Risk factors and outcomes of contrast-induced nephropathy in hospitalised South Africans

Background. Despite ranking third as a cause of hospital-acquired acute kidney injury (AKI), iatrogenic contrast-induced nephropathy (CIN) impacts significantly on morbidity and mortality and is associated with high hospital costs. In  sub-Saharan Africa, the rates and risk factors for CIN and patient outcomes remain unexplored.Methods. We conducted a prospective observational study at the Charlotte Maxeke Johannesburg Academic Hospital, South Africa, from 1 July 2014 to 30 July 2015. Hospitalised patients undergoing computed tomography scan contrast media administration and angiography were consecutively recruited to the study and followed up for development of AKI. CIN was defined as an increase in serum creatinine >25% or an absolute increase of >44 μmol/L from baseline at 48 - 72 hours post exposure to contrast media. Outcome variables were the occurrence of CIN, length of hospitalisation and in-hospital mortality.Results. We recruited 371 hospitalised patients with a mean (standard deviation) age of 49.3 (15.9). The rates of CIN, assessed using an absolute or relative increase in serum creatinine from baseline, were 4.6% and 16.4%, respectively. Anaemia was an independent predictor for the development of CIN (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.01 - 2.87; p=0.04). The median serum  albumin was 34 g/L (interquartile range (IQR) 29 - 39.5) and 38 g/L (IQR 31 - 42) in the CIN and control groups, respectively (p=0.01), and showed a significant trend for CIN development (RR 1.68, 95% CI 0.96 - 2.92; p=0.06). Mortality was  significantly increased in the CIN group (22.4% v. 6.8%; p<0.001), and CIN  together with anaemia increased mortality twofold (RR 2.39, 95% CI 1.20 - 4.75; p=0.01) and threefold (RR 3.32, 95% CI 1.48 - 7.43; p=0.003), respectively.Conclusions. CIN has a relatively high incidence in sub-Saharan Africa and predicts poorer clinical outcomes. The presence of CIN and anaemia positively predicted mortality. Caution should be exercised in patients with hypoalbuminaemia and anaemia undergoing contrast media administration

Deep learning of HIV field-based rapid tests

Although deep learning algorithms show increasing promise for disease diagnosis, their use with rapid diagnostic tests performed in the field has not been extensively tested. Here we use deep learning to classify images of rapid human immunodeficiency virus (HIV) tests acquired in rural South Africa. Using newly developed image capture protocols with the Samsung SM-P585 tablet, 60 fieldworkers routinely collected images of HIV lateral flow tests. From a library of 11,374 images, deep learning algorithms were trained to classify tests as positive or negative. A pilot field study of the algorithms deployed as a mobile application demonstrated high levels of sensitivity (97.8%) and specificity (100%) compared with traditional visual interpretation by humans-experienced nurses and newly trained community health worker staff-and reduced the number of false positives and false negatives. Our findings lay the foundations for a new paradigm of deep learning-enabled diagnostics in low- and middle-income countries, termed REASSURED diagnostics1, an acronym for real-time connectivity, ease of specimen collection, affordable, sensitive, specific, user-friendly, rapid, equipment-free and deliverable. Such diagnostics have the potential to provide a platform for workforce training, quality assurance, decision support and mobile connectivity to inform disease control strategies, strengthen healthcare system efficiency and improve patient outcomes and outbreak management in emerging infections

The African intellectuals’ project

Soon after taking the position of editor of IJARS at the beginning of 2019, I was contacted by the dean of Unisa’s College of Graduate Studies (CGS), Prof. Lindiwe Zungu, who informed me that the university’s principal and vice-chancellor, Prof. Mandla Makhanya, had decided to revive his project, the African Intellectuals’ Project (AIP). I was asked to coordinate this project, through which Makhanya sought to invite scholars, academics, and intellectuals, both on and outside of the African continent, to deliver presentations reflecting on the ills afflicting Africa and, at the same time, to offer possible solutions. In pursuing the AIP, Prof. Makhanya was carrying on a perennial tradition

Uraemic tumoral calcinosis in patients on haemodialysis in the renal unit at Dr George Mukhari Hospital, Pretoria

Objective. Uraemic tumoral calcinosis refers to metastatic calcifications that occur rarely on the extensor surfaces of joints in patients undergoing long-term haemodialysis. The aim of the study was to assess the incidence of uraemic tumoral calcinosis in participants undergoing haemodialysis and to investigate any relationship that might exist between the development of uraemic tumoral calcinosis and the length of time on dialysis. Design. Twenty-four of the 25 patients on haemodialysis at the time of the study underwent radiographs of their shoulders and hips to look for calcinosis, which were then read by the researcher and two independent readers to assess for calcinosis. Study setting. Dr George Mukhari Hospital, Pretoria. Results. Eight per cent (N=2) of participants were found to have asymptomatic calcinosis of the hips. No relationship to length of time on dialysis was found. Conclusions. The study was constrained by a small sample size but the presence of calcinosis in 8% of the participants indicates that an extensive study of a larger sample could prove to be useful in determining the true incidence of uraemic tumoral calcinosis in the region. Long-term follow-up could provide more information on the development of calcinosis and length of time on dialysis

Endovascular treatment of vein of Galen aneurysmal malformation

No abstac

Increased gametocytemia after treatment: an early parasitological indicator of emerging sulfadoxine-pyrimethamine resistance in falciparum malaria.

BACKGROUND: Although malaria treatment aims primarily to eliminate the asexual blood stages that cause illness, reducing the carriage of gametocytes is critical for limiting malaria transmission and the spread of resistance. METHODS: Clinical and parasitological responses to the fixed-dose combination of sulfadoxine and pyrimethamine in patients with uncomplicated falciparum malaria were assessed biannually since implementation of this treatment policy in 1998 in Mpumalanga Province, South Africa. RESULTS: Despite sustained cure rates of > 90% (P = .14), the duration of gametocyte carriage increased from 3 to 22 weeks (per 1000 person-weeks) between 1998 and 2002 (P < .001). The dhfr and dhps mutations associated with sulfadoxine-pyrimethamine resistance were the most important drivers of the increased gametocytemia, although these mutations were not associated with increased pretreatment asexual parasite density or slower asexual parasite clearance times. The geometric mean gametocyte duration and area under the gametocyte density time curve (per 1000 person-weeks) were 7.0 weeks and 60.8 gametocytes/microL per week, respectively, among patients with wild-type parasites, compared with 45.4 weeks (P = .016) and 1212 gametocytes/microL per week (P = .014), respectively, among those with parasites containing 1-5 dhfr/dhps mutations. CONCLUSIONS: An increased duration and density of gametocyte carriage after sulfadoxine-pyrimethamine treatment was an early indicator of drug resistance. This increased gametocytemia among patients who have primary infections with drug-resistant Plasmodium falciparum fuels the spread of resistance even before treatment failure rates increase significantly

The Influence of Additives on the Interfacial Bonding Mechanisms Between Natural Fibre and Biopolymer Composites

There has not been extensive research into the subjects of the interfacial bonding quality and the interaction mechanisms of biopolymers and natural fibres. Attempts have been made to incorporate natural fibres/fillers (biofibres) into the manufacture of composites in order to increase the functionality and performance of biopolymers synthesised from natural sources/microbial systems. However, the interfacial bonding quality and other substantial technical challenges still need to be addressed if their industrial use is to be realized. The interfacial bonding quality ultimately dictates the mechanical and physical performance of bio-composites. This review paper attempts to collate the state-of-the-art regarding coupling agents/ additives and their roles in interaction mechanisms with biofibres and biopolymers. Two potential pathways for narrowing the performance gap between biopolymer-based bio-composites and their petroleum-based counterparts are: i) improving the interfacial bonding quality by the synthesis of a specific coupling agent, and ii) improving the processability of bio-composites by blending two or more biopolymers