEⅡ score of mortality in operation group and non-surgical group were no significant difference(x2=2.28,x2=1.98,P＞0.05);APACHE Ⅱ score were(10.12±6.27)in survival group(n=46)were lower than (25.75±7.90)in death group(n=14)(t=2.525,P＜0.05.Conclusion The score of dynamic APACHE Ⅱ has better effect to judge the timing of surgery,and the score of POSSUM has high value to predict post-operative complications and deaths occurred in patients with severe acute pancreatitis.

Management of Preterm Labor / 영남의대학술지

Premature birth is the single largest cause of perinatal mortality and morbidity in nonanomalous infants in developing countries. Advances in neonatal care have lead to increased survival and reduced short and long term morbidity for preterm infants. but the rate of preterm birth has actually increased. This review provides recent multifactorial approaches to treatment and prevention of preterm birth.

Estimation of mortaliy and morbidity risk in aged patients undergoing thoracic surgery using POSSUM / 解放军医学杂志

Objective To evaluate the clinical validity of physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) in aged patients undergoing thoracic surgery. Methods Physiological and operative severity scores were kept in 206 aged patients undergoing thoracic surgery, in which peritoneal soiling was converted to pleura soiling. The physiological score and the operative risk score were compared between the groups with or without the postoperative complications. The mortality and morbidity rates were calculated. Actual mortality and morbidity rates were compared with the rates predicted by POSSUM. Results Among 206 patients, there were postoperative complications in 97 patients. The physiological score and the operative severity score were significantly higher in the group in whom complications occurred compared with those without complications (19.3?0.7 vs 15.1?0.6 for physiological score, P