Chronic kidney disease

In his review article in the March 2015 edition ofCME, Prof. A M Meyers refers to chronic kidneydisease as ‘an important disease group that threatenshealth’. I fully concur with this observation andwish to go a step further and assert that kidneydisease, together with other related non-communicable diseases(NCDs), poses not only a threat to health but also to theoverall development of South Africa (SA). It is now almost 4 yearssince the adoption of the Political Declaration of the High-levelMeeting of the General Assembly on the Prevention and Controlof Non-communicable Diseases (September 2011), where itwas emphatically stated that member States that have signed theDeclaration (including SA) ‘Acknowledge that the global burdenand threat of non-communicable diseases constitutes one of themajor challenges for development in the twenty-first century,which undermines social and economic development throughoutthe world, and threatens the achievement of internationallyagreed development goals’

Incidence and All-Cause Mortality Rates in Neonates Infected With Carbapenem Resistant Organisms

INTRODUCTION: Multidrug-resistant, Gram-negative infections, particularly due to carbapenem resistant organisms (CRO), have increased globally. Few studies have reported on the burden of CRO in neonates from low-middle income countries (LMIC). This study aimed to determine the incidence and mortality rates of culture-confirmed Gram-negative infections, with a special focus on CRO in a neonatal unit from a LMIC. MATERIALS AND METHODS: Positive bacterial cultures from sterile sites of infants admitted in the neonatal unit from the 1st January 2018 to 31st December 2019, were reviewed retrospectively. Type of organism, susceptibility and outcomes were recorded. Data on Gram-negative isolates, including the CRO, were extracted. Rates and outcomes were analysed. RESULTS: There were 2219 neonates with organisms isolated from sterile sites (blood and cerebrospinal fluid), accounting for 30% of all admissions, giving a neonatal sepsis incidence of 17.9/1000 patient-days. There was a total of 1746 positive isolates (excluding coagulase negative Staphyloccocus). Of these, 1706 (98%) were isolated from blood, and 40 (2%) from cerebrospinal fluid. Overall, 1188 (68%) were Gram-negative, 371 (21%) Gram-positive and 187 (10.7%) fungal isolates. The common Gram-negatives were Acinetobacter baumannii (526/1188;44%) and Klebsiella pneumoniae (469/1188;40%). Carbapenem resistance was observed in 359 (68%) of the Acinetobacter baumannii (CRAB) and in 103 (18%) of the Enterobacterales (CRE) isolates, with 98% of CRE being Klebsiella pneumoniae (CR-Klebs). Twenty-four (41%) of Pseudomonas species were carbapenem resistant. Overall, carbapenem resistance was seen in 42% of all Gram-negative organisms. The rate of CRAB and CRE were 2.9 and 0.8/1000 patient-days respectively. The overall, all-cause in-hospital mortality rate in infants with Gram-negative isolates was 22%, with higher mortality rate in those infected with CRO compared to non-CRO (34% vs 13%; OR 3.44; 95% CI 2.58–4.60; p < 0.001). The mortality rate in infants with CRE was higher than those with CRAB (48% vs 33%; OR 1.85; 95% CI 1.18–2.89; p = 0.007). CONCLUSION: We observed a high incidence of positive cultures from sterile sites. The common organisms isolated were Gram-negatives, and among these carbapenem resistance was high and was associated with high mortality. Mortality was higher in infants with CRE compared to those with CRAB

Discovery, observations, and modelling of a new eclipsing polar: MASTER OT J061451.70-272535.5

We report the discovery of a new eclipsing polar, MASTER OT J061451.70-272535.5, detected as an optical transient by MASTER auto-detection software at the recently commissioned MASTER-SAAO telescope. Time resolved (10-20 s) photometry with the SAAO 1.9-m and 1.0-m telescopes, utilizing the SHOC EM-CCD cameras, revealed that the source eclipses, with a period of 2.08 h (7482.9 +/- 3.5 s). The eclipse light curve has a peculiar morphology, comprising an initial dip, where the source brightness drops to 50 percent of the pre-eclipse level before gradually increasing again in brightness. A second rapid ingress follows, where the brightness drops by 60-80 per cent, followed by a more gradual decrease to zero flux. We interpret the eclipse profile as the result of an initial obscuration of the accretion hot-spot on the magnetic white dwarf by the accretion stream, followed by an eclipse of both the hot-spot and partially illuminated stream by the red dwarf donor star. This is similar to what has been observed in other eclipsing polars such as HU Aqr, but here the stream absorption is more pronounced. The object was subsequently observed with South African Large Telescope (SALT) using the Robert Stobie Spectrograph (RSS). This revealed a spectrum with all of the Balmer lines in emission, a strong He II 4686 angstrom line with a peak flux greater than that of H beta, as well as weaker He I lines. The spectral features, along with the structure of the light curve, suggest MASTER OT J061451.70-272535.5 is a new magnetic cataclysmic variable, most likely of the synchronized Polar subclass