Traumatic vulvar hematomas. Assessing and treating nonobstetric patients

Management of the vast majority of vulvar hematomas is conservative. Most resolve spontaneously when simple measures are taken. Serial examinations are necessary to distinguish uncomplicated hematomas from those requiring surgery. The clinician must also be vigilant for the possibility of sexual abuse and respond with appropriate workup and referral if this situation is suspected.     

Perceived causes of obstetric fistulae from rural southern Tanzania

Background

Although the magnitude of obstetric fistulae (OF) is reported to have decreased in industrialized countries, it is still a major problem in developing countries. While the main cause of OF is prolonged obstructed labour without prompt medical attention, misconceptions about OF exist.

Objective

To determine awareness and perceived causes of OF in rural areas of southern Tanzania.

Methods

A cross-sectional survey was conducted among women of reproductive age, men, health personnel, birth attendants, community leaders and OF cases using qualitative and quantitative approaches.

Results

More than 60% of interviewees reported to be aware of OF with a connotation of urine in the names. Perceived causes of OF include sorcery, prolonged labour, delivering by operation where doctors/nurses make mistakes perforate the urinary bladder, physique of the expecting mother, poor skills of doctors/nurses to conduct caesarean section, young or old age of an expecting mother and having sex before recovering from the operation.

Conclusion

Although OF is not reported to exist, most of the interviewees were aware of them. However, were few respondents are able to mention the main cause of OF. Maternal health education is important as a strategy to minimize the spread of misconceptions about causes of OF.     

Paternal age and the risk of birth defects in Norway

PURPOSE: We studied 1,869,388 births from The Medical Birth Registry of Norway to assess the effect of father's age on risks of birth defects in offspring. METHOD: Thirteen separate categories were studied including pooled categories of neural tube defects and any type of defect. We used logistic regression models to adjust for maternal age, year of birth, maternity institution, parity, and correlation between siblings. RESULTS: There was little evidence of increased risk by high paternal age for any category of defects, except for a category of "other central nervous system" where risk estimates were 2.5-fold (95% CI: 1.2-5.5) for fathers aged between 45 and 49 years compared with the reference age group (25-29 years). The risk for neural tube defects was 1.3-fold (95% CI: 1.1-1.5) when the father was aged between 20 and 24 years relative to the reference. A pattern of moderately higher risks for younger fathers was consistent for anencephaly and spina bifida. Increased risk of heart defects was also estimated among children of young fathers. CONCLUSIONS: This study does not show consistent evidence that paternal ageing is a risk for birth defects among offspring. Low paternal age, or factors associated with younger parents, may however be associated with increased risk of neural tube defects in their offspring.     

SEM observations of an IUD from a patient with Actinomyces-like organisms on papanicolaou smear

Scanning electron microscopy (SEM) was used to study an IUD from an asymptomatic patient with Actinomyces-like organisms on Papanicolaou smear and in whom Actinomyces israelii was determined to be present in cervical smears. The objective was to determine if there were any variations in surface morphology that might be correlated with the Actinomyces-like organisms. SEM revealed numerous areas of thick surface encrustation. The surface morphology of the IUD fragments showed basic similarities to the morphologies observed in other cases. Encrustations were attached to the arms and stem of the device. A unique finding was apparently biological material adherent to a fragment of encrusted material. Filamentous structures radiated perpendicularly from a central core. These filaments resembled Actinomyces-like organisms in the patient's Pap smear. Also of interest was a delicate network of hair-like structures at the bottom of a naturally occurring space in the surface encrustation.     

Suicide in the Dar es Salaam region, Tanzania, 2005

Suicide surveillance was launched at the Muhimbili National Hospital mortuary in Dar es Salaam Region, Tanzania from 1st January to 31st December, 2005 to determine its magnitude and characteristics. Following the WHO guidelines with minor modifications, information on sex, dates of birth and death, places of residence and death, occupation, reasons and means of suicide were collected. There were 65 (2.3 per 100,000 population) suicides recorded in 2005. The suicide rate for males was 3.4/100,000 and for females was 1.2/100,000 which maybe some of the lowest rates ever reported in the world. The mean age at suicide was 32.9 (SD=13.1) years. Males were about three times more likely to commit suicide as females. The main motive behind suicide was recorded for 26 (40%) victims as family-related and for 11 (17%) as health related. Although there was a wide range of ages at which people committed suicide, the average age seems to be very low. Since reasons for suicide are coated with family problems, strategies to improve awareness of psychological and mental health services and to provide alternative economic and social support networks are advocated.