Multidisciplinary Training to Undergraduate Students in the Faculty of Health Sciences: Hypertension as a Case Study

Background: Healthcare students should be aware of the specific skills, knowledge and management options of other disciplines in order to achieve an effective and cohesive working relationship. Aim: The aim of this study was to expose healthcare students at the University of the Free State to one another\'s domains, as related to hypertension management, during a formal didactic lecture attended by medical, physiotherapy and dietetic students, and to determine whether they could apply in practice the theoretical knowledge regarding blood pressure measurement and exercise, obtained during a multidisciplinary session. The perceptions of students regarding multidisciplinary sessions were also to be obtained. Method: Students received a formal lecture on hypertension from a medical doctor, a dietitian, a physiotherapist and an occupational therapist and they then worked in multidisciplinary groups to demonstrate the physiological effect of exercise on blood pressure and pulse rate. Students had to report their findings and perceptions of the session by completing data forms. Results: A total of 125 medical, physiotherapy and human nutrition students participated in the session. The students were able to demonstrate the influence of exercise on blood pressure and pulse measurements. They reported that they enjoyed the multidisciplinary session and gained information on the scope of practice of the domains of the other disciplines. Negative feedback was received on the size of the groups and lack of equipment. Conclusion: The students could apply theoretical knowledge in practice and all gave positive feedback. The sessions will continue in the current format but attention will be given to smaller groups and the availability of more equipment. South African Journal of Family Practice Vol. 50 (4) 2008: pp. 70a-70

Case report of sudden death in a child with Williams syndrome following administration of anaesthesia

Williams syndrome is a neurodevelopmental disorder characterized by distinctive personality traits, facial features (so called “elfin face”) and cardiac abnormalities, of which supravalvular aortic stenosis is the most common lesion found. The cause is a deletion of a group of genes on chromosome 7q11.23. Administration of anaesthesia to these patients carries a higher risk for sudden death due to the cardiac defects. The purpose of this case study is to demonstrate the entity in the South African population, to review the literature, to put emphasis on the multi-disciplinary approach in the pre-operative management, and to review the medico-legal investigation of intra-operative deaths. Furthermore, administration of anaesthesia in the remote location and to syndromic children will also be discussed.Keywords: deletion of genes on chromosone 7q11.23, intra-operative deaths, sudden death, supravalvular aortic stenosis, Williams syndrom

Nutritional, immune, micronutrient and health status of HIV-infected children in care centres in Mangaung

Aim: To assess the nutritional, immune, micronutrient and health status of antiretroviral-naïve HIV-infected children.Method: A cross-sectional descriptive study was undertaken between September 2004 and March 2006 amongst HIV-infected children of which none received antiretroviral therapy, in care centres in Mangaung, Free State.Results: The study included 37 clinically stable and food-secure HIV-infected children. Their median age was 5.4 years (range 1.2–10.2 years). Fifteen children (41%) were underweight, 30 (81%) were stunted and one (3%) was wasted. The most commonly observed clinical features were lymphadenopathy (84%), skin rashes (51%), hepatomegaly (32%) and pallor (41%). Eight per cent of children had features of TB, while 19% had a lower respiratory tract infection. The median viral load of the group (n = 35) was 117 000 copies/ml, the median CD4+ cell count was 477 cells/mm3 and the median CD4 percentage was 22.5%. A significant negative correlation could be demonstrated between viral load and nutritional indicators. Children had deficient serum levels relative to normal reference values for glutathione (91% of children), albumin (78%), vitamin A (63%), vitamin D (44%), zinc (38%) and vitamin E (13%). Sixty per cent of the children were anaemic and 30% were iron deficient.Conclusion: A high prevalence of acute and chronic malnutrition and micronutrient deficiencies occurred among HIV-infected children residing in care centres. The study highlights the need to investigate early initiation of antiretroviral therapy and nutrition interventions, including aggressive supplementation, in order to improve the prognosis of these children

Assessment of job satisfaction among dentists working in different settings in the Tshwane metro

INTRODUCTION: Job satisfaction of dentists is important, as dentists are critical in the delivery of comprehensive health care. Whilst job satisfaction among dentists has been widely investigated elsewhere, it is poorly researched in South Africa. AIMS AND OBJECTIVES: To assess job satisfaction among dentists working in Tshwane district. DESIGN: A cross-sectional study. METHODS: Data were collected using a self-administered, validated, modified questionnaire adapted from the Dentists' Satisfaction Survey. Demographic data and the responses associated with job satisfaction in various settings were collected. Two of the questions were qualitative and open-ended. Data were analysed using statistical software package (STATA) version 10. Ethical clearance was obtained and all data were anonymous. RESULTS: The response rate was 77% and 53 %( 41) of respondents were female. Perception of income, relationships with patients and personal time were significantly positively associated with job satisfaction. Patient happiness with treatment, the autonomy and flexibility of private practice and imparting knowledge also contributed to job satisfaction. Unrealistic expectations of patients, long working hours, restricted funding and lack of equipment contributed to job dissatisfaction. CONCLUSION: Overall the dentists were satisfied, however, satisfaction and dissatisfaction were conditional and influenced by factors such as perception of income and unrealistic patient expectations.https://www.sada.co.za/the-sadjam2020Community DentistrySchool of Health Systems and Public Health (SHSPH

Diagnostic performance of dobutamine stress echocardiography: A South African experience

Background. Dobutamine stress echocardiography (DSE) is a well-established modality for the diagnosis of coronary artery disease, but there are no reported diagnostic data in southern Africa. Objectives. To compare the safety, sensitivity and specificity of a South African (SA) DSE programme with larger, international series. Methods. All patients undergoing DSE from 2019 to 2021 at a single SA centre were included. A new wall motion abnormality (≥2 segments) signified inducible ischaemia. Results. A total of 106 patients (mean (standard deviation) age 61 (11) years, 68% male) were analysed. Six patients (6%) experienced chest pain during DSE and 4 (4%) developed an atrial arrhythmia. The sensitivity and specificity for epicardial coronary stenosis were 77% and 74%, respectively, changing to 82% and 72% when excluding those who had previous coronary artery bypass surgery. Conclusion. The sensitivity, specificity and safety of an SA DSE programme were comparable to international series. A DSE programme is feasible in a resource-constrained environment

Stochastic upscaling of hydrodynamic dispersion and retardation factor in a physically and chemically heterogeneous tropical soil

[EN] Stochastic upscaling of flow and reactive solute transport in a tropical soil is performed using real data collected in the laboratory. Upscaling of hydraulic conductivity, longitudinal hydrodynamic dispersion, and retardation factor were done using three different approaches of varying complexity. How uncertainty propagates after upscaling was also studied. The results show that upscaling must be taken into account if a good reproduction of the flow and transport behavior of a given soil is to be attained when modeled at larger than laboratory scales. The results also show that arrival time uncertainty was well reproduced after solute transport upscaling. This work represents a first demonstration of flow and reactive transport upscaling in a soil based on laboratory data. It also shows how simple upscaling methods can be incorporated into daily modeling practice using commercial flow and transport codes.The authors thank the financial support by the Brazilian National Council for Scientific and Technological Development (CNPq) (Project 401441/2014-8). The doctoral fellowship award to the first author by the Coordination of Improvement of Higher Level Personnel (CAPES) is acknowledged. The first author also thanks the international mobility grant awarded by CNPq, through the Sciences Without Borders program (Grant Number: 200597/2015-9). The international mobility grant awarded by Santander Mobility in cooperation with the University of Sao Paulo is also acknowledged. DHI-WASI is gratefully thanked for providing a FEFLOW license.Almeida De-Godoy, V.; Zuquette, L.; Gómez-Hernández, JJ. (2019). Stochastic upscaling of hydrodynamic dispersion and retardation factor in a physically and chemically heterogeneous tropical soil. 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Hydration of dicalcium silicate and diffusion through neo-formed calcium-silicate-hydrates at weathered surfaces control the long-term leaching behaviour of basic oxygen furnace (BOF) steelmaking slag

Alkalinity generation and toxic trace metal (such as vanadium) leaching from basic oxygen furnace (BOF) steel slag particles must be properly understood and managed by pre-conditioning if beneficial reuse of slag is to be maximised. Water leaching under aerated conditions was investigated using fresh BOF slag at three different particle sizes (0.5–1.0, 2–5 and 10 × 10 × 20 mm blocks) and a 6-month pre-weathered block. There were several distinct leaching stages observed over time associated with different phases controlling the solution chemistry: (1) free-lime (CaO) dissolution (days 0–2); (2) dicalcium silicate (Ca₂SiO₄) dissolution (days 2–14) and (3) Ca–Si–H and CaCO₃ formation and subsequent dissolution (days 14–73). Experiments with the smallest size fraction resulted in the highest Ca, Si and V concentrations, highlighting the role of surface area in controlling initial leaching. After ~2 weeks, the solution Ca/Si ratio (0.7–0.9) evolved to equal those found within a Ca–Si–H phase that replaced dicalcium silicate and free-lime phases in a 30- to 150-μm altered surface region. V release was a two-stage process; initially, V was released by dicalcium silicate dissolution, but V also isomorphically substituted for Si into the neo-formed Ca–Si–H in the alteration zone. Therefore, on longer timescales, the release of V to solution was primarily controlled by considerably slower Ca–Si–H dissolution rates, which decreased the rate of V release by an order of magnitude. Overall, the results indicate that the BOF slag leaching mechanism evolves from a situation initially dominated by rapid hydration and dissolution of primary dicalcium silicate/free-lime phases, to a slow diffusion limited process controlled by the solubility of secondary Ca–Si–H and CaCO₃ phases that replace and cover more reactive primary slag phases at particle surfaces

Histological and immunohistochemical features suggesting aetiological differences in lymph node and (muco)cutaneous feline tuberculosis lesions

Objectives To identify and describe histological and immunohistochemical criteria that may differentiate between skin and lymph node lesions associated with Mycobacterium (M.) bovis and M. microti in a diagnostic pathology setting.Materials and Methods<jats:p/>Archived skin and lymph node biopsies of tuberculous lesions were stained with haematoxylin and eosin, Ziehl‐Neelsen and Masson's Trichrome. Immunohistochemistry was performed to detect the expression of calprotectin, CD3 and Pax5. Samples were scored for histological parameters (i.e. granulomas with central necrosis versus small granulomas without central necrosis, percentage necrosis and/or multinucleated giant cells), number of acid‐fast bacilli (bacterial index) and lesion percentage of fibrosis and positive immunohistochemical staining.Results Twenty‐two samples were examined (M. bovis n=11, M. microti n=11). When controlling for age, gender and tissue, feline M. bovis‐associated lesions more often featured large multi‐layered granulomas with central necrosis. Conversely, this presentation was infrequent in feline M. microti‐associated lesions, where small granulomas without central necrosis predominated. The presence of an outer fibrous capsule was variable in both groups, as was the bacterial index. There were no differences in intralesional expression of immunohistochemical markers.Clinical Significance Differences in the histological appearance of skin and lymph node lesions may help to infer feline infection with either M. bovis or M. microti at an earlier stage when investigating these cases, informing clinicians of the potential zoonotic risk. Importantly, cases of tuberculosis can present with numerous acid‐fast bacilli. This implies that a high bacterial index does not infer infection with non‐zoonotic non‐tuberculous mycobacteria