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Biomedical subjects

I Niemand

Publications and source records attributed to I Niemand.

13 recordsLinked to original sources
PubMed2002

Factors influencing a mother's choice of feeding after discharge of her baby from a neonatal unit.

OBJECTIVE: To assess feeding methods chosen by mothers of babies who spent time in a neonatal unit. Factors influencing this decision were investigated. DESIGN: Descriptive study. METHODS: Mothers were interviewed on the day they took their babies home. Basic demographic data on mother and baby were collected from the hospital records. SETTING: The neonatal unit, Pelonomi Hospital, Bloemfontein from May 1996 to May 1998. SUBJECTS: Eighty-one mothers of babies admitted to the neonatal unit. OUTCOME MEASURES: At discharge 60% of mothers intended to breast-feed their babies exclusively the next day. The mother's decision to breast-feed her baby at home was significantly associated with her decision before delivery (P = 0.0050). Other factors positively associated with the decision to breast-feed exclusively at home were a significantly higher birth weight of the baby (P < 0.0008) and gestational age of the baby (P < 0.0005). The only hospital practice positively associated with this decision was the frequency with which mothers saw their babies during their stay in the unit (P = 0.0153). Mothers' knowledge of how to increase breast-milk supply was very poor. CONCLUSIONS: Infants with a lower weight and gestational age, who stayed in the unit longer, were less likely to be breast-fed after discharge from the neonatal unit. The mothers' experience in the unit did not seem to alter their choice of feeding method decided upon before delivery. This suggests that efforts to promote breast-feeding in the neonatal unit were either ineffectual or inadequate. In order to remedy this situation it is necessary to keep the mother-infant pair together (lodger mothers) and to promote breast-feeding before and after delivery. It would also be necessary to train staff in the management of lactation problems.

Birth Weight↗
PubMed2001

Complications associated with cesarean section in HIV-infected patients.

OBJECTIVE: To document complications associated with cesarean section in HIV-infected women. METHOD: A cross-sectional study was done on 307 women who delivered by cesarean section. All these patients, irrespective of their HIV-status, were managed according to the same preset protocol. RESULT: Of the 307 women, 59 (19%) were HIV-positive. The only significant differences were a higher prevalence of positive serology for syphilis (32% vs. 12%, P=0.0014) as well as more cases of post-operative endometritis in the HIV-positive group (24% vs. 7%, P=0.0003). Post-operative endometritis was documented in 44% of HIV-infected patients with a CD4 count below 400. However, the severity of endometritis, measured by antibiotic treatment and duration of hospital stay, was similar in the two groups. Overall, there was no difference in the duration of hospital stay, post-operative anemia, wound infection, birth weight and perinatal mortality between the two groups. CONCLUSION: HIV-infected patients undergoing cesarean section are at increased risk for post-operative endometritis, but the severity of the infection is not different from that in HIV-negative patients.

Adolescent↗
PubMed2000

Speculoscopy vs. the acetic acid test for cervical neoplasia.

OBJECTIVE: To compare the specificity of speculoscopy and the acetic acid test (AAT). METHODS: A randomized controlled trial was performed on 1150 women in a primary healthcare clinic. The main end-points were the sensitivity and specificity of speculoscopy and the AAT. RESULTS: The mean age of the patients was 37.7 years in the speculoscopy group (n=545) and 37.5 years in the AAT group (n=605). Cervicography (the golden standard) was positive in 11.3% of the participants, speculoscopy in 20.4% and the AAT in 25.1%. The sensitivity, specificity and the kappa value for speculoscopy were 53.5%, 83.6% and 0.23, respectively. For the AAT, the corresponding figures were 51.1%, 77.3% and 0.15. No statistically significant differences were found between these two groups. Of clinical importance, however, was a finding that speculoscopy did not miss a single case of high grade squamous intra-epithelial lesion or cancer whilst the AAT missed five such lesions. CONCLUSION: Speculoscopy could not be shown to have an improved specificity when compared with the acetic acid test. The low specificity of both the tests will result in the referral of too many patients for colposcopy.

Acetic Acid↗
PubMed2000

Screening for cervical neoplasia during pregnancy.

OBJECTIVE: To evaluate cytology as a screening method for cervical neoplasia in pregnancy and to compare it with cervicography and the acetic acid test (AAT). METHODS: In a large antenatal clinic in South Africa, 842 women were screened utilizing cytology, cervicography and the acetic acid test simultaneously. The proportion of positive results of the different tests were compared and the agreement calculated by the kappa statistic. RESULTS: The mean age of the women was 27 years, and 12.5% smoked. Cytological smears were abnormal (low-grade squamous intra-epithelial lesion and higher degrees of abnormality) in 1.4% of cases, cervicography in 6.3% and the AAT in 14.3% (P = 0.5400). Kappa values were as follows: cytology vs. cervicography 0.01, cytology vs. AAT 0.0 and cervicography vs. AAT 0.2. CONCLUSIONS: As a result of cytology's rather low yield and the small measure of agreement between the tests, cytology should be supplemented by an additional screening test in pregnancy.

Adolescent↗
PubMed1999

Review of the granulosa-theca cell tumors from the emil Novak ovarian tumor registry.

OBJECTIVE: Our purpose was to review patients with granulosa and theca cell tumors as filed in the Emil Novak Ovarian Tumor Registry. STUDY DESIGN: Our study was a descriptive, retrospective study of 454 case records. RESULTS: The reviewed diagnoses were for 97 patients with granulosa cell tumors, 116 with theca cell tumors, and 97 with granulosa-theca cell tumors. The remaining cases (n = 144) were reclassified as "nonspecific" gonadal stromal tumors (n = 61), luteomas of pregnancy (n = 7), and 76 "other" cases. These included poorly differentiated cancer, metastatic cancer, mixed mesodermal tumors, and sarcomas. The tumor-related mortality rate for the 310 patients with granulosa, theca, and granulosa-theca cell tumors was 7% (37.3% for granulosa cell tumors only). The surgical stage of disease was the most significant prognostic factor, with a mortality rate of at least 40%, given that the tumor had spread beyond the ovary. CONCLUSION: Because the differential diagnoses of particularly granulosa cell tumors included several conditions with an extremely poor prognosis, an accurate histologic diagnosis is crucial.

Diagnosis, Differential↗
PubMed1999

Vaginitis, cervicitis, and cervical length in pregnancy.

OBJECTIVE: We sought to determine the possible association among vaginitis, cervicitis, and cervical length in pregnancy. STUDY DESIGN: Primigravid volunteers, between 20 and 36 weeks' gestation (n = 210), were examined. Vaginitis was diagnosed by pH determination and wet mount smear, cervicitis was diagnosed by cervicography, and cervical length was diagnosed by vaginal ultrasonographic measurement. Patients with both vaginitis and cervicitis (n = 70) were compared with those without any trace of infection (n = 23). The remainder (n = 117) had variable degrees of infection and were excluded. RESULTS: The mean gestational age was 28.3 weeks. No significant association was found among vaginitis, cervicitis, and cervical length. In the infection group (n = 70), however, a significant association between an elevated vaginal pH (>5) and a shortened cervical length (r = 0.29) was noted. CONCLUSION: No significant association exists among vaginitis, cervicitis, and cervical length, but in patients with clinical signs of infection, an elevated pH appears to be associated with a decreased cervical length.

Adult↗
PubMed1998

Granulosa and theca cell tumors in children: a report of 17 cases and literature review.

The files of the Emil Novak Ovarian Tumor Registry (ENOTR) were searched for granulosa and theca cell tumors in children aged 12 years and less. In addition, an extensive literature search was done for English publications on children with these tumors aged 10 years or less. Of the 17 children from the ENOTR, 5 had adult-type granulosa cell tumors, 6 had juvenile granulosa cell tumors, and 1 had a luteinized granulosa cell tumor. In addition, there were three cases with gonadal stomal tumors, one theca cell tumor, and one granulosa-theca cell tumor. Precocious pseudopuberty was present in 70 percent of the children, abdominal pain in 24 percent, and ascites in 18 percent. The literature review revealed a tumor-related mortality rate of 9 percent (based on 163 cases with granulosa cell tumors, including the juvenile type). Some of these tumors are large with acute pain, but nevertheless, the prognosis is good, particularly in cases with precocious puberty. Treatment can be conservative.

Adolescent↗
PubMed1997

Reregistration of gynaecologists in South Africa--results of a 1-year trial run.

OBJECTIVE: Evaluation of an Australian system of reregistration with recommendations for a possible future South African system. DESIGN: Cohort descriptive study. SETTING: Gynaecologists from both private and full-time academic practices. PARTICIPANTS: One hundred and eighty volunteers participated for a period of 1 year. INTERVENTION: Each participant had to obtain a minimum of 25 points and an additional subminimum in at least two of the following practice-related categories: audit, continuing medical education (CME), self-study and research or tuition. OUTCOME MEASURES: Compliance with the rules of the system and participants' comments. RESULTS: Ten of the 180 volunteers withdrew from the study. Only 42% of the remaining 170 participants returned their logbooks and a mere 32% their self-study questionnaires. The majority were in favour of self-study programmes or CME as future methods of reregistration. CONCLUSION: A future system of reregistration must be based on self-study programmes and a well-structured and relevant CME curriculum.

Attitude of Health Personnel↗
PubMed1995

Reregistration of gynaecologists in South Africa--the profession's opinion.

OBJECTIVE: Testing of the profession's opinions and attitudes with regard to a possible reregistration system. METHODS: A questionnaire was sent to all the gynaecologists in South Africa to test their opinions and attitudes with regard to reregistration. RESULTS: After two mailings, 62.4% of the 603 gynaecologists had responded. Seventy per cent of the respondents were in private practice while 19% were in full-time academic positions. More than two-thirds (68%) of the respondents resided in a city, close to a medical school. Although 74% were in favour of the implementation of a reregistration system, only 56% were enthusiastic about it. Congress attendance and self-study programmes were the categories in which more than 85% of the respondents would be able to earn points. The general feeling was that such a system should be governed by the profession. CONCLUSIONS: The profession was in favour of a system of reregistration, but great concern was expressed at the contents of such a programme and the manner in which it would be governed.

Attitude of Health Personnel↗
PubMed1995

Maternal deaths in Bloemfontein, South Africa--1986-1992.

OBJECTIVE: Determination of the maternal mortality ratio and the main causes of maternal death. SETTING: Pelonomi Hospital, a tertiary care and referral hospital in Bloemfontein. METHODS: Review of prospectively completed structured questionnaires on all maternal deaths from 1986 to 1992. RESULTS: The maternal mortality ratio at our institution was 171 per 100 000 live births. Haemorrhage (25%), infection (24%) and hypertensive disease (18%) were the most important causes of death. Seventy-one per cent were direct obstetric deaths and 23% indirect; in the remaining 6%, the cause was uncertain. Of all deaths, 35% were considered preventable. CONCLUSIONS: The maternal mortality ratio has decreased since our previous report for the period 1980-1985, and haemorrhage has replaced infection as the leading cause of death.

Adolescent↗
PubMedDate not supplied

Effects of dilute acetic acid on the cervical smear.

OBJECTIVE: To evaluate the effect of 5% acetic acid on the cells and cellular content of cervical smears. STUDY DESIGN: A randomized, controlled trial was performed with 42 patients in each group. The study group received acetic acid application to the cervix followed by a smear, while the sequence was reversed in the control group. Cytologic evaluation of the smears was done without knowledge of the group allocation in each case. RESULTS: The group in which acetic acid was applied before the smear was taken showed significantly poorer staining properties of the smear (P < .0001) and also significantly lower cellular content (P = .0006). CONCLUSION: Acetic acid has adverse effects on the cervical smear and should be applied after the smear is taken.

Acetic Acid↗