A retrospective review of the adverse effects of biological therapy and reasons for its discontinuation in a resource-limited setting

Background. Biological disease-modifying antirheumatic drug therapies have become the gold standard of treatment for refractory rheumatic conditions in well-resourced countries. There is a significant risk of infection and reactivation of latent infections, in particular tuberculosis, with the use of biological therapies. Their safety and reasons for discontinuation in a resource-limited environment are still unclear.Objectives. The primary objective was to describe the nature and frequency of adverse events as well as the main reason for discontinuation of biological treatment.Methods. We conducted a retrospective, descriptive folder review of all patients started on biological therapy for rheumatic conditions from November 2011 to December 2016.Results. A total of 31 patients were included. The rheumatic diseases included in the study were ankylosing spondylitis (AS) (35%), rheumatoid arthritis (RA) (19%), systemic lupus erythematosus (16%), juvenile idiopathic arthritis (13%), vasculitides (10%) and psoriatic arthritis (7%). Adverse events occurred in 26 patients (84%). Serious adverse events occurred in 14 patients (45%) with recurrent uveitis being the most common, occurring in 5 patients (16%). One patient developed pulmonary tuberculosis (PTB). Discontinuation or switching of biological therapy occurred in 13 patients (42%), with the main reasons being serious adverse events in 7 patients (23%) and treatment failure in 6 (19%). The median (interquartile range (IQR)) Bath Ankylosing Spondylitis Disease Activity Index score improved from 6.4 (5 - 7.4) to 2.8 (0.9 - 5.0), a statistically significant difference of –3.5 (p=0.001) (95% confidence interval (CI) –5.3 - –1.7) over a median (IQR) of 20 (9 - 30) months in the AS group. The median (IQR) Clinical Disease Activity Index score improved from 39 (34.5 - 43) to 21 (18.7 - 25.5), a statistically significant difference of –17.4 (p=0.044) (95% CI –34.1 - –0.7) over a median (IQR) of 39 (21 - 50) months in the RA group.Conclusions. Recurrent uveitis occurred in almost half of the patients with AS and was also the main reason for discontinuation of biological therapy. We did not document an increased risk of PTB. Disease activity scores showed significant improvement. The study is limited by the small number of patients on biological therapy, a reflection of the impact of severe resource constraints

Evaluating an online self-help intervention for parents of children with food allergies

Background Parents of children with food allergies (CwFA) experience reduced quality of life (QoL) and may have reduced access to in-person interventions in the COVID-19 pandemic. This trial developed and evaluated an online, self-help, information provision website, aimed at improving QoL in parents of CwFA. Methods In a single-blinded, randomised controlled trial (RCT), participants were randomised to either receive access to the website or a waiting-list control. At baseline, post-intervention (week 4) and follow-up (week 8), measures of parental food allergy-related QoL, depression, anxiety, stress, intolerance of uncertainty (IU) and self-efficacy were obtained. Results A total of 205 participants were randomised; 97% were females, 91% white and 78% educated ≥ degree level, with a mean age of 38.95 years (SD = 6.89). 44.9% (n = 92) were retained at follow-up. The arms did not significantly differ on any outcome at any time point. For a sub-group of participants above the clinical cut-off for depression at baseline, the intervention may have improved QoL. Participants reported the website content as useful and accessible, but accessed it infrequently. In baseline data, IU and self-efficacy were significantly associated with QoL. Conclusion While the COVID-19 pandemic has encouraged greater provision of online interventions, our RCT suggests this particular website is not suitable for this population in general, although future research could examine its efficacy for depressed parents of CwFA, to increase confidence that the sub-group finding was not a Type 1 error. The baseline data suggest IU and self-efficacy remain potential proximal targets for intervention

Orthopaedic referrals using a smartphone app: Uptake, response times and outcome

Background. It is well established that South Africa (SA) suffers an immense burden of violence and injuries. The responsibility of providing care for these injuries falls mainly on public health services, resulting in overloading of the health system. Prior to a recent intervention, the large burden had been exacerbated by limitations in the traditional referral system that highlighted the need for a better referral system. Vula’s smartphone app was introduced at Tygerberg Hospital in August 2016. This study evaluated the uptake, response times and outcomes using this app.Objectives. The main objectives of the study were to describe: (i) the number of referrals; (ii) referral response times; (iii) referring facilities; and (iv) referral outcomes. Secondary objectives were to: (i) evaluate whether the referral outcome pathway was appropriate; and (ii) assess professional conduct and evidence of upskilling.Methods. This retrospective, descriptive study investigated Vula app referrals to the Division of Orthopaedic Surgery at Tygerberg Hospital between 1 August 2016 and 31 March 2017. Vula was advertised to key facilities in the hospital’s referral network. All referrals to the division during the study period were systematically included in the analysis of operational outcomes, although some were excluded from the subsequent referral outcome analysis. Operational outcomes included the number of referrals, referring facilities and referral response times. Referral outcome analysis included the clinical diagnosis, referral pathway, whether the referral was used for upskilling and whether it was conducted in a professional manner.Results. A total of 2 275 referrals from 39 different facilities were received during the study period from 238 individual users; 50% of referrals received a response within 11 minutes, while a small percentage received no response. Clinical and demographic characteristics of 1 985 patients included in the referral outcome analysis indicated that the majority of trauma and emergency referrals involved males, with closed fractures being the most frequent clinical presentation. Although the most common referral outcome was immediate transfer, one-third of the patients were treated at the referring hospital with advice only.Conclusions. The large volume of orthopaedic referrals received through the Vula app suggests that Vula represents a successful alternative to traditional referral methods. Referrals managed by advice only could suggest that Vula facilitates some relief for the overburdened trauma services. Future research could further explore Vula’s role in strengthening the public health system, including interventions for high-volume referral areas and upskilling of referring health workers.

Interaction Effects of 3-Mercaptohexan-1-ol (3MH), Linalool and Ethyl Hexanoate on the Aromatic Profile of South African Dry Chenin Blanc Wine by Descriptive Analysis (DA)

Interaction studies are some of the most interesting sensory experiments that highlight the effect of composition on wine perception. The use of single compounds, viz. an ester (ethyl hexanoate), a terpene (linalool) and a thiol (3-mercaptohexanol, 3MH), which have previously been shown to be representative of Chenin Blanc wines, resulted in typical descriptors for these compounds, such as ‘apple, ‘floral’ and ‘guava’ respectively. Interaction effects were observed between the compounds, and these were reflected in both the nature and the level of attributes generated. Additionally, interaction effects between the compounds (singles and combinations) and the wine matrix indicated that the latter plays an important role in theperception of wine aromas. The use of a dearomatised neutral wine base added an extra dimension to this study, which usually is done in a simpler matrix, such as a model wine

Sauvignon blanc wine : contribution of ageing and oxygen on aromatic and non-aromatic compounds and sensory composition : a review

CITATION: Coetzee, C. & Du Toit, W. J. 2015. Sauvignon blanc wine : contribution of ageing and oxygen on aromatic and non-aromatic compounds and sensory composition : a review. South African Journal for Enology and Viticulture, 36(3):347-365, doi:10.21548/36-3-968.The original publication is available at http://www.journals.ac.za/index.php/sajevOxidation and the capacity for sufficient ageing potential of white wines are constant problems for winemakers worldwide. In general, it is accepted that certain grape varieties are especially sensitive to oxidation, suggesting that some of the chemical components key to their sensory attributes are strongly modulated by oxygen exposure. Sauvignon blanc is a well-documented example of an oxygen-sensitive wine, and understanding the stability of various compounds is crucial in order to preserve the fresh and fruity characters of Sauvignon blanc wines while preventing the formation of off-odours over a long period of time. Compounds such as the volatile thiols and methoxypyrazines are key aroma compounds responsible for the typical Sauvignon blanc aroma, while other aroma compounds, such as esters, alcohols and acids, can also contribute to the wine aroma. Oxidation-related compounds (such as aldehydes) can occur under certain conditions and it is essential to understand the chemistry behind oxidation to control and manage the development of various characteristics in wine. The sensory interactions occurring between various compounds (both aromatic and non-aromatic) are also important due to enhancing or suppressive effects that can mask certain aroma nuances. This review focuses on the stability of certain compounds of Sauvignon blanc wines during oxidation and ageing and how it affects the aromatic and non-aromatic composition of these wines.http://www.journals.ac.za/index.php/sajev/article/view/968Publisher's versio

Oxygen Consumption in South African Sauvignon Blanc Wines: Role of Glutathione, Sulphur Dioxide and Certain Phenolics

The aim of this research was to investigate the interaction between sulphur dioxide, glutathione (GSH) and certain phenols in the presence of oxygen in a synthetic wine and in clarified Sauvignon blanc wine. In this study, the clarified wine, from which most of the phenols had been removed, was compared to synthetic wine solution, with both mediums being enriched with caffeic acid to investigate the effect of different levels of sulphur dioxide and GSH on oxygen consumption. Moreover, thirteen young South African Sauvignon blanc wines with different levels of sulphur dioxide were oxygenated, and the oxygen consumption and phenolic and colour changes were monitored over time. The results show that oxygen consumption was influenced greatly by the presence of sulphur dioxide and, to a lesser extent, by the presence of GSH, with both compounds decreasing during the course of the experiment. During oxidation, an increase was observed in glutathionyl caffeic acid, as well as in oxidised glutathione (GSSG); however, this did not coincide with the percentage decrease in GSH. Oxidation further led to an increase in absorbance measurements at 420 and 440 nm (yellow-orange colour), which were reduced by the presence of SO2. A large variation was also observed in the oxygen consumption of the young wines, with this rate increasing with an increase in SO2 concentration. Positive correlations were also observed between oxygen, SO2, GSH and Cu concentrations, which were again negatively correlated with absorbance at 420 and 440 nm and GSSG concentrations

Characterisation of Pinotage Wine During Maturation on Different Oak Products

The effect of oak contact on the phenolic composition, total antioxidant capacity (TAC) and colour of Pinotage wineswas investigated during maturation. Oak maturation included traditional treatments, such as new, second-fill andthird-fill barrels, as well as alternative treatments (oak chips, staves, extract and dust) applied in old barrels over aperiod of 28 weeks. Oak maturation using traditional and alternative treatments improved the objective colour ofPinotage wine by decreasing the L* value. Losses in TAC caused by decreased concentrations of monomeric phenoliccompounds (most anthocyanins, flavan-3-ols, flavonols and hydroxycinnamic acids) during oak maturation werenegated by increased concentrations of gallic acid and the formation of new oligomeric and polymeric pigments.Wine maturation in stainless steel containers also resulted in a decrease in anthocyanin content. The decreasein phenolic acid content for wines matured in stainless steel was less pronounced, while their flavan-3-ol contentremained stable. The new-barrel treatment had the most pronounced effect on all parameters. Oak maturation canbe used for the production of Pinotage wine when the retention of TAC is a high priority

Immune Dysregulation Is Associated with Neurodevelopment and Neurocognitive Performance in HIV Pediatric Populations—A Scoping Review

HIV-1 is known for its complex interaction with the dysregulated immune system and is responsible for the development of neurocognitive deficits and neurodevelopmental delays in pediatric HIV populations. Considering that HIV-1-induced immune dysregulation and its association with neurodevelopmental and neurocognitive impairments in pediatric populations are not well understood, we conducted a scoping review on this topic. The study aimed to systematically review the association of blood and cerebrospinal fluid (CSF) immune markers with neurocognitive deficits and neurodevelopmental delays in pediatric HIV populations. PubMed, Scopus, and Web of Science databases were searched using a search protocol designed specifically for this study. Studies were selected based on a set eligibility criterion. Titles, abstracts, and full texts were assessed by two independent reviewers. Data from the selected studies were extracted and analyzed by two independent reviewers. Seven studies were considered eligible for use in this context, which included four cross-sectional and three longitudinal studies. An average of 130 (±70.61) children living with HIV, 138 (±65.37) children exposed to HIV but uninfected and 90 (±86.66) HIV-negative participants were included across the seven studies. Results indicate that blood and CSF immune markers are associated with neurocognitive development/performance in pediatric HIV populations. Only seven studies met the inclusion criteria, therefore, these limited the number of significant conclusions which could have been made by using such an approach. All considered, the evidence suggests that immune dysregulation, as in the case of adult HIV populations, also has a significant association with neurocognitive performance in pediatric HIV populations

Orthopaedic referrals using a smartphone app : uptake, response times and outcome

CITATION: Morkel, R. W., et al. 2019. Orthopaedic referrals using a smartphone app : uptake, response times and outcome. South African Medical Journal, 109(11):859-864, doi:10.7196/SAMJ.2019.v109i11.13986.The original publication is available at http://www.samj.org.zaBackground. It is well established that South Africa (SA) suffers an immense burden of violence and injuries. The responsibility of providing care for these injuries falls mainly on public health services, resulting in overloading of the health system. Prior to a recent intervention, the large burden had been exacerbated by limitations in the traditional referral system that highlighted the need for a better referral system. Vula’s smartphone app was introduced at Tygerberg Hospital in August 2016. This study evaluated the uptake, response times and outcomes using this app. Objectives. The main objectives of the study were to describe: (i) the number of referrals; (ii) referral response times; (iii) referring facilities; and (iv) referral outcomes. Secondary objectives were to: (i) evaluate whether the referral outcome pathway was appropriate; and (ii) assess professional conduct and evidence of upskilling. Methods. This retrospective, descriptive study investigated Vula app referrals to the Division of Orthopaedic Surgery at Tygerberg Hospital between 1 August 2016 and 31 March 2017. Vula was advertised to key facilities in the hospital’s referral network. All referrals to the division during the study period were systematically included in the analysis of operational outcomes, although some were excluded from the subsequent referral outcome analysis. Operational outcomes included the number of referrals, referring facilities and referral response times. Referral outcome analysis included the clinical diagnosis, referral pathway, whether the referral was used for upskilling and whether it was conducted in a professional manner. Results. A total of 2 275 referrals from 39 different facilities were received during the study period from 238 individual users; 50% of referrals received a response within 11 minutes, while a small percentage received no response. Clinical and demographic characteristics of 1 985 patients included in the referral outcome analysis indicated that the majority of trauma and emergency referrals involved males, with closed fractures being the most frequent clinical presentation. Although the most common referral outcome was immediate transfer, one-third of the patients were treated at the referring hospital with advice only. Conclusions. The large volume of orthopaedic referrals received through the Vula app suggests that Vula represents a successful alternative to traditional referral methods. Referrals managed by advice only could suggest that Vula facilitates some relief for the overburdened trauma services. Future research could further explore Vula’s role in strengthening the public health system, including interventions for high-volume referral areas and upskilling of referring health workers.http://www.samj.org.za/index.php/samj/article/view/12758Publisher's versio