The effect of tuberculous meningitis on the cognitive and motor development of children

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Preterm labour - Is Mycoplasma hominis involved?

Objective. To assess whether Mycoplasma hominis is associated with preterm labour in primigravidae  and multigravidae with previous midtrimester abortion or preterm labour.Design. Cohort analytical study. Setting. Tygerberg Hospital, a tertiary academic hospital in the Western Cape.Methods. Gram's stains were done on smears taken from the posterior vaginal fornix, at the first  antenatal visit, between 16 and 26 weeks' gestation, in primigravidae and multigravidae at risk for preterm labour. Cultures for M. hominis and other commonly occurring organisms were done ·from endocervical swabs taken at the same visit. The outcome of pregnancy in mothers with positive cultures for M. hominis was then compared with outcome in women with negative cultures.Outcome measures. Prevalence of Chlamydia trachomatis, Ureaplasma urealyticum, bacterial vaginosis and preterm delivery, birth weight and perinatal deaths.Results. Cultures for M. hominis were positive in 83 patients  (21 %) and negative in 312 (79%).  Significantly more mothers in the positive group (40%) delivered before 37 weeks' gestation than in the negative group (28%, P = 0.0313). Their babies weighed significantly less (2 669 g v. 2 864 g, P = 0.0141). The positive group was also associated with more alcohol use in pregnancy and fewer of them  were married. C. trachomatis was found in 18% of mothers in the positive group but in 8% of the negative group (P = 0.0082). U. urealyticum was cultured in 96% of mothers in the positive group in contrast to 81 % in the negative group (P = 0.001). Bacterial vaginosis was observed on 75% of mothers  with positive cultures for M. hominis but in 22% with negative cultures (P = 0.00001, odds ratio 10.21, 95% confidence interval: 5.63 - 18.65). Conclusion. Positive culture for M. hominis was associated with more preterm deliveries and also with a higher frequency of C. trachomatis, U. urealyticum and bacterial vaginosis

Species richness patterns and functional traits of the bat fauna of arid southern Africa

The bat fauna of arid regions is still poorly studied mostly due to a lack of interest in areas with low species richness and a low number of threatened species. In this study, we reviewed the status of bat diversity in the arid parts of southern Africa, with the aim of setting up a baseline for future work. In particular, we described species richness patterns across four arid zones within the region (Namib Desert, Kalahari, Nama Karoo and Succulent Karoo), exploring abiotic gradients and local landscape structure. Additionally, we examined bat functional groups in this region and compared them with those of three other arid regions of the world to identify potential similarities and differences. The southern African arid region hosted 17 bat species, representing eight families, of which three are endemic to the region (Rhinolophus denti, Laephotis namibensis and Cistugo seabrae) and one is vagrant (the fruit bat Eidolon helvum). Species richness varied spatially within this arid region, being highest in the drier but topographically heterogeneous Namib Desert, probably as a result of roost availability. With regards to functional groups, the southern African arid region had few bat species adapted to foraging in open spaces, particularly when compared with the neighbouring savannahs. Drawing from this study, we suggest that: a) despite species richness decreasing with increasing aridity at the sub-continental scale, at a more local scale landscape features (e.g. habitat structure) might be more relevant than aridity in determining bat species richness; and b) an unknown factor, possibly patterns of temperature limiting the availability of insects flying high above the ground, restricted the diversity of the open air foragers throughout the region. We highlight additional areas of research worth investigation

Practical management of therapeutic diphenylhydantoin concentrations in children

Objective. Development of easy, practical methods for the management and optimisation of therapeutic diphenylhydantoin (DPH) concentrations in children.Design. Investigation of DPH concentration profiles and pharmacokinetic parameters in children with poorly controlled epilepsy. Subsequent determination of individual-specific DPH maintenance dosage and volume of distribution data suitable for use in routine therapeutic concentration management procedures.Setting. Department of Paediatrics and Child Health and Department of Pharmacology, University of Stellenbosch, Tygerberg Hospital.Subjects. Children of both sexes between the ages of 4 and 12 years with poorly controlled epilepsy receiving DPH as sole medication.Results. In all subjects evaluated epilepsy was unsatisfactorily controlled because of inadequate DPH dosage regimens. Individual-specific maintenance dosage and volume of distribution data could be calculated for all individuals participating in the trial. The calculated data were· suitable for use in routine management procedures and in no instance was it necessary to recalculate parameters in a 12-month follow-up period subsequent to evaluation.Conclusions. Therapeutic DPH concentration profiles can be managed satisfactorily in children if individual-specific DPH pharmacokinetic parameters are derived and skilfully applied

Preterm labour - is bacterial vaginosis involved?

Objective. To assess the efficacy of treatment of bacterial vaginosis (BV) using metronidazole to reduce  preterm labour in primiravidae and multigravidae with previous midtrimester abortion or preterm labour.Design. Randomised controlled trial.Setting. Tertiary academic hospital.Method. Two different groups of patients were screened for BV at the first antenatal visit, namely  primigravidae and high-risk multigravidae who had had a previous midtrimester abortion or preterm delivery. Patients where BV was diagnosed clinically or on Gram's stain of a smear taken from the posterior vaginal fornix, received either 400 mg metronidazole, or 100 mg vitamin C orally twice daily for 2 days. The Gram's stain was repeated after 4 weeks. If BV W?S found again, treatment with the same  drug was repeated.Outcome measures. Preterm delivery, birth weight and perinatal deaths.Results. One thousand and five patients entered the study, but 40 were excluded for various reasons and 10 were lost to follow-up. There were 464 primigravidae, of whom 150 (32%) had BV. Except for the 5-minute Apgar score, no significant differences were found between primigravidae negative for BV and those who received either metronidazole or vitamin C. There were 491 high-risk multigravidae, of whom 127 (26%) had BV. The mean gestational age in the BVnegative group was 37 weeks, in contrast to 37.4 weeks in the vitamin C group and 35.6 weeks in the metronidazole group. Birth weights in these three groups were 2 752 g, 2 759 g and 2 475 g respectively, significantly less (P == 0.0109) in the  metronidazole group in comparison with the BV-negative group. Delivery before 37 weeks occurred in 29% of high-risk multigravidae with no BV but in 24% of those who took  vitamin C and in 43% who took metronidazole. Differences were significant between the BV-negative and metronidazole groups (P = 0.0231) and also between the metrol'.idazole and vitamin C groups (P = 0.0274). Delivery before 28 weeks occurred in 4% of the high-risk multigravidae with no UV but in 10% of those with BV who took metronidazole. The difference was significant (P =0.0430). Analysis for maximum likelihood estimates for preterm labour identified only previous preterm labour or midtrimester abortion as risk factors.Conclusion. Metronidazole does not seem to reduce the prevalence of preterm labour when given for BV before 26 weeks' gestation

Maternal near-miss audit in the Metro West maternity service, Cape Town, South Africa: A retrospective observational study

Background. A maternal near-miss is defined as a life-threatening pregnancy-related complication where the woman survives. The World Health Organization (WHO) has produced a tool for identifying near-misses according to criteria that include the occurrence of a severe maternal complication together with organ dysfunction and/or specified critical interventions. Maternal deaths have been audited in the public sector Metro West maternity service in Cape Town, South Africa, for many years, but there has been no monitoring of near-misses.Objectives. To measure the near-miss ratio (NMR), maternal mortality ratio (MMR) and mortality index (MI), and to investigate the near-miss cases.Methods. A retrospective observational study conducted during 6 months in 2014 identified and analysed all near-miss cases and maternal deaths in Metro West, using the WHO criteria.Results. From a total of 19 222 live births, 112 near-misses and 13 maternal deaths were identified. The MMR was 67.6 per 100 000 live births and the NMR 5.83 per 1 000 live births. The maternal near-miss/maternal death ratio was 8.6:1 and the MI 10.4%. The major causes of near-miss were hypertension (n=50, 44.6%), haemorrhage (n=38, 33.9%) and puerperal sepsis (n=13, 11.6%). The first two conditions both had very low MIs (1.9% and 0%, respectively), whereas the figure for puerperal sepsis was 18.9%. Less common near-miss causes were medical/surgical conditions (n=7, 6.3%), non-pregnancy-related infections (n=2, 1.8%) and acute collapse (n=2, 1.8%), with higher MIs (33.3%, 66.7% and 33.3%, respectively). Critical interventions included massive blood transfusion (34.8%), ventilation (40.2%) and hysterectomy (30.4%). Considering health system factors, 63 near-misses (56.3%) initially occurred at a primary care facility, and the patients were all referred to the tertiary hospital; 38 (33.9%) occurred at a secondary hospital, and 11 (9.8%) at the tertiary hospital. Analysis of avoidable factors identified lack of antenatal clinic attendance (11.6%), inter-facility transport problems (6.3%) and health provider-related factors (25.9% at the primary level of care, 38.2% at secondary level and 7.1% at tertiary level).Conclusions. The NMR and MMR for Metro West were lower than in other developing countries, but higher than in high-income countries. The MI was low for direct obstetric conditions (hypertension, haemorrhage and puerperal sepsis), reflecting good quality of care and referral mechanisms for these conditions. The MIs for non-pregnancy-related infections, medical/surgical conditions and acute collapse were higher, suggesting that medical problems need more focused attention.

Cretaceous fossils from the Orapa Diamond Mine

Main articleThe Orapa kimberlite pipe, situated in north-central Botswana, is well-known for its rich reserves of diamonds. It is indeed one of the largest and richest diamond mines in the world. The kimberlite magma transporting the diamonds from the upper mantle erupted through a sequence ofKaroo-aged rocks before the deposition ofthe Kalahari Sands. This eruption has been radiometrically dated at early Late Cretaceous (Cenomanian-Coniacian). When volcanism ceased, a succession of epiclastic crater lake sediments was deposited above the kimberlite plug. Analysis of these sediments, which mostly comprise the results of mudflows and debris flows and fmer sediments during quiescenttimes, suggests that most of the sediments within the crater were deposited rapidly as mass flows, and were therefore mobilised soon after the volcanic eruption. Buried within the fine-grained sediments is a unique assemblage of fossils including flowering plants and many whole-bodied insects. The fossils are commonly exquisitely preserved in extremely fine-grained mudstone. Interpretation of the sedimentary facies and fossils is that the mid-Cretaceous climate of central Botswana was temperate, seasonal and wet, and the area surrounding the crater was forested. The fossils represent the recovery of the biota of the area after the violent eruptions of Orapa and other nearby kimberlite fissures and pipes. The fossils have contributed considerably to our understanding of mid-Cretaceous insects and flowering plants and suggest intimate relationships between the two at an early stage in the radiation of flowering plants. It seems that southern Gondwana (including southern Africa) was a centre of diversification for both insects and angiosperms in the mid-Cretaceous.Friends of the Museum, Gaborone; Debswana (Orapa); University of the Witwatersrand; South African Foundation for Research Developmen

Dietary generalism accelerates arrival and persistence of coral‐reef fishes in their novel ranges under climate change

Climate change is redistributing marine and terrestrial species globally. Life‐history traits mediate the ability of species to cope with novel environmental conditions, and can be used to gauge the potential redistribution of taxa facing the challenges of a changing climate. However, it is unclear whether the same traits are important across different stages of range shifts (arrival, population increase, persistence). To test which life‐history traits most mediate the process of range extension, we used a 16‐year dataset of 35 range‐extending coral‐reef fish species and quantified the importance of various traits on the arrival time (earliness) and degree of persistence (prevalence and patchiness) at higher latitudes. We show that traits predisposing species to shift their range more rapidly (large body size, broad latitudinal range, long dispersal duration) did not drive the early stages of redistribution. Instead, we found that as diet breadth increased, the initial arrival and establishment (prevalence and patchiness) of climate migrant species in temperate locations occurred earlier. While the initial incursion of range‐shifting species depends on traits associated with dispersal potential, subsequent establishment hinges more on a species’ ability to exploit novel food resources locally. These results highlight that generalist species that can best adapt to novel food sources might be most successful in a future ocean