Sentinel seroprevalence of SARS-CoV-2 in Gauteng Province, South Africa, August - October 2020

Background. Estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) for tracking the COVID-19 epidemic are lacking for most African countries.Objectives. To determine the prevalence of antibodies against SARS-CoV-2 in a sentinel cohort of patient samples received for routine testing at tertiary laboratories in Johannesburg, South Africa.Methods. This sentinel study was conducted using remnant serum samples received at three National Health Laboratory Service laboratories in the City of Johannesburg (CoJ) district. Collection was from 1 August to 31 October 2020. We extracted accompanying laboratory results for glycated haemoglobin (HbA1c), creatinine, HIV, viral load and CD4 T-cell count. An anti-SARS-CoV-2 targeting the nucleocapsid (N) protein of the coronavirus with higher affinity for IgM and IgG antibodies was used. We reported crude as well as population-weighted and test-adjusted seroprevalence. Multivariate logistic regression analysis was used to determine whether age, sex, HIV and diabetic status were associated with increased risk for seropositivity.Results. A total of 6 477 samples were analysed, the majority (n=5 290) from the CoJ region. After excluding samples with no age or sex stated, the model population-weighted and test-adjusted seroprevalence for the CoJ (n=4 393) was 27.0% (95% confidence interval (CI) 25.4 - 28.6). Seroprevalence was highest in those aged 45 - 49 years (29.8%; 95% CI 25.5 - 35.0) and in those from the most densely populated areas of the CoJ. Risk for seropositivity was highest in those aged 18 - 49 years (adjusted odds ratio (aOR) 1.52; 95% CI 1.13 - 2.13; p=0.0005) and in samples from diabetics (aOR 1.36; 95% CI 1.13 - 1.63; p=0.001).Conclusions. Our study conducted between the first and second waves of the pandemic shows high levels of current infection among patients attending public health facilities in Gauteng Province

Utility of WIfI foot assessment tool in a Sri Lankan setting; an initial experience

Introduction: Potential for limb salvage and wound healing in a lower limb ulcer depends on degreeof ischemia, wound grade and superadded foot infection.Objectives: Our objective was to assess the feasibility of applying WIfI classification system to stratifypatients presenting with limb ulceration according to risk of undergoing amputation and benefit ofrevascularization.Methods: Fifty four consecutive patients with ulcerated limbs presenting over two months to theUniversity unit at the National Hospital were staged according to the Society for Vascular Surgery(SVS)Wound, Ischemia, and Foot Infection (WIfI) classification system.Results: The median age was 64 (39-93), and 42 (79%) patients were males. Diabetes (87%),hypertension (53%), ischemic heart disease (14%), cerebrovascular disease (13%), chronic renal disease(13%) were identified risk factors. Smoking was reported among 35%. Median Anterior TibialArtery(ATA), Posterior Tibial Artery(PTA), Toe pressures, Ankle Brachial Index, Pole test values ofthe affected side lower limbs were 114.5mmHg, 107.5mmHg, 41mmHg, 0.87 and 85cm respectively.Values for the contralateral limb were 140mmHg, 120mmHg, 74mmHg, 1.0 and 85cm respectively.84% of ATA and 90 % of PTA pulses were not palpable on the affected side. Grades of ischemia were;none (23.3%), mild (27.9%), moderate (18.6%), severe (30.2%), grades of infection were none (20.9%),mild (37.2%), moderate (39.5%), severe (2.3%), and wound grades were 0(0%), 1(20%.9), 2(39.5%),3(39.5%). Estimated risk of amputation were high (65.1%), moderate (11.6%), low (11.6%), very low(11.6%) and estimated benefit of revascularization were high (46.5%) moderate (23.3%), low (7.0%),very low (23.3%).Conclusions: Application of WIfI system was useful to prioritize patients with eminent limb loss forurgent intervention. Toe pressure assessment for diabetic foot ulcer stratification should become acommon practice

Expectations versus reality in chronic venous ulceration; a quality of life assessment study

Introduction: Chronic venous ulceration is a common problem worldwide with a significant effect onQuality of Life (QoL).Objectives: Our objective was to assess Sri Lankan patients’ perspective with regard to this scenario.Methods: We involved 141 consenting patients presenting to the OPD, National Hospital with a venousulcer lasting one month or more. Data was collected using an interviewer administered questionnaire, aclinical interview and a lower limb duplex scan. Short form 36 questionnaire was used for QoLassessment.Results: The majority were elderly (median age 53 years) men (n=9[69.5%]). Fifty four (38.3%) wereunemployed at the time of the study and 28 (19.9%) directly attributed the ulcer as the cause forunemployment. Median duration of ulcer was 10[1-360] months and mean Venous Clinical SeverityScore (VCSS) was 13.85(4-24). Family history (44[31.2%]), previous limb trauma or non-venoussurgery (24[17.0%]), smoking among men (57 [58.2%]) and history of pregnancy among females(34[79.1%]) were identified as risk factors. Role limitation due to physical health (28.4[SD 42.8]) androle emotional problems (40.9 [SD 46.7]) had a mean SF 36 score below 50. Factors such as pain,duration of ulcer, older age and higher BMI significantly affected many domains of QoL (p<0.05). Sixtysix (46.8%) patients continue to have ulcers despite having had surgical treatment for varicose veins.Conclusions: Venous ulcers have a considerable impact on the quality of life in Sri Lankan patientswith venous ulcer. The need for providing preventive and rapid healing methods together with socialsupport must be emphasized

Features of home and neighbourhood and the liveability of older South Africans

While older people live in developing countries, little is known about the relative importance of features of their communities in influencing their liveability. We examinecomponents of home and neighbourhood among older South Africans. Linear regression analyses revealed that features of home (basic amenities, household composition, financial status and safety) and neighbourhood (ability to shop for groceries, participate in organizations and feel safe from crime) are significantly associated with life satisfaction. Approaches to liveability that are person-centred and also set within contexts beyond home and neighbourhood are needed to addressboundaries between home and neighbourhood; incorporate personal resources into liveability models and import broader environmental contexts such as health and social policy

The dog as an animal model for DISH?

Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic disorder of the axial and peripheral skeleton in humans and has incidentally been described in dogs. The aims of this retrospective radiographic cohort study were to determine the prevalence of DISH in an outpatient population of skeletally mature dogs and to investigate if dogs can be used as an animal model for DISH. The overall prevalence of canine DISH was 3.8% (78/2041). The prevalence of DISH increased with age and was more frequent in male dogs, similar to findings in human studies. In the Boxer breed the prevalence of DISH was 40.6% (28/69). Dog breeds represent closed gene pools with a high degree of familiar relationship and the high prevalence in the Boxer may be indicative of a genetic origin of DISH. It is concluded that the Boxer breed may serve as an animal model for DISH in humans

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

High risk of malnutrition associated with depressive symptoms in older South Africans living in KwaZulu-Natal, South Africa: a cross-sectional survey

Background Malnutrition contributes to functional and cognitive decline in older adults, which results in decreased quality of life and loss of independence. This study aimed to identify determinants of nutritional risk among community-dwelling adults in KwaZulu-Natal, South Africa. Methods A cross-sectional survey was undertaken in 1008 subjects aged 60 years and over who were randomly selected by systematic sampling. Demographics, socioeconomic data and self-reported history of medical conditions were recorded. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to screen for nutritional risk, and the Centre for Epidemiologic Studies Depression scale was administered to all subjects. Descriptive statistics and the Pearson chi-square and Kruskal-Wallis tests were used for statistical analysis. Logistic regression modelling determined predictors of nutritional risk. Results Of the 984 participants (mean age = 68.8 ± 7.4 years; range 60-103 years) who completed the MNA-SF, 51 % were classified as having a normal nutritional status, 43.4 % at risk for malnutrition and 5.5 % classified as malnourished. Men were more likely to be either at risk for malnutrition or be malnourished than women (p = 0.008), as were subjects with a monthly household income of ≤R1600 per month (~133 USD) (p = 0.003). In logistic regression models, depressed people were 2.803 (p \u3c 0.001) times more likely to be at risk or be malnourished than those not depressed. Conclusion A high prevalence of risk of malnutrition was identified in older South Africans living in an urban area with poor infrastructure. Further investigations are warranted to determine whether the higher prevalence of depressive symptomatology in nutritionally at risk individuals is a determinant or a consequence of malnutrition, in order to develop targeted nutritional interventions in this age group

High risk of malnutrition associated with depressive symptoms in older South Africans living in KwaZulu-Natal, South Africa : a cross-sectional survey

CITATION: Naidoo, I., Charlton, K. E., Esterhuizen, T. M. & Cassim, B. 2015. High risk of malnutrition associated with depressive symptoms in older South Africans living in KwaZulu-Natal, South Africa : a cross-sectional survey. Journal of Health, Population and Nutrition, 33:19, doi:10.1186/s41043-015-0030-0.The original publication is available at http://jhpn.biomedcentral.comBackground: Malnutrition contributes to functional and cognitive decline in older adults, which results in decreased quality of life and loss of independence. This study aimed to identify determinants of nutritional risk among community-dwelling adults in KwaZulu-Natal, South Africa. Methods: A cross-sectional survey was undertaken in 1008 subjects aged 60 years and over who were randomly selected by systematic sampling. Demographics, socioeconomic data and self-reported history of medical conditions were recorded. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to screen for nutritional risk, and the Centre for Epidemiologic Studies Depression scale was administered to all subjects. Descriptive statistics and the Pearson chi-square and Kruskal-Wallis tests were used for statistical analysis. Logistic regression modelling determined predictors of nutritional risk. Results: Of the 984 participants (mean age = 68.8 ± 7.4 years; range 60–103 years) who completed the MNA-SF, 51 % were classified as having a normal nutritional status, 43.4 % at risk for malnutrition and 5.5 % classified as malnourished. Men were more likely to be either at risk for malnutrition or be malnourished than women (p = 0.008), as were subjects with a monthly household income of ≤R1600 per month (~133 USD) (p = 0.003). In logistic regression models, depressed people were 2.803 (p < 0.001) times more likely to be at risk or be malnourished than those not depressed. Conclusion: A high prevalence of risk of malnutrition was identified in older South Africans living in an urban area with poor infrastructure. Further investigations are warranted to determine whether the higher prevalence of depressive symptomatology in nutritionally at risk individuals is a determinant or a consequence of malnutrition, in order to develop targeted nutritional interventions in this age group.http://jhpn.biomedcentral.com/articles/10.1186/s41043-015-0030-0Publisher's versio

Allergic rhinitis in medical students at the University of the Free State

Background: Allergic rhinitis, the most common form of chronic rhinitis, can adversely affect quality of life. The prevalence of allergic rhinitis in adolescents in South Africa has been estimated to be 38.5%, but there is a paucity of data from African countries on allergic rhinitis.Aim: The aim of this study was to determine the prevalence of allergic rhinitis in medical students in the Faculty of Health Science at the University of the Free State (UFS). Information was acquired on the effects that the condition had on participants with regard to symptoms, quality of life, disease management and treatment.Methods: A cross-sectional study design was used. A self-administered anonymous questionnaire was distributed to all medical students registered with the Faculty of Health Sciences at UFS in 2016. The estimated population was 706 students.Results: The response rate was 62.6%. The prevalence of allergic rhinitis was 39.1%. The most common symptoms were rhinorrhoea (64.8%), repeated sneezing (64.3%) and nasal obstruction (58.5%). Symptoms were at their worst during August to October. Antihistamines had been used by 82.4% of participants to treat their symptoms in the previous 12 months, while 28.8% had used an intranasal steroid spray.Conclusion: The prevalence of allergic rhinitis in medical students at UFS was 39.1%. Rhinorrhoea, sneezing and nasal obstruction were the most frequent and bothersome symptoms