Paul Swart

Bio: Paul Swart is an academic researcher from University of Pretoria. The author has contributed to research in topics: Luteal phase & Menstrual cycle. The author has an hindex of 4, co-authored 7 publications receiving 48 citations.

Estrogen causes ultrastructural changes of fibrin networks during the menstrual cycle: A qualitative investigation

Abstract: Introduction Hormonal fluctuations may influence fibrin structure. During the menstrual cycle, plasma fibrinogen levels change, mainly due to the variations of estrogen. Throughout the menstrual cycle estrogen levels peak twice, first during the mid-follicular phase and then a lower second peak during the luteal phase. Materials and methods In order to investigate the possible changes in the fibrin network throughout the menstrual cycle, the fibrin network ultrastructure of six healthy female participants were studied at different intervals in the menstrual cycle where differences in estrogen levels are prevalent. Blood plasma smears were prepared for scanning and transmission electron microscopy analysis. Results The external and internal structure of the fibrin fibers showed different morphologies throughout the menstrual cycle. The fibrin fibers were smooth during days 1–5. However, during days 12–14 of the menstrual cycle the fibrin fiber morphology started to change, becoming less smooth. During the luteal phase of the cycle (days 20–25), the network appears sticky, where the minor, thin fibers are more prominent between the thick fibers when compared to the menstrual phase. Conclusion The two estrogen peaks of the menstrual cycle coincide with the changes seen in the current qualitative research, where the fibrin morphology changes during the same time as the estrogen peaks occur. Purified fibrinogen confirmed that it is indeed estrogen that causes the altered fibrin network morphology. This research is the first to show ultrastructural changes in fibrin fiber morphology resulting from estrogen changes during the menstrual cycle. Microsc. Res. Tech. 77:594–601, 2014. © 2014 Wiley Periodicals, Inc.

Wet-smear diagnosis of genital schistosomiasis.

Abstract: The diagnosis of genital schistosomiasis can be made only on the presence of ova on histological or cytological material. In 7 out of 8 consecutive cases of genital schistosomiasis we were able to make the diagnosis on a wet-smear preparation in an outpatient clinic.

Part 2: Ultrastructural changes of fibrin networks during three phases of pregnancy: A qualitative investigation

Abstract: Introduction: Normal pregnancy is characterized by significant alterations in the haemostatic system accompanied by an augmented risk of thrombosis. Materials and methods: The fibrin network ultrastructure of different phases of pregnancy, namely early pregnancy (week 8–14), late pregnancy (week 36–40) as well as post-partum (week 6–8 after birth) were compared with nonpregnant fibrin networks as well as each other to establish whether differences in fibrin network morphology exist during pregnancy. Scanning electron microscopy was employed to analyse fibrin network morphology. Results: The fibrin networks from all phases of pregnancy appeared similar to each other, exhibiting prominent coagulant formation, an increase in the formation of minor, thin fibers, and the presence of granular globules. All three phases, however, differ from the typical fibrin network ultrastructure exhibited by the fibrin networks from nonpregnant individuals. The increase in estrogen associated with pregnancy may cause the increase in coagulation factors and ultimately the prothrombotic state characteristic of pregnancy. Conclusions: Since no differences were apparent between the different phases of pregnancy it suggests that activation of the coagulation system commences with pregnancy and this pro-thrombotic state continues till at least 8 weeks after birth. These results may shed light on possible pathological mechanisms employed in the development of abnormal or ailing pregnancy. Microsc. Res. Tech. 77:602–608, 2014. © 2014 Wiley Periodicals, Inc.

Symptomatic pelvic organ prolapse: Experience at a tertiary urogynaecology clinic

Abstract: Background. Pelvic organ prolapse (POP) is a common reason for gynaecological consultation, especially in the elderly. Associated symptoms have been shown to negatively affect bladder, bowel and sexual function, as well as general quality of life. Treatment options include either surgical repair with mesh or native tissue, or conservative management with vaginal pessaries. There is a lack of data regarding POP in South African (SA) women. Objectives. To determine the demographic characteristics in patients presenting with symptomatic POP to a tertiary urogynaecology clinic, and to compare patients who opt for surgical treatment with those who request vaginal pessary insertion. Methods. The study was conducted at the urogynaecology clinic at Steve Biko Academic Hospital, Pretoria, SA. Demographic information was recorded after a detailed history, physical examination and completion of a self-administered symptom questionnaire. Results. A total of 305 patients were included in this study. The mean age was 62 (range 24 - 96) years and the mean vaginal parity was 3.7 (range 0 - 13); 147 patients opted for surgical intervention and 158 for pessary treatment. Cystocoele was the most common type of prolapse found on clinical examination. One-quarter of patients were sexually active (25.5%, n=242). Awareness and visualisation or feeling of a lump was the most common symptom reported. Age (p=0.004) and mean vaginal parity (p=0.003) were statistically significant in the pessary group. Finding of a cystocoele was significantly greater in patients who opted for pessary insertion (p=0.005). Conclusion. Patients who opt for vaginal pessary insertion are older and more vaginally parous than patients who opt for surgical intervention, and cystocoele was statistically more significant in women opting for pessary insertion.

PREMENSTRUAL SYNDROMES – An Approach to Diagnosis and Treatment

Abstract: The premenstrual syndromes are characterised by physical and/or affective symptoms that occur in the luteal phase of the menstrual cycle. Symptoms and severity of symptoms vary and therefore the impact of these syndromes on psychosocial and economical aspects is difficult to quantify and generalise.

Association between genital schistosomiasis and HIV in rural Zimbabwean women.

Abstract: The objective was to determine the association between female genital Schistosoma haematobium infection and HIV. A cross-sectional study with a 1-year follow-up. Gynecological and laboratory investigations were performed for S. haematobium and HIV. Sexually transmitted infections demographic and urogenital history were analysed as confounders. The participants were 527 sexually active non-pregnant non-menopausal women between the ages of 20 and 49 years. The setting was a rural Zimbabwean community where S. haematobium related lesions were found in 46% of the women HIV in 29% and herpes simplex type-2 (HSV-2) in 65%. In permanent residents (> 3 years residency) HIV was found in 41% (29/70) of women with laboratory proven genital schistosomiasis as opposed to 26% HIV positive (96/375) in the schistosomal ova negative group [odds ratio (OR) 2.1; 95% confidence interval (CI) 1.2-3.5; P = 0.008. In multivariate analysis S. haematobium infection of the genital mucosa was significantly associated with HIV seropositivity (adjusted OR 2.9; 95% CI 1.11-7.5; P = 0.030). All seven women who became HIV positive during the study period (seroincidence 3.1%) had signs of S. haematobium at baseline. In accordance with other studies HIV was significantly associated with HSV-2 (OR 3.0; 95% CI 1.7-5.3; P < 0.001) syphilis and human papillomavirus. The highest HIV prevalence (45%) was found in the 25-29 years age group. Women with genital schistosomiasis had an almost three-fold risk of having HIV in this rural Zimbabwean community. Prospective studies are needed to confirm the association. (authors)

Simple clinical manifestations of genital schistosoma haematobium infection in rural zimbabwean women

Abstract: Up to 75% of women with urinary schistosomiasis have Schistosoma haematobium ova in the genitals. This study aimed to describe the prevalence of gynecologic S. haematobium infection and to differentiate the disease from sexually transmitted infections (STIs). Gynecologic and laboratory investigations for S. haematobium and STIs were performed in 527 women between the ages of 20 and 49 in rural Zimbabwe. Genital homogenous yellow and/or grainy sandy patches, the commonest type of genital pathology, were identified in 243 (46%) women. Grainy sandy patches were significantly associated with S. haematobium ova only. Genital S. haematobium ova was also significantly associated with homogenous yellow sandy patches, mucosal bleeding, and abnormal blood vessels. The presence of ova was not a predictor for ulcers, papillomata, leukoplakia, polyps, or cell atypia. Mucosal sandy patches seem to be pathognomonic for S. haematobium infection in the female genitals. Coexistence of ova and other lesions may not be causal.