Obstetric admissions and outcomes in an intensive care unit in Malawi.

BACKGROUND: Despite international commitment to Millennium Development Goal 5, maternal mortality remains high in low- and middle-income countries (LMICs) of sub-Saharan Africa. This is in part due to infrastructure gaps, including availability of intensive care units (ICUs). We sought to use obstetric ICU utilization as a marker of severe maternal morbidity and provide an initial characterization of its relationship with in-hospital mortality. METHODS: A prospective observational cohort study of all obstetric subjects admitted to the ICU of Kamuzu Central Hospital in Malawi from September 2016 to March 2018. We reviewed charts at the time of ICU admission to assess the indication for admission, clinical characteristics and laboratory values. Subjects were followed until death or discharge. The primary outcome was in-hospital mortality. RESULTS: One-hundred-and-five obstetric patients were admitted to the study ICU (23% of all admissions). The median age was 26 years. The majority (79%) had undergone recent surgery; 40 (52%) an abdominal postnatal or cesarean hysterectomy and 31 (40%) a cesarean delivery without hysterectomy. Ninety-five percent required mechanical ventilation and 48% required vasopressors. Overall in-hospital mortality was 49%. CONCLUSIONS: The proportion of obstetric subjects admitted to the ICU in Malawi is nearly 1 in 4, which exceeds that found in high-income countries by orders of magnitude. Intensive care unit admission was associated with high mortality in this population. Investments in improving infrastructure and care gaps may include addressing available ICU bed and blood-banking needs, and increasing the number of providers trained in managing critical illness among obstetric patients.

Pulmonary embolism in the setting of HELLP syndrome.

HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) complicates 0.5-0.9% of pregnancies and is frequently associated with multiorgan dysfunction. Treatment relies on prompt diagnosis, delivery and supportive care. The clinical presentation may make the concurrent diagnosis and management of other disease entities challenging. This case report describes a patient with postpartum HELLP syndrome complicated by severe multiorgan dysfunction and pulmonary embolism.

[Prevalence of risk factors: obesity and lipid profile]. / Prevalencia de factores de riesgo de enfermedad cardiovascular: obesidad y perfil lipídico.

INTRODUCTION: Cardiovascular diseases are associated with risks factors such as obesity and dyslipaemia, which if present during infancy could continue throughout adult life. OBJECTIVES: To investigate the prevalence of overweight and study lipid profiles. To relate body mass index (BMI) with the studied parameters. MATERIALS AND METHODS: Descriptive and observational study of 1,043 children and adolescents, stratified into three age groups. Taking into account their BMI, they were classified as within normal weight, overweight and obese. Total cholesterol (T-chol), HDL-cholesterol (HDL-chol) and triglycerides (TG) were determined and LDL-chol and non HDL-chol were calculated. RESULTS: BMI: Among the total population, the percentage overweight was 13.9 % and obesity was 5.4 %, with a higher prevalence between 10 and 14 years and also between 5 and 9 years. BMI means were correlated with age in females and males, being higher for females at all ages. Lipid profile (classified according National Cholesterol Education Program): values of cholesterol in potential risk situations were found in 30 % of the population, 16 % for triglycerides, 28 % for LDL-cholesterol and 17 % for non-HDL cholesterol, the risk values being 3 %, 2 %, 4 % and 3 % respectively. Significant differences were observed in lipid values in the total population, overweight and obesity. CONCLUSION: A high prevalence of overweight was observed, as well as a correlation between body mass index and dyslipaemia. This emphasises the need for prevention of overweight and dyslipaemias from an early age.

Prevalencia de factores de riesgo de enfermedad cardiovascular: obesidad y perfil lipídico / Prevalence of risk factors: obesity and lipid profile

Introducción: Las enfermedades cardiovasculares se asocian a factores de riesgo como la obesidad y la dislipemia que, instalados en la infancia, tienden a mantenerse en la adultez. Objetivo: Estimar la prevalencia de exceso de peso y estudiar el perfil lipídico. Relacionar el índice de masa corporal con las variables en estudio. Material y métodos: Estudio descriptivo observacional de 1.043 niños y adolescentes, estratificados en tres grupos etarios. Según el índice de masa corporal se clasificaron en normopeso, sobrepeso y obesos. Se determinó el colesterol total, el colesterol de las lipoproteínas de alta densidad (c-HDL) y los triglicéridos. Se calculó el colesterol de las lipoproteínas de baja densidad (c-LDL) y el colesterol no-HDL (c-no-HDL). Resultados: Índice de masa corporal: en la población total el porcentaje de sobrepeso fue del 13,9 % y de obesidad del 5,4 %. Las mayores prevalencias fueron entre 10 y 14 años (16,9 %) y entre 5 y 9 años (9,9 %), respectivamente. Los índices promedio se correlacionaron con la edad en varones y mujeres. Perfil lipídico (categorización según el National Cholesterol Education Program): se hallaron valores en situación de riesgo potencial en el 30 % de la población total para colesterol, el 16 % para triglicéridos, el 28 % para c-LDL y el 17 % para colesterol no-HDL. Los valores de riesgo fueron del 3, 2, 4 y 3 %, respectivamente. Se observaron diferencias significativas en los valores de lípidos alterados entre la población total y aquella con sobrepeso y obesidad. Conclusión: Se observa alta prevalencia de exceso de peso y correlación entre el índice de masa corporal y dislipemias, con mayores alteraciones lipídicas en la obesidad. Esto enfatiza la necesidad de la prevención del sobrepeso y las dislipemias desde edades tempranas (AU)

Introduction: Cardiovascular diseases are associated with risks factors such as obesity and dyslipaemia, which if present during infancy could continue throughout adult life. Objectives: To investigate the prevalence of overweight and study lipid profiles. To relate body mass index (BMI) with the studied parameters. Materials and methods: Descriptive and observational study of 1,043 children and adolescents, stratified into three age groups. Taking into account their BMI, they were classified as within normal weight, overweight and obese. Total cholesterol (T-chol), HDL-cholesterol (HDL-chol) and triglycerides (TG) were determined and LDL-chol and non HDL-chol were calculated. Results: BMI: Among the total population, the percentage overweight was 13.9 % and obesity was 5.4 %, with a higher prevalence between 10 and 14 years and also between 5 and 9 years. BMI means were correlated with age in females and males, being higher for females at all ages. Lipid profile (classified according National Cholesterol Education Program): values of cholesterol in potential risk situations were found in 30 % of the population, 16 % for triglycerides, 28 % for LDL-cholesterol and 17 % for non-HDL cholesterol, the risk values being 3 %, 2 %, 4 % and 3 % respectively. Significant differences were observed in lipid values in the total population, overweight and obesity. Conclusion: A high prevalence of overweight was observed, as well as a correlation between body mass index and dyslipaemia. This emphasises the need for prevention of overweight and dyslipaemias from an early age (AU)