Polycystic ovary syndrome and metabolic disorders: A review of the literature.

Polycystic ovarian syndrome (PCOS) is one of the most common female endocrinopathies and is a leading cause of infertility. The syndrome derives its name from the pathological appearance of the ovary in women with menstrual irregularities and hyperandrogenism. Its symptoms appear as early as adolescence in the form of amenorrhea, hirsutism and obesity. The majority of patients are overweight, obese or of normal weight, but metabolically obese. The prevalence of PCOS is on the increase and is associated with a significantly higher risk of various metabolic disorders including cardiovascular disease (CVD), Type2 diabetes (T2DM), gestational diabetes, hypercholesterolemia and different types of cancer, including endometrial and possibly ovarian cancer, especially if associated with hyperinsulinaemia. In contrast, in women with PCOS who have normal insulin levels, it is likely that genetics, inflammation, oxidative stress and possible interaction with environmental factors are present that link these women to metabolic disorders. The mechanism of PCOS is not well understood and this review aims to provide a detailed description of the mechanism underlying the development of PCOS and associated metabolic disorders with a full description of all possible scenarios associating PCOS to metabolic disorders, as well as an epidemiological overview regarding the relationship between these metabolic disorders and PCOS.

Increased Access to Antiretroviral Therapy Is Associated with Reduced Maternal Mortality in Johannesburg, South Africa: An Audit from 2003-2012.

OBJECTIVE: To assess the impact of expanded access to antiretroviral treatment (ART) on maternal mortality in Johannesburg, South Africa between 2003 and 2012. METHODS: Audit of patient files, birth registers and death certificates at a tertiary level referral hospital. Cause of death was assigned independently, by two reviewers. We compared causes of deaths and the maternal mortality ratios (MMR, deaths/100,000 live births) over three periods corresponding to changes in government policy on ART provision: period one, 2003-2004 (pre-ART); period two, 2005-2009 (ART eligibility with CD4 count <200cells/µL or WHO stage 4 disease); and period three, 2010-2012 (eligibility with CD4 count <350 cells/µL). RESULTS: There were 232 deaths and 80,376 deliveries in the three periods. The proportion of pregnant women tested for HIV rose from 43.4% in 2003 to 94.6% in 2012. MMR was 301, 327 and 232 in the three periods, (p = 0.10). The third period MMR was lower than the first and second combined (p = 0.03). Among HIV-positive women, the MMR fell from 836 in the first time period to 431 in the third (p = 0.008) but among HIV negative women it remained unchanged over the three periods, averaging 148. Even in the third period, however, the MMR among HIV-infected women was 3-fold higher than in other women. Mortality from direct obstetric causes such as hemorrhage did not decline over time, but deaths from tuberculosis and HIV-associated malignancy did. In 38.3% of deaths, women had not attended antenatal care. CONCLUSION: Higher coverage of HIV testing and ART has substantially reduced MMR in this hospital setting. Though the gap in MMR between women with and without HIV narrowed, a third of deaths still remain attributable to HIV. Lowering overall MMR will require further strengthening of HIV services, increased antenatal care coverage, and improved care for obstetric emergencies at all levels of care.

South African Menopause Society revised consensus position statement on menopausal hormone therapy, 2014.

The South African Menopause Society (SAMS) consensus position statement on menopausal hormone therapy (HT) 2014 is a revision of the SAMS Council consensus statement on menopausal HT published in the SAMJ in May 2007. Information presented in the previous statement has been re-evaluated and new evidence has been incorporated. While the recommendations pertaining to HT remain similar to those in the previous statement, the 2014 revision includes a wider range of clinical benefits for HT, the inclusion of non-hormonal alternatives such as selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors for the management of vasomotor symptoms, and an appraisal of bioidentical hormones and complementary medicines used for treatment of menopausal symptoms. New preparations that are likely to be more commonly used in the future are also mentioned. The revised statement emphasises that commencing HT during the 'therapeutic window of opportunity' maximises the benefit-to-risk profile of therapy in symptomatic menopausal women.

The obstetric face and challenge of HIV/AIDS.

The human immunodeficiency virus (HIV) pandemic is one of the most serious health crises facing the world. Of the estimated 33.2 million people living with HIV worldwide, 22.5 million (68%) live in Sub-Saharan Africa, where women of childbearing age are most severely affected. Children primarily acquire HIV infection through mother-to-child transmission. Despite recent encouraging success, low-income countries have not been able to effectively curtail transmission of HIV to the infant during or after pregnancy, resulting in about 90% of the estimated 420,000 newly infected children per annum occurring in Sub-Saharan Africa.

The use of vaginal misoprostol for second-trimester pregnancy termination in women with previous single cesarean section.

INTRODUCTION: This retrospective study reports of 85 women in the second trimester with one prior cesarean section undergoing medical abortion of a viable unwanted pregnancy using vaginal misoprostol. Two regimens that were selected in a nonrandomized manner were used. MATERIALS AND METHODS: Eighty-five women treated with vaginal misoprostol in a 3-year period were retrospectively analyzed. All received 400 mug of misoprostol initially and 22 (25.8%) aborted. Then Group A (n=43) received subsequent administration of 200 microg every 6 h, whereas Group B (n=20) received 400 microg/6 h. RESULTS: All patients aborted. The groups had no statistical difference in mean age, gravidity, parity, gestational age, and time from previous cesarean section, and there was no difference in occurrence of side effects and mean induction to abortion time interval. The lower dosage group received a median of 600 microg of vaginal misoprostol (min 600 microg to max 1000 microg). There were no uterine ruptures, need for hysterotomy, or excess bleeding in any patient. CONCLUSIONS: This is the largest series reported to date of second-trimester pregnancy termination in cases with one previous cesarean section using only vaginal misoprostol. The study shows that both used regimens are safe and equally effective. All 85 women aborted.

Detection of raised FSH levels among older women using depomedroxyprogesterone acetate and norethisterone enanthate.

The objective of this study was to investigate whether follicle-stimulating hormone (FSH) levels can be used reliably to indicate approaching menopause in older (aged 40-49), long-term users of depomedroxyprogesterone acetate (DMPA) and norethisterone enanthate (NET-EN). One-hundred and seventeen women using DMPA, 60 NET-EN users and 161 nonusers of contraception were recruited. At recruitment, serum FSH levels were measured and questions were asked regarding menopausal symptoms, menstrual cycle and date of last injection. Results of the recruitment blood test showed that 32% of the nonusers had FSH levels in the menopausal range >25.8 mIU/mL compared to 28% of the DMPA users and 9% of the NET-EN group. After adjusting for age, there was no significant difference between the 3 groups (p = 0.13). An increase of 1 year in age increased the FSH level by 3 mIU/mL (p < 0.001). All the hormonal contraceptive users were between 1 day and 12 weeks of their injection interval. Many had been using the injectable contraceptive method for over 10 years and almost all were amenorrheic at the time of recruitment. The data show that a raised FSH level can be detected during use of DMPA and NET-EN and could be used as a menopausal indicator without interrupting method use in this group of contraceptive users.