Sirolimus-induced lymphoedema

Sirolimus is an inhibitor of the mammalian target of rapamycin (mTOR), used as an immunosuppressant for solid-organ transplant recipients and patients with autoimmune disorders. We report a case of lymphoedema, a rare complication of sirolimus, and discuss the mechanism of drug action, the adverse effects and the challenges of treating a kidney transplant recipient with this complication in a resource-limited environment. Lymphoedema is a rare complication of sirolimus, and the mechanisms are not completely understood; however, early recognition can prevent permanent disfiguration. This case highlights the need for early recognition of adverse drug effects and further research into their pathophysiology and management

History teaching in South Africa within the context of the human and social sciences : an outcomes-based approach with reference to anti-racism

This study begins by analysing and exploring problems associated with (a) history teaching as part of the Human and Social Sciences learning area, (b) history teaching within an Outcomes-based approach, and (c) history teaching and racism. In an effort to provide solutions to these problems the study proceeds to propose a framework for teaching history within the Human and Social Sciences learning area, to suggest a viable Outcomes-based approach to teaching history in the context of this learning area, and an attempt is also made to provide criteria for an anti-racist approach to history teaching. Further, teaching and learning strategies of how far learners can exhibit antiracist perspectives and attitudes have been developed. Overall, the study found that an interdisciplinary approach - intended to preserve history's identity within the Human and Social Sciences learning area- is worthwhile and essential, given the rich potential of the discipline to enrich and even gain from the unique insights that other disciplines within the learning area can provide. It is evident that history, either by itself or in association with other disciplines, lends itself well to Outcomes-based Education; and that while it is important and necessary to differentiate between learning outcomes on the one hand, and aims and objectives on the other, the former and the latter two demonstrate some significant overlaps. Given the crucial importance of improving race and a range of other relations in South Africa, the findings of the study seem to prove to be a feasible and indeed critically important way in which history teaching could deal with racial and other forms of viprejudice, injustice and discrimination. This seems to be the case because the findings reveal that learners registered progress in various aspects of anti-racist history teaching. Given the gains by learners, therefore, an Outcomes-based history teaching within the Human and Social Sciences learning area would seem to be an essential approach to learning programme development in the South African system of education and training.Educational StudiesD. Ed. (Didactics

A comparative study of the verb structure in northern, central and southern Khoesan: the case of Ju/’hoansi, Naro and !Xóõ

Text in EnglishThis dissertation, deals with the verb structure found in Ju/̕hoansi, Naro and !Xóõ, which form part of the Northern, Central and Southern Khoesan respectively. Although previous studies have been conducted on these languages, no study has been done to date involving a detailed comparison of the structures in these languages. Thus, not much has been done in the area of syntax; particularly syntactical comparison. Previous studies ignored comparisons of grammatical categories and structures such as noun class markers, plural formation markers, tense and aspect markers and verbal extensions. This dissertation consists of six chapters. Chapter 1 covers the language situation in Botswana. Chapter 2 is devoted to the literature review. Chapter 3 deals with the linguistic features found in the three languages. Chapter 4 covers the methodology and the theoretical framework adopted in the dissertation. The theoretical framework is eclectic in nature, in other words, the study is largely descriptive. However, on occasion, some aspects of lexical functional grammar (LFG) are used. This theoretical framework is appealing as it best handles important aspects of the languages under consideration, particularly the verb extensions. Chapter 5 describes the noun class system, highlighting the markers found in different noun classes. It also covers tense and aspect markers as well as the verbal extensions found in the three languages. Specifically, it is argued in this chapter that plural formation occurs in three ways; regular plurals, irregular plurals and neutral plurals. The study reveals a close relationship between tense and aspect and the motion of the events, points of reference and moment of speech encoded in the verbs involved. Adverbials can co-occur with the relevant tenses. Lastly, it is shown that verbal extensions do not just combine freely; they are subject to different kinds of sequential constraints. Chapter 6 summarizes the main findings, highlighting the similarities and differences in the three languages. Naro is SOV while Ju/'hoansi and !Xóõ are SVO. Chapter 6 also indicates areas in these Khoesan Languages requiring further research.African LanguagesD. Litt. et Phil. (African Languages

Sirolimus-induced lymphoedema

Sirolimus is an inhibitor of the mammalian target of rapamycin (mTOR), used as an immunosuppressant for solid-organ transplant recipients and patients with autoimmune disorders. We report a case of lymphoedema, a rare complication of sirolimus, and discuss the mechanism of drug action, the adverse effects and the challenges of treating a kidney transplant recipient with this complication in a resource-limited environment. Lymphoedema is a rare complication of sirolimus, and the mechanisms are not completely understood; however, early recognition can prevent permanent disfiguration. This case highlights the need for early recognition of adverse drug effects and further research into their pathophysiology and management

HIV treatment failure-a retrospective analysis of patients receiving 2nd line ARVS at the Tshepong wellness clinic

A research report submitted in partial fulfilment of the requirements for the degree: MMED (internal medicine), University of the Witwatersrand February 2016Background: Expansion of the antiretroviral (ARV) programme has led to an increasing number of patients requiring second line ARV therapy. Little is known about the outcomes and factors influencing the success of second line regimens in South Africa, a resource limited setting. Objectives: To report the treatment outcomes of patients on second line ARVs, and factors predisposing to treatment failure. Methods: We conducted a retrospective record review of patients receiving Lopinavir/ritonavir (lpv/rtv) containing second line ARVs at a public hospital in Klerksdorp, South Africa. Results: In the two years to December 2012, 383 potentially eligible patients were included in the study. 160 were excluded due to: switches due to adverse drug reactions (14%) or absence of an HIV viral load (VL) after second line regimen change (26%). Of the 223 included patients, median age was 42 years (IQR, 36 – 49), and 58% were women. Overall, median baseline CD4 count at first ARV initiation was 96 cells/mm3 (IQR, 36 – 160) and at initiation of lpv/rtv was 179 cells/mm3 (IQR, 101 – 275). The median VL at second line initiation was 46,838 (IQR, 21,341-151,333). Median follow up was 62 months (IQR, 46 – 83) since first line ARV initiation and 27 months (IQR: 19-42) since second line initiation; 47% of patients had suppressed VL on second line ARVs with a median time to suppression of seven months (IQR, 6 – 12 months) after switch. By Kaplan Meier survival analysis, the 2 mean time to second line treatment failure from initiation of ARVs was 43.6 months. The median CD4 count and HIV VL at the time of the regimen switch was 148 cells/mm3 (IQR, 71-221) and 49,000 copies/ml (IQR, 12,000-176,400), respectively. Thirty six (16%) of study patients had genotypic drug resistance studies performed. Of these, 75% had significant NRTI and NNRTI mutations. There were no clinically significant PI mutations. Using univariate and multivariate analysis, predictors of treatment failure were as follows: 1) patients never suppressed on first line therapy (HR 1.798, 95% CI 1.239 – 2.610) and 2) age > 49 years (HR 1.577, 95% CI 1.159 – 2.942). Conclusion: This study showed that there is an high rate of failure on second line ARVs in this resource-limited setting with increasing age and failure to suppress on first line therapy associated with treatment failure. Adherence is a major patient mediated factor, which fosters the selection of resistance mutations. Based on earnest results, second line ARVs would be effective in all the patients who received resistance testing. Reinforcement of adherence and compliance measures is needed, clinicians require training, and the role of resistance testing in these patients needs to be evaluated.MT201

Hosannah

Church choral hymn with singing and drummin

Alleluia, Alleluia, Alleulia

Church choral hymn with singing and drummin

Truly The Lord has risen

Church choral hymn with singing and drummin

Ciencia y tecnología en la escuela, memorias del seminario : la Formación en Ciencia y Tecnología en la Educación Básica Media /

Los conocimientos generados porla ciencia y la tecnología han contribuidos de manera definitiva al desarrollo atual no sólo en el campo material sino en la compresión de los fenómenos humanos y en el camio de valores y prácticas sociales. La producción científico-tecnológica y la utilizacion de sus conimientos, acompañadas de una apropiación social efectiva, son factores de definen, en gran medida. El desarrollo de un país y marcan las diferencias entre las naciones

Improvement in CD4 cells counts in newly diagnosed HIV infected Cameroonian patients under HARRT is counterbalanced by the mild deleterious effects of antiretroviral therapy on liver function: a longitudinal study

Human immunodeficiency virus (HIV) infection still is a worldwide public health concern, but especially so in Cameroon. Still, the health of HIV-infected people has greatly improved following the introduction of highly active antiretroviral therapy (HAART). Conversely, some authors reported the occurrence of side effects. Unfortunately, data on the topic are scarce in Cameroon. This study aimed at investigating the impact of HAART on liver function in newly diagnosed HIV-infected people. An 18-month longitudinal study was carried out in a health facility in the town of Douala, Cameroon. Investigative methods relied on a questionnaire approach, clinical and biological analyses and medical records exploitation. A total of 107 patients aged 18-45 years old were included in the study. Most participants were females (94, 87.9%) and aged 30-40 years (60, 56.1%). A higher significant fraction of patients had CD4 lymphocytes counts less than 200 cells/mm3 (42, 39.3%) at baseline. We recorded a 1.5-fold increment in the CD4 lymphocytes counts over the follow up period (P-value < 0.0001). Indeed, globally, a significant increasing in ALT level was recorded over follow up. There is a critical need for paying attention to liver function in people living with HIV/AIDS and under therapy