The effects of a single treatment of an acaricide, Acarosan, and a detergent, Metsan, on Der p 1 allergen levels in the carpets and mattresses of asthmatic children

Baseline levels of the house-dust mite allergen, Der p 1, were measured on the carpets and mattresses of 60 pure-mite-sensitive asthmatic children in the Cape Peninsula, by means of an enzyme-linked immunosorbent assay (ELISA). High levels of mite allergens were recorded (range 2 - 50 µg Der p 1/g dust). In order to investigate the efficacy of the application of acaricides to carpets and bedding, 3 groups of 20 children were studied. Carpets and mattresses in group A were treated with a detergent, Metsan (Snowchem), and in group B with Metsan combined with the acaricide, Acarosan (Noristan). Group C was a control group in which no treatment was applied. The level of airway hyperreactivity (PC20) to histamine was measured at the beginning of the study and again 3 months after acaricide treatment. Significant reductions in carpet Der p 1 levels were achieved in group A (22,83 v. 13,26 µg Der p 1/g dust; P =0,04) and group B (21,76 v. 13,26 µg Der p 1/g dust; P =0,01), but mite levels were not reduced in any of the manresses treated. There was also no improvement in airway hyperreactivity in any of the groups. This study clearly demonstrates that at present it is not possible to reduce Der p 1 antigen levels in mattresses in the Cape Peninsula with the available acaricides, even when one of these is combined with a detergent solution.

Do South African international cricket pace bowlers have similar bowling volume and injury risk associates compared to other elite fast bowlers?

BACKGROUND While many cricket-playing nations have conducted research on bowling volume (BV) and injury risk, this relationship among international South African pace bowlers is yet to be investigated. Environmental, socio-economic, and training strategy differences warrant similar research in a South African context. The purpose of this preliminary study was to establish if South African pace bowlers have similar bowling volume and injury associates compared to other elite fast bowlers. METHODS This study was a prospective, observational, cohort study that monitored match and training BV and injuries among pace bowlers playing for the South African national team between April 2017 and April 2019. A sample of convenience that included fourteen bowlers was selected. Bowling volume was quantified as the number of deliveries bowled during training and competition. Acute-, chronic- and acute: chronic bowling volume ratios were independently modeled as association variables. RESULTS There were 39 injuries with the most being to the lumbar spine (25.64%). Moderate-to-low and a moderate-to-high acute: chronic bowling load ratios were associated with a lower risk of injury. Chronic bowling load was associated with injury (z = 2.82, p = 0.01). A low acute workload, low chronic workload, moderate-high chronic workload, and moderate-low acute: chronic ratio was also associated with an increased risk of injury. CONCLUSION These findings confirm that there appears to be a dose-response effect between training bowling volume and the likelihood of an injury occurring with a moderate-to-low and a moderate-to-high bowling volume ratio being optimal. Considering the small sample size, the findings should be interpreted with caution

Non-IgE-mediated food allergies

Non-imunoglobulin E (IgE)-mediated conditions include combined IgE and cell-mediated conditions such as atopic dermatitis and eosinophilic oesophagitis, and pure T-cell-mediated conditions such as food protein-induced enterocolitis syndrome, allergic proctocolitis and enteropathy syndromes. Diagnosing mixed or non-IgE-mediated allergy is challenging. A clear cause-effect relationship between exposure to the suspected food and symptoms is not always possible, as symptoms develop over time and are more chronic in nature. Skin-prick tests and specific IgE to the allergen are usually negative. An elimination diet may be necessary to diagnose non-IgE-mediated type food allergy. The suspected allergen should be excluded from the diet for 2 - 6 weeks under dietetic guidance to assess for improvement of symptoms. After symptom improvement, a rechallenge is necessary to definitively prove causal relation.

Guideline for the management of chronic asthma in children - 2009 update

Objective. To revise the guideline for the diagnosis and management of chronic asthma in children in view of the following considerations: the existing South African Childhood Asthma Working Group (SACAWG) guideline for the management of chronic childhood asthma was produced 10 years ago; diagnosis of asthma in young children remains a challenge; evidence-based treatment is the new paradigm; new treatment approaches to achieving and maintaining control; therapeutic roles of several medications have evolved; morei studies and data on treatment in young children; new medications and formulations; a change of emphasis in assessing asthma control to guide treatment changes. The main aim of the guideline is to promote a better standard of treatment based on the understanding of the pathophysiology and pharmacotherapy of asthma, and encouraging uniformity in asthma management. Evidence. A detailed literature review by a working group of clinicians from relevant disciplines. The strategies recommended are classified according to the evidence category in Appendix B, and denoted as Evidence A, B, C and D. Recommendations. These include an appropriate diagnostic approach, environmental control measures, treatment options, definition of asthma control, and strategies to achieve control. Endorsement. The guideline document was endorsed by the South African Thoracic Society (SATS), the National Asthma Education Programme (NAEP), the South African Paediatric Association (SAPA) and the South African Academy of Family Practice

The increasing burden of asthma in South African children: A call to action

Background. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed.Objectives. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context.Methods. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system.Conclusions. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children

Functional outcomes and quality of life following complex tibial fractures treated with circular external fixation : a comparison between proximal, midshaft, and distal tibial fractures

AIM AND OBJECTIVE: The purpose of this study was to compare clinical results following complex proximal, midshaft, and distal tibial fractures and investigate whether there are differences in outcomes between these locations. MATERIALS AND METHODS: Patients between 18 years and 65 years of age and minimum follow-up of 12 months with complex tibial fractures treated with a circular ring fixator were included. Functional outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) functional and bone scores, Foot Function Index (FFI), Four Step Square Test (FSST), and Timed Up and Go Test (TUG). Quality of life was assessed by the EQ-5D score. RESULTS: A total of 45 patients were included: proximal fractures, n= 11; midshaft fractures, n= 17; and distal fractures, n= 17. ASAMI functional (p= 0.8) and bone scores (p= 0.3) were not different. Excellent and good bone scores were achieved in >90% in all groups. FFI was 30.9 + 24.7 in the proximal group, 33.9 + 27.7 in the midshaft group, and 28.8 + 26.9 in the distal group (p = 0.8). TUG was 9.0 + 2.7 sec in the proximal group, 9.0+3.5 in the midshaft group, and 8.5+2.0 in the distal group (p = 0.67). FSST was 10.7 + 2.5 sec in the proximal, 10.3 + 3.8 in the midshaft, and 8.9 + 1.8 in the distal fracture groups (p = 0.5). EQ-5D index value was highest in the distal (0.72), lowest in the proximal (0.55), and 0.70 in the midshaft fracture groups (p = 0.001). EQ-5D VAS was significantly different between the proximal (65) and midshaft (82.3) (p = 0.001) and between the distal (75) and proximal (65) fracture groups (p = 0.001). CONCLUSIONS: The results of this study suggest that the functional outcomes between proximal, midshaft, and distal complex tibial fractures are comparable. Their ability to ambulate afterward is comparable to age-related normative data, but complex tasks are more difficult and better compared to the ambulating ability of a healthy population aged 65 to 80 years. Patients with proximal tibial fractures had significantly more disability by at least one functional level and/or one health dimension.https://www.stlrjournal.com/journalDetails/STLRdm2022Orthopaedic Surger

Summary of childhood asthma guidelines, 2021 : a consensus document

Asthma is the most common chronic illness of childhood. The prevalence is rising and the mortality and morbidity from asthma are unacceptably high in South Africa. It is important to make a correct diagnosis based, most importantly, on the clinical history and supported by investigations. The appropriate drug and device must be chosen to achieve good asthma control. Patients must be followed up regularly and their asthma control must be assessed. The treatment can then be adjusted according to the level of control. The COVID-19 pandemic has placed new challenges on the care of our asthmatics. Asthma education and adherence are important components of management of the condition.http://www.samj.org.zadm2022Paediatrics and Child Healt