Approach to asthma in adults

Asthma is a chronic inflammatory disease that causes hyper-responsiveness of the bronchial tree, with reversible airflow obstruction. The condition places a significant burden on our healthcare system. Chronic asthma can cause remodelling of the airway. Patients suffering from asthma should be aware of its signs and symptoms, as well as factors that can precipitate an asthmatic attack. Asthma is mostly classified as either acute or chronic. The diagnosis of asthma is based on identification of both a characteristic pattern of  respiratory symptoms and variable expiratory airflow limitation. Treatment is based on how the patient presents, and includes bronchodilators, inhaled corticosteroids and mast cell stabilisers. This article provides an overview of the diagnosis, characterisation and treatment of asthma.Keywords: asthma, bronchodilator, inhaled corticosteroid, β2 agonist, peak expiratory flow, spirometry, SABA, LAB

Factors determining clinical outcomes in intussusception in the developing world: Experience from Johannesburg, South Africa

Background. Rates of open reduction of intussusception were noted to be unacceptably high during an institutional internal audit.Objectives. To determine the impact of revised protocols to better select patients for pneumatic reduction (PR), and document associated morbidity and mortality, and the factors that affect the above.Methods. Medical records of patients between 3 months and 3 years of age presenting to the Department of Paediatric Surgery at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, from 2007 to 2010 were reviewed. Determining factors, including duration of symptoms, admission C reactive protein (CRP) level and weight, were analysed against clinical outcomes, notably PR, bowel resection, relook laparotomy and death.Results. A total of 97 cases were suitable for inclusion. In 62 of these (63.9%), PR was attempted; this was successful in 32 cases (51.6%), giving an overall successful PR rate of 33.0%. In 7 of the 62 patients, a pneumoperitoneum was documented during the reduction attempt. Of the 65 patients who underwent surgery, 53 required intestinal resection and 12 had spontaneous or manual reduction. Ileostomy was necessary in 9 patients, and 7 required relook laparotomy. The overall mortality rate was 9.1%. Averages of ‘determining factors’ assessed against clinical outcome were as follows: mean weight (standard deviation (SD)) 7.4 (4.3) kg, mean duration of symptoms (DOS) 3.0 (SD 2.2) days, and admission CRP level 50.9 mg/L (range 1 - 249.3). Prolonged DOS and a raised CRP level predicted a poor outcome.Conclusions. Despite marked improvements in management and PR outcomes, intussusception remains associated with significant morbidity and mortality. Prolonged DOS and an elevated CRP predict worse outcomes. The use of these markers in association with clinical factors may assist management decisions, specifically with regard to operative or non-operative management. Awareness and education are key to prompt presentation and early diagnosis. Well-defined protocols introduced at all points of contact ensure early recognition and resuscitation as well as prompt referral for definitive management

Red Palm Oil and Its Antioxidant Potential in Reducing Oxidative Stress in HIV/AIDS and TB Patients

Scientific evidence has shown that HIV infection is caused by a retrovirus, the Human Immunodeficiency Virus (HIV) which is a ribonucleic acid (RNA) virus so designated because of its genome that encodes an unusual enzyme, reverse transcriptase (RT) that enables the virus to make copies of its own genome as DNA in its host’s cells (human T4 helper lymphocytes) (Oguntibeju et al., 2008). The drastic increase in the number of people infected with HIV is not peculiar to a particular racial group, country or community despite multidimensional efforts which have been made to combat this scourge (Weiss, 1996; Oguntibeju et al., 2007a). It is reported that the virus selectively attacks and depletes T-lymphocyte bearing CD4+ cells (T-helper cells) causing a predisposition to opportunistic infections and malignancies (Weiss, 1996) and ultimately resulting in Acquired Immunodeficiency Syndrome (AIDS). The cellular receptors to HIV are cells that express the CD4+ T cell receptor (CD4+ T-cells or T4-cells) as well as other white blood cells including monocytes and macrophages. Glial cells in the central nervous system, chromaffin cells in the intestine and Langerhans cells in mucous membranes and skin that express CD4+ T cell receptors can also be infected (Paxon et al., 1996). The possibility that there are other cellular targets apart from CD4+T-cells is proved by the likelihood of neurons that can be infected. This creates the possibility of the presence of co-receptors in addition to CD4+ T cells to mediate fusion between HIV and its target cells (Grossman and Heberman, 1997). Recognition of the CD4+ T-cells by HIV-1 envelope glycoprotein (gp120) to which the virus binds and enters host cells to initiate rapid replication cycles (Oguntibeju et al., 2007b) depicts significant cytopathic consequences of HIV infection of CD4+ T-cells (Bartlett, 1998) and is an important factor in the initiation of HIV infection. The shed virions which are immunogenic, stimulate B cells to produce humoral antibodies and plasma cells through lymphoid hyperplasia that ultimately results in decreased number of infected cells as the CD4+ T-cells migrate through the germinal cells. The depletion in the number of CD4+ T-cells exceeds the formation of new cells and may maintain this phase for many years resulting in general disorganization of the lymphoid nodes, loss of lymphoid function and integrity

DNA Methylation and Demethylation Are Regulated by Functional DNA Methyltransferases and DnTET Enzymes in Diuraphis noxia

Aphids are economically important insect pests of crops worldwide. Despite resistant varieties being available, resistance is continuously challenged and eventually broken down, posing a threat to food security. In the current study, the epigenome of two related Russian wheat aphid (Diuraphis noxia, Kurdjumov) biotypes (i.e., SA1 and SAM) that differ in virulence was investigated to elucidate its role in virulence in this species. Whole genome bisulfite sequencing covered a total of 6,846,597,083 cytosine bases for SA1 and 7,397,965,699 cytosine bases for SAM, respectively, of which a total of 70,861,462 bases (SA1) and 74, 073,939 bases (SAM) were methylated, representing 1.126 ± 0.321% (SA1) and 1.105 ± 0.295% (SAM) methylation in their genomes. The sequence reads were analyzed for contexts of DNA methylation and the results revealed that RWA has methylation in all contexts (CpG, CHG and CHH), with the majority of methylation within the CpG context (± 5.19%), while the other contexts show much lower levels of methylation (CHG − ± 0.27%; CHH − ± 0.34%). The top strand was slightly (0.02%) more methylated than the bottom strand. Of the 35,493 genes that mapped, we also analyzed the contexts of methylation of each of these and found that the CpG methylation was much higher in genic regions than in intergenic regions. The CHG and CHH levels did not differ between genic and intergenic regions. The exonic regions of genes were more methylated (±0.56%) than the intronic regions. We also measured the 5mC and 5hmC levels between the aphid biotypes, and found little difference in 5mC levels between the biotypes, but much higher levels of 5hmC in the virulent SAM. RWA had two homologs of each of the DNA methyltransferases 1 (DNMT1a and DNMT1b) and DNMT3s (DNMT3a and DNMT3b), but only a single DNMT2, with only the expression of DNMT3 that differed significantly between the two RWA biotypes. RWA has a single ortholog of Ten eleven translocase (DnTET) in the genome. Feeding studies show that the more virulent RWA biotype SAM upregulate DnDNMT3 and DnTET in response to wheat expressing antibiosis and antixenosis

Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa

Background. Paediatric patients are particularly prone to medication errors as they are classified as the most fragile population in ahospital setting. Paediatric medication errors in the South African healthcare setting are comparatively understudied.Objectives. To determine the incidence of medication errors in neonatal and paediatric inpatients, investigate the origin of medicationerrors that occurred and describe and categorise the types of medication errors made in both the neonatal intensive care unit (NICU) andpaediatric wards.Methods. The study followed a prospective, quantitative design with a descriptive approach. A prospective record review of inpatients’medication charts was undertaken to determine what was prescribed by the physician, dispensed by the pharmacy and administered bythe nurses. The researcher also directly observed the preparation and administration techniques as performed by the nurses. A medicationerror checklist was used to collect the data.Results. A total of 663 medication errors were detected in 227 patients over the study period of 16 weeks, of which 177 (78%) patients hadone or more error(s). There were 338 (51%) administration errors and 309 (47%) prescribing errors. Incorrect dosing was the most frequenttype of error (34%), followed by omission of medication (18.5%) and medication given at the incorrect time (12%). The causes of thesemedication errors were mostly due to miscalculation (26%), failure to monitor (15%) and procedures not followed (15%). Anti-infectives(43%) and analgesics (25%) had the most errors.In 118 (67%) patients the errors resulted in no harm to the patient, whereas in 59 (33%)patients the medication error resulted in some level of harm.Conclusion. The incidence of medication errors in the NICU and paediatric wards at the teaching hospital was higher than values reportedelsewhere globally. Most errors occur during prescribing and administration of medication. Dosing errors are a common problem inpaediatrics. Therefore, a formalised system to record these errors should be introduced alongside regular discussions on preventivemeasures among the multidisciplinary team

\u3cem\u3eRhizobium\u3c/em\u3e-White Clover Symbiosis and Nitrogen Fixation along a Soil Organic Carbon Gradient

Sustainable cultivated pasture production in the southern Cape region of South Africa requires management practices that will support soil quality (Swanepoel and Botha 2012). Soil organic carbon (Corg) sequestration is regarded as one of the most important ways to promote soil quality. Dairy farmers in the southern Cape attempt to increase Corg by following minimum-tillage practices. These irrigated dairy-pastures require high levels of nitrogen (N) to maintain highly productive pastures. Nitrogen fertilisers have be-come very expensive and severely strain profitability of these dairy-pastures. Forage legumes are frequently incorporated into the grass pastures to overcome economic and environmental problems associated with high levels of inorganic fertiliser application. Their capacity to fixate atmospheric N contributes greatly to nutritional value, palatability and subsequently profitability of pastures (Botha 2003). Since C and N are biophilic compounds, Corg may have a direct effect on the N-fixating legume plant or the Rhizobium population that infects its roots (Swanepoel et al. 2011). The aim of this study was to determine the effects of Corg on white clover (Trifolium repens) biomass production and N-fixation by host-specific Rhizobium

Helicobacter pylori prevalence in non-ulcer dyspepsia ethnic and socio-economic differences

Helicobacter pylori is an important cause of gastritis and a number of therapeutic. trials suggest that it may be important in the genesis of duodenal ulcer recurrence. The reported prevalence of gastric colonisation by the organism varies considerably. The aiIn of this cross-sectional survey was to determine its prevalence in non-ulcer dyspeptics and to determine whether this is influenced by age, race, sex, socio-economic status, educational level and the nwnber of persons sharing accommodation. One hundred and sixty-nine patients underwent endoscopy; biopsy speciInens were taken from the antrwn and H. pylori status was determined histologically. Gastric colonisation was found in 106 patients (63%). The prevalence showed a marked ethnic difference: 40% in whites and 71% in coloureds (P < 0,001). The ethnic groups were characterised by significant differences in socio-economic status (P < 10-6), educational level (P < 10-6), number of persons sharing accommodation (P < 10-6 ) and age (P < 0,001). These same differences were found when comparing the H. pylori-positive and negative groups, but were less marked and could be attributed to the marked differences between ethnic groups. We conclude that H. pylori prevalence differs between the ethnic groups studied. This may be because of varying degrees of exposure risk

A case control study of breast cancer risk and exposure to injectable progestogen contraceptives

No Abstract