The Central African journal of medicine
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Postpartum Haemorrhage (PPH) is the most common cause of maternal mortality globally, leading to a woman's death every seven minutes. In Zimbabwe, there has been a 300% increase in the Maternal Mortality Ratio (MMR) between 1994 and 2010 and the MMR was estimated at 960 maternal deaths per 100,000 live births in 2012.2-3 Overall, 14% of all maternal deaths in Zimbabwe are due to PPH. Ensuring prompt access to high-quality prevention and treatment of PPH for all women who deliver is an essential strategy to combat PPH-related morbidity and mortality and to make progress toward reaching Millennium Development Goal 5, the reduction of maternal mortality by three-quarters by 2015.
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Notable progress has been achieved in our understanding of the pathogenesis of pulmonary hypertension, in particular the role of vasodilators, vasoconstrictors and the intracellular signaling pathways, cytokines, chemokines and growth factors involved. A comprehensive history and clinical examination is mandatory in the assessment and determination of the cause of pulmonary hypertension. This should be complemented by a rationale approach to investigation. ⋯ General measures include oxygen therapy and judicious use of diuretics in patients with overt right heart failure. Newer therapies that have been developed for the treatment of idiopathic pulmonary hypertension include prostanoids, modulators of vascular remodelling such as bosentan and its analogues and PGE-5 inhibitors such as sildenafil. New therapies are likely to become available in the future as our understanding of the pathogenesis of pulmonary hypertension evolves.
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To describe the status of ethics review as pertaining to medical research in Zimbabwe, to compare this with international guidelines, and thus to identify potential improvements in the process. ⋯ A focus on research ethics education for researchers and IREC members, as well as ensuring appropriate respect for IREC review, are opportunities for improvement in the process.
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Molecular oxygen is a colourless and odorless gas which is essential to life. It accounts for 21% of the atmospheric air. Apart from its central role in oxidative phosphorylation to produce biological energy in the form of adenosine triphosphate (ATP), molecular oxygen is used as substrate by two other enzyme systems for the killing of bacteria in the phagocytes and for collagen synthesis by the fibroblast during wound healing. In the immediate post operative period atmospheric oxygen might become inadequate for a number of reasons including hypoventilation due to central pharmacological depression, diffusion hypoxia and increased metabolic rate due to shivering (the so called halothane shakes).
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Pain is a prevalent symptom in cancer patients, affecting up to 50% of patients undergoing active cancer treatment and up to 90% of those with advanced disease. Although adequate relief can be achieved in the majority of cancer patients, pain is often treated inadequately in traditional settings and sometimes even under the management of more specialised units. ⋯ This is in keeping with increasing recognition by bodies such as the World Health Organisation and other governmental agencies who have recognised the importance of pain management as part of routine cancer care. Conducting a comprehensive assessment, competently providing analgesic drugs, and communicating with the patient and family allow effective management of pain in the cancer patient.