Gynaecological cancer-related deaths in a tertiary hospital: A four-year retrospective review.

The aim of this study is to describe the profile, causes of death, and associated complications among women who died with a diagnosis of gynecological cancer during a four-year period in a gynae oncology unit in a tertiary hospital. The study is based on a retrospective review of clinical records of patients. There were 368 gynecological cancer admissions during the study period and 51 gynecological cancer-related deaths (13.8%); however, only 48 (13%) of the 51 files were available for analysis. The mean age of the women who died was 52.7 years (SD ±16.92). Most of the women who died were South African citizens (41, 85%), black (44, 91.7%) and unemployed (37, 77.1%). The most common comorbidities were hypertension and HIV which occurred at similar frequencies (20, 41.7%), followed by diabetes mellitus (7, 14,6%). The three most common cancers were cervical (18, 37.5%), ovarian (13, 27.1%), and endometrial (12, 25,0%). All women who died (48, 100%) had some form of cancer-related complications on admission to the hospital. The most common complication at presentation was obstructive uropathy (16, 31.3%) followed by ascites (11, 21.6%) and pleural effusion (8, 15.8%). Just less than half of the patients (22, 45.8%) received palliative treatment due to advanced-stage disease, and the remainder, (20, 41.6%) and (5, 10.4%) surgical and radiation therapy, respectively. The surgical procedure performed was staging laparotomy for ovarian and endometrial cancer (19, 95%) and radical hysterectomy and lymph node dissection for operatable cervical cancer (01, 5%). Forty-nine complications were recorded among the 20 women who underwent surgical treatment. The most common complications were sepsis and hemorrhage followed by organ injury.

Le but de cette étude est de décrire le profil, les causes de décès et les complications associées chez les femmes décédées avec un diagnostic de cancer gynécologique au cours d'une période de quatre ans dans une unité de gynécologie-oncologie d'un hôpital tertiaire. L'étude est basée sur une revue rétrospective des dossiers cliniques des patients. Il y a eu 368 admissions pour cancer décès liés au cancer gynécologique 51 décès d'origine gynécologique (13,8 %) ; cependant, seulement 48 (13 %) des 51 dossiers étaient disponibles pour analyse. L'âge moyen des femmes décédées était de 52,7 ans (ET ± 16,92). La plupart des femmes décédées étaient des citoyennes sud-africaines (41, 85 %), noires (44, 91,7 %) et au chômage (37, 77,1 %). Les comorbidités les plus courantes étaient l'hypertension et le VIH, qui survenaient à des fréquences similaires (20, 41,7 %), suivis du diabète sucré (7, 14,6 %). Les trois cancers les plus courants étaient le cancer du col de l'utérus (18, 37,5 %), de l'ovaire (13, 27,1 %) et de l'endomètre (12, 25,0 %). Toutes les femmes décédées (48, 100 %) ont présenté une forme ou une autre de complications liées au cancer lors de leur admission à l'hôpital. La complication la plus fréquente lors de la présentation était l'uropathie obstructive (16, 31,3 %), suivie de l'ascite (11, 21,6 %) et de l'épanchement pleural (8, 15,8 %). Un peu moins de la moitié des patients (22, 45,8 %) ont reçu un traitement palliatif en raison d'un stade avancé de la maladie, et le reste (20, 41,6 %) et (5, 10,4 %), une chirurgie et une radiothérapie, respectivement. L'intervention chirurgicale réalisée était une laparotomie de stadification pour un cancer de l'ovaire et de l'endomètre (19, 95 %) et une hystérectomie radicale et un curage ganglionnaire pour un cancer du col de l'utérus opérable (01, 5 %). Quarante-neuf complications ont été enregistrées parmi les 20 femmes ayant bénéficié d'un traitement chirurgical. Les complications les plus courantes étaient la septicémie et l'hémorragie, suivies de lésions organiques.

Diagnosis and management of a pelvic solitary fibrous tumor in a postmenopausal woman - a case report.

Background: Solitary fibrous tumors, previously known as hemangiopericytomas, originate from mesenchymal tissue and can occur at many body sites, such as the thorax, head and neck, retroperitoneal space and abdomen. These tumors are generally rare and pelvic location is extremely uncommon. Consequently, pelvic solitary tumors could be mistaken for ovarian cancer in menopausal women. This report presents a case of pelvic solitary tumor to highlight the importance of considering this diagnosis in a postmenopausal woman presenting with a solid pelvic mass, normal tumor markers and no ascites. Case: A 54-year-old woman presented with amenorrhea, abdominal pain, constipation, nausea, vomiting, and frequency of urination. On examination she had a pelvic mass of approximately 20-24 weeks in size. Ultrasound and computed tomography imaging showed a well-defined, round, centrally hypodense, irregular thick and peripheral, enhancing solid mass originating from the left ovary. Carcinoembryonic antigen, carbohydrate antigen-125, and carcinoembryonic antigen 19-9 were all normal. Intraoperatively the tumor was attached to the peritoneum and mesentery. Part of the large bowel, including the sigmoid colon, were attached to it. The exact origin of the tumor could not be ascertained during surgery. The tumor was successfully excised, and specimen sent for histology and immunochemistry analysis. The definitive diagnosis was confirmed with immunochemistry. The patient had an uneventful postsurgical course and was discharged on day 4 after surgery for routine gynecological follow-up. Conclusion: Solitary fibrous tumor is very rare; however, the diagnosis should be considered in a postmenopausal woman with solid pelvic mass, normal tumor markers and no ascites.

An audit of adherence to cervical cancer screening guidelines in a tertiary-level HIV clinic.

Background: Cervical cancer is the most common malignancy affecting South African women aged 15-44 years, with a higher prevalence among women living with HIV (WLWH). Despite recommendations for a screening target of 70%, the reported rate of cervical cancer screening in South Africa is 19.3%. Objectives: To investigate the adherence of healthcare workers to cervical cancer screening guidelines in a tertiary-level HIV clinic. Method: A retrospective cross-sectional record audit of women attending the Charlotte Maxeke Johannesburg Academic Hospital HIV Clinic over a 1-month period. Results: Out of 403 WLWH who attended the clinic, 180 (44.7%) were screened for cervical cancer in the 3 years prior to the index consultation. Only 115 (51.6%) of those women with no record of prior screening were subsequently referred for screening. Women who had undergone screening in the previous 3 years were significantly older (47 years vs 44 years, P = 0.046) and had a longer time since diagnosis of their HIV (12 years vs 10 years, P = 0.001) compared to women who had not undergone screening. There was no significant difference in CD4 count or viral suppression between women who had and had not undergone screening. Conclusion: The rate of cervical cancer screening in our institution is below that recommended by the World Health Organization and the South African National Department of Health.

Trends and Determinants of Operative Vaginal Delivery at Two Academic Hospitals in Johannesburg, South Africa 2005-2019.

Operative Vaginal delivery (OVD) can reduce perinatal and maternal morbidity and mortality especially in low resource setting such as South Africa. We evaluated the trends and determinants of OVD rates using join point regression at Charlotte Maxeke Johannesburg (CMJAH) and Chris Hani Baragwaneth (CHBAH) Academic Hospitals from 1 January 2005−31 December 2019 and conducted a comparative study of OVD (n = 179) and normal delivery (n = 179). Over the 15-year study period (2005−2019), 323,617 deliveries and 4391 OVDs were conducted at CHBAH giving an OVD rate of 1.36 per 100 births. In CMJAH, 74,485 deliveries and 1191 OVDs were conducted over an eleven-year period (2009−2019) with OVD rate of 1.60 per 100 births. OVD rate at CHBAH increased from 2005−2014 at 9.1% per annum and declined by 13.6% from 2014−2019, while OVD rates fluctuates at CMJAH. Of the 179 patients who had OVD, majority (n = 166,92.74%) had vacuum. Women who had OVDs were younger than those who vaginal delivery (p-value < 0.001). The prevalence of OVDs was higher among nulliparous women (p-value < 0.001), HIV negative women (p-value = 0.021), underweight (p-value < 0.001) as compared to normal delivery. The OVD rates has dramatically reduced over the study period This study heightens the need to further evaluate barriers to OVD use in our environment

The Understanding and Perception of the Menstrual Cup Among Medical Students.

Background: Menstruation and menstrual health management remains a challenge worldwide, largely owing to gender inequality, social and cultural stigma, inaccessibility, and poverty. Menstrual cups may offer solutions to the many challenges. The role of medical students in the promotion of women's health cannot be understated. Objectives: To investigate the understanding and perception of medical students on the use, safety, and efficacy of the menstrual cup as a menstrual hygiene product. Methods: This was a prospective, cross-sectional, quantitative study conducted at the University of the Witwatersrand on medical students. Questionnaires were emailed to students. The study was approved by the Wits HREC (M200885). Statistical software SPSS® 23.0 was used. Results: Two hundred and fifteen participants were recruited. One hundred and seventy-eight were included and analyzed; 58.93% had a basic understanding of the menstrual cup as a menstrual hygiene product (p < 0.001). There was an association between the gender of the respondents and knowledge of the device (p < 0.0001). Females were 7.467 times more likely to have heard about it. There was an association between gender and understanding the cost-effectiveness (p = 0.01), the year of study, and understanding of how it works (p = 0.012). The majority perceived the menstrual cup as convenient in terms of use, comfort, hygiene, and safety. Conclusion: It is important that the menstrual cup is not only introduced to society but also promoted and receives endorsement by healthcare workers. There is an understanding regarding the use, safety, and efficacy of the MC and a willingness to advise for use.

Performance of the Swede score to predict cervical intraepithelial neoplasia in women with HIV-1 in Johannesburg, South Africa.

OBJECTIVE: To evaluate the performance of the Swede score to detect cervical intraepithelial neoplasia (CIN) in women with HIV-1 in Johannesburg, South Africa. METHODS: A cross-sectional study using secondary data analysis from the HPV in Africa Research Partnership (HARP) study that compared the performance of three different screening tests to detect CIN. Colposcopy was performed on any woman who screened positive and findings were recorded using the Swede score. A biopsy of any lesion and a four-quadrant biopsy was taken. The score was evaluated against a histological diagnosis of >CIN1. The sensistivity, specificity, PPV and NPV for each score was calculated. RESULTS: Median age and CD4+ count of the 576 women eligible from the Johannesburg cohort was 34 years (IQR, 30-39) and 427 cells/mm3 (IQR, 323-579), respectively. Almost two-thirds (64%) were on ART and about 21% had CIN 2+ on histology. A Swede score of 5 or greater had the best combination of sensitivity and specificity for CIN 2+ with an AUC of 0.72 (95% CI, 0.68-0.76) corresponding to a sensitivity of 72.1 (95% CI, 63.5-79.6) and specificity of 71.8 (95% CI, 67.4-75.9). CONCLUSION: The Swede score can assist in determining whether women with HIV/AIDS should have treatment at the first colposcopy visit versus those who may be followed up, thereby individualizing treatment.

A rare case of concomitant bilateral nipple and vulval condyloma accuminatum.

In this case study, we have presented a rare case of concomitant human papillomavirus condylomata lesions of both breast nipples and giant vulval warts in an HIV-positive woman on antiretroviral therapy. The woman underwent successful surgical excision and reconstruction for both breast nipple condylomata and vulval warts. Histology of the excised breast nipple and vulval tissue confirmed low-risk human papillomavirus infection. Concomitant vulval and bilateral breast nipple condylomata pose a management dilemma. It is possible that the pathogenesis of these lesions is through both direct contact spread as well as haematogenous dissemination of the human papillomavirus.