Customer's self-audit to improve the technical quality of maternity care in Tabriz: a community trial

Pregnant women have a major role to play in assessing and improving their own quality of care. This study in Tabriz, Islamic Republic of Iran, aimed to assess the effectiveness of an intervention for pregnant women-based on education and support groups and involvement in quality assessment activities-in order to improve the technical quality of public maternity care at public health centres. The intervention phase took place between September 2012 and may 2013. The outcome measure was health-care providers' degree of adherence to the Iranian maternity care standards. An intervention group of 92 pregnant women from 10 health centres was compared with a control group of 93 pregnant women from 11 centres. Logistic regression analysis showed that the self-assessed technical quality of maternity care received by the women was significantly better in the intervention that the control group for several of the standards concerning clinical examinations, maternal education and vitamin and mineral supplements

Les femmes enceintes ont un rôle majeur à jouer dans l'évaluation et l'amélioration de la qualité des soins qui leur sont dispensés. Cette étude conduite à Tabriz, en République islamique d'Iran, avait pour objectif d'évaluer l'efficacité d'une intervention pour les femmes enceintes, reposant sur des programmes éducationnels et des groupes de soutien ainsi que sur l'implication dans des activités d'évaluation de la qualité, dans le but d'améliorer la qualité technique des soins de maternité publics dispensés dans les centres de santé publique. La phase d'intervention s'est déroulée entre septembre 2012 et mai 2103. La mesure du résultat était le degré d'adhésion des prestataires de soins de santé aux normes de soins de maternité iraniennes. Un groupe d'intervention de 92 femmes enceintes venues de 10 centres de santé a été comparé à un groupe témoin de 93 femmes venues de 11 centres. L'analyse de régression logistique a montré que la qualité technique auto-évaluée des soins de maternité reçus par les femmes était sensiblement meilleure dans le groupe d'intervention que dans le groupe témoin en ce qui concerne plusieurs normes liées à l'examen clinique, à l'éducation des mères et à la supplémentation en vitamines et en minéraux

Cell engineering: nanometric grafting of poly-N-isopropylacrylamide onto polystyrene film by different doses of gamma radiation.

Poly-N-isopropylacrylamide was successfully grafted onto a polystyrene cell culture dish and γ-preirradiated in air. In this study, the effect of a γ-pre-irradiation dose of radiation (radiation absorbed dosages of 10, 20, 30, 40 KGy) under appropriate temperature and grafting conditions was investigated. The Fourier transform infrared spectroscopy analysis showed the existence of the graft poly-N-isopropylacrylamide (PNIPAAm) on the substrate. The optimal value of the dose for grafting was 40 KGy at 50°C. The scanning electron microscopy and atomic force microscopy (AFM) images clearly showed that increasing the absorbed dose of radiation would increase the amount of grafting. Surface topography and graft thickness in AFM images of the radiated samples showed that the PNIPAAm at the absorbed dose of radiation was properly grafted. The thickness of these grafts was about 50-100 nm. The drop water contact angles of the best grafted sample at 37°C and 10°C were 55.3 ± 1.2° and 61.2 ± 0.9° respectively, which showed the hydrophilicity and hydrophobicity of the grafted surfaces. Differential scanning calorimetry analysis also revealed the low critical solution temperature of the grafted sample to be 32°C. Thermoresponsive polymers were grafted to dishes covalently which allowed fibroblast cells to attach and proliferate at 37°C; the cells also detached spontaneously without using enzymes when the temperature dropped below 32°C. This characteristic proves that this type of grafted material has potential as a biomaterial for cell sheet engineering.

Intravenous immunoglobulin in symptomatic and asymptomatic children with perinatal HIV infection.

One hundred thirty-five children born to human immunodeficiency virus (HIV)-infected mothers were selected randomly to receive immunoglobulin (Gamimune-N, Miles Pharmaceutical Co) 200 mg/kg monthly for 1 year. All patients were seropositive by ELISA and Western blot at birth. At the time of the study, 15 symptomatic (P2) and 57 asymptomatic (P1) patients with evidence of viral infection (positive HIV culture or P24 antigen) received the immunoglobulin. Sixty-three indeterminate (PO) patients with no evidence of infection served as the control. Mean age for infants in group P2 was 32 months, 26 months for group P1, and 11 months for group PO. Significant reduction in the frequency of bacterial infections (ie, otitis media, upper respiratory tract infections, urinary tract infections, and acute gastroenteritis) was seen in the symptomatic group compared with both the asymptomatic and the control groups. Growth as measured by weight and height > 50th percentile was also markedly better in the symptomatic group than either asymptomatic or control patients. There was no significant difference in head circumference in all three groups. These results indicate that monthly intravenous immunoglobulin infusion (IVIG) appears to be beneficial to both symptomatic and asymptomatic HIV patients in reducing the frequency of bacterial infection and also enhancement of the immune response. However, symptomatic patients responded much better than the asymptomatic patients.

Impact of intrauterine exposure to phencyclidine (PCP) and cocaine on neonates.

A total of 505 newborns who were exposed to illicit drugs during intrauterine life were studied to investigate the prevalence, growth parameters, newborn manifestations, and other effects of intrauterine exposure to cocaine and phencyclidine (PCP). The results support the hypotheses that both drugs have serious effects on growth parameters, but this effect was much more pronounced in the cocaine group than in the PCP group. Furthermore, the incidence of borderline microcephalic infants (head circumferences less than the 10th percentile) was much higher in the cocaine group. It also appears that the signs and symptoms observed in both groups are not withdrawal manifestations typically seen in narcotic-exposed infants; rather, these symptoms are true drug effects and should not be considered manifestations of drug withdrawal symptoms.

Scrapie prion rod formation in vitro requires both detergent extraction and limited proteolysis.

Scrapie prion infectivity can be enriched from hamster brain homogenates by using limited proteolysis and detergent extraction. Purified fractions contain both scrapie infectivity and the protein PrP 27-30, which is aggregated in the form of prion rods. During purification, PrP 27-30 is produced from a larger membrane protein, PrPSc, by limited proteolysis with proteinase K. Brain homogenates from scrapie-infected hamsters do not contain prion rods prior to exposure to detergents and proteases. To determine whether both detergent extraction and limited proteolysis are required for the formation of prion rods, microsomal membranes were prepared from infected brains in the presence of protease inhibitors. The isolated membranes were then detergent extracted as well as protease digested to evaluate the effects of these treatments on the formation of prion rods. Neither detergent (2% Sarkosyl) extraction nor limited proteinase K digestion of scrapie microsomes produced recognizable prion amyloid rods. Only after combining detergent extraction with limited proteolysis were numerous prion rods observed. Rod formation was influenced by the protease concentration, the specificity of the protease, and the duration of digestion. Rod formation also depended upon the detergent; some combinations of protease and detergent did not produce prion amyloid rods. Similar results were obtained with purified PrPSc fractions prepared by repeated detergent extractions in the presence of protease inhibitors. These fractions contained amorphous structures but not rods; however, prion rods were produced upon conversion of PrPSc to PrP 27-30 by limited proteolysis. We conclude that the formation of prion amyloid rods in vitro requires both detergent extraction and limited proteolysis. In vivo, amyloid filaments found in the brains of animals with scrapie resemble prion rods in their width and their labeling with prion protein (PrP) antisera; however, filaments are typically longer than rods. Whether limited proteolysis and some process equivalent to detergent extraction are required for amyloid filament formation in vivo remains to be established.

Hemophilus para-influenzae meningitis in a two-day-old term infant.

A two-day-old black male term infant developed meningitis due to Hemophilus para-influenzae, a rare cause of neonatal meningitis. The organism was sensitive to ampicillin and chloramphenicol. Of interest was that the mother had the same organism in her cervix. The need for prompt investigation and institution of appropriate antibiotic therapy is emphasized.

Prenatal care and perinatal mortality in a black population.

Using three-year cumulative data relative to perinatal mortality, the present study examines the relationship of prenatal care and birth weight to pregnancy outcome. The results support the hypothesis that links prenatal care to pregnancy outcome and the relationship between birth weight and pregnancy outcome is found to be strong. The study indicates that the knowledge of birth weight would reduce the number of errors in predicting the chances of survival of the newborn by 37.0%.

Prenatal factors affecting perinatal mortality in blacks.

A study of 222 black mothers who gave birth to low-birth-weight infants in a tertiary care center showed that prenatal care plays a significant role in perinatal outcome; the effect of prenatal care was especially dramatic in the infants weighting less than 1,500 grams. In addition, maternal age is an important factor when less than 17 years. When a teenage pregnancy is associated with a lack of, or irregular, prenatal care, fetal outcome is compromised.

Clinical significance of supernumerary nipples in black neonates.

The frequency of accessory nipples in black Americans is almost eight times greater than in white European patients. Association of a wide range of abnormalities with supernumerary nipples in whites has, thus far, not been our experience in black Americans.

Perinatal asphyxia I: Pathogenesis of multisystemic sequelae.

This paper describes the clinical and pathologic sequelae of perinatal asphyxia manifested by 17 neonates treated at Howard University Hospital over an 18-month period. Multiple systemic complications, occurring in 76.5 percent of the patients, were the rule rather than the exception. All vital organs were involved, singly or in combination. Understanding the pathogenesis and extent of these complications is of utmost importance not only to those rendering health care to acutely ill newborns, but also to those responsible for prenatal and maternal intrapartum care.

Studies in sickle cell anemia: Preliminary observation on gastrointestinal digestion and absorption.

This study investigates certain aspects of the adequacy of digestion, absorption, motility, and morphology of the gastrointestinal tract of children with sickle cell anemia. Medical literature contains a paucity of information on this subject.

Observations on methadone withdrawal in 16 neonates.

The recent extensive use of methadone for treatment of heroin addiction has taught that, in adults, withdrawal of methadone can produce a withdrawal syndrome similar to heroin. After considerable experience with heroin withdrawal in neonates and in view of controversy and limited studies regarding methadone withdrawal, the study herein reported was undertaken to compare the experiences with both heroin and methadone withdrawal symptoms in newborns. A number of methadone-treated pregnant women deliver their infants at Freedmen's Hospital, affording the opportunity to observe neonates born to methadone-addicted mothers.