Improving Diversity in Learning Activities in a Teaching Curriculum in Higher Medical Education.

The growing demand for medical professionals in undergraduate and graduate/postgraduate medical education to attain comprehensive health training has not abated and necessitates the development of curricula encompassing relevant issues pertaining to clinical practice as well as the educational context. Therefore, diversity in learning activities should be embedded in a teaching curriculum to achieve the required competencies. This includes considering at least the following during the design and analysis of a teaching curriculum: Harden's ten questions to be posed when designing a curriculum; Canadian Medical Education Directives for Specialists (CanMEDS) competency framework which has been approved by the Royal College of Physicians and Surgeons of Canada; 21st-century skills; Diana Laurilliard's conversational framework; and general quality measures to improve diversity in a teaching curriculum.

Caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a psychiatric tertiary hospital in South Africa.

Background: Chronic mental illnesses such as schizophrenia affect patients' functioning, making caregiving necessary although burdensome.

Aim: This study aimed to determine caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a Psychiatric Outpatient Department (POD).

Setting: Tertiary hospital in Northern Pretoria, South Africa.

Preventing maternal morbidity and mortality from preeclampsia and eclampsia particularly in low- and middle-income countries.

Preeclampsia (PE) is a complex heterogeneous disorder with overlapping clinical phenotypes that complicate diagnosis and management. Although several pathophysiological mechanisms have been proposed, placental dysfunction due to inadequate remodelling of uterine spiral arteries leading to mal-perfusion and syncytiotrophoblast stress is recognized as the unifying characteristic of early-onset PE. Placental overgrowth and or premature senescence are probably the causes of late-onset PE.

Necrotising fasciitis presenting as a blister: A case report on improving early recognition of surgical site infection following caesarean delivery.

Early recognition and treatment of surgical site infection (SSI) may prevent devastating consequences of wound infections complicating caesarean delivery (CD). SSI complicates 3-15% of CDs; among the severe forms are necrotising fasciitis (NF) and clostridial gas gangrene, with the latter being the most rapidly spreading and fatal. The aim of this report is to improve early recognition of SSI complicating CD.

Pregnancy outcomes of women presenting with stage 1 hypertension during the first prenatal clinic visit before 20 gestational weeks.

Objective: To determine the pregnancy outcomes of women who had 2017 American College of Cardiologists stage 1 hypertension during the first prenatal clinic visit before 20 gestational weeks in a tertiary hospital in South Africa.

Study Design: A retrospective cohort study involving the review of medical records of 127 participants with stage 1 hypertension and 128 control with blood pressure (BP) less than stage 1 hypertension before 20 weeks' gestation.

Main Outcome Measures: The primary outcome measure was progression to stage 2 hypertension (BP ≥ 140/90 mmHg).

Teaching Philosophy in a Teaching Portfolio: Domain Knowledge and Guidance.

Background: Teaching philosophy defines the beliefs and ideas that guide practices in teaching and learning. Writing teaching philosophy statements for promotion or employment is daunting for inexperienced new faculty members.

Aim: This article aims to discuss the principles of relevant educational domains that academics need to know to be well informed when writing their teaching philosophy.

The role of genetics in maternal susceptibility to preeclampsia in women of African ancestry.

Racial disparities exist in the prevalence of preeclampsia (PE), with women of African ancestry suffering the highest rates of morbidity and mortality. Genetic changes may play a role in the preponderance of PE among women of African ancestry. This review discusses 30 genes with variants that have been studied in PE in women of African ancestry.

Prevention of surgical site infection and sepsis in pregnant obese women.

Obesity is a major determinant of health outcomes and is on the increase in women worldwide. It predisposes to surgical site infection (SSI). Risk factors for the SSI include extremes of age, smoking, comorbidities such as hypertension and diabetes, inappropriate vertical abdominal and or uterine wall incisions, increased operating time, subcutaneous layer of 3 cm or more, and unnecessary use of subcutaneous drain.

Inequality in health care services in urban and rural settings in South Africa.

In low- and middle-income countries, urban and rural settings are distinct communities with the latter being more likely to have limited resources, particularly in health care services. We assessed the inequality in health care services in urban and rural settings in South Africa, highlighting the disparities between public and private health services, given that the latter are located mainly in urban settings. Rural settings suffer the highest inequality in the availability of drugs and supplies, overcrowding of health care facilities, delays in transporting patients, inadequate emergency medical services, and lack of experienced health care professionals.

Obstetric rectal buttonhole tear and a successful three-layer repair: A case report.

An obstetric rectal buttonhole tear (ORBT) is a rare obstetric complication with only 21 cases reported in the literature. The choice of two- or three-layer repair of ORBT is controversial. In this case, the author describes (with high-quality images) an ORBT repaired in three layers in order to provide clinical lessons to healthcare professionals involved in obstetrical care.

Atypical preeclampsia-eclampsia syndrome at 18 weeks of gestation: A case report.

Background: Preeclampsia is currently defined as new-onset hypertension occurring with significant proteinuria, maternal organ dysfunction, and/or placental insufficiency at or after 20 weeks of gestation. In the majority of cases, it occurs before 48 h postpartum. Therefore, preeclampsia occurring before 20 weeks of gestation or after 48 h postpartum is atypical and may not be easily diagnosed.

Renal cyst mimicking hydronephrosis after uterine artery ligation for postpartum haemorrhage.

Background: The proximity of the uterus and the cervix to the urinary tract predisposes the latter to injury during obstetrical and gynaecological surgical procedures. Following a difficult surgical procedure on the lower uterine segment and or adnexa, urinary tract injury should be excluded.

Methods: A booked 39-year-old G3P2 lady who suffered an ischaemic stroke in the index pregnancy had a caesarean delivery at 39 weeks of gestation and sustained an extensive tear that extended inferiorly on the left lateral aspect of the uterus and this resulted in postpartum haemorrhage.

Multiple uterine perforations during manual vacuum aspiration: the need to increase the clinical awareness of attending healthcare professionals.

Background: The risk of uterine perforation during manual vacuum aspiration (MVA) is reduced by using Karman cannula (which has a rounded tip) during the procedure.

Methods: A 35-year-old multigravida at 13 gestational weeks presented with vaginal bleeding of a day duration and ultrasound evidence of retained products of conception suggestive of incomplete miscarriage. The patient was rhesus D positive and stable.

Surgical excision of benign spindle cell neoplasm of the cervix predating miscarriage due to cervical insufficiency: A case report.

This case report is on cervical spindle cell neoplasm and complications of its excision. A 34-year-old multiparous woman presented with a one-year history of mild to moderate non-radiating lower abdominal pain and a sensation of a mass in the vagina when urinating. These symptoms were associated with a recurrent foul-smelling yellow vaginal discharge which was unresponsive to antibiotic therapy prescribed at a primary healthcare clinic.

COVID-19 death: A novel method of improving its identification when a patient has multiple diagnoses.

Assigning a primary cause of death to a deceased patient who had multiple principal diagnoses including coronavirus disease 2019 (COVID-19) is challenging because of the difficulty in selecting the most appropriate cause. To proffer a solution, the authors reviewed the literature on assigning a primary cause of death. In 2015, the Nnabuike-Jagidesa (NJ) model II was devised to improve the International Classification of Diseases and related health problems, 10th revision (ICD-10) guideline on how to assign a primary cause of death.

Childbirth resulting in traumatic stretching and prolapsing of the anterior lip of the cervix outside the vagina: A case report.

Background: We report on childbirth trauma resulting in a rare stretching and prolapsing of the anterior lip of the cervix beyond the vaginal introitus, and describe the management

Case Presentation: A 17-year-old primigravida who had normal antenatal care delivered a live normal male baby weighing 3600 g at 39 weeks of gestation. The patient sustained a birth trauma resulting in the anterior lip of the cervix becoming stretched and prolapsing outside the vagina. There was an associated uterovaginal prolapse (Pelvic Organ Prolapse Quantification System grade 2).

Blood pressure control in hypertensive patients attending a rural community health centre in Gauteng Province, South Africa: A cross-sectional study.

Background: Hypertension is a major cause of morbidity and mortality and its control has important clinical and socio-economic benefits to the family and community. Unfortunately, the extent of blood pressure (BP) control and its potential predictors in hypertensive patients in many rural communities in low-resource settings are largely unknown. This study assessed the extent of uncontrolled BP and its predictors amongst hypertensive patients accessing primary health care in a rural community in South Africa.

Fatal pulmonary oedema associated with severe pre-eclampsia: challenges and lessons.

Pre-eclampsia complicated by pulmonary oedema, severe hypertension, tachycardia and desaturation is a devastating condition. A comprehensive understanding of the aetiopathogenesis during such an emergency is challenging in the absence of functional and responsive point-of-care imaging, and laboratory and other critical-care services. An unbooked 26-year-old gravida 3 para 1+1 presented to a primary healthcare clinic with features of pre-eclampsia, severe hypertension and pulmonary oedema.