Systemic sclerosis in Zimbabwe:Autoantibody biomarkers, clinical and laboratory correlates

IntroductionSystemic sclerosis (SScl) is an autoimmune disease whose prevalence is rarely reported in Africa. Autoantibodies are the biomarkers of the condition, precede overt disease and determine disease phenotypes. SSc specific autoantibodies also vary between racial groupings. Objective: To investigate the clinical and laboratory characteristics of Zimbabwean patients who were reactive SSc specific autoantibodies.Materials and Method240 patients, 173 of them female with SSc specific autoantibodies were included. Autoantibodies were detected by indirect immunofluorescence microscopy and immunoblotting using a panel of 13 SScl (Euroimmun Ag., Germany). Demographic, clinical and laboratory parameters relevant to the monitoring of SScl were captured. These included pulmonary function tests, hematology, clinical chemistry, serology and thyroid function tests. Allergy skin prick tests (SPT) to inhalant and food allergen sources were conducted when indicated.ResultsAll the 240 patients (median age was 36 years) expressed SSc specific autoantibodies. 86% were Black, 11% White and 3% Asian and a fifth (20%) were younger than 16 years. Eleven (4.6%) fulfilled the ACR/EULAR classification of SSc. Clinically they had limited cutaneous (n=6), diffuse cutaneous (n=3) and SScl/inflammatory myopathy overlap (n=2). The most frequently detected antibodies anti-RNA polymerase III (RNAP) 55%, anti-Th/To (28%) anti-RNAP 11 (22%), anti-CENPB (18%) and anti-Scl-70/ATA (13%). Racial variations in the expression of these antibodies were apparent between Black, White and Asian patients. The majority (95%), who did not fulfil the ARA/EULAR criteria were symptomatic. Raynaud’s Phenomenon was documented in 24%. Respiratory symptoms included coughing, dyspnea and wheezing. There was a restrictive ventilatory defect with increased FEV1/FVC ratio. Pruritus, urticaria and skin depigmentation were the main cutaneous features while constipation, bloating, Gastroesophageal reflux disease (GERD) and abdominal pain dominated GI symptoms. Mean blood pressure readings while normal varied with biomarkers. Haematology and biochemistry parameters were within normal reference ranges.ConclusionThe expression of SSc specific autoantibodies is common and associated with known SSc symptoms. The types and frequency of autoantibodies varied with racial groupings. A fifth of the patients were children below the age of 16 years

A holistic approach of process variation reduction: a case of UK chocolate manufacturing

Purpose: This research is elucidating quality control theories to reduce variation in chocolate manufacturing process in the UK food company that will help maintain the processes stable and predictable. The main objectives of this research are to reduce defects of the output; to identify the root causes of variation; to establish and implement solutions to this variation problem; and establish a control system to monitor and report any variation in the process. Methodology: We use experimental case study of a chocolate company to achieve our objective. In this paper, we predominantly use established theory DMAIC (definemeasure-analyse-improve-control), customised to the case of the chocolate factory to reduce variations in production processes. Findings: Our results confirm that customised-traditional theoretical quality models will support manufacturing companies to maintain customer satisfaction while enhancing quality and reliability. Practical implication: Implementation of customised approach reduced the rate of defect from 8 percent to 3.7 percent. The implications of reduced variation are improved product quality; reprocessing elimination; and a more stable process that support sustainability and reliability in producing chocolates to meet customer needs. Limitations: We used an experimental based case study approach to test with one company. Testing in multiple case companies may help to generalise results. Originality: Our research study experimentally tested quality approach with a real case company and hence findings of this study can be applied to other cases working in similar settings

Determining the burden of fungal infections in Zimbabwe.

Zimbabwe currently faces several healthcare challenges, most notably HIV and associated infections including tuberculosis (TB), malaria and recently outbreaks of cholera, typhoid fever and COVID-19. Fungal infections, which are also a major public health threat, receive considerably less attention. Consequently, there is dearth of data regarding the burden of fungal diseases in the country. We estimated the burden of fungal diseases in Zimbabwe based on published literature and 'at-risk' populations (HIV/AIDS patients, survivors of pulmonary TB, cancer, chronic obstructive pulmonary disease, asthma and patients receiving critical care) using previously described methods. Where there was no data for Zimbabwe, regional, or international data was used. Our study revealed that approximately 14.9% of Zimbabweans suffer from fungal infections annually, with 80% having tinea capitis. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in HIV/AIDS were estimated at 41/100,000 and 63/100,000, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) was 2,739/100,000. The estimated burden of fungal diseases in Zimbabwe is high in comparison to other African countries, highlighting the urgent need for increased awareness and surveillance to improve diagnosis and management

Policy considerations for African food systems : towards the United Nations 2021 Food Systems Summit

Achieving food and nutrition security and ending hunger is a complex and multi-faceted global challenge, which requires urgent attention, particularly in Africa. To eliminate hunger, the continent needs to transition to new sustainable, inclusive, and resilient food systems that deliver nutritious food and a healthy planet for all. This paper discusses challenges and opportunities highlighted during the “Food Systems Transformation to Address the SDGs” session convened by the African Research Universities Alliance (ARUA) and partners at the 8th World Sustainability Forum (WSF2020) held in September 2020. The paper reflects on how African food systems need to change to achieve the food systems related and interconnected the Sustainable Development Goals (SDGs). It also presents issues for consideration at the 2021 United Nations Food Systems Summit. Key considerations include (i) the realization that nutrition insecurity is not food insecurity, (ii) the need for Africa to actualize its potential, (iii) the need to demystify policy development processes; (iv) the need to invest in better measurements and indicators; and (v) the need to create nature-based climate-smart solutions.The U.K. Research and Innovation the Global Challenges Research Fund.https://www.mdpi.com/journal/sustainabilityam2022Centre for the Advancement of Scholarshi

Validation of the global lung initiative 2012 multi-ethnic spirometric reference equations in healthy urban Zimbabwean 7-13 year-old school children: a cross-sectional observational study.

BACKGROUND: The 2012 Global Lung Function Initiative (GLI2012) provide multi-ethnic spirometric reference equations (SRE) for the 3-95 year-old age range, but Sub-Saharan African populations are not represented. This study aimed to evaluate the fit of the African-American GLI2012 SRE to a population of healthy urban and peri-urban Zimbabwean school-going children (7-13 years). METHODS: Spirometry and anthropometry were performed on black-Zimbabwean children recruited from three primary schools in urban and peri-urban Harare, with informed consent and assent. Individuals with a history or current symptoms of respiratory disease or with a body mass index-z score (BMI) < - 2 were excluded. Spirometry z-scores were generated from African-American GLI2012 SRE, which adjust for age, sex, ethnicity and height, after considering all GLI2012 modules. Anthropometry z-scores were generated using the British (1990) reference equations which adjust for age and sex. The African-American GLI2012 z-score distribution for the four spirometry measurements (FVC, FEV1, FEV1/FVC and MMEF) were evaluated across age, height, BMI and school (as a proxy for socioeconomic status) to assess for bias. Comparisons between the African-American GLI2012 SRE and Polgar equations (currently adopted in Zimbabwe) on the percent-predicted derived values were also performed. RESULTS: The validation dataset contained acceptable spirometry data from 712 children (344 girls, mean age: 10.5 years (SD 1.81)). The spirometry z-scores were reasonably normally distributed, with all means lower than zero but within the range of ±0.5, indicating a good fit to the African-American GLI2012 SRE. The African-American GLI2012 SRE produced z-scores closest to a normal distribution. Z-scores of girls deviated more than boys. Weak correlations (Pearson's correlation coefficient < 0.2) were observed between spirometry and anthropometry z-scores, and scatterplots demonstrated no systematic bias associated with age, height, BMI or socioeconomic status. The African-American GLI2012 SRE provided a better fit for Zimbabwean paediatric spirometry data than Polgar equations. CONCLUSION: The use of African-American GLI2012 SRE in this population could help in the interpretation of pulmonary function tests

Nanofluid Flow over a Permeable Surface with Convective Boundary Conditions and Radiative Heat Transfer

We investigate the effects of thermal radiation and convective boundary conditions on heat and mass transfer in nanofluid flow over a permeable flat plate. The mathematical model for the nanofluid incorporates variations in the nanoparticle volume fraction of up to 20%. The performance of two water-based nanofluids, namely, stable suspensions of copper and gold nanoparticles in water was investigated. The governing partial differential equations were transformed into ordinary ones using a similarity transformation and solved numerically. The numerical results were validated by comparison with previously published results in the literature. The main focus of this paper is to study the fluid and surface parameters such as the radiation parameter, and suction/injection parameter, solute concentration profiles, as well as the skin friction coefficient and heat and mass transfer rates were conducted

Changes in neutrophil count, creatine kinases and muscle soreness after repeated bouts of downhill running

Objective. A primary objective was to examine circulating neutrophil count after repeated bouts of downhill running. An additional aim was to determine creatine kinase (CK) levels during the initial 12 hours, after repeated DHRs. Design. Eleven healthy, untrained Caucasian males performed 2 x 60 min bouts of DHR (-13.5%), spaced 14 days apart, at a speed equal to 75% VO2max on a level grade. Blood was collected before, after, and every hour for 12 hours, and every 24 hours for 6 days. Absolute neutrophil count, CK, and delayed-onset muscle soreness (DOMS) were assessed. Results were analysed using repeated measures ANOVA (

Lack of knowledge of hepatitis B vaccine the main reason for poor vaccine uptake among healthcare workers caring for the South African elderly

Introduction: A 3-dose hepatitis B vaccine (HepB) series is recommended for healthcare workers (HCWs) who continue to be at risk of nosocomial hepatitis B virus (HBV) infection due to poor vaccination rates. Data on reasons for HepB decision-making amongst HCWs caring for the elderly are limited. Consequently, a need to investigate and provide future guidance. Objectives: To investigate HepB uptake and reasons for vaccination decision-making amongst HCWs caring for the South African elderly. Method: Descriptive study using a self-administered structured questionnaire, conducted among 360 HCWs present on the day of data collection at 18 community health centres and 44 public and private sector old age homes. Data were captured using Microsoft Excel® and imported to Epi InfoTM 7 for descriptive statistical analysis. Ethics approval to conduct the study was obtained. All participants provided informed consent. Results: The response rate was 76.7% (276/360). Only 29.7% (82/276) were fully vaccinated while 70.3% (194/276) of the respondents were not vaccinated at all against HBV. The main reason for accepting HepB (90.2% [74/82]) was to protect themselves. For those who did not receive HepB, the main reason was lack of knowledge about HepB (63.4% [123/194]), while 35.1% (68/194) reported HepB stock-outs at their facilities. Conclusions: HepB uptake by HCWs caring for the elderly was sub-optimal. Lack of knowledge about HepB and the non-availability of the vaccine were the main reasons for non-vaccination. Training for HCWs should underscore the importance, safety, effectiveness and acceptance of HepB