Umbilical artery Doppler velocimetry in the prediction of intrapartum fetal compromise

CITATION: Howarth, G. R. et al. 1992. Umbilical artery Doppler velocimetry in the prediction of intrapartum fetal compromise. South African Medical Journal, 81:248-250.The original publication is available at http://www.samj.org.zaThe value of early intrapartum umbilical artery Doppler velocimetry in the prediction of fetal compromise was studied. One hundred patients were recruited into the study and fetal compromise was diagnosed by abnormal first- or second-stage fetal heart rate traces, a 5-minute Apgar score less than 7, or the development of hypoxic ischaemic encephalopathy. Fetal compromise developed in 30 patients. An umbilical artery resistance index (RI) of 0,66 or less did not predict fetal compromise (sensitivity 13%, specificity 89%, positive predictive value 25%, negative predictive value 70%). Since the mean umbilical artery RI was identical in the compromised and the noncompromised groups, we conclude that early intrapartum Doppler velocimetry is of very little clinical value in predicting fetal compromise at term.Publisher’s versio

Management of incomplete abortions at South African public hospitals

Objective. The objective of this report was to review and describe the management of incomplete abortion by public sector hospitals.Design. A descriptive study in which data were collected prospectively from routine hospital records on all women admitted with incomplete abortion to a stratified random sample of hospitals between 14 and 28 September 1994.Setting. Public sector hospitals in South Africa.Patients. Women with incomplete abortions.Main outcome measures. Length of hospital stay, details of medical management, details of surgical management, determinants of the above.Main results. Data were collected on 803 patients from the 56 participating hospitals. Of these, 767 (95.9%) were in hospital for 1 day or more, and 753 (95.3%) women underwent evacuation of the uterus. Sharp curettage wasthe method employed in 726 (96.9%) and general anaesthesia was used for 601 (88%) of the women requiring uterine evacuation. Antibiotics were prescribed for 396 (49.5%) and blood transfusions were administered to 125 (17%) women. Statistical analysis showed length of stay to be longer in small hospitals (under 500 beds) and when the medical condition was more severe. Antibiotic  usage and blood transfusion were more common with increasing severity and a low haemoglobin level on admission. However, some inappropriate management was identified with regard to both.Main conclusions. It is suggested that uncomplicated incomplete abortion can be more effectively and safely managed using the manual vacuum aspiration technique with sedation/analgesia as an outpatient procedure. Attention should be directed at the introduction of this management routine at all types of hospital and to the ensuring of appropriate management of women with complicated abortion

Helicobacter pylori prevalence in non-ulcer dyspepsia ethnic and socio-economic differences

Helicobacter pylori is an important cause of gastritis and a number of therapeutic. trials suggest that it may be important in the genesis of duodenal ulcer recurrence. The reported prevalence of gastric colonisation by the organism varies considerably. The aiIn of this cross-sectional survey was to determine its prevalence in non-ulcer dyspeptics and to determine whether this is influenced by age, race, sex, socio-economic status, educational level and the nwnber of persons sharing accommodation. One hundred and sixty-nine patients underwent endoscopy; biopsy speciInens were taken from the antrwn and H. pylori status was determined histologically. Gastric colonisation was found in 106 patients (63%). The prevalence showed a marked ethnic difference: 40% in whites and 71% in coloureds (P < 0,001). The ethnic groups were characterised by significant differences in socio-economic status (P < 10-6), educational level (P < 10-6), number of persons sharing accommodation (P < 10-6 ) and age (P < 0,001). These same differences were found when comparing the H. pylori-positive and negative groups, but were less marked and could be attributed to the marked differences between ethnic groups. We conclude that H. pylori prevalence differs between the ethnic groups studied. This may be because of varying degrees of exposure risk

A case control study of breast cancer risk and exposure to injectable progestogen contraceptives

No Abstract

Exposure impacts of environmentally relevant concentrations of a glufosinate ammonium herbicide formulation on larval development and thyroid histology of Xenopus laevis

Thyroid hormones play critical roles in body growth and development as well as reproduction. They also influence the activities of a wider variety of tissues and biological functions, such as osmoregulation, metabolism, and especially metamorphosis in organisms, such as frogs. These complex activities of thyroid hormones are prone to disruption by agricultural pesticides, often leading to modulation of growth and the reproductive system in particular. These substances include Glufosinate ammonium, Glyphosates, Imazapyr, Penoxsulam, and Diquat dibromide among other herbicides. In this study, the standardized Xenopus Metamorphosis Assay protocol was used to assess the potential thyroid-modulatory properties of the Glufosinate ammonium Basta formulation, at relevant environmental concentrations (0.05 mg/L, 0.15 mg/L, and 0.25 mg/L) for 21 days. The results showed that this formulation only reduced the hind-limb length among the morphological endpoints. Histological evaluation showed that the mean thyroid gland area and the mean thyroidal follicle epithelium height were significantly increased following 0.15 and 0.25 mg/L exposures. The present study confirmed that this Basta formulation interacts with the thyroid axis and therefore potentially pose health hazard to amphibian in particular and potentially metamorphic aquatic vertebrates. Furthermore, the result is a signal of inherent potential thyroid disrupting activities that must be further investigated and characterised in some of the aquatic herbicide formulations to safeguard the aquatic biodiversity.Appendix : Table 2 The Gas chromatography analytical results with very low variations compared to the predicted nominal concentrations). The limit of detection was 0.05 μg/L.The Water Research Commission, South Africa and the Working for Water Department, Ministry of Water Affairs, South Africa.http://link.springer.com/journal/244hj2022Paraclinical Science

Risk factors for coronary heart disease in the black population of the Cape Peninsula The BRISK study

A cross-sectional study of risk factors for ischaemic heart disease (IHO) in a random sample of 986 black people aged 15 - 64 years living in the Cape Peninsula revealed a population at lower risk for IHO than other South Africans. Blood pressures of 140/95 mmHg or above were found in 14,4% of males and 13,7% of females. Fifty-two per cent of males and 8,4% of females smoked, while 16,5% of males and 25,8% of females had a total cholesterol (TC) level imparting risk for developing IHO. In this population the TC level is not a good surrogate measure for low-density lipoprotein cholesterol because of the high level of high-density lipoprotein cholesterol (HOLC) found in this population. A protective HOLC/TC ratio of 20% was found in 96% of males and 96,1% of females. When considering the three major reversible IHO risk factors at a high level of risk, 30,8% of males and 12,5% of females had at least one such a risk factor. The population was frequently exposed to the media, with 80% listening to the radio every day and 55% watching television at least once a week. This suggests that a healthy lifestyle could be promoted successfully by means of these media. In addition, schools should promote a healthy lifestyle and the prevention of chronic degenerative diseases should be incorporated into the evolving primary health care services in South Africa

Prevalence of drug-drug interactions of antiretroviral agents in the private health care sector in South Africa

Objectives. Human immunodefiency virus (HIV) infection can be effectively treated with highly active antiretroviral therapy (HAART), requiring concomitant administration of three to four different agents, often with a high potential for drug-drug interactions (DDIs). This study aimed to determine the prevalence of possible DDIs between antiretrovirals (ARVs) themselves and other drugs. Design. Retrospective drug-utilisation study using data from from a national medicine claims database for the period 1 January to 31 December 2004. Setting. A section of the private healthcare sector in South Africa. Subjects. All ARV prescriptions (N=43482) claimed during 2004. The possible DDIs found were classified according to a clinical significant rating as described by Tatro7 (2005) in his book, “Drug Interactions – Facts and comparisons.” Results. A total of 5305882 medicine items were prescribed, of these, 1.92% (N=101 938) accounted for ARVs. Of the total number of 2595254 prescriptions, 1.68% (N=43 482), were ARVs. A total number of 18035 DDIs (81 different types) were identified, of these, 83.89%, (n=15130) were DDIs between ARVs and other drugs, while 16.11% (n=2905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major, n=17) and 2 (moderate, n=1436) represented 8.06% (n=1 453) of the total number of identified interactions. Conclusions. Since concomitant use of ARVs and other drugs used to treat HIV complications is increasing, there is a great need of understanding and anticipating these DDIs, overcoming them by dose adjustments and patient education by pharmacists, so that they are not life threatening to HIV/AIDS patients

Principles for transformative ocean governance

With a focus on oceans, we collaborated across ecological, social and legal disciplines to respond to the United Nations call for transformation in the ‘2030 Agenda for Sustainable Development’. We developed a set of 13 principles that strategically and critically connect transformative ocean research to transformative ocean governance (complementing the UN Decade for Ocean Science). We used a rigorous, iterative and transparent consensus-building approach to define the principles, which can interact in supporting, neutral or sometimes conflicting ways. We recommend that the principles could be applied as a comprehensive set and discuss how to learn from their interactions, particularly those that reveal hidden tensions. The principles can bring and keep together partnerships for innovative ocean action. This action must respond to the many calls to reform current ocean-use practices which are based on economic growth models that have perpetuated inequities and fuelled conflict and environmental decline