Frost damage and restoration of limestone domes and spheres in a heritage building

B

Influence of vitamin K antagonist treatment on activated partial thromboplastin time

A

'Failed' contraception in a rural South African population

Objective. To investigate whether the free availability of contraception affects the need for termination of pregnancy (TOP).Design. Case-control study.Setting. South African rural hospitaLPopulation. Three thousand and ninety-five TOP seekers and 439 non-pregnant controls.Methods. Structured questionnaire followed by ultrasonography.Main outcome measures. Current use or recent discontinuation of contraception and the reason for discontinuation.Results. Less than one-third (28.6%) of TOP seekers claimed to be using contraception versus 85.0% of controls. Injectable contraception (IC)was preferred by the controls and oral contraception (OC) by TOP seekers (x2 = 48.5, p < 0.0001, OR 0.34 (95% confidence interval 0.25, 0.46)). The percentage of discontinuation of hormonal contraception was higher in controls (x2 = 6.3, p = 0.012, OR 0.51 (0.31, 0.85)). The reason for discontinuation of hormonal contraception was obtained from 31.2% of TOP seekers and 63.3% of controls; no reason for discontinuation was acknowledged by 30.1% of the former and 6.3% of the latter (x2 = 33.4, p < 0.0001, OR 6.40 (3.25, 12.56)). Side-effects of hormonal contraception prompted more discontinuation in the failed-contraception group (x2 = 120.5, p < 0.0001, OR 49.4 (21.6, 112.5)). Poor compliance and absence of an acknowledged reason for discontinuing hormonal contraception  resulted in 173 unwanted pregnancies.                                                                                                                                      Conclusion. In South Africa two main components of women's reproductive health and rights are freely available, namely contraception and TOP. Not using contraception is one of the main causes of unwanted pregnancy. Better education of both service providers and users is needed to improve use, compliance and perseverance with contraception

Does the knowledge of the human immunodeficiency virus serostatus influence the clinical diagnostic proficiency of Kaposi’s sarcoma?

Objectives: Kaposi’s sarcoma is an acquired immunodeficiency syndrome (AIDS)-defining illness. A spectrum of non- Kaposi’s sarcoma clinical and histopathological mimickers contributes to the potential over- or underdiagnosis of Kaposi’s sarcoma. The aim of this audit was to investigate the clinical diagnostic accuracy of Kaposi’s sarcoma and to find out whether or not knowledge of the human immunodeficiency virus (HIV) serostatus influenced the clinical diagnostic accuracy.Design: Cross-sectional study of 511 mucocutaneous biopsies.Settings and subjects: All the biopsies were from African patients from the Limpopo province. The HIV seropositive status was known in 327 cases (64.2%). The clinical diagnosis, provided in 369 cases (72.2%) was compared with the biopsy. A Kaposi’s sarcoma herpesvirus-positive immunophenotype on biopsy served as the diagnostic gold standard.Outcome measure: Concordance or discordance between the clinical provisional diagnosis and the histopathological gold standard.Results: The rate of provisional clinical diagnosis of non- Kaposi’s sarcoma in biopsy-proven Kaposi’s sarcoma was 18.1% in HIV-positive, and 39.5% in HIV unknown, serostatus (chi-square 11.8, p-value = 0.0006). The concordance between the clinical diagnosis and biopsy was 76.5% in the HIV-positive, and 49.9% in the HIV-unknown, cases (chi-square 16.9, p-value < 0.0001).Conclusion: Knowledge of the patient’s serostatus significantly improved the clinical diagnostic accuracy of Kaposi’s sarcoma. Biopsy remains the diagnostic gold standard.Keywords: Kaposi’s sarcoma, mimics, clinical diagnosis, HI