Late termination of pregnancy by intracardiac potassium chloride injection: 5 years’ experience at a tertiary referral centre

Objectives. To report our experience with intracardiac potassium chloride (KCl) injection as a method of feticide for severe congenital abnormalities beyond 24 weeksf gestation.Method. A retrospective chart review. Patient demographics and types of fetal anomalies were analysed according to the groups that acceptedor declined late termination of pregnancy (LTOP, .24 weeks) for severe congenital abnormalities.Results. Of 3 896 women referred to the Fetal Medicine Unit at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, 2 209 (56.7%) were at .24weeksf gestation at their first visit. LTOP for severe congenital  abnormalities was offered to 253 (11.5%), of whom 191 (75.5%) accepted. Differences in maternal age, parity, race and religion were not statistically significant. The type of fetal abnormalities and gestational age at diagnosis influenced the decision-making process in >80% of the women. The most frequent indications for LTOP were brain and spinal  abnormalities (53.0%), and aneuploidy (20.6%). Feticide by ultrasound-guided intracardiac KCl injection was performed in 138/191 cases (72.2%); 53 women who accepted LTOP did not undergo feticide for a variety of reasons. The mean interval between diagnosis and performance of feticide was 10 days (range 0 - 42 days). Fetal asystole was achieved in all cases within 2 minutes by a single-needle injection of intracardiac KCl; the mean duration of the procedure was 12 minutes (range 6 - 25 minutes). There were no maternal complications, and stillbirths occurred in all cases.Conclusion. Feticide by ultrasound-guided intracardiac KCl injection was an acceptable, safe and effective method for LTOP. Further studies are needed to determine the minimum dosage of KCl required to achieve the desired effect

Soft-tissue tumour of the fetal thigh

No Abstract. South African Medical Journal Vol. 96 (3) 2006: 187-18

Trade mark parody in South Africa — The last laugh!

This article endeavours to find the balance (if any) in South African law between the rights of trade mark owners from infringement of their trade marks, and the constitutional right to free expression (with particular reference to parody) in a society that advocates the values of democracy and freedom. As intellectual property, registered trade marks deserve the protection of the law, a careful balancing act between property rights and fundamental freedoms must be performed to determine if one outweighs the other. In this regard Laugh It Off Promotions CC v South African Breweries International will be discussed. The position of parody in South African trade mark law desperately needs to have a last laught, once and for all

Survival and development of Amblypelta nitida Stål, A. l. lutescens Distant (Hemiptera: Coreidae) and the egg parasitoid, Anastatus sp. (Hymenoptera: Eupelmidae) at constant rearing temperatures

The effects of constant rearing temperatures on the development and survival of Amblypelta nitida, Amblypelta lutescens lutescens (Hemiptera: Coreidae) and their egg parasitoid, Anastatus sp. (Hymenoptera: Eupelmidae), were studied in the laboratory. Amblypelta nitida and A. l. lutescens survival and development were studied at 10,15, 20, 25,30 and 35 degrees C. The development rate of both species increased linearly with increasing temperature but insects only developed to adults at 20, 25 and 30 degrees C; at these temperatures, mean development times for A. nitida were 87, 64 and 29 days and forA. l. lutescens they were 93, 65 and 31 days respectively. No eggs of either species hatched at 10 degrees C and only A l. lutescens eggs hatched at 35 degrees C At all temperatures at which insects developed beyond the first instar, mortality rates were highest in the second instar for both species. Lower developmental threshold temperatures to complete development were 15.9 degrees C and 17.1 degrees C for A. nitida and A. l. lutescens respectively; A. nitida required 421 degree-days and A.l. lutescens required 404 degree-days to complete development. Anastatus sp. completed development at all six study temperatures and development times decreased from 54 days at 17.5 degrees C to 16 days at 30 degrees C; similarly Anastatus sp, survival increased with increasing temperature. The lower developmental threshold temperature and degree-days required for Anastatus sp. to complete development were 15.0 degrees C and 234 degree-days respectively. Results are discussed with respect to the different geographical distributions of A. nitida and A. l. lutescens and likely interactions with Anastatus sp. (C) 2016 Korean Society of Applied Entomology, Taiwan Entomological Society and Malaysian Plant Protection Society. Published by Elsevier B.V. All rights reserved

Utility of the Robson Ten Group Classification System to determine appropriateness of caesarean section at a rural regional hospital in KwaZulu-Natal, South Africa

Background: High caesarean section (CS) rates are not only costly but associated with significant perinatal and maternal morbidity and mortality. It has recently been suggested that structured auditing of CSs may identify those groups in the obstetric population that contribute substantially to the high rates and for which focused interventions may bring about change.Objective: To evaluate the utility of the Robson Ten Group Classification System (RTGCS) in determining appropriateness of CS at a regional rural hospital in KwaZulu-Natal Province, South Africa.Methods: A retrospective review of the hospital records of women delivered by CS over a 3-month period was performed. The RTGCS was used to categorise women according to parity, age, past obstetric history, singleton or multiple pregnancy, fetal presentation, gestational age and mode of onset of labour/delivery.Results: There were 2 553 hospital births over the 3-month study period. The CS rate was 42.4% (1 082/2 553). According to the RTGCS, groups 1 (n=296, 27.4%), 5 (n=186, 17.2%) and 10 (n=253, 23.4%) were substantial contributors to the overall CS rate. The main indications for CS were fetal distress (36.5%) and cephalopelvic disproportion (26.8%).Conclusion: The RTGCS is a useful tool with which to identify patient groups warranting interventions to reduce high CS rates in a rural regional hospital setting. Group 1 (nullipara: single cephalic term pregnancy; spontaneous labour) warrants the most attention. Applying stricter criteria and due diligence in decision-making for primary CS may decrease the high CS rates

Teaching and learning considerations during the COVID 19 pandemic: Supporting multimodal student learning preferences

Background. The advent of COVID‑19 and the subsequent national lockdown has catapulted higher education institutions into emergency remote teaching (ERT). A principal challenge in this shift is the ability to stimulate student interest towards engagement with, and retention of, course content. The creation of teaching and learning (T&L) resources and activities using a combination of the visual, aural, read/write and kinaesthetic (VARK) modes is fundamental in ensuring student engagement. Objectives. To determine the learning style profiles of undergraduate students and to explore how student learning profiles may be incorporated in T&L approaches during ERT. Methods. This descriptive study profiles the learning preferences of undergraduate students in a health science faculty using the VARK questionnaire. The study further outlines modifications in T&L implemented to support the varied learning preferences during the COVID‑19 ERT response. Results. Our findings demonstrate that the majority of our students have a multimodal learning preference, with the kinaesthetic modality being the most preferred. Voice-over PowerPoint presentations with transitioning images, and audio files, supported the visual and aural learners through asynchronous engagement. Additionally, online discussion forums and applied projects (such as theme park designs) enhanced asynchronous learning by stimulating the visual, read/write and kinaesthetic preferences, respectively. Microsoft Team sessions with PowerPoint presentations supported visual and aural learning preferences through synchronous engagement. Conclusions. Rethinking traditional T&L approaches towards supporting the diverse student learning preferences is critical in student-centred T&L amidst the many challenges that ERT has precipitated. Academics need to be dynamic in their T&L approaches and intuitive in their awareness of how subject content may be modified/enhanced in the ERT environment

Acceptance of a complementary food prepared with yellow, provitamin A-biofortified maize by black caregivers in rural KwaZulu-Natal

Objectives: The objective was to assess the sensory acceptability and consumer perceptions of soft porridge made with yellow, provitamin A-biofortified maize by black African female infant caregivers from rural KwaZulu-Natal.Design: This was a cross-sectional study.Setting: The study was conducted at Edendale Hospital, located in the uMgungundlovu District, KwaZulu-Natal province. The hospital serves a high proportion of people from rural areas in this district.Subjects: Sixty black African female infant caregivers participated in the study.Outcome measures: The sensory acceptability of soft porridge made from two varieties of provitamin-A biofortified maize and one variety of white maize were evaluated by black African female infant caregivers (n = 60) using a five-point facial hedonic scale. Some of the subjects (n = 21) participated in focus group discussions to assess consumer perceptions.Results: There was no significant difference in the sensory acceptability of the biofortified maize porridge and the white maize porridge, irrespective of caregiver age (p-value > 0.05). The caregivers expressed a willingness to give their infants porridge made with provitamin A-biofortified maize if it was more affordable, readily available and beneficial to health.Conclusion: The biofortified maize soft porridge was found to be as  acceptable as the white maize soft porridge to black African female infant caregivers from rural KwaZulu-Natal. Provitamin A-biofortified maize has the potential to be used as a complementary food item that would contribute to the alleviation of vitamin A deficiency

Piloting a trauma surveillance tool for primary healthcare emergency centres

Objective. We aimed to pilot a trauma surveillance tool for use ina primary healthcare emergency centre to provide a risk profile ofinjury patterns in Elsies River, Cape Town.Methods. Healthcare workers completed a one-page questionnairecapturing demographic and injury data from trauma patients presenting to the emergency unit of the Elsies River Community Health Centre over a period of 10 days.Results. Trauma cases comprised about one-fifth of the total headcount during the study period. Most injuries took place before midnight. Approximately 47% of the trauma patients were suspected of being under the influence of alcohol with 87% of these cases caused by interpersonal violence; 28% were males between 19 and 35 years old, suspected of being under the influence of alcohol and presenting with injuries due to violence.Conclusion. Injury surveillance at primary healthcare emergency centres provides an additional perspective on the injury burden compared with population-level mortality statistics, but the quality of data collection is limited by resource constraints. We recommend that the current trauma register be revised to separate trauma and medical headcounts and enable better resource planning at a facility and subdistrict level. Information gathered must be linked to health and safety interventions aimed at reducing the trauma burden within communities

Inflation driven by causal heat flux

We find a simple inflationary solution in an inhomogeneous spacetime with heat flux. The heat flux obeys a causal transport equation, and counteracts the inflationary decrease of energy density. At late times, the heat flux tends to zero and the fluid approaches the equation of state $p=-\rho$.Comment: Latex 5 pages; to appear Gen. Rel. Gra