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1.
Eur J Obstet Gynecol Reprod Biol ; 287: 227-231, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37390756

RESUMEN

OBJECTIVES: This prospective randomised control trial aimed to compare outcome measures of vaginal hysterectomy (VH) and laparoscopically-assisted vaginal hysterectomy (LAVH) in obese vs. non-obese women undergoing hysterectomy for benign uterine conditions with a non-prolapsed uterus. The primary objective of the study was to estimate operation time, uterine weight and blood loss amongst obese and non-obese patients undergoing VH and LAVH. The secondary objective was to determine any difference in hospital stay, the need for post-operative analgesia, intra- and immediate post-operative complications, and the rate of conversion to laparotomy for obese vs. non-obese patients undergoing VH and LAVH. STUDY DESIGN: A prospective randomised control study was undertaken in the Department of Obstetrics and Gynaecology of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Women admitted between January 2017 and December 2019 for hysterectomy due to benign conditions, meeting the inclusion criteria set by the unit (vaginally accessible uterus, uterine size ≤ 12 weeks of gestation or ≤ 280gr on ultrasound examination, pathology confined to the uterus) were included in the study. The VH procedures were performed by the residents in training, under the supervision of specialists with large experience in vaginal surgery. All the LAVHs were performed by one surgeon (AC). In addition to the patient characteristics and surgical approach to hysterectomy, operative time, estimated blood loss, uterine weight, length of hospital stay, intra-operative and immediate post-operative complications were also recorded in obese and non-obese patient groups and comparatively analysed. RESULTS: A total of 227 women were included in the study. 151 patients underwent VH and 76 LAVH, upon randomisation on a 2:1 basis, reflecting the habitual proportion of hysterectomy cases in the Urogynaecology and Endoscopy Unit at CMJAH. No significant differences were found in mean shift of pre-operative to post-operative serum haemoglobin, uterine weight, intra- and immediate post-operative complications, and convalescence period when comparing obese and non-obese patients in both the VH and LAVH groups. There was a statistically significant difference in operating time between the two procedures. The LAVHs took longer compared to the VHs to be performed (62.8 ± 9.3 vs. 29.9 ± 6.6 min in non-obese patients, and 62.7 ± 9.8 vs 30.0 ± 6,9 min for obese patients). All VHs and LAVHs were successfully accomplished without major complications. CONCLUSION: VH and LAVH for the non-prolapsed uterus is a feasible and safe alternative for obese patients demonstrating similar perioperative outcome measures as non-obese women undergoing VH and LAVH. Where possible, VH should be preferred to LAVH as it is a safe route of hysterectomy, with operation time being significantly shorter.


Asunto(s)
Histerectomía Vaginal , Laparoscopía , Femenino , Humanos , Histerectomía Vaginal/métodos , Estudios Prospectivos , Laparoscopía/métodos , Sudáfrica , Histerectomía/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento
2.
Clin Appl Thromb Hemost ; 29: 10760296231160748, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36972476

RESUMEN

BACKGROUND: The efficacy and safety of thromboprophylaxis in pregnancy at intermediate to high risk of venous thrombo-embolism (VTE) is an area of ongoing research. AIM: This study aimed to assess thrombosis and bleeding outcomes associated with thromboprophylaxis in women at risk of VTE. METHODS: A cohort of 129 pregnancies, who received thromboprophylaxis for the prevention of VTE, were identified from a specialist obstetric clinic in Johannesburg, South Africa. Intermediate-risk pregnancies, with medical comorbidities or multiple low risks, were managed with fixed low-dose enoxaparin antepartum and for a median (interquartile range) of 4 (4) weeks postpartum. High-risk pregnancies, with a history of previous VTE, were managed with anti-Xa adjusted enoxaparin antepartum and for a median of 6 (0) weeks postpartum. Pregnancy-related VTE was objectively confirmed. Major bleeding, clinically relevant nonmajor bleeding (CRNMB) and minor bleeding were defined according to the International Society on Thrombosis and Hemostasis Scientific Subcommittee. RESULTS: Venous thrombo-embolism occurred antepartum in 1.4% (95% CI: 0.04-7.7) of intermediate and 3.4% (95% CI: 0.4-11.7) of high-risk pregnancies. Bleeding events occurred in 7.1% (95% CI: 2.4-15.9) of intermediate and 8.5% (95% CI: 2.8-18.7) of high-risk pregnancies. Of these bleeding events, 3.1% (95% CI: 1.0-8.0) were classified as major bleeding. On univariate analysis, no independent predictors of bleeding were identified. CONCLUSION: The rates of thrombosis and bleeding in this predominantly African population were consistent with similar studies and can be used to inform pregnant women of the benefits of anticoagulation and the risks of potential bleeding.


Asunto(s)
Embolia , Trombosis , Tromboembolia Venosa , Femenino , Embarazo , Humanos , Anticoagulantes/uso terapéutico , Enoxaparina/efectos adversos , Mujeres Embarazadas , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/tratamiento farmacológico , Estudios Longitudinales , Sudáfrica , Heparina de Bajo-Peso-Molecular/uso terapéutico , Hemorragia/inducido químicamente , Hemorragia/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Embolia/tratamiento farmacológico
3.
S Afr Med J ; 111(4): 315-320, 2021 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-33944763

RESUMEN

BACKGROUND: Workplace bullying and other negative workplace behaviours are problems that need to be addressed across many work settings, including at universities. OBJECTIVES: To examine the prevalence of bullying among academics, and factors associated with bullying, in a faculty of health sciences (FHS) of a South African university. METHODS: All academic staff, except senior managers, were invited to participate by completing a self-administered, web-based questionnaire hosted on REDCap. In adition to sociodemographic information, the survey collected information on bullying, and the factors associated with experiences of workplace bullying. Survey data were exported to Stata 13 for analysis. The data were weighted to take account of the distribution of staff in the FHS. Chi-square tests and a multiple logistic regression model for bullying were utilised. RESULTS: The majority of study participants were white (52%), female (70%) and South African (85%). Bullying in the workplace was experienced by 58% of respondents, of whom 44% experienced bullying more than once, and 64% of participants had witnessed bullying. Being female (adjusted odds ratio (aOR) 1.83; 95% confidence interval (CI) 1.14 - 2.93; p<0.05) and being jointly appointed as both a clinician in a health facility and an academic in the university (aOR 1.73; 95% CI 1.29 - 2.32; p<0.001) increased the odds of experiencing workplace bullying. CONCLUSIONS: A combination of strategies is needed, including clear FHS policies to prevent bullying, training in bullying prevention and critical diversity, and positive practice environments.


Asunto(s)
Centros Médicos Académicos , Acoso Escolar , Docentes Médicos/psicología , Centros Médicos Académicos/estadística & datos numéricos , Adulto , Acoso Escolar/estadística & datos numéricos , Docentes Médicos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Sudáfrica/epidemiología , Encuestas y Cuestionarios , Adulto Joven
4.
Basic Res Cardiol ; 108(4): 366, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23812247

RESUMEN

Peripartum cardiomyopathy (PPCM) is a life-threatening heart disease developing towards the end of pregnancy or in the months following delivery in previously healthy women in terms of cardiac disease. Enhanced oxidative stress and the subsequent cleavage of the nursing hormone Prolactin into an anti-angiogenic 16 kDa subfragment emerged as a potential causal factor of the disease. We established a prospective registry with confirmed PPCM present in 115 patients (mean baseline left ventricular ejection fraction, LVEF: 27 ± 9 %). Follow-up data (6 ± 3 months) showed LVEF improvement in 85 % and full recovery in 47 % while 15 % failed to recover with death in 2 % of patients. A positive family history of cardiomyopathy was present in 16.5 %. Pregnancy-associated hypertension was associated with a better outcome while a baseline LVEF ≤ 25 % was associated with a worse outcome. A high recovery rate (96 %) was observed in patients obtaining combination therapy with beta-blocker, angiotensin-converting enzyme (ACE) inhibitors/angiotensin-receptor-blockers (ARBs) and bromocriptine. Increased serum levels of Cathepsin D, the enzyme that generates 16 kDa Prolactin, miR-146a, a direct target of 16 kDa Prolactin, N-terminal-pro-brain-natriuretic peptide (NT-proBNP) and asymmetric dimethylarginine (ADMA) emerged as biomarkers for PPCM. In conclusion, low baseline LVEF is a predictor for poor outcome while pregnancy-induced hypertensive disorders are associated with a better outcome in this European PPCM cohort. The high recovery rate in this collective is associated with a treatment concept using beta-blockers, ACE inhibitors/ARBs and bromocriptine. Increased levels of Cathepsin D activity, miR-146a and ADMA in serum of PPCM patients support the pathophysiological role of 16 kDa Prolactin for PPCM and may be used as a specific diagnostic marker profile.


Asunto(s)
Cardiomiopatías/tratamiento farmacológico , Cardiomiopatías/fisiopatología , Manejo de la Enfermedad , Periodo Periparto , Fenotipo , Sistema de Registros , Adulto , Antihipertensivos/uso terapéutico , Bromocriptina/uso terapéutico , Cardiomiopatías/epidemiología , Estudios de Cohortes , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Estrés Oxidativo/fisiología , Embarazo , Estudios Prospectivos , Volumen Sistólico/fisiología , Resultado del Tratamiento
5.
Paediatr Int Child Health ; 32(1): 35-42, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22525446

RESUMEN

BACKGROUND: Available tests to diagnose infection in neonates often provide results after 12-24 hours. A bedside test that is reliable will facilitate earlier exclusion or diagnosis of infection. OBJECTIVE: To validate a bedside C-reactive protein (CRP) test against the currently available laboratory CRP test in neonates with suspected sepsis. METHODS: This was a prospective observational study where a bedside CRP was done concurrently with and validated against a laboratory CRP in neonates with suspected sepsis. The sensitivities, specificities and predictive values for the bedside CRP tests were calculated using the laboratory CRPs as the reference test. RESULTS: There were 209 measured CRP-sample pairs. Seventy per cent of these had suspected early-onset neonatal sepsis and 30% had suspected late-onset neonatal sepsis. Twelve per cent had culture-proven sepsis. At the recommended cut-off of 8.0 mg/L for the bedside CRP test, the sensitivity, specificity, positive and negative predictive values were 84%, 80%, 30% and 97%, respectively. Adjusting the cut-off value from 8.0 to 15.0 mg/L improved the specificity to 88%. The sensitivity, specificity and positive and negative predictive values were not different between early-onset and late-onset sepsis. The receiver operating characteristic curve had an area below the curve of 0.84 for the cut-off at 16.2 mg/L on the beside CRP test. CONCLUSIONS: The bedside CRP test may be used as a screening test to aid decisions to either commence or discontinue antibiotics in circumstances where the clinical diagnosis of sepsis is in doubt. By using a cut-off of 16.0 mg/L for the bedside CRP test, the possibility of a false negative result is minimised.


Asunto(s)
Proteína C-Reactiva/análisis , Enfermedades del Recién Nacido/diagnóstico , Sistemas de Atención de Punto , Juego de Reactivos para Diagnóstico , Sepsis/diagnóstico , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/sangre , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , Sepsis/sangre
6.
Clin Appl Thromb Hemost ; 17(3): 264-72, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20460356

RESUMEN

BACKGROUND: Patients with human immunodeficiency virus (HIV) infection on protease inhibitors (PIs) have a heightened risk of arterial thrombosis but little is known about treatment-naive patients. METHODS/RESULTS: Prospective study from South Africa comparing thrombotic profiles of HIV-positive and -negative patients with acute coronary syndrome (ACS). A total of 30 treatment-naive HIV-positive patients with ACS were compared to 30 HIV-negative patients with ACS. Patients with HIV were younger; and besides smoking (73% vs 33%) and low high-density lipoprotein (HDL; 0.8 ± 0.3 vs 1.1 ± 0.4), they had fewer risk factors. Thrombophilia was more common in HIV-positive patients with lower protein C (PC; 82 ± 22 vs 108 ± 20) and higher factor VIII levels (201 ± 87 vs 136 ± 45). Patients with HIV had higher frequencies of anticardiolipin (aCL; 47% vs 10%) and antiprothrombin antibodies (87% vs 21%). CONCLUSION: Treatment-naive HIV-positive patients with ACS are younger, with fewer traditional risk factors but a greater degree of thrombophilia compared with HIV-negative patients.


Asunto(s)
Síndrome Coronario Agudo/sangre , Factor VIII/análisis , Seropositividad para VIH/sangre , Proteína C/análisis , Trombofilia/sangre , Síndrome Coronario Agudo/etiología , Síndrome Coronario Agudo/terapia , Adulto , Factores de Edad , Anciano , Anticuerpos Anticardiolipina/sangre , Población Negra , Femenino , Seropositividad para VIH/complicaciones , Seropositividad para VIH/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Sudáfrica , Trombofilia/etiología , Trombofilia/terapia
7.
J Interv Cardiol ; 23(1): 70-7, 2010 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20015160

RESUMEN

BACKGROUND: HIV patients on protease inhibitors have greater risk of acute coronary syndromes (ACS) but little is known about treatment-naïve patients. METHODS AND RESULTS: Authors conducted a prospective single-center study from Soweto, South Africa, comparing the clinical and angiographic features of treatment-naïve HIV positive and negative patients with ACS. Between March 2004 and February 2008, 30 consecutive treatment-naïve HIV patients with ACS were compared to the next HIV-negative patient as a 1:1 control. HIV patients were younger (43 +/- 7 vs. 54 +/- 13, P = 0.004) and, besides smoking (73% vs. 33%, P = 0.002), had fewer risk factors than the control group with less hypertension (23% vs. 77%, P = 0.0001), diabetes (3% vs. 23%, P = 0.05), LDL hyperlipidemia (2.2 +/- 0.9 vs. 3.0 +/- 1.2, P = 0.006), and other coronary risk factors (7% vs. 53%, P = 0.0001). HDL was lower in the HIV group (0.8 +/- 0.3 vs. 1.1 +/- 0.4, P = 0.001). Atherosclerotic burden was lower in the HIV group with more normal infarct-related arteries (47% vs. 13%, P = 0.005) but a higher degree of large thrombus burden (43% vs. 17%, P = 0.02). Stents were used to a similar degree in HIV and control patients (30% vs. 37%, P = 0.78) with more target lesion revascularization in the HIV group (56% vs. 0%, P = 0.008). CONCLUSION: Treatment-naïve HIV patients with ACS are younger and have fewer traditional risk factors than HIV-negative patients. HIV patients have less atherosclerotic but higher thrombotic burden which may imply a prothrombotic state in the pathogenesis of ACS in these patients.


Asunto(s)
Síndrome Coronario Agudo/epidemiología , Terapia Antirretroviral Altamente Activa , Población Negra , Infecciones por VIH/fisiopatología , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/diagnóstico por imagen , Adulto , Factores de Edad , Fármacos Anti-VIH/uso terapéutico , Estudios de Casos y Controles , LDL-Colesterol , Intervalos de Confianza , Angiografía Coronaria , Diabetes Mellitus , Femenino , Infecciones por VIH/tratamiento farmacológico , VIH-1 , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Estudios Prospectivos , Inhibidores de Proteasas/uso terapéutico , Fumar/efectos adversos , Sudáfrica/epidemiología , Estadística como Asunto , Ultrasonografía
10.
BJOG ; 114(7): 833-7, 2007 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-17567418

RESUMEN

OBJECTIVE: To determine accuracy of clinicians in estimating cervical dilatation during the active phase of labour and how this is affected by clinician experience and obstetric factors. DESIGN: Prospective, cross-sectional, comparative study. SETTING: Chris Hani Baragwanath Hospital labour ward, Johannesburg, South Africa. POPULATION: Women at term in the active phase of labour, with vertex presentations and live fetuses. METHODS: The researcher performed cervical assessment immediately after the clinician on duty. The researcher and clinician were unaware of each other's findings. The researcher, used as the standard, was an experienced obstetric consultant, and the clinicians were hospital consultants and registrars at various levels of training. Accuracy was defined as agreement of the clinician's cervical dilatation estimate with that of the researcher. Multivariate logistic regression analysis was carried out to determine independent predictors of inaccuracy. MAIN OUTCOME MEASURE: Agreement in estimation of cervical dilatation between the researcher and the clinicians. RESULTS: Examinations were performed on 508 women. The researcher and clinicians agreed on the dilatation in 250 instances (49.2%) and differed by 2 cm or more in 56 (11.0%) (kappa = 0.40, 95% CI 0.34-0.45). Accuracy was greater at low (3-4 cm) and high (8-10 cm) dilatations. Reduced accuracy was associated with decreasing clinician experience and with lower stations of fetal head. CONCLUSION: This is the first study to investigate accuracy of cervical assessment in parturient women. Results were similar to those found in studies that used models, with about 90% of estimations accurate to within 1 cm.


Asunto(s)
Competencia Clínica/normas , Primer Periodo del Trabajo de Parto/fisiología , Cuerpo Médico de Hospitales/normas , Adulto , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Variaciones Dependientes del Observador , Embarazo , Estudios Prospectivos
12.
Arch Intern Med ; 161(7): 965-71, 2001 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-11295959

RESUMEN

BACKGROUND: Thiazides are recommended to initiate antihypertensive drug treatment in black subjects. OBJECTIVE: To test the efficacy of this recommendation in a South African black cohort. METHODS: Men and women (N = 409), aged 18 to 70 years, with a mean ambulatory daytime diastolic blood pressure between 90 and 114 mm Hg, were randomized to 13 months of open-label treatment starting with the nifedipine gastrointestinal therapeutic system (30 mg/d, n = 233), sustained-release verapamil hydrochloride (240 mg/d, n = 58), hydrochlorothiazide (12.5 mg/d, n = 58), or enalapril maleate (10 mg/d, n = 60). If the target of reducing daytime diastolic blood pressure below 90 mm Hg was not attained, the first-line drugs were titrated up and after 2 months other medications were added to the regimen. RESULTS: While receiving monotherapy (2 months, n = 366), the patients' systolic and diastolic decreases in daytime blood pressure averaged 22/14 mm Hg for nifedipine, 17/11 mm Hg for verapamil, 12/8 mm Hg for hydrochlorothiazide, and 5/3 mm Hg for enalapril. At 2 months the blood pressure of more patients treated with nifedipine was controlled: 133 (63.3%, P

Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/clasificación , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/clasificación , Antihipertensivos/uso terapéutico , Población Negra , Bloqueadores de los Canales de Calcio/clasificación , Bloqueadores de los Canales de Calcio/uso terapéutico , Enalapril/clasificación , Enalapril/uso terapéutico , Hidroclorotiazida/clasificación , Hidroclorotiazida/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipertensión/genética , Nifedipino/clasificación , Nifedipino/uso terapéutico , Inhibidores de los Simportadores del Cloruro de Sodio/clasificación , Inhibidores de los Simportadores del Cloruro de Sodio/uso terapéutico , Vasodilatadores/clasificación , Vasodilatadores/uso terapéutico , Verapamilo/clasificación , Verapamilo/uso terapéutico , Adolescente , Adulto , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Antihipertensivos/farmacología , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/farmacología , Diástole/efectos de los fármacos , Diuréticos , Quimioterapia Combinada , Enalapril/farmacología , Femenino , Humanos , Hidroclorotiazida/farmacología , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/patología , Hipertrofia Ventricular Izquierda/prevención & control , Masculino , Persona de Mediana Edad , Nifedipino/farmacología , Guías de Práctica Clínica como Asunto , Modelos de Riesgos Proporcionales , Inhibidores de los Simportadores del Cloruro de Sodio/farmacología , Sudáfrica , Factores de Tiempo , Resultado del Tratamiento , Vasodilatadores/farmacología , Verapamilo/farmacología
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