The reliability of trace DNA or low copy number (LCN) DNA evidence in court proceedings

Although forensic DNA testing is well established, some experts disagree with the interpretation and statistical significance of test results obtained from very small samples. This article discusses the problems regarding the use of the low copy number (LCN) technique as well as the value that can be derived from such an analysis. It focuses on the problematic results that can arise from using very small samples for forensic DNA identification. Since this kind of analysis is based on low amounts of DNA samples (between 100 picograms and 200 picograms in South Africa) that are amplified by using more than the normal 28 cycles to create larger samples for analysis, the reliability of the analysis has been questioned. The amplification process, known as the Polymerase Chain Reaction (PCR), is associated with risks such as stochastic effects and contamination that could make interpretation of the results difficult for the defence. While standard operating laboratory protocols could prevent contamination and although the electropherograms could aid the detection of contamination, it is highly problematic for the defence counsel to ascertain whether these procedures were indeed strictly followed. Drawing on foreign jurisprudence, this article considers the risks and key controversies and explains what lawyers need to know, in order to be able to recognise controversial results that could stem from using the LCN DNA technique for forensic DNA identification. The conclusions thus drawn may be of particular relevance to the South African context, as no reported case law exists in which the issues relating to the use of LCN DNA have yet come to the fore

Forensic entomology: relevant to legal dispute resolution?

Forensic entomology is the study of insects and other arthropods associated with certain suspected criminal events, for the purpose of uncovering information useful to a legal investigation. This contribution considers the relevance of this biological science to the judicial process.We conclude that although the inherent nature of the science and a lack of expertise and resources hamper its integration into the legal system, its value and general acceptance is consistently recognized in other jurisdictions. Although forensic entomology evidence has to date been accepted in only one South African case, it has been utilized in numerous criminal investigations in this country. Also, various initiatives have been launched to increase its utilization and improve the reliability of its results. If these endeavours prove to be successful, forensic entomology could become increasingly relevant to legal dispute resolution

HIV-1 co-infection does not reduce exposure to rifampicin, isoniazid, and pyrazinamide in South African tuberculosis outpatients

There are contrasting data in the literature about antituberculosis plasma drug concentrations in HIV-1-coinfected patients. We report the pharmacokinetics of rifampin, isoniazid, and pyrazinamide in a cohort of patients being treated for active tuberculosis, the majority of whom were coinfected with HIV-1 and had commenced antiretroviral therapy within 2 months of starting antituberculosis treatment. We also examined the association between antituberculosis drug concentrations and reported drug side effects at the 2-month clinical review. One hundred patients with pulmonary tuberculosis (65% coinfected with HIV-1) were intensively sampled to determine rifampin, isoniazid, and pyrazinamide plasma concentrations after 7 to 8 weeks of a daily quadruple-therapy regimen dosed according to World Health Organization (WHO) weight bands. Pharmacokinetic parameters were determined for each patient by using nonlinear mixed-effects models. HIV-1-coinfected patients had lower clearance rates for rifampin (21% decrease) and isoniazid (23% decrease) than HIV-1-uninfected patients, with resulting higher areas under the concentration-time curve from 0 to 24 h (AUC0–24) and maximum concentrations of drug in serum (Cmax). Antiretroviral therapy (ART) that included double-standard-dose lopinavir/ritonavir further lowered rifampin clearance, by 46%, and increased the AUC0–24. The current uniform dosing (per kilogram of body weight) across WHO weight bands was associated with a trend of decreased pharmacokinetic exposures for the lowest weight band. Use of fat-free mass as opposed to total body weight for allometric scaling of clearance significantly improved the model. Ambulant HIV-1-coinfected patients, the majority of whom were coprescribed ART, did not have reduced antituberculosis drug concentrations compared to HIV-1-uninfected patients

Hard choices: Ethical challenges in phase 1 of COVID-19 vaccine roll-out in South Africa

Access to COVID-19 vaccines has raised concerns globally. Despite calls for solidarity and social justice during the pandemic, vaccine nationalism, stockpiling of limited vaccine supplies by high-income countries and profit-driven strategies of global pharmaceutical manufacturers have brought into sharp focus global health inequities and the plight of low- and middle-income countries (LMICs) as they wait in line for restricted tranches of vaccines. Even in high-income countries that received vaccine supplies first, vaccine roll-out globally has been fraught with logistic and ethical challenges. South Africa (SA) is no exception. Flawed global institutional strategies for vaccine distribution and delivery have undermined public procurement platforms, leaving LMICs facing disproportionate shortages necessitating strict criteria for vaccine prioritisation. In anticipation of our first consignment of vaccines, deliberations around phase 1 roll-out were intense and contentious. Although the first phase focuses on healthcare personnel (HCP), the devil is in the detail. Navigating the granularity of prioritising different categories of risk in healthcare sectors in SA is complicated by definitions of risk in personal and occupational contexts. The inequitable public-private divide that characterises the SA health system adds another layer of complexity. Unlike other therapeutic or preventive interventions that are procured independently by the private health sector, COVID-19 vaccine procurement is currently limited to the SA government only, leaving HCP in the private sector dependent on central government allocation. Fair distribution among tertiary, secondary and primary levels of care is another consideration. Taking all these complexities into account, procedural and substantive ethical principles supporting a prioritisation approach are outlined. Within the constraints of suboptimal global health governance, LMICs must optimise progressive distribution of scarce vaccines to HCP at highest risk

The proof of the pudding: the presentation and proof of expert evidence in South Africa

Imagine, as one may well imagine at this time of the day, a chocolate mousse, dark and delectable, or a tempting tiramasu or a perfect pavlova. How are you going to decide which is best? Yes, indeed the actual presentation of the puddings may influence your choice, but to be able to make an informed choice, you would need to taste them. Do you have to make the choice according to your own taste, or do you have to decide which should go best with your menu for your dinner party? If you have to decide which is best, you would have to be able to rank them in relation to other mousses, tiramasus or pavlovas. You need to know the ingredients, and for a professional decision you would need some knowledge of the art of cooking. Proof in the art of cooking, science, and also in law depends on the quantum and quality of evidence or data sufficient to support a conclusion. Loevinger concludes that “[p]roof ultimately depends on the ability of the human mind to make appropriate and useful distinctions and connections among data or items of evidence”

Relationship between lta4h promotor polymorphism and tuberculosis-associated immune reconstitution inflammatory syndrome and its prevention with prednisone

The development of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) and its prevention using prednisone may potentially be mediated by the LTA4H genotype. We assessed this hypothesis in a clinical trial evaluating prednisone to prevent TB-IRIS. We did not find an association between LTA4H genotype and TB-IRIS incidence or prednisone efficacy

Talking South African fathers: a critical examination of men’s constructions and experiences of fatherhood and fatherlessness

The absence of biological fathers in South Africa has been constructed as a problem for children of both sexes but more so for boy-children. Arguably the dominant discourse in this respect has demonized non-nuclear, female-headed households. Fathers are constructed as either absent or ‘bad’. Thus it has become important to explore more closely how male care-givers have been experienced by groups of men in South Africa. This article examines discourses of fatherhood and fatherlessness by drawing on qualitative interviews with a group of 29 men who speak about their reported experiences and understandings of being fathered or growing up without biological fathers. Two major and intertwined subjugated discourses about adult men’s experiences of being fathered that counter- balance the prevailing discourses about meaning of fatherhood and fatherlessness became evident, namely, ‘being always there’ and ‘talking fatherhood’. The importance of the experience of fatherhood as ‘being there’, which relates to a quality of time and relationship between child and father rather than physical time together, is illustrated. It is not only biological fathers who can ‘be there’ for their sons but also social fathers, other significant male role models and father figures who step in at different times in participants’ lives when biological fathers are unavailable for whatever reason. Second, many positive experiences of fathers or father figures that resist a traditional role of authority and control and subscribe to more nurturant and non-violent forms of care, represented as ‘talking’ fathers, are underlined. If we are to better understand the impact of colonial and apartheid history and its legacy on family life in contemporary society, there is a need for more historically and contextually informed studies on the meaning of fatherhood and fatherlessness.Web of Scienc

Mediating and Moderating Effects of Iron Homeostasis Alterations on Fetal Alcohol-Related Growth and Neurobehavioral Deficits

We have previously demonstrated prenatal alcohol exposure (PAE)-related alterations in maternal and infant iron homeostasis. Given that early iron deficiency and PAE both lead to growth restriction and deficits in recognition memory and processing speed, we hypothesized that PAE-related iron homeostasis alterations may mediate and/or moderate effects of PAE on growth and neurobehavior. We examined this hypothesis in a prenatally recruited, prospective longitudinal birth cohort [87 mother-infant pairs with heavy prenatal alcohol exposure (mean = 7.2 drinks/occasion on 1.4 days/week); 71 controls], with serial growth measures and infant neurobehavioral assessments. PAE was related to growth restriction at 2 weeks and 5 years, and, in infancy, poorer visual recognition memory, slower processing speed, lower complexity of symbolic play, and higher emotionality and shyness on a parental report temperament scale. Lower maternal hemoglobin-to-log(ferritin) ratio, which we have shown to be associated with PAE, appeared to exacerbate PAE-related 2-week head circumference reductions, and elevated maternal ferritin, which we have shown to be associated with PAE, appeared to exacerbate PAE-related visual recognition memory deficits. In causal inference analyses, PAE-related elevations in maternal ferritin and hemoglobin:log(ferritin) appeared to statistically mediate 22.6–82.3% of PAE-related growth restriction. These findings support potential mechanistic roles of iron homeostasis alterations in fetal alcohol spectrum disorders (FASD)