Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia.

BACKGROUND: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their own FHR and alert a midwife of changes detected. METHODS: Four hundred seventy-four women admitted in labour without obstetric complications were approached. Four hundred sixty-one consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately 1 minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded. RESULTS: Four hundred sixty-one out of 474 women gave consent, of whom 431 of 461 (93%) completed the monitoring themselves. Three hundred eighty-seven of 400 women who gave comments, reported positive and 13 negative experiences. FHR changes were reported in 28 participants and confirmed in 26. Twenty-four of these 26 FHR changes were first identified by mothers. Fetal death was identified on admission during training in one mother. Thirteen neonates required resuscitation, with 12 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl's ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. CONCLUSIONS: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

The effect of sulfide on alpha-glucosidases: implications for starch degradation in anaerobic bioreactors.

Membrane associated alpha-glucosidase activity was investigated in a methanogenic bioreactor (MR) and a biosulfidogenic bioreactor (SR). Temperature and pH optima studies showed temperature optima of 50 degrees C and pH optima of 8.0 for the alpha-glucosidases from both the MR and SR. Sulfide (at a concentration of 150 mg l(-1)) resulted in the complete loss of all alpha-glucosidase activity in both the MR and SR. beta-Glucosidase activities in our bioreactors were previously shown to be stimulated in the presence of sulfide. alpha-Glucosidases, in contrast, are inhibited by sulfide. This differential effect of sulfide on alpha-glucosidase and beta-glucosidase activities is highlighted and is of crucial consequence to the respective degradation and utilization of starch and cellulose substrates in natural anaerobic environments and anaerobic bioreactors specifically designed for the accelerated digestion of wastewater sludge under biosulfidogenic conditions.

Sham feeding as a procedure for assessing the influence of diet palatability on food intake.

Most of the methods used to evaluate the role of taste factors on food intake are confounded by the postingestional consequences of the ingested diet which interfere with measurements of consumption based strictly upon the stimulus properties of the food. The present experiment examines the utility of sham feeding in the gastric fistulated rat as a means of isolating, and thereby evaluating, the contribution of hedonically positive (sweet) and hedonically negative (bitter) taste factors on the magnitude of food intake. Rats equipped with open gastric cannulae sham fed solutions varying in their sucrose or quinine concentrations. The results revealed that the magnitude of sham feeding in a fixed time period varied systematically with the taste properties of the food. It is concluded that sham feeding represents a useful technique for isolating the influence of diet palatability on food intake. Furthermore, the present data identify one of the parameters that influences the magnitude of the sham feeding response, information that is important for studies using this preparation as a means of examining oral sensory controls of food intake control systems.

Effects of atropine methyl nitrate on sham feeding in the rat.

The purpose of this experiment was to clarify the effects of administration of peripheral cholinergic blocking agents on sham feeding. Rats were implanted with chronically indwelling gastric cannulae and allowed to sham feed sucrose solutions varying in their degree of diet palatability. Prior to the sham feeding tests, rats received an intraperitoneal injection of either atropine methyl nitrate (250 micrograms/kg) or a control substance, physiological (0.9%) saline. The results indicated that atropine methyl nitrate inhibited sham feeding at all levels of diet palatability tested. This reduction in food intake level following drug administration was apparent from the initiation of the sham feeding bout and did not result from a more rapid cessation of feeding under the drug condition. Further, similar doses of AMN did not reduce sham drinking of water in water-deprived animals. The implications of these findings to a cholinergic involvement in food intake control systems are discussed.

Focal myositis of the neck with idiopathic orbital myositis.

Focal myositis (of Heffner) in the right trapezius and paraspinal muscles accompanied by a pseudotumour of the left orbit has not been reported previously. The clinical, pathological and radiological features of these unusual benign pseudotumours of the head and neck are discussed. Computerized tomography (CT) scan of the neck and orbital ultrasound were suggestive of an inflammatory process without an abscess formation. This was followed by fine needle aspiration cytology (FNAC), which confirmed the diagnosis. The patient was treated with intravenous steroids and antibiotics, that led to complete resolution of symptoms, and there was no recurrence at six months follow-up. This report highlights the importance of imaging in inflammatory neck swellings.

Maxillary sinus hypoplasia.

Functional endoscopic sinus surgery (FESS) is now a routine surgical procedure performed all around the world. A pre-operative computed tomography (CT) scan is considered mandatory in most countries where these are available but there are still some surgeons who question the need for imaging especially in patients due to undergo limited FESS or middle meatal antrostomy. There are excellent papers, describing how to read scans looking for anatomical abnormalities, but unfortunately their description of maxillary sinus hypoplasia and the associated uncinate process deformities are limited. This article describes two cases, one of unilateral and one of bilateral maxillary sinus hypopolasia (MSH) and discusses their implications. Awareness of these anatomical variants is crucial to avoid orbital complications.

Reality ignored: health reform and people with disabilities.

The current health system reform debate largely has omitted the impact of different proposals on people with disabilities. Yet this population has a profound impact on the health care system and vice versa. The perspective of people with disabilities is different from that of other consumers and should be included in any health reform plan.

Combined laparoscopic incarcerated herniorrhaphy and small bowel resection.

Laparoscopic femoral herniorrhaphy using a preperitoneal plug and patch appears to be a feasible laparoscopic approach to femoral hernia. A modified preperitoneal femoral hernia repair with mesh and resection of incarcerated small bowel has been successfully completed under laparoscopic guidance in a 64-year-old patient with incarcerated femoral hernia. To our knowledge, this is the first such case reported in the United States. With further experience, laparoscopic femoral herniorrhaphy could provide a viable alternative to the standard treatment of femoral hernia.

Gangrenous ligamentum teres hepatis causing acute abdominal symptoms.

This unusual case of a gangrenous round ligament manifested by acute abdominal symptoms underscores the importance of the recent radiologic descriptions of the round ligament in computerized tomography and ultrasonography. The cause of the gangrenous process in this case remains unresolved.