scholarly journals An Observational Pilot Study Evaluating the Utility of Minimally Invasive Tissue Sampling to Determine the Cause of Stillbirths in South African Women

2019 ◽  
Vol 69 (Supplement_4) ◽  
pp. S342-S350 ◽  
Author(s):  
Shabir A Madhi ◽  
Jayani Pathirana ◽  
Vicky Baillie ◽  
Clare Cutland ◽  
Yasmin Adam ◽  
...  
Keyword(s):  
Pilot Study ◽  
Minimally Invasive ◽  
South African ◽  
Fluid Collection ◽  
African Women ◽  
World Health ◽  
Molecular Testing ◽  
Microbial Culture ◽  
Tissue Sampling ◽  
Biological Investigation

Abstract Background Despite approximately 2.6 million stillbirths occurring annually, there is a paucity of systematic biological investigation and consequently knowledge on the causes of these deaths in low- and middle-income countries (LMICs). We investigated the utility of minimally invasive tissue sampling (MITS), placental examination, and clinical history, in attributing the causes of stillbirth in a South African LMIC setting. Methods This prospective, observational pilot study undertook sampling of brain, lung, and liver tissue using core biopsy needles, blood and cerebrospinal fluid collection, and placental examination. Testing included microbial culture and/or molecular testing and tissue histological examination. The cause of death was determined for each case by an international panel of medical specialists and categorized using the World Health Organization’s International Classification of Diseases, Tenth Revision application to perinatal deaths. Results A cause of stillbirth was identifiable for 117 of 129 (90.7%) stillbirths, including an underlying maternal cause in 63.4% (n = 83) and an immediate fetal cause in 79.1% (n = 102) of cases. The leading underlying causes of stillbirth were maternal hypertensive disorders (16.3%), placental separation and hemorrhage (14.0%), and chorioamnionitis (10.9%). The leading immediate causes of fetal death were antepartum hypoxia (35.7%) and fetal infection (37.2%), including due to Escherichia coli (16.3%), Enterococcus species (3.9%), and group B Streptococcus (3.1%). Conclusions In this pilot, proof-of-concept study, focused investigation of stillbirth provided granular detail on the causes thereof in an LMIC setting, including provisionally highlighting the largely underrecognized role of fetal sepsis as a dominant cause.

scholarly journals Potential of Minimally Invasive Tissue Sampling for Attributing Specific Causes of Childhood Deaths in South Africa: A Pilot, Epidemiological Study

2019 ◽  
Vol 69 (Supplement_4) ◽  
pp. S361-S373 ◽  
Author(s):  
Richard Chawana ◽  
Vicky Baillie ◽  
Alane Izu ◽  
Fatima Solomon ◽  
Quique Bassat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Diarrheal Disease ◽  
Respiratory Infections ◽  
Clinical Information ◽  
International Classification Of Diseases ◽  
Community Acquired Pneumonia ◽  
Microbial Culture ◽  
Tissue Sampling ◽  
Classification Of Diseases ◽  
Syncytial Virus

Abstract Background Current estimates for causes of childhood deaths are mainly premised on modeling of vital registration and limited verbal autopsy data and generally only characterize the underlying cause of death (CoD). We investigated the potential of minimally invasive tissue sampling (MITS) for ascertaining the underlying and immediate CoD in children 1 month to 14 years of age. Methods MITS included postmortem tissue biopsies of brain, liver, and lung for histopathology examination; microbial culture of blood, cerebrospinal fluid (CSF), liver, and lung samples; and molecular microbial testing on blood, CSF, lung, and rectal swabs. Each case was individually adjudicated for underlying, antecedent, and immediate CoD by an international multidisciplinary team of medical experts and coded using the International Classification of Diseases, Tenth Revision (ICD-10). Results An underlying CoD was determined for 99% of 127 cases, leading causes being congenital malformations (18.9%), complications of prematurity (14.2%), human immunodeficiency virus/AIDS (12.6%), diarrheal disease (8.7%), acute respiratory infections (7.9%), injuries (7.9%), and malignancies (7.1%). The main immediate CoD was pneumonia, sepsis, and diarrhea in 33.9%, 19.7%, and 10.2% of cases, respectively. Infection-related deaths were either an underlying or immediate CoD in 78.0% of cases. Community-acquired pneumonia deaths (n = 32) were attributed to respiratory syncytial virus (21.9%), Pneumocystis jirovecii (18.8%), cytomegalovirus (15.6%), Klebsiella pneumoniae (15.6%), and Streptococcus pneumoniae (12.5%). Seventy-one percent of 24 sepsis deaths were hospital-acquired, mainly due to Acinetobacter baumannii (47.1%) and K. pneumoniae (35.3%). Sixty-two percent of cases were malnourished. Conclusions MITS, coupled with antemortem clinical information, provides detailed insight into causes of childhood deaths that could be informative for prioritization of strategies aimed at reducing under-5 mortality.

scholarly journals Bone density and depression in premenopausal South African women: a pilot study

2010 ◽  
Vol 13 (1) ◽  
Author(s):  
C Govender ◽  
AME Du Plessis ◽  
P Bipath ◽  
D Povey ◽  
G Viviers ◽  
...  
Keyword(s):  
Pilot Study ◽  
Bone Density ◽  
South African ◽  
African Women ◽  
South African Women

scholarly journals Osteoporosis in Black South African Women: Myth or Reality

2017 ◽  
Vol 5 (2) ◽  
pp. 111-116
Author(s):  
Lineo Matsela ◽  
Olakunle Towobola ◽  
Ephraim T Mokgokong
Keyword(s):  
South Africa ◽  
Postmenopausal Women ◽  
South African ◽  
African Women ◽  
World Health ◽  
Mineral Density ◽  
Black South African ◽  
Significant Difference ◽  
Perimenopausal Women ◽  
South African Women

ABSTRACT Aim The study was conducted to ascertain the severity of the occurrence of osteopenia and osteoporosis among black South African women during their transition from premenopause to postmenopause. Materials and methods Sixty-eight black South African women, aged between 32 and 77 years, residents of three districts of Pretoria, South Africa, constituted the participants in the study. Following informed consent, the women were randomly recruited and assessed for age, medical history, and lifestyle data. Each woman was classified as being premenopause, perimenopause, or postmenopause based on her menstrual history within the preceding 12 months to the study. Bone mineral density (BMD) of the L1-L4 vertebrae and the hip vertebrae was measured using dual-energy X-ray absorptiometry (DEXA) method and the results were expressed as T-scores based on World Health Organization (WHO) classifications for osteopenia and osteoporosis. Results Osteopenia was found in 2 of the 8 (25%) premenopausal women aged 37 and 38 years. Similarly, 2 perimenopausal women out of the 28 (7.1%), aged 45 and 49 years, also had evidence of osteopenia. Among 32 postmenopausal women, 11 (34.4%) had osteopenia and 8 (25%) were diagnosed with osteoporosis. There was no statistical significant difference (p = 0.0832) for osteopenia between premenopausal and perimenopausal women. However, the incidence of osteopenia became statistically significant between premenopausal and postmenopausal women (p = 0.0137), and between perimenopausal and postmenopausal women (p = 0.0218). Conclusion Even from this small cohort study, it is apparent that osteoporosis does afflict postmenopausal black South African women. The need to institute screening strategies and appropriate guidance to prevent osteoporosis in these women is strongly advocated. Clinical significance The study draws special attention to the necessity to investigate black South African women for early detection of osteopenia and osteoporosis. How to cite this article Matsela L, Towobola O, Mokgokong ET. Osteoporosis in Black South African Women: Myth or Reality. J South Asian Feder Menopause Soc 2017;5(2):111-116. Source of support The authors herewith express their gratitude to both MSD (South Africa) and the South African Menopause Society for their financial donations, which enabled the DEXA evaluations of participants in this study.

Evaluation Of The AMLprofiler in The South African Context: Report On Preliminary Findings

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5590-5590
Author(s):  
Marco Alessandrini ◽  
Emil Beltchev ◽  
Roger Pool ◽  
Michael Pepper
Keyword(s):  
South Africa ◽  
Bone Marrow ◽  
South African ◽  
Peripheral Blood ◽  
Genetic Alterations ◽  
Molecular Biomarkers ◽  
World Health ◽  
Molecular Testing ◽  
The South ◽  
The Public

Abstract Acute myeloid leukaemia (AML) is typified by diverse genetic abnormalities and marked heterogeneity in both response to treatment and survival. Diagnosis is made according to a World Health Organisation classification system, whereby clinicians are able to categorise cases into favourable, intermediate and poor risk groups. This has recently been augmented by several novel molecular biomarkers, such as genetic alterations of NPM1 and CEBPA that infer a favourable prognosis, and increased expression levels of BAALC and EVI1 that infer an unfavourable prognosis. Molecular investigations for the prognostic stratification of AML are limited in South Africa, and only FLT3 and NPM1 variants are requested for a minority of cases. The AMLprofilerTM from Skyline Diagnostics is a novel diagnostic microarray that incorporates seven molecular variables used to predict post therapy survival rates. The goals of the study are to evaluate the benefits of the AMLprofilerTM in the South African setting. Bone marrow was collected from patients diagnosed with de novo AML, based on a blast count of greater 20%, and material was submitted for routine cytogenetic, FISH and molecular testing. Although the AMLprofilerTM is not indicated for diagnostic use on peripheral blood, matching samples were collected where possible, and also in cases where clinicians were unable to obtain bone marrow from patients. RNA was isolated within 48 hours of collection and the samples prepared for analysis on an Affymetrix microarray platform (GeneChip® System 3000Dx v.2). Results were investigated for concordance with routine testing methods and value-add with respect to cost, time and the personnel required. Samples from both the public and private sectors are being collected, for which logistical aspects differ significantly and are considered for the comparisons. A total of 65 AML patient samples are planned for collection, of which 50 will be from bone marrow and 15 from peripheral blood. To date, 22 samples have been assayed to completion and reported. The sample thus far is comprised of 68% Caucasian and 32% Black African samples; 72% male and 25% female; 90% from the public sector and 10% from private. Results indicate that several samples were determined to be positive for molecular biomarkers not routinely investigated in South Africa, including CEBPA, BAALC and EVI1. Interestingly, none of the samples were reported to harbour the favourable prognostic marker NPM1, which is reported globally at frequencies ranging from 25-40%. Reporting via standard approaches varies in cost and time to result, which ranges from five to 27 days. Implementation of the AMLprofilerTM would offer an opportunity to report in a consistent manner and price, and in a more reliable time frame. Preliminary data indicates benefit for use of AMLprofilerTM in South Africa, and would allow for improved risk stratification of patients with AML. The comprehensive nature of the microarray and the considerable decreased time to result are factors that could potentially lead to more rapid initiation of appropriate therapy for patients with AML. Disclosures: No relevant conflicts of interest to declare.

THE SINS OF THE FATHER: GENDER- BASED VIOLENCE IN POST-APARTHEID SOUTH AFRICA

2017 ◽  
Vol 14 (2) ◽  
pp. 57-70 ◽  
Author(s):  
Lyn Snodgrass
Keyword(s):  
South Africa ◽  
Black Women ◽  
South African ◽  
African Women ◽  
Gender Based Violence ◽  
Political Issues ◽  
Race And Gender ◽  
Gender Based ◽  
And Gender ◽  
South African Women

This article explores the complexities of gender-based violence in post-apartheid South Africa and interrogates the socio-political issues at the intersection of class, ‘race’ and gender, which impact South African women. Gender equality is up against a powerful enemy in societies with strong patriarchal traditions such as South Africa, where women of all ‘races’ and cultures have been oppressed, exploited and kept in positions of subservience for generations. In South Africa, where sexism and racism intersect, black women as a group have suffered the major brunt of this discrimination and are at the receiving end of extreme violence. South Africa’s gender-based violence is fuelled historically by the ideologies of apartheid (racism) and patriarchy (sexism), which are symbiotically premised on systemic humiliation that devalues and debases whole groups of people and renders them inferior. It is further argued that the current neo-patriarchal backlash in South Africa foments and sustains the subjugation of women and casts them as both victims and perpetuators of pervasive patriarchal values.

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