The prevalence of side-effects: ciprofloxacin 500 mg single dose prophylaxis against Neisseria meningitidis outbreak in Potchefstroom during July 2003: research

Potchefstroom experienced an outbreak of Neisseria meningitidis (N. meningitidis) during May-July 2003. An opportunity for obtaining valuable data arose when mass prophylactic treatment to approximately 28% of the Potchefstroom community was provided by the Department of Health, North-West Province. The aim of this study was to investigate the prevalence of side-effects experienced by staff and students of the Potchefstroom University for Christian Higher Education (PU for CHE) who received a single prophylactic dose of oral ciprofloxacin 500 mg between 23 and 29 July 2003. Information gained from the Potchefstroom outbreak may be valuable for the future management of similar outbreaks in other communities. Various stakeholders have published related reports, protocols, recommendations and guidelines, which mostly focused on the prevention, management and control of meningococcal disease. Very little has been reported about the side-effects experienced, especially in cases where ciprofloxacin 500 mg single dose had been dispensed. One or more side-effects were reported by 24.2% of the participants, while 5.4% had to consult with a health care worker due to the severity of side-effects resulting from a single dose. Practical significance could not be demonstrated for any of the side-effects reported after single versus multiple doses nor when the effects of gender or requirement for medical consultation were tested. Key Words: Neisseria meningitidis; Ciprofloxacin; Single dose; Side effects; Prophylactic OPSOMMING ‘n Uitbraak van Neisseria meningitidis (N. meningitidis) gedurende Mei-Julie 2003 en die daaropvolgende verskaffing van massa-profilakse deur die Departement van Gesondheid, Noordwesprovinsie aan ongeveer 28% van die plaaslike gemeenskap het ‘n geleentheid geskep om waardevolle inligting in te win. Die doel van die studie was om die voorkoms van newe-effekte te ondersoek wat deur die personeel en studente van die Potchefstroomse Universiteit vir Christelike Hoër Onderwys ervaar is na toediening van ‘n enkel profilaktiese dosis van siprofloksasien 500 mg tussen 23-29 Julie 2003. Inligting wat hieruit voortspruit mag waardevol wees tydens toekomstige bestuur van uitbrake in ander gemeenskappe. Verskillende belanghebbendes het verslae, protokolle, aanbevelings en riglyne gepubliseer, wat meestal op die voorkoming, bestuur en beheer van meningokokkale siekte gefokus het. Daar is egter min gerapporteer oor die newe-effekte wat ondervind is veral waar siprofloksasien 500mg enkeldosis toegedien is. Een of meer newe-effekte is deur 24.2% van die deelnemers ervaar en 5.4% het dit nodig geag om ‘n gesondheidswerker te konsulteer in verband met die newe-effekte wat ervaar is. Geen prakties betekenisvolle verskille is aangedui indien die effeksgrootte bereken is vir die newe-effekte getoets tussen die enkeldosis versus die meervoudige dosis nie, selfs ook nie nadat die effek van geslag of konsultasie getoets is nie. Health SA Gesondheid Vol.9(3) 2004: 42-5

Associations between plasma tenofovir concentration and renal function markers in HIV-infected women

Background: Tenofovir disoproxil fumarate (TDF) has been associated with kidney tubular dysfunction and reduced renal function. Limited studies were performed in Europe and Asia that related plasma tenofovir (TFV) concentration with renal function; no such studies to date have been performed on Africans.Objective: To investigate the correlation between plasma tenofovir (TFV)  concentration and certain renal function markers in HIV-infected women on TDF antiretroviral therapy (ART). These markers were also compared to a HIV-uninfected control group.Methods: HIV-infected women (n = 30) on TDF-based ART were matched with 30 controls for age and body mass index. Renal markers analysed were estimated glomerular filtration rate (eGFR), creatinine clearance (CrCl), serum creatinine, albuminuria, glucosuria, serum urea, serum uric acid, urine sodium and maximum tubular reabsorption of phosphate. Baseline eGFR and CrCl data were obtained retrospectively for the HIV-infected women. Plasma TFV was assayed using a validated HPLC-MS/MS method. Stepwise regression, Mann–Whitney test, unpaired and paired t-tests were applied in the statistical analyses.Results: TFV concentration was independently associated with albuminuria (adjusted r2 = 0.339; p = 0.001) in HIV-infected women. In the adjusted (weight) analysis, eGFR (p = 0.038), CrCl (p = 0.032) and albuminuria (p = 0.048) were significantly higher in HIV-infected compared to the uninfected women, but eGFR was abnormally high in HIV-infected women. Both eGFR (p < 0.001) and CrCl (p = 0.008) increased from baseline to follow-up in HIV-infected women.Conclusion: Plasma TFV concentration was associated with increased albuminuria in HIVinfected women in this sub-study. Both eGFR and CrCl were increased in HIV-infected women from baseline. These findings should be confirmed in larger studies, and hyperfiltration in HIV-infected women warrants further investigation

A "site" for sore eyes

It is known that not all red eyes are caused by infections. Furthermore, not all eye infections will react to antibiotic eye drops. Most cases of conjunctivitis are due to viral causes, do not require antibiotic eye drops and are usually self-limiting. Serious ophthalmic conditions such as infectious keratitis can lead to blindness; it is an emergency that requires specialist treatment. Also infectious endophthalmitis has become more frequent with the use of intravitreal injections. Intravitreal antibiotics are needed to try and prevent visual loss. To ensure therapeutic local exposure ophthalmic antibiotic solutions should be applied frequently into the eye

Hypertriglyceridaemia and the risk of pancreatitis six months post lopinavir/ritonavir initiation

Background: Hypertriglyceridaemia (HTG) is an important risk factor for pancreatitis and cardiovascular disease (CVD), depending on severity. Hypertriglyceridaemia is common in human immunodeficiency virus (HIV) infection and is also a common complication of lopinavir/ritonavir (LPV/r).Objectives: To evaluate the risk of pancreatitis associated with HTG in patients six months post initiation of LPV/r-based therapy in a regional public hospital.Methods: Triglyceride (TG), serum amylase (s-amylase) and CD4+ count values were retrospectively investigated six months post LPV/r-based initiation. Age, gender, previous antiretroviral regimen and period since HIV diagnosis were also recorded.Results: The final sample consisted of 194 patients, 50 males and 144 females; mean (± standard deviation [s.d.]) age was 39.52 (± 9.98) years, and the mean (± s.d.) period since HIV diagnosis was 91.32 (± 25.18) months. Normal TG levels (< 1.70 mmol/L) were detected in only 55% of patients and the rest presented with some degree of HTG. The mean (± s.d.) TG for the entire sample was elevated at 1.94 (± 1.30) mmol/L with the mean (± s.d.) of the males at 2.36 (± 1.74) – statistically higher compared to the females at 1.79 (± 1.08) mmol/L (p = 0.034). No cases of pancreatitis were recorded and the time since HIV diagnosis did not indicate any statistically significant differences in the means of the TG, serum amylase or CD4 count values.Conclusion: Triglyceride levels were not substantially elevated to induce pancreatitis at six months post initiation of LPV/r, but were elevated above the accepted upper normal limit of 1.70 mmol/L which may have implications for cardiovascular risk

A retrospective descriptive investigation of adult patients receiving third-line antiretroviral therapy in the North West province, South Africa

Greater access and prolonged exposure to ART may inevitably lead to more treatment failure and increase the need for third-line ART (TLART) in a resource-limited setting. Objective: To describe characteristics and resistance patterns of adult patients initiated on TLART in three districts of the North West province. Method: All-inclusive retrospective descriptive investigation. Demographics and clinical variables were recorded from adult patient health records (2002-2017) and analysed. Results: 21 Patients (17 females, 4 males) with median (IQR) age of 34 years (30.2-37.8) at HIV diagnosis and 45 years (39.5-47) at TLART initiation were included. Median duration (days) from HIV diagnosis to first-line ART initiation was 101 (37-367), treatment duration on first-line, second-line and between second-line failure and TLART initiation were: 1 269 (765-2 343); 1 512 (706-2096) and 71 (58-126) days respectively

A retrospective descriptive investigation of adult patients receiving third-line antiretroviral therapy in the North West province, South Africa

Background: Greater access and prolonged exposure to ART may inevitably lead to more treatment failure and increase the need for third-line ART (TLART) in a resource-limited setting. Objective: To describe characteristics and resistance patterns of adult patients initiated on TLART in three districts of the North West province. Method: All-inclusive retrospective descriptive investigation. Demographics and clinical variables were recorded from adult patient health records (2002-2017) and analysed. Results: 21 Patients (17 females, 4 males) with median (IQR) age of 34 years (30.2-37.8) at HIV diagnosis and 45 years (39.5-47) at TLART initiation were included. Median duration (days) from HIV diagnosis to first-line ART initiation was 101 (37-367), treatment duration on first-line, second-line and between second-line failure and TLART initiation were: 1 269 (765-2 343); 1 512 (706-2096) and 71 (58-126) days respectively. High-level resistance most prevalent were: nelfinavir/r (85.7%), indinavir/r (80.9%), lopinavir/r (76.2%), emtricitabine and lamivudine (95.2%), nevirapine (76.2%) and efavirenz (71.4%). Resistance to 3 major PI mutations in 95% of patients and cross resistance were documented extensively. Conclusion: This study support the need for earlier resistance testing. It firstly reported on time duration post diagnosis on various ART regimens and secondly resistance patterns of adults before TLART was initiated in these districts

Parental reporting of adverse drug reactions in South Africa: An online survey

The high incidence of adverse drug reactions (ADRs) in children is of global concern. Enhancing the reporting of ADRs could contribute to making safer medicines available to children.To assess parents’ awareness of reporting ADRs and their knowledge on the reporting procedures in South Africa.The questionnaire was completed voluntarily by 206 respondents. The majority of participants (70.9%) were aware of the term ADR. Significant associations between not being aware of the term ADR and single marital status, lower education level, not having private medical aid and accessing public clinics for medical services were found. The majority (66.5%) of participants did report an ADR to a healthcare professional whilst only 15% reported it to a product manufacturer. More than half of the participants (58.7%) knew how to report ADRs whilst 72.8% knew what type of ADRs to report. Almost a third (32.5%) did not know where more information on ADR reporting could be found or how ADRs could be reported (31.5%

Factors associated with bone mineral density and bone resorption markers in postmenopausal hiv-infected women on antiretroviral therapy: A prospective cohort study

The study aimed to determine factors associated with changes in bone mineral density (BMD) and bone resorption markers over two years in black postmenopausal women living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART). Women (n = 120) aged > 45 years were recruited from Potchefstroom, South Africa. Total lumbar spine and left femoral neck (LFN) BMD were measured with dual energy X-ray absorptiometry. Fasting serum C-Telopeptide of Type I collagen (CTx), vitamin D and parathyroid hormone were measured. Vitamin D insufficiency levels increased from 23% at baseline to 39% at follow up. In mixed linear models serum CTx showed no change from baseline to end (p = 0.363, effect size = 0.09). Total and LFN BMD increased significantly over two years, but effect sizes were small. No significant change in spine BMD over time was detected (p = 0.19, effect size = 0.02). Age was significantly positively associated with CTx over time, and negatively with total and LFN BMD. Physical activity (PA) was positively associated with LFN BMD (p = 0.008). Despite a decrease in serum vitamin D, BMD and CTx showed small or no changes over 2 years. Future studies should investigate PA interventions to maintain BMD in women living with HIV

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Taxation of electronic commerce

M.Comm.The study deals with the taxation of electronic commerce ("E-Commerce") transactions. The main focus of the study is to identify and discuss the international income tax problems that arise from E-Commerce transactions. The impact of E-Commerce on indirect taxes such as value-added tax and customs and excise duties is also briefly discussed, as well as the problems and possibilities from a tax administrator's perspective. No detailed study on the implications of E-Commerce on our source legislation has yet been conducted in South Africa. This study will therefore be limited to discussions on possible effects of E-Commerce on the current source legislation as at 1998. This document is not intended to provide solutions to the problems identified. Internationally, no country has, as yet, been brave enough to provide solutions to the E-Commerce problems. A number of first-world countries, for example the United States and Australia, have done detailed research and studies on the topic, but both countries issued the documents as discussion papers. These countries have, however, made a few statements on the topic, but none of them provide solutions to the problems. For example, the United States have announced a five-year moratorium on taxes on the Internet and issued a statement on the principles to be followed in the E-Commerce environment. The Organisation for Economic Co-operation and Development has also released a discussion paper on the taxation of E-Commerce transactions, but again with no firm solutions. The possible solutions discussed in these discussion papers will be covered separately in this study