L-NAME, nitric oxide and jejunal motility, blood flow and oxygen uptake in dogs.

1. The effects of the inhibitor of nitric oxide (NO) synthesis, NG-nitro-L-arginine methyl ester (L-NAME), on systemic arterial blood pressure and jejunal motility, blood flow, and oxygen uptake have been investigated in anaesthetized dogs. 2. L-NAME (cumulative doses of 0.1-20 mg kg-1, i.v.) dose-dependently increased blood pressure and jejunal motility and decreased heart rate. The maximal response of these three variables occurred at doses, 3, 10 and 10 mg kg-1, respectively. L-NAME (cumulative doses of 0.5-5 mg kg-1) also dose-dependently induced jejunal vasoconstriction. The jejunal vascular resistance returned to control values as the cumulative doses reached 10 and 20 mg kg-1, which corresponded to the maximal increase in jejunal motility. 3. A single intravenous injection of L-NAME (10 mg kg-1) produced a prompt increase in blood pressure, which lasted for at least 50 min. 4. L-NAME (10 mg kg-1) produced a progressive rise in jejunal motility reaching its maximum (47 +/- 6 mmHg) 15 min after the administration, and lasting for 40-50 min. Both the basal lumen pressure and the amplitude of rhythmic contractions increased during this period. 5. L-NAME (10 mg kg-1) produced a triphasic change in jejunal vascular resistance and blood flow measured by timed collection of venous outflow. The blood flow decreased initially (-43% at 5 min), increased (+35%) and returned to control value between 15 and 35 min, then decreased (-35%) 40-50 min post-infusion. Jejunal vascular resistance reflected the blood flow response (+88% at both 5 and 50 min).(ABSTRACT TRUNCATED AT 250 WORDS)     

Risk factors for surgical site infections in obstetrics: a retrospective study in an Ethiopian referral hospital

Background

Pregnant women are at risk of infection during labor and delivery. Infection in obstetrics accounts for the second most common cause of maternal mortality next to post partum hemorrhage. Knowing the prevalence and associated risk factors would help to undertake optimal precautions and standard surgical techniques to reduce surgical site infection which poses increased hospital cost and total hospital stay of the patients.

Method

Facility based retrospective observational study design was carried out purposively to assess the prevalence of surgical site infections and associated risk factors among mothers who had delivery related surgery at obstetric ward of Assela teaching referral hospital from April, 23, 2015 to September 5, 2015. A total of 384 women who had surgery for delivery were included in the study. The risk associated with SSIs was assessed by multivariate regression logistic analysis.

Results

The age of the women ranged from 17 to 40 years with the mean age of 26 (±5) years. The rate of surgical site infection was 9.4%(36/384). The risk factors for surgical site infection were age less than 19 (OR = 3.5, 95%CI 1.17–10.01), preterm gestation age (OR = 4.225 95%CI 1.254–14.238), duration of labor ≥24 h (OR = 2.219 95%CI1.054–4.670), duration of rupture of membrane ≥12 h (OR = 5.99, 95% CI2.75–13.02),chorioamnionitis (OR = 9.743, 95%CI 3.077–30.848), vertical skin incision(OR = 4,95%CI 1.709–13.322), pre operation Hematocrit (OR = 6.4,95%CI1.021–40.137),perioperative blood transfusion(OR = 6.75,95%CI 2.47,18.49), abdominal hysterectomy(OR = 7.9,95%CI1.698–36.960), and diabetic mellitus (OR = 3.7,95%CI 1.112–12.519).

Conclusions

Obstetric ward of Assela teaching referral hospital are encouraged to use properly WHO surgical safety checklist and examine how to sensibly integrate these essential safety steps into their normal operative workflow. Prophylactic antibiotic administration should be provided within one hour before the surgical incision or within two hours if the patient is receiving vancomycin or floroquinolones.

     

Traditional treatment of mental disorders in rural Ethiopia

BACKGROUND: Mental disorders are known to be as prevalent in Ethiopia as in other countries. Only 26 psychiatrists are working in the country with close to 80 million inhabitants. To this should be added clinics run by psychiatric nurses in most of the general hospitals. This means that still most of the mentally ill in the country are trected and cared for in a traditional way. OBJECTIVES: This paper presents the situation regarding traditional treatment of mental illness in a rural area in central Ethiopia, Butajira, with a population of about 350,000 persons, predominantly Muslim. METHODS: All traditional healers in Butajira area were mapped by asking key informants. Twenty-four healers were so identified and interviewed about their perception of mental illness and the treatment they offer. Clients from the healers and patients from the local health centre were interviewed about their opinions on the service given. FINDINGS: A majority of both clients and patients were satisfied with the consultation, but the clients of the healers were more satisfied than the patients in health centres. CONCLUSION: As most persons with mental disorders are treated by traditional healers in rural Ethiopia and in most other developing countries it is important to do more comprehensive studies on the traditional treatment and to find ways of collaboration between traditional practice and modern medicine.     

Understanding factors associated with rural-urban disparities of stunting among under-five children in Rwanda: A decomposition analysis approach

Childhood stunting in its moderate and severe forms is a major global problem and an important indicator of child health. Rwanda has made progress in reducing the prevalence of stunting. However, the burden of stunting and its geographical disparities have precipitated the need to investigate its spatial clusters and attributable factors. Here, we assessed the determinants of under-5 stunting and mapped its prevalence to identify areas where interventions can be directed. Using three combined rounds of the nationally representative Rwanda Demographic and Health Surveys of 2010, 2015 and 2020, we employed the Blinder-Oaxaca decomposition analysis and the hotspot and cluster analyses to quantify the contributions of key determinants of stunting. Overall, there was a 7.9% and 10.3% points reduction in moderate stunting among urban and rural areas, respectively, and a 2.8% and 8.3% points reduction in severe stunting in urban and rural areas, respectively. Child age, wealth index, maternal education and the number of antenatal care visits were key determinants for the reduction of moderate and severe stunting. Over time, persistent statistically significant hotspots for moderate and severe stunting were observed in Northern and Western parts of the country. There is a need for an adaptive scaling approach when implementing national nutritional interventions by targeting high-burden regions. Stunting hotspots in Western and Northern provinces underscore the need for coordinated subnational initiatives and strategies such as empowering the rural poor, enhancing antenatal health care, and improving maternal health and education levels to sustain the gains made in reducing childhood stunting.     

Direct colorimetric assay for rapid detection of rifampin-resistant Mycobacterium tuberculosis

The colorimetric 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was standardized for direct detection of rifampin-resistant Mycobacterium tuberculosis in sputum samples. The sensitivity and specificity of the direct MTT assay matched those of the standard indirect susceptibility assay on 7H10 medium, and interpretable results were obtained for 98.5% of the samples within 2 weeks. Traditional methods of in vitro drug susceptibility testing are time consuming and laborious. Susceptibility tests on clinical isolates require 6 to 9 weeks, and tests conducted directly on smear-positive samples take about 3 weeks (International Union Against Tuberculosis and Lung Disease, The public health service national tuberculosis reference laboratory and the national laboratory network. Minimum requirements, role and operation in a low-income country, Paris, France, 1998, and P. T. Kent and G. P. Kubica, Public health mycobacteriology. A guide for the level III laboratory, Centers for Disease Control and Prevention, Atlanta, Ga., 1985). More-rapid methods are available but are very expensive for routine use under program conditions in countries with high levels of tuberculosis endemicity.     

Enhanced Defluoridation of Water Using Zirconium—Coated Pumice in Fixed-Bed Adsorption Columns

Millions of people across the globe suffer from health issues related to high fluoride levels in drinking water. The purpose of this study was to test modified pumice as an adsorbent for the purification of fluoride-containing waters. The adsorption of fluoride onto zirconium-coated pumice (Zr–Pu) adsorbent was examined in fixed-bed adsorption columns. The coating of zirconium on the surface of VPum was revealed by X-ray diffractometer (XRD), Inductively coupled plasma-optical emission spectroscopy (ICP-EOS), and X-ray fluorescence (XRF) techniques. The degree of surface modification with the enhanced porosity of Zr–Pu was evident from the recorded scanning electron microscope (SEM) micrographs. The Brunauer-Emmett-Teller (BET) analysis confirmed the enhancement of the specific surface area of VPum after modification. The Fourier transform infrared (FTIR) examinations of VPum and Zr–Pu before and after adsorption did not reveal any significant spectrum changes. The pH drift method showed that VPum and Zr–Pu have positive charges at pH_PZC lower than 7.3 and 6.5, respectively. Zr–Pu yielded a higher adsorption capacity of 225 mg/kg (2.05 times the adsorption capacity of VPum: 110 mg/kg), at pH = 2 and volumetric flow rate (Q_O) of 1.25 mL/min. Breakthrough time increases with decreasing pH and flow rate. The experimental adsorption data was well-matched by the Thomas and Adams-Bohart models with correlation coefficients (R²) of ≥ 0.980 (Zr–Pu) and ≥ 0.897 (VPum), confirming that both models are suitable tools to design fixed-bed column systems using volcanic rock materials. Overall, coating pumice with zirconium improved the defluoridation capacity of pumice; hence, a Zr–Pu-packed fixed-bed can be applied for defluoridation of excess fluoride from groundwater. However, additional investigations on, for instance, the influences of competing ions are advisable to draw explicit conclusions.     

Incidence and Predictors of Mortality among Preterm Neonates Admitted to the Neonatal Intensive Care Unit at Debre Markos Referral Hospital,Northwest Ethiopia

BackgroundPrematurity is the most frequent cause of neonatal death and the second leading cause of under-five mortality. Preterm related complications accounts for 35 % of neonatal deaths within the first week after birth. So far, most studies done in Ethiopia have focused on estimating the prevalence and determinant factors of premature neonatal death. The current study aimed to assess the incidence and predictors of mortality among preterm neonates admitted to neonatal intensive care unit at Debre Markos Referral Hospital.MethodsAn institution-based retrospective follow up study was conducted among premature neonates admitted to Neonatal Intensive Care Unit at Debre Markos Referral Hospital from July 2019 to October 2019. Around 498 patients were selected randomly. A multivariable cox proportional hazards model was fitted to identify predictors of mortality.ResultsA total of 498 preterm babies were followed, and the mean age for follow up at the time of admission to NICU was 15 hours ± 38 SD. Death rate in preterm was estimated to be 27.11% (95% CI: 23.3%, 31.1%). Preterm neonates with gestational age of less than 32 weeks (AHR=1.51; 95% CI: 1.02, 2.24), respiratory distress syndrome (AHR=1.49; 95% CI: 1.03, 2.17), perinatal asphyxia (AHR=1.74, 95% CI: 1.01, 2.76) and congenital malformation (AHR=3.38, 95% CI: 1.21, 8.77) were statistically significant predictors of mortality among preterms.ConclusionThe incidence of death in preterm neonates is relatively low. Gestational age less than 32 weeks, perinatal asphyxia, respiratory distress syndrome and congenital malformation were found as predictors.     

Variation of Ultrasonic Renal Volume between Hypertensive and Non-Hypertensive Individuals in Relation to Body Size Parameters

BackgroundEstimation of renal size is vital for the diagnosis of abnormal structural change on the kidneys due to the adverse effects of chronic diseases like hypertension. This study evaluated renal volume by ultrasound in relation to body size parameters, notably body mass index (BMI) and body surface area(BSA) in hypertensive and non-hypertensive individuals.MethodsA hospital-based comparative cross-sectional study was conducted from February to September 2018 at the Radiology department of the Jimma University Medical Center (JUMC). The study included consecutively selected samples of 85 ambulatory hypertensive patients and 60non-hypertensive controls recruited consecutively on voluntary basis. After receiving verbal consent, each subject underwent abdominal ultrasound examination and length, width and thickness of both kidneys were measured and used for estimation of renal volume. The statistical evaluation included independent samples t-tests for mean differences with regard to ultrasonic renal measurements between hypertensive and non-hypertensive groups.ResultsA total of 145 adults aged 16 – 80 years (mean ±SD=44 ±17) participated in the study. In the hypertensive group, mean renal volume of 97.7cm³ for the right kidney and104.4cm³ for the left kidney whereas in the control group, it was 101.1cm³ for the right and 111.8 cm³ for the left kidney. The mean right renal volume to BSA ratio was 58.2cm³/m² in hypertensive group, while it was 62.6cm³/m² among the control group (p=0.076). The mean left renal volume to BSA of the patients was 62.2cm³/m² and significantly (p=0.012) lower than that of the non-hypertensive group, which was 69.3 cm³/m².ConclusionSlightly smaller bilateral renal volume among hypertensive patients as compared the controls was obtained.     

Addressing the Impact of Noncommunicable Diseases and Injuries (NCDIs) in Ethiopia: Findings and Recommendations from the Ethiopia NCDI Commission

BackgroundNoncommunicable diseases and injuries (NCDIs) are the leading causes of premature mortality globally. Ethiopia is experiencing a rapid increase in NCDI burden. The Ethiopia NCDI Commission aimed to determine the burden of NCDIs, prioritize health sector interventions for NCDIs and estimate the cost and available fiscal-space for NCDI interventions.MethodsWe retrieved data on NCDI disease burden and concomitant risk factors from the Global Burden of Disease (GBD) Study, complemented by systematic review of published literature from Ethiopia. Cost-effective interventions were identified through a structured priority-setting process and costed using the One Health tool. We conducted fiscal-space analysis to identify an affordable package of NCDI services in Ethiopia.ResultsWe find that there is a large and diverse NCDI disease burden and their risk factors such as hypertension and diabetes (these conditions are NCDIs themselves and could be risk factors to other NCDIs), including less common but more severe NCDIs such as rheumatic heart disease and cancers in women. Mental, neurological, chronic respiratory and surgical conditions also contribute to a substantial proportion of NCDI disease burden in Ethiopia. Among an initial list of 235 interventions, the commission recommended 90 top-priority NCDI interventions (including essential surgery) for implementation. The additional annual cost for scaling up of these interventions was estimated at US$550m (about US$4.7 per capita).ConclusionsA targeted investment in cost-effective interventions could result in substantial reduction in premature mortality and may be within the projected fiscal space of Ethiopia. Innovative financing mechanisms, multi-sectoral governance, regional implementation, and an integrated service delivery approach mainly using primary health care are required to achieve these goals.