Aerobic Bacteria Associated with Septic Abortion

Aerobic Bacteria Associated with Septic Abortion Aerobic bacteria associated with septic abortion among Sudanese women Yagoub Hamadt Allah Elhaj Abd Elseed1*, Mohamed, A E.M. Ibrahim2 Waled Amen Mohammed Ahmed3 Abstract Background: Septic abortion is a common health problem with short- and long-term complications that affect the quality of life of those fortunate enough to avoid mortality. Both spontaneous and induced abortion may result in septic complications. Objective: This study aimed to isolate and identify aerobic bacterial causative agents of septic abortion in Sudan. Method: A descriptive study was conducted in the period from March 2013 till June 2013 in Gynecological Unit in Khartoum Teaching Hospital, Sudan. Thirty women with vaginal bleeding in the unit were included in the study. Thirty high vaginal swabs and cervical swabs were collected from the selected ladies admitted to the hospital with bleeding. Results: The prevalence of abortion was as fallows, in age group(20-25) abortion cases were (13.3%), in group(26-30) abortion cases were (33.3%), in group(31-35) cases were (20%), in group(36-40) cases were (33.3%) (P > 0.05). Isolated bacteria from those cases were; Staphylococcus epidermidis (86.2%), Klebsiella ozaenae (6.9%), Proteus mirabilis (3.4%), Escherichia coli (3.4%) and Staphylococcus aureus (3.4%). The present study showed that induced abortion (73.3%) was insignificantly more than habitual abortion (26.3%), (P=0.07). Conclusion: The major isolated organism was Staphylococcus epidermidis (86.2%), which was isolated from both complete and initial cases. But aerobic pathogenic bacteria isolated were Klebseilla ozaenae, Proteus mirabilis, Staphylococcus aureus and Escherichia coli. Keywords: Septic abortion, vaginal swab, pregnant women, Stahpylococcus epidermidis. Introduction: Septic abortions contribute significantly to maternal morbidity and mortality. Improving literacy rate in the female population and effective family planning should reduce its incidence [1]. In 1900, the rationale of therapy of the incomplete septic abortion was divided into a medical or surgical approach. Medical therapy comprising oxytocic, bed rest and supportive measures theoretically decreased the incidence of sepsis, while increasing the problem of blood loss and prolonged hospitalization. The surgical approach classified by some as controlled blood loss but theoretically increased the incidence of sepsis [1]. In 1973, a report described an adolescent admitted to a large Boston Teaching Hospital with what proved to be incomplete septic abortion [2]. Deaths from illegal abortion are mainly due to infection[2,3].Additional to that At 1990 a review of deaths due to abortion in the united states noted that 62 percent of the deaths from illegal abortion and 51 percent of deaths from spontaneous abortion were due to infection, as compared which only 21 percent of death from legal abortion [4] . Mccormick (I944) estimated that 3,500 women died annually in America from this complication of pregnancy and a recent estimate in Turkey suggested that 10,000 women a year died from this cause in that country[5]. A recent publication by Sedgh et al. (2007) estimated that a total of 42 million abortions were performed in 2003, down from 46 million estimated for 1995 using the same methods. The same study showed that 20% of all pregnancies, including miscarriages and stillbirths, terminate in abortion each year. This means that one out of every five pregnancies worldwide is voluntarily terminated annually, a statistic that illustrates its enormous dimensions. Expressed another way, the worldwide rate of induced abortion was approximately 29 per 1000 women between ages 15 and 44 years in 2003, down from 35 per 1000 in 1995. This means that globally one out of every 34 women within that age range has an abortion each year [6]. On the basis of verbal autopsy data and hospital records it is estimated that approximately 25% of maternal deaths are caused by hemorrhage, 15% by infection,12% by pregnancy-induced hypertension, and 8% by obstructed labor[7]. At the last years it has been observed that there is an increase in the prevalence of septic abortion among pregnant women, and its complication upon community. Septic abortion is considered nowadays one of the most important issues concerning Maternal health .There are not much studies traced in Sudan investigating the septic abortion prevalence and its causative agent. Therefore, this study aimed to isolate and identify aerobic bacterial causative agents of septic abortion in Khartoum, Sudan. Material and Method This is a descriptive study. It had been conducted among pregnant women in age of (20 – 40 ) years, who are being admitted to the Gynecology bleeding emergency room of Khartoum Teaching Hospital, Sudan, in the period from March 2013 till June 2013. High vaginal swabs: After the introduction of the speculum, the swab should be rolled firmly over the surface of the vaginal vault. The swab should then be placed in Amies transport medium with charcoal or/and Stuarts transport medium. Cervical swabs: After introduction of the speculum to the vagina, the swab should be rotated inside the endocervix. The swab should then be placed in Amies transport medium with charcoal or Stuarts transport medium. Then all collected specimens were inoculated on Blood agar (aerobic 370c), chocolate agar (aerobic 370c and 5-10% co2) and Macconkey agar (aerobic 370c). Incubated for overnight based on report done by Fawad A. et al 2008[8], when puerperal sepsis or septic abortion is suspected inoculate the specimen on two plates of blood agar and incubate aerobically at 35–370C overnight. Inoculate the specimen on Macconkey agar and incubate the plate aerobically at 35–370c overnight [8]. Examine the colonies for Gram stained smear: It is done to examine the smear for pus cells and bacteria (8). Identification tests: done to identify the pathogenic bacteria include Catalase test, Coagulase test, Deoxyriboneuclease test, Kligler iron agar, Citrate utilization test, Simmons citrate agar, Urease test, Indole test, Sugar fermentation test and Methyl Red test. Results: The total number of 30 samples were collected from pregnant women suffering from bleeding, out of these 11 specimens (36.67%) were collected after complete abortion, whilst 19 (63.33%) samples were collected at initial time of bleeding, as indicated in Table (1) . Table (1): The collected specimens time from women with bleeding in Khartoum Teaching Hospital. Parameter Number Percentage Specimens collected after complete abortion 11 36.67% Specimens collected at initial time of bleeding 19 63.33% Total cases 30 100% According to demographic characters, septic abortion appearing more frequently at the age of 26-30 and 36-40 and most cases were induced abortion (73.3%) as shown in Table (2). Table (2): Demographic characteristics of women attending with bleeding Khartoum Teaching Hospital: Demographic character Frequency Percentage Age categories 20-25 4 13.34% 26-30 10 33.33% 31-35 6 20% 36 40 10 33.33% Total 30 100% Type of abortion Habitual 8 26.67% Induced 22 73.33% Total 30 100% Types of aerobic bacteria isolated from specimens collected at complete stage of abortion were Staphylococcus epidermidis, Klebseilla ozaenae, Staphylococcus aureus, Escherichia coli and Proteus mirabilis. Staphylococcus epidermidis was isolated from both initial stage and complete stage of abortion. It was isolated from 14 specimens out of 19 specimens, Table (3). Table (3): Number of different bacteria isolate from septic abortion cases from women attending to Khartoum Teaching Hospital. Parameter Organism isolated Frequency Percentage Organism isolated from complete stage of abortion Staphylococcus epidermidis 6 54.5% Klebsiella ozaenae 2 18.2% Staph. aureus 1 9.1% Escherichia coli 1 9.1% Proteus mirabilis 1 9.1% Total 11 100% Organism isolated from initial stage of abortion Staphylococcus epidermidis 14 73.68% No growth 5 26.32% Total 19 100% Table(4): Relationship between the age of women, and type of abortion and the time of specimens in Khartoum Teaching Hospital Demographic character Complete abortion n(%) Initial abortion n(%) p-value Age categories 20-25 1 (9.1%) 3 (15.8%) 0.08 26-30 4 (36.3%) 6 (31.6%) 31-35 2 (18.2%) 4 (21.1%) 36 40 5 (45.4%) 5 (26.3%) Type of abortion Habitual 3 (27.27%) 5 (26.32%) 0.07 Induced 8 (72.73) 14(73.68%) Discussion: Out of 30 cases involved in this study 11 (36.67%) cases were caused by aerobic bacteria which may indicate that abortion may be caused by other causative agents than aerobic bacteria. The Percentage of septic abortion have been notably decreased , this is mostly because health care provider contribute significantly to reduce the expose of woman to septic complication by providing surfaces in a safe environment, this is un consistent with other published reviews[9]. The highest incidence were in age group 26-30 also in group36-40 (P > 0.05) the incidence were high , which is in inconsistent with other published reviews in other countries [9] ,but its consistent with the research of (Fawad, et al 2008) who found that the majority of patient were of middle age[8]. Also habitual abortion occupied about (27.3%) (P > 0.05) and induced abortion about (72.7%) (P > 0.05). Earlier published review showed that most isolated organism was Escherichia coli (20%) ,either alone or in combination with other bacteria ,which is inconsistent with our study (9.1%). Also the reviewer isolate Proteus mirabilis in combination with Escherichia coli (6%), in our study we found Proteus mirabilis (9.1%) [5]. The percentage of Klebsiella ozaenae isolate was (18.2%) which is higher than pervious study (Isibor, et.al 2011) with percentage of (4.4%) among pregnant woman [10] Staphylococcus aureus isolate percentage was (9.1%) in disagree with study done by (Isibor, et al 2011), which found that Staphylococcus aureus occupies about (26.7%). this may be attributed to immune status of the individual, personal hygiene and the proximity of the vagina to urethra [11]. References Atrash H.K., Lawson H.W., Smith J.C., Legal abortion in the US : trends and mortality . Contemp Ob/Gyn, 1990;p35(2);58-69. jewett J.F., septic induce abortion . N Engl J Med,1973,p289:9-748. Cates W .Jr. , Rochat R.W. , Smith J.C. , Taylor C.W. Jr., Trends and national abortion mortality ,United State,1940-1974:implification for prevention of future abortion deaths .Adv Plann Parent 1976,11:106-13. Cates W.Jr. , rochat R.W., Ilegal abortion in the united states:1972-1974.Fam Plann perspect1976;8:86-92. Botes M., The Parameters of Septic Abortion, S.A. Journal of obstetrics and gynecology, 11 September 1971, p4 ;37-41. Sedgh G., Henshaw S., Singh S., Ahman E., and Shah I.H.,Induced abortion: estimated rates and trends worldwide. Lancet ,2007 ,p370: 1338–1345. Sedgh G., Henshaw S., Singh S., Ahman E., and Shah I.H.,Induced abortion: estimated rates and trends worldwide. Lancet ,2007 ,p370: 1338–1345. Fawad A., Nazk H., K. Anisa , Septic induced abortion , J. Ayub Med. Coll. Abbottabad ,2008,20. Osazuwa H., Aziken M., Septic abortion: a review of social and demographic characteristics , Arch. Gynecol. Obstet. ,2007,p 275:117–119. Isibor J. O., Samuel S. O., Nwaham C. I., Amanre I. N., Igbinovia O., and Akhile A. O., Prevalence of bacterial and Candida albicans infection amongst women attending Irrua Specialist Teaching Hospital, Irrua, Nigeria, African Journal of Microbiology Research, Vol.30 ,September, 2011, p 5(20),. 3126-3130 Rosenow E. C., Studies in Elective Localization, Jour. Dent. Research, vol. 1, No. 3, September, 1919,52.

Misery, by Stephen King - Annie Wilkes :: Misery Stephen King

Misery, by Stephen King - Annie Wilkes What does it take to frighten an author of best-selling horror novels?   In Misery, Stephen King embodies a writer's fears about himself as a writer and about the continuation of his creativity in a richly elaborated and horrifi-cally psychotic woman, Annie Wilkes.   In the novel, Annie represents a mother figure, a goddess, and a "constant reader".   In reality, however, An-nie merely represents a creative part of King's mind. Annie Wilkes is a proud mother of two children--a historical-romance novelist, Paul Sheldon, and his extremely popular heroine Misery Chastain.   Annie must nurse and educate Paul.   Gottschalk elaborates, "Annie views Paul in a madly maternal way.   Early in her custody of Paul, she brings him pills for his excruciating pain, but he must suck them off her fingers in a grotesque parody of a nursing child" (125).   If she leaves him untended too long, Paul wets his bed, and she must change his sheets and clothes. When he is tired or frustrated, he weeps like a small child.   Annie ensures his childlike dependence on her and an ""expression of maternal love" (King 159) with his addiction to pain killing-drugs.   Annie's disciplinary actions contribute to her mother figure, also.   Gottschalk writes, "When he has been bad, she disciplines him but in motherly fashion often comforts him while doing so" (127).   Annie punishes Sheldon's attempts to get free by ampu-tating h is foot and thumb with an ax, "exercising editorial authority over his body" (King 264).   Annie acts as a virginal and protective mother of the vir-gin Misery,   "Annie prevents Paul from letting Misery Chastain die in child-birth.   She must live and a novel must be born" (Gottschalk 126).   Annie nurtures Misery's return as well, "Nothing will interfere with [Misery's] safety or the birth of the book she is nurturing" (Gottschalk 127).   There are no doubts as to the significance of Annie's maternal image in the novel. Behind Annie's destructiveness lies a goddess figure--a goddess in charge of Paul's, as well as Misery's, life.   Paul is at the mercy of Annie.   He makes it through the days, but only in a complete fear of being murdered by Annie.   Gottschalk illustrates Annie's powerful grip over Paul, "Annie 'raped' Paul back into life, and she will hunt him down if he tries to escape" (127).   King compares Annie's powerful figure to a giant furnace, "That's what it would look like†¦If you built a furnace inside the mouth of one of those idols in the H.

Basic Chemistry for investigating living things

Which test tube represents the control? The one with water. C. Why? When protein molecules are present, Beirut Reagent reacts with the protein to form a purple color. Tube number one is the control tube because it is distilled water and has no protein; the tube has no color. C. Which test tube contained the most test substance? Amylase D. Other than the control, which test tube contained the least test substance? Hard to say because the other ones didn't have much of a color, so it didn't seem like there was much protein at all. E. Did the results agree with your initial hypothesis in every case? Yes F. Why or why to?Starches and sugars are helped by protein enzymes and Amylase is an enzyme. Good source of protein, so I thought Albumen would have protein Eggs are a foods, but the Beirut reagent isn't strong enough to pick up small amounts G. If the color change is not as you expected, what might be the reasons? Contamination H. Add another 5 drops of Beirut Reagent to each test tube and stir as before. Do your results change? I didn't notice any change Discussion A. What is the purpose of this exercise? To use color to detect if substances have protein since Beirut reagent would react with a protein to form a purple color B.Why is it important to clean droppers and equipment between chemical uses? To avoid cross contamination C. What other types of foods or substances contain high levels of protein? Meat or fingernails D. Suggest a situation where you might use the Beirut Reagent colorimetric test. It kidney disease E. What other types of analytical procedures detect the presence of proteins? The Lowry Method Exercise 2: Testing for the Presence of Starch in Cells A. What is the test substance? Starch B. Which test tube represents the control? Water C. Why? Water has no starch and it turned amber, so if your color was amber, you ad no starch D.Which test tube contained the most test substance? Potato starch Other than the control, which test tube contained the least test substance? Albumen and amylase E. Did the results agree with your initial hypothesis in each case, why or why not? Known to have starch, and they did. I didn't expect the proteins Yes, potatoes are to have starch sources, but they're not in every natural food source G. If the color change is not as you expected it to be, what might be the reasons? That items I did not think had starch, actually did have it. A. What is the purpose of this exercise?Iodine reacts with carbohydrates to form a dark blue color, so you would know if the substance had carbohydrates based on the color it turned. B. What other types of foods or substances contain high levels of starch? Wheat grain C. Suggest a situation where you might use the iodine colorimetric test. Testing for thyroid issues D. What other types of analytical procedures detect the presence of starch? Detect the presence of starch by using the chemical method A. What is the test substance? Sugar C. Why? There is no sugar in water , and it turned a light blue.Any test with that color old mean that there was no sugar C. Which test tube contained the most test substance? Glucose D. Besides the control, which test tube contained the least test substance? Potato starch D. Did the results agree with your initial hypothesis in every case? Yes E. Why or why not? The test specifically looks for glucose, so other carbohydrates and starches that don't have glucose, will not show sugar F. What are you conclusions about the results? Glucose will react with Benedicts reagent G. If the color change is not as expected, what might be the reasons? Contamination

The evolution of apes was a possibility in the 19th...

The evolution of apes was a possibility in the 19th century. Although religion had been cherished for centuries, the doubts in people’s mines began to express many uncertainties about the bible and started to question their own beliefs. The issue of evolution was a huge concern in the 19th century as it was destroying the view of god and how he made the world; this caused many people to either change their views on life or their religion which had a huge part in resolving people’s beliefs in their own culture. This has had a huge impact on today’s society due to the involvement of Charles Darwin and his theory of evolution. In the 19th century people believed that we came/ were made by Adam Eve, but through Darwinism there was a†¦show more content†¦(2006).). The impact on today’s society has shown us how far science has come. From the release of the evolution theory in 1859, to today, science has changed phenomenally. The effect on society back in the 19th century was the outstanding criticism that was brought out by this theory. It changed people’s beliefs, views and their overall thought on the world. Today many things have changed; there have been investigations into the evolution theory, discoveries of bones and many more things which have also changed many people’s perspectives. Charles Darwin’s book sparked large debates across the world, large numbers of reviews, critiques and negative responses were published. When Darwin released the book â€Å"The origin of species† he was more worried about the effects it would have on his fellow scientists than the public. â€Å"Through all this, Darwin largely kept his nose out of things, safely hidden in the comfort of Down House, trying to tease out what reviewers thought of his science amidst all the politics and rhetoric.†(â€Å"Chalres Darwin Evolution† (2009).). Darwin kept on with his work, publishing the evolution in plants, animals (including humans), adding to the large amount of evidence he had collected over the years. As the scientific world started to come to terms with evolutional theory, Darwin collected more and more evidence which started to go in his favour. The fact that Charles Darwin’s idea was not accepted for many years shows us