Obstetrical care and women's health in the aftermath of disasters: the first 14 days after the 2010 Haitian earthquake.

OBJECTIVE: Natural disasters disproportionately injure women and children. Disaster teams need intensive training in the management of obstetrics and women's healthcare at the disaster site. DESIGN: This article summarizes the obstetrical experience for the International Medical Surgical Response Team (IMSuRT) stationed at Gheskio in Port Au Prince during the first 2 weeks after the 2010 Haitian earthquake. The world's literature on the impact of disasters on women is reviewed. SETTING: Sixty-three members of the IMSuRT and Disaster Medical Assistance Team set up a mobile surgical field hospital after the 2010 Haitian earthquake. One member (AG) managed all the obstetrical care and taught the other team members essentials of labor management and assessment in pregnancy. PATIENTS, PARTICIPANTS: Six hundred patients were treated in the first 14 days. Ten percent of these patients were pregnant.There were 12 deliveries. INTERVENTIONS: All pregnant patients were evaluated by a Sonosite ultrasound device. Pregnant patients with earthquake-related injuries were treated for their injuries.Women in labor were managed by active management in labor. No cesarean sections were needed. MAIN OUTCOME MEASURE(S): Well-being of mother and babies. RESULTS: Sixty pregnant women presented to the mobile hospital for evaluation from January 17, 2010, through January 28, 2012. Twelve women in labor delivered healthy infants by vaginal delivery. Gestational ages ranges from 34 to 40 weeks. Active management of labor included the use of intravenous Pitocin, which was titrated to contractions. Duration of labor ranged from 2 to 12 hours. Three team members participated in each delivery. Two women were discharged on the same day as their deliveries. Eight women were discharged on the first postpartum day and two on the second postpartum day. CONCLUSIONS: Pregnant women suffered severe injuries. Additionally, pregnant women with pre-existing medical conditions were treated after the earthquake. Active management of labor allowed all women to deliver vaginally. The labor management required tremendous team resources to facilitate vaginal deliveries and avoid cesarean sections. Cesarean sections in an austere environment have the potential for devastating consequences such as sepsis, wound dehiscence, and the long-term risks of uterine rupture with subsequent pregnancies. Our experience highlights the need to include trained obstetrical providers on the first response team. ORAL PRESENTATION: Data from this article were included in the presentation, "An urgent need for women's health specialists in disaster response," at the Disaster Response Workshop, Annual Meeting Society Maternal Fetal Medicine, Dallas, 2012.

Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies: report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict.

Limb amputations are frequently performed as a result of trauma inflicted during conflict or disasters. As demonstrated during the 2010 earthquake in Haiti, coordinating care of these patients in austere settings is complex. During the 2011 Humanitarian Action Summit, consensus statements were developed for international organizations providing care to limb amputation patients during disasters or humanitarian emergencies. Expanded planning is needed for a multidisciplinary surgical care team, inclusive of surgeons, anesthesiologists, rehabilitation specialists and mental health professionals. Surgical providers should approach amputation using an operative technique that optimizes limb length and prosthetic fitting. Appropriate anesthesia care involves both peri-operative and long-term pain control. Rehabilitation specialists must be involved early in treatment, ideally before amputation, and should educate the surgical team in prosthetic considerations. Mental health specialists must be included to help the patient with community reintegration. A key step in developing local health systems the establishment of surgical outcomes monitoring. Such monitoring can optimizepatient follow-up and foster professional accountability for the treatment of amputation patients in disaster settings and humanitarian emergencies.

Best practice guidelines on surgical response in disasters and humanitarian emergencies: report of the 2011 Humanitarian Action Summit Working Group on Surgical Issues within the Humanitarian Space.

The provision of surgery within humanitarian crises is complex, requiring coordination and cooperation among all stakeholders. During the 2011 Humanitarian Action Summit best practice guidelines were proposed to provide greater accountability and standardization in surgical humanitarian relief efforts. Surgical humanitarian relief planning should occur early and include team selection and preparation, appropriate disaster-specific anticipatory planning, needs assessment, and an awareness of local resources and limitations of cross-cultural project management. Accurate medical record keeping and timely follow-up is important for a transient surgical population. Integration with local health systems is essential and will help facilitate longer term surgical health system strengthening.

Glucocorticoid inhibition of 235-1 rat pituitary tumor cell cycle progression.

Control of the cell cycle is accomplished by sequentially activated cyclin-dependent kinases and the action of inhibitory proteins. We have shown that exposure of 235-1 rat pituitary tumor cells to dexamethasone (DEX) leads to a 50% reduction in growth rate. We examined the mechanism by which DEX affects 235-1 cell proliferation by determining the expression levels of proteins involved in cell-cycle progression. The expression of the G1 markers c-Myc and cyclin D3 were unaffected by DEX treatment. Levels of retinoblastoma family proteins p107 and p116 Rb were not altered. The levels of p1 30/Rb2 were increased by DEX within 36 h of initiating treatment. Additionally, a higher-mobility Rb2-related protein appeared within 24 h and was further increased in DEX-treated cells by 36 h. We also observed reduced levels of M-phase proteins, Cdc2 kinase, and cyclin B in DEX-treated cells. These changes occurred prior to the reduction in cell numbers and thus may represent causative factors. Our data suggest that DEX induces a late G1 block in 235-1 cell-cycle passage, accompanied by a reduction in the levels of the regulatory proteins required for passage through subsequent phases of the cell cycle.