Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model

Background

In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians.

Methods

Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians), and forty-four nurse-midwives and clinical officers (associate clinicians) were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals.

Findings

After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03) in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS) were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND) in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively). Of all deaths (maternal and IVEND) 84% to 96% were considered avoidable.

Conclusions

These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve maternal and perinatal health.     

The effect of dexamethasone on the occurrence and ultrastructure of rodlet cells in goldfish

In the bulbus arteriosus of goldfish Carassius auratus a subendothelial 'reticular space' was comprised of reticular-like cells, neutrophils, medium-sized granular leucocytes, phagocytes, endothelial cells and reticulo-endothelial cells; herein, rodlet cells (RCs) accumulated and probably matured. Four classes of RCs were identified: (1) Those occurring in the reticular space and contacting reticular-like cells; (2) those present in the reticular space contacting reticular-like and endothelial cells; here the RCs were discharging; (3) those occurring in the bulbar lumen anchored to lining endothelial cells or other RCs; (4) those free in the bulbar lumen. There was no significant difference in the number of RCs among control and saline- and dexamethasone-treated fish, but significant differences were found in RCs' class partition and in their discharge modality. In dexamethasone-treated goldfish class (3) RCs were almost absent (2% v. 10% of the other experimental groups), moreover 35% of the RCs developed a 'bleb' discharge modality rather than the most typical 'koronenartigen konfiguration' which developed in the vast majority (90%) of the other experimental groups.     

Opioid peptides in micellar systems: conformational analysis by CD and by one-dimensional and two-dimensional 1H-NMR spectroscopy

beta-Endorphin has been studied in SDS micelles by one- and two-dimensional nmr spectroscopy (1D and 2D nmr), and to explore the influence of peptide length and composition on the polypeptide structure, the investigation was extended to a number of fragments. The nmr results are compared with those obtained from CD experiments and discussed in terms of a secondary structure that involves the central region of beta-endorphin.     

Early and delayed glutamate effects in rat primary cortical neurons. Changes in the subcellular distribution of protein kinase C isoforms and in intracellular calcium concentration

Glutamate-induced changes in the subcellular distribution of protein kinase C isoforms and in the intracellular calcium concentration were investigated in rat primary cortical neurons. Western blot analysis of protein kinase C isoforms (alpha, beta1, beta2, gamma, delta, epsilon, zeta and theta), performed 30 min after a 10 min treatment with 30 microM glutamate, revealed a decrease in the total beta1 (-24%) and beta2 (-40%) isoform levels, without any significant change in any of the other isozymes. All conventional isoforms translocated to the membrane compartment, while delta, epsilon, zeta and theta; maintained their initial subcellular distribution. Twenty-four hours after glutamate treatment, the total protein kinase C labelling had increased, particularly the epsilon isoform, which accounted for 34% of the total densitometric signal. At this time, protein kinase C beta1, delta, epsilon and zeta isoforms were mainly detected in the membrane compartment, while gamma and theta; signals were displayed almost solely in the cytosol. Basal intracellular calcium concentration (FURA 2 assay) was concentration-dependently increased (maximum effect +77%) 30 min, but not 24h after a 10 min glutamate (10-100 microM) treatment, while the net increase induced by electrical stimulation (10 Hz, 10s) was consistently reduced (maximum effect -64%). The N-methyl-d-aspartate receptor antagonist, MK-801, 1 microM, prevented glutamate action both 30 min and 24 h after treatment, while non-selective protein kinase C inhibitors, ineffective at 30 min, potentiated it at 24 h. These findings show that protein kinase C isoforms are differently activated and involved in the early and delayed glutamate actions, and that the prevailing effect of their activation is neuroprotective.     

1,8-Naphthyridin-4-one derivatives as new ligands of A2A adenosine receptors

A series of 1,8-naphthyridine derivatives bearing various substituents in position 3, 4, and 7 of the heterocyclic nucleus have been synthesized and evaluated for their affinity at the bovine and human adenosine receptors. The new compounds were found to lack the affinity toward A(1)AR, whereas many of them are able to acquire an interesting affinity and selectivity for the A(2A)AR.     

Infrastructure in the electric sense: admittance data from shark hydrogels

Elasmobranchs (sharks, skates, and rays) possess an electrosensory system with an infrastructure of canals connecting the electrosensors to the environment. The electrosensors and canals are filled with a uniform hydrogel, but the gels function has not yet been determined. We present electrical admittance spectra collected from the hydrogel from 0.05 to 100 kHz, covering the effective range of the electrosensors. We have taken samples of this gel, postmortem, from Triaenodon obesus and Carcharodon carcharias; for purposes of comparison, we have synthesized a series of collagen-based hydrogel samples. The shark hydrogels demonstrate suppressed admittance when compared to both seawater and collagen gels. In particular, collagen hydrogels with equivalent ion concentrations are roughly 2.5 times more polarizable than the shark samples. We conclude that the shark hydrogels strongly localize ionic species, and we discuss the implications for the related roles of the gel and the canals in the electric sense. The gel-filled canals appear better suited to fostering voltage differences along their length than to providing direct electrical contact to the seawater environment.     

2-Styrylchromones As Novel Inhibitors of Xanthine Oxidase. A Structure-activity Study

The purpose of this study was the evaluation of the xanthine oxidase (XO) inhibition produced by some synthetic 2-styrylchromones. Ten polyhydroxylated derivatives with several substitution patterns were synthesised, and these and a positive control, allopurinol, were tested for their effects on XO activity by measuring the formation of uric acid from xanthine. The synthesised 2-styrylchromones inhibited xanthine oxidase in a concentration-dependent and non-competitive manner. Some IC 50 values found were as low as 0.55 μM, which, by comparison with the IC 50 found for allopurinol (5.43 μM), indicates promising new inhibitors. Those 2-styrylchromones found to be potent XO inhibitors should be further evaluated as potential agents for the treatment of pathologies related to the enzyme's activity, as is the case of gout, ischaemia/reperfusion damage, hypertension, hepatitis and cancer.     

Late Quaternary Palaeoichnological Sites from the Southern Atlantic Coast of Buenos Aires Province,Argentina: Mammal,Bird and Hominid Evidence

Palaeontological and palaeoichnological studies were made along the southeastern coast of Buenos Aires province, Argentina. Continental Late Pleistocene and continental, transitional and marine Holocene stratigraphic units were identified. The former are represented by fossil mammal bones and ichnites dated from 16,000 to 12,000 y. B.P. Continental Early Holocene beds dated circa 8,100 years B.P. contain fish, rodent and bird remains. Middle Holocene sediments 6,930 to 6,570 years B.P. are recorded by deposits bioturbated by estuarine crabs. During the Late Holocene, between 5,000 and 4,800 B.P., a marine transgression is recorded by a very rich mollusc fauna. The palaeoenvironmental variety recorded along a few tens of kilometers of the coast is a distinctive feature of this part of the Argentine coastal region. At Monte Hermoso beach, in the eastern part of the studied zone, archaeological materials were dated 7,300 years B.P., and human footprints dated 7,125 years B.P. were also recorded. In January 2005 some isolated human footprints were found at Pehuen-Co palaeoichnological site, which are older than those found at Monte Hermoso beach and of the same age as the oldest human archaeological findings in Patagonia, that is about 12,000 yeas B.P.     

Prevalence and sequence comparison of Phyllodistomum folium from zebra mussel and from freshwater fish in the Ebro River

We utilised DNA analysis to detect the presence of the digenean Phyllodistomum folium in three cyprinid species, Scardinius erythrophthalmus, Cyprinus carpio and Rutilus rutilus. DNA sequencing of the region containing the genes ITS1-5.8S-ITS2 revealed 100% sequence identity between DNA from the sporocysts found in zebra mussels and DNA from adults located in the urinary system of 29 cyprinid fish. A second genetically different (variation=1.6%) sequence was observed in two samples from R. rutilus. In our opinion, the existence of a complex of species reported as P. folium is supported by recent genetic studies, including our own results. The overall prevalence of P. folium in mussels from the Ebro River was 4.67% in 2006, although during the summer months the rates frequently exceeded 10%.     

Quantitative Detection of Epstein-Barr Virus DNA in Cerebrospinal Fluid and Blood Samples of Patients with Relapsing-Remitting Multiple Sclerosis

The presence of Epstein-Barr Virus (EBV) DNA in cerebrospinal fluid (CSF) and peripheral blood (PB) samples collected from 55 patients with clinical and radiologically-active relapsing-remitting MS (RRMS) and 51 subjects with other neurological diseases was determined using standardized commercially available kits for viral nucleic acid extraction and quantitative EBV DNA detection. Both cell-free and cell-associated CSF and PB fractions were analyzed, to distinguish latent from lytic EBV infection. EBV DNA was detected in 5.5% and 18.2% of cell-free and cell-associated CSF fractions of patients with RRMS as compared to 7.8% and 7.8% of controls; plasma and peripheral blood mononuclear cells (PBMC) positivity rates were 7.3% and 47.3% versus 5.8% and 31.4%, respectively. No significant difference in median EBV viral loads of positive samples was found between RRMS and control patients in all tested samples. Absence of statistically significant differences in EBV positivity rates between RRMS and control patients, despite the use of highly sensitive standardized methods, points to the lack of association between EBV and MS disease activity.