Scourge of intra-partum foetal death in Sub-Saharan Africa

Intra-partum foetal death has been variously defined.However, a definition adopted at a technical consultation in 2006 is employed in this review. The quality of intrapartum care is a crucial factor for pregnancy outcome for both mothers and new-borns. Intra-partum stillbirth is defined as late foetal death during labour, which clinically presents as fresh stillbirth. The largest proportion of the world's stillbirths occurs in the late preterm, term and intra-partum periods. The Western Pacific region has the greatest reduction in stillbirth with a 3.8% annual decline between 1995 and 2009; however, the annual decline in the African region is less than 1%. Caesarean delivery is still uncommon, especially in rural areas: 1% of births in rural Sub-Saharan Africa and 5% in rural South Asia are by caesarean delivery; 62% of stillbirths occurred during the intra-partum period; 61.4% of stillbirths are attributable to obstetrical complications. Preventive measures aimed at reducing the incidence of intra-partum foetal death entail all measures aimed at improving quality antenatal care and preventing intrapartum asphyxia. This review discusses intra-partum foetal deaths from a Sub-Saharan African perspective. It explores the contribution of research within the region to identifying its impact on new-born health and potential cost-effective policy interventions.     

Oral infectious diseases: a potential risk factor for HIV virus recrudescence?

As the highly active antiretroviral therapy (HAART) has transitioned human immunodeficiency virus (HIV) infection into a 'chronic disease' management strategy, there is growing evidence that infection with non-HIV pathogens in HIV+ patients may have important public health implications in undermining HAART success and acquired immunodeficiency syndrome progression. Several bacterial and host cell products during infections with non-HIV pathogens have shown the capacity to regulate HIV replication in latently infected cells. A high prevalence of oral infections caused by bacteria, viruses and fungi has been described in HIV+ patients, including periodontal disease. The oral cavity appears to be a site of HIV pathogenesis and potential reservoir for the disease as HIV RNA and DNA forms are present in saliva as well as in gingival crevicular fluid, and oral epithelial cells are susceptible to either cell free or cell-associated HIV infection. The clinical and biological bases of potential associations between chronic oral inflammatory disorders, such as periodontal disease, and exacerbation of HIV viraemia have received little attention. This review attempts to evaluate the current understanding of HIV reactivation as a result of co-infection and/or inflammation induced by non-HIV pathogens in HIV-infected patients, and presents a hypothetic model about the potential role of periodontitis as a global oral infection that potentially contributes to HIV recrudescence.     

Intrapartum Rupture of the Uterus Diagnosed by Ultrasound

Background

Spontaneous uterine rupture is a life threatening obstetrical emergency encountered infrequently in the emergency department. Its diagnosis is often missed or delayed, leading to maternal and fetal mortality.

Method

We present a case of ruptured uterus diagnosed by ultrasound in a 33-year-old gravid female with two previous cesarean sections.

Objective

To show the role of ultrasound in uterine rupture

Result

Ultrasound demonstrates uterine laceration and intra-abdominal dislocation of placenta and foetus

Conclusion

Because of the severity of the complication and the great variation of symptoms in connection with it, the authors encourage the use of ultrasound screening in the detection of this rare, but often catastrophic complication.     

Verletzungen und deren Ursache bei Fahrradunfällen

From April to September 1984 456 bicycle accidents were registered (73% adults, 27% children) and classified according to type and severity of injury and cause of accident. Of 594 injuries those of the upper extremities were predominant followed by mostly severe head injuries. The commest injury was the fracture of clavicle and thereafter fractures of the radial head and distal radial fractures in children. 59% of accidents occurred without involvement of another person. 58% of accidents were caused by the bicycle riders themselves.     

Therapievarianten beim Spannungspneumothorax

Zusammenfassung Nach eigenen Beobachtungen sind beim Spannungspneumothorax akut und chronisch verlaufende Bilder zu unterscheiden. Die Therapievarianten sollten sich danach sowie nach der Pathomorphologie richten. Am eigenen Krankengut von 182 Patienten waren in 70,8% nur „offene”, d. h. operative Methoden zielführend.

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Summary For treatment of tension pneumothorax one should consider, whether a chronic or acute condition exists. In addition the pathomorphology should influence the mode of treatment as well. The experience gained from 182 own cases is reported. In 71% a satisfactory result was achieved by an “open” (operative) treatment.

     

Die Versorgung der Schultereckgelenkssprengung mit der Hakenplatte nach Wolter

Wolter's hook-plate provides active abduction and forward-flexion of up to 90° two days postoperatively. Prebending of the plate and a precise drill hole for the hook in the acromion prevents later impingement of the hook on the humeral head or subluxation in the acromioclavicular joint, respectively. According to the shoulder evaluation form of C. R. Constant, 33 of 35 patients operated on between 1987 and 1991 at the trauma departments in Schwaz/Tirol and Bad Ischl showed excellent results one year postoperatively.