Peyronie's disease - a perspective on the disease and the long-term results of radiotherapy

From 1966 to 1988, 98 of 108 patients with symptomatic Peyronie's disease received radiotherapy at our institution. In 11 of 61 patients (18%) who attended the clinic regularly for follow-up for longer than a year, new lesions distinct from the original lesions developed. This confirms that there is progression of the disease in a substantial number of cases after treatment. Long-term follow-up over an average of 111,5 months was achieved by means of a questionnaire in 47 of the 98 cases (48%). Forty-one of these patients (87,2%) had sexual intercourse after radiation. Twenty-eight of the 41 (68,3%) still have intercourse. Their average age at present is 59,6 years while the average age of the 13 patients (31,7%) not having intercourse is 70,9 years. The decline in sexual activity is thus age-related. Twenty-one of 25 patients (84%) experienced relief from pain, and angulation of the penis improved in 17 of 44 patients (38,6%) after radiotherapy. Radiotherapy may therefore be of benefit to patients with active Peyronie's disease and should be investigated in a randoIIlised controlled study

High dose-rate brachytherapy in the radical treatment of cervical cancer. An analysis of dose effectiveness and incidence of late radiation complications

Published ArticleWorldwide, uterine cervical cancer is one of the most frequently occurring cancers in women, with more than 80% of these cases occurring in developing countries. The South African screening policy and screening program, implemented in 2001, attempt to reduce this incidence of cervical cancer in South Africa. It is essential to treat these women with the best modalities available. This retrospective study focused specifically on the curative potential of radiotherapy administered to patients at the Oncology Department, Bloemfontein, since a new modality of high dose-rate intracavitary brachytherapy was implemented in 1994. Late radiation complications were also investigated

Predicting the throughput of grain products at the multipurpose terminal at the Port of Cape Town

CITATION: Goedhals-Gerber, L. L. 2016. Predicting the throughput of grain products at the multipurpose terminal at the Port of Cape Town. Journal of Transport and Supply Chain Management, 10(1), a249, doi:10.4102/jtscm.v10i1.249.The original publication is available at http://www.jtscm.co.zaENGLISH SUMMARY : Background: Ports provide vital links in the maritime supply chains on which the trading of countries depend, and their efficiency and performance can contribute largely to the international competitiveness of those countries. However, to achieve and maintain such a contribution, port operators need to understand their role in a national economy and the factors that underlie the efficiency of the intermodal link that ports constitute in international supply chains. One such factor is the capacity of specialised cargo terminals. Objectives: This article described a possible technique for forecasting the throughput of grain imports through the bulk grain terminal at the Port of Cape Town. It determined whether the capacity in the bulk grain terminal is sufficient to handle current and forecasted volumes of imported grains or whether the volumes justify expansion or upgrading of the bulk grain terminal in the Port of Cape Town. Method: The Box–Jenkins methodology for autoregressive integrated moving average (ARIMA) models was applied. An ARIMA model – 2 parameter, 1 difference – was selected to do the forecast. Results: The average tonnage of all grains imported through the Port of Cape Town that can be expected in a month is approximately 90 000 tons. The maximum tonnage of all grains imported through the Port of Cape Town that can be expected in a month is approximately 180 000 tons. Conclusion: The analyses show that the demand for imports of grain products at the multipurpose terminal in the Port of Cape Town is not growing substantially. The analyses also identify that the current upper limits of grain imports are within the existing handling and storage capacities of the bulk grain terminal.http://www.jtscm.co.za/index.php/jtscm/article/view/249Publisher's versio

Identifying temperature deviations in the hake cold chain from Namibia to Spain

Background: Research shows that significant volumes of fresh fish produced globally are wasted because of failures in the cold chain. As fresh hake is extremely temperature sensitive, fluctuations in temperature will influence the quality and the shelf life, resulting in losses in revenue. Objective: The main objective of the research was to detect deviations in temperature along the fresh hake export cold chain from Namibia to Spain. Method: This article presents a case study on a company that exports fresh hake from Walvis Bay, Namibia to a large supermarket chain in Spain, Europe. Results: This article confirms that temperature breaches and breaks occur and are sometimes unavoidable. However, if the avoidable temperature deviations could be resolved, it would improve both the effectiveness and efficiency of the export cold chain. The results indicate that temperature breaches and breaks mainly occur along the export cold chain when the product is at the airport during transfer flights either at Hosea Kutako Airport near Windhoek or Frankfurt Airport in Germany or in the refrigerated truck during the inland transport leg either from Walvis Bay, Namibia or Frankfurt, Germany to Zaragoza, Spain. Conclusion: This article makes recommendations to assist in solving identified problems and streamlining the fresh hake export cold chain. The research benefits the Namibian fishing industry as the export of fresh fish is both a precarious and taxing venture. As relevant research is lacking in Namibia, this article will contribute to the management of an efficient and effective export cold chain. Contribution: This research adds to the current knowledge of maintaining the export cold chain of fresh fish from developing countries. Preventing temperature deviations in the fresh hake export cold chain would extend the shelf life and help to maintain the quality of the fresh product and in so doing improve the competitiveness of developing countries in the global trade of fresh fish

Corrigendum: Investigating supply chain sustainability in South African organisations

No abstract available

Progression to AIDS in South Africa Is Associated with both Reverting and Compensatory Viral Mutations

We lack the understanding of why HIV-infected individuals in South Africa progress to AIDS. We hypothesised that in end-stage disease there is a shifting dynamic between T cell imposed immunity and viral immune escape, which, through both compensatory and reverting viral mutations, results in increased viral fitness, elevated plasma viral loads and disease progression. We explored how T cell responses, viral adaptation and viral fitness inter-relate in South African cohorts recruited from Bloemfontein, the Free State (n = 278) and Durban, KwaZulu-Natal (n = 775). Immune responses were measured by γ-interferon ELISPOT assays. HLA-associated viral polymorphisms were determined using phylogenetically corrected techniques, and viral replication capacity (VRC) was measured by comparing the growth rate of gag-protease recombinant viruses against recombinant NL4-3 viruses. We report that in advanced disease (CD4 counts <100 cells/µl), T cell responses narrow, with a relative decline in Gag-directed responses (p<0.0001). This is associated with preserved selection pressure at specific viral amino acids (e.g., the T242N polymorphism within the HLA-B*57/5801 restricted TW10 epitope), but with reversion at other sites (e.g., the T186S polymorphism within the HLA-B*8101 restricted TL9 epitope), most notably in Gag and suggestive of “immune relaxation”. The median VRC from patients with CD4 counts <100 cells/µl was higher than from patients with CD4 counts ≥500 cells/µl (91.15% versus 85.19%, p = 0.0004), potentially explaining the rise in viral load associated with disease progression. Mutations at HIV Gag T186S and T242N reduced VRC, however, in advanced disease only the T242N mutants demonstrated increasing VRC, and were associated with compensatory mutations (p = 0.013). These data provide novel insights into the mechanisms of HIV disease progression in South Africa. Restoration of fitness correlates with loss of viral control in late disease, with evidence for both preserved and relaxed selection pressure across the HIV genome. Interventions that maintain viral fitness costs could potentially slow progression

Container terminal spatial planning : a 2041 paradigm for the Western Cape Province in South Africa

The original publication is available at http://www.jtscm.co.za/index.php/jtscm/article/view/59This paper investigates the suitable location for an intermodal inland container terminal (IICT) in the city of Cape Town. A container market segmentation approach is used to project growth for container volumes over a 30-year period for all origin and destination pairings on a geographical district level in an identified catchment area. The segmentation guides the decision on what type of facility is necessary to fulfil capacity requirements in the catchment area and will be used to determine the maximum space requirements for a future IICT. Alternative sites are ranked from most suitable to least suitable using multi-criteria analysis, and preferred locations are identified. Currently, South Africa’s freight movement is dominated by the road sector. Heavy road congestion is thus prevalent at the Cape Town Container Terminal (CTCT). The paper proposes three possible alternative sites for an IICT that will focus on a hub-and-spoke system of transporting freight

Hepatitis B virus seroepidemiology data for Africa:Modelling intervention strategies based on a systematic review and meta-analysis

BACKGROUND: International Sustainable Development Goals (SDGs) for elimination of hepatitis B virus (HBV) infection set ambitious targets for 2030. In African populations, infant immunisation has been fundamental to reducing incident infections in children, but overall population prevalence of chronic hepatitis B (CHB) infection remains high. In high-prevalence populations, adult catch-up vaccination has sometimes been deployed, but an alternative Test and Treat (T&T) approach could be used as an intervention to interrupt transmission. Universal T&T has not been previously evaluated as a population intervention for HBV infection, despite high-profile data supporting its success with human immunodeficiency virus (HIV). METHODS AND FINDINGS: We set out to investigate the relationship between prevalence of HBV infection and exposure in Africa, undertaking a systematic literature review in November 2019. We identified published seroepidemiology data representing the period 1995-2019 from PubMed and Web of Science, including studies of adults that reported prevalence of both hepatitis B surface antigen (HBsAg; prevalence of HBV infection) and antibody to hepatitis B core antigen (anti-HBc; prevalence of HBV exposure). We identified 96 studies representing 39 African countries, with a median cohort size of 370 participants and a median participant age of 34 years. Using weighted linear regression analysis, we found a strong relationship between the prevalence of infection (HBsAg) and exposure (anti-HBc) (R2 = 0.45, p < 0.001). Region-specific differences were present, with estimated CHB prevalence in Northern Africa typically 30% to 40% lower (p = 0.007) than in Southern Africa for statistically similar exposure rates, demonstrating the need for intervention strategies to be tailored to individual settings. We applied a previously published mathematical model to investigate the effect of interventions in a high-prevalence setting. The most marked and sustained impact was projected with a T&T strategy, with a predicted reduction of 33% prevalence by 20 years (95% CI 30%-37%) and 62% at 50 years (95% CI 57%-68%), followed by routine neonatal vaccination and prevention of mother to child transmission (PMTCT; at 100% coverage). In contrast, the impact of catch-up vaccination in adults had a negligible and transient effect on population prevalence. The study is constrained by gaps in the published data, such that we could not model the impact of antiviral therapy based on stratification by specific clinical criteria and our model framework does not include explicit age-specific or risk-group assumptions regarding force of transmission. CONCLUSIONS: The unique data set collected in this study highlights how regional epidemiology data for HBV can provide insights into patterns of transmission, and it provides an evidence base for future quantitative research into the most effective local interventions. In combination with robust neonatal immunisation programmes, ongoing PMTCT efforts, and the vaccination of high-risk groups, diagnosing and treating HBV infection is likely to be of most impact in driving advances towards elimination targets at a population level

A systematic review of hepatitis B virus (HBV) drug and vaccine escape mutations in Africa: A call for urgent action

<div><p>International sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the pressing need to optimize strategies for prevention, diagnosis and treatment. Selected or transmitted resistance associated mutations (RAMs) and vaccine escape mutations (VEMs) in hepatitis B virus (HBV) may reduce the success of existing treatment and prevention strategies. These issues are particularly pertinent for many settings in Africa where there is high HBV prevalence and co-endemic HIV infection, but lack of robust epidemiological data and limited education, diagnostics and clinical care. The prevalence, distribution and impact of RAMs and VEMs in these populations are neglected in the current literature. We therefore set out to assimilate data for sub-Saharan Africa through a systematic literature review and analysis of published sequence data, and present these in an on-line database (<a href="https://livedataoxford.shinyapps.io/1510659619-3Xkoe2NKkKJ7Drg/" target="_blank">https://livedataoxford.shinyapps.io/1510659619-3Xkoe2NKkKJ7Drg/</a>). The majority of the data were from HIV/HBV coinfected cohorts. The commonest RAM was rtM204I/V, either alone or in combination with associated mutations, and identified in both reportedly treatment-naïve and treatment-experienced adults. We also identified the suite of mutations rtM204V/I + rtL180M + rtV173L, that has been associated with vaccine escape, in over 1/3 of cohorts. Although tenofovir has a high genetic barrier to resistance, it is of concern that emerging data suggest polymorphisms that may be associated with resistance, although the precise clinical impact of these is unknown. Overall, there is an urgent need for improved diagnostic screening, enhanced laboratory assessment of HBV before and during therapy, and sustained roll out of tenofovir in preference to lamivudine alone. Further data are needed in order to inform population and individual approaches to HBV diagnosis, monitoring and therapy in these highly vulnerable settings.</p></div