Sacrocolpopexy - a report on 262 consecutive operations

Objectives. This report analyses the outcome and complications of 262 consecutive sacrocolpopexy procedures for the repair of vaginal vault prolapse and enterocele. Methods. From March 1994 to February 2001, 262 patients underwent surgical repair using a standardised retroperitoneal technique. Initially dura mater strips were used and from the 19th patient onwards, Gore-tex soft tissue patch was used to suspend the vaginal apex to the anterior sacral ligament. Halban-type occluding sutures were placed in the pouch of Douglas. All patients were followed up and the minimum duration of follow-up was 16 months. Results. Vaginal vault prolapse was successfully managed in 259 of 262 patients giving a success rate of 98.8%. In addition, 4 patients had a repeat enterocele that required surgical repair. The overall surgical complication rate was low. Erosion of the patch through the vaginal vault occurred in 10 patients, necessitating removal of the patch. Prolapse did not recur in any of these patients. Conclusion. Abdominal sacrocolpopexy is a very successful and safe surgical management of vaginal vault prolapse. (South African Medical Journal: 2002 92(12): 982-985

FIGO has revised the staging of carcinoma of the vulva

Cancers are staged to allow for standardised terminology, appropriate prognosis, and worldwide communication. Therapeutic guidelines often flow from staging data. FIGO (International Federation of Gynecology and Obstetrics) has provided a staging system since 1958. More recently, International Union Against Cancer and the American Joint Commission on Cancer have also generated staging systems. As staging is based on research data and progressive science, the staging systems need to be revised frequently

Vulvar conditions where allergy plays a role

The vulvar skin in the adult comprises about one percent of the body surface and it is a highly specialised and adaptable skin. The competency of the vulvar and vaginal skin to withstand injury and infection is a remarkable feat of humankind. However, a number of allergic conditions may affect this region of the female body. The major symptomatology of vulvar disease can be summarised as pain, pruritus, swelling, local masses and dyspareunia and most of these are common in allergic diseases in this area. Symptoms of contact dermatitis include severe pruritus, swelling and usually a date of onset. Several causes of contact dermatitis are known, including allergy to condom contents. Atopic vulvar dermatitis is the vulvar component of systemic atopy and the vulva displays the symptoms of pruritus and burning. Allergens may produce the condition known as painful vulva syndrome, which presents as vulvodynia. The vulva is sometimes the only affected part of the skin in women with eczema.http://www.allergysa.org/journal.htmhttp://reference.sabinet.co.za/sa_epublication/caciam201

The Child Act, consent matters and obstetrics and gynaecology

This edition of the O&G Forum is dedicated to various aspects of Obstetrical and Gynaecological care of nadolescents. In modern medical ethics, patient autonomy is considered a major principle in decision-making regarding one’s health. Those receiving healthcare should be allowed to exercise that right consciously and freely. Healthcare providers are obligated to respect this right and allow patients to practice their autonomy in the cause of their treatment.http://www.journals.co.za/content/journal/medogam2018Obstetrics and Gynaecolog

Postnatal depressive features in mothers of neonates admitted to a neonatal unit at Steve Biko Academic Hospital : the role of sociodemographic and psychosocial factors

BACKGROUND: Postnatal depression (PND) is one of the most common complications following delivery. The development of PND is closely linked with biological, psychological, socioeconomic and cultural factors. OBJECTIVES: To determine the prevalence and identify risk factors for PND in mothers delivering at Steve Biko Academic Hospital (SBAH) whose babies were admitted to the neonatal unit. METHODS: We conducted a prospective observational study at SBAH, Pretoria, South Africa (SA). Women who delivered between 26 and 42 weeks' gestation at SBAH and whose babies were admitted to the neonatal unit were recruited at delivery. Interview screening using the Edinburgh Postnatal Depression Scale (EPDS) was conducted regarding the mother’s experience of her pregnancy and delivery. Sociodemographic and psychosocial data from the mothers were included in a multiple logistic regression model to estimate association with PND symptoms. RESULTS: Between 11 March and 30 December 2017, 2 671 mothers delivered at SBAH. Of these, 196 (7.3%) babies were admitted to the neonatal intensive care unit (NICU) and 10 (0.3%) were admitted to the neonatal high care unit (NHC). Mothers’ accommodation during their babies’ admission to the neonatal unit (p=0.002), having poor interpersonal relationships (p<0.0001), and intimate partner violence (IPV) (p=0.004) were significantly associated with screening positive for PND. CONCLUSION: Accommodation during neonatal care, availability of counselling, inclusion of the partner in postnatal care and IPV are significant factors in the depressive symptoms experienced by mothers postpartum in this settinghttp://www.sajog.org.za/index.php/SAJOGpm2020Obstetrics and Gynaecolog

Elucidating the Antimycobacterial Mechanism of Action of Decoquinate Derivative RMB041 Using Metabolomics

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), still remains one of the leading causes of death from a single infectious agent worldwide. The high prevalence of this disease is mostly ascribed to the rapid development of drug resistance to the current anti-TB drugs, exacerbated by lack of patient adherence due to drug toxicity. The aforementioned highlights the urgent need for new anti-TB compounds with different antimycobacterial mechanisms of action to those currently being used. An N-alkyl quinolone; decoquinate derivative RMB041, has recently shown promising antimicrobial activity against Mtb, while also exhibiting low cytotoxicity and excellent pharmacokinetic characteristics. Its exact mechanism of action, however, is still unknown. Considering this, we used GCxGC-TOFMS and well described metabolomic approaches to analyze and compare the metabolic alterations of Mtb treated with decoquinate derivative RMB041 by comparison to non-treated Mtb controls. The most significantly altered pathways in Mtb treated with this drug include fatty acid metabolism, amino acid metabolism, glycerol metabolism, and the urea cycle. These changes support previous findings suggesting this drug acts primarily on the cell wall and secondarily on the DNA metabolism of Mtb. Additionally, we identified metabolic changes suggesting inhibition of protein synthesis and a state of dormancy

Exploring the adequacy of obtaining informed consent for caesarean deliveries : a patient perspective

OBJECTIVES : The objective of this study was to assess the adequacy of informed consent obtained from patients prior to caesarean delivery. DESIGN : Descriptive study SETTING : Tertiary level hospitals in a major South African center in Pretoria, South Africa SUBJECTS : Two-hundred-and-fi fty patients who underwent elective and emergency caesarean deliveries OUTCOME MEASURES : The assessment of the adequacy of the informed consent was assessed via a questionnaire that the participants answered on day 2-3 post caesarean delivery. RESULTS : Average age of participants was 28.8 years (28.75 ± 5.92). Twenty three percent (23.2%) of the participants underwent elective and 76.8% underwent emergency caesarean deliveries. Seventy fi ve percent (75.6%) of the participants knew the name of the procedure, although only 29.2% were aware of the associated risks, and 59.2% of participants knew of their right to refuse the procedure. CONCLUSION : Adequate communication is essential to all aspects of medicine and this study has highlighted the inadequacy of the informed consent process that takes place at our institution. Information regarding risks and complications was not adequately communicated. A standardized informed consent document that healthcare professionals can use for counseling, starting antenatally, should be considered.https://journals.co.za/journal/medogam2022Obstetrics and GynaecologyStatistic

Marine Copepods, The Wildebeest of the Ocean

Copepods are amongst the most abundant animals on our planet. Who knew?! These small (typically 1–10 mm) crustaceans are found in all of the world’s oceans and play an important role in regulating Earth’s climate. Like wildebeest in the Serengeti graze on grasslands and are food for lions, herbivorous copepods represent a vital link in oceanic food chains between microscopic algae and higher predators, such as fish, birds, and whales. A group of copepods called Calanus are particularly important in the Northern Hemisphere. These tiny-but-mighty animals also share the wildebeest’s need to make a large annual migration—but in their case, they sink thousands of meters downwards to spend the winter in the deep, dark ocean. Understanding the lives of marine copepods, and how their populations will respond to climate change, is crucial for predicting the future health of the marine environment and how it helps our planet

HPV vaccine : can we afford to hesitate?

CITATION: Richter, K. L., Dreyer, G., Lindeque, B. G. and Botha, M. H. 2014. HPV vaccine: can we afford to hesitate? South African Medical Journal, 104(8):522-523, doi:10.7196/SAMJ.8449.The original publication is available at http://www.samj.org.zaNo abstract.http://www.samj.org.za/index.php/samj/article/view/8449Publisher's versio