Control of rheumatoid arthritis with conventional disease-modifying antirheumatic drugs in a tertiary hospital in central South Africa

Background. Rheumatoid arthritis (RA) is a highly prevalent disease with a significant impact on morbidity and life expectancy. There is a paucity of literature relating to the current state of disease control in South Africa, and none on Free State Province.Objectives. To evaluate control of RA with conventional disease-modifying antirheumatic drugs (DMARDs) in the rheumatology outpatient department of Universitas Academic Hospital, Bloemfontein, and to determine the relative impact of various factors contributing to the prevention of disease control.Methods. A cross-sectional study was undertaken over a period of 8 months from December 2016 to August 2017 in the rheumatology outpatient department of Universitas Academic Hospital. Data were collected by means of information sheets and questionnaires completed by attending doctors. The information pertained to disease activity, possible factors contributing to poor control, and relevant demographic data.Results. Information was collected from 169 patients, and data analysis was performed on 161. The results revealed that RA was controlled in 34 patients (21.1%). Of the 127 patients with uncontrolled disease, 61 (48.0%) reported dispensing issues relating to poor drug availability. Seventy-two (56.7%) of the patients with uncontrolled disease were deemed to be on insufficient treatment for their disease state, of whom 33 (45.8%) also reported concomitant dispensing issues. Other factors such as transport/access problems, administrative issues, adverse events and poor compliance/insight contributed to the inadequate control of RA to a minor extent. In terms of monthly dispensing, 159 patients (98.8%) reported receiving all their DMARDs during the first month. The vast majority of these drugs were dispensed from Universitas Hospital. This figure decreased to 119 patients (73.9%) who received all their DMARDs during the second month, mostly from district units. Only 55.3% (n=89) of the patients reported receiving all of their DMARDs from their down-referral units.Conclusions. Control of RA at this institution is suboptimal compared with national and international standards. The main contributors to poor control appear to be problems relating to dispensing of medication and inadequate escalation of therapy by doctors. Most of the concern with the dispensing of medication lies with the poor availability of DMARDs in peripheral unit pharmacies. These factors are remediable and should be attended to

Utilisation of maternity services by black women in rural and urban areas of the Orange Free State

An epidemiological survey was undertaken to evaluate the utilisation of maternal services for black women in the Orange Free State. Two hundred and forty clusters were selected from the rural (farms) and urban (local authorities) black population and eight households were interviewed in each cluster. Information was gathered from 237 rural women (from 959 households) and 168 urban women (from 926 households) who had delivered a baby or aborted during the preceding year. Antenatal care was received by 71 % of the rural women and 87% of the urban women. Rural women delivered at home in 60% of cases while 37% delivered in hospitals. Only 23% of urban women delivered at home while 67% of their deliveries were conducted in hospitals. Nurses supervised deliveries in both instances in more than 60% of cases, but in rural areas traditional midwives managed 26% of the confinements. The conclusions are that the maternity service was largely provided by nurses and was predominantly limited to hospitals and homes. It is recommended that the quality of service be upgraded and more emphasis placed on midwife obstetric units

Ultraviolet Imaging Polarimetry of the Large Magellanic Cloud. II. Models

Motivated by new sounding-rocket wide-field polarimetric images of the Large Magellanic Cloud, we have used a three-dimensional Monte Carlo radiation transfer code to investigate the escape of near-ultraviolet photons from young stellar associations embedded within a disk of dusty material (i.e. a galaxy). As photons propagate through the disk, they may be scattered or absorbed by dust. Scattered photons are polarized and tracked until they escape to be observed; absorbed photons heat the dust, which radiates isotropically in the far-infrared, where the galaxy is optically thin. The code produces four output images: near- UV and far-IR flux, and near-UV images in the linear Stokes parameters Q and U. From these images we construct simulated UV polarization maps of the LMC. We use these maps to place constraints on the star + dust geometry of the LMC and the optical properties of its dust grains. By tuning the model input parameters to produce maps that match the observed polarization maps, we derive information about the inclination of the LMC disk to the plane of the sky, and about the scattering phase function g. We compute a grid of models with i = 28 deg., 36 deg., and 45 deg., and g = 0.64, 0.70, 0.77, 0.83, and 0.90. The model which best reproduces the observed polarization maps has i = 36 +2/-5 degrees and g ~0.7. Because of the low signal-to-noise in the data, we cannot place firm constraints on the value of g. The highly inclined models do not match the observed centro-symmetric polarization patterns around bright OB associations, or the distribution of polarization values. Our models approximately reproduce the observed ultraviolet photopolarimetry of the western side of the LMC; however, the output images depend on many input parameters and are nonunique.Comment: Accepted to AJ. 20 pages, 7 figure

PMS20 Baseline Characteristics of Rheumatoid Arthritis Patients Starting Certolizumab Pegol Therapy And Glucocorticoid Prescription In The Eclair Study In 2012–2013

International audienc

Emerging trends in non-communicable disease mortality in South Africa, 1997 - 2010

Objectives. National trends in age-standardised death rates (ASDRs) for non communicable diseases (NCDs) in South Africa (SA) were identified between 1997 and 2010.Methods. As part of the second National Burden of Disease Study, vital registration data were used after validity checks, proportional redistribution of missing age, sex and population group, demographic adjustments for registration incompleteness, and identification of misclassified AIDS deaths. Garbage codes were redistributed proportionally to specified codes by age, sex and population group. ASDRs were calculated using mid-year population estimates and the World Health Organization world standard.Results. Of 594 071 deaths in 2010, 38.9% were due to NCDs (42.6% females). ASDRs were 287/100 000 for cardiovascular diseases (CVDs), 114/100 000 for cancers (malignant neoplasms), 58/100 000 for chronic respiratory conditions and 52/100 000 for diabetes mellitus. An overall annual decrease of 0.4% was observed resulting from declines in stroke, ischaemic heart disease, oesophageal and lung cancer, asthma and chronic respiratory disease, while increases were observed for diabetes mellitus, renal disease, endocrine and nutritional disorders, and breast and prostate cancers. Stroke was the leading NCD cause of death, accounting for 17.5% of total NCD deaths. Compared with those for whites, NCD mortality rates for other population groups were higher at 1.3 for black Africans, 1.4 for Indians and 1.4 for coloureds, but varied by condition.Conclusions. NCDs contribute to premature mortality in SA, threatening socioeconomic development. While NCD mortality rates have decreased slightly, it is necessary to strengthen prevention and healthcare provision and monitor emerging trends in cause-specific mortality to inform these strategies if the target of 2% annual decline is to be achieved

Epigenetic memory in response to environmental stressors

Exposure to environmental stressors, toxicants, and nutrient deficiencies can affect DNA in several ways. Some exposures cause damage and alter the structure of DNA, but there is increasing evidence that the same or other environmental exposures, including those that occur during fetal development in utero, can cause epigenetic effects that modulate DNA function and gene expression. Some epigenetic changes to DNA that affect gene transcription are at least partially reversible (i.e., they can be enzymatically reversed after cessation of exposure to environmental agents), but some epigenetic modifications seem to persist, even for decades. To explain the effects of early life experiences (such as famine and exposures to other stressors) on the long-term persistence of specific patterns of epigenetic modifications, such as DNA methylation, we propose an analogy with immune memory. We propose that an epigenetic memory can be established and maintained in self-renewing stem cell compartments. We suggest that the observations on early life effects on adult diseases and the persistence of methylation changes in smokers support our hypothesis, for which a mechanistic basis, however, needs to be further clarified. We outline a new model based on methylation changes. Although these changes seem to be mainly adaptive, they are also implicated in the pathogenesis and onset of diseases, depending on individual genotypic background and types of subsequent exposures. Elucidating the relationships between the adaptive and maladaptive consequences of the epigenetic modifications that result from complex environmental exposures is a major challenge for current and future research in epigenetics.-Vineis, P., Chatziioannou, A., Cunliffe, V. T., Flanagan, J. M., Hanson, M., Kirsch-Volders, M., Kyrtopoulos, S. Epigenetic memory in response to environmental stressors

Detection of [O I] 63 <i>μ</i>m in absorption toward Sgr B2

A high signal-to-noise 52-90 μm spectrum is presented for the central part of the Sagittarius B2 complex. The data were obtained with the Long Wavelength Spectrometer on board the Infrared Space Observatory (ISO). The [O I] 63 μm line is detected in absorption even at the grating spectral resolution of 0.29 μm. A lower limit for the column density of atomic oxygen of the order of 1019 cm-2 is derived. This implies that more than 40% of the interstellar oxygen must be in atomic form along the line of sight toward the Sgr B2 molecular cloud

Developing fencing policies in dryland ecosystems

The daily energy requirements of animals are determined by a combination of physical and physiological factors, but food availability may challenge the capacity to meet nutritional needs. Western gorillas (Gorilla gorilla) are an interesting model for investigating this topic because they are folivore-frugivores that adjust their diet and activities to seasonal variation in fruit availability. Observations of one habituated group of western gorillas in Bai-Hokou, Central African Republic (December 2004-December 2005) were used to examine seasonal variation in diet quality and nutritional intake. We tested if during the high fruit season the food consumed by western gorillas was higher in quality (higher in energy, sugar, fat but lower in fibre and antifeedants) than during the low fruit season. Food consumed during the high fruit season was higher in digestible energy, but not any other macronutrients. Second, we investigated whether the gorillas increased their daily intake of carbohydrates, metabolizable energy (KCal/g OM), or other nutrients during the high fruit season. Intake of dry matter, fibers, fat, protein and the majority of minerals and phenols decreased with increased frugivory and there was some indication of seasonal variation in intake of energy (KCal/g OM), tannins, protein/fiber ratio, and iron. Intake of non-structural carbohydrates and sugars was not influenced by fruit availability. Gorillas are probably able to extract large quantities of energy via fermentation since they rely on proteinaceous leaves during the low fruit season. Macronutrients and micronutrients, but not digestible energy, may be limited for them during times of low fruit availability because they are hind-gut fermenters. We discuss the advantages of seasonal frugivores having large dietary breath and flexibility, significant characteristics to consider in the conservation strategies of endangered species

Laser nephelometry applied in an automated microplate system to study filamentous fungus growth.

By contrast with photometry (i.e., the measurement of light transmitted through a particle suspension), nephelometry is a direct method of measuring light scattered by particles in suspension. Since the scattered light intensity is directly proportional to the suspended particle concentration, nephelometry is a promising method for recording microbial growth and especially for studying filamentous fungi, which cannot be efficiently investigated through spectrophotometric assays. We describe herein for the first time a filamentous fungi–tailored procedure based on microscale liquid cultivation and automated nephelometric recording of growth, followed by extraction of relevant variables (lag time and growth rate) from the obtained growth curves. This microplate reader technique is applicable for the evaluation of antifungal activity and for large-scale phenotypic profiling

The role of laboratory testing in hospitalised and critically ill COVID-19-positive patients

The COVID-19 pandemic has placed healthcare resources around the world under immense pressure. South Africa, given the condition of its healthcare system, is particularly vulnerable. There has been much discussion around rational healthcare utilisation, ranging from diagnostic testing and personal protective equipment to triage and appropriate use of ventilation strategies. There has, however, been little guidance around use of laboratory tests once COVID-19 positive patients have been admitted to hospital. We present a working guide to rational laboratory test use, specifically for COVID-19, among hospitalised patients, including the critically ill. The specific tests, the reasons for testing, their clinical usefulness, timing and frequency are addressed. We also provide a discussion around evidence for the use of these tests from a clinical perspective.The Critical Care Society of Southern Africahttp://www.sajcc.org.za/index.php/SAJCCam2021Critical Car