The behaviourally disturbed patient with HIV/AIDS

While HIV invades the brain early in the course of HIV infection,1 severe mental illness probably only occurs later in the disease.2 In many instances this may be the first presentation of a psychiatric illness in a younger person.In addition, the clinical syndrome may include manic and/or psychotic  features, together with neurocognitive disturbance. These patients are at risk of secondary opportunistic infections or other features of systemic  immunocompromise which may cause or confound the clinical picture

VLBI astrometry of PSR J2222-0137: a pulsar distance measured to 0.4% accuracy

The binary pulsar J2222-0137 is an enigmatic system containing a partially recycled millisecond pulsar and a companion of unknown nature. Whilst the low eccentricity of the system favors a white dwarf companion, an unusual double neutron star system is also a possibility, and optical observations will be able to distinguish between these possibilities. In order to allow the absolute luminosity (or upper limit) of the companion object to be properly calibrated, we undertook astrometric observations with the Very Long Baseline Array to constrain the system distance via a measurement of annual geometric parallax. With these observations, we measure the parallax of the J2222-0137 system to be 3.742 +0.013 -0.016 milliarcseconds, yielding a distance of 267.3 +1.2 -0.9 pc, and measure the transverse velocity to be 57.1 +0.3 -0.2 km/s. Fixing these parameters in the pulsar timing model made it possible to obtain a measurement of Shapiro delay and hence the system inclination, which shows that the system is nearly edge-on (sin i = 0.9985 +/- 0.0005). Furthermore, we were able to detect the orbital motion of J2222-0137 in our VLBI observations and measure the longitude of ascending node. The VLBI astrometry yields the most accurate distance obtained for a radio pulsar to date, and is furthermore the most accurate parallax for any radio source obtained at "low" radio frequencies (below ~5 GHz, where the ionosphere dominates the error budget). Using the astrometric results, we show the companion to J2222-0137 will be easily detectable in deep optical observations if it is a white dwarf. Finally, we discuss the implications of this measurement for future ultra-high-precision astrometry, in particular in support of pulsar timing arrays.Comment: 22 pages, 7 figures, accepted for publication in Ap

Emergency medical services - poor response time in the rural Eastern Cape

Emergency medical services (EMS) throughout South Africa are of unequal quality owing to historical population inequalities and under-resourced EMS in rural areas. There are no data regarding the quality of ambulance services in the rural Eastern Cape. The assessment of EMS is not easy, but an assessment tool has been established. We prospectively audited the response time to ambulance requests from a community health centre in the rural Eastern Cape

Advanced System Design Requirements for Large and Small Fixed-wing Aerial Application Systems for Agriculture

Several candidate aircraft configurations were defined over the range of 1000 to 10,000 pounds payload and evaluated over a broad spectrum of agricultural missions. From these studies, baseline design points were selected at 3200 pounds payload for the small aircraft and 7500 pounds for the large aircraft. The small baseline aircraft utilizes a single turboprop powerplant while the large aircraft utilizes two turboprop powerplants. These configurations were optimized for wing loading, aspect ratio, and power loading to provide the best mission economics in representative missions. Wing loading of 20 lb/sq ft was selected for the small aircraft and 25 lb/sq ft for the large aircraft. Aspect ratio of 8 was selected for both aircraft. It was found that a 10% reduction in engine power from the original configurations provided improved mission economics for both aircraft by reducing the cost of the turboprop. Refined configurations incorporate a 675 HP engine in the small aircraft and two 688 HP engines in the large aircraft

Diagnosis of bacterial infection

Accurate diagnosis of bacterial infection is crucial to avoid unnecessary antibiotic use and to focus appropriate therapy. Bacterial infectionis the combination of the presence of bacteria and inflammation or systemic dysfunction; therefore, more than one diagnostic modality isusually required for confirmation. History and examination to determine if a patient fits a clinical case definition is sometimes adequate toconfirm or exclude a diagnosis. The second stage is bedside tests – some are used widely, such as urine dipstick tests, but others, such as skinscrapings of petechial rashes, are underutilised. The third stage is laboratory tests – indirect non-culture-based tests, including C-reactiveprotein and procalcitonin tests, when negative, can be used to prevent the unnecessary use of antibiotics. Direct non-culture-based testsdetect antigens or specific antibodies, e.g. group A streptococcal antigen testing can be employed to reduce antibiotic use. Culture-basedtests are often considered the reference standard in modern microbiology. Because of slow turnaround times, these tests are frequentlyused to focus or stop antibiotic therapy after empiric initiation. Nucleic acid amplification tests raise the possibility of detecting organismswith high sensitivity, specificity and reduced turnaround time, and novel diagnostic modalities relying on nanotechnology and massspectrometry may dramatically alter the practice of microbiology in future

Preparing healthcare facilities to operate safely and effectively during the COVID-19 pandemic: The missing piece in the puzzle

The stated objective of the COVID-19 lockdown was to allow time to prepare healthcare facilities. Preparation must include administrative and environmental measures, which when combined with personal protective equipment, minimise the risk of the spread of infection to patients and healthcare workers (HCWs) in facilities, allowing HCWs to safely provide essential services during the pandemic and limit the indirect effects of COVID-19 caused by healthcare disruption. We present our model for facility preparation based on colour-coded zones, social distancing, hand hygiene, rapid triage and separate management of symptomatic patients, and attention to infection transmission prevention between HCWs in communal staff areas. This model specifically addresses the challenges in preparing a facility for COVID-19 in a low-resource setting and in rural areas. In addition, we include links to resources to allow workers in low-resource settings to prepare their facilities adequately

Manual Therapy and Exercise in Treatment of Patients with Cervical Radiculopathy: A Protocol for a Case Series

Study Design: Manual therapy and exercise in the treatment of patients with cervical radiculopathy: A protocol for a case series. Background: Cervical radiculopathy (CR) most commonly originates from space occupying lesions, resulting in upper extremity radicular pain. Numerous physical therapy interventions are available for treating CR symptoms, however present practice patterns incorporate the application of a combination of interventions with inconclusive or mixed results. Clinical practice guidelines advocate for the utilization of thoracic manipulation to treat CR. Objectives: It is hypothesized that the use of specific manual therapy techniques combined with exercise will have a positive effect on CR as measured by reduced levels of pain, disability, and improved range of motion (ROM), yet there are no studies to support this theory. Therefore, the purpose of this case series is to observe the short-term effects of specific manual therapy techniques and exercise directed to the thoracic and cervical spine in patients with CR. Methods:  The protocol utilizes a one-group pretest-posttest design.  This quasi-experimental design is intended to determine the short-term effects of thoracic manipulation, cervical rotation mobilization and exercise on pain and disability. Subjects completed the Neck Disability Index (NDI), the Numeric Pain Rating Scale (NPRS) at pre and post intervention, and a Global Rating of Change (GROC). Inclusion criteria: Subjects 18-60 years old, scored a 5 or higher on the NDI, and tested positive for at least 3 out of the 4 test items as reported in Wainner et al’s clinical prediction rule (CPR) for CR. Exclusion criteria: Any red flag items indicating non-musculoskeletal origin of symptoms or contraindications to manipulation. Interventions included thoracic manipulations followed by local cervical rotation mobilization and exercise prescription. Results: Of 5 subjects screened, only one fit the inclusion criteria of our study. This subject demonstrated decreases in NDI scores short of estabilished minimal detectable change (MDC) thresholds and decreases in NPRS scores that met MDC thresholds immediately following treatment and at 48 hour follow up.  The subject reported improvement on the GROC scale that did not meet minimally cinically important difference (MCID) threshold. Conclusion: Due to the single subject who qualified for inclusion, we were unable to draw statistically meaningful conclusions about our protocol.  This could be due to the fact that this condition does not commonly affect the demographics represented in the subject pool.  However, the subject who did qualify showed a clinically meaningful change on the NDI and NPRS outcome measures suggesting that further investigation using this protocol is warranted

Following Guidelines for Drug-Resistant Tuberculosis: “Yes, it’s a challenge”

BACKGROUND: Drug-resistant tuberculosis (DR-TB) is a major contributor to antimicrobial resistance (AMR) globally and is projected to be responsible for up to a quarter of AMR-associated deaths in the future. Management of DR-TB is increasingly decentralised to primary healthcare settings, and simultaneously becoming more complex due to a growing range of treatment options (e.g. novel agents, shorter regimens). This is reflected in the numerous recent updates to international guidelines and as such understanding the barriers and enablers to how healthcare workers access and use guidelines is vital. MATERIAL AND METHODS: We used an established psychological framework – the theoretical domains framework (TDF) – to construct and analyse an online survey and focus groups to explore healthcare workers current use of DR-TB guidelines in South Africa. We aimed to identify barriers and enablers with which to direct future attempts at improving guideline use. RESULTS: There were 19 responses to the online survey and 14 participants in two focus groups. 28% used the most up-to-date national guidelines, 79% accessed guidelines primarily on electronic devices. The TDF domains of ‘Social Influences’ (mean Likert score = 4.3) and ‘Beliefs about Consequences’ (4.2) were key enablers, with healthcare workers encouraged to use guidelines and also recognising the value in doing so. ‘Environmental Resources’ (3.7) and ‘Knowledge’ (3.3) were key barriers with limited, or variable access to guidelines and lack of confidence using them being notable issues. This was most noted for certain subgroups: children, HIV co-infected, pregnant women (2.7). DISCUSSION: Current use of DR-TB guidelines in South Africa is suboptimal. Planned interventions should focus on overcoming the identified key barriers and might include an increased use of digital tools

The estimated burden of fungal disease in South Africa

Background. With a population of 56.5 million, over 7 million persons living with HIV, one of the world’s highest rates of tuberculosis (TB) and a large proportion of the population living in poverty, South Africa (SA)’s fungal disease burden is probably substantial and broad in scope.Objectives. To estimate the burden of fungal disease in SA.Methods. Using total and at-risk populations and national, regional and occasionally global data, we estimated the incidence and prevalence of the majority of fungal diseases in SA.Results. Estimates for the annual incidence of HIV-related life-threatening fungal disease include cryptococcal meningitis (8 357 cases), Pneumocystis pneumonia (4 452 cases) and endemic mycoses (emergomycosis, histoplasmosis and blastomycosis, with 100, 60 and 10 cases per year, respectively). We estimate 3 885 cases of invasive aspergillosis annually. The annual burden of candidaemia and Candida peritonitis is estimated at 5 421 and 1 901 cases, respectively. The epidemic of pulmonary TB has probably driven up the prevalence of chronic pulmonary aspergillosis to 99 351 (175.8/100 000), perhaps the highest in the world. Fungal asthma probably affects >100 000 adults. Mucosal candidiasis is common, with an annual prevalence estimated at 828 666 and 135 289 oral and oesophageal cases, respectively, complicating HIV infection alone (estimates in other conditions not made), and over a million women are estimated to be affected by recurrent vulvovaginal candidiasis each year. Tinea capitis in children is common and conservatively estimated at >1 000 000 cases. The inoculation mycoses sporotrichosis, chromoblastomycosis and eumycetoma occur occasionally (with 40, 40 and 10 cases estimated, respectively). Overall, we estimate that over 3.2 million South Africans are afflicted by a fungal disease each year (7.1% of the population).Conclusions. Significant numbers of South Africans are estimated to be affected each year by fungal infections, driven primarily by the syndemics of HIV, TB and poverty. These estimates emphasise the need for better epidemiological data, and for improving the diagnosis and management of these diseases