Vascular disease in HIV/AIDS patients

Objectives. An ongoing prospective clinical survey to determine the spectrum of vascular disease in HIV/AIDS patients and the risk factors affecting clinical outcome in order to formulate a management protocol for future use. Methods. Comprehensive screening for risk factors for vascular disease as well as HIV/AIDS-related conditions. Disease pattern and presentation are noted and patients treated accordingly. Vascular emergencies are managed regardless of HIV status because this information is usually not available at the time of presentation. Elective management is based on immune status and risk stratification. Results. 42 patients tested positive for HIV. The majority of patients presented with occlusive disease (57%), followed by anearysms (21%) and vascular trauma (19%). A variety of vascular surgical procedures were performed on 36 patients. There was no surgical mortality and 10 patients developed complications, including 2 amputations and 7 cases of minor wound sepsis. The 3 patients who received preoperative antiretroviral therapy showed a marked reduction in viral count and a significant improvement in CD4 T-cell count. Conclusion. Surgery can be safe and effective in HIV-positive patients provided the necessary precautions are taken to reduce surgical morbidity. (South African Medical Journal: 2002 92(12): 974-977

The value of medical student hepatitis B immunisation as part of clinical skills training in the Clinical Skills Unit of the University of the Free State

Background: It is compulsory for medical students of the University of the Free State to be immunised against hepatitis B before they have contact with clinical patients. Previously, the students were vaccinated on campus at the student health services. With the implementation of Curriculum 2000 (the revised MBChB programme), hepatitis B immunisation, as an example of an invasive procedure, was incorporated into the medical students’ clinical skills training programme. The aim of this study was to assess the students’ perceptions regarding immunising their peers, being immunised by their peers and the educational value of this process.Methods: Medical students in Phase II of the MBChB programme were included in this observational descriptive study and participation was voluntary. Students immunised their peers with a hepatitis B vaccine in the upper arm under the supervision of medical and nursing personnel in the laboratory of the Skills Unit. After the final immunisation, the students completed an anonymous questionnaire.Results: Sixty-six students completed the questionnaire. Of these, 80% felt that that they had improved their understanding of the theory of immunisation. Some (8%) students preferred to have the immunisation performed at a clinic or by a doctor and 6% had a problem with being vaccinated by a peer. A few (3%) students found it unacceptable to be immunised in a mixed gender group, 5% thought they had suffered complications and 5% indicated that there had been inadequate supervision. Most of the students (98%) responded positively to immunising their peers and 95% felt that it was advantageous to receive the immunisation in the skills laboratory environment. Approximately half (56%) of the students wanted to receive additional important immunisations.Conclusion: Students were positive about practising immunisation techniques on their peers.SA Fam Pract 2005;47(4): 54-5

Re-imagining community participation at the district level: Lessons from the DIALHS collaboration.

In South Africa, the value of community participation as one of the central components of a primary health care approach is highlighted in legislation, policy documents and strategic plans. There is widespread acceptance that community participation strengthens community empowerment, disease prevention and access to services. Since 2010, the District Innovation and Action Learning for Health System Development collaboration has co-produced knowledge about how to strengthen district health systems. Nested within this collaboration is a series of engagements seeking to understand and strengthen community participation including a multi-stakeholder health risks and assets mapping activity; ‘Local Action Group’ initiatives; reflective meetings with service colleagues about community participation experiences; and a capacity-development initiative (community participation-related short courses and mentoring). These engagements hold a number of lessons for those interested in enhancing the population orientation of primary health care and the district health system, the first of which is the clear benefit to those interested in community roles and engagement of convening spaces for dialogue. However, it is not easy to generate and sustain these spaces. Through the application of a framework of collective capacity, this chapter aims to shed light on why this is the case, and in so doing, to highlight a second lesson, which is the perhaps unrecognised capacities of certain cadres, particularly environmental health practitioners, in the implementation of community participation. Ultimately, the chapter seeks to stimulate thinking and engagement about the ways in which dialogue and participation can enrich the South African health system

The effect of different anaesthetic mask shapes on the anatomical dead space using infant, child and adult part-task trainers

Dead space is the portion of tidal volume that does not participate in alveolar gas exchange. The purpose of this study was to compare the dead space contribution of differently shaped masks, of the same size, by measuring the volume of each mask. The study was conducted in the Clinical Simulation Unit of the School of Medicine, University of the Free State (UFS) using formed masks with inflatable polyvinylchloride (PVC) cuffs and rounded masks with non-inflatable PVC cuffs. The masks were placed on the faces of the infant, child and adult part-task trainers as well as on a flat surface. The cuffs of the formed masks were inflated to 5 cm water and 70 cm water. Masks were filled with water and the volume was measured.The volumes (ml) of the masks on the flat surface were significantly larger than those measured on the part-task trainers’ faces. The volume of the rounded masks was greater than the volume of the formed masks. The amount of cuff inflation pressure (5 cm water vs. 70 cm water) did not lead to a significant change in mask volume: 102.3 ml (standard deviation [SD] 75.9) vs. 110.2 ml (SD 82.3), averaged for all sizes.Formed masks contribute less to anatomical dead space than rounded masks and are thus possibly the better choice. Cuff inflation pressure has insignificant influence on dead space volume.Keywords: anaesthesia, anatomical dead space, inhalation, masks, pulmonary ventilation, respirator

Towards a data transfer agreement for the South African research community: The empowerment approach

The idea of a data transfer agreement (DTA) template for the South African (SA) research community is receiving increasing attention. Whiledeveloping such a DTA template is certainly a worthwhile project, questions regarding the project’s practical execution should be addressed,including how to best operationalise the envisioned DTA template, and the content of the envisioned DTA template. It is proposed that anempowerment approach be followed in operationalising the envisioned DTA template, which is contrasted with the regulatory approachfollowed with the material transfer agreement that the Minister of Health promulgated in 2018. While the regulatory approach would entailgovernment making the use of the envisioned DTA template compulsory regardless of the quality of such a template, the empowermentapproach, by contrast, entails a focus on developing a high-quality, professionally drafted DTA template for the SA research community andmaking the use thereof a matter of own choice. Regarding the content of the envisioned DTA template, four hot-button content provisionsare analysed, and it is argued that SA research institutions and researchers should be empowered to: (i) have clarity and legal certaintyregarding their ownership of data, where relevant; (ii) be able to commercialise their research findings without unnecessary contractualconstraints; (iii) avoid falling into the trap of unlawful benefit sharing with research participants; and (iv) be aware that their legal role asresponsible parties, where relevant, cannot be contracted out via a DTA

Outcome determinants of urethroplasty in the management of inflammatory anterior urethral strictures

Published ArticleBackground. Limited data are available on outcomes of the surgical management of inflammatory urethral strictures secondary to infection, a major cause of stricture. Several shortcomings that need to be addressed have been identified in the past. Objective. To determine the impact of stricture length, position and degree of obliterative urethral lumen on the surgical outcomes of corrective procedures for inflammatory anterior urethral strictures. Methods. This retrospective analysis used the records of patients who presented with proven infective anterior urethral strictures at an academic hospital from 2007 to 2010. All patients were followed up after 48 months. Urethroplasty outcomes were analysed according to stricture location and length and effect of urethral obliteration. Results. The median age of the 174 patients in the study was 47 (range 21 - 86) years. Anastomotic urethroplasty was successful in 59/99 (59.6%) patients. Augmented anastomotic urethroplasty was successful in 11/15 (73.3%) patients. Dorsal onlay buccal mucosa graft urethroplasty was successful in 23/32 (71.9%) patients, significantly higher than in 2/9 (22.2%) patients who underwent ventral onlay buccal mucosa graft urethroplasty (p=0.017; hazard ratio 3.4; 95% confidence interval 1.29 - 9.40). The one-stage circular pedicled penile skin-flap urethroplasty was successful in 1/12 (8.3%) patients. Two-stage urethroplasty was successful in 5/7 (71.4%) patients. A primary component analysis of the 73 failed procedures showed that stricture length was the main contributor to failure (eigenvalue 1.79; 45%). Conclusions. Urethroplasty remains a challenge in inflammatory urethral strictures, where stricture length was the main reason for treatment failure

Renewing Criminalized and Hegemonic Cultural Landscapes

The Mafia's long historical pedigree in Mezzogiorno, Southern Italy, has empowered the Mafioso as a notorious, uncontested, and hegemonic figure. The counter-cultural resistance against the mafiosi culture began to be institutionalized in the early 1990s. Today, Libera Terra is the largest civil society organization in the country that uses the lands confiscated from the Mafia as a space of cultural repertoire to realize its ideals. Deploying labor force through volunteer participation, producing biological fruits and vegetables, and providing information to the students on the fields are the principal cultural practices of this struggle. The confiscated lands make the Italian experience of anti-Mafia resistance a unique example by connecting the land with the ideals of cultural change. The sociocultural resistance of Libera Terra conveys a political message through these practices and utters that the Mafia is not invincible. This study draws the complex panorama of the Mafia and anti-Mafia movement that uses the ‘confiscated lands’ as cultural and public spaces for resistance and socio-cultural change. In doing so, this article sheds new light on the relationship between rural criminology and crime prevention policies in Southern Italy by demonstrating how community development practice of Libera Terra changes the meaning of landscape through iconographic symbolism and ethnographic performance

Safeguarding the future of genomic research in South Africa: Broad consent and the protection of Personal Information Act No. 4 of 2013

Genomic research has been identified in South Africa (SA) as important in developing a strong bio-economy that has the potential to improve human health, drive job creation and offer potential solutions to the disease burden harboured by low- and middle-income countries. Central to the success of genomic research is the wide sharing of biological samples and data, but the true value of data can only be unlocked if there are laws and policies in place that foster the legal and ethical sharing of genomic data. The introduction and entry into force of SA's Protection of Personal Information Act (POPIA) No. 4 of 2013 is to be welcomed, but the wording of POPIA as it pertains to consent for the processing of personal information for research purposes has sparked a debate about the legal status of broad consent. We argue that a purposive interpretation of the legislation would permit broad consent for the processing of personal information for research. Although there are ongoing debates surrounding the ethical use of broad consent in Africa, the objective of this article is not to engage with the ethics of broad consent itself, but rather to focus on the legal status of broad consent for genomic data sharing under POPIA

Privacy rights of human research participants in South Africa must be taken seriously

Letter by Thaldar and Townsend, following an article by the same authors (Thaldar D, Townsend B. Genomic research and privacy: A response to Staunton et al. S Afr Med J 2020;110(3):172-174. https://doi.org/10.7196/SAMJ.2020.v110i3.14431) and both commenting on an article by Staunton et al. (Staunton C, Adams R, Botes M, et al. Safeguarding the future of genomic research in South Africa: Broad consent and the Protection of Personal Information Act No. 4 of 2013. S Afr Med J 2019;109(7):468-470. https://doi.org/10.7196/SAMJ.2019.v109i7.14148); and response to article and letter by Staunton et al