Kaposi’s sarcoma, a South African perspective: Demographic and pathological features

Background. The incidence of Kaposi’s sarcoma (KS) has increased dramatically since the onset of the  AIDS epidemic. Of the estimated 66 200 cases of KS worldwide, 58 800 are considered to have occurred in sub-Saharan Africa.Objectives. To describe the epidemiology and pathological characteristics of KS at Chris Hani  Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa.Methods. A retrospective cross-sectional study design was used. Nine hundred and thirty-eight  histopathology reports of KS diagnosed in 901 patients at CHBAH between 2005 and 2009 were reviewed.  Age, gender, topographic site, CD4 count, HIV status, KS histological stage, findings of human  herpesvirus 8 latency-associated nuclear antigen 1 immunohistochemistry and concomitant pathological findings were recorded.Results. The male/female ratio was 1.2:1, the mean age 37 years and the median CD4 count 128 cells/ìL. Lower limb skin biopsies accounted for 49.6% of cases. Paediatric, visceral and endemic KS accounted for only limited proportions (1.4%, 1.4% and 1.3% of biopsies, respectively). There were concomitant pathological findings in 4.6% of biopsy specimens, infections and inflammatory dermatoses being the most frequent.Conclusion. The findings of this study highlight the need for allocation of diagnostic and treatment resources for KS. Documentation of the various demographic aspects of KS will prove to be of historical, clinical and histopathological interest as the long-term outcomes of antiretroviral therapy begin to  emerge

Pediatric regional anesthesia: A review of the relevance of surface anatomy and landmarks used for peripheral nerve blockades in infants and children

In regional anesthesia, accurate knowledge of surface anatomy and landmarks are essential for successful nerve blockades with least possible complications. The long-established anatomical landmarks used for peripheral nerve blockades in adult patients have also gained a place in pediatric anesthesia. Despite the continuing benefits and need for more effective peripheral techniques in pediatrics, there is a paucity of data on pediatric landmarks, and hence the absence of more appropriate techniques for the different age groups of children. Recent advancement in imaging has shown that there is a greater awareness for the different surface projections at various stages of postnatal development, as compared with that of adults. Thus, if adult landmarks are not appropriately adapted for use in children, complication rates may rise due to injuries to anatomical structures. This review evaluated the existing evidence of the pediatric nerve block landmarks in the reported literature, in order to highlight the limitations in our current understanding of pediatric surface anatomy and landmarks. A literature search was done using five databases to obtain 141 references. Only a few of these studies provided detailed reports of the relations of relevant nerves to anatomical landmarks. A few clinical imaging studies have provided new anatomical landmarks in children with reference to their age-related growth and anatomy. Most landmarks need to be standardized in children of various ages, and furthermore, inconsistencies in the current descriptions of the surface landmarks need to be validated and standardized for use in pediatric clinical practice. Clin. Anat. 32:803–823, 2019. © 2019 Wiley Periodicals, Inc

Magnetic resonance imaging study of the sciatic nerve variation in the pediatric gluteal region: Implications for the posterior approach of the sciatic nerve blockade

Introduction: In pediatric patients, the sciatic nerve is one of the most commonly blocked peripheral nerves during orthopedic procedures of the lower limb. Ultrasound guidance is the current standard for a successful localization of the sciatic nerve in the gluteal region. Relevant anatomical landmarks are also used to determine the nerve location when ultrasound is not available or inadequate. However, reports have demonstrated paucity of information regarding the sciatic nerve location and variation in the hip throughout pediatric development. This imaging study aimed to document and analyze the relative morphometric relationship of the sciatic nerve in the pediatric gluteal region throughout development. Methods: The location of the sciatic nerve in relation to bony landmarks was measured in 84 pediatric magnetic resonance imaging of patients aged 0.7–15.8 years. Results: The sciatic nerve was identified medial to the most lateral point of greater trochanter at the level of ischial spine and the tip of coccyx. The strong positive correlation between sciatic nerve to landmark distances and age and stature demonstrated linear variation between sciatic nerve location with age and growth of children. To predict the nerve location in the gluteal region, regression equations using patient age were created, having implications for the posterior approach of the sciatic nerve blockade in children. Clinically significant differences were found between sexes, specifically in the older age group. Conclusion: Despite the small sample size of younger age group, this study is the first to document the morphometric changes of the sciatic nerve in the gluteal region across pediatric development and may be useful for providing confirmatory guidelines for nerve location when ultrasound is not accessible or cannot be utilized for practice

The influence of emotional intelligence on change management strategies in establishing self-managing schools : a multi-site case study

In South Africa, the trend has been towards the decentralising of authority and giving greater powers to schools. This implies the active involvement of the school governing body members, the school management team members and the Level One educators in the day-to-day functioning of the school. Whilst some schools have welcomed this change and seen this devolution of power as an added advantage contributing to the efficacy of schools, some schools have struggled, while others have failed dismally to cope with this added responsibility of managing their own resources. The researcher, being an educator involved in this transition, has been intrigued by the success of some self-managing schools and the failure of others. The following words of Oliver Wendell Holmes have inspired the investigator to conduct this research to ascertain the reasons for the success of certain schools and the failure of others: “What lies behind us and what lies before us are tiny matters compared to what lies within us.” Since the performance of schools is normally ranked according to their matriculation pass rates, this research focused on six self-managing schools in the Port Elizabeth District. These schools were selected on the basis of their matriculation performances in 2008. Two of the schools had achieved an above 85 percent matriculation pass rate (Category A); two obtained a 50 percent pass rate (Category B); while the other two schools obtained matriculation pass rates of between 25 percent and 30 percent (Category C). Although the research relied strongly on a qualitative method of inquiry, because of the nature of the data and the need to obtain a better understanding of the feelings, attitude and perceptions of those in management positions, governing body positions and members of the personnel, multiple instruments for data collection such as a literature review and the study of school documents and questionnaires, were used. This inclusion of these multiple instruments for obtaining information, which is also called triangulation, contributed to the reliability and validity of the empirical investigation. Although the data was presented in the form of tables and graphs, vi which alludes to a quantitative approach, a narrative interpretation of the findings, which is associated with a qualitative method of inquiry, was also presented. An analysis of the findings revealed that there was a great amount of involvement of the principals, school management team members and Level One educators in Category A schools, which had a matriculation pass rate of above 85%, in the following change management strategies: the establishment of a vision, planning and organising, teamwork, training and development, communication, praise and incentives, and evaluation and feedback. There was also a great contribution by the school governing body members. However, the study revealed that Category B and Category C schools did not effectively use communication, praise and incentives and evaluation and feedback as change management strategies. It was evident from the empirical investigation that in Category B and C schools, the school governing body members were less, or not involved in the usage of the change management strategies applied. According to the results based on the six-facet model of Emotional Intelligence, Category A schools obtained 80% and above in the competencies relating to the self and social domain. Category B schools fluctuated between 50 percent and 80 percent in both dimensions, while Category C schools fluctuated between 30 percent and 80 percent. The findings suggest that there should be greater involvement of all stakeholders, especially the school governing body members, in the establishment of a vision, planning and organising, communication, teamwork, training and development, praise and incentives and the provision of feedback and evaluation for self-managing schools to become effective and improve their performances. Professional development, especially in the areas pertaining to Emotional Intelligence competencies such as personal and interpersonal skills, should be prioritised. This thesis proposes that, on the basis of the investigation carried out at the six participating schools on the influence of Emotional Intelligence on the change management strategies adopted in self-managing schools, schools use strategies such as the establishment of a vision, planning and organising, communication, teamwork, training and development, praise and incentives and evaluation and feedback to ameliorate the damaging impact of change. There should be continuous training and development at schools, especially for the school governing body members, who are elected every three years. The newly elected school governing body members need to develop the necessary skills to effectively contribute to the efficacy of schools. The human resource is the vital ingredient in schools, thus for any progression or improvement, all stakeholders need to be informed, trained and enriched. Since Emotional Intelligence can be learned, professional development in the area of Emotional Intelligence should be given more thought and included in training courses, focusing on the development of personal and interpersonal skills. The Emotional Intelligence training should be conducted as part of teacher training courses as well as on an annual basis for educators already in the teaching system, since Emotional Intelligence can influence the use of change management strategies at schools and enhance the efficacy of the functioning of self-managing schools

Atypical teratoid/rhabdoid tumour in a supratentorial location: a report of two cases

Atypical teratoid/rhabdoid tumour of the central nervous system is a rare, highly aggressive childhood malignancy. The age of presentation is usually <2 years, but this tumour may occur in other age groups. The typical location is the posterior fossa, with supratentorial origin less common. We present two cases of atypical teratoid/rhabdoid tumours, with the suprasellar location of one case proving to be a diagnostic radiological challenge

The stylomastoid artery as an anatomical landmark to the facial nerve during parotid surgery: a clinico-anatomic study

BACKGROUND: The identification of the facial nerve can be difficult in a bloody operative field or by an incision that limits exposure; hence anatomical landmarks and adequate operative exposure can aid such identification and preservation. In this clinico-anatomic study, we examined the stylomastoid artery (SMA) and its relation to the facial nerve trunk; the origin of the artery was identified on cadavers and its nature was confirmed histologically. METHODS: The clinical component of the study included prospective reviewing of 100 consecutive routine parotidectomies; while, the anatomical component of the study involved dissecting 50 cadaveric hemifaces. RESULTS: We could consistently identify a supplying vessel, stylomastoid artery, which tends to vary less in position than the facial nerve. Following this vessel, a few millimetres inferiorly and medially, we have gone on to identify the facial nerve trunk, which it supplies, with relative ease. The origin of the stylomastoid artery, in our study, was either from the occipital artery or the posterior auricular artery. CONCLUSION: This anatomical aid, the stylomastoid artery, when supplemented by the other more commonly known anatomical landmarks and intra-operative facial nerve monitoring further reduces the risk of iatrogenic facial nerve damage and operative time

Razvoj i vrednovanje dvoslojnih tableta propranolol hidroklorida

The objective of the present research was to develop a bilayer tablet of propranolol hydrochloride using superdisintegrant sodium starch glycolate for the fast release layer and water immiscible polymers such as ethyl cellulose, Eudragit RLPO and Eudragit RSPO for the sustaining layer. In vitro dissolution studies were carried out in a USP 24 apparatus I. The formulations gave an initial burst effect to provide the loading dose of the drug followed by sustained release for 12 hrs from the sustaining layer of matrix embedded tablets. In vitro dissolution kinetics followed the Higuchi model via a non-Fickian diffusion controlled release mechanism after the initial burst release. FT-IR studies revealed that there was no interaction between the drug and polymers used in the study. Statistical analysis (ANOVA) showed no significant difference in the cumulative amount of drug release after 15 min, but significant difference (p 0.005) in the amount of drug released after 12 h from optimized formulations was observed.U radu je opisan razvoj dvoslojnih tableta propranolol hidroklorida, koristeći superdezintegrator škrob glikolat natrij u sloju za brzo oslobađanje i polimere koji se ne miješaju s vodom (etil celuloza, Eudragit RLPO i Eudragit RSPO) u sloju za usporeno oslobađanje. In vitro oslobađanje praćeno je u USP aparatu I te je uočeno početno naglo oslobađanje ljekovite tvari iza kojeg slijedi polagano oslobađanje tijekom 12 sati. In vitro kinetika oslobađanja prati Higouchijev model, dok mehanizam kontroliranog oslobađanja ne slijedi Fickov zakon poslije početnog naglog oslobađanja. FT-IR studije ukazuju da nema interakcije između ljekovite tvari i polimera upotrebljenih u oblikovanju. Statistička analiza (ANOVA) nije pokazala značajne razlike u kumulativnoj količini oslobođenog lijeka iz optimiranih formulacija poslije 15 minuta i polije 12 h

Prognosis of ovarian cancer subsequent to venous thromboembolism: a nationwide Danish cohort study

BACKGROUND: Venous thromboembolism (VTE) is associated with ovarian cancer and may impact the prognosis of ovarian cancer. Our aims were to examine the extent of disease at the time of the diagnosis of ovarian cancer and to estimate the impact of VTE on survival of ovarian cancer. METHODS: We identified 12,835 ovarian cancer patients diagnosed from 1980 to 2003 in the Danish Cancer Registry and obtained information on previous primary VTE diagnosis from the Danish National Hospital Discharge Registry. Ovarian cancer patients with previous VTE related to other cancers, surgery, or pregnancy were excluded. The vital status was determined by linking data to the Civil Registration System. RESULTS: We identified 50 ovarian cancer patients diagnosed less than 4 months after the VTE and 78 ovarian cancer patients diagnosed more than 4 months after the VTE diagnosis. Advanced stages tended to be more common among patients with VTE. One-year survivals were 44% and 54% among the two VTE groups, compared with 63% among patients without VTE. Adjusted (for age, calendar time, comorbidity, and FIGO-stage) mortality ratios were 1.7 (95% CI = 1.2–2.5) and 1.2 (95% CI = 0.8–1.7), respectively. CONCLUSION: Ovarian cancer diagnosed less than four months before VTE is associated with an advanced stage and a poorer prognosis

The extent of interruptions to primary care medical officers’ consultations in the Western Cape

Background: Administrative tasks are an increasing burden for primary care doctors globally and linked to burnout. Many tasks occur during consultations. They cause interruptions with possible effects on patients’ and doctors’ experiences and care. The burden and typology of interruptions of doctors in primary care consultations have not been studied in South Africa. Given the link between administrative loads and burnout, describing the extent of these interruptions would help. This study’s aim was to assess the extent of interruptions on primary care doctors in the Western Cape. Methods: This was a descriptive cross-sectional survey. Doctors from rural and urban primary care clinics in the Western Cape answered an online self-administered survey on the types of interruptions experienced during consultations. Interruptions were categorised and their prevalence calculated. Clinical and non-clinical interruption categories were compared. Results: There were 201 consultations from 30 doctors. Most interruptions were from retrieving and recording the current patient’s information (93.0%), paperwork for other patients (50.7%), and telephone calls about the current patient (41.8%). Other prevalent interruptions were for emergencies (39.8%) and acquiring consumables (37.3%). The median (interquartile range [IQR]) of four (2–4) interruption types per consultation was higher than global settings. Conclusion: Doctors experienced many interruptions during consultations. Their wide range included interruptions unrelated to the current patient. Contribution: This study adds insights from the global south on clinicians’ administrative burden. It elaborates on the types of activities that interrupt consultations in an upper-middle income primary care setting. Exploration of interventions to decrease this burden is suggested

Draft genome sequence of marine alphaproteobacterial strain HIMB11, the first cultivated representative of a unique lineage within the Roseobacter clade possessing an unusually small genome

© The Author(s), 2014. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Standards in Genomic Sciences 9 (2014): 632-645, doi:10.4056/sigs.4998989.Strain HIMB11 is a planktonic marine bacterium isolated from coastal seawater in Kaneohe Bay, Oahu, Hawaii belonging to the ubiquitous and versatile Roseobacter clade of the alphaproteobacterial family Rhodobacteraceae. Here we describe the preliminary characteristics of strain HIMB11, including annotation of the draft genome sequence and comparative genomic analysis with other members of the Roseobacter lineage. The 3,098,747 bp draft genome is arranged in 34 contigs and contains 3,183 protein-coding genes and 54 RNA genes. Phylogenomic and 16S rRNA gene analyses indicate that HIMB11 represents a unique sublineage within the Roseobacter clade. Comparison with other publicly available genome sequences from members of the Roseobacter lineage reveals that strain HIMB11 has the genomic potential to utilize a wide variety of energy sources (e.g. organic matter, reduced inorganic sulfur, light, carbon monoxide), while possessing a reduced number of substrate transporters.We gratefully acknowledge the support of the Gordon and Betty Moore Foundation, which funded the sequencing of this genome. Annotation was performed as part of the 2011 C-MORE Summer Course in Microbial Oceanography (http://cmore.soest.hawaii.edu/summercourse/2011/index.htm), with support by the Agouron Institute, the Gordon and Betty Moore Foundation, the University of Hawaii and Manoa School of Ocean and Earth Science and Technology (SOEST), and the Center for Microbial Oceanography: Research and Education (C-MORE), a National Science Foundation-funded Science and Technology Center (award No. EF0424599)