Medicolegal, infrastructural, and financial aspects in gynecologic cancer surgery and their implications in decision making processes: Quo Vadis?

Surgical decision making is complex and involves a combination of analytic, intuitive, and cognitive processes. Medicolegal, infrastructural, and financial factors may influence these processes depending on the context and setting, but to what extent can they influence surgical decision making in gynecologic oncology? This scoping review evaluates existing literature related to medicolegal, infrastructural, and financial aspects of gynecologic cancer surgery and their implications in surgical decision making. Our objective was to summarize the findings and limitations of published research, identify gaps in the literature, and make recommendations for future research to inform policy.

Neonatal infection in Sub-Saharan Africa: a cross-sectional pilot study on bacterial pathogens and maternal risk factors.

Introduction: Although child morbidity and mortality could be reduced in Sub-Saharan Africa during the last years both remain high. Since neonatal infections play a major role, we conducted a cross-sectional pilot study in the lake region of Western Tanzania in order to analyze not only the prevalence of neonatal infection with its bacterial etiology including antimicrobial resistance pattern but also to detect potential maternal risk factors. Methods: We screened 156 women for potential risk factors and examined their neonates for clinical signs of an infection including microbiological verification. All women were interviewed for medical history and their socio-economic background. High-vaginal swabs (HVS) of pregnant women and blood cultures of sick infants were investigated for bacterial pathogens using culture followed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) or polymerase-chain-reaction (PCR)-based assays. Antimicrobial resistances were determined using a disk diffusion test and verified by VITEK 2. Maternal malaria, blood glucose, and hemoglobin levels were determined by rapid tests and helminth infections by stool microscopy. Results and discussion: Our results showed a prevalence of 22% for neonatal infections. In total, 57% of them had culture-positive bloodstream infections with Gram-negative bacteria being the most prevalent. All these expressed resistance against ampicillin. The prevalence of maternal infection with helminths or Plasmodium was low, indicating that anti-worming strategies and intermittent preventive treatment of malaria for pregnant women (IPTp) are effective. The study identified maternal urinary tract infection (UTI) and an elevated blood glucose level as potential maternal risk factors for early neonatal infection, an elevated blood glucose level, and maternal anemia for a late-onset infection. Conclusion: Our study, therefore, indicates that monitoring maternal UTI in the last trimester as well as levels of maternal hemoglobin and blood glucose might be important to predict and eventually manage neonatal infections. As Gram-negative bacteria with resistance to ampicillin were most prevalent in culture-proven neonatal sepsis, WHO recommendations for calculated antibiosis in the sick young infant should be discussed.

Treponema pallidum infection among women with macerated stillbirth in Mwanza Tanzania: an underestimated tragedy in Tanzania.

Background: Treponema pallidum is one of the commonest cause of stillbirths world-wide. This study investigated the magnitude of T. pallidum among women with macerated stillbirth in Mwanza, Tanzania. Methods: A cross-sectional study involving 301 women with macerated stillbirths attending selected health facilities in the region of Mwanza was conducted between October-2017 and March-2018. Detection of T. pallidum was done using venereal diseases research laboratory (VDRL) and T. pallidum hemagglutination test (TPHA). Data were analyzed by the STATA version 13. Results: The median age of the enrolled women was 27 (IQR: 22 - 34) years. Eighteen (6.0%, 95% CI: 3.0-8.0) of women were T. pallidum seropositive. Seropositivity of T. pallidum was significantly higher among women residing in rural areas than urban areas (p=0.010), and among HIV seropositive than HIV seronegative women (p=0.036). By multivariable regression analysis, the odds of being T. pallidum seropositive were significantly high among women with positive HIV serostatus (OR: 3.9, 95% CI: 1.2-14.1, p=0.036) and those residing in rural areas (OR: 5.6, 95% CI: 1.5-20.3, p=0.010). Conclusion: Seropositivity of T. pallidum is higher among women with macerated stillbirth than in normal pregnant women as previously reported which calls for the need to improve screening services in rural areas of Tanzania.