Outcomes of patients admitted to the intensive care unit for complications of hypertensive disorders of pregnancy at a South African tertiary hospital - a 4-year retrospective review.

Background: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal mortality and adverse outcomes. A previous study in the intensive care unit (ICU) at King Edward VIII Hospital, Durban, South Africa, in 2000 found 10.5% mortality among eclampsia patients. Objectives: To describe the mortality and adverse neurological outcomes associated with HDP in a tertiary ICU, compare these with results from 2000 and describe factors associated therewith. Methods: The data of 85 patients admitted with HDP to ICU at King Edward VIII Hospital from 2010 to 2013 were retrospectively reviewed. Mortality and adverse neurological outcome (Glasgow Coma Scale (GCS) ≤14 on discharge from ICU) were assessed. Two sets of analyses were conducted. The first compared those alive on discharge from ICU with those who died in ICU. The second compared good neurological outcome with poor outcome (adverse neurological outcome, or death). Results: The mortality was 11.6%, and overall, 9% had adverse neurological outcomes. There was no significant difference in mortality between patients with eclampsia in 2010 - 2013 (11.0%) and those in 2000 (10.5%) (p=0.9). Factors associated with mortality were: intra- or postpartum onset of seizures; twins; failure to perform operative delivery when indicated; lowest GCS score <10; failure to use magnesium sulphate when indicated; respiratory failure; and lower respiratory tract infections. Factors associated with poor outcomes (adverse neurological outcome, or death) were: parity (better outcomes in primiparous patients); time of antenatal onset of hypertension (worse if earlier onset); HIV infection; failure to perform operative delivery when indicated; lowest GCS score <10; failure to use magnesium sulphate when indicated; use of anticonvulsants other than magnesium sulphate or benzodiazepines in eclampsia. Conclusion: The lack of improvement in ICU eclampsia mortality demonstrates a need to develop and implement a protocol for HDP management. Contributions of the study: The study provides a comparison of present mortality among eclamptic patients with hyperensive disorders of pregnancy (HDP) with the mortality of eclamptic patients described in an article from the year 2000. It further looks at adverse maternal outcomes, specifically adverse neurological outcomes.In addition, it analyses other factors that may affect outcomes in HDP patients. This information is useful in making recommendations in an attempt to improve the outcomes.

Outcomes of patients admitted to the intensive care unit for complications of hypertensive disorders of pregnancy at a South African tertiary hospital ­ a 4-year retrospective review

Background. Hypertensive disorders of pregnancy (HDP) are a major cause of maternal mortality and adverse outcomes. A previous study in the intensive care unit (ICU) at King Edward VIII Hospital, Durban, South Africa, in 2000 found 10.5% mortality among eclampsia patients. Objectives. To describe the mortality and adverse neurological outcomes associated with HDP in a tertiary ICU, compare these with results from 2000 and describe factors associated therewith. Methods. The data of 85 patients admitted with HDP to ICU at King Edward VIII Hospital from 2010 to 2013 were retrospectively reviewed. Mortality and adverse neurological outcome (Glasgow Coma Scale (GCS) ≤14 on discharge from ICU) were assessed. Two sets of analyses were conducted. The first compared those alive on discharge from ICU with those who died in ICU. The second compared good neurological outcome with poor outcome (adverse neurological outcome, or death). Results. The mortality was 11.6%, and overall, 9% had adverse neurological outcomes. There was no significant difference in mortality between patients with eclampsia in 2010 - 2013 (11.0%) and those in 2000 (10.5%) (p=0.9). Factors associated with mortality were: intra- or postpartum onset of seizures; twins; failure to perform operative delivery when indicated; lowest GCS score <10; failure to use magnesium sulphate when indicated; respiratory failure; and lower respiratory tract infections. Factors associated with poor outcomes (adverse neurological outcome, or death) were: parity (better outcomes in primiparous patients); time of antenatal onset of hypertension (worse if earlier onset); HIV infection; failure to perform operative delivery when indicated; lowest GCS score <10; failure to use magnesium sulphate when indicated; use of anticonvulsants other than magnesium sulphate or benzodiazepines in eclampsia. Conclusion. The lack of improvement in ICU eclampsia mortality demonstrates a need to develop and implement a protocol for HDP management

Sickle cell solubility test: evaluation of an in-house method.

This study aims to assess the performance of an in-house sickle cell solubility test (SCT) and compare it against data published on other in-house and commercial methods. Also assessed are the effects of possible interference due to haemoglobin (Hb) level, Hb F and Hb S levels, as well as lipaemia, icterus and haemolysis index. A total of 1030 patient samples were tested by the SCT and subsequently confirmed by high-performance liquid chromatography (HPLC). Seventy-five (7.3%) samples revealed a positive SCT whereas 955 (92.7%) were negative. The sensitivity and specificity of the method was 100% and it was shown to detect low levels of Hb S (12.1%). These data show that the authors' in-house SCT method has an excellent performance against other documented methods (including some commercial kits), which is probably explained by its robustness against low levels of Hb S and interfering substances such as lipaemia. The authors believe this shows that in-house tests are able to produce highly reliable results comparable to, if not better than, certain commercially available CE-marked kits.

Risk groups in children under six months of age using self-organizing maps.

Fetal and infant growth tends to follow irregular patterns and, particularly in developing countries, these patterns are greatly influenced by unfavorable living conditions and interactions with complications during pregnancy. The aim of this study was to identify groups of children with different risk profiles for growth development. The study sample comprised 496 girls and 508 boys under six months of age from 27 pediatric primary health care units in the city of Rio de Janeiro, Brazil. Data were obtained through interviews with the mothers and by reviewing each child's health card. An unsupervised learning, know as a self-organizing map (SOM) and a K-means algorithm were used for cluster analysis to identify groups of children. Four groups of infants were identified. The first (139) consisted of infants born exclusively by cesarean delivery, and their mothers were exclusively multiparous; the highest prevalences of prematurity and low birthweight, a high prevalence of exclusive breastfeeding and a low proportion of hospitalization were observed for this group. The second (247 infants) and the third (298 infants) groups had the best and worst perinatal and infant health indicators, respectively. The infants of the fourth group (318) were born heavier, had a low prevalence of exclusive breastfeeding, and had a higher rate of hospitalization. Using a SOM, it was possible to identify children with common features, although no differences between groups were found with respect to the adequacy of postnatal weight. Pregnant women and children with characteristics similar to those of group 3 require early intervention and more attention in public policy.

Stabilization of antiferromagnetism in CeFe(2) alloys: the effects of chemical and hydrostatic pressure.

Effects of Al, Mn and Sb dopings in CeFe(2) and the effect of applied pressure have been investigated. Al doping gives rise to the FM-AFM transition and a reduction in the magnetic moment and T(C) values, clearly indicating the growth of the AFM component. Mn and Sb dopings only cause a reduction in the T(C) value. It is found that, in general, external pressure enhances the antiferromagnetism in both the pure and the doped alloys. Enhancement of the Ce 4f-Fe 3d hybridization as a result of doping and with the external pressure may be the reason for the stabilization of antiferromagnetism in these alloys.

[The pregnancy during adolescence as a risk factor for low birth weight, Brazil]. / Gravidez na adolescência como fator de risco para baixo peso ao nascer no Município do Rio de Janeiro, 1996 a 1998.

OBJECTIVE: To identify the role of pregnancy during adolescence as a risk factor to low birth weight (LBW). METHODS: A stratified sample of live births from the Information System of Live Births in the municipality of Rio de Janeiro, in the period 1996-98, was selected. The risk factors of LBW were analyzed for the two strata composed by the mother age, 15-19 and 20-24 years old. For the statistical analysis, odds ratios and correspondent confidence intervals were estimated. Logistic regression procedures were used. RESULTS: The LBW was significantly greater among the adolescent mothers group than the 20-24 years one. Regarding prenatal care, adolescents had a lower number of appointments and a higher percentage of no attendance. More than 50% of the older mothers completed high school, but only 31.5% among the younger mothers had the same level of instruction. The percentage of premature live births in this group was significantly greater. Differences were observed by type of hospital (public or private) and there was a predominant use of public hospitals by the adolescents. The logistic regression analysis showed a significant effect of the mother age on LBW, even when controlled for other variables. CONCLUSIONS: The results suggest that further investigation on the mechanisms that underlie the association between LBW and pregnancy during adolescence should be carried out, taking into consideration sociocultural factors such as poverty and social deprivation, as well as biological and nutritional factors during pregnancy.

Statistical properties of passive tracers in a positive four-point vortex model

Stochastic properties of systems formed by many passive particles conducted by four point vortices, each one with positive circulation, are investigated. A statistical chi(2) test is developed in order to study the spatial distribution of particles in the chaotic background (lambda(L)>0). The fact that the uniform distribution is an invariant measure of the spatial distribution of particles is used to debug the chi(2) test. This procedure is applied in the same conditions as described in Babiano et al. in order to study the uniformity of passive particles. It is observed that uniformity is not attained up to times of order 10(5) natural time unity, when either a Gaussian or a uniform initial distribution is considered in a small region away from the vortices.

Time evolution of the eddy viscosity in two-dimensional navier-stokes flow

The time evolution of the eddy viscosity associated with an unforced two-dimensional incompressible Navier-Stokes flow is analyzed by direct numerical simulation. The initial condition is such that the eddy viscosity is isotropic and negative. It is shown by concrete examples that the Navier-Stokes dynamics stabilizes negative eddy viscosity effects. In other words, this dynamics moves monotonically the initial negative eddy viscosity to positive values before relaxation due to viscous term occurs.

Classification of foetal heart rate sequences based on fractal features.

Visual inspection of foetal heart rate (FHR) sequences is an important means of foetal well-being evaluation. The application of fractal features for classifying physiologically relevant FHR sequence patterns is reported. The use of fractal features is motivated by the difficulties exhibited by traditional classification schemes to discriminate some classes of FHR sequence and by the recognition that this type of signal exhibits features on different scales of observation, just as fractal signals do. To characterise the signals by fractal features, two approaches are taken. The first modes the FHR sequences as temporal fractals. The second uses techniques from the chaos-theory field and aims to model the attractor based on FHR sequences. The fractal features determined by both approaches are used to design a Bayesian classification scheme. Classification results for three classes are presented; they are quite satisfactory and illustrate the importance of this type of methodology.

[Epidemiological characterization of meningococcal disease in a metropolitan area in Southeastern Brazil, 1976-1994]. / Caracterização epidemiológica da doença meningocócica na área metropolitana do Rio de Janeiro, Brasil, 1976 a 1994.

INTRODUCTION: Meningococcal disease continues to warrant assessment as to its endemic and epidemic multicausality and temporal trends in various locations. MATERIAL AND METHOD: Based on a standardization of epidemiological investigation of meningococcal disease in the municipality of Rio de Janeiro county, Southeastern Brazil, as from epidemic of the 1970s a study to characterized the epidemiological characteristics of the disease, was realized. The total of 4,155 cases reported between 1976 and 1994 were analyzed in a retrospective, descriptive, and analytical study, using the epidemiological investigation forms issued by the Municipal Health Secretariat. Statistical analysis was performed using the chi 2, Wilcoxon-Mann-Whitney, and Kruskal-Wallis tests. RESULTS: The study resulted in the definition of three periods, classified as post-epidemic (1976-79), endemic (1980-86), and epidemic (1987-94), differentiated by the incidence rates and the predominant meningococcal serogroup. The mean incidence rates per period in the municipality were 3.51, 1.67, and 6.53 cases/ 100,000 inhabitants, respectively. Serogroups A and C predominated during the post-epidemic period, B and A in the endemic, and B in the epidemic. CONCLUSION: The mean case fatality rate remained virtually unchanged over time, but it varied by hospital, and during all three periods was lower in the State government reference hospital than in the other hospitals, whether public or private. The highest incidence and case fatality rates were associated with patients under one year of age, and the risk of acquiring the disease was greater among males. The highest incidence coefficients tended to occur in the same areas of the county during the three epidemiological periods, and the shanty-town population was at twice the risk of acquiring the disease.

Risk factors for hospitalization and death from diarrhea in a public pediatric hospital in Rio de Janeiro, Brazil.

OBJECTIVE: This study was carried out in a public pediatric hospital located in the city of Rio de Janeiro, Brazil, with the aim of identifying risk factors for hospitalization and/or death due to diarrhea in children. MATERIAL AND METHODS: The study included 406 children under three years of age who were seen or admitted for diarrhea from January 1987 to February 1988. The main variable of interest was the outcome of clinical evaluation and subsequent hospitalization, which was classified as follows: 1) outpatient treatment; 2) hospitalization and survival; and 3) death during hospitalization. The chi-square test was used to identify variables (p = < 0.05) that were significantly related to the treatment outcome. RESULTS: The group was composed by 60.6% males and 39.4% females. A proportion of 26.8% of children was under two months of age, 24.9% was 3-5 months old, 25.9% was 6-11 months old, and 22.4% was 12 months or older. The variables most significantly related to the risk of hospitalization from diarrhea were age, current nutritional status (weight-for-age percentile), and concomitant illness. Variables most significantly associated with risk of death from diarrhea were low birth weight and past hospitalization. CONCLUSIONS: Use of this study's results by health services could make a substantial contribution to reducing children's hospitalization and death due to diarrhea in the city of Rio de Janeiro.

[Maternal perception of dehydration in children with diarrhea. A study on agreement with clinical diagnosis]. / Percepção materna da desidratação em crianças com diarréia. Estudo de concordância com diagnóstico médico.

The mother's perception of signs and symptoms of dehydration in children under three years of age was studied and compared with the medical classification. The study was carried out in a children's hospital in the city of Rio de Janeiro, among children hospitalized with diarrhoea between January, 1987 and February, 1988. The number of excretions and of vomitings, thirst and condition of eyes constituted the signs and symptoms most frequently reported by mothers. However, they had difficulty in judging the amount of urine, humidity of mouth and tongue and turgidity of the skin. These signs were almost always regarded as normal or, at most, as indicating only slight alteration. Those mothers who tended to underestimate the severity of the dehydration indicated by the physician were of a lower educational level and had more severely undernourished children and greater difficulty of access to the hospital. On the other hand, those who tended to overestimate it belonged to a higher educational level, had better-nourished children, greater ease of access to the hospital and were attended to by a smaller number of health care services before reaching the hospital surveyed. Those who agreed with the medical diagnosis were in an intermediate situation, although they tended to be closer to those who underestimated the gravity of the dehydration. Those mothers whose children had already gone through a dehydration episode did not present a more intense agreement with the physician's diagnosis, thus evidencing that the information afforded at the health care service was either non-existent or inadequate.