The accessibility to oral health services in Lesotho’s public health sector

Lesotho is a land-locked mountainous country in Southern Africa. Both geography and poverty impact on dental health in low-income patients. Information on the number and function of dentists and dental therapists in public hospitals, are lacking. The aim was to investigate accessibility to oral health services. Objectives were to investigate the number and geographical distribution of oral health personnel and document the availability of dental services in Lesotho. A cross-sectional mixed methods study design was used. Four dental therapists of the six employed by the government, participated in in-depth interviews. Questionnaires about access to oral health services were administered to government employed dentists. The Lesotho National Department of Oral Health provided information regarding dental patient statistics between 2017 and 2019. It was found that 20 dentists and 10 dental therapists provided limited dental services in public facilities. In 2017, 2018 and 2019; the annual numbers of dental patients were 85 776, 75 148 and 97 425 respectively. Approximately 40% of patients visited two hospitals in Maseru. It was concluded that there was a shortage of oral health personnel, resulting in inadequate access to dental services, particularly in rural areas

Cation-exchange solid-phase and liquid-liquid extraction for the determination of khat alkaloids by reversed phase HPLC-DAD

Leaves of khat (Catha edulis) are masticated to elicit their psycho-stimulating properties, resulting from the presence of the phenylpropylamino alkaloids. The determination of these alkaloids is important in pharmacological, phytochemical, forensic and law enforcement environments. In this study, the use of strong cation exchange-solid phase extraction (SCX-SPE) was investigated as an alternative means of sample purification prior to the determination of cathinone, cathine and norephedrine by reversed phase (C18) high performance liquid chromatography (HPLC). Extraction parameters for SCX, including loading capacity and washing solvents, were established. An existing liquid-liquid extraction (LLE) method was improved in terms of recoveries obtained, by using ethyl acetate as extractant. For pure standards of the khat alkaloids, recoveries ranged from 83 to 97%. Preconcentration, using a Genevac evaporator after the addition of acidified water to the sample, restricted analyte losses when compared to concentration under nitrogen. Although comparable recoveries were obtained when preconcentration was achieved in the presence of acidified water by rotary evaporation, this method is not suitable for large sample numbers. Best recoveries, ranging from 94 to 102%, were obtained by SCX from spiked samples. Although the extraction efficiencies of LLE were lower (87-90%), LLE yielded less complex chromatograms, indicating a purer extract. KEY WORDS: Khat alkaloids, Solid phase extraction, Liquid-liquid extraction, HPLC, Genevac Bull. Chem. Soc. Ethiop. 2015, 29(3), 331-339.DOI: http://dx.doi.org/10.4314/bcse.v29i3.

The Socio-Economic Benefit of the Livestock Traceability System on Communal Beef Farmers in Swaziland

In this article, Swaziland is placed in the forefront as a small African country that implemented a livestock traceability system to benefit both communal and commercial farmers. The communal farmers are also able to export beef to European countries, markers that were previously unavailable to them, due to the successful implementation of the Swaziland Livestock Information and Traceability System (SLITS).  Livestock traceability is briefly explained to align it with the importance of safe food production for human consumption and a few aspects are highlighted. The traceability systems is further explained in terms of its benefit to the rural economy, its role in growing the GDP and the realization of its aims as was initially expected by the Swazi Government. The data collection methods used were a document review, a case study and five interviews. It is concluded that livestock traceability systems should be adopted wider by other developing countries as it has a direct effect on the improvement of the socio-economic conditions of the rural poor. Its development and implementation remains very expensive, but Swaziland can be used as an example of a country that is able to reap the rewards from a commodity that is ample in their country, but scarce globally, leading to wider food sustainability

MaLT - combined motor and language therapy tool for brain injury patients using Kinect

Background: The functional connectivity and structural proximity of elements of the language and motor systems result in frequent co-morbidity post brain injury. Although rehabilitation services are becoming increasingly multidisciplinary and "integrated", treatment for language and motor functions often occurs in isolation. Thus, behavioural therapies which promote neural reorganisation do not reflect the high intersystem connectivity of the neurologically intact brain. As such, there is a pressing need for rehabilitation tools which better reflect and target the impaired cognitive networks. Objectives: The objective of this research is to develop a combined high dosage therapy tool for language and motor rehabilitation. The rehabilitation therapy tool developed, MaLT (Motor and Language Therapy), comprises a suite of computer games targeting both language and motor therapy that use the Kinect sensor as an interaction device. The games developed are intended for use in the home environment over prolonged periods of time. In order to track patients' engagement with the games and their rehabilitation progress, the game records patient performance data for the therapist to interrogate. Methods: MaLT incorporates Kinect-based games, a database of objects and language parameters, and a reporting tool for therapists. Games have been developed that target four major language therapy tasks involving single word comprehension, initial phoneme identification, rhyme identification and a naming task. These tasks have 8 levels each increasing in difficulty. A database of 750 objects is used to programmatically generate appropriate questions for the game, providing both targeted therapy and unique gameplay every time. The design of the games has been informed by therapists and by discussions with a Public Patient Involvement (PPI) group. Results: Pilot MaLT trials have been conducted with three stroke survivors for the duration of 6 to 8 weeks. Patients' performance is monitored through MaLT's reporting facility presented as graphs plotted from patient game data. Performance indicators include reaction time, accuracy, number of incorrect responses and hand use. The resultant games have also been tested by the PPI with a positive response and further suggestions for future modifications made. Conclusion: MaLT provides a tool that innovatively combines motor and language therapy for high dosage rehabilitation in the home. It has demonstrated that motion sensor technology can be successfully combined with a language therapy task to target both upper limb and linguistic impairment in patients following brain injury. The initial studies on stroke survivors have demonstrated that the combined therapy approach is viable and the outputs of this study will inform planned larger scale future trials

Short-term effect of monocuspid valves on pulmonary insufficiency and clinical outcome after surgical repair of tetralogy of fallot

AbstractIn the surgical repair of tetralogy of Fallot, monocuspid valves are sometimes inserted within a transannular patch to prevent pulmonary insufficiency. To determine whether this monocuspid valve prevents short-term postoperative pulmonary insufficiency and improves clinical outcome, we reviewed clinical data and preoperative and postoperative echocardiographic variables from 61 patients who underwent one of three different procedures for repair of tetralogy of Fallot between August 1992 and March 1994. We compared features from 24 patients who had undergone transannular patch repair with a monocuspid valve (patch-valve) with those from 17 patients who had undergone patch repair without a monocuspid valve (patch) and 20 patients who had undergone repair without a transannular patch (no patch). We used the ratio of pulmonary valve insufficiency jet width to pulmonary artery diameter, as measured by color-flow Doppler flowmetry, as an index of severity of pulmonary insufficiency. Moderate to severe pulmonary insufficiency was arbitrarily defined as a ratio of at least 0.50. We found no significant differences in ratios among the patch-valve group (0.73 ± 0.25, mean ± standard deviation), the patch group (0.79 ± 0.20), and the no patch group (0.59 ± 0.23). The percentages of patients with moderate to severe pulmonary insufficiency did not differ among the three groups (patch-valve 80%, patch 90%, no patch 64%). Clinical data (including mortality, number of reoperations, intensive care unit and hospital lengths of stay, and postoperative hemodynamics) were similar in the three groups. We conclude that insertion of a monocuspid valve in repair of tetralogy of Fallot does not prevent short-term postoperative pulmonary insufficiency and does not improve immediate postoperative outcome for these patients. (J Thorac Cardiovasc Surg 1996;112:33-7

Assessment of levels of V, Cr, Mn, Sr, Cd, Pb and U in bovine meat

Pollution of the environment with heavy metals can be a serious problem. In SouthAfrica, particularly, there are many sources of heavy metals, often due to smelter and mining activities. This has led to toxic metals in the environment that directly affect air, water and food. The presence of heavy metal residues in foodstuffs is potentially hazardous to humans and animals. Heavy metals accumulate in certain organs, particularly in the liver and kidney. The objective of this study was to determine the levels of V, Cr, Mn,Sr, Cd, Pb and U in bovine organs and tissues obtained from polluted areas of North West Province, South Africa. Bovine liver, kidney, muscle, fat and bone samples were freeze-dried, homogenized and mineralized using a microwave-assisted digestion system. The levels were quantified using dynamic reaction cell inductively coupled plasma mass spectrometry (DRC-ICP-MS). A bovine muscle (NIST-RM8414) and bovine liver, reference material (NIST-RM1577b), were also analyzed and results agreed with certified values. The study revealed accumulation of Sr in bone, Cd, Pb and U in kidney and bone, Mn in liver and, V and Cr in kidney tissues of cattle.Tshwane University of Technology (TUT) and National Research Fund (NRF).http://journals.sabinet.co.za/sajchem/nf201

An in vitro system for the comparison of excision and wet-dry swabbing for microbiological sampling of beef carcasses.

An in vitro system for the comparison of wet-dry swabbing and surface tissue excision was developed to ascertain whether the commonly accepted statement of the advantage (in terms of bacterial recovery) of the tissue excision method is also legitimate when different kinds of bacteria are used. A total of 1,770 sections (2.5 by 10 cm) of bovine skin were individually inoculated on the subcutaneous fat side by spreading various suspensions of marker organisms (nalidixic acid-resistant Escherichia coli, vancomycin-resistant Enterococcus faecalis, and methicillin-resistant Staphylococcus aureus) at different concentrations and sampled by two standard methods: cotton wet-dry swabbing and excision. Most counts from cuts sampled by excision were significantly (P < 0.05) higher than the wet-dry swabs; however, no differences were observed between the control and the sampling method when sections were inoculated with bacterial solutions at a concentration of 10(3) CFU/ml and sampled by excision. For sections inoculated with bacterial solutions at a concentration of 10(3) CFU/ml, counts given as log CFU/25 cm2 ranged from 1.97 (S. aureus sampled by wet-dry swab) to 3.06 (S. aureus sampled by excision). For sections inoculated at a concentration of 10(4), counts given as log CFU/25 cm(2) ranged from 2.15 (E. faecalis sampled by wet-dry swab) to 3.19 (S. aureus sampled by excision). For sections inoculated at 10(5), counts given as log CFU/25 cm(2) ranged from 2.94 (E. faecalis, wet-dry swab) to 3.98 (S. aureus, excision), and for sections inoculated at 106, counts given as log CFU/25 cm(2) ranged from 3.53 (E. coli, wet-dry swab) to 4.69 (S. aureus, excision). The proposed system, which enabled a considerable amount of samples to be analyzed under controlled experimental conditions and a large number of data to be generated in a short time, demonstrated among the tested microorganisms that whereas the excision method recovered the highest number of bacteria, control means were always (with the exception of an inoculum of 10(3)/ml) significantly higher than means from either of the sampling methods. Our results indicate that particular attention should be paid to the diverse microflora that can contaminate carcasses in a given slaughterhouse and that it is not appropriate to generalize by saying that the destructive method is the reference technique for the bacteriological sampling of carcasses in slaughterhouses, especially when the contamination is higher than 10(3) CFU/25 cm(2)

Late Status of Fontan Patients With Persistent Surgical Fenestration

ObjectivesThis study was undertaken to determine the effects of creating a systemic-to-pulmonary venous atrial-level communication (fenestration) at the time of the Fontan procedure on late outcomes.BackgroundFenestrations are frequently performed during Fontan procedures, but late consequences are not well described.MethodsPatient characteristics were compared between those with and without surgical fenestration among 536 subjects (mean age 11.9 years) enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. The status of the fenestration and the association of a currently patent fenestration with health status and measures of ventricular performance were investigated.ResultsFenestration was performed in 361 patients (67%), and frequency differed by year and center (p < 0.001 for each). After adjustment for center, age at Fontan, year of Fontan, and prior superior cavopulmonary surgery, the fenestrated group had shorter length of Fontan hospital stay. At the time of cross-sectional testing 8 ± 3 years after Fontan, the fenestration remained open in 19% of subjects. Among those with confirmed fenestration closure, 59% were by catheter intervention and 1% by surgical intervention, and 40% had apparent spontaneous closure. Compared with those without evidence of a fenestration, subjects with a current fenestration were taking more medications (p = 0.02) and had lower resting oxygen saturation (median 89% vs. 95%, p < 0.001). Functional health status, exercise performance, echocardiographic variables, prevalence of post-Fontan stroke or thrombosis, and growth did not differ by current fenestration status.ConclusionsSurgical fenestration is associated with well-demonstrated early post-operative benefits. This cross-sectional study found few associations between a persistent fenestration and deleterious later outcomes