Clinico-Pathological discrepancies in the Diagnosis of Causes of Maternal Death in Sub-Saharan Africa: Retrospective Analysis

Background Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. Methods and Findings A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n ¼ 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). Conclusions Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.

Bosque y turismo

This paper presents a number of considerations on the recreational/tourism function offorests and some regulations that should be present in the planning of the public use of forestspace. We are going to examine studies on frequency of use, the features that condition theuse of forests and the criteria that should be present on planning of recreational use of forests

Las entidades sub-nacionales en Norteamérica y la lucha contra el cambio climático: desarrollo normativo y vinculación de sistemas de comercio de derechos de emisión

[spa] Mientras que en Europa la interdependencia y la dimensión transfronteriza de las cuestiones ligadas al cambio climático ha facilitado una cierta"continentalización" de la gestión de este fenómeno, favorecida por el carácter intergubernamental de las medidas que se adoptan en el marco de la Unión Europea, al otro lado del Atlántico la transversalidad de este mismo fenómeno explica la necesidad de que, ante las limitaciones del marco regional, se pongan en marcha mecanismos que faciliten la intervención no sólo estatal sino también de las entidades sub-nacionales. En este sentido, la ausencia de la acción federal tanto en Estados Unidos como en Canadá ha comportado un mayor desarrollo de la acción de las entidades sub-nacionales, que han tomado el liderazgo en la lucha contra el cambio climático. Son estas medidas las que se han visualizado en el escenario internacional. Ello ha favorecido el establecimiento de mecanismos de coordinación de la acción de estas entidades sub-nacionales en el seno de redes transnacionales, que han ido adquiriendo una mayor relevancia en la implementación del Convenio Marco sobre el Cambio Climático y del Protocolo de Kyoto, particularmente en relación a uno de sus instrumentos, el comercio de los derechos de emisión de gases de efecto invernadero. En este contexto, la futura vinculación de los sistemas de comercio de derechos de emisión de gases de efecto invernadero en Norteamérica con el sistema de la Unión Europea presenta diversos retos de carácter material y formal.

Anomalous sub aortic left brachiocephalic vein: a case report

The left brachiocephalic vein occasionally follows an aberrant course. It is usually associated with congenital cardiac anomaly. We present a case of anomalous left brachiocephalic vein which followed a sub aortic course, with no cardiac abnormality. Multi detector computed tomography is very useful in accurate diagnosis of this condition and prevents any further investigation in cases of isolated abnormalities.

Patrón espacial de un ecotono bosque subalpino pastos alpinos (Las Cutas, Ordesa, Pirineos Centrales)

Describimos el patrón espacial de un ecotono bosque subalpino-pastos alpinos, que incluye los límites altitudinales del bosque y del árbol, dominado por Pinus uncinata Ram. y localizado en los Pirineos Centrales. Situamos una parcela rectangular (30 x 140 m) cruzando el ecotono con su lado mayor paralelo a la pendiente. Para cada individuo de R uncinata dentro de la parcela medimos: su localización (coordenadas x, y), y variables estructurales (p. ej. altura) y de forma de crecimiento (número y tipo -vivo o muerto, vertical o arbustivo- de pies por individuo). Los individuos vivos de P. uncinata se clasificaron según su tamaño (adultos, jóvenes, vástagos y plántulas) y forma de crecimiento (krurmnhoIz -individuos arbustivos policórmicos-, krummholz con pies verticales). Describimos cuantitativamente el tipo de sustrato (suelo, materia orgánica, grava, roca) y la cobertura de herbáceas, arbustos y P. uncinata usando transectos paralelos a la pendiente. La estructura del ecotono se describió mediante: (a) los análisis del patrón de puntos (K de Ripley) y (b) del patrón de superficies (correlogramas espaciales de la altura); (c) la detección y descripción de fronteras usando la densidad o variables de tamaño y forma de crecimiento de los indidividos ; (d) la síntesis de las variaciones en la presencia y diversidad de sustratos y de herbáceas y arbustos-, y (e) la ordenación de los cuadrados en que subdividimos la parcela (115 cuadrados de 6 x 6 m), de acuerdo a su posición espacial en el ecotono, al tipo de sustrato, a la cobertura de herbáceas y arbustos y al número, tamaño y forma de crecimiento de los individuos de P. uncinata. La mayoría de los individuos vivos de P. uncinata eran krummhoIz, situándose por encima del límite del bosque. Los individuos krummholz mostraron interacción espacial positiva con las plántulas. En el área inferior del ecotono, los individuos grandes, verticales y unicórmicos...

Posterior Sub-Tenon Triamcinolone Injection for Chronic Macular Oedema Associated With Non-Ischemic Branch or Central Retinal Vein Occlusion

Aims: To evaluate the effectiveness and safety of Posterior Sub-Tenon (PST) Triamcinolone Acetonide (TA) injection for persistent macular oedema associated with non-ischemic Central Retinal Vein Occlusion (CRVO) or Branch Retinal Vein Occlusion (BRVO) in non-vitrectomized eye. Methods: Fourteen consecutive eyes of 14 patients characterized by macular oedema lasting more than 3 months and with a visual acuity of less than 20/40 were enrolled. Six eyes presented with BRVO, 8 eyes with CRVO. PST injection of 40 mg TA was performed in topical anaesthesia. All patients were phakic, and followed for at least 6 months. Snellen visual acuity converted to LogMAR units and anatomic responses were evaluated before, and at 1, 3, 6, and 12 (if required) months after injections and re-injection considered. Results: In the BRVO group, mean foveal thickness was 548.2±49.50 μm preoperatively, and 452.8±56.2 μm and 280.8±62.5 μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (P<.05, paired t test) 3 months after injections. Improvement of visual acuity by at least 0.2 LogMAR was seen in 3(50%) of the 6 eyes. No re-injection was needed. In the CRVO group, mean foveal thickness was 543.7±34.4 μm preoperatively, and 283.0±29.0 μm and 234.8±23.6 μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (P<.05, paired t test). Improvement of visual acuity by at least 0.2 LogMAR was seen in 7 eyes (88%). Mean number of re-injection was of 2.1±0.3. Intraocular pressure elevation of 22 mm Hg or higher was found in 2/14 eyes (14%). Cataract progression was noted in 5/14 eyes (36%). Conclusions: PST injection of TA appears to be as safe and effective treatment for chronic macular oedema associated due to both non-ischemic BRVO or CRVO, with a better efficacy in BRVO.

Research and training in medicinal chemistry in south and central american countries and sub-saharan Africa

With the proposal to search for universal cooperation in the field of Medicinal Chemistry, the IUPAC group has elaborated a line of work divided into two phases: a- An Awareness of the true situation of Medicinal Chemistry in the different geographic areas of the world; b- A proposal of actions as to achieve more effective cooperation. This first report presents and discusses the actual situation in South and Central America as well as in sub-Saharan Africa.

Serological and virological surveys of the influenza A viruses in Antarctic and sub-Antarctic penguins

To evaluate the avian influenza virus (AIV) circulation in Antarctic and sub-Antarctic penguins we carried out a serosurvey on six species from Livingston, Marion and Gough islands. Seropositivity against AIV was performed on serum samples using a competitive enzyme-linked immunosorbent assay and haemagglutination and neuraminidase inhibition assays. Some oropharyngeal and cloacal swabs were also assayed to detect influenza virus genomes by real time reverse transcription-polymerase chain reaction. Overall, 12.1% (n = 140) penguins were seropositive to AIV. By species, we detected 5% (n = 19) and 11% (n = 18) seroprevalence in sub-Antarctic rockhopper penguins (Eudyptes spp.) from Gough and Marion islands, respectively, 42% (n = 33) seroprevalence in macaroni penguins (Eudyptes chysolophus Brandt), but no positives in the three other species, gentoo (Pygoscelis papua Forster; n = 25) and chinstrap penguins (P. antarctica Forster; n = 16), from Livingston Island and king penguins (Aptenodytes patagonicus Miller; n = 27) from Marion Island. While seropositivity reflected previous exposure to the AIV, the influenza genome was not detected. Our results indicate that AIV strains have circulated in penguin species in the sub-Antarctic region, but further studies are necessary to determine the precise role that such penguin species play in AIV epidemiology and if this circulation is species (or genus) specific.

Capillary thermal desorption unit for near real-time analysis of VOCs at sub-trace levels. Application to the analysis of environmental air contamination and breath samples

A capillary microtrap thermal desorption module is developed for near real-time analysis of volatile organic compounds (VOCs) at sub-ppbv levels in air samples. The device allows the direct injection of the thermally desorbed VOCs into a chromatographic column. It does not use a second cryotrap to focalize the adsorbed compounds before entering the separation column so reducing the formation of artifacts. The connection of the microtrap to a GC–MS allows the quantitative determination of VOCs in less than 40 min with detection limits of between 5 and 10 pptv (25 °C and 760 mmHg), which correspond to 19–43 ng m−3, using sampling volumes of 775 cm3. The microtrap is applied to the analysis of environmental air contamination in different laboratories of our faculty. The results obtained indicate that most volatile compounds are easily diffused through the air and that they also may contaminate the surrounding areas when the habitual safety precautions (e.g., working under fume hoods) are used during the manipulation of solvents. The application of the microtrap to the analysis of VOCs in breath samples suggest that 2,5-dimethylfuran may be a strong indicator of a person's smoking status

Indicadores químicos de qualidade da matéria orgânica de solo da sub-bacia do Rio das Mortes sob manejos diferenciais de cafeeiro

This work evaluated the chemical quality of organic matter (OM) of a Brazilian Oxisol cultivated with coffee plants, under organic and conventional managements. Total organic C (TOC), light fraction C (LF-C) and C in humic (HA-C) and fulvic (FA-C) acids fractions was measured. Amongst the evaluated indexes, TOC and LF-C discriminated better OM attributes as a function of management. The stratification ratio (TOC5-10cm/TOC10-20cm) did not show differences between the systems studied. The organic system can contribute to the sustainability of coffee plantations in Brazil, because it maintains the chemical attributes of OM closer to the indexes verified under forest conditions.

De fatis scientiae chemicae sub epocha patrum

Invocatio: D.D.

De candela sub aquis ardente

Invocatio: Q.F.F.Q.S.

Avaliação da qualidade de sedimentos - estudo de caso: sub-bacia do Ribeirão Espírito Santo, afluente do Rio São Francisco

This study evaluated the environmental impact resulting from surface water and sediment contamination by metals in a watershed affected by a tailing basin that controls effluents coming from a zinc-ore beneficiation plant. The studies combined assessments of sediment chemistry (exceedances of sediment quality guidelines), benthic assemblage structure and acute and chronic ecotoxicity. The results showed that the levels of metal contamination in sediments are not yet enough to cause deleterious effects to the biota. However, the ecotoxicity tests indicated the occurrence of chronic effects, demonstrating that other factors, as the use of fertilizers, could also be a source of contamination.

Indicia mineralogiae in Fennia sub gentilismo

Invocatio: I.N.D.