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Summary: Background: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. Funding: Medical Research Council of South Africa.

Background:Genetic diversity of three polymorphic markers in the phenylalanine hydroxylase(PAH) gene region including PvuII(a), PAHSTR and MspI were investigated.Methods:Unrelated individuals (n=139) from the Iranian populations were genotyped using primers specific to PAH gene markers including PvuII(a),MspI and PAHSTR. The amplified products for PvuII(a),MspI were digested using the appropriate restriction enzymes and separated on 1.5% agarose. The PAHSTR alleles were identified using polyacrylamide gel electrophoresis followed by silver staining. The exact size of the STR alleles was determined by sequencing. The allele frequency and population status of the alleles were estimated using PHASE, FBAT and GENEPOP software.Results: The estimated degree of heterozygosity for PAHSTR, MspI and PvuII (a) was 66%, 56% and 58%, respectively. The haplotype estimation analysis of the markers resulted in nine informative haplotypes with frequencies ≥5%.Moreover,the results obtained from Ewens-Watterson test for neutrality suggested that the markers were under balancing selection in the Iranian population.Conclusion:These findings suggested the presence of genetic diversity at these three markers in the PAH gene region. Therefore, the markers could be considered as functional markers for linkage analysis of the PAH gene mutations in the Iranian families with the PKU disease.

Background: Clinico-epidemiological profile of the Human immunodeficiency virus (HIV) epidemic in India is varied and depends on multitude of factors including geographic location. We analyzed the characteristics of HIV-infected patients attending our Immunodeficiency Clinic to determine any changes in their profile over five years. Settings and Design: A retrospective observational study. Materials and Methods: The study sample included all patients with HIV infection from January 1, 2003 to December 31, 2007. Diagnosis of HIV was made according to National AIDS Control Organization guidelines. Results: Of 3 067 HIV-infected patients, 1 887 (61.5%) were male and 1 180 (38.5%) were female patients. Mean age of patients was 35.1 ± 9.0 years. Majority (91.8%) of patients were in the age group of 15 to 49 years. Progressively increasing proportion of female patients was noted from year 2004 onward. Median CD4 count at presentation in year 2003 was 197/μl (Interquartile range [IQR] = 82.5-373) while in year 2007 it was 186.5/μl (IQR = 86.3-336.8). Mean CD4 count of male patients was 203.7 ± 169.4/μl, significantly lower as compared with female patients, which was 284.8 ± 223.3/μl (P value ≤0.05). Every year, substantial proportions of patients presenting to clinic had CD4 count

Background: The aim of the study was to determine the incidence of non-bacterial acute gastroenteritis associated with diar­rheal diseases in Mazandaran Province, northern Iran.Methods: A total of 400 symptomatic cases from patients with acute gastroenteritis from Mazandaran Province in Iran were screened using EIA method for the presence of rotavirus, adenovirus and astrovirus during 2005-2006. Chi-square tests were used for testing relationships between different variables.Results: Rotavirus, adenovirus and astrovirus were detected in 62%, 2.3%, and 3% of samples, respectively. The maximum rate of rotaviruses was detected in the

"nBackground: The haplotype phasing is more useful than genotyping markers independently at carrier detection and prena­tal diagnosis of diseases. The PAH gene region contains several markers used in detection of PKU disease. In the present study, the efficiency of BglII-EcoRI-VNTR haplotype phasing in Iranian family trios was investigated. Then, this informa­tion was compared with those obtained for unrelated individuals."nMethods: Blood samples were collected from 20 healthy family trios and 60 unrelated individuals. The genomic DNA was ex­tracted by use of salting-out procedure. The two markers BglII and EcoRI were genotyped by use of PCR-RFLP. The geno­type of VNTR marker was identified by use of PCR and electrophoresis. The genotyping data obtained from family trios was used to infer haplotype phase. We also compared this data with results obtained from a widely used method for hap­lotype frequency inference from unrelated individuals, the PHASE program."nResults: The haplotype phase of all members was only ascertained at eight family trios. The comparison of this data with the results obtained by use of PHASE program showed that eight haplotypes [211, 221, 215, 216, 214, 121, 225 and 111] were in­formative haplotypes in Iranian population."nConclusion: Since diversity of BglII-EcoRI-VNTR haplotypes was high in Iranian population, haplotype phasing at family trios was difficult. The results of this study showed that the genotyping data obtained from family trios could not provide enough information for BglII-EcoRI-VNTR haplotype phasing at Iranian PKU families and the genotyping of other family mem­bers was necessary at most cases.

Background: Medical Equipments have main rule in patients diagnosis and therapy trend and society health. In addition, technology development and increasing prices of these equipments cause vast quantity of exchange is designated to equipments import. Regarding to present level of economical development ability of manufacturing for different kinds of medical equipments is high in our country, there is no need to import in many cases, of course we can have export in this area. The aim of this research is survey of quantity development of medical equipments export emphasizing on 87 article of fourth economical, social and cultural development plan law. Material and Methods: This research is descriptive applied study. Data have been gathered from checklists, meetings with related experts, library and internet studies and eventually former research documents investigation. Finally data have been analysis through comparative and adaptive tables and comparison of statistics calculated from statistical forms and checklists. Results: Export rate of medical equipment from 1/08% of import rate, before the fourth economical, social and cultural development plan law, has increased to1/77% of import rate, after that .This rate had a growth rate equal to 63/88%.The ratio of number of certifications on number of medical equipment companies from 1/4, before the law, has increased to 2/12 after that .This ratio had a growth rate equal to 85/96%.The number of medical equipment companies have been presented at international exhibitions has increased too, from 13 to 71. Conclusion :In quantity development area, the actualized growth rate in medical equipment export in first two years of fourth development plan law, in spite of increasing import, is remarkable. In quality development area as results showed, while increasing in number of companies, the number of certifications that will increase export rate, has increased too. The number of companies have been presented at international exhibitions also has a considerable growth that shows medical equipment quality has improved that plays main role in medical equipment industry presentation to the international market.

Background and Aim: Foodstuffs additives are a general term for materials that are added to the foodstuffs in order to increase durability and to improve the appearance, composition, taste and food nutritional value. Colors are classified in this group and are added to foodstuffs in order to increase their attraction. The aim of this survey was to analyze status of added colors to the juice of black cherry and juice of barberry which are produced in Tehran City, capital of Iran. Materials and Methods: Three haundred thirty six samples of dried sweets were randomly collected and analyzed from different areas of Tehran. First, the samples were de-colored by Clorhidric Acid, and then were analyzed after refining by Thin Layer Chromatography (T.L.C) method. Results: Eighty nine percent from the total samples contained colors. Among chromatic samples, 62 samples (18.5%) out the total samples, contained artificial, non-edible colors and 237 samples (70.5%) from the total samples contained artificial and edible colors (for Industrial Producers) and 37 samples (11%), contained natural colors. Carmoisine color was detected more than added colors in juice of black cherry and juice of barberry. Conclusion: Low costs, stability, Ph and similarity of artificial dyes with natural dyes motivate the producers for high utilization of these dyes without considering their possible hazards and/or their edible quality aspects.

Background and Aim: Foodstuffs additives are a general term for materials that are added to the foodstuffs in order to increase durability and to improve the appearance, composition, taste and food nutritional value. Colors are classified in this group and are added to foodstuffs in order to increase their attraction. The aim of this survey was to analyze status of added colors to the juice of black cherry and juice of barberry which are produced in Tehran City, capital of Iran.Materials and Methods: Three haundred thirty six samples of dried sweets were randomly collected and analyzed from different areas of Tehran. First, the samples were de-colored by Clorhidric Acid, and then were analyzed after refining by Thin Layer Chromatography (T.L.C) method.Results: Eighty nine percent from the total samples contained colors. Among chromatic samples, 62 samples (18.5%) out the total samples, contained artificial, non-edible colors and 237 samples (70.5%) from the total samples contained artificial and edible colors (for Industrial Producers) and 37 samples (11%), contained natural colors. Carmoisine color was detected more than added colors in juice of black cherry and juice of barberry.Conclusion: Low costs, stability, Ph and similarity of artificial dyes with natural dyes motivate the producers for high utilization of these dyes without considering their possible hazards and/or their edible quality aspects.

Introduction and objectives: Despite the advances in the control of food-borne diseases, still one of the dilemmas in the health of most societies and a matter of concern for health authorities is food poi­soning and food-borne diseases by unsafe foods. Materials and methods: In total 390 samples, including 195 samples of raw kebabs and hamburgers and 195 samples of the cooked ones were gathered from shops, sampling raw and cooked meat at the same time, and they were sent to the laboratory for testing, over a period of one year. The methods used for the tests were based on the Iranian National Standard procedures, numbers 356 and 2394. Results: All the cooked specimens had bacterial contamination in acceptable standard levels and there­fore were considered consumable. From the 165 raw kebab samples, 90 samples (54.5%) were con­sumable but 75 samples (45.5%) were not fit for consumption, where from 30 raw hamburger samples, 22 samples (73.3%) were consumable and 8 (26.7%) were inconsumable. In serological evaluations, Thompson serotype had the highest prevalence in kebab and hamburger samples. Conclusion: The results of present study show that there is no reason for concern in consuming cooked kebabs.

Background: MediCapt is a mobile application, currently under development, that digitises a medical intake form for sexual violence survivors such that it captures and preserves court-admissible evidence. The medical intake forms currently in use tend to produce incomplete, illegible, or even inconsistent reports that are often dismissed in court. MediCapt replaces paper documents and will be designed with prompts that help doctors avoid common mistakes, remind them of the necessary information needed for a forensic medical examination, and catch inconsistencies before the form is completed. MediCapt v1.0 was piloted in Bukavu, Democratic Republic of Congo (DRC) in January, 2014, with seven clinicians, all of whom were participants in Physicians for Human Rights (PHR) trainings on forensic documentation. We then tested MediCapt in the field to gather feedback on the usability of MediCapt within the DRC that would inform ongoing development. Methods: PHR is employing a process of “collaborative design” in the development of MediCapt. This process seeks and incorporates feedback from the ultimate end-users and is in iterative process. We conducted a 3 month field test of MediCapt with seven clinicians in both North and South Kivu from March to May, 2014. During this field test, clinicians were asked to (1) provide feedback on various aspects of the app including ease of use, and (2) complete several tasks including the inputting of patient case scenarios to simulate real-life patient information. Findings: Clinicians initially reported a lack of usability, and suggested that the form on the application be shorter. They suggested enhanced features including a camera function and ability to draw on a pictogram, and that the system be able to accommodate use by not only clinicians but also others within the justice process. Interpretation: Using the lessons learned from both the pilot and field-test of the first MediCapt version reported here, we developed MediCapt v2.0, which was tested with Congolese clinicians in January, 2015. Feedback from this testing will be reflected in the next version of MediCapt due later in 2015. In addition to improving documentation of individual cases, MediCapt, when in wide use, will also address gaps in data collection. By aggregating the data from the uploaded medical forms, Physicians for Human Rights will have access to de-identified information on cases of sexual violence that can inform humanitarian responses across various regions. MediCapt will also strengthen the security of medical data, improve standardisation of forensic assessments, and enhance the quality of the forensic medical evidence to ultimately support effective prosecutions of sexual violence cases. Challenges related to the application's development include ensuring proper security standards and data encryption, developing strategies to overcome low network connectivity in end users' environments, and users' fluency with a smart-phone-based application. A robust monitoring and evaluation plan is being concurrently developed to track the early testing phases of the application. Funding: The MediCapt project receives funding from the US State Department's Bureau of International Narcotics and Law Enforcement (INL).

Diabetes is characterized by a nitric oxide deficiency at the wound site. Diabetes is a factor that influences all stages of wound healing. In animals with acute experimental diabetes induced by streptozotocin (STZ), the early inflammatory responses after wounding is impaired, fibroblast and endothelial cell proliferation is reduced as well as accumulation of reparative collagen and gain in wound breaking strenght. This study investigated whether exogenous nitric oxide supplimentation with nitric oxide donor DETA NONOate could reverse impaired healing in diabetes. The results suggest nitric oxide donor DETA NONOate can reverse impaired healing associated with diabetes (P

Background: Genetic diversity of three polymorphic markers in the phenylalanine hydroxylase (PAH) gene region including PvuII (a), PAHSTR and MspI were investigated. Methods: Unrelated individuals (n=139) from the Iranian populations were genotyped using primers specific to PAH gene markers including PvuII(a), MspI and PAHSTR. The amplified products for PvuII(a), MspI were digested using the appropriate restriction enzymes and separated on 1.5% agarose. The PAHSTR alleles were identified using polyacrylamide gel electrophoresis followed by silver staining. The exact size of the STR alleles was determined by sequencing. The allele frequency and population status of the alleles were estimated using PHASE, FBAT and GENEPOP software. Results: The estimated degree of heterozygosity for PAHSTR, MspI and PvuII (a) was 66%, 56% and 58%, respectively. The haplotype estimation analysis of the markers resulted in nine informative haplotypes with frequencies ≥5%. Moreover, the results obtained from Ewens-Watterson test for neutrality suggested that the markers were under balancing selection in the Iranian population. Conclusion: These findings suggested the presence of genetic diversity at these three markers in the PAH gene region. Therefore, the markers could be considered as functional markers for linkage analysis of the PAH gene mutations in the Iranian families with the PKU disease.

Occupational safety and health are key issues today, with growing industrialization and labor market. To intro duce and maintain a high standard of safety and health at workplace, it is essential to have an overall picture of the pre sent workplace scenario, different hazards and probable health effects. This is a review of all previously published articles on occupational safety and health in Nepal. Key words such as Nepal, Occupation, Safety, and Health were used to search for relevant articles in PUBMED and Google Scholar. A total of 15 research articles were found, which dealt with different forms of work, like agriculture, health ser vices, child labor, small scale household industries, brick kilns, and textile factories. The overall status of occupational safety and health does not look satisfactory. Standard work situations and criteria have to be set up and regular monitoring should be done to ensure the maintenance of quality at work.

Occupational safety and health are key issues today, with growing industrialization and labor market. To introduce and maintain a high standard of safety and health at workplace, it is essential to have an overall picture of the present workplace scenario, different hazards and probable health effects. This is a review of all previously published articles on occupational safety and health in Nepal. Key words such as Nepal, Occupation, Safety, and Health were used to search for relevant articles in PUBMED and Google Scholar. A total of 15 research articles were found, which dealt with different forms of work, like agriculture, health services, child labor, small scale household industries, brick kilns, and textile factories. The overall status of occupational safety and health does not look satisfactory. Standard work situations and criteria have to be set up and regular monitoring should be done to ensure the maintenance of quality at work. Key Words: environment; exposure; hazards; labor; work place DOI: http://dx.doi.org/10.3126/ijosh.v1i1.4725 International Journal of Occupational Safety and Health, Vol 1 (2011) 19-26

Background: The aim of the study was to determine the incidence of non-bacterial acute gastroenteritis associated with diar­rheal diseases in Mazandaran Province, northern Iran. Methods: A total of 400 symptomatic cases from patients with acute gastroenteritis from Mazandaran Province in Iran were screened using EIA method for the presence of rotavirus, adenovirus and astrovirus during 2005-2006. Chi-square tests were used for testing relationships between different variables. Results: Rotavirus, adenovirus and astrovirus were detected in 62%, 2.3%, and 3% of samples, respectively. The maximum rate of rotaviruses was detected in the

Background: The haplotype phasing is more useful than genotyping markers independently at carrier detection and prena­tal diagnosis of diseases. The PAH gene region contains several markers used in detection of PKU disease. In the present study, the efficiency of BglII-EcoRI-VNTR haplotype phasing in Iranian family trios was investigated. Then, this informa­tion was compared with those obtained for unrelated individuals. Methods: Blood samples were collected from 20 healthy family trios and 60 unrelated individuals. The genomic DNA was ex­tracted by use of salting-out procedure. The two markers BglII and EcoRI were genotyped by use of PCR-RFLP. The geno­type of VNTR marker was identified by use of PCR and electrophoresis. The genotyping data obtained from family trios was used to infer haplotype phase. We also compared this data with results obtained from a widely used method for hap­lotype frequency inference from unrelated individuals, the PHASE program. Results: The haplotype phase of all members was only ascertained at eight family trios. The comparison of this data with the results obtained by use of PHASE program showed that eight haplotypes [211, 221, 215, 216, 214, 121, 225 and 111] were in­formative haplotypes in Iranian population. Conclusion: Since diversity of BglII-EcoRI-VNTR haplotypes was high in Iranian population, haplotype phasing at family trios was difficult. The results of this study showed that the genotyping data obtained from family trios could not provide enough information for BglII-EcoRI-VNTR haplotype phasing at Iranian PKU families and the genotyping of other family mem­bers was necessary at most cases.

Diabetes is characterized by a nitric oxide deficiency at the wound site. Diabetes is a factor that influences all stages of wound healing. In animals with acute experimental diabetes induced by streptozotocin (STZ), the early inflammatory responses after wounding is impaired, fibroblast and endothelial cell proliferation is reduced as well as accumulation of reparative collagen and gain in wound breaking strenght. This study investigated whether exogenous nitric oxide supplimentation with nitric oxide donor DETA NONOate could reverse impaired healing in diabetes. The results suggest nitric oxide donor DETA NONOate can reverse impaired healing associated with diabetes (P

PROBLEM: A multinational company with operations in several African countries was committed to offer antiretroviral treatment to its employees and their dependants. APPROACH: The Accelerating Access Initiative (AAI), an initiative of six pharmaceutical companies and five United Nations' agencies, offered the possibility of obtaining brand antiretroviral drugs (ARVs) at 10% of the commercial price. PharmAccess, a foundation aimed at removing barriers to AIDS treatment in Africa, helped to establish an HIV policy and treatment guidelines, and a workplace programme was rolled out from September 2001. LOCAL SETTING: Private sector employers in Africa are keen to take more responsibility in HIV prevention and AIDS care. An important hurdle for African employers remains the price and availability of ARVs. RELEVANT CHANGES: The programme encountered various hurdles, among them the need for multiple contracts with multiple companies, complex importation procedures, taxes levied on ARVs, lack of support from pharmaceutical companies in importation and transportation, slow delivery of the drugs, lack of institutional memory in pharmaceutical companies and government policies excluding the company from access to ARVs under the AAI. LESSONS LEARNED: The launch of the AAI enabled this multinational company to offer access to ARVs to its employees and dependants. The private sector should have access to these discounted drugs under the AAI. A network of local AAI offices should be created to assist in logistics of drugs ordering, purchase and clearance. No taxes should be levied on ARVs.