Ethics opinion : the practitioner in need of care

The generally used way of defining impairment when referring to medical practitioners is the inability to practice medicine with reasonable skill and safety for patients. This may be due to progressive physical or mental illness of the practitioner, loss of motor skills, deterioration through ageing or excessive use or abuse of alcohol or drugs, be it high schedule medication or illicit drugs (AMA 2011, Dhai 2006). It is important to note that the entire projection of the statement is towards the patient, care of the patient and safety aspects of the patients. A practitioner who may be impaired would internalise the dilemma but the reality is that the interest of the patient is paramount and that dictates the dealings with the practitioner.http://www.ogf.co.z

Dysmenorrhoea

Dysmenorrhoea is a descriptive term for several conditions that cause menstrual pain. While various grades of menstrual pain occur commonly in the menstruating population, approximately 15% of this group of women experience sufficient pain and discomfort to report to healthcare services. Dysmenorrhoea is classified as either primary or secondary, and consideration should be given to a third type, i.e. once-off, at the time of passing an endometrial cast. Primary dysmenorrhoea is predominantly found in young women, is caused by prostaglandin activity, and responds well to oral contraceptive use, as well as nonsteroidal anti-inflammatory drug medication. Secondary dysmenorrhoea, which can occur in any age group, and appears as a consequence of other serious conditions, is the main challenge. The most common other serious conditions include endometriosis, the use of intrauterine contraceptive devices, pelvic infections, uterine adenomyosis, sometimes fibroids, and ovarian cysts. Clearly, these conditions must be considered, diagnosed and treated to resolve the main complaint of dysmenorrhoea.www.tandfonline.com/ojfpam201

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

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

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

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

Qualitative serum organic acid profiles of HIV-infected individuals not on antiretroviral treatment

The first application of gas chromatography mass spectrometry (GC–MS) metabolomics to the analysis of organic acid profiles in sera of asymptomatic human immunodeficiency virus (HIV)-infected individuals (n = 18) compared to uninfected controls (n = 21), is reported here. Several organic acids are well-established diagnostic biomarkers of mitochondrial dysfunction, making the analysis of the organic acid metabolome well suited to monitoring the progressive disruption of mitochondrial structure and function during HIV infection. Using a multifaceted analytical-bioinformatics procedure, at least 10 of these metabolites could be linked to (1) disrupted mitochondrial metabolism, (2) changes in lipid metabolism and (3) oxidative stress, all of which are aberrations caused by HIV infection. Because of the role of the mitochondria in apoptosis, higher levels of this type of cell death in infected (compared to uninfected) individuals was used to support GC–MS data. This study demonstrates that mass spectrometry metabolomics detects biomarkers of mitochondrial dysfunction which could potentially be developed into indicators of HIV infection, perhaps also to monitor disease progression and the response to antiretroviral treatment.The National Research Foundationhttp://www.springerlink.com/content/1573-3882/nf201

Part 2 : Ultrastructural changes of fibrin networks during three phases of pregnancy : a qualitative investigation

INTRODUCTION: Normal pregnancy is characterized by significant alterations in the haemostatic system accompanied by an augmented risk of thrombosis. MATERIALS AND METHODS: The fibrin network ultrastructure of different phases of pregnancy, namely early pregnancy (week 8 – 14), late pregnancy (week 36 – 40) as well as post-partum (week 6 – 8 after birth) were compared to non-pregnant fibrin networks as well as each other to establish whether differences in fibrin network morphology exist during pregnancy. Scanning electron microscopy was employed to analyse fibrin network morphology. RESULTS: The fibrin networks from all phases of pregnancy appeared similar to each other, exhibiting prominent coagulant formation, an increase in the formation of minor, thin fibers, and the presence of granular globules. Al three phases however differ from the typical fibrin network ultrastructure exhibited by the fibrin networks from non-pregnant individuals. The increase in estrogen associated with pregnancy may cause the increase in coagulation factors and ultimately the pro-thrombotic state characteristic of pregnancy. CONCLUSIONS: Since no differences were apparent between the different phases of pregnancy it suggests that activation of the coagulation system commences with pregnancy and this pro-thrombotic state continues till at least 8 weeks after birth. These results may shed light on possible pathological mechanisms employed in the development of abnormal or ailing pregnancy.http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1097-0029hb201