Global obstetric anaesthesia: bridging the gap in maternal health care inequities through partnership in education.

Maternal mortality rates are unacceptably high globally. Low- and middle-income countries (LMICs) face challenges of an inadequate anaesthesia workforce, under-resourced healthcare systems and sub-optimal access to labour and delivery care, all of which negatively impact maternal and neonatal outcomes. In order to effect the changes in surgical-obstetric-anaesthesia workforce numbers advocated by the Lancet Commission on Global Surgery to support the UN sustainable development goals, mass training and upskilling of both physician and non-physician anaesthetists is imperative. The implementation of outreach programmes and partnerships across organisations and countries has already been shown to improve the provision of safe care to mothers and their babies, and these efforts should be continued. Short subspecialty courses and simulation training are two cornerstones of modern obstetric anaesthesia training in poorly resourced environments. This review discusses the challenges to accessing quality maternal healthcare in LMICs and the use of education, outreach, partnership and research to protect the most vulnerable women from coming to harm in the peripartum period.

Global issues in obstetric anaesthesia: perspectives from South Africa, Japan, China, Latin America and North America.

South Africa is classified as a low- and middle-income country, with a complex mixture of resource-rich and resource-limited settings. In the major referral hospitals, the necessary skill level exists for the management of complex challenges. However, this contrasts with the frequently-inadequate skill levels of anaesthesia practitioners in resource-limited environments. In Japan, obstetricians administer anaesthesia for 40% of caesarean deliveries and 80% of labour analgesia. Centralisation of delivery facilities is now occurring and it is expected that obstetric anaesthesiologists will be available 24 h a day in centralised facilities in the future. In China, improvements in women's reproductive, maternal, neonatal, child, and adolescent health are critical government policies. Obstetric anaesthesia, especially labour analgesia, has received unprecedented attention. Chinese obstetric anaesthesiologists are passionate about clinical research, focusing on efficacy, safety, and topical issues. The Latin-American region has different landscapes, people, languages, and cultures, and is one of the world's regions with the most inequality. There are large gaps in research, knowledge, and health services, and the World Federation of Societies of Anaesthesiologists is committed to working with governmental and non-governmental organisations to improve patient care and access to safe anaesthesia. Anaesthesia workforce challenges, exacerbated by coronavirus disease 2019, beset North American healthcare. Pre-existing struggles by governments and decision-makers to improve health care access remain, partly due to unfamiliarity with the role of the anaesthesiologist. In addition to weaknesses in work environments and dated standards of work culture, the work-life balance demanded by new generations of anaesthesiologists must be acknowledged.

Primeira descrição de pseudoparasitismo por esporocistos de Monocystis sp. em tatu-galinha, Dasypus novemcinctus (Linnaeus, 1758) - relato de caso / First description of pseudoparasitism by sporocysts of Monocystis sp. in nine banded armadillo, Dasypus novemcinctus (Linnaeus, 1758) - case report

O presente artigo é um relato sobre uma fêmea de D. novemcinctus que foi capturada de forma imprevista, durante um projeto de avaliação sanitária de animais silvestres sinantrópicos do município de Toledo/PR (autorização Sisbio/Ibama n. 55109-1). Durante a avaliação física, amostras de fezes foram coletadas após defecação espontânea e encaminhadas para análise. O material foi submetido aos métodos de flutuação simples em solução hipersaturada de cloreto de sódio e centrífugo-flutuação em sacarose. Na leitura das lâminas obtidas pelo método de centrífugo-flutuação em sacarose, foram observadas estruturas com comprimento de aproximadamente 10µm, forma bicônica e um tampão em cada extremidade, compatíveis com esporocistos de Monocystis sp. Protozoários do filo Apicomplexa, os Monocystis sp., são geralmente parasitas de anelídeos, como as minhocas. Esse organismo é comumente correlato a pseudoparasitismo em vários animais, porém não foram encontrados relatos de pseudoparasitismo desse agente em tatus-galinhas, logo essa é a primeira descrição de Monocystis sp. em espécime de D. novemcinctus.(AU)

The present article is an account of a female of D. novemcinctus which was captured during a sanitary evaluation project of synanthropic wild animals of the municipality of Toledo/PR (license SISBIO/ICMBIO n°. 55109-1). During a physical evaluation, samples of feces were collected, after spontaneous defecation, and sent for analysis. The material was subjected to simple flotation methods in hypersaturated sodium chloride solution and centrifugal-flotation solutions in sucrose. In a test reading by the centrifugal-flotation method in sucrose, structures with approximately 10µm, biconical shape and one plate at each end were observed, compatible with sporocysts of Monocystis sp. Protozoa of the phylum Apicomplexa, like Monocystis sp., it is common parasitic annelids, such as worms. This organism is a correlate of pseudoparasitism in several animals but was not found to describe this product as an agent in nine banded armadillos, so this is a first description of Monocystis sp. in specimen of D. novemcinctus.(AU)

Outcome of laparoscopic inguinal hernia repair in a South African private practice setting.

OBJECTIVE: The aim of this study was to determine the recurrence and complication rates of laparoscopic inguinal hernia repair performed in a private practice in Cape Town. DESIGN AND SUBJECTS: An unselected cohort of 507 patients who underwent laparoscopic totally extraperitoneal (TEP) inguinal hernia repair before September 2005 were included in this study, thus ensuring a minimum 5-year follow-up. Patient demographic data, clinical notes, operating notes and outpatient follow-up notes were studied. Patients were interviewed telephonically regarding hernia recurrence, chronic pain and technique preference if they had previously undergone an open repair. All data collected were recorded on an electronic spreadsheet. The primary outcome parameter was recurrence. The secondary outcome parameters were postoperative and long-term complications. RESULTS: Of the 507 patients, 267 were contactable telephonically. There were 384 hernia repairs with a mean follow-up of 8.8 years. There were 9 recurrences (2.3%). The overall complication rate was 7.9%. Two per cent of patients suffered from chronic groin pain with gradual improvement since surgery. Sixteen per cent of patients had had previous open repair of an inguinal hernia, either on the ipsilateral or the contralateral side, and all judged the open repair to have been more painful. CONCLUSIONS: The recurrence and complication rates for laparoscopic TEP inguinal hernia repair in this practice are low and comparable to the best reported series. There is a low incidence of persistent postoperative pain with the laparoscopic technique, and it is the technique preferred by patients who previously underwent an open repair.