La mortalité périnatale : ampleur et causes à Lubumbashi,République démocratique du Congo

BackgroundThe present study was initiated in order to determine the rate, the causes and the risk factors for perinatal mortality in Lubumbashi, Democratic Republic of Congo.MethodsData for this cross-sectional study were collected by interviewing participating women and by analysis of medical files. Women who gave birth in 2010 and were residents of Lubumbashi during the same year were included. Women were included irrespective of the pregnancy outcome and perinatal survival was determined for newborns aged at least seven days. Women were recruited from households selected by cluster sampling for healthcare zones. Perinatal mortality was defined as stillbirths and early neonatal deaths per 1000 births. Risk factors were sought using the odds ratio method adjusted by logistic regression using a 5% threshold.ResultsAmong 11,536 surveyed women, there were 11,633 births including 177 stillbirths and 133 early neonatal deaths. Perinatal mortality was 27‰ (95%IC = 23.7–29.6‰). The causes of this mortality were respiratory distress (58.2%), neonatal infection (pneumonia and neonatal meningitis, 13.5%), complications of prematurity (9.0%), neonatal tetanus (1.6%), congenital malformations (0.6%). The cause of perinatal death was unknown for 17.1%. Risk factors for perinatal mortality were: unmarried mother; home delivery; complicated delivery; dystocia; caesarean-section; multiple pregnancy; low birth weight; prematurity.ConclusionAction should be taken to improve availability, use and quality of Emergency obstetrical and neonatal care. Women should be better informed concerning the danger signs of pregnancy and childbirth.     

Retrieving of Pups by Neonatally Stressed Mothers

Abstract

In the rat, perinatal food and maternal deprivation provoke long-lasting effects upon the retrieving responses of dams to displaced pups. In the current study, the retrieving latency and the disruption in the body area of pups chosen by the mother to transport them to a new location was investigated on days 4, 8 and 12 postpartum in lactating Wistar rats. Rats, neonatally underfed by daily (12 h) mother-litter separation in an incubator from days 1 to 23 postpartum, exhibited prolonged retrieving latencies and disruption in the body area of young ones chosen by the dam to transport them to the nest. Furthermore, neonatally underfed dams frequently transported pups in a rude manner eliciting sonic distress cries from them compared to control mothers. These findings are possibly relevant to understand the impact of epigenetic influences on offspring brain and physiological maturation partly mediated through maternal care.     

NADPH-diaphorase Histochemical Labeling Patterns in the Hippocampal Neuropil and Visual Cortical Neurons in Weaned Rats Reared during Lactation on Different Litter Sizes

Abstract

Tissue distribution of nitric oxide-synthases was investigated in the rat hippocampus and visual cortex under nutritional changes induced by modification of the litter size. Young (30-45-days-old) rats, suckled in litters formed by 3, 6 or 12 pups (called small, medium and large litters, respectively), were studied by using nicotine-adenine-dinucleotide phosphate-diaphorase histochemistry (shortly, diaphorase), a simple and robust procedure to characterize tissue distribution of nitric oxide-synthases. We assessed morphometric features of the diaphorase-positive cells in visual cortex, and the neuropil histochemical activity in hippocampal CA1 and dentate gyrus using densitometry analysis. In the large-litter group, the labeled-cell density in white matter of area 17 was higher, as compared to the small-litter group. There was a clear trend, in the large-litter group, to lower values of soma area, dendritic field and branches per neuron, but the differences were not significant. Densitometry analysis of hippocampus revealed a significant increase in the relative neuropil histochemical activity of the dentate gyrus molecular layer in the larger litters, which may be associated to increased compensatory blood flow in the hippocampus. The pathophysiological mechanisms of the observed changes remain to be investigated.     

区分医院感染与社区感染耐药菌监测对合理用药的影响

目的了解社区感染菌与医院感染菌的耐药性差异及在细菌耐药预警机制中的影响差异,从而为临床合理使用抗菌药物提供更准确的参考。方法 2010年对微生物室分离菌株感染性质进行区分,比较两类菌的耐药性差异.并以耐药率>75.0%作为合理用药的最高预警机制,比较社区感染菌株与医院感染菌株差异。结果两类感染株排前5位的均为金黄色葡萄球菌、鲍氏不动杆菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌,但排名顺序不同,且两类感染的耐药率差异有统计学意义(P<0.05);其中金黄色葡萄球菌、鲍氏不动杆菌医院感染株对多数抗菌药物的耐药率>75.0%,铜绿假单胞菌的耐药率均<75.0%;以上5种分离菌中除铜绿假单胞菌无明显差异外,其他均存在差异。结论耐药菌监测及治疗过程中应区分不同的感染性质,能更合理使用抗菌药物,减少细菌耐药性的产生。     

本科护生定科实习初期真实体验的质性研究

[目的]了解与探讨本科护生定科实习初期1～2个月内的真实体验,为定科实习护生带教管理提供依据.[方法]运用质性研究中Van Manan的诠释现象学研究方法,对12名定科实习的本科护生进行深入访谈. [结果]用类属分析方法对资料进行反思、比较和归纳,提炼出“工作压力仍然存在;不能自主有效地进行职业生涯规划;不能进行有效沟通,感到无助;综合素质能力较差”4个主题. [结论]医院应制定系统的带教计划,关心定科实习本科护生的转变状态,帮助进行减压管理;尽早向护生提供职业生涯规划的系统知识与全面信息,引导其进行制定个人职业生涯规划;注重培养学生的自主学习能力,与学校联合改革带教方法,满足护生继续学习与科研需求.     

Digital mammography screening: weighing reduced mortality against increased overdiagnosis

Objective

Digital mammography has been shown to increase the detection of ductal carcinoma in situ (DCIS) compared to screen-film mammography. The benefits and risks of such an increase were assessed.

Methods

Breast cancer detection rates were compared between 502,574 screen-film and 83,976 digital mammograms performed between 2004 and 2006 among Dutch screening participants. The detection rates were then modeled using a baseline model and two extreme models that respectively assumed a high rate of progression and no progression of preclinical DCIS to invasive cancer. With these models, breast cancer mortality and overdiagnosis were predicted.

Results

The DCIS detection rate was significantly higher at digital mammography (1.2 per 1000 mammograms (95% C.I. 1.0-1.5)) than at screen-film mammography (0.7 per 1000 mammograms (95% C.I. 0.6-0.7)). Consequently, 287 (range progressive- non progressive model: 1-598) extra breast cancer deaths per 1,000,000 women (a 4.4% increase) were predicted to be prevented. An extra 401 (range: 165-2271) cancers would be overdiagnosed (a 21% increase).

Conclusion

Modeling predicted that digital mammography screening would further reduce breast cancer mortality by 4.4%, at a 21% increased overdiagnosis rate. The consequences of digital screening, however, are sensitive to underlying assumptions on the natural history of DCIS.     

急性特发性面神经麻痹的早期康复护理的临床观察

目的观察早期康复护理对急性特发性面神经麻痹的疗效。方法将63例急性脑卒中偏瘫患者随机分成康复护理组和临床护理组（对照组）两组,康复护理组予神经内科常规治疗,为患者制订康复护理计划,进行早期康复护理;对照组给予神经内科常规治疗和一般临床护理,治疗前后定期对患者进行神经功能缺损评定,神经功能缺损评定采用改良portmann简易评分法,以治疗第14天分值的改变作为主要疗效判断标准。结果康复护理组痊愈率、总有效率与对照组比较,差异有统计学意义（P〈0．05）。结论早期康复护理能有效改善急性特发性面神经麻痹的预后。     

新生儿先天性心脏病早期诊断

[目的]为提高临床诊断率,降低先心病病死率及致残率,总结新生儿先天性心脏病患者早期诊断特点。[方法]选择2008年1月～2010年12月住院新生儿科的先心病患儿共61例,所有患儿均经过彩色多普勒超声明确诊断,回顾分析心儿先天性心脏病临床特征性表现及各辅助检查结果。[结果]彩超查显示,新生儿先天性心脏病中以室间隔缺损居多,其次为房间隔缺损。CR拍片显示心影扩大者20例(32.7%),肺野淤血者16例(26.2%),肺野缺血者9例(14.8%)。心电图检查显示右室肥厚者20例(32.7%),心电左偏者9例(14.8%),心率不整者8例(13.1%),室上性心动过缓者3例(4.9%),s-T段压低者1例(1.6%)。[结论]新生儿先天性心脏病缺乏特征性临床表现,以气促多见,以室间隔缺损病理类型居多,辅助诊断方法中,彩超检查具有特有的优势。     

早期康复对脑卒中患者日常生活能力的影响

[目的]探讨早期康复对脑卒中患者日常生活能力的影响。[方法]将符合纳入标准患者按入院时间先后分为康复组和对照组。每组按方案进行治疗,治疗前及治疗40d后分别进行改良巴氏指数评定表评分,根据评分判断临床疗效。[结果]治疗前,康复组患者Barthel指数评分为28.75±13.55,对照组为29.33±14.07,差异无统计学意义(P﹥0.05)。治疗40d后,康复组患者Barthel指数评分为69.50±16.67,对照组为52.33±19.08,两组均有不同程度的改善,但康复组的改善程度明显优于对照组(P﹤0.05)。[结论]早期康复可以明显提高脑卒中患者日常生活能力。     

胃肠道手术后规范化序贯肠内肠外营养支持疗法与肠外营养支持的临床随机对照研究

目的比较胃肠道手术后规范化序贯肠内肠外营养支持疗法与肠外营养支持的临床疗效。方法采用随机数字表法,将126例拟行开腹胃肠道手术的患者随机分为早期肠内肠外营养支持疗法组（EEN＋PN组,n=62）和肠外营养支持组（PN组,n=64）,分别于手术前,手术后第3、7天监测患者的体重、体重指数、血清白蛋白、前白蛋白、血脂、血生化、血淋巴细胞计数、血C反应蛋白变化情况,比较两组患者术后胃肠道功能恢复时间、手术并发症、营养支持相关费用及住院天数。结果术前两组患者的营养相关指标、血生化指标和炎症及免疫指标差异均无统计学意义（P〉0．05）;术后第3天,EEN＋PN组患者前白蛋白水平显著高于PN组[（160．3±23．0）g／L比（137．0±28．7）g／L,P=0．000];术后第7天,EEN＋PN组患者前白蛋白[（210．6±34．6）g／L比（154．8±36．9）g／L,P=0．000]、白蛋白[（33．6±3．8）g／L比（31．8±4．7）g／L,P=0．042]、淋巴细胞计数[（2．33±0．53）×10^9/L比（1．04±0．36）×10^9g／L,P=0．046]水平均显著高于PN组,血γ-谷氨酰转肽酶[（48．12±33．84）U／L比（71．54±34．00）U／L,P=0．048]、C反应蛋白[（31．15±19．00）mmol／L比（45．90±23．21）mmol／L,P=0.042]、总胆固醇[（3．09±0．83）mmol／L比（3．29±0．91）mmol／L,P=0．045]、低密度脂蛋白[（2．01±0．39）mmol／L比（2．31±0．72）mmol／L,P=0．049]水平显著低于PN组。EEN＋PN组患者术后胃肠道功能恢复时间显著短于PN组[（65．7±15．6）h比（75．1±27．0）h,P=0．036],围手术营养支持疗法总费用显著低于PN组[（2634．5±1306．8）元比（3058．6±1216．0）元,P=0．046]。结论胃肠道手术后早期规范化序贯肠内肠外营养支持疗法可以改善机体术后前白蛋白水平,有益于术后患者免疫功能和组织损伤水平的恢复,促进早期胃肠道功能恢复,降低营养支持疗法相关费用。