Reflections: A Somalia mission experience

Reports about The Horn of Africa Famine Crisis in 2011 flooded our news bulletins and newspapers. Yet the nations of the world failed to respond and alleviate the unfolding disaster. In August 2011, the Gift of the Givers Foundation mobilised what was to become the largest humanitarian mission ever conducted by an African organisation. Almost a year later, the effort continues, changing the face of disaster medicine as we know it

Features of home and neighbourhood and the liveability of older South Africans

While older people live in developing countries, little is known about the relative importance of features of their communities in influencing their liveability. We examinecomponents of home and neighbourhood among older South Africans. Linear regression analyses revealed that features of home (basic amenities, household composition, financial status and safety) and neighbourhood (ability to shop for groceries, participate in organizations and feel safe from crime) are significantly associated with life satisfaction. Approaches to liveability that are person-centred and also set within contexts beyond home and neighbourhood are needed to addressboundaries between home and neighbourhood; incorporate personal resources into liveability models and import broader environmental contexts such as health and social policy

Accurate non-invasive diagnosis and staging of non-alcoholic fatty liver disease using the urinary steroid metabolome

Background The development of accurate, non-invasive markers to diagnose and stage non-alcoholic fatty liver disease (NAFLD) is critical to reduce the need for an invasive liver biopsy and to identify patients who are at the highest risk of hepatic and cardio-metabolic complications. Disruption of steroid hormone metabolic pathways has been described in patients with NAFLD. Aim(s) To assess the hypothesis that assessment of the urinary steroid metabolome may provide a novel, non-invasive biomarker strategy to stage NAFLD. Methods We analysed the urinary steroid metabolome in 275 subjects (121 with biopsy-proven NAFLD, 48 with alcohol-related cirrhosis and 106 controls), using gas chromatography-mass spectrometry (GC-MS) coupled with machine learning-based Generalised Matrix Learning Vector Quantisation (GMLVQ) analysis. Results Generalised Matrix Learning Vector Quantisation analysis achieved excellent separation of early (F0-F2) from advanced (F3-F4) fibrosis (AUC receiver operating characteristics [ROC]: 0.92 [0.91-0.94]). Furthermore, there was near perfect separation of controls from patients with advanced fibrotic NAFLD (AUC ROC = 0.99 [0.98-0.99]) and from those with NAFLD cirrhosis (AUC ROC = 1.0 [1.0-1.0]). This approach was also able to distinguish patients with NAFLD cirrhosis from those with alcohol-related cirrhosis (AUC ROC = 0.83 [0.81-0.85]). Conclusions Unbiased GMLVQ analysis of the urinary steroid metabolome offers excellent potential as a non-invasive biomarker approach to stage NAFLD fibrosis as well as to screen for NAFLD. A highly sensitive and specific urinary biomarker is likely to have clinical utility both in secondary care and in the broader general population within primary care and could significantly decrease the need for liver biopsy

Stirring up the pot of gold: Import parity pricing in South Africa

No Abstract

Iron therapy for the treatment of preoperative anaemia in patients with colorectal carcinoma: a systematic review

Preoperative anaemia is associated with increased morbidity and mortality. The aim of this systematic review is to evaluate the efficacy of preoperative iron supplementation in the treatment of anaemia, and its effect on the postoperative recovery of patients undergoing surgery for colorectal carcinoma. This systematic review was performed using MEDLINE, EMBASE and the Cochrane library to assess current evidence on the role of iron supplementation in the treatment of preoperative anaemia. Our main outcomes were absolute increase in haemoglobin, blood transfusion rate and postoperative morbidity. Main inclusion criteria were: preoperative iron supplementation, presence of colorectal carcinoma and elective surgery. The Downs-Black questionnaire was used for quality assessment of the included studies. Of the 605 studies analysed, seven, three randomized controlled trials and four cohort studies, were included. Despite iron supplementation, the three randomized controlled trials showed a decrease in haemoglobin level. This was contrary to the four cohort studies which all showed a significant increase. All studies showed a decreased blood transfusion rate following iron supplementation. None of the included studies assessed postoperative morbidity. Due to heterogeneity in study design, duration of treatment, dosages and variation in iron substrates, we were unable to perform a meta-analysis. In anaemic patients who require surgery for colorectal carcinoma, current evidence is of inadequate quality to draw a definitive conclusion on the efficacy of the various measures to treat preoperative anaemi

The Tropospheric Ozone Assessment Report : Trends in ozone and ozone metrics relevant for human health

Ozone is an air pollutant formed in the atmosphere from precursor species (NOx, VOCs, CH4, CO) that is detrimental to human health and ecosystems. The global Tropospheric Ozone Assessment Report (TOAR) initiative was recently initiated by the International Global Atmospheric Chemistry Project (IGAC) with the mission to provide the research community with an up-to-date scientific assessment of tropospheric ozone’s global distribution and trends from the surface to the tropopause. TOAR has assembled the world’s largest database of surface ozone observations and is generating ozone exposure and dose metrics at thousands of measurement sites around the world. This talk will present results from the assessment focused on those indicators most relevant to human health. An overview of trends in ozone concentrations across the globe, with an emphasis on urban areas because of their high population density and thereby relevance for human health, will be shown. Trends in different world regions will be compared, as well as differences within regions. Additionally, there are a variety of existing metrics aimed at assessing ozone concentrations and the protection of human health in use worldwide. The message communicated can be very different depending on metric used and whether this is focused on peak ozone concentrations or longer-term average concentrations. A selection of these metrics has been made to represent different conditions and applied to the ozone data gathered in the TOAR effort. The sensitivity of the trends to the selection of metric will be discussed

Effects of 1,3-Dimethylamylamine and Caffeine Alone or in Combination on Heart Rate and Blood Pressure in Healthy Men and Women

The use of 1,3-dimethylamylamine (geranamine), alone and in combination with caffeine, is becoming widespread within the dietary supplement industry. To our knowledge, no data are available concerning the effects of oral geranamine intake on heart rate (HR) and blood pressure in individuals. Ten young healthy men and women ingested 1 of 5 conditions on different days using a double-blind, randomized, crossover design. The following were ingested after a 10-hour overnight fast: 250 mg caffeine (C), 50 mg geranamine (G 50 mg), 75 mg geranamine (G 75 mg), 250 mg caffeine + 50 mg geranamine (C + G 50 mg), and 250 mg caffeine + 75 mg geranamine (C + G 75 mg). Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and rate pressure product (RPP) were measured pre-ingestion and at 30, 60, 90, and 120 minutes post-ingestion. Plasma norepinephrine (NE) and epinephrine (EPI) were measured pre-ingestion and at 60 and 120 minutes post-ingestion. Heart rate was unaffected by treatment, but blood pressure and RPP were higher with geranamine, generally in a dose-dependent manner. The peak percent change from pre-ingestion in SBP (~20%), DBP (~17%), and RPP (~9%) was noted with C + G 75 mg at 60 minutes post-ingestion. Plasma NE and EPI were relatively unaffected by treatment. We report for the first time that acute ingestion of 1,3-dimethylamylamine alone and in combination with caffeine results in an increase in SBP, DBP, and RPP without an increase in HR. The largest increase is observed at 60 minutes post-ingestion of C + G 75 mg. These changes cannot be explained by circulating NE and EPI