Infant feeding knowledge, perceptions and practices among women with and without HIV in Johannesburg, South Africa: a survey in healthcare facilities

BACKGROUND: South Africa has a history of low breastfeeding rates among women with and without Human Immunodeficiency Virus (HIV). In this study, we assessed infant feeding knowledge, perceptions and practices among pregnant and postpartum women with and without HIV, in the context of changes in infant feeding and Prevention of Mother-to-Child Transmission of HIV (PMTCT) guidelines. METHODS: This was a cross-sectional survey conducted from April 2014 to March 2015 in 10 healthcare facilities in Johannesburg, South Africa. A total of 190 pregnant and 180 postpartum women (74 and 67, respectively, were HIV positive) were interviewed using a semi-structured questionnaire. Multiple regression analyses assessed factors associated with an intention to exclusively breastfeed, and exclusive breastfeeding of infants less than six months of age. RESULTS: Women with HIV had better overall knowledge on safe infant feeding practices, both in general and in the context of HIV infection. There were however gaps in knowledge among women with and without HIV. Information from healthcare facilities was the main source of information for all groups of women in the study. A greater percentage of women without HIV 80.9% (93/115), reported an intention to exclusively breastfeed, compared to 64.9% (48/74) of women with HIV, p = 0.014. Not having HIV was positively associated with a reported intention to breastfeed, Adjusted Odds Ratio (AOR) 3.60, 95% CI 1.50, 8.62. Other factors associated with a reported intention to exclusively breastfeed were prior breastfeeding experience and higher knowledge scores on safe infant feeding practices in the context of HIV infection. Among postpartum women, higher scores on general knowledge of safe infant feeding practices were positively associated with reported exclusive breastfeeding, AOR 2.18, 95% CI 1.52, 3.12. Most women perceived that it was difficult to exclusively breastfeed and that cultural factors were a barrier to exclusive breastfeeding. CONCLUSIONS: While a greater proportion of women are electing to breastfeed, HIV infection and cultural factors remain an important influence on safe infant feeding practices. Healthcare workers are the main source of information, and highlight the need for accurate and consistent messaging for both women with and without HIV

Poly(ethylene glycol) enclatherated pectin-mucin submicron matrices for intravaginal anti-HIV-1 drug delivery

This paper explores the potential of polyethylene glycol enclatherated pectin-mucin (PEGencl- PEC:MUC) submicron matrices (SMMs) as an intravaginal drug delivery system capable of delivering an anti-HIV-1 agent (zidovudine; AZT) over a prolonged duration. A three factor and three level (33) Box-Behnken statistical design was employed to optimize the SMMs. Optimized PEG-encl-PEC:MUC SMMs prepared as a stable W/O emulsion (determined by the degree of reversible colloidal phenomena) were spherical with a mean particle size of 270.6±5.533nm and mean zeta potential of -34.4±0.539mV. The microencapsulation of AZT and the hydrogen bonding mediated shielding of AZT by SMMs was confirmed by Fourier Transform Infrared (FTIR) analysis. The thermochemical (differential scanning calorimetry and thermogravimetric analysis) data proposed that Ca2+- based macromolecular ionic crosslinking as well as the intermolecular interactions may be responsible for the thermal stability of the delivery system. The partially amorphous nature of drug-loaded SMMs, as confirmed by X-ray diffraction patterns, further strengthened the matricization of AZT into the pectin-mucin matrix. In vitro drug release studies from the SMMs showed approximately 91% zidovudine release in simulated vaginal fluid (SVF) and 94% in phosphate buffered saline (PBS) in 24 hours. The mean dissolution time (MDT) of zidovudine from the SMMs was 5.974 hours. The attainment of required dimensional structure and drug release profiles from SMMs highlights the potential of their inclusion into a secondary carrier system for extended and controlled intravaginal stay.National Research Foundation (NRF) of South Africa.http://www.elsevier.com/locate/ijpharm2017-04-30hb2016Chemistr

Ostrich, Southern Ostrich or Common Ostrich? The ‘eternal vexed question’ of English bird names and name changes in southern Africa through eight editions of Roberts field guides, 1940–2016

A set of stable simple common bird names helps non-ornithologist birders, who contribute to conservation by visiting protected areas and participating in citizen science projects. Changes in English bird names have caused discomfort in the local birding community, especially those that followed international standardisation of common bird names between 2000 and 2005. To understand the extent and nature of English bird name changes, an analysis was done of all southern African bird names through the eight editions of Roberts Birds of South/Southern Africa field guides published from 1940 to 2016. Of 813 species listed in both the first and the latest of the field guides, 453 (55.7%) had their names changed, among which 108 (13.3%) had changes in both the group name and the species epithet. The greatest single wave of changes (31.4%) occurred in the first ‘Roberts bird guide’ (the seventh field guide) in 2007, following international standardisation. Mean word and syllable counts of bird names also increased significantly in that edition. Name changes were associated with new authorships, taxonomic changes and use of geographic species epithets. There was a trend towards name stability for southern African endemic species. Further name changes should be kept to a minimum, shortening and simplifying wherever possible

Gestational trophoblastic disease managed at Grey's Tertiary Hospital : a five-year descriptive study

BACKGROUND: A study was undertaken to describe the outcomes of gestational trophoblastic disease (GTD) and to determine the influence of antecedent pregnancy, the distance travelled by patients to Grey’s Hospital (GH), and HIV status on the disease and clinical outcomes. METHODS: The files of all patients admitted to GH with a diagnosis of GTD from January 2013 to December 2017 were retrospectively reviewed. RESULTS: Sixty-three files were analysed. Thirty-six (57.1%) patients travelled < 80.5 km and 27 (42.9%) travelled ≥ 80.5km to GH. Eighteen (29%) patients were HIV positive with CD4 count ≥ 200 cells/mm3 . Twenty-six (41.3%) patients had antecedent term pregnancies, 12 (19.1%) and 11 (17.5%) had antecedent hydatidiform molar pregnancy (HMP) and spontaneous miscarriage respectively. Fifty (79.4%) patients presented with vaginal bleeding. Thirty (47.6%) patients were diagnosed with molar pregnancy and 33 (52.4%) patients had gestational trophoblastic neoplasia (GTN). Fourteen (42.4%) patients received singledrug chemotherapy while 19 (57.6%) received multidrug chemotherapy with a remission rate of 90.9%. The final outcome of the study patients was 41 (65.1%) alive without disease, 2 (3.2%) alive with disease, 3 (4.8%) who died and 17 (27%) lost to follow-up. Antecedent term pregnancy was associated with delayed diagnosis, while HMP was associated with early diagnosis of GTN. Long distance travelled by patients was associated with statistically significant levels of poor compliance and final outcomes. HIV-positive status was associated with higher FIGO staging. CONCLUSIONS: The study showed that antecedent pregnancy, HIV status and distance travelled by the patients have an influence on the diagnosis, staging and treatment outcomes of GTN respectively. However, more prospective research is needed to further substantiate these findings.https://medpharm.tandfonline.com/toc/ojgo20/currentpm2020Obstetrics and Gynaecolog

Why does the yield curve predict economic activity? Dissecting the evidence for Germany and the United States

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Submicron matrices embedded in a polymeric caplet for extended intravaginal delivery of Zidovudine

In this study, an intravaginal delivery system able to deliver an anti-HIV-1 agent for the purpose of potentially reducing HIV-1 transmission acting over an extended duration was successfully formulated. This delivery system was a composite polymeric caplet comprising zidovudine-loaded polyethylene glycol enclatherated pectin-mucin submicron matrices embedded within a poly (D,L-lactide), magnesium stearate, Kollidon® SR, and Carbopol® 974P NF-based polymeric caplet matrix. A three-factor and three-level Box-Behnken statistical design was utilized to optimize the polymeric caplet. The optimized directly compressed composite polymeric caplet hardness was 22.1 ± 0.3 N and the matrix resilience was 62.4 ± 0.6%. The swelling- and diffusion-controlled fractional zidovudine (AZT) release from the optimized caplet was 0.74 ± 0.01 in simulated vaginal fluid (SVF), which increased to 0.81 ± 0.21 in phosphate-buffered saline (PBS) simulating seminal fluid, over 30 days. Caplet matrix swelling was directly related to the percentage Carbopol 974P NF composition. An intravaginal system for AZT delivery was tested in the pig model over 28 days. X-ray analysis depicted delivery system swelling with matrix contrast fading over time as vaginal fluid permeated the matrix core. Plasma, vaginal fluid swab eluates, and tissue AZT concentrations were measured by gradient ultra-performance liquid chromatography (UPLC)-tandem photodiode array detection. Vaginal tissue and vaginal fluid swab eluate AZT concentrations remained above effective levels over 28 days and were higher than plasma AZT concentrations, availing a system with reduced systemic toxicity and more effective inhibition of viral replication at the site of entry.This study was derived from the Master’s dissertation of first author, Felix Mashingaidze, submitted 24 March 2014.The Council for Scientific and Industrial Research, South Africa (CSIR SA), the South African National Research Foundation (NRF) and the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.https://link.springer.com/journal/122482018-11-04hj2017Chemistr

Parents without children An evaluation and research report

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Trial Profile.

<p>Trial Profile.</p