Hepatitis B and C virus infections and liver function in AIDS patients at Chris Hani Baragwanath Hospital, Johannesburg

Background: Impaired liver function tests and co-infection with hepatitis viruses in AIDS patients are common in western countries.Objective: To assess liver function and prevalence of co-infection with hepatitis B and hepatitis C viruses in AIDS patients at Chris Hani Baragwanath Hospital.Design: A prospective study.Setting: Chris Hani Baragwanath Hospital, Johannesburg, South Africa.Patients: One hundred consecutive patients with AIDS admitted to Chris Hani Baragwanath Hospital.Results: There were 52 males and 48 females aged 16 to 54 years (mean + SD: 34.6 + 7.5 years). The results of laboratory test were as follows: LFTs: bilirubin 11.8 (+15.6) ìmol/ l; AST: 79.6 (±116.6) iu/L; alkaline phosphatase: 204.3 (±237.4) iì/L; albumin: 23.9 (±6.2) g/l; CD4+ Iymphocytes: 141.5 (±168.6) ìl; CD8+: 666.9 (±618.3) ìl; HBV - HbsAg: 6 (6%); HbsAg + eAg: 3 (3%); previous disease (Anti HBs and/or anti HBc): 35%, HCV: 1(1%).Conclusion: Liver function tests were impaired in the majority of patients with AIDS (93%) in our setting. Evidence of previous and present HBV infection was present in 41%. This is different from what is observed in western countries (90-95%). The results also suggest that patients here acquired HBV infection while still immuno competent. HCV infectionwas rare

Haematological profile of healthy adult blood donors in Mwanza, Tanzania

Background: While it is customary to apply the same haematological reference ranges, variations exist between populations. This study was conducted to determine hematologic profiles among a local population of north-western Tanzania.Methods:  This was a cross sectional study, which enrolled healthy adult blood donors in Mwanza, Tanzania. Collected blood samples were put in EDTA-coated tubes and haematological indices were determined using Auto Hematology-Analyzer. Results are summarized in medians plus 95% interquartile ranges and compared using either Mann–Whitney U or Kruskal–Wallis tests depending on appropriateness.Results:  A total of 163 (143 males and 20 females) adult healthy blood donors (median age= 31 years) were enrolled.  We found a median haemoglobin level of 15.1 g/dL [10.5-23.8], erythrocytes of 5.3x106/µL [4.1-8.3 x106], haematocrit of 44.0 % [32.4-71.4], total leucocytes of 4300 cells/μL [1700-8500], lymphocytes 1700/μL [800-3000], neutrophils 2100/μL [300-5300]; mid-sized cells (monocytes, eosinophils and basophils) of 400/μL [100-1400] and platelets of 194x103/μL [55.2-379.0 x103].  We observed significantly higher haemoglobin level (P = 0.017) as well as erythrocytes (P = 0.012) and haematocrit (p = 0.006) among males than females.   Conclusion: The percentile range (2.5%-97.5%) which can be used to determine the higher and lower values of haematological profile normal ranges for most indices differ from Western adopted reference values.  Therefore, we recommend a large study to establish local normal hematologic reference values

Hepatitis C infection at a tertiary hospital in South Africa: Clinical presentation, non-invasive assessment of liver fibrosis, and response to therapy

Background. Hepatitis C is a viral infection that leads to chronic liver disease, resulting in significant morbidity and mortality.Objectives. To describe the demographic characteristics and clinical presentation of patients with chronic hepatitis C infection. The aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis index based on 4 factors (FIB-4) were assessed for prediction of liver fibrosis.Methods. We retrospectively reviewed 87 records of patients who presented to the liver clinic at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, from January 2007 to December 2016. Patients’ records were reviewed and analysed using SPSS statistical software version 24. Convenience sampling was used.Results. The patients’ mean (standard deviation (SD)) age was 52.6 (12.3) years. Fifty-four percent were female. Hepatitis C virus genotype 5 was exclusively found in blacks (p<0.001), constituting 60.3% of infections in this ethnic group and 48.7% in the cohort, followed by genotype 1 (21.8%), genotype 3 (15.4%), genotype 4 (10.3%) and mixed-genotype infections (3.8%). Genotype 5 patients were older (mean (SD) age 56.7 (9.8) years) than genotype 1 (46.3 (11.4) years) and genotype 3 (42 (9.8) years) (p=0.002 and p<0.001, respectively). The receiver operating characteristic curve for METAVIR F0 v. APRI (cut-off <0.7) showed a moderate correlation, with an area under the curve (AUC) of 0.349 (p=0.002), sensitivity of 78.8%, specificity of 70.6% and a negative predictive value (NPV) of 63.2%. METAVIR F4 v. APRI (cut-off ≥1.5) showed an AUC of 0.881 (p=0.001) with sensitivity of 85.7%, specificity of 93% and a positive predictive value (PPV) of 67%. METAVIR F0 v. FIB-4 (cut-off <1.45) showed a moderate correlation, with an AUC of 0.332 (p=0.021), sensitivity of 78.3%, specificity of 53.8% and an NPV of 73.7%. METAVIR F4 v. FIB-4 (cut-off >3.25) had a strong correlation, with an AUC of 0.952 (p<0.001), sensitivity of 63.6%, specificity of 100% and a PPV of 100%. Early virological response (EVR) was found to predict sustained virological response (SVR) to therapy (odds ratio 27.8; 95% confidence interval 2.8 - 274.3; p=0.004).Conclusions. Compared with other genotypes, genotype 5 was predominant in our cohort, particularly in older age groups. Moreover, APRI and FIB-4 scores correlated significantly with advanced fibrosis in HCV patients. Finally, EVR during therapy was found to determine SVR

Infrastructure for sustainable use of animal genetic resources in southern and eastern Africa

The Global Plan of Action (GPA) for Animal Genetic Resources (AnGR) adopted by FAO recognizes the role of AnGR for food security through improved productivity while maintaining genetic diversity. A critical issue for conservation and genetic improvement programmes is the availability of supportive infrastructure. The objective of the present study was to assess existing and needed infrastructure for sustainable use of AnGR in a sample of countries in Southern and Eastern Africa. Information was primarily obtained from semi-structured interviews with key personnel in animal breeding during country visits. Countries studied are at different stages of development. No complete breeding programmes are in place but some conservation programmes exist in most countries. Except for a few cases, livestock recording as basis for R&D and breeding practice is lacking. The institutional setup to support animal breeding programmes is fragmented and needs to be better integrated. Shortage of skilled personnel is noted as the most serious constraint for development. Countries with least university training in animal breeding have least developed AnGR activities. However, since the GPA was agreed upon, many countries have re-casted their policies and make efforts to develop breeding policies. A change in mindsets aiming at closer collaboration among institutions, farmer involvement and capacity development and strengthening at all levels is suggested

Ocular manifestations of HIV infection at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

Background. The pattern of HIV-associated eye disease has changed with ongoing advancements in highly active antiretroviral therapy (HAART). HIV-infected individuals now live longer, enabling us to observe the long-term effects of HIV and HAART on the eye. There are few recent studies on HIV-related ocular disease in sub-Saharan Africa. Objectives. To describe the ocular manifestations of HIV in patients attending the Nthabiseng HIV clinic at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Methods. A cross-sectional study was conducted in 2021 and 2022 using convenience sampling of patients at the HIV clinic. The participants’ clinical history was taken, their files were reviewed, and they underwent ocular examination. Correlation between eyes was managed by taking disease in one eye as the presence of disease in the participant. Descriptive statistics were used to summarise participant characteristics. Univariate and multivariate logistic regression models were used to assess the odds ratio (OR) of developing HIV-associated ocular diseases, and a p-value of <0.05 was used to define statistical significance. Results. There were 182 participants (139 females and 43 males), with a mean (standard deviation) age of 48.9 (10.6) years. The most common anterior segment diagnoses were conjunctival microangiopathy (34.6%), pinguecula (31.3%) and cataracts (30.2%), while the most common posterior segment finding was peripheral retinal scarring with features in keeping of previous cytomegalovirus retinitis (24.2%). Notably, only 1.1% of patients had HIV retinopathy. A CD4 count <200 cells/μL showed an increased OR for cataracts (OR 4.24; p=0.003) and any anterior segment diagnoses (OR 10.05; p=0.029), while a CD4 count ≥200 cells/μL showed an increased risk of conjunctival microangiopathy (OR 2.14; p=0.017). Conclusion. With the advent of HAART, ocular manifestations of HIV are changing and the incidence of severe ocular opportunistic infections and HIV retinopathy has decreased precipitously. Although this study has shown that patients with a CD4 count <200 cells/μL are at increased risk of developing anterior ocular manifestations of HIV, including cataracts, these diseases are relatively innocuous or easily treatable. Routine ocular screening of HIV patients seems to be substantially less important now than it was in the pre-HAART era

Ally Financial Sale of Trust Preferred Securities Letter Agreements

Contains:- Letter Agreement between Ally Financial and the U.S. Department of Treasury - Form of Company Counsel Opinion - Form of Tax Counsel Opinion - Form of Delaware Counsel Trust Opinion - Form of Delaware Trustee Counsel Opinion - Form of the Institutional Trustee, The Guarantee Trustee and the Indenture Trustee Counsel Opinion - Letter from Ally Financial to the U.S. Department of Treasur

Underwriting Agreement - Ally Financial Sale of Trust Preferred Securities

Includes:- Underwriting Agreement - Final Term Sheet for Ally Financial - Opinion of In-House Counsel to the Company - Opinion of Davis Polk & Wardwell LLP, special counsel to the Company - Negative Assurance Letter of Davis Polk & Wardwell LLP, special counsel to the Company - Opinion of Davis Polk & Wardwell LLP, special tax counsel to the Company - Opinion of Emmet, Marvin & Martin, LLP, counsel to BNYM - Opinion of Richards, Layton & Finger, P.A., counsel to BNY Mellon Trust of Delaware - Opinion of Richards, Layton & Finger, P.A., counsel to the Trus

reastfeeding Experience of Women of High Socioeconomic Status: A Phenomenological Study

Studies on the implications brought about socioeconomic and breastfeeding practices is not sufficiently explored in the Philippines. The aim of the study is to explore the breastfeeding experiences among Filipino women with high socioeconomic status, as well as their needs in order to initiate and continue breastfeeding. The study utilized qualitative research methods. Six respondents participated in the study and were selected using snowball sampling. A semi-structured interview was done to obtain relevant information about the study. Colaizzi’s method was used to analyze the collected data. The emergent themes developed as follows: (1) perceptions of mothers about breastfeeding, (2) breastfeeding experience of mothers, and (3) needs of the mothers in order to breastfeed successfully. All mothers found breastfeeding to be difficult, most thought that it is best for infants and mothers. All mothers planned to breastfed antenatally and had to balance employment and breastfeeding. Most of them received support from their families, others from breastfeeding support groups, and workplaces. All mothers highlighted the importance of breastfeeding education for mothers, families, and health workers. They all found that determination and family support are significant for mothers to accomplish her desired breastfeeding goals.&nbsp; The researchers recommended that future studies should look into the specific knowledge deficiency of mothers, particularly those of high socioeconomic status regarding breastfeeding; development an extensive breastfeeding education program for health care professionals, pregnant and breastfeeding women, and family members

Breastfeeding Experience of Women of High Socioeconomic Status: A Phenomenological Study

Studies on the implications brought about socioeconomic and breastfeeding practices is not sufficiently explored in the Philippines. The aim of the study is to explore the breastfeeding experiences among Filipino women with high socioeconomic status, as well as their needs in order to initiate and continue breastfeeding. The study utilized qualitative research methods. Six respondents participated in the study and were selected using snowball sampling. A semi-structured interview was done to obtain relevant information about the study. Colaizzi’s method was used to analyze the collected data. The emergent themes developed as follows: (1) perceptions of mothers about breastfeeding, (2) breastfeeding experience of mothers, and (3) needs of the mothers in order to breastfeed successfully. All mothers found breastfeeding to be difficult, most thought that it is best for infants and mothers. All mothers planned to breastfed antenatally and had to balance employment and breastfeeding. Most of them received support from their families, others from breastfeeding support groups, and workplaces. All mothers highlighted the importance of breastfeeding education for mothers, families, and health workers. They all found that determination and family support are significant for mothers to accomplish her desired breastfeeding goals.&nbsp; The researchers recommended that future studies should look into the specific knowledge deficiency of mothers, particularly those of high socioeconomic status regarding breastfeeding; development an extensive breastfeeding education program for health care professionals, pregnant and breastfeeding women, and family members