Venous malformations (VMs) are ectatic channels which arise as a result of vascular dysmorphogenesis, commonly caused by activating mutations in the endothelial tyrosine kinase receptor (TIE2)/phosphatidylinositol 3-kinase (PI3Kinase) pathway. With a prevalence of 1% in the general population, and a diverse clinical presentation depending on site, size and tissue involvement, their treatment requires a personalised and multidisciplinary approach. Larger lesions are complicated by local intravascular coagulopathy (LIC) causing haemorrhagic and/or thrombotic complications which can progress to disseminated intravascular coagulopathy (DIC). Methods We performed a literature review using a PubMed® search and identified 15 articles to include. References of these texts were examined to further expand the literature review. Principle findings: Several treatment options have been explored, including compression, sclerotherapy, laser therapy, cryoablation and surgery in addition to the management of LIC with low-molecular-weight-heparin (LMWH) and other anticoagulants. Targeted molecular therapies acting on the phosphatidylinositol 3-kinase (PI3Kinase)/Protein Kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway are newly emerging. Conclusion Despite a wealth of literature, larger, multi-centric, randomised and prospective trails are required to offer further clarification on the therapeutic management of coagulopathy control and to provide symptomatic benefit to patients with VMs. There should be efforts to provide long term follow up and to use standardised risk stratification tools and quality of life (QOL) questionnaires to aid comparison of agents and treatment protocols.
IntroductionUninterrupted access to HIV and sexual and reproductive health (SRH) services is essential, particularly in high HIV prevalence settings, to prevent unintended pregnancy and vertical HIV transmission. Understanding the challenges that COVID-19 and associated social distancing measures (SDMs) posed on health service access is imperative for future planning.MethodsThis cross-sectional study was conducted in Botswana between January–February 2021. A web-based questionnaire was disseminated on social media as part of the International Sexual Health and REproductive Health (I-SHARE) Survey. Respondents answered questions on SRH, before and during COVID-19 SDMs. Subgroup analysis and comparison of descriptive data was performed for people living with HIV (PLWH).ResultsOf 409 participants, 65 were PLWH (80% female, 20% male). During SDMs, PLWH found it more difficult to access condoms and treatment for HIV and STIs; attend HIV appointments; and maintain adherence to antiretroviral therapy. Compared to HIV-negative women, a higher proportion of women living with HIV used condoms as their primary method of contraception (54% vs. 48%), and had lower use of long-acting reversible contraception (8% vs. 14%) and dual contraception (8% vs. 16%).DiscussionMirroring global trends, COVID-19 disrupted HIV and SRH service access in Botswana. However, in high HIV-prevalence settings, disruption may more severely impact population health with disproportionate effects on women. Integration of HIV and SRH services could build health system capacity and resilience, reduce missed opportunities for delivering SRH services to PLWH and limit the consequences of future restrictions that may cause health system disruption
Introduction: Measures intended to curb COVID-19 transmission and mortality may have indirect effects on access to, provision, and uptake of essential healthcare services including sexual and reproductive health (SRH). These indirect effects may disproportionately affect women and vulnerable groups through impaired delivery of contraception, antenatal and HIV care services. In Botswana, SRH needs were significant prior to the onset of the COVID-19 pandemic, with a high HIV prevalence, high rates of unintended pregnancy and a high maternal mortality ratio. We aimed to understand the impact of COVID-19 restrictions on SRH access and provision in Botswana. Methods: This observational, cross-sectional study was conducted in Botswana over a 5-week period in early 2021. Data were collected through an online survey disseminated as part of the International Sexual Health and REproductive Health (I-SHARE) Survey. Respondents answered questions on SRH, including sexual behaviours, access to contraception, antenatal and postnatal care and HIV management, in the 3 months before and during Botswana’s COVID-19 restrictions. Results: 409 participants (82% female) completed the survey. 87% (n = 356) reported following COVID-19 restrictions ‘a lot’ or ‘very strictly’. 54% (n = 221) reported worsening of their household economic situation since the onset of COVID-19 restrictions, and a quarter reported a relationship breakdown with their partner. Since the onset of COVID-19 restrictions, respondents reported difficulties in accessing contraception (15%); STI/HIV treatment (15%) and maternity services (29%). Reasons for hindered access to SRH services included movement restrictions or lack of transport; closure of, inaccessibility of, or lack of appropriately-trained staff at healthcare facilities; and fear of acquiring COVID-19. Contraception use reflected that of previous studies conducted in Botswana with condom use predominating (49%) and limited long-acting reversible contraceptive coverage (13%). Conclusion: Botswana’s COVID-19 restrictions had indirect effects on the breadth of SRH services studied, resulting in reduced access to contraception, maternity care and HIV treatment. Prioritisation of SRH services in future national emergencies may minimize disruption to SRH care and prevent avoidable harms including unintended pregnancies, maternal and neonatal mortality, and HIV transmission. Achieving better coverage of long-acting contraceptives may help to mitigate against disruptions to contraception access.
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