A postpartum haemorrhage package with condom uterine balloon tamponade: a prospective multi-centre case series in Kenya, Sierra Leone, Senegal, and Nepal.

OBJECTIVE: To evaluate the effectiveness and safety of an ultra-low-cost uterine balloon tamponade package (ESM-UBT™) for facility-based management of uncontrolled postpartum haemorrhage (PPH) in Kenya, Sierra Leone, Senegal, and Nepal. DESIGN: Prospective multi-centre case series. SETTING: Facilities in resource-scarce areas of Kenya, Sierra Leone, Nepal, and Senegal. POPULATION: Women with uncontrolled postpartum haemorrhage in 307 facilities across the four countries. METHODS: A standardised ESM-UBT package was implemented in 307 facilities over 29 months (1 September 2012 to 1 February 2015). Data were collected via a multi-pronged approach including data card completion, chart reviews, and provider interviews. Beginning in August 2014, women who had previously undergone UBT placement were sought and queried regarding potential complications associated with UBT use. MAIN OUTCOME MEASURES: All-cause survival, survival from PPH, and post-UBT use complications (surgery, hospitalisation, antibiotics for pelvic infection) associated with UBT use. RESULTS: 201 UBTs were placed for uncontrolled vaginal haemorrhage refractory to all other interventions. In all, 38% (71/188) of women were either unconscious or confused at the time of UBT insertion. All-cause survival was 95% (190/201). However, 98% (160/163) of women survived uncontrolled PPH if delivery occurred at an ESM-UBT online facility. One (1/151) potential UBT-associated complication (postpartum endometritis) was identified and two improvised UBTs were placed in women with a ruptured uterus. CONCLUSIONS: These pilot data suggest that the ESM-UBT package is a clinically promising and safe method to arrest uncontrolled postpartum haemorrhage and save women's lives. The UBT was successfully placed by all levels of facility-based providers. Future studies are needed to further evaluate the effectiveness of ESM-UBT in low-resource settings. TWEETABLE ABSTRACT: Evidence for ESM-UBT as a clinically promising and safe method to arrest uncontrolled PPH and save women's lives.

Prevalence of Salmonella spp. and thermophilic Campylobacter spp. in the small Asian mongoose (Herpestes javanicus) in Barbados, West Indies.

From April to July 2005, rectal swabs were collected from 48 free-ranging small Asian mongooses (Herpestes javanicus) on the east and south coasts of Barbados and analyzed for Salmonella and Campylobacter spp. Salmonella was recovered in 21.12% (7/33) of mongooses at the east-coast site and 26.67% (4/15) at the south-coast site. Four serotypes were isolated: Salmonella enterica serovar Rubislaw, Kentucky, Javiana, and Panama. One east-coast sample of 11 tested for Campylobacter was positive (9.09%). These results indicate that mongooses in Barbados are carriers and shedders of Salmonella and Campylobacter spp. and are a potential wildlife reservoir for these enteropathogens.

Abortions in N'Dama cattle due to salmonellosis.

An outbreak of diarrhoea, dysentery, abortion and death among N'Dama cattle is reported. Eight animals involved were examined ante- and/or postmortem yielding salmonella belonging to three serotypes, S. visby, S. hadar and S. taksony. The need for further studies to elucidate the problem of salmonella abortion in cattle in Sierra Leone is highlighted.

Adrenal gland involvement in mice with hereditary obesity and diabetes mellitus. Morphological studies.

The contribution of the adrenal gland to the development of the spontaneous syndrome of obesity and diabetes in Yellow-KK (Y-KK) mice was studied. Six-month old Y-KK mice exhibited hyperadrenocorticism and adrenal cortex enlargement. Light microscopic morphometric studies of Y-KK adrenals revealed an expanded volume of the adrenal cortex resulting from hyperplasia of zona fasciculata and reticularis cells. Ultrastructural studies revealed fewer lipid droplets, increased numbers of mitochondria and a more extensively developed Golgi system with zona fasciculata and reticularis cells. This cytological evidence of enhanced steroid biosynthetic and secretory activity was consistent with increased levels of plasma immunoreactive corticosterone. Structural and functional abnormalities of Y-KK adrenals were preceded by the development of obesity, hyperglycaemia and hyperinsulinaemia. It is unlikely, therefore, that the adrenal plays a casual role in the syndrome's pathogenesis, although, hyperadrenocorticism may be in part responsible for an exacerbation of the observed phenomena.

Growing up and growing old: the politics of age exclusion.

The young and the old are inherently vulnerable to the workings of power in a society dominated by the middle-aged. This situation is an outcome of the gradual exclusion of the two ends of the life cycle from productive roles, despite their increasing biological capacities. Consequences of age-based exclusion include economic discrimination, age stereo-typing, and territorial segregation.