Meeting women's health needs in Yemen: a midwifery perspective

Maternal mortality in Yemen is one of the highest in the world. Reaching the rural majority of the population with primary health care services has been a continual priority for the nation. Despite efforts to expand health services, access to maternal and child health care remains low. The training of community midwives nationwide has been undertaken recently to address the need for maternal and child health services, particularly in rural areas. Several lessons have been gained through this initial training that will improve future efforts.     

Bilateral chronic conjunctivitis and corneal scarring in a boy with X-linked hypogammaglobulinaemia

ABSTRACT We report an unusual case of bilateral chronic conjunctivitis and corneal scarring in a boy with X-linked hypogammaglobulinaemia (XLH) who did not respond to the usual antibacterial and antiviral therapy. An immunofluorescence test for Chlamydia trachomatis from an eye swab was strongly positive. Within days of commencement of local and systemic tetracycline therapy, he showed marked improvement. Since conjunctival follicle formation, which depends on the presence of a B-cell population, may not occur in XLH, clinical examination in chlamydia conjunctivitis may be misleading and lead to a delay in diagnosis and treatment with resulting corneal complications, unless laboratory evidence of chlamydia infection is specifically sought.     

Health care and its costs for children with perinatally acquired HIV infection

Objective : To describe survival patterns, use of health services and related costs for Australian children with perinatally acquired human immunodeficiency virus (HIV) infection.
Methodology : A retrospective cross-sectional survey was made of 20 children with HIV infection (91% of those diagnosed) and 13 children with maternal antibodies who subsequently seroreverted, treated at 10 medical centres. Details of disease progression and use of health services were obtained from hospital medical records. Monthly costs for three phases of infection were estimated by linking service usage rates with estimates of the unit cost of each service. The average lifetime cost was estimated by combining monthly costs and phase duration estimates from the literature.
Results : Patterns of disease progression were similar to those reported internationally, with a median survival of 8 years. Use, of health services increased with severity of illness. Mean monthly costs were $120 per month (1992 Australian dollars) for children with maternal antibodies who subsequently seroreverted, $320 per month for children with HIV infection but no acquired immunodeficiency syndrome (AIDS)-defining illness, and $1830 per month for children with AIDS. The present value of total lifetime cost for a child with HIV infection was $48174,46% of which was for treatment of AIDS.
Discussion : The mean lifetime cost for a perinatally infected child was just over half that for a man with HIV in Australia. Health service usage and costs were lower for Australian than American children with HIV.     

A comparison of 600 and 200 mg mifepristone prior to second trimester abortion with the prostaglandin misoprostol

Objective To compare the use of 600 and 200 mg mifepristone prior to second trimester termination of pregnancy with the prostaglandin misoprostol.
Design A randomised study. Setting A Scottish teaching hospital.
Participants Seventy women undergoing legal induced abortion between 13 and 20 weeks of gestation.
Intervention Administration of either 600 or 200 mg mifepristone 36 to 48 hours prior to prostaglandin.
Main outcome measure Induction-abortion interval.
Results The geometric mean induction abortion interval was 6.9 (95 % CI 5.8–8.4) h and 6.9 (95 % CI 5.8–8.2) h in the 600 and 200 mg groups, respectively (no significant difference). The median dose of misoprostol was 1600 pg (three doses) in each group. Analgesic requirements and prostaglandin-related side effects were similar between groups. Overall, 11-4% of women required surgical evacuation of the uterus as a result of retained placenta.
Conclusions The dose of mifepristone used in second trimester abortion can be reduced from 600 to 200 mg.     

Simultaneous measurement of gallbladder emptying with cholescintigraphy and US during infusion of physiologic doses of cholecystokinin: a comparison

Both ultrasonography (US) and cholescintigraphy are used to study gallbladder dynamics. The present study was undertaken to determine whether the two methods provide the same or different information relating to gallbladder emptying. Emptying was simultaneously studied with both methods during infusion of graded physiologic doses of cholecystokinin (CCK) in six healthy subjects. Infusion of stepwise increasing doses of CCK, ranging from 0.03 to 0.5 Ivy dog units per kilogram of body weight per hour (IDU/kg.h), induced significant dose-related increases in plasma CCK, decreases in gallbladder volume assessed with US, and gallbladder emptying assessed with cholescintigraphy. The threshold dose for inducing significant gallbladder emptying was 0.13 IDU/kg.h, as determined with both techniques, indicating similar detection limits. There was a highly significant correlation between decreases in gallbladder volume and decreases in radioactive counts over the gallbladder region, with a tendency toward greater gallbladder responses at sonography during the early phase of gallbladder contraction and toward greater responses at cholescintigraphy during the later phase of gallbladder contraction. It is concluded that these methods can be used interchangeably for the quantitation of gallbladder emptying.