Dissident president? : Thabo Mbeki, critical discourse analysis and the struggle to define HIV and AIDS in South Africa, 1998-2003.

Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2003.This dissertation is an examination of presidential communication, focusing primarily on how Mbeki promoted a fringe group of researchers (the Virodene researchers) and a discredited scientific position (the AIDS dissidents). It employs aspects of critical discourse analysis in order to examine Mbeki's speeches, articles, interviews and letters dealing with HIV/AIDS from 1998 to 2003 in order to identify how his views and beliefs on the epidemic changed from the orthodox position that HIV causes AIDS to a dissident view, which led to him asserting that it was impossible for one virus to be the single cause of a wide range of illnesses defined as AIDS. In addition, it examines briefly how civil society, particularly the TAC, responded to Mbeki's unconventional approach to HIV/AIDS, and how Mbeki reacted to criticism of his views on HIV/AIDS. By using the relations of antithesis, entailment and equivalence, this dissertation finds that, although Mbeki moved from an orthodox to a dissident position on HIV/AIDS, there are common threads running through all his discourse. These threads include an intense interest in science and a concern with the plight of the "underdogs", namely those that he feels have been discriminated against by the scientific establishment particularly the pharmaceutical industry. Mbeki's dissident views were not a crude assertion that HIV does not cause AIDS, as has been suggested by other researchers, or those of a sophist seeking excuses for his government's inability to deploy adequate resources to HIV/AIDS. His interest in dissident theory is considered and he has clearly engaged with the scientific arguments of the dissidents. However, this is not the case when Mbeki deals with his critics. It is a matter of concern that Mbeki used the power of the Office of the President to undermine and discredit his opponents by accusing them of being racists or "Uncle Toms" for opposing his dissident views on HIV/AIDS

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification