Thursday, April 30, 2015

Use of intravenous fluids before cesarean section: effects on perinatal glucose, insulin, and sodium homeostasis.

Perinatal glucose, insulin, and sodium homeostasis were assessed in relation to antepartum intravenous infusions administered to 59 normal mothers undergoing cesarean section at term without labor under epidural anesthesia. Group A (N = 20) received 1 L of Ringer's lactate without dextrose during one hour; group B (N = 20), 1 L of 5% dextrose in water during one hour; and group C (N = 19), 1 L of 5% dextrose in water during two and one half hours. Mean maternal and fetal serum glucose and insulin and sodium concentrations at delivery differed among all groups in direct relationship to the rate of glucose infusion. Neonatal hypoglycemia (30 mg/dL or less) correlated with the presence of a glucose infusion, a maternal glucose concentration of 117 mg/dL or greater, and an umbilical venous insulin concentration of 26 microU/mL or greater. Among group A patients who received sodium, and group B and C patients who did not, fetal hyponatremia (umbilical venous sodium 130 mEq/L or less) correlated with the absence of sodium in the prepartum infusion. The results suggest that the antepartum administration of a balanced electrolyte solution without excess glucose infusion can minimize the incidence of fetal hyperglycemia and hyponatremia and neonatal hypoglycemia.
 1984 May;63(5):654-8.

Tuesday, April 14, 2015

Warning over rising C-section rates Story

          Caesarean section is one of the most common surgeries in the world, with rates continuing to rise, particularly in high- and middle-income countries.

          Although it can save lives, Caesarean section is often performed without medical need, putting women and their babies at-risk of short- and long-term health problems. A new statement from the World Health Organisation (WHO) underscores the importance of focusing on the needs of the patient, on a case by case basis, and discourages the practice of aiming for “target rates”.

           Caesarean section may be necessary when vaginal delivery might pose a risk to the mother or baby—for example due to prolonged labour, foetal distress, or because the baby is presenting in an abnormal position. However, Caesarean sections can cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications.

           Since 1985, the international healthcare community has considered the “ideal rate” for Caesarean sections to be between ten per cent and 15 per cent. New studies reveal that when Caesarean section rates rise towards ten per cent across a population, the number of maternal and newborn deaths decreases. But when the rate goes above ten per cent, there is no evidence that mortality rates improve.

           It is estimated that globally, the rate of Caesarean section is higher than the ideal. In the Americas, the average is 38.9 per cent, according to the most recent data from 25 countries. However, this figure could be higher given that in many cases it does not include Caesarean sections done by private sector health services.

             “It’s very worrisome that almost four out of every ten births in the region are by C-section,” said Suzanne Serruya, director of the Latin American Centre for Perinatology, Women, and Reproductive Health (CLAP) of the Pan American Health Organisation (PAHO), regional office for the Americas of WHO. “Doctors, midwives, obstetric nurses, those responsible for health policies, mothers and fathers, and society as a whole should work together to reduce this number and use Caesarean sections only when it’s needed for medical reasons.”

             Across a population, the effects of Caesarean section rates on maternal and newborn outcomes such as stillbirths or morbidities like birth asphyxia are still unknown. More research on the impact of Caesarean section on women’s psychological and social well-being is still needed.

            “Having too many Caesarean sections is exposing more women to new health problems, like abnormal placentation, which in the case of a second Caesarean section can occur in 40 per cent of cases, and in the case of a third Caesarean, can occur all the way up to 60 per cent of cases. This represents a risk for maternal death by haemorrhage,” warned Bremen de Mucio, regional adviser on Sexual and Reproductive Health in PAHO/WHO´s CLAP.

              Due to their increased cost, high rates of unnecessary Caesarean sections can pull resources away from other services in overloaded and weak health systems.

             The lack of a standardised internationally accepted classification system to monitor and compare Caesarean section rates in a consistent and action-oriented manner is one of the factors that has hindered a better understanding of this trend. WHO proposes adopting the Robson classification as an internationally applicable Caesarean section classification system.

              The Robson system classifies all women admitted for delivery into one of ten groups based on characteristics that are easily identifiable, such as number of previous pregnancies, whether the baby comes head first, gestational age, previous uterine scars, number of babies and how labour started. Using this system would facilitate comparison and analysis of Caesarean rates within and between different facilities and across countries and regions.

Sunday, April 12, 2015

Heart Disease and Height: Do Shorter People Need to Worry?

(Health Day News) — Shorter people may be more likely to have coronary artery disease (CAD), and that increased risk could be linked to the genetics that also determine height, a British-led research team suggests. The study was published online April 8 in the New England Journal of Medicine.
To better understand the cardiovascular risks associated with short stature, researchers pooled data from two recent international research efforts into the human genome, one of which explored the genetics of height and the other the genetics of CAD, study coauthor Christopher O'Donnell, M.D., M.P.H., associate director of the Framing-ham Heart Study for the U.S. National Heart, Lung, and Blood Institute, told Health Day.
The research team first tested the association between a change in height and risk of CAD by examining 180 different height-associated genetic variants in 193,449 people, and concluded that there's a relative 13.5 percent increase in CAD risk for every 2.5 inches shaved off a person's height. They then drilled down to very specific individual genetic data from a smaller pool of 18,249 people. They identified a number of pathways by which genes related to height could also influence CAD risk.
A person's risk of CAD increases about 13.5 percent for every 2.5 inches of difference in height, the scientists said. That means a 5-foot-tall person has an average 32 percent higher risk of CAD than a person who's 5-foot 6-inches tall, according to the researchers. Interestingly, the effect of height on CAD risk may be gender-specific. "We found a clear-cut effect in men, but we didn't see a clear-cut effect in women," study coauthor Nilesh Samani, M.D., of the University of Leicester in the United Kingdom, told HealthDay, adding that significantly fewer women in the study could have affected the statistics.

Saturday, April 11, 2015

SAFE MOTHERHOOD:- KEY MESSAGES




1. Girls who are educated and healthy and who have a nutritious diet throughout their childhood and teenage years are more likely to have healthy babies and go through pregnancy and childbirth safely if childbearing begins after 18 years of age.
2. The risks associated with childbearing for the mother and her baby can be greatly reduced if a woman is healthy and well-nourished before becoming pregnant. During pregnancy and while breastfeeding, all women need more nutritious meals, increased quantities of food, more rest than usual, iron-folic acid or multiple micro nutrient supplements, even if they are consuming fortified foods, and iodized salt to ensure the proper mental development of their babies
3 .Every pregnancy is special. All pregnant women need at least four prenatal care visits to help ensure a safe and healthy pregnancy. Pregnant women and their families need to be able to recognize the signs of labour and the warning signs of pregnancy complications. They need to have plans and resources for obtaining skilled care for the birth and immediate help if problems arise.
4. Childbirth is the most critical period for the mother and her baby. Every pregnant woman must have a skilled birth attendant, such as a midwife, doctor or nurse, assisting her during childbirth, and she must also have timely access to specialized care if complications should occur
5. Post-natal care for the mother and child reduces the risk of complications and supports mothers and fathers or other caregivers to help their new baby get a healthy start in life. The mother and child should be checked regularly during the first 24 hours after childbirth, in the first week, and again six weeks after birth. If there are complications, more frequent check-ups are necessary.
6. A healthy mother, a safe birth, essential newborn care and attention, a loving family and a clean home environment contribute greatly to newborn health and survival.
7. Smoking, alcohol, drugs, poisons and pollutants are particularly harmful to pregnant women, the developing fetus, babies and young children.
8. Violence against women is a serious public health problem in most communities. When a woman is pregnant, violence is very dangerous to both the woman and her pregnancy. It increases the risk of miscarriage, premature labour and having a low-birth weight baby.
9. In the workplace, pregnant women and mothers should be protected from discrimination and exposure to health risks and granted time to breastfeed or express breast milk. They should be entitled to maternity leave, employment protection, medical benefits and, where applicable, cash support.
10. Every woman has the right to quality health care, especially a pregnant woman or a new mother. Health workers should be technically competent and sensitive to cultural practices and should treat all women, including adolescent girls, with respect.
                                                                                                    

Sunday, April 5, 2015

Sanitizers and Disinfectants: The Chemicals of Prevention. FOOD SAFETY MAGAZINE August/September 2011

Sanitizers and Disinfectants: The Chemicals of Prevention

In the food industry, chemicals are routinely used to sanitize and disinfect product contact surfaces. These chemicals provide a necessary and required step to ensure that the foods produced and consumed are as free as possible from microorganisms that can cause food borne illness. Prevention is the name of the game. What are these chemicals, how do they function and how are they used?

Disinfecting Versus Sanitizing
Before discussing the chemicals, the differences between sanitizers and disinfectants as used in the food industry must be understood. To disinfect means to destroy or irreversibly inactivate specified infectious fungi and bacteria, but not necessarily the spores, on hard surfaces.[1] To sanitize means to reduce microorganisms of public health importance to levels considered safe, based on established parameters, without adversely affecting either the quality of the product or its safety.[2] While disinfection measures may be employed in food processing and preparation, it is much more common to utilize sanitization methods to reduce microbial presence.

To achieve the required level of sanitization or disinfection, the chemical in question must be applied at a certain concentration for a specified amount of time. These parameters are described on the product label and must be followed to achieve the desired microbial control. In most cases, these products are registered for use as pesticides with the U.S. Environmental Protection Agency (EPA). Once applied, the allowable residues and the monitoring thereof in food processing and preparation are the responsibility of the U.S. Food and Drug Administration. Facilities operating under the jurisdiction of the U.S. Department of Agriculture must additionally use products approved by that agency. Of course, the task of ensuring the chemicals are prepared and applied properly to avoid inappropriate residues rests with the food processor and foodservice operator.

The efficacy of a chemical used for sanitizing or disinfection rests upon its ability to reduce the contamination level. The sanitization standard for contamination reduction of food contact surfaces is generally accepted as 99.999% (a 5-log reduction) achieved in 30 seconds (Official Detergent Sanitizer Test).[3] The sanitization standard for nonfood contact surfaces is accepted as a reduction of 99.9% (3 logs) within 30 seconds. Disinfection, in contrast, must destroy or irreversibly inactivate all specified organisms within a certain time, usually 10 minutes. Some chemicals may function as both sanitizers and disinfectants.

The process of sanitization depends upon the preparation of the surfaces in question. Most sanitizers must be applied to surfaces that are free of organic matter and cleaner residues. The generally accepted order of events is rinse, clean, rinse and sanitize. The cleaner utilized in the cleaning step needs to be oriented and appropriate for the soil present. For example, alkaline detergents more efficiently remove fat- and protein-based soils, while mineral-based soils require acid cleaners. Thankfully, modern cleaning agents are mixtures of chemical components that can address various cleaning scenarios.

Sanitizing Chemicals
The food industry most often uses sanitizing procedures, so the information presented herein will focus on the more common products utilized. Regardless of the product, the sanitizing solution must be tested to verify that the desired concentration is consistently present. Too little sanitizer, of course, can result in unacceptable efficacy, while too much sanitizer can yield residues that do not meet standards.

Hypochlorites
Effectiveness, low cost and ease of manufacturing make hypochlorites the most widely used sanitizers. Sodium hypochlorite is the most common compound and is an ideal sanitizer, as it is a strong oxidizer.

Hypochlorites cause broad microbial mortality by damaging the outer membrane, likely producing a loss of permeability control and eventual lysis of the cell.[4,5] In addition, these compounds inhibit cellular enzymes and destroy DNA. Spores, however, are resistant to hypochlorites, as the spore coat is not susceptible to oxidation except at high concentrations coupled with long contact times at elevated temperatures.

While hypochlorites are very reactive, their useful properties are negatively impacted by factors such as suspended solids, high temperatures, light, water impurities and improper pH levels. In routine use, surfaces must be as free as possible of organic materials, and the pH must be maintained between 5 to 7 to ensure that the greatest amount of hypochlorous acid is available. As with any sanitizer, measurements must be taken periodically to make certain that the freely available chlorine is at the desired level. For no-rinse applications, the maximum allowable concentration of available chlorine is 200 ppm.

Other disadvantages of hypochlorites are corrosiveness to metals, health concerns related to skin irritation and mucous membrane damage and environmental contamination. The latter is of concern as chlorine can combine with organic substances to form toxic chlorinated compounds, such as trihalomethanes and dioxins. Hypochlorite use may be further restricted in the future. Care must be taken when cleaning hypochlorite spills as organic materials such as cloth, sawdust and paper may spontaneously combust upon drying.

Chlorine Dioxide
This inorganic compound is a broad sanitizer effective against bacteria, fungi and viruses. Chlorine dioxide is an oxidizer that reacts with the proteins and fatty acids within the cell membrane, resulting in loss of permeability control and disruption of protein synthesis.[6,7]

While chlorine dioxide is an explosive gas, it is relatively safe in solution. It is produced on-site as it can’t be compressed or stored commercially in gaseous form. Most chlorine dioxide generation is accomplished with complex systems. However, recent advances in formulation procedures allow the production of solutions of chlorine dioxide on-site without the use of expensive equipment.

Compared with hypochlorites, chlorine dioxide requires much lower concentrations to achieve microbial mortality. For example, a 5-ppm solution is effective as a sanitizer on food contact surfaces with a contact time of at least 1 minute. Further, disinfection can be achieved with 100 ppm using a contact time of 10 minutes.

Chlorine dioxide reacts more selectively with compounds present in microbial cells as opposed to reacting with organic compounds in general. This ability allows chlorine dioxide to function in more organically loaded solutions, though as organic load increases, efficacy does decrease. Chlorine dioxide functions well over a pH range of about 6 to 10, thus allowing increased mortality of some microbes at higher values. Another advantage is that chlorine dioxide does not form chlorinated organic compounds, making it more environmentally friendly.

Iodophors
These compounds are less active than hypochlorites but are effective sanitizers and disinfectants. Iodophors attach to the sulfurs of proteins such as cysteine, causing inactivation and cell wall damage.[8] Carriers with iodophor solutions allow a sustained-release effect, resulting in continuous microbial mortality.

Iodophors fare better in situations in which the pH is slightly acidic, as less active forms exist above neutral pH. The common concentration for sanitization is 25 ppm for 1 minute. Unfortunately, iodine compounds easily stain many surfaces, particularly plastics. On the plus side, they are common sanitizers used on glass surfaces, such as in the beer and wine bottling industries. The EPA has assessed iodophors as having no significant effect on the environment.[9]

Peroxyacetic Acid (PAA)
PAA is an effective sanitizer that is active against many microorganisms and their spores. Mortality is produced by the disruption of chemical bonds within the cell membrane.[10] PAA-based sanitizers are frequently paired with stabilized hydrogen peroxide. These sanitizers function well under cold conditions (~ 4 °C), thus producing acceptable microbial mortality on equipment normally held below ambient temperature. PAA is also effective in removing biofilms and is more active than hypochlorites.[11]

PAA solutions can be attenuated by the organic load and will begin to lose activity as the pH approaches neutral. These solutions are applied at concentrations ranging from about 100 ppm to 200 ppm for peroxyacetic acid and 80 ppm to 600 ppm for hydrogen peroxide.

PAA-based sanitizers are environmentally friendly as the compounds therein break down into acetic acid, oxygen and water. These sanitizers are also less corrosive to equipment than hypochlorites. As with any highly active oxidizer, concentrated PAA can present a safety hazard.

Quaternary Ammonium Compounds (QACs or Quats)
Quaternary ammonium compounds are fairly complex chemicals in which nitrogen is bound to four organic groups. The positively charged cations in the compounds bind with the acidic phospholipids in the microbial cell wall.[12] This action blocks the uptake of nutrients into the microbial cell and prevents the discharge of waste. In general, QACs are effective against a wide range of microbes, although the spore phase is unaffected. At lower concentrations, Gram-positive bacteria are more sensitive to QACs than Gram-negative bacteria.10 QACs are formulated in many different variations for specific situations.

QACs may be applied at concentrations varying from about 100 ppm to 400 ppm. As sanitizers, QACs are commonly applied at 200 ppm to food contact surfaces, and the solution is allowed to dry. Once dry, a residue of the QAC compounds remains and provides germicidal activity until degradation occurs. QACs also can function as detergents when present in high concentration because the compounds possess both hydrophilic and lipophilic chemical groups.

QACs are usually odorless, nonstaining, noncorrosive and relatively nontoxic to users. They function well over a broad temperature range and a wide pH range, although activity is greater at warmer temperatures and in alkaline situations. While QACs tolerate light organic loads, heavy soil will decrease QAC activity significantly. Some QACs may not function adequately in hard water, but others are formulated with added chelating agents that allow such use.[11]

While QACs do combine with organic compounds and are discharged into the environment, the concentrations are low and heterotrophic bacteria are not negatively impacted.[13] Soil-inhabiting bacteria such as Pseudomonas spp. andXanthomonas spp. can degrade QACs.[14] In addition, the low amounts of QACs flowing into commercial sewage treatment facilities appear to combine with the anionic surfactants present to form complexes that reduce or eliminate toxicity.[15]

Resistance to Sanitizers
Any time a chemical is used to produce microbial mortality, the possibility of promoting resistance exists. This is because not all of the microbes are killed. A 5-log reduction (99.999%) still means that of 1,000,000 microbes present, 10 have survived, even though the process has reduced the population to what can be termed a safe level. The sanitizer could have just missed these 10 organisms or they could inherently be immune. If these 10 microbes are indeed immune, over time they will proliferate, and the usual sanitizing concentration and/or chemical will no longer produce acceptable mortality. At this point, measures must be taken to disinfect the surfaces in question. It then becomes imperative to know what organisms are specifically present so that the proper disinfectant at the proper strength maintained for the required time can be applied.

Sometimes, it is thought that bacterial resistance is present when actually the organisms are avoiding contact with the sanitizing chemical because a biofilm is present. Biofilms are polysaccharides that allow attachment to most any surface. Bacteria such as Escherichia coli, Salmonella spp., Listeria spp., Campylobacter spp. and several others can produce biofilms. Over time, the film becomes enhanced and may contain different species of bacteria, yielding a constant source of contamination. Whether biofilms are truly products of bacterial resistance may be a philosophical question, but the presence of biofilms can be an indisputable problem for those assigned to find a solution.

Conclusions
As you probably have noted, no mention has been made of another chemical used extensively, namely, water. Various forms of water can sanitize, but, as stated initially, the focus of this discussion was on the more common chemicals traditionally used for sanitization.

Allan Pfuntner, M.A., REHS, is with Hartono and Company LLC. He can be reached at apfuntner@msn.com.

References
1. U. S. Environmental Protection Agency, Antimicrobial Pesticide Products Fact Sheet.
2. Code of Federal Regulations, Title 21, Sec. 110.3.
3. AOAC International Official Methods of Analysis. 2009. AOAC International, Gaithersburg, MD.
4. Venkobachar, C., L. Iyengar and A.V.S.P. Rao. 1977. Mechanism of disinfection: Effect of chlorine on cell membrane functions. Water Res 11:727–729.
5. Virto, R., P. Mañas, I. Alvarez, S. Condon and J. Raso. 2005. Membrane damage and microbial inactivation by chlorine in the absence and presence of a chlorine-demanding substrate. Appl Environ Microbiol 71:5022–5028.
6. Berg, J.D., P.V. Roberts and A. Matin. 1986. Effect of chlorine dioxide on selected membrane functions ofEscherichia coliJ Appl Bacteriol 60(3):213–220.
7. EPA, Guideline Manual, Alternative disinfectants and oxidants. April 1999.
8. McDonnell, G.E. 2007. Antisepsis, disinfection and sterilization. Washington, DC: ASM Press.
9. EPA Ecological Hazard and Environmental Risk Assessment and Environmental Fate. Docket number EPA-HQ-OPP-2006-0599.
10. Block, S.S. 2001. Disinfection, sterilization and preservation. Philadelphia: Lippincott, Williams and Wilkins.
11. Schmidt, R.H. 2003. Basic elements of equipment cleaning and sanitizing in food processing and handling operations. University of Florida Extension Document FS14.
12. McBain, A.J., R.G. Ledder, L.E. Moore, C.E. Catrenich and P. Gilbert. 2004. Effects of quaternary-ammonium–based formulations on bacterial community dynamics and antimicrobial susceptibility. Appl Environ Microbiol70(6):3449–3456.
13. Ventullo, R.M. and R.J. Larson. 1986. Adaptation of aquatic microbial communities to quaternary ammonium compounds. Appl Environ Microbiol 51(2):356–361.
14. Raymond, D.D. and M. Alexander. 1977. Bacterial metabolism of quaternary ammonium compounds. Appl Environ Microbiol 33(5):1037–1041.
15. Boethling, R.S. 1984. Environmental fate and toxicity in wastewater treatment of quaternary ammonium surfactants. Water Res 18(9):1061–1076.

Wednesday, April 1, 2015

After a Cesarean birth

It may take 6 – 12 weeks for your body to heal – avoid heavy or strenuous activity in the first six weeks then slowly build up as comfortable. If you feel tired or your body aches, you need to rest.
Do these exercises  as soon as you feel comfortable, usually
around day three. Stop if you feel pain.

PRINCIPLE  

  • A daily walk is a good way to loosen up and improve fitness (from week one). Start with short distances (10 minutes) on flat ground, then progress distance and difficulty as comfortable. 
  • Light housework such as cooking and dusting is okay, but avoid vacuum cleaning and lifting anything heavier than your baby in the first six weeks. 
  • As a general guide, any lifting which results in breath holding indicates the load is too heavy.
  • Driving may be safe when you are able to brake suddenly, move feet between pedals and look over your shoulder without pain. 
  • However, some car insurance companies do not cover you in the first six weeks after abdominal surgery, so call and check with them  before driving.
Following Cesarean Birth.!
BENEFITS
  •  Prevent postoperative complication
  •  Restore abdominal and pelvic floor muscles and 
  •  Helps in Faster recovery 

RISKS of not doing exercise

  • Back problems
  • Weak abdominal muscles resulting large belly.
  • Bowel and bladder problems

Any Alternative

  • Unfortunately "NO"


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