Maternal Near Miss and Mortality in a Rural Referral Hospital in Northern Tanzania: A Cross-Sectional Study.

Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. In order to lower maternal morbidity and mortality in the immediate term, reduction of delay in the provision of quality obstetric care is of prime importance. The aim of this study is to assess the occurrence of severe maternal morbidity and mortality in a rural referral hospital in Tanzania as proposed by the WHO near miss approach and to assess implementation levels of key evidence-based interventions in women experiencing severe maternal morbidity and mortality. A prospective cross-sectional study was performed from November 2009 until November 2011 in a rural referral hospital in Tanzania. All maternal near misses and maternal deaths were included. As not all WHO near miss criteria were applicable, a modification was used to identify cases. Data were collected from medical records using a structured data abstraction form. Descriptive frequencies were calculated for demographic and clinical variables, outcome indicators, underlying causes, and process indicators. In the two-year period there were 216 maternal near misses and 32 maternal deaths. The hospital-based maternal mortality ratio was 350 maternal deaths per 100,000 live births (95% CI 243-488). The maternal near miss incidence ratio was 23.6 per 1,000 live births, with an overall case fatality rate of 12.9%. Oxytocin for prevention of postpartum haemorrhage was used in 96 of 201 women and oxytocin for treatment of postpartum haemorrhage was used in 38 of 66 women. Furthermore, eclampsia was treated with magnesium sulphate in 87% of all cases. Seventy-four women underwent caesarean section, of which 25 women did not receive prophylactic antibiotics. Twenty-eight of 30 women who were admitted with sepsis received parenteral antibiotics. The majority of the cases with uterine rupture (62%) occurred in the hospital. Maternal morbidity and mortality remain challenging problems in a rural referral hospital in Tanzania. Key evidence-based interventions are not implemented in women with severe maternal morbidity and mortality. Progress can be made through up scaling the use of evidence-based interventions, such as the use of oxytocin for prevention and treatment of postpartum haemorrhage

ANTIBIOTIC RESISTANCE PATTERNS OF URINARY TRACT INFECTIONS IN A NORTHEASTERN BRAZILIAN CAPITAL

Urinary tract infection is a common problem worldwide. Its clinical characteristics and susceptibility rates of bacteria are important in determining the treatment of choice and its duration. This study assessed the frequency and susceptibility to antimicrobials of uropathogens isolated from community-acquired urinary tract infections in the city of Natal, Rio Grande do Norte State capital, northeastern Brazil, from 2007 to 2010. A total of 1,082 positive samples were evaluated; E. coli was the most prevalent pathogen (60.4%). With respect to the uropathogens susceptibility rates, the resistance of enterobacteria to ciprofloxacin and sulfamethoxazole-trimethoprim was 24.4% and 50.6%, respectively. Susceptibility was over 90% for nitrofurantoin, aminoglycosides and third-generation cephalosporins. High resistance rates of uropathogens to quinolones and sulfamethoxazole-trimethoprim draws attention to the choice of these drugs on empirical treatments, especially in patients with pyelonephritis. Given the increased resistance of community bacteria to antimicrobials, local knowledge of susceptibility rates of uropathogens is essential for therapeutic decision making regarding patients with urinary tract infections

A review of soil carbon change in New Zealand’s grazed grasslands

Soil organic matter is a potential sink of atmospheric carbon (C) and critical for maintaining soil quality. We reviewed New Zealand studies of soil C changes after conversion from woody vegetation to pasture, and under long-term pasture. Soil C increased by about 13.7 t C ha⁻¹ to a new steady state when forests were initially converted to pasture. In the last 3–4 decades, resampling of soil profiles demonstrated that under long-term pasture on flat land, soil C had subsequently declined for allophanic, gley and organic soils by 0.54, 0.32 and 2.9 t C ha⁻¹ y⁻¹ , respectively, and soil C had not changed in the remainder of sampled soil orders. For the same time period, pasture soils on stable midslopes of hill country gained 0.6 t C ha⁻¹ y⁻¹ . Whether these changes are ongoing is not known, except for the organic soils where losses will continue so long as they are drained. Phosphorus fertiliser application did not change C stocks. Irrigation decreased carbon by 7 t C ha⁻¹ . Carbon losses during pasture renewal ranged between 0.8 and 4.1 t C ha⁻¹ . Some evidence suggests tussock grasslands can gain C when fertilised and not overgrazed. When combined to the national scale, different data sets suggest either no change or a gain of C, but with large uncertainties. We highlight key land-use practices and soil orders that require further information of soil C stock changes and advocate for a better understanding of underpinning reasons for changes in soil C

A review of soil carbon change in New Zealand’s grazed grasslands

Soil organic matter is a potential sink of atmospheric carbon (C) and critical for maintaining soil quality. We reviewed New Zealand studies of soil C changes after conversion from woody vegetation to pasture, and under long-term pasture. Soil C increased by about 13.7 t C ha⁻¹ to a new steady state when forests were initially converted to pasture. In the last 3–4 decades, resampling of soil profiles demonstrated that under long-term pasture on flat land, soil C had subsequently declined for allophanic, gley and organic soils by 0.54, 0.32 and 2.9 t C ha⁻¹ y⁻¹ , respectively, and soil C had not changed in the remainder of sampled soil orders. For the same time period, pasture soils on stable midslopes of hill country gained 0.6 t C ha⁻¹ y⁻¹ . Whether these changes are ongoing is not known, except for the organic soils where losses will continue so long as they are drained. Phosphorus fertiliser application did not change C stocks. Irrigation decreased carbon by 7 t C ha⁻¹ . Carbon losses during pasture renewal ranged between 0.8 and 4.1 t C ha⁻¹ . Some evidence suggests tussock grasslands can gain C when fertilised and not overgrazed. When combined to the national scale, different data sets suggest either no change or a gain of C, but with large uncertainties. We highlight key land-use practices and soil orders that require further information of soil C stock changes and advocate for a better understanding of underpinning reasons for changes in soil C

Implications of Antibiotic Resistance in the Management of Helicobacter pylori Infection: Canadian Helicobacter Study Group

Eradication of Helicobacter pylori from the gastric and duodenal mucosa is an important clinical goal in the treatment of infected patients with peptic ulcer disease and other H pylori-associated conditions. Although several oral drug combination regimens are associated with eradication rates of approximately 85% in controlled trials, the success rate in patients infected with a resistant strain of H pylori is closer to 75%. Resistance to metronidazole and clarithromycin, which are common components of combination treatment regimens, is of greatest concern. Reported rates of H pylori resistance to various antibiotics vary considerably. In Canada, the data documenting H pylori susceptibility are limited but suggest that resistance to these antibiotics varies geographically and within specific treatment groups. Although susceptibility testing is not a prerequisite for initial treatment of individual patients infected with H pylori, formal efforts to identify and monitor both the causes and prevalence of antibiotic resistance across Canada are a much needed step in the ongoing management of this important infection. Recommended treatment regimens may be useful, even for treating apparently resistant H pylori strains. However, it is important to understand the mechanisms of the development of resistant strains to manage patients with treatment failure better