Starvation ketoacidosis in pregnancy presenting as euglycaemic, high anion gap metabolic acidosis: A case report highlighting the significance of early recognition and prompt intervention

Starvation ketoacidosis (SKA) constitutes an important consideration in the pregnant patient who presents with profound metabolic acidosis. Pregnancy-related changes predispose the patient to develop SKA following relatively short periods (12 - 14 hours) of ‘starvation’. Patients also typically look clinically well in relation to the significant metabolic derangements that accompany the condition. Prompt recognition and early institution of appropriate therapy is therefore extremely important in terms of optimising maternal and fetal outcome. We describe a pregnant patient with SKA who presented with profound euglycaemic ketoacidosis that resolved rapidly following the early initiation of appropriate therapy. Furthermore, appropriate therapy resulted in our patient avoiding the need for an emergency caesarean section, which is often reported in this scenario. The ensuing discussion addresses SKA in pregnancy, the unique features of our patient, and management considerations from a maternal and fetal perspective. We also discuss the various causes of ketoacidosis such as diabetic ketoacidosis (DKA), euglycaemic DKA, alcohol-induced euglycaemic ketoacidosis and SKA in pregnant patients

Starvation ketoacidosis in pregnancy presenting as euglycaemic high anion gap metabolic acidosis: A case report highlighting the significance of early recognition and prompt intervention

Starvation ketoacidosis (SKA) constitutes an important consideration in the pregnant patient who presents with profound metabolic acidosis. Pregnancy-related changes predispose the patient to develop SKA following relatively short periods (12 - 14 hours) of ‘starvation’. Patients also typically look clinically well in relation to the significant metabolic derangements that accompany the condition. Prompt recognition and early institution of appropriate therapy is therefore extremely important in terms of optimising maternal and fetal outcome. We describe a pregnant patient with SKA who presented with profound euglycaemic ketoacidosis that resolved rapidly following the early initiation of appropriate therapy. Furthermore, appropriate therapy resulted in our patient avoiding the need for an emergency caesarean section, which is often reported in this scenario. The ensuing discussion addresses SKA in pregnancy, the unique features of our patient, and management considerations from a maternal and fetal perspective. We also discuss the various causes of ketoacidosis such as diabetic ketoacidosis (DKA), euglycaemic DKA, alcohol-induced euglycaemic ketoacidosis and SKA in pregnant patients

Noise-induced hearing loss and hearing conservation in the iron and steel industry in South Africa

BACKGROUND AND PURPOSE: The iron and steel industry in South Africa has been identified as one of the highest risk industries in terms of noise induced hearing loss (NIHL). The National Institute for Occupational Health was commissioned by the Department of Labour to audit the current noise exposure levels and hearing conservation practices in eight major producers of iron and steel, and to make recommendations regarding prevention strategies. METHODS: The audit was conducted in two parts: the noise exposure levels and hearing conservation practices were assessed by the occupational hygiene department. The occupational medicine department assessed the hearing conservation policies and procedures, reviewed employees’ medical records to ascertain the number of NIHL cases, and conducted verification of audiograms on a sample of employees working in noise zones. RESULTS: Area noise levels exceeding 105 dB(A) were measured in four of the eight workplaces. The estimated average annual incidence of NIHL varied from 0.7 - 8.3/1000/year. All companies did baseline, periodic and exit audiometric testing, but there were notable discrepancies between companies and verification audiograms and differences of more than 20 dB(A) were found. Although information and training on noise was reportedly done in all worksites, a high proportion of workers could not demonstrate correct fitting of hearing protection devices or recall when last they were trained. CONCLUSION: A detailed standard operating procedure should be implemented for medical surveillance for NIHL with action timelines that initiate remedial processes prior to employee developing compensable disease. Aggregated audiometric testing results should be communicated to managers and health and safety teams to provide guidance to prioritise areas for control measures. A quality assurance programme for audiometric testing must be implemented. An evaluation tool to measure the effectiveness of the noise and hearing conservation training provided to employees, including contracted employees, should be adopted.http://www.occhealth.co.zaam201

The Impact of a Community-based Pilot Health Education Intervention for Older People as Caregivers of Orphaned and Sick Children as a Result of HIV and AIDS in South Africa

The increasing HIV and AIDS epidemic in South Africa poses a substantial burden to older people, in particular older women who mainly provide care for sick adult children and their grandchildren who have become orphaned and rendered vulnerable by the death or illness of their parents. In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge. The results provided valuable information upon which the development of future interventions may be based and psychosocial and structural needs of the older caregivers may be addressed by relevant stakeholders

End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

<p>Abstract</p> <p>Background</p> <p>End of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL care is ethical and culturally appropriate. This article aims to synthesize qualitative research on EoL care in sub-Saharan Africa to inform policy, practice and further research. It seeks to identify areas of existing research; describe findings specifically relevant to the African context; and, identify areas lacking evidence.</p> <p>Methods</p> <p>Relevant literature was identified through eight electronic databases: AMED, British Nursing Index & Archive, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, and the Social Sciences Citation Index; and hand searches. Inclusion criteria were: published qualitative or mixed-method studies in sub-Saharan Africa, about EoL care. Study quality was assessed using a standard grading scale. Relevant data including findings and practice recommendations were extracted and compared in tabular format.</p> <p>Results</p> <p>Of the 407 articles initially identified, 51 were included in the qualitative synthesis. Nineteen came from South Africa and the majority (38) focused on HIV/AIDS. Nine dealt with multiple or unspecified conditions and four were about cancer. Study respondents included health professionals, informal carers, patients, community members and bereaved relatives. Informal carers were typically women, the elderly and children, providing total care in the home, and lacking support from professionals or the extended family. Twenty studies focused on home-based care, describing how programmes function in practice and what is needed to make them effective. Patients and carers were reported to prefer institutional care but this needs to be understood in context. Studies focusing on culture discussed good and bad death, culture-specific approaches to symptoms and illness, and the bereavement process.</p> <p>Conclusions</p> <p>The data support or complement the findings from quantitative research. The review prompts a reconsideration of the assumption that in Africa the extended family care for the sick, and that people prefer home-based care. The review identifies areas relevant for a research agenda on socio-cultural issues at the EoL in sub-Saharan Africa.</p

Bye-bye Barack: dislocating afropolitanism, spectral marxism and dialectical disillusionment in two Obama-era novels

In contextually specific and formally distinctive ways, Chimamanda Ngozi Adichie’s Americanah and Imbolo Mbue’s Behold the Dreamers are fictional interrogations of Obama’s presidential pledge to resuscitate the American dream on the wake of the global financial crash. This paper explores how they supplement and challenge familiar tropes associated with African and American, rather than African-American, diaspora writing. Given broader debates within transnational literary studies about flows and exchanges (of people, finance, cultural production, dissemination, consumption et al.) linking the global South and North, I consider how these texts grapple with the complexities and complicities of contemporary neoliberalism through the lens of renascent African Marxisms. While my chosen writers could not be described as Marxist, I engage with more materially oriented scholarship, such as Krishnan’s Writing Spatiality in West Africa and Ngugi’s The Rise of the African Novel, to consider how Americanah and Behold the Dreamers circulate in a global literary marketplace where certain texts, not to mention authors, are seen as symptomatic of an African and/or Afropolitan and/or ‘Africapitalist’ renaissance. By grappling with Marxist-inflected scholarship, this paper interrogates the politics, as well as poetics, of the oft-conspicuous airbrushing of those socio-economic, specifically class concerns at the heart of these entangled debates

n-Butanol derived from biochemical and chemical routes: A review

Traditionally, bio-butanol is produced with the ABE (Acetone Butanol Ethanol) process using Clostridium species to ferment sugars from biomass. However, the route is associated with some disadvantages such as low butanol yield and by-product formation (acetone and ethanol). On the other hand, butanol can be directly produced from ethanol through aldol condensation over metal oxides/ hydroxyapatite catalysts. This paper suggests that the chemical conversion route is more preferable than the ABE process, because the reaction proceeds more quickly compared to the fermentation route and fewer steps are required to get to the product

Direct fermentation of sweet sorghum juice by Clostridium acetobutylicum and Clostridium tetanomorphum to produce bio-butanol and organic acids

Single- and co-culture clostridial fermentation was conducted to obtain organic alcohols and acids from sweet sorghum juice as a low cost feedstock. Different inoculum concentrations of single cultures (3, 5, 10 v/v %) as well as different ratios of C. acetobutylicum to C. tetanomorphum (3:10, 10:3, 6.5:6.5, 3:3, and 10:10 v/v %, respectively) were utilized for the fermentation. The maximum butanol concentration of 6.49 g/L was obtained after 96 h fermentation with 10 % v/v C. acetobutylicum as a single culture. The fermentation with 10% v/v C. tetanomorphum resulted in more than 5 g/l butyric acid production. Major organic acid concentration (lactic acid) of 2.7 g/L was produced when an inoculum ratio of 6.5: 6.5 %v/v C. acetobutylicum to C. tetanomorphum was used