AIDS-related progressive multifocal leukoencephalopathy (PML): A retrospective study from Pretoria, South Africa

Introduction and objectives. Progressive multifocal leukoencephalopathy (PML), caused by the John Cunningham (JC) virus, results from lytic infection of predominantly oligodendrocytes. Following the HIV pandemic, the incidence of PML has risen sharply, but has rarely been reported in Africa. An increasing number of PML cases were seen recently in a tertiary South African hospital, and this study describes their clinical and radiological features.Methods. Patients with positive cerebrospinal fluid (CSF) JC virus confirmed by real-time polymerase chain reaction (PCR) were retrospectively identified from January 2008 to June 2012. Adults seen at Neurology with PML were identified, and clinical features, laboratory findings and imaging studies were analysed.Results. Of 121 specimens, 19 were positive; records of 17 patients were available (ages 27 - 64; CD4 counts 11 - 328 x106/ìl); clinical manifestations included focal weakness (47%), impaired co-ordination (41%), and speech disturbances (12%), and CSF analysis showedhigh protein in 76%, and pleocytosis in 35%. Fifteen patients had CT brain scans, showing white matter involvement in 12; MRI studies in 13 patients showed typical PML lesions.Conclusion. This report is the first case series of patients with PML from a South African neurology unit, emphasising the fact that PML occurs commonly in South African patients with HIV infection

AIDS-related progressive multifocal leukoencephalopathy (PML) : a retrospective study from Pretoria, South Africa

INTRODUCTION AND OBJECTIVES: Progressive multifocal leukoencephalopathy (PML), caused by the John Cunningham (JC) virus, results from lytic infection of predominantly oligodendrocytes. Following the HIV pandemic, the incidence of PML has risen sharply, but has rarely been reported in Africa. An increasing number of PML cases were seen recently in a tertiary South African hospital, and this study describes their clinical and radiological features. METHODS Patients with positive cerebrospinal fluid (CSF) JC virus confirmed by real-time polymerase chain reaction (PCR) were retrospectively identified from January 2008 to June 2012. Adults seen at Neurology with PML were identified, and clinical features, laboratory findings and imaging studies were analysed. RESULTS: Of 121 specimens, 19 were positive; records of 17 patients were available (ages 27 - 64; CD4 counts 11 - 328 x106/μl); clinical manifestations included focal weakness (47%), impaired co-ordination (41%), and speech disturbances (12%), and CSF analysis showed high protein in 76%, and pleocytosis in 35%. Fifteen patients had CT brain scans, showing white matter involvement in 12; MRI studies in 13 patients showed typical PML lesions. CONCLUSION: This report is the first case series of patients with PML from a South African neurology unit, emphasising the fact that PML occurs commonly in South African patients with HIV infection.http://www.samj.org.zaam2014ay201

An Integrated Theory of Corporate Environmental Compliance and Overcompliance

Prior research on corporate environmental behavior has produced myriad factors that explain offending and overcompliance, yet the literature lacks cohesion and would benefit from disentangling corporate- and individual-level explanations. In this study, a cross-level integrated theory of corporate environmental behavior uses Gunningham et al’s. (2003) license framework and Paternoster and Simpson’s (1993; 1996) rational choice theory of corporate crime to portray how individuals within corporations decide to offend or to overcomply with environmental regulations while accounting for the organizational context. Specifically, external pressures (legal, social, and economic) on the corporation, plus internal corporate policies and culture, affect individual-level cost-benefit analyses. In turn, these cost-benefit calculations impact the behavioral decisions made by corporate managers. Four sets of hypotheses based on this integration are tested using an environmental vignette survey of individuals. The results provide mixed support for the integrated theory. It is also noted that predictors of environmental offending are different from those predicting overcompliance. Implications for theory and practice are discussed