Zinc, Hydrochlorothiazide and Sexual Dysfunction.

A CAJM article on sexual dysfunction.This study was designed to test the hypothesis that hydrochlorothiazide a diuretic used to treat hypertension depletes body zinc and thereby cause sexual dysfunction. Serum zinc and sexual dysfunction were measured in 39 middle aged hypertensive men who had been taking hydrochlorothiazide in average daily doses of between 25 and 50 mg daily for at least six months, and a control group of 27 unmedicated middle aged normotensive men. The medicated group had a higher incidence of sexual dysfunction (56 pc) as compared to 11 pc in the control group. The use of hydrochlorothiazide did affect serum zinc levels significantlyin 20 patients. Sexual dysfunction occurred more often in older and overweight patients (p < 0,004). Three of the normotensive men experienced sexual dysfunction probably related to old age

How do South African obstetricians manage hypertensive disorders of pregnancy - a survey

Objective. To determine the current management of hypertensive disorders of pregnancy in South Africa.Method. A postal questionnaire was sent to 600 South African obstetricians.Results. The response rate was 72% (432/600), with 425 questionnaires suitable for analysis. South African obstetricians disagree on the definitions of various hypertensive disorders of pregnancy. Methyldopa was the antihypertensive used most frequently for the treatment of mild to moderate hypertension (diastolic blood pressure between 90 and 109 mmHg), while intravenous dihydralazine was preferred in severe hypertension (diastolic blood pressure ;0, 110 rnrnHg and proteinuria ≥, ++). To stop convulsions in eclampsia, 256 respondents (60%) said they would use diazepam, 28 (11%) said tlIey woUld continue with a diazepam infusion, and the remairling 228 (89%) preferred magnesium sulphate (MgS04) to prevent further convulsions. The intramuscular route was the preferred method of administration for MgS04. In cases of eclampsia, 273 respondents (64%) said they would use intravenous dihydralazine to lower high blood pressure (≥, 160/110 rnrnHg) and proteinuria; 98 respondents (23%) said they would use met.'1yldopa, 38 (9%) nifedipine, and 8 (2%) apresoline. Eight (2%) said they would not use antihypertensives. In patients with severe pre-eclampsia and impending eclampsia, 330 respondents (78%) said they would"use MgS04 as prophylaxis, 46 (11%) diazepam, and 6 (1.4%) phenobarbitone. Forty-three of the respondents did not prescribe prophylactic anticonvulsant therapy. To prevent pre-eclampsia, 247 of the respondents (58%) said they would prescribe Iow-dose aspirin.Conclusion. This study demonstrates that South African obstetricians show great uniformity in terms of the treatment of hypertensive disorders of pregnancy

A Case of Emmonsiosis in an HIV-Infected Child

Opportunistic fungal infections can cause significant morbidity and mortality in immunocompromised patients. We describe a paediatric case of an unusual disseminated fungal infection. A three-year-old HIV-infected child with severe immunosuppression (CD4+ T-cell count 12 × 106/L) was admitted to hospital with pneumonia, gastroenteritis and herpes gingivostomatitis. Despite antibacterial and antiviral therapy, he experienced high fevers and developed an erythematous maculopapular rash and abdominal tenderness. The child’s condition progressively worsened during the admission. A thermally dimorphic fungus was cultured from bone marrow and identified as an Emmonsia species on DNA sequencing. The patient made a good recovery on amphotericin B deoxycholate and antiretroviral therapy. Itraconazole was continued for a minimum of 12 months, allowing for immune reconstitution to occur. This case is the first documented description of disseminated disease caused by a novel Emmonsia species in an HIV-infected child in South Africa

Risk determinants of peripheral neuropathy in patients with Type II diabetes mellitus attending follow-Up clinics at University Kebangsaan Malaysia Medical Center (UKMMC): a cross sectional study

Peripheral neuropathy is highly associated with foot complications among diabetics. This study aimedto identify risk factors associated with the development of peripheral neuro­pathy in diabetic patients and their association with degree of severity of peri­pheral neu­ropathy. Across-sectional study was conducted in follow-up clinics at the Uni­versiti Ke­bangsaan Malaysia Medical Centre (UKMMC), Malaysia involving 72 diabetic patients and 19 controls. Exclusion criteria were those with amputated limbs, gross foot deformity and existing peripheral neuropathy. Controls were non diabetics who walked normally, had no history of foot problem and attended the clinic as sub­jects’ companion. Quantita­tive assessment of neuropathy was done using Semmes-Weinstein monofila­ment. Neu­ropathy Disability Score (NDS) were used to quantify se­verity of diabetic neu­ropathy. Spearman’s Rank test and Mann-Whitney test were used to determine correlation be­tween variables and their differences. Logistic regression analysis was used to deter­mine risk factors associated with peripheral neuropathy. The mean HbA1c among di­abetics was 8.6% + 4.1, and mean NDS was 7.0 + 6.0. A total of 79.1% demonstrated various level of neuropathy with presence of callus was asso­ciated with higher NDS scores. Older age (P=0.02), body weight (P=0.03), HbA1c (P=0.005) and duration of di­abetes (P <0.005) showed positive correlation with NDS. Proper foot care program for diabetics should include recognition of the callus, with special emphasis given to those with heavier weight and increasing age

tert-Butyl 2-hy­droxy-3-(4-methyl­benzene­sulfonamido)­butano­ate

In the crystal of the title compound, C15H23NO5S, mol­ecules are linked through N—H⋯O and O—H⋯O hydrogen-bond inter­actions, resulting in centrosymmetric dimers in which the N—H⋯O inter­actions generate R 2 2(12) rings and the O—H⋯O inter­actions generate R 2 2(14) rings. Weak inter­molecular C—H⋯O inter­actions are also observed

The petrology and significance of a stratiform mafic segregation pegmatite in a Karoo-aged dolerite sheet

A sub-horizontal stratiform mafic segregation pegmatite, of the order of 30 cm thick, occurs within 25 m of the top contact of a Karoo-aged dolerite sheet at Pietermaritzburg, South Africa. The host rock is an orthopyroxene-rich dolerite containing 5 - 8% interstitial granophyre. The pegmatite is similar to the host dolerite in many respects, except that the granophyre content is higher, and acicular augite is the only pyroxene. At its upper contact, a laterally continuous sub-horizontal joint forms a sharp boundary to the pegmatite, whilst the lower contact is gradational over a few millimetres. Low MgO and chalcophiles, and elevated incompatible element contents, are the main geochemical attributes of the pegmatite

(2R,3S)-Methyl 2-hy­droxy-3-(4-methyl­benzene­sulfonamido)-3-phenyl­propano­ate

In the title mol­ecule, C17H19NO5S, the p-tolyl ring is oriented approximately parallel to the phenyl ring [dihedral angle = 17.2 (1)°], resulting in an intra­molecular π–π inter­ation [centroid–centroid distance = 3.184 (10) Å]. In the crystal, mol­ecules are linked through O—H⋯O and C—H⋯O hydrogen bonds, forming hydrogen-bonded sheets lying diagonally across the ac face

P14-07. Offering new prevention modalities in HIV vaccine trials: experience with male circumcision in the Phambili trial

Background: New prevention options will be added to the 'standard of prevention' offered in HIV vaccine efficacy trials as new methods prove effective. The HVTN503/Phambili trial was initiated in January 2007, shortly after results from 3 randomized controlled trials of male circumcision (MC) demonstrated that MC reduces the risk of HIV acquisition. Thus, HVTN503 investigators made plans to offer MC at no cost to enrolled male participants. Methods: All participants were informed of the benefits of MC as a component of HIV risk reduction counseling, including how and where MC could be accessed. One site offered on-site MC and the others provided referral to local services for men who requested MC. We present data on uptake of MC post-enrollment. Results: Prior to discontinuation of enrolment, 441 men joined the trial, of whom 312 (70.7%) were uncircumcised. Of these, 82 (26.3% of uncircumcised men) requested MC after enrolment. Uptake varied by site, being lower (70%) at the eThekwini site, the site with lowest baseline MC prevalence. Among 3 sites with intermediate baseline MC prevalence, uptake varied from 3.3 to 37.6%, being highest at the site providing MC on site. Uptake was similar in vaccine and placebo arms of the trial [42 (26.1%) vs. 40 (26.5%)]. There was no significant difference by arm in the timing of circumcision relative to randomization assignment being provided to participants following release of the STEP trial results [post-unblinding, vaccine 18 (42.9%) vs. placebo 13 (32.5%), p = 0.37]. Conclusion: MC, a new prevention modality, was offered as part of HIV prevention services in HVTN503. Uptake varied by provision of care model and inversely with baseline MC prevalence, but did not differ between treatment arms, and remained similar even after provision of treatment

HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: Results from a prospective observational demonstration project.

BACKGROUND: Operational research is required to design delivery of pre-exposure prophylaxis (PrEP) and early antiretroviral treatment (ART). This paper presents the primary analysis of programmatic data, as well as demographic, behavioural, and clinical data, from the TAPS Demonstration Project, which offered both interventions to female sex workers (FSWs) at 2 urban clinic sites in South Africa. METHODS AND FINDINGS: The TAPS study was conducted between 30 March 2015 and 30 June 2017, with the enrolment period ending on 31 July 2016. TAPS was a prospective observational cohort study with 2 groups receiving interventions delivered in existing service settings: (1) PrEP as part of combination prevention for HIV-negative FSWs and (2) early ART for HIV-positive FSWs. The main outcome was programme retention at 12 months of follow-up. Of the 947 FSWs initially seen in clinic, 692 were HIV tested. HIV prevalence was 49%. Among those returning to clinic after HIV testing and clinical screening, 93% of the women who were HIV-negative were confirmed as clinically eligible for PrEP (n = 224/241), and 41% (n = 110/270) of the women who were HIV-positive had CD4 counts within National Department of Health ART initiation guidelines at assessment. Of the remaining women who were HIV-positive, 93% were eligible for early ART (n = 148/160). From those eligible, 98% (n = 219/224) and 94% (n = 139/148) took up PrEP and early ART, respectively. At baseline, a substantial fraction of women had a steady partner, worked in brothels, and were born in Zimbabwe. Of those enrolled, 22% on PrEP (n = 49/219) and 60% on early ART (n = 83/139) were seen at 12 months; we observed high rates of loss to follow-up: 71% (n = 156/219) and 30% (n = 42/139) in the PrEP and early ART groups, respectively. Little change over time was reported in consistent condom use or the number of sexual partners in the last 7 days, with high levels of consistent condom use with clients and low use with steady partners in both study groups. There were no seroconversions on PrEP and 7 virological failures on early ART among women remaining in the study. Reported adherence to PrEP varied over time between 70% and 85%, whereas over 90% of participants reported taking pills daily while on early ART. Data on provider-side costs were also collected and analysed. The total cost of service delivery was approximately US$126 for PrEP and US$406 for early ART per person-year. The main limitations of this study include the lack of a control group, which was not included due to ethical considerations; clinical study requirements imposed when PrEP was not approved through the regulatory system, which could have affected uptake; and the timing of the implementation of a national sex worker HIV programme, which could have also affected uptake and retention. CONCLUSIONS: PrEP and early ART services can be implemented within FSW routine services in high prevalence, urban settings. We observed good uptake for both PrEP and early ART; however, retention rates for PrEP were low. Retention rates for early ART were similar to retention rates for the current standard of care. While the cost of the interventions was higher than previously published, there is potential for cost reduction at scale. The TAPS Demonstration Project results provided the basis for the first government PrEP and early ART guidelines and the rollout of the national sex worker HIV programme in South Africa