The impact of the manual vacuum aspiration (MVA) technique on health care services at Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi.

OBJECTIVES: To assess the impact of the manual vacuum aspiration (MVA) technique on health care services and its acceptability to patients and staff. DESIGN: Prospective descriptive survey. SETTING: The university teaching hospital, Blantyre, Malawi. PARTICIPANTS: All 456 patients who had MVA for treatment or investigation between 10 January and 9 April 1994, the nurses and doctors working in the unit and hospital administrators. MAIN OUTCOMES: Proportion of incomplete abortion patients who had MVA, the need for pain relief, patients' reactions, staff opinion, and reduction in ward occupancy rates and duration of hospitalisation. RESULTS: Of the total, 97.4% had MVA for treatment of incomplete abortion; these comprised 81.2% of all incomplete abortion patients treated during the study period. The mean volume of uterine contents was 33.4 ml. There was no relationship between the volume and either the gestational age or uterine size (P > 0.05). Only 10.7% of patients required pain relief. The bed occupancy rates in the gynaecological ward dropped from an average of 150% before to 130% after the introduction of MVA, and the mean hospital stay was reduced from 3 days, with 78.4% staying for more than 2 days, to 2 days, with 52% staying for less than 24 hours (P < 0.05). Most patients expressed general satisfaction with the method, while the staff were happler because their work had been made easier. There were no major complications associated with the procedure. CONCLUSION: The findings show that MVA is a safe, reliable, effective and acceptable method of treating incomplete abortion, and can conserve hospital resources.

Identification and partial characterization of Trypanosoma cruzi antigens recognized by T cells and immune sera from patients with Chagas' disease.

Trypanosoma cruzi antigenic specificities involved in human T-cell and antibody responses were compared in chronic chagasic patients affected with cardiomyopathy (C) or with the indeterminate form (I), the asymptomatic form of chronic Chagas' disease. T-cell Western blotting (immunoblotting) was performed to identify the most active antigens in epimastigote extracts (EPI-Ag). The patterns of peripheral blood mononuclear cell (PBMC) and T-cell proliferative responses induced by fractions blotted to nitrocellulose were heterogeneous, but the computation of their frequency distribution disclosed some important antigen specificities. Molecules ranging from 100 to 150 kilodaltons (kDa) were frequently stimulatory to PBMC from I patients (5 of 8 cases) and were less so when confronted with C patient (1 of 7 cases) lymphocytes. In contrast, both groups of patients actively responded to fractions ranging from 48 to 57 and 28 to 32 kilodaltons (kDa). The Western immunoblotting patterns of antibody reactivity displayed by 17 C and 15 I patients were also similar, yielding outstanding staining in the molecular mass ranges of 70 to 80 and 43 to 57 kDa. The latter antigen complex was recognized by 100% of the 32 chronic Chagas' disease serum specimens tested and closely corresponded to the migratory position recognized by T cells of most patients tested. The identification of the active molecules contained in the 43- to 57-kDa region was sought, with a focus on GP57/51, an antigen with well-established serodiagnostic properties. Immunoblotting analysis of EPI-Ag with a monoclonal antibody to GP57/51 confirmed its presence within the predicted molecular weight region. Highly purified GP51 was then used to demonstrate directly its capacity to promote specific PBMC proliferative responses in vitro. Data computed from a survey with 12 patients have shown a linear correlation (r = 0.93) between PBMC responses to EPI-Ag and to purified GP51, suggesting that the immune response to this particular glycoprotein may be an important component of human immune responses against T. cruzi.