Abstract The delivery of safe maternity care has become an increasing focus of attention, especially in recent years due to high-profile serious failings in care at individual NHS trusts.[1,2] Preventable tragic adverse events in maternity care have devastating consequences for families, and the associated negligence claims create huge costs for the NHS.[4] Reducing harm in maternity care is a major priority to protect families and NHS sustainability.[5] Much work to date has focused on identifying what goes wrong in maternity care. Much has been learned from inquiries and investigations into adverse events in maternity care. [1,35] However, the resulting recommendations have not, as in other areas of quality and safety, always had impacts that are as powerful or consistent as might be hoped.[21] This review article takes a fresh and positive perspective and shares learning on the key findings of the recent national maternal inquiries and investigations reports into adverse events in the care given to some mothers and babies. [5,6] It makes a case for the universal implementation of specific key measures in order to improve the quality of maternity care and its safety profile.[35] It is now imperative that the health system shifts its focus from counting to acting and changing practice. Adequate resources and funding are required to ensure that recommendations of national maternity investigation reports are implemented and sustained to make care as safe as the best.[11] Serious incidents and harm sustained to mothers and babies when the care provided has fallen short are heartbreaking and catastrophic for the families. So we have a moral duty to do anything we possibly can to reduce them.

Abstract The COVID-19 pandemic, particularly the Delta variant, has been associated with an increase in opportunistic infections, such as mucormycosis, especially in immunocompromised individuals. This case series presents three patients with type-2 diabetes mellitus who developed mucormycosis after receiving high-dose steroid treatment during their COVID-19 treatment. Despite the best medical and surgical efforts, all three patients faced severe outcomes, highlighting the challenges in managing mucormycosis, particularly in the context of COVID-19. Each patient exhibited extensive tissue necrosis, primarily affecting the nasal and paranasal regions, with rapid progression to orbital and cerebral involvement in some cases. Radiological evaluations, including CT and MR imaging, revealed extensive sinus involvement and necrotic changes, necessitating aggressive surgical debridement. The management included sinus surgery, maxillectomy, orbital exenteration, and the use of systemic antifungals like amphotericin-B. However, despite these interventions, all patients succumbed to the disease due to the angioinvasive nature of the infection and the complications of their underlying conditions. The pathophysiology of COVID-19-related mucormycosis is multifaceted. Hyperglycemia, often exacerbated by steroid use, along with the immunosuppressive effects of COVID-19, creates an environment conducive to fungal proliferation. Moreover, endothelial damage and reduced phagocytic function contribute to the angioinvasive behavior of Mucorales. Early diagnosis, close monitoring, and prompt surgical intervention are critical for improving survival rates. This case series underscores the importance of vigilance in at-risk patients and the need for a multidisciplinary approach to manage such infections effectively.

Abstract Introduction Dengue is endemic in the Lao People’s Democratic Republic. In 2013, dengue cases exceeded the epidemic threshold from January onwards. A high case fatality ratio (CFR) was reported from Vientiane Capital and Champasack Province. This study aimed to identify the causes of dengue deaths during the 2013 outbreak in the two provinces in order to make recommendations for improvement of case management. Methods Dengue data were collected from the Lao Early Warning Alert and Response system. All dengue deaths admitted to seven hospitals during the dengue epidemic in 2013 in Vientiane Capital and Champasack province were analyzed. Data were collected from the hospitals by reviewing the mortality forms and dengue case management forms. Descriptive statistical analyses were performed. Results A total of 44 171 dengue cases including 95 deaths were reported in 2013 (CFR=0.21%). The majority of deaths were reported from Champasack (n=35) and Vientiane Capital (n=26); most (74%) were aged less than 15 years. Most of the death cases were admitted to the hospital late (median of 4 days from onset) with severe bleeding (59%) or fluid overloading due to prior intravenous fluid therapy (41%). Late or incorrect diagnosis for dengue with warning signs was not uncommon (10/61, 16%). Conclusion It was the largest epidemic year for dengue in 2013 with a high number of fatal cases. Ongoing training for healthcare providers should be implemented to improve diagnosis, case management, and treatment outcomes. Further community-based surveys on the health-seeking behavior of dengue patients may indicate potential risk factors for severe dengue outcomes.

Abstract Civil Society and healthcare organizations, together with Patient Advocacy Groups (PAGs) and EU umbrella patient organizations - a total of 42 entities from 16 Member States, all united in protecting the health rights of European citizens - recently wrote an open letter to the newly elected European Commissioner for Health to express serious concerns about the healthcare workforce crisis in Europe, which requires immediate and comprehensive action from the highest levels of political leadership. With 15 million healthcare professionals, constituting over 7% of the EU workforce and almost 4% of the EU population, their indispensable role in ensuring the well-being of our citizens and fostering trust in our healthcare systems cannot be overstated. The relevance of the initiative did not leave indifferent the Members of the European Parliament, some of whom formally supported the message. The new EU Institutions are called upon to address the health workforce crisis by supporting healthcare professionals’ knowledge acquisition and upskilling, which are the main preconditions for greater protection of patients rights across Europe.

Abstract A cross-sectional study using a structured and semi-structured questionnaire was conducted from July 15 to September 30, 2022, in Kellem Wollega Zone, with the main goal of determining the communitys knowledge, attitudes, and practices (KAPs) regarding common zoonotic diseases (Anthrax, Brucellosis, and Rabies) and their prevention and control measures. A total of 392 (267 male and 125 female) respondents were interviewed face to face that includes 50 (12.8%) degree and above, 66 (16.8%) diplomas, 99 (25.3%) grade 1-8, 48 (12.2%) learning or completed high school and 129 (32.9%) uneducated respondents. With respect to occupation, 46 (11.7%) animal health and human health professionals, 66 (16.8%) other experts, 56 (14.3%) students, 34 (3.6%) merchants, and 190 (48.5%) farmers were contacted for interviews. The communitys Knowledge, attitudes, and practices of the study area regarding zoonotic diseases were 221 (56.4%), 317 (80.8%), and 219 (55.8%), respectively. From the total of 263 educated respondents, 178(67.7%) have good knowledge, good perceptions, and practices regarding common zoonotic diseases, while only 85 (32.3%) of them have no information about zoonotic diseases. But, of the total 129 uneducated respondents, only 51(39.5%) have general knowledge, good perceptions, and practices on these diseases, and 78(60.5%) of them heard nothing about zoonotic diseases. In general, out of 392 respondents, 186 (47.5%) have general information on all common zoonotic diseases in the study area (Anthrax, Brucellosis, and Rabies). More respondents have awareness of Rabies 213 (54.3%), followed by Anthrax 201 (51.3%) and Brucellosis 90 (22.9%) as indicated in Table 2 and Figure 3. Statistically, sex, educational level, and type of occupation have a significant impact (P<0.05) on the knowledge, attitudes, and practices of the community on zoonotic diseases (Table 3). This indicates that females, uneducated respondents, and those respondents with non-related occupations to the health profession were found to have less awareness of zoonotic diseases. It may be due to a lack of training or education, the presence of a knowledge gap from person to person, and differences in circumstances of awareness creation from place to place on zoonotic diseases. Therefore, designing a strategic and continuous health education is mandatory and all concerned professionals need to be committed to creating awareness for the community on zoonotic diseases.