The nutritional status of continuous ambulatory peritoneal dialysis patients at a Johannesburg hospital

Objectives: To assess the nutritional status of continuous ambulatory peritoneal dialysis (CAPD) patients in our hospital using different assessment tools, and to assess the correlation between nutritional status and other parameters such as solute clearance. Method: A cross-sectional study was performed on end-stage renal disease patients treated with CAPD at Charlotte Maxeke Academic Hospital, Johannesburg, South Africa. The nutritional status of each patient was assessed using subjective global assessment (SGA), anthropometric parameters including body mass index (BMI), mid-upper arm circumference (MUAC), triceps skin fold (TSF), arm muscle area (AMA) and arm fat area (AFA), and biochemical parameters including serum albumin and total cholesterol levels. Dialysis adequacy was assessed by solute clearance measurement. Results: The mean age of the patients was 37.9 ± 13.4 years, 54% were males and 74 % were black. The mean BMI was 24.8 ± 3.5 kg/m2, mean MUAC was 28.5 ± 3.9 cm, mean TSF 85.6 ± 41.5 cm, mean serum albumin was 37.1 ± 7.6 mg/dl, while mean serum cholesterol was 5.32 ± 1.7 mmol/l. Based on SGA scores, 42% were well nourished, 50% moderately undernourished, while 8% were severely malnourished. We noted significant correlation between the SGA score and anthropometric parameters (BMI, MUAC) and there was no significant correlation between the nutritional parameters and the solute clearance. Conclusion: Malnutrition is common among CAPD patients in our centre, without a significant correlation between the nutritional status and the solute clearance. There is thus a need for ongoing nutritional assessment and support among these patients.Keywords: nutritional status, peritoneal dialysis patients, Johannesburg, Afric

Lead poisoning in shooting-range workers in Gauteng Province, South Africa: Two case studies

Background. Lead exposure constitutes a major public health concern globally. Relative to developed nations, lead exposure is understudied and poorly addressed in Africa, and there is a dearth of information available to inform lead poisoning prevention strategies, even in highrisk groups such as workers in shooting ranges who are potentially exposed to lead daily.Methods. Two workers at a private shooting range in Gauteng, South Africa (SA), had blood lead levels and exposure histories taken.Results. Workers had highly elevated blood lead levels and clinical symptoms associated with elevated blood lead levels.Conclusion. Workers in private SA shooting ranges are vulnerable to lead exposure and poisoning, and scaled-up action is required to protect them and their families, as well as shooting-range users, from lead and the related health risks

The prevalence of intentional and unintentional injuries in selected Johannesburg housing settlements

Intentional and unintentional injuries were reported to be the second leading cause of Disability Adjusted Life Years in South Africa in 2000. We present household experiences of such injuries in 5 impoverished housing settlements in Johannesburg, Gauteng Province. Data for this study were extracted from the database of the Health, Environment and Development (HEAD) project. The incidence of reported intentional injuries was determined to be double that of unintentional injuries. Households in the Hospital Hill and Riverlea settlements reported the highest prevalence of stabbing and gunshot incidents. We concluded that impoverished South African neighbourhoods bear a high burden of intentional injury; surveillance mechanisms are  required to inform prevention strategies at an individual, a community and a societal level.S Afr Med J 2011;101:835-838

A scoping review to identify the type and effect of hand hygiene interventions on the reduction of infectious diseases (including COVID-19) in preschool children

Abstract: Background. Proper handwashing can reduce the burden of diseases related to hand hygiene (HH) and so contribute reducing under-5 mortality. Preschoolers can benefit from HH interventions by the burden of disease and absenteeism being reduced. Objective. To perform a scoping review of literature to assess the types and effectiveness of HH interventions at preschools, with a view to providing a guideline for appropriate interventions for South African facilities. Methods. A literature search was conducted through the PubMed database to identify relevant studies. An iterative screening process to focus the review allowed for information on the type and effectiveness of interventions to be collated. An updated PubMed search was conducted to determine whether any interventions related to COVID-19 at preschools could be included. Results. No additional studies relating to COVID-19 were found. Of the 305 studies identified during the initial search, only 12 fitted the specific search criteria. Of these, 10 studies showed improvements in HH-related indicators following the interventions. Only two studies used health education as an intervention, whereas the others included the supply of HH products (to varying extents) as part of the intervention. Conclusion. HH interventions appear successful in reducing diseases spread by poor HH, improving general HH practices and reducing absenteeism among preschoolers. Studies using innovative, entertaining methods of educating children have shown to be successful in improving handwashing techniques and decreasing microbial growth on children’s hands. HH interventions are suggested as an effective measure to improve HH during the COVID-19 pandemi

Tenofovir alafenamide: An initial experience at Groote Schuur Hospital, Cape Town, South Africa

Background. Hepatitis B virus (HBV) remains endemic in South Africa (SA), with a concomitantly high prevalence of HIV co-infection. Chronic kidney disease in these subpopulations also has a high prevalence. Tenofovir is an important component of management, but the associated risk of nephrotoxicity makes dosing a challenge in patients with impaired kidney function. A new formulation, tenofovir alafenamide fumarate (TAF), with a more favourable renal toxicity profile, is now available.Objectives. To evaluate our initial experience of TAF use at Groote Schuur Hospital, Cape Town.Methods. We retrospectively reviewed patients with HBV mono-infection and HIV-HBV co-infection who were initiated on TAF since 2018. We recorded all relevant demographic, serological, virological and biochemical data from patient records. Adherence was documented by pill collection at the pharmacy.Results. A total of 26 patients were included in the evaluation, median (interquartile range (IQR)) age 48 (39 - 51) years, 73% (n=19) male, 27% (n=7) hepatitis B e-antigen-positive, and 46% (n=12) HIV co-infected. The median (IQR) duration of treatment with TAF was 13 (9 - 15) months. The median (IQR) baseline creatinine level was 180 (130 - 227) µmol/L, with significant improvement at 12 months, 122 (94 - 143) µmol/L; p=0.017. Reflecting this change, the estimated glomerular filtration rate improved significantly from baseline to month 12 (42 (25 - 52) and 51 (48 - 68) mL/min/1.73 m2, respectively; p=0.023). Similarly, serum alanine aminotransferase (ALT) normalised from a baseline of 33 (18 - 52) to 18 (15 - 24) U/L at month 12 (p=0.012). HBV DNA viral load also declined, from a baseline of log10 4.04 (2.5 - 7.8) IU/mL to a median of <log10 1.3 IU/mL at month 12. HIV viral load was less than the lower level of quantification at months 6 and 12.Conclusions. TAF was well tolerated, with stable and significantly improving kidney function throughout a 12-month follow-up period. Serum ALT normalised, mirrored by declining HBV viral load. HIV viral load remained undetectable at 6 and 12 months

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

The prevalence of intentional and unintentional injuries in selected Johannesburg housing settlements

Intentional and unintentional injuries were reported to be the second leading cause of Disability Adjusted Life Years in South Africa in 2000. We present household experiences of such injuries in 5 impoverished housing settlements in Johannesburg, Gauteng Province. Data for this study were extracted from the database of the Health, Environment and Development (HEAD) project. The incidence of reported intentional injuries was determined to be double that of unintentional injuries. Households in the Hospital Hill and Riverlea settlements reported the highest prevalence of stabbing and gunshot incidents. We concluded that impoverished South African neighbourhoods bear a high burden of intentional injury; surveillance mechanisms are required to inform prevention strategies at an individual, community and societal level

Giant cell tumour of tendon sheath masquerading as trigger finger.

We report a case of a 59-year-old female who presented in the general orthopaedic clinic with triggering of her right middle finger. She did not respond to conventional treatment methods; subsequently she underwent surgical open release under local anaesthesia. Five months postoperatively, the patient presented with signs and symptoms of acute flexor tenosynovitis, and was thought to have a postoperative infection. Re-examination by a hand surgeon raised the possibility of a different aetiology. Based on clinical findings and response to initial treatment, giant cell tumour of the flexor tendon sheath was suspected and later confirmed following surgical biopsy. A high index of suspicion and knowledge of the variegated presentations of giant cell tumour in the hand are beneficial in these types of cases

Characterising dark net marketplace purchasers in a sample of regular psychostimulant users

Background: The past five years has seen a proliferation in marketplaces operating on the 'dark net' selling licit and illicit substances. While monitoring systems have investigated the specific substances for sale on these marketplaces, less is known about consumer motivations for accessing these marketplaces and factors associated with their use. Methods: An Australian national sample (n = 800) recruited on the basis of regular psychostimulant use was recruited and asked about purchasing substances from dark net marketplaces and the reasons for doing so. Respondents who had purchased any drug from a dark net marketplace in the preceding year were compared to those who had not in terms of demographic information and factors including drug use, criminal activity, and sexual and mental health. Results: Nine percent (n = 68) of the sample had purchased from dark net markets in the past year. MDMA, LSD and cannabis were the three most commonly purchased substances, and the main benefits cited for purchasing online were the better quality and lower cost of drugs available. Controlling for other factors, participants who purchased from dark net marketplaces in the past year tended to be younger, more likely to be involved in recent property crime and to have used more classes of drugs in the preceding six months, specifically psychedelics and 'new psychoactive drugs'. Conclusions: Though a small minority of participants reported having purchased drugs online in the preceding six months, these appeared to be a more