Awareness of obstetric warning signs in Ecuador: a cross-sectional study.

OBJECTIVE: In Ecuador, the reported maternal death rate was 45.71 per 100,000 live births in 2013. This may be partly due to a lack of maternal knowledge of obstetric warning signs during pregnancy, delivery and the post-partum period. This study sought to evaluate awareness of obstetric warning signs among pregnant women in relation to individual demographic and area-level socio-economic indicators. STUDY DESIGN: We conducted a cross-sectional analysis of data collected by Ecuador's Ministry of Health at the conclusion of a national maternal health campaign (2014-2015). A nationally representative sample of 3435 pregnant women from the nine administrative zones completed surveys regarding basic demographics and their awareness of obstetric warning signs. METHODS: We defined eight obstetrical warning signs according to the literature and Ecuadorian practice that could occur during pregnancy, delivery and the post-partum period (severe headache, strong abdominal ache, bleeding or presence of malodorous secretion, rupture of the amniotic sac, high fever, abnormal presentation of the baby, decrease in baby's movements and delayed labour). A woman was considered 'aware' if she recognised at least four of the eight warning signs and stated she would seek immediate healthcare at their presentation. For each administrative zone, four socio-economic indicators (poverty, illiteracy, unemployment and subemployment) were obtained from the National Institute of Statistics and Census. Correlates of awareness of the obstetric warning signs were evaluated using hierarchical logistic models clustered by the administrative zone. RESULTS: Nationally, 86.9% of women were 'aware' of obstetric warning signs. After adjustment for age, socio-economic indicators and clustering, indigenous participants were 59% less likely to be aware of obstetric warning signs than mestizos (odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.28-0.59). For every 1% increase in area poverty, participants had a 5% decreased likelihood of being aware of obstetric warning signs (OR = 0.95, 95% CI = 0.93-0.96), adjusting for age, ethnicity and other socio-economic indicators. The most effective source of campaign information about obstetric warning signs was personal communication with a healthcare professional, as opposed to mass media advertisements (OR = 1.90, 95% CI = 1.34-2.71). CONCLUSIONS: A majority of Ecuadorian pregnant and post-partum women are aware of obstetric warning signs. Indigenous ethnicity and area-level poverty are associated with a lack of awareness. Personal communication with a healthcare professional was the most effective source of information. These findings have implications for improvement of maternal awareness of warning signs.

Safe switching from a pdFIX (Immunine®) to a rFIX (Bax326).

The ability to switch between coagulation factors safely is of common interest to haemophilia patients and treating physicians. This is the first formal prospective comparative evaluation of safety, efficacy and incremental recovery of a plasma-derived FIX (pdFIX) and a recombinant FIX (rFIX) in the same haemophilia B patients following a switch from pdFIX Immunine® to a recently developed rFIX Bax326 product. Patients (aged <65 years) who completed a pretreatment study which prospectively documented the exposure to Immunine® and monitored FIX inhibitors while receiving prophylactic treatment were transitioned into pivotal (patients aged 12-65 years) and paediatric (patients aged <12 years) clinical studies investigating prophylaxis and treatment of bleeding episodes with Bax326. None of the 44 patients developed inhibitory or specific binding anti-FIX antibodies during the course of the studies. A total of 38 unrelated adverse events (AEs) were occurred in 20/44 (45.5%) subjects during the Immunine® study. Following a switch to Bax326, 51 AEs were reported in 25/44 (56.8%) subjects. The incidence of AEs related to Bax326 treatment (two episodes of dysgeusia in one patient) was low (2.3%); there were no serious adverse reactions. The comparison between Immunine® and Bax326 demonstrated analogous haemostatic characteristics and annualized bleeding rates. Overall, there is direct evidence indicating a safe and clinically effective transition from a pdFIX (Immunine®) to a newly developed rFIX (Bax326(1) ) for prophylaxis and treatment of bleeding in previously treated patients of all age cohorts with severe or moderately severe haemophilia B.

Impact of intensive care management on the prognosis of tetanus. Analysis of 641 cases.

These studies show the results of intensive care management of 306 consecutive patients with tetanus compared with 335 patients treated conservatively in the same hospital before the institution of the ICU. The impact of the ICU treatment was manifested in a decrease in mortality, from 43.58 percent to 15 percent. In addition, while patients treated conservatively died as a consequence of early acute respiratory failure, the main cause of death in the ICU-treated patients was unexpected cardiac arrest, probably related to overactivity of the autonomic nervous system. We conclude that to ensure a high survival rate in patients with tetanus, the treatment must be performed according to established protocol in an ICU.

[Multiple trichoepitheliomas with genital and paragenital localization. Ultrastructural study]. / Tricoepitelioma múltiplo com localização genital e paragenital.

We report a case of trichoepithelioma papulosum multiplex in a 35 year-old woman. Genital and paragenital lesions were found for the first time. The islands of basaloid cells and horny cysts were studied by electron microscopy. Ultrastructural differences between the trichoepithelioma papulosum multiplex and the basal cell epithelioma are discussed.

Epidemiology of diarrhea due to rotavirus on an Indian reservation: risk factors in the home environment.

Analysis of outpatient visits for diarrheal disease at the San Carlos Apache Reservation, Arizona, during 1977-1979 revealed a sharp increase in cases of infantile gastroenteritis of unknown etiology in October and November of each year. During the 1980 autumn diarrhea season, 19 patients and 12 control subjects were selected from among outpatients under two years of age and were interviewed and studied for bacterial and viral enteric pathogens. Eleven (58%) of 19 patients and two (17%) of 12 control subjects were positive for fecal rotavirus by enzyme-linked immunosorbent assay (P = 0.03). Ten (91%) of 11 rotavirus-positive patients were under one year of age. The most significant risk factor for illness was the presence of a household contact under the age of two years (P - 0.004). Dog ownership was also associated with rotavirus infection (P = 0.05).

Bedside pulmonary angiography in the critically ill patient.

A simple technique to perform pulmonary angiography at the bedside in critically ill patients is presented. A central venous pressure catheter placed into the right ventricle or in the main pulmonary artery allows manual contrast injection into the vascular pulmonary tree which can be satisfactorily visualized by means of a "penetrated" chest x-ray film. The method discussed herein presents evidence of usefulness in establishing the differential diagnosis of acute pulmonary embolism in patients who cannot be mobilized or in those institutions where facilities of catheterization-angiographic laboratory are not available.