Differentiating Crohn’s disease from intestinal tuberculosis at presentation in patients with tissue granulomas

Background. Overlapping clinical, endoscopic, radiographic and histological features, coupled with poor microbiological yield, make differentiating Crohn’s disease (CD) from intestinal tuberculosis (ITB) challenging. Granulomas are present in both diseases; in CD they predict the need for immunosuppressive therapy that requires ITB to be excluded before initiation.Objectives. To compare granuloma-positive CD and ITB, to identify factors that may aid in diagnosis.Methods. This was a retrospective cohort study evaluating granuloma-positive CD and ITB identified from a pathology database.Results. Sixty-eight ITB and 48 CD cases were identified. Patients with ITB were more likely to be male, and to have HIV infection, isolated colitis, night sweats and tachycardia. ITB was also associated with lower serum albumin and haemoglobin and higher C-reactive protein levels, a chest radiograph showing active tuberculosis, and lymph nodes >1 cm on imaging. Extraintestinal manifestations (EIMs) were predictive of CD. There were no significant differences in smoking status, symptom duration or perianal disease. On multivariate analysis, HIV positivity (odds ratio (OR) 29.72, 95% confidence interval (CI) 2.15 - 410.96; p=0.01), isolated colitis (OR 6.17, 95% CI 1.17 - 32.52; p=0.03) and the absence of EIMs (OR 0.10, 95% CI 0.01 - 0.65; p=0.02) remained significant risk factors for ITB.Conclusion. This is the first study to identify clinical and biochemical factors to aid in differentiating granuloma-positive ITB from CD. EIMs support a diagnosis of CD, while isolated colitis and HIV are predictors of ITB.

Tuberculosis in an inflammatory bowel disease cohort from South Africa

Background. Potent immunosuppressive therapy is standard treatment for inflammatory bowel disease (IBD) but carries a risk of reactivating latent tuberculosis (TB). No data exist on the burden of TB in South African patients with IBD. Objective. To evaluate the burden of TB in IBD patients attending a large tertiary IBD clinic. Methods. A retrospective analysis was performed on data pertaining to patients attending the Groote Schuur Hospital IBD clinic. Data were extracted from an existing IBD database, patient notes, the National Health Laboratory Services database and chest X-ray analysis. Results. Of 614 patients, 72 (11.7%) were diagnosed with TB; 40 (55.6%) developed TB prior to the diagnosis of IBD. On regression analysis, coloured IBD patients were at increased risk for TB development (p=0.004, odds ratio (OR) 3.57, 95% confidence interval (CI) 1.49 - 8.56), as were patients with extensive Crohn’s disease (CD) compared with those with less extensive disease (p=0.001,OR 2.84, 95% CI 1.27 - 6.33). No other risk factors, including the use of immunosuppressive agents, were identified for the development of TB. Conclusions. Of over 600 patients, 12% had TB either before or after IBD diagnosis. The high rate of previous TB and positive association with ethnicity probably reflects the high burden of TB in a socio-economically disadvantaged community. We recommend that IBD patients should be screened actively and monitored for TB when immunosuppressive medications are used

Evaluation of a locally produced rapid urease test for the diagnosis of Helicobacter pylori infection

Background. The rapid urease test (RUT) is used at Groote Schuur Hospital for diagnosing Helicobacter pylori infection. This is an in-house method, which has not been validated. Objective. To validate our practice of reading the RUT immediately after endoscopy (RUT0), by comparing this with a reading at 24 hours (RUT24) and with histological analysis. Design. Ninety consecutive patients undergoing upper endoscopy over a 6-week period from October 2005 to November 2005, and in whom rapid urease testing was indicated, were included in the study. Patients with recent exposure (within 2 weeks of endoscopy) to proton pump inhibitors (PPIs), histamine receptor antagonists (H2RAs) and antibiotics (confounders) were noted and included in the cohort. Two antral and two body biopsies were taken for histological examination and a third antral biopsy was placed in the RUT bottle. Both haematoxylin and eosin and modified Giemsa staining methods were used to identify H. pylori. The RUT was read immediately (within 5 minutes of upper endoscopy) (RUT0), as per our current practice, and each specimen was re-read at 24 hours (RUT24). Sensitivity, specificity, positive and negative predictive values and the impact of confounders were calculated. Results. Of the 90 patients undergoing rapid urease testing, 39% were male and 61% were female, with a mean age of 55 years (range 22 - 79 years). Histological examination revealed H. pylori in 67.8% (N=61) of the biopsy specimens. In the 65 patients without confounders, the sensitivity and specificity of the RUT0 were 65.9% and 100% respectively, and 90.9% and 100% for RUT24. After including the 25 patients with confounders, the sensitivity and specificity were 68.8% and 100% for RUT0, and 90.1% and 100% for RUT24 respectively. Thirteen RUT0 specimens (30.9%) that were initially negative became positive at the RUT24 reading. There were 6 (9.8%) RUT0- and RUT24-negative but histology-positive specimens. Four of these 6 false-negative RUT24 results could be accounted for by a low H. pylori density on histological analysis (2 patients were taking PPIs). Confounders did not alter the sensitivity and specificity outcomes or impact on the number of false-negative RUTs. Conclusions. Our locally prepared RUT is a specific test for the detection of H. pylori infection. The sensitivity is greatly enhanced by reading the test at 24 hours. The use of PPIs, H2RAs and antibiotics preceding endoscopy did not impact significantly on the results

Evaluation of a locally produced rapid urease test for the diagnosis of Helicobacter pylori infection

Background. The rapid urease test (RUT) is used at Groote Schuur Hospital for diagnosing Helicobacter pylori infection. This is an in-house method, which has not been validated. Objective. To validate our practice of reading the RUT immediately after endoscopy (RUT0), by comparing this with a reading at 24 hours (RUT24) and with histological analysis. Design. Ninety consecutive patients undergoing upper endoscopy over a 6-week period from October 2005 to November 2005, and in whom rapid urease testing was indicated, were included in the study. Patients with recent exposure (within 2 weeks of endoscopy) to proton pump inhibitors (PPIs), histamine receptor antagonists (H2RAs) and antibiotics (confounders) were noted and included in the cohort. Two antral and two body biopsies were taken for histological examination and a third antral biopsy was placed in the RUT bottle. Both haematoxylin and eosin and modified Giemsa staining methods were used to identify H. pylori. The RUT was read immediately (within 5 minutes of upper endoscopy) (RUT0), as per our current practice, and each specimen was re-read at 24 hours (RUT24). Sensitivity, specificity, positive and negative predictive values and the impact of confounders were calculated. Results. Of the 90 patients undergoing rapid urease testing, 39% were male and 61% were female, with a mean age of 55 years (range 22 - 79 years). Histological examination revealed H. pylori in 67.8% (N=61) of the biopsy specimens. In the 65 patients without confounders, the sensitivity and specificity of the RUT0 were 65.9% and 100% respectively, and 90.9% and 100% for RUT24. After including the 25 patients with confounders, the sensitivity and specificity were 68.8% and 100% for RUT0, and 90.1% and 100% for RUT24 respectively. Thirteen RUT0 specimens (30.9%) that were initially negative became positive at the RUT24 reading. There were 6 (9.8%) RUT0- and RUT24-negative but histology-positive specimens. Four of these 6 false-negative RUT24 results could be accounted for by a low H. pylori density on histological analysis (2 patients were taking PPIs). Confounders did not alter the sensitivity and specificity outcomes or impact on the number of false-negative RUTs. Conclusions. Our locally prepared RUT is a specific test for the detection of H. pylori infection. The sensitivity is greatly enhanced by reading the test at 24 hours. The use of PPIs, H2RAs and antibiotics preceding endoscopy did not impact significantly on the results. South African Medical Journal Vol. 97 (12) 2007: pp. 1281-128

Novel multicomponent B2-ordered aluminides: Compositional design, synthesis, characterization, and thermal stability

For the first time, multicomponent alloys belonging to a B2-ordered single phase were designed and fabricated by melting route. The design concept of high entropy alloys is applied to engineering the transition metal sublattice of binary B2 aluminide. The equiatomic substitution of transition metal elements in the Ni sublattice of binary AlNi followed to produce Al(CoNi), Al(FeNi), Al(CoFe), Al(CoFeNi), Al(CoFeMnNi), and Al(CoCuFeMnNi) multicomponent alloys. CALculation of PHAse Diagrams (CALPHAD) approach was used to predict the phases in these alloys. X-ray diffraction and transmission electron microscopy were used to confirm the B2 ordering in the alloys. Thermal stability of the B2 phase in these alloys was demonstrated by prolonged heat treatments at 1373 K and 1073 K up to 200 h. © 2020 by the author. Licensee MDPI, Basel, Switzerland

Novel Multicomponent B2-Ordered Aluminides: Compositional Design, Synthesis, Characterization, and Thermal Stability

For the first time, multicomponent alloys belonging to a B2-ordered single phase were designed and fabricated by melting route. The design concept of high entropy alloys is applied to engineering the transition metal sublattice of binary B2 aluminide. The equiatomic substitution of transition metal elements in the Ni sublattice of binary AlNi followed to produce Al(CoNi), Al(FeNi), Al(CoFe), Al(CoFeNi), Al(CoFeMnNi), and Al(CoCuFeMnNi) multicomponent alloys. CALculation of PHAse Diagrams (CALPHAD) approach was used to predict the phases in these alloys. X-ray diffraction and transmission electron microscopy were used to confirm the B2 ordering in the alloys. Thermal stability of the B2 phase in these alloys was demonstrated by prolonged heat treatments at 1373 K and 1073 K up to 200 h. © 2020 by the author. Licensee MDPI, Basel, Switzerland

Book Reviews

Basic Neurology. Ed. by J. Gilroy and P. L. Holliday. Pp. vii + 373. Illustrated. R27,90. London: Macmillan. 1982.The Pathology of the Heart. By E. G. J. Olsen. Pp. ix + 402. Illustrated. R91,85. London: Macmillan. 1982.Profile of Disease and Health Care in South Africa. By H. C. J. van Rensburg and A. Mans. Pp. xvii + 319. R29,50. Pretoria: Academica Press. 1982.Principles of Ambulatory Medicine. Ed. by L. R. Barker, J. R. Burton and P. D. Zieve. Pp. xiii + 1127. Illustrated. R78,-. Baltimore, Maryland: Williams & Wilkins. 1982.Topical Reviews in Accident Surgery, vol. 2. Ed. by N. Tubbs and P. S. London. Pp. ix +258. Illustrated. £18,50. London: Wright PSG.1982.Early Care of the Injured Patient. 3rd ed. Ed. by A. J. Wait, L. F. Peltier, B. A. Pruitt jun, D. D. Trunkey and R. F. Wilson. Pp. xv + 413. Illustrated. Philadelphia: W. B. Saunders. 1982.Current Pediatric Therapy. 10th ed. By S. S. Gellis and B. M. Kagan. Pp. xxxviii + 776. R94,25. Philadelphia: W. B. Saunders. 1982.Selected Techniques in Interventional Radiology,vol. 19 (Saunders Monographs in Clinical Radiology). By S. Kadir, S. L. Kaufman, K. H. Barth and R. 1. White jun. Pp. xi +216. Illustrated. R76,75. Philadelphia: W. B. Saunders. 1982.Clinical Topics in Internal Medicine. Ed. by G. M. Tisi and H. M. Ranney. Pp. xii 173. Illustrated. Baltimore, Maryland: Williams & Wilkins. 1982.Recognizable Patterns of Human Malformation: Genetic Embryologic and Clinical Aspects (Major Problems in Clinical Pediatrics, vo!. vii). 3rd ed. By W. David and M. D. Smith. Pp. xvii + 653. Illustrated. R78,55. Philadelphia: W. B. Saunders. 1982.The Patient and the Plastic Surgeon. By R. M. Goldwyn. Pp. xiii + 255. Boston: Little, Brown. 1981.The Aging Lumbar Spine. By S. W. Wiesel, P. Bernini and R. H. Rothman. Pp. 257. Illustrated. R69,55. Philadelphia: W. B. Saunders. 1982.Postoperative Complications of Intracranial Neurological Surgery. By N. H. Horwitz and H. V. Rizzoli. Pp. xi + 472. Illustrated. Baltimore: Williams & Wilkins. 1982.Current Topics in Inflammation and Infection (International Academy of Pathology Monograph). Ed. by G. Majno, R. S. Cotran and . Kaufman. Pp. xi + 242. Illustrated. Baltimore, Maryland: Williams & Wilkins. 1982.Radiology of the Ear, Nose and Throat. By G. E. Valvassori, G. D. Porter, W. N. Hanafee, B. L. Carter and R. A. Buckingham. Pp. viii + 342. Illustrated. RI94,30. Philadelphia: \Y/. B. Saunders. 1982.Neuropathology ofParasitic Infections. By W. J. Brown and M. Voge. Pp. 240. Illustrated. RI5,-. Oxford: Oxford Medical Publishers. 1982.Herzkrankheiten: Pathophysiologie, Diagoostik, Therapie. 2nd ed. By H. Roskamm and H. Reindel!. Pp. xxxiii + 1543. Illustrated. DM 278,-. Berlin: Springer-Verlag. 1982.Review ofSpeech, Language and Hearing, vols I, 2and 3. By N. J. Lass, L. V. McReynolds, J. L. Northern and D. E. Yoder. Illustrated. R36,20 each. Philadelphia: W. B. Saunders. 1982

The role of contracting strategies in social value implementation

There has been an increasing demand for social value (SV) implementation to assume a cardinal position in the infrastructure delivery efforts of infrastructure client organisations (ICOs). However, whereas successful implementation has been recorded in some projects, monumental failures have also been recorded in others. This variance in implementation performance is a cause for concern. The mode of governance applied in an infrastructure delivery endeavour has been identified as capable of influencing the implementation of SV. This observation makes imperative an investigation into the role of contracting strategies – an integral part of governance modes – adopted by ICOs on SV implementation performance. This is the aim of this study. Using a case study approach, three infrastructure projects which used different contracting strategies were selected from two different countries, the UK and Nigeria. Semistructured interviews were conducted with ICO representatives on these projects and subsequently analysed using qualitative content analysis. Findings confirmed that the kind of contract adopted by ICOs influenced their ability to drive the successful implementation of desirable SV objectives through their supply chain. It is therefore recommended that ICOs ensure that the selected contracting strategies are capable of ensuring successful implementation of the desired objectives

Rationalising "for" and "against" a policy of school-led careers guidance in STEM in the U.K. : a teacher perspective

This paper reports on teacher attitudes to changes in the provision of careers guidance in the U.K., particularly as it relates to Science, Technology, Engineering and Mathematics (STEM). It draws on survey data of n = 94 secondary-school teachers operating in STEM domains and their attitudes towards a U.K. and devolved policy of internalising careers guidance within schools. The survey presents a mixed message of teachers recognising the significance of their unique position in providing learners with careers guidance yet concern that their ‘relational proximity’ to students and ‘informational distance’ from higher education and STEM industry may produce bias and misinformation that is harmful to their educational and occupational futures