Research Articles (Obstetrics and Gynaecology)

Permanent URI for this collectionhttp://hdl.handle.net/2263/2376

Browse

Now showing 1 - 20 of 441

Acceptability and safety of thermal ablation treatment for cervical cytological abnormalities in Pretoria, South Africa
(Medpharm Publications, 2025-02) Malaza, C.K.; Dreyer, Greta; Snyman, Leon Cornelius; Visser, Cathy; Buchmann, E.J.
BACKGROUND : Cervical cancer is one of the leading causes of cancer deaths in women, and 90% of the deaths occur in low- to middle-income countries (LMICs). Accessible cervical cancer screening and treatment options are an urgent priority. Thermal ablation (TA) is an alternative treatment option available for cervical premalignant conditions. The World Health Organization (WHO) has endorsed TA and published guidelines on its use. Most studies on the treatment’s efficacy, safety, and acceptability are from high-income countries. METHODS : A prospective cohort study that recruited women who presented with abnormal cytology results from three hospitals in Pretoria, South Africa. Colposcopy examinations were done to assess patients’ eligibility for TA. Post-treatment questionnaires were completed by participating doctors and women to assess the acceptability and safety profile of the treatment. Follow-ups were scheduled on day 7 to assess the safety profile further, and adverse events (AEs) were recorded. RESULTS : The analysis included 58 women. The mean age was 42.4 years. Our findings showed a safety rate of 91.4% and a patient satisfaction rate of 96.6%. All the participating doctors and women recommended the treatment. Most of our findings were consistent with those from previous studies. CONCLUSION : Our study demonstrated TA as a safe and acceptable treatment method for cervical premalignant conditions in low- resource settings. The treatment does not require expensive infrastructure and can be performed by generalist doctors.
Incompleteness and misclassification of maternal deaths in Zimbabwe : data from two reproductive age mortality surveys, 2007-2008 and 2018-2019
(Springer, 2024-12) Musarandega, Reuben; Nystrom, Lennarth; Murewanhema, Grant; Gwanzura, Chipo; Ngwenya, Solwayo; Pattinson, Robert Clive; Machekano, Rhoderick; Munjanja, Stephen Peter; Zimbabwe Maternal and Perinatal Mortality Study Group
INTRODUCTION : We implemented two cross-sectional reproductive age mortality surveys in 2007–2008 and 2018–2019 to assess changes in the MMR and causes of death in Zimbabwe. We collected data from health institutions, civil registration and vital statistics, the community, and surveillance. This paper analyses missingness and misclassification of deaths in the two surveys. METHODS : We compared proportions of missed and misclassified deaths in the surveys using Chi-square or Fisher’s exact tests. Using log-linear regression models, we calculated and compared risk ratios of missed deaths in the data sources. We assessed the effect on MMRs of misclassifying deaths and analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and risk ratios calculated through Binomial exact tests. RESULTS : All data sources missed and misclassified the deaths. The community survey was seven times [RR 7.1 (5.1–9.7)] and CRVS three times [RR 3.4 (2.4–4.7)] more likely to identify maternal deaths than health records in 2007–08. In 2018–19, CRVS [RR 0.8 (0.7–0.9)] and surveillance [RR 0.7 (0.6–0.9)] were less likely to identify maternal deaths than health records. Misclassification of causes of death significantly reduced MMRs in health records [RR 1.4 (1.2–1.5)]; CRVS [RR 1.3 (1.1– 1.5)] and the community survey/surveillance [RR 1.4 (1.2–1.6)]. CONCLUSION : Incompleteness and misclassification of maternal deaths are still high in Zimbabwe. Maternal mortality studies must triangulate data sources to improve the completeness of data while efforts to reduce misclassification of deaths continue.
Evaluating the therapeutic potential of curcumin and synthetic derivatives : a computational approach to anti-obesity treatments
(MDPI, 2024-02-23) Moetlediwa, Marakiya T.; Jack, Babalwa U.; Mazibuko-Mbeje, Sithandiwe E.; Pheiffer, Carmen; Titinchi, Salam J.J.; Salifu, Elliasu Y.; Ramharack, Pritika
Natural compounds such as curcumin, a polyphenolic compound derived from the rhizome of turmeric, have gathered remarkable scientific interest due to their diverse metabolic benefits including anti-obesity potential. However, curcumin faces challenges stemming from its unfavorable pharmacokinetic profile. To address this issue, synthetic curcumin derivatives aimed at enhancing the biological efficacy of curcumin have previously been developed. In silico modelling techniques have gained significant recognition in screening synthetic compounds as drug candidates. Therefore, the primary objective of this study was to assess the pharmacokinetic and pharmacodynamic characteristics of three synthetic derivatives of curcumin. This evaluation was conducted in comparison to curcumin, with a specific emphasis on examining their impact on adipogenesis, inflammation, and lipid metabolism as potential therapeutic targets of obesity mechanisms. In this study, predictive toxicity screening confirmed the safety of curcumin, with the curcumin derivatives demonstrating a safe profile based on their LD50 values. The synthetic curcumin derivative 1A8 exhibited inactivity across all selected toxicity endpoints. Furthermore, these compounds were deemed viable candidate drugs as they adhered to Lipinski’s rules and exhibited favorable metabolic profiles. Molecular docking studies revealed that both curcumin and its synthetic derivatives exhibited favorable binding scores, whilst molecular dynamic simulations showed stable binding with peroxisome proliferator-activated receptor gamma (PPARγ), csyclooxygenase-2 (COX2), and fatty acid synthase (FAS) proteins. The binding free energy calculations indicated that curcumin displayed potential as a strong regulator of PPARγ (−60.2 ± 0.4 kcal/mol) and FAS (−37.9 ± 0.3 kcal/mol), whereas 1A8 demonstrated robust binding affinity with COX2 (−64.9 ± 0.2 kcal/mol). In conclusion, the results from this study suggest that the three synthetic curcumin derivatives have similar molecular interactions to curcumin with selected biological targets. However, in vitro and in vivo experimental studies are recommended to validate these findings.
A scoping review on continuing professional development programs for midwives : optimising management of obstetric emergencies and complications
(BMC, 2025-02) Musie, Maurine Rofhiwa; Tagutanazvo, Oslinah Buru; Sepeng, Nombulelo Veronica; Mulaudzi, Fhumulani Mavis; Hlongwane, Tsakane; maurine.musie@up.ac.za
BACKGROUND : Midwives play a pivotal role in ensuring safe childbirth, particularly in the management of obstetric emergencies and complications (EmONC). Continuous Professional Development (CPD) programs are essential to keep midwives updated with the latest skills and knowledge, ensuring high-quality maternal care. AIM : The study aimed to map and synthesize evidence on continuing professional development for midwives optimising management of obstetric emergencies and complications to reveal evidence to address the knowledge gap and implementation of policy. METHODS : This scoping review was guided by the adapted version of Arksey and O’Malley methodological framework (2005). We searched databases from 2013 to 2023: PubMed, SCOPUS, Web of Science, EBSCOhost (CINAHL, MEDLINE and Academic search): and ProQuest central. The studies were appraised using mixed methods appraisal tool (MMAT) version 2018. Content analysis and synthesis of the findings were conducted using Nvivo 12. RESULTS : Of the 752 articles identified through database searching, 31 articles met the inclusion criteria and reported according to the Preferred reporting items for systematic reviews and meta-analyses extension for scoping review (PRISMA-ScR) checklist. After data extraction, content analysis yielded the following 4 major themes: Types of CPD training programs, Effectiveness of CPD on management of obstetric emergencies, Barriers/Challenges with lack of implementation of CPD programs and Suggestion for implementation of CPD programs. CONCLUSION : The findings revealed the significance of CPD programs in equipping midwives with the necessary skills and knowledge to handle obstetric emergencies effectively. The program can be offered in various approaches including simulation-based training, technology-based simulation, online modules, workshops, and interdisciplinary/interprofessional learning sessions, have shown to be effective. Each method offers unique advantages, such as hands-on practice in simulations and flexibility in online learning with smart applications such as SAFE delivery applications.
Gestational diabetes and the gut microbiota : fibre and polyphenol supplementation as a therapeutic strategy
(MDPI, 2024-04) Pheiffer, Carmen; Riedel, Sylvia; Dias, Stephanie; Adam, Sumaiya
Gestational diabetes mellitus (GDM) is an escalating public health concern due to its association with short- and long-term adverse maternal and child health outcomes. Dysbiosis of microbiota within the gastrointestinal tract has been linked to the development of GDM. Modification of microbiota dysbiosis through dietary adjustments has attracted considerable attention as adjunct strategies to improve metabolic disease. Diets high in fibre and polyphenol content are associated with increased gut microbiota alpha diversity, reduced inflammation and oxidative processes and improved intestinal barrier function. This review explores the potential of fibre and polyphenol supplementation to prevent GDM by investigating their impact on gut microbiota composition and function.
Gestation-dependent increase in cervicovaginal pro-inflammatory cytokines and cervical extracellular matrix proteins is associated with spontaneous preterm delivery within 2 weeks of index assessment in South African women
(Frontiers Media, 2024-08) Amabebe, Emmanuel; Ikumi, Nadia; Oosthuizen, Ally; Soma-Pillay, Priya; Matjila, Mushi; Anumba, Dilly O. C.
INTRODUCTION: Inflammation-induced remodelling of gestational tissues that underpins spontaneous preterm birth (sPTB, delivery < 37 weeks’ gestation) may vary by race and context. To explore relationships between markers of these pathological processes, we (a) characterised the cervicovaginal fluid (CVF) cytokine profiles of pregnant South African women at risk of PTB; (b) determined CVF matrix-metalloproteinase-9 (MMP-9) and its regulator tissue inhibitor of metalloproteinase-1 (TIMP-1); and (c) explored the predictive potential of these markers for sPTB. METHOD OF STUDY: The concentrations of 10 inflammatory cytokines and MMP-9 and TIMP-1 were determined by ELISA in CVF samples from 47 non-labouring women at high risk of PTB. We studied CVF sampled at three gestational time points (GTPs): GTP1 (20–22 weeks, n = 37), GTP2 (26–28 weeks, n = 40), and GTP3 (34–36 weeks, n = 29) and analysed for changes in protein concentrations and predictive capacities (area under the ROC curve (AUC) and 95% confidence interval (CI)) for sPTB. RESULTS: There were 11 (GTP1), 13 (GTP2), and 6 (GTP3) women who delivered preterm within 85.3 ± 25.9, 51.3 ± 15.3, and 11.8 ± 7.5 (mean ± SD) days after assessment, respectively. At GTP1, IL-8 was higher (4-fold, p = 0.02), whereas GM-CSF was lower (~1.4-fold, p = 0.03) in the preterm compared with term women with an average AUC = 0.73. At GTP2, IL-1b (18-fold, p < 0.0001), IL-8 (4- fold, p = 0.03), MMP-9 (17-fold, p = 0.0007), MMP-9/TIMP-1 ratio (9-fold, p = 0.004), and MMP-9/GM-CSF ratio (87-fold, p = 0.005) were higher in preterm compared with term women with an average AUC = 0.80. By contrast, IL-10 was associated with term delivery with an AUC (95% CI) = 0.75 (0.55–0.90). At GTP3, IL-1b (58-fold, p = 0.0003), IL-8 (12-fold, p = 0.002), MMP-9 (296-fold, p = 0.03), and TIMP-1 (35-fold, p = 0.01) were higher in preterm compared with term women with an average AUC = 0.85. Elevated IL-1b was associated with delivery within 14 days of assessment with AUC = 0.85 (0.67–0.96). Overall, elevated MMP-9 at GTP3 had the highest (13.3) positive likelihood ratio for distinguishing women at risk of sPTB. Lastly, a positive correlation between MMP-9 and TIMP-1 at all GTPs (r ≥ 0.61, p < 0.01) for women delivering at term was only observed at GTP1 for those who delivered preterm (r = 0.70, p < 0.03). CONCLUSIONS: In this cohort, sPTB is associated with gestation-dependent increase in pro-inflammatory cytokines, decreased IL-10 and GM-CSF, and dysregulated MMP-9-TIMP-1 interaction. Levels of cytokine (especially IL-1b) and ECM remodelling proteins rise significantly in the final 2 weeks before the onset of labour when sPTB is imminent. The signalling mechanisms for these ECM remodelling observations remain to be elucidated.
Assessment of current biomarkers and interventions to identify and treat women at risk of preterm birth
(Frontiers Media, 2024-07) Gravett, Michael G.; Menon, Ramkumar; Tribe, Rachel M.; Hezelgrave, Natasha L.; Kacerovsky, Marian; Soma-Pillay, Priya; Jacobsson, Bo; McElrath, Thomas F.
Preterm birth remains an important global problem, and an important contributor to under-5 mortality. Reducing spontaneous preterm birth rates at the global level will require the early identification of patients at risk of preterm delivery in order to allow the initiation of appropriate prophylactic management strategies. Ideally these strategies target the underlying pathophysiologic causes of preterm labor. Prevention, however, becomes problematic as the causes of preterm birth are multifactorial and vary by gestational age, ethnicity, and social context. Unfortunately, current screening and diagnostic tests are nonspecific, with only moderate clinical risk prediction, relying on the detection of downstream markers of the common end-stage pathway rather than identifying upstream pathway-specific pathophysiology that would help the provider initiate targeted interventions. As a result, the available management options (including cervical cerclage and vaginal progesterone) are used empirically with, at best, ambiguous results in clinical trials. Furthermore, the available screening tests have only modest clinical risk prediction, and fail to identify most patients who will have a preterm birth. Clearly defining preterm birth phenotypes and the biologic pathways leading to preterm birth is key to providing targeted, biomolecular pathway-specific interventions, ideally initiated in early pregnancy Pathway specific biomarker discovery, together with management strategies based on early, mid-, and-late trimester specific markers is integral to this process, which must be addressed in a systematic way through rigorously planned biomarker trials.
Comparative effects of tumor necrosis factor alpha, lipopolysaccharide, and palmitate on mitochondrial dysfunction in cultured 3T3-L1 adipocytes
(Springer, 2025-03) Jack, Babalwa U.; Dias, Stephanie; Pheiffer, Carmen
We have previously reported that dysregulated lipid metabolism and inflammation in 3T3-L1 adipocytes is attributed to tumor necrosis factor alpha (TNFα) rather than lipopolysaccharide (LPS) and palmitate (PA). In this study, we further compared the modulative effects of TNFα, LPS, and PA on mitochondrial function by treating 3T3-L1 adipocytes with TNFα (10 ng/mL), LPS (100 ng/mL), and PA (0.75 mM) individually or in combination for 24 h. Results showed a significant reduction in intracellular adenosine triphosphate (ATP) content, mitochondrial bioenergetics, total antioxidant capacity, and the mRNA expression of citrate synthase (Cs), sirtuin 3 (Sirt3), protein kinase AMP-activated catalytic subunit alpha 2 (Prkaa2), peroxisome proliferator-activated receptor gamma coactivator 1 alpha (Ppargc1α), nuclear respiratory factor 1 (Nrf1), and superoxide dismutase 1 (Sod1) in cells treated with TNFα individually or in combination with LPS and PA. Additionally, TNFα treatments decreased insulin receptor substrate 1 (Irs1), insulin receptor substrate 2 (Irs2), solute carrier family 2, facilitated glucose transporter member 4 (Slc2a4), and phosphoinositide 3 kinase regulatory subunit 1 (Pik3r1) mRNA expression. Treatment with LPS and PA alone, or in combination, did not affect the assessed metabolic parameters, while the combination of LPS and PA increased lipid peroxidation. These results show that TNFα but not LPS and PA dysregulate mitochondrial function, thus inducing oxidative stress and impaired insulin signaling in 3T3-L1 adipocytes. This suggests that TNFα treatment can be used as a basic in vitro model for studying the pathophysiology of mitochondrial dysfunction and related metabolic complications and screening potential anti-obesity therapeutics in 3T3-L1 adipocytes.
The need for diverting colostomy in obstetric and non-obstetric anorectal injury repair
(Inhouse Publishers, 2023-05) Blignaut, Quinton Craig; Abdool, Zeelha
Between 0,2% and 6% of women experience severe anorectal injuries in the form of third- and fourth-degree tears during vaginal birth. Early diagnosis and correct repair by experienced surgeons reduce morbidity and devastating complications such as faecal incontinence and fistulae formation. While there is sufficient evidence for the correct surgical suturing techniques, the use of diverting colostomies remains controversial and poorly researched. In this review we performed a MEDLINE search of all published studies on the role of diverting colostomies in obstetric and non-obstetric anorectal injury repair. Most authors avoid commenting on the utility of colostomies as part of their surgical approach making it difficult to make recommendations for clinical practice. We conclude that, based on published opinions, case series and clinical outcomes, the use of colostomy is seldom warranted. Comparative data is absent and further research is needed.
A design thinking approach to disentangle the wicked problem of re-curriculation during a pandemic
(Unisa Press, 2023-10) Lubbe, Johanna Catharina (Irene); Adam, Sumaiya; Cordier, Werner; werner.cordier@up.ac.za
Covid-19 continues to cause major disruptions and unique challenges in the higher education sector. Some of the most profound disruptions are in health sciences where students depend on current, up-to-date information, interdisciplinary collaboration, and work-integrated learning to acquire the needed skill set to become proficient clinical practitioners. Combining the Covid-19 pandemic with emergency remote teaching and an outdated 25-yearold non-responsive, fragmented curriculum created the perfect storm for a wicked problem. (A problem that is almost impossible to solve due to incomplete, contradictory, and changing requirements that are often difficult to recognise.) In this article, the authors share their journey-in-process of design thinking disentanglement to solve this current and wicked problem. Shortly before the start of the pandemic, the specific medical school under study embarked on a re-curriculation process-a process that was rudely and abruptly distorted and tangled by the pandemic. However, despite the initial setback, they continue with this mammoth task, basing their activities on “design thinking” principles. They purposively approach this task from within a human-centred, value-based, solution-focused, action-orientated and systematic reasoning process. The five intertwined, non-linear design thinking phases of empathise (stake-holder analysis and data collection), define (data analysis and problem statement), ideate (possible solutions), prototype (integrated draft curriculum) and test (stake-holder feedback and input) were adopted as a method to facilitate and expedite the re-curriculation process. The process discussed in this manuscript has value beyond the health sciences. The approach to storyboarding, creating, and unpacking a new curriculum is applicable to all disciplines in multiple educational settings.
The performance of single and combination test strategies using visual inspection, cytology, high-risk HPV DNA and HPV16/18 to screen South African women with and without HIV-infection
(BMC, 2024-05) Dreyer, Greta; Visser, Cathy; Dreyer, Gerrit Jan; Botha, Matthys H.; Van der Merwe, Frederick H.; Richter, Karin Louise; Snyman, Leon Cornelius
BACKGROUND : Cervical cancer screening strategies should ideally be informed by population-specific data. Strategies recommended for secondary prevention, are often inadequately studied in populations with high cervical disease burdens. This report describes the test performance measured against CIN2 + /CIN3 + histology in HIV-positive women (HPW) and HIV-negative women (HNW) with the aim to determine the most effective strategies to identify South African women at risk. METHODS : Primary screening using visual inspection, cytology and HPV DNA (cobas®) was performed in two South African provinces on 456 HPW and 639 HNW participating in the multicentric DiaVACCS trial. Histology was obtained for 91.7% screen-positive and 42.7% screen-negative participants, and unavailable histology was determined by multiple imputation to adjust for verification bias. Cross-sectional test performance was calculated for single and combination test strategies with and without intermediate risk categories using different cut-offs. Minimum acceptability for sensitivity and specificity, treatment and follow-up numbers were considered to evaluate strategies. RESULTS : The only single test to reach acceptability in HPW was cytology (LSIL) [sensitivity 71.2%; specificity 90.5%; treatment 33.4%]; in HNW only HPV (hr) qualified [sensitivity 68.2%; specificity 85.2%; treatment 23.5%]. The universally best performing strategy which also resulted in smaller treatment numbers without intermediate risk group was primary HPV(hr), with treatment of both HPV(16/18) and cytology (ASCUS +) [HPW: sensitivity 73.6%; specificity 89.7%; treatment 34.7%. HNW: sensitivity 59.1%; specificity 93.6%; treatment 13.9%]. DNA testing for hrHPV (any) and hrHPV (16/18) was the best universally acceptable strategy with an intermediate risk category (early follow-up) in HPW [sensitivity 82.1%; specificity 96.4%; treatment 17.1%; follow-up 31.4%] and HNW [sensitivity 68.2%; specificity 96.7%; treatment 7.6%; follow-up 15.9%]. In comparison, using both HPV (16/18) and cytology (ASCUS +) as secondary tests in hrHPV positive women, decreased follow-up [HPW 13.8%, HNW 9.6%], but increased treatment [HPW 34.7%, HNW 13.9%]. CONCLUSION : Using hrHPV (any) as primary and both HPV16/18 and cytology as secondary tests, was universally acceptable without an intermediate risk group. Strategies with follow-up groups improved screening performance with smaller treatment numbers, but with effective management of the intermediate risk group as prerequisite.
FIGO good practice recommendations on optimizing models of care for the prevention and mitigation of preterm birth
(Wiley, 2024-09) Anumba, Dilly; Soma-Pillay, Priya; Bianchi, Ana; Gonzalez, Catalina M. Valencia; Jacobbson, Bo; FIGO Committee for Preterm Birth
The global challenge of preterm birth persists with little or no progress being made to reduce its prevalence or mitigate its consequences, especially in low-resource settings where health systems are less well developed. Improved delivery of respectful person-centered care employing effective care models delivered by skilled healthcare professionals is essential for addressing these needs. These FIGO good practice recommendations provide an overview of the evidence regarding the effectiveness of the various care models for preventing and managing preterm birth across global contexts. We also highlight that continuity of care within existing, context-appropriate care models (such as midwifery-led care and group care), in primary as well as secondary care, is pivotal to delivering high quality care across the pregnancy continuum—prior to conception, through pregnancy and birth, and preparation for a subsequent pregnancy—to improve care to prevent and manage preterm birth.
Management of obesity across women's life course : FIGO best practice advice
(Wiley, 2023-01) Maxwell, Cynthia V.; Shirley, Rachelle; O'Higgins, Amy C.; Rosser, Mary L.; O'Brien, Patrick; Hod, Moshe; O'Reilly, Sharleen L.; Medina, Virna P.; Smith, Graeme N.; Hanson, Mark A.; Adam, Sumaiya; Ma, Ronald C.; Kapur, Anil; McIntyre, Harold David; Jacobsson, Bo; Poon, Liona C.; Bergman, Lina; Regan, Lesley; Algurjia, Esraa; McAuliffe, Fionnuala M.; FIGO Committee on Impact of Pregnancy on Long-term Health and the FIGO Division of Maternal and Newborn Health
Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long-term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma-informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre-, ante-, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre-existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.
Evaluation of the medically necessary, time sensitive triage score during and beyond the local COVID-19 pandemic in the gynaecologic oncology unit of a tertiary hospital in South Africa
(Public Library of Science, 2023-04-13) Sajo, Adekunle Emmanuel; Mouton, Arrie; Olorunfemi, Gbenga; Visser, Cathy; Van Aardt, M.C. (Matthys Cornelis); Dreyer, Greta
OBJECTIVE : The main objective of this study was to evaluate the Medically Necessary Time Sensitive (MeNTS) scoring system in triaging gynaecologic oncologic surgery during and beyond the COVID-19 pandemic. MATERIAL AND METHODS : This was a retrospective cross-sectional study including 209 patients who either had surgery (151) or surgery postponed (58) between the 26th March and 30th September 2020 in an academic hospital in South Africa. The MeNTS score was used to independently score each patient three times by two observers. RESULTS : The mean age of the participants was 46.6 ± 15 years and the cumulative mean MeNTS score was 51.0 ± 5.1. Over two-thirds of the cases had surgery. There was no significant difference between the first and second observers’ cumulative scores, 51.0 vs 51.1 (p 0.77). The cumulative score among those who had surgery was significantly lower than that for those whose surgeries were postponed, 49.8 vs 54.1 (p <0.0001). The intra-observer and inter-observer reliability were 0.78 and 0.74 respectively. After adjusting for confounding variables, those with low cumulative MeNTS scores were about 5 times more likely to have surgery than those with high scores (Adj. OR = 4.67, 95% CI: 1.92–11.4, p <0.001. Patients with malignant diagnosis were also 5 times more likely to be operated than those with benign diagnosis (Adj. OR = 5.03, 95% CI: 1.73–14.6, p <0.001. The area under the curve (AUC) was 0.85 suggesting an excellent discriminatory power between those who were operated and those who were postponed. CONCLUSION : The study provided some insight into the potential usefulness of MeNTS score in prioritizing patients for surgery in gynaecologic oncologic sub-specialty. The score performed well across a range of gynaecologic conditions and procedures with good intra-observer and inter-observer consistency and reliability. This is a prioritization tool that is dynamically adaptable to accommodate changes in resources availability and operating theatre capacity.
Accuracy of a smartphone application for blood pressure estimation in Bangladesh, South Africa, and Tanzania
(Wiley, 2023-04-17) Festo, Charles; Vannevel, Valerie; Ali, Hasmot; Tamrat, Tigest; Mollel, Getrud J.; Hlongwane, T.M.A.G. (Tsakane); Fahmida, Kaniz A.; Alland, Kelsey; Barreix, María; Mehrtash, Hedieh; Silva, Ronaldo; Thwin, Soe Soe; Mehl, Garrett; Labrique, Alain B.; Masanja, Honorati; Tuncalp, Ozge
Undetected and unmonitored hypertension carries substantial mortality and morbidity, especially during pregnancy. We assessed the accuracy of OptiBPTM, a smartphone application for estimating blood pressure (BP), across diverse settings. The study was conducted in community settings: Gaibandha, Bangladesh and Ifakara, Tanzania for general populations, and Kalafong Provincial Tertiary Hospital, South Africa for pregnant populations. Based on guidance from the International Organization for Standardization (ISO) 81,060–2:2018 for non-invasive BP devices and global consensus statement, we compared BP measurements taken by two independent trained nurses on a standard auscultatory cuff to the BP measurements taken by a research version of OptiBPTM called CamBP. For ISO criterion 1, the mean error was 0.5 ± 5.8mm Hg for the systolic blood pressure (SBP) and 0.1 ± 3.9 mmHg for the diastolic blood pressure (DBP) in South Africa; 0.8 ± 7.0 mmHg for the SBP and −0.4 ± 4.0 mmHg for the DBP in Tanzania; 3.3 ± 7.4 mmHg for the SBP and −0.4 ± 4.3 mmHg for the DBP in Bangladesh. For ISO criterion 2, the average standard deviation of the mean error per subject was 4.9 mmHg for the SBP and 3.4 mmHg for the DBP in South Africa; 6.3 mmHg for the SBP and 3.6 mmHg for the DBP in Tanzania; 6.4 mmHg for the SBP and 3.8 mmHg for the DBP in Bangladesh. OptiBPTM demonstrated accuracy against ISO standards in study populations, including pregnant populations, except in Bangladesh for SBP (criterion 2). Further research is needed to improve performance across different populations and integration within health systems.
Dietary supplements potentially target plasma glutathione levels to improve cardiometabolic health in patients with diabetes mellitus : a systematic review of randomized clinical trials
(MDPI, 2023-02-14) Dludla, Phiwayinkosi V.; Ziqubu, Khanyisani; Mabhida, Sihle E.; Mazibuko-Mbeje, Sithandiwe E.; Hanser, Sidney; Nkambule, Bongani B.; Basson, Albertus K.; Pheiffer, Carmen; Tiano, Luca; Kengne, Andre P.
Cardiovascular diseases (CVDs) continue to be the leading cause of death in people with diabetes mellitus. Severely suppressed intracellular antioxidant defenses, including low plasma glutathione (GSH) levels, are consistently linked with the pathological features of diabetes such as oxidative stress and inflammation. In fact, it has already been established that low plasma GSH levels are associated with increased risk of CVD in people with diabetes. Dietary supplements are widely used and may offer therapeutic benefits for people with diabetes at an increased risk of developing CVDs. However, such information remains to be thoroughly scrutinized. Hence, the current systematic review explored prominent search engines, including PubMed and Google Scholar, for updated literature from randomized clinical trials reporting on the effects of dietary supplements on plasma GSH levels in people with diabetes. Available evidence indicates that dietary supplements, such as coenzyme Q10, selenium, curcumin, omega-3 fatty acids, and vitamin E or D, may potentially improve cardiometabolic health in patients with diabetes. Such beneficial effects are related to enhancing plasma GSH levels and reducing cholesterol, including biomarkers of oxidative stress and inflammation. However, available evidence is very limited and additional clinical studies are still required to validate these findings, including resolving issues related to the bioavailability of these bioactive compounds.
Using FIGO nutrition checklist counselling in pregnancy : a review to support healthcare professionals
(Wiley, 2023-01) Killeen, Sarah Louise; Donnellan, Niamh; O'Reilly, Sharleen L.; Hanson, Mark A.; Rosser, Mary L.; Medina, Vina P.; Jacob, Chandni Maria; Divakar, Hema; Hod, Moshe; Poon, Liona C.; Bergman, Lina; O'Brien, Patrick; Kapur, Anil; Jacobsson, Bo; Maxwell, Cynthia V.; McIntyre, Harold David; Regan, Lesley; Algurjia, Esraa; Ma, Ronald C.; Adam, Sumaiya; FIGO Committee on Impact of Pregnancy on Long-term Health and the FIGO Division of Maternal and Newborn Health
The period before and during pregnancy is increasingly recognized as an important stage for addressing malnutrition. This can help to reduce the risk of noncommunicable diseases in mothers and passage of risk to their infants. The FIGO Nutrition Checklist is a tool designed to address these issues. The checklist contains questions on specific dietary requirements, body mass index, diet quality, and micronutrients. Through answering these questions, awareness is generated, potential risks are identified, and information is collected that can inform health-promoting conversations between women and their healthcare professionals. The tool can be used across a range of health settings, regions, and life stages. The aim of this review is to summarize nutritional recommendations related to the FIGO Nutrition Checklist to support healthcare providers using it in practice. Included is a selection of global dietary recommendations for each of the components of the checklist and practical insights from countries that have used it. Implementation of the FIGO Nutrition Checklist will help identify potential nutritional deficiencies in women so that they can be addressed by healthcare providers. This has potential longstanding benefits for mothers and their children, across generations.
Pregnancy as an opportunity to prevent type 2 diabetes mellitus : FIGO best practice advice
(Wiley, 2023-01) Adam, Sumaiya; McIntyre, Harold David; Tsoi, Kit Ying; Kapur, Anil; Ma, Ronald C.; Dias, Stephanie; Okong, Pius; Hod, Moshe; Poon, Liona C.; SmithGraeme N.; Smith, Graeme N.; Bergman, Lina; Algurjia, Esraa; O'Brien, Patrick; Medina, Vina P.; Maxwell, Cynthia V.; Regan, Lesley; Rosser, Mary L.; Jacobsson, Bo; Hanson, Mark A.; O'Reilly, Sharleen L.; FIGO Committee on the Impact of Pregnancy on Long-term Health and the FIGO Division of Maternal and Newborn Health; sumaiya.adam@up.ac.za
Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8–10- fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.
Hypertensive disorders of pregnancy and long-term cardiovascular health : FIGO best practice advice
(Wiley, 2023-01) Poon, Liona C.; Nguyen-Hoang, Long; Smith, Graeme N.; Bergman, Lina; O'Brien, Patrick; Hod, Moshe; Okong, Pius; Kapur, Anil; Maxwell, Cynthia V.; McIntyre, Harold David; Jacobsson, Bo; Algurjia, Esraa; Hanson, Mark A.; Rosser, Mary L.; Ma, Ronald C.; O'Reilly, Sharleen L.; Regan, Lesley; Adam, Sumaiya; Medina, Virna P.; McAuliffe, Fionnuala M.; FIGO Committee on the Impact of Pregnancy on Long-term Health and the FIGO Division of Maternal and Newborn Health
Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high-income countries and approximately 25% in low-and middle-income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long-term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.
Pregnant women's dietary patterns and knowledge of gestational weight gain : a cross-sectional study
(Wiley, 2024-08) Dikgale, Busisiwe; Dlakavu, Fuziwe; Masenge, Andries; De Gouveia, Slava; Adam, Sumaiya; sumaiya.adam@up.ac.za
OBJECTIVE : Excess gestational weight gain (GWG) is a risk factor for various unfavorable maternal and neonatal outcomes that may be preventable. Maintaining a healthy lifestyle while pregnant can help prevent uncontrollable weight gain. The aim of this study was to assess pregnant women's knowledge on weight, GWG, diet, and knowledge of obesity-related complications among women who seek care at our semi-urban, regional setting. METHODS : A prospective observational study was conducted at the prenatal clinic at Kalafong Academic Hospital. Prospective participants completed a questionnaire on their perception of GWG, attitudes toward GWG, knowledge of GWG, associated complications of obesity, and food choices. Data analysis was performed using SAS version 9.4. RESULTS : The majority of the 500 individuals were overweight or obese prior to pregnancy. By the end of the third trimester, this increased by 10.1% (n = 420; 86.1%). Nearly half (n = 240; 48.78%) of the overweight and obese women underestimated their weight. Only 26.53% (n = 26) of women who checked their body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) gained weight according to recommendations. However, less than half (n = 96; 30.5%) gained weight within the recommended range, despite the fact that the majority of them (n = 315; 64%) were aware of the harmful effects of obesity on the cardiovascular system and the effects of high calories on weight gain (n = 321; 65%). CONCLUSION : Despite basic knowledge of the impact of high-caloric intake on weight gain and cardiovascular complications, less than half of the study population gained weight within the recommended range.

Browse

Recent Submissions