Maternal serum fructosamine values after delivery of macrosomic babies and unexplained stillbirths

Measurement of serum fructosamine and haemoglobin A, levels and glucose tolerance tests were performed in 75 women in the immediate postpartum period. None had predisposing factors to gestational diabetes. They were divided into three groups: group I consisted of 15 women who delivered an unexplained stillbirth; group 11 of 30 women who gave birth to babies weighing between 2500 g and 3900 g at term; and group III of 30 women who delivered babies weighing≥ 4000 g. There was a significant difference in the mean level of serum fructosamine between the unexplained stillbirth and control groups (P < 0,001). Although the HbA, values varied in the three groups, there was a significant difference between the unexplained stillbirth group and the macrosomic infant group (P < 0,05). All patients had normal glucose tolerance tests

Modulation of oxazolone-induced hypersensitivity in mice by selective PDE inhibitors

The effects of PDE inhibitors on oxazolone-induced contact hypersensitivity (CS) were studied in mice. Rolipram, Ro 20-1724 and theophylline dose dependently inhibited CS but none caused >53% inhibition. ED30 values at 24 h before challenge for rolipram, Ro 20-1724 and theophylline were 2.1, 5.4 and 30.4 mg/kg, p.o., respectively. Milrinone and SKF 94836 at 30 mg/kg caused a small, but significant inhibition of 13% and 18%, respectively, although the inhibition (8%) caused by zaprinast was not significant. Betamethasone (10 mg/kg, p.o.) caused a marked inhibition (80%) as did indomethacin (65% at 5 mg/kg, p.o.). Rolipram and Ro 20-1724 inhibited proliferation of mouse lymphoblasts with IC50 values of 0.08 μM and 0.83 μM, respectively. In contrast, zaprinast caused only a weak inhibition (IC50 = 119 μM) of lymphocyte proliferation, whereas SKF 94836 and theophylline failed to cause any significant inhibition at 100 μM (26% and 2%, respectively). These findings suggest that PDE IV isozymes play a principal role in mediating CS by inhibiting lymphocyte activation

The costs of delivering human papillomavirus vaccination to Grade 4 learners in KwaZulu-Natal, South Africa

Background. The national human papillomavirus (HPV) vaccination roll-out in South Africa provides two doses of Cervarix to all female Grade 4 learners in state schools. This study estimated the costs of vaccinating all learners in KwaZulu-Natal Province (females or males and females) using either the two- or three-dose strategies for both the bivalent and quadrivalent vaccines.Objective. To determine costs of the HPV vaccination programme in KwaZulu Natal.Methods. Costs were determined adapting World Health Organization vaccination costing guidelines.Results. The 2014 current cost of delivering three doses of Gardasil was ZAR510 per learner. The projected cost of delivering Cervarix to female learners at two or three doses over the period 2014 - 2018, adjusted for inflation, was ZAR172 717 342 and ZAR250 048 426, respectively. Similarly, the cost for Gardasil at these doses was ZAR197 482 200 and ZAR287 194 361, respectively. For male and female learners the cost for Cervarix over this period at two or three doses was ZAR337 101 132 and ZAR540 150 713, respectively. Similarly, the cost for Gardasil at these doses was ZAR426 597 971 and ZAR620 392 784, respectively. Accounting for population variation for females over 5 years, the cost of two doses of Cervarix ranged from ZAR168 888 677 to ZAR 176 545 977 at the lower and upper 95% confidence intervals (CIs), respectively. For three doses the cost ranged from ZAR244 505 544 to ZAR255 591 263 at the lower and upper 95% CIs, respectively. Similarly, the cost for two doses of Gardasil ranged from ZAR193 104 566 to ZAR201 859 798. For three doses the cost ranged from ZAR280 828 057 to ZAR293 560 614.Conclusion. This study gives decision makers a basis for structured planning and cost apportionment to ensure effective roll-out of the HPV vaccination programme

Comparison of educational facilitation approaches for Grade R English Additional Language learning in rural Mpumalanga

The Early Childhood Development Manager in Mpumalanga is faced with the problem of providing evidence-based guidance of the best facilitation approach in the Grade R context. An investigation on the effect of   facilitation, i.e. play-based or formal instruction, on Grade R performance scores in English Additional Language (EAL) learning was conducted.  Literature findings attest to formal learning contributing to better   performance scores than play-based learning, yet most rural schools in Mpumalanga use the play-based approach. The English Language Proficiency (ELP) standards assessment tool is reported to have no cultural bias and was used to collect the data. The tool assessed learners’ listening and speaking skills in EAL. A quantitative methodology was followed, using a static two-group comparison design. Participants in the two groups were matched according to age and all had a similar exposure period to EAL learning, a rural upbringing, poverty level, and all were mainstream  learners. Inter-rater reliability was obtained since two raters assessed learners’ proficiency in EAL skills. A one-way Analysis of Variance (ANOVA) was used to analyse the data. It was found that the formal based approach contributed to better EAL scores when compared to the play-based  approach. Implications for practice are discussed.Keywords: EAL learning; ELP standards assessment tool; formal  instruction;Grade R facilitation; learners’ first language; play-based approach

Incarcerated fallopian tube presenting in an incisional hernia : a case report

No AbstractKeywords: Incisional hernia, incarcerated fallopian tub

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

Background. In South Africa (SA), the Saving Mothers Reports have shown an alarming increase in deaths during or after caesarean delivery.Objective. To improve maternal surgical safety in KwaZulu-Natal Province, SA, by implementing the modified World Health Organization surgical safety checklist for maternity care (MSSCL) in maternity operating theatres.Methods. The study was a stratified cluster-randomised controlled trial conducted from March to November 2013. Study sites were 18 hospitals offering maternal surgical services in the public health sector. Patients requiring maternal surgical intervention at the study sites were included. Pre-intervention surgical outcomes were assessed. Training of healthcare personnel took place over 1 month, after which the MSSCL was implemented. Post-intervention surgical outcomes were assessed and compared with the pre-intervention findings and the control arm. The main outcome measure was the mean incidence rate ratios (IRRs) of adverse incidents associated with surgery.Results. Significant improvements in the adverse incident rate per 1 000 procedures occurred with combined outcomes (IRR 0.805, 95% confidence interval (CI) 0.706 - 0.917), postoperative sepsis (IRR 0.619, 95% CI 0.451 - 0.849), referral to higher levels of care (IRR 1.409, 95% CI 1.066 - 1.862) and unscheduled return to the operating theatre (IRR 0.719, 95% CI 0.574 - 0.899) in the intervention arm. Subgroup analysis based on the quality of implementation demonstrated greater reductions in maternal mortality in hospitals that were good implementers of the MSSCL.Conclusions. Incorporation of the MSSCL into routine surgical practice has now been recommended for all public sector hospitals in SA, and emphasis should be placed on improving the quality of implementation

Partition distribution of selected organochlorine pesticides in water, sediment pore water and surface sediment from uMngeni River, KwaZulu-Natal, South Africa

Abstract: Organochlorine pesticides (OCPs) were analysed in surface water, pore water and surface sediment samples collected from the uMngeni River, which is one of the largest rivers in the province of KwaZulu-Natal, South Africa. Liquid-liquid extraction was used to extract the analytes from water and pore water samples and soxhlet extraction was used to extract sediment samples with subsequent florisil clean-up and gas chromatography-mass spectrometry (GC-MS) analysis. Twelve selected OCPs were analysed and their total concentrations were found to range from 8.04–21.06 ng/mL, 36.06–188.43 ng/mL and 148.17–554.73 ng/g in unfiltered surface water, unfiltered pore water and surface sediment (dry weight (dw)), respectively. The results indicated that the concentrations of these selected pesticides were far higher in sediment (72%) than in pore water (25%) and water (3%). The most polluted sites were Northern Wastewater Treatment influent (NWTI) for water (Σ12OCP = 19.41 ± 1.43 ng/mL) and Northern Wastewater Treatment effluent (NWTE) for pore water (Σ12 OCP = 166.23 ± 7.16 ng/mL) and sediment (Σ12 OCP = 495.21 ± 32.38 ng/g). The most abundant individual OCPs and their average concentrations in general in the river were p,p′-DDE in unfiltered water (1.62 ±0.22 ng/mL) and unfiltered sediment pore water (17.09 ±7.96 ng/mL), and endrin in surface sediment (55.57 ± 19.01 ng/g, dw)

Consent for critical care research after death from COVID-19: Arguments for a waiver

Pandemics challenge clinicians and scientists in many ways, especially when the virus is novel and disease expression becomes variable or unpredictable. Under such circumstances, research becomes critical to inform clinical care and protect future patients. Given that severely ill patients admitted to intensive care units are at high risk of mortality, establishing the cause of death at a histopathological level could prove invaluable in contributing to the understanding of COVID-19. Postmortem examination including autopsies would be optimal. However, in the context of high contagion and limited personal protective equipment, full autopsies are not being conducted in South Africa (SA). A compromise would require tissue biopsies and samples to be taken immediately after death to obtain diagnostic information, which could potentially guide care of future patients, or generate hypotheses for finding needed solutions. In the absence of an advance written directive (including a will or medical record) providing consent for postmortem research, proxy consent is the next best option. However, obtaining consent from distraught family members, under circumstances of legally mandated lockdown when strict infection control measures limit visitors in hospitals, is challenging. Their extreme vulnerability and emotional distress make full understanding of the rationale and consent process difficult either before or upon death of a family member. While it is morally distressing to convey a message of death telephonically, it is inhumane to request consent for urgent research in the same conversation. Careful balancing of the principles of autonomy, non-maleficence and justice becomes an ethical imperative. Under such circumstances, a waiver of consent, preferably followed by deferred proxy consent, granted by a research ethics committee in keeping with national ethics guidance and legislation, would fulfil the basic premise of care and research: first do no harm. This article examines the SA research ethics framework, guidance and legislation to justify support for a waiver of consent followed by deferred proxy consent, when possible, in urgent research after death to inform current and future care to contain the pandemic in the public interest