Birth Weight for Gestational Age Norms for a Large Cohort of Infants Born to HIV-Negative Women in Botswana Compared with Norms for U.S.-Born Black Infants

Background: Standard values for birth weight by gestational age are not available for sub-Saharan Africa, but are needed to evaluate incidence and risk factors for intrauterine growth retardation in settings where HIV, antiretrovirals, and other in utero exposures may impact birth outcomes. Methods: Birth weight data were collected from six hospitals in Botswana. Infants born to HIV-negative women between 26-44 weeks gestation were analyzed to construct birth weight for gestational age charts. These data were compared with published norms for black infants in the United States. Results: During a 29 month period from 2007-2010, birth records were reviewed in real-time from 6 hospitals and clinics in Botswana. Of these, 11,753 live infants born to HIV-negative women were included in the analysis. The median gestational age at birth was 39 weeks (1st quartile 38, 3rd quartile 40 weeks), and the median birth weight was 3100 grams (1st quartile 2800, 3rd quartile 3400 grams). We constructed estimated percentile curves for birth weight by gestational age which demonstrate increasing slope during the third trimester and leveling off beyond 40 weeks. Compared with black infants in the United States, Botswana-born infants had lower median birth weight for gestational age from weeks 37 through 42 (p < .02). Conclusions: We present birth weight for gestational age norms for Botswana, which are lower at term than norms for black infants in the United States. These findings suggest the importance of regional birth weight norms to identify and define risk factors for higher risk births. These data serve as a reference for Botswana, may apply to southern Africa, and may help to identify infants at risk for perinatal complications and inform comparisons among infants exposed to HIV and antiretrovirals in utero

The heliospheric modulation of 3-10 Mev electrons: modeling of changes in the solar wind speed in relation to perpendicular polar diffusion

Abstract The discrepancy between cosmic ray model predictions representing solar minimum conditions in the heliosphere and the 3-10 MeV post-1998 electrons observations by the Kiel Electron Telescope (KET) onboard Ulysses suggests the need for consistent changes in model parameters with increasing solar activity. In order to reduce this discrepancy, an effort is made to model the KET observations realistically during periods of increased solar activity by applying an advanced three-dimensional, steady-state electron modulation model based on ParkerÕs transport equation including the Jovian electron source. Some elements of the diffusion tensor which were not previously emphasized are revisited. A new relation is also established between the latitudinal dependence of the solar wind speed and the perpendicular polar diffusion. Based on this relation, a transition of an average solar wind speed from solar minimum to solar maximum conditions, as observed on board the Ulysses spacecraft, is modeled on the concept of the time-evolution of large polar coronal holes. These changes are correlated to different scenarios of the enhancement of perpendicular polar diffusion. Effects of these scenarios are illustrated, as a series of steady-state solutions, on the computed 7 MeV Jovian and galactic electrons in comparison with 3-10 MeV electrons observed from the period 1998 to the end of 2003. It is shown that this approach improves compatibility with the KET observations but it also points to the need for a time-dependent electron modulation model to fully describe modulation during moderate to extreme solar maximum conditions

Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic, Antiretroviral-Naive, HIV-Infected Adults in Botswana

IMPORTANCE Micronutrient deficiencies occur early in human immunodeficiency virus (HIV) infection, and supplementation with micronutrients may be beneficial; however, its effectiveness has not been investigated early in HIV disease among adults who are antiretroviral therapy (ART) naive. OBJECTIVE To investigate whether long-term micronutrient supplementation is effective and safe in delaying disease progression when implemented early in adults infected with HIV subtype C who are ART-naive. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of supplementation with either daily multivitamins (B vitamins and vitamins C and E), seleniumalone, or multivitamins with selenium vs placebo inafactorial design for 24 months. The study was conducted in 878 patients infected with HIV subtype C with a CD4 cell count greater than 350/μL who were not receiving ART at Princess Marina Hospital in Gaborone, Botswana, between December 2004 and July 2009. INTERVENTIONS Daily oral supplements of B vitamins and vitamins C and E, selenium alone, or multivitamins plus selenium, compared with placebo. MAIN OUTCOMES AND MEASURES Reaching a CD4 cell count less than 200/μL until May 2008; after this date, reaching a CD4 cell count of 250/μL or less, consistent with the standard of care in Botswana for initiation of ART at the time of the study. RESULTS There were 878 participants enrolled and randomized into the study. All participants were ART-naive throughout the study. In intent-to-treat analysis, participants receiving the combined supplement of multivitamins plus selenium had a significantly lower risk vs placebo of reaching CD4 cell count 250/μL or less (adjusted hazard ratio [HR], 0.46; 95% CI, 0.25-0.85; P = .01; absolute event rate [AER], 4.79/100 person-years; censoring rate, 0.92; 17 events; placebo AER, 9.22/100 person-years; censoring rate, 0.85; 32 events). Multivitamins plus selenium in a single supplement, vs placebo, also reduced the risk of secondary events of combined outcomes for disease progression (CD4 cell count ≤250/μL, AIDS-defining conditions, or AIDS-related death, whichever occurred earlier [adjusted HR, 0.56; 95% CI, 0.33-0.95; P = .03; AER, 6.48/100 person-years; censoring rate, 0.90; 23 events]). There was no effect of supplementation on HIV viral load. Multivitamins alone and selenium supplementation alone were not statistically different from placebo for any end point. Reported adverse events were adjudicated as unlikely to be related to the intervention, and there were no notable differences in incidence of HIV-related and health-related events among study groups. CONCLUSIONS AND RELEVANCE In ART-naive HIV-infected adults, 24-month supplementation with a single supplement containing multivitamins and selenium was safe and significantl

Language rights, intercultural communication and the law in South Africa

This article seeks to explore the present language scenario in courts of law. The article makes use of section 6 of the Constitution of the Republic of South Africa (1996), as a point of departure. At face value this section seems to entrench the language rights of individuals. This would mean that individuals could request trials to be held in their mother tongues, with fluent and competent speakers of that mother tongue sitting on the bench. However, this has not materialised. Contrary to popular opinion, the article argues that individual language rights are to some extent entrenched in the Constitution, but there are no mechanisms to secure such rights in the public domain. The article argues that it is often only language privileges that are preserved in institutions such as the justice system. Legally speaking, there is an obligation on the State to provide interpreters to facilitate access to all eleven official languages in courts of law. This in itself presents numerous challenges. The article argues further that the corollary to this is that there is very little space for intercultural communication in courts of law (as defined by Ting-Toomey, 1999, and Gibson, 2002). There has been little or no capacity building in this regard. It is English, to some extent Afrikaans, and the western cultural paradigm, which prevails. The result is further communication breakdown and language intolerance. In this article, the notion of language rights in courts of law is explored against the backdrop of existing theories of intercultural communication

Percutaneous nephrolithotomy in patients with chronic kidney disease: efficacy and safety

Although the effects of percutaneous nephrolithotomy (PCNL) on patients with normal functioning kidneys have been widely studied, the outcomes of PCNL in populations with renal insufficiency remain underreported. We aimed to examine the literature and evaluate the efficacy and safety of PCNL in this non-indexed patient group. A systematic search was performed in accordance with Cochrane guidelines. This systematic search served to identify original studies investigating PCNL carried out in the adult population with chronic kidney disease published over the past 20 years (since 1997).</p

Safety, feasibility, and efficacy of bilateral synchronous percutaneous nephrolithotomy for bilateral stone disease: Evidence from a systematic Review

INTRODUCTION: With the evolution of endourologic technology, bilateral synchronous percutaneous nephrolithotomy (BS-PCNL) has emerged as a potentially practical intervention for patients with bilateral lithiasis. Although tradition has favored a staged approach, an increasing number of original studies have reported their experiences with the synchronous approach.MATERIALS AND METHODS: A Cochrane style search was performed after development of a sensitive and predefined search strategy. Primary outcomes measured were initial and final stone-free rate (SFR), drop in hemoglobin, hospital stay, operative time, and complication rates. Additional information was collected on (but not limited to) baseline characteristics, stone complexity, number of tracts made, success rate, and transfusion rate.RESULTS: From a total 187 studies, 11 were identified (published between 1997 and 2015), and they were included in this review. In total, 594 patients with a mean age of 46 years and a male:female ratio of 3:1 underwent BS-PCNL procedures, the majority of which was under the prone position. In 87.1% (range: 71.4%-100%) of cases, the synchronous approach was performed as planned. Multiple access tracts were established in an average of 16.7% (4.1%-24%) renal units. Mean initial SFR and final SFR were 72.6% (49%-85%) and 92.4% (87%-96.9%), respectively, with a mean operative time of 171.1 minutes (range: 107.4-269 minutes). Mean hospital stay was 3.9 days (range: 1.25-15 days). Mean complication rate per study was 23.4% (range: 12.1%-54% per study). The majority were Clavien Grade 1 (60.9%), of which fever resolving spontaneously was the most common complication. No deaths were reported in any of the papers.CONCLUSION: BS-PCNL seems to be a good endourologic approach for patients with bilateral stone disease, which can render high SFRs and maintain a noninferior safety profile compared with the staged approach. This technique demands careful patient selection, counseling and should be preferably performed in endourology centers with large case volumes.</p