Breast cancer and HRT

No Abstract. South African Family Practice Vol. 47(6) 2005: 48-5

The HPV Vaccine - What the Family Practitioner Needs to Know

This article reviews the impact of human papilloma virus infection on the development of cervical cancer and the efficacy of newly developed HPV vaccines. These vaccines may have a major impact on the reduction of these common malignancies. South African Journal of Family Practice Vol. 50 (4) 2008: pp. 22-2

A prospective study of iron status in white and black pregnant women in an urban hospital

Evaluation of the iron status (haemoglobin and ferritin concentrations, and percentage transferrin saturation) in a prospective study of 65 pregnant women (55 white and 10 black) revealed that adequate maternal iron stores during pregnancy cannot be maintained with prevailing dietary patterns. Although 80,6% of the patients had normal indices in the first trimester, only 12,3% were normal in the third. Significant depletion of iron stores occurred in the second trimester, but significant iron-deficient erythropoiesis only occurred in the third trimester. Despite the decline in iron status, iron deficiency anaemia was only seen in 7 - 8% of the patients. Even after correction for the haemodilution and increased transferrin concentrations in pregnancy, over 70% of women had depleted iron stores in the third trimester. No beneficial effect on fetal birth weights was found on withholding of maternal iron supplementation. This study clearly demonstrated that white and urban black pregnant women require iron prophylaxis to maintain iron stores

Birth asphyxia - Presenting the case for' A stitch in time'

Objectives. To. review the current birth asphyxia and subsequent cerebral palsy (CP) rates at a teaching hospital in a developing country, and to place these rates within the context of the current caesarean section (CS) rate. To determine the number of cases of birth asphyxia that are preventable.Design. Retrospective, descriptiv.e study.Setting. Neonatal nursery and intensive care unit, Johannesburg Hospital.Methods. Maternal and mionatal records were reviewed for 48 babies weighing less than 1 800 g born between 1 January and 31 December 1997 with birth asphyxia. Outcome after discharge was determined from the neonatal follow-up notes until 31 March 1998.Results. Mortality in the group of birth-asphyxiated babies was 12.5%. The birth asphyxia rate was 6/1 000 live births, and the CP rate in the study group was 1.15/1 000 live births. The CS rate for the group was 29%, with an overall CS rate at the hospital of 20.5%. In 22 cases (46%) the cause of birth asphyxia was considered to have been preventable.Conclusion. The cr rate is considerably higher than that quoted for developed  countries, and a significant number of cases of birth asphyxia in the study were  preventable. In the face of the high birth asphyxia and cr rates, the CS rate appears to be inappropriately Iow. The CS rate should be audited in the context of the birth asphyxia and cr rates

Should pregnant urban South African women be screened for hepatitis B?

The prevalence of hepatitis B virus (HBV) infection in the South African urban obstetric population, which consists of white, black, coloured and Asian patients from different socio-economic, cultural and geographical backgrounds, is unknown. Routine screening performed in 3 469 urban pregnant women revealed that 42 patients were HBV surface antigen-positive (a prevalence of 1,21%). Only 2 patients (4,6%) were hepatitis B e antigen (HBeAg)-positive (0,06% of the entire cohort), whereas the remaining 40 were identified as hepatitis B e antibody-positive. Despite a significant increase in the numbers of black patients, there has not been an accompanying increase in the number of HBV carriers. Replicative infection was equally distributed among white and black pregnant women

South African Menopause Society revised consensus position statement on menopausal hormone therapy, 2014

PKThe South African Menopause Society (SAMS) consensus position statement on menopausal hormone therapy (HT) 2014 is a revision of the SAMS Council consensus statement on menopausal HT published in the SAMJ in May 2007. Information presented in the previous statement has been re-evaluated and new evidence has been incorporated. While the recommendations pertaining to HT remain similar to those in the previous statement, the 2014 revision includes a wider range of clinical benefits for HT, the inclusion of non-hormonal alternatives such as selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors for the management of vasomotor symptoms, and an appraisal of bioidentical hormones and complementary medicines used for treatment of menopausal symptoms. New preparations that are likely to be more commonly used in the future are also mentioned. The revised statement emphasises that commencing HT during the ‘therapeutic window of opportunity’ maximises the benefit-to-risk profile of therapy in symptomatic menopausal women

Is antenatal screening for rubella and cytomegalovirus justified?

Altogether 2 250 asymptomatic pregnant women attending an antenatal clinic were investigated for serological evidence of past exposure to rubella and cytomegalovirus (CMV) as well as for active primary infection or reinfection/ reactivation. Only 7 (0,3%) active rubella infections were diagnosed, none of them primary. Similarly, out of 132 patients with active CMV, only 5 primary infections (3,8%) were diagnosed; the vast majority 127 (96%)- had reactivation infections. No congenital rubella infections were detected, while the transplacental transmission rate for CMV was 6,4%. None of the infants followed up was clinically affected at birth or at 6 months. No racial differences in seroprevalences for CMV or rubella immunoglobulin were observed, but immunoglobulin antibody prevalence to CMV was significantly lower in the white group. From this study there appeared to be no indication for routine antenatal screening for CMV in asymptomatic mothers

Books

Current Ocular Therapy. Ed. by F. T. Fraunfelder, F. Hampton Roy and S. Martha Meyer. Pp. xiii + 792. Illustrated. £55. Nonhmead: WB Saunders. 1989.Dysfunctional Uterine Bleeding and Menorrhagia. Bailliere's Clinical Obstetrics and Gynaecolcgy: International Practice and Research, June 1989. Ed. by J. O. Drife. Pp. 217 + 428. Illustrated. £18,50. Northmead: WE Saunders.1989.Treatment of Cancer. 2nd ed. Ed. by Karol Sikora and Keith E. Halnan. Pp. ix + 916. Illustrated. Price £99,50. London: Chapman and Hall Medical. 1990.Ocular Syndromes and Systemic Diseases. 2nd edition. Ed. by F. Hampton Roy. Pp. xlvii + 470. £40. Northmead: WE Saunders. 1989.Non-invasive Cardiac Imaging. British Medical Bulletin. Vol. 45, No. 4. Ed. by D. G. Gibson. Pp. 830 + 1109. Illustrated. £25 (UK) or £31,50 (overseas). New York: Churchill Livingstone. 1989.Laparoscopic Surgery. Bailliere's Clinical Obstetrics and Gynaecology: International Practice and Research, September 1989. Ed. by C. J. G. Sunon. Pp. 429 + 686. Illustrated. £18,50. Northmead: WB Saunders. 1989.Management ofMinor Head Injuries. Ed. by I. J. Swann and D. W. Yates. Pp. x + 102. Illustrated: £14,95. Hampshire: Chapman & Hall Medical. 1989.ABC of Child Abuse. Ed. by Roy Meadow. Pp. 59. Illustrated. London: BMJ. 1989.The Facts of Life. Ed. by Marina Petropulos. Pp. 1 + 222. Illustrated. R19,95 exc!. GST. Cape Town: Tafelberg. 1990.Physical Examination of the Heart and Circulation. 2nd ed. Ed. by Joseph K. Perloff. Pp. viii + 292. Illustrated. £17,95. Northmead: WB Saunders. 1989.Growth Regulation of Thyroid Gland and Thyroid Tumours: Frontiers ofHormone Research. Vo!. 18. Ed. by P. E. Goretzki, and H. D. Roher. Pp. viii + 163. Illustrated. £68,80. Basel: S. Karger. 1989.Topical Diagnosis in Neurology: Anatomy, Physiology, Signs, Symptoms. 2nd revised ed. Ed. by P. Duus. Pp. x + 337. Illustrated. DM 370. Stungart: Georg Thieme Verlag. 1989

Determinants of Acceptance of Cervical Cancer Screening in Dar es Salaam, Tanzania.

To describe how demographic characteristics and knowledge of cervical cancer influence screening acceptance among women living in Dar es Salaam, Tanzania. Multistage cluster sampling was carried out in 45 randomly selected streets in Dar es Salaam. Women between the ages of 25-59 who lived in the sampled streets were invited to a cervical cancer screening; 804 women accepted and 313 rejected the invitation. Information on demographic characteristics and knowledge of cervical cancer were obtained through structured questionnaire interviews. Women aged 35-44 and women aged 45-59 had increased ORs of 3.52 and 7.09, respectively, for accepting screening. Increased accepting rates were also found among single women (OR 2.43) and among women who had attended primary or secondary school (ORs of 1.81 and 1.94). Women who had 0-2 children were also more prone to accept screening in comparison with women who had five or more children (OR 3.21). Finally, knowledge of cervical cancer and awareness of the existing screening program were also associated with increased acceptance rates (ORs of 5.90 and 4.20). There are identifiable subgroups where cervical cancer screening can be increased in Dar es Salaam. Special attention should be paid to women of low education and women of high parity. In addition, knowledge and awareness raising campaigns that goes hand in hand with culturally acceptable screening services will likely lead to an increased uptake of cervical cancer screening