230 research outputs found

    The possible role of hybridization in adaptive radiations

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    Positive Postoperative Blood Cultures in Major Abdominal Surgery Patients Attending a Tertiary Hospital in Durban, South Africa

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    Background: Evidence from high-income countries suggests that bloodstream infection is an essential complication following major surgery. However, studies of bloodstream infections following major surgery in lower-income settings, particularly in Africa, are rare. This study aimed to determine the incidence of postoperative bloodstream infection and to explore any association with mortality in high-risk laparotomy patients in South Africa. Methods: This study was a retrospective study, reviewing 435 consecutive adults who underwent laparotomy at a South African tertiary hospital over a five-year period. Incident postoperative bloodstream infection, defined as a positive blood culture following surgery, was determined from laboratory reports in the patient’s medical chart. Source infections and the causative microorganisms were established from laboratory reports. Inpatient mortality was determined from the patient’s hospital discharge summary. Data were summarized using descriptive statistics. Potential associations between bloodstream infection and mortality were tested using the chi-square test.Results: The incidence of postoperative bloodstream infection was 7.4%. Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus were isolated from 21.9%, 18.7%, and 15.6% of blood cultures. Mortality in patients with bloodstream infection was 46.9% vs. 16.1% in patients without bloodstream infection (p<0.001).Conclusions: Postoperative bloodstream infection is an essential complication following major abdominal surgery with K. pneumoniae, E. coli, and S. aureus being the most common causative agents. Bloodstream infection is associated with a higher risk of postoperative mortality. Further studies are recommended to confirm the findings and improve patient management

    Large Bowel Perforation in Patients with Colorectal Cancer: A South African Perspective

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    Introduction: Large bowel perforation (LBP) occurs in up to 10% of colorectal cancer (CRC) patients and is a potential surgical emergency. Data on LBP in CRC patients from resource-limited countries are required to improve the management of this condition in these settings. Our study aimed to describe LBP amongst CRC patients in KwaZulu-Natal, South Africa. Materials and Methods: This was a descriptive sub-analysis of LBP data from an ongoing CRC registry. This study explores free and contained perforations and describes LBP characteristics, surgical management, histological findings, overall survival, and CRC recurrence. Results: Ninety-four out of 2523 CRC patients had LBP (3.7%). The median age was 53.0 years (interquartile range: 43.0–64.0). The male-to-female ratio was 1.4:1. Thirty-three patients (35.1%) had a coexisting bowel obstruction. Tumor site perforations occurred in 87 patients (92.6%) and were mostly in the sigmoid colon (36.2%). Perforations were contained in 77 patients (81.9%). Eighty-nine patients (94.7%) underwent resection (elective resection: 76/89 patients, 85.4%). The post-operative inpatient mortality rate was 2.2%. Most patients had Stage III CRC (46 patients, 48.9%) and moderately differentiated tumors (77 patients, 81.9%). Overall survival at 12 months following CRC diagnosis was 55.4%. The early recurrence rate for CRC disease was 5.4%. Conclusion: Tumor site perforations predominated, and most were contained. Patients were younger when compared with the international literature. We reaffirm that diastatic-free and contained perforations are two distinct clinical entities

    Molecular Biogeography: Towards an Integrated Framework for Conserving Pan-African Biodiversity

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    BACKGROUND: Biogeographic models partition ecologically similar species assemblages into discrete ecoregions. However, the history, relationship and interactions between these regions and their assemblages have rarely been explored. METHODOLOGY/PRINCIPAL FINDINGS: Here we develop a taxon-based approach that explicitly utilises molecular information to compare ecoregion history and status, which we exemplify using a continentally distributed mammalian species: the African bushbuck (Tragelaphus scriptus). We reveal unprecedented levels of genetic diversity and structure in this species and show that ecoregion biogeographic history better explains the distribution of molecular variation than phenotypic similarity or geography. We extend these data to explore ecoregion connectivity, identify core habitats and infer ecological affinities from them. CONCLUSIONS/SIGNIFICANCE: This analysis defines 28 key biogeographic regions for sub-Saharan Africa, and provides a valuable framework for the incorporation of genetic and biogeographic information into a more widely applicable model for the conservation of continental biodiversity

    Population structuring in Southern Africa zebras

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    Bibliography: leaves 157-172

    Post-operative acute kidney injury in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension

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    Hypertension is an independent predictor of acute kidney injury (AKI) in non-cardiac surgery patients. There are a few published studies which report AKI following non-suprainguinal vascular procedures, but these studies have not investigated predictors of AKI, including anti-hypertensive medications and other comorbidities, in the hypertensive population alone. We sought to identify independent predictors of post-operative AKI in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension. We performed univariate (chi-squared, or Fisher’s exact testing) and multivariate (binary logistic regression) statistical analysis of prospectively collected data from 243 adult hypertensive patients who underwent non-suprainguinal vascular surgery (lower limb amputation or peripheral artery bypass surgery) at a tertiary hospital between 2008 and 2011 in an attempt to identify possible associations between comorbidity, acute pre-operative antihypertensive medication administration, and post-operative AKI (a post-operative increase in serum creatinine of ≥ 25 % above the pre-operative measurement) in these patients. The incidence of post-operative AKI in this study was 5.3 % (95 % Confidence Interval: 3.2-8.9 %). Acute pre-operative β-blocker administration was independently associated with post-operative AKI in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension (Odds Ratio: 3.24; 95 % Confidence Interval: 1.03-10.25). The acute pre-operative administration of β-blockers should be carefully considered in non-suprainguinal vascular surgery patients with a pre-operative history of hypertension, in lieu of an increased risk of potentially poor post-operative renal outcomes

    The association between preoperative clinical risk factors and in-hospital strokes and death following carotid endarterectomy in South African patients

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    Background: Current surgical management of carotid artery disease includes carotid endarterectomy (CEA). In-hospital strokes and death following CEA might be associated with preinduction blood pressure (BP) measurements and other clinical risk factors.Method: The aim of our study was to determine whether or not there is an association between preinduction BP, other clinical risk factors, and in-hospital strokes or death following CEA in a cohort of South African patients. We collected data from medical records relating to clinical risk factors in patients, preinduction BP measurements, and in-hospital strokes and death, following CEA. The association between preinduction BP and clinical risk factors, and postoperative neurological morbidity and mortality, was analysed using univariate statistical methods.Results: Our cohort consisted of 76 patients who underwent CEA. Eight of these patients had in-hospital strokes or death following their surgery. An association between a history of hypertension or other clinical risk factors and an in-hospital stroke and death was not identified in these 76 CEA patients following univariate analysis. However, patients with preinduction BP within the lowest or highest quartile for preinduction BP were at a significantly increased risk of an in-hospital stroke and death following their surgery (p-value = 0.003). A subanalysis of patients who were hypertensive also showed this univariate association (p-value = 0.003).Conclusion: It is possible that extremes of preinduction BP might be associated with in-hospital strokes and death in CEA patients following their surgery, although further research is required to confirm this.Keywords: carotid endarterectomy, carotid stenosis, mortality, strokes, surger

    A CROSS-SECTIONAL INFOVEILLANCE STUDY ON WIKIPEDIA WAS USED FOR ACCESSING MAMMOGRAM INFORMATION.

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    Background Wikipedia has emerged as a source of health information for patients and the public. The study aimed to identify trends in the use of Wikipedia to access information on mammograms and to assess the quality of this information. Methods This was a trend analysis of cross-sectional data, namely Wikipedia page views for mammogram-related searches between 2016 and 2022. Data was analyzed with descriptive statistics. Overall trends in page views were analyzed by year and month. Pairwise comparisons were assessed with Analysis of Variance (ANOVA) testing. The quality of mammogram-related information on Wikipedia was evaluated using Couto and Lope's four quality assessment features (Completeness, authority, informativeness, and consistency). Results The total number of page views for mammography-related terms during 2016-2022 was 1 180 947. The data fluctuated across years and months. When analyzed by year, mean page views peaked during 2018 (mean = 20 600.6) and were lowest during 2021 (mean = 10 267.9). When analyzed by month, mean page views peaked during March and October (means = 15 845.7 and 15 608.6, respectively). Overall, there were strong trends in page views across years (R2=0.99) and months (R2=0.73). The pairwise comparisons revealed numerous statistically significant differences in mean page views across years and months, which manifested as the observed polynomial trends. The quality assessment scores were as follows: Completeness (Medium), authority (Medium), informativeness (Low), and consistency (Medium). Conclusions Wikipedia is a potentially important source of mammogram information for patients and the public. This platform could be improved (diversity of page content and image presentation) and used to support public health awareness campaigns in combating breast cancer worldwide. Recommendation Efforts should be made to encourage the sustained use of Wikipedia by patients and the public as a source of mammogram information

    INCIDENCE AND FACTORS ASSOCIATED WITH BLOOD TRANSFUSION IN A SAMPLE OF SOUTH AFRICAN PATIENTS UNDERGOING PRIMARY HIP ARTHROPLASTY: A RETROSPECTIVE DATABASE STUDY.

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    Background: Despite improvements in arthroplasty and blood conservation practices, surgical blood loss remains a challenge. The blood products used to address perioperative bleeding are scarce and should be effectively managed. Our study objectives were to 1) establish the cumulative incidence of peri-operative transfusion in a sample of South African primary hip arthroplasty patients and 2) identify factors associated with transfusions. Methods: This study was a sub-analysis of an existing database of 174 adult primary hip arthroplasty patients who underwent surgery at Inkosi Albert Luthuli Central Hospital between 01 January 2015 and 30 June 2016. A retrospective chart review process was used to collect the data analyzed using descriptive statistical methods, Mann-Whitney testing, and Chi-squared testing. The study outcome was perioperative blood transfusion, defined as receipt of at least 1 unit of packed red cells anytime between the surgical incision and discharge from the hospital. Results: The incidence of perioperative blood transfusion was 13.8% (95%CI: 9.0-19.8%). The median number of blood units received was 2.0 (Range: 1.0-4.0) units.  The proportion of patients who received blood transfusions was higher in those who had longer surgery (41.7% vs. 14.7 % p=0.002) or received postoperative thromboprophylaxis (91.7% vs. 68% p=0.017). Conclusion: The incidence of perioperative blood transfusion observed in our study of patients undergoing primary hip arthroplasty was within range of that reported in international studies. Longer surgery and postoperative thromboprophylaxis are potentially important predictors of perioperative transfusion following hip arthroplasty in our setting. We recommend further research to confirm our findings

    DOES MICRORNA-140 PLAY A ROLE IN THE DEVELOPMENT AND PROGRESSION OF OESOPHAGEAL SQUAMOUS CELL CARCINOMA? - A SYSTEMATIC REVIEW.

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    Background Oesophageal squamous cell carcinoma (OSCC) is one of the most common and lethal cancers worldwide. Despite advances in treatment, the five-year survival rate for OSCC remains suboptimal. Recent studies reveal that microRNAs (miRNAs) are involved in developing and progressing various types of cancer. Therefore, the modulation of miRNAs could have implications for new OSCC treatments. The purpose of this research was to summarise the published evidence on the impact of miRNA-140 on OSCC development and progression. Methods PubMed and Scopus were searched for the relevant literature. Study inclusion criteria were: basic science studies published during 1 June 2014–1 June 2023. Study exclusion criteria were: research without an appropriate analysis, non-English language publications, and grey literature. No study quality assessment tool currently exists for basic science studies, and all studies that met the eligibility criteria were incorporated in the review. The literature search results were analyzed with descriptive statistics (frequencies, percentages) and presented as a narrative synthesis. Results  Eight papers were included in this review. All included studies were from China, and ECA109 was the most common OSCC cell line used (8 studies, 100%). Findings from studies involving transfection of OSCC cell lines with miRNA-140 mimics suggest that increased levels of miRNA-140 impair OSCC development and progression. Several genes appear to be regulated by miRNA-140 in OSCC development and progression (NFYA, ZEB1 &amp; 2, ErbB4, and NRIP1). Hypoxia reduces miRNA-140 levels, thereby promoting OSCC development and progression. High levels of miRNA-140 were found to confer resistance to platinum-based chemotherapy drugs. Conclusion  miRNA-140 plays multiple roles in the development and progression of OSCC, including influencing tumorigenesis, apoptosis of tumor cells, genome instability, invasion, metastasis, and chemotherapy resistance. Recommendation  More research is needed to extend and validate these results, and to develop OSCC therapies aimed at modulating miRNA-140
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