The burden of serious adverse drug reactions in South Africa

Background The burden of serious adverse drug reactions (ADRs) in South Africa (SA) is not well characterised, and may be influenced by the high HIV prevalence. This thesis aims to describe this burden, by reporting findings of three hospital-based surveys of (1) ADRs causing death among adult medical inpatients, (2) ADRs causing admission of adults to medical wards, and (3) serious ADRs causing admission, prolongation of existing admission, or death among paediatric medical inpatients. Survey findings are contextualised in a systematic review of studies characterising serious ADR burden in sub-Saharan Africa (SSA). Methods In each of the three surveys, folder review with the assistance of trigger tools was used to identify potential serious ADRs. Multidisciplinary teams assessed causality, preventability, and seriousness of these events using published criteria. The World Health Organization-Uppsala Monitoring Centre system for standardised case causality assessment was used. This choice was informed by a study using a sample of cases from one of our adult surveys, which demonstrated its higher interrater agreement compared with the Liverpool ADR Causality Assessment Tool. Multivariable logistic regression was used to explore associations between demographic and clinical factors and the occurrence of serious ADRs. Results Among adult medical inpatients 56 of 357 deaths (16%) and 164 of 1951 admissions (8.4%) were ADR-related, and 43% and 45% respectively of these serious ADRs were preventable. Drugs used in the management of HIV and tuberculosis were frequently implicated. Among paediatric inpatients 3.8 serious ADRs occurred per 100 drug-exposed admissions, of which 23% were preventable and 20% fatal or near-fatal. A broad range of drugs was implicated in these serious paediatric ADRs. HIV positive status was independently associated with an increased risk of ADRs in every survey. Fifteen studies contributed to the systematic review. The median proportion of admissions attributed to ADRs was 6.4% [IQR 4.0% to 8.4%] among nine active surveillance studies in adults in SSA, with antiretroviral and antituberculosis drugs often implicated in serious ADRs. Conclusions Fatal, near-fatal, and hospitalising ADRs occurred frequently in South African hospitals. Many of these serious ADRs, particularly in adults, were preventable. Serious ADRs should be addressed in patient and health worker education, and safety monitoring systems improved. In SA and SSA the high HIV prevalence appears to be a driver of serious ADRs

Description of a new species of Cordylus Laurenti (Reptilia: Cordylidae) from the south-western Cape, South Africa

A new species of girdled lizard in the Cordylus genus is described from the south-western Cape, South Africa. Unlike other Cordylus taxa the new form usually has only two supraciliaries per side, the posterior parietals are usually separated mesially by a small post-interparietal scale and the lateral body scales are larger than the dorsal scales. The relationships of this new form to other members of the Cordylus group are discussed

Paradoxical reproduction and body size in the rock lizard, Agama atra atra, in Namaqualand, South Africa

The original publication is available at http://africanzoology.journals.ac.za/pub.The rock lizard Agama atra atra from Namaqualand differs in both body size and reproduction from other populations of this species occurring elsewhere in southern Africa. Both sexes from Namaqualand are significantly larger than their counterparts in the south-western Cape. While reproduction in this species is strongly seasonal elsewhere, it is apparently continuous in Namaqualand. Females with vitellogenic ovarian follicles and/or oviducal eggs were collected during the winter months, a time when females are typically reproductively quiescent in other populatlons. Aseasonal reproduction and large body size of this species in Namaqualand do not correlate with prevailing environmental conditions in the area.T he presence of at least one other species with continuous reproduction and two others with tropical affinities in the same general area, suggests that the Namaqualand population of A. a. atra may be a tropical relict.Publisher's versio

A model explaining patterns of geographic character variation in Cordylus cordylus (Reptilia; Cordylidae) in the south-western Cape, South Africa

A model is proposed for the evolution of three morphotypes of the girdled lizard Cordylus cordylus (Linnaeus) in the south-western Cape. The available data are interpreted as indicating that a vicariant splitting of a warm-adapted ancestral population during the last glacial period occurred. Differential evolution of the two daughter populations in response to different environmental pressures resulted. One of the daughter populations remaining in the coastal lowlands to the west of the Cape Fold Mountains, became cold-adapted, an event which was followed by a rapid range expansion. The other daughter population to the south and east of the Cape Fold Mountains apparently experienced less severe climatic conditions, maintained a larger population size, and for these reasons remained warm-adapted. During the subsequent warmer, interglacial period the now cold-adapted daughter population was again fragmented into two populations. Of these, one is presently found along the south-western coast and the other along the higher peaks of the western section of the Cape Fold Mountains. On the other hand the amelioration of the climate during the interglacial allowed the warm-adapted daughter population to the south and east to expand its range, eventually penetrating into the areas formerly occupied by the cold-adapted populations. Subsequently zones of secondary contact were established. In the area under discussion similar patterns of contraction and expansion can be observed in other closely related species. Our data support the turnover-pulse hypothesis of Vrba (1985)

Paradoxical reproduction and body size in the rock lizard, Agama atra atra, in Namaqualand, South Africa

The rock lizard Agama atra atra from Namaqualand differs in both body size and reproduction from other populations of this species occurring elsewhere in southern Africa. Both sexes from Namaqualand are significantly larger than their counterparts in the south-western Cape. While reproduction in this species is strongly seasonal elsewhere, it is apparently continuous in Namaqualand. Females with vitellogenic ovarian follicles and/or oviducal eggs were collected during the winter months, a time when females are typically re productively quiescent in other populations. Aseasonal reproduction and large body size of this species in Namaqualand do not correlate with prevailing environmental conditions in the area. The presence of al least one other species with continuous reproduction and two others with tropical affinities in the same general area, suggests that the Namaqualand population of A. a. atra may be a tropical relict

The 2mrad horizontal crossing angle IR layout for a TeV ILC

The current status of the 2mrad crossing angle layout for the ILC is reviewed. The scheme developed in the UK and France is described and the performance discussed for a TeV machine. Secondly, the scheme developed at SLAC and BNL is then studied and modified for a TeV machine. We find that both schemes can handle the higher energy beam with modifications, and share many common features.Comment: The proceedings of the 2005 International Linear Collider Workshop, March 2005. 4 pages, 5 figure

Description of a new species of Afroedura (Loveridge) (Reptilia: Gekkonidae) from the south-western Cape

A new gekkonid species, Afroedura hawequensis, is described from the south-western Cape (South Africa). The three species groups recognized in the genus are discussed

Reproduction and sexual dimorphism in the montane viviparous lizard, Pseudocordylus capensis (Sauria: Cordylidae)

Pseudocordylus capensis, a melanistic lizard, is regarded as a basal species in the phylogeny of the family Cordylidae and is endemic to the Cape Fold Mountains. Data for this study were obtained from measurements and dissections of museum specimens (N = 68). Sexual maturity in both sexes is attained at around 80-90 mm snout-vent length (SVL). Body sizes (SVL) differed significantly between sexes, the mean SVL of adult males being 92.3 mm (range 78.4−104.2) and that of adult females 95.9 mm (range 83.1-108.5). Although the rate of increase in head measurements did not differ significantly between sexes, analysis of covariance (ancova) indicated that head dimensions are marginally, but significantly, larger in males than in females of equivalent SVL. The slight female-plus dimorphism in SVL and male-plus dimorphism in head dimensions is suggested to be related to life in the cold montane environment, and to differential growth to increase female reproductive fitness, rather than to be the result of sexual selection. Males exhibit testicular recrudescence during autumn, with full spermiogenesis during winter maintained through spring (October). The testicular cycle shows characteristics of both ‘post-nuptial’ and ‘pre-nuptial’ cycles previously described in Cordylidae lizards. Small testicular volume, associated with testicular regression, was recorded during summer (November/December). Spermatozoa were present in the epididymis from May through to October. In synchrony with the spermatogenic cycle, the onset of vitellogenesis in females starts in autumn, culminating in ovulation during spring (September-October). Females are gravid during summer and give birth to 2-3 young in late summer (December-January). The timing of events during the reproductive cycle of females corresponds to the autumn cycles reported for all other female Cordylidae lizards studied to date, therefore pointing to strong conservatism regarding the timing of female reproductive cycles in this lizard family. Fatbody size in individuals of both sexes is largest during late summer and autumn, and progressively declines during winter to reach smallest sizes during the summer months. The fact that this phylogenetically basal species exhibits well-synchronised male and female autumn gonadal cycles adds to the data that suggest these reproductive traits evolved during the early divergence from the Cordyliformes ancestor and that the evolution of viviparity may be linked to this event or followed soon after