Academic and psychosocial challenges of Health Sciences students during the COVID-19 pandemic: A University of Technology perspective

The COVID-19 pandemic resulted in South African universities and institutes of higher learning experiencing an unprecedented shift to online learning in 2020, coupled by limited access to campus, in order to prevent community transmission. However, the potential impact of the outbreak on the academic and psychosocial wellbeing of students warrants further exploration, as the rapid changes and the disruption to normal academic life, has left many students feeling socially isolated and struggling to cope with massive uncertainty. In addition, Health Sciences students may experience added anxiety due to their line of work, which places them at the forefront of the healthcare environment. This study explored the academic and psychosocial challenges experienced by students enrolled in a Health Sciences faculty in a University of Technology (UoT), as they transitioned through the COVID-19 pandemic and the ensuing lockdown. A qualitative approach with an exploratory descriptive design was used to guide the study. A sample of students across all levels of study (first, second and third years as well as postgraduates) from the Faculty of Health Sciences at the Durban University of Technology (DUT) in South Africa were selected. Sample recruitment was done through non-probability sampling techniques which include purposive and convenience sampling. Data saturation was reached after interviewing 15 participants on Microsoft Teams. The interview schedule comprised key points on understanding how the COVID-19 pandemic and the ensuing lockdown affected students personally and academically. Interviews were recorded, transcribed and subjected to content and thematic analyses. Six broad themes emerged from the data, which captured the disruption students experienced within the context of their academic life, their personal fears and anxieties, struggles with online learning and connectivity issues. Students also expressed challenges whilst studying remotely at home. The findings suggested that there is an urgent need for universities to reflect on ensuring students’ mental health wellbeing as well as ensuring academic success amidst a turbulent physical and psychological environment

The Use of Soluble FMS-like Tyrosine Kinase 1/Placental Growth Factor Ratio in the Clinical Management of Pre-eclampsia

Hypertensive disorders of pregnancy in particular the category preeclampsia (PE), remains a major cause of both maternal and fetal morbidity and mortality. Angiogenic growth factors (PlGF and VEGF) and their tyrosine kinase receptors -1 and 2 (Flt-1 and KDR) are involved in both fetal and placental development. Inadequate placentation and the consequent release of antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt-1) is thus instrumental in the etiology of this disease. sFlt-1 binds to both angiogenic growth factors and neutralizes their effect thereby creating an angiogenic imbalance. This imbalance is frequently reported in women diagnosed with preeclampsia occurring before the clinical manifestation of the disease. The recent prognostic value of the sFlt-1/PlGF ratio has received considerable attention as a risk indicator of preeclampsia development. The aim of this review is to highlight the current advances in the diagnostic utility of the sFlt-1/PlGF ratio with regards to preeclampsia development. (Afr J Reprod Health 2018; 22[4]: 135-143).Keywords: Preeclampsia, sFlt-1, PlGF, treatment, predictio

Rehabilitation of HIV-associated neurocognitive disorder : a systematic scoping review of available interventions

OBJECTIVE : Strong healthcare systems require rich rehabilitation protocols for improving the outcomes of disabling ailments such as HIV-associated neurocognitive disorder (HAND). Currently, the rehabilitative interventions for HAND are unknown. We thus reviewed the putative rehabilitative interventions for HAND and evaluated their post-treatment outcomes. METHODS : This is a systematic scoping review of articles published in English, between 2009 and 2019. The review was guided by the PRISMA extension for scoping reviews. We searched for articles in PubMed, MEDLINE, Cochrane Library, CINAHL, Academic Search Complete and PsycINFO. Data were selected and extracted according to predesigned eligibility criteria using a standardised data extraction table. We appraised the methodological quality of the included studies using the Mixed Method Appraisal Tool. RESULTS : We identified 423 records, which were screened for eligibility. Twenty two articles were identified, representing a sample of 2795 PLWHIV, who were on average 47 ± 8 years old, with 13 ± 3 years of education. From the reviewed literature, we identified two putative rehabilitative intervention options for HAND, namely cognitive training otherwise known as psycho-cognitive training, and physical activity interventions. All articles reporting on cognitive training for HAND showed improved post-treatment performance, while two of the six interventional physical activity studies recorded improved post-treatment cognitive performance. DISCUSSION : There are limited rehabilitative options available for HAND. Psycho-cognitive training appears to be an effective intervention for HAND, however, the conditions of far-transfer effects need to be set forth. There is insufficient evidence available to support the use of physical activity for HAND thus warranting further research. REGISTRATION : The review protocol was registered with Open Science Framework (OSF) registry. The registration DOI:10.17605/OSF.IO/RWQCF.The University Pretoria Doctoral Research Bursary.https://www.tandfonline.com/loi/ramh20hj2023Physiotherap

Impact of HIV‑associated cognitive impairment on functional independence, frailty and quality of life in the modern era: a meta‑analysis

HIV-associated neurocognitive disorder (HAND) is an important sequela of HIV infection. Combined antiretroviral therapy (cART) has improved the health outcomes of many people living with HIV but has given rise to a less severe but limiting form of HAND. The study aimed to evaluate the impact of HAND on medication adherence, activities of daily living (ADL), quality of life and frailty. This systematic review adheres to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched MEDLINE, PubMed, CINAHL, Academic Search Complete, and PsycINFO online databases. Studies were included if they examined the relationship between HAND and medication adherence, ADL, quality of life and frailty, and were conducted between 1997 and 2021. We used a random-efects meta-analysis model to assess the impact of HAND on outcome variables. Forty papers, totaling 11,540 participants, were included in the narrative and quantitative syntheses. Cognitive impairment was associated with poorer medication adherence (r= 0.601, CI 0.338 to 0.776, p = 0.001, I 2 = 94.66). Cognitive impairment did not infuence ADL (r = 0.167, CI-0.215 to 0.505, p = 0.393) and quality of life (r = 0.244, CI 0.117 to 0.548, p = 0.182). In the cART era, HAND appears to be associated with adherence to medication, which may infuence future health outcomes. In PLWHIV who are adherent to cART, cognitive impairment does not appear to interfere with ADL and quality of life.The National Student Financial Aid Scheme (NSFAS) via the University Pretoria Doctoral Research Bursary.https://www.nature.com/srepPhysiotherap

Aerobic exercise in HIV-associated neurocognitive disorders : protocol for a randomized controlled trial

BACKGROUND : Since the introduction of antiretroviral therapy (ART), the incidence of HIV-associated dementia has drastically fallen. Despite using ART, people living with HIV continue to experience less severe but limiting forms of HIV-associated neurocognitive disorder (HAND). People living with HIV who are on ART and experiencing symptoms of HAND may benefit from aerobic exercise. OBJECTIVE : This protocol describes a randomized controlled trial designed to determine the effects of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. METHODS : At least 68 patients diagnosed with HAND will be randomly placed into either an aerobic exercise group or control group. Patients in the aerobic exercise group will perform a moderate intensity workout on a stationary bicycle ergometer, 3 times a week for 12 weeks. We will measure the primary outcomes including neurocognitive performance, prevalence of HAND, viral load, and CD4 count. We will evaluate postexercise neurocognitive performance using reliable neuropsychological tests relevant to people living with HIV, in line with the Frascati criteria. We will assess secondary outcomes such as quality of life, activity limitation, and social participation using the World Health Organization Quality of Life (WHOQOL)-Brief, and the Oxford Participation and Activities questionnaire. We will use exploratory statistics to test the data for normality and homogeneity. We will analyze the effect of the exercise program on HAND using relative risk (RR) and absolute risk reduction (number needed to treat). Analysis of covariance will be run to estimate the effect of exercise on quality of life and activity and participation level. RESULTS : This funded trial was approved by the Institutional Review Board in May 2020. The protocol was approved on June 15, 2020. Enrollment commenced in January 2021 and was completed in May 2021. Over 60% of the participants were recruited at the time of first submission to JMIR Mental Health. Data curation is still ongoing; hence, data analysis is yet to be executed. Study outcomes are expected to be published in March 2022. CONCLUSIONS : This is a protocol for a randomized controlled trial that aims to evaluate the effect of a 12-week aerobic exercise program on HAND in Southeastern Nigeria.SUPPLEMENTARY MATERIALS : APPENDIX 1. Beck Depression Inventory.APPENDIX 2. Alcohol Use Disorder Identification Test (AUDIT).APPENDIX 3. Drug Abuse Screening Test.APPENDIX 4. International HIV Dementia Scale.APPENDIX 5. Controlled Oral Word Association Test (COWAT) (Verbal Fluency Test).APPENDIX 6. Hopkin Verbal Learning Test-Revised.APPENDIX 7. Trail Making Test A & B.APPENDIX 8. Digit span test.APPENDIX 9. Lawton Instrumental Activities of Daily Living (IADL) scale.APPENDIX 10. The World Health Organization Quality of Life (WHOQoL) Bref.APPENDIX 11. Oxford Participation and Activities Questionnaire (Ox-PAQ).APPENDIX 12. Physical Activity Readiness Questionnaire.APPENDIX 13. Adverse events form.The National Student Financial Aid Scheme (NSFAS) via the University Pretoria Doctoral Research Bursary.http://www.researchprotocols.orgPhysiotherap

Circulating soluble fms-like tyrosine kinase-1, soluble endoglin and placental growth factor during pregnancy in normotensive women in KwaZulu-Natal, South Africa

Background: Based on the increased pre-eclampsia and HIV antenatal incidence in South Africa, we determined the angiogenic profiles due to its mechanistic link in preeclampsia development, throughout uncomplicated pregnancies in HIV positive and negative women.Objective: To determine the angiogenic profiles throughout uncomplicated pregnancies in HIV positive and HIV negative women. We explored possible correlations between angiogenic serum levels and selected maternal characteristics (HIV status, gestational age, maternal factors, and pregnancy outcomes).Method: This study was conducted at a primary health care facility in Durban, South Africa. Forty-six pregnant women aged 18-45 years, were enrolled at 10-20, 22-30 and 32-38 weeks’ gestation, respectively through convenient sampling. Serum samples were collected and quantitatively evaluated using ELISAs. Clinical and epidemiological data were analysed using STATA (version 14). A probability level of p < 0.05 was considered statistically significant.Results: Of those enrolled, 28.3% were nulliparous, 82% were HIV positive and none developed pre-eclampsia. Systolic and diastolic blood pressure increased slightly throughout pregnancy. Fluctuating angiogenic and anti-angiogenic levels were demonstrated during pregnancy.Conclusion: This study contributes to the current angiogenic knowledge in normotensive pregnancies, and may assist as a reference range against which these factors may be compared in HIV complicated pregnancies.Keywords: sFlt-1, PlGF, sEng, pregnancy, HIV

Normative scores for select neuropsychological battery tests for the detection of HIV‑associated neurocognitive disorder amongst Nigerians

BACKGROUND : The study aimed to derive socio‑demographic–corrected norms for selecting neuropsychological (NP) battery tests for people living with HIV (PLWHIV) in Nigeria. This cross‑sectional study was conducted amongst patients who attended the general outpatient clinic and junior staff of the University of Nigeria Teaching Hospital (UNTH), Ituku‑Ozalla. AIMS AND OBJECTIVES : To determine the normative scores for select neuropsychological battery test for the detection of neurocognitive disorder amongst Nigerians PLWHIV. A sample of 92 individuals received voluntary HIV testing. METHODS : Eligibility criteria were being HIV negative, aged 18–64 years and formal education. We undertook a brief neuromedical examination to identify putative exclusion criteria. We sampled four NP tests covering seven cognitive domains and the motor speed component of the International HIV Dementia Scale (IHDS‑MS). We presented the normative scores using statistics of mean, median, standard deviation (SD), kurtosis and skewness. RESULTS : All the participants were Nigerians aged 18–64 years. Most (74.1%) of the participants were females. The mean and median ages of the participants were 42.6 ± 11.42 years and 44 years, respectively. The effect of gender on NP performance was limited to the digit span test (DST)‑forwards, while education affected all expect IHDS‑MS and DST‑backwards. The cut‑off scores for defining mild and severe impairment varied (moving from 1SD to 2SD) for all cognitive domains except for IHDS‑MS and DST. CONCLUSIONS : With these preliminary normative scores, it will be easier to identify and classify the severity of neurocognitive impairment amongst PLWHIV in Nigeria, thus facilitating the goal of keeping HIV‑associated dementia to a minimum. The lack of variability in the IHDS‑MS and DST is unfavourable.http://www.npmj.orgam2023Physiotherap

Circulating soluble fms-like tyrosine kinase-1, soluble endoglin and placental growth factor during pregnancy in normotensive women in KwaZulu-Natal, South Africa

Background: Based on the increased pre-eclampsia and HIV antenatal incidence in South Africa, we determined the angiogenic profiles due to its mechanistic link in preeclampsia development, throughout uncomplicated pregnancies in HIV positive and negative women. Objective: To determine the angiogenic profiles throughout uncomplicated pregnancies in HIV positive and HIV negative women. We explored possible correlations between angiogenic serum levels and selected maternal characteristics (HIV status, gestational age, maternal factors, and pregnancy outcomes). Method: This study was conducted at a primary health care facility in Durban, South Africa. Forty-six pregnant women aged 18-45 years, were enrolled at 10-20, 22-30 and 32-38 weeks\u2019 gestation, respectively through convenient sampling. Serum samples were collected and quantitatively evaluated using ELISAs. Clinical and epidemiological data were analysed using STATA (version 14). A probability level of p < 0.05 was considered statistically significant. Results: Of those enrolled, 28.3% were nulliparous, 82% were HIV positive and none developed pre-eclampsia. Systolic and diastolic blood pressure increased slightly throughout pregnancy. Fluctuating angiogenic and anti-angiogenic levels were demonstrated during pregnancy. Conclusion: This study contributes to the current angiogenic knowledge in normotensive pregnancies, and may assist as a reference range against which these factors may be compared in HIV complicated pregnancies. DOI: https://dx.doi.org/10.4314/ahs.v19i2.4 Cite as: Ogunlola M, Reddy P, Sibiya MN, O\u2019Connor L, Borg D, Haffejee F, Ghuman S, Ngxongo T, Govender N. Circulating soluble fmslike tyrosine kinase-1, soluble endoglin and placental growth factor during pregnancy in normotensive women in KwaZulu-Natal, South Africa. Afri Health Sci.2019;19(2): 1821-1832. https://dx.doi.org/10.4314/ahs.v19i2.

Demographic stratification of Type 2 diabetes and comorbidities in district healthcare in KwaZulu-Natal

Background: Diabetes has been reported as the second leading cause of death and the top leading cause of death amongst women in South Africa; it is important to evaluate any epidemiological or demographic transition related to diabetes. This study evaluated the demographically stratified prevalence of type 2 diabetes mellitus (T2DM) and existing comorbidities amongst an outpatient population in a district healthcare facility in Kwazulu-Natal (KZN).Methods: This retrospective cross-sectional study was conducted at a district hospital, and a retrospective record review of all outpatients who reported to the hospital to be treated for T2DM between the period, August 2018–January 2019, was used. Data, such as age, sex, ethnicity and any coexisting morbidity, were collected from outpatient hospital registers and electronically captured using a record review tool.Results: There were significantly more female patients (3072) compared to male patients (1050) (p 0.001) with a mean age of 59.21 years. Hypertension (77.9%) and cardiovascular problems (11.16%) were most frequent. Approximately 84% of women presented with T2DM and either one or two morbidities simultaneously. Female patients were at significantly higher risk of presenting with hypertension (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.20;1.71), whilst their risk for cardiovascular problems was significantly lower compared to male patients (OR = 0.67, 95% CI: 0.54;0.83).Conclusion: The prevalence of T2DM and comorbidities differed by demographic factors, such as sex, ethnicity and age. There is a need for flexible and adaptive approaches for the prevention and management of T2DM cases in order to allocate medical resources efficiently and according to the true burden of disease because of T2DM complications

Circulating levels of transforming growth factor beta-1, 2 and 3 in HIV associated preeclamptic pregnancies

The active role of transforming growth factor-beta in implantation, embryonic development and decidualization has driven our interest to evaluate circulating TGF-β(1–3) in the synergy of HIV associated pregnancy. Serum TGF-β(1–3) was quantified in normotensive (n = 38) and preeclamptic (n = 38) pregnant women, who were stratified by HIV status, HIV negative (n = 19) and HIV positive (n = 19), using a Bioplex immunoassay. Based on HIV status, we report no significant difference in TGF-β-1 (p = .95) and TGF-β2 (p = .80) however, TGF-β3 was significantly downregulated in HIV positive (p = .03) vs the HIV negative groups. A significant positive correlation (p < .05) was noted between TGF-β3 and gestational age (p = .03) (r = 0.51), birth weight (p = .04) (r = 0.53) and CD4 count (p = .02) (r = 0.53). Bivariate correlation between isoforms based on HIV status showed several significant positive associations. In the synergy of HIV infected PE, we demonstrate an association between TGF-β(1–3) with PE emanating from the hypoxic microenvironment that affects receptor-SMAD activity. Decreased TGF-β3 levels in HIV infected PE, may originate from ARV usage and/or the mutational/physiological dysregulation of SMAD expression. Impact Statement What is already known on this subject? TGF-β overexpression can convert its protective functions into pathogenic variants. It has a significant role in the oxidatively stressed and inflammatory condition of tissue fibrosis and hence may also be dysregulated in the microenvironment of PE. In HIV infection, TGF-β promotes viral replication and spreading through the induction of cellular proteins which induce TGF-β production. Also, mononuclear phagocytes infected with HIV also produce increased TGF-β mRNA and proteins. What do the results of the study add? Our results show no association of TGF-β isoforms (1–3) based on pregnancy type (PE vs normotensive pregnant) at term. The lack of association may be linked to TGF-βs dual promoter/suppresser nature or to gestational age. What are the implications of these findings for clinical practice and/or further research? Large-scale comprehensive clinical trials are warranted to elucidate the association and mechanistic role of TGF-β receptor-SMAD signalling, the effect of its inhibitors on cell invasion and angiogenesis as well as to deliver valuable data for the detection of novel therapeutic agents in pregnancies complicated by HIV infection