The Negative Impacts of COVID-19 Containment Measures on South African Families - Overview and Recommendations

The World Health Organization (WHO) reported various pneumonia cases (‘Coronavirus Disease 2019’ [COVID-19]) on 31 December 2019 in Wuhan City, China, which has spread to many countries, including South Africa. In response to this, the President of South Africa declared a state of national disaster on 15th March 2020, followed by introducing various COVID-19 containment measures to minimize the spread of the virus. This paper examines the negative impacts that COVID-19 containment measures may have had on the family as a unit of society and furthermore provides recommendations to mitigate the impacts of these measures. It can be concluded that COVID-19 containment measures, specifically the lockdown restrictions, would yield both short-term and long-term impacts on proper family functioning. Several families in South Africa have been impacted financially due to the closure of business which led to the temporary/ permanent unemployment of some breadwinners in the families. This also has had a cascading impact on the food security of families and their ability to afford other basic necessities. Distress as a result of financial challenges or failure to provide for the family alongside spending much time locked down together as a family has also led to violence in the family. This was further exacerbated by the fact that the victims were stuck with the abusers and some could not report or find help due to the restricted movements. Furthermore, since most institutions predominantly moved learning online, results indicated that the lockdown restrictions affected the ability of some individuals especially those from poor families to access formal education during the period due to the lack of digital devices and internet facilities. In order to mitigate the impacts of the COVID-19 containment measures on the family, there is a need for collaborative efforts at intrapersonal, interpersonal, institutional, community and policy levels using the ecological framework

Multifocal nodular episcleritis and scleritis with undiagnosed Hodgkin's lymphoma.

PURPOSE: To report the case of a patient with undiagnosed Hodgkin's lymphoma who presented with coexistent unilateral nodular episcleritis and scleritis. DESIGN: Interventional case report and literature review METHODS: Review of clinical history, laboratory findings, histology of episcleral and cervical lymph node biopsies, and follow-up. RESULTS: A 20-year-old female presented with a 5-month history of redness and pain in her left eye, with associated symptoms of dyspnea, malaise, and fever. The patient was found to have multifocal nodular episcleritis and scleritis that was not responsive to topical steroids or systemic nonsteroidal anti-inflammatory treatment. Laboratory tests subsequently revealed evidence of systemic inflammation, and radiologic studies showed extensive mediastinal and cervical adenopathy. A cervical lymph node biopsy showed Reed-Sternberg cells and a chronic lymphocytic infiltrate consistent with nodular sclerosing Hodgkin's lymphoma. Histopathologic analysis of an episcleral nodule revealed a necrotizing granuloma with vasculitis. Systemic chemotherapy was instituted for the Hodgkin's disease; this therapy abolished the nodular scleritis. CONCLUSIONS: This case raises the possibility of concurrent undiagnosed systemic vasculitis with only an ocular manifestation with Hodgkin's lymphoma, either as a coincidence or as a paraneoplastic syndrome. Moreover, it emphasizes the important role of tissue biopsy in establishing diagnosis and directing treatment

Triglyceride rich lipoproteins from type 2 diabetic patients activate platelets

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Trois profils cliniques à risque de comportements violents dans une cohorte de patients présentant un premier épisode de psychose [Three clinical risk profiles of violent behavior in a cohort of early psychosis patients]

This study aims to determine whether it is possible to identify clinical profiles at risk of violent behaviors (VB) in the early phase of psychotic disorders, on the basis of the main dynamic psychopathological risk factors and describe characteristics of the groups with highest levels of violent behaviors. A total of 265 patients, aged 18 to 35, treated at the Treatment and early Intervention in Psychosis Program (TIPP-Lausanne), a specialized early psychosis program, were included in this study. We conducted a latent-class analysis and a discriminative analysis on the basis of the main dynamic VB risk factors: substance use disorder, impulsivity, positive symptoms, insight, aggression, hostility, anger, emotional instability and adherence to treatment. These factors were evaluated by specialized scales and on the basis of the Positive and Negative Syndrome Scale (PANSS). VB were restricted to physical aggression against people, defined as "serious violence". They were assessed on the basis of a questionnaire listing violent offenses (Swiss Criminal Code) and VB such as assault and battery, information through the forensic psychiatric services and on the basis of the Staff Observation Aggression Scale (SOAS-R scale) during inpatient treatment phase. Four heterogeneous subgroups were identified with respect to the studied clinical characteristics, including two groups with high rates of VB. The first group, comprising 46% of patients with VB, is distinguished by the prevalence of a range of dimensions related to hostility, impulsivity and emotional instability, associated with high levels of substance abuse and positive symptoms. These clinical dimensions are very significant at the statistical level, since they explain 70% of the construction of subgroups (discriminant analysis). The second group with 37% of patients with VB, is characterized by a lack of insight, lack of adherence to treatment and substance use. These two clinical profiles could increase the impairment of cognitive, functional and relational abilities and contribute to the development of VB in this early phase of psychosis. The third subgroup, with a violent behaviors rate of 28.6%, is distinguished by its high proportion of diagnoses of substance abuse (100%) and women (54%). A last subgroup of patients, the largest quantitatively, has a low proportion of VB (15%) and the lowest levels on the studied factors, suggesting that the majority of patients with this profile commit few VB. Our results show that it is possible to identify groups at risk of violent behaviors during the early phase of psychosis on the basis of clinical characteristics that may evolve and therefore be the focus of preventive care. These results highlight the need to target substance use, impulsivity and lack of insight at follow-up in order to prevent VB

Postprandial triglyceride-rich lipoproteins from type 2 diabetic women activate platelets

International audienceIncreased concentrations of fasting and post-prandial (PP) triglycerides (TG), carried out in the circulation by triglyceride-rich lipoproteins (TGRL), are a risk factor for atherothrombosis in patients with type 2 diabetes (T2D). The objective of our clinical study was to determine the effects of fasting and PP TGRL from T2D patients on platelet activation while assessing the fatty acid (FA) and sphingolipid (SL) composition of TGRL. Thirty women with T2D were randomly assigned a breakfast containing 20 g lipids from a hazelnut-cocoa spread rich in palm oil (Palm Nut) versus butter. Both breakfasts were rich in palmitic acid, and the Palm Nut breakfast also contained 45% oleic acid. Blood samples were collected at fasting and 4h after the breakfast, and TGRL were isolated from the plasma by ultra-centrifugation at a density equivalent to that of chylomicrons (d<1.000). TGRL FA and SL composition were analyzed by gas chromatography and tandem mass spectrometry, respectively. Both breakfasts similarly increased plasma apoB-48 (Palm Nut: +78%, butter: +67%), plasma TG (Palm Nut: +33%, butter: +30%) and TGRL TG concentrations (Palm Nut: 200% and butter: 71%). TGRL mean diameter (146 ± 5 nm) increased after both breakfasts and was greater after the butter breakfast. The ingestion of the Palm Nut breakfast mainly resulted in increased proportions of oleic acid in TGRL while butter led to increased proportions of palmitic acid. Compared to fasting TGRL, the ingestion of the meals enriched in saturated FA led to increased TGRL total ceramide concentrations, especially C16:0, C24:1 and C24:0 molecular species. Pre-incubation of platelets from healthy donors with fasting and PP TGRL increased collagen-stimulated aggregation. Fasting and PP TGRL similarly increased agonist-induced thromboxane B2 concentrations. In conclusion, PP TGRL from T2D women after a palm-oil spread or butter-based mixed meal induced similar acute in vitro platelet activation

Postprandial triglyceride-rich lipoproteins from type 2 diabetic women activate platelets

International audienceIncreased concentrations of fasting and post-prandial (PP) triglycerides (TG), carried out in the circulation by triglyceride-rich lipoproteins (TGRL), are a risk factor for atherothrombosis in patients with type 2 diabetes (T2D). The objective of our clinical study was to determine the effects of fasting and PP TGRL from T2D patients on platelet activation while assessing the fatty acid (FA) and sphingolipid (SL) composition of TGRL. Thirty women with T2D were randomly assigned a breakfast containing 20 g lipids from a hazelnut-cocoa spread rich in palm oil (Palm Nut) versus butter. Both breakfasts were rich in palmitic acid, and the Palm Nut breakfast also contained 45% oleic acid. Blood samples were collected at fasting and 4h after the breakfast, and TGRL were isolated from the plasma by ultra-centrifugation at a density equivalent to that of chylomicrons (d<1.000). TGRL FA and SL composition were analyzed by gas chromatography and tandem mass spectrometry, respectively. Both breakfasts similarly increased plasma apoB-48 (Palm Nut: +78%, butter: +67%), plasma TG (Palm Nut: +33%, butter: +30%) and TGRL TG concentrations (Palm Nut: 200% and butter: 71%). TGRL mean diameter (146 ± 5 nm) increased after both breakfasts and was greater after the butter breakfast. The ingestion of the Palm Nut breakfast mainly resulted in increased proportions of oleic acid in TGRL while butter led to increased proportions of palmitic acid. Compared to fasting TGRL, the ingestion of the meals enriched in saturated FA led to increased TGRL total ceramide concentrations, especially C16:0, C24:1 and C24:0 molecular species. Pre-incubation of platelets from healthy donors with fasting and PP TGRL increased collagen-stimulated aggregation. Fasting and PP TGRL similarly increased agonist-induced thromboxane B2 concentrations. In conclusion, PP TGRL from T2D women after a palm-oil spread or butter-based mixed meal induced similar acute in vitro platelet activation