Stroke in the young

CITATION: De Villiers, R. V. P., February, E. & De Villiers, M. L. 2003. Stroke in the young. South African Medical Journal, 93(11):836-837.The original publication is available at http://www.samj.org.za[No abstract available]Publisher’s versio

Stroke outcomes in a socio-economically disadvantaged urban community

Aims. To determine survival, disability and functional outcomes of stroke patients following their discharge from an acute stroke unit in an urban community with limited rehabilitative resources. Methods. Stroke patients were recruited from a district hospital in Cape Town and followed-up for 6 months. Clinical characteristics, demographic and socioeconomic data, and disability and function as measured by modified Rankin Score (mRS), modified Barthel Index (mBI) at recruitment and 3 follow-up visits, were recorded. Results. The study included 196 patients. Median age was 60 (IQR 51 - 69) years, 135 (68.9%) were female, 57.7% black, 42.3% coloured, and 45 (23%) died within 6 months. At discharge, median mBI score was 7 (IQR 3 - 12) and median mRS 4 (IQR 3 - 5). In the multivariate regression models, only function (mBI OR 0.88, 95% confidence interval (CI) 0.79 - 0.96, p<0.0001) and disability (mRS 0R 2.34, 95%CI 1.20 - 4.54, p<0.0001) were independently associated with risk of death. Shack housing was independently associated with moderate or severe disability (odds ratio 3.42, 95%CI 1.22 - 9.59, p=0.02). Despite limited rehabilitation resources, 67% of survivors had mild to moderate disability at 6 months. Conclusion. Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation resources to high-risk groups to improve outcomes

Thick domain walls around a black hole

We discuss the gravitationally interacting system of a thick domain wall and a black hole. We numerically solve the scalar field equation in the Schwarzschild spacetime and obtain a sequence of static axi-symmetric solutions representing thick domain walls. We find that, for the walls near the horizon, the Nambu--Goto approximation is no longer valid.Comment: 18 pages, 11 figures, one reference adde

Formulation of a topical sun protection cream for people with albinism

The aim of this investigation was to design and develop a sun protection product for people with albinism that is affordable, applicable to their specific skin condition, and provide them with the maximum sun protection possible. To achieve the required Sun Protection Factor value of > 20, simple creams were combined with very fine inorganic oxides (zinc oxide and titanium dioxide) and organic sunscreen filters (2-ethylhexyl cinnamate and octyl methoxycinnamate). These combinations also ensured high UVA/UVB protection ratios. The physical stability and change in Sun Protection Factor were for products stored for 8 weeks at 25°C (60% RH) and 45°C (75% RH) were also determined. Hypoallergenic and physically stable product(s) were formulated with SPF values between 20 to 30 and UVA/UVB ratios above 0.8 by combining simple cream formulations with fine particle inorganic oxides and organic UV protection agents. This approach offered an opportunity to formulate broad-spectrum sunscreen products that met the needs of albinos.Keywords: sun protection cream, sun protection factor, albinismThe East and Central African Journal of Pharmaceutical Sciences Vol. 7(3) 2006: 60-6

Sacroiliac tuberculosis masquerading as mechanical lower back pain in a collegiate basketball athlete: a case presentation

Background: Sacroiliac tuberculosis is a rare condition for which early diagnosis and effective management frequently proves challenging. This report describes a case that was initially overlooked due to its presentation and unreported constitutional symptoms.Aim: To alert clinicians about skeletal tuberculosis, an often neglected diagnostic differential, which requires a high index of clinical suspicion, especially for patients from endemic areas.Findings: This patient’s presentation (sports injury) and unreported constitutional symptoms resulted in a delay in the diagnosis and initial institution of treatment.Implications: This report illustrates the importance of specifically asking about constitutional symptoms, even in sports injury settings and being mindful of infectious diseases or other chronic medical conditions, which may masquerade as common sports injuries.Keywords: skeletal tuberculosis, sacroiliitis, hip pai

Profile and management of patients at a memory clinic

Increasing longevity and a growing older population are being accompanied by a higher prevalence of dementia and concomitant demand for care. In this connection, the University of Cape Town/Groote Schuur Hospital (UCT/ GSH) Memory Clinic provides a valuable service to patients, families and health professionals. High levels of behavioural and psychological symptoms of dementia need expert tertiary level assessment and management. Public education on dementia, early referral for assessment by primary care health professionals, and advanced training of health professionals are needed to encourage early recognition and appropriate management. Community-based care services too are needed to support caregivers of cognitively impaired older individuals

Instability of a membrane intersecting a black hole

The stability of a Nambu-Goto membrane at the equatorial plane of the Reissner-Nordstr{\o}m-de Sitter spacetime is studied. The covariant perturbation formalism is applied to study the behavior of the perturbation of the membrane. The perturbation equation is solved numerically. It is shown that a membrane intersecting a charged black hole, including extremely charged one, is unstable and that the positive cosmological constant strengthens the instability.Comment: 12 pages, 3 figures, to be published in Physical Review

The role of educational strategies to reverse the inverse performance spiral in academically-isolated rural hospitals

The importance of continuous professional development for health care workers is widely acknowledged, but the identification of optimal implementation strategies remains a challenge, particularly in academically isolated rural areas. We report the results of a qualitative study that evaluated the effect of an educational intervention aimed at rural doctors in the Western Cape Province, South Africa. We also present a conceptual framework for developing best practice educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals. Doctors felt that participation in relevant learning activities improved their competence, increased the levels of job satisfaction they experienced, increased their willingness to stay in a rural environment, and impacted positively on the quality of services provided. However, the success of educational strategies is heavily dependant on the local environment (context), as well as the practical applicability and clinical relevance of the activities (process). Successful educational strategies may help to reverse the inverse performance spiral previously described in academically isolated rural hospitals, however, this requires effective local leadership that creates a positive learning environment and supports clinically relevant learning activities. The study findings also indicate the need for health care providers and institutions of higher education to join forces to improve the quality of rural health care. South African Family Practice Vol. 49 (7) 2007: pp. 1

Results from South Africa's 2016 report card on physical activity for children and youth

Background: We present results of the 2016 Healthy Active Kids South Africa (HAKSA) Report Card on the current status of physical activity (PA) and nutrition in South African youth. The context in which we interpret the findings is that participation in PA is a fundamental human right, along with the right to "attainment of the highest standard of health." Methods: The HAKSA 2016 Writing Group was comprised of 33 authorities in physical education, exercise science, nutrition, public health, and journalism. The search strategy was based on peer-reviewed manuscripts, dissertations, and 'gray' literature. The core PA indicators are Overall Physical Activity Level; Organized Sport Participation; Active and Outdoor Play; Active Transportation; Sedentary Behaviors; Family and Peer Influences; School; Community and the Built Environment; and National Government Policy, Strategies, and Investment. In addition, we reported on Physical Fitness and Motor Proficiency separately. We also reported on nutrition indicators including Overweight and Under-nutrition along with certain key behaviors such as Fruit and Vegetable Intake, and policies and programs including School Nutrition Programs and Tuck Shops. Data were extracted and grades assigned after consensus was reached. Grades were assigned to each indicator ranging from an A, succeeding with a large majority of children and youth (81% to 100%); B, succeeding with well over half of children and youth (61% to 80%); C, succeeding with about half of children and youth (41% to 60%); D, succeeding with less than half but some children and youth (21% to 40%); and F, succeeding with very few children and youth (0% to 20%); INC is inconclusive. Results: Overall PA levels received a C grade, as we are succeeding with more than 50% of children meeting recommendations. Organized Sports Participation also received a C, and Government Policies remain promising, receiving a B. Screen time and sedentary behavior were a major concern. Under-and over-weight were highlighted and, as overweight is on the rise, received a D grade. Conclusion: In particular, issues of food security, obesogenic environments, and access to activity-supportive environments should guide social mobilization downstream and policy upstream. There is an urgent need for practice-based evidence based on evaluation of existing, scaled up interventions.Scopu