Reducing infections among women undergoing cesarean section in Colombia by means of continuous quality improvement methods.

BACKGROUND: Improving obstetric care in resource-limited countries is a major international health priority. OBJECTIVE: To reduce infection rates after cesarean section by optimizing systems of obstetric care for low-income women in Colombia by means of quality improvement methods. METHODS: Multidisciplinary teams in 2 hospitals used simple methods to improve their systems for prescribing and administering perioperative antibiotic prophylaxis. Process indicators were the percentage of women in whom prophylaxis was administered and the percentage of these women in whom it was administered in a timely fashion. The outcome indicator was the surgical site infection rate. RESULTS: Before improvement, prophylaxis was administered to 71% of women in hospital A; 24% received prophylaxis in a timely fashion. Corresponding figures in hospital B were 36% and 50%. Systems improvements included implementing protocols to administer prophylaxis to all women and increasing the availability of the antibiotic in the operating room. These improvements were associated with increases in overall and timely administration of prophylaxis (P<.001) in both hospitals by time series analysis, with adjustment for volume and case mix. After improvement, overall and timely administration of prophylaxis was 95% and 96% in hospital A and 89% and 96% in hospital B. In hospital A, the surgical site infection rate decreased immediately after the improvements (P<.001). In hospital B, the infection rate began a downward trend before the improvements that continued after their implementation (P =.04). CONCLUSION: Simple quality improvement methods can be used to optimize obstetric services and improve outcomes of care in resource-limited settings.

Arachidonic acid products-mediated contraction induced by bradykinin in relaxed mesenteric arterial rings from Holtzman rats.

This study describes the contractile action of bradykinin on rat isolated mesenteric arterial rings and a possible mechanism responsible for this action. Bradykinin induced dose-dependent contraction of relaxed mesenteric arterial rings from Holtzman rats, but not from Wistar rats. A second bradykinin challenge in the same ring induced a very small effect or no effect at all. Destruction of the endothelium did not modify the response to bradykinin. des-Arg9-[Leu8]bradykinin failed to antagonize bradykinin's action. HOE 140 (D-Arg- [Hyp3, Thi5,D-Tic7,Oic8]bradykinin) reduced bradykinin-induced contractions. Indomethacin abolished the contractile response to bradykinin; prostaglandin F2 alpha induced a long-lasting contraction, dissimilar from that induced by bradykinin; L-655,240 (3-[1-(4-chlorobenzyl)-5-fluoro-3-methyl-indol-2-yl]-2,2-dimethyl propanoic acid), an antagonist of the thromboxane receptor, inhibited bradykinin-induced contractions. These results suggest that bradykinin-induced contraction in mesenteric arterial rings is indirect, through activation of bradykinin B2 receptors, resulting in liberation of prostanoids from outside the endothelium. Thromboxane A2 is probably an intermediate in this response but we cannot exclude the participation of other prostanoids.

Inhibition of drug-induced contractions of guinea-pig ileum by Annona crassiflora seed extract.

A hydro-alcoholic extract of dried Annona crassiflora seeds (AR.1) showed a non-specific inhibitory effect on drug-induced contractions of guinea-pig ileum. Maximum responses to histamine, acetylcholine and bradykinin were reduced increasingly with increasing doses of AR.1. Affinities of the gut to the above agonists, expressed as respective pD2 values were not changed by AR.1. Dose-response curves of calcium-induced contractions in depolarized preparations were shifted to the right but maximum responses were not changed by AR.1. It is suggested that the inhibitory effect of AR.1 is due to a decrease in membrane permeability to calcium. This inhibitory effect may be responsible for the effect of Annona crassiflora as a remedy against snake venom.