A public health assessment during March, 1993, in Bosnia-Herzegovina and in the areas of Serbia and Montenegro hosting Bosnian refugees, revealed extensive disruption to basic health services, displacement of more than 1 million Bosnians, severe food shortages in Muslim enclaves in eastern Bosnia, and widespread destruction of public water and sanitation systems. War-related violence remains the most important public health risk; civilians on all sides of the conflict have been intentional targets of physical and sexual violence. The impact of the war on the health status of the population has been difficult to document; however, in the central Bosnian province of Zenica, perinatal and child mortality rates have increased twofold since 1991. The crude death rate in one Muslim enclave between April, 1992, and March, 1993, was four times the pre-war rate. Prevalence rates of severe malnutrition among both adults and children in central Bosnia have been increasing since November, 1992. Major epidemics of communicable diseases have not been reported; however, the risk may increase during the summer of 1993 when the effects of disrupted water and sanitation systems are more likely to promote enteric disease transmission. Economic sanctions against Serbia and Montenegro may lead to declining health care standards in those republics if basic medical supplies cannot effectively be exempted.

This article reflects an investigation of knowledge, attitudes and behaviours and HIV/STI prevalence of Sudanese refugees and Ethiopian sex workers in 1992. It represents one of the earliest such investigations within an African refugee population. The investigation took place in the Dimma refugee settlement in south-western Ethiopia and study participants included Sudanese refugee men and women and Ethiopian female sex workers. Methods used for this investigation included focus group discussions, behavioural surveys and serologic testing. The main outcome measures of the investigation were HIV/STI knowledge, attitudes and behaviours and biological markers for HIV, syphilis and herpes simplex 2. The study findings indicate that in the early 1990s, knowledge about AIDS and condom use was low among Sudanese refugee women and not one reported having ever used a condom. Furthermore, sexual contact between refugee men and sex workers was frequent during the time of this study and the prevalence of HIV and other STIs was high. The results confirm a widely held assumption that highly mobile and transient populations in Africa are susceptible to STIs and HIV, in large part due to their knowledge, attitudes and behaviours.

Little is known about the HIV epidemic in conflict-affected southern Sudan. During 2002-2003, we conducted behavioral and biological surveillance surveys and sequential sampling in antenatal clinics in Yei, Western Equatoria, and Rumbek, Bar-el-Ghazal. HIV prevalence among individuals aged 15-49 years ranged between 0.4% in Rumbek town and 4.4% in Yei town, and among pregnant women between 0.8 and 3.0%, respectively. After the recent peace agreement, targeted prevention programmes are urgently needed to prevent further spread.

We examine the relation of key neonatal outcomes to pregnancy complications and to the use of antenatal steroids and investigate whether there is evidence of recent change in this relation. Complete information on pregnancy and neonatal course was available for 749 out of 949 singleton births without major congenital anomalies below 1501 g admitted to seven regional neonatal intensive care units between August 1, 1988 and June 30, 1991. Mortality was highest in infants born after labor with spontaneous rupture of fetal membranes of less than 24 hours duration (odds ratio [OR] = 1.6, 95% confidence interval [1.0, 2.6]). Spontaneous rupture of membranes of over 24 hours duration was associated with decreased risk of respiratory distress syndrome (OR = 0.42, [0.28, 0.64]) and decreased risk of patent ductus arteriosus (OR = 43, [0.28, 0.66]). Pregnancy induced hypertension was associated with increased risk of respiratory distress syndrome in those born at less than 20 weeks' gestation (OR = 6.0, [2.0, 17]). Labor with or without rupture of membranes of short duration was associated with increased risk of intraventricular hemorrhage (OR = 1.9, [1.2, 2.5]). These associations were not different in early versus late time periods of the study. Antenatal steroids were associated with dramatically reduced risk of mortality (OR = 0.20, [0.09, 0.50] ), respiratory distress syndrome (OR = 0.52, [0.32, 0.85]), and intraventricular hemorrhage (OR = 0.37, [0.21-0.65]).

to investigate mortality in periviable neonates ≤23 weeks gestational age and calculate its impact on overall neonatal mortality rate over a 12-year period (1998-2009). Verify if periviable mortality decreased in the period (2010-2015). Retrospective review. Neonatal mortality rate per 1000 live births was 11.4. Three hundred forty-nine live birth infants weighed ≤500 g and 336 died. Their proportion to the total neonatal mortality rate was 48.6%; out of 298 periviables 146 (43%) were ≤20 weeks gestational age. In 269 (80%) we could not determine the cause of death. Two hundred ninety-seven neonates (88.3%) died in the delivery room. Sixteen (5%) had an autopsy. Neonatal mortality rate from periviability was 96. 2% and constituted half of the overall rate in the period (1998-2009). There was not significant reduction of periviable mortality between 2010 and 2015. Current live birth definition and a reporting system that considers a 100 g periviable live birth infant as a neonatal death has placed Ohio and the United States at a significant disadvantage compared to other countries using different reporting systems.

The term reflection has been been used to describe a form of re-entry in a linear bundle in which two regions of excitable tissue are separated by an area of depressed conduction.4 During reflection, excitation occurs slowly in one direction along the bundle and is followed by continued propagation and excitation in the opposite direction. One form of reflection may be micro re-entry due to functional longitudinal dissociation within the depressed segments Parasystole An ectopic pacemaker may sometimes be connected to the remainder of the heart through tissue in which there is unidirectional block. Such block prevents the dominant rhythm, usually a sinus rhythm, from entering the region where the ectopic pacemaker is located. As a result, the ectopic pacemaker is not suppressed by the dominant rhythm. Moreover, because the block is unidirectional, impulses generated by the ectopic pacemaker can be conducted out to other regions of the heart provided these regions are not refractory, causing premature beats or even a tachycardia. This kind of rhythm is called parasystole. Phase 4 block An impulse may be blocked if it arrives at a site-eg, in the His bundle or one of the bundle branches-that is partly depolarised during spontaneous phase 4 depolarisation but has not reached threshold. This spontaneous diastolic depolarisation can depolarise the tissue sufficiently to inactivate the fast sodium channels and cause failure of propagation. 10

rate for IUFD was found at 39 weeks (0.14% of deliveries at 39 weeks). The lowest rates for NICU admission, any respiratory morbidity, and diagnosis of TTN or RDS were each found at 38 weeks gestational age. Adjusted odds ratios (with 95% confidence intervals) showed 3.48 (1.24-9.79) risk of IUFD at 37 vs 39 weeks, 2.09 (1.47-2.98) risk of NICU admission at 37 vs 38 weeks, 2.54 (1.62-3.97) risk of respiratory morbidity at 37 vs 38 weeks, and 3.38 (1.84-6.18) risk of TTN/RDS at 37 vs 38 weeks.CONCLUSION: Neonatal respiratory morbidity was lowest for deliveries at 38-39 weeks. IUFD was 3.5 times more likely at 37 weeks vs 39 weeks, which was a significant finding. Our findings support current guidelines advising clinicians when to deliver term pregnancies.