A descriptive study of uterine artery embolisation for leiomyoma in an African population in a low-resource setting

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Obstetrics and Gynaecology MBBCh (Wits) Date: 22 September 2015Introduction Uterine leiomyomas are the commonest benign tumours in women of reproductive age. Fibroids have a significant impact on the woman’s quality of life as well as her fertility. Women who have symptomatic fibroids can present with abnormal uterine bleeding, pressure symptoms, pain, infertility, miscarriage or pregnancy complications. This necessitates treatment. There are many available options, apart from medical and surgical management, such as uterine artery embolisation. This alternative to surgical treatment in an African population, who have a higher risk of fibroids, within a low resource setting is assessed in this study. Uterine artery embolisation (UAE), is an interventional radiologic procedure that has developed over the last 10 years and is gaining popularity. It involves occlusion of the uterine arteries thereby decreasing the blood supply to the fibroid, thus improving symptoms in patients. The complications and outcomes of this procedure was assessed. Objectives and Methods The four objectives in this study were 1. To describe the demographics of the women who have attended the Uterine Artery Embolisation clinic from January 2004 till December 2011. 2. To describe the presenting complaints of the women attending Uterine Artery Embolisation clinic. 3. To quantify the response of the fibroid to Uterine Artery Embolisation in terms of size. 4. To document complications and outcomes associated with the procedure. There were 100 women in the study sample ultimately who had UAE done after specific inclusion and exclusion criteria were met. The procedure was performed by interventional radiologists. This was a longitudinal descriptive study where the data was collected retrospectively. Results The mean age of women in this study was 34.5 years. Thirty four women (46%) had never conceived. The mean gravidity was 1 but 57 women (70%) were nulliparous. Pain was the most common symptom experienced, followed by menorrhagia. Fibroids were located intramurally in 94% of cases. Most patients experienced overall symptomatic relief at follow-up visits. The commonest complication immediately post-UAE was pain. Post-embolisation syndrome occurred in 24% of women. At follow-up visits PV discharge, pain and bleeding were complications present. Incidental outcomes which could be defined as adverse events were assessed post-UAE procedure in a total of 24 patients over the 5 follow-up visits, although the questionnaire applied to all the women who underwent UAE. Two patients were discharged (8%), 8 patients became amenorrhoeic (33%) and 5 patients became pregnant (21%). Three patients were referred for hysterectomy (13%) and 5 patients for myomectomy (21%). The mean height of fundus (HOF) at presentation of women in this study was 17.8cm and the final mean HOF after UAE was 12.5cm. There was a 5.3cm difference in the mean height of fundus after treatment which was statistically significant. The mean area of the dominant fibroid at initial presentation was 109.8cm2 and at final visit was 71.9cm2. There was a mean area difference of 40.0cm2, this was also statistically significant. Conclusion Symptomatic fibroids occur more commonly in younger African women with more severe symptoms, that impact on quality of life and have a high disease burden, yet conservative treatment that preserves the uterus is a sought after alternative. UAE provides a safe and effective alternative to invasive surgery. After the results shown in this study, patients, gynaecologists and interventional radiologists should be encouraged to use UAE as a modality for the conservative management of fibroids in suitable candidates.MT201

Raynaud's of the tongue

We describe a 40-year-old lady who presents with a painful white tongue on exposure to the cold. The differential diagnosis and investigations are outlined with a discussion about this unusual presentation of a common problem

The “Recursive Cosmosis” Model: South African Women in Higher Education Finding Strength and Resilience

This study investigates how the concepts sense of coherence and spirituality are inter-related and contribute to the health and wellbeing of 13 women working in South African higher education institutions. Drawing from Antonovsky’s work on salutogenesis data are analyzed in terms of three sub-components, namely, manageability, comprehensibility, and meaningfulness. Interview data on manageability point to an action component where the pursuit of work-life balance is uniquely experienced by women, not only as a challenge, but is also actively pursued as a strength resource. On comprehensibility, the data captured women’s attitudes in terms of being realistic and understanding of others and of the work context. The data show that women rely most on meaningfulness as a coping resource wheather they are speaking of their life orientation (SOC) or their spiritual orientation. Spirituality in this study is connected foremost to transpersonality. A connection between women’s spirituality and their sense of coherence, is made by positing that combined, they serve as a coping and wellbeing resource in the work place. A “recursive cosmosis model” is then offered to illustrate the key salutogenic and spiritual strength resources used by women leaders in this study

The accommodation of the Islamic law institution of Takaful under the South African insurance law

With the rapid development of the Islamic banking and finance in South Africa, the legal regime of South Africa, must be able to progress at the same rate of development. The recognition of a foreign legal system such as Islamic law in South Africa is challenging and difficult. South Africa, has an interest based insurance legislative framework and this is not aligned with the principles of the Islamic financial system. As a result of this, regulators have taken various measures to develop and promote the Islamic Industry. The amendment to the South African Tax legislation has created an equitable and level playing field for Islamic law. The South African government also has a further obligation which is to develop a legislative framework to govern Islamic law, as well as to enhance the regulatory and supervisory framework. The study of the development of the Islamic legal regime is an important area that aids legal practitioners in identifying and resolving legal disputes. The purpose of this paper is to examine the accommodation of the Islamic law of Takaful under the South African Insurance legal framework.Public, Constitutional and International LawLL. M. (Public, Constitutional and International Law

'Juggling the glass balls ...': Workplace spirituality in women leaders

This qualitative study explored workplace spirituality in women leadership in higher education institutions (HEIs). Interviews were conducted with women leaders of the Higher Education Research Service network across eight institutions. Observations were made in one organisation. Findings show that women leaders are highly aware of their spirituality and religious affiliation which influence their work and work spirituality. Workplace spirituality includes how women leaders approach life and work, how spirituality expands their concept of religion and how the interwoven concepts of spirituality and religion help them to manage their work optimally. The study was limited to a relatively small sample size of 23 women leaders and was further bound to the qualitative research methodology. This study provides valuable insights into workplace spirituality regarding women leaders in South African HEIs. The findings provide a base for future research on women leaders in organisations and for leadership training of women within HEIs.

The Leadership Preferences of Women Leaders Working in Higher Education

The purpose of this study was to explore the emic concepts and self-perceptions of leadership of women working in South African Higher Education institutions (HEIs). The study uses a phenomenological-hermeneutical research approach and qualitative methods to analyse twenty-three semi-structured interviews and data from observations in organizations. Findings show that women in HEIs in South Africa prefer associating leadership with certain characteristics which correspond to their core values of human existence. These core values are seen to influence the actions of women in leadership positions in HEIs. Based on their self-perceptions, women leaders use mindfulness which is characterized by various self-competencies, defined attitudes, spirituality at work and certain management practices. However, women leaders also feel that their mindful practices seem to be misunderstood in a highly competitive HEI environment in South Africa

Women Leaders as Containers: Systems Psychodynamic Insights into their Unconscious Roles

The purpose of this article is to explore the self-defined roles of women leaders working in higher education institutions (HEIs) in South Africa. The aim is to explore women leadership roles in the context of systems psychodynamics to increase the understanding of unconscious dynamics in HEIs from the perspective of women leaders. The article reports on a qualitative study based on the research paradigm of Dilthey's modern hermeneutics. Interviews were conducted with 23 women leaders from the HERS-SA (Higher Education Research Services) network across eight institutions. Observations were made in one organization to support the data analysis and interpretation. Data was analysed through content analysis. Women leaders are containers of anxieties in South African HEIs, while they also act out defense mechanisms, such as splitting, projection, projective identification, introjection, idealization, simplification and rationalization. Splitting seems to be one important defense mechanism in terms of mother/professional, mother/daughter, women/men leaders and White/Black women leaders. Women leaders further seem to have introjected the roles of their mothers and female family members from their past and childhood. They do not seem to embrace the full authority and agency of their leadership positions, and they explore their own difficulties and negative emotions in others through projective identification. The findings create awareness of the roles of women leaders, strengthen women leadership and emphasise the need for leadership training taking the systems psychodynamic perspective into account

Women Leaders as Containers: Systems Psychodynamic Insights into their Unconscious Roles

The purpose of this article is to explore the self-defined roles of women leaders working in higher education institutions (HEIs) in South Africa. The aim is to explore women leadership roles in the context of systems psychodynamics to increase the understanding of unconscious dynamics in HEIs from the perspective of women leaders. The article reports on a qualitative study based on the research paradigm of Dilthey's modern hermeneutics. Interviews were conducted with 23 women leaders from the HERS-SA (Higher Education Research Services) network across eight institutions. Observations were made in one organization to support the data analysis and interpretation. Data was analysed through content analysis. Women leaders are containers of anxieties in South African HEIs, while they also act out defense mechanisms, such as splitting, projection, projective identification, introjection, idealization, simplification and rationalization. Splitting seems to be one important defense mechanism in terms of mother/professional, mother/daughter, women/men leaders and White/Black women leaders. Women leaders further seem to have introjected the roles of their mothers and female family members from their past and childhood. They do not seem to embrace the full authority and agency of their leadership positions, and they explore their own difficulties and negative emotions in others through projective identification. The findings create awareness of the roles of women leaders, strengthen women leadership and emphasise the need for leadership training taking the systems psychodynamic perspective into account

At the edge of the Fourth Industrial Revolution: Employees’ perceptions of employment equity from a CIBART perspective

Abstract: Orientation: In accordance with global trends, South Africa is striving for the Fourth Industrial Revolution (4IR). Discourses of employees’ employment equity (EE) perceptions within the 4IR context are studied 25 years after apartheid. Research purpose: The purpose of the study was to understand the systems psychodynamics underneath the surface of employees’ perceptions of EE in South Africa within the context of the 4IR. Motivation for the study: South African workplaces are debated nationally and urged to compete with 4IR changes on a global level. This research focuses on employees’ perceptions of EE underneath the surface and aims at understanding employees’ perceptions through the conflict, identity, boundaries, authority, roles, task (CIBART) model..