Evaluation and correlation of mammographically suspicious lesions with histopathology at Addington Hospital, Durban

Background. Stereotactic core-needle biopsies (SCNBs) are a reliable alternative to surgical biopsy for microcalcifications. The positivepredictive value (PPV) of SCNB has been shown to be reproducible in several studies using the Breast Imaging Reporting and Data System(BIRADS) classification, which is the current gold standard in mammographic reporting. At this stage, no study has been done in KwaZulu-Natal to assess local outcomes against BIRADS. The current standard of care utilises vacuum-assisted breast biopsy, but is not availablein a resource-constrained environment such as ours. The need, therefore, is for constant evaluation of existing practice to ensure that it isoptimised for the challenges and limitations facing local radiologists.Objective. To assess the PPV of SCNB in Addington Hospital, and to compare it with that of BIRADS.Material and methods. Mammographically detected lesions were assigned to 3 categories: benign, indeterminate and suspicious. Aretrospective review of 67 SCNBs was performed for lesions falling within the suspicious category, and the PPV and rates of ductalcarcinoma in situ (DCIS) were determined.Results. Our study demonstrated a PPV of 20.9%. This correlated well with international studies for BIRADS 4 and 5 lesions. DCISaccounted for 21.4% of detected malignancies, which is in keeping with current literature.Conclusion. Despite resource limitations, local outcomes were comparable with those of BIRADS. Given our fairly general categorisationof lesions, however, it should be emphasised that BIRADS allows better organisation, consistency and clarity in breast imaging reporting,as well as accurate data comparison between centres facing limitations similar to our own

The profile of indications for radiography in the Neonatal Intensive Care Unit at Universitas Academic Hospital, Bloemfontein

Introduction. Radiography is a key diagnostic tool in paediatric care. A pro-active approach (including the use of radiography) is required to ensure e ective management of these patients. Taking into account the widely documented harmful e ects of ionising radiation and the small organ masses of neonates, the number of radiographs that neonates receive during hospital admission is of particular concern. A reduction in radiation exposure tailored to speci c indications would be advantageous. e aim of this study was therefore to establish a pro le of indications for radiographs in the Neonatal Intensive Care Unit at Universitas Academic Hospital, Bloemfontein, South Africa. Methods. A retrospective, descriptive study was conducted over a 1-month period (8 September -8 October 2010). Information was obtained from the online Medi-Tech system used to request radiographs. Results. A total of 469 radiographs were performed on 51 neonates. Twenty-seven male and 24 female neonates received 226 (48.2%) and 243 (51.8%) radiographs, respectively. e radiographs were classi ed into routine (91.9%) and urgent (8.1%). Chest radiographs were requested most frequently (59.5%). e most commonly recorded indication was prematurity (37.1%), followed by respiratory-related indications (28.5%). e highest number of radiographs performed on a single neonate was 46. Conclusions. All radiographs were requested online, supporting the validity of the study with regard to the number of radiographs performed and their respective indications. A representative pro le of indications was successfully obtained, which can assist with the implementation of further research on the strati cation of radiation exposure according to indications for radiographs

The Impact of International Legal Rules in Facilitating the Public's Access to Medicines in South Africa

This paper explores the role played by international legal treaties, conventions and agreements that are binding on South Africa, in promoting the public’s access to medicines. In greater detail the impact that the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) of 1994, the Convention on Biological Diversity of 1992, and the United States of America’s Bahy-Dole Act of 1980 have had in the development of South Africa intellectual property (IP) law is examined. In addition, a question regarding whether such international legal instruments have positively impacted the public’s access to medicines is considered. The paper concludes that compliance with international IP law rules is not a silver bullet that will solve South Africa’s challenges relating to access to medicines. The protection of the public’s right to access to medicines in South Africa is strongly dependent on the government’s political will of ensuring that IP law is implemented to serve public good and public and private pharmaceutical patent holders are held accountable regarding the socially-responsible utilization of their IP

Emission factors from road dust resuspension in a Mediterranean freeway

Particulate matter emissions from paved roads are currently one of the main challenges for a sustainable transport in Europe. Emissions are scarcely estimated due to the lack of knowledge about the resuspension process severely hampering a reliable simulation of PM and heavy metals concentrations in large cities and evaluation of population exposure. In this study the Emission Factors from road dust resuspension on a Mediterranean freeway were estimated per single vehicle category and PM component (OC, EC, mineral dust and metals) by means of the deployment of vertical profiles of passive samplers and terminal concentration estimate. The estimated PM10 emission factors varied from 12 to 47 mg VKT?1 (VKT: Vehicle Kilometer Traveled) with an average value of 22.7 ? 14.2 mg VKT?1. Emission Factors for heavy and light duty vehicles, passenger cars and motorbikes were estimated, based on average fleet composition and EPA ratios, in 187e733 mg VKT?1, 33e131 VKT?1, 9.4e36.9 VKT?1 and 0.8e3.3 VKT?1, respectively. These range of values are lower than previous estimates in Mediterranean urban roads, probably due to the lower dust reservoir on freeways. PM emitted material was dominated by mineral dust (9e10 mg VKT?1), but also OC and EC were found to be major components and approximately 14 e25% and 2e9% of average PM exhaust emissions from diesel passenger cars on highways respectively

An analysis of the temperature dependence of force, during steady shortening at different velocities, in (mammalian) fast muscle fibres

We examined, over a wide range of temperatures (10–35°C), the isometric tension and tension during ramp shortening at different velocities (0.2–4 L0/s) in tetanized intact fibre bundles from a rat fast (flexor hallucis brevis) muscle; fibre length (L0) was 2.2 mm and sarcomere length ~2.5 μm. During a ramp shortening, the tension change showed an initial inflection of small amplitude (P1), followed by a larger exponential decline towards an approximate steady level; the tension continued to decline slowly afterwards and the approximate steady tension at a given velocity was estimated as the tension (P2) at the point of intersection between two linear slopes, as previously described (Roots et al. 2007). At a given temperature, the tension P2 declined to a lower level and at a faster rate (from an exponential curve fit) as the shortening velocity was increased; the temperature sensitivity of the rate of tension decline during ramp shortening at different velocities was low (Q10 0.9–1.5). The isometric tension and the P2 tension at a given shortening velocity increased with warming so that the relation between tension and (reciprocal) temperature was sigmoidal in both. In isometric muscle, the temperature T0.5 for half-maximal tension was ~10°C, activation enthalpy change (∆H) was ~100 kJ mol−1 and entropy change (∆S) ~350 J mol−1 K−1. In shortening, these were increased with increase of velocity so that at a shortening velocity (~4 L0/s) producing maximal power at 35°C, T0.5 was ~28°C, ∆H was ~200 kJ mol−1 and ∆S ~ 700 J mol−1 K−1; the same trends were seen in the tension data from isotonic release experiments on intact muscle and in ramp shortening experiments on maximally Ca-activated skinned fibres. In general, our findings show that the sigmoidal relation between force and temperature can be extended from isometric to shortening muscle; the implications of the findings are discussed in relation to the crossbridge cycle. The data indicate that the endothermic, entropy driven process that underlies crossbridge force generation in isometric muscle (Zhao and Kawai 1994; Davis, 1998) is even more pronounced in shortening muscle, i.e. when doing external work

A 'snip' in time: what is the best age to circumcise?

<p>Abstract</p> <p>Background</p> <p>Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves.</p> <p>Discussion</p> <p>We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used.</p> <p>Summary</p> <p>Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.</p

Effects of hydrostatic pressure on single intact muscle fibres

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