Annexure to Scientific Review Report

Contained in the main Scientific Review report is a summary of the recommendations regarding the existing surface and groundwater monitoring sites for all the Water Management Areas (WMAs) following the nine Regional Network Design Workshops held in Nelspruit, Cape Town, Durban, King Williams Town, Bela-Bela and Bloemfontein from March to June 2016. During these workshops theoretical monitoring network considerations for each WMA were presented to various stakeholders, and the considerations were used to review the existing networks and obtain changes and improvements to the networks as recommendations. The main objectives of the workshops were to review the existing monitoring networks against the prioritized National Monitoring Objectives in terms of: Existing sites meeting the identified objectives; Redundancies in the existing monitoring network; Gaps in the spatial coverage with regards to meeting important monitoring objectives; Possible physical constraints associated with existing and potential new monitoring sites. Reported in Annexures 1 to 9 of this document are the detailed outcomes, comments and prioritization of all existing and proposed monitoring sites per WMA. The WMAs are reported as per the second National Water Resources Strategy (DWS, 2013e)(see Figure A.1).The annexures are structured as follows: Annexure 1: Limpopo WMA Annexure 2: Olifants WMA Annexure 3: Inkomati-Usuthu WMA Annexure 4: Pongola-uMzimkulu WMA Annexure 5: Vaal WMA Annexure 6: Orange WMA Annexure 7: Mzimvubu-Tsitsikamma WMA Annexure 8: Breede-Gouritz WMA Annexure 9: Berg-Olifants WM

The effect of oxygen and paraquat on the 14C-glucose oxidation of rabbit alveolar macrophages and lung slices

CITATION: Rossouw, D. J. & Engelbrecht, F. M. 1979. The effect of oxygen and paraquat on the 14C-glucose oxidation of rabbit alveolar macrophages and lung slices. South African Medical Journal, 55:558-560.The original publication is available at http://www.samj.org.zaIn this study, we measured the effects of different concentrations of paraquat (0.01 mM and 1.0 mM) on the 1-14CO2 and 6-14CO2 production of rabbit lung slices and isolated alveolar macrophages, in 20% and 95% oxygen phases respectively. A 95% oxygen phase induced an increase in the 6-14C-glucose oxidation of control lung slices over a 3-hour period, while the increased activity of the pentose pathway over the first 2 hours started to decline during the third hour of incubation. Paraquat (1.0mM) in 20% oxygen caused a consistent increase in the 6-14CO2 production by lung slices, but in a 95% oxygen phase gradually inhibited the 6-14C-glucose oxidation over a period of 3 hours. The pentose phosphate pathway was highly significantly stimulated by 1.0 mM paraquat in 20% and 95% oxygen over 3 hours. When isolated alveolar macrophages (viability 95%) were incubated in a 20% and a 95% oxygen phase respectively, both the 6-14C-glucose oxidation rates were significantly inhibited by 1.0 mM paraquat after 1 hour. Our results confirmed the initial increase in glycolytic metabolism induced by paraquat, but also indicated that the 6-14CO2 production was significantly inhibited by paraquat when lung slices were incubated in a 95% oxygen phase. The fact that the glucose metabolism in alveolar macrophages is more sensitive to paraquat exposure than that of cells in lung slices may be related to the genesis of the intra-alveolar pulmonary lesions described in the literature.Publisher’s versio

The effect of paraquat on the aerobic metabolism of rabbit alveolar macrophages and lung fibroblasts

CITATION: Rossouw, D. J. & Engelbrecht, F. M. 1979. The effect of paraquat on the aerobic metabolism of rabbit alveolar macrophages and lung fibroblasts. South African Medical Journal, 55:20-23.The original publication is available at http://www.samj.org.zaIn this study the effects of paraquat on the aerobic metabolism and viability of isolated rabbit alveolar macrophages and lung fibroblasts were investigated, and compared with the effects of other known metabolic inhibitors, i.e. sodium fluoride (NaF) and potassium cyanide (KCN). The manometrically and polarographically determined endogenous oxygen consumption of lavaged alveolar macrophages compared very well (180,9 ± 35,8 and 169,3 ± 26,8 nmol per 106 viable cells per hour respectively). Exogenous glucose (10 mM) and autologous serum (1:3 v/v) added to the medium had no significant effect on the basal respiration rate. The mean cell protein content, determined by the micro-Kjeldahl and Lowry techniques, amounted to 242,6 ± 37,6 μg/106 macrophages. Paraquat (2 mM), like NaF (20 mM) and KCN (5 mM), decreased the viability of the macrophages far less than it did the oxygen utilization of the viable cells, and resulted in an 80% inhibitin of oxygen uptake. In contrast, paraquat (1 mM) induced a marked stimulation (230%) of the cyanide-insensitive respiration of alveolar macrophages. The concentrations of paraquat (nmol/103 cells) which reduce macrophage metabolism to almost zero were virtually non-toxic to fibroblasts, as measured by their oxygen consumption.Publisher’s versio

Lupus nephritis. Part I. Histopathological classification, activity and chronicity scores

CITATION: Bates, W. D. et al. 1991. Lupus nephritis. Part I. Histopathological classification, activity and chronicity scores. South African Medical Journal, 79:256-259.The original publication is available at http://www.samj.org.zaRenal biopsy has made a major contribution to the understanding and management of patients with lupus nephritis. In a 5-year retrospective study the renal morphology of 55 biopsies from 51 patients with lupus nephritis was classified acccrding to World Health Organisation criteria. In addition, semi-quantitative activity and chronicity scores were documented. The findings were similar to series from other parts of the world. Of the biopsies reviewed, 6 were class II, 13 class III, 32 class IV and 4 class V. In situations of overlap, segmental proliferative features determined the class to which a biopsy specimen was assigned. Twenty-five of the patients, all WHO class IV, showed activity scores in the severe range. Most of the activity score features were common and easily recognised but necrotising angiitis was only seen in 1 patient. Haematoxylin bodies were difficult to document and the nature and value of the haematoxylin body is questioned.Publisher’s versio

Has the character of gastric cancer changed? A descriptive study of a IO-year period

Over the 10-year period January 1976 - December 1985, 446 patients with histologically verified adenocarcinoma of the stomach were treated at Tygerberg Hospital. Coloured patients made up 63,4% of the study population and a significant increase in the annual proportion of this group was observed. Coloured men comprised 47,6% of the total group. The mean age of white and coloured patients differed significantly (68,9 v. 56,5; P < 0,001). The symptom complex was essentially similar in the two racial groups and in general the character of the symptoms had no bearing on the prevalence of resection. Although antral tumours were most common in whites and in coloureds, there was a significant increase in tumours located in the fundus in whites. The resection rate remained unchanged over the 10-year period. Only 4 cases of early gastric cancer were detected during this period without any signs of an increased yield of early lesions over time. This audit revealed no beneficial changes over time, which is in stark contrast with reports from Japan regarding the proportion of curable lesions

The weirdness of having a bunch of other minds like yours in the room: The lived experiences of mentalization‐based therapy for borderline personality disorder

Objectives: Studies of lived experiences are important for improving treatment effectiveness, but most studies of mentalisation-based therapy (MBT) are quantitative. This qualitative study aimed to better understand service users’ lived experiences of MBT, including their experiences of change. Design: This is a qualitative study that used one-to-one semi-structured interviews. Method: Semi-structured interviews were conducted with eight MBT service users recruited via four NHS trusts. Interviews were analysed using interpretative phenomenological analysis (IPA). Results: Three superordinate themes were identified: being borderline, being in the group, and being on a journey. ‘Experiences of diagnosis’ and ‘the group’ are salient topics in the lived experiences of service users’ during the MBT journey, as is the nature/type of ‘change’ which can create symptom reduction albeit alongside a negative felt experience. Conclusion: Our research aligns with current thought regarding the complexity and challenges of treating BPD via psychotherapy and adds a further dimension, that of experiencing MBT and changes during therapy. The participants’ experiences of BPD, and of experiencing MBT are discussed

Metabolic, inflammatory and haemostatic effects of a low-dose continuous combined HRT in women with type 2 diabetes: potentially safer with respect to vascular risk?

BACKGROUND Conventional hormone replacement therapy (HRT) containing conjugated equine oestrogen (CEE) and medroxyprogesterone acetate (MPA) increases triglyceride, C- reactive protein (CRP) and coagulation Factor VII concentrations, potentially explaining their increased coronary heart disease (CHD) and stroke risk. OBJECTIVE To assess the metabolic effects of a continuous combined HRT containing 1 mg oestradiol and 0.5 mg norethisterone or matching placebo. DESIGN Double-blind, randomized placebo-controlled trial. PATIENTS Fifty women with type 2 diabetes. MEASUREMENTS Classical and novel risk factors for vascular disease. RESULTS Triglyceride concentration was not altered (P = 0.31, change in active arm relative to placebo) and low-density lipoprotein (LDL) cholesterol concentration declined 13% (P = 0.018). IL-6 concentration (mean difference -1.42 pg/ml, 95% CI: -2.55 to - 0.29 IU/dl, P = 0.015), Factor VII (-32 IU/dl, -43 to -21 IU/l, P lt 0.001) and tissue plasminogen activator antigen (by 13%, P = 0.005) concentrations fell, but CRP was not significantly altered (P = 0.62). Fasting glucose (P = 0.026) also declined significantly, but there are no significant effects on HBA1c, Factor IX or APC resistance. CONCLUSIONS HRT containing 1 mg oestradiol and 0.5 mg norethisterone may avoid the adverse metabolic effects potentially implicated in the elevated CHD and stroke risk induced by conventional higher dose HRT. This type of preparation may therefore be more suitable than conventional HRT for women at elevated CHD risk such as those with type 2 diabetes. Large randomized controlled trials of such low dose preparations, powered for cardiovascular end points, are now needed

The effect of hormone therapy on mean blood pressure and visit-to-visit blood pressure variability in postmenopausal women: results from the Women's Health Initiative randomized controlled trials

Objectives: Mean and visit-to-visit variability (VVV) of blood pressure (BP) are associated with an increased cardiovascular disease risk. We examined the effect of hormone therapy on mean and VVV of BP in postmenopausal women from the Women's Health Initiative (WHI) randomized controlled trials. Methods: BP was measured at baseline and annually in the two WHI hormone therapy trials, in which 10 739 and 16 608 postmenopausal women were randomized to conjugated equine estrogens (CEEs, 0.625 mg/day) or placebo, and CEEs and medroxyprogesterone acetate (MPA, 2.5 mg/day) or placebo, respectively. Results: At the first annual visit (year 1), mean SBP was 1.04 mmHg [95% confidence interval (CI) 0.58, 1.50] and 1.35 mmHg (95% CI 0.99, 1.72) higher in the CEEs and CEEs and MPA arms, respectively, compared with the corresponding placebos. These effects remained stable after year 1. CEEs also increased the VVV of SBP (ratio of VVV in CEEs vs. placebo, 1.03; P < 0.001), whereas CEEs and MPA did not (ratio of VVV in CEEs and MPA vs. placebo, 1.01; P = 0.20). After accounting for study drug adherence, the effects of CEEs and CEEs and MPA on mean SBP increased at year 1, and the differences in the CEEs and CEEs and MPA arms vs. placebos also continued to increase after year 1. Further, both CEEs and CEEs and MPA significantly increased the VVV of SBP (ratio of VVV in CEEs vs. placebo, 1.04; P < 0.001; ratio of VVV in CEEs and MPA vs. placebo, 1.05; P < 0.001). Conclusion: Among postmenopausal women, CEEs and CEEs and MPA at conventional doses increased mean and VVV of SBP