Implementation of an HACCP model in foot and mouth disease control programmes.

The organisation and structure of the official Veterinary Services (OVS) are designed to meet a specific aim--the health certification of animal health, welfare and food safety in the production and processing stage. Disease prevention and control calls for programmes and projects that, depending on the characteristics of each disease, may involve any branch of the OVS, from the laboratory to field activities. For the purpose of this work, the model used is that of a country that is 'free from foot and mouth disease with vaccination' in accordance with the conditions stipulated in Chapter 8.8. of the World Organisation for Animal Health Terrestrial Animal Health Code. These conditions state that, to maintain this health status, a programme of monitoring and continuous control of the relevant variables must be implemented. This is achieved by applying good practice and identifying the critical control points in all processes, using a checklist that simplifies the task. The system that is developed can also serve as a guide for internal or external programme audits.

Quantitative risk assessment of FMDV introduction in a FMD free country through bone-in beef and offal importation from a FMD free with vaccination country/zone.

Quantitative risk assessment was used to estimate the risk of introducing foot-and-mouth disease (FMD) through bone-in beef from Argentina (FMD-free with vaccination status) into other FMD-free countries. A stochastic model was built to characterize all the steps from primary production to bone-in beef export and introduction into an FMD-free country. The probability that bone-in beef from at least one animal infected with the FMD virus (FMDV) was exported during a year was 5.27 × 10-3 (95% CI <10-10 - 5.19 x 10-2) or in other words one case in 190 years. The risk of FMDV introduction was sensitive to the probability of an outbreak occurring in Argentina (r [Spearman´s rank correlation] = 0.99) and the number of herds affected during an outbreak (r = 0.10). Additionally, the probability that susceptible animals in the importing country came into contact with infective material (bones) and generated an outbreak was 6.16 × 10-4 (95% CI <10-10 - 6.20 ×10-3) or one FMD outbreak every 1623 years on average. Based on the quantitative risk assessment results, the probability of FMDV introduction into a FMD-free country where vaccination is not practiced from a FMD-free country where vaccination is practiced associated with bone-in beef trade from Argentina was negligible. The risk of an FMD outbreak caused by the potential introduction of the FMDV was associated with the existing conditions in the country. Thus, maintaining the FMD-free status with or without vaccination would not be relevant.

Oestrogen and progesterone receptor concentrations in leiomyoma and normal myometrium.

The content of cytoplasmic 17 beta oestradiol and progesterone receptors in human uterine leiomyoma and normal myometrium in the Negroid population was determined. Eighteen women of reproductive age, at various stages of the menstrual cycle, were included in the study. The serum oestrogen and progesterone concentrations were also measured. This is the first report in the literature in which oestrogen and progesterone receptors in leiomyoma are significantly higher than in normal myometrium (P = 0.0002). The steroid dependence of the growth of leiomyomas may be related to the steroid receptor level. The presence of persistently high concentrations of oestrogen and progesterone receptors in leiomyoma should be helpful in the treatment of this benign tumour.

Polycystic ovarian syndrome. Evidence for an autoimmune mechanism in some cases.

Antiovarian autoantibodies localized to the granulosa cells were detected in 50% of a group of eight patients diagnosed with polycystic ovarian syndrome. An analogy is drawn to other endocrinopathies characterized by hypersecretion of hormones, notably thyroid and adrenal, and a pathogenetic mechanism involving stimulating antibody is postulated.

Transient postpartum amaurosis. A report of four cases.

The association between amaurosis and preeclampsia has been extensively documented of late. In four women with amaurosis, the major etiologic factor appeared to be dramatic fluctuations in blood pressure associated with an excessive peripartum blood loss. One patient was found to have an area of cortical infarction, as evidenced by computed tomography. All four patients made a full recovery.

'Look and Lletz'--a Chris Hani Baragwanath Hospital experience.

OBJECTIVES: An audit was undertaken of a 'colposcopy and treatment' clinic between April 2003 and December 2006, to determine: (i) the frequency of overtreatment with Papanicolaou smear on its own, colposcopy on its own or a combination of the two methods; (ii) differences in overtreatment between patients who are HIV positive and those who are HIV negative; and (iii) the short-term complications of Lletz (large loop excision of the transformation zone) at this clinic. DESIGN: An analysis of the data from the colposcopy clinic database of patients, who were referred according to national guidelines. SETTING: Patients who are referred to Chris Hani Baragwanath Hospital. RESULTS: Normal histology was found in 1.3% of patients, and cervical intraepithelial neoplasia (CIN)1 or human papillomavirus (HPV) in 8.4%. The overall complication rate was 3%. CONCLUSION: The high loss to follow-up and the low early complication rate together with an acceptable overtreatment rate make this a justifiable approach in our situation. HIV-negative women were more likely to be overtreated than HIV-positive patients(p=0.03).

Cervical length at 23 weeks' gestation--relation to demographic characteristics and previous obstetric history in South African women.

OBJECTIVES: To determine the distribution of cervical length in a routine population of singleton pregnancies; to examine the relationship between cervical length, demographic characteristics, and previous obstetric history; and to compare these data with data from a similar study undertaken in the UK. PATIENTS AND METHODS: The study was conducted among women attending routine antenatal clinics at Coronation, Johannesburg General and Chris Hani Baragwanath hospitals. Cervical length was measured by means of transvaginal ultrasound at 23 weeks' gestation in women with singleton pregnancies attending these clinics, as part of a multicentre randomised trial investigating the value of cerclage in a short cervix. The distribution of cervical length was determined and the significance of differences in median cervical lengths between subgroups was calculated according to maternal age, ethnic origin, maternal body mass index (BMI), cigarette smoking, alcohol intake, and previous obstetric history. RESULTS: Cervical screening was offered to women (N = 2 173) attending clinics for a 23-week scan during the study period (July 1999-September 2002). Most women (N = 1 920) accepted, while 253 declined. Complete outcomes (date and mode of delivery, gestation at delivery, birth weight, Apgar scores, maternal blood loss, whether the patient was cerclaged or not, and any complications) were obtained for 1 603 women who accepted screening. Cervical length was measured successfully in all cases. Median cervical length was 33.7 mm and in 64 cases (3.3%) the length was 15 mm or less. Significantly shorter cervical lengths were found in those with a history of previous miscarriage, preterm delivery, those aged less than 20 years and those with an abnormal BMI. Cervical length was not significantly shorter in black women than in coloured and white women. CONCLUSIONS: At 23 weeks' gestation the median cervical length in a South African population was 33.2 mm. In 3.3% of the population the length was < or = 15 mm. There was an association between cervical length, demographic characteristics and previous obstetric history.

Maternal intensive care.

The evolution of a maternal intensive care unit (ICU) is described and the management of the patients treated over a 10-month period is outlined. The principles, practice and methods of intensive care for the parturient are discussed.

'One-visit' therapy for pelvic inflammatory disease.

Acute pelvic inflammatory disease is a very common gynaecological disorder, and more often than not it is caused by a mixed infection of aerobic and anaerobic organisms. Routine bacteriological investigation is consequently of little practical value in determining the therapeutic approach. In an open comparative trial, 60 patients were divided into two treatment groups of 30 patients each. Both groups received a combination of penicillins, probenecid, a sulphonamide and an imidazole derivative active against protozoa and anaerobes. Both regimens resulted in virtually the same therapeutic response in patients hospitalized for 6 days. The regimen consisting of ornidazole (as opposed to metronidazole) and the ultralong-acting sulphonamide, sulphadoxine (as opposed to sulphadimidine), can be given in a once-only administration, thereby greatly reducing the possibility of non-compliance in patients treated, as is customary, on an outpatient basis.

Trial labour conducted under continuous epidural analgesia.

Two hundred Black women who required trial labour for suspected disproportion were adminstered continuous lumbar epidural analgesia by an obstetrician. The effects, side-effects, and results are described and discussed. Epidural block provides safe, effective analgesia for trial labour, and does not adversely affect the delivery or fetal condition.

Internal iliac artery ligation in obstetrics and gynaecology.

Ligation of one or both internal iliac arteries is described in 5 obstetric and 5 gynaecological patients. The procedure was performed for control of severe pelvic haemorrhage. The anatomy and technique are briefly outlined, and the freedom from complications is stressed. Modern views as to the probable postoperative haemodynamics are discussed. A plea is made for more frequent use of this simple operation, and for its routine teaching during the training of pelvic surgeons.

Meconium during labour--self-medication and other associations.

Prior to artificial rupture of membranes, 498 women were questioned about obstetric and social factors including self-medication during pregnancy. Caesarean section (P less than 0,01) and low Apgar scores (P less than 0,001) were significantly more common in pregnancies complicated by fetal meconium passage. Meconium passage was more common in women who had recently taken castor oil (P less than 0,01) and possibly herbal substances called 'sihlambezo' (trend P less than 0,2). Use of laxatives or enemas and other obstetric risk factors were not associated with meconium passage.

Labour in patients with a caesarean section scar. The place of oxytocin augmentation.

Fifty-two patients who had had a single previous caesarean section were submitted to a trial of scar. Labour was monitored by internal tocography and direct fetal heart rate monitoring. Oxytocin infusion was employed when uterine work proved to be inadequate. The oxytocin-augmented and unstimulated groups were compared. Oxytocin augmentation improved uterine work and did not result in significant fetal or maternal morbidity or mortality. Internal tocography was found to be of value, but fetal heart rate monitoring was essential.

Betamimetics in fetal distress: randomised controlled trial.

The objective of the study was to investigate if a single dose of Hexoprenaline administered to patients diagnosed as having fetal distress improves neonatal outcome and whether there are any side effects and complications related to hexoprenaline injection. Patients with fetal distress diagnosed by electronic fetal heart rate monitoring with a gestational age of 35 weeks or more in active labor were eligible. Once the decision to deliver the patient by Cesarean section was made, patients were approached and randomised by sealed opaque envelopes to hexoprenaline or control groups. Ten micrograms of hexoprenaline were administered intravenously to study patients. Main outcomes were cord blood gas values, Apgar scores, the need for resuscitation and admission to intensive care. There were no statistically significant differences in the main outcome measures between the two groups. Fewer babies in the hexoprenaline group had a pH of < 7.2 and a base excess of < -10, but this was not statistically significant. The fetal heart rate pattern was improved in significantly more patients after hexoprenaline administration than controls. In conclusion, despite the statistically significant improvement in fetal heart rate tracings, Apgar scores and blood gas values showed only a trend towards improvement in the hexoprenaline group.

Pregnancy complicated by maternal hydrocephalus. A report of 3 cases.

The obstetric management of 3 women with stable hydrocephalus is presented. The few obstetric complications were unrelated to the maternal hydrocephalus, and specific management of the maternal condition was not necessary. Better management of hydrocephalus in infancy, as well as of the other forms of non-tumoral hydrocephalus, has led to more adults in a stable state with the condition and pregnancy will occur in some of these. A plea is made for all female patients with hydrocephalus to have a ventriculoperitoneal shunt rather than a ventriculoatrial one, with a view to reduction of complications in later pregnancies.

Low survival of South African urban black women with cervical cancer.

In Soweto, Johannesburg, the incidence of cervical cancer, the most common cancer in black women, is higher than in most white populations but lower than in many other populations. In a series of 210 patients who were diagnosed in 1981 and 1982, 50% had died within 1.6 years of diagnosis, a third of the reported survival time in white patients. The pattern of stage at presentation was similar to, although sometimes later than, those reported for various white communities. Data on patients' age at birth of first child, parity, smoking practice, and socioeconomic status, differed little from those in a control group. Neither these factors, nor availability of medical services, could be correlated with the distressingly short period of survival, which also occurs among urban black patients with breast and oesophageal cancers. Presumably, unidentified factors linked with low socioeconomic status affect survival time.